Storekeeper perspectives on improving dietary intake in 12 rural remote western Alaska communities: the “Got Neqpiaq?” project

Abstract

Low intake of fruits and vegetables and high intake of sugar-sweetened beverages persists as a public health concern in rural remote Alaska Native (AN) communities. Conducting key informant interviews with 22 storekeepers in 12 communities in the Yukon-Kuskokwim region of Alaska, we explored potential factors impeding or facilitating dietary change towards healthier food choices. We selected these sites as part of a multi-level intervention aimed at introducing more traditional AN subsistence foods, increasing fruit and vegetable intake, and decreasing SSB consumption among young children enrolled in Head Start (preschool) programmes (Clinicaltrials.gov #NCT03601299). Storekeepers in these communities agreed that seasonality and flight schedules were primary factors determining commercial foods’ availability. Several storekeepers noted that federal food assistance programmes that specify which food items may be purchased with funds received from the programme and community policies that set limits on less healthy items promote customer purchases of healthier products. The fact that storekeepers are comfortable enforcing government assistance programme guidelines, company policies, and tribal resolutions suggests an important role storekeepers play in improving nutritional intake in their communities.

Traditional Heart-Healthy Diet and Medication Adherence in the Norton Sound Region: An 18-Month Telehealth Intervention

“…As reported by members of the community and in published literature, more recent generations tend to have a diet consisting of fewer traditional foods than older generations whether due to globalization, climate change, or other reasons [ 42 ]. Younger participants appear more prone to select readily available, highly processed Western foods [ 9 , 10 ]. Targeting the cultural diet intervention to younger adults, with more explicit instructions on how to procure and prepare more traditional foods, may be warranted for future interventions.…”

“…Response options for each food item were: Did not eat it this week; Once this week; 2–3 times this week; 4–6 times this week; Once or twice each day; More than twice each day; Refused (i.e., declined to answer). Nine of the 34 foods were traditional to the Alaska Native diet, or local to the region and enjoyed by communities prior to Western state influences (e.g., wild berries, moose, and whale oil) [ 9 ]. These were selected in consultation with team members who were of Alaska Native origin to reflect the traditional diet in the Norton Sound region.…”

“…Community connectedness is a predominant feature of Alaska Native traditional culture and shown to be associated with traditional food intake [ 9 , 10 ]. This was measured at baseline with a MacArthur ladder question: “How connected do you feel to the larger community?…”

“…In Alaska, declines in traditional food consumption have shifted toward more shelf-stable, highly processed, store-bought foods associated with a higher risk of CVD [ 5 , 6 , 7 , 8 ]. In more rural and removed Alaska Native communities, there are challenges to obtaining whole, fresh, and minimally processed foods, as many commercial and Western foods must be flown in on small planes sometimes without refrigeration [ 9 , 10 ]. Therefore, fresh, whole foods are often more expensive and less available.…”

Impact of Assistance Programs on Indigenous Ways of Life in 12 Rural Remote Western Alaska Native Communities: Elder Perspectives Shared in Formative Work for the “Got Neqpiaq?” Project

“…Challenges of access to the communities make it difficult to obtain fresh produce or other products with a relative short shelf life. The expense involved in transporting these products is then passed onto consumers, making them cost prohibitive [ 38 ]. The addition of time to transport these items increases the chances of spoilage, another factor in increased cost.…”