DR. PÉREZ-STABLE: GOOD
AFTERNOON EVERYONE MY NAME IS
ELISEO PÉREZ-STABLE, DIRECTOR,
NIMHD.
THANK YOU FOR JOINING
YESTERDAY'S NIMHD DIRECTOR'S
SEMINAR SERIES.
THIS MONTH WE ARE CELEBRATING
NATIVE AMERICAN HERITAGE MONTH.
WHICH EACH YEAR HONORS THE
DIVERSE TRADITIONS, WHICH
HISTORIES AND CONTRIBUTIONS OF
NATIVE AMERICANS AND THE
INDIGENOUS RESILIENCE
OVERCOMING BARRIERS WHICH ASKS
US TO REFLECT ON THE ENDURING
SPIRIT AND CULTURAL RICHNESS OF
NATIVE AMERICAN COMMUNITIES AND
THEIR ONGOING CONTRIBUTIONS AND
THE STRENGTH THEY BRING TO
SOCIETY AND NIH.
THROUGH ACTIVITIES AND EVENTS,
WE WILL HIGHLIGHT NATIVE
AMERICAN CULTURE WHILE
ADDRESSING CONTEMPORARY ISSUES.
I MENTIONED THAT JUST LAST
MONTH, I WAS IN NORTH DAKOTA.
VISITED TURTLE MOUNTAIN
COLLEGE THERE WITH THE FORMER
TRIBAL HEALTH RESEARCH OFFICE
DIRECTOR DAVID WILSON. AND IT
IS ALWAYS A GOOD EXPERIENCE IN
INDIAN COUNTRY.
I AM PLEASED TODAY TO INTRODUCE
DR. VALARIE BLUE BIRD JERNIGAN
OF OKLAHOMA STATE UNIVERSITY AS
OUR SPEAKER TODAY IN HER
PRESENTATION WILL FOCUS ON
ADDRESSING NUTRITION
DISPARITIES IN NATIVE AMERICAN
COMMUNITIES. RESEARCH AND
ACTION.
VALERIE RECEIVED HER DOCTORATE
IN PUBLIC HEALTH FROM THE
UNIVERSITY OF CALIFORNIA
BERKELEY AND COMPLETED A
POSTDOCTORAL FELLOWSHIP IN
CARDIOVASCULAR VASCULAR DISEASE
RISK REDUCTION AT THE STANFORD
PREVENTION RESEARCH CENTER. TWO
GROUPS AND INSTITUTIONS THAT I
KNOW OF.
SHE HAS PUBLISHED OVER 60
PEER-REVIEWED PAPERS AND
CONTRIBUTED TO SEVERAL
DOCUMENTARY FILM AND MULTIMEDIA
PUBLICATIONS.
VALERIE IS ALSO A MEMBER OF THE
NIMHD ADVISORY COUNCIL.
DR. VALARIE BLUE BIRD JERNIGAN
IS ENROLLED CITIZEN OF THE
CHOCTAW NATION OF OKLAHOMA AND
DIR. FOR THE CENTER OF
INDIGENOUS HEALTH RESEARCH AND
POLICY AND A PROFESSOR OF
MEDICINE AND RURAL HEALTH AT
THE CENTER OF RURAL SCIENCES AT
OKLAHOMA STATE UNIVERSITY.
SHE ALSO DIRECTS THE
UNIVERSITY'S CENTER FOR
INDIGENOUS INNOVATION AND
HEALTH EQUITY. AN ACADEMIC
COMMUNITY PARTNERSHIP WITH
INDIGENOUS PEOPLES, WORKING TO
RESTORE TRADITIONAL FOODS, AND
FOOD PRACTICES TO PROMOTE
HEALTHY DIETS AND REDUCE
CHRONIC DISEASE.
SHE IS A RESEARCHER FOCUSED ON
INDIGENOUS PEOPLES, AND
TRAINING AND INTERVENTION
SCIENCE. SHE HAS BEEN THE
PRINCIPAL INVESTIGATOR FOR MORE
THAN A DOZEN RESEARCH STUDIES,
ON IMPROVING INDIGENOUS FOOD
SYSTEMS, THROUGH POLICY AND
ENVIRONMENTAL INTERVENTIONS.
IN 2011, DR. JERNIGAN BECAME
THE INAUGURAL CHAIR OF THE
CANCER RESEARCH INNOVATIVE
RESEARCH TO IMPROVE NATIVE
AMERICAN HEALTH IN
COLLABORATION WITH
INITIATIVES AND SERVES ON
SEVERAL ADVISORY PANELS ON
BOARD INCLUDING A RECENT
COMPLETION OF BEING A MEMBER OF
THE ENDING UNEQUAL TREATMENT
REPORT THAT NIMHD COMMISSION
AND THE NATIONAL ACADEMIES
PUBLISHED EARLIER THIS YEAR SHE
IS AN ADVISORY COMMITTEE MEMBER
OF THE DIETARY GUIDELINES FOR
AMERICANS FROM THE UNITED
STATES DEPARTMENT OF
AGRICULTURE.
PLEASE JOIN ME IN GIVING A
VIRTUAL WELCOME TO OUR NATIVE
AMERICAN HERITAGE MONTH'S
SPEAKER DR. VALARIE BLUE BIRD
JERNIGAN. VALERIE?
>> DR. JERNIGAN: THANK YOU SO
MUCH ELISEO. I AM GOING TO
SHARE MY SCREEN.
I WANT TO SAY THANK YOU SO MUCH
TO DR. ELISEO PÉREZ-STABLE, AND
THE ORGANIZERS FOR THE NIMHD
DIRECTOR'S SEMINAR SERIES. I
AM SO HUMBLED AND HONORED TO BE
ABLE TO PRESENT TO YOU ALL
TODAY.
I WILL BE SHARING A NUMBER OF
RESEARCH STUDIES, SUPPORTED BY
THE NATIONAL INSTITUTES OF
HEALTH. AND SO I WANT TO HONOR
AND ACKNOWLEDGE THE NIH'S ROLE
AND SUPPORTING MY RESEARCH AND
PARTICULARLY THE INTERVENTION
RESEARCH TO IMPROVE NATIVE
AMERICAN HEALTH, OR IRINAH
FUNDING OPPORTUNITY WHICH HAS
PLAYED A HUGE ROLE IN THE
COMMITTEE-BASED PARTICIPATORY
RESEARCH STUDY DID YOU HEAR
ABOUT TODAY.
I WANT TO ACKNOWLEDGE MY
PARTNERS, THE CHOCTAW NATION OF
OKLAHOMA, OSAGE NATION, THE
CHICKASAW NATION, AND THE
PARTNERING COMMUNITIES WITH THE
CENTER FOR INDIGENOUS
INNOVATION AND HEALTH EQUITY AS
PART OF THE OFFICE OF MINORITY
HEALTH'S FUNDED GRANT, THE
CENTER FOR INDIGENOUS
INNOVATION AND HEALTH EQUITY
AND INDIGENOUS FOOD AND HEALTH
INITIATIVE WHICH HAS SOME
PLUMBING SUPPORTED BY NOVO
NORDISK FOUNDATION AND I WANT
TO THANK THE OSU LEADERSHIP AND
STAFF. I CERTAINLY CANNOT DO
THIS WORK WITHOUT OSU'S
SUPPORT. AND THE AMAZING WORK
THAT IS DONE EVERY DAY AT OSU.
I WOULD LIKE TO SAY I AM
COMMUNITY MADE; NONE OF US
COULD DO THIS WORK WITHOUT EACH
OTHER. SO THANK YOU SO MUCH.
THE CENTER FOR INDIGENOUS
HEALTH RESEARCH AND POLICY AT
OSU, WE LAUNCH THIS CENTER IN
2019. OUR PURPOSE IS RESEARCH,
TRAINING AND CAPACITY BUILDING
AND WE FOCUS ON HEALTH
PROMOTION AND DISEASE
PREVENTION INITIATIVES, DRIVEN
BACK IN PRIORITIES AND
CULTURALLY CENTERED STRATEGIES.
WE CENTER ON CBPR/ TRIBALLY LED
RESEARCH AND CURRENTLY HAVE
MORE THAN 15 ACTIVE RESEARCH
PROJECTS APPLYING INDIGENOUS
METHODOLOGIES AND I WELCOME YOU
TO VISIT A WEBSITE WHICH HAS
LINKS WITH FREE AND OPEN ACCESS
AND DESCRIPTIVE FOR STUDIES.
AND WE HAVE VIDEOS AND
COMMUNITIES AND WEBINAR SO
PLEASE CHECK OUT OUR WEBSITE
AND I HAVE INCLUDED OUR
FACEBOOK PAGE. PLEASE LIKE OUR
FACEBOOK PAGE SO WE CAN BUMP UP
OUR LIKES. THANK YOU VERY MUCH.
I CALLOUT THE INTERVENTION
RESEARCH TO IMPROVE NATIVE
AMERICAN HEALTH FUNDING
MECHANISMS, AS PART OF THIS
PRESENTATION. BECAUSE THIS
GRANT PROGRAM REALLY CAME AT A
TIME WHEN MY CAREER WAS JUST
BEGINNING. AND IT IS FOCUSED ON
DEVELOPING, ADAPTING AND
TESTING CULTURALLY APPROPRIATE
INTERVENTIONS TO IMPROVE HEALTH
OUTCOMES WITHIN NATIVE AMERICAN
COMMUNITIES. AND, USES THE R01,
>> [RECORDING STOPPED]1, AND
R34 GRANT MECHANISMS. REALLY
EMPHASIZE WITH THESE PROGRAMS,
WITH COMMUNITY ENGAGEMENT AND
CULTURALLY RELEVANT APPROACHES,
AND AIMS TO REDUCE THE
MORBIDITY AND MORTALITY WITH
THE NATIVE AMERICAN POPULATION
I REALLY COULD NOT HAVE VENDORS
WORK WITHOUT SUCH GREAT SUPPORT
FROM THE IRIHNA FUNDING
MECHANISM SO THE WORK AND
ADVOCACY THAT WENT ON BEHIND
THE SCENES TO REALLY SUPPORT
AND PROMOTE THE FUNDING
MECHANISM ALONG WITH THE NARCH
FUNDING MECHANISM ALLOWED US TO
DO INDIGENOUS SCIENCE. AND
SUPPORT INITIATIVES THAT MAY
NOT HAVE OTHERWISE BEEN
SUPPORTED AND SO IT HAS BEEN A
REALLY POWERFUL FUNDING
OPPORTUNITY TO SUPPORT THE
DEVELOPMENT OF INDIGENOUS
HEALTH SCIENCE.
THE DISPARITIES IN NUTRITION
AND HEALTH ARE ONGOING AND
PERSISTENT IN THE AMERICAN
INDIAN AND ALASKA NATIVE
POPULATION. MY EARLY WORK FOCUS
ON LIMITED ACCESS TO FRESH
FRUITS AND VEGETABLES. AND MUCH
OF IT STILL DOES. AND FOOD
INSECURITY.
THE 2020 PREVALENCE OF FOOD
INSECURITY WAS ABOUT 10.5%
AMONG US HOUSEHOLDS. AND AMONG
AMERICAN INDIANS AND ALASKA
NATIVES, THIS RATE IS MUCH
GREATER AT ABOUT 45.7%.
IN OKLAHOMA, OUR RESEARCH
SHOWED THAT THE PERCENT OF
AMERICAN INDIANS, ALASKAN
NATIVES SURVEY WORK FOOD
INSECURE. AND AMERICAN INDIANS
AND ALASKA NATIVES ARE NEARLY 3
TAB MORE LIKELY TO HAVE
DIABETES COMPARED TO
NON-HISPANIC WHITES, 2.3 TIMES
MORE LIKELY TO DIE FROM THE
DISEASE AND AMERICAN INDIANS
AND ALASKA NATIVES ARE 50% MORE
LIKELY TO BE DIAGNOSED WITH
CORONARY HEART DISEASE THAN
NON-HISPANIC WHITES.
AND IN THE 20 YEARS THAT I HAVE
BEEN DOING THIS RESEARCH, IT'S
BEEN REALLY CHALLENGING TO
CHANGE THOSE NUMBERS.
I WILL SHARE SOME SELECTED
IRINAH SUPPORTED FOOD SYSTEM
INTERVENTIONS WITH YOU TODAY
THAT ADDRESS NUTRITION
DISPARITIES. AS I HAVE INCLUDED
THIS REALLY EXCELLENT AND
SIMPLE DIAGRAM OR FAILURE OF
THE FOOD SYSTEM.
THE FOOD SYSTEM-- INCLUDING
FOOD ENVIRONMENTS AND THE FOOD
SUPPLY CHAINS-- HAS REALLY BEEN
WHAT I HAVE FOCUSED ON IN MY
INTERVENTION SCIENCE. I REALLY
LOOK AT THE BIG PICTURE OF
POLICY SYSTEMS, AND
ENVIRONMENTAL CHANGE IN THE
WORK THAT I DO WITH NATIVE
COMMUNITIES. AND YOU HEAR
EXAMPLES OF INTERVENTIONS LET'S
(CORRECTION) THAT SPAN ACROSS
VARIOUS PARTS OF THE FOOD
SYSTEM INCLUDING ACCESS,
AFFORDABILITY, PROMOTION,
ADVERTISING, INCLUDE PRODUCTION
AND AVAILABILITY AS WELL AS
PACKAGING AND PROMOTION, AND
RETAIL AND MARKETS. SO WE
REALLY INTERVENE ACROSS ALMOST
ALL ASPECTS OF THE FOOD SYSTEM.
I WILL SHARE INFORMATION ABOUT
THE THRIVE HEALTHY RETAIL STUDY
WHICH WAS HELD IN THE
CHICKASAW/ CHOCTAW NATIONS OF
OKLAHOMA AND FUNDED BY NHLBI.
AND THE FRESH STUDY WHICH IS A
FARM TO SCHOOL INITIATIVE IN
THE OSAGE NATION FUNDED BY THE
-- AND THE OSAGE INDIGENOUS
SUPPORTED AGRICULTURE STUDY
ALSO FUNDED BY NIMHD, IN THE
CONTINUATION OF THE WORK BUILT
WITHIN THE FRESH STUDY.
SO TO START OUT, I WANT TO
INTRODUCE THE ...
ISSUE OR THE CONCEPT OF
INDIGENOUS FOOD SOVEREIGNTY.
THIS IS OFTEN DEFINED AS THE
RIGHT AND RESPONSIBILITY OF
INDIGENOUS PEOPLE TO HEALTHY
AND CULTURALLY APPROPRIATE
FOODS, PRODUCED THROUGH
TRADITIONAL INDIGENOUS
PRACTICES.
THIS IS NOT SOMETHING THAT CAME
OUT OF THE PUBLIC HEALTH
LEXICON SO TO SPEAK. IT IS
DEFINITELY A COMMUNITY LED
MOVEMENT THAT SUPPORTS
INDIGENOUS COMMUNITIES IN
HAVING GREATER CONTROL OVER THE
LAND AND FOOD SYSTEMS BY
INCREASING AND PROTECTING
TRADITIONAL AND HEALTHY FOODS
AND REDUCING DEPENDENCE ON
PACKAGED AND FAST FOODS.
FOOD SOVEREIGNTY ADDRESSES THE
NEED FOR NUTRITION AND HEALTH
EQUITY APPROACHES THAT ARE
EMBEDDED WITHIN AN INDIGENOUS
CONCEPT OF HEALTH AND WELLNESS.
AND SELF-DETERMINATION. AND
FOOD SOVEREIGNTY BUILDS UPON
COMMUNITY STRENGTHS AND
CULTURAL PRACTICES.
SO THE THRIVE STUDY IS A
CONVENIENCE STORE STUDY THAT
WAS IMPLEMENTED IN 2012-2017.
IT IS AN RCT OF HEALTHY FOOD
MAKEOVERS IN TRIBALLY OWNED
AND OPERATED CONVENIENCE STORES
IN CHICKASAW AND CHOCTAW
NATIONS.
IF YOU LOOK AT THE PICTURES YOU
CAN SEE THESE REALLY AWESOME
CONVENIENCE STORES ALL OVER THE
STATE, ESPECIALLY IN THE
SOUTHEASTERN CORNER OF THE
STATE ABOUT THE (CORRECTION) IN
THE STATE OF OKLAHOMA. I SAY
"AWESOME" BECAUSE THEY REALLY
HELP THE ECONOMIES IN TRIBAL
NATIONS AND THEY PROVIDE A LOT
OF JOBS AND HELP PEOPLE GET
ACCESS TO THEIR FOODS. 60% OF
THE NATIVE PEOPLE HE SURVEYED
REPORTING SHOPPING FOR FOOD AT
THE STORE THREE TIMES OR MORE
PER WEEK, SO WE CHOSE TO
INTERVENE WHERE THE PEOPLE ARE.
AND YOU CAN SEE THE INSIDE OF
ONE OF THE STORES AND IT IS
MOSTLY SHELFSTABLE, PACKAGE
FOODS AND YOU CAN SEE WHERE THE
RED DOTS ARE ON THE OKLAHOMA
MAP.
THAT IS WHERE THE NUMBER OF
STORES WERE WHEN WE STARTED
THIS INITIATIVE BY THEY HAVE
SINCE BUILT A OF EXTRA
ADDITIONAL STORES. SO THERE ARE
MANY STORES NOW.
HERE ARE SOME PICTURES OF THE
INSIDE OF THE STORES WHEN WE
STARTED THE INTERVENTION. ONE
OF THE MOST POPULAR FEATURES OF
THE STORES WAS THE HOTBOX,
WHICH IS DOWN AT THE BOTTOM,
LEFT-HAND CORNER OF THE SLIDE.
AND YOU CAN SEE REALLY A LOT OF
FRIED FOODS, YOU KNOW FOODS ON
THE GO FOR PEOPLE WHO ARE VERY
BUSY, AND TRAVELING. AND IT IS
ALSO, YOU KNOW, SUPPLIED TO THE
LOCAL SCHOOLS. AND SUPPLIED TO
THE FOOTBALL TEAMS. AND OUR
TRIBAL MEMBERS, YOU KNOW, SPENT
A LOT OF TIME IN THE STORES AND
SOME OF THE ELDERS VISIT THERE.
THEY HAVE COFFEE SO IT IS MORE
THAN JUST A STORE. IN MANY
COMMUNITIES THE STORES FUNCTION
AS KIND OF A PLACE TO GATHER
AND SIT, AND MEET FOLKS.
THERE'S EVEN BIRTHDAY PARTIES
HELD THAT THE STORES.
AND YOU CAN SEE AGAIN AT THE
TOP SOME EXAMPLES OF WHAT THE
STORES LOOK LIKE. OUR
INTERVENTION COMPONENTS -- AND
AGAIN WE PUBLISHED ON ALL OF
THESE METHODS AND OUTCOMES SO
THIS IS AVAILABLE TO READ IN
MORE DEPTH.
BUT WE INTERVENED ON THE PPPR
PIECE AS IT IS CALLED, PRODUCT,
PLACEMENT, PROMOTION AND
PRICING. SO WE WANTED TO
CONDUCT ASSESSMENTS ON THE
HEALTH AVAILABILITY OF HEALTHY
FOODS IN THE STORES.
AND SO INTERVENTION COMPONENTS
AS I SAID INCLUDED PRODUCT AND
PLACEMENT PROMOTION AND PRICING
AND YOU CAN SEE SOME OF THE
SHELF DIAGRAMS, HOW WE WE
PLANNED WHAT THE DIFFERENT NEW
OPTIONS ARE GOING TO BE AND
WHERE THEY ARE GOING TO BE SET
UP IN THE STORES.
SOME OF THE STORES HAD A
DIFFICULT TIME OFFERING HEALTHY
OPTIONS. NONE OF THE FOOD THAT
WAS AVAILABLE AT THE STORES MET
SOME OF OUR NUTRITION CRITERIA.
AND SO, IN THE CHOCTAW NATION,
SOME OF THE MORE RURAL STORES
ENDED UP HAVING TO SOME
REMODELING TO EXPAND THEIR
KITCHENS TO BE ABLE TO ACTUALLY
PACKAGE THEIR OWN FOODS, AND
SELL THOSE FOODS TO MEET
CRITERIA FOR THE HEALTHY FOOD
OPTIONS AS PART OF THE STUDY.
WHICH I THINK SHOWS THE LEVEL
OF COMMITMENT THAT THE TRIBAL
LEADERSHIP HAD IN THE SUCCESS
OF THE STUDY. AND IN TAKING
VERY SERIOUSLY THE NEED TO
OFFER HEALTHY OPTIONS.
IF YOU SEE THE BOTTOM LEFT-HAND
CORNER, YOU CAN SEE SOME OF
THOSE HEALTHIER CHOICES THAT
WERE CREATED AS PART OF THE
STUDY. AT THE TOP YOU SEE SOME
OF THE PROMOTIONAL SIGNAGE.
AND SO WE HAD THE LANGUAGE
TRANSLATED FROM ENGLISH TO
CHOCTAW (SPANISH LANGUAGE NAME)
BETTER CHOICES HAVE ARRIVED,
AND YOU CAN SEE SOME OF THE
OTHER SIGNAGE, VALUE CHOICE AND
FRESHER CHOICE. INDIVIDUALS
SURVEYED DOLLARS THE FOOD THAT
WERE IMPORTANT TO THEM AND
THESE WERE SOME OF THE OPTIONS
OFFERED IN THE LARGE WALKAROUND
COOLERS THAT WE INSTALLED AS
PART OF THE HEALTHY RETAIL
MAKEOVERS.
HERE YOU HAVE A TABLE FROM THE
OUTCOMES PAPER, WHICH WAS
PUBLISHED IN THE AMERICAN
JOURNAL FOR PUBLIC HEALTH. AND
YOU CAN READ MORE ABOUT THE
OUTCOMES IN THAT PAPER BUT THIS
IS A TREND ANALYSIS OF
INTERVENTION EXPOSURE BASED ON
FREQUENCY OF SHOPPING.
SO THE THRIVE INCREASE BOTH THE
AVAILABILITY AND THE PURCHASING
OF FRUIT AND VEGETABLES AND
OTHER HEALTHY FOODS IN BOTH
NATIONS. IF YOU LOOK AT THE
LIGHTEST BARS, IS ONE OR --
TIMES A WEEK AND THE DARKER
BARS ARE TWO TIMES OR MORE.
THE MORE THE PERSON SHOP THAT
THE STORES, THE MORE EXPOSURE
THE HEAD TO THE INTERVENTION
AND THE MORE LIKELY THEY WERE
TO NOTICE THE REACH AND FOOD
COOLERS. AND NOTICE THE
DEFINITION SIGNAGE, AND
PURCHASE FOOD AND VEGETABLES
FROM THE REGION COOLERS.
ONE OF THE MOST IMPORTANT
ASPECTS OF THE STUDY IS THE
POLICY CHANGE THAT OCCURRED AT
THE PROCUREMENT AND
DISTRIBUTION LEVELS. AND THE
STORE LEVELS.
AND SO BECAUSE THE DISTRIBUTION
COMPANIES THAT WORK WITH THE
TRIBAL NATIONS DID NOT WANT TO
LOSE THEIR CONTRACT WITH THE
TRIBES, THEY WERE ABLE TO
SECURE A BROADER SCOPE OF
HEALTHY FOOD CHOICES FOR THE
STUDY. WHICH THEY THEN BECAME
PERMANENT CHANGES TO THEIR FOOD
OFFERINGS.
AND SO, THAT BECAME AVAILABLE
TO BOTH TRIBES NOT JUST IN
THEIR CONVENIENCE STORES. BUT
ALSO ACROSS ALL OF THEIR
BUSINESSES. SO THE HOTELS, THE
CASINOS, THE RESTAURANTS. ALL
OF THOSE SITES HAD BROADER
OFFERINGS THAT INCLUDED
HEALTHCARE FOODS.
I WANT TO NOW TURN TO THE FRESH
FARM-TO HEAD START STUDY, ALSO
AND IRINAH SUPPORTED STUDY, AND
BY THE NIMHD IMPLEMENTED FROM
2016 TO 2021. AND THE STUDY
GOES BEYOND THE RETAIL
ENVIRONMENT TO THE ACTUAL
PRODUCTION OF HEALTHY FOOD. IT
WAS CONDUCTED IN PARTNERSHIP
WITH THE OSAGE NATION. IT IS A
MULTILEVEL FARM TO SCHOOL,
WAIT-LIST CONTROL TRIAL FOR
COMMUNITIES, MATCHED BY SIZE,
DISTANCE INSULTED DEMOGRAPHIC
CHARACTERISTICS. AND INCLUSION
CRITERIA, AMERICAN INDIAN WITH
THE CHILD ENROLLED IN ONE OF
THE HEAD START AGED 3 TO 5 AND
NO PLANS OF MOVING WITHIN THE
NEXT YEAR.
AND THIS WAS A 16 WEEK
INTERVENTION FROM JANUARY 2018
TO DECEMBER, 2018.
TWO COMMUNITIES WERE RANDOMIZED
TO INTERVENTION GROUP WHICH WAS
FIVE HEAD START AND TWO
COMMUNITIES WERE RANDOMIZED TO
THE CONTROL GROUP WHICH WAS
FOUR OF THE HEAD STARTS. AND
THE TOTAL PARTICIPANTS, 193
CHILDREN AGE 3 TO 5 AND SOME OF
THEM TURNED 6 DURING THE SCHOOL
YEAR.
THE PRIMARY OUTCOMES: INCREASE
VEGETABLE WILLINGNESS TO TRY
AND IN TAKING CHILDREN. AND WE
HAD A FOCUS ON BEANS, SQUASH,
PEPPERS AND SPANISH, THE FOODS
THAT THE TRIBAL NATION GREW.
AND REPRIORITIZE THOSE FOODS
AND INCLUDED THEM IN THE
INTERVENTION AND THAT IS
CHIEF-- STANDING THERE AND I
LOVE THIS PICTURE. BECAUSE HE
WAS STANDING IN FRONT OF THE
LAND THAT WAS BEING REPURPOSED
TO GROW THE FARM. AND I LOVE
THIS PICTURE BECAUSE NOW THE
FARM IS HUGE, AND THERE HAS
BEEN INCREDIBLE WORK THAT HAS
BEEN DONE, AND I STILL HAVE THE
PICTURE OF THE VERY BEGINNING
WHEN ALL OF THIS STARTED. AND
YOU CAN SEE A BEAUTIFUL HARVEST
PLAN LOGO, IN THEIR LANGUAGE,
AT THE BOTTOM OF THE SLIDE.
THE FRESH STUDY METHODS,
ENVIRONMENTAL, DEVELOPMENT OF
TRIBAL FARM HARVEST LAND.
SCHOOL LEVEL WE CHANGE THE
SCHOOL MENU. WE REPLACE CANNED
OR PROCESSED FOODS WITH LOCAL
VEGETABLES. AND CHANGE
DEFEATING PRACTICES TO A
FAMILY-STYLE FEEDING PRACTICE.
WE ALSO BUILT SCHOOL GARDENS AT
EACH HEADSTART. AND WE CREATED
AN ACCOMPANYING CURRICULUM THAT
WAS IN ENGLISH AND THE OSAGE
LANGUAGE. AND IMPLEMENTED
WITHIN THE HEADSTART.
THE FAMILY INTERVENTION
COMPONENT WAS A PASSIVE
INTERVENTION COMPONENT. IT
INCLUDED WEEKLY MEAL KITS WITH
FARM PRODUCE THAT THEY WOULD
TAKE HOME EVERY WEEKEND, AND
PREPARE WITH THEIR FAMILIES.
THERE WAS A WEB-BASED PARENT
CURRICULUM THAT WAS ALSO PART
OF THE FAMILY INTERVENTION.
AND MONTHLY FAMILY NIGHT.
WHERE WE WOULD HOST FAMILIES
AND COMMUNITIES AND COOK FOODS
AND JUST SHARE AND BE IN
COMMUNITY AS PART OF THAT.
THE FRESH STUDY OUTCOMES. IT
WAS VERY EXCITING AND
INTERESTING TO LEARN HOW TO
ASSESS VEGETABLE INTAKE IN 3 TO
5-YEAR-OLD. YOU CAN'T SIMPLY
ASK THEM TO TELL YOU WHAT THEY
ATE THAT DAY. YOU HAVE TO
THINK OF CREATIVE WAYS TO
ASSESS THE INTAKE. SO WE USED
TWO STRATEGIES: WILLINGNESS TO
TRY SCORES. AS WELL AS PLATE
WASTE.
YOU CAN SEE FROM AGAIN
PUBLICATIONS, ALL LISTED ON THE
SLIDE. WE HAVE A TABLE HERE,
DIFFERENCES IN BASELINE AND
FOLLOW-UP MEASUREMENTS OF
OUTCOMES FOR CHILDREN IN THE
FRESH STUDY.
YOU CAN SEE THAT VEGETABLE
INTAKE SIGNIFICANTLY INCREASED
IN THE VEGETABLE CONTROL FOR
SQUASH AND BEANS AND
WILLINGNESS TO TRY SCORES FOR
BEANS AND INTERVENTION TOMATOES
IN BOTH GROUPS AND AGAIN.
POLICY CHANGES HAPPENED AS A
RESULT OF THIS.
THE OSAGE NATION CONGRESS
ADOPTED THE FARM TO SCHOOL
INTERVENTION, AS POLICY ACROSS
ALL OF THE HEAD STARTS. AND
THEY ALSO EXPANDED HARVEST LAND
FOR AN INDIGENOUS SUPPORTED
AGRICULTURE INITIATIVE THAT WE
ARE CURRENTLY IMPLEMENTING.
HERE ARE SOME PHOTOS OF THE
HARVEST LAND NOW. IT IS REALLY
LARGE AND THIS IS OUR RESEARCH
GROUP, PRESENTING AT CONGRESS.
YOU CAN SEE AS IN THE BOTTOM
LEFT-HAND CORNER, AFTER THEY
ADOPTED THE STUDY INTERVENTION
AS POLICY. AND THESE ARE SOME
PHOTOS OF THE FARM, WITH SOME
OF THE HEADSTART KIDS.
I SHOULD ALSO SAY THAT WE MADE
A DOCUMENTARY FILM AS PART OF
THAT. I DID NOT INCLUDE IT IN
THE PICTURE; BUT YOU CAN FIND
THAT DOCUMENTARY LINK ON OUR
WEBSITE. AND WE HAD SOME REALLY
EXCITING OUTCOMES OF THAT
STUDY. ONE OF WHICH IS THE GO
HEALTHY STUDY, OF FOLLOW-UP
STUDY.
ONCE THE HARVEST LAND OSAGE
NATION DECIDED TO EXPAND THEIR
FARM, IT MADE IT POSSIBLE FOR
US TO PROPOSE AN ASSESSMENT OF
A COMMUNITY SUPPORTED
AGRICULTURE INITIATIVE, IN A
TRIBAL NATION WHICH TO OUR
KNOWLEDGE AT THE TIME HAD NEVER
BEEN DONE. AND SO IF YOU ARE
NOT VERY FAMILIAR WITH CSAS, OR
COMMUNITY SUPPORTED AGRICULTURE
INITIATIVES, IT IS BASICALLY A
FOOD-GROWING INITIATIVE THAT
SUPPORTS LOCAL FARMERS TO KEEP
THEIR PRODUCE WITHIN THE
COMMUNITIES WHERE THEY ARE
LOCATED. AND DISTRIBUTE THE
PRODUCE TO THE LOCAL
COMMUNITIES. RATHER THAN SHIP
IT ALL OUT TO KIND OF MAJOR
CITY AREAS. AND IT ELIMINATES
THE MIDDLEMAN SO TO SPEAK. SO
COMMUNITIES CAN BUY IN ADVANCE
SHARES OF THE PRODUCE. AND
THEY ARE ABLE TO ACCESS THE
PRODUCE DIRECTLY FROM THE
FARMER, WITHOUT HAVING TO GO TO
THE GROCERY STORE. IT SAVES
TIME AND MONEY. IT OVERCOMES
TRANSPORTATION BARRIERS, AND
REDUCES COSTS.
SO WE WANT TO ASSESS IF AN
INDIGENOUS SUPPORTED
AGRICULTURAL INITIATIVE, WHICH
IS WHAT WE CALLED THIS, WOULD
BE EFFICACIOUS IN SUPPORTING
SOME OF THE HEALTH OUTCOMES
THAT THE TRIBAL NATION WAS
INTERESTED IN LOOKING AT.
AGAIN THIS WAS SUPPORTED BY
NIMHD; IS CURRENTLY STILL
UNDERWAY AND WILL LAUNCH THIS
IN 2020. AND WE JUST WRAPPED UP
FINAL DATA COLLECTION. WE HAVE
DONE SOME INITIAL ANALYSIS.
AND WE HAVE SOME INITIAL
FINDINGS WHICH ARE VERY
POSITIVE.
YOU CAN SEE THE BEAUTIFUL LOGO
FOR THE ISA, OR INDIGENOUS
SUPPORTED AG. GO HEALTHY IN THE
POSTAGE LIE WITHIN THIS IS A 16
WEEK CT TO TEST THE ISA'S
PROGRAM ON DIET. BLOOD PRESSURE
AND BLOOD LIPIDS, WHICH ARE THE
PRIMARY OUTCOMES AS WELL AS
BODY MASS INDEX, HEMOGLOBIN
A1C, FOOD INSECURITY AND HEALTH
STATUS, WHICH ARE THE SECONDARY
OUTCOMES.
WE ARE ALSO PERFORMING AN
ECONOMIC EVALUATION FOR
INDIVIDUAL, ORGANIZATION, AND
COMMUNITY LEVEL OUTCOMES. AS I
SAID, BEFORE POLICY CHANGES
REALLY WERE SUSTAINABLE OVER
TIME, IF THESE INNOVATIONS ARE
TO BE ADOPTED AS POLICY IT IS
REALLY IMPORTANT TO HAVE
ECONOMIC DATA AS PART OF THIS
WE ALWAYS WORK WITH A HEALTH
ECONOMIST. AND WE INVOLVE THE
TRIBAL LEADERSHIP AT THE VERY
BEGINNING FOR THE PLANNING OF
THESE GRANTS. REALLY TRY TO
UNDERSTAND WHAT THEY WOULD NEED
TO INTEGRATE A SUCCESSFUL
PROGRAM SHOULD IT BE SUCCESSFUL
INTO THEIR OVERALL NATIONS.
AND, WE ARE DOCUMENTING AND
DISSEMINATING THE STUDY
PROCESSES AND FINDINGS USING
PARTICIPATORY VIDEO METHODS.
SO A LOT OF THE COMMUNITY
PARTNERS ARE SHARING VIDEOS OF
THEIR EXPERIENCE. AND WHAT
THEY-- YOU KNOW-- WHAT THEY
HAVE DONE AS PART OF THE STUDY.
THEIR COOKING HABITS AND HOW
THOSE THAT CHANGE AND THE
IMPACT ON THEIR FAMILIES.
AND HERE'S SOME PHOTOS OF THE
ISA. YOU CAN SEE THE HEALTHY
FOOD BOXES ON THE CORNER. AND
THE FACT ALONG THE TRAVEL FARM
COULD GO FROM AN INITIAL STUDY
WHERE THE SUPPLY WAS ONLY TWO
ELDERS, AND TO THE HEADSTARTS,
THE PRIORITY POPULATIONS IT HAS
GOTTEN SO LARGE NOW THAT THEY
CAN SUPPLY THE TRIBAL NATION
WITH THESE FOODS. SO YOU CAN
SEE THE HEALTHY PRODUCE AND
SOME HERBS IN THE BOXES THAT
THEY RECEIVE EVERY WEEK FOR 16
WEEKS. AS WELL AS THE KITCHEN
STARTER KITS THAT WERE OFFERED
AS PART OF THE INTERVENTION.
FOR THE STUDY A PERSON HAD TO
BE 18 TO 75, IDENTIFIED AS
AMERICAN INDIAN OR ALASKA
NATIVE AND IDENTIFIED AS
OVERWEIGHT AND LIVING IN THE
OSAGE NATION ARE NOT PLANNING
TO MOVE IN THE NEXT YEAR AND
NOT PREGNANT OR PLANNING TO
BECOME PREGNANT IN THE NEXT
YEAR.
AND ASSESSES THE INTERVENTION
COMPONENTS: THE ISA PRODUCE
BOX. HEALTHY EATING AND
TRADITIONAL FOOD CURRICULUM
WHICH IS A WEEKLY CURRICULUM
INSIDE THE BOXES AND THEY GOT
THESE BEAUTIFUL RECIPE CARDS
AND THEY HAD A COOKBOOK WHICH
FEATURED STORIES. IT WAS IN
OSAGE LANGUAGE SO THE WORDS FOR
EACH OF FOODS FEATURED EACH
WEEK. AND A KITCHEN STARTER
KIT. HEALTHY EATING AND
TRADITIONAL INDIGENOUS FOODS.
COOKING WORKSHOPS WERE OFFERED.
THOSE WERE OFFERED EVERY MONTH.
AND WE WOULD FEATURE OSAGE
CHEFS COOKING THE FOOD AS PART
OF THE DEMONSTRATIONS.
AND SO WE IDENTIFIED A NUMBER
OF PRACTICES. AND I WILL SHARE
A COUPLE OF EXAMPLES. BUT THE
ORIGINAL IDEA FOR THIS WORK IS
REALLY CENTERED IN CEREMONY AND
TRADITION.
AND SO YOU CAN SEE A PICTURE
OF OUR RESEARCH PARTNERS
GATHERING FOR A CROSS-CULTURAL
RESEARCH EXCHANGE WITH PARTNERS
IN HAWAII. AND YOU CAN SEE
MEMBERS OF THE CHEROKEE NATION,
CHOCTAW NATION. WE HAD SOME
MUSCOGEE CREEK NATION FOLKS.
AND SOME MAORI FOLKS FROM NEW
ZEALAND OR ATUROA (PHONETIC),
AND WHO CAME AND PARTICIPATED
AS WELL AND THAT IS THE IDEA
FOR THIS, AND THE TRAINING ON
FOOD SOVEREIGNTY AND HOW AND IN
THE AMERICAN INDIANS AND ALASKA
NATIVES, NATIVE HAWAIIAN
POPULATIONS.
AND SO THERE IS A CENTER HERE
IN OKLAHOMA, AND A CENTER AT
THE UNIVERSITY OF HAWAII. THEN
WE HAVE THIS I THINK PERSONALLY
EXCELLENT FOCUS ISSUE IN HEALTH
PROMOTION PRACTICE THAT WE
PUBLISHED JUST LAST JANUARY.
AND IT TALKS ABOUT ALL THE
DIFFERENT FOOD SOVEREIGNTY
INITIATIVES. IN THE WORK THAT
IS BEING DONE. I INCLUDED THE
LINKS. PLEASE CHECK THAT OUT.
YOU CAN LEARN A LOT MORE ABOUT
THE DIFFERENT PARTNERS.
THESE ARE THE PARTNERS IN THE
CIIHE. THE ORIGINAL PARTNERS
WERE FOUR GROUPS: THE OSAGE
NATION AND THE CHOCTAW NATION
OF OKLAHOMA; AND THE
SOUTH-CENTRAL FOUNDATION AND
THE UNIVERSITY OF ALASKA
FAIRBANKS, IN FAIRBANKS AND
THOSE ARE THE ALASKA PARTNERS.
AND YOU CAN SEE THE YELLOW ARE
THE KIND OF CURRENT PARTNERS,
IN THE FIRST ROUND OF CIIHE. WE
ARE NOW ON ROUND 2 OF CIIHE.
AND WE EXPANDED THAT TO INCLUDE
PARTNERS WITH A GREEN STARS.
TURTLE MOUNTAIN COMMUNITY
COLLEGE, WASHINGTON STATE
UNIVERSITY, THE IROQUOIS TRIBE,
AND THE NOMME ESKIMO COMMUNITY
IN ALASKA.
AND WE HAVE ADDED THE QUAPAW
NATION AND THE MUSKOGEE NATION,
IN CHICKASAW NATION, AND THE
ARIC AND BURNING CEDAR CENTER
IN TULSA OKLAHOMA.
SO THESE ARE THE PARTNER SITES.
THE PURPOSE IS TO IDENTIFY AND
UPLIFT INDIGENOUS FOOD
SOVEREIGNTY INITIATIVES AS I
SAID, USING DECOLONIZED
INDIGENOUS APPROACH TO MEASURE
THE IMPACT OF THE WORK AND THIS
ALLOWS US TO UNDERSTAND
COLLECTIVELY WHAT INDIGENOUS
RESEARCH REALLY LOOKS LIKE.
AND HOW WE WILL ACTUALIZE THAT
IN OUR RESPECTIVE COMMUNITIES.
ONE OF THE KEY TOPICS THAT WE
ARE ADDRESSING CURRENTLY IS THE
PROCESS OF COLLECTING
INTERTRIBAL DATA.
WHEN WE THINK ABOUT DATA
SOVEREIGNTY, AND WE THINK ABOUT
THE VALUE OF DATA ACROSS
MULTIPLE TRIBAL NATIONS DOING
THAT IN A WAY THAT IS
RESPECTFUL AND MAKING SURE TO
GIVE BACK FINDINGS AS WELL AS
BENEFIT TO THE PARTNERING
COMMUNITIES RATHER THAN IN AN
EXTRACTIVE PROCESS SO PART OF
THAT IS TO DEFINE WHAT DOES IT
MEAN TO BE A GOOD RELATIVE IN
RESEARCH PARTNERSHIPS?
AND SO WE USE THAT QUESTION TO
DRIVE THE PROCESSES. AND HOW
WE DETERMINE THE
APPROPRIATENESS OF EACH OF THE
ACTIVITIES THAT WE UNDERTAKE
COLLECTIVELY.
WE ALSO DOCUMENT INDIGENOUS
FOOD SYSTEMS. AS WE KNOW
CLIMATE CHANGE IS IMPACTING
INDIGENOUS FOOD SYSTEMS. IT IS
IMPORTANT TO GET THESE STORIES
AND THE PRACTICES DOCUMENTED TO
SUPPORT THE TRANSMISSION OF
GENERATIONAL KNOWLEDGE. AND
SUPPORT AND STRENGTHEN
PLACE-BASED KNOWLEDGE.
ONE OF THE THINGS I HAVE
LEARNED OVER TIME IS THAT THERE
IS OFTEN A FOCUS ON
DISSEMINATION. AND THAT IS
VERY IMPORTANT, DNI
IMPLEMENTATION AND BEING
BROUGHT TO SCALE POLICY. BUT IT
IS A RISK TO LOSE THE
INDIGENOUS KNOWLEDGE DEVELOPED
OVER CENTURIES AND IT IS REALLY
RELEVANT TO THAT PLACE, MAY NOT
NECESSARILY BE USEFUL IN THE
CONTEXT OF OTHER ENVIRONMENTS,
AND OTHER TRIBAL NATIONS SO
THAT IS A CHALLENGE.
AND SO IT IS ALSO A REALLY
BEAUTIFUL VALLEY OF CIIHE. TO
UNDERSTAND THAT THE IMPORTANCE
OF PLAYSPACE KNOWLEDGE AND TO
SUPPORT IT.
ONE OF THINGS THAT WE DID IS TO
LOOK AT HOW INDIGENOUS FOOD
SOVEREIGNTY IS DIRECTLY RELATED
TO HEALTH FROM THE PERSPECTIVE
OF COMMUNITIES. THIS IS PART
OF THAT FOCUS ISSUE; THE
PUBLICATION THAT ARE SHARED AND
WE LISTED OUT-- IN SPEAKING TO
INDIGENOUS COMMUNITIES-- FOOD
SOVEREIGNTY ACTIVITIES. AND
ONCE WE COMPILED A LIST, WE
BASICALLY ORGANIZED THOSE
ACTIVITIES AT THE INDIVIDUAL,
FAMILY, COMMUNITY AND LAND AND
PLACE LEVELS.
ON THE FAR LEFT YOU CAN SEE
SOME EXAMPLES OF THOSE
ACTIVITIES. CULTURAL TEACHING,
LANGUAGE, RELATIONAL
RESPONSIBILITY, FOOD KNOWLEDGE
SHARING AND STORIES,
SUBSISTENCE KNOWLEDGE,
CEREMONY, CARING FOR LAND,
HUNTING AND FISHING, GATHERING
AND FORAGING AND FARMING AND
CARING FOR RELATIVES AND ANIMAL
AND PLANT RELATIVES. SO THOSE
ARE SOME EXAMPLES OF FOOD
SOVEREIGNTY ACTIVITIES AND THE
PROXIMAL AND DISTAL EFFECTS.
AND SO THESE ACTIVITIES LEAD TO
EXPOSURE TO HEALTHY FOODS, AND
INDIGENOUS FOODS AND CREATING
POSITIVE ATTITUDES TOWARDS
EATING VEGETABLES AND FRUITS.
INCREASING CULTURAL CONNECTION
AND TRAVEL IDENTITY. AND YOU
CAN SEE AGAIN EXAMPLES OF HOW
THESE ACTIVITIES FROM THE
PERSPECTIVE OF INDIGENOUS
COMMUNITIES, AS WELL AS BACKED
WITH THE SCIENTIFIC STUDIES
THAT WE CITE IN THIS PAPER,
REALLY ACCOMPLISH AND ACHIEVE
SOME OF THESE OUTCOMES OR
EFFECTS. AND WE POSIT THAT IN
THIS MECHANISM OF ACTION SO TO
SPEAK. REALLY CONNECTEDNESS;
SUPPORTING CONNECTEDNESS.
ONE OF THE FEW EXAMPLES WE HAVE
OF AN INDIGENOUS THEORY, IN
ADDITION TO KARINA WALTER'S
WORK IS JESSICA ALDRICH'S
(PHONETIC) WORK WHICH INCLUDES
CONNECTEDNESS AND
SELF-DETERMINATION AND CULTURAL
CONTINUITY AS MECHANISMS TO
SUPPORT AND STRENGTHEN AND
PROMOTE HEALTH.
AND SO, WE ARE ASSESSING THE
IMPACT OF THESE ACTIVITIES ON
THE OUTCOMES WITHIN THESE
COMMUNITIES. SO I HAVE A COUPLE
OF EXAMPLES, HERE YOU CAN SEE
THE FIRST EXAMPLE I AM SHARING
IS GROWING HOPE, IMPLEMENTED IN
THE CHOCTAW NATION OF OKLAHOMA,
MY OWN TRIBE. FOCUSING ON
RESTORING TRADITIONAL CHOCTAW
GARDENING BY DISTRIBUTING
TRADITIONAL SEEDS. HEIRLOOM
SEEDS THAT WERE CARRIED FROM
THE ORIGINAL ANCESTORS ACROSS
THE TRAIL OF TEARS.
THESE SEEDS WERE SOWN INTO THE
DRESSES OF THE WOMEN AS THEY
WALKED ACROSS THE TRAIL OF
TEARS TO WHAT IS OKLAHOMA. AND
THEY BROUGHT THE SEEDS WITH
THEM AS PART OF THAT PROCESS.
THOSE SEEDS WERE LOVINGLY CARED
FOR OVER THE GENERATIONS AND
KEPT. IN THEY ARE DISSEMINATED
AS PART OF THIS INITIATIVE TO
TEACH CHOCTAW FAMILIES HOW TO
GROW OUR TRADITIONAL FOODS. AS
WELL AS THE STORIES OF THOSE
SEEDS, OF THE FAMILIES THAT
KEPT THEM, THE WAYS THAT WE HAD
BOTH INDIVIDUAL FAMILY AND
LARGE COMMUNITY GARDENS. WE ARE
AN AGRICULTURAL TRIBE. SO OUR
GARDENS ARE CLOSELY TIED TO OUR
IDENTITIES.
AND WE-- THE EXPERIENCE FOR
MANY CHOCTAW PEOPLE IN OUR
INITIAL STUDIES HAVE SHOWN THAT
THIS HAS HAD A TREMENDOUS
IMPACT ON THEIR PERSPECTIVES OF
FOOD AND CULTURE AS WELL SO ALL
OF THE SEEDS COME PACKAGED TO
YOUR HOME, IN BOTH CHOCTAW AND
ENGLISH. AND SEED STORIES COME
AS PART OF THE SEEDS AND WE
FOLLOW THE FAMILIES AS THEY
GROW THEIR OWN FOOD IN THEIR
GARDENS, AND PREPARE THEIR OWN
RECIPES.
AND WE HAVE EXPANDED GROWING
HOPE TO THE JONES ACADEMY, A
BOARDING SCHOOL AND WE ARE
GETTING THE YOUTH INVOLVED IN
TO THE PROGRAM WHICH IS KIND OF
THE EXPANSION OF THE GROWING
HOPE INITIATIVE.
OUTCOMES OF FOOD SECURITY,
DIETARY INTAKE, BLOOD PRESSURE,
BLOOD LEVELS, SELF-REPORTED
HEALTH. AND OTHER QUALITATIVE
OUTCOMES INCLUDING TRANSMISSION
OF GENERATIONAL KNOWLEDGE, AND
CONNECTEDNESS AND OTHER
MEASURES.
CHICKASAW NATION IS
IMPLEMENTING A TRAVELING GARDEN
MARKET AS PART OF THEIR
INITIATIVE. FRESH FRUITS AND
VEGETABLES WILL BE SOURCED FROM
LOCAL PRODUCERS THAT THEY HAVE
WITHIN THEIR NATION. AND
DISTRIBUTED IN EIGHT LOW FOOD
ACCESS COMMUNITIES.
AND THEY WILL PILOT THIS
PROGRAM WITH THE CHICKASAW WIC
PROGRAM RECIPIENTS. THEY WILL
ALSO PARTNER WITH SNAP-ED FOR
ON-SITE NUTRITION EDUCATION AND
VIRTUAL COOKING DEMONSTRATIONS.
AND THEY HOPE TO ASSESS
PRE/POST CHANGES AMONG ADULT
PARTICIPANTS IN DIET, BLOOD
PRESSURE, HBA1C AMONG DIABETIC
PARTICIPANTS, FOOD SECURITY,
AND SELF RATED HEALTH.
THE SOUTH-CENTRAL FOUNDATION
HOLTER TRADITIONAL FOOD
GATHERING, WHICH IS WHAT THEY
HAVE CHOSEN TO DO AS PART OF
THIS YOU CAN SEE THE BEAUTIFUL
ADVERTISEMENT FOR THIS. AND
ONE OF THEIR PARTICIPANTS.
THIS IS A GATHERING THAT WAS
HELD WITH 27 WORKSHOPS HOSTED
BY 38 SPEAKERS IN THREE
PARALLEL TRACKS. SO IT WAS A
HUGE ENDEAVOR.
VIDEO RECORDINGS WERE CONDUCTED
OF ALL THE WORKSHOPS OFFERED TO
REALLY DOCUMENT THE FOOD
PRACTICES AND CULTURAL
PRACTICES WITHIN THESE
COMMUNITIES. AND MOST REGIONS
OF ALASKA WERE REPRESENTED.
130 PEOPLE WERE IN ATTENDANCE
IN THE FIRST YEAR. AND NOW WE
ARE PLANNING FOR THE SECOND
YEAR. THEY CONDUCTED PRE-AND
POST-EVALUATIONS. AND YOU CAN
READ ABOUT SOME OF THE INITIAL
FINDINGS IN THIS INITIATIVE.
THEY ARE NOW OFFERING
CONTINUING MEDICAL EDUCATION
CREDITS TO PARTICIPANTS. AND
THEIR NEXT GATHERING WHICH IS
AS I SAID, PLANNING IS UNDERWAY
AND THE OUTCOMES THEY ARE
LOOKING AT ARE INCREASING
KNOWLEDGE OF TRADITIONAL FOODS,
EXPANDED TO FOCUS ON CHANGES IN
KNOWLEDGE AND PRACTICE. SO NOT
JUST ONE INITIATIVE BUT TO HAVE
THIS MULTIPLE TIMES PER YEAR.
THE OSAGE NATION LAUNCHED A
MOBILE MARKET. YOU CAN SEE THE
BOTTOM LEFT-HAND CORNER, THE
BEAUTIFUL TRUCK WHICH WAS
REHABILITATED TO BE THIS MOBILE
MARKET. AND THEY TAKE THE
HARVEST LAND FOODS YOU HEARD
ABOUT IN THE FRESH AND ISIS
STUDY AND THEY SHARED THOSE
FOODS TO THE MOST RURAL AND
REMOTE PARTS OF THE
RESERVATION. FOLKS WHO MAYBE
AREN'T AS EASILY ABLE TO ATTEND
THE FARM AND PARTICIPATE IN
MOST OF THE EVENTS.
THEY ARE ABLE TO TAKE OUT OUT
AND OFFER THE PRODUCE OF THOSE
PLACES AND ASSESS PRE-AND
POST-CHANGES INCLUDE ACTIVE,
INTAKE, FOOD SECURITY, AND SELF
RATED HEALTH.
AND THEY ARE ADDING CLINICAL
MEASURES WHICH IS SOMETHING
VERY IMPORTANT TO THE OSAGE
NATION TO ASSESS SOME OF THE
CHANGES IN CLINICAL MEASURES.
AND THE DENAKKANAAGA CULTURAL
CAMPS A VERY SPECIAL
INITIATIVE. IN FAIRBANKS
ALASKA. WITH THE DENAKKANAAGA
NONPROFIT ORGANIZATION AND THE
UNIVERSITY OF ALASKA FAIRBANKS
AND HE TEACHES TRADITIONAL
FOODS KNOWLEDGES AND PRACTICES
WITH AN EMPHASIS ON RESIDENTIAL
SCHOOL SURVIVORS AND FAMILIES.
ELDERS WHO DIDN'T REALLY BE
ABLE TO LEARN THEIR CULTURAL
PRACTICES DUE TO BOARDING
SCHOOL ARE BEING TAUGHT THESE
PRACTICES, AS A WAY TO HEAL AND
OVERCOME THEIR EXPERIENCES. AND
ELDERS WHO MAYBE DID NOT GET A
CHANCE TO TEACH OUR OFFERING
THE TRADITIONAL KNOWLEDGE. AND
THE OUTCOMES ARE SOCIAL AND
EMOTIONAL WELL-BEING, CULTURAL
CONNECTEDNESS, SELF-REPORTED
HEALTH, AND DIETARY INTAKE. AND
THEY ARE ALSO EXPANDING THIS TO
BE MORE FOR YEAR-ROUND EVENTS.
THIS IS A SUMMARY OF KEY
LEARNINGS TO DATE. BOTH IRINAH
AND CIIHE USES A MECHANISM
THROUGH AECOLONIZING D APPROACH
ACCESSING THE PRECOLONIAL MIND,
A TERM THAT VANESSA WALKS
(PHONETIC), A CANADIAN USES.
ALLOWING US TO SPEND THE
TRADITIONAL PRACTICE AND IN
THAT PROCESS WE RECONNECT AND
RESTORE SO MUCH OF WHAT HAS
BEEN BROKEN IN OUR COMMUNITIES.
AND STRENGTHEN OUR IDENTITIES
AND OUR SENSE OF SELF AND
COMMUNITY, WHICH IS SO
IMPORTANT TO OUR HEALTH.
THESE INITIATIVES VALUE STORY
AS A PRIMARY METHOD FOR
COLLECTING AND SHARING
KNOWLEDGE. IN THE CENTER
SELF-DETERMINATION AS
FUNDAMENTAL TO THE HEALTH OF
NATIVE COMMUNITIES. WE KNOW
FROM YEARS OF RESEARCH IN
SOCIAL EPIDEMIOLOGY, AND TIMES
WORK IN THE WORK OF MICHAEL
MARMA (PHONETIC), YOURSELF
DETERMINATION AND AUTONOMY AND
THE ABILITY TO DETERMINE YOUR
OWN LIFE IS KEY TO HEALTH.
THAT IS SOMETHING WE REALLY
CENTER IN THESE INITIATIVES.
THAT IS MY LAST SLIDE. YAKOKE!
THANK YOU SO MUCH FOR THIS
AMAZING OPPORTUNITY, VERY
HOWLING OPPORTUNITY TO
PARTICIPATE AS A SPEAKER IN THE
NIMHD DIRECTOR'S SEMINAR
SERIES.
AND I WILL STOP SHARING NOW.
AND LOOK FORWARD TO HAVING A
DISCUSSION WITH YOU. THANK YOU.
>> DR. PÉREZ-STABLE: THAT WAS
FANTASTIC VALERIE. DON'T SHUT
OFF YOUR MIC WE ARE GOING TO
ASK YOU QUESTIONS ABOUT THE
CONVERSATION. GINA WILL MONITOR
THE Q&A AND PLEASE THOSE IN THE
AUDIENCE, DON'T HESITATE TO
SEND THESE QUESTIONS. AND I
WILL PASS THEM ON TO VALERIE SO
SHE CAN ANSWER THEM.
I HAD A COUPLE OF REACTIONS.
FIRST I NOTED THAT ONE OF YOUR
NEW SITES IN CIIHE HIS IN
TURTLE MOUNTAIN COLLEGE WHICH I
MENTIONED IN YOUR INTRODUCTION
THAT I VISITED JUST LAST MONTH
WHICH IS FANTASTIC. IT BRINGS
IT ALL HOME.
I WAS ALSO PLEASED TO SEE HOW
YOU TRIED TO BLEND IN, NOT ONLY
THE INDIGENOUS CULTURE, BUT
RIGOROUS METHODS IN
IMPLEMENTATION SCIENCE. AND THE
OUTCOMES THAT SPEAK TO NOT JUST
PERHAPS SELF-REPORT MEASURES
WHICH ARE IMPORTANT OF COURSE.
AFTER ALL WE ARE IN THE
BUSINESS TO MAKE PEOPLE FEEL
BETTER. BUT ALSO OUTCOMES
RELATED TO HEALTH LIKE A1C,
WHICH ONE WOULD EXPECT WOULD BE
SENSITIVE TO THE NUTRITIONAL
INTERVENTION.
SO WHAT IS... YOU INTRIGUED ME.
THIS INTERVENTION HAS POSITIVE
OUTCOMES. DO YOU SEE FROM A 16
WEEK INTERVENTION IN CHANGES IN
A1C AND BLOOD PRESSURE?
>> DR. JERNIGAN: WELL WE HAVE
NOT ANALYZED A1C AND BLOOD
PRESSURE YET. BUT WE SAW
SIGNIFICANT CHANGES AND
IMPROVEMENTS IN HEALTHY EATING
INDEXING THE INNOVATION AND
CONTROL GROUPS. AND WHAT WE
INITIALLY ANALYZE WHAT THE DIET
WHICH WAS THE PRIMARY OUTCOME.
WE HAVE NOT LOOKED AT THE OTHER
OUTCOMES AS OF YET. THIS IS
LITERALLY A COUPLE OF HOURS AGO
THAT WE GOT THE API TABLE IN
AN EMAIL.
YOU CAN SEE CHANGES IN BLOOD
PRESSURE PRETTY QUICKLY. YOU
MAY OR MAY NOT BE ABLE TO SEE
A1C CHANGES. AND IT IS REALLY
TOUGH TO MOVE THE NEEDLE ON BMI
CHANGES. AS ALL OF THESE YOU
WELL KNOW.
THESE ARE INDICATORS THAT WE
PROPOSE, AND WE OFFER. IN SOME
OF THE NATIONS ARE VERY
INTERESTED IN ACCESSING THESE
OUTCOMES. WITH OTHER
COMMUNITIES OR NATIONS, IT MAY
BE INITIALLY SELF-REPORTED TO
START AND DEPENDING ON
CAPACITY, THEY MOVE TO THAT
NEXT, YOU KNOW, STEP OF TAKING
CLINICAL MEASURES.
OFTEN IT DEPENDS ON IF THEY
HAVE ACCESS TO HEALTHCARE
CLINIC. EITHER IHS OR IF THEY
HAVE THEIR OWN, AND THEIR OWN
LAB. WE HAVE SEEN SO MUCH
DIVERSITY IN TRIBAL NATIONS AND
WE HAVE SEEN THAT IT HAS BEEN
REALLY EXCITING FOR ME THAT A
LOT OF THE NEEDED RESEARCHERS--
BECAUSE THE CIIHE IS ALL
INDIGENOUS RESEARCHERS. WE HAVE
ENOUGH NATIVE PHD RESEARCHERS
NOW THAT YOU CAN HAVE A
NATIONAL CENTER WITH ALL NATIVE
PHD RESEARCHERS AS THE PIS,
WHICH IS AMAZING TO ME.
BUT WHAT I FOUND IS THAT THEIR
INITIAL STUDIES LOOKED AT SOME
QUALITATIVE OUTCOMES. BUT A LOT
OF THESE-- SEVERAL OF THESE
INDIGENOUS SCHOLARS ARE NOW
MOVING INTO THE STAGE WHERE
THEY WANT TO APPLY FOR AND RO1.
AND THEY WANT TO PROPOSE SOME
CLINICAL MEASURES AS THE NEXT
STEP AT THE CIIHE PROJECT AND
THEY ARE LOOKING TO US TO SAY,
HOW WOULD WE DESIGN AN RO1 THAT
BUILDS UPON CIIHE? AND BUILDS
UPON WHAT WE HAVE DONE AS PART
OF THIS CULTURE CAMP? HOW DO WE
EXPAND THAT?
AND I THINK I SAID IN THE MEET
AND GREET PRIOR TO THIS,
FORTUNATELY I GOT SOME GREAT
MENTORING. SO WRITING RO1
STUDIES IS SOMETHING I REALLY
ENJOY. AND WE HELP THEM
DEVELOP SOME OF THESE DESIGNS
THAT THEY HAVE BEEN WORKING
WITH THE COMMUNITY TO REALLY
TAILOR AND MOVE INTO
APPLICATIONS FOR RO1S.
>> DR. PÉREZ-STABLE: I REMEMBER
THAT YOU ENJOY WRITING RO1S. I
DON'T RUN INTO THAT TOO OFTEN.
COMMENTS FROM THE AUDIENCE.
FANTASTIC PRESENTATION AND IS
THERE A PLANT COLLECT DATA ON
THE LONG-TERM OUTCOMES ON THIS
INTERVENTION? NOT SURE WHICH
ONE. YOU TALKED ABOUT SEVERAL.
WILL YOU BE MEASURING ANY
SPILLOVER EFFECTS? ARE THERE
OPPORTUNITIES TO ENHANCE THIS
WITH ADDITIONAL HEALTH LITERACY
INTERVENTIONS? FROM VJ -- AT
NIH.
>> DR. JERNIGAN: AT THIS POINT
DON'T KNOW IF I HAVE ANY
LONG-TERM DATA COLLECTION PLAN
FOR ANY OF THE INTERVENTIONS
THAT I SHARED. ALTHOUGH IT IS
DEFINITELY SOMETHING THAT I
THOUGHT ABOUT. ESPECIALLY WITH
THE CHICKASAW AND CHOCTAW
NATIONS. BECAUSE OUR
PARTNERSHIPS WITH THEM ARE NOW
10+ YEARS. WE HAVE DONE SO
MANY PROJECTS TOGETHER THAT IS
NOT WERE SOMETHING THAT THEY
REALLY WANTED, IT WOULD BE
SOMETHING THAT WE COULD STUDY.
ESPECIALLY GIVEN THE
INVESTMENT, THE INITIAL
INVESTMENT THAT THE NIH MADE TO
SEE IF THESE LONG-TERM CHANGES
HAVE HAPPENED.
BOTH TRIBAL NATIONS ARE
EXCELLENT AND COMFORTABLE WITH
TAKING CLINICAL MEASURE
OUTCOMES. SOMETHING IN THE
INITIAL THRIVE STUDY AND WE
WERE CAUTIOUS BECAUSE THE STUDY
WAS IMPLEMENTING CONVENIENCE
STORES. THERE WAS NOT ENOUGH
SPACE TO DO A LOT OF DATA
COLLECTION THERE.
WE HAVE SUBSEQUENTLY GONE ON TO
DO -- WE DID ANOTHER
IRINAH-SUPPORTED STUDY THAT DID
NOT MENTIONED IN THIS
PRESENTATION. BUT IT WAS
LOOKING AT ADAPTING THE DASH
DIET TO BE CULTURALLY
APPROPRIATE IN CHICKASAW
NATION. THAT ONE HAPPENED
RIGHT AT THE BEGINNING OF
COVID. SO WE HAD TO MODIFY IT A
LITTLE BIT. BUT THAT ONE WAS A
VERY SUCCESSFUL INTERVENTION.
IN CLINICAL MEASURES WERE TAKEN
AS PART OF THAT AND WE SAW THE
REDUCTION IN BLOOD PRESSURE.
WE ALSO SAW A LOT OF COST
SAVINGS. I CAN PROBABLY INCLUDE
THE LINK TO THAT BUT THERE WAS
A HEALTHY ECONOMIC ANALYSIS
DONE AS PART OF THAT SO THE
HIGHER SOMEONE'S BLOOD PRESSURE
WAS, THE HIGHER THE COST
SAVINGS FOR THE TRIBAL NATION.
SO THAT STUDY ENDED UP BEING
REALLY COST-EFFECTIVE FOR
SOMEBODY WHOSE BLOOD PRESSURE
WAS IN HIGHEST QUADRANTS OF
THAT, OF THOSE ASSESSMENTS.
AS FAR AS SPILLOVER, WHAT YOU
MEAN IN THAT QUESTION? NOT
REALLY SURE.
>> DR. PÉREZ-STABLE: WE HAVE TO
INTERPRETED AS YOU WISH BECAUSE
WE DO NOT HAVE MEMBERS LIVE. I
SUPPOSE UNEXPECTED BENEFITS.
>> DR. JERNIGAN: WILL FOR SURE,
THESE ARE RELATIVELY SMALL
COMMUNITIES. GOING BACK TO THE
THRIVE CONVENIENCE STORE STUDY
WE GOT A LOT OF COMPLAINTS MADE
STUDY BECAUSE PEOPLE WERE
DRIVING ALL OVER THE NATION AND
SEEING A LOT OF THE INNOVATION
STORE HAD A LOT OF DIFFERENT
FOODS AND THEY WERE
COMPLAINING, WHY DON'T THE
LOCAL STORES HAVE THAT? WHEN
ARE WE GETTING THESE FOODS?
THERE WASN'T A LOT OF VARIETY
OR OPTIONS AVAILABLE TO THEM.
AND AS A NATIVE TRIBAL MEMBER I
WOULD LIKE LESS GIVEN THE FOOD.
THIS IS GREAT AND THIS IS WHAT
THEY WANT. AND THE
EPIDEMIOLOGISTS WOULD GO NO,
THAT WILL CONTAMINATE THE
STUDY. IT IS AWFUL! IT MADE HER
SKIN CRAWL TO EVEN PROPOSE
THAT.
SO THERE'S A LOT OF BENEFIT IN
DOING THIS WORK IN SMALL TRIBAL
COMMUNITIES. CAN I WOULD SAY
SOMETHING THAT THE OSAGE NATION
TOLD US WHEN WE LAUNCHED FRESH.
FROM OUR PERSPECTIVE AND HIS
LEADERSHIP IN THE OSAGE NATION,
THE STUDY HAS ALREADY BEEN
SUCCESSFUL BECAUSE OF THE TIME
AND PLANNING AND LOVE AND CARE
THAT HAS TAKEN TO DEVELOP THE
FARM, AND TO DO THIS
INTERVENTION WE HAVE ALREADY
SHOWN THE INVESTMENT IN THESE
CHILDREN. AND THAT IN AND OF
ITSELF IS A POSITIVE OUTCOME OF
THE STUDY THAT WE WANT.
AND SO I TAKE THOSE OUTCOMES TO
HEART. BECAUSE WHEN YOU GET
FEEDBACK LIKE THAT, MEAN THAT
IS WHAT YOU REALLY LOVE AS A
NATIVE RESEARCHER. SO WE GET A
LOT OF FEEDBACK LIKE THAT. I
THINK THERE'S A LOT OF POSITIVE
SPILLOVER IS THAT IS WHAT THEY
MEANT.
>> DR. PÉREZ-STABLE: WHEN I
FIRST HEARD ABOUT YOUR STORE
STUDY BEFORE I GOT TO THE NIH,
I THOUGHT IT WAS BRILLIANT A
THING ABOUT DOING A STRUCTURAL
INTERVENTION TO ALTER PEOPLE'S
BEHAVIOR. LIKE PUTTING IN EASY
ACCESS STAIRS FOR PEOPLE TO BE
ABLE TO GO UP ONE FLOOR INSTEAD
OF TAKING THE ELEVATOR. AND I
THINK THAT WE JUST NEED TO
DISSEMINATE MORE OF THAT AND AT
THE COMMUNITY LEVEL SINCE IT IS
NOT GOING TO HAPPEN AT THE
MACROLEVEL. WE SEE IT ALL THE
TIME THE WAY THE MARKETS ARE,
AND HOW MARKETING OF ULTRA
PROCESSED, DENSE FOODS;
INEXPENSIVE AND THEY ARE RIGHT
THERE IN YOUR FACE AS YOU ARE
CHECKING OUT. IT IS REALLY,
PEOPLE PICK THEM UP. AND SO I
APPLAUD YOU FOR THAT.
DID YOU EVER USE THE TECHNIQUE
OF PHOTO VOICE IN ANY OF YOUR
WORK? JUST CURIOUS.
>> DR. JERNIGAN: I WENT TO FILM
SCHOOL AS PART OF MY POSTDOC.
AND I DID THAT BECAUSE I WOULD
DO PHOTO VOICE WITH NATIVE
COMMUNITIES. AND THE POWER OF
STORY-- WHICH I KNEW JUST FROM
MY OWN CHILDHOOD AND GROWING
UP-- BUT WHEN I DID IT AS A
PUBLIC HEALTH PROFESSIONAL, AS
A COMMUNITY MEMBER, AS AN
ACTIVIST AND AN ACADEMIC, AND
AN ADVOCATE, FOR THEM TO SEE
THEMSELVES REPRESENTED BACK IT
WAS A VERY HEALING EXPERIENCE.
AND PEOPLE WOULD SAY, WE HAVE
EVIDENCE THAT WE HAVE DONE THIS
WORK FOR FUTURE GENERATIONS.
AND SO YES I'VE DONE A LOT OF
PHOTO VOICE. WE HAVE DONE VIDEO
VOICE SO WE GIVE CAMERAS TO
COMMITTEE MEMBERS AND HAVE THEM
SHARE STORIES AND THE
PERSPECTIVE OF WHAT THEIR
EXPERIENCES LIKE AS PART OF
THESE INTERVENTIONS.
WE FILM ALL OF OUR MEETINGS.
SO WE HAVE THE PROCESS OF, YOU
KNOW, HOW DO DECISIONS GET MADE
FROM THE HIGHEST LEVEL IN
TRIBAL GOVERNMENT LEADERSHIP?
YOU KNOW?
IN RIB, I FILMED MYSELF
RESENTED TO THE CHOCTAW RIB,
AND WHAT THAT IS LIKE. TO THE
LEVELS OF LIKE DEBATING AND
DISCUSSING WHAT QUESTIONS
SHOULD BE ADDED IN A SURVEY.
YOU KNOW, SO WHAT THOSE THEN
SERVE TO PROVIDE US WITH, IS
ALMOST LIKE A MANUAL FOR HOW WE
DID THIS. AND MAYBE THIS WILL
HELP YOU IMPLEMENT SOMETHING
SIMILAR IF YOU HAVE THAT
DESIRE, WITHIN YOUR OWN TRIBAL
NATION.
BUT I THINK STORY IS A REALLY
POWERFUL WAY TO SHARE
KNOWLEDGE. OBVIOUSLY THAT IS
WHAT WE DO, AS NATIVE PEOPLE.
BUT, YES. VERY MUCH SO.
>> DR. PÉREZ-STABLE: THANK YOU
AND I SHOULD PUT THOSE TWO
TOGETHER; THAT YOU WERE
INVOLVED IN FILM, AND WENT TO
FILM SCHOOL. IT WOULD MAKE
SENSE. THAT IS FANTASTIC. I
WILL HAVE TO ASK YOU ABOUT THAT
AT COUNCIL.
SO I HAVE ANOTHER QUESTION FROM
THE AUDIENCE. THANKING YOU FOR
VERY IMPORTANT AND INSPIRING
WORK USING FOOD AND COVERING
THE LENS. IN THE THRIVE STUDY,
OUR STORE SELECTED? WERE
BUSINESSES PROVIDED INCENTIVE
FOR FUNDING TO SUPPORT THE
IMPLEMENTATION OF THE
INTERVENTION? AND FINDINGS ON
BUSINESS SATISFACTION, FINDINGS
ON HOW DID THE CHANGES AFFECT
PROFITABILITY, SUSTAINABILITY?
THIS IS COMING FROM PAUL BURNS
AT NIMHD, ONE OF OUR PROGRAM
OFFICIALS.
>> DR. JERNIGAN: THE STORES
WERE MATCHED BY SIZE AND
CHARACTERISTICS OF THE LOCAL
TOWNS. I THINK WE HAD 20
STORES. THERE WERE A LOT OF
STORES. SO WE INTERVENE IN
EIGHT STORES. FOUR WERE CONTROL
AND FOUR WERE INTERVENTION
STORES. SO THEY WERE MATCHED BY
SIZE OF THE TOWNS. AN INCOME
AND DEMOGRAPHIC CHARACTERISTICS
OF THE TOWNS AND THE TRIBES.
AND AS FAR AS INCENTIVES GO,
ONE OF THOSE FOUR PS THAT YOU
SAW WAS PRICING. AND SO ONE OF
THE THINGS THAT HAPPENED AS
PART OF THE THRIVE STUDY IS
THAT WE SAID, WE ARE GOING TO
OFFER ADDITIONAL FOODS. WE ARE
NOT GOING TO TAKE ANY FOODS
AWAY. WE UNDERSTAND HOW
IMPORTANT THESE STORES ARE TO
TRIBAL ECONOMIES. I KNOW
RELATIVES WHO WORK IN THESE
STORES. AND THEY ARE IMPORTANT.
AND WE DON'T WANT TO HAVE THIS
BE A PENALIZING INTERVENTION.
THIS IS SOMETHING THAT OFFERS
NEW AND DIFFERENT VARIETY AND
OPTIONS.
IF THE FOODS ARE INCLUDED AS
PART OF THE INTERVENTION, SO
THERE WERE FIVE NEW MEALS
OFFERED AND 10 NEWSMAX OFFERED
IN EACH OF THE INTERVENTION
STORES AND THEY MET CERTAIN
NUTRITIONAL CRITERIA THAT WE
SHARED AND PUBLISHED, IF THEY
DON'T SELL, THE GRANT COVERS
THE COST OF THOSE FOODS. SHOULD
THEY NOT SELL.
AND THE TRIBE SAID GREAT. THAT
IS FINE. WE WILL START
PRESSING THEM AT THE SUGGESTED
RETAIL PRICE. BECAUSE WE HAVE
TO ESTABLISH BASELINE.
BUT, FROM THERE, IF THEY DON'T
SELL WE WILL REDUCE PRICING
UNTIL THEY DO. WE NEVER
ACTUALLY EVEN HAD TO REDUCE THE
SUGGESTED RETAIL PRICE, BECAUSE
ALL THE FOOD SOLD OUT WITHIN
THE FIRST FEW WEEKS OF THE
INTERVENTION. AND, THEY WERE
NOT ABLE TO KEEP THEM IN STOCK
IN BOTH TRIBES.
SO THAT TOLD US THAT, YOU KNOW,
THIS WAS SOMETHING THAT CLEARLY
PEOPLE WANTED. AND, THEY KNEW
THAT KEEPING THESE AS POLICY--
BOTH OF THE STORES STILL HAVE
THESE SECTIONS IN THERE TODAY.
SO THAT IS WHAT WENT ON WITH
THE STORES.
WE DID HAVE TO COMPETE WITH BIG
FOOD MANUFACTURERS LIKE TO READ
DORITOS AND CHEETOS, AND THEY
DO OFFER INCENTIVES. BUT BOTH
DRIVERS MADE IT A POLICY TO
CENTER AROUND THE LARGE
WALKAROUND COOLERS AND MOVE THE
HOT BOXES BEHIND THE CASH
REGISTER AND SOME OTHER
PHYSICAL CHANGES TO THE STORES
THAT THEY MADE AS PART OF THIS.
SO THAT IS PART OF THE
INTERVENTION IS PERMANENT
CHANGES.
I SHOULD ALSO SAY ONE MORE
THING TO THIS QUESTION. AS
PART OF THIS INITIATIVE, IT IS
IMPORTANT TO EMPHASIZE, BECAUSE
IT IS COMMUNITY-BASED
PARTICIPATORY RESEARCH
INITIATIVE THAT IS SO
INCREDIBLY TRIBALLY DRIVEN, WE
HAD FULL ACCESS TO ALL SALES
DATA IN ALL OF THE STORES. WE
GOT-- WE PUBLISHED A PAPER AND
AGAIN IT IS ON OUR WEBSITE, BUT
IT BASICALLY SHORES THAT NOT
ONLY DID THEY NOT LOSE REVENUE,
BUT THEY ACTUALLY INCREASE
THEIR SALES. SO IT WASN'T AN
INITIATIVE THAT CONTAINED ANY
KIND OF FINANCIAL RISK TO THE
TRIBAL NATIONS.
>> DR. PÉREZ-STABLE: FANTASTIC.
AND ULTIMATELY, IF WE ARE
WORKING WITH THESE
ORGANIZATIONS THAT'S GOING TO
BE A CRITICAL COMPONENT THAT
THEY NEED TO ACCEPT. OTHERWISE,
THEY MAY NOT ACCEPT IT OR IT
WON'T LAST.
I HAVE ANOTHER QUESTION FROM
THE AUDIENCE. DID NEW RECIPES
DETERMINED SIMILAR FOODS THAT
WERE NEW FOODS-- I AM NOT SURE
I UNDERSTAND THAT-- HOW DID THE
PROCESS GO WHERE THE ADDED
TRADITIONAL FOODS, AND THE
PERSON, YOWA IFATEIO
(PHONETIC), NO AFFILIATION.
>> DR. JERNIGAN: BOTH OF THE
RO1S HAD TO CHANGES. IN THE
STORE SETTINGS FOODS WERE
IDENTIFIED BY THE NUTRITIONAL
CRITERIA WE ESTABLISHED, BASED
ON THE GREAT DIETARY
GUIDELINES.
AND THEN WHAT THE DISTRIBUTORS
SOURCE LISTINGS HAD AS PART OF
THEIR FULL OFFERINGS, AND SO WE
GOT COPIES OF ALL OF THE LOCAL
DISTRIBUTORS THAT SUPPLIED THE
STORES WITH THEIR FOODS. AND WE
BASICALLY WENT THROUGH AND LOOK
AT THE NUTRITIONAL CONTENT OF
ALL THE FOODS AVAILABLE.
SOME OF THOSE FOODS WERE BEING
CARRIED BY SOME OF THE STORES.
BUT MOST OF THE FOODS WERE NOT
BEING CARRIED BY MOST OF THE
STORES. AND THERE WERE OPTIONS
THAT WERE HEALTHY, THAT COULD
EASILY BE ADDED. HOWEVER, SOME
OF THE MORE REMOTE, RURAL
STORES, THAT WOULD THEN MEAN
THAT THE TRUCK HAD TO VISIT THE
STORES TWICE A WEEK, RATHER
THAN ONCE A WEEK AND SO ON AND
SO FORTH. SO WITH THIS
INFORMATION, WE THEN HAD TO
MAKE DECISIONS AROUND ... YOU
KNOW SHOULD WE USE A DIFFERENT
DISTRIBUTOR?
SHOULD WE INCORPORATE NEW
PRODUCERS THAT ARE LOCAL THAT
COULD SUPPLY THESE FOODS?
ULTIMATELY THAT IS A CHOICE
THAT WAS MADE. BUT THE
DECISION WAS TOGETHER PRODUCE
AND THEN PACKAGED FOODS INSIDE
THE STORES IN AN EXPANDED
KITCHEN. SO I MEAN THAT WAS A
HUGE INVESTMENT THAT I DID NOT
EXPECT TO HAPPEN AS A RESULT OF
THE INTERVENTION BUT I THINK
CHOCTAW NATION-- WHICH IS THE
TRIBE WROTE THAT THIS-- SAW
THAT THIS WAS A DEMAND. SAW
THAT THE TRIBE POPULATION WAS
EATING AT THESE STORES AND
REALLY WANTED THERE TO BE FOOD
THERE THAT WAS HEALTHY. AND SO
THE CHANGES THAT HAVE TO BE
MADE WERE MADE. AND THAT IS
KIND OF THE PROCESS THAT WE
WENT THROUGH IN DETERMINING
WHICH FOODS.
>> DR. PÉREZ-STABLE: LET ME SEE
IF AN OVER INTERPRETING THE
COMMENT. IN THE TRADITIONAL
FOOD APPROACH, ARE THERE NEW
INGREDIENTS? LIKE I DON'T KNOW,
THINGS THAT WE LEARNED; OR
LET'S SAY, INDIGENOUS OR
TRADITIONAL FOODS FROM OTHER
CULTURES THAT WE NOW HIGHLY
VALUE. WHETHER THEY BE
AVOCADOS OR WHATEVER. I DON'T
KNOW. IS THAT SOMETHING THAT
WENT INTO THE FORMULA WHEN
YOU'RE THINKING ABOUT THIS? OR
WHEN THE COMMUNITY IS THINKING
ABOUT THIS?
>> DR. JERNIGAN: FOR THRIVE WE
HAVE TO LOOK AT WHAT WAS
POSSIBLE BEFORE WE PROMISED
ANYTHING BECAUSE WE KNEW THAT
WE ENCOURAGED THE TASTE TEST.
WITH THE TASTE TESTS. AND WE
WOULD INVITE TRIBAL MEMBERS TO
COME TO THE PARKING SYMBOLS
FOR WHERE WE HAD THESE TASTE
TESTS, AND CLICKER POLES. WHAT
WOULD YOU THINK ABOUT DIFFERENT
FOODS? HOW MUCH WOULD YOU BUY?
HOW MUCH WOULD YOU PAY? AND
EACH OF THE QUESTIONS WOULD POP
UP AND PEOPLE WOULD VOTE AND WE
WOULD SAY WELL WHICH OBLIGES
OVER A HOT DOG? HOW MUCH WOULD
IT HAVE TO COST? AND SO WE ALL
BECAME THESE WEIRD EXPERTS IN
CONSUMER SCIENCE.
AND SO YOU KNOW, WE HAD REALLY
FUNNY EXPERIENCES. LIKE TRYING
HUMMUS. PEOPLE DID NOT KNOW AT
THE TIME WHAT HUMMUS WAS. ONE
OF THE POTENTIAL OFFERINGS. OH,
IT IS LIKE BEAN DIP. SO
SOMETHING THEY COULD RELATE TO
ABOUT WHAT IT WAS.
WE DEFINITELY WANTED TO OFFER
FOODS THAT WE KNEW HAD A CHANCE
OF BEING SUCCESSFUL IN
COMMUNITIES. THAT THEY WANTED
AND WERE OPEN TO TRYING. AND
THE SAME WAS TRUE WITH THE
OSAGE NATION WITH FRESH. WE HAD
TO LOOK AT WHAT FOODS COULD
GROW. WHAT FOODS PEOPLE MOSTLY
ATE. AND WHAT FOODS THEY WERE
LESS LIKELY TO TRY. WE HAD TO
CONSIDER ALL OF THIS IN THE
FOOD INTERVENTIONS, AND THAT
INVOLVES LOTS AND LOTS OF
ROUNDS OF DISCUSSION AND
UNDERSTANDING WHAT PEOPLE WOULD
HAVE THE CAPACITY TO COOK AND
TO PREPARE.
AND SO YES, ON ALL OF THE
THINGS. AND I THINK THAT PART
OF THE REASON WHY THE CHILDREN
HAD PLEASANT CHANGES IN THE
BEAN INTAKE AND THE SQUASH
INTAKE WAS BECAUSE OF THE
CULTURAL TRADITIONS AROUND THE
THREE SISTERS, AND NATIVE
AGRICULTURAL PRACTICE. AND THAT
WAS KEY IN ALL OF THE
INTERVENTIONS.
THE FOODS THAT HAVE DEEPER
MEANING, DEEPER RELEVANCE TO
COMMUNITIES, ARE ALWAYS THE
FOODS THAT TEND TO DO MUCH
BETTER. THERE IS A BIG
DIFFERENCE BETWEEN TRADITIONAL
INDIGENOUS FOODS AND HEALTHY
WESTERN FOODS. AND SO
INDIGENOUS FOOD SOVEREIGNTY
INTERVENTION THERE IS A
DISTINCTION BETWEEN THAT. BUT
PEOPLE ALSO LOOK TO OUR FROM
THE GROCERY STORE THE NEED TO
INCREASE THE SUPPLY OF FOOD,
AND FOOD THEY CAN ACCESS
QUICKLY FROM THE POTENTIALLY
LOCAL FARM. AND SO THEY PLAN
THOSE ASPECTS AS WELL.
>> DR. PÉREZ-STABLE: THAT HELPS
ALSO TALKING CIRCLES TO TASTE
FOOD. I HAVE A COMMENT ABOUT
PRAISING YOUR PRESENTATION IN
VOLUNTEERING TO HELP. I DON'T
KNOW THIS ORGANIZATION -- WOULD
LOVE TO HELP WITH DATA
COLLECTION AND DIESEL HEALTH
LITERACY AND PATIENT EDUCATION.
I AM SURE GINA CAN GET THESE
COMMENTS.
A QUESTION AND COMMENT FROM
KAREEM BAKER FROM NIMHD, ON OUR
STAFF AND I WONDER IF THERE ANY
EXPENSES OR MEMORIES BY THE
KIDS WHO WERE PART OF THE FRESH
STUDY THAT STAND OUT TO YOU?
AND SHE ALSO PRAISED YOUR
PRESENTATION.
>> DR. JERNIGAN: HMM... YOU
KNOW? THERE ARE SO MANY. I
THINK PROBABLY ONE OF THE
THINGS THAT I THINK WAS MOST
EXCITING WAS TO SEE THE KIDS,
THEY WOULD TAKE HOME THE
TAKE-HOME MEALS, AND THEY WOULD
PREPARE THEM WITH THEIR
FAMILIES. AND THEY WOULD POST
THEM ON FACEBOOK. AND IT WAS
REALLY SWEET.
BECAUSE I THINK IN A LOT OF
THESE COMMUNITIES, IT WAS TIME
OF HELLO FRESH, AND THOSE WHO
ARE POPULAR AND PEOPLE ORDERING
THOSE AT HOME FOOD KITS. BUT
THOSE WERE OUT OF REACH OF A
LOT OF NATIVE FAMILIES WHO DID
NOT HAVE THE MONEY TO DO THAT.
BUT THIS WAS A VERSION OF THAT
THAT THEY COULD SHARE, AND POST
ONLINE ENACTING IT WAS REALLY
MOVING TO SEE THESE KIDS. AND
THEY WERE EATING THIS FOOD
BECAUSE I GREW UP IN OKLAHOMA.
I AND FROM OKLAHOMA AND WE ATE
COMMODITY FOODS, AND SOLD THAT
A LOT OF PARENTS WHO WERE PART
OF THE FRESH STUDY. AND I DID
NOT TASTE FRESH VEGETABLE UNTIL
I WAS 24 YEARS OLD.
AND SO WE BECOME REAL PARTNERS
WITH OUR COMMUNITIES. WE GET
TO KNOW THE FAMILIES. AND SO,
WE HAVE SEEN A LOT OF THESE
KIDS GROW UP. THAT IS BEING
REALLY LUCKY WITH MY JOB.
>> DR. PÉREZ-STABLE: I CAN SAY
THAT EVEN FOR ME, GROWING UP AS
A CHILD IN CUBA, IN THE 1960S,
I DON'T THINK I HAD ANY FRESH
VEGETABLES UNTIL I WAS MAYBE
NOT 24, BUT AN ADULT. SO IT
USED TO BE A COMMON PATTERN,
EATING PROCESSED FOODS. THAT
WAS MORE PREDOMINANT.
ONE LAST QUESTION I HAVE HERE.
ELEVATED CO2 LEVELS CAN RESULT
IN DECREASED NUTRITIONAL
QUALITY OF CROPS. I ASSUME
THEY ARE REFERRING TO THE
CLIMATE. ESPECIALLY FOR
PROTEIN, IRON AND ZINC AMONG
OTHER NUTRIENTS. ESSENTIAL
ELEMENTS. HOW MIGHT THESE
IMPACTS FROM CLIMATE CHANGE
INTERACT WITH FOOD SOVEREIGNTY
INITIATIVES? THIS IS COMING
FROM CAROL AT ALLEGHENY
COLLEGE.
>> DR. JERNIGAN: WELL, THAT IS
A GREAT QUESTION. I DO NOT
KNOW... YOU KNOW? I DON'T
REALLY KNOW MUCH ABOUT THE
IMPACT OF CLIMATE CHANGE ON THE
NUTRITIONAL QUALITY OF CROPS.
I AM NOT A CLIMATE SCIENTIST. I
AM A PUBLIC HEALTH
INTERVENTIONIST. BUT I DO KNOW
THAT A BIG ISSUE FOR THE NATIVE
POPULATIONS THAT I HAVE BEEN
WORKING WITH AS PART OF CIIHE
IS THE SHIPPPING OF FOOD FROM
ONE PLACE TO ANOTHER. AND THERE
IS A CULTURAL PERSPECTIVE THAT
THE FOOD LOSES ITS NUTRIENTS.
AND IT LOSES ITS ABILITY TO
BASICALLY FUNCTION AS A FOOD AS
MEDICINE. IT ALSO LOSES THE
CONNECTEDNESS THAT A PERSON HAS
AS THEY GROW IT. AND THE
COMMUNITY HAS AS PART OF EATING
THEIR FOODS THAT THEY GROW ON
THEIR OWN LAND.
FROM THAT PERSPECTIVE, WHICH I
GUESS WOULD BE AN INDIGENOUS
SCIENCE PERSPECTIVE, THERE IS A
SENSE THAT THE NUTRITIONAL
QUALITY DIFFERS WITHIN LOCAL
FOOD EATEN VERY FRESH AND FOODS
THAT HAVE TRAVELED LONG
DISTANCES. AND SO THAT WILL BE
AN INTERESTING QUESTION TO LOOK
AT, AS FAR AS YOU KNOW, THE
ELEVATED CO2 LEVELS AND
POTENTIAL IMPACT THAT SOME OF
THEIR CONCERNS WOULD HAVE ON
THAT.
WE DO PLAN ON INCORPORATING A
CLIMATE SCIENTIST INTO A
RESEARCH AS PART OF CIIHE.
BECAUSE SOME OF THESE QUESTIONS
LIKE THAT QUESTION, SOME OF THE
COMMUNITIES HAVE POSTS. AND
WHEN THAT HAPPENS IT IS A GREAT
OPPORTUNITY FOR US TO
INCORPORATE SCIENTISTS WHO
REALLY ARE ABLE TO ADDRESS
COMMUNITY PRIORITIES. SO THAT
IS KIND OF ONE PHASE THAT IS
HAPPENING THIS YEAR. BECAUSE
WE ARE ADDING CLIMATE CHANGE
QUESTIONS ON TO OUR INTERTRIBAL
DATA QUESTION SURVEY. I HOPE WE
MAY HAVE ANSWERS TO THAT.
>> DR. PÉREZ-STABLE: THEY TALK
ABOUT THE WHOLE FIELD OF
ADAPTATION INTERVENTIONS. AND
ADAPTATION RESEARCH. I WOULD
THINK PROBABLY MORE TANGIBLE
EFFECTS ARE DROUGHT, WHICH WERE
EXPERIENCING THROUGHOUT THE
COUNTRY, IN MOST OF THE COUNTRY
ANYWAY. AND SO THAT WILL
IMPACT THE CROPS.
AND THE NOTION THAT FOOD THAT
YOU SOURCED FROM A LOCAL FARM
WILL TASTE BETTER THAN THINGS
THAT ARE SHIPPED ACROSS THE
COUNTRY OR ACROSS THE WORLD
EVEN, IS COMMON SENSE IN MANY
WAYS AND WE CAN TEST THAT EVERY
DAY. YOU EAT AN APPLE FROM THE
FARMERS MARKET VERSUS ONE THAT
GOT SHIPPED OVER FROM THE STATE
OF WASHINGTON OR SOMETHING.
I LIED, THERE IS ONE MORE
QUESTION. AND THEN WILL WIND
DOWN. THANK YOU FOR
REPRESENTATION IN GREAT TO HEAR
ABOUT INDIGENOUS GARDEN
TRADITIONS AND STUDIES
INVOLVING COMMUNITIES AND LOCAL
SHOPS. CAN DR. JERNIGAN COMMENT
ON THE FOOD AND INDIGENOUS
GATHERING TRADITIONS? AND WHAT
DATA ON HEALTHY EATING IS
NEEDED UNLESS I? ARE THERE ANY
ONGOING STUDIES? FROM TATIANA--
AT NIH. SHE IS REFERRING TO
INDIGENOUS GATHERINGS.
>> DR. JERNIGAN: DATA IS
CHANGING OVER TIME IN NATIVE
COMMUNITIES IN A POSITIVE WAY
THAT I'VE SEEN OVER 20 YEARS.
ONE OF MY FRIENDS PUT IT THIS
WAY. WHEN I WAS GROWING UP HE
USED TO SEE A NATIVE PERSON AT
A POWWOW STUMBLING. THEY WERE
DRUNK. AND WE WOULD SAY OH,
THAT'S FUNNY. WE WOULD LAUGH.
AND HE WAS LIKE, OVERTIME WE
DON'T LAUGH AT THAT NOW. WE
LOOK AT THAT AND WE SAY, OH,
THAT'S SAD. YOU KNOW?
THE THINGS THAT I HAVE SEEN
OVER THE 20 YEARS THAT I'VE
BEEN DOING THIS WORK IS THAT
THERE HAS BEEN A HUGE SHIFT IN
CELEBRATING INDIGENOUS FOODS.
AND YOU SEE THAT IN GATHERINGS.
YOU SEE PEOPLE THAT HAVE THE
TRADITIONAL FOODS OFFERED AS
PART OF THEIR CONFERENCES FOR
THE GATHERINGS. AND WHEN THEY
DO THAT, IT CREATES A
COMPLETELY DIFFERENT
ENVIRONMENT AND SPIRIT THAN IF
YOU WERE TO PROVIDE THE
STANDARD CONFERENCE FOOD. OR
THE STANDARD GATHERING FOOD
FROM FAST FOOD OR FROM THE
GROCERY STORE.
AND SO THE EXPECTATIONS FOR
THAT HAVE CHANGED. AND, YOU
KNOW, SO THAT HAS BEEN A
REALLY POSITIVE DEVELOPMENT.
YOU ALSO SEE LASHAWN SHERMAN
(PHONETIC) AND SOME OF THE
TRADITIONAL FOODS COOKING. OUR
FOODS ARE GETTING THE ATTENTION
THEY DESERVE. THEY ARE GETTING
A NATIONAL STAGE. PEOPLE ARE
FINALLY STARTING TO COME AROUND
AND UNDERSTAND THE CONTINENT,
AND ALL THE ABUNDANT FOODS THAT
WE HAVE AVAILABLE THAT ARE
INDIGENOUS TO THIS LAND. AND SO
I HAVE SEEN IT REALLY CHANGE
OVER TIME.
AS FAR AS GATHERINGS, YOU KNOW,
OFTENTIMES THERE ARE STILL
GATHERINGS WITH THE NATIVE
COMMUNITIES, ESPECIALLY REALLY
SMALL, LOCAL GATHERINGS. WHERE
THERE ARE PACKAGED FOODS AND
FOODS THAT ARE NOT SINCERELY
VERY HEALTHY. USUALLY AN
AFFORDABILITY ISSUE.
SO TYPICALLY, YOU KNOW, THAT IS
NOT SOMETHING THAT PEOPLE
NECESSARILY SEE AS A BAD THING.
BECAUSE GETTING TOGETHER ABOVE
AND BEYOND IS MOST IMPORTANT.
BUT I DO THINK OVERALL, I KNOW
WHEN THE NATIVE NUTRITION
CONFERENCE, AT AT OTHER
CONFERENCES WE SEE FOODS
CENTERED ON INDIGENOUS FOODS
AND PEOPLE WEARING THE RIBBON
SKIRTS, AND WEARING THE
TRADITIONAL REGALIA. AND SO
THERE IS AN EMBRACE OF
INDIGENOUS CULTURE THAT HAS
BECOME REALLY BEAUTIFUL
OVERTIME TO SEE OVER TIME.
PEOPLE RELEARNING THEIR
LANGUAGE, RELEARNING THE
CULTURAL TRADITIONS; THAT HAS
BEEN A HUGE POSITIVE FOR ME.
>> DR. PÉREZ-STABLE: SO WITH
THAT, I WILL CLOSE AND THANK
YOU SO MUCH FOR A WONDERFUL
PRESENTATION.
I LEARNED SO MUCH. WE HAVE A
TRADITION; I THINK ABOUT THE
FOOD THAT IS NATIVE TO THE
AMERICAS. AND WHAT WOULD
CERTAIN CULTURES OR FOODS IN
EUROPE BE WITHOUT THESE? ONE IS
A TOMATO, THE POTATO, MAIZ, AND
OF COURSE CHOCOLATE. AND SO,
THESE ARE THINGS THAT CAME OUT
OF INDIGENOUS CULTURES IN THE
AMERICANS AND PEOPLE-- THESE
THINGS GET FORGOTTEN.
BUT THIS WAS REALLY A WONDERFUL
PRESENTATION VALERIE. I LOOK
FORWARD TO CONTINUING TO LEARN
FROM YOU. AND WE WILL MAKE SURE
YOU GET SOME FEEDBACK. AND THE
LINK TO THE VIDEO, SO YOU CAN
PUT IT ON YOUR WEBSITE IF YOU
WOULD LIKE.
>> DR. JERNIGAN: THANK YOU VERY
MUCH THIS IS SUCH A GREAT
OPPORTUNITY FOR ME AND I'M
GRATEFUL. I LOVED IT. I REALLY
APPRECIATE THIS OPPORTUNITY.
>> DR. PÉREZ-STABLE: THANKS
BYE-BYE.
>> DR. JERNIGAN: THANK YOU
BYE-BYE.