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Title: Barriers and facilitators to following the Dietary Guidelines for Americans reported by rural, Northern Plains American-Indian children

Author
item Jahns, Lisa
item MCDONALD, LEANDER - Cankdeska Cikana Community College
item WADSWORTH, ANN - Cankdeska Cikana Community College
item MORIN, CHARLES - Tate Topa Tribal School, Spirit Lake Dakota Nation
item LIU, YAN - Children'S Nutrition Research Center (CNRC)
item NICKLAS, THERESA - Children'S Nutrition Research Center (CNRC)

Submitted to: Public Health Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/5/2014
Publication Date: 2/1/2015
Citation: Jahns, L.A., McDonald, L., Wadsworth, A., Morin, C., Liu, Y., Nicklas, T. 2015. Barriers and facilitators to following the Dietary Guidelines for Americans reported by rural, Northern Plains American-Indian children. Public Health Nutrition. 18(3):482-489.

Interpretive Summary: Estimates of obesity among US children aged 6–11 years range from 14 to 24%, depending upon racial/ethnic group, with the highest prevalence observed in minority children. Recent estimates of the prevalence of obesity among Northern Plains American-Indian children is 28%; similar to that reported in other studies. The number of obese American-Indian children is increasing despite an apparent levelling off among other racial/ethnic groups in the USA. The findings of the present study resulted in two key accomplishments: first, identifying children's self-reported barriers and facilitators to following the Dietary Guidelines for Americans recommendations; and second, increasing the intervention capacity of this tribal community. To our knowledge, the present study is the first to provide a child's view of the problems, and opportunities, around complying with federal dietary guidance on a rural reservation. These results may benefit the community, and provide valuable information to support tribal community efforts to improve the health of children through the application, adoption and adherence to recommendations by the 2005 and 2010 Dietary Guidelines for Americans.

Technical Abstract: The Dietary Guidelines for Americans promote healthy dietary choices for all Americans aged 2 years and older; however, the majority of Americans do not meet recommendations. The goal of the present study was to identify both barriers and facilitators to adherence to Dietary Guidelines for Americans recommendations for consumption of five recommended food groups: grains (specifically whole grains), vegetables, fruits, meat/beans and milk (specifically reduced-fat/non-fat), among American-Indian children. Nominal group technique sessions were conducted to identify and prioritize children's perceived barriers and facilitators to following the DGA, as presented in the 'MyPyramid' consumer education icon. After response generation to a single question about each food group (e.g. 'What sorts of things make it harder (or easier) for kids to follow the MyPyramid recommendation for vegetables?'), children individually ranked their top five most salient responses. Ranked responses are presented verbatim. The study took place in a rural Northern Plains American-Indian reservation, USA. The participants were 61 self-selected fifth-grade children. Core barriers for all food groups studied included personal preference (i.e. 'don't like') and environmental (i.e. 'cost too much'; 'store is too far to get them'; 'grandma don't have'). Core facilitators included suggestions, i.e. 'make a garden and plant vegetables'; 'tell your friends to eat healthy'. Barriers and facilitators are dissimilar for individual food groups, suggesting that dietary interventions should target reduction of barriers and promotion of facilitators specific to individual food groups recommended by the Dietary Guidelines for Americans.