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Increasing the Fruit and Vegetable Consumption Amongst Native American Youths
Samara Heller
Nutrition Education 334 Sec. 1
Professor Kiresich
May 5, 2016

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A. Introduction
The cultural context underlying the history of the Native American population is that of
oppression and deprivation. For five hundred years, Native Americans were subjected to
suffering regulated by forced coercion of land ownership, despite being the original peoples of
the continent. Thus, many Native Americans today face higher proportions of disease than
other populations in regards to suffering from alcoholism, suicide, anxiety, depression, and
school dropouts. Side effects of chronic neglect have caused psychological distress
manifestations including bursts of violence thought to result from post-colonial stress. As self-
control deteriorates from such perpetual stress, control becomes sought in other areas. This is
often exhibited in the form of eating disorders to compensate for dissipated control over the
broad spectrum of life. One such type of eating disorder often seen in normal or overweight
individuals is binge eating, which is classified by engaging in abnormal eating patterns such as
eating excessive sums of food rapidly or when not physically hungry. This transcends to
implicate other forms of chronic disease including obesity. Unfortunately, obesity is an
upward-reaching trend in the Native American population that can ultimately lead to diabetes.
(Dorton, 2007)
B. Background
a. Target audience
My target audience is Native American youths that are at a high risk for obesity and
Type 2 Diabetes in the Los Angeles area. More specifically, my target audience is the Tongva
tribe and their descendants in the greater Los Angeles area. Most Native American tribes
including the Tongva, are not federally recognized. This equates to a lack of federal funds
being granted to them for assistive programs. Therefore especially in California, Native

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Americans are essentially land poor as any rights previously garnered have been terminated
by federal and state governments. Despite this land dissemination, the population of tribes in
California has continued to grow reaching 75,000. This exponential growth rate has impeded
the original intentions of the Urban Indian Relocation Program as it is not only exhibited by
California tribes but those nationwide. Consequentially, the tribes originally considered native
to California are losing their individualized culture. Thus, the battle for federal and distinct
cultural recognition trudges forward on unsteady terms for the Tongva tribe.
Inevitably, this lack of federal recognition as a tribe has resulted in the Tongva
composing part of the lower economic bracket. As a result of this status, many other
correlational factors linked to poverty arise including unemployment. This transcends into the
realm of food security causing a lack thereof. Many Native American families do not have
sufficient income to allocate on food expenditure, meaning much of their diet constitutes
processed, more affordable fare. Oftentimes, the food provided by assistance programs
determines their dietary consumption of meals and is subjective to being provided by
donations, avoiding the criteria established by the dietary guidelines program. This
equivocates to a menagerie of multiple health problems including both physiologic and
psychological. Most populations that encompass the bracket of food insecurity have increased
risk for developing chronic disease and psychological traumas induced by constant obsessive
thoughts of food. Individuals experiencing poverty are subject to perpetuating uncertainties
and violations of safety causing significant emotional stress and decreasing overall quality of
life. Thus, due to the accumulation of such life conditions, Native American children suffer
from more severe health problems and decreased educational opportunities. In order to

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alleviate some of these symptoms ample resources and planning are required (White House,
2004).
b. Health Issue and Target Behavior
i. This campaign will focus on addressing Native American youth`s prevalence for
developing chronic diseases resulting from severe obesity. When comparing Native American
youths to other minority groups, they exhibit much higher rates: 39% of Native American boys
and 14% of Native American girls are severely overweight, whereas 14% of African American
boys and 10% of African American girls are severely obese. It is imperative to address obesity
early as it is a chronic form of disease, meaning that the longer an individual exhibits the
landmarks of an obesity diagnosis, the more likely they will exhibit additional co-morbidities.
Several of these co-morbidities include increased risk for diabetes and cardiovascular disease.
Much of the Native American youth population is already experiencing these co-morbidities:
76% have already been diagnosed with Type 2 Diabetes Mellitus. Again, disparities in this
disproportionality high diagnoses are seen as 22% of Hispanics and 33% of African American
youths have Type 2 Diabetes Mellitus. If left untreated, the side effects related to obesity will
only worsen over time. These risk factors include hyperglycemia, dyslipidemia, inflammation,
hypertension, and a higher rate of adult-onset cardiovascular disease. This is separate from the
likelihood of developing obstructive sleep apnea, asthma, fatty liver, orthopedic problems,
ovarian hyperandrogenism, and chronic kidney disease, also associated with childhood obesity.
Being subcategorized as “obese” at such a young age is not limited to only affecting bodily
functions. Rather, obese children are subjected to more psychosocial issues including social
isolation, decreased school performance, and negative self-image. (Carprio, et al., 2008)

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ii. Much of the Native American population exists under the all-encompassing umbrella of
poverty. This equates to limited income to be feasibly spent on nutritious foods. Thus, Native
American youths are not consuming the recommended amounts of fruits, vegetables, or whole
grains. In their place, refined carbohydrates, flours, and shortenings are used as more cost-
effective options. A general lack of options introduces additional undesirable meal choices for
this population. As most Native Americans are residents of “food deserts,” their fresh produce
availability is near non-existent. Meaning that their living area itself impedes a Native
American`s ability to choose nutritionally-sound options. This greatly contrasts against the set
recommendations by MyPlate for girls and boys aged 14-18 years. MyPlate recommends that
girls and boys consume 1 ½ cups of fruit; 2 ½ and 3 cups of vegetables; 6 and 8 ounce
equivalents of whole grains; 5 and 61/2 ounce equivalents of protein; 3 cups of dairy; and 5 and
6 teaspoons of oil daily. As the youths are not meeting MyPlate criteria, they are also unable to
adhere to dietary guidelines. As indicated above, Native American youths are not converting half
of their plate to vegetables or eating a variety, not making half of their grains whole, consuming
less added sugars, eating low-fat dairy products, or monitoring their sodium intake (USDA,
2016).
C. Motivation for behavior change
a. Barriers to facilitating a change within the Native American population originate from the
classification of poverty. When compared to the remainder of the United States population, more
Native Americans fall below the federal poverty line (24%) compared to 15% of the population
as a whole. This matter is worsened by the federal government refusing to acknowledge tribal
recognition of the most Native American tribes. Much of the population survives without being
able to delineate themselves from the branch of poverty, and yet the government refuses to grant

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subsides. Thus, most of the potential barriers exhibited arise from financial constraints. Most
Native Americans do not possess the funds to purchase more healthful foods nor have the access
to them. Oftentimes, the nearest grocery store is over two miles away as many tribal members do
not own a form of transportation, much of their shopping is done at local gas station’s
convenience stores. The variety of fruit and vegetable options at these store fronts is near
nonexistent. A convenience store`s perception of fruit and vegetable offerings coincides with a
basket of lemons, processed fruit containers, and several sandwich types. Thus, a lack of
availability and transportation also present barriers as Native Americans live in what is now
deemed a “food desert.” A cultural barrier presents itself due to the adaptation of what is now
seen as normative foods. The historical diet of Native Americans was well-balanced and
contained leaner sources of protein, fruits, vegetables, and a lack of refined sugars and sodium.
In order to obtain these foods, Native Americans were required to hunt and gather. However with
the passage of the Indian Removal Act, the traditional methods and sources of food were taken
away and substituted with rations of flour, lard, and sugar. Consequentially, these empty-calorie
commodities infused themselves as the new traditional foods, originating the rise in obesity and
diabetes seen today (Goetz, 2012).
Other barriers that could potentially contribute to impeding the increased consumption of
fruits and vegetables within the Native American population include those at an individual level.
Much of this population relies on the preparation skills of their parents. When left to their own
devices, a lack of self-confidence in fruit and vegetable preparation could arise. It is highly likely
that many of these youths have never attempted to prepare these types of foods. Thus, a barrier
exists in the perception that the foods themselves could not be cooked. The Native American
venture itself is highly participative in family, meaning that adolescents could find it difficult to

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break away from their newly adopted “traditional” foods if their parents refute to do so. In order
to facilitate a behavior change, parental ties and influence must be incorporated (Goetz, 2012).
b. Other motivational factors to consider are that of cues to action. One of the mainstay
foods in current Native American diets is known as the “frybread.” This concoction is a deep-
fried mixture of flour and lard eaten with butter, jam, or meat and cheese-essentially a trans-fat-
laden commodity. This food is by no means traditional but nonetheless seen as essential as it
was born from the necessity of requiring adequate calories with limited availability. Due to this
precocious invention, frybread is now identified as a comfort food. As this food is composed of
a higher trans-fat content, it encourages not only weight gain but also heart disease. By using
cues to action or external cues, frybread could be designated as a special occasion food. Thus,
social media could be explicated to show early onset manifestations of heart disease and to list
the multiple fruit and vegetable substitutes for frybread use. The use of perceived susceptibility
and severity could also be used in conjunction with cues to action. Increasing the personal notes
of both perceived susceptibility and severity could be accomplished through the use of statistics
to illustrate the disproportionate number of Native American youths with obesity and other
chronic disease-related co-morbidities. Self-efficacy could be increased by introducing options to
the target population. Merely enabling them to recognize the variety of fruit and vegetable
options available to them will increase the likelihood of their inclusion in future meal choices
(Goetz, 2012).
D. Social Marketing Campaign Description
a. Strategy Design
i. My intention for this intervention is not to change the taste perception of Native
American youths per say, as it is not within the realm or purpose of nutrition educators to do so.

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Rather, my aim of this intervention is to introduce healthier substitutions for the current foods
consumed by this population. One of the normative foods is frybread. Frybread`s main ingredient
is lard, contributing to the severe obesity exhibited by this population. Other foods typically
consumed are of similar poor nutritional value constituting mainly refined starches and simple
sugars. As noted previously, this population has a disproportionally high rate of inheriting many
chronic diseases including obesity, diabetes, hypertension, and alcoholism. Therefore, it is
imperative to reinforce healthier eating habits now to discourage long term side effects from
manifesting. Thus, my intervention will not necessarily discourage the consumption of these
foods but will introduce the youths to options. This will individualize the intervention as I will
still incorporate the foods that they are currently consuming, but include ways to healthily
contribute to the meals. Options in this area will include adding more vegetable sides and using
alternative methods of preparation for their “staple” foods. I will tip the scales in my favor by
remaining unbiased, open, and nonjudgmental to their current intake to inspire truthful current
intakes from the youths. This will then transcend into their description of self-efficacy in regards
to the likelihood that they will be able to incorporate healthier options in the future. Instead of
explicating fear tactics to discourage food choices, I will tip the scales by providing the benefits
of adding more fruits and vegetables to the diet including weight management and decreased
consumption of added sugars.
ii. My campaign will employ the use of a grocery store. Much of this population lacks
access to adequate resources to obtain food. This is not only result of a lack of transportation but
access to normal grocery stores. However, the Native American culture is largely family-based.
Many of those especially in the case of residents on reservations are related and willing to help
their family members by any means necessary. Keeping this in mind, I will first obtain

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information on those who possess means of transportation and are willing to transport large
groups to nearby grocery stores. Once I have a designated number, I will create a grocery store
tour schedule by means of a carpool system. Incentives to explicate car use will be obtained from
stakeholders willing to provide reimbursement for gas expenditures. After the creation of this
schedule, a grocery store tour will ensue. The purpose of this tour will be to introduce the youth
to healthier alternatives to their current refined starch intake. This will include highlighting
whole grains, fresh and frozen vegetables, and olive oil or butter as substitutes for lard.
iii. The main barrier discouraging Native American youths from consuming a more healthful
diet is an aversion for fruits and vegetables. This aversion coincides with the belief that parents
will be unsupportive in their reformation attempts, that the prices of these products are too
disproportionately high, and fear in not knowing how to properly prepare the products. Other
barriers arise when an attempt is physically taken to obtain fruits and vegetables, as one of the
main barriers exhibited in this population is a lack of transportation. This makes reaching sources
of food other than convenience stores within walking distance difficult. To illustrate overcoming
these barriers, they have been explicated through the use of the 4 Ps. In the case of discouraging
parents, a need to induce a supportive environment for their children arises. Thus, the product is
education classes to illustrate the impacts a healthful diet has on youths with heightened potential
for adverse side effects. The price is a comparison illustrating the economic routes a healthful
diet results in versus that of chronic medication use. Therefore, the place is to recruit all parents
whose children have already been diagnosed with diabetes in the hopes that this case will present
its relevance. This will be promoted through community leader advertisement. In the case of the
barrier of price, the product is manufacturer coupons of fresh produce to be used during a
community field trip to the grocery store. Prior to the tour commencing, the store`s weekly

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advertisement will be given to participants, equating to promotional practices. During this tour,
frozen, in-season, and weekly special products will be highlighted. The barrier of transportation
is addressed through the P of place. Carpools will be created, centered from the community`s
main congregation area to the store. This transcends into the barrier of not being able to reach the
market itself. The product to address this barrier is tangible community carpool charts that will
be printed out and provided to each member, making the place the description of how they will
be reaching the grocery store. A nutrition educator`s intent is never to change taste preferences,
rather it is to enthuse their audience to try new foods. Thus, the promotion to try fruits and
vegetables is to provide cooking demonstrations that demonstrate the numerous ways fruits and
vegetables may be prepared (product). The price of attendance is the promise to try each item
prepared, while the promotion is recipe handouts to encourage copycat cooking. A similar
approach for the 4 Ps is illustrated below in the case of not knowing how to cook fruits and
vegetables. However, the product is to recruit actual audience members to personally attempt the
endeavors demonstrated.
iv. Encouraging Fruit and Vegetable Consumption in Native American Youths
Barriers Product Price Place Promotion
I`m afraid that
my parents will
not want me to
eat fruits and
vegetables.
Teach parent
education classes
on the long term
side effects
associated with
child-diagnosed
chronic diseases
including obesity
and diabetes.
Provide saving
comparisons on
how healthful
diets are more
economical
alternatives when
compared to
chronic
medication use.
Recruit all
parents whose
children have
already been
diagnosed with
diabetes.
Have community
leaders
encourage all
parent
attendance.
I don`t know if I
can afford fresh
fruits and
vegetables.
Provide
participants with
manufacturer`s
coupons of fresh
produce provided
by stakeholders.
Conduct grocery
store tours that
highlight in-
season, frozen,
and weekly
special produce.
Provide
participants with
the grocery
store`s weekly ad
from which the
tour will be

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conducted.
I don`t have
transportation.
Carpools will be
organized from
the main
congregation
area after an
analysis of those
with
transportation
has been
conducted.
I don`t know
how I will be
able to get to the
market.
Carpool
community
charts with
designated days
and times for all
willing
participants.
Make copies and
distribute to
everyone.
Carpool charts
will designate
how community
members will be
transported to
and from the
closest fully-
stocked grocery
store.
Provide all
community
members with
recipe ideas for
the products that
are purchased
from the store.
I don`t like fruits
and vegetables.
Provide cooking
demonstrations
that illustrate the
numerous ways
fruits and
vegetables can be
prepared.
In order to attend
a demonstration,
everything that is
cooked must be
tasted by the
participant.
Those who
attempt to
recreate some of
the various
techniques
demonstrated in
the class will
receive
additional recipes
and coupons for
future purchases.
I don`t know
how to cook
fruits and
vegetables.
Ask for audience
participation
during cooking
demonstrations.
Participant must
try whatever fruit
or vegetable they
prepare.
Fliers will be
distributed to
community
leaders to
advertise upon
their discretion.
b. Implementation
i. Introduction

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-Relate the topic to the audience to make it personal: ask does anyone like fruits and vegetables?
Do any of you believe that you have any chronic diseases? Have any of you been told that you
have diabetes?
-Emphasize the importance of the topic: provide health facts and figures to illustrate the health
disparities exhibited within the Native American population.
-Make an intriguing statement: everyday no new action is implemented is a day of victory for
diabetes.
-Ask stimulating questions: what does a typical day of eating look like? How do you feel about
your current health? Do you feel in charge of it?
-Tell a story: describe how health is within personal power and small steps that can be taken to
reach it.
-Promote a single message: do not burden the audience with multiple ideals and pieces requiring
change, focus on promoting the inclusion of more fruits and vegetables and healthier
substitutions. Do not inquire immediately on physical activity levels or current medication use.
-Emotional appeal: show audience the necessity of change for their survival.
-Conclusion: explicitly state versus implying.
c. Evaluation
i. An evaluation will be performed on my campaign by way of pre and post-education
surveys. Prior to beginning my lesson, I will ask participants to complete a survey asking them to
rate their level of confidence in being able to incorporate more fruits and vegetables into their
diets. The questions will pertain not only to that of consumption but also preparation and ability
to obtain fresh produce. The questions will be rated on a 1 to 5 scale, with 1 designating the
lowest confidence level and 5 the highest. At the conclusion of my presentations, the same

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questions will once again be administered to determine if I was successful in convincing my
target audience that they are capable of eating more fruits and vegetables.
E. Written Description
a. Primary and Secondary Purposes of the Piece
i. The primary purpose of this piece is not to incite fear in the target population. Rather, the
main purpose of this piece is to allow Native American youths to see that there are many ways to
increase their fruit and vegetable consumption via substitutions. The reason I chose to include a
commodity food or the frybread sandwich, versus that of a healthier alternative is to show that
staple foods can still be enjoyed but also modified. These modifications do not need to alter the
food in its entirety. By way of substituting just a few ingredients such as red bell peppers for
refried beans, the amount of fruit and vegetables eaten can increase. This is especially the case if
small modifications were made every day. One of my secondary purposes is to increase
awareness of the benefits of a healthful diet in the treatment and maintenance of diabetes.
Consuming complex carbohydrates rather than those from refined sources contributes to control:
control of glycated hemoglobin, blood glucose, and cholesterol levels. Therefore, my mention of
control by way of consuming more fruits and vegetables versus fried fare is geared towards
illustrating my secondary purpose. Another secondary purpose of this piece is to help my target
audience see that their own health is within personal power. By mere modifications and
substitutes, health can be achieved. It is important that individuals realize at a younger age that
being healthy is a wise choice. Eating healthfully in youth can prevent the long term
manifestations of co-morbidities and maintain the best wellbeing throughout life.
b.

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i. Motivating : My piece is motivating as it is tailored specifically to a Native American
audience. Due to the pillage of their lands, Native Americans created frybread in order to
consume adequate sums of calories, unaware of the heightened trans-fat content. Thus, my piece
includes a healthier alternative comparison to illicit not only nostalgia and familiarity but also a
sense of attainment. My piece shows that through minor modifications a healthier alternate
sandwich to the frybread is possible.
ii. Simple and direct: My piece is simple and direct as it contains no pessimistic or negative
connotations; all of the wording was carefully selected to illicit positive change. No large
vernacular is used in the piece and it is not stated in an overtly wordy theme.
iii. Design considerations: Design considerations were considered as the font throughout the
piece is consistent and clear. The only paragraph on the page is short and easy to read. The
amount of white space on the piece is adequate for the corresponding text. The text itself is
divided into columns for easier discernment. The piece is short, constituting a single page in its
entirety.
F. Conclusion
It is imperative to encourage Native Americans to seek health. This population has been
subjected to pillage and plunders unlike that of any other racial group. Thus, chronic disease
manifestations are far more prevalent within their ranks, including that of their youths. As the
proportionality of these infestations are so high, so too are the coinciding co-morbidities. This
grants long term complications more time to wreak havoc on their host`s body. In order to
disseminate some of these health disparities, more nutritious diet choices must be explored
sooner. The first step in attaining health for this population is to encourage fruit and vegetable
consumption. This can be accomplished by introducing healthier alternatives and substitutions to

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some of their current staple foods. By exciting this population with the task of the joint-effort
“Let`s Make a Sandwich,” they are provided with the means to do so. The journey to health for
this population begins with first taking smaller steps; substituting fruit and vegetables in small
dosages is a step in the right direction. Health can be attained.

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References
Carprio, S., Daniels, S. R., Drewnowski, A., Kaufman, F. R., Palinkas, L. A., Rosenbloom, A.
L., & Schwimmer, J. B. (2008, November 31). Influence of Race, Ethnicity and Culture
on Childhood Obesity: Implications for Prevention and Treatment. Retrieved from PMC
US National Library of Medicine National Institutes of Health:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2571048/
Dorton, J. G. (2007, July). The Relationships of Historical Loss, Acculturation, Racism, and
Emotional Distress to Binge Eating and Body Mass Index Among Native Americans. Ann
Arbor: ProQuest Information and Learning Company. Retrieved from
https://books.google.com/books?hl=en&lr=&id=IopBIG6IzGgC&oi=fnd&pg=PA1&dq=
TONGVA+eating+behaviors&ots=sCFeZp15iP&sig=SLelFuU7p6f3JkZ4h7iZAU77m7
Q#v=onepage&q&f=false
Fleischhacker, Sheila. (2016). Emerging Opportunities for Registered Dietitian Nutritionists to
help raise a Healthier Generation of Native American Youth. Journal of Academy of
Nutrition and Dietetics, 116, 219-225.
http://www.sciencedirect.com.ezproxy.library.csulb.edu/science/article/pii/S2212267215
016238?via%3Dihub
Goetz, G. (2012, March 5). Nutrition a Pressing Concern for American Indians. Retrieved from
Food Safety News: http://www.foodsafetynews.com/2012/03/nutrition-a-pressing-
concern-for-american-indians/#.Vx-vBy-cHIU
Kittler, P. G., & Sucher, K. P. (2008). Food and Culture. Belmomt: Thomson Wadsworth, a part
of The Thomson Corporation.

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Schwartzkope, S. (2013, July 29). Top 5 Cities With the Most Native Americans. Retrieved from
Indian Country: http://indiancountrytodaymedianetwork.com/2013/07/29/top-five-cities-
most-native-americans-150634
Nelms, M., Sucher, K., Lacey, K., & Roth, S. L. (2016). Nutrition therapy and pathophysiology
(3rd ed.). Boston, MA: Cengage Learning
United States Department of Agriculture. (2016). Dietary Guidelines for Americans 2015-2020.
Retrieved from ChooseMyPlate.gov: http://www.choosemyplate.gov/dietary-guidelines
https://www.kcet.org/shows/departures/gabrieleno-tongva-mission-indians - provides <5min
lessons about the Tongva by Tongva Chief Redblood