2 The Navajo Epidemiology Center manages Navajo public health information systems, and 3 provides data and reports that inform health programming for the over 330,000 enrolled 4 members of the Navajo tribe. Their reports have documented high prevalence of diabetes 5 and obesity, limited availability of healthy traditional foods, and high rates of consumption of 6 sugar sweetened beverages. To address these issues and its consequences, the Navajo 7 Nation passed the Healthy Din Nation Act (HDNA) in November 2014. The law includes a 8 2% tax on foods of little-to-no-nutritional value (?junk foods?), the first-ever such tax in the 9 United States. Revenues from the tax are distributed annually to each of the 110 local 10 government entities (chapters) to develop and support local wellness projects. The law was 11 passed with the expectation that the increased cost would impact the food environment, lead 12 to reduced consumption of junk foods and provide a sustainable source of funds to support 13 local needs for wellness programming. 14 To date, however, a comprehensive assessment of the impact of the tax has not been 15 completed. Therefore, the research team, consisting of the Navajo Epidemiology Center, 16 Northern Arizona University and Harvard?s Brigham and Women?s Hospital local community 17 affiliate propose to study the impact of the tax on 3 major components: 1) chapter wellness 18 programming supported by tax revenue, 2) changes in the food store environment and 19 pricing following the tax implementation; and 3) changes in sugar sweetened beverage and 20 fruit/vegetable intake following the tax implementation. Chapter wellness programming will be 21 assessed via data from the Division of Community Development, who are supportive of the 22 project. Changes in the food store environment will be assessed via a follow-up of a 2013 23 (pre-tax) survey of 83 stores across the Navajo Nation, which will also identify positive 24 outliers in terms of changes in healthy food offerings. Consumption behaviors will be 25 assessed by conducting a follow-up of the unique Navajo BRFSS, which is a population wide 26 survey following rigorous BRFSS methods. The team has active Navajo IRB protocols to 27 support each aim, and have collaborative support from key stakeholders, positioning us well 28 to deliver on the proposed aims. It is our belief that information from this study is timely, 29 urgent and will be essential for the Navajo Nation leadership to make an informed decision 30 about the continuation of the junk food tax.
To address substantial health disparities among the Navajo people, the Navajo Nation passed the 2014 Healthy Din Nation Act (HDNA), which includes a 2% tax on junk foods. This proposal aims to assess the impact of the junk food tax by utilizing several high quality and culturally specific data sources developed by the Navajo Epidemiology Center. Specifically, we will summarize chapter wellness programming supported by tax revenue, assess changes in the food store environment and behaviors including consumption of sugar- sweetened beverages, fruit and vegetables.