Title: Engaging Navajo Elementary Schools in a Randomized Controlled Trial: Yego! Healthy Eating & Gardening Project Leaders: Kevin Lombard, NMSU; Shirley Beresford, India Ornelas; Fred Hutch [The content of this Pilot Proposal is identical in the NMSU and Fred Hutch proposals] PROJECT SUMMARY/ABSTRACT Navajo families are at increased risk for obesity, diabetes and cancer in part due to low fruit and vegetable consumption. The proposed study aims to increase fruit and vegetable consumption among Navajo families through a school-based intervention focused on gardening and healthy eating. The study builds on our longstanding collaboration with the Navajo Nation through which, we have shown that gardening is a culturally appropriate strategy for improving healthy eating in this population. Our previous research has highlighted the importance of family in shaping health behaviors, and a desire to protect the health of the next generation by encouraging healthy eating habits. We have developed and are currently pilot testing a healthy eating and gardening curriculum to promote both gardening and healthy eating among Navajo elementary school children. The intervention was developed based on social cognitive theory, literature on previous school-based gardening interventions, and our own formative work in Navajo communities. The integrated intervention comprises 1) a 24-unit curriculum on both healthy eating and gardening, and 2) a school garden, and aims to build students? self-efficacy to grow and eat fruits and vegetables, as well as making other healthy food choices. In the new proposed study, we will estimate the efficacy of the intervention using a small, randomized delayed intervention comparison trial in two Navajo Nation Chapters (towns), involving about six schools in all. During the first year, we will identify and engage schools in the Navajo Division of Education system interested in participating in the trial. We will match schools within each town, and randomize schools within towns to intervention and delayed intervention groups. In the second year, we will implement the integrated intervention in the intervention schools, and will assess changes in outcomes over the school year among a sample of the elementary school children in grades 3 and 4 at each school (in both the intervention and comparison schools) as well as their parent. The primary outcomes are child measures: a) tendency to choose vegetable and fruit items to eat; b) healthy eating score from a Navajo foods picture sort; c) gardening at home and d) self-efficacy to garden. Analyses estimating the intervention effect will use the differential change over this school year between the two groups of schools, adjusting for school level clustering. We will also assess process outcomes, including recruitment, retention and intervention fidelity. After the primary evaluation is complete, the delayed intervention group will receive the curriculum intervention in the second school year. An additional assessment for secondary analysis purposes will occur at the end of that year. Continued engagement and skill strengthening will occur through quarterly parent workshops for all participating schools. This proposal is timely as the Navajo Nation consider their policy on dietary and activity benchmarks for schools as part of a rounded curriculum.
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