Context: To promote the health of the Navajo people, the Navajo Nation passed the Healthy Diné Nation Act (HDNA) in 2014. The HDNA included a 2% tax on “minimal-to-no-nutritional-value” foods and waived 5% sales tax on healthy foods, the first such policy in the United States and any sovereign Tribal nation. Uniquely aligned with Tribal government structures, revenue was directly allocated to 110 small local government entities (Chapters) for self-determined wellness projects. Objective: To characterize HDNA-funded wellness projects, test for variation in project type, and funding amount over time by region and community size. Design: Longitudinal study assessing funded wellness projects from tax inception through 2019. Setting: The Navajo Nation. Participants: One hundred ten Navajo Nation Chapters receiving funding for self-determined wellness projects. Outcome Measures: The categories and specific types of wellness projects and funding over 4 years by region and community size. Results: Of revenue collected in 2015-2018, more than 99.1% was disbursed through 2019 ($4.6 million, $13 385 annually per community) across 1315 wellness projects (12 per community). The built recreational environment category received 38.6% of funds, equipment/supplies 16.5%, instruction 15.7%, food and water initiatives 14.0%, and social events 10.2%. Most common specific projects were walking trails ($648 470), exercise equipment ($585 675), food for events ($288 879), playgrounds ($287 471), and greenhouses ($275 554). Only the proportion allocated to instruction changed significantly over time (increased 2% annually, P = .02). Smaller communities (population <1000) allocated significantly higher proportions to traditional, agricultural, and intergenerational projects and less to the built environment. Conclusions: Through 2019, more than 99% of HDNA revenue was successfully disbursed to 110 rural, Tribal communities. Communities chose projects related to promoting the built recreational environment, agriculture, and fitness/nutrition education, with smaller communities emphasizing cultural and intergenerational projects. These findings can inform other indigenous nations considering similar policies and funding distributions.

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

Being the least-represented ethnic/racial group in college settings, American Indian students may experience loneliness and self-doubt related to the challenges of adapting to an environment that embodies values, norms, and culture so different from those represented in their traditional culture. Ongoing health disparities and psychosocial inequities, and persisting impacts of historical colonization, have led to additional hardships for these students that further complicate their academic experiences. Fostering culturally safe learning environments where compassionate and caring faculty provide culturally aligned teaching is important in addressing these complex disparities. Derived from American Indian values and teachings, we present a culturally safe intergenerational mentoring approach that emphasizes the nursing mentors’ responsibility to support the growth and success of American Indian nursing students. This approach, drawn from the wisdom of American Indian teachings, focuses on students’ strengths and culturally based protective factors. Culturally informed faculty who are aware of the historical impacts of colonization and who have adequate mentoring capacity (time, interest, and commitment) contribute to safe and effective learning environments. Culturally safe mentoring is one approach to promoting American Indian students’ potential for academic and professional success.

Navajo (Diné) and other American Indian children are more affected by overweight and obesity than their U.S. counterparts. In this descriptive study, the authors combined a socioecological and Navajo cultural framework to analyze the various factors that influence food choices available to children in schools. The Healthy Hunger-Free Kids Act of 2010 updated nutrition standards for school meals and all other foods and beverages sold in schools. Some studies have shown that improved nutrition standards were not favorably received by students and school food programs. To better understand these broader trends in a Navajo context, the researcher administered in-person surveys to 6 principals and 14 food service workers from a sample of 6 schools and performed on-site observations of two schools. Data were analyzed using a combination of descriptive statistics, matrix analysis, and thematic analysis techniques. Results showed that schools were offering more healthy food options in school lunches and that some schools were still serving unhealthy foods, such as pizza, tater tots, and French fries. Classroom and fundraising events provided other sources for low-nutrient foods and beverages. Participants had mixed responses about the updated nutrition standards, and food waste of healthy foods was a major concern. This study proposes opportunities for nurses to engage in research and advance stronger policies that increase healthy food options and limit access to less healthy foods.

Context: The Healthy Diné Nation Act (HDNA) of 2014 included a 2% tax on foods of little-to-no-nutritious value (“junk foods”) on the Navajo Nation. The law was the first ever in the United States and any Indigenous nation worldwide with a population at a high risk for common nutrition-related conditions. To date, research on community support for food tax legislation among Indigenous nations is entirely lacking. Objective: To assess the extent of support for the HDNA and factors associated with support including sociodemographic variables, knowledge of the HDNA, nutrition intake, and pricing preferences. Design: Cross-sectional survey. Setting: The Navajo Nation. Participants: A total of 234 Navajo Nation community members across 21 communities. Outcome Measures: The percentage of participants who were supportive of the HDNA. Results: Participants were 97% Navajo, on average middle-aged, 67% reported an income below $25 000 annually, and 69.7% were female. Half of the respondents said they “support” (37.4%) or “strongly support” (13.0%) the tax, while another 35% of people said they were neutral or somewhat supportive; 15% did not support the tax. Participants with higher income ( P = .025) and education ( P = .026) and understanding of the legislation ( P < .001 for “very well” vs “not at all”) had increased odds of greater support, as did people who believed that the HDNA would make Navajo people healthier (vs not, P < .001). Age, gender, language, and reported nutrition intake (healthy or unhealthy) were not associated with HDNA support, but participants willing to pay 5% or 12%-15% higher prices for fast food and soda had increased odds of greater support ( P values range from .023 to <.001). Conclusions: The majority of Navajo community members surveyed were moderately supportive of the Navajo Nation tax on unhealthy foods. Higher income and education and understanding of the law were associated with greater support, but nutrition intake was not.

Obesity among American Indian youth remains a critical health disparity, placing them at elevated risk for chronic diseases such as diabetes, cardiovascular disease, and obesity-related cancers. School environments in Tribal communities are uniquely positioned to support obesity prevention through structured health education, physical activity opportunities, and school meal programs and school wellness policy initiatives. Yet, school-based obesity prevention research in American Indian communities remains limited, and have not been as successful in improving weight status in AIAN youth, particularly in leveraging the requirement of school wellness policies as participants in the National School Lunch Program. We describe the procedure and rationale for evaluating the Rural Tribal School Partnership for the Primary Prevention of Obesity (P2) project, a multi-component health promotion curriculum intervention addressing nutrition and physical activity through three integrated components – classroom, food services and policy. We will evaluate the efficacy of P2 for improving BMI, nutrition and physical activity knowledge and behaviors (primary outcomes) among American Indian 4th grade students in rural, Tribal communities. We will employ a cluster, non-randomized design across four schools, with one intervention arm and one control arm. Enrolled 4th grade youth will complete pre- (start of school year) and post-intervention (end of school year) measurements. Secondary outcomes include physical activity tracking, dietary recall, student perception of school environment policies and practices, objective fruit and vegetable intake using Veggie Meter ^® . Study findings will inform best practices and a scalable culturally responsive health promotion curriculum model for rural and American Indian serving schools. Clinical trials registration: NCT06864468, https://register.clinicaltrials.gov/prs/beta/records .