Community Research Project Supports Healthier Lifestyles for Wisconsin American Indian Families

Life on a northern Wisconsin Indian reservation can pose a challenge to healthy living. Just like in an inner city, it may be difficult to find fresh fruits and vegetables and safe places to walk, play, and exercise.

But three Wisconsin Indian tribes, with support from Alexandra Adams, MD, PhD, and a team of researchers in the Department of Family Medicine (DFM), are trying to change that.

A community-based research project called Healthy Children, Strong Families, Supportive Communities is helping the tribes tackle the environmental barriers to healthy nutrition and physical activity choices—and identify positive supports—so they can lead healthier lives and decrease the risks of chronic disease.

Community Advisory Boards: The Mechanism for Change

The Supportive Communities portion of the project was designed so each tribal community could be in charge of its own unique cultural and environmental issues. This is accomplished through establishing Community Advisory Boards (CABs) at each of the three participating Indian tribes:

• Bad River Band of Lake Superior Chippewa Indians
• Menominee Tribe of Wisconsin
• Lac du Flambeau band of Lake Superior Chippewa Indians

Agency representatives, community members, and individuals from all facets of tribal life (including tribal planning, nutrition, health, recreation, transportation, language and culture, commerce, education, housing, law enforcement, and elders) are invited to participate in their tribe's CAB.

The first CAB meetings feature talks by tribal members and UW staff, plus a healthy meal that includes traditional native ingredients such as wild rice. The group then identifies and prioritizes the key barriers and supports for healthy nutrition and physical activity in the community.

For example, barriers have included:

• Lack of a supermarket on the reservation;
• Loose dogs roaming free;
• The busy schedules of most families; and
• Long distances between homes and sources of healthy food.

Supports have included:

• Tribal employers offering 30 minutes of paid time for exercise during the work day;
• The supportive community atmosphere; and
• The beauty of the natural surroundings on the reservation.

Guest experts or key community members are then brought in to provide additional information on relevant issues "This is a way for everyone involved to learn more about an issue—together," said Jamie Rose Scott, MS, a senior research specialist on the team.

Then, with the support of the research team and the experts, the CAB develops and implements plans to reduce the barriers and increase the supports identified in initial meetings. UW staff assist in designing sustainable interventions and obtaining additional funding to implement them.

Interventions: Fresh Food and Safe Play

The most pressing barrier for the Menominee CAB is lack of access to healthy food. The Menominee reservation, like many Indian reservations, has no grocery store, and the nearby convenience stores offer few healthy food options like fresh vegetables and fruit.

To address this problem, the Menominee CAB launched the following initiatives and interventions:

• Community gardens
  • Eight raised-bed community gardens have been planted at agencies throughout the reservation.
  • Seeds, plants, compost, tillers, raised beds, and tools have been distributed, and gardening expertise and tips are available from UW-Extension and other gardeners.
  • Food Commodities representatives have helped over 32 individuals plant gardens on their personal property. Housing Department residents have also tilled, mulched, and planted a garden for the first time.
  • The Tribal Clinic Diabetes Program purchased and built a greenhouse at elder-assisted housing, distributed lumber for raised beds, and also made plants and seeds available.
  • During the fall harvest, UW-Extension, Food Commodities, and other CAB representatives will offer cooking and canning clinics and supply participants with pressure cookers so they can preserve produce for the winter.
• Farmers' market access
  • The CAB has arranged for shuttle service from the reservation to the Saturday farmers' market in Shawano.
  • WIC vouchers available from the Menominee Tribal Clinic can be used at the market.
  • Any unsold produce from the market can be transported back to the reservation where it can be distributed the following Monday.

In addition, two community members have received partial funding to develop a strip mall on the reservation. They are planning to rent to a tenant who would open a grocery store with meat processing in that location.

At the Bad River CAB, the primary area of concern is the lack of safe play areas for children. The CAB is in the process of creating a culturally and environmentally sound play space near the day care and Head Start buildings.

The project, currently in the design phase, will include a water play area, a dugout canoe in wild rice grass, traditional plants, tricycle paths, a storytelling circle, and an eagles' nest play area. This playground is being developed by the tribes with assistance from the UW research team members and landscape architect Sam Dennis, PhD.

The Lac du Flambeau Tribe will begin organizing their CAB this summer. The Oneida Tribe has just begun its affiliation with the Healthy Children, Strong Families project, and has not yet entered the Supportive Communities portion of the project.

Partnering for Sustainability

The long-term goal of the project is to create lasting, self-sustaining, positive change in each community. "We hope to write grants that sustain the CABs' work; community members are already stepping forward to lead initiatives," Scott said.

A key element of community organizing is developing a mutual trust and working on issues that the community partners identify as important to them and their families. When the CABs identify their goals and work to meet them, they then start to bring in new ideas for the next focus.

The fluidity of the CABs supports this. "The CABs are always changing," Scott said. "People bring friends to the meetings. New faces show up. Fresh ideas and new people are what this is all about."

The partnership model extends beyond the individual tribe. The CABs have also talked about ways to increase collaboration between tribes, because there are a lot of things they could accomplish by working together that they couldn't do separately.

Supportive Communities is part of a larger project, Healthy Children, Strong Families, led by DFM Associate Professor Alexandra Adams, MD, PhD. The overall goal of Healthy Children, Strong Families is to promote long-term wellness in American Indian children and families through healthy lifestyle changes.