Using a Health Impact Assessment to Engage Tribal Leaders and Inform the Development of a Healthy Food Retail Intervention: The THRIVE Study

Obesity is a critical public health and economic issue facing American Indian (AI) tribes. In Oklahoma, where 42% of AIs are obese, most tribal members report living more than 10 miles from a grocery store and shop for food, weekly or more often, at large tribally owned convenience stores that serve high calorie, high fat, hot foods (e.g., hot dogs, fried chicken) and packaged foods (e.g., chips, cookies, soda), with few or no fruits or vegetables. Tribal nations are uniquely suited to intervene broadly at policy and environmental levels to address obesity; however such interventions are rare, and tribal policymaking processes are poorly understood. The THRIVE study is an NHBLI-funded randomized controlled trial of two obesity policy strategies shown to influence consumer behavior – menu labeling and reduced pricing for healthy foods, currently planned for implementation in the 20 tribally-owned and operated convenience stores throughout the Chickasaw Nation and Choctaw Nation of Oklahoma. In this presentation we will discuss the use of a health impact assessment as part of the THRIVE study to 1) engage tribal decision makers; 2) assess costs and potential health impact of the interventions; and 3) provide recommendations for policy formulation in the subsequent scale-up and adoption of the menu labeling and reduced pricing strategies as tribal policy. Study processes and findings will inform tribes in integrating more solid health impact data as a foundation for evidence-based policy formulation and the scaling-up of successful policy and environmental interventions to eliminate AI obesity disparities.