This project examined the availability of healthy food in the Cheyenne and Arapaho Tribal Jurisdictional Area (C&A TJA). More than 12,000 people are enrolled in the C&A Tribes, with over 8,600 living within Oklahoma (41, 42). The C&A TJA (formerly their late 19th -century reservation) includes 8,996 square miles with more than fifty towns in the western part of the state (41). We audited all retail stores that sell food within nine C&A TJA communities. Participating communities ranged from small rural communities with few food options to more urbanized population centers with multiple food stores and full-service grocery stores; population sizes ranged from fewer than 100 people to over 16,000 (see Table 1). Food stores were identified using Google search, augmented by the firsthand knowledge of team members who resided within the C&A TJA (e.g., small stores with minimal internet presence, recent store openings/closings). A total of 57 food stores were audited between March 2014 and June 2015. This study was approved by the Cheyenne & Arapaho Health Board and given exempt status as non-human subject research by The University of Oklahoma Institutional Review Board.
Table 1
Frequency of food stores and store type within C&A TJA communities in the study area (N = 57). Population totals from US Census Bureau subcounty population estimates, 2010 (45).
Community
(2010 population)
|
Total stores
|
Store type
|
Convenience stores
|
Supermarkets
|
Dollar/discount stores
|
Local markets
|
Farm & ranch stores
|
Concho (92)
|
1
|
1
|
0
|
0
|
0
|
0
|
Calumet (507)
|
2
|
2
|
0
|
0
|
0
|
0
|
Hammon (568)
|
1
|
1
|
0
|
0
|
0
|
0
|
Canton (625)
|
3
|
2
|
0
|
0
|
1
|
0
|
Geary (1,280)
|
4
|
3
|
0
|
0
|
1
|
0
|
Kingfisher (4,663)
|
7
|
2
|
2
|
1
|
1
|
1
|
Watonga (5,111)
|
7
|
4
|
2
|
1
|
0
|
0
|
Clinton (9,033)
|
15
|
8
|
2
|
3
|
1
|
1
|
El Reno (16,749)
|
17
|
11
|
2
|
2
|
2
|
0
|
We measured food availability using the Freedman Grocery Store Survey (FGSS) (46, 47) and several modified items from the Healthy Food Assessment Survey (HFAS) (47). The FGSS ascertains the availability of healthy foods (e.g., fruit, vegetables, dairy products, juice, lean meats, whole-grain bread) as well as tobacco and alcohol products. The FGSS also facilitates the mapping of a store’s layout, including the location of major product groupings. The modified HFAS items focused on store characteristics (e.g., cleanliness, shopper characteristics, customer service quality, produce quality, etc.). These factors were included given their potential impacts on American Indian customers shopping in stores mostly owned and managed by non-Natives.
Food stores were coded into types (e.g., supermarket, local market, convenience store—with and without gasoline pumps) following the FGSS (46). To meet criteria for a supermarket, a store needed to have: all major food groups, five or more different types of vegetables and five or more different kinds of fruits (depending on the availability of organic produce), reduced- or low-fat dairy products, and lean meats (46). Two additional food store types were identified, dollar/discount and farm/ranch stores. Convenience stores comprised the largest single category of food stores in the sample (59.7%), followed by supermarkets (14.0%), dollar/discount stores (12.3%), local markets (10.5%), and farm & ranch stores (3.5%).
To measure the variety of healthy food in stores, we created an index based on the ratio of available healthy food to total measured options across five categories: fruits, vegetables, dairy, meat, and bread (Cronbach’s alpha = 0.92, see Table 4 below for more details on index construction). A similar index measured unhealthy product variety using alcohol and tobacco availability (Cronbach’s alpha = 0.78).
Data were entered into MS Excel and transferred into Stata/SE 17 for analysis. Statistical analyses included frequencies, analysis of variance (ANOVA), and linear regression.