Apache Healthy Stores

Apache Healthy Stores

Primary Aims

  • To improve the availability of healthy foods in local stores.

  • To promote the purchase of healthy food alternatives in local stores using health communications approaches.

  • To evaluate how successful the program is in increasing knowledge and changing food purchasing, preparation and consumption.

Project Features

  • One year intervention period: March 2003-March 2004.

  • Involves 15 small and large food stores located on the San Carlos and White Mountain Apache reservations

  • Messages developed with approval and participation of tribal leaders

  • After a positive evaluation, in mid-2005 work began to make the AHS intervention sustainable in the community setting.


Diabetes, obesity and heart disease are severe problems among the White Mountain and San Carlos Apache. Most of these problems are related to a changing lifestyle. Eating a diet that is low in fat and sugar and high in fiber is part of improving lifestyle.

The Apache Healthy Stores Program was created to address these problems by working to improve healthy food availability and to promote healthy eating.

Project Reports

Project Leaders

Associate Professor at the Johns Hopkins Bloomberg School of Public Health, Division of Human Nutrition. Dr. Gittelsohn has extensive experience in developing community-based interventions to prevent obesity and chronic disease in low income and minority populations. He was the co-PI of the Johns Hopkins component of Pathways, a multi-site obesity prevention trial, and served on several Committees and Working Groups (Formative Assessment (Chair), Intervention, Process Evaluation, Knowledge, Attitudes and Behaviors, Dietary Assessment, School Climate), and is currently a co-investigator in TAAG, a multi-center intervention trial to increase physical activity in adolescent girls, where he also serves in several ways (Formative Assessment (Chair), Formative and Process Evaluation, Intervention, Promotions). He is also a co-investigator in an intervention trial using home visits to prevent obesity in African American children in Baltimore City.

Director and Professor at the Center for Human Nutrition at the Johns Hopkins School of Public Health. His areas of research include childhood obesity and amino acid and protein metabolism. He was the Principal Investigator of the Pathways project and has led other studies which seek to identify risk factors for obesity in children at different ages, including dietary patterns, physical activity, and growth patterns during early life. He is interested in the primary prevention of obesity in both the developed and developing world. His current work includes the Nutrition Transition in China Project, which is documenting the impact of socio-economic changes in China on nutrition and health by assessing dietary intake, body composition, physical activity, insulin receptor sensitivity, and lipoprotein, leptin and homocysteine levels in 6,000 children and adults from rural, suburban, and urban communities.

Research Associate Professor with the Department of Nutrition at the University of Massachusetts. She has over 25 years experience on community-based interventions for culturally diverse populations. She played a major role in the development and delivery of the food service interventions for Pathways and supervised that component at all elementary schools in the White Mountain and San Carlos Apache reservations. As Co-Principal Investigator and Director of Interventions for two NCI-funded projects, she developed successful interventions to improve dietary behaviors of culturally diverse WIC participants. She has also worked with other culturally diverse populations through home and school-based interventions.

Research Assistant Professor at the Cancer Research Center of Hawai’i. She has significant experience developing quantitative food frequency questionnaires for African origin peoples, including those living in urban settings. Dr. Sharma is currently a consultant on the Apache Healthy Stores project, where she took the lead in developing the food frequency questionnaire and in training the data collectors in its use. She will develop the quantitative food frequency for use in the inner city population for the Baltimore Healthy Stores project, conduct training of data collectors in the use of the instrument, and will contribute to the analysis and writing up of these data.

Member of the White Mountain Apache Tribe, with a strong record of community work in the areas of health and education. She was Project Coordinator of the Pathways study, supervising a research staff of over 15 field workers.

She brings skills in writing, graphic design and website development to the Healthy Stores projects and is interested in the power of effectively-designed messages and materials to promote social and behavioral change. She designs brochures, posters, and educational displays for the Apache Healthy Stores and Baltimore Healthy Stores projects and oversees the development of the Healthy Stores website.

Communication Methods and Materials

Apache Healthy Stores Manual of Procedures

The Bashas’ supermarket chain is partnering with Apache Healthy Stores to promote healthy foods in their grocery stores on the White Mountain and San Carlos Reservations. Apache Healthy Stores thanks Bashas’ Sign Department for their assistance with printing the intervention materials.


  • Owners encouraged to stock healthy food choices
  • Shelf labels to identify healthy foods
  • Cooking demonstrations and taste tests
  • Recipe cards and flyers
  • Posters

Mass Media:

  • Radio announcements of key events and themes
  • Newspaper ads
  • Promotional video


Vastine, A.E.*, Gittelsohn, J., Ethelbah, B., Anliker, J., and Caballero, B. (2005) Formative research and stakeholder participation in intervention development. Am J Health Behavior, 29(1): 57-69.


Curran S*, Gittelsohn J, Anliker JA, Ethelbah B, Blake K, Sharma S and Caballero B (2005) “Process evaluation of a store-based environmental obesity intervention on two American Indian reservations,” Health Education Research, 20(6):719-29.


Gittelsohn J, Anliker JA, Sharma S, Vastine AE*, Caballero B and Ethelbah B (2006) “Psychosocial determinants of food purchasing and preparation in American Indian households,” Journal of Nutrition Education and Behavior, May-Jun;38(3):163-8.


Sharma S, Cao X, Gittelsohn J, Ethelbah B, Anliker J, Caballero B. (2007) “Dietary intake and a food frequency instrument to evaluate a nutrition intervention for the Apache in Arizona,” Public Health Nutrition, Apr 4;:1-9 [Epub ahead of print].


Sharma S, Cao X, Gittelsohn J, Ethelbah B, Anliker J, Caballero B. (2008) “Nutritional composition of traditional Apache foods in Arizona.” International Journal of Food Science and Nutrition, Feb;59(1):1-10.


If you would like the data collection forms please email Joel Gittelsohn. 

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