Nutrition education for native Americans : a guide for nutrition educators

              »~ United States
:{t'-jJ.) Department of
~ Agriculture
Food and
Nutrition
Service
FNS-249
Nutrition Education for
Native Americans:
A Guide for Nutrition Educators
Depository
u J )
These are equa1 opportunity progr-.s. If you believe you have
been discrim.nated against because of race, color, national
origin, sex, age, handicap, religious creed, or political
beliefs, write i-ediately t:o the Secretary of Agriculture,
Vasbiogton, D.C. 20250.
Septeaber 1984
Acknowledgments
The following persons were responsible for the preparation of
this guide:
Technical Content: Nutrition and Technical Services Division
(NTSD): Joyce Arango, M.P.H., R.D., Margaret Fujikawa, M.S.,
M.P.A., R.D., Ching-Ye Lee, M.S., M.A., Professional Diploma
for Specialist in Nutrition Education (formerly with NTSD),
Jim Krebs-Smith, M.P.H., R.D. (formerly with NTSD)
Editorial Assistance: Helen Lilly, M.S. (NTSD), Martha
Poolton, Ed.D. (NTSD), Beverly Westmoreland, Public
Information
Format and Word Processing: Mary Jean Daniels, Regina Hart,
Joyce Hawkins
The authors would like to thank especially the many individuals
who reviewed the numerous drafts of the publication and gave us
the benefit of their knowledge and experience in working with
Native Americans.
This publication was prepared in collaboration with the Indian
Health Service (Patricia Roseleigh, M.S., R.D.) and the Bureau
of Health Care Delivery and Assistance (Doris Lauber, M.P.H.,
R.D., formerly Regional Nutrition Consultant, Public Health
Service (PHS), Region IX), Health Resources and Service
Administration, PHS, u.s. Department of Health and Human
Services.
Compilation and publication of the resources listed in this
guide do not imply endorsement by the Food and Nutrition Service,
U.S. Department of Agriculture.
Contents
1 INTRODUCTION
3 I. BACKGROUND INFORMATION
3 Nutritional Status and Nutrition-Related Illnesses
7 Traditional and Contemporary Native American Dietary
Practices
13 Lifestyle and Food Behavior
16 Effective Communication Through Materials Adaptation
17 Potential for Nutrition Education Activities in
19
20
25 II.
26
27
28
29
30
33
34
37 III.
Various Programs or Delivery Systems Serving Native
Americans
References
Bibliography
SUGGESTIONS FOR COUNSELING
Cultural Values
Noninterference with Others
Preventive Care/Self-Help Approach
Use and Preparation of Traditional Foods
Counseling Techniques
References
Bibliography
RESOURCES FOR NUTRITION EDUCATION
37 Technical Assistance Resources
42 Information Sources for Consumers and Professionals
APPENDIXES
47 A. Regional Offices, Food and Nutrition Service, U.S.
Department of Agriculture
49 B. State Offices, Extension Service, u.s. Department
of Agriculture
53 C. Administrative Offices, Indian Health Service, U.S.
Department of Health and Human Services
55 D. Regional Nutrition Consultants, Division of
Maternal and Child Health, Bureau of Health Care
Delivery and Assistance, Health Resources and
Service Administration, Public Health Service, u.s.
Department of Health and Human Services
57 E. Directors of Nutrition Services in State Health
Agencies
63 F. Regional Offices, Administration on Aging, U.S.
Department of Health and Human Services
iii
65 G. Regional Consumer Affairs Officers, Food and Drug
Administration, U.S. Department of Health and Human
Services
67 H. Regional Offices, Administration for Children,
TABLES
4 1.
10 2.
11 3.
14 4.
FIGURE
Youth, and Families, u.s. Department of Health and
Human Services
Summary of Nutrition-Related Health Problems and
Appropriate Nutrition Interventions for Native
Americans
Some Traditional Foods Eaten By Native Americans
Contemporary Foods Eaten By Native Americans
Cultural Acceptance of Commodity Foods
8 Areas of Native American Culture in the United States
Introduction
The purpose of this guide is to help nutrition educators*
working with food assistance and other programs with a
nutrition component to better address the nutritional concerns
and unique nutrition education needs of Native Americans. It
is written primarily as an aid to understanding the cultural
characteristics and basic health and diet-related problems of
Native Americans to promote more effective nutrition counseling
and community nutrition education. The guide contains three
major sections: 1) background information, 2) suggestions for
counseling, and 3) resources for nutrition education.
Background Information. This section of the guide briefly
discusses the nutritional status, nutrition-related illnesses,
and_ traditional and contemporary dietary practices of Native
Americans. Included is some information on lifestyles and food
behavior, adaptation of materials for Native American cultures,
and current nutrition education activities in various programs
or delivery systems that may be of help to nutrition educators.
References pertaining to these topics are provided at the end
of the section.
Suggestions for Counseling. This section provides several
counseling strategies offered by some individuals who work with
or have worked closely with Native Americans in different
geographic locations. This section was developed especially
for those nutrition educators who may not have experience
working with Native Americans. References pertaining to
counseling are provided at the end of the section.
Resources for Nutrition Education. The final section of the
guide offers a variety of resources for nutrition educators.
It includes both government and private sector resources.
*"Nutrition educator," as used here, refers to a professional
who may be involved in nutrition education in food assistance
programs and other programs with a nutrition component. Such
professionals may include physicians, dentists, nurses, health
educators, teachers, nutritionists and dietitians, and home
economists.
I. Background Information
Nutritional Status and Nutrition-Related Illnesses
Nutrition-related health problems of Native Americans can be
identified throughout the life cycle (table 1). Nutrition
education efforts may focus on making healthy children and
adults aware of the role of good nutrition in disease
prevention. In addition, nutrition education efforts may help
prevent further complications in those persons who already have
nutrition-related health problems. '
Nutritional adequacy of a population is often reflected by the
socioeconomic status of the people. Many Native Americans live
in remote and harsh areas of the country. Isolation often
leads to difficulties in acquiring or purchasing food. A harsh
climate and land also make it difficult to grow food. Well
over two-thirds of the Native American population live on land
which does not produce adequate food, or in areas where jobs
are limited to infrequent seasonal work. The employment rate
is about 49 percent (_!21).
Seventy-five percent of Native American families have annual
incomes below the poverty level of $7,000 (12). As a
population, Native Americans have certain diseases and health
problems in all age groups that are greater in magnitude than
in other Americans. This is indicative of a link between
income level and health. Medical problems related to nutrition
occur throughout ~he population.
The severity of health problems among Native Americans is
compounded by environmental conditions. One common health
problem caused by poor environmental conditions is diarrhea,
especially among Native American infants and children.
Diarrhea interferes with normal nutrient absorption. Recurrent
episodes of diarrhea can reduce or limit the nutrient supply to
the body, which can then affect normal growth and development.
In 1979, the death rate from gastrointestinal disease for
Native Americans was 1.8 times higher than the rate for all
races in the general U.S. population.
1underscored n~mbers in parentheses refer to the references at
the end of each section.
~
Table 1. Summary of Nutrition-Related Health Problems and Appropriate Nutrition
Interventions for Native Americans
POPULATION IIEALTII PROBLEMS NUTRITION INTERVENTION ---------------------------------------------------
Women of Childbea~ing Age Obesity
Infanta and Child~en
Adolescents
Adults and Elderly
AnerRia
Digestive Diseases
Respi~ato~y Diseases
Ane•ia
Dental Carles
Obe<y
Underweight
Unde~developed (Stunting)
Obesity.
Dental Carles
Obe<y
Diabetes
llyperten11lon
CardlovaRcular Diseases
Reduce foods high in calories
Inc~ease nut~ient denae foods
Inc~ease iron, protein, vitamin C,
follc acid
lmp~ove food sanitation
Imp~ove gene~al nut~ition
lnc~ease iron, protein, vitamin C
Reduce suga~, sticky sweets
Reduce foods high in calories
Increase nutrient dense foods
Increase nutritious foods high
in calories \
Increase foods high ln calories,
protein, calcium, vitamins A, C
Reduce foods high in calories
Increase nut~ient dense foods
Reduce sugar, sticky sweets
Reduce foods high in calories
Increase nutrient dense foods
Necessary dietary management
Reduce foods high in sodluna
Reduce foods high in saturated
fat, cholesterol, sodium, calories
Source: Co•piled by Nutrition and Technical Se~vices Stnff, Food and Nut~itlon Se~vlce, U.S. Department of
Agrlcultul"e, from varlous references cited and r.otnnents from apeciallsts who work with Native Alaerlcans.
Some homes on Indian reservations lack refrigeration
facilities ; storage space for food is often inadequate and may
not be rodent proof. Many homes also lack runni?g water and
sanitary waste disposal systems. Flies are a serious problem
in many areas, as is unsanitary disposal of food waste and a
lack of screens on doors and windows. All these conditions
compound health problems.
Pregnant and Breastfeeding Women
A low prevalence of abnormal hemoglobin values was found among
the Native American women whose values were reported to the
Pregnancy Nutrition Surveillance System of the Centers for
Disease Control (CDC) in 1980 (9). Low birth weight, less than
2,501 grams or about 5-1/2 pounds, was more prevalent among
Native American infants than among infants of all other ethnic
origins, according to the data in the 1980 CDC Pediatric
Nutrition Surveillance System Summary (9). The same
surveillance data revealed that Native American mothers were
more likely to breastfeed than mothers of other ethnic groups,
with 46.7 percent having breastfed their infants.
Infants and Children
Native American children were found to have the second highest
prevalence of nutrition-related abnormalities in children of
all ethnic groups, according to the 1980 CDC Nutrition
Surveillance System Summary (9). A high prevalence of short
stature, low height for age, and overweight among preschool
Native American children was a consistent finding. The
prevalence of short stature was low, 3.5 percent, for infants
less than 3 months old; however, it increased with age until
the peak prevalence of 13.9 percent was reached between ages 12
months and 23 months. Among children 6 through 9 years old,
the prevalence of short stature had decreased to 2.7 percent.
Among children, the prevalence of overweight was lowest among
the youngest and the oldest age groups, 5.4 percent and 5.3
percent, respectively. The peak prevalence of 16.3 percent was
found among those children 2 through 5 years old. Relative to
other ethnic groups, Native American children 6 months through
5 years old have the highest weight-for-height. Whether or not
this early propensity for overweight is· associated with ethnic­specific
feeding patterns, or with other environmental factors,
cannot yet be determined. However, the prevalence reflects a
clear risk ?f overweight for one out of six Native American
children ( 9).
Among Native American children less than 2 years old, 8.6
percent of the children were thin, which was considerably
higher than expected. However, of all ethnic groups,
5
6
Native American children from birth through 9 years old tended
to be the least anemic (9).
Adults, ages 20 and over, make up- 55 percent of the Native
American population, with 29 percent aged 35 years and over.
This compares with 68 percent ages 20 and over, and 42 percent,
ages 35 and over, for the All Races category in the general
U.S. population (10). The frequency of poor nutritional status
of Native American-adults is reflected in their nutrition­related
health problems. These problems include obesity,
diabetes, diseases of the heart, and alcoholism. Although
reliable data on the prevalence of obesity among Native
Americans are not available, obesity is now generally accepted
as an important risk factor for development of diabetes, heart
disease, and high blood pressure. The high morbidity and
mortality due to diabetes among the adult Native American
population poses a major health problem.
Data collected by the Indian Health Service for 1982 (10) show
that the death rate from diabetes among the Native American
population is consistently much higher than that of the general
U.S. population. For the age group 25 to 34 years, the
diabetes mellitus death rate for Native Americans was 1.2 times
the rate for all races in the United States. Succeeding 10-
year groups experienced death rates 2.7, 3.9, 2.7, and 2.4
times as high as the rate for all races in the general u.s.
population. Since diabetes affects the circulatory system,
diabetics are more prone to the development of heart and small
blood vessel diseases.
The death rate attributed to major cardiovascular diseases
among Native Americans is higher than that of the general U.S.
population up to age 44 (10). After age 44, the death rate of
the general U.S. population is higher than that of Native
Americans. In both groups, the death rate from cardiovascular
diseases doubles in each succeeding 10-year period after age
44. However, these diseases kill a greater percentage of
Native Americans during their younger years, when they are able
to be most productive in their communities.
Deaths of Native Americans due to alcoholism are very high,
with a rate that is 7.7 times higher than that of the general
U.S. population (~. The nutritional effects on those who
consume large quantities of alcohol can be quite significant
over time. These effects include nutrient deficiencies,
obesity, and birth defects in children whose mothers drink
during pregnancy.
Traditional and Contemporary Native American Dietary Practices
Dietary practices of individuals and groups of Native Americans
vary from region to region (see figure). As with any culture,
these dietary patterns reflect the physiological, sociological,
and psychological needs of those who adhere to them.
Native Americans encompass many groups with distinctly
different cultural patterns. Anthropologists have grouped them
into basic geographic areas representing different climatic
zones with different plant and animal distributions. The zones
in the United States are: Eastern Woodlands, Plains,
Southwest, California Hasin and Plateau, Northwest Coast, and
Alaska.
The diets of the Native American groups living within each of
these zones have been influenced by the natural food supplies
of the environment. Although migration of tribes has brought
about cultural exchanges, basic dietary patterns have persisted
<.!.!).
Traditional Practices
People of the Eastern Woodlands zone traditionally consumed
mostly small game, fish and seafood from coastal waters and
streams, and a wide variety of plant food.
The hunters of the Plains relied heavily on the abundance of
buffalo and other game for their food.
In the Southwest, the Navajo Indians herded sheep and ate lamb
and mutton, while the Pima Indians tilled and irrigated land
using the Gila River. Their diet was predominantly vegetarian.
The Apache Indians were hunters and ate antelope and small game
and fowl. Corn, squash, chili, melon, and pinon nuts were used
to a great extent by all tribes in the region.
Indian tribes in the California Basin and Plateau zone gathered
seeds, nuts, and a variety of wild plants; they also hunted
small mammals and fowl. Those living near the coast also ate a
variety of fish and shellfish.
The Northwest Coast Indians were traditionally fishermen, using
salmon as a staple food. The Alaskan Natives ate a variety of
salmon, seal, whale, walrus, bear, and other game and fowl.
Although the contemporary Native American diet includes modern
processed foods, most tribes retain a preference for certain
traditional foods. Many Native American traditional foods are
good sources of protein, vitamins, and minerals.
When game and fish are plentiful, they are important sources of
food for those tribes that rely on fishing and hunting
7
CD
~~~
.. -
~
Culture Areas and Approximate Location of American Indian Tribes
Today (originally published by the Indian Arts and Crafts Board)
UtTiaiOI . NUalU. '""· t · JI ·IJ ·UM
Figure: Areas of Native American Culture in the United States
expeditions. However, feast or famine conditions may still
exist in those areas. Fruits, berries, roots, and wild greens
are highly valued foods, but have become scarce in many areas.
When in season, fresh produce is eaten in large quantities.
Preservation, either by drying or cold storage, is a common
practice.
Native Americans traditionally are efficient in their use of
foods. In Alaska, when a seal is caught, the whole village
shares in the feast and none is wasted. When a sheep or goat
is slaughtered by tribes of the Southwest Region, the entire
carcass, including all organs and blood, is used in stews and
cornmeal casseroles.
In some cases, traditional food preparation methods may
increase the availability of some nutrients contained in
traditional foods. For example, Hopi Indians add plant ash to
corn, which may make more of the minerals in the corn available
for absorption (~).
Table 2 identifies traditional food habits of Native Americans
located in different geographic areas.
Contemporary Practices
The contemporary diet of the Native American combines
indigenous natural foods of their cultural heritage with
processed foods and fresh foods, when available. However,
since those indigenous foods often are not available,
especially to those Native Americans living off the
reservation, the daily diet of many people consists mainly of
commodity foods donated by the U.S. Department of Agriculture
(USDA) and foods purchased at stores. Fresh fruits and
vegetables may not be available for purchase, or may be too
expensive in many areas, unless they are locally grown.
Studies on current dietary practices among many Native American
population groups show that their diets are often high in
calories, carbohydrates, and saturated fat (1,2,5,6). Excess
caloric intake and a low level of activity over a period of
time result in obesity, which may predispose the onset of
diabetes in certain adults. Saturated fat in the diet may
contribute to the development of coronary heart disease, which
is often a complication of diabetes.
Table 3 shows that there is much similarity in foods now eaten
by Native Americans in various regiQns. Some reported meal
patterns, however, show that the contemporary diet of many
Native Americans lacks a wide variety of foods. The diet may
then be inadequate in several key nutrients, and the nutrient
density may be low. In many cases, the meal pattern is also
high in refined sugar, cholesterol, fat, and salt.
9
0
Table 2. Some Traditional Foods Eaten by Native Americans
FOODS REGIONS: ALASKA NORTHWEST COAST CALIF. BASIN & PLATEAU PLAINS EASTERN WOODV.NDS SOUTIIo/EST
Gaiiie --~Bear~eal, wair~Deer-~aild 111all iaitaiule,-~oeer; eU:, other 1aoiie, Buffalo; ellt, aritelope;--oeer~ana eoii&ll ~-beer .Mai: jerky,
Fowl whale, deer, wild wild fowl Grouee, wild turkey, and and a variety of aaall •a-..ale, wild Mutton (aheep,
fowl other fowl aa• .. l• and fowl fowl goat), wild fowl
SeafoOd Salmon, other fieh Flah - eapecl&lly flah - e&l~~an, othen Fhh Flin-;:,- iiir1ety-~ Har1 - 111aii
ahellfiah aal110n Eel Clase, 11usaele, a11ount
Gralna
Seede
Roote
Eel Claaa, •ueaele oyetere
Cla••• 11ueeele, oyetere
COrn, beane Corn, be ana, Corn, bean•, -corn~lieana-,- -~- --- Corn, beans,
Roote - variety bitter roote, wild rice, wide range of blue corn•eal,
biecuit ca11u1, wild wild potato, roott, wild rice, bread, du•plinga,
carrote, wild turnipl, turnip wild potato bhcuita
wild potato potatoea
Wild greens Variety in eprln1 Fern Wild celery, Greene - Greene -wide v!'rhty -Fern--~- ~- Wild i(ii.nach,
l'lowen & fall Greene - wide variety wide variety r011e hipe, rote bude Greene - wide chili pep pen,
Vegetable• Squash Squash Hint variety cacti, Cholh
Pruite Berriee
Nut a
Other• Ani•al Fat
Squaah buda, Squash
Berries
aervice
berry
- huckleberry, Berries - huckleberry, Berry - etra.iberry, Fruita arid
berry, talaoa eervtce berry, tal.on eervice berry berries - wide
berry Choke cherry, wild plu11 variety
Choke cherry, wild Choke cherry, wild plUII Red hav, roee hipe
plu11 Kelona, peachea
Hazel -iiut-a,-r-048 ted Hazel nuu, routed -- -Nuti-;- leeds - wide -- tluta, aeede -
equaeh and pumpkin squaah and pumpkin variety variety
aeede eeede, acorne Acorn•
Llchene Llchene Lard Llchena
Lard Lard fry bread Lard
Pry bread Fry bread Maple augar Maple augar
Du•plingl, biaculta Wheat flour, dumplinse,
bhcultl
Melone, pumpkins
Pinon nuts,
roasted squaah,
pU111pkln, and
watermelon eeeda
LArd, other
ani•al fat
fry bread
Wheat tort ill a
Indian teal
Source: Co•piled by Nutrition and Technical Services Staff, Food and Nutrllion Service, U.S. Oepart11ent of Agriculture, from various reference• cited
and comaenta fro• apecialiata who work with Native Americana.
..6
.A
Table 3. Contemporary Foods Eaten by Native Americans
t'ooos ki':GloHS o, ALASKA NOiiTIIIJESt COAST CALlY. IIASlN ' PLAtEAU PLAINS !ASfERHilOOI>LARDS m- - S()1ftllll£Sf
Heat *Traditional foods - · JifiadHional foods-- SiaUar to NorthWeet Sialr&rto HortliWeiit~sraillirto-Ncirtliweiitlleei~j>ork~-eh!C:k:en,
Poultry
Saafood
Egg
Nut a
Bl:eBd
Cereal
bear, aeal, walrus, deer, aaall aaaaala, Coaat
whale, deer, wlld fowl wlld fowl
aeat and Uah Beef, pork, canned aeat,
Flab - fresh, canned luncheon aeat, bacon,
Egg aix aauaage, chicken, turkey
Peanut butter Fiah - freah, canned
Freah and dried egga
Peanuts, peanut butter
loaated aquaah and puap­kin
aeeda
Coast Coast
Leaa flah and seafood
autton, deer jerky,
organ ~~eata
Saall a11ount
canned flab, canned
aeet, chort&a,
luncheon ~~eats,
Egga - fresh and
drled,
Peanuts, peanut
butter, pinon, other
nuts, and aeeda
Cereals- hot Cereals- hot and cold Slailar to Horthweat Slallar to Northwest SlDllar to NorthWeif--cereai~hot and
and cold Pancakes, blaculu, Coaat Coaat Coaat cold
bread, rice, aacaronl Flour tortilla,
Traditional foods - blue cornaeel, auah
duapllnga, fry bread bread, pudding,
Traditional foods -
du11pllnga, btacuita,
fry bread
l'ruiu aiid Co~nned, drhd, Fruh fruit ln aeaaon .;--Uairart~rtliWeet-------sfiillar tot4ortlnieat--Uillirto tlortnweit -Preah frultln
Fruit juice aeBaonal berrlel cherrie1, berriea, Coaat Coaat Coaat aeaaon - aelon,
Canned fruit jules apricot, peach, apple, plua, orange,
pear, plua, orange, apple, apricot,
11elon, banana, peach
Canned fruit - fruit Canned fruit julcea
cocktail, pear, peach, Dried fruit
apricot, pineapple Helon, puapkln,
Canned fruit juice other fruit
Cholla buda
*Couteaporary diet still contains soae traditional foods • Continued
.....
1\:1
FOODS REGIONS
Vegetable•
l.oot a
Seede
Milk ard
Cheeae
lleveragee
Sweet I
Fall
Other
Table 3. Contemporary Foods Eaten by Native Americans-Continued
ALASKA
Cenned lteae
Freeh lteaa locally
available 1a apring
ard fall
Milk - canned,
powdered
Cheeee
Coffee
Candy, jaa, jelly,
honey
Cookiea
Shortening and
anlaal fat
NORTHWEST COAST CALIF, IIASlN & PI.ATt:AU
Canned- cora, beana, Statlar to Northweet
peas Coast
Freeh - cabbage, carrot,
celery, areen beana,
corn, aaparagua, toaato,
aquaah, peal, potatoea,
wild roota
Wild sreens in eeaaon
Dried beana
HUk ~- freah,- canned,
powdered
Cheeae
lee Creaa
Stallar to Northwest
Coaat
Coffee, -tea, Sttallar to Northwest
Juice drinka, aoft Coaat
drinke
Syrup, jaa, jelly
Cookiea, cakea, piee,
paatriea, donutl
Shortening, aargarine
Potato chtra, aalt pork,
bacon, baa hock
PLAlNS
Slallar to Northweat
Coaat
Slmllar to Northwest
Coast
Statlar to Northwest
Coaat
I!.AS'ft:RN WOODLANDS
Stallar to Northwest
Co a at
st.tlar to Northwest
Coaet
Slallsr to Northwest
Coaat
SOUTHWEST
Potatoea, cabbage,
onlona, puapkina,
Freah vegetable& in
season - lettuce,
aplnach, aquaah,
beana, chili pepper,
to11atoes, corn,
carrots
Canned green beans,
corn and to~aatoes
When available, wild
greens, asparagus
St~allar to Northwest
Coast
Fresh allk little
use.J if no
refrigeration
avaUable
st .. tlar to Northwest
Coast
Source: Coapiled by Nutrition and Technical Servicel Staff, Food and Nutrition Service, u.s. Uepartment of Agriculture, fro. varioue references cited
ard coa.ente froa epecialletl who work with Native Aaerlcana,
Since there is some diversity in eating patterns of Native
Americans from various zones, as well as within tribes, there
is no single appropriate way of approaching each of the diet­related
problems of Native Americans. Instead, nutrition
educators must decide the best approach to take when discussing
health problems with the members of the tribal communities they
serve, whether on or off the reservation. Additionally, it is
important that nutrition educators attempt to determine current
dietary patterns before counseling.
Lifestyle and Food Behavior
While nutrition education for Native Americans is usually
focused on dietary changes related to a specific condition or
diet-related disease, the lifestyle of the client/patient needs
to be considered. This lifestyle usually centers around the
family and tribal community. Often traditional values are
reflected in food behavior.
It is the nature of most Native Americans to share food with
strangers, and it is considered impolite to ever refuse food
offered (11). The extended family structure of many tribes is
reflected-at the dining table. Family structure may also
strongly affect food preferences and practices. Food is an
important element of feasts on ceremonial occasions such as
weddings, rites of passage, seasonal changes, and modern
holidays. These ceremonies serve as a means to share food
resources, as well as a means to symbolically express
friendship or social status (11).
There are many culturally related food concepts that determine
food acceptance. One of these is the dipolar concept of food,
which is common among some tribes. According to this concept,
some foods are considered "strong," while other foods are
considered "weak." An example of this can be found among the
Navajo, where meat and blue cornmeal are considered "strong"
foods, while milk is considered a "weak" food (_!!).
Religious or ceremonial significance is attached to many foods.
Corn is considered sacred to many cultures and is often used in
ceremonies, such as weddings. Blue corn is especially
important to Hopi and Navajo tribes.
Dietary taboos against many foods exist among different tribes.
For example, many Crow Indians place a taboo on fish and stream
"creatures," and Delaware Indians often discourage pregnant
women from eating cabbage, onions, or salt.
Since USDA commodity foods are available to many tribes
nationwide, some indications of their cultural acceptance may
be useful. Table 4 identifies commodities currently offered
and provides comments regarding cultural acceptance of these
items among various tribes and groups.
~
Dry Beans -
Canned HeaU -
Peanut Butter
And Peanuts -
Dry IUlk -
Processed
Cheese -
Table 4. Cultural Acceptance of Commodity Foods
Heat/Heat Alternates
Highly acceptable to •any tribes;
generally acceptable to others except
that beana require long cooking,
which aay not be desirable for
faailiea with li•ited cooking
facilities.
Heat ia considered an i•portant food
to Navajos, but not very iaportant to
Papagos, whose diet is high in
carbohydrates and plant food.
Generally acceptable to all groups,
especially those which traditionally
gathered nuts.
Egg Hix -
Canned Flah
(Tuna) -
Hilk and Cheeses
Not widely accepted; considered a
"weak" food by Navajos; aany groups
do not know how to use dry •ilk in
preparing coauaon recipes.
Cenerally well accepted among all
groups.
Evaporated
Milk-
Acceptable to so•e tribes and
pri•arily used as breakfast food,
but not well accepted by others.
Many tribes do not know how to use
egg •ix in preparing coaaon recipes
that call for eggs.
Highly acceptable to Northwest and
California groups where fish is a
traditional diet coaponent; not
eaten by Southwest groups except on
special occasions; considered a
"taboo" food by so•e Plains Indiana.
Uaually considered an infant food
by Papagoa, used by Navajos in
coffee; generally aore acceptable
than dry •Ilk.
Continued
(}1
Flour -
Cornmeal -
Canned
Vegetable. -
Butter -
Table 4. Cultural Acceptance of Commodity Foods-Continued
Breada and Cereala
Hoat widely accepted coa~odity;
very iaportant to the Navajo and
Papago diet for breadaaking.
Well accepted by many trlbea except
the Navajo a•~ Sioux trlbea. Navajoa
prefer •blue~ corn.eal.
Rice -
Oata -
Fruita and Vegetablea
Culturally linked to agricultural
aocletlea (i.e., !aatern Woodlands),
especially corn, beans, and pumpkin;
not aa Important to Southwest groupe.
Pri•arlly used for aeaaonlng by
Navajoa, but not well accepted by
•any groupe due to inadequate
storage facllltles.
Other
Potatoes,
Instant -
Canned Frul t,
Fruit Juices -
Shortening -
Highly acceptable to nany tribea
where wild rice la culturally
l~portant.
Generally acceptable to •oat groups,
but especially the Plalna tribea.
Potatoes are an Important staple to
aany groupe, especially Navajo.
Highly acceptable to all groupe.
High usage by Southwest, Northwest,
and Plalna Groups for frying.
Sources Co•l'lled by Nutrltlon and Technical Servlcea Stnff, fo•J<I nnd Nutrition Service, U.S. l)t!JIIII'"lmcnt of
Agriculture, ftOfl vnrloue references cltC<I ond r.c,.anents frOtt tlpeclallsts who work wllh Nntlve Aleetlcans.
However, these comments are generalizations, and variations in
acceptance of certain foods are to be expected, both within
tribes and within regions. We suggest that nutrition educators
contact the regional and State resource people listed in the
appendixes to get ideas on how to improve the acceptance of
foods among Native Americans. Many times the lack of
acceptance of foods is due to unfamiliarity with the form of
the food that is available, for example, egg mix or dry milk.
Incorporating these foods into culturally accepted or familiar
recipes can increase their acceptance.
Effective Communication Through Materials Adaptation
Most Native Americans use the English language in everyday
life. Although about 250 Indian languages still exist today in
the United States, few are widely spoken. Navajo, Cherokee,
and Teton Sioux, however, are still spoken by many people (3).
A high percentage of Native American adults have less than a
high school education (8), and many tribal groups have low
reading levels. -
Therefore, in designing educational posters and pamphlets,
nutrition educators should use simple and concise language, and
illustrations compatible with the Native American culture. For
example, use simple, multicolored line drawings on a flip chart
to convey a single message on each page. Include a seal,
walrus, or salmon, and a variety of seafood in the meat group
in a publication for Alaskan Natives to increase the relevance
of the concepts to the audience.
Nutrition educators also can adapt various nutrition education
aids to help communicate dietary changes. Using food models of
both traditional and nontraditional foods can show nutritious
combinations and serving sizes. Developing food guides that
incorporate commonly consumed food items also can demonstrate
to Native Americans how to achieve variety and a balanced diet.
In general, nutrition educators should prepare materials for
local use for a selected audience, and should incorporate the
audience's particular customs and values~ Using simple, single
concept messages and keeping the print to a minimum is most
desirable. Graphics are an important means of conveying
messages, and should incorporate culturally appropriate colors,
signs, symbols, and pictures. Materials should also
incorporate traditional foods and methods of preparation.
Therapeutic diets can be adapted to include more traditionally
or regionally popular foods; for example, adaptation of the
diabetic exchange list.
Potential for Nutrition Education Activities in Various
Programs and Delivery Systems Serving Native Americans
Many programs and delivery systems appropriate for nutrition
education can be found in most tribal communities and other
areas where Native Americans reside. Although it can vary from
place to place, nutrition information can be, and often is,
conveyed through any or all of the ongoing nutrition and health
programs serving the tribal community, or through the mass
media. A coordinated approach and consistency of the message
will help to increase the effectiveness of nutrition education
efforts.
Food Assistance Programs
~utrition ~ducation activities can be provided at the local
sites where participants in the various federally funded food
programs come to obtain assistance. See page 38 for a list of
food assistance programs administered by the Food and Nutrition
Service (FNS), U.S. Department of Agriculture. Appendix A
gives the addresses of regional FNS offices. Commodity
distribution centers, food stamp offices, and Special
Supplemental Food Program for Women, Infants, and Children
(WIC) certification offices are examples of places where
nutrition education is being provided, or can be introduced to
program participants. Where congregate meals are served for
the elderly, often in school cafeterias or senior citizen
centers, effective nutrition education activities can be
planned cooperatively with the staffs of these programs. See
the listing on page 40, Office of State and Tribal Programs,
Administration on Aging, for information on the services
provided to people under the Older Americans Act.
Helping preschool children develop good food habits is an
integral part of the Head Start program, and should be
encouraged in day care centers. To assist care providers with
ideas for appropriate activities for these children, FNS has
prepared a resource guide in nutrition education for
preschoolers (]_).
For school-age children, the Nutrition Education and Training
Program (NET) has been available in many areas since 1979. NET
has provided funds through a system of grants to State
educational agencies, or alternate agencies such as the State
health departments, for the purposes of:
• encouraging good eating habits and teaching children the
relationship between food and health;
• training food service personnel in nutrition and food
service management and encouraging the use of the cafeteria
as an environment for learning about food and nutrition;
17
18
~ · '
• instructing educators in nutrition education and in the uses
of the cafeteria as a learning laboratory; and
• developing appropriate education materials and curricula.
Some of the ways in which nutrition education can be provided,
depending on the setting, are:
1) simple, self-instructional posters and audiovisuals;
2) printed information sheets;
3) onsite nutrition educators and paraprofessionals to provide
group or individual counseling; and
4) classroom nutrition education activities involving teachers,
school food service personnel, parents, and students.
Health Programs
Nutrition is an important component of health service programs.
Public health nutritionists are employed by several agencies
including: 1) Indian Health Service (IRS) in Area and Program
Offices; 2) Maternal and Child Health in Regional Offices,
Public Health Service (PHS); 3) Tribal Health Departments; 4)
State and local health departments. Nutritionists in these
agencies can provide technical assistance for nutrition
education efforts. Explanations of the services provided by
these health agencies begin on page 39.
Other Programs
Several other programs conducted by local governments,
voluntary organizations, industry, and educational institutions
include nutrition activities. Examples include the Cooperative
Extension Service, which administers the Expanded Food and
Nutrition Education Program (EFNEP) (see page 38),
organizations concerned with specific health problems such as
diabetes and heart disease, food and utility companies, and
food and nutrition departments of colleges and universities.
References
1. Bass, M.A. and Wakefield, L.M., "Nutrient Intake and
Food Patterns of Indians on Standing Rock Reservation."
Journal of the American Dietetic Association 63:36-41,
1974.
2. Collected information from the U.S. Department of Health
and Human Services, Indian Health Service, Nutrition and
Dietetics Branch, 1981.
3. Kuhnlein, H.V. et al., "Composition of Traditional Hopi
Foods." Journal of the American Dietetic Association 7 5:
37-41, 1979.
4. Martin, E.A., Nutrition in Action. 4th Edition.
New York: Holt, Rinehart and Winston, Inc., 1978.
5. Nance, E.G., "A Study of Food Consumed by Navajo People
Receiving Food Donated by the United States Department of
Agriculture." Master of Science Thesis. Texas Woman's
University, Denton, Texas, 1972.
6. U.S. Department of Agriculture, Food and Nutrition
Service, Nutrition Education for Preschoolers, A Resource
Guide for Use in the Child Care Food Program, FNS-241.
U.S. Government Printing Office, Washington, D.C., October
1983. .
7. u.s. Department of Commerce, Bureau of the Census,
Population Characteristics Series, General Social and
Economic Chart. Publication No. P-CS0-1-C (1980).
8. U.S. Department of Health and Human Services, Centers for
Disease Control, Nutrition Surveillance 1980. HHS
Publication No. (CDC) 83-8295. U.S. Government Printing
Office, Washington, D.C. Issued November 1982.
9. u.s. Department of Health and Human Services, Health
Resources and Service Administration, Indian Health
Service, Fiscal Year 1984 Budget Appropriation, Indian
Health Service, "Chart Series" Tables. Issued April 1983.
10. U.S. Department of Health, Education and Welfare, National
Institute of Child Health and Human Development,
Nutrition, Growth and Development of North American Indian
Children, DREW Publication No. (NIH) 72-26. U.S.
Government Printing Office, Washington, D.C., 1972.
11. u.s. Department of the Interior, Bureau of Indian Affairs,
Indian Service Population Labor Force Report. January
1983.
12. U.S. Department of the Interior, Bureau of Indian Affairs,
Information About Indians. 1978.
Bibliography
Nutritional Status and Nutrition-Rel@ted Illnesses
Aase, J.M., "The Fetal Alcohol Syndrome in American Indians: A
High Risk Group." Neurobehavioral Toxicology and Teratology
3:153-156, 1981.
Bass, M.A. and Wakefield, L.M., "Nutrient Intake and Food
Patterns of Indians on Standing Rock Reservation." Journal
of the American Dietetic Association 63:36-41, 1974.
Beltrame, T. and McQueen, D.V., "Urban and Rural Indian
Drinking Patterns: The Special Case of the Lumbee."
International Journal of Addiction 14:533-548, 1979.
Bennion, L.J. and Li, T., "Alcohol Metabolism in American
Indians and Whites." New England Journal of Medicine
294:9-13, January 1976.
Bennett, P.R., "The Pima Indians: Do They Hold the Key?"
Diabetes Forecast 30:22-24, 1977.
Blumenthal, D.S. et al., "Nutritional Status of Residents of
the Blackfeet Indian Reservation. II. Comparison of the
Results' of the 1961 and 1973 Surveys." Nutrition Reports
International 23:377-390, 1981.
Brosseau, J.D. et al., "Diabetes Among the Three Affiliated
Tribes: Correlation with Degree of Indian Inheritance."
American Journal of Public Health 69:1277-1278, 1979.
Broussard, B.A. et al., "The Cherokee Diabetic View of Dietary
Non-Compliance." Paper presented at the Society for
Nutrition Education Annual Meeting. 1981.
Butte, N.F. et al., "Nutritional Assessment of Pregnant and
Lactating Navajo Women." American Journal of Clinical
Nutrition 34:2216-2228, 1981.
Calloway, D.H. and Gibbs, J.C., "Food Patterns and Food
Assistance Programs in the Cocopah Indian Community."
Ecology of Food and Nutrition 5:183-196, 1976.
Ellestad-Sayad, J.J. et al., "Milk Intolerance in Manitoba
Indian School Children." American Journal of Clinical
Nutrition 33:2198-2201, 1980.
Foman, M.R. et al., "The Pima Infant Feeding Study." American
Journal of Clinical Nutrition 25:1477-1486, 1982.
Hollow, W.B. and Wilkins, R.L., "Hypertension in an Urban
Indian Practice Population." Preventive Medicine 9:436-
437, 1980.
Horner, M.R. et al., "Nutritional Status of Chippewa Head
Start Children in Wisconsin." American Journal of Public
Heal t h 6 7 : 18 5, 1 9 77.
Johns ton, F. E. et al. , "Physical Growth and Development of
Urban Native Americans: A Study of Urbanization and Its
Implications for Nutritional Status." American Journal of
Clinical Nutrition 31:1017-1027, 197~.
Knapp, B. and Panruk, P., "Southwest Alaskan USA Eskimo Dietary
Survey of 1978." Proceedings of the 30th Alaska Scientific
Conference, 1979.
Knowler, W.C. et al., "Mortality and Body Mass Index in a
Population With a High Incidence of Diabetes." American
Journal of Epidemiology 112:437, 1980.
MacNeill, C.A. et al., "Nutritional Status of Residents of the
Blackfeet Indian Reservation." Nutrition Reports
International 23:327-345, 1981.
May, P.A. and Broudy, D.W., Health Problems of the Navajo Area
and Suggested Interventions. Publication No. (HRA) 232-8Q-
0007. Indian Health Service. 1979.
Nutrition, Growth, and Development of North American Indian
Children. DHEW Publication No. (NIH) 72:26. U.S.
Government Printing Office. Washington, D.C., 1972.
Owen, G.M. et al., "Nutrition Studies with White Mountain
Apache Preschool Children in 1976 and 1969." American
Journal of Clinical Nutrition 34:226, 1981.
Read, M.H. and Boling, M.A., "Effect of Feeding Practices on
the Incidence of Iron Deficiency Anemia and Obesity in a
Native American Population." Nutrition Reports International
26:689-694, 19~2.
Reid, J .M. et al., "Nutrient Intake of Pima Indian Women;
Relationships to Diabetes Mellitis and Gallbladder
Diseases." American Journal of Clinical Nutrition 24:1281-
1289, 1971.
Robson, J .R.K. and Wadsworth, G.R., "The Health and Nutrition
Status of Primitive Populations." Ecology of Food and
Nutrition 6:187-202, 1977.
Rusch, J.L., "Assessment of Nutritional Status of Pregnant
Teenagers Served by the Phoenix Indian Medical Center."
Arizona State University. December 1981.
Story, M., "Food and Nutrient Intake Practices and
Anthropometric Data of Cherokee Indian High School Students
in Cherokee, North Carolina." Doctoral Dissertation, Florida
State University. June 1980.
21
22
Streissgurth, A.P. et al., "Teratogenic ~ffects of Alcohol in
Humans and Laboratory Animals." S<:_ience 209:353, 191:W.
Van Duzen, J.L. et al., "Protein and Caloric Malnutrition
Among Preschool Navajo Indian Children: A Follow-up."
American Journal of Clinical Nutrition 29:657-662, 1976.
West, K.M., "Diabetes in American Indians and Other Native
Populations of the New World." Diabetes 23:841-855, 1974.
- West, K.M., Epidemiology of Diabetes and Its Vascular
Lesions. New York, Elsevier. 1978.
Traditional and Contemporary Dietary Practices and Food
Composition
Alaska's Game Is Good Food. Cooperative Extension Service.
University of Alaska Publication 126. July 1974.
Alford, B.B. and Nance, E.B., "Customary Foods of the Navajo
Diet." Journal of the American Dietetic Association 68:538-
539, 1976.
Bean, L.S. and Saubel, K.S., Temalpakh: Cahuilla Indian
Knowledge and Usage of Plants. Banning, California: Malki
Museum Press. 1972.
Benson, E.M. et al., "Wild Edible Plants of the Pacific
Northwest." Journal of the American Dietetic Association
6 2 : 1 4 3-14 7 , 1 9 7 3 •
Berkes, F. and Farkas, C.S., "Eastern James Bay Cree Indians:
Changing Patterns of Wild Food Use and Nutrition." Ecology
of Food and Nutrition 7:155-172, 1978.
Broussard, B.A., Bass, M.A., and Jackson, M. Y., "Reasons for
Diabetic Diet Noncompliance Among Cherokee Indians." Journal
of Nutrition Education 14:56-57, 1982.
Calloway, D.H. et al., "The Superior Mineral Content of Some
Indian Foods in Comparison to Federally Donated Counterpart
Commodities." Ecology of Food and Nutrition 3:203, 1974.
Draper, H.H., "The Aboriginal Eskimo Diet in Modern
Perspective." American Anthropology 79:309-316, 19 77.
Felger, R. and Moser, M.B., "Eelgrass (Zostera marina L.) in
the Gulf of California: Discovery of Its Nutritional Value
By the Seri Indians." Science 181:355-356, 1973.
Guide to the Nutritive Value of Traditional Navajo Foods.
University of Arizona, Tucson. 1983.
Hamel, P.B. and Chiltoskey, M.U., "Cherokee Plants- Their
Uses. A 400 Year History." The Cherokee Museum, Cherokee,
North Carolina. 1975.
Holden, G.K. and Lamb, M.W., "Early Foods of the Southwest."
Journal of the American Dietetic Association 40:218-223,
1962.
Hooper, H.M., Nutrient Analysis of Twenty Southeast Alaska
Native Foods. Reports 1 and 2. Indian Health Service.
1981.
Katz, S.H. et al., "Traditional Maize in the New World."
Science 184:765-773, 1974.
Knapp, B. and Panruh, P., "Southwest Alaska Eskimo Dii.etary
Survey of 1978." The Yukon Kuskokwim Health Corporation,
Bethel, Alaska. 1979.
Konlande, J.E. and Robson, J.R.K., "The Nutritive Value of
Cooked Camas As Consumed By Flathead Indians." Ecology of
Food and Nutrition 1:193-195, 1972.
Kuhnlein, H.V. and Calloway, D.H., "Contemporary Hopi Food
Intake Patterns •. " Ecology of Food and Nutrition 6:159-173,
1977 0
Kuhnlein, H.V. et al., "Composition of Traditional Hopi
Foods." Journal of the American Dietetic Association 75:37-
41, 1979.
Niethammer, C., American Indian Food and Lore. New York,
MacMillan Publishing Company, Inc. 1974.
Nutritive Values of Native Foods of Warm Springs Indians.
Extension Service. Oregon State University. Circular 809.
July 1972.
Renaud, E. B., "Influence of Food on Indian Culture." Social
Forces 10:97-101, 1931.
Stevens, O.R., "Plants Used By Indians in the Missouri River
Area." North Dakota History 32:101-106, 1965.
Toma, R.B. and Curry, M.L., "North Dakota Indians Traditional
Foods." Journal of the American Dietetic Association 76:589,
1980.
Watson, J.B., "How the Hopi Classify Their Foods." Plateau
15:49-52, 1943.
Will, G.F. and Hyde, G.E., Corn Among the Indians of the Upper
Missouri. University of Nebraska Press. 1976.
II.· Suggestions for Counseling
Nutrition counseling techniques for use with Native Americans
are much the same as those for other Americans. However,
Native American cultural attitudes and practices are distinct
from those of other cultural and ethnic groups. Effective
communication is essential to the counseling process.
Therefore, understanding these unique attitudes and practices
can help the nutrition educator. This is especially true if he
or she has a cultural orientation different from Native
Americans and has not worked extensively with tribal
communities.
Keep in mind the various stages that are involved in achieving
planned behavioral change by the learner in the counseling
situation (l)· These stages include the following sequence:
1. Awareness:
Helping the individual, family, or group to identify
problems related to food consumption.
2. Receptiveness:
a) Developing a receptive framework for learning by
establishing the credibility of the nutrition
educator.
b) Becoming aware of the learner's prior perceptions
about food and nutrition.
c) Helping the learner to state the desirable changes in
food practices and to decide which are feasible.
3. Experimentation:
Testing ideas, techniques, and the teaching programs until
acceptable ones are identified.
4. Reinforcement:
Strengthening the learning gained during the
experimentation period.
5. Adoption of Change:
Guiding the decision to accept the change and to put it
into practice.
25
In summary:
"Eating behavior is psychologically motivated, but is
culturally and biologically determined. Any effective
educational program must recognize this interaction even
though it may deal actively with only one part. The
solutions to nutrition problems must be diversified in
approach if they are to have a signfi~ant, overall effect.
Values, attitudes, and beliefs control man's behavior;
therefore, planned change is a deliberate effort to improve
nutrition through intervention, and it occurs by
design. "(~_)
The counseling suggestions that follow are compiled from the
literature and from comments provided by nutritionists and
paraprofessionals who work closely with Native American people
in a variety of geographic locations. We appreciate their
generosity, and hope you find these suggestions helpful.
Cultural Values
In order to communicate easily and to exchange meaningful
information, the counselor needs to understand the client's
cultural values. Not all Native Americans adhere to
"traditional" values. Even for those who do adhere, some
variation from those values is to be expected; therefore,
stereotyping should be avoided. One suggestion is to function
within the Native American cultural framework, and to avoid
injecting non-Native American cultural standards. This
requires knowledge of tribal cultures. Seeking information
directly from Native Americans may be the most effective way to
learn. The following examples adapted from Zintz (3) can help
the educator understand the differences that may exist in
cultural values of Native Americans and other Americans.
Sl1E 'lRADITIOtW.. NATIVE AMERICAN
<llLWRAL VALlES
Traditional Native American families
may be said to have occeptei general
patterr~> as described below:
Hanmny with nature. Nature will
prOITi.de for man if lE will l:ehave
as lE shJul.d ani obey nature's laws.
Treatnerc is sought when ooe is out
of harnony with nature.
Sl1E IDN-NATIVE AMERICAN QJLWRAL
VAllES
N:>rrNative .Amerlcam gererally
place greater value on these
practices:
Mastery over nature. Man nust
harress arrl cause tl'E forces of
nature to "WOrk for him. It is
within our cootrol to conqter
diseases ani to determine our
realth arrl l~evity.
Presert: tine oriert:ation. Life is
concerned with the !Ere ani now.
Accept nature in its season; we
will get throogh the years, one
at a tine. "If the tl:rl.qss I
an doing now are g:xxl, to be
daiq?; these tl:rl.qss all ~ life
will be g:xxt... 1b wait is
considera:l a gocxl quility.
Level of ~pi.ration. Follow in tlE
ways of the old people. Young
people keep quiet because they
lack maturity ani experience. A
~hasis on exper:i.JJ£R:,
innovation, ani change.
Work. <he slnuld wrk to satisfy
present needs. .AcouDJlating uore
than one nee:ls coold be COffi trued
as selfish, stingy, or bigoted.
Shariq?;. <he shares freely -nat
he has. <he traditional practice
was that a man coold prOili.de a
ceremmi.al f~t for the village
if he were able to oo so.
NJn-sdentific exp.lanation for
natural phernnena. Mytrology,
fear of the supernatural, witches,
am sorcery may be used to
explain behavior.
Cooperation. Rema:iniq?; subnerged
within the grrup. Traditionally
a man did net: seek offices or
leadership or att~ to dominate
his people. NJ one CMil8i larrl.
In sports, if he w:>n once, he was
now realy to let c.t:lEIS win.
Ancnymity. .Accept~ grrup
sanctions, keeping life
rootinized. Soft sp>ken am
non-directive. May not
esta:>lish eye conta:t.
ExteOOed family living.
Noninterference with Others
Future tjne oriE!OCation. NJn­Native
.llnerican; essetti.ally look
to tonvrrav. Such item:; as
insurance, savings for college,
am plan; for vacation suggest tle
extent to wch non-Native
ltnerican; rold this value.
Level of ~pi.ration. Clini> tlE
la:lder of success. Success is
neasuroo by a wide rarge of super­latives:
fimt, the nn>t, best,
etc.
Work. Success will be achie.red
by hanl wrk. .AcomJlation of
wealth is gocxl ani a higher
incooe is actively srught.
Savirl?;. Everybcxly slDuld save for
tre future. "A lElilY saved is a
penny earnal." "Put souet~ away
for a rainy day." If you wrk hard
ani save mney, yru' 11 be rewarded.
Scientific exp.lanation for all
behavior. NJtl:rl.qs happen; cootrary
to natural law. 'Here is a scien­tific
explanation for e.rerytl:rl.qs.
Canpetition. <he canpetes to win.
Winning fimt prize all the t~
is a covetoo goal. Assertiveress
ani aggressiveness at tim::s are
acceptable.
Individuality. Each one shapes his
own destiny. Self-realization for
ea:h person is net: limited. ttlclear
family unit is predcmi.nant.
The principle of noninterference with others is shared by many
Native Americans, and needs to be considered in the counseling
situation (!)• This is particularly important when counseling
27
28
Native Americans who still adhere to traditional cultural
values. Acknowledging and complying with this principle can
help the counselor avoid misunderstandings and increase the
effectiveness of the counseling relationship.
According to this principle, Native Americans place great
importance on respect and consideration for others. They
resist what appears to be interference or meddling of any
kind. Suggestions, even discreet ones, and commands are
considered interference.
Many Native Americans also consider their inner thoughts and
personal lives to be private and do not want to share them with
others until those people are known and trusted. In the
counseling situation, this may appear as though the client
lacks interest or is indifferent to the counselor or to the
subject being discussed. Actually, the client is carefully
observing the counselor's manner of presentation and behavior.
Several procedures can increase a person's effectiveness as a
counselor. First, it is important to have patience, which
requires adjusting one's ideas of time to those of "Indian
time," that relates to natural events instead of clocks. Next,
do not "push" concepts and expectations, particularly at the
beginning of a counseling relationship. Avoid the slightest
suggestion that could be perceived as coercive. Rather, while
discussing topics or events of interest, discreetly interject a
few helpful ideas. When the client finally decides to try out
your ideas, recognize the importance of the opportunity to give
a positive solution to the problem. When the client finds the
solution to be successful, word will travel quickly and other
clients will be encouraged to seek your advice.
Preventive Care/Self-Help Approach
Preventive health care, specifically the self-help approach, is
a difficult concept to communicate to Native Americans,
especially to those who adhere to traditional cultural values.
The traditional cultural values of present time orientation and
anonymity may conflict with those ideas which focus attention
on the individual and on his or her changes in behavior which
will gain future benefits. This conflict may be evident
particularly in counseling older members of the tribal
community. Poverty may also influence a person's self-concept.
Some Native Americans have a feeling of hopelessness about
their health in old age. Also, they may not view obesity as
a serious health risk. Fat babies and children may be seen
as more healthy than thin ones. Also, some persons may think
it is a compliment to a host to eat a lot of food. While in
some cultures, it is considered that weight reduction will ·
improve physical appearance, many Native Americans do not think
they would look good if they lost weight. Further, some Native
Americans feel that they have no control over their own bodies
when a disease such as diabetes occurs.
There are methods that may help to change these feelings and
attitudes. It is important to get to know your clients and
their activity level, lifestyle, and living situation. By
understanding the clients' backgrounds and by knowing their
interests, you are better able to help them help themselves.
You can use examples from daily life that draw upon those
interests to help make a point. Storytelling is one way to
provide indirect suggestions or guidance that may help clients
understand that specific behaviors can contribute to improved
health and well-being for them and their families.
Here are some examples of effective storytelling suggested by
nutritionists. "Being obese is like carrying around an extra
heavy backpack day and night and never being able to put it
down. By losing some weight you are reducing the extra burden
or stress on your body and heart, just as though you were
lightening the backpack or taking it off." When talking about
the value of exercise to weight reduction, it may be helpful to
mention that "ranchers keep animals confined in a pen while
they are trying to fatten them up for the market. The animals
would not get fat if they were allowed to roam freely."
Storytelling can be used to teach other concepts. For example,
"Shalako" houses are built in preparation for a Zuni tribal.
ceremony each winter. Usually, the inside of the house is left
unfinished until after the ceremony when the family uses it as
their home. This analogy is used to teach the concept of
proper development of the fetus during pregnancy. Through the
story, the counselor can convey what happens when a child is
born with poor brain development or incomplete growth. The
"shell" of the child is there, but it is incomplete, due to
poor nutrition of the mother during pregnancy.
Referring to the traditional value of harmony with nature may
provide an incentive to avoid overweight. Some tribes consider
overweight a condition which conflicts with the laws of nature;
it is wise "to be in harmony with nature and only eat what one
needs." The counselor can reinforce positive habits by
pointing out good foods and preparation techniques already
being used by the client. This should be done even before
recommending other ways in which the diet may be improved.
This will further encourage the client to assume responsibility
for his or her own well-being.
Use and Preparation of Traditional Foods
In some regions of the country, traditional foods are not
readily available or are served only on special occasions. In
other regions, such foods are still a regular part of the daily
fare.
It is a good idea to talk with clients about the use of
traditional foods. However, the counselor may want to suggest
29
30
that they balance or enhance these foods with nontraditional
foods, if necessary. Be careful not to declare either
traditional or nontraditional foods as "better," but encourage
their complementary use.
In cases where foods are prepared by frying, the counselor may
want to suggest other methods of preparation using less fat,
such as baking, boiling, or broiling. Another suggestion may
be to replace lard and shortening with unsaturated fats (i.e.,
vegetable oils) where possible. These alternative methods of
food preparation can make a significant dietary impact, if they
are accepted. Clients may be interested to know that frying is
a relatively new method of Indian food preparation adopted from
the Europeans. More traditional preparation methods include
barbecuing, steaming, and drying.
Counseling Techniques
Extended Family
The extended family unit is a dominant force in the traditional
Native American community. Therefore, gradually work toward
involving all interested family members when counseling a
client. Individuals respect the opinions of their family
members and depend on them for support. Since opinions of the
older family members are particularly respected, the counselor
may want to talk to grandparents, too.
When extended family members live together, one person will
often prepare the meals for all. Therefore, it is important to
include that person in the counseling sessions, particularly
when counseling older people who do not do their own cooking,
or a pregnant teenager whose mother prepares the meals. The
person who prepares meals also needs to be informed of any diet
modifications, and to be consulted about these changes.
Since several family members may be involved in different
nutrition programs, such as WIC, Head Start, or the Elderly
Nutrition Program, it is important to interact with staff from
these programs. This may help to coordinate and increase the
consistency of the messages given during counseling sessions.
Involving the Community
The community plays a very important role in the lives of most
Native Americans. By involving other community members in
counseling and teaching, especially those who are most
respected in the tribe, you are likely to indirectly reach a
great number of people. This is particularly true with older
individuals and spiritual leaders. Information transmitted by
them will carry more weight because they are so highly
regarded.
For example, one particular concept that has been used
successfully in weight control is a team concept. Several
groups compete with one another to see who can achieve their
weight goal. At the end of the "game," a party is held and a
tribal leader is asked to be the guest speaker and present a
plaque or prize to the winning team. The party involves the
whole community. Generally, low-calorie drinks and snacks are
served.
Scheduling
Although it may be best to counsel Native American clients in a
private place on a one-to-one basis, there are also other ways
of communicating. Some types of information can be transmitted
in casual meetings, such as at the post office or local store.
Sometimes it may be possible to disseminate nutrition
information at gatherings such as powwows or community dinners.
Depending on the orientation of the tribe and individual to the
concept of time, it may be better not to set specific
appointment times. Instead, choose a date, and schedule either
a morning or afternoon, for counseling. This allows the client
flexibility in making arrangements for transportation or child
care. When possible, combine the client's visit with a
doctor's appointment, food distribution pickup, or food stamp
certification. This may prevent an extra trip to the clinic or
a lengthy wait between appointments. More structured
appointments may, however, be necessary in satellite clinics or
other sites that operate only a few days each month.
Single Concept Approach
One of the best ways to provide information is to present only
one main idea or concept at a time. This will help avoid
confusion that may be caused by providing too much detail or
nonessential information all in one session. Most nutrition
educators who work with Native Americans recommend a patient,
nonthreatening approach. They establish priorities according
to the information that is most important to the client at that
particular time.
At a later meeting the counselor can fill in details and
provide supplementary information. Remember that graphics and
concrete examples help to achieve simplicity and a better
understanding by the client. Also, written materials
appropriate to the reading level of the client can help
reinforce the concepts presented.
32 ,
Eye Contact
Some groups of Native Americans traditionally do not make eye
contact with the speaker. This-- lack of contact should not be
interpreted as a sign of meekness or humility. Rather, in most
instances, it is a demonstration of respect for others. When
in a one-to-one situation, especially with an older person, it
may make the person uncomfortable to meet your eyes. Do not
press the issue. The suggestion has been made that the
counselor first talk with the client about his or her family or
community events, which may help both you and the client relax.
As a general practice, counselors may use eye contact, but they
should realize that it may not be returned. In time, you may
achieve eye contact and this may be an important signal that
the message has been received.
Vocabulary
Avoid technical terms and medical jargon when counseling. When
using such terms, be sure to explain them in easy-to-understand
language. Do not hurry, and take time to be sure that the
client understands. The use of repetition, examples, and
analogies is also helpful when explaining something that may be
difficult for a client to grasp. One example of this method is
explaining the concept of energy from food by relating it to
the gasoline that runs a car. Another analogy can be made to
cars: "Cars need checkups to run smoothly, and so do people."
Again, remember that graphics and pictorial representations are
useful when trying to simplify a difficult concept.
It is important to allow clients to make the decisions
regarding their own health care. One should treat adults with
lower education levels as adults, but simplify the terminology.
Clients should be given enough information to allow them to
make informed health decisions, along with suggestions as to
what changes they might make to improve their health and to
decrease their risk of disease.
1
-~
;\
References
1. Good Tracks, J .G., "Native American Non-Interference."
Social Work 18(6):30-34, 1973.
2. "Position Paper on Nutrition Education for the Public."
Journal of the American Dietetic Association 62(4):429-430,
1973.
3. Zintz, M.V., Director, The Indian Research Study: The
Adjustment of Indian and Non-Indian Children in the-public
Schools of New Mexico. 1957-1960 Final Report.
Albuquerque, New Mexico, College of Education, University
of New Mexico, 1961(?).
33
..
34
Bibliography
Counseling Skills and Nutrition Education
Andrews, B.J., "Interviewing and Counseling Skills." Journal
of the American Dietetic Association 66:576, 1975.
Barlow, D.H. and Tillotson, J.L., "Behavioral Science and
Nutrition: A New Perspective." Journal of the American
Dietetic Association 72:368-371, 1978.
Bryde, J.F., Modern Indian Psychology, Vermillion, South
Dakota, The Institute of Indian Studies. University of
South Dakota. 1971.
Culture Bound and Sensory Barriers to Communication With
Pa tients: Strategies and Resources for Health Education.
Di vi sion of Health Education, Center for Health Promotion and
Education, Centers for Disease Control, Atlanta, Georgia
30333, 1982.
Danish, S.J. et al., "The Anatomy of a Dietetic Counseling
Interview." Journal of the American Dietetic Association
75:626-630, 1979.
Diet Therapy Section Committee, The American Dietetic
Association, "Guidelines for Diet Counseling." Journal
of the American Dietetic Association 66:571-575, June 1975 •
Evans, R.I. and Hall, Y., "Social-Psychologic Perspective in
Motivating Changes in Eating .Behavior." Journal of the
American Dietetic Association 72:378-383, 1978.
Frankle, R.T. and Owen, A.Y., "Community Nutrition Programs:
Strategies at the Local Level," in Nutrition in the
Community, The Art of Delivering Service, Chapter 5,
pp. 132-136, St. Louis, Missouri: C.V. Mosby Co., l978.
Gifft, H.H. et al., Nutrition, Behavior and Change. Englewood
Cliffs, New Jersey: Prentice-Hall, 1972.
Glanz, K., "Dietitians' Effectiveness and Patient Compliance
with Dietary Reg'imens: A Pilot Study." Journal of the
American Dietetic Association 75:631-636, 1979.
Hochbaum, G.M., "Human Behavior and Nutrition Education."
Nutrition News 40 (1), National Dairy Council, 1977.
Leverton, R.M., "What Is Nutrition Education?" Journal of the
American Dietetic Association 64:17-18, 1974.
Lowenburg, M.E., "The Development of Food Patterns." Journal
of the American Dietetic Association 65:263-268, 1974.
"Nutrition Services in State and Local Public Health Agencies.
A Policy Paper." Public Health Reports 98:7-20, 1983.
U.S. Department of Health Education and Welfare, Office of
the Assistant Secretary for Health and the Surgeon General,
Healthy People, The Surgeon General's Report on Health
Promotion and Disease Prevention. DHEW Publication No.
(PHS) 79-55071, U.S. Government Printing Office, Washington,
D.C., 1979.
Sherman, A.K., Lewis, K.J., and Guthrie, H.A., "Learner
Objectives for a Nutrition Education Curriculum." Journal of
Nutrition Education 10:63-68, 1978.
Shortridge, R.C., "Learner Success or Failure?" Journal of
Nutrition Education 8:18-20, 1976.
Simonds, S.K., "Psychosocial Determinants of Dietitians'
Listening Patterns." Journal of the American Dietetic
Association 63:615-619, 1973.
Strickland, B. and Arnn, J., "Orientation on Understanding
Interpersonal Influence." Journal of the American Dietetic
Association 71:229-234, 1977.
Zifferblatt, S.M. and Wilbur, C.S., "Dietary Counseling: Some
Realistic Expectations and Guidelines." Journal of the
American Dietetic Association 70:591-595, 1977.
35
Ill. Resources for Nutrition Education
The resources that follow were selected based on their
potential usefulness to those people who work with Native
Americans. Two categories are included: 1) technical
assistance resources, and 2) sources for consumers and
professionals. We recognize that many people work on
reservations that are in remote areas and may not have access
to resource information that is available to those working in
nonreservation settings. Thus, some additional detailed
information is included regarding the technical assistance
resources. Extensive listings of regional and State offices of
various agencies are given in the appendixes.
The technical assistance resources include those related to
government-sponsored food assistance and nutrition education
programs, health agencies that serve Native Americans in a
variety of settings, and several other related agencies. For
each resource listed a description is given of the types of
information and assistance available to counselors for
developing nutrition education services for Native Americans.
The information sources for consumers and professionals provide
services and materials on a national, rather than local, basis.
These resources are from both government supported services and
private sector organizations. The government-supported services
are primarily information centers and clearinghouses. The
private sector organizations represent professional, nonprofit,
· and consumer-oriented groups. Taken together, they represent a
broad spectrum of perspectives on nutrition education topics
and issues, with an emphasis on those that are most relevant to
Native American concerns. Other information sources serving
particular cities or geographic areas are available and can be
located through local directories or referral networks.
Technical Assistance Resources
Food Assistance and Nutrition Education Programs ·
1. Nutrition and Technical Services Division
Food and Nutrition Service, USDA
3101 Park Center Drive, Room 602
Alexandria, Virginia 22302
( 703) 7 56-3554
(See appendix A for addresses of Food and Nutrition Service
(FNS) regional offices.)
38
The Food and Nutrition Service, u.s. Department of Agriculture,
administers 10 food assistance programs: Food Stamp Program,
National School Lunch and School Breakfast Programs, Child Care
Food Program, Summer Food Service Program, Special Milk
Program, Special Supplemental Food Program for Women, Infants,
and Children (WIC), Commodity Supplemental Food Program (CSFP),
Food Distribution Program, and the Nutrition Education and
Training (NET) Program. The FNS regJonal offices can provide
specific information about each of these programs.
The nutritionists and food service/food technology specialists
of the Nutrition and Technical Services staffs in the
headquarters and regional offices provide consultation and
technical assistance to State and local program staffs. They
also prepare program guidance and technical assis.tance
materials on nutrition education and food service topics.
Additionally, they coordinate with other USDA agencies and with
several agencies of the Department of Health and Human
Services, including the Indian Health Service and the Division
of Maternal and Child Health of the Public Health Service.
2. Home Economics and Human Nutrition
E.~{ t ens ion Service, USDA
~ outh Agricultural Building, Room 3443
14th and Independence Ave., S.W.
Washington, D.C. 20250
(202) 447-2908
(See appendix B for addresses of State Extension Service
offices.)
The Extension Service located at the land-grant university in
each State is cooperatively funded, administered, and managed
by Federal, State, and local governments. At the Federal
level, a small staff of program leaders and specialists
administer and coordinate the various programs in the
Federal/State/county partnership, providing national leadership
and cooperation with related agencies.
Extension home economics program leaders and specialists at
State land-grant colleges and universities give direction and
backup support to local county extension home economists.
State staff provide the county staff with research results and
current information on topics of interest and concern to
families. They also provide in-service training and teaching
materials to county field staff. Field staff then adapt and
apply that information to meet identified local needs with
special emphasis on food and nutrition educational services and
materials for homemakers and families. The Expanded Food and
Nutrition Education Program (EFNEP) is a special Extension
Service program that employs paraprofessional aides to teach
low-income homemakers on a one-to-one basis, or in small
groups, how to improve their families' diets with their
existing resources.
To obtain service, the first contact should be with the county
agent or county home economist in the county Extension Service
office. EFNEP is also a source of information. If there is no
EFNEP operating in the county Extension Service office,
inquiries should be made at the State Extension Service office
located at the land-grant university.
Health Agencies
Health Resources and Services Administration, Public Health
Service, Department of Health and Human Services
1. Indian Health Service, DHHS
Parklawn Building, Room 5A-10
5600 Fishers Lane
Rockville, Maryland 20857
(301) 443-1114
(See appendix C for addresses of regional offices.)
The Indian Health Service (IHS) provides comprehensive health
services and programs. The Nutrition and Dietetics Branch has
program responsibility for total education in nutrition and
nutritional care services. This is accomplished through
Area/Program Offices and Service Unit personnel who are
excellent resources for technical assistance.
2. Division of Maternal and Child Health
Bureau of Health Care Delivery and Assistance
Health Resources and Service Administration, DHHS
Parklawn Building, Room 6-05
5600 Fishers Lane
Rockville, Maryland 20857
(301) 443-2370
(See appendix D for addresses of regional offices.)
The Division helps States to maintain and improve the health of
mothers and children through the Maternal and Child Health
(MCH) Services Block Grant and through special projects of
regional and national significance. The public health
nutritionists in the central and regional offices provide
leadership in developing public health nutrition services.
They also provide nutrition consultation and technical
assistance to State and local health agencies serving mothers
and children, and provide direction and assistance to
educational institutions in the development and implementation
of short- and long-term training programs related to nutrition
and maternal and child health. Additionally, they serve as
liaison with USDA staff, including WIC and other staff of the
Food and Nutrition Service.
39
40
Tribal Corporation Health Departments
(See appendix C for addresses of regional offices.)
Through Public Law 93-638, Indian Tribes and Alaska
Corporations have the authority to administer their own health
departments funded by the Indian Health Service. Nutrition
services are part of the overall health care delivery. For
specific Tribal Health Departments, contact either the Tribal
Government Office or the Nutrition and Dietetics Branch Chief
in the specific areas.
State and Local Health Departments 1
(See appendix E for addresses.)
Nutritionists who work in State health agencies primarily
provide technical assistance and consultation to key
administrative and professional staff in the agency,
administrators and staff of local health agencies,
organizations, and institutions. In some State agencies,
public health nutritionists also provide or contract for the
direct delivery of nutrition services to the public. At the
local level, public health nutritionists act as specialists in
specific programs that serve defined populations or as
generalists responsible for providing a broad array of services
in assigned geographic areas.
Other Agencies
1. Office of State and Tribal Programs
Administration on Aging
Department of Health and Human Services
330 Independence Ave., S.W.
Washington, DC 20201
(202) 245-0011
(See appendix F for addresses of regional offices.)
The Administration on Aging (AOA) administers the Older
Americans Act, under which congregate and home delivered meal
service is provided to older persons. State agencies on aging
receive an allocation of funds based on a formula and manage
the operation of nutrition services within the State. Under
Title VI of the Older Americans Act the AOA makes direct grants
to tribal governments for the development of aging services for
older citizens including congregate and home delivered meal
service.
For consultation and assistance on State-operated nutrition
services under the Older Americans Act, contact the appropriate
State agency on aging or regional offices of the AOA listed in
appendix F. For information and assistance provided under
Title VI of the Older Americans Act, contact the Office of
State and Tribal Programs, AOA, Washington, D.C.
2. Office of Public Information and Education
Administration for Children, Youth, and Families (ACYF),
DHHS
P.O. Box 1182
Washington, D.C. 20013
( 202) 7 55-7724
(See appendix H for addresses of regional offices.)
The Office serves as the central informational resource for the
ACYF. Inquiries are answered using publications from various
offices of the ACYF on the subjects of child abuse, day care,
domestic violence, and Head Start. This Office publishes the
journal, Children Today (bimonthly), with articles by and for
those whose jobs and interests are children, youth, and
families.
3. Center for Health Promotion and Education
Centers for Disease Control
1600 Clifton Rd., Bldg. 3, Room SSB 33A
Atlanta, GA 30333
(404) 329-3492 or (404) 329-3698
The Center provides leadership and program direction for the
prevention of disease, disability, premature death, and
undesirable and unnecessary health problems through health
education.
4. Office of Consumer Affairs, Consumer Inquiries Staff
Food and Drug Administration (FDA), DHHS
5600 Fishers Lane (HFE-88)
Rockville, MD 20857
(301) 443-3170
(See appendix G for addresses of regional offices.)
Consumer Affairs Officers are available for technical
assistance
inquiries.
variety of
additives,
to professionals and responses to consumer
They also provide consumer publications on a
topics such as vitamins and minerals, food
food safety, and food facts and fallacies.
41
42
Information Sources for Consumers and Professionals
Government Supported Resources
1. Consumer Information Center
Pueblo, CO 81009
(202) 566-1794
The Center distributes consumer publications on topics such as
children, food and nutrition, health, exercise, and weight
control. The Consumer Information Catalog, published
periodically, is available free from the Center and must be
used to identify publications being requested.
2. Food and Nutrition Information Center (FNIG)
National Agricultural Library Building, Room 304
Beltsville, MD 20705
(301) 344-3719
The Center provides information to professionals interested in
nutr tion education and food service management. The Center
acquires books, journals, and audiovisual materials ranging
from research literature to children's books. Reference
responses are provided to all inquirers. Those who are
eligible for lending privileges include individuals employed by
Federal and State Governments and anyone associated with USDA
programs.
3. High Blood Pressure Information Center
120/80 National Institutes of Health
Bethesda, MD 20205
(301) 496-1809
The Center provides information on the detection, diagnosis,
and management of high blood pressure to consumers and health
professionals.
4. National Center for Education in
Maternal and Child Health
3520 Prospect St., N.W., Suite 1
Washington, DC 20057
(202) 625-8400
The Center provides information on maternal and child health to
both consumers and health professionals.
5. National Clearinghouse for Alcohol Information
P.o. Box 2345
Rockville, MD 20852
(301) 468-2600
The clearinghouse gathers and disseminates current information
on alcohol-related subjects to the public, as well as health
professionals. A variety of publications on alcohol abuse are
available.
6. National Diabetes Information Clearinghouse
Box: NDIC
Bethesda, MD 20205
(3l)l) 468-2162
The clearinghouse collects and disseminates information on
patient education materials and coordinates the development of
materials and programs for diabetes education.
7. National Health Information Clearinghouse
P.O. Box 1133
Washington, DC 20013-1133
(800) 336-4797; (703) 522-2590 (in VA)
The clearinghouse helps the public locate health information
through identification of resources and an inquiry and referral
system. Inquirers are referred to appropriate health resources
that, in turn, respond directly to them.
8. President's Council on Physical Fitness and Sports
450 5th St., N.W., Suite 7103
Washington, DC 20001
(202) 272-3430
The Council conducts a public service advertising program and
cooperates with governmental and private groups to promote the
development of physical fitness leadership, facilities, a nd
programs. The Council produces informational materials on
exercise, school physical education programs, sports, and
physical fitness for youth, adults, and the elderly.
Private Sector Organizations
The following agencies and organizations are possible sources
of nutrition and health information in the private secto r .
Many other qualified sources of such information exist ,
including tribal and State and local health agencies, whi ch
generally serve as comprehensive repositories of consumer­oriented
health information. Most of the groups listed here
offer free or low-cost literature. The statements or
viewpoints of the organizations listed are not necessarily
supported by the USDA.
1. American Academy of Pediatrics
1801 Hinman Avenue
Evanston, IL 60204
(312) 869-4255
43
44
2. American Alliance for Health, Physical
Education, Recreation, and Dance
Promotions Unit
1201 Sixteenth Street, N.W.
Washington, DC 20036
(202) 833-5534
3. American College of Obstetricians and Gynecologists
Resource Center
Suite 2700
1 East Wacker Drive
Chicago, IL 60601
(312) 222-1600
4. American College of Sports Medicine
1440 Monroe Street
Madison, WI 53706
(608) 262-3632
5. American Dental Association
Bureau of Health Education and Audiovisual Services
Chicago, IL 60611
(312) 440-2593
6. American Diabetes Association, Inc.
2 Park Avenue
New York, NY 10016
(212) 683-7444
7. American Heart Association
7320 Greenville Avenue
Dallas, TX 75231
(214) 750-5300
8. American Home Economics Association
2010 Massachusetts Avenue, N.W.
Washington, DC 20036-1028
(202) 862-8300
9. American Indian Health Care
Association
245 E. 6th Street, Suite 815
St. Paul, MN 55101
(612) 293-0233
10. American Lung Association
(contact your local American
Lung Association)
11. Blue Cross and Blue Shield Associations
Public Relations Office
840 North Lake Shore Drive
Chicago, IL 60611
(312) 440-5955
12. La Leche League International, Inc.
9616 Minneapolis Avenue
Franklin Park, IL 60131
(312) 455-7730
13. National Center for Health Education
211 Sutter Street (4th Floor)
San Francisco, CA 94108
(415) 781-6144
14. National Council on Alcoholism
733 Third Avenue
New York, NY 10017
(212) 986-4433
15. National Foundation - March of Dimes
Public Health Education Department
1275 Mamaroneck Avenue
White Plains, NY 10605
(914) 428-7100
16. National Indian Health Board
1602 S. Parker Road, Suite 200
Denver, CO 80231
(303) 7 52-0931
17. Society for Nutrition Education
1736 Franklin Street, Suite 900
Oakland, CA 94612
(415) 444-7133
18. The American Dietetic Association
430 North Michigan Avenue
Chicago, IL 60611
(312) 280-5000
19. The Nutrition Foundation, Inc.
Suite 300
888 Seventeenth Street, N.W.
Washington, DC 20006
(202) 872-0778
Appendix A
Regional Offices
Food and Nutrition Service
U.S. Department of Agriculture
Mid'"'1\tlantic Region
Director
t-Urition am Teclmical Services
Food and l'iltrition Service, USDA.
Mid-Atlantic Regional Office
Mercer Corporate Park
Corporate Blvd. <N 02150
Trenton, NJ 00650
(600) 259-5010
Miclwes t Region
Director
tiltrition am Teclmical Services
Food and l'iltrition Service, USDA.
Miclwest Regional Office
50 E. Washington Street
Chicago, IL 6())02
(312) 886-5301
Mountain Pl.a.i.ffi Region
Director
N.Jtrition ard Technical Services
Food and l'iltrition Service, USDA.
Mountain Pl.a.i.ffi Regional Office
2420 West 26th Avei.Ule
DeJlller, 00 80211
(303) 844-5116
N:>rt lEa3 t Region
Director
Nutrition am Technical Services
Food and Nltrition Service, USD\
N:>rt!Ea3t Regional Office
33 N:>rth Averue
&.lrli~n, MA 01803
(617) 272-8833
Director
N.Jtrition am Teclmical Services
Food and l'iltrition Service, USD\
&xlt!Ea3t Regional Office
1100 Spring Street, N.W.
Atlanta, GA 30300
(404) 881-4028
S:>utllvest Region
Director
N.ltrition ani Technical Services
Food and l'iltrition Service, USn\
&xltllvest Regional Office
1100 ~ce Street
lhllas, TX 75202
(214) 767-{)204
Western Region
Director
N.ltrition ani Technical Services
Food and l'iltrition Service, USD\
Western Regional Office
550 Kearny Street
San Frarrlsco, CA 94108
(415) 556-4939
47
State Offices
Extension Service
Appendix 8
U.S. Department of Agriculture
County Extension Service offices are located in the county seat
town, generally in the courthouse, post office, or other
government buildings. The Extension Service is usually listed
under county government in the telephone directory.
For further assistance in locating the county Extension Service
office, write to the appropriate State Director of the
Extension Service as listed below:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of
Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Auburn University, Auburn 36849
Alabama A&M University, Normal 25762
Tuskegee Institute, Tuskegee 36088
University of Alaska, Fairbanks 99701
University of Arizona, Tucson 85721
University of Arkansas, Little Rock 72203
University of Arkansas, Pine Bluff 71601
University of California, Berkeley 94720
Colorado State University, Fort Collins
80523
University of Connecticut, Storrs 06268
University of Delaware, Newark
Delaware State College, Dover
19711
19901
University of the District of Columbia,
Washington, D.C. 20005
University of Florida, Gainesville
Florida A&M University, Tallahassee
University of Georgia, Athens 30602
32611
32307
The Fort Valley State College, Fort Valley
31030
University of Guam, Agana 96910
University of Hawaii, Honolulu 96822
University of Idaho, Moscow 83843
University of Illinois, Urbana 61801
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
Purdue University, West Lafayette 47907
Iowa State University, Ames 50011
Kansas State University, Manhattan 66506
University of Kentucky, Lexington 40506
Kentucky State University, Frankfort 40601
Louisiana State University, Baton Rouge
70803
Southern University and A&M College, Baton
Rouge 70813
University of Maine, Orono 04473
University of Maryland, College Park 20742
University of l1aryland, Eastern Shore,
Princess Anne 21853
University of Massachusetts, Amherst 01003
Michigan State University, East Lansing
48824
University of Minnesota, St. Paul 55108
Mississippi State University, Mississippi
State 39762
Al~orn State College, Lorman 39096
University of Missouri, Columbia
Lincoln University, Jefferson City
Montana State University, Bozeman
65211
65101
59715
University of Nebraska, Lincoln 68583
University of Nevada, Reno 89557
University of New Hampshire, Durham 03824
Rutgers State University, New Brunswick
08903
New Mexico State University, Las Cruces
88003
New York State College of Agriculture,
Ithaca 14853
North Carolina State University, Raleigh
27650
North Carolina A&T State University,
Greensboro 27420
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
North Dakota State University, Fargo 58105
The Ohio State University, Columbus 43210
Oklahoma State University, Stillwater 74078
Langston University, Langston 73050
Oregon State University, Corvallis 97331
The Pennsylvania State University,
University Park 16802
University of Puerto Rico, Mayaguez 00708
University of Rhode Island, Kingston 02881
Clemson University, Clemson 29631
South Carolina State College, Orangeburg
29115
South Dakota State University, Brookings
57006
University of Tennessee, Knoxville 37901
Tennessee State University, Nashville 37203
Texas A&M University, College Station 77843
Prairie View A&M College, Prairie View
77445
Utah State University, Logan 84321
University of Vermont, Burlington 05401
Virginia Polytechnic Institute and State
University, Blacksburg 24061
Virginia State College, Petersburg 23803
College of the Virgin Islands, St. Croix
00850
Washington State University, Pullman 99164
West Virginia University, Morgantown 26506
University of Wisconsin, Madison 53706
University of Wyoming, Laramie 82070
For information on the Extension Service at the national and
interna_~ional level, write to the Extension Service, U.S.
Department of Agriculture, Washington, DC 20250.
51
Administrative Offices
Indian Health Service
Appendix C
U.S. Department of Health and Human Services
lfad:J.uarters
I.rrlian Health Service, IHIS
Parkl.awn Buildiq?;
5600 Fisl'Ers Lare
Pockville, .MD 20057
Area Offices
Arerdeen Area
Indian IEal.t:h Service, Illllli
Feieral Bui.ldiq1;
115 4th Averue Soutreast
Aberdeen, SD 57401
Alaska Area
Niti ve Ieilth Service, IIIHS
P.O. Box 7-741
Ancmrage, AK 99510
Alb.JqrenJ.re Area
Indian IEal.t:h Service, IEHS
Roan 4005, Feieral Buildiq?; &
u.s. Coortlu.lse
500 <bld Averue, S. W.
Alhlqrerque, tM 87101
Billiq?;S Area
Irxlian IEal.t:h Service, IEHS
P.O. Box 2143
Billings, Mr 59103
Navajo Area
Irxlian IEal.t:h Service, IEHS
P.O. Box G
Winlow Rock, AZ 86515
Ckl.alnna City Area
Irxlian Ieilth Service, IIIHS
215 Dean A. McGee Street, N.W.
Ckl.atDna City, CK 73102-'3477
Ph>enix Area
Indian IEal.t:h Service, IEHS
3738 N. 16th Street, Suite A
Ph:>enix, AZ 85016-5981
O>ntact:
Chief, tiltrition arxl Dietetics Branch
(301) 443-1114
N.ltrition Comultant
(605) 225-0250
tiltrition Coffiultant
( 907) 279-6661
N..itrition Comultant
(505) 766-2151
N.ltrition Comultant
(406) 657-6403
N.ltrition Comultant
(602) 871-5811
N.ltrition Comultant
(405) 231-4796
N.ltrition Comultant
(602) 241-2052
54
furtlarrl Area
Indian Health Service, IllliS
Feieral Buildi~, Roan 476
1220 S.W. 3rd Avenue
Portlarrl, CR 97204-2892
Program Offices
Banidji Indian Health
Program Office, .lllliS
203 Feieral Buildi~
P.O. Box 489
Banidji, MN 56601
California Indian Health
Program Office, !HIS
2999 Fulton Avenue
Sacranento, CA 95821
Nashville Indian Health
Program Office, rnHS
1101 Kennit Drive, Suite 810
Nashville, 'IN 37217-2191
Nutrition an:l Dietetics
Training Cent:er
Indian Health Service, lliHS
P.O. Box 5558
Sart:a Fe, N1 87502
tbtri tion O::msultant
(503) 221-2020
N.ltri-tion O::m>ultant
(218) 751-7701
N.ltrition Comultant
(916) 484-4836
N.ltrition Comultant
(615) 251-5104
N.ltrition Comultant
(505) 988-6470
Appendix D
Regional Nutrition Consultants
Division of Maternal and Child Health
Hureau of Health Care Delivery and Assistance
Health Resources and Service Administration
Public Health Service
U.S. Department of Health and Human Services
Region I
Regional N.ltrition Consultant
PHS/HHS/Family/Child lf.alth ani
Special Pr<wans
JFK Fe<Eral Bldg., ~. 1401
Boston, MA. 02.a)3
(617) 22H668
Region III
Regional N.ltrition Consultaoc
PHS/HHS/Di. vision of lf.alth
Services
P.O. Box 13716
3535 Market Street
4127 Gateway Bldg.
Philadelphia, PA 19104
(215) 596-6686
Region V
Regional l'btrition Consultant
Maternal arrl Child lfalth
PHS/HHS/Bureru of Carm.mity
~alth Services Delivery
300 South Wacker Drive, 34th Fl.
Chicago, IL 600J6
(312) 353-1700
Region VII
Regional N.ltrition Consultant
PHS/HHS/Di.vision of lfalth
Services lhli very
601 East 12th St., 5th Fl. West
Kansas City, MO 64106
(816) 374-2916
Region II
Regional N.ltrition Consultant
Family lf.alth Branch
PHS/HHS/Division of !falth lhlivery
Federal Bldg.
26 Fa:ieral Plaza, Rm. 3300
New York, Ni 10278
(212) 264-2547
Region IV
Regional N.ltrition Consultant
PHS/HHS/Di.vision of lf.alth Services
101 Marietta Towers, I®. 1202
Atlanta, Gl\ 30323
( 404) 221-5254
Region VI
Regional N.ltrition Consultant
PHS/HHS/Division of lfalth
Services Delivery
1200 Main Tower, I®. 1835
Mlas, TX 7 5202
(214) 767-6578
Region VIII
Regional N.ltrition Consultant
PHS/HHS/Fam:ily lfal.th Branch
1961 Stout Street, I®. 1194
~nver, CO 80294
(303) 837-3203
55
56
Region IX
Regional N.ltrition Q:msultant
PHS/HHS/Di.vision of I£alth Service
50 lh:ited N:ltions Plaza, I®. 341
San Frarrisco, CA 94102
(415) 556-8673
Region X
Regional N.ltrition U:>nsultant
PHS/HHS/Fani.ly ani Child I£alth Pr~an
Arcade Plaza Bldg.
1321 Secorrl Averue, Mail Stop 833
Seattle, ~A 98101
(206) 442-1021)
Appendix E
Directors of Nutrition Services in State Health Agencies
Note: For names and addresses of local health department
nutritionists, contact the State nutritionist for the
area concerned.
Alabama
rbtrition Services Mn:i.ni.strator
Adni.ni.st:ration of IDeal Health
Services
Alabama Dept. of Public Health
State Office Building
Mort:~ry, AL 36103
(205) 832-6776
Alaska
<lrl.ef riltritionist
Alaska· Ilepart.nJart: of Health
arrl &>cial Services
Pouch H-068
Juneau, AK 99801
('X>7) 465-3100
Arizona
Chief, Burea1 N.Jtrition Services
Arizona Dept. of Health Services
3424 N. Cert:ral Averue, Suite 300
Ftnenix, AZ 85012
( 602) 255-1215
Arkansas
N.Jtrition Su]:ervisor
Arkansas Dept. of Health
4815 West Markhan Street
Little Rock, AR 72201
(501) 661-2250
California
N.ltrition Comultart:
California ~part:DEnt of Health
714 "p" Street
SocraJEnto, CA 95814
(916) 312:-4787
Colonrlo
rbtrition CoiBUltant
Colomio Dept. of Health
4210 East 11th Avenue
Ienver, CO 80220
(303) 32G-8333, ext. 4407
Connecticut
Qlief, rbtrition Section
Umwnity Health Division
Connecticut State ~pt. of Health
79 Elm Street
Hartford, cr 06115
(203) 566-2520
Director, N.Jtrition Section
Division of Public Health
Iept. of Health ani &>cial Services
Jesse Cooper Bldg.
lbver, 1E 19~ 1
(302) 678-4725
District of Columbia
N.Jtrition Coordinator, MCH
Dept. of lbnan Services
1875 Connecticut Ave., N.W., 8th Fl.
Washington, OC 20009
(202) 673-{)707
Florida
Su]:ervisor, N.Jtrition lliit
Florida Dept. of Health and
Rehabilitative Services
1323 w~ Boolevard
Thllahassee, FL 32301
(<x>4) 488-6565
57
58
Georgia
Qlief t'Utritionist
Division of Physical Health
Georgia ~t. of lllnan Resources
47 Trinity Ave., S.W., I®.. 354-S
Atlanta, GA 30334
( 404) 656-4826
Chief, tbtrition Branch
Hawaii State ]):!pt. of fealth
P.O. Box 3378
lbnolulu, HI 95801
(800) 548-6552
Idaro
l'Altrition Comultant
Bureau of Otild H:alth
Idam ]):!pt. of lfalth ani
Welfare
State lbuse
Boise, ID 83720
( 200) 384-3471
illinois
Nutrition Section Coordinator
illinois ]):!pt. of 1:\Jblic
lealth
535 West Jefferron Street
Spri~field, IL 62761
(312) 293-6840
Wiana
Director, l'Utrition Di.vision
Wiana State Board of lfalth
1330 West Michigan Street
Wianapolis, IN 46206
(317) 63:Hl206
Director, N.ltrition ani Di.etary
Mal:!ageuEnt Sect ion
Iowa State ~t. of lfalth
Incas State Office Bldg.
Ia:> Moines, IA 50318
(515) 281-4124
Kansas
t'Utrition G.>multant
Bureru of MCH
I<ansas ]):!pt. of lfalth & Fnvironnent
Forres Field, Bldg. 740
Topeka, KS 66620
(913) 862-9360
Kentucky
Administrator, l'«Jtrition Section
Di. vision of MQl Services
Kentucky ~t. of Buran Resources
?J5 Fast Main Street
l<rankfort, KY 4())01
(502) 564-3527
I.J:>uisiana
Administrator, N.ltrition Services
I.J:>uisiana ]):!pt. of lEalth arrl
Human Resources
Office of lealth Services &
EhvirCllllEII:al Q.lali. ty
P.O. Box 60630
tew Orleam, IA 70160
(504) 568-5())5
Maine
tbtrition Comultant
]):!pt. of lllnan Services
State lbuse
Augusta, ME 04333
(2fJ7) 289-2546
Marylarrl
Qlief, N.ltrition Services
Chronic Di.seare Control
Mary l.an:l. State ~t. of
lealth ani Mental Hygiene
201 West Preston Street
BaltinDre, MD 212fJ1
(301) 383-6521
Massaclusetts
Public lealth N.ltritionist
Massaclusetts ]):!pt. of Public lealth
600 Washi.Jl?;ton Street
&5ton, MA 02111
(617) 727-2642
Michigan
Qli.ef N.ltritionist
Bureru of Personal ~al.th Service
Michigan ~t. of fublic ~alth
p .o. fux 30035
lansing, MI 48909
(517) 374-9500
Mirmesota
Sup:!rvisor of N.ltritionists
Minnesota ~t. of !Ealth
717 Delaware Street, S.E.
Minneapolis, MN 5.5440
( 612) 296-5437
Mississippi
Coordinator of i'btrition Services
Mississippi State Board of IEalth
P. 0. fux 1700
Jackson, MS 39205
(601) 354-6600
Missouri
Director, Bureru of i'btrition
Ill vision of IEalth
Mis~uri Iept. of &>cial. Service
P. 0 • .&>x 570
Jefferson City, M1 65102
(314) 751-2713
Mort: ana
N.ltrition Consultant
Maternal & Child ~al.th Bureru
State Dept. of IEalth an::l
Fnvir()[lrert:al Sciences
~Bldg.
Helena, MI' 59601
( 406) 449-2554
Nebraska
Dlrector, riltrition Ill vision
Nebraska Iept. of ~th
P.O. Box 95007
lincoln, NB 68500
(402) 471-2781
tevada
i'htrition Consultant
Nevada Dlvision of IEalth
Capitol ilinplex, Kinkead Bldg.
505 East Kirg Street
Carson City, NV 89710
(702) 885-4797
tew llalq>shire
i'btritionist, Public !Ealth
N.ltrition Program
tew Hampshire Division of Public realth
Hazen Drive
Coocord, NH 03301
(603) 271-4550/4551
tew Jersey
l'btrition Comultant
New Jersey State Iepart:nent of IEalth
John Fitch Way, fux 1540
Trenton, NJ 00615
( 60)) 292-8106
New Mexico
!Eai, N..Itrition Unit
IEalth Services Ill vision
~th & Fnvir()[lrent Iept.
P.O. Box 968
Sart:a Fe, N1 87503
(505) 827-3201, ext. 485
tew York
i'htrition Comultant
Dlvision of Child ~alth
New York State Iept. of !Ealth
Flnpire State Plaza - To>wer Bldg.
Al.bmy, NY 12237
(518) 474-4374
N:>rt h Carolina
~, N.ltrition and Dletary
Services Braoch
Dlvision of IEalth Services
N:>rth Carolina Iept. of Hunan Resources
P.O. fux 2091
Raleigh, l'C 27602
(919) 733-2351
59
, ..
60
N.:>rt h D:lkota
Di.etitian, Division of Materoal
& Child ~th
N.:>rth Dakota State I£al.th ~·
State Capitol Buildi~
Bismarck, ND .58505
( 701) 224-2493
Chio
Chief, tbtrition Division
Chi.o ~t. of IEalth
266 N. Fourth Street, Box 118
Colunbus, OH 43216
(614) 271-4676
Cklalnna
Director, ~trition Division
Cklalnna State ~t. of teal.th
N.E. l():h Street & Stonewel.l
Cklalnna City, (]( 73105
(405) 271-4676
Oregon
~trition Consultant
Oregon State Division of teal.th
P. O. Box 231
Fbrtl.arrl, <R 97207
(503) 22.9-5745
Pennsylvania
Director, Ill vision of :tbtrition
Pennsylvania ~t. of J£alth
604 ~th & Welfare Bldg.
Harrishlrg, PA 17120
(717) 787-5376
ROOde Isl.arrl
Chief, .Public ~th tbtrition
ROOde Island ~pt. of J£alth
7 5 D:lvis Street
Provi~nce, RI 02~
(401) 277-3003
!blth Carolina
Director, Division of ~trition
!blth Carolina Dept. of teal.th
& Ehvirooent:al Control
2600 &ill. Street
Columbia, oc 29201
(803) 758-5443
South Dakota
tbtritionist/Wl Pr~an
S:>uth Dakota ~pt. of !Ealth
Pierre, SD 57501
(605) 773-4794
Thnressee
Director, Dlv. of ~trition Services
R. S. Gass State Office Bldg.
Ben Allen Road
Nashville, 'IN 37216
(615) 741-7218
Director, ~trition Services
Burea.1 of Personal teal.th Services
Texas~· of IEalth Resources
1100 West 49th Street
Austin, TX 78756
(512) 4.58-7668
~ah
Maternal & Child ~th
~trition Cbnsultant
State ~t. of Health
44 Medical Irtve
Salt Lake City, ur 94113
(801) 533-6181
Verm::mt
.Public teal.th tbtrition Chief
Vernvnt ~· of l:£alth
115 Colchester Averue
Burlington, VT 05401
( 802) 862-5 701
Virginia
Director, ltltritiDn
State ~pt. of IEal.th
109 Governor Street
Riclm>rrl, VA 23219
( 804) 786-4865
ltltritionist
Washi.rgton ~t. of &>cial. ani
lealth Services
P. O. Box 1788, M.S. l.JJ-11-A
Olympia, WA 98504
(206) 753-7520
West Virginia
Director, Burea.1 of llit.ritiDn
West Virginia ~· of lealth
1800 Washi.rgton Street, East
Charleston, WV 25305
(304) 348-2985
Wi.sCOffiin
art.ef, Section of ltltritiDn
Wisc~in State Division of IEal.th
P.O. Box 309
Malison, WI 53701
(600) 266-2661
Director of ltltritiDn & Dietary
Services
Di. vision of lealth & Merlical Services
Hathao1ay Bldg.
~, WY 82002
(307) 777-7166
61
Regional Offices
Administration on Aging
Appendix F
U.S. Department of Health and Human Services
Region I
Regional Program Director
Mninistration on Agi~
IlffiS Regional Office
JFK FErleral Bldg. , Roan 207
Boston, MA 02203
( 617) 223-6885
Region III
Regional Pr~am Director
Administration on Aging
DillS Fegional Office
P. 0. Box 13716
Philadephia, PA 19101
(215) 596-6892
Region V
Regional Program Director
Mninistration on Agi~
IllHS Regional Office
300 ~h Wacker Iki.ve
Chicago, II.. 60606
(312) 353-3141
Region VII
Regional Prc::gran Director
Adm:inis tration on Aging
DI:IIS Fegional Office
601 East 12th Street
Karsas City, MO 64106
(816) 374-2955
Region IX
Regional Program Director
Mninistration on Agi~
IEHS Regional Office
50 UnitErl Natiom Plaza
San Francisco, CA 94102
( 415) 556-{)003
Fegion II
Regional Program Director
Mn:inistration en Agi~
IllHS Regional Office
Feieral Bldg. , 26 Fe::leral Plaza
~York, N'i 10007
(212) 2h4-4::82
Region IV
Regional Pr~an Director
Mn:i.ni.stration on Aging
IllliS Pegional Office
101 Marietta 'lbwers
Atlanta, GA. 30323
(404) 242-~72
Region VI
Regional Program Director
Mni.nistration on AgiJl5
IllHS Regional Office
Fidelity lliion 'lbwers Bldg.
1509 Pacific Averrue
Ihllas, TX 75201
(214) 65.5-~71
Region VIII
Regional Pr~am Director
Adm:inistr&ion on Aging
IllliS Fegional Office
1961 Stout Street
~nver, 00 80294
(303) 844-2951
Fegion X
Regional Program Director
Mnini.stration on Agifl5
IllHS Regional Office
Arcade Plaza Bldg.
1321 Secord Avenue
Seattle, WA 98101
(206) 442-5341
63
Appendix G
Regional Consumer Affairs Officers
Food and Drug Administration
U.S. Department of Health and Human Services
Region I
Col'lSliler Affairs Officers
Foc:xl ani Drug Administration, IliHS
.585 Camercial Street
Boston, MA 02109
(617) 22.3-.5857
Region III
Col'lSliler Affairs Officers
Foc:xl ani Drug Administration, IliHS
~u.s. Custanlnlse, &n. 900
2rrl ani <h!stnut Streets
Ihllade!hla, PA 19106
(215) 597~37
Region V
CoilSU!Ier Affairs Officers
Foc:xl ani Drug Administration, IliHS
1222 Main Post Office Bldg.
433 W. Van Buren Street
Chicago, n.. 6WY+
(312) 353-712.6
Region VII_
CoilSU!Ier Affairs Officers
Foc:xl ani Drug Administration, IliHS
1009 Grerry Street
Kamas City, NO 64106
(816) 374-3817
Region IX
Comtm:r Affairs Officers
Food and Drug Administration, lEHS
50 United. Natiom Plaza
Rm. 524
San Fraoci.sco, CA 94102
( 415) 556-2.682
Region II
CoilSU!Ier Affairs Officers
Foc:xl ani Drug Administration, IliHS
850 Third Avenue
Brooklyn, NY 11232
(212) 965-5043 or 5754
Region IV
Col'lSliler Affairs Officers
Foc:xl ani Drug Administration, IliHS
1182 W. Peachtree Street, N.W.
Atlanta, GA 30300
(404) 881-7355
Region VI
CoilSl.IIIEr Affairs Officers
Foc:xl ani Drug Administration, IliHS
1200 Main ~r Bldg. , Rm. 1545
Il9.11as , TX 7 5202
(214) 767-5433
Region VIII
Conswer Affairs Officers
Foc:xl ani Drug Administration, IliHS
500 u.s. Custoorouse
19th ani California Streets
Ienver, en 80202
(303) 837-4915
Region X
Constm:r Affairs Officers
Food and Drug Administration, fHlS
Fed.eral Office Bldg.
909 First Avenue, &xxn 5009
Seattle, WA 98174
(206) 442-52.58
65
Appendix H
Regional Offices
Administration for Children, Youth, and Families (ACYF)
U.S. Department of Health and Human Services
Region I Region II
Regional Program Director, AC'iF,
JFK Bldg., Roan 2011
IliHS Regional Program Director, AC'iF, lliHS
Fa:leral Bldg., 41st Fl.
Boston, MA 02203
( 617) 223-3236
Region III
Regional Pr~am Director, AC'iF, OOHS
Box 13716
3535 Market Street, Rm. 5450
Ihlladephia, PA 19101
(215) 596-0356
Region V
Regional Program Director, AC'iF, IEHS
300 &ruth Wacker Drive, 13th Fl.
Chicago, IL 60606
(312) 35}-6503
Region VII
Regional Pr~am Director, AC'iF, IliHS
601 E. 12th Street, Rm. 384
Kaffias City, ~ 64106
(816) 374-5401
Region IX
Regional Pr~am Director, AC'iF, OOHS
50 tbited N:ltions Plaza, Rm. 477
San Frarci.sco, Ca 94102
(415) 556-6153
26 Federal Plaza
New York., NY 10278
(212) 264-2974
Region~
Regional Prqsran Director, AC'iF, IliH.S
101 t-'larietta ~r, Suite ~3
Atlanta, GA. 30323
(404) 221-2134
Region VI
Regional Program Director, AC'iF, fHI.S
1200 Main Tower Bldg. , Rm. 2040
lhllas, TX 7 5202
(214) 767-2976
Region VIII
Regional Pr~am Director, AC'iF, IliHS
Federal Office Bldg.
1961 Stout Street, Rm. 908
ll:nver, 00 80294
(303) 844-3106
Region X
Regional Prcgram Director, AC'iF, lllliS
Third and Broad Bldg. , M/ S 413
2901 Third Averue
Seattle, WA 98121
(206) 442....0038