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Primary Aims

  • Improve the availability of healthy foods in local stores.
  • Promote the purchase and consumption of healthy food alternatives through schools, stores, and health/social services channels.
  • Increase the levels of physical activity among all community members.
  • Evaluate how successful the programs are in increasing knowledge and improving eating patterns and physical activity.

Project Features

9 month intervention period:
Round 1 – September 2005-June 2006
Round 2 – September 2006-June 2007
Involves 7 First Nations and schools, stores, and health providers serving them.

Messages developed with approval and participation of community leaders.

The expanded trial will include a revised program based on the results of the feasibility study to be implemented in two rounds in 18-20 First Nations in Ontario and Manitoba, Canada and American Indian Tribes in Michigan and Wisconsin, USA.


Diabetes is one of the major causes of morbidity and mortality in aboriginal Canadians. This and other chronic diseases are related to a changing lifestyle. Increasing physical activity levels and eating a diet that is low in fat and sugar and high in fiber are parts of improving lifestyle.

Project Leaders

  • Joel Gittelsohn, PhD
  • Stewart Harris, MD
  • Sangita Sharma, PhD
  • Anthony Hanley, PhD
  • Bernard Zinman, MD
  • Lara Ho, MHS, RN
  • Elizabeth Ford, MA
  • Amanda Rosecrans
  • Stephanie Oppenheimer

Project Reports

  • May 2006
  • January-May 2006
  • December 2005
  • June 2004
  • May 2006

Check out the ZA:TPD Spring Newsletter (pdf)

  • January-May 2006

Recruitment of additional Ontario First Nations and Michigan Tribes for the expanded trial.

  • December 2005

Round 1 of the intervention is underway. Preliminary description of the process evaluation and study design/baseline results.

  • June 2004

Preliminary formative research (Development of an integrated diabetes prevention program with First Nations in Canada) engaged three Native Canadian communities in investigating their concepts, needs, and resources surrounding diabetes prevention using participatory methods, and examined how the Sandy Lake Health and Diabetes Project (SLHDP) programs could be adapted for use with other Native reserves. Data from this project were used to develop the Zhiiwaapenewin Akino´maagewin: Teaching to Prevent Diabetes (ZA: TPD) program. ZA: TPD consists of three components: a school program, a food store program (First Nations Healthy Stores), and community activities.

Communication Methods and Materials


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


  • Workshops and events
  • Band offices encouraged to make healthier options available

Mass Media:

  • Radio/TV announcements of key events and themes
  • Cartoons and notices in band and school newsletters
  • Posters, flyers and recipe cards


  • 3rd and 4th grade healthy living curriculum
  • Principals encouraged to provide healthy food choices and ban junk foods


Ho LS*, Gittelsohn J, Harris SB, and Ford E. (2006) “Development of an integrated diabetes prevention program with First Nations in Canada,” Health Promotion International, Jun;21(2):88-97.


Rosecrans AM, Gittelsohn J, Ho LS, Harris S, Nagshbandi M, Sharma S, (2007) “Process Evaluation of a Multi-institutional Community-based Program for Diabetes Prevention among First Nations,” Health Education Research, Jul 26; [Epub ahead of print].


Sharma S, Cao X, Gittelsohn J, Ho LS, Ford E, Rosecrans A, Hanley A, Zinman B. (2007) “Dietary intake and development of a quantitative food frequency questionnaire for a lifestyle intervention to reduce risk of chronic diseases in Canadian First Nations.” Public Health Nutrition, Dec 7:1-10 [Epub ahead of print].


Ho LS, Gittelsohn J, Rimal R, Treuth M, Sharma S, Rosecrans A, Harris SB, (2008) “An integrated multi-institutional diabetes prevention program improves knowledge and healthy food acquisition in northwestern Ontario First Nations,” Health Education and Behavior, May 2. [Epub ahead of print]


Ho LS*, Gittelsohn J, Sharma S, Cao X, Treuth M, Rimal R, Harris SB (2008). “Food related behavior, physical activity, and dietary intake in First Nations – a population at high risk for diabetes,” Ethnicity and Health, Sep;13(4):335-49.


Kumar M, GittelsohnJ, HoLS, RosecransA, RimalR, HarrisSB, SharmaS, “Exposure to components of a diabetes risk behavior prevention program associated with improvements in psychosocial and dietary factors and body mass index,” (Manuscript submitted to Health Promotion International, March 2008).

Ho LS, Gittelsohn J, Rosecrans A, Sharma S, McGinnis M and Harris S. “Understanding variability in participation: Context and stakeholder roles in a First Nations diabetes prevention program” (under review Social Science and Medicine).

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

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Zhiiwaapenewin Akino´Maagewin
Zhiiwaapenewin Akino´Maagewin
Zhiiwaapenewin Akino´Maagewin


The Healthy Food Systems projects aim to improve health and prevent obesity and disease in low-income communities through culturally appropriate educational, environmental and policy interventions that increase access to healthy foods and promote their purchase, preparation and consumption.
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