Preventing dentures and putting aside the fry bread: A systematic review of micro, mezzo, and macro conditions for dental health and obesity interventions for Native American youth


  • Rodney C Haring
  • Nina Wampler
  • Warren Skye
  • Maxine Brings-Him-Back–Janis
  • Brenda L Battleson
  • Myra Muramoto


obesity, dental health, oral health, childhood, youth, pediatric, intervention, Native American, American Indian, First Nations, Aboriginal, systematic review


This systematic literature review was focused on childhood obesity and dental health interventions which have relevance to Native American communities. Childhood oral health and obesity have become significant problems across North America and among Native American Nations. Subsequently, a growing number of dental health and obesity interventions are surfacing for ethnic minority populations including Native peoples. The value and purpose of this review was to stimulate thinking about obesity and dental health intervention commonalities within micro, mezzo, and macro conditions. Two macro findings included the need for schools to be involved contributors in the intervention process and the promotion of both sensible eating and healthy drinking. Micro and mezzo results included the importance of nutrition and food preparation education for food service staff within schools; the incorporation of culturally attuned activities for physical education incorporating family, and structuring intervention programs to be multi-year.


Bachar, J. J., Lefler, L. J., Reed, L., McCoy, T., Bailey, R., & Bell, R. (2006). Cherokee Choices: a diabetes prevention program for American Indians. Preventing Chronic Disease, 3(3), A103.

Brown, B.D., Harris, K. J., Harris, J. L., Parker, M., Ricci, C., and Noonan, C. (2010). Translating the diabetes prevention program for Northern Plains Indian youth through community-based participatory research methods. Diabetes Education, 36(6), 924–935.

Bothwell, E., Eberling & Reifel, N., (1994). The World Health Organization international collaborative study of oral health outcomes (ICS-II): preliminary results from American Indian communities. Albuquerque , NM : US Public Health Service, Indian Health Service.

Bruerd, B., Kinney, M. B. and Bothwell, E. (1989). Preventing baby bottle tooth decay in American Indian and Alaska native communities: a model for planning. Public Health Reports, 104(6), 631-640.

Caballero, B., Clay, T., Davis, S. M., Ethelbah, B., Rock, B. H., Lohman, T., et al. (2003). Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. American Journal of Clinical Nutrition, 78(5), 1030-1038.

Carrel, A., Meinen, A., Garry, C., and Storandt, R. (2005). Effects of nutrition education and exercise in obese children: the Ho-Chunk Youth Fitness Program. World Medical Journal, 104(5), 44-47.

Centers for Disease Control and Prevention, Eagle Books Home Page (retrieved June 23, 2014). html

Davis, S., Gomez, Y., Lambert, L., and Skipper, B. (1993). Primary prevention of obesity in American Indian children. Annals of the New York Academy of Sciences, 699, 167-180.

DeRenne, C., Maeda, J. K., Chai, D. X., Ho, K., Kaluhiokalani, N. and Braun, K. L. (2008). Afterschool physical activity program to reduce obesity-related cancer risk: a feasibility study. Journal of Cancer Education, 23(4), 230-234.

Flores, G. & Lin, H. (2013). Trends in racial/ethnic disparities in medical and oral health, access to care, and use of services in US children: Has anything changed over the years? International Journal of Equity in Health. 12:10, 1-16.

Gittelsohn, J., Merkle, S., Story, M., Stone, E. J., Steckler, A., Noel, J., et al. (2003B). School climate and implementation of the Pathways study. Preventive Medicine, 37(Suppl.), S97-S106.

Glaser, B. G. (1978). Theoretical sensitivity. Mill Valley, CA: Sociology Press.

Going, S., Thompson, J., Cano, S., Stewart D., Stone E., Harnack, L., et al. (2003). The effects of the Pathways Obesity Prevention Program on physical activity in American Indian children. Preventive Medicine, 37, S62-9.

Haring, R.C.; Skye, Jr., W. Battleson, B; Brings-Him-Back-Janis, M; Teufel-Shone, N. (2014). Teeth and heavyset kids: Intervention similarities between childhood obesity and oral health interventions within Native American societies. Journal of Indigenous Research 3(1), 5, 1-24.

Harvey-Berino, J., and Rourke, J. (2003). Obesity prevention in preschool Native-American children: a pilot study using home visiting. Obesity Research, 11(5), 606-611.

Hearst, M.O., Biskeborn, K., Christensen, M., Cushing, C. (2013). Trends of overweight and obesity among white and American Indian school children in South Dakota, 1998-2010. Obesity, Jan, 21(1), 26-32.

Henson, K. E. (2005). Childhood obesity in the United States of America with a special focus on Native American reservation dwelling youths: The problem, the treatments, and how psychology can help. Unpublished dissertation, Alliant International University, San Francisco, CA.

Karanja, N., Lutz, T., Ritenbaugh, C., Maupome, G., Jones, J., Becker, T., et al. (2010). The TOTS community intervention to prevent overweight in American Indian toddlers beginning at birth: a feasibility and efficacy study. Journal of Community Health, 35(6), 667-675.

Kirst-Ashman, K., & Hull, G. (1999). Understanding generalist practice (2nd ed.). Chicago: Nelson-Hall.

Kirst-Ashman, K., & Hull, G. (2008). Understanding generalist practice (5th ed.). Chicago: Nelson-Hall.

Macnab, A. J., Rozmus, J., Benton, D., and Gagnon, F. A. (2008). 3-year results of a collaborative school-based oral health program in a remote First Nations community. Rural & Remote Health, 8(2), 882.

Montori, V. M., Swiontkowski, M. F., and Cook, D. J. (2003). Methodologic issues in systematic reviews and meta-analyses. Clinical Orthopaedics and Related Research, 413, 43-54.

National Congress of American Indians Resolution #PDX-11-047 (2011) http:// make-oral-health-care-services-more-accessible-through-the-development-of- the-dental-therapist-provider-model-pioneered-by-the-alaska-dental-health-aide- therapist-program

Noyes J, Popay J, Pearson A, Hannes K, Booth A. Chapter 20: Qualitative research and Cochrane reviews. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1 [updated September 2008].

The Cochrane Collaboration, 2008. Available from

Onwuegbuzie, A.J., Leech, N.L., Collins, M.T. (2012). Qualitative analysis techniques for the review of literature. The Qualitative Report, 17(56), 1-28.

Patrick, D.L., Lee Shuk Yin, R., Nucci, M., Grembowski, D., Jolles, C.Z., Milgrom, P. (2006). Reducing oral health disparities: A focus on social and cultural determinants. BMC Oral Health, 6(Suppl I):S4,

Perry, C. and Hoffman, B. (2010). Assessing tribal youth physical activity and programming using a community-based participatory research approach. Public Health Nursing, 27(2), 104-114.

Perez, G. (2008). Plate Full of Color. US Department of Health and Human Services, Centers for Disease Control and Prevention, Division of Diabetes Translation, Native Diabetes Wellness Program.

Perez, G. (2008). Tricky Treats. US Department of Health and Human Services, Centers for Disease Control and Prevention, Division of Diabetes Translation, Native Diabetes Wellness Program.

Ritenbaugh, C., Teufel-Shone, N. I., Aickin, M. G., Joe, J. R., Poirier, S., Dillingham, D. C., et al. (2003). A lifestyle intervention improves plasma insulin levels among Native American high school youth. Preventive Medicine, 36(3), 309-319.

Saksvig, B. I., Gittelsohn, J., Harris, S. B., Hanley, A. J. G., Valente, T. W., & Zinman, B. (2005). A pilot school-based healthy eating and physical activity intervention improves diet, food knowledge, and self-efficacy for native Canadian children. Journal of Nutrition, 135(10), 2392-2398.

Snyder, P., Anliker, J., Cunningham-Sabo, L., Dixon, L. B., Altaha, J., Chamberlain, A., et al. (1999). The Pathways study: a model for lowering the fat in school meals. The American Journal of Clinical Nutrition, 69(4 Suppl), 810S-815S.

Stevens, J., Story, M., Ring, K., Murray, D. M., Cornell, C. E., Juhaeri, et al. (2003). The impact of the Pathways intervention on psychosocial variables related to diet and physical activity in American Indian schoolchildren. Preventive Medicine, 37(Suppl.), S70-79.

Strauss, A. and Corbin, J. M. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, Calif.: Sage Publications.

Strube, M. J. and Hartman, D. P. (1982). A critical appraisal of meta-analysis. British Journal of Clinical Psychology, 21(2), 129–139.

Teufel, N.I., Perry, C.L., Story, M., Flint-Wagner, H.G., Levin, S., Clay, T.E., et al. (1999). Pathways family intervention for third-grade American Indian children. American Journal of Clinical Nutrition,69(4 suppl):803S–9S.

Weber, J. L., Cunningham-Sabo, L., Skipper, B., Lytle, L., Stevens, J., Gittelsohn, J., et al. (1999). Portion-size estimation training in second- and third-grade American Indian children. American Journal of Clinical Nutrition, 69(Suppl.), 782S-787S.