New Study Develops Culturally-Informed Food Insecurity Screener for Navajo Nation Patients

A new study published in the Journal of Nutrition Education and Behavior, published by Elsevier, highlights the development of a culturally-informed approach to screening for food insecurity among patients at Northern Navajo Medical Center (NNMC) in Shiprock, New Mexico. The alternative screener aims to reduce stigma, improve patient comfort, and reflect local food traditions and community food access better.

American Indian households experience food insecurity at disproportionately high rates—nearly four times that of the general US population. In the Navajo Nation, geographic isolation, limited grocery store access, high food costs, and transportation barriers contribute to this ongoing public health challenge. Standard screening tools, however, were developed without significant input from American Indian communities and may not capture culturally relevant dimensions of food security.

Researchers from the University of Washington and the University of California, Davis, partnered with NNMC to create an alternative screening tool that incorporated community feedback, visual aids of traditional and convenience foods, and a focus on dietary quality and satisfaction—not just quantity. In a two-phase study involving interviews and surveys with 122 adult participants, the new screener revealed different patterns of food insecurity compared to the existing two-item federal measure, suggesting it may capture unique and important aspects of the issue.

“Community members told us that the current questions can feel uncomfortable or stigmatizing. By using familiar images, acknowledging traditional foods, and focusing on strengths, we aimed to create a tool that not only identifies need but also respects cultural values that are reflective of the Navajo community in Shiprock, New Mexico,” said lead author Tia Benally, MPH, Research Coordinator at the Indigenous Wellness Research Institute, and the School of Public Health, University of Washington, Seattle. “Future initiatives should consider the assets present in the Navajo Nation, such as the close-knit family and community connections that can be further supported to provide a foundation for a food-secure future.”

The authors emphasize that while screening is critical, it should be paired with adequate resources and support to address the root causes of food insecurity. They also call for more research to refine culturally grounded screening tools for use in Navajo Nation and other Indigenous communities.

Notes for editors

The article is "Culturally-Informed Food Insecurity Screening: Evidence From Northern Navajo Medical Center," by Tia R. Benally, MPH; Kelli W. Begay, MS, MBA, RDN; Lydia Kim, MD, MPH; Preyanka Makadia, DO; Amanda M. Fretts, PhD; and Cassandra J. Nguyen, PhD (https://doi.org/10.1016/j.jneb.2025.05.201). It appears in the Journal of Nutrition Education and Behavior, volume 57, issue 9 (September 2025), published by Elsevier.

The article is openly available at https://www.jneb.org/article/S1499-4046(25)00333-1/fulltext.

Full text of the article is also available to credentialed journalists upon request; contact Eileen Leahy at 732 406 1313 or [email protected] to obtain a copy. To schedule an interview with the author(s), please contact Tia (Tee) R. Benally, MPH, at [email protected] or Cassandra J. Nguyen, PhD, at [email protected].

This work was funded by the University of Washington Public Health Initiative Pilot Grant program and matching funds from the University of Washington School of Public Health and the Department of Epidemiology.

An audio podcast featuring an interview with one of the co-senior authors, Cassandra Nguyen, PhD, and other information for journalists are available at https://www.jneb.org/content/media. Excerpts from the podcast may be reproduced by the media with permission from Eileen Leahy.

About the Journal of Nutrition Education and Behavior (JNEB)

The Journal of Nutrition Education and Behavior (JNEB), the official journal of the Society for Nutrition Education and Behavior (SNEB), is a refereed, scientific periodical that serves as a resource for all professionals with an interest in nutrition education and dietary/physical activity behaviors. The purpose of JNEB is to document and disseminate original research, emerging issues, and practices relevant to nutrition education and behavior worldwide and to promote healthy, sustainable food choices. It supports the society’s efforts to disseminate innovative nutrition education strategies, and communicate information on food, nutrition, and health issues to students, professionals, policy makers, targeted audiences, and the public.

The Journal of Nutrition Education and Behavior features articles that provide new insights and useful findings related to nutrition education research, practice, and policy. The content areas of JNEB reflect the diverse interests of health, nutrition, education, Cooperative Extension, and other professionals working in areas related to nutrition education and behavior. As the Society's official journal, JNEB also includes occasional policy statements, issue perspectives, and member communications. www.jneb.org

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