Conclusion
Findings indicate that TPB is useful for predicting factors directly related to healthy eating behavior but not for predicting the indirect effect of intention in a sample of urban Native American youth. This suggests that other factors besides intention are driving healthy eating behavior and can be used to develop intervention strategies to promote healthy eating practices in youth who overweight or at risk for overweight. Since barriers, attitude, subjective norm, and self-efficacy appear to be factors affecting healthy eating behaviors they should be incorporated in program design. Nutrition professionals should work with Native American community leaders and elders to provide sound nutritional knowledge to the entire community. This data also suggests that working through the family is important. Encouraging parents and caretakers to purchase and make healthy foods regularly available to their children could reduce youths' perceived barriers to healthy eating. Because the extended family and community are a valuable component of Native American culture, youth appear more willing to accept and follow dietary advice from members of their community. Gender differences may require the need for separate programs or at least special considerations for boys and girls. Boys who have lower self-efficacy but seem receptive to subjective norms, would benefit more from activities involving family and peers to increase healthy eating behaviors. Girls who are most affected by barriers to healthy eating, would benefit more from programs designed to increase the availability of healthy foods and promote the awareness that healthy foods are also tasty. Because of the alarming prevalence of obesity in urban Native American youth, future studies should continue to investigate the factors influencing obesity, such as eating and activity behavior, to identify the most effective way to solve this problem.