1. A Regional Approach to Community Engagement and Healthy Food Access in Underserved Communities Erin Laird Public Health Associate Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention PHAP Spring Training April 5, 2016 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. Food Desert Census Tracts in Manatee and Sarasota, FL Counties United States Department of Agriculture Economic Research Service Low Income and Low Access at 1 and 10 miles

3. Cascading Impact  Only 25% of adults in Manatee County, and 27% in Sarasota County, live within ½ mile of a healthy food retailer  Only 17% of adults in Manatee County, and 18% in Sarasota County, report eating at least five servings of fruits and vegetables per day  Consequently, 62% of Manatee County adults and 58% of Sarasota County adults are overweight or obese * Florida Community Health Assessment Tool Set (Florida CHARTS)

4. Key Assessment Features  Cross-county collaboration  Reduce duplication  Maximize staff time and department resources  Share best practices  Robust Community Engagement  Plain Language  Extensive piloting

5. ASSESSMENT METHODOLOGY AND RESULTS Community Based Participatory Research

6. Assessment Methodology  Key Informant Interviews  Focus Groups  Surveys  Recorded Personal Narratives  Photo-Voice

7. Key Informant Interviews  Informed the engagement plan  Define geographic scope of the project  Share wisdom on cultural groups  Provide access to target population  Examples include:  Cindy Sloan, Director, Food Bank Manatee  Lawrence Livingston, Reverend, Eternity Temple  Pat Stream, Principal, Samoset Elementary  Yvonne Daniels, Deputy, Manatee County Sheriff’s Office

8. Focus Groups  Thirteen groups total  Eight in Manatee County  Five in Sarasota  Held in convenient community locations  Churches  Public Housing  Schools

9. Focus Group at Senior Friendship

10.  Perceived Barriers  Cost  Availability  Lack of Knowledge  Preferred Solutions  Gardens  Centrally located markets, equipped to accept EBT  Classes Focus Group Themes

11. Focus Group Participant Quotes  “I need to learn more about how to eat healthy.”  “We have to buy what we can afford, not what we like to get.”  “In this community, there’s not really stores, there are ‘food stores,’ or whatever but it’s just like going to a gas station.”  “When you’re low-income, it’s hard to go to the grocery store and pick out a meal that’s healthy and also cheap.”

12. Randomized Door-to-Door Survey  Repurposed CDC’s Community Assessment for Public Health Emergency Response (CASPER) Toolkit  Selected census tracts  Randomly selected 30 census blocks  Survey 7 randomly selected homes per block  Complete 168-210 surveys (per county)  Collected 291 Surveys  170 in Manatee County  121 in Sarasota County

13. Erin Laird, PHAP Associate

14. Survey Results Focus Group Theme: Cost  We asked: What would make it easier to get more fruits and vegetables?  In Manatee County, 73% (n=124) of respondents said they would get them more often if they didn’t cost as much  In Sarasota County, 69% (n=83) of respondents said they would get them more often if they didn’t cost as much

15. Survey Results Focus Group Theme: Availability  We asked: What would make it easier to get more fruits and vegetables?  In Manatee County, 40% (n=68) of respondents said they would get them more often if they were sold closer to their home  In Sarasota County, 47% (n=57) of respondents said they would get them more often if they were sold closer to their home

16. Survey Results Focus Group Theme: Market Options  We asked: Would you shop at a farm stand if there were one near your home?  In Manatee County, 58% (n=) of respondents said they would like a farm stand in their neighborhood  In Sarasota County, 76% (n=) of respondents said they would like a farm stand in their neighborhood

17. Survey Results Focus Group Theme: Market Options  We asked: What days would you most likely shop at a farm stand?  In both Manatee and Sarasota Counties, the most frequently selected days were Friday, Saturday, and Sunday.

18. Survey Results Focus Group Theme: Gardening  We asked: Would you like to grow your own food?  In Manatee County, 53% (n=90) of respondents said they would like to grow their own food.  In Sarasota County, 48% (n=58) of respondents said they would like to grow their own food.

19. Survey Results Focus Group Theme: Gardening  We asked: Where would you like to grow your food?  In a community garden: 32% (n=93)  In your own yard: 84% (n=244)

20. Survey Results Focus Group Theme: Education  We asked: Would you be interested in attending any of the following free classes? We read a list of class topics and respondents could say “yes” or “no” to each. Top four classes were the same for both counties:  Vegetable Gardening  Budgeting  Cooking  Nutrition

21. Survey Results Focus Group Theme: Education  We asked: “What would make it possible for you to attend these classes?” Top three responses were the same for both counties:  The class would need to be held in my neighborhood.  The class would need to be shorter than an hour.  I would need to have childcare provided, or be able to bring my child.

22. Survey Conclusion  Confirmed focus group themes  Provided a statistically representative data sample  Allowed us to gather more specific data to inform planning

23. CREATIVE DATA COLLECTION Photo-Voice and Personal Narratives

24. Photo-Voice  “Visual Focus Group”  Highly participatory  Displays data visually  Makes a POWERFUL impact on decision makers

25. Photo-Voice from Manatee County Public Housing Resident “Look at that, that’s sad right there. That’s what my fridge and cabinet always look like. I don’t have a car, so I gotta walk to the store. I would go to a pantry, but I can’t get there. I do have a lot of peanut butter. People are always giving me peanut butter. Sometimes I just eat it with a spoon for dinner.”

26. Photo-Voice from Manatee County Public Housing Resident

27. Personal Narratives  Partnered with local college students to collect recorded interviews  Collected six personal narrative stories  Created a compilation video with all six stories and food desert background information

28. Growing in the Community: Craig’s Story https://youtu.be/GRdcG1CMG1E

29. So what did we DO with this information?  Coordinated EBT at the Downtown Bradenton Farmers’ Market in collaboration with Realize Bradenton  Assisted Geraldson Community Farm in development of a Mobile Market to serve food desert neighborhoods, via a $100,000 USDA grant  Partnered with Manatee County Agriculture Extension to: (1) align education with communities that want classes, and (2) develop community gardens and support home gardens

30. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Thank you Erin Laird ypr5@cdc.gov Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support