1. WIC Family Food Access Project 2011

2. Goals for Assessing WIC Family Food Access WIC staff obtain assessment information that can be used to improve food security in WIC families. WIC can be integrated into broader initiatives in south King County. UW grad students build skills in –Working within communities –Data collection, analysis and presentation –Public health practice

3. Components of Access to Healthy Foods FinancialAffordability given other financial demands PhysicalProximity to retailers; consistent, reliable transportation NutritionalAvailability supports well-rounded, balanced, healthy diet CulturalCultural relevance of available food; familiarity with storage & preparation

4. Access by all people at all times to sufficient food for an active and healthy life. Food security includes at a minimum: the ready availability of nutritionally adequate and safe foods, and an assured ability to acquire acceptable foods in socially acceptable ways. Economic Access: Food Security

5. Very Low Food Insecurity Reports of multiple indications of disrupted eating patterns and reduced food intake. http://www.ers.usda.gov/briefing/foodsecurity/labels.htm

6. Children’s Alliance, Hungry in Washington, November 2010 http://wafoodcoalition.org/Hungry%20in%20Washington2010%20_FINAL_.pdf

7. Percent of Low Income Washington Residents Who Live Farther than One Mile to a Grocery Store Physical Access Food Environment Atlas, USDA Economic Research Service

8. Washington Farmers Markets per 1,000 population Food Environment Atlas, USDA Economic Research Service.

9. Healthy Food national dietary guidelines and provides plenty of vegetables, fruits, whole grains, low fat dairy products and healthy fats like olive and canola oil and protein, such as lean meats and legumes. Food that can provide an individual with a balanced diet that meets

10. Finding Healthy Food in Washington 84% of residents said they could find many healthy food choices in their local grocery store. 59% said they could find healthy food for meals eaten away from home at delis or restaurants

11. Food Security – 6 Item USDA Survey 1.The food that (I/we) bought just didn’t last, and (I/we) didn’t have money to get more. 2.“(I/we) couldn’t afford to eat balanced meals 3.In the last 12 months, since last (name of current month), did (you/you or other adults in your household) ever cut the size of your meals or skip meals because there wasn't enough money for food?

12. 4.IF YES ABOVE, ASK] How often did this happen—almost every month, some months but not every month, or in only 1 or 2 months 5.In the last 12 months, did you ever eat less than you felt you should because there wasn't enough money for food? 6.In the last 12 months, were you every hungry but didn't eat because there wasn't enough money for food?

13. Nutritional Access 10. How easy or hard is if for you to provide your family with foods that are nutritious? Very easy Not too hard Hard Don’t know or refused

14. Cultural Access 11. How easy is it for you to provide your family with foods that are right for your culture or religion? Very easy Not too hard Hard Don’t know or refused

15. Physical Access: 1. What is the name of the main store where your household purchases most of your foods to eat? Albertsons Central Market Costco Fred Meyers Grocery Outlet PCC QFC Red Apple Safeway Top Foods Trader Joes WinCo Foods Ranch Other Specify ___________________ Don’t know or refused

16. Physical Access: 3. Can you please tell me what street or intersection this store is on or show me on this map about where this store is? (Administrator has map of south King County and writes approximate cross streets based on where client points)

17. Physical Access: Transportation 4. What is your PRIMARY method of getting to and from this store? (Please check one) Bus/Access Van Own Car Ride with Friends Walk Bike Taxi Other _________ Don’t know or refused

18. 5. What are the names of other stores where your household purchases foods to eat? What kinds of stores do you consider these stores to be? How do you get there? Store Kind of Store a.corner store or convenience store b.small neighborhood grocery store c.ethnic grocery store (for example halal, or Asian market) d.medium size grocery store e.supermarket f.large warehouse store g.drug store h.Other _________________ Transportation a.Bus/Access Van b.Own Car c.Ride with Friends d.Walk e.Bike f.Taxi g.Other _________ Albertsons Central Market Costco Fred Meyers Grocery Outlet PCC Etc…..

19. 6. What is the name of the store where you use your WIC checks________________? 7. Can you please tell me what street or intersection this store is on or show me on this map about where this store is? 8. Please check any other places where your household got food in the past 12 months: 9. IN THE PAST 12 MONTHS, did anyone in this household receive SNAP (Food Stamps or a Food Stamp benefit card)?

20. Human Subjects Students take recruitment flyers that WIC staff will present to clients: –Flyer on project web site When WIC clients agree to be part of the study, students can approach them Screen for age – only interview those 18 or older All potential participants have the right to refuse to participate & not to answer any question Read the opening statement on the survey Keep data in locked file & secure computer/server

21. I’m a graduate student at the University of Washington, and I’d like to ask you a few survey questions. First, I’d like to give you the information you need to decide if you want to take the survey. The survey will take about 5 to 10 minutes. This survey will be used to provide WIC staff and other Seattle-King County Public Health staff with information about access to food in WIC families. You do not have to complete this survey if you don’t want to. Some questions may make you uncomfortable and you can tell us that you don’t want to answer these questions. You will continue to get WIC checks if you do not take the survey.

22. We will not ask you for your name or other information that could identify you. We will take our completed surveys back to the university and destroy your survey results once we have put them in a computer. The results of the survey will be confidential, and the reports will not provide information about any one person. You will not benefit directly from completing the survey, but if changes are made as a result of this survey, some parents may find it easier to feed their families.

23. After you fill out the survey, the WIC staff will put your name in a drawing for a $25.00 Safeway gift card. We will have a drawing at the end of the day for everybody who took a survey here at your WIC clinic today. To be part of the drawing, you’ll need to fill out a slip of paper with your name and address so we can mail you the card. Your name and address will be put in a box for the drawing and will not be attached to your survey.

24. Confidentiality Do not repeat what you have heard from respondents outside of the research setting. No data should have identifiers other than what has been approved. No individual data should be presented.

25. Deliverables: Due March 15 A full report of all the findings and recommendations: Analysis of the WIC client surveys: key data presented visually, associations in the data explored, most data provided in tables or appendices Map of WIC family food access patterns Brief description of existing efforts in these neighborhoods to increase access to healthy foods Discussion of what the findings mean in light of what is known about financial, geographic, nutritional and cultural access to foods Recommendations for policy improvements to improve access to healthy foods and food security specifically for WIC clients in south King County Recommendations for how you might evaluate progress toward these policy improvements and their impact on families. A forty five minute PowerPoint presentation to Stakeholders for March 15th A one or two page briefing document with highlights of the findings and recommendations

26. Student Evaluation Group Each of products demonstrates comprehension and appropriate application of basic concepts learned in class for cultural competence, evidence based practice, practical program evaluation, and strong links between assessment finding and recommendations. 85 Organization and presentation of final products15 Rating of individual effort by other members of group: Rating Sheet (please post to class dropbox:Rating Sheet Individual Successful participation in steps of data collection, data compilation and analysis, and policy development 40 Role in phase one & two and final presentations10 Rating of individual by peers – download sheet & post to dropbox 50

27. Timeline January 14Phase One: Data collection in clinics January 21Phase One: Data collection in clinics January 28Phase One: Data collection in clinics February 4Phase One: Data collection in clinics Phase Two: Teams A-D prepare deliverables February 11Phase Two: Teams A-D prepare deliverables February 18Presentation of phase One findings & Phase Two Deliverables February 25Phase Three: Teams prepare final deliverables March 4 Phase Three: Teams prepare final deliverables March 11Phase Three: Teams prepare final deliverables March 15 10:30-12:20 Presentation to Stakeholders

28. Beginning Resources Position of the American Dietetic Association: Food Insecurity in the United States USDA ERS: Food Insecurity in the United States Briefing Room King County Food and Fitness Initiative King County Communities Putting Prevention to Work (CPPW) How Farmers Markets Can Promote Access to Healthy Food:A Look at How Population Groups and Farmers Markets Interact The Supermarket Gap: How to Ensure Equitable Access to Affordable, Healthy Foods The Search for Affordable Nutrient Rich Foods: A comparison of supermarket food prices in Seattle-King County Can low income Americans afford a healthy diet?

29. Phase Two Team A: Financial Access and Food Security Prepare a well referenced briefing paper that outlines: The determinants of food insecurity in populations and households Recommended interventions to address food insecurity Basic information about the SNAP program: what it is, recent trends in participation, participation rates, barriers and enhancers of participation, Rates of food insecurity in the US and among high risk groups Methods of assessing food insecurity, with an emphasis on what is known about the 6 question USDA instrument

30. Phase Two Team B: Physical & Geographic Access Prepare a well referenced briefing paper that outlines: The determinants of physical & geographic access to healthy foods Current knowledge about rates and trends of lack of physical and geographic access to healthy foods Current knowledge about differences in food prices across food stores Current efforts underway in south King County neighborhoods to improve access to healthy foods. Recommended interventions to increase physical and geographic access to healthy foods.

31. Phase Two Team C: Nutritional and Cultural Access Prepare a well referenced briefing paper that outlines: Current knowledge about barriers to providing nutrient dense foods to households. Current knowledge about role of cultural in food choice and limitations of access to culturally appropriate foods Recommended interventions to assure access to affordable, nutrient dense and culturally appropriate foods for low income households

32. Phase Two Team D: Data Compilation Develop database Enter and verify results from surveys using USDA's Instructions on the use of the 6 item food security module.nstructions on the use of the 6 item food security module Clean data and prepare general reports on distribution, mean, range, etc. as appropriate Prepare map with indicators of sources of food used by respondents using Instructions for using Google map for this: Log in to Google. Then go to "My Maps" and "Create a new map" that is public. Zoom to locations of interest and right-click, then "Add a placemark," and edit the title and description. Other icons can be selected by clicking the icon in the upper right of the same callout that allows editing of the title and description. Icons can be added from URLs,. Click for an example.Click for an example Once the map is completed, click "Done." The maps can be shared by clicking the "link" in the upper right and copying the URL to an e-mail message, Click for a simple example.Click for a simple example.

33. Next Today… Each student commits & schedules for 3-4 clinic visits between January 7 and February 4. Divide into four teams for Phase Two deliverables Meet with fellow team members and determine action steps and responsibilities