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[lizebotha97]

Macropost #4

Competency F2 - Select  Quantitative and Qualitative Data Collection Methods Appropriate for a Given Public Health Context

As mentioned in my previous macroposts, this semester, Elisa, Savannah, Marisa and I partnered with Feast Down East, a non-profit organization that works in the Southeastern region of North Carolina to combat food insecurity by promoting the local economy and by making food more accessible. Our main goal was to expand Feast Down East’s resources into Pender County, North Carolina by assessing the food needs of the local community. We decided to create and distribute a Community Needs Assessment to evaluate the food needs in Pender County due to the high number of food insecure people in the county. According to Feeding America 2018, 13.6% of adults and 19.4% of children in Pender County are food insecure (Feeding America, 2018). Therefore, we initially conducted a qualitative survey to gain insight on what we needed to include on our community needs assessment and then we conducted quantitative research in the form of the community needs assessment. 

First, we contacted our community partners either via phone call or email to see what they would want to include in the community needs assessment. We asked them a set of questions on a Google Form to gain insight on the community partner’s views about food insecurity and the needs that they address in the county. The questions were important to understand what the needs in the county are from an insider's perspective. Some of the community partners wanted to include questions about where people buy their food, home gardens, how far people travel to get food, and access to utilities like electricity. 

After we received feedback for our community partners, we created a quantitative community needs assessment due to the limited amount of time left in the semester to create, distribute, and analyze the data. We created a 67-question survey that included all the recommendations from the initial survey as well as other questions that we thought were important. Then we sent the community needs assessment to our preceptors, Jordyn and Cara Stretch, to approve the assessment. After reviewing and finalizing the assessment, we distributed it to Pender County residents. With the help of one of our community partners, Liz Peterson from NC Cooperative Extension, we reached over 1,500 people. In the end, a total of 107 people filled out the community needs assessment. Fourteen respondents' surveys were excluded because their zip codes did not fall within county lines. 

Unfortunately, not all respondents answered all the questions in the survey. Therefore, we had to analyze each question as a new variable and we had to include the sample size for each variable. A demographic analysis of the data showed that 85% of the respondents (n=93) were white, 9% were African American, and 6% selected the “Other” category. Ten percent of our respondents identified as Hispanic or Latino (n=84). We had an oversampling of women (93.25%) with only 6.7% of respondents being male. After our data analysis we found that 32% (n=84) of respondents stated that they needed more money to buy enough food for their household. Between food access, healthy/fresh food, and financial/cost of living needs, the most immediate need from our respondents was healthy/fresh food (n=35). It is worth noting that we did not reach the general population in our sampling method so most of these responses cannot be generalized to the public, but the findings should still not be neglected. Future research should focus on reaching a broader population of Pender County so that the findings can be generalized and better conclusions can be made. 

As stated in a previous post, food insecurity is, ironically, higher in rural areas where most food is typically grown for the rest of the nation (Warren, Smalley, 2014). Rural grocery stores also tend to sell inexpensive foods with lower nutrients compared to urban grocery stores (Warren, et al., 2014). As discussed in class, food insecurity has its roots in poverty. Poverty in the rest of the world (malnourished, thin people) looks different from poverty in the United States, which often looks like obesity. Why is this? In class we discussed the idea that the Deep South is the nation’s heaviest and most food insecure region. We aso noted that the more rural you get in the Deep South, the more obese and the more inactive you get. This could be due to the industrialization of farms making farmers more inactive while eating the same high caloric meals that they ate when they were active all day long. Now, they are mostly sitting in a tractor not expending those calories. Food insecurity is related to quantity and quality of food in terms of four domains, that is access, availability, stability, and health. People in rural areas have less access to healthy, nutritious food due to geographical barriers. Sometimes there isn’t a permanent and durable access to food resources that disrupts the stability of food. And sometimes the residents do not know what is considered “healthy food options.”

Therefore, it is important to assess the food needs and underlying factors that contribute to food insecurity in rural areas. I am very thankful for the opportunity that I received this semester to learn from Feast Down East and my teammates!

References

Feeding America, Map the Meal Gap. (2018). 

Warren, C. J., Smalley, K.. B. (2014). Rural public health: Best practices and preventive models. New York: Springer Publishing Company. 

@drtillman

[lizebotha97]

Macropost #3

Competency R1 - Differentiate the impacts of social determinants of health that contribute to health disparities in rural communities as compared to urban communities.

This semester my practicum group and I had the opportunity to assess the social determinants of health that contribute to health disparities in the Southeastern region of North Carolina with the help of Feast Down East. More specifically, rural counties like Pender County. During our free community outreach event we experienced some of the health disparities that we were taught in class. We planned our event with multiple organizations and partners of Feast Down East but unfortunately, our event location was double-booked. Therefore, we had to delay handing out our flyers. We finally got word of a new location only five days before the event! Nevertheless, Feast Down East and other partnering organizations distributed our flyers for the Free Food Drive Event on social media and on paper copies. My group and I were scared that nobody would show up since we got the word out so late… In the weeks leading up to the event we reached out to community partners to find donations and several organizations agreed to donate supplies. Among these organizations were dentists, the Pender County Health Department, a non-profit thrift store, an organization that works with schools to address child needs, and of course, our precepting organization Feast Down East who provided free local produce. We distributed diapers, feminine hygiene products, blankets, children’s books, and of course the food bags thanks to these organizations. After working tirelessly all morning to prepare the food bags, food samples, and hygiene bags we finally went over to our event location to set up. To our surprise, there was already a string of cars wrapping around the neighborhood. Our event was only supposed to start at 4:00pm, but we started distributing food and other healthcare items to the residents of Pender County early due to the large influx of people waiting. We served about 183 people in roughly an hour. Unfortunately, we ran out of food bags due to the large number of people who showed up. It was great to see how involved (and patient) the community was while everyone waited for their turn to grab a bag of fresh produce that was picked that morning from one of the local farms along with other goodies.  

There are several social determinants of health that are unique to rural areas, such as poverty, unemployment, and lack of transportation (Warren, Smalley, 2014). Rural residents face challenges with access to nutritious, healthy foods due to geographical isolation, lack of employment opportunities, lack of public and private transportation. One of our partners even asked if people could walk through the event due to a lack of transportation. These social determinants of health contribute to the high volumes of food insecure people in rural areas compared to their urban counterparts. Ironically, food insecurity is higher in rural areas where most food is grown for the rest of the nation (Warren, Smalley, 2014). Rural grocery stores also tend to sell inexpensive foods with lower nutritional value compared to urban grocery stores (Warren, Smalley, 2014). One of our partners, Liz Peterson from NC Cooperative Extension, kept track of the demographics of everyone who showed up to the event. These social determinants of health contribute to the health disparities of rural areas. For example, we got to experience the racial/ethnic disparities in rural counties first hand during our event. According to the U.S. Census Bureau, majority of the residents in Pender County are White (76%), 14%  are African American, and 7% are Hispanic or Latinx (U.S. Census, 2020). When we analyzed the demographical data from the event, we saw some of the racial/ethnic disparities that we have been talking about in class play out in a real world situation. That is, even though 74% of Pender County is considered White, only 45% showed up, and to no surprise, 27% of participants were African American, and 28% were Hispanic or Latinx. 

I am beyond thankful that I got to spend the day out in the community alongside my group members. I experienced so many emotions throughout the day. I was happy that we could help the people of Pender County and I even caught myself tearing up once or twice during the event due to an overwhelming feeling of gratitude for organizations and people who want to help others! So, as I think of the future, I can only hope that more people try to make the shift to helping rural, food insecure communities. This can be by donating food to local food pantries or even by driving that extra mile to support a local farm. As someone who comes from a third world country, it breaks my heart to see how so many people in the United States, one of the richest countries in the world, can be food insecure and hungry!  Food insecurity is a big concern for Public Health and organizations like Feast Down East do a tremendous job of improving food insecurity rates in rural North Carolina. I hope we can all work together to improve food insecurity rates for all, especially vulnerable rural populations.

U.S. census bureau QuickFacts: North Carolina.census.gov/quickfacts/fact/table/NC/IPE120219

Warren, C. J., Smalley, K.. B. (2014). Rural public health: Best practices and preventive models. 

New York: Springer Publishing Company.

@drtillman

[lizebotha97]

Macropost #2

Competency F14 - Advocate for political, social, or economic policies and programs that will improve health in diverse populations

This semester my practicum group and I were asked to add an advocacy component to our practicum hours. More specifically, we were asked to advocate for Bill S.4202 that was recently introduced in the Senate, or the “Expanding Snap Actions Act of 2020.” My practicum group and I are working with Feast Down East, a non-profit organization that serves in the Southeastern region of North Carolina to combat food insecurity. Our practicum group created a social media campaign to raise awareness for the Bill mentioned above. 

Bill S.2402 was introduced to increase the opportunity for community members to purchase food online by utilizing the Supplemental Nutrition Assistance Program (SNAP) as a payment method. This bill was introduced by Dick Durbin and Tammy Duckworth, two U.S. Senators in Illinois. Many Americans have hunger needs and the COVID-19 pandemic has only made it worse (Durbin, 2020). About 40 million Americans use SNAP as their main payment source for groceries, which has drastically increased since the start of the pandemic due to the increasing unemployment rate (Durbin, 2020). More than 45 million people in the United States have filed for unemployment since the start of the pandemic and many small businesses had to close their doors (Durbin, 2020). Many Americans are avoiding grocery stores in order to stay safe from the virus. Instead, their groceries are ordered online and sent to their doorsteps or picked up outside the store (Durbin, 2020). Unfortunately, this has not been the case for those who rely on SNAP, because only a very limited number of stores accept SNAP benefits online due to technological and financial barriers. The purchase of the online app-based portal is very expensive and most small businesses cannot afford to implement it. In some states people who rely on SNAP can only buy their groceries online from Walmart and Amazon (Durbin, 2020). 

The acceptance of this bill is vital this year due to the COVID-19 global pandemic, because the bill allows consumers to buy fresh, locally grown food online at home that minimizes their risk of being exposed to the virus when buying groceries in-store. Therefore, the main purpose of the Expanding SNAP Options Act is to provide the necessary funding to create an online, app-based program that can be used universally to allow all SNAP retailers an easy-to-navigate system for their customers (Durbin, 2020). In return, the Act will also allow an increase in accessibility to nutritious foods from the wider variety of SNAP retailers. Small businesses like local farms can also benefit from the economical advantages of SNAP payments if this Act is implemented (Durbin, 2020). There are already some retailers who allow SNAP users to pick up their groceries in-store, but this is not the safest option for consumers during the pandemic. 

To address the hunger needs during the COVID-19 pandemic (and hopefully after the pandemic too), the Expanding SNAP Options Act will do three things, that it, 1) “require the Secretary of Agriculture to implement online SNAP purchasing in all states,” 2) provide $25 million for the development and maintenance of an online app-based portal that is secure and user-friendly. The portal will also support small businesses by offering online SNAP purchasing that reaches more customers, and 3) the Act will provide $75 million to create a USDA Technical Assistance Center that facilitates online purchasing that can be used by small businesses. The Technical Assistance Center will also give information to the public on which businesses accept SNAP online purchasing benefits (Durbin, 2020). 

This semester my practicum group and I focused on Pender County, a rural county in the Southeastern region of North Carolina that has been identified as a food desert, an area that has limited access to affordable and nutritious food. Many small businesses in Pender County are small, local farms and many in rural counties face food insecurity problems. The USDA ERS defines food insecurity as, “the lack of access to sufficient, safe, and nutritious food” (Smith, Meade, 2019). Ironically, food insecurity is higher among rural areas where most food is grown for the rest of the nation (Warren, Smalley, 2014). Rural grocery stores tend to sell inexpensive foods with lower nutrients compared to urban grocery stores (Warren, Smalley, 2014). North Carolina ranks above the average level of food insecurity in the nation and the Southeastern region of NC is one of three major areas of persistent poverty in the state (Feast Down East, 2020). Pender County has a high food insecurity rate (13.6%) (Feeding America, 2018). Many Americans who live in rural counties like Pender would benefit from the Expanding SNAP Options Act, because they would have access to more nutritious food that can be delivered straight to their doorsteps. 

Our practicum group created an online advocacy campaign on social media. We created two back-to-back online Facebook events encouraging people to email their local representatives about the Act. We included a template of an email letter for people to send to local representatives, and we gave a list of representatives for North Carolina. Instructions on how to find senators for those registered to vote outside of the state of North Carolina was also provided. We also created an Instagram account called Bills You Should Know About, where we posted infographics about the event and instructions to join the Facebook events to increase our audience. Unfortunately, we did not reach a wide audience. Personally, I found it difficult to spread the word about our online event because I am an international student and I do not know a lot of Americans who could participate in our online Facebook events. Nonetheless, I am very grateful for the opportunity to learn more about the needs of Americans and what is being done to help! I am hopeful that this Bill will be passed and that many Americans will be safer and healthier because of it!

References

Feast Down East (2020). www.feastdowneast.org

Dick Durbin United States Senator Illinois (2020). https://www.durbin.senate.gov/newsroom/press-releases/durbin-duckworth-introduce-bill-to-implement-and-expand-online-snap-purchasing-nationwide#:~:text=The%20Expanding%20SNAP%20Options%20Act,easy%20to%20navigate%20for%20consumers

Smith, M. D., Meade, B. (2019). Who are the world’s food insecure? Identifying the rik factors of food insecurity around the world. USDA Economic Research Service, ers.usda.gov/amber-waves/2018/june/who-are-the-world-s-food-insecure-identifying-the-risk-factors-of-food-insecurity-arouund-the-world.  

Warren, C. J., Smalley, K. B. (2014). Rural public health: Best practices and preventive models. New York: Springer Publishing Company

@drtillman

[lizebotha97]

A few weeks ago we hosted a Food Drive Community Drive Through Event to keep it COVID-19 friendly. Local members of the community had the opportunity to come and pick up food bags, books, diapers, and other supplies related to health. A total of around 182 people showed up! Pender County is a rural county that has been classified as a food desert. It was great to spend the day with my peers and with some of the amazing members of Feast Down East! This organization does great things for the community by making food more accessible by hosting events like this one (for free)! I am thankful that we could host an in-person event this semester!

@drtillman

[lizebotha97]

Week 9:

Tonight, we are going to attempt to analyze our data after receiving our Community Needs Assessment back from the community last week. I am thankful for this amazing, flexible team who is always so willing to help! :)

@drtillman​

[lizebotha97]

Macropost #1

Competency F7: Assess population needs, assets, and capacities that affect communities’ health. 

Food plays a vital role in every person’s life. While most people in the United States almost never think about where their next meal is coming from, 13.7 million US households face this problem of food insecurity every day. That is 10.5% of US households according to the United States Department of Agriculture Economic Research Services (USDA ERS, 2019). This semester, I chose to be part of Team FEAST to work with a non-profit organization, Feast Down East. Feast Down East works in the Southeastern region of North Carolina to combat food insecurity in the region, especially among rural communities. They support local farm businesses, educate new farmers on sustainability, distribute local produce, educate the public on the importance of buying local foods to name a few. I am very excited to be a part of this amazing team who does so much for North Carolina. 

Feast Down East works in eleven counties in North Carolina, i.e. Bladen, Brunswick, Carteret, Columbus, Duplin, New Hanover, Hoke, Onslow, Pender, Robeson, and Sampson County. Team FEAST, our practicum group, is focusing specifically on Pender County this semester. Our primary goal is to determine the food needs within the county. To accomplish this goal, we distributed a few surveys to gain insight from the community. First, we made and distributed a survey to 40 community partners to gain valuable insight on what the partners wanted to include in the Community Needs Assessment. The community partners consisted of various groups like local food banks, local farmers and faith-based organizations like churches. Only 17 out of the 40 community partners responded to the initial survey and they all provided valuable insight into which questions we should include in our community needs assessment. Their main suggestions were to include questions about transportation, food access, where the locals buy their food, and immediate needs. We also asked if the community partners would be willing to distribute our community needs assessment and 14 agreed to. After receiving the community partner’s responses, we created a 67-question Community Needs Assessment in both English and Spanish that included questions related to the suggestions from the initial survey. The purpose of the Community Needs Assessment was to gain insight on what the food needs in Pender County are. One of Feast Down East’s biggest assets is their community partners as demonstrated by Liz Peterson from NC Cooperative Extension. Liz Peterson distributed our community needs assessment survey to about 1,700 people. Members of the community could complete the survey online or in paper format. We received about 100 responses from the community, although not all surveys were fully completed. Analysis of the survey results is currently underway. We are also in the process of planning a drive through event to distribute food boxes and additional resources related to nutrition, food access, and overall health. 

The USDA ERS defines food insecurity as “the lack of access to sufficient, safe, and nutritious food” (Smith, Meade, 2019). Ironically, food insecurity is higher in rural areas where most food is typically grown for the rest of the nation (Warren, Smalley, 2014). Rural grocery stores tend to sell inexpensive foods with lower nutrients compared to urban grocery stores (Warren, et al., 2014). Food insecurity is a social and economic issue and it is also a concern to public health. North Carolina ranks above the average level of food insecurity in the nation and the Southeastern region of North Carolina is one of the three major areas of persistent poverty in the state (Feast Down East, 2020). Food insecurity also looks different from one rural county to the next (Feeding America, 2018). As we discussed in class, the average cost of a meal in Wayne County, NC is lower than the average cost of a meal in Harnett County, NC. Both of these counties are considered rural, so why is there a difference? One explanation that we discussed in class is because Harnett County is adjacent to Wake County, which is considered an urban county and this changes the context in Harnett County. The overall food insecurity rate in the United States is 11.5% vs. 15.1% for the child food insecurity rate (Feeding America, 2018). As someone who comes from a developing country where food insecurity is seen around every corner, it is hard to wrap my brain around the idea that so many people in the United States, one of the most affluent and influential countries in the world, can be food insecure. 

Therefore, I am very grateful that I got chosen to be a part of this practicum group. This practicum has opened my eyes to see the needs of a whole community in terms of food. My peer group members and I all have different career paths in mind, but we all share a common goal and motivation for this project, i.e. to help people! I think Team FEAST can make a great impact in Pender county this semester, especially with the help of our preceptors from Feast Down East, the ladies at the Pender County Health Department, and the partners at NC Cooperative Extension. All of these organizations are very willing to help and they are making our first practicum experience one to remember. I am looking forward to the event that we have planned in a few weeks!

References

Feast Down East. (2020). www.feastdowneast.org 

Feeding America, Map the Meal Gap. (2018). map.feedingamerica.org/county/2018/child

Smith, M. D., Meade B. (2019). Who are the world’s food insecure? Identifying the risk factors of food insecurity around the world. USDA Economic Research Service,  ers.usda.gov/amber-waves/2019/june/who-are-the-world-s-food-insecure-identifying-the-risk-factors-of-food-insecurity-around-the-world 

USDA ERS. (2020). Key statistics and graphs. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/key-statisticsgraphics.aspx#:~:text=In%202019%3A,with%20adults%2C%20were%20food%20insecure.

Warren, C. J., Smalley, K.. B. (2014). Rural public health: Best practices and preventive models. New York: Springer Publishing Company.

@drtillman

[lizebotha97]

Week 8:

This week, Team FEAST finalized our Community Outreach Event - we created a flyer (now, we are waiting on our location confirmation before we send our flyer out to the community). We also drove to Pender County to meet with Jordyn Appel-Hughes from Feast Down East! What a fun, quick trip! :)

@drtillman

[lizebotha97]

Week 7

We distributed our Community Needs Assessment in English and Spanish to the community! The survey was also distributed in both online and paper formats, depending on the need of the community partners. Thanks to Liz Peterson from NC Cooperative Extension, our survey was sent to 1,700 people! We are eager to get the results back!

Image from https://www.mycustomer.com/experience/voice-of-the-customer/20-stats-that-will-change-the-way-you-survey-your-customers

@drtillman

[lizebotha97]

Big smiling faces coming from Team FEAST this week, because we finalized the community needs assessment! We are waiting for our translator to translate the community needs assessment to Spanish so that we can reach a larger population in Pender County. We are looking forward to distributing the community needs assessment later this week!

@drtillman

[lizebotha97]

Week 5:

During this week, Team FEAST attended the Pender County Food Council Call to tell the local partners who we are and what our vision is for our practicum project this semester. It was a privilege to get connected to the local partners and to inform them on the purpose of the community needs assessment that we will distribute within the next few weeks.

@drtillman

Photo Credit:

https://www.carolana.com/NC/Counties/pender_county_nc.html

[lizebotha97]

Community Needs Assessment

Week 4:

This week Team FEAST made a commu needs assessment that will be distributed in the near future. The community needs assessment asks questions from multiple domains and not just food access. For example, questions asking about access to transportation and utilities like running water and electricity were added to the community needs assessment. We hope that we will be able to identify the food needs in Pender County with the current community needs assessment.

Photo Credit:

https://www.google.co.za/search?q=needs+assessment&client=safari&hl=en-za&prmd=ibvn&sxsrf=ALeKk00kUEc-L9BZaZZ-o0ItbVs8dCNsSA:1601472884186&source=lnms&tbm=isch&sa=X&ved=2ahUKEwj5gISz_5DsAhVOmXIEHcdYBy0Q_AUoAXoECCEQAQ&biw=414&bih=715#imgrc=0JGZdjD5xL28oM&imgdii=HImeo56k_L7hMM

@drtillman

[lizebotha97]

During week 3 Team FEAST reached out to the Pender County partners to assess the needs of the community. We are planning to form a community needs assessment based on their survey results. We are looking forward to build connections with these partners who are already helping people with food needs. We are also looking forward to get a better understanding of the food needs in Pender County.

@drtillman

[lizebotha97]

Helping the community.

This week Team FEAST expanded the existing resource guide for Pender County. This includes resources for the general public, resources for seniors, resources for children, seeing which farms are offering pick-up and delivery, and which farmers markets are available.

@drtillman

[lizebotha97]

Last week the members of Team FEAST met for the first time. We were also introduced to our preceptor, Cara Stretch, the Executive Director of Feast Down East. I am excited to work with these ladies this semester to address food insecurity in Pender County, NC. I am looking forward to creating an advocacy campaign around the Expanding SNAP Actions Act to make food more accessible in rural NC. Hopefully we can also plan a resource fair for Pender County during these uncertain times.

@drtillman