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DR. KAREN GLANZ: Everyone, good morning or good
afternoon, depending on where you are.

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Welcome to day three of the NIH Food Insecurity,
Food Environment and Neighborhood Health Disparities

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State of the Science workshop.

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Today we'll focus on Implementation Science,
Policy, Community-Based Research and exploring

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what works, what doesn't work and why?

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Yesterday, we had a series of wonderful presentations
focused on the neighborhood food environment

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and some evaluations of strategies to inform
policy and practice that may improve food

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environments and prevent diet related health
disparities.

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In reflecting on the talks that we heard yesterday,
I want to call your attention to one cross-cutting

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theme which has to do with correlation versus
causality.

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This I'm going to talk about it in the context
of neighborhood food environments, but it

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applies to food insecurity as well.

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What I think is really important is that we
align any interventions with our understanding

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and with a good understanding of the causes
of the problems, this problem is unhealthy

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diet, risk factors, disease and so forth.

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And also, that we calibrate the outcomes that
we expect from interventions to realistic

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expectations.

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So let me give some examples.

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There are many coexisting causes of unhealthy
diets and risk factors and... ..to use the

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example of a lack of supermarkets in the neighborhood
or too many fast food restaurants, those aren't

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the only causes or determinants out there.

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Other determinants might include poverty,
discrimination, issues related to housing,

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transportation, crime and so on.

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So, we're isolating the lack of a supermarket,
let's say, as a cause of poor diet but it

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doesn't operate in a vacuum.

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And some of those things are measured and
some of those things are unmeasured in our

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research and for some of them we can get data
from other sources at the neighborhood level,

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from the Census, American Community Survey
and so forth.

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And I think that's really important when we
think that the intervention of putting a supermarket,

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for example, in a community in and of itself
should bring about change when there are other

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things going on in the background that are
also important, potentially causal and may

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be amenable to change.

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Another example has to do with restaurant
food environments.

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We've seen a lot of interventions, a very
active area has been calorie labeling and

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policies for calorie labeling have prompted
a lot of this research and that really acts

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on the information environment within restaurants.

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It's not the whole overall environment and
the findings have been mixed about whether

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or not calorie labeling affects people's food
choices, purchases, and what they eat.

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Another way to change the restaurant food
environment that Chris Economos gave a good

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example of with the Silver Diner study is
menu changes, actually changing foods in the

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environment.

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And she took it one step further to go beyond
availability and talked about defaults or

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nudges.

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So not only making the healthier choices available
but making the healthy choice the easy choice

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as we say in the behavioral economics or environmental
change arena.

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A third example that was presented yesterday
by Joel Gittelsohn had to do with corner stores

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and corner store interventions and anyone
who's worked in this area in practice or in

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research knows that one of the great challenges
of trying to improve the food environment

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in corner stores is not just to increase the
access to healthier food, putting in some

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fruits and vegetables, etc.

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But to balance out the healthy versus the
unhealthy because unhealthy cheap food is

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often plentiful in these food settings.

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And Joel Gittlesohn, with his years of work
in this setting identified a lever that could

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be potentially tangible which had to do with
the food supply chain that the owners of these

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stores did not have an easy way to get the
healthier foods whereas they had very easy

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ways to get the less healthy foods and so
he's currently working on an intervention

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to try to make a difference in that that
they may really reshape the environment in

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small ways and potentially in larger ways
eventually.

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So those are some examples about kind of looking
at causation and not just correlation when

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we're thinking about introducing interventions
and evaluating them.

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We also heard a lot about research methods
and particularly about measurement of neighborhood

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food environments and one important takeaway
out of that was that our measures should be

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aligned at the level of our leverage points
for action.

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So ground treating is very important when
we use available commercial lists to identify

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where different stores and food venues are.

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Done a lot of research on that, we didn't
hear too much about that research yesterday.

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We're going to hear actually a little bit
more about that today in terms of what people

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encounter and Martin Caraher's talk gave the
example of the crowdsourcing approach to food

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locations in the community that people on
the ground can help us to learn more than

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just what we learned from a researcher's perspective.

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So those are a couple of lessons from yesterday.

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Today we're going to focus on implementation
science and very specifically with two sessions

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about what works and what hasn't worked and
why?

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In both food insecurity and neighborhood food
environment.

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I encourage you to listen closely and to think
deeply about your own work.

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Sometimes we get results that are disappointing
or only partly successful and we're eager

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to kind of present them as being more successful
than they were without misleading maybe because

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we've invested time, energy and funding from
our funders to get these things done.

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I would urge you to think about if something
does not work or does not work as well or

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on the outcomes that we expected to think
about why that is, what we can learn from

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it and how it can affect our collective efforts
to try to improve health in the long run.

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So with that I want to first remind everyone
that you can add questions through the chat

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box.

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We love to hear your questions.

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We have some terrific speakers lined up today
and at the end of each panel we'll have time

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for your questions.

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And now it's my pleasure to introduce to you,
Dr. George Mensah.

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Dr. Mensah is the director of the Center for
Translational Research and Implementation

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Science at the NHLBI, the National Heart,
Lung and Blood Institute.

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And one of the things that I like about the
name of that center is that the acronym is

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CTRIS and so that's a really good leading
to a workshop having to do with food.

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Dr. Mensah will provide us with an introduction
on implementation science.

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Thank you, George.

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DR. GEORGE A. MENSAH: Karen, thank you very much.

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That was wonderful introduction.

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I must say just listening to you go over what
you've covered in the first two days just

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shows how rich and how informative this workshop
has already been.

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And you are yet to even take a deep dive into
panels five, six and seven where you tackle

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the huge challenges of what works, what doesn't,
why?

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And also hear perspectives from community
organizations of how we can do better.

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So really, congratulations to all of you because
this looks like has been a really terrific

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workshop and I'm just delighted to have the
opportunity to be part of bringing closure

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to this three-day effort by focusing on implementation
science first.

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I'm glad that Karen liked the name of our
center, actually, one of the original logos

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that was proposed for CTRIS was after the
fruit, so it didn't stick.

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but we still we're still happy that people
remember CTRIS.

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And just by way of introduction, CTRIS was
formed to serve as a strategic focal point

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to...align and bring implementation science
across all of NHLBI so that the discoveries

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that we're making in heart, in lung, in blood, and in sleep research can be rapidly translated

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into routine care.

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So that's really the basis and so the implementation
in our name we take very seriously.

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I really want to thank Karen.

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I want to thank Angela and Allison for giving
me this opportunity to participate.

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This is my disclaimer and disclosure slide
and as you can see, I have no conflicts in

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presenting and please don't take what I say
here to represent an official position of

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the NIH or the US government.

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There is no question at all that most of what
we're doing here today relies on the real

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importance of our need for food and water.

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This is just a cartoon that when the…in this effort to look at some 20 to 30

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major challenges that we face.

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It turns out that the need for food is really
number one.

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So, it's not a surprise that we pay a lot
of attention to the disparities that are found

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in this field.

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You are all experts, and you all know the
epidemiologic data that shows the stark realities

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when it comes to nutrition disparities.

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And some of the challenges of the neighborhood
environment but the real issue for us today

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is that there have been several global strategies
that have been recommended and yet implementation

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remains a major challenge and that's why focusing
on the implementation science, it's important.

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We need to try and distinguish implementation,
the act of doing something, making it come

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into being versus the science of the rigorous
study of implementation.

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So, in our center and across most of NIH,
we define implementation science as a study

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of rigorous methods to promote and to accelerate
the integration of research findings and evidence

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into policy and practice.

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I've highlighted both policy and practice
because it's not one or the other.

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It's both clinical and public health practice
but also to inform policies.

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And that's critical because very often it's
the policies that help sustain the clinical

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and public health practices that were put
into place.

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Implementation science is really the big umbrella
under which you find dissemination research

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and implementation research.

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So even though from time to time we tend to
use implementation science and implementation

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research interchangeably, they're not the
same.

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Implementation research is a rigorous scientific
study of the use of strategies that lead to

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adoption and integration of proven effective
interventions or evidence-based health interventions

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into routine day to day clinical settings,
community settings in order to do what?

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In order to improve patient or community or
population outcomes.

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Now dissemination research all goes hand in
hand with implementation research because

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that's the study of targeted distribution
of information that comes out of all of the

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research that you're doing, so that we can
identify the best strategies, the specific

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public health or clinical practice or population
or community settings at the right channels

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to distribute that information.

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And the intent is to understand how best to
spread and to sustain that knowledge and the

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associated evidence-based innovations.

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Now this is a very important slide and I've
intentionally highlighted in blue many of

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the themes that we look for when we are looking
for meritorious applications, we should fund

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within implementation science.

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Now we all know that establishing efficacy
and effectiveness is very important but it's

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really not enough when we're talking about
implementation science.

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It's the field of dreams, a phenomenon.

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The fact that you build it doesn't mean that
would come.

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And if nothing at all we've learned from the
COVID era is that you can have an innovation

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that's innovative, that's nearly 100 percent
truly nearly 100 percent effective in preventing

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death and 95 percent or so effective in preventing
serious disease but we can't assume that people

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would take it.

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So, we must explicitly steady the implementation
of that innovation.

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What are the barriers?

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What are the facilitators that can sustain
uptake?

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It's also important that we understand the
context within which that innovation will

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be accepted, will be adopted or will be modified
and used as intended with very high fidelity.

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Very important that we also assess and ensure
that the innovations we are talking about

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are not only available, but they are accessible
to the intended population of interest and

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especially that they're also affordable.

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How do we have very broad reach for the intended
population?

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And then finally, we must study how to scale
up, how to spread, what works and just as

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importantly, to learn what doesn't.

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That's why I'm very excited about the challenge
before you today, learning from what doesn't

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work but also learning to spread and scale
up what's effective and what works.

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Now within our center, this is the model that
we try to remember every day.

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If you look at the NIH's mission for biomedical
research, we are across the entire spectrum

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from fundamental discoveries to translation
to humans, to translation to patients, to

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translation to the bedside but we tend to
focus on the real-world settings translating

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our discoveries into real world settings used
and dissemination and implementation research.

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And very importantly, the big arrow going
from right to left is to show that in fact,

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there are many lessons we can learn from the
work we do in implementation research that

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can inform the earlier phases of research.

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Here are a few examples of some of the design
studies as you think about the challenges

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you have today that can help enhance and sustain
adherence.

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I've highlighted bullets two and three because
it's really critical, very much as Karen said.

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Very often we're not talking about only one
specific factor within the environment that

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is responsible for the outcome of interest.

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So thinking about the use of multilevel, multidisciplinary
strategies that are really informed by dissemination

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and implementation science frameworks that
multiple frameworks that can really inform

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the research designs that you put in place
and regardless of which framework you use,

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prioritizing the community engagement, community
outreach and bringing in community stakeholders

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early into the design to identify the important
questions around food, food insecurity and

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nutrition, the disparities and what will be
important outcomes meaning outcomes important

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to them not outcomes that we as academicians
or researchers find exciting.

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So, incorporating those outcomes to the most
meaningful to the communities of interest

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becomes very important.

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I'm showing you here in this slide only just
two examples of the frameworks that I used

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in implementation size.

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The RE-AIM Framework is really very important
and several of the questions that are asked

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reach, for example, what are your plans for
reaching the population of interest?

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Again, effectiveness.

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How would you know that the intervention that
you've just described that has been demonstrated

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to be effective in a different context can
be effective in the context that you study

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in the particular neighborhood that you were
working in?

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And how about adoption?

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How would you know that it will be adopted
and used in the way it was intended where

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it's original effectiveness or efficacy was
demonstrated?

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So really very important to have a framework
whether it's theoretical or conceptual.

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It's probably not as crucial as having the
framework that guides the intervention that

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you're going to be doing.

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A second example is the CFIR which is the
Consolidated Framework for Implementation

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Research.

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This particular model I'm showing here is
one that's modified using advances in process

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redesign, but these are only two.

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There are multiple others that can be used.

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A tip for you for those of you thinking about
sending applications to us at NIH.

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If you really want the application to be viewed
as meritorious and it's really within the

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arena of implementation science, there must
be a conceptual or theoretical framework that

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informs what you're doing and particularly
for food insecurity, for nutrition research,

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it helps to have that framework.

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Now very often we do things in a very linear
fashion as this slide shows going from left

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to right, designing the steady very carefully
making sure that the benefits to the population,

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to the community, to the neighborhood that
we're thinking about can actually be measured

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and then making sure that people can have
access and can adhere to the protocol that

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we're using all the way to the end asking
can it really work in this environment?

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We work out all the kinks and then we say,
well, let's then figure out what the dissemination

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strategy and the implementation strategy should
be.

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We think that's the wrong approach and in
fact, we must think of their implementation

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strategies at the very beginning and the dissemination
of strategies as well.

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Who's going to deliver this intervention you're
talking about in this particular community

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of interest?

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And how well does it fit socially, economically,
culturally, within that community?

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So, the social determinants of health put
in the appropriate context at the very beginning

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is really crucial.

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And of course, it always helps when you build
in some elements of training, of support, elements

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of adherence, all critical parts.

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But please let's not think of the implementation
and dissemination at the end.

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Let's think of it even at the beginning so
that we can design effective interventions

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for sustained impact.

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Implementation science, as you all know, is a relatively new field. Although, we now have

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a very well respected journals, there is at
least...several very good authoritative books

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and I'm just showing two here.

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You know, a 10-minute presentation can't go
into all the important resources available

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for this field.

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But we strongly encourage you, no matter what
your special interest is, thinking of implementation

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would help us. It is really not acceptable that the best interventions we have still take 

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on average 17 years to get into routine day
to day care.

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And that's for the clinical biomedical setting,
where very often we don't have as many social,

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cultural, linguistic challenges as we do when
we start to talk about diet and nutrition.

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So, really very important that we become fully
engaged in the discussions you are having today

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about the importance of implementation, the
importance of how innovations work, why they

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don't work, and what we can learn from them.

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In addition, I've shown you here and these
are hyperlinked on the slides that will come

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to you the resources available from NIH website,
including our major landmark PAR, program

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announcement.

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And certainly, we also have the classic R01
mechanism where if you have ideas, particularly

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mechanistic approaches, to help explain why
some innovations worked, and others didn't

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work, we always welcome investigator-initiated
research to help advance this field.

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Let me conclude by saying it's we all know
it's really essential that the effective innovations

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you are helping design be widely adopted and
scaled up and spread to the communities who

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need them the most.

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That's where implementation science helps.

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And that's why we have to invest in implementation
science.

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We also know that innovations that went well
in one community may not necessarily work

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well in another, we need to know we need to
study in a rigorous fashion, what works well,

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where and why and when it does.

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And that, again, is why implementation science
is a really real benefit.

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We need to understand why some interventions
fail.

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This is an excellent example where failure
can be turned into success.

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Because by knowing why things fail, we can
plan our next interventions much better.

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We can't do this alone.

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So, collaborations are critical and are particularly
forming strategic collaborations among community

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organizations within academic health centers,
and not forgetting about our policymakers.

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Because making sure that very early on they
know what we're doing so that when the results

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come out, they can inform the policies that
can help sustain the innovations would be

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critical.

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So, in sum...you can tell that implementation
science is really fundamental to addressing

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our health challenges, our health disparities,
challenges, and helping advance health equity

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because it can help identify the barriers,
the facilitators, that would enable us to

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have successful strategies that would really
go for long term sustainability.

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This is my final slide, and I want to show
that, please visit us on our website.

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And again, you can...also follow our official
Twitter site.

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Very often when we have important implementation science publications or important implementation 

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science, innovations, and strategies.

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We tweet about them here.

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So, let me stop and turn it over to Karen.

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Thank you very much.

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DR. KAREN GLANZ: Thank you so much, Dr. Mensah, for your
thoughtful comments.

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It's so relevant to the next session about
the critical role of implementation science

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and understanding what works, what doesn't
work for who and why, and the critical role

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of community and policy makers and their engagement
in this type of research in addressing the

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issues at a population level.

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Our next session is exactly that.

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We're going to focus in session seven, on what
is what has and hasn't worked to address food

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insecurity and health.

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Our objectives of this session are to highlight
efforts by one of the largest charitable hunger

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relief organizations in the U.S. to discuss
strategies.

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To address food insecurity among high-risk
populations in the context of the social determinants

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of health, that influence implementation,
and waste, improve these interventions, describe

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00:27:57,789 --> 00:28:03,870
positive effects or lack thereof, and the
terms of research methodology and interventions,

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00:28:03,870 --> 00:28:04,870
assumptions, and features.

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00:28:04,870 --> 00:28:11,409
And then to examine research methodologies
and interventions to explore what's worked,

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00:28:11,409 --> 00:28:17,610
what hasn't worked, including case studies
of effective interventions as well as future

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00:28:17,610 --> 00:28:18,610
opportunities.

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This is a two part session and we have the
opportunity to hear from as was mentioned,

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one of the leading hunger relief organizations
in the United States, Feeding America, to kick

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off this session, I'm delighted to
introduce Gita Rampersad, who is the Vice

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00:28:39,940 --> 00:28:45,041
President of Health and Nutrition at Feeding
America and a close colleague who will provide

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an overview of Feeding America's efforts. During
this presentation, as we talked about before,

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feel free to enter your questions in the chatbox,
any comments that you have, and then we'll

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00:29:01,130 --> 00:29:05,200
move into the second part of the presentation
where we have a panel.

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00:29:05,200 --> 00:29:08,149
So, I'm going to turn it over to Gita.

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00:29:08,149 --> 00:29:13,440
DR. GITA RAMPERSAD: Good afternoon.

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00:29:13,440 --> 00:29:22,789
I'm Gita Rampersad, and I'm here on behalf
of Feeding America, I have no conflicts or

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disclosures.

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00:29:24,980 --> 00:29:29,280
For those of you who aren't familiar, the
Feeding America network is made up of close

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00:29:29,280 --> 00:29:35,399
to 200 food banks and over 60,000 food pantry
and meal programs across the country.

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We also have two national offices.

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One is in Chicago and the other one is in
Washington, DC, where I'm located.

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00:29:44,409 --> 00:29:50,970
The way the Feeding America network works
is the Feeding America purchases or acquires

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00:29:50,970 --> 00:29:54,590
surplus food from public and private sources.

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00:29:54,590 --> 00:30:02,230
In turn, makes it available to local food
banks, who then distribute it to the over

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00:30:02,230 --> 00:30:12,150
60,000 meal partners that they have in their
communities, which results in 1 in 7 Americans served.

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00:30:12,150 --> 00:30:18,480
Last year, we helped 40 million people in
America by providing over six and a half billion meals

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and by rescuing close to five billion pounds
of food that would have ordinarily gone to waste.

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In addition, the food banks are often involved
in SNAP application assistance.

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And that was a year last year was an incredibly
busy year for us too.

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This is a slide that shows the numbers for
hunger in America in 2019.

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In 2019, there were 35 million Americans struggling
to afford the food they needed.

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And about 11 million of those 35 million were
children and 4 million of them were seniors.

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You know, the positive piece on this is that
we were really moving the needle on hunger

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00:31:01,510 --> 00:31:02,510
in this country

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00:31:02,510 --> 00:31:03,510
prior to COVID-19.

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00:31:03,510 --> 00:31:10,429
We were seeing record lows in terms of food
insecurity rates, the rates that we hadn't

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00:31:10,429 --> 00:31:12,630
seen since before the great recession.

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00:31:12,630 --> 00:31:21,889
One thing that we are continuing to see are
disparities in hunger.

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People of color are more likely to face hunger.

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One in 13 white households face hunger, as compared
to one in six Latino households, one in five

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00:31:32,130 --> 00:31:38,610
black households, and one in four Native American
households that report being food insecure.

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We also know that COVID-19 has had a disproportionate
impact on people of color facing hunger.

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They faced higher rates of unemployment, hospitalization,
disease, and death.

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At Feeding America, we projected that COVID-19
was going to have a significant impact on food

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insecurity for 2021.

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00:32:04,970 --> 00:32:11,879
We estimated that 42 million people would
be considered food insecure as a result of

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00:32:11,879 --> 00:32:16,380
the pandemic in 2021 including 13 million
children.

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Additionally, the numbers were going up for
those who would experience very low food security.

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And that means that they would be relying
more heavily and regularly on the charitable

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food system.

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Another way to really kind of conceptualize
hunger in America is, you know, to follow

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this slide.

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Before COVID-19, 1 in 9 people faced hunger
in this country and 1 in 7 children were food

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insecure.

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Pandemic made some drastic changes to those
numbers.

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Last year, we saw that those numbers shifted
to one in six people who are facing hunger

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and one in four children.

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00:33:02,600 --> 00:33:07,590
We also saw record numbers seeking help from
the charitable food system.

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Our food banks reported a 60% uptick in the
number of clients served last year and also

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reported that roughly 40% of the individuals
that were being served had never had to have

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to rely on the food on the charitable food
system before.

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For us, we are always focused on research
that serves the charitable food system and

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informs national thought leaders.

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And one of our colleagues, Dr. Waxman, will
be leading the forthcoming panel.

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And it's always for us at Feeding America,
it's always important that we recognize our

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research partners because we know that we
can't do this alone,

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and our goal is really to enable our food
banks to understand and more effectively serve

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the food insecure populations in their communities.

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This is one of our research tools.

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This is a Map the Meal Gap.

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And this is the 2019 version of Map the Meal Gap.

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And what it's showing here is that hunger
is ripe with what is ripe with an equity. Where

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you live matters.

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So, if you live in the south, in the southern
region of the United States, you are more

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00:34:25,669 --> 00:34:30,310
likely to experience higher levels of food
insecurity.

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00:34:30,310 --> 00:34:36,280
Hunger also pushes people to have to make
tough choices.

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00:34:36,280 --> 00:34:41,839
We know that for people that we serve household
income doesn't cover basic needs, we see that

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there's, you know, close to 70% having to
make tough choices between paying for utilities

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00:34:47,380 --> 00:34:52,919
and food, transportation and food, medical
care, and food and almost 60% have reported

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00:34:52,919 --> 00:34:56,159
having to choose between paying for housing
and food.

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00:34:56,159 --> 00:35:01,990
And for me as vice president of health and
nutrition, very concerned about the reality

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00:35:01,990 --> 00:35:06,570
that people have to make a medical care decision
over a food decision.

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00:35:06,570 --> 00:35:11,880
In other words, somebody may have to choose
between whether they can purchase their insulin

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00:35:11,880 --> 00:35:17,349
for the month or feed their family.

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00:35:17,349 --> 00:35:21,839
These tough choices lead to really an unhealthy
cycle.

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When our households are faced with these tough
choices, they often have to stretch a budget

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and purchase inexpensive unhealthy food.

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And as you can see close to 80% report having
to do that processed food and that you know

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00:35:38,270 --> 00:35:42,250
sort of eating in excess of processed food
can often lead to fluctuations in weight and

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00:35:42,250 --> 00:35:48,579
blood sugar, which then in turn actually turn
into full blown chronic conditions like high

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00:35:48,579 --> 00:35:52,130
blood pressure, heart disease, diabetes, and
obesity.

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00:35:52,130 --> 00:35:57,071
In fact, one in three households in the Feeding
America that served by the Feeding America

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00:35:57,071 --> 00:36:01,640
network report a member living with diabetes.

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00:36:01,640 --> 00:36:05,980
This also has an incredible impact on the
U.S. healthcare system.

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00:36:05,980 --> 00:36:09,740
In a study that we did with our partners at
the University of California, San Francisco,

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00:36:09,740 --> 00:36:17,069
and help Dr. Hilary Seligman, we found that
for every food insecure person in this country,

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00:36:17,069 --> 00:36:24,740
you can add an extra 2,000 dollars of healthcare
costs to their annual expenditures.

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00:36:24,740 --> 00:36:31,080
And you know, when you multiply that by something
like 35 million, we're talking about 70 billion

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00:36:31,080 --> 00:36:34,710
dollars that we think could be saved.

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00:36:34,710 --> 00:36:40,210
One thing we always are talking about at Feeding
America are where are the research gaps and

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00:36:40,210 --> 00:36:47,150
opportunities and I wanted to just, you know,
highlight a few of them today, those being

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00:36:47,150 --> 00:36:51,200
data disaggregation, hunger, and health, and
nutrition security.

403
00:36:51,200 --> 00:36:54,160
I think we need to do better at disaggregating
data.

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00:36:54,160 --> 00:36:59,760
And we need to begin with, you know, race,
ethnicity, and language and go from there.

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00:36:59,760 --> 00:37:03,010
We're currently in the process of doing that
for food security.

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00:37:03,010 --> 00:37:10,990
We've certainly identified many drivers of
health and disaggregated those data by race.

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00:37:10,990 --> 00:37:18,859
But it's important to be able to see exactly
who is you know, sort of realizing the most

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00:37:18,859 --> 00:37:26,000
need so that we can tailor our resources and
our services to make sure that we can correct

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00:37:26,000 --> 00:37:27,000
that.

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00:37:27,000 --> 00:37:31,030
The other gap an opportunity area that are
highlighted here is hunger and health.

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00:37:31,030 --> 00:37:38,270
I think it's important we continue to strengthen
the messaging that there is a strong connection

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00:37:38,270 --> 00:37:43,060
between hunger and health, through our programs
through some of our policies, and definitely

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00:37:43,060 --> 00:37:46,010
through some of our best practices.

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00:37:46,010 --> 00:37:53,650
And finally, we are currently in discussion
around this, this term this hot topic nutrition

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00:37:53,650 --> 00:37:59,890
security, and for Feeding America, we're working
to define what nutrition security means for

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00:37:59,890 --> 00:38:07,390
us and for the charitable food system, and
how we can measure it.

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00:38:07,390 --> 00:38:15,340
So... going back to COVID-19, on the one hand,
COVID-19 created the perfect storm, and you

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00:38:15,340 --> 00:38:21,120
know, it up ended the need for food assistance,
and it created unchecked rates of disease

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00:38:21,120 --> 00:38:22,120
and mortality.

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00:38:22,120 --> 00:38:25,480
But it also open doors to new opportunity.

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00:38:25,480 --> 00:38:29,931
And there is overwhelming interest in the
intersect of hunger, health, and I will say

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00:38:29,931 --> 00:38:32,300
equity in this country.

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00:38:32,300 --> 00:38:37,300
And it's time, you know, this is our moment,
this is our moment to really capitalize on

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00:38:37,300 --> 00:38:50,700
this interest, partner and collaborate to
overcome hunger in poor health in this country.

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I always like to put this slide in my presentations,
because I think it's a really clear example

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of the disparities that exists.

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00:38:59,660 --> 00:39:02,900
The racial disparities exists when we talk
about hunger and health.

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00:39:02,900 --> 00:39:09,290
So, this is a map of Georgia. In the middle, it's broken down by county. In the middle

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00:39:09,290 --> 00:39:15,720
is the is the percent of black people living
in different counties.

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00:39:15,720 --> 00:39:21,240
And the deeper the shade of red, the higher
the black population in that area, in those

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00:39:21,240 --> 00:39:22,240
areas.

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00:39:22,240 --> 00:39:25,130
On the left side is the Georgia Map the Meal Gap.

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00:39:25,130 --> 00:39:31,780
And then, again, the deeper shades of green
indicate higher rates of food insecurity.

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00:39:31,780 --> 00:39:39,470
And then on the right side, we have the map
of Georgia representing COVID-19 deaths.

435
00:39:39,470 --> 00:39:44,390
And red indicates the highest rates and then
the darker shades of blue indicate the next

436
00:39:44,390 --> 00:39:48,240
highest rates and so on.

437
00:39:48,240 --> 00:39:56,859
And I think it's pretty, clear here that there's
a pattern and, you know, that really is sort

438
00:39:56,859 --> 00:39:59,700
of making a case for health equity.

439
00:39:59,700 --> 00:40:03,450
And you know and should not be ignored.

440
00:40:03,450 --> 00:40:14,859
And I think you'll hear from Adam in during
the panel, who will talk about how COVID-19

441
00:40:14,859 --> 00:40:19,920
has impacted food insecurity for the state
of Washington.

442
00:40:19,920 --> 00:40:27,740
So, you know, what is our, what's our vision?
What how are we going to advance health and nutrition

443
00:40:27,740 --> 00:40:33,900
given the, you know, the changes that
the pandemic has brought in think, we've decided

444
00:40:33,900 --> 00:40:39,700
that we need to be very, we need to be bold,
we think that we can make a measurable impact

445
00:40:39,700 --> 00:40:42,710
on the health and well-being of all communities
we serve.

446
00:40:42,710 --> 00:40:45,390
But we can't do this alone.

447
00:40:45,390 --> 00:40:52,520
We know that we will need to partner, and
we are partnering to be innovative and able

448
00:40:52,520 --> 00:40:57,830
to ensure equitable access to nutrition to
nutritious food.

449
00:40:57,830 --> 00:41:09,780
Part of our commitment last year to change
was to really focus in and prioritize equity,

450
00:41:09,780 --> 00:41:13,180
diversity, and inclusion and that includes
health equity.

451
00:41:13,180 --> 00:41:18,480
So, at Feeding America, health equity means
all people facing hunger have a fair and just

452
00:41:18,480 --> 00:41:22,280
opportunity to be as healthy as possible across
the lifespan.

453
00:41:22,280 --> 00:41:27,050
And we've adopted our definition from the
Robert Wood Johnson Foundation.

454
00:41:27,050 --> 00:41:37,400
I wanted to add this slide because this is
gives you a good picture of how we are sort

455
00:41:37,400 --> 00:41:43,890
of narrowing our focus areas to be able to
close gaps and advance health and nutrition

456
00:41:43,890 --> 00:41:45,619
for people facing hunger.

457
00:41:45,619 --> 00:41:52,810
We're very focused on healthcare partnerships
in order to be able to view food as medicine

458
00:41:52,810 --> 00:41:59,740
and develop programs and best practices relevant
to that concept.

459
00:41:59,740 --> 00:42:04,660
We I think a minimum of 50% of our work could
probably be categorized as health and nutrition

460
00:42:04,660 --> 00:42:05,660
equity.

461
00:42:05,660 --> 00:42:06,850
So, we're doing a lot of work.

462
00:42:06,850 --> 00:42:12,740
There's a lot of momentum around equity when
it comes to health and nutrition.

463
00:42:12,740 --> 00:42:21,980
And you'll hear from Dr. Schwartz and in the
panel around some of our best practices, specifically

464
00:42:21,980 --> 00:42:29,390
the HER guidelines that we're very proud of
and how we are transforming the charitable

465
00:42:29,390 --> 00:42:31,500
food experience.

466
00:42:31,500 --> 00:42:37,980
I wanted to also add a few examples of food
banks that I think are you know, really kind

467
00:42:37,980 --> 00:42:41,530
of push moving the needle on hunger, health
inequity.

468
00:42:41,530 --> 00:42:47,730
I'm not going to go into these initiatives in
detail but just know that there's, you know,

469
00:42:47,730 --> 00:42:53,910
this is just a handful there, there are a
lot of really innovative projects that are

470
00:42:53,910 --> 00:42:56,579
being that are taking flight across our network.

471
00:42:56,579 --> 00:43:03,770
And I think you'll also hear from another
panelist, Dr. Caspi, about how food pantries

472
00:43:03,770 --> 00:43:10,100
are also doing their part to transform the charitable,
food experience, and particularly in examples

473
00:43:10,100 --> 00:43:11,100
in Minnesota.

474
00:43:11,100 --> 00:43:20,190
So, before I leave, I just wanted to, you
know, sort of mention that I think what

475
00:43:20,190 --> 00:43:25,200
we're seeing here overall, you know, very
much due to COVID-19

476
00:43:25,200 --> 00:43:28,000
and our public health crisis is a shift.

477
00:43:28,000 --> 00:43:31,819
We're no longer really just thinking about
things in sort of health and nutrition terms,

478
00:43:31,819 --> 00:43:36,500
we're really shifting towards more towards
population health improvement. Our donors

479
00:43:36,500 --> 00:43:38,970
are no longer considered donors.

480
00:43:38,970 --> 00:43:40,619
They're our partners, they're our collaborators.

481
00:43:40,619 --> 00:43:46,160
They're at the table with us designing these
programs and interventions.

482
00:43:46,160 --> 00:43:49,589
And they're accountable just like we are.

483
00:43:49,589 --> 00:43:53,871
We also are moving away from our pilot programs,
we've done a lot of exploratory work in health,

484
00:43:53,871 --> 00:43:58,740
nutrition, and we're now doing, you know,
we're now engaging in designing high impact

485
00:43:58,740 --> 00:43:59,930
models and interventions.

486
00:43:59,930 --> 00:44:04,510
We're also not thinking about things in terms
of just feeding people, I mean, nutrition

487
00:44:04,510 --> 00:44:07,319
security is a real deal.

488
00:44:07,319 --> 00:44:08,860
And so is food justice.

489
00:44:08,860 --> 00:44:15,119
And so that's, you know, we're starting to
think more broadly about our impact in those

490
00:44:15,119 --> 00:44:16,329
areas.

491
00:44:16,329 --> 00:44:21,630
And we're also thinking about people slightly
differently, people facing hunger, or you

492
00:44:21,630 --> 00:44:25,920
know, are not really being thought of in terms
of like, you know, what chronic condition

493
00:44:25,920 --> 00:44:30,750
goes along with that, as we know, many people
facing hunger have higher rates of chronic

494
00:44:30,750 --> 00:44:37,480
disease. We're going in with a whole person
approach, so to health, because physical,

495
00:44:37,480 --> 00:44:39,130
just looking at the physical is not enough.

496
00:44:39,130 --> 00:44:42,300
We have to think about the mental and the
emotional well-being.

497
00:44:42,300 --> 00:44:47,040
And then finally, we recognize that we have
to meet people where they are and continue

498
00:44:47,040 --> 00:44:49,790
to center people facing hunger in this country.

499
00:44:49,790 --> 00:44:53,400
It's never going to be a one size fits all.

500
00:44:53,400 --> 00:45:00,350
So, we thank you for your time, and I welcome
you to join us and join me on this journey

501
00:45:00,350 --> 00:45:04,320
to end hunger.

502
00:45:04,320 --> 00:45:06,960
Thank you.

503
00:45:06,960 --> 00:45:16,440
DR. KAREN GLANZ: Thank you so much Gita for sharing
the work of Feeding America.

504
00:45:16,440 --> 00:45:20,960
We're going to move into our panel and then Gita
will return during the Q&A.

505
00:45:20,960 --> 00:45:28,190
So, I've already seen some questions in the
chat for Gita and so she'll be back at the

506
00:45:28,190 --> 00:45:34,050
end of the panel and we'll have a robust discussion
about strategies to address food insecurity

507
00:45:34,050 --> 00:45:37,960
and think more about what works and what doesn't.

508
00:45:37,960 --> 00:45:40,910
I'm going to turn it over to Elaine Waxman.

509
00:45:40,910 --> 00:45:45,430
We're thrilled to have her as the moderator
for this session.

510
00:45:45,430 --> 00:45:55,069
Dr. Elaine Waxman is at the Urban Institute,
and she has done extensive work in food insecurity

511
00:45:55,069 --> 00:46:00,130
and looking at the determinants, as well as
the consequences of food insecurity.

512
00:46:00,130 --> 00:46:01,970
And so, I'm going to turn it over to you, Elaine.

513
00:46:01,970 --> 00:46:02,970
Thanks.

514
00:46:02,970 --> 00:46:03,970
DR. ELAINE WAXMAN: Great.

515
00:46:03,970 --> 00:46:05,180
Thank you so much, Angela.

516
00:46:05,180 --> 00:46:13,569
So, in this panel session, we're going to explore
some of the research methods and various interventions

517
00:46:13,569 --> 00:46:18,849
that can help us shed light on what has worked
and what hasn't worked, and why.

518
00:46:18,849 --> 00:46:24,150
So, we have three panelists, and then we will
have an open discussion at the end.

519
00:46:24,150 --> 00:46:31,680
I would encourage you to enter questions into
the Q&A box at any point that something strikes

520
00:46:31,680 --> 00:46:36,820
you during the presentations, or again as
we come back together as a group.

521
00:46:36,820 --> 00:46:41,640
So, our first panelist is Dr. Marlene Schwartz
from the University of Connecticut, and she's

522
00:46:41,640 --> 00:46:46,710
going to talk with us about her study on Nutrition
Standards in the Emergency Food System.

523
00:46:46,710 --> 00:46:52,819
We will then hear from Dr. Adam Drewnowski
of the University of Washington, and he will

524
00:46:52,819 --> 00:46:58,040
address Food Insecurity in the context of
COVID-19.

525
00:46:58,040 --> 00:47:03,250
And then Dr. Caitlin Caspi from the University
of Connecticut will be our final speaker,

526
00:47:03,250 --> 00:47:09,380
and who will address Food Pantry Transformations
in Minnesota.

527
00:47:09,380 --> 00:47:16,090
And then, as Angela mentioned, Gita Rampersad
will join us at the end and we'll have a group

528
00:47:16,090 --> 00:47:17,160
discussion.

529
00:47:17,160 --> 00:47:24,619
So we'll begin now with Dr. Schwartz.

530
00:47:24,619 --> 00:47:31,380
DR. MARLENE B SCHWARTZ: Hello, my name is Marlene
Schwartz, and today I'll be sharing some research

531
00:47:31,380 --> 00:47:39,150
we've done on the topic of Nutrition Ranking
within the Charitable Food System.

532
00:47:39,150 --> 00:47:40,150
So why focus on nutrition in this setting?

533
00:47:40,150 --> 00:47:41,150
Well, one reason is because it's important
to clients.

534
00:47:41,150 --> 00:47:51,990
A few years ago, as we were beginning this
work, we surveyed clients from several food

535
00:47:51,990 --> 00:47:53,710
pantries and asked them about their preferences
for different types of nutrition interventions.

536
00:47:53,710 --> 00:47:59,420
And one of the questions we asked was to indicate
the most important reasons why they choose

537
00:47:59,420 --> 00:48:01,839
certain foods at the pantry.

538
00:48:01,839 --> 00:48:06,390
And as you can see, nutrition was the most
frequently cited reason.

539
00:48:06,390 --> 00:48:10,320
So, if the goal is to ensure that the nutritious
foods that clients want are available to them

540
00:48:10,320 --> 00:48:18,760
at the pantry, what can we do to shift the
entire system toward more of these foods?

541
00:48:18,760 --> 00:48:23,510
This conceptual scheme illustrates several
components of the charitable food system,

542
00:48:23,510 --> 00:48:27,730
and the elements are represented by gears
in order to communicate that as one setting

543
00:48:27,730 --> 00:48:33,069
makes a change either in the foods that are
donated or selected, it will affect the other

544
00:48:33,069 --> 00:48:34,660
settings and people's choices.

545
00:48:34,660 --> 00:48:38,870
But in order to assess changes over time,
we need a way to measure the nutritional quality

546
00:48:38,870 --> 00:48:43,220
of the food, and that's where a nutrition
ranking system comes in.

547
00:48:43,220 --> 00:48:51,249
One system that was specifically developed
for food pantries is called SWAP, an acronym

548
00:48:51,249 --> 00:48:53,600
for Supporting Wellness at Pantries.

549
00:48:53,600 --> 00:48:55,079
It's a stoplight system, as you can see, and
it also incorporates behavioral nudges, such

550
00:48:55,079 --> 00:49:02,440
as organizing the food on shelves so that
the green options are at eye level and communicating

551
00:49:02,440 --> 00:49:08,280
nutrient information along with the color-coded
signs.

552
00:49:08,280 --> 00:49:13,320
One of the first studies we did testing SWAP
was to see if implementing it changed the

553
00:49:13,320 --> 00:49:16,349
inventory in a food pantry over time.

554
00:49:16,349 --> 00:49:19,750
So, we worked with six food pantries in Connecticut.

555
00:49:19,750 --> 00:49:22,020
We helped them implement SWAP.

556
00:49:22,020 --> 00:49:26,420
And before we started, we collected data on
their inventory for four weeks.

557
00:49:26,420 --> 00:49:35,300
We went in and looked at all of their food,
put it into categories, and ranked it as green, yellow, or red.

558
00:49:35,300 --> 00:49:36,830
Here are the baseline findings.

559
00:49:36,830 --> 00:49:43,151
One of the things that's interesting is that
a large portion of the foods available were

560
00:49:43,151 --> 00:49:44,151
vegetables.

561
00:49:44,151 --> 00:49:49,880
And another interesting thing was that the
combination meals were the category that seemed

562
00:49:49,880 --> 00:49:52,170
to have the largest proportion of red foods.

563
00:49:52,170 --> 00:50:01,460
So, combination meals are things like soups,
stews, macaroni and cheese, and frozen entrees.

564
00:50:01,460 --> 00:50:05,320
Here are the findings a year later, we used
regression analyses and found a significant

565
00:50:05,320 --> 00:50:09,099
increase in the availability of green foods
overall, but no significant changes overall

566
00:50:09,099 --> 00:50:10,480
in yellow or red foods.

567
00:50:10,480 --> 00:50:15,270
It is interesting to note, though, that if
you look at the combination meals, there was

568
00:50:15,270 --> 00:50:19,980
a decrease in the proportion of red foods
in that category.

569
00:50:19,980 --> 00:50:26,380
So, the next study we did was designed to
look upstream at the effect of nutrition ranking

570
00:50:26,380 --> 00:50:27,380
at the food bank.

571
00:50:27,380 --> 00:50:32,050
So, we were working with a food bank that
had been ranking their food for a number of

572
00:50:32,050 --> 00:50:38,570
years, and initially, it was done internally
to really help them understand their own inventory and make some purchasing decisions.

573
00:50:38,570 --> 00:50:49,890
But after a while, they decided to share this
information with the food pantries. Here's a screenshot of the ordering platform
that the food pantries used when they got

574
00:50:49,890 --> 00:50:58,000
food from this food bank, and what they did
was add a column that says, nutrition description, and it had green, yellow or red listed.

575
00:50:58,000 --> 00:51:03,319
So, people shopping could easily see the nutrition
rank of the food they were ordering.

576
00:51:03,319 --> 00:51:09,000
So, this happened in April of 2019, and it
provided an opportunity for us to compare

577
00:51:09,000 --> 00:51:16,030
the ordering of the pantries before and after
they could see this information.

578
00:51:16,030 --> 00:51:21,430
So, to test this hypothesis that seeing the
nutrition rank would shift ordering behavior,

579
00:51:21,430 --> 00:51:26,540
we used an interrupted time series analysis
from the 25 largest pantries and all of their

580
00:51:26,540 --> 00:51:30,260
orders, so it was about 64,000 ordering records.

581
00:51:30,260 --> 00:51:38,059
And we compared what they ordered during a
15-month baseline period and then a 14-month

582
00:51:38,059 --> 00:51:39,510
intervention period.

583
00:51:39,510 --> 00:51:44,849
So, after the nutrition rank information was
available, there was a significant increase

584
00:51:44,849 --> 00:51:47,050
in the average monthly orders of green foods.

585
00:51:47,050 --> 00:51:51,110
You can also see that the orders of red foods
decreased over time.

586
00:51:51,110 --> 00:51:56,790
However, this began prior to the intervention
and we were able to look at the food actually

587
00:51:56,790 --> 00:52:01,790
available for the pantries to select throughout
this time period, and found that that decrease

588
00:52:01,790 --> 00:52:07,610
in red food was really attributable to a decrease
in red foods available at the food bank.

589
00:52:07,610 --> 00:52:12,349
So, the last study I'll share today was done
when a food pantry decided to implement the

590
00:52:12,349 --> 00:52:18,069
SWAP system and wanted to assess whether it
was associated with a change in the foods

591
00:52:18,069 --> 00:52:19,520
their clients selected.

592
00:52:19,520 --> 00:52:23,549
So, we went to the food pantry before they
made any changes.

593
00:52:23,549 --> 00:52:26,190
We collected data from about 120 clients over
a few days.

594
00:52:26,190 --> 00:52:28,230
Then SWAP was implemented over a holiday weekend.

595
00:52:28,230 --> 00:52:38,800
We waited a couple of weeks and went back
and collected data from about 100 clients.

596
00:52:38,800 --> 00:52:43,670
Here's the baseline data, again, lots of fruits
and vegetables, as seen on the left.

597
00:52:43,670 --> 00:52:51,770
And interestingly, a large portion of the
combination meals were rated red.

598
00:52:51,770 --> 00:52:54,690
After SWAP is implemented, the overall profile
of the baskets improved with a significant

599
00:52:54,690 --> 00:53:02,670
11% increase in the proportion of green items
and a significant 7% decrease in the proportion

600
00:53:02,670 --> 00:53:04,950
of red items.

601
00:53:04,950 --> 00:53:09,020
Looking closely by category, it seems that
the increase in green items was driven by

602
00:53:09,020 --> 00:53:13,609
an increase in green fruits and vegetables
and also an increase in green dairy, while

603
00:53:13,609 --> 00:53:20,480
the decrease in red was evident in the drop
in red fruits and vegetables and the drop

604
00:53:20,480 --> 00:53:22,800
in combination meals.

605
00:53:22,800 --> 00:53:27,520
So how realistic is it for food banks all
over the country to implement nutrition ranking?

606
00:53:27,520 --> 00:53:33,240
Well, the good news is back in 2017, the anti-hunger
organization, MAZON, conducted a survey of

607
00:53:33,240 --> 00:53:38,840
all U.S. food banks, and one of the questions
was whether they use the system to track their inventory.

608
00:53:38,840 --> 00:53:45,920
And the responses indicated that 54% were
using some type of nutrition inventory tracking

609
00:53:45,920 --> 00:53:50,040
system, although there were quite a few different
systems in use.

610
00:53:50,040 --> 00:53:53,859
So that highlighted a challenge, if there's
going to be a national effort to shift the

611
00:53:53,859 --> 00:53:58,190
nutrition quality of the food throughout the
charitable food system, it would be helpful

612
00:53:58,190 --> 00:54:04,290
to have one set of nutrition criteria that
everybody was using.

613
00:54:04,290 --> 00:54:07,640
So that was the impetus for the Robert Wood
Johnson Foundation's Healthy Eating Research

614
00:54:07,640 --> 00:54:12,070
Program to create an expert panel to develop
nutrition guidelines for the charitable food

615
00:54:12,070 --> 00:54:13,070
system.

616
00:54:13,070 --> 00:54:17,300
Director, Mary Storey, and deputy director,
Megan Lott, invited this group of experts

617
00:54:17,300 --> 00:54:23,130
to work together to develop a set of nutrition
guidelines, and Hilary Seligman and I co-chaired

618
00:54:23,130 --> 00:54:24,130
the panel.

619
00:54:24,130 --> 00:54:28,109
It's notable that the members included both
researchers and people who currently work

620
00:54:28,109 --> 00:54:30,430
in food banks.

621
00:54:30,430 --> 00:54:32,510
So, we faced the challenge.

622
00:54:32,510 --> 00:54:38,089
On the one hand, the guidelines needed to
be supported by scientific evidence.

623
00:54:38,089 --> 00:54:46,450
We reviewed existing guidelines from the charitable
food system, government, and industry, and

624
00:54:46,450 --> 00:54:51,265
we anchored all of our decisions in the 2015-2020
Dietary Guidelines for Americans.

625
00:54:51,265 --> 00:54:56,320
On the other hand, the system we developed
had to work within the charitable food setting.

626
00:54:56,320 --> 00:55:00,460
So, we took a number of things into account,
a couple of them were limited capacity to

627
00:55:00,460 --> 00:55:05,510
add staff time or increase costs, and also
the reliance on volunteers.

628
00:55:05,510 --> 00:55:10,079
So the system needed to be straight forward
enough that you could train volunteers to

629
00:55:10,079 --> 00:55:11,220
use it accurately.

630
00:55:11,220 --> 00:55:18,280
Finally, we were able to give a draft of the
guidelines to a national task force that Feeding

631
00:55:18,280 --> 00:55:23,299
America put together, made up of food bank
staff, and they provided detailed feedback

632
00:55:23,299 --> 00:55:32,340
for us, which we were able to incorporate
into the final version of the guidelines.

633
00:55:32,340 --> 00:55:38,720
The first step in ranking of food is to place
it into one of these 11 categories.

634
00:55:38,720 --> 00:55:42,210
I will note that the last two categories remain
unranked.

635
00:55:42,210 --> 00:55:48,859
The committee felt that it was important not
to rank condiments and cooking staples, because

636
00:55:48,859 --> 00:55:51,760
on their own, they typically wouldn't rank
very well.

637
00:55:51,760 --> 00:55:56,859
But they really are used to prepare meals
at home, and we wanted to make sure that we

638
00:55:56,859 --> 00:56:02,580
were not in any way deterring people from
taking these foods and using them in their

639
00:56:02,580 --> 00:56:03,580
own cooking.

640
00:56:03,580 --> 00:56:07,020
We also decided not to rank what we call miscellaneous
items.

641
00:56:07,020 --> 00:56:13,050
So, these are foods like baby food or nutritional
supplements that typically have a very specific

642
00:56:13,050 --> 00:56:14,740
audience.

643
00:56:14,740 --> 00:56:23,809
The second step is to identify key nutrients
using one serving based on the Nutrition Facts Label.

644
00:56:23,809 --> 00:56:30,170
So, the three nutrients that you want to focus
on are saturated fat, sodium, and added sugars.

645
00:56:30,170 --> 00:56:40,890
The third step is to take the specific values
of saturated fat, sodium, and added sugar

646
00:56:40,890 --> 00:56:48,480
and apply them using this chart to determine
whether the food ranks as, choose often, choose

647
00:56:48,480 --> 00:56:52,180
sometimes, or choose rarely for that nutrient.

648
00:56:52,180 --> 00:57:00,680
You then determine the overall product's ranking
as the lowest tier of any of those key nutrients.

649
00:57:00,680 --> 00:57:06,920
So, the final version of the guidelines was
released in March of 2020, and the full report

650
00:57:06,920 --> 00:57:12,780
is available on the Healthy Eating Research
website at the link that's listed below.

651
00:57:12,780 --> 00:57:16,319
They've been really well received, and it's
been really exciting to see how different

652
00:57:16,319 --> 00:57:18,280
organizations have taken the guidelines and
incorporated them into the work that they

653
00:57:18,280 --> 00:57:21,339
are doing with communities.

654
00:57:21,339 --> 00:57:28,460
Thank you so much for your attention.

655
00:57:28,460 --> 00:57:32,530
DR. ADAM DREWNOWSKI: Hello, everyone.

656
00:57:32,530 --> 00:57:38,910
My presentation today will be about addressing
food insecurity in Washington State in the

657
00:57:38,910 --> 00:57:41,049
context of the COVID-19 epidemic.

658
00:57:41,049 --> 00:57:49,700
I will try and stress the importance of collecting
local data at its fine granular level as opposed

659
00:57:49,700 --> 00:57:55,110
to relying on national data to drive local
interventions.

660
00:57:55,110 --> 00:57:59,170
Let me show you the difference here.

661
00:57:59,170 --> 00:58:08,290
First of all, in the last couple of weeks,
the USDA Economic Research Service released

662
00:58:08,290 --> 00:58:13,240
a report on Food Insecurity in the year 2020.

663
00:58:13,240 --> 00:58:21,141
These were data based on the United States
Census collected in December 2020 for a representative

664
00:58:21,141 --> 00:58:25,589
sample of 34,000 households.

665
00:58:25,589 --> 00:58:30,480
Food insecurity was assessed over the previous
12 months.

666
00:58:30,480 --> 00:58:38,451
The results showed that food insecurity was
estimated to affect 10.5% of households, and

667
00:58:38,451 --> 00:58:44,010
that prevalence remained essentially unchanged
since...

668
00:58:44,010 --> 00:58:45,010
2019.

669
00:58:45,010 --> 00:58:52,890
But looking within the USDA report, you can
find huge social disparities.

670
00:58:52,890 --> 00:58:58,260
Higher prevalence rates were observed among
households with children, black and non-Hispanic

671
00:58:58,260 --> 00:59:01,250
and Hispanic groups, and among the unemployed.

672
00:59:01,250 --> 00:59:05,910
There are also further disparities by income.

673
00:59:05,910 --> 00:59:14,510
So, in this slide, I reported USDA data by
year, and notice there is not much of an effect

674
00:59:14,510 --> 00:59:16,070
between 2019 and 2020.

675
00:59:16,070 --> 00:59:24,559
When you start looking at social disparities,
you find huge differences.

676
00:59:24,559 --> 00:59:28,400
Let's start from the bottom.

677
00:59:28,400 --> 00:59:30,230
Poverty to income ratio.

678
00:59:30,230 --> 00:59:39,369
We're looking at the lowest incomes at the
bottom and the prevalence rate of food insecurity

679
00:59:39,369 --> 00:59:41,819
is in the order of 35%.

680
00:59:41,819 --> 00:59:52,130
This decreases somewhat as income goes up
and plunges to about 5% or under with incomes

681
00:59:52,130 --> 00:59:54,980
at twice poverty.

682
00:59:54,980 --> 01:00:02,559
Then notice the data for female head of household,
no spouse, here approaching 30%.

683
01:00:02,559 --> 01:00:05,710
Data for black non-Hispanic and Hispanic groups.

684
01:00:05,710 --> 01:00:12,920
And what I'm showing you at the top are local
data by state, Washington State compared to

685
01:00:12,920 --> 01:00:18,190
Washington, D.C., compared to data from Louisiana,
Mississippi, and West Virginia.

686
01:00:18,190 --> 01:00:28,220
Just this selection to show that food insecurity
can go from 5% prevalence to 35% prevalence,

687
01:00:28,220 --> 01:00:33,610
depending who you are and where you live.

688
01:00:33,610 --> 01:00:41,319
So, the national data 10% to some extent,
mask, some of the very profound local disparities

689
01:00:41,319 --> 01:00:43,180
by neighborhood.

690
01:00:43,180 --> 01:00:44,920
And this is where we come in.

691
01:00:44,920 --> 01:00:49,940
Since last year, we have been engaged in mapping
food insecurity within Washington State.

692
01:00:49,940 --> 01:00:58,750
There were three online surveys, WAFOOD1,
June-July of last year, WAFOOD2, December

693
01:00:58,750 --> 01:01:04,690
of last year-January of this year, and then
most recently, Summer 21, WAFOOD3.

694
01:01:04,690 --> 01:01:08,910
These were all online surveys, not representative.

695
01:01:08,910 --> 01:01:14,790
To the contrary, these were surveys of the
most affected groups.

696
01:01:14,790 --> 01:01:23,339
Our samples were mostly female, 81%, with
children under 18, 40%, and with incomes below

697
01:01:23,339 --> 01:01:27,720
$35,000 per year for the household.

698
01:01:27,720 --> 01:01:31,579
30% of our population was low income.

699
01:01:31,579 --> 01:01:36,380
Our data were also coded by county and also
by zip code.

700
01:01:36,380 --> 01:01:42,890
So, when you start looking at the map and
the bubble graph on the right, you start realizing

701
01:01:42,890 --> 01:01:48,839
that within Washington State, the prevalence
of food insecurity was not the same across

702
01:01:48,839 --> 01:01:49,839
all counties.

703
01:01:49,839 --> 01:01:55,039
In fact, there was a socioeconomic gradient
that you see on the bottom-right, with median

704
01:01:55,039 --> 01:02:04,000
household income by county, related weekly,
but related nonetheless to food insecurity

705
01:02:04,000 --> 01:02:07,820
observed in the WAFOOD surveys by county.

706
01:02:07,820 --> 01:02:15,730
Let's move on here to show you the same gradient
that the USDA found out.

707
01:02:15,730 --> 01:02:24,380
So here we look at, from the bottom, the lowest
income group, $15,000 per year, that's below

708
01:02:24,380 --> 01:02:25,380
poverty.

709
01:02:25,380 --> 01:02:35,069
And notice how food insecurity goes up with
lower incomes and goes down as incomes increase.

710
01:02:35,069 --> 01:02:40,240
Here we see a difference also for families
with children and those without, more affected

711
01:02:40,240 --> 01:02:41,920
are families with children.

712
01:02:41,920 --> 01:02:44,950
There's a big difference by race-ethnicity.

713
01:02:44,950 --> 01:02:53,079
And there's a huge gradient by education,
higher rates of food insecurity among groups

714
01:02:53,079 --> 01:02:56,039
with high school education and some college.

715
01:02:56,039 --> 01:03:03,619
The data I'm showing you are for WAFOOD1,
July, and WAFOOD2, December.

716
01:03:03,619 --> 01:03:09,010
By December, the initial shock wore off a
bit and the data on food insecurity was somewhat

717
01:03:09,010 --> 01:03:15,630
attenuated compared to what we found in the
early months of the epidemic.

718
01:03:15,630 --> 01:03:22,890
Same gradients as before, but here our numbers
are much higher because, of course, our population

719
01:03:22,890 --> 01:03:26,710
is lower-income, mostly female, mostly with
children.

720
01:03:26,710 --> 01:03:36,080
So here, we're also finding the link between
food insecurity, diet quality, and food expenditures.

721
01:03:36,080 --> 01:03:45,619
So first of all, all households reported reduced
access to food in WAFOOD1, that was the time

722
01:03:45,619 --> 01:03:47,869
to remember of some food shortages.

723
01:03:47,869 --> 01:03:54,250
And notice that there is a big difference
between the food secure households who don't

724
01:03:54,250 --> 01:04:01,850
seem to be too worried and food insecure households
who are very worried about access to meat,

725
01:04:01,850 --> 01:04:11,750
and chicken, and milk, and yogurt, and other
foods, including fresh fruit and fresh vegetables.

726
01:04:11,750 --> 01:04:19,299
What we find is that access to those foods
was actually related to spending.

727
01:04:19,299 --> 01:04:23,900
So here we have, again, from WAFOOD data file,
estimated food spending, foods away-from-home,

728
01:04:23,900 --> 01:04:34,789
and foods at home during the pandemic, before
the pandemic, and again, we stratified by

729
01:04:34,789 --> 01:04:35,789
food security.

730
01:04:35,789 --> 01:04:43,349
So here the total food spending would be in
the order of $50 to $60 per capita per week

731
01:04:43,349 --> 01:04:49,290
and $200 to $240 per month.

732
01:04:49,290 --> 01:04:57,750
Notice that there is a big difference in terms
of spending between the food secure and the

733
01:04:57,750 --> 01:05:00,030
food insecure respondents.

734
01:05:00,030 --> 01:05:08,619
What was very striking here was that the food
away-from-home pretty much halved or not disappeared

735
01:05:08,619 --> 01:05:14,069
completely, but certainly, food spending on
food away-from-home was reduced, not surprising

736
01:05:14,069 --> 01:05:18,500
at the time a lot of the restaurants were
closed.

737
01:05:18,500 --> 01:05:21,800
So here we have detailed data on food spending.

738
01:05:21,800 --> 01:05:28,410
Contrast those with national data, we're seeing
the food secure and very food insecure households

739
01:05:28,410 --> 01:05:36,529
are spending the exact same amount estimated
$50 for the medium per week.

740
01:05:36,529 --> 01:05:46,779
We find much finer gradations on food away-from-home
with at-home and big difference by food security.

741
01:05:46,779 --> 01:05:49,430
Of course, eating habits changed.

742
01:05:49,430 --> 01:05:52,570
We knew that from before.

743
01:05:52,570 --> 01:06:00,099
And there was a greater reliance on rice,
and beans, and peas, and legumes and packaged,

744
01:06:00,099 --> 01:06:06,859
boxed snack foods, bread, and so on, and the
quality of the diet was reported as reduced.

745
01:06:06,859 --> 01:06:14,750
Many of our respondents said their diets had
gotten worse and the majority, 64%, noted

746
01:06:14,750 --> 01:06:18,569
rising food cost.

747
01:06:18,569 --> 01:06:24,119
And so to summarize, based on the results
from WAFOOD1 and WAFOOD2, we estimated the

748
01:06:24,119 --> 01:06:31,849
mean prevalence of food insecurity to approximately
30% in a WAFOOD sample.

749
01:06:31,849 --> 01:06:38,349
Note that we're looking at 30-day prevalence,
not a year of the prevalence, but 30 day prevalence

750
01:06:38,349 --> 01:06:39,859
of food insecurity.

751
01:06:39,859 --> 01:06:47,049
And our sample was, as I said before, largely
female, largely lower-income, and with children.

752
01:06:47,049 --> 01:06:53,650
Not surprisingly, we found more food insecurity
among the newly unemployed, households with

753
01:06:53,650 --> 01:07:00,690
children, and minorities, and we linked food
insecurity to lower food expenditures and

754
01:07:00,690 --> 01:07:02,990
to reduced diet quality.

755
01:07:02,990 --> 01:07:09,640
Let me emphasize here, you'll be hearing more
about this in the session that food assistance

756
01:07:09,640 --> 01:07:12,170
played an enormously important role.

757
01:07:12,170 --> 01:07:17,299
And this was not only federal food assistance,
SNAP and WIC programs, but also food assistance

758
01:07:17,299 --> 01:07:21,190
and the state and local level.

759
01:07:21,190 --> 01:07:26,700
And let's not forget about the food banks
and charitable initiatives, which played a

760
01:07:26,700 --> 01:07:32,010
critical role in alleviating food insecurity
among our respondents.

761
01:07:32,010 --> 01:07:40,170
But let me now get back to neighborhoods (INAUDIBLE)
maps.

762
01:07:40,170 --> 01:07:48,670
You will appreciate that fine-level geographic
resolution unmasks social disparities by area.

763
01:07:48,670 --> 01:07:57,690
So, when you look at, for example, state-level
obesity rates, the difference is between 20%,

764
01:07:57,690 --> 01:08:00,289
25%, 35% by state.

765
01:08:00,289 --> 01:08:07,330
But the moment I start looking at obesity
by Seattle neighborhood, I uncovered gigantic

766
01:08:07,330 --> 01:08:17,949
differences going from 5% obesity to 35% obesity, depending on where people live.

767
01:08:17,949 --> 01:08:25,830
So, the map on the right shows you modeled
obesity rates in Seattle at the unprecedented

768
01:08:25,830 --> 01:08:27,549
census block level.

769
01:08:27,549 --> 01:08:35,450
Notice there is more obesity by the freeway
and virtually no obesity among the waterfront

770
01:08:35,450 --> 01:08:36,450
estates.

771
01:08:36,450 --> 01:08:45,529
DR. ADAM DREWNOWKI: It all has to do with socioeconomic
status, and more pointedly, the value of your

772
01:08:45,529 --> 01:08:46,529
home.

773
01:08:46,529 --> 01:08:54,259
So, our question was whether the same gradient
would be observed with food insecurity.

774
01:08:54,259 --> 01:09:02,500
And...our results show, yes, we found the
same exact gradient.

775
01:09:02,500 --> 01:09:09,730
Just to walk you through the logic, on the
left you see the components of a deprivation

776
01:09:09,730 --> 01:09:12,850
index, the famous SEN index.

777
01:09:12,850 --> 01:09:21,040
Deprivation at census tract level based on
census data, which include poverty, income,

778
01:09:21,040 --> 01:09:25,339
single-parent families, housing, education
and employment.

779
01:09:25,339 --> 01:09:31,700
The very same factors which were driving higher
rates of food insecurity.

780
01:09:31,700 --> 01:09:40,120
We were able to plot prevalence of food insecurity
by zip code, because our respondents. 

781
01:09:40,120 --> 01:09:46,210
Were geocoded by zip code, and you can see
similarities, there is more food insecurity

782
01:09:46,210 --> 01:09:48,989
in the more deprived neighborhoods.

783
01:09:48,989 --> 01:09:59,679
So, deprivation, reduced budgets, unemployment,
bad social conditions lead to more food insecurity.

784
01:09:59,679 --> 01:10:03,440
But there is more.

785
01:10:03,440 --> 01:10:12,909
What we were able to do is to join some of
our data with the dashboard produced by King

786
01:10:12,909 --> 01:10:17,440
County for COVID risk, COVID infections, and
even COVID mortality.

787
01:10:17,440 --> 01:10:25,130
So, what you see here on the left is our map
of property values by zip code from the WAFOOD

788
01:10:25,130 --> 01:10:26,130
studies.

789
01:10:26,130 --> 01:10:34,360
What you see in the center are data for COVID
positivity from Public Health Seattle King

790
01:10:34,360 --> 01:10:35,360
County dashboard.

791
01:10:35,360 --> 01:10:43,770
The two maps are mirror images of each other,
and the map on the right shows you COVID mortality

792
01:10:43,770 --> 01:10:46,230
also from Public Health Seattle King County.

793
01:10:46,230 --> 01:10:49,940
And I would argue there's also a relation.

794
01:10:49,940 --> 01:10:53,110
So sometimes we say, you know, the virus does
not discriminate.

795
01:10:53,110 --> 01:10:55,240
Of course, it does.

796
01:10:55,240 --> 01:11:02,219
Food insecurity, deprivation, COVID risk and
even COVID mortality are absolutely related

797
01:11:02,219 --> 01:11:09,710
to the underlying social structures and the
wealth, or more to the point, the deprivation

798
01:11:09,710 --> 01:11:11,020
of neighborhoods.

799
01:11:11,020 --> 01:11:13,550
So, I'm going to stop here.

800
01:11:13,550 --> 01:11:23,480
Thank you for your attention and I'm going
to now be able to answer some questions.

801
01:11:23,480 --> 01:11:26,730
Thank you so much.

802
01:11:26,730 --> 01:11:30,810
DR. CAITLIN CASPI: Today, I'm going to talk about SuperShelf,
which is a collaborative partnership across

803
01:11:30,810 --> 01:11:31,840
a number of organizations in Minnesota.

804
01:11:31,840 --> 01:11:38,040
And what SuperShelf aims to do is to transform
food pantries to be more welcoming environments

805
01:11:38,040 --> 01:11:39,750
for clients to access healthy and appealing
foods.

806
01:11:39,750 --> 01:11:46,840
So, my colleague Marlene Schwartz, gave a
background on the need for and the current

807
01:11:46,840 --> 01:11:51,300
efforts around obtaining and distributing
high quality food in the charitable food system.

808
01:11:51,300 --> 01:11:56,440
And I'll add that when we survey clients across
the state of Minnesota, they overwhelmingly

809
01:11:56,440 --> 01:12:03,500
indicate that they want healthy foods like
fruits and vegetables, but they can't take

810
01:12:03,500 --> 01:12:09,030
what's not available, and they probably won't
take food that is not fresh and appealing.

811
01:12:09,030 --> 01:12:13,900
So, a lot of the work of SuperShelf is in
working on both the supply side and the demand

812
01:12:13,900 --> 01:12:14,900
side.

813
01:12:14,900 --> 01:12:22,960
So, in the SuperShelf intervention, we focused
mainly in these two areas.

814
01:12:22,960 --> 01:12:28,170
So, the first is in increasing food supply,
not using a tool kit approach, but actually

815
01:12:28,170 --> 01:12:33,150
having a consultant that works with the pantry
over several months, to increase the sourcing

816
01:12:33,150 --> 01:12:37,430
of high quality foods and the variety of healthy
foods.

817
01:12:37,430 --> 01:12:44,600
And then after that stuff is done, it becomes
a focus on increasing the appeal of the foods

818
01:12:44,600 --> 01:12:45,842
that are offered using behavioral economics.

819
01:12:45,842 --> 01:12:52,500
So, the whole food pantry is organized into
food groups like a grocery store, and the

820
01:12:52,500 --> 01:12:55,989
healthy food is made prominent and appealing.

821
01:12:55,989 --> 01:13:02,200
So, this is an example of how the food that
people are allowed to take changed before

822
01:13:02,200 --> 01:13:04,880
and after the SuperShelf intervention.

823
01:13:04,880 --> 01:13:10,440
So, before you see the first two items that
clients were offered when they walked in were

824
01:13:10,440 --> 01:13:11,980
pancake mix and pancake syrup.

825
01:13:11,980 --> 01:13:19,080
And these were offered to everyone first thing,
and then after the first items are fruits

826
01:13:19,080 --> 01:13:20,130
and vegetables.

827
01:13:20,130 --> 01:13:23,900
So frozen fruits and vegetables and then unlimited
fresh produce, and the pancake stuff is still

828
01:13:23,900 --> 01:13:27,409
there, but it's offered when the cart is full
at the end.

829
01:13:27,409 --> 01:13:33,940
This is a visual of the transformation that
the pantry makes before and after, where everything

830
01:13:33,940 --> 01:13:42,520
is organized by food group and it's arranged
appealingly and it's really displayed like

831
01:13:42,520 --> 01:13:44,650
it would be in a grocery store.

832
01:13:44,650 --> 01:13:47,750
So maybe you can see in the slide on the right.

833
01:13:47,750 --> 01:13:55,820
The whole grains are at eye level and there's
clear signage throughout.

834
01:13:55,820 --> 01:14:02,900
So, we evaluated this intervention in a cluster
randomized study, where we were selecting

835
01:14:02,900 --> 01:14:09,290
16 food pantries, and we're randomized to
the intervention or delayed intervention condition.

836
01:14:09,290 --> 01:14:15,620
I mean, the delayed intervention they did
transform, but not until we finished all the

837
01:14:15,620 --> 01:14:17,000
data collection.

838
01:14:17,000 --> 01:14:21,690
So, we collected data in two waves of eight
pantries each.

839
01:14:21,690 --> 01:14:27,480
And I do want to note that in the final five
pantries, we couldn't collect measures that

840
01:14:27,480 --> 01:14:33,820
required in-person visits because of COVID,
and the food pantries changed their operations

841
01:14:33,820 --> 01:14:37,540
and closed during this time.

842
01:14:37,540 --> 01:14:42,720
We collected many measures in SuperShelf,
at the client level and the pantry level,

843
01:14:42,720 --> 01:14:47,340
and in all these measures, we collected data
at baseline and then one year follow up.

844
01:14:47,340 --> 01:14:53,920
So, the measures I'm going to focus on today
are the ones that we assessed by HEI, or healthy

845
01:14:53,920 --> 01:14:54,920
eating index.

846
01:14:54,920 --> 01:15:01,900
So, we have data that we collected from client
dietary recalls, from client carts as they

847
01:15:01,900 --> 01:15:11,449
selected food from the food pantry, and then
of the inventory of the food pantry.

848
01:15:11,449 --> 01:15:18,909
So, the healthy eating index score is a measure
that has a maximum score of 100, and it's

849
01:15:18,909 --> 01:15:21,030
comprised of 13 subcomponents.

850
01:15:21,030 --> 01:15:30,570
And overall, it measures the degree of alignment
between a set of foods and the dietary guidelines

851
01:15:30,570 --> 01:15:31,570
for Americans.

852
01:15:31,570 --> 01:15:38,380
So, a higher score is going to indicate better
alignment with the 2015 to 2020 dietary guidelines.

853
01:15:38,380 --> 01:15:44,710
So, the results that I am going to present
are based on a sample of choice-based food

854
01:15:44,710 --> 01:15:48,580
pantries that were selected to be part of
the evaluation.

855
01:15:48,580 --> 01:15:58,270
And they are located across Minnesota in urban
and rural areas, and the client level data

856
01:15:58,270 --> 01:16:02,530
is based on 316 clients.

857
01:16:02,530 --> 01:16:12,410
The majority of whom were female and white,
as may be typical of clients across the state

858
01:16:12,410 --> 01:16:13,520
of Minnesota.

859
01:16:13,520 --> 01:16:17,400
These are the HEI scores at all three levels.

860
01:16:17,400 --> 01:16:25,540
So, the food pantry inventory HEI score was
65.1, which is higher than the scores for

861
01:16:25,540 --> 01:16:32,250
the food selected by clients of the pantry,
which is higher still than the diet quality

862
01:16:32,250 --> 01:16:33,250
score for clients.

863
01:16:33,250 --> 01:16:37,730
But I want to put these numbers a little bit
into context.

864
01:16:37,730 --> 01:16:43,480
So, the HEI score in 2015 for the whole US
food supply was about 55.

865
01:16:43,480 --> 01:16:51,050
So, the total score for inventory is really
not low by comparison, but there's still definitely

866
01:16:51,050 --> 01:16:55,970
room for improvement, especially when we look
at the subcomponents.

867
01:16:55,970 --> 01:17:04,040
So, we made this radar plot to visualize the
subcomponents, at each of the levels inventory

868
01:17:04,040 --> 01:17:06,540
in red, client cart in orange and dietary
recalls in yellow.

869
01:17:06,540 --> 01:17:08,480
This is again for our baseline scores.

870
01:17:08,480 --> 01:17:14,380
We see that for subcomponent scores of inventory,
many of them are quite high, but it's not

871
01:17:14,380 --> 01:17:15,380
across the board.

872
01:17:15,380 --> 01:17:23,950
And that subcomponent score is particularly
for refined grains and dairy are really quite

873
01:17:23,950 --> 01:17:24,950
low.

874
01:17:24,950 --> 01:17:30,540
And then when we look at the diet quality
subcomponent scores for client diet based

875
01:17:30,540 --> 01:17:36,570
on the recalls, they're almost uniformly low.

876
01:17:36,570 --> 01:17:43,280
So now we're going to look at pre/post change
results, so in the 11 food pantries where

877
01:17:43,280 --> 01:17:48,320
we have complete data, we measured implementation
on a 100-point scale.

878
01:17:48,320 --> 01:17:53,090
That includes four subcomponents of change,
and our measure of implementation suggests

879
01:17:53,090 --> 01:17:59,340
that the SuperShelf transformation was feasible
and well implemented as it was intended in

880
01:17:59,340 --> 01:18:04,490
the transformation group, and there were very
few changes in the delayed transformation

881
01:18:04,490 --> 01:18:05,490
group.

882
01:18:05,490 --> 01:18:12,000
So, in the transformation group, we saw changes
in our subcomponent measures that included

883
01:18:12,000 --> 01:18:18,210
the number of healthy foods stocked, healthy
and unhealthy food placement, as well as aesthetics

884
01:18:18,210 --> 01:18:24,000
and layout.

885
01:18:24,000 --> 01:18:30,140
When we looked at pre/post change in our three
HEI measures, we didn't see any statistically

886
01:18:30,140 --> 01:18:37,160
significant changes over time in the transformation
group, compared with the comparison group.

887
01:18:37,160 --> 01:18:43,710
You will note that we did see a six-point
increase in inventory HEI scores, but again,

888
01:18:43,710 --> 01:18:48,010
this wasn't statistically significant compared
to the comparison group.

889
01:18:48,010 --> 01:18:55,860
And in the other measures, we really didn't
see much change.

890
01:18:55,860 --> 01:19:02,300
Even though diet quality score didn't change,
clients did notice the change, and they were

891
01:19:02,300 --> 01:19:04,550
reporting higher satisfaction after the intervention.

892
01:19:04,550 --> 01:19:11,080
So, on the survey, we saw statistically significant
increases, compared to the delayed intervention

893
01:19:11,080 --> 01:19:16,170
in how clients were reporting the food selection.

894
01:19:16,170 --> 01:19:18,151
They were more pleased after the intervention.

895
01:19:18,151 --> 01:19:24,860
And then when we were asking staff and volunteers
in qualitative interviews what changes they

896
01:19:24,860 --> 01:19:25,860
noticed.

897
01:19:25,860 --> 01:19:31,440
They were also remarking on the clients who
were saying that they were happier, and they

898
01:19:31,440 --> 01:19:36,969
were appreciating the changes that they saw.

899
01:19:36,969 --> 01:19:40,040
The interviews with food pantry staff and
volunteers also showed that they were really

900
01:19:40,040 --> 01:19:41,210
satisfied with the changes.

901
01:19:41,210 --> 01:19:47,690
And I think this is notable because food pantries
are low resource settings and they can't always

902
01:19:47,690 --> 01:19:51,420
implement change and sometimes, we've seen
that they've had trouble buying into the notion

903
01:19:51,420 --> 01:19:52,520
that clients want healthy food.

904
01:19:52,520 --> 01:19:58,650
So indeed, one of the quotes from our interviews
said, we weren't going to spend our money

905
01:19:58,650 --> 01:20:04,860
on whole grains and brown rice because people
don't like those anyway, which is not true

906
01:20:04,860 --> 01:20:05,860
from what we're finding.

907
01:20:05,860 --> 01:20:06,860
And they were also noting other aspects of
SuperShelf beyond the nutrition that we're

908
01:20:06,860 --> 01:20:08,890
really working for them, notably creating
a friendly and positive environment, and appreciative

909
01:20:08,890 --> 01:20:13,150
of the effect that that could have on their
clients.

910
01:20:13,150 --> 01:20:22,600
So, the key points are that the intervention
was feasible to implement and that clients,

911
01:20:22,600 --> 01:20:27,219
food health managers and volunteers were satisfied
with the changes.

912
01:20:27,219 --> 01:20:29,230
However, we didn't see that it resulted in
changes in healthy eating index scores, but

913
01:20:29,230 --> 01:20:34,960
we can think of some reasons why this might
be the case.

914
01:20:34,960 --> 01:20:45,460
So first, HEI scores were pretty high at baseline,
so there might have been some sort of ceiling

915
01:20:45,460 --> 01:20:50,000
effect in our measure.

916
01:20:50,000 --> 01:20:54,690
And then also clients were still constrained
in what they were allowed to take at their

917
01:20:54,690 --> 01:20:55,690
visit.

918
01:20:55,690 --> 01:21:00,800
And so that sort of, it makes me want to ask
what would happen if clients were really allowed

919
01:21:00,800 --> 01:21:05,739
to shop as they would in a healthy environment
without constraints?

920
01:21:05,739 --> 01:21:09,460
What kind of behavior change might we see
then?

921
01:21:09,460 --> 01:21:16,190
And then finally, in this study, we didn't
really account for the food that people were

922
01:21:16,190 --> 01:21:21,270
getting outside of the pantry, and we know
that's going to be a substantial portion of

923
01:21:21,270 --> 01:21:22,690
their diet.

924
01:21:22,690 --> 01:21:27,600
So, all this being said two opportunities
I want to pay particularly close attention

925
01:21:27,600 --> 01:21:35,440
to is, first, any opportunity to look at food
obtained inside and outside the food pantry

926
01:21:35,440 --> 01:21:36,520
in the same study.

927
01:21:36,520 --> 01:21:42,561
So, I think particularly looking at the interaction
of what people buy, maybe even with their

928
01:21:42,561 --> 01:21:46,340
federal nutrition benefits like SNAP, and
what they obtain at the pantry, in total,

929
01:21:46,340 --> 01:21:53,240
that's going to tell us more about where we
need interventions, and so kind of the cross

930
01:21:53,240 --> 01:21:55,750
collaboration between the retail sector and
the charitable food sector.

931
01:21:55,750 --> 01:22:01,429
And then also, I think there are a lot of
opportunities in new models for food pantries

932
01:22:01,429 --> 01:22:04,179
that are emerging post-pandemic.

933
01:22:04,179 --> 01:22:08,989
So, in the last month or so, I've talked to
two food pantries in Minnesota that are opening

934
01:22:08,989 --> 01:22:09,989
with no restrictions.

935
01:22:09,989 --> 01:22:13,420
So, clients can go as often as they want,
and with almost no exceptions, they can take

936
01:22:13,420 --> 01:22:14,420
anything.

937
01:22:14,420 --> 01:22:17,360
And as much of anything as they want.

938
01:22:17,360 --> 01:22:24,650
And I think what this does is it offers an
opportunity to look at the positive effects

939
01:22:24,650 --> 01:22:31,050
of a food pantry visit and its potential to
help people beyond just nutrition, including

940
01:22:31,050 --> 01:22:37,679
outcomes like connection with community resources
and reduce stigma, which we know are really

941
01:22:37,679 --> 01:22:42,719
important for food insecurity.

942
01:22:42,719 --> 01:22:51,550
DR. KAREN GLANZ: Thank you. Great, thank you so much.

943
01:22:51,550 --> 01:22:54,079
Great presentations.

944
01:22:54,079 --> 01:22:59,550
We have a short time to take some questions
and we've had several, so I'm going to try

945
01:22:59,550 --> 01:23:02,070
to at least get through a few of those.

946
01:23:02,070 --> 01:23:10,900
First of all, several of you have talked about
food bank and food pantry inventory, and interested

947
01:23:10,900 --> 01:23:17,440
here to hear about anything you have to share
on what may be done with respect to culturally

948
01:23:17,440 --> 01:23:20,290
tailored foods for specific communities.

949
01:23:20,290 --> 01:23:27,730
Are there food banks who are working on healthy
offerings that are culturally responsive,

950
01:23:27,730 --> 01:23:36,900
or are any of them partnering, for example,
with ethnic groceries...grocers to help... support those

951
01:23:36,900 --> 01:23:43,540
who are not consuming traditional Western
diets?

952
01:23:43,540 --> 01:23:55,090
Marlene, I don't think we can hear you.

953
01:23:55,090 --> 01:23:58,340
OK.

954
01:23:58,340 --> 01:24:02,120
While you're (CROSSTALK).

955
01:24:02,120 --> 01:24:09,360
DR. GITA RAMPERSAD: I can offer a little feedback from the national
level, from Feeding America, if that helps

956
01:24:09,360 --> 01:24:10,880
while she's reconnecting.

957
01:24:10,880 --> 01:24:17,380
You know, I thought this is a great question
because it is definitely a focus for us in

958
01:24:17,380 --> 01:24:20,940
health and nutrition at Feeding America's
National Office.

959
01:24:20,940 --> 01:24:28,010
We ran a session at one of our annual conferences,
the Feed Nourish Connect conference over the

960
01:24:28,010 --> 01:24:32,080
summer, and we featured some of our food banks
that are doing just that.

961
01:24:32,080 --> 01:24:38,860
And it's a priority for us in so much as we
develop our own nutrition and food banking

962
01:24:38,860 --> 01:24:42,500
toolkit for the network, for our network of
food banks.

963
01:24:42,500 --> 01:24:46,930
And you know, and there's a pretty large section
devoted to the culturally sensitive delivery

964
01:24:46,930 --> 01:24:50,570
of food and choices, needs and preferences.

965
01:24:50,570 --> 01:24:55,380
So, I see you're back, I'll let you take over.

966
01:24:55,380 --> 01:24:59,320
That was exactly what I was going to say.

967
01:24:59,320 --> 01:25:02,760
Great. Alright. So, a question.

968
01:25:02,760 --> 01:25:08,320
Stepping back a little bit about the food
insecurity data.

969
01:25:08,320 --> 01:25:13,100
So maybe Adam Drewnowski, do you might want
to speak to this?

970
01:25:13,100 --> 01:25:17,840
You've talked about the spikes in food insecurity
and the experiences among different groups.

971
01:25:17,840 --> 01:25:23,070
But the report that came from USDA, a couple
of weeks ago showed that the overall rate

972
01:25:23,070 --> 01:25:26,250
was fairly flat, as you noted.

973
01:25:26,250 --> 01:25:32,330
So, what do you make of the gaps in what you've
seen on the ground and food insecurity estimates

974
01:25:32,330 --> 01:25:35,070
from Feeding America and what we heard from
USDA?

975
01:25:35,070 --> 01:25:39,880
DR. ADAM DREWNOWSKI: Well, let me take this on because I
think that when you look at national data

976
01:25:39,880 --> 01:25:46,590
and averages for something as individual as
food insecurity, you can get misleading information,

977
01:25:46,590 --> 01:25:51,350
for example, if you have two meals and I have
none.

978
01:25:51,350 --> 01:25:53,730
On average, we have one each.

979
01:25:53,730 --> 01:25:54,989
Yes, we do.

980
01:25:54,989 --> 01:26:01,199
So even though the national average may be
10%, the pockets and areas and communities

981
01:26:01,199 --> 01:26:07,460
with food insecurity reaches 40% or even higher,
and we need to address that issue.

982
01:26:07,460 --> 01:26:11,440
So, the average on a national level is fine.

983
01:26:11,440 --> 01:26:17,730
But there are communities in need, and I think
this is where very fine detailed maps at the

984
01:26:17,730 --> 01:26:23,400
county level, zip code level, even census
tract level are invaluable, because they give

985
01:26:23,400 --> 01:26:25,880
food insecurity essentially an address.

986
01:26:25,880 --> 01:26:30,570
You know which neighborhood to go to and where
to intervene.

987
01:26:30,570 --> 01:26:32,369
DR. KAREN GLANZ: Great.

988
01:26:32,369 --> 01:26:36,110
Gita, do you want to add anything to that?

989
01:26:36,110 --> 01:26:43,090
DR. GITA RAMPERSAD: Sure, yeah, I echo everything that Adam says
that we were also looking at this from surveys

990
01:26:43,090 --> 01:26:45,520
that we were running within our network.

991
01:26:45,520 --> 01:26:52,469
And so...as I spoke to some of our food banks
in follow up conversations, even those numbers

992
01:26:52,469 --> 01:26:55,600
weren't reflective of what they were saying,
just like Adam was saying.

993
01:26:55,600 --> 01:27:01,260
I mean, we saw one in three in Boston, for
instance, people going hungry during 2020.

994
01:27:01,260 --> 01:27:08,220
So yeah, I think it's important to really
try to get as close to that person facing

995
01:27:08,220 --> 01:27:13,500
hunger measurement as you can, so that zip
code opportunities where, you know, where

996
01:27:13,500 --> 01:27:14,500
we're headed.

997
01:27:14,500 --> 01:27:19,650
DR. ADAM DREWNOWSKI:  Yeah, I was actually using the obesity
statistics as an example because we've been

998
01:27:19,650 --> 01:27:25,510
able to drill down to the census block level
and, again, points to huge social disparities

999
01:27:25,510 --> 01:27:29,120
in area geographic distribution of obesity
and diabetes.

1000
01:27:29,120 --> 01:27:34,280
And I'm saying food insecurity is absolutely
linked to the underlying social structures,

1001
01:27:34,280 --> 01:27:35,619
the same exact ones.

1002
01:27:35,619 --> 01:27:41,300
You know, it has to do with food spending,
diet quality and access to healthy foods,

1003
01:27:41,300 --> 01:27:43,750
which are actually more expensive.

1004
01:27:43,750 --> 01:27:50,840
The USDA came out with the finding of surprising,
that it actually costs more to eat healthier.

1005
01:27:50,840 --> 01:27:56,510
This was just in a recent review of the first
food bank, but we knew that.

1006
01:27:56,510 --> 01:27:59,510
DR. KAREN GLANZ: Great, thank you so much.

1007
01:27:59,510 --> 01:28:06,510
So, we heard earlier from Gita that a lot
of, and also from Adam, that a lot of food

1008
01:28:06,510 --> 01:28:11,100
insecure families are struggling also with
diabetes, hypertension, other chronic disease.

1009
01:28:11,100 --> 01:28:18,450
So, a question here about whether you think
pairing a food pantry offerings with nutrition,

1010
01:28:18,450 --> 01:28:27,290
education or other kinds of supports for the
consumer behaviors would make a difference?

1011
01:28:27,290 --> 01:28:34,610
And in what parts of the country might we
see those kinds of interventions?

1012
01:28:34,610 --> 01:28:37,179
DR. GITA RAMPERSAD: Definitely, I think we should.

1013
01:28:37,179 --> 01:28:45,040
It's hard to say when we will see a difference,
but I certainly think it's part of care coordination.

1014
01:28:45,040 --> 01:28:47,360
So, I certainly support that.

1015
01:28:47,360 --> 01:28:54,680
I think we have work to do in trying to figure
out what the balance is, because you cannot

1016
01:28:54,680 --> 01:28:57,230
deliver this type of information in a vacuum.

1017
01:28:57,230 --> 01:29:01,640
People need to understand just as much about
their health as they need to understand about

1018
01:29:01,640 --> 01:29:07,430
the food that they are taking in, and also
understanding their environment, and what's

1019
01:29:07,430 --> 01:29:08,430
available to them.

1020
01:29:08,430 --> 01:29:13,600
So, I'm certainly for it, but I think it's
again, you know, more of a collective effort

1021
01:29:13,600 --> 01:29:21,280
to kind of look at it from a care coordination
standpoint.

1022
01:29:21,280 --> 01:29:24,110
DR. KAREN GLANZ: Great, and then the question specifically
for Caitlin.

1023
01:29:24,110 --> 01:29:28,440
Are there other studies that have shown positive
impacts of the similar types of interventions

1024
01:29:28,440 --> 01:29:30,350
that you've tried?

1025
01:29:30,350 --> 01:29:38,590
DR. CAITLIN CASPI: Well, we just heard about the SWAP system,
which I actually think would kind of pair

1026
01:29:38,590 --> 01:29:40,520
nicely with the SuperShelf approach.

1027
01:29:40,520 --> 01:29:44,389
It's kind of not either/or.

1028
01:29:44,389 --> 01:29:51,730
You can think of ways that SWAP wallet addresses
the actual nutritional quality of food.

1029
01:29:51,730 --> 01:29:56,330
It pays less attention to things like aesthetic.

1030
01:29:56,330 --> 01:30:01,840
And you could think of ways that you could
bolster an intervention like SuperShelf, if

1031
01:30:01,840 --> 01:30:12,619
we paid even more attention to some of the,
um...dietary guidelines and aligns the intervention

1032
01:30:12,619 --> 01:30:16,590
in the same way that SWAP does with those
dietary guidelines.

1033
01:30:16,590 --> 01:30:25,250
So, while, I can't think of that sort of companion
intervention, that has elements of SuperShelf,

1034
01:30:25,250 --> 01:30:26,250
that has been effective.

1035
01:30:26,250 --> 01:30:31,570
I think that there's opportunities to combine
some of the evidence and make for a stronger

1036
01:30:31,570 --> 01:30:32,570
intervention.

1037
01:30:32,570 --> 01:30:39,469
DR. KAREN GLANZ: Great. And on that note, unfortunately, we have to
bring it to a close.

1038
01:30:39,469 --> 01:30:44,540
So, thank you for some really rich insights
today.

1039
01:30:44,540 --> 01:30:49,830
And look forward to these conversations obviously
continuing outside of our virtual boxes.

1040
01:30:49,830 --> 01:30:52,739
Just a reminder for everybody.

1041
01:30:52,739 --> 01:30:57,950
We will now actually move into our first poster
session, so hopefully, you had a chance to

1042
01:30:57,950 --> 01:31:00,140
begin viewing the posters throughout the workshop.

1043
01:31:00,140 --> 01:31:04,989
But if not, this is the designated time to
actually view the food and security posters

1044
01:31:04,989 --> 01:31:07,450
and also chat with the poster authors.

1045
01:31:07,450 --> 01:31:14,771
So, you can visit the poster hall, for poster
session one, food insecurity track one, that

1046
01:31:14,771 --> 01:31:16,310
starts promptly now.

1047
01:31:16,310 --> 01:31:23,020
We have nearly 130 poster submissions on a
broad range of topics, so we hope you enjoy

1048
01:31:23,020 --> 01:31:24,780
that next stop.

1049
01:31:24,780 --> 01:31:31,330
And then after that, we'll return for Session
8 about what has and hasn't worked to address

1050
01:31:31,330 --> 01:31:35,449
neighborhood food environments and that will
be at 2:20. Thank you.

1051
01:31:35,449 --> 01:31:37,969
DR. KAREN GLANZ: Good afternoon.

1052
01:31:37,969 --> 01:31:39,679
Welcome back from the break.

1053
01:31:39,679 --> 01:31:46,650
I hope as many of you as possible got a chance
to attend the poster session network and so

1054
01:31:46,650 --> 01:31:47,650
forth.

1055
01:31:47,650 --> 01:31:51,659
I’m delighted to introduce this next session.

1056
01:31:51,659 --> 01:31:58,610
Previous session was on what has and hasn’t
worked in terms of reducing food insecurity.

1057
01:31:58,610 --> 01:32:05,290
This session is on what has and hasn’t worked
to address neighborhood food environments.

1058
01:32:05,290 --> 01:32:12,230
The moderator for this session will be Dr.
Eric Rimm from Harvard University.

1059
01:32:12,230 --> 01:32:19,409
And so after an introductory talk, he will
take over and also moderate the question and

1060
01:32:19,409 --> 01:32:20,409
answers.

1061
01:32:20,409 --> 01:32:26,050
But first, we’re delighted to have a special
talk about CDC funded community-based initiatives

1062
01:32:26,050 --> 01:32:30,699
to address a neighborhood food environment.

1063
01:32:30,699 --> 01:32:35,631
We’re very excited to have Captain Heidi
Blanck of the Center for Disease Control and

1064
01:32:35,631 --> 01:32:37,210
Prevention as our presenter.

1065
01:32:37,210 --> 01:32:40,800
Heidi’s been a real leader in this area
over the years, so I’ll now turn it over

1066
01:32:40,800 --> 01:32:43,260
to Heidi.

1067
01:32:43,260 --> 01:32:45,719
Thank you.

1068
01:32:45,719 --> 01:32:50,639
CAPT. HEIDI BLANCK: Hello.

1069
01:32:50,639 --> 01:32:56,320
I’d like to thank the organizers for inviting
me here today to talk about CDCs funded community-based

1070
01:32:56,320 --> 01:33:00,739
initiatives to support healthy food environments.

1071
01:33:00,739 --> 01:33:05,940
In the division of nutrition, physical activity
and obesity at the CDC's, we support public

1072
01:33:05,940 --> 01:33:08,800
health actions to support nutrition across
the lifespan.

1073
01:33:08,800 --> 01:33:13,730
This includes work to reduce micronutrient
deficiencies, establish healthier food environments,

1074
01:33:13,730 --> 01:33:17,880
and to help ensure food and nutrition security
across the lifespan.

1075
01:33:17,880 --> 01:33:26,900
The majority of our funding goes to support
public health actions through recipients at

1076
01:33:26,900 --> 01:33:28,530
the state and local level.

1077
01:33:28,530 --> 01:33:30,850
I’m going to go through some of our examples.

1078
01:33:30,850 --> 01:33:36,179
One of our programs is SPAN, or the State
Physical Activity and Nutrition Program that

1079
01:33:36,179 --> 01:33:39,469
funds state, health departments and local
recipients.

1080
01:33:39,469 --> 01:33:45,090
Currently, we fund 16 state health departments
in 152 communities.

1081
01:33:45,090 --> 01:33:49,830
They implement interventions that support
breastfeeding health and nutrition, as well

1082
01:33:49,830 --> 01:33:50,989
as physical activity.

1083
01:33:50,989 --> 01:33:56,630
Our practitioners work to support state levels,
statewide systems changes, and they evaluate

1084
01:33:56,630 --> 01:34:01,800
these through specific select strategies as
well as performance metrics.

1085
01:34:01,800 --> 01:34:06,270
Another one of our programs is the High Obesity
Program.

1086
01:34:06,270 --> 01:34:10,810
The High Obesity Program funds 15 land grant
universities that leverage community extension

1087
01:34:10,810 --> 01:34:14,389
services to increase community access to healthier
foods and physical activity.

1088
01:34:14,389 --> 01:34:19,670
In counties that have 40 percent or more of
adults with obesity, residents may have less

1089
01:34:19,670 --> 01:34:23,850
access to healthy foods and fewer opportunities,
and many of these are in rural areas.

1090
01:34:23,850 --> 01:34:27,420
Recipients implement community and anchor
institution strategies to increase access

1091
01:34:27,420 --> 01:34:33,110
to healthier foods, and there’s an evaluation
component for program improvement.

1092
01:34:33,110 --> 01:34:39,790
The next program I want to tell you about
is our Racial and Ethnic Approaches to Community

1093
01:34:39,790 --> 01:34:41,450
Health or REACH program.

1094
01:34:41,450 --> 01:34:45,429
The REACH program focuses on improving chronic
disease for specific racial and ethnic groups

1095
01:34:45,429 --> 01:34:49,690
in urban, rural, and tribal communities that
have a high burden of chronic disease.

1096
01:34:49,690 --> 01:34:54,199
We currently fund 36 organizations across
the country to implement strategies to address

1097
01:34:54,199 --> 01:34:57,420
racial and ethnic health disparities with
the centering of equity.

1098
01:34:57,420 --> 01:35:01,040
And this includes local tailoring of evidence
informed interventions to support…support

1099
01:35:01,040 --> 01:35:05,830
healthy nutrition, as well as PA, reduced
tobacco use and community clinical linkages.

1100
01:35:05,830 --> 01:35:10,929
Again, these public health programs have both
performance metrics as well as select strategy

1101
01:35:10,929 --> 01:35:12,650
evaluations.

1102
01:35:12,650 --> 01:35:19,480
To get into detail in some of the nutrition
interventions, I’ll start with SPAN.

1103
01:35:19,480 --> 01:35:23,489
Within our State Physical Activity Nutrition
Program, we work with mostly state health

1104
01:35:23,489 --> 01:35:27,000
departments to implement food service guidelines.

1105
01:35:27,000 --> 01:35:32,430
Food service guidelines operationalize the
dietary guidelines for Americans, and they’re

1106
01:35:32,430 --> 01:35:38,230
a way to implement healthy nutrition standards
in many of the places we spend our time, such

1107
01:35:38,230 --> 01:35:44,150
as hospitals, universities or colleges, private
workplaces, as well as state, local and Tribal

1108
01:35:44,150 --> 01:35:45,150
government facilities.

1109
01:35:45,150 --> 01:35:49,170
There’s a number of community settings,
including parks, stadiums and buildings where

1110
01:35:49,170 --> 01:35:54,790
organizations meet as well as multiple venues
within these places, such as cafeterias, cafes,

1111
01:35:54,790 --> 01:35:59,540
grills, snack bars, and really this is to
create healthy defaults, so increasing the

1112
01:35:59,540 --> 01:36:00,540
supply of healthy foods.

1113
01:36:00,540 --> 01:36:05,840
The food service guidelines were first published
in 2011.

1114
01:36:05,840 --> 01:36:08,060
We then updated them in 2017.

1115
01:36:08,060 --> 01:36:13,850
And we currently include four domains, nutrition
standards for healthier foods, food safety,

1116
01:36:13,850 --> 01:36:19,420
behavioral design that helps with business
practices and choice architecture, as well

1117
01:36:19,420 --> 01:36:24,650
as sustainability and local product preference.

1118
01:36:24,650 --> 01:36:28,910
The HOP and REACH community nutrition strategies
are a little bit different.

1119
01:36:28,910 --> 01:36:31,900
They include working with food vendors, distributors,
and producers to enhance healthier food procurement

1120
01:36:31,900 --> 01:36:33,400
and sales.

1121
01:36:33,400 --> 01:36:37,159
This could be through cooperative buying,
such as through food hubs.

1122
01:36:37,159 --> 01:36:40,550
It could be a collective of network of food
sales outlets.

1123
01:36:40,550 --> 01:36:44,480
It can be tools to match local producers with
institutions.

1124
01:36:44,480 --> 01:36:48,330
And again, there’s more opportunity for
innovative practices that are really community

1125
01:36:48,330 --> 01:36:49,330
driven.

1126
01:36:49,330 --> 01:36:53,660
In addition, we help them support healthy
nutrition standards and key institutions.

1127
01:36:53,660 --> 01:36:58,540
Again, this might be in places like hospitals,
after school and recreation programs, community

1128
01:36:58,540 --> 01:37:03,040
health centers, faith-based organizations,
food banks and pantries, as well as in this

1129
01:37:03,040 --> 01:37:06,450
area we include early care and education settings.

1130
01:37:06,450 --> 01:37:10,239
Thirdly, they can make improvements to state
and local programs or systems.

1131
01:37:10,239 --> 01:37:15,070
So some of this includes supportive voucher
incentive programs, increasing electronic

1132
01:37:15,070 --> 01:37:20,020
benefit, tractor acceptance, improving public
transportation routes to food stores, and

1133
01:37:20,020 --> 01:37:23,150
access to healthier venues.

1134
01:37:23,150 --> 01:37:28,480
Here’s an example of some of the healthy
incentive programs that are within the REACH

1135
01:37:28,480 --> 01:37:29,480
program.

1136
01:37:29,480 --> 01:37:34,010
So for example, partners in Health in Navajo
Nation in a number of communities, Allegheny,

1137
01:37:34,010 --> 01:37:37,590
Pennsylvania, County of San Diego, as well
as Marion County.

1138
01:37:37,590 --> 01:37:42,350
So for example, in Marion County, Indianapolis,
their reach food system strategies include

1139
01:37:42,350 --> 01:37:46,610
working on nutrition incentives, the SNAP
matching program, for example, that was established

1140
01:37:46,610 --> 01:37:47,610
in 2013.

1141
01:37:47,610 --> 01:37:50,030
They also work on produce prescriptions.

1142
01:37:50,030 --> 01:37:54,230
They have healthy retail initiatives including
corner store work, as well as work with small

1143
01:37:54,230 --> 01:37:55,580
independent grocers, and then food service
guidelines or nutrition standards in healthcare

1144
01:37:55,580 --> 01:38:01,790
settings and in food pantries.

1145
01:38:01,790 --> 01:38:05,480
I just wanted to show an example.

1146
01:38:05,480 --> 01:38:08,940
So we provide training and technical assistance
to support food service guidelines.

1147
01:38:08,940 --> 01:38:13,730
And in part of our materials, we do include
logic models that can be used by both the

1148
01:38:13,730 --> 01:38:20,179
evaluators as well as individuals who partner
with our programs on more aspects of research.

1149
01:38:20,179 --> 01:38:25,130
Folks may be aware that for public health
practice, they’re not allowed to conduct

1150
01:38:25,130 --> 01:38:26,210
research per se.

1151
01:38:26,210 --> 01:38:31,550
It’s really for improving their own program,
but they can have a secondary goal of studying

1152
01:38:31,550 --> 01:38:34,090
impacts as it relates to more generalized…information.

1153
01:38:34,090 --> 01:38:40,239
I’d like to also point out that, because
these are often in the business community,

1154
01:38:40,239 --> 01:38:44,429
we also have interests by researchers and
evaluators to look at business practices as

1155
01:38:44,429 --> 01:38:49,130
it relates to job creation, as well as sales.

1156
01:38:49,130 --> 01:38:54,610
For folks who’ve looked at the UNC Center
for Training and Research Translation, they

1157
01:38:54,610 --> 01:38:59,180
also have a number of logic models that are
used by evaluators in our public health practice

1158
01:38:59,180 --> 01:39:00,180
programs.

1159
01:39:00,180 --> 01:39:02,790
For example, this is out of the Los Angeles
County Food Service area.

1160
01:39:02,790 --> 01:39:07,060
This was assessment of their contracts as
it related to outcomes.

1161
01:39:07,060 --> 01:39:11,960
And we were able to look at, for example,
here, the target populations and whether they

1162
01:39:11,960 --> 01:39:17,909
were able to increase consumption of healthier
foods and whether this led to greater penetration

1163
01:39:17,909 --> 01:39:21,909
of healthy food access within the community.

1164
01:39:21,909 --> 01:39:27,980
Here’s one more example of logic models
that can be used by evaluators in assessing

1165
01:39:27,980 --> 01:39:32,010
both improvements in their program, as well
as then more generalized information that

1166
01:39:32,010 --> 01:39:33,520
can be published as research.

1167
01:39:33,520 --> 01:39:38,480
So this, for example, is a healthy corner
store initiative, for example here, looking

1168
01:39:38,480 --> 01:39:43,250
at what improvements in the food environments
within WIC stores, and then what that meant

1169
01:39:43,250 --> 01:39:44,760
for sales to WIC participants.

1170
01:39:44,760 --> 01:39:50,739
I just wanted to point out a couple of publications
that have come out of recipients.

1171
01:39:50,739 --> 01:39:53,260
This included work in three Louisiana parishes.

1172
01:39:53,260 --> 01:39:59,040
This included a healthy food demonstrations
within stores in-store marketing and encouraging

1173
01:39:59,040 --> 01:40:01,000
owners to stock healthier food items.

1174
01:40:01,000 --> 01:40:05,840
This example that was published in preventing
chronic disease, unfortunately, did not show

1175
01:40:05,840 --> 01:40:11,190
an increase in purchasing of healthier foods
or a change in healthier diet habits, although

1176
01:40:11,190 --> 01:40:14,100
it did find modest changes in the food store
environments.

1177
01:40:14,100 --> 01:40:20,631
As another example, in the HOP program from
rural Kentucky, they were able to work with

1178
01:40:20,631 --> 01:40:25,110
both a social marketing campaign that was
called Plate it Up Kentucky Proud, as well

1179
01:40:25,110 --> 01:40:28,219
as changes within stores themselves and markets.

1180
01:40:28,219 --> 01:40:33,001
The bottom of the slide does show here from
year one to year two of the program, the mean

1181
01:40:33,001 --> 01:40:38,869
number of servings per day of fruit increased
significantly from 2.71 to 2.94, and as well

1182
01:40:38,869 --> 01:40:42,270
as an increase in servings of vegetables per
day.

1183
01:40:42,270 --> 01:40:46,570
So there are some examples where public
health practitioners are able to publish research

1184
01:40:46,570 --> 01:40:49,040
on the work they’re doing in these spaces.

1185
01:40:49,040 --> 01:40:52,560
Finally, I wanted to end with some systems
change work.

1186
01:40:52,560 --> 01:40:57,230
This includes our Building Resiliency in Communities,
our BRIC program, again, during COVID, I,

1187
01:40:57,230 --> 01:41:02,869
there’s been a large interest in the charitable
food system and how we can ensure that individuals

1188
01:41:02,869 --> 01:41:08,900
are…being both food secure and decreasing
hunger.

1189
01:41:08,900 --> 01:41:12,880
This includes quite a bit of work on food
councils or coalitions and how food pantries

1190
01:41:12,880 --> 01:41:17,710
and food banks are able to take part in the
planning efforts, increasing nutrition standards

1191
01:41:17,710 --> 01:41:22,940
or guidelines and food banks, ensuring that
we’re reaching populations in need, and

1192
01:41:22,940 --> 01:41:28,900
then also, again, in bringing in community
venues using financial incentive programs.

1193
01:41:28,900 --> 01:41:33,449
So, to end the, I’d like to thank you today
for your attention.

1194
01:41:33,449 --> 01:41:38,199
Just to bring about that CDC’s funding really
does try to support addressing social determinants

1195
01:41:38,199 --> 01:41:40,639
of health, including food and nutrition security.

1196
01:41:40,639 --> 01:41:44,390
Our recipients are involved every day with
interventions that we would probably classify

1197
01:41:44,390 --> 01:41:46,900
in the research setting as natural experiments.

1198
01:41:46,900 --> 01:41:49,820
They’re very much involved in implementation
science…principles such as engagement and

1199
01:41:49,820 --> 01:41:53,750
their evaluation can go from light to rigorous.

1200
01:41:53,750 --> 01:41:58,900
They do have a primary goal of improving their
programs, but they can have a secondary goal

1201
01:41:58,900 --> 01:42:02,030
of informing the field, creating generalizable
knowledge.

1202
01:42:02,030 --> 01:42:08,020
And so we do really often suggest where we
can to match, make researchers to also become

1203
01:42:08,020 --> 01:42:09,020
program evaluators.

1204
01:42:09,020 --> 01:42:19,050
This really helps us spread lessons learned
using implementation science principles with

1205
01:42:19,050 --> 01:42:25,860
an equity lens. Thank you.

1206
01:42:27,210 --> 01:42:32,640
DR. ERIC RIMM: Thank you, Heidi. That was great, and thank you, Karen, for
the introduction.

1207
01:42:32,640 --> 01:42:37,470
I’m glad to help out with facilitating the
Q&A for the next panel.

1208
01:42:37,470 --> 01:42:43,650
And I’m, I’m really delighted that Heidi
has agreed to stick around and be part of

1209
01:42:43,650 --> 01:42:45,800
our next Q&A for our panel.

1210
01:42:45,800 --> 01:42:51,380
So, if anybody has questions for Heidi, please
put them in the Q&A at the bottom.

1211
01:42:51,380 --> 01:42:59,110
Next up, we’re going to have us move on
to panel six, which is strategies to improve

1212
01:42:59,110 --> 01:43:03,590
neighborhood food environments, what…what
has and hasn’t worked and why.

1213
01:43:03,590 --> 01:43:11,139
This, this panel will…will examine policies,
strategies and contextual social factors that

1214
01:43:11,139 --> 01:43:14,540
can influence neighborhood food environments.

1215
01:43:14,540 --> 01:43:19,639
So I want to welcome everyone to our panel.

1216
01:43:19,639 --> 01:43:23,790
It’s…it’s…we’re going to be looking
at both actually effective and ineffective

1217
01:43:23,790 --> 01:43:29,020
interventions that have been used to address
food environment changes that influence dietary

1218
01:43:29,020 --> 01:43:30,020
behaviors.

1219
01:43:30,020 --> 01:43:33,929
So I’m going to introduce the…the three
speakers now, and then we’ll have a Q&A

1220
01:43:33,929 --> 01:43:35,849
at the, at the end.

1221
01:43:35,849 --> 01:43:41,711
So, remember that if you have questions for
any of the three speakers, put them in the

1222
01:43:41,711 --> 01:43:45,860
Q&A and specifically address them to which
of the speakers you’d like to answer.

1223
01:43:45,860 --> 01:43:51,880
So let me first…first up will be Dr. Roland
Sturm of the Pardee RAND Graduate School.

1224
01:43:51,880 --> 01:43:56,730
He will discuss the outcome of a fast-food
ban in Los Angeles.

1225
01:43:56,730 --> 01:44:02,630
Our next speaker, Dr. Chelsea Singleton of
Tulane University School of Public Health

1226
01:44:02,630 --> 01:44:07,630
in Tropical Medicine, whose presentation will
focus on evaluating the Healthy Food Financing

1227
01:44:07,630 --> 01:44:09,940
Initiative.

1228
01:44:09,940 --> 01:44:13,960
And finally, our last speaker, Dr. Allison
Karpyn of the University of Delaware, will

1229
01:44:13,960 --> 01:44:18,880
discuss healthy in-store marketing practices.

1230
01:44:18,880 --> 01:44:28,530
So I, I look forward to, to your talk and
I’ll pass it over to Roland.

1231
01:44:28,530 --> 01:44:29,650
DR.

1232
01:44:29,650 --> 01:44:35,780
ROLAND STURM: My talk is about zoning for
health and with a particular focus on the

1233
01:44:35,780 --> 01:44:40,270
Los Angeles fast-food ban.

1234
01:44:40,270 --> 01:44:44,159
The 2008 fast-food ban is narrower in scope
than fast-food ban sounds.

1235
01:44:44,159 --> 01:44:51,150
It was a regulation, an ordinance that prohibited
remodeling, opening, building new standalone

1236
01:44:51,150 --> 01:44:52,739
fast-food restaurants in South LA.

1237
01:44:52,739 --> 01:44:58,270
So not all of the city of Los Angeles, but
an area of about 700,000 people.

1238
01:44:58,270 --> 01:45:04,570
It’s relevant sort of for the history of
anti-obesity and diet is, that is the first

1239
01:45:04,570 --> 01:45:07,159
zoning regulation that explicitly mentioned
it.

1240
01:45:07,159 --> 01:45:12,449
So, language included, it’s an over-concentration
of fast-food restaurants in South LA and that’s

1241
01:45:12,449 --> 01:45:16,570
detrimental to the health of the people of
the community.

1242
01:45:16,570 --> 01:45:20,790
And this map shows the fast-food ban area.

1243
01:45:20,790 --> 01:45:27,500
Black is the LA, Los Angeles County, green
is the City of Los Angeles.

1244
01:45:27,500 --> 01:45:32,020
The fast-food ban area is the shaded area
that is the sort of the South and part of

1245
01:45:32,020 --> 01:45:33,570
East Los Angeles.

1246
01:45:33,570 --> 01:45:37,639
Let’s step back in time.

1247
01:45:37,639 --> 01:45:44,460
Even though the 2008…regulation may have
been the first one about diet, obesity, zoning

1248
01:45:44,460 --> 01:45:46,349
regulation has been around for much longer.

1249
01:45:46,349 --> 01:45:52,170
In fact, 100 years prior to the fast-food
ban, LA passed the first citywide zoning into

1250
01:45:52,170 --> 01:45:53,420
residential industrial districts.

1251
01:45:53,420 --> 01:45:58,170
And it may have been the first one in the
US above for city doing the whole area itself.

1252
01:45:58,170 --> 01:46:02,790
It followed up piecemeal regulation that has
been around where you can bury your dad or

1253
01:46:02,790 --> 01:46:05,610
get drunk or keep your cows.

1254
01:46:05,610 --> 01:46:07,940
That was clearly about health and quality
of life.

1255
01:46:07,940 --> 01:46:09,940
And there was some idealism involved.

1256
01:46:09,940 --> 01:46:16,630
Nowadays, zoning gets also bad rap with a
single-family housing contribution to sprawl

1257
01:46:16,630 --> 01:46:17,710
inequities.

1258
01:46:17,710 --> 01:46:24,360
And any regulation or the zoning laws, there’s
always the risk of captured by interest groups.

1259
01:46:24,360 --> 01:46:31,230
This was the 1908 language of...in Los Angeles,
I have a facsimile from Bakersfield, when

1260
01:46:31,230 --> 01:46:34,810
they adopted the same…regulations.

1261
01:46:34,810 --> 01:46:41,360
You can clearly see from the restrictions
in residential areas.

1262
01:46:41,360 --> 01:46:46,190
This is an environmental health safety aspect.

1263
01:46:46,190 --> 01:46:52,889
So now, in residential areas, you could no
longer have stone crushers and fireworks factories

1264
01:46:52,889 --> 01:47:02,050
and slaughterhouses…laws and regulations
are absolutely essential for functioning society.

1265
01:47:02,050 --> 01:47:06,211
But they also need to be good laws and regulations.

1266
01:47:06,211 --> 01:47:10,610
Any regulation has its costs so we want to
make sure it achieves its goal and it’s

1267
01:47:10,610 --> 01:47:12,390
not just a burden.

1268
01:47:12,390 --> 01:47:17,630
It’s particularly important because regulations
can be captured by interest groups that have

1269
01:47:17,630 --> 01:47:18,750
their own agenda.

1270
01:47:18,750 --> 01:47:23,250
For me, as a researcher, the first question
is, do the magnitudes line up?

1271
01:47:23,250 --> 01:47:28,620
So does the regulation, in fact, deal with
the targeted problem?

1272
01:47:28,620 --> 01:47:33,630
My first analysis was just looking at the
business patterns to make sure that what was

1273
01:47:33,630 --> 01:47:37,230
claimed about the business structure actually
is true.

1274
01:47:37,230 --> 01:47:41,949
Here was still using data from for U.S.A.
later, I used the food inspection data from

1275
01:47:41,949 --> 01:47:43,480
the county itself.

1276
01:47:43,480 --> 01:47:50,750
Here I calculated densities per 100,000 residents
and also per roadway miles.

1277
01:47:50,750 --> 01:47:58,330
Fast-food density per capita was actually
not that high in South LA before the regulation.

1278
01:47:58,330 --> 01:47:59,940
As long as you define fast-food by the big
chain, the franchises, the ones that were

1279
01:47:59,940 --> 01:48:03,270
target, the prototypical ones, if you look
at McDonald’s, Burger King’s, the biggest

1280
01:48:03,270 --> 01:48:08,600
names, they were very similar between South
LA, West LA, which is a rich area or the county

1281
01:48:08,600 --> 01:48:09,600
average.

1282
01:48:09,600 --> 01:48:18,230
And if you look at all the franchise chains,
they were actually lower in South LA.

1283
01:48:18,230 --> 01:48:21,530
Now, the actual business counts.

1284
01:48:21,530 --> 01:48:25,630
Were really hard to reconcile with the claims
about the over-concentration because we get

1285
01:48:25,630 --> 01:48:26,630
two things.

1286
01:48:26,630 --> 01:48:30,510
Either the density of fast-food chains are
lower and using the per capita measure, which

1287
01:48:30,510 --> 01:48:31,540
would be my preferred one.

1288
01:48:31,540 --> 01:48:36,530
But if you say per capita is the wrong measure
and you have to do per roadway amounts, then

1289
01:48:36,530 --> 01:48:38,360
the density of fast-food chain would be similar.

1290
01:48:38,360 --> 01:48:42,960
But the real difference in the one we, you
would want it to address is there would be

1291
01:48:42,960 --> 01:48:49,880
far more small food stores and convenience
stores.

1292
01:48:49,880 --> 01:48:54,040
And a few years later, of course, I wanted
to know what happened after the regulation.

1293
01:48:54,040 --> 01:48:57,770
And for that, I got the retail food permit
data from the LA County Department of Public

1294
01:48:57,770 --> 01:48:58,770
Health.

1295
01:48:58,770 --> 01:49:01,590
That is, the data they use for the food inspection.

1296
01:49:01,590 --> 01:49:08,280
They are data spreadsheets and to look at
which are the new permits that came up in…in…in

1297
01:49:08,280 --> 01:49:12,360
the years, distinguishing sort of all the
different types of places, including the small

1298
01:49:12,360 --> 01:49:14,340
food stores.

1299
01:49:14,340 --> 01:49:21,400
So the new food outlets that popped up in
the, that was the four years after the…regulation.

1300
01:49:21,400 --> 01:49:27,130
Mostly small food stores, very rarely independent,
larger restaurants.

1301
01:49:27,130 --> 01:49:31,880
And you can see there are differences in the
business structure.

1302
01:49:31,880 --> 01:49:36,050
So, I really would say there are two key differences
here.

1303
01:49:36,050 --> 01:49:41,000
The largest group of food, new outlets in
South LA are small food stores, just lots

1304
01:49:41,000 --> 01:49:42,000
of them.

1305
01:49:42,000 --> 01:49:46,340
And elsewhere, they’re larger restaurants,
but they’re not part of a big chains.

1306
01:49:46,340 --> 01:49:49,610
They’re really no significant other differences.

1307
01:49:49,610 --> 01:49:54,190
And during that time period, there were eight
new fast-food outlets they belonged that were

1308
01:49:54,190 --> 01:50:01,380
not standalone, so they were allowed because
it was, the regulation only affected standalone

1309
01:50:01,380 --> 01:50:02,380
restaurants.

1310
01:50:02,380 --> 01:50:04,070
Also looked at individual level data.

1311
01:50:04,070 --> 01:50:08,711
Now, I had really no expectation that this
would have anything to do with the fast-food

1312
01:50:08,711 --> 01:50:12,960
ban, just because the fast-food ban did not
change the build environment in any meaningful

1313
01:50:12,960 --> 01:50:13,960
way.

1314
01:50:13,960 --> 01:50:16,159
Some size here were kind of small.

1315
01:50:16,159 --> 01:50:18,250
It was the California Health Interview survey.

1316
01:50:18,250 --> 01:50:22,480
I had 5,000 people in the city, but it was
enough really to show significant differences

1317
01:50:22,480 --> 01:50:23,510
here.

1318
01:50:23,510 --> 01:50:31,420
South LA as expected had higher BMI and high
obesity rates than the city or the county.

1319
01:50:31,420 --> 01:50:36,170
Significantly higher and more disconcerting,
it increased even more.

1320
01:50:36,170 --> 01:50:38,660
So disparities widened.

1321
01:50:38,660 --> 01:50:42,849
Again, you can’t blame the fast-food ban
for it, but nor did the fast-food ban make

1322
01:50:42,849 --> 01:50:45,369
any difference.

1323
01:50:45,369 --> 01:50:52,070
And looking at food consumption, per se, there
are really no difference.

1324
01:50:52,070 --> 01:50:55,520
Things go up everywhere or they go down everywhere.

1325
01:50:55,520 --> 01:50:57,909
The bright spot is really the decline in soft
drinks.

1326
01:50:57,909 --> 01:50:59,670
It goes down everywhere.

1327
01:50:59,670 --> 01:51:04,672
That really happened nationwide and happened
in the early 2000s.

1328
01:51:04,672 --> 01:51:10,270
On the other hand, fast-food consumption
still at that point was increasing everywhere.

1329
01:51:10,270 --> 01:51:14,260
So my summary here would be changes in diet
and obesity.

1330
01:51:14,260 --> 01:51:16,409
Well, the fast-food ban didn’t do anything.

1331
01:51:16,409 --> 01:51:23,580
This was distracting from the, the real problem,
the trends that are both positive and negative,

1332
01:51:23,580 --> 01:51:25,050
they’re largely the same.

1333
01:51:25,050 --> 01:51:30,190
High obesity rates everywhere, more fast-food
consumption, reduction in soft drink consumption.

1334
01:51:30,190 --> 01:51:33,329
But the…the tread was worse in…in South
LA.

1335
01:51:33,329 --> 01:51:37,340
VIDEO RECORDING AUDIO: Well, it’s 2021 and I’m in
South LA.

1336
01:51:37,340 --> 01:51:41,790
In fact, in Watts at the, is the iconic Watts
Tower, which is really tiny.

1337
01:51:41,790 --> 01:51:47,730
But, strangely enough, Watts is not a fast-food
ban area, but the areas around it are.

1338
01:51:47,730 --> 01:51:50,820
And so we’ll take a look at those.

1339
01:51:50,820 --> 01:51:56,790
DR. ROLAND STURM: I just pulled from Adams onto
Crenshaw Boulevard, and that intersection

1340
01:51:56,790 --> 01:52:00,159
was in, got lots of pictures because of all
the fast-foods there.

1341
01:52:00,159 --> 01:52:03,070
There was El Pollo Loco, McDonald’s, a Taco
Bell.

1342
01:52:03,070 --> 01:52:07,670
Here’s a Subway on the right, a Yoshinoya
on the left coming up.

1343
01:52:07,670 --> 01:52:12,340
And those have been there since before the
fast-food ban.

1344
01:52:12,340 --> 01:52:20,619
What has changed, however, is all the places
in here that are not part of the regulation.

1345
01:52:20,619 --> 01:52:24,140
The King Donut is here.

1346
01:52:24,140 --> 01:52:31,310
There’s a little Caesars, there’s American
Deli, there’s Mexican place, and those are

1347
01:52:31,310 --> 01:52:32,310
new.

1348
01:52:32,310 --> 01:52:34,830
And to summarize, the LA ordinance may have
been important first, but probably not for

1349
01:52:34,830 --> 01:52:36,460
the right reason.

1350
01:52:36,460 --> 01:52:42,620
The justification that there were too many
large fast-food franchises was really inconsistent

1351
01:52:42,620 --> 01:52:45,160
with the business structure doesn’t match
up.

1352
01:52:45,160 --> 01:52:48,570
Sure, you can find examples, and I just showed
you them on the video.

1353
01:52:48,570 --> 01:52:52,790
So this was a intersection that got a lot
of pictures in the media.

1354
01:52:52,790 --> 01:52:55,110
But it’s really not that typical.

1355
01:52:55,110 --> 01:53:00,420
Much more typical would’ve been the little
turn I did into the strip mall.

1356
01:53:00,420 --> 01:53:05,639
There’s really no evidence that the ordinance
really achieved change in the business structure,

1357
01:53:05,639 --> 01:53:10,010
or a reduction in fast-food consumption or
obesity among the residents.

1358
01:53:10,010 --> 01:53:15,500
I think type of foods, portion sizes, they’re
arguably more important than the type of outlets.

1359
01:53:15,500 --> 01:53:20,520
So if you think about a Chipotle freestanding
type restaurants, typically very much would

1360
01:53:20,520 --> 01:53:22,950
be prohibited by the regulation.

1361
01:53:22,950 --> 01:53:30,090
Was the King Donut the first thing you saw
when I pulled into the strip mall?

1362
01:53:30,090 --> 01:53:34,250
That is allowed, so…that does not really
help with diet quality regulations too crude

1363
01:53:34,250 --> 01:53:37,750
to tool for this.

1364
01:53:37,750 --> 01:53:43,920
There are still value in regulations for the
right reasons.

1365
01:53:43,920 --> 01:53:47,341
I think for example, the drive-through bans
to improve walkability is fine, but if you

1366
01:53:47,341 --> 01:53:53,150
say drive-through bans so people eat healthier,
that is much harder to swallow.

1367
01:53:53,150 --> 01:53:55,910
I have a little coda just now.

1368
01:53:55,910 --> 01:54:02,730
Santa Monica Wealthy West Side City created
this ordinance that prohibits fast-food restaurants

1369
01:54:02,730 --> 01:54:04,650
on the promenade.

1370
01:54:04,650 --> 01:54:07,440
Fast-food here is defined as more than 150
outlets nationwide.

1371
01:54:07,440 --> 01:54:14,320
And the fear is that there’s so many empty
spots right now because of the pandemic that

1372
01:54:14,320 --> 01:54:17,079
those will be filled by fast-food chains.

1373
01:54:17,079 --> 01:54:23,840
But unlike the fast-food ban in LA that was
celebrated in 2008 and then 2010 again, and

1374
01:54:23,840 --> 01:54:28,380
in later years, the pushback that people here
in Santa Monica is very different.

1375
01:54:28,380 --> 01:54:36,170
And here’s sort of the criticism that’s
very much what you hear in the council meetings.

1376
01:54:36,170 --> 01:54:41,020
DR. CHELSEA SINGLETON: Hello, my name is Chelsea
Singleton and I’m an assistant professor

1377
01:54:41,020 --> 01:54:43,520
at Tulane University in New Orleans, Louisiana.

1378
01:54:43,520 --> 01:54:48,460
And I’m excited to be here today speaking
to you at this wonderful virtual workshop

1379
01:54:48,460 --> 01:54:49,530
in session eight.

1380
01:54:49,530 --> 01:54:53,710
And today I’ll be talking about the Healthy
Food Financing Initiative and its impact on

1381
01:54:53,710 --> 01:54:57,360
neighborhood food environments in the US as
well as Illinois.

1382
01:54:57,360 --> 01:55:02,270
I’m presenting on behalf of the Policy Practice
and Prevention Research Center at the University

1383
01:55:02,270 --> 01:55:05,929
of Illinois Chicago, which is where I completed
my postdoc fellowship.

1384
01:55:05,929 --> 01:55:15,520
So I have nothing to disclose, however, I
would like to acknowledge our funding source.

1385
01:55:15,520 --> 01:55:19,349
So, the research I’m going to present towards
the end of this presentation was actually

1386
01:55:19,349 --> 01:55:21,420
funded by a CDC NOPREN grant.

1387
01:55:21,420 --> 01:55:23,840
So I want to acknowledge the NOPREN network.

1388
01:55:23,840 --> 01:55:28,760
So let me give you a little bit of background
information about the Healthy Food and Financing

1389
01:55:28,760 --> 01:55:34,020
Initiative for all event attendees who are
unfamiliar with this particular initiative.

1390
01:55:34,020 --> 01:55:39,719
So, the USDA estimates about 17.4 percent
of US households live in census tracts that

1391
01:55:39,719 --> 01:55:42,500
are designated as low income and low access.

1392
01:55:42,500 --> 01:55:48,960
Low access, meaning that they have low access
to retailers that sell on stock a large supply

1393
01:55:48,960 --> 01:55:51,920
of healthy food like supermarkets and grocery
stores.

1394
01:55:51,920 --> 01:55:56,880
So this particular public health concern is
what sparked the…the Obama administration

1395
01:55:56,880 --> 01:56:00,230
to create and announce the Healthy Food Financing
Initiative in 2010.

1396
01:56:00,230 --> 01:56:02,670
It was actually part of the Let’s Move campaign.

1397
01:56:02,670 --> 01:56:07,330
So the Healthy Food Financing Initiative has
specific set of goals, including to address

1398
01:56:07,330 --> 01:56:11,910
inequities and healthy food access, that are
impacting underserved communities in the country,

1399
01:56:11,910 --> 01:56:17,810
to diversify the retailers that sell food
in these communities, and also to engage with

1400
01:56:17,810 --> 01:56:18,960
these communities.

1401
01:56:18,960 --> 01:56:25,190
And since then, the Healthy Food Financing
Initiative has contributed to the expansion

1402
01:56:25,190 --> 01:56:30,670
of healthy food retail and underserved communities
across the United States in a number of different

1403
01:56:30,670 --> 01:56:31,670
ways.

1404
01:56:31,670 --> 01:56:36,310
So it has contributed tens of thousands of
square footage of healthy food retail space

1405
01:56:36,310 --> 01:56:40,270
through a number of different mechanisms and
projects.

1406
01:56:40,270 --> 01:56:45,920
So some of them being the creation of new
stores such as supermarkets and grocery stores.

1407
01:56:45,920 --> 01:56:51,560
And then also there has been projects that
have supported existing food retailers to

1408
01:56:51,560 --> 01:56:55,570
help them expand their supply of healthy food.

1409
01:56:55,570 --> 01:57:02,250
So, corner stores, smaller grocery stores,
to…to allow them to carry a larger stock

1410
01:57:02,250 --> 01:57:03,770
of healthy food.

1411
01:57:03,770 --> 01:57:08,820
And I want to acknowledge the Food Trust,
the PolicyLink, as well as the Reinvestment

1412
01:57:08,820 --> 01:57:13,199
fund because these particular organizations,
many of you are familiar with them or are

1413
01:57:13,199 --> 01:57:17,480
affiliated with them, have studied the broad
impact of the Healthy Food Financing Initiative.

1414
01:57:17,480 --> 01:57:22,619
And they have been a great source of information
on this initiative since its inception.

1415
01:57:22,619 --> 01:57:26,360
And they have published a number of reports
on it.

1416
01:57:26,360 --> 01:57:29,710
But one of the things I do want to highlight
is the economic contributions of the HFFI.

1417
01:57:29,710 --> 01:57:35,739
So over 4,000 jobs have been created, and
that job creation has led to workforce expansion

1418
01:57:35,739 --> 01:57:41,739
as well as local…economy growth and community
empowerment in the communities that have received

1419
01:57:41,739 --> 01:57:43,810
HFFI support.

1420
01:57:43,810 --> 01:57:50,960
So on this particular slide, I quickly summarized
some of the research that has been conducted

1421
01:57:50,960 --> 01:57:51,960
today.

1422
01:57:51,960 --> 01:57:56,670
And much of it has been conducted by presenters
and attendees of this virtual event.

1423
01:57:56,670 --> 01:58:01,810
But out of all the studies that have been
conducted, many of them have been conducted

1424
01:58:01,810 --> 01:58:08,540
and in sites where there have been HFFI supported
projects and they have looked at outcomes

1425
01:58:08,540 --> 01:58:15,510
such as community level impact the changes
that retailer availability, density and diversity.

1426
01:58:15,510 --> 01:58:17,960
They’ve also looked at store outcomes.

1427
01:58:17,960 --> 01:58:24,200
So, looking at the food retailers in communities
as well as the, the, the new retailers to

1428
01:58:24,200 --> 01:58:28,659
see what if they’re stocking, the prices
of food and beverages as well as, you know,

1429
01:58:28,659 --> 01:58:30,010
in-store marketing strategies.

1430
01:58:30,010 --> 01:58:36,300
And then finally, a…a research has focused
on outcomes that have impacted the consumer.

1431
01:58:36,300 --> 01:58:43,130
So we’re really interested in knowing how
HFFI supported projects have resulted in changes

1432
01:58:43,130 --> 01:58:48,090
to consumer behavior such as food and beverage
purchasing, their food security status, various

1433
01:58:48,090 --> 01:58:52,690
different aspects of dietary intake and even
some health outcomes such as obesity.

1434
01:58:52,690 --> 01:58:59,420
And overall, a lot of the research is in the
community and store space, looking at changes

1435
01:58:59,420 --> 01:59:01,280
to the neighborhood food environment.

1436
01:59:01,280 --> 01:59:07,190
However, there is a small subset of studies
that have…collected consumer information,

1437
01:59:07,190 --> 01:59:13,710
although a lot of this research hasn’t found
much findings in terms of significant changes

1438
01:59:13,710 --> 01:59:16,079
to outcomes such as diet and obesity.

1439
01:59:16,079 --> 01:59:21,369
So I’m going to talk a little bit about
the HFFI in Illinois, because that’s what

1440
01:59:21,369 --> 01:59:25,790
I mostly worked on when I was a postdoc at
the University of Illinois and Chicago.

1441
01:59:25,790 --> 01:59:30,090
So, like I said, UIC’s Prevention Research
Center received a NOPREN grant to actually

1442
01:59:30,090 --> 01:59:37,270
study the…the HFFI and its impact on neighborhood
food environments in two areas of Illinois

1443
01:59:37,270 --> 01:59:40,570
that receives HFFI support.

1444
01:59:40,570 --> 01:59:47,550
So the first area being Rockford, Illinois,
which is about 90 miles Northwest of Chicago.

1445
01:59:47,550 --> 01:59:52,590
And a nonprofit organization called the IFF,
the Illinois Facilities Fund actually leveraged

1446
01:59:52,590 --> 01:59:57,070
HFFI funds to develop a new supermarket in
Rockford.

1447
01:59:57,070 --> 02:00:02,059
And then on the South side of Chicago, the
community…the Chicago Community Loan Fund

1448
02:00:02,059 --> 02:00:08,280
leveraged some HFFI support to open a new supermarket
in the Inglewood community on the South side

1449
02:00:08,280 --> 02:00:09,280
of Chicago.

1450
02:00:09,280 --> 02:00:11,110
So we’re going to talk about those two sites
specifically.

1451
02:00:11,110 --> 02:00:17,940
So this is some descriptive information about
UIC's NOPREN project that I participated in

1452
02:00:17,940 --> 02:00:20,500
when I was a…a fellow at UIC.

1453
02:00:20,500 --> 02:00:26,350
And I would like to say that all of our research
findings have been published already.

1454
02:00:26,350 --> 02:00:30,270
So I’m happy to share with you all of the
papers that have come out of this project.

1455
02:00:30,270 --> 02:00:37,910
From 2015 to 2018, we collected data from
four communities, two of them being in Rockford

1456
02:00:37,910 --> 02:00:41,030
and two of them being in Chicago.

1457
02:00:41,030 --> 02:00:44,699
The Rockford site, they actually received
a stabilized supermarket.

1458
02:00:44,699 --> 02:00:46,860
It opened in August of 2015.

1459
02:00:46,860 --> 02:00:51,500
And on the South side of Chicago and the Inglewood
community, they received a Whole Foods Market

1460
02:00:51,500 --> 02:00:53,900
and opened in September of 2016.

1461
02:00:53,900 --> 02:00:59,610
Both of these communities were predominantly
African-American and had a large number of…residents

1462
02:00:59,610 --> 02:01:01,159
who were impoverished.

1463
02:01:01,159 --> 02:01:06,380
And again, what we were interested in was
actually studying how these stores were going

1464
02:01:06,380 --> 02:01:12,520
to impact the existing food environment, which
primarily comprised of non-chain grocery stores,

1465
02:01:12,520 --> 02:01:15,670
corner stores, gas station, liquor stores,
pharmacies and discount stores.

1466
02:01:15,670 --> 02:01:20,610
So we collected data from the existing stores
to see if there was any change in food and

1467
02:01:20,610 --> 02:01:22,350
beverage availability and marketing.

1468
02:01:22,350 --> 02:01:27,900
So, like I said, all of our papers have been
published.

1469
02:01:27,900 --> 02:01:32,550
So, if you were really interested in what
happened in the Rockford site, I’m happy

1470
02:01:32,550 --> 02:01:33,920
to share with you that paper.

1471
02:01:33,920 --> 02:01:36,750
Just shoot me an email and I will get that
information to you.

1472
02:01:36,750 --> 02:01:41,670
But I’m going to focus specifically on what
took place on the South side of Chicago and

1473
02:01:41,670 --> 02:01:42,670
the Inglewood community.

1474
02:01:42,670 --> 02:01:47,290
So, like I said, a Whole Foods Market opened,
and this is the Whole Foods Market that opened

1475
02:01:47,290 --> 02:01:48,610
in Inglewood Square.

1476
02:01:48,610 --> 02:01:54,830
It’s actually now this square is the home
of several other retail businesses, some of

1477
02:01:54,830 --> 02:01:56,400
them being non-food retail businesses.

1478
02:01:56,400 --> 02:02:00,060
And it has led to the development of hundreds
of jobs.

1479
02:02:00,060 --> 02:02:04,340
Many of these jobs are occupied by people
who live in the Inglewood community.

1480
02:02:04,340 --> 02:02:09,900
So again, it shows that broader economic impact
on this community.

1481
02:02:09,900 --> 02:02:15,469
Because of this HFFI supportive market coming
into the community.

1482
02:02:15,469 --> 02:02:22,280
We recently published our paper with the findings
from the Whole Food site, the Inglewood site,

1483
02:02:22,280 --> 02:02:26,010
and it’s…is demographically matched community,
which is North Lawndale.

1484
02:02:26,010 --> 02:02:33,810
So you can see in that paper we summarized
changes in food and beverage availability

1485
02:02:33,810 --> 02:02:37,389
across this community over the course of two
years after the store opened.

1486
02:02:37,389 --> 02:02:44,950
So our baseline findings reflect 2016, and
then we did two follow up periods, 2017 and

1487
02:02:44,950 --> 02:02:45,950
2018.

1488
02:02:45,950 --> 02:02:50,710
This is just a snapshot of the paper, so you
can actually see fruit and vegetable availability

1489
02:02:50,710 --> 02:02:53,410
in the small stores that existed.

1490
02:02:53,410 --> 02:02:59,400
And as you can see, on average, these stores
were not offering a large variety of fruits

1491
02:02:59,400 --> 02:03:06,219
and vegetables at baseline and two and as
well as two years post the store opening the

1492
02:03:06,219 --> 02:03:07,980
Whole Foods Market opening.

1493
02:03:07,980 --> 02:03:11,480
So that was one of the key take home messages
that we didn’t see significant changes in

1494
02:03:11,480 --> 02:03:14,280
the existing food retail environment.

1495
02:03:14,280 --> 02:03:20,230
However, adding this market greatly contributed
to the total amount of healthy food retail

1496
02:03:20,230 --> 02:03:24,110
space in the Inglewood community.

1497
02:03:24,110 --> 02:03:30,520
So looking ahead, I…I quickly want to summarize…as
I wrap up my presentation today is that we

1498
02:03:30,520 --> 02:03:35,290
have there…we have a lot of knowledge right
now about the Healthy Food Financing Initiative.

1499
02:03:35,290 --> 02:03:41,780
However, I do believe there are some gaps
and some opportunities for the field to really

1500
02:03:41,780 --> 02:03:47,381
expand its understanding of the Healthy Food
Financing Initiative and its impact on neighborhood

1501
02:03:47,381 --> 02:03:48,381
food environments.

1502
02:03:48,381 --> 02:03:51,809
So the first thing is that a lot of the projects
that have been conducted to date have been

1503
02:03:51,809 --> 02:03:55,920
very…in terms of research projects have
been very site specific.

1504
02:03:55,920 --> 02:04:01,210
So we focus solely on what’s going on in
Chicago or what’s going on in Pittsburgh

1505
02:04:01,210 --> 02:04:02,639
or what’s going on in New York.

1506
02:04:02,639 --> 02:04:06,830
We don’t really have a solid understanding
of what’s going on at the national level

1507
02:04:06,830 --> 02:04:11,870
in terms of that detail…detailed data at
the national level.

1508
02:04:11,870 --> 02:04:14,440
So I think that’s an opportunity for some
research.

1509
02:04:14,440 --> 02:04:21,370
I think it will be great to really understand
how the HFFI has impacted inequities by community

1510
02:04:21,370 --> 02:04:26,310
characteristics, racial ethnic composition,
as well as differences between urban and rural

1511
02:04:26,310 --> 02:04:27,310
communities.

1512
02:04:27,310 --> 02:04:31,480
I think that will be a great opportunity to
expand our understanding of the HFFI.

1513
02:04:31,480 --> 02:04:37,699
Finally, we see that the, we see that the
HFFI has affected, you know, local, the local

1514
02:04:37,699 --> 02:04:41,849
economy, but it’d really be interesting
to see how has it impacted social and environmental

1515
02:04:41,849 --> 02:04:44,570
issues such as blight, violence, social cohesion,
and educational opportunities.

1516
02:04:44,570 --> 02:04:51,120
And of course, everybody is studying the COVID
19 pandemic right now.

1517
02:04:51,120 --> 02:04:55,599
So I’m really curious to see how the pandemic
has affected neighborhood food environments

1518
02:04:55,599 --> 02:05:03,040
that have been the sites for HFFI supported
retail expansion projects.

1519
02:05:03,040 --> 02:05:07,480
And also, I just want to highlight that I
think it would be a great opportunity to really

1520
02:05:07,480 --> 02:05:11,610
understand the HFFI if we developed a central
research hub.

1521
02:05:11,610 --> 02:05:16,580
So that means like bringing researchers together
who do this research so we can collaborate

1522
02:05:16,580 --> 02:05:21,630
and, you know, develop synergy across projects
so that we can get a better understanding

1523
02:05:21,630 --> 02:05:28,090
of the HFFI and…and pull together our resources
and share them to the public.

1524
02:05:28,090 --> 02:05:34,489
So I just want to acknowledge all of my former
mentors, Dr. Powell, Dr. Zenk, Dr. Angela

1525
02:05:34,489 --> 02:05:35,489
Odoms-Young.

1526
02:05:35,489 --> 02:05:39,630
I want to acknowledge Yu Li at UIC, as well
as Amber, who is the Deputy Director of the

1527
02:05:39,630 --> 02:05:41,420
Prevention Research Center.

1528
02:05:41,420 --> 02:05:45,340
So, thank you all for listening to my talk
today in session eight.

1529
02:05:45,340 --> 02:05:46,890
This is my email address.

1530
02:05:46,890 --> 02:05:50,040
You can contact me if you want access to any
of our papers.

1531
02:05:50,040 --> 02:05:59,829
You can also follow me on Twitter @DrCRSingleton. Thank you.

1532
02:05:59,829 --> 02:06:12,210
DR. ALLISON KARPYN: Hello, my name is Allison
Karpyn and I’d like to thank the NIH workshop

1533
02:06:12,210 --> 02:06:17,860
conveners for inviting me to present today
on strategies to improve neighborhood food

1534
02:06:17,860 --> 02:06:22,420
environments, including a review of what has
and hasn’t worked and why, particularly

1535
02:06:22,420 --> 02:06:24,929
related to healthy in-store marketing strategies.

1536
02:06:24,929 --> 02:06:31,889
I’ll be drawing from a recent review article
that was published with my colleagues, Kathleen

1537
02:06:31,889 --> 02:06:37,710
McCallops, Henry Wolgast, and Karen Glanz
in the International Journal of Environmental

1538
02:06:37,710 --> 02:06:38,850
Research and Public Health.

1539
02:06:38,850 --> 02:06:42,760
I encourage you to go there if you’re interested
in more details on this study.

1540
02:06:42,760 --> 02:06:51,790
So we know the foundation of the field is
really in the concept of four Ps, product,

1541
02:06:51,790 --> 02:06:53,619
placement, price, and promotion.

1542
02:06:53,619 --> 02:06:59,219
And it’s the manipulation of these four
Ps and different combinations that results

1543
02:06:59,219 --> 02:07:06,119
in the basis of a lot of the in-store marketing
interventions that we see in public health.

1544
02:07:06,119 --> 02:07:12,120
Initially this concept was well described
in the document, harnessing the power of supermarkets

1545
02:07:12,120 --> 02:07:18,560
to help reverse childhood obesity, which kicked
off much of the thinking in this space.

1546
02:07:18,560 --> 02:07:23,600
I want to touch on some of the prior reviews.

1547
02:07:23,600 --> 02:07:30,940
Going back to 2012, Karen Glanz and colleagues
initiated a study to look at the grocery retail

1548
02:07:30,940 --> 02:07:38,850
marketing strategies that were employed between
1995 and 2010, and they found 125 studies

1549
02:07:38,850 --> 02:07:44,980
and captured that promotion and placement
strategies were very common and also saw an

1550
02:07:44,980 --> 02:07:48,329
increasing number of multicomponent intervention
studies at the time.

1551
02:07:48,329 --> 02:07:55,010
There was concern for some over reliance on
self-report data and also low response rates,

1552
02:07:55,010 --> 02:08:02,230
as well as concern for lack of…diversity
in the populations of interest, in particular

1553
02:08:02,230 --> 02:08:04,449
among business literature.

1554
02:08:04,449 --> 02:08:11,710
There’s also recognition that there was
an increasing number of online studies which

1555
02:08:11,710 --> 02:08:15,409
had not been transferred to be tested in real
life settings.

1556
02:08:15,409 --> 02:08:20,730
So some uncertainty about the extent to which
some of those online applications would apply

1557
02:08:20,730 --> 02:08:27,900
to real life settings in some of the computerized
studies.

1558
02:08:27,900 --> 02:08:34,790
Another study was published in 2013 looking
at some of these same interventions, 33, and

1559
02:08:34,790 --> 02:08:41,960
found similar results including concern for
the rigor that was reported in the studies

1560
02:08:41,960 --> 02:08:47,809
and, and in particular, lack of information
about the effect of interventions on customer

1561
02:08:47,809 --> 02:08:49,210
purchasing behavior.

1562
02:08:49,210 --> 02:08:56,360
The review also pointed out the prominence
of point of…purchase information strategies,

1563
02:08:56,360 --> 02:09:01,619
including those strategies at the register,
which might include anything from couponing

1564
02:09:01,619 --> 02:09:09,489
taste testing to recipe card give outs, and
also display strategies at the register.

1565
02:09:09,489 --> 02:09:16,730
Our goal with the most recent review was to
update the state of the literature.

1566
02:09:16,730 --> 02:09:20,790
And so we incorporated studies from 2010 to
2019.

1567
02:09:20,790 --> 02:09:25,540
We included mixed method studies as well as
quantitative data.

1568
02:09:25,540 --> 02:09:31,320
And our focus was on researcher or retail
or initiated studies that were conducted inside

1569
02:09:31,320 --> 02:09:32,320
the retail environment.

1570
02:09:32,320 --> 02:09:36,670
So we excluded things that would not have
been conducted inside the retail environment.

1571
02:09:36,670 --> 02:09:41,320
We focused also exclusively on purchasing
and consumption related outcomes.

1572
02:09:41,320 --> 02:09:45,559
So if a study didn’t have an outcome that
was related to purchase or consumption measures,

1573
02:09:45,559 --> 02:09:47,500
it was not included.

1574
02:09:47,500 --> 02:09:50,920
All in all, we ended up with 64 studies.

1575
02:09:50,920 --> 02:09:57,809
We started off with a large search, ended
up excluding many, and then did a backward

1576
02:09:57,809 --> 02:10:05,820
search where we found another 22 studies for
a total of 64.

1577
02:10:05,820 --> 02:10:12,739
If we look now at the…what we see initially,
and we’re going to describe here a capture

1578
02:10:12,739 --> 02:10:18,900
of the types of studies first, and then we’ll
look a little bit more detail at the outcomes

1579
02:10:18,900 --> 02:10:19,900
that we saw.

1580
02:10:19,900 --> 02:10:25,880
But if we capture the types of studies, the
research designs were largely non-experimental.

1581
02:10:25,880 --> 02:10:30,920
So while one in three studies were, which
is positive, we found that about two thirds

1582
02:10:30,920 --> 02:10:31,920
were not.

1583
02:10:31,920 --> 02:10:36,400
And in fact many had no control group at all.

1584
02:10:36,400 --> 02:10:40,110
We also found that the duration of the average
study was relatively short.

1585
02:10:40,110 --> 02:10:44,949
Most were less than one year, very few were
more than one year.

1586
02:10:44,949 --> 02:10:47,699
And even as short as 22 minutes.

1587
02:10:47,699 --> 02:10:54,340
We found the settings that were reflected
in the studies to be quite broad and honestly

1588
02:10:54,340 --> 02:10:56,949
mirrored a lot of what we saw 10 years ago.

1589
02:10:56,949 --> 02:11:05,340
So we’re still seeing largely equal representation,
perhaps a few more in the supermarket of supermarket

1590
02:11:05,340 --> 02:11:07,170
corner store and other grocery store.

1591
02:11:07,170 --> 02:11:11,770
And this is defined largely by the number
of registers or the size of the store or even

1592
02:11:11,770 --> 02:11:16,650
the types of products that the store sells
are thriving.

1593
02:11:16,650 --> 02:11:21,579
About half of the studies that we looked at
when it came to these purchasing related measures

1594
02:11:21,579 --> 02:11:29,940
or consumption-related measures focused on
objective purchase related data that said

1595
02:11:29,940 --> 02:11:34,920
the other half did not, and where they did
not, we saw a lot of self-report purchases

1596
02:11:34,920 --> 02:11:37,000
or expenditures.

1597
02:11:37,000 --> 02:11:42,250
When it came to consumption related measures,
again, we see a domination of self-reported

1598
02:11:42,250 --> 02:11:49,190
diet or consumption survey type tools and
much fewer application overall of consumption

1599
02:11:49,190 --> 02:11:54,100
related measures, but then certainly of more
rigorous measures.

1600
02:11:54,100 --> 02:12:00,329
If we look at trends in the type, the number
of components for the interventions, whether

1601
02:12:00,329 --> 02:12:05,590
it’s a single component intervention or
a multicomponent intervention, we see that

1602
02:12:05,590 --> 02:12:10,960
the trend toward both single and multicomponent
interventions is increasing.

1603
02:12:10,960 --> 02:12:16,420
So there’s an upward trend in the literature,
and we don’t see a domination, for example,

1604
02:12:16,420 --> 02:12:17,420
multicomponent interventions.

1605
02:12:17,420 --> 02:12:25,489
We’re seeing approximate equal usage of
both types of study designs or intervention

1606
02:12:25,489 --> 02:12:26,489
designs.

1607
02:12:26,489 --> 02:12:32,639
So if I start with the good news, because
we should all begin with optimism, right?

1608
02:12:32,639 --> 02:12:38,969
We do see that 56 of the 64 studies that we
reviewed had at least one positive effect.

1609
02:12:38,969 --> 02:12:45,099
And that of those that both used an objective
measure of sales and a more rigorous method

1610
02:12:45,099 --> 02:12:49,780
in their research design, 100 percent found
at least one positive effect.

1611
02:12:49,780 --> 02:12:51,380
So good news in that front.

1612
02:12:51,380 --> 02:12:58,600
We do know though that many 24, as it turns
out of our 64 or 38 percent were conducted

1613
02:12:58,600 --> 02:13:00,840
without any control or comparison group.

1614
02:13:00,840 --> 02:13:02,599
So that’s clearly problematic.

1615
02:13:02,599 --> 02:13:07,570
And only 14 of these studies were both experimental
and included objective data, which is also

1616
02:13:07,570 --> 02:13:10,710
problematic.

1617
02:13:10,710 --> 02:13:18,460
If we look at intervention outcomes by single
component interventions versus these multicomponent

1618
02:13:18,460 --> 02:13:25,570
interventions, we find that predominantly
what’s in the field are promotion related

1619
02:13:25,570 --> 02:13:28,619
interventions and that they’re generally
found to be effective.

1620
02:13:28,619 --> 02:13:35,040
So we found at least one positive effect in
27 of the 30 interventions.

1621
02:13:35,040 --> 02:13:40,750
We also find that within multicomponent interventions,
again, there’s a predominance of positive

1622
02:13:40,750 --> 02:13:44,929
results in the literature, in this case, 29
of 34.

1623
02:13:44,929 --> 02:13:49,590
Also interesting in this space when it comes
to the multicomponent interventions is that

1624
02:13:49,590 --> 02:13:53,989
many are multi are manipulating three of the
Ps.

1625
02:13:53,989 --> 02:13:59,739
So for example, promotion, product and placement,
rather than just two of the Ps.

1626
02:13:59,739 --> 02:14:06,260
So when they’re doing multicomponent interventions,
they’re pretty comprehensive type interventions.

1627
02:14:06,260 --> 02:14:12,739
So future directions, we know we need studies
that are conducted with control groups.

1628
02:14:12,739 --> 02:14:14,480
Rigor has been an issue all along.

1629
02:14:14,480 --> 02:14:21,430
And our review in the last 10 years, 24 out
of 63 studies had no control or comparison

1630
02:14:21,430 --> 02:14:22,430
group.

1631
02:14:22,430 --> 02:14:26,340
And some of this concern for rigor two carries
over into the outcome measures, whether it

1632
02:14:26,340 --> 02:14:31,460
be focused on store sales or other dietary
outcomes.

1633
02:14:31,460 --> 02:14:37,340
We also are encouraging as a result of this
review more thinking around substitution.

1634
02:14:37,340 --> 02:14:43,430
So a lot of this data right, is focused on
increased in purchasing or increased consumption,

1635
02:14:43,430 --> 02:14:46,800
but it’s not really thinking that much about
the whole diet.

1636
02:14:46,800 --> 02:14:52,210
So how we start to integrate this work into
thinking about the whole diet is important,

1637
02:14:52,210 --> 02:14:56,890
especially when it comes to substitutions
for less healthy foods.

1638
02:14:56,890 --> 02:15:05,220
We also think that this body of work begins
to ask more questions about sustained effects.

1639
02:15:05,220 --> 02:15:13,370
So we found that most of the studies are only
looking at data around three months or less

1640
02:15:13,370 --> 02:15:17,170
and that there’s very few that go to a year
or more.

1641
02:15:17,170 --> 02:15:24,630
And when it comes to these kinds of interventions,
we know that people tire of recognizing potentially

1642
02:15:24,630 --> 02:15:30,080
the intervention and might need more opportunity
for turnover, but we don’t know what those

1643
02:15:30,080 --> 02:15:34,290
parameters really look like.

1644
02:15:34,290 --> 02:15:39,400
We also know that we need to study these strategies
in emerging online sales environments.

1645
02:15:39,400 --> 02:15:45,650
The movement toward online sales has shifted
some purchasing patterns potentially and also

1646
02:15:45,650 --> 02:15:47,040
preferences.

1647
02:15:47,040 --> 02:15:51,750
So the extent to which these product promotion
and placement strategies translate to online

1648
02:15:51,750 --> 02:15:54,580
environments is really largely unknown.

1649
02:15:54,580 --> 02:16:01,370
While we do have some of those online studies,
we haven’t really tested them in this real-world

1650
02:16:01,370 --> 02:16:02,450
online environment.

1651
02:16:02,450 --> 02:16:10,550
We also know that multicomponent strategies
could examine and probably should, the added

1652
02:16:10,550 --> 02:16:14,690
effect of each additional component, because
as of now, they’re all done….

1653
02:16:14,690 --> 02:16:16,070
So that’s my review.

1654
02:16:16,070 --> 02:16:26,690
I really appreciate your time and thoughts
and look forward to future conversation and

1655
02:16:26,690 --> 02:16:27,699
questions.

1656
02:16:27,699 --> 02:16:29,719
Thank you.

1657
02:16:29,719 --> 02:16:33,760
DR. ERIC RIMM: Welcome back everybody.

1658
02:16:33,760 --> 02:16:34,969
Thank you for the fantastic presentations.

1659
02:16:34,969 --> 02:16:43,380
That was really fun to walk through and it
was a great lead off, Heidi, that you, you

1660
02:16:43,380 --> 02:16:44,450
started us with.

1661
02:16:44,450 --> 02:16:48,059
So, for, for anybody that wants to add any
more questions, we’ve had a bunch of questions

1662
02:16:48,059 --> 02:16:54,719
that have come in, but for those people that
have some questions for the next 10 or 15

1663
02:16:54,719 --> 02:16:57,969
minutes, we can ask each of the presenters.

1664
02:16:57,969 --> 02:17:03,550
So let me, let me start out as I pull up the
questions.

1665
02:17:03,550 --> 02:17:10,320
There was a few questions, Heidi, that were
specific to your presentation on, I guess

1666
02:17:10,320 --> 02:17:13,410
food service management guidelines that you
mentioned.

1667
02:17:13,410 --> 02:17:18,871
First of all, do they apply to all food service
management companies as, you know, everything

1668
02:17:18,871 --> 02:17:24,580
up to Sodexo and Compass down to smaller food
service management groups?

1669
02:17:24,580 --> 02:17:27,179
CAPT. HEIDI BLANCK: Thanks, Eric.

1670
02:17:27,179 --> 02:17:33,319
And just to review that a little bit, so,
we have provided food service guidelines and

1671
02:17:33,319 --> 02:17:38,880
we work with our recipients, which could be
local health departments or community-based

1672
02:17:38,880 --> 02:17:40,830
organizations or healthcare organizations.

1673
02:17:40,830 --> 02:17:46,830
And with their partners, which often could
be that independent food service management

1674
02:17:46,830 --> 02:17:52,330
company or one of the large, large groups,
they really determine whether that is voluntary,

1675
02:17:52,330 --> 02:17:55,930
is it an…or they can incorporate it into
a policy.

1676
02:17:55,930 --> 02:18:00,530
So it could be within their contracts, it
could be within their wellness policy of their

1677
02:18:00,530 --> 02:18:01,530
organization.

1678
02:18:01,530 --> 02:18:09,109
So these are really meant for that relational,
you know…opportunity for within those organizations.

1679
02:18:09,109 --> 02:18:12,530
So CDC doesn’t have requirements of these.

1680
02:18:12,530 --> 02:18:16,330
They start off as voluntary and then it’s
really at that organization level to turn

1681
02:18:16,330 --> 02:18:21,510
them into, whether it’s, again, a voluntary
opportunity within the food service management

1682
02:18:21,510 --> 02:18:24,750
or whether it becomes part of an actual contractual
agreement.

1683
02:18:24,750 --> 02:18:26,750
DR. ERIC RIMM: Okay, great.

1684
02:18:26,750 --> 02:18:30,780
So some of the research that you described,
I guess, was where some of the guidelines

1685
02:18:30,780 --> 02:18:36,609
were being implemented or was testing how
well the…the guidelines were being implemented

1686
02:18:36,609 --> 02:18:38,370
as opposed to mandating the guidelines?

1687
02:18:38,370 --> 02:18:40,069
CAPT. HEIDI BLANCK: Correct.

1688
02:18:40,069 --> 02:18:43,670
We do surveillance actually on policies at
both the state and local level.

1689
02:18:43,670 --> 02:18:47,609
But that’s a little bit more in the surveillance
realm and…less on implementation research.

1690
02:18:47,609 --> 02:18:49,609
DR. ERIC RIMM: In, in the areas.

1691
02:18:49,609 --> 02:18:53,280
That other question was related, where you
do surveillance or monitoring, does that,

1692
02:18:53,280 --> 02:18:58,479
is that given feedback or are your results
given back to the groups that you were monitored,

1693
02:18:58,479 --> 02:19:00,440
that you were monitoring, I guess?

1694
02:19:00,440 --> 02:19:05,800
CAPT. HEIDI BLANCK: So CDCs funding, you know,
70 percent of our funding goes out to the

1695
02:19:05,800 --> 02:19:08,889
state and local recipients within their grants
or cooperative agreements.

1696
02:19:08,889 --> 02:19:12,899
They are to set aside about 10 percent of
their funding for evaluation.

1697
02:19:12,899 --> 02:19:17,719
So that’s how we’re really able to really
provide that on the ground information.

1698
02:19:17,719 --> 02:19:25,080
It is really mostly done by them, and so they’re
really trying to improve for quality improvement.

1699
02:19:25,080 --> 02:19:31,750
We do have a number of writing workshops where
CDC supports the evaluators as well as organizations

1700
02:19:31,750 --> 02:19:34,219
that are…you know, naturally researchers.

1701
02:19:34,219 --> 02:19:38,870
So we do have a forthcoming journal supplement
and I, I just glanced at it while we were

1702
02:19:38,870 --> 02:19:43,730
talking, and it includes Eastern Michigan
University, Penn State College of Medicine,

1703
02:19:43,730 --> 02:19:46,019
University of Arkansas Medical Sciences.

1704
02:19:46,019 --> 02:19:49,270
So you can see that we have in these, were
all reach grantees.

1705
02:19:49,270 --> 02:19:53,490
So, what’s great about public health practice
is that, you know, we’re really pairing

1706
02:19:53,490 --> 02:19:58,290
that on-the-ground interventions with folks
from the research community.

1707
02:19:58,290 --> 02:20:01,479
DR. ERIC RIMM: Great. Thanks.

1708
02:20:01,479 --> 02:20:08,290
So, Roland, we, we had a question that came
in even though overall you concluded that

1709
02:20:08,290 --> 02:20:13,270
the, the, some of the guidelines did not work
in LA if you look really carefully, it does

1710
02:20:13,270 --> 02:20:19,540
look like SSBs and French fries went down
more so in South LA…compared to other neighborhoods.

1711
02:20:19,540 --> 02:20:24,990
Maybe that’s just sort of a, there’s a
targeted benefit, as you noted, you know,

1712
02:20:24,990 --> 02:20:29,880
donuts don’t go down because they weren’t
part of the targeted intervention, but is

1713
02:20:29,880 --> 02:20:34,250
it possible that the guidelines were somewhat
positive for individual foods that we’d

1714
02:20:34,250 --> 02:20:35,851
like to limit consumption of?

1715
02:20:35,851 --> 02:20:39,170
DR. ROLAND STURM: I see no evidence for that.

1716
02:20:39,170 --> 02:20:43,180
And, in fact, I would disagree with you if
we look closely and closely means you have

1717
02:20:43,180 --> 02:20:45,319
to take into account the quality of the data.

1718
02:20:45,319 --> 02:20:48,820
What a big effect, what a small effect, what
can you say with precision?

1719
02:20:48,820 --> 02:20:52,120
I would say that I see nothing in there.

1720
02:20:52,120 --> 02:20:55,220
The fast-food is going up everywhere.

1721
02:20:55,220 --> 02:21:02,360
Sodas is going down and, you know, if you
try to split things finally and…P-hacking

1722
02:21:02,360 --> 02:21:04,000
aggressively just get nonsense.

1723
02:21:04,000 --> 02:21:06,000
DR. ERIC RIMM: Yeah.

1724
02:21:06,000 --> 02:21:10,920
DR. ROLAND STURM: And that’s very common in,
in the diet area really, because people are

1725
02:21:10,920 --> 02:21:15,910
looking for something and, but then get carried
away and don’t take into account what do

1726
02:21:15,910 --> 02:21:18,260
we know what’s better and lower reliability.

1727
02:21:18,260 --> 02:21:21,300
So I would say no…no to that.

1728
02:21:21,300 --> 02:21:23,300
DR. ERIC RIMM: Okay.

1729
02:21:23,300 --> 02:21:29,520
DR. ROLAND STURM: Now, here’s another thing
that we don’t really measure, and that is

1730
02:21:29,520 --> 02:21:32,760
probably a little bit related to your question.

1731
02:21:32,760 --> 02:21:41,350
Does the health food ban create a signal something
that changes the social norms around it?

1732
02:21:41,350 --> 02:21:46,840
Because all now health food that I think is
important and the interaction then between

1733
02:21:46,840 --> 02:21:51,760
social norms and what will be offered that
will play out slowly over time.

1734
02:21:51,760 --> 02:21:54,130
We, we definitely saw that with cigarette
taxes, right?

1735
02:21:54,130 --> 02:21:55,189
It was not just—

1736
02:21:55,189 --> 02:21:56,189
DR. ERIC RIMM: Right.

1737
02:21:56,189 --> 02:22:00,120
DR. ROLAND STURM: Cigarette tax change smoking,
it was when you visited somebody, it was no

1738
02:22:00,120 --> 02:22:04,060
longer an acceptable norm that they offer
you cigarette.

1739
02:22:04,060 --> 02:22:07,450
DR. ERIC RIMM: Right. So it may be something that—

1740
02:22:07,450 --> 02:22:11,560
DR. ROLAND STURM: [inaudible] the intersection
between demand and supply is important, and

1741
02:22:11,560 --> 02:22:15,540
so the social…social norms play a role there
too.

1742
02:22:15,540 --> 02:22:19,540
DR. ERIC RIMM: Yep. Great. Thank you.

1743
02:22:19,540 --> 02:22:20,900
Chelsea, we had a few questions for you.

1744
02:22:20,900 --> 02:22:25,510
You kind of gave us a teaser saying you have
published two papers and you gave us the results

1745
02:22:25,510 --> 02:22:29,900
for the Whole Foods and not for the Save A
Lot.

1746
02:22:29,900 --> 02:22:35,070
And both, both questions were, well, one question
was in, in Whole Foods, there’s not a, a

1747
02:22:35,070 --> 02:22:39,920
tremendous amount of in-store marketing for
unhealthy foods and that most of the foods

1748
02:22:39,920 --> 02:22:41,170
that are in Whole Foods are healthy.

1749
02:22:41,170 --> 02:22:44,500
And so you’re bringing fresh fruits and
vegetables to a, to a neighborhood that maybe

1750
02:22:44,500 --> 02:22:46,170
had less before.

1751
02:22:46,170 --> 02:22:50,180
But can you sort of speak to the Save A Lot
where they may have had a lot more fresh fruits

1752
02:22:50,180 --> 02:22:54,100
and vegetables, but probably also had a lot
more in-store marketing for sugar sweetened

1753
02:22:54,100 --> 02:22:56,190
beverages or for other…unhealthy foods?

1754
02:22:56,190 --> 02:22:59,630
DR. CHELSEA SINGLETON: Yeah, I can talk about
that.

1755
02:22:59,630 --> 02:23:07,811
Yeah, so…and so just to clarify, the goal
of the project was to really look at changes

1756
02:23:07,811 --> 02:23:09,399
to the existing food environment.

1757
02:23:09,399 --> 02:23:14,189
So a lot of our focus was on the stores that
were in the community before the store, the,

1758
02:23:14,189 --> 02:23:17,720
the supermarket opened, so that’s the Save
A Lot and the Whole Foods.

1759
02:23:17,720 --> 02:23:22,390
But we did collect data from the Save A Lot
and we collect data from the Whole Foods.

1760
02:23:22,390 --> 02:23:28,380
And the…the Save A Lot was…the Save A
Lot did have marketing, like, they were marketing

1761
02:23:28,380 --> 02:23:35,450
in store, you know, more unhealthier items
like, you know, salty snacks, candy, sugar-sweetened

1762
02:23:35,450 --> 02:23:36,450
beverages.

1763
02:23:36,450 --> 02:23:37,680
We did see that.

1764
02:23:37,680 --> 02:23:43,310
However, our findings were very similar when
we actually looked at the existing stores

1765
02:23:43,310 --> 02:23:44,399
in the community.

1766
02:23:44,399 --> 02:23:51,420
We didn’t see significant changes to what
other stores, the small food stores were stocking

1767
02:23:51,420 --> 02:23:55,670
and carrying and, and advertising in Rockford
as well.

1768
02:23:55,670 --> 02:23:58,530
The original health hypothesis was that, you
know, this supermarket was going to come in

1769
02:23:58,530 --> 02:24:03,250
and maybe these stores were going to adapt
somehow, maybe for the better, maybe for the

1770
02:24:03,250 --> 02:24:04,250
worse.

1771
02:24:04,250 --> 02:24:08,790
Maybe they were going to try to stock and
advertise more healthier items, or maybe they

1772
02:24:08,790 --> 02:24:13,539
were going to pull back and stock focus on
the unhealthier items.

1773
02:24:13,539 --> 02:24:19,830
However, we didn’t see significant changes
and, you know, we actually been thinking,

1774
02:24:19,830 --> 02:24:21,540
you know, thinking deeply about that.

1775
02:24:21,540 --> 02:24:26,940
And I know there’s been some qualitative
work really around, you know, really understanding

1776
02:24:26,940 --> 02:24:30,210
small food stores and the relationship that
they have with communities.

1777
02:24:30,210 --> 02:24:33,290
And, you know, we didn’t see significant
changes to their business.

1778
02:24:33,290 --> 02:24:37,700
We didn’t see like the number of store,
we didn’t see store closings as well.

1779
02:24:37,700 --> 02:24:43,109
So, yeah, I mean, adding these stores to the
community of course contributed to the expansion

1780
02:24:43,109 --> 02:24:46,620
of the retail space because the store wasn’t
there before then.

1781
02:24:46,620 --> 02:24:50,700
However, we didn’t see significant changes
to the retail food environment in either community.

1782
02:24:50,700 --> 02:24:52,700
DR. ERIC RIMM: Okay, thanks.

1783
02:24:52,700 --> 02:24:56,410
So it didn’t, it didn’t change the overall
demand for fruits and vegetables across the

1784
02:24:56,410 --> 02:25:00,279
community such that it, you know, one store
didn’t raise up the entire neighborhood

1785
02:25:00,279 --> 02:25:04,859
or sink the entire neighborhood, but as you
noted, it brought a lot more employment to

1786
02:25:04,859 --> 02:25:07,850
the neighborhood, so that was a sort of indirect
benefit.

1787
02:25:07,850 --> 02:25:08,850
So that’s great.

1788
02:25:08,850 --> 02:25:10,850
DR. CHELSEA SINGLETON: Yeah.

1789
02:25:10,850 --> 02:25:16,070
DR. ERIC RIMM: So, Allison, there’s a, a few
questions for you. Let’s see.

1790
02:25:16,070 --> 02:25:21,729
So one, one of the question is what is the
sort of the status of examining the role of

1791
02:25:21,729 --> 02:25:27,649
the food environment beyond the, beyond the
actual food store and the neighborhood?

1792
02:25:27,649 --> 02:25:31,760
Meaning what about the food environment of
an individual’s work commute or examining

1793
02:25:31,760 --> 02:25:34,950
if people do actually stop within their neighborhood?

1794
02:25:34,950 --> 02:25:38,660
Or is it…are we concerned about beyond the
neighborhood?

1795
02:25:38,660 --> 02:25:45,200
DR. ALLISON KARPYN: I’m not sure if this is,
yeah, really a question for me, given the

1796
02:25:45,200 --> 02:25:48,140
presentation that I’ve been giving, but
I do happen to understand a bit about this,

1797
02:25:48,140 --> 02:25:49,902
given some of the research that I’ve been
doing.

1798
02:25:49,902 --> 02:25:54,609
But I think that we do know that the food
environment, the studies of the food environment

1799
02:25:54,609 --> 02:26:03,050
and where you shop for food, whether it be
on and on your commute, which is a very common

1800
02:26:03,050 --> 02:26:09,180
place of shopping for food, at least before
COVID, and where your primary store is, is

1801
02:26:09,180 --> 02:26:11,010
a major point of research interest,

1802
02:26:11,010 --> 02:26:15,680
especially when it comes to the HFFI funded
stores, whether or not people are shopping

1803
02:26:15,680 --> 02:26:18,870
at them has been a major area of interest.

1804
02:26:18,870 --> 02:26:24,340
I think Tamara Dubowitz’s work and others
has really pointed out that this is a major

1805
02:26:24,340 --> 02:26:25,340
factor.

1806
02:26:25,340 --> 02:26:27,240
I don’t know if that answers the question
entirely, but…

1807
02:26:27,240 --> 02:26:30,420
DR. ERIC RIMM: Yeah, no, I think that’s, I mean,
I think that speaks to the question.

1808
02:26:30,420 --> 02:26:35,221
So, Allison, are there, can you, are there
specific policy implications that you have

1809
02:26:35,221 --> 02:26:36,221
in mind?

1810
02:26:36,221 --> 02:26:41,979
You summarize the area there; you found some
good and bad things that are going on in the store.

1811
02:26:41,979 --> 02:26:47,190
Can…is the, is this leading to something
where you’d, like, is there’s a specific

1812
02:26:47,190 --> 02:26:53,649
policy, whether it be FDA or USDA that could
come out of this, that could benefit the food

1813
02:26:53,649 --> 02:26:54,649
environment when you’re in the store?

1814
02:26:54,649 --> 02:26:59,950
DR. ALLISON KARPYN: Yeah, I think there’s a
couple of opportunities that could be, could

1815
02:26:59,950 --> 02:27:00,950
be pursued.

1816
02:27:00,950 --> 02:27:06,790
I also recently published a article on WIC
vendor criteria.

1817
02:27:06,790 --> 02:27:11,840
And I think there might be an opportunity
to look more critically at what we’ve learned

1818
02:27:11,840 --> 02:27:19,640
from the in-store marketing literature and
what we know is possible from WIC vendor criteria

1819
02:27:19,640 --> 02:27:20,640
perspectives.

1820
02:27:20,640 --> 02:27:22,740
We know there’s a lot of variation across
the country.

1821
02:27:22,740 --> 02:27:28,470
We know there’s opportunities when it comes
to labeling, for example, shelf labeling for WIC.

1822
02:27:28,470 --> 02:27:33,490
And maybe there’s a way for us to…to merge
some of our learnings across both of those fronts.

1823
02:27:33,490 --> 02:27:39,540
So I see that as one of the…obviously it’s…it’s
not an easy approach, but I think it’s one

1824
02:27:39,540 --> 02:27:44,920
that seems very possible in…in a reasonable
period of time to start to think about how

1825
02:27:44,920 --> 02:27:45,920
to integrate.

1826
02:27:45,920 --> 02:27:47,920
DR. ERIC RIMM: Yeah.

1827
02:27:47,920 --> 02:27:49,560
So do you mean to like extend that to SNAP?

1828
02:27:49,560 --> 02:27:53,300
There’s sort of what’s, what’s working
for WIC try to make SNAP eligible scores also?

1829
02:27:53,300 --> 02:28:00,250
DR. ALLISON KARPYN: Yeah, I think WIC might be
the easiest first step, but SNAP is certainly

1830
02:28:00,250 --> 02:28:04,970
another possibility I think because the literature
tends to target a better for you product and

1831
02:28:04,970 --> 02:28:06,920
WIC tends to target better for you products.

1832
02:28:06,920 --> 02:28:11,170
There’s a little bit potentially more of
a synergy there, but it doesn’t mean that

1833
02:28:11,170 --> 02:28:16,140
if we got some great minds together, we couldn’t
think about how to apply it to SNAP too.

1834
02:28:16,140 --> 02:28:18,140
DR. ERIC RIMM: Yeah.

1835
02:28:18,140 --> 02:28:22,530
Well, we have four great minds on this (laughs),
four great minds right here.

1836
02:28:22,530 --> 02:28:28,360
Let’s see…Heidi, do you have any, any
thoughts on, on that sort of the, the surveillance

1837
02:28:28,360 --> 02:28:31,490
of the marketing aspects of what’s going
on?

1838
02:28:31,490 --> 02:28:35,330
CAPT. HEIDI BLANCK: Well, I was actually just
thinking about the other component that Allison

1839
02:28:35,330 --> 02:28:36,330
was bringing up.

1840
02:28:36,330 --> 02:28:41,120
You know, CDC, we’ve been working one of
them with one of the major dollar format stores

1841
02:28:41,120 --> 02:28:42,850
around their healthier brand selection.

1842
02:28:42,850 --> 02:28:48,580
They have moved to have an in-store or…or
a dietician for their headquarters that’s

1843
02:28:48,580 --> 02:28:54,540
reviewing their, their healthier brands to
reduce added sugars, sodium add, and more fiber.

1844
02:28:54,540 --> 02:28:57,930
But they’re not currently a major WIC
retailer.

1845
02:28:57,930 --> 02:29:02,130
And that has to do with their distribution
chain because right now we have 50 state models

1846
02:29:02,130 --> 02:29:03,260
of what’s accepted on WIC.

1847
02:29:03,260 --> 02:29:05,260
DR. ERIC RIMM: Right.

1848
02:29:05,260 --> 02:29:10,350
CAPT. HEIDI BLANCK: And so Tennessee may say
it has to be a 12-ounce jar of Jiffy peanut

1849
02:29:10,350 --> 02:29:14,620
butter and Kentucky might say that it’s
got to be a 10-ounce jar of creamy peanut

1850
02:29:14,620 --> 02:29:18,030
butter, and Georgia may say it’s a 16 ounce.

1851
02:29:18,030 --> 02:29:23,109
And so that’s very difficult for interstate
commerce for the trucks that are running across

1852
02:29:23,109 --> 02:29:29,360
our nation with supplies to be able to ensure
that each…each store is going to get what

1853
02:29:29,360 --> 02:29:30,360
it needs.

1854
02:29:30,360 --> 02:29:34,550
And so I think there’s a lot of discussion
that could happen about creating maybe a core

1855
02:29:34,550 --> 02:29:40,140
package that’s maybe a 70 percent healthy
foods of what’s in the WIC package, tuna,

1856
02:29:40,140 --> 02:29:47,020
brown rice, peanut butter, soy yogurt that
maybe independent grocers could meet, or small

1857
02:29:47,020 --> 02:29:49,210
mom and pops could also meet.

1858
02:29:49,210 --> 02:29:54,330
Right now, you have to be a very large vendor
to be able to really negotiate and have an

1859
02:29:54,330 --> 02:29:56,090
efficiency in stocking those WIC standards.

1860
02:29:56,090 --> 02:29:58,200
DR. ERIC RIMM: Yeah, that is a challenge.

1861
02:29:58,200 --> 02:30:04,270
That’s why I was kind of nudging towards
making it SNAP because SNAP is nationwide

1862
02:30:04,270 --> 02:30:09,000
even though there’s, you know, very few
guidelines, but we could somehow merge the

1863
02:30:09,000 --> 02:30:15,090
what’s offered on SNAP with what’s what,
how you’re allowed to offer it in the store

1864
02:30:15,090 --> 02:30:20,010
such that…that the healthy foods somehow
are, are pushed forward and the less healthy

1865
02:30:20,010 --> 02:30:25,440
foods are pulled back as sort of part of being
a SNAP eligible store, so.

1866
02:30:25,440 --> 02:30:27,440
Okay. Well, thank you all.

1867
02:30:27,440 --> 02:30:32,470
That was really a interesting discussion and,
and the reality does set in that there are,

1868
02:30:32,470 --> 02:30:37,040
there are some things that work and some things,
as Roland said, may take several decades to

1869
02:30:37,040 --> 02:30:42,979
work, like the cigarette taxes and, and
maybe fast-food bans, well, don’t work right

1870
02:30:42,979 --> 02:30:49,960
away, but some, some aspect of changing the,
the social setting may, may take a long time

1871
02:30:49,960 --> 02:30:51,400
to, to change.

1872
02:30:51,400 --> 02:30:52,400
So, okay.

1873
02:30:52,400 --> 02:30:56,720
So, thank you all for, for the questions and
for the, the session.

1874
02:30:56,720 --> 02:31:03,360
We’re going to take a…a moment for a break
now between 3:20 and 3:35.

1875
02:31:03,360 --> 02:31:09,130
You can come back to the networking lounge
and…and hang out and talk to some of your

1876
02:31:09,130 --> 02:31:10,130
colleagues.

1877
02:31:10,130 --> 02:31:15,030
And then at 3:35 to 5:55, we’re going to
go to poster session two.

1878
02:31:15,030 --> 02:31:17,460
I…I’ve taken a peek.

1879
02:31:17,460 --> 02:31:22,100
We have over 50 posters ranging from intervention
research to case studies and qualitative research.

1880
02:31:22,100 --> 02:31:27,081
So I urge you to take a look at the poster
session for 20 minutes and then we’ll come

1881
02:31:27,081 --> 02:31:32,819
back for session nine, the cross-sectoral partnerships
to address food insecurity and neighborhood

1882
02:31:32,819 --> 02:31:35,380
food environments that will start at 3:55.

1883
02:31:35,380 --> 02:31:38,561
So thank you. Thank you again.

1884
02:31:38,561 --> 02:31:40,750
DR. ANGELA ODOMS-YOUNG: Welcome back.

1885
02:31:40,750 --> 02:31:44,860
I hope you enjoyed the Neighborhood Food Environment
poster session.

1886
02:31:44,860 --> 02:31:50,200
We're moving into session nine Cross-Sectoral
Partnerships to Address Food Insecurity and

1887
02:31:50,200 --> 02:31:52,310
Neighborhood Food Environments.

1888
02:31:52,310 --> 02:31:58,270
Our next panel will examine the best practices
in bridging gaps among various settings when

1889
02:31:58,270 --> 02:32:04,149
developing effective interventions to reduce
nutrition related disparities and promote

1890
02:32:04,149 --> 02:32:05,490
health equity.

1891
02:32:05,490 --> 02:32:11,229
We have Dr. Diane Harris from the Centers
for Disease Control and Prevention who will

1892
02:32:11,229 --> 02:32:13,479
serve as our moderator for session nine.

1893
02:32:13,479 --> 02:32:16,040
And so, I'm going to turn it over to you, Diane.

1894
02:32:16,040 --> 02:32:17,040
Thanks so much.

1895
02:32:17,040 --> 02:32:19,920
DR. DIANE HARRIS: Thank you, Angela.

1896
02:32:19,920 --> 02:32:24,080
And welcome everyone to our final panel of
the workshop.

1897
02:32:24,080 --> 02:32:29,689
Our panelists will highlight exemplars that
focus on the importance of community engagement,

1898
02:32:29,689 --> 02:32:34,520
community-based participatory research and
health care partnerships that tackle food

1899
02:32:34,520 --> 02:32:37,520
insecurity and poor neighborhood food environments.

1900
02:32:37,520 --> 02:32:44,080
First, Dr. Antwi Akom of San Francisco State
University and University of California, San

1901
02:32:44,080 --> 02:32:50,000
Francisco will speak on community engagement
perspectives and the use of technology to

1902
02:32:50,000 --> 02:32:51,200
address health disparities.

1903
02:32:51,200 --> 02:32:55,391
The next speaker will be Dr. Jennifer Obadia
from Project Bread.

1904
02:32:55,391 --> 02:32:59,920
She will discuss emergency food systems and
the health care partnerships that they have

1905
02:32:59,920 --> 02:33:04,189
at Project Bread to address hunger and food
security.

1906
02:33:04,189 --> 02:33:09,609
In the session, we will have Dr. Tiffany Gary-Webb,
University of Pittsburgh to talk on the REACH

1907
02:33:09,609 --> 02:33:16,410
Program and the Diabetes Prevention Program,
two programs that are funded by CDC targeted

1908
02:33:16,410 --> 02:33:19,630
to at risk communities.

1909
02:33:19,630 --> 02:33:23,840
Roll it.

1910
02:33:23,840 --> 02:33:38,620
DR. ANTWI AKOM: Hi, my name is Antwi Akom and
I am a distinguished professor and founding

1911
02:33:38,620 --> 02:33:44,040
director of the first and only joint research
lab between UCSF and the medical school in

1912
02:33:44,040 --> 02:33:48,500
San Francisco State University and the only
college of ethnic studies in the United States.

1913
02:33:48,500 --> 02:33:52,490
And it's called the SOUL Lab, the Social Innovation
and Universal Opportunity Lab.

1914
02:33:52,490 --> 02:33:58,939
Today, I'd like to talk to you about how participatory
technology and community driven data is transforming

1915
02:33:58,939 --> 02:34:04,609
poor food environments and advancing health
equity with our nation's most vulnerable populations.

1916
02:34:04,609 --> 02:34:11,490
In particular, I'd like to focus on some of
the work we are doing and have been doing

1917
02:34:11,490 --> 02:34:17,761
around the country, building local data capacity,
increasing access to healthier foods, physical

1918
02:34:17,761 --> 02:34:22,729
activity centering community voice, building
power and self-determination, building the

1919
02:34:22,729 --> 02:34:27,520
evidence-base around racial and spatial
data, racial and spatial justice.

1920
02:34:27,520 --> 02:34:33,939
Making data equitable, actionable, shareable
to drive systems change, developing effective

1921
02:34:33,939 --> 02:34:38,160
community-powered interventions to reduce
nutrition health disparities.

1922
02:34:38,160 --> 02:34:42,040
And all of this not from the top down, but
from the ground up.

1923
02:34:42,040 --> 02:34:48,290
These are some of the key session objectives
which you can view at your own discretion.

1924
02:34:48,290 --> 02:34:52,700
A little bit about who we are.

1925
02:34:52,700 --> 02:34:57,790
Over the last five years, the SOUL lab, which
I have just introduced you to has developed

1926
02:34:57,790 --> 02:35:00,381
a platform at a process called Streetwyze.

1927
02:35:00,381 --> 02:35:08,689
And Streetwyze is a power building and participatory
technology, mobile mapping and SMS platform

1928
02:35:08,689 --> 02:35:14,550
that gives everyday people, residents, community-
based organizations, health care providers,

1929
02:35:14,550 --> 02:35:18,771
a complete picture of what makes us healthy
and unhealthy in our communities.

1930
02:35:18,771 --> 02:35:25,641
We have partnered with CBOs, with block clubs,
with food banks, with food pantries, with

1931
02:35:25,641 --> 02:35:30,980
public health departments, with community
clinics, with whole health care systems.

1932
02:35:30,980 --> 02:35:35,320
And we in Streetwyze believe the people closest
to the problem are the people closest to the

1933
02:35:35,320 --> 02:35:38,891
solution and that everyday people are experts
in their own communities.

1934
02:35:38,891 --> 02:35:44,950
If you haven't heard about Streetwyze way,
way, way back in the day, it seems like a

1935
02:35:44,950 --> 02:35:51,300
long time ago, in 2016, President Obama did
invite myself as well as the co-founder Aekta

1936
02:35:51,300 --> 02:35:57,930
Shah to the Frontiers Conference which brought
together the world's top innovators to present

1937
02:35:57,930 --> 02:35:58,930
our work.

1938
02:35:58,930 --> 02:36:02,490
And subsequently, we were invited into the
White House Opportunity Project.

1939
02:36:02,490 --> 02:36:07,620
So, on the right hand side is a picture of
myself at the White House all dressed up as

1940
02:36:07,620 --> 02:36:12,870
you can see, standing next to the former Chief
Data Scientist DJ Patil.

1941
02:36:12,870 --> 02:36:16,910
There's Aekta, the co-founder of Streetwyze
and a community member and in the bottom right

1942
02:36:16,910 --> 02:36:20,550
hand corner is a handwritten note from DJ
Patil thanking Streetwyze for everything we're

1943
02:36:20,550 --> 02:36:22,630
doing to make cities work for 100% of the
people.

1944
02:36:22,630 --> 02:36:26,010
Subsequently, there's been press about Streetwyze
in the Atlantic City Lab has written about

1945
02:36:26,010 --> 02:36:33,900
Streetwyze as one of the top 12 data tools
to help vulnerable populations climb the economic ladder.

1946
02:36:33,900 --> 02:36:38,430
PolicyLink has written about Streetwyze as
one of the top ten health equity in action

1947
02:36:38,430 --> 02:36:39,859
design tools.

1948
02:36:39,859 --> 02:36:45,210
The Root has an article about Streetwyze helping
to transform so-called food swamps or food

1949
02:36:45,210 --> 02:36:51,000
desert into food oases or food 'oasi' and Green
Biz has an article about Streetwyze as being

1950
02:36:51,000 --> 02:36:56,310
one of the few platforms that can measure
different forms of resiliency with community,

1951
02:36:56,310 --> 02:37:01,449
social resiliency, culture resiliency, climate
resiliency and built-environment resiliency.

1952
02:37:01,449 --> 02:37:07,670
The big idea here is we've found a way to
integrate community-driven data with big data

1953
02:37:07,670 --> 02:37:14,990
and predictive analytics so we can move upstream
solutions to food justice as well as the social

1954
02:37:14,990 --> 02:37:15,990
and structural determinants of health.

1955
02:37:15,990 --> 02:37:20,460
We believe our work can help you all and the
many people watching this webinar move from

1956
02:37:20,460 --> 02:37:26,310
good to great, or if you're already great
from great to greater by providing community-driven,

1957
02:37:26,310 --> 02:37:30,401
community-powered, community-owned, real-time
data and location-based data, and building

1958
02:37:30,401 --> 02:37:35,760
local data capacity for community powered
health interventions.

1959
02:37:35,760 --> 02:37:40,010
The bigger idea is nothing about us without
us.

1960
02:37:40,010 --> 02:37:41,170
Everything for us, by us.

1961
02:37:41,170 --> 02:37:44,550
How can we make sure that we center community
voice?

1962
02:37:44,550 --> 02:37:48,350
And this is so important because we are facing
a data invisibility gap.

1963
02:37:48,350 --> 02:37:51,760
We know the secondary data doesn't tell the
whole story.

1964
02:37:51,760 --> 02:37:55,670
And we know that low-income communities and
communities of color have direct relevant

1965
02:37:55,670 --> 02:38:01,490
experience that is otherwise not accessible
to public bureaucracies about food justice,

1966
02:38:01,490 --> 02:38:06,529
about health equity, and that this lack of
information is a major barrier to building

1967
02:38:06,529 --> 02:38:12,689
policies and practices that improve nutrition,
prevent obesity and advance health equity.

1968
02:38:12,689 --> 02:38:17,470
So Streetwyze fills these missing data gaps
happening on the ground or at the street level.

1969
02:38:17,470 --> 02:38:19,479
We believe the missing link.

1970
02:38:19,479 --> 02:38:24,750
If we want more equitable food systems, if
we want more community-powered health interventions,

1971
02:38:24,750 --> 02:38:31,020
is something that we call tech-equity which
is this integration of community powered health

1972
02:38:31,020 --> 02:38:34,300
informatics, which give us real-time data,
location-based data, data visualization in

1973
02:38:34,300 --> 02:38:35,859
a hyperlocal data.

1974
02:38:35,859 --> 02:38:43,340
And our methodology and way of doing that
is something that we call People Power Placemaking,

1975
02:38:43,340 --> 02:38:48,100
which is real-time, two-way communication
with everyday people so they can participate

1976
02:38:48,100 --> 02:38:51,950
in the design solutions that meet their local
needs.

1977
02:38:51,950 --> 02:38:58,660
In terms of imagining how Streetwyze works,
imagine getting this 360-degree view of what's

1978
02:38:58,660 --> 02:39:02,220
happening from the ground up beneath regulatory
data sets.

1979
02:39:02,220 --> 02:39:06,580
For example, if we're talking about how walkable
is my neighborhood, we might use something

1980
02:39:06,580 --> 02:39:08,680
called Walk Score.

1981
02:39:08,680 --> 02:39:13,640
We know Walk Score well because they are owned
by Redfin and Redfin was part of the White

1982
02:39:13,640 --> 02:39:16,220
House cohort that I mentioned to you earlier.

1983
02:39:16,220 --> 02:39:22,870
Walk Scores, it's a great tool, but Walk Score
doesn't differentiate between different kinds

1984
02:39:22,870 --> 02:39:24,930
of amenities like liquor stores and corner
stores.

1985
02:39:24,930 --> 02:39:32,880
So, you could be living in a so-called food
swamp or a food desert and have a high Walk Score.

1986
02:39:32,880 --> 02:39:37,230
Imagine Streetwyze giving you this 360-degree
view of the social and structural determinants

1987
02:39:37,230 --> 02:39:38,230
of health.

1988
02:39:38,230 --> 02:39:41,020
Whether we're talking about public transit,
how safe is the street?

1989
02:39:41,020 --> 02:39:42,540
Where can I buy fresh, affordable, healthy
food?

1990
02:39:42,540 --> 02:39:46,190
What are the real issues in my community that
people care about?

1991
02:39:46,190 --> 02:39:49,240
And here's an example of Streetwyze in action.

1992
02:39:49,240 --> 02:39:53,439
What you're looking at it right now, is a
public data set from the Alameda County Department

1993
02:39:53,439 --> 02:39:58,420
of Public Health, where the so-called purple
dots, where the purple dots represent the

1994
02:39:58,420 --> 02:40:01,110
so-called number of grocery stores in East
Oakland.

1995
02:40:01,110 --> 02:40:06,391
This is what the mayor sees, this is what
the Alameda County Food Bank sees.

1996
02:40:06,391 --> 02:40:09,810
This is what the everyday community member
who just wants to know how many grocery stores

1997
02:40:09,810 --> 02:40:10,859
in their neighborhood sees.

1998
02:40:10,859 --> 02:40:15,790
And as you can see, from all of those purple
dots, it looks like East Oakland is a veritable

1999
02:40:15,790 --> 02:40:16,790
food oasis.

2000
02:40:16,790 --> 02:40:20,560
But when you ground truth that information
with the Streetwyze platform and process,

2001
02:40:20,560 --> 02:40:24,650
what you realize is that those are not grocery
stores.

2002
02:40:24,650 --> 02:40:28,779
In fact, most of them are liquor stores and
corner stores, and only a handful of them

2003
02:40:28,779 --> 02:40:30,439
are grocery stores.

2004
02:40:30,439 --> 02:40:35,590
And the powerful thing about Streetwyze is
you can upload pictures, audio, video, you

2005
02:40:35,590 --> 02:40:39,800
can integrate with social media, which it's
a multilingual platform for those hard and

2006
02:40:39,800 --> 02:40:45,080
harder to reach populations or for those monolingual
speaking populations which are often disproportionately

2007
02:40:45,080 --> 02:40:51,680
impacted by the inability to access fresh
and healthy food.

2008
02:40:51,680 --> 02:40:55,250
So right now, we just want to play a quick video
of Streetwyze in action.

2009
02:40:55,250 --> 02:40:56,250
This is the 1.0 version.

2010
02:40:56,250 --> 02:41:01,479
Imagine we're like an iPhone so we're on like
Streetwyze ten right now, but this is a young

2011
02:41:01,479 --> 02:41:03,149
lady narrating the food environment in her
neighborhood.

2012
02:41:03,149 --> 02:41:04,149
(VIDEO PLAYING)

2013
02:41:04,149 --> 02:41:17,789
SPEAKER: OK, so what are you looking at? How was it when you went inside? It was dirty when I went inside, and I would
never eat anything in there.

2014
02:41:17,789 --> 02:41:27,469
Do you consider this to be a grocery store? Hell no. Why? Because they don't sell any groceries, and
it's just a bunch of junk food in there.

2015
02:41:27,469 --> 02:41:33,429
And I mean, they have little sandwiches, but
I would never eat that because it's dirty.

2016
02:41:33,509 --> 02:41:37,889
And then all the fruit, it's all like wrinkly
and looks old.

2017
02:41:37,889 --> 02:41:41,059
And then all the like meat that they did
have like the bacon and all that and the little

2018
02:41:41,059 --> 02:41:47,180
thing looks like it's been sitting in there
for about a year or something like that.

2019
02:41:47,260 --> 02:41:52,440
I wouldn't call it a grocery store at all.

2020
02:41:52,440 --> 02:41:53,980
So, hell no I wouldn't eat there.

2021
02:41:53,980 --> 02:41:55,540
(VIDEO STOPPED PLAYING)

2022
02:41:55,540 --> 02:42:00,420
DR. ANTWI AKOM: So, even in this 1.0 version of
our platform and again right now we're the

2023
02:42:00,420 --> 02:42:05,140
version ten, you can get a sense of what the
neighborhood food environment is like even

2024
02:42:05,140 --> 02:42:09,450
if you have never been to East Oakland from
the perspective of community members.

2025
02:42:09,450 --> 02:42:15,180
And because of this kind of data, we were
able to put terms of policy wins and programmatic wins.

2026
02:42:15,180 --> 02:42:18,859
We were able to put a farmers’ market at
the store that previously had never existed.

2027
02:42:18,859 --> 02:42:23,600
We were able to go to each of those liquor
stores and corner stores.

2028
02:42:23,600 --> 02:42:28,930
We were able to go and do retail audits and
neighborhood audits and repopulate and repackage

2029
02:42:28,930 --> 02:42:32,880
the food environment in terms of access to
fresh, affordable, culturally appropriate

2030
02:42:32,880 --> 02:42:37,880
food that were offered in the stores with
Our Fresh Fund.

2031
02:42:37,880 --> 02:42:44,229
And then we were able to use this data with
measured JJ to help pass a multimillion-dollar

2032
02:42:44,229 --> 02:42:45,229
food commissary.

2033
02:42:45,229 --> 02:42:49,620
In terms of other quick success and partnerships,
we partnered with the Alameda County Food

2034
02:42:49,620 --> 02:42:53,820
Bank, providing real time data on what's working
and not working in terms of the food and health

2035
02:42:53,820 --> 02:42:55,590
infrastructure in Alameda during COVID.

2036
02:42:55,590 --> 02:43:02,710
We've worked with the state of California
CalFRESH in terms of the ease of finding culturally

2037
02:43:02,710 --> 02:43:09,020
appropriate, healthy, affordable food in low-income
communities and communities of color.

2038
02:43:09,020 --> 02:43:13,779
We've worked and partnered with the Kresge
Foundation which was the first national funder

2039
02:43:13,779 --> 02:43:19,720
to intentionally fund and integrate food,
art and community driven data to drive neighborhood

2040
02:43:19,720 --> 02:43:21,540
revitalization at scale.

2041
02:43:21,540 --> 02:43:26,950
We've collaborated with some of my colleagues
at UCSF with the EatSF program to map affordable,

2042
02:43:26,950 --> 02:43:31,730
healthy food, the healthy food landscape.

2043
02:43:31,730 --> 02:43:34,240
And we realized that food is a much bigger
issue.

2044
02:43:34,240 --> 02:43:39,800
It intersects with other social [inaudible]
with folks like Enterprise Community Partners,

2045
02:43:39,800 --> 02:43:42,910
the largest nonprofit affordable housing provider
in the United States.

2046
02:43:42,910 --> 02:43:47,680
They launched an opportunity index on housing,
powered in part by Streetwyze.

2047
02:43:47,680 --> 02:43:53,399
So, we help them build, provide real-time
data on housing, build an evidence-based assessment

2048
02:43:53,399 --> 02:43:58,021
framework, make it open source and make it
community engagement partnership toolkit.

2049
02:43:58,021 --> 02:44:01,391
And we've mapped the geography of homelessness
with some of my other colleagues.

2050
02:44:01,391 --> 02:44:08,880
And what we've learned is to really have effective,
community powered, JEDI driven solutions,

2051
02:44:08,880 --> 02:44:10,680
just, equitable, diverse and inclusive.

2052
02:44:10,680 --> 02:44:14,520
You have to ask the right questions, whose
data is it?

2053
02:44:14,520 --> 02:44:19,770
Who owns it? What purpose does it serve? Whose data counts? Who is missing?

2054
02:44:19,770 --> 02:44:21,380
Who has decision-making power?

2055
02:44:21,380 --> 02:44:26,149
We've also learned that's so important to
acknowledge community needs to acknowledge

2056
02:44:26,149 --> 02:44:30,010
community strengths to always ensure and center
community voice.

2057
02:44:30,010 --> 02:44:35,149
And finally, if we really want to increase community
data capacity, then we have to increase the

2058
02:44:35,149 --> 02:44:39,109
community's capacity through general supports
rather than programmatic grants only.

2059
02:44:39,109 --> 02:44:43,870
We have to increase training on data science
and digital storytelling on participatory

2060
02:44:43,870 --> 02:44:45,390
technology, on social media.

2061
02:44:45,390 --> 02:44:50,330
We have to implement culturally and community
responsive technologies and methodologies,

2062
02:44:50,330 --> 02:44:55,319
we have to increase with communities, their
capacity to build power and self-determination.

2063
02:44:55,319 --> 02:44:59,580
And we have to increase awareness of structural
racism and other systemic issues.

2064
02:44:59,580 --> 02:45:04,620
And when we do these things, we will achieve
food justice and health equity.

2065
02:45:04,620 --> 02:45:09,920
We hope that you join us at Streetwyze and
the SOUL Lab in building a new community-driven,

2066
02:45:09,920 --> 02:45:14,521
community-powered, community-owned data sharing
revolution that integrates the power of local

2067
02:45:14,521 --> 02:45:20,450
knowledge with official knowledge that helps
makes communities and food systems more transparent,

2068
02:45:20,450 --> 02:45:24,899
open, connected, smart, shareable, sustainable
and equitable for all.

2069
02:45:24,899 --> 02:45:29,990
If you want to contact us, please contact us
at the emails below or give us a shout out

2070
02:45:29,990 --> 02:45:30,990
at Streetwyze.

2071
02:45:30,990 --> 02:45:36,279
Thank you so much and we look forward to hearing
from you and building with you.

2072
02:45:36,279 --> 02:45:37,279
DR.

2073
02:45:37,279 --> 02:45:41,000
JENNIFER OBADIA: Hello, my name is Jen Obadia,
and I'm the senior director of health care

2074
02:45:41,000 --> 02:45:43,220
partnerships at Project Bread.

2075
02:45:43,220 --> 02:45:47,939
Thank you to the organizers for inviting me
to participate in this conversation.

2076
02:45:47,939 --> 02:45:53,100
I'm happy to be here today and I'll be sharing
with you our experience participating in the

2077
02:45:53,100 --> 02:45:55,771
Flexible Services Program in Massachusetts.

2078
02:45:55,771 --> 02:46:01,620
Project Bread for those who are unfamiliar
with us is a statewide anti-hunger organization

2079
02:46:01,620 --> 02:46:06,800
in Massachusetts, and we work both directly
on the ground, providing direct services,

2080
02:46:06,800 --> 02:46:15,340
as well as advocating for systems change to
address the root causes of hunger.

2081
02:46:15,340 --> 02:46:21,471
The flexible services program is enabled through
a five-year waiver that MassHealth, our state

2082
02:46:21,471 --> 02:46:24,710
Medicaid agency received from CMS.

2083
02:46:24,710 --> 02:46:27,140
And there are many components of this waiver.

2084
02:46:27,140 --> 02:46:29,740
It's really a step towards a more value-based
payment system.

2085
02:46:29,740 --> 02:46:35,689
But as part of that, MassHealth members are
required to be screened annually for different

2086
02:46:35,689 --> 02:46:38,090
social determinants of health.

2087
02:46:38,090 --> 02:46:43,020
And members who are food insecure, homeless
or at risk of homelessness in conjunction

2088
02:46:43,020 --> 02:46:49,520
with having a behavioral or physical health
need may be eligible for this flexible services

2089
02:46:49,520 --> 02:46:50,520
program.

2090
02:46:50,520 --> 02:46:57,240
And really, the idea behind this program is
to get at some of those root issues, get out

2091
02:46:57,240 --> 02:47:04,320
some of the social determinants that are underlying
reasons why different individuals might be

2092
02:47:04,320 --> 02:47:12,010
having worse health outcomes or not able to
follow their doctor's orders, take their medication,

2093
02:47:12,010 --> 02:47:13,010
etc.

2094
02:47:13,010 --> 02:47:19,360
So, Project Bread Program focuses specifically
on food security and nutrition support services.

2095
02:47:19,360 --> 02:47:24,569
And the way that our program works is we receive
referrals from any of our three different

2096
02:47:24,569 --> 02:47:31,200
accountable care organization partners and
at the time of referral the individuals have

2097
02:47:31,200 --> 02:47:36,569
already been screened and been confirmed for
program eligibility.

2098
02:47:36,569 --> 02:47:40,000
And then we call and do an initial assessment.

2099
02:47:40,000 --> 02:47:44,350
The point of that initial assessment is really
to have a conversation to understand what

2100
02:47:44,350 --> 02:47:49,490
the specific barriers are that that individual
is facing to accessing healthy food.

2101
02:47:49,490 --> 02:47:54,460
And then we're able to provide a variety of
different goods and services based on the

2102
02:47:54,460 --> 02:47:56,460
barriers that they're experiencing.

2103
02:47:56,460 --> 02:48:02,021
So, we can provide grocery store gift cards,
we can purchase kitchen supplies and even

2104
02:48:02,021 --> 02:48:03,760
appliances like refrigerator.

2105
02:48:03,760 --> 02:48:10,109
We offer transportation support, so help getting
back and forth from a grocery store.

2106
02:48:10,109 --> 02:48:14,290
And then we also do virtual cooking classes
as well as nutrition counseling.

2107
02:48:14,290 --> 02:48:18,820
We do have three dietitians on our team who
are able to offer that one-on-one support.

2108
02:48:18,820 --> 02:48:25,240
Finally, we're aware of the fact that our
program is not long term, depending on which

2109
02:48:25,240 --> 02:48:29,590
accountable care organizations we're partnered
with, it's anywhere from six to nine months

2110
02:48:29,590 --> 02:48:30,650
in duration.

2111
02:48:30,650 --> 02:48:36,100
So, we also always try to work with our clients
to make sure that they are participating in

2112
02:48:36,100 --> 02:48:41,520
federal nutrition assistance programs so that
they continue to have support, even once our

2113
02:48:41,520 --> 02:48:42,640
programs ends.

2114
02:48:42,640 --> 02:48:47,819
And then finally, we do follow up calls with
each individual every three months just to

2115
02:48:47,819 --> 02:48:51,649
touch base, make sure they're receiving their
goods and services, but then also to see if

2116
02:48:51,649 --> 02:48:58,150
there are any changes to their situation,
any changes to their diagnosis, to their employment,

2117
02:48:58,150 --> 02:49:05,260
to their living conditions so that we can
adjust the goods and services that they receive

2118
02:49:05,260 --> 02:49:06,569
accordingly.

2119
02:49:06,569 --> 02:49:11,050
Our program's been in operation for a little
over a year now, about actually almost a year

2120
02:49:11,050 --> 02:49:12,391
and a half at this point.

2121
02:49:12,391 --> 02:49:19,380
And we are starting to see some early trends
that are moving in the right direction.

2122
02:49:19,380 --> 02:49:26,819
So, we are seeing positive food security and
diet quality improvement, we are seeing that

2123
02:49:26,819 --> 02:49:31,859
healthcare is really a critical access point
for addressing food security.

2124
02:49:31,859 --> 02:49:38,870
And then, of course, really being able to
dive deeper into what the components are of

2125
02:49:38,870 --> 02:49:45,070
food security that are necessary to address
recognizing that it's so much more than just

2126
02:49:45,070 --> 02:49:46,979
food itself.

2127
02:49:46,979 --> 02:49:54,370
So, all of the clients sent to us are referred
to using the Hunger Vital Signs which is a

2128
02:49:54,370 --> 02:49:56,149
two questions screener.

2129
02:49:56,149 --> 02:50:02,530
At the time of referral everyone answered
at least sometimes or often, to the question

2130
02:50:02,530 --> 02:50:06,390
about whether or not they worry their food
would run out and that they wouldn't have

2131
02:50:06,390 --> 02:50:09,120
sufficient resources to get more.

2132
02:50:09,120 --> 02:50:16,529
And you can see here that by six months into
the program, 25% of our program participants

2133
02:50:16,529 --> 02:50:22,130
never worried about whether their food would
run out and that we were seeing a shift away

2134
02:50:22,130 --> 02:50:29,770
from folks who are often worried towards most
being only sometimes worried.

2135
02:50:29,770 --> 02:50:35,220
In terms of diet quality, we ask about fruit
and vegetable consumption each time we speak

2136
02:50:35,220 --> 02:50:41,370
with our clients, and we can see that there's
been an increase from the time of the initial

2137
02:50:41,370 --> 02:50:50,180
assessment to six months of almost a full
serving per day, half of serving increase

2138
02:50:50,180 --> 02:50:53,850
in fruits and four tenths of a serving per
day increase in vegetables which is a really

2139
02:50:53,850 --> 02:50:55,690
significant increase.

2140
02:50:55,690 --> 02:51:03,370
And then we also ask our clients about the
number of weeks they have access to the foods

2141
02:51:03,370 --> 02:51:06,500
that they feel are important for a healthy
diet.

2142
02:51:06,500 --> 02:51:12,180
And this is a question that was validated
through Feeding America's diabetes study.

2143
02:51:12,180 --> 02:51:17,729
And at the time of the assessment, only 21%
of our clients felt that they could access

2144
02:51:17,729 --> 02:51:21,750
healthy foods for more than half a month,
so for three or four weeks.

2145
02:51:21,750 --> 02:51:27,250
And by six months, we've seen that jump to
53% of the clients being able to access healthy

2146
02:51:27,250 --> 02:51:28,670
foods for three or four months...

2147
02:51:28,670 --> 02:51:30,250
three or four weeks out of the month.

2148
02:51:30,250 --> 02:51:35,569
So, we're really excited to see things moving
in the right direction.

2149
02:51:35,569 --> 02:51:42,570
You know, we also are seeing that health care is a really
critical access point.

2150
02:51:42,570 --> 02:51:49,320
SNAP is one of the most important programs
in terms of serving as a safety net for those

2151
02:51:49,320 --> 02:51:53,050
who are food insecure.

2152
02:51:53,050 --> 02:51:58,050
And even though the vast majority of the clients
who are referred to us are eligible, only

2153
02:51:58,050 --> 02:52:03,080
58% were participating in the program at the
time of that referral.

2154
02:52:03,080 --> 02:52:08,439
And so, we're excited that by six months into
the program, we were able to increase that

2155
02:52:08,439 --> 02:52:12,470
to 72% of all of our clients participating
in SNAP.

2156
02:52:12,470 --> 02:52:16,570
And this is work we would not have been able
to do people, we would not have been able

2157
02:52:16,570 --> 02:52:21,900
to connect with these resources if it weren't
for the relationship that we've developed

2158
02:52:21,900 --> 02:52:27,320
with health care through this program.

2159
02:52:27,320 --> 02:52:32,670
And then finally, of course, we're coming
to understand just how many layers there are

2160
02:52:32,670 --> 02:52:38,149
to food security and that it is about so much
more than just food.

2161
02:52:38,149 --> 02:52:45,899
And so over just the first six months of 2021,
we saw 40 clients in need of a refrigerator,

2162
02:52:45,899 --> 02:52:49,480
two thirds of our clients needed something
needed basic kitchen supplies.

2163
02:52:49,480 --> 02:52:57,520
So, cups, bowls, plates, things along those
lines, 10% needed transportation assistance

2164
02:52:57,520 --> 02:53:00,791
and 38% had very low confidence or had low
confidence in their nutrition knowledge and

2165
02:53:00,791 --> 02:53:06,170
weren't really sure what they should be eating
or how to go about preparing those foods.

2166
02:53:06,170 --> 02:53:10,850
So, this just really reinforces for us that
it's critical to be offering a variety of

2167
02:53:10,850 --> 02:53:19,189
services and not looking only at how to get
food into the household.

2168
02:53:19,189 --> 02:53:24,470
In terms of next steps, there are some critical,
both policy and programmatic changes that

2169
02:53:24,470 --> 02:53:25,630
we think are important.

2170
02:53:25,630 --> 02:53:36,689
From a policy perspective, we are really excited
to see that MassHealth is interested in expanding

2171
02:53:36,689 --> 02:53:41,399
support for nutrition support services to
the household level is currently were only

2172
02:53:41,399 --> 02:53:49,029
able to provide support to the individual
whose insurance it is that makes them eligible

2173
02:53:49,029 --> 02:53:50,680
for the program.

2174
02:53:50,680 --> 02:53:56,630
We also are looking to the state to help us
develop a set of shared metrics so that we

2175
02:53:56,630 --> 02:54:03,859
can gather data and compare across all nutrition
programs to really begin to understand what

2176
02:54:03,859 --> 02:54:11,271
types of services and what type of programming
is most impactful for which types of patients.

2177
02:54:11,271 --> 02:54:18,170
And then finally, at the state level, we're really
interested in seeing MassHealth make participation

2178
02:54:18,170 --> 02:54:23,271
in flexible services, a requirement for all
of our accountable care organizations in the

2179
02:54:23,271 --> 02:54:28,050
state and not just optional.

2180
02:54:28,050 --> 02:54:36,489
And then in terms of programmatic changes,
we are really continuing to dive deep into

2181
02:54:36,489 --> 02:54:37,489
research.

2182
02:54:37,489 --> 02:54:43,730
We'll be conducting focus groups and interviews
in the next year to really start to better

2183
02:54:43,730 --> 02:54:52,770
identify what we're overlooking at this point,
how to best modify our programming to meet

2184
02:54:52,770 --> 02:54:55,140
the needs of the clients that we're working
with.

2185
02:54:55,140 --> 02:55:01,720
And then we're really looking to focus on
components of the program that will have a

2186
02:55:01,720 --> 02:55:02,760
longer-term impact.

2187
02:55:02,760 --> 02:55:08,090
So, components that will outlive the duration
of the program itself because we know, of

2188
02:55:08,090 --> 02:55:15,000
course, that the resource, the financial resources
that we provide to purchase food will be utilized

2189
02:55:15,000 --> 02:55:16,160
during the program itself.

2190
02:55:16,160 --> 02:55:23,040
So we want to make sure that we're able to have
a more enduring impact.

2191
02:55:23,040 --> 02:55:33,540
That is all I have prepared for you today,
so thank you so much for your time.

2192
02:55:33,540 --> 02:55:34,540
And I look forward to our conversation.

2193
02:55:34,540 --> 02:55:36,540
DR. TIFFANY GARY-WEBB: Good afternoon, my name
is Tiffany Gary-Webb, I'm associate professor

2194
02:55:36,540 --> 02:55:40,920
of Epidemiology at the Graduate School of
Public Health at the University of Pittsburgh

2195
02:55:40,920 --> 02:55:44,650
and also the associate dean for Diversity,
Equity and Inclusion.

2196
02:55:44,650 --> 02:55:50,200
And today, I'd like to talk to you about the
REACH program, the Racial and Ethnic Approaches

2197
02:55:50,200 --> 02:55:54,990
to Community Health Program in Allegheny County
which is the Pittsburgh, Pennsylvania area

2198
02:55:54,990 --> 02:55:55,990
and vicinity.

2199
02:55:55,990 --> 02:56:07,680
In our area, similar to other areas and nationally,
we do have racial disparities in many different

2200
02:56:07,680 --> 02:56:10,210
outcomes, including chronic disease outcomes.

2201
02:56:10,210 --> 02:56:15,930
This is a study that my team did looking at
disparities over time in our county.

2202
02:56:15,930 --> 02:56:21,239
And as you can see, some disparities have
improved over time.

2203
02:56:21,239 --> 02:56:27,330
But if you look at the diabetes and hypertension
that are highlighted in the red boxes, you'll

2204
02:56:27,330 --> 02:56:36,870
see that at 2009 and 2015, there are still
black-white disparities in the both diabetes

2205
02:56:36,870 --> 02:56:41,140
and hypertension, with black residents having
higher rates.

2206
02:56:41,140 --> 02:56:47,930
So, given the disparities that we see in our
region and some of the health equity work

2207
02:56:47,930 --> 02:56:53,160
and partnerships that we've been developing
over the years, we embarked on this strategic

2208
02:56:53,160 --> 02:56:56,120
partnership from the REACH program.

2209
02:56:56,120 --> 02:57:00,891
This is funded by the Centers for Disease
Control and Prevention.

2210
02:57:00,891 --> 02:57:02,170
It's a five-year grant.

2211
02:57:02,170 --> 02:57:08,160
We're working in six priority communities
that are predominantly African American, working

2212
02:57:08,160 --> 02:57:12,560
in three strategies that I'll talk a little
bit more about later, nutrition, physical

2213
02:57:12,560 --> 02:57:15,810
activity and linking community to clinical
care.

2214
02:57:15,810 --> 02:57:23,250
We have 11 contracted partners working on
the project, but we have granted many grants

2215
02:57:23,250 --> 02:57:32,350
to 20, more than 20 community ambassadors
which are grassroot organizations working

2216
02:57:32,350 --> 02:57:35,380
in the neighborhoods.

2217
02:57:35,380 --> 02:57:42,550
So, our REACH goals are to build community
engagement, we want to do relationship building,

2218
02:57:42,550 --> 02:57:45,630
active listening, responding to community
needs.

2219
02:57:45,630 --> 02:57:51,870
Our partners are promoting healthy behaviors,
so healthy eating, fitness and routine screenings,

2220
02:57:51,870 --> 02:57:54,710
and we're connecting residents to resources.

2221
02:57:54,710 --> 02:58:03,220
So, community resources and community organizations
and our partners coming together to really

2222
02:58:03,220 --> 02:58:06,690
provide tangible resources within these communities.

2223
02:58:06,690 --> 02:58:15,200
So, here's a map and a table depicting our
priority communities per CDC requirements.

2224
02:58:15,200 --> 02:58:21,470
We had to choose census tracts that had at
least 20% of the population below the 100%

2225
02:58:21,470 --> 02:58:27,160
federal poverty threshold and a high African
American poverty rate.

2226
02:58:27,160 --> 02:58:29,630
So, these are our priority neighborhoods.

2227
02:58:29,630 --> 02:58:37,000
And as you can see, many of them are in the
center of Allegheny County which is a city

2228
02:58:37,000 --> 02:58:38,319
of Pittsburgh.

2229
02:58:38,319 --> 02:58:43,529
But we also have several communities outside
of the city, particularly communities within

2230
02:58:43,529 --> 02:58:46,279
the Monongahela River Valley.

2231
02:58:46,279 --> 02:58:53,910
But as you can see, most of the communities
are predominantly African American, and there's

2232
02:58:53,910 --> 02:59:01,720
a high African American to white poverty ratio
within the communities.

2233
02:59:01,720 --> 02:59:08,900
When you compare the REACH communities average
to the county as a whole, the REACH communities

2234
02:59:08,900 --> 02:59:15,210
have significantly more chronic diseases,
particularly heart disease, diabetes, high

2235
02:59:15,210 --> 02:59:24,120
blood pressure and more unhealthy behaviors.

2236
02:59:24,120 --> 02:59:30,899
Just for our REACH communities, we can see
that many of them have high rates of food

2237
02:59:30,899 --> 02:59:32,370
insecurity as well.

2238
02:59:32,370 --> 02:59:41,200
So, this is a graph of our team and we, for
outward facing things, we are the live well

2239
02:59:41,200 --> 02:59:46,120
Alleghany square, we're lifting wellness in
African American and black populations in

2240
02:59:46,120 --> 02:59:47,120
Allegheny County.

2241
02:59:47,120 --> 02:59:52,689
As I mentioned, the primary guarantee is the
Allegheny County Health Department.

2242
02:59:52,689 --> 02:59:58,729
My team at the University of Pittsburgh is
the evaluation team and we are working with

2243
02:59:58,729 --> 03:00:06,270
the coalition to plan for a healthier Allegheny
that brings together partners across the county

2244
03:00:06,270 --> 03:00:09,930
to work on a number of different issues, but
they have a chronic disease working group

2245
03:00:09,930 --> 03:00:18,140
that helped us to form the organizations within
the District three strategies.

2246
03:00:18,140 --> 03:00:25,069
I mentioned that we had a community fund that
was matched by the Highmark Foundation that

2247
03:00:25,069 --> 03:00:28,160
allowed us to give the many grants to our
community ambassadors.

2248
03:00:28,160 --> 03:00:36,899
And we also have a specific funds for comprehensive
community communication strategies to get

2249
03:00:36,899 --> 03:00:40,050
the messages out to communities.

2250
03:00:40,050 --> 03:00:45,750
This is our kickoff meeting, all of our partners,
along with our CDC project officer.

2251
03:00:45,750 --> 03:00:48,820
Our nutrition strategies are broad.

2252
03:00:48,820 --> 03:00:55,590
So we have nutrition standards where our Children's
Hospital of Pittsburgh is working on health

2253
03:00:55,590 --> 03:01:03,210
and nutrition guidelines mostly and healthy
out of school time, sites and healthy early

2254
03:01:03,210 --> 03:01:04,540
childhood sites.

2255
03:01:04,540 --> 03:01:09,279
Our food systems strategy is what I'll highlight
today.

2256
03:01:09,279 --> 03:01:15,120
Our Pittsburgh Food Policy Council is working
with our school district to change procurement,

2257
03:01:15,120 --> 03:01:17,300
so that's a longer-term strategy.

2258
03:01:17,300 --> 03:01:23,000
But organizations just harvest, and the food
trucks are trying to increase the promotion

2259
03:01:23,000 --> 03:01:29,460
and availability of healthy food options using
SNAP and food bucks all over the city, but

2260
03:01:29,460 --> 03:01:32,050
particularly at farmer's markets and corner
stores.

2261
03:01:32,050 --> 03:01:36,930
And we do have a breastfeeding strategy where
we have the Pittsburgh Black Breastfeeding

2262
03:01:36,930 --> 03:01:43,630
Circle working with African American mothers
in the communities and also training peer

2263
03:01:43,630 --> 03:01:48,529
lactation counselors to do circles in other
communities.

2264
03:01:48,529 --> 03:01:55,210
Our physical activity strategy is related
to the built environment.

2265
03:01:55,210 --> 03:02:01,340
So, we are working on community design variables
and our community clinical linkages strategy

2266
03:02:01,340 --> 03:02:08,223
links communities to clinical care and screening
for chronic disease prevention, diabetes prevention

2267
03:02:08,223 --> 03:02:11,061
and so forth.

2268
03:02:11,061 --> 03:02:19,210
OK, and I mentioned our community ambassadors,
these are just a list of some of the organizations

2269
03:02:19,210 --> 03:02:22,529
that are working on the ground in various
communities.

2270
03:02:22,529 --> 03:02:28,450
They are the grants are to partner with our
contracted partners.

2271
03:02:28,450 --> 03:02:33,819
These organizations may be neighborhood level
organizations that work on economic development

2272
03:02:33,819 --> 03:02:38,569
or working on physical activity or working
in schools.

2273
03:02:38,569 --> 03:02:46,380
But collectively, they are the supporting
the work of the partners.

2274
03:02:46,380 --> 03:02:54,130
My team is using a community-based evaluation,
comprehensive, community-based evaluation.

2275
03:02:54,130 --> 03:02:58,890
We're using data from all kinds of sources,
from our community surveys and so forth to

2276
03:02:58,890 --> 03:03:03,779
really do asset mapping and needs assessment
in the beginning.

2277
03:03:03,779 --> 03:03:11,450
We are doing qualitative interviews with our
partners, with our residents, with the stakeholders.

2278
03:03:11,450 --> 03:03:19,979
We are submitting CDC performance measures
yearly to the CDC so that they can combine

2279
03:03:19,979 --> 03:03:26,150
those metrics with the other REACH projects
across the country and can really identify

2280
03:03:26,150 --> 03:03:29,160
the collective impact of REACH as a whole.

2281
03:03:29,160 --> 03:03:34,220
Right now, I believe there are 36 different
partners across the country.

2282
03:03:34,220 --> 03:03:40,450
So, we've mapped out our strategies and our
partners to the performance measures.

2283
03:03:40,450 --> 03:03:43,370
And so, CDC is very specific.

2284
03:03:43,370 --> 03:03:50,609
We have sub-strategies under the food systems
and so I'm talking about the sub-strategy

2285
03:03:50,609 --> 03:03:58,660
where just harvests and the food trust are
really working in food markets, excuse me,

2286
03:03:58,660 --> 03:04:07,200
farmers markets, corner stores, in the community
trying to increase the use of SNAP and EBT

2287
03:04:07,200 --> 03:04:13,290
at the farmers markets, giving out community
food box that can be redeemed either at farmer's

2288
03:04:13,290 --> 03:04:16,910
markets or certain corner stores.

2289
03:04:16,910 --> 03:04:21,790
And even thinking about the mix of products
within the farmer’s market.

2290
03:04:21,790 --> 03:04:29,300
So how many of the vendors are selling produce
or selling healthy options?

2291
03:04:29,300 --> 03:04:36,149
And so, this is a just a summary of what we
found in year one.

2292
03:04:36,149 --> 03:04:44,000
In year one, we were able to provide nine
new or enhanced places for this strategy,

2293
03:04:44,000 --> 03:04:51,479
two new farmer's markets within the priority
communities two food bucks or, excuse me,

2294
03:04:51,479 --> 03:04:57,380
seven enhanced food bucks distribution sites,
four farmers' markets and three mobile markets.

2295
03:04:57,380 --> 03:05:05,240
And this potentially impacted 31,366 people.

2296
03:05:05,240 --> 03:05:11,910
For year two, we've also measured these performance
measures, so for years one and two, we were

2297
03:05:11,910 --> 03:05:16,990
able to impact over 46,000 people in ten locations.

2298
03:05:16,990 --> 03:05:24,240
And for year two, we were able to increase
our food box distribution by over 200%.

2299
03:05:24,240 --> 03:05:31,460
And this was due to COVID, the need really
became increased during COVID in some sense.

2300
03:05:31,460 --> 03:05:36,180
So, some of our partners pivoted to doing
food distributions.

2301
03:05:36,180 --> 03:05:43,790
So, from year one to two, we were able to
increase those sites and we hope by year five

2302
03:05:43,790 --> 03:05:50,680
of this project that we will have in site,
excuse me, and farmer's markets within all

2303
03:05:50,680 --> 03:05:52,560
of these communities.

2304
03:05:52,560 --> 03:05:59,460
And so finally, I mentioned that we have a
communications firm, a black-owned communications

2305
03:05:59,460 --> 03:06:01,680
firm that gets messages out for us.

2306
03:06:01,680 --> 03:06:06,860
This is just a summary of our project that
goes out publicly.

2307
03:06:06,860 --> 03:06:12,521
This firm also helps us with social media
messages and success stories.

2308
03:06:12,521 --> 03:06:18,670
Here are just a few of our success stories
from the Food Systems Strategy.

2309
03:06:18,670 --> 03:06:25,590
These are pictures of people out at farmers
markets, a mom using her EBT card to buy a

2310
03:06:25,590 --> 03:06:27,520
produce set at markets.

2311
03:06:27,520 --> 03:06:33,779
And this is a success story that we put out
this year that's based on the work of all

2312
03:06:33,779 --> 03:06:35,820
of our community partners.

2313
03:06:35,820 --> 03:06:42,290
And so, as I mentioned, many of them had to
pivot to food distributions and things because

2314
03:06:42,290 --> 03:06:43,290
of COVID.

2315
03:06:43,290 --> 03:06:49,740
But in the past year, we've had eight mini-grant
organizations working with us, impacting over

2316
03:06:49,740 --> 03:06:59,130
2,000 participants and giving over 500 weekly
meals, or produce boxes and 12 physical activity

2317
03:06:59,130 --> 03:07:01,050
opportunities per week.

2318
03:07:01,050 --> 03:07:04,060
And so, we are really encouraged by this work.

2319
03:07:04,060 --> 03:07:11,590
We did have to pivot for COVID and a lot of
our partners have now gone to helping us with

2320
03:07:11,590 --> 03:07:15,689
vaccine COVID and flu vaccine distributions
and so forth.

2321
03:07:15,689 --> 03:07:20,260
But we are getting back to some of our community
design work and some of the work that we had

2322
03:07:20,260 --> 03:07:21,800
planned pre-COVID.

2323
03:07:21,800 --> 03:07:26,899
So, I'd like to acknowledge the leadership
team of the REACH project, and I thank you

2324
03:07:26,899 --> 03:07:28,460
for your attention.

2325
03:07:28,460 --> 03:07:31,900
Thank you very much.

2326
03:07:31,900 --> 03:07:40,130
DR. DIANE HARRIS: Thank you to all the presenters.

2327
03:07:40,130 --> 03:07:46,450
What amazing presentations, so engaging and
so interesting.

2328
03:07:46,450 --> 03:07:48,310
Thank you again for sharing your work.

2329
03:07:48,310 --> 03:07:54,960
So, we have a number of questions in the chat
box and you can continue to add your questions,

2330
03:07:54,960 --> 03:08:01,340
but we're going to dive right into those that
are here now.

2331
03:08:01,340 --> 03:08:07,110
So, Dr. Akom, nothing about us, everything
for us or by us.

2332
03:08:07,110 --> 03:08:13,319
The question is Streetwyze as an impressive
example of community-based dissemination research

2333
03:08:13,319 --> 03:08:15,040
at the local level.

2334
03:08:15,040 --> 03:08:18,930
Can you speak about how these interventions
have shown some early benefits to improve

2335
03:08:18,930 --> 03:08:21,200
community behaviors and health outcomes?

2336
03:08:21,200 --> 03:08:29,149
DR. ANTWI AKOM: Yeah, I think in the last presentation,
which was also fantastic, thank you for that,

2337
03:08:29,149 --> 03:08:32,120
as was the presentation before that.

2338
03:08:32,120 --> 03:08:40,170
I think there were a bunch of examples about
how platforms and processes that are community-centered,

2339
03:08:40,170 --> 03:08:48,260
community-based can really improve our key
performance metrics from a position of making

2340
03:08:48,260 --> 03:08:52,510
them more just, equitable, inclusive and diverse.

2341
03:08:52,510 --> 03:08:59,350
For us, we've been able to do things like
increase 30% ease finding in terms of finding

2342
03:08:59,350 --> 03:09:03,580
culturally appropriate and healthy food.

2343
03:09:03,580 --> 03:09:08,840
We partnered with the Alameda County Food
Bank during COVID, and we were able to show

2344
03:09:08,840 --> 03:09:16,810
that, you know, some people were driving 30
and 45 miles to get a fresh meal for their

2345
03:09:16,810 --> 03:09:20,570
family when there was a fresh meal within
a one-mile radius.

2346
03:09:20,570 --> 03:09:28,460
And so, I think this ability to provide experiential
data and to create a local knowledge ecosystem

2347
03:09:28,460 --> 03:09:35,090
with community members on the ground, has
all kinds of benefits, real-time benefits.

2348
03:09:35,090 --> 03:09:38,850
The last example was the number of farmers
markets, right?

2349
03:09:38,850 --> 03:09:43,720
The last speaker was talking about they created
two farmers markets where before there weren't

2350
03:09:43,720 --> 03:09:45,939
any same in our projects, right?

2351
03:09:45,939 --> 03:09:50,770
We were able to create multiple farmers' markets
in different neighborhood environments that

2352
03:09:50,770 --> 03:09:53,030
previously didn't exist.

2353
03:09:53,030 --> 03:09:57,770
And our partnership and then I'll pass it
to other speakers, and our partnership with

2354
03:09:57,770 --> 03:10:03,260
Enterprise Community Partners, we had four
million people who actually participated in

2355
03:10:03,260 --> 03:10:10,280
that project around access, the relationship
between housing and access to fresh, affordable,

2356
03:10:10,280 --> 03:10:11,280
healthy food.

2357
03:10:11,280 --> 03:10:15,330
So, we've been able to have some huge social
impact in the projects that we've been in.

2358
03:10:15,330 --> 03:10:17,609
And thank you so much for that question.

2359
03:10:17,609 --> 03:10:23,920
DR. DIANE HARRIS: Sure, there's a quick follow
up question about how did you get people to

2360
03:10:23,920 --> 03:10:27,020
participate, to contribute to the app?

2361
03:10:27,020 --> 03:10:30,800
What were some of your communication and outreach
strategies?

2362
03:10:30,800 --> 03:10:35,420
DR. ANTWI AKOM: We have a train the trainer’s
model.

2363
03:10:35,420 --> 03:10:41,810
So, we would come in and either during COVID
via video webinar like this or in a pre or

2364
03:10:41,810 --> 03:10:47,460
post COVID if we ever get their context, we
can show up ourselves and we train the trainers

2365
03:10:47,460 --> 03:10:49,340
on how to actually use the platform.

2366
03:10:49,340 --> 03:10:52,229
We train the community residents on how to
use it.

2367
03:10:52,229 --> 03:10:58,229
We also train community-based leaders in the
organizations on how to use our platform.

2368
03:10:58,229 --> 03:11:01,979
And what we've seen in that work is pretty
exceptional.

2369
03:11:01,979 --> 03:11:08,069
We have a 7% user growth week after week when
you launch this kind of platform and process.

2370
03:11:08,069 --> 03:11:12,850
I think many of us are used to doing this
kind of work, this engagement work where it's

2371
03:11:12,850 --> 03:11:13,920
sort of one and done.

2372
03:11:13,920 --> 03:11:19,080
And I think Streetwyze brings to the table
this opportunity to do continuous community

2373
03:11:19,080 --> 03:11:20,080
engagement.

2374
03:11:20,080 --> 03:11:25,649
When people, when the residents themselves
feel like participating, they can participate

2375
03:11:25,649 --> 03:11:28,490
versus we're having this one workshop and
you need to show up.

2376
03:11:28,490 --> 03:11:32,930
But you also have to weigh out whether you
have childcare that night or do you have to

2377
03:11:32,930 --> 03:11:36,210
work that night or these other things.

2378
03:11:36,210 --> 03:11:40,010
And we also see 98% of our users contributing
content.

2379
03:11:40,010 --> 03:11:45,819
So those are some of the metrics that we've
seen in our work that we think could really

2380
03:11:45,819 --> 03:11:51,440
add value to many of the processes and projects
that are out there aiming to transform and

2381
03:11:51,440 --> 03:11:55,840
revolutionize food security with our nation's
most vulnerable population.

2382
03:11:55,840 --> 03:11:59,300
DR. DIANE HARRIS: Thank you.

2383
03:11:59,300 --> 03:12:04,060
Moving to Dr. Obadia, thank you for the wonderful
work you shared today.

2384
03:12:04,060 --> 03:12:09,820
But the questionnaire agrees with everyone
else, but they have a few questions.

2385
03:12:09,820 --> 03:12:15,000
Does the eligibility requirements for patients
to have a specific health need stop you from

2386
03:12:15,000 --> 03:12:16,920
doing true prevention work?

2387
03:12:16,920 --> 03:12:21,380
Have you been able to enroll children or is
the program only targeting adults?

2388
03:12:21,380 --> 03:12:24,990
DR. JENNIFER OBADIA: Yeah, so these are good questions.

2389
03:12:24,990 --> 03:12:32,970
And I'll say that so we at Project Bread launched
our work in this program in April of 2020,

2390
03:12:32,970 --> 03:12:39,229
right as the pandemic was starting, but statewide,
it all just began in 2020.

2391
03:12:39,229 --> 03:12:47,100
So, everything is still new and evolving including
what's allowable by the state, what's allowable

2392
03:12:47,100 --> 03:12:50,490
by the Centers for Medicaid and Medicare,
and sort of what the federal government will

2393
03:12:50,490 --> 03:12:53,460
give us permission to do with Medicaid dollars.

2394
03:12:53,460 --> 03:13:00,819
So, there's a lot of pieces that are still
moving and lots of room for continual growth

2395
03:13:00,819 --> 03:13:03,340
and improvement in this space.

2396
03:13:03,340 --> 03:13:07,319
The exciting thing is…is that the state
really wants to move forward on this and sees

2397
03:13:07,319 --> 03:13:11,970
health equity other as a critical top priority.

2398
03:13:11,970 --> 03:13:17,060
In terms of working with children or adults,
we do work with children actually.

2399
03:13:17,060 --> 03:13:23,810
One of our partners is a children's hospital
here in Massachusetts, and it...needing to

2400
03:13:23,810 --> 03:13:26,479
have a diagnosis is, I think, a little bit
tricky.

2401
03:13:26,479 --> 03:13:34,780
And so that has been well recognized by all
of those who are involved in this work here

2402
03:13:34,780 --> 03:13:35,780
in the state.

2403
03:13:35,780 --> 03:13:42,430
And so, as we submit our next waiver requests
to the federal government, we're looking at,

2404
03:13:42,430 --> 03:13:49,280
Masshealth is looking at how children are
different from adults and how can we get at kids

2405
03:13:49,280 --> 03:13:54,960
before they have a diagnosis as opposed to
having to wait for that diagnosis to start

2406
03:13:54,960 --> 03:13:57,160
to do this type of work.

2407
03:13:57,160 --> 03:14:00,689
So, we're not there yet, but there's full
recognition that we need to get there if that

2408
03:14:00,689 --> 03:14:03,180
helps answer the question.

2409
03:14:03,180 --> 03:14:05,630
DR. DIANE HARRIS: Thank you.

2410
03:14:05,630 --> 03:14:11,319
There's another question about determining
which rewards at the most impact on health

2411
03:14:11,319 --> 03:14:12,330
outcomes?

2412
03:14:12,330 --> 03:14:16,170
How did you determine that health outcomes
improved in your program?

2413
03:14:16,170 --> 03:14:20,850
DR. JENNIFER OBADIA: Yeah, so there's a couple
of layers to that and try not to take too

2414
03:14:20,850 --> 03:14:26,479
much time to answer, but so from a state level
or accountable care organizations are all

2415
03:14:26,479 --> 03:14:34,500
looking at total cost of care, use of emergency
department and then they each have a different

2416
03:14:34,500 --> 03:14:38,310
specific health outcome that they might be
looking at.

2417
03:14:38,310 --> 03:14:46,710
So A1C level or behavioral health outcomes,
things like that.

2418
03:14:46,710 --> 03:14:51,460
So, it does differ from organization to organization.

2419
03:14:51,460 --> 03:14:53,680
So that's about most fundamental.

2420
03:14:53,680 --> 03:15:02,729
And then at our level as a community organization
at Project Bread, we're really looking at

2421
03:15:02,729 --> 03:15:05,120
self-reported data from the participants.

2422
03:15:05,120 --> 03:15:12,750
So, looking at do they feel that they have
access to the foods that they need to be healthy?

2423
03:15:12,750 --> 03:15:17,030
How do they feel about the process by which
they're accessing these foods?

2424
03:15:17,030 --> 03:15:23,239
Are there different resources they feel that
they need in order to be able to prepare the

2425
03:15:23,239 --> 03:15:25,080
types of healthy foods they want for their
families?

2426
03:15:25,080 --> 03:15:33,220
And then, of course we're looking at some
kind of more straightforward numbers like

2427
03:15:33,220 --> 03:15:39,210
fruit and vegetable consumption, use the hunger
vital signs to determine food security, so

2428
03:15:39,210 --> 03:15:41,310
things along those lines.

2429
03:15:41,310 --> 03:15:49,630
But we're as a nonprofit really able create more
of the texture and and tell the human story

2430
03:15:49,630 --> 03:15:52,300
behind an A1C number.

2431
03:15:52,300 --> 03:15:55,120
DR. DIANE HARRIS: Thank you for that.

2432
03:15:55,120 --> 03:15:58,130
I think we have time to speak in one more
question.

2433
03:15:58,130 --> 03:16:01,040
This one is for Dr. Gary Webb.

2434
03:16:01,040 --> 03:16:06,270
You talked about your community-based evaluation.

2435
03:16:06,270 --> 03:16:11,460
Can you talk about that a little bit about
how you engage the community in designing

2436
03:16:11,460 --> 03:16:12,640
the evaluation?

2437
03:16:12,640 --> 03:16:18,491
I saw all your different components, but can
you talk a little bit more about how the community

2438
03:16:18,491 --> 03:16:20,490
was engaged in that design?

2439
03:16:20,490 --> 03:16:27,239
DR. TIFFANY GARY-WEBB: Yeah, so, you know, breaches
is that the performance measures and so forth

2440
03:16:27,239 --> 03:16:31,250
that we present to CDC are very structured.

2441
03:16:31,250 --> 03:16:38,359
So, what we try to do is make sure that we
reported the structure to CDC but then we

2442
03:16:38,359 --> 03:16:41,521
also added all these other components.

2443
03:16:41,521 --> 03:16:48,330
So, I'll just say a couple of things that
we did to work with our partners because what

2444
03:16:48,330 --> 03:16:55,270
we realized is that a lot of the grassroots
organizations did not have the capacity to

2445
03:16:55,270 --> 03:17:00,690
participate in something like REACH as a contracted
partner.

2446
03:17:00,690 --> 03:17:07,420
So, what we did is a lot of racial equity
training that included our contractor partners

2447
03:17:07,420 --> 03:17:14,260
and our grassroots organizations so that we
can really have that perspective come to our team.

2448
03:17:14,260 --> 03:17:18,920
That's one of the first things that we did
and we did that over the course of a year.

2449
03:17:18,920 --> 03:17:26,710
So, we did a two day retreat and then we did
affinity groups over a course of a year.

2450
03:17:26,710 --> 03:17:32,550
Then what we did is we did focus groups and
so forth in our REACH communities.

2451
03:17:32,550 --> 03:17:34,620
And the communities are very, very different.

2452
03:17:34,620 --> 03:17:41,340
And so, it was really eye-opening just to
do them in the separate communities and see

2453
03:17:41,340 --> 03:17:42,450
what their concerns are.

2454
03:17:42,450 --> 03:17:50,880
We have lots of environmental concerns in
our Monongahela Valley community versus some

2455
03:17:50,880 --> 03:17:56,069
of the other communities, you know, food access
is more of an issue.

2456
03:17:56,069 --> 03:18:03,380
So anyway, the combination of focus groups
with our residents and pulling in the community

2457
03:18:03,380 --> 03:18:10,960
ambassadors, that was really our way of trying
to get more grassroots input into the project.

2458
03:18:10,960 --> 03:18:13,319
DR. DIANE HARRIS: Thank you.

2459
03:18:13,319 --> 03:18:17,189
Well, unfortunately, I think we've run out
of time.

2460
03:18:17,189 --> 03:18:20,510
I appreciate all of you for your presentations.

2461
03:18:20,510 --> 03:18:28,100
Thank you also to the audience for thoughtful
questions, and it's been really fun to have

2462
03:18:28,100 --> 03:18:30,620
this opportunity to speak with you all.

2463
03:18:30,620 --> 03:18:34,520
So now we're going to move on to the final networking
break.

2464
03:18:34,520 --> 03:18:40,689
You can continue to have discussions for the
next few minutes in the networking room.

2465
03:18:40,689 --> 03:18:46,840
It's called the networking lounge, so enjoy
those conversations when you return at 4:45

2466
03:18:46,840 --> 03:18:51,190
to the auditorium, there'll be the final wrap
up and the closing session.

2467
03:18:51,190 --> 03:18:52,190
Thank you.

2468
03:18:52,190 --> 03:18:53,760
DR. ANGELA ODOMS-YOUNG: Welcome back.

2469
03:18:53,760 --> 03:19:01,390
We've made it to the end of the food insecurity,
neighborhood food environment and nutrition

2470
03:19:01,390 --> 03:19:04,739
health disparities, state of the science.

2471
03:19:04,739 --> 03:19:11,090
We're very excited about this virtual workshop
and we hope that you enjoyed it.

2472
03:19:11,090 --> 03:19:17,439
We also hope that you enjoy the networking
session right before this closing session.

2473
03:19:17,439 --> 03:19:26,820
So, this is the closing of day three and me
and my co-chair, Karen Glanz.

2474
03:19:26,820 --> 03:19:33,680
We're going to give some closing remarks and
just a summary of the workshop and then talk

2475
03:19:33,680 --> 03:19:37,239
a little bit about some gaps and opportunities.

2476
03:19:37,239 --> 03:19:42,640
I'm going to start out talking about food insecurity
and then we're going to, I'm going to turn it

2477
03:19:42,640 --> 03:19:48,210
over to Karen, who is going to dig deeper
into neighborhood food environments, and then

2478
03:19:48,210 --> 03:19:52,830
we will announce the posters and have some
acknowledgment.

2479
03:19:52,830 --> 03:20:01,970
So, just to summarize, throughout the workshop,
we had several excellent presenters really

2480
03:20:01,970 --> 03:20:07,590
highlight the state of the science when it
comes to food insecurity, both causes, and

2481
03:20:07,590 --> 03:20:12,830
consequences of food insecurity, and then
the strategies and solutions or potential

2482
03:20:12,830 --> 03:20:16,170
strategies and solutions to address food insecurity.

2483
03:20:16,170 --> 03:20:21,359
And we talked about these in day two, but
I really wanted to just hit the highlights

2484
03:20:21,359 --> 03:20:27,450
because one issue that continues to come up
is this limited research data, particularly

2485
03:20:27,450 --> 03:20:33,260
on certain populations and populations that
are at great risk for food insecurity are

2486
03:20:33,260 --> 03:20:42,029
young people that are not in college, our
Indigenous communities, our population, both

2487
03:20:42,029 --> 03:20:48,189
when we think about intersectionality, where
race and other conditions like, I mean race

2488
03:20:48,189 --> 03:20:50,680
in conditions such as disability.

2489
03:20:50,680 --> 03:20:56,949
So, we have issues when it comes to data and
a need for more data and an understanding

2490
03:20:56,949 --> 03:20:58,280
of these populations.

2491
03:20:58,280 --> 03:21:05,350
We need to use diverse methodologies and look
at different approaches to understand the

2492
03:21:05,350 --> 03:21:11,500
lived experience of those that are food insecure,
both in individuals and families.

2493
03:21:11,500 --> 03:21:15,229
Further, define nutrition insecurity and nutrition
security.

2494
03:21:15,229 --> 03:21:21,489
This is a term that's emerging, and we need
to have a better understanding of how do you

2495
03:21:21,489 --> 03:21:26,420
define nutrition security and how do you measure
nutrition security.

2496
03:21:26,420 --> 03:21:32,150
Our multi-level determinants, this is a complex
issue.

2497
03:21:32,150 --> 03:21:38,920
Triple factors that contribute to food insecurity
and then multiple consequences, as was highlighted

2498
03:21:38,920 --> 03:21:43,649
by several of the speakers associated with
food insecurity.

2499
03:21:43,649 --> 03:21:51,070
And so, we need to know more about the determinants
and causes at multiple levels, particularly

2500
03:21:51,070 --> 03:21:57,580
at the social and structural levels, to understand
those social and structural drivers of food

2501
03:21:57,580 --> 03:21:58,580
insecurity.

2502
03:21:58,580 --> 03:22:02,420
And then the intersection between food insecurity
and neighborhood food environments.

2503
03:22:02,420 --> 03:22:08,790
Many of the communities that have a high rate
of food insecurity also are disproportionately

2504
03:22:08,790 --> 03:22:12,660
impacted by low food resource environments.

2505
03:22:12,660 --> 03:22:17,689
And so, it's important that we look at the
intersection between the two.

2506
03:22:17,689 --> 03:22:21,070
And then strategies and solutions to address
food insecurity.

2507
03:22:21,070 --> 03:22:26,040
What do we know about the lived experience
of those that participate in food assistance

2508
03:22:26,040 --> 03:22:27,660
programs and what are the barriers?

2509
03:22:27,660 --> 03:22:33,189
Several the speakers highlighted the issue
of stigma and just navigating that managed

2510
03:22:33,189 --> 03:22:34,830
process.

2511
03:22:34,830 --> 03:22:37,270
The impact of restrictions and incentives.

2512
03:22:37,270 --> 03:22:42,310
How do we look at restrictions and incentives
and food assistance programs and be able to

2513
03:22:42,310 --> 03:22:46,140
encourage and support healthy eating?

2514
03:22:46,140 --> 03:22:50,770
Methodological approaches to understand program
implementation, there's been several efforts

2515
03:22:50,770 --> 03:22:58,860
to address food insecurity and how do we really
understand those by using different methodologies?

2516
03:22:58,860 --> 03:23:04,989
Understand [inaudible] Particularly with the
combination of different intervention strategies

2517
03:23:04,989 --> 03:23:14,989
and approaches, how do we maximize and understand
what works both in a more controlled experiment

2518
03:23:14,989 --> 03:23:20,620
like RCTs, but also with the natural experiments
and within the real world?

2519
03:23:20,620 --> 03:23:26,670
We had a talk about implementation science
and just how important it is to have studies

2520
03:23:26,670 --> 03:23:32,859
apply implementation science frameworks so
we can understand what's happening and how

2521
03:23:32,859 --> 03:23:39,399
do we get to those positive outcomes and improve
more equitable access.

2522
03:23:39,399 --> 03:23:47,750
And then we have challenges as far as heterogeneity
of programs that are implemented in different ways.

2523
03:23:47,750 --> 03:23:49,680
We don't have many structural interventions.

2524
03:23:49,680 --> 03:23:52,070
So really, how do we address poverty?

2525
03:23:52,070 --> 03:23:59,899
How do we address racism and understand the
impact of food insecurity and be able to look

2526
03:23:59,899 --> 03:24:04,540
at the impact on downstream outcomes such
as diet.

2527
03:24:04,540 --> 03:24:11,000
Community-driven solutions, our panel, last
panel highlighted many community-driven solutions

2528
03:24:11,000 --> 03:24:18,729
to foster food insecurity, but also in our
day two discussion and our day one discussion

2529
03:24:18,729 --> 03:24:22,970
about food sovereignty and more community-driven
solutions.

2530
03:24:22,970 --> 03:24:29,020
And then how do we decolonize methodologies
in use indigenous ways of knowing theories

2531
03:24:29,020 --> 03:24:36,200
such as critical race theory to look at food
insecurity and apply that land?

2532
03:24:36,200 --> 03:24:42,410
I think it's important we kicked off with
day one and Alicia Coleman-Jensen, Dr.

2533
03:24:42,410 --> 03:24:50,330
Alicia Coleman-Jensen highlighted the recent
data on food insecurity, and I think one important

2534
03:24:50,330 --> 03:24:55,400
point was the discussion about comparisons
by race.

2535
03:24:55,400 --> 03:25:01,899
We have this racial gap that's persisted for
many years is not new, but one of the things

2536
03:25:01,899 --> 03:25:07,740
that was striking was this rise in food insecurity
in some populations as compared to others.

2537
03:25:07,740 --> 03:25:13,420
And so, it's important that we try to understand
why is this if we're going to look at effective

2538
03:25:13,420 --> 03:25:20,640
solutions, why do we see differences across
different groups?

2539
03:25:20,640 --> 03:25:28,330
And many of us, me included, we're interested
in the physiological consequences of food

2540
03:25:28,330 --> 03:25:34,979
insecurity, such as the physical sensation
of hunger, nutritional inadequacy that

2541
03:25:34,979 --> 03:25:39,021
results in dietary quality, reduced food intake.

2542
03:25:39,021 --> 03:25:47,170
Well, we also have to think about the other
parts of food insecurity because it is a multidimensional

2543
03:25:47,170 --> 03:25:48,170
concept.

2544
03:25:48,170 --> 03:25:54,689
The psychological effects like food anxiety
and stress and stigma, social isolation, and

2545
03:25:54,689 --> 03:25:56,570
exclusion that happens.

2546
03:25:56,570 --> 03:26:03,300
And then just navigating many programs, navigating
the community to access food.

2547
03:26:03,300 --> 03:26:11,100
And so that's very important for us to not
only take the view of diet but also think

2548
03:26:11,100 --> 03:26:12,370
broader.

2549
03:26:12,370 --> 03:26:17,609
And then several of the speakers really talked
about the need to go upstream, and this is

2550
03:26:17,609 --> 03:26:23,370
just the adaptation of the Solar and Irwin
conceptual framework on social determinants

2551
03:26:23,370 --> 03:26:24,489
of health.

2552
03:26:24,489 --> 03:26:29,620
And we many times we think about the downstream
impact on nutrition.

2553
03:26:29,620 --> 03:26:35,239
But we also have to realize as many of our
speakers highlighted that these structural

2554
03:26:35,239 --> 03:26:41,359
factors are present, and they impact people's
privilege and power.

2555
03:26:41,359 --> 03:26:48,920
They shape people's material circumstances,
their behaviors, their biology, their psychosocial

2556
03:26:48,920 --> 03:26:49,920
context.

2557
03:26:49,920 --> 03:26:55,880
And so these are really important when we
think about moving forward to address those

2558
03:26:55,880 --> 03:26:58,420
gaps and maximize the opportunities.

2559
03:26:58,420 --> 03:27:04,899
And then in closing, I'm going to turn it over
to Karen for her final comment.

2560
03:27:04,899 --> 03:27:12,689
But I wanted to just include that, thinking
about this is taking an anti-racist and anti-oppressive

2561
03:27:12,689 --> 03:27:22,090
approach to really engage those that are most
impacted and understand not only what they

2562
03:27:22,090 --> 03:27:25,239
are doing, but the context.

2563
03:27:25,239 --> 03:27:30,500
And this is particularly important the lens
that we use, and I just want to advocate for

2564
03:27:30,500 --> 03:27:36,569
us to understand more and take this anti-racist
anti-oppressive approach to research, and

2565
03:27:36,569 --> 03:27:40,220
I'm going to turn it over to Karen.

2566
03:27:40,220 --> 03:27:45,520
DR. KAREN GLANZ: Thanks, Angela.

2567
03:27:45,520 --> 03:27:58,860
It's great pleasure to kind of give a few
closing thoughts at a fairly high level about

2568
03:27:58,860 --> 03:28:05,770
the neighborhood food environment, but also
most of my comments apply to food insecurity

2569
03:28:05,770 --> 03:28:06,810
as well.

2570
03:28:06,810 --> 03:28:17,010
So, I come back to the story of the blind
man and the elephant.

2571
03:28:17,010 --> 03:28:23,370
Because if we want to make sure we don't leave
any elephants in the room that we're ignoring here.

2572
03:28:23,370 --> 03:28:24,830
There are many different perspectives.

2573
03:28:24,830 --> 03:28:26,600
Each one is only part of the picture.

2574
03:28:26,600 --> 03:28:31,330
Food insecurity, neighborhood food environments
are really complex.

2575
03:28:31,330 --> 03:28:36,870
And as researchers, we feel like a holistic
approach is important.

2576
03:28:36,870 --> 03:28:39,320
We want a person-centered approach.

2577
03:28:39,320 --> 03:28:41,770
We want a community-centered approach.

2578
03:28:41,770 --> 03:28:47,479
We want to distinguish the environment, the
policies, and the individual behaviors.

2579
03:28:47,479 --> 03:28:55,550
And we really need to respect the complexity
of it all as we each work collectively on

2580
03:28:55,550 --> 03:28:58,830
our pieces of the puzzle.

2581
03:28:58,830 --> 03:29:06,899
Want to hit on the issues related to health
equity, you've seen this slide before.

2582
03:29:06,899 --> 03:29:08,550
Gita Rampersad showed it.

2583
03:29:08,550 --> 03:29:17,569
This is a picture that I believe that the
Robert Wood Johnson Foundation has kind of

2584
03:29:17,569 --> 03:29:22,000
promulgated, and I think it's really important
because it distinguishes between equality

2585
03:29:22,000 --> 03:29:27,810
and equity, with equity being meeting people
where they're at, not just giving everybody

2586
03:29:27,810 --> 03:29:31,000
the same bicycle and hoping it works for them.

2587
03:29:31,000 --> 03:29:35,650
And it really means increasing opportunities
for everyone to live the healthiest life possible,

2588
03:29:35,650 --> 03:29:41,069
no matter who they are, where they live, or
how much money they make.

2589
03:29:41,069 --> 03:29:47,319
We have focused a lot of our attention on
disadvantaged groups and disparities groups

2590
03:29:47,319 --> 03:29:57,890
defined by race, virality, disability, low
education, and so on.

2591
03:29:57,890 --> 03:30:04,821
In this workshop, and we've done that because
these tend to be the groups at highest need

2592
03:30:04,821 --> 03:30:11,370
with diet-related risk factors and health
problems with greatest food insecurity and

2593
03:30:11,370 --> 03:30:12,790
so forth.

2594
03:30:12,790 --> 03:30:23,210
And one question that's always kind of puzzled
me and made me think is, you know, how do

2595
03:30:23,210 --> 03:30:26,020
we approach the idea of reducing health disparities?

2596
03:30:26,020 --> 03:30:31,160
You know, if you just make things worse for
the advantaged people, you will have lower

2597
03:30:31,160 --> 03:30:32,160
health disparities.

2598
03:30:32,160 --> 03:30:35,850
But the situation won't be any better.

2599
03:30:35,850 --> 03:30:41,080
A lot of us talk about lifting a rising tide
lifting our votes that if we make conditions

2600
03:30:41,080 --> 03:30:44,729
better, they can become better for everyone.

2601
03:30:44,729 --> 03:30:52,500
And we have very few examples that actually
empirically looked into this kind of dilemma.

2602
03:30:52,500 --> 03:31:00,820
And the slide that is showing now is a snippet
from an article by Althoff and others that

2603
03:31:00,820 --> 03:31:08,330
was published in Nature in 2017, where they
used global data in many different countries.

2604
03:31:08,330 --> 03:31:11,680
This isn't a physical activity area.

2605
03:31:11,680 --> 03:31:19,090
I don't know of any analogy in the nutrition
area, but they looked at how walkable environments

2606
03:31:19,090 --> 03:31:20,810
lower activity inequality.

2607
03:31:20,810 --> 03:31:29,160
And their analysis was really interesting
in the key finding that interventions focused

2608
03:31:29,160 --> 03:31:35,830
on reducing inequality achieved reductions
four times greater than population-wide approaches.

2609
03:31:35,830 --> 03:31:44,040
So, focusing on the activity poorest and those
most in need in terms of healthful eating

2610
03:31:44,040 --> 03:31:50,890
and food insecurity living in the poorest
nutrition environments, that actually that

2611
03:31:50,890 --> 03:31:55,439
is probably the way we should go.

2612
03:31:55,439 --> 03:32:02,189
And when you think about it, at a minimum,
it's a good way to use limited resources.

2613
03:32:02,189 --> 03:32:07,020
Maybe things get too watered down if we just
take a more general approach.

2614
03:32:07,020 --> 03:32:14,330
So, I think that the focus on disparities
and on and reducing inequalities that we've

2615
03:32:14,330 --> 03:32:20,850
talked about so much in this workshop is really
promising and one that we should continue

2616
03:32:20,850 --> 03:32:22,600
to move forward with.

2617
03:32:22,600 --> 03:32:30,819
This workshop and listening to all the different
speakers has inspired a lot of thinking in

2618
03:32:30,819 --> 03:32:36,120
my own mind beyond, you know, what I came
into the workshop thinking about.

2619
03:32:36,120 --> 03:32:43,690
And one of the things that I think we need,
that I put on my wish list, is that to really

2620
03:32:43,690 --> 03:32:49,720
move forward in important ways in this field
that we really need to increase the fluidity

2621
03:32:49,720 --> 03:32:52,229
between research, policy, and practice.

2622
03:32:52,229 --> 03:33:00,750
We're not only siloed by diseases, by agencies,
we're siloed by nations and different organizations,

2623
03:33:00,750 --> 03:33:06,420
both governmental and non-governmental, have
their specific mission.

2624
03:33:06,420 --> 03:33:13,490
And I think that if we can find more ways
to cross over, we may find that we can accelerate

2625
03:33:13,490 --> 03:33:14,640
progress.

2626
03:33:14,640 --> 03:33:22,330
And that's what I really want to push for
in my dreams, in my optimism for the future.

2627
03:33:22,330 --> 03:33:28,020
So, a couple of examples we've heard about
today, the Healthy Food Financing Initiative

2628
03:33:28,020 --> 03:33:30,010
that Chelsea Singleton discussed.

2629
03:33:30,010 --> 03:33:35,340
Huge, enormous program with tons of funding.

2630
03:33:35,340 --> 03:33:37,140
And yet there's no national-level evaluation.

2631
03:33:37,140 --> 03:33:42,319
Now, a national-level evaluation also has
to parse out what's happening at different

2632
03:33:42,319 --> 03:33:43,960
local levels.

2633
03:33:43,960 --> 03:33:47,989
But that feels like a missed opportunity.

2634
03:33:47,989 --> 03:33:56,290
NIH, which is the primary sponsor of this
workshop, is dedicated to research and increasingly

2635
03:33:56,290 --> 03:33:59,070
to applied research and implementation science.

2636
03:33:59,070 --> 03:34:06,760
At the same time, we have USDA and CDC who
have enormous influence in nutrition, obesity-related

2637
03:34:06,760 --> 03:34:07,760
areas.

2638
03:34:07,760 --> 03:34:15,439
But with their emphasis being on policies
and programs, with evaluation and research

2639
03:34:15,439 --> 03:34:21,550
being secondary, in my ideal world, there
would be more crossover between the two.

2640
03:34:21,550 --> 03:34:28,319
There would be more leveraging of all programs
to try to come up with creative approaches

2641
03:34:28,319 --> 03:34:30,399
for research.

2642
03:34:30,399 --> 03:34:38,550
We would do things like increase pragmatic
trials that may tell us more about how some

2643
03:34:38,550 --> 03:34:41,650
of the programs that CDC and USDA are funding
or doing.

2644
03:34:41,650 --> 03:34:44,200
We would do more than performance monitor.

2645
03:34:44,200 --> 03:34:50,530
We would really use some of the current available
technologies and leverage them that way.

2646
03:34:50,530 --> 03:34:57,100
At the state and local levels those of us
interested in health and nutrition need to

2647
03:34:57,100 --> 03:35:03,520
work with or the units that work on housing,
on safety, and economic development, we've

2648
03:35:03,520 --> 03:35:06,270
had some good examples of this today.

2649
03:35:06,270 --> 03:35:10,810
These are not revolutionary idea that I'm
suggesting, but they're ideas that I think

2650
03:35:10,810 --> 03:35:16,771
we need to take on more vigorously if we're
going to again, accelerate solutions.

2651
03:35:16,771 --> 03:35:23,770
And last in this space, I think that incentivizing
collaboration rather than competition could

2652
03:35:23,770 --> 03:35:26,080
help us move along faster.

2653
03:35:26,080 --> 03:35:32,180
We kind of live in this space where we compete
for grants.

2654
03:35:32,180 --> 03:35:34,340
We compete for publications.

2655
03:35:34,340 --> 03:35:41,420
And yet some of the biggest, gnarliest, most
wicked health problems that are being solved

2656
03:35:41,420 --> 03:35:48,689
by huge foundations like the Gates Foundation
have built a culture of collaboration where

2657
03:35:48,689 --> 03:35:54,090
they're accelerating discovery and application
of findings by putting in requirements for

2658
03:35:54,090 --> 03:36:00,310
collaboration, not just a multicenter trial,
but really making sure that people work together.

2659
03:36:00,310 --> 03:36:07,530
That, of course, requires us to change some
norms in terms of recognition and career development.

2660
03:36:07,530 --> 03:36:12,529
But I really think it's something that we
could benefit greatly from.

2661
03:36:12,529 --> 03:36:19,689
So, to make significant progress in these
areas of food insecurity and nutrition environments,

2662
03:36:19,689 --> 03:36:26,080
in a nutshell, some of my top six lists, I
think we need innovation and flexibility,

2663
03:36:26,080 --> 03:36:28,210
collaboration and coordination.

2664
03:36:28,210 --> 03:36:32,399
We need to balance internal and external validity.

2665
03:36:32,399 --> 03:36:39,609
We could spend a whole afternoon talking about
practical ways of collecting scientifically

2666
03:36:39,609 --> 03:36:44,670
valid data from disadvantaged populations
in ways that aren't biased due to selection.

2667
03:36:44,670 --> 03:36:49,270
There's a lot of work to be done in that area.

2668
03:36:49,270 --> 03:36:53,140
We need to address supply and demand in the
food space.

2669
03:36:53,140 --> 03:36:58,810
We need to study individual and aggregate
effects, and we always need to keep in mind

2670
03:36:58,810 --> 03:37:04,189
the people that are in need that should be
driving what we're doing.

2671
03:37:04,189 --> 03:37:11,920
I like this quote from the Dalai Lama, who
says, "Science and technology are powerful tools.

2672
03:37:11,920 --> 03:37:15,930
But we must decide how best to use them.

2673
03:37:15,930 --> 03:37:22,000
Perhaps the most important point is to ensure
that science never becomes divorced from the

2674
03:37:22,000 --> 03:37:27,119
basic human feelings of empathy with our fellow
human beings."

2675
03:37:27,119 --> 03:37:35,730
And if I may take a slight cue from Mariana
Chilton's talk on day one, where she urged

2676
03:37:35,730 --> 03:37:37,750
us to find joy in the work we do.

2677
03:37:37,750 --> 03:37:42,870
I would say work hard, work smart, and always
have fun.

2678
03:37:42,870 --> 03:37:47,350
And some of you will recognize Matt Wilpers,
one of my favorite Peloton instructors there.

2679
03:37:47,350 --> 03:37:50,840
That's a takeoff on one of his catchphrases.

2680
03:37:50,840 --> 03:37:57,750
So, I'm going to turn this back to Angela, who
will announce the Poster Awards.

2681
03:37:57,750 --> 03:38:08,100
DR. ANGELA ODOMS-YOUNG: Thanks, Karen, and I'm
very excited about announcing the Poster Awards.

2682
03:38:08,100 --> 03:38:14,850
The...we get so many submissions, wonderful
submissions, as you noticed when you went

2683
03:38:14,850 --> 03:38:22,069
into the poster area on the virtual platform,
just phenomenal work that's happening nationally.

2684
03:38:22,069 --> 03:38:28,310
The criteria for scoring the awards, the purpose
needed to be clearly stated.

2685
03:38:28,310 --> 03:38:35,830
The methods and data presented, the quality
of that and the quality of the results, the

2686
03:38:35,830 --> 03:38:42,610
appropriateness of the conclusions based on
the results, and then innovation and potential impact.

2687
03:38:42,610 --> 03:38:52,210
So, I'm going to read the, just the name of the
first author that received awards and the title.

2688
03:38:52,210 --> 03:39:02,290
So, the first award was given to Elizabeth
Ackley at Roanoke College and her title was

2689
03:39:02,290 --> 03:39:09,610
Advanced Equity and Neighborhood Food Access
Insights from a Cohort Initiative.

2690
03:39:09,610 --> 03:39:16,350
Juliana, I'm sorry Camargo from [inaudible]
Medical Center.

2691
03:39:16,350 --> 03:39:23,270
Her title was the Intersection of Food Insecurity,
Diet and Gestational Diabetes in Latinas.

2692
03:39:23,270 --> 03:39:26,470
Sean Cash from Tufts.

2693
03:39:26,470 --> 03:39:36,260
Their title was Household Food Expenditures
at Dollar Stores and Implications for Health.

2694
03:39:36,260 --> 03:39:43,949
Roger Figueroa, the title was A Latent Profile
Analysis of the Food Environment in the Brooklyn

2695
03:39:43,949 --> 03:39:45,800
Borough of New York City.

2696
03:39:45,800 --> 03:39:52,340
Nora Frank-Buckner and I'm sorry, I forgot
to mention that Roger, who was my colleague,

2697
03:39:52,340 --> 03:39:53,340
is from Cornell.

2698
03:39:53,340 --> 03:39:55,930
How could I miss that?

2699
03:39:55,930 --> 03:40:01,850
Nora Frank-Buckner from the Northeast Portland
Area Indian Health Board.

2700
03:40:01,850 --> 03:40:11,149
The title was COVID-19 Food Insecurity Among
American Indian Alaska Natives in Washington

2701
03:40:11,149 --> 03:40:13,330
State.

2702
03:40:13,330 --> 03:40:21,399
Ana Poblacion from Children's Healthwatch
in Boston Medical Center.

2703
03:40:21,399 --> 03:40:26,920
The title was Children's Weight Trajectory
and its Association with Food Insecurity

2704
03:40:26,920 --> 03:40:28,500
and Air Pollution.

2705
03:40:28,500 --> 03:40:32,069
Yui Qin from Purdue.

2706
03:40:32,069 --> 03:40:39,271
The title was Usual Nutrient Intake of U.S.
Older Adults among SNAP Participants and Income-Eligible

2707
03:40:39,271 --> 03:40:40,271
Nonparticipants.

2708
03:40:40,271 --> 03:40:50,800
Providencia Rocco from Temple, the title was
Farm to Families: Food as Medicine in an Urban

2709
03:40:50,800 --> 03:40:51,800
Hub.

2710
03:40:51,800 --> 03:40:59,750
June Tester from UCSF University of California,
San Francisco, and the title was a Recipe4Health:

2711
03:40:59,750 --> 03:41:04,400
Clinic-based Approaches for Food
Insecurity, and Chronic Disease.

2712
03:41:04,400 --> 03:41:11,890
And then the last winner of the award was
Rebecca Walker from the Medical College of

2713
03:41:11,890 --> 03:41:19,199
Wisconsin, and the title was Medical Expenditures
in U.S. Adults Reporting Food Insecurity.

2714
03:41:19,199 --> 03:41:26,300
So, congratulations to our award winners,
the Scientific Consulting Group will contact

2715
03:41:26,300 --> 03:41:29,310
awardees to coordinate the awards.

2716
03:41:29,310 --> 03:41:32,760
Please contact Mark Dennis at the email here.

2717
03:41:32,760 --> 03:41:38,270
If you have not received the information regarding
the awards within two weeks and congratulations,

2718
03:41:38,270 --> 03:41:41,120
I'm going to turn it back over to Karen.

2719
03:41:41,120 --> 03:41:48,100
DR. KAREN GLANZ: Thank you, Angela.

2720
03:41:48,100 --> 03:41:52,330
Now I want to extend our appreciation to everyone
who's made this workshop possible.

2721
03:41:52,330 --> 03:41:57,229
First, I want to say a special thank you to
Angela and Diane.

2722
03:41:57,229 --> 03:42:05,979
It's a pretty intense process working on a
workshop like this.

2723
03:42:05,979 --> 03:42:12,750
And in particular, being in midstream of the
workshop trying to keep things going, it's

2724
03:42:12,750 --> 03:42:18,100
been a real pleasure and a lot of fun working
with Angela as well.

2725
03:42:18,100 --> 03:42:23,650
We want to thank our federal sponsors and
partners for this workshop.

2726
03:42:23,650 --> 03:42:32,140
So, the workshop was officially led by the
NIH Office of Nutrition because of the topic

2727
03:42:32,140 --> 03:42:33,460
that we've been focusing on.

2728
03:42:33,460 --> 03:42:41,300
It was also supported by these other institutes
and federal partners at the CDC and USDA.

2729
03:42:41,300 --> 03:42:47,930
And what many of you in the audience should
really appreciate is that representatives

2730
03:42:47,930 --> 03:42:55,920
of each of these institutes and agencies were
actively involved in shaping the agenda and

2731
03:42:55,920 --> 03:43:01,340
in carrying it out and in helping to make
this really come to fruition.

2732
03:43:01,340 --> 03:43:05,949
So, we're really grateful to them.

2733
03:43:05,949 --> 03:43:15,260
And of course, it couldn't be done without
a crowd, and we certainly had an amazing collection

2734
03:43:15,260 --> 03:43:20,060
of people working on the organizing committee
and support staff.

2735
03:43:20,060 --> 03:43:31,120
First, major kudos to Tanya Agurs Collins
from NCI and Allison Brown from NHLBI.

2736
03:43:31,120 --> 03:43:32,229
They were at the helm.

2737
03:43:32,229 --> 03:43:38,949
This has been on their agenda and on their
to-do list for, I would say, going on a year

2738
03:43:38,949 --> 03:43:42,420
and they did a tremendous job leading us.

2739
03:43:42,420 --> 03:43:50,520
Kimberly Barch from the Office of Nutrition
Research at NIH has also been steering us

2740
03:43:50,520 --> 03:43:51,989
all throughout the way.

2741
03:43:51,989 --> 03:44:01,739
There's been a substantial communications
team and we want to thank all of our organizing

2742
03:44:01,739 --> 03:44:03,570
committee members.

2743
03:44:03,570 --> 03:44:11,420
Many of them you've seen who've been either
presenters or moderators today and the support

2744
03:44:11,420 --> 03:44:12,430
staff at NCI.

2745
03:44:12,430 --> 03:44:21,069
And of course, Labroots who was able to help
us pull this off in the era of COVID, making

2746
03:44:21,069 --> 03:44:27,489
it actually look like it was a real conference
with a lobby, a networking lounge, and auditorium,

2747
03:44:27,489 --> 03:44:29,010
and all of the above.

2748
03:44:29,010 --> 03:44:38,859
Based on the input that we received over the
past three days, we'll be developing an executive

2749
03:44:38,859 --> 03:44:43,899
summary of that workshop, highlighting key
research areas and opportunities, and that

2750
03:44:43,899 --> 03:44:48,070
will be published and posted.

2751
03:44:48,070 --> 03:44:56,909
And the presentations from the entire three
days will be available for viewing beginning

2752
03:44:56,909 --> 03:45:06,630
on October 7th online, and they will be up on
the Labroots platform for up to a year after

2753
03:45:06,630 --> 03:45:07,630
the workshop.

2754
03:45:07,630 --> 03:45:10,850
So, if you miss something, if you weren’t
able to attend part of the workshop, you’ll

2755
03:45:10,850 --> 03:45:14,070
be able to view it afterward.

2756
03:45:14,070 --> 03:45:21,800
With that and with thanks for everyone for
all your participation, your attention.

2757
03:45:21,800 --> 03:45:29,750
We hope that you’ve enjoyed the workshop,
learned a few things, and will be able to

2758
03:45:29,750 --> 03:45:33,300
make a difference going forward. Thank you all.