NURS 340 Jerrene Bramble Angelique Kinyon Joella Show Sherry Brabon

Problem Statement
Kent County residents are at risk of imbalanced nutrition related to lack of healthy food resources as evidenced by limited access to grocery stores, high rates of food insecurity and obesity.

Objectives

Identify nutritional concerns in Kent County Assess current access to nutrition resources Identify strengths and weaknesses related to access to healthy food Identify modifiable factors for good nutrition Provide interventions to improve nutritional intake to Kent County residents Evaluate effectiveness of interventions

Kent County Statistics

Population in 2012 - 614,562 Median household income, 2007-2011 - $50,801 Persons below poverty level, 14.8%(United States Census Bureau,
2012).

Number of grocery stores -118

Kent County 1.96/10,000 population Michigan 2.34/10,000 population (City-Data.com, 2012).

Modifiable Factors Modifiable factors involved in obtaining a diet rich in

healthy whole foods: Knowledge
Understanding Awareness

Availability
Farmers Markets Grocery Stores

Food within the school systems and work places

Meals Vending machines

Individual financial need

Resources

Community Strengths Weaknesses

Community Gardens Farmers Markets Food Banks SNAP benefits WIC Double-Up Program Healthy options available in some of the schools

Lack of knowledge about public transportation Lack of grocery stores/food sources/ limited farmers markets Crime rate Poverty Vending machines in schools with unhealthy choices Some school meal programs do not provide healthy choices Convenience/availability of fast food options Inconvenience/high cost of fresh whole foods

Community Gardens "Community gardens provide residents of underserved

communities the opportunity to grow their own fruits and vegetables, increasing access and affordability.(Local Government Commission, n.d.). There are over 20 community gardens in the Kent County area For more information on a community garden in Kent County go to:
foodshed.net School and Community Gardens on the Kent County Facebook Page

Extra produce harvested from community gardens can be canned, dried, or frozen for use during the winter months

Food Banks & Food Insecurity

Food Banks Food provided by the food bank to people in need is nutritionally deficit in specific areas. Supplies of food are too little to adequately assist in relieving the food insecurity.
Deficits of West Michigan Food Banks 93% deficit of meat, poultry and fish 89% deficit of fresh fruits and vegetables 88% deficit of dairy products Available food fell short of USDA recommendations

Government Assistance & Availability Issues Availability Issues Government Assistance

In 2010 18% of people in There are very little or no Kent county relied on low-cost grocery stores in SNAP the inner city of Grand Rapids. Choices are limited Some individuals who by stores such as WalMart, qualify for SNAP do not Meijers, and Krogers understand how to apply for the benefits and/or are A program from Michigan undocumented State University called immigrants and are afraid Project Fit is targeting of being deported if they neighborhood convenience make themselves known stores to increase healthy by applying for SNAP and affordable food

Transportation Disability advocates of Kent County offer transportation

to qualified individuals The Rapid (Interurban Transit Partnership, ITP)
Go!Bus, PASS, RideLink, Car & Van Pooling

Faith in Motion (FIM) The Hope Network provides transportation for individuals with disabilities or disadvantages Other providers of transportation in Kent County, MI, many of which are non-profit

AIDS Care Network (G.R.A.C.E.), American Cancer Society, American Red Cross, Area Community Service Employment and Training Council (ACSET), FISH for my people (G.R.A.C.E.), Ready Ride Transportation, INC., Senior Neighbors, Sunshine Senior Assistance (RLS & Associates, Inc., 2011)

Farmer's Markets "Farmers markets allow consumers to have access to

locally grown, farm fresh produce, enables farmers the opportunity to develop a personal relationship with their customers, and cultivate consumer loyalty with the farmers who grows the produce." (United States Department of Agriculture [USDA], 2013). There are 13 Farmer's Markets in Kent County
All but 1 are only open seasonally All have limited hours Most only open 1 day Only 6 take WIC or SNAP

Community Concerns
19,172 Kent County residents do not have access to a grocery store with fresh produce 17,920 residents have limited access Overall 15.2% of this population report food insecurities, children are reported to experience this at a rate of 23.2% (Michigan Public Health Institute[MPHI], 2011)

Health Concerns
Only 26% of adults and 34% of youth in Kent County report eating healthy balanced meals Lower income adult residents (<$35,000 per annum) have higher obesity rates than higher income residents
29% of adults in Kent County are obese. (KCHC, 2013a)

34% of the youth eat 5 or more servings of fruits and vegetables daily 52.4% of the youth report 60 minutes of physical activity in at least 5 days per week 10.5% of youth are obese (MPHI, 2011)

Importance of Diet
Dietary factors are the cause of 4 out of the 10 leading causes of death. Heart disease, cancer, stroke and type 2 diabetes are all controlled with diet (Harkness and DeMarco, 2012)

USDA Recommendations:
Make 1/2 your plate fruits and vegetables Make at least 1/2 your grains whole grains Make your protein choices low fat Switch to fat free or low fat (1%) milk

Edible Food Forest: Seven Level Beneficial Guild

Goals

Forest Levels
1. 2. 3. 4. 5.

Mimics nature while providing free healthy food to the community Providing fruits and nuts to those who cannot afford to purchase them Works on the honor system: Take some but leave some for others (Edible Forest, 2012).

6.
7.

Canopy- Large fruit and nut trees Low tree layer-Dwarf fruit trees Shrub layers- Berries Herbaceous- Herbs Rhizosphere- Root vegetables Soil surface- Ground cover (such as strawberries) Vertical layer- Climbers and vines (Beacon Food Forest,2012).

Community Education:
Recognizing the Need and Getting Involved

Help the members of the community to recognize the lack of access some people have to nutritious food Encourage a banding together of community members to provide for neighbors by donating to the food pantry Encourage local schools to serve nutritious food Advertise for food drives Involve churches and other non-profit organizations

Health Model
The collaborative model
Requires all community members Best to involve affected residents Requires funding from stakeholders Allows for resident suggestions for improvement which may promote program sustainability

Stakeholders/Partners
It requires a community to feed a community.
There are two sides

The entire community in Kent County should be involved regardless of which side they are on.
Healthcare facilities/ healthcare professionals Community leaders/ public officials Local business owners, farmers Individuals, families, churches, volunteer groups Schools: Students, parents, and staff: From Pre-K to college Senior citizens, ethnic or specific cultural groups

Those who lack access to nutritious foods Those who have enough nutritious food

Local health department Michigan State University Extension USDA-Farmers markets and farm to school programs

Target Population: Senior Citizens

Senior Meals Program, Inc.

All seniors deserve access to healthy, nutritious food Home delivered meals
Meals cooked from scratch, chilled, and delivered all over Kent County, MI

Dining centers Senior pantry Nutritional supplements Emergency meals Project fresh Nutrition information

Target Population: School Children

Improve quality of food served and/or available in schools More fruits and vegetables Less sodium Reduce amount of nutritionally deficient foods and drinks Provide free cold drinking water Provide nutrition education for students and families Work with the schools to institute a Farm to School program

Target Population: Native Americans & Men

0.7% American Indian and Alaska Native persons (United States Census
Bureau, 2012)

Establish report Provide education on health and nutritious foods Offer assistance in the form of WIC or SNAP 49% of the entire population consists of male persons (United States
Census Bureau, 2012)

Identify tribal leaders

Identify predominant male workplaces

Encourage employers as stakeholders Offer healthy foods in vending machines Offer information specific for healthy foods
Handouts with income guidelines for WIC and SNAP Food pantry locations and times Farmers market information

Goals

Long term - 5 Years Reduced rates of obesity Reduced rates of stroke, diabetes, and heart disease

Short Term - 1 Year Greater access to nutrition foods Fresh produce available to all residents of Kent County

Outcome / Evaluation
Successful implementation of a USDA approved "Farm to School" Program in all public schools in Kent County within two years. This should be evaluated frequently. Survey all schools in three month intervals to evaluate progress until full implementation is reached.

 The percentage of residents with limited access to healthy foods will decrease until the National Benchmark is reached
5% of the population in Kent county currently has limited access to healthy foods The National Benchmark is 1% This can be evaluated via tracking made possible by County Health Rankings & Roadmaps (Robert Wood Johnson Foundation, 2013)
A decrease of at least 0.5% per year is necessary or revaluation of interventions will be required

Outcome / Evaluation

 The percentage of adult residents of Kent county with obesity (a BMI 30) will decrease to at least the level of the National Benchmark or further.
Reports for 2013 show 30% of Kent County adults are obese. The National Benchmark is 25%

Outcome / Evaluation

This can be evaluated via tracking made possible by County Health Rankings & Roadmaps (Robert Wood Johnson Foundation, 2013).
A decrease of 0.5% or more per year is necessary or revaluation of interventions will be required.

Outcome / Evaluation The percentage of residents within Kent County with

diabetes, heart disease, and/or stroke will decrease steadily as the overall health of the community increases

This can be tracked through hospital records and reporting

Prevalence of diabetes in 2005: 49.6 people per every 100,000 people Prevalence of heart disease in 2005: 17.7 people per every 100,000 people Prevalence of stroke in 2005: 206.8 people per every 100,000 people (Kent County Health Department, 2005) A decrease of 0.2% after 1 year followed by 0.5% each year after until the National Benchmarks have been met or exceeded is necessary or revaluation of interventions and plan are required

Long-Term Monitoring Healthcare facilities and professionals will be

utilized to monitor the overall health of individuals. Monitoring of health data and trends through the health department and organizations such as the Robert Woods Johnson Foundation will continue indefinitely in an effort to prevent recurrence of the issue. Residents will be surveyed one year after implementation of interventions then annually until all benchmarks have been met or exceeded.
The survey will be utilized to monitor the public perception and understanding in addition to overall health status.

Conclusion

Our group wanted to focus our efforts on enhancing the strengths of the community and capturing those groups most affected by poor nutrition. It was decided that educating the public and offering some solutions that involve community members would help sustain our interventions. This is a long term commitment that will require ongoing program evaluation and intervention modification to remain successful.

Baders, S., & Rydahl, N. (2010). Reducing food insecurity in Kent county: Assessing the progress. Retrieved from http://faculty.gvsu.edu/borderss/Food%20Insecurity%20in%20Kent%20County.pdf
City-Data.com. (2012). Kent County, Michigan. Retrieved from http://www.citydata.com/county/Kent_County-MI.html Cramer, J. (n.d.). Beacon Food Forest-About. Retrieved June 26, 2013, from http://beaconfoodforest.weebly.com/ Harkness, G. and DeMarco, R. (2012). Community and public health nursing. Philadelphia: Lippincott Williams and Wilkins. Kent County Health Connect (KCHC). (2013a). The facts. Retrieved from http://www.kchcct.com/THEFACTS.aspx Kent County Health Connect (KCHC). (2013b). Healthy eating and active living strategies. Retrieved from http://www.kchcct.com/en-us/healthyeatingactiveliving.aspx

References

Kent County Health Department. (2005). The health of Kent County, 2005. Retrieved from http://www.accesskent.com/Health/Publications/
Local Government Commission. (n.d.). Cultivating community gardens. Retrieved from http://www.urbantilth.org/wp-content/uploads/2008/09/local-government-commission-flyer-on-policiesto-encourage-community-gardens.pdf Michigan Public Health Institute [MPHI]. (2011). 2011 Community health needs assessment and health profile. Retrieved from http://www.kentcountychna.org/default.html

Michigan State University [MSU]. (2012). Michigan farm to school. Retrieved from http://www.mifarmtoschool.msu.edu/

References

RLS & Associates, Inc. (2011). Kent County transit needs assessment. Retrieved from http://www.gvmc.org/transportation/documents/KCTNA/Kent%20County%20Final%20Report-1.pdf Robert Woods Johnson Foundation. (2013). Kent County, MI: County rankings and roadmaps. Retrieved from http://www.countyhealthrankings.org/app/michigan/2013/kent/county/outcomes/overall/snapshot/byrank Senior Meals Program, Inc. (2011). About us. Retrieved from http://seniormealsonwheels.org/about-us United States Census Bureau. (2012). Kent County QuickFacts. Retrieved from http://quickfacts.census.gov/qfd/states/26/26081.html United States Department of Agriculture [USDA]. (2012). Choose a food group. Retrieved from http://www.choosemyplate.gov/food-groups/ United States Department of Agriculture [USDA]. (2013). Agricultural Marketing Service: Farmers markets and local food marketing. Retrieved from http://www.ams.usda.gov/AMSv1.0/farmersmarkets Wall, T. (2012). Edible Forest Free for All in Seattle. Retrieved June 26, 2013, from http://news.discovery.com/earth/plants/edible-forest-free-for-all-in-Seattle-120321.htm