2012 Community Health Clerkship (CHC) University of Massachusetts Medical School/Graduate School of Nursing

Disparities in Quality of Nutrition and Barriers to Increased Consumption of Local Produce, Fish and Meats among Year-‘round Residents of Martha’s Vineyard

The health of our nation is being threatened by an epidemic of obesity and associated chronic illnesses. The federal health-related guidelines, Healthy People 20201 and the Dietary Guidelines for Americans2 target evidence-based outcome measures to help counter the direction and slope of this mostly preventable health crisis. Each community can establish health-related indicators of improved health of local citizens. The island of Martha’s Vineyard, a rural community, is not immune to this unhealthy trend. Preliminary data of BMI of students in our school system indicates it equals the national level of 30% overweight and obese children. Alarmingly, our youth are becoming the first generation of children to have shorter life spans than their parents. On our island we are segregated from the fast food industry, but are still victims of poor nutritional habits. The Dukes County Health Council is working with MASS in Motion (a CDC Community Transformation grant administered by the MA DPH), Island Grown Initiative (IGI), island schools, and the town Boards of Health to make a “sea-change” in the course of the island’s eating and activity habits. The purpose of the overall MASS in Motion-MV project is to take a prevention-based approach to improving health and wellness in the six island towns. We request Rural Scholar assistance for the Healthy Eating portion of our effort. The question is “What are the disparities in quality of nutrition and the barriers to increased consumption of local produce, fish, and meats among year-‘round residents of Martha’s Vineyard”. Some major efforts have already been initiated at the local grammar schools with IGI-Schools. But, we do not know what is happening with families, seniors, and people of different income, race/ethnicity, and language. This is where the rural scholars can help.

GOALS: 1) To obtain a baseline survey (in conjunction with MASS in Motion–MV) of habits, needs, and barriers to eating healthy and partaking of fresh local foods - utilizing a subset of validated reliable questions from standardized questionnaires if possible - in a variety of formats and in English and Portuguese 2) To become familiar with the many facets of carrying out a community health project in the overall context of health care, disease prevention and health promotion. 3) To offer recommendations for the future

ACTIVITIES: The Rural Scholars will: 1) Assist with face-to-face interviews at local grocery stores and possibly assist with other methods of survey administration; 2) Access aggregated computerized sales records of major grocery stores on MV (focus on off- season); 3) Help to organize and prepare data for preliminary analysis (see Outcome Report below); 4) Meet with MV groups and individuals already engaged in addressing healthy eating on Martha’s Vineyard in order to integrate observations and initiatives into their analysis where appropriate (Island Grown Initiative; Produce Connection; School kitchens and wellness councils; Meals on Wheels; Martha’s Vineyard Commission; Dukes County Health Care Access Program; Martha’s Vineyard Hospital; the Youth Task Force, and others.); 5) If time allows, participate in focus groups of community individuals; 6) Discuss preliminary findings with MA DPH- MASS in Motion and the Healthy People/Healthy Economy Coalition to analyze Martha’s Vineyard year-‘round population habits in light of the Farmer’s Market and Food Desert categories of the First Annual Report Card for Massachusetts3.

Outcome Report: Based on surveys, field observations and discussions, Rural Scholars will:

1) characterize food consumption on MV by source and nature of food, in relation to national and Massachusetts data on food consumption; 2) identify “food deserts”, if any -- geographic areas on MV where deficiencies in availability and affordability affect the quality of nutrition of residents of those areas; 3) identify availability/affordability gaps in healthy food consumption according to population subgroups, such as ethnic, immigrant, socio-economic, or age-based, as well as any interrelationships among these group identifiers; 4) seek to identify factors other than availability/affordability affecting unhealthy eating patterns on MV 5) write a report including recommendations as to what towns, food producers, purveyors of food and non-profit or social service organizations can do to assure that all island residents have maximum access to healthy, nutritional food, including information on how to obtain, cook, and preserve healthy plant-based foods as part of their diet. 6) prepare a Power Point Presentation for a public forum and local MVTV station airing.

LEARNING OBJECTIVES: In producing the outcome report, students will work with Mass in Motion staff and participants at the State and local level to develop strategies to advocate for disparate sections of the population: . Apply basic epidemiological skills and concepts to characterize the eating habits of Islanders, identify mediating factors, disparities, and barriers, and assist with analysis of the survey . Locate, Interpret, and display relevant survey data . Conduct a SWOT analysis (strengths-weaknesses, opportunities, threats) of access and affordability of healthy food sources.

1U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion ODPHP Publication No. B0132 November 2010 (2011). Healthy People 2020. Retrieved from http://www.healthypeople.gov/2020/TopicsObjectives2020/pdfs/HP2020brochure_with_LHI_508.pdf 2 U.S. Department of Agriculture and U.S. Department of Health and Human Services (2011, January). Dietary Guidelines for Americans, 2010. 7th Edition, Washington DC: US Government Printing Office, December, 2010. Retrieved from http://www.cnpp.usda.gov/dgas2010-dgacreport.htm 3Healthy People/Health Economy Coalition (2011). Healthy People/Healthy Economy: First Annual Report Card. Retrieved from http://bostonfoundation.org/uploadedFiles/tbforg/Utility_Navigation/Multimedia_Library/Reports/HPHE_ReportCard_2011.pdf