Right Choice Fresh Start Farmers’ Market Pilot Study

1. Right Choice Fresh Start Farmers’ Market Pilot Study USC CPCRN Pilot Project

2. Location: Orangeburg County, SC • Population (2010): 95,501 • 62.2% Black, 34.3% White • Median household income (2009): $33,567 • Persons below poverty (2009): 24.5% • 67,326 in City of Orangeburg • Home to 3 colleges (Claflin, SC State, Orangeburg-Calhoun Technical College). • Congressman James E. Clyburn attended SC State University • Civil Rights history – site of Orangeburg Massacre.

3. Location: Orangeburg County, SC • County Health Ranking (1=healthiest): 41 of 46 • Overweight or Obese: 75% • Diabetes: 13% • 4th highest county incidence of prostate cancer in SC

4. Site Selection • Community Readiness Assessment (June-October 2010) • Indictors of readiness for starting an environmental intervention focused on improving access to healthy foods at a federally qualified health center (Freedman et al., 2011)

5. Site: Family Health Centers, Inc. (FHC) • Umbrella organization that operates 7 FQHCs in rural SC. • Largest site in Orangeburg • Serves >22,000 patients &employs > 160 persons. • Strong, community development, civil rights-focused Executive Director (retired 12/2010). • Connections and involvement with local schools and universities, hospitals, churches, and city government. • ≥50% FHC Board members are from target community. • Ability to address logistical factors (e.g., space, electricity, phone, bathrooms, maintenance assistance). • Vision for farmers’ market integrated with mission of FHC • Medical Director had a goal of reducing A1C levels after market season

6. Implementation Framework • Community-based participatory research (CBPR) • Importance of context • Intervention goals and procedures developed in collaboration with community partner • Flexibility of intervention to achieve multiple goals • Theory-based: Food access influenced by multiple dimensions (Freedman, Blake, & Liese, under review) • Economic • Service Delivery • Spatial • Social • Temporal • Personal • Data-driven: Informed by farmers’ market model developed with Boys and Girls Clubs and extant research on farmers’ markets

7. Timeline

8. Right Choice Fresh Start Farmers’ Market Project Goals • Increase access to healthy foods and healthcare among patients at Family Health Centers, Inc. • Improve dietary behaviors and A1C levels among adult patients at FHC diagnosed with diabetes. • Increase demand for fruits and vegetables grown by farmers in Orangeburg and the adjacent counties. • Disseminate findings using diverse mediums.

9. Right Choice Fresh Start Farmers’ Market

10. Evaluation Protocol

11. Evaluation Protocol

12. Evaluation Protocol

13. Evaluation Protocol

14. Scientific Outputs: Accepted Presentations • Freedman, D.A., Whiteside, Y.O., Brandt, H.; Young, V.; Friedman, D.; & Hebert, J.R. (2011, April). Measuring readiness for establishing farmers’ markets at federally qualified health centers in South Carolina. Poster presentation at the James E. Clyburn Health Disparities Lecture Series, Columbia, SC. • Freedman, D.A. (2011, June). Innovative approaches for engaging communities in research. Symposium organized by Dr. Freedman for the Society for community Research and Action Conference, Chicago, IL. • Freedman, D.A. & Whiteside, O. (2011, June). A visioning process for generating research questions. Oral presentation at the Society for community Research and Action Conference, Chicago, IL. • Freedman, D.A., Young, V.M., Brandt, H.M., Armstrong, P., Cobbs, E., Friedman, D.B., & Hebert, J.R. (2011, August). Assessing readiness for establishing a farmers’ market at community health centers. Poster presentation at the National Association of Community Health Centers annual conference, San Diego, CA. • Freedman, D.A., Whiteside, Y.O., Young, V.M., Brandt, H.M., Willms, L., Hatala, J., Friedman, D.B., & Hebert, J.R. (2011, October). Pharmacies to farm stands: Assessing readiness for establishing a farmers’ market at a federally qualified health center. Power presentation at the 139th Annual American Public Health Association Conference, Washington, DC. • Brandt, H. & Freedman, D.A. (2011, December). Planting Healthy Roots: A look at the Right Choice Fresh Start Farmers’ Market. Invited colloquium at the University of South Carolina Science and Health Communication Research Group, Columbia, SC. • Kugler, K., Freedman, D.A., Butler, P., Friedman, D., & Hebert, J. (2012, April). Farmers’ markets: Promoting health by connecting community members in underserved environments. Poster presentation at the 33rd Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine Conference, New Orleans, LA.

15. Scientific Outputs: Accepted Publications • Freedman, D.A., Whiteside, Y.O., Brandt, H.M., Young, V., Friedman, D.B., & Hebert, J.R. (2011). Assessing readiness for establishing a farmers' market at a community health center. Journal of Community Health. DOI: 10.1007/s10900-011-9419-x

16. Scientific Outputs: Papers in Progress • Influence of FM on F/V consumption and AIC levels among diabetics • Influence of patient-provider communication on usage of health center-based farmers’ market • Actors and social interactions at a health center-based farmers’ market • Sales trends and satisfaction among customers and farmers at health center-based farmers’ market • Multi-level, multicomponent evaluation approach • Economic opportunity for small-scale rural farmers vending at a health center-based farmers’ market • Dissemination of health innovations through documentary film

17. Community Dissemination • Planting Healthy Roots Screenings • October 13, 2011, Trinity United Methodist Church, Orangeburg, SC • October 18, 2011, South Carolina State University, Orangeburg, SC • January 28, 2012, Nickelodeon Theater, Columbia, SC • Documentary Distribution (free) • Mailings: December 2011-March 2012 • Available online: by April 2012 • Request free DVD at http://www.surveymonkey.com/s/QRKMGW2

18. Grants • University of South Carolina, Science and Health Communication Research Group Grant (awarded March 2011) – funded documentary project • U.S. Department of Agriculture, Community Food Project (developed but not submitted, November 2011) • South Carolina Cancer Alliance (due January 2011) • South Carolina Department of Agriculture, Community Transformation Grant Sub-contraction, $5M/year for 5 years with demonstrated effect (potential opportunity for evaluating SNAP usage at farmers’ markets)

19. Opportunities for Growth and Collaboration • Expansion to more sites to test model • More targeted marketing to reach low-income consumers • Addition of interactive cooking classes • Enhance patient-provider communication about health benefits of market/foods from market • RCFS prescription v. FHC prescription • More training for farmers to use sales data for planning and economic growth

20. Acknowledgements • Funders: • This RCFS pilot study was supported by the South Carolina Cancer Prevention and Control Research Network funded under Cooperative Agreement Number 3U48DP001936-01W1 from the Centers for Disease Control and Prevention and the National Cancer Institute. • Planting Healthy Roots documentary was supported by the USC Science and Health Communication Research Group. • Partners: Family Health Centers, Inc., South Carolina Primary Health Care Association, RCFS Advisory Council • Research Collaborators: James Hebert, Daniela Friedman, Heather Brandt, Madeline Broderick, Lyn McCracken, Tom Hurley. • Research Assistants: KassyKugler, Lucy Willms, Natalia Carvalho, Shanna Hastie, Jason Greene, Paul Butler, Peter Georgantopoulos. • Service Learning Volunteers: 22 students and community members.

21. Questions