Franklin County is a geographically isolated county located at the west end of the Big Bend in the Florida Panhandle. There are no major State highways located within the county. Travel to destinations with populations over ten-thousand is one and a half hours. Franklin and Gulf Counties are designated by the U.S. Department of Health and Human Services as Health Professional Shortage Areas and Medically Underserved Populations. According to the 2013 Florida Charts Database, Franklin County’s population was 11,596 and Gulf County’s population was 15,944. Both counties have high populations living below 100% of the poverty level, with Franklin at 25.6% and Gulf 16.4%, compared to the state average of 13.8%. The median household incomes in Franklin ($36,490) and Gulf ($37,716) remain below the state average $47,661.
The Closing the Gap Program seeks to improve the health outcomes and the elimination of health disparities in the following areas: diabetes, heart disease, hypertension and certain types of cancers among both African-American and Hispanic populations in Franklin and Gulf Counties. Current public health issues information gathered by The Florida Department of Health Florida Charts database provides evidence of local African-American and Hispanic populations disproportionately impacted by chronic disease rates. The prevalence of health disparities exist primarily in the City of Port St. Joe located in Gulf County and the City of Apalachicola located in Franklin County. Franklin and Gulf non-Hispanic African-American adult obesity percentages are significantly higher than other racial populations when comparing county and state data. The overall population reports 27% of Franklin and 20% of Gulf adults consume at least five servings of fruits and vegetables per day. Over 60% of adults in Franklin and Gulf Counties are overweight or obese. Middle and high school students in both counties exceed the state rate in the overweight category.
The goal of this program is to increase fruit and vegetable consumption among minority populations. This objective is achieved by conducting healthy cooking demonstrations in local grocery stores by targeting seasonal foods. These healthy cooking classes promote healthy eating and educational opportunities that focus on chronic disease prevention. The Program is designed to address health related illnesses among both African-American and Hispanic populations in Gulf and Franklin Counties. Information obtained from Florida Charts for Gulf and Franklin Counties indicate an all-time high in cancer, diabetes, heart disease, and obesity rates for minorities. The purpose of the program is to reduce and ultimately eliminate racial and ethnic health disparities such as diabetes, cardiovascular disease, and certain types of cancers among the minority populations.
The cooking demonstrations were implemented through grocery stores in both Franklin and Gulf Counties where minorities shop. The Florida Department of Health in both Franklin and Gulf Counties (DOH-Franklin/Gulf) was awarded grant funding to implement a Closing the Gap Program. DOH-Franklin/Gulf partnered with local grocery stores and faith-based organizations to implement healthy cooking demonstrations using diabetic-friendly recipes incorporating seasonal fruits and vegetables.
Results show that the Closing the Gap Program has successfully implemented the cooking demonstrations into the grocery stores. The 2013-2014 project year objectives were met, 40% of participants of the healthy cooking demonstrations increased fruit and vegetable consumptions by 1-2 servings a day.
DOH-Franklin/Gulf expanded the success of this initiative into the faith-based organizations by teaching families using the evidence-based curriculum “Cooking Matters”. The main objective was to see an increase of one to two fruit and vegetable servings in 50% of participants who competed the curriculum. The 2014-2015 project year results found 50% of the faith-based participants did increase their fruit and vegetable consumptions by one to two servings per day. In 2015-16, the program will implement the “Body and Soul Wellness Program” as an Online Toolkit for African-American churches. “Body and Soul” is a faith-based initiative to encourage African-Americans to maintain healthy diet and an active lifestyle. Designed to help African Americans take charge of their health, “Body & Soul; A Celebration of Healthy Eating & Living” promotes the national recommendation for Americans to eat five to nine servings of fruits and vegetables a day for better health. The toolkit consists of handouts, information and other resources
The public health impact demonstrated by this practice is to motivate, educate and encourage minorities to incorporate more fruits and vegetables in their daily lives. This also raises awareness and support in informing the community of the healthy affordable foods and meals that they can obtain at their local grocery store. This will help reduce and ultimately eliminate certain chronic disease such as: diabetes, high blood pressure, heart disease, and obesity.
The public health issues addressed by The Closing the Gap Program is to improve the health outcomes and the elimination of health disparities in the following areas: diabetes, heart disease, high blood pressure, obesity, and certain types of cancers among both African-American and Hispanic populations in Franklin and Gulf Counties. Current statistical information gathered by The Florida Department of Health Florida Charts database provides evidence of local African-American and Hispanic populations disproportionately impacted by chronic disease rates. The prevalence of health disparities exist primarily in the City of Port St. Joe located in Gulf County and the City of Apalachicola located in Franklin County. The African-American population has high rates of poverty and death related to cancer, heart disease, and diabetes. African Americans and Hispanics populations are also more likely to die from a heart attack.
Additionally, the Franklin/Gulf non-Hispanic African-American adult obesity percentages are significantly higher than other racial populations when comparing county and state data. The overall population reports on 27% of Franklin and 20% of Gulf adults consume at least five servings of fruits and vegetables per day. Over 60% of adults in Franklin and Gulf Counties are overweight or obese. Middle and high school students who are overweight exceed the state rate in both counties.
The target population is African American and Hispanic population in both Franklin and Gulf Counties. Per Florida Charts health profile statistics, Franklin County has 1,675 and Gulf County has 2,946 African American population. For Hispanic population, Franklin has 579 and Gulf County has 709 residents. Of the minority population listed, The Closing the Gap Program had 532 African Americans and 192 Hispanics who participated in the program.
In the past, DOH-Franklin/Gulf had few resources to support this initiative. There was no other health disparity program focusing on the same activities. The current Closing the Gap Program is better because it’s reaching targeted populations that have not been reached before ultimately helping them to increase their fruit and vegetable intake and bring awareness to chronic disease prevention activities.
It is innovative because this is a new initiative regarding public health in Franklin and Gulf Counties. Creativity comes in when the program implemented the Cooking Matters evidence-based curriculum into the faith-based organizations.
The practice addresses CDC Winnable Battles regarding Nutrition, Physical Activity, and Obesity.
The goal of this program is to increase fruit and vegetable consumptions among minority populations. This objective is achieved by conducting healthy cooking demonstrations in local grocery stores by targeting seasonal foods for demonstrations. These healthy cooking classes promote healthy eating and chronic disease prevention activities and education throughout the community. The Closing the Gap Program is designed to address death related illnesses among both African-American and Hispanic populations in Gulf and Franklin Counties. Information obtained from Florida Charts for Gulf and Franklin Counties indicate an all-time high for cancer, diabetes, heart disease, and obesity rates for minorities in these counties. The purpose of the program is to reduce and ultimately eliminate racial and ethnic health disparities such as diabetes, cardiovascular disease, and certain types of cancers among minority populations.
The first step in establishing The Closing the Gap Program was obtaining a grant through the Office of Minority Health, in August 2013. Partnerships were solidified and programs were developed when the grant was rewarded. The program has been in effect for two years.
With limited resources and economic constraints, rural counties work to create unique opportunities designed to maximize target populations potential. When it comes to the accessibility of healthy foods, there are limited resources to choose from. In fact, Franklin County has only four grocery outlets: the Piggly Wiggly being the most popular. Gulf County, which has three stores, recently opened a Dollar General Market Grocery store, which is centrally located in the community with the highest African-American and Hispanic populations. The Dollar Market sells a variety of healthy produce at a cheaper price and the Piggly Wiggly in Franklin County is widely used by the minority population therefore, it was ideal to strategically implement the healthy cooking demonstrations in these outlets. The healthy cooking demonstration in grocery stores project would support the following SMART Objective: By the end of June 30, 2015, there will be an increase of fruit and vegetable consumption among African-American and Hispanic populations in Gulf and Franklin Counties by two to three servings per day.
Franklin and Gulf Counties target was: 350 unduplicated African-American adults and 80 unduplicated Hispanic adults. The timeframe of the cooking demonstrations occurred between: October 2014 and March 2015, 24 healthy cooking demonstrations per county, per month, each for a minimum of 3 hours in length.
The process started with the health educator developing a community calendar and campaign for the public which included the dates of the cooking demonstrations and recipes. Mass media advertisement was utilized via websites, local radio, newspaper ads, newsletters, and local media. Both television and radio commercials were aired to highlight the importance of healthy eating habits as well. During the cooking demonstration timeframe, media advertisements recognized the grocery stores who had adopted healthy cooking policies and discussed event project dates and details. The Closing the Gap Project Coordinator and Health Educator implemented healthy diabetic friendly cooking demonstrations at the selected grocery store establishment which incorporated seasonal fresh fruits and vegetables. Healthy recipes caloric information, helpful eating tips, and chronic disease educational material which incorporate healthy food as a prevention/control was distributed to participants. The project coordinator utilized credible resources including, the Choose My Plate Campaign and the National Diabetes Association to select culturally appropriate diabetic friendly meal options, which emphasized fruits and vegetables. This helped to increase awareness of the event among shoppers. In addition, participants were given a sign-in sheet to collect demographics including name, telephone number, race, age, primary language and daily fruit and vegetable consumptions. The participants who completed the pre-survey on site were mailed a follow-up with a post-survey or interviewed via telephone to determine whether visiting the grocery store cooking site increased sustainable impacts to add more fruits and vegetables to their diet.
Faith-based institutions play a critical part in reaching out to community citizens and providing information that will improve the lives of their congregants and communities. As many faith-based leaders connect physical health to spiritual health, they are in a unique position and may incorporate health message into church activities.
The popularity of the cooking demonstrations in grocery store outlets has sparked interest with African-American faith-based organizations in Franklin and Gulf Counties. Local African-American church leaders reached out to the Closing the Gap Program to conduct health presentations in their churches. Many connections to resources are made and DOH-Franklin/Gulf realized another opportunity for sustainable health habits. The DOH-Franklin/Gulf further expanded the successful cooking demonstrations/grocery store initiative into faith-based organizations by teaching families using the evidence-based cooking curriculum, “Cooking Matters”. The “Cooking Matters” curriculum teaches families how to cook and eat healthy on a budget.
Therefore, the Cooking Matters Faith-Based project supports the following SMART Objective: By the end of June 30, 2015 there will be a 50% increase in fruit and vegetable consumptions among African-Americans “Cooking Matters” participants in Franklin/Gulf Counties by one to two servings. The target goal was to include four faith-based organizations, two from each county, 40 unduplicated African-American participants with a minimum of 10 adults per faith-based organization. Youth were encouraged to attend in order to implement the curriculum for families. The “Cooking Matters” classes is a six week youth-friendly and evidence-based curriculum program. Youth were educated in monthly blocks for a total of six months. Each class included a 30 minute curriculum session and 30 minute cooking demonstration.
The Closing the Gap Coordinator and Health Educator met with faith-based leaders in Franklin and Gulf Counties to get approval to implement the curriculum; however, to make a more sustainable impact on the faith-based group, the Closing The Gap Coordinator and Health Educator utilized the Train the Trainer Model to teach the first lesson and provided healthy cooking demonstrations during church activities to church leaders. The remaining five lessons were taught by members of the church leadership. Church Leadership was provided with training and curriculum materials to assist in teaching other members about the benefits of incorporating more fruits and vegetables into their daily diets. Flyers were distributed to all members of the selected faith-based organizations and churches to encourage participation. CHIP members helped to increase awareness by reaching out to their communities. Media advertisements such as newspaper, radio, television, and newsletter were aired to recognize the faith-based organizations which agreed to implement the “Cooking Matters” curriculum and discuss event project details. The program staff made use of health fairs and community events, as they occurred, to further increase and expand awareness of the “Cooking Matters” and healthy eating initiatives.
In addition, participants were given a sign-in sheet to collect demographic information including name, telephone number, race, age, primary language and fruit and vegetable consumptions. The participants who completed the pre-survey at the church at the beginning of the first class were then followed up after the end of the curriculum and given a post-survey to see if there was an increase in their fruits and vegetables intake over the past six months.
The Closing the Gap grant comes in perfect alignment with DOH-Franklin/Gulf’s Community Health Improvement Planning (CHIP) process. The Closing the Gap program in partnership with CHIP members collaborated with local residents, faith-based communities, health care professionals, business, and other organizations vested in creating healthier communities. The goal of the project was to create strategic plans and action cycles that prioritized community selected public health issues and identified solutions and resources to address them. Improving the health of the community is a shared responsibility and increasing awareness of community resources and quality access to care for minority populations. The program attended monthly CHIP meetings that allows all partners opportunities to update the group on accomplishments and to brainstorm ways to improve health behaviors and outcomes in Gulf and Franklin Counties. Community stakeholders that support the program initiatives are: Weems Memorial Hospital, Community Health Improvement Partners, Sacred Heart Hospital on the Gulf, Franklin and Gulf County Healthy Start Programs, Tobacco Programs, Franklin’s Promise, Gulf County Health Partners Coalition, The Washington Improvement Group, Eastpoint and Wewahitchka Medical Center, faith-based organizations, Refuge House, local and state decision makers, local media, health educators, county businesses and grocery store managers.
Collaborating with these organizations improves the programs ability to increase visibility and to conduct outreach services within the community. In addition, the Closing the Gap Coordinator and Health Educator participated in the February 2014 Day of Dialogue on Minority Health Outcomes: Big Bend Area Highlights panel in Tallahassee. The Day of Dialogue on Minority Health is an annual event that brings churches and faith-based leaders together from North Florida counties with multi-health organizations, university faculty, student, and community leaders to identify health concerns, examine the role of the church, share best practices, and develop action plans. During these events, the Closing the Gap Coordinator provides an overview of the program and discussed the chronic disease issues that are primarily affecting the African American/Hispanic communities in both counties. Franklin/Gulf Counties hosted the Day of Dialogue on Minority Health in February 2015.
The annual operation cost of the Closing the Gap Project was $80,000 in the 2013-2014 grant year, which was funded through the Office of Minority Health. DOH-Franklin/Gulf provided $26,972 of in-kind services to the grant. The program was so successful in the first year that the Office of Minority Health increased the funding for the 2014-2015 fiscal year to $150,000 and DOH-Franklin/Gulf provided $49,688 of in-kind match. The budget break-down consists of the following: Personnel- $69,513, Fringe- $33,254, Staff Travel- $1068, Training and Seminars- $1364, Office, Educational, Promotional, Food Supplies- $44,801 totaling $150,000.
The goal was to increase fruit and vegetable consumptions for proper nutrition among African-American and Hispanic populations of Franklin and Gulf Counties. By the end of June 30, 2015, there was a noted 40% increase in fruit and vegetable consumption among both African-Americans and Hispanic cooking demonstration participants by one to two servings during the 2013-2014 grant year and two to three servings during the 2014-2015 grant year. Interventions that address healthy life-styles including nutritious foods can improve weight management, chronic disease prevention and control, and overall health outcomes. The key to the success of this initiative will be the continued support of faith-based groups and grocery store outlets to host cooking demonstrations.
Frequent monitoring of accountability measures included signed grocery store agreements, a list of events and dates, participant sign-in sheets, participant surveys, and media documents. Monthly, quarterly, and annual status reports were provided to the Closing the Gap contract manager with the Office of Minority Health. Monitoring, feedback, successes, and barriers were shared with the CHIP partners during the monthly CHIP meetings. If barriers or challenges occurred, CHIP partners were there to support and helped develop alternative steps to ensure the overall outcome was met. Initial surveys (pre-surveys) were distributed after educating the participants, which collected demographics, current fruit and vegetable servings per day and the impact of the cooking demonstrations. Follow-up surveys (post-surveys) was conducted at the end of the demonstration periods to collect data for increased fruit and vegetable consumption as a result of participation of cooking demonstrations. The Florida Charts data includes adults who consume at least five servings of fruit and vegetables. Obesity and chronic disease death rates were also monitored during this time.
The end results of the grocery store cooking demonstration are as follows:
· 2013-2014 – 532 African Americans and 192 Hispanics participated in the cooking demonstrations in the grocery stores.
· 41% increased their fruit and vegetable consumptions by 1-2 servings per day.
· 2014-2015- 469 African Americans and 97 Hispanics participated in the cooking demonstrations in the grocery stores.
· 43% increased their fruit and vegetable consumptions by 2-3 servings per day.
Evaluation: Faith-Based Cooking Matters
The intended outcome for the faith-based organization was to have a 50% increase in fruit and vegetable consumptions among African-American and Hispanic participants in the faith-based organizations. Frequent monitoring of accountability measures will include signed faith-based agreements, list of curriculum dates, participants sign-in sheets, participant surveys, and media documents used. Monthly, quarterly, and annual status reports were provided to The Office of Minority Health contract manager. Monitoring feedbacks, successes and barriers were shared with CHIP partners during the monthly CHIP meetings. Pre-surveys were distributed prior to the first curriculum lesson, which collected demographics, healthy eating questions and inquired of current fruit and vegetable servings per day. Post-surveys were conducted at the end of the six weeks (6-months) curriculum to collect data for increase fruit and vegetable consumption as a result of participation in cooking demonstrations. Both pre and post surveys were conducted by the program staff. In addition, a follow-up survey was conducted by staff as well to document the sustainability of fruit and vegetable intake. The Florida Charts data included adults who consume at least five servings of fruits and vegetables as well as monitoring obesity and chronic disease death rates. The contract manager from the Office of Minority Health also conducted a site visit with the DOH-Franklin/Gulf Administrator, Operations Manager, and the Closing the Gap grantee once a year to monitor the progress of the program.
The end results of the faith-based “Cooking Matters” curriculum are as follows:
2014-2015 – They faith-based organization increased their fruit and vegetable intake by 1-2.5 servings per day, which is a 61% increase.
In August 2013, the Closing the Gap grant was the only funding support received to help kick off the cooking demonstrations initiatives. Successful outcomes, as a result of the grant included an increase knowledge of fruit and vegetable consumption among cooking demonstration participants. At this time there were no other health disparities programs in Franklin/Gulf Counties focusing on the same activities. The curriculums implemented in the faith-based organizations are evidence based. The focus of sustainability for this program has been the faith-based component. Members of each participating faith-based organization is trained to continue the cooking demonstrations. This is a train-the-trainer concept that has been very successful in the local churches and is very sustainable without funding.