Clemson University Healthy Options Program - SC has the 13th highest rate of obesity in the nation with 24 (52%) of SC’s 46 counties experiencing adult obesity rates over 40%. This proposal targets 10 of the eligible counties where significant health disparity exists including Marlboro, Dillon, Marion, Darlington, Florence, Lee, Orangeburg, Allendale, Bamberg, and Hampton; counties characterized by rurality, high percentages of minority populations, and high rates of poverty and unemployment. Parisi and Griffin bring more than 30 years combined experience to this project including experience as Co-PIs for the 2018-CDC-HOP grant which has shown excellent results. Together, with a team of evaluation, topic, and Extension experts and a workforce of 10 county-level Extension agents, we will plan, supervise, implement and evaluate the 4 evidence-based strategies identified in the HOP logic model in SC.
For Strategy 1a., we will train individuals from target organizations through Extension nutrition, food and distribution training and certification activities that promote implementation of nutrition standards and behavioral design in food service and distribution locations. We will expand work from the 2018-HOP grant in Marion, Lee, and Hampton Counties, and implement policies in faith-based food pantries for healthy food standards adoption to qualify as SNAP vendors and become local producer food hubs. For strategy 1b, we will educate healthcare providers on referral to voucher programs and food security assistance programs. Providers will be encouraged to adopt routine screening tools for food insecurity, and we will establish community-clinical linkages with referral pathways to Extension agents for patient resource navigation related to healthy food access points. We will work with providers on produce prescriptions and assist patients receiving these with healthy food procurement to support chronic disease prevention and self-management.
We will address strategy 2 by partnering with city and county governments and a city planning consultant to assess existing plans in each of the 10 counties. Extension agents and stealth teams from local coalitions, will advocate for changes that improve walkability with county administrators and councils. Strategy 3 will create connections between local minority farmers and ECEs in target counties for produce box distribution. Strategy 4, FHWP, will be rolled out into target counties over the duration of the grant. Formal partnerships with healthcare partners and referral pathways between providers and county-level Extension agents will be established.
The collaborations that have been fostered between departments, colleges, and faculty at Clemson will be leveraged to maximize expertise on topics related to HOP strategies. Existing external health system partnerships will facilitate community-clinical linkages and produce box distribution points at health fairs in the target counties. They will serve as referral sources for individuals screened at risk for food insecurity and youth diagnosed with obesity to Extension agents for resource and FHWP navigation.
We will employ equity-focused and mixed-methods approaches in collecting and interpreting process and outcome measures. The process evaluation will assess outputs and short-term outcomes by focusing on implementation of activities described in the work plan and contextual factors associated with health inequities and implementation successes or struggles. Process and outcome evaluation will be a high project priority and evaluation specialists will be engaged to complete all evaluation activities. The project will achieve desired outcomes: increased number of settings that increase access to healthier foods; increased number of policies, plans, or community design changes that increase access to physical activity; increased number of ECE center programs that are impacted by Farm to ECE center improvements; and increased number of supports for implementation of FHWM programs.