Addressing Nutritional Risk of Vulnerable Migrant Communities

Submitted by Christina Chang, Shin Ting Chang, and Danielle Laub

I. EXECUTIVE SUMMARY

Our organization Eat Well, Live Well requests a grant of $3 million dollars for our nutrition
intervention program called Addressing Nutritional Risk of Vulnerable Migrant Communities
which will be focused on a specific target group in Whoville, CA.

Cardiovascular disease and Type II diabetes are important health concerns for Americans.
According to the Centers for Disease Control and Prevention, type II diabetes was the
seventh leading cause of death for Americans in 2011 while cardiovascular disease was the
number one leading cause of death in 2011. Research also suggests that being overweight
or obese increases the risk of type II diabetes and cardiovascular disease.

With your help, our project will effectively help reduce prevalence of type II diabetes and
cardiovascular disease among the the overweight and obese adults living in the migrant
farm centers of Whoville, CA. Just as your mission is to improve the health status of low-
income Americans, we too aim to do the same thing through our projects strategies.

II. BACKGROUND

According to the USDAs statistics, Californias 80,500 farms produce about 50% of all US-
grown fruits, nuts, and vegetables. Furthermore, in 2013 Californias agricultural exports
were valued at $21.24 billion which represented a 15% increase over the previous year.
Many of Californias farm workers are migrant farm workers who work at various farms
depending on the crop cycle. When working, these migrant farm workers and their families
live in communities commonly known as Migrant Farm Labor Centers. The largest
Migrant Farm Labor Center is located in Central California, in a rural town called Whoville,
CA. The farm worker population consists mostly of people who left their native countries
for the United States in hopes of finding better opportunities. However, many of them do
not speak or read English fluently and have limited resources available to them in Whoville.
For example, there are only liquor stores and fast-food restaurants near the Migrant Farm
Labor Center and the closest grocery store and hospital are over 40 miles away.

Despite previous job stability, California as a whole has experienced a significant drought in
the past few years which has negatively impacted its agriculture and consequently, many
farm workers have lost their jobs and currently rely on unemployment checks. This
unfortunate situation has heavily influenced the nutritional status of the farm workers and
their families. The obesity rates in Whovilles children and adults have steadily increased
over the last decade. As of right now, about 86% of the adults and 69% of the children are
overweight or obese. The increase in weight has consequently led to an increase in
comorbidities, such as cardiovascular disease and type II diabetes. To help prevent
malnutrition, local food banks have provided food baskets with non-perishable foods, such
as canned fruits and vegetables. However, this is not a long term solution. Further affecting
the communities health is the current condition of Whovilles water. The water contains
high levels of minerals and has lead the community to believe the water in undrinkable.
Therefore, residents consume bottled water, sweetened beverages or liquor from nearby
stores.

III. PROJECT DESCRIPTION

The overall goal of this project is to reduce the prevalence and risk of cardiovascular
disease and type 2 diabetes of the adults living in the Migrant Farm Centers in Whoville, CA
by 25% by 2017. The grant funds will be used for the duration of the program (estimated 2
years total) to achieve this goal and the subsequent objectives.

PROJECT OBJECTIVES

1. By 2017, the number of overweight and obese adults living in the migrant farm
centers in Whoville, CA will be reduced by 25%.
1. By 2017, the amount of fruits and vegetables consumed will increase to five times a
week among 25% of the target group.
2. By 2017, 50% of the target group will be able to name at least 3 low-fat, low-
cholesterol food alternatives to typical high-fat, high-cholesterol foods.
3. By 2017, the amount of sweetened beverages and alcohol consumed will be reduced
to less than 2 times a week among the target group.

INTERVENTIONS

A. Community Farmers Market

To decrease the prevalence of overweight individuals in Whoville, CA, the people of

the city need to have easier access to fresh fruits and vegetables. With this in mind,
our teams first intervention to help the people of Whoville is to organize a weekly
community farmers market. We plan to recruit members of the community to
participate in the farmers market as leaders who help make decisions about the
market. With locals involved in the decision making and designing of the market, we
hope to create a farmers market that appeals to all members of the community. We
 also plan to establish a working relationship with the closest hospital with the hope
that medical professionals will volunteer by performing basic health check-ups (i.e.
vitals) once a month. Any time volunteers are not available, we will pay our staff
physicians to be at the market. We hope that the target groups close proximity to
the farmers market will encourage them to consume more fresh fruits and
vegetables weekly, and this, in turn, will help lower the risk of cardiovascular
disease and type II diabetes.

B. Informational Cards and Pamphlets

In order to reach out to the members of the community, members of our team will
be present at the community farmers market to answer questions, handout
informational material, and perform surveys. We will have an information table set
up with one of our staff members available for questions, as well as another staff
member to walk around the market to hand out information cards and pamphlets.
Due to the high number of non-English speakers, the information cards and
pamphlets will be written a language the target population is able to understand.
The cards will have recipes that use the produce available at the farmers market
and include notes on which vegetables are a good source of specific vitamins and
minerals. The pamphlets will contain health information regarding relevant diseases
and include information on food choices for those diseases.

C. Nutrition Education Classes

In order to further discuss nutrition-related topics with the target group, our team
will host nutrition education classes at the community farmers market, the local
food bank, and the Migrant Farm Labor Center (if permitted by the residents). These
classes will be taught by nutritionists along with translators as necessary. Methods
will be interactive and demonstrative (i.e. cooking demonstrations). The classes will
be a short 60 minutes, to accommodate the busy schedules of the target group, and
we will allow time for questions at the end to allow for more personalized
education. Topics may include education on health and how nutrition can affect that,
as well as food choices and preparation. Schedules of the classes will be posted at
the local food banks, farmers market, and other public locations.

D. Hydration Stations and Presentations

Due to high levels of manganese and iron in the water, residents in Whoville, believe
it is unsafe to drink the water. Instead, they consume sweetened beverages and
bottled water to meet their daily fluid needs. As a result, our team proposes to
 install 60 hydration stations with filters to improve the taste and quality of the
water. These stations will allow members of the target population to have constant
access to water. The hydration stations will be installed in areas where most
residents live and socialize, such as the food banks, public schools, and other
community locations. In addition to the hydration stations, our team will invite
experts who work at the regional water control quality board, to assure residents
that the water is drinkable and doing so will have no harmful side effects.

MONITORING AND EVALUATION

A. Community Farmers Market

To evaluate the effect of the farmers market, we will collect data regarding the
number of people from the target group who visit the market, how much money is
being spent at the market, and record what is being sold. Additionally we will
monitor data collected by the volunteer doctors and interns. We will track how the
data changes over time and monitor our intervention progress as well as make
changes according to data we receive.

B. Informational Cards and Pamphlets

To monitor the effectiveness of the informational cards and pamphlets, our team
will keep track of how many pamphlets and cards have been distributed to
members of the target population. Then to determine if the recipients are actually
reading these pamphlets and cards, our team will host games at the farmers market
that require the knowledge from the pamphlets and cards. As an incentive to read
and learn the information, prizes will be available for participants. Prizes may
include water bottles that we either buy using grant money or receive from donors,
as well as small trinkets like pens and key chains.

C. Nutrition Education Classes

The first way our team will monitor the effectiveness of this class is to monitor
attendance by having the people attending sign in. Second, to monitor the effect of
the nutrition education classes, the teacher will give quizzes or play in class games,
such as Jeopardy, that test for knowledge, but are more entertaining. We will also
ask for feedback from participants in the class to get their opinion on whether the
class has been helpful. Lastly, our staff will use this opportunity to gather data on
the health status of the target population by having attendees fill out a
questionnaire about height, weight, age, and gender, as well as completing a food
 frequency survey. We will gather this information to help us determine if we our
interventions are having an effect on diet and health.

D. Hydration Stations

The fountains have built in green ticker counters that record the number of plastic
bottles saved from landfills. To monitor the use of the hydration stations, our team
will record these numbers monthly to analyze usage and determine how much
water was consumed by the community.

SUSTAINABILITY

A. Community Farmers Market

Our team will initially be in charge of set-up decisions but, as mentioned previously,
we will recruit members of the target population as leaders for the farmers market
board. By getting the members of the target group involved in the farmers market,
we hope that they feel empowered to make decisions that will benefit their
community. This should ensure the long-term success of the farmers market since
the market will be run by the community for the community. With growing
popularity of the market, we hope that the families in Whoville will continue to
attend and support the market.

B. Nutritional Information Cards and Pamphlets

We anticipate that the information given to the people of Whoville through the
information cards and pamphlets will be applied to their lives and therefore not
forgotten. Ideally the cards and pamphlets will be kept, but if lost, the information
will still be available on our website.

C. Nutrition Education Classes

The nutrition education classes will be designed to continue in the future after the
2-year program has ceased. We will do this by teaching classes specifically aimed at
training community members how to teach basic nutrition concepts to the rest of
the community. We also hope that the nearby hospital will continue to send
volunteer physicians, nurses, and interns to continue nutrition and health education.

D. Hydration Stations and Presentations

 After installation, the hydration stations only require filter changes and occasional
maintenance as needed. To make sure the stations are maintained, our team will be
looking to the organizations in the building in which they are installed to continue
maintenance. Our team will reach out to them before installation to sign contracts
saying that our organization will pay for the machine, installation, and maintenance
for the first two years, and the organization will take over after that period.

IV. PROJECT TIMELINE

A. Community Farmers Market

a. June 2015:
i. Obtain proper licensing and permits to start farmers market. Pay any
fees due with grant money.
ii. Start recruiting local farmers, businesses and members of the
community to participate and sell produce at the farmers market.
iii. Contact larger companies that might be willing to donate items (i.e.
equipment, bags, paper, water bottles, etc.) for free.
iv. Contact the local hospital to invite them to send volunteering doctors,
nurses, and/or interns to host a free clinic once a month.
v. Start looking for a location for the market (outdoors for summer and
indoors for winter).
b. July 2015:
i. Secure the indoor and outdoor location. Pay any fees (i.e. deposit)
with grant money.
ii. Continue recruiting local farmers, particularly those from the target
group, for leadership roles and vendor participants. Have at least 10
vendors by the end of July with established contracts.
iii. Obtain proper equipment (i.e. tables, chairs, booths, EBT services,
etc.) using grant money.
iv. Start advertising the farmers market which will start in August 2015.
1. Fliers in public areas (i.e. local food bank, liquor stores).
2. Public Service Announcements on the radio
3. Social Media (Twitter, Facebook, Instagram, etc.)
4. Have local media add the Grand Opening date to the calendar
in the newspaper
v. Confirm volunteer agreement with the local hospital through a
contract.
c. August 2015:
i. Host first farmers market by the second week of August 2015.
 1. Keep track of vendor receipts.
2. Obtain feedback from vendors and participating community
members.
3. Pass out nutritional information cards and pamphlets.
ii. Analyze raw data and make any modifications for the next farmers
market schedule for the last week of August 2015.
iii. Start planning for new features to gain more popularity.
1. Develop a calendar of cultural holidays to host a special market
that weekend.
iv. Send thank-you letters to companies who donated items in order to
foster a positive long-term relationship with them.
d. September 2015
i. Start hosting farmers markets every weekend (instead of just twice a
month).
ii. Continue obtaining raw data and feedback, passing out nutritional
cards and pamphlets, and making changes as necessary.
iii. Start implementing new features to farmers market with grant
money:
1. Hosting games with prizes to encourage target group to read
nutritional cards and pamphlets.
2. Appropriate nutrition classes that incorporate information of
the produce from the farmers market
3. Free clinics provided by local hospital to do basic health check-
ups, anthropometric measures, and vitals.
iv. Recruit more members of the target group to be in a leadership
position or be a vendor. (Minimum of 5 desired.)
e. October 2015
i. Continue hosting farmers markets every weekend.
ii. Continue obtaining raw data and feedback, passing out nutritional
cards and pamphlets, and making changes as necessary.
iii. Continue hosting the free clinic and other new features.
iv. Host a farmers market celebrating any cultural holidays/occasions.
v. Continue fostering business relationship with companies who donate.
1. Invite them to donate more since the holidays are coming up.
f. November 2015
i. Finish planning indoor farmers markets. The first one is schedule for
December 2015.
1. Research cultural holiday traditions that can be implemented
in the markets.
 2. Publicize the change of location in public areas including
schools, food banks, current outdoor location, etc.
ii. Continue hosting farmers markets every weekend.
iii. Continue obtaining raw data and feedback, passing out nutritional
cards and pamphlets, and making changes as necessary.
iv. Continue hosting free clinic and other popular features.
v. Continue fostering business relationship with companies who donate.
g. December 2015 - February 2016
i. Host indoor farmers market.
1. Gather feedback and plan to make adjustments as necessary.
ii. Continue obtain raw data and feedback, passing out nutritional cards
and pamphlets, and making any changes.
iii. Continue hosting free clinic.
h. March 2016
i. Plan for moving the farmers market back outdoors.
ii. Train more community members to be a part of the leadership
committee.
1. Involve younger members of the community too.
iii. Continue other activities as scheduled.
1. Obtain and analyzing raw data
2. Securing vendors and donations.
3. Free clinic
4. Nutrition cards, classes, and demonstrations.
i. April 2016
i. Host outdoor farmers market as usual.
ii. Plan to host farmers market more frequently (i.e. twice a week).
iii. Continue other activities as scheduled.
1. Obtain and analyzing raw data
2. Securing vendors and donations.
3. Free clinic
4. Nutrition cards, classes, and demonstrations.
iv. Train community members in the leadership committee on the
operations of running the farmers market.
j. May 2016
i. Host farmers market twice a week.
ii. Continue other activities as scheduled.
1. Obtain and analyzing raw data
2. Securing vendors and donations.
3. Free clinic
4. Nutrition cards, classes, and demonstrations.
 iii. Leadership committee does a majority of the planning of Junes farmer
markets. Assist very little unless necessary.
iv. Hire community volunteers to assist with market operations.
k. June 2016
i. Leadership committee hosts their first farmers markets.
1. Provide feedback and suggestions.
ii. Continue other activities as scheduled.
1. Obtain and analyzing raw data
2. Securing vendors and donations.
3. Free clinic
4. Nutrition cards, classes, and demonstrations.
l. July 2016 - May 2017
i. Leadership committee continues to plan and coordinate farmers
market.
1. Make and prepare budget.
2. Plan and incorporate fun events (may or may not be culturally
related).
3. Gather more community volunteers to assist with nutrition
classes and demonstrations.
ii. Continue other activities as scheduled.
1. Obtain and analyzing raw data
2. Securing vendors and donations.
3. Free clinic
4. Nutrition cards, classes, and demonstrations.
m. June 2017
i. Prepare leadership committee to officially withdraw.
ii. Review statistics and determine if this intervention was successful.

B. Nutrition Education Classes

a. June 2015
i. Start recruiting nutritionists or other health professionals who would
like to teach classes
ii. Contact local food banks and other community centers about the
locations and fees of hosting nutrition education classes
iii. Design the structures of the classes: presentations, interactive
discussions, and demonstrations of food preparation
iv. Create lesson plans (i.e. topics of discussion)
b. July 2015
i. Finish the recruitment of nutritionists or other health professionals
ii. Confirm the locations and fees of nutrition education classes
 iii. Nutrition education classes and related materials, such as handouts,
presentations, and demonstrations are fully prepared according to
lesson plans
iv. Advertise nutrition education classes through posting fliers at
community centers, food banks, farmers market, and buildings where
hydration stations are built, etc., and announcing information about
nutrition education classes through social media, such as Facebook,
Twitter, etc.
c. August 2015
i. Host the first nutrition education class by the third week of August
ii. Get feedback from participants through discussions at the beginning
of class and surveys
iii. Continue advertising nutrition education classes through the methods
described above
iv. Start implementing the classes based on the feedbacks received from
the participants, i.e. topics, lesson structures, etc.
d. September 2015
i. Host nutrition education classes that are offered at different locations
within the community
ii. Implement classes monthly based on the participants feedbacks
iii. Experiment with one-on-one advice meetings with participants by
request
iv. Start giving out bi-monthly quizzes or have participants play jeopardy
games to test
their knowledge and how much they learn from each class
e. October 2015-June 2017
i. Adhere to monthly evaluation of the classes: class attendance,
participants knowledge on learned topics from the quizzes and jeopardy
games, and health status data from each participant
ii. Adhere to monthly class implementation based on the feedbacks of
participants: i.e. changes in class structures, lesson plans
iii. Continue with one-on-one advice meetings if the meetings proved to be
successful. The one-on-one advice meetings are held once a week based
on the availabilities of the nutritionists, staffs and participants.

C. Nutritional Information Cards and Pamphlets

a. June 2015
i. Brainstorm and design the information, such as recipes, nutrition concepts,
etc. displayed on the nutritional information cards and pamphlets by
consulting nutritionists and others staffs
 ii. Determine the production and distribution of these nutritional
information cards and pamphlets
iii. Research the primary languages used in Whoville, CA to convey the
information on the nutritional information cards and pamphlets in
efficient manner
b. July 2015
i. Complete the information displayed on the nutritional information
cards and pamphlets
ii. Complete the discussion of the production and distribution of these
nutritional information cards and pamphlets i.e. cost, staff members, site
and time of distribution, target population, etc.
iii. Distribute the first nutrition information cards and pamphlets by the
fourth week of July and answering nutrition related questions
iv. Receive feedbacks from residents
c. August 2015-June 2015
i. Adhere to monthly implementation of the information displayed on the
nutritional information cards and pamphlets i.e. various topics, recipes
regard to the local produce at the farmers market
ii. Adhere to monthly discussions between nutritionists and staff members
regarding to the content of the nutritional information cards and
pamphlets and feedbacks from residents
iii. Distribution of the nutritional information cards and pamphlets twice a
week at the farmers market and answering nutrition-related questions
iv. Adhere to monthly evaluation of the quantity and quality of these
nutritional information cards and pamphlets, such as hosting games that
test their knowledge based on the content displayed on the cards and
pamphlets. Then make adjustments accordingly as mentioned above.

D. Hydration Stations
a. June 2015
i. Talk to local organizations about installing hydration stations in their
buildings (government buildings, community buildings, schools, Food
Bank, WIC, etc.)
b. July 2015
i. Establish necessary contracts for payment of maintenance fees
ii. Order hydration stations
iii. Make announcement to community about their installation and
benefit
1. Social Media
2. Public Service Announcement on the radio
 3. Post signs in the buildings in which they are installed
c. August 2015
i. Installation of hydration stations
ii. Promote use of them at the farmers market (i.e. giving away reusable
water bottles at the market)
d. Monthly - after installation
i. record green ticker number to track usage
1. Until June 2017
e. Every four months after installation (i.e. December 2015, April 2016, August
2016, December 2016, etc.)
i. maintenance (i.e. water filter replacement)
1. Until June 2017

V. BUDGET

Salaries and Benefits of Staff Members:

- Employment of nutritionists: $50,000/year for 1 nutritionist, 10 nutritionists
- total $500,000/year
- Staffs from regional water quality control: $23,000/year for 1 staff, 3 staff
- total $69,000/year
- Other staffs (i.e. analysts, technicians): $30,000/year for 1 staff, 6 staffs
- total $180,000/year
Total: $1,498,000

Farmers Market Production Fees:

- Equipment (i.e. EBT equipment, SNAP, tables, chairs etc.)
- Location rental fees
- Certification/permits
- Promotion/advertising: design and printing of flyers
- Transportation
Total: $ 560,000

Recruitment of Famers/Local Businesses:

- Incentives (i.e. discounts, thank you cards/gifts/events)
- Transportation
- Contract notary/legal fees
Total: $325,000

Production of Nutritional Information Cards and Pamphlets:

- Design (nutrient content)
 - Translate content in several languages
- Print and distribute
- Transportation
Total: $27,000

60 Hydration Stations:
- installation of 60 hydration stations is $69,000 for the first year
- maintenance and changing of filters cost $21,000 each year
Total: $90,000

Nutrition Education Classes:

- Materials (i.e. handouts, free samples, ingredients for demonstrations)
- Location rental, if applicable
- Technology purchase/rental (i.e. laptop, projector, etc.), if applicable
Total: $80,000

Evaluation of the Program:

- data collection and analysis
- incentives to have target group fill out survey
Total: $420,000

Expenditure Category Fund Request

Salaries of Staffs $1,498,000

Farmers Market Production $560,000

Recruitment of Farmers/Local Businesses $325,000

Production of Nutritional Information $27,000

Cards and Pamphlets

60 Hydration Stations + Maintenance $90,000

Nutrition Education Classes $80,000

Evaluation of the Program $420,000

Total $3,000,000
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