Partner Feature: Joe Dake
Chair/Professor, University of Toledo
Dr. Joseph Dake was born and raised in Toledo, Ohio, and received all three of his degrees locally – a bachelor’s degree in psychology from the University of Toledo (UT), a master’s of public health from a consortium program consisting of the University of Toledo, Bowling Green State University and the Medical College of Ohio, and a PhD in health education from UT. He began his career at Wayne State University in Detroit then later moved to his alma mater. Married for 15 years, he and his wife, Tina, have two sons (11-year-old Lucas and 14-year-old Andrew) who are budding scientists. He says they love to play family games from ping pong to board games to cards.
GSCN: When did you first begin working with the Center, and in what capacity?
Dake: I began working with GSCN in the Fall of 2015 after UT and GSCN were both competing for the same funding opportunity from ProMedica. After evaluating both grant submissions, ProMedica requested that UT and GSCN work together to accomplish the grant goals.
GSCN: Describe our partnership and the benefits you see from it.
Dake: Prior to starting, it was strange to be asked to collaborate with an out-of-state agency with whom we were originally competing for the same evaluation contract. However, it quickly became evident that it was an excellent partnership. While both UT and GSCN have expertise in evaluation, we both brought different, complementary facets to the table. GSCN had a stronger foundation in the area of food insecurity and needs assessments around nutrition issues. UT brought the knowledge of the local area, community partnerships, and managed much of the actual data collection. Together, we are using the data to answer the evaluation questions and to generate additional research questions.
GSCN: Why do you think it is important to evaluate projects like Market on the Green?
Dake: There are numerous projects that focus on improving the health and well-being of the individuals within a community. Unfortunately, it is unknown whether many of these programs are effective. With the limited funding available to address the myriad public health needs, it is important that we are using those resources in the most efficient manner possible. Well-designed and -conducted evaluations help to determine whether projects like Market on the Green are accomplishing their objectives. It also helps to provide information on how a program could shift in order to better meet the needs of the community with the available resources. These well-designed evaluations also serve to inform the scientific community when the results are published and presented. There is no need to “reinvent the wheel.” Part of being efficient with our resources is to ensure that we learn from the work of others, build upon that work, and contribute to the existing knowledge base through appropriate dissemination of our own work.
GSCN: What insights do you hope to glean from the evaluation?
Dake: Our partnership is exploring the local impact of a nonprofit grocery store (Market on the Green) being placed in a food desert. Additionally, the facility (ProMedica Ebeid Institute) which houses Market on Green will be offering nutrition education, cooking classes and financial and employment coaching. The outcomes that are being evaluated include changes in dietary behaviors, food access and affordability, and perceptions of the local neighborhood. These outcomes are being explored by a variety of factors including income, race, age, sex, housing, employment and use of nutrition assistance programs. In summary, we want to be able to share how impactful Market on Green and ProMedica Ebeid Institute are on the health and well-being of the local community.
GSCN: Is there anything about our partnership that makes this project unique?
Dake: The unique aspect of this partnership lies in the synergistic relationship that has developed between UT and GSCN even though we are located 700 miles apart. All of the staff on both sides seem to share the same passion for evaluation and research dissemination. While I have been involved in numerous program evaluations, this partnership with GSCN has been very different yet extremely positive. I hope to continue to work with them beyond the timeframe of this current project.
GSCN: What food philosophies or rituals have you instilled in your life?
Dake: About two years ago, I made a life change around nutrition. I saw my weight continuing to increase despite no perceived changes in my diet or physical activity. It was obvious that my previous behaviors of eating until I was full and drinking multiple cans of Mountain Dew daily were not doing me any favors. I decided to change to a new style where I eat until comfortable, eat many more fruits and vegetables, and eliminate all pop and caffeinated beverages from my diet. This relatively simple change has resulted in more than 20 pounds of weight loss and a more positive trajectory for my own personal health.
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Services Feature: Longitudinal Study
PARTNERS: ProMedica’s Ebeid Institute (funder and intervention implementer) and University of Toledo (evaluation partner)
PROJECT: Evaluation of the Ebeid Institute’s nutrition and economic impacts on a low-income neighborhood in Toledo, Ohio
 ProMedica is a nonprofit health care system with locations in northwest Ohio and southeast Michigan. Established with a donation to ProMedica by philanthropist Russ Ebeid, the ProMedica Ebeid Institute opened a healthy food market in Toledo’s Uptown neighborhood, classified as a food desert due to its lack of ready access to fresh, healthy and affordable food. Market on the Green opened in the Ebeid Institute building in December 2015, and the site will also host community organizations’ services such as healthy cooking and nutrition classes, financial literacy programs, job training and others.
The Gretchen Swanson Center for Nutrition and partners at the University of Toledo are leading a three-year longitudinal study to identify the nutrition and economic impacts the Ebeid Institute has on the Uptown neighborhood and its surrounding area. Measures included in the Ebeid Institute study include food insecurity, hunger coping, diet, food shopping behaviors, economic factors, and knowledge and skills related to nutrition, cooking, budgeting and employment.
A longitudinal study follows the same group of people over time with multiple instances of collecting data. Many studies are cross-sectional; collecting data at one point in time. The primary advantage of using a longitudinal design is that it allows researchers to make a stronger case for cause and effect, compared to cross-sectional study designs. Specifically, to prove the cause happened before the effect. Cross-sectional studies can only show that two factors are related, which is important, but they cannot prove for certain that one happened before (and therefore caused) the other.
 In order to plan for long-term study participation and participant attrition for a longitudinal study, a good retention strategy needs to be developed from the beginning. Extensive contact information (including cell phone, home phone, e-mail addresses, mailing addresses, social media and friend/family contact information) is collected initially and then updated every three to four months. Also, communication is regularly shared with participants about the study, and incentives such as gift cards are provided for their participation. Constant communication and updates are time intensive when maintaining a large group of people.
Participant recruitment differs for longitudinal studies because a lot of personal information is captured upfront, which can be uncomfortable for some individuals. Also, potential participants are sometimes deterred when they learn about requirements to participate more than once over the course of the study timeline. Therefore, initial recruitment is more time consuming and challenging than for other types of studies.
One of the first steps in beginning any evaluation study, including longitudinal, is to create a theory of change, or logic model. The components of the intervention (in this case, the services offered by the Ebeid Institute) are identified, as well as their expected outputs. For example, an output could be the number of people served through the job training program. Outputs should lead to outcomes – which are the measures listed earlier (food insecurity, hunger coping, economic factors, etc.). If designed well, researchers can be confident that changes are happening as a result of the intervention rather than unrelated outside factors.
This past summer, study participants were recruited and data for the Year 1 baseline was collected. Two additional data collection points are planned for summer 2017 and summer 2018. Yearly reports will be written for the Ebeid Institute, including a baseline characteristics report. In this report, study participant needs are being reviewed in order to adjust programming offered at the Ebeid Institute. Needs were identified through surveys from residents of the Uptown Toledo neighborhood, interviews with a portion of these residents, and grocery store receipts collected and shared by some of the residents. For example, needs may include low utilization of Supplemental Nutrition Assistance Program (SNAP) benefits (from survey responses), less healthful grocery shopping patterns (from grocery store receipts) and specific recommendations for improvement (from resident interviews).
The Year 1 report was completed last month, and participant contact information will be updated prior to next summer’s data collection.
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Evaluation of Three-Year Omaha Hunger Initiative Ends
 The Omaha Plan: Child Hunger Ends Here project was a three-year, multi-stakeholder, collective impact approach to reduce childhood hunger and food insecurity in the Omaha metro area. The initiative, funded by Conagra Brands Foundation (formerly Conagra Foods Foundation), was launched in 2014 and concluded in December 2016 with the Center serving as its external evaluator.
Over the three-year period, the evaluation took a two-pronged approach – an evaluation of the impact of partner initiatives as well as an overall evaluation.
PARTNER IMPACT
The multi-stakeholder effort included five partners, each doing work in the community in their respective areas of focus, with the shared goal of reducing childhood hunger in Omaha. Highlighted below for each partner is a selected issue and success that can be attributed in part to the Omaha Plan initiative.
Food Bank for the Heartland
Issue: Many children rely heavily on the National School Breakfast and Lunch Programs for the majority of their nutrition and calories. Children and families are most susceptible to food insecurity and hunger during out-of-school times.
Success: In 2015, Food Bank for the Heartland helped serve 62,191 after-school meals and 46,386 summer meals at community locations, and distributed 171,728 backpacks for weekend food.
The Hunger Collaborative
Issue: There are well over 100 food pantries in the Omaha metro area. This over-saturation can lead to duplication of services and incomplete referrals where clients are not getting the resources they need most.
Success: Three of Omaha’s largest hunger-relief organizations formed a collaborative, hired a shared employee, developed a shared client database, and now utilize a shared truck to distribute food. Referrals between organizations can now be tracked, and the streamlining of resources has allowed the collaborative to significantly increase their meals served.
Omaha Public Schools
Issue: Low-income children face multiple barriers to getting to school on time, which often means they go without breakfast. Being hungry at school can have negative effects on attention, behavior, attendance, and as a result, academic performance.
Success: Approximately 50 Omaha Public Schools elementary schools have implemented grab-and-go breakfast programs, where children can “grab” breakfast items and eat during the homeroom period.
Douglas County Health Department
Issue: Food-insecure families may prioritize less healthful foods over fresh fruits and vegetables in order to best stretch their food budgets. Poor diets can contribute to a vast array of poor health outcomes.
Success: In 2016, the Douglas County Health Department implemented a grocery pilot program whereby electronic benefits transfer (EBT) card users who purchase a $5 produce bag receive a second produce bag at no additional cost. The program will continue in 2017 and expand locations.
Creighton University Financial Success Program
Issue: Lower income families are often forced to make financial trade-offs when they are low on resources. For example, healthful food may be less of a priority when facing utility shut-off notices or burdened by medical bills.
Success: In 2015, the Creighton University Financial Success Program was able to secure debt consolidation loans for 13 of its clients, secure memorandums of understanding with seven utility companies for level-payment plans and coordinate other similar agreements.
OVERALL IMPACT
As part of the overall evaluation, the Center also conducted a cross-sectional survey. Participants were recruited from libraries, food pantries, school events and other community locations, primarily along or near an area referred to as the 24th Street Corridor, where many of the partners’ interventions converge. Survey measures included demographics and household characteristics, food security status, hunger-coping behaviors, dietary patterns, household chaos, participation in Omaha Plan interventions and participation in food assistance programs.
Approximately 300 individuals were surveyed during each data collection period. A large majority of participants were female, and about one-third of participants reported annual household incomes of $5,000 or less across all three years. The sample was ethnically and racially diverse, with a large representation from the African American and Hispanic communities in Omaha.
As previously mentioned, food security status was assessed for all participants using a six-item screener developed by the U.S. Department of Agriculture. Based on responses, participants were stratified into one of four categories – high food security, marginal food security, low food security and very low food security. One exciting preliminary finding from the Omaha Plan evaluation is that across the three years, the percentage of households with very low food security decreased from 41% to 33%, and the percentage of households with high food security increased from 15% to 19%.
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FRESH Foods Study Data Collection Training
This week, Executive Director Amy Yaroch, PhD, Research Scientist Eric Calloway and Project Manager Katie Stern are conducting a data collection training for food banks participating in the FRESH Foods study in San Diego, Calif. These food banks will be field testing a survey (developed by Center staff) at some of their food pantries. The survey will assess diet, perceptions, attitudes and health indicators of food pantry clients. The participating food banks are Atlanta Community Food Bank, Food Bank of Western New York and Feeding San Diego. Research partners on this project are University of California San Francisco and Feeding America, and the project is funded by the Centers for Disease Control and Prevention.
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Brian O’Malley is chef-instructor and executive director of the Institute for the Culinary Arts at Metropolitan Community College in Omaha. O’Malley was executive chef at Vanilia in Greece and manager-instructor at the New England Culinary Institute in Montpelier, Vt. Among other responsibilities at Metro, he is lead chef-instructor for the SAGE student bistro, coordinates student experiential travel, and is developing an open kitchen program with workshops, studio time and other activities for the general public.
