The Garden Box Project Mid Internship Report

      Many city residents experience a lack of accessible fresh, organic, and local food options. In 2018, the state of California, Alameda County community food bank, measured a rate of 9.1% experiencing food insecurity, which roughly translates to over 150,000 residents.¹ One out four San Francisco residents experience food insecurity, which translates to 337,000 residents living below either 100% or 200% of the federal poverty level, with the highest poverty concentration among African Americans, Native Americans, and Pacific Islanders.² Although correlation has been shown that consumption of fruits and vegetables increases with garden participants, very few studies show direct impact from community garden output; a study in San Jose measured the production output, which averages at 0.75 pounds of fruits and vegetables per square foot of a community garden.³ Therefore, this leads to the question of whether a single planter box or a 5 feet x 10 feet section of a community garden is enough for a family of four or potentially more, and what produce ought to be grown based on its ability to regenerate.

Past studies show that people who garden tend to consume more fruits and vegetables, meet nutrition health diet recommendations, and reduce risks for diabetes, cardiac disease, and obesity. ^4,5 Healthy Black Families Inc. (HBF), in Berkeley, California, is a not for profit organization that seeks to bring equity to underserved families impacted by systemic institutional racism. HBF started in 2002, with the Black Infant Health Program as a community advisory board with the mission “to educate, engage, and advocate for the holistic growth and development of diverse Black individuals and families.”⁶ Specifically, HBF’s work focuses on bringing community members of traditionally disadvantaged backgrounds to shop at the local farmer’s market, cooking demonstrations, and nutrition education. Hence, the vision of HBF is “a society that is fair, equitable, and just, particularly concerning Black individuals and families. Health equity is achieved when we no longer see health disparities based on race.”⁶ The board president and founder of HBF, Dr. Vicki Alexander, strive to achieve equity through advocacy and provide health services using the lens of equity and challenge institutional racism to narrow the gaps associated with socioeconomic disparities.  For example, Dr. Alexander led the sugar-sweetened beverage (SSB) tax or the soda tax in the city of Berkeley as a negative reinforcement for soda consumption. Madsen et al. recently report that those from traditionally disadvantaged backgrounds are more likely to purchase SSB from a corner store due to convenience than a large box store, like Safeway.⁷ This finding is an example of socioeconomic disparities. First, Convenience stores are within walking distance and preclude the need for additional transportation.⁷ Further, decisions to purchase SSB over healthier alternatives preys on the sugary beverage's perceived value as the value of bottled water is diminished when a person can obtain it relatively free from the faucet.

Besides nutritional benefits, there is a growing literature to demonstrate a relationship between participating in community gardening and positive mental health status. These findings are appearing in qualitative studies. Specifically, participants who regularly participate in community gardens report positive mental health attitudes, a sense of community connection, and better scores on the Patient Healthcare Questionnaire (PHQ).⁸  The PHQ 2 or 9 (PHQ-2/PHQ-9) is a valid and reliable questionnaire to assess mental health.⁸ In our (i.e., my preceptor and me) recent discussion with the San Francisco Parks and Recreation Department (SFPRD) for Community Gardens, Program Manager Ms. Mei Ling Hui emphasized the physical and mental benefits and needs based on her experiences of community gardens in the San Francisco neighborhoods.  Hence the need to determine garden participants' social determinants of mental health became apparent to my preceptor and me. The PHQ 9 can be administered from the start with a PHQ2 follow up nine months or one year into a community garden program is a recommendation that can be included in my needs assessment for future study potential.

While methodologies to address the two recommendations are still developing, I will meet with additional stakeholders to gain qualitative and quantitative data to inform the needs assessment. The qualitative assessment focuses on garden managers, who manage and address daily needs at the site and are the primary contact for garden participants. Qualitative questions are open-ended, and its findings are expected to guide the quantitative portion of developing the participant’s survey. The second portion of the survey for the needs assessment is to collect quantitative data per response of the community garden participants. The study is a prospective cross-sectional design using a combination of Likert scale and ordinal ranking questions. The challenge is how the survey is to be administered. Initially, my thought was to have program managers email their participants to partake in an online questionnaire. However, a concern brought up by Mei Ling was that participants were over surveyed, and our questions may not be received warmly. My preceptor presented the idea of having focus groups so that participation and response would be easier to capture. Response from participants would also include a qualitative aspect to gather additional stakeholder input. Analysis of the compiled survey to determine the best recommendations for the four counties of San Francisco, Marin, Alameda, and Contra Costa. Marin County is the only county of the four with a previous needs assessment and will be used as a reference.
SMART objectives
            Although much effort has been made to maintain original time-bound deadlines, there have been slight delays. In November, though initially scheduled, I developed a Ghannt chart with my preceptor's guidance to keep scheduled objectives on track and group items from my student learning contract. Everything was on track until meeting with the SFPRD program manager, who provided extensive, invaluable knowledge, but suggested developing a different approach when surveying community garden participants. A focus group to collect diverse quantitative and qualitative data and capture better results. However, the recent shelter in place (SIP) affects this study as the city manages community gardens, and participants are harder to recruit to capture diverse stakeholder inputs response may be more challenging to capture.

Competency 1 - Describe the importance of cultural competence in communicating public health content. Several studies show that Black and Hispanic communities tend not to garden and intake 20% fewer fruits and vegetables. ^2,4 Using demographic information and mapping locations of each garden, the needs assessment can provide an overview of potential future garden locations. The needs assessment can provide recommendations such as encouraging private, not for profit organizations like the YMCA and the Boys & Girls club to participate and strategically plan for new gardens, landscape planning, and local park remodeling.

Competency 2 - Assess population needs, assets, and capacities that affect communities’ health. City or county managed community gardens are in high demand and have a low participant turnover rate. Some participants have been known to wait up to a year or longer for a community garden plot. However, a previous study showed that White and Asians are more likely to be involved with community gardens resulting in Blacks and LatinX disconnected from community gardens, indicating a racial disparity that needs filling.⁴ Cultural centric community gardens are essential and can benefit from safe space community gardens like East Oakland Black Cultural Zone Collaborative, which provides food education through pipelines and environments that meet the needs of the community at their level. ⁹ A mapping analysis will be a part of the needs assessment because it showed that nearly three-fourths of the community gardens are located in the city's southeast portion in a data shapefile by SFPRD. The other part of San Francisco community gardens are decorative, but it could be a mental health aspect like grieving for a passed family member. It may be possible that those regions may not have food accessibility concerns or a community garden group policy. One aspect I have noticed while researching community gardens is that community gardens' location and concentration seem to follow property development patterns. Cities that have single-family homes seem to have fewer or one city managed community garden. However, cities like Oakland, Berkeley, and San Francisco have numerous multifamily housing like apartment complexes that tend to have more community gardens. Unfortunately, no study on the correlation between housing type and community gardens has been done and is based on personal observation while achieving this competency.

Competency 3 - Propose strategies to identify stakeholders and build coalitions and partnerships for influencing public health outcomes. The stakeholders are critical as they help guide many of the city’s needs. Current City of Berkeley Mayor Jesse Arreguin helped push such partnerships in 2017 by waiving permits and encouraging property developers to create residential rooftop community gardens and permit community and communal gardens on private property to increase community access. ¹⁰ The strategy is to interview garden managers to obtain qualitative data and quantitative data from garden participants to help identify best partnerships to grow community gardens to affect public health outcomes, especially among people of color.

Competency 4 - Interpret the results of data analysis for public health research, policy, or practice. Current policy practices have made incredible efforts to improve fresh food consumption, but the mental health aspect was lacking. In the next few weeks, I will finalize my questions and email them to all garden managers. I will analyze the managers’ responses to identify themes that will be used to inform the needs assessment. Participant questions may be setup as focus groups and record results. I plan to reach out to city of Berkeley Mayor Jesse Arreguin on the continuation of their 2017 policy proposal to waive permit fees for garden development.¹⁰

Competency 5 - Select communication strategies for different audiences and sectors. As previously mentioned, garden participants have been excessively surveyed, which means we need to approach it more differently. Focus groups in a town hall setting and giving people a voice to comment are methods to increase participation. Analysis of this needs assessment will be provided. Garden managers and city staff will want to know how best they can serve and need analysis and supported data information for future planning and project study potentials.

Competency 6 - Explain the strategic planning processes and the relationship to budget formulation and sustainability planning. Everything has a price, and it is through budget formulation that planning can be developed. Having a business degree background, I can ascertain the wholesale cost from tools, fencing, gear, and even seeds' cost.  However, Ms. Hui brought up an exciting endeavor that occurred organically amongst the community, an exchange program. Working with other gardening programs, home gardeners, and not-for-profit, simple things like exchanging seeds have grown to swap supplies and even grown food items. Ms. Hui mentioned that participants use the picnic tables provided at each site to leave extras for others and collect vegetables or fruit left for others. This unofficial swap created a nonfinancial swap program that is incredibly sustainable. Another recommendation was that instead of growing single item food items like cabbage, regenerative produce is recommended like kale or spinach, increasing food yield.

Challenges to say that they are not focused on COVID19 are incredibly difficult because the city or county manages most community gardens. Current shelter in place restrictions mandated by the State of California and counties have limited the availability of city or county employees who manage community gardens. Additional factors that have attenuated progress include in-home learning of children, which challenges availability and internet bandwidth to have uninterrupted meetings on both the stakeholder’s and my end. My preceptor also shares these same concerns.

Reference:

1. Hunger & Poverty in Florida | Map the Meal Gap. Feeding America. http://map.feedingamerica.org/county/2018/overall/california/organization/alameda-county-community-food-bank. Published 2017. Accessed May 29, 2020.
2. Department of Public Health - Food Security Task Force. FSTF-2018-Assessment-Of-FoodSecurity. https://www.sfdph.org/dph/comupg/knowlcol/FSTF/default.asp. Published 2018. Accessed December 28, 2020.
3. Algert SJ, Baameur A, Renvall MJ. Vegetable output and cost savings of community gardens in San Jose, California. J Acad Nutr Diet. 2014;114(7):1072-1076. doi:10.1016/j.jand.2014.02.030
4. Kegler M, Prakash R, Hermstad A, Williamson D, Anderson K, Haardörfer R. Home gardening and associations with fruit and vegetable intake and BMI. Public Health Nutr. 2020:1-6. doi:10.1017/S1368980020001329
5. Alaimo K, Beavers AW, Crawford C, Snyder EH, Litt JS. Amplifying Health Through Community Gardens: A Framework for Advancing Multicomponent, Behaviorally Based Neighborhood Interventions. Curr Environ Heal reports. 2016;3(3):302-312. doi:10.1007/s40572-016-0105-0
6. Healthy Black Families Inc. https://www.healthyblackfamiliesinc.org/. Accessed December 28, 2020.
7. Madsen KA, Falbe J, Olgin G, Ibarra-Castro A, Rojas N. Purchasing patterns in low-income neighbourhoods: implications for studying sugar-sweetened beverage taxes. Public Health Nutr. 2019;22(10):1807-1814. doi:10.1017/S1368980019000375
8. Hartwig KA, Mason M. Community Gardens for Refugee and Immigrant Communities as a Means of Health Promotion. J Community Health. 2016;41(6):1153-1159. doi:10.1007/s10900-016-0195-5
9. Tyska J. New Black Cultural Zone helps East Oakland neighborhood thrive. Bay Area News Group. https://rootsclinic.org/new-black-cultural-zone-helps-east-oakland-neighborhood-thrive/. Published 2020. Accessed January 1, 2021.
10. Arreguin J. Community Garden Zoning. https://www.cityofberkeley.info/uploadedFiles/Planning_and_Development/Level_3_-_Commissions/Commission_for_Planning/2017-10-04_Item 10 Urban Agriculture_Complete.pdf. Published 2017.