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Hello, everybody, and thanks for being here. Welcome to the fifth Health Equity Webinar. I'm Sue Higgins, and I'm representing the three NIH funded research centers hosting this webinar from Montana State University in Bozeman. These are the Center for American Indian and Rural Health Equity, Montana INBRE, and the American Indian/Alaska Native Clinical and Translational Research Program. In offering this webinar we first acknowledge and honor with respect the Indigenous stewards on whose traditional territories MSU now stands, in whose historical relationships with the land continue to this day. MSU is located in the common hunting ground and made major traditional crossroads for plains Native Nations including Shoshone Nez, Perce Dakota, Salish, Crow, and Blackfeet. Now, we're really excited to welcome two experts to offer a presentation on a really increasingly critical topic here in Montana and elsewhere: food security. Dr. Carmen Byker Shanks will kick things off. Carmen joined the faculty at MSU in 2011 as associate professor of food and nutrition in sustainable food systems. Carmen is a CAIRHE project leader and co-directs the Food and Health Lab for research aims to develop evidence-based strategies in food environments that inspire individuals to eat better for the health of the population and the planet. She's especially interested in promoting healthy eating patterns positively impacting health outcomes and decreasing health disparities. She'll be joined by Dr. Michelle Grocke, a medical anthropologist who joined MSU in 2018 as an assistant professor in the Health and Human Development Department and as the health and wellness specialist for MSU Extension. In addition to teaching global health and health disparities classes on campus, Michelle's research focuses on assessing social-cultural determinants of health to inform appropriate community-based health interventions. Her current Extension projects include work to minimize prescription opioid misuse throughout Montana, equip Montana agricultural producers with tools to manage their stress levels, and design physical activity programs for older adults. Welcome to both of you. Carmen and Michelle, a few notes before we begin. Carmen and Michelle will present in sequence and then we ask you to hold all of your questions till the end. We'll have plenty of time for questions and answers on that note please use the Q&A function I think most of you will see it at the bottom of your screen to enter questions and we'll do our best to feel them the chat function is mostly disabled but you can post any technical difficulties there we're recording this entire webinar and so if you missed something we'll send a link to all who registered and we'll also be placing a link to this webinar on our respective web sites for you access so thank you so much for joining us today I know many of you are involved all day long now sitting in zoom meeting so we're really glad you joined us for this one with that um I will ask dr. Carmen biker shanks to please begin and I'm gonna unmute her here we go and she's gonna share her screen thanks everybody can everyone hear me yes okay hi everyone thanks sue for that really nice introduction I will I will move past the introduction of Michelle and myself and introduce the webinar that we're here to give you all today thank you for joining us today where our webinar focuses on exploring the impact of Kovan 19 on food security and health behaviors in Montana and our overall goal is to build a public health system lots of two crises given the new challenges were facing so we want to tell you how we did this and go through some of the preliminary data that we have so far we collected data about the impact of the Copa 19 pandemic on Montanans health particularly as it relates to food security along with other connected factors of health behaviors such as physical activity and stress through a statewide survey and this is an online survey we chose this route because of the social distancing guidelines in place and we will go over the results of the preliminary results of the survey today we want to highlight that these results are preliminary as the kovat 19 situation continues the survey is still open we plan to keep the survey open until the beginning of phase 3 and as we don't know when that is we are unsure the exact date it will close but we do think it's really important that we share these findings now because the situation is happening now and many of you are in positions where you can address food security and health behaviors in your communities and places of work and at the end we really want to start a discussion with you all about how we can build a responsive public health system that supports food security and healthy behaviors in Montana now and during any public health crisis hoping another one doesn't happen again but we want to be prepared as these are preliminary results will say this down will say it at the end but please continue to share this survey there's a link on the screen as well as a link will be sent to you at the end of the webinar by your email address you registered with so two overall goals of the webinar today we want to discuss preliminary survey results with you and then based upon the data we want to talk about some recommendations with you all and build Strad think about what strategies we as people working in Montana can do to build a public health system that responds to the data that we've collected with that I'm gonna pass it over to Michelle hurry thanks so much Carmen and again thank you everyone on the call today for joining us I know everyone has really busy schedules so we need to surely appreciate it so before we dive into the data itself we want to just give a little bit of information about the demographics of the survey participants just so we all have some context moving forward so again all the results you'll see here today are presented and collected as of June 2nd 2020 and as of that day two days ago we had 1852 survey participants so we're excited about that number but still hope to hear from more folks and again we asked all adults from all 56 counties of Montana and all reservations to participate a next slide please you all right so again just a brief overview of demographics before we dive into the data so in terms of gender you'll see here on the screen that nearly 90 percent of participants identified as female so certainly in this next push for getting more responses we are looking to target more male participants we also had a few that responded as trans male trans female and a few respondents that identify as genderqueer in terms of ethnicity you'll see here on the table on the screen 91% of participants identify or are white non-hispanic we do have two percent Hispanic Latino or Spanish and two percent American Indian or Alaska native and we do know that six point five of Montana's current population is American Indians so we do want to see that number be a little bit more representative of the demographics today in Montana level of education so here we do see some a little bit more variability here you see on the pie chart that nearly 70 percent have completed four-year college degree university or higher but we have 16 percent of our participants that enrolled in some college but did not complete a degree some representation from those who completed a two-year junior community college or trade school equivalent and then some with high school equivalent or GED or less than high school terms of marital status we're looking at this as well to make sure we hear from a variety of folks from across the state so far with our participant 64% are married we do have representation from those that are not legally married but living with a partner those that are widowed divorced are separated and 15% of participants are single income ranges so we wanted to include this but with the caveat that because we're not you know done with collecting data we haven't crossed tabulated income ranges with household size yet so in order to see who is below at or above the federal poverty line we certainly need to do that so that is yet to come but just to give you an idea of income ranges of our participants you'll see that 977 respondents earn more than 50,000 per year but again after looking through preliminary data we do have a lot of larger households represented so we certainly look forward to doing this next step to see about you know work for folks stand in relation to poverty lines employment this one was really important especially since we're looking at impacts of COBIT on third security employment obviously plays a big role so here we did ask before the start of coab in nineteen what was your employment situation so you'll see that 59% were employed year-round in a job for more than 30 hours a week a lot smaller we have in the purple folks were not employed but they were looking for a job so that was only 1% actually so far we also have a variety of folks that were employed half-time in seasonal work or you know full-time student and those that you'll see in the blue all right so with that that was just again a quick overview of demographics and now I'm going to turn it over to Carmen to dive into the food security specific data we collected all right so this portion of the webinar is going to focus on food security specifically and to make sure that we're all working from the same definition I am going to discuss how we defined food security in the survey we use the USDA's definition as having consistent access to enough food for an active and healthy life and I included this chart on the slide to show you a study from the University of Arkansas that was recently published that took a representative sample of food in citizens in America and looked at food and security status by region and you can see Montana is in the blue region and food insecurity status is around 40% in the western region of the United States and it's above 34% in all regions of the US this is really alarming and one of the motivating factors of doing this work before coab in nineteen before the onset of koban nineteen food insecurity was slightly over 11 percent across the United States so you can see that a jump from 11% to between 34 and 41 percent is really alarming - what's happening to people's ability to having consistent access to enough food for an active and healthy life and so our goal is one of our main goals is really to figure out how we can address this alarming upshot in Montana specifically with public health systems that can immediately react to such prints so two crises such as this so when did we find we asked a set of household food security questions that are distributed by the USDA and we asked these to montanans and as this is preliminary you can see this this table isn't isn't graphically done yet but eventually it will be um so I'm gonna summarize it for you you can see that there are the questions on the left side and their response variables are often true sometimes true and never true um so going through an example question the food that my household bought just didn't last and we didn't have money to get more the participant the survey participant could have responded often true sometimes true or never true and you can see here before Koba 19 and during Koba 19 the data that we have so far shows that food insecurity is on the rise in Montana and food security is decreasing so if someone responded often true or sometimes true to any of these questions they would be classified as more food insecure if they responded never true to any of these questions they would be classified as more food secure so you can see in every one of these cases before cope in nineteen point eight five percent said that they were food insecure to this question and three percent after Cobin nineteen began stated that they were food insecure so on the other side of the graphic you can see that food security goes down from ninety-one percent to eighty five percent we found this trend in every single question on the household food security questionnaire and so we asked more questions to get to the bottom of what is really happy within households people are eating less because they're worried that they don't have enough money for food some people are cutting meals and there's definitely stress and worry about having enough money for nutritious meals so digging down further into what is happening in households we asked if anyone in their household received any of the following services in the three months before or during coveted 19 and we asked about several social or community programs you can see that snap use went slightly that slightly increased WIC which is the program for women infants and children slightly increased other social and federal programs such as SSDI SSI free and reduced lunch and those are the federal programs that increase slightly with the population on Tanith decrease slightly and then after-school our summer meals programs decreased slightly and we would say that's because the actor school programs have been significantly cut and then at the bottom there are more community-based services that people would engage in so food from food banks or food pantries we were surprised to see that people are relying on these resources less even though we hear a lot of news from our local food banks and food pantries as well as nationally that food banks and food pantries use is on the rise and so we definitely want to dig deeper into that and maybe increase our sample of food bank and food pantry participants food gifts from relatives or friends decreased we weren't really surprised about this because of social distance social distancing relying on alternative sources of food stayed about the same and farmers market or CSA use increased and we are not surprised about that either because in later questions we find that people are really concerned about their local food systems and local businesses so in the next slide we also ask people how they're supporting others as part of the COBIT 19 pandemic there's a lot of social support happening in different ways especially around helping local communities so donating food to a food bank helping with child care for someone else who still has to work donating money to local businesses and organizations donating money to families or friends donating food to a family or friend picking up and delivering groceries and essential supplies these are all pretty significant categories where we received at least 200 responses in in the ways that people are supporting each other we asked about how food acquisition was happening and so in these this set of questions we are basically grouped these questions together and asked people if their behaviors are around acquiring food or getting food decreased slightly just decreased no changes slightly increased or increased some that I would like to point out that you may have experienced in your own life or heard of happening in the community leaving the house for groceries uh by and large Kri so people are shopping less at the grocery store overall eating out less overall eating at other people's houses overall less taking away or picking up foods the largest response was decreased purchasing foods from online real online retailers overall did not see any changes in Montana which in other places are huge changes to food acquisition through online real retailers buying food out of fear or anxiety overall no changes and then then cut the next category that comes in pretty closely is a slight increase and then relying on others to get groceries for you overall no changes on this question is about exactly when people go to the grocery store where all the foods available that they wanted when they shopped and by and large most people said no all the foods were not available this we then asked which foods were not available and we feel that this is a question that can be directly addressed in our food system in our food supply many of the foods that people said were not available which this is called a verbal and it's a graphic that basically takes all of the responses and makes the most frequent responses the largest and so flour milk canned canned goods in general eggs vegetables bread rice yeast beans many of these products are shelf-stable or can be preserved in some way and so this is a really important finding for people who do source in the food supply or contribute to some sort of food supply it's at grocery stores or in food assistance programs or other places and the next one is about food consumption so really asking people about their own food consumption behaviors did they decrease slightly decrease have no changes have a slight increase or increase their behavior many people either had no changes or had a slight increase to stockpiling food cooking and that actually explains a lot of the food supply issues in the last slide many retailers and other food outlets weren't prepared for the stock cut the increase in stockpiling cooking food at home by and large this increased greatly eating fresh fruits and vegetables eating canned fruits and vegetables and eating frozen fruits and vegetables either saw no change or slight increase interestingly in the eating fresh fruits and vegetables the highest category was a slight decrease as there have been questions about the safety of the food supply and also going to the store less frequently it's harder to eat fruits and vegetables um other categories of interest there was a slight increase in people eating out of fear or anxiety wasting food there overall there was no changes or a slight decrease drinking alcohol overall there were no changes or a slight increase snacking the same so no changes or slight increase baking no changes or a slight increase and many people reported no changes to gaining weight or having a slight increase so by and large food consumption behaviors there there is are some things to address in terms of healthy eating behaviors and people's lifestyles rapidly shifted during the köppen 19 endemic and are still shifted so addressing patterns such as drinking alcohol gaining weight and continuing to cook healthy meals at home and eat fruits and vegetables are really important for the future and lastly in terms of food security we asked which of the following resources about food would be helpful for you and your loved ones during this time this graphic displays the resources that people responded to and they could check all that apply um you can see here I first want to highlight that many people really wanted advice on how to support local food producers and how to support local food businesses in Montana in the comments to this question there's huge concern about the local food system and what's going to happen to it and so this is something that local communities can immediately address the next was advice on home gardening something that our state Extension is really interested in doing and residents around the state are you know seeing a greater need for self sufficiency and wanting fresh fruits and vegetables for gardening information about food availability in my area as well as advice on how to reduce or prevent waste and food safety advice are others that rose to the top you know each of these categories had almost 100 or nearly 100 individuals wanting some sort of information that given our sample size is almost 2,000 people in Montana that's really a large representation of people wanting information about every single one of these categories given that food insecurity is increasing we were surprised that not as many people wanted information about federal food assistance programs and would like to find out more information about the motivation for not checking that box next I'm going to pass it over to Michelle who is going to talk about the complimentary health behavior data great thanks Carmen so as we mentioned before we asked a lot of questions like Carmen just reviewed that specifically had to do with food security but we also asked a slew of questions that were a little bit more general also asking folks about suggestions or you know things that they would do to help them through this crisis and so the first piece of data that I want to talk to you about and sorry I can't advanced from over here so Carmen if you could advance one over so we asked folks and this was specifically geared towards those that either never stopped working going to work or we're working in a setting that was deemed essential by the governor and so they were back to work kind of right after you know Kovac came to Montana and the question was what do you think could be improved to make your work environment safer and so you know these were qualitative responses so again just so you all know we didn't do a thorough thematic analysis but trying to group these into three categories so on the left you'll see a lot of things where community residents are really wanting their safety beach safety to be taken you know a bit more seriously requiring masks of either the employees and/or those going into the shop or business they're recommending that their temperatures be taken daily making gloves hand sanitizer additional cleaning products available so that really tells us that in a lot of settings these things were not are not happening and so that was a suggestion by participants the middle column is a little bit about you know try to group these in a category about how workplaces could be more flexible to make for a safer environment so we had many suggestions about adjusting hours to make social distancing compliance more realistic so for example you know having some people come in earlier and you know leaving earlier and another shift of workers kind of taking a later time to make that that physical distancing easier to do many folks question whether or not their job could be done from home but they were still being asked to go to work and the last thing was limiting the number of people allowed in a particular place of business so clearly since many people are saying these things again these are themes that we preliminary picked out these are some other suggestions that can help in terms of structurally making the situation a bit more safe and everything on the right has a bit to do more with communication from the supervisors so folks want more communication and they want faster communication and they want to see that a little bit more insurance that staff are complying with safety measures are occurring alright so the next two slides are similar in that we asked a similar question about a different component of health in this first one we asked participants whether the pandemic has made it a little or a lot more challenging than usual to get the same amount of physical activity as before and so 58% which you know it is quite a large number said it was either a little or a lot more challenging for them and so if you look on the left now these are direct quotes that we picked out but they really are representative of a lot of the sentiment that we heard as to why it's been more challenging so many participants are saying you know they normally go to a gym or fitness center or a pool and those have been closed so it's been harder to get the same amount physical-activity many responses having to do with having to you know take care of children with no child care being available and so really that person is juggling so many things often times juggling homeschooling their own work and so it doesn't really leave much time for themselves and that's where they see that physical activity piece fitting in and so that's been tricky for many lastly is this element of fear or anxiety we do live in a rural state there's lots of places to go outside and and get exercise but many people are still saying that they're fearful of going somewhere they normally do again for fear of not being able to physically distance and having to see more people that may feel comfortable with on the other side we did want to make clear though that I mean 58 percent said it was a little or a lot more challenging but that leaves the rest of everyone and just to give you all some idea about what was happening on the kind of the other side so for the folks that said actually it's been less challenging some of their responses were you know they're less busy so there's more time for physical activity unfortunately some of those were laid off but we'll be interested to look and some you know compiled and crosstab some of that data more thoroughly when we're done collecting data many people were very excited about working out at home getting physical activity at home via online videos that were at once for a cost and now have been posted for free and then again for more of our rural counties many people said it's just as easy as before to go out you don't see anyone and they can still stay active and again another quote about working out from home so this next slide and if those numbers before we're a little bit shocking to you this might be even more shocking but here we asked the same question but about whether or not the pandemic has made it a little or a lot more challenging than usual to maintain healthy relationships with family friends and coworkers and or coworkers and 78% so quite a majority said that this has been you know very tricky since the start of Cove in nineteen and if you look at the more challenging quotes again people are saying that the physical distancing component has made it so hard to stay socially connected many people don't feel safe visiting friends even in outdoor settings where risk is lower you'll see that many you know you look through these qualitative responses many people are just spending too much time are overwhelmed with online platforms and are saying that that's a challenge to keep up with social connections that way and this last one we found pretty telling this last quote on the Left people have different people having different viewpoints on the pandemic makes it hard so they're having a social relationship with a family member friend or co-worker who doesn't agree perhaps with directive coming down from this date or risk factor and having different viewpoints there is making it hard to maintain social relationships on the other side of the coin though we wanted to talk about the 22 percent who said it was less challenging just to show you the other slide again this could be you know just a bit of a change in perspective but first quote my relationships have not changed they have just been altered so a lot of sentiment kind of geared towards that the zoom:1 is funny because we see it on the one hand people are overwhelmed and saying it's not a substitute for face-to-face contact but then some people are saying it's been fun it's something new that I didn't do before and so kind of think goodness for technology these three last quotes on the right all have to do with phone video chat or zooms so those that are seeing less break in social connectivity are using technology and though the majority are certainly seeing their social ties becomes ever all right so these next two slides we did want to include some measure of psychological distress and so what we decided you know we also didn't want to make the survey too long so we decided upon the six questions so the K six Kessler psychological distress scale so this was first used by the US government's National Center for Health Statistics and it's validated measure it's been a widely used screener for mental health problems and the scale consists of these six questions so we asked it both before the start of COBIT and then after during so here you'll see before the start of Colvin how often do people feel nervous do they feel hopeless Restless or fidgety so sad that nothing could cheer them up did they feel that everything was an effort and worthless so you'll see those and we apologize that some of this is a bit small but if you look at all of the time I mean we had thousands of respondents and we see six people feeling nervous all the time three people feeling worthless all the time so quite positive responses we do have quite a bit more feeling these things a little bit of the time but if we switch to the next slide you'll see this change now since the start of the koban pandemic and so really what I want to draw your attention to is some of the time in a little of the time you know we're really seeing these numbers into the six hundreds with the three indicators that seeing the most uptick are nervousness restlessness or feeling fidgety or feeling that everything was an effort and again that's that yellow bar so we're really interested in diving deeper into this data to see you know how these mental health indicators relate to some of the other questions including the food security data that Carmen just reviewed um so on a more positive note we did want to find out from participants if anything was happening in their life that they deemed a positive health behavior change due to Kovac so something positive that they hadn't been doing before that they now were doing since Kovac began and we were really pleased to see that more than half of participants actually said yeah we have made some positive health behavior changes and so going through again all of this qualitative data again preliminary grouped it into four categories and so you'll see the first category is food behavior change a lot of positive things happening in this area so many more people mentioned they are now cooking home-cooked meals more consisting of unprocessed foods they are more appreciative of the foods they're eating not wasting as many leftovers and this last one I'll just read the quote Co quit nineteen has read up my feelings for the need of local everything especially food so Carmen mentioned before a lot more interest in local supporting local and we see that here too in some of the direct quotes we do see some people making great positive changes when it comes to physical activity so going for more walks started exercising every day in that case it wasn't something that person was doing before many people have expressed that they just have more time to try new things so to that seemed positive to us are engaging in reading you know a positive activities started meditating and someone drew the connection to for them it's a good strategy for managing their stress also some things related to finance and family one participant said they've been better able to budget their money they lots of sentiment towards you know really seeing the importance of family time and valuing the increased family time that they've gotten to have all right so on the other side certainly less people so 37% said they have started engaging in negative health behavior change so again it wasn't continuing something negative that they have been doing but since Koba they have started engaging in some negative health behavior change and again we group these into four categories so the first one on the flip side with food and beverage intake really something we wanted to highlight was the amount of people that talked about drinking more alcohol many people you know there were quotes that said they may have drank on occasion holidays special events and now they're finding themselves drinking multiple times a week so we really think this is an area of concern that certainly you know we need to look at this data more closely but it certainly popped out in these preliminary analyses lots of people have mentioned stress eating eating sugar to you know to somehow help with stress constantly snacking a few people also said eating more fast food because it's easier than making sort of this big ordeal of going to the store with a mask and having it be you know more of an event than it normally was on the flipside to those that are getting more physical activity there were a lot of responses talking about that it's harder increased sedentary time so people talking about spending more time and friend the TV in front of their screens you know stayed in bed longer and we're curious when we look at you know is the decreased activity related to economic hardship and job loss could it be correlated to an uptick in mental health outcomes so these are some of the connections that were excited to explore families some people are expressing some negative health behavior change they're less patients with their children and then some people directly reference the mental health struggles so isolation has decreed or excuse me increase their depressive behaviors and the high stress that results from quarantine with family members and children alright so this kind of segues us into the question that we're going to ask you all here in a second but we wanted to hear from participants about advice that they have so is there anything that policy or decision makers could do to help participants and their family be physically and mentally healthy drink Ovid and so we were really pleased with everybody volunteering up you know really nice responses to this question but I do want to highlight and it's on in the purple with the asterisks on the right side of your screen that many people did take the time in this question to say that they were very appreciative of efforts already being made in the state of Montana so that's you know some positive news and something we wanted to share but to look at what the recommendations were I mean so far we could group it pretty nicely in these categories so many folks want more and clearer information and this has to do with wanting more clear and honest information about certain precautions so many people said should we wear a mask should we not wear a mask you know how long when when and where do we wear the mask on some more clear direction many participants stated that having nutrition recommendations especially when they're home cooking more would be very very beneficial many asked about more information about how to recreate outdoors safely what are some things they can do to maintain physical activity outside how to keep a person safe during crisis so you know more public health information is certainly needed you know if this is showing up in response to this question and then again we put this in here it goes along with this theme of you know those that were perhaps less impacted you know or you know just want to lend a helping hand many people want to know how to do that whether or not there's contactless volunteering opportunities available and you know not getting quite the information that they that they would want lots of mention of increase in mental health services um many folks were wondering about positive coping mechanisms and getting more information about that and more and less expensive mental health services many mentioned free telehealth therapy that that would really help them make it easier for them and their families during this time this last category so more supplies but then also more infrastructure community infrastructure like increased lighting to help you know illuminate and makes you for public walking areas so keep in mind I mean now it's sunny for longer but when this started in March it was certainly quite dark and so this makes a lot of sense that people are asking for this online community engagement opportunities was another one really to help kind of foster the social connection aspect of health and lastly in part because the slide is only as big as it is we grouped financial services and child care together but there was a lot of frustration about timely payment about employment claims and making that process easier that was certainly a suggestion and then the last one and many people said you know we understand physical distancing requirements but is there something for childcare is there something of support that could help us with that so with that I'll turn it back over to Carmen who has a question that we'd like all of you you all to think about so we're curious and you all can I you all can try man or right in the Q&A what are your ideas for ways to promote Montanans food security and healthy behaviors in order to build a responsive public health system during and after a crisis using your own experience in the field and the data that we've presented today this is preliminary we're still collecting data as we said and one of the goals of this webinar is to get your input so we'd love to hear any thoughts that you have okay so I'm if I could just interrupt for a second hopefully you'll be able to list some thoughts in the Q&A I'm not seeing any right now and I will look to change some of the options here for allowing you to do that and in addition Carmen and Michelle were you open to having questions at this time or did you want to add more to the presentation yeah we're also open to questions as well and I do see if something came in through the chat from Heather so incentivize home gardening making classes supplies and techniques more available and fantastic and does align with what we what Carmen presented one of the the slides when survey participants were mentioning what would be helpful to them so that's great thank you very much for that Heather okay we have a question here from Blake I'd be curious about the local and national discussion regarding grocery story and similar waste grocery store in similar nursery stores in similar waste um so we're what we're seeing nationally if that household waste is going down but within the distribution system there has been a lot of issues with getting food to where it needs to go safely and we've seen an uptick in waste in the distribution system you all probably have seen this in the news but you know literally dumping out milk in destroying crops and this is definitely something that needs to be addressed now and in future crises as we've seen food insecurity increased to 40 percent nationally it's just shameful that we don't have a system that can handle the food in appropriate time and distribute it to people who need it ok thank you Carmen we're seeing lots of responses to your question and I think one of the things we might do after this call is is compile these many responses and get them back to all of you will help to review them during this webinar but for a minute there's another question that has come up these have been an issue this year an increasing local seed availability and food local food production is critical also we need to see ways to increase distribution of foods locally when supply chains are disrupted that's a kind of some advice and do you have comments on that issue Michelle or Carmen about seed distribution and availability I think that um you know no one was prepared for this crisis and like our supply chain is so stretched in terms of distributing foods and supplies including seeds that many stores who usually sell seeds are simply out of them and are waiting for the next shipment and it's an issue that we see across all suppliers and across the whole supply chain and so I hope that supply chain companies in the future especially those that distribute food can come up with better systems and a lot of times like Montana communities are at the end of the line of a supply chain so they might come from a port in Seattle and then the last stops are Montana communities so trucks especially food trucks they may not have enough space if a lot of stores before them increase their orders which we saw in which we are seeing now because of the stockpiling in people's households and then so the stores in Montana have to wait even longer for their orders and so I know that seeds have definitely been affected and that's definitely something that Michelle and I can bring up to extension colleagues yeah and I'm just reading a few more responses so this is a comment suggestion from a participant maybe create better regional food system partnerships between producers processors distributors something big came in so I lost it here maybe in the same u.s. regions as we're shown in that food insecurity map I mean that's a great point and we will we will save all of these comments when we get further along in the analysis there was another comment about um can you take the survey twice from the same computer yes you can we also do track when surveys come in so there was a comment about the mental health question and whether or not we will be looking at you know spikes in mental health issues and whether or not that's changing with time so that's a great suggestion and we'll certainly do that when we look at that question specifically and CJ is also asking if you will be sharing your results with the governor's co19 task force and County Health Department's at some point I mean assuming you will publish this information and make it available we will so we were asked by several health departments as well as some different departments at the state to come up with county level reports and one of our goals is to have enough participants within each county so that we have a representative sample to give back to County Health Department's in the next couple months these can be used for strategic planning such as on the governor's task force in within County Health Department's community health plans and so we think that this data will be really useful for different communities and counties to use for planning what to do in the next couple of years yeah and additionally we those county level fact sheets will be distributed by the extension network and I misused so we have extension offices in you know throughout the state and so folks working in the extension network will see the results directly and we do just to put up on the slide since we have six more minutes the next slide just shows our next steps and we should keep talking about this idea but we can kind of show you the plan going forward what we are planning to do so we're going to continue collecting data until these three and we have great attendances webinar and really appreciate your attendance as n as one of the follow-ups we love your help getting more responses from residents of Montana in ver in rural pieces representing tribal communities etc and we can only do that with your help so please do help us to distribute this survey and so that we can give back really represented to data about what's happening and we are going to examine relationships between questions as preliminary data is simply the results from each question and it is rather descriptive so with this data we can look at county differences in food security for example we also have some more questions on about media use and people's view of the news that we are collaborating with another faculty in the library about and will analyze those questions as well we're going to examine the relationship between health outcomes and demographic variables we plan to do follow-up in-depth telephone interviews with a subset of participants to really dive down into some of the questions that we have about the data such as how come there isn't you know a huge uptick in snap use when the snap program has been extended overall formal FINA automatic analysis of the qualitative data formal statistical analysis of the quantitative data and then we're going to develop a range of resources so County fact sheets and summary reports to share the data back with counties and communities so that you all can take the data to help improve public health systems in Montana after the substantial crisis and hopefully another one does not happen but if it is this is one way we can all be prepared to address food insecurity and health outcomes and one thing that came up on the comment boxes we do want to mention that five other states have joined in our efforts and are using this exact survey to collect the same data their state and so you know kind of farther down the road is comparing state to state level data on the questions that we asked and so many comments have come in on the chat box so sue I wonder if there's a way that we can grab that and then Carmen and I can reach out to everyone that has offered up great suggestions or asked us questions that we haven't been able to respond to and we can do that by email when we're finished up here I'm just gonna say that the interest and the first of all the thanks for your great work for many and no critical this issue is and there's so many comments and ideas and resources listed in Q&A on and on chat then we will grab those and make them available to you and try to answer some of these questions that we are not able to do today clearly this is a very topic of great interest we're seeing lots of questions about you know how to get this survey to Native communities we know that there was a not a lot a high response rate there and how we can do that how we can make this information available through extension which of course Michelle you're a connector there so we'll go ahead and do that and I hate to cut this off but I just wanted to thank both of you very much for bringing this to the forefront and I think maybe we should have a follow-up webinar at some point and just wanted to give you an opportunity for last words before we sign off and thank everybody for attending Michelle and Carmen yeah thank you all for attending and we will certainly do a follow-up webinar or some sort of final sharing of the results once we have our survey clothes and all of the data analyzed by county thanks so much everyone for taking time to listen and thanks for all your great suggestions and advice and we look forward to connecting with those of you after this. Thanks, everybody; have a great day. Bye-bye !