Non Technical Summary
On September 26th, 2024, South Carolina (SC) was hit by Hurricane Helene, the most devastating inland hurricane on record. Widespread, extended power outages resulted in significant losses for many individuals and organizations, including food and medications. Hurricane Helene's impact is particularly concerning for populations with diet-related chronic conditions that require consistent, long-term access to specific foods. Notably, South Carolina is burdened with higher chronic disease rates (13.7% live with diabetes) than the national average and has the highest prevalence of very low food security (6.8%) in the U.S. Clemson University Extension's Rural Health and Nutrition (RHN) team originated in 2016, focusing to date on developing infrastructure, programming, and collaborations. An extreme weather event like Hurricane Helene has not occurred in South Carolina since the team's creation, leaving few resources to utilize during Hurricane Helene disaster relief. Thus, this Rapid Response program offers an essential opportunity to support RHN's efforts to promote food and nutrition security and diet-related chronic disease management among SC residents affected by Hurricane Helene. To achieve this goal, we will: 1) identify and address impacts of Hurricane Helene-related losses of medically tailored groceries among Clemson Extension chronic disease prevention and self-management program participants; 2) develop nutrition and health education resources to address immediate Hurricane Helene and future weather-related impacts across South Carolina; and 3) assess and increase capacity of SC food assistance organizations to address immediate and future food and nutrition security needs across the lifespan following Hurricane Helene.We expect this project to both address immediate nutrition and health needs among South Carolinians impacted by Hurricane Helene as well as fill gaps in our current knowledge and available state-specific resources about diet-related chronic disease management during weather-related disasters. Specifically, we expect to see improved food security among participants in objective 1, immediate and long-term usage of materials developed in objective 2, and adoption and implementation of disaster relief/preparedness activities/partnerships among at least half of contacted organizations.

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
807	6099	3020	70%
703	6099	3020	15%
704	6099	3020	15%

Knowledge Area
703 - Nutrition Education and Behavior; 807 - Disaster Preparedness, Mitigation, Response, and Recovery; 704 - Nutrition and Hunger in the Population;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
3020 - Education;

Goals / Objectives
The goal of the proposed project is to promote food and nutrition security and diet-related chronic disease management among South Carolina residents affected by Hurricane Helene. The three objectives to achieve our goal are to:identify and address impacts of Hurricane Helene-related losses of medically tailored groceries among South Carolina Extension chronic disease prevention and self-management program participants;develop nutrition and health education resources to address immediate Hurricane Helene and future weather-related impacts across the state; andassess and increase capacity of food assistance organizations to address immediate and future food and nutrition security needs across the lifespan following Hurricane Helene.

Project Methods
Objective 1: Medically Tailored Grocery LossesThe Clemson Extension Rural Health and Nutrition (RHN) team is currently implementing multiple chronic disease prevention and self-management programs, including Know Diabetes by Heart and the Health Extension for Diabetes (HED) program, with several in person and online cohorts in counties with widespread and localized Hurricane Helene impacts. To support chronic disease management among these program participants impacted by Hurricane Helene, participants will be offered the opportunity to complete a screener for Hurricane Helene-related food insecurity and/or food losses of medically tailored groceries and other nutritious foods, utilizing an adapted version of the USDA Six-item Short Form of the Food Security survey module delivered to recruited and consented participants at baseline. Participants who report hurricane-related food insecurity and/or food losses due to extended hurricane-related power outages will be offered cost coverage of up to two produce boxes from their local FoodShare (an organization in South Carolina dedicated to providing fresh fruits and vegetable boxes to individuals), to support vegetable and fruit intake that promotes diabetes management during hurricane recovery. Given the current coverage of Clemson Extension RHN team's chronic disease prevention and self-management programs in counties with widespread and localized Hurricane Helene impacts, we estimate approximately 125 participants will report hurricane-related food insecurity and/or food losses due to extended hurricane-related power outages. For participants in counties without a FoodShare site, a grocery delivery platform will be utilized to supply participants with a produce box of comparable cost and nutritional value to that of a FoodShare box.Due to the immediate nature of these impacts, recruitment and food insecurity/food loss reporting will take place within the first two months of the proposed project, with at least one produce box distributed by the end of month 3. The percentage of consented participants who pick up/receive the first and second produce boxes will be calculated from ongoing recruitment and retention tracking.To assess the impact of the produce box distribution on fruit and vegetable intake, the 10 fruit and vegetable items from the 26-item Dietary Screener Questionnaire (DSQ) will be asked of consented participants at baseline and approximately 2 weeks after receiving their second produce box.Objective 2: Post-Hurricane Nutrition and Health Education ResourcesTo support systematic development of nutrition- and health-related resources that target challenges to diet-related disease management during and in the aftermath of Hurricane Helene in South Carolina, RHN Extension chronic disease prevention and self-management program and other interested program participants will be invited to participate in Zoom interviews with the research team at baseline. Interview guides will address multiple levels of the Social Ecological Model to identify immediate educational opportunities post-Hurricane Helene as well as any additional environmental supports that may promote immediate disease management in addition to that implemented in Objective 1. Participants will be provided the consent form prior to their scheduled Zoom interview.Based on interview findings, resources will be created in a variety of formats to increase reach across audiences of all ages, including digital and print fact sheets to be shared with participants and non-participants of existing Extension programs, as well as digital reels/short videos that can be posted to social media and other digital platforms to reach broader audiences including those not currently participating in Extension programs. Usage of digital resources will be tracked (e.g., number of likes on social media posts), but identifying information will not be collected.Objective 3: Post-Hurricane Capacity of Food Assistance OrganizationsThe capacity of South Carolina food assistance organizations to continue to offer assistance during and after extreme weather-related disasters is dependent on a wide variety of organizational factors (e.g., structural and operational characteristics, personnel, size, centralization, complexity, interconnectedness, and external partners [e.g., faith- and other community-based affiliations], among others). Given the relatively unprecedented nature of Hurricane Helene's impacts across South Carolina, capacity-related needs of food assistance organizations (e.g., food banks and pantries, food rescue organizations, soup kitchens/free dining rooms, shelters, and other non-profit organizations) are still relatively unknown. To identify and address these needs through the network of South Carolina community partners (i.e., Extension and/or other agricultural and health-related partners), Zoom interviews will be conducted with staff and/or volunteers of these organizations. Participants will be provided the consent form prior to their scheduled Zoom interview. Interview guides will be based on the Consolidated Framework for Implementation Research (CFIR), which helps guide systematic assessment of potential barriers and facilitators for implementation strategies, such as offering medically tailored groceries and other nutritious foods during weather-related disasters. Based on needs identified through interviews, county Extension agents, regional and statewide Extension associates, and research support staff will facilitate connections between local food assistance organizations and community partners who can support post-Hurricane Helene needs.While many capacity-related needs have yet to be systematically identified, an immediate need was identified at the onset of the Hurricane Helene disaster related to the capacity of Extension office-based breastmilk banks. As previously discussed, widespread and lasting power outages resulted in a loss of significant amounts of food for populations of all ages, including families with infants reliant on breastmilk banks. Nine county Extension offices currently serve as breastmilk donation sites for the Mothers Milk Bank of South Carolina program, but due to a lack of proper equipment to monitor length of power outages and refrigerator/freezer temperatures, significant losses were experienced during Hurricane Helene. To support the replenishment of donated breastmilk supplies in Extension office-based milk banks, power and temperature monitoring devices will be purchased for all refrigerators/freezers.