Health Center–Based Community-Supported Agriculture: An RCT
Naysha ShahidAmerican Journal of Preventive Medicine
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Abstract
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Poor diet quality significantly contributes to morbidity and mortality, particularly among lower socioeconomic status (SES) groups. Community-supported agriculture (CSA) could be a promising intervention to improve diet quality in these populations. This study aimed to evaluate the impact of subsidized CSA shares on diet quality among individuals at high risk for diet-related illness, hypothesizing that participation would lead to measurable improvements. The findings suggest that CSA participation could effectively enhance dietary habits, with implications for public health interventions targeting food insecurity and diet quality disparities.
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Community Supported Agriculture Programs: A Novel Venue for Theory-Based Health Behavior Change Interventions
Ecology of Food and Nutrition, 2015
In recent years, the "buy local" movement has escalated in popularity, with the number of farm-based local foods programs, such as farmers' markets and community supported agriculture programs (CSAs), dramatically increasing in the last few decades. In 1970, for instance, only about 340 farmers' markets existed in the United States. By 2012, however, nearly 7,864 markets were operating across the country (USDA 2013a). And although the concept of the CSA was introduced to the United States as recently as the early 1980's, it's estimated that over 4,000 farms operate CSAs today, with some estimates placing the number as high as 6,000 (Ernst and Woods, 2013). Additionally, in the United States, some of the nation's largest retailers, such as Wal-Mart, are vastly increasing their purchases of locally grown produce (Nunes, 2013; Bustillo and Kesmodel, 2011). Despite the heightened interest in locally grown foods and local foods programs, little research exists documenting the extent to which involvement in local foods programs might affect dietary behaviors and other health outcomes (McCormack et al., 2010; George, Kraschnewski and Rovniak, 2011). CSAs, in particular, remain poorly studied with respect to dietary and health outcomes. However, because of the way these programs are structured, CSAs might be of specific interest with respect to nutrition-related outcomes. Using the Theory of Planned Behavior (TPB; Fishbein and Ajzen, 1975) as a foundation upon which a CSA-based intervention could be investigated, consumers' perceptions, values, and motivations with respect to involvement in CSAs were examined through three semi-structured focus groups, comprising a total of twenty-two participants. Specifically, we sought to understand consumer motives for joining (and withdrawing from) CSAs, as well as their experiences and self-reported outcomes of belonging to a CSA using the TPB as a theoretical structure. A number of themes emerged relating both to motivations for join a CSA, as well as outcomes of CSA involvement. The condensed themes are presented graphically in the TPB framework (see Figure 1). Connecting participant self-reported attitudes and behaviors to behavior change constructs provides a theoretical basis for potential future behavior change interventions focused on improving dietary intake, specifically fruit and vegetable consumption. For example, participants noted strong motivations for joining a CSA, including behavioral beliefs that CSA produce would contribute to a healthier, safer, and more environmentally sustainable diet. Participants also noted that CSAs offer built-in social connections, leading to shared normative beliefs about CSA produce use among participants and family members. Finally, participants described important control beliefs, in most cases identifying location and cost as convenience factors improving their ability to make use of the produce they received. They also noted an enhanced sense of control over the healthfulness, freshness, 'naturalness,' and sustainability of the food they ate by receiving produce through a CSA. As a result of these enhance beliefs, a number of outcomes were noted, including healthier food consumption behaviors; enhanced social connections with family, community, and the food system itself; changes in beliefs about previously acceptable products and practices (e.g., amount and variety of produce, conventional produce procurement, conventional food retailers, foodservice outlets); improved self-efficacy; and an array of strongly felt emotions ranging from pride, anticipation, adventure and accomplishment to guilt. Using the TPB as a framework to categorize findings, data revealed that the outcomes of CSA membership were discussed far more extensively than respondents' original motives for joining. The three components of behavioral intentionattitude toward the behavior, beliefs about others' expectations, and perceived self-efficacywere all discussed as outcomes of CSA membership. It is therefore possible that these reported outcomes in connection to theoretical constructs could serve as a foundation for future intervention research. In particular, respondents' attitudes towards continued CSA membership were positively shaped by myriad outcomes, which included: children and family member involvement and education; connection with nature; perceived benevolence of supporting local farming; consideration and re-examination of conventional food retailing; realization of health connection; higher degree of involvement (importance) of produce; and reflection of one's self and/or a reinforced self-image. Importantly, the affect associated with continued membership (e.g., anticipation, adventure, safety assuredness) also contributed toward positively held attitudes. The involvement and anticipation by othersincluding family, friends, neighbors, and work colleagues-served to reinforce the normative component of CSA membership. Specifically mentioned were rituals involving dinner preparation and eating togethera time not only for bonding with family, but for discussion to occur. Finally, the tremendous sense of pride and accomplishment in mastering new recipes and successfully maneuvering their ways through new and abundant produce, enhanced respondents' perceived control. Fruit and vegetable consumption remains poor among Americans. Identifying novel avenues for dietary change interventions can contribute to the constellation of approaches necessary to address lifestyle-related conditions and diseases. Based on the results of this qualitative study, a number of qualities inherent in CSA programs might lend themselves to theoretically based dietary interventions to improve fruit and vegetable consumption. However, future research is needed to examine both the feasibility and effectiveness of CSA-based interventions to impact dietary behavior.
Making community-supported agriculture accessible to low-income families: findings from the <i>Farm Fresh Foods for Healthy Kids</i> process evaluation
Translational behavioral medicine, 2020
Curricula that emphasize local foods should be designed to address the (greaterthan-expected) range of knowledge, attitudes, skills, and behaviors of those who self-select to participate. Policy: Cost-offset community-supported agriculture (CO-CSA) can be feasibly integrated with a skill-building, health-promoting curriculum, but appeal may be limited to a unique subset of low-income households. Research: Future studies of multimodal food system interventions should explore whether such models can be implemented with greater flexibility (e.g., varying CSA pickup frequency) and allowance for adaptation (e.g., site-tailored educational content) without compromising participant outcomes and farmer viability.
Farm Fresh Foods for Healthy Kids: Innovative Cost-Offset Community Supported Agriculture Intervention
Journal of Nutrition Education and Behavior, 2018
Evaluation: CK, NE, and CD were poorly attended, and ID showed little change for the amount of time/cost, suggesting these four components lacked feasibility. Given small cell sizes, we utilized descriptive analyses of prepost changes in mean scores and present Cohen's d effect sizes comparing the MD/CW to the control condition. The MD/CW combination showed pre-post increased fruit/ vegetable intake (0.16), decreased sugar sweetened beverages (-0.22), decreased fast food consumption (-0.36), decreased parental low preferences for cooking (-0.20), increased use of more whole foods in meal preparation (0.24), decreased food insecurity (0.22), increased basic cookware sufficiency (0.42), and increased family functioning (0.36). However, the effect size for changes in parents/ children eating together was negligible (0.05). We are partnering with Meals on Wheels as the preparation/ delivery modality in evaluating MD/CW in an RCT. Conclusions and Implications: Results will inform policy (e.g. where limited resources may be best allocated) and interventions (e.g. supports most effective in promoting family meals).
Adults and Children in Low-Income Households that Participate in Cost-Offset Community Supported Agriculture Have High Fruit and Vegetable Consumption
Nutrients, 2017
This paper examines fruit and vegetable intake (FVI) in low-income households that participated in a cost-offset (CO), or 50% subsidized, community-supported agriculture (CSA) program. CSA customers paid farms upfront for a share of the harvest, and received produce weekly throughout the growing season. A cohort of adults and children 2-12 y in a summer CO-CSA were surveyed online twice: August 2015 (n = 41) and February 2016 (n = 23). FVI was measured by the National Cancer Institute's (NCI) Fruit and Vegetable Screener (FVS) and an inventory of locally grown fruits and vegetables. FVI relative to United States (US) recommendations and averages, and across seasons, were tested with non-parametric tests and paired t-tests (p < 0.05). Both adults and children in the CO-CSA had higher FVI than the US averages, and more often met recommendations for vegetables. Some summer fruits and vegetables were more often eaten when locally in-season. The CO-CSA model warrants further exami...
Farm Fresh Foods for Healthy Kids (F3HK): An innovative community supported agriculture intervention to prevent childhood obesity in low-income families and strengthen local agricultural economies
BMC public health, 2017
Childhood obesity persists in the United States and is associated with serious health problems. Higher rates of obesity among children from disadvantaged households may be, in part, attributable to disparities in access to healthy foods such as fruits and vegetables. Community supported agriculture can improve access to and consumption of fresh produce, but the upfront payment structure, logistical barriers, and unfamiliarity with produce items may inhibit participation by low-income families. The aim of this project is to assess the impact of subsidized, or "cost-offset," community supported agriculture participation coupled with tailored nutrition education for low-income families with children. The Farm Fresh Foods for Healthy Kids community-based, randomized intervention trial will build on formative and longitudinal research to examine the impact of cost-offset community supported agriculture on diet and other health behaviors as well as the economic impacts on local ...
The perceived influence of cost-offset community-supported agriculture on food access among low-income families
Public health nutrition, 2018
To examine perspectives on food access among low-income families participating in a cost-offset community-supported agriculture (CO-CSA) programme. Farm Fresh Foods for Healthy Kids (F3HK) is a multicentre randomized intervention trial assessing the effect of CO-CSA on dietary intake and quality among children from low-income families. Focus groups were conducted at the end of the first CO-CSA season. Participants were interviewed about programme experiences, framed by five dimensions of food access: availability, accessibility, affordability, acceptability and accommodation. Transcribed data were coded on these dimensions plus emergent themes. Nine communities in the US states of New York, North Carolina, Washington and Vermont. Fifty-three F3HK adults with children. CSA models were structured by partner farms. Produce quantity was abundant; however, availability was enhanced for participants who were able to select their own produce items. Flexible CSA pick-up times and locations ...
Community supported agriculture plus nutrition education improves skills, self-efficacy, and eating behaviors among low-income caregivers but not their children: a randomized controlled trial
International Journal of Behavioral Nutrition and Physical Activity, 2021
Background Adults and children in the U.S. consume inadequate quantities of fruit and vegetables (FV), in part, due to poor access among households with lower socioeconomic status. One approach to improving access to FV is community supported agriculture (CSA) in which households purchase a ‘share’ of local farm produce throughout the growing season. This study examined the effects of cost-offset (half-price) CSA plus tailored nutrition education for low-income households with children. Methods The Farm Fresh Foods for Healthy Kids (F3HK) randomized controlled trial in New York, North Carolina, Vermont, and Washington (2016–2018) assigned caregiver-child dyads (n = 305) into cost-offset CSA plus education intervention or control (delayed intervention) groups. Following one growing season of CSA participation, changes in children’s diet quality, body mass index (BMI), and physical activity; caregivers’ nutrition knowledge, attitudes, behaviors, and diet quality; and household food ac...
Farm Fresh Foods for Healthy Kids: Innovative Cost-Offset Community Supported Agriculture Intervention to Prevent Childhood Obesity and Strengthen Local Agricultural Economies
Journal of Nutrition Education and Behavior, 2017
Objective: To test the impact of cost-offset community supported agriculture (CO-CSA) on availability, accessibility, preparation skills, and consumption of fruits and vegetables (FV) as a pathway to childhood obesity prevention. Description: This community-based CO-CSA intervention includes: 15-24 week summer produce share at 50% price reduction; weekly SNAP/EBT or cash balance payments of $8-$21 depending upon size selected; choice of 2-4 large kitchen tools; and nine CSA-tailored education classes. Households were eligible if: income <185% of the federal poverty level, had not participated in a CSA for >3y (or ever), included a child 2-12y who also was willing to participate, and paid a deposit equivalent to two weekly balance payments. Evaluation: Two-hundred households (53% of eligible) enrolled in spring 2016 and were randomly assigned to intervention (CO-CSA in 2016 and 2017) or delayed intervention (CO-CSA in 2017 and 2018). Groups were comparable in size and characteristics (all P>0.05). Most adults were women (97%), 31-50y (68%), and half graduated from college (49%). Adults scored between neutral and confident in eating and cooking FV; some reported difficulty financially affording FV (30%). At baseline, median FV intake was 2.8c for adults and 2.9c for children. Most participants picked-up at least three-quarters of their weekly CSA shares (57%), and attended at least one CSAtailored education class (68%). Most households (78%) provided follow-up data in fall 2016. Conclusions and Implications: Additional recruitment into the intervention will conclude in summer 2017, total recruitment target of 240 households enrolled at 13 farms across 4 states. Preliminary findings will be
P78 Low-Income Adults Enrolled in a Cost-Offset, Community-Supported Agriculture Intervention are not Nationally Representative
Journal of Nutrition Education and Behavior, 2020
biking routes, equal pricing for healthful foods, and more available healthful food options. Among the least important priority was to require first-year and transfer students to take a wellness course. Conclusions: This process provided a tool that was well developed and validated for college campuses to use to improve health promotion activities. Because free water availability was deemed the most important priority regardless of school characteristic, additional exploration is warranted to understand why and what improvements college campuses can make. Funding: NIFA.
Food Security Status and Produce Intake and Behaviors of Special Supplemental Nutrition Program for Women, Infants, and Children and Farmers’ Market Nutrition Program Participants
Journal of The American Dietetic Association, 2007
Objective This study identified differences between women from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)Ϫ and WIC/Farmers' Market Nutrition ProgramϪparticipating households regarding household food security status, fruit and vegetable intake and behaviors, perceived diet quality, and education level; and assessed the relationship between household food security status and perceived diet quality and perceived health. Design, subjects/setting Cross-sectional survey of women from Athens County, Ohio (WIC, nϭ829; Farmers' Market Nutrition Program, nϭ246) living in WIC households. Results Of 228 participants completing the food security portion of the survey, 61 (26.8%) were living in food secure households, while 47 (20.6%), 75 (32.9%), and 45 (19.7%) were living in households at risk for (marginal) food insecurity, with low food security, and with very low food security, respectively. For the entire sample, food insecurity was associated with poorer diet quality (rϭϪ0.248, PϽ0.001). Food security status ( 2 ϭ2.117, Pϭ0.548) did not differ between groups. Farmers' Market Nutrition Program reported higher education levels (Pϭ0.027). Unlike fruit intake (t test, Pϭ0.769), vegetable intake servings were greater among Farmers' Market Nutrition Program (2.2Ϯ1.2), compared to WIC (1.9Ϯ1.0) (t test, Pϭ0.040). Both perceived benefit ( 2 ϭ4.574, Pϭ0.032) and perceived diet quality ( 2 ϭ7.219, Pϭ0.027) were greater for Farmers' Market Nutrition Program. Conclusions Farmers' Market Nutrition Program participants exhibit more indicators of a healthful diet, but appear not to be more food secure. Nutrition education regarding the benefits of fresh produce intake can help to improve diet quality and increase Farmers' Market Nutrition Program participation.
Knowledge, Attitudes, Beliefs and Behaviors Regarding Fruits and Vegetables among Cost-Offset Community-Supported Agriculture (CSA) Applicants, Purchasers, and a Comparison Sample
Nutrients, 2019
Community-supported agriculture (CSA) participation has been associated with high fruit and vegetable (FV) consumption, which may be due to better access to FV for CSA purchasers, or to positive knowledge, attitudes, and beliefs (KAB) regarding healthy eating among CSA applicants. The objective of this study was to examine KAB and consumption, in association with application to a cost-offset CSA (CO-CSA) program, and with CO-CSA purchase among applicants. We conducted a cross-sectional survey of CO-CSA applicants and a comparison sample in August 2017. All respondents were English-reading adults with a child 2–12 years old and household income of ≤185% of the federal poverty level. Among CO-CSA applicants, some were CO-CSA purchasers (n = 46) and some were not (n = 18). An online comparison sample met equivalent eligibility criteria, but had not participated in CSA for three years (n = 105). We compared CO-CSA applicants to the comparison sample, and compared purchasers and non-purc...
Cost analysis and cost effectiveness of a subsidized community supported agriculture intervention for low-income families
International Journal of Behavioral Nutrition and Physical Activity, 2023
Background The food system has a dynamic influence on disparities in food security and diet-related chronic disease. Community supported agriculture (CSA) programs, in which households receive weekly shares of produce from a local farmer during the growing season, have been examined as a possible food systems-based approach for improving diet and health outcomes. The purpose of this study was to estimate the cost of implementing and participating in a multi-component subsidized community supported agriculture intervention and calculate costeffectiveness based on diet and food security impacts. Methods Using data from the Farm Fresh Foods for Healthy Kids (F3HK) randomized controlled trial in New York, North Carolina, Vermont, and Washington (n = 305; 2016-2018), we estimated programmatic and participant costs and calculated incremental cost-effectiveness ratios (ICERs) for caregivers' daily fruit and vegetable (FV) intake, skin carotenoids, and household food security from program and societal perspectives.
Can CSA Cost-Offset Programs Improve Diet Quality for Limited Resource Families?
2017
Americans currently eat less than two-thirds of the recommended amounts of fruit and vegetables, as well as lower than recommended levels of nutrient-dense dark green and orange vegetables (U.
Healthy Foods, Healthy Families: combining incentives and exposure interventions at urban farmers' markets to improve nutrition among recipients of US federal food assistance
Background: Healthy Foods, Healthy Families (HFHF) is a fruit and vegetable (F&V) exposure/ incentive program implemented at farmers' markets in low-income neighborhoods, targeting families receiving US federal food assistance. We examined program effects on participants' diet and associations between attendance, demographics and dietary change. Methods: Exposure activities included F&V tastings and cooking demonstrations. Incentives included 40% F&V bonus for electronic benefit transfer (EBT) card users and $20 for use purchasing F&V at every third market visit. Self-report surveys measuring nutritional behaviors/ literacy were administered to participants upon enrollment (n = 425, 46.2% Hispanic, 94.8% female). Participants were sampled for follow-up at markets during mid-season (n = 186) and at season end (n = 146). Attendance was tracked over 16 weeks. Results: Participants post-intervention reported significantly higher vegetable consumption (P = 0.005) and lower soda consumption (P = 0.005). Participants reporting largest F&V increases attended the market 6-8 times and received $40 in incentives. No change in food assistance spent on F&V (P = 0.94); 70% reported significant increases in family consumption of F&V, indicating subsidies increased overall F&V purchasing. Participants reported exposure activities and incentives similarly affected program attendance. Conclusion: Interventions combining exposure activities and modest financial incentives at farmers' markets in low-income neighborhoods show strong potential to improve diet quality of families receiving federal food assistance.
Effect of a Targeted Subsidy on Intake of Fruits and Vegetables Among Low-Income Women in the Special Supplemental Nutrition Program for Women, Infants, and Children
American Journal of Public Health, 2008
RESEARCH AND PRACTICE Objectives. Intake of fruits and vegetables protects against several common chronic diseases, and low income is associated with lower intake. We tested the effectiveness of a subsidy for fruits and vegetables to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods. Women who enrolled for postpartum services (n = 602) at 3 WIC sites in Los Angeles were assigned to an intervention (farmers' market or supermarket, both with redeemable food vouchers) or control condition (a minimal nonfood incentive). Interventions were carried out for 6 months, and participants' diets were followed for an additional 6 months. Results. Intervention participants increased their consumption of fruits and vegetables and sustained the increase 6 months after the intervention was terminated (model adjusted R 2 = .13, P < .001). Farmers' market participants showed an increase of 1.4 servings per 4186 kJ (1000 kcal) of consumed food (P<.001) from baseline to the end of intervention compared with controls, and supermarket participants showed an increase of 0.8 servings per 4186 kJ (P = .02). Conclusions. Participants valued fresh fruits and vegetables, and adding them to the WIC food packages will result in increased fruit and vegetable consumption.
Impact of a Community-based Intervention on Serving and Intake of Vegetables among Low-income, Rural Appalachian Families
Journal of Nutrition Education and Behavior, 2012
Objective: To evaluate the effectiveness of a community-based intervention promoting the serving and eating of deep-orange, cruciferous, and dark-green leafy vegetables. Design: Randomized, parallel-group, community-based intervention with a baseline/postintervention/ 3-month follow-up design. Setting and Participants: Low-income food preparers (n ¼ 50) and their partners (n ¼ 50) in rural Appalachia Pennsylvania. Intervention: Experimental food preparers attended 8 weekly interactive lessons; control food preparers received 8 weekly mailings that included similar recipes and handouts. Main Outcome Measures: Target vegetable intake and frequency of serving by experimental and control treatment groups and by high and low meal diary scores, a measure of recipe acceptability. Analysis: Linear mixed-model analysis with repeated measures. Results: No significant differences resulted between the original experimental and control treatment groups. When grouped by high and low meal diary scores, more experimental families had high scores than in controls. High scores were associated with significant changes in frequency of serving and intake of the target vegetables. Conclusions and Implications: Meal diary use may foster food preparer negotiation with partners and children to become involved in vegetable dish evaluation. Tools to help the trained food preparer draw family members into recipe evaluation, such as the meal diary, are useful and needed.
Perceptions of nutrition education classes offered in conjunction with a community-supported agriculture intervention among low-income families
Public Health Nutrition, 2020
Objective: To examine participants' experiences with nutrition education classes that were implemented with and designed to complement a cost-offset community-supported agriculture (CSA) programme. Design: Qualitative analysis of data from twenty-eight focus groups with ninety-six participants enrolled in Farm Fresh Foods for Healthy Kids (F3HK). Transcribed data were coded and analysed by a priori and emergent themes. Setting: Rural and micropolitan communities in New York, North Carolina, Vermont and Washington (USA). Participants: Ninety-six F3HK participants. Results: Participants found recipes and class activities helpful and reported improvements in nutrition knowledge, food preservation skills and home cooking behaviours for themselves and their children; they also reported that classes promoted a sense of community. Some educators better incorporated CSA produce into lessons, which participants reported as beneficial. Other obligations and class logistics were barriers to attendance; participants recommended that lessons be offered multiple times weekly at different times of day. Other suggestions included lengthening class duration to encourage social engagement; emphasising recipes to incorporate that week's CSA produce and pantry staples and offering additional strategies to incorporate children in classes. Conclusion: Complementing a cost-offset CSA with nutrition education may enhance programme benefits to low-income families by improving nutrition knowledge and cooking behaviours. However, future interventions will benefit from ongoing coordination between educators and local growing trajectories to maximise timely coverage of unfamiliar produce in lessons; synchronous scheduling of CSA pickup and classes for participant convenience and creative strategies to engage children and/or provide childcare.
P104 Theory-Informed Predictors of Fruit and Vegetable Intake Among Cost-Offset Community Supported Agriculture Enrollees
Journal of Nutrition Education and Behavior, 2020
Dietary intake and dietary quality of low-income adults in the Supplemental Nutrition Assistance Program
The American journal of clinical nutrition, 2012
Background: The Supplemental Nutrition Assistance Program (SNAP) aims to alleviate hunger among its beneficiaries by providing benefits to purchase nutritious foods. Objective: We conducted a comprehensive dietary analysis of lowincome adults and examined differences in dietary intake between SNAP participants and nonparticipants. Design: The study population comprised 3835 nonelderly adults with a household income #130% of the federal poverty level from the 1999-2008 NHANES. The National Cancer Institute method was used to estimate the distributions of usual intake for dietary outcomes. Relative differences in dietary intake by SNAP participation were estimated, adjusted for sociodemographic characteristics and household food security. Results: Few low-income adults consumed recommended amounts of whole grains, fruit, vegetables, fish, and nuts/seeds/legumes. Conversely, many low-income adults exceeded recommended limits for processed meats, sweets, and bakery desserts and sugar-sweetened beverages. Approximately 13-22% of low-income adults did not meet any food and nutrient guidelines; virtually no adults met all of the guidelines. Compared with nonparticipants, SNAP participants consumed 39% fewer whole grains (95% CI: 257%, 215%), 44% more 100% fruit juice (95% CI: 0%, 107%), 56% more potatoes (95% CI: 18%, 106%), 46% more red meat (95% CI: 4%, 106%), and, in women, 61% more sugar-sweetened beverages (95% CI: 3%, 152%). SNAP participants also had lower dietary quality scores than did nonparticipants, as measured by a modified Alternate Healthy Eating Index. Conclusion: Although the diets of all low-income adults need major improvement, SNAP participants in particular had lower-quality diets than did income-eligible nonparticipants.
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A Systematic Scoping Review of How Healthcare Organizations Are Facilitating Access to Fruits and Vegetables in Their Patient Populations
The Journal of Nutrition
Background There is compelling evidence on the impact of diet as preventative medicine, and with rising health care costs healthcare organizations are attempting to identify interventions to improve patient health outcomes. Objectives The purpose of this systematic scoping review was to characterize existing healthcare organization–based interventions to improve access to fruits and vegetables (F&V) for their patient populations. In addition, we aimed to review the impact of identified interventions on dietary intake and health outcomes. Methods Titles and abstracts were searched in PubMed® (MEDLINE®), Embase®, CINAHL®, and the Cochrane Library® from 1 January 1990 to 31 December 2019. To be selected for inclusion, original studies must have included a healthcare organization and have had a programmatic focus on increasing access to or providing fresh F&V to patients in an outpatient, naturalistic setting. The Effective Public Health Practice Project tool was used to assess study qu...
Community supported agriculture plus nutrition education improves skills, self-efficacy, and eating behaviors among low-income caregivers but not their children: a randomized controlled trial
International Journal of Behavioral Nutrition and Physical Activity, 2021
Background Adults and children in the U.S. consume inadequate quantities of fruit and vegetables (FV), in part, due to poor access among households with lower socioeconomic status. One approach to improving access to FV is community supported agriculture (CSA) in which households purchase a ‘share’ of local farm produce throughout the growing season. This study examined the effects of cost-offset (half-price) CSA plus tailored nutrition education for low-income households with children. Methods The Farm Fresh Foods for Healthy Kids (F3HK) randomized controlled trial in New York, North Carolina, Vermont, and Washington (2016–2018) assigned caregiver-child dyads (n = 305) into cost-offset CSA plus education intervention or control (delayed intervention) groups. Following one growing season of CSA participation, changes in children’s diet quality, body mass index (BMI), and physical activity; caregivers’ nutrition knowledge, attitudes, behaviors, and diet quality; and household food ac...
Dietary Macronutrient Composition and Quality, Diet Quality, and Eating Behaviors at Different Times Since Laparoscopic Sleeve Gastrectomy
Obesity Surgery
Purpose This study aimed to compare energy, macronutrients (quantity and quality), the overall dietary quality, and eating behaviors of patients undergoing laparoscopic sleeve gastrectomy (LSG) at different times since surgery. Materials and Methods This cross-sectional study included 184 adults at least 1 year post-LSG. Dietary intakes were assessed by a 147-item food frequency questionnaire. Macronutrient quality was assessed by computing the macronutrient quality index (MQI), carbohydrate quality index, fat quality index, and healthy plate protein quality index (HPPQI). The Healthy Eating Index (HEI)-2015 was used to assess diet quality. The Dutch Eating Behavior Questionnaire was used to assess eating behaviors. Based on the time since LSG, the time at which eating data were also collected, participants were categorized into three groups: 1-2 years (group 1), 2-3 years (group 2), and 3-5 years (group 3). Results Group 3 consumed significantly more energy and absolute carbohydrates than group 1. The MQI and HPPQI scores of group 3 were significantly lower than those of group 1. The HEI score was significantly lower in group 3 compared to group 1, with a mean difference of 8.1 points. Compared to patients with 1-2 years following LSG, those with 2-3 and 3-5 years consumed more refined grains. Eating behavior scores did not differ between groups. Conclusion Patients at 3-5 years post-LSG consumed more energy and carbohydrates than those at 1-2 years after the surgery. Protein quality, overall macronutrient quality, and overall diet quality decreased as time passed following surgery.
Cost analysis and cost effectiveness of a subsidized community supported agriculture intervention for low-income families
International Journal of Behavioral Nutrition and Physical Activity, 2023
Background The food system has a dynamic influence on disparities in food security and diet-related chronic disease. Community supported agriculture (CSA) programs, in which households receive weekly shares of produce from a local farmer during the growing season, have been examined as a possible food systems-based approach for improving diet and health outcomes. The purpose of this study was to estimate the cost of implementing and participating in a multi-component subsidized community supported agriculture intervention and calculate costeffectiveness based on diet and food security impacts. Methods Using data from the Farm Fresh Foods for Healthy Kids (F3HK) randomized controlled trial in New York, North Carolina, Vermont, and Washington (n = 305; 2016-2018), we estimated programmatic and participant costs and calculated incremental cost-effectiveness ratios (ICERs) for caregivers' daily fruit and vegetable (FV) intake, skin carotenoids, and household food security from program and societal perspectives.
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