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Fruit and Vegetable Preferences and Practices May Hinder Participation in Community-Supported Agriculture Among Low-Income Rural Families.

ABSTRACT: OBJECTIVE:Describe fruit and vegetable (FV) preferences and other factors that may influence participation in community-supported agriculture (CSA). DESIGN:In-depth, semi-structured interviews. SETTING:Eight rural/micropolitan communities in 4 US states. PARTICIPANTS:There were 41 caregivers and 20 children (8-12 years of age) from low-income, English-speaking households. PHENOMENA OF INTEREST:Knowledge, attitudes, and behaviors regarding FVs; perceived barriers to CSA participation. ANALYSIS:Transcribed verbatim and iteratively coded. RESULTS:Caregivers and children believed FVs were important to health, yet FVs were not featured in dinners or snacks and consumption was challenged by limited preferences and neophobia. Few caregivers and children knew about the seasonality of FV. Most caregivers were unfamiliar with CSA and had concerns about CSA cost, accessibility, produce quality, and selection. CONCLUSIONS AND IMPLICATIONS:These qualitative data support improvements in: 1) CSA distribution practices to offer flexible payment and pick-up options, more fruits, and self-selection of FV; 2) public awareness of produce seasonality and the CSA distribution model as necessary precursors to participation, and lower cost for low-income families who highlighted this barrier; and 3) capacity to prepare FV by enhancing skills and providing time-saving kitchen tools. Approaches to aligning CSA practices with the needs and preferences of low-income families warrant further research.

SUBMITTER: Hanson KL

PROVIDER: S-EPMC6467078 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Fruit and Vegetable Preferences and Practices May Hinder Participation in Community-Supported Agriculture Among Low-Income Rural Families.

Hanson Karla L KL Garner Jennifer J Connor Leah M LM Jilcott Pitts Stephanie B SB McGuirt Jared J Harris Raiven R Kolodinsky Jane J Wang Weiwei W Sitaker Marilyn M Ammerman Alice A Seguin Rebecca A RA

Journal of nutrition education and behavior 20181006 1

<h4>Objective</h4>Describe fruit and vegetable (FV) preferences and other factors that may influence participation in community-supported agriculture (CSA).<h4>Design</h4>In-depth, semi-structured interviews.<h4>Setting</h4>Eight rural/micropolitan communities in 4 US states.<h4>Participants</h4>There were 41 caregivers and 20 children (8-12 years of age) from low-income, English-speaking households.<h4>Phenomena of interest</h4>Knowledge, attitudes, and behaviors regarding FVs; perceived barrie ...[more]

PMID: 30301601

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Project description:BackgroundChildhood 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.Methods/designThe 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 economies. The intervention will involve reduced-price community supported agriculture shares which can be paid for on a weekly basis, nine skill-based and seasonally-tailored healthy eating classes, and the provision of basic kitchen tools. Low income families with at least one child aged 2-12 years will be recruited to join existing community supported agriculture programs in New York, North Carolina, Vermont, and Washington. In each program, families will be randomized 1:1 to intervention or delayed intervention groups. Data will be collected at baseline, and in the fall and spring for 3 years. The primary outcomes are children's intake of fruits and vegetables and foods high in sugar and/or (solid) fat, as well as diet quality; secondary outcomes include physical, behavioral, psychosocial, and environmental variables. Cost-effectiveness and economic impact at the farm and community levels also will be assessed.DiscussionThis integrated project will provide important information and contribute to the evidence base regarding the use of local agricultural interventions to improve children's dietary behaviors and weight maintenance. Findings also will inform the development of a toolkit for farmers and education modules related to local food system innovations for undergraduate and graduate students.Trial registrationClinicalTrials.gov NCT02770196 . Registered 5 April 2016.

Project description:IntroductionSocioeconomically vulnerable individuals often face poor access to nutritious food and bear a disproportionate burden of diet-related chronic illness. This study tested whether a subsidized community-supported agriculture intervention could improve diet quality.Study designAn RCT was conducted from May 2017 to December 2018 (data analyzed in 2019).Setting/participantsAdults with a BMI >25 kg/m2 seen at a community health center in central Massachusetts, or who lived in the surrounding county, were eligible.InterventionIndividuals were randomized to receive either subsidized community-supported agriculture membership (which provided a weekly farm produce pickup from June to November) or healthy eating information (control group). For equity, the control group received financial incentives similar to the intervention group.Main outcome measuresThe primary outcome was the Healthy Eating Index 2010 total score (range, 0-100; higher indicates better diet quality; minimum clinically meaningful difference, 3). Healthy Eating Index was assessed using 3 24-hour recalls per participant collected each growing season. Intention-to-treat analyses compared Healthy Eating Index scores between the intervention and control group, accounting for repeated measures with generalized estimating equations.ResultsThere were 128 participants enrolled and 122 participants for analysis. The participants' mean age was 50.3 (SD=13.6) years; 82% were women; and 88% were white, non-Hispanic, with a similar distribution of baseline characteristics comparing the intervention and control groups. Baseline Healthy Eating Index total score was 53.9 (SD=15.3) in the control group and 55.1 (SD=15.2) in the intervention group (p=0.68). The intervention increased the mean Healthy Eating Index total score relative to the control group (4.3 points higher, 95% CI=0.5, 8.1, p=0.03). Food insecurity was lower in the intervention group (RR=0.68, 95% CI=0.48, 0.96).ConclusionsA community-supported agriculture intervention resulted in clinically meaningful improvements in diet quality. Subsidized community-supported agriculture may be an important intervention for vulnerable individuals.Trial registrationThis study is registered at www.clinicaltrials.gov NCT03231592.Supplement informationThis article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.

Project description:ImportanceFood insecurity is associated with a less healthy diet. The Supplemental Nutrition Assistance Program (SNAP) is associated with reduced food insecurity, but benefit levels may be insufficient for beneficiaries to afford healthy foods.ObjectiveTo evaluate whether participation in SuperSNAP, a program that provides an additional $40 per month for the purchase of fruits and vegetables with no added sugar, sodium, or fat to SNAP beneficiaries, is associated with changes in food purchasing.Design, setting, and participantsThis longitudinal cohort study used data from transaction records of a large supermarket chain with approximately 500 stores located across North Carolina from October 2019 to April 2020. Participants were SNAP beneficiaries.ExposureSuperSNAP participation.Main outcomes and measuresMonthly spending on all fruits, vegetables, legumes, and nuts (primary outcome); spending on less healthy food categories; and spending on sugar-sweetened beverages as 1 category of less healthy foods. Monthly data on purchases by SNAP beneficiaries before and during SuperSNAP participation were compared with data from SNAP beneficiaries not enrolled in the program who shopped at the same stores. Overlap weighting (a propensity score-based method) was used to account for confounding, and linear mixed-effects models were fitted with random effects to account for repeated measures and clustering by store.ResultsThe study included 667 SuperSNAP participants and 33 246 SNAP beneficiaries who did not use SuperSNAP but shopped in the same stores; 436 SuperSNAP participants had preintervention data and were included in the main analysis. SuperSNAP participation was associated with increased monthly purchases of fruits, vegetables, nuts, and legumes ($31.84; 95% CI, $31.27-$32.42; P < .001; 294.52 oz; 95% CI, 288.84-300.20 oz; P < .001). Only a small increase in spending on less healthy food categories compared with the SNAP beneficiaries who did not use SuperSNAP ($1.60; 95% CI, $0.67-$2.53; P < .001) was observed. As total spending increased, the proportion of total food and beverage spending on less healthy foods significantly decreased (difference, 4.51%; 95% CI, 4.27%-4.74%; P < .001). Monthly spending on sugar-sweetened beverages decreased (difference, $1.83; 95% CI, $1.30-$2.36; P < .001).Conclusions and relevanceIn this cohort study, participation in SuperSNAP was associated with meaningful increases in healthy food purchasing. Subsequent studies should investigate whether healthy food incentive programs improve health outcomes.

Project description:ImportanceFruit and vegetable vouchers have been implemented by cities and counties across the US to increase fruit and vegetable intake and thereby improve overall nutritional quality.ObjectiveTo determine whether and why use of fruit and vegetable vouchers are associated with varied nutritional intake across different populations and environments.Design, setting, and participantsIn a population-based pre-post cohort study of 671 adult participants with low income before and during (6 months after initiation) participation in a 6-month program, fruit and vegetable vouchers were distributed for redemption at local San Francisco and Los Angeles neighborhood grocery and corner stores between 2017 and 2019. A transportability analysis was performed to identify factors that may explain variation in voucher use between cities.ExposureReceipt of $20 per month in produce vouchers for 6 months from 2017 to 2019.Main outcomes and measuresChange in total fruits and vegetables (as defined by the US Department of Agriculture) consumed per person per day (change in cup-equivalents between month 6 and month 0).ResultsA total of 671 adults (median age, 54.9 years [interquartile range, 45.0-65.0 years]; 61.7% female; 30.9% Black; 19.7% Hispanic) were enrolled. An increase in fruit and vegetable intake of 0.22 cup-equivalents per day overall (95% CI, 0.14-0.31 cup-equivalents; P < .001) was observed. However, the observed increase was larger in Los Angeles compared with San Francisco (0.64 cup-equivalents per day; 95% CI, 0.41-0.88 cup-equivalents vs 0.10 cup-equivalents per day; 95% CI, 0.01-0.19 cup-equivalents). When the concurrently sampled San Francisco group (n = 157) was weighted in transportability analysis to demographically match the Los Angeles group (n = 155) in observed covariates, the weighted San Francisco group had an estimated increase of 0.53 fruit and vegetable cup-equivalents per day (95% CI, 0.27- 0.79 cup-equivalents, P = .03), with income being the variable needed to allow the 95% confidence intervals to overlap between the weighted San Francisco and unweighted Los Angeles populations.Conclusions and relevanceIn this study, the use of fruit and vegetable vouchers appeared to be associated with greater benefit among those with lower incomes, suggesting that further investigation of flat-rate rather than income-scaled benefits is warranted.

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Fruit and Vegetable Preferences and Practices May Hinder Participation in Community-Supported Agriculture Among Low-Income Rural Families.

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Fruit and Vegetable Preferences and Practices May Hinder Participation in Community-Supported Agriculture Among Low-Income Rural Families.

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