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.

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. 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 access and security were examined using multiple linear or logistic regression, with adjustment for baseline value within an intent-to-treat (ITT) framework in which missing data were multiply imputed. No significant net effects on children's dietary intake, BMI, or physical activity were observed. Statistically significant net improvements were observed after one growing season for caregivers' cooking attitudes, skills, and self-efficacy; FV intake and skin carotenoid levels; and household food security. Changes in attitudes and self-efficacy remained one-year after baseline, but improvements in caregiver diet and household food security did not. The number of weeks that participants picked up a CSA share (but not number of education sessions attended) was associated with improvements in caregiver FV intake and household food security. Cost-offset CSA plus tailored nutrition education for low-income households improved important caregiver and household outcomes within just one season of participation; most notably, both self-reported and objectively measured caregiver FV intake and household food security improved. Households that picked up more shares also reported larger improvements. However, these changes were not maintained after the CSA season ended. These results suggest that cost-offset CSA is a viable approach to improving adult, but not child, FV intake and household food security for low-income families, but the seasonality of most CSAs may limit their potential to improve year-round dietary behavior and food security. ClinicalTrials.gov . NCT02770196 . Registered 5 April 2016. Retrospectively registered.

Seguin-Fowler RA ，Hanson KL ，Jilcott Pitts SB ，Kolodinsky J ，Sitaker M ，Ammerman AS ，Marshall GA ，Belarmino EH ，Garner JA ，Wang W ... -  《International Journal of Behavioral Nutrition and Physical Activity》

Cost analysis and cost effectiveness of a subsidized community supported agriculture intervention for low-income families.

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 cost-effectiveness based on diet and food security impacts. 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. F3HK cost $2,439 per household annually ($1,884 in implementation-related expenses and $555 in participant-incurred costs). ICERs ranged from $1,507 to $2,439 per cup increase in caregiver's FV intake (depending on perspective, setting, and inclusion of juice); from $502 to $739 per one thousand unit increase in skin carotenoid score; and from $2,271 to $3,137 per household shifted out of food insecurity. Given the known public health, healthcare, and economic consequences of insufficient FV intake and living in a food insecure household, the costs incurred to support these positive shifts in individual- and household-level outcomes via a F3HK-like intervention may be deemed by stakeholders as a reasonable investment. This work helps to advance a critical body of literature on the cost-effectiveness of subsidized CSAs and other economic and food system interventions for the sake of evidence-based allocation of public health resources. ClinicalTrials.gov. NCT02770196. Registered 5 April 2016. Retrospectively registered. https://www. gov/ct2/show/NCT02770196 .

Garner JA ，Hanson KL ，Jilcott Pitts SB ，Kolodinsky J ，Sitaker MH ，Ammerman AS ，Kenkel D ，Seguin-Fowler RA ... -  《International Journal of Behavioral Nutrition and Physical Activity》

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.

Seguin RA ，Morgan EH ，Hanson KL ，Ammerman AS ，Jilcott Pitts SB ，Kolodinsky J ，Sitaker M ，Becot FA ，Connor LM ，Garner JA ，McGuirt JT ... -  《BMC PUBLIC HEALTH》

Fruit and Vegetable Preparation Changes During and After Cost-Offset Community-Supported Agriculture Plus Nutrition Education.

Inadequate consumption of fruits and vegetables (FV) can negatively impact health. Cost-offset, or subsidized, community-supported agriculture (CO-CSA) may change FV preparation behaviors among caregivers in low-income households. We assessed changes in FV preparation frequency and methods during and after participation in a CO-CSA plus tailored nutrition education intervention. Longitudinal comparison of outcomes at baseline, end of CO-CSA season, and 1 year later. Caregivers of children aged 2-12 years from households with low income in rural areas of 4 US states (n = 148). Summer season, half-price CO-CSA share plus tailored nutrition education classes. Comparison to a control group not included in this analysis. Monthly frequency of preparing 9 FV for children's snacks and 5 vegetables for dinner; use of healthy preparation methods for dinner. Repeated measures ANCOVA including state with Bonferroni correction and 95% confidence. At baseline, caregivers prepared fruit for children's snacks and vegetables for dinner almost daily and vegetables for children's snacks every other day. The frequency of total FV preparation and most vegetable varieties increased during the intervention. Increases in total vegetables for snacks, dinner, and leafy greens were maintained 1 year later (n = 107). Community-supported agriculture plus education is a promising approach to sustained increases in vegetable preparation for children's snacks and dinner meals.

Marshall GA ，Garner JA ，Hanson KL ，Ammerman AS ，Jilcott Pitts SB ，Kolodinsky J ，Sitaker M ，Seguin-Fowler RA ... -  《-》

The perceived influence of cost-offset community-supported agriculture on food access among low-income families.

White MJ ，Jilcott Pitts SB ，McGuirt JT ，Hanson KL ，Morgan EH ，Kolodinsky J ，Wang W ，Sitaker M ，Ammerman AS ，Seguin RA ... -  《-》