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 ... -  《-》

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》

Adults and Children in Low-Income Households that Participate in Cost-Offset Community Supported Agriculture Have High Fruit and Vegetable Consumption.

Hanson KL ，Kolodinsky J ，Wang W ，Morgan EH ，Pitts SBJ ，Ammerman AS ，Sitaker M ，Seguin RA ... -  《Nutrients》

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

Describe fruit and vegetable (FV) preferences and other factors that may influence participation in community-supported agriculture (CSA). In-depth, semi-structured interviews. Eight rural/micropolitan communities in 4 US states. There were 41 caregivers and 20 children (8-12 years of age) from low-income, English-speaking households. Knowledge, attitudes, and behaviors regarding FVs; perceived barriers to CSA participation. Transcribed verbatim and iteratively coded. 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. 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.

Hanson KL ，Garner J ，Connor LM ，Jilcott Pitts SB ，McGuirt J ，Harris R ，Kolodinsky J ，Wang W ，Sitaker M ，Ammerman A ，Seguin RA ... -  《-》

Knowledge, Attitudes, Beliefs and Behaviors regarding Fruits and Vegetables among Cost-offset Community-Supported Agriculture (CSA) Applicants, Purchasers, and a Comparison Sample.

Hanson KL ，Volpe LC ，Kolodinsky J ，Hwang G ，Wang W ，Jilcott Pitts SB ，Sitaker M ，Ammerman AS ，Seguin RA ... -  《Nutrients》