Kasprzak C.M., Sauer, H.A., Schoonover, J.J., Lapp, M.M., Leone, L.A, “Barriers and facilitators to fruit and vegetable consumption among lower-income families: matching preferences with stakeholder resources.” Journal of Hunger and Environmental Nutrition. Published Online 06 Aug 2020
Experts generally agree that greater access to healthy food results in better diet and health for underserved communities. However, we still know very little about which strategies are most likely to reach target populations or have the most success improving diet. Using qualitative methods, we seek to understand the food access needs of lower-income Western New York families and the capacity of stakeholders. Top barriers to healthy food consumption included cost, accessibility, availability, and taste preferences. Top facilitators included affordability and nutrition education. There is interest and capacity among stakeholders to facilitate access to affordable and quality healthy food.
Masci, J., Kasprzak, C., Schooner, J., Vermont, L., French, L.T., Leone, L.A. “Double Up Food Bucks: A Qualitative Evaluation of Usage, Impact, Barriers, and Facilitators.” Journal of Nutrition Education and Behavior. Published Online 27 August 2020.
Objective Evaluate implementation of a farmers market–based fruit and vegetable incentive program. Design Four focus groups and 6 interviews with program participants from April through November 2017. Setting Double Up Food Bucks (DUFB) program in Western New York. Participants Western New York DUFB program participants. Phenomenon of Interest Customer DUFB usage, how DUFB affects purchasing, and program barriers or facilitators. Analysis Two independent researchers coded focus group and interview transcripts. Researchers summarized codes as themes and selected illustrative quotes. Results Participants (n = 36) were mostly female (75%); 69.4% reported a household income less than $20,000. They reported taking home and consuming more fruits and vegetables because of DUFB, almost always earning the maximum amount of DUFB and saving DUFB for later use. Barriers to using DUFB included limited hours and locations, running out of tokens, poor access to farmers market, and limited stocking. Participants recommended improved program communication, more venues, and convenient schedules to facilitate program use. Conclusions and Implications Findings indicated that incentive programs increased fruit and vegetable consumption and purchasing among those who use them, however barriers to using incentives still existed. To improve the participant experience, program administrators should implement technology-based systems, provide robust communication, and offer incentives at varied locations and times.
Hollis-Hansen, K., Vermont, L., Zafron, M., Seidman, J. Leone, L.A. “The introduction of new food retail opportunities in lower-income communities and the impact on fruit and vegetable intake: A systematic review.” Translational Behavioral Medicine 2019 Oct 1;9(5):837-846
A lack of access to fresh fruits and vegetables (F&Vs) is associated with consumption of fewer F&Vs and higher risk of obesity, especially for lower-income individuals. It is widely believed that the addition of new food retail opportunities could improve F&V consumption and subsequently reduce the chronic disease burden. Observational studies provide some support for these hypotheses, but contradictions exist. In this study we sought to examine if the introduction of a food retailer affects F&V consumption in lower-income communities. We used a systematic PRISMA approach to conduct this study. We searched PubMed, EMBASE, and ProQuest Dissertations & Theses for academic journal references and gray literature published before August 2018. Included studies were those looking at the effect of the introduction of a new food retailer on F&V consumption. Studies were also categorized based on which dimensions of food access were targeted by the food retailer. We identified 15 studies meeting inclusion criteria: 11 studies reported a positive increase in F&V consumption attributable to the introduction of a new food retailer, of which 6 were statistically significant. The remaining 4 studies, all of which examined the impact of introducing a new retail supermarket, showed no change or a decrease in F&V intake. Results from studies which change the food environment generally support the idea that increased access to healthy food improves diet, but more studies are needed in order to assess the differences between the various types of retailers, and to identify strategies for improving impact. Understanding which types of new food retail programs are most likely to impact diet has implications for policies which incentivize new food retail.
Haynes-Maslow L.,Tripicchio, G.L., McGuirt, J., Armstrong-Brown, J., Ammerman, A.S. Leone L.A., “Examining perceived and objective measures of fruit and vegetable access as a predictor of intake in low-income populations.”Translational Behavioral Medicine (In Press).
Carr, L.B., Nezami, B.T., Leone, L.A.“Perceived Benefits and Barriers in the Mediation of Exercise Differences in Older Black Women with and Without Obesity.” Journal of Racial and Ethnic Health Disparities. Aug 2020; 7(4), 807-815.
Objectives Weight control is an exercise benefit, important for older Black women, a group experiencing obesity disparities. We compared perceived exercise benefits and barriers between Black women with and without obesity and determined which mediated the weight group-exercise relationship. MethodsA survey (n = 234) was administered to determine attitudinal agreement between weight groups (obese or non-obese). Multiple mediation analysis was used to investigate if attitudes mediated the weight group-exercise relationship. Results High agreement with all exercise benefits was observed between women with and without obesity. Compared with women without obesity, women with obesity were more likely to report the barriers of only exercising to lose weight (OR = 2.52, 95% CI 1.40–4.55), lack of will power (OR = 1.82, 95% CI 1.05–3.19), weight (OR = 3.04, 95% CI 1.34–6.83), and cost (OR = 2.14, 95% CI 1.02–4.47). Exercising to lose weight and lack of will power mediated the weight group-exercise relationship. Conclusions Women largely agreed on the exercise benefits. Lack of will power and engaging in exercise only for weight loss were barriers that were more common among older Black women with obesity. The barriers partially explained the lower exercise engagement in women with obesity. Future work may address these barriers to increase exercise in older Black women.
Leone, L.A. Tripicchio, G.L., Haynes-Maslow, L., McGuirt, J., Grady Smith, J.S., Kowitt, S., Armstrong-Brown, J., Gizlice, Z. Ammerman, A. “A Cluster-Randomized Trial of Mobile Produce Market Program in 12 Communities in North Carolina: Program Development, Methods and Baseline Results.” Journal of the Academy of Nutrition and Dietetics. 2018 Jan 5;15(1):2.
Background: Mobile markets are an increasingly popular method for providing access to fresh fruits and vegetables (F/V) in underserved communities; however, evaluation of these programs is limited, as are descriptions of their development, study designs, and needs of the populations they serve. Objective: Our aim was to describe the development and theoretical basis for Veggie Van (VV), a mobile produce market intervention, the study design for the VV evaluation, and baseline characteristics of the study population. Design: The protocol and sample for a cluster-randomized controlled trial with 12 sites are described. Participants/setting: Community partner organizations in the Triangle region of North Carolina that primarily served lower-income families or were located in areas that had limited access to fresh produce were recruited. Eligible individuals at each site (older than 18 years of age, self-identified as the main shoppers for their household, and expressed interest in using a mobile market) were targeted for enrollment. A total of 201 participants at 12 sites participated in the VV program and evaluation, which was implemented from November 2013 to March 2016. Main outcome measures: Change in F/V intake (cups/day), derived from self-reported responses to the National Cancer Institute F/V screener, was the main outcome measure. Statistical analyses performed: We performed a descriptive analysis of baseline sample characteristics. Results: Mean reported F/V intake was 3.4 cups/day. Participants reported generally having some access to fresh F/V, and 57.7% agreed they could afford enough F/V to feed their family. The most frequently cited barriers were cost (55.7%) and time to prepare F/V (20.4%). Self-efficacy was lowest for buying more F/V than usual and trying new vegetables. Conclusions: By addressing cost and convenience and building skills for purchasing and preparing F/V, the VV has the potential to improve F/V consumption in underserved communities.
Leone L.A.,Tripicchio, G.L., Haynes-Maslow L.,McGuirt, J., Armstrong-Brown, J., Grady Smith, J.S., Gizlice, Z., Ammerman, A.S., “Cluster randomized controlled trial of a mobile market intervention to increase fruit and vegetable intake among adults in lower-income communities in North Carolina.” International Journal of Behavioral Nutrition and Physical Activity. (2018) 15:2.
Background: Poorer diets and subsequent higher rates of chronic disease among lower-income individuals may be partially attributed to reduced access to fresh fruits and vegetables (F&V) and other healthy foods. Mobile markets are an increasingly popular method for providing access to F&V in underserved communities, but evaluation efforts are limited. The purpose of this study was to determine the impact of Veggie Van (VV), a mobile produce market, on F&V intake in lower-income communities using a group randomized controlled trial. Methods: VV is a mobile produce market that sells reduced-cost locally grown produce and offers nutrition and cooking education. We recruited 12 sites in lower-income communities in North Carolina (USA) to host VV, randomizing them to receive VV immediately (intervention) or after the 6-month study period (delayed intervention control). Participants at each site completed baseline and follow-up surveys including F&V intake, perceived access to fresh F&V and self-efficacy for purchasing, preparing and eating F&V. We used multiple linear regression to calculate adjusted differences in outcomes while controlling for baseline values, education and clustering within site. Results: Among 142 participants who completed the follow-up, baseline F&V intake was 3.48 cups/day for control and 3.33 for intervention. At follow-up, adjusted change in F&V consumption was 0.95 cups/day greater for intervention participants (p = 0.005), but was attenuated to 0.51 cups per day (p = 0.11) after removing extreme values. VV customers increased their F&V consumption by 0.41 cups/day (n = 30) compared to a 0.25 cups/day decrease for 111 non-customers (p = 0.04). Intervention participants did not show significant improvements in perceived access to fresh F&V, but increased their self-efficacy for working more F&V into snacks (p = 0.02), making up a vegetable dish with what they had on hand (p = 0.03), and cooking vegetables in a way that is appealing to their family (p = 0.048). Conclusions: Mobile markets may help improve F&V intake in lower-income communities.
Leone, L.A., Haynes-Maslow, L., Ammerman, A.S. “Veggie Van Pilot Study: Impact of a Mobile Produce Market for Underserved Communities on Fruit and Vegetable Access and Intake.” Journal of Hunger and Environmental Nutrition. 2017; 12 (1):89-100.
We conducted a pilot evaluation of the Veggie Van, a mobile produce market that brings weekly boxes of reduced-cost locally grown fruits and vegetables (F&V) to lower-income communities and offers cooking and nutrition education to customers. We conducted surveys just prior to starting Veggie Van at each of 3 sites and again at 2-3 months. F&V intake was measured with a 2-question item and a 10-item food frequency questionnaire (FFQ) in a subset of participants. At baseline, average servings/day of F&V was 4.9 (SD = 2.6, n = 60). At follow-up, individuals who reported shopping at Veggie Van frequently (n = 32) increased their F&V consumption by 0.41 servings/day compared with a decrease of -1.19 for those who rarely/never used Veggie Van (n = 27), a total difference of 1.6 servings/day (P = .01). There were no statistically significant differences in F&V consumption between groups based on the FFQ measure. Frequent shoppers reported additional health improvements and increases in their ability to buy enough F&V. We conclude that offering weekly boxes of affordable F&V paired with education in underserved communities may improve F&V consumption for frequent program users.
Haynes-Maslow, L.,Parsons, S.,Wheeler, S.B., Leone, L.A. “A qualitative study of perceived barriers to fruit and vegetable consumption among low-income populations, North Carolina, 2011.” Preventing Chronic Disease. 2013; 10:120206
Introduction: Obesity is the leading preventable cause of illness and a major contributor to chronic disease. Eating fresh fruits and vegetables can help manage and prevent weight gain and reduce the risk of chronic diseases. Low-income communities often lack stores that sell fresh fruit and vegetables and have instead stores that sell foods low in nutritional value. The objective of this study was to understand perceived community-level barriers to fruit and vegetable consumption among low-income people. Methods: We conducted 8 focus groups involving 68 low-income participants in 2 North Carolina counties, from May 2011 through August 2011. The socioecological model of health guided data analysis, and 2 trained researchers coded transcripts and summarized findings. Four focus groups were conducted in each county; 1 was all male, 5 all female, and 2 mixed sexes. Most participants were black (68%), most were women (69.1%), and most had a high school education or less (61.8%). Almost half received support from either the Supplemental Nutrition Assistance Program or another government assistance program. Results: We identified 6 major community-level barriers to access to fruits and vegetables: cost, transportation, quality, variety, changing food environment, and changing societal norms on food. Conclusion: Policymakers should consider supporting programs that decrease the cost and increase the supply of high-quality fruits and vegetables in low-income communities.
Tripicchio, G.L., Grady Smith, J,S., Armstrong-Brown, J., Haynes-Maslow, L.1, McGuirt, J., Ammerman, A.S. Paintal, J.S., Mardovich, S.J., Leone, L.A. “Recruiting Community Partners for Veggie Van: Strategies and Lessons Learned From a Mobile Market Intervention in North Carolina, 2012–2015.” Preventing Chronic Disease. 2017 April 27:14:E36
Background Food access interventions are promising strategies for improving dietary intake, which is associated with better health. However, studies examining the relationship between food access and intake are limited to observational designs, indicating a need for more rigorous approaches. The Veggie Van (VV) program was a cluster-randomized intervention designed to address the gap between food access and intake. In this article, we aim to describe the approaches involved in recruiting community partners to participate in VV. Community Context The VV mobile market aimed to improve access to fresh fruits and vegetables by providing subsidized, high-quality, local produce in low-resource communities in North Carolina. This study describes the strategies and considerations involved in recruiting community partners and individual participants for participation in the VV program and evaluation.
Methods To recruit partners, we used various strategies, including a site screener to identify potential partners, interest forms to gauge future VV use and prioritize enrollment of a high-need population, marketing materials to promote VV, site liaisons to coordinate community outreach, and a memorandum of understanding between all invested parties.
Outcome A total of 53 community organizations and 725 participants were approached for recruitment. Ultimately, 12 sites and 201 participants were enrolled. Enrollment took 38 months, but our approaches helped successfully recruit a low-income, low-access population. The process took longer than anticipated, and funding constraints prevented certain strategies from being implemented. Interpretation Recruiting community partners and members for participation in a multi-level, community-based intervention was challenging. Strategies and lessons learned can inform future studies.