The purpose of this study is to better understand how participation in cost-subsidized community supported agriculture programs paired with tailored education can affect diet quality and energy balance among children in low-income households.
Community Supported Agriculture (CSA) is an innovative approach to increasing consumer access to and consumption of fresh produce, thereby lowering obesity prevalence. However, CSA "share" costs may be a barrier for low-income households with children. This multistate study examines whether subsidizing the cost of CSAs, integrated with tailored education: 1) increases consumption of fruits and vegetables, 2) substitutes fruits and vegetables for more energy-dense foods, and 3) improves overall diet quality and energy balance, thus helping children maintain healthy body weights. It also investigates how cost-offset CSAs ("CO-CSAs") contribute to local agricultural economies. Given the well-documented risk for obesity and limited access to fresh produce among low-income individuals, those households are the target of the intervention in four geographically-diverse states: Vermont, New York, North Carolina and Washington. FORMATIVE AND LONGITUDINAL RESEARCH: Qualitative and quantitative research is being used to inform implementation of the randomized trial, refine outcome assessment strategies, and provide information needed to design a tailored curriculum to enhance low-income households' knowledge, skills, attitudes, and behaviors related to the use of CSA produce and healthy eating. In the first year of the study, the investigators conducted interviews and focus groups with stakeholders to gather in-depth data related to the potential of CO-CSA operations to meet the needs and preferences of low-income households and the types of information that would be most valuable to include in the study's curriculum. Key stakeholder groups included adults and children from low-income households, CSA farmers, current full-paying CSA members, and nutrition educators. The investigators also are conducting a longitudinal quantitative examination of dietary behaviors among current CO-CSA participants in an existing statewide program in Vermont. Using online surveys, the investigators are measuring dietary outcomes quarterly among children, and biannually among adults, from low-income households in the program. Data from Year 1 was used to inform the intervention, while data from subsequent time points will provide an opportunity for analysis of longitudinal patterns. RANDOMIZED INTERVENTION: In the second phase of the project, the investigators will implement and evaluate a three-year delayed intervention randomized controlled trial of CO-CSA plus skill-based, CSA-tailored education in the four states. The investigators will compare changes in dietary behaviors, reported consumption, energy intake, and weight status parameters between children aged 2-12 in 120 control and 120 intervention households. Two hundred households were enrolled in 2016 and an additional 40 households will be enrolled in 2017. Participant households enrolled in 2016 will receive a CO-CSA share for two seasons and education during their first CO-CSA season (Y1 for intervention households and Y2 for control households). Households enrolled in 2017 will receive a CO-CSA share and education for one season (Y2 for intervention households and Y3 for control households). In addition to outcomes with participants, investigators will conduct economic analysis to evaluate the impact of CO-CSA for farms and communities. While these analyses are not related to the human participants, they are central to the overall project goals.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
305
Participants will receive subsidized share of CSA produce (50% standard member price) weekly for approximately 20 weeks each year. In addition, they will attend nine skill-based, nutrition education sessions focused on use of CSA produce.
Barker
Change in child's fruit and vegetable intake as measured by short dietary screener
Data collected using the National Cancer Institute's All-Day Fruit and Vegetable Screener.
Time frame: Baseline to 4 months, 12 month follow-up, 16-month follow-up, 24-month follow-up, and 28-month follow-up
Change in child's fruit and vegetable intake as measured by 24-hour dietary recall
Data collected with dietary recalls using the online Automated Self-Administered 24-Hour Dietary Recall (ASA24) system
Time frame: Baseline to 4 months, 16-month follow-up, and 28-month follow-up
Change in child's intake of sugar-sweetened beverages and processed snacks as measured by short dietary questionnaire
Data collected using the Fred Hutchison Cancer Research Center's 'Beverage and Snack Questionnaire 2'
Time frame: Baseline to 4 months, 12-month follow-up, 16-month follow-up, 24-month follow-up, and 28-month follow-up
Change in child's intake of sugar-sweetened beverages and processed snacks as measured by 24-hour dietary recall
Data collected with dietary recalls using the online Automated Self-Administered 24-Hour Dietary Recall (ASA24) system
Time frame: Baseline to 4 months, 16-month follow-up, and 28-month follow-up
Change in child's caloric intake as a percent of estimated energy requirements
Data collected with dietary recalls using the online Automated Self-Administered 24-Hour Dietary Recall (ASA24) system
Time frame: Baseline to 4 months, 16-month follow-up, and 28-month follow-up
Change in child's dermal carotenoid levels
Carotenoid levels measured by resonance Raman spectroscopy using the Bio-Photonic Scanner (NuSkin Enterprises)
Time frame: Baseline to 4 months, 16-month follow-up, and 28-month follow-up
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Barker, New York, United States
Corning
Corning, New York, United States
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Gasport, New York, United States
Lockport
Lockport, New York, United States
Medina
Medina, New York, United States
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Newfane, New York, United States
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Watertown, New York, United States
Chapel Hill
Chapel Hill, North Carolina, United States
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Chapel Hill, North Carolina, United States
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Pittsboro, North Carolina, United States
...and 19 more locations
Change in child's diet quality
Data collected with dietary recalls using the online Automated Self-Administered 24-Hour Dietary Recall (ASA24) system
Time frame: Baseline to 4 months, 16-month follow-up, and 28-month follow-up
Change in child's BMI percentile
Height and weight measured by trained research staff
Time frame: Baseline to 4 months, 16-month follow-up, and 28-month follow-up
Change in child's physical activity
Data collected using survey question on physical activity adapted from Youth Risk Behavior Surveillance System (YRBSS) questionnaire
Time frame: Baseline to 4 months, 12 month follow-up, 16-month follow-up, 24-month follow-up, and 28-month follow-up
Change in child's sedentary behavior
Data collected using survey questions on TV, video, and computer use adapted from Youth Risk Behavior Surveillance System (YRBSS) questionnaire
Time frame: Baseline to 4 months, 12 month follow-up, 16-month follow-up, 24-month follow-up, and 28-month follow-up
Changes in parent's ability to select, store, and prepare CSA produce
Data collected using questionnaire module on parent's ability to select, store, and prepare CSA produce
Time frame: Baseline to 4 months, 16-month follow-up, and 28-month follow-up
Changes in parent's ability to prepare foods to minimize added (solid) fat and sugar
Data collected using questionnaire module on parent's ability to prepare foods to minimize added (solid) fat and sugar
Time frame: Baseline to 4 months, 16-month follow-up, and 28-month follow-up
Changes in parent's ability to substitute fruit and vegetables for energy-dense foods
Data collected using questionnaire module on parent's ability to substitute fruit and vegetables for energy-dense foods
Time frame: Baseline to 4 months, 16-month follow-up, and 28-month follow-up
Changes in parent's knowledge, attitudes, and beliefs about fruits and vegetables
Data collected using questionnaire module on parent's knowledge, attitudes, and beliefs about fruits and vegetables
Time frame: Baseline to 4 months, 16-month follow-up, and 28-month follow-up
Changes in availability and accessibility of fruits and vegetables in the home
Data collected using questionnaire module on the availability and accessibility of fruits and vegetables in the home
Time frame: Baseline to 4 months, 16-month follow-up, and 28-month follow-up
Change in parent's fruit and vegetable intake as measured by short dietary screener
Data collected using the National Cancer Institute's All-Day Fruit and Vegetable Screener
Time frame: Baseline to 4 months, 12 month follow-up, 16-month follow-up, 24-month follow-up, and 28-month follow-up
Change in parent's intake of sugar-sweetened beverages and processed snacks as measured by short dietary questionnaire
Data collected using the Fred Hutchison Cancer Research Center's 'Beverage and Snack Questionnaire 2'
Time frame: Baseline to 4 months, 12 month follow-up, 16-month follow-up, 24-month follow-up, and 28-month follow-up
Change in parent's dermal carotenoid levels
Carotenoid levels measured by resonance Raman spectroscopy using the Bio-Photonic Scanner (NuSkin Enterprises)
Time frame: Baseline to 4 months, 16-month follow-up, and 28-month follow-up
Changes in household food security
Data collected using the USDA 6-item Food Security Survey Module with 30-day reference period
Time frame: Baseline to 4 months, 12 month follow-up, 16-month follow-up, 24-month follow-up, and 28-month follow-up