Exploring the Impact of Policies to Improve Geographic and Economic Access to Vegetables among Low-Income,Predominantly Latino Urban Residents: An Agent-Based Model

Modifying the food environment of cities is a promising strategy for improving dietary behaviors, but using traditional empirical methods to test the effectiveness of these strategies remains challenging. We developed an agent-based model to simulate the food environment of Austin, Texas, USA, and to test the impact of different food access policies on vegetable consumption among low-income, predominantly Latino residents. The model was developed and calibrated using empirical data from the FRESH-Austin Study, a natural experiment. We simulated five policy scenarios: (1) business as usual; (2)–(4) expanding geographic and/or economic healthy food access via the Fresh for Less program (i.e., through farm stands, mobile markets, and healthy corner stores); and (5) expanding economic access to vegetables in supermarkets and small grocers. The model predicted that increasing geographic and/or economic access to healthy corner stores will not meaningfully improve vegetable intake, whilst implementing high discounts (>85%) on the cost of vegetables, or jointly increasing geographic and economic access to mobile markets or farm stands, will increase vegetable intake among low-income groups. Implementing discounts at supermarkets and small grocers is also predicted to be an effective policy for increasing vegetable consumption. This work highlights the utility of agent-based modeling for informing food access policies.     

Association between fruit and vegetable consumption in mothers and children in low-income, urban neighborhoods.

To understand factors influencing fruit and vegetable (F&V) consumption in children, the authors studied the association between F&V consumption in mothers and children in a sample of 1,106 boys and girls in Grades 4-6 in 24 elementary schools in low-income, multiethnic neighborhoods in Montreal, Canada. Approximately 10% of girls and 19% of boys reported not having eaten any vegetables in the week prior to questionnaire administration; 53% of girls and 63% of boys did not consume whole fruits daily. Each unit increase in F&V consumption in mothers was associated with a 10% to 20% increase in F&V consumption in children. Interventions to improve F&V consumption should aim to improve awareness among parents of the importance of fruits and vegetables and of the impact of their own behavior on their children's F&V consumption.     

Evaluation of the South Carolina seniors farmers' market nutrition education program

The Seniors Farmers' Market Nutrition Program (SFMNP) provides vouchers to low-income seniors for use at local farmers' markets. This study was conducted to determine if SFMNP participants increased fruit and vegetable consumption. A total of 15,000 people from 13 counties received vouchers. A random sample of 1,500 received a follow-up survey, of which 658 (44%) were returned. Of the 98% of respondents who used the vouchers, 531 respondents (83%) did not purchase foods that they had never tried before, but 89% reported the intention to eat more fruits and vegetables year round because of the program. Farmers reported benefits from the program, have a positive attitude about it, and are willing to make certain accommodations to participate in it again. The SFMNP is an effective method for increasing consumption of agricultural commodities from farmers' markets by low-income seniors and is worthy of continued funding.     

The Veggie Project: A Case Study of a Multi-component Farmers�� Market Intervention

This case study provides an in-depth examination of process and feasibility factors associated with the development of a multi-component environmental intervention designed to increase access to fresh fruits and vegetables in four low-income, minority, urban communities with few healthy food retail outlets. The intervention, the Veggie Project, included three components: (a) onsite farmers' markets, (b) a Super Shopper voucher program, and (c) a Youth Leader Board. We analyzed receipts from sales transactions at the farmers' markets, close-ended surveys with participants, in-depth interviews with project stakeholders, and journal entries completed by youth participants. Thirty-four farmers' markets occurred, resulting in 1,101 sales transactions. Financial vouchers were used to purchased 63% of the produce. All of the youth Super Shoppers came to the market at least once and made significantly more purchase transactions than adults. The farmers' markets were never accessed by 38% of the adult Super Shoppers. The Veggie Project increased access to healthy foods, particularly among youth. More research is warranted to examine the relationship between market use and dietary behaviors as well as other factors (i.e., besides physical and economic) influencing food access among adults.     

Perceptions of older, low-income women about increasing intake of fruits and vegetables

Focus groups were conducted with 28 older, low-income women in order to identify factors that affected their fruit and vegetable (F&V) consumption. Themes emerging from data analysis include barriers to making dietary changes, specifically to increasing F&V consumption; beliefs about benefits of consuming F&V as compared with other dietary changes; and use of supplements as a substitution for eating F&V. A prominent subtheme concerned the conflict women felt between their desire to consume more F&V and their desire not to waste food. Focus group participants gave concrete suggestions on how to help older, low-income women increase F&V consumption, which included environmental supports.     

School Lunch Environmental Factors Impacting Fruit and Vegetable Consumption

Objective

Assess impact of school lunch environmental factors on fruit and vegetable (F&V) consumption in second and third grade students.

Effects of a food hub initiative in a disadvantaged community: A quasi-experimental evaluation

A quasi-experiment evaluated a food hub's (FH) impact in a low-income/low-access (food desert) setting on fruit and vegetable (F&V) intake, diet quality, kilocalories, perceived food environment, BMI, and farmers' market shopping versus a matched community (n = 265 FH, n = 262 Comparison). Comparison shoppers had better baseline perceptions of their food environment, but FH shoppers improved significantly more than Comparison shoppers. Comparison shoppers significantly increased F&V intake versus FH shoppers. Effects were not significant for other diet outcomes, BMI, or farmers' market shopping. Factors besides spacial access to healthy food need consideration to address dietary intake and obesity in disadvantaged communities.     

Perceived Produce Availability and Child Fruit and Vegetable Intake: The Healthy Communities Study

Children eat more fruits and vegetables when more are available at home, but less is known about how the neighborhood food environment relates to children’s diet and weight outcomes. The goal of this study was to determine whether parental perception of the food environment (neighborhood and home) is associated with children’s fruit and vegetable (F&V) intake and weight outcomes, and to assess differences by household food security status and household income. Cross-sectional data from the 2013–2015 U.S. Healthy Communities Study included 5138 children, aged 4 to 15 years old, from 130 U.S. communities. Neighborhood and home food environments were assessed with parent-reported, perceived F&V availability scores. Associations were tested with multi-level linear regression models. Parents’ perception of produce availability was associated with household F&V availability ratings (β = 0.09 points, p < 0.001). Household F&V availability was associated with child F&V intake (β = 0.32 cups/day or 25.6 g/day, p < 0.001). A higher child F&V intake was associated with a lower child BMI z-score (β = −0.05, p = 0.002). Weaker relationships were seen for children living in food insecure or low-income households. Optimizing neighborhood and home access to F&V may help children improve diet quality, but may not be as effective for children living in food insecure or low-income households.     

A measure of outcome expectations for fruit and vegetable consumption among fourth and fifth grade children: reliability and validity

An outcome expectations questionnaire for fruit and vegetable(F&V) consumption among fourth and fifth grade studentswas developed, pilot-tested at one school and field-tested attwo schools. Seventeen questions generated from focus groupswere listed for fruits and repeated for vegetables. Principalcomponents analysis indicated two subscales ‘social’and ‘health and physical ability’ accounting for37.3% of the total variance; items loaded on the same subscaleswhen applied to fruits or vegetables. Internal consistenciesand test-retest reliabilities for the subscales were acceptable.Mean scores for the ‘health and physical ability’subscale were almost twice as large as the ‘social’subscale regardless of gender, grade and ethnicity. Pearsoncorrelations between F&V outcome expectation subscales andconsumption of F&V (from daily food records) were low, similarto patterns of correlations with preferences for F&V. Furtherresearch regarding outcome expectations is needed to clarifythe extent of their impact on F&V consumption specifically,and perhaps on consumption in general, among pre-adolescentchildren.     

Explaining school children's fruit and vegetable consumption: the contributions of availability, accessibility, exposure, parental consumption and habit in addition to psychosocial factors

We studied the contributions of parental fruit and vegetable (F&V) consumption, availability and accessibility of F&V in the home, exposure to F&V, and habit, in addition to psychosocial factors, in explaining F&V consumption in 4-12-year-old children. Furthermore, we looked for effect modification by ethnicity and gender. Children's parents (n = 1739) completed a questionnaire assessing psychosocial and additional factors regarding their children's F&V consumption. Consumption was assessed by a food-frequency questionnaire. The model explained the children's F&V consumption better when the additional factors were included (R2 = .49 and R2 = .50 for fruit consumption, and R2 = .33 and R2 = .33 for vegetable consumption). Stepwise multi-level regression analyses revealed that habit was the most influential correlate of F&V consumption. It is concluded that nutrition education interventions aimed at stimulating F&V consumption among children should take into account that the consumption of fruit and that of vegetables are clearly different behaviors, with different influencing factors for boys and girls and children of native or non-native background. Furthermore, interventions to increase F&V consumption should include strategies aimed at making these behaviors habitual.     

Sisters in health: experiential program emphasizing social interaction increases fruit and vegetable intake among low-income adults

Sisters in Health, a nutrition education program aimed at increasing fruit and vegetable consumption among low-income women, includes active food experiences, positive social settings, a flexible meeting series, and small-group facilitation by paraprofessionals. The program's impact was evaluated in a nonrandom sample of 269 low-income adults in 32 intervention and 10 control groups in New York State using a quasi-experimental, pre-/postprogram evaluation design. Intervention groups reported increased fruit and vegetable consumption, measured by a brief screener, of 1.6 times a day (versus 0.8 times in the control groups) and were 0.44 times more likely to be eating fruits and vegetables 5 or more times a day (P < .05) than control groups. Group support, taste, and food skill experiences can be effective for increasing fruit and vegetable consumption.     

Fruit and vegetable availability among ten European countries: how does it compare with the 'five-a-day' recommendation? DAFNE I and II projects of the European Commission

Recasting the role of fruit and vegetables (F&V) in the diet, and planning national and international campaigns to enhance their consumption are major public health service objectives. The present study seeks to describe F&V availability patterns in ten European countries and examine compliance with current recommendations. The mean and median F&V availability (g/person per d) was estimated based on household budget survey data retrieved from the Data Food Networking (DAFNE) databank. Low F&V consumers were identified based on WHO international recommendations (minimum combined F&V intake of about 400 g/person per d) and current conservative guidelines of a minimum daily intake of three portions of vegetables and two portions of fruit. Considerable disparities in F&V availability were found among the surveyed European populations. Only in Mediterranean countries did the mean daily population intake clearly exceed combined F&V recommendations. Dietary patterns were positively skewed in all populations studied, on account of the presence of exceptionally high values among segments of the populations. Moreover, the correlation was unexpectedly weak between the proportion of low fruit and low vegetable consumers (Spearman's correlation coefficient +0.18). More than 50% of the households in the surveyed populations are likely to consume less than the recommended daily vegetable intake of three portions, and this applies even to the two Mediterranean populations. The efficiency of F&V promoting strategies may be enhanced if F&V are addressed separately; furthermore, interventions that would specifically focus on vegetables are probably needed.     

Eat Smart,Live Strong Intervention Increases Fruit and Vegetable Consumption Among Low-Income Older Adults

This study evaluated the impact of a four-session interactive nutrition education program—Eat Smart, Live Strong (ESLS)—on the consumption of fruit and vegetables by low-income older adults. A pre–post quasi-experimental design study was conducted with a longitudinal sample of 614 low-income Supplemental Nutrition Assistance Program (SNAP) participants and those eligible for SNAP, aged 60 to 80 years, in 17 intervention and 16 comparison senior centers in Michigan. The study compared participants’ self-reports of their consumption of fruit and vegetables using a modified version of the University of California Cooperative Extension Food Behavior Checklist. ESLS increased participants’ average daily consumption of fruit by 0.2 cups (P < 0.05) and vegetables by 0.31 cups (P < 0.01). ESLS, a four-session, cognitive-behavioral nutrition education program is an effective curriculum for helping low-income older adults eat more fruit and vegetables.     

Patterns of fruit and vegetable consumption among Iranian adults: a SuRFNCD-2007 study

The aim of the present study was to describe the patterns of fruit and vegetable (F&V) intake in a nationally representative sample of the Iranian population. The data collected in the Third National Surveillance of Risk Factors of Non-communicable Diseases (SuRFNCD-2007) were used. In a sample of 3702 Iranian adult participants, patterns of F&V consumption were assessed using the WHO STEPwise method. Low F&V consumption was defined as intake of less than five servings of fruit and/or vegetable daily according to the WHO guidelines. F&V consumption was compared among different age groups, sex and urban/rural areas using complex sample analysis. On average, 1·26 servings of fruit and 1·32 servings of vegetables were consumed daily. Taken together, Iranian adults consumed 2·58 F&V servings per d, with females eating more than males (P ≤ 0·001). Moreover, there was a trend towards lower consumption rates in older-age categories (P = 0·003). Prevalence of low F&V intake (less than five servings daily) was 87·5 % and also tended to be higher in older-age categories (P = 0·004). Prevalence of low intake did not differ significantly among men and women or urban and rural areas. A high prevalence of low F&V consumption in the Iranian adult population was documented. These findings may guide health policy makers in developing specific plans to encourage adequate F&V intake.     

Review of the Nutritional Implications of Farmers' Markets and Community Gardens: A Call for Evaluation and Research Efforts

The development and promotion of farmers' markets and community gardens is growing in popularity as a strategy to increase community-wide fruit and vegetable consumption. Despite large numbers of farmers' markets and community gardens in the United States, as well as widespread enthusiasm for their use as a health promotion tool, little is known about their influcence on dietary intake. This review examines the current scientific literature on the implications of farmers' market programs and community gardens on nutrition-related outcomes in adults. Studies published between January 1980 and January 2009 were identified via PubMed and Agricola database searches and by examining reference lists from relevant studies. Studies were included in this review if they took place in the United States and qualitatively or quantitatively examined nutrition-related outcomes, including dietary intake; attitudes and beliefs regarding buying, preparing, or eating fruits and vegetables; and behaviors and perceptions related to obtaining produce from a farmers' market or community garden. Studies focusing on garden-based youth programs were excluded. In total, 16 studies were identified for inclusion in this review. Seven studies focused on the impact of farmers' market nutrition programs for Special Supplemental Nutrition Program for Women, Infants, and Children participants, five focused on the influence of farmers' market programs for seniors, and four focused on community gardens. Findings from this review reveal that few well-designed research studies (eg, those incorporating control groups) utilizing valid and reliable dietary assessment methods to evaluate the influence of farmers' markets and community gardens on nutrition-related outcomes have been completed. Recommendations for future research on the dietary influences of farmers' markets and community gardens are provided.     

5 a day fruit and vegetable intervention improves consumption in a low income population

OBJECTIVE: This study evaluated the Michigan Farmers' Market Nutrition Program in one Michigan county to determine its effect on fruit and vegetable consumption behavior. SUBJECTS/SETTING: Subjects were selected from WIC and Community Action Agency populations: 564 low income women completed the pretest; 455 completed the posttest. Attrition rate was 19.3%. INTERVENTION: Subjects were assigned to one of 4 interventions: education about the use, storage and nutritional value of fruits and vegetables, distribution of farmers' market coupons, both education and coupons, or no intervention. DESIGN: Education-only and coupon and education groups were randomly assigned; clinic appointment timing determined assignment to no-intervention and coupon-only groups. MAIN OUTCOME MEASURES: A self-administered questionnaire before and after intervention measured attitudes about fruit and vegetable consumption and intake of fruits and vegetables. WIC records documented redemption of coupons. STATISTICAL ANALYSES: Data analysis included 2-way multivariate analysis of covariance, univariate analysis of covariance, logistic regression, and covariance structure modeling. RESULTS: Both the education interventions and the coupon interventions had positive effects. Coupons had a direct effect on increasing fruit and vegetable consumption behavior but no effect on attitudes. Education had a direct effect on attitudes and seemed to exert an effect on consumption behavior through attitudes. The maximum impact of the intervention was achieved through a combination of education and coupons. APPLICATIONS: This study demonstrated that a low-income population may be more likely to increase its fruit and vegetable consumption behavior when incentives such as coupons improve affordability.     

The effects of a fruit and vegetable promotion intervention on unhealthy snacks during mid‐morning school breaks: results of the Dutch Schoolgruiten Project

Background: Ample fruit and vegetable (F&V) intake has been associated with a decreased risk of chronic disease. The health‐enhancing effects of increased F&V consumption, however, would be even more apparent if the increased F&V consumption additionally led to a lower intake of unhealthy, high calorie snacks. Therefore, the present study aimed to investigate whether a primary school‐based intervention (the Dutch Schoolgruiten Project) that promoted F&V intake could additionally reduce the intake of unhealthy, high calorie snacks during school breaks. Methods: The study applied a longitudinal design with baseline and two follow‐up measurements. Children were aged 9–10 years old at baseline; 705 children were included. The main strategy was a F&V scheme that improved the availability, accessibility and exposure to F&V at school by providing one serving of fruit or vegetables twice a week at no cost. The amounts of F&V and unhealthy snacks for consumption at school were measured using a single‐item question included in a questionnaire. Multilevel autoregressive logistic regression models with a three‐level structure (school, child and time) were used to assess the effect of the intervention on both F&V and unhealthy snack consumption. Results: The children of the intervention group brought F&V from home to school at follow‐up significantly more often than the children of the control schools [odds ratio (OR) = 1.41, 95% confidence interval (CI) = 1.04; 1.90] and brought fewer unhealthy snacks (OR = 0.56, 95% CI = 0.34; 0.92). Conclusion: The present study provides some evidence that the Schoolgruiten intervention effect on F&V intake also reduced unhealthy snacking during school breaks.     

Food Insecurity Was Associated with Lower Fruits and Vegetables Consumption but Not with Overweight and Obesity in Children from Mexican Fishing Communities

ABSTRACT

Food insecurity has been associated with decreased household food supplies, which could affect children’s fruit and vegetables intakes and increases their risk of being overweight or obese. The aim of this study was to determine if food insecurity was associated with lower fruit and vegetables consumption and overweight and obesity in children from Mexican fishing communities. A cross-sectional study was 4conducted with 100 elementary-school children aged 6–12 years. A survey that evaluated socioeconomic conditions, food insecurity, and fruits and vegetables consumption was applied. Weight and height were measured. The association between key variables and food insecurity was assessed using linear regression. Sixty-four percent of households experienced food insecurity. Food-insecure children reported lower consumption of fruits and fruits plus vegetables than did their peers with food security (P trend = 0.040 and 0.038, respectively). Food insecurity was also associated with lower chance to meet the recommendation of fruit and vegetable consumption (P trend in logit < 0.001), but was negatively associated with the prevalence of overweight and obesity (P trend in logit < 0.001). Food-insecure children had lower fruits and vegetables consumption but were no more likely to be overweight or obese than their food-secure counterparts.     

Purchasing habits of senior farmers' market shoppers: utilizing the theory of planned behavior

The purpose of this study was to understand fresh fruit and vegetable purchasing habits among senior farmers' market shoppers using the theory of planned behavior. A survey instrument was developed to collect information on seniors' fruit and vegetable purchasing habits. A convenience sample of seniors shopping at farmers' markets was employed. A total of 184 surveys were collected. Respondents were divided into two groups based on response to a question of whether they received Senior Farmers' Market Nutritional Program (SFMNP) checks: 35 were on the SFMNP and 149 were not. Results indicated attitudes, subjective norms (SN), and perceived behavioral control (PBC) were all significantly correlated with intentions at the p?相似文献