El Valor de Nuestra Salud (The Value of Our Health)

描述（由申请人提供）：膳食摄入量是肥胖和癌症风险的重要决定因素。水果和蔬菜的消费可以降低风险，但在拉丁美洲人中，现在有明确的证据表明，随着对美国文化的更大适应，水果和蔬菜的消费量会减少。针对社会生态框架的个人和人际层面的干预措施导致了饮食摄入量的变化。然而，这些研究没有考虑到，除非改变发生在更高的影响水平（例如，在商店，在餐馆），个人行为的改变不太可能得到加强和维持。我们建议完善一项试点干预措施，以改变杂货店的食物环境，促进水果和蔬菜的消费。El Valor de Nuestra Salud[我们健康的价值]将识别、招募并匹配18家杂货店（特别是中小型拉丁裔杂货店或tiendas），并将它们随机分为两种情况之一：干预与无治疗对照。干预措施将包括两种沟通变化战略和两种结构变化战略，目标是改变社会和自然环境的各个方面。干预将包括员工和经理培训，以促进水果和蔬菜的销售，以及如何开展食品营销活动。此外，我们将向零售商提供设备和其他物质资源，以促进即食水果和蔬菜的销售，并与他们合作修改肉类和即食食品部门的选择。将在商店顾客层面评估干预后（基线后6个月）360名成年商店顾客自我报告的水果和蔬菜摄入量的变化，以及在6个月的随访（基线后12个月）中这些变化的维持情况。在25%的顾客亚样本中收集的血清类胡萝卜素水平将为饮食自我报告的有效性提供证据。干预效果将在员工、经理和商店层面进行评估，采用自我报告和观察的方法。如果干预措施能改善顾客的膳食摄入量，将会利用“再健康目标”框架评估推广干预措施的潜力。这项研究响应了NCI关于饮食和交流的建议，并且考虑到墨西哥/墨西哥裔美国人的参与，响应了NCI减少种族/民族健康差异的使命。

DESCRIPTION (provided by applicant): Dietary intake is an important determinant of risk for obesity and cancer. Consumption of fruits and vegetables reduces risk, yet among Latinos, there is now clear evidence that fruit and vegetable consumption decreases with greater acculturation to the U.S. Interventions targeted at the intrapersonal and interpersonal levels of the Socio-Ecological Framework have resulted in changes to dietary intake. However, these studies have neglected to consider that unless changes occur at higher levels of influence (e.g., in stores, in restaurants), individual behavior changes are unlikely to be reinforced and sustained. We propose to refine a pilot-tested intervention to change the food environment of grocery stores to promote consumption of fruits and vegetables. El Valor de Nuestra Salud [The Value of Our Health] will identify, recruit, and match 18 grocery stores (specifically small-to-medium sized Latino grocery stores or tiendas) and randomize them into one of two conditions: intervention versus a no-treatment control condition. The intervention will consist of two communication change strategies and two structural change strategies with the goal of changing aspects of the social and physical environments. The intervention will include employee and manager trainings to promote sales of fruits and vegetables and how to conduct a food marketing campaign. In addition, we will provide equipment and other material resources to the tiendas to promote sales of ready-to-eat fruits and vegetables, and to work with them to modify selections available in the meat and ready-to-eat food departments. Efficacy will be evaluated at the store customer level in terms of baseline to immediate post-intervention (6 months post-baseline) changes in self-reported fruit and vegetable intake in a sample of 360 adult store customers, and maintenance of these changes at the 6-month follow-up (12 months post-baseline). Levels of serum carotenoids collected in a 25% subsample of customers will provide evidence for the validity of dietary self- report. Intervention effectiveness will be evaluated at the employee, manager, and store levels using both self-reported and observed methodological approaches. The RE-AIM framework will be used to assess the potential for disseminating the intervention if it results in improvements in customers' dietary intake. This study is responsive to NCI's call for proposals on Diet and Communication, and given the involvement of a Mexican/Mexican-American population, is responsive to NCI's mission to reduce racial/ethnic health disparities.