Fresh to You: Multilevel approaches in low income housing to increase F&V intake

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DESCRIPTION (provided by applicant): Eating ample amounts of fruits and vegetables (F&V) is associated with a lower risk of chronic disease. Dietary guidelines recommend eating more F&V, but most Americans fall short of recommendations especially low income populations. Cost-effective multilevel interventions that improve access and availability to F&V as well as provide education and change the social environment to increase the F&V intake of underserved population are critically needed. The proposed research will study the efficacy of innovative interventions by building upon a successful pilot F&V delivery intervention that was conducted in worksites. The study will be conducted in 16 subsidized housing projects that will be pair-matched. A random sample of 135 household addresses will be chosen at each of the housing projects. Door-to-door recruitment will take place to enroll 108 households in an evaluation cohort. Individuals who agree will complete a baseline survey as well as 6 and 12 month follow-up surveys. Randomization will occur into one of two intervention groups after the baseline is completed: a Fresh To You group (including delivery of reduced price F&V directly to the housing project by a F&V distribution company, plus educational interventions) vs. a comparison group (receiving an attention placebo intervention and access to Fresh To You after the study). The primary outcome will be F&V consumption. The Specific Aims are: S.A.1 To conduct formative research with low income, ethnically diverse individuals living in subsidized housing projects to inform the adaptation of multi-level interventions to improve F&V intake and evaluation tools and measures. S.A.2 To employ a group randomized trial to study the efficacy of an innovative intervention combining educational interventions with a F&V delivery intervention to increase F&V access and availability on increasing participants' F&V consumption (Fresh To You intervention) compared to a Comparison intervention. We will also examine mechanisms involved in delivery and receipt of programming and the causal pathway of the intervention by addressing the following secondary aims: a) To include extensive implementation process evaluation to determine costs, reach, fidelity and dose and the relationship of these variables with evaluation outcomes; b) To use a mediating variable framework to examine relationships among important psychosocial factors/determinants with changes in F&V consumption.