Effects of DASH Groceries on Blood Pressure in Black Residents of Urban Food Deserts

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Elevated blood pressure (BP) and hypertension are rampant in the US, disproportionately affecting over half of black adults. Interventions that lower BP reduce risk of cardiovascular disease (CVD), stroke, and premature death. The DASH diet, a balanced eating plan that emphasizes fruits, vegetables, low fat dairy, and lean meats, is efficacious in lowering BP among black adults with hypertension. However, uptake among black adults is poor. In fact, unhealthy diet is the most significant determinant of disparities in hypertension management among black adults. Despite numerous educational initiatives encouraging adults to eat 7-9 daily servings of fruits and vegetables, average consumption of fruits and vegetables by adults of lower socioeconomic status has stagnated at 1.3 servings daily. Access, cost, and cultural dissonance in urban "food deserts" have been cited as significant barriers to healthier eating. Thus, innovative research is urgently needed to devise strategies that improve consumption of healthy foods and reduce health disparities among black adults living in urban food deserts. Novel innovations in grocery delivery have the potential to overcome barriers to healthy eating on a massive scale. With the advent of large technology-based companies, which have unprecedented sourcing and delivery capabilities, it is possible to overcome traditional barriers and facilitate choice of palatable healthy foods throughout urban black communities. However, whether virtual supermarkets with home delivery can be leveraged to meaningfully improve diet and BP in an urban food desert has never been tested. We will perform a 12-week individual-level, randomized trial to determine the health effects of complete dietary replacement with home-delivered, low-sodium, DASH-pattern groceries ordered virtually with dietitian assistance. Our proposal represents a partnership with community clinics serving urban communities in consultation with leaders in culturally sensitive meal preparation and community-based participatory research to enroll black adults living in local urban food deserts with elevated BP or hypertension. Participants will have autonomy to choose their own groceries weekly through AmazonFresh, following a pattern that portions food groups according to the DASH feeding plan at an amount that exceeds their Calorie needs. After 12 weeks, we will assess the effects of the groceries on systolic BP (primary outcome) and secondarily on CVD risk factors (cholesterol). Our proposal also includes 8 weeks of dedicated observation to characterize facilitators and barriers of sustained DASH adherence via mixed methods. This trial will establish a scalable, patient-oriented solution that overcomes poor access to healthful foods and addresses health disparities. Knowledge to be gained from this proposal is directly relevant to evolving U.S. food stamp (SNAP) policy toward e-commence groceries and will inform iterative innovation on interventions that reduce dietary disparities among black adults. Ultimately, our proposal accomplishes a major strategic priority of the NIMHD for scientific research to “develop and test interventions to reduce health disparities.”