The FRESH Study: The Fresh Bucks racial equity, socioeconomic & health outcomes study

FRESH 研究：新鲜雄鹿队种族平等、社会经济

• 批准号: 10635729
• 负责人: Barbara I Baquero
• 金额: $ 75.32万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10635729
• 关键词: Address; Affect; American; Black Populations; Black race; Blood Pressure; Body mass index; Cardiometabolic Disease; Cessation of life; Communities; Consumption; Data; Diet; Disparity; Eating; Economic Factors; Economics; Electronic Health Record; Eligibility Determination; Employment; Enrollment; Equity; Ethnic Origin; Exclusion; Family member; Federal Government; Feeling; Food; Health; Health Food; Health Promotion; Healthy Eating; High-Income Populations; Hour; Household; Immigrant; Impact evaluation; Incentives; Income; Inequity; Intake; Intervention; Language; Latinx; Latinx population; Low Income Population; Low income; Marketing; Methodology; Methods; Minority Groups; Municipalities; Neighborhoods; Outcome; Outcome Study; Participant; Persons; Play; Policies; Policy Maker; Population; Poverty; Price; Qualifying; Quasi-experiment; Race; Racial Equity; Randomized; Risk Factors; Sample Size; Services; Source; Spatial Distribution; Structural Racism; Supermarket; Waiting Lists; Work; access disparities; beneficiary; cardiometabolic risk; cardiometabolism; cardiovascular risk factor; cohort; comparison group; cost; design; dietary; experience; farmers markets; financial incentive; food insecurity; food security; fruits and vegetables; health inequalities; health record; high risk; improved; incentive program; innovation; mortality; operation; people of color; programs; racial identity; socioeconomics; structural determinants; systemic barrier; usability

ABSTRACT. Stark disparities in cardiometabolic health outcomes exist by racialized identity and income level. Low-income populations experience 40-70% higher risk for cardiovascular mortality compared to higher-income populations. Black and Latinx populations experience higher rates of at-risk cardiovascular profiles compared to White populations. Diet quality is hypothesized to play a key role in these disparities. But consuming a health- promoting diet is out of reach for many Americans, and disproportionately so for low-income populations and people of color. Structural and economic factors make high-quality diets out of reach for many. Specifically, the intersecting experience of food insecurity, poverty, structural racism, precarious employment, high cost, and difficult to access healthier foods creates a discriminatory and unjust context where accessing, purchasing, and eating a health-promoting diet, particularly one high in fruits and vegetables, is unattainable. As a result, interventions and policies that reduce these structural and economic barriers have high potential to improve food security, dietary quality, and ultimately improve health. To this end, the federal government, several states, and municipalities have introduced policy interventions that provide financial incentives to promote the purchase of fruits and vegetables by low-income populations. However, several prominent design features of these programs leave many of the structural causes of food insecurity and low fruit and vegetable consumption in place. In this study, we can improve what is known about the equity and impact of fruit and vegetable incentive programs through the study of Seattle's Fresh Bucks Program. This program has been designed with several features that have the potential to overcome the limitations of previous programs. Methodologically, we propose a mixed methods study that leverages randomized assignment for assessing causal impact, includes participatory approaches and a sequential explanatory mixed methods design to assess equity in implementation, and a quasi-experimental design to utilize electronic health records of program participants and a matched comparison population to estimate associations with long-term (2-4 years) program enrollment and health outcomes in the following Aims: 1) Determine the impact of Fresh Bucks on fruit and vegetable intake and food insecurity, leveraging randomized program assignment for causal impacts. 2) Assess Fresh Bucks implementation equity through redemption rates and experience. 3) Assess the impact of long-term access to Fresh Bucks on cardiometabolic health, including blood pressure and BMI, in a cohort of recipients and family members with matched electronic health records. Decreasing food insecurity and improving diet quality among low-income and minoritized populations is of primary importance for policymakers concerned about reducing systemic barriers to health. Upon completion of this work, we will have substantially advanced what is known about the dietary, health and implementation equity impacts of fruit and vegetable incentive programs and the potential for these policies to reduce systemic barriers to health.

抽象的。种族认同和收入水平在心脏代谢健康结果方面存在明显差异。 与高收入人群相比，低收入人群的心血管死亡风险高出40%-70% 人口。与以下人群相比，黑人和拉丁裔人群患心血管疾病的风险更高 白人人口。饮食质量被认为在这些差异中起着关键作用。但消费健康-- 推广节食对许多美国人来说是遥不可及的，对低收入人群和 有色人种。结构和经济因素使高质量的饮食对许多人来说遥不可及。具体地说， 粮食不安全、贫困、结构性种族主义、不稳定的就业、高成本和 难以获得更健康的食品造成了一种歧视性和不公平的环境，在这种情况下，获得、购买和 吃一种促进健康的饮食，特别是富含水果和蔬菜的饮食，是不可能实现的。结果, 减少这些结构性和经济障碍的干预措施和政策具有改善粮食的巨大潜力 安全、饮食质量，并最终改善健康。为此，联邦政府、几个州和 市政当局采取了政策干预措施，提供财政奖励，以促进购买 低收入人口的水果和蔬菜。然而，这些程序的几个突出的设计特征 保持粮食不安全和水果和蔬菜消费量低的许多结构性原因不变。在这 通过研究，我们可以提高人们对水果和蔬菜激励计划的公平性和影响的了解 通过对西雅图的鲜鹿计划的研究。该程序的设计具有以下几个功能 有可能克服以前项目的局限性。在方法论上，我们提出了一种混合的 利用随机分配评估因果影响的方法研究，包括参与性研究 为评估执行中的公平性而设计的各种方法和顺序解释性混合方法，以及 利用计划参与者电子健康记录的准实验设计和匹配比较 人口评估与长期(2-4年)计划注册和健康结果之间的关系 目的如下：1)确定新鲜雄鹿对水果和蔬菜摄入量和食物不安全的影响， 利用随机化的计划分配来产生因果影响。2)评估Fresh Bucks实施公平性 通过兑换率和经验。3)评估长期接触新鲜雄鹿对 心脏代谢健康，包括血压和BMI，在一组患有 匹配的电子健康记录。减少低收入和低收入者的粮食不安全和改善饮食质量 对于关心减少系统性障碍的政策制定者来说，人口小型化具有首要意义 为健康干杯。这项工作完成后，我们将大大推进有关饮食的已知内容， 水果和蔬菜奖励计划的健康和实施公平影响及其潜力 减少健康的系统性障碍的政策。