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。由于种族化的身份和收入水平存在心脏代谢健康结果的明显差异。 与高收入相比，低收入人群的心血管死亡率高40-70％ 人群。与黑人和拉丁裔种群相比 白人人群。假设饮食质量在这些差异中起关键作用。但是要吃健康 - 对于许多美国人而言，促进饮食遥不可及，对于低收入人群和 有色人种。结构性和经济因素使许多人无法应付高质量的饮食。具体来说， 粮食不安全，贫穷，结构性种族主义，不稳定的就业，高成本和相交的经验 很难获得更健康的食物会创造出歧视性和不公正的环境，在该环境中，购买，购买和 吃一种促进健康的饮食，尤其是一种高水果和蔬菜的饮食，这是无法实现的。因此， 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高潜力 安全性，饮食质量，最终改善健康状况。为此，联邦政府，几个州和 市政当局提出了政策干预措施，提供了经济激励措施来促进购买 低收入人群的水果和蔬菜。但是，这些程序的几个突出的设计功能 留下许多粮食不安全的结构原因，以及低水果和蔬菜消费量。在这个 研究，我们可以改善对水果和蔬菜激励计划的公平和影响的了解 通过研究西雅图的新鲜雄鹿计划。该程序的设计具有多个功能 有可能克服以前程序的局限性。从方法上讲，我们提出了混合 方法研究，利用随机分配来评估因果影响，包括参与式 方法和顺序解释性混合方法设计，以评估实施中的公平性，并 准实验设计利用程序参与者的电子健康记录和匹配的比较 人口估计与长期（2 - 4年）计划入学率和健康成果的关联 以下目的：1）确定新鲜桶对水果和蔬菜摄入量和粮食不安全的影响， 利用随机程序分配因果影响。 2）评估新鲜雄鹿的实施权益 通过赎回率和经验。 3）评估长期获得新鲜雄鹿对的影响 心脏代谢健康，包括血压和BMI，在一个接受者和家庭成员中 匹配的电子健康记录。低收入和 对于关心减少全身障碍的政策制定者而言，少数人群至关重要 健康。完成这项工作后，我们将大大提高有关饮食的了解 水果和蔬菜激励计划的健康和实施平等影响以及这些的潜力 减少系统性障碍的政策。