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

摘要。心脏代谢健康结果存在种族身份和收入水平的明显差异。 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。黑人和拉丁裔人群的心血管风险发生率高于 白色人口。假设饮食质量在这些差异中起着关键作用。但是消耗健康- 促进饮食对许多美国人来说是遥不可及的，对低收入人群来说更是如此， 有色人种结构和经济因素使许多人无法获得高质量的饮食。具体而言是 粮食不安全、贫困、结构性种族主义、就业不稳定、高成本和 很难获得更健康的食物，造成了一种歧视性和不公正的环境， 吃促进健康的饮食，特别是富含水果和蔬菜的饮食，是不可能实现的。因此，在本发明中， 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状况的巨大潜力 安全，饮食质量，并最终改善健康。为此，联邦政府、几个州和 市政府采取了政策干预措施，提供财政奖励，以促进购买 低收入人群的水果和蔬菜。然而，这些程序的几个突出设计特征 造成粮食不安全和水果蔬菜消费量低的许多结构性原因仍然存在。在这 通过这项研究，我们可以改善水果和蔬菜激励计划的公平性和影响力 通过研究西雅图的新鲜巴克斯计划。该程序设计有几个功能， 有可能克服以前计划的局限性。在方法论上，我们提出了一个混合的 利用随机分配评估因果影响的方法研究，包括参与性研究 评估执行公平性的顺序解释性混合方法， 准实验设计，利用计划参与者的电子健康记录和匹配比较 估计与长期（2-4年）计划入学和健康结果的相关性 以下目的：1）确定新鲜巴克斯对水果和蔬菜摄入量和食品不安全的影响， 利用随机程序分配的因果影响。2)评估Fresh巴克斯实施公平性 通过兑换率和经验。3)评估长期获得新鲜巴克斯的影响 心脏代谢健康，包括血压和BMI，在接受者和家庭成员的队列中， 匹配的电子健康记录减少低收入和低收入群体的粮食不安全状况， 少数群体对于关注减少系统性障碍的决策者来说至关重要 对健康在这项工作完成后，我们将大大推进什么是已知的饮食， 水果和蔬菜激励计划对健康和实施公平的影响，以及这些计划的潜力 减少系统性健康障碍的政策。

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.