Effectiveness and Implementation of a Research Tested Mobile Produce Market Designed to Improve Diet in Underserved Communities

摘要 这一行政补充将支持Rosaura Romero的研究和专业发展， 技能，并为她提供研究生院的指导。我们不建议对范围或 父母补助金和摘要的人类受试者仍然如下：低收入和少数群体 在肥胖、癌症、心脏病和其他与饮食有关的慢性疾病方面， 条件饮食不佳，水果和蔬菜（F & V）含量低，饱和脂肪、钠和糖含量高， 造成弱势群体面临的许多健康问题。虽然社会经济地位和其他 个体水平因子（即，食物偏好、准备健康食物的时间和技能等）可导致减少 F & V消费，这些必须在环境背景下看待。与高收入相比 社区，低收入和少数民族社区不太可能有商店出售各种 F & V和其他健康食品。当商店可用时，产品可能不是负担得起的，高质量的， 文化上合适。农贸市场和移动的农产品市场越来越受欢迎 在服务不足的社区缓解粮食获取问题的战略。然而，目前尚不清楚这些 这些计划有必要的组成部分，对饮食产生明显的影响。我们的研究团队最近 完成了一个名为蔬菜货车（VV）的MM项目的首批随机对照试验之一。vv 向社区提供新鲜的本地种植的农产品和以食品为重点的教育， F & V消费的障碍包括可用性、可负担性、质量和知识。在这个小小的星团里- 在12个社区（N = 201）的随机试验中，我们看到了干预后F & V摄入量的显著变化 参与者每天比对照组多吃1杯F & V。干预参与者还 据报道，健康食品和VV客户感知获得的增加归因于许多饮食变化， MM计划。虽然这些结果非常有希望，但我们认为重要的是要测试 验证与确认计划由多个社区的不同组织实施。如果被证明是有效的， 我们可以创建一个经过研究测试的干预工具包， 国家在本研究中，我们确定了全国范围内8个有资格实施验证与确认的组织 模型组织将确定MM分娩的适当地点（共32个），我们将随机分配这些地点， 无论是实施还是规划条件。在我们团队的技术帮助下， 资金，合作伙伴组织将在这个过程中吸引社区成员，并启动一个MM计划。我们 我将使用1型混合免疫力-实施来测量有效性（饮食、BMI、皮肤 类胡萝卜素）和实施（客户覆盖和销售，过程测量，与MM的定性访谈 工作人员）。我们还将审查MM财务模式的可持续性，并确定实施标准 (i.e.,维持影响所需的剂量），以便纳入我们的MM工具包，供将来传播。

Abstract This administrative supplement will support the development of Rosaura Romero's research and professional skills and provide her with mentoring for graduate school. We are not proposing any changes to the scope or human subjects of the parent grant and the abstract remains as follows: Lower-income and minority groups face significant health disparities with respect to obesity, cancer, heart disease and other diet-related chronic conditions. Poor diets, low in fruits and vegetables (F&V) and high in saturated fat, sodium and sugar, contribute to many of the health problems faced by vulnerable groups. While socioeconomic status and other individual level factors (i.e., food preferences, time and skills to prepare healthy food, etc.) can lead to reduced F&V consumption, these must be viewed in an environmental context. Compared with higher-income neighborhoods, lower-income and minority neighborhoods are less likely to have stores that sell a variety of F&V and other healthy foods. When stores are available, produce may not be affordable, high quality or culturally appropriate. Farmers' markets and mobile produce markets (MM) have become increasingly popular strategies to alleviate food access concerns in underserved communities. However, it is unclear if these programs have the necessary components to have an appreciable impact on diet. Our research team recently completed one of the first randomized controlled trials of a MM program called the Veggie Van (VV). VV delivered boxes of fresh, locally grown produce and food-focused education to communities with significant barriers to F&V consumption including availability, affordability, quality and knowledge. In this small cluster- randomized trial in 12 communities (N=201), we saw impressive changes in F&V intake with intervention participants eating almost 1 more cups per day of F&Vs than the control group. Intervention participants also reported increases in perceived access to healthy foods and VV customers attributed many dietary changes to the MM program. While these results are very promising, we believe it is important to test the effectiveness of the VV program when implemented by different organizations in multiple communities. If shown to be effective, we can create a research-tested intervention toolkit which can be disseminated to communities across the country. For this research, we identified 8 organizations nationwide that are well-qualified to implement the VV model. Organizations will identify appropriate sites for MM deliveries (32 total) and we will randomize them to either an implementation or planning condition. With the help of our team's technical assistance and provided funding, partner organizations will engage community members in the process and initiate a MM program. We will use a Type 1 Hybrid Effectiveness-Implementation to measure effectiveness (diet, BMI, dermal carotenoids) and implementation (customer reach and sales, process measures, qualitative interviews with MM staff). We will also examine sustainability of MM financial models and determine implementation standards (i.e., dose needed to maintain impact) for inclusion in our MM toolkit for future dissemination.