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

摘要 这一行政副刊将支持Rosaura Romero的研究和专业发展 技能，并为她的研究生院提供指导。我们不建议对范围或 人类的父母津贴和摘要保持如下：低收入群体和少数群体 在肥胖、癌症、心脏病和其他与饮食有关的慢性疾病方面面临显著的健康差距 条件。饮食差，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 个人层面的因素(即食物喜好、准备健康食物的时间和技巧等)可能导致减少 F&V消费，这些必须从环境的角度来看待。与收入较高的人相比 社区、低收入和少数族裔社区不太可能有出售各种 F&V和其他健康食品。当有商店可用时，产品可能买不起、质量不高或 在文化上是合适的。农贸市场和流动农产品市场越来越受欢迎 缓解服务不足社区的粮食获取问题的战略。然而，目前还不清楚这些是否 计划有必要的组成部分，以对饮食产生明显的影响。我们的研究团队最近 完成了名为素食面包车(VV)的MM计划的首批随机对照试验之一。vv 将一箱箱新鲜的、当地种植的农产品和以食品为重点的教育送到有重要意义的社区 F&V消费的障碍包括可获得性、可负担性、质量和知识。在这个小星团里- 在12个社区(N=201)的随机试验中，我们看到干预后F&V摄入量发生了令人印象深刻的变化 与对照组相比，参与者每天多吃1杯F&V。干预参与者也 报告称，人们对健康食品和VV消费者的感知增加，将许多饮食变化归因于 MM计划。虽然这些结果非常有希望，但我们认为，重要的是测试 当VV计划由多个社区的不同组织实施时。如果证明是有效的， 我们可以创建一个经过研究测试的干预工具包，可以传播到整个社区 国家。在这项研究中，我们在全国范围内确定了8个有资格实施VV的组织 模特。组织将为MM交付确定合适的地点(共32个)，我们将随机将它们分配到 实施或规划条件。在我们团队的技术帮助下，并提供了 资助后，合作伙伴组织将让社区成员参与这一过程，并启动MM计划。我们 将使用类型1混合有效性-实施来衡量有效性(饮食、BMI、皮肤 类胡萝卜素)和实施(客户范围和销售、流程措施、与MM的定性访谈 员工)。我们还将审查MM财务模式的可持续性，并确定实施标准 (即维持影响所需的剂量)，以纳入我们的MM工具包，以供将来传播。

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.