A multilevel community engaged intervention to build a sustainable and equitable food economy with food is medicine offerings in the Mississippi Delta to improve minority health and reduce disparities

项目总结/摘要 该项目的目标是测试是否有多层次的，社区参与的干预，以建立一个可持续的 在密西西比三角洲，食品经济和食品即药品计划可以改善少数民族的健康， 健康差距。我们的中心假设是，积极的社区参与开发的干预措施 增加水果和蔬菜（FV）的本地生产和分配，将增加FV消费， 降低体重指数（BMI）、血红蛋白A1 c（HbA 1c）和参与成人的健康差异 在12个月的研究期内与对照组进行比较。 目标1：设计一种新型干预措施，促进当地食品经济并实现食品即药品 为持续处于不利地位的社区内的少数群体人口编制方案。使用 社区参与研究的原则和过程，我们将团结社区合作伙伴和成员， 玻利瓦尔，华盛顿，和向日葵县在当地的多部门三角洲粮食政策理事会（FPC）。的FPC 将设计和实施多层次的干预措施，以提供适当的营养，重点是当地种植的 FV，建立可持续的粮食经济和改善健康成果。 目的2：测试新的干预措施是否通过改善相关结果来减少健康差异 肥胖症和糖尿病的发病率。我们将与FPC合作， 实施和评估一项多层次、社区参与、随机对照的干预措施， 成年人（>25岁），食物不安全，BMI >25，HbA 1c>5.7- 8.5%。结果指标为（* 主要）： 个体水平：增加F+V消耗 *;降低肥胖（BMI）*、糖尿病风险（HbA 1c）* 和收缩压 血压 社区一级：增加粮食作物的生产和分配;建立生产和减少粮食的机会 不安全;减少保健利用 目标3：建立可复制和可扩展的粮食经济模式，以减少肥胖和改善糖尿病。 该模式将重点关注生活在弱势地区的成年人，并制定可持续的食品即药品政策 向州和联邦立法机构提出与SNAP、医疗保险/医疗补助和农业法案有关的建议。 预期影响：以社区为中心的努力，建立至关重要的地方粮食经济，以支持粮食即药品 规划是一项重大创新，将营养纳入医疗保健系统和社会安全 净改善疾病，减少差距，并节省数十亿美元的医疗保健支出每年。

PROJECT SUMMARY/ABSTRACT The goal of this project is to test whether a multi-level, community-engaged intervention to build a sustainable food economy with food-is-medicine programs in the Mississippi Delta can improve minority health and reduce health disparities. Our central hypothesis is that an intervention developed with active community engagement to increase local production and distribution of fruits and vegetables (FV), will increase FV consumption and decrease body mass index (BMI), hemoglobin A1c (HbA1c) and health disparities among participating adults compared to control participants over a 12-month study period. Aim 1: To design a novel intervention that bolsters the local food economy and delivers food-is-medicine programming to a minority population within communities with persistent disadvantage. Using the principles and processes of community-engaged research, we will unite community partners and members of Bolivar, Washington, and Sunflower Counties in a local multi-sector Delta Food Policy Council (FPC). The FPC will design and implement a multi-level intervention to provide appropriate nutrition, focusing on locally grown FV, to build a sustainable food economy and improve health outcomes. Aim 2: To test whether the novel intervention reduces health disparities by improving outcomes related to obesity and diabetes among a rural minority population. We will work collaboratively with the FPC to implement and evaluate a multi-level, community-engaged, randomized controlled intervention targeting 300 adults (>25 y) with food insecurity, BMI >25, and HbA1c)>5.7-8.5%. Outcome measures are (*primary): Individual-level: increase F+V consumption*; decrease obesity (BMI)*, diabetes risk (HbA1c)*, and systolic blood pressure Community-level: increase production and distribution of FV; institute access to produce and decrease food insecurity; and decrease health care utilization Aim 3: Generate a replicable and scalable food economy model to reduce obesity and improve diabetes. The model will focus on adults living in areas with disadvantage and make sustainable food-is-medicine policy recommendations related to SNAP, Medicare/Medicaid and the Farm Bill to state and federal legislatures. Expected impact: Community-centered efforts that build vital local food economies to support food-is-medicine programming represent a major innovation that integrates nutrition into the healthcare system and social safety net to ameliorate disease, mitigate disparities, and save billions of dollars in health care expenditures annually.