El Valor de Nuestra Salud (The Value of Our Health)

描述(由申请人提供)：饮食摄入量是肥胖和癌症风险的重要决定因素。水果和蔬菜的消费降低了风险，但在拉美裔中，现在有明确的证据表明，水果和蔬菜的消费量随着对美国的更多适应而减少。针对社会生态框架个人内部和人际层面的干预措施导致了饮食摄入量的变化。然而，这些研究忽略了这样的考虑：除非改变发生在更高级别的影响(例如，在商店、餐馆)，否则个人行为改变不太可能得到加强和持续。我们建议完善一项试点测试的干预措施，以改变杂货店的食物环境，以促进水果和蔬菜的消费。El Valor de Nuestra Salud[我们健康的价值]将识别、招募并匹配18家杂货店(特别是中小型拉丁裔杂货店或天桥)，并将它们随机分为两种情况之一：干预和非治疗对照条件。干预措施将包括两项传播变革战略和两项结构性变革战略，目的是改变社会和物质环境的各个方面。干预措施将包括对员工和经理进行培训，以促进水果和蔬菜的销售，以及如何开展食品营销活动。此外，我们将向Tiendas提供设备和其他物质资源，以促进即食水果和蔬菜的销售，并与他们合作修改肉类和即食食品部的选择。将从基线到干预后即刻(基线后6个月)对360名成年商店客户自我报告的水果和蔬菜摄入量的变化，以及在6个月随访(基线后12个月)这些变化的维持情况，在商店客户层面进行评估。在25%的顾客样本中收集的血清类胡萝卜素水平将为饮食自我报告的有效性提供证据。干预效果将使用自我报告和观察的方法在员工、经理和商店层面进行评估。RE-AIM框架将用于评估传播干预措施的潜力，如果干预措施导致消费者饮食摄入量的改善。这项研究响应了NCI关于饮食和交流的建议，并考虑到墨西哥人/墨西哥裔美国人的参与，响应了NCI减少种族/民族健康差距的使命。

DESCRIPTION (provided by applicant): Dietary intake is an important determinant of risk for obesity and cancer. Consumption of fruits and vegetables reduces risk, yet among Latinos, there is now clear evidence that fruit and vegetable consumption decreases with greater acculturation to the U.S. Interventions targeted at the intrapersonal and interpersonal levels of the Socio-Ecological Framework have resulted in changes to dietary intake. However, these studies have neglected to consider that unless changes occur at higher levels of influence (e.g., in stores, in restaurants), individual behavior changes are unlikely to be reinforced and sustained. We propose to refine a pilot-tested intervention to change the food environment of grocery stores to promote consumption of fruits and vegetables. El Valor de Nuestra Salud [The Value of Our Health] will identify, recruit, and match 18 grocery stores (specifically small-to-medium sized Latino grocery stores or tiendas) and randomize them into one of two conditions: intervention versus a no-treatment control condition. The intervention will consist of two communication change strategies and two structural change strategies with the goal of changing aspects of the social and physical environments. The intervention will include employee and manager trainings to promote sales of fruits and vegetables and how to conduct a food marketing campaign. In addition, we will provide equipment and other material resources to the tiendas to promote sales of ready-to-eat fruits and vegetables, and to work with them to modify selections available in the meat and ready-to-eat food departments. Efficacy will be evaluated at the store customer level in terms of baseline to immediate post-intervention (6 months post-baseline) changes in self-reported fruit and vegetable intake in a sample of 360 adult store customers, and maintenance of these changes at the 6-month follow-up (12 months post-baseline). Levels of serum carotenoids collected in a 25% subsample of customers will provide evidence for the validity of dietary self- report. Intervention effectiveness will be evaluated at the employee, manager, and store levels using both self-reported and observed methodological approaches. The RE-AIM framework will be used to assess the potential for disseminating the intervention if it results in improvements in customers' dietary intake. This study is responsive to NCI's call for proposals on Diet and Communication, and given the involvement of a Mexican/Mexican-American population, is responsive to NCI's mission to reduce racial/ethnic health disparities.