Fresh to You: Multilevel approaches in low income housing to increase F&V intake

描述（由申请人提供）：食用大量的水果和蔬菜（F&V）与较低的慢性疾病风险相关。饮食指南建议多吃食品和饮料，但大多数美国人都达不到这一建议，尤其是低收入人群。迫切需要具有成本效益的多层次干预措施，以改善食品和饮料的获取和供应，并提供教育和改变社会环境，以增加服务不足人口的食品和饮料摄入量。拟议的研究将通过在工作场所进行的成功的试点F&V交付干预来研究创新干预措施的有效性。这项研究将在16个补贴住房项目中进行，这些项目将成对进行。每个住房项目将随机抽取135个家庭住址作为样本。将进行挨家挨户的招募，将108户家庭纳入评估队列。同意的个人将完成一项基线调查以及6个月和12个月的随访调查。基线完成后，将随机分为两个干预组：Fresh To You组（包括由F&V分销公司直接向住房项目提供降价的F&V，加上教育干预）与对照组（接受关注安慰剂干预，并在研究结束后获得Fresh To You）。主要结果将是食品和饮料消费。具体目标是对保障性住房项目中低收入、不同种族的个体进行形成性研究，以了解多层次干预措施对改善F&V摄入的适应性以及评估工具和措施。S.A.2采用一项组随机试验来研究一种创新的干预措施，将教育干预与食品和饮料提供干预相结合，以增加食品和饮料的获取和可用性，与比较干预措施相比，增加参与者的食品和饮料消费（Fresh To You干预）。我们还将通过解决以下次要目标来审查规划的交付和接收所涉及的机制以及干预的因果途径：a)包括广泛的实施过程评估，以确定成本、覆盖范围、保真度和剂量以及这些变量与评估结果的关系；b)使用中介变量框架来检查重要的社会心理因素/决定因素与食品和饮料消费变化之间的关系。

DESCRIPTION (provided by applicant): Eating ample amounts of fruits and vegetables (F&V) is associated with a lower risk of chronic disease. Dietary guidelines recommend eating more F&V, but most Americans fall short of recommendations especially low income populations. Cost-effective multilevel interventions that improve access and availability to F&V as well as provide education and change the social environment to increase the F&V intake of underserved population are critically needed. The proposed research will study the efficacy of innovative interventions by building upon a successful pilot F&V delivery intervention that was conducted in worksites. The study will be conducted in 16 subsidized housing projects that will be pair-matched. A random sample of 135 household addresses will be chosen at each of the housing projects. Door-to-door recruitment will take place to enroll 108 households in an evaluation cohort. Individuals who agree will complete a baseline survey as well as 6 and 12 month follow-up surveys. Randomization will occur into one of two intervention groups after the baseline is completed: a Fresh To You group (including delivery of reduced price F&V directly to the housing project by a F&V distribution company, plus educational interventions) vs. a comparison group (receiving an attention placebo intervention and access to Fresh To You after the study). The primary outcome will be F&V consumption. The Specific Aims are: S.A.1 To conduct formative research with low income, ethnically diverse individuals living in subsidized housing projects to inform the adaptation of multi-level interventions to improve F&V intake and evaluation tools and measures. S.A.2 To employ a group randomized trial to study the efficacy of an innovative intervention combining educational interventions with a F&V delivery intervention to increase F&V access and availability on increasing participants' F&V consumption (Fresh To You intervention) compared to a Comparison intervention. We will also examine mechanisms involved in delivery and receipt of programming and the causal pathway of the intervention by addressing the following secondary aims: a) To include extensive implementation process evaluation to determine costs, reach, fidelity and dose and the relationship of these variables with evaluation outcomes; b) To use a mediating variable framework to examine relationships among important psychosocial factors/determinants with changes in F&V consumption.