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

描述(由申请人提供)：食用充足的水果和蔬菜(F&V)与较低的慢性病风险相关。饮食指南建议吃更多的F&V食物，但大多数美国人没有达到建议，特别是低收入人群。迫切需要具有成本效益的多层次干预措施，以改善获得性暴力的机会和可获得性，并提供教育和改变社会环境，以增加未得到充分服务的人口对性暴力的摄入量。拟议的研究将以在工作场所进行的成功的F&V交付干预试点为基础，研究创新干预的有效性。这项研究将在16个补贴住房项目中进行，这些项目将进行配对。每个住房项目将随机抽取135个家庭地址作为样本。将进行挨家挨户的招募，将108户家庭纳入评估队列。同意的个人将完成基线调查以及6个月和12个月的后续调查。基线完成后，将随机分为两个干预组之一：Fresh to You组(包括由F&V分销公司直接向住房项目提供降价F&V，外加教育干预)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F&V消费。具体目标是：S.A.1对居住在补贴住房项目中的低收入、不同种族的个人进行形成性研究，以告知适应多层次干预措施，以改善F&V的摄入量以及评估工具和措施。S.A.2采用一组随机试验来研究与对照干预相比，教育干预与F&V交付干预相结合的创新干预在增加参与者F&V消费(Fresh to You干预)方面的有效性。我们还将通过解决以下次要目标来审查方案的交付和接受所涉及的机制和干预的因果途径：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心理社会因素/决定因素与F&V消费变化的关系。与公共健康相关：多吃水果和蔬菜(F&V)是一项主要的国家饮食建议，因为它可以降低患许多慢性病的风险。然而，许多美国人，特别是低收入者，没有吃足够的F&V。拟议的研究的目的是对16个经济适用房项目进行一项小组随机研究，以研究Fresh to You干预措施的有效性，其中包括定期向住房项目提供降价F&V，并进行教育干预，以增加居民F&V的摄入量。

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. PUBLIC HEALTH RELEVANCE: Eating more fruits and vegetables (F&V) is a major national dietary recommendation because it reduces risk for many chronic diseases. However, many Americans, especially low income individuals, are not eating adequate F&V. The purpose of the proposed research is to conduct a group-randomized study with 16 affordable housing projects to study the effectiveness of the Fresh To You intervention, which includes providing regular delivery of reduced price F&V to the housing project together with educational interventions to increase residents' F&V intake.