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

摘要 低收入群体和少数群体在肥胖、癌症、心脏病等方面面临着巨大的健康差距 疾病和其他与饮食有关的慢性病。饮食不佳，水果和蔬菜(F&V)含量低， 饱和脂肪、钠和糖导致了弱势群体面临的许多健康问题。而当 社会经济地位和其他个人水平因素(即食物偏好、准备时间和技能 健康食品等)可以减少F&V消耗，必须从环境的角度来看待这些问题。 与高收入社区相比，低收入社区和少数族裔社区不太可能 有出售各种F&V和其他健康食品的商店。当商店可用时，农产品可以 不是负担得起的、高质量的或文化上合适的。农贸市场和流动农产品市场(MM) 已经成为越来越受欢迎的战略，以缓解服务不足社区对粮食获取的担忧。 然而，目前还不清楚这些计划是否有必要的组成部分，对 节食。我们的研究团队最近完成了MM计划的首批随机对照试验之一，名为 素食面包车。蔬菜面包车是与我们的团队和北方的一个小型非营利性组织合作运营的 卡罗莱纳州；它向社区运送一箱箱新鲜的、当地种植的农产品和以食物为重点的教育 F&V消费的重大障碍包括可获得性、可负担性、质量和知识。在这个小地方 在12个社区(N=201)进行的整群随机试验，我们看到了F&V摄入量的显著变化 干预参与者每天比对照组多吃1杯F&V。干预 参与者还报告说，他们认为健康食品的可及性增加了，素食面包车的顾客认为 MM计划的许多饮食变化。虽然这些结果非常有希望，但我们认为重要的是 测试素食面包车计划在不同组织实施时的有效性 社区。如果被证明是有效的，我们可以创建一个经过研究测试的干预工具包，它可以 传播到全国各地的社区。对于这项研究，我们将使用征求建议书 确定全国范围内有资格实施素食面包车模式的8个组织的过程。 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 实施或计划的条件。在我们团队的技术援助和资金的帮助下， 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 一种类型1的混合有效性-实施 测量有效性(饮食、体重指数、皮肤类胡萝卜素)和 执行(客户范围和销售，流程措施，与MM员工的定性访谈)。我们会 还审查MM财务模型的可持续性并确定执行标准(即所需剂量 以保持影响力)，以包含在我们的MM工具包中，以供将来传播。

Abstract 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. And 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. Veggie Van was run in partnership with our team and a small non-profit organization in North Carolina; it 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 Veggie Van 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 Veggie Van 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 will use a request for proposals process to identify 8 organizations nationwide that are well-qualified to implement the Veggie Van 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.