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

项目摘要/摘要 该项目的目标是测试多层次的、社区参与的干预措施是否能够建立一个可持续的 在密西西比河三角洲实施食品即药品计划的食品经济可以改善少数族裔的健康，减少 健康差距。我们的中心假设是，干预是在积极的社区参与下发展起来的 增加当地水果和蔬菜的生产和分配，将增加水果和蔬菜的消费和 降低参与研究的成年人的体重指数(BMI)、糖化血红蛋白(HbA1c)和健康差距 在为期12个月的研究期内与对照组参与者进行比较。 目标1：设计一种新的干预措施，支持当地的食物经济，并提供食物就是药物 向长期处于不利地位的社区内的少数群体编制方案。使用 社区参与研究的原则和过程，我们将联合社区合作伙伴和成员 玻利瓦尔、华盛顿州和向日葵县在当地一个多部门的三角洲食品政策委员会(FPC)。金融政策委员会 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，以建立可持续的粮食经济和改善健康结果。 目标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距 在农村少数民族人口中，肥胖和糖尿病的风险很大。我们将与金融政策委员会合作， 实施和评估以300人为目标的多层次、社区参与的随机受控干预 成年人有食物不安全、体重指数和糖化血红蛋白5.7%-8.5%。结果衡量标准是(*主要)： 个人水平：增加F+V摄入量*；减少肥胖(BMI)*、糖尿病风险(HbA1c)*和收缩压 血压 社区一级：增加FV的生产和分配；建立生产和减少粮食的渠道 不安全；并减少卫生保健利用率 目标3：创造一种可复制和可扩展的食物经济模式，以减少肥胖和改善糖尿病。 该模式将重点关注生活在不利地区的成年人，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、联邦医疗保险/医疗补助和农场法案有关的建议。 预期影响：以社区为中心的努力，建立至关重要的当地粮食经济，以支持粮食即药品 规划是将营养纳入医疗保健系统和社会安全的一项重大创新 Net用于改善疾病、缩小差距，并每年节省数十亿美元的卫生保健支出。

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.