Offsetting the cost of Community Support Agriculture (CSA) for low-income families: Perceptions and experiences of CSA farmers and members

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.Community-supported agriculture (CSA) is an alternative food marketing model in which community members subscribe to receive regular shares of a farm's harvest. Although CSA has the potential to improve access to fresh produce, certain features of CSA membership may prohibit low-income families from participating. A ‘cost-offset’ CSA (CO-CSA) model provides low-income families with purchasing support with the goal of making CSA more affordable. As a first step toward understanding the potential of CO-CSA to improve access to healthy foods among low-income households, we interviewed 24 CSA farmers and 20 full-pay CSA members about their experiences and perceptions of the cost-offset model and specific mechanisms for offsetting the cost of CSA. Audio recordings were transcribed verbatim and coded using a thematic approach. Ensuring that healthy food was accessible to everyone, regardless of income level, was a major theme expressed by both farmers and members. In general, CSA farmers and CSA members favored member donations over other mechanisms for funding the CO-CSA. The potential time burden that could affect CSA farmers when administering a cost-offset was a commonly-mentioned barrier. Future research should investigate various CO-CSA operational models in order to determine which models are most economically viable and sustainable.ECU/Cambridge Open Access Publishing Agreemen

Associations between maternal employment and time spent in nutrition-related behaviours among German children and mothers

Objective To examine associations between maternal employment and time spent engaging in nutrition-related behaviours among mothers and children using a nationally representative sample of households in West and East Germany. Design A cross-sectional analysis was performed using time-use data for a sample of mother–child dyads. Associations between maternal employment and time spent in nutrition-related activities such as eating at home, eating away from home and food preparation were estimated using a double-hurdle model. Setting German Time Budget Survey 2001/02. Subjects The overall sample included 1071 households with a child between 10 and 17 years of age. The time-use data were collected for a 3 d period of observation (two weekdays and one weekend day). Results Maternal employment was associated with the time children spent on nutrition-related behaviours. In households with employed mothers, children spent more time eating alone at home and less time eating meals with their mothers. Moreover, employed mothers spent less time on meal preparation compared with non-employed mothers. There were regional differences in time spent on nutrition-related behaviours, such that East German children were more likely to eat at home alone than West German children. Conclusions Maternal employment was associated with less time spent eating with children and preparing food, which may be related to the increasing childhood obesity rates in Germany. Future national surveys that collect both time-use data and health outcomes could yield further insight into mechanisms by which maternal time use might be associated with health outcomes among children

Association Between Physical Activity and Proximity to Physical Activity Resources Among Low-Income, Midlife Women

INTRODUCTION: The association between levels of physical activity and perceived and objectively measured proximity to physical activity resources is unclear. Clarification is important so that future programs can intervene upon the measure with the greatest association. We examined correlations between perceived and objectively measured proximity to physical activity resources and then examined associations between both measures of proximity and objectively measured physical activity. METHODS: Participants (n = 199) were underinsured women from three counties in southeastern North Carolina. Perceived proximity to physical activity resources (e.g., parks, gyms, schools) was measured using surveys. Objectively measured proximity included geographic information systems road network distance to the closest resource and existence of resources within 1- and 2-mile buffers surrounding participants' homes. To examine the association between proximity to resources and activity, the dependent variable in multiple linear regression models was the natural logarithm of accelerometer-measured moderate to vigorous physical activity in minutes per day. RESULTS: Pearson correlation coefficients for perceptions of distance and objectively measured distance to physical activity resources ranged from 0.40 (gyms, schools) to 0.54 (parks). Perceived distance to gyms and objective number of schools within 1-mile buffers were negatively associated with activity. No statistically significant relationships were found between activity and perceived or objectively measured proximity to parks. CONCLUSION: Results indicate the need for both individual and environmental intervention strategies to increase levels of physical activity among underinsured, midlife women. More work is needed to determine the most effective strategies

The association between the food environment and weight status among eastern North Carolina youth

Objective: To examine associations between various measures of the food environment and BMI percentile among youth. Design: Cross-sectional, observational. Setting: Pitt County, eastern North Carolina. Subjects:We extracted the electronic medical records for youth receiving well child check-ups from January 2007 to June 2008. We obtained addresses for food venues from two secondary sources and ground-truthing. A geographic information systems database was constructed by geocoding home addresses of 744 youth and food venues. We quantified participants\u27 accessibility to food venues by calculating \u27coverage\u27, number of food venues in buffers of 0●25, 0●5, 1 and 5 miles (0●4, 0●8, 1●6 and 8●0 km) and by calculating \u27proximity\u27 or distance to the closest food venue. We examined associations between BMI percentile and food venue accessibility using correlation and regression analyses. Results:There were negative associations between BMI percentile and coverage of farmers\u27 markets/produce markets in 0●25 and 0●5 mile Euclidean and 0●25, 0●5 and 1 mile road network buffers. There were positive associations between BMI percentile coverage of fast-food and pizza places in the 0●25 mile Euclidean and network buffers. In multivariate analyses adjusted for race, insurance status and rural/urban residence, proximity (network distance) to convenience stores was negatively associated with BMI percentile and proximity to farmers\u27 markets was positively associated with BMI percentile. Conclusions: Accessibility to various types of food venues is associated with BMI percentile in eastern North Carolina youth. Future longitudinal work should examine correlations between accessibility to and use of traditional and non-traditional food venues

Associations between farmers market managers’ motivations and market-level Supplemental Nutrition Assistance Program Electronic Benefit Transfer (SNAP/EBT) availability and business vitality

Ward, R., Slawson, D., Wu, Q., & Pitts, S. J. (2015). Associations between farmers market managers’ motivations and market-level Supplemental Nutrition Assistance Program Electronic Benefit Transfer (SNAP/EBT) availability and business vitality. Journal of Agriculture, Food Systems, and Community Development, 6(1), 121–130. http://dx.doi.org/10.5304/jafscd.2015.061.010. Licensed under a CC BY 4.0 license.Farmers markets are promoted to improve access to healthy food for low-income consumers by providing affordable produce via Supplemental Nutrition Assistance Program Electronic Benefit Transfer (SNAP/EBT). Having SNAP/EBT at markets also expands revenue opportunities for participating farmers. Market managers play a key role in implementing SNAP/EBT and promoting business opportunities for farmers, yet they are not motivated equally by public health and business goals. There are few studies examining market managers’ influence on food access for low-income households and business opportunities for farmers. We examined associations between managers’ motivations and (1) food access for low-income households, measured by SNAP/EBT availability, and (2) business vitality, measured by vendor participation. A survey assessing manager motivation, SNAP/EBT availability, and vendor participation was sent to all market managers (N=271) in North Carolina. Seventy (26%) managers completed the survey. Multiple regression models were used to examine the association between managers’ motivations to (1) improve access to healthful food and SNAP/EBT availability, and to (2) support business opportunities and total vendor count, weekly vendor count, and the number of vendors who sell only what they produce (“producer-only�). There was no significant association between food access motivation and SNAP/EBT availability, or business motivation and total and weekly vendor count. A high business motivation score was positively associated with having 13 more producer-only vendors at the market. Manager pay was positively correlated with vendor participation, including total vendor, weekly, and producer-only vendor counts. Our results suggest that public health interventions should emphasize the business opportunities offered by SNAP/EBT at farmers’ markets, ultimately leveraging market managers’ business goals to encourage SNAP/EBT implementation.ECU Open Access Publishing Support Fun

Conducting Community Audits to Evaluate Community Resources for Healthful Lifestyle Behaviors: An Illustration From Rural Eastern North Carolina

A community audit is a qualitative and quantitative research technique in which researchers drive through a community to observe its physical and social attributes, primarily through windshield tours and "ground truthing." Ground truthing is a verification process that uses data gathered by direct observation to corroborate data gathered from secondary sources. Community audits have been used for epidemiologic studies and in program planning for health-promotion interventions. Few studies have detailed the methodology for conducting community audits in rural areas or the extent to which community audits can contribute to an accurate assessment of community characteristics (eg, presence of sidewalks) and nutrition and physical activity resources (eg, produce stands, parks) that may promote healthful lifestyle behaviors. The objective of this article is to describe our approach to conducting a community audit (consisting of windshield tours and ground truthing) to enumerate resources, to assess community characteristics, and to inform revisions to a community guide on nutrition and physical activity resources. We conducted an audit in 10 communities in a rural eastern North Carolina county in 2010. We also collected data from secondary sources to make comparisons with community audit data. The initial resource guide included 42 resources; the community audits identified 38 additional resources. There was moderate to high agreement between windshield tour observations and secondary data sources for several community characteristics, such as number of fast-food restaurants (67% agreement) and existence of sidewalks (100% agreement). Community audits improved the description of health-promoting community resources and the context in which people make lifestyle choices

Commute Times, Food Retail Gaps, and Body Mass Index in North Carolina Counties

Introduction: The prevalence of obesity is higher in rural than in urban areas of the United States, for reasons that are not well understood. We examined correlations between percentage of rural residents, commute times, food retail gap per capita, and body mass index (BMI) among North Carolina residents. Methods: We used 2000 census data to determine each county\u27s percentage of rural residents and 1990 and 2000 census data to obtain mean county-level commute times. We obtained county-level food retail gap per capita, defined as the difference between county-level food demand and county-level food sales in 2008, from the North Carolina Department of Commerce, and BMI data from the 2007 North Carolina Behavioral Risk Factor Surveillance System. To examine county-level associations between BMI and percentage of rural residents, commute times, and food retail gap per capita, we used Pearson correlation coefficients. To examine cross-sectional associations between individual-level BMI (n=9,375) and county-level commute times and food retail gap per capita, we used multilevel regression models. Results: The percentage of rural residents was positively correlated with commute times, food retail gaps, and county-level BMI. Individual-level BMI was positively associated with county-level commute times and food retail gaps. Conclusions: Longer commute times and greater retail gaps may contribute to the rural obesity disparity. Future research should examine these relationships longitudinally and should test community-level obesity prevention

A Community-Driven Approach to Identifying “Winnableâ€? Policies Using the Centers for Disease Control and Prevention’s Common Community Measures for Obesity Prevention

Federally funded, community-based participatory research initiatives encourage the development and implementation of obesity prevention policies. In 2009, the Centers for Disease Control and Prevention (CDC) published the Common Community Measures for Obesity Prevention (COCOMO), which include recommended strategies and measures to guide communities in identifying and evaluating environmental and policy strategies to prevent obesity. Agreeing on "winnable" policy issues can be challenging for community members. We used CDC's COCOMO to structure in-depth interviews and group discussions with local stakeholders (ie, planners, town managers, and a local community advisory council) to stimulate interest in and identify health-promoting policies for local policy and planning agendas. We first asked stakeholders to rank the COCOMO recommendations according to feasibility and likelihood of success given community culture, infrastructure, extent of leadership support, and likely funding support. Rankings were used to identify the most and least "winnable" COCOMO policy strategies. We then used questions from the evidence-based Community Readiness Handbook to aid discussion with stakeholders on the facilitators and barriers to enacting the most and least winnable policy options identified. Finally, we discuss potential adaptations to COCOMO for rural jurisdictions

One-Year Follow-Up Examination of the Impact of the North Carolina Healthy Food Small Retailer Program on Healthy Food Availability, Purchases, and Consumption

We examined the short-term impact of the North Carolina Healthy Food Small Retailer Program (HFSRP), a legislatively appropriated bill providing funding up to $25,000 to small food retailers for equipment to stock and promote healthier foods, on store-level availability and purchase of healthy foods and beverages, as well as customer dietary patterns, one year post-policy implementation. We evaluated healthy food availability using a validated audit tool, purchases using customer bag-checks, and diet using self-reported questionnaires and skin carotenoid levels, assessed via Veggie Meter™, a non-invasive tool to objectively measure fruit and vegetable consumption. Difference-in-difference analyses were used to examine changes in HFSRP stores versus control stores after 1 year. There were statistically significant improvements in healthy food supply scores (availability), with the Healthy Food Supply HFS score being −0.44 points lower in control stores and 3.13 points higher in HFSRP stores pre/post HFSRP (p = 0.04). However, there were no statistically significant changes in purchases or self-reported consumption or skin carotenoids among customers in HFSRP versus control stores. Additional time or other supports for retailers (e.g., marketing and promotional materials) may be needed for HFSRP implementation to influence purchase and consumption