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

The Need for Evidence-Based Interventions to Reduce Food Insecurity Among College Students

Food insecurity is defined as insufficient resources to meet food needs. This is a global problem but is not confined to those countries identified as poor. One group of Americans who are particularly affected, and for whom the effects are particularly severe, is college students

A Mentor-Led Text-Messaging Intervention Increases Intake of Fruits and Vegetables and Goal Setting for Healthier Dietary Consumption among Rural Adolescents in Kentucky and North Carolina, 2017

Text-messaging interventions hold promise for successful weight loss interventions. However, there is limited research on text-messaging interventions to improve dietary intake among rural adolescents, who are at greater risk for obesity and related risk factors. The goal of this study was to test an eight-week, mentor-led text-messaging intervention among 14–16-year-old rural adolescents: the “Go Big and Bring It Home� Project to improve fruit and vegetable and healthy beverage intake. Methods and Materials—Eight rural high schools in eastern Kentucky and eastern North Carolina participated (n = 4 were randomized as intervention schools and n = 4 were randomized as control schools). Adolescents were recruited to participate in the eight-week text-messaging intervention. The text messages were primarily affective messages, and included a weekly challenge related to consuming fruits, vegetables, or healthy/low-calorie beverages. Undergraduate nutrition students sent text messages on Tuesday and Saturday every week over the eight-week period via the “Group Me� mobile application. Delayed controls received no information or text messages during the eight-week intervention. Fruit and vegetable intake was measured with the National Cancer Institute Fruit and Vegetable screener and beverage intake was assessed using the Beverage Questionnaire-10 (BEVQ-10). Intention-to-treat analyses were conducted among all those that completed the baseline and post-intervention survey (n = 277 intervention students and n = 134 delayed control students). All linear regression models were adjusted for race and were clustered on school to control for intraclass correlation. Results—In adjusted analyses, there was a statistically significant positive intervention effect on the primary outcome of fruit and vegetable servings/day with a mean difference between intervention and control participants of 1.28 servings/day (95% Confidence Interval 1.11, 1.48). There was no intervention effect on beverage intake. There was a statistically significant increase in the odds of goal setting for healthier dietary behaviors among intervention participants relative to controls. Conclusion—An eight-week text-messaging intervention led to increases in self-reported fruit and vegetable intake and improvements in goal setting for healthier dietary behaviors. Due to the use of undergraduate students to deliver the messages, and use of an existing web application, this text-messaging intervention can be sustained in underserved, rural environments. Thus there is potential for significant reach and public health impact to improve dietary patterns

Association between Spatial Access to Food Outlets, Frequency of Grocery Shopping, and Objectively-Assessed and Self-Reported Fruit and Vegetable Consumption

Because supermarkets are a critical part of the community food environment, the purpose of this paper is to examine the association between accessibility to the supermarket where participants were surveyed, frequency of shopping at the supermarket, and self-reported and objectively-assessed fruit and vegetable consumption. Accessibility was assessed using Geographic Information Systems (GIS) measured distance and multiple versions of the modified Retail Food Environment Index (mRFEI), including a localized road network buffer version. Frequency of shopping was assessed using self-report. The National Cancer Institute Fruit and Vegetable screener was used to calculate daily servings of fruits and vegetables. Skin carotenoids were assessed using the “Veggie Meter™� which utilizes reflection spectroscopy to non-invasively assess skin carotenoids as an objective measure of fruit and vegetable consumption. Bivariate and multivariable statistics were used to examine the associations in RStudio. There was a positive association between skin carotenoids and the Special Supplemental Nutrition Program for Women Infants and Children (WIC) and mRFEI scores, suggesting that WIC participation and a healthier food environment were associated with objectively-assessed fruit and vegetable consumption (skin carotenoids). Future research should examine these associations using longitudinal study designs and larger sample sizes

Access to Primary Care: Comparing driving distance from Health Professional Shortage Area (HPSA) counties versus non-HPSA counties

The criteria used to identify Health Professional Shortage Areas dates back to the 1970’s and very little has changed since then. This study examined driving distance from patient address to provider address as one component of a geographical HPSA. Primary care-related services located in adjacent areas to whole-county HPSAs are considered excessively distant when travel time exceeds 30 minutes or the equivalent of 20 miles in this study. We found similarities in travel distance to primary care-related services from patients living in HPSA counties compared to those living in non-HPSA counties. This could indicate the need to re-examine HPSA definitions to more accurately identify truly underserved populations in rural areas

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

A possible dose–response association between distance to farmers’ markets and roadside produce stands, frequency of shopping, fruit and vegetable consumption, and body mass index among customers in the Southern United States

Background: The association between farmers’ market characteristics and consumer shopping habits remains unclear. Our objective was to examine associations among distance to farmers’ markets, amenities within farmers’ markets, frequency of farmers’ market shopping, fruit and vegetable consumption, and body mass index (BMI). We hypothesized that the relationship between frequency of farmers’ market shopping and BMI would be mediated by fruit and vegetable consumption. Methods: In 15 farmers’ markets in northeastern North Carolina, July–September 2015, we conducted a crosssectional survey among 263 farmers’ market customers (199 provided complete address data) and conducted farmers’ market audits. To participate, customers had to be over 18 years of age, and English speaking. Dependent variables included farmers’ market shopping frequency, fruit and vegetable consumption, and BMI. Analysis of variance, adjusted multinomial logistic regression, Poisson regression, and linear regression models, adjusted for age, race, sex, and education, were used to examine associations between distance to farmers’ markets, amenities within farmers’ markets, frequency of farmers’ market shopping, fruit and vegetable consumption, and BMI. Results: Those who reported shopping at farmers’ markets a few times per year or less reported consuming 4.4 (standard deviation = 1.7) daily servings of fruits and vegetables, and those who reported shopping 2 or more times per week reported consuming 5.5 (2.2) daily servings. There was no association between farmers’ market amenities, and shopping frequency or fruit and vegetable consumption. Those who shopped 2 or more times per week had a statistically significantly lower BMI than those who shopped less frequently. There was no evidence of mediation of the relationship between frequency of shopping and BMI by fruit and vegetable consumption. Conclusions: More work should be done to understand factors within farmers’ markets that encourage fruit and vegetable purchases.ECU Open Access Publishing Support Fun

Adaptation of a Modified Diet Quality Index to Quantify Healthfulness of Food-Related Toy Sets

The objective of this cross-sectional study was to examine the construct validity of an adapted modified Diet Quality Index (aDQI) as a measure of the healthfulness of food-related toy sets for young children (3–8 years). A standardized online search was used to identify toy sets (n = 50) from 10 retailers. An aDQI score (aDQI score, range 0–50) was determined for each toy set, mean (standard deviation) = 28.7 (6.1). Regression analyses demonstrated a positive association between aDQI score and percentage of dairy, refined grains, protein, vegetables, and fruit and inverse association with percentage of desserts, sugar-sweetened beverages, and total number of servings. Sets contained more protein and fewer fruits than recommended. The aDQI score demonstrates construct validity to objectively assess the healthfulness of food-related toy sets. There is opportunity for toy manufacturers to make changes to improve the healthfulness in toy sets for young children, and future research can explore the impact of food-related toy sets on nutrition behaviors

Skin Carotenoid Status Over Time and Differences by Age and Sex Among Head Start Children (3-5 years) Living in Eastern North Carolina

OBJECTIVE: Examine differences in skin carotenoid status (SCS) based on time, age, and sex of preschool-aged children (PSAC) enrolled in Head Start (HS) in North Carolina (NC). DESIGN: Data were collected using surveys from participating families. PSAC’s SCS were measured 3 times over a 6-month period. SETTING: 3 HS centers in NC PARTICIPANTS: 112 children aged 3-5 years old, enrolled in HS MAIN OUTCOME MEASURE(S): Differences in SCS assessed using the Veggie Meter® based on time, sex and age ANALYSIS: One-way Analysis of Variance (ANOVA) to assess SCS at Time 1 between sex and age (n=112). Repeated measures ANOVA with a Greenhouse-Geisser correction to assess SCS over time (n=45) using Bonferroni correction(b). RESULTS: On average, children were 4 years old, African American (81.3%), male (57%) and mean SCS 266 (SD 82.9). SCS were significantly different over time (p<.001). Significant differences were observed between ages (p=.01) and sex (p=.01). CONCLUSIONS AND IMPLICATIONS: The Veggie Meter® is a promising tool to assess fruit and vegetable intake but needs to be validated in PSAC as has in adults. Sex and age are potential confounders which should be assessed in future studies using the Veggie Meter®