Multilevel approaches to increase fruit and vegetable intake in low-income housing communities: final results of the ‘Live Well, Viva Bien’ cluster-randomized trial

Abstract

BackgroundFruit and vegetable (F&V) intake can reduce risks for chronic disease, but is much lower than recommended amounts in most Western populations, especially for those with low income levels. Rigorous research is needed on practical, cost-effective interventions that address environmental as well as personal determinants of F&V intake. This paper presents the results of a cluster randomized controlled trial evaluating the efficacy of ‘Live Well, Viva Bien’ (LWVB), a multicomponent intervention that included discount, mobile fresh F&V markets in conjunction with nutrition education.MethodsFifteen subsidized housing sites in Providence County, Rhode Island (8 intervention and 7 control sites) were randomized using a random number generator. Of these, nine housed elderly and/or disabled residents and six housed families. A total of 1597 adult housing site residents (treatment n = 837; control n = 760) were enrolled (73% women, 54% Hispanic, 17% black, Mean age 54 years). A year-long multicomponent intervention including mobile F&V markets plus nutrition education (e.g. campaigns, DVDs, newsletters, recipes, and chef demonstrations) was implemented at intervention sites. Physical activity and stress interventions were implemented at control sites. Follow-up occurred at 6 and 12 months. The main outcome measure was F&V consumption measured by National Cancer Institute’s ‘Eating at America’s Table All Day Screener’.ResultsFrom baseline to 12 months, the intervention group increased total F&V intake by 0.44 cups with the control group decreasing intake by 0.08 cups (p < .02). Results also showed an increased frequency of F&V eating behaviors compared to the control group (p < .01). There was a clear dose response effect of the F&V markets with participants who reported attending all or most of the markets increasing F&V intake by 2.1 cups and 0.86 cups, respectively compared with less than half cup increases for lower levels of market attendance (p < .05). Use of the DVDs, recipes and taste-testings was also associated with greater increases in F&V intake; however, use of other educational components was not.ConclusionsLWVB is the first cluster, randomized controlled trial to demonstrate the efficacy of year-round F&V markets on improving F&V intake for low-income adults, which provides an evidence-base to bolster the mission of mobile produce markets. Further, the results more broadly support investment in environmental changes to alleviate disparities in F&V consumption and diet-related health inequities.Trial registration numberClinicatrials.gov registration number: NCT02669472

Do multiple community-based interventions on health promotion tackle health inequalities?

“…Of these, 14 were set in Europe [16][17][18][19][20][21][22][23][24][25][26][27][28][29], five in North America [30][31][32][33][34], three in Australia/Oceania [35][36][37], and one study took place in a country in Central America [38] (see Table 2). The studies used various designs, including RCTs (n = 1) [38], cluster randomized trials (n = 3) [25,30,34], quasiexperimental designs (n = 11) [16, 18, 22, 23, 27-29, 33, 35-37], pre-post-tests without control group (n = 3) [17,19,31], and secondary analyses (n = 5) [20,21,23,26,32]. The sample sizes at baseline varied from 200 to nearly 250,000 in 60 intervention areas, with study populations having a variety of socio-demographic and socioeconomic backgrounds.…”

“…Only one of the programs contained elements of all six strategies [16]. Six programs comprised five strategies [22,23,[25][26][27]32], five consisted of four [21,23,25,28,37], six of three [17,19,29,33,34,36] and five of two strategies [18,20,28,30,36].…”

Rural SNAP Participants and Food Insecurity: How Can Communities Leverage Resources to Meet the Growing Food Insecurity Status of Rural and Low-Income Residents?

“…Although increasing access to nutritious foods, including FV, may be challenging in a community with limited income, it is possible [ 47 , 48 , 49 ]. Rural communities continue to struggle with food accessibility within the retail food landscape, and in a particularly impoverished community, such as the one of this study, addressing the mechanisms and avenues that support food access is imperative.…”

The provision of recipes and single-use herb/spice packets to increase egg and protein intake in community-dwelling older adults: a randomised controlled trial

“…Sustained intakes were only found in the intervention group, and these findings suggest that the continued consumption of higher numbers of eggs by this group was a direct result of the intervention. It is very plausible that recipe provision results in sustained behaviour changes; various studies suggest recipe use and reuse over time is possible and likely (39)(40)(41)(42)(43)(44) . These findings suggest that recipe and single-use herb/spice provision may be particularly useful in the longer term.…”