Cluster randomized controlled trial of a mobile market intervention to increase fruit and vegetable intake among adults in lower-income communities in North Carolina

Lucia A Leone, Gina L Tripicchio, Lindsey Haynes-Maslow, Jared McGuirt, Jacqueline S Grady Smith, Janelle Armstrong-Brown, Ziya Gizlice, Alice Ammerman, Lucia A Leone, Gina L Tripicchio, Lindsey Haynes-Maslow, Jared McGuirt, Jacqueline S Grady Smith, Janelle Armstrong-Brown, Ziya Gizlice, Alice Ammerman

Abstract

Background: Poorer diets and subsequent higher rates of chronic disease among lower-income individuals may be partially attributed to reduced access to fresh fruits and vegetables (F&V) and other healthy foods. Mobile markets are an increasingly popular method for providing access to F&V in underserved communities, but evaluation efforts are limited. The purpose of this study was to determine the impact of Veggie Van (VV), a mobile produce market, on F&V intake in lower-income communities using a group randomized controlled trial.

Methods: VV is a mobile produce market that sells reduced-cost locally grown produce and offers nutrition and cooking education. We recruited 12 sites in lower-income communities in North Carolina (USA) to host VV, randomizing them to receive VV immediately (intervention) or after the 6-month study period (delayed intervention control). Participants at each site completed baseline and follow-up surveys including F&V intake, perceived access to fresh F&V and self-efficacy for purchasing, preparing and eating F&V. We used multiple linear regression to calculate adjusted differences in outcomes while controlling for baseline values, education and clustering within site.

Results: Among 142 participants who completed the follow-up, baseline F&V intake was 3.48 cups/day for control and 3.33 for intervention. At follow-up, adjusted change in F&V consumption was 0.95 cups/day greater for intervention participants (p = 0.005), but was attenuated to 0.51 cups per day (p = 0.11) after removing extreme values. VV customers increased their F&V consumption by 0.41 cups/day (n = 30) compared to a 0.25 cups/day decrease for 111 non-customers (p = 0.04). Intervention participants did not show significant improvements in perceived access to fresh F&V, but increased their self-efficacy for working more F&V into snacks (p = 0.02), making up a vegetable dish with what they had on hand (p = 0.03), and cooking vegetables in a way that is appealing to their family (p = 0.048).

Conclusions: Mobile markets may help improve F&V intake in lower-income communities.

Trial registration: Clinicaltrials.gov ID# NCT03026608 retrospectively registered January 2, 2017.

Keywords: Cluster-randomized trial; Food environment; Fruits and vegetables; Lower-income; Mobile market.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Institutional Review Board at the University of North Carolina at Chapel Hill. All participants in this study provided verbal informed consent.

Consent for publication

Not applicable.

Competing interests

Drs. Leone. Haynes-Maslow and Armstrong-Brown are unpaid board members for Community Nutrition Partnership, the non-profit organization that runs the Veggie Van program.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Recruitment and randomization of participants for the Veggie Van mobile market program and the Green Cart Evaluation study

References

    1. Dankwa-Mullan I, Rhee KB, Williams K, Sanchez I, Sy FS, Stinson N, Jr, Ruffin J. The science of eliminating health disparities: summary and analysis of the NIH summit recommendations. Am J Public Health. 2010;100(Suppl 1):S12–S18. doi: 10.2105/AJPH.2010.191619.
    1. Whitney EN. Understanding nutrition. Toronto: Nelson Education; 2012.
    1. Leone LA, Beth D, Ickes S, MacGuire K, Nelson E, Smith RA, Tate DF, Ammerman AS. Attitudes towards fruit and vegetable consumption and farmers’ market usage among low-income north Carolinians. J Hunger Environ Nutr. 2012;7:64–76. doi: 10.1080/19320248.2012.651386.
    1. Haynes-Maslow L, Parsons SE, Wheeler SB, Leone LA. A qualitative study of perceived barriers to fruit and vegetable consumption among low-income populations, North Carolina, 2011. Prev Chronic Dis. 2013;10:E34. doi: 10.5888/pcd10.120206.
    1. Walker RE, Keane CR, Burke JG. Disparities and access to healthy food in the United States: a review of food deserts literature. Health Place. 2010;16:876–884. doi: 10.1016/j.healthplace.2010.04.013.
    1. Story M, Kaphingst KM, Robinson-O'Brien R, Glanz K. Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health. 2008;29:253–272. doi: 10.1146/annurev.publhealth.29.020907.090926.
    1. What is the Healthy Food Financing Initiative? Healthy Food Financing Initiative, Office of Community Services; 2017. .
    1. Sadler RC, Gilliland JA, Arku G. A food retail-based intervention on food security and consumption. Int J Environ Res Public Health. 2013;10:3325–3346. doi: 10.3390/ijerph10083325.
    1. Dubowitz T, Ghosh-Dastidar M, Cohen DA, Beckman R, Steiner ED, Hunter GP, Florez KR, Huang C, Vaughan CA, Sloan JC, et al. Diet and perceptions change with supermarket introduction in a Food Desert, but not because of supermarket use. Health Aff (Millwood) 2015;34:1858–1868. doi: 10.1377/hlthaff.2015.0667.
    1. Cummins S, Flint E, Matthews SA. New neighborhood grocery store increased awareness of food access but did not alter dietary habits or obesity. Health Aff (Millwood) 2014;33:283–291. doi: 10.1377/hlthaff.2013.0512.
    1. Gorham G, Dulin-Keita A, Risica PM, Mello J, Papandonatos G, Nunn A, Gorham S, Roberson M, Gans KM. Effectiveness of fresh to you, a discount fresh fruit and vegetable market in low-income neighborhoods, on Children’s fruit and vegetable consumption, Rhode Island, 2010-2011. Prev Chronic Dis. 2015;12:E176. doi: 10.5888/pcd12.140583.
    1. Freedman DA, Choi SK, Hurley T, Anadu E, Hebert JR. A farmers’ market at a federally qualified health center improves fruit and vegetable intake among low-income diabetics. Prev Med. 2013;56:288–292. doi: 10.1016/j.ypmed.2013.01.018.
    1. Evans AE, Jennings R, Smiley AW, Medina JL, Sharma SV, Rutledge R, Stigler MH, Hoelscher DM. Introduction of farm stands in low-income communities increases fruit and vegetable among community residents. Health Place. 2012;18:1137–1143. doi: 10.1016/j.healthplace.2012.04.007.
    1. Abusabha R, Namjoshi D, Klein A. Increasing access and affordability of produce improves perceived consumption of vegetables in low-income seniors. J Am Diet Assoc. 2011;111:1549–1555. doi: 10.1016/j.jada.2011.07.003.
    1. Leone LA, Haynes-Maslow L, Ammerman AS. Veggie van pilot study: impact of a mobile produce market for underserved communities on fruit and vegetable access and intake. J Hunger Environ Nutr. 2017;12:89–100. doi: 10.1080/19320248.2016.1175399.
    1. Quandt SA, Dupuis J, Fish C, D'Agostino RB., Jr Feasibility of using a community-supported agriculture program to improve fruit and vegetable inventories and consumption in an underresourced urban community. Prev Chronic Dis. 2013;10:E136. doi: 10.5888/pcd10.130053.
    1. Robinson T. Applying the socio-ecological model to improving fruit and vegetable intake among low-income African Americans. J Community Health. 2008;33:395–406. doi: 10.1007/s10900-008-9109-5.
    1. Caspi CE, Sorensen G, Subramanian SV, Kawachi I. The local food environment and diet: a systematic review. Health Place. 2012;18:1172–1187. doi: 10.1016/j.healthplace.2012.05.006.
    1. Tripicchio GL, Grady Smith J, Armstrong-Brown J, McGuirt J, Haynes-Maslow L, Mardovich S, Ammerman AS, Leone L. Recruiting Community Partners for Veggie van: strategies and lessons learned from a mobile market intervention in North Carolina, 2012-2015. Prev Chronic Dis. 2017;14:E36. doi: 10.5888/pcd14.160475.
    1. Leone LA, Tripicchio GL, Haynes-Maslow L, McGuirt J, Grady Smith JS, Armstrong-Brown J, Kowitt S, Gizlice Z, Ammerman AS. A cluster-randomized trial of a mobile produce market program in 12 communities in North Carolina: program development, methods and baseline results. J Acad Nutr Diet Under Rev.
    1. Thompson FE, Midthune D, Kahle L, Dodd KW. Development and Evaluation of the National Cancer Institute's Dietary Screener Questionnaire Scoring Algorithms. J Nutr. 2017;147(6):1226–33.
    1. Thompson FE, Subar AF, Smith AF, Midthune D, Radimer KL, Kahle LL, Kipnis V. Fruit and vegetable assessment: performance of 2 new short instruments and a food frequency questionnaire. J Am Diet Assoc. 2002;2002:1764–1772. doi: 10.1016/S0002-8223(02)90379-2.
    1. Yaroch AL, Tooze J, Thompson FE, Blanck HM, Thompson OM, Colón-Ramos U, Shaikh AR, McNutt S, Nebeling LC. Evaluation of Three Short Dietary Instruments to Assess Fruit and Vegetable Intake: The National Cancer Institute’s Food Attitudes and Behaviors Survey. Journal of the Academy of Nutrition and Dietetics. 2012;112:1570–7.
    1. Dietary Screener Questionnaires (DSQ) in the NHANES 2009-10. National Cancer Institute; 2016. .
    1. Echeverria SE, Diez-Roux AV, Link BG. Reliability of self-reported neighborhood characteristics. J Urban Health. 2004;81:682–701. doi: 10.1093/jurban/jth151.
    1. Green SH, Glanz K. Development of the perceived nutrition environment measures survey. Am J Prev Med. 2015;49:50–61. doi: 10.1016/j.amepre.2015.02.004.
    1. Anderson ES, Winett RA, Wojcik JR. Social-cognitive determinants of nutrition behavior among supermarket food shoppers: a structural equation analysis. Health Psychol. 2000;19:479–486. doi: 10.1037/0278-6133.19.5.479.
    1. Donner A, Klar N. Statistical considerations in the design and analysis of community intervention trials. J Clin Epidemiol. 1996;49:435. doi: 10.1016/0895-4356(95)00511-0.
    1. Donner A, Klar N. Design and analysis of cluster randomization trials in Health Research. New York: Oxford University Press; 2000.
    1. Leone LA, Allicock M, Pignone MP, Walsh J, Johnson LS, Armstrong-Brown J, Carr C, Landford A, Ni A, Resnicow K, Campbell MK. Cluster Randomized Trial of a Church-based Peer Counselor and Tailored Newsletter Intervention to Promote Colorectal Cancer Screening and Physical Activity among Older African Americans. Health Educ Behav. 2016;43(5):568–76. doi: 10.1177/1090198115611877.
    1. Frison L, Pocock S. Repeated measures in clinical trials: analysis using mean summary statistics and its implications for design. Stat Med. 1992;11:1685–1704. doi: 10.1002/sim.4780111304.
    1. Vickers AJ, Altman DG. Statistics notes: analysing controlled trials with baseline and follow up measurements. BMJ. 2001;323:1123. doi: 10.1136/bmj.323.7321.1123.
    1. Ibrahim S, Sidani S. Strategies to recruit minority persons: a systematic review. J Immigr Minor Health. 2014;16:882–888. doi: 10.1007/s10903-013-9783-y.
    1. Gans KM, Gorham G, Risica PM, Dulin-Keita A, Dionne L, Gao T, Peters S, Principato L. A multi-level intervention in subsidized housing sites to increase fruit and vegetable access and intake: rationale, design and methods of the ‘Live well, viva Bien’ cluster randomized trial. BMC Public Health. 2016;16:521. doi: 10.1186/s12889-016-3141-7.
    1. Haynes-Maslow L, Parsons S, Leone L. Real & perceived food deserts in Orange & Durham County. North Carolina: Southern Food and Ve; 2011.
    1. Haynes-Maslow L, Auvergne L, Mark B, Ammerman A, Weiner BJ. Low-income Individuals’ perceptions about fruit and vegetable access programs: a qualitative study. J Nutr Educ Behav. 2015;47:317–324. doi: 10.1016/j.jneb.2015.03.005.
    1. Cohen AJ, Richardson CR, Heisler M, Sen A, Murphy EC, Hesterman OB, Davis MM, Zick SM. Increasing use of a healthy food incentive: a waiting room intervention among low-income patients. Am J Prev Med. 2017;52:154–162. doi: 10.1016/j.amepre.2016.11.008.
    1. Zepeda L, Reznickova A, Lohr L. Overcoming challenges to effectiveness of mobile markets in US food deserts. Appetite. 2014;79:58–67. doi: 10.1016/j.appet.2014.03.026.
    1. McGuirt JT, Ward R, Elliott NM, Bullock SL, Jilcott Pitts SB. Factors influencing local food procurement among women of reproductive age in rural eastern and western North Carolina, USA. J Agric Food Syst Community Dev. 2014;4:143–154.

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