Farm Fresh Foods for Healthy Kids (F3HK): An innovative community supported agriculture intervention to prevent childhood obesity in low-income families and strengthen local agricultural economies

Rebecca A Seguin, Emily H Morgan, Karla L Hanson, Alice S Ammerman, Stephanie B Jilcott Pitts, Jane Kolodinsky, Marilyn Sitaker, Florence A Becot, Leah M Connor, Jennifer A Garner, Jared T McGuirt, Rebecca A Seguin, Emily H Morgan, Karla L Hanson, Alice S Ammerman, Stephanie B Jilcott Pitts, Jane Kolodinsky, Marilyn Sitaker, Florence A Becot, Leah M Connor, Jennifer A Garner, Jared T McGuirt

Abstract

Background: Childhood obesity persists in the United States and is associated with serious health problems. Higher rates of obesity among children from disadvantaged households may be, in part, attributable to disparities in access to healthy foods such as fruits and vegetables. Community supported agriculture can improve access to and consumption of fresh produce, but the upfront payment structure, logistical barriers, and unfamiliarity with produce items may inhibit participation by low-income families. The aim of this project is to assess the impact of subsidized, or "cost-offset," community supported agriculture participation coupled with tailored nutrition education for low-income families with children.

Methods/design: The Farm Fresh Foods for Healthy Kids community-based, randomized intervention trial will build on formative and longitudinal research to examine the impact of cost-offset community supported agriculture on diet and other health behaviors as well as the economic impacts on local economies. The intervention will involve reduced-price community supported agriculture shares which can be paid for on a weekly basis, nine skill-based and seasonally-tailored healthy eating classes, and the provision of basic kitchen tools. Low income families with at least one child aged 2-12 years will be recruited to join existing community supported agriculture programs in New York, North Carolina, Vermont, and Washington. In each program, families will be randomized 1:1 to intervention or delayed intervention groups. Data will be collected at baseline, and in the fall and spring for 3 years. The primary outcomes are children's intake of fruits and vegetables and foods high in sugar and/or (solid) fat, as well as diet quality; secondary outcomes include physical, behavioral, psychosocial, and environmental variables. Cost-effectiveness and economic impact at the farm and community levels also will be assessed.

Discussion: This integrated project will provide important information and contribute to the evidence base regarding the use of local agricultural interventions to improve children's dietary behaviors and weight maintenance. Findings also will inform the development of a toolkit for farmers and education modules related to local food system innovations for undergraduate and graduate students.

Trial registration: ClinicalTrials.gov NCT02770196 . Registered 5 April 2016.

Keywords: Childhood obesity; Community supported agriculture; Diet; Fruit and vegetables; Local agriculture; Local food system; Nutrition.

Figures

Fig. 1
Fig. 1
Flow of participants in component 4 (randomized trial) from recruitment through the end of the study

References

    1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. J Am Med Assoc. 2014;311:806–814. doi: 10.1001/jama.2014.732.
    1. Skinner AC, Perrin EM, Skelton JA. Prevalence of obesity and severe obesity in US children, 1999-2014. Obesity. 2016;24:1116–1123. doi: 10.1002/oby.21497.
    1. Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 2011;378:815–825. doi: 10.1016/S0140-6736(11)60814-3.
    1. Biro FM, Wien M. Childhood obesity and adult morbidities. Am J Clin Nutr. 2010;91:1499–1505. doi: 10.3945/ajcn.2010.28701B.
    1. Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes. 2011;35:891–898. doi: 10.1038/ijo.2010.222.
    1. Franks PW, Hanson RL, Knowler WC, Sievers ML, Bennett PH, Looker HC. Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med. 2011;362:485–493. doi: 10.1056/NEJMoa0904130.
    1. Wang Y, Beydoun MA. The obesity epidemic in the United States - gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev. 2007;29:6–28. doi: 10.1093/epirev/mxm007.
    1. Braveman PA, Cubbin C, Egerter S, Williams DR, Pamuk E. Socioeconomic disparities in health in the United States: what the patterns tell us. Am J Public Health. 2010;100(Suppl 1):S186–S196. doi: 10.2105/AJPH.2009.166082.
    1. Frederick CB, Snellman K, Putnam RD. Increasing socioeconomic disparities in adolescent obesity. Proc Natl Acad Sci U S A. 2014;111:1338–1342. doi: 10.1073/pnas.1321355110.
    1. Singh GK, Siahpush M, Kogan MD. Rising social inequalities in US childhood obesity, 2003-2007. Ann Epidemiol. 2010;20:40–52. doi: 10.1016/j.annepidem.2009.09.008.
    1. Liu RH. Health-promoting components of fruits and vegetables in the diet. Adv Nutr. 2013;4:384S–392S. doi: 10.3945/an.112.003517.
    1. Boeing H, Bechthold A, Bub A, Ellinger S, Haller D, Kroke A, Leschik-Bonnet E, Müller MJ, Oberritter H, Schulze M, Stehle P, Watzl B. Critical review: vegetables and fruit in the prevention of chronic diseases. Eur J Nutr. 2012;51:637–663. doi: 10.1007/s00394-012-0380-y.
    1. Ledoux TA, Hingle MD, Baranowski T. Relationship of fruit and vegetable intake with adiposity: a systematic review. Obes Rev. 2011;12(5):e143–e150. doi: 10.1111/j.1467-789X.2010.00786.x.
    1. Krebs-Smith SM, Guenther PM, Subar AF, Kirkpatrick SI, Dodd KW. Americans do not meet federal dietary recommendations. J Nutr. 2010;140:1832–1838. doi: 10.3945/jn.110.124826.
    1. Moore LV, Dodd KW, Thompson FE, Grimm KA, Kim SA, Scanlon KS. Using behavioral risk factor surveillance system data to estimate the percentage of the population meeting US Department of Agriculture food patterns fruit and vegetable intake recommendations. Am J Epidemiol. 2015;181:979–988. doi: 10.1093/aje/kwu461.
    1. Kim S, Moore L, Galuska D, Wright A, Harris D, Grummer-Strawn L, Merlo C, Nihiser A, Rhodes D. Vital signs: fruit and vegetable intake among children — United States, 2003–2010. MMWR Morb Mortal Wkly Rep. 2014;63:671–676.
    1. Gamm LD, Hutchison L, Dabney B, Dorsey A, editors. Rural healthy people 2010: a companion document to healthy people 2010. College Station: The Texas A&M University System Health Science Center, School of Rural Public Health, Southwest Rural Health Research Center; 2003.
    1. O’Connor A, Wellenius G. Rural-urban disparities in the prevalence of diabetes and coronary heart disease. Public Health. 2012;126:813–820. doi: 10.1016/j.puhe.2012.05.029.
    1. Di Cesare M, Khang YH, Asaria P, Blakely T, Cowan MJ, Farzadfar F, Guerrero R, Ikeda N, Kyobutungi C, Msyamboza KP, Oum S, Lynch JW, Marmot MG, Ezzati M. Inequalities in non-communicable diseases and effective responses. Lancet. 2013;381:585–597. doi: 10.1016/S0140-6736(12)61851-0.
    1. Pearson N, Biddle S, Gorely T. Family correlates of fruit and vegetable consumption in children and adolescents: a systematic review. Public Health Nutr. 2009;12:267–283. doi: 10.1017/S1368980008002589.
    1. Bowman S. Low economic status is associated with suboptimal intakes of nutritious foods by adults in the National Health and nutrition examination survey 1999-2002. Nutr Res. 2007;27:515–523. doi: 10.1016/j.nutres.2007.06.010.
    1. Lallukka T, Pitkäniemi J, Rahkonen O, Roos E, Laaksonen M, Lahelma E. The association of income with fresh fruit and vegetable consumption at different levels of education. Eur J Clin Nutr. 2010;64:324–327. doi: 10.1038/ejcn.2009.155.
    1. Larson NI, Story MT, Nelson MC. Neighborhood environments: disparities in access to healthy foods in the U.S. Am J Prev Med. 2009;36:74–81. doi: 10.1016/j.amepre.2008.09.025.
    1. Zenk SN, Odoms-Young AM, Dallas C, Hardy E, Watkins A, Hoskins-Wroten J, Holland L. “you have to hunt for the fruits, the vegetables”: environmental barriers and adaptive strategies to acquire food in a low-income African American neighborhood. Health Educ Behav. 2011;38:282–292. doi: 10.1177/1090198110372877.
    1. Hendrickson D, Smith C, Eikenberry N. Fruit and vegetable access in four low-income food deserts communities in Minnesota. Agric Human Values. 2006;23:371–383. doi: 10.1007/s10460-006-9002-8.
    1. Glanz K, Yaroch AL. Strategies for increasing fruit and vegetable intake in grocery stores and communities: policy, pricing, and environmental change. Prev Med. 2004;39(Suppl 2):S75–S80. doi: 10.1016/j.ypmed.2004.01.004.
    1. O’Kane G. What is the real cost of our food? Implications for the environment, society and public health nutrition. Public Health Nutr. 2012;15:268–276. doi: 10.1017/S136898001100142X.
    1. Cooley JP, Lass DA. Consumer benefits from community supported agriculture membership. Rev Agric Econ. 1998;20:227–237. doi: 10.2307/1349547.
    1. Russell WS, Zepeda L. The adaptive consumer: shifting attitudes, behavior change and CSA membership renewal. Renew Agric Food Syst. 2008;23:136–148. doi: 10.1017/S1742170507001962.
    1. Perez J, Allen P, Murrell J. Community supported agriculture on the central coast: the CSA member experience. Santa Cruz: Center for Agroecology and Sustainable Food Systems, University of California, Santa Cruz; 2003.
    1. Brehm JM, Eisenhauer BW. Motivations for participating in community-supported agriculture and their relationship with community attachment and social capital. South Rural Sociol. 2008;23:94–115.
    1. Curtis KR, Allen K, Ward RA. Food consumption, attitude, and behavioral change among CSA members: a northern Utah case study. J Food Distrib Res. 2015;46:3–16.
    1. Cohen JN, Gearhart S, Garland E. Community supported agriculture: a commitment to a healthier diet. J Hunger Environ Nutr. 2012;7:20–37. doi: 10.1080/19320248.2012.651393.
    1. Wharton CM, Hughner RS, MacMillan L, Dumitrescu C. Community supported agriculture programs: a novel venue for theory-based health behavior change interventions. Ecol Food Nutr. 2015;54:280–301. doi: 10.1080/03670244.2014.1001980.
    1. Hedden JL. The effect of CSA membership on fruit and vegetable intake. Fort Collins: Colorado State University; 2011.
    1. Minaker LM, Raine KD, Fisher P, Thompson ME, Van LJ, Frank LD. Food purchasing from farmers’ markets and community-supported agriculture is associated with reduced weight and better diets in a population-based sample. J Hunger Environ Nutr. 2014;9(4):485–497. doi: 10.1080/19320248.2014.898175.
    1. McCormack LA, Laska MN, Larson NI, Story M. Review of the nutritional implications of farmers’ markets and community gardens: a call for evaluation and research efforts. J Am Diet Assoc. 2010;110:399–408. doi: 10.1016/j.jada.2009.11.023.
    1. Brown C, Miller S. The impacts of local markets: a review of research on farmers markets and community supported agriculture (CSA) Am J Agric Econ. 2008;90:1296–1302. doi: 10.1111/j.1467-8276.2008.01220.x.
    1. Galt RE. The moral economy is a double-edged sword: explaining farmers’ earnings and self-exploitation in community-supported agriculture. Econ Geogr. 2013;89:341–365. doi: 10.1111/ecge.12015.
    1. LeRoux MN, Schmit TM, Roth M, Streeter DH. Evaluating marketing channel options for small-scale fruit and vegetable producers. Renew Agric Food Syst. 2010;25:16–23. doi: 10.1017/S1742170509990275.
    1. Sabih S, Baker L. Alternative financing in agriculture: a case for the CSA method. Acta Hort. 2000;524:141–148. doi: 10.17660/ActaHortic.2000.524.16.
    1. Saulny S. Cutting out the middlemen, shoppers buy slices of farms. New York City: The New York Times; 2008.
    1. Stagl S. Local organic food markets: potentials and limitations for contributing to sustainable development. Empirica. 2002;29:145–162. doi: 10.1023/A:1015656400998.
    1. Hardesty SD, Leff P. Determining marketing costs and returns in alternative marketing channels. Renew Agric Food Syst. 2010;25:24–34. doi: 10.1017/S1742170509990196.
    1. Cone C, Myhre A. Community-supported agriculture: a sustainable alternative to industrial agriculture? Hum Organ. 2000;59:187–197. doi: 10.17730/humo.59.2.715203t206g2j153.
    1. Lass D, Bevis A, Hendrickson J, Ruhf K. Community supported agriculture entering the 21st century: results from the 2001 national survey. Amherst: University of Massachusetts, Department of Resource Economics; 2003.
    1. Strochlic R, Shelley C. Community supported agriculture in California, Oregon and Washington: challenges and opportunities. California Institute for Rural Studies: Davis; 2004.
    1. Lyson TA. Civic agriculture: reconnecting farm, food, and community. Lebanon: Univesity Press of New England; 2004.
    1. Thilmany McFadden D, Conner D, Deller S, Hughes D, Meter K, Morales A, Schmit T, Swenson D, Bauman A, Goldenberg MP, Hill R, Jablonski BBR, Tropp D. The economics of local food systems: a toolkit to guide community discussions, assessments and choices. Washington: Agricultural Marketing Service, US Department of Agriculture; 2016.
    1. Community Supported Agriculture. . Accessed 1 June 2016.
    1. Landis B, Smith TE, Lairson M, Mckay K, Nelson H, O’Briant J. Community-supported agriculture in the research triangle region of North Carolina: demographics and effects of membership on household food supply and diet. J Hunger Environ Nutr. 2010;5(1):70–84. doi: 10.1080/19320240903574403.
    1. Hayden J, Buck D. Doing community supported agriculture: tactile space, affect and effects of membership. Geoforum. 2012;43:332–341. doi: 10.1016/j.geoforum.2011.08.003.
    1. MacMillan Uribe AL, Winham DM, Wharton CM. Community supported agriculture membership in Arizona. An exploratory study of food and sustainability behaviours. Appetite. 2012;59:431–436. doi: 10.1016/j.appet.2012.06.002.
    1. Guthman J, Morris AW, Allen P. Squaring farm security and food security in two types of alternative food institutions. Rural Sociol. 2006;71:662–684. doi: 10.1526/003601106781262034.
    1. Andreatta S, Rhyne M, Dery N. Lessons learned from advocating CSAs for low-income and food insecure households. South Rural Sociol. 2008;23:116–148.
    1. Quandt SA, Dupuis J, Fish C, D’Agostino RB. 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 doi: 10.5888/pcd10.130053.
    1. Beets MW, Swanger K, Wilcox DR, Cardinal BJ. Using hands-on demonstrations to promote cooking behaviors with young adolescents: the culinary camp summer cooking program. J Nutr Educ Behav. 2007;39:288–289. doi: 10.1016/j.jneb.2007.05.002.
    1. Dixon JE, Condrasky MD, Sharp LJ, Corr Quinn A, Dixon EJ, Sharp JL, Corr AQ. Cooking confidence and healthy eating choices of preadolescent participants at a cooking camp. Top Clin Nutr. 2013;28:21–33. doi: 10.1097/TIN.0b013e31826f8de1.
    1. Levy J, Auld G. Cooking classes outperform cooking demonstrations for college sophomores. J Nutr Educ Behav. 2004;36:197–203. doi: 10.1016/S1499-4046(06)60234-0.
    1. Condrasky M, Graham K, Kamp J. Cooking with a chef: an innovative program to improve mealtime practices and eating behaviors of caregivers of preschool children. J Nutr Educ Behav. 2006;38:324–325. doi: 10.1016/j.jneb.2006.04.005.
    1. Hersch D, Perdue L, Ambroz T, Boucher JL. The impact of cooking classes on food-related preferences, attitudes, and behaviors of school-aged children: a systematic review of the evidence, 2003-2014. Prev Chronic Dis. 2014;11:E193. doi: 10.5888/pcd11.140267.
    1. Reicks M, Trofholz AC, Stang JS, Laska MN. Impact of cooking and home food preparation interventions among adults: outcomes and implications for future programs. J Nutr Educ Behav. 2014;46:259–276. doi: 10.1016/j.jneb.2014.02.001.
    1. An R. Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments. Public Health Nutr. 2013;16:1215–1228. doi: 10.1017/S1368980012004715.
    1. Niebylski ML, Redburn KA, Duhaney T, Campbell NR. Healthy food subsidies and unhealthy food taxation: a systematic review of the evidence. Nutrition. 2015;31:787–795. doi: 10.1016/j.nut.2014.12.010.
    1. Liberato SC, Bailie R, Brimblecombe J. Nutrition interventions at point-of-sale to encourage healthier food purchasing: a systematic review. BMC Public Health. 2014;14:919. doi: 10.1186/1471-2458-14-919.
    1. Anderson JV, Bybee DI, Brown RM, McLean DF, Garcia EM, Breer ML, Schillo BA. 5 a day fruit and vegetable intervention improves consumption in a low income population. J Am Diet Assoc. 2001;101:195–202. doi: 10.1016/S0002-8223(01)00052-9.
    1. Webb P, Kennedy E. Impacts of agriculture on nutrition: nature of the evidence and research gaps. Food Nutr Bull. 2014;35:126–132. doi: 10.1177/156482651403500113.
    1. Ruel MT, Alderman H, Maternal and Child Nutrition Study Group Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet. 2013;382:536–551. doi: 10.1016/S0140-6736(13)60843-0.
    1. Mahieu P, Andersson H, Beaumais O. Is choice experiment becoming more popular than contingent valuation? A systematic review in agriculture, environment and health. FAERE Work Pap. 2014;2014:12.
    1. McGuirt JT, Jilcott Pitts SB, Ward R, Crawford TW, Keyserling TC, Ammerman AS. Examining the influence of price and accessibility on willingness to shop at farmers’ markets among low-income eastern north carolina women. J Nutr Educ Behav. 2014;46:26–33. doi: 10.1016/j.jneb.2013.06.001.
    1. Clark-Ibáñez M. Framing the social world with photo-elicitation interviews. Am Behav Sci. 2004;47:1507–1527. doi: 10.1177/0002764204266236.
    1. Caraher M, Baker H, Burns M. Children’s views of cooking and food preparation. Br Food J. 2004;106:255–273. doi: 10.1108/00070700410529537.
    1. National Cancer Institute. Automated Self-Administered 24-Hour Recall (ASA24). Bethesda, MD; 2016.
    1. Bandura A. Self-efficacy: the exercise of control. New York: WH Freeman; 1997.
    1. US Department of Health and Human Services, US Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th edition. 2015. . Accessed 1 June 2016.
    1. US Department of Health and Human Services. Physical Activity Guidelines for Americans. 2008. . Accessed 1 June 2016.
    1. Norris JA. From telling to teaching: a dialogue approach to adult learning. North Myrtle Beach: Learning By Dialogue; 2003.
    1. Veila J. Learning to listen, learning to teach: the power of dialogue in educating adults. San Francisco: Jossey-Bass; 2002.
    1. Knowles M. The adult learner: a neglected species. 4th edition. Houston: Gulf Publishing Co.; 1990.
    1. Merriam SB, editor. The new update on adult learning rheory. San Francisco: Jossey-Bass; 2001.
    1. Lohman TG, Roche AF, Martorell R, editors. Anthropometric standardization reference manual. Champaign: Human Kinetics Books; 1988.
    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;102:1764–1772. doi: 10.1016/S0002-8223(02)90379-2.
    1. Nelson M, Atkinson M, Darbyshire S. Food photography II: use of food photographs for estimating portion size and the nutrient content of meals. Br J Nutr. 1996;76:31–49. doi: 10.1079/BJN19960007.
    1. Beverage and Snack Questionnaire 2. . Accessed 28 Apr 2015.
    1. Neuhouser ML, Lilley S, Lund A, Johnson DB. Development and validation of a beverage and snack questionnaire for use in evaluation of school nutrition policies. J Am Diet Assoc. 2009;109:1587–1592. doi: 10.1016/j.jada.2009.06.365.
    1. Condrasky MD, Williams JE, Catalano PM, Griffin SF. Development of psychosocial scales for evaluating the impact of a culinary nutrition education program on cooking and healthful eating. J Nutr Educ Behav. 2011;43:511–516. doi: 10.1016/j.jneb.2010.09.013.
    1. Beydoun MA, Wang Y. Do nutrition knowledge and beliefs modify the association of socio-economic factors and diet quality among US adults? Prev Med. 2008;46:145–153. doi: 10.1016/j.ypmed.2007.06.016.
    1. Robinson-O’Brien R, Neumark-Sztainer D, Hannan PJ, Burgess-Champoux T, Haines J. Fruits and vegetables at home: child and parent perceptions. J Nutr Educ. 2009;41:360–364. doi: 10.1016/j.jneb.2008.08.003.
    1. Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide to measuring household food security, revised 2000. Alexandria: Food and Nutrition Service, US Department of Agriculture; 2000.
    1. CDC . NHANES diet behavior and nutrition questionnaire, 2013–2014. 2015.
    1. CDC . NHANES food security module, 2011–2012. 2013.
    1. CDC . Middle school youth risk behavior survey. 2015.
    1. Burdette HL, Whitaker RC, Daniels SR. Parental report of outdoor playtime as a measure of physical activity in preschool-aged children. Arch Pediatr Adolesc Med. 2004;158:353–357. doi: 10.1001/archpedi.158.4.353.
    1. CDC . NHANES current health status, 2015–2016. 2015.
    1. US Census Bureau . The American community survey. 2015.
    1. CDC . Behavioral risk factor surveillance survey system questionnaire. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2014.
    1. Wilson MG, Basta TB, Bynum BH, Dejoy DM, Vandenberg RJ, Dishman RK. Do intervention fidelity and dose influence outcomes? Results from the move to improve worksite physical activity program. Health Educ Res. 2010;25:294–305. doi: 10.1093/her/cyn065.
    1. Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–207. doi: 10.7326/0003-4819-158-3-201302050-00583.
    1. Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981;19:127–140. doi: 10.1097/00005650-198102000-00001.
    1. Tolley GS, Kenkel DS, Fabian R, editors. Valuing health for policy: an economic approach. Chicago: Chicago University Press; 1994.
    1. Gold MR, Siegel JE, Russell LB, Weinstein MC, editors. Cost-effectiveness of health and medicine. New York: Oxford University Press; 1996.
    1. Jonas DE, Russell LB, Sandler RS, Chou J, Pignone M. Value of patient time invested in the colonoscopy screening process: time requirements for colonoscopy study. Med Decis Mak. 2007;28:56–65. doi: 10.1177/0272989X07309643.
    1. Lazarus WF, Platas DE, Morse GW. IMPLAN’s weakest link: production functions or regional purchase coefficients? J Reg Anal Policy. 2002;32:33–48.
    1. Schmit TM, Jablonski BB, Kay D. Assessing the economic impacts of regional food hubs: the case of regional access. Ithaca: Cornell University; 2013.
    1. Swenson D. Exploring small-scale meat processing expansions in Iowa. Ames, Iowa: Leopold Center for Sustainable Agriculture, Iowa State University; 2011.
    1. Jablonski BBR, Schmit TM. Differential expenditure patterns of local food system participants. Renew Agric Food Syst. 2015;31(2):139–147. doi: 10.1017/S1742170515000083.
    1. Patton M. Qualititave research and evaluation methods. 3. Thousand Oaks: Sage Publications; 2002.
    1. International Committee of Medical Journal Editors. Recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals. 2015. . Accessed 1 Mar 2016.
    1. Darmon N, Drewnowski A. Does social class predict diet quality? Am J Clin Nutr. 2008;87:1107–1117.
    1. Craigie AM, Lake AA, Kelly SA, Adamson AJ, Mathers JC. Tracking of obesity-related behaviours from childhood to adulthood: a systematic review. Maturitas. 2011;70:266–284. doi: 10.1016/j.maturitas.2011.08.005.

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