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Multilevel approaches to increase fruit and vegetable intake in low-income housing communities: final results of the 'Live Well, Viva Bien' cluster-randomized trial.
Int J Behav Nutr Phys Act. 2018 08 20; 15(1):80.IJ

Abstract

BACKGROUND

Fruit 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.

METHODS

Fifteen 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'.

RESULTS

From 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.

CONCLUSIONS

LWVB 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 NUMBER

Clinicatrials.gov registration number: NCT02669472.

Authors+Show Affiliations

Department of Human Development and Family Studies, University of Connecticut, Storrs, USA. kim.gans@uconn.edu. University of Connecticut Intitute for Collaboration in Health, Interventions and Policy, Storrs, USA. kim.gans@uconn.edu. Center for Health Equity Research, Brown University School of Public Health, Providence, USA. kim.gans@uconn.edu. Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA. kim.gans@uconn.edu.Center for Health Equity Research, Brown University School of Public Health, Providence, USA. Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA.Center for Health Equity Research, Brown University School of Public Health, Providence, USA. Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA.Center for Health Equity Research, Brown University School of Public Health, Providence, USA.Center for Health Equity Research, Brown University School of Public Health, Providence, USA.University of Connecticut Intitute for Collaboration in Health, Interventions and Policy, Storrs, USA. University of Connecticut Rudd Center for Food Policy and Obesity, Hartford, USA.Department of Statistical Scieces, Brown University School of Public Health, Providence, USA.Yale University School of Public Health, New Haven, USA.Department of Human Development and Family Studies, University of Connecticut, Storrs, USA.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

30126463

Citation

Gans, Kim M., et al. "Multilevel Approaches to Increase Fruit and Vegetable Intake in Low-income Housing Communities: Final Results of the 'Live Well, Viva Bien' Cluster-randomized Trial." The International Journal of Behavioral Nutrition and Physical Activity, vol. 15, no. 1, 2018, p. 80.
Gans KM, Risica PM, Keita AD, et al. Multilevel approaches to increase fruit and vegetable intake in low-income housing communities: final results of the 'Live Well, Viva Bien' cluster-randomized trial. Int J Behav Nutr Phys Act. 2018;15(1):80.
Gans, K. M., Risica, P. M., Keita, A. D., Dionne, L., Mello, J., Stowers, K. C., Papandonatos, G., Whittaker, S., & Gorham, G. (2018). Multilevel approaches to increase fruit and vegetable intake in low-income housing communities: final results of the 'Live Well, Viva Bien' cluster-randomized trial. The International Journal of Behavioral Nutrition and Physical Activity, 15(1), 80. https://doi.org/10.1186/s12966-018-0704-2
Gans KM, et al. Multilevel Approaches to Increase Fruit and Vegetable Intake in Low-income Housing Communities: Final Results of the 'Live Well, Viva Bien' Cluster-randomized Trial. Int J Behav Nutr Phys Act. 2018 08 20;15(1):80. PubMed PMID: 30126463.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multilevel approaches to increase fruit and vegetable intake in low-income housing communities: final results of the 'Live Well, Viva Bien' cluster-randomized trial. AU - Gans,Kim M, AU - Risica,Patricia Markham, AU - Keita,Akilah Dulin, AU - Dionne,Laura, AU - Mello,Jennifer, AU - Stowers,Kristen Cooksey, AU - Papandonatos,George, AU - Whittaker,Shannon, AU - Gorham,Gemma, Y1 - 2018/08/20/ PY - 2018/03/03/received PY - 2018/07/20/accepted PY - 2018/8/22/entrez PY - 2018/8/22/pubmed PY - 2018/12/12/medline KW - Diet KW - Farmer’s market KW - Fruit and vegetable KW - Mobile market KW - Nutrition education, housing, community, food environment KW - Nutrition, food access SP - 80 EP - 80 JF - The international journal of behavioral nutrition and physical activity JO - Int J Behav Nutr Phys Act VL - 15 IS - 1 N2 - BACKGROUND: Fruit 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. METHODS: Fifteen 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'. RESULTS: From 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. CONCLUSIONS: LWVB 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 NUMBER: Clinicatrials.gov registration number: NCT02669472. SN - 1479-5868 UR - https://www.unboundmedicine.com/medline/citation/30126463/Multilevel_approaches_to_increase_fruit_and_vegetable_intake_in_low_income_housing_communities:_final_results_of_the_'Live_Well_Viva_Bien'_cluster_randomized_trial_ L2 - https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-018-0704-2 DB - PRIME DP - Unbound Medicine ER -