BackgroundChildhood 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/designThe 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.DiscussionThis 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. Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4202-2) contains supplementary material, which is available to authorized users.
Community-supported agriculture (CSA) is a widely-used approach for farmers to sell directly to consumers. We used the product, place, price, and promotion (4P) marketing mix framework to examine characteristics that help farms offering CSA maintain member satisfaction and thus competitiveness. We conducted semi-structured interviews with 20 CSA members and 24 CSA farmers in four states. CSA members additionally completed a modified choice experiment. Qualitative data were coded iteratively, and choice experiment data were summarized and compared across scenarios. CSA members and farmers were motivated by a range of personal, social, environmental, and economic objectives. Members favored high-quality staple vegetables (e.g., lettuce, green beans), ideally produced organically. Trust and a sense of personal connection with the farmer comprised part of the "value added" of CSA participation. Time and location of share pickup were very important; thus, farmers tried to offer convenient sites or an enriched pickup experience. Small changes in price appeared unlikely to impact participation among current members. Social networks and word-of-mouth were powerful for marketing, but may limit the ability to reach diverse populations. Future research should examine the ability of CSAs to meet the needs of those who do not currently participate.
There is a need to improve geographical and financial access to healthy foods for limited resource populations in rural areas. Community Supported Agriculture (CSA) programs can improve access to healthy foods in rural and limited-resource populations. However, research is needed to discern the most appealing conditions for a CSA (e.g. price, frequency, food quantity) among rural, low-income customers. The goal of this study was to understand low-income consumers' preferences related to participation in a CSA program, considering price, frequency, food quantity and accessibility (e.g. distance) conditions. A modified exploratory choice experiment exercise was embedded within in-depth interviews to examine willingness to participate in CSA under a variety of conditions among 42 low-income adults with at least one child in the household in North Carolina, New York, Vermont and Washington. Willingness to participate in a CSA under each condition was summed and compared across conditions. Results were stratified by race, number of children and household members and McNemar's test and Student's t-test were used to examine differences in willingness between conditions. Salient quotes were extracted to support themes related to each condition. Our analysis suggests that the ideal CSA would be a full-sized share of eight to nine items of mixed variety, distributed every other week, priced at less than US$15, no more than 10 min further than the supermarket (SM) from their home and preferably less expensive but no more than 20% more expensive than SM prices. CSAs interested in reaching rural low-income populations may benefit from considering these consumer-level preferences.
Some farmers are offering subsidized or "cost-offset" community supported agriculture (CO-CSA) shares as a strategy to counter market saturation and improve low-income families' access to fresh local foods. However, little is known about farm-
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