A Multi-Pronged Evaluation of a Healthy Food Access Initiative in Central Texas: Study Design, Methods, and Baseline Findings of the FRESH-Austin Evaluation Study

Abstract

Food insecurity and limited healthy food access are complex public health issues and warrant multi-level evaluations. The purpose of this paper was to present the overall study design and baseline results of the multi-pronged evaluation of a healthy food access (i.e., Fresh for Less (FFL)) initiative in Central Texas. The 2018–2021 FRESH-Austin study was a natural experiment that utilized a cluster random sampling strategy to recruit three groups of participants (total n = 400): (1) customers at FFL assets, (2) residents that lived within 1.5 miles of an FFL asset, and (3) residents from a comparison community. Evaluation measures included annual cohort surveys, accelerometers and GPS devices, store-level audits, and built environment assessments. Data are being used to inform and validate an agent-based model (ABM) to predict food shopping and consumption behaviors. Sociodemographic factors and food shopping and consumption behaviors were similar across the three groups; however, customers recruited at FFL assets were lower income and had a higher prevalence of food insecurity. The baseline findings demonstrate the need for multi-level food access interventions, such as FFL, in low-income communities. In the future, ABM can be used as a cost-effective way to determine potential impacts of future large-scale food environment programs and policies.

Exploring the Impact of Policies to Improve Geographic and Economic Access to Vegetables among Low-Income, Predominantly Latino Urban Residents: An Agent-Based Model

“…Fresh for Less aims to increase access to healthy food among low-income, diverse residents, by strategically placing non-traditional retail outlets, including farm stands, mobile markets, and healthy corner stores, in low-income areas of Eastern Travis County [ 38 ]. Farm stands refer to small pop-up markets that sell locally grown, fresh produce at subsidized prices [ 32 , 38 ]. Meanwhile, mobile markets are small pop-up markets that sell locally grown, fresh produce as well as healthy staple goods (eggs, canned vegetables, etc.)…”

“…Meanwhile, mobile markets are small pop-up markets that sell locally grown, fresh produce as well as healthy staple goods (eggs, canned vegetables, etc.) at subsidized prices [ 32 , 38 ]. Finally, healthy corner stores are participating convenience stores that agreed to carry a suite of healthy products including fresh produce, whole grains, low-fat dairy, low-sodium canned vegetables, and other products, informed by the Food Trust Healthy Corner Store model in Philadelphia [ 32 , 38 , 39 ].…”

“…The agent-based model presented in this paper is one of multiple components of the Food Retail: Evaluating Strategies for a Healthy Austin (FRESH-Austin) Study [ 32 ]. The FRESH-Austin Study aims to comprehensively assess the City of Austin’s Fresh for Less Program and to increase our understanding of the complexities involved in designing and implementing effective food access policies in low-income, diverse urban communities [ 32 ]. As a whole, the study includes a robust primary data component set within the context of a natural experiment (constituting the expansion of the Fresh for Less program in Eastern Travis County).…”

“…Data collection for this portion of the work took place from 2018 to 2021. The methods and baseline results of the empirical component of the FRESH-Austin study have been extensively described elsewhere [ 32 ].…”

“…The aim of this study was to develop, calibrate and use an agent-based model to simulate the impact of different types of food access policies on vegetable consumption levels among low-income, predominantly Latino urban communities in Central Texas. Our simulation exercise is unique in that it was directly informed by a natural experiment, which employed empirical methods and a longitudinal observational design to assess the impact of real-life, small-scale strategies aimed at increasing geographic and economic access to fresh fruits and vegetables through non-traditional food retail stores (farm stands, mobile markets, and healthy corner stores) [ 32 ]. Through our modeled scenarios, we examine the possibility of scaling up these types of strategies in varying ranges.…”