Community supported agriculture plus nutrition education improves skills, self-efficacy, and eating behaviors among low-income caregivers but not their children: a randomized controlled trial

Abstract

Background Adults and children in the U.S. consume inadequate quantities of fruit and vegetables (FV), in part, due to poor access among households with lower socioeconomic status. One approach to improving access to FV is community supported agriculture (CSA) in which households purchase a ‘share’ of local farm produce throughout the growing season. This study examined the effects of cost-offset (half-price) CSA plus tailored nutrition education for low-income households with children. Methods The Farm Fresh Foods for Healthy Kids (F3HK) randomized controlled trial in New York, North Carolina, Vermont, and Washington (2016–2018) assigned caregiver-child dyads (n = 305) into cost-offset CSA plus education intervention or control (delayed intervention) groups. Following one growing season of CSA participation, changes in children’s diet quality, body mass index (BMI), and physical activity; caregivers’ nutrition knowledge, attitudes, behaviors, and diet quality; and household food access and security were examined using multiple linear or logistic regression, with adjustment for baseline value within an intent-to-treat (ITT) framework in which missing data were multiply imputed. Results No significant net effects on children’s dietary intake, BMI, or physical activity were observed. Statistically significant net improvements were observed after one growing season for caregivers’ cooking attitudes, skills, and self-efficacy; FV intake and skin carotenoid levels; and household food security. Changes in attitudes and self-efficacy remained one-year after baseline, but improvements in caregiver diet and household food security did not. The number of weeks that participants picked up a CSA share (but not number of education sessions attended) was associated with improvements in caregiver FV intake and household food security. Conclusions Cost-offset CSA plus tailored nutrition education for low-income households improved important caregiver and household outcomes within just one season of participation; most notably, both self-reported and objectively measured caregiver FV intake and household food security improved. Households that picked up more shares also reported larger improvements. However, these changes were not maintained after the CSA season ended. These results suggest that cost-offset CSA is a viable approach to improving adult, but not child, FV intake and household food security for low-income families, but the seasonality of most CSAs may limit their potential to improve year-round dietary behavior and food security. Trial registration ClinicalTrials.gov. NCT02770196. Registered 5 April 2016. Retrospectively registered.

Offsetting the cost of community-supported agriculture (CSA) for low-income families: perceptions and experiences of CSA farmers and members

“…The CO-CSA model holds promise as a strategy to remove access barriers to locally grown produce and increase FV consumption among low-income adults (Quandt et al, 2013;Izumi et al, 2018;Berkowitz et al, 2019;Seguin-Fowler et al, 2021). Potential collateral benefits include connections to the land and the farmers who grow the food, as well as participation in a community of residents that appreciates local agriculture (Hanson et al, 2019).…”

Participation in cost-offset community-supported agriculture by low-income households in the USA is associated with community characteristics and operational practices

“…Third, although the F3HK intervention trial required partner farms to accept both weekly payments and to include SNAP as an accepted form of payment, other operational characteristics were decided upon and implemented by partner farms. Although acceptance of SNAP benefits was required, only 24 % of participants used SNAP benefits all or most weeks (28) . Farms likely select their practices in consideration of the local community context which limits our ability to disentangle associations among contextual characteristics, CO-CSA operational practices and participation levels.…”

“…Participants agreed to use SNAP benefits or money to pay for the CO-CSA share weekly and to attend nine CSA-tailored nutrition education classes (27) . A total of 685 caregivers were screened for eligibility, 542 (79•1 %) were eligible and 305 of those enrolled (56•3 %), of which 148 were assigned to the intervention group (28) . Two communities (one each in NC and VT) were excluded from this analysis due to low F3HK enrolment (≤7 participants, >1 SD below mean sample size of 12), and the remaining 137 intervention participants in 10 communities are the focus of this analysis.…”

“…The F3HK intervention was implemented in the context of a randomised controlled trial with 1:1 random assignment of child-caregiver dyads to intervention and control groups (27) . F3HK reported overall improvements relative to control in caregiver nutrition attitudes, self-efficacy, FV intake, skin carotenoids, preparation of FV as snacks for children and household food security (28) . However, F3HK was implemented in small and micropolitan communities across four states, each with a unique context for implementation.…”

المعرفة التغذویة للطلاب والسلوك الغذائی: الدور الوسیط للكفاءة الذاتیة للطلاب والدور المعدل للتعلیم التغذوی

“…It was shown that people's lack of nutrition education can reduce their self-efficacy in nutrition and consequently affect the quality of their dietary behavior and nutrition advice for others (Kushner et al, 2014). Many previous studies revealed that providing nutritional education to students improves their nutritional knowledge and self-efficacy in some aspects such as meal planning, shopping, and cooking (Haylee, 2016), acquiring new culinary skills as well as their dietary habits (Zimmerman & Keller, 2016), the use of basic cooking techniques and methods, the use of spices, vegetables and fruits to prepare highly nutritious meals, and the ability to select and purchase low-cost products within the specified budget (Kerrison et al, 2017), providing nutritional counseling to others (Gotwals, 2011;Gotwals, 2018;Magallanes et al, 2021), serving fruits and vegetables, and supported food security practices for low-income households (Seguin-Fowler et al, 2021). Walter et al (2018) illustrated that nutrition education improved students' nutritional knowledge and dietary behaviors and improved the general and academic self-efficacy of students who study nutrition majors.…”