Multilevel approaches to increase fruit and vegetable intake in low-income housing communities: final results of the 'Live Well, Viva Bien' cluster-randomized trial.

Publisher: BioMed Central Country of Publication: England NLM ID: 101217089 Publication Model: Electronic Cited Medium: Internet ISSN: 1479-5868 (Electronic) Linking ISSN: 14795868 NLM ISO Abbreviation: Int J Behav Nutr Phys Act Subsets: MEDLINE

Original Publication: [London] : BioMed Central, c2004-

Commerce* ; Diet* ; Feeding Behavior* ; Food Supply* ; Housing* ; Poverty*; Health Promotion/*methods; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Demography ; Diet, Healthy ; Eating ; Energy Intake ; Female ; Fruit ; Health Education/methods ; Humans ; Income ; Male ; Middle Aged ; Program Evaluation ; Rhode Island ; Vegetables ; Young Adult

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.

Prev Chronic Dis. 2015 Oct 15;12:E176. (PMID: 26469949)
J Acad Nutr Diet. 2013 Oct;113(10):1317-31. (PMID: 23871110)
J Acad Nutr Diet. 2016 Jul;116(7):1136-55. (PMID: 27021526)
Health Educ Q. 1988 Winter;15(4):351-77. (PMID: 3068205)
J Acad Nutr Diet. 2013 Oct;113(10):1366-74. (PMID: 23958116)
Int J Behav Nutr Phys Act. 2016 Jan 25;13:9. (PMID: 26810760)
Appetite. 2014 Aug;79:58-67. (PMID: 24727100)
Prev Chronic Dis. 2014 May 22;11:E87. (PMID: 24854238)
J Am Diet Assoc. 2010 Mar;110(3):399-408. (PMID: 20184990)
Prev Med Rep. 2017 Jun 27;7:176-179. (PMID: 28702315)
Am J Epidemiol. 2013 Aug 15;178(4):590-602. (PMID: 23599238)
Am J Health Promot. 1996 Mar-Apr;10(4):282-98. (PMID: 10159709)
J Am Diet Assoc. 2002 Aug;102(8):1105-18. (PMID: 12171455)
Proc Nutr Soc. 2013 May;72(2):236-45. (PMID: 23324158)
Public Health Nutr. 2003 Apr;6(2):159-68. (PMID: 12675958)
Int J Cancer. 2012 Sep 15;131(6):E963-73. (PMID: 22392502)
Am Psychol. 1989 Sep;44(9):1175-84. (PMID: 2782727)
J Acad Nutr Diet. 2012 May;112(5):624-635.e6. (PMID: 22709767)
MMWR Morb Mortal Wkly Rep. 2015 Jul 10;64(26):709-13. (PMID: 26158351)
World Health Organ Tech Rep Ser. 2003;916:i-viii, 1-149, backcover. (PMID: 12768890)
Adv Nutr. 2013 Nov 06;4(6):665-6. (PMID: 24228195)
Eur Heart J. 2011 May;32(10):1235-43. (PMID: 21245490)
BMJ. 2014 Jul 29;349:g4490. (PMID: 25073782)
Public Health Nutr. 2013 Nov;16(11):1944-52. (PMID: 23701901)
Lipids Health Dis. 2006 Jun 05;5:14. (PMID: 16753064)
Appetite. 2012 Aug;59(1):41-6. (PMID: 22446723)
Lancet. 2012 Dec 15;380(9859):2224-60. (PMID: 23245609)
J Am Diet Assoc. 2011 Oct;111(10):1549-55. (PMID: 21963022)
J Am Diet Assoc. 2001 Feb;101(2):195-202. (PMID: 11271692)
Am J Public Health. 2008 Jan;98(1):98-105. (PMID: 18048803)
BMC Public Health. 2016 Jun 28;16:521. (PMID: 27353149)
Public Health Nutr. 2017 Oct;20(14):2636-2641. (PMID: 27539192)
Am J Epidemiol. 2001 Dec 15;154(12):1089-99. (PMID: 11744511)
Prev Med. 2013 May;56(5):288-92. (PMID: 23384473)
Diabetes Educ. 2014 Jan-Feb;40(1):100-6. (PMID: 24159007)
Public Health Nutr. 2010 Apr;13(4):480-7. (PMID: 19807933)
J Prev Interv Community. 2015;43(2):148-62. (PMID: 25898221)
Public Health Nutr. 2014 Sep;17(9):2061-70. (PMID: 23988018)
J Am Diet Assoc. 2000 May;100(5):567-70. (PMID: 10812383)
Health Place. 2012 Sep;18(5):1137-43. (PMID: 22608130)

R01 CA134903 United States CA NCI NIH HHS; R01CA134903 United States CA NCI NIH HHS

Keywords: Diet; Farmer’s market; Fruit and vegetable; Mobile market; Nutrition education, housing, community, food environment; Nutrition, food access

ClinicalTrials.gov NCT02669472

Date Created: 20180822 Date Completed: 20181211 Latest Revision: 20240330

20240330

PMC6102886

10.1186/s12966-018-0704-2

30126463