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.
Highlights
Because food purchasing and consumption behaviors are influenced by multiple factors and levels and given the multi-pronged nature of the interventions being assessed, we developed and validated an agent-based model (ABM) which was informed by the primary data collected in this study, and by pre-existing secondary data sources
The FRESH-Austin study will examine the impact of the Fresh for Less (FFL) Initiative at the individual and community levels through cohort surveys, audits, etc., which subsequently is informing the development and validation of an agent-based model
The findings presented in this manuscript were data obtained from the baseline cohort survey, which were collected between October 2018 and March 2019
Summary
Food Insecurity and Food Access as Public Health Issues. Food insecurity is considered a public health concern because of its association with numerous health issues such as obesity and overweight, malnutrition, anemia, diabetes, hypertension, and other chronic conditions [2,3,4,5,6]. Food insecurity is a marker of economic disparities. In the United States (US), food insecurity just prior to the COVID-19 pandemic affected 11.8% of all US households [7]. In some states and specific localities, the prevalence of food insecurity was substantially higher, and in Texas, 14% of families were estimated to be food insecure at the time [7], as were 16% of households in the Greater Austin area. Austin is one of the most economically vibrant and fastest growing urban centers in the country, and a highly demographically
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