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

Rebecca A Seguin-Fowler,Alice S Ammerman,Jane Kolodinsky,Stephanie B Jilcott Pitts,Emily H Belarmino,Karla L Hanson,Jennifer A Garner,Marilyn Sitaker,Weiwei Wang,Grace A Marshall

doi:10.1186/s12966-021-01168-x

Abstract

BackgroundAdults 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.MethodsThe 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.ResultsNo 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.ConclusionsCost-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 registrationClinicalTrials.gov. NCT02770196. Registered 5 April 2016. Retrospectively registered.

Highlights

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
Households that picked up more shares reported larger improvements. These changes were not maintained after the community supported agriculture (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
Shares were offered at half-price and caregivers paid weekly, on average $13, with money or Supplemental Nutrition Assistance Program (SNAP) benefits throughout the season [43]; research funds paid the other half of the price to the farm before the CSA summer season began

Summary

Introduction

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. One strategy to reduce disparities in FV access and intake is to leverage direct-to-consumer marketing of fresh produce – such as community supported agriculture (CSA) – to reach more low-income households [7, 8]. Most studies have shown the purchase of fullpriced CSA to be positively associated with FV intake: CSA members consumed more FV [9, 10], had greater increases in FV intake than non-members [11, 12], and ate more fruits and/or vegetables during the CSA season than before [13,14,15,16]. CSA participation may have implications for body mass index (BMI); one study showed a beneficial association between CSA and BMI [23] and another showed none [21]

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