P147 Cost-offset Community-Supported Agriculture plus Nutrition Education Improves Household Food Security and Nutrition Attitudes and Self-efficacy: A Randomized Controlled Trial

Abstract

Background Subsidized or ‘cost-offset’ Community-Supported Agriculture (CO-CSA) has the potential to improve food security in low-income households. Furthermore, CO-CSA coupled with tailored nutrition education may affect nutrition knowledge, attitudes, and self-efficacy. To date, many studies of CO-CSA had small samples and no comparison group; few studies incorporated formal nutrition education into CO-CSA. Objective To understand the effect of CO-CSA plus education on nutrition knowledge, attitudes, self-efficacy, and food security among low-income families; whether any observed effects are durable beyond the CO-CSA season; and whether intervention dose mediated net effect. Study Design, Setting, Participants Farm Fresh Foods for Healthy Kids (F3HK), a randomized controlled trial in New York, North Carolina, Vermont, and Washington (2016-2018) that assigned caregiver-child dyads (n = 305) from low-income households into intervention or control. The F3HK intervention included a cost-offset (50% subsidy) CSA, weekly payments (including SNAP-EBT), kitchen equipment, and 9 CSA-tailored education classes. Measureable Outcome/Analysis Household food security was measured using the 6-item Short Form of the US Department of Agriculture Food Security Survey Module (FSSM). Caregiver knowledge was assessed by asking recommended cups of fruit and vegetables (FV) per day and FV as a fraction of a dinner plate. The 4-item Negative Cooking Attitude Scale measured caregiver's attitudes towards cooking. The 4-item Self-Efficacy for Eating/Cooking Fruits and Vegetables Scale measured FV self-efficacy. Results Significant net effects were observed for outcomes related to household food security as well as caregiver nutrition attitudes and self-efficacy. Improvements in caregiver attitudes and self-efficacy remained 6 months post-intervention. Weeks of CSA pick-up mediated changes household food security. Conclusions CO-CSA plus nutrition education for low-income caregivers and their children improved household food security and caregiver attitudes and self-efficacy. Attitude and self-efficacy but not food security effects were maintained post-intervention, indicating both the promise and limitations of seasonal food access interventions. Funding USDA.