Community Supported Agriculture Program Research Articles

The Integrating Cultural Aspects Into Diabetes Education (INCLUDE) Study to Prevent Diabetes in Chinese Immigrants: Protocol for a Randomized Controlled Trial.

Type 2 diabetes (T2D) contributes to significant morbidity and mortality for Chinese immigrants in the United States, exacerbated by social determinants of health (SDOH) barriers such as language barriers, limited access to healthy foods, and low health literacy. The goal of the Integrating Cultural Aspects into Diabetes Education (INCLUDE) study is to test a social media-based intervention adapting the Diabetes Prevention Program (DPP) for Chinese immigrants alongside a culturally adapted, community-supported agriculture program. Here, we report the protocol for the INCLUDE study. INCLUDE is a 3-year randomized controlled trial (n=150). Participants with prediabetes or at risk for T2D are enrolled and randomized into either the control or intervention group (n=75 each). Participants from the intervention group receive 2-3 culturally tailored, in-language DPP videos weekly for 12 weeks, as well as biweekly phone calls from bilingual study staff to review video content, support goal setting, and assess and address SDOH-related barriers such as food insecurity. Intervention participants will also be given produce for 10 weeks as part of the community-supported agriculture program. Weight (primary outcome), self-efficacy, diet, physical activity, and food insecurity (secondary outcomes) are measured at baseline, 3-month, and 6-month intervals. Splined linear mixed models will be used to examine group differences in longitudinal weight and other secondary outcomes. The INCLUDE study was approved by the Institutional Review Board at the NYU Grossman School of Medicine. Recruitment started in May 2023, with the first cohort of 75 participants enrolled and randomized into 2 groups in July 2023. The 3-month and 6-month assessment of the first-year cohort has been completed. We have recruited 75 participants for the second cohort as of July 2024. The INCLUDE study will serve as an innovative model for culturally adapted, multilevel interventions for underserved communities previously unable to access evidence-based diabetes prevention initiatives. Aligning with several national calls for multilevel interventions, the INCLUDE intervention will provide critical data that will inform how researchers and public health professionals address SDOH barriers faced by underserved populations and prevent diabetes. ClinicalTrials.gov NCT05492916; https://clinicaltrials.gov/study/NCT05492916. DERR1-10.2196/65455.

Understanding factors affecting non-participants’ interest in community-supported agriculture

Community-supported agriculture (CSA) has emerged as a viable solution for addressing the agricultural challenges faced by countries like Indonesia. This study uses the well-established unified theory of acceptance and use of technology (UTAUT2) model to examine the interest in CSA of potential customers in Indonesia. A standardized questionnaire was distributed to 1200 respondents, and the data were analyzed using structural equation model-partial least square (SEM-PLS) in SmartPLS 4.0 software. The results capture potential CSA consumer interest and will help to improve CSA development strategies in Indonesia. The model explains 44.4% of customers’ intentions, and identifies performance expectancy as the decisive factor in customers’ willingness to participate in CSA. Performance expectancy (0.292), hedonic motivation (0.262), social influence (0.259), and facilitating conditions (0.086) positively influence customers’ interest in participating in a CSA program. The adoption of CSA programs by both farmers and customers could be increased by implementing regulations that provide tax incentives and subsidies, offering training on sustainable farming practices, facilitating the establishment of distribution channels, and establishing guidelines for fair price and quality standards. This study shows the high potential for the implementation of CSA in Indonesia. It could also be used as a foundation for the development of new policies regarding sustainable agriculture markets in Indonesia.

A qualitative study to inform the development of a subsidized community-supported agriculture program for Chinese Americans in Brooklyn, New York, U.S

The objective of this study was to inform the development of a subsidized, culturally adapted Community-Supported Agriculture (CSA) program for the Chinese American (CA) community in Brooklyn, New York (NY), USA. We conducted interviews with CA adults to understand their eating and shopping behaviors, interests in CSAs, and recommendations for educational content to inform the development of a subsidized and culturally adapted CSA. We then conducted thematic analysis of those interviews and identified major themes. CA adult participants shared interest in a CSA primarily to support their own health, interact socially with farmers and other participants, and gain access to fresh, culturally appropriate produce. Major concerns for participation, especially among older adults, included language barriers, transportation, and mobility. The unique needs and motivations of CAs should be centered in the development of alternative food access interventions for this population. CA adult participants living in Brooklyn, NY may be interested in a subsidized culturally adapted CSA that includes health information about the produce and provides in-language support. Engaging communities in the development of a health program may be important to ensure accessibility and acceptability for CA populations.

A Subsidized and Culturally-adapted Community Supported Agriculture Program to Improve Diet of Chinese Immigrant Communities

A Subsidized and Culturally-adapted Community Supported Agriculture Program to Improve Diet of Chinese Immigrant Communities

Experiences with Pandemic Food Access Among Clinic-Based Community Supported Agriculture Program Participants.

The COVID-19 pandemic intensified food insecurity (FI) across the country, and families with children were disproportionately affected. This study explores experiences with FI and social resources during the pandemic among families participating in a free, clinic-based community supported agriculture (CSA) program. Free weekly boxes of organic produce from local farms were distributed to pediatric caregivers for 12 weeks at two pediatric outpatient centers associated with a children's hospital in a low-income, urban area. Demographics and a two-question FI screen were collected. Caregivers were purposively selected to participate in semi-structured interviews about experiences with FI and community or federal nutrition programs during the pandemic. Interviews were recorded and transcribed. Content analysis with constant comparison was used to code interviews inductively and identify emerging themes. The 31 interviewees were predominantly female; more than half were Black, FI, and SNAP beneficiaries. Study participants were more likely to have repeat participation in the CSA program. Interviews elucidated four major themes of barriers to food access during the pandemic: (1) fluctuations in price, availability, and quality of food; (2) financial strain; (3) faster consumption with all family members home; (4) shopping challenges: infection fears, store closures, childcare. SNAP, WIC, and school meal programs were generally facilitators to food access. Increased SNAP allotments were particularly useful, and delays of mailed WIC benefits were challenging. This qualitative study describes facilitators and barriers to food access among clinic-based CSA program participants during the pandemic. The findings highlight areas for further exploration and potential policy intervention.

Farm to Families: Clinic-based Produce Provision to Address Food Insecurity During the Pandemic.

With rising rates of food insecurity (FI) during the pandemic, we implemented a clinic-based, community-supported agriculture program at 2 outpatient centers in low-income areas associated with an urban children's hospital and evaluated (1) the program's ability to reach FI families without preceding eligibility criteria, and (2) caregiver experiences and preferences for programming. Free boxes of produce were distributed weekly to caregivers of pediatric patients during a 12 week pilot period. Ability to reach the target population was measured by number of participating families and caregiver demographic information. We purposively sampled 31 caregivers for semistructured interviews on a rolling basis to understand program preferences. Content analysis with constant comparison was employed to code interviews inductively and identify emerging themes. Of 1472 caregivers who participated in the program, nearly half (48.3%) screened positive for FI, and 45% were receiving federal food assistance. Although many caregivers were initially "surprised" by the clinic-based program, they ultimately felt that it reinforced the hospital's commitment to "whole health" and perceived it to be safer than other food program settings during the pandemic. Several programmatic features emerged as particularly important: ease and efficiency of use, kindness of staff, and confidentiality. This advocacy case study demonstrates that a community-supported agriculture program in the clinical setting is an acceptable approach to supporting food access during the pandemic, and highlights caregiver preferences for a sustainable model. Furthermore, our data suggest that allowing families to self-select into programming may streamline operations and potentially facilitate programmatic reach to families who desire assistance.

Who Does Not Attend Farmers Markets and the Community Supported Agriculture (CSA) Programs?

This study uses data from 172 consumers who participated in mail survey distributed in 2020 to within the Southcentral Kentucky region. The purpose was to analyze consumer habits of attending farmers markets focusing on characteristics of those who do not attend and analyze their likelihood to participate in the Community Supported Agriculture (CSA) program. We used both Multinomial and Ordered Logit models to analyze data. Results indicate that respective relative probabilities for “never attend”, “attend occasionally”, and “attend frequently” are 55%, 29%, and 16%, respectively. Male consumers, rural residents, primary shoppers, and those with a 2-year associate degree are less likely to attend farmers markets. This study finds that educated consumers and those who were satisfied with previous market experiences are more likely to attend a market frequently. Another finding is that consumers with interests in using an App to purchase fresh produce are more likely to attend farmers markets and participate in CSA programs. We further found that consumers are less likely to join a CSA program if they live in a rural area. This study contributes to the understanding of characteristics of consumers who do not use direct-to-consumer market outlets, particular farmers’ markets, and CSA programs. It informs policy makers who seek to promote these two market outlets. This study is also useful to managers of farmers markets and CSA programs when making marketing decisions.

Examining Food Security, Choices and Barriers among Community Supported Agriculture Participants during COVID- 19 in Kentucky

ABSTRACT The coronavirus disease (COVID-19) pandemic is challenging food security. Our study’s purpose was to examine relationships among food security status, eating patterns and perceived barriers to food choices among shareholders (N = 209) in a Community Supported Agriculture (CSA) program during stay-at-home restrictions due to the pandemic. The food insecure group (n = 33) reported lower consumption of fruits/vegetables, whole grains and greater consumption of fast foods and more barriers to food choices compared to the food secure group (p < .05). A low food insecure proportion (16%) among the CSA participants suggests a potential role of a CSA program to prevent food insecurity.

Abstract 10560: Reducing Cardiovascular Risk Among Participants in a Community Supported Agriculture Program

Introduction: Eating a diet high in vegetables translates to lower risk for cardiovascular disease. Only 10% of Americans consume the recommended servings of vegetables per day. Community supported agriculture (CSA) programs support local farmers while promoting increased consumption of vegetables. At the University of Kentucky (UK), employees receive vouchers to encourage CSA program participation while giving financial support to local farms that allow them to operate in an economically sustainable manner. Our objective was to examine the effect of participation in a CSA voucher program on CVD risk factors as a new approach to CVD risk management. Methods: Participants self-selected in the UK employee Health and Wellness CSA voucher program. Biometric measurements (blood pressure, lipid levels, and noninvasive dermal carotenoid levels via Veggie Meter) and vegetable intake via six-question BRFSS were collected pre- and post- CSA program participation. Descriptive statistics, independent t-tests, paired t-tests and cluster analysis were used to analyze the data. Results: Among 204 eligible individuals, 85 enrolled pre-program and 52 completed post program for a 61.2% retention rate. Average participant age was 42 + 10 years, predominantly Caucasian females. Systolic blood pressure was significantly reduced from pre- to post program (125.8 compared to 120.6 mmHg, p = 0.012). Carotenoid levels significantly increased from pre- to post program (286.3 ± 110 to 295.9 ± 124,) while controlling for age and sex (p = &lt;0.001). Frequency of total vegetable, red/orange vegetables, dark green vegetables and other vegetable intake also increased from pre- to post- program while controlling for age and sex (p = 0.003, 0.004, 0.013, &lt; 0.001 and 0.011 respectively). Conclusion: Our data identifies participation in a CSA employer incentivized program can effectively reduce blood pressure and increase vegetable intake (dermal carotenoids) and self-reported quantity and variety of vegetable consumption thereby reducing CVD risk.

Development of a Tribally-led Gardening Curriculum for Indigenous Preschool Children: The FRESH Study

Development of a Tribally-led Gardening Curriculum for Indigenous Preschool Children: The FRESH Study

A Photovoice Inquiry Into the Impacts of a Subsidized CSA Program on Participants' Health.

Although consumption of fruits and vegetables is associated with reduced risk of disease, many Americans do not eat the recommended quantity or variety. This is especially true for low-income populations, who may face significant barriers to accessing fresh produce, including cost. Community-supported agriculture (CSA) Partnerships for Health is a subsidized community-supported agriculture program designed to reduce barriers to accessing fresh produce in a low-income population. This Photovoice study gave participants (n = 28) an opportunity to take photos representing how the program affects their lives. The aim was to understand the program's impact from the perspective of CSA members. Participants had 2 to 4 weeks to take photographs, and then selected a few to discuss during a subsequent focus group. Through this discussion, we learned that participants see the program as (a) supporting positive changes to their physical and social health and (b) facilitating learning about new foods, cooking, and agriculture. The study suggests that a reduced-cost CSA membership that incorporates cooking education supports participants' ability to try new foods, build skills, and improve health outcomes.

CSA Partnerships for Health: outcome evaluation results from a subsidized community-supported agriculture program to connect safety-net clinic patients with farms to improve dietary behaviors, food security, and overall health.

Safety-net clinic patients are at risk for food insecurity, which is associated with poor diet quality and negative health outcomes. Research on the impact of interventions addressing food insecurity in health care settings is limited. The primary aim of this study was to determine the preliminary effectiveness of Community-Supported Agriculture (CSA) Partnerships for Health, a 23 week grant-subsidized CSA program, in improving dietary behaviors, self-efficacy to eat vegetables, food security, and overall health among safety-net clinic patients. This single-group pretest-posttest study used interviewer-administered surveys. Study participants were 48 safety-net clinic patients. Outcomes included fruit and vegetable intake, frequency of dark green and orange vegetable intake, self-efficacy to eat vegetables, eating habits, food security status and ability to afford to eat healthy meals, emotional health, social health, and general health status. Differences in values at postintervention versus preintervention were examined using two-sided paired t-tests, McNemar's tests, and generalized estimating equation models. The difference between postintervention versus preintervention values was statistically significant for a number of outcomes, including vegetable intake (p = .030), orange vegetable intake (p = .004), eating habits (p = .039), food security (p = .039), ability to afford to eat healthy meals (p = .003), and general health status (p = .039). Generalized estimating equation models showed similar associations. CSA Partnerships for Health may have the potential to improve dietary behaviors, reduce food insecurity, and improve overall health among safety-net clinic patients.

A Potential Sustainable Pathway for Community-Supported Agriculture in Taiwan: The Consumer Perspective in a Farmers’ Market

Community Supported Agriculture (CSA) has become an alternative approach for small-sized farmers in many countries. However, CSA is a somewhat challenging concept in Taiwan because many CSA projects face difficulties and obstacles related to sustainability, so relevant literature is rare. This pilot study investigates a potential CSA program in a farmers’ market to observe whether farmers’ market consumers would like to participate or not. A total of 320 survey responses collected from a farmers’ market were examined by an interval regression model. Results show that respondents are willing to pay and to be a CSA member of the farmers’ market. This study identifies that consumers are willing to share the risks of upfront payment with farmers. The preferred length of the contract means that a compromise is made in order to implement the CSA program. The implications involving a flexible length of contract and the budget should be taken into consideration by farmers, farmers’ market managers, and policymakers for devising promotion strategies, enrolling shareholders, and promoting CSA in Taiwan. Future study should focus on the consumer characteristics and factors affecting their decision to subscribe to CSA.

A Randomized Trial to Encourage Healthy Eating Through Workplace Delivery of Fresh Food.

This study aimed to increase the consumption of home-cooked meals among employees at a large urban worksite through a fully subsidized Community Supported Agriculture (CSA) program. Randomized trial. Worksite in a large northeast city. Employees were recruited through flyers, e-mail listservs, and outreach from departmental administrators (n = 60). Intervention participants received 8 biweekly fresh food deliveries through a CSA program. They also received cooking education and support. Control participants received usual employee benefits. Consumption of meals prepared at home was the primary end point. Increased consumption of fresh fruits and vegetables was the secondary end point, and food insecurity was an exploratory end point. Poisson regression was used to assess mean differences in weekly consumption of home-cooked meals. To assess differences in fruit and vegetable consumption and food insecurity, binary logistic regression was used to estimate odds ratios. Compared to the control group, intervention participants consumed 29% more home-cooked meals per week (P < .01). Fruit and vegetable consumption also increased among intervention participants. The odds of at least twice-daily fruit consumption were 3.8 times higher among intervention participants than among controls, and the odds of at least twice-daily vegetable consumption were 6.2 times higher among intervention participants than among controls. Compared to control participants, intervention participants experienced a statistically significant 89% reduction in the odds of reporting food insecurity at follow-up, when controlling for baseline food insecurity. Participants reported perceived intervention benefits, including the opportunity to experiment with new, healthful foods without financial risk, as well as the social value of sharing recipes, food, and related conversation with colleagues. The study demonstrated the feasibility and potential positive effects of a subsidized workplace CSA program, augmented with cooking education and support.

A modified choice experiment to examine willingness to participate in a Community Supported Agriculture (CSA) program among low-income parents

AbstractThere is a need to improve geographical and financial access to healthy foods for limited resource populations in rural areas. Community Supported Agriculture (CSA) programs can improve access to healthy foods in rural and limited-resource populations. However, research is needed to discern the most appealing conditions for a CSA (e.g. price, frequency, food quantity) among rural, low-income customers. The goal of this study was to understand low-income consumers' preferences related to participation in a CSA program, considering price, frequency, food quantity and accessibility (e.g. distance) conditions. A modified exploratory choice experiment exercise was embedded within in-depth interviews to examine willingness to participate in CSA under a variety of conditions among 42 low-income adults with at least one child in the household in North Carolina, New York, Vermont and Washington. Willingness to participate in a CSA under each condition was summed and compared across conditions. Results were stratified by race, number of children and household members and McNemar's test and Student's t-test were used to examine differences in willingness between conditions. Salient quotes were extracted to support themes related to each condition. Our analysis suggests that the ideal CSA would be a full-sized share of eight to nine items of mixed variety, distributed every other week, priced at less than US$15, no more than 10 min further than the supermarket (SM) from their home and preferably less expensive but no more than 20% more expensive than SM prices. CSAs interested in reaching rural low-income populations may benefit from considering these consumer-level preferences.

Feasibility of Using a Community-Supported Agriculture Program to Increase Access to and Intake of Vegetables among Federally Qualified Health Center Patients

ObjectiveThis study explored the feasibility of using a 23-week subsidized community-supported agriculture program to increase access to and intake of vegetables among Federally Qualified Health Center patients. MethodsOutcomes were measured using pre-post intervention surveys (n = 9). Process data were collected in post-intervention surveys and focus groups (n = 15). ResultsMost participants (77%) indicated that the program improved their health and all (100%) reported that they were eating a greater variety of vegetables because of their participation in the program. Three themes emerged from the focus groups: increased access to fresh and/or organic vegetables, improved diet quality, and the importance of social support during the program. Conclusions and ImplicationsLinking subsided community-supported agriculture programs with Federally Qualified Health Centers has the potential to increase access to and intake of vegetables among low-income patients. However, further research is needed with a larger sample size and a more robust study design.

A5197 - Partnering a Surgical Weight Loss Program with a Community-Supported Agriculture Program to Influence Patient Behavior and Outcomes

A5197 - Partnering a Surgical Weight Loss Program with a Community-Supported Agriculture Program to Influence Patient Behavior and Outcomes

Educators’ Experiences with a Local Foods Curriculum for Low-Income Households in a Subsidized Community Supported Agriculture Program

Educators’ Experiences with a Local Foods Curriculum for Low-Income Households in a Subsidized Community Supported Agriculture Program

Factors Affecting Current and Future CSA Participation

Community Supported Agriculture (CSA) is one of the widely used direct marketing strategies for small- and midsized farmers. CSA programs are an important option for sustainable production and consumption. It helps growers generate income (improve financial security) and consumers obtain fresh local foods. Sustaining and growing CSA participation is critical in order to continue enjoying these benefits. We used a national online survey in conjunction with discrete choice models to investigate the impact of demographic characteristics, lifestyle preferences, and different information outlets on the probability that a consumer is or will become a CSA member. The results indicate that the factors affecting current and future CSA participation differ substantially. While none of the demographic characteristics has a significant impact on current CSA participation, some of them significantly affect the probability that a consumer will become a CSA member in the future. Lifestyle preferences have a significant impact on current and future CSA participation. Although none of the information outlets examined affect current CSA participation, word-of-mouth and online sources significantly influence the probability that a consumer will join a CSA program in the future. These findings may have important implications for policy makers’ and CSA farm managers’ efforts to sustain future CSA development.

Individualist and collectivist consumer motivations in local organic food markets

Community-Supported Agriculture programs have become a popular model for providing consumers with direct economic engagement with independent local organic farms. The degree to which Community-Supported Agriculture members are unified in their identity and consumer interests, however, is unclear. One possibility is that mostly individual interests including supposed nutritional benefits, superior taste, and avoidance of synthetic pesticides motivate Community-Supported Agriculture members. Another is that they are motivated more by environmental and economic concerns at the collective level. Our study engages this debate by analyzing emergent themes in consumers’ motivational narratives using interview data with 58 members of a Community-Supported Agriculture program in a large southwestern city in the United States. We find that Community-Supported Agriculture members are largely unified in their consumer orientation and pursue individualist and collectivist goals equally. In other words, Community-Supported Agriculture members are neither primarily altruistic nor egoistic consumers, but they approach their consumption as a holistic act. Specifically, they emphasize environmental issues and a commitment to sustainability through local organic consumption as a pathway to individual health. This suggests that an internally homogeneous, yet multidimensional, framework constitutes the motivational structure of local organic food consumption. We argue this framework aligns with an emerging eco-habitus exhibited in environmentally conscious market fields that translate into both collective and individual benefits.