The FRESH Study: The Fresh Bucks racial equity, socioeconomic & health outcomes study

FRESH 研究：新鲜雄鹿队种族平等、社会经济

基本信息

批准号：
10635729
负责人：
Barbara I Baquero
金额：
$ 75.32万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10635729
关键词：
Address Affect American Black Populations Black race Blood Pressure Body mass index Cardiometabolic Disease Cessation of life Communities Consumption Data Diet Disparity Eating Economic Factors Economics Electronic Health Record Eligibility Determination Employment Enrollment Equity Ethnic Origin Exclusion Family member Federal Government Feeling Food Health Health Food Health Promotion Healthy Eating High-Income Populations Hour Household Immigrant Impact evaluation Incentives Income Inequity Intake Intervention Language Latinx Latinx population Low Income Population Low income Marketing Methodology Methods Minority Groups Municipalities Neighborhoods Outcome Outcome Study Participant Persons Play Policies Policy Maker Population Poverty Price Qualifying Quasi-experiment Race Racial Equity Randomized Risk Factors Sample Size Services Source Spatial Distribution Structural Racism Supermarket Waiting Lists Work access disparities beneficiary cardiometabolic risk cardiometabolism cardiovascular risk factor cohort comparison group cost design dietary experience farmers markets financial incentive food insecurity food security fruits and vegetables health inequalities health record high risk improved incentive program innovation mortality operation people of color programs racial identity socioeconomics structural determinants systemic barrier usability

项目摘要

ABSTRACT. Stark disparities in cardiometabolic health outcomes exist by racialized identity and income level. Low-income populations experience 40-70% higher risk for cardiovascular mortality compared to higher-income populations. Black and Latinx populations experience higher rates of at-risk cardiovascular profiles compared to White populations. Diet quality is hypothesized to play a key role in these disparities. But consuming a health- promoting diet is out of reach for many Americans, and disproportionately so for low-income populations and people of color. Structural and economic factors make high-quality diets out of reach for many. Specifically, the intersecting experience of food insecurity, poverty, structural racism, precarious employment, high cost, and difficult to access healthier foods creates a discriminatory and unjust context where accessing, purchasing, and eating a health-promoting diet, particularly one high in fruits and vegetables, is unattainable. As a result, interventions and policies that reduce these structural and economic barriers have high potential to improve food security, dietary quality, and ultimately improve health. To this end, the federal government, several states, and municipalities have introduced policy interventions that provide financial incentives to promote the purchase of fruits and vegetables by low-income populations. However, several prominent design features of these programs leave many of the structural causes of food insecurity and low fruit and vegetable consumption in place. In this study, we can improve what is known about the equity and impact of fruit and vegetable incentive programs through the study of Seattle's Fresh Bucks Program. This program has been designed with several features that have the potential to overcome the limitations of previous programs. Methodologically, we propose a mixed methods study that leverages randomized assignment for assessing causal impact, includes participatory approaches and a sequential explanatory mixed methods design to assess equity in implementation, and a quasi-experimental design to utilize electronic health records of program participants and a matched comparison population to estimate associations with long-term (2-4 years) program enrollment and health outcomes in the following Aims: 1) Determine the impact of Fresh Bucks on fruit and vegetable intake and food insecurity, leveraging randomized program assignment for causal impacts. 2) Assess Fresh Bucks implementation equity through redemption rates and experience. 3) Assess the impact of long-term access to Fresh Bucks on cardiometabolic health, including blood pressure and BMI, in a cohort of recipients and family members with matched electronic health records. Decreasing food insecurity and improving diet quality among low-income and minoritized populations is of primary importance for policymakers concerned about reducing systemic barriers to health. Upon completion of this work, we will have substantially advanced what is known about the dietary, health and implementation equity impacts of fruit and vegetable incentive programs and the potential for these policies to reduce systemic barriers to health.

抽象的。种族身份和收入水平导致心脏代谢健康结果存在明显差异。与高收入人群相比，低收入人群的心血管死亡风险高出 40-70% 人口。与黑人和拉丁裔人群相比，黑人和拉丁裔人群的心血管疾病风险率更高白人人口。据推测，饮食质量在这些差异中发挥着关键作用。但消费健康—— 对于许多美国人来说，提倡饮食是遥不可及的，对于低收入人群和有色人种。结构和经济因素使许多人无法获得高质量的饮食。具体来说，粮食不安全、贫困、结构性种族主义、就业不稳定、高成本和难以获得更健康的食品造成了歧视性和不公正的环境，在这种环境中，获取、购买和吃促进健康的饮食，特别是富含水果和蔬菜的饮食，是不可能实现的。因此，减少这些结构性和经济障碍的干预措施和政策对于改善粮食状况具有很大潜力安全、饮食质量，最终改善健康。为此，联邦政府、几个州和各城市出台了政策干预措施，提供财政激励措施以促进购买低收入人群的水果和蔬菜。然而，这些程序的几个突出的设计特点消除造成粮食不安全和水果和蔬菜消费量低的许多结构性原因。在这个研究表明，我们可以提高对水果和蔬菜激励计划的公平性和影响的了解通过对西雅图新鲜雄鹿计划的研究。该程序的设计具有以下几个特点：有潜力克服以前计划的局限性。在方法论上，我们提出了一种混合的利用随机分配来评估因果影响的方法研究，包括参与性方法和顺序解释性混合方法设计，以评估实施的公平性，以及利用项目参与者的电子健康记录和匹配比较的准实验设计人口来估计与长期（2-4年）计划入学率和健康结果的关联以下目标： 1) 确定 Fresh Bucks 对水果和蔬菜摄入量以及粮食不安全的影响，利用随机计划分配来确定因果影响。 2) 评估 Fresh Bucks 的实施公平性通过兑换率和经验。 3) 评估长期使用 Fresh Bucks 对用户的影响一组接受者及其家庭成员的心脏代谢健康状况，包括血压和体重指数匹配的电子健康记录。减少低收入和低收入人群的粮食不安全并提高饮食质量对于关心减少系统性障碍的政策制定者来说，少数民族人口至关重要为了健康。完成这项工作后，我们将大大推进对饮食的了解，水果和蔬菜奖励计划对健康和实施公平的影响及其潜力减少系统性健康障碍的政策。