Lucia A. Leone

Objective: Food prescriptions can help address food insecurity, however older adults have unique barriers to food prescription utilization, including transportation, that threaten program effectiveness. This research compares utilization of two delivered food prescription programs with a standard of care control. Design: Participants were randomized to be offered one of three 12-week free food prescriptions: (1) Home-Delivered Produce Prescription: a customizable fresh produce box, (2) Home-Delivered Meal Kits: an equivalent amount of produce plus complementary food items to make three recipes, or (3) Mobile Market Produce Prescription (control): a voucher to use at local mobile market. Prescription redemption and produce usage were reported on weekly phone or text surveys. Setting: Mobile market or home delivery. Participants: Patients aged 65 and older from hospital-based primary care clinics with difficulty accessing fresh fruits and vegetables ( N = 67). Results: There were no statistically significant differences in enrollment rates across arms: 84.6% in produce prescription ( n = 22), 88.5% in meal kit ( n = 23), and 73.3% in mobile market ( n = 22). Self-reported redemption across 12 weeks was higher ( p < 0.001) in the produce prescription (89.2%) and meal kit (89.2%) arms compared to control (28.3%). Among those who redeemed their prescription, produce usage did not differ, but total possible dosage received was significantly higher ( p < 0.001) in the produce prescription (75.7%) and meal kit (77.7%) compared to the control (24.9%). Conclusion: While redemption rates were higher in both delivery arms, the meal kit did not improve produce usage above control, suggesting that delivery had the most impact on food prescription utilization among older adults.

Background: Veggie Van (VV) is a multi-level mobile produce market intervention that increased fruit and vegetable (F&V) consumption in lower-income communities in an efficacy study. The aim of this study was to understand the impact of the VV intervention delivered by multiple community partners on food security and diet-related behaviors. Methods: This cluster-randomized trial was conducted in partnership with nine organizations (e.g., food focused non-profits) across four states in the United States. Partner organizations selected 33 community sites that reached individuals with lower-income and limited access to healthy food. Eligible study participants were age 18+, the primary household shopper, and lived near/frequented the community site; 699 participants were enrolled across all communities. Sites were randomized in pairs to receive the VV intervention ( n = 17 sites) or a planning condition ( n = 16 sites) for one year. Outcomes were change in food security, F&V consumption measured by food frequency and 24-hour recalls, dermal carotenoid levels and nutrition-related psychosocial measures. Generalized linear mixed models were used to examine the effect of the intervention while adjusting for clustering within sites and baseline values. Additional analyses compared individuals based on their utilization of the VV (users/non-users) and communities that entered the study after peak COVID-19 shutdowns (Post-COVID sites). Results: In the intent-to-treat analyses, there were no statistically significant differences in food security or F&V consumption between intervention and control sites. VV users at post-COVID sites had significantly better (p=0.01) average food security scores (n=102, adj. mean=1.4, SE=0.18) after 1 year than non-users (n=201, adj. mean=2.0, SE 0.15). Conclusions: This research was the first study to evaluate the effectiveness of mobile markets across states, when implemented by different community organizations. Study implementation, recruitment, and data collection were significantly altered by the COVID-19 pandemic. While the magnitude of changes in F&V intake at post-COVID sites was similar to previous research, we did not find statistically significant differences between groups for F&V intake. Analyses also indicated that VV users improved their food security. Future research will examine how fidelity to the VV model by partners affected participant outcomes. Trial registration: This trial was registered at https://www.clinicaltrials.gov on January 29, 2020 (NCT04246593).

Background Veggie Van (VV) is a multi-level mobile produce market intervention that increased fruit and vegetable (F&V) consumption in lower-income communities in an efficacy study. The aim of this study was to understand the impact of the VV intervention delivered by multiple community partners on food security and diet-related behaviors. Methods This cluster-randomized trial was conducted in partnership with nine organizations across four states in the United States. Partner organizations selected 33 community sites that reached lower-income individuals with limited access to healthy food. Eligible study participants were age 18+, the primary household shopper, and lived near/frequented the community site; 699 participants were enrolled across all communities. Sites were randomized in pairs to receive the VV intervention (n = 17 sites) or a planning condition (n = 16 sites) for one year. Trial registration This trial was registered at www.clinicaltrials.gov on January 29, 2020 (NCT04246593).

Background: US children’s diets are high in calories and are of poor nutritional quality, and a likely contributing factor is the consumption of food from restaurants. While children readily accept the sweet and salty foods that characterize restaurant children’s menus, research shows that their taste preferences are malleable, and regular exposure to healthier foods can promote their acceptance. Objective: We describe a cluster-randomized controlled trial testing the effects of behavioral intervention strategies (choice architecture and repeated exposure) on ordering and dietary intake among children in restaurants and present baseline demographic data for the study cohort. Methods: Six locations of a regional quick-service restaurant chain were randomized to the intervention or control group in pairs based on income in surrounding census tracts. Families with children aged 4 to 8 years were recruited and asked to complete 8 visits to the study restaurant, including a baseline assessment completed at the time of enrollment, followed by 6 visits during a designated 2-month exposure period and a final posttest assessment. Intervention content provided to intervention group families after baseline assessments includes placemats promoting 2 healthier kids’ meals and the opportunity to redeem their kids’ meal “cone token” for a toy instead of a dessert (choice architecture strategies). In addition, participating families receive frequent diner cards, which can be used to earn a free kids’ meal after purchasing a promoted kids’ meal 6 times (repeated exposure strategy). Families in control restaurants receive generic versions of these materials (eg, frequent diner cards that can be redeemed for a free kids’ meal after purchasing any 6 kids’ meals). The primary outcome is the meal ordered for the child at a posttest restaurant visit following the exposure period (ie, whether or not a promoted meal was ordered). Additional order data will include calories, saturated fat, sodium, and sugar content of children’s orders at posttest. Other outcomes include children’s in-restaurant and daily consumption of calories, saturated fat, sodium, and sugar. Results: This study was funded in 2019, with preregistration completed in 2020, data collection occurring from June 2021 to November 2024, and data processing, analysis, and primary outcome manuscript preparation in 2025-2026. A total of 236 families provided baseline data on children’s orders and comprise the study cohort; 234 of these families provided demographic data (n=184, 78.3% female parents; n=133, 56.8% female children; child mean age 6.5, SD 1.3 years). Conclusions: Given that restaurants are normative eating contexts for many children, this intervention has the potential to impact children’s dietary intake and health. If found to be successful, future directions could include scaling the current intervention approach and conducting further effectiveness, implementation, and dissemination research to understand its applicability and impact across different types of restaurants and sociodemographic contexts. Trial Registration: ClinicalTrials.gov NCT04334525; https://clinicaltrials.gov/study/NCT04334525 International Registered Report Identifier (IRRID): DERR1-10.2196/73618

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: US children’s diets are high in calories and are of poor nutritional quality, and a likely contributing factor is the consumption of food from restaurants. While children readily accept the sweet and salty foods that characterize restaurant children’s menus, research shows that their taste preferences are malleable, and regular exposure to healthier foods can promote their acceptance. Objective: We describe a cluster-randomized controlled trial testing the effects of behavioral intervention strategies (choice architecture and repeated exposure) on ordering and dietary intake among children in restaurants and present baseline demographic data for the study cohort. Methods: Six locations of a regional quick-service restaurant chain were randomized to the intervention or control group in pairs based on income in surrounding census tracts. Families with children aged 4 to 8 years were recruited and asked to complete 8 visits to the study restaurant, including a baseline assessment completed at the time of enrollment, followed by 6 visits during a designated 2-month exposure period and a final posttest assessment. Intervention content provided to intervention group families after baseline assessments includes placemats promoting 2 healthier kids’ meals and the opportunity to redeem their kids’ meal “cone token” for a toy instead of a dessert (choice architecture strategies). In addition, participating families receive frequent diner cards, which can be used to earn a free kids’ meal after purchasing a promoted kids’ meal 6 times (repeated exposure strategy). Families in control restaurants receive generic versions of these materials (eg, frequent diner cards that can be redeemed for a free kids’ meal after purchasing any 6 kids’ meals). The primary outcome is the meal ordered for the child at a posttest restaurant visit following the exposure period (ie, whether or not a promoted meal was ordered). Additional order data will include calories, saturated fat, sodium, and sugar content of children’s orders at posttest. Other outcomes include children’s in-restaurant and daily consumption of calories, saturated fat, sodium, and sugar. Results: This study was funded in 2019, with preregistration completed in 2020, data collection occurring from June 2021 to November 2024, and data processing, analysis, and primary outcome manuscript preparation in 2025-2026. A total of 236 families provided baseline data on children’s orders and comprise the study cohort; 234 of these families provided demographic data (n=184, 78.3% female parents; n=133, 56.8% female children; child mean age 6.5, SD 1.3 years). Conclusions: Given that restaurants are normative eating contexts for many children, this intervention has the potential to impact children’s dietary intake and health. If found to be successful, future directions could include scaling the current intervention approach and conducting further effectiveness, implementation, and dissemination research to understand its applicability and impact across different types of restaurants and sociodemographic contexts. Trial Registration: ClinicalTrials.gov NCT04334525; https://clinicaltrials.gov/study/NCT04334525

Objective: Veggie Van (VV) is an evidenced-based intervention for improving diet through a mobile market (MM) and is disseminated through an online toolkit. Understanding the user experience of the VV toolkit is crucial to inform its refinement and ensure future implementation success and positive public health impact. Design: We conducted semi-structured interviews to understand the VV toolkit user experience including their familiarity and utilization of the toolkit, experience navigating, feedback on specific content, comprehension of the evidence base, and feedback on training and technical assistance options. Interviews were deductively analyzed using Atlas.ti 22.0 qualitative software. Setting: Interviews were conducted via web conference over the spring and summer of 2022. Participants: Interviews were conducted with 16 key informants (KIs) from established MM organizations and frequent toolkit users. Results: The majority of KIs were previously familiar with the VV toolkit and had used it in their work or referred others to the toolkit. The toolkit was perceived to be thorough and well-done, but more appropriate for an organization earlier in the process of starting an MM, despite the toolkit being intended for organizations of all experience levels. KIs cited that the toolkit facilitated planning for markets and bolstered their legitimacy in conversations with stakeholders. Most could not accurately define the core components of the VV model and how it differed from other models; it was also unclear to what degree practitioners are implementing its practices. Conclusions: This evaluation provided valuable feedback on the perceptions and utility of our online toolkit as well as comprehension of the evidence base. Clarifying the VV model components and enhancing the appeal of the toolkit to more established practitioners will ensure proper knowledge translation and increase the reach of the intervention.

Background: Women with higher body mass index report low rates of and face unique barriers to exercise. Increasing exercise participation can improve mental and physical health independent of weight loss; however, most exercise programs targeting this population focus predominately on losing weight. This paper aims to describe the development of Fit&Fab, a community-based exercise intervention focused on increasing exercise participation and enjoyment for women with obesity. Methods: In partnership with the YMCA, we recruited women ages 35–64 years (body mass index ≥ 30) to participate in 4 focus groups to understand exercise preferences. Formative work was used to identify theory constructs and associated intervention components. Women from the focus groups were recruited for a community advisory board that finalized the intervention design, recruitment, and evaluation plan. Results: Focus groups participants (N = 29) preferred to exercise without men and wanted a cohort-style class that included women of similar exercise levels and body types, incorporated social support, fun activities, and broke exercise into smaller bouts. They wanted a supportive instructor who was fit but understood weight-related challenges. The community advisory board and research team used focus group findings to inform design of the final intervention including group exercise classes, psychosocial support sessions, personalized training, exercise tracking, outcome monitoring, and rewards. Conclusions: Our findings emphasize the need to focus on exercise enjoyment and benefits other than losing weight to improve exercise participation among women with higher body mass index. In addition to having outcomes other than weight loss, exercise interventions with this population should also consider group composition, instructor, and class format.