Does the British Columbia Farmers' Market Nutrition Coupon Program Improve the Diet Quality and Food Security of Parents and Children With Lower Incomes? A Dose-response, Pragmatic Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 538
- 试验地点
- 1
- 主要终点
- Overall Diet Quality in Parents
研究概览
简要总结
The British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) provides lower-income households with coupons to purchase healthy foods at farmers' markets. This pragmatic randomized controlled trial (RCT) will examine the effectiveness and cost-effectiveness of two higher subsidies for healthy food ($54/weeek or $81/week), compared to the usual FMNCP healthy food subsidy ($27/week), on the diet quality (primary outcome), food insecurity, and other health-related outcomes of 276 parent-child dyads with lower incomes. 276 parent-child dyads who are enrolled in the FMNCP will be randomly assigned to one of the three subsidy arms. Participants will receive 16 weeks of coupons that can be redeemed for up to 20 weeks. Outcomes will be assessed in one parent (18-64 years) and child (6-17 years) from each household pre-, mid- and post-intervention.
详细描述
Background: The British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) is a healthy eating initiative designed to facilitate access to nutritious food for lower-income households. The program provides households with 16 weeks of coupons valued at $27/week to purchase healthy foods at BC farmers' markets, including fruits, vegetables, dairy, meat, poultry, fish, eggs, nuts, fruit and vegetable plants, honey and herbs. The expectation is that individuals will purchase and consume healthier foods when they are financially supported to do so, and that their overall well-being and health will improve as a result.
In a prior randomized controlled trial (RCT) in adults, the investigators found that the FMNCP did not improve adults' diet quality; however, it did reduce household food insecurity by 79%. It is hypothesized that parents in the prior RCT predominantly used their subsidies to feed their children and that higher subsidies are needed to ensure both parents and children benefit. A novel dose-response RCT among parent-child dyads is essential to examine how variations in subsidy amounts affect distinct outcomes among parents and children.
This pragmatic RCT will examine the effectiveness and cost-effectiveness of two higher subsidies for healthy food, compared to the usual FMNCP healthy food subsidy, on the diet quality (primary outcome), food insecurity, and other health-related outcomes of 276 parent-child dyads with lower incomes. The primary outcome is overall diet quality post-intervention. Secondary outcomes mid- and post-intervention include: 1) Other dietary outcomes: overall diet quality (mid-intervention only), diet quality components, food purchasing, intake of ultra-processed foods; 2) Food insecurity: food insecurity status and severity, nutrition security, parental shielding; and 3) Self-reported health-related outcomes: mental well-being, sense of community, perceived stress, perceived health, food literacy, BMI.
Methods: In this single-blind, three-arm, parallel-group pragmatic RCT, 276 parent-child dyads in lower-income households will be randomized to receive the usual FMNCP healthy food subsidy ($27/week) or a subsidy that is two ($54/week) or three times ($81/week) higher. Participants will receive 16 weeks of coupons that can be redeemed for up to 20 weeks. Outcomes will be assessed in one parent (18-64 years) and one child (6-17 years) from each household pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons). Dietary intake will be collected via two 24-hour dietary recalls using the Automated Self-Administered 24-hour Dietary Recall at each time point to assess diet quality. Foods purchased with coupons will be assessed by analyzing pictures taken by participants. Food insecurity and other health-related outcomes will be assessed using validated self-reported instruments. Mixed effects regression will assess the effects of the interventions, relative to the usual food subsidy, on outcomes in parents and children. A full incremental analysis will quantify the cost-effectiveness ratios of the three healthy food subsidies.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Triple (Care Provider, Investigator, Outcomes Assessor)
盲法说明
Participants cannot be blinded to group assignment but will be blinded to the study objectives. Community partners who distribute coupons and vendors who redeem coupons at farmers' markets will be blinded to group assignment. Researchers who collect and analyze the data will not be involved in delivering the intervention and thus will remain blinded
入排标准
- 年龄范围
- 6 Years 至 64 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Meet existing FMNCP-specific annual household income eligibility cut-offs that account for the local cost of living
- •Have 2-5 members in the household, specifically with a parent 18-64 years and a child 6-17 years. If there are multiple eligible individuals, the parent who is the primary food shopper and the youngest child will be enrolled.
- •Parent-child dyads must reside together ≥5 days/week
- •Are the only dyad in their household participating in the study
- •Have access to the internet and a camera
- •Able to communicate in English or have someone to translate
排除标准
- •Trying to conceive, pregnant or breastfeeding
- •Participating in other trials that might interfere with the intervention
- •Reside in a facility that provides meals (e.g., shelter, long-term care) or where they cannot prepare meals (e.g., hotel)
- •Anticipate being outside of their community for >2 consecutive weeks during the study
- •Expect to move to a non-FMNCP community during the study
- •Expect a significant change in their household income or composition during the study
结局指标
主要结局
Overall Diet Quality in Parents
时间窗: Assessed pre- and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons)
Difference between intervention groups and SUBSIDY-Usual in diet quality by Healthy Eating Food Index-2019 scores in parents. Dietary intake will be collected via two 24-hour dietary recalls at each time point to calculate diet quality. Scores can range from 0-80. A higher score indicates a higher diet quality.
Overall Diet Quality in Children
时间窗: Assessed pre- and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons)
Difference between intervention groups and SUBSIDY-Usual in diet quality by Healthy Eating Food Index-2019 scores in children. Dietary intake will be collected via two 24-hour dietary recalls at each time point to calculate diet quality. Scores can range from 0-80. A higher score indicates a higher diet quality.
次要结局
- Overall Diet Quality in Parents(Assessed pre- and mid-intervention (i.e., after 8 weeks of coupons have been distributed))
- Overall Diet Quality in Children(Assessed pre- and mid-intervention (i.e., after 8 weeks of coupons have been distributed))
- Proportion of Coupons Spent on Foods Classified as Minimally Processed, Culinary, Ingredients, Processed, and Ultra-processed(Assessed each time participants purchase food using FMNCP coupons from pre- to post-intervention (i.e., when the farmers' market a household shops at closes for the season))
- Proportion of Coupons Spent on Foods Classified as Very Poor, Poor, Fair, Good and Excellent Choice(Assessed each time participants purchase food using FMNCP coupons from pre- to post-intervention (i.e., when the farmers' market a household shops at closes for the season))
- Proportion of Coupons Spent on Foods Classified as Sell Most, Sell Sometimes and Do Not Sell(Assessed each time participants purchase food using FMNCP coupons from pre- to post-intervention (i.e., when the farmers' market a household shops at closes for the season))
- Overall Diet Quality in Parents(Assessed pre- and mid-intervention (i.e., after 8 weeks of coupons have been distributed))
- Overall Diet Quality in Children(Assessed pre- and mid-intervention (i.e., after 8 weeks of coupons have been distributed))
- Diet Quality Component Scores in Parents(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Diet Quality Component Scores in Children(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Percent Energy from Ultra-Processed Foods in Parents(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Self-Rated Health in Parents(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Self-Rated Health in Children(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Body Mass Index in Parents(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Body Mass Index Z-Scores in Children(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Percent Energy from Ultra-Processed Foods in Children(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Household Food Insecurity Status(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Parental Shielding(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Household Food Insecurity Severity(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Household Nutrition Security(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Proportion of Coupons Spent on Foods Classified as Minimally Processed, Culinary, Ingredients, Processed, and Ultra-processed(Assessed each time participants purchase food using FMNCP coupons from pre- to post-intervention (i.e., when the farmers' market a household shops at closes for the season))
- Proportion of Coupons Spent on Foods Classified as Very Poor, Poor, Fair, Good and Excellent Choice(Assessed each time participants purchase food using FMNCP coupons from pre- to post-intervention (i.e., when the farmers' market a household shops at closes for the season))
- Proportion of Coupons Spent on Foods Classified as Sell Most, Sell Sometimes and Do Not Sell(Assessed each time participants purchase food using FMNCP coupons from pre- to post-intervention (i.e., when the farmers' market a household shops at closes for the season))
- Mental Well-Being in Parents(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Mental Well-Being in Children(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Sense of Community in Parents(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Perceived Stress in Parents(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Perceived Stress in Children(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
- Food Literacy in Parents(Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 15 weeks of coupons))
研究者
Dana Lee Olstad
Associate Professor
University of Calgary