Dietary Habits
Conditions
Keywords
farmers market, Appalachia, physical activity, fruit and vegetable voucher program
Brief summary
The Tanglewood Trail Walking Program is a well-established community health initiative that encourages community members to walk approximately 1 mile to the Whitesburg Farmers Market each Saturday. The study aims to determine if walking to the market with a community health coach results in healthier options being selected at the market.
Detailed description
In the summer of 2017, community members of Whitesburg, KY were recruited to join the Tanglewood Trail Walking Program to the Whitesburg farmers market. Each Saturday, participants reported whether or not they walked the 1-mile trail to the farmers market and they reported which fruits and vegetables they purchased. The Walking Program was held June - Sept 2017. Participants completed questionnaires about fruit and vegetable consumption and physical activity. Participants also provided physical and biological measurements. Although originally designed to compare data among walkers and non-walkers, the protocol was changed due to participant feasibility. Data were analyzed by comparing low engagers - those who walked to the market fewer than three times during the program - or high engagers - those who walked three or more times during the program. Data were collected at baseline and 3 months. The data for years 2019 and 2020 of the Tanglewood to Trail walking program are registered separately in ClinicalTrials.gov.
Interventions
Subjects will walk 1 kilometer from a pre-determined point to a local farmer's market.
Sponsors
National Institute of Environmental Health Sciences (NIEHS)
Dawn Brewer
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* ability to walk 1 kilometer
Exclusion criteria
* pregnant * institutionalized adults * impaired consent ability * prisoners
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Carotenoid Levels Over Time | Baseline and 3 months | Subjects' carotenoid status will be measured using a carotenoid Raman Spectroscopy to determine if walking combined with a voucher for fruits and vegetables increases intake in fruits and vegetables as measured by carotenoid status. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in LDL Cholesterol | Baseline and 3 months | Subjects' LDL will be measured to determine if walking combined with a voucher for fruits and vegetables changes participant LDL. |
| Change in HDL Cholesterol | Baseline and 3 months | Subjects' HDL will be measured to determine if walking combined with a voucher for fruits and vegetables changes participant HDL. |
| Change in Total Cholesterol | Baseline and 3 months | Subjects' total cholesterol will be measured to determine if walking combined with a voucher for fruits and vegetables changes participant total cholesterol. |
| Change in Weight | Baseline and 3 months | Subjects' weight will be measured to determine if walking combined with a voucher for fruits and vegetables changes participant weight. |
| Change in Waist Circumference | Baseline and 3 months | Subjects' waist circumference will be measured to determine if walking combined with a voucher for fruits and vegetables changes participant waist circumference. |
| Change in Self-reported Activity Level | Baseline and 3 months | Subjects' self-reported activity level will be measured as self-reported days of leisure physical activity per week. |
| Change in Self-reported Fruit and Vegetable Intake | Baseline and 3 months | Subjects' self-reported total servings of fruit and vegetable intake per day. |
| Change in A1c | Baseline and 3 months | Subjects' A1c will be measured to determine if walking combined with a voucher for fruits and vegetables changes participant A1c. Data were collected at baseline and 3 months and the difference will be calculated. |
| Understanding of Plant-based Phytonutrients | 3 months | Participants will be asked a question demonstrating their understanding of the importance of ingesting plant-based nutrients. Possible answers are yes, no, or not sure. Data will be presented as the number of participants in each group that understood the importance of plant-based nutrients. |
| Belief in the Benefit of Plant-based Nutrients | 3 months | Participants will be asked a question demonstrating their appreciation of plant-based nutrients. Possible answers are yes, no, or not sure. Data will be presented as the number of participants in each group that understood the importance of plant-based nutrients. |
| Belief in the Preventative Effects of Plant-Based Nutrients | 3 months | Participants will be asked a question demonstrating their beliefs of plant-based nutrients. Possible answers are yes, no, or not sure. Data will be presented as the number of participants in each group that understood the importance of plant-based nutrients. |
| Belief in the Role of Healthy Diet in Protecting Health From Pollutants | 3 months | Participants will be asked a question demonstrating their beliefs that a healthy diet might protect health from environmental pollutants. Possible answers are yes, no, or not sure. Data will be presented as the number of participants in each group that understood the importance of a healthy diet. |
| Knowledge of Which Foods Contain Phytonutrients | 3 months | Participants will be asked a question about which foods contain phytonutrients. Possible answers are meat, dairy, plant foods, all foods, or don't know. Data will be presented as the number of participants in each group that correctly identified plant foods. |
| Knowledge of Environmental Pollutants | 3 months | Participants will be asked to identify environmental pollutants from a list. Possible answers are polychlorinated biphenyls (PCBs), mercury, nitrites, all of those, none of those, or don't know. Data will be presented as the number of participants in each group that correctly identified all of those. |
| Group Cohesion | 3 months | Subjects' group cohesion was measured post-intervention using the Physical Activity Group Environment Questionnaire (also known as PAGE-Q). There are 20 questions, ranked using a Likert Scale with 1 being strongly disagree and 9 strongly agree. Scores range from 20-180; higher scores indicate more social cohesion. |
Countries
United States
Participant flow
Recruitment details
123 participants were enrolled, but two participants dropped out of the study within the first month due to lack of interest.
Participants by arm
| Arm | Count |
|---|---|
| Walking Group (Low Engagers) Subjects will participate in a walking group led by a community organizer as a means to get to a local farmer's market. Low engagers are defined as those participants who walked to the market two or fewer times during the program.
walking group led by a community organizer: Subjects will walk 1 kilometer from a pre-determined point to a local farmer's market. | 60 |
| Walking Group (High Engagers) Subjects will participate in a walking group led by a community organizer as a means to get to a local farmer's market. High engagers are defined as those participants who walked to the market three or more times during the program.
walking group led by a community organizer: Subjects will walk 1 kilometer from a pre-determined point to a local farmer's market. | 61 |
| Total | 121 |
Baseline characteristics
| Characteristic | Walking Group (High Engagers) | Total | Walking Group (Low Engagers) |
|---|---|---|---|
| Age, Continuous | 46.7 years STANDARD_DEVIATION 14.7 | 50.2 years STANDARD_DEVIATION 15 | 53.9 years STANDARD_DEVIATION 14.7 |
| ASCVD (Atherosclerotic Cardiovascular Disease) Risk | 9.1 risk STANDARD_DEVIATION 10 | 10.2 risk STANDARD_DEVIATION 12.4 | 11.2 risk STANDARD_DEVIATION 14.2 |
| Body Mass Index (BMI) | 33.4 kg/m^2 STANDARD_DEVIATION 7 | 33.4 kg/m^2 STANDARD_DEVIATION 7.1 | 33.4 kg/m^2 STANDARD_DEVIATION 7.3 |
| Diastolic Blood Pressure | 84.3 mmHg STANDARD_DEVIATION 10.8 | 82.5 mmHg STANDARD_DEVIATION 10.2 | 80.6 mmHg STANDARD_DEVIATION 9.3 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 58 Participants | 116 Participants | 58 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 3 Participants | 5 Participants | 2 Participants |
| Hemoglobin A1c | 6.2 percentage of glycosylated hemoglobin STANDARD_DEVIATION 1.4 | 6.2 percentage of glycosylated hemoglobin STANDARD_DEVIATION 1.4 | 6.2 percentage of glycosylated hemoglobin STANDARD_DEVIATION 1.3 |
| LDL Cholesterol | 92.4 mg/dL STANDARD_DEVIATION 27.3 | 92.7 mg/dL STANDARD_DEVIATION 26.5 | 93.0 mg/dL STANDARD_DEVIATION 25.9 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 1 Participants | 3 Participants | 2 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) White | 59 Participants | 116 Participants | 57 Participants |
| Region of Enrollment United States | 61 participants | 121 participants | 60 participants |
| Sex: Female, Male Female | 37 Participants | 72 Participants | 35 Participants |
| Sex: Female, Male Male | 24 Participants | 49 Participants | 25 Participants |
| Systolic Blood Pressure | 129.1 mmHg STANDARD_DEVIATION 18 | 128.8 mmHg STANDARD_DEVIATION 16.9 | 128.4 mmHg STANDARD_DEVIATION 15.7 |
| Total Cholesterol | 169.1 mg/dL STANDARD_DEVIATION 37.4 | 168.8 mg/dL STANDARD_DEVIATION 36 | 168.6 mg/dL STANDARD_DEVIATION 34.8 |
| Total Cholesterol/HDL Ratio | 4.1 ratio STANDARD_DEVIATION 1.5 | 4.1 ratio STANDARD_DEVIATION 1.6 | 4.2 ratio STANDARD_DEVIATION 1.7 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Change in Carotenoid Levels Over Time
Subjects' carotenoid status will be measured using a carotenoid Raman Spectroscopy to determine if walking combined with a voucher for fruits and vegetables increases intake in fruits and vegetables as measured by carotenoid status.
Time frame: Baseline and 3 months
Population: No data were collected for this outcome measure.
Secondary
Belief in the Benefit of Plant-based Nutrients
Participants will be asked a question demonstrating their appreciation of plant-based nutrients. Possible answers are yes, no, or not sure. Data will be presented as the number of participants in each group that understood the importance of plant-based nutrients.
Time frame: 3 months
Population: Not all participants completed the questionnaire.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Walking Group (Low Engagers) | Belief in the Benefit of Plant-based Nutrients | baseline | 7 Participants |
| Walking Group (Low Engagers) | Belief in the Benefit of Plant-based Nutrients | 3 months | 5 Participants |
| Walking Group (High Engagers) | Belief in the Benefit of Plant-based Nutrients | baseline | 12 Participants |
| Walking Group (High Engagers) | Belief in the Benefit of Plant-based Nutrients | 3 months | 19 Participants |
Secondary
Belief in the Preventative Effects of Plant-Based Nutrients
Participants will be asked a question demonstrating their beliefs of plant-based nutrients. Possible answers are yes, no, or not sure. Data will be presented as the number of participants in each group that understood the importance of plant-based nutrients.
Time frame: 3 months
Population: Not all participants completed the questionnaire.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Walking Group (Low Engagers) | Belief in the Preventative Effects of Plant-Based Nutrients | baseline | 8 Participants |
| Walking Group (Low Engagers) | Belief in the Preventative Effects of Plant-Based Nutrients | 3 months | 11 Participants |
| Walking Group (High Engagers) | Belief in the Preventative Effects of Plant-Based Nutrients | baseline | 11 Participants |
| Walking Group (High Engagers) | Belief in the Preventative Effects of Plant-Based Nutrients | 3 months | 18 Participants |
Secondary
Belief in the Role of Healthy Diet in Protecting Health From Pollutants
Participants will be asked a question demonstrating their beliefs that a healthy diet might protect health from environmental pollutants. Possible answers are yes, no, or not sure. Data will be presented as the number of participants in each group that understood the importance of a healthy diet.
Time frame: 3 months
Population: Not all participants completed the questionnaire.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Walking Group (Low Engagers) | Belief in the Role of Healthy Diet in Protecting Health From Pollutants | baseline | 6 Participants |
| Walking Group (Low Engagers) | Belief in the Role of Healthy Diet in Protecting Health From Pollutants | 3 months | 9 Participants |
| Walking Group (High Engagers) | Belief in the Role of Healthy Diet in Protecting Health From Pollutants | baseline | 9 Participants |
| Walking Group (High Engagers) | Belief in the Role of Healthy Diet in Protecting Health From Pollutants | 3 months | 15 Participants |
Secondary
Change in A1c
Subjects' A1c will be measured to determine if walking combined with a voucher for fruits and vegetables changes participant A1c. Data were collected at baseline and 3 months and the difference will be calculated.
Time frame: Baseline and 3 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Walking Group (Low Engagers) | Change in A1c | -0.31 percent change | Standard Deviation 0.53 |
| Walking Group (High Engagers) | Change in A1c | -0.20 percent change | Standard Deviation 0.52 |
Secondary
Change in HDL Cholesterol
Subjects' HDL will be measured to determine if walking combined with a voucher for fruits and vegetables changes participant HDL.
Time frame: Baseline and 3 months
Population: Data are shown by sex: low engagers (10 males and 24 females) and high engagers (11 male and 37 female). Not all participants completed this outcome measure.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Walking Group (Low Engagers) | Change in HDL Cholesterol | Males | 1.6 mg/dL | Standard Deviation 4.3 |
| Walking Group (Low Engagers) | Change in HDL Cholesterol | Females | 0.04 mg/dL | Standard Deviation 8.5 |
| Walking Group (High Engagers) | Change in HDL Cholesterol | Males | 8.8 mg/dL | Standard Deviation 7.2 |
| Walking Group (High Engagers) | Change in HDL Cholesterol | Females | 5.3 mg/dL | Standard Deviation 10 |
Secondary
Change in LDL Cholesterol
Subjects' LDL will be measured to determine if walking combined with a voucher for fruits and vegetables changes participant LDL.
Time frame: Baseline and 3 months
Population: Not all participants completed this outcome measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Walking Group (Low Engagers) | Change in LDL Cholesterol | -11.9 mg/dL | Standard Deviation 23.8 |
| Walking Group (High Engagers) | Change in LDL Cholesterol | -12.7 mg/dL | Standard Deviation 17.5 |
Secondary
Change in Self-reported Activity Level
Subjects' self-reported activity level will be measured as self-reported days of leisure physical activity per week.
Time frame: Baseline and 3 months
Population: Not all participants completed this outcome measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Walking Group (Low Engagers) | Change in Self-reported Activity Level | 1.7 days of physical activity per week | Standard Deviation 2.6 |
| Walking Group (High Engagers) | Change in Self-reported Activity Level | 1.4 days of physical activity per week | Standard Deviation 2.1 |
Secondary
Change in Self-reported Fruit and Vegetable Intake
Subjects' self-reported total servings of fruit and vegetable intake per day.
Time frame: Baseline and 3 months
Population: Not all participants completed this outcome measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Walking Group (Low Engagers) | Change in Self-reported Fruit and Vegetable Intake | 1.0 servings of fruit and vegetables per day | Standard Deviation 4.2 |
| Walking Group (High Engagers) | Change in Self-reported Fruit and Vegetable Intake | 2.4 servings of fruit and vegetables per day | Standard Deviation 2.7 |
Secondary
Change in Total Cholesterol
Subjects' total cholesterol will be measured to determine if walking combined with a voucher for fruits and vegetables changes participant total cholesterol.
Time frame: Baseline and 3 months
Population: Not all participants completed this outcome measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Walking Group (Low Engagers) | Change in Total Cholesterol | -14.8 mg/dL | Standard Deviation 32.5 |
| Walking Group (High Engagers) | Change in Total Cholesterol | -11.0 mg/dL | Standard Deviation 24.2 |
Secondary
Change in Waist Circumference
Subjects' waist circumference will be measured to determine if walking combined with a voucher for fruits and vegetables changes participant waist circumference.
Time frame: Baseline and 3 months
Population: Data are shown by sex: low engagers (10 male and 25 female) and high engagers (11 male and 39 female). Not all participants completed this outcome measure.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Walking Group (Low Engagers) | Change in Waist Circumference | Male | -0.30 inches | Standard Deviation 1.3 |
| Walking Group (Low Engagers) | Change in Waist Circumference | Female | -0.33 inches | Standard Deviation 2.3 |
| Walking Group (High Engagers) | Change in Waist Circumference | Male | -0.34 inches | Standard Deviation 2.1 |
| Walking Group (High Engagers) | Change in Waist Circumference | Female | -0.88 inches | Standard Deviation 3.8 |
Secondary
Change in Weight
Subjects' weight will be measured to determine if walking combined with a voucher for fruits and vegetables changes participant weight.
Time frame: Baseline and 3 months
Population: Not all participants completed this outcome measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Walking Group (Low Engagers) | Change in Weight | 0.23 lb | Standard Deviation 5.4 |
| Walking Group (High Engagers) | Change in Weight | -1.4 lb | Standard Deviation 11.8 |
Secondary
Group Cohesion
Subjects' group cohesion was measured post-intervention using the Physical Activity Group Environment Questionnaire (also known as PAGE-Q). There are 20 questions, ranked using a Likert Scale with 1 being strongly disagree and 9 strongly agree. Scores range from 20-180; higher scores indicate more social cohesion.
Time frame: 3 months
Population: Not all participants completed this outcome measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Walking Group (Low Engagers) | Group Cohesion | 130.2 score on a scale | Standard Deviation 53.1 |
| Walking Group (High Engagers) | Group Cohesion | 155.3 score on a scale | Standard Deviation 40.7 |
Secondary
Knowledge of Environmental Pollutants
Participants will be asked to identify environmental pollutants from a list. Possible answers are polychlorinated biphenyls (PCBs), mercury, nitrites, all of those, none of those, or don't know. Data will be presented as the number of participants in each group that correctly identified all of those.
Time frame: 3 months
Population: Not all participants completed the questionnaire.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Walking Group (Low Engagers) | Knowledge of Environmental Pollutants | baseline | 13 Participants |
| Walking Group (Low Engagers) | Knowledge of Environmental Pollutants | 3 months | 8 Participants |
| Walking Group (High Engagers) | Knowledge of Environmental Pollutants | 3 months | 15 Participants |
| Walking Group (High Engagers) | Knowledge of Environmental Pollutants | baseline | 22 Participants |
Secondary
Knowledge of Which Foods Contain Phytonutrients
Participants will be asked a question about which foods contain phytonutrients. Possible answers are meat, dairy, plant foods, all foods, or don't know. Data will be presented as the number of participants in each group that correctly identified plant foods.
Time frame: 3 months
Population: Not all participants completed the questionnaire.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Walking Group (Low Engagers) | Knowledge of Which Foods Contain Phytonutrients | baseline | 17 Participants |
| Walking Group (Low Engagers) | Knowledge of Which Foods Contain Phytonutrients | 3 months | 13 Participants |
| Walking Group (High Engagers) | Knowledge of Which Foods Contain Phytonutrients | baseline | 17 Participants |
| Walking Group (High Engagers) | Knowledge of Which Foods Contain Phytonutrients | 3 months | 27 Participants |
Secondary
Understanding of Plant-based Phytonutrients
Participants will be asked a question demonstrating their understanding of the importance of ingesting plant-based nutrients. Possible answers are yes, no, or not sure. Data will be presented as the number of participants in each group that understood the importance of plant-based nutrients.
Time frame: 3 months
Population: Not all participants completed the questionnaire.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Walking Group (Low Engagers) | Understanding of Plant-based Phytonutrients | baseline | 11 Participants |
| Walking Group (Low Engagers) | Understanding of Plant-based Phytonutrients | 3 months | 12 Participants |
| Walking Group (High Engagers) | Understanding of Plant-based Phytonutrients | baseline | 17 Participants |
| Walking Group (High Engagers) | Understanding of Plant-based Phytonutrients | 3 months | 20 Participants |