Diet Interventions, Food Security, Fruit and Vegetable Intake, Nutrition Security
Conditions
Keywords
Mobile market, Lower-income, Fruit and Vegetable Intake, Quasi-Experimental, Vouchers, Nutrition Incentives
Brief summary
Increasing access to healthy foods is crucial to combating chronic disease in rural communities. The Ripe for Revival mobile market, a non-profit eastern NC-based mobile market, seeks to improve healthy food access among those at greatest risk of food insecurity and poor health. By implementing vouchers at the mobile market, this study will help make healthy food affordable and accessible without stigma. This project is poised to improve diet and health among rural residents in eight counties and promote sustainable local food systems in North Carolina.
Detailed description
Increasing fruit and vegetable (FV) intake and reducing saturated fat, salt, and added sugar are central lifestyle recommendations in the Dietary Guidelines for Americans to prevent chronic disease. Yet, while diet is modifiable, rural families face structural and systemic inequities that make accessing affordable, healthy food more difficult. Recognizing these disparities and adverse impacts, there is a clear need to create opportunities for improved nutrition through comprehensive solutions that account for rurality, affordability, and accessibility. One potential strategy to improve rural food access is mobile markets. Ripe for Revival is a 501(c)3 based in Rocky Mount, North Carolina, with a mission to increase access to fresh foods in lower-resourced communities with a mobile market model. Ripe for Revival owns and operates a produce farm, purchases excess food from eastern NC farmers, and then sells fresh foods to patrons at roughly 20% discounted prices through its mobile market. The mobile market (a retrofitted school bus) offers fresh produce, eggs, meat, and milk weekly in eastern and central NC counties. This project continues NC State Extension's partnership with Ripe for Revival to implement vouchers to help increase mobile market affordability and assess program impacts among rural NC families. The specific aims of this proposed study include: Aim 1. Determine the nutrition-related impacts of mobile market vouchers among Ripe for Revival (RfR) shoppers in eight rural eastern NC counties (Bertie, Halifax, Hertford, Jones, Lenoir, Northampton, Warren, and Washington). Aim 2: Determine the health-related impacts of mobile market vouchers among RfR mobile market shoppers. Aim 3. Examine voucher redemption rates, volume, and dollars of local produce purchased, and suggestions for mobile market improvements among Ripe for Revival mobile market customers. This proposed project will promote health and advance equity among underserved rural families. The project addresses barriers to equitable food access, promotes a balanced diet to prevent chronic disease, and fosters sustainable local agriculture through a mobile market model.
Interventions
BEHAVIORALMobile Market Voucher Outcomes Study
Voucher participants will be referred by Extension professionals who serve lower-resourced individuals during routine programs (i.e., NC Extension programs such as Expanded Food and Nutrition Education Program (EFNEP). After receiving the referrals from Extension professionals, a member of the research team will contact the referred participant to provide a $20 monthly voucher each month for three months for use at the mobile market. Trained researchers will collect data at baseline (when a voucher is issued), at \~4 weeks (4-6 weeks, 2nd voucher), 8 weeks (8-10 weeks, 3rd voucher), and 12-16 weeks (post-program) at the NC Cooperative Extension office. FV intake will be measured by skin carotenoid scan. Researchers will obtain height (baseline), weight, and blood pressure at each data collection time point. Survey measures will include the secondary outcomes using adapted versions of validated instruments, with questions on demographics and food and nutrition security status.
Sponsors
North Carolina State University
East Carolina University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Quasi-experimental design
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 18 years of age or older * Communicates fluently in English or Spanish * An active participant in an NC Cooperative Extension program May 2026 - March 2028 * At risk of food insecurity * Willing to shop at or visit a Ripe for Revival mobile produce market * Willing to use the provided $20 monthly voucher to shop at the Ripe for Revival mobile produce market * Works or lives in a North Carolina county where this study is being conducted, including Bertie, Halifax, Hertford, Jones, Lenoir, Northampton, Warren, or Washington
Exclusion criteria
* Individuals who do not meet the inclusion criteria above cannot participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Skin Carotenoids | Enrollment/baseline (week 0), 4-6 weeks, 8-10 weeks, and at 12-16 weeks | Fruit and vegetable intake measured by skin carotenoids (derived from a validated reflection spectroscopy device, Veggie Meter® |
| Fruit and vegetable intake | Enrollment/baseline (week 0), 4-6 weeks, 8-10 weeks, and at 12-16 weeks | Measured by the National Cancer Institute (NCI) Dietary Screener Questionnaire (DSQ) FV screener. The 10-item NCI DSQ FV screener data are collected through participant survey responses. Responses will be converted to daily cup-equivalent estimates using the NCI research team-developed DSQ scoring algorithms, based on age, sex, portion-size estimates, and regression coefficient data. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Weight/Body Mass Index | Enrollment/baseline (week 0), 4-6 weeks, 8-10 weeks, and at 12-16 weeks | Weight/Body Mass Index. Weight measured by an electronic scale SECA 876 as the average of two measures. Height (baseline only) will be measured by a SECA 217 stadiometer. |
| Blood Pressure | Enrollment/baseline (week 0), 4-6 weeks, 8-10 weeks, and at 12-16 weeks | Blood pressure measured by noninvasive automated monitor (Omron HEM-907XL, Vernon Hills, IL) with a first measure after seated for 5 minutes and 2 repeat measures at 1-minute intervals. |
| Food Security Status | Enrollment/baseline (week 0), 4-6 weeks, 8-10 weeks, and at 12-16 weeks | Food security status, measured by the USDA household 6-item screener. Scores range from 0 to 6, with a lower score (0 to 2) representing food security and a higher score (3 or higher) representing food insecurity |
| Nutrition Security Status | Enrollment/baseline (week 0), 4-6 weeks, 8-10 weeks, and at 12-16 weeks | Measured by the Center for Nutrition \& Health Impact 4-item Nutrition Security Screener. The four items within the measure are scored from 0 (participant selects "Always") to 4 (participant selects "Never"). The measure's score is the mean of the responses, with higher scores indicating a greater degree of household nutrition security, or a household that is able to acquire healthful foods without resource limitations or worry. "Low" scores are 2.00 or below |
| Food Utilization | Enrollment/baseline (week 0), 4-6 weeks, 8-10 weeks, and at 12-16 weeks | Measured by the Center for Nutrition \& Health Policy Impact 4-item screener. The 4 items within the measure are scored from 0 (participant selects "Always") to 4 (participant selects "Never"). The measure's score is the mean of the responses, with higher scores indicating a greater degree of household food utilization, or the ability to use the food that a household has access to in a safe manner, with the resources to store healthful meals. "Low" scores are 2.00 or below. |
| Voucher Redemption Rate | Monthly through study completion for up to 2 years | Tracked in Excel in dollars redeemed per voucher and the number of vouchers redeemed |
| Local produce distributed | Monthly through study completion for up to 2 years | Measured by mobile market POS system in pounds and dollars of produce distributed at each market |
| Mobile Produce Market Satisfaction | Enrollment/baseline (week 0), 4-6 weeks, 8-10 weeks, and at 12-16 weeks | Measured by self-reported survey using a 5-point Likert scale from 1 (Strongly dissatisfied) to 5 (Strongly satisfied). Additional multiple-choice and open-ended questions ask about mobile market improvements. |
Countries
United States
Contacts
CONTACTBasheerah Enahora, PhD, RDN, LDN
PRINCIPAL_INVESTIGATORBasheerah Enahora, PhD, RDN, LDN
NC State University
Outcome results
None listed