A store-based intervention to increase fruit and vegetable consumption: The El Valor de Nuestra Salud cluster randomized controlled trial.
BACKGROUND
Most evidence-based interventions to improve fruit and vegetable (FV) consumption target individual behaviors and family systems; however, these changes are difficult to sustain without environmental support. This paper describes an innovative social and structural food store-based intervention to increase availability and accessibility of FVs in tiendas (small- to medium-sized Latino food stores) and purchasing and consumption of FVs among tienda customers.


METHODS
Using a cluster randomized controlled trial with 16 tiendas pair-matched and randomized to an intervention or wait-list control condition, this study will evaluate a 2-month intervention directed at tiendas, managers, and employees followed by a 4-month customer-directed food marketing campaign. The intervention involves social (e.g., employee trainings) and structural (e.g., infrastructure) environmental changes. Three hundred sixty-nine customers (approximately 23 per tienda) serve on an evaluation cohort and complete assessments (interviews and measurements of weight) at 3 time points: baseline, 6-months post-baseline, and 12-months post-baseline. The primary study outcome is customer-reported daily consumption of FVs. Manager interviews and monthly tienda audits and collection of sales data will provide evidence of tienda-level intervention effects, our secondary outcomes. Process evaluation methods assess dose delivered, dose received, and fidelity.


RESULTS
Recruitment of tiendas, managers, employees, and customers is complete. Demographic data shows that 30% of the customers are males, thus providing a unique opportunity to examine the effects of a tienda-based intervention on Latino men.


CONCLUSIONS
Determining whether a tienda-based intervention can improve customers' FV purchasing and consumption will provide key evidence for how to create healthier consumer food environments.
San Diego State University, 5900 Campanile Drive, San Diego, CA 92182, United States; Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 220, San Diego, CA 92123, United States. Electronic address: ayala@mail.sdsu.edu.
Guadalupe X
GX
Ayala
University of Iowa, College of Public Health, Community & Behavioral Health, N418 CPHB, 105 River Street, Iowa City, IA 52242, United States. Electronic address: barbara-baquero@uiowa.edu.
Barbara
B
Baquero
Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 220, San Diego, CA 92123, United States. Electronic address: jpickrel@mail.sdsu.edu.
Julie L
JL
Pickrel
San Diego State University, 5900 Campanile Drive, San Diego, CA 92182, United States; Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 220, San Diego, CA 92123, United States. Electronic address: jmayer@mail.sdsu.edu.
Joni
J
Mayer
San Diego State University, 5900 Campanile Drive, San Diego, CA 92182, United States. Electronic address: belch@mail.sdsu.edu.
George
G
Belch
University of California, San Diego, School of Medicine, Department of Family and Preventive Medicine, 9500 Gilman Drive #0901, La Jolla, CA 92093-0901, United States. Electronic address: crock@ucsd.edu.
Cheryl L
CL
Rock
University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, 359 Rosenau Hall, 135 Dauer Drive, Campus Box 7440, Chapel Hill 27599, United States. Electronic address: linnan@email.unc.edu.
Laura
L
Linnan
Center for Human Nutrition and Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD 21205-2179, United States. Electronic address: jgittel1@jhu.edu.
Joel
J
Gittelsohn
Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 220, San Diego, CA 92123, United States; San Diego State University-University of California at San Diego Joint Doctoral Program in Health Behavior, 5900 Campanile Drive, San Diego, CA 92182, United States. Electronic address: jesanchez@mail.sdsu.edu.
Jennifer
J
Sanchez-Flack
San Diego State University, 5900 Campanile Drive, San Diego, CA 92182, United States; Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 220, San Diego, CA 92123, United States. Electronic address: jelder@mail.sdsu.edu.
John P
JP
Elder
D000328:Adult; D002140:California; D004032:Diet; D004777:Environment; D005260:Female; D005523:Food Supply; D005638:Fruit; D006293:Health Promotion / Q000458:organization & administration*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D040541:Marketing / Q000458:organization & administration*; D008875:Middle Aged; D011203:Poverty; D012944:Social Support; D014675:Vegetables
Employee training; Environmental change; Food store; Fruits and vegetables; Latino; Tiendas