title: A multi-level intervention in subsidized housing sites to increase fruit and vegetable access and intake: Rationale, design and methods of the 'Live Well, Viva Bien' cluster randomized trial.
abstract: Adequate fruit and vegetable (F&V) intake is important for disease prevention. Yet, most Americans, especially low-income and racial/ethnic minorities, do not eat adequate amounts. These disparities are partly attributable to food environments in low-income neighborhoods where residents often have limited access to affordable, healthful food and easy access to inexpensive, unhealthful foods. Increasing access to affordable healthful food in underserved neighborhoods through mobile markets is a promising, year-round strategy for improving dietary behaviors and reducing F&V intake disparities. However, to date, there have been no randomized controlled trials studying their effectiveness. The objective of the 'Live Well, Viva Bien' (LWVB) cluster randomized controlled trial is to evaluate the efficacy of a multicomponent mobile market intervention at increasing F&V intake among residents of subsidized housing complexes.
  
  
  
  One housing complex served as a pilot site for the intervention group and the remaining 14 demographically-matched sites were randomized into either the intervention or control group. The intervention group received bimonthly, discount, mobile, fresh F&V markets in conjunction with a nutrition education intervention (two F&V campaigns, newsletters, DVDs and cooking demonstrations) for 12 months. The control group received physical activity and stress reduction interventions. Outcome measures include F&V intake (measured by two validated F&V screeners at baseline, six-month and twelve-months) along with potential psychosocial mediating variables. Extensive quantitative and qualitative process evaluation was also conducted throughout the study.
  
  
  
  Modifying neighborhood food environments in ways that increase access to affordable, healthful food is a promising strategy for improving dietary behaviors among low-income, racial and ethnic minority groups at increased risk for obesity and other food-related chronic diseases. Discount, mobile F&V markets address all the major barriers to eating more F&V (high cost, poor quality, limited access and limited time to shop and cook) and provide a year-round solution to limited access to healthful food in low-income neighborhoods. LWVB is the first randomized controlled trial evaluating the effectiveness of mobile markets at increasing F&V intake. If proven efficacious at increasing F&V consumption, LWVB could be disseminated widely to neighborhoods that have low access to fresh F&V.
  
  
  
  Clinicatrials.gov registration number: NCT02669472 First Received: January 19, 2016.
authors.affiliation: Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02912, USA. kim.gans@uconn.edu.|Department of Human Development and Family Studies and Center for Health Interventions and Prevention, University of Connecticut, Storrs, CT, 06269, USA. kim.gans@uconn.edu.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Gans
authors.affiliation: Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02912, USA.
authors.forename: Gemma
authors.initials: G
authors.lastname: Gorham
authors.affiliation: Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02912, USA.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Risica
authors.affiliation: Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02912, USA.
authors.forename: Akilah
authors.initials: A
authors.lastname: Dulin-Keita
authors.affiliation: Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02912, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Dionne
authors.affiliation: Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02912, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Gao
authors.affiliation: Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02912, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Peters
authors.affiliation: Department of Management, Sapienza University of Rome, Sapienza University, Rome, Italy.
authors.forename: Ludovica
authors.initials: L
authors.lastname: Principato
mesh_terms: D016000:Cluster Analysis; D004032:Diet; D005260:Female; D005380:Financing, Government; D005523:Food Supply; D005638:Fruit / Q000600:supply & distribution; D006266:Health Education; D006798:Housing; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D010865:Pilot Projects; D011203:Poverty; D012107:Research Design; D012237:Rhode Island; D014675:Vegetables / Q000600:supply & distribution
keywords: Diet; Farmer’s market; Food access; Fruit and vegetable; Mobile market; Nutrition education: Low income