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In recent years, the long-standing questions of why, how, and which farm families continue farming in the face of ongoing changes have increasingly been studied through the resilience lens. While this body of work is providing updated and novel insights, two limitations, a focus on macro-level challenges faced by the farm operation and a mismatch between the scale of challenges and resilience measures, likely limit our understanding of the factors at play. We use the example of medical economic vulnerability, a micro-level challenge traditionally confined to the household sphere of the agri-family system, as a way to call attention to these limitations. Focusing on United States (U.S.) farm households, we assess: (1) To what extent are they experiencing medical economic vulnerability when using objective and subjective outcome measures? (2) Which demographic and farm characteristics are associated with experiencing medical economic vulnerability? (3) What is the association between institutional arrangements and medical economic vulnerability? Our analysis of over 900 surveys coupled with a conceptual framework merging complementary insights from three bodies of literature revealed seemingly large differences in the prevalence of medical economic vulnerability across the objective and subjective measures with the subjective measure indicating a general sentiment of medical economic vulnerability in a majority of respondents. Conversely, limited variations were noted in who experiences medical vulnerability on the basis of demographic and farm characteristics, with stronger associations being connected to the households' health insurance arrangements. We conclude with three implications of our findings for the farm resilience literature.
RESUMO
BACKGROUND: Childhood obesity persists in the United States and is associated with serious health problems. Higher rates of obesity among children from disadvantaged households may be, in part, attributable to disparities in access to healthy foods such as fruits and vegetables. Community supported agriculture can improve access to and consumption of fresh produce, but the upfront payment structure, logistical barriers, and unfamiliarity with produce items may inhibit participation by low-income families. The aim of this project is to assess the impact of subsidized, or "cost-offset," community supported agriculture participation coupled with tailored nutrition education for low-income families with children. METHODS/DESIGN: The Farm Fresh Foods for Healthy Kids community-based, randomized intervention trial will build on formative and longitudinal research to examine the impact of cost-offset community supported agriculture on diet and other health behaviors as well as the economic impacts on local economies. The intervention will involve reduced-price community supported agriculture shares which can be paid for on a weekly basis, nine skill-based and seasonally-tailored healthy eating classes, and the provision of basic kitchen tools. Low income families with at least one child aged 2-12 years will be recruited to join existing community supported agriculture programs in New York, North Carolina, Vermont, and Washington. In each program, families will be randomized 1:1 to intervention or delayed intervention groups. Data will be collected at baseline, and in the fall and spring for 3 years. The primary outcomes are children's intake of fruits and vegetables and foods high in sugar and/or (solid) fat, as well as diet quality; secondary outcomes include physical, behavioral, psychosocial, and environmental variables. Cost-effectiveness and economic impact at the farm and community levels also will be assessed. DISCUSSION: This integrated project will provide important information and contribute to the evidence base regarding the use of local agricultural interventions to improve children's dietary behaviors and weight maintenance. Findings also will inform the development of a toolkit for farmers and education modules related to local food system innovations for undergraduate and graduate students. TRIAL REGISTRATION: ClinicalTrials.gov NCT02770196 . Registered 5 April 2016.