Factors associated with continued participation in a matched monetary incentive programme at local farmers' markets in low-income neighbourhoods in San Diego, California.

OBJECTIVE: The Farmers' Market Fresh Fund Incentive Program is a policy, systems and environmental intervention to improve access to fresh produce for participants on governmental assistance in the USA. The current study examined factors associated with ongoing participation in this matched monetary incentive programme. DESIGN: Relationship of baseline factors with number of Fresh Fund visits was assessed using Poisson regression. Mixed-effects modelling was used to explore changes in consumption of fruits and vegetables and diet quality. SETTING: San Diego, California. SUBJECTS: Recipients of Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Security Income (SSI) who attended participating farmers' markets from 2010 to 2012 (n 7298). RESULTS: Among those with participation for ≤6 months, factors associated with increased visits included reporting more daily servings of fruits and vegetables (F&V) at baseline, being Vietnamese or Asian/Pacific Islander, and eligibility because of SNAP/CalFresh or SSI (v. WIC). Among those who came for 6-12 months, being Asian/Pacific Islander, eligibility because of SNAP/CalFresh and enrolling in the autumn, winter or spring were associated with a greater number of Fresh Fund visits. Among those who came for >12 months, being male and eligibility because of SSI were associated with a greater number of visits. Overall, the odds of increasing number of servings of F&V consumed increased by 2 % per month, and the odds of improved perception of diet quality increased by 10 % per month. CONCLUSIONS: Sustaining and increasing Fresh Fund-type programme operations should be a top priority for future policy decisions concerning farmers' market use in low-income neighbourhoods.

Monetary matched incentives to encourage the purchase of fresh fruits and vegetables at farmers markets in underserved communities.

INTRODUCTION: Farmers market programs may increase access to more healthful foods and reduce the high prevalence of obesity in low-income communities. The objective of this study was to examine outcomes of the Fresh Fund farmers market program serving low-income neighborhoods in San Diego, California. METHODS: Through its Farmers Market Fresh Fund Incentive Program, the County of San Diego Health and Human Services Agency offered monetary incentives to government nutrition assistance recipients to purchase fresh produce at 5 farmers markets. Participants enrolled at participating markets from June 1, 2010, through December 31, 2011; they completed baseline and follow-up surveys of daily consumption and weekly spending on fruits and vegetables. We examined enrollment, participation, participant health perceptions, and vendor revenue. RESULTS: During the study period, 7,298 eligible participants enrolled in Fresh Fund; most (82%) had previously never been to a farmers market. Among 252 participants with matched surveys at baseline and 12-month follow-up, the proportion who reported their diet to be "healthy" or "very healthy" increased from 4% to 63% (P < .001); nearly all (93%) stated that Fresh Fund was "important" or "very important" in their decision to shop at the farmers market. Vendors reported that 48% of all market revenue they received was received through the Fresh Fund program. At 2 markets, revenue from June 1, 2011, through January 31, 2012, increased by 74% and 68% compared with revenue from June 1, 2010, through January 31, 2011. CONCLUSION: Participants in the Fresh Fund program self-reported increases in daily consumption and weekly spending on fruits and vegetables, and vendors at participating farmers markets also increased their revenue.

Resting energy expenditure: a better marker than BMI for BMD in African-American women.

PURPOSE: African-American women tend to be more overweight and to have lower resting energy expenditures (REE) compared with Caucasian women. Weight is associated with bone mineral density (BMD), but the relation between BMD and REE has not been reported. METHODS: Four hundred postmenopausal African-American women aged 45-87 (yr) from San Diego, CA participated in this community-based cross-sectional study. Body composition (fat mass, lean body mass), bone mineral content (BMC) and BMD of the lumbar spine, hip (femoral neck, greater trochanter, intertrochanter), and total body were measured using dual energy x-ray absorptiometry (DXA). REE was calculated using the Harris-Benedict equation; grip strength was measured by isometric dynamometry. RESULTS: REE (r range: 0.32-0.79) showed the strongest correlation with spine, total hip, and total body BMC and BMD. In stepwise multiple linear regressions adjusted for age and grip strength, REE explained 15% of the variance in spine BMD, 33% of the variance in total hip, and 32% of the total body BMD variance. REE explained 63% of the total body BMC variance. When body weight replaced REE in the models, weight became the strongest covariate of BMC and BMD but explained 1% less of the variance in spine BMD, 5% less of the variance in total hip BMD, 4% less of the variance in total body BMD, and 3% less of the variances in spine, total hip, and total body BMC than did REE. CONCLUSION: In this cohort of African-American women, weight explained less of the BMC and BMD variance than REE. Poor energy economy may contribute to being overweight and may explain the lower rates of osteoporosis observed in African-American women.