Outcomes of a Community-Wide Health Intervention in a Low-Income, Primarily Hispanic Community: The Go! Austin/Vamos! Austin (GAVA) Initiative.

OBJECTIVES: To describe outcomes of a 4-year physical activity (PA) and nutrition intervention (2013-2017) in Dove Springs, a low-income urban community in Texas. METHOD: Go! Austin/Vamos! Austin is a place-based intervention targeting the built and social environments of PA and nutrition. Baseline and follow-up measures related to PA and nutrition were obtained from 357 parent-child dyads (final n = 236) in the intervention community and a control community. A three-level dose of exposure measure was created to indicate the amount of exposure to intervention activities across the 4 years. Pre-post changes in key outcomes by level of exposure and contrasts across "high exposure" and "no exposure" categories were obtained using repeated-measures regression, adjusting for important confounders. RESULTS: "High exposure" adult participants showed consistently more favorable changes than "no exposure" participants across a variety of indicators, including positive perceptions and utilization of community PA resources, amount of moderate PA, utilization of retail outlets offering fresh produce, and measures of healthy eating. Few improvements were seen in child-level outcomes. CONCLUSIONS: Community interventions can successfully improve health-promoting behaviors provided they ensure sufficient dose of exposure.

Who shops at their nearest grocery store? A cross-sectional exploration of disparities in geographic food access among a low-income, racially/ethnically diverse cohort in Central Texas.

We examined whether Central Texans shop at their nearest supermarket, how far they travel for groceries, and explored differences by race/ethnicity, urbanicity, motivations for store selection and other demographic characteristics. Using cross-sectional data and GIS, continuous network distances from participants' homes to nearest and usual supermarkets were calculated and multivariate linear regression assessed differences. <19% shopped at their nearest supermarket. Regression models found that urbanicity played a large role in distance traveled to preferred supermarket, but other factors varied by race/ethnicity. Our findings demonstrate racial/ethnic and urbanicity disparities in food access and multiple domains of food access need greater consideration.

Exploring the Impact of Policies to Improve Geographic and Economic Access to Vegetables among Low-Income, Predominantly Latino Urban Residents: An Agent-Based Model.

Modifying the food environment of cities is a promising strategy for improving dietary behaviors, but using traditional empirical methods to test the effectiveness of these strategies remains challenging. We developed an agent-based model to simulate the food environment of Austin, Texas, USA, and to test the impact of different food access policies on vegetable consumption among low-income, predominantly Latino residents. The model was developed and calibrated using empirical data from the FRESH-Austin Study, a natural experiment. We simulated five policy scenarios: (1) business as usual; (2)−(4) expanding geographic and/or economic healthy food access via the Fresh for Less program (i.e., through farm stands, mobile markets, and healthy corner stores); and (5) expanding economic access to vegetables in supermarkets and small grocers. The model predicted that increasing geographic and/or economic access to healthy corner stores will not meaningfully improve vegetable intake, whilst implementing high discounts (>85%) on the cost of vegetables, or jointly increasing geographic and economic access to mobile markets or farm stands, will increase vegetable intake among low-income groups. Implementing discounts at supermarkets and small grocers is also predicted to be an effective policy for increasing vegetable consumption. This work highlights the utility of agent-based modeling for informing food access policies.

Change in Depression and Its Determinants during the COVID-19 Pandemic: A Longitudinal Examination among Racially/Ethnically Diverse US Adults.

This study examined longitudinal data to identify changes in the occurrence of depressive symptoms, and to explore if such changes were associated with socio-demographic, movement behaviors, and health variables during the COVID-19 pandemic, among a diverse sample of central Texas residents. Participants who completed two online surveys in 2020 (in June and November) from an on-going longitudinal study were included. Depressive symptoms were measured by Patient Health Questionnaire-2. Change in depressive symptoms' occurrence status between the two time points was categorized into (1) stable/improved, and (2) consistent depressive symptoms/declined. Sociodemographic factors, movement behaviors and health data were self-reported. Statistical analyses utilized descriptive statistics and logistical regression. Among a total of 290 individuals (84.1% female; 71.0% racial/ethnic minorities), 13.5% were categorized as consistent depressive symptoms/declined. Multivariable logistic regression indicated that racial/ethnic minorities, older age, and increased physical activity were associated with a lower likelihood, while greater sedentary time was associated with higher likelihood of consistent depressive symptoms/declined status. Between 3 months and 8 months into the pandemic, various socio-demographic and behavioral variables were associated with changes in depressive symptoms' occurrence status. Future research should explore the longer-term impacts of COVID-19 on depression among a diverse population and identify risk factors for depression.

Examining Geographic Food Access, Food Insecurity, and Urbanicity among Diverse, Low-Income Participants in Austin, Texas.

The purpose of this study was to explore the association between geographic food access and food insecurity and the potential role of race/ethnicity, income, and urbanicity among a low-income, diverse sample in Central Texas. Utilizing a cross-sectional study design, secondary data analysis of an existing cohort was used to examine the association between food insecurity; geographic food access; and sociodemographic factors of race/ethnicity, income, urbanicity, and additional covariates using binomial logistic regression models. The existing cohort was recruited from lower-income communities in Travis County, Texas. The sample (N = 393) was predominantly Hispanic, lived in urban areas, and nearly 40% were food insecure. Geographic food access was not found to be significantly associated with food insecurity. However, rural residents had greater odds of being food insecure than urban residents. Also, participants who earned USD 45,000-64,999 and over USD 65,000 had lower odds of being food insecure than participants who earned under USD 25,000. These findings add to the inconsistent literature about the association between geographic food access and food insecurity and contribute to urbanicity and income disparities in food-insecurity literature. Future work should consider urbanicity, income, and utilize community-specific data to gain greater understanding of the association between geographic food access and food insecurity.

Association between Fresh Fruit and Vegetable Consumption and Purchasing Behaviors, Food Insecurity Status and Geographic Food Access among a Lower-Income, Racially/Ethnically Diverse Cohort in Central Texas.

The aims of this study were to determine if fresh fruit and vegetable consumption and purchasing behaviors were associated with geographic food access and/or food insecurity status, and to explore the role of sociodemographic characteristics among participants of a lower-income, racially/ethnically diverse cohort. This study used a cross-sectional design and baseline survey data from the FRESH-Austin study (N = 393). Associations between fresh produce consumption/purchasing and food insecurity status and geographic access to food were assessed utilizing univariate, bivariate, and multivariate linear regression methods and potential interactions were examined. The sample 40% reported being food insecure and the majority identified as Hispanic. Geographic food access was directly associated with fresh produce consumption (ß = 0.46, p = 0.02); however, the directionality of the relationship between food insecurity and fresh produce consumption varied due to a significant interaction with race/ethnicity. Only utilizing food assistance was associated with purchasing fewer fresh produce (ß= -1.83, p = 0.03). Findings suggest that communities experience food insecurity and limited healthy food access in different ways, and in some situations, are associated with fresh produce consumption and purchasing behaviors. Future research adopting an intersectionality-sensitive approach to better understand how to best support communities at risk is needed.

Fresh for Less: Cross-Sector Collaboration for Funding, Implementation, and Evaluation of a Local Initiative to Improve Equitable Healthy Food Access.

INTRODUCTION: This study describes the cross-sector collaboration, dynamic implementation/evaluation, and implications of Fresh for Less (FFL); an equity-focused, multi-strategy healthy food access promotion program that has been implemented since 2017 in underserved communities in Austin, Texas through farmstands, mobile markets, and Healthy Corner Stores. METHODS: Annual evaluation has consisted of repeat cross-sectional quantitative surveys, qualitative customer/staff interviews, audits and cost-effective analyses. RESULTS: Farmstand/mobile market customers reported increased fresh produce consumption and high satisfaction. During COVID-19, mobile markets quickly pivoted to delivery, filling a huge need for safe and affordable grocery delivery. Healthy Corner Stores were not as successful, and this strategy was adapted and reintroduced in 2021. Audits show increased produce provision over time and that mobile markets offered increasingly competitive pricing. DISCUSSION: Fresh for Less demonstrates how cross-sector collaborators can work together to ensure that a program designed to improve equitable food access can be resilient, sustainable, and successful.

A Multi-Pronged Evaluation of a Healthy Food Access Initiative in Central Texas: Study Design, Methods, and Baseline Findings of the FRESH-Austin Evaluation Study.

Food insecurity and limited healthy food access are complex public health issues and warrant multi-level evaluations. The purpose of this paper was to present the overall study design and baseline results of the multi-pronged evaluation of a healthy food access (i.e., Fresh for Less (FFL)) initiative in Central Texas. The 2018-2021 FRESH-Austin study was a natural experiment that utilized a cluster random sampling strategy to recruit three groups of participants (total n = 400): (1) customers at FFL assets, (2) residents that lived within 1.5 miles of an FFL asset, and (3) residents from a comparison community. Evaluation measures included annual cohort surveys, accelerometers and GPS devices, store-level audits, and built environment assessments. Data are being used to inform and validate an agent-based model (ABM) to predict food shopping and consumption behaviors. Sociodemographic factors and food shopping and consumption behaviors were similar across the three groups; however, customers recruited at FFL assets were lower income and had a higher prevalence of food insecurity. The baseline findings demonstrate the need for multi-level food access interventions, such as FFL, in low-income communities. In the future, ABM can be used as a cost-effective way to determine potential impacts of future large-scale food environment programs and policies.

Correlates of Transitions in Food Insecurity Status during the Early Stages of the COVID-19 Pandemic among Ethnically Diverse Households in Central Texas.

Food insecurity increased substantially in the USA during the early stages of the 2020 COVID-19 pandemic. The purpose of this study was to identify potential sociodemographic and food access-related factors that were associated with continuing or transitioning into food insecurity in a diverse population. An electronic survey was completed by 367 households living in low-income communities in Central Texas during June-July 2020. Multinomial logistic regression models were developed to examine the associations among food insecurity transitions during COVID-19 and various sociodemographic and food access-related factors, including race/ethnicity, children in the household, loss of employment/wages, language, and issues with food availability, accessibility, affordability, and stability during the pandemic. Sociodemographic and food access-related factors associated with staying or becoming newly food insecure were similar but not identical. Having children in the household, changes in employment/wages, changing shopping location due to food availability, accessibility and/or affordability issues, issues with food availability, and stability of food supply were associated with becoming newly food insecure and staying food insecure during the pandemic. Identifying as Latino and/or Black was associated with staying food insecure during COVID-19. These findings suggest that the COVID-19 pandemic did not create new food insecurity disparities. Rather, the pandemic exacerbated pre-existing disparities.

Characterizing Micro-scale Disparities in Childhood Obesity: Examining the Influence of Multilevel Factors on 4-Year Changes in BMI, Healthy Eating, and Physical Activity, Among a Cohort of Children Residing in Disadvantaged Urban Enclaves.

The childhood obesity epidemic in the United States disproportionately affects minority, low-income populations. Hispanics have one of the highest childhood obesity rates, and are the fastest growing population subgroup in the country. Past research has examined disparities in the occurrence of obesity, healthy eating, and physical activity at a macro-geographic level, with less emphasis on examining the multilevel, micro-scale determinants of childhood obesity in disadvantaged urban ethnic enclaves. The aim of our study was to identify child-, parental-, familial-, community-, and neighborhood-level factors associated with differences in 4-year changes in BMI, healthy eating, and physical activity, among children residing in low-income, predominantly Hispanic urban enclaves in Austin, Texas. This analysis used data from the Go Austin! Vamos Austin! (GAVA) Evaluation study, a cohort with 4 years of follow-up from 313 child-caregiver dyads. The dependent variables were change categories denoting 4-year increase, decrease, or no change in Body Mass Index (BMI) percentile, fruit and vegetable intake, and physical activity, among child participants. The independent variables were factors at multiple levels of the socio-ecological model: child, parental, familial, community, and environmental. Multinomial logistic regression models were used to estimate the odds of children being in the "increasing" or "decreasing" categories for the three dependent variables (vs. "no change"), in association with the studied independent variables. The results showed that among children residing in this low-income, predominantly Hispanic urban enclave, weight gain prevention and weight loss have different determinants. We identified relevant micro-scale disparities, and micro-level factors of influence on child BMI and its related health behaviors, at all levels of the socio-ecological model. Our results revealed evidence, through the characterization of positive deviance cases (children for whom decreases in BMI, increases in fruit and vegetable intake, or increases in physical activity were observed) which could potentially help mitigate established unhealthy habits among high need populations. Factors associated with positive deviance for BMI (decreases in child BMI) included male child sex (OR: 0.33, 95% CI: 0.12-0.83) and living in a food-insecure household (OR: 0.24, 95% CI: 0.13-0.79). Our findings may inform the design of obesity prevention interventions in these types of disadvantaged urban Hispanic enclaves.

Design and evaluation of a coalition-led obesity initiative to promote healthy eating and physical activity in low-income, ethnically diverse communities: the Go! Austin/Vamos! Austin initiative.

BACKGROUND: Go! Austin/Vamos! Austin (GAVA) is a coalition-led health initiative that targets low-income communities with disparities in access to healthy food and physical activity. The purpose of this initiative was to increase healthy eating and physical activity among residents by facilitating access to food and physical activity opportunities through environmental and policy changes. Although GAVA is ongoing, this paper describes the original GAVA intervention and the 5-year evaluation study (2013-2018), presenting selected baseline data obtained through its cohort sub-study. METHODS: To assess the impact of GAVA, the evaluation plan included multiple sub-studies and involved collection of quantitative, qualitative, and observational data at different levels. The main cohort sub-study followed 313 parent-child dyads over 5 years. Annually, parents completed self-administered surveys regarding awareness and use of community assets/resources as well as their diet and activities. Heights and weights also were measured. RESULTS: Cohort participants were primarily Hispanic (87%), very low-income (77%), and food insecure (58%), with high overweight/obesity prevalence among both parents (81%) and children (41%). Awareness and use of community physical activity and healthy eating resources were low, and reported barriers to using these resources were many. Engagement in physical activity and healthy eating also was low. CONCLUSIONS: Given the baseline statistics, GAVA resident teams chose and implemented strategies to address the noted barriers and low usage of community resources. This approach built community capacity and governance. Both the GAVA intervention approach and evaluation protocol can serve as models for other community initiatives to be implemented in other locations and contexts.