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BMC Public Health. 2017 Apr 8;17(1):306. doi: 10.1186/s12889-017-4202-2.

Farm Fresh Foods for Healthy Kids (F3HK): An innovative community supported agriculture intervention to prevent childhood obesity in low-income families and strengthen local agricultural economies.

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Division of Nutritional Sciences, Cornell University, Savage Hall, Ithaca, NY, 14853, USA.
Division of Nutritional Sciences, Cornell University, Savage Hall, Ithaca, NY, 14853, USA.
Department of Nutrition, Gillings School of Global Public Health & School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-8140, USA.
Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-8140, USA.
Brody School of Medicine, East Carolina University, Lakeside Annex 8, Room 126, 600 Moye Boulevard, Greenville, NC, 27834, USA.
Center for Rural Studies, University of Vermont, 206 Morrill Hall, Burlington, VT, 05405, USA.
Department of Community Development and Applied Economics, University of Vermont, Morrill Hall, Burlington, VT, 05405, USA.
The Evergreen State College, 2700 Evergreen Pkwy NW, Olympia, WA, 98505, USA.



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.


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.


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: NCT02770196 . Registered 5 April 2016.


Childhood obesity; Community supported agriculture; Diet; Fruit and vegetables; Local agriculture; Local food system; Nutrition

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