A multilevel community engaged intervention to build a sustainable and food economy with food is medicine offerings in the Mississippi Delta to improve minority health and reduce disparities - Modified Project Summary/Abstract Section The goal of this project is to test whether a multi-level, community-engaged intervention to build a sustainable food economy with food-is-medicine programs in the Mississippi Delta can improve minority health and reduce health disparities. This project focuses on Bolivar, Washington, and Sunflower, contiguous rural counties in the Delta. While rural Americans of all races die earlier from heart disease, stroke, and diabetes compared to their urban counterparts, the burden is heaviest in the Delta, where poverty is high and healthy food is hard to access. In fact, rural Black/African American adults experience substantial disparities in chronic disease mortality and die from diabetes at twice the rate of rural White adults, and from high blood pressure at nearly three times the rate. Our central hypothesis is that an intervention developed with active community engagement to increase local production and distribution of fruits and vegetables (FV) will increase FV consumption and decrease body mass index (BMI), hemoglobin A1c (HbA1c) and health disparities among participating adults compared to control participants over a 12-month study period. Our central hypothesis is that an intervention developed with active community engagement to increase local production and distribution of fruits and vegetables (FV) will increase FV consumption and decrease body mass index (BMI), hemoglobin A1c (HbA1c) and health disparities among participating adults compared to control participants over a 12-month study period. Aim 1: To design a novel intervention that bolsters the local food economy and delivers food is medicine programming to an at-risk population within rural communities. Using the principles and processes of community-engaged research, we will unite community partners and members of Bolivar, Washington, and Sunflower Counties in a local multi-sector Delta Food Policy Council (FPC). The FPC will design and implement a multi-level intervention to provide appropriate nutrition, focusing on locally grown FV, to build a sustainable food economy and improve health outcomes. Aim 2: To test whether the novel intervention reduces health disparities by improving outcomes related to obesity and diabetes among a rural minority population. We will work collaboratively with the FPC to implement and evaluate a multi-level, community-engaged, randomized controlled intervention targeting 300 adults (>25 y) with food insecurity, BMI >25, and HbA1c >5.7-8.5%. No racial or ethnic minority groups or subgroups will be excluded from participation. The proposed study counties (Bolivar, Sunflower, and Washington) are majority Black/African American, with Black residents comprising 63.7%, 73.8%, and 72.4% of each county population, respectively. At the primary recruitment site, Delta Health Center, 89.7% of patients identify as Non-Hispanic Black. The study sample is therefore expected to reflect both the county-level demographic composition and the patient population from which participants will be recruited. Outcome measures are (*primary): • Individual-level: increase FV consumption; decrease obesity (BMI), diabetes risk (HbA1c)*, and systolic blood pressure • Community-level: increase production and distribution of FV; institute access to produce and decrease food insecurity; and decrease health care utilization Aim 3: Generate a replicable and scalable food economy model to reduce obesity and improve diabetes. The evidence generated from this sustainable food is medicine model, focused on adults living in rural areas, will be widely disseminated. Expected impact: Community-centered efforts that build vital local food economies to support food-is-medicine programming represent a major innovation that integrates nutrition into the healthcare system to ameliorate disease, mitigate disparities, and save billions of dollars in health care expenditures annually.
