This paper examines fruit and vegetable intake (FVI) in low-income households that participated in a cost-offset (CO), or 50% subsidized, community-supported agriculture (CSA) program. CSA customers paid farms upfront for a share of the harvest, and received produce weekly throughout the growing season. A cohort of adults and children 2–12 y in a summer CO-CSA were surveyed online twice: August 2015 (n = 41) and February 2016 (n = 23). FVI was measured by the National Cancer Institute’s (NCI) Fruit and Vegetable Screener (FVS) and an inventory of locally grown fruits and vegetables. FVI relative to United States (US) recommendations and averages, and across seasons, were tested with non-parametric tests and paired t-tests (p < 0.05). Both adults and children in the CO-CSA had higher FVI than the US averages, and more often met recommendations for vegetables. Some summer fruits and vegetables were more often eaten when locally in-season. The CO-CSA model warrants further examination as an avenue for improving vegetable consumption among adults and children in low-income households. However, causality between CO-CSA participation and FVI cannot be inferred, as CO-CSA participants may be positive deviants with respect to FVI. A multi-state randomized controlled trial is currently underway to evaluate impacts of CO-CSAs on FVI and related outcomes.

Background: Adults and children in the U.S. consume inadequate quantities of fruit and vegetables (FV), in part, due to poor access among households with lower socioeconomic status. One approach to improving access to FV is community supported agriculture (CSA) in which households purchase a ‘share’ of local farm produce throughout the growing season. This study examined the effects of cost-offset (half-price) CSA plus tailored nutrition education for low-income households with children. Methods: The Farm Fresh Foods for Healthy Kids (F3HK) randomized controlled trial in New York, North Carolina, Vermont, and Washington (2016–2018) assigned caregiver-child dyads (n = 305) into cost-offset CSA plus education intervention or control (delayed intervention) groups. Following one growing season of CSA participation, changes in children’s diet quality, body mass index (BMI), and physical activity; caregivers’ nutrition knowledge, attitudes, behaviors, and diet quality; and household food access and security were examined using multiple linear or logistic regression, with adjustment for baseline value within an intent-to-treat (ITT) framework in which missing data were multiply imputed. Results: No significant net effects on children’s dietary intake, BMI, or physical activity were observed. Statistically significant net improvements were observed after one growing season for caregivers’ cooking attitudes, skills, and self-efficacy; FV intake and skin carotenoid levels; and household food security. Changes in attitudes and self-efficacy remained one-year after baseline, but improvements in caregiver diet and household food security did not. The number of weeks that participants picked up a CSA share (but not number of education sessions attended) was associated with improvements in caregiver FV intake and household food security. Conclusions: Cost-offset CSA plus tailored nutrition education for low-income households improved important caregiver and household outcomes within just one season of participation; most notably, both self-reported and objectively measured caregiver FV intake and household food security improved. Households that picked up more shares also reported larger improvements. However, these changes were not maintained after the CSA season ended. These results suggest that cost-offset CSA is a viable approach to improving adult, but not child, FV intake and household food security for low-income families, but the seasonality of most CSAs may limit their potential to improve year-round dietary behavior and food security. Trial registration: ClinicalTrials.gov. NCT02770196. Registered 5 April 2016. Retrospectively registered.

Using a mixed-methods design, we evaluated Farm Fresh Food Box (F3B) a market innovation designed to expand producer markets, stabilize rural retail businesses, and improve rural food access. In the F3B model, pre-ordered Community Supported Agriculture (CSA)-style produce boxes are sold through rural retail outlets. F3B was implemented from 2016 to 2018 as part of a United States Department of Agriculture (USDA)-funded multi-state extension and research collaboration project in 3 geographically diverse and rural areas: Vermont, Washington, and California. The F3B evaluation aimed to (1) assess market potential; (2) determine logistics for successful implementation; (3) describe the benefits and drawbacks for farmers and retailers; and (4) measure consumers’ attitudes and purchase behavior. A national market survey indicated consumers would be likely to purchase F3B if it was perceived to offer good value on fresh local produce, without need for a subscription. The model put a few additional labor burdens on farmers and retailers, but required time for relationship-building and more record-keeping time for farmers. Those who purchased a F3B were generally satisfied with the quality, quantity and variety of produce each week and a high proportion considered F3B to be a good value for the money. As a new business innovation, F3B showed only modest profit, but retailers and farmers felt it was worthwhile to expand their customer base, promote their brand and develop their partnership. F3B began a means to address flattened growth in direct to consumer produce sales, food deserts and dwindling retail options for fresh foods in rural areas. We discuss F3B as a potential solution to food system weaknesses exposed by the COIVD-19 pandemic because it offers touch-free, high-quality local produce ready for curbside pickup at a convenient location.

Community-supported agriculture (CSA) participation has been associated with high fruit and vegetable (FV) consumption, which may be due to better access to FV for CSA purchasers, or to positive knowledge, attitudes, and beliefs (KAB) regarding healthy eating among CSA applicants. The objective of this study was to examine KAB and consumption, in association with application to a cost-offset CSA (CO-CSA) program, and with CO-CSA purchase among applicants. We conducted a cross-sectional survey of CO-CSA applicants and a comparison sample in August 2017. All respondents were English-reading adults with a child 2–12 years old and household income of ≤185% of the federal poverty level. Among CO-CSA applicants, some were CO-CSA purchasers (n = 46) and some were not (n = 18). An online comparison sample met equivalent eligibility criteria, but had not participated in CSA for three years (n = 105). We compared CO-CSA applicants to the comparison sample, and compared purchasers and non-purchaser sub-groups, using Mann-Whitney U tests and chi-square analysis. CO-CSA applicants reported better knowledge, self-efficacy, home habits, and diet than the comparison sample. Among applicants, CO-CSA purchasers and non-purchasers had equivalent KAB, but children in purchaser households had higher FV consumption than in non-purchaser households (4.14 vs. 1.83 cups, p = 0.001). Future research should explore associations between CO-CSA participation and diet using experimental methods.

To open new markets, some farmers have adapted direct-to-consumer (DTC) models, such as Community Supported Agriculture (CSA), to reach new settings or audiences. We compared sociodemographic and geospatial contexts to farmers’ experience with one of two DTC innovations: a cost-offset CSA for low-income families and food boxes distributed through rural convenience stores. We geocoded addresses of thirteen farms and DTC pickup sites in two U.S. states (Vermont and Washington) and calculated road network distances from pickup to supermarket, farmers’ market, and farm. We compiled Census block-level demographic and transportation data, and compared it to postseason interviews to explore the effect of suitability of the pickup location; proximity to food retail; and potential farmer burden. Most pickup areas were heavily car-dependent, with low walkability and few public transportation options. Conventional sources of fresh produce were within six miles of most pickups, but farmers markets were further away. Despite modest profitability, both models were deemed worth pursuing, as they expanded farmers’ customer base. Farmers implementing the store-distributed food box were sensitive to market trends and customer needs in choosing pickup location. Farmers seemed more concerned with marketing in convenience store settings, and finding efficient ways to conduct recordkeeping than with delivery distances.

Accurate measurement of fruit and vegetable (FV) intake is important for nutrition surveillance and evaluation of dietary interventions. We compared two tools for reporting FV intake to objective measurement of skin carotenoids among children. FV cups/day was assessed by repeated 24 h dietary recalls (24H FV) and the National Cancer Institute’s All-Day Fruit and Vegetable Screener (NCI FV). Skin carotenoids were measured by repeated resonance Raman spectroscopy (RRS) of the palm. FV cups were regressed on RRS scores in unadjusted, field-based, and research-setting models with covariates feasible in each scenario. Data were baseline values from children aged 2–12 years in low-income households enrolled in a healthy eating randomized trial in four U.S. states (n = 177). Twenty-four-hour FV cups were associated with skin carotenoids in all models (p < 0.001) but NCI FV cups were not. Predicted RRS scores for discrete 24H FV cups provide a guide to interpretation of RRS in children (2 cups FV intake ~36,000 RRS units), with the research-setting scenario generally providing the narrowest prediction range (+/−1924). When self-reported data are required, 24 h recalls are more accurate than NCI FV screener data; and, when limited time, resources, or literacy must be considered, RRS scores can be quickly obtained and easily interpreted.