Dietary intake is an important determinant of risk for obesity and cancer. Consumption of fruits and vegetables reduces risk, yet among Latinos, there is now clear evidence that fruit and vegetable consumption decreases with greater acculturation to the U.S. Interventions targeted at the intrapersonal and interpersonal levels of the Socio-Ecological Framework have resulted in changes to dietary intake. However, these studies have neglected to consider that unless changes occur at higher levels of influence (e.g., in stores, in restaurants), individual behavior changes are unlikely to be reinforced and sustained. We propose to refine a pilot-tested intervention to change the food environment of grocery stores to promote consumption of fruits and vegetables. El Valor de Nuestra Salud [The Value of Our Health] will identify, recruit, and match 18 grocery stores (specifically small-to-medium sized Latino grocery stores or tiendas) and randomize them into one of two conditions: intervention versus a no-treatment control condition. The intervention will consist of two communication change strategies and two structural change strategies with the goal of changing aspects of the social and physical environments. The intervention will include employee and manager trainings to promote sales of fruits and vegetables and how to conduct a food marketing campaign. In addition, we will provide equipment and other material resources to the tiendas to promote sales of ready-to-eat fruits and vegetables, and to work with them to modify selections available in the meat and ready-to-eat food departments. Efficacy will be evaluated at the store customer level in terms of baseline to immediate post-intervention (6 months post-baseline) changes in self-reported fruit and vegetable intake in a sample of 360 adult store customers, and maintenance of these changes at the 6-month follow-up (12 months post-baseline). Levels of serum carotenoids collected in a 25% subsample of customers will provide evidence for the validity of dietary self- report. Intervention effectiveness will be evaluated at the employee, manager, and store levels using both self-reported and observed methodological approaches. The RE-AIM framework will be used to assess the potential for disseminating the intervention if it results in improvements in customers'dietary intake. This study is responsive to NCI's call for proposals on Diet and Communication, and given the involvement of a Mexican/Mexican-American population, is responsive to NCI's mission to reduce racial/ethnic health disparities.
Risk for obesity and certain cancers are higher among U.S. Latinos as compared with non-Latinos. Risk factors for obesity and cancer include not eating enough fruits and vegetables and other healthy foods, and this is particularly pronounced among Latinos who have less access to healthy foods. This study adds to the growing body of research on environmental-level interventions by proposing to work with Latino grocery stores to increase the availability of fruits and vegetables and ultimately impact the diets of its customers.
