Objectives: Chronic diseases have grown exponentially in recent years and have become a major burden on our society by increasing rates of premature death and disability, decreasing productivity, and increasing health care costs. Employer-based health promotion programs are increasingly common as a tool to improve employee health and to curb costs related to chronic diseases. This study evaluated the effectiveness of a novel, employer-based health promotion intervention to improve the dietary intake and health status of employees using Community Supported Agriculture (CSA). The key objectives were to evaluate the overall experience of CSA participants, to determine whether participants reported a change in their household food environment and meal patterns, and to investigate the association of CSA participation with dietary intake and health outcomes. Methods: A convenience sample of employees from three employers was recruited using multiple communication methods with a total of 324 employees completing all study requirements. Data was collected using baseline and follow-up CSA surveys and the HealthPartners annual health assessment taken prior to and following completion of the study. Descriptive statistics were used to examine participant demographic characteristics and variables related to the CSA experience. To evaluate whether prior CSA experience and share utilization were predictive of participants' future CSA plans, logistic regression was used. Changes in the household food environment and meal patterns were assessed using paired sample t-tests and the Wilcoxon signed-rank test. Linear regression methods were used to investigate associations of CSA participation with dietary intake and health outcomes. Results: The majority of study participants were female, White, college educated, and lived in households with children and two adults. Common reasons CSA participants reported for joining CSA included fresh food, a dislike of grocery stores, and the educational and family experience of being part of CSA. Participants were generally satisfied with their overall CSA experience, and the majority reported that they planned to renew their CSA membership in the following year or that they were unsure of their plans. Additionally, those participants with a history of prior CSA experience and higher share utilization rates were more likely to report that they planned to renew their membership in the following year. CSA participation was also found to be associated with an increase in the presence of vegetables in the household, the frequency of offering fruits and vegetables at snacks or meals, and the frequency of household meals. Additionally, CSA participation was associated with a decrease in the frequency of eating at all types of restaurants and fast food restaurants specifically. Participants reported that the amount and variety of produce consumed increased as a result of CSA participation, although inferential analyses of the change in daily produce servings and weekly produce variety from baseline to follow-up did not support this finding. CSA share type, weekly utilization, and prior CSA participation were not predictive of daily produce servings. In addition, there was not a significant association between CSA participation and health status or BMI. Conclusions: The overall experience of employer-based CSA members was similar to that of CSA members in previous studies, although some discrepancies in employees' motivations for joining and differences in individual satisfaction variables were identified. For example, study participants were more likely to be satisfied with logistics such as the CSA pick-up site and distribution time of day than participants in previous studies. The results of this study also demonstrated that CSA participation is associated with improvements in the household food environment such as an increase in the number of vegetables present, frequency with which produce is served at snacks and meals, frequency of household meals, and frequency of restaurant eating. The findings regarding the association between CSA participation and dietary intake and health were less definitive. Participants indicated that they felt the amount and variety of produce consumed increased as a result of CSA participation in response to the self-report questions on the follow-up CSA survey, but objective measures did not show a change in daily produce servings, weekly produce variety, health status, or BMI from baseline to follow-up when compared to matched controls.
University of Minnesota Ph.D. dissertation. November 2014. Major: Nutrition. Advisor: Mary Story, Ph.D., R.D., 1 computer file (PDF); x, 170 pages, appendices A-E.
Vasquez, Angela Marie.
A novel dietary improvement strategy: examining the potential impact of community supported agriculture membership.
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