Colón-Ramos Uriyoán, Lewis Emma C, Tucker Anna Claire, Poirier Lisa, Pathiravasan Chathurangi H, Estradé Michelle, Igusa Takeru, Wolfson Julia A, Mui Yeeli, Vélez-Burgess Veronica, Thomas Audrey E, Hua Shuxian, Cheskin Lawrence J, Trujillo Antonio J, Oladimeji Ayoyemi T, Williamson Stacey, Romero Rosalinda, Hernández Patricia Sánchez, Gittelsohn Joel
Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, United States.
Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
Front Public Health. 2025 Jan 7;12:1427792. doi: 10.3389/fpubh.2024.1427792. eCollection 2024.
High dietary quality can protect against diet-related chronic diseases. In the United States, racial and ethnic minorities and those with lower incomes consistently exhibit lower dietary quality. Independently-owned restaurants are a common prepared food source in minority low-income communities, but there are significant knowledge gaps on how to work with these restaurants to offer healthy food, due to underlying and dynamic complexities associated with providing healthy food options.
The (FRESH) study addresses this complex problem by leveraging systems science approaches to work with independently-owned restaurants. FRESH has two interrelated objectives: (1) to test impact on regular customer dietary quality via a multisite cluster randomized controlled trial in two low-income urban areas (Baltimore and the Washington DC metropolitan area), and (2) to use systems science approaches to develop, parameterize, and calibrate a simulation model. The intervention is theory-and practice-based, comprising three phases: restaurant engagement, low-sugar beverages and healthy meals. The FRESH intervention will be implemented for 12 months in a total of 24 intervention and 24 comparison restaurants. The study is powered to detect a 5-point change in the Healthy Eating Index (HEI) score of regular customers, which would signify a meaningful shift toward healthier eating patterns.
The FRESH study will test a novel, multilevel, multisite intervention that aims to improve access to healthier prepared food options among small, independently-owned restaurants located in under-resourced settings. The design of the FRESH intervention and its evaluation are described, as well as plans for the development of a system dynamics simulation model for policymakers and other stakeholders to virtually test future restaurant-based interventions.
https://clinicaltrials.gov, identifier, NCT05869149.
高膳食质量可预防与饮食相关的慢性病。在美国，少数族裔和低收入人群的膳食质量一直较低。独立经营的餐馆是少数族裔低收入社区常见的预制食品来源，但由于提供健康食品选择存在潜在的动态复杂性，在如何与这些餐馆合作提供健康食品方面存在重大知识空白。
“新鲜食品促进健康饮食（FRESH）”研究通过运用系统科学方法与独立经营的餐馆合作来解决这一复杂问题。FRESH有两个相互关联的目标：（1）通过在两个低收入城市地区（巴尔的摩和华盛顿特区都会区）进行的多地点整群随机对照试验，测试对常客膳食质量的影响；（2）运用系统科学方法开发、参数化和校准一个模拟模型。干预基于理论和实践，包括三个阶段：餐馆参与、低糖饮料和健康餐食。FRESH干预将在总共24家干预餐馆和24家对照餐馆中实施12个月。该研究有能力检测常客健康饮食指数（HEI）得分5分的变化，这将意味着向更健康饮食模式的有意义转变。
FRESH研究将测试一种新颖的、多层次、多地点的干预措施，旨在改善资源匮乏地区小型独立经营餐馆提供更健康预制食品选择的情况。描述了FRESH干预措施的设计及其评估，以及为政策制定者和其他利益相关者开发系统动力学模拟模型以虚拟测试未来基于餐馆的干预措施的计划。
