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01.12.2017 | Study protocol | Ausgabe 1/2017 Open Access

BMC Public Health 1/2017

Farm Fresh Foods for Healthy Kids (F3HK): An innovative community supported agriculture intervention to prevent childhood obesity in low-income families and strengthen local agricultural economies

BMC Public Health > Ausgabe 1/2017
Rebecca A. Seguin, Emily H. Morgan, Karla L. Hanson, Alice S. Ammerman, Stephanie B. Jilcott Pitts, Jane Kolodinsky, Marilyn Sitaker, Florence A. Becot, Leah M. Connor, Jennifer A. Garner, Jared T. McGuirt
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Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-017-4202-2) contains supplementary material, which is available to authorized users.



Childhood obesity persists in the United States and is associated with serious health problems. Higher rates of obesity among children from disadvantaged households may be, in part, attributable to disparities in access to healthy foods such as fruits and vegetables. Community supported agriculture can improve access to and consumption of fresh produce, but the upfront payment structure, logistical barriers, and unfamiliarity with produce items may inhibit participation by low-income families. The aim of this project is to assess the impact of subsidized, or “cost-offset,” community supported agriculture participation coupled with tailored nutrition education for low-income families with children.


The Farm Fresh Foods for Healthy Kids community-based, randomized intervention trial will build on formative and longitudinal research to examine the impact of cost-offset community supported agriculture on diet and other health behaviors as well as the economic impacts on local economies. The intervention will involve reduced-price community supported agriculture shares which can be paid for on a weekly basis, nine skill-based and seasonally-tailored healthy eating classes, and the provision of basic kitchen tools. Low income families with at least one child aged 2–12 years will be recruited to join existing community supported agriculture programs in New York, North Carolina, Vermont, and Washington. In each program, families will be randomized 1:1 to intervention or delayed intervention groups. Data will be collected at baseline, and in the fall and spring for 3 years. The primary outcomes are children’s intake of fruits and vegetables and foods high in sugar and/or (solid) fat, as well as diet quality; secondary outcomes include physical, behavioral, psychosocial, and environmental variables. Cost-effectiveness and economic impact at the farm and community levels also will be assessed.


This integrated project will provide important information and contribute to the evidence base regarding the use of local agricultural interventions to improve children’s dietary behaviors and weight maintenance. Findings also will inform the development of a toolkit for farmers and education modules related to local food system innovations for undergraduate and graduate students.

Trial registration

ClinicalTrials.​gov NCT02770196. Registered 5 April 2016. 
Additional file 1: Cost Offset Community Supported Agriculture (CO-CSA) Research Intervention Consent Form. (DOC 150 kb)
Additional file 2: SPIRIT 2013 Checklist: Recommended Items to Address in a Clinical Trial Protocol and Related Documents. (DOC 123 kb)
Additional file 3: Publication, Presentation, and Dissemination Guidelines: Innovative Community Supported Agriculture (CSA) Cost-Offset Intervention to Prevent Childhood Obesity and Strengthen Local Agricultural Economies. (DOCX 69 kb)
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