SBIR-STTR Award

Poverty, ethnic minority status, and rural residence are strong predictors of poor health. There are multiple contributors to high chronic disease rates, including food insecurity (lack of access to affordable, nutritionally valuable food) and unemployment. Rural poverty in the Southeast is exacerbated by reduced economic opportunity associated with agricultural transitions and historical loan discrimination against farmers of color. The Center for Disease Control and Prevention (CDC) estimates 86% of the $2.7 trillion annual health care expenditures are to care for chronic conditions. Reducing food insecurity and increasing economic opportunity are key to combatting health disparities in low-income communities. We are pursuing a business model that provides healthy, affordable food and economic opportunities for farmers and small businesses in rural communities. Corner stores are significant sources of food in these communities but fresh produce and meats have a short shelf-life. Pre-packaged frozen meals are convenient and have a much longer shelf life but are traditionally high in sodium with few vegetables or whole grains. We propose a cost-offset or sliding scale model, in which locally sourced, healthy frozen meals (Good Bowls) are sold at a higher price in high- end stores and at a lower price in corner stores and at worksites. Using a franchise-like arrangement, Good Bowls, LLC in collaboration with a larger Value Added Processing Facility (VAPF) will provide the food production and distribution expertise, recipes, packaging, labeling, food safety, marketing, and general technical assistance to two smaller/rural VAPFs that will produce Good Bowls and sell them to both higher- and lower-cost food retailers. Good Bowls recipes, developed to promote an evidence-based healthful dietary patter (Mediterranean-style diet) were well received in a small pilot study by both high and low income consumers. By using traditional, lower-cost southern vegetables like sweet potatoes, collard greens, and peppers, we have created an affordable and well-liked product. Using grade B produce or "seconds" will avoid food waste, give farmers more income, and reduce the cost of production. Good Bowls will provide the identical high-quality product to both lower- and higher-income consumers, just at different price points. Family size bowls will be available and our website (with links to the packaging) will provide recipes for all products and simple tips for healthy eating on a budget. Specific Aims: AIM 1) Viability of Good Bowls production in one larger/central facility near Chapel Hill and two satellite/franchises in rural, low income NC communities (customer satisfaction, production capability and cost, sales, and retail price points); AIM 2) Early stage impact on food insecurity and nutrition (replacement of less healthy options and impact of supplemental web-based nutrition information/education) and AIM 3) Contributions to economic development in rural communities for farmers and small businesses (revenue and jobs creation).

Public Health Relevance Statement:
PROJECT NARRATIVE Poverty, ethnic minority status, and rural residence are associated with poor health and food insecurity (lack of access to affordable, nutritionally valuable food). To address food-related health disparities, we will create healthy delicious frozen meals for sale in local corner stores using food from local farmers produced in local commercial kitchens and sold at a subsidized price. By improving community nutrition and job opportunities, we hope to improve the health of the community.

Project Terms:
Agriculture; agricultural; Altruism; altruistic; Budgets; United States Centers for Disease Control and Prevention; United States Centers for Disease Control; Centers for Disease Control and Prevention; Centers for Disease Control; CDC; Centers for Disease Control and Prevention (U.S.); chronic disorder; Chronic Illness; Chronic Disease; Color; Communities; diabetes; Diabetes Mellitus; dietary; Diet; whole grain; Dietary Fiber; Cognitive Discrimination; Discrimination; Economical Development; Economic Development; Economics; Educational aspects; Education; healthcare expenditure; health care expenditure; Health Expenditures; facial; faces; Face; Family; Family Sizes; Food or Food Product; Food; Freezing; Health; heart disorder; Cardiac Disorders; Cardiac Diseases; Heart Diseases; Economical Income; Economic Income; Income; Marketing; Meat; Motivation; North Carolina; nutrition; obese population; obese person; obese people; obese; corpulentia; corpulency; corpulence; adiposity; Obesity; Professional Positions; Jobs; Occupations; web based; online computer; On-Line Systems; Online Systems; pilot study; Pilot Projects; Poverty; pressure; Production; Research; Research Resources; Resources; Running; Sales; Schools; Seasons; Na element; Sodium; Survey Instrument; Surveys; Testing; Leanness; Thinness; Time; Tobacco; unemployed; out of work; joblessness; jobless; Unemployment; dietary vegetable; Vegetables; Work; Generations; pricing; Price; Businesses; Rural Community; Food Vending Machine; Workplace; work setting; Worksite; Work-Site; Work Place; Work Location; Job Site; Job Setting; Job Place; Job Location; Label; improved; nutrition education; diet education; Link; farmer; Distress; Conscious; Consciousness; wasting; Rural; satisfaction; Collaborations; Health Food; healthy food; fast food; convenience food; Life; programs; Slide; Red Pepper; Green Pepper; Bell Peppers; Source; Country; S-nitro-N-acetylpenicillamine; SNAP; Collard Greens; interest; Services; empowered; Recipe; Modeling; Sweet potato - dietary; Sweet Potato; Pseudo Yam; disparity in health; health disparity; Dietary intake; Low income; Address; Food Safety; Nutritional; nutritious; Process; Community Health; Development; developmental; web site; website; cost; Food Access; Chronic Care; ethnic minority population; ethnic minority; community organizations; combat; evidence base; health equity; Healthy Eating; rural poverty; rural residence; rural households; rural dwelling; service delivery; Food production; food insecurity

Low-income and ethnic minority status as well as rural residence are strong predictors of poor health. Contributors to high chronic disease rates include food insecurity (lack of access to affordable, nutritious food) and lack of economic opportunity. Rural poverty in the Southeast is exacerbated by historical discrimination against Black farmers, and ongoing structural racism. At the intersection of diet and wellbeing, the blue-collar workforce is particularly vulnerable to the conditions and impacts of poor nutrition on health and productivity, as these typically low-wage workers face heightened challenges surrounding accessibility (affordability and convenience) of healthy food, yet rely on good health to support often physically demanding labor. Few approaches to mitigating health disparities have addressed both healthy food access and economic opportunity. Equiti Foods developed Good Bowls as healthy, affordable, good-tasting frozen meals that are convenient, locally-produced, and culturally-conscious. Our mission is to decrease health disparities by increasing the availability and consumption of nutritious food in high-need communities while providing economic opportunities for local farms and small businesses. We propose rigorously testing Good Bowls' health impact and potential health care costs savings in rural blue-collar worksites. Our solution leverages the team's nutrition expertise to create culturally appealing meals by adapting the evidence- based Mediterranean diet to southeastern seasonal availability and taste preferences ("Med-South"). We partner with local farms and businesses to produce the bowls, making use of normally wasted seasonal excess or "cosmetically challenged" produce to curb costs and expand markets for farmers. To create a sustainable business model, Good Bowls are sold using a cost-offset subsidy approach, allowing for needs-based pricing. In our worksite RCT, subsidized Good Bowls will be paired with smart phone digital infrastructure enabling Bluetooth nudges at the worksite and educational programing for home and family. The Specific Aims of this Phase II project are: 1) Establish Employee Wellness Committees to refine implementation strategies and facilitate engagement with blue-collar workers and families; 2) Test the impact of subsidized Good Bowls availability and promotion alone (Good Bowls) relative to Good Bowls + the phone App nudge and home- based education program (Nudge/Education) using a delayed intervention randomized controlled trial; and 3) Further develop and test our cost-offset model using both direct-to-consumer and retail sales to assess the volume and pricing of high end sales needed to support the social mission. We will also assess health care- related cost savings for worksites and economic benefits to partner businesses (farms, caterers, non-profits) involved with Good Bowls production. Working in partnership with rural blue-collar worksites and with local farms and businesses, Equiti Foods seeks to reduce health disparities by improving the dietary intake of those at greatest risk for chronic disease while creating economic opportunity in rural communities.

Public Health Relevance Statement:
Narrative - Reducing food insecurity and increasing economic opportunity are key to combatting health disparities in low- income communities. Recognizing this, Equiti Foods created Good Bowls, healthy frozen meals that are made affordable through a cost-offset business model allowing for needs-based pricing. Working in partnership with rural blue-collar worksites and with local farms and businesses, Equiti Foods seeks to improve the dietary intake of those at greatest risk for chronic disease while creating economic opportunity for struggling businesses.

Project Terms:
Adoption; Adult; 21+ years old; Adult Human; adulthood; Attitude; Behavior Therapy; Behavior Conditioning Therapy; Behavior Modification; Behavior Treatment; Behavioral Conditioning Therapy; Behavioral Modification; Behavioral Therapy; Behavioral Treatment; Conditioning Therapy; behavior intervention; behavioral intervention; Belief; Cardiovascular Diseases; cardiovascular disorder; Carotenoids; Carotenes and Carotenoids; carotenoid biosynthesis; Chronic Disease; Chronic Illness; chronic disorder; Communities; Cosmetics; cosmetic product; Non-Insulin-Dependent Diabetes Mellitus; Adult-Onset Diabetes Mellitus; Ketosis-Resistant Diabetes Mellitus; Maturity-Onset Diabetes Mellitus; NIDDM; Non-Insulin Dependent Diabetes; Noninsulin Dependent Diabetes; Noninsulin Dependent Diabetes Mellitus; Slow-Onset Diabetes Mellitus; Stable Diabetes Mellitus; T2 DM; T2D; T2DM; Type 2 Diabetes Mellitus; Type 2 diabetes; Type II Diabetes Mellitus; Type II diabetes; adult onset diabetes; ketosis resistant diabetes; maturity onset diabetes; type 2 DM; type II DM; type two diabetes; Diet; diets; Discrimination; Cognitive Discrimination; Economics; Education; Educational aspects; Ethnic group; Ethnic People; Ethnic Population; Ethnicity People; Ethnicity Population; ethnicity group; Face; faces; facial; Family; Food; Food or Food Product; Freezing; Health; Heart; Household; Low Income Population; Minority Groups; Minority People; Minority Population; Mission; Morale; nutrition; Obesity; adiposity; corpulence; Personal Satisfaction; well-being; wellbeing; Production; Productivity; Research; Restaurants; Risk; Wages; Salaries; Sales; Social support; social support network; Taste Perception; Gustation; Taste; gustatory perception; gustatory processing; gustatory response; taste processing; taste response; Telephone; Phone; Testing; Transportation; Wellness Program; Work; Measures; Price; pricing; Cost Savings; Health Care Costs; Health Costs; Healthcare Costs; African American; Afro American; Afroamerican; Black Populations; black American; Businesses; Healthcare; health care; Rural Community; Workplace; Job Location; Job Place; Job Setting; Job Site; Work Location; Work Place; Work-Site; Worksite; work setting; base; density; improved; Site; Area; Phase; farmer; Conscious; Consciousness; Individual; Rural; Randomized Controlled Trials; Health Food; healthy food; convenience food; fast food; Life; programs; Farm; farm environment; Farming environment; Supermarket; empowered; American; Employee; Structure; Reporting; Modeling; Intervention Strategies; interventional strategy; Intervention; Enhancement Technology; Cell Phone; Cellular Telephone; iPhone; smart phone; smartphone; Cellular Phone; Mediterranean Diet; disparity in health; health disparity; Dietary intake; Low income; Address; Measurable; randomisation; randomization; randomly assigned; Randomized; Nutritional; nutritious; pandemic disease; pandemic; cost; digital; design; designing; Minority; Food Access; Consumption; ethnic minority population; ethnic minority; racial and ethnic; ethnoracial; fruits and vegetables; evidence base; primary outcome; secondary outcome; health equity; phase 2 study; phase II study; Taste preferences; racial minority; rural poverty; lower income families; rural residence; rural dwelling; rural households; farmers markets; agricultural community; Bluetooth; implementation strategy; strategies for implementation; Infrastructure; food insecurity; virtual coach; coronavirus disease; COVID; CoV disease; corona virus disease; economic disparity; poor communities; impoverished communities; poverty communities; Job loss; Home; Structural Racism; implementation facilitation; food desert