Can encouraging participation in local farmers markets improve fruit and vegetable consumption among mothers? -- Implications for communication and community initiatives from the ReadNPlay for a Bright Future initiative

There remains significant disparities in fruit and vegetable (F&V) intake among low-income and rural populations despite the documented health benefits. In 2013, only 46.3% and 25.4% of Tennessee adults reported consuming F&V less than one time daily respectively. Low-income households face many barriers to accessing healthy foods. Farmers markets (FM) have the potential to improve the health of underserved communities, shape people’s perceptions/behaviors about healthy eating. Well Child Visits (WCV) communication and provider modeling of healthy behaviors about the use of farmers market may influence food-related perceptions and dietary behaviors among families with infants addressed as part of a multi-level, multi-component intervention project called ReadNPlay for a Bright Future. We identified barriers/perceptions and analyzed the associations between availability of food venues (FM and grocery stores) and F&V consumption among mothers of 9-24 months infants presenting for WCV at a pediatrics clinic in rural Appalachian, Tennessee. We recruited a convenience sample of mothers of children at a pediatrics clinic in a large rural hospital in Tri-cities, Tennessee. We facilitated two FM events within our community by distributing $10 coupons to mothers during WCV for purchasing F&V and by hosting a ReadNPlay family event at the market. 80 mothers of 9-24 month infants completed an anonymous written survey during a WCV during summer 2013. 76% of these mothers (with 9-24 months-old infants) reported receiving WIC. The frequency of use of local FM for shopping was predictive of daily consumption of F&V (p<0.014) among the 47.3% of mothers who shop at FM. Increased F&V consumption was also independently associated with participation in FM. An expressed preference for shopping at the local FM over grocery stores based on taste/quality of items, prices, and enjoyment of the experience determined the mothers amount of F&V servings per day (p<0.03). Clinic surveys during WCV identified opportunities for improving education about healthy eating. Novel clinical tools, including the ReadNPlay BabyBook, may facilitate communication about the use of local FM in a rural population of low-income families. Understanding these factors may inform public health approaches to increase fresh F&V consumption in communities at high risk for preventable chronic diseases.