A Mixed-Methods Evaluation of a SNAP-Ed Farmers' Market-Based Nutrition Education Program.

OBJECTIVE: Evaluate the effectiveness of the Stellar Farmers' Market program. DESIGN: Mixed methods including focus groups and a quasi-experiment comparing a control group of market shoppers who had never attended a class, participants attending 1 class, and participants attending ≥ 2 classes. SETTING: Eighteen farmers' markets in New York City. PARTICIPANTS: A total of 2,063 survey respondents; 47 focus group participants. INTERVENTION: Farmers' market-based nutrition education and cooking classes paired with vouchers for fresh produce. MAIN OUTCOME MEASURES: Attitudes, self-efficacy, and behaviors regarding fruit and vegetable (FV) preparation and consumption. ANALYSIS: Bivariate and regression analysis examined differences in outcomes as a function of number of classes attended. Qualitative analysis based on a grounded theory approach. RESULTS: Attending ≥ 1 classes was associated with more positive attitudes toward consuming FV; attending ≥ 2 classes was associated with greater FV consumption and higher self-efficacy to prepare and consume produce. Respondents attending ≥ 2 classes consumed almost one-half cup more FV daily than others. These associations remained after controlling for age, race/ethnicity, education, and gender. CONCLUSIONS AND IMPLICATIONS: Offering nutrition education and cooking classes at farmers' markets may contribute to improving attitudes, self-efficacy, and behaviors regarding produce preparation and consumption in low-income populations.

Impacts of a farmers' market incentive programme on fruit and vegetable access, purchase and consumption.

OBJECTIVE: The present study examines the impact of Health Bucks, a farmers' market incentive programme, on awareness of and access to farmers' markets, and fruit and vegetable purchase and consumption in low-income New York City neighbourhoods. DESIGN: The evaluation used two primary data collection methods: (i) an on-site point-of-purchase survey of farmers' market shoppers; and (ii) a random-digit-dial telephone survey of residents in neighbourhoods where the programme operates. Additionally, we conducted a quasi-experimental analysis examining differential time trends in consumption before and after programme introduction using secondary Community Health Survey (CHS) data. SETTING: New York City farmers' markets and communities. SUBJECTS: Farmers' market shoppers (n 2287) completing point-of-purchase surveys in a representative sample of New York City farmers' markets in 2010; residents (n 1025) completing random-digit-dial telephone survey interviews in 2010; and respondents (n 35 606) completing CHS interviews in 2002, 2004, 2008 and 2009. RESULTS: Greater Health Bucks exposure was associated with: (i) greater awareness of farmers' markets; (ii) increased frequency and amount of farmers' market purchases; and (iii) greater likelihood of a self-reported year-over-year increase in fruit and vegetable consumption. However, our CHS analysis did not detect impacts on consumption. CONCLUSIONS: While our study provides promising evidence that use of farmers' market incentives is associated with increased awareness and use of farmers' markets, additional research is needed to better understand impacts on fruit and vegetable consumption.