Basheerah Enahora, PhD, MBA, RDN, LDN

(tentative) This project utilizes evidence-based obesity prevention strategies in multiple community settings, in order to provide an integrated approach to healthy eating and physical activity in the eastern NC counties with the highest obesity rates.

Clemson, NC State and three other Land Grant University Cooperative Extensions will implement and evaluate evidence-based strategies in counties identified as ���high need��� to improve diabetes self-care practices, quality of care, and early detection of complications among people with diabetes. Clemson University will apply for Component B of this NOFO. NC State will receive a sub-award in the amount of $100,000-$150,000 per year.

Increasing access to healthy foods is crucial to combating health disparities in rural communities. The Ripe for Revival mobile market, a non-profit eastern NC-based mobile market, seeks to improve healthy food access among those at greatest risk of food insecurity and diet-related chronic disease. By implementing vouchers at the mobile market, we will evaluate voucher redemption and nutrition-related program impacts (fruit and vegetable intake, food security, nutrition security) among voucher recipients. We will also assess the volume and dollars of local produce purchased at the mobile market. This project is poised to improve diet and health among rural residents in six NC counties and promote sustainable local food systems in North Carolina.

NC State University/NC State Extension has launched an innovative produce prescription program, PhytoRx Families, that addresses health inequities in rural North Carolina. The program consists of numerous community collaborations, including the Division of Public Health, United Health Care, local farmers, and federally qualified health centers (FQHCs). The program focuses on rural North Carolina families with school-aged children at greatest risk of food insecurity and diet-related chronic disease. PhytoRx Families consists of (1) training healthcare providers at Federally Qualified Health Centers (FQHCs) via a 4-hour self-paced virtual course on nutrition basics that can be completed from numerous devices (i.e., phone, tablet, computer), and prescribing FV to their patients, (2) sixteen weeks of fresh fruits and vegetables (~15 lbs.; feeds a family of 4 roughly 7-8 servings of fruits and vegetables; seasonal locally sourced as much as possible) delivered weekly to participants��� homes by a local food hub, (3) and a sixteen-week culturally adapted nutrition/culinary education program (adapted from Expanded Food and Nutrition Education Program (EFNEP) Families Eating Smart Moving More curriculum) with in-person sessions every other week for the entire family delivered by NC Cooperative Extension staff. These unique program features address the challenges of equitable access to healthy foods, food security, and nutritional care, which many rural NC communities face.

Increasing access to healthy foods is crucial to combating health disparities in rural communities. The Ripe for Revival mobile market, a non-profit eastern NC-based mobile market, seeks to improve healthy food access among those at greatest risk of food insecurity and diet-related chronic disease. By implementing vouchers at the mobile market, we will evaluate voucher redemption and nutrition-related program impacts (fruit and vegetable intake, food security, nutrition security) among voucher recipients. We will also assess the volume and dollars of local produce purchased at the mobile market. This project is poised to improve diet and health among rural residents in six NC counties and promote sustainable local food systems in North Carolina.

Low-income, ethnic minority status, and rural residence are strong predictors of chronic diseases such as cardiovascular disease, type 2 diabetes, and obesity. Poor nutrition and food insecurity contribute to an increased risk of chronic disease, a significant public health concern among adults and children in low-income households. Equiti Foods developed Good Bowls as healthy, affordable, good-tasting, locally-produced frozen meals to address both healthy food access and economic opportunity. While Good Bowls fills a critical need, learning food resource management skills can improve nutrition quality by helping families purchase healthy foods while stretching dollars. Developing culinary skills also increases cooking confidence and teaches individuals to select and prepare healthy meal options. Delivering culinary and food resource management education through mobile health (mHealth) holds promise to easily help low-income individuals acquire new skills and reinforce nutrition behaviors. Thus, this diversity supplement aims to pilot test tailored educational messages, videos, and text-message reinforcement to encourage the uptake of culinary and food resource management skills (CulinaryFRM going forward). We hypothesize that those receiving CulinaryFRM education will have higher diet quality (assessed using the modified Med-Diet 14 item validated screener in the parent study). The Specific Aims of this diversity supplement are: (1) to pilot test CulinaryFRM, randomizing the participants in the delayed intervention control arm of the parent study to either Good Bowls + Worksite-App nudges and home-based virtual coaching + Home- based CulinaryFRM or Good Bowls + Worksite-App nudges, (2) assess the feasibility and acceptability of delivering CulinaryFRM via the mobile phone-based app of the parent study, (3) determine the efficacy of CulinaryFRM on diet quality (primary outcome assessed using the Med-Diet 14 item validated screener), culinary skills, and food resource management (FRM) skills. The information gained from this research will provide the necessary foundation for the development of mHealth-based personalized culinary nutrition-focused interventions to improve health outcomes among low-income families.