Design of the Focus on Restaurant Engagement to Strengthen Health (FRESH) study: leveraging systems science to work with independently-owned restaurants to increase access to and promotion of healthful foods

Authors

Uriyoán Colón-Ramos, Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, United States.
Emma C. Lewis, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
Anna Claire Tucker, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
Lisa Poirier, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
Chathurangi H. Pathiravasan, Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
Michelle Estradé, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
Takeru Igusa, Department of Civil and Systems Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, United States.
Julia A. Wolfson, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
Yeeli Mui, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
Veronica Vélez-Burgess, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
Audrey E. Thomas, Department of Health Education and Health Communication, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
Shuxian Hua, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
Lawrence J. Cheskin, Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, United States.
Antonio J. Trujillo, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
Ayoyemi T. Oladimeji, Department of Civil and Systems Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, United States.
Stacey Williamson, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
Rosalinda Romero, Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, United States.
Patricia Sánchez Hernández, Columbian College of Arts and Sciences, George Washington University, Washington, DC, United States.
Joel Gittelsohn, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.

Document Type

Journal Article

Publication Date

1-1-2024

Journal

Frontiers in public health

Volume

12

DOI

10.3389/fpubh.2024.1427792

Keywords

dietary quality; food disparities; food systems; formative research; group model building; healthy eating index; restaurants; systems science

Abstract

BACKGROUND: High dietary quality can protect against diet-related chronic diseases. In the United States, racial and ethnic minorities and those with lower incomes consistently exhibit lower dietary quality. Independently-owned restaurants are a common prepared food source in minority low-income communities, but there are significant knowledge gaps on how to work with these restaurants to offer healthy food, due to underlying and dynamic complexities associated with providing healthy food options. METHODS: The Focus on Restaurant Engagement to Strengthen Health (FRESH) study addresses this complex problem by leveraging systems science approaches to work with independently-owned restaurants. FRESH has two interrelated objectives: (1) to test impact on regular customer dietary quality via a multisite cluster randomized controlled trial in two low-income urban areas (Baltimore and the Washington DC metropolitan area), and (2) to use systems science approaches to develop, parameterize, and calibrate a simulation model. The intervention is theory-and practice-based, comprising three phases: restaurant engagement, low-sugar beverages and healthy meals. The FRESH intervention will be implemented for 12 months in a total of 24 intervention and 24 comparison restaurants. The study is powered to detect a 5-point change in the Healthy Eating Index (HEI) score of regular customers, which would signify a meaningful shift toward healthier eating patterns. DISCUSSION: The FRESH study will test a novel, multilevel, multisite intervention that aims to improve access to healthier prepared food options among small, independently-owned restaurants located in under-resourced settings. The design of the FRESH intervention and its evaluation are described, as well as plans for the development of a system dynamics simulation model for policymakers and other stakeholders to virtually test future restaurant-based interventions. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov, identifier, NCT05869149.

APA Citation

Colón-Ramos, Uriyoán; Lewis, Emma C.; Tucker, Anna Claire; Poirier, Lisa; Pathiravasan, Chathurangi H.; Estradé, Michelle; Igusa, Takeru; Wolfson, Julia A.; Mui, Yeeli; Vélez-Burgess, Veronica; Thomas, Audrey E.; Hua, Shuxian; Cheskin, Lawrence J.; Trujillo, Antonio J.; Oladimeji, Ayoyemi T.; Williamson, Stacey; Romero, Rosalinda; Hernández, Patricia Sánchez; and Gittelsohn, Joel, "Design of the Focus on Restaurant Engagement to Strengthen Health (FRESH) study: leveraging systems science to work with independently-owned restaurants to increase access to and promotion of healthful foods" (2024). GW Authored Works. Paper 6399.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6399

Department

Global Health