A Multi-Pronged Evaluation of a Healthy Food Access Initiative in Central Texas: Study Design, Methods, and Baseline Findings of the FRESH-Austin Evaluation Study.

Food insecurity and limited healthy food access are complex public health issues and warrant multi-level evaluations. The purpose of this paper was to present the overall study design and baseline results of the multi-pronged evaluation of a healthy food access (i.e., Fresh for Less (FFL)) initiative in Central Texas. The 2018-2021 FRESH-Austin study was a natural experiment that utilized a cluster random sampling strategy to recruit three groups of participants (total n = 400): (1) customers at FFL assets, (2) residents that lived within 1.5 miles of an FFL asset, and (3) residents from a comparison community. Evaluation measures included annual cohort surveys, accelerometers and GPS devices, store-level audits, and built environment assessments. Data are being used to inform and validate an agent-based model (ABM) to predict food shopping and consumption behaviors. Sociodemographic factors and food shopping and consumption behaviors were similar across the three groups; however, customers recruited at FFL assets were lower income and had a higher prevalence of food insecurity. The baseline findings demonstrate the need for multi-level food access interventions, such as FFL, in low-income communities. In the future, ABM can be used as a cost-effective way to determine potential impacts of future large-scale food environment programs and policies.