Optimization Trial to Empower sElection of Nutritious Foods

OPT-TEEN: Optimization Trial to Empower sElection of Nutritious Foods

Type 2 diabetes (T2D) disproportionately affects Black and Hispanic youth compared to their White peers. Although prediabetes can rapidly progress, youth who maintain or lose weight are able to revert the condition. Youth-led online Diabetes Prevention Programs (DPP) show promise for improving healthy behaviors, but alone does not address systemic barriers, such as affordability, availability, and accessibility of healthy foods, hindering adoption of lifestyle changes. Low-income Black and Hispanic youth are more likely to live in communities with low access to affordable and healthy foods, that protect against T2D. Online grocery shopping has the potential to improve access by addressing transportation barriers. However, delivery fees and digital literacy may unintentionally widen inequities. To address these gaps, this proposal will leverage existing national programs (USDA's Online Purchasing Pilot and online-DPP) to test three experimental components (Youth-led Online DPP, Financial Incentive, Instant Shoppable List). This work will aim to 1) conduct formative research to gather barriers, facilitators of fruit, vegetable, and legume (FVL) purchase and consumption among ethnically diverse, low-income families with youth (12-17 years old); 2) determine the combination of intervention components that maximizes the effect on household purchase and youth consumption of FVL and sugar. A multiphase optimization strategy (MOST) on a 23 factorial randomized, controlled study will estimate both individual and interactive effects of each intervention component. This research will generate new knowledge about behavioral, social, cultural, environmental, and policy factors that influence healthy eating, which can be used to address disparities in obesity and T2D among low-income youth.

OPT-TEEN will utilize the Multiphase Optimization Strategy (MOST), a highly efficient methodological approach for intervention development, partnering with the private sector (Instacart) to leverage strategies from the public sector (SNAP) and test three experimental components designed to reduce barriers to online healthy food selection. These three components consist of 1) an online youth-led advocacy health promotion program (youth-led wellness program), 2) a weekly financial incentive match of up to $10 for purchasing fruits, vegetables, and legumes (FVL) online, and 3) weekly instant shoppable grocery lists featuring tailored meal suggestions using SNAP-Ed recipes. To promote equity in enrollment and support digital literacy, all participants will receive a baseline package during the 12-week intervention period, informed by a prior pilot study demonstrating that waiving delivery fees enabled more equitable participant enrollment and online grocery uptake, which includes waived online delivery fees, a tutorial video and setup call addressing digital literacy, a monthly service fee waiver (3 in total), and a monthly $5 stipend applied toward service fees (3 in total). A sample of 200 families with youth ages 12 to 17 who are at risk for Type 2 Diabetes (T2D) and living in low-income urban communities across New York City will be randomized to receive a specific combination of these experimental components for 12 weeks, with component effects tested immediately post-intervention and behavioral maintenance evaluated in the absence of the intervention (no fee waivers or experimental components) at 9 months post-intervention. Prior to implementation, formative research will be conducted to ensure cultural tailoring and youth relevance by holding 25 to 30 in-depth interviews with Bronx-serving policymakers, community-based organization (CBO) leaders, caregivers, and older youth (ages 18 to 22) with lived experience in the Bronx. These interviews will guide the development of all intervention materials and research procedures structured around six key dimensions of the Ecological Validity Model: language (wording and tone feedback on materials), persons (recruitment strategies and "buy-in" factors), metaphors (symbols and sayings that resonate), content (grocery items to address food insecurity and cultural appropriateness), methods (evaluation of text messages, online surveys, and delivery), and context (assessing barriers to participation and protocol adherence). Additionally, the team will conduct 2 to 3 focus group discussions with Bronx youth ages 12 to 22 to gather specific, targeted feedback on the youth-led advocacy health promotion program.

Inclusion Criteria:

Adult (> 21 years old)

Live in a household with a young child(ren) under the age of 18 years and above age 12

Youth must be 12 to 17 and at-risk for Type 2 Diabetes

Primary shopper for the household

Have access to a smartphone or computer to place online orders

Participation in the Supplemental Nutrition Assistance Program in the past year or income eligible (annual household income =< 130% of the federal poverty line)

Agree to share itemized grocery receipts during the study (12 months)

Willing to order groceries online

English or Spanish speaker

Informed consent