# Systems Science Approaches to Improve Access to Healthier Foods: The FRESH Trial

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2024 · $515,485

## Abstract

Project Summary
High dietary quality is protective against cancer. Previous work to improve dietary quality by changing the food
environment has emphasized increasing access to healthy foods in retail stores, but relatively little attention
has focused on intervening in independently owned restaurants, which have the potential to contribute to
cancer prevention in predominantly minority, low-income urban neighborhoods. Our team has worked
extensively with these types of restaurants to increase access to and promote healthier entrees, sides and
beverages, leading to significant increases in total revenues, sales, and purchasing of promoted foods.
Stemming from that work, this study has two interrelated objectives to sustainably improve access to and
promotion of healthier foods in independently owned restaurants: 1) to use systems science approaches to
refine, implement and test the effects of a novel intervention (FRESH: Focus on Restaurant Engagement to
Strengthen Health) on dietary quality, and health of regular customers, among other outcomes; and 2) to use
FRESH formative, baseline, implementation and outcome data to develop, parametrize, and calibrate a system
dynamics model that will allow stakeholders to virtually test the effects of FRESH strategies on outcomes in
their own communities. FRESH is a multilevel theory- and practice-based intervention for independently owned
restaurants with 3 core components: food preparation, food access & procurement, and consumer nutrition
environment. Aim 1) To use systems science approaches to refine existing materials from our successful
restaurant interventions and adapt the intervention to two urban sites (Baltimore and the DC metro area) that
are predominantly low-income and minority (African American and Latinx). Aim 2) To implement FRESH in 24
independently owned restaurants across both sites during 16 months and collect process data. Aim 3) To
assess the impact of FRESH using a multisite cluster randomized controlled trial on dietary quality (primary
outcome); health indicators; psychosocial factors of regular customers (n=576), and evaluate its impacts on
unit sales and weekly revenues. Primary Hypothesis: Regular customers of participating restaurants in FRESH
intervention neighborhoods will demonstrate at least a 5-point increase in Healthy Eating Index score, as
compared to restaurant customers in comparison neighborhoods. Data from Aims 1- 3 will be used to develop,
parameterize, and calibrate a system dynamics model to simulate the effects of FRESH intervention strategies
under different scenarios, leading to Aim 4) To disseminate a planning tool that enables stakeholders to
simulate and virtually test FRESH intervention strategies in other urban contexts, visualizing potential effects
on unit sales, revenues, customer health indicators, and cancer-prevention dietary behaviors, via a web-based
user-friendly interactive dashboard. This study will yield results that are both novel and signifi...

## Key facts

- **NIH application ID:** 10890107
- **Project number:** 5R01MD018022-03
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Uriyoan Colon-Ramos
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $515,485
- **Award type:** 5
- **Project period:** 2022-09-26 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10890107

## Citation

> US National Institutes of Health, RePORTER application 10890107, Systems Science Approaches to Improve Access to Healthier Foods: The FRESH Trial (5R01MD018022-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10890107. Licensed CC0.

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