Adoption and Reach of a statewide policy, systems, and environment intervention to increase access to fresh fruits and vegetables in West Virginia.

Food deserts-areas with limited access to affordable, healthy foods-are disproportionately in low-income areas of the USA and have been linked with poorer nutrition behaviors and health outcomes. From a social ecological perspective, increasing access to affordable fresh fruits and vegetables in communities should encourage consumption and health improvements. Change the Future West Virginia, a statewide intervention, was undertaken to make policy, system, and environment (PSE) changes to enhance access to fresh fruits and vegetables in schools, farmers markets, and retail food outlets. Previous local scale PSE change interventions have shown feasibility and population reach, but broader dissemination has not been evaluated. Thus, the purpose was to evaluate the Adoption and Reach of Change the Future West Virginia statewide nutrition-based PSE strategies, especially in food deserts. Evaluation data were collected monthly using an online performance monitoring tool, including open-ended items to assess barriers and facilitators of PSE changes. Schools from 48 of 55 counties with 261,829 enrollment (54% low-income) implemented 231 PSE activities, resulting in 35 counties serving locally produced foods. Adoption included two thirds (n = 82) of all farmers markets in the state-signed collaboration agreements, adding electronic benefit transfer machines at 29. Retail food Adoption included signed agreements with 22.1% (n = 101) of all grocery stores and 14.1% (n = 162) of all convenience stores in the state reaching 110,258 people (21.5%) in 27 food desert census tracts. Personnel consistency, local connections, and in-person meetings were important for PSE changes, highlighting the importance of human resources in the rural public health system and the potential of these intervention activities in rural, low-income states.