{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T17:25:06Z","timestamp":1787851506827,"version":"build-2784847793"},"reference-count":43,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005825","name":"National Institute of Food and Agriculture","doi-asserted-by":"publisher","award":["2022-68015-36497"],"award-info":[{"award-number":["2022-68015-36497"]}],"id":[{"id":"10.13039\/100005825","id-type":"DOI","asserted-by":"publisher"}]},{"award":["2022-68015-36497"],"award-info":[{"award-number":["2022-68015-36497"]}],"id":[{"id":"https:\/\/ror.org\/05qx3fv49","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Rural Appalachian communities experience high rates of food insecurity, poor diet quality, and chronic disease. Community-based participatory research (CBPR) and policy, systems, and environmental (PSE) approaches may improve nutrition-related outcomes through locally tailored interventions. This study evaluated the impact of Laurel HARVEST (Helping Appalachia Restore a Vibrant Food Environment for Self-Sufficiency, Together) on dietary quality and food security in Appalachian Kentucky. Methods: A prospective cohort study was conducted in Laurel County, Kentucky (intervention) and Pike County, Kentucky (comparison). Adults aged \u226518 years were recruited at baseline (2022\u20132023) and followed through 2025. CBPR-guided interventions included nutrition education, recipe card dissemination, raised bed gardens, and community mini-grants. Outcomes included Healthy Eating Index (HEI) scores derived from 24 h dietary recalls, dermal carotenoid concentrations measured using the Veggie Meter\u00ae, and food security assessed with the USDA 10-item Household Food Security Module. Results: A total of 282 participants were enrolled at baseline (Laurel n = 121; Pike n = 161), and 147 completed follow-up assessments. Dermal carotenoid scores increased significantly more in Laurel County (37.3 points) than in Pike County (13.3 points) (p = 0.032). No significant between-county differences were observed for total HEI score or food security. Conclusions: CBPR-driven, multilevel interventions were associated with modest improvements in fruit and vegetable intake but did not significantly improve overall dietary quality or food security. Longer-term structural and policy-level approaches may be needed to address nutrition and food access challenges in rural Appalachian communities.<\/jats:p>","DOI":"10.3390\/nu18172813","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:47:13Z","timestamp":1787849233000},"page":"2813","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Community-Based Participatory Approaches to Improve Diet Quality and Food Security in Rural Appalachia: Outcomes from the Laurel HARVEST Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6332-215X","authenticated-orcid":false,"given":"Makenzie","family":"Barr-Porter","sequence":"first","affiliation":[{"name":"Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40546, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6897-9337","authenticated-orcid":false,"given":"Courtney","family":"Luecking","sequence":"additional","affiliation":[{"name":"Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40546, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4355-7672","authenticated-orcid":false,"given":"Stacey","family":"Slone","sequence":"additional","affiliation":[{"name":"Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, KY 40536, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4219-0298","authenticated-orcid":false,"given":"Dawn","family":"Brewer","sequence":"additional","affiliation":[{"name":"Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40546, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joley","family":"Helton","sequence":"additional","affiliation":[{"name":"Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40546, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashton","family":"Potter","sequence":"additional","affiliation":[{"name":"The Food Connection, University of Kentucky, Lexington, KY 40506, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Cardarelli","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health, University of Louisville, Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e615","DOI":"10.1161\/CIR.0000000000000753","article-title":"Call to action: Rural health: A presidential advisory from the American Heart Association and American Stroke Association","volume":"141","author":"Harrington","year":"2020","journal-title":"Circulation"},{"key":"ref_2","unstructured":"American Diabetes Association (2026, June 20). Help Prevent Diabetes. Treat Obesity. Available online: https:\/\/diabetes.org\/sites\/default\/files\/2025-05\/the-burden-of-obesity-kentucky-05-08-25.pdf."},{"key":"ref_3","unstructured":"Centers for Disease Control and Prevention (2026, June 20). BRFSS Prevalence & Trends Data, Available online: https:\/\/www.cdc.gov\/brfss\/brfssprevalence\/."},{"key":"ref_4","unstructured":"Appalachian Regional Committee (2026, June 20). Health Disparities in Appalachian Kentucky, Available online: https:\/\/www.arc.gov\/wp-content\/uploads\/2020\/07\/KYHealthDisparitiesKeyFindings8-17.pdf."},{"key":"ref_5","unstructured":"Feeding America (2026, June 20). Who Faces Hunger?. Available online: https:\/\/www.feedingamerica.org\/hunger-in-america\/who-faces-hunger."},{"key":"ref_6","unstructured":"(2026, June 25). America\u2019s Health Rankings. Food Insecurity (Households). Available online: https:\/\/www.americashealthrankings.org\/explore\/measures\/food_insecurity_household."},{"key":"ref_7","unstructured":"Appalachian Regional Committee (2026, June 22). Food Insecurity in the Appalachian Region: Report, Available online: https:\/\/www.arc.gov\/wp-content\/uploads\/2023\/11\/Food-Insecurity-in-Appalachia-Report.pdf."},{"key":"ref_8","unstructured":"United Health Foundation (2026, June 26). America\u2019s Health Rankings Analysis of U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Fruit & Vegetable Consumption in Kentucky. Available online: https:\/\/www.americashealthrankings.org\/explore\/measures\/fvcombo\/KY."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1037\/amp0000167","article-title":"Community-based participatory research (CBPR): Towards equitable involvement of community in psychology research","volume":"73","author":"Collins","year":"2018","journal-title":"Am. Psychol."},{"key":"ref_10","unstructured":"Kentucky Cooperative Extension Service (2026, June 26). Overview of Kentucky Cooperative Extension. Available online: https:\/\/ces-manuals.mgcafe.uky.edu\/overview-kentucky-cooperative-extension."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1146\/annurev-nutr-092021-050805","article-title":"Advancing health equity efforts to reduce obesity: Changing the course","volume":"42","author":"Kumanyika","year":"2022","journal-title":"Annu. Rev. Nutr."},{"key":"ref_12","unstructured":"University of Wisconsin Population Health Institute (2026, June 26). County Health Rankings & Roadmaps, Laurel, Kentucky. Available online: https:\/\/www.countyhealthrankings.org\/health-data\/kentucky\/laurel?year=2025."},{"key":"ref_13","unstructured":"Laurel County Health in Motion Coalition (2026, March 18). Community Health Assessment Laurel County. Available online: https:\/\/www.laurelcohealthdept.org\/s\/Laurel-Co-CHA-2023-with-descriptions.pdf."},{"key":"ref_14","unstructured":"Feeding America (2026, March 18). Hunger & Poverty in Kentucky: Map the Meal Gap. Overall (All Ages) Hunger & Poverty in the United States. Available online: https:\/\/map.feedingamerica.org\/county\/2023\/overall\/kentucky."},{"key":"ref_15","unstructured":"Centers for Disease Control and Prevention (2026, June 24). Diagnosed Diabetes\u2014Total, Adults Aged 20+ Years, Age-Adjusted Percentage, Laurel County, Kentucky, Available online: https:\/\/usdss.cdc.gov\/diabetes\/surveillance.html."},{"key":"ref_16","unstructured":"Catholic Health Initiative Saint Joseph Health (2026, June 22). 2025 Community Health Implementation Strategy and Plan. Available online: https:\/\/www.commonspirit.org\/content\/dam\/commonspiritorg\/en\/chisj\/soky\/marketing\/docs\/pdfs\/community\/2025-continuing-care-hospital-implementation-strategy.pdf."},{"key":"ref_17","unstructured":"University of Kentucky Cooperative Extension Service (2023). UK Extension Community Needs Assessment Summart of Respondents\u2019 Comments, Laurel County, University of Kentucky Cooperative Extension Service."},{"key":"ref_18","unstructured":"University of Wisconsin Population Health Institute (2026, June 24). County Health Rankings & Roadmaps, Pike, Kentucky. Available online: https:\/\/www.countyhealthrankings.org\/health-data\/kentucky\/pike?year=2025."},{"key":"ref_19","unstructured":"United States Census Bureau (2025). QuickFacts Pikeville City, Kentucky, United States Census Bureau."},{"key":"ref_20","unstructured":"Feeding America (2023). Food Insecurity in Pike County, Kentucky, Feeding America."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Luecking, C.T., Barr-Porter, M., Brewer, D., and Cardarelli, K.M. (2025). Community-Engaged Approach to Improve Food Access and Consumption of Fruits and Vegetables in a Rural Appalachian Community. Nutrients, 17.","DOI":"10.3390\/nu17030431"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1093\/tbm\/ibaa037","article-title":"Evaluation of a social marketing approach to healthy, home-cooked family meals for low-income mothers of young children","volume":"10","author":"Walters","year":"2020","journal-title":"Transl. Behav. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014A metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J. Biomed. Inform."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: Building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J. Biomed. Inform."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1016\/j.jand.2012.04.016","article-title":"The Automated Self-Administered 24-hour dietary recall (ASA24): A resource for researchers, clinicians, and educators from the National Cancer Institute","volume":"112","author":"Subar","year":"2012","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"233","DOI":"10.3945\/ajcn.114.083238","article-title":"Performance of the Automated Self-Administered 24-hour Recall relative to a measure of true intakes and to an interviewer-administered 24-h recall","volume":"100","author":"Kirkpatrick","year":"2014","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1016\/j.jand.2023.05.015","article-title":"Healthy eating index-2020: Review and update process to reflect the dietary guidelines for Americans, 2020\u20132025","volume":"123","author":"Pannucci","year":"2023","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"nzaa059_036","DOI":"10.1093\/cdn\/nzaa059_036","article-title":"Adoption, implementation and maintenance of the food and physical activity questionnaire for national nutrition education program evaluation","volume":"4","author":"Koenings","year":"2020","journal-title":"Curr. Dev. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"409.3","DOI":"10.1096\/fasebj.30.1_supplement.409.3","article-title":"Skin carotenoids as biomarker for vegetable and fruit intake: Validation of the reflection-spectroscopy based \u201cVeggie Meter\u201d","volume":"30","author":"Ermakov","year":"2016","journal-title":"FASEB J."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Di Noia, J., and Gellermann, W. (2021). Use of the spectroscopy-based Veggie Meter\u00ae to objectively assess fruit and vegetable intake in low-income adults. Nutrients, 13.","DOI":"10.3390\/nu13072270"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/02601060211022275","article-title":"Examining fruit and vegetable intake in low-income older adults using the Veggie Meter\u00ae","volume":"28","author":"Fultz","year":"2022","journal-title":"Nutr. Health"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Caparello, G., Groccia, G.D., Ceraudo, F., Cesario, M., Bonofiglio, R., Augimeri, G., and Bonofiglio, D. (2023). Association between Skin Carotenoid Score Measured with Veggie Meter\u00ae and Adherence to the Mediterranean Diet among Adolescents from Southern Italy. Nutrients, 15.","DOI":"10.3390\/nu15234920"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1016\/j.tjnut.2023.02.017","article-title":"Reflection Spectroscopy-Assessed Skin Carotenoids Are Sensitive to Change in Carotenoid Intake in a 6-Week Randomized Controlled Feeding Trial in a Racially\/Ethnically Diverse Sample","volume":"153","author":"Moran","year":"2023","journal-title":"J. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"107521","DOI":"10.1016\/j.cdnut.2025.107521","article-title":"Association of Veggie Meter-Assessed Skin Carotenoids and Dietary Intake Among Indigenous Families: The Indigenous Supported Agriculture \u201cGo Healthy\u201d Study","volume":"9","author":"Sisson","year":"2025","journal-title":"Curr. Dev. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"nzab104","DOI":"10.1093\/cdn\/nzab104","article-title":"Recommendations for the Use of the Veggie Meter\u00ae for Spectroscopy-Based Skin Carotenoid Measurements in the Research Setting","volume":"5","author":"Radtke","year":"2021","journal-title":"Curr. Dev. Nutr."},{"key":"ref_36","unstructured":"Economic Research Service U.S. Department of Agriculture (2026, June 24). Survey Tools: Food Security in the U.S, Available online: https:\/\/www.ers.usda.gov\/topics\/food-nutrition-assistance\/food-security-in-the-us\/survey-tools."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.nutres.2024.11.010","article-title":"A reflection-spectroscopy measured skin carotenoid score strongly correlates with plasma concentrations of all major dietary carotenoid species except for lycopene","volume":"133","author":"Wu","year":"2025","journal-title":"Nutr. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1017\/S1368980023001581","article-title":"Associations between food and beverage purchases and skin carotenoids among diverse small food retail store customers","volume":"26","author":"Dixon","year":"2023","journal-title":"Public Health Nutr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s12571-015-0433-1","article-title":"Systems, food security and human health","volume":"7","author":"Friel","year":"2015","journal-title":"Food Secur."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"103256","DOI":"10.1016\/j.jrurstud.2024.103256","article-title":"Social determinants of rural food security: Findings from Michigan\u2019s Upper Peninsula","volume":"107","author":"Lu","year":"2024","journal-title":"J. Rural Stud."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1093\/tbm\/ibaa138","article-title":"Physical activity and healthy eating behavior changes among rural women: An exploratory mediation analysis of a randomized multilevel intervention trial","volume":"11","author":"Lo","year":"2021","journal-title":"Transl. Behav. Med."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Norman-Burgdolf, H., DeWitt, E., Gillespie, R., Cardarelli, K.M., Slone, S., and Gustafson, A. (2023). Impact of community-driven interventions on dietary and physical activity outcomes among a cohort of adults in a rural Appalachian county in Eastern Kentucky, 2019\u20132022. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1142478"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"E117","DOI":"10.5888\/pcd16.190057","article-title":"Multilevel faith-based public health initiative in rural Alabama, 2017","volume":"16","author":"Powers","year":"2019","journal-title":"Prev. Chronic Dis."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/17\/2813\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:52:18Z","timestamp":1787849538000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/17\/2813"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":43,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["nu18172813"],"URL":"https:\/\/doi.org\/10.3390\/nu18172813","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]}}}