Abstract - Low-income and ethnic minority status as well as rural residence are strong predictors of poor health. Contributors to high chronic disease rates include food insecurity (lack of access to affordable, nutritious food) and lack of economic opportunity. Rural poverty in the Southeast is exacerbated by historical discrimination against Black farmers, and ongoing structural racism. At the intersection of diet and wellbeing, the blue-collar workforce is particularly vulnerable to the conditions and impacts of poor nutrition on health and productivity, as these typically low-wage workers face heightened challenges surrounding accessibility (affordability and convenience) of healthy food, yet rely on good health to support often physically demanding labor. Few approaches to mitigating health disparities have addressed both healthy food access and economic opportunity. Equiti Foods developed Good Bowls as healthy, affordable, good-tasting frozen meals that are convenient, locally-produced, and culturally-conscious. Our mission is to decrease health disparities by increasing the availability and consumption of nutritious food in high-need communities while providing economic opportunities for local farms and small businesses. We propose rigorously testing Good Bowls’ health impact and potential health care costs savings in rural blue-collar worksites. Our solution leverages the team’s nutrition expertise to create culturally appealing meals by adapting the evidence- based Mediterranean diet to southeastern seasonal availability and taste preferences (“Med-South”). We partner with local farms and businesses to produce the bowls, making use of normally wasted seasonal excess or “cosmetically challenged” produce to curb costs and expand markets for farmers. To create a sustainable business model, Good Bowls are sold using a cost-offset subsidy approach, allowing for needs-based pricing. In our worksite RCT, subsidized Good Bowls will be paired with smart phone digital infrastructure enabling Bluetooth nudges at the worksite and educational programing for home and family. The Specific Aims of this Phase II project are: 1) Establish Employee Wellness Committees to refine implementation strategies and facilitate engagement with blue-collar workers and families; 2) Test the impact of subsidized Good Bowls availability and promotion alone (Good Bowls) relative to Good Bowls + the phone App nudge and home- based education program (Nudge/Education) using a delayed intervention randomized controlled trial; and 3) Further develop and test our cost-offset model using both direct-to-consumer and retail sales to assess the volume and pricing of high end sales needed to support the social mission. We will also assess health care- related cost savings for worksites and economic benefits to partner businesses (farms, caterers, non-profits) involved with Good Bowls production. Working in partnership with rural blue-collar worksites and with local farms and businesses, Equiti Foods seeks to reduce health disparities by improving the dietary intake of those at greatest risk for chronic disease while creating economic opportunity in rural communities.

Narrative - Reducing food insecurity and increasing economic opportunity are key to combatting health disparities in low- income communities. Recognizing this, Equiti Foods created Good Bowls, healthy frozen meals that are made affordable through a cost-offset business model allowing for needs-based pricing. Working in partnership with rural blue-collar worksites and with local farms and businesses, Equiti Foods seeks to improve the dietary intake of those at greatest risk for chronic disease while creating economic opportunity for struggling businesses.