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.

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