Effect of Pay-What-You-Can Restaurants on Coronary Heart Disease-Related Outcomes Among Guests with Food Insecurity and Hypertension

About This Grant

ABSTRACT A gap exists in identifying charitable food assistance programs that reduce coronary heart disease (CHD) risk among hypertensive, food-insecure individuals by improving diet quality and ameliorating stressors. Pay-what-you-can cafes, an untested model, may improve diet quality and psychological stress by providing healthy meals and social connection. The long-term goal is to understand cafes’ impact on CHD-related outcomes among hypertensive, food-insecure individuals. The overall objective is to prospectively evaluate the impact of eating at two Texas cafes on CHD-related physiological and psychosocial/behavioral outcomes among hypertensive, food-insecure guests using a natural experiment and mixed-methods process evaluation. The central hypothesis is that there will be significantly greater improvements in blood pressure (primary outcome) and other CHD-related outcomes among hypertensive, food-insecure individuals who utilize cafes than those who do not. The two specific aims are: (1) Test within and between-group differences in CHD-related physiological and psychosocial/behavioral outcomes between a cohort of hypertensive, food-insecure cafe guests and a matched control location without a cafe; (2) Characterize how cafes address CHD-related outcomes among hypertensive, food-insecure guests by conducting a mixed-methods RE-AIM process evaluation. In Aim 1, a longitudinal, prospective natural experiment will be conducted, and data will be collected at baseline, then every 3 months for 1 year. Changes in CHD-related physiological and psychosocial/behavioral outcomes will be compared between new cafe guests from Taste Community Restaurants (cafe group; n=155) and residents of matched control locations without a cafe in West Dallas, TX (control group; n=155). The physiological outcomes are blood pressure, blood lipid levels, blood glucose level, and waist-to-height ratio. The psychosocial/behavioral outcomes are diet quality, psychological stress, food security score, and nutrition security. In Aim 2, a mixed methods approach will be conducted to determine reach, effectiveness, adoption, implementation, and maintenance (RE- AIM) outcomes for hypertensive, food-insecure café guests. The research proposed is innovative because it will be the first longitudinal natural experiment of the cafe model to understand its influence on CHD-related outcomes, comprehensively measuring food and nutrition security and objective CHD- related measures. The research is significant because advancing understanding of cafe model can help inform funding streams and policies to support cafes and reduce CHD disparities nationwide.