Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Leah M. Ferrucci


ABSTRACTBackground: High intake of fruits and vegetables is associated with many health benefits including a lower risk of incident hypertension, heart disease, stroke, obesity, Alzheimer’s, and dementia. Dietary choices are impacted by a variety of individual socio-psychological and environmental factors. For this reason, Blue Zones Project (BZP) hypothesized that a multilevel intervention combining psychological, social, and environmental factors would have the largest impact on eating behaviors compared to a single-level approach. We assessed the impact of a BZP food environment intervention on fruit and vegetable intake and food insecurity among adults on the island of Hawai’i (or the Big Island). Methods: Using data from 3,237 respondents in the Gallup-Sharecare Well-Being Index (WBI) on the Big Island (North Hawai’i, East Hawai’i, and West Hawai’i), we assessed odds of frequent fruit and vegetable consumption and food insecurity pre (2015) and post (2018) the introduction of the BZP multilevel intervention via multivariable logistic regression. We adjusted for sex, age, race, body mass index, and monthly income. Frequent fruit and vegetable consumption was defined as having 5 or more servings of fruits and vegetables on at least 5 of the last 7 days. The BZP intervention on the Big Island included a Double Up Food Bucks program (starting in 2017), grocery store and restaurant initiatives (2016), and a mobile market (2017), among other elements. Results: In fully adjusted models, compared with pre-intervention, we found no change in frequent fruit and vegetable consumption (odds ratio (OR): 1.06, 95% confidence intervals (CI): 0.89,1.25, p-value: 0.539) or food insecurity (OR: 0.86, CI: 0.65,1.15, p-value: 0.306) after the implementation of the BZP intervention. Conclusion: There was no evidence of statistically significant improvements in fruit and vegetable consumption or food insecurity post BZP intervention. Further analysis is warranted to investigate whether more time is needed to observe effects.


This is an Open Access Thesis.

Open Access

This Article is Open Access