Community-Based Participatory Approaches to Improve Diet Quality and Food Security in Rural Appalachia: Outcomes from the Laurel HARVEST Study

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 ≥18 years were recruited at baseline (2022–2023) 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®, 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.