Background Rates of childhood obesity are higher in American Indian and Alaska Native populations, and food insecurity plays a major role in diet-related disparities. To address this need, local healthcare providers and a local non-profit launched the Navajo Fruit and Vegetable Prescription (FVRx) Program in 2015. Children up to six years of age and their caregivers are enrolled in the six-month program by healthcare providers. Families attend monthly health coaching sessions where they receive vouchers redeemable for fruits, vegetables, and healthy traditional foods at retailers participating in the FVRx program. Objective We assessed the impact of a fruit and vegetable prescription program on the health outcomes and behaviors of participating children. Methods Caregivers completed voluntary surveys to assess food security, fruit and vegetable consumption, hours of sleep, minutes of physical activity; healthcare providers also measured children's body mass index (BMI) z-score at initiation and completion of the program. We calculated changes in health behaviors, body mass index, and food security at the end of the program, compared with baseline values. Results A total of 243 Navajo children enrolled in Navajo FVRx between May 2015 and September 2018. Fruit and vegetable consumption significantly increased from 5.2 to 6.8 servings per day between initiation and program completion (p < 0.001). The proportion of participant households reporting food insecurity significantly decreased from 82% to 65% (p < 0.001). Among children classified as overweight or obese at baseline, 38% achieved a healthy BMI z-score at program completion (p < 0.001). Sixty-five % of children were retained in the program. Conclusions The Navajo FVRx program improves fruit and vegetable consumption among young children. Children who are obese or overweight may benefit most from the program.

Structural inequities contribute to food systems in which tribal communities in the U.S. are more likely to experience barriers to healthy food access, including financial barriers, lack of geographic proximity, or both. Food sovereignty movements improve food access by shifting power to local people to build food systems that support cultural, social, economic, and environmental needs. Finan­cial incentive programs, including produce pre­scription programs, have emerged as a promising intervention to improve food access and support food sovereignty. This case study describes the implementation of two federally funded produce prescription programs (Produce Prescription Pro­jects or PPR) under the U.S. Department of Agri­culture (USDA) Gus Schumacher Nutrition Incen­tive Program (GusNIP) in two rural tribal communities: the Yukon Kuskokwim Delta region in Alaska, and the Navajo Nation, which spans parts of New Mexico, Arizona, and Utah. We illus­trate how PPR can be tailored to accommodate local and diverse cultures, strengthen community power, and be uniquely suited for the challenges of increasing access to nutritious food in rural tribal communities. We also highlight recommendations and future areas of research that may be useful for other rural tribal communities implementing PPR.