Assessment of a Fruit and Vegetable Prescription Program in the Northern Manhattan Community

Abstract

Purpose This study aimed to assess whether produce prescription redemption was associated with food insecurity (FI), sociodemographics, and nutrition-related health measures, and to identify factors affecting participation. Design Retrospective, cross-sectional study. Patients, equally divided between groups who redeemed and did not redeem prescriptions, completed a follow-up survey. Setting Northern Manhattan, NY. Subjects 242 patients referred to Nutrition at an academic medical center between June and November 2019. Intervention All patients referred to Nutrition received prescriptions for produce at local Greenmarkets (patients with FI received $20; other patients received $10). Measures We assessed patient satisfaction and factors impacting participation. Sociodemographics and nutrition-related health measures were extracted from medical records. Analysis The χ 2 test for categorical data and Student’s t-test for continuous variables. Results Prescription redeemers were significantly more likely to be very satisfied with the program ( P < .001), have FI ( P < .01), and have elevated hemoglobin A1C than non-redeemers (6.3 vs 5.5%, P < .001). Distance, time constraints, and forgetting or losing the prescription were common barriers, while convenience and valuing healthy eating facilitated redemption. Conclusion Higher FI and worse hemoglobin A1c in patients who redeemed prescriptions suggests that our program reaches the target audience: patients needing food assistance and a healthier diet. Awareness of barriers offers areas for improvement. This provides a feasible model for hospital investment to increase access to produce to improve health and health equity.

A Systematic Literature Review of Nutrition Interventions Implemented to Address Food Insecurity as a Social Determinant of Health

“…Table 1 shows an overview of the included studies, and Table 2 provides more details on all of the studies included. A total of 21 studies were reviewed, including 13 (61.9%) food or produce prescription program studies [16][17][18][19][20][21][22][23][24][25][26][27][28][29], 4 (19.0%) medically tailored meal (MTM) program studies [5,[30][31][32], and 4 (19.0%) community-supported agriculture (CSA) studies [33][34][35]. Fifteen studies (71.4%) focused on adult populations and four (19.0%) focused primarily focused on families and pediatric populations.…”

“…In terms of the outcomes assessed (Table 3) in the 21 studies, 10 studies (47.6%) assessed changes in BMI, 17 examined changes in dietary intake (81.0%), 13 (61.9%) examined improvement in food security status, 14 (66.7%) measured improvements in participants' chronic conditions, 12 (57.1%) assessed feasibility-related outcomes, and 4 (19.0%) assessed cost-related outcomes. Of the 10 studies that assessed changes in BMI, 2 studies [27,32] found a statistically significant reduction in BMI, 7 [17,18,26,28,30,31,35] found non-statistically significant changes, and 1 [33] found an increase in BMI. For dietary intake in the 17 studies (81.0%), 9 (42.9%) found an increase in fruit and/or vegetable intake [19][20][21][22][23][24][25]28,32], and 5 (23.8%) found no statistically significant changes in this intake [19,26,31,33,34].…”

“…However, four studies found reductions in blood pressure [18,22,29,35], four found decreases in hemoglobin A1c [22,26,31,33], two found reductions in waist circumference [22,29], and one found improvements in cholesterol [27]. In terms of feasibility, 12 of the studies examined aspects of feasibility [16][17][18][19]24,26,27,[31][32][33][34][35] using the main measurements of redemption or distribution rates, adherence to nutrition education when offered, food waste, and participant satisfaction. For studies that tracked cost-related outcomes [5,16,26,27], these included cost per redemption, total cost distributed to participants, avoided produce costs to participants, and estimated reduction in medical costs per month.…”

“…One outcome that was used to assess feasibility was a measure of redemption rate, but redemption rates were measured differently across the articles. For example, Abel et al [17] examined the total number of vouchers redeemed divided by the total number of vouchers distributed, while Aiyer et al [16] examined the average number of prescriptions redeemed per participant and the mean number of times the prescriptions were redeemed. Additional studies could determine the most salient measures of redemption rates in order to ensure that future studies define redemption rates similarly across studies.…”

Pediatric produce prescription initiatives in the U.S.: a scoping review

“…2 and results in Table 2 . Ten studies were quantitative, 39 – 41 , 45 , 46 , 48 , 49 , 51 – 53 five were qualitative, 42 , 44 , 50 , 54 , 55 and four used mixed methods. 43 , 47 , 56 , 57 Of the 14 quantitative or mixed methods studies, 13 were longitudinal and one was cross-sectional.…”