Effects of a Fruit and Vegetable Prescription Program With Expanded Education for Low-Income Adults.

Fruit and Vegetable Prescription (FVRx) Programs combine produce prescriptions and nutrition education to reduce fruit and vegetable consumption barriers and promote health among low-income patient populations. This study examined whether a multi-level FVRx intervention model with intensive education improves dietary behaviors, food security, and health outcomes over single-level interventions alone. A 6-month nonrandomized, parallel, controlled trial was conducted with one intervention, FVRx (n = 31) and two comparison groups, Ad hoc Nutrition Education (n = 13) and Control (n = 16). The FVRx group received produce prescriptions (US$1/day/household member) redeemable at a farmer's market, two SNAP-Ed programs, one financial literacy program, and monthly health screenings. The Nutrition Education (NE) group participated in one SNAP-Ed program, and the Control group received safety-net clinic care only. Surveys assessed dietary intake, food security, food purchasing practices, and financial and food resource management. Pre-post clinical biomarkers (blood lipid and hemoglobin A1c) and monthly biometrics (anthropometrics and blood pressure) were measured. Descriptive analysis and one-way analysis of variance (ANOVA) were conducted. Compared with comparison groups, FVRx participants significantly increased the frequency of consuming dark green vegetables, FVRx (0.36 ± 0.72); NE (0.14 ± 0.33); Control (-0.09 ± 0.19) cups/day (p < .05). FVRx participants significantly improved multiple healthful food purchasing practices, and the ability to afford more utilities (FVRx (33%); NE (0%); Control (10%); p < .05). Limited changes were observed in food security and clinical biomarker outcomes between groups. Combining expanded nutrition and financial literacy education with produce prescriptions improves low-income adults' financial and food resources, preference, knowledge, purchase, and consumption of locally grown vegetables over single-level interventions.

Food Security and Clinical Outcomes of the 2017 Georgia Fruit and Vegetable Prescription Program.

OBJECTIVE: Evaluate improvements in food security and health outcomes associated with participation in a produce prescription program. DESIGN: Program evaluation with repeated measures over 6 months. SETTING: Six sites across Georgia. PARTICIPANTS: Of the 159 enrolled through primary care sites, 122 participants were considered graduates (attended at least 3 of the 6 monthly visits). The majority of program graduates were Black (78.7%), earned <$25,000 annually (76.6%), and were food insecure (74.2%). INTERVENTION: Six-month program offering group-based nutrition and cooking education along with subsidies for fresh produce worth $1 per family member per day, redeemable weekly. MAIN OUTCOME MEASURES: Food security, blood pressure, body mass index, waist circumference, and glycated hemoglobin. ANALYSIS: Linear mixed models estimating association of change in outcomes with program visits 1-6. Fixed effects included participant sex and age, whereas random effects included random intercepts and slopes for the site of program participation and participants. RESULTS: Participation in a produce prescription program combining subsidies for produce and nutrition education decreased food insecurity (P < 0.001) and diastolic blood pressure significantly (P = 0.019). CONCLUSIONS AND IMPLICATIONS: These findings highlight the promise of this program and similar programs for improving patient food security and health outcomes among the most vulnerable, underserved communities while aiding in setting realistic expectations and suggestions for program implementation.

Food Insecurity and Eating Behavior Relationships Among Congregate Meal Participants in Georgia.

This study explored relationships of food insecurity with cognitive restraint, uncontrolled eating, and emotional eating behaviors among congregate meal participants in northeast Georgia [n = 118 years, age 60 years and older, mean (SD) age = 75 ( 8 ) years, 75% female, 43% Black, 53% obese (Body Mass Index ≥ 30)]. Food insecurity was assessed with a 6-item questionnaire. Scores ranged from 0 to 6 and were defined as high or marginal food security, FS, 0-1 (70%); low food security, LFS, 2-4 (20%); very low food security, VLFS, 5-6 (10%); and low and very low food security, LVLFS, 2-6 (30%). Eating behavior was assessed with an 18-item Three-Factor Eating Questionnaire R-18. In bivariate analyses food insecurity was consistently associated with cognitive restraint scores above the median split and to a lesser extent with uncontrolled eating scores (p ≤ 0.05). No association was found between emotional eating and food insecurity. In multivariate linear and logistic regression analyses, food insecurity was consistently associated with cognitive restraint (p ≤ 0.05) even when controlled for potential confounders (demographics, Body Mass Index, and chronic diseases). Food insecurity was also associated with uncontrolled eating (p ≤ 0.05), but the relationship was attenuated when controlled for potential confounding variables. Although cognitive restraint is defined as the conscious restriction of food intake to control body weight or promote weight loss, these findings suggest there may be other dimensions of cognitive restraint to consider in nutritional assessment and interventions among food-insecure older adults.