Session
Tackling Nutrition and Health Disparities: Impacts and Opportunities of Produce Prescription Programs
APHA 2022 Annual Meeting and Expo
Abstract
Welcoming Remarks
APHA 2022 Annual Meeting and Expo
Abstract
Pooled, participant-level evaluation across nine produce prescription programs: impacts on diet, food security and health outcomes
APHA 2022 Annual Meeting and Expo
Introduction
Produce prescriptions (Produce Rx) have been associated with improved diet and food security, with mixed results for health outcomes in smaller studies. We pooled data from 22 Produce Rx programs to evaluate impacts on fruit and vegetable (F&V) intake, food insecurity, and health outcomes in the largest evaluation of Produce Rx to date.
Methods
Participant-level data (n = 2,539; 750 adults and 1,221 children) from 22 Produce Rx programs in 12 US states were pooled for analysis without external controls. Eligibility criteria were having a diet-related illness and food insecurity. Intervention included financial incentives to purchase F&V at retail grocery or farmers markets. Surveys assessed daily F&V intake and food insecurity; clinicians measured Hemoglobin A1c (HbA1c), blood pressure (BP), and body mass index (BMI) for adults and age-sex specific BMI z-score for children. We used multilevel mixed models that accounted for program- and individual-level clustering.
Results
F&V intake increased by 0.83 cups per day (95% CI: 0.67, 0.98) among adults and by 0.25 cups per day (0.08, 0.42) among children. The odds of being food-insecure halved after participation (OR= 0.51 (0.42, 0.61)). Among adults, HbA1c declined by 0.34 percentage points (-0.47, -0.20); systolic and diastolic BP declined by 8.79 mmHg (-10.52, -7.04) and 4.96 mmHg (-5.99, -3.94), respectively; and BMI lowered by 0.35 kg/m2 (-0.63, -0.08). No significant changes in child BMI z-score were identified.
Discussion
Participation was associated with improvements in F&V intake and food insecurity, and clinically relevant improvements in HbA1c, BP, and BMI among adults.
Abstract
Q&A
APHA 2022 Annual Meeting and Expo
Abstract
Understanding Experiences and Implementation of a Produce Prescription Program: A mixed-method study
APHA 2022 Annual Meeting and Expo
Background and Purpose: Produce Prescription (Produce Rx) programs vary by funders, program mechanisms, target populations, and implementation period. There are gaps in knowledge regarding key components of what makes programs effective and implementation practices. This study sought to better understand participants’ and stakeholders' experiences with Produce Rx programs including barriers and facilitators to participation, and perceptions of Produce Rx programs implementation in healthcare settings.
Methods: 221 participants (63 Produce Rx participants, 96 clinic employees, and 62 community stakeholders) were recruited through internet-based and texting outreach, and snowball sampling, and completed an online survey. The survey for participants included questions about their experience with Produce Rx programs, and barriers and facilitators to participation. Clinic workers were asked questions about screening for food insecurity, and barriers and facilitators to implementation of Produce Rx programs. Separate focus groups were conducted with a subset of Produce Rx participants and clinic workers. Quantitative data was analyzed via regression analysis. Qualitative data utilized thematic analysis.
Results: Quantitative and qualitative data revealed participants and clinic workers found value in Produce Rx programs being implemented in health care settings. Participants indicated they had positive experiences with the programs. Clinic workers indicated concerns about time constraints on implementation in the clinic. Stakeholders indicated issues with the implementation process as a potential barrier to participation.
Conclusions and Implications: These findings suggest while these programs are viewed as an important addition to clinical care, more efforts may be needed to explore implementation processes that address time constraints in clinics.
Abstract
Q&A
APHA 2022 Annual Meeting and Expo
Abstract
Are Food Prescriptions Cost-Effective?: Evidence from the FoodRX program
APHA 2022 Annual Meeting and Expo
The FoodRX program is available to low income patients with diabetes, and “prescribes fresh produce and other healthy food at no cost at various Houston Food Bank locations. Our objective is to estimate the cost-effectiveness of this program. In order to do so, we estimate quality-adjusted life years added, averted medical costs (based on counts of complications), and the cost of FoodRX itself, using a Microsoft Excel-based simplified version of the Diabetes Cost-Effectiveness Model (CDC-RTI Model) jointly developed by the Centers for Disease Control and Prevention and RTI, Inc. The model simulates the development of diabetes-related microvascular (ie. nephropathy, neuropathy and retinopathy) and macrovascular (ie. coronary heart disease and stroke) complications separately. Our model includes glycemic level (A1c), blood pressure, cholesterol, smoking status and disease duration and demographics (age, gender, race, ethnicity, etc.), for clients and controls who entered the program between May 2018 and March 2021. Our main result is that FoodRX costs $48,000 per quality-adjusted year life year added. This is just under the conservative willingness-to-pay threshold of $50,000 per quality-adjusted life year added. We conducted several sensitivity analyses. Increasing and decreasing glycemic control by 20% had the largest impact on the cost-effectiveness ratio with a range of $35,930 to $64,682. However, this is still within most cost-effectiveness thresholds, which are often as high as $100,000.
Abstract
Q&A
APHA 2022 Annual Meeting and Expo
Abstract
Produce Prescriptions: Policy Opportunities for Expanding Access to Nutrition Interventions in Federal Health Care Programs
APHA 2022 Annual Meeting and Expo
Introduction: Access to healthy food is a critical driver of both health outcomes and health care costs in the United States. Diet quality is the leading risk factor for death in the nation, and diet-related health conditions—such diabetes, hypertension, cancer, and stroke—cost the country trillions of dollars each year in health care expenses and lost economic productivity. At the same time, a growing body of research indicates that incorporating nutrition supports into health care delivery may be associated with improved health.
Approach: In response to these trends, health care payers and providers are showing increased interest in using nutrition interventions such as produce prescriptions to mitigate the impacts of diet-related disease. However, access to such interventions remains limited in many parts of the country due, in part, to lack of sustainable funding streams. Recent changes to laws, regulations, and guidance governing Medicaid and Medicare have established new strategies (such as Special Supplemental Benefits for the Chronically Ill and In Lieu of Services) to pay for nutrition interventions.
Results: These new policies present valuable opportunities to sustain, scale, and evaluate produce prescriptions. However current data indicates that uptake has been slow, and the limitations of these pathways may create inequitable access—suggesting a need for more comprehensive policy reform.
Discussion: In this presentation, we will examine current federal health care payment pathways for nutrition interventions, trends in uptake, and ongoing gaps. We will then highlight policy reforms that could promote more widespread, equitable access in the long-term.
Abstract
Q&A
APHA 2022 Annual Meeting and Expo