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Umstattd Meyer MR, Houghtaling B, Wende ME, Kheshaifaty KH, Delgado H, Eze SA, Mecate C, Summerall Woodward R, Morgan RL, Krey KJ. A scoping review of policies to encourage breastfeeding, healthy eating, and physical activity among rural people and places in the United States. BMC Public Health 2024; 24:2160. [PMID: 39123168 PMCID: PMC11313091 DOI: 10.1186/s12889-024-19173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 06/17/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Rural U.S. residents experience a disproportionate burden of diet and physical activity (PA) related chronic disease compared to urban residents, due to resource and economic challenges. Diverse policy approaches for chronic disease prevention have been implemented to address barriers to breastfeeding, healthy eating, and PA. Therefore, the purpose of this paper is to describe policy supports for breastfeeding, healthy eating, and/or PA occurring in rural U.S. areas. METHODS A scoping review was conducted March-June 2020 to identify policy, systems, and environment change approaches occurring in the rural U.S. for breastfeeding, healthy eating, and PA. Search procedures were guided by the PRISMA-ScR, Arksey and O'Malley's work (2007), and a science librarian. Medline, PubMed, Web of Science, and Agricola were used to identify peer-reviewed research. ProQuest Dissertations and Theses A&I were used to identify dissertation research. Grey literature searches included Google, Google Scholar, government pages, and public health, federal nutrition assistance program, Cooperative Extension Services, and related webpages. Policy results are reported and inclusion criteria were: (1) breastfeeding, healthy eating, and/or PA focus; (2) about policy factors; (3) specific to U.S. rural populations/places; and (4) English language. Outcomes (study/source design, objective(s), methods/measurement, setting, population characteristics, behavioral focus, policy-specific results) were extracted into a standardized Excel document. RESULTS Results include 122 total sources: original research, with some sources referencing multiple behaviors, (n = 74 sources: 8 breastfeeding, 41 healthy eating, 42 PA), grey literature (n = 45 sources: 16 breastfeeding, 15 healthy eating, 27 PA), and graduate research (n = 3 sources: 1 breastfeeding, 2 healthy eating, 1 PA). Breastfeeding policy initiatives included policies or programs at hospitals, increasing access to resources, and improving culture or norms at workplaces. Healthy eating policy initiatives included increasing access to healthy foods, reducing financial burden, implementing programs, food assistance programs, and healthy food prescriptions at healthcare facilities. PA policy initiatives focused on Complete Streets, joint or shared use efforts, Safe Routes to Schools, master plans for greenways, trails, and/or transportation, school health plans, and childcare/school standards. CONCLUSIONS Results from this scoping review compile and offer commentary on existing policy solutions to improve breastfeeding, healthy eating, and/or PA in the rural U.S.
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Affiliation(s)
- M Renée Umstattd Meyer
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA.
| | | | - Marilyn E Wende
- Department of Health Education and Behavior, College of Health and Human Performance University of Florida, Gainesville, FL, USA
| | - Khawlah H Kheshaifaty
- School of Nutrition and Food Science, Louisiana State University Agricultural Center, Louisiana State University, Baton Rouge, LA, USA
| | - Haley Delgado
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Stephanie A Eze
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Cassady Mecate
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Rebekah Summerall Woodward
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | | | - Kathy J Krey
- School of Education, Baylor University, Waco, TX, USA
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Rudel RK, Byhoff E, Fielman SB, Strombotne KL, Drainoni ML, Greece JA. A Qualitative Study of A Health Center-Based Mobile Produce Market. J Ambul Care Manage 2024; 47:134-142. [PMID: 38771169 DOI: 10.1097/jac.0000000000000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Healthcare-based food assistance programs have the potential to improve patients' food security, but are underutilized. We conducted a qualitative study of user and staff perceptions of an on-site mobile market at a federally-qualified health center (FQHC). Five themes were identified: 1) financial need drives the decision to use the market, 2) people attend specifically to receive healthy food, 3) users feel a connection to the FQHC, which increases participation, 4) social networks increase usage of the program, and 5) long lines, inclement weather, inaccessibility, and inconsistent marketing and communication are attendance barriers. Findings should inform implementation of future healthcare-based food assistance programs.
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Affiliation(s)
- Rebecca K Rudel
- Author Affiliations: Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts (Drs Rudel and Greece); Department of Medicine, Section of Infectious Diseases, Boston University Chobanian Avedisian School of Medicine/Boston Medical Center, Boston, Massachusetts (Drs Rudel and Drainoni); Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts (Dr Byhoff); Boston University School of Public Health, Department of Health, Law, Policy and Management, Boston, Massachusetts (Drs Strombotne and Drainoni); and Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian Avedisian School of Medicine, Boston, Massachusetts, (Dr Drainoni)
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Houghtaling B, Short E, Shanks CB, Stotz SA, Yaroch A, Seligman H, Marriott JP, Eastman J, Long CR. Implementation of Food is Medicine Programs in Healthcare Settings: A Narrative Review. J Gen Intern Med 2024:10.1007/s11606-024-08768-w. [PMID: 38662283 DOI: 10.1007/s11606-024-08768-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
Food is Medicine (FIM) programs to improve the accessibility of fruits and vegetables (FVs) or other healthy foods among patients with low income and diet-related chronic diseases are promising to improve food and nutrition security in the United States (US). However, FIM programs are relatively new and implementation guidance for healthcare settings using an implementation science lens is lacking. We used a narrative review to describe the evidence base on barriers and facilitators to FIM program integration in US healthcare settings following the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Evidence surrounding the EPIS Inner Context was a focus, including constructs Leadership, Organizational Characteristics, Quality and Fidelity Monitoring and Support, Organizational Staffing Processes, and Individual Characteristics. Peer-reviewed and grey literature about barriers and facilitators to FIM programs were of interest, defined as programs that screen and refer eligible patients with diet-related chronic disease experiencing food insecurity to healthy, unprepared foods. Thirty-one sources were included in the narrative review, including 22 peer-reviewed articles, four reports, four toolkits, and one thesis. Twenty-eight sources (90%) described EPIS Inner Context facilitators and 26 sources (84%) described FIM program barriers. The most common barriers and facilitators to FIM programs were regarding Quality and Fidelity Monitoring and Support (e.g., use of electronic medical records for tracking and evaluation, strategies to support implementation) and Organizational Staffing Processes (e.g., clear delineation of staff roles and capacity); although, barriers and facilitators to FIM programs were identified among all EPIS Inner Context constructs. We synthesized barriers and facilitators to create an EPIS-informed implementation checklist for healthcare settings for use among healthcare organizations/providers, partner organizations, and technical assistance personnel. We discuss future directions to align FIM efforts with implementation science terminology and theories, models, and frameworks to improve the implementation evidence base and support FIM researchers and practitioners.
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Affiliation(s)
- Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA.
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA.
| | - Eliza Short
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | | | - Sarah A Stotz
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Amy Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Hilary Seligman
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
- Division of General Internal Medicine and Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | | | - Jenna Eastman
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
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Frank HE, Guzman LE, Ayalasomayajula S, Albanese A, Dunklee B, Harvey M, Bouchard K, Vadiveloo M, Yaroch AL, Scott K, Tovar A. Developing and testing a produce prescription implementation blueprint to improve food security in a clinical setting: a pilot study protocol. Pilot Feasibility Stud 2024; 10:51. [PMID: 38521931 PMCID: PMC10960480 DOI: 10.1186/s40814-024-01467-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/16/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Food insecurity is common in the United States, especially in Rhode Island, where it affects up to 33% of residents. Food insecurity is associated with adverse health outcomes and disproportionally affects people from minoritized backgrounds. Produce prescription programs, in which healthcare providers write "prescriptions" for free or reduced cost vegetables, have been used to address food insecurity and diet-related chronic disease. Although there is growing evidence for the effectiveness of produce prescription programs in improving food security and diet quality, there have been few efforts to use implementation science methods to improve the adoption of these programs. METHODS This two-phase pilot study will examine determinants and preliminary implementation and effectiveness outcomes for an existing produce prescription program. The existing program is funded by an Accountable Care Organization in Rhode Island and delivered in primary care practices. For the first phase, we conducted a formative evaluation, guided by the Consolidated Framework for Implementation Research 2.0, to assess barriers, facilitators, and existing implementation strategies for the produce prescription program. Responses from the formative evaluation were analyzed using a rapid qualitative analytic approach to yield a summary of existing barriers and facilitators. In the second phase, we presented our formative evaluation findings to a community advisory board consisting of primary care staff, Accountable Care Organization staff, and staff who source and deliver the vegetables. The community advisory board used this information to identify and refine a set of implementation strategies to support the adoption of the program via an implementation blueprint. Guided by the implementation blueprint, we will conduct a single-arm pilot study to assess implementation antecedents (i.e., feasibility, acceptability, appropriateness, implementation climate, implementation readiness), implementation outcomes (i.e., adoption), and preliminary program effectiveness (i.e., food and nutrition security). The first phase is complete, and the second phase is ongoing. DISCUSSION This study will advance the existing literature on produce prescription programs by formally assessing implementation determinants and developing a tailored set of implementation strategies to address identified barriers. Results from this study will inform a future fully powered hybrid type 3 study that will use the tailored implementation strategies and assess implementation and effectiveness outcomes for a produce prescription program. TRIAL REGISTRATION Clinical trials: NCT05941403 , Registered June 9, 2023.
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Affiliation(s)
- Hannah E Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Linda E Guzman
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Shivani Ayalasomayajula
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Ariana Albanese
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brady Dunklee
- Integra Community Care Network, Providence, RI, USA
- Care New England Health System, Providence, RI, USA
| | - Matthew Harvey
- Integra Community Care Network, Providence, RI, USA
- Care New England Health System, Providence, RI, USA
| | - Kelly Bouchard
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Maya Vadiveloo
- Department of Nutrition and Food Science, University of Rhode Island, Kingston, RI, USA
| | - Amy L Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Kelli Scott
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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Jd Steer K, Olstad DL, Jt Campbell D, Beall R, Anstruther SM, Caron-Roy S, Spackman E. The Impact of Providing Material Benefits to Improve Access to Food on Clinical Parameters, Dietary Intake, and Household Food Insecurity in People with Diabetes: A Systematic Review with Narrative Synthesis. Adv Nutr 2023; 14:1067-1084. [PMID: 37245685 PMCID: PMC10509434 DOI: 10.1016/j.advnut.2023.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/20/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023] Open
Abstract
The high cost of healthy foods makes maintaining a healthy dietary pattern challenging, particularly among people with diabetes who are experiencing food insecurity. The objectives of this study were to: 1) review evidence on the impact of providing material benefits (e.g., food coupons/vouchers, free food, or financial subsidies/incentives) to improve access to food on clinical parameters, dietary intake, and household food insecurity in people with diabetes, and 2) review relevant economic evidence. Six databases were searched from inception to March 2023 for longitudinal studies with quantitative outcomes. Twenty-one studies were included in the primary review and 2 in the economic analysis. Risk of bias was high in 20 studies and moderate in 1 study. The number of randomized controlled trials and nonrandomized studies reporting statistically significant improvement, alongside Grading of Recommendations Assessment, Development, and Evaluation (GRADE) certainty of the evidence was: HbA1c: 1/6 and 4/12 (very low), systolic blood pressure: 0/3 and 1/8 (very low), diastolic blood pressure: 0/3 and 1/7 (very low), BMI: 0/5 and 2/8 (very low), body weight: 0/0 and 1/3 (very low), hypoglycemia: 1/2 and 1/2 (very low), daily intake of fruits and vegetables: 1/1 and 1/3 (very low), daily intake of whole grains: 0/0 and 0/2 (very low), overall diet quality: 2/2 and 1/1 (low), and household food insecurity: 2/3 and 0/0 (very low). The 2 studies included in the economic analysis showed no difference in Medicare spending from Supplemental Nutrition Assistance Program participation and cost-savings from medically tailored meals in an economic simulation. Overall, providing material benefits to improve access to food for people with diabetes may improve household food insecurity, fruit and vegetable intake, and overall diet quality, but effects on clinical parameters and whole grain intake are unclear. The certainty of evidence was very low to low by GRADE. PROSPERO (CRD42021212951).
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Affiliation(s)
- Kieran Jd Steer
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - David Jt Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University Drive Northwest, Calgary, Alberta, Canada
| | - Reed Beall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Se'era M Anstruther
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stéphanie Caron-Roy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Stotz SA, Budd Nugent N, Ridberg R, Byker Shanks C, Her K, Yaroch AL, Seligman H. Produce prescription projects: Challenges, solutions, and emerging best practices – Perspectives from health care providers. Prev Med Rep 2022; 29:101951. [PMID: 36161127 PMCID: PMC9502043 DOI: 10.1016/j.pmedr.2022.101951] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sarah A. Stotz
- University of Colorado, Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
- Corresponding author at: University of Colorado, Anschutz Medical Campus, Colorado School of Public Health, Mail Stop F800, 13055 East 17th Avenue, Aurora, CO 80045.
| | | | | | | | - Ka Her
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Amy L. Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Hilary Seligman
- Division of General Internal Medicine, University of California, San Francisco, CA and Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA, USA
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Zack RM, Rodríguez Bronico JV, Babbin M, Nguyen T, Weil R, Granick J, Fiechtner L, Mulugeta W, Odayar V, Cortés DE. Facilitators and Barriers to Patient Attendance at a Free Health Center Produce Market. Am J Prev Med 2022; 63:S131-S143. [PMID: 35987525 PMCID: PMC10680439 DOI: 10.1016/j.amepre.2022.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/24/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patient participation in healthcare system‒sponsored efforts to address food insecurity varies widely. This mixed-methods study sought to understand the patient sociodemographic factors associated with and barriers and facilitators to the use of a monthly produce market held at Cambridge Health Alliance in partnership with The Greater Boston Food Bank. METHODS Baseline surveys (N=715) were conducted from February 2019 to March 2020 before market attendance, followed by 1-year follow-up surveys (n=514) and qualitative interviews (n=45). Robust Poisson regression estimated associations between sociodemographic characteristics and market attendance. Analyses were conducted from 2021 to 2022. RESULTS A total of 37.1% attended the market ≥1 time. Market attendance was associated with being aged 30-49 years (Risk Ratio (RR)=1.36, 95% CI=1.00, 1.86), having a monthly household income <$1,000 (RR=1.73, 95% CI=1.29, 2.32), identifying as Asian (RR=2.48, 95% CI=1.58, 3.89), having a preferred language for medical care other than English (RR=1.35, 95% CI=1.03, 1.76), being retired (RR=1.90, 95% CI=1.17, 3.08), and living in the city of the market's location (RR=1.36, 95% CI=1.12, 1.63). Barriers included limited time (28%), work conflict (23%), forgetfulness (23%), and not knowing market location/date (22%). Interviews revealed that accessibility barriers (e.g., limited market hours, transportation issues, competing demands, medical conditions, long lines) were obstacles to attendance, whereas access to novel, healthy foods motivated attendance. CONCLUSIONS Healthcare-based food distributions have the potential to reach patients with unmet food needs who cannot or would not access other forms of food assistance. Time constraints, physical limitations, and transportation challenges impact attendance; program modifications are necessary to improve accessibility.
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Affiliation(s)
- Rachel M Zack
- The Greater Boston Food Bank, Boston, Massachusetts.
| | | | - Molly Babbin
- Community Health Improvement Department, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Tra Nguyen
- The Greater Boston Food Bank, Boston, Massachusetts
| | - Rachel Weil
- The Greater Boston Food Bank, Boston, Massachusetts
| | - Jean Granick
- Community Health Improvement Department, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Lauren Fiechtner
- The Greater Boston Food Bank, Boston, Massachusetts; Division of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts; Division of Gastroenterology and Nutrition, Mass General Hospital for children, Boston, Massachusetts
| | | | - Varshini Odayar
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Dharma E Cortés
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
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Olstad DL, Beall R, Spackman E, Dunn S, Lipscombe LL, Williams K, Oster R, Scott S, Zimmermann GL, McBrien KA, Steer KJD, Chan CB, Tyminski S, Berkowitz S, Edwards AL, Saunders-Smith T, Tariq S, Popeski N, White L, Williamson T, L'Abbé M, Raine KD, Nejatinamini S, Naser A, Basualdo-Hammond C, Norris C, O'Connell P, Seidel J, Lewanczuk R, Cabaj J, Campbell DJT. Healthy food prescription incentive programme for adults with type 2 diabetes who are experiencing food insecurity: protocol for a randomised controlled trial, modelling and implementation studies. BMJ Open 2022; 12:e050006. [PMID: 35168964 PMCID: PMC8852661 DOI: 10.1136/bmjopen-2021-050006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The high cost of many healthy foods poses a challenge to maintaining optimal blood glucose levels for adults with type 2 diabetes mellitus who are experiencing food insecurity, leading to diabetes complications and excess acute care usage and costs. Healthy food prescription programmes may reduce food insecurity and support patients to improve their diet quality, prevent diabetes complications and avoid acute care use. We will use a type 2 hybrid-effectiveness design to examine the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of a healthy food prescription incentive programme for adults experiencing food insecurity and persistent hyperglycaemia. A randomised controlled trial (RCT) will investigate programme effectiveness via impact on glycosylated haemoglobin (primary outcome), food insecurity, diet quality and other clinical and patient-reported outcomes. A modelling study will estimate longer-term programme effectiveness in reducing diabetes-related complications, resource use and costs. An implementation study will examine all RE-AIM domains to understand determinants of effective implementation and reasons behind programme successes and failures. METHODS AND ANALYSIS 594 adults who are experiencing food insecurity and persistent hyperglycaemia will be randomised to a healthy food prescription incentive (n=297) or a healthy food prescription comparison group (n=297). Both groups will receive a healthy food prescription. The incentive group will additionally receive a weekly incentive (CDN$10.50/household member) to purchase healthy foods in supermarkets for 6 months. Outcomes will be assessed at baseline and follow-up (6 months) in the RCT and analysed using mixed-effects regression. Longer-term outcomes will be modelled using the UK Prospective Diabetes Study outcomes simulation model-2. Implementation processes and outcomes will be continuously measured via quantitative and qualitative data. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Calgary and the University of Alberta. Findings will be disseminated through reports, lay summaries, policy briefs, academic publications and conference presentations. TRIAL REGISTRATION NUMBER NCT04725630. PROTOCOL VERSION Version 1.1; February 2022.
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Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Reed Beall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharlette Dunn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine L Lipscombe
- 2Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kienan Williams
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
| | - Richard Oster
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Sara Scott
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gabrielle L Zimmermann
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Knowledge Translation Platform, Alberta SPOR SUPPORT Unit, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry A McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada
| | - Kieran J D Steer
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Catherine B Chan
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Sheila Tyminski
- Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Seth Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Gatineau, Quebec, Canada
| | - Alun L Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
| | - Terry Saunders-Smith
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Saania Tariq
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Naomi Popeski
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Laura White
- Alberta Region, First Nations and Inuit Health Branch, Indigenous Services Canada, Edmonton, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mary L'Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Sara Nejatinamini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aruba Naser
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Cardiovascular Health and Stroke Strategic Clinic Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Petra O'Connell
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Judy Seidel
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Primary Health Care Integration Network, Primary Health Care, Alberta Health Services, Calgary, Alberta, Canada
| | - Richard Lewanczuk
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Calgary, Alberta, Canada
| | - Jason Cabaj
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David J T Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University Drive NW, Calgary, Alberta, Canada
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Bhat S, Coyle DH, Trieu K, Neal B, Mozaffarian D, Marklund M, Wu JHY. Healthy Food Prescription Programs and their Impact on Dietary Behavior and Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis. Adv Nutr 2021; 12:1944-1956. [PMID: 33999108 PMCID: PMC8483962 DOI: 10.1093/advances/nmab039] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/21/2020] [Accepted: 03/11/2021] [Indexed: 12/11/2022] Open
Abstract
The enormous burden of diet-related chronic diseases has prompted interest in healthy food prescription programs. Yet, the impact of such programs remains unclear. The aim of this study was to conduct a systematic review of healthy food prescription programs and evaluate their impact on dietary behavior and cardiometabolic parameters by meta-analysis. A systematic search was carried out in Medline, Embase, Scopus, and Cochrane Central Register of Controlled Trials databases since their inception to 3 January, 2020 without language restriction. A systematic search of interventional studies investigating the effect of healthy food prescription on diet quality and/or cardiometabolic risk factors including BMI, systolic (SBP) and diastolic blood pressure (DBP), glycated hemoglobin (HbA1c), or blood lipids was carried out. Thirteen studies were identified for inclusion, most of which were quasi-experimental (pre/post) interventions without a control group (n = 9). Pooled estimates revealed a 22% (95% CI: 12, 32; n = 5 studies, n = 1039 participants; I2 = 97%) increase in fruit and vegetable consumption, corresponding to 0.8 higher daily servings (95% CI: 0.2, 1.4; I2 = 96%). BMI decreased by 0.6 kg/m2 (95% CI: 0.2, 1.1; I2 = 6.4%) and HbA1c by 0.8% (95% CI: 0.1, 1.6; I2 = 92%). No significant change was observed in other cardiometabolic parameters. These findings should be interpreted with caution in light of considerable heterogeneity, methodological limitations of the included studies, and moderate to very low certainty of evidence. Our results support the need for well-designed, large, randomized controlled trials in various settings to further establish the efficacy of healthy food prescription programs on diet quality and cardiometabolic health.
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Affiliation(s)
- Saiuj Bhat
- School of Medicine, The University of Western Australia, Crawley, Australia
| | - Daisy H Coyle
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Public Health, Imperial College London, London, United Kingdom
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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10
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Cook M, Ward R, Newman T, Berney S, Slagel N, Bussey-Jones J, Schmidt S, Sun Lee J, Webb-Girard A. Food Security and Clinical Outcomes of the 2017 Georgia Fruit and Vegetable Prescription Program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:770-778. [PMID: 34509277 DOI: 10.1016/j.jneb.2021.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Miranda Cook
- Laney Graduate School, Emory University, Atlanta, GA.
| | | | - Taylor Newman
- College of Family and Consumer Sciences, University of Georgia, Athens, GA
| | | | - Nicholas Slagel
- College of Family and Consumer Sciences, University of Georgia, Athens, GA
| | | | | | - Jung Sun Lee
- College of Family and Consumer Sciences, University of Georgia, Athens, GA
| | - Amy Webb-Girard
- Hubert Department of Global Health, Emory University, Atlanta, GA
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11
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Influence of a Pediatric Fruit and Vegetable Prescription Program on Child Dietary Patterns and Food Security. Nutrients 2021; 13:nu13082619. [PMID: 34444778 PMCID: PMC8399668 DOI: 10.3390/nu13082619] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/20/2022] Open
Abstract
Limited access to fresh foods is a barrier to adequate consumption of fruits and vegetables among youth, particularly in low-income communities. The current study sought to examine preliminary effectiveness of a fruit and vegetable prescription program (FVPP), which provided one USD 15 prescription to pediatric patients during office visits. The central hypothesis was that exposure to this FVPP is associated with improvements in dietary patterns and food security. This non-controlled longitudinal intervention trial included a sample of caregiver–child dyads at one urban pediatric clinic who were exposed to the FVPP for 1 year. Patients received one USD 15 prescription for fresh produce during appointments. A consecutive sample of caregivers whose children were 8–18 years of age were invited to participate in the study. Dyads separately completed surveys that evaluated food security and dietary behaviors prior to receipt of their first prescription and again at 12 months. A total of 122 dyads completed surveys at baseline and 12-month follow-up. Approximately half of youth were female (52%), and most were African American (63%). Mean caregiver-reported household food security improved from baseline to 12 months (p < 0.001), as did mean child-reported food security (p = 0.01). Additionally, child-reported intake of vegetables (p = 0.001), whole grains (p = 0.001), fiber (p = 0.008), and dairy (p < 0.001) improved after 12 months of exposure to the FVPP. This study provides evidence that pediatric FVPPs may positively influence food security and the dietary patterns of children.
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12
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Heasley C, Clayton B, Muileboom J, Schwanke A, Rathnayake S, Richter A, Little M. "I was eating more fruits and veggies than I have in years": a mixed methods evaluation of a fresh food prescription intervention. ACTA ACUST UNITED AC 2021; 79:135. [PMID: 34301335 PMCID: PMC8298943 DOI: 10.1186/s13690-021-00657-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 07/10/2021] [Indexed: 11/10/2022]
Abstract
Background Food insecurity is associated with poor nutritional health outcomes. Prescribing fresh fruits and vegetables in healthcare settings may be an opportunity to link patients with community supports to promote healthy diets and improve food security. This mixed methods study evaluated the impacts of a fresh food prescription pilot program. Methods The study took place at two Community Health Centre locations in Guelph, Ontario, Canada. Sixty food insecure patients with ≥1 cardio-metabolic condition or micronutrient deficiency participated in the intervention. Participants were prescribed 12 weekly vouchers to Community Food Markets. We conducted a one-group pre-post mixed-methods evaluation to assess changes in fruit and vegetable intake, self-reported health, food security, and perceived food environments. Surveys were conducted at baseline and follow-up and semi-structured interviews with participants were conducted following the intervention. Results Food security and fruit and vegetable consumption improved following the intervention. Food security scores increased by 1.6 points, on average (p < 0.001). Consumption of fruits and 'other' vegetables (cucumber, celery, cabbage, cauliflower, squashes, and vegetable juice) increased from baseline to follow-up (p < 0.05). No changes in self-reported physical or mental health were observed. Qualitative data suggested that the intervention benefited the availability, accessibility, affordability, acceptability, and accommodation of healthy foods for participating households. Conclusions Fresh food prescription programs may be a useful model for healthcare providers to improve patients' food environments, healthy food consumption, and food security.
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Affiliation(s)
- Cole Heasley
- Department of Population Medicine, University of Guelph, Guelph, ON Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, BC Canada
| | | | - Jade Muileboom
- Arrell Food Institute, University of Guelph, Guelph, ON Canada
| | - Anna Schwanke
- Food From Thought, University of Guelph, Guelph, ON Canada
| | | | - Abby Richter
- Guelph Community Health Centre, Guelph, ON Canada
| | - Matthew Little
- School of Public Health and Social Policy, University of Victoria, Victoria, BC Canada
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13
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White ND. Produce Prescriptions, Food Pharmacies, and the Potential Effect on Food Choice. Am J Lifestyle Med 2020; 14:366-368. [PMID: 33281515 DOI: 10.1177/1559827620915425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
When it comes to health and longevity, what we eat may be the most important choice we make on a daily basis. This choice is influenced by a variety of determinants, including cost and accessibility of healthy foods as well as knowledge, attitudes and beliefs about how food impacts health. Produce prescriptions and food pharmacies are innovative care models directed at promoting intake of healthy foods. These programs as well as their potential effect on food choice is described.
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Affiliation(s)
- Nicole D White
- Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska
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14
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Veldheer S, Scartozzi C, Knehans A, Oser T, Sood N, George DR, Smith A, Cohen A, Winkels RM. A Systematic Scoping Review of How Healthcare Organizations Are Facilitating Access to Fruits and Vegetables in Their Patient Populations. J Nutr 2020; 150:2859-2873. [PMID: 32856074 DOI: 10.1093/jn/nxaa209] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/18/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is compelling evidence on the impact of diet as preventative medicine, and with rising health care costs healthcare organizations are attempting to identify interventions to improve patient health outcomes. OBJECTIVES The purpose of this systematic scoping review was to characterize existing healthcare organization-based interventions to improve access to fruits and vegetables (F&V) for their patient populations. In addition, we aimed to review the impact of identified interventions on dietary intake and health outcomes. METHODS Titles and abstracts were searched in PubMed® (MEDLINE®), Embase®, CINAHL®, and the Cochrane Library® from 1 January 1990 to 31 December 2019. To be selected for inclusion, original studies must have included a healthcare organization and have had a programmatic focus on increasing access to or providing fresh F&V to patients in an outpatient, naturalistic setting. The Effective Public Health Practice Project tool was used to assess study quality in 6 domains (selection bias, study design, confounders, blinding, data collection methods, and withdrawals and dropouts). RESULTS A total of 8876 abstracts were screened, yielding 44 manuscripts or abstracts from 27 programs. Six program models were identified: 1) a cash-back rebate program, 2) F&V voucher programs, 3) garden-based programs, 4) subsidized food box programs, 5) home-delivery meal programs, and 6) collaborative food pantry-clinical programs. Only 6 of 27 studies included a control group. The overall quality of the studies was weak due to participant selection bias and incomplete reporting on data collection tools, confounders, and dropouts. Given the heterogeneity of outcomes measured and weak study quality, conclusions regarding dietary and health-related outcomes were limited. CONCLUSIONS Healthcare-based initiatives to improve patient access to F&V are novel and have promise. However, future studies will need rigorous study designs and validated data collection tools, particularly related to dietary intake, to better determine the effect of these interventions on health-related outcomes.
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Affiliation(s)
- Susan Veldheer
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Christina Scartozzi
- Penn State Health, St. Joseph's Family and Community Medicine Residency Program, Hershey, PA, USA
| | - Amy Knehans
- Penn State College of Medicine, Harrell Library, Hershey, PA, USA
| | - Tamara Oser
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.,Department of Family Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Natasha Sood
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel R George
- Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | | | - Alicia Cohen
- Departments of Family Medicine and Health Services, Policy, and Practice, Providence VA Medical Center and Brown University, Providence, RI, USA
| | - Renate M Winkels
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,Wageningen University, Division of Human Nutrition and Health, Wageningen, Netherlands
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15
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Child Consumption of Whole Fruit and Fruit Juice Following Six Months of Exposure to a Pediatric Fruit and Vegetable Prescription Program. Nutrients 2019; 12:nu12010025. [PMID: 31877635 PMCID: PMC7019436 DOI: 10.3390/nu12010025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/16/2022] Open
Abstract
Public health recommendations suggest limiting child consumption of fruit juice in favor of whole fruit due to juice’s high sugar content, lack of fruit fiber, and potential for excess intake. However, replacing juice with whole fruit may be particularly challenging for low-income and minority children, who report the highest intake of 100% juice. To address access and affordability challenges among low-income children, researchers partnered with pediatricians in an urban food desert community, to introduce a fruit and vegetable prescription program (FVPP) that provided a $15 prescription for fresh produce to every child during each office visit. Participating vendors included a farmers’ market and local mobile market. This study assessed changes in daily consumption of total fruit and whole fruit among 108 pediatric patients following six months of exposure to the FVPP. Child-reported mean daily intake of whole fruit increased significantly from the baseline to the 6-month follow-up (p = 0.03): 44% of children reported an increased intake of at least ¼ cup per day, and 30% reported an increased intake of at least ½ cup per day. Changes in total fruit intake (including fruit juice) were not significant. Results suggest a pediatric FVPP may have meaningful impacts on children’s dietary behaviors, particularly with regard to the intake of whole fruits.
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16
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Fruit and Vegetable Prescriptions for Pediatric Patients Living in Flint, Michigan: A Cross-Sectional Study of Food Security and Dietary Patterns at Baseline. Nutrients 2019; 11:nu11061423. [PMID: 31242555 PMCID: PMC6627167 DOI: 10.3390/nu11061423] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 01/31/2023] Open
Abstract
Though fruit and vegetable consumption is essential for disease prevention and health maintenance, intake among children fails to meet dietary recommendations. Limited access to and the affordability of fresh produce, particularly among low-income youth, are barriers to adequate intake. To address these challenges, researchers and pediatricians in Flint, Michigan, expanded a successful fruit and vegetable prescription program that provides one $15 prescription for fresh fruits and vegetables to every child at every office visit. Vendors include the downtown farmers' market and a local mobile market. This study describes baseline characteristics, dietary patterns, food access, and food security among 261 caregiver-child dyads enrolled August 2018-March 2019. The child-reported mean daily intake of vegetables (0.72 cups ± 0.77), dairy products (1.33 cups ± 1.22), and whole grains (0.51 ounces ± 0.49) were well below recommendations. Furthermore, 53% of children and 49% of caregivers who completed the food security module indicated low or very low food security. However, there were no statistically significant differences in the child consumption of fruits and vegetables between households that reported high versus low food security (p > 0.05). Results validate and raise deep concerns about poor dietary patterns and food insecurity issues facing Flint children, many of whom continue to battle with an ongoing drinking water crisis. Additional poverty-mitigating efforts, such as fruit and vegetable prescription programs, are necessary to address these gaps.
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17
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Trapl ES, Smith S, Joshi K, Osborne A, Benko M, Matos AT, Bolen S. Dietary Impact of Produce Prescriptions for Patients With Hypertension. Prev Chronic Dis 2018; 15:E138. [PMID: 30447106 PMCID: PMC6266424 DOI: 10.5888/pcd15.180301] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Little is known regarding the impact of produce prescriptions within the context of hypertension visits at safety net clinics. We evaluated intervention effectiveness on patient usage of farmers markets and dietary change related to fruit and vegetable consumption. METHODS Health Improvement Partnership - Cuyahoga worked with 3 clinics to integrate, implement, and evaluated a produce prescription for hypertension (PRxHTN) program. PRxHTN involves 3 monthly, nonphysician provider visits, comprising blood pressure measurement, nutrition counseling, and four $10 farmers market produce vouchers, for hypertensive adult patients screening positive for food insecurity. Dietary measures were collected at visits 1 and 3. Voucher use was tracked via farmers market redemption logs. RESULTS Of the 224 participants from 3 clinics, most were middle-aged (mean age, 62 y), female (72%), and African American (97%) and had a high school education or less (62%). Eighty-six percent visited a farmers market to use their produce vouchers, with one-third reporting it was their first farmers market visit ever. Median number of farmers market visits was 2 (range: 0-6), and median number of vouchers redeemed was 8 (range: 0-12). Among the subsample with follow-up survey data (n = 137), significant improvement in fruit and vegetable consumption was observed as well as a decline in fast food consumption. CONCLUSION PRxHTN participants visited at least 1 farmers market, reported increases in provider communication related to diet, and exhibited significant changes in dietary behavior. PRxHTN can serve as a strong model for linking safety net clinics with farmers markets to promote community resource use and improve fruit and vegetable consumption among food-insecure patients with hypertension.
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Affiliation(s)
- Erika S Trapl
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
- Prevention Research Center for Healthy Neighborhoods, BioEnterprise Bldg, Room 445, 11000 Cedar Ave, Cleveland, OH 44106-7069.
| | | | - Kakul Joshi
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | | | | | - Anna Thornton Matos
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Shari Bolen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
- Department of Medicine, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio
- Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio
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18
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Hébert JR, Adams SA, Ureda JR, Young VM, Brandt HM, Heiney SP, Seel JS, Friedman DB. Accelerating Research Collaborations Between Academia and Federally Qualified Health Centers: Suggestions Shaped by History. Public Health Rep 2017; 133:22-28. [PMID: 29182891 DOI: 10.1177/0033354917742127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- James R Hébert
- 1 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,2 Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
| | - Swann Arp Adams
- 1 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,2 Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.,3 College of Nursing, University of South Carolina, Columbia, SC, USA
| | | | - Vicki M Young
- 5 South Carolina Primary Health Care Association, Columbia, SC, USA
| | - Heather M Brandt
- 2 Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.,6 Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,7 The Graduate School, University of South Carolina, Columbia, SC, USA
| | - Sue P Heiney
- 3 College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Jessica S Seel
- 2 Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
| | - Daniela B Friedman
- 2 Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.,6 Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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19
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Swinburne M, Garfield K, Wasserman AR. Reducing Hospital Readmissions: Addressing the Impact of Food Security and Nutrition. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2017; 45:86-89. [PMID: 28661295 DOI: 10.1177/1073110517703333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Food insecurity in the United States is a profound public health challenge that hospitals are uniquely situated to address. Through the enactment of the Hospital Readmission Reduction Program, the Affordable Care Act provides a strong economic incentive for hospitals to actively confront food insecurity within the communities they serve. While there is a spectrum of nutrition interventions that hospitals can look to when engaging in these efforts, healthy food prescriptions and medically tailored meals are two particularly innovative and promising approaches that could help hospitals reduce readmissions by addressing the nutritional needs of vulnerable patients.
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Affiliation(s)
- Mathew Swinburne
- Mathew Swinburne, J.D., is a Senior Staff Attorney for the Network for Public Health Law. He received a J.D. from the University of Maryland Francis King Carey School of Law, Baltimore, MD and a B.S. from Tufts University, Medford, MA. Katie Garfield, J.D., M.Phil., is a Staff Attorney at the Center for Health Law and Policy Innovation of Harvard Law School. She received a J.D. from Harvard Law School, Cambridge, MA; MPhil from the University of Cambridge, Cambridge, UK; and B.A. from Yale University, New Haven, CT. Aliza R. Wasserman, M.P.H., was at the time of submission the Policy & Advocacy Manager for Wholesome Wave in Washington, DC. She received an M.S. and M.P.H. from Tufts University, Medford, MA and a B.S. from Cornell University, Ithaca, NY
| | - Katie Garfield
- Mathew Swinburne, J.D., is a Senior Staff Attorney for the Network for Public Health Law. He received a J.D. from the University of Maryland Francis King Carey School of Law, Baltimore, MD and a B.S. from Tufts University, Medford, MA. Katie Garfield, J.D., M.Phil., is a Staff Attorney at the Center for Health Law and Policy Innovation of Harvard Law School. She received a J.D. from Harvard Law School, Cambridge, MA; MPhil from the University of Cambridge, Cambridge, UK; and B.A. from Yale University, New Haven, CT. Aliza R. Wasserman, M.P.H., was at the time of submission the Policy & Advocacy Manager for Wholesome Wave in Washington, DC. She received an M.S. and M.P.H. from Tufts University, Medford, MA and a B.S. from Cornell University, Ithaca, NY
| | - Aliza R Wasserman
- Mathew Swinburne, J.D., is a Senior Staff Attorney for the Network for Public Health Law. He received a J.D. from the University of Maryland Francis King Carey School of Law, Baltimore, MD and a B.S. from Tufts University, Medford, MA. Katie Garfield, J.D., M.Phil., is a Staff Attorney at the Center for Health Law and Policy Innovation of Harvard Law School. She received a J.D. from Harvard Law School, Cambridge, MA; MPhil from the University of Cambridge, Cambridge, UK; and B.A. from Yale University, New Haven, CT. Aliza R. Wasserman, M.P.H., was at the time of submission the Policy & Advocacy Manager for Wholesome Wave in Washington, DC. She received an M.S. and M.P.H. from Tufts University, Medford, MA and a B.S. from Cornell University, Ithaca, NY
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20
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Trapl ES, Joshi K, Taggart M, Patrick A, Meschkat E, Freedman DA. Mixed Methods Evaluation of a Produce Prescription Program for Pregnant Women. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2016. [DOI: 10.1080/19320248.2016.1227749] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Erika S. Trapl
- Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kakul Joshi
- Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Morgan Taggart
- St. Clair Superior Development Corporation, Cleveland, Ohio, USA
| | | | - Erika Meschkat
- Ohio State University Extension, Franklin County, Columbus, Ohio, USA
| | - Darcy A. Freedman
- Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA
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21
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Brandt HM, Freedman DA, Friedman DB, Choi SK, Seel JS, Guest MA, Khang L. Planting Healthy Roots: Using Documentary Film to Evaluate and Disseminate Community-Based Participatory Research. FAMILY & COMMUNITY HEALTH 2016; 39:242-50. [PMID: 27536929 PMCID: PMC4991561 DOI: 10.1097/fch.0000000000000120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Documentary filmmaking approaches incorporating community engagement and awareness raising strategies may be a promising approach to evaluate community-based participatory research. The study purpose was 2-fold: (1) to evaluate a documentary film featuring the formation and implementation of a farmers' market and (2) to assess whether the film affected awareness regarding food access issues in a food-desert community with high rates of obesity. The coalition model of filmmaking, a model consistent with a community-based participatory research (CBPR) approach, and personal stories, community profiles, and expert interviews were used to develop a documentary film (Planting Healthy Roots). The evaluation demonstrated high levels of approval and satisfaction with the film and CBPR essence of the film. The documentary film aligned with a CBPR approach to document, evaluate, and disseminate research processes and outcomes.
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Affiliation(s)
- Heather M. Brandt
- Associate Professor, Department of Health Promotion, Education, and Behavior, Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, South Carolina 29208, Telephone: 803-576-5649
| | - Darcy A. Freedman
- Associate Professor, Department of Epidemiology and Biostatistics, Social Work Associate Director, Prevention Research Center for Healthy Neighborhoods Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106-7069
| | - Daniela B. Friedman
- Associate Professor, Department of Health Promotion, Education, and Behavior, Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, South Carolina 29208
| | - Seul Ki Choi
- PhD Student, Department of Health Promotion, Education, and Behavior, Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street. Columbia, South Carolina 29208
| | - Jessica S. Seel
- MPH Student, Department of Health Promotion, Education, and Behavior, Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina 915 Greene Street, Columbia, South Carolina 29208
| | - M. Aaron Guest
- PhD Student, Graduate Center for Gerontology, College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40536
| | - Leepao Khang
- Adjunct Instructor, Department of Public Health, California State University, Fresno, 2345 East San Ramon Avenue M/S MH30, Fresno, California 93740
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Abstract
OBJECTIVE One challenge to healthy nutrition, especially among low-income individuals, is access to and consumption of fresh fruits and vegetables. To address this problem, Veggie Rx, a healthy food incentive programme, was established within a community clinic to increase access to fresh produce for low-income patients diagnosed with obesity, hypertension and/or type 2 diabetes. The current research aimed to evaluate Veggie Rx programme effectiveness. DESIGN A retrospective pre/post design using medical records and programme data was used to evaluate the programme. The study was approved by the University of Albany Institutional Review Board and the Patient Interest Committee of a community clinic. SETTING The study was conducted in a low-income, urban neighbourhood in upstate New York. SUBJECTS Medical record data and Veggie Rx programme data were analysed for fifty-four eligible participants. An equal-sized control group of patients who were not programme participants were matched on age, ethnicity and co-morbidity status. RESULTS A statistically significant difference in mean BMI change (P=0·02) between the intervention and the control group was calculated. The intervention group had a mean decrease in BMI of 0·74 kg/m2. CONCLUSIONS Greater improvement in BMI was found among Veggie Rx programme participants. This information will guide programme changes and inform the field on the effectiveness of healthy food incentive programmes for improving health outcomes for low-income populations.
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Friedman DB, Wilcox S, Hebert JR. Proposing an Interdisciplinary, Communication-Focused Agenda for Cancer and Aging Researchers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:218-20. [PMID: 25893924 PMCID: PMC4609582 DOI: 10.1007/s13187-015-0822-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cancer is mainly a disease of older people. Costs for cancer prevention and control are rising due to increased life expectancy and the large cohort of aging “baby boomers.” An effective strategy for better understanding processes related to cancer and aging across the entire cancer continuum (i.e., from prevention through to end-of-life care) is to approach this challenge collaboratively. Communication-focused research is an area of collaborative study for cancer and aging researchers that would provide evidence regarding the most effective means for reaching older adults with messages about cancer prevention, control, and quality of life issues. Specifically we recommend research that is guided by multidisciplinary communication frameworks, involves health care providers, incorporates an intergenerational and family-centered approach into designing and implementing empirical studies, and creates culturally appropriate messaging through community-engaged research.
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Affiliation(s)
- Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
- Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
- , 915 Greene Street, Room 235, Columbia, SC, 29208, USA.
| | - Sara Wilcox
- Department of Exercise Science and Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - James R Hebert
- Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
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Adams SA, Choi SK, Eberth JM, Friedman DB, Yip MP, Tucker-Seeley RD, Wigfall LT, Hébert JR. Is Availability of Mammography Services at Federally Qualified Health Centers Associated with Breast Cancer Mortality-to-Incidence Ratios? An Ecological Analysis. J Womens Health (Larchmt) 2015. [PMID: 26208105 DOI: 10.1089/jwh.2014.5114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Mammography is the most effective method to detect breast cancer in its earliest stages, reducing the risk of breast cancer death. We investigated the relationship between accessibility of mammography services at Federally Qualified Health Centers (FQHCs) and mortality-to-incidence ratio (MIR) of breast cancer in each county in the United States. METHODS County-level breast cancer mortality and incidence rates in 2006-2010 were used to estimate MIRs. We compared breast cancer MIRs based on the density and availability of FQHC delivery sites with or without mammography services both in the county and in the neighboring counties. RESULTS The relationship between breast cancer MIRs and access to mammography services at FQHCs differed by race and county of residence. Breast cancer MIRs were lower in counties with mammography facilities or FQHC delivery sites than in counties without a mammography facility or FQHC delivery site. This trend was stronger in urban counties (p=0.01) and among whites (p=0.008). Counties with a high density of mammography facilities had lower breast cancer MIRs than other counties, specifically in urban counties (p=0.01) and among whites (p=0.01). Breast cancer MIR for blacks was the lowest in counties having mammography facilities; and was highest in counties without a mammography facility within the county or the neighboring counties (p=0.03). CONCLUSIONS Mammography services provided at FQHCs may have a positive impact on breast cancer MIRs. Expansion of services provided at the FQHCs and placement of FQHCs in additional underserved areas might help to reduce cancer disparities in the United States.
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Affiliation(s)
- Swann Arp Adams
- 1 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.,2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.,3 College of Nursing, University of South Carolina , Columbia, South Carolina
| | - Seul Ki Choi
- 1 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.,4 Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - Jan M Eberth
- 1 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.,2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - Daniela B Friedman
- 1 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.,4 Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - Mei Po Yip
- 5 Division of General Internal Medicine, University of Washington , Seattle, Washington
| | - Reginald D Tucker-Seeley
- 6 Center for Community Based Research, Dana-Farber Cancer Institute , Boston, Massachusetts.,7 Department of Social and Behavioral Sciences, Harvard School of Public Health , Boston, Massachusetts
| | - Lisa T Wigfall
- 8 Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - James R Hébert
- 1 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.,2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
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Friedman DB, Toumey C, Porter DE, Hong J, Scott GI, Lead JR. Communicating with the public about environmental health risks: a community-engaged approach to dialogue about metal speciation and toxicity. ENVIRONMENT INTERNATIONAL 2015; 74:9-12. [PMID: 25305416 DOI: 10.1016/j.envint.2014.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/18/2014] [Accepted: 09/26/2014] [Indexed: 05/09/2023]
Affiliation(s)
- Daniela B Friedman
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Christopher Toumey
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Dwayne E Porter
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Jie Hong
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Geoffrey I Scott
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Jamie R Lead
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
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Hébert JR, Satariano WA, Friedman DB, Armstead CA, Greiner A, Felder TM, Coggins TA, Tanjasiri S, Braun KL. Fulfilling Ethical Responsibility: Moving Beyond the Minimal Standards of Protecting Human Subjects from Research Harm. Prog Community Health Partnersh 2015; 9 Suppl:41-50. [PMID: 26213403 PMCID: PMC4659710 DOI: 10.1353/cpr.2015.0021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PROBLEM Rules for protecting human subjects, in place federally since 1974, have focused primarily on guarding against placing research subjects at social, physical, or psychological risk or violating their privacy and confidentiality. Nevertheless, high-risk communities are routinely subjected to "sins of omission," which limit access to potentially significant research opportunities and result in the absence of studies that could confer high degree of community beneficence. PURPOSE OF ARTICLE To describe "sins of omission" and provide examples from the Community Networks Program Centers (CNPC) to illustrate how community-based participatory research (CBPR) can prevent them. KEY POINTS CBPR is an effective antidote to sins of omission. Activities undertaken by the CNPCs illustrate how adherence to CBPR principles can improve research access and outcomes. CONCLUSIONS By working with community members as partners, we expand the concept of beneficence to include "community beneficence," thus reducing the probability of "sins of omission."
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Friedman DB, Brandt HM, Freedman DA, Adams SA, Young VM, Ureda JR, McCracken JL, Hébert JR. Innovative and community-driven communication practices of the South Carolina cancer prevention and control research network. Prev Chronic Dis 2014; 11:E127. [PMID: 25058673 PMCID: PMC4112920 DOI: 10.5888/pcd11.140151] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The South Carolina Cancer Prevention and Control Research Network (SC-CPCRN) is 1 of 10 networks funded by the Centers for Disease Control and Prevention and the National Cancer Institute (NCI) that works to reduce cancer-related health disparities. In partnership with federally qualified health centers and community stakeholders, the SC-CPCRN uses evidence-based approaches (eg, NCI Research-tested Intervention Programs) to disseminate and implement cancer prevention and control messages, programs, and interventions. We describe the innovative stakeholder- and community-driven communication efforts conducted by the SC-CPCRN to improve overall health and reduce cancer-related health disparities among high-risk and disparate populations in South Carolina. We describe how our communication efforts are aligned with 5 core values recommended for dissemination and implementation science: 1) rigor and relevance, 2) efficiency and speed, 3) collaboration, 4) improved capacity, and 5) cumulative knowledge.
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Affiliation(s)
- Daniela B Friedman
- University of South Carolina, Arnold School of Public Health, Cancer Prevention and Control Program, 915 Greene St, Suite 235, Columbia, SC. E-mail:
| | | | - Darcy A Freedman
- Case Western Reserve University and the Prevention Research Center for Healthy Neighborhoods, Cleveland, Ohio
| | | | - Vicki M Young
- South Carolina Primary Health Care Association, Columbia, South Carolina
| | - John R Ureda
- Insights Consulting, Inc, Columbia, South Carolina
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