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Saxe-Custack A, Egan S, Farmer B, Pulka K, Sampson A. Caregiver-reported barriers to engagement in a paediatric fresh fruit and vegetable prescription programme. J Nutr Sci 2024; 13:e33. [PMID: 39314532 PMCID: PMC11418078 DOI: 10.1017/jns.2024.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 06/18/2024] [Accepted: 07/02/2024] [Indexed: 09/25/2024] Open
Abstract
Paediatric fruit and vegetable prescription programmes hold promise in improving food security and dietary patterns among youth. However, programme success is largely dependent upon caregiver and family engagement. The current study sought to gain a better understanding of environmental barriers to engagement in a paediatric fruit and vegetable prescription programme in one low-income, urban community (Flint, Michigan, USA). Following the implementation of a paediatric fruit and vegetable prescription programme, researchers conducted thirty-two semi-structured interviews with caregivers. Researchers explored caregivers' understanding of the fruit and vegetable prescription programme, barriers to programme engagement, and recommendations for improvement. Telephone interviews were transcribed for textual analysis. Researchers used thematic analysis to examine qualitative data, determine patterns across transcripts, and develop emerging themes. Researchers concluded interviews when data saturation was reached. The majority of participants were female (94%), African American (66%), and residents of Flint (72%). Five recurrent themes emerged: (1) nutrition security; (2) prescription distribution; (3) prescription redemption; (4) educational supports; and (5) programme modifications. Although caregivers indicated that the prescription programme addressed household food insecurity, environmental barriers to engagement were apparent. Caregivers provided suggestions, such as partnering with large grocery stores and developing digital prescriptions, to address programme engagement challenges. Fundamental to the success of fruit and vegetable prescription programmes is the understanding of barriers to engagement from the perspective of participants. This study explores challenges with one paediatric fruit and vegetable prescription programme and provides actionable solutions, from the viewpoint of caregivers, to address these challenges.
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Affiliation(s)
- Amy Saxe-Custack
- Charles Stewart Mott Department of Public Health, Michigan State University–Hurley Children’s Hospital Pediatric Public Health Initiative, Flint, MI, USA
| | - Sarah Egan
- Charles Stewart Mott Department of Public Health, Michigan State University–Hurley Children’s Hospital Pediatric Public Health Initiative, Flint, MI, USA
| | - Bridget Farmer
- Charles Stewart Mott Department of Public Health, Michigan State University–Hurley Children’s Hospital Pediatric Public Health Initiative, Flint, MI, USA
| | - Kimberly Pulka
- Charles Stewart Mott Department of Public Health, Michigan State University–Hurley Children’s Hospital Pediatric Public Health Initiative, Flint, MI, USA
| | - Anna Sampson
- Charles Stewart Mott Department of Public Health, Michigan State University–Hurley Children’s Hospital Pediatric Public Health Initiative, Flint, MI, USA
- Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
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Harper Z, Alvarado AV, Katz SE, Rovner AJ, Steeves EA, Raynor HA, Robson SM. Examining Food Security, Fruit and Vegetable Intake, and Cardiovascular Disease Risk Outcomes of Produce Prescription (PPR) Programs: A Systematic Review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024:S1499-4046(24)00387-7. [PMID: 39217534 DOI: 10.1016/j.jneb.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 06/28/2024] [Accepted: 06/28/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Outcomes from produce prescription (PPR) programs, an exemplar of a Food is Medicine intervention, have not been synthesized. The objective of this study was to conduct a systematic review to examine the impact of PPR programs on food security, fruit and vegetable (FV) intake, and/or cardiovascular risk factors (HbA1c, blood pressure, and blood lipids). DESIGN Searches were conducted across three databases (PubMed, CINAHL, and Web of Science). Eligible studies were published between August 2012 and April 2023, conducted in the US in child/family, or adult populations, written in English and had a PPR program as an exposure. OUTCOMES VARIABLES MEASURED Food security, FV intake, and/or cardiovascular risk factors. RESULTS Twenty studies ranging from a duration of between 6 weeks to 24 months were included. Of the 5 studies (3 in child/family and 4 in adult populations) that analyzed changes in food security status, all reported significant (P < 0.05) improvements after the PPR program. Approximately half of the included studies found significant (P < 0.05) increases in fruit, vegetable, and/or FV intake. Only studies in adult populations included cardiovascular risk factor outcomes. In these studies, mixed findings were reported; however, there were significant (P < 0.05) improvements in HbA1c when PPR programs enrolled individuals with type 2 diabetes. CONCLUSIONS AND IMPLICATIONS PPR programs provide an opportunity to improve food security in child/family, and adult populations. Evidence to support whether PPR programs increase FV intake and improve cardiovascular disease risk factors outside of HbA1c in adult populations with high HbA1c upon enrollment is less known.
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Affiliation(s)
- Zoe Harper
- Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, DE
| | | | - Sarah E Katz
- Library, Museums and Press, University of Delaware, Newark, DE
| | - Alisha J Rovner
- Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, DE
| | | | - Hollie A Raynor
- Department of Nutrition, University of Tennessee, Knoxville, TN
| | - Shannon M Robson
- Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, DE.
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Saxe-Custack A, LaChance J, Kerver JM. A Fresh Fruit and Vegetable Prescription Program for Prenatal Patients in Flint, Michigan: Baseline Food Security and Dietary Intake. Nutrients 2024; 16:1234. [PMID: 38674924 PMCID: PMC11054465 DOI: 10.3390/nu16081234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Although adequate nutritional status during pregnancy is necessary to support optimal fetal development, many low-income women have poor access to fresh, high-nutrient foods. To address these challenges, a pediatric fruit and vegetable (FV) prescription program was expanded to include pregnant women, providing one prescription for fresh FVs worth 15 US dollars during each prenatal office visit for redemption at farmers'/mobile markets. This analysis describes baseline sociodemographic characteristics, food security, and dietary intake among 253 pregnant women in Flint, Michigan in 2022-23. Dietary recall data were collected and analyzed using the Automated Self-Administered 24-h Tool developed by the US National Cancer Institute, with nutrition output reported in relation to adherence to US Dietary Guidelines. Most participants (mean ± SD age 26.51 ± 4.90 years) identified as African American (53%) and were receiving publicly funded health insurance (66%). Most (75%) reported no food insecurity, yet the majority failed to meet dietary recommendations for whole grains (99.3%), vegetables (93.1%), dairy (93.1%), and fruits (69.4%). Moreover, most did not meet micronutrient recommendations through food sources, including vitamin D (100%), iron (98.6%), folic acid (98.6%), vitamin A (82.6%), calcium (68.8%), and vitamin C (62.5%). Results raise deep concerns regarding diet and nutrition among pregnant women in this US city.
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Affiliation(s)
- Amy Saxe-Custack
- Charles Stewart Mott Department of Public Health, Michigan State University-Hurley Children’s Hospital Pediatric Public Health Initiative, Flint, MI 48502, USA;
| | - Jenny LaChance
- Charles Stewart Mott Department of Public Health, Michigan State University-Hurley Children’s Hospital Pediatric Public Health Initiative, Flint, MI 48502, USA;
| | - Jean M. Kerver
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48823, USA;
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Muleta H, Fischer LK, Chang M, Kim N, Leung CW, Obudulu C, Essel K. Pediatric produce prescription initiatives in the U.S.: a scoping review. Pediatr Res 2024; 95:1193-1206. [PMID: 38049646 PMCID: PMC11035140 DOI: 10.1038/s41390-023-02920-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/04/2023] [Accepted: 10/30/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND To describe pediatric Produce Prescription (PRx) interventions and their study designs, outcomes, and opportunities for future research. METHODS A scoping review framework was used to describe PRx interventions published between January 2000 and September 2023. Articles from online databases were uploaded into Covidence. Data on study characteristics, outcomes of interest (health, food insecurity (FI), nutritional and culinary efficacy, and fruit and vegetable (F/V) consumption), and feasibility were extracted. The Mixed Methods Appraisal Tool (MMAT) was used for quality assessment. RESULTS 19 articles met inclusion criteria. Ten studies were quantitative, five were qualitative, and four used mixed-methods. Interventions included food vouchers (n = 14) or food box/pantries (n = 5). Four studies allowed food items in addition to F/Vs. Six studies measured changes in FI and five reported a statistically significant decrease. Seven studies measured changes in F/V consumption and five reported a statistically significant increase. One study reported a statistically significant reduction in child BMI z-score. Most studies reported high feasibility. Few studies used high-quality methods. CONCLUSIONS Pediatric PRx interventions show promising potential to reduce FI and improve diet quality and health-related outcomes. Future studies should utilize rigorous study designs and validated assessment tools to understand the impact of pediatric PRx on health. IMPACT This work offers a summary of programmatic outcomes including retention, redemption, incentives, nutrition education, study design and quality limitations to help inform future work. We found positive impacts of pediatric produce prescriptions (PRx) on FI, F/V consumption, and nutritional knowledge and culinary skills. More high-quality, rigorous studies are needed to understand the best delivery and design of PRx and their impact on child behavior and health outcomes. This work provides support for the need for rigorous studies and the potential for PRx to play a role in multi-pronged strategies that address pediatric FI and diet-related disease.
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Affiliation(s)
- Hemen Muleta
- General and Community Pediatrics, Children's National Hospital, DC, Washington, USA
- Pediatric Hospital Medicine, Children's Hospital at Montefiore, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Laura K Fischer
- General and Community Pediatrics, Children's National Hospital, DC, Washington, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Megan Chang
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Noah Kim
- General and Community Pediatrics, Children's National Hospital, DC, Washington, USA
| | - Cindy W Leung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chinwe Obudulu
- Center for Nutrition Policy and Promotion, United States Department of Agriculture, Washington, DC, USA
| | - Kofi Essel
- General and Community Pediatrics, Children's National Hospital, DC, Washington, USA.
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Health Outcomes Organization, Elevance Health, Indianapolis, IN, USA.
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Rhodes EC, Pérez-Escamilla R, Okoli N, Hromi-Fiedler A, Foster J, McAndrew J, Duran-Becerra B, Duffany KO. Clients' experiences and satisfaction with produce prescription programs in California: a qualitative evaluation to inform person-centered and respectful program models. Front Public Health 2024; 12:1295291. [PMID: 38572012 PMCID: PMC10990041 DOI: 10.3389/fpubh.2024.1295291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/26/2024] [Indexed: 04/05/2024] Open
Abstract
Background Produce prescription programs have strong potential to improve food security, fruit and vegetable consumption, and health across the life course. Understanding clients' experiences and satisfaction with produce prescription programs is critical for evaluating the person-centeredness and quality of these programs. The objectives of this study were to (1) describe client experiences and satisfaction with produce prescription programs, with an emphasis on the extent to which they felt they were treated with respect and dignity, and (2) identify recommendations for improving client experiences. Methods We conducted four focus group discussions with clients of produce prescription programs in two Federally Qualified Health Centers in California. We used a modified framework analysis approach and organized participants' experiences with programs into themes. Results Three themes captured participants' program experiences. First, respectful produce prescription programming encompassed interactions with individuals delivering the programs that felt respectful (e.g., program staff showing they cared about participants' health and offering timely assistance with financial incentives) and disrespectful (e.g., not receiving prompt responses to questions about incentives), as well as aspects of program design perceived to be respectful (e.g., provision of gift cards as financial incentives, which offered privacy when purchasing produce). Second, having autonomy to use gift cards to choose their preferred fresh fruits and vegetables was viewed as a positive experience, though participants desired greater autonomy to shop at stores other than the program designated stores. Third, participants frequently discussed program usability, with some reporting that joining the programs and using the cards was easy, and others describing difficulties activating cards and using them at stores due to cashiers' lack of awareness of the programs. Overall, participants were highly satisfied with the programs. To improve client experiences, they recommended increasing privacy (e.g., by educating cashiers on the programs so that clients do not need to explain in public what the card is for) and autonomy (e.g., allowing cards to be used at other chain or local stores). Discussion Our findings inform efforts to make produce prescription programs more person-centered and respectful, which in turn may increase program demand, engagement, and impact.
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Affiliation(s)
- Elizabeth C. Rhodes
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, United States
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
- Yale-Griffin Prevention Research Center, Derby, CT, United States
| | - Ngozi Okoli
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
- Community Alliance for Research and Engagement, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Amber Hromi-Fiedler
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Jaime Foster
- Yale-Griffin Prevention Research Center, Derby, CT, United States
| | - John McAndrew
- Yale-Griffin Prevention Research Center, Derby, CT, United States
- Wholesome Wave, Bridgeport, CT, United States
| | - Beatriz Duran-Becerra
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
- Community Alliance for Research and Engagement, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Kathleen O’Connor Duffany
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
- Yale-Griffin Prevention Research Center, Derby, CT, United States
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Xu L, Plakias Z, Hanks AS, Garner J. Food insecurity, fruit and vegetable consumption, and use of the Supplemental Nutrition Assistance Program (SNAP) in Appalachian Ohio. PLoS One 2024; 19:e0295171. [PMID: 38329953 PMCID: PMC10852251 DOI: 10.1371/journal.pone.0295171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/16/2023] [Indexed: 02/10/2024] Open
Abstract
Food insecurity and inadequate nutrition are two major challenges that contribute to poor health conditions among U.S. households. Ohioans continue to face food insecurity, and rates of food insecurity in rural Southeast Ohio are higher than the state average. The main purpose of this project is to evaluate the associations between Supplemental Nutrition Assistance Program (SNAP) participation and food security in rural Ohio, and to explore the association between SNAP participation and fruit/vegetable consumption. We control for food shopping patterns, such as shopping frequency, because previous research reports a significant relationship between shopping patterns and food security. To achieve our purpose, we use novel household-level data on food insecurity and SNAP participation in rural Southeast Ohio, collected during the COVID-19 pandemic. We find that people who experience higher levels of food insecurity than others are more likely to participate in SNAP, though this is likely a function of selection bias. To correct for the bias, we employ the nearest neighbor matching method to match treated (SNAP participant) and untreated (similar SNAP nonparticipant) groups. We find that participating in SNAP increases the probability of being food secure by around 26 percentage points after controlling for primary food shopping patterns. We do not find any significant association between SNAP participation and estimated intake of fruits and vegetables. This study provides policymakers with suggestive evidence that SNAP is associated with food security in rural Southeast Ohio during the pandemic, and what additional factors may mediate these relationships.
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Affiliation(s)
- Lei Xu
- Department of Agricultural, Environmental, and Development Economics, The Ohio State University, Columbus, OH, United States of America
| | - Zoë Plakias
- Department of Economics, Western Washington University, Bellingham, Washington, United States of America
| | - Andrew S. Hanks
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States of America
| | - Jennifer Garner
- Department of Nutritional Sciences, University of Michigan School of Public Health, Columbus, OH, United States of America
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Abstract
PURPOSE OF REVIEW Poor diet and food insecurity contribute to the dramatic rise in diet-related chronic disease and increasing cost of healthcare. The Food as Medicine (FAM) framework describes food-based interventions designed to prevent, manage, and treat diet-related diseases. However, FAM interventions have not been widely implemented or evaluated in pediatric populations, so critical questions remain about their optimal delivery and design, efficacy, and funding opportunities. We have reviewed the recent literature and offer insights into potential funding and implementation strategies for pediatric healthcare providers. RECENT FINDINGS Data from adult and population-level interventions provide evidence that FAM interventions positively impact diet quality, food security, health outcomes, and healthcare utilization and cost in adults and households with children. Evidence from recent pediatric-based FAM interventions and population data from recent changes to federal nutrition programs support the use of food-based interventions to improve child diet quality, food insecurity, and potentially impact long-term health and healthcare utilization and cost. SUMMARY Applying the entire spectrum of evidence-based FAM interventions in pediatric settings from prenatal to adolescent stages will offer the greatest opportunity to ensure all children have access to enough healthful food so they can achieve their highest potential in life.
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Affiliation(s)
- Laura Fischer
- Children's National Hospital, General and Community Pediatrics, Washington, DC
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Hemen Muleta
- Children's Hospital at Montefiore, Pediatric Hospital Medicine
- Albert Einstein College of Medicine, Department of Pediatrics, Bronx, New York
| | - Kofi Essel
- Children's National Hospital, General and Community Pediatrics, Washington, DC
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
- Elevance Health, Indianapolis, Indiana, USA
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Cruz Herrera E, Figueroa-Nieves AI, Woo Baidal JA. The potential role of social care in reducing childhood obesity. Curr Opin Pediatr 2024; 36:10-16. [PMID: 37972976 DOI: 10.1097/mop.0000000000001309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW This review evaluates the current evidence for relationships of social factors with childhood obesity and for a role of social care in reduction of childhood obesity. RECENT FINDINGS Most literature on the relationship between social factors and childhood obesity has examined food insecurity as a risk factor for obesity. Associations between food insecurity and excess weight in children are most consistent during infancy and among those with food insecurity at more than one time point. A few pilot food security interventions that link patients with produce or groceries show feasibility and potential promise for reducing childhood obesity risk factors. However, full-scale, randomized studies to examine interventions that reduce social needs and their effects on childhood obesity are lacking. Future research is needed to examine holistic social care approaches to effectively reduce childhood obesity risk factors. SUMMARY Food insecurity acts as a barrier to childhood obesity prevention and treatment. Patient-centered, validated measures of social needs and effective interventions to address social needs are needed to equitably prevent and treat childhood obesity.
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Affiliation(s)
- Evianna Cruz Herrera
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center and NewYork-Presbyterian, New York, New York, USA
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Haushalter K, Burgermaster M, Hudson E, Landry MJ, Sharma SV, Davis JN. An Increase in Food Insecurity Correlated with an Increase in Plasma Triglycerides among Latinx Children. J Nutr 2024; 154:565-573. [PMID: 38110183 PMCID: PMC10900190 DOI: 10.1016/j.tjnut.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Food insecurity and metabolic diseases both disproportionately affect Hispanic children. Cross-sectional studies have linked food insecurity with adverse cardiometabolic markers, including elevated plasma triglycerides and glucose concentrations. However, the association between changes in food insecurity and changes in cardiometabolic markers in children remains to be explored. Furthermore, few studies have assessed the impact of school-based nutrition interventions on household food insecurity. OBJECTIVE The objectives of this study are to assess the effect of the TX Sprouts intervention on household food insecurity and to examine the association between changes in household food insecurity and changes in cardiometabolic markers over 1 academic year. METHODS This secondary analysis used data from TX Sprouts, a cluster-randomized school-based gardening, cooking, and nutrition trial. The study enrolled 3rd-5th-grade students from 16 schools that served primarily (>50%) Hispanic families with low income in Austin, TX. Participants (n = 619) provided household food insecurity data and fasting lipid panels at both baseline and postintervention, ∼9 mo following. RESULTS There was no intervention effect on household food insecurity. Independent of the intervention, a 1-point increase in food insecurity, indicative of becoming more food insecure, was associated with a 2.61 mg/dL increase in triglycerides (P = 0.001; 95% CI: 1.04, 4.19) at follow-up. Children who were food insecure at baseline and became food secure at follow-up had a mean 5.05 mg/dL decrease in triglycerides compared with a 7.50 mg/dL increase in triglycerides in children who remained food insecure throughout (95% CI: -23.40, -1.71, P = 0.023). There were no other associations between changes in food insecurity and cardiometabolic markers. CONCLUSION Although the intervention did not improve food insecurity, reductions in food insecurity over 9 mo were associated with improved cardiometabolic markers in high-risk children, emphasizing the need for interventions targeting food insecurity. The study is registered at clinicaltrials.gov under NCT02668744 (https://classic. CLINICALTRIALS gov/ct2/show/NCT02668744).
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Affiliation(s)
- Keally Haushalter
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, United States
| | - Marissa Burgermaster
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, United States; Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Erin Hudson
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, United States
| | - Matthew J Landry
- Department of Population Health and Disease Prevention, University of California, Irvine, Irvine, CA, United States
| | - Shreela V Sharma
- Department of Epidemiology, Human Genetics and Environmental Sciences (UTHealth) School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jaimie N Davis
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, United States.
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Mathur M, Marshall A, Yeragi P, Prabhu V, Markham C, Preston A, Stark K, Pomeroy M, McKay S, Gaminian A, Chuang RJ, Kow R, Tang M, Sharma S. Design and protocol of a clinic-based comparative effectiveness randomized controlled trial to determine the feasibility and effectiveness of food prescription program strategies in at-risk pediatric populations. Contemp Clin Trials 2023; 135:107379. [PMID: 37935306 DOI: 10.1016/j.cct.2023.107379] [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: 05/30/2023] [Revised: 10/16/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Produce prescription programs are gaining traction in the U.S.; however, data on the impact of such approaches in pediatric populations are limited. The purpose of our clinic-based comparative effectiveness randomized controlled trial (CE RCT) is to evaluate the preliminary effectiveness of two produce prescription strategies (at-home delivery and grocery store vouchers) implemented by the Brighter Bites non-profit organization in improving obesity-related health outcomes and dietary behaviors among low-income 5-12-year-olds in Houston, Texas. This paper presents the study design, intervention components, and the study measures. METHODS Participants (n = 150) are being recruited from two pediatric clinics in Houston, Texas. Child eligibility criteria are aged 5-12 years, Medicaid recipients, body-mass index (BMI) percentile ≥85 and living within 10 miles of a Brighter Bites distribution site. Following consent and baseline measures, children are randomized into one of three arms: (1) Bi-weekly $25 vouchers redeemable for produce at stores (n = 50), (2) Bi-weekly produce delivery to participants' homes through DoorDash (n = 50), and (3) wait-list usual care controls (n = 50). Intervention participants also receive Brighter Bites nutrition education materials. Main child outcome measures are BMI z-scores, blood pressure, hemoglobin A1c, liver panels, and lipid panels. Other outcomes including household food insecurity, child diet quality, and home nutrition environment will be collected through parent surveys. Outcome measures are collected at baseline and post-intervention. Process evaluation will measure program dosage, reach, acceptability, and feasibility. CONCLUSIONS Our paper presents the design and next steps to ensure the successful implementation of a produce prescription program in a pediatric clinic setting.
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Affiliation(s)
- Mallika Mathur
- Center for Health Equity, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Allison Marshall
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Prajakta Yeragi
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - Vinay Prabhu
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - Christine Markham
- Center for Health Equity, Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alexis Preston
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - Kaitlyn Stark
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | | | - Sandra McKay
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | | | - Ru-Jye Chuang
- Center for Health Equity, Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rebecca Kow
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - Miao Tang
- Center for Health Equity, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shreela Sharma
- Center for Health Equity, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Sadler RC, Saxe-Custack A. 'Nobody Shops at the Neighborhood Store': Leveraging a Community's Pediatric Fresh Produce Prescription Program to Inform Future Participating Store Redemption Locations. CITIES & HEALTH 2023; 8:70-81. [PMID: 38585045 PMCID: PMC10997326 DOI: 10.1080/23748834.2023.2281764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/06/2023] [Indexed: 04/09/2024]
Abstract
Research examining the nature of food shopping often considers proximity to the nearest or overall distance travelled to multiple stores. Such studies make up a portion of new work on so-called 'food deserts' and the issues inherent in the term, including that most people do not shop at their nearest store, and mobility challenges vary vastly from one person to the next. Increasing the knowledge base on shopping characteristics could be useful for behavioral interventions and programs aimed at increasing healthy food shopping. In this study, we examined the shopping characteristics of 627 caregivers whose children were enrolled in a pediatric fresh produce prescription program at one of three large pediatric clinics in Flint, Michigan. We compared these characteristics to the potential of a new food cooperative to improve geographic accessibility to healthy food. In particular, we propose the expansion of the prescription program to this new cooperative for health-related as well as local economic development reasons. Our work bridges topics of interest to researchers and practitioners working in nutrition, food access, and economic development.
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Affiliation(s)
- Richard C. Sadler
- Departments of Public Health and Family Medicine, Michigan State University, Flint, MI, USA
| | - Amy Saxe-Custack
- Departments of Public Health and Food Science & Human Nutrition, Michigan State University, Flint, MI, USA
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Norris K, Jilcott Pitts S, Reis H, Haynes-Maslow L. A Systematic Literature Review of Nutrition Interventions Implemented to Address Food Insecurity as a Social Determinant of Health. Nutrients 2023; 15:3464. [PMID: 37571400 PMCID: PMC10421408 DOI: 10.3390/nu15153464] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Policy initiatives have provided funding for non-acute nutrition interventions to address food insecurity as a social determinant of health, but more research is needed to understand the outcomes of these initiatives in order to determine the areas of highest impact. Therefore, the purpose of this systematic review was to evaluate the outcomes that were assessed in three nutrition interventions (produce prescription programs, medically tailored meals, and community supported agriculture) that aim to address food insecurity as a social determinant of health, and this was undertaken in order to identify future areas of study that can heighten impact. METHODS This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria. A list of search terms and keywords were compiled by the research team. A Boolean search was conducted from 1 January 2000 to 1 January 2023 in the PubMed advanced search database. RESULTS A total of 1015 articles were initially pulled from the PubMed database, and, after a screening process, 21 articles were included in our review. Nineteen of the articles focused on adult populations or families and two focused on children. The main outcomes assessed were changes in self-reported dietary intake, while a few of the articles addressed feasibility and cost-related outcomes. CONCLUSIONS More research is needed to assess whether nutritional interventions to address food insecurity as a social determinant of health are feasible and more cost effective in the long term. Additionally, more work should be conducted in pediatric populations, which could have a robust return on investment in terms of both healthcare utilization and healthcare expenditure.
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Affiliation(s)
- Kennedy Norris
- Department of Public Health, East Carolina University, Greenville, NC 27834, USA
| | | | - Heidi Reis
- Laupus Health Sciences Library, East Carolina University, Greenville, NC 27834, USA
| | - Lindsey Haynes-Maslow
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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A Produce Prescription Program in Eastern North Carolina Results in Increased Voucher Redemption Rates and Increased Fruit and Vegetable Intake among Participants. Nutrients 2022; 14:nu14122431. [PMID: 35745161 PMCID: PMC9229115 DOI: 10.3390/nu14122431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
Few produce prescription programs have taken place in rural areas, in the context of existing public health programs. Thus, the purpose of this mixed-methods study was to examine voucher redemption rates, change in fruit and vegetable intake, and suggestions for improvement among participants enrolled in a produce prescription program occurring in existing public health programs throughout rural eastern North Carolina. We examined voucher redemption rates and conducted pre- (n = 125) and post-intervention surveys assessing fruit and vegetable intake. t-tests were used to examine changes in intake pre- versus post-intervention among 50 participants. Participants (n = 32) also completed a semi-structured, telephone interview. Qualitative data were thematically analyzed to determine potential improvements. The overall voucher redemption rate was 52%. There was a 0.29 (standard deviation = 0.91, p = 0.031) cup increase in self-reported fruit intake comparing post- to pre-intervention data. Qualitative analyses indicated that participants enjoyed the financial benefits of the program and wanted it to continue. The produce prescription program was successful in increasing self-reported fruit intake among participants. More research is needed to determine if changes in intake persist when measured objectively, and on best methods for the program’s financial sustainability.
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Fischer L, Bodrick N, Mackey ER, McClenny A, Dazelle W, McCarron K, Mork T, Farmer N, Haemer M, Essel K. Feasibility of a Home-Delivery Produce Prescription Program to Address Food Insecurity and Diet Quality in Adults and Children. Nutrients 2022; 14:nu14102006. [PMID: 35631144 PMCID: PMC9144615 DOI: 10.3390/nu14102006] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
Produce prescription programs aim to improve food insecurity (FI) and nutrition but their effectiveness is unclear. We conducted a pilot study to demonstrate the feasibility and explore the potential impact of a family-based, home-delivery produce prescription and nutrition education program. We measured enrollment, satisfaction, participation, and retention as measure of feasibility. Adult participants answered pre-post self-report questionnaires assessing FI, child and adult fruit and vegetable intake, and culinary literacy and self-efficacy. To understand participants' lived experiences, qualitative interviews were conducted at the 6-month time point. Twenty-five families were enrolled. Feasibility measures indicate participants were generally satisfied with the program but there were important barriers to participation. Qualitative data revealed themes around reduced food hardship, healthy eating, budget flexibility, and family bonding. Fruit and vegetable consumption increased in a small subgroup of children, but post-intervention intake remained below recommended levels, particularly for vegetables. FI scores were not significantly different post-intervention, but qualitative findings indicated improved access and reliability of food. This is the first intervention of its kind to be evaluated for feasibility and our results suggest the intervention is well-received and supportive. However, further study, with a larger sample size, is needed to understand factors influencing participation and assess effectiveness.
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Affiliation(s)
- Laura Fischer
- Department of General and Community Pediatrics, Children’s National Hospital, Washington, DC 20010, USA; (L.F.); (N.B.)
- School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA; (E.R.M.); (W.D.)
| | - Nia Bodrick
- Department of General and Community Pediatrics, Children’s National Hospital, Washington, DC 20010, USA; (L.F.); (N.B.)
- School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA; (E.R.M.); (W.D.)
| | - Eleanor R. Mackey
- School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA; (E.R.M.); (W.D.)
- Center for Translational Research, Children’s National Hospital, Washington, DC 20010, USA
| | | | - Wayde Dazelle
- School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA; (E.R.M.); (W.D.)
| | - Kristy McCarron
- YMCA of Metropolitan Washington, Washington, DC 20009, USA; (K.M.); (T.M.)
| | - Tessa Mork
- YMCA of Metropolitan Washington, Washington, DC 20009, USA; (K.M.); (T.M.)
| | - Nicole Farmer
- National Institutes of Health Clinical Center, Translational Biobehavioral and Health Disparities Branch, Bethesda, MD 20892, USA;
| | - Matthew Haemer
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80121, USA;
| | - Kofi Essel
- Department of General and Community Pediatrics, Children’s National Hospital, Washington, DC 20010, USA; (L.F.); (N.B.)
- School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA; (E.R.M.); (W.D.)
- Correspondence: ; Tel.: +1-202-994-0275
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Kahlon MK, Aksan NS, Aubrey R, Barnes J, Clark N, Cowley-Morillo M, Engelman L, Guerra J, Guevara A, Marshall A, Hoelscher DM. Effect of Brief Produce Exposure and Unconstrained Grocery Gift Cards on Caregiver Influence on Diet of Elementary Age Children: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2212973. [PMID: 35622367 PMCID: PMC9142863 DOI: 10.1001/jamanetworkopen.2022.12973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Children's diets affect health trajectories but are difficult to influence, especially for resource-constrained families. OBJECTIVE To assess the effectiveness of providing 4 weeks of grocery gift cards and small produce boxes to caregivers on their ability to support healthy shifts in children's diets. DESIGN, SETTING, AND PARTICIPANTS This 2-group randomized clinical trial was conducted from May to July 2021, with 4 weeks of intervention and follow-up at 8 weeks. Resources were provided curbside at 3 schools, 3 housing sites, and 1 after-school site for use at home. Participants consisted of 1 index child ages 5 to 11 years with 1 index caregiver from 68 low-income families. Data were analyzed from July 2021 through March 2022. INTERVENTIONS During each week for 4 weeks, caregivers were offered 10-lb (4.5 kg) boxes of fruits and vegetables, $10.00 grocery gift cards, an additional $10.00 gift card over the last 3 weeks triggered by a task completion, and a 1-time choice of a $25.00 food preparation tool. MAIN OUTCOMES AND MEASURES Index child and caregiver diets were measured together over the phone at baseline, 4 weeks, and 8 weeks using the 2019 to 2020 Texas School Physical Activity and Nutrition (SPAN) tool, which measures the number of times food items were eaten over the prior day to report a SPAN Healthy Eating Index (SHEI) score and subscores for specific categories of foods (range, 0-57, with higher scores indicating a more healthful diet). RESULTS Among 68 children (mean [SD] age, 8.2 [1.7] years; 35 [51.5%] girls) and caregivers (mean [SD] age, 37.9 [7.9] years; 63 mothers [92.6%]) from primarily low-income families, 26 caregivers were Hispanic or Latino (38.2%), while 18 caregivers were Black (26.4%), 25 caregivers were White (36.7%), and 24 caregivers had more than 1 race (35.3%). Most families were below the federal poverty level (41 of 60 families that reported income [68.3%]). Per participating caregiver, a mean (SD) 2.7 [1.4] fruit and vegetable boxes and $42.35 ($25.46) worth of gift cards were picked up over 4 weeks. Mean (SE) child SPAN SHEI increased from 32.03 (0.62) times/d to 33.75 (0.69) times/d at 4 weeks (ie, postintervention) and 34.03 (0.69) times/d 4 weeks later (ie, at 8 weeks of follow-up). Mean (SE) child fruit and vegetable intake increased from 5.31 (0.47) times/d to 5.78 (0.51) times/d postintervention and 6.03 (0.51) times/d at follow-up. Children in the control group did not have improved diet (overall mean [SE] SHEI: 31.48 [0.58] times/d at baseline, 31.68 [0.54] times/d postintervention, and 31.81 [0.52] times/d at follow-up; mean [SE] fruit and vegetable intake: 5.21 [0.45] times/d at baseline, 4.77 [0.45] times/d postintervention, and 4.68 [0.41] times/d at follow-up). Compared with children in the control group, mean SHEI was increased for children in the intervention group by 2.07 times/d postintervention and 2.23 times/d at follow-up. Improvements as a function of program dose were statistically significant for child SHEI (P = .01) and fruit and vegetable intake (P = .03). No significant changes in caregiver diets were found. CONCLUSIONS AND RELEVANCE This study found that easily accessed fruits and vegetables and unconstrained grocery store cards provided directly to caregivers over 4 weeks resulted in improvements in child diet, which were sustained over 4 additional weeks. Future work may investigate whether diet improvement from a brief intervention optimized for caregiver flexibility reflects a natural maximum or potential for greater improvements on extension. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04827654.
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Affiliation(s)
- Maninder K. Kahlon
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Nazan S. Aksan
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Rhonda Aubrey
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Jenn Barnes
- Boys and Girls Clubs of the Austin Area, Austin, Texas
| | - Nicole Clark
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Maria Cowley-Morillo
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Lindsey Engelman
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Julia Guerra
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Alejandro Guevara
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Allison Marshall
- Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston School of Public Health in Austin
| | - Deanna M. Hoelscher
- Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston School of Public Health in Austin
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Saxe-Custack A, Todem D, Anthony JC, Kerver JM, LaChance J, Hanna-Attisha M. Effect of a pediatric fruit and vegetable prescription program on child dietary patterns, food security, and weight status: a study protocol. BMC Public Health 2022; 22:150. [PMID: 35062926 PMCID: PMC8778506 DOI: 10.1186/s12889-022-12544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although nutrients in fruits and vegetables are necessary for proper development and disease prevention, most US children consume fewer servings than recommended. Prescriptions for fruits and vegetables, written by physicians to exchange for fresh produce, address access and affordability challenges while emphasizing the vital role of diet in health promotion and disease prevention. Michigan’s first fruit and vegetable prescription program (FVPP) exclusively for children was introduced in 2016 at one large pediatric clinic in Flint and expanded to a second clinic in 2018. The program provides one $15 prescription for fresh produce to all pediatric patients at every office visit. Prescriptions are redeemable at a year-round farmers’ market or a local mobile market. The current study will assess the impact of this FVPP on diet, food security, and weight status of youth.
Methods
Demographically similar pediatric patient groups with varying levels of exposure to the FVPP at baseline will be compared: high exposure (> 24 months), moderate exposure (12–24 months), and no previous exposure. Data collection will focus on youth ages 8–16 years. A total of 700 caregiver-child dyads (one caregiver and one child per household) will be enrolled in the study, with approximately 200 dyads at clinic 1 (high exposure); 200 dyads at clinic 2 (moderate exposure), and 300 dyads at clinic 3 (no previous exposure). Children with no previous exposure will be introduced to the FVPP, and changes in diet, food security, and weight status will be tracked over two years. Specific aims are to (1) compare baseline diet, food security, and weight status between pediatric patients with varying levels of exposure to the FVPP; (2) measure changes in diet, food security, and weight status before and after never-before-exposed children are introduced to the FVPP; and (3) compare mean 12- and 24-month follow-up measures of diet, food security, and weight status in the initial no exposure group to baseline measures in the high exposure group.
Discussion
Completion of study aims will provide evidence for the effectiveness of pediatric FVPPs and insights regarding the duration and intensity of exposure necessary to influence change.
Trial registration
The study was registered through clinicaltrials.gov [ID: NCT04767282] on February 23, 2021.
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