Abstract
BackgroundAlthough 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.MethodsDemographically 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.DiscussionCompletion 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 registrationThe study was registered through clinicaltrials.gov [ID: NCT04767282] on February 23, 2021.
Highlights
Nutrients in fruits and vegetables are necessary for proper development and disease preven‐ tion, most US children consume fewer servings than recommended
By grounding the study with the theoretical framework of Social Cognitive Theory (SCT), we suggest that pediatrician issuance of a prescription for fruits and vegetables to every child at each office visit will promote food access and self-efficacy to consume healthy foods
Discussion the current US Farm Bill provides funding opportunities for produce prescription programs, there are multiple knowledge gaps related to duration and intensity of exposure; ideal program timing and length; implementation components; and overall effectiveness
Summary
Nutrients in fruits and vegetables are necessary for proper development and disease preven‐ tion, 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. While most young people across the US struggle to attain even the minimum daily recommendations related to fruit and vegetable consumption, [7, 8] ultra-processed foods comprise the majority of total energy intake among US youths 2–19 years [9]. Increased adiposity related to shifts in diet and exercise have prompted public health action to encourage intake of fresh or minimally processed food among children and adolescents [10]. The programs differ in design and scope, yet most include health provider-issued prescriptions that patients can exchange, without charge, for fresh produce at local farmers’ markets, mobile markets, or food stores. With childhood and adolescence representing a critical period of development when many are establishing lifelong dietary behaviors [11,12,13], these programs are likely to have meaningful health implications
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