Assistant Professor McGovern Medical School at the University of Texas Health Science Center at Houston Houston, Texas, United States
Background: Produce prescription programs are gaining traction in the U.S to improve diet quality. However, evidence on effective strategies required to ensure successful implementation of such programs in pediatric clinical settings is limited. The produce prescription program is a comparative effectiveness randomized controlled trial (CE RCT) being conducted in two pediatric clinics at University of Texas Health Science Center (UT Health) in Houston, Texas. Objective: To evaluate the feasibility of two produce prescription strategies (at home delivery and grocery store vouchers) in improving obesity-related health outcomes and dietary behaviors among elementary-aged children Methods: UTHealth partnered with a national non-profit, Brighter Bites, to provide fresh produce and nutritional education to overweight or obese, low-income children aged 5-12 years. Design/Methods: Children are prescribed the program at the time of their well-child visit. Outcomes are measured at baseline and post intervention. Main outcome measures are child’s BMI, blood pressure, hemoglobin A1c, liver panels, and lipid panels. Secondary outcomes including food insecurity, diet quality, and home nutrition environment will be collected through parent surveys. Successful integration of the program involved: clinic stakeholders identifying community partners who had the infrastructure to provide the necessary produce distributions, buy-in from clinic staff, researchers with the evaluation knowledge, and a theoretical framework to guide the planning and evaluation of the program. Buy-in from clinic staff was an essential first step to help incorporate the program, and development of a strong process map and framework aided in a successful program launch. Results: Participants were randomized into one of three study arms: (1) Fresh produce delivery, (2) Produce vouchers, and (3) standard care control group. Each group consisted of 50 participants, for a total of 150. 182 participants were approached either at the time of the appointment or after the visit, with 21 refusing. The average age of participants at baseline was 9 years, with a mean BMI z-score was 2.06, indicating majority of the participants fell into the obese category. Participants had a mean hemoglobin A1C vale of 5.29 and a total cholesterol value of 155.
Conclusion(s): The successful incorporation of the program into the clinic provides key steps for future program expansion. Baseline data indicates a strong need for produce prescription programs. Having a strong framework and support can encourage pediatricians to engage in community and academic partnerships.
