Ma#hew B. Fine 1,2 Capstone Mentor: Sara Berney- Execu>ve Director 2,3 1 Department of Environmental Health, Rollins School of Public Health | 2 Wholesome Wave Georgia Background Chronic disease is at epidemic propor0ons in the United States, with 34.9% of Americans being overweight or obese and 9% suffering from type II diabetes; v In Georgia these numbers are 30.4% and 10.4%, respec0vely; Those of low socioeconomic status are dispropor0onately affected by these diseases, diet quality follows a similar paJern to the SES gradient in health; v Nutrient density, energy density, and cost are inversely related; Fruits and vegetables have been found to be protec0ve against many forms of chronic illness; however, a diet high in produce is considerably more expensive than what is feasible for low SES families; v A diet that met all federal nutri0on recommenda0ons would consume up to 40% of a low income households income; Programs like Food Stamps begin to address the issues of food insecurity, but simply supplemen0ng the cost is not enough to encourage healthy shopping behaviors; v One must also address issues of accessibility and knowledge of healthy food/ea0ng; Wholesome Wave Georgia (WWG) works to incen0vize healthy ea0ng through the use of federal nutri0on incen0ves at producer only farmers markets across the state of Georgia. Methodology FVRx Protocol Objec>ve Fruits and vegetables are important components of chronic disease preven0on and management. The Fruit and Vegetable Prescrip0on Program (FVRx) seeks to increase its par0cipants knowledge of healthy ea0ng, increase their access to healthy foods, and improve their health. This project seeks to evaluate the Augusta, GA FVRx and make informed recommenda0ons on how to best improve the program protocol based off of a literature review of similar studies. Literature Review and Program Evalua0on In order to best adapt our protocol based off of best prac0ces a brief literature review using PubMed and Google Scholar was conducted, the The search terms fall into the following categories: v Health effects of low SES; v Farmers market nutri0on assistance programs; v Federal Nutri0on incen0ves and health; v Cooking and Nutri0on Educa0on and health. Results 3 Acknowledgments: Special thanks to Sara Berney and the rest of the staff at Wholesome Wave Georgia for this opportunity. FVRx While there was no appreciable change in weight or blood pressure, the average blood pressure for pa0ents who completed follow up dropped from the hypertensive to normal range (p<0.05). Pa0ents saw an increase of one serving of fruit and vegetable per week, which was determined to be sta0s0cally but not prac0cally significant Farmers Market v 89% of prescrip0ons were redeemed at the Augusta Veggie Truck Farmers Market v 42 varie0es of produce were sold at the farmers market v 10,081 cup standard servings of produce were purchased v 3,758 servings of fruit v 6,060 servings of vegetables v 983 servings of greens 0 2 4 6 8 10 12 14 16 18 $- $50.00 $100.00 $150.00 $200.00 $250.00 $300.00 $350.00 $400.00 $450.00 $500.00 9-Jun 16-Jun 23-Jun 30-Jun 7-Jul 14-Jul 21-Jul 28-Jul 4-Aug 11-Aug 18-Aug 25-Aug 1-Sep 8-Sep 15-Sep 22-Sep 29-Sep 6-Oct 13-Oct 20-Oct 27-Oct FVRx Par>cipant A#endance Total Tokens Distributed Market Date FVRx Par>cipant A#endance and Token Distribu>on by Market Date Tokens Par0cipants “I did not realize how liJle we were ea0ng of fresh fruits and veggies. We always bypassed most of them because they were more expensive than the canned ones. But for the last 2 weeks we have had at least 4 servings a day with the variety of things we’ve goJen”-FVRx Par0cipant “I was always big on prescribing cheap prescrip0ons to my pa0ents. I had never thought about prescribing food. My pa0ents were not going to the farmers markets; they were buying the 4 for $4 at Wendy’s. I saw the endless cycle of health problems created by food and what my pa0ents were ea0ng… The Rx program completely changed the way I prescribed medicine. Now I prescribe food.” -FVRx Provider Evalua>on and Recommenda>ons Using the program evalua0on as a baseline the literature review led to the following recommenda0ons for adjustments to the program protocol: v Improve pa0ent recruitment by relaxing enrollment guidelines, include children or any that could benefit; v Make clinic visits more flexible or more appropriate for par0cipants schedules; v Create new marke0ng materials; v Incen0vize healthy produce shopping at convenience stores, to diversify types of food venues to make shopping more convenient; v Provide economic support for transporta0on costs to and from both the market and clinic visits; v Create a more robust nutri0on educa0on and cooking program by focusing on cooking on a budget/one-pot cookbooks; v Track the increase in home cooked meals and decrease in fast food purchases as an addi0onal tool for program evalua0on. ** ** ** Conclusion The FVRx saw marginal improvements in the health of its par0cipants and moderate increases in the servings of fruits and vegetables consumed. Despite these small gains the FVRx is a feasible route to managing and eventually preven0ng chronic illnesses in disadvantaged popula0ons. The combina0on of economic incen0ves and nutri0on educa0on is a good star0ng point to crea0ng behavior change and incen0vize healthy ea0ng habits. As the program expands through the state of Georgia it will be important to see how results translate from urban to rural popula0ons. Overall the FVRx is poten0ally an important health policy mechanism to halt the growth of chronic disease incidence while incen0vizing a healthy diet for future genera0ons. Photo 1: FVRx par0cipants shopping at the Augusta Veggie Truck Farmers Market Photo 2: Dishes prepared by FVRx par0cipants with produce they purchased at the market Photo 3: Par0cipants preparing food at the cooking class