Nutrients in fruits and vegetables are critical for proper growth and development, cognitive function, and prevention of chronic disease; however, most US children consume fewer servings of fruits and vegetables than recommended. Evidence suggests that limited access to and affordability of fresh, high-quality produce are significant barriers to adequate consumption, particularly among low-income youth. Subsidized prescriptions for fruits and vegetables, written by physicians in exchange for fresh produce, address access and affordability challenges while emphasizing the vital role of diet in health promotion. With childhood consistently identified as a critical period for the establishment of lifelong dietary patterns, primary care physicians who prescribe fresh fruits and vegetables to their young patients are likely to influence lifelong dietary behaviors. Our preliminary work suggests that caregivers whose children were exposed to a year-round fruit and vegetable prescription program that provided one $15 prescription for fresh produce at every office visit perceived prescriptions to be effective in improving child dietary patterns as well as household food security. Although American Academy of Pediatrics recommends that physicians screen all households with children for food insecurity, many do not screen nor play an active role in addressing the underlying problem due to lack of resources to support families who screen positive. We suggest that providing a prescription for fruits and vegetables to every child at every office visit goes beyond traditional nutrition education to address persistent environmental challenges related to access and affordability of fresh produce. The objective of this application is to address gaps in knowledge related to the influence of pediatric fruit and vegetable prescription programs on food security, child dietary patterns, and weight status. To do this, we will compare demographically similar pediatric patient groups from three large clinics in a low-income urban city based on their exposure to a fruit and vegetable prescription program (FVPP) that provides one $15 prescription for fresh fruits and vegetable to every child at every office visit. Three clusters will be identified based on child exposure to the pediatric FVPP at baseline: high exposure (>24 months), moderate exposure (12-24 months), and no previous exposure. We will then introduce the FVPP to never exposed patients and collect, record, and compare changes in dietary intake, food security, and weight status over time. We will test the hypothesis that exposure to the FVPP is associated with higher intake of fruits and vegetables, better food security, and lower rates of obesity among children.
The first aim will compare baseline dietary intake, food security, and weight status between high exposure, moderate exposure, no exposure groups.
The second aim will measure changes in diet, food security, and weight status at 6-, 12-, 18-, and 24-months among children newly exposed to the FVPP.
The third aim will compare follow-up measures of dietary intake, food security, and weight status in the initial no exposure group to baseline measures in the high exposure group.
This study will provide novel knowledge regarding the role of pediatric fruit and vegetable prescriptions in addressing persistent barriers to access and affordability of fresh foods, particularly among low-income, urban households. This work will inform public health research, particularly pediatricians and primary care physicians who recognize the consequences of food insecurity among young patients and are seeking tangible solutions that not only provide food to hungry children but ensure that the food provided is high in nutrients needed to support healthy growth and development.
