P3B142: A Mixed-methods Evaluation of a Primary-care Based Food Insecurity Intervention for Children and Adolescents At-risk of Diet-related Chronic Disease

Background: Food insecurity (FI) is associated with increased risk of chronic disease, low-quality diet and higher health care utilization and cost in adults and children. Interventions that address FI and diet quality may help reduce diet-related disease burden and associated healthcare costs. Produce Prescription Programs (PPPs) are becoming more widely utilized interventions to address FI and improve diet quality in adults. However, few studies have explored the impact of PPPs in pediatric populations and there is very little data on diet-related outcomes.

Methods: A PPP, designed to address FI and diet quality in children (0-18 years old) and their adult caretakers, provided 6 months of fresh produce deliveries and nutrition education to eligible patients of two pediatric clinics in Washington, DC. Beginning November 2021, families who screened positive for FI during a clinic visit were referred to the program. All referred families received at least two produce deliveries, as a courtesy, and were screened for diet-related chronic disease risk eligibility criteria. Eligible families who provided their informed consent and completed a baseline survey were enrolled in the 6-month intervention. At the end of the program participants completed self-report surveys and a semi-structured interview to assess participant’s perceptions of the program. Interviews were recorded, transcribed, and analyzed. Codes were developed and preliminary themes were created using a content thematic analysis approach. Descriptive statistics were used to summarize demographic and participation data and a paired T-test was used to evaluate the longitudinal change in FI score.

Results: Between November 2021 to December 2022, 203 families were referred to the program, 107 eligible adults provided their informed consent and completed baseline assessments. Between May 2022 to April 2023, 30 enrolled participants completed the 6 month program and longitudinal data collection, and 28 completed qualitative interviews. Program participation, as quantified by self-reported produce utilization and monthly nutrition education attendance, was relatively high (above 50%). Three salient themes were identified from qualitative interviews: (1) Improved diet quality, (2) Increased produce utilization, (3) Enhanced financial flexibility. The average FI score at baseline was 2.58 (+/-2.17) and1.96 (+/-2.01) post-intervention, representing a statistically significant decrease in severity of FI (p=0.02).

Conclusion: PPPs that offer fresh produce and nutrition education may improve severity of FI and healthy eating habits, including quality and quantity of fruits and vegetables, among families with children at risk of diet-related chronic disease. Future research should examine the sustained impact of PPP on FI, dietary intake, and health outcomes among caregivers and their children, and the healthcare cost and utilization rates among PPP participants.