A Prescription for Health Equity: A Healthcare Provider-based Produce Prescription Program for People With Prediabetes and Type 2 Diabetes
NCT ID: NCT05939349
Last Updated: 2023-08-14
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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UNKNOWN
NA
134 participants
INTERVENTIONAL
2023-09-01
2025-08-31
Brief Summary
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Specific Aims:
In collaboration with community partners and community members, utilize implementation science strategies to identify and address community, systemic, and structural barriers and assets to co-design a tailored produce prescription program (PPR) intervention that emphasizes health equity in a low-income population served by Griffin Hospital (GH) and/or Griffin Faculty Physicians (GFP).
Hypothesis: Collaborating with our community partners on the design and implementation of a PPR will lead to a successful design and implementation of the PPR to our population of focus, as evidenced by satisfaction, retention, experiences of dignity/respect, improved self-efficacy related to fruit and vegetable consumption, and diet quality.
Demonstrate improvements, in intervention group vs delayed intervention control group, in food security status, diet quality, and cardio-metabolic outcomes in individuals with prediabetes or type 2 diabetes through implementation of a tailored PPR in a low-income population served by GH and/or GFP.
Hypothesis: The PPR designed with community input will improve food security status, diet quality, self-reported health related quality of life and cardio-metabolic outcomes (Hemoglobin A1C, weight/body mass index, lipids, blood pressure), among our intervention participants compared with a control over a 6-month period.
Evaluate the impact of a tailored PPR on healthcare cost among low-income participants with prediabetes or type 2 diabetes.
Hypothesis: The successful implementation of the tailored PPR will lead to a reduction in certain healthcare cost specifically related to medication usage (including dose) and reduction in emergency department visit and/or hospitalization among intervention participants compared with a control over a 6-month period.
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Detailed Description
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Increasing the consumption of fruits and vegetables can improve health by promoting healthy weight and reducing blood sugar, the risk of heart disease, stroke, some types of cancer, and digestive problems. Studies have shown that even without reducing caloric consumption, increasing fruit and vegetable consumption can provide independent benefits by increasing fiber intake, reducing sodium and fat intake, and increasing the micronutrient content of the consumer's diet. There are grave disparities in access to healthy foods based on income, race, geographic location, and immigration status, which in turn drive disparities in obesity, diabetes, overall health, and quality of life.
Fruit and vegetable incentive programs are a prudent method of improving food security, while not investing in or allocating money for poor nutritional quality food. They guarantee that the money spent goes to fruits and vegetables known to improve nutritional status, and a growing body of evidence demonstrates that money allocated to the purchase of fruits and vegetables can improve diet quality, purchasing patterns and sometimes health in a statistically and clinically significant manner. Produce prescription programs have the potential to reduce health disparities resulting from differential access to healthy food. In addition to providing free or discounted access to produce, many PPRs also attempt to address other cultural and socio-contextual barriers to accessing healthy food by providing educational and skill-building programming such as cooking demonstrations, suggested family meal plans, and nutritional information at the point of purchase. The few studies that examine the effectiveness of PPRs suggest that they are associated with dietary improvements and reductions in food insecurity. Overall, fruit and vegetable incentive programs have demonstrated positive impact (with few studies reporting no impact or minimal impact) on fruit and vegetable intake and or diet quality, reduced hemoglobin A1C, and reduced body weight.
Fruit and vegetable incentive programs are designed to increase the budget share available to a household for the purchase of fruits and vegetables.14 Incentive programs have the ability to immediately increase fruit and vegetable purchases, although the benefits of increasing fruit and vegetable purchases and consumption might take longer to realize. Incentives make it possible to encourage healthier purchasing patterns that are necessary for longer term behavior change that leads to improved health status. According to a 2020 meta-analysis conducted by Engel and Ruder, overall, fruit and vegetable incentive programs have a demonstrated benefit on fruit and vegetable purchase patterns.14 In Connecticut's Lower Naugatuck Valley (LNV), poverty and low-income rates (8% and 21%, respectively, in 2017) have been increasing across the region since 2000, according to a 2019 report on community well-being in the LNV. The seven communities (Ansonia, Beacon Falls, Derby, Naugatuck, Oxford, Seymour, and Shelton) of the LNV have a combined population of approximately 140,000, with increasing racial and ethnic diversity. Food insecurity and nutrition-related chronic disease are significant issues among the area's residents, with 12% of adults reporting food insecurity. Nutrition related chronic diseases such as obesity (affecting 28% of the population) are high. Heart disease and diabetes are among the eight leading causes of premature death and account for an average of 14 and 15 years of potential life lost per disease, respectively.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
PREVENTION
NONE
Study Groups
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Intervention Group
The PPR intervention will span 6 months and will include 2 main components: produce vouchers and nutrition education.
Produce Prescription Group
Participants will receive vouchers equal to $40/household/month, with an additional $5/month per additional household member, for the purchase of fresh fruits and vegetables during the six-month intervention period. The vouchers will be administered in the form of a restricted Mastercard debit card.
A variety of nutrition education options will be offered throughout the intervention period and participation will be tracked. The Nutrition education options will include a periodic newsletter to participants that will include nutrition and diabetes prevention and management opportunities available through Griffin Hospital Population Health Team, the local health department, program and education opportunities available through the Registered Dietitians, local offerings by SNAP-Education and The Expanded Food and Nutrition Education Program.
Delayed Intervention Group
For participants enrolled in the delayed control group they will complete all the biometric measurements and surveys during the 9-month period while the intervention group received the 6-month intervention and completes the 3-month post intervention assessments.
No interventions assigned to this group
Interventions
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Produce Prescription Group
Participants will receive vouchers equal to $40/household/month, with an additional $5/month per additional household member, for the purchase of fresh fruits and vegetables during the six-month intervention period. The vouchers will be administered in the form of a restricted Mastercard debit card.
A variety of nutrition education options will be offered throughout the intervention period and participation will be tracked. The Nutrition education options will include a periodic newsletter to participants that will include nutrition and diabetes prevention and management opportunities available through Griffin Hospital Population Health Team, the local health department, program and education opportunities available through the Registered Dietitians, local offerings by SNAP-Education and The Expanded Food and Nutrition Education Program.
Eligibility Criteria
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Inclusion Criteria
2. a patient of GH and/or GFP
3. diagnosis of prediabetes or Type 2 diabetes consistent with the American Diabetes Association diagnostic criteria
4. low-income and eligible for SNAP (Supplemental Nutrition Assistance Program, formerly known as Food Stamps) and/or Medicaid.
Exclusion Criteria
2. having had gastric bypass or other bariatric surgeries
3. having an eating disorder, or other substantial, clinical dietary restrictions.
18 Years
ALL
No
Sponsors
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Griffin Faculty Physicians
UNKNOWN
About Fresh
UNKNOWN
Griffin Hospital
OTHER
Responsible Party
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Principal Investigators
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Monica Oris, RN, MSHA, CCM
Role: STUDY_DIRECTOR
Griffin Hospital
Beth P Comerford, MS
Role: STUDY_DIRECTOR
Yale-Griffin Prevention Research Center
Jaime S Foster, PhD
Role: PRINCIPAL_INVESTIGATOR
Yale-Griffin Prevention Research Center
Central Contacts
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References
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Liu J, Rehm CD, Onopa J, Mozaffarian D. Trends in Diet Quality Among Youth in the United States, 1999-2016. JAMA. 2020 Mar 24;323(12):1161-1174. doi: 10.1001/jama.2020.0878.
Andreyeva T, Tripp AS, Schwartz MB. Dietary Quality of Americans by Supplemental Nutrition Assistance Program Participation Status: A Systematic Review. Am J Prev Med. 2015 Oct;49(4):594-604. doi: 10.1016/j.amepre.2015.04.035. Epub 2015 Aug 1.
Lagisetty PA, Priyadarshini S, Terrell S, Hamati M, Landgraf J, Chopra V, Heisler M. Culturally Targeted Strategies for Diabetes Prevention in Minority Population. Diabetes Educ. 2017 Feb;43(1):54-77. doi: 10.1177/0145721716683811.
Teutsch S. The cost-effectiveness of preventing diabetes. Diabetes Care. 2003 Sep;26(9):2693-4. doi: 10.2337/diacare.26.9.2693. No abstract available.
American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018 May;41(5):917-928. doi: 10.2337/dci18-0007. Epub 2018 Mar 22.
Beckles GL, Chou CF. Disparities in the Prevalence of Diagnosed Diabetes - United States, 1999-2002 and 2011-2014. MMWR Morb Mortal Wkly Rep. 2016 Nov 18;65(45):1265-1269. doi: 10.15585/mmwr.mm6545a4.
Mozaffarian D, Liu J, Sy S, Huang Y, Rehm C, Lee Y, Wilde P, Abrahams-Gessel S, de Souza Veiga Jardim T, Gaziano T, Micha R. Cost-effectiveness of financial incentives and disincentives for improving food purchases and health through the US Supplemental Nutrition Assistance Program (SNAP): A microsimulation study. PLoS Med. 2018 Oct 2;15(10):e1002661. doi: 10.1371/journal.pmed.1002661. eCollection 2018 Oct.
Abdullah MM, Gyles CL, Marinangeli CP, Carlberg JG, Jones PJ. Cost-of-illness analysis reveals potential healthcare savings with reductions in type 2 diabetes and cardiovascular disease following recommended intakes of dietary fiber in Canada. Front Pharmacol. 2015 Aug 11;6:167. doi: 10.3389/fphar.2015.00167. eCollection 2015.
Dodd AH, Briefel R, Cabili C, Wilson A, Crepinsek MK. Disparities in consumption of sugar-sweetened and other beverages by race/ethnicity and obesity status among United States schoolchildren. J Nutr Educ Behav. 2013 May-Jun;45(3):240-9. doi: 10.1016/j.jneb.2012.11.005. Epub 2013 Feb 13.
Bowling AB, Moretti M, Ringelheim K, Tran A, Davison K. Healthy Foods, Healthy Families: combining incentives and exposure interventions at urban farmers' markets to improve nutrition among recipients of US federal food assistance. Health Promot Perspect. 2016 Mar 31;6(1):10-6. doi: 10.15171/hpp.2016.02. eCollection 2016.
Cavanagh M, Jurkowski J, Bozlak C, Hastings J, Klein A. Veggie Rx: an outcome evaluation of a healthy food incentive programme. Public Health Nutr. 2017 Oct;20(14):2636-2641. doi: 10.1017/S1368980016002081. Epub 2016 Aug 19.
Cooksey-Stowers K, Schwartz MB, Brownell KD. Food Swamps Predict Obesity Rates Better Than Food Deserts in the United States. Int J Environ Res Public Health. 2017 Nov 14;14(11):1366. doi: 10.3390/ijerph14111366.
Ghosh-Dastidar B, Cohen D, Hunter G, Zenk SN, Huang C, Beckman R, Dubowitz T. Distance to store, food prices, and obesity in urban food deserts. Am J Prev Med. 2014 Nov;47(5):587-95. doi: 10.1016/j.amepre.2014.07.005. Epub 2014 Sep 10.
Engel K, Ruder EH. Fruit and Vegetable Incentive Programs for Supplemental Nutrition Assistance Program (SNAP) Participants: A Scoping Review of Program Structure. Nutrients. 2020 Jun 4;12(6):1676. doi: 10.3390/nu12061676.
Bhat S, Coyle DH, Trieu K, Neal B, Mozaffarian D, Marklund M, Wu JHY. Healthy Food Prescription Programs and their Impact on Dietary Behavior and Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis. Adv Nutr. 2021 Oct 1;12(5):1944-1956. doi: 10.1093/advances/nmab039.
Li R, Zhang P, Barker LE, Chowdhury FM, Zhang X. Cost-effectiveness of interventions to prevent and control diabetes mellitus: a systematic review. Diabetes Care. 2010 Aug;33(8):1872-94. doi: 10.2337/dc10-0843.
Aiyer JN, Raber M, Bello RS, Brewster A, Caballero E, Chennisi C, Durand C, Galindez M, Oestman K, Saifuddin M, Tektiridis J, Young R, Sharma SV. A pilot food prescription program promotes produce intake and decreases food insecurity. Transl Behav Med. 2019 Oct 1;9(5):922-930. doi: 10.1093/tbm/ibz112.
Trapl ES, Joshi K, Taggart M, Patrick A, Meschkat E, Freedman DA. Mixed Methods Evaluation of a Produce Prescription Program for Pregnant Women. J Hunger Environ Nutr. 2017;12(4):529-543. doi:10.1080/19320248.2016.1227749
Bridle C, Riemsma RP, Pattenden J, et al. Systematic review of the effectiveness of health behavior interventions based on the transtheoretical model. Psychol Health. 2005;20(3):283-301. doi:10.1080/08870440512331333997
Mainstreaming Produce Prescriptions - Center For Health Law and Policy Innovation. Accessed October 7, 2021. https://www.chlpi.org/health-law-and-policy/projects/mainstreaming-producerx/
Ridberg RA, Yaroch AL, Nugent NB, Byker Shanks C, Seligman H. A Case for Using Electronic Health Record Data in the Evaluation of Produce Prescription Programs. J Prim Care Community Health. 2022 Jan-Dec;13:21501319221101849. doi: 10.1177/21501319221101849.
2019 Valley Community Index: Understanding the Valley Region | DataHaven. Accessed June 30, 2022. https://www.ctdatahaven.org/reports/2019-valley-community-index-understanding-valley-region
Chinchanachokchai S, Jamelske EM, Owens D. Tracking the Use of Free Produce Coupons Given to Families and the Impact on Children's Consumption. WMJ. 2017 Feb;116(1):40-3.
Katie Garfield, Sarah Downer, Rachel Landauer, et al. Produce-RX-March-2021.Pdf.; 2021. Accessed August 19, 2021. https://www.chlpi.org/wp-content/uploads/2013/12/Produce-RX-March-2021.pdf
ASA24® Dietary Assessment Tool | EGRP/DCCPS/NCI/NIH. Accessed June 30, 2022. https://epi.grants.cancer.gov/asa24/
Guenther PM, Casavale KO, Reedy J, Kirkpatrick SI, Hiza HA, Kuczynski KJ, Kahle LL, Krebs-Smith SM. Update of the Healthy Eating Index: HEI-2010. J Acad Nutr Diet. 2013 Apr;113(4):569-80. doi: 10.1016/j.jand.2012.12.016. Epub 2013 Feb 13.
Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide to Measuring Household Food Security. USDA; Food and Nutrition Services; Office of Analysis, Nutrition, and Evaluation; 2000:1-82. https://fns-prod.azureedge.net/sites/default/files/FSGuide_0.pdf
Hennessy CH, Moriarty DG, Zack MM, Scherr PA, Brackbill R. Measuring health-related quality of life for public health surveillance. Public Health Rep. 1994 Sep-Oct;109(5):665-72.
Guidelines for assessing nutrition-related knowledge, attitudes and practices. Accessed June 30, 2022. https://www.fao.org/3/i3545e/i3545e00.htm
Other Identifiers
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2022-06
Identifier Type: -
Identifier Source: org_study_id
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