BUFFALO, N.Y. – People who eat fresh food are healthier than those who don't. That simple fact is the basis of food prescription programs that make fruits, vegetables and other foods free for people who are food insecure.
But just giving people vouchers to redeem for fresh produce isn't enough. Research shows that only 9% to 18% of those who receive such vouchers actually use them.
A new study by University at Buffalo researchers has found that when fresh produce is delivered directly to participants' homes, those numbers jump to nearly 90%. The findings were published last month in Frontiers in Public Health .
"The problem historically with food prescription programs is that people get the vouchers but don't redeem them," says Lucia A. Leone, PhD , corresponding author and associate professor of community health and health behavior in the School of Public Health and Health Professions at UB. "Our goal was to test different versions of home delivery to ideally boost redemption and compare to what has been the standard approach, which was to give people vouchers to redeem at a mobile market."
Over 65 and food insecure
The 12-week, randomized controlled study consisted of two intervention arms and a standard-of-care arm. A total of 67 adults, mostly African-Americans, over the age of 65, who had indicated that they have at times been food insecure were recruited from primary care clinics at Erie County Medical Center (ECMC) in Buffalo.
A third of participants received weekly fresh produce boxes delivered to their homes via FreshFix, a local food delivery company co-founded by Leone. Participants were able to customize their produce if they chose to. Another third received home deliveries of healthy meal kits, which included produce plus ingredients needed to make three meals with that produce. Each week they could choose from five to six different meal kit options.
In the standard-of-care arm, participants received vouchers that they could redeem at the ECMC mobile market or at one of several FeedMore Western New York markets across Buffalo.
Participation levels in traditional programs may be low, Leone explained, because people lack the transportation required to get to the place where vouchers can be redeemed, or because they don't want to be seen as needing assistance. The markets where people can redeem their food prescription vouchers often operate out of food pantries, which recipients may feel are stigmatizing.
"We wanted to overcome those barriers," says Leone. "We wanted to find out, does delivery improve redemption of food prescriptions? Does having a meal kit mean that people would use more produce?"
For both interventions, redemption (meaning preparation and consumption of the delivered produce) reached 89.2%, while the control arm, where people had to go to the mobile market to redeem their produce, was just 28.3%.
Leone says redemption fell short of 100% when participants were out of town or if they felt they had sufficient food on hand. She noted that the addition of meal kits didn't improve the use of the produce probably because these people, all over 65, knew how to use the produce so the meal kit didn't make a difference in cooking, but the overall greater quantity of food did help improve food security.
High marks for the program – and its driver
Participants in both intervention arms scored the program higher than 9 out of 10. They definitely said they would recommend the program to others.
Participants also made positive comments about the FreshFix delivery driver, Charles Humphrey, whom Leone describes as a "wonderful, personable person" who made all deliveries throughout the study.
"That's something we see across the research," she says, "the connection with one particular person. If they're a good ambassador, it can really improve the success of the program." Humphrey, a FreshFix community outreach coordinator, has previous experience working at mobile markets including the UB Veggie Van.
The UB study was unique because getting a food delivery was the default, Leone explains. "We didn't require customers to do anything to redeem their prescription, but they could customize their order if desired" says Leone, "two components that may have contributed to its success. In a lot of delivery programs, everybody gets the same food, so we were really lucky to be able to partner with FreshFix so that we could do delivery and customization. It's always better if it's not a one-size-fits-all approach and can be tailored to specific populations."
She adds that large programs, like those offered through Medicaid, for example, may find it harder to customize for specific populations.
Co-authors on the study are: Anne Lally Mathiebe, PhD, assistant director in UB's Community Health Interventions Lab in the School of Public Health and Health Professions; Jennifer A. Stoll, PhD, research assistant professor, the late Jill Tirabassi, MD, both of the Department of Family Medicine; and Rocco A. Paluch, research coordinator in the Department of Pediatrics in the Jacobs School of Medicine and Biomedical Sciences at UB.
The study was funded by the American Heart Association. Preliminary work for this research was supported by UB's Civic Engagement Research Fund . Partners on the research were FreshFix, FeedMore WNY, and the UB Veggie Van.
Leone and colleagues have now been funded by the National Institutes of Health to conduct a similar study with a more challenging population: families on Medicaid experiencing food insecurity with children ages 2-6. The UB researchers will conduct this study in partnership with local pediatric practices.
