Fruit & Vegetable Prescription Programs in Georgia Disclaimer: I don’t work for WWG anymore! Rachael Ward Nutrition Director ACCESS

Wholesome Wave Georgia Statewide network partner of Wholesome Wave Separate 501c3 Mission: Increase access to fresh, healthy, locally grown food for all Georgians Main programs: Georgia Fresh for Less Fruit & Vegetable Prescription Program (now Georgia Food for Health) SNAP enrollment

Food Insecurity & Chronic Disease in Georgia 1.4 million Georgians receive SNAP benefits every month 1.1 million Georgians have diabetes 3.4 million Georgians have hypertension 1 in 5 Georgians are food insecure 30% of adults are obese 1 in 4 Georgia children are food insecure 35% of children obese 1 in 7 Oregonians are food insecure 30% of Oregon adults obese

Fruit & Vegetable Prescription Program (FVRx) Launched the first FVRx program in the southeast in 2015 Affordable access to fruits & vegetables and healthy eating through partnership with healthcare providers, community organizations and fresh produce retailers Evidence based model of preventative healthcare with a demonstrated impact, resulting in healthier communities, food systems, and local economies

2018 FVRx Sites Athens Nurses Clinic Harrisburg Family Clinic 9 cohorts at 7 locations (cohorts of 20-30 households) Ranged from large hospital systems to small family clinics All serve clients on Medicaid/Medicare Grady Asa Yancy Health Center Grady Primary Care Clinic Grady Ponce de Leon Center Grady Diabetes Clinic (2 cohorts) Good Samaritan Health Center (2 cohorts)

Model Target audience: Duration: Components: Patients with food insecurity & diet related chronic illnesses Duration: 6 months (May-Oct) Components: 6 weeks cooking education 6 monthly clinic visits Weekly Rx redemption Patients screened by healthcare providers using EMRs and phone calls, Dr’s recruited into program

Cooking Education Different curriculums by site Front loaded in first 6 weeks Focused on cooking healthy on a budget Emphasis on fresh and local foods Nutrition education wrapped in Gift of a major piece of cooking equipment at the end (crockpot, food processor, etc) Cooking Matters & local curriculums

Monthly Clinic Visits Vitals taken: height, weight, waist circumference, blood pressure Healthy living class Peer support Goal setting Supportive classes (budgeting, meal prep, gardening, etc) Prescriptions given out for the month Additional metrics like body fat percentage, A1Cs taken at pre and post

Weekly F&V Prescriptions $1/household member/day (family of 4 received $28/week) Only to be spent on fresh fruits & veggies Written by a healthcare professional (PA, dietician, etc) Redeemed with local farmers at: Farmers markets, on site farm stands, Marta markets, CSA boxes Paper prescriptions given and exchanged for tokens at market Assistance with transportation to markets Not need to be written by a dr, just someone well respected

Evaluation Pre & Post surveys Demographics Knowledge, attitudes, practices around healthy eating and local foods F&V consumption Biometric measurements (A1c, Triglycerides, HDL, LDL, total cholesterol, heart rate) Monthly surveys BMI, BP, waist circumference, F&V consumption 6 months post Reunion & activity Repeat post survey Focus groups & interviews

Retention Needed to attend at least 3/6 monthly clinic visits and complete pre & post surveys Reminder texts and calls each week Peer support Cooking equipment incentives Peer champions Transportation assistance to attend classes and redeem vouchers Retention rates ranged from 48% to 91% Later added in Rx redemption at least once a month as criteria for retention

2017 Evaluation Results: Snapshot $47,376 fruit & vegetable prescriptions redeemed 219 Households enrolled 75-89% decrease in food insecurity indicators 3.1 More servings of fruit consumed each week on average 5.1 More servings of vegetables consumed each week on average 5% decrease in waist circumference on average 10.6% decrease in Body Mass Index on average

2017 Evaluation Results: Demographics

2017 Evaluation Results: Food Security

2017 Evaluation Results: Barriers to Consumption Significant changes in what made eating F&V difficult pointed out with arrow -48% decrease in those who said cost was a barrier -22% decrease in those who said knowledge of prep was a barrier -52% decrease in those who reported that they had any barriers to eating F&V!

2017 Evaluation Results: Knowledge 0 – No knowledge 1- Little knowledge 2 - Some knowledge 3 – Very knowledgeable *significant increases in all sites

2017 Evaluation Results: Consumption Fruit: 3.1 more servings per week Other veg: 5.1 more servings per week Shopped for produce 0.9 times more per week Cooked 0.5 more meals at home Statistically significant increases: Other vegetable consumption, produce shopping frequency

2017 Evaluation Results: Biometrics BMI decrease by 10.6% on average Waist circumference decrease by 5% on average Systolic BP decrease 8.8% on average Diastolic BP decrease 2.2% on average

2017 Evaluation Results: Participant Feedback “The best part of the program was the visits to the market, and the warmth of the people in the market. It was one of the best experiences I've had. I also liked the way they taught us how to cook, thanks to that now I cook healthier. And the group of people that make up the program I liked”

Thank you! Questions? Rachael Ward Nutrition Director ACCESS rward@accesshelps.org 541-774-4320