1. Miranda Cook, MPH, Laney Graduate School, Emory University
Food as medicine? How $1 per day can increase food security and improve health
Miranda Cook, MPH, Laney Graduate School, Emory University

2. introduction
Diet behavior change is made more challenging by economic barriers for individuals in low-income food insecure communities
Especially true for those who experience diet-related chronic disease
Food insecurity is associated with chronic disease, especially among women
Food security associated w/ disease based on NHANES data:

3. Food Insecurity in Georgia
1.7 million Georgian’s received SNAP benefits every month
1 in 7 Georgians are food insecure
Stats from 2016
1 in 5 Georgian children are food insecure

4. FVRx Program Overview Participants receive FVRx prescriptions*2.
Participants receive FVRx prescriptions* 3.
Participants redeem prescriptions for fresh fruits and vegetables at local farmers markets 1.
Participants attend FVRx clinic visits, cooking and nutrition education classes
4. Participants prepare and eat healthy meals with family and schedule their next FVRx visit
Description of WW National model and how it has evolved
FVRx program objectives:
Decrease food insecurity
Improve clinical and behavioral health outcomes
Increase exposure to and demand for healthy, Georgia-grown food
Eligibility criteria:
Food insecurity
At least 1 chronic disease risk factor
Photo & visual courtesy of: Wholesome Wave Georgia
*FVRx prescription is equal to $1/day for each participant and household member; e.g., a family of 4 would receive $28 per week

5. Sites of intervention
Morehouse Healthcare (East Point, Georgia) N = 14
Good Samaritan Health Center (Atlanta, Georgia) N = 50
Athens Nurses Clinic in Athens, Georgia N = 23
6 primary care clinics serving low-income communities in Atlanta, Athens, & Augusta, Georgia
Partnership development:
Partnerships with healthcare sites were developed through local connections- usually a farmers market tied to another WWG program (GF4L) which then connected to their local clinic. From there a leadership committee was formed with community members and representatives from the market, health care site, nutrition education provider, etc to develop the program. The main exception to this was Grady where WWG connected to staff through a board member (Jada Bussey Jones) and took a more active role in developing the program. The FVRx coordinator for Grady was housed under WWG (Sajani) but the Grady sites have since taken more ownership of their individual program.
Grady Ponce De Leon Center (Atlanta, Georgia) N = 29
Grady Primary Care Clinic (Atlanta, Georgia) N = 25
Harrisburg Family Health Care Clinic in Augusta, Georgia N = 43
Photos: Google Maps Street View images

6. Evaluation - Survey tools
Pre- & Post-surveys
Participants completed surveys at baseline and at the end of the 6-month program
Monthly-collected measures
Clinical measurements & monthly surveys collected at monthly program visits
Surveys were completed in paper format
Data from surveys and monthly clinic visits double-entered into Qualtrics by staff at each site

7. Evaluation – Data collected
Information Collected in Pre-/Post-Surveys:
Demographic characteristics
Food security
Nutrition and cooking knowledge and confidence
Difficulties involved in purchasing & consuming produce
Frequency of fruit & vegetable consumption
Information Collected Monthly at all sites:
Fruit & vegetable consumption
Weight
Blood pressure
Waist circumference (all except Augusta)
Some sites collected additional monthly measures:
Grady IDP site:
A1c
Triglycerides
HDL
LDL
Total cholesterol
Augusta:
Heart rate
Blood glucose
Information collected over the course of the 6-month program

8. Results 219 households enrolled in the program
76% reported household income <$25,000
54% reported receiving public assistance
78% were of non-Hispanic black race
118 participants successfully graduated the program (~54% retention rate)
$47,376 food subsidies redeemed
*Graduation involved completing at least 50% of the visits (3 out of 6 total monthly visits)

9. Results - Food security
OVERALL
At baseline:
Post-intervention:
21% often couldn’t afford a balance meal
8% often couldn’t afford a balance meal
37% often cut the size of meals or skipped meals due to financial constraints
20% often cut the size of meals or skipped meals due to financial constraints
32% were often hungry because there wasn’t enough food
5% were often hungry because there wasn’t enough food
* Only includes individuals with data available at both time points

10. Results: Difficulties Decreased and & Knowledge improved
Categories of knowledge
BL mean score (N)
Post-Intervention Mean Score (N)
% Difference
Mean Change (95% CI)
T-test P-Value
Types of fruits and vegetables grown locally
1.3 (76)
2.0 (75)
53.8
0.8 (0.5, 1.0)
<.0001
How to prepare fresh fruits & vegetables
2.1 (76)
2.6 (76)
23.8
0.6 (0.4, 0.8)
Where to buy produce
1.8 (60)
2.4 (75)
33.3
0.6 (0.3, 0.9)
Importance of fruits & vegetables in family’s diet
2.2 (76)
2.8 (75)
27.3
0.5 (0.3, 0.7)

11. Results – Diet and Clinical Outcomes
Number of daily fruit servings increased by servings per visit
Number of daily vegetable servings increased significantly by servings per visit
Diastolic blood pressure reduced significantly by mmHg per visit
*There were no significant findings for BMI, cholesterol, waist circumference, or hemoglobin A1c outcomes

12. Questions & Contact Information
Miranda Cook, MPH PhD student, Nutrition & Health Sciences, Laney Graduate School, Emory University
Amy Webb-Girard, PhD
Assistant Professor, Rollins School of Public Health, Emory University
Denise Blake
Executive Director, Wholesome Wave Georgia