Fruit and vegetable prescriptions for pediatric patients in Flint, Michigan: Program development, methods, and baseline characteristics

Objectives: To address food access and affordability challenges among low-income children and adolescents, some health care providers are prescribing fresh fruits and vegetables. However, the evaluation of these programs is limited as are descriptions of study designs and needs of the population they serve. Our objectives were to describe the development of a fruit and vegetable prescription program for pediatric patients, baseline characteristics of the study population, child dietary patterns, and household food security.

Methods: Researchers partnered with pediatricians in Flint, Michigan to offer one $15 prescription for fresh fruits and vegetables to children at every office visit. Participating vendors included the downtown farmers' market as well as a local mobile market, which accepts on-line or telephone orders for fruit and vegetable boxes delivered to homes. Following receipt of the prescription, patients (7-18 years of age) were invited to participate in the current study with one caregiver. Researchers restricted enrollment to one child per family. Caregiver-child dyads completed evaluation instruments with a trained research assistant during their pediatric office visit. In addition to completing a demographic survey, caregivers and children responded to questions about dietary patterns, food security, and food access.

Results: 320 caregiver-child dyads enrolled in the study. Most of the children (mean age 12.7 ± 2.9) were African American (68%) and residents of Flint (73%). The majority of caregivers (mean age 39.7 ± 9.7) were female (91%), African American (65%), and receiving SNAP benefits (54%). Of the 277 children who completed the food screener, average intake of vegetables (0.71 cups ± 0.73) and dairy (1.3 cups ± 1.1) as well as whole grains (0.48 ounces ± 0.47) were well below current recommendations. Moreover, nearly half of caregivers who enrolled in the study (47%) reported low or very low household food security.

Conclusions: Results confirm and continue to raise deep concerns about dietary behaviors and food insecurity among children in Flint, many of whom continue to face an ongoing drinking water crisis. By addressing both access to fresh produce and food insecurity, the prescription program has the potential to improve fruit and vegetable intake.