Impacts of a produce prescription program on food security, diet quality, and psychosocial health of adults with Medicaid and chronic health conditions: A 12-month longitudinal evaluation

BACKGROUND: Food insecurity (FI) is a driver of chronic disease. Produce prescription (PRx) interventions pair access to produce with education, but evidence among Medicaid-insured adults remains limited. 

OBJECTIVE: Evaluate the impact of PRx on FI, fruit and vegetable (FV) intake, and psychosocial and clinical outcomes among adults with chronic conditions. 

DESIGN: Prospective, non-randomized cohort study with a matched comparison group. 

PARTICIPANTS: A total of 125 Medicaid-insured, food-insecure adults with chronic metabolic conditions were enrolled in the intervention cohort and 92 matched to the Supplemental Nutrition Assistance Program (SNAP)-only cohort. 

INTERVENTION: Weekly home-delivered produce, registered dietitian-led coaching, and education over 12 months. 

MAIN MEASURES: FI (USDA 10-item Food Security Survey Module), FV intake (National Cancer Institute screener), depression (PHQ-9), loneliness (UCLA 3-item), fatigue (FACIT-F), healthcare utilization and costs, and blood pressure (BP). For the comparison cohort, some measures were obtained for 6 months of follow-up. 

KEY RESULTS: At 6 months, based on between-group differences, PRx was associated with greater improvements in FV intake (difference in change: + 0.3 vs. + 0.03 cups/day, p = 0.002) and greater reductions in loneliness (difference in change: -0.6 points, p = 0.022). Between-group differences for FI (-8.2 percentage points, p = 0.26) and moderate-to-severe depression (-10.8 percentage points, p = 0.07) favored PRx but were not statistically significant. At 12 months, no significant between-group differences in healthcare utilization and costs were observed. Among the 105 (84%) intervention participants who completed 12-month follow-up, between the pre- and post-intervention periods, FI declined by 17.1% (p = 0.003), FV intake increased by 0.4 cups/day (p < 0.001), fatigue improved by 3.1 points (p = 0.019), and among participants with elevated baseline BP (n = 73), systolic BP decreased by 8.6 mmHg (p = 0.003). 

DISCUSSION: In this study, PRx was associated with improved diet quality and loneliness compared with a SNAP-only comparison. Within-group analyses demonstrated improvements across dietary, psychosocial, and BP outcomes, supporting further evaluation using randomized or comparative designs.