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Background <p>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.</p> Objective <p>Evaluate the impact of PRx on FI, fruit and vegetable (FV) intake, and psychosocial and clinical outcomes among adults with chronic conditions.</p> Design <p>Prospective, non-randomized cohort study with a matched comparison group.</p> Participants <p>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.</p> Intervention <p>Weekly home-delivered produce, registered dietitian-led coaching, and education over 12&#xa0;months.</p> Main Measures <p>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&#xa0;months of follow-up.</p> Key Results <p>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,<i> p</i> = 0.002) and greater reductions in loneliness (difference in change: −0.6 points, <i>p</i> = 0.022). Between-group differences for FI (−8.2 percentage points, <i>p</i> = 0.26) and moderate-to-severe depression (−10.8 percentage points, <i>p</i> = 0.07) favored PRx but were not statistically significant. At 12&#xa0;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% (<i>p</i> = 0.003), FV intake increased by 0.4 cups/day (<i>p</i> &lt; 0.001), fatigue improved by 3.1 points (<i>p</i> = 0.019), and among participants with elevated baseline BP (<i>n</i> = 73), systolic BP decreased by 8.6&#xa0;mmHg (<i>p</i> = 0.003).</p> Discussion <p>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.</p>

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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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月14日

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  • Rachel Zimmer,
  • Lindsey Abdelfattah,
  • Diane Shenberger,
  • Charlotte Crotts,
  • Sarah Birken,
  • Amresh Hanchate

摘要

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.