Source: Community Action Duluth submitted to NRP
HEALTHY FOOD FOR HEALTHY COMMUNITIES: FOOD AND FOOD PREPARATION EDUCATION FOR UNDERSERVED COMMUNITIES AND MEASURING THE EFFECTS PRESCRIPTION PRODUCE HAS IN REDUCING HEALTH DISPARITIES.
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
ACTIVE
Funding Source
Reporting Frequency
Annual
Accession No.
1031460
Grant No.
2023-70413-41062
Cumulative Award Amt.
$454,662.00
Proposal No.
2023-06431
Multistate No.
(N/A)
Project Start Date
Sep 15, 2023
Project End Date
Sep 14, 2026
Grant Year
2023
Program Code
[PPR]- Produce Prescription
Recipient Organization
Community Action Duluth
19 North 21st Avenue West
Duluth,MN 55806
Performing Department
(N/A)
Non Technical Summary
Duluth, Minnesota has several neighborhoods that deal with high barriers to access healthy food. This iscaused, in part, by lack of transportation and an absence of grocery stores. Without access to fresh produce,peopleare more likely to suffer from diet-related health conditions and have higher healthcare costs.Essentia Health and Community Action Duluth (CAD) seek primarily to improve dietary health by facilitating increased consumption of fruits and vegetables, reduce foodinsecurity, and collect data to measure the effects of the program.Essentia will identify 180 participants who will receive $80 a month for nine months. Thisstipend will be used to purchase fresh produce at CAD's existing Mobile Market and farmers'markets. The Mobile Market brings a variety of produce to low-income, high-barrier communities. CAD will add programming to the Mobile Market that teaches people how to prepare fresh food at home andgive them free cooking utensils. Thesemarkets will serve not only as a source of food, but as safe gathering spaces, which fosters community interaction.
Animal Health Component
34%
Research Effort Categories
Basic
33%
Applied
34%
Developmental
33%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
70460991010100%
Goals / Objectives
Our primary goals with this HFHC PPR are those of the GusNIP PPR, specifically: 1)improving participants' dietary health through increasing the consumption of fruits andvegetables; 2) reducing participants' individual and household food insecurity; and 3) reducing participants' healthcare use and associated costs. Secondary goals recommended by the GusNIPPPR include: 1) evaluating the impact of the HFHC PPR on participant self-reported depression,anxiety, loneliness, and internalized weight bias and participants' blood pressure, body massindex, and HbA1c from the EHR; and 2) understanding participants' experiences participating inthe program, including to provide deeper insight into both survey results and EHR findings,identify what worked well and what could be improved, and to illustrate the experiential aspectsof the program.In achieving our primary and secondary goals, we will enroll 60 participants in ourHFHC PPR in three separate nine-month cohorts (total n = 180). Each participant will receive$80 per month for nine months. Nine-month cohorts allow time between the start of each cohortfor the program managers to integrate what we have learned and start recruitment for the nextcohort, while also being long enough for participants to engage deeply with markets, specificallygetting to know our Mobile Market and farmers market locations, what the markets have to offer,and the other services our agency and partners provide. Nine months will also allow each cohortto overlap with the part of the farmers market season with the most produce available, which inour northern climate is usually July-September with bi-monthly indoor markets October-January. Furthermore, employing a duration longer than 4 to 6 months yet less than a year will provide the Nutrition Incentive Program Training, Technical Assistance, Evaluation, and InformationCenters (NTAE) with data on a different duration than is typically used in GusNIP PPRs.
Project Methods
Health care providers identify qualifying participants.Health care providers "prescribe" produce in the form of $80 gift cards that can be used at local mobile and farmers markets.Provide $80 per month for 3 9-month cohorts of 60 people to be spent at the mobile and farmers markets.Create spaces for community-led nutrition and cooking classes for participants.In meeting our primary goals, we will collect all NTAE core metricsto assess participant outcomes from start to end of each HFHC PPR cohort, like significant increases in self-reported consumption of fresh fruits and vegetables,individual and household food security, and use of SNAP, as well as significantly fewerhospitalizations, 30-day readmissions, no-show clinic visits, emergency department visits foremergent and non-emergent issues, reduced healthcare costs/charges incurred, and increased wellvisit rates. We will also supplement these core metrics by examining additional participantoutcomes as part of our secondary goals, specifically assessing for significantly lower levels ofparticipants' self-reported depression, anxiety, internalized weight bias, and loneliness betweenpre- and post-intervention surveys for program cohorts, as well as significantly lower changes inblood pressure, weight, body mass index, and HbA1C in the EHR, and differences in EHR-basedoutcomes with a matched comparison cohort. Furthermore, we will examine the effects ofsociodemographic and household characteristics on participant outcomes. Finally, qualitativeinterviews will help capture the experiences of HFHC PPR participants so that we can betterunderstand what participating in the HFHC PPR was like for participants, as well as identifyareas of strength and those that could benefit from improvement

Progress 09/15/23 to 09/14/24

Outputs
Target Audience:Beginning in June, we started reaching our target audience through the methods described in our project initiation. We identified over 60 people who qualified for our program,60 underwent the initital surveying, and 58 were successfullyonboarded into the program. Our participants share key qualities; they had previouslyidentified food worry during a clinic visitand are participants of Medicaid and/or SNAP, but otherwise come from a diversity of backgrounds. Participants live across the Duluth-Superior metro, but are particularly concentrated in neighborhoods in Duluth where there are no grocery stores and have been historically under resourced. Changes/Problems:We have experience two problems: Like many other projects, our IRB approval took more time than anticipated and delayed our start. We have reworked our timeline to make up for this; instead of a break between groups, cohorts will overlap. We have also struggled with adequate staffing among our participant-facing staff members. The staff member assigned to the duties for this project has struggled significantly with time management, and because of some internal policies and the recent unionization of staff, reassigning staff has been difficult. We expect to have a resolution to this issue shortly. What opportunities for training and professional development has the project provided?Project director attended the annual project directors meeting in December of2023. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period, we will have finished cohort one and begun evalutation of self-reported data, data from EHR, and healthcare use and cost. We will integrate learnings from cohort one into our initiation of cohort two.

Impacts
What was accomplished under these goals? We have enrolled participants in our first cohort and had reached the 1/3 point by the end of this reporting period. Because we are in the midst of cohort one, we have not yet evaluated the impact of the PPR on participant self-reported health outcomes. Anecdotaly, we have heard from some of the active participants that the program has helped decrease food worry and thatthey have increased their consumption of fruits and vegetables.

Publications