Progress 08/15/24 to 08/14/25

Outputs
Target Audience:During this reporting period, Comiendo Fresco (CF)/Eating Fresh PPR program served community adults between thirty-five and eighty yrs of age, residing in Douglas, AZ, and the surrounding communities. Program participants are from low-income households and face multiple barriers to accessing affordable, fresh and nutritious fruits and vegetables. Many of the individuals and or their families reached are living with chronic diseases such as diabetes, high blood pressure, and obesity, which place them at higher risk for poor health outcomes. The program's target audience was reached through a combination of trusted community partnerships and direct outreach efforts. Partners such as Chiricahua Community Health Centers (CCHCs) played a central role in identifying and connecting individuals who are managing or at risk of developing chronic diseases, and those that could benefit from participating in the program. Additionally, the program's Community Health Worker (CHW) team participated in community outreach events, this provided them the opportunity to meet residents where they gather and build relationships. During this community events CF CHWs were able to identify and refer community members that did not have an establish healthcare provider to CCHC. This will allow the identified individual or family to establish a healthcare provider and become patients of CCHC. Comiendo Fresco (CF) staff also provided them with education on the importance of having a good and balanced nutrition that includes fruits and vegetables. By participating in the community events, the Comiendo Fresco CHWs are able to interact and refer participants to other resources in the community. Due to this interaction, families are now starting to look for CF CHWs for nutrition guidance and for other resources that can support their social drivers of health needs. What CF CHWs have been able to document based on the program participants intakes is that many of them are parents, grandparents, and or caregivers who often are the ones preparing meals for the households. The importance of engaging this group is vital. We know that in many households the nutrition content depends on two factors; budget and the person who is deciding what to cook for the household. This is why it is so important to reach and engage this population that can impact the nutrition content of every individual in the household. The Comiendo Fresco program not only supports the health of the individual participants, but also indirectly impacts younger family members who benefit from healthier meals and food choices. This generational influence makes the program especially meaningful for improving the overall well-being of the community. By focusing on our target population and engaging them through familiar, trusted, and culturally relevant channels, Comiendo Fresco ensures that participants are receiving nutritional education; with an emphasis on culturally familiar foods and recipes prepared in a healthier and traditional ways. This approach increases the likelihood that the knowledge gained will be applied in their daily life. The Comiendo Fresco program is making a difference in this population. We are providing practical, accessible tools to improve health, reduce food insecurity, and strengthen community well-being in a region with limited nutrition and health resources. Changes/Problems:Other that due to the program's embargo we had a late program start, there were no major challenges to implementation during year 1 and all requirements were met. What opportunities for training and professional development has the project provided?The Comiendo Fresco program has provided several opportunities for training and professional development of program staff, program collaborators and partners. 4:36 Both the Comiendo Fresco Program Director (PD) and Program Coordinator (PC) attended the National Convening in Minneapolis in May 2025. This gathering was vital in them learning from other convening participants how their programs have been successful in developing strategies to address food insecurity in their states. Additional trainings completed by the PC/CHW include: Participation in nutrition education classes offered through the UA Cooperative Extension EFNEP. The PC/CHW of completion of Academy Leadership Training, an 8-week course designed to build leadership skills and support positive community action. Attendance at the Arizona Rural Annual Conference and other meetings/conferences focused on current and relevant topics related to building healthy communities. Have participated in webinars on chronic disease prevention and management, and mental health wellbeing. How have the results been disseminated to communities of interest?Since Comiendo Fresco is currently in its first pilot cohort, outcome data will not be available until next year. In the interim, progress and key milestones are being shared on a regular basis with the Project Leadership Team (PLT) to ensure ongoing guidance and oversight. Updates have also been communicated to community partners, local health workers, and organizations through regular check-ins, planning meetings, and collaborative discussions. Although formal evaluation results are pending, the project has prioritized transparency and engagement by providing partners with information on recruitment progress, participant enrollment, and program activities. These updates help maintain community awareness, build trust, and encourage shared ownership of the project's goals. Once outcome data become available, findings will be shared broadly with the PLT, participating organizations, and community partners through written reports, presentations. In addition, the project team plans to disseminate results in culturally and linguistically appropriate formats, such as bilingual handouts and community workshops, to ensure accessibility and relevance for all participants and partners. What do you plan to do during the next reporting period to accomplish the goals?The program will be guided by an annual plan and will continue supporting participants with a focus on addressing health-related social needs (HRSN). Comiendo Fresco will refine and adjust the program based on lessons learned from the pilot cohort, and will then proceed to enroll 60 participants in Cohort 2 and another 60 participants in Cohort 3. A core goal of the program is to ensure that participants are steadily increasing their consumption of fruits and vegetables, while also receiving the support and resources needed to resolve HRSN that may be limiting their ability to maintain healthy lifestyles. To achieve this, Comiendo Fresco will continue to offer healthy living classes at the AzCHOW offices, where participants learn practical strategies for meal preparation, nutrition, and incorporating fresh produce into daily diets. In addition, Comiendo Fresco staff will remain active at community events to strengthen connections, maintain regular contact with participants, and better understand evolving community needs. This ongoing presence will allow Comiendo Fresco to adapt approaches, enhance outreach, and continue learning directly from the community in order to make the program more successful.CF will also continue collaborating closely with project partners to track progress, adapt strategies as needed, and ensure that program delivery aligns with both individual and community priorities. The CF Evaluator will maintain close coordination with the PC/CHW and PD to carry out all evaluation-related activities, including tracking increases in fruit and vegetable consumption, monitoring the resolution of HRSN, and capturing broader program outcomes.

Impacts
What was accomplished under these goals? 1.- By the end of each project year, 95% of participants will increase purchasing of F&V through redemption of F&V vouchers at local stores, farmers markets and growers. Participants of Comiendo Fresco are actively redeeming the vouchers for fruits and vegetables at an average of 90% at the local stores. We have seen that during this first month of the program, participants have been reporting the increased access to fresh produce, and mentioned that now they feel fortunate to have the opportunity to increase the intake of fruits and vegetables in their households. 2. By the end of each project year, increase average daily dietary intake (consumption) of F&V in 75% of participants. Nutrition education sessions with the University of Arizona Cooperative Extension (UofACE), and the health sessions offered by the Comiendo Fresco CHWs have emphasized the importance of daily fruit and vegetable consumption, and the cooking demonstrations provided by the (UoACE) have introduced practical, culturally familiar ways to prepare their meals utilizing the produce bought with the PP vouchers. (80 % of participation) 3. By the end of each project year, 60% of participants will show improvements on self- reported health status and/or 40% of participants will have reduction in one or more biomarkers (HbA1c, BP, BMI). Due to the PPR program just having one month of initiating, participants do not have the biomarkers of a full 9 month participating in program, we have gathered some preliminary comments from participants. In this first month of participating in CF, we have that 90% have reported improvements in their overall health status, including having more energy, better meal planning, and greater confidence in managing chronic diseases. They expressed feeling more motivated to stay active and healthy, especially since weight loss is the first goal for most of them. 4. By the end of each project year, decreased food/nutritionsecuritystatusin75% ofparticipants uponcompletion. Through voucher distribution, connections to local food resources, and nutrition classes, many participants reported reduced stress around accessing nutritious foods. The program continues to address food insecurity by combining support through PP voucher and nutrition education. Participants have expressed how the program has supported them in increasing fruit and vegetable consumption. By receiving the PP weekly voucher, they can afford to buy fruits that otherwise were out of their reach and intake. 5. By the end of each project year, 75% of participants in evidenced-based nutrition education and activities will show improved knowledge, skills, and dietary patterns. This objective has only been in effect for the past two months. Information on nutrition is very preliminary. So far, cooking classes showed that participants increased their knowledge of nutrition basics, such as reading food labels, portion control, and healthier cooking methods. Participants also demonstrated improved skills in meal planning and grocery shopping. Many shared that they have been making changes in their dietary habits, to ensure that they increase the intake of the fresh fruit and vegetables obtained with the PP vouchers. 6. By the end of each project year, 90% of participants will report on CHW's effectiveness in providing support, retention, and referrals to address HRSN. It is very early to have a % available. What we can report thus far is that the PC/CHW plays a central role in engaging participants by providing individualized support. CHWs have been providing participants with referrals to resources on social services that range from ESL classes to employment agencies. Participants are reporting that by receiving this support from CHWs has been vital because now they know what services are available in their own communities. This strong CHW involvement has built trust and increased program participation and satisfaction. 7. By the end of the POP, 75% of participants will report reduced need for HRSN. Participants of Comiendo Fresco receive one-on-one support and guidance in connecting with other community organizations. By addressing health-related social needs, the program has been helping participants work toward greater stability in regards to their HRSN needs. 8. By the end of the POP, CF will demonstrate improved health care utilization and reduced unnecessary care/costs in 40% of participants (PCP, hospital & ED's/urgent care visits). It is too early to provide this outcome but due to the current success of the program, we are confident that participants will demonstrate improved health outcomes, due to their increase health knowledge and health behaviors. Comiendo Fresco aims to reduce unnecessary ED's, urgent care visits and associated high costs over the course of the program.

Publications