USING FRESH PRODUCE TO IMPROVE THE HEALTH OF SNAP PARTICIPANTS IN CENTRAL OREGON

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: ACTIVE
• Funding Source: OTHER GRANTS
• Reporting Frequency: Annual
• Accession No.: 1028894
• Grant No.: 2022-70422-37758
• Cumulative Award Amt.: $378,210.00
• Proposal No.: 2022-06171
• Project Start Date: Sep 15, 2022
• Project End Date: Sep 14, 2025
• Grant Year: 2022
• Program Code: [PPR]- Produce Prescription

Recipient Organization
HIGH DESERT FOOD & FARM ALLIANCE
334 NE HAWTHORNE AVE
BEND,OR 97701

Performing Department
(N/A)

Non Technical Summary
Food insecurity, the lack of access to enough food for a healthy lifestyle, remains a persistent issue across the US and affects over 35,000 Central Oregonians. Such individuals are twice as likely to suffer from diet-modifiable chronic diseases (e.g. heart disease, diabetes, and/or obesity) due to the consumption of a diet that lacks fresh vegetables and fruits. Through our project, "Using Fresh Produce to Improve the Health of SNAP Participants in Central Oregon", The High Desert Food & Farm Alliance (HDFFA, a non-profit) will partner with over 100 community and health care workersacross the region and thestate of Oregonto implement and quantify the impact of a fresh produce prescription program. This program will provide 20 weeksof fresh produce along with printed nutrition education materials, dietary counseling, and social interactions in a Farmers Market setting on a weekly basis. In partnership with our health care partners, we will collect both qualitative and quantitative data, including biometrics, to study the state of change in a person's behaviour and physical being.Our program goals, identical tothe Produce Prescription GusNIP goals, will be accomplished over three years. HDFFA will improve individual, and by proximityfamily health, by increasing the consumption of fresh vegetables and fruits and providing nutritioneducation that empowers participates to feel comfortableshoping, storing, preparingand cooking with fresh foods.Participants will also experience improved food security by having access to affordable fresh foods on a weekly basis for 20 weeks, enough time to integrate behaviour changes that has a postive and lasting affect. Lastly, HDFFA recognizes that individual health is more than just access to and delivery of care by a doctor;it is influenced by social and economic conditions such as food and housing. This project will research and analyze the reduction on healthcare costs by comparing VeggieRx participants to a control group in order to adovate for programs like this to be integrated into upstream health.

Animal Health Component

75%

Research Effort Categories

Basic

0%

Applied

75%

Developmental

25%

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
724	6050	1060	25%
724	6050	1010	55%
724	6050	3020	20%

Knowledge Area
724 - Healthy Lifestyle;

Subject Of Investigation
6050 - Communities, areas, and regions;

Field Of Science
1060 - Biology (whole systems); 3020 - Education; 1010 - Nutrition and metabolism;

Keywords

produce

veggierx

nutrition

prescription

Goals / Objectives
HDFFA is proposing to expand their existing VeggieRx program to a research-driven program in order to further understand the impact from a clinical lens. The goals of this proposal are to: Improve individual health through increased consumption of fresh fruits and vegetables, Reduce individual and household food insecurity, andReduce healthcare use and associated costs.HDFFA will achieve these goals through the expansion of theirestablished VeggieRx program.Goal 1: Improve individual dietary health through increased consumption of fresh fruits/vegetables, including but not limited to: leafy and hearty greens, garlics/onions, crucifers, legumes, melons/squashes, nightshades, root vegetables/tubers, berries, and tree fruits; and increase participant knowledge of nutrition through weekly nutrition education and two one-on-one appointments with a registered dietitian.Goal 2: Reduce individual and household food insecurity (FI) through access to free fresh produce. We will determine the relationship between VRx and household FI using NTAE FI questions.Goal 3: Reduce healthcare use and costs. HDFFA recognizes that individual health is more than access to and delivery of care, it is influenced by social conditions and economics such as food and housing. To determine our impact on health we will use Medicaid metrics, including individual health care costs, ER utilization, and reliance on prescription medications.

Project Methods
Technical capabilities to be acquired prior to program start include:Obtain IRB approval (obtained 3/25/21)Create seamless flow of information between the St Charles Health Center and HDFFA's VeggieRx program.Actions to achieve goalsGoal 1:Improve dietary health through increased consumption of fresh fruits and vegetables; and Goal 2:Reduce individual and household food insecurity.Maintain IRB approval (obtained 3/25/21)HDFFA and St. Charles to consent to and recruit over 300 participants in three years and verify eligibility through health care screening for food insecurity anddiet modifiable disease(s)HDFFA and St. Charles to conduct and oversee the completion of pre/during/post surveys ofHbA1c lab tests and body weight measurements for comparisonHDFFA to implement a Produce Prescription Program for enrolled patients at two SNAP-authorized farmers markets and providetwenty weeks of fresh food kits per participantBend Farmers Market (years 1,2,3)Madras Farmers Market (years 2,3)HDFFA to provide 20 weeks ofnutrition education and in person nutritional counseling in addition to online resourcesHDFFA and St. Charles to oversee completion of participant post-survey and HbA1c lab tests and body weight measurementsHDFFA to analyze the assessments, and quantify the relationship of VeggieRx on food insecurity, fresh produce intake, and health outcomes.Goal 3:Reduce healthcare use and costs,HDFFA and St. Charles.Determine the relationship between participation in VeggieRx and healthcare use and costs by:Selecting a panel of healthcare use and cost measures to evaluate across Medicaid (VeggieRx) participantsQuantifyingselected measures for Medicaid participants over a 1-year periodComparingselected measures of VeggieRx participants to a propensity-matched group that did not participate in VeggieRx over that same year.Evaluation (analysis, evaluation and interpretation)The main VeggieRx activities selected for this program have been extensively evaluated and shown to be successful in improving the nutritional intake of participants with diet modifiable disease. Over 75% of the activities listed have already been performed at least three times (2018-2020) by HDFFA and partners.New to this application is our partnership with the St. Charles Health System (SCHS) and the collection of HbA1C lab tests, bodyweight measurements, and data referencing health care use and costs. To overcome any challenges with data collection, we implemented a small pilot program in 2021 (n=45) that tested our ability to successfully collect, measure, and analyze these data. SCHS was instrumental in choosing which measurements to collect.The hired evaluator, Cultivare', who has worked with HDFFA to implement this program since its inception, will detail out the evaluation, analysis and interpretation which will be included in an annual report for each year of the program.

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

Outputs
Target Audience:The target audience for this past reporting period was in two main groups. The largest group was centralized at the Bend Farmers Market. This group had a variety of ages, genders, and ethnicities. This last year we had a few people whose primary language was Spanish. Many participants in this particular group heard about VeggieRx through their provider, or friend, or had participated in years prior. This group had a requirement of 18 years or older, experiencing food insecurity, and diagnosed with some type of diet-modifiable disease(s). The second group was located on the Confederated Tribes of the Warm Springs. This group had the same criteria, however, participants also had to be a tribal member. The participants in this group were all referred by their local health clinic, IHS. The purpose of these target populations is to meet our grant and organization goals of decreasing food insecurity in Central Oregon. Avenues to reach these populations were attending provider meetings at clinics where patients on OHP are members, sending and putting out flyers at organizations that serve lower-income populations, and advertising through our own organization's social media platforms. Changes/Problems:We are hoping that the project change proposal we submit this year to hire a VeggieRx Coordinator in Warm Springs will be accepted. If this change is accepted we can hire a VeggieRx staff in Warm Springs to locally manage the program. Our hope is by having someone locally manage the program, attendance, and engagement amongst that cohort will increase. We also will be increasing the number of weeks in the VeggieRx session from 10 to 15 weeks so we can provide participants with a longer season to access fresh locally grown produce. What opportunities for training and professional development has the project provided?We did not provide any training or professional develoment opportunities for others, butthe VeggieRx Senior Manager was able to attend specific VeggieRx work groups and conferences. Being able to see how other agencies around the county and world host food is medicine sites has been eye-opening. HDFFA has two cohorts. The Bend Farmers Market group in Deschutes County is one of the least diverse populations in Oregon versus the cohort in Warm Springs, which is on tribal land. Being able to attend and learn from programs that prominently serve minority populations has been a great experience to glean different ways to approach and manage VeggieRx cohorts in more diverse communities. How have the results been disseminated to communities of interest?The data we collect throughout the season gets shared with participating farmers and providers. We also use this data in internal and external grant reporting, applying for grants, and on our social media platform to inform the community and our followers. What do you plan to do during the next reporting period to accomplish the goals?We plan to continue to perform pre and post-program surveys, provide nutrition education including 1:1 nutrition coaching, use household size for token distribution, and collect qualitative data. We also hope to hire a VeggieRx Support staff to help in our rural communities so there is an opportunity for participants to build trust and have someone within the community enrolling and distributing their produce to them, which in turn has the potential to increase engagement in the cohorts that typically have low attendance. ?

Impacts
What was accomplished under these goals? Goal #1: We were able to enroll about 175 participants in the program and reach the 100 pre and post-survey three-year grant goals in year two. With this being said, this year's data shows an increase in vegetable and fruit consumption by .73 cups which is higher than last year. In terms of qualitative data, there were testimonials every week from participants stating that they were trying new foods, and recipes, and have overall healthier eating habits. "I wanted to share my gratitude and experience with the veggie RX program. My family and I have been lucky enough to be part of this program for the last two seasons. Because of this program we have been able to introduce and implement a healthier well-rounded diet. We have been able to try and experience new fruits and produce we otherwise could not have. My partner and I have both managed to lose roughly 40 pounds each by implementing a healthy dose of fruits and veggies as well as the energy to exercise. I wholeheartedly believe the veggie RX program had a direct impact on the overall health results of my family and I!" -2024 VeggieRx Participant Goal #2: In the 2024 season, we were able to expand VeggieRx vouchers to household size versus individual. By increasing the amount of money to participants this year, not only did participants get to increase the amount of produce they got to shop for every week, but our local farm vendors also reaped the benefits of this spending increase. We were able to stimulate our local economy and increase food security by twofold. Our reimbursement rate increased by over 40% this year. Many participants described their experience by how it positively affected their food budget. Not only participants were able to access fresh food they normally would not have access to, but also learned how to stretch their meals with produce so their food would last longer. By supporting local farmers, many participants experienced their produce from these vendors lasting longer than the produce they purchased at the grocery store. "Thank you so much! I really appreciate it. Fresh produce is what we always run out of first, and we've never been able to buy from the Farmer's Market before-until now. Thank you for making a positive difference in our lives!" -2024 Bend Farmers Market Participant?? Goal #3: We use the NTAE health care utilization questions to glean information about how the program is meeting goal #3. HDFFA does not partner with a local medical clinic so we cannot capture electronic medical records and do regular biometric checks. The data collected from program surveys in 2024 shows that there was no significant change in the overall health that people reported on their post-program survey nor was there a significant change in the amount they needed to see a doctor. With that being said, it is important to note that the past two years of the VeggieRx program have only been a session of ten weeks each and have not had a medical clinic partner. This coming year we can expand the session to 15 weeks. With an increase of five extra weeks, we hope to better capture information about how the impacts of increased consumption of produce on the participants' health care utilization. Many participants throughout their ten weeks spoke to me about how much weight they had lost, how many points their A1C went down, and how cholesterol levels improved. "I'm starting to question why I would pay for a prescription rather than treat myself to farm fresh foods. If a doctor recommends a magic pill, the money for it appears. I believe the real issue lies in the mind, and finding permission to access these "fancy" things. I can see how this method works in me to develop a new habit. A habit that supports me, and my local community." -2024 Bend Farmers Market Participant "My partner and I have both managed to lose roughly 40 pounds each by implementing a healthy dose of fruits and veggies as well as the energy to exercise. I wholeheartedly believe the veggie RX program had a direct impact on the overall health results of my family and I!" -2024 Bend Farmers Market Participant

Publications

Progress 09/15/22 to 09/14/23

Outputs
Target Audience:The VeggieRx program targets low- or limited-income individuals with diagnosed diet related diseases who are also experiencing food insecurity. During this reporting period, the project primarily reached residents of Central Oregon, including the Warm Springs Indian Reservation. Changes/Problems:Lack of reliable and affordable transportation has proven to be a significant barrier to participation in VeggieRx.To address this issue, we are providing more transportation support to participants. What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest?HDFFA staff has attended numerous Oregon Community Food Systems Network (OCFSN) and Central Oregon Health Council (COHC) workgroups in order to share our work and collaborate with mission-aligned entities. In addition, we share program challenges and accomplishments with our Food Security Advisory Committee (FSAC) and Agricultural Advisory Committee (AAC). During the reporting period, HDFFA distributed a monthly e-newsletter to VeggieRx (and other Food Access program participants) who opted in. This provided information and updates on HDFFA programs and impact, and other relevant resources. The audience for this newsletter grew to 400 recipients. We also send a broader organizational newsletter to Central Oregon community members, with a reach of 1,878 unique participants. We disseminate program and project goals and results annually through our Food & Farm Directory, with 37,000 copies printed and distributed. HDFFA's Annual Report, published on our website and sent to key stakeholders and donors, includes key VeggieRx program statistics. We share our Food Access programming with the broader community through our website. Our website (hdffa.org) also offers educational materials in English and Spanish about nutrition and cooking. Furthermore, we post about upcoming VeggieRx enrollment opportunities and program metrics through social media, where we have 3,300 Facebook followers and 3,1043 Instagram followers, as of September 15, 2023. What do you plan to do during the next reporting period to accomplish the goals?We will continue our expansion and refinement of the VeggieRx program, working with local organizations with tri-county reach. We have already initiated community partnerships to make this possible during the next reporting period. We will recruit new members of the Food Security Advisory Committee with a focus on rural community representation, and will continue to provide stipends for participants. The Committee helps inform our approach to Food Access programming including VeggieRx. Feedback from participants, participating farms, and VeggieRx volunteers will inform the program for the next reporting period. In particular, we are focused on identification of program barriers (such as transportation) and will work to address those barriers during the next reporting period. ?

Impacts
What was accomplished under these goals? Goal 1: Improve individual dietary health through increased consumption of fresh fruits/vegetables: On average, participants increased their vegetable intake by about .4 cups/day. The majority of participants reported using 76% of the produce they received during the VeggieRx program. There was an increased trend for participants in the ability to stretch their meals using the produce they received. About seventy percent attended one private session with VeggieRx Senior Manager, who is a Registered Dietitian. Each participant that attended the 1:1 session with the RDN, said that they have increased their produce intake because of being a participant of the VeggieRx program Goal 2:Reduce individual and household food insecurity (FI) through access to free fresh produce. We do not yet have sufficient data to support that the program has significantly reduced food insecurity for the participants. Goal 3: Reduce healthcare use and costs: In general, no decrease in healthcare utilization has been recorded to date.

Publications