Abstract Body (Do not enter title and authors here): Background: Produce prescription programs (PRx) have the potential to enhance diet quality and improve food security. However, key implementation questions remain.
Research Question: How does PRx dose affect benefit redemption (primary outcome), along with food security and fruit/vegetable (FV) intake (secondary outcomes).
Methods: This prospective community-partnered randomized clinical trial assigned participants to one of three arms: $40, $80, or $110 monthly PRx benefits for 6 months. PRx benefits were distributed electronically, redeemable at major grocery stores, and reflected 10%, 20%, or 30% of the recommended FV budget for a four-person household under the USDA Thrifty Food Plan. Outcomes were assessed at 3 months (primary endpoint) and 6 months (secondary endpoint). Analyses used targeted minimum loss estimation to examine the different PRx dose effects.
Results: Study participants (n=242) were randomized to the $40 (n=81), $80 (n=80), or $110 (n=81) PRx arms. Demographics (mean [SD] or n [%]: age 35.16 [9.5] years, 235 [97.1%] female, 200 [82.6%] Hispanic, $4,335 [$10,428] monthly income, 4.72 [1.7] person household), baseline food insecurity (overall prevalence: 64.9%), and baseline FV consumption (overall mean: 2.8 cups/day; SD: 0.77) were similar across arms. Over the entire study, more benefits were redeemed in the $110 group ($410, 95%CI $319 to $507) than the $40 group ($140, 95%CI $120 to $160, p<0.001) and the $80 group ($319, 95% CI $284 to $355, p<0.001). In relative terms, the percent of available benefits redeemed was greater for the $110 group (69%, 95%CI 62% to 77%) than the $40 group (58%, 95%CI 50% to 66%, p=0.04) and the $80 group (66%, 95%CI 59% to 74%, p=0.57)—though not statistically significant at $80. At 3-months, food insecurity was lower in the $110 group (47%, 95%CI 32% to 63%) than the $40 group (74%, 95%CI 65% to 87%, p<0.01) and the $80 group (66%, 95%CI 50% to 82%, p=0.10)—though not statistically significant at $80. FV consumption was higher in the $110 group (2.9 cups/day, 95%CI 2.7 to 3.2) than the $40 group (2.6, 95%CI 2.4 to 2.8, p=0.04) and the $80 group (2.7, 95%CI 2.5 to 3.0, p=0.28)—though not statistically significant at $80.
Conclusion: Higher PRx dose increases benefit redemption, food security, and FV consumption, especially when comparing the $110 and $40 dose. Dose is an important design element to consider in efforts to increase PRx redemption levels and improve PRx-related health outcomes.