Ma#hewB.Fine1,2CapstoneMentor:SaraBerney-Execu>veDirector2,3

1DepartmentofEnvironmentalHealth,RollinsSchoolofPublicHealth|2WholesomeWaveGeorgiaBackground

Chronicdiseaseisatepidemicpropor0onsintheUnitedStates,with34.9%of Americans being overweight or obese and 9% suffering from type IIdiabetes;v  InGeorgiathesenumbersare30.4%and10.4%,respec0vely;Thoseoflowsocioeconomicstatusaredispropor0onatelyaffectedbythesediseases,dietqualityfollowsasimilarpaJerntotheSESgradientinhealth;v Nutrientdensity,energydensity,andcostareinverselyrelated;Fruitsandvegetableshavebeenfoundtobeprotec0veagainstmanyformsof chronic illness; however, a diet high in produce is considerably moreexpensivethanwhatisfeasibleforlowSESfamilies;v Adiet thatmet all federal nutri0on recommenda0onswould consume

upto40%ofalowincomehouseholdsincome;ProgramslikeFoodStampsbegintoaddressthe issuesoffoodinsecurity,but simply supplemen0ng the cost is not enough to encourage healthyshoppingbehaviors;v Onemustalsoaddress issuesofaccessibilityandknowledgeofhealthy

food/ea0ng;Wholesome Wave Georgia (WWG) works to incen0vize healthy ea0ngthrough the use of federal nutri0on incen0ves at producer only farmersmarketsacrossthestateofGeorgia.

MethodologyFVRxProtocol

Objec>veFruits and vegetables are important components of chronic diseasepreven0on and management. The Fruit and Vegetable Prescrip0onProgram (FVRx) seeks to increase its par0cipants knowledge of healthyea0ng, increase their access to healthy foods, and improve their health.This project seeks to evaluate theAugusta,GA FVRx andmake informedrecommenda0onsonhowtobestimprovetheprogramprotocolbasedoffofaliteraturereviewofsimilarstudies.

LiteratureReviewandProgramEvalua0onInordertobestadaptourprotocolbasedoffofbestprac0cesabriefliteraturereviewusingPubMedandGoogleScholarwasconducted,theThesearchtermsfallintothefollowingcategories:v HealtheffectsoflowSES;v Farmersmarketnutri0onassistanceprograms;v FederalNutri0onincen0vesandhealth;v CookingandNutri0onEduca0onandhealth.

Results

3Acknowledgments:SpecialthankstoSaraBerneyandtherestofthestaffatWholesomeWaveGeorgiaforthisopportunity.

FVRxWhiletherewasnoappreciablechangeinweightorbloodpressure,theaverageblood pressure for pa0ents who completed follow up dropped from thehypertensivetonormalrange(p<0.05).Pa0entssawanincreaseofoneservingoffruit and vegetable perweek,whichwas determined to be sta0s0cally but notprac0callysignificant

FarmersMarketv 89% of prescrip0ons were redeemed at the Augusta Veggie Truck Farmers

Marketv 42varie0esofproduceweresoldatthefarmersmarketv 10,081cupstandardservingsofproducewerepurchased

v 3,758servingsoffruitv 6,060servingsofvegetablesv 983servingsofgreens

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“IdidnotrealizehowliJlewewereea0ngoffreshfruitsandveggies.Wealwaysbypassed most of them because they were more expensive than the cannedones. But for the last 2weekswe have had at least 4 servings a daywith thevarietyofthingswe’vegoJen”-FVRxPar0cipant

“Iwas always big on prescribing cheap prescrip0ons tomy pa0ents. I had neverthought about prescribing food. My pa0ents were not going to the farmersmarkets; they were buying the 4 for $4 at Wendy’s. I saw the endless cycle ofhealth problems created by food and what my pa0ents were ea0ng… The RxprogramcompletelychangedthewayIprescribedmedicine.NowIprescribefood.”-FVRxProvider

Evalua>onandRecommenda>onsUsingtheprogramevalua0onasabaselinetheliteraturereviewledtothefollowingrecommenda0onsforadjustmentstotheprogramprotocol:v  Improvepa0ent recruitmentby relaxingenrollmentguidelines, include

childrenoranythatcouldbenefit;v Make clinic visits more flexible or more appropriate for par0cipants

schedules;v Createnewmarke0ngmaterials;v  Incen0vizehealthyproduceshoppingatconveniencestores,todiversify

typesoffoodvenuestomakeshoppingmoreconvenient;v Provideeconomicsupportfortransporta0oncoststoandfromboththe

marketandclinicvisits;v Create a more robust nutri0on educa0on and cooking program by

focusingoncookingonabudget/one-potcookbooks;v Track the increase in home cooked meals and decrease in fast food

purchasesasanaddi0onaltoolforprogramevalua0on.

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ConclusionThe FVRx saw marginal improvements in the health of itspar0cipants and moderate increases in the servings of fruits andvegetables consumed. Despite these small gains the FVRx is afeasible route to managing and eventually preven0ng chronicillnesses in disadvantaged popula0ons. The combina0on ofeconomicincen0vesandnutri0oneduca0onisagoodstar0ngpointtocrea0ngbehaviorchangeandincen0vizehealthyea0nghabits.Asthe program expands through the state of Georgia it will beimportant to see how results translate from urban to ruralpopula0ons. Overall the FVRx is poten0ally an important healthpolicymechanism to halt the growth of chronic disease incidencewhileincen0vizingahealthydietforfuturegenera0ons.

Photo1:FVRxpar0cipantsshoppingattheAugustaVeggieTruckFarmersMarketPhoto2:DishespreparedbyFVRxpar0cipantswithproducetheypurchasedatthemarketPhoto3:Par0cipantspreparingfoodatthecookingclass