Impact of a Produce Prescription Program and Nutrition Education Intervention on Cardiovascular Health in Youth

This is a single-center, prospective interventional study to evaluate the effect of a providing pre-paid produce prescription debit cards and participating in nutrition classes on fruit and vegetable (FV) intake, cardiovascular health, and food security in a cohort of participants with risk factors for cardiovascular disease.

We will recruit 150 dyads (participants and parents) between the ages of 2-17 years old along with their caregiver from the Boston Children's Hospital (BCH) pediatric cardiology outpatient clinics. Patients will qualify for enrollment if they have cardiovascular risk factors including high blood pressure, elevated non-HDL cholesterol, or elevated BMI and who qualify for (1) Benefits under the Food and Nutrition Act of 2008 (7 USC 2011 et seq.); or enrolled in (2) medical assistance under a State plan or a waiver of such a plan under title XIX of the Social Security Act (42 USC 1392 et seq.). We will exclude patients who have hypertensive urgency or emergency or end-stage renal disease.

Participants enrolled in this study will receive $50 monthly deposits loaded onto a Fresh Connect produce prescription debit card for six months, and will attend biweekly nutrition classes for three months. Participants will complete a baseline survey assessing diet quality and food security.

Patient contact information will be provided to the Fresh Connect team, who will facilitate card enrollment and provide ongoing support. The nutrition classes will be led by a dietitian who specializes in pediatric preventive cardiology and will be offered in English and Spanish. These classes will be conducted via a virtual Zoom platform. Course content will begin with an introduction to DASH and Mediterranean-style eating patterns, which align with healthy cardiovascular eating patterns with additional sessions discussing different aspects of healthy eating, including nutrition label reading and cooking classes. As classes progress, we will focus on nutrition education and incorporate cooking skills by preparing a recipe during the class. To encourage participation, we will send the recipe and ingredients needed ahead of time so that families can join in from home as they watch the virtual class. We will focus on simple, inexpensive recipes that feed an entire family. We will allow time for feedback and ideas for different fruits or vegetables that participants would like to try as the classes progress. Given the diversity of participants to be enrolled, we will plan to make the sessions culturally relevant and appropriate by involving families from the communities we serve in the creation of the curriculum. We plan to host groups of 10-20 dyads in each class to allow for interaction between participants and between participants and our dietitian. Post-intervention surveys and assessments will be completed at 6 months and 12 months.

Pilot intervention: The first 15 dyads enrolled into this study will be considered the pilot group. At the end of their second month of participation, after they have completed 3-4 nutrition classes, they will be asked to complete a qualitative interview assessing satisfaction with the classes and inquiring about suggestions for improvement. After this data is analyzed, we will enroll a larger prospective cohort of 135 dyads over the next 34 months. During this time, the pilot group will complete the remainder of the study.