Pediatric Produce Prescription Program Grounded in Community Connection Improves Fruit Intake in Hawai'i

In Hawai'i, 50% of Native Hawaiian and Pacific Islander children live in a household experiencing food insecurity. Individuals from food insecure households experience increased risk for chronic health conditions that may be alleviated with healthy food. Wellness for Native Hawaiian and Pacific Islander populations can be achieved through the Pilinahā framework, comprising connection to self; community; past, present, and future; and land. The Keiki (child) Produce Prescription Program was designed to address the Pilinahā framework through a 6-month intervention that provided pediatric participants with vouchers totaling $50 per month to exchange for local, fresh fruits and vegetables from the farmers market along with nutrition education kits.

The community-designed intervention connected pediatric patients from a large federally qualified health center with the community farmers' market. Eligibility consisted of children aged 2-17 years who screened positive for a nutrition-related chronic disease or food insecurity. Baseline survey and 6-month data collected included sociodemographic data, household food security, and fruit and vegetable consumption. Monthly voucher redemption was tracked.

One hundred and twenty-one participants enrolled, 90 participants redeemed vouchers for 6 months, and 75 (62%) completed 6-month survey data. Participants redeemed $210 (70%) in vouchers on average. Children's fruit consumption increased by 1.0 cups per day (p=0.014), whereas parent fruit consumption increased by 1.2 cups per day (p=0.0001). No changes to household food security or total fruit and vegetable consumption were observed.

The Keiki Produce Prescription Program improved fruit intake among households with children. High levels of program participation and completion reinforce the importance of community-engaged approaches to program development. Rigorous testing through RCTs and increasing engagement with nutrition education are recommended for future studies.