Factors Associated with Produce Prescription Program Enrollment and Benefit Use among Patients with Diabetes and at...

Area of Science:

• Public Health
• Nutrition Science
• Health Disparities

Background:

• Food insecurity significantly worsens Type 2 Diabetes (T2D) outcomes by limiting access to healthy foods and impairing glycemic control.
• Produce Prescription (PRx) programs offer a promising intervention by subsidizing fruits and vegetables to enhance food security and dietary quality.
• However, understanding the factors influencing engagement with PRx programs remains crucial for optimizing their effectiveness.

Purpose of the Study:

• To investigate the demographic, socioeconomic, and clinical factors associated with enrollment in a PRx program.
• To identify predictors of benefit utilization, including any spending, high spending, and highest spending among enrolled participants with T2D at risk for food insecurity.

Main Methods:

• An observational cohort study analyzed data from a pragmatic randomized trial within a large integrated health system.
• Participants (n=2,177) with T2D and food insecurity risk factors were enrolled in the EatWell PRx program, receiving $80/month for fruits and vegetables.
• Multivariate logistic regression models examined predictors of enrollment and spending patterns, controlling for various covariates.

Main Results:

• Enrollment was lower among older adults, males, Medicaid recipients, those in high area deprivation index (ADI) regions, and non-Hispanic White and Hispanic/Latino individuals compared to Black participants.
• Among those who activated their cards, higher spending was linked to older age.
• The highest spending levels were associated with being married and identifying as Black compared to White.

Conclusions:

• Significant demographic and socioeconomic disparities were observed in PRx program enrollment and utilization.
• Multimodal outreach and targeted implementation strategies are essential to ensure equitable access and effectiveness of PRx programs for all patients with T2D.
• Addressing social determinants of health is critical for improving health outcomes in T2D management.