Evaluation of a Fruit and Vegetable Voucher Program in a Prenatal and Pediatric Primary Care-Based Obesity Prevention Program

<b><i>Background:</i></b> Maternal consumption of fruits and vegetables can reduce future childhood obesity risk. <i>Health Bucks</i>, a fruit and vegetable voucher program redeemable at New York City (NYC) farmers' markets, supports access to fresh produce. <b><i>Methods:</i></b> In a cross-sectional analysis within a cohort study, we evaluated the integration of <i>Health Bucks</i> into the prenatal expansion of a primary care-based obesity prevention program. We analyzed data from 176 pregnant Latina participants at a NYC public hospital, with vouchers given to 114 (64.8%) participants. Later in infancy, we measured maternal outcomes (fruit and vegetable intake, stress) and food access (food environment, household food insecurity). We performed adjusted regression analyses to evaluate outcome differences between those who received vouchers and those who did not. Secondary analyses assessed whether voucher redemption or first-trimester timing of distribution were associated with outcomes. <b><i>Results:</i></b> Receipt of vouchers was associated with higher daily fruit and vegetable intake (incident rate ratio [IRR] = 1.3 [95% confidence interval [CI]: 1.1, 1.6]), and lower stress (<i>B</i> = -1.9 [95% CI: -3.7, -0.1]). Voucher redemption was associated with higher daily fruit and vegetable intake (IRR = 1.3 [95% CI: 1.04, 1.6]). First trimester receipt was associated with a favorable view of the neighborhood food environment (adjusted odds ratio = 5.5 [95% CI: 1.04, 28.6]) and lower stress (<i>B</i> = -3.8 [95% CI: -7.5, -0.1). We did not detect associations with food insecurity. <b><i>Conclusion:</i></b> Integrating <i>Health Bucks</i> into a prenatal obesity prevention program was associated with favorable outcomes. Subgroup analyses showed that voucher redemption and first-trimester receipt were associated with positive outcomes, guiding strategies for fruit and vegetable voucher distribution.