Evaluating the impact of a multi-year produce prescription program on fruit and vegetable intake, and food security in south central New York

Abstract Background Rural communities experience high rates of diet-related chronic diseases, driven by limited access to healthy food, poor diet quality, and high food insecurity. Produce Prescription (PRx) programs aim to improve fruit and vegetable access and intake, alleviate food insecurity, yet evidence of their sustained impacts remains limited. Objective To evaluate the short-and long-term impacts of a PRx program in rural New York State on fruit and vegetable intake, food security, self-reported health, and diet quality, with complementary insights into participants' experiences and program engagement. Methods This multi-year evaluation included 1400 low-income participants with diet-related chronic diseases recruited from 2022 to 2024. The matched samples ranged from 117 to 261 participants per year, with a longitudinal cohort of 187 participants. Over three seasons, participants received farm shares or vouchers ($15/week for ~ 24 weeks) to purchase fruits and vegetables. Surveys assessed fruit and vegetable intake (times/day), food security, self-rated diet quality, and health status. Program use and engagement were measured through redemption data and patient feedback. The Wilcoxon and Stuart-Maxwell tests were used for year-by-year comparisons, multivariable mixed-effects models for longitudinal changes across three seasons, and thematic analysis of participants’ feedback. Results The yearly analysis revealed small-to-moderate increases in fruit and vegetable intake and a moderate reduction in the mean number of affirmative responses, along with a significant shift towards higher food security categories. The mixed-effects models showed a sustained within-person increases in fruit, fruit juice, green vegetables, and other vegetables, with mean intake frequency rising by 0.27 (95% CI, 0.07 to 0.46), 0.33 (95% CI, 0.03 to 0.64), 0.17 (95% CI, 0.06 to 0.27), and 0.26 (95% CI, 0.11 to 0.40) times/day, respectively. The cumulative reduction in affirmative responses was -0.75 (95% CI, -1.11 to -0.39), and the odds of being in a more secure food category more than doubled across all intervention points compared to baseline, peaking at the 2024 pre-intervention timepoint, AOR = 3.06 (95% CI, 1.76 to 5.34). A redistribution toward marginal and high food security was evident, though low food security remained persistent. Improvements in self-rated health and diet quality were modest and inconsistent. Program engagement was high, with over 93% of participants receiving vouchers, and 65% redeemed them more than 10 times/season. Participants appreciated how PRx improved access to and affordability of fresh produce and suggested increasing the number of vendors, the voucher amounts, and extending the program duration. Conclusion This evaluation showed both short- and long-term improvements in fruit and vegetable intake and food security, with greater benefits observed with continued participation. However, improvements in food security reflected reduced severity rather than a full transition to food security, underscoring the need for supplementary structural supports.