Produce Prescription Dose Response: A Randomized Community Trial

Abstract Background Produce prescriptions (PRx) may improve diet quality and food security. However, there is little data to inform PRx dose recommendations. Objective To identify how PRx dose affects benefit redemption, food security, and fruit/vegetable (FV) intake. Design Three-arm, prospective randomized community trial. Participants Adult clients of a community-based nonprofit social service provider. Interventions Monthly electronic distribution of $40, $80, or $110 (equivalent to 10%, 20%, or 30% of the FV component of the USDA Thrifty Food Plan) for 6 months, redeemable at major grocery stores only for FV. Main Measures Primary (benefit redemption) and secondary (food security and FV intake) outcomes were assessed at 3 months (primary endpoint) and 6 months. Key Results Study participants ( n = 242) were randomized to $40 ( n = 81), $80 ( n = 80), or $110 ( n = 81) PRx arms. Mean (SD) age was 35.16 (9.45) years and 235 (97.1%) self-identified as female and 200 (82.6%) as Hispanic. Overall, there appeared to be a dose-response relationship with progressively greater benefit redemption rate, food security, and FV consumption as PRx dose increased. Compared with $40, the $110 PRx dose significantly improved food insecurity ( p = 0.01) and FV intake ( p = 0.03) at 3 months, and the benefit redemption rate ( p = 0.04) at 6 months. At 3 months, the benefit redemption rate was 60.2% (95%CI 51.9–68.6%) $40 group, 67.6% (95%CI 59.9–75.3%) $80 group, and 70.4% (95%CI 63.0–77.9%) $110 group. Food insecurity was reported for 74.3% (95%CI 62.0–86.6%) $40 group, 66.2% (95%CI 50.1–82.2%) $80 group, and 47.4% (95%CI 31.6–63.1%) $110 group. Mean FV consumption in cups/day was 2.51 (95%CI 2.31–2.72) $40 group, 2.66 (95%CI 2.38–2.95) $80 group, and 2.89 (95%CI 2.61–3.17) $110 group. Conclusions Higher PRx dose increased benefit redemption, food security, and FV consumption, especially when comparing the $110 and $40 doses. Dose is an important design element to improve PRx redemption levels and potentially PRx-related health outcomes.