Factors Associated with Produce Prescription Program Enrollment and Benefit Use among Patients with Diabetes and at Risk for Food Insecurity.

BACKGROUND: Food insecurity (FI) exacerbates type 2 diabetes (T2D) by limiting access to nutritious foods and worsening glycemic control. Produce prescription (PRx) programs subsidize fruits and vegetables to improve food security and diet quality, yet factors associated with PRx engagement patterns remain understudied. OBJECTIVES: This study aimed to evaluate factors associated with enrollment and benefit use in a PRx program among patients with T2D at risk for FI. METHODS: This observational cohort study analyzed participants from a pragmatic randomized trial in a large integrated health system. Eligible adults (≥18 y) had recent glycated hemoglobin measurements and FI risk based on Medicaid enrollment, high Area Deprivation Index (ADI ≥7), or documented unmet social needs. Of 9644 contacted, 2177 enrolled and were randomly divided 2:1 to receive the EatWell PRx program, receiving a reloadable debit card providing $80/mo for 12 mo to purchase fruits and vegetables. We examined predictors of: 1) study enrollment, 2) any spending (>$0), 3) high spending (>$53/mo median), and 4) highest spending (>$70/mo). Multivariate logistic regression included demographic, socioeconomic, and clinical covariates. RESULTS: Of the 9644 contacted, 2177 enrolled (22.6%), 1450 were assigned to the PRx arm, and 1148 (79.2% of enrollees) activated their cards. Enrollment was lower among older adults [per 10-y increase: odds ratio (OR): 0.75; 95% confidence interval (CI): 0.72, 0.77], males (OR: 0.57; 95% CI: 0.51, 0.63), Medicaid enrollees (OR: 0.61; 95% CI: 0.53, 0.69), high-ADI (OR: 0.62; 95% CI: 0.55, 0.70), and non-Hispanic White (OR: 0.76; 95% CI: 0.68, 0.85) and Hispanic/Latino (OR: 0.72; 95% CI: 0.57, 0.90) participants compared with Black participants. Among card activators, high spending was associated with older age (OR: 1.15; 95% CI: 1.04, 1.27), whereas highest spending was associated with being married (OR: 1.43; 95% CI: 1.03, 1.96) and Black compared with White race (OR: 1.56; 95% CI: 1.09, 2.22). CONCLUSIONS: Demographic and socioeconomic factors are significantly associated with PRx enrollment and utilization. Multimodal outreach strategies and targeted implementation approaches may be necessary to ensure equitable program reach and effectiveness. This trial is registered at clinicaltrials.gov as NCT05896644.

Duke Scholars

Author Susan Elizabeth Spratt Medicine, Endocrinology, Metabolism, and Nutrition

Author Cierra Buckman