Providing food-insecure families with produce vouchers and nutritional education on planning, preparing, and eating healthy food led to improved household food security compared with providing only produce vouchers by themselves, according to a randomized controlled trial presented at the annual meeting of Pediatric Academic Societies.
Despite the improvement in food security, however, the program did not show improvement in the children's or adults' eating habits over time.
An estimated 18 million US households -- about one out of every seven households -- had difficulty accessing enough food at some point in 2023, according to the US Department of Agriculture (USDA), and most of those homes had children. Around 14 million children faced uncertainty about their next meal in 2023, so pediatricians need tools to help families living with food insecurity.
Referrals to emergency food assistance or federal benefits programs have not been shown in past research to be sufficient to improve food security or diet quality. Researchers from Children's Hospital of Philadelphia (CHOP), Philadelphia, therefore tested a program they developed called Home Plate, "a cooking and food literacy intervention that employs trauma-informed, experiential learning to support low-income families with planning, procuring, preparing, and eating healthy food," Senbagam Virudachalam, MD, MSHP, an assistant professor of pediatrics at CHOP and the Perelman School of Medicine, Philadelphia, told attendees.
They recruited 90 families with children aged 2-5 years who were at risk for poor nutrition either due to food insecurity or due to having overweight or obesity while also using federal health insurance. The families came from two pediatric primary care clinics and one Early Head Start site, and they were randomly assigned to receive one of three interventions.
One group received only "produce prescriptions" -- $50 vouchers provided every 2 weeks for 2 months that could be redeemed for fresh produce at grocery stores and farmers markets. Another group received produce prescriptions along with the Home Plate Lite program, which involved six weekly texts or emails linking to videos and handouts. The third group received produce prescriptions, Home Plate Lite, and Virtual Home Plate, which added six weekly virtual interactive sessions with other parents.
The researchers assessed the three groups in terms of food security with an 18-item USDA survey and with the USDA's Healthy Eating Index (HEI), which is based on 24-hour diet recall.
The families were predominantly Black individuals (64%) and included 19% Hispanic participants. Just over half had either some college or technical schooling (16%) or a college degree (39%). More than one third were unemployed (38%), about half of whom were seeking employment. Over 1 in 4 (27%) had an income under $22,000 while most others were evenly distributed among income brackets from $22,000 to $74,999. About half (53%) received Supplemental Nutrition Assistance Program, 31% received Special Supplemental Nutrition Program for Women, Infants, and Children, and 10% received government cash assistance (families may receive more than one of these), while a third (34%) received no state or federal benefits.
The group using Home Plate Lite and Home Plate Virtual showed a significant increase in household food security on its own (P = .002) compared with the produce prescription-only group (P = .009). The Home Plate Lite group showed a modest, nonsignificant increase in food security, but their household food security at follow-up was better than that of the produce prescription-only group.
The HEI assessed how much fruit, grain, vegetables, protein, fatty acids, sodium, fats, and sugars children ate. Children's scores did not increase within groups or between groups during the study, and while adults did see significant improvements in their HEI within groups, the groups were not different from one another over time.
"Home Plate combined with produce prescriptions is the first evidence-based intervention to improve household food security among low-income households with young children," the authors concluded, but they noted the need for larger studies to better understand how these programs affect the quality of families' diets.
Michelle Tobin, MD, a clinical associate professor of pediatric gastroenterology, liver disease, and nutrition at Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, and Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York, told Medscape Medical News that some of the findings were discouraging, but nevertheless, "providing families with financial support and education on how to utilize their funds shows great promise."
She was surprised that no significant improvement occurred in the HEI and that food insecurity did not improve significantly in the produce prescription-only group.
"I was pleased to see, however, that there was an increase in protein intake and total fruit intake in the Virtual Home Plate + Home Plate Lite and produce prescriptions group compared to baseline which was found to be statistically significant," she said. "It was also encouraging to note that there was an increase in food security found in the two groups provided with Home Plate lite and Virtual Home Plate compared to produce prescriptions only. This proves that their education made an impact."
She wasn't surprised that adding education made a difference for the families using Home Plate Lite. "Providing produce prescriptions alone is not sufficient for these families to have food security or an improvement in their HEI score, as shown by the study," Tobin said. "In order to be successful, this program requires concomitant therapy, financial support, and the proper nutritional education. Providing educational support is a key ingredient for families to understand what are the appropriate foods to purchase in order to have a well-balanced dietary intake."
The education's lack of impact on children's eating habits remained concerning to Tobin, however. "Perhaps their content did not meet the audience's needs appropriately, and the content requires further adjustment," she suggested. She also pointed out that the study did not mention whether the intervention was offered in any languages besides English, given that 1 in 5 participating families were Hispanic individuals. She said that more research would be important "so that we can identify what educational content is most impactful to make significant change in families' food insecurity and diet quality over time."
Information on funding was not provided. Virudachalam and Tobin had no relevant financial disclosures.