Health Benefits of Participating in the Healthy Harvest Food Box Program for a Food Insecure Population Nich chol olas K Katch cher M MD Rus Russell l Steffen ensen DO, Eliz lizabeth Bock ckhol old MD Hins nsda dale le F Family M Medi dicine ine R Reside dency 6/10/2020
• Food insecurity is defined as the inability to afford food, altering spending habits to have money to purchase food, or avoiding healthy food options due to expense. • Perishable foods in general, cost more and expire quicker. Methods and • Community Memorial Foundation provided a $28,000 grant to the Northern Illinois Food Bank in conjunction Objectives with AMITA Hinsdale Hospital and Hinsdale Family Medicine Residency to provide fresh fruit and vegetable boxes to food insecure patients. • This project was on an initial pilot project at Kishwaukee Hospital System Project which ran from December 2016 until March 2017.
• Patients were screened for food insecurity using the standardized Medi dicaid S d Screeni ning ng Q Que uestio ionna naire for Food security. (2 questions) • Any patient deemed at risk was subsequently screened using the USDA food insecurity questionnaire. (6 questions), score of 2 or higher deemed positive. Methods & • Patient who were determined to be food insecure were given vouchers redeemable for one 25 25-30 30 lb box ox of f fres esh fruits a and v veget etables es p per week. Vouchers were Objectives given/ mailed monthly to the participants. • Boxes were given out from July, 2018 until June, 2019. • Project funding would have allowed for up to 75 boxes per week, however our cafeteria refrigerator space was limited to 35 boxes.
• On average, 30-35 boxes were provided each week . • Patients were given the opportunity to opt out of the project at any time. New participants were added to the program as they were screened. Methods & • Patients most in need were the first to receive boxes . Initially individuals with a score 5/6 or Objectives greater were included. • Leftover boxes were given to anyone who was able to use the boxes, regardless of food box score. (See No Data column on graph)
Does h s havin ing r regula lar a access t s to f fruit its a s and v vegetable les h s have positive o e outcomes es o on food i insecu ecure i e individual als/f /fam amilies es? Does h having r regular acce access t to fr fresh fru fruits a and v vegetables mak ake i it ea easier for p patients ts t to ea eat h hea ealthy? Research Does es r regular u ar use of food b boxes es l lead t to: Questions Decrea eased ed B BMI o of o overwei eight/obes ese p e partici cipan ants? Decrea eased ed H HBA1c i c in diabetic p c part rtici cipan ants? Lower S er SBP i in HTN partici cipan ants?
• 300+ patients screened. Number er of B Boxes es/P /Patien ents b by Food I Insec ecurity Score 170 screened 1000 900 food insecure 895 NUMBER OF BOXES 800 700 600 129 patients 500 screened “high 400 300 risk” for food 200 248 insecurity 100 11 3 1 0 3 62 0 6/6 5/6 4/6 3/6 2/6 1/6 0/6 No data 1223 boxes 88 30 12 12 3 9 41 16 dispersed. NUMBER OF PATIENTS BY SCORE
DM Patient Data # Diabetics who DID % Diabetics who receive # Diabetics who DID DID receive # Diabetics who % Diabetics who food box w/ receive food box w/ DID receive DID receive pre-program food box w/ post-program food box food box A1c >7 post-program P value A1c <7 (uncontrolled) A1c <7 (controlled) now controlled 23 67.6% 17 6 35.3% 0.012 # Diabetic patients Average A1c # Diabetic who % Diabetic patients change in patients who DID receive boxes who Diabetic who # Boxes DID receive w/ DID receive boxes w/ DID receive Received P Value boxes A1c Reduction A1c Reduction boxes 1 or more boxes received 23 15 65.2% -0.93 0.015 5 or more boxes received 8 62.5% -0.75 5 0.18 # Diabetic patients who % Diabetic patients who Average change in # Diabetic DID NOT receive boxes DID NOT receive boxes A1c who # Boxes patients who w/ with DID NOT Received P value DID NOT receive boxes A1c 1c r reductio ion A1c r reduction receive boxes 0 11 2 18.2% +0.28 0. 0.23 23
Inclusion/ Exclusion Criteria • Data below is collected only on clinic patients. Data collection is completely dependent on patient follow up in clinic. • Children age <18 were not included in the study due to age associated variables
Food d same/ e/not enoug ugh h variet ety… Foo ood not ot fr fresh 5% 5% Reasons for Participant ceasing activity in the program Mo Moved ed 14% 14% Only ly pic picked ed up up at cl clinic 30% 30% Trans nspo portatio ion 16% 16% Ha Had to to b be Deliv livered ed t to Dista tance home me 16% 16% 12% 12% Does n Doe not ot drive 2% 2%
Patient/Participant Surveys Patients were asked to take a survey on their experience with the food boxes We had ~10% response rate. % % % % Respondents Respondents Respondents Respondents Reporting % % Reporting Reporting Reporting “Making Lasting Respondents Respondents “Eating More “Eating “Improved Health Changes in Reporting Reporting “Eating Fruits and Healthier” Overall Health” Their Life” “Increased Activity” Out Less” Vegetables” 94.74% 71.43% 84.21% 47.37% 42.11% 100.00%
Conclusions • Diabetic patients who received at least 1 box had reduction in HbA1c. • Receiving food boxes appears to show a trend in lower SBP compared to non-recipients • Regardless of sample size, the patient’s experiences were overwhelmingly positive • Patients who received boxes appear to have a significant reduction in HbA1c compared to those who did not receive boxes. • We cannot quantify, (if any) health benefits of those in the homes of the participant that may have shared the boxes. • Our data does NOT account for confounding variables.
“Food d is c costly a and d we don't n't have f food s d stamps. T Thank nk you for t the f food. d. God B d Bless.” “It's g good d to be a able to have a and d eat fruits a and v d vegetabl bles a and s nd share w with h your g r grandc ndchi hildr dren. n. It was so e easy and m made a a huge d difference in o our d diets. Bot oth myself a and ou our s son on a are e dia iabetic ics and d it gave m me…be better opt ptions f for meals t that h helpe ped d get o our blood s d sugars u unde der c r control. …Tha hank nk y you v u very much f h for l letting us b be a a part o of this p program. I It made de a a HUGE differenc nce f for us a at a time w when life see eemed t to o be h e hitting u us f from om a all s ll sides. W We a e are s so g o grateful t to o you ou Ju Julie lie, and the en e entir ire staff for or a all y ll you our h help. B Bless Y You ou!” "My husbands cancer went into remission, although I am sure from treatment. "My husbands cancer went into remission, although I am sure from treatment. The e addi ddition of n of… good good f frui uits ts a and v d vegg ggies, s, c chang nged t the w way I cook ooked a and d helped h d him t to o feel good good du during ng t treatm tment. nt.“
Acknowledgements Community Memorial Foundation Northern Illinois Food Bank Julie Thomas RN Dr. Elizabeth Bockhold Hester Bury HFMC Front Desk Staff Sharon McNeil Adam Maycock Michael Murrill William Paul Hinsdale Hospital Kitchen Staff
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