Jenna M. Bacolor, MPH, MSW Lily Guzmán, MPH, MSW

Washtenaw County Public Health

Why Prescription for Health? Downtown Ypsilanti Farmers’ Market Clinic process 2008 program results Plans for 2009

Patients

Health Clinics

Farmers’ Market

High food insecurity Low consumption of fruits and vegetables New farmers’ market with lots of energy

and partnerships Already programs for low income customers Clinics giving nutrition advice, but… Sense that clinics may not be connected to

local sources of healthy food

City of Ypsilanti

Supermarket

Grocery

Farmers’ market

Specialty grocery

Pharmacy

Convenience-snack

Convenience-alcohol

City of Ypsilanti

• Started in 2006 in response to community food assessment results

• Management• Programs for low-

income customers• Funding from multiple

sources• Marketing &

community events

Primary: increased community awareness and use of farmers’ market

Increased awareness of and utilization of Food Stamps/EBT at market

Increased consumption of fruits and vegetables

Long term…decreased chronic disease risk

Consulted with staff from four clinics: ◦ St. Joseph Mercy Health System - Neighborhood Health Clinic◦ University of Michigan Health System - Ypsilanti Health

Center◦ The Corner Health Center◦ Hope Clinic

Doctor-patient relationship as starting point Grant funding from Ypsilanti Beyer Memorial

Health Foundation paid for tokens; clinics also contributed cash match

Public health provided orientation

Clinics “prescribed” patients PFH packet:◦ $5 in tokens◦ program brochure◦ recipe card◦ pre-program questionnaire

Posters for waiting rooms

Key Findings

Token use at market tracked weekly Pre-program questionnaire completed by

all participants Post-program telephone survey

completed by ~30% of participants Post-program semi-structured interviews

conducted with lead staff at each clinic

344 patients participated◦ 79% female◦ 50% African American, 45% white, 5% Latino◦ Average age: 40◦ 71% less than $15,000 yearly income◦ 49% currently use Food Stamps◦ 2 fruit and 1.9 vegetable servings consumed

on a typical day◦ 80% had not shopped at farmers’ market

before

41% of tokens prescribed were redeemed, resulting in almost $1,500 additional market sales from PFH tokens

Tokens were redeemed June-October By clinic, redemption ranged from 30% to

49%

36%

10%33%

9%12%

"At the clinic, who recommended this program to you?"

Doctor

Social Worker

Front office

Other

Program material

Asked on post-test: 103 respondents

75% of participants became repeat farmers’ market shoppers in 2008

50% of participants spent additional money at the market◦ 95% bought additional produce

51%41%

2%6%

"Next year, how likely are you to shop at the farmers' market on a regular basis?"

Very likely

Somewhat likely

Somewhat unlikely

Very unlikely

Asked on post-test: 103 respondents

Overall, 70% of participants lived in Ypsilanti zip codes

Residency varied by clinic

Where patients lived was associated with token use

Home zip code

All tokens redeemed

No tokens redeemed

Ypsilanti Zips

66% 25%

All other 50% 40%

45

27.5

7.55

2.5 2.5

17.5

05

101520253035404550

Percent

"Why didn't you use the tokens?"

Hard to get to market

Market not at good time/dayPoor selection

Cost

Not worth effort

Hard to carry food

Other

Note: Respondents could choose as many answers as they wanted, thus results total more than 100%.

$355 $462

$2,757

$870

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

EBT Sales

EBT Sales 2006-2009

2006

2007

2008

2009

High percentage of patients eligible for food stamps, but only 49% reported receiving them

44% aware of EBT at market Post-test respondents reported increased

consumption of fruits and vegetables, even if they hadn’t redeemed tokens

It appeared that receiving more than one packet increased token redemption

Materials had mixed impact: posters in waiting room were effective; brochures may not have been

Fit with clinic mission: “one stop shopping,” consider “whole person”

Program complemented medical advice Very satisfied with program, but wanted to

increase redemption

Patients residence in 48197 or 48198

Receiving multiple packets

Prescribing earlier in the market season and ending in September

Displaying promotional flyers in waiting room

Expanded to five clinics! Extra coupon on 3 special days – additional

incentive to use tokens – get redemption up Evaluation Repeating EBT message Michigan Department of Community Health

is our funder

Our dedicated graduate student interns: Carissa Williams, UM School of Social Work

and & School of Public Health Leslie Paulson, UM School of Social Work Sarah Freedman, UM School of Social Work

Jenna M. Bacolor, MPH, MSW◦ 734-544-2969◦ bacolorj@ewashtenaw.org

Lily Guzmán, MPH, MSW◦ 734-544-2983◦ guzmanL@ewashtenaw.org