The Prescription for Health program provided $5 tokens to low-income patients at local health clinics to redeem for produce at the Downtown Ypsilanti Farmers' Market. In 2008, 344 patients participated, with 41% redeeming tokens. The program increased market awareness and produce consumption. For 2009, the program expanded to more clinics and added incentives to boost token redemption rates. Evaluation found the program complemented clinics' missions by promoting nutrition.

1. Jenna M. Bacolor, MPH, MSW
Lily Guzmán, MPH, MSW
Washtenaw County Public Health

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

3. Patients
Farmers’ Market
Health Clinics

4.  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

5. City of
Ypsilanti
Supermarket
Grocery
Farmers’ market
Specialty grocery
Pharmacy
Convenience-snack
Convenience-alcohol
City of Ypsilanti

6. • Started in 2006 in
response to community
food assessment
results
• Management
• Programs for low-
income customers
• Funding from multiple
sources
• Marketing &
community events

7.  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

8.  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

9.  Public health provided
orientation
 Clinics “prescribed”
patients PFH packet:
◦ $5 in tokens
◦ program brochure
◦ recipe card
◦ pre-program questionnaire
 Posters for waiting
rooms

11. Key Findings

12.  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

13.  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

14.  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%

15. "At the clinic, who recommended this program to you?"
12%
9% 36%
Doctor
Social Worker
Front office
33% Other
10%
Program material
Asked on post-test: 103 respondents

16.  75% of participants became repeat farmers’
market shoppers in 2008
 50% of participants spent additional money at
the market
◦ 95% bought additional produce

17. "Next year, how likely are you to shop at the farmers'
market on a regular basis?"
2%
6%
Very likely
51%
41% Somewhat likely
Somewhat unlikely
Very unlikely
Asked on post-test: 103 respondents

18.  Overall, 70% of
participants lived in
Home All No tokens
Ypsilanti zip codes
zip tokens redeemed
 Residency varied by code
Ypsilanti
redeeme
66% 25%
d
clinic Zips
 Where patients lived All other 50% 40%
was associated with
token use

19. "Why didn't you use the tokens?"
50
45 Hard to get to market
45
40 Market not at good
35 time/day
Poor selection
30 27.5
25 Cost
20 17.5
Not worth effort
15
10 7.5 Hard to carry food
5
5 2.5 2.5
Other
0
Percent
Note: Respondents could choose as many answers as they wanted, thus results total more than 100%.

20. EBT Sales 2006-2009
$3,000 $2,757
$2,500
$2,000 2006
$1,500 2007
$1,000 $870 2008
$355 $462 2009
$500
$0
EBT Sales

21.  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

22.  Fit with clinic mission: “one stop shopping,”
consider “whole person”
 Program complemented medical advice
 Very satisfied with program, but wanted to
increase redemption

24.  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

26.  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

27. 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

28.  Jenna M. Bacolor, MPH, MSW
◦ 734-544-2969
◦ bacolorj@ewashtenaw.org
 Lily Guzmán, MPH, MSW
◦ 734-544-2983
◦ guzmanL@ewashtenaw.org