2009 FSEP Conference

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