Transcript Garden on the Go Demonstration Study

Garden on the
Go
Demonstration
Study
Cynthia K. Lewis, MPH
Terrell W. Zollinger, DrPH, MSPH
Outline
 Background
 Purpose
 Methods
 Characteristics of participants
 Changes in clinical measures
 Other changes
 Conclusions
 Recommendations
Background
Background
 Recommendation is 5 servings or 4 ½ cups a day
 Lower blood pressure
 Reduce risk of heart disease, strokes, diabetes,
cancer, digestive diseases, etc.
 Weight control
 Builds strong bones
 Only ¼ of Indianapolis residents report eating
recommended amount of fruit and vegetables
 1/3 of Indianapolis residents are obese
Indianapolis Inner City
 Don’t have ready access to
fresh fruits and vegetables
 Don’t consume the amount
recommended
 Unhealthy meals/unhealthy
eating patterns
 Increased risk of poor health
 Increased need for medical
care
IU Health:
Garden on the Go
 Purpose: Increase access to
fresh fruit and vegetables in
targeted communities.
 Mobile produce delivery
program to make available
affordable fruit and
vegetables to those in
underserved neighborhoods.
 Green Bean Delivery is a
Partner
 25,000 transactions to-date
since May 2011
Produce Delivery Truck
Schedule
 Five days per week
 22 locations
 4 stops per day
 45 min to 1 hour at stop
 Year around schedule
 Indoor set-up
Purpose of
Demonstration
Study
Purpose
 Will Garden on the Go clients participate in a
longitudinal study?
 Can relevant data be gathered from clients in a
valid and reliable manner?
 Is there evidence that clients’ health measures
and food intake behavior may be improving as a
result of Garden on the Go?
Design and Methods
 Prospective interventional cohort study
 Collected baseline (March) measures with mid-point
(June) and final (September) measures
 IRB approved
 Recruited 120 subjects from 4 locations
 Measured:
 Dietary and lifestyle behaviors
 Clinical health screening
 Program participation
 Incentive given to participants ($20 gift card at baseline,
$30 at final)
Data Collection Methods
 Clinical screening at baseline and 6-month
follow-up
 Weight and height
 Blood pressure
 Hb A1c
 Surveys of behaviors and experiences at
baseline, mid-point, and 6-month follow-up
 Face-to-face interviews at baseline and final
 Telephone at mid-point
Data Analysis
 Compared mid-point to baseline
 Compared final to baseline
 Used paired statistical testing
 McNemar test for categorical measures
 Paired t-tests for continuous measures
 P-values less than 0.05 were considered
significant
 SPSS and Microstat used
Participants
 70% Females
 58% Black/African American
 56% Age 55 or older
 Only adult in the household
 No children at home
 42% on Supplemental
Nutrition Assistance Program
(SNAP)
Diagnosed Chronic Disease
Prevalence
70%
63%
60%
50%
43%
40%
37%
36%
Baseline
32%
30%
Marion County
20%
11%
10%
0%
Diabetes
High Blood Pressure
High Cholesterol
Chronic Disease Burden
 36% with diagnosed diabetes (11% in general population)
 Of those, 86% on medication
 Of those, 65% taking medication regularly
 Of those diagnosed, only 56% were always taking medication
 63% with diagnosed hypertension (32% in general population
 Of those, 83% on medication
 Of those, 75% taking medication regularly
 Of those diagnosed, only 62% were always taking medication
 43% diagnosed with dyslipidemia (37% in general population)
 Of those, 71% on medication
 Of those, 73% taking medication regularly
 Of those diagnosed, only 62% were always taking medication
Risky Behaviors and Factors
95%
100%
90%
76%
80%
70%
60%
60%
50%
Baseline
42%
40%
30%
32%
24%
20%
10%
0%
Tobacco Use
Consume less than 5
servings of fruits and
vegetables per day
Obese
Marion
County
Use of Garden on the Go
 63% were previous users
 Bought food from program 3.1 times/month on
average
 Purchased 5 different items each time on
average – typically both fruit and vegetables
 Purchased fruit and vegetables 2.5 times/month
at other locations
 Garden on the Go significantly (70%) or
somewhat (20%) increased their access to fresh
fruit and vegetables
Changes in Clinical
Measures
Changes in BMI
 Percent of participants who were considered
obese at Baseline did not change at the Final
 Three participants who were obese at Baseline
were considered overweight at the Final
Obese at Baseline
Overweight At Final
Number
Percent
Number
Percent
47
63.5%
3
6.4%
Normal or Overweight at
Baseline
Obese At Final
Number
Percent
Number
Percent
27
36.5%
3
11.1%
Changes in Hb A1c
 Percent of participants who had high Hb A1c levels at Baseline
did not change at the Final
 One participant who was in the “high” group at Baseline
was in the “not high” at the Final
High Hb A1c at Baseline
Not High At Final
Number
Percent
Number
Percent
18
24.0
1
5.6
Not High Baseline
High At Final
Number
Percent
Number
Percent
56
74.7
2
3.6
Changes in Blood Pressure
 Percent of participants who had high blood pressure levels at
baseline did not change at the Final
 Ten participants who were in the “high” group at Baseline
were in the “not high” at the Final
High at Baseline
Normal At Final
Number
Percent
Number
Percent
33
44.0
10
30.3
Not High Baseline
High At Final
Number
Percent
Number
Percent
42
56.0
8
19.0
Changes in Health
Status
Changes in Perceived
Health Status
20%
18%
18%
16%
14%
12%
10%
8%
8%
8%
Baseline
Final
6%
4%
3%
2%
0%
Excellent
Very good
N=79 pairs
Changes in Exercise
Changes in Exercise
Frequency
40%
34%
35%
31%
30%
25%
20%
22%
18%
Baseline
15%
Final
10%
5%
0%
Always
Most weeks
N=78 pairs
Changes in Eating
Behavior and Food
Intake
Change in Fruit and
Vegetable Consumption
14%
13%
12%
10%
8%
8%
Baseline
6%
4%
Final
2%
0%
5 or more servings per day
N=79 pairs
Changes in High Fat Food
Consumption
35%
30%
30%
25%
25%
20%
20%
21%
Baseline
15%
10%
Final
5%
0%
Every day
Most days
N=79 pairs
Changes in Fast Food
Consumption
40%
34%
35%
30%
30%
25%
Baseline
20%
15%
10%
Final
7%
4%
5%
0%
Daily
Weekly
N=76 pairs
Change in Eating Meals
Prepared at Home
80%
76%
70%
63%
60%
50%
40%
Baseline
30%
Final
20%
10%
0%
Daily
N=79 pairs
Change in Eating Meals
while Watching TV
45%
42%
41%
40%
35%
30%
Baseline
25%
20%
Final
15%
10%
5%
0%
Every time
N=79 pairs
Change in Purchasing Fresh
Fruit at Other Places
50%
47%
45%
39%
40%
35%
33%
32%
30%
25%
Baseline
20%
15%
Final
10%
5%
0%
Every time
Sometimes
N=75 pairs
Change in Purchasing Fresh
Vegetables at Other Places
50%
47%
45%
40%
35%
37%
33%
31%
30%
Baseline
25%
20%
Final
15%
10%
5%
0%
Every time
Sometimes
N=79 pairs
Other impact of Garden on the
Go
 Clients get recipes
 Opportunity for friends and
family to socialize
 Clients often walked to site
 Those at high risk or who
need health care are
referred to places where
they can get services
Study Limitations
 Small size of cohort
 One-third were lost-to-follow-up over 6 months
 55% were able to be interviewed by phone
 Self-reported behaviors
 Time frame may be too short to expect clinical
impact
 Not a true baseline
Conclusions
 Clients are at high risk of poor health and could
benefit from continuation of the program
 Purpose of study was achieved:
 Garden on the Go clients were willing to participate
in the study
 Key clinical, behavioral, and experience data could
be collected
 Some evidence that health status and behaviors
may be improving
Recommendations for
Program
 Promote the benefits of increasing fruit and
vegetable consumption
 Ensure that purchased fresh fruit and vegetables
are prepared in a healthful manner and served in
attractive way
 Continue to refer Garden on the Go clients to
health services to address other health problems
Recommendations for
Further Study
 Conduct a larger scale study
 Include new customers only
 Include a longer follow up
 Limit use of telephone surveys
 Develop a robust method to track subjects