Research
Most kids in the United States fall short on eating the recommended servings of fruits and vegetables each day. Rich in vitamins, minerals, and fiber, fruits and vegetables play a vital role in promoting healthy growth during childhood and reducing the risk of developing diseases such as type 2 diabetes and heart disease later in life.
The Fruit and Vegetable Prescription Program is designed to support children in meeting their nutritional needs and cultivating lifelong healthy eating habits. Our research has found that The Fruit and Vegetable Prescription Program is having a meaningful impact on diet, food security, and health outcomes for Flint children.
The Fruit and Vegetable Prescription Program is improving dietary patterns.
Our research has found that fruit and vegetable prescriptions help children to consume more daily servings of fruits and vegetables. Additionally, fruit and vegetable prescriptions encourage families to shop at the local farmers’ market , promote family bonding while food shopping, and give children agency to select their own foods.
The Fruit and Vegetable Prescription Program is improving food security.
After receiving fruit and vegetable prescriptions, our research has found that both child and household food security improves (more research here). Families also share that, with the cost of fruits and vegetables covered by prescriptions, they have more financial flexibility to purchase other foods or necessities for their children.
The Fruit and Vegetable Prescription Program is improving health outcomes.
Our research has found that children who receive fruit and vegetable prescriptions have healthier blood pressure compared to children who do not receive prescriptions. In addition, children in the program report higher levels of physical activity, suggesting that receiving prescriptions may encourage other healthy behaviors.
Flint Kids Cook Program Findings
Flint Kids Cook is designed to introduce children to a variety of culinary techniques, healthy foods, and nutrition education to guide them in preparing and eating nutritious food. Our research has found that Flint Kids Cook is improving cooking skills, nutrition knowledge, healthy food acceptance, and quality of life for Flint children.
Flint Kids Cook is improving cooking skills.
After learning different culinary skills from a professional chef, children who participate in Flint Kids Cook report improved cooking skills (more research here, here, and here) and have a greater desire to cook (more research here and here).
Flint Kids Cook is improving nutrition knowledge.
Our research has found that children have better knowledge of nutrition (more research here) after learning from a registered dietitian in Flint Kids Cook.
Flint Kids Cook is improving healthy food acceptance.
After cooking and tasting new foods, Flint Kids Cook participants are more accepting of healthy foods and have improved self-efficacy to consumes fruits and vegetables.
Flint Kids Cook is improving quality of life.
Our research has found that children have improved health-related quality of life, including physical health, emotional health, and social health, after completing Flint Kids Cook.
Flint Families Cook is improving family connectedness.
Our virtual, family-based cooking class provides families with a weekly activity to connect and spend quality time together.
Influence of a Prenatal Fruit and Vegetable Prescription Program on Diet and Household Food Security in a Low-Income, Urban Community
Recent Publications
Association between youth blood pressure and exposure to pediatric fruit and vegetable prescriptions
Caregiver-reported barriers to engagement in a pediatric fresh fruit and vegetable prescription program
Publications
Saxe-Custack A, LaChance J, Shipp G, Haggerty D. Influence of a Prenatal Fruit and Vegetable Prescription Program on Diet and Household Food Security in a Low-Income, Urban Community. Maternal and Child Health. 2025. DOI: doi.org/10.1007/s10995-025-04212-5
Saxe-Custack A, Todem D, LaChance J, Kerver J, Anthony J. Association between youth blood pressure and exposure to pediatric fruit and vegetable prescriptions. Pediatric Research. 2024;98:654–662. DOI: doi.org/10.1038/s41390-024-03671-w.
Saxe-Custack A, Egan S, Farmer B, Pulka K, Sampson A. Caregiver-reported barriers to engagement in a pediatric fresh fruit and vegetable prescription program. Journal of Nutritional Sciences. 2024;13:e33. DOI: doi.org/10.1017/jns.2024.33.
Saxe-Custack A, LaChance J, Kerver JM. A Fresh Fruit and Vegetable Prescription Program for Prenatal Patients in Flint, Michigan: Baseline Food Security and Dietary Intake. Nutrients. 2024;16(8):1234. DOI: doi.org/10.3390/nu16081234
Sadler RC, Saxe-Custack A. ‘Nobody shops at the neighborhood store’: leveraging a community’s pediatric fresh produce prescription program to inform future participating store redemption locations.Cities & Health. 2023;8(1):70-81. DOI: doi.org/10.1080/23748834.2023.2281764
Saxe-Custack A, Egan S, Sadler R, Wojciechowski T. Relative impacts of a virtual cooking and nutrition program for children and families. Appetite. 2023;191: 107041. DOI: doi.org/10.1016/j.appet.2023.107041
Saxe-Custack A, Todem D, Anthony J, Kerver J, LaChance J, Hanna-Attisha M. Effect of a pediatric fruit and vegetable prescription program on child dietary patterns, food security, and weight status: a study protocol. BMC Public Health. 2022;22(1):150. DOI: doi.org/10.1186/s12889-022-12544-y
Saxe-Custack A, Egan S. Flint Families Cook: A virtual cooking and nutrition program for families. Journal of Nutrition Education and Behavior. 2022;54:359-363. DOI: doi.org/10.1016/j.jneb.2022.01.002
Saxe-Custack A, Lofton H, Dawson C, Egan S, Hanna-Attisha M. “The shelves are bare”: The impact of COVID-19 on families enrolled in a pediatric produce prescription program. Cureus. 2022;14(11):e31540. DOI: doi.org/10.7759/cureus.31540
Saxe-Custack A, LaChance J, Hanna-Attisha M, Goldsworthy M, Ceja T. Household supplemental Nutrition Assistance Program participation is associated with higher fruit and vegetable consumption. Journal of Nutrition Education and Behavior. 2021. 53(12):P1060-1065. DOI: doi.org/10.1016/j.jneb.2021.06.017.
Saxe-Custack A, LaChance J, Jess J, Hanna-Attisha M. Influence of a pediatric fruit and vegetable prescription program on child dietary patterns and food security. Nutrients. 2021; 13(8):2619. DOI: doi.org/10.3390/nu13082619.
Saxe-Custack A, Goldsworthy M, Lofton HC, Hanna-Attisha M, Nweke O. Family perceptions of a cooking and nutrition program for low-income children and adolescents. Global Pediatric Health. 2021; DOI: doi.org/10.1177/2333794X21989525
Saxe-Custack A, LaChance J, Hanna-Attisha M, Dawson C. Flint Kids Cook: Positive influence of a farmers’ market cooking and nutrition programme on health-related quality of life of US children in a low-income, urban community. Public Health Nutrition. 2020;24(6):1492-1500. DOI: doi.org/10.1017/S136898002000395X
Saxe-Custack A, Sadler R, LaChance J, Hanna-Attisha M, Ceja T. Participation in a fruit and vegetable prescription program for pediatric patients is positively associated with farmers’ market shopping. International Journal of Environmental Research and Public Health. 2020; 17(12): E4202. DOI: doi.org/10.3390/ijerph17124202
Saxe-Custack A, LaChance J, Hanna-Attisha M. Child consumption of whole fruit and fruit juice following six months of exposure to a pediatric fruit and vegetable prescription program. Nutrients. 2020; 12(1):25. DOI: doi.org/10.3390/nu12010025
Saxe-Custack A, Lofton HC, Hanna-Attisha M, Tata Z, Ceja T, LaChance J. Caregiver experiences with an innovative farmers’ market incentive program for children in Flint, Michigan. Global Pediatric Health. 2019;6:2333794X19870989. DOI: https://doi.org/10.1177/2333794X19870989
Saxe-Custack A, Kerver JM, Mphwanthe G, Weatherspoon L. Participant experiences in a paraprofessional-led weight management program for children and families. Sage Open Medicine. 2019; 7:2050312119863920. DOI: https://doi.org/10.1177/2050312119863920
Saxe-Custack A, LaChance J, Hanna-Attisha M, Ceja T. Fruit and vegetable prescriptions for pediatric patients living in Flint, Michigan: A cross-sectional study of food security and dietary patterns at baseline. Nutrients. 2019; 11(6):1423. DOI: https://doi.org/10.3390/nu11061423
Saxe-Custack A, Hanna-Attisha M, Zvoch K. Fruit and vegetable prescriptions for pediatric patients in Flint, Michigan: Program development, methods, and baseline characteristics. Current Developments in Nutrition. 2019; 3(Suppl 1): NZZ051.FS02-05-19. DOI: https://doi.org/10.1093/cdn/nzz051.FS02-05-19
Saxe-Custack A, Lofton H, Hanna-Attisha M, Victor C, Reyes G, Ceja T, LaChance J. Caregiver perceptions of a fruit and vegetable prescription programme for low-income paediatric patients. Public Health Nutrition. 2018. 21(13):2497-2506. DOI: https://doi.org/10.1017/S1368980018000964
Saxe-Custack A, Weatherspoon L. A qualitative assessment of self-management priorities among persons with type 2 diabetes. Journal of Nutrition Education and Behavior. 2014; 46(4):S186. DOI: https://doi.org/10.1016/j.jneb.2014.04.283
Funded Research
Community Foundation of Greater Flint
05/01/2024 to 04/30/2025
Fresh Produce Prescriptions for Women and Children in Need
Although research has suggested that exposure to this FVPP among youth 8-18 years leads to improvements in dietary patterns, food security, and shopping behaviors, we have also documented challenges with program engagement — including limited redemption sites — that have worsened since the COVID-19 pandemic. The current proposal supports the cost of fruit and vegetable prescriptions at participating pediatric and OB/GYN clinics as the PPHI Nutrition Team partners with one major chain grocery store to expand redemption sites across Genesee County. Researchers will monitor trends in prescription distribution and redemption rates through 2024.
Hurley Foundation
01/01/2024 to 12/31/2024
Hurley Children’s Center Produce Prescription Program
With increasing evidence to support the benefits of the FVPP on dietary patterns, food security, food access, and shopping behaviors, the grant supports the cost of fresh produce prescriptions at Hurley Children’s Center as the program is expanded to include full-service grocery stores.
Stephanie and David Spina Family Foundation
01/01/2024 to 12/31/2024
Flint Kids Cook
Grounded in social cognitive theory, Flint Kids Cook focuses on improving self-efficacy for healthy cooking through interactive nutrition and food preparation activities. In January 2021, a virtual version of the program, entitled Flint Families Cook, was introduced. This grant supports continued implementation and evaluation of in-person Flint Kids Cook and Flint Kids Bake classes and virtual Flint Families Cook classes. Additionally, funds will be used to support the cost of fresh produce prescriptions at five medical clinics in Flint.
Centers for Disease Control and Prevention
09/01/2023 to 08/31/2028
Greater Flint Area REACH Project
The Greater Flint Area REACH Project is an implementation-ready project that leverages existing and emerging food system, breastfeeding continuum of care, and physical activity efforts to maximize REACH funding and close the gap to improve African American and Hispanic health in the Greater Flint Area. The pediatric fruit and vegetable prescription program is one key component of the REACH Project with resources supporting increased staffing to address challenges with program engagement as well as development and testing of digital prescriptions for ease of use among prescription program participants and vendors.
Michigan Health Endowment Fund
09/01/2023 to 08/31/2025
Improving Engagement in Produce Prescription Programs
To address important gaps in information and challenges with program engagement, the proposed project will: (1) examine the effectiveness of a prenatal fresh produce prescription programs with and without participation in Rx Kids (an unconditional cash incentive program from pregnant mothers in Flint); and (2) address prescription program engagement through redemption site expansion to full-service grocery stores.
Community Foundation of Greater Flint
06/01/2022 to 05/31/2024
Pediatric Produce Prescriptions for Health
With previous research demonstrating the effectiveness of pediatric fresh fruit and vegetable prescriptions among youth, the current proposal is a specific request for funding to support the cost of prescriptions through the Pediatric Public Health Initiative. Funding will support prescriptions at three pediatric clinics and two OB/GYN clinics that currently offer the program.
Michigan Health Endowment Fund
09/01/2021 to 06/30/2024
Expansion of Produce Prescriptions: A Prenatal Pilot
This project expands our evidence-based pediatric fruit and vegetable prescription program to the prenatal patients. This prenatal pilot program will start in one large Flint obstetric clinic, the Hurley Women’s Health Center, with the long-term goal of widespread adoption in Flint and beyond. The current grant also supports a study to assess program feasibility and preliminary effectiveness.
NIH-NICHD
09/01/2020 to 08/31/2024
R01 HD102527-01
Innovative Nutrition Practices in Pediatric Health Care: Assessment of a Fruit and Vegetable Prescription Program for Children in Need
The goal of the project is to assess the influence of pediatric fruit and vegetable prescription programs (FVPP) on food security, child dietary patterns, and weight status. We will compare demographically similar pediatric patient groups from three large urban clinics based on their exposure to a FVPP: high exposure (>24 months), moderate exposure (12-24 months), and no previous exposure. We will then introduce the FVPP to never exposed patients and compare changes in dietary intake, food security, and weight status. Results will provide novel knowledge regarding the role of FVPPs in addressing barriers to access and affordability of fresh produce.
