Cress Lab and Resource PlatformRECENT COMPLETED RESEARCH
My lab has completed work with community partners that use food and food education to reduce the risk of chronic diseases, specifically in communities that face significant barriers to health. Consistent with the goals of community based participatory research, these projects are aimed to help the community residents, and to inform policy around questions of health disparities and food access. Here are several examples of the work we have done.
These projects were all done with my PhD student at the time, Jeneen Ali, PhD. Jeneen is now a Research Area Specialist Intermediate/Project Coordinator at the University of Michigan, and Adjunct Lecturer, University of Michigan, School of Public Health.
Fresh Rx: A food prescription program in Detroit. This “Food as Medicine” program was one of the first in the country to pilot the idea of a food prescription program, spearheaded by the CHASS center in Southwest Detroit. The program built partnerships between local food providers, the healthcare system, and low-income patients in Detroit. Patients at risk for chronic disease were given prescriptions by their physicians, and were allowed to fill these prescriptions at partnering farm stands or farm markets where they also received nutrition counseling, cooking demonstrations, and support for making healthy lifestyle changes.
Our role was to provide nutrition counseling, and to develop, administer and analyze surveys to assess program outcomes. It has become the model for food prescriptions across the country. Among other successes, this pilot study found that:
- 71 percent of participants reported being better able to manage their health conditions after participating in the program.
- Over $8,200 was spent on fresh, local produce through the Fresh Prescription program, helping to build the local food system in Detroit.
- 44 percent of participants reported a decrease in the number of times they consumed unhealthy foods during an average week, while 85 percent of participants reported eating more fruits and vegetables.
Cooking Matters: Diabetes Prevention Program (CM:DPP) Pilot Study: This study was a research partnership between Gleaners Community Food Bank, National Kidney Foundation of Michigan (NKFM), and Wayne State University. The Diabetes Prevention Program (DPP) is an effective community-based intervention known to reduce progression to diabetes in at-risk individuals. However, program completion rates are low in low-income communities. Cooking Matters (CM), a program developed by Share Our Strength, teaches healthy meal preparation, food resource management, and nutrition. We hypothesized that by combining DPP and Cooking Matters curricula, more participants would complete the program, have a better appreciation of healthy cooking methods, and experience lower HbA1C values as a result. This pilot study indicated improved program participation with the hands-on model of education, and spurred the HI:DPP project.
Health Impact: Diabetes Prevention Program (HI:DPP) study: HI:DPP was a partnership between Gleaners Community Food Bank, the National Kidney Foundation of Michigan, and Wayne State University that is a follow-up to the CM:DPP Pilot Study, described above.
In both the pilot study and the follow-up study we found that program completion was dramatically better than national averages for the Diabetes Prevention Program, a 12-month intervention program. Major study outcomes were weight and glycosylated hemoglobin levels (HbA1c, a measure of diabetes risk). Our study showed significant improvements in both measures as compared to the usual treatment of DPP alone. We concluded that the addition of hands-on cooking and nutrition education around resource management was effective at improving health and managing chronic health risks in these populations.
Here is a sampling of our findings:
- Attendance: the primary outcome objective.
- In standard programing, on average 14 sessions are attended with a 43 % completion rate.
- We saw on average 27 sessions attended, with a 100% completion rate
- Weight: managing weight is a treatment objective in preventing progression from prediabetes to diabetes
- In standard programing, 35% of participants meet the weight loss goal, with an average weight loss of 4.2%
- We found that 69.5% of participants met the weight loss goal, with an average weight loss of 7.2%.
- HbA1c data: This is a measure that indicates whether an individual is prediabetic, diabetic, or normoglycemic. All participants were selected based on the presence of prediabetes.
- There is no data on HbA1c in standard programming, because that data is not collected.
- A unique feature of our study was the collection of blood samples to analyze HbA1c, and we found that every participant lowered their HbA1c level.
- In addition to reducing levels, 77% of the participants lowered their HbA1c into the normoglycemic range.
In addition to the specific findings of this project, this work demonstrated that there are unique ways to work with community partners and utilize community resources to improve health outcomes in under-served communities. This emphasizes the need to be creative with the resources at hand to reduce barriers to good health.
The Healthy Table (Le Mesa Saludable): The goal of this project was to understand how improved food security might improve health outcomes in vulnerable patient populations. Research has demonstrated that food insecurity results in poor health outcomes, however, little research has explored the inverse. Thus, this project was designed to help determine whether improving food security by providing access to healthy food and nutrition education could positively impact health outcomes for patients. Patients in this study were selected based on a high BMI and uncontrolled diabetes. Unlike the first two studies, this study utilized a clinic-based approach to reaching participants. Survey data indicated positive impacts of this intervention, but COVID shutdowns in community research stopped this study ahead of schedule.