"I don't have to choose between everything": Self-reported fruit and vegetable affordability, purchasing shifts, and healthcare utilization among produce prescription program participants in North Carolina.

Objective. Examine self-reported fruit and vegetable affordability, purchasing shifts, and healthcare utilization among produce prescription program participants in North Carolina, US. Methods. We conducted cross-sectional online surveys in September-October 2022 and July 2023 among participants in two produce prescription programs (total n = 726) in North Carolina, US. We report descriptive statistics for whether participants could afford fruits, vegetables, and other items, and use bivariate regression models to explore if these vary by demographic characteristics and food insecurity risk. We additionally describe the non-fruit-and-vegetable items participants purchased. Results. One-quarter (27.3%) of participants reported being able to afford fruits and vegetables before participating whereas 91.2% reported being able to afford them while participating. Over half (59.2%) of participants reported that they were able to reallocate personal funds to purchase other items (e.g., meat/proteins, staple foods, dairy, household supplies) and could thus support their families and children. Fewer participants reported shopping at mass merchandisers (-15.5%-point), dollar stores (-8.3%-point), and warehouse club stores (-6.5%-point) while participating, and over one-third (38.9%) of participants were more likely to go to their healthcare provider. Conclusions. Produce prescription programs in North Carolina improve self-reported affordability and access to health-promoting foods, support household needs, and enhance healthcare utilization.