Navigating hypertension and food insecurity: a produce prescription program to improve health outcomes for native hawaiian and pacific islander communities

The University of Hawaii at Manoa received a $2.83 million Project Grant awarded September 1, 2025, through the National Institute on Minority Health and Health Disparities (NIMHD) under the Minority Health and Health Disparities Research program (CFDA 93.307). The project, "Navigating Hypertension and Food Insecurity: A Produce Prescription Program to Improve Health Outcomes for Native Hawaiian and Pacific Islander Communities," addresses the disproportionately high prevalence of hypertension among Native Hawaiian and Pacific Islander (NHPI) adults and the elevated food insecurity rates within these communities—approximately four times higher than among White populations. The intervention combines produce prescription programming with community health worker (CHW) navigation to increase access to fresh fruits and vegetables, thereby improving dietary quality and reducing blood pressure among food-insecure NHPI individuals with hypertension.

The research initiative, spanning from September 1, 2025, through June 30, 2029, pursues three primary objectives: identifying existing systems impacting produce prescription program implementation and outcomes; examining the impact of CHW-navigated produce prescriptions compared to programs without CHWs on participant blood pressure; and quantifying the cost-effectiveness of the intervention. The program was developed through a community-academic partnership involving university researchers, community partners, and healthcare providers at the Waianae Coast Comprehensive Health Center (WCCHC), which serves as a sub-awardee. WCCHC, a federally qualified health center serving 35,217 patients annually in West Oahu with 73 percent identifying as Native Hawaiian or Pacific Islander, provides the clinical infrastructure and community engagement necessary to implement this multilevel intervention addressing behavioral, environmental, and healthcare system factors.

Abstract

Over half of native hawaiian and pacific islander (NHPI) adults are diagnosed with hypertension (HTN), which is the strongest, modifiable risk factor for cardiovascular disease (CVD), the leading cause of death for NHPI. HTN risk is influenced by a myriad of factors, including diet, activity level, but also economic factors such as food insecurity. Nhpis are at 4 times greater risk of food insecurity when compared with whites. Following a healthy eating pattern is considered the gold standard for reducing cardiometabolic disease mortality, all individuals, but especially those with HTN, are recommended to consume at least 5 servings of FV daily. Alleviating food insecurity may be an effective strategy to improve FV consumption to reduce blood pressure (BP) among nhpis with HTN but will require intervention at multiple domains (behavioral, personal environment, health care system) and levels (individual, interpersonal, community, societal). Produce prescription programs increase individuals' access to fresh FV, and are promising strategies to improve diet quality and reduce chronic disease risk among food insecure populations. The long-term objective of this research is to reduce nutrition-related health conditions via clinical-community based programming. This produce prescription (PRX) program was developed and implemented by enlisting university and community researchers and health care providers at the waianae coast comprehensive health center (WCCHC). The current study builds on the community-academic partnership to achieve the following specific aims 1: identify existing systems that impact PRX implementation and impact; 2: examine the impact of the CHW navigated PRX, in comparison to a program without chws, on participant BP; 3: quantify the cost and cost-effectiveness of the PRX intervention. A community based participatory research approach to carry out a randomized controlled trial that measures the effect of the PRX on BP, diet, and food insecurity on 250 participants from 3 federally qualified health centers will be conducted. This research will generate robust evidence on effective strategies to reduce food insecurity and HTN, informing targeted interventions and improving health outcomes.