Abstract
Objective
To carry out a pilot study to determine whether a supermarket double-dollar fruit
and vegetable (F&V) incentive increases F&V purchases among low-income families.
Design
Randomized controlled design. Purchases were tracked using a loyalty card that provided
participants with a 5% discount on all purchases during a 3-month baseline period
followed by the 4-month intervention.
Setting
A supermarket in a low-income rural Maine community.
Participants
A total of 401 low-income and Supplemental Nutrition Assistance Program (SNAP) supermarket customers.
Intervention
Same-day coupon at checkout for half-off eligible fresh, frozen, or canned F&V over
4 months.
Main Outcome Measure
Weekly spending in dollars on eligible F&V.
Analysis
A linear model with random intercepts accounted for repeated transactions by individuals
to estimate change in F&V spending per week from baseline to intervention. Secondary
analyses examined changes among SNAP-eligible participants.
Results
Coupons were redeemed among 53% of eligible baskets. Total weekly F&V spending increased
in the intervention arm compared with control ($1.83; 95% confidence interval [CI],
$0.29 to $3.88). The largest increase was for fresh F&V ($1.97; 95% CI, $0.49 to $3.44).
Secondary analyses revealed greater increases in F&V spending among SNAP-eligible
participants who redeemed coupons ($5.14; 95% CI, $1.93 to $8.34) than among non–SNAP
eligible participants who redeemed coupons ($3.88; 95% CI, $1.67 to $6.08).
Conclusions and Implications
A double-dollar pricing incentive increased F&V spending in a low-income community
despite the moderate uptake of the coupon redemption. Customers who were eligible
for SNAP saw the greatest F&V spending increases. Financial incentives for F&V are
an effective strategy for food assistance programs to increase healthy purchases and
improve dietary intake in low-income families.
Key Words
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References
- Birch L.L. Parker L. Burns A. Early Childhood Obesity Prevention Policies Committee on Obesity Prevention Policies for Young Children. National Academies Press, Washington, DC2011
- Relationship between the home environment and fruit and vegetable consumption in children aged 6–12 years: a systematic review.Public Health Nutr. 2017; 20: 464-480
- Children's daily fruit and vegetable intake: associations with maternal intake and child weight status.J Nutr Educ Behav. 2011; 43: 396-400
- Food spending behaviors and perceptions are associated with fruit and vegetable intake among parents and their preadolescent children.J Nutr Educ Behav. 2007; 39: 26-30
- Home environmental determinants of children's fruit and vegetable consumption across different SES backgrounds.Pediatr Obes. 2015; 10: 134-140
- Higher food prices may threaten food security status among American low-income households with children.J Nutr. 2013; 143 (12): 1659-1665
- Low-income households' expenditures on fruits and vegetables.(US Department of Agriculture, Economic Research Service, Agricultural Economic Report 833)http://ageconsearch.umn.edu/bitstream/34041/1/ae040833.pdfDate accessed: October 16, 2017
- Supplemental Nutrition Assistance Program (SNAP.http://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program-snapDate: 2017Date accessed: October 16, 2017
- Associations of food stamp participation with dietary quality and obesity in children.Pediatrics. 2013; 131: 463-472
- Is participation in food and income assistance programmes associated with obesity in California adults? Results from a state-wide survey.Public Health Nutr. 2010; 14: 645-652
- Diet Quality of Americans by Food Stamp Participation Status: Data From the National Health and Nutrition Examination Survey, 1999–2004.US Dept of Agriculture, Food and Nutrition Service, Office of Research, Nutrition and Analysis, Alexandria, VA2008
- Low-income Supplemental Nutrition Assistance Program participation is related to adiposity and metabolic risk factors.Am J Clin Nutr. 2012; 95: 17-24
- Using the food stamp program and other methods to promote healthy diets for low-income consumers.Am J Public Health. 2010; 100: 1562-1564
- Dietary intake and dietary quality of low-income adults in the Supplemental Nutrition Assistance Program.Am J Clin Nutr. 2012; 96: 977-988
- Foods Typically Purchased by Supplemental Nutrition Assistance Program (SNAP) Households.https://fns-prod.azureedge.net/sites/default/files/ops/SNAPFoodsTypicallyPurchased.pdfDate: 2016Date accessed: October 16, 2017
- Transactions at a Northeastern supermarket chain: differences by Supplemental Nutrition Assistance Program use.Am J Prev Med. 2017; 53: e131-e138
- Focus Group Report Relating to Education Programs and Messaging for the Maine SNAP-Ed program. Pan Atlantic SMS Group for Ethos Marketing and the University of New England SNAP-Ed Program, Portland, ME2014
- Diffusion of Innovations.Free Press, New York, NY2003
- Financial incentive-based approaches for weight loss: a randomized trial.JAMA. 2008; 300: 2631-2637
- Effects of subsidies and prohibitions on nutrition in a food benefit program: a randomized clinical trial.JAMA Intern Med. 2016; 176: 1610-1618
- Incentive and restriction in combination—Make food assistance healthier with carrots and sticks.JAMA Intern Med. 2016; 176: 1619-1620
- Farmers markets: consumer trends, preferences and characteristics.J Extension. 2002; 40
- Enhancing food security of low-income consumers: an investigation of financial incentives for use at farmers markets.Food Policy. 2015; 52: 64-70
- Systematic review of factors influencing farmers' market use overall and among low-income populations.J Acad Nutr Diet. 2016; 116: 1136-1155
- The prospective impact of food pricing on diet: a systematic review and meta analysis.PLoS ONE. 2017; 12 (e0172277)
- Office of Research and Analysis.(Healthy Incentives Pilot (HIP) Early Implementation Report)http://www.fns.usda.gov/research-and-analysisDate accessed: October 16, 2017
- Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments.Public Health Nutr. 2013; 16: 1215-1228
- Most U.S. households do their main grocery shopping at supermarkets and supercenters regardless of income.
- Where households get food in a typical week: findings from USDA's FoodAPS. EIB-156.(US Dept of Agriculture, Economic Research Service)https://www.ers.usda.gov/webdocs/publications/80542/eib-156.pdf?v=42663Date: 2016Date accessed: October 16, 2017
- SNAP to Health: A Fresh Approach to Improving Nutrition in the Nutrition Assistance Program.(Washington, DC)https://www.snaptohealth.org/wp-content/uploads/2012/10/CSPC-SNAP-Report.pdfDate: 2012Date accessed: October 16, 2017
- Supplemental Nutrition Assistance Program State Activity Report fiscal year.http://www.fns.usda.gov/sites/default/files/snap/2015-State-Activity-Report.pdfDate: 2015Date accessed: October 16, 2017
- SNAP to Health: A Fresh Approach to Improving Nutrition in the Supplemental Nutrition Assistance Program.https://www.snaptohealth.org/wp-content/uploads/2012/10/CSPC-SNAP-Report.pdfDate: 2012Date accessed: October 16, 2017
- The State of Obesity: Maine Press Release.http://healthyamericans.org/reports/stateofobesity2015/release.php?stateid=MEDate: 2015Date accessed: October 16, 2017
- The Grocery Gap: Who Has Access to Healthy Food and Why It Matters.http://thefoodtrust.org/uploads/media_items/grocerygap.original.pdfDate: 2010Date accessed: October 16, 2017
- Patterns of fruit and vegetable availability and price competitiveness across four seasons are different in local food outlets and supermarkets.Public Health Nutr. 2015; 18: 2846-2854
- Local food prices and their associations with children's weight and food security.Pediatrics. 2014; 133: 422-430
- Guiding Stars: the effect of a nutrition navigation program on consumer purchases at the supermarket.Am J Clin Nutr. 2010; 91: 1090S-1094S
- Development and implementation of the guiding stars nutrition guidance program.Am J Health Promot. 2011; 26: e55-e63
- Protection of human subjects.(45 CFR 46)http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm(Revised November 13, 2001; Effective December 13, 2001)Date accessed: October 20, 2017
- Personalization or scale? Now, you don't have to choose.www.catalina.com(St. Petersburg, FL)Date accessed: February 13, 2018
- Using mirrors and social norms to improve fruit and vegetable purchases in grocery stores.https://une.idm.oclc.org/login?url=https://search.proquest.com/docview/1845974714?accountid=12756Date: 2016Date accessed: October 16, 2017
- This way to produce: strategic use of arrows on grocery floors facilitate produce spending without increasing shopper budgets.J Nutr Educ Behav. 2016; 48: 512-513
- Supermarket and grocery store–based interventions to promote healthful food choices and eating practices: a systematic review.Prev Chronic Dis. 2013; 10 ([Erratum appears in Prev Chronic Dis. 2014;11.]; 120156): 120156
Article info
Publication history
Published online: November 07, 2017
Accepted:
September 21,
2017
Footnotes
Conflict of Interest Disclosure: The authors' conflict of interest disclosures can be found onlinewith this article on www.jneb.org.
Identification
Copyright
© 2017 Society for Nutrition Education and Behavior. Published by Elsevier, Inc. All rights reserved.
ScienceDirect
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- CorrigendumJournal of Nutrition Education and BehaviorVol. 52Issue 8
- PreviewThe March 2018 issue of the Journal of Nutrition Education and Behavior carried a Research Article titled “A Supermarket Double-Dollar Incentive Program Increases Purchases of Fresh Fruits and Vegetables Among Low-Income Families With Children: The Healthy Double Study” (J Nutr Educ Behav. 2018;50(3):217-228; https://doi.org/10.1016/j.jneb.2017.09.013 ). Due to a systematic error in the research team's sales database, the reported sales from quantity and price for some items were miscalculated. These errors do not affect the interpretation of results or conclusions, but changes the values reported in the Results and Discussion sections of the article.
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