Few Americans meet national recommendations for fruit and vegetable (FV) consumption, and the high price of fresh produce is a commonly cited barrier.
We conducted a randomized controlled trial to determine if a same-day, two-for-one FV coupon (Double Bucks) combined with a point-of-purchase nutrition education program (Cooking Matters) would increase FV purchases and consumption among low-income families who were regular customers of a rural Maine supermarket.
We randomized 605 parents who regularly shopped at a Maine supermarket to a six-month intervention (Double Bucks on FV up to $10/day plus Cooking Matters) or a control arm. All participants were given a study loyalty card, which provided a 5% discount on groceries and tracked purchases during the three-month baseline and six-month intervention periods. The primary outcome was change in weekly spending on FV from baseline to follow-up in intervention and control groups. We also compared changes from baseline to follow-up in daily servings of FV among parents and children using a 135-item food frequency questionnaire. A baseline survey asked about the household's participation in the Supplemental Nutrition Assistance Program (SNAP), income, and food insecurity. Subgroup analyses compared intervention effects by SNAP participation.
At baseline, half of participants reported food insecurity. Overall, 52% were income-eligible for SNAP, and 32% participated in SNAP. Cooking Matters participation was low (11%). Compared to control, the intervention group increased weekly spending on FV by 23% ($2.23, 95% CI = $1.00, $3.46); among SNAP participants, the intervention group increased weekly spending by 43% ($2.17, 95% CI = $0.84, $3.50). Preliminary analyses revealed no overall change in FV consumption among parents or children.
Conclusions and Implications
Supermarket financial incentives increase household purchases of FV among SNAP and non-SNAP participants, with no evidence of increased spending on other, unhealthful foods and beverages.