Alicia J Cohen1, Caroline R Richardson2, Michele Heisler3, Ananda Sen4, Ellen C Murphy5, Oran B Hesterman6, Matthew M Davis7, Suzanna M Zick4. 1. Robert Wood Johnson Foundation Clinical Scholars program, University of Michigan, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan. Electronic address: calicia@umich.edu. 2. Robert Wood Johnson Foundation Clinical Scholars program, University of Michigan, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan. 3. Robert Wood Johnson Foundation Clinical Scholars program, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; School of Public Health, University of Michigan, Ann Arbor, Michigan. 4. Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; School of Public Health, University of Michigan, Ann Arbor, Michigan. 5. Wayne State University School of Medicine, Detroit, Michigan. 6. Fair Food Network, Ann Arbor, Michigan. 7. Division of Academic General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois; Mary Ann and J. Milburn Smith Child Health Research Program, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois; Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois.
Abstract
INTRODUCTION: Diet-related disease is disproportionately concentrated in low-income communities where fruit and vegetable consumption is far below guidelines. To address financial barriers, Double Up Food Bucks (DUFB)-a statewide healthy food incentive-matches Supplemental Nutrition Assistance Program (SNAP) funds spent at farmers markets. However, incentive use is limited. This study examined the impact of a brief waiting room-based intervention about DUFB on program utilization and produce consumption. STUDY DESIGN: Longitudinal, repeated measures, quasi-experimental trial. SETTING/PARTICIPANTS: SNAP-enrolled adults at a health center in a low-income, racially and ethnically diverse area of Southeast Michigan. INTERVENTION: Participants received a brief explanation of DUFB, written program materials, a map highlighting market locations and hours, and an initial $10 market voucher. DUFB use and produce consumption were measured through four surveys over 5 months (August 2014-January 2015). MAIN OUTCOME MEASURES: Outcome measures included DUFB use and fruit and vegetable consumption (analyses conducted in 2015-2016). RESULTS: A total of 302 eligible adults were identified, and 177 (59%) enrolled. One hundred twenty-seven (72%) completed all surveys. At baseline, 57% of participants reported shopping at a farmers market within the last year; 18% had previously used DUFB. By the end of the DUFB season, participants were significantly more likely to report DUFB use than at baseline (AOR=19.2, 95% CI=10.3, 35.5, p<0.001), with 69% of participants reporting use of DUFB at least once, and 34% reporting use of DUFB three or more times. Adjusted fruit and vegetable consumption increased from baseline by 0.65 servings/day (95% CI=0.37, 0.93, p<0.001) at 3 months, and remained 0.62 servings/day (95% CI=0.32, 0.92, p<0.001) higher than baseline 2 months post-DUFB season. CONCLUSIONS: A brief clinic-based intervention was associated with a nearly fourfold increase in uptake of a SNAP incentive program, as well as clinically and statistically significant increases in produce consumption. Results suggested sustained behavior change even once the financial incentive was no longer available. Providing information about healthy food incentives is a low-cost, easily implemented intervention that may increase produce consumption among low-income patients. Published by Elsevier Inc.
INTRODUCTION: Diet-related disease is disproportionately concentrated in low-income communities where fruit and vegetable consumption is far below guidelines. To address financial barriers, Double Up Food Bucks (DUFB)-a statewide healthy food incentive-matches Supplemental Nutrition Assistance Program (SNAP) funds spent at farmers markets. However, incentive use is limited. This study examined the impact of a brief waiting room-based intervention about DUFB on program utilization and produce consumption. STUDY DESIGN: Longitudinal, repeated measures, quasi-experimental trial. SETTING/PARTICIPANTS: SNAP-enrolled adults at a health center in a low-income, racially and ethnically diverse area of Southeast Michigan. INTERVENTION: Participants received a brief explanation of DUFB, written program materials, a map highlighting market locations and hours, and an initial $10 market voucher. DUFB use and produce consumption were measured through four surveys over 5 months (August 2014-January 2015). MAIN OUTCOME MEASURES: Outcome measures included DUFB use and fruit and vegetable consumption (analyses conducted in 2015-2016). RESULTS: A total of 302 eligible adults were identified, and 177 (59%) enrolled. One hundred twenty-seven (72%) completed all surveys. At baseline, 57% of participants reported shopping at a farmers market within the last year; 18% had previously used DUFB. By the end of the DUFB season, participants were significantly more likely to report DUFB use than at baseline (AOR=19.2, 95% CI=10.3, 35.5, p<0.001), with 69% of participants reporting use of DUFB at least once, and 34% reporting use of DUFB three or more times. Adjusted fruit and vegetable consumption increased from baseline by 0.65 servings/day (95% CI=0.37, 0.93, p<0.001) at 3 months, and remained 0.62 servings/day (95% CI=0.32, 0.92, p<0.001) higher than baseline 2 months post-DUFB season. CONCLUSIONS: A brief clinic-based intervention was associated with a nearly fourfold increase in uptake of a SNAP incentive program, as well as clinically and statistically significant increases in produce consumption. Results suggested sustained behavior change even once the financial incentive was no longer available. Providing information about healthy food incentives is a low-cost, easily implemented intervention that may increase produce consumption among low-income patients. Published by Elsevier Inc.
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