Financial Incentives Increase Purchases Of Fruit And Vegetables Among Lower-Income Households With Children

Moran A, Thorndyke A, Franckle R, Boulos R, Doran H, Fulay A, Greene J, Blue D, Block JP, Rimm EB, Polacsek M
Source: Health Affairs
Publication Year: 2019
Patient Need Addressed: Food insecurity
Population Focus: Low income
Demographic Group: Child, Rural
Study Design: Pre-post with Comparison Group
Type of Literature: White
link: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05420
Abstract

The high cost of fruit and vegetables can be a barrier to healthy eating, particularly among lower-income households with children. We examined the effects of a financial incentive on purchases at a single supermarket by primary shoppers from low-income households who had at least one child. Participation in an in-store Cooking Matters event was requested for incentivized subjects but optional for their nonincentivized controls. The sample included but was not limited to Supplemental Nutrition Assistance Program participants. Compared to the controls, incentivized shoppers—who were given an immediate 50 % discount on qualifying fruit and vegetables—increased weekly spending on those items by 27 %; this change was for fresh produce. There was no change in purchases of frozen and canned produce or unhealthful foods. Estimated annual average daily consumption of fruit and vegetables by the incentivized shoppers and by one designated child per incentivized household did not change. Attendance at Cooking Matters events was low. These findings support financial incentive programs to increase fruit and vegetable purchasing but suggest that effective complementary approaches are needed to improve diet quality.

Insights Results

Overview of article

  • This article examined the effects of a financial incentive on purchases at a single supermarket by primary shoppers from low-income households who had at least one child
  • Lower-income children and adults have a disproportionately high prevalence of diet-related diseases (e.g., obesity, diabetes, cardiovascular disease), which contribute to significant disparities in health, well-being and opportunities for economic well-being. As such, interventions that target households are needed to promote sustained healthful dietary behaviors, especially for children
  • This randomized controlled trial tests the effects of a multi-faceted supermarket financial incentive and in-store education intervention on the food purchases and dietary consumption of lower-income households with children, including households participating in the Supplemental Nutrition Assistance Program (SNAP), over 8 months
  • Program participants were given a loyalty program card, loyalty number and barcode providing a 5% discount on all purchases made at the study supermarket. This was intended to incentivize shopping at the study store. At check out, participants were unstructured to show the card. The intervention also included Cooking Matters, a nutrition education event that included curriculum on education about food shopping and preparation

Methods of article

  • The research team assessed the dietary intake of each subject and one reference child in the household at baseline and follow-up using validated adult and child semiquantitative food frequency questionnaires
  • Purchases were tracked at the item level via universal product codes (UPCs) on packaged items and product look-up (PLU) codes for loose, fresh produce entered by cashiers at checkout. Purchases were linked to households via loyalty number
  • The primary outcomes assessed were the change in mean weekly spending per household on eligible fresh, frozen or canned fruit and vegetables over the study, and change in estimated annual mean daily consumption of half-cup servings of fruit and vegetables per primary shopper and reference child

Results

  • The intervention was associated with an increase in weekly spending on fruits and vegetables by $2.83, which was driven by increased on fresh produce. There was no change in spending on frozen or canned fruit. More specifically, there was a significant increase in mean weekly fruit and vegetable spending among SNAP nonparticipants. Among SNAP participants, the intervention was associated with a large relative increase in spending on fruit and vegetables. Compared to all other participants, weekly spending on fruit and vegetable was much higher among Cooking Matters attendees
  • There was no association between the intervention and changes in estimated annual average daily consumption of fruit and vegetables among primary shoppers or reference children
  • Importantly, the study found no evidence that the intervention group used financial savings to purchase less healthful foods or beverages

Key takeaways/implications

  • Possible reasons why there were no observed changes in reported consumption of fruits and vegetables include limitations to the dietary assessment tool (i.e., timing of the baseline and follow-up periods, precision of consumption categories, and length of reference period), or that there was truly no change in dietary intake
  • The low attendance to Cooking Matters is reflective of participation in the SNAP voluntary nutrition education program’s many options where very few SNAP recipients participate
  • Findings from the study support continued funding for SNAP incentive programs, however, future policies and interventions should address the high cost of providing incentives and their limited effects on consumption
  • Future research should prioritize testing alternative means of delivery that target low-income people who may be most likely to benefit, regardless of SNAP participation, identifying the optimal incentive level and delivery system, and assessing the synergistic effects of incentives and restrictions
  • Limitations to the study include limit to purchases made by participants who shopped during the intervention, inability to measure purchase outside of the study store, potential overestimation of fruit and vegetable consumption over time, low participation in Cooking Matters, not all incentives were issued and redeemed because of coupon system outages, and potentially limited generalizability
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