A Supermarket Double-Dollar Incentive Program Increases Purchases of Fresh Fruits and Vegetables Among Low-Income Families With Children: The Healthy Double Study

Abstract

Objective: To carry out a pilot study to determine if 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: 401 low-income and 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 to control ($1.83, 95% CI=$0.29, 3.88). The largest increase was for fresh F&V ($1.97, 95% CI=$0.49, 3.44). Secondary analyses revealed greater increases in F&V spending among SNAP-eligible participants who redeemed coupons ($5.14, 95% CI =$1.93, 8.34) than among non-SNAP-eligible participants who redeemed coupons ($3.88, 95% CI =$1.67, 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. SNAP-eligible customers 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.

Associations between Governmental Policies to Improve the Nutritional Quality of Supermarket Purchases and Individual, Retailer, and Community Health Outcomes: An Integrative Review

“…Nineteen studies examined the impact of supermarket fruit and vegetable subsidies, incentives, vouchers, or prescriptions targeted towards low-income households or individuals [ 47 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ]. Results from randomized trials and natural experiments consistently demonstrate increases in household fruit and vegetable purchases or adult fruit and vegetable intake when incentives are targeted towards SNAP participants [ 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]; yet, few studies have been conducted with children [ 52 ]. Studies assessing substitution found little evidence that fruit and vegetable incentives changed unhealthful food intake or expenditures [ 51 , 52 , 53 , 59 ].…”

Evaluating the Impact of Financial Incentives on SNAP Transactions Shopping at Mobile Produce Markets

“…Prior research has shown that offering subsidies and discounts for produce increases fruit and vegetable purchases among SNAP participants shopping in supermarkets and farmer markets. (19)(20)(21)(22)(23)(24)(25) The most prominent example is USDA's Healthy Incentives Pilot (HIP), which offered SNAP participants an incentive of 30 cents for every dollar of SNAP bene ts that they spent on eligible fruits and vegetables in participating supermarkets. (21) Spending on eligible fruit and vegetables increased by 11% and consumption of fruit and vegetables increased by 26% in HIP households compared to non-HIP households.…”

“…(19,20) Researchers have also tested the impact of nancial incentives in supermarket settings, and have found that matching credits and discounts lead to higher spending on fresh fruits and vegetables among eligible customers. (21)(22)(23)(24)(25) Mobile produce markets may be an acceptable setting for SNAP incentive programs because they concurrently address physical access barriers to healthy food retailers and incorporate elements of community engagement in their program design. Though mobile produce markets are a promising strategy for mitigating nancial barriers to healthy food consumption, few, if any, studies have examined whether SNAP participants purchase more fruit and vegetables as a result of receiving nancial incentives in a mobile produce market setting.…”

“…We hypothesized that customers using SNAP bene ts would spend more on fruits and vegetables per month compared to those not using SNAP bene ts in market transactions, as a result of the FOTM program. Based on the success of previous incentive programs in supermarket and farmer's market settings, (19)(20)(21)(22)(23)(24)(25) we hypothesized that offering nancial incentives would increase fruit and vegetable purchases among customers shopping at mobile produce markets.…”

Legal Feasibility and Implementation of Federal Strategies for a National Retail‐Based Fruit and Vegetable Subsidy Program in the United States

“…Strong evidence, including from randomized interventions, demonstrates that lowering the price of healthier food through subsidies increases their purchase and consumption across various settings and populations 11‐15 . Such analyses suggest that federal expansion of a 30% F&V subsidy to the broader US population could prevent more than 30,000 cardiovascular deaths annually 16 .…”