Effects Of Alternative Food Voucher Delivery Strategies On Nutrition Among Low-Income Adults

Abstract

Nutrition assistance programs are the subject of ongoing policy debates. Two proposals remain uninformed by existing evidence: whether restricting benefits to allow only fruit and vegetable purchases improves overall dietary intake, and whether more frequent distribution of benefits (weekly versus monthly) induces more fruit and vegetable consumption and less purchasing of calorie-dense foods. In a community-based trial, we randomly assigned participants to receive food vouchers that differed in what foods could be purchased (fruit and vegetables only or any foods) and in distribution schedule (in weekly or monthly installments, holding total monthly value constant). The use of vouchers for fruit and vegetables only did not yield significantly greater improvements than the unrestricted voucher did in terms of fruit and vegetable consumption or Healthy Eating Index (HEI) score. Weekly vouchers also failed to yield significantly greater improvements than monthly vouchers did. Proposed policies to make assistance more restricted or more frequent, while holding benefit value constant, might not improve nutrition among low-income Americans. Nutrition assistance programs governed by the 2018 Farm Bill have come under increasing scrutiny. 1,2 Federal programs such as the Supplemental Nutrition Assistance Program

Association between Food Insecurity and Health-Related Quality of Life: a Nationally Representative Survey

“…[15][16][17] Common food insecurity interventions include clinic-based screening followed by referral to community food resources (e.g., food pantries), food subsidies, and medically tailored meal delivery programs. [18][19][20][21][22][23][24][25] Typically, these programs are evaluated based on their ability to improve disease-specific biomarkers (e.g., hemoglobin A1c for individuals with diabetes), or healthcare utilization (e.g., emergency department visits). However, evaluation of these interventions should include effects on patient-centered outcomes, such as HRQoL.…”

Heterogeneity in the Effects of Food Vouchers on Nutrition Among Low-Income Adults: A Quantile Regression Analysis

“…We implemented a community-based RCT of 4 voucher designs that varied on which foods could be purchased (fruit and vegetables only or unrestricted) and the allowable redemption schedule (weekly or monthly). The main analyses found no average effect on fruit and vegetable (FV) intake by voucher type, 4 although prior research has shown that voucher effects may differ by subgroup. 5 One important subgroup includes individuals with low baseline FV intake, who have the greatest room for improvement, as supported by research that baseline diet may be an important determinant of dietary changes.…”

“…Major eligibility criteria included residence in San Francisco, California, age ≥21 years old, household (HH) income <250% of the federal poverty level, and fluency in English; complete eligibility criteria have been previously published. 4 Participants were recruited from transit and web advertisements, fliers, and word of mouth.…”

The impact of financial incentives and restrictions on cyclical food expenditures among low-income households receiving nutrition assistance: a randomized controlled trial

“…However, we find that there may be significant intra-monthly variation in fruit and vegetable expenditures in response to financial incentives. While more frequent distribution of benefits has been proposed to help smooth household expenditures and improve the dietary quality of SNAP households, a recent study of low-income households in San Francisco found that weekly benefit distribution of food vouchers did not improve fruit and vegetable intake or dietary quality [ 41 ]. More targeted interventions in the second half of the benefit month may therefore be necessary to directly address the benefit cycle and the attendant cycles in nutrition and dietary quality.…”