The Use of Incentives to Promote Healthier Eating in Low-income Communities

Identifying effective strategies for improving healthier eating for low- income populations is both a clinical challenge and a public health priority. Approximately one-fifth of the children in the United States are either overweight or obese. Obesity is even more common in low- income populations as are other related health conditions such as diabetes, hypertension and cardiovascular diseases.

The consumption of fruits and vegetables is strongly associated with the prevention and management of obesity and diabetes and cardiovascular diseases. Overall, only about 38% of Americans consume the recommended servings of vegetables and only 23% consume the suggested amount of fruit. Close to 20% of low- income households do not purchase fruits and vegetables at all.

The proposed research offers an opportunity to investigate a different approach to incentives for healthier eating in a low-income urban population. Specifically, this study will examine a rewards-based incentive for fruit and vegetable purchases with rewards based on cumulative purchases. Previous studies have shown that incentives may be an effective means of promoting behavior change. The proposed study will provide essential data about the impact of targeted incentives to promote acquisition of fruits and vegetables by individuals living in households with young children. The investigators plan to design a subsequent, larger study based on the results of this study. In the proposed study, the investigators will specifically contribute to this knowledge by investigating the effects of rewards-based incentives that provide delayed reinforcement.

SPECIFIC AIMS AND STUDY HYPOTHESES

The goal of this study is to investigate whether incentives to low-income families to encourage purchase of healthier foods can be used to help stem the tide of childhood obesity. Although this study is a randomized trial, a major function is collecting data to be used in the design of a larger randomized controlled trial comparing two different interventions using incentives to promote healthier eating in low-income communities. The investigators will test a supermarket "gift card" with rewards based on purchases of fruits and vegetables during the intervention periods. The specific objective is to determine whether that incentive system-(where the rewards can be used to purchase anything in that supermarket) increases healthier food purchasing practices by low-income families. The primary outcomes are: number of servings, and percent of total food dollars spent on fruits and vegetables (fresh and frozen). The primary hypotheses are:

1. Households in the intervention group will purchase more fruits and vegetables than controls per week, both during: a) each intervention phase as compared to the baseline period and b) in the follow up phase compared to the baseline period. (Between group comparisons over time of intervention versus control group)

   The secondary hypotheses are:

2. Households in the intervention group will purchase more fruits and vegetables per week both during: a) each intervention phase as compared to the baseline period and b) in the follow up phase compared to baseline. (Within group comparisons over time)

Study Overview

• Status: Completed
• Conditions: Focus of the Study is on the Use of Incentives to Promote; Healthier Eating in Low-income Communities
• Intervention / Treatment: Behavioral: Fruit and vegetable rewards

• Study Type: Interventional
• Enrollment (Actual): 58
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19144

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Self-identified as primary shopper for household of at least 2 people [with at least one child between the ages of 5 and 16 years ]
• Has registered frequent shopper card for Fresh Grocer supermarkets
• Minimum 8 week history of shopping at this Fresh Grocer supermarket
• Shops at the identified supermarket at least 3 times a month
• Capable of providing informed consent.
• Has working contact telephone number and mailing address
• Able to communicate in English

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Wait listed control; Participants grocery shop without the intervention for extended baseline and have delayed entrance into the intervention period.
Experimental: Rewards for purchases & topic education; Participants earn reward points at 50% the rate of how much they spend on fruit and vegetables.	Behavioral: Fruit and vegetable rewards; Participants earn reward points at 50% the rate of how much they spend on fruit and vegetables. The earned reward points are distributed as money added to gift cards to be redeemed at the market.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Servings of fruit and vegetables	The number of servings of fruit and vegetables purchased per household per week	Participants will be followed for a minimum of 20 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cost of fruit and vegetables	The amount spent on fresh and frozen fruit and vegetables per household per week.	Participants will be followed for a minimum of 20 weeks

Collaborators and Investigators

• Sponsor: Albert Einstein Healthcare Network
• Collaborators: Robert Wood Johnson Foundation
• Investigators: Principal Investigator: Etienne J Phipps, PhD, Albert Einstein Healthcare Network

Study record dates

Study Major Dates

• Study Start: November 1, 2010
• Primary Completion (Actual): October 1, 2011
• Study Completion (Actual): October 1, 2011

Study Registration Dates

• First Submitted: June 7, 2012
• First Submitted That Met QC Criteria: June 8, 2012
• First Posted (Estimate): June 12, 2012

Study Record Updates

• Last Update Posted (Estimate): January 24, 2017
• Last Update Submitted That Met QC Criteria: January 23, 2017
• Last Verified: June 1, 2012

More Information

Terms related to this study

• Keywords: Fruit; Vegetables; Incentives
• Other Study ID Numbers: 68246