Increasing Affordable Fruits and Vegetables for Families With Food Insecurity

Increasing Use of SNAP Fruit and Vegetable Incentive Programs for Families With Food Insecurity

Investigator will test an intervention to increase use of a fruit and vegetable incentive program in South Carolina for families in the Supplemental Nutrition Assistance Program (SNAP) experiencing food insecurity. Caregivers are randomized to an intervention or an education-only, wait-list control group. The investigators hypothesize the intervention will improve diet-related outcomes, above and beyond the education-only wait-list control.

Study Overview

• Status: Recruiting
• Conditions: Diet
• Intervention / Treatment: Behavioral: Veggie Vouchers

Detailed Description

This study will test an intervention to increase use of a fruit and vegetable incentive program for families in the Supplemental Nutrition Assistance Program (SNAP) using a randomized controlled trial design. Caregivers are randomized to the intervention or an education-only wait-list control group. All caregivers are given brief education about a SNAP fruit and vegetable incentive program. Caregivers in the intervention are also given an initial "free trial" of this program and free home delivery. The primary aim is to examine intervention efficacy on diet-related outcomes.

• Study Type: Interventional
• Enrollment (Estimated): 296
• Phase: Phase 1

Contacts and Locations

• Study Contact: Name: Elizabeth Adams, PhD; Phone Number: 803-777-0269; Email: elizabeth-adams@sc.edu

Study Locations

• United States
  • South Carolina
    • Columbia, South Carolina, United States, 29204
      • Recruiting
      • University of South Carolina
      • Contact: Elizabeth Adams, PhD; Phone Number: 803-777-0269; Email: elizabeth-adams@sc.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Primary caregiver 18+ years of age
• Has a child 2-10 years of age
• Speaks English
• Screens positive for food insecurity
• Currently enrolled in the Supplemental Nutrition Assistance Program (SNAP)
• Lives with a feasible radius for home delivery
• Consistent access to a phone that receives text messages

Exclusion Criteria:

• Anticipate no longer being enrolled in SNAP during the study duration
• Recent use of the SNAP fruit and vegetable incentive program
• Caregiver or child has a medical condition that impacts their ability to eat fruits and vegetables
• Caregiver or child has a significant food allergy, preference, or intolerance that impacts their ability to eat fruits and vegetables

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Diet intervention; Caregivers will receive brief education about a SNAP fruit and vegetable incentive program in South Carolina during their child's pediatrician visit. Following the visit, caregivers will receive a "free trial" of this SNAP program to encourage first-time use. After the free trial, caregivers can continue purchasing the same fruit and vegetable boxes at a steeply discounted price using their SNAP card. Free home delivery during the "free trial" and for all subsequent boxes purchased at a discounted rate will be offered during the full study duration.	Behavioral: Veggie Vouchers; Caregivers will receive brief education about a SNAP fruit and vegetable incentive program in South Carolina during their child's pediatrician visit. Following the visit, caregivers will receive a "free trial" of this SNAP program to encourage first-time use. After the free trial, caregivers can continue purchasing the same fruit and vegetable boxes at a steeply discounted price using their SNAP card. Free home delivery during the "free trial" and for all subsequent boxes purchased at a discounted rate will be offered during the full study duration.
No Intervention: Education-only wait-list control; Caregivers will only receive brief education about a SNAP fruit and vegetable incentive program in South Carolina during their child's pediatrician visit. Once caregivers complete all study measures, they will be moved off the wait list and offered the intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Child diet quality	Caregivers will complete a 3-day food record for their child's dietary intake. Child diet quality will then be assessed using the Healthy Eating Index.	Baseline, 6, 18, and 30 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Caregiver diet quality	Caregivers will complete a 3-day food record for their dietary intake. Caregiver diet quality will then be assessed using the Healthy Eating Index.	Baseline, 6, 18, and 30 weeks
Child Eating Behaviors	The Children's Eating Behavior Questionnaire will be used to assess children's food fussiness. The food fussiness sub-scale consists of 5-pt Likert scale items ranging from Never (1) to Always (5). The mean of the response values is calculated. Higher score indicating a greater degree of food fussiness.	Baseline, 6, 18, and 30 weeks
Process metrics	Process metrics will examine the reach of families who received brief education during clinic visits at each site, utilization of the free trial, use of home delivery, and families who cycled off SNAP within the study duration (%, #, timing).	Through study completion, an average of 3 years
Intervention utilization	Semi-structured phone interviews and surveys will be administered to caregivers to elicit perceptions on intervention components, barriers/facilitators to intervention use, and suggestions for future dissemination.	Through study completion, an average of 3 years
Perspectives of the intervention	Focus groups and online surveys will be administered to key informants to assess barriers and facilitators to intervention implementation and sustainability.	Through study completion, an average of 3 years
Food security	The United States Department of Agriculture Household Food Security Module (18-item) will be administered. Higher scores indicate less food security.	Baseline, 6, 18, and 30 weeks
Availability Pillar of Food Security	The Perceived Limited Availability scale will be administered (6-items). Items are summed to create a total score for food stores (3-items) and food pantries (3 items). Each total score ranges 0-3. Higher scores are considered less desirable.	Baseline, 6, 18, and 30 weeks
Utilization Pillar of Food Security	The Utilization Barriers scale (8-items) will be administered. Items are summed to create a score ranging 0-8. Higher scores are considered less desirable.	Baseline, 6, 18, and 30 weeks
Stability Pillar of Food Security	The Food Insecurity Stability scale (12-items) will be administered. Participants receive 4 scores, each ranging from 0-3 for chronic, seasonal, monthly, and intermittent food insecurity. Higher scores indicate a greater degree of chronic, seasonal, monthly, and intermittent food insecurity.	Baseline, 6, 18, and 30 weeks
Nutrition Security	Nutrition security will be measured using the Household Nutrition Security scale (4-items). Item scores range 0 ("Always") to 4 ("Never"). The mean of item scores is calculated. Higher scores indicate a greater degree of nutrition security.	Baseline, 6, 18, and 30 weeks
Household Healthfulness Choice	The Household Healthfulness Choice (3-items) survey will be administered. Items are scored from 4 ("Always") to 0 ("Never"). The mean of the item scores is calculated. Higher scores indicate a greater degree healthfulness choice.	Baseline, 6, 18, and 30 weeks
Dietary Choice	The Dietary Choice (3-items) survey will be administered. Item scores range from 0 ("Always") to 4 ("Never"). The mean of the item scores is calculated. Higher scores indicate a greater degree of dietary choice.	Baseline, 6, 18, and 30 weeks
SNAP fruit and vegetable incentive program utilization	Purchasing data will be used to quantify the number and type of produce boxes purchased as part of the Supplemental Nutrition Assistance Program (SNAP) fruit and vegetable incentive program in South Carolina.	Through study completion, an average of 3 years

Collaborators and Investigators

• Sponsor: University of South Carolina
• Collaborators: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); Virginia Commonwealth University; Cornell University

Study record dates

Study Major Dates

• Study Start (Actual): March 6, 2025
• Primary Completion (Estimated): January 1, 2029
• Study Completion (Estimated): January 1, 2029

Study Registration Dates

• First Submitted: February 10, 2025
• First Submitted That Met QC Criteria: February 10, 2025
• First Posted (Actual): February 14, 2025

Study Record Updates

• Last Update Posted (Actual): April 4, 2025
• Last Update Submitted That Met QC Criteria: April 3, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: diet; fruit; healthy eating; food insecurity; pediatrician; vegetable; Supplemental Nutrition Assistance Program
• Other Study ID Numbers: Pro00136502; R01DK140677 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No