Increasing Use of a Healthy Food Incentive: A Waiting Room Intervention Among Low-Income Patients

Alicia J Cohen, Caroline R Richardson, Michele Heisler, Ananda Sen, Ellen C Murphy, Oran B Hesterman, Matthew M Davis, Suzanna M Zick, Alicia J Cohen, Caroline R Richardson, Michele Heisler, Ananda Sen, Ellen C Murphy, Oran B Hesterman, Matthew M Davis, Suzanna M Zick

Abstract

Introduction: Diet-related disease is disproportionately concentrated in low-income communities where fruit and vegetable consumption is far below guidelines. To address financial barriers, Double Up Food Bucks (DUFB)-a statewide healthy food incentive-matches Supplemental Nutrition Assistance Program (SNAP) funds spent at farmers markets. However, incentive use is limited. This study examined the impact of a brief waiting room-based intervention about DUFB on program utilization and produce consumption.

Study design: Longitudinal, repeated measures, quasi-experimental trial.

Setting/participants: SNAP-enrolled adults at a health center in a low-income, racially and ethnically diverse area of Southeast Michigan.

Intervention: Participants received a brief explanation of DUFB, written program materials, a map highlighting market locations and hours, and an initial $10 market voucher. DUFB use and produce consumption were measured through four surveys over 5 months (August 2014-January 2015).

Main outcome measures: Outcome measures included DUFB use and fruit and vegetable consumption (analyses conducted in 2015-2016).

Results: A total of 302 eligible adults were identified, and 177 (59%) enrolled. One hundred twenty-seven (72%) completed all surveys. At baseline, 57% of participants reported shopping at a farmers market within the last year; 18% had previously used DUFB. By the end of the DUFB season, participants were significantly more likely to report DUFB use than at baseline (AOR=19.2, 95% CI=10.3, 35.5, p<0.001), with 69% of participants reporting use of DUFB at least once, and 34% reporting use of DUFB three or more times. Adjusted fruit and vegetable consumption increased from baseline by 0.65 servings/day (95% CI=0.37, 0.93, p<0.001) at 3 months, and remained 0.62 servings/day (95% CI=0.32, 0.92, p<0.001) higher than baseline 2 months post-DUFB season.

Conclusions: A brief clinic-based intervention was associated with a nearly fourfold increase in uptake of a SNAP incentive program, as well as clinically and statistically significant increases in produce consumption. Results suggested sustained behavior change even once the financial incentive was no longer available. Providing information about healthy food incentives is a low-cost, easily implemented intervention that may increase produce consumption among low-income patients.

Published by Elsevier Inc.

Figures

Figure 1
Figure 1
Study flow diagram. SNAP, Supplemental Nutrition Assistance Program
Figure 2
Figure 2
Adjusted change in fruit and vegetable consumption. Notes: Multivariable linear mixed model (n=168), adjusted for gender, age, children <18 in household, race/ethnicity, baseline fruit and vegetable consumption, baseline farmers market use in the past year, baseline DUFB use, ≥1 household-members with diet-related disease, and employment status. * difference from baseline, p<0.001 DUFB, Double Up Food Bucks
Figure 3
Figure 3
Adjusted change in fruit and vegetable consumption, by DUFB use. Notes: Multivariable linear regression, adjusted for gender, age, children <18 in household, race/ethnicity, baseline fruit and vegetable consumption, baseline farmers market use in the past year, baseline DUFB use, ≥1 household-members with diet-related disease, and employment status. * difference from baseline, p<0.001; **difference from baseline, p=0.039 DUFB, Double Up Food Bucks

References

    1. Murphy SL, Kochanek KD, Xu JQ, Arias E. Mortality in the United States, 2014. Hyattsville, MD: National Center for Health Statistics; 2015.
    1. Murray CJ, Atkinson C, Bhalla K, et al. The state of U.S. health, 1990–2010: Burden of diseases, injuries, and risk factors. JAMA. 2013;310(6):591–608. .
    1. Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among U.S. adults: A 2012 update. Prev Chronic Dis. 2014;11:E62. .
    1. U.S. Department of Agriculture. Scientific report of the 2015 Dietary Guidelines Advisory Committee. Washington, DC: USDA; 2015.
    1. Wang DD, Leung CW, Li Y, et al. Trends in dietary quality among adults in the United States, 1999 through 2010. JAMA Intern Med. 2014;174(10):1587–1595. .
    1. Darmon N, Drewnowski A. Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutr Rev. 2015;73(10):643–660. .
    1. Monsivais P, Drewnowski A. The rising cost of low-energy-density foods. J Am Diet Assoc. 2007;107(12):2071–2076. .
    1. Drewnowski A. The cost of U.S. foods as related to their nutritive value. Am J Clin Nutr. 2010;92(5):1181–1188. .
    1. Darmon N, Drewnowski A. Does social class predict diet quality? Am J Clin Nutr. 2008;(87):1107–1117.
    1. Bleich SN, Jones-Smith J, Wolfson JA, Zhu X, Story M. The complex relationship between diet and health. Health Aff (Millwood) 2015;34(11):1813–1820. .
    1. Block JP, Subramanian SV. Moving beyond “food deserts”: Reorienting United States policies to reduce disparities in diet quality. PLoS Med. 2015;12(12):e1001914. .
    1. Gordon E, Dawkins-Lyn N, Hogan-Yarbro R, et al. Approaches for promoting healthy food purchases by SNAP participants. U.S. Department of Agriculture, Food and Nutrition Service; 2014.
    1. King M, Dixit-Joshi S, MacAllum K, Steketee M, Leard S. Famers market incentive provider study. U.S. Department of Agriculture, Food and Nutrition Service; 2014.
    1. Bartlett S, Klerman J, Wilde P, et al. Evaluation of the Healthy Incentives Pilot (HIP) final report. U.S. Department of Agriculture, Food and Nutrition Service; 2014.
    1. Young CR, Aquilante JL, Solomon S, et al. Improving fruit and vegetable consumption among low-income customers at farmers markets: Philly Food Bucks, Philadelphia, Pennsylvania, 2011. Prev Chronic Dis. 2013;10:E166. .
    1. Savoie-Roskos M, Durward C, Jeweks M, LeBlanc H. Reducing food insecurity and improving fruit and vegetable intake among farmers’ market incentive program participants. J Nutr Educ Behav. 2016;48(1):70–76. .
    1. Phipps EJ, Braitman LE, Stites SD, et al. Impact of a rewards-based incentive program on promoting fruit and vegetable purchases. Am J Public Health. 2015;105(1):166–172. .
    1. Fair Food Network. [Accessed December 30, 2015];Double Up National Network. 2015 .
    1. Karakus M, MacAllum K, Milfort R, Hao H. Nutrition assistance in farmers markets: Understanding the shopping patterns of SNAP participants. U.S. Department of Agriculture, Food and Nutrition Service; Oct, 2014.
    1. Olsho LE, Payne GH, Walker DK, Baronberg S, Jernigan J, Abrami A. Impacts of a farmers’ market incentive programme on fruit and vegetable access, purchase and consumption. Public Health Nutr. 2015;18(15):2712–2721. .
    1. Beck AF, Henize AW, Kahn RS, Reiber KL, Young JJ, Klein MD. Forging a pediatric primary care-community partnership to support food-insecure families. Pediatrics. 2014;134(2):e564–571. .
    1. Garg A, Sandel M, Dworkin PH, Kahn RS, Zuckerman B. From medical home to health neighborhood: transforming the medical home into a community-based health neighborhood. J Pediatr. 2012;160(4):535–536. e531. .
    1. Beck AF, Henize A, Kahn R, Reiber K, Klein M. Curtailing food insecurity with clinical-community collaboration. [Accessed May 15, 2016];Health Affairs Blog. 2015
    1. Stenmark S, Solomon L, Allen-Davis J, Brozena C. Linking the clinical experience to community resources to address hunger in Colorado. [Accessed May 15, 2016];Health Affairs Blog. 2015
    1. Garg A, Toy S, Tripodis Y, Silverstein M, Freeman E. Addressing social determinants of health at well child care visits: A cluster RCT. Pediatrics. 2015;135(2):e296–304. .
    1. Freedman DA, Choi SK, Hurley T, Anadu E, Hebert JR. A farmers’ market at a federally qualified health center improves fruit and vegetable intake among low-income diabetics. Prev Med. 2013;56(5):288–292. .
    1. Resnicow K, Odom E, Wang T, et al. Validation of three food frequency questionnaires and 24-hour recalls with serum carotenoid levels in a sample of African-American adults. Am J Epidemiol. 2000;152(11):1072–1080. .
    1. Allicock M, Johnson LS, Leone L, et al. Promoting fruit and vegetable consumption among members of black churches, Michigan and North Carolina, 2008–2010. Prev Chronic Dis. 2013;10:e33. .
    1. Leone LA, Beth D, Ickes SB, et al. Attitudes toward fruit and vegetable consumption and farmers’ market usage among low-income North Carolinians. J Hunger Environ Nutr. 2012;7(1):64–76. .
    1. Dimitri C, Oberholtzer L, Zive M, Sandolo C. Enhancing food security of low-income consumers: An investigation of financial incentives for use at farmers markets. Food Policy. 2015;52:64–70. .
    1. Ammerman AS, Lindquist CH, Lohr KN, Hersey J. The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: A review of the evidence. Prev Med. 2002;35(1):25–41. .
    1. Resnicow K, Jackson A, Blissett D, et al. Results of the healthy body healthy spirit trial. Health Psychol. 2005;24(4):339–348. .
    1. Lindsay S, Lambert J, Penn T, et al. Monetary matched incentives to encourage the purchase of fresh fruits and vegetables at farmers markets in underserved communities. Prev Chronic Dis. 2013;10:E188. .
    1. Anliker JA, Winne M, Drake LT. An evaluation of the Connecticut farmers’ market coupon program. J Nutr Educ. 1992;24(4):185–191. .
    1. Kunkel ME, Luccia B, Moore AC. Evaluation of the South Carolina seniors farmers’ market nutrition education program. J Am Diet Assoc. 2003;103(7):880–883. .
    1. Wholesome Wave. [Accessed December 30, 2015];Our initiatives. 2014

    1. Agricultural Act of 2014. Pub.L. 113–79.

    1. American Academy of Pediatrics. Promoting food security for all children. Pediatrics. 2015;136(5):e1431–1438. .
    1. Institute of Medicine. Capturing social and behavioral domains and measures in electronic health records: Phase 2. Washington, DC: The National Academies Press; 2014.
    1. American Academy of Family Physicians. [Accessed January 2, 2016];Social determinants of health policy. 2013 .

Source: PubMed

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