Financial incentives and purchase restrictions in a food benefit program affect the types of foods and beverages purchased: results from a randomized trial

Simone A French, Sarah A Rydell, Nathan R Mitchell, J Michael Oakes, Brian Elbel, Lisa Harnack, Simone A French, Sarah A Rydell, Nathan R Mitchell, J Michael Oakes, Brian Elbel, Lisa Harnack

Abstract

Background: This research evaluated the effects of financial incentives and purchase restrictions on food purchasing in a food benefit program for low income people.

Methods: Participants (n=279) were randomized to groups: 1) Incentive- 30% financial incentive for fruits and vegetables purchased with food benefits; 2) Restriction- no purchase of sugar-sweetened beverages, sweet baked goods, or candies with food benefits; 3) Incentive plus Restriction; or 4) Control- no incentive or restrictions. Participants received a study-specific debit card where funds were added monthly for 12-weeks. Food purchase receipts were collected over 16 weeks. Total dollars spent on grocery purchases and by targeted food categories were computed from receipts. Group differences were examined using general linear models.

Results: Weekly purchases of fruit significantly increased in the Incentive plus Restriction ($4.8) compared to the Restriction ($1.7) and Control ($2.1) groups (p <.01). Sugar-sweetened beverage purchases significantly decreased in the Incentive plus Restriction (-$0.8 per week) and Restriction ($-1.4 per week) groups compared to the Control group (+$1.5; p< .0001). Sweet baked goods purchases significantly decreased in the Restriction (-$0.70 per week) compared to the Control group (+$0.82 per week; p < .01).

Conclusions: Paired financial incentives and restrictions on foods and beverages purchased with food program funds may support more healthful food purchases compared to no incentives or restrictions.

Clinical trial registration: Clinicaltrials.gov Identifier: NCT02643576 .

Keywords: Financial incentives; Food purchases; Low income; Restrictions; SNAP (supplemental nutrition assistance program).

Conflict of interest statement

Author information

Not Applicable.

Ethics approval and consent to participate

The University of Minnesota IRB approved the study. All participants consented to take part in the study.

Consent for publication

All authors consented to the present version of the manuscript submitted here.

Competing interests

The authors have no conflicts to report.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Consort Diagram

References

    1. Bhattacharaya J, Currie J, Haider S. Poverty, food insecurity and nutritional outcomes in children and adults. J Health Econ. 2004;23:839–862. doi: 10.1016/j.jhealeco.2003.12.008.
    1. Leung CW, Ding EL, Catalano PJ, Villamor E, Rimm EB, Willet WC. Dietary intake and dietary quality of low-income adults in the supplemental nutrition assistance program. Am J Clin Nutr. 2012;96:977–988. doi: 10.3945/ajcn.112.040014.
    1. Condon E, Drilea S, Jowers K, Lichtenstein C, Mabil J, Niland K. Diet quality of Americans by SNAP participation status: Data from the National Health and Nutrition Examination Survey, 2007-2010. In: Book Diet quality of Americans by SNAP participation status: Data from the National Health and Nutrition Examination Survey, 2007–2010. Walter R. McDonald & Associates, Inc: Mathematica Policy Research for the Food and Nutrition Service; 2015.
    1. Guthrie JF, Lin B-H, Ver Ploeg M, Frazao E. Can food stamps do more to improve food choices? In book can food stamps do more to improve food choices? Economic Research Service: US Department of Agriculture; 2007.
    1. Yen ST. The effects of SNAP and WIC programs on nutrient intakes of children. Food Policy. 2010;35:576–583. doi: 10.1016/j.foodpol.2010.05.010.
    1. Leung CW, Blumenthal SJ, Hoffnagle EE, Jensen HH, Foerster SB, Nestle M, Cheung LWY, Mozaffarian D, Willett WC. Associations of food stamp participation with dietary quality and obesity in children. Pediatrics. 2013;131:463–472. doi: 10.1542/peds.2012-0889.
    1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. J Am Med Assoc. 2012;307:483–490. doi: 10.1001/jama.2012.40.
    1. Freedman DS, Zuguo M, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa heart study. J Pediatr. 2007;150(1):12–17. doi: 10.1016/j.jpeds.2006.08.042.
    1. Hersey J, Anliker J, Miller C, Mullis RM, Daugherty S, Das S, Bray CR, Dennee P, Sigman-Grant M, Thomas HO. Food shopping practices are associated with dietary quality in low-income households. J Nutr Educ. 2001;33:S16–S26. doi: 10.1016/S1499-4046(06)60066-3.
    1. Crawford D, Ball K, Mishra G, Salmon J, Timperio A. Which food related behaviors are associated with healthier intakes of fruit and vegetables among women? Public Health Nutr. 2007;10(3):256–265. doi: 10.1017/S1368980007246798.
    1. Klerman J, Wilde P, Olsho L, Logan C, Blocklin M, Beauregard M, Enver A. Experimental Fruit and Vegetable Pricing Intervention on Fruit and Vegetable Purchases Among SNAP participants: Healthy Incentives Program HIP: Final Report. Prepared by Abt Associates for Danielle Berman. In: Experimental Fruit and Vegetable Pricing Intervention on Fruit and Vegetable Purchases Among SNAP participants: Healthy Incentives Program HIP: Final Report. Prepared by Abt Associates for Danielle Berman. USDA, Food Nutrition Service; 2013.
    1. Del Tredici AM, Joy AB, Omelich CL, Laughlin SG. Evaluation study of the California expanded food and nutrition program: 24-hour food recall data. J Am Diet Assoc. 1988;88(2):185–190.
    1. French SA, Wall M, Mitchell N, Shimotsu ST, Welch E. Annotated receipts capture food purchases from a broad range of sources. Int J Behav Nutr and Phys Act. 2009;6:37. doi: 10.1186/1479-5868-6-37.
    1. French SA, Wall M, Mitchell N. Household income differences in food sources and food items purchased. Int J Behav Nutr Phys Act. 2010;7:77. doi: 10.1186/1479-5868-7-77.
    1. 2015–2020 Dietary Guidelines for Americans. /. Accessed 21 March 2017.
    1. Andreyeva T, Luedicke J, Henderson KE, Tripp AS. Grocery store beverage choices by participants in federal food assistance and nutrition programs. Am J Prev Med. 2012;43:411–418. doi: 10.1016/j.amepre.2012.06.015.
    1. Brownell KD, Farley MD, Willett WC, Popkin BM, Chaloupka FJ, Thompson JW, Ludwig DS. The public health and economic benefits of taxing sugar-sweetened beverages. N Engl J Med. 2009;361:1599–1605. doi: 10.1056/NEJMhpr0905723.
    1. Supplemental Nutrition Assistance Program (SNAP) .
    1. Harnack L, Oakes J, Elbel B, Beatty TK, Rydell S, French SA. Effects of subsidies and prohibitions on nutrition in a food benefit program: a randomized clinical trial. JAMA Intern Med. 2016;176(11):1640–1618. doi: 10.1001/jamainternmed.2016.5633.
    1. French SA, Gerlach AF, Mitchell NR, Welsh EM. Household obesity prevention take action: a group randomized trial. Obesity. 2011;19:2082–2088. doi: 10.1038/oby.2010.328.
    1. Bickel G, Nord M, Price C, Hamilton W, Cook J. Measuring food security in the United States: guide to measuring household food security. In: Measuring Food Security in the United States: Guide to Measuring Household Food Security. 2000;
    1. French SA, Story M, Jeffery RW, Snyder MP, Eisenberg M, Sidebottom A, Murray DM. Pricing strategy to promote fruit and vegetable purchase in high school cafeterias. J Am Diet Assoc. 1997;97(9):1008–1010. doi: 10.1016/S0002-8223(97)00242-3.
    1. Jeffery RW, French SA, Raether C, Baxter JE. An environmental intervention to increase fruit and salad purchases in a cafeteria. Prev Med. 1994;23(6):788–792. doi: 10.1006/pmed.1994.1135.
    1. Jeffery RW. Risk behaviors and health. Contrasting individual and population perspectives. Am Psychol. 1989;44(9):1194–1202. doi: 10.1037/0003-066X.44.9.1194.
    1. Epstein LH, Jankowiak N, Nederkoom C, Raynor HA, French SA, Finkelstein E. Experimental research on relation between food price changes and food-purchasing patterns: a targeted review. Am J Clin Nutr. 2012;95:789–809. doi: 10.3945/ajcn.111.024380.
    1. Frazao E, Andrews A, Smallwood D, Prell M. Will increasing purchasing power result in healthier food choices? USDA Economic Research Service. Economic Information Bulletin Number 29–4. September 2017.
    1. Block JP, Chandra A, McManus KD, Willett WC. Point-of-purchase price and education intervention to reduce consumption of sugary soft drinks. Am J Public Health. 2010;100:1427–1433. doi: 10.2105/AJPH.2009.175687.
    1. Elbel B, Taksler GB, Mijanovich KD, Abrams CB, Dixon LB. Promotion of healthy eating through public policy: a controlled experiment. Am J Prev Med. 2013;45:49–55. doi: 10.1016/j.amepre.2013.02.023.
    1. Jue JJ, Press MJ, McDonald D, Volpp KG, Asch DA, Mitra N, Stanowski AC, Loewenstein G. The impact of price discounts and calorie messaging on beverage consumption: a multi-site field study. Prev Med. 2012;55:629–633. doi: 10.1016/j.ypmed.2012.10.009.
    1. Hastings JS, Shapiro JM. How are SNAP benefits spent? Evidence from a retail panel. National Bureau of Economic Research. Working paper 23112. 2017; Available at:

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel