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Cited by 66Food Security and Health in Diverse PopulationsNutrition, Health and Food BehaviorOrganic Food and Agriculture

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

Open access
Cohen, Alicia J., Richardson, Caroline R., Heisler, Michele, Sen, Ananda, Murphy, Ellen C., Hesterman, Oran B., Davis, Matthew M., Zick, Suzanna M.·2017·American Journal of Preventive Medicine
DOI 10.1016/j.amepre.2016.11.008PMC PMC5444808
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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.

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  • Studies describing interventions providing food or vouchers reported mixed results for the actual change in fruit/vegetable intake, averaging to no impact when pooled (SMD = -0.03, 95% CI, -0.66 to 0.61).

    “Studies describing interventions providing food or vouchers reported mixed results for the actual change in fruit/vegetable intake, averaging to no impact when pooled (-0.03, 95% CI, -0.66 to 0.61).”

    From Interventions Addressing Food Insecurity in Health Care Settings: A Systematic Review (2019) · cites this paper as [17]

    The Abstract Results report that fruit and vegetable consumption increased after this healthy-food incentive intervention. The paper does not report mixed results across studies or the pooled estimate of −0.03 (95% CI, −0.66 to 0.61); its single-study finding cannot substantiate that part of the claim. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • In cases where data were not included in the original manuscript (n = 3), the authors contacted study authors to request information for SMD calculations.

    “In cases where data were not included in the original manuscript (n = 3), we contacted study authors to request information for SMD calculations. 16-18 Only 1 study team was able to provide additional information. 18”

    From Interventions Addressing Food Insecurity in Health Care Settings: A Systematic Review (2019) · cites this paper as [17]

    The Methods > Statistical Analysis section describes this study’s analyses but does not address whether a later review contacted its authors for data needed to calculate SMDs. Searches for SMD calculations, author requests, and additional information found no passage that verifies the contact or the reported response. Page numbers were not available in our copy. (LLM, conf=0.74)

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Research works printed but not linked: 1

  1. [4]U.S. Department of Agriculture Scientific report of the 2015 Dietary Guidelines Advisory Committee Washington, DC USDA 2015 PMC4717899 26773024

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Authors
Cohen, A. J., Richardson, C. R., Heisler, M., Sen, A., Murphy, E. C., Hesterman, O. B., Davis, M. M., & Zick, S. M.
Affiliations
  • University of Michigan (US)
  • Wayne State University (US)
  • Lurie Children's Hospital (US)
Corresponding author
Cohen, Alicia J.
ORCID
Venue
American Journal of Preventive Medicine
Publisher
Elsevier BV
Published
2017-02
Volume
52
Issue
2
Pages
154-162
ISSN
0749-3797 (ISSN-L)
DOI
10.1016/j.amepre.2016.11.008
PMC
PMC5444808
OpenAlex
W2574341698
Cited by
66
References
35
Citations by year
2026: 2 · 2025: 5 · 2024: 1 · 2023: 8 · 2022: 9 · 2021: 11 · 2020: 9 · 2019: 5 · 2018: 9 · 2017: 6
FWCI
12.86
Type
journal article
Language
en
Update notices
erratum (2017-04-01)
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • American Journal of Preventive Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Robert Wood Johnson Foundation
  • AcademyHealth
  • University of Michigan
  • W.K. Kellogg Foundation
  • Medical School, University of Michigan
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926)
Topics
  • Health Sciences › Health Professions › General Health Professions › Food Security and Health in Diverse Populations
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
  • Life Sciences › Agricultural and Biological Sciences › Plant Science › Organic Food and Agriculture
Keywords
Supplemental Nutrition Assistance Program, farmers' markets, fruit and vegetable intake, waiting room intervention, low-income patients, health center patients, program uptake, behavior change, low-income communities, diet-related diseases, health disparities, Southeast Michigan, Michigan, food vouchers, racial and ethnic diversity
MeSH terms
Adult, Diabetes Mellitus, Diet, Feeding Behavior, Female, Fruit, Health Promotion, Heart Diseases, Humans, Hypertension, Longitudinal Studies, Male, Michigan, Middle Aged, Motivation, Obesity, Poverty, Vegetables, Self Report, Food Assistance

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