Cost Effectiveness of Subsidizing Fruit and Vegetable Purchases Through the Supplemental Nutrition Assistance Program

Introduction: The 2018 Farm Bill represents a major opportunity to reduce disparities in diet and health. The largest component is the Supplemental Nutrition Assistance Program (SNAP), feeding 1 in 6 Americans. Potential options include subsidizing fruits & vegetables (F&V), restricting sugar-sweetened beverages (SSBs), or implementing a broader food incentive/disincentive framework that preserves choice. Their comparative health impacts and cost-effectiveness are not established. Methods: Using a validated microsimulation model (CVD PREDICT), we estimated changes in CVD events, quality-adjusted life-years (QALYs), costs, and cost-effectiveness of 3 policy scenarios in SNAP adults: 1) 30% subsidy on F&V; 2) 30% F&V subsidy + SSB restriction; and 3) 30% subsidy on F&V, whole grains, nuts/seeds, seafood, plant-based oils, and 30% disincentive on SSBs, junk food, and processed meats. Model inputs included national data from NHANES (2009-2014), policy effects from SNAP pilots and food pricing meta-analyses, diet-disease effects from meta-analyses, and policy, food subsidy, and healthcare costs. Results: From a societal perspective, all 3 scenarios were cost-savings at 5, 10, 20 y and lifetime ( Table ). At 5 y, a F&V subsidy would prevent 32,218 CVD events, gain 18,072 QALYs, and save $1.04B ($6.05B lifetime). Corresponding values for a F&V subsidy + SSB restriction were 63,898, 45,772, and $4.47B ($38.83B); and for a broader incentive/disincentive framework that preserved choice, 65,078, 26,663, and $3.98B ($29.90B). Government affordability varied by program duration and by whether subsidy costs for SNAP adults or all SNAP participants were included. Scenario 3 was generally most cost-effective or -saving, followed by scenario 2 and then scenario 1; all were cost-effective over a lifetime from a government affordability perspective. Conclusions: Financial incentives/disincentives through SNAP could generate substantial health benefits and be cost-effective or cost savings.

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Fruit and vegetable consumption and food values: National patterns in the United States by Supplemental Nutrition Assistance Program eligibility and cooking frequency

Preventive Medicine ◽

10.1016/j.ypmed.2015.03.019 ◽

2015 ◽

Vol 76 ◽

pp. 1-7 ◽

Cited By ~ 25

Author(s):

Julia A. Wolfson ◽

Sara N. Bleich

Keyword(s):

United States ◽

Vegetable Consumption ◽

The United States ◽

Fruit And Vegetable Consumption ◽

Supplemental Nutrition Assistance Program ◽

Fruit And Vegetable ◽

Supplemental Nutrition ◽

Assistance Program ◽

Nutrition Assistance

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Fruit and Vegetable Incentive Programs for Supplemental Nutrition Assistance Program (SNAP) Participants: A Scoping Review of Program Structure

Nutrients ◽

10.3390/nu12061676 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1676

Author(s):

Katherine Engel ◽

Elizabeth H. Ruder

Keyword(s):

Scoping Review ◽

Program Effectiveness ◽

Supplemental Nutrition Assistance Program ◽

Fruit And Vegetable ◽

Program Structure ◽

Supplemental Nutrition ◽

Assistance Program ◽

Incentive Programs ◽

Incentive Program ◽

Nutrition Assistance

The low intake of fruits/vegetables (FV) by Supplemental Nutrition Assistance Program (SNAP) participants is a persistent public health challenge. Fruit and vegetable incentive programs use inducements to encourage FV purchases. The purpose of this scoping review is to identify structural factors in FV incentive programs that may impact program effectiveness, including (i.) differences in recruitment/eligibility, (ii.) incentive delivery and timing, (iii.) incentive value, (iv.) eligible foods, and (v.) retail venue. Additionally, the FV incentive program impact on FV purchase and/or consumption is summarized. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, a search of four bibliographic databases resulted in the identification of 45 publications for consideration; 19 of which met the pre-determined inclusion criteria for full-length publications employing a quasi-experimental design and focused on verified, current SNAP participants. The data capturing study objective, study design, sample size, incentive program structure characteristics (participant eligibility and recruitment, delivery and timing of incentive, foods eligible for incentive redemption, type of retail venue), and study outcomes related to FV purchases/consumption were entered in a standardized chart. Eleven of the 19 studies had enrollment processes to receive the incentive, and most studies (17/19) provided the incentive in the form of a token, coupon, or voucher. The value of the incentives varied, but was usually offered as a match. Incentives were typically redeemable only for FV, although three studies required an FV purchase to trigger the delivery of an incentive for any SNAP-eligible food. Finally, most studies (16/19) were conducted at farmers’ markets. Eighteen of the 19 studies reported a positive impact on participant purchase and/or consumption of FV. Overall, this scoping review provides insights intended to inform the design, implementation, and evaluation of future FV incentive programs targeting SNAP participants; and demonstrates the potential effectiveness of FV incentive programs for increasing FV purchase and consumption among vulnerable populations.

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