The impact of financial incentives and restrictions on cyclical food expenditures among low-income households receiving nutrition assistance: a randomized controlled trial

Abstract Background The Supplemental Nutrition Assistance Program (SNAP) is the largest anti-hunger program in the United States. Two proposed interventions to encourage healthier food expenditures among SNAP participants have generated significant debate: financial incentives for fruits and vegetables, and restrictions on foods high in added sugar. To date, however, no study has assessed the impact of these interventions on the benefit cycle, a pattern of rapid depletion of SNAP benefits that has been linked to worsening nutrition and health outcomes over the benefit month. Methods Low-income households not currently enrolled in SNAP (n = 249) received benefits every 4 weeks for 12 weeks on a study-specific benefit card. Households were randomized to one of four study arms: 1) incentive (30% incentive for fruits and vegetables purchased with study benefits), 2) restriction (not allowed to buy sugar-sweetened beverages, sweet baked goods, or candy using study benefits), 3) incentive plus restriction, or 4) control (no incentive or restriction). Weekly household food expenditures were evaluated using generalized estimating equations. Results Compared to the control group, financial incentives increased fruit and vegetable purchases, but only in the first 2 weeks after benefit disbursement. Restrictions decreased expenditures on foods high in added sugar throughout the benefit month, but the magnitude of the impact decreased as the month progressed. Notably, restrictions mitigated cyclical expenditures. Conclusions Policies to improve nutrition outcomes among SNAP participants should consider including targeted interventions in the second half of the month to address the benefit cycle and attendant nutrition outcomes. Trial registration ClinicalTrial.gov, NCT02643576. Retrospectively registered December 22, 2014.

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Food Insecurity in a Low-Income, Predominantly African American Cohort Following the COVID-19 Pandemic

American Journal of Public Health ◽

10.2105/ajph.2020.306041 ◽

2021 ◽

Vol 111 (3) ◽

pp. 494-497

Author(s):

Tamara Dubowitz ◽

Madhumita Ghosh Dastidar ◽

Wendy M. Troxel ◽

Robin Beckman ◽

Alvin Nugroho ◽

...

Keyword(s):

African American ◽

Food Insecurity ◽

Low Income ◽

The United States ◽

Supplemental Nutrition Assistance Program ◽

Food Bank ◽

Assistance Program ◽

Nutrition Assistance ◽

National Trends ◽

The Impact

Objectives. To examine the impact of COVID-19 shutdowns on food insecurity among a predominantly African American cohort residing in low-income racially isolated neighborhoods. Methods. Residents of 2 low-income African American food desert neighborhoods in Pittsburgh, Pennsylvania, were surveyed from March 23 to May 22, 2020, drawing on a longitudinal cohort (n = 605) previously followed from 2011 to 2018. We examined longitudinal trends in food insecurity from 2011 to 2020 and compared them with national trends. We also assessed use of food assistance in our sample in 2018 versus 2020. Results. From 2018 to 2020, food insecurity increased from 20.7% to 36.9% (t = 7.63; P < .001) after steady declines since 2011. As a result of COVID-19, the United States has experienced a 60% increase in food insecurity, whereas this sample showed a nearly 80% increase, widening a preexisting disparity. Participation in the Supplemental Nutrition Assistance Program (52.2%) and food bank use (35.9%) did not change significantly during the early weeks of the pandemic. Conclusions. Longitudinal data highlight profound inequities that have been exacerbated by COVID-19. Existing policies appear inadequate to address the widening gap.

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The impact of financial incentives on SNAP transactions at mobile produce markets

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-021-01093-z ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Pasquale E. Rummo ◽

Reece Lyerly ◽

Jennifer Rose ◽

Yelena Malyuta ◽

Eliza Dexter Cohen ◽

...

Keyword(s):

Low Income ◽

Financial Incentives ◽

Fixed Effects ◽

Fruits And Vegetables ◽

Disease Risk ◽

Farmers Markets ◽

Fruit And Vegetable ◽

Assistance Program ◽

The Difference ◽

The Impact

Abstract Background Offering financial incentives promotes increases in fruit and vegetable purchases in farmers’ markets and supermarkets. Yet, little is understood about whether food-insecure adults purchase more fruits and vegetables as a result of receiving financial incentives in mobile produce market settings. Methods In 2018–2019, Food on the Move provided a 50% discount to customers using Supplemental Nutrition Assistance Program (SNAP) benefits to purchase fruit and vegetables from 16 market locations in Rhode Island (n = 412 market occasions). We used mixed multivariable linear regression to estimate the difference in total dollar sales per transaction per month between SNAP transactions and non-SNAP transactions. We also estimated the difference in out-of-pocket dollar sales per transaction per month between SNAP and non-SNAP transactions, less the 50% discount. This reflects the actual amount spent on fresh fruits and vegetables purchased per visit. In both models, we controlled for the number of market sites per month, with fixed effects for quarter and year. We estimated random intercept variance for date of transaction and market site to adjust for clustering. Results In 2018–2019, the majority of market transactions (total n = 13,165) were SNAP transactions [n = 7.988 (63.0%)]. On average, customers spent $17.38 (SD = 16.69) on fruits and vegetables per transaction per month. However, customers using SNAP benefits spent significantly more on FVs per transaction per month [$22.01 (SD = 17.97)] compared to those who did not use SNAP benefits [9.81 (SD = 10.68)] (β = $10.88; 95% CI: 10.18, 11.58). Similarly, out-of-pocket dollar sales per SNAP transaction per month (i.e., less the 50% discount) were significantly higher [$11.42 (SD = 9.44)] relative to non-SNAP transactions [$9.40 (SD = 9.33)] (β = $1.85; 95% CI: 1.44, 2.27). Conclusions Financial incentives contributed to higher fruit and vegetable purchases among low-income customers who shop at mobile produce markets by making produce more affordable. Higher spending on fruits and vegetables may promote healthy diet behaviors and reduce chronic disease risk among food-insecure adults.

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Accelerating Evaluation of Financial Incentives for Fruits and Vegetables: A Case for Shared Measures

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182212140 ◽

2021 ◽

Vol 18 (22) ◽

pp. 12140

Author(s):

Nadine Budd Nugent ◽

Carmen Byker Shanks ◽

Hilary K. Seligman ◽

Hollyanne Fricke ◽

Courtney A. Parks ◽

...

Keyword(s):

Low Income ◽

Financial Incentives ◽

Fruits And Vegetables ◽

Financial Incentive ◽

Evaluation Model ◽

Health Impact ◽

Dietary Quality ◽

Assistance Program ◽

Nutrition Assistance ◽

The U.S

Food insecurity, or lack of consistent access to enough food, is associated with low intakes of fruits and vegetables (FVs) and higher risk of chronic diseases and disproportionately affects populations with low income. Financial incentives for FVs are supported by the 2018 Farm Bill and United States (U.S.) Department of Agriculture’s Gus Schumacher Nutrition Incentive Program (GusNIP) and aim to increase dietary quality and food security among households participating in the Supplemental Nutrition Assistance Program (SNAP) and with low income. Currently, there is no shared evaluation model for the hundreds of financial incentive projects across the U.S. Despite the fact that a majority of these projects are federally funded and united as a cohort of grantees through GusNIP, it is unclear which models and attributes have the greatest public health impact. We explore the evaluation of financial incentives in the U.S. to demonstrate the need for shared measurement in the future. We describe the process of the GusNIP NTAE, a federally supported initiative, to identify and develop shared measurement to be able to determine the potential impact of financial incentives in the U.S. This commentary discusses the rationale, considerations, and next steps for establishing shared evaluation measures for financial incentives for FVs, to accelerate our understanding of impact, and support evidence-based policymaking.

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Evaluating the Impact of Financial Incentives on SNAP Transactions Shopping at Mobile Produce Markets

10.21203/rs.3.rs-54032/v1 ◽

2020 ◽

Author(s):

Pasquale Rummo ◽

Reece Lyerly ◽

Jennifer Rose ◽

Yelena Malyuta ◽

Eliza Dexter Cohen ◽

...

Keyword(s):

Low Income ◽

Financial Incentives ◽

Fixed Effects ◽

Fruits And Vegetables ◽

Disease Risk ◽

Farmers Markets ◽

Fruit And Vegetable ◽

Assistance Program ◽

The Difference ◽

The Impact

Abstract Background. Offering financial incentives promotes increases in fruit and vegetable purchases in farmers’ markets and supermarkets. Yet, little is understood about whether food-insecure adults purchase more fruits and vegetables as a result of receiving financial incentives in mobile produce market settings.Methods. In 2018-2019, Food on the Move provided a 50% discount to customers using Supplemental Nutrition Assistance Program (SNAP) benefits to purchase fruit and vegetables from 16 market locations in Rhode Island (n=412 market occasions). We used mixed multivariable linear regression to estimate the difference in total dollar sales per transaction per month between SNAP customers and non-SNAP customers. We also estimated the difference in out-of-pocket dollar sales per transaction per month between SNAP and non-SNAP customers, less the 50% discount. This reflects the actual amount spent on fresh fruits and vegetables purchased per visit. In both models, we controlled for the number of market sites per month, with fixed effects for quarter and year.Results. In 2018-2019, the majority of market transactions (n=13,165) were SNAP transactions [n=8,293 (66.0%)]. On average, customers spent $17.32 (SD=16.61) on fruits and vegetables per transaction per month. However, SNAP customers spent significantly more on FVs per transaction per month [$21.68 (SD=17.87)] compared to non-SNAP customers [$9.89 (SD=10.71)] (β=$10.54; 95% CI: 9.85, 11.23). Similarly, out-of-pocket dollar sales per transaction per month (i.e., less the 50% discount) were significantly higher among SNAP customers [$11.47 (SD=9.44)] relative to non-SNAP customers [$9.48 (SD=9.36)] (β=$1.86; 95% CI: 1.44, 2.27).Conclusions. Financial incentives contributed to higher fruit and vegetable purchases among low-income customers who shop at mobile produce markets compared to non-eligible customers. Higher spending on fruits and vegetables may promote healthy diet behaviors and reduce chronic disease risk among food-insecure adults.

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Trends in cyclical food expenditures among low-income households receiving monthly nutrition assistance: results from a prospective study

Public Health Nutrition ◽

10.1017/s136898002000405x ◽

2020 ◽

pp. 1-8

Author(s):

Sruthi Valluri ◽

Susan M Mason ◽

Hikaru H Peterson ◽

Simone A French ◽

Lisa J Harnack

Keyword(s):

Food Security ◽

Low Income ◽

Fruits And Vegetables ◽

Household Composition ◽

Household Characteristics ◽

Food Expenditures ◽

Food Security Status ◽

Food Retailer ◽

Nutrition Assistance ◽

Low Income Households

Abstract Objective: Supplemental Nutrition Assistance Program (SNAP) benefits are rapidly depleted after distribution. This phenomenon, known as the benefit cycle, is associated with poor nutrition and health outcomes. However, to date, no study has evaluated trends in food expenditures before and after households receive benefits using prospective data, and whether these trends vary by household characteristics. Design: Generalised estimating equations were used to model weekly household food expenditures during baseline (pre-benefit) and intervention months by vendor (restaurants and food retailers). Food retailer expenditures were further evaluated by food category (fruits and vegetables and foods high in added sugar). All expenditures were evaluated by household composition, demographics and economic means. Setting: Minneapolis-St. Paul, Minnesota, metropolitan area. Participants: Low-income households (n 249) enrolled May 2013–August 2015. Results: Weekly food retailer expenditures did not vary during baseline (pre-benefit), but demonstrated a cyclical pattern after households received benefits across all household characteristics and for both food categories, particularly for fruits and vegetables. Households with greater economic resources spent more throughout the month compared with those with fewer resources. Households with lower food security status experienced more severe fluctuations in spending compared with more food secure households. Conclusions: Cyclical food purchasing was observed broadly across different household characteristics and food categories, with notable differences by household economic means and food security status. Proposed SNAP policy changes designed to smooth food expenditures across the benefit month, such as increased frequency of benefit distribution, should include a focus on households with fewest resources.

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The impact of financial incentives on SNAP transactions at mobile produce markets

10.21203/rs.3.rs-54032/v2 ◽

2021 ◽

Author(s):

Pasquale Rummo ◽

Reece Lyerly ◽

Jennifer Rose ◽

Yelena Malyuta ◽

Eliza Dexter Cohen ◽

...

Keyword(s):

Low Income ◽

Financial Incentives ◽

Fixed Effects ◽

Fruits And Vegetables ◽

Farmers Markets ◽

Fruit And Vegetable ◽

Assistance Program ◽

Total N ◽

The Difference ◽

The Impact

Abstract Background. Offering financial incentives promotes increases in fruit and vegetable purchases in farmers’ markets and supermarkets. Yet, little is understood about whether food-insecure adults purchase more fruits and vegetables as a result of receiving financial incentives in mobile produce market settings.Methods. In 2018-2019, Food on the Move provided a 50% discount to customers using Supplemental Nutrition Assistance Program (SNAP) benefits to purchase fruit and vegetables from 16 market locations in Rhode Island (n=412 market occasions). We used mixed multivariable linear regression to estimate the difference in total dollar sales per transaction per month between SNAP transactions and non-SNAP transactions. We also estimated the difference in out-of-pocket dollar sales per transaction per month between SNAP and non-SNAP transactions, less the 50% discount. This reflects the actual amount spent on fresh fruits and vegetables purchased per visit. In both models, we controlled for the number of market sites per month, with fixed effects for quarter and year. We estimated random intercept variance for date of transaction and market site to adjust for clustering.Results. In 2018-2019, the majority of market transactions (total n=13,165) were SNAP transactions [n=7.988 (63.0%)]. On average, customers spent $17.38 (SD=16.69) on fruits and vegetables per transaction per month. However, customers using SNAP benefits spent significantly more on FVs per transaction per month [$22.01 (SD=17.97)] compared to those who did not use SNAP benefits [9.81 (SD=10.68)] (β=$10.88; 95% CI: 10.18, 11.58). Similarly, out-of-pocket dollar sales per SNAP transaction per month (i.e., less the 50% discount) were significantly higher [$11.42 (SD=9.44)] relative to non-SNAP transactions [$9.40 (SD=9.33)] (β=$1.85; 95% CI: 1.44, 2.27).Conclusions. Financial incentives contributed to higher fruit and vegetable purchases among low-income customers who shop at mobile produce markets compared to non-eligible customers. Higher spending on fruits and vegetables may promote healthy diet behaviors and reduce chronic disease risk among food-insecure adults.

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Effectiveness of mobile produce markets in increasing access and affordability of fruits and vegetables among low-income seniors

Public Health Nutrition ◽

10.1017/s1368980020002931 ◽

2020 ◽

Vol 23 (17) ◽

pp. 3226-3235

Author(s):

Reece Lyerly ◽

Pasquale Rummo ◽

Sarah Amin ◽

Whitney Evans ◽

Eliza Dexter Cohen ◽

...

Keyword(s):

Rhode Island ◽

Low Income ◽

Fruits And Vegetables ◽

Economic Status ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Assistance Program ◽

Logistic Regression Models ◽

Populations At Risk ◽

Nutrition Assistance

AbstractObjective:Mobile produce markets (MPM) offering Supplemental Nutrition Assistance Program (SNAP) incentive programmes have the potential to provide accessible and affordable fruits and vegetables (FV) to populations at risk of food insecurity. The objective of this study is to characterise the customer base of an MPM and describe their participation at twelve market sites serving low-income seniors.Design:In 2018, customers from an MPM in Rhode Island (RI) participated in a cross-sectional survey (n 330; 68 % response rate), which measured dietary patterns, food security and food shopping behaviours. We compared the shopping habits and market experiences of customers who currently received SNAP benefits with those who did not currently receive SNAP benefits.Setting:An MPM in RI which offers a 50 % discount for FV purchased with SNAP benefits.Participants:This study describes current market customers at twelve market sites serving low-income seniors.Results:Market customers were mostly low-income, female, over the age of 50 years and Hispanic/Latino. Most customers received SNAP benefits, and almost half were food insecure. In addition, three quarters of SNAP customers reported their SNAP benefits last longer since shopping at the markets. Mixed logistic regression models indicated that SNAP customers were more likely to report buying and eating more FV than non-SNAP customers.Conclusions:MPM are critical resources of affordable produce and have been successful in improving access to FV among individuals of low socio-economic status in RI. This case study can inform policy and programme recommendations for MPM and SNAP incentive programmes.

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An Examination of the Adequacy of Supplemental Nutrition Assistance Program (SNAP) Benefit Levels: Impacts on Food Insecurity

Agricultural and Resource Economics Review ◽

10.1017/age.2019.30 ◽

2019 ◽

Vol 48 (3) ◽

pp. 433-447 ◽

Cited By ~ 6

Author(s):

Craig Gundersen ◽

Elaine Waxman ◽

Amy S. Crumbaugh

Keyword(s):

Food Insecurity ◽

Low Income ◽

The United States ◽

Food Prices ◽

Supplemental Nutrition Assistance Program ◽

Supplemental Nutrition ◽

Assistance Program ◽

The Difference ◽

Nutrition Assistance ◽

The Cost

The Supplemental Nutrition Assistance Program (SNAP) serves as the primary tool to alleviate food insecurity in the United States. Its effectiveness has been demonstrated in numerous studies, but the majority of SNAP recipients are still food insecure. One factor behind this is the difference in food prices across the country—SNAP benefits are not adjusted to reflect these differences. Using information from Feeding America's Map the Meal Gap (MMG) project, we compare the cost of a meal by county based on the Thrifty Food Plan (TFP)—which is used to set the maximum SNAP benefit—with the cost of the average meal for low-income food-secure households. We find that the cost of the latter meal is higher than the TFP meal for over 99 percent of the counties. We next consider the reduction in food insecurity if, by county, the maximum SNAP benefit level was set to the cost of the average meal for low-income food-secure households. We find that if this approach were implemented, there would be a decline of 50.9 percent in food insecurity among SNAP recipients at a cost of $23 billion.

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Perceptions of the Food Environment and Access among Predominantly Black Low-Income Residents of Rural Louisiana Communities

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17155340 ◽

2020 ◽

Vol 17 (15) ◽

pp. 5340

Author(s):

Denise Holston ◽

Jessica Stroope ◽

Matthew Greene ◽

Bailey Houghtaling

Keyword(s):

Food Security ◽

Focus Group ◽

Food Insecurity ◽

Low Income ◽

Food Environment ◽

Food Access ◽

The United States ◽

Grocery Store ◽

Assistance Program ◽

Nutrition Assistance

Food insecurity in rural settings is complex and not fully understood, especially from the perspective of low-income and Black residents. The goal of this study was to use qualitative methods to better understand experiences with food access and perceptions of the food environment among low-income, predominately Black rural Louisiana residents in the United States. Data were collected from focus group discussions (FGD) and focus group intake forms. Study participants were all rural residents eligible to receive at least one nutrition assistance program. FGD questions focused on perceptions of the food environment, with an emphasis on food access. Participants (n = 44) were predominately Black and female. Over half (n = 25) reported running out of food before the end of the month. Major themes included: store choice, outshopping, methods of acquiring foods other than the grocery store, and food insecurity. Concerns around price, quality, and transportation emerged as factors negatively impacting food security. Understanding residents’ perceptions and experiences is necessary to inform contextually appropriate and feasible policy and practice interventions that address the physical environment and social conditions that shape the broader physical food environment in order to achieve equitable food access and food security.

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“Now I Feel a Little Bit More Secure”: The Impact of SNAP Enrollment on Older Adult SSI Recipients

Nutrients ◽

10.3390/nu13124362 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4362

Author(s):

Katie Savin ◽

Alena Morales ◽

Ronli Levi ◽

Dora Alvarez ◽

Hilary Seligman

Keyword(s):

Older Adult ◽

Low Income ◽

Assistance Program ◽

Public Benefits ◽

Nutrition Assistance ◽

Effective Use ◽

The Impact ◽

First Time ◽

Depth Interviews ◽

Neighborhood Level

In June 2019, California expanded Supplemental Nutrition Assistance Program (SNAP) eligibility to Supplemental Security Income (SSI) beneficiaries for the first time. This research assesses the experience and impact of new SNAP enrollment among older adult SSI recipients, a population characterized by social and economic precarity. We conducted semi-structured, in-depth interviews with 20 SNAP participants to explore their experiences with new SNAP benefits. Following initial coding, member-check groups allowed for participants to provide feedback on preliminary data analysis. Findings demonstrate that SNAP enrollment improved participants’ access to nutritious foods of their choice, contributed to overall budgets, eased mental distress resulting from poverty, and reduced labor spent accessing food. For some participants, SNAP benefit amounts were too low to make any noticeable impact. For many participants, SNAP receipt was associated with stigma, which some considered to be a social “cost” of poverty. Increased benefit may be derived from pairing SNAP with other public benefits. Together, the impacts of and barriers to effective use of SNAP benefits gleaned from this study deepen our understanding of individual- and neighborhood-level factors driving health inequities among low-income, disabled people experiencing food insecurity and SNAP recipients.

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