1
|
Parks CA, Mitchell E, Byker Shanks C, Budd Nugent N, Reynolds M, Sun K, Zhang N, Yaroch AL. Which Program Implementation Factors Lead to more Fruit and Vegetable Purchases? An Exploratory Analysis of Nutrition Incentive Programs across the United States. Curr Dev Nutr 2023; 7:102040. [PMID: 38130331 PMCID: PMC10733675 DOI: 10.1016/j.cdnut.2023.102040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 12/23/2023] Open
Abstract
Background Nutrition incentive (NI) programs help low-income households better afford fruits and vegetables (FVs) by providing incentives to spend on FVs (e.g., spend $10 to receive an additional $10 for FVs). NI programs are heterogeneous in programmatic implementation and operate in food retail outlets, including brick-and-mortar and farm-direct sites. Objective This study aimed to explore NI program implementation factors and the amount of incentives redeemed. Methods A total of 28 NI projects across the United States including 487 brick-and-mortar and 1078 farm-direct sites reported data between 2020 and 2021. Descriptive statistics and linear regression analyses (outcome: incentives redeemed) were applied. Results Traditional brick-and-mortar stores had 0.48 times the incentives redeemed compared with small brick-and-mortar stores. At brick-and-mortar sites, automatic discounts had 3.47 times the incentives redeemed compared with physical discounts; and auxiliary services and marketing led to greater redemption. Farm-direct sites using multilingual and direct promotional marketing had greater incentives redeemed. Conclusions To our knowledge, this is the first national study to focus on NI program implementation across sites nationwide. Factors identified can help inform future programming and research.
Collapse
Affiliation(s)
| | - Elise Mitchell
- Gretchen Swanson Center for Nutrition, Omaha, NE United States
| | | | | | - Megan Reynolds
- Gretchen Swanson Center for Nutrition, Omaha, NE United States
| | - Kiki Sun
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Nanhua Zhang
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Amy L Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE United States
| |
Collapse
|
2
|
Slagel N, Thompson JJ, Lee JS. Produce Prescriptions and Nutrition Education Improve Experiences and Perceptions of Farm Direct Settings in Adults With Low Income. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:1011-1023. [PMID: 36357040 DOI: 10.1016/j.jneb.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To examine Fruit and Vegetable Prescription (FVRx) Program participants' and nonparticipants' experiences and perceptions of farm direct (FD) settings. DESIGN Multiple-case study of adults with low income from 3 study groups: (1) FVRx intervention (produce prescription, nutrition education [NE], financial literacy education, health screening), (2) NE only, and (3) control (standard health care). Participant interviews with each group at baseline and 6 months. SETTING Supplemental Nutrition Assistance Program-Education (SNAP-Ed) eligible adults from 3 Georgia counties. PARTICIPANTS A total of 46 adults with ≥ 1 diet-related condition. PHENOMENA OF INTEREST Fruit and Vegetable Prescription Program participant and nonparticipant experiences and perceptions of FD settings. ANALYSIS Constant comparative methods and thematic analysis of qualitative interview data across groups. FINDINGS Two main themes emerged: (1) baseline FD setting experiences and perceptions and (2) divergent experiences and perceptions with FD settings postintervention. Participants across each group employed price-conscious food purchasing practices because of limited food budgets, limiting local food access. Combining produce prescription, NE, and farmers' market access enhanced FVRx participant associations with FD settings to reinforce motivation for accessing and purchasing fruits and vegetables beyond program participation. CONCLUSIONS AND IMPLICATIONS Fruit and Vegetable Prescription Programs reduce multiple barriers to participating in FD settings compared with NE or standard health care alone.
Collapse
Affiliation(s)
- Nicholas Slagel
- Department of Kinesiology, Nutrition and Dietetics, University of Northern Colorado, Greeley, CO.
| | | | - Jung Sun Lee
- Department of Foods and Nutrition, University of Georgia, Athens, GA
| |
Collapse
|
3
|
Freedman DA, Clark JK, Lounsbury DW, Boswell L, Burns M, Jackson MB, Mikelbank K, Donley G, Worley-Bell LQ, Mitchell J, Ciesielski TH, Embaye M, Lee EK, Roche A, Gill I, Yamoah O. Food system dynamics structuring nutrition equity in racialized urban neighborhoods. Am J Clin Nutr 2022; 115:1027-1038. [PMID: 34792095 DOI: 10.1093/ajcn/nqab380] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The food system is a social determinant of health and a leverage point for reducing diet-related racial inequities. Yet, food system interventions have not resulted in sustained improvement in dietary outcomes for underrepresented minorities living in neighborhoods with a history of disinvestment. Research is needed to illuminate the dynamics structuring food systems in racialized neighborhoods to inform intervention development. OBJECTIVES To conduct participatory research examining the complexity and inequity of food systems in historically redlined neighborhoods to identify feedback mechanisms to leverage in efforts to transform system outcomes for racial equity. METHODS We conducted a mixed-methods study in Cleveland, Ohio, USA from 2018 to 2021 using participatory system dynamic modeling with 30 academic and community partners, in-depth qualitative interviews with 22 key stakeholders, and public convenings with 250 local food policy council affiliates. Data were synthesized into causal loop diagrams depicting feedback mechanisms reinforcing or balancing neighborhood-level food system dynamics. RESULTS We identified 10 feedback mechanisms structuring nutrition equity, which was identified as a meta-goal for food systems in racialized neighborhoods. Feedback mechanisms were organized in 3 domains: 1) meeting basic food needs with dignity (i.e., side hustle, government benefits, emergency food assistance, stigma, and stereotypes); 2) local food supply and demand dynamics (i.e., healthy food retail, job security, food culture, and norms); and 3) community empowerment and food sovereignty (i.e., community power, urban agriculture, risk of gentrification). Five exogenous factors moderate feedback dynamics: neighborhood crisis, neighborhood investments, household costs, government benefit funding, and voter participation. CONCLUSIONS We identified nutrition equity as an overarching goal for local food systems, which reflects a state of having freedom, agency, and dignity in food traditions resulting in people and communities healthy in body, mind, and spirit. It is a transformative goal designed to spur system-level interventions that further racial equity through improved local food system dynamics.
Collapse
Affiliation(s)
- Darcy A Freedman
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Jill K Clark
- Department of Geography, John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, USA
| | - David W Lounsbury
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | | | - Marilyn Burns
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.,Community Leader, Cleveland, OH, USA
| | - Michelle B Jackson
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.,Activist and Community Organizer, Cleveland, OH, USA
| | | | - Gwendolyn Donley
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Timothy H Ciesielski
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Milen Embaye
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Eun Kyung Lee
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Abigail Roche
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - India Gill
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Owusua Yamoah
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
4
|
Karpyn A, Pon J, Grajeda SB, Wang R, Merritt KE, Tracy T, May H, Sawyer-Morris G, Humphrey DL, Hunt A. Purchases, Consumption, and BMI of SNAP Farmers’ Market Shoppers. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2021.1997860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Allison Karpyn
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | - Julia Pon
- Wholesome Wave, Berkeley, California, USA
| | - Sara Bernice Grajeda
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | - Rui Wang
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | | | - Tara Tracy
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | - Henry May
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | - Ginnie Sawyer-Morris
- Human Development & Family Sciences, The University of Delaware, Newark, Delaware, USA
| | - D. Layne Humphrey
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | - Alan Hunt
- Wholesome Wave, Bridgeport, Connecticut, USA
| |
Collapse
|
5
|
Garner JA, Coombs C, Savoie-Roskos MR, Durward C, Seguin-Fowler RA. A Qualitative Evaluation of Double Up Food Bucks Farmers' Market Incentive Program Access. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:705-712. [PMID: 31924558 PMCID: PMC7338242 DOI: 10.1016/j.jneb.2019.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Explore factors affecting access to and use of Double Up Food Bucks (DUFB), a farmers' market program that doubles Supplemental Nutrition Assistance Program benefits for use toward the purchase of fruits and vegetables (FV). DESIGN Focus groups. SETTING Metro and nonmetro counties in Utah and western Upstate New York. PARTICIPANTS Nine groups composed of 62 low-income adults (3-9/group). PHENOMENA OF INTEREST Satisfaction with, barriers to, and facilitators of program use; suggestions for improvement. ANALYSIS Transcribed verbatim and coded thematically in NVivo 11 software according to template analysis. RESULTS Program satisfaction was high and driven by FV affordability, perceived support of local farmers, positive market experiences, and high-quality FV. Primary barriers to using DUFB were lack of program information and inconvenient accessibility. Insufficient program communication was a consistent problem that elicited numerous suggestions regarding expansion of program marketing. Emergent topics included issues related to the token-based administration of DUFB and debate regarding stigma experienced during DUFB participation. CONCLUSIONS AND IMPLICATIONS Results suggest that although DUFB elicits many points of satisfaction among users, program reach may be limited owing to insufficient program marketing. Even among satisfied users, discussion of barriers was extensive, indicating that program reach and impact may be bolstered by efforts to improve program accessibility.
Collapse
Affiliation(s)
- Jennifer A Garner
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH; John Glenn College of Public Affairs, Ohio State University, Columbus, OH.
| | - Casey Coombs
- Department of Nutrition, Dietetics, and Food Science, Utah State University, Logan, UT
| | | | - Carrie Durward
- Department of Nutrition, Dietetics, and Food Science, Utah State University, Logan, UT
| | | |
Collapse
|