Opportunities and Challenges of California's Fruit and Vegetable Electronic Benefit Transfer Pilot Project at Farmers' Markets: A Qualitative Study with Supplemental Nutrition Assistance Program Shoppers and Farmers' Market Staff

BACKGROUND/OBJECTIVES

Nutrition incentive programs can increase access to fresh fruits and vegetables and improve food security among Supplemental Nutrition Assistance Program (SNAP) participants and others in the United States. This qualitative study explored SNAP participants' and farmers' market staff's perceptions of and experiences with a pilot supplemental benefit program offered at seven farmers' markets in 2023 as part of the California Fruit and Vegetable Electronic Benefit Transfer Pilot Project. The pilot introduced specific characteristics that differ from more traditional nutrition incentive program dollar-for-dollar match incentive models, particularly the traditional model operating in California. Specific differences included the following: (1) offering a monthly USD 60 supplemental benefit that could be redeemed in a single shopping trip; (2) providing the supplemental benefit as a match that could be spent on any SNAP-eligible item in any retail location (rather than solely on fruits and vegetables at the farmers' market).

METHODS

We conducted a qualitative, cross-sectional study including seven focus groups with 40 SNAP shoppers and six focus groups with 14 farmers' market staff at six pilot-participating farmers' markets in California. All focus groups were conducted by trained research staff and were recorded, transcribed, and analyzed using the immersion crystallization method.

RESULTS

Our findings include that shoppers appreciated several features of the pilot, particularly the ability to obtain an entire month's supplemental benefit during one shopping trip and the ability to spend the benefit earned on any SNAP-eligible item at any SNAP retailer. Farmers' market staff appreciated that the pilot benefited shoppers but found it difficult to manage due to staff and shopper confusion about the program, increased program utilization, subsequent long lines, and the spending of the earned incentives at other SNAP retailers. Both shoppers and staff reported that the program was difficult to understand.

CONCLUSIONS

These findings can inform future nutrition incentive program designs to benefit SNAP participants while offering sustainable models for farmers' markets.

The British Columbia Farmers' Market Nutrition Coupon Program Reduces Short-Term Household Food Insecurity Among Adults With Low Incomes: A Pragmatic Randomized Controlled Trial

BACKGROUND

The British Columbia Farmers' Market Nutrition Coupon Program (BC FMNCP) provides households with low incomes with coupons to purchase healthy foods from farmers' markets.

OBJECTIVE

To examine the impact of the BC FMNCP on the short-term household food insecurity, malnutrition risk, mental well-being, sense of community (secondary outcomes), and subjective social status (exploratory outcome) of adults with low incomes post-intervention and 16 weeks post-intervention.

DESIGN

Secondary analyses from a pragmatic randomized controlled trial conducted in 2019 that collected data at baseline, post-intervention, and 16 weeks post-intervention.

PARTICIPANTS/SETTING

Adults ≥18 years with low incomes were randomized to an FMNCP group (n = 143) or a no-intervention control group (n = 142).

INTERVENTION

Participants in the FMNCP group received 16 coupon sheets valued at $21 Canadian dollars (CAD)/sheet over 10 to 15 weeks to purchase healthy foods from farmers' markets and were eligible to participate in nutrition skill-building activities.

MAIN OUTCOME MEASURES

Outcomes included short-term household food insecurity (modified version of Health Canada's 18-item Household Food Security Survey Module), malnutrition risk (Malnutrition Universal Screening Tool), mental well-being (Warwick-Edinburgh Mental Well-Being Scale), sense of community (Brief Sense of Community Scale), and subjective social status (MacArthur Scale of Subjective Social Status community scale).

STATISTICAL ANALYSIS

Mixed-effects linear regression and multinomial logistic regression examined between-group differences in outcomes post-intervention and 16 weeks post-intervention.

RESULTS

The risk of marginal and severe short-term household food insecurity was lower among those in the FMNCP group compared with those in the control group (relative risk ratio [RRR] 0.15, P = 0.01 and RRR 0.16, P = 0.02) post-intervention, with sustained reductions in severe household food insecurity 16 weeks post-intervention (RRR 0.11, P = 0.01). No statistically significant differences were observed in malnutrition risk, mental well-being, sense of community, or subjective social status post-intervention or 16 weeks post-intervention.

CONCLUSIONS

The BC FMNCP reduced short-term household food insecurity but was not found to improve malnutrition risk or psychosocial well-being among adults with low incomes compared with a no-intervention control group.

Community-based nutrition education and hands-on cooking intervention increases farmers' market use and vegetable servings

OBJECTIVE

The objective of the current study was to evaluate the impact of the Market to MyPlate (M2MP) program on participants' reported farmers' market (FM) attitudes and shopping behaviours, frequency of serving vegetables to their families, food resource management behaviours and food security. A secondary objective was to identify facilitators and barriers to shopping at FM and food waste reduction techniques used by low-income families.

DESIGN

The current study used a mixed methods evaluation embedded within a cluster randomised trial of the M2MP intervention.

SETTING

The 7-week M2MP program was delivered at Extension offices and community centres in central Illinois.

PARTICIPANTS

Participants included 120 adults and their families. Class cohorts were randomly assigned to one of three treatment groups: (1) nutrition education and cooking classes with produce allocations (PAE, n 39); (2) nutrition education and cooking classes only (EO, n 36) or (3) control group (n 45).

RESULTS

Compared with control participants, PAE participants were significantly more likely to report shopping at FM (P = 0·029) and reported serving more vegetables to their families (P = 0·010) (EO participants did not differ from the control group on any outcomes). There were no differences between conditions in survey-based measures of food security or food resource management behaviours. Interview results describe facilitators and barriers to shopping at FM and a variety of food waste reduction techniques (including food placement and food resource management).

CONCLUSIONS

These findings suggest that fresh produce provision coupled with nutrition and culinary education can positively impact shopping and dietary behaviours.

Comparison of Fruit and Vegetable Prices between Farmers' Markets and Supermarkets: Implications for Fruit and Vegetable Incentive Programs for Food Assistance Program Participants

This cross-sectional study was part of a larger evaluation of a fruit and vegetable (FV) incentive program for Supplemental Nutrition Assistance Program (SNAP) participants in California. We examined the price differences in FV to explore whether these could help explain a previously observed lack of effect of the incentive program on FV consumption. Differences by type (organic/no-spray or conventional), among a convenience sample of farmers' markets (n = 11) and nearby supermarkets (n = 7), were assessed using Wilcoxon rank-sum tests adjusting for clustering by market. We calculated the cost of market baskets comprising recommended FV servings for a household using median prices to consider the implications of FV price differences for SNAP shoppers who use financial incentives for FV. We found that farmers' markets primarily offered organic FV while supermarkets primarily offered conventionally grown FV. Farmers' market prices tended to be lower than supermarkets for organic FV but higher for conventional FV. Compared to supermarkets, the market basket composed only of organic FV cost USD 16.34 less at farmers' markets, whereas a basket comprised of a mix of conventionally and organically grown FV cost USD 3.68 more. These differences warrant further exploration; FV price and type should be considered in studies aimed at understanding the impact of SNAP financial incentive programs.

Reducing food insecurity and improving fruit and vegetable intake through a nutrition incentive program in Michigan, USA

Background

Nutrition incentive (NI) programs increase the purchase of fruits and vegetables (FVs) among low-income participants. Double Up Food Bucks (DUFB) is a robust statewide NI program in the United States. The purpose of this paper is to report findings from DUFB in Michigan describing the factors related to FV intake (FVI) and food insecurity among participants in a NI program.

Methods

We administered a repeated cross-sectional survey with a convenience sample of DUFB participants at farmers markets and grocery stores (over the 2016, 2017, 2018 seasons). The survey was conducted online via paper-pencil. Descriptive statistics were calculated for all variables. A logistic regression model estimated household food insecurity and a linear regression estimated FVI with DUFB use/perceptions, sociodemographics, and health status as independent variables (significance level = p < 0.05).

Results

Descriptive results revealed that participants that completed surveys at grocery stores tended to be more racially-ethnically diverse and younger than participants that completed surveys at farmers markets. Participants with lower length of time participating in DUFB (i.e., lower dose) (p < 0.001), greater FV purchases (p < 0.05), and lower perceived health status (p < 0.001) tended to report being food insecure more frequently. Participants with increased length of time participating in DUFB (p < 0.05), greater FV purchases (p < 0.001), being male (p < 0.01), and greater perceived health status (p < 0.001) tended to report higher levels of FVI more frequently.

Conclusions

Longer participation in DUFB leads to improved outcomes with FVI and food security, suggesting that NI programs do have the intended positive impact they were designed to achieve.

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Low income populations carry a larger burden of obesity, food insecurity, and chronic disease.

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Nutrition incentive programs were developed to address affordability barriers to healthy eating among SNAP participants.

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Participants at grocery stores tended to be more racially-ethnically diverse and younger than participants at farmers markets.

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Participants with longer time in the program reported greater FVI and higher levels of food security.

Qualitative Study on Participant Perceptions of a Supermarket Fruit and Vegetable Incentive Program

BACKGROUND

Complete Eats Rx is a fruit and vegetable prescription program designed to incentivize fruit and vegetable consumption among Supplemental Nutrition Assistance Program (SNAP) participants via $10 incentives distributed either weekly or per encounter to purchase fruits and vegetables at a mid-price supermarket chain in Washington State.

OBJECTIVE

To better understand SNAP participants' experience, and to determine perceived impacts and consequences of the program.

DESIGN

Qualitative analysis of nine photovoice sessions. Participants chose the topics for discussion. Sessions were audiorecorded and transcribed. Thematic content analysis was performed to identify key emergent themes using Atlas.ti.

SETTING

Spokane, Seattle, and Yakima, Washington.

PARTICIPANTS

Twenty-six individuals who received a fruit and vegetable prescription within the past 6 months, 23 of whom attended all three photovoice sessions offered at their site. Participants were recruited from three participating health care or public health organizations in Spokane, Seattle, and Yakima, Washington.

ANALYSIS

Transcriptions were coded using inductive methods. Coded statements were organized into major themes. Coding structures and analysis were strengthened by iterative interactions between researchers.

RESULTS

Participants reported Complete Eats Rx was an important resource for families and improved food security, diet quality, and the ability to purchase healthy foods, including a greater variety of fruits and vegetables. Primary barriers to food security and fruit and vegetable consumption included limited geographic accessibility and the high cost of fruits and vegetables, exacerbated by other financial constraints such as rising housing costs. Participants reported supermarket checkout difficulty because of embarrassment, stigmatization, and inability to redeem incentives. The most frequently mentioned barrier to perceived program acceptability was having only one supermarket chain as the acceptor of the incentive.

CONCLUSION

Partnering with supermarkets to accept fruit and vegetable incentives is a unique strategy to increase produce purchasing that can be adopted by other localities. Focus on geographic accessibility, appropriate price points, and positive shopping experiences via expansion to local grocers, improvements in staff interactions, and a transition to an electronic system may improve incentive redemption and usability.

Higher Fruit and Vegetable Intake Is Associated with Participation in the Double Up Food Bucks (DUFB) Program

Incentivizing fruit and vegetable (F&V) purchases may help address barriers to healthy eating among populations with low income. In a repeated measures natural experiment study, we examined whether participation in the Double Up Food Bucks (DUFB) program increased F&V consumption among Supplemental Nutrition Assistance Program (SNAP) recipients. Two hundred and twelve participants recruited at baseline through telephone calls were informed about the availability of DUFB at their local farmers’ market (FM). F&V consumption frequency and DUFB use were obtained at baseline, mid FM, and end of FM season approximately 5 months later. Participants (N = 212) were primarily white (76.4%) women (77.3%) with an average age of 43.5 years. Only 34 participants opted to use the DUFB program. A linear mixed model showed a significant main effect of DUFB use (p = 0.001) and of time (p = 0.002), with a decrease in F&V intake over time. Compared to non-users, DUFB users had a significantly higher F&V consumption at baseline and midpoint (p = 0.02 and p = 0.02, respectively). F&V consumption was associated with participation in the DUFB program and higher F&V consumption frequency was observed prior to program use among program participants. Future interventions that specifically target SNAP recipients with low F&V intake to use the DUFB program are needed.

Healthy eating strategies for socioeconomically disadvantaged populations: a meta-ethnography

Purpose: In developed countries, diet-related health inequalities between people with different levels of socioeconomic advantage persist. However, there is limited qualitative evidence to inform the design of effective healthy eating (HE) strategies in socioeconomically disadvantaged populations (SDPs). The purpose of this review was to explore the characteristics influencing HE strategies for SDPs and develop a new understanding of how and why they influence their success.

Methods: A qualitative evidence synthesis using a systematic meta-ethnographic approach. The twelve studies included were conducted in the USA, Canada, Australia, and UK.

Results: The studies described a range of HE strategies, including nutrition education programs, food vouchers, and community gardens. Personal values and sense of pride and autonomy were found to have an influence on participants’ attitudes towards HE strategies. Similarly, social characteristics such as level of social support and opportunities for shared benefits influenced participants’ engagement. Structural characteristics such as the affordability and accessibility of healthy foods determined strategy acceptability and success. Finally, organizational characteristics such as flexibility influenced how well strategies supported the circumstances of participants.

Conclusions: These overlapping characteristics may be used to inform the development, implementation, and evaluation of strategies to improve healthy eating in SDPs.

Farmers Market Food Navigator Program: Key Stakeholder Perceptions and Program Outcomes

The Farmers Market (FM) Food Navigator program was designed over 3 years and follows a social ecological framework to increase vulnerable populations' access to local foods and build confidence to shop in a FM supporting local food systems while promoting fruit and vegetable consumption. Food Navigators followed a program Playbook, though unlike many similar programs, the program did not offer incentives to subsidize FM purchases. To inform program design and understand outcomes, data were collected from Food Navigators, shoppers, FM managers, and FM vendors. Food Navigators supported five to seven FMs each season (May through October), spending 590 days in FMs over three seasons. Due to their interaction with Food Navigators, shoppers in Season 3 (n = 689) indicated that they would: shop more at the FM (80%); eat more vegetables (52%); and purchase more vegetables (50%). Of shoppers who interacted with Food Navigators more than once (n = 55), 26% reported a higher frequency of vegetable consumption on their last survey compared with their first. In Season 3, at least half of FM managers (n = 4, 50%) and vendors (n = 68, 57%) agreed that food navigators helped increase overall market fruit and vegetables sales. Findings indicated the program did influence multiple levels of a social ecological framework as intended. FM nutrition programs can have success at increasing market sales and improving health-related behaviors without offering incentives. As a result, programs could operate with smaller budgets and be more likely to have increased shopper fruit and vegetable consumption sustainably beyond the direct subsidy of purchases.

Double Up Food Bucks: A Qualitative Evaluation of Usage, Impact, Barriers, and Facilitators

OBJECTIVE

Evaluate implementation of a farmers market-based fruit and vegetable incentive program.

DESIGN

Four focus groups and 6 interviews with program participants from April through November 2017.

SETTING

Double Up Food Bucks (DUFB) program in Western New York.

PARTICIPANTS

Western New York DUFB program participants.

PHENOMENON OF INTEREST

Customer DUFB usage, how DUFB affects purchasing, and program barriers or facilitators.

ANALYSIS

Two independent researchers coded focus group and interview transcripts. Researchers summarized codes as themes and selected illustrative quotes.

RESULTS

Participants (n = 36) were mostly female (75%); 69.4% reported a household income less than $20,000. They reported taking home and consuming more fruits and vegetables because of DUFB, almost always earning the maximum amount of DUFB and saving DUFB for later use. Barriers to using DUFB included limited hours and locations, running out of tokens, poor access to farmers market, and limited stocking. Participants recommended improved program communication, more venues, and convenient schedules to facilitate program use.

CONCLUSIONS AND IMPLICATIONS

Findings indicated that incentive programs increased fruit and vegetable consumption and purchasing among those who use them, however barriers to using incentives still existed. To improve the participant experience, program administrators should implement technology-based systems, provide robust communication, and offer incentives at varied locations and times.

Participant Perceptions of the Double Up Food Bucks Program at Oregon Farmers' Markets

OBJECTIVE

To explore perceptions of program impact among Double Up Food Bucks participants in Oregon.

METHODS

Data were collected from 1,223 Double Up Food Bucks participants at 42 Oregon farmers' markets. Chi-square tests of independence and logistic regressions were used to examine associations among key variables.

RESULTS

Most participants reported buying more fruits and vegetables (FVs) (91.0%), trying new FV types (82.2%), eating less processed food (69.8%), having more food available at home (81.1%), and perceiving improvements in health (87.9%). Perceptions of affordability were higher among younger adults (P < 0.001) and households with 3-5 people (P = 0.02), with children (P < 0.001), and without chronic disease (P = 0.003). Perceptions of increased FV purchases were higher in households with children (P = 0.009) and reported overall health improvements were higher among non-White participants (P = 0.04). Perceptions of increased FV purchases and affordability were associated with other positive program outcomes.

CONCLUSIONS AND IMPLICATIONS

Participants may perceive barriers to purchasing FVs from farmers' markets, which are not fully addressed by the increased purchasing power from a FV incentive. Targeted redesign, outreach, and education may improve program experiences among groups with less positive perceptions. Further research to identify explanations for variation in program experience is needed.

A Qualitative Evaluation of Double Up Food Bucks Farmers' Market Incentive Program Access

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.

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

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.

Impact of a farmers' market nutrition coupon programme on diet quality and psychosocial well-being among low-income adults: protocol for a randomised controlled trial and a longitudinal qualitative investigation

INTRODUCTION

Low-income populations have poorer diet quality and lower psychosocial well-being than their higher-income counterparts. These inequities increase the burden of chronic disease in low-income populations. Farmers' market subsidies may improve diet quality and psychosocial well-being among low-income populations. In Canada, the British Columbia (BC) Farmers' Market Nutrition Coupon Programme (FMNCP) aims to improve dietary patterns and health among low-income participants by providing coupons to purchase healthy foods from farmers' markets. This study will assess the impact of the BC FMNCP on the diet quality and psychosocial well-being of low-income adults and explore mechanisms of programme impacts.

METHODS AND ANALYSIS

In a parallel group randomised controlled trial, low-income adults will be randomised to an FMNCP intervention (n=132) or a no-intervention control group (n=132). The FMNCP group will receive 16 coupon sheets valued at CAD$21/sheet over 10-15 weeks to purchase fruits, vegetables, dairy, meat/poultry/fish, eggs, nuts and herbs at farmers' markets and will be invited to participate in nutrition skill-building activities. Overall diet quality (primary outcome), diet quality subscores, mental well-being, sense of community, food insecurity and malnutrition risk (secondary outcomes) will be assessed at baseline, immediately post-intervention and 16 weeks post-intervention. Dietary intake will be assessed using the Automated Self-Administered 24-hour Dietary Recall. Diet quality will be calculated using the Healthy Eating Index-2015. Repeated measures mixed-effect regression will assess differences in outcomes between groups from baseline to 16 weeks post-intervention. Furthermore, 25-30 participants will partake in semi-structured interviews during and 5 weeks after programme completion to explore participants' experiences with and perceived outcomes from the programme.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board, Rutgers University Ethics and Compliance, and University of Waterloo Office of Research Ethics. Findings will be disseminated through policy briefs, conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

NCT03952338.

Caregiver Experiences With an Innovative Farmers' Market Incentive Program for Children in Flint, Michigan

An innovative farmers’ market incentive program designed specifically for children was implemented to address persistent challenges with accessing fresh, nutrient-rich foods in a food desert community. The current study sought to qualitatively examine caregiver perceptions of the incentive program. Following distribution of farmers’ market incentives to all children (ages 0 to 15 years) at 43 Flint-area early childcare facilities and elementary schools, researchers conducted semistructured interviews with 37 caregivers (mean age = 39.59 ± 11.73 years). The majority were female (87%) and African American (53%). Through these interviews, researchers explored family experiences with the farmers’ market incentive program, as well as changes in environmental factors that may have resulted from program participation. Interviews were audio recorded and transcribed verbatim for textual analysis. Thematic analysis was used to identify patterns across transcripts and formulate emerging themes. Four recurrent themes emerged during interviews: (1) fruit and vegetable access, (2) child influence, (3) autonomous grocery shopping, and (4) program expansion. Interview participants indicated that the farmers’ market incentive program was an effective tool to both encourage families to visit the farmers’ market and purchase fresh foods there. Program design, particularly distribution to children, was credited with introducing families to the local farmers’ market. The current study suggests that a farmers’ market incentive program targeting children who reside in a food desert community may have meaningful impacts on access to fresh, nutrient-rich foods.

Facilitators and Barriers to Supplemental Nutrition Assistance Program Incentive Use: Findings From a Clinic Intervention for Low-Income Patients

INTRODUCTION

Healthy food incentives matching Supplemental Nutrition Assistance Program (SNAP) benefits spent on fruits and vegetables subsidize increased produce consumption among low-income individuals at risk for food insecurity and diet-related disease. Yet many eligible participants do not use these incentives, in part because of limited awareness. This study examined the acceptability and impact of a primary care-based informational intervention on facilitators and barriers to use of the statewide SNAP incentive program Double Up Food Bucks.

METHODS

Focus groups (n=5) were conducted April-June 2015 among a purposive sample (n=26) of SNAP-enrolled adults from a Michigan health clinic serving low-income patients. All had participated in a waiting room-based informational intervention about Double Up Food Bucks; none had used Double Up Food Bucks before the intervention. Groups were stratified by Double Up Food Bucks use/non-use during the 6-month intervention period. Results were analyzed in 2016-2017 through an iterative content analysis process.

RESULTS

Participants reported the waiting room intervention was acceptable and a key facilitator of first-time Double Up Food Bucks use. Motivators for Double Up Food Bucks use included (1) eating more healthfully, (2) stretching SNAP benefits, (3) higher-quality produce at markets, and (4) unique market environments. Remaining barriers included (1) lack of transportation, (2) limited market locations/hours, and (3) persistent confusion among a small number of participants regarding incentive use.

CONCLUSIONS

Low-income patients who received an informational intervention about Double Up Food Bucks reported numerous benefits from participation. Yet barriers remained for a subset of patients. Improving geographic accessibility and ease of SNAP incentive redemption may further improve dietary quality and food security among vulnerable populations.

Double Up Food Bucks Participation is Associated with Increased Fruit and Vegetable Consumption and Food Security Among Low-Income Adults

OBJECTIVE

To evaluate the effect of the Utah Double Up Food Bucks (DUFB) program on fruit and vegetable (F&V) intake and food security status among Supplemental Nutrition Assistance Program (SNAP) recipients.

METHODS

Data were collected in 2015, using a before-and-after study design. At the farmers' market, a convenience sample of SNAP recipients was recruited for a survey and a 4-week telephone follow-up survey. Differences between the 2 surveys in food security and F&V intake were tested using the Wilcoxon signed-rank test.

RESULTS

Follow-up surveys were completed with 138 (40%) of the 339 baseline participants. Median F&V consumption increased from 2.82 times per day to 3.29 times per day (median, interquartile range 1.48-3.99 and 3.28-5.02, respectively, P = .002). The percentage of DUFB participants who were food secure increased by 15% (P = .001).

CONCLUSIONS AND IMPLICATIONS

The present results add to the growing literature indicating farmers' market incentives are associated with increased F&V consumption and decreased food insecurity. Although more research is needed, farmers' market incentives may be an effective area of policy intervention.

Sustainability in Alternative Food Networks: A Systematic Literature Review

In recent years, increasing attention has been paid to individuals’ organizing themselves and managing food systems in an ‘alternative’ and more sustainable way. Such emerging food initiatives are most commonly known as ‘Alternative Food Networks’ (AFNs). However, there is an ongoing debate concerning the extent to which AFNs facilitate social, economic and environmental change. There are criticisms of the overall sustainability promise of AFNs related to sufficiency of impact, possible counter effects and the relevance of impacts. Because empirical studies often only focus on specific sustainability issues or AFNs, it has been difficult to develop more robust theories about the relations between diverse AFNs arrangements and sustainability. Thus, the aim of this paper is to contribute towards reducing this knowledge gap through a systematic literature review on AFNs in relation to sustainability. We summarize main methodological approaches, the types of AFNs studied and sustainability dimensions addressed in literature to date. Findings serve as reference to propose opportunities for future research regarding sustainability in AFNs.

Caregiver perceptions of a fruit and vegetable prescription programme for low-income paediatric patients

OBJECTIVE

The physical and social environments that surround children should support good health. However, challenges with food security and access prevent many children from consuming a healthy diet, which is critical to proper growth and development. The present study sought to gain a better understanding of primary care initiatives to address these issues in a low-income setting.

DESIGN

Following the relocation of a paediatric clinic to a farmers' market building and the implementation of a fruit and vegetable prescription programme, researchers conducted thirty-two semi-structured interviews with caregivers. Researchers elicited caregivers' perceptions of clinic co-location with the farmers' market; experiences with the prescription programme; opinions of the farmers' market; and perceived impact on child consumption of fresh produce. Interview recordings were transcribed for textual analysis. Using thematic analysis, researchers examined qualitative data to identify patterns across transcripts and formulate emerging themes. Researchers concluded when data saturation was reached.

SETTING

Flint, Michigan, USA.

SUBJECTS

The majority of participants were female (91 %) and African American (53 %).

RESULTS

Four recurrent themes emerged during interviews: (i) convenience of relocation; (ii) attitude towards prescription programme; (iii) challenges with implementation; and (iv) perceived impact of combined interventions. Caregivers indicated that the co-location and prescription programme increased family shopping at the farmers' market, improved access to high-quality produce and improved food security.

CONCLUSIONS

A fruit and vegetable prescription programme involving a partnership between a farmers' market and paediatric clinic was perceived as effective in improving food security, food access and child consumption of fresh fruits and vegetables.

Barriers to fruit and vegetable consumption among farmers’ market incentive programme users in Illinois, USA

Objective

Previous research indicates that low-income individuals often struggle to consume the recommended amount of fruits and vegetables (F&V). LINK Up Illinois is a farmers’ market incentive programme that aims to increase F&V consumption among Supplemental Nutrition Assistance Program (SNAP) recipients by improving access to and affordability of locally grown foods. The present research aimed to identify barriers to F&V consumption that exist among users of the LINK Up Illinois programme.

Design

Cross-sectional.

Setting

Farmers’ markets in Chicago, Springfield, Northbrook, Woodstock, Aurora and Urbana, IL.

Subjects

In 2016, a volunteer sample of 140 LINK Up Illinois users (mean age 42·5 years; 81·7 % female; 28·7 % African American; 44·0 % obese) completed a survey at participating farmers’ markets across the state. Information on demographics, food shopping behaviours, programme satisfaction, barriers to F&V consumption and frequency of F&V consumption was collected and examined.

Results

Approximately 23 % of survey participants reported consuming F&V ≥3 times/d. The barriers to F&V consumption most often reported by survey participants were the cost of F&V (29·5 %), spoilage (18·6 %), knowing how to cook F&V (8·7 %) and not thinking about F&V when hungry (8·6 %). Results from multivariable-adjusted logistic regression models suggested that reporting one or more barriers was associated with reduced odds of consuming vegetables ≥3 times/d, but not fruits.

Conclusions

Cost, spoilage and knowledge of cooking are key barriers to F&V consumption that exist among LINK Up Illinois users. Strategies are needed to mitigate these barriers and increase F&V consumption in this population.