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John S, Melendrez B, Leng K, Nelms A, Seligman H, Krieger J. Advancing Equity in the Farm Bill: Opportunities for the Gus Schumacher Nutrition Incentive Program (GusNIP). Nutrients 2023; 15:4863. [PMID: 38068722 PMCID: PMC10707921 DOI: 10.3390/nu15234863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/24/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
The Gus Schumacher Nutrition Incentive Program (GusNIP) is a federally funded grant program that provides nutrition incentives-subsidies for purchasing fruits and vegetables (FV)-to Supplemental Nutrition Assistance Program (SNAP) participants. GusNIP currently advances nutrition equity by improving FV access for people with low incomes, yet inequities exist within GusNIP. We sought to identify inequities in GusNIP at the community, organization, partner, and individual levels and develop recommendations for farm bill provisions to make the program more equitable. In Spring 2021, a group of nutrition incentive experts (n = 11) from across the country convened to discuss opportunities to enhance equity in GusNIP. The iterative recommendation development process included feedback from key stakeholders (n = 15) and focus group participants with GusNIP lived experience (n = 12). Eleven recommendations to advance equity in GusNIP in the farm bill emerged across six categories: (1) increase total GusNIP funding, (2) increase funding and support to lower-resourced organizations and impacted communities, (3) eliminate the match requirement, (4) support statewide expansion, (5) expand and diversify retailer participation, and (6) expand program marketing. Including these recommendations in the upcoming and future farm bills would equitably expand GusNIP for SNAP participants, program grantees, and communities across the country.
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Affiliation(s)
- Sara John
- Center for Science in the Public Interest, Washington, DC 20005, USA;
| | - Blanca Melendrez
- Center for Community Health, University of California San Diego, La Jolla, CA 92037, USA;
| | - Kirsten Leng
- Healthy Food America, Seattle, WA 98122, USA; (K.L.); or (J.K.)
| | - Amy Nelms
- Center for Science in the Public Interest, Washington, DC 20005, USA;
| | - Hilary Seligman
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA 94143, USA;
| | - James Krieger
- Healthy Food America, Seattle, WA 98122, USA; (K.L.); or (J.K.)
- School of Public Health, University of Washington, Seattle, WA 98195, USA
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Stotz SA, Nugent NB, Akers M, Leng K, Byker Shanks C, Yaroch AL, Krieger J, Szczepaniak M, Seligman H. How the Gus Schumacher Produce Prescription Program Works: An Adaptation of a Nutrition Incentive Theory of Change. Nutrients 2023; 15:3352. [PMID: 37571289 PMCID: PMC10421213 DOI: 10.3390/nu15153352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
The United States Department of Agriculture's Gus Schumacher Nutrition Incentive Program (GusNIP) supports nutrition incentive (NI) and produce prescription programs (PPRs). PPRs allow healthcare providers to "prescribe" fruits and vegetables (FVs) to patients experiencing low income and/or chronic disease(s) and who screen positive for food insecurity. We developed a Theory of Change (TOC) that summarizes how and why PPRs work, identifies what the programs hope to achieve, and elucidates the causal pathways necessary to achieve their goals. We created the PPR TOC through an iterative, participatory process that adapted our previously developed GusNIP NI TOC. The participatory process involved food and nutrition security experts, healthcare providers, PPR implementors, and PPR evaluators reviewing the existing NI TOC and suggesting modifications to accurately reflect PPRs. The resulting TOC describes the mechanisms, assumptions, rationale, and underpinnings that lead to successful and equitable outcomes. Modifications of the NI TOC centered around equity and focused on inclusion of healthcare as an additional partner and the importance of health and healthcare utilization as outcomes. The TOC describes how the GusNIP PPR program reaches its goals. This understanding will be useful for PPR developers, implementers, funders, and evaluators for describing the pathways, assumptions, and foundations of successful PPRs.
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Affiliation(s)
- Sarah A. Stotz
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Nadine Budd Nugent
- Gretchen Swanson Center for Nutrition, Omaha, NE 68154, USA; (N.B.N.); (C.B.S.); (A.L.Y.); (M.S.)
| | - Melissa Akers
- Division of General Internal Medicine, University of California, San Francisco, CA 94143, USA; (M.A.); (H.S.)
- Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Kirsten Leng
- Healthy Food America, Seattle, WA 98122, USA; (K.L.); (J.K.)
| | - Carmen Byker Shanks
- Gretchen Swanson Center for Nutrition, Omaha, NE 68154, USA; (N.B.N.); (C.B.S.); (A.L.Y.); (M.S.)
| | - Amy L. Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE 68154, USA; (N.B.N.); (C.B.S.); (A.L.Y.); (M.S.)
| | - James Krieger
- Healthy Food America, Seattle, WA 98122, USA; (K.L.); (J.K.)
- School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Morgan Szczepaniak
- Gretchen Swanson Center for Nutrition, Omaha, NE 68154, USA; (N.B.N.); (C.B.S.); (A.L.Y.); (M.S.)
| | - Hilary Seligman
- Division of General Internal Medicine, University of California, San Francisco, CA 94143, USA; (M.A.); (H.S.)
- Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA 94110, USA
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Leng KH, Yaroch AL, Nugent NB, Stotz SA, Krieger J. How Does the Gus Schumacher Nutrition Incentive Program Work? A Theory of Change. Nutrients 2022; 14:nu14102018. [PMID: 35631159 PMCID: PMC9146513 DOI: 10.3390/nu14102018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/30/2022] [Accepted: 05/05/2022] [Indexed: 12/27/2022] Open
Abstract
Increased fruit and vegetable (FV) intake is associated with decreased risk of nutrition-related chronic diseases. Sociodemographic disparities in FV intake indicate the need for strategies that promote equitable access to FVs. The United States Department of Agriculture’s Gus Schumacher Nutrition Incentive Program (GusNIP) supports state and local programs that offer nutrition incentives (NIs) that subsidize purchase of FVs for people participating in the Supplemental Nutrition Assistance Program (SNAP). While a growing body of research indicates NIs are effective, the pathways through which GusNIP achieves its results have not been adequately described. We used an equity-focused, participatory process to develop a retrospective Theory of Change (TOC) to address this gap. We reviewed key program documents; conducted a targeted NI literature review; and engaged GusNIP partners, practitioners, and participants through interviews, workshops, and focus groups in TOC development. The resulting TOC describes how GusNIP achieves its long-term outcomes of increased participant FV purchases and intake and food security and community economic benefits. GusNIP provides NIs and promotes their use, helps local food retailers develop the capacity to sell FVs and accept NIs in accessible and welcoming venues, and supports local farmers to supply FVs to food retailers. The TOC is a framework for understanding how GusNIP works and a tool for improving and expanding the program.
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Affiliation(s)
- Kirsten H. Leng
- Healthy Food America, Seattle, WA 98122, USA;
- Correspondence: ; Tel.: +1-206-412-0997
| | - Amy L. Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE 68154, USA; (A.L.Y.); (N.B.N.)
| | - Nadine Budd Nugent
- Gretchen Swanson Center for Nutrition, Omaha, NE 68154, USA; (A.L.Y.); (N.B.N.)
| | - Sarah A. Stotz
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - James Krieger
- Healthy Food America, Seattle, WA 98122, USA;
- School of Public Health, University of Washington, Seattle, WA 98195, USA
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