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| Name | Class |
|---|---|
| Tufts University | OTHER |
| MAXIMUS | UNKNOWN |
| USDA Food and Nutrition Service | FED |
| Massachusetts Department of Transitional Assistance |
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The USDA Healthy Incentives Pilot (HIP) evaluated the impact of a 30% financial incentive on fruit and vegetable intake among adult participants in the USDA Supplemental Nutrition and Assistance Program (SNAP).
U.S. fruit and vegetable intake remains below recommendations, particularly for low-income populations. Evidence on effectiveness of financial incentives for addressing this shortfall is limited.
This study examined effects of USDA's Healthy Incentives Pilot (HIP), which offered financial incentives to Supplemental Nutrition Assistance Program (SNAP) participants for purchasing targeted fruits and vegetables (TFV).
A randomized controlled trial of HIP was conducted in Hampden County, Massachusetts. 7,500 randomly selected SNAP households received a 30% rebate on TFV purchased using SNAP benefits. The remaining 47,595 SNAP households in the county received benefits as usual. Adults in 5,076 households were randomly sampled to complete telephone surveys, including 24-h dietary recall interviews. Surveys were conducted at baseline-1-3 mo pre-implementation-and in two follow-up rounds, 4-6 mo and 9-11 mo post-implementation. 2,784 adults (1,388 HIP, 1,396 non-HIP) completed baseline interviews; data were analyzed for 2,009 adults (72%) also completing at least one follow-up interview.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| HIP | Experimental | Received a 30% rebate on targeted fruits and vegetables (TFV) purchased using SNAP benefits in participating retailers. TFV earning the rebate included fresh, canned, frozen, and dried fruits and vegetables without added sugars, fats, oils, or salt, excluding white potatoes, mature legumes (dried beans and peas), and 100% juice. |
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| Non-HIP | No Intervention | Received SNAP benefits as usual. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| HIP | Other |
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| Measure | Description | Time Frame |
|---|---|---|
| Targeted fruit and vegetable (TFV) intake | Daily adult intake of fresh, canned, frozen, and dried fruits and vegetables without added sugars, fats, oils, or salt, excluding white potatoes, mature legumes (dried beans and peas), and 100% juice. In total and by USDA food pattern group (all targeted fruits; citrus, melon, and berries; other fruits; all targeted vegetables; dark green vegetables; red & orange vegetables (including tomatoes and other red & orange vegetables); starchy vegetables (excluding white potatoes); and other vegetables.) Assessed via computer-assisted telephone interview 24-hour dietary recall (Automated Multiple Pass Method). Measured in cup-equivalents based on USDA Food Pattern Equivalents Database (FPED). Secondary analyses assessed changes between follow-up rounds. | Intake in prior 24 hours; assessed in two follow-up rounds (4-6 mo and 9-11 mo post-implementation) with 10% replicate subsample in each round; data pooled across two follow-up rounds and replicate samples for primary analysis |
| Measure | Description | Time Frame |
|---|---|---|
| All fruit and vegetable intake | Daily adult intake of all fruits and vegetables (fresh, canned, frozen, or dried). In total and by USDA food pattern group (all fruits; citrus, melon, and berries; other fruits; all vegetables; dark green vegetables; red & orange vegetables (including tomatoes and other red & orange vegetables); starchy vegetables (including white potatoes and other starchy vegetables); legumes; and other vegetables.) Assessed via computer-assisted telephone interview 24-hour dietary recall (Automated Multiple Pass Method). Measured in cup-equivalents based on USDA Food Pattern Equivalents Database (FPED). Secondary analyses assessed changes between follow-up rounds. |
| Measure | Description | Time Frame |
|---|---|---|
| Family food environment | Series of nine individual categorical measures describing current family food environment. Assessed via computer-assisted telephone interview. Survey items: "How often do you...
Response categories: 1=never/no refrigerator or freezer, 2=rarely, 3=sometimes, 4=most of the time, 5=always. Secondary analyses assessed changes between follow-up rounds. Baseline values used as covariates in impact estimation regression models to improve precision. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Susan Bartlett, PhD | Abt Associates | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | Abt Associates Inc. Healthy Incentives Pilot: Updated Study Plan. USDA, Food and Nutrition Service, 2011. http://www.fns.usda.gov/sites/default/files/study_plan.pdf. | ||
| Background | Bartlett S, Beauregard M, Logan C, Komarovsky M, Wommack T, Wilde P, Owens C, Melham M, McLaughlin T. Healthy Incentives Pilot (HIP): Early Implementation Report. USDA, Food and Nutrition Service, 2013. http://www.fns.usda.gov/sites/default/files/HIP_Early_Implementation.pdf. | ||
| Background | Chu, A. Evaluation of the Healthy Incentives Pilot (HIP): Participant survey weighting methodology. Alexandria, VA: USDA, Food and Nutrition Service, Office of Policy Support, 2014. | ||
| Result | Bartlett S, Klerman J, Olsho L, Logan C, Blocklin M, Beauregard M, Enver A, Wilde P, Owens C, Melhem M. Evaluation of the Healthy Incentives Pilot (HIP): Final Report. USDA, Food and Nutrition Service, 2014. http://www.fns.usda.gov/healthy-incentives-pilot-final-evaluation-report. | ||
| Result | Wilde P, Klerman JA, Olsho LEW, Bartlett S. Explaining the impact of USDA's Healthy Incentives Pilot on different spending outcomes. Appl Econ Perspect Policy 2015 (Epub ahead of print; DOI: Epub ahead of print; DOI: doi:10.1093/aepp/ppv028). | ||
| Result | Klerman JAK, Bartlett S, Wilde P, Olsho L. The short-run impact of the Healthy Incentives Pilot Program on fruit and vegetable intake. Am J Agr Econ 2015;96:1372-82. |
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Public use dataset available by request from USDA Food & Nutrition Service.
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| OTHER |
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| Intake in prior 24 hours; assessed in two follow-up rounds (4-6 mo and 9-11 mo post-implementation) with 10% replicate subsample in each round; data pooled across two follow-up rounds and replicate samples for main analysis |
| Intake of other foods | Daily adult intake of other foods. By USDA food pattern group (total grains (including whole and refined grains) (ounce-equivalents); total dairy (cup-equivalents); total protein foods (ounce-equivalents); total oils (gram-equivalents); solid fats (gram-equivalents); added sugars (teaspoons); and alcoholic drinks (drinks)). Assessed via computer-assisted telephone interview 24-hour dietary recall (Automated Multiple Pass Method). Measured in servings based on units as specified in the USDA Food Pattern Equivalents Database (FPED). Secondary analyses assessed changes between follow-up rounds. | Intake in prior 24 hours; assessed in two follow-up rounds (4-6 mo and 9-11 mo post-implementation) with 10% replicate subsample in each round; data pooled across two follow-up rounds and replicate samples for main analysis |
| HEI-2010 | Healthy Eating Index-2010 (Guenther et al. 2014). Total and component scores (total fruit; whole fruit; total vegetables; beans and greens; whole grains; dairy; total protein foods; seafood and plant proteins; fatty acids; refined grains; sodium; empty calories). Assessed via computer-assisted telephone interview 24-hour dietary recall (Automated Multiple Pass Method). Servings calculated based on units as specified in the USDA Food Pattern Equivalents Database (FPED). Estimated via population ratio method (see Freedman et al. 2010). Secondary analyses assessed changes between follow-up rounds. | Calculated based on intake in prior 24 hours; assessed in two follow-up rounds (4-6 mo and 9-11 mo post-implementation) with 10% replicate subsample in each round; data pooled across two follow-up rounds and replicate samples for main analysis |
| Assessed at baseline (1-3 mo prior to implementation) and two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis |
| Exposure to nutrition education and promotion | Two individual binary measures describing exposure to nutrition education and promotion in prior three months. Assessed via computer-assisted telephone interview. Survey items: "In the past three months, have you...
Response categories: 1=yes, 2=no. Secondary analyses assessed changes between follow-up rounds. Baseline values used as covariates in impact estimation regression models to improve precision. | Past 3 months; assessed at baseline (1-3 mo prior to implementation) and two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis |
| Food preferences and beliefs | Six individual 5-point Likert scales describing current food preferences and beliefs. Assessed via computer-assisted telephone interview. Survey items: "How much do you agree or disagree with the following statements?
Response categories: 1=strongly disagree, 2=disagree, 3=neither agree nor disagree, 4=agree, 5=strongly agree. Secondary analyses assessed changes between follow-up rounds. Baseline values used as covariates in impact estimation regression models to improve precision. | Assessed at baseline (1-3 mo prior to implementation) and two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis |
| Perceived barriers to fruit and vegetable consumption | Seven individual 5-pt Likert scales re: barriers to fruit & vegetable consumption. Assessed via computer-assisted telephone interview. Svy items: "How much do you agree/disagree that
Responses: 1=strongly disagree, 2=disagree, 3=neither agree nor disagree, 4=agree, 5=strongly agree. Secondary analyses assessed changes btw follow-up rounds. Baseline values used as covariates in impact regression models to improve precision. | Assessed at baseline (1-3 mo prior to implementation) and two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis |
| Perceived barriers to grocery shopping | Two individual 5-point Likert scales describing perceived barriers to grocery shopping. Assessed via computer-assisted telephone interview. Survey items: "How often are you kept from grocery shopping by...
Response categories: 1=never, 2=rarely, 3=sometimes, 4=most of the time, 5=always. Secondary analyses assessed changes between follow-up rounds. Baseline values used as covariates in impact estimation regression models to improve precision. | Assessed at baseline (1-3 mo prior to implementation) and two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis |
| Average monthly household Supplemental Nutrition Assistance Program (SNAP) food expenditures | Constructed from SNAP electronic benefit transfer (EBT) transactions data for March-October 2012.
Secondary analyses assessed changes between follow-up rounds. | Assessed for two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis |
| Self-reported monthly household expenditures | Self-reported monthly household expenditures, by category. Assessed via computer-assisted telephone interview. Survey item: "Please tell us how much you usually spend per month on....
Secondary analyses assessed changes between follow-up rounds. Baseline values used as covariates in impact estimation regression models to improve precision. | Assessed at baseline (1-3 mo prior to implementation) and two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis |
| Usual grocery shopping location | Usual store type for grocery shopping. Assessed via computer-assisted telephone interview. Survey item: "Where do you usually go grocery shopping?
Secondary analyses assessed changes between follow-up rounds. Baseline values used as covariates in impact estimation regression models to improve precision. | Assessed at baseline (1-3 mo prior to implementation) and two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis |
| 27334234 | Derived | Olsho LE, Klerman JA, Wilde PE, Bartlett S. Financial incentives increase fruit and vegetable intake among Supplemental Nutrition Assistance Program participants: a randomized controlled trial of the USDA Healthy Incentives Pilot. Am J Clin Nutr. 2016 Aug;104(2):423-35. doi: 10.3945/ajcn.115.129320. Epub 2016 Jun 22. |