Social Determinants of Health: Fruit and Vegetable Incentive Programs

Snapshot What the CPSTF Found Supporting Materials Considerations for Implementation

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends fruit and vegetable incentive (FVI) programs for households with lower incomes based on strong evidence of effectiveness in reducing household food insecurity and increasing household fruit and vegetable consumption.

Programs in which incentives were provided to participants who were at risk for or had diet-related health conditions improved blood glucose as measured using A1c levels.

Fruit and vegetable incentive programs are expected to improve health equity across the United States by improving affordability and access to healthier foods for households with lower incomes.

Intervention

Fruit and vegetable incentive programs offer people financial incentives to purchase fruits and vegetables. These programs aim to improve affordability and access to fruits and vegetables for participants with lower incomes. Examples include produce prescriptions, bonus dollars, market bucks, produce coupons, and nutrition incentives.

People can use incentives to help pay for fruits and vegetables at a range of venues, including farmers markets, mobile markets, or grocery stores. Incentive models may include:

Point-of-sale discounts (i.e., percentage off regular price)
Rebates (i.e., cash back for future purchases)
Matches (i.e., money tied to the dollar amount spent)
Subsidies (i.e., a fixed amount of money available to purchase fruits and vegetables)

Programs may be implemented by community-based organizations; local, state, territorial, or tribal governments; or health systems. Programs may also offer participants nutrition education, such as cooking lessons or demonstrations.

The impact of the federal nutrition assistance programs such as the Supplemental Nutrition Assistance Program (SNAP); the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and the Food Distribution Program on Indian Reservations (FDPIR) are outside the scope of this review.

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

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About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 30 studies (search period database inception through February 2023) conducted in the United States.

The systematic review was conducted on behalf of CPSTF by a team of specialists in systematic review methods, social determinants of health, and in research, practice, and policy related to food and nutrition security.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The CPSTF finding is based on evidence from a systematic review of 30 studies conducted in the United States. Evidence from the included studies showed fruit and vegetable incentive programs reduced household food insecurity and increased fruit and vegetable consumption. Evidence also showed that programs in which incentives were provided to participants who were at risk for or had diet-related health conditions showed improved blood glucose as measured using A1c levels. Across the studies, the programs:

Reduced household food insecurity

Percent who were food insecure decreased by 18 percentage points (7 studies).

Increased fruit and vegetable consumption

Servings: Increased by 1.10 servings per day (5 studies)
Cups: Increased by 0.13 cups per day (8 studies)
Number of times: Increased by 0.49 times per day (5 studies)

Improved blood glucose measures (among participants at risk for or with diet-related health conditions)

Hemoglobin A1c levels decreased by 0.64 percentage points (6 studies).

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Based on results from this systematic review, the finding should be applicable to people with lower incomes in urban, suburban, and rural settings across the United States, regardless of sex, race or ethnicity, age, or educational attainment. Findings are applicable regardless of the organization that offered the program, incentive redemption venue, whether programs offered other intervention components in addition to incentives, incentive frequency and model, and intervention duration.

Evidence Gaps

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base.

CPSTF identified the following questions as priorities for research and evaluation:

What is the long-term impact of FVI programs and how can improvement in outcomes be sustained after the program ends?
How does effectiveness vary among population groups (e.g., children, recipients of SNAP or WIC, people with or at risk for diet-related health conditions)?
How can programs best be tailored to participants to improve incentive redemption and program effectiveness?

Remaining questions for research and evaluation identified in this review include:

How can researchers use consistent dietary measures for fruit and vegetable consumption to enable comparisons across studies?
How does the seasonality of farmers markets impact participants’ fruit and vegetable purchases and consumption? How can improvements in outcomes be sustained during the off-season?
What is the total incentive amount provided by programs? Does program effectiveness vary by the amount provided?
Does program effectiveness vary by the incentive model? Specifically, do point-of-sale discounts and rebates work as well as subsidies and matches?
What are the best strategies for recruiting people who are eligible for nutritional assistance programs (e.g., SNAP), but not enrolled?

Study Characteristics

Study designs included single group pre-post (18 studies), randomized control trial (5 studies), pre-post with concurrent comparison group (5 studies), retrospective cohort (1 study), and time series with no comparison group (1 study).
All of the included studies were conducted in the United States (30 studies).
Over half of the included studies evaluated fruit and vegetable incentive programs in urban areas (16 studies). The remaining studies were conducted in a combination of urban, suburban, and rural settings (9 studies), rural areas alone (4 studies), or tribal lands (1 study).
Studies that collected information on sex (25 studies) reported most of their participants were female (72%).
Studies that collected information on participants’ self-identified racial or ethnic background reported that 37% participants were Hispanic or Latino (24 studies), 28% were Black or African American (26 studies), 27% were White (25 studies), 14% were Native Hawaiian or Other Pacific Islander (1 study), 9% were Asian (7 studies), 3% were two or more races (4 studies), 2% were American Indian or Alaska Native (4 studies), and 4% identified as other race or ethnicity (16 studies).
All studies included participants with lower income (30 studies).
In studies reporting participation in the Supplemental Nutrition Assistance Program (SNAP; 14 studies), 55% of participants received SNAP benefits.
In studies reporting participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC; 11 studies), 16% of participants received WIC benefits.
The median participant age was 42 years (22 studies).
Studies included programs offered through local government or community organizations (16 studies) and health care providers (13 studies), or a mix of both (1 study).
Studies included incentives that were redeemed in farmers markets (16 studies), grocery stores (3 studies), or a mix of both (9 studies).
Of studies reporting additional components, programs offered nutrition or diet-related disease prevention education (16 studies), activities or materials in multiple languages (6 studies), and retailer training or support (4 studies). Other components offered were vendor signage (2 studies) and participant training on how the program works (2 studies). One study each reported having community health workers to follow up on progress of goals, kitchen cooking supplies kit, customized informational mailings, and transportation to the intervention venue.
Participants received incentives monthly (7 studies), weekly (4 studies), at the time of their visit to the program implementation or redemption venue (12 studies), all incentives at one time (3 studies), or without a formal schedule (4 studies).
Programs offered incentives in the form of subsidies (i.e., a fixed amount of money available to purchase fruits and vegetables; 21 studies), matches (i.e., money tied to the dollar amount spent; 6 studies), and point-of-sale discounts (i.e., percentage off regular price; 1 study).
The median program duration was 6 months (22 studies).

Analytic Framework

Effectiveness Review

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Summary Evidence Table

Effectiveness Review

Summary Evidence Table – Effectiveness Review [PDF – 616 KB]

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Anliker JA, Winne M, Drake LT. An evaluation of the Connecticut Farmers’ Market coupon program. Journal of Nutrition Education. 1992;24(4):185-91.

Atoloye AT, Savoie-Roskos MR, Durward CM. Higher Fruit and Vegetable Intake Is Associated with Participation in the Double Up Food Bucks (DUFB) Program. Nutrients. 2021;13(8):29.

Bartlett S, Klerman J, Olsho L, Logan C, Blocklin M, Beauregard M, et al. Evaluation of the Healthy Incentives Pilot (HIP): Final Report. Prepared by Abt Associates for the U.S. Department of Agriculture, Food and Nutrition Service. 2014.

Basu S, Akers M, Berkowitz SA, Josey K, Schillinger D, Seligman H. Comparison of Fruit and Vegetable Intake Among Urban Low-Income US Adults Receiving a Produce Voucher in 2 Cities. JAMA netw. 2021;4(3):e211757.

Basu S, Gardner CD, White JS, Rigdon J, Carroll MM, Akers M, et al. Effects Of Alternative Food Voucher Delivery Strategies On Nutrition Among Low-Income Adults. Health Aff (Millwood). 2019;38(4):577-84.

Bowling AB, Moretti M, Ringelheim K, Tran A, Davison K. Healthy Foods, Healthy Families: combining incentives and exposure interventions at urban farmers’ markets to improve nutrition among recipients of US federal food assistance. Health promot. 2016;6(1):10-6.

Bryce R, Guajardo C, Ilarraza D, Milgrom N, Pike D, Savoie K, et al. Participation in a farmers’ market fruit and vegetable prescription program at a federally qualified health center improves hemoglobin A1C in low income uncontrolled diabetics. Prev Med Rep. 2017;7:176-9.

Bryce R, Wolfson JA, Cohen A, Milgrom N, Garcia D, Steele A, et al. A pilot randomized controlled trial of a fruit and vegetable prescription program at a federally qualified health center in low income uncontrolled diabetics. Prev Med Rep. 2021;23:101410.

Cavanagh M, Jurkowski J, Bozlak C, Hastings J, Klein A. Veggie Rx: an outcome evaluation of a healthy food incentive programme. Public Health Nutr. 2017;20(14):2636

Cook M, Ward R, Newman T, Berney S, Slagel N, Bussey-Jones J, et al. Food Security and Clinical Outcomes of the 2017 Georgia Fruit and Vegetable Prescription Program. J Nutr Educ Behav. 2021;53(9):770-8.

Durward CM, Savoie-Roskos M, Atoloye A, Isabella P, Jewkes MD, Ralls B, et al. Double Up Food Bucks Participation is Associated with Increased Fruit and Vegetable Consumption and Food Security Among Low-Income Adults. J Nutr Educ Behav. 2019;51(3):342-7.

Fertig AR, Tang X, Dahlen HM. The effect of a fresh produce incentive paired with cooking and nutrition education on healthy eating in low-income households: a pilot study. Public Health Nutr. 2021;24(9):2704-14.

Gordon B, Ridinger S, Krick R, Grosvenor L, Charron R. Fruit and Vegetable Prescription Program for Diabetes Control Among Community Health Centers in Rural Idaho and Oregon. Am J Public Health. 2022;112(7):975-9.

GusNIP NTAE. Gus Schumacher Nutrition Incentive Program (GusNIP): Impact Findings Y3: September 1, 2021 to August 31, 2022. Prepared for U.S. Department of Agriculture, National Institute of Food and Agriculture; 2023.

Harnack L, Oakes JM, Elbel B, Beatty T, Rydell S, French S. Effects of Subsidies and Prohibitions on Nutrition in a Food Benefit Program: A Randomized Clinical Trial. JAMA Intern Med. 2016;176(11):1610-8.

Herman DR, Harrison GG, Afifi AA, Jenks E. Effect of a targeted subsidy on intake of fruits and vegetables among low-income women in the Special Supplemental Nutrition Program for Women, Infants, and Children. Am J Public Health. 2008;98(1):98-105.

Jones LJ, VanWassenhove-Paetzold J, Thomas K, Bancroft C, Ziatyk EQ, Kim LS, et al. Impact of a Fruit and Vegetable Prescription Program on Health Outcomes and Behaviors in Young Navajo Children. Curr. 2020;4(8):nzaa109.

Lyonnais MJ, Rafferty AP, Spratt S, Jilcott Pitts S. A Produce Prescription Program in Eastern North Carolina Results in Increased Voucher Redemption Rates and Increased Fruit and Vegetable Intake among Participants. Nutrients. 2022;14(12):11.

Moran A, Thorndike A, Franckle R, Boulos R, Doran H, Fulay A, et al. Financial Incentives Increase Purchases Of Fruit And Vegetables Among Lower-Income Households With Children. Health Aff (Millwood). 2019;38(9):1557-66.

Ratigan AR, Lindsay S, Lemus H, Chambers CD, Anderson CA, Cronan TA, et al. Factors associated with continued participation in a matched monetary incentive programme at local farmers’ markets in low-income neighbourhoods in San Diego, California. Public Health Nutr. 2017;20(15):2786-95.

Ridberg RA, Bell JF, Merritt KE, Harris DM, Young HM, Tancredi DJ. A Pediatric Fruit and Vegetable Prescription Program Increases Food Security in Low-Income Households. Journal of Nutrition Education and Behavior. 2019;51(2):224-30.e1.

Ridberg RA, Levi R, Marpadga S, Akers M, Tancredi DJ, Seligman HK. Additional Fruit and Vegetable Vouchers for Pregnant WIC Clients: An Equity-Focused Strategy to Improve Food Security and Diet Quality. Nutrients. 2022;14(11):01.

Ridberg RA, Marpadga S, Akers MM, Bell JF, Seligman HK. Fruit and Vegetable Vouchers in Pregnancy: Preliminary Impact on Diet & Food Security. Journal of Hunger and Environmental Nutrition. 2021;16(2):149-63.

Savoie-Roskos M, Durward C, Jeweks M, LeBlanc H. Reducing Food Insecurity and Improving Fruit and Vegetable Intake Among Farmers’ Market Incentive Program Participants. J Nutr Educ Behav. 2016;48(1):70-6.e1.

Saxe-Custack A, LaChance J, Hanna-Attisha M. Child Consumption of Whole Fruit and Fruit Juice Following Six Months of Exposure to a Pediatric Fruit and Vegetable Prescription Program. Nutrients. 2019;12(1):20.

Saxe-Custack A, LaChance J, Jess J, Hanna-Attisha M. Influence of a Pediatric Fruit and Vegetable Prescription Program on Child Dietary Patterns and Food Security. Nutrients. 2021;13(8):29.

Trapl ES, Smith S, Joshi K, Osborne A, Benko M, Matos AT, et al. Dietary Impact of Produce Prescriptions for Patients With Hypertension. Prev Chronic Dis. 2018;15:E138.

Veldheer S, Scartozzi C, Bordner CR, Opara C, Williams B, Weaver L, et al. Impact of a Prescription Produce Program on Diabetes and Cardiovascular Risk Outcomes. J Nutr Educ Behav. 2021;53(12):1008-17.

Vericker T, Dixit-Joshi S, Taylor J, Giesen L, Gearing M, Baier K, et al. The Evaluation of Food Insecurity Nutrition Incentives (FINI) Interim Report. Prepared by Westat, Inc. for the U.S. Department of Agriculture, Food and Nutrition Service. 2019.

Weinstein E, Galindo RJ, Fried M, Rucker L, Davis NJ. Impact of a focused nutrition educational intervention coupled with improved access to fresh produce on purchasing behavior and consumption of fruits and vegetables in overweight patients with diabetes mellitus. Diabetes Educ. 2014;40(1):100-6.

Search Strategies

Effectiveness Review

The CPSTF recommendation is based on a systematic review of 30 studies (published through February 2023). Databases searched for this review included CINAHL, Cochrane Library, Embase, Google Scholar, Medline, PsycInfo, Scopus, Sociological Abstracts, and the USDA website.

CINAHL

S1 TI ( (access* OR incentive* OR intervention* OR “Double Up Food Bucks” OR “Gus Schumacher” OR GUSNIP OR “Double-Dollar” OR “Health Bucks*” OR “Dollar for Dollar” OR coupon* OR voucher* OR subsid* OR rebate* OR match* OR prescri* OR discount OR motivation OR price OR usage) ) OR AB ( (access* OR incentive* OR intervention* OR “Double Up Food Bucks” OR “Gus Schumacher” OR GUSNIP OR “Double-Dollar” OR “Health Bucks*” OR “Dollar for Dollar” OR coupon* OR voucher* OR subsid* OR rebate* OR match* OR prescri* OR discount OR motivation OR price OR usage) )
S2 TI ( (health N2 promotion) OR (nutrition N2 assistance) OR (FINI N2 program) OR (nutrition N2 education) OR (government N2 financ*) ) OR AB ( (health N2 promotion) OR (nutrition N2 assistance) OR (FINI N2 program) OR (nutrition N2 education) OR (government N2 financ*) )
S3 TI (double N2 dollar) OR AB (double N2 dollar)
S4 TI ( ((program* OR project*) N5 ((produce* N2 prescription*) OR (food N2 prescription*) OR (nutrition N2 incentive*) OR nutrition)) ) OR AB ( ((program* OR project*) N5 ((produce* N2 prescription*) OR (food N2 prescription*) OR (nutrition N2 incentive*) OR nutrition)) )
S5 TI ( ((FVs OR FVI OR (fruit* N2 vegetable*)) N5 (assistance OR health* OR purchase* Or program* OR suppl* OR securit* OR access* OR incentive* OR intervention* OR coupon* OR voucher* OR subsid* OR rebate* OR match* OR prescrip* OR discount OR motivation OR price OR impact OR usage OR insecurit* OR benefit*)) ) OR AB ( ((FVs OR FVI OR (fruit* N2 vegetable*)) N5 (assistance OR health* OR purchase* Or program* OR suppl* OR securit* OR access* OR incentive* OR intervention* OR coupon* OR voucher* OR subsid* OR rebate* OR match* OR prescrip* OR discount OR motivation OR price OR impact OR usage OR insecurit* OR benefit*)) )
S6 TI (farmer* N2 Market*) OR AB (farmer* N2 Market*)
S7 TI ( (“Supplementary Nutrition Assistance Program” OR SNAP OR “WIC”)) ) OR AB ( (“Supplementary Nutrition Assistance Program” OR SNAP OR “WIC”)) )
S8 S1 OR S2 OR S3 OR S4
S9 S5 OR S6 OR S7
S10 S8 AND S9
Exclude Medline Journals

Cochrane Library

#1 ( access* OR incentive* OR intervention* OR “Double Up Food Bucks” OR “Gus Schumacher” OR gusnip OR “Double-Dollar” OR “Healthy Bucks” OR “Dollar For Dollar” OR coupon* OR voucher* OR subsid* OR rebate* OR match* OR prescri* OR discount OR motivation OR price OR usage):ti,ab
#2 (health NEAR/2 promotion) OR (nutrtion NEAR/2 assistance) OR (FINI NEAR/2 program) OR (Nutrition NEAR/2 education) OR (government NEAR/2 financ*) OR ((program* OR project*) NEAR/5 ((produce NEAR/2 prescription*) OR (food NEAR/2 prescription*) OR (nutrition NEAR/2 incentive*) OR nutrition)):ti,ab
#3 #1 OR #2
#4 ((FVs OR fvi OR (fruit* NEAR/2 vegetable*)) NEAR/5 (assistance OR health* OR purchase* OR program* OR suppl* OR securit* OR access* OR incentive* OR intervention* OR coupon* OR voucher* OR subsid* OR rebate* OR match* OR prescrip* OR discount OR motivation OR price OR impact OR usage OR insecurit* OR benefit)) OR (farmer* NEAR/2 market*) OR ((Supplementary Nutrition Assistance Program OR SNAP OR WIC)):ti,ab
#5 #3 AND #4

Embase

1 ((FVs or FVI or (Fruit* adj2 vegetable*)) adj5 (assistance or health* or purchas* or program* or suppl* or secuit* or insecuriti* or benefit*)).ti,ab.
2 (farmer* adj2 market*).ti,ab. or produce.ti.
3 (nutrition adj2 security).ti,ab.
4 SNAP.ti,ab.
5 WIC.ti,ab.
6 healthy diet/
7 Fruit/ and (Food Assistance/ or Healthy Diet/ or Prescription/)
8 Vegetable/ and (Food Assistance/ or Healthy Diet/ or Prescription/)
9 food assistance/
10 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9
11 motivation/
12 program evaluation/
13 health promotion/
14 (Gus Schumacher or GUSNIP).mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term word]
15 ((program* or project*) adj5 ((produce* adj2 prescription*) or (nutrition adj2 incentive*) or nutrition)).ti,ab.
16 (FINI adj2 program).ti,ab.
17 (Double Up Food Bucks or DUFB).ti,ab.
18 ((Double adj2 dollar) or double-dollar or double up or (bonus adj2 dollar*)).ti,ab. 58
19 (health adj2 promotion).ti,ab.
20 (access* or incentive* or intervention* or coupon* or voucher* or subsid* or rebate* or match* or prescri* or discount or motivation or price or usage or (government adj2 financ*)).ti,ab.
21 (nutrition adj2 education).ti,ab,kw,kf.
22 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21
23 10 and 22
24 exp Animal/ not exp Human/
25 23 not 24
26 limit 25 to (english language and “remove medline records”)

Google Scholar

Incentive OR Program AND Farmers Market OR USDA OR Fruits OR Vegetables

Medline

1 ((FVs or FVI or (Fruit* adj2 vegetable*)) adj5 (assistance or health* or purchas* or program* or suppl* or secuit* or insecuriti* or benefit*)).ti,ab.
2 (farmer* adj2 market*).ti,ab. or produce.ti.
3 (Nutrition adj2 security).ti,ab.
4 SNAP.ti,ab.
5 WIC.ti,ab.
6 Food/ec
7 Diet, Healthy/ec
8 Fruit/ and (Food Assistance/ or Food Supply/ or Diet, Healthy/ or Prescriptions/)
9 Vegetables/ and (Food Assistance/ or Food Supply/ or Diet, Healthy/ or Prescriptions/)
10 Food Assistance/ec
11 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10
12 Motivation/
13 Financing, Government/
14 Program Evaluation/
15 Health Promotion/
16 (Gus Schumacher or GUSNIP).mp.
17 ((program* or project*) adj5 ((produce adj2 prescription*) or (food adj2 prescription*) or (nutrition adj2 incentive*) or nutrition)).ti,ab
18 (FINI adj2 program).ti,ab.
19 (Double Up Food Bucks or DUFB).ti,ab.
20 ((Double adj2 dollar) or double-dollar or double up or (bonus adj2 dollar*)).ti,ab.
21 (health adj2 promotion).ti,ab.
22 (access* or incentive* or intervention* or coupon* or voucher* or subsid* or rebate* or match* or prescri* or discount or motivation or price or usage or (government adj financ*)).ti,ab.
23 (nutrition adj2 education).ti,ab,kw,kf.
24 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23
25 11 and 24
26 exp Animal/ not exp Human/
27 25 not 26 5942
28 limit 27 to english language

PsycInfo

1 ((FVs or FVI or (Fruit* adj2 vegetable*)) adj5 (assistance or health* or purchas* or program* or suppl* or secuit* or insecuriti* or benefit*)).ti,ab.
2 (farmer* adj2 market*).ti,ab.
3 (nutrition adj2 security).ti,ab.
4 SNAP.ti,ab.
5 WIC.ti,ab.
6 (Fruit and (food assistance or food supply or healthy diet or Prescription*)).mp.
7 (vegetables and (food assistance or food supply or healthy diet or prescription*)).mp.
8 food assistance.mp.
9 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8
10 Motivation/
11 (financ* adj2 government).mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures, mesh word]
12 Program Evaluation/
13 Health Promotion/
14 (Gus Schumacher or GUSNIP).mp.
15 ((program* or project*) adj5 ((produce* adj2 prescription*) or (nutrition adj2 incentive*) or nutrition)).ti,ab.
16 (FINI adj2 program).ti,ab.
17 (Double Up Food Bucks or DUFB).ti,ab.
18 ((double adj2 dollar) or double-dollar or double up or (bonus adj2 dollar*)).ti,ab.
19 (health adj2 promotion).ti,ab.
20 (access* or incentive* or intervention* or coupon* or voucher* or subsid* or rebate* or match* or prescri* or discount or motivation or price or usage or (government adj2 financ*)).ti,ab.
21 (nutrition adj2 education).ti,ab.
22 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21
23 9 and 22
24 limit 23 to english language

Scopus

( TITLE-ABS ( access* OR incentive* OR intervention* OR “Double Up Food Bucks” OR “Gus Schumacher” OR gusnip OR “Double Dollar” OR “Healthy Bucks” OR “Dollar For Dollar” OR coupon* OR voucher* OR subsid* OR rebate* OR match* OR prescri* OR discount OR motivation OR price OR usage ) OR TITLE-ABS ( health W/2 promotion ) OR TITLE-ABS ( nutrition W/2 assistance ) OR TITLE-ABS ( “FINI program” ) OR TITLE-ABS ( nutrition W/2 education ) OR TITLE-ABS ( government W/2 financ* ) OR TITLE-ABS ( ( program* OR project* ) W/5 ( ( produce W/2 prescription* ) OR ( food W/2 prescription* ) OR ( nutrition* W/2 incentive* ) OR nutrition ) ) ) AND ( TITLE-ABS ( ( fvs OR fvi OR ( fruit* W/2 vegetable* ) ) W/5 ( assistance OR health* OR purchase* OR program* OR suppl* OR securit* OR access* OR incentive* OR intervention* OR coupon* OR voucher* OR subsid* OR rebate* OR match* OR prescrip* OR discount OR motivation OR price OR impact OR usage OR insecurit* OR benefit* ) ) OR TITLE-ABS ( farmer* W/2 market* ) OR TITLE-ABS ( “Supplementary Nutrition Assistance Program” OR snap OR “WIC” ) ) AND NOT INDEX ( medline ) AND ( LIMIT-TO ( LANGUAGE , “English” )

Sociological Abstracts

noft((((FVs OR fvi OR (fruit* NEAR/2 vegetable*)) NEAR/5 (assistance OR health* OR purchase* OR program* OR suppl* OR securit* OR access* OR incentive* OR intervention* OR coupon* OR voucher* OR subsid* OR rebate* OR match* OR prescrip* OR discount OR motivation OR price OR impact OR usage OR insecurit* OR benefit)) OR (farmer* NEAR/2 market*) OR ((Supplementary Nutrition Assistance Program OR SNAP OR WIC))))

AND

noft(((access* OR incentive* OR intervention* OR “Double Up Food Bucks” OR “Gus Schumacher” OR gusnip OR “Double-Dollar” OR “Healthy Bucks” OR “Dollar For Dollar” OR coupon* OR voucher* OR subsid* OR rebate* OR match* OR prescri* OR discount OR motivation OR price OR usage)) OR ((“health promotion”) OR (“nutrition assistance”) OR (“FINI program”) OR (“Nutrition education”) OR (government NEAR/2 financ*) OR (“double dollar*”) OR ((program* OR project*) NEAR/5 ((produce NEAR/2 prescription*) OR (food NEAR/2 prescription*) OR (nutrition NEAR/2 incentive*) OR nutrition))))

Limits:

Language: English

Review References

Anliker JA, Winne M, Drake LT. An evaluation of the Connecticut Farmers’ Market coupon program. Journal of Nutrition Education. 1992;24(4):185-91

Arnotti K, Bamber M. Fruit and vegetable consumption in overweight or obese individuals: a meta-analysis. Western Journal of Nursing Research 2019; 42(4).

Atoloye AT, Savoie-Roskos MR, Durward CM. Higher Fruit and Vegetable Intake Is Associated with Participation in the Double Up Food Bucks (DUFB) Program. Nutrients. 2021;13(8):29.

Cavanagh M, Jurkowski J, Bozlak C, Hastings J, Klein A. Veggie Rx: an outcome evaluation of a healthy food incentive programme. Public Health Nutr. 2017;20(14):2636-41.

Centers for Disease Control and Prevention. Priority Nutrition Strategy: Fruit and Vegetable Voucher Incentives and Produce Prescriptions. Atlanta (GA); 2023. Available from URL:. https://www.cdc.gov/nutrition/state-and-local-strategies/priority-incentives-prescriptions.html

Centers for Disease Control and Prevention. Food and Nutrition Security: NCCDPHP’s Program Successes. Atlanta (GA); 2023. Available from URL:. https://www.cdc.gov/chronicdisease/healthequity/sdoh-and-chronic-disease/nccdphp-and-social-determinants-of-health/food-and-nutrition-security.htm

Dagfinn A, Giovannucci E, Boffetta P, et al, Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality—a systematic review and dose-response meta-analysis of prospective studies, International Journal of Epidemiology, Volume 46, Issue 3, June 2017, Pages 1029–1056

Grigsby-Toussaint, D. S., et al. Availability of commonly consumed and culturally specific fruits and vegetables in African-american and Latino neighborhoods. J Am Diet Assoc. 2010; 110(5): 746-752.

Healty People 2030. Current Population Survey Food Security Supplement. Accessed on February 5, 2024. https://health.gov/healthypeople/objectives-and-data/data-sources-and-methods/data-sources/current-population-survey-food-security-supplement-cps-fss

Lee SH, Moore LV, Park S, et al. Adults meeting fruit and vegetable intake recommendations— United States, 2019. Morbidity and Mortality Weekly Report 2022; 71: 1-9.

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(10):2018.

Ma, H., et al. Food insecurity and premature mortality and life expectancy in the US. JAMA Internal Medicine. 2024

Mozaffarian, D., et al. A Food is Medicine approach to achieve nutrition security and improve health. Nat Med 2022; 28: 2238-2240.

Rabbitt MP, Hales LJ, Burke MP, & Coleman-Jensen A. (2023). Household Food Security in the United States in 2022 (Report No. ERR-325), U.S. Department of Agriculture, Economic Research Service.

Saxe-Custack A, LaChance J, Jess J, Hanna-Attisha M. Influence of a Pediatric Fruit and Vegetable Prescription Program on Child Dietary Patterns and Food Security. Nutrients. 2021;13(8):29.

Seligman, H. K., et al. Food insecurity is associated with chronic disease among low-income NHANES participants. Journal of Nutrition 2010; 140(2): 304-310.

Trapl ES, Smith S, Joshi K, Osborne A, Benko M, Matos AT, et al. Dietary Impact of Produce Prescriptions for Patients With Hypertension. Prev Chronic Dis. 2018;15:E138.

Wang P, Fang J, Gao Z, et al. Higher intake of fruits, vegetables or their fiber reduces the risk of type 2 diabetes: A meta-analysis. Journal of Diabetes Investigation 2016; 7: 56-69

Zenk, S. N., et al. Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. American Journal of Public Health 2005; 95(4): 660-667.

Considerations for Implementation

The following considerations for implementation are drawn from studies included in the existing evidence review, the broader literature, and expert opinion.

Program participation and retention may be improved by:

Tailoring the program so that it carefully considers the culture and context of specific populations (Saxe-Custack et al. 2021, Jones et al. 2020).
Offering additional program components such as cooking demonstrations, grocery store tours, and activities for children (Anliker et al. 1992, Fertig et al. 2021, Bowling et al. 2016).
Including reinforcing messages about the benefits of increased fruit and vegetable consumption from healthcare providers in programs that offer produce prescriptions (Cavanagh et al. 2017).

Incentive use may be improved by:

Identifying redemption sites that are accessible to participants to reduce distance and transportation barriers (Bartlett et al. 2014, Veldheer et al. 2021).
Providing participants with information about how incentives work, which items are eligible for redemption, and where incentives can be redeemed (Atolye et al. 2021, Vericker 2019).
Providing more flexibility to participants in terms of where incentives can be redeemed.

Other implementation considerations include:

Fruit and vegetable incentive programs may have a more significant impact in regions and states with higher rates of household food insecurity (Rabbitt et al. 2023).
Engaging with community partners (e.g., faith communities, community-based organizations) in program design and recruitment to improve program implementation (Fertig et al. 2021, Lyonnais et al. 2022).
Supporting participants after the program has ended so they may sustain behavior change without financial incentives.
Providing implementers with access to technological tools to improve tracking of participants’ incentive use and products purchased.

There are several publicly available resources that provide guidance on fruit and vegetable incentive program implementation:

CDC: Priority Nutrition Strategy: Fruit and Vegetable Voucher Incentives and Produce Prescriptions offers strategies for state and local partners to expand existing programs.
Nutrition Incentive Hub provides training, technical assistance, reporting, and evaluation support to strengthen fruit and vegetable incentive programs.
How to Run a Nutrition Incentive Nutrition Program: A Toolkit for Wholesome Wave’s National Nutrition Network [PDF – 6.6 MB] is designed for market managers, electronic benefit transfer (EBT) coordinators, and other program administrators interested in bringing programs to farm-to-retail venues.
How Does the Gus Schumacher Nutrition Incentive Program (GusNIP) Work? A Theory of Change [PDF – 631 KB] GusNIP funds government agencies and non-profit organizations to implement fruit and vegetable incentive programs. This article provides an overview of how GusNIP nutrition incentives work.
An Introduction to Incorporating Diversity, Equity, and Inclusion (DEI) into Nutrition Incentive Program Research and Evaluation [PDF – 2.2 MB] provides strategies for incorporating DEI into FVI program research and evaluation.
Supporting Food & Nutrition Security through Healthcare [PDF – 12.2 MB] serves as resource for healthcare systems and their public health and community partners to support food and nutrition security in their communities through programs, policies, and practices, including produce prescription programs.
No Kid Hungry’s Rural Produce Prescription Toolkit provides a toolkit for people planning and operating produce prescription programs in rural areas.
Food Sovereignty, Health, and Produce Prescription Programs: A Case Study in Two Rural Tribal Communities describes the implementation of produce prescription programs in two rural tribal communities. The article also provides strategies for addressing unique challenges of implementing fruit and vegetable incentive programs in tribal communities.

Crosswalks

Healthy People 2030

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.