CPSTF Recommends Fruit and Vegetable Incentive Programs
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.
What are Fruit and Vegetable Incentive Programs?
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.
Why is this important?
Food and nutrition security—having reliable access to enough high-quality food to avoid hunger and stay healthy—is a critical social determinant of health. It reduces chronic diseases, helps people avoid unnecessary health care, and supports overall health (Mozaffarian, Blanck et al. 2022). Conversely, individuals experiencing food insecurity face an elevated risk of premature mortality and a diminished life expectancy compared to their food-secure counterparts (Ma, Wang et al. 2024).
In 2022, 12.8% of U.S. households (17 million) experienced food insecurity, significantly more than the 10.5% prevalence in 2021 (Rabbitt, Hales et al. 2023). People with lower incomes and some racial and ethnic populations are disproportionately affected. In 2021, 35.2% of households below 130% of the poverty threshold, and 20% of Black, 18% of Hispanic or Latino, and 22% of multiracial households, respectively, experienced food insecurity (Healthy People 2030).
Some populations, such as those residing in rural areas, tribal communities, and low-income neighborhoods, face challenges in accessing affordable and nutritious foods like fruits and vegetables. Moreover, certain racial and ethnic groups may encounter difficulties in accessing culturally preferred healthy food options (Zenk, Schulz et al. 2005) (Seligman, Laraia and Kushel 2010) (Ploeg, Breneman et al. n.d.) (Grigsby-Toussaint, Zenk et al. 2010)
Elevated intake of fruits and vegetables has been linked to improved health and well-being including weight loss and reduced risks of type 2 diabetes, stroke, cardiovascular disease, cancer, and all-cause mortality (Arnotti and Bamber 2019) (Dagfinn, Giovannucci et al. 2017) (Wang, Fang et al. 2016). Despite the benefits of fruits and vegetables, only 12% and 10% of U.S. adults meet the recommended daily intake of fruits and vegetables, respectively. Notably, vegetable consumption is particularly low among individuals with lower incomes and Black individuals (7% for both groups) (Lee, Moore et al. 2022).
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References
Arnotti K et al. Fruit and vegetable consumption in overweight or obese individuals: a meta-analysis. Western Journal of Nursing Research 2019; 42(4).
Healthy 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
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.
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.
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.
Ploeg, M. V., et al. (n.d.). “Access to affordable and nutritious food-measuring and understanding food deserts and their consequences: Report to congress.” Retrieved January 17, 2024, from http://www.ers.usda.gov/publications/pub-details/?pubid=42729.
Rabbitt, M. P., et al. Household Food Security in the United States in 2022 (Report No. ERR-325), U.S. Department of Agriculture, Economic Research Service. 2023
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.
Wang, P., 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: 56-59.
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.