Evaluation of a State-Level Incentive Program to Improve Diet

Area of Science:

• Nutrition Science
• Public Health Policy
• Health Disparities

Background:

• Fruit and vegetable incentive programs aim to improve dietary quality for Supplemental Nutrition Assistance Program (SNAP) participants.
• Few such programs have been implemented at scale, necessitating an understanding of state-level effectiveness for policy decisions.
• The Eat Well, Be Well (EWBW) program in Rhode Island is the first state-level SNAP fruit and vegetable incentive initiative.

Purpose of the Study:

• To evaluate the association of the Eat Well, Be Well (EWBW) program with dietary intake and program awareness among SNAP participants.
• To assess the effectiveness of a state-level fruit and vegetable incentive program during its initial implementation phase.

Main Methods:

• A pre-post cohort study design with a comparison site (Connecticut) was employed, utilizing difference-in-differences analysis.
• Data were collected from SNAP recipients aged 18+ in Rhode Island (intervention) and Connecticut (comparison) via community-based recruitment and text messages.
• The intervention involved automatic enrollment with a $0.50 credit per $1 spent on fruits and vegetables (up to $25/month) via Electronic Benefits Transfer cards.

Main Results:

• No significant overall change in fruit and vegetable intake was observed in Rhode Island relative to Connecticut (0.12 [95% CI, -0.04 to 0.28] cup equivalents per 1000 kcal).
• Stratified analyses revealed a significant increase in fruit and vegetable intake among participants with higher baseline consumption in Rhode Island compared to Connecticut (0.29 [95% CI, 0.03-0.54] cup equivalents per 1000 kcal).
• Program awareness was moderate (36.8% correctly identified purpose), and usage was low (26.4% reported using discounts).

Conclusions:

• The EWBW program, with its 50% incentive and automatic enrollment, did not yield significant relative changes in overall fruit and vegetable intake among SNAP participants.
• The program demonstrated benefits for participants who already consumed higher amounts of fruits and vegetables.
• Enhanced implementation strategies, including broader retail partnerships, improved outreach, and targeted interventions, are crucial for maximizing public health outcomes.