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Evaluation of a State-Level Incentive Program to Improve Diet.

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The Eat Well, Be Well (EWBW) program did not significantly increase fruit and vegetable intake for all Supplemental Nutrition Assistance Program (SNAP) participants. However, it benefited those already consuming higher amounts, suggesting targeted strategies are needed for broader impact.

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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.