The California Nutrition Incentive Program: Participants’ Perceptions and Associations with Produce Purchases, Consumption, and Food Security
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants and Recruitment
2.3. Procedures
2.4. Instruments
2.5. Measures
2.6. Data Analysis
2.7. Qualitative Data Analysis
3. Results
3.1. Use, Perception, and Awareness of the Incentive Program
3.2. Produce Purchasing Behavior
3.3. Produce Consumption
3.4. Food Security
3.5. Qualitative Findings
4. Discussion
4.1. Limitations
4.2. Implications for Research and Practice
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Lee-Kwan, H.S.; Moore, V.L.; Blanck, M.H.; Harris, M.D.; Galuska, D. Disparities in State-Specific Adult Fruit and Vegetable Consumption-United States, 2015. Morb. Mortal. Wkly. Rep. 2017, 66, 1241–1247. [Google Scholar] [CrossRef] [PubMed]
- Hu, E.A.; Steffen, L.M.; Coresh, J.; Appel, L.J.; Rebholz, C.M. Adherence to the Healthy Eating Index-2015 and Other Dietary Patterns May Reduce Risk of Cardiovascular Disease, Cardiovascular Mortality, and All-Cause Mortality. J. Nutr. 2020, 150, 312–321. [Google Scholar] [CrossRef] [PubMed]
- Schwingshackl, L.; Bogensberger, B.; Hoffmann, G. Diet Quality as Assessed by the Healthy Eating Index, Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension Score, and Health Outcomes: An Updated Systematic Review and Meta-Analysis of Cohort Studies. J. Acad. Nutr. Diet. 2018, 118, 74–100.e111. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Zhang, F.F.; Liu, J.X.; Rehm, C.D.; Wilde, P.; Mande, J.R.; Mozaffarian, D. Trends and Disparities in Diet Quality Among US Adults by Supplemental Nutrition Assistance Program Participation Status. JAMA Netw. Open 2018, 1, e180237. [Google Scholar] [CrossRef] [Green Version]
- Fernald, L.C.H.; Gosliner, W. Alternatives to SNAP: Global Approaches to Addressing Childhood Poverty and Food Insecurity. Am. J. Public Health 2019, 109, 1668–1677. [Google Scholar] [CrossRef]
- Niles, M.T.; Bertmann, F.; Belarmino, E.H.; Wentworth, T.; Biehl, E.; Neff, R. The Early Food Insecurity Impacts of COVID-19. Nutrients 2020, 12, 2096. [Google Scholar] [CrossRef]
- Wolfson, J.A.; Leung, C.W. Food Insecurity and COVID-19: Disparities in Early Effects for US Adults. Nutrients 2020, 12, 1648. [Google Scholar] [CrossRef]
- Leddy, A.M.; Weiser, S.D.; Palar, K.; Seligman, H. A conceptual model for understanding the rapid COVID-19-related increase in food insecurity and its impact on health and healthcare. Am. J. Clin. Nutr. 2020, 112, 1162–1169. [Google Scholar] [CrossRef]
- Coleman-Jensen, A.; Rabbit, M.P.; Gregory, C.A.; Singh, A. Household Food Security in the United States in 2020; United States Department of Agriculture, Economic Research Service: Washington, DC, USA, 2021. [Google Scholar]
- Nord, M. How much does the Supplemental Nutrition Assistance Program alleviate food insecurity? Evidence from recent programme leavers. Public Health Nutr. 2011, 15, 811–817. [Google Scholar] [CrossRef] [Green Version]
- Mabli, J.; Worthington, J. Supplemental Nutrition Assistance Program Participation and Child Food Security. Pediatrics 2014, 133, 610. [Google Scholar] [CrossRef] [Green Version]
- Gosliner, W.; Shah, H.D. Participant voices: Examining issue, program, and policy priorities of SNAP-Ed eligible adults in California. Renew. Agric. Food Syst. 2019, 35, 407–415. [Google Scholar] [CrossRef] [Green Version]
- Caswell, J.A.; Yaktine, A.L. Supplemental Nutrition Assistance Program: Examining the Evidence to Define Benefit Adequacy; Food and Nutrition Board; Institute of Medicine andNational Research Council: Washington, DC, USA, 2013. [Google Scholar]
- Waxman, E.; Gundersen, C.; Thompson, M. How Far Do SNAP Benefits Fall Short of Covering the Cost of a Meal? Urban Institute: Washington, DC, USA, 2018. [Google Scholar]
- Edin, K.; Boyd, M.; Mabli, J.; Ohls, J.; Worthington, J.; Greene, S.; Redel, N.; Sridharan, S. SNAP Food Security in-Depth Interview Study; Mathematica Policy Research: Princeton, NJ, USA, 2013. [Google Scholar]
- Zhongming, Z.; Linong, L.; Xiaona, Y.; Wangqiang, Z.; Wei, L. USDA Modernizes the Thrifty Food Plan, Updates SNAP Benefits; United States Department of Agriculture: Washington, DC, USA, 2021. Available online: https://www.usda.gov/media/press-releases/2021/08/16/usda-modernizes-thrifty-food-plan-updates-snap-benefits (accessed on 1 June 2022).
- Dubowitz, T.; Zenk, S.N.; Ghosh-Dastidar, B.; Cohen, D.A.; Beckman, R.; Hunter, G.; Steiner, E.D.; Collins, R.L. Healthy food access for urban food desert residents: Examination of the food environment, food purchasing practices, diet and BMI. Public Health Nutr. 2015, 18, 2220–2230. [Google Scholar] [CrossRef] [Green Version]
- Lucas, F.D. HR 2642—Agricultural Act of 2014. In 113th Congress (2013–2014); 2014. Available online: https://www.congress.gov/bill/113th-congress/house-bill/2642 (accessed on 13 December 2021).
- Parks, C.A.; Stern, K.L.; Fricke, H.E.; Clausen, W.; Fox, T.A.; Yaroch, A.L. Food Insecurity Nutrition Incentive Grant Program: Implications for the 2018 Farm Bill and Future Directions. J. Acad. Nutr. Diet. 2019, 119, 395–399. [Google Scholar] [CrossRef]
- Vericker, T.; Dixit-Joshi, S.; Taylor, J.; May, L.; Baier, K.; Williams, E.S. Impact of Food Insecurity Nutrition Incentives on Household Fruit and Vegetable Expenditures. J. Nutr. Educ. Behav. 2021, 53, 418–427. [Google Scholar] [CrossRef]
- Nutrition Incentive Matching Grant Program. California Assembly Bill 1321. Sacramento, CA, USA. 2015. Available online: http://www.leginfo.ca.gov/pub/15-16/bill/asm/ab_1301-1350/ab_1321_bill_20151002_chaptered.htm (accessed on 1 June 2022).
- Olsho, L.E.; Klerman, J.A.; Wilde, P.E.; 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, 104, 423–435. [Google Scholar] [CrossRef]
- Vericker, T.; Dixit-Joshi, S.; Taylor, J.; Giesen, L.; Gearing, M.; Baier, K.; Lee, H.; Trundle, K.; Manglitz, C.; May, L. The Evaluation of Food Insecurity Nutrition INcentives (FINI) Interim Report; United States Department of Agriculture, Food and Nutrition Service: Washington, DC, USA, 2019. [Google Scholar]
- Masci, J.M.; Schoonover, J.J.; Vermont, L.N.; Kasprzak, C.M.; French, L.; Leone, L.A. Double Up Food Bucks: A Qualitative Evaluation of Usage, Impact, Barriers, and Facilitators. J. Nutr. Educ. Behav. 2020, 52, 1100–1110. [Google Scholar] [CrossRef]
- Engel, K.; Ruder, E.H. Fruit and Vegetable Incentive Programs for Supplemental Nutrition Assistance Program (SNAP) Participants: A Scoping Review of Program Structure. Nutrients 2020, 12, 1676. [Google Scholar] [CrossRef]
- Polacsek, M.; Moran, A.; Thorndike, A.N.; Boulos, R.; Franckle, R.L.; Greene, J.C.; Blue, D.J.; Block, J.P.; Rimm, E.B. A Supermarket Double-Dollar Incentive Program Increases Purchases of Fresh Fruits and Vegetables Among Low-Income Families With Children: The Healthy Double Study. J. Nutr. Educ. Behav. 2018, 50, 217–228.e211. [Google Scholar] [CrossRef]
- Durward, C.M.; Savoie-Roskos, M.; Atoloye, A.; Isabella, P.; Jewkes, M.D.; Ralls, B.; Riggs, K.; LeBlanc, H. 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, 342–347. [Google Scholar] [CrossRef]
- Ratigan, A.R.; Lindsay, S.; Lemus, H.; Chambers, C.D.; Anderson, C.A.; Cronan, T.A.; Browner, D.K.; Wooten, W.J. 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, 2786–2795. [Google Scholar] [CrossRef] [Green Version]
- Olsho, L.E.; Payne, G.H.; Walker, D.K.; Baronberg, S.; Jernigan, J.; Abrami, A. Impacts of a farmers’ market incentive programme on fruit and vegetable access, purchase and consumption. Public Health Nutr. 2015, 18, 2712–2721. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Dimitri, C.; Oberholtzer, L.; Zive, M.; Sandolo, C. Enhancing food security of low-income consumers: An investigation of financial incentives for use at farmers markets. Food Policy 2015, 52, 64–70. [Google Scholar] [CrossRef]
- 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, 70–76.e71. [Google Scholar] [CrossRef] [PubMed]
- Baronberg, S.; Dunn, L.; Nonas, C.; Dannefer, R.; Sacks, R. The Impact of New York City’s Health Bucks Program on Electronic Benefit Transfer Spending at Farmers Markets, 2006–2009. Prev. Chronic Dis. 2013, 10, E163. [Google Scholar] [CrossRef] [Green Version]
- Freedman, D.A.; Mattison-Faye, A.; Alia, K.; Guest, M.A.; Hébert, J.R. Comparing farmers’ market revenue trends before and after the implementation of a monetary incentive for recipients of food assistance. Prev. Chronic Dis. 2014, 11, E87. [Google Scholar] [CrossRef] [Green Version]
- Oberholtzer, L.; Dimitri, C.; Schumacher, G. Linking farmers, healthy foods, and underserved consumers: Exploring the impact of nutrition incentive programs on farmers and farmers’ markets. J. Agric. Food Syst. Community Dev. 2012, 2, 63–77. [Google Scholar] [CrossRef]
- Choi, S.E.; Seligman, H.; Basu, S. Cost effectiveness of subsidizing fruit and vegetable purchases through the Supplemental Nutrition Assistance Program. Am. J. Prev. Med. 2017, 52, e147–e155. [Google Scholar] [CrossRef] [Green Version]
- Mozaffarian, D.; Liu, J.; Sy, S.; Huang, Y.; Rehm, C.; Lee, Y.; Wilde, P.; Abrahams-Gessel, S.; Jardim, T.d.S.V.; Gaziano, T. Cost-effectiveness of financial incentives and disincentives for improving food purchases and health through the US Supplemental Nutrition Assistance Program (SNAP): A microsimulation study. PLoS Med. 2018, 15, e1002661. [Google Scholar] [CrossRef]
- Thompson, F.E.; Midthune, D.; Kahle, L.; Dodd, K.W. Development and Evaluation of the National Cancer Institute’s Dietary Screener Questionnaire Scoring Algorithms. J. Nutr. 2017, 147, 1226–1233. [Google Scholar] [CrossRef] [Green Version]
- Thompson, F.E.; Midthune, D.; Subar, A.F.; Kahle, L.L.; Schatzkin, A.; Kipnis, V. Performance of a short tool to assess dietary intakes of fruits and vegetables, percentage energy from fat and fibre. Public Health Nutr. 2004, 7, 1097–1105. [Google Scholar] [CrossRef]
- Blumberg, S.J.; Bialostosky, K.; Hamilton, W.L.; Briefel, R.R. The effectiveness of a short form of the Household Food Security Scale. Am. J. Public Health 1999, 89, 1231–1234. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Survey Tools, Food Security in the U.S. Six-item Short Form of the Food Security Survey Module. Available online: https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/survey-tools/#adult (accessed on 7 June 2021).
- Dietary Screener Questionnaire (DSQ) in the NHANES 2009-10: Data Processing & Scoring Procedures. Available online: https://epi.grants.cancer.gov/nhanes/dietscreen/scoring/ (accessed on 18 November 2019).
- Perneger, T.V. What’s wrong with Bonferroni adjustments. BMJ 1998, 316, 1236–1238. [Google Scholar] [CrossRef] [PubMed]
- Rothman, K.J. No adjustments are needed for multiple comparisons. Epidemiology 1990, 1, 43–46. [Google Scholar] [CrossRef] [Green Version]
- Starks, H.; Brown Trinidad, S. Choose your method: A comparison of phenomenology, discourse analysis, and grounded theory. Qual. Health Res. 2007, 17, 1372–1380. [Google Scholar] [CrossRef] [PubMed]
- National Academies of Sciences, Engineering and Medicine. Implementation science: Methods and approaches. In Proceedings of the Applying an Implementation Science Approach to Genomic Medicine: Workshop Summary; National Academies of Sciences: Washington, DC, USA, 2016; p. 136. [Google Scholar]
- Nord, M. Effects of the Decline in the Real Value of SNAP Benefits From 2009 to 2011; United States Department of Agriculture, Economic Research Service: Washington, DC, USA, 2013. [Google Scholar] [CrossRef]
- Rummo, P.E.; Lyerly, R.; Rose, J.; Malyuta, Y.; Cohen, E.D.; Nunn, A. The impact of financial incentives on SNAP transactions at mobile produce markets. Int. J. Behav. Nutr. Phys. Act. 2021, 18, 26. [Google Scholar] [CrossRef]
- Phipps, E.J.; Braitman, L.E.; Stites, S.D.; Singletary, S.B.; Wallace, S.L.; Hunt, L.; Axelrod, S.; Glanz, K.; Uplinger, N. Impact of a Rewards-Based Incentive Program on Promoting Fruit and Vegetable Purchases. Am. J. Public Health 2015, 105, 166–172. [Google Scholar] [CrossRef] [PubMed]
- Lindsay, S.; Lambert, J.; Penn, T.; Hedges, S.; Ortwine, K.; Mei, A.; Delaney, T.; Wooten, W.J. Monetary matched incentives to encourage the purchase of fresh fruits and vegetables at farmers markets in underserved communities. Prev. Chronic Dis. 2013, 10, E188. [Google Scholar] [CrossRef] [Green Version]
- Payne, G.H.; Wethington, H.; Olsho, L.; Jernigan, J.; Farris, R.; Walker, D.K. Implementing a farmers’ market incentive program: Perspectives on the New York City Health Bucks Program. Prev. Chronic Dis. 2013, 10, E145. [Google Scholar] [CrossRef] [Green Version]
- Young, C.R.; Aquilante, J.L.; Solomon, S.; Colby, L.; Kawinzi, M.A.; Uy, N.; Mallya, G. Improving fruit and vegetable consumption among low-income customers at farmers markets: Philly Food Bucks, Philadelphia, Pennsylvania, 2011. Prev. Chronic Dis. 2013, 10, E166. [Google Scholar] [CrossRef] [Green Version]
- Klerman, J.A.; Bartlett, S.; Wilde, P.; Olsho, L. The Short-Run Impact of the Healthy Incentives Pilot Program on Fruit and Vegetable Intake. Am. J. Agric. Econ. 2014, 96, 1372–1382. [Google Scholar] [CrossRef]
- Thompson, F.E.; Subar, A.F. Chapter 1-Dietary Assessment Methodology. In Nutrition in the Prevention and Treatment of Disease, 4th ed.; Coulston, A.M., Boushey, C.J., Ferruzzi, M.G., Delahanty, L.M., Eds.; Academic Press: Cambridge, MA, USA, 2017; pp. 5–48. [Google Scholar] [CrossRef]
- Nuss, H.; Skizim, M.; Afaneh, H.; Miele, L.; Sothern, M. Farmers’ Market Utilization among Supplemental Nutrition Assistance Program Recipients in New Orleans, Louisiana: Preliminary Findings. Ethn. Dis. 2017, 27, 295–302. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Garner, J.A.; Coombs, C.; Savoie-Roskos, M.R.; Durward, C.; Seguin-Fowler, R.A. A qualitative evaluation of Double Up Food Bucks farmers’ market incentive program access. J. Nutr. Educ. Behav. 2020, 52, 705–712. [Google Scholar] [CrossRef] [PubMed]
- Hewawitharana, S.C.; Webb, K.L.; Strochlic, R.; Gosliner, W. Comparison of Fruit and Vegetable Prices between Farmers’ Markets and Supermarkets: Implications for Fruit and Vegetable Incentive Programs for Food Assistance Program Participants. Nutrients 2022, 14, 1842. [Google Scholar] [CrossRef] [PubMed]
Demographic Characteristic | Farmers’ Market Shoppers | Supermarket Shoppers | All Shoppers (n = 325) | ||||
---|---|---|---|---|---|---|---|
No Match Incentive (n = 40) | $10 Maximum Incentive (n = 65) | $20 Maximum Incentive (n = 58) | Total Farmers’ Market Shoppers (n = 163) | Supermarket Shoppers That Do Not Shop at Farmers’ Markets (n = 104) | Supermarket Shoppers That Also Shop at Farmers’ Markets (n = 58) | ||
Age (Mean (SE)) | |||||||
Age | 38.7 (2.3) | 39.0 (2.6) | 41.4 (3.8) | 39.8 (1.6) | 40.3 (1.4) | 39.7 (0.7) | 39.9 (0.9) |
Gender (% (SE)) | |||||||
Female | 72.5% (5.0) | 89.2% (7.4) | 79.3% (2.0) | 81.6% (3.9) | 61.5% (6.2) | 77.6% (7.5) | 74.5% (3.9) |
Race/ethnicity (% (SE)) 2 | |||||||
Hispanic | 32.5% (8.4) | 70.8% (27.4) | 13.8% (2.3) | 41.1% (13.7) | 45.2% (13.0) | 46.6% (12.6) | 43.4% (9.0) |
Non-Hispanic White | 50.0% (10.4) | 21.5% (22.0) | 60.3% (4.9) | 42.3% (10.6) | 36.5% (9.7) | 34.5% (10.5) | 39.1% (6.8) |
Non-Hispanic Black/African American 3 | 5.0% (5.8) | 1.5% (1.6) | 8.6% (3.1) | 4.9% (2.1) | 2.9% (1.2) | 1.7% (1.8) | 3.7% (1.2) |
Non-Hispanic Other | 12.5% (8.3) | 6.2% (4.0) | 17.2% (5.1%) | 11.7% (3.3) | 15.4% (4.3) | 17.2% (3.9) | 13.8% (2.6) |
Education (% (SE)) 2 | |||||||
High school graduate, GED, or less | 35.0% (6.9) | 55.4% (22.7) | 13.8% (3.8) | 35.6% (10.9) | 63.5% (3.4) | 51.7% (12.2) | 47.4% (7.0) |
Associate’s degree, vocational certificate, or some college | 30.0% (8.7) | 24.6% (7.0) | 48.3% (5.7) | 34.4% (5.1) | 28.8% (2.7) | 32.8% (8.0) | 32.3% (3.2) |
Bachelor’s degree or higher | 35.0% (11.8) | 20.0% (15.8) | 37.9% (9.3) | 30.1% (7.6) | 7.7% (2.3) | 15.5% (8.2) | 20.3% (4.9) |
Income (% (SE)) 2 | |||||||
Less than $10,000 | 42.5% (11.6) | 47.7% (11.1) | 29.3% (1.3) | 39.9% (5.8) | 46.2% (5.9) | 36.2% (5.5) | 41.2% (3.3) |
$10,000–$19,999 | 40.0% (6.1) | 33.8% (4.9) | 41.4% (6.5) | 38.0% (3.2) | 30.8% (5.0) | 31.0% (6.5) | 34.5% (2.6) |
$20,000 or more | 17.5% (8.6) | 18.5% (10.9) | 29.3% (6.1) | 22.1% (5.1) | 23.1% (4.4) | 32.8% (8.1) | 24.3% (2.8) |
Employment Status (% (SE)) 2 | |||||||
Employed full-time | 15.0% (7.0) | 9.2% (6.0) | 15.5% (3.7) | 12.9% (3.1) | 12.5% (4.7) | 12.1% (6.3) | 12.6% (2.6) |
Employed part-time | 22.5% (15.2) | 23.1% (14.4) | 25.9% (3.2) | 23.9% (6.1) | 24.0% (5.5) | 25.9% (5.1) | 24.3% (3.6) |
Unemployed seeking employment | 27.5% (9.9) | 13.8% (1.5) | 17.2% (2.8) | 18.4% (3.5) | 27.9% (7.2) | 20.7% (8.9) | 21.8% (3.4) |
Not employed and not seeking employment | 35.0% (8.9) | 53.8% (20.6) | 41.4% (4.0) | 44.8% (8.2) | 35.6% (6.5) | 41.4% (8.0) | 41.2% (4.6) |
Household Size (Mean (SE)) | |||||||
Household Size | 2.5 (0.6) | 3.8 (0.9) | 2.8 (0.3) | 3.1 (0.4) | 3.7 (0.3) | 3.8 (0.5) | 3.4 (0.3) |
Incentive program use, perceived value, and reported produce purchasing behavior (% (SE)) | |||||||
Reported that Market Match was “Very Important” to their decision to shop at the farmers’ market | N/A 4 | 78.5% (8.3) | 79.3% (2.0) | N/A 4 | N/A 4 | N/A 4 | N/A 4 |
Received maximum Market Match incentive at farmers’ market | N/A 4 | 98.5% (1.4) | 65.5% (5.7) | N/A 4 | N/A 4 | N/A 4 | N/A 4 |
Reported mechanism for learning about the incentive program (% (SE)) | |||||||
Information at farmers’ market during a prior visit | N/A 4 | 49.2% (11.3) | 70.7% (6.1) | N/A 4 | N/A 4 | N/A 4 | N/A 4 |
Friend or family member | N/A 4 | 24.6% (1.4) | 15.5% (3.7) | N/A 4 | N/A 4 | N/A 4 | N/A 4 |
County social services or other agency | N/A 4 | 16.9% (4.9) | 8.6% (0.1) | N/A 4 | N/A 4 | N/A 4 | N/A 4 |
Other 3 | N/A 4 | 21.5% (3.3) | 8.6% (6.0) | N/A 4 | N/A 4 | N/A 4 | N/A 4 |
$10 Maximum Incentive Farmers’ Market Shoppers vs. No Match Incentive Farmers’ Market Shoppers | $20 Maximum Incentive Farmers’ Market Shoppers vs. No Match Incentive Farmers’ Market Shoppers | $20 Maximum Incentive Farmers’ Market Shoppers vs. $10 Maximum Incentive Farmers’ Market Shoppers | All farmers’ Market Shoppers vs. Supermarket Shoppers That Do Not Shop at Farmers’ Markets | |||||
---|---|---|---|---|---|---|---|---|
Reported produce purchasing behavior | n | Odds Ratio 1 | n | Odds Ratio 1 | n | Odds Ratio 1 (95% Confidence Interval) | n | Odds Ratio 1 (95% Confidence Interval) |
(95% Confidence Interval) | (95% Confidence Interval) | |||||||
Reported purchasing more than half their produce at farmers’ market | 105 | 2.581 | 98 | 8.113 | 123 | 3.144 | N/A 2 | N/A 2 |
(0.610, 10.922) | (2.218, 29.675) | (1.138, 8.681) | ||||||
Produce consumption (cup equivalent per day) | n | Beta Coefficient 3 | n | Beta Coefficient 3 | n | Beta Coefficient 3 | n | Beta Coefficient 3 |
(95% Confidence Interval) | (95% Confidence Interval) | (95% Confidence Interval) | (95% Confidence Interval) | |||||
Fruit | 105 | −0.077 | 98 | 0.088 | 123 | 0.165 | 267 | 0.155 |
(−0.274, 0.121) | (−0.268, 0.444) | (−0.156, 0.485) | (−0.101, 0.411) | |||||
Vegetables and legumes (NOT fried potatoes) | 105 | 0.122 | 98 | −0.088 | 123 | −0.210 | 267 | 0.312 |
(−0.082, 0.325) | (−0.284, 0.108) | (−0.466, 0.046) | (0.098, 0.526) | |||||
Fruit, vegetables, and legumes (NOT fried potatoes) | 105 | 0.06 | 98 | −0.005 | 123 | −0.065 | 267 | 0.548 |
(−0.302, 0.421) | (−0.523, 0.513) | (−0.618, 0.488) | (0.137, 0.960) | |||||
Food insecurity | n | Odds Ratio 1 | n | Odds Ratio 1 | n | Odds Ratio 1 | n | Odds Ratio 1 |
(95% Confidence Interval) | (95% Confidence Interval) | (95% Confidence Interval) | (95% Confidence Interval) | |||||
Food insecure | 99 | 0.757 | 94 | 0.76 | 117 | 1.004 | 257 | 0.575 |
(0.448, 1.280) | (0.387, 1.493) | (0.436, 2.308) | (0.308, 1.074) | |||||
Food bought did not last | 104 | 1.05 | 98 | 1.46 | 122 | 1.391 | 265 | 0.441 |
(0.422, 2.615) | (0.558, 3.821) | (0.657, 2.942) | (0.215, 0.904) | |||||
Could not afford to | 102 | 1.465 | 96 | 1.15 | 122 | 0.785 | 264 | 0.623 |
buy balanced meals | (0.855, 2.510) | (0.440, 3.010) | (0.309, 1.997) | (0.284, 1.369) | ||||
Cut the size of or skipped meals | 105 | 0.814 | 97 | 0.586 | 122 | 0.721 | 266 | 0.525 |
(0.489, 1.354) | (0.275, 1.249) | (0.269, 1.931) | (0.304, 0.906) | |||||
Ate less than felt should | 104 | 0.846 | 98 | 0.626 | 122 | 0.74 | 266 | 0.621 |
(0.536, 1.333) | (0.298, 1.315) | (0.326, 1.679) | (0.374, 1.033) | |||||
Were hungry but did not eat | 103 | 0.437 | 97 | 0.478 | 120 | 1.092 | 263 | 0.345 |
(0.236, 0.811) | (0.198, 1.151) | (0.416, 2.864) | (0.159, 0.748) |
Produce Consumption (Cup Equivalents/Day) | (95% Confidence Interval) |
---|---|
Fruit (n = 221) | 0.000 (−0.003, 0.004) |
Vegetables and legumes (NOT fried potatoes) (n = 221) | 0.000 (−0.002, 0.003) |
Fruit, vegetables, and legumes (NOT fried potatoes) (n = 221) | 0.001 (−0.005, 0.007) |
Food Security | OR (95% Confidence Interval) |
Cut the size of or skipped meals (n = 220) | 0.990 (0.979, 1.000) |
Ate less than felt should (n = 220) | 0.988 (0.978, 0.998) |
Were hungry but did not eat (n = 218) | 0.982 (0.968, 0.996) |
Food bought did not last (n = 220) | 0.999 (0.988, 1.011) |
Could not afford to eat balanced meals (n = 217) | 0.996 (0.988, 1.005) |
Food insecure (n = 212) | 0.987 (0.976, 0.999) |
Theme | Supporting Quotations |
---|---|
Participants credit CNIP with helping them to eat more healthfully and improving their health | I’m eating better because I can afford to get fresh food, fresh vegetables and fruit that I wouldn’t get otherwise.When I was shopping in supermarkets, I wasn’t buying specifically fruits and vegetables, but here, the farmer’s market allows me to buy those fruits and vegetables and make food at home as opposed to buying more unhealthy foods that are processed and prepackaged.…we eat more fruits and vegetables this way. A lot more. (CNIP) has helped us to … eat a lot more fruits and vegetables instead of junk food.I think that for the household to be healthy, you have to be less stressed financially and this reduces the financial stresses for many families. Now, they can eat healthy, and it probably also affects their relationships with their families, friends, and communities. |
CNIP has helped participants to be able to buy more food overall, as well as a greater quantity of fruits and vegetables | We’re able to get more food than money that we have because they match it, so we’re able to actually eat more fruits and vegetables and have enough food.We eat more fruits and vegetables because… we get more money to spend on produce instead of not having any food money budget left at the end of the month. I’m able to buy more of the kinds of foods that I like that I normally couldn’t afford or buy as many of them. So, it’s definitely been an amazing thing to happen and I’m so happy I found out about it and that is the reason I come (to the farmers’ market).”It’s really helped bring in larger amounts produce for less money, which is important when I’m budgeting with the EBT.I eat more fruits and vegetables because of this farmer’s market… it enables me to eat more of what’s good for me… It gives me a little bit more wiggle room to buy more of the fresh vegetables and things because it matches my dollar for dollar… It makes (the way my family eats) better because I can get more fruits and vegetables into my diet. |
CNIP allowed participants to buy a wider variety of produce and enabled them to try new things | We get a little more variety. We’re more willing to try fruits and vegetables that we might not have otherwise because we’re getting the match. That’s been a good way to experiment with new flavors and trying to cook new things.We’re having so much variety with the fruits and vegetables that we’re able to get here… I’ll buy items even if we’re not used to eating it and we’ll experiment. And so, we’ll find new things that we can enjoy (that) I wouldn’t have if I hadn’t come here and seen such a great price on it.I’m able to have more variety of different choices of fruits and vegetables. I’m able to expand on different sorts of meals, not just be limited to which fruits and vegetables I can choose. As the seasons change, I’m able to buy different fruits and vegetables and try out different meals. |
CNIP facilitated purchasing higher quality fruits and vegetables that were fresher | It offers us the ability to purchase higher quality food. It’s improved the types of food that we eat.It allows me to get organic and good produce, especially for my son. He always gets fresh food and I don’t think we would be able to do it without the match program.It allows me to feed my child more fresh foods every single day and without the… program, I don’t think I’d be able to do that. |
Participants appreciate the opportunity CNIP provides them to engage with and support their local community | I think it’s been great. It’s encouraged me to bring my son out to the market and get involved in the community.It’s really important to support the local economy and support the local farmers as much as possible. Having the program really helps do that…I think we can all vote with our dollar and while these aren’t technically my dollars, that makes me feel more responsible because I’m receiving assistance and so I want to use those dollars as wisely as I can and put that money–cycle it back in.It’s just important to eat locally. You support your community, and they support you and that’s a good thing. |
Participants expressed appreciation for CNIP and wanted to see the program expand | This is a very important program. It encourages people to spend money locally and support local growers in addition to allowing people to have better access to fruits and vegetables that are grown fresh. The match will allow people who have very little income or no income at all to be able to extend their spending dollars more.It’s been very important for my family. I have appreciated it and so I would definitely recommend continuing it. I think it’s good to promote to other families. I know that there’s probably a lot of families out there who don’t know about it yet and it could help them and so, I would recommend it for that too.I would say absolutely expand it because farmer’s markets are extremely important for both the consumers and the people selling the food because it helps put money back into the local farmers. People really need to start eating differently and I think that farmer’s markets encourage that because they have a lot of healthy food options. It’s definitely something that needs to be expanded. I think it should be everywhere.I think it’s an excellent program that I hope is available to more and more people in the future.Some of us really depend on (CNIP) to get fresh food for us and our kids and we feel so blessed that we’re able to do it. |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Gosliner, W.; Hewawitharana, S.C.; Strochlic, R.; Felix, C.; Long, C. The California Nutrition Incentive Program: Participants’ Perceptions and Associations with Produce Purchases, Consumption, and Food Security. Nutrients 2022, 14, 2699. https://doi.org/10.3390/nu14132699
Gosliner W, Hewawitharana SC, Strochlic R, Felix C, Long C. The California Nutrition Incentive Program: Participants’ Perceptions and Associations with Produce Purchases, Consumption, and Food Security. Nutrients. 2022; 14(13):2699. https://doi.org/10.3390/nu14132699
Chicago/Turabian StyleGosliner, Wendi, Sridharshi C. Hewawitharana, Ron Strochlic, Celeste Felix, and Caroline Long. 2022. "The California Nutrition Incentive Program: Participants’ Perceptions and Associations with Produce Purchases, Consumption, and Food Security" Nutrients 14, no. 13: 2699. https://doi.org/10.3390/nu14132699
APA StyleGosliner, W., Hewawitharana, S. C., Strochlic, R., Felix, C., & Long, C. (2022). The California Nutrition Incentive Program: Participants’ Perceptions and Associations with Produce Purchases, Consumption, and Food Security. Nutrients, 14(13), 2699. https://doi.org/10.3390/nu14132699