International Journal of Environmental Research and Public Health

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15 pages, 338 KiB

Open AccessArticle

Integrating Produce Prescriptions into the Healthcare System: Perspectives from Key Stakeholders

by Alyssa Auvinen, Mary Simock and Alyssa Moran

Int. J. Environ. Res. Public Health 2022, 19(17), 11010; https://doi.org/10.3390/ijerph191711010 - 02 Sep 2022

Cited by 9 | Viewed by 2305

Abstract

People with low incomes suffer disproportionately from diet-related chronic diseases and may have fewer resources to manage their diseases. The “food as medicine” movement encourages healthcare systems to address these inequities while controlling escalating healthcare costs by integrating interventions such as produce prescriptions, [...] Read more.

People with low incomes suffer disproportionately from diet-related chronic diseases and may have fewer resources to manage their diseases. The “food as medicine” movement encourages healthcare systems to address these inequities while controlling escalating healthcare costs by integrating interventions such as produce prescriptions, in which healthcare providers distribute benefits for fruit and vegetable purchases. The purpose of this study was to identify perceived facilitators and barriers for designing and implementing produce prescriptions within the healthcare system. Nineteen semi-structured in-depth interviews were conducted with experts, and interviews were analyzed using thematic analysis. Overall, interviewees perceived that produce prescriptions could impact patients’ diets, food security, disease management, and engagement with the healthcare system, while reducing healthcare costs. Making produce prescriptions convenient to use for patients, while providing resources to program implementers and balancing the priorities of payers, will facilitate program implementation. Integrating produce prescriptions into the healthcare system is feasible but requires program administrators to address implementation barriers such as cost and align complex technology systems (i.e., electronic medical records and benefit/payment processing). Engaging patients, clinics, retailers, and payers in the design phase can improve patient experience with a produce-prescription program; enhance clinic and retail processes enrolling patients and redeeming benefits; and ensure payers can measure outcomes of interest. Full article

(This article belongs to the Special Issue Nutrition and Health Equity: Revisiting the Importance of Fruit and Vegetable Availability, Purchasing, and Consumption)

15 pages, 318 KiB

Open AccessArticle

California WIC Participants Report Favorable Impacts of the COVID-Related Increase to the WIC Cash Value Benefit

by Catherine E. Martinez, Lorrene D. Ritchie, Danielle L. Lee, Marisa M. Tsai, Christopher E. Anderson and Shannon E. Whaley

Int. J. Environ. Res. Public Health 2022, 19(17), 10604; https://doi.org/10.3390/ijerph191710604 - 25 Aug 2022

Cited by 9 | Viewed by 2828

Abstract

The United States Department of Agriculture approved an increase to the Cash Value Benefit (CVB) for the purchase of fruits and vegetables issued to participants receiving an eligible Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package. In order to [...] Read more.

The United States Department of Agriculture approved an increase to the Cash Value Benefit (CVB) for the purchase of fruits and vegetables issued to participants receiving an eligible Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package. In order to understand satisfaction, perceptions, and the overall impact of additional benefits for fruits and vegetables at the household level, a qualitative study consisting of structured phone interviews was conducted with families served by WIC in Southern California from November to December 2021 (n = 30). Families were selected from a large longitudinal study sample (N = 2784); the sample was restricted by benefit redemption and stratified by language and race. WIC participants were highly satisfied with the CVB increase, reporting increased purchasing and consumption of a variety of fruits and vegetables. Respondents noted the improved quality and variety of fruits and vegetables purchased due to the increased amount. Findings are expected to inform policy makers to adjust the CVB offered in the WIC food package with the potential to improve participant satisfaction and increase participation and retention of eligible families with benefits from healthy diets supported by WIC. Full article

(This article belongs to the Special Issue Nutrition and Health Equity: Revisiting the Importance of Fruit and Vegetable Availability, Purchasing, and Consumption)

14 pages, 655 KiB

Open AccessArticle

“I Think That’s the Most Beneficial Change That WIC Has Made in a Really Long Time”: Perceptions and Awareness of an Increase in the WIC Cash Value Benefit

by Emily W. Duffy, Daniele A. Vest, Cassandra R. Davis, Marissa G. Hall, Molly De Marco, Shu Wen Ng and Lindsey Smith Taillie

Int. J. Environ. Res. Public Health 2022, 19(14), 8671; https://doi.org/10.3390/ijerph19148671 - 16 Jul 2022

Cited by 10 | Viewed by 2861

Abstract

During the COVID-19 pandemic, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Cash Value Benefit (CVB) for fruits and vegetables increased by roughly USD 25/month/person. We sought to understand WIC participant perceptions of this change and barriers and facilitators to [...] Read more.

During the COVID-19 pandemic, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Cash Value Benefit (CVB) for fruits and vegetables increased by roughly USD 25/month/person. We sought to understand WIC participant perceptions of this change and barriers and facilitators to using the CVB. We conducted 10 virtual focus groups (5 rural, 5 urban/suburban) with WIC participants (n = 55) in North Carolina in March 2022. Focus groups were recorded and transcribed. We open-coded the content and used thematic analysis to uncover consistencies within and between sampled groups. Participants expressed favorable perceptions of the CVB increase and stated the pre-pandemic CVB amount was insufficient. Barriers to using the increased CVB were identifying WIC-approved fruits and vegetables in stores and insufficient supply of fruits and vegetables. Barriers were more pronounced in rural groups. Facilitators of CVB use were existing household preferences for fruits and vegetables and the variety of products that can be purchased with CVB relative to other components of the WIC food package. Participants felt the CVB increase allowed their families to eat a wider variety of fruits and vegetables. The CVB increase may improve fruit and vegetable intake, particularly if made permanent, but barriers to CVB and WIC benefit use may limit the potential impact. Full article

(This article belongs to the Special Issue Nutrition and Health Equity: Revisiting the Importance of Fruit and Vegetable Availability, Purchasing, and Consumption)

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10 pages, 302 KiB

Open AccessArticle

Understanding Impacts of SNAP Fruit and Vegetable Incentive Program at Farmers’ Markets: Findings from a 13 State RCT

by Allison Karpyn, Julia Pon, Sara B. Grajeda, Rui Wang, Kathryn E. Merritt, Tara Tracy, Henry May, Ginnie Sawyer-Morris, McKenna M. Halverson and Alan Hunt

Int. J. Environ. Res. Public Health 2022, 19(12), 7443; https://doi.org/10.3390/ijerph19127443 - 17 Jun 2022

Cited by 4 | Viewed by 2061

Abstract

Disparities in healthy food access and consumption are a major public health concern. This study reports the findings from a two-year randomized control trial conducted at 77 farmers’ markets (FMs) in 13 states and the District of Columbia that sought to understand the [...] Read more.

Disparities in healthy food access and consumption are a major public health concern. This study reports the findings from a two-year randomized control trial conducted at 77 farmers’ markets (FMs) in 13 states and the District of Columbia that sought to understand the impact of fruit and vegetable (FV) incentive vouchers, randomly issued at varied incentive levels to Supplemental Nutrition Assistance Program (SNAP) recipients, for use at FMs. Measures included FV and overall household food purchasing; FV consumption; food insecurity; health status; market expenditure; and demographics. A repeated-measures mixed-effects analysis and the Complier Average Causal Effect (CACE) were used to examine outcomes. Despite 82% reporting food insecurity in the prior year, the findings showed that financial incentives at FMs had statistically significant, positive effects on FV consumption; market expenditures increased with added incentives. SNAP recipients receiving an incentive of USD 0.40 for every USD 1.00 in SNAP spent an average of USD 19.03 per transaction, while those receiving USD 2 for every USD 1 (2:1) spent an average of USD 36.28 per transaction. The data showed that the incentive program at the highest level (2:1) maximally increased SNAP FM expenditure and FV consumption, increasing the latter by 0.31 daily cups among those who used their incentive (CACE model). Full article

(This article belongs to the Special Issue Nutrition and Health Equity: Revisiting the Importance of Fruit and Vegetable Availability, Purchasing, and Consumption)

13 pages, 522 KiB

Open AccessArticle

Understanding SNAP Recipient Characteristics to Guide Equitable Expansion of Nutrition Incentive Programs in Diverse Food Retail Settings

by Lauren Vargo, Timothy H. Ciesielski, Milen Embaye, Ana Bird and Darcy A. Freedman

Int. J. Environ. Res. Public Health 2022, 19(9), 4977; https://doi.org/10.3390/ijerph19094977 - 20 Apr 2022

Cited by 5 | Viewed by 2564

Abstract

Structural barriers, such as food costs, reduce access to healthy foods for populations with limited income, including those benefitting from the Supplemental Nutrition Assistance Program (SNAP). Nutrition incentive programs seek to address this barrier. Evaluations of SNAP-based incentive programming often focus on one [...] Read more.

Structural barriers, such as food costs, reduce access to healthy foods for populations with limited income, including those benefitting from the Supplemental Nutrition Assistance Program (SNAP). Nutrition incentive programs seek to address this barrier. Evaluations of SNAP-based incentive programming often focus on one setting (i.e., either farmers’ markets or grocery stores). We examined use patterns, characteristics, and preferences among 253 SNAP consumers with access to incentive programming at both a farmers’ market and a grocery store located within five miles of their home. Cross-sectional survey data were collected in 2019 in two Ohio cities. Despite geographic access, 45% of those surveyed were not using the incentive program; most non-users (80.5%) were unaware of the program. Program users compared to non-users had higher household incomes (p < 0.001) and knew more people using the program (p < 0.001). Grocery stores were the most common setting of use (59%); 29% used at farmers’ markets; 11% used in both settings. User characteristics varied by store setting based on demographics, program experience, fruit and vegetable purchasing and consumption patterns, and social dynamics related to use. Our findings support comprehensive awareness-raising efforts and tailored implementation of incentive programming that attends to diverse segments of SNAP consumers to promote equity in program reach. Full article

(This article belongs to the Special Issue Nutrition and Health Equity: Revisiting the Importance of Fruit and Vegetable Availability, Purchasing, and Consumption)

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12 pages, 507 KiB

Open AccessArticle

U.S. Fruit and Vegetable Affordability on the Thrifty Food Plan Depends on Purchasing Power and Safety Net Supports

by Sabrina K. Young and Hayden Stewart

Int. J. Environ. Res. Public Health 2022, 19(5), 2772; https://doi.org/10.3390/ijerph19052772 - 27 Feb 2022

Cited by 3 | Viewed by 3042

Abstract

The Supplemental Nutrition Assistance Program (SNAP) increases the food purchasing power of lower-income households so that they can better afford a nutritious diet. Benefit amounts are based in part on the cost for a household to follow the Thrifty Food Plan (TFP), a [...] Read more.

The Supplemental Nutrition Assistance Program (SNAP) increases the food purchasing power of lower-income households so that they can better afford a nutritious diet. Benefit amounts are based in part on the cost for a household to follow the Thrifty Food Plan (TFP), a meal pattern designed to meet the Dietary Guidelines for Americans. In October 2021, the U.S. Department of Agriculture (USDA) reformulated the TFP and increased its cost by 21%. However, the TFP still does not account for differences in food prices across the country. This study examines: (1) how geographic variation in food prices affects fruit and vegetable affordability and (2) to what extent raising the cost of the TFP (and therefore the maximum SNAP benefit) has mitigated these effects. We use data on fruit and vegetable prices from the USDA and simulation techniques to create and cost out food baskets with a sufficient quantity and variety of fruits and vegetables for a representative household to satisfy guidelines over one week. We find that the increase in SNAP benefits will increase fruit and vegetable affordability for participating households. However, households facing food prices greater than national average food prices may still face tradeoffs to purchase a balanced diet. Full article

(This article belongs to the Special Issue Nutrition and Health Equity: Revisiting the Importance of Fruit and Vegetable Availability, Purchasing, and Consumption)

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Other

Jump to: Research

12 pages, 376 KiB

Open AccessCommentary

Improving Fruit and Vegetable Accessibility, Purchasing, and Consumption to Advance Nutrition Security and Health Equity in the United States

by Bailey Houghtaling, Matthew Greene, Kaustubh V. Parab and Chelsea R. Singleton

Int. J. Environ. Res. Public Health 2022, 19(18), 11220; https://doi.org/10.3390/ijerph191811220 - 07 Sep 2022

Cited by 4 | Viewed by 2651

Abstract

In recent years, national and local efforts to improve diet and health in the United States have stressed the importance of nutrition security, which emphasizes consistent access to foods and beverages that promote health and prevent disease among all individuals. At the core [...] Read more.

In recent years, national and local efforts to improve diet and health in the United States have stressed the importance of nutrition security, which emphasizes consistent access to foods and beverages that promote health and prevent disease among all individuals. At the core of this endeavor is fruit and vegetable (FV) consumption, a dietary practice that is integral to attaining and sustaining a healthy diet. Unfortunately, significant inequities in FV accessibility, purchasing, and consumption exist, particularly among populations that are socially and economically disadvantaged. To achieve nutrition and health equity in the United States, the field must center the goal of nutrition security and initiatives that aim to increase FV consumption, specifically, in future work. The International Journal of Environmental Research and Public Health (IJERPH) Special Issue titled “Nutrition and Health Equity: Revisiting the Importance of Fruit and Vegetable Availability, Purchasing, and Consumption” features several scholarly publications from experts conducting timely research on these topics. In this commentary, we (1) summarize the U.S.-based literature on inequities in FV accessibility, purchasing, and consumption, (2) describe how the contributions to this IJERPH special issue can advance nutrition security and health equity, and (3) outline future research questions from our perspective. Full article

(This article belongs to the Special Issue Nutrition and Health Equity: Revisiting the Importance of Fruit and Vegetable Availability, Purchasing, and Consumption)

16 pages, 486 KiB

Open AccessCommentary

Accelerating Evaluation of Financial Incentives for Fruits and Vegetables: A Case for Shared Measures

by Nadine Budd Nugent, Carmen Byker Shanks, Hilary K. Seligman, Hollyanne Fricke, Courtney A. Parks, Sarah Stotz and Amy L. Yaroch

Int. J. Environ. Res. Public Health 2021, 18(22), 12140; https://doi.org/10.3390/ijerph182212140 - 19 Nov 2021

Cited by 15 | Viewed by 3385

Abstract

Food insecurity, or lack of consistent access to enough food, is associated with low intakes of fruits and vegetables (FVs) and higher risk of chronic diseases and disproportionately affects populations with low income. Financial incentives for FVs are supported by the 2018 Farm [...] Read more.

Food insecurity, or lack of consistent access to enough food, is associated with low intakes of fruits and vegetables (FVs) and higher risk of chronic diseases and disproportionately affects populations with low income. Financial incentives for FVs are supported by the 2018 Farm Bill and United States (U.S.) Department of Agriculture’s Gus Schumacher Nutrition Incentive Program (GusNIP) and aim to increase dietary quality and food security among households participating in the Supplemental Nutrition Assistance Program (SNAP) and with low income. Currently, there is no shared evaluation model for the hundreds of financial incentive projects across the U.S. Despite the fact that a majority of these projects are federally funded and united as a cohort of grantees through GusNIP, it is unclear which models and attributes have the greatest public health impact. We explore the evaluation of financial incentives in the U.S. to demonstrate the need for shared measurement in the future. We describe the process of the GusNIP NTAE, a federally supported initiative, to identify and develop shared measurement to be able to determine the potential impact of financial incentives in the U.S. This commentary discusses the rationale, considerations, and next steps for establishing shared evaluation measures for financial incentives for FVs, to accelerate our understanding of impact, and support evidence-based policymaking. Full article

(This article belongs to the Special Issue Nutrition and Health Equity: Revisiting the Importance of Fruit and Vegetable Availability, Purchasing, and Consumption)

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