Search Results (28)

Nutrition education, framed within Supplemental Nutrition Assistance Program Education (SNAP-Ed) guidance, was provided to SNAP-eligible shoppers at community supported agriculture (CSA) sites in Michigan where SNAP nutrition incentives were accepted. An evaluation was conducted on data sources from sites where the CSA Food Navigator program was implemented to assess the delivery of nutrition education, understand the needs and experiences of SNAP-eligible shoppers, and measure behavioral outcomes. A multi-phase, mixed-methods design incorporated (1) outcome surveys with SNAP-eligible shoppers at participating CSA sites; (2) open-ended feedback surveys from CSA site staff; (3) nutrition educator activity logs; (4) a semi-structured nutrition educator focus group; and (5) semi-structured focus groups with SNAP-eligible shoppers. In phase one, descriptive analysis was completed on the quantitative data and constant comparative analysis was completed on the qualitative data. In phase two, these data were collated into case reports for respective CSA sites; then, a cross-case analysis was performed. In phase three, statistical tests were performed on SNAP-eligible shoppers’ survey data to assess outcomes against a nationally representative sample of nutrition incentive program participants. Results indicate significantly higher fruit and vegetable consumption among shoppers relative to SNAP incentive participants nationally. Key qualitative themes were (1) relating over transacting: investing in multi-level relationships, (2) personalizing engagement and experiential nutrition education, (3) activating social–ecological spheres to promote changes in access, and (4) enhancing education support and resources for accessibility. The findings have practical implications to enhance the delivery and impact of CSA-based nutrition education. Full article

Background/Objectives: Safety-net health centers are increasingly screening for food insecurity and providing patients with referrals to public assistance programs—e.g., the Supplemental Nutrition Assistance Program (SNAP). However, not all individuals actively participate in or are eligible for these programs. Onsite distributions of free produce at health center sites represent a promising complementary option for addressing this need. This study examines free produce events at these sites and their associations with attendees’ food and vegetable consumption, household food insecurity, and SNAP participation (study outcomes). Methods: In 2024, an intercept survey was conducted with 497 adults attending produce events at 16 safety-net health center sites in Los Angeles County, California, USA. Descriptive analyses profiled these food events, gathering information on attendee characteristics. Multivariable regressions examined associations between event attendance and study outcomes. Results: Over 80% of attendees lived in food-insecure households. Among those who were patients of the event site, 68% and 28%, respectively, indicated they received information about Medicaid and SNAP from the clinic staff. Compared to first-time attendees, those who attended produce events frequently consumed, on average, one additional serving of fruit and vegetables a day (p < 0.000). Conclusions: Offering free produce events at health center sites, where many attendees receive usual care, is a promising strategy for increasing healthy food access among safety-net populations. This underutilized approach is a viable intervention for improving access to healthy food, especially in circumstances where patients are not eligible for public assistance or nutrition incentive and/or food pharmacy programs are not readily available. Full article

Climate-smart agriculture (CSA) has emerged as a critical strategy to address the intertwined challenges of climate change, food insecurity, and environmental degradation, particularly among smallholder farmers in Southern Africa. This study reviews the existing literature on the adoption and scaling of CSA innovations among smallholder farmers in South Africa, focusing specifically on the roles played by institutional mechanisms, policy frameworks, and market dynamics. The findings reveal that while CSA interventions—such as conservation agriculture, drought-tolerant crop varieties, and precision irrigation—have demonstrated positive outcomes in enhancing productivity, food and nutritional security, and climate resilience, adoption remains uneven and limited. Key barriers include insecure land tenure, insufficient extension and climate information services, limited access to credit and inputs, and fragmented institutional support. The analysis highlights the importance of secure land rights, functional farmer cooperatives, effective NGO involvement, and inclusive governance structures in facilitating CSA adoption. Further, the review critiques the implementation gaps in South Africa’s climate and agricultural policy landscape, despite the existence of comprehensive strategies like the National Climate Change Response Policy and the Agricultural Policy Action Plan. This study concludes that scaling CSA among smallholder farmers requires a holistic, multi-level approach that strengthens institutional coordination, ensures policy coherence, improves market access, and empowers local actors. Targeted financial incentives, capacity-building programs, and value chain integration are essential to transform CSA from a conceptual framework into a practical, scalable solution for sustainable agricultural development in South Africa. Full article

Background/Objectives: Nutrition incentive programs can increase access to fresh fruits and vegetables and improve food security among Supplemental Nutrition Assistance Program (SNAP) participants and others in the United States. This qualitative study explored SNAP participants’ and farmers’ market staff’s perceptions of and experiences with a pilot supplemental benefit program offered at seven farmers’ markets in 2023 as part of the California Fruit and Vegetable Electronic Benefit Transfer Pilot Project. The pilot introduced specific characteristics that differ from more traditional nutrition incentive program dollar-for-dollar match incentive models, particularly the traditional model operating in California. Specific differences included the following: (1) offering a monthly USD 60 supplemental benefit that could be redeemed in a single shopping trip; (2) providing the supplemental benefit as a match that could be spent on any SNAP-eligible item in any retail location (rather than solely on fruits and vegetables at the farmers’ market). Methods: We conducted a qualitative, cross-sectional study including seven focus groups with 40 SNAP shoppers and six focus groups with 14 farmers’ market staff at six pilot-participating farmers’ markets in California. All focus groups were conducted by trained research staff and were recorded, transcribed, and analyzed using the immersion crystallization method. Results: Our findings include that shoppers appreciated several features of the pilot, particularly the ability to obtain an entire month’s supplemental benefit during one shopping trip and the ability to spend the benefit earned on any SNAP-eligible item at any SNAP retailer. Farmers’ market staff appreciated that the pilot benefited shoppers but found it difficult to manage due to staff and shopper confusion about the program, increased program utilization, subsequent long lines, and the spending of the earned incentives at other SNAP retailers. Both shoppers and staff reported that the program was difficult to understand. Conclusions: These findings can inform future nutrition incentive program designs to benefit SNAP participants while offering sustainable models for farmers’ markets. Full article

The participants in the Supplemental Nutrition Assistance Program (SNAP) consume greater amounts of sugar and sweetened beverages (SSBs) compared to non-eligible individuals, which could result in potential negative health outcomes. This can be attributed to the lack of restrictions on SSB purchases with SNAP benefits. In view of the increasing calls from advocates and policymakers to restrict the purchase of SSBs with SNAP benefits, we performed a systematic review to assess its impact towards SSB purchases and consumption. We searched articles from five databases—Cochrane, EBSCO, SCOPUS, Web of Science, and PubMed—and selected seven studies, four of which were randomized controlled trials (RCTs) and three were simulation modeling studies. All three simulation studies and one RCT reported outcomes in terms of consumption, while the other three RCTs reported outcomes in terms of purchases. All seven studies found that an SSB restriction led to a decrease in SSB consumption or purchases, with six studies reporting significant results. Nonetheless, limitations exist. These include limited studies on this subject, potential workarounds circumventing SSB restrictions, like making purchases using personal cash, potentially differed estimated effects when combined with incentives or other initiatives, and the limited geographical scope among the selected RCTs. Full article

The Gus Schumacher Nutrition Incentive Program (GusNIP) is a federally funded grant program that provides nutrition incentives—subsidies for purchasing fruits and vegetables (FV)—to Supplemental Nutrition Assistance Program (SNAP) participants. GusNIP currently advances nutrition equity by improving FV access for people with low incomes, yet inequities exist within GusNIP. We sought to identify inequities in GusNIP at the community, organization, partner, and individual levels and develop recommendations for farm bill provisions to make the program more equitable. In Spring 2021, a group of nutrition incentive experts (n = 11) from across the country convened to discuss opportunities to enhance equity in GusNIP. The iterative recommendation development process included feedback from key stakeholders (n = 15) and focus group participants with GusNIP lived experience (n = 12). Eleven recommendations to advance equity in GusNIP in the farm bill emerged across six categories: (1) increase total GusNIP funding, (2) increase funding and support to lower-resourced organizations and impacted communities, (3) eliminate the match requirement, (4) support statewide expansion, (5) expand and diversify retailer participation, and (6) expand program marketing. Including these recommendations in the upcoming and future farm bills would equitably expand GusNIP for SNAP participants, program grantees, and communities across the country. Full article

The United States Department of Agriculture’s Gus Schumacher Nutrition Incentive Program (GusNIP) supports nutrition incentive (NI) and produce prescription programs (PPRs). PPRs allow healthcare providers to “prescribe” fruits and vegetables (FVs) to patients experiencing low income and/or chronic disease(s) and who screen positive for food insecurity. We developed a Theory of Change (TOC) that summarizes how and why PPRs work, identifies what the programs hope to achieve, and elucidates the causal pathways necessary to achieve their goals. We created the PPR TOC through an iterative, participatory process that adapted our previously developed GusNIP NI TOC. The participatory process involved food and nutrition security experts, healthcare providers, PPR implementors, and PPR evaluators reviewing the existing NI TOC and suggesting modifications to accurately reflect PPRs. The resulting TOC describes the mechanisms, assumptions, rationale, and underpinnings that lead to successful and equitable outcomes. Modifications of the NI TOC centered around equity and focused on inclusion of healthcare as an additional partner and the importance of health and healthcare utilization as outcomes. The TOC describes how the GusNIP PPR program reaches its goals. This understanding will be useful for PPR developers, implementers, funders, and evaluators for describing the pathways, assumptions, and foundations of successful PPRs. Full article

College students face unique challenges with leading healthful lifestyles. Using a community-based participatory research approach, college student research partners at two land-grant universities collected data and developed a tailored intervention to improve the well-being of college students. To inform the design of the program, college students were trained to conduct a needs assessment that included a campus-wide survey on the health behaviors of college students, environmental audits of health policies and food pantries on campus, and stakeholder interviews with campus health professionals. Outcomes of the needs assessment data highlighted university students ranked their health as “good” but nutrition health as “fair/poor.” Low or very low food security was self-reported by 36.9% of participants and had an overall diet quality score of 47.6 ± 10.1 out of 100. Health professional interview data indicated campuses provide healthful resources to students, but students are not aware those resources exist. Utilizing the needs assessment data previously mentioned, the nominal group technique was then used for student research partners to collaboratively determine the best intervention approaches and develop a wellness program. Student partners identified (1) education, (2) sharing of campus resources, and (3) incentives as important areas of intervention. Using the data collected, the student research partners developed a program titled, The College Cooking Connection, to address health-related quality of life in college students. Using a community-based participatory research approach to program planning, educators and researchers have a greater likelihood of addressing the current needs of the population they are targeting and developing a successful intervention to meet those health concerns. This study aims to partner with young adult university students to understand the college environment and allow the target community to be involved with the development of intervention programs for their campus. Full article

We examined the associations of a Supplemental Nutrition Assistance Program (SNAP) point-of-purchase financial incentive program at farmers’ markets with produce purchase, consumption, and food security outcomes. We conducted cross-sectional, interviewer-administered intercept surveys with 325 adult SNAP participants at six incentive programs, five comparison farmers’ markets, and nine comparison supermarkets in California in the summer of 2018. The program provided dollar-for-dollar point-of-purchase incentives with $10 or $20 maximum at participating farmers’ markets. We measured produce consumption by an NCI screener; food security by the USDA 6-item screener; and program satisfaction with open-ended questions asked of a subsample. The quantitative analysis involved multilevel linear and logistic regression, adjusted for covariates. Qualitative data were coded and analyzed thematically. Shoppers at farmers’ markets offering $20 incentives had significantly higher odds of purchasing most of their produce at farmers’ markets than shoppers at $10 incentive (3.1, CI: 1.1, 8.7) or comparison markets (8.1, CI 2.2, 29.7). Incentives were not associated with quantitatively measured produce consumption. Each additional incentive dollar was associated with reduced odds of food insecurity (0.987, CI 0.976, 0.999). Participants appreciated the program; supermarket shoppers lacked awareness. Point-of-purchase incentives are appreciated and underutilized. Further understanding of optimal program design for produce consumption and food security impact is needed. Full article

School nutrition programs mitigate food insecurity and promote healthy eating by offering consistent, nutritious meals to school-aged children in communities across the United States; however, stringent policy guidelines and contextual challenges often limit participation. During COVID-19 school closures, most school nutrition programs remained operational, adapting quickly and innovating to maximize reach. This study describes semi-structured interviews with 23 nutrition directors in North Carolina, which aimed to identify multi-level contextual factors that influenced implementation, as well as ways in which the innovations during COVID-19 could translate to permanent policy and practice change and improve program reach. Interviews were conducted during initial school closures (May–August 2020) and were deductively analyzed using the Social Ecological Model (SEM) and Consolidated Framework for Implementation Research (CFIR). Analysis elicited multiple relevant contextual factors: director characteristics (motivation, leadership style, experience), key implementation stakeholders (internal staff and external partners), inner setting (implementation climate, local leadership engagement, available resources, structural characteristics), and outer setting (state leadership engagement, external policies and incentives). Findings confirm the strength and resilience of program directors and staff, the importance of developing strategies to strengthen external partnerships and emergency preparedness, and strong support from directors for policies offering free meals to all children. Full article

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

Increased fruit and vegetable (FV) intake is associated with decreased risk of nutrition-related chronic diseases. Sociodemographic disparities in FV intake indicate the need for strategies that promote equitable access to FVs. The United States Department of Agriculture’s Gus Schumacher Nutrition Incentive Program (GusNIP) supports state and local programs that offer nutrition incentives (NIs) that subsidize purchase of FVs for people participating in the Supplemental Nutrition Assistance Program (SNAP). While a growing body of research indicates NIs are effective, the pathways through which GusNIP achieves its results have not been adequately described. We used an equity-focused, participatory process to develop a retrospective Theory of Change (TOC) to address this gap. We reviewed key program documents; conducted a targeted NI literature review; and engaged GusNIP partners, practitioners, and participants through interviews, workshops, and focus groups in TOC development. The resulting TOC describes how GusNIP achieves its long-term outcomes of increased participant FV purchases and intake and food security and community economic benefits. GusNIP provides NIs and promotes their use, helps local food retailers develop the capacity to sell FVs and accept NIs in accessible and welcoming venues, and supports local farmers to supply FVs to food retailers. The TOC is a framework for understanding how GusNIP works and a tool for improving and expanding the program. Full article

This cross-sectional study was part of a larger evaluation of a fruit and vegetable (FV) incentive program for Supplemental Nutrition Assistance Program (SNAP) participants in California. We examined the price differences in FV to explore whether these could help explain a previously observed lack of effect of the incentive program on FV consumption. Differences by type (organic/no-spray or conventional), among a convenience sample of farmers’ markets (n = 11) and nearby supermarkets (n = 7), were assessed using Wilcoxon rank-sum tests adjusting for clustering by market. We calculated the cost of market baskets comprising recommended FV servings for a household using median prices to consider the implications of FV price differences for SNAP shoppers who use financial incentives for FV. We found that farmers’ markets primarily offered organic FV while supermarkets primarily offered conventionally grown FV. Farmers’ market prices tended to be lower than supermarkets for organic FV but higher for conventional FV. Compared to supermarkets, the market basket composed only of organic FV cost USD 16.34 less at farmers’ markets, whereas a basket comprised of a mix of conventionally and organically grown FV cost USD 3.68 more. These differences warrant further exploration; FV price and type should be considered in studies aimed at understanding the impact of SNAP financial incentive programs. Full article

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

The purpose of this communication is to describe the preliminary evaluation of the Virginia Fresh Match (VFM) financial incentive program for fresh fruits and vegetables for Virginia Supplemental Nutrition Assistance Program shoppers and to determine if there were differences in incentive outcomes by race. In this cross-sectional study, a questionnaire was administered to shoppers using Virginia Fresh Match incentives at participating farmers markets and community-based food retail outlets. Repeated measures ANOVAs were used to detect differences in fruit and vegetable consumption between demographic groups over time. Chi-square tests were used to determine if there were associations between race and perceived impact of VFM incentives on making food last and the attribution of VFM incentives to changes in fruit and vegetable consumption frequency. Frequency of fruit and vegetable intake was significantly higher during VFM incentive use, with a difference of 1.17 ± 0.07 and 1.07 ± 0.07 on a Likert scale measure, respectively (p ≤ 0.001). There were racial differences in assertions that VFM incentives helped food to last. VFM incentives were effective at increasing fruit and vegetable consumption, but racial differences should be considered in the administration of VFM to avoid reinforcing systems or approaches that may contribute to disparities in food access and food security. Full article