Fruit & vegetable incentive programs

Fruit and vegetable incentive programs, often called bonus dollars, market bucks, produce coupons, or nutrition incentives, offer low income participants matching funds to purchase healthy foods, especially fresh fruits and vegetables. Incentive amounts vary from dollar-to-dollar matches to matched spending increments (i.e., $1 for $5 spent); most programs set a daily benefit limit, often $10 or $20. Incentives are frequently redeemed at farmers markets, but can also be used at grocery stores, mobile markets, or through community supported agriculture (CSA) shares. Programs are typically funded and managed by non-profit organizations, private foundations, or local governments. Many programs match funds to Supplemental Nutrition Assistance Program (SNAP) benefit spending amounts. SNAP-based incentive programs must be registered and comply with the US Department of Agriculture’s Food and Nutrition Service rules and regulations (USDA-King 2014).

Expected Beneficial Outcomes (Rated)

  • Increased access to healthy food

  • Increased healthy food purchases

  • Increased fruit & vegetable consumption

Other Potential Beneficial Outcomes

  • Improved dietary habits

  • Increased food security

  • Improved food environment

  • Improved weight outcomes

Evidence of Effectiveness

There is strong evidence that fruit and vegetable incentive programs increase affordability, access, purchase (Polascek 2018*, Olstad 2017, Wilde 2016*, AHA-Mozaffarian 2012, Anderson 2001*, Steele-Adjognon 2017, Baronberg 2013), and consumption of fruits and vegetables (Olsho 2016, AHA-Mozaffarian 2012, Anderson 2001*, French 2017, Kral 2016*). In general, subsidies and financial incentives for healthy foods have been shown to increase healthy food purchases (Gittelsohn 2017, Grech 2015*, Jaime 2009*, Kocken 2012*, An 2013*, AHA-Mozaffarian 2012), which enables increased healthy food consumption (Gittelsohn 2017, An 2013*, AHA-Mozaffarian 2012). However, additional evidence is needed to confirm long-term effects, especially after incentives are discontinued.

Fruit and vegetable incentive programs can significantly increase sales and the use of food assistance (e.g., SNAP or WIC) at farmers’ markets (Freedman 2014, USDA-King 2014, Young 2013a). In a Massachusetts-based study, produce incentives reduced the gap between baseline fruit and vegetable consumption and recommended levels for a healthy diet by about 20% for SNAP participants (Olsho 2016). In a Philadelphia-based study, purchases with incentives increased by an average of 8 more servings of vegetables and 2.5 more servings of fruit per week than purchases without incentives (Phipps 2015*); however, other studies suggest more modest effects (Steele-Adjognon 2017).

Fruit and vegetable incentive programs can increase the variety of fruits and vegetables purchased (Steele-Adjognon 2017), and can improve dietary intake for families with low incomes (Polascek 2018*). Participants with low levels of education who consume low levels of fresh produce before receiving incentives often have the greatest increases in fruit and vegetable consumption (Dimitri 2015*). Fruit and vegetable incentives can also improve home food environments among older adults (Kral 2016*), and may improve food security among families with low incomes (Savoie-Roskos 2016a*).

In some circumstances, increased fruit and vegetable consumption continues two to six months after participation in an incentive program (Cohen 2017*, AHA-Mozaffarian 2012), which suggests incentives may change food preferences and effects may be sustainable (AHA-Mozaffarian 2012). In other cases, effects do not last (Steele-Adjognon 2017, Phipps 2015*).

Combining healthy food incentive programs with restrictions on unhealthy food sales can reduce excess sugar consumption, increase fruit consumption, and improve healthy eating habits more than incentive programs or unhealthy food restrictions alone (French 2017, Harnack 2016*). Among older adults, for example, incentive programs increase vegetable consumption but do not replace unhealthy food choices or improve weight outcomes; incentive programs may need a longer duration and additional components to improve eating habits and weight outcomes (Kral 2016*).

Successful incentive programs include an educational component (Wetherill 2017, Anderson 2001*), distribute incentives early in the farmers market season (Payne 2013), and use promotion efforts to raise awareness (USDA-Karakus 2014). Partnerships with community-based organizations can help promote nutrition incentives, provide educational program components, and raise awareness about incentives. Implementing a multi-component intervention that includes healthy food incentives, establishing farmers markets in low income neighborhoods, and accepting SNAP electronic benefit transfer (EBT) payment may increase farmers market use among SNAP populations (Freedman 2017). A study among rural, Mexican heritage households suggests fruit and vegetable incentive programs may be more successful when designed with an awareness of participants’ cultural values and inclusion of culturally important produce (Hanbury 2017*).

An analysis of the expansion of the Healthy Incentives Pilot (HIP) program, which offers SNAP households a 30% rebate on produce purchases, suggests HIP is a cost effective way to modestly increase SNAP households’ fruit and vegetable purchases and consumption (An 2015*).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

Wholesome Wave’s National Nutrition Incentive Network operates incentive programs at nearly 600 farmers markets, CSAs, and mobile markets in 42 states and Washington DC (WW-NNIN). A few examples include SNAP-EBT Match at the Gorge Grown Food Network’s markets in the Pacific Northwest (GGFN-Food assistance); Market Match at Crescent City Farmers Market in New Orleans, Louisiana (CCFM-Special programs); Produce Plus at farmers markets in Washington DC (DC Greens-Food access); Boston Bounty Bucks in Boston, Massachusetts (CDC-Bovenzi 2015); Double Value Coupons available at 39 farmers markets in several cities and towns in Illinois (IDHS-Farmers markets & DVC); and Market Bucks matching SNAP-EBT spending dollar-for-dollar (up to $10) at participating farmers markets across Minnesota (HSM-Market Bucks).

In 2012, nine states introduced legislation to support nutrition incentive programs at farmers markets (NCSL-Farmers market).

Implementation Resources

WW-Running NIP toolkit - Wholesome Wave (WW). How to run a nutrition incentive program (NIP): A toolkit for Wholesome Wave’s National Nutrition Incentive Network.

WW-Growing NIP toolkit - Wholesome Wave (WW). How to grow your nutrition incentive program (NIP): A toolkit for Wholesome Wave’s National Nutrition Incentive Network.

WW-SNAP agency partner guide 2015 - Wholesome Wave (WW). National Nutrition Incentive Network: Partnering with your local/state SNAP agency. 2015.

NAFMNP-MarketLink - National Association of Farmers Market Nutrition Programs (NAFMNP). MarketLink.

Citations - Evidence

* Journal subscription may be required for access.

Polascek 2018* - Polacsek M, Moran A, Thorndike AN, et al. A supermarket double-dollar incentive program increases purchases of fresh fruits and vegetables among low-income families with children: The healthy double study. Journal of Nutrition Education and Behavior. 2018;50(3):217-228.e1.

Olstad 2017 - Olstad DL, Crawford DA, Abbott G, et al. The impact of financial incentives on participants’ food purchasing patterns in a supermarket-based randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity. 2017;14:115.

Wilde 2016* - Wilde P, Klerman JA, Olsho LEW, Bartlett S. Explaining the impact of USDA’s healthy incentives pilot on different spending outcomes. Applied Economic Perspectives and Policy. 2016;38(4):655-672.

AHA-Mozaffarian 2012 - Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association (AHA). Circulation. 2012;126(12):1514–63.

Anderson 2001* - Anderson JV, Bybee DI, Brown RM, et al. 5 A Day fruit and vegetable intervention improves consumption in a low income population. Journal of the American Dietetic Association. 2001;101(2):195-202.

Steele-Adjognon 2017 - Steele-Adjognon M, Weatherspoon D. Double Up Food Bucks program effects on SNAP recipients’ fruit and vegetable purchases. BMC Public Health. 2017;17:946.

Baronberg 2013 - 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. Preventing Chronic Disease. 2013;10(E163):130113.

Olsho 2016 - Olsho LEW, Klerman JA, Wilde PE, 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. The American Journal of Clinical Nutrition. 2016;104(2):423-435.

French 2017 - French SA, Rydell SA, Mitchell NR, et al. Financial incentives and purchase restrictions in a food benefit program affect the types of foods and beverages purchased: Results from a randomized trial. International Journal of Behavioral Nutrition and Physical Activity. 2017;14:127.

Kral 2016* - Kral TVE, Bannon AL, Moore RH. Effects of financial incentives for the purchase of healthy groceries on dietary intake and weight outcomes among older adults: A randomized pilot study. Appetite. 2016;100:110-117.

Gittelsohn 2017 - Gittelsohn J, Trude ACB, Kim H. Pricing strategies to encourage availability, purchase, and consumption of healthy foods and beverages: A systematic review. Preventing Chronic Disease. 2017;14(E107):170213.

Grech 2015* - Grech A, Allman-Farinelli M. A systematic literature review of nutrition interventions in vending machines that encourage consumers to make healthier choices. Obesity Reviews. 2015;16(12):1030-1041.

Jaime 2009* - Jaime PC, Lock K. Do school based food and nutrition policies improve diet and reduce obesity? Preventive Medicine. 2009;48(1):45-53.

Kocken 2012* - Kocken PL, Eeuwijk J, Van Kesteren NMC, et al. Promoting the purchase of low-calorie foods from school vending machines: a cluster-randomized controlled study. Journal of School Health. 2012;82(3):115–22.

An 2013* - An R. Effectiveness of subsidies in promoting healthy food purchases and consumption: A review of field experiments. Public Health Nutrition. 2013;16(7):1215-28.

Freedman 2014 - Freedman DA, Mattison-Faye A, Alia K, Guest MA, Hébert JR. Comparing farmers’ market revenue trends before and after the implementation of a monetary incentive for recipients of food assistance. Preventing Chronic Disease. 2014;11:130347.

USDA-King 2014 - King M, Dixit-Joshi S, MacAllum K, Steketee M, Leard S. Farmers market incentive provider study. Alexandria, VA: US Department of Agriculture (USDA), Food and Nutrition Service (FNS), Office of Policy Support; 2014.

Young 2013a - Young CR, Aquilante JL, Solomon S, et al. Improving fruit and vegetable consumption among low-income customers at farmers markets: Philly Food Bucks, Philadelphia, Pennsylvania, 2011. Preventing Chronic Disease. 2013;10:120356.

Phipps 2015* - Phipps EJ, Braitman LE, Stites SD, et al. Impact of a rewards-based incentive program on promoting fruit and vegetable purchases. American Journal of Public Health. 2015;105(1):166-172.

Dimitri 2015* - 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.

Savoie-Roskos 2016a* - Savoie-Roskos M, Durward C, Jeweks M, LeBlanc H. Reducing food insecurity and improving fruit and vegetable intake among farmers’ market incentive program participants. Journal of Nutrition Education and Behavior. 2016;48(1):70-76.e1.

Cohen 2017* - Cohen AJ, Richardson CR, Heisler M, et al. Increasing use of a healthy food incentive: A waiting room intervention among low-income patients. American Journal of Preventive Medicine. 2017;52(2):154-162.

Harnack 2016* - Harnack L, Oakes JM, Elbel B, et al. Effects of subsidies and prohibitions on nutrition in a food benefit program: A randomized clinical trial. JAMA Internal Medicine. 2016;176(11):1610-1619.

Wetherill 2017 - Wetherill MS, Williams MB, Gray KA. SNAP-based incentive programs at farmers’ markets: Adaptation considerations for Temporary Assistance for Needy Families (TANF) recipients. Journal of Nutrition Education and Behavior. 2017;49(9):743-751.e1.

Payne 2013 - Payne GH, Wethington H, Olsho L, et al. Implementing a farmers’ market incentive program: Perspectives on the New York City Health Bucks Program. Preventing Chronic Disease. 2013;10:120285.

USDA-Karakus 2014 - Karakus M, Milfort R, MacAllum K, Hao H. Nutrition assistance in farmers markets: Understanding the shopping patterns of SNAP participants. Alexandria, VA: US Department of Agriculture (USDA), Food and Nutrition Service (FNS), Office of Policy Support; 2014.

Freedman 2017 - Freedman DA, Flocke S, Shon EJ, et al. Farmers’ market use patterns among Supplemental Nutrition Assistance Program recipients with high access to farmers’ markets. Journal of Nutrition Education and Behavior. 2017;49(5):397-404.e1.

Hanbury 2017* - Hanbury MM, Gomez-Camacho R, Kaiser L, Sadeghi B, de la Torre A. Purchases made with a fruit and vegetable voucher in a rural Mexican-heritage community. Journal of Community Health. 2017;42(5):942-948.

An 2015* - An R. Nationwide expansion of a financial incentive program on fruit and vegetable purchases among Supplemental Nutrition Assistance Program participants: A cost-effectiveness analysis. Social Science & Medicine. 2015;147:80-88.

Citations - Implementation Examples

* Journal subscription may be required for access.

WW-NNIN - Wholesome Wave (WW). National Nutrition Incentive Network (NNIN).

GGFN-Food assistance - Gorge Grown Food Network (GGFN). Food assistance: Discounts and vouchers at local farmers markets/farm stands.

CCFM-Special programs - Crescent City Farmers Market (CCFM). Token policy & special programs: Market match.

DC Greens-Food access - DC Greens. Food access: Produce Plus and Produce Rx.

CDC-Bovenzi 2015 - Bovenzi M. Farmers’ markets pilot digital incentive program in Boston, Massachusetts: The Boston Bounty Bucks system. Centers for Disease Control and Prevention (CDC) Success Stories. 2015.

IDHS-Farmers markets & DVC - Illinois Department of Human Services (IDHS). Farmers markets that accept the Illinois Link Card and Double Value Coupons (DVC).

HSM-Market Bucks - Hunger Solutions Minnesota (HSM). Market Bucks: Market Bucks match SNAP-EBT spending dollar-for-dollar (up to $10) at participating farmers markets across Minnesota.

NCSL-Farmers market - National Conference of State Legislatures (NCSL). Farmers’ market.

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