Financial incentives increase fruit and vegetable intake among Supplemental Nutrition Assistance Program participants: a randomized controlled trial of the USDA Healthy Incentives Pilot

Olsho, Lauren; Klerman, Jacob Alex; Wilde, Parke; Bartlett, Susan

doi:10.3945/ajcn.115.129320

Cited by 165 publications

(149 citation statements)

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“…For example, SSB taxes may reduce SSB consumption (57,58), and incentives for purchasing healthier foods could improve the nutritional profile of household purchases (18,19,59,60). The US might also follow other countries in adopting nonfiscal strategies such as imposing marketing restrictions or requiring warning labels on unhealthy items (61).…”

Section: Discussionmentioning

confidence: 99%

“…The estimation of the current purchases of SNAP households can help identify specific dietary areas to target in future interventions. In addition, policymakers and researchers have proposed a number of reforms to the SNAP benefits package, including calls to provide incentives for purchasing fruit and vegetables (18)(19)(20) and to end subsidies for candy (21), junk foods (21,22), and sugar-sweetened beverages (SSBs) (2,(22)(23)(24)(25). Estimates of current purchases of policy-relevant items are needed to define the potential for these policies to meaningfully change the overall nutritional quality of SNAP household purchases.…”

Section: Introductionmentioning

confidence: 99%

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Nutritional profile of Supplemental Nutrition Assistance Program household food and beverage purchases ,

Grummon

Taillie

2017

The American Journal of Clinical Nutrition

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Background: The Supplemental Nutrition Assistance Program (SNAP), which is the largest federal nutrition assistance program in the United States, serves nearly 1 of 7 Americans. To date, few studies have examined food and beverage purchase behaviors in SNAP participants with the use of electronic purchase data. Objective: In this cross-sectional study, we examined household store purchases of key food, beverage, and nutrient groups in SNAP participants and nonparticipants. Design: Using a data set of US households' (n = 98,256 householdby-quarter observations) packaged food and beverage purchases and SNAP status [current participant, income-eligible nonparticipant (income #130% of the Federal Poverty Level [FPL]), and higherincome nonparticipants (income .130% of the FPL)] from 3 quarters during 2012-2013, we estimated pooled ordinary least-squares models, clustered at the household level, to examine the association between SNAP status and purchases while controlling for sociodemographic characteristics. We examined purchases of healthand policy-relevant food and beverage groups [e.g., fruit and sugar-sweetened beverages (SSBs)] and nutrients (e.g., total calories and sodium). Results: Regardless of SNAP status, households had low mean purchases of fruit, vegetables, and fiber and high mean purchases of junk foods, saturated fat, and sodium. After adjustment for multiple comparisons and demographic characteristics, we found significant differences by SNAP status of purchases of fruit, processed meat, salty snacks, sweeteners and toppings, SSBs, and total calories, fiber, sugar, and sodium. Several of these differences were clinically important. For example, compared with income-eligible and higher-income nonparticipants, SNAP participants purchased an additional w15-20 kcal $ person 21 $ d 21 from SSBs (P , 0.0001) and w174-195 mg total Na $ person 21 $ d 21 (P ,0.0001). Results were robust to corrections for sample-selection bias and to the exclusion of observations with potentially misreported SNAP status. Conclusions: American households, including SNAP households, show room for improvement in the nutritional quality of store purchases. New interventions and policies may be needed to improve food and beverage purchases in both SNAP and non-SNAP households.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nutritional profile of Supplemental Nutrition Assistance Program household food and beverage purchases ,

Grummon

Taillie

2017

The American Journal of Clinical Nutrition

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“…Results of population interventions in Massachusetts, 12–13 Minnesota, 14 and Mexico 6–7 support healthier dietary choices as a result of subsidies on healthier foods and taxes on less healthy foods. A recent analysis by our group used the US IMPACT model to compare the mortality effects of fruit and vegetable media health promotion campaigns vs. price policies on CVD mortality, finding that pricing policies had larger effects and were also more equitable for benefits by race.…”

Section: Discussionmentioning

confidence: 99%

“…12–13 Because most SNAP participants also purchase foods with their own funds outside the EBT system, 13 we modeled a smaller net effect of this intervention on total dietary consumption. For these SNAP-specific interventions, a 1% reduction in price would lead to an average 0.87% increase in consumption among SNAP participants.…”

Section: Methodsmentioning

confidence: 99%

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Reductions in national cardiometabolic mortality achievable by food price changes according to Supplemental Nutrition Assistance Program (SNAP) eligibility and participation

Wilde

Conrad

Rehm

et al. 2018

J Epidemiol Community Health

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Background Suboptimal diets are a major contributor to cardiometabolic disease (CMD) mortality, and substantial disparities exist for both dietary quality and mortality risk across income groups in the United States. Research is needed to quantify how food pricing policies to subsidize healthy foods and tax unhealthy foods could affect US CMD mortality, overall and by Supplemental Nutrition Assistance Program (SNAP) eligibility and participation. Methods Comparative risk analysis based on national data on diet (NHANES, 2003–2012) and mortality (mortality-linked NHIS) and meta-analyses of policy-diet and diet-disease relationships. Results A national 10% price reduction on fruits, vegetables, nuts, and whole grains was estimated to prevent 19,600 CMD deaths/year, including 2.6% (95% UI: 2.4%, 2.8%) of all CMD deaths among SNAP participants, 2.7% (2.4%, 3.0%) among SNAP-eligible non-participants, and 2.6% (2.4%, 2.8%) among SNAP-ineligible non-participants. Adding a national 10% tax on sugar-sweetened beverages (SSBs) and processed meats would prevent a total of 33,700 CMD deaths/year, including 5.9% (5.4%, 7.4%) of all CMD deaths among SNAP participants, 4.8% (4.4%, 5.2%) among SNAP-eligible non-participants, and 4.1% (3.8%, 4.5%) among SNAP-ineligible non-participants. Adding a SNAP-targeted 30% subsidy for the same healthy foods would offer the largest reductions in both CMD mortality and disparities. Conclusion National subsidies for healthy foods and taxes on SSBs and processed meats would each reduce CMD mortality; taxes would also reduce CMD mortality more steeply for SNAP participants than for non-participants.

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Potential Policy Approaches to Address Diet-Related Diseases

Jacobson

Krieger²,

Brownell

2018

JAMA

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The Centers for Disease Control and Prevention (CDC) recently published 2 reports that should inspire vigorous action to improve the diets of individuals in the United States. One report found that in 2015-2016 the prevalence of obesity (BMI Ն30) in adults (39.6%) increased to new highs, and obesity levels remained disturbingly high among youth (18.5%). 1 By comparison, in 19761 By comparison, in -1980.0% of adults and 5.5% of youth were obese. Each uptick in the prevalence of obesity increases the risks of hypertension, stroke, myocardial infarction, certain cancers, and, especially, type 2 diabetes. High BMI is responsible for an estimated 386 000 excess deaths per year. 2 A second report, based on 24-hour urinary excretion samples from 827 individuals, found that mean sodium consumption was approximately 4000 mg/d, or more than 1.5 times the recommended daily limit of 2300 mg. 3 High sodium intake increases the risk of hypertension and, thus, myocardial infarction and stroke. Excess sodium intake may cause as many as 92 000 deaths annually. 4 According to a report from the US Burden of Disease Collaborators, dietary factors were associated with 529 299 deaths in 2016 in the United States, making them the leading risk factor for mortality. 2 Social inequities in dietary patterns are increasing. It may be expected that such findings would prompt concern among policy makers, but neither Congress nor the executive branch has proposed a comprehensive plan to improve the US diet.It is time to reinvigorate the discussion about preventing diet-related diseases. While more research on effective interventions is needed, this Viewpoint presents a 7-pronged policy-oriented proposal intended to promote a healthier food supply and improve diet quality to prevent disease.

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Financial incentives increase fruit and vegetable intake among Supplemental Nutrition Assistance Program participants: a randomized controlled trial of the USDA Healthy Incentives Pilot

Cited by 165 publications

References 37 publications

Nutritional profile of Supplemental Nutrition Assistance Program household food and beverage purchases ,

Nutritional profile of Supplemental Nutrition Assistance Program household food and beverage purchases ,

Reductions in national cardiometabolic mortality achievable by food price changes according to Supplemental Nutrition Assistance Program (SNAP) eligibility and participation

Potential Policy Approaches to Address Diet-Related Diseases

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