Veggie Vouchers for Diet Improvement

Overseen By Elizabeth Adams, PhD

Age: < 18

Sex: Any

Trial Phase: Phase 1

Sponsor: University of South Carolina

Disqualifiers: Not in SNAP, Recent program use, Medical condition, Food allergy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 12

296 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how a program offering fruit and vegetable vouchers can improve eating habits for families in South Carolina who use the Supplemental Nutrition Assistance Program (SNAP) and face food insecurity. Participants will either receive these veggie vouchers to encourage healthier eating or receive education about the program and access it later. The goal is to determine if the vouchers lead to better eating habits than education alone. This trial suits caregivers who are part of SNAP, have children aged 2-10, and struggle with food insecurity. As a Phase 1 trial, the research focuses on understanding how the treatment works in people, providing participants a chance to benefit from this innovative approach.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

Is there any evidence suggesting that the Veggie Vouchers intervention is likely to be safe?

Research has shown that programs like Veggie Vouchers, which assist people in purchasing fruits and vegetables, are generally safe. These programs promote healthier eating by providing financial support for these foods.

One study found that similar programs helped SNAP benefit users consume more fruits and vegetables, enhancing their diet without reported health risks. Another review demonstrated that these programs can reduce food insecurity and improve health.

Although Veggie Vouchers are still under evaluation in an early study, evidence from similar programs suggests they are safe and well-tolerated, making them a promising option for improving diet-related health. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Veggie Vouchers program because it introduces an innovative approach to dietary improvement by making fruits and vegetables more accessible and affordable. Unlike traditional nutritional interventions that might rely on education alone, this program provides caregivers with tangible incentives and the convenience of home delivery. The combination of a "free trial" and ongoing discounts through the SNAP program encourages sustained healthy eating habits, potentially leading to long-term health benefits. This method stands out by directly addressing economic barriers to accessing fresh produce, which is a significant challenge for many families.

What evidence suggests that Veggie Vouchers might be an effective treatment for diet improvement?

Research has shown that Veggie Vouchers, part of programs providing healthy food vouchers, usually help people make better food choices. These programs often lead to increased purchases and consumption of fruits and vegetables, enhancing nutrition knowledge and improving food access. In this trial, one group of participants will receive a "free trial" of a SNAP fruit and vegetable incentive program, including Veggie Vouchers, to encourage first-time use. A study found that these vouchers are particularly beneficial for people with lower incomes, leading to better eating habits. Additionally, programs offering incentives for fruits and vegetables can make healthier foods more affordable and accessible. Overall, evidence suggests that Veggie Vouchers positively impact diet, especially for families struggling with food insecurity. ^{6 7 8 9 10}

Are You a Good Fit for This Trial?

This trial is for caregivers in South Carolina who are part of the SNAP program and struggle with food insecurity. It's not clear what specific exclusions apply, so potentially any SNAP participant facing these challenges could be eligible.

Inclusion Criteria

Screens positive for food insecurity

Speaks English

Currently enrolled in the Supplemental Nutrition Assistance Program (SNAP)

Exclusion Criteria

Anticipate no longer being enrolled in SNAP during the study duration

Recent use of the SNAP fruit and vegetable incentive program

Caregiver or child has a medical condition that impacts their ability to eat fruits and vegetables

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Caregivers receive brief education about a SNAP fruit and vegetable incentive program and a 'free trial' of the program with free home delivery

30 weeks

Visits at baseline, 6, 18, and 30 weeks

Follow-up

Participants are monitored for diet-related outcomes and food security measures

30 weeks

Assessments at baseline, 6, 18, and 30 weeks

Process Evaluation

Process metrics and intervention utilization are assessed through interviews and surveys

3 years

What Are the Treatments Tested in This Trial?

Interventions

• Veggie Vouchers

Trial Overview The study is testing 'Veggie Vouchers' to see if they help families buy more fruits and vegetables compared to just getting educational materials. Caregivers will either receive vouchers or be placed on a wait-list while receiving education.

How Is the Trial Designed?

Group I: Diet intervention Experimental Treatment 1 Intervention

Caregivers will receive brief education about a SNAP fruit and vegetable incentive program in South Carolina during their child's pediatrician visit. Following the visit, caregivers will receive a "free trial" of this SNAP program to encourage first-time use. After the free trial, caregivers can continue purchasing the same fruit and vegetable boxes at a steeply discounted price using their SNAP card. Free home delivery during the "free trial" and for all subsequent boxes purchased at a discounted rate will be offered during the full study duration.

Group II: Education-only wait-list control Active Control 1 Intervention

Caregivers will only receive brief education about a SNAP fruit and vegetable incentive program in South Carolina during their child's pediatrician visit. Once caregivers complete all study measures, they will be moved off the wait list and offered the intervention.

Who Is Running the Clinical Trial?

University of South Carolina

Lead Sponsor

Trials

233

Recruited

122,000+

Virginia Commonwealth University

Collaborator

Trials

732

Recruited

22,900,000+

Cornell University

Collaborator

Trials

179

Recruited

14,090,000+

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Collaborator

Trials

2,513

Recruited

4,366,000+

Published Research Related to This Trial

A systematic review of 10 studies on food provision programs for patients with type 2 diabetes or prediabetes showed that those including nutrition education consistently reduced HbA1c levels, indicating improved diabetes management.

Programs varied widely in their design and implementation, but those that incorporated nutrition education—covering topics like general nutrition and fruit/vegetable consumption—tended to yield better dietary quality and health outcomes compared to those without such education.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A narrative review of clinic-community food provision interventions aimed at improving diabetes outcomes among food-insecure adults: examining the role of nutrition education. Schier, HE., Chetty, KS., Garrity, K., et al.[2023]

The FLAM study, involving 92 parent-child pairs in a French urban district, demonstrated that providing vouchers for fruits and vegetables (FV) significantly reduced the number of children consuming less than 3.5 servings of FV per day, from 66.7% in the control group to 29.4% in the intervention group after one year.

The high utilization rate of the vouchers (82%) suggests that this intervention could effectively promote healthier eating habits among children from disadvantaged families, addressing social inequalities in health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Fruits and vegetables at home (FLAM): a randomized controlled trial of the impact of fruits and vegetables vouchers in children from low-income families in an urban district of France. Buscail, C., Margat, A., Petit, S., et al.[2022]

A study involving 671 low-income adults showed that providing $20 per month in fruit and vegetable vouchers for 6 months led to an overall increase in fruit and vegetable intake by 0.22 cup-equivalents per day, with a significant increase observed in Los Angeles (0.64 cup-equivalents) compared to San Francisco (0.10 cup-equivalents).

The findings suggest that fruit and vegetable vouchers are particularly beneficial for lower-income populations, indicating that flat-rate benefits may be more effective than income-scaled ones in improving nutritional intake.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of Fruit and Vegetable Intake Among Urban Low-Income US Adults Receiving a Produce Voucher in 2 Cities. Basu, S., Akers, M., Berkowitz, SA., et al.[2022]

Community-based fruit and vegetable prescription programs, primarily targeting low-income, non-white females, have shown significant improvements in diet quality (94% of studies), health outcomes (83%), and food security (82%), indicating their effectiveness in promoting healthier eating habits.

Despite the positive outcomes, the considerable variation in study design and measurement techniques makes it difficult to compare the effectiveness of different program methodologies, highlighting the need for more standardized and well-designed research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Community-based fruit and vegetable prescription programs: a scoping review. Greatorex Brooks, E., McInerney, M.[2023]

In a study involving 33 cancer patients receiving food vouchers, participants spent 50% of their funds on healthy items like animal protein, fruits, and vegetables, indicating a positive shift in their food purchasing behaviors.

The supplemental food voucher program led to patients purchasing more healthy foods than national averages, particularly among those born outside the U.S. or with limited English proficiency, highlighting the program's potential effectiveness in improving dietary choices for food insecure cancer patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Food Purchasing Behavior of Food Insecure Cancer Patients Receiving Supplemental Food Vouchers. Paolantonio, L., Kim, SY., Ramirez, J., et al.[2023]

Citations

1. sciencedirect.com sciencedirect.com/science/article/pii/S2161831325001681

Healthy Food Voucher Programs: Global Evidence on ... Most evidence indicates that HFVPs increase the purchase and consumption of healthy foods, improve food security, and enhance nutrition knowledge. However, ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7062145/

Effects Of Alternative Food Voucher Delivery Strategies On ... Receiving fruit and vegetable– only vouchers did not significantly increase HEI scores compared with receiving unrestricted vouchers, and receiving weekly ...

3. countyhealthrankings.org countyhealthrankings.org/strategies-and-solutions/what-works-for-health/strategies/fruit-vegetable-incentive-programs

Fruit & vegetable incentive programs Potential Benefits · Improved dietary habits · Increased food security · Improved food environment · Improved weight outcomes · Reduced emissions.

4. cdc.gov cdc.gov/nutrition/php/public-health-strategy/voucher-incentives-produce-prescriptions.html

Strategies for Fruit and Vegetable Voucher Incentives and ... Fruit and vegetable voucher incentives and produce prescriptions can improve affordability and access to healthier food.

5. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2777738

Fruit and Vegetable Intake Among US Adults Receiving a ... In this study, the use of fruit and vegetable vouchers appeared to be associated with greater benefit among those with lower incomes.

6. fns.usda.gov fns.usda.gov/snap/healthy-incentives

SNAP Healthy Incentives FINI increased fruit and vegetable purchases by 12-16% in three of the treatment groups. · The overall redemption rate for FINI incentives was about 82%. For ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5632594/

SNAP-based incentive programs at farmer's markets Findings suggest maternal vegetable intake, but not fruit intake, is associated with FM use among WIC participants. Additionally, past program voucher use, ...

8. ajpmonline.org ajpmonline.org/article/S0749-3797(24)00411-2/abstract

Impact of Fruit and Vegetable Incentive Programs on Food ... Impact of fruit and vegetable incentive programs on food insecurity, fruit and vegetable consumption, and health outcomes: A community guide systematic review.

9. sciencedirect.com sciencedirect.com/science/article/pii/S0002916522045555

Financial incentives increase fruit and vegetable intake ... The HIP significantly increased FV intake among SNAP participants, closing ~20% of the gap relative to recommendations and increasing dietary quality.

10. health.ny.gov health.ny.gov/prevention/nutrition/call_to_action.htm

Call to Action to Support the Expansion and Enhancement of ... Fruit and vegetable incentive (FVI) programs are proven strategies to increase access to and consumption of fruits and vegetables for households ...