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

Trial Summary

What is the purpose of this trial?

Investigator will test an intervention to increase use of a fruit and vegetable incentive program in South Carolina for families in the Supplemental Nutrition Assistance Program (SNAP) experiencing food insecurity. Caregivers are randomized to an intervention or an education-only, wait-list control group. The investigators hypothesize the intervention will improve diet-related outcomes, above and beyond the education-only wait-list control.

Will I have to stop taking my current medications?

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

What data supports the effectiveness of the treatment Veggie Vouchers for diet improvement?

Research shows that programs providing fruit and vegetable vouchers can significantly improve diet quality, health outcomes, and food security status. These programs have been effective in increasing fruit and vegetable consumption among low-income and at-risk populations. ^{1 2 3 4 5}

Is it safe for humans to use Veggie Vouchers for purchasing fruits and vegetables?

The research on Veggie Vouchers, which provided financial support for buying fresh fruits and vegetables, did not report any safety concerns for participants. The studies involved low-income families and showed high usage of the vouchers without any noted barriers or negative effects. ^{6 7 8 9 10}

How do Veggie Vouchers differ from other treatments for diet improvement?

Veggie Vouchers are unique because they provide financial assistance specifically for purchasing fruits and vegetables, aiming to improve diet quality by increasing access to healthy foods, especially among low-income populations. Unlike other treatments that might involve medication or supplements, this approach directly targets dietary habits and accessibility. ^{2 3 7 9 10}

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

References

1. United States 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. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Heterogeneity in the Effects of Food Vouchers on Nutrition Among Low-Income Adults: A Quantile Regression Analysis. [2022]

3. England pubmed.ncbi.nlm.nih.gov

Fruit and vegetables on prescription: a brief intervention in primary care. [2016]

4. England pubmed.ncbi.nlm.nih.gov

Community-based fruit and vegetable prescription programs: a scoping review. [2023]

5. Germany pubmed.ncbi.nlm.nih.gov

Food Purchasing Behavior of Food Insecure Cancer Patients Receiving Supplemental Food Vouchers. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

Choices made by low-income women provided with an economic supplement for fresh fruit and vegetable purchase. [2007]

7. England 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. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Testing the effectiveness of in-home behavioral economics strategies to increase vegetable intake, liking, and variety among children residing in households that receive food assistance. [2016]

9. United States pubmed.ncbi.nlm.nih.gov

Comparison of Fruit and Vegetable Intake Among Urban Low-Income US Adults Receiving a Produce Voucher in 2 Cities. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Effects Of Alternative Food Voucher Delivery Strategies On Nutrition Among Low-Income Adults. [2020]