Financial incentives increase fruit and vegetable intake among Supplemental Nutrition Assistance Program participants: a randomized controlled trial of the USDA Healthy Incentives Pilot
Financial incentives increase fruit and vegetable intake among Supplemental Nutrition Assistance Program participants: a randomized controlled trial of the USDA Healthy Incentives Pilot
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DOI：
10.3945/ajcn.115.129320
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发表时间：
2016-08-01
影响因子：
7.1
通讯作者：
Bartlett, Susan
中科院分区：
文献类型：
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作者：
Olsho, Lauren E. W.;Klerman, Jacob A.;Bartlett, Susan
背景：美国的水果和蔬菜 (FV) 摄入量仍低于建议值，特别是对于低收入人群。关于回扣在解决这一缺口方面的有效性的证据有限。 目的：本研究评估了美国农业部健康激励试点 (HIP)，该试点为购买目标 FV (TFV) 的补充营养援助计划 (SNAP) 参与者提供回扣。 设计：作为马萨诸塞州汉普登县随机对照试验的一部分，随机选择的 7500 个 SNAP 家庭在通过 SNAP 购买 TFV 时获得了 30% 的回扣好处。该县其余 47,595 户 SNAP 家庭获得了正常福利。随机抽取 5076 个 HIP 和非 HIP 家庭的成年人进行电话调查，包括 24 小时饮食回忆访谈。调查在基线（实施前 1-3 个月）和 2 轮后续轮（实施后 4-6 个月和 9-11 个月）进行。 2784 名成年人（1388 名 HIP，1396 名非 HIP）完成了基线访谈；对 2009 名成年人 (72%) 的数据进行了分析，这些成年人也完成了 >= 1 次随访访谈。 结果：HIP 参与者中随访时的回归调整平均 TFV 摄入量高出 0.24 杯当量/天（95% CI：0.13，0.34 杯当量/天）。在所有水果和蔬菜 (AFV) 中，HIP 参与者的回归调整平均摄入量高出 0.32 杯当量/天（95% CI：0.17，0.48 杯当量/天）。 AFV-TFV 差异的解释是更多地摄入 100% 果汁（0.10 杯当量/天；95% CI：0.02、0.17 杯当量/天）；购买果汁没有获得 HIP 回扣。 HIP 参与者的精制谷物摄入量降低了 0.43 盎司当量/天（95% CI：-0.69，-0.16 盎司当量/天），这可能表明存在替代效应。增加 AFV 摄入量和减少精制谷物摄入量有助于 HIP 参与者提高 2010 年健康饮食指数得分（4.7 分；95% CI：2.4、7.1 分）。 结论：HIP 显着增加了 SNAP 参与者的 FV 摄入量，与建议相比缩小了约 20% 的差距，并提高了膳食质量。有必要对作用机制进行更多研究。
Background: US fruit and vegetable (FV) intake remains below recommendations, particularly for low-income populations. Evidence on effectiveness of rebates in addressing this shortfall is limited.Objective: This study evaluated the USDA Healthy Incentives Pilot (HIP), which offered rebates to Supplemental Nutrition Assistance Program (SNAP) participants for purchasing targeted FVs (TFVs).Design: As part of a randomized controlled trial in Hampden County, Massachusetts, 7500 randomly selected SNAP households received a 30% rebate on TFVs purchased with SNAP benefits. The remaining 47,595 SNAP households in the county received usual benefits. Adults in 5076 HIP and non-HIP households were randomly sampled for telephone surveys, including 24-h dietary recall interviews. Surveys were conducted at baseline (1-3 mo before implementation) and in 2 follow-up rounds (4-6 mo and 9-11 mo after implementation). 2784 adults (1388 HIP, 1396 non-HIP) completed baseline interviews; data were analyzed for 2009 adults (72%) who also completed >= 1 follow-up interview.Results: Regression-adjusted mean TFV intake at follow-up was 0.24 cup-equivalents/d (95% CI: 0.13, 0.34 cup-equivalents/d) higher among HIP participants. Across all fruit and vegetables (AFVs), regression-adjusted mean intake was 0.32 cup-equivalents/d (95% CI: 0.17, 0.48 cup-equivalents/d) higher among HIP participants. The AFV-TFV difference was explained by greater intake of 100% fruit juice (0.10 cup-equivalents/d; 95% CI: 0.02, 0.17 cup-equivalents/d); juice purchases did not earn the HIP rebate. Refined grain intake was 0.43 ounce-equivalents/d lower (95% CI: -0.69, -0.16 ounce-equivalents/d) among HIP participants, possibly indicating substitution effects. Increased AFV intake and decreased refined grain intake contributed to higher Healthy Eating Index-2010 scores among HIP participants (4.7 points; 95% CI: 2.4, 7.1 points).Conclusions: The HIP significantly increased FV intake among SNAP participants, closing similar to 20% of the gap relative to recommendations and increasing dietary quality. More research on mechanisms of action is warranted.