Coupons for Healthy Intake Using Variable Economic Strategies (CHIVES)
Phase: NA
Conditions: Cardiovascular Diseases
Sponsor: Stanford University

|
 
coupons for healthy intake 
using variable economic strategies 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Manual of Operational Procedures 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, November 21, 2016 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
 
 
 
 
 
A randomized 312-subject behavioral intervention 
trial of effectiveness and cost-effectiveness of 
different food vouchers in a low-income population. 
 
 
 
 
Co-Principal Investigators: 
Sanjay Basu, MD, PhD, Epidemiologist & Physician, Stanford University 
Hilary Seligman, MD, MAS, Epidemiologist & Physician, UCSF 
 
 
 
Supported by: 
The National Institutes of Health 
Grant: 1R01 HL132814-01, SPO: 121890 
 
Registered with: 
www.ClinicalTrials.gov  
Identifier: NCT02843178 
 
Approved by: 
Stanford University Institutional Review Board 
Protocol ID: 36763, IRB #: 6208 
Approval Period: 5/21/2019 – 2/28/2020 
 
University of California San Francisco Institutional Review Board 
IRB #: 15-17957, Reference #: 160999 
Approval Period: 03/18/2019 – 3/17/2020 
 
 
 
Version 2.0  
December 20, 2016
coupons for healthy intake 
using variable economic strategies 
| 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
TABLE OF CONTENTS 
PAGE 
 
 
 
 
STUDY OVERVIEW ................................................................................................................. vii 
Study Title ................................................................................................................................. vii 
Aims ..................................................................................................................................................... ivii 
Design ....................................................................................................................................... vii 
Outcomes .................................................................................................................................. vii 
Schedule of Participant Flow & Outcome Measures .................................................................. v 
Sample Size, Covariate-Adaptive Randomization, & Population .............................................. iv 
Interventions and Duration ......................................................................................................... iii 
STUDY TEAM ROSTER .............................................................................................................. i 
Principal Investigators: Sanjay Basu, MD, PhD & Hilary Seligman, MD, MAS ........................ i 
Co-Investigators: Christopher Gardner, PhD; Matthew Harding, PhD; & Justin White, PhD ..... i 
PROTOCOL CONTRIBUTOR.................................................................................................... i 
PARTICIPATING STUDY SITES ............................................................................................... i 
1 
STUDY AIMS ........................................................................................................................ 1 
1.1 
Primary Aim .................................................................................................................... 1 
1.2 
Secondary Aim ................................................................................................................ 1 
2 
BACKGROUND AND RATIONALE ................................................................................. 2 
2.1 
Background on cardiovascular disease............................................................................ 2 
2.2 
Study Rationale ............................................................................................................... 2 
3 
STUDY DESIGN ................................................................................................................... 4 
4 
SELECTION AND ENROLLMENT OF PARTICIPANTS ............................................ 9 
4.1 
Inclusion Criteria ............................................................................................................. 9 
4.2 
Exclusion Criteria............................................................................................................ 9 
4.3 
Study Enrollment Procedures .......................................................................................... 9 
5 
STUDY INTERVENTIONS ............................................................................................... 15 
5.1 
Interventions, Administration, and Duration ................................................................. 15 
5.2 
Handling of Study Interventions ........................................................................................ 16 
5.3 
Concomitant Interventions ................................................................................................. 30 
5.3.1 Allowed Interventions ............................................................................................... 30 
5.3.2 Required Interventions ................................................................................................... 30 
5.3.3 Prohibited Interventions ................................................................................................. 30 
5.4 
Adherence Assessment .................................................................................................. 30 

CHIVES Manual of Operational Procedures 
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6 
STUDY PROCEDURES .......................................................................................................... 31 
6.1 
Schedule of Participant Flow & Outcome Measures .................................................... 32 
6.2 
Description of Evaluations ............................................................................................ 33 
6.2.1 Screening Evaluation ................................................................................................ 37 
6.2.2 Baseline Assessment, Randomization, and Enrollment ............................................ 38 
6.2.3 Follow-up Visits ........................................................................................................ 39 
6.2.4 Completion/Final Evaluation .................................................................................... 39 
7 
SAFETY ASSESSMENTS ................................................................................................. 40 
8 
INTERVENTION DISCONTINUATION, WITHDRAWL, & MODIFICATION ...... 41 
9 
STATISTICAL CONSIDERATIONS............................................................................... 42 
9.1 
General Design Issues ................................................................................................... 42 
9.2 
Sample Size and Randomization ................................................................................... 42 
9.3 
Interim analyses and Stopping Rules ............................................................................ 42 
9.4 
Outcomes ...................................................................................................................... 42 
9.4.1 Primary outcome ....................................................................................................... 42 
9.4.2 Secondary outcomes ....................................................................................................... 42 
9.4.3 Other outcomes ......................................................................................................... 43 
9.5 
Statistical Analyses ....................................................................................................... 43 
10 DATA COLLECTION AND QUALITY ASSURANCE ................................................. 45 
10.1 
Data Collection Forms .................................................................................................. 45 
10.2 
Data Management ......................................................................................................... 45 
10.3 
Quality Assurance ......................................................................................................... 46 
10.3.1 
Training ...................................................................................................................... 46 
10.3.2 
Quality Control Committee ................................................................................... 46 
10.3.3 
Metrics ........................................................................................................................ 46 
10.3.4 
Protocol Deviations ............................................................................................... 46 
10.3.5 
Monitoring ............................................................................................................ 46 
10.4 
Data Sharing .................................................................................................................. 47 
11 PARTICIPANT RIGHTS AND CONFIDENTIALITY .................................................. 48 
11.1 
Institutional Review Board (IRB) Review .................................................................... 48 
11.2 
Informed Consent Forms ............................................................................................... 48 
11.3 
Participant Confidentiality ............................................................................................ 48 
11.4 
Study Discontinuation ................................................................................................... 48 
12 ETHICAL CONSIDERATIONS ....................................................................................... 49 
13 COMMITTEES ................................................................................................................... 50 
13.1 
Study Contributors – Main Roles and Responsibilities ................................................. 50 
13.2 
Steering Committee ....................................................................................................... 51 
13.3 
Data Management Team .................................................................................................. 515 
14 PUBLICATION OF RESEARCH FINDINGS ................................................................. 52 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
15 APPENDICES ................................................................................................................................. 53 
I. 
Stanford University Institutional Review Board Approval Letter 
II. 
University of California San Francisco Institutional Review Board Approval Letter 
III. 
Recruitment Flyers & Recruitment Appointment Card 
IV. 
Waiver of Documentation & Pre-Screening Survey 
V. 
Participant Consent Form 
VI. 
Self-Administered Screening Surveys (English & Spanish) – for orientation 
VII. 
Participant Handout – Expectations, Guidelines, & Timeline – for orientation 
VIII. 
Food Amounts Booklet for Dietary Recalls – for orientation 
IX. 
Food Resources Handout & EatSF Program Referral Handout – for all ineligible 
candidates 
X. 
Participant Handout - How to Use Vouchers & List of Store Vendors – to be mailed 
with Month 1 Vouchers 
XI. 
Participant Handout – Reminder for Month 6 Data Collection & Incentives – to be 
mailed with Month 5 Vouchers 
XII. 
Participant Survey Measures 
XIII. 
Month 0/Baseline Survey, Month 6 Survey, and Main Survey 
XIV. 
24-Hour Dietary Recall REDCap Form and 2-item food security questions 
XV. 
Dietary Recall Script for text messages, voicemails, and e-mails 
XVI. 
Vendor Memorandum of Understanding 
XVII. 
Vendor Surveys 
XVIII. 
Vendor Handout – “cheat sheet” for store staff on how to accept CHIVES vouchers 
XIX. 
Data Safety and Monitoring Protocol 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
STUDY OVERVIEW 
 
Study Title 
 
CHIVES: A randomized 312-subject behavioral intervention trial of effectiveness and cost- 
effectiveness of different food vouchers in a low-income population. 
 
Aims 
 
Primary Aim: Compare the effectiveness of alternative strategies for delivering food vouchers to 
low-income populations, as measured by consumption of fruits and vegetables. The alternative 
strategies are weekly versus monthly receipt of vouchers (with the same total monthly monetary 
value), and targeted (to fruits and vegetables) versus untargeted (eligible for any food purchase) 
vouchers. 
 
Secondary Aim: Compare the cost-effectiveness of alternative food voucher delivery strategies 
for low-income populations. 
 
Design 
 
Design: This study is a randomized 312-subject behavioral intervention trial of effectiveness and 
cost-effectiveness of different food voucher assignments in a low-income population of adults 
ages 21 years and older. Participants will be randomly assigned to 6 months of one of four food 
voucher assignments. 
 
Outcomes 
 
Primary Outcome Measure: 
- 
Individual self-reported change in fruit and vegetable intake (measured in cup-equivalents) at 
Month 6 of study participation, as compared to Month 0. Participant fruit and vegetable 
intake will be evaluated by two verbal 24-hour dietary recall assessments conducted over the 
phone with a diet assessor at each data collection time point (Month 0/Baseline, Month 6,  
and Month 12). 
 
Secondary Outcome Measures: 
- 
Individual self-reported change in fruit and vegetable intake (measured in cup-equivalents) at 
Month 12 of their study participation, as compared to Month 0. This measurement will 
reflect on fruit and vegetable intake 6 months after their final use of food vouchers, to 
determine maintenance of behavior change after cessation of food voucher receipt. 
- 
Healthy Eating Index and Alternative Healthy Eating Index scores at Months 6 and 12, 
calculated from the 24-hour dietary recall data. 
- 
Change in monthly food consumption cycle of overall consumption, comparing total calories 
and fruit and vegetable consumption in Week 4 versus Week 1 of Months 6 and 12, as 
compared to Month 0. 
- 
Voucher utilization rate at Month 6. The percent of vouchers utilized by participants in each 
study arm will be calculated. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
Other Outcome Measures: 
 
- 
Voucher ease of use, assessed through of a verbal 20-minute survey conducted over the 
phone with a diet assessor at Month 6. Survey asks whether vouchers were easy to use and 
allow for free-text response of why or why not vouchers were easy to use. 
- 
Fruit and vegetable acquisition, attitudes, and consumption, also assessed during 
aforementioned verbal 20-minute survey conducted over the phone with a diet assessor at 
Months 0, 6, and 12. 
- 
Self-reported height and weight, also assessed during aforementioned verbal 20-minute 
survey conducted over the phone with a diet assessor at Months 0, 6, and 12. 
- 
Participant food security status, also assessed during aforementioned verbal 20-minute 
survey conducted over the phone with a diet assessor at Months 0, 6, and 12. Questions 
include participation in nutritional assistance programs and the 6-item United States 
Department of Agriculture adult food security scale. 

Version 2.0, December 20, 2016 
 
 
 
Schedule of Participant Flow & Outcome Measures 
 
Timeframe 
Month 0, ≤ 4th Week 
Recruitment, 
Orientation, Consent, & 
Screening 
Month 0, 4th Week 
Baseline Data 
Collection 
Month 1, 1st Week 
Data Collection, 
Initiation of Voucher 
Utilization 
Month 6, 1st Week 
End of Intervention 
Data Collection, 
Final Month of Voucher 
Utilization 
Month 6, 4th Week 
End of Intervention 
Data Collection, 
Final Month of Voucher 
Utilization 
Month 12, 1st Week 
6-month Follow Up 
Data Collection after 
final Voucher Utilization 
Month 12, 4th Week 
6-month Follow Up 
Data Collection after 
final Voucher Utilization 
Participant Perspective 
x Recruited to participate 
in CHIVES 
x Sign up for orientation 
x Attend orientation, 
give informed consent 
to participate, & 
complete screening 
survey 
x Deemed eligible to 
participate & 
contacted for baseline 
data collection 
x Before voucher 
receipt & 
randomization 
x Complete two 24-hour 
dietary recalls & 
baseline survey over 
the phone 
x Receive randomized 
voucher assignment 
x Receive in mail 1st 
month of vouchers 
after completing two 
24-hour dietary recalls 
over the phone 
xUse vouchers for final 
month in trial 
xComplete two 24-hour 
dietary recalls & 
Month 6 survey over 
the phone 
x Use vouchers for final 
month in trial 
x Complete two 24-hour 
dietary recalls & Month 
6 survey (if not already 
completed during 1st 
Week) over the phone 
x Receive $20 incentive 
for Month 6 data 
completion 
x No vouchers used for 
past 6 months 
x Complete two 24-hour 
dietary recalls & 
Month 12 survey over 
the phone 
x No vouchers used for 
past 6 months 
x Complete two 24- 
hour dietary recalls & 
Month 12 survey (if 
not already completed 
during 1st Week) over 
the phone 
x Receive $20 incentive 
for Month 12 data 
completion 
x Final involvement in 
study participation 
Evaluation Measures 
Two 24-hour dietary 
recalls (ideally one 
weekday + one 
weekend) 
Two 24-hour dietary 
recalls (ideally one 
weekday + one 
weekend) 
Two 24-hour dietary 
recalls (ideally one 
weekday + one 
weekend) 
Two 24-hour dietary 
recalls (ideally one 
weekday + one 
weekend) 
Two 24-hour dietary 
recalls (ideally one 
weekday + one 
weekend) 
Two 24-hour dietary 
recalls (ideally one 
weekday + one 
weekend) 
F&V acquisition, 
attitudes, and 
consumption survey 
questions 
F&V acquisition, 
attitudes, and 
consumption survey 
questions* 
F&V acquisition, 
attitudes, and 
consumption survey 
questions* 
F&V acquisition, 
attitudes, and 
consumption survey 
questions* 
F&V acquisition, 
attitudes, and 
consumption survey 
questions* 
Participation in nutrition 
assistance programs 
survey questions 
(WIC/SNAP/EatSF) 
Participation in nutrition 
assistance programs 
survey questions 
(WIC/SNAP/EatSF) * 
Participation in nutrition 
assistance programs 
survey questions 
(WIC/SNAP/EatSF) * 
Participation in nutrition 
assistance programs 
survey questions 
(WIC/SNAP/EatSF) * 
Participation in nutrition 
assistance programs 
survey questions 
(WIC/SNAP/EatSF) * 
Participant food security 
status survey questions 
Participant food security 
status survey questions* 
Participant food security 
status survey questions* 
Participant food security 
status survey questions* 
Participant food security 
status survey questions* 
Self-reported height & 
weight, pregnancy / 
lactation status 
Self-reported height & 
weight, pregnancy / 
lactation status* 
Self-reported height & 
weight, pregnancy / 
lactation status* 
Self-reported height & 
weight, pregnancy / 
lactation status* 
Self-reported height & 
weight, pregnancy / 
lactation status* 
Voucher ease of use 
survey questions* 
Voucher ease of use 
survey questions* 
 
CHIVES Manual of Operational Procedures 
* Surveys administered during Months 6 & 12 may be completed during 1st or 4th Week of either month, 
whichever more convenient for participant. Only one set of surveys at Months 6 & 12 need to be completed. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
Sample Size, Covariate-Adaptive Randomization, and Population 
 
Sample Size: We aim to have 312 total participants in this trial, with 78 participants assigned to 
each of the four intervention arms. Participants will be divided into six cohorts, with a goal of 
enrolling approximately 52 participants per cohort. We anticipate an 8% attrition rate, or plan for 
approximately 25 enrolled participants to be lost to follow up, or drop out of study, which would 
leave 288 participants with complete data for analysis. 
 
Covariate-Adaptive Randomization: We will use covariate-adaptive randomization to place 
participants into their randomly assigned intervention arm by the following factors: 
- 
Age 
- 
Sex 
- 
Race 
- 
Ethnicity 
- 
Income category 
- 
Current Supplemental Nutrition Assistance Program (SNAP) / CalFresh participation status 
 
Population:  We anticipate that all participants at baseline will be: 21 years of age or older; 
residents of San Francisco who do not plan to move out of San Francisco within the next 12 
months; free of cancer or congestive heart failure; not currently pregnant or breastfeeding; not 
concurrently participating in any other dietary or nutrition studies that would impact their normal 
eating patterns; not currently receiving EatSF vouchers; have a household income at ≤250% of 
the federal poverty level; have regular access to a mobile phone with ability to send and receive 
text messages; and are willing to receive a random assignment to one of the four intervention 
arms. Although any resident of San Francisco is potentially eligible for the study, we anticipate 
that most participants will reside in San Francisco’s Bayview neighborhood, based on where we 
plan to recruit for the study. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
Interventions and Duration 
 
Intervention arms: 
 
Participants will be randomly assigned to one of the following four intervention arms: 
 
(1) Monthly & Untargeted Food Vouchers. Participants will receive four $5 food vouchers per 
month ($20/month) that are each valid for the entire calendar month. They are able to spend 
these food vouchers on any CalFresh/SNAP-eligible grocery item. 
(2) Monthly & Targeted Food Vouchers. Participants will receive four $5 food vouchers per 
month ($20/month) that are each valid for the entire calendar month. They are able to spend 
only on fresh and frozen fruits and vegetables with no added sugar or salt. 
(3) Weekly & Untargeted Food Vouchers. Participants will receive four $5 food vouchers per 
month ($20/month) that are each valid for a sequential Week* of the calendar month. They 
are able to spend these food vouchers on any CalFresh/SNAP -eligible grocery item. 
(4) Weekly & Targeted Food Vouchers. Participants will receive four $5 food vouchers per 
month ($20/month) that are each valid for a sequential Week* of the calendar month. They 
are able to spend only on fresh and frozen fruits and vegetables with no added sugar or salt. 
 
Chart of intervention arms: 
Untargeted 
Targeted 
Monthly 
Monthly & Untargeted Food Vouchers 
- 
Voucher Timeframe: 4 vouchers / 
month, each valid for 1 month 
- 
Voucher Exchangeable for: any 
CalFresh/SNAP-eligible grocery item 
- 
Voucher value: Each monthly food 
voucher worth $5, total of $20 / month 
Monthly & Targeted Food Vouchers 
- 
Voucher Timeframe: 4 vouchers / 
month, each valid for 1 month 
- 
Voucher Exchangeable for: any fresh 
and frozen fruits and vegetables with 
no added sugar or salt 
- 
Voucher value: Each monthly food 
voucher worth $5, total of $20 / month 
Weekly 
Weekly & Untargeted Food Vouchers 
- 
Voucher Timeframe: 4 vouchers / 
month, each valid for a sequential Week* 
- 
Voucher Exchangeable for: any 
CalFresh/SNAP-eligible grocery item 
- 
Voucher value: Each weekly food 
voucher worth $5, total of $20 / month 
Weekly & Targeted Food Vouchers 
- 
Voucher Timeframe: 4 vouchers / 
month, each valid for a sequential 
Week* 
- 
Voucher Exchangeable for: any fresh 
and frozen fruits and vegetables with 
no added sugar or salt 
- 
Voucher value: Each weekly food 
voucher worth $5, total of $20 / month 
 
* Because most months are not exactly 7 x 4 = 28 days, we will label vouchers to clarify the 
exact dates over which a weekly voucher is valid. To ensure we consistently track the monthly 
food consumption cycle, Week 1 and Week 4 will always be 7 days. Then Weeks 2 and 3 will be 
split evenly among the remaining days. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
Duration: 
Each eligible candidate who chooses and consents to participate in the study will partake in the 
intervention for a total of 6 months. During this 6-month timeframe, each participant will receive 
and utilize food vouchers on a monthly basis and participate in specified data collection time 
points. All participants, regardless of whether they complete the 6-month intervention will also 
be asked to participate in a follow-up data collection period at 12 months after baseline, or 6 
months after their participation in the intervention has ended (i.e., they have not received food 
vouchers for 6 months). 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
STUDY TEAM ROSTER 
 
Principal Investigators: 
 
Sanjay Basu, MD, PhD 
Stanford University 
1070 Arastradero Road #282 
Palo Alto, CA 94304 
Telephone: (650) 498-5678 
Fax: (650) 498-8258 
E-mail: basus@stanford.edu 
 
Main responsibilities & roles: 
- 
Contact Principal Investigator; 
- 
Aim 1: will oversee recruitment, retention 
and assessment for the trial; 
- 
Aim 2: will oversee model design, 
programming and validation for cost- 
effectiveness analysis. 
Hilary Seligman, MD, MAS 
University of California San Francisco 
Box 1364 
San Francisco, CA 94143 
Telephone: (415) 206-4448 
Fax: (415) 206-5586 
E-mail: hilary.seligman@ucsf.edu 
 
Main responsibilities & roles: 
- 
Logistics Principal Investigator; 
- 
Aim 1: oversee voucher distribution and 
retention of vendors for the trial; 
- 
Aim 2: inform modeling of impact of 
healthy eating on cardiovascular disease 
disparities for cost-effectiveness analysis 
 
Co-Investigators: 
 
Christopher Gardner, PhD 
Stanford University 
1265 Welch Road 
Palo Alto, CA 94305 
Telephone: (650) 725-2751 
E-mail: 
cgardner@stanford.edu 
 
Main responsibilities & roles: 
- 
Aim 1: contribute staff, 
expertise, and supervision 
to ensure accurate and 
successful completion of 
dietary recalls and their 
analysis 
Matthew Harding, PhD 
University of California, Irvine 
3207 Social Science Plaza B 
Irvine, CA 92697-5100 
Telephone: (949) 824-1511 
E-mail: harding1@uci.edu 
 
 
Main responsibilities & roles: 
- 
Aim 1: will integrate 
economic and food 
environment data into the 
cost-effectiveness analysis 
for national projections 
Justin White, PhD 
University of California San 
Francisco 
3333 California Street 
San Francisco, CA 94118 
Telephone: (415) 476-8045 
E-mail: justin.white@ucsf.edu 
 
Main responsibilities & roles: 
- 
Aim 1: inform trial design and 
conduct; assist in recruitment, 
randomization, and retention 
strategy development and 
execution; 
- 
Aim 2: inform cost-effectiveness 
analysis components 
 
PROTOCOL CONTRIBUTOR * 
Mandy Murphy Carroll, MPH, RD 
Stanford University 
Role: Study coordinator 
Telephone: (650) 509-0004 
E- mail: mandyiam@stanford.edu 
PARTICIPATING STUDY SITES 
Participant Point of Contact – 
San Francisco Bayview Office 
1485 Bayshore Boulevard, Suite 437 
San Francisco, CA 94124 
 
* In addition to Principal Investigators, the study 
coordinator was also a primary protocol contributor. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
1 
STUDY AIMS 
 
Overall, this study tackles a stubborn scientific issue—the design and implementation of 
effective and cost-effective interventions for healthy eating among low-income populations—to 
reduce cardiovascular disease disparities. 
 
1.1 Primary Aim: Determine the most effective food voucher design for significantly  
increasing participant consumption of fruits and vegetables by testing whether weekly vouchers 
are more effective than monthly vouchers, and whether targeted vouchers are more effective than 
untargeted vouchers. 
 
Our benchmark for effectiveness will be to double the daily consumption of fruits and vegetables 
among our low-income participants at Month 6—from 0.7 to 1.4 cup-equivalents—meeting the 
Healthy People 2020 goal for fruit and vegetable consumption. Secondary end-points include 
metrics of overall dietary quality assessed through 24-hour dietary recalls at Months 0, 6 and 12 
(6 months after vouchers end); and voucher utilization. Assessment months include Week 1 and 
Week 4 dietary recalls of a given month—testing the hypothesis that frequent vouchers smooth 
the monthly food consumption cycle. This improves upon trials where theorized mediators were 
rarely tested a priori with sufficient power. Additional surveys at Months 0, 6, and 12 will detect 
other moderators and mediators of effectiveness (food insecurity, CalFresh/SNAP participation, 
ease of voucher use, and fruit and vegetable attitudes) for future intervention refinement. 
 
1.2 Secondary Aim: Calculate the cost-effectiveness of voucher programs. 
 
Interventions that support healthy dietary intake reduce population-level cardiovascular disease 
disparities over the course of decades. Hence, the full benefits of such interventions are not 
possible to directly observe through time-limited trials. The lack of clarity about whether 
vouchers are cost-effective over the long term has hindered their wider adoption, according to a 
recent Institute of Medicine review. To address this gap, we will follow recent National Institutes 
of Health policy statements and apply an innovative, validated microsimulation modeling 
approach—a systems science method to integrate trial results with comprehensive data on the 
effect of dietary changes on cardiovascular disease outcomes and associated healthcare costs over 
the life course. We will estimate the cost-effectiveness of vouchers, identifying which voucher 
delivery strategies (monthly, weekly, untargeted, targeted) most cost-effectively reduce 
socioeconomic disparities in cardiovascular disease. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
2 
BACKGROUND AND RATIONALE 
 
2.1 
Background – how cardiovascular disease affects society. 
This study tackles a stubborn scientific issue—how to design and implement cost-effective 
interventions to support healthy eating among low-income populations—in an effort to reduce 
cardiovascular disease disparities between low- and higher-income Americans. According to the 
Centers for Disease Control & Prevention, over 610,000 Americans die of heart disease every 
year, making heart disease responsible for approximately one in every four deaths. 
Cardiovascular disease is the leading cause of death for American men and women. 
 
2.2 
Study Rationale – how the CHIVES study tackles cardiovascular disease disparities. 
Unhealthy diets are a key contributor to socioeconomic disparities in cardiovascular disease. 
Improving diets, particularly through increased fruit and vegetable (F&V) consumption, 
significantly reduces the risk of hypertension, obesity, type II diabetes, myocardial infarction,  
and stroke. Disparities in healthy diets are related to the accessibility and affordability of F&Vs. 
Yet federal food programs that aim to increase the accessibility and affordability of F&Vs among 
low-income Americans have been hindered by the food consumption cycle associated with 
poverty: the tendency to over-consume calorie-dense foods shortly after receiving funds at the 
beginning of each month, draining the budget for F&V purchases, or for all food purchases, by 
month’s end. This food consumption cycle persists even if healthy foods are affordable and 
accessible. 
 
Our study will inform the design of these existing federal food assistance programs in which 1 in 
every 7 Americans are enrolled. Such nutrition programs are currently under federal review. 
According to the Institute of Medicine, new research is needed to guide decisions about which 
program delivery strategies (e.g., weekly versus monthly, targeted versus untargeted) are most 
effective for improving dietary intake among program participants. Already, the Special 
Supplemental Nutrition Program for Women, Infants and Children (WIC) and Senior Farmer’s 
Market Nutrition Program have started providing monthly, targeted F&V vouchers, which 
significantly increased F&V consumption; however, maintenance of F&V consumption at 6 
months was lowest (bordering on non-significance, p=0.05) among participants subject to 
continued food consumption cycling. These vouchers were never compared to weekly or 
untargeted vouchers. Additionally, many cities are starting to fund voucher programs that apply 
to supermarkets and corner stores, not just farmer’s markets. A recent systematic review found 
that extant studies did not evaluate how such programs could address the food consumption 
cycle, or differential effects of targeted versus untargeted funding (given that substitution 
between food groups may critically affect the impact of targeted funds). Our study will address 
these major gaps in the literature using our two-by-two factorial study design and comprehensive 
24-hour dietary recalls validated among low-literacy, community-dwelling populations. 
 
To improve healthy eating interventions, we will directly address the food consumption cycle. 
Our preliminary data suggest that interventions helping low-income individuals transition from 
extreme cycles of consumption to more stable consumption patterns can improve overall dietary 
quality. The interventions utilize an emerging theory about dietary behavior: that providing funds 
for food in smaller installments (i.e., weekly) distributed throughout the month will smooth the 
food consumption cycle and improve healthy eating—counteracting the tendency to respond to 
lump sum, once-monthly funding installments by purchasing calorie-dense foods immediately 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
after funds are received. Consistent with our preliminary data, the theory implies that nutrition 
programs could use smaller, more frequent funding installments to reduce disparities in healthy 
eating. The theory also suggests that funds targeted toward specific healthy foods (e.g., F&Vs) 
will improve diets more than untargeted funds, despite the inconvenience of utilizing targeted 
funds. Our test of both hypotheses derived from this theory is of potentially high impact and 
timely, as 1 in 7 Americans are enrolled in nutrition programs that currently use monthly, 
untargeted funding approaches. 
 
We will test these hypotheses in a real-world setting by comparing alternative approaches for 
delivering food purchasing vouchers. We have established the infrastructure to provide vouchers 
accepted by all major food stores, including supermarkets, corner stores, and farmer’s markets in 
three San Francisco neighborhoods. We have successfully tested the voucher system among 250 
low-income participants in a pilot study whose preliminary results support the theory. 
Leveraging this innovative and unique infrastructure, we will implement this randomized trial 
with a two-by-two factorial design, comparing $20 of vouchers valid for one month to four $5 
vouchers each valid for a sequential week of the month (testing lump-sum versus distributed 
funding), and comparing vouchers restricted to F&V purchases to vouchers redeemable for any 
food (testing targeted versus untargeted funding). Low-income adults (N=312 with income 
≤250% federal poverty level) recruited through our community partners will be randomized to 
one of four 6-month voucher interventions balanced on time and attention from study staff: 
monthly untargeted, monthly targeted, weekly untargeted, or weekly targeted vouchers. 
Participants will be assessed for the primary outcome measure through efficient verbal 24-hour 
dietary recalls validated among low-literacy populations and verbal surveys to assess other 
moderators and mediators. 
 
No known or potential risks are anticipated while the participant partakes in the 6-month 
intervention period. After the 6-month intervention period, participants may experience difficulty 
purchasing the same foods as during the intervention, as they will no longer receive the          
extra $20 per month for foodstuffs. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
3 
STUDY DESIGN 
 
Study Design. The CHIVES study is a two-by-two factorial design that randomly assigns 
participants to one of four food voucher assignments (monthly untargeted, monthly targeted, 
weekly untargeted, or weekly targeted). Diet assessors who are primary data collectors will be 
blinded to participant voucher assignment, as well as the study statistician and the study director. 
Only the participants and the study coordinator will not be blinded to participant voucher 
assignment. Study staff who are blinded will not be unblinded for any reason. 
 
Outcomes. 
 
Outcomes 
 
Primary Outcome Measure: 
- 
Individual self-reported change in fruit and vegetable intake (measured in cup-equivalents) at 
Month 6 of study participation, as compared to Month 0. Participant fruit and vegetable 
intake will be evaluated by two verbal 24-hour dietary recall assessments conducted over the 
phone with a diet assessor at each data collection time point (Month 0/Baseline, Month 6,  
and Month 12). 
 
Secondary Outcome Measures: 
- 
Individual self-reported change in fruit and vegetable intake (measured in cup-equivalents) at 
Month 12 of their study participation, as compared to Month 0. This measurement will 
reflect on fruit and vegetable intake 6 months after their final use of food vouchers, to 
determine maintenance of behavior change after cessation of food voucher receipt. 
- 
Healthy Eating Index and Alternative Healthy Eating Index scores at Months 6 and 12, 
calculated from the 24-hour dietary recall data. 
- 
Change in monthly food consumption cycle of overall consumption, comparing total calories 
and fruit and vegetable consumption in Week 4 versus Week 1 of Months 6 and 12, as 
compared to Month 0. 
- 
Voucher utilization rate at Month 6. The percent of vouchers utilized by participants in each 
study arm will be calculated. 
 
Other Outcome Measures: 
 
- 
Voucher ease of use, assessed through of a verbal 20-minute survey conducted over the 
phone with a diet assessor at Month 6. Survey asks whether vouchers were easy to use and 
allow for free-text response of why or why not vouchers were easy to use. 
- 
Fruit and vegetable acquisition, attitudes, and consumption, also assessed during 
aforementioned verbal 20-minute survey conducted over the phone with a diet assessor at 
Months 0, 6, and 12. 
- 
Self-reported height and weight, also assessed during aforementioned verbal 20-minute 
survey conducted over the phone with a diet assessor at Months 0, 6, and 12. 
Participant food security status, also assessed during aforementioned verbal 20-minute 
survey conducted over the phone with a diet assessor at Months 0, 6, and 12. Questions 
include participation in nutritional assistance programs and the 6-item United States 
Department of Agriculture adult food security scale. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
 
Study Population. We anticipate that all participants at baseline will be: 21 years of age or older; 
residents of San Francisco who do not plan to move out of San Francisco within the next 12 
months; free of cancer or congestive heart failure; not currently pregnant or breastfeeding; not 
concurrently participating in any other dietary or nutrition studies that would impact their normal 
eating patterns; not currently receiving EatSF vouchers; have a household income at ≤250% of 
the federal poverty level; have regular access to a mobile phone with ability to send and receive 
text messages; and are willing to receive a random assignment to one of the four intervention 
arms. Although any resident of San Francisco is potentially eligible for the study, we anticipate 
that most participants will reside in San Francisco’s Bayview neighborhood, based on where we 
plan to recruit for the study. 
 
Sample Size. We aim to have 312 total participants in this trial, with 78 participants assigned to 
each of the four intervention arms. Participants will be divided into six cohorts, with a goal of 
enrolling approximately 52 participants per cohort. We anticipate an 8% attrition rate, or plan for 
approximately 25 enrolled participants to be lost to follow up or drop out of study, which would 
leave 288 participants with complete data for analysis. 
 
The study director calculated a 265-participant sample size minimum using G*Power software, 
aiming for a sample size that would give us 90% statistical power to detect two main effects 
(weekly versus monthly, targeted versus untargeted), and their interaction (F-test using 
ANCOVA with baseline F&V intake as the main covariate), assuming a moderate Cohen’s d = 
1.4 effect size. Thus, taking into account up to a 15% participant attrition rate, we aim to enroll 
312 participants so that we have sufficient statistical power for our analyses. 
 
In sum, for optimal statistical power (≥90%), our goal will be to recruit 312 participants. For a 
less ideal statistical power (≥80%), we will aim to recruit at the very minimum 236 participants. 

CHIVES Manual of Operational Procedures 
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Intervention arms. Participants will be randomly assigned to one of the following four 
intervention arms: 
 
(1) Monthly & Untargeted Food Vouchers. Participants will receive four $5 food vouchers per 
month ($20/month) that are each valid for the entire calendar month. They are able to spend 
these food vouchers on any CalFresh/SNAP-eligible grocery item. 
(2) Monthly & Targeted Food Vouchers. Participants will receive four $5 food vouchers per 
month ($20/month) that are each valid for the entire calendar month. They are able to spend 
only on fresh and frozen fruits and vegetables with no added sugar or salt. 
(3) Weekly & Untargeted Food Vouchers. Participants will receive four $5 food vouchers per 
month ($20/month) that are each valid for a sequential Week* of the calendar month. They 
are able to spend these food vouchers on any CalFresh/SNAP-eligible grocery item. 
(4) Weekly & Targeted Food Vouchers. Participants will receive four $5 food vouchers per 
month ($20/month) that are each valid for a sequential Week* of the calendar month. They 
are able to spend only on fresh and frozen fruits and vegetables with no added sugar or salt. 
 
Chart of intervention arms: 
Untargeted 
Targeted 
Monthly 
Monthly & Untargeted Food Vouchers 
- 
Voucher Timeframe: 4 vouchers / 
month, each valid for 1 month 
- 
Voucher Exchangeable for: any 
CalFresh/SNAP-eligible grocery item 
- 
Voucher value: Each monthly food 
voucher worth $5, total of $20 / month 
Monthly & Targeted Food Vouchers 
- 
Voucher Timeframe: 4 vouchers / 
month, each valid for 1 month 
- 
Voucher Exchangeable for: any fresh 
and frozen fruits and vegetables with 
no added sugar or salt 
- 
Voucher value: Each monthly food 
voucher worth $5, total of $20 / month 
Weekly 
Weekly & Untargeted Food Vouchers 
- 
Voucher Timeframe: 4 vouchers / 
month, each valid for a sequential Week* 
- 
Voucher Exchangeable for: any 
CalFresh/SNAP-eligible grocery item 
- 
Voucher value: Each weekly food 
voucher worth $5, total of $20 / month 
Weekly & Targeted Food Vouchers 
- 
Voucher Timeframe: 4 vouchers / 
month, each valid for a sequential 
Week* 
- 
Voucher Exchangeable for: any fresh 
and frozen fruits and vegetables with 
no added sugar or salt 
- 
Voucher value: Each weekly food 
voucher worth $5, total of $20 / month 
 
* Because most months are not exactly 7 x 4 = 28 days, we will label vouchers to clarify the 
exact dates over which a weekly voucher is valid. To ensure we consistently track the monthly 
food consumption cycle, Week 1 and Week 4 will always be 7 days. Then Weeks 2 and 3 will be 
split evenly among the remaining days. 

CHIVES Manual of Operational Procedures 
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Study location. This study is taking place in a community setting. Participants and participating 
vendors will be recruited from the Bayview area – a southeastern neighborhood of San  
Francisco, California. The study office will also be located in the Bayview neighborhood at 1485 
Bayshore Boulevard, a central location for residents. While participants are permitted to be 
residentially located outside of the Bayview neighborhood, they must have a primary address 
from the city of San Francisco, and all will be required to redeem food vouchers at one of the 
local participating Bayview, SoMa, or Tenderloin vendor locations. 
 
Approximate duration of enrollment period and follow-up. Each eligible candidate who chooses 
and consents to participate in the study will partake in the intervention for a total of 6 months. 
During this 6-month timeframe, each participant will receive and utilize food vouchers on a 
monthly basis and participate in specified data collection time points. All participants, regardless 
of whether they complete the 6-month intervention will also be asked to participate in a follow- 
up data collection period at 12 months after baseline, or 6 months after their participation in the 
intervention has ended (i.e., they have not received food vouchers for 6 months). 
 
Recruitment and enrollment for the study as a whole will begin in December 2016 and last 
through approximately July 2017. However, a small pilot trial of N=5 participants will begin in 
late October 2016 to allow our team to become aware of and work through any issues that arise 
before the official study starts a few months later. The intervention period will begin in January 
2017, in which data collection and voucher distribution will begin in the fourth calendar week of 
the month. We will aim to enroll six distinct cohorts, each consisting of 52 participants per 
month starting in January 2017, until the final goal of 312 participants is reached in June 2017. 
Each cohort of participants will be enrolled in the study for a total of 12 months, the first 6 
months of which they will actively participate in the intervention and receive food vouchers, and 
the final 6 months of which they will no longer be in the intervention and no longer receive food 
vouchers, but will be asked to complete one final round of data collection at 12 months for 
follow up. 
 
Description of intervention and administration. The intervention primarily entails participant’s 
utilization of assigned food vouchers throughout their six months of study participation. Study 
staff will mail food vouchers to participants at the end of each of the six months to spend for the 
following month. Participants will then be expected to spend their four monthly food vouchers at 
approved vendors within the timeframe they are valid. During the sixth month of the intervention 
period, diet assessors will contact each participant to complete the Month 6 data collection. 
 
Randomization. Once participants have consented, taken screening survey, been deemed eligible, 
and completed first part of Baseline/Month 0 assessment (two 24-hour dietary recalls and 
baseline survey), participants will be randomly assigned by covariate-adaptive randomization to 
one of the four voucher group assignments through a statistical minimization process based on 
the baseline survey data stored in our online database management program REDCap. The study 
statistician will generate these randomized group assignments for each participant, which he will 
be uploaded into REDCap. Each participant will then automatically have a group assignment 
visible under their REDCap profile page (Groups 1 through 4). The study coordinator will have 
the key for which study group (monthly/weekly and untargeted/targeted) corresponds with each 
group 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
number. This will remain concealed from the statistician and staff during the intervention. Staff 
will only see that participant are assigned to Groups 1, 2, 3, or 4. 
 
Blinding. The study coordinator will be unblinded to participant voucher assignment because she 
will translate which group number represents which voucher group when preparing to mail 
vouchers. Since participants have to know which voucher assignment they receive in order to 
participate in the program, they will not be blinded either. However, diet assessors who collect 
data at each time point will be blinded to participant voucher assignment, as will the study 
statistician and study director, to prevent any bias or predisposition to a certain outcome.  Study 
staff who are blinded will not be unblinded for any reason. 
 
Covariate-adaptive randomization. We will randomize participants into their assigned 
intervention arm by balancing across the following factors in each cohort of 52 participants: 
- 
Age 
- 
Sex 
- 
Race 
- 
Ethnicity 
- 
Income category 
- 
Current Supplemental Nutrition Assistance Program (SNAP) / CalFresh participation status 

CHIVES Manual of Operational Procedures 
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4 
SELECTION AND ENROLLMENT OF PARTICIPANTS 
 
The study director has chosen the following inclusion and exclusion criteria in order to select for 
a reasonably representative sample of the populations and are characteristics that will allow for 
sufficient generalizability. 
 
4.1 
Inclusion Criteria. Participants must meet all of the following inclusion criteria to 
participate in this study; each participant must: 
 
x Be age 21 years or older; 
x Have self-reported household income ≤250% of the federal poverty level; 
x Have regular access to a mobile phone with ability to send and receive text messages; 
x Understand English sufficiently to provide informed consent; 
x Be a resident of the City of San Francisco as defined by official municipal boundaries; 
x Be willing to be randomized to one of four food voucher assignments. 
 
4.2 Exclusion Criteria. All candidates who meet any of the exclusion criteria at baseline will 
be excluded from study participation. If candidates are found to meet any of the exclusion 
criteria at the Month 6 or Month 12 surveys but not at the Month 0 survey, they will be 
included in the intent-to-treat analysis but a robustness check will be performed with their 
exclusion. Any candidate will be excluded at baseline if he/she is found to: 
 
x Currently be participating in any other dietary or nutrition studies that would impact their 
normal eating patterns; 
x Currently receiving EatSF vouchers; 
x Currently have diagnosed cancer or congestive heart failure; 
x Be planning to move out of San Francisco in the next year; 
x Currently pregnant or breastfeeding. 
 
4.3 Study Enrollment Procedures 
Recruitment strategy. As this is a community-based intervention, we aim to recruit participants 
where they most frequent within the Bayview neighborhood and plan to use a variety of 
strategies to recruit potential study participants. Our planned recruitment strategy includes the 
following: 
x “Tabling” at important community places & events. Have two to three study staff 
standing at a table with banner, flyers, and study information that invites questions and 
candidates to sign up for orientation. 
o Table at frequented local grocery stores; 
o Table at local health clinics; 
o Table at 3rd on 3rd community event – community block party on 3rd Street every 
third Friday of the month (10/21/2016, 11/18/2016, 12/16/2016, 1/20/2017, 
2/17/2017, 3/17/2017, 4/21/2017, 5/19/2017, 6/16/2017, 7/21/2017). 
x Posting flyers at frequented community places. Use simple, attention-grabbing flyers with 
pull-off tabs with study survey link as well as Quick Response (QR) code to study survey 
[Appendix III]. 

CHIVES Manual of Operational Procedures 
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o Local grocery stores & corner stores; 
o Local health clinics; 
o YMCA; 
o Local community pool; 
o City College San Francisco on Oakdale Avenue; 
o Bayview Library; 
o Faith-based organizations; 
o SF Food Bank & food pantries; 
o Laundromats. 
x Posting Facebook & Craigslist advertisements. Create simple, attention-grabbing 
advertisements for targeted demographic on Facebook, and under “gigs” and/or 
“volunteer” section of Craigslist on a weekly basis. 
x Partnering with community advocates. Announce study, pass out flyers at community 
meetings (BMAGIC & Bayview HealZone), and ask for feedback, support, and/or 
recruitment ideas every third Tuesday of the month (12/20/2016, 1/17/2017, 2/21/2017, 
3/21/2017, 4/18/2017, 5/16/2017, 6/20/2017, 7/18/2017). 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
Active 
Recruitment 
(in-person) 
Passive 
Recruitment 
 
Recruitment flow. Once candidates are either actively recruited through a tabling event or community partner, or they read about the 
study through flyer or advertisement, they will: 
 
 
 
 
 
Tabling 
event 
 
Health 
Clinic 
 
Staff directly sign up candidates for 
orientation via REDCap survey & give 
appointment card [Appendix III] for 
orientation. 
 
 
Staff give candidate flyer with link / QR 
code that sends them to study survey. 
 
 
 
 
 
 
Candidate takes survey, signs up for 
orientation, inputting contact info to receive 
auto-reminders. 
 
Candidate e-mails or calls, staff does online 
screener with candidate over the phone, 
inputting contact info to send auto-reminders. 
 
 
 
 
 
 
 
 
End goal for 
recruitment: 
 
Candidate 
attends 
orientation! 
 
 
 
Flyers 
[Appendix III] 
 
 
 
Facebook/ 
Craigslist 
Ads 
 
Candidate takes flyer with link / QR code 
that sends them to study survey. 
 
 
 
Candidate finds ad with link / QR code 
that sends to survey as well as study 
contact info: e-mail address & phone 
number. 
 
 
 
Candidate takes survey, signs up for 
orientation, inputting contact info to receive 
auto-reminders. 
 
Candidate e-mails or calls, staff does online 
screener with candidate over the phone, 
inputting contact info to send auto-reminders. 

CHIVES Manual of Operational Procedures 
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From recruitment to orientation. Orientations will be in a group format with 10 to 15 study 
candidates and last approximately 60 minutes. The purpose of the orientation will be to relay to 
candidates a clear understanding of what the study entails, the benefits and risks of participating, 
the possibility of being randomized into any one of four food voucher assignment groups, and 
what would be expected of them should they choose to participate. The study coordinator and/or 
study staff will lead the orientations using the visual aid of a PowerPoint presentation as well as  
a study expectations handout [Appendix VII] and Food Amounts Booklet [Appendix VIII] for 
dietary recalls for each attendee. At the end of the orientation presentation, the study staff who is 
presenting will lead candidates through consent form and screening survey page by page. Then, 
candidates will read through and sign the consent, HIPAA, and Personal Health Information 
forms [Appendix V] and complete a self-administered screening survey [Appendix VI], during 
which study staff will be available to answer any questions. As each candidate leaves 
orientation, study staff will review all paperwork to assess for completeness. After orientation, 
study staff will determine whether orientation attendees are eligible to participate based on their 
answers to the self-administered screening survey. 
Determining participant eligibility & next steps. If study staff determine that candidates meet all 
of the inclusion criteria and do not meet any of the exclusion criteria, study staff will mark them 
as eligible in REDCap. REDCap will then send an automated text message to inform them they 
are eligible to participate and that they will begin completing the baseline data collection. 
Determining candidate ineligibility & next steps. If study staff determines that any candidate  
does not meet all of the inclusion criteria or meets any of the exclusion criteria, REDCap will 
send an automated text message to inform them there are not eligible at this time, and to please 
contact us with any questions. Study staff will not disclose the reason(s) for ineligibility. In 
addition, if the candidate is not eligible specifically due to being pregnant or currently 
breastfeeding, study staff will mail any of these ineligible pregnant or breastfeeding candidates a 
food resources handout [Appendix IX] to ensure she is hooked into available community  
services (WIC, EatSF, etc.) Additionally, any candidate deemed ineligible will be mailed two $5 
EatSF vouchers to thank them for their time, as well as a handout referring them to EatSF  
website and EatSF project office at San Francisco General Hospital to encourage them to 
determine whether they are eligible to participate in the EatSF program [Appendix IX]. Because 
there are a finite number of EatSF vouchers to distribute to ineligible CHIVES candidates, study 
staff must track each ineligible participant who is mailed EatSF vouchers in the Google Sheet 
“Tracking of ineligible participants & EatSF voucher distribution” by REDCap Record ID. No 
personal health information will be tracked in the Google Sheet. Currently UCSF has budgeted 
for 75 EatSF vouchers, or enough EatSF vouchers for approximately 37 ineligible candidates. 
 
 
“Tracking of ineligible participants & EatSF voucher distribution” Google Sheet 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
Tracking of eligible participants & ineligible candidates. All candidates who attend orientation 
and complete screening survey will be recorded in REDCap. If any candidate is deemed 
ineligible to participate in the study, study staff will record the reason for exclusion in REDCap 
(optional reasons: did not meet inclusion criteria, declined to participate, or specify other reasons 
for ineligibility). Study staff will mark in REDCap whether any ineligible pregnant or 
breastfeeding candidate was mailed the appropriate food resources handout [Appendix IX], and 
whether all other ineligible candidates were mailed two $5 EatSF vouchers and a handout 
referring them to EatSF program [Appendix IX]. Any candidate that is deemed eligible to 
participate will also be tracked in REDCap as they complete baseline data collection, are then 
randomized, and receive the first month of vouchers. 
Change in participation status. If, at any point, participant status should change (e.g., participant 
chooses to drop out or cannot be reached), study staff will record this in either REDCap Project 
(CHIVES Screening Candidates or CHIVES Main Project, depending on when the participant 
drops out) under the “Status” instrument form with a clear reason as to why participant chose to 
drop out of study. Careful tracking of candidates and participants in study will ensure that the 
study always conforms with the CONSORT guidelines. 
 
 
“Status” REDCap instrument 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
Randomization procedure for assigning an eligible participant to an intervention group. Once 
eligible participants complete Month 0/Baseline survey data collection over the phone with study 
staff (and staff have entered, simultaneously with the phone call, the data into REDCap), the 
study coordinator will notify the statistician, who will run a randomization program using 
covariates (age, sex, race, ethnicity, income category, and current SNAP / CalFresh participation 
status). The statistician will perform covariate-adaptive randomization to minimize differences  
in these covariates among individuals when randomizing participants into each of the four 
intervention arms, using blinded labels (Group 1, Group 2, Group 3, or Group 4), and will upload 
the assignments under each participant REDCap record ID number into REDCap. Only the  
study coordinator will know which group number corresponds to which intervention arm 
(monthly untargeted, monthly targeted, weekly untargeted, or weekly targeted). 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
5 
 STUDY INTERVENTIONS 
 
5.1 
Interventions, Administration, and Duration 
Description of intervention and administration. The primary intervention is the participant’s 
utilization of assigned food vouchers throughout the six months of their study participation. 
From an administrative standpoint, there is no anticipated differential treatment to participants, 
based on the arm of the intervention to which a participant is assigned. Regardless of which arm 
of the intervention any given participant is assigned, he/she will go through virtually the same 
procedures to receive and spend vouchers that any other participant will, with balanced time and 
attention from study staff across all four intervention groups. Study staff will mail appropriate 
food vouchers to participants at the end of each of the six months to spend for the following 
month. 
 
Month 1 of food voucher distribution. The first month of food vouchers will be mailed along  
with “How to Use Vouchers & List of Store Vendors” Handout [Appendix X] after participants 
have completed all baseline data collection. Participants will then be expected to spend their four 
monthly food vouchers at approved Bayview, SoMa, and Tenderloin vendors within the 
timeframe for which they are valid; these dates will be hand-stamped in the “start date” and “end 
date” boxes on every food voucher.  Study staff will track all mailed food vouchers in REDCap 
with date, time, staff name, and any relevant comments. 
 
“ADMIN: Mailing Vouchers Monthly” REDCap instrument 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
Months 2 through 6 of food voucher distribution. For all subsequent intervention months (Month 
2 through Month 6), study staff will simply continue to mail one month’s worth of vouchers 
during the last week of the month before which the food vouchers are valid (e.g., study staff will 
mail out March food vouchers during the last week of February). Study staff will record in 
REDCap the date, time, staff name, and any relevant comments in regards to all food vouchers 
that are sent via mail. During Month 5 of the intervention, study staff will include a handout 
[Appendix XI] for participants, reminding them about the upcoming data collection period and 
that Month 6 will be their final month of receiving vouchers. 
 
Month 6 data collection. During the sixth and final month of the intervention period, diet 
assessors will contact each participant to complete the Month 6 data collection pieces (recalls 
and surveys) during the 1st and 4th Week of that final intervention month. The recalls and 
surveys will be scheduled according to the participant’s indicated availability on screening 
survey [Appendix VI]. Also, while in theory it would be less participant burden and ensure data 
completeness to combine the surveys with one of the four dietary recall phone calls, the dietary 
recalls and surveys may be completed during separate phone calls. Diet assessors will inquire 
when the participant would like to complete the survey during the first phone call. 
 
Month 12 data collection. After the Month 6, participants will no longer receive any food 
vouchers, and will not be considered part of the active intervention. However, diet assessors will 
contact them during the 1st and 4th Weeks of Month 12 from baseline to complete final set of data 
collection. 
 
5.2 Handling of Study Interventions 
Food voucher administration & distribution. Vouchers will be mailed to participants on a 
monthly basis for six months. 
 
Timing of food voucher preparation. 
 
For cohorts that are beginning the CHIVES Project, i.e., will be receiving Month 1 of vouchers, 
study staff will prepare their vouchers toward the end of Month 1 Week 1 (ideally on 8th or 9th 
day of any given month, as Month 1 Week 1 data collection is wrapping up). 
 
For cohorts that are continuing with the CHIVES Project, i.e., will be receiving Months 2  
through 6 of vouchers, study staff will prepare their vouchers during Weeks 2 or 3 of each month 
(ideally between data collection periods). These must be finished and mailed out several days 
before the end of each month so that participants will receive their vouchers by the 1st of the 
month at the latest. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
Study Coordinator Instructions for Unblinding Food Voucher Assignment: 
 
1) During Weeks 2 and 3 of each month, the study coordinator will download the “Mailing 
Vouchers” REDCap report from CHIVES Main Project with the following information: 
first name, last name, street address, apartment number, city, state, zip code, CHIVES ID, 
blinded food voucher assignment (Group 1, 2, 3, or 4), and cohort into a .csv file. 
 
 
“Mailing Vouchers” REDCap Report – column headers 
 
 
 
2) The study coordinator will save this originally downloaded file as: “[Month] Mailing 
Vouchers with addresses,” for example: “February Mailing Vouchers with addresses.” 
 
 
 
3) The study coordinator will delete the randomize_group column, convert all ‘1’ values 
under state column to “CA,” and check that all city values are “San Francisco,” as 
opposed to “SF” or “SAN Francisco.” 
 
“[Month] Mailing Vouchers with addresses” saved file to later use for generating address labels 
 
 
 
4) The study coordinator will sort data by apt_number column. This will put any entries 
that have an apartment number together at the top of the excel sheet. 
 
“[Month] Mailing Vouchers with addresses” file sorted by apt_number. 
 
 
 
5) The study coordinator will insert a column to the left of the apt_number column and 
name this column “apt.” The study coordinator will add the word “Apt.” next to only the 
rows with any value entered for apartment number. 
 
 
“[Month] Mailing Vouchers with addresses” file with inserted “apt” column and the word “Apt.” 
next to all entries with anything entered for apartment number. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
6) The study coordinator will sort the data one final time by chives_id column, so that all 
participants are in numerical order by their CHIVES ID. The study coordinator will save 
and close the file, which will later be used to prepare address labels with Avery software. 
 
“[Month] Mailing Vouchers with addresses” file sorted by chives_id. 
 
 
7) Now the study coordinator will open the original CSV file downloaded from REDCap (in 
downloads folder) and will delete all columns with contact information (name & address 
columns), leaving only the chives_id column, the randomize_group, and elig_cohort 
columns. The study coordinator will then sort the data by group number 
(randomize_group): 
 
“Mailing Vouchers” REDCap Report – sorted by randomize_group with no contact information. 
 
8) The study coordinator will then convert (unblind) the group number to actual voucher 
assignment (monthly CalFresh, monthly fruits & vegetables, weekly CalFresh, weekly 
fruits & vegetables), separate each of these food voucher assignment groups onto a 
different tab within the excel file, and save this as a new file: “[Month] Mailing Vouchers 
unblinded,” for example, “February Mailing Vouchers unblinded.” 
 
 
 
 
 
 
Study coordinator’s new excel file “[Month] Mailing Vouchers unblinded” with CHIVES ID, group 
number, and cohort matched to unblinded voucher assignment, each on a separate tab. 
**Please note: these are not actual unblinded voucher assignments. This is merely an example.** 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
9) The study coordinator will insert a row at the top of each sheet, and write in what each of 
the four sheets represents (e.g., “Monthly F&V”). 
 
“[Month] Mailing Vouchers unblinded” file with inserted voucher assignment as header. 
 
 
 
10) The study coordinator will then delete the randomize_group column from each of the  
four tabs. The only two columns on each sheet to be printed out are the chives_id column 
and elig_cohort column. 
 
 
“[Month] Mailing Vouchers unblinded” file with only CHIVES ID and cohort columns, 
ready for print. 
 
 
 
11) Finally, the study coordinator will print four different lists of all active study participants 
by unblinded food voucher assignment (monthly CalFresh, monthly fruits & vegetables, 
weekly CalFresh, weekly fruits & vegetables). Each list will contain all active study 
participants in one of the food voucher assignments. 

CHIVES Manual of Operational Procedures 
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Study Staff Instructions for Voucher Preparation: 
 
Next, study staff will divide the blank food vouchers into four different piles by type: monthly 
fruits & vegetables, weekly CalFresh, weekly fruits & vegetables, and monthly CalFresh. The 
fruits & vegetables versus CalFresh voucher are distinguished by color: the former are green, and 
the latter are orange. Study staff will each take one of the four lists of study participants that 
correspond to the correct food voucher type and proceed to write each CHIVES ID on a total of 
four vouchers in the six boxes under “Participant #.” 
 
 
Sample blank fruit & vegetable food voucher. 
 
Once study staff have hand-written all CHIVES IDs on food vouchers, they will then proceed to 
stamp the correct dates for which each food voucher is valid. 
 
For monthly food vouchers, the start date will typically be the first day of the month (e.g., APR 
01 2017), which will be stamped in the “First day to use” box directly on the food voucher, and 
the end date will always be the final day of the month (e.g., APR 30 2017), which will be 
stamped in the “Last day to use” box. 
 
However, for Month 1 of the intervention, the monthly food vouchers will have a start date that 
is the tenth day of the month (e.g., APR 10 2017). This is to ensure that participants do not start 
using food vouchers before their baseline data collection that occurs during Week 1 of Month 1 
is complete. Refer to charts below for specifics. 
 
For weekly food vouchers, the start date for the 1st voucher will typically be the first day of the 
month (e.g., APR 01 2017), which will be stamped in the “First day to use” box directly on the 
food voucher, and the end date will typically be the 7th day of the month (e.g., APR 7 2017), 
which will be stamped in the “Last day to use” box.  The start date for the 4th voucher will 
always be seven days before the last day of the month (e.g., APR 24 2017) and the end date will 
always be the final day of the month (e.g., APR 30 2017). The start dates for the 2nd and 3rd 
vouchers will vary, depending on how many days are in the month (i.e., 28, 30, or 31 days). For 
a month with 30 days (e.g., April), the 2nd and 3rd vouchers will each last 8 days. 
handwritten 6-digit 
study id 
food voucher type: 
untargeted or targeted 
stamped start date for 
which specified food 
voucher is valid 
stamped end date for 
which specified food 
voucher is valid 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
As is with the monthly food vouchers, Month 1 of weekly food vouchers will have a slightly 
different dating system. The 2nd through 4th vouchers will remain the same. However, the 1st 
voucher will have a start date that is the tenth day of the month (e.g., APR 10 2017) and end date 
that is the final day of the month (e.g., APR 30 2017). Once again, we need to ensure that 
participants do not start using food vouchers before their baseline data collection that occurs 
during Week 1 of Month 1 is complete. Since we cannot provide food vouchers during Week 1 
of Month 1, participants receiving weekly vouchers would not be able to spend their 1st voucher, 
as it is only valid the first seven days of the month. Therefore, the 1st voucher of Month 1 will be 
valid for the final three Weeks of the month to allow participants to spend it when it makes most 
sense for them. Refer to charts below for specifics. 
 
Once all vouchers for the coming month are filled out with CHIVES ID as well as stamped start 
and end dates, study staff will put all four food vouchers for each participant in an envelope, 
writing the CHIVES ID in pencil on the front of the envelope, where the participant address label 
will later be placed.  If preparing Month 1 vouchers, study staff will include Month 1 Handout 
[Appendix X]; if preparing Month 5 vouchers, study staff will include Month 5 Handout 
[Appendix XI]. Study staff will then seal the envelope closed, organize all envelopes  
numerically by CHIVES ID, and place all envelopes in a single pile, indicating they are ready to 
be matched with an address label. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
Chart of dating for weekly vouchers – Month 1 
*Remember to include Month 1 Handout [Appendix X] in envelope.* 
Chart of dating for weekly vouchers – Months 2 though 6 
*Remember to include Month 1 Handout [Appendix XI] in envelope.* 
 
 
Day of 
Month 
28-day month 
February 
30-day months 
April, June, September, 
November 
31-day months 
January, March, May, 
July, August, October, 
December 
1 
Voucher 1: 1st - 7th 
Voucher 1: 1st - 7th 
Voucher 1: 1st - 7th 
2 
3 
4 
5 
6 
7 
8 
Voucher 2: 8th - 14th 
Voucher 2: 8th - 15th 
Voucher 2: 8th - 16th 
9 
10 
11 
12 
13 
14 
15 
Voucher 3: 15th - 21st 
16 
Voucher 3: 16th - 23rd 
17 
Voucher 3: 17th - 24th 
18 
19 
20 
21 
22 
Voucher 4: 22nd - 28th 
23 
24 
Voucher 4: 24th - 30th 
25 
Voucher 4: 25th - 31st 
26 
27 
28 
29 
n/a 
30 
n/a 
31 
n/a 
n/a 
Day of 
Month 
28-day month 
February 
30-day months 
April, June, September, 
November 
31-day months 
January, March, May, 
July, August, October, 
December 
1 
Voucher 1: 10th - 28th 
Voucher 1: 10th - 30th 
Voucher 1: 10th - 31st 
2 
3 
4 
5 
6 
7 
8 
Voucher 2: 10th - 14th 
Voucher 2: 10th - 15th 
Voucher 2: 10th - 16th 
9 
10 
11 
12 
13 
14 
15 
Voucher 3: 15th - 21st 
16 
Voucher 3: 16th - 23rd 
17 
Voucher 3: 17th - 24th 
18 
19 
20 
21 
22 
Voucher 4: 22nd - 28th 
23 
24 
Voucher 4: 24th - 30th 
25 
Voucher 4: 25th - 31st 
26 
27 
28 
29 
n/a 
30 
n/a 
31 
n/a 
n/a 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
Chart of dating for monthly vouchers – Month 1 
*Remember to include Month 1 Handout [Appendix X] in envelope.* 
Chart of dating for monthly vouchers – Months 2 though 6 
*Remember to include Month 5 Handout [Appendix XI] in envelope.* 
 
 
 
Day of 
Month 
28-day month 
February 
30-day months 
April, June, September, 
November 
31-day months 
January, March, May, 
July, August, October, 
December 
1 
Vouchers 1-4: 1st - 28th 
Vouchers 1-4: 1st - 30th 
Vouchers 1-4: 1st - 31st 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
n/a 
30 
n/a 
31 
n/a 
n/a 
Day of 
Month 
28-day month 
February 
30-day months 
April, June, September, 
November 
31-day months 
January, March, May, 
July, August, October, 
December 
1 
Vouchers 1-4: 10th - 28th 
Vouchers 1-4: 10th - 30th 
Vouchers 1-4: 10th - 31st 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
n/a 
30 
n/a 
31 
n/a 
n/a 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
Study Staff Instructions for Printing Address Labels: 
 
Study staff, or study coordinator, will then print sheets of address labels for all active 
participants. The address labels will be printed using the Avery Design & Print software system 
(login: chivesproject@stanford.edu, password: ChivesProject1485): 
 
1) Click “Open a Saved Project” tab.  Then click “Open” under “CHIVES Mailing 
Addresses” project. 
 
 
 
 
 
 
 
 
 
 
 
 
2) Select the text box by clicking on text. 
 
3)  Under “Import Data” tab on left, click “Change Mail Merge.” 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
4) Then click “Select File,” and browse for “[Month] Mailing Vouchers with addresses” 
file. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
5) The file will upload with all the data in the needed fields to print address labels. 
 
 
Unselect first row, so headers do not appear. Then, click “Next.” 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
6) Double-click each field (with Mac), or drag & drop fields (with PC), so that they appear 
 
 
7) When the formatting looks like above image, click “Complete Merge.” 
with the following as in “Arrange fields” box: 
- Add a comma and space after “city” field. 
- Put a line break after “city, state zipcode” line and before chives_id line, so there is 
more space to allow for white out process. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
 
8) On the next screen, highlight the CHIVES ID field and make it 7-point font, so that it is 
easier to white out. 
 
 
9) Look through a few labels to make sure they are centered correctly for each participant. 
Make special note to look through any addresses with apartment field. Choose either 
“Edit One” or “Edit All” to make changes as necessary. 
 
10) Click “Review & Print” when finished editing. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
 
 
 
 
12) Open Tray 1 in printer and add necessary number of label sheets to Tray 1 in printer, with 
labels facing down. Then, click print! 
11) Click “Fill Down.” Then, “Print.” 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
Each label will have the participant name, address, and in small font below, the participant’s 
corresponding identification number (CHIVES ID). The address labels will be printed 
numerically by CHIVES ID. Study staff will match participant address label to envelope with 
corresponding CHIVES ID, covering up the hand-written CHIVES ID previously written on the 
envelope, and simultaneously place both a CHIVES Project return address label and a postage 
stamp on each envelope, if envelope does not already have these adhered. Study staff will use 
white out to cover up the participant’s CHIVES ID on the mailing label. 
 
For each mailed set of vouchers, study staff will note in REDCap the date and time of mailed 
vouchers, the staff name, and any relevant comments under each participant profile. Once study 
staff complete all preparation for mailed vouchers, a designated staff member will place all 
envelopes in United States Postal Service mailbox located immediately outside the office 
building for outgoing mail no later than the 3rd day prior to the end of the month. 
 
 
Printed Avery address labels. 
 
 
hand-written 
CHIVES ID 
in pencil 
printed study 
return address 
printed address label with 
participant name & CHIVES ID 
postage 
stamp 
The CHIVES Project 
1485 Bayshore Blvd., Suite 437 
San Francisco, CA 94124 
CP0147 
Fulano Sanchez 
123 17th Street 
San Francisco, CA 94110 
CP0147 
Front of sealed envelope to be mailed. 
Front of sealed envelope to be mailed. 
study 
id – 
to be 
whited 
out 
participant name 
& address 
Fulano Sanchez 
123 17th Street 
San Francisco, CA 94110 
CP0147 
Polly Applegate 
765 17th Street 
San Francisco, CA 94110 
CP0149 
Thomas Webster 
888 17th Street 
San Francisco, CA 94110 
CP0150 
CHIVES ID 
John Smith 
Thomas Webster 
Fulano Sanchez 
343 17th Street 
888 17th Street 
123 17th Street 
San Francisco, CA 94110 
San Francisco, CA 94110 
San Francisco, CA 94110 
CP0148 
CP0150 
CP0147 
Polly Applegate 
765 17th Street 
San Francisco, CA 94110 
CP0149 
John Smith 
343 17th Street 
San Francisco, CA 94110 
CP0148 
John Smith 
343 17th Street 
San Francisco, CA 94110 
CP0148 
Thomas Webster 
Fulano Sanchez 
Polly Applegate 
888 17th Street 
123 17th Street 
765 17th Street 
San Francisco, CA 94110 
San Francisco, CA 94110 
San Francisco, CA 94110 
CP0150 
CP0147 
CP0149 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
5.3 
Concomitant Interventions 
 
5.3.1 Allowed Interventions 
Participants are allowed to be concurrently enrolled in the CalFresh (also known as the 
Supplemental Nutrition Assistance Program, or SNAP). Participants, or members in their 
household, are also allowed to be concurrently enrolled in WIC.  Participants may receive 
food from their local food bank. 
 
5.3.2 Required Interventions 
Since this study is a community effectiveness intervention, participants will be included 
in the data analysis regardless of how many vouchers they redeem during the 6-month 
intervention period. Therefore, participants are only required to complete the Month 
0/Baseline dietary recalls to receive vouchers and be included in data analysis. 
 
5.3.3 
Prohibited Interventions 
Candidates will not initially be allowed in the study if they report in the screening survey 
that they are currently participating in any other dietary or nutrition studies that would 
impact their normal eating patterns, or if they are currently receiving EatSF vouchers. 
 
5.4 Adherence Assessment 
Adherence to study intervention will be defined as participants who have redeemed 80% of their 
food vouchers. All participants will be included in the final analysis, but those who have meet 
this adherence criteria will be included in a special sensitivity analysis. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
6 
STUDY PROCEDURES 
 
The Schedule of Participant Flow & Outcome Measures in Section 6.1 includes all study 
evaluations. This is primarily intended for study staff, but a simplified version of this will be 
shared in a handout with potential study participants in orientation [Appendix VII] to set up their 
expectations for their required involvement in the study, should they choose to participate. 

Version 2.0, December 20, 2016 
 
 
 
6.1 
Schedule of Participant Flow & Outcome Measures 
 
Timeframe 
Month 0, ≤ 4th Week 
Recruitment, 
Orientation, Consent, & 
Screening 
Month 0, 4th Week 
Baseline Data 
Collection 
Month 1, 1st Week 
Data Collection, 
Initiation of Voucher 
Utilization 
Month 6, 1st Week 
End of Intervention 
Data Collection, 
Final Month of Voucher 
Utilization 
Month 6, 4th Week 
End of Intervention 
Data Collection, 
Final Month of Voucher 
Utilization 
Month 12, 1st Week 
6-month Follow Up 
Data Collection after 
final Voucher Utilization 
Month 12, 4th Week 
6-month Follow Up 
Data Collection after 
final Voucher Utilization 
Participant Perspective 
x Recruited to participate 
in CHIVES 
x Sign up for orientation 
x Attend orientation, 
give informed consent 
to participate, & 
complete screening 
survey 
x Deemed eligible to 
participate & 
contacted for baseline 
data collection 
x Before voucher 
receipt & 
randomization 
x Complete two 24-hour 
dietary recalls & 
baseline survey over 
the phone 
x Receive randomized 
voucher assignment 
x Receive in mail 1st 
month of vouchers 
after completing two 
24-hour dietary recalls 
over the phone 
xUse vouchers for final 
month in trial 
xComplete two 24-hour 
dietary recalls & 
Month 6 survey over 
the phone 
x Use vouchers for final 
month in trial 
x Complete two 24-hour 
dietary recalls & Month 
6 survey (if not already 
completed during 1st 
Week) over the phone 
x Receive $20 incentive 
for Month 6 data 
completion 
x No vouchers used for 
past 6 months 
x Complete two 24-hour 
dietary recalls & 
Month 12 survey over 
the phone 
x No vouchers used for 
past 6 months 
x Complete two 24- 
hour dietary recalls & 
Month 12 survey (if 
not already completed 
during 1st Week) over 
the phone 
x Receive $20 incentive 
for Month 12 data 
completion 
x Final involvement in 
study participation 
Evaluation Measures 
Two 24-hour dietary 
recalls (ideally one 
weekday + one 
weekend) 
Two 24-hour dietary 
recalls (ideally one 
weekday + one 
weekend) 
Two 24-hour dietary 
recalls (ideally one 
weekday + one 
weekend) 
Two 24-hour dietary 
recalls (ideally one 
weekday + one 
weekend) 
Two 24-hour dietary 
recalls (ideally one 
weekday + one 
weekend) 
Two 24-hour dietary 
recalls (ideally one 
weekday + one 
weekend) 
F&V acquisition, 
attitudes, and 
consumption survey 
questions 
F&V acquisition, 
attitudes, and 
consumption survey 
questions* 
F&V acquisition, 
attitudes, and 
consumption survey 
questions* 
F&V acquisition, 
attitudes, and 
consumption survey 
questions* 
F&V acquisition, 
attitudes, and 
consumption survey 
questions* 
Participation in nutrition 
assistance programs 
survey questions 
(WIC/SNAP/EatSF) 
Participation in nutrition 
assistance programs 
survey questions 
(WIC/SNAP/EatSF) * 
Participation in nutrition 
assistance programs 
survey questions 
(WIC/SNAP/EatSF) * 
Participation in nutrition 
assistance programs 
survey questions 
(WIC/SNAP/EatSF) * 
Participation in nutrition 
assistance programs 
survey questions 
(WIC/SNAP/EatSF) * 
Participant food security 
status survey questions 
Participant food security 
status survey questions* 
Participant food security 
status survey questions* 
Participant food security 
status survey questions* 
Participant food security 
status survey questions* 
Self-reported height & 
weight, pregnancy / 
lactation status 
Self-reported height & 
weight, pregnancy / 
lactation status* 
Self-reported height & 
weight, pregnancy / 
lactation status* 
Self-reported height & 
weight, pregnancy / 
lactation status* 
Self-reported height & 
weight, pregnancy / 
lactation status* 
Voucher ease of use 
survey questions* 
Voucher ease of use 
survey questions* 
 
CHIVES Manual of Operational Procedures 
* Surveys administered during Months 6 & 12 may be completed during 1st or 4th Week of either month, 
whichever more convenient for participant. Only one set of surveys at Months 6 & 12 need to be completed. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
 
6.2 Description of Evaluations 
24-hour dietary recalls. The dietary recall method was previously tested among low-income 
populations in both independent studies and in our own prior trials. The method has good 
internal consistency (Cronbach’s alpha >0.80) and high correspondence among individuals 
≤250% FPL to the lengthier Automated Multi-Pass Method used in the National Health and 
Nutrition Examination Survey, and to intake estimates obtained via doubly-labeled water. 
 
Briefly, the method includes distinct passes to obtain a participant’s food intake during the 
previous 24 hours, including foods obtained at home and away from home, and including 
bartered, foraged, food pantry, and other non-purchased items. Participants will receive a 
standard 2-dimensional paper copy of the Food Amounts Booklet [Appendix VIII] during the 
orientation session to enhance estimating portion sizes during each dietary recall. The diet 
assessors are blinded to the participant’s intervention arm and are skilled in guiding dietary 
recalls among diverse participants in a non-judgmental, comprehensive manner. 
 
As in prior trials, quality control/lead diet assessor Sarah Farzinkhou will provide 20 hours of 
standardized staff training for diet assessors via written manuals and protocols, case studies, and 
role play to cover content such as recall procedures; techniques to support participants and gather 
recalls in a non-judgmental manner; provide tailored feedback and problem-solving skills; and 
engage in facilitation techniques such as active listening. 
 
The diet assessor will collect data from the participant using a standardized verbal protocol and 
enter the data into the Nutrition Data System for Research (NDSR, University of Minnesota), a 
computer-based software application developed at the University of Minnesota Nutrition 
Coordinating Center (NCC). NDSR records foods using standardized codes to match 
comprehensive nutrient databases. 
 
Dietary recalls will be collected in a standardized fashion using a multiple-pass interview 
approach consisting of five steps to ensure completeness and accuracy. First, diet assessors will 
ask participants to list all foods and beverages consumed in the previous 24 hours (i.e., midnight 
to midnight). Second, the diet assessor will review the list with the participant. Third, the diet 
assessor will collect detailed information about each reported food and beverage (e.g., method of 
preparation and amount consumed). Fourth, the diet assessor will probe for commonly forgotten 
foods and beverages. Fifth, the diet assessor reviews the information for completeness, 
correctness, and marks each recall as a typical or atypical day. 
 
Throughout each recall, the NDSR software searches for foods and brand name products by 
name and will prompt the diet assessors with requests for additional detailed information. The 
NCC Food and Nutrient Database serves as the source of food composition information in 
NDSR. This database includes over 18,000 foods including 8,000 brand name products. 
Ingredients and preparation methods allow for more than 160,000 food variants. Values for 165 
nutrients, nutrient ratios, and other food components were generated by the database. The USDA 
Nutrient Data Laboratory is the primary source for nutrient composition for the database. These 
values are supplemented by food manufacturers' information and data available in the scientific 
literature. Diet assessors will apply standardized, published imputation procedures to minimize 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
missing values. The diet assessors will enter recipes for homemade and restaurant items not 
included in the software. 
 
In addition to using NDSR to specifically capture foods and beverages consumed, diet assessors 
will also record in REDCap whether each completed recall was a weekday or weekend day,  
when each recall was completed (date and time), and who completed each recall. Also, each diet 
assessor will be prompted in REDCap to ask participants at each recall a 2-item food security 
survey in order to later correlate any abnormal food days (i.e., days of especially low caloric 
intake) with possible food insecurity [Appendix XIV]. If any dietary recall day is deemed to be 
abnormal (typically, and daily intake of ≤600 calories, but determined on a case-by-case basis by 
diet assessor), the diet assessor will attempt to complete a third dietary recall within the given 
data collection period. Diet assessors will also record any third recalls in REDCap and ask the 2- 
item food security survey at end of recall. 
 
In general, diet assessors will complete a total of twelve recalls per participant, two recalls at 
each of six timepoints: 
 
(1) Month 0/Week 4 (baseline – before randomization, before voucher use); 
(2) Month 1/Week 1 (baseline – after randomization, before voucher use); 
(3) Month 6/Week 1 (follow up – during final month of voucher use and intervention); 
(4) Month 6/Week 4 (follow up – during final month of voucher use and intervention); 
(5) Month 12/Week 1 (follow up – no voucher use for prior 6 months); 
(6) Month 12/Week 4 (follow up – no voucher use for prior 6 months). 
 
Two dietary recalls (one weekday and one weekend day) will be done during Week 1, which 
reflect the first seven consecutive days of the month, and two during Week 4, which reflect the 
last seven consecutive days, of the assessment months. Ideally one weekday (recall of a Monday 
through Friday) and one weekend day (recall of a Saturday or Sunday) will be collected for each 
timepoint. However, we will alternatively accept two weekdays or two weekend days. In the 
worst-case scenario, we will also accept one weekday recall only or weekend day recall only. 
 
Also, while recalls are technically to reflect the first or last seven days of the month, recalls may 
include up to first or last eight consecutive days of the assessment month to allow for a 1-day 
buffer period. This would mean Week 1 recalls take place the 2nd through the 9th of any given 
month in order to reflect the first eight consecutive days of the month.  And, Week 4 recalls take 
place the 22nd through the 1st for 28-day months, the 24th through the 1st for 30-day months, and 
the 25th through the 1st for 31-day months. For clarification as to when dietary recalls take place 
each month, please refers to the graphics below: 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
 
28-day month 
(e.g., February 2017) 
30- day months 
(e.g., April 2017) 
31- day months 
(e.g., May 2017) 
 
 
 
 
 
When dietary recalls take place each month. 
KEY 
 
Diet assessors will attempt recalls during time periods in which the participants have specified 
they are likely available. (In the orientation screening survey, participants will mark all 2 to 3- 
hour time blocks during which they are available each day of the week. These will be recorded in 
REDCap and transferred to a shared diet assessor dietary recall calendar). We are hopeful with 
these “semi-scheduled” recalls that diet assessors will not have to call participants multiple times 
in order to complete each required dietary recall. 
 
However, we know that some participants will need to be called repeatedly in order to complete 
the two dietary recalls required for each week during data collection window at each timepoint. 
Diet assessors will attempt to call participants a total of seven times during each 8-day period 
(“Week 1” – reflects first eight consecutive days of the assessment month, or “Week 4” – reflects 
last eight consecutive days of the assessment month). Diet assessors will not attempt to call more 
than once per day, unless they hear back from a participant via text message, or a call that they 
are available later that same day. For each time diet assessors attempt to call participants and do 
not reach them, they will leave a scripted voicemail and follow up with a quick scripted text 
message [Appendix XV] to see when participants might be available for the call. Diet assessors 
will record each attempt in the shared diet assessor dietary recall calendar, and make any  
pertinent participant notes in REDCap. 
 
Overall, this dietary recall plan minimizes the number of recalls required to capture intra-person 
variation in diet between weekdays and weekends, while simultaneously capturing the monthly 
food consumption cycle among participants (the key hypothesized mediator for the lump 
sum/monthly versus distributed/weekly voucher effect). The method limits participant fatigue, 
even in low-literacy, low-income populations; fewer than 10% of participants cited the recalls as 
detracting from completion of a prior trial. To ensure adequate follow-up and data completion at 
Months 6 and 12, a $20 gift card to a popular local store will be mailed following the final Week 
4 recalls of Months 6 and 12. The same recall protocol will be utilized for Months 0, 6 and 12, 
except the $20 gift card given only at Months 6 and 12. 
 
The 24-hour dietary recalls are the most critical evaluation measure as data obtained from these 
will be used to assess the primary outcome measure and two of the three secondary outcome 
measures. 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
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1 
2 
3 
4 
5 
6 
7 
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18 
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22 
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2 
3 
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14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
1 
Week 1 recalls 
Week 4 recalls 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
Participant surveys. Diet assessors will verbally administer the participant surveys over the 
phone, preventing literacy-based biases, consistent with recent Institute of Medicine 
recommendations. These 20-minute surveys [Appendix XIII] will be conducted at Months 0, 6, 
and 12. At each data collection time point, diet assessors will assess which phone call would be 
most convenient for participant to answer the additional 20-minute survey. The baseline survey 
may be administered during either of the two phone calls for dietary recalls during Week 4 of 
Month 0. The Month 6 and Month 12 surveys may be administered during one of any of the four 
phone calls for Month 6 and Month 12. 
 
The participant survey will cover attitudes and preferences regarding the food vouchers and 
F&Vs generally, shopping patterns, food expenditures, household environment, participation in 
nutrition assistance programs, food insecurity, and self-reported height and weight, pregnancy 
and lactation status. Survey measures [Appendix XII] were chosen over alternatives due to 
brevity, good internal consistency (Cronbach’s alpha>0.8), high construct and criterion validity 
both in English and Spanish versions among low-literacy and low-income adults, and because 
participants in our pilot feasibility study indicated excellent comprehension of the questions 
during post-pilot focus groups. The only difference in survey questions between Month 
0/Baseline, Month 6, and Month 12 survey will be an additional four questions at Month 6 to 
assess voucher usability. 
 
Vendor surveys. The Bayview, SoMa, and Tenderloin vendors are highly enthusiastic about their 
participation because it offers positive advertising, additional foot traffic, and financial support 
for turnover of perishable products. Memorandums of Understanding (MOUs) were signed by 
every vendor and EatSF program staff before the EatSF pilot study began. 
 
Study staff will present the updated EatSF and CHIVES Project MOU [Appendix XVI] to all 
participating CHIVES vendors during Month 0 (January 2017) through in-person meetings to 
read and sign two copies of the MOU, as well as provide updated training materials for store  
staff on how to accept CHIVES vouchers [Appendix XVIII]. The vendor will keep one signed 
copy for their own records, and the CHIVES study coordinator will keep the other copy of each 
signed MOU in the study office.  The updated MOU outlines that participating vendors agree to 
study staff visiting vendors on a monthly basis to: (i) gather any feedback, resolve any issues or 
confusion, and hear about any misuse; (ii) routinely assess product pricing (to ensure prices do 
not increase in response to the intervention); and (iii) assess the available quality, quantity, and 
variety of F&Vs. Finally, the MOU will state that the participating vendors agree to participate in 
a post-intervention vendor survey [Appendix XVII]. 
 
Study staff will visit participating vendors after the final intervention month for the last cohort 
(estimated to be early 2018), to conduct the post-intervention survey as an in-person interview. 
The survey questions will be modeled on a United States Department of Agriculture survey of 
retailers participating in a prior subsidy program, which assesses: (i) whether vendors have any 
difficulties with the voucher system and whether those difficulties are at the point of sale, at the 
point of reimbursement, and/or when answering questions to customers about the vouchers; (ii) 
what if any activities were used by vendors to promote F&Vs during the voucher trial period; 
(iii) what if any activities they had engaged in to sell more F&Vs; and (iv) a free text entry to 
elicit what changes vendors would propose to the voucher system in future iterations.  Study staff 

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will continue to visit vendors until all survey interviews are completed. [Note: at larger stores, 
such as Foods Co and Safeway, the EatSF contact will be interviewed, as opposed to the store 
owner or general manager in the small stores.] 
6.2.1 Screening Evaluation  
Consenting Procedure 
When candidates visit the online recruitment survey via REDCap during recruitment, 
they will fill out a pre-screening survey with a Waiver of Documentation [Appendix 
IV] that gives a general overview of the study, and is something they must agree to in 
order to continue with the pre-screening questions.  This is the candidate’s first form 
of acknowledgement of being in a study. 
 
When candidates agree to the Waiver of Documentation form, they agree to answer 
pre-screening questions and potentially share contact information, if they are eligible 
based on pre-screening questions. If they are deemed eligible based on their answers 
to the pre-screening questions, they will then be asked to share contact information 
and sign up for an orientation date. 
 
If they attend the orientation session for which they signed up, they will read and sign 
a single informed consent form that describes both the screening and study procedures 
during the orientation session [Appendix V]. 
 
The study director, the study coordinator, and/or the study staff will review the major 
components of the consent, page by page, in the group orientation with the visual aid 
of a PowerPoint presentation. The candidate will then have time to individually 
review consent in detail, ask any questions to available staff members, and sign once 
they fully understand the components of the consent form. 
 
As candidates are leaving orientation, study staff will collect consent forms, answer 
any additional questions, and ensure the consent form was signed and dated correctly. 
 
Signed consent forms will be organized alphabetically by last name in a secure folder 
locked in the study coordinator’s file cabinet. 
 
Screening 
All candidates who have signed the consent form during orientation will then be 
invited to complete the 16-item self-administered screening survey [Appendix VI]. 
This brief survey captures whether each candidate meets all enrollment criteria 
(inclusion and exclusion criteria), and captures availability for phone survey and food 
recalls. 
The screening survey must be dated within two months of baseline data collection. If 
more than two months have passed since the candidate attended orientation and 
completed the screening survey, study staff must administer an additional screening 
survey over the phone to ensure the candidate is still eligible to participate. 

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6.2.2 Baseline Assessments, Randomization, and Enrollment 
Baseline Assessments (4th Week of Month 0) 
For participants who have successfully been screened for eligibility and are consented 
into the study, baseline assessments are executed so that we can measure against these 
at Months 6 and 12 to calculate study outcomes. They also ensure that the groups are 
balanced with respect to baseline characteristics. 
The baseline assessments during 4th Week of Month 0 will include: 
x Two 24-hour dietary recalls (1 weekday + 1 weekend day) 
x One 20-minute baseline survey [Appendix XIII] 
Randomization 
During Week 4 of Month 0 for each cohort, study coordinator will daily run a report 
in REDCap that shows how many participants have completed all Month 0 data 
collection (two 24-hour dietary recalls and survey) over the phone with diet assessors. 
Once study coordinator identifies that the minimum of 48 participants has been 
reached, or it is the first day of Month 1 (i.e., Week 4 of Month 0 data collection will 
cease by end of day), the study coordinator will inform the study statistician that it is 
time to run the code to match all eligible participants to a randomization assignment. 
The study statistician will download all de-identified information needed for 
covariate-adaptive randomization (age, sex, race, ethnicity, income category, and 
current SNAP / CalFresh participation status) from REDCap. 
 
The statistician will run the randomization code, and will perform covariate-adaptive 
randomization to minimize differences in these covariates among individuals when 
randomizing participants into each of the four intervention arms, using blinded labels 
(Group 1, Group 2, Group 3, or Group 4). The study statistician will generate these 
randomized group assignments for each participant. Upon generating the randomized 
group assignments, the study statistician will inform the study coordinator of 
completion. The study coordinator will then go into the Randomization Check-Data 
Push report in REDCap, which has been automatically prepopulated with randomized 
group assignments, and manually click on the first participant ID, open JOE’S 
FORM: Randomization, click the check box by Randomization Check and save the 
record. The study coordinator will do this for every participant being randomized. 
This will then transfer the randomization data from the CHIVES Screening Project to 
the CHIVES Main Project. Each participant will then automatically have a group 
assignment visible under their REDCap profile page (Groups 1 through 4), and at 
that point, each participant will be considered as having received a randomization 
allocation. 
 
Once participants are randomized into their group assignments, an automated text 
message will be sent from REDCap to inform participants of their randomization 
assignment. All relevant dates (Month 0/Baseline data collection completion dates, 
and randomization date) will be recorded in REDCap. 
 
Enrollment 
A participant will be officially enrolled in the study once they are randomized into 
one of the four group assignments. This will typically happen between the 4th Week 

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of Month 0 and the 1st Week of Month 1. 
 
The official randomization date in the participant record will automatically be 
recorded in REDCap. This will help to ensure that not too much time (more than two 
months) has lapsed since the participant attended orientation, signed the consent 
form, and completed the screening survey. 

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Baseline Assessments (1st Week of Month 1) 
Once the participant is randomized into one of the four intervention arms, diet 
assessors will complete the baseline data collection during the 1st Week of Month 1: 
two 24-hour dietary recalls (1 weekday + 1 weekend day). 
 
Chart of Baseline Assessments, Randomization, and Enrollment. 
 
Month 0 
Month 0 – 4th Week 
Between Month 0 & 
Month 1 
Month 1 – 1st Week 
-  Participant attends 
orientation 
-  Baseline/Month 0 data 
collection (two 24-hour 
dietary recalls + baseline 
survey) 
- Randomization & 
Enrollment 
- REDCap sends out an 
automated text message 
to inform participant of 
their randomization 
allocation, or food 
voucher assignment 
- Baseline/Month 1 data 
collection (two 24-hour 
dietary recalls) 
- Participants receive food 
vouchers via mail once 
all remaining data 
collection is complete 
6.2.3 Follow-up Visits 
During the 6-month intervention period, participants will receive food vouchers via 
mail. They are not required to return to the study office during the intervention. 
Beyond receiving food vouchers and spending them during specified timeframes, the 
study requires no other commitments from participants during the 6-month 
intervention period. 
 
Participants will complete the end of intervention data collection during 1st and 4th 
Weeks of Month 6, according to evaluation schedule. Diet assessors will call the 
participant a total of four times to complete two separate 24-hour dietary recalls 
during both 1st and 4th Weeks and the 20-minute participant survey during any of the 
four phone calls. If the participant desires, the 20-minute survey can also be 
conducted during a separate phone call. For completion of Month 6 data collection, 
participants will receive a $20 gift card to compensate them for their time and to 
ensure optimal participant retention. To remind participants of upcoming data 
collection and $20 incentive, study staff will mail out a reminder handout [Appendix 
XI] along with Month 5 vouchers. 
 
6.2.4 Completion/Final Evaluation 
Six months after the intervention period has ended, or Month 12 from Month 
0/Baseline, diet assessors will contact participants to complete final data collection 
during 1st and 4th Weeks of Month 12. Again, diet assessors will call the participant a 
total of four times to complete two separate 24-hour dietary recalls during both 1st and 
4th Weeks and the 20-minute participant survey during any of the four phone calls. 
For completion of Month 12 data collection, participants will receive a $20 gift card 
to compensate them for their time and to ensure optimal participant retention. 
 
For participants who did not complete the full 6-month intervention (e.g., they 
stopped picking up vouchers), diet assessors will still attempt to contact them to 
complete the final Month 12 data collection. 

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7 
SAFETY ASSESSMENTS 
Participant safety will be monitored once an individual is enrolled in the study, primarily through 
feedback, complaints, and concerns from participants and vendors. During orientation, 
participants will be encouraged to share any feedback, complaints, and concerns about their 
participation or voucher use via phone call, e-mail, or by visiting the study office. Study staff 
will directly elicit feedback from vendors during regular monthly vendor visits. Due to the  
nature of this study and the low-risk intervention, we do not have any safety concerns or 
anticipate any adverse events or serious adverse events. The are no plans for compensation if any 
adverse event or serious adverse event occurs. 
 
The possible foreseeable risks associated with this study are: 
x The inconvenience of maintaining a consistent mailing address to receive vouchers once 
per month for six months. 
x The inconvenience of remembering to use the vouchers when you shop for food. 
x The time and inconvenience of answering surveys and describing everything that you ate. 
x The psychological discomfort of talking about whether it was difficult for you to obtain 
nutritious food or enough food. 
x The small possibility of communicable disease from F&V purchased with vouchers. This 
is a general risk in the population consuming F&Vs, which is not unduly elevated 
because of participation in the voucher study. 
 
Any study staff that are made aware of safety concerns and/or adverse events will immediately 
report these to the study coordinator and/or study director.  The study director will record any 
adverse events on the adverse event form and communicate this to the Data Safety Monitoring 
Board as well as the two approving Institutional Review Boards within 48 hours. 

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8 
INTERVENTION DISCONTINUATION, WITHDRAWAL & MODIFICATION 
 
Intervention discontinuation. We do not foresee discontinuing any participants. However, the 
only foreseeable reasons for which the study coordinator or study director will discontinue a 
participant’s intervention are: 
 
x If the participant has acted in a violent or inappropriate manner to study staff or any 
vendors; 
x If participant moves from San Francisco area, is unable to receive food vouchers via mail, 
and/or spend vouchers at specified vendors; 
x If participant no longer has regular access to a mobile phone and is unable to complete 
data collection. 
 
Study withdrawal. We anticipate that the majority of participants will be able to complete the 
intervention, due to its inherent low-risk nature. However, participants may withdraw their 
participation in the study at any time. 
 
If for any reason a participant chooses to withdraw their participation and stop receiving 
vouchers and participate in subsequent data collection, he/she must contact study staff who will 
detail this in his/her REDCap file. Due to the nature of the study, participants will not be able to 
temporarily withdraw and rejoin the study. If a participant decides to withdraw from the study, 
this decision will be effective permanently. When any participant decides to withdraw from the 
study, study staff will record this in either REDCap Project (CHIVES Screening Candidates or 
CHIVES Main Project, depending on when the participant drops out) under the “Status” 
instrument form with a clear reason as to why participant chose to drop out of study.  For 
voluntary withdrawals, study staff will inquire whether participant would allow contact for 
Month 6 and Month 12 data collections, which study staff will note in REDCap file to ensure 
study staff follows up with subsequent data collection, according to recorded answer. 
 
If any participant chooses to withdraw due to safety reasons or adverse events, this will be 
recorded in REDCap and communicated to the study director immediately. The study director 
will record this in the adverse event form and communicate this to the Data Safety Monitoring 
Board as well as the two approving Institutional Review Boards within 48 hours. There are no 
plans for compensation if any adverse event or serious adverse event occurs. 
 
Study modification. We have decided not to modify the intervention mid-study in any way. 

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9 
STATISTICAL CONSIDERATIONS 
 
9.1 General Design Issues 
This study tests two hypotheses: that increasing the frequency of food assistance (weekly versus 
monthly), but not the overall amount of assistance, and targeting assistance toward healthy fruits 
and vegetables increases dietary quality in a manner that can cost-effectively reduce 
cardiovascular disease disparities. 
 
Thus, we have chosen a two-by-two factorial study design that randomly assigns participants to 
one of four food voucher assignments (monthly untargeted, monthly targeted, weekly untargeted, 
or weekly targeted) to test the two hypotheses. 
 
9.2 Sample Size and Randomization 
We aim to have 312 total participants in this trial. We anticipate an 8% attrition rate, or plan for 
approximately 25 enrolled participants to be lost to follow up or drop out of study, which would 
leave 288 participants with complete data for analysis. 
 
The study director calculated a 265-participant sample size minimum using G*Power software, 
aiming for a sample size that would give us 90% statistical power to detect two main effects 
(weekly versus monthly, targeted versus untargeted), and their interaction (F-test using 
ANCOVA with baseline F&V intake as the main covariate), assuming a moderate Cohen’s d = 
0.4 effect size. Thus, taking into account up to a 15% participant attrition rate, we aim to enroll 
312 participants so that we have sufficient statistical power for our analyses. 
 
In sum, for optimal statistical power (≥90%), our goal will be to recruit 312 participants. For a 
less ideal statistical power (≥80%), we will aim to recruit at the very minimum 236 participants. 
 
9.3 Interim analyses and Stopping Rules 
There will be no interim analyses conducted. Thus, no stopping rules are in place. We do not 
foresee stopping the trial. 
 
9.4 Outcomes 
 
9.4.1 Primary outcome 
- 
Individual self-reported change in fruit and vegetable intake (measured in cup- 
equivalents) at Month 6 of study participation, as compared to Month 0. Participant 
fruit and vegetable intake will be evaluated by two verbal 24-hour dietary recall 
assessments conducted over the phone with a diet assessor at each data collection 
time point (Month 0/Baseline, Month 6, and Month 12). 
 
9.4.2 Secondary outcomes 
- 
Individual self-reported change in fruit and vegetable intake (measured in cup- 
equivalents) at Month 12 of their study participation, as compared to Month 0. This 
measurement will reflect on fruit and vegetable intake 6 months after their final use of 
food vouchers, to determine maintenance of behavior change after cessation of food 

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voucher receipt. 
- 
Healthy Eating Index and Alternative Healthy Eating Index scores at Months 6 and 
12, calculated from the 24-hour dietary recall data. 
- 
Change in monthly food consumption cycle of overall consumption, comparing total 
calories and fruit and vegetable consumption in Week 4 versus Week 1 of Months 6 
and 12, as compared to Month 0. 
- 
Voucher utilization rate at Month 6. The percent of vouchers utilized by participants 
in each study arm will be calculated. 
 
9.4.3 Other outcomes 
- 
Voucher ease of use, assessed through of a verbal 20-minute survey conducted over 
the phone with a diet assessor at Month 6. Survey asks whether vouchers were easy 
to use and allow for free-text response of why or why not vouchers were easy to use. 
- 
Fruit and vegetable acquisition, attitudes, and consumption, also assessed during 
aforementioned verbal 20-minute survey conducted over the phone with a diet 
assessor at Months 0, 6, and 12. 
- 
Self-reported height and weight, also assessed during aforementioned verbal 20- 
minute survey conducted over the phone with a diet assessor at Months 0, 6, and 12. 
- 
Participant food security status, also assessed during aforementioned verbal 20- 
minute survey conducted over the phone with a diet assessor at Months 0, 6, and 12. 
Questions include participation in nutritional assistance programs and the 6-item 
United States Department of Agriculture adult food security scale. 
 
9.5 Statistical Analyses 
 
Our trial is powered for a standard ANCOVA to test the mean effects of both axes (frequency 
and targeting) and their mediators on the primary outcome of F&V consumption at Month 6, as 
well as to test the interaction between frequency and targeting of vouchers. To explicitly test the 
mediator of the consumption cycle on the effectiveness of the weekly versus monthly vouchers, 
we will test the significance of the interaction between voucher frequency assignment (weekly or 
monthly) and the ratio of Week 4 to Week 1 F&V intake and total calorie intake at Month 6 
relative to Month 0. To explicitly test the mediator of ease of use on the effectiveness of the 
targeted versus untargeted vouchers, we will test the significance of the interaction between 
differences in ease of use of vouchers between groups (from the survey) and change in F&V 
intake between Month 0 and Month 6. 
 
We aim for power (1 - β) of 0.80 with a two-tailed significance threshold α set to 0.01 
(Bonferroni corrected for five tests: two main effects, their interaction, and two mediators). We 
aim to detect a minimum effect size of Cohen’s d=0.44 between weekly and monthly vouchers 
based on the 95% lower bound effect size observed in our pilot study; this is smaller than the 
minimum effect size of d=0.71 between targeted and untargeted vouchers estimated in a 
comparison of recipients of targeted F&V vouchers to propensity score matched recipients of a 
general grocery purchasing discount, or the d=0.76 in the direct targeted versus untargeted 
voucher study in the United Kingdom. Using the lowest (more conservative) effect size, we 
calculated power with a conservative 15% attrition rate over the study period, requiring N=288 
people (n=72 people per intervention condition; G*Power software v. 3.1). Strengths of the 
ANCOVA approach include the ability to isolate the impact of the mediators while correcting for 

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within-person time-invariant confounders (i.e., accounting for the fact that different individuals 
start from different F&V intake levels and exhibit different responsiveness to the same 
incentive). In a secondary analysis, we will assess the extent to which healthy eating habits are 
maintained after the voucher period ends by comparing mean effects at Month 6 to those of 
Month 12, which requires less power. We will conduct an intent-to-treat analysis under the 
conservative assumption that those lost to follow-up had no change in intake; in sensitivity 
analyses, we will use a well-established multiple imputation technique for missing data, which 
fills in missing values in multiple variables iteratively using chained equations (a sequence of 
univariate imputation methods with conditional specification that accommodates arbitrary 
missing-value patterns). 
 
In further statistical analyses, we will explore other mediators of effectiveness captured in our 
survey (e.g., food security), and moderators of gender and race/ethnicity consistent with the NIH 
Policy on the Inclusion of Women and Minorities in Clinical Research (n.b., the policy does not 
require high statistical power for each subgroup). We will also perform subgroup analyses by 
SNAP status, to identify the impact of the vouchers independent of, versus in addition to, 
existing food support program dollars. 
 
Vendor survey data will be summarized using descriptive statistics of survey responses to inform 
future intervention refinement, with free-text comments classified into categories related to 
willingness to participate, ease of participation, and suggestions for improvement. 

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10 
DATA COLLECTION AND QUALITY ASSURANCE 
10.1 Data Collection Forms. Below is a brief description of each data collection form, how 
information about each participant will be collected and by whom. 
Pre-screening survey. This survey asks candidates some basic inclusion and exclusion criteria, 
how they found out about the study, their contact information, and what orientation date works 
best for them to attend. Candidates complete this survey themselves online either through their 
mobile device or computer. Data entered here goes directly into REDCap [Appendix IV]. 
 
Screening survey. This survey is given to candidates during orientation and asks candidates a 
few additional eligibility criteria, information needed for balancing into randomization groups, 
their contact information, and availability for data collection phone calls. Candidates complete 
this survey themselves during orientation with pen and paper. Immediately after orientation, 
study staff will transcribe all answers from paper survey directly into REDCap. Once done, they 
will store all paper copies of screening survey in locked filing cabinet in study office [Appendix 
VI]. 
 
Month 0, Month 6, and Main Surveys. These surveys capture whether the participant understood 
how to use vouchers, general feelings and attitudes about fruits and vegetables, availability of 
fruits and vegetables in the home, participation in food assistance programs, 6-item food security 
questions, height and weight, and pregnancy and breastfeeding status.  Study staff will verbally 
ask participants these questions over the phone as a part of Month 0 / Baseline, Month 6, and 
Month 12 data collection forms. Study staff ask questions directly from REDCap, and enter 
answers in real-time into REDCap database [Appendix XIII]. 
 
24-hour Dietary Recalls. These recalls capture all the food and beverages a participant consumed 
in the previous 24-hour period. Study staff will verbally conduct these recalls with participants 
over the phone, simultaneously entering data into NDSR, using NDSR protocols [Appendix 
XIV]. 
 
10.2 Data Management 
Data from orientation sessions will be collected via paper form and subsequently typed into the 
REDCap data management system. NDSR diet data will be collected via telephone interview 
and directly typed into the NDSR data collection system. NDSR reports will be stored on a 
secure server. Key variables for the statistical analysis will be extracted from these securely 
stored NDSR reports. NDSR report 9 contains the variables necessary to compute cup 
equivalents of fruits and vegetables, the main study outcome. Specifically, servings of the 7 
NDSR food groups that count as fruits and the 10 NDSR food groups that count as vegetables 
will be summed and divided by 2 as report 9 displays servings (equal to half cup equivalents). 
The derivation of the main study outcome will be executed in R version 3.3.2. 
 
Our study statistician will calculate the Healthy Eating Index 2010, or the most updated Healthy 
Eating Index score at the time of analysis, from the relevant NDSR reports using R. The R code 
he creates and uses will be made publicly accessible via the Stanford Digital Repository 
(sdr.stanford.edu) concurrent with publication. 

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10.3 Quality Assurance 
 
10.3.1 Training. As in prior trials, quality control/lead diet assessor Sarah Farzinkhou 
will provide 20 hours of standardized staff training for diet assessors via written 
manuals and protocols, case studies, and role play to cover content such as recall 
procedures; techniques to support participants and gather recalls in a non- 
judgmental manner; provide tailored feedback and problem-solving skills; and 
engage in facilitation techniques such as active listening. Also, study coordinator 
Mandy Carroll will review REDCap thoroughly will study staff to familiarize 
them with data collection instruments and have study staff run two mini-pilots 
(one with participants and one with each other) to practice using all data 
collection instruments. 
 
10.3.2 Quality Control Committee. The study director Sanjay Basu, quality control & 
lead diet assessor Sarah Farzinkhou, and study coordinator Mandy Carroll make 
up the quality control committee. Sarah will monitor the NDSR database and 
Mandy will monitor the REDCap data entry. Sanjay will serve as support in both 
of these projects. 
 
10.3.3 Metrics. The study statistician will review the full dataset for outliers, both in diet 
data generated by NDSR dietary recalls and in survey responses. The individual 
parameters to define outliers for each nutrient or food category will be determined 
upon analysis. 
 
10.3.4 Protocol Deviations. No protocol deviations are anticipated. The study 
coordinator is here to ensure compliance to trial protocol.  However, if study 
coordinator or study staff identifies any deviations in the protocol, they will notify 
the study director immediately. The study director and study coordinator will 
review and document any changes together. 
 
10.3.5 Monitoring. Study coordinator will regularly be monitoring participant flow and 
data entry through the REDCap database throughout the study. Before any 
participant is randomized and enrolled in the study, the study coordinator will use 
the REDCap instrument “ADMIN: Ready to be Randomized” to go through 
individual candidate files to ensure that the consent form was properly signed and 
dated, the screening survey was filled out, both dietary recalls have been 
completed, and the Month 0 and Main Surveys have been completed. 

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“ADMIN: Ready to be Randomized” REDCap instrument 
 
To monitor dietary recalls, the lead diet assessor will conduct a quality check after 
data collection at each data collection time point (Baseline/Month 0, Month 6, and 
Month 12). This includes an in-depth review of both individual and composite 
reports for completeness and errors. 
 
Finally, there will be weekly full team meetings to encourage regular 
communication, and allow for any issues around monitoring to be discussed. 
 
10.4 Data sharing. Only study director and study statistician will have access to final trial 
dataset. Per NIH rules, the de-identified data will be disclosable to third parties. 
Furthermore, anyone who desires access to full trial protocol, participant-level dataset, 
and/or statistical code will be able to access via National Heart, Lung, and Blood Institute 
repository after peer-reviewed publication. 

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11 
PARTICIPANT RIGHTS AND CONFIDENTIALITY 
 
11.1 Institutional Review Board (IRB) Review 
 
This IRB protocol [IRB approval letters: Appendix I & II] and the informed consent document 
[Appendix V] and any subsequent modifications will be reviewed and approved by the IRB or 
ethics committee responsible for oversight of the study. 
 
11.2 Informed Consent Forms 
Prior to attending orientation, candidates will fill out a pre-screening survey with a Waiver of 
Documentation sheet that gives a general overview of the study, and is something they must 
agree to in order to continue with the pre-screening questions [Appendix IV]. Candidates who 
attend orientation will be competent in the English language and able to complete the consent 
form independently.  There is a single informed consent form that describes both the screening 
and study procedures [Appendix V]. 
 
The study director, the study coordinator, and/or the study staff will review the major 
components of the consent, page by page, in the group orientation with the visual aid of a 
PowerPoint presentation. The candidate will then have time to individually review consent in 
detail, ask any questions to available staff members, and sign once they fully understand the 
components of the consent form. 
 
As candidates are leaving orientation, study staff will collect consent forms, answer any 
additional questions, and ensure the consent form was signed and dated correctly. 
Study staff will record all signed and dated consent forms in REDCap after orientation, and then 
organize alphabetically by last name in a secure folder locked in the study coordinator’s secure 
file cabinet. 
 
11.3 Participant Confidentiality 
As much as possible, any data, forms, survey responses, and other records that contain  
participant information, will be identified only by a participant identification number (CHIVES 
ID). Any data, forms, survey responses, and other records that must leave the study office will 
be identified only by a CHIVES ID to maintain confidentiality. All physical records with patient 
health information, along with all blank food vouchers will be kept in a locked file cabinet. All 
computer entry and networking programs (mostly NDSR and REDCap) will be done using 
CHIVES IDs / REDCap Record ID. Information will not be released without written permission 
of the participant, except as necessary for monitoring by Institutional Review Board or the 
National Institutes of Health. 
 
11.4 Study Discontinuation 
The study may be discontinued at any time by the Institutional Review Board, the National 
Institutes of Health, or other government agencies as part of their duties to ensure that research 
participants are protected. 

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12 ETHICAL CONSIDERATIONS 
All study candidates and participants will be treated equally and with utmost respect, in 
accordance with principles outlined in the Declaration of Helsinki. All participants will have the 
right to make informed decisions regarding their participation in the study. No minors or people 
who are not capable of giving informed consent will be recruited for the study. 

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13 COMMITTEES 
The committee overseeing the trial is the Data Safety Monitoring Board, which consists of Jason 
Block from Harvard University, Arjumand Siddiqi from University of North Carolina, and 
Kristina Lewis from Wake Forest University, all of whom are independent from the study 
sponsor and have no competing interests. The study director will update them immediately with 
any adverse events and quarterly, otherwise. More details are available in the Data Safety and 
Monitoring Protocol [Appendix XIX]. 
 
13.1 Study Contributors – Main Roles and Responsibilities 
None of the investigators, co-investigators, or study staff have any financial or other competing 
interests. 
 
Co-Principal Investigators 
Sanjay Basu, MD, PhD Stanford University 
Main role: Contact Principal Investigator 
Main responsibilities: 
- 
Aim 1: will oversee recruitment, retention and assessment for the trial; 
- 
Aim 2: will oversee model design, programming and validation for cost-effectiveness 
analysis. 
Hilary Seligman, MD, MAS University of California San Francisco 
Main role: Logistics Principal Investigator 
Main responsibilities: 
- 
Aim 1: oversee voucher distribution and retention of vendors for the trial; 
- 
Aim 2: inform modeling of impact of healthy eating on cardiovascular disease disparities 
for cost-effectiveness analysis 
 
Co-Investigators: 
Christopher Gardner, PhD Stanford University 
Main responsibility: 
- 
Aim 1: contribute staff, expertise, and supervision to ensure accurate and successful 
completion of dietary recalls and their analysis 
Matthew Harding, PhD University of California, Irvine 
Main responsibility: 
- 
Aim 1: will integrate economic and food environment data into the cost-effectiveness 
analysis for national projections 
Justin White, PhD University of California San Francisco 
Main responsibilities: 
- 
Aim 1: inform trial design and conduct; assist in recruitment, randomization, and retention 
strategy development and execution; 
- 
Aim 2: inform cost-effectiveness analysis components 

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13.2 Steering Committee 
 
The steering committee is made up of the co-principal investigators – Sanjay Basu, MD, PhD 
and Hilary Seligman, MD, MAS as well as the study coordinators – Mandy Carroll, MPH, RD 
and Melissa Akers, MPH, CPH. 
 
13.3 Data Management Team 
 
The data management team is made up of the co-principal investigators – Sanjay Basu, MD, PhD 
and Hilary Seligman, MD, MAS; the study coordinators – Mandy Carroll, MPH, RD and Melissa 
Akers, MPH, CPH; and the diet assessment team – Sarah Farzinkhou, MPH (lead diet assessor), 
Carrie McKinley, Lindsay Durand, RD, and Elizabeth Zanley, RD. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
14 PUBLICATION OF RESEARCH FINDINGS 
Publication of the results of this trial will be governed by the policies and procedures developed 
under the Co-Principal Investigator agreement submitted with the original R01 grant for this 
proposal (see National Institutes of Health Data Sharing Policy). Who is eligible for authorship 
in this trial is based on International Committee of Medical Journal Editors criteria. 
 
Study director and/or study coordinator will communicate trial results to participants by 
community meeting. Study director will communicate trial results to professionals and interest 
groups via peer-reviewed publication. Also, study director will post trial results on 
clinicaltrials.gov, per SPIRIT guidelines. 
 
Anyone who desires access to full trial protocol, participant-level dataset, and/or statistical code 
will be able to access via National Heart, Lung, and Blood Institute repository after peer- 
reviewed publication. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
15 APPENDICES 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
I. Stanford University Institutional Review 
Board Approval Letter 

STANFORD UNIVERSITY
Stanford, CA 94305 [Mail Code 5579]
 David D Oakes, M.D.
CHAIR, PANEL ON MEDICAL HUMAN SUBJECTS
(650) 723-5215
May 21, 2019
Date:
Christopher D Gardner, PhD, Medicine - Med/Stanford Prevention Research Center
To:
 David D Oakes, M.D., Administrative Panel on Human Subjects in Medical Research
From:
Mandy Murphy Carroll MA, Jennifer L. Robinson MA
eProtocol Title:
eProtocol #:
IRB
Designing Food Voucher Programs to Reduce Disparities in Healthy Diets
36763
6208)
The IRB approved human subjects involvement in your research project on 05/21/2019.  'Prior to subject
recruitment and enrollment, if this is:  a Cancer-related study, you must obtain Cancer Center Scientific
Review Committee (SRC) approval; a CTRU study, you must obtain CTRU approval; a VA study, you must obtain
VA R and D Committee approval; and if a contract is involved, it must be signed.'
 David D Oakes, M.D., Chair
05/21/2019 - 02/28/2020
Approval Period:
EXPEDITED - MODIFICATION
Review Type:
NIH / NHLBI - Grant: 1R01 HL132814-01, SPO: 121890
Funding:
FWA00000935 (SU)
Assurance #:
Includes: Personnel changes. Sanjay Basu, MD, PhD has left Stanford and Christopher Gardner, PhD has assumed
PI role on the project. NIH approved this change in PI.
The expiration date of this approval is 02/28/2020 at Midnight.  If this research is to continue beyond that date,  it is
your responsibility to submit a Continuing Review application in eProtocol. Research activities must be reviewed and
re-approved on or before midnight of the expiration date. The approval period may be less than one year if so
determined by the IRB. Proposed changes to approved research must be reviewed and approved prospectively by
the IRB.  No changes may be initiated without prior approval by the IRB, except where necessary to eliminate
apparent immediate hazards to subjects.  (Any such exceptions must be reported to the IRB within 10 working
days.)  Unanticipated problems involving risks to participants or others and other events or information, as defined
and listed in the Report Form, must be submitted promptly to the IRB.  (See Events and Information that Require
Prompt Reporting to the IRB at http://humansubjects.stanford.edu.) Upon completion, you must report to the IRB
within 30 days.
Please remember that all data, including all signed consent form documents, must be retained for a minimum of
three years past the completion of this research.  Additional requirements may be imposed by your funding agency,
your department, HIPAA, or other entities.  (See Policy 1.9 on Retention of and Access to Research Data at
http://doresearch.stanford.edu/policies/research-policy-handbook)
This institution is in compliance with requirements for protection of human subjects, including 45 CFR 46, 21 CFR 50
and 56, and 38 CFR 16.
Certification of Human Subjects Approvals
7
Expedited Under Category:
Waiver of Individual Authorization for recruitment under 45 CFR 164.512(i)(2)(ii)(A),(B),(C), pursuant to information
provided in the HIPAA section of the protocol application.
Alteration of HIPAA Authorization under 45 CFR 164.512(i)(2)(ii), pursuant to information provided in the HIPAA
section of the protocol application.
(Registration #:
8

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
II. University of California San Francisco 
Institutional Review Board Approval Letter 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

 
 
 
 
 
 
 
 
Human Research Protection Program 
Institutional Review Board (IRB) 
 
Expedited Review Approval 
 
 
Principal Investigator 
Hilary K Seligman M.D., 
 
 
Type of Submission:  Submission Correction for Continuing Review Submission Form 
Study Title: 
 
Coupons for Healthy Intake using Varied Economic Strategies (Designing 
Food Voucher Programs to Reduce Disparities in Healthy Diets) 
 
 
 
IRB #: 
 
15-17957 
Reference #: 
 
245983 
Committee of Record: San Francisco General Hospital Panel 
Study Risk Assignment: Minimal 
 
Approval Date: 03/18/2019 
Expiration Date: 03/17/2020 
 
This submission was eligible for expedited review as: 
Category 7: Research on individual or group characteristics or behavior (including, but not limited to, 
research on perception, cognition, motivation, identity, language, communication, cultural beliefs or 
practices, and social behavior) or research employing survey, interview, oral history, focus group, 
program evaluation, human factors evaluation, or quality assurance methodologies. 
Data analysis phase: 
This study is in data analysis and involves no greater than minimal risk for the population being 
studied. 
 
IRB Comments:  
All changes to a study must receive UCSF IRB approval before they are implemented. Follow the 
modification request instructions. The only exception to the requirement for prior UCSF IRB review 
and approval is when the changes are necessary to eliminate apparent immediate hazards to the subject 
(45 CFR 46.103.b.4, 21 CFR 56.108.a). In such cases, report the actions taken by following these 
instructions.   
 
Expiration Notice: The iRIS system will generate an email notification eight weeks prior to the 
expiration of this study’s approval.  However, it is your responsibility to ensure that an application for 
continuing review approval has been submitted by the required time. In addition, you are required to 
submit a study closeout report at the completion of the project. 

Documents Reviewed and Approved with this Submission (includes all versions – final approved 
versions are labeled ‘Approved’ in the Outcome column): 
 
Other Study Documents 
 
Study Document 
Title 
Version # 
Version Date 
Outcome 
Vendor 
Version 1.0 
03/30/2016 
Approved 
Consent Form 
Version 1.0 
03/30/2016 
Approved 
Stanford IRB Approval Version 1.0 
03/15/2016 
Approved 
Protection of Human 
Subjects Section of NIH 
Grant 
Version 1.0 
03/07/2016 
Approved 
Participant 
questionnaire 
Version 1.0 
03/07/2016 
Approved 
Vendor questionnaire 
Version 1.0 
03/07/2016 
Approved 
Study flyer 
Version 1.0 
03/07/2016 
Approved 
 
 
For a list of all currently approved documents, follow these steps: Go to My Studies and open the study – Click 
on Informed Consent to obtain a list of approved consent documents and Other Study Documents for a list of 
other approved documents. 
 
San Francisco Veterans Affairs Medical Center (SFVAMC): If the SFVAMC is engaged in this research, you 
must secure approval of the VA Research & Development Committee in addition to UCSF IRB approval and 
follow all applicable VA and other federal requirements. The UCSF IRB website has more information. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
III. Recruitment Flyers & 
Recruitment Appointment Card 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

 
 
 
 
 
 
- - - - - - - - - - - - - - - - - - - - 
CHIVES Food Voucher Project 
visit:  is.gd/chivesproject 
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CHIVES Food Voucher Project 
visit:  is.gd/chivesproject 
- - - - - - - - - - - - - - - - - - - - 
CHIVES Food Voucher Project 
visit:  is.gd/chivesproject 
- - - - - - - - - - - - - - - - - - - - 
CHIVES Food Voucher Project 
visit:  is.gd/chivesproject 
- - - - - - - - - - - - - - - - - - - - 
CHIVES Food Voucher Project 
visit:  is.gd/chivesproject 
- - - - - - - - - - - - - - - - - - - - 
CHIVES Food Voucher Project 
visit:  is.gd/chivesproject 
- - - - - - - - - - - - - - - - - - - - 
CHIVES Food Voucher Project 
visit:  is.gd/chivesproject 
- - - - - - - - - - - - - - - - - - - - 
CHIVES Food Voucher Project 
visit:  is.gd/chivesproject 
- - - - - - - - - - - - - - - - - - - - 
CHIVES Food Voucher Project 
visit:  is.gd/chivesproject 
- - - - - - - - - - - - - - - - - - - - 
CHIVES Food Voucher Project 
visit:  is.gd/chivesproject 
DO YOU HAVE A HARD TIME 
AFFORDING HEALTHY FOODS? 
CHIVES Project can help! 
If you are interested: 
- You will receive $20 worth of vouchers to 
purchase foods each month for 6 months. 
- You will be asked to complete phone 
surveys about the foods you eat. 
- Visit the website to see if you qualify: 
is.gd/chivesproject 
Your participation is voluntary. 
Participant's rights questions, 
contact 1-866-680-2906. 
Enrolling CHIVES participants through July 2017. 
FOR MORE INFORMATION: 

 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
Appointment Card CHIVES Project Orientation 
To receive food vouchers, you will need to 
attend the following orientation session. 
My orientation is: 
□M □Tu □W □Th □F 
  
at 
am/pm 
1485 Bayshore Blvd., SF 
Conference Room 230* 
* to the left of 
reception desk 
Appointment Card CHIVES Project Orientation 
To receive food vouchers, you will need to 
attend the following orientation session. 
My orientation is: 
□M □Tu □W □Th □F 
  
at 
am/pm 
1485 Bayshore Blvd., SF 
Conference Room 230* 
* to the left of 
reception desk 
Appointment Card CHIVES Project Orientation 
To receive food vouchers, you will need to 
attend the following orientation session. 
My orientation is: 
□M □Tu □W □Th □F 
  
at 
am/pm 
1485 Bayshore Blvd., SF 
Conference Room 230* 
* to the left of 
reception desk 
Appointment Card CHIVES Project Orientation 
To receive food vouchers, you will need to 
attend the following orientation session. 
My orientation is: 
□M □Tu □W □Th □F 
  
at 
am/pm 
1485 Bayshore Blvd., SF 
Conference Room 230* 
* to the left of 
reception desk 
Appointment Card CHIVES Project Orientation 
To receive food vouchers, you will need to 
attend the following orientation session. 
My orientation is: 
□M □Tu □W □Th □F 
  
at 
am/pm 
1485 Bayshore Blvd., SF 
Conference Room 230* 
* to the left of 
reception desk 
Appointment Card CHIVES Project Orientation 
To receive food vouchers, you will need to 
attend the following orientation session. 
My orientation is: 
□M □Tu □W □Th □F 
  
at 
am/pm 
1485 Bayshore Blvd., SF 
Conference Room 230* 
* to the left of 
reception desk 
Appointment Card CHIVES Project Orientation 
To receive food vouchers, you will need to 
attend the following orientation session. 
My orientation is: 
□M □Tu □W □Th □F 
  
at 
am/pm 
1485 Bayshore Blvd., SF 
Conference Room 230* 
* to the left of 
reception desk 
Appointment Card CHIVES Project Orientation 
To receive food vouchers, you will need to 
attend the following orientation session. 
My orientation is: 
□M □Tu □W □Th □F 
  
at 
am/pm 
1485 Bayshore Blvd., SF 
Conference Room 230* 
* to the left of 
reception desk 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IV. Waiver of Documentation & Pre-Screening 
Survey 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

12/21/2016 1:59pm 
www.projectredcap.org 
 
Contidential 
More information about the CHIVES Project 
 
Page 1 ot 9 
 
 
 
 
DESCRIPTION: 
You are invited to participate in a research study on how food vouchers affect people's nutrition. First, you will be 
asked to attend an orientation to give you more information about the research study. If you choose to participate 
and if you are eligible, you will be asked to use food vouchers at local stores to purchase some of your groceries. 
You will also be asked to participate in approximately 12 phone calls over the course of the next year to provide 
information on what you eat and other information about your food preferences and habits. 
 
TIME INVOLVEMENT: 
Your participation will take approximately 10 hours over the next year. 
 
RISKS AND BENEFITS: 
There are no anticipated major risks for you participating in this study, except for the inconvenience of having to use 
your food vouchers while buying groceries, and possible discomfort talking about some personal information over the 
phone. The benefits for participating in this study are receiving an additional $20 monthly to spend on groceries, 
which may positively influence your eating behaviors. 
 
PAYMENTS: 
In addition to the $20 food vouchers you will receive the first six months, you will also receive one $20 gift certificate 
for completing the final 4 phone calls after participating in the study 6 months, and an additional $20 gift certificate 
for completing the final 4 phone calls at 12 months. 
 
SUBJECT'S RIGHTS: 
If you have read this form and have decided to participate in this project, please understand your participation is 
voluntary and you have the right to withdraw your consent or discontinue participation at any time without penalty or 
loss of benefits to which you are otherwise entitled.  The alternative is not to participate. 
 
CONTACT INFORMATION: 
If you have any questions, concerns, or complaints about this research, its procedures, risks and benefits, contact the 
Protocol Director, Sanjay Basu at (844) 4-CHIVES, or (844) 424-4837. If you want to talk to someone separate from 
the research team about a concern or complaint or your rights as a possible research subject, feel free to contact the 
Stanford Institutional Review Board (IRB) at (650) 723-5234 or toll free at (866) 680-2906. 
 
If you agree to participate in this research, please click to box below that states you agree to share your contact 
information, and sign up for an orientation session in a following screen. 
 
After reading the above information, do you agree to 
Yes 
provide your contact information, and sign up for an 
No 
orientation? 
 
Sorry to hear that. We will miss working with you. 
Thanks for checking out the CHIVES Project! 

12/21/2016 1:59pm 
www.projectredcap.org 
 
Contidential 
 
 
Page 2 ot 9 
 
 
 
Thank you for your interest in the CHIVES Project! 
 
Please answer the next few questions to see if you are likely to be eligible to participate in the 
CHIVES Project. 
 
Are you 21 years or older? 
Yes 
No 
 
Do you have regular access to a cell phone? 
Yes 
No 
 
Are you able to send & receive text messages with 
Yes 
your cell phone? 
No 
 
Are you a resident of San Francisco? 
Yes 
No 
 
Are you planning to move out of San Francisco in the 
Yes 
next year? 
No 
 
Are you currently participating in any nutrition 
Yes 
study or trial? 
No 
 
Are you currently participating in the EatSF voucher 
Yes 
program? 
No 
(Answer "yes" only if you have received an EatSF 
voucher in the past 4 weeks.) 
 
Are you currently pregnant? 
Yes 
No 
 
Are you currently breastfeeding? 
Yes 
No 
 
Do you currently have cancer? 
Yes 
No 
 
Do you currently have heart failure or congestive 
Yes 
heart failure? 
No 
 
How did you hear about the CHIVES Project? 
Community event 
Craigslist ad 
Facebook 
Flyer 
My church 
My health clinic 
My local grocery store 
Word of mouth 
Other 
 
Please let us know which community event. 
                                   
 
Please let us know where you saw the flyer. 
                                   
 
Please let us know at which church you heard about 
                                  
the CHIVES Project. 

12/21/2016 1:59pm 
www.projectredcap.org 
 
Contidential 
 
 
Page 3 ot 9 
 
Please let us know which health clinic. 
Arthur H. Coleman Medical Center, Bayview Hunters 
Point Clinic 
Silver Avenue Family Health Center 
Southeast Health Center 
Other Health Clinic 
 
At which health clinic did you hear about the CHIVES 
                                  
Project? 
 
Please let us know in which grocery store you heard 
Duc Loi's Pantry 
about the CHIVES Project. 
Foods Co (on Folsom) 
Foods Co (on Williams) 
Friendly's  Market 
Heart of the City Farmer's Market 
Lee's Market 
Palou Market 
Safeway 
Super Save 
Other Grocery Store 
 
At which grocery store did you hear about the CHIVES 
                                  
Project? 
 
Please let us know how you found out about the CHIVES 
                                  
Project. 

12/21/2016 1:59pm 
www.projectredcap.org 
 
Contidential 
 
 
Page 4 ot 9 
 
 
 
Great! 
 
It looks like you are likely able to participate in the CHIVES Project.* 
 
Please fill out you contact information below, and which date works best for you to attend an 
orientation session on the CHIVES Project. 
 
*Please note: One reason you may not qualify is if your annual income is too high. The study 
will be limited to people with an income of less than 250% of the federal poverty level. For 1 
person, this means an annual income of 
 
First Name 
                                   
 
Last Name 
                                   
 
Preferred Name / Nickname 
                                   
 
E-mail Address 
                                   
 
Cell Phone 
                                   
 
Are you able to send & receive text messages with 
Yes 
this cell phone? 
No 
Additional Phone Number 
                                  
What is this additional phone number? 
 
Home phone number 
Work phone number 
Different cell phone 
Other phone 
 
Please provide us with a secure mailing address. If you wish to participate, and you are eligible, we will send the food 
vouchers to this address. 
 
Please note: This cannot be a P.O. Box. 
 
Street Address 
                                   
 
Apartment number 
                                   
 
City 
                                   
 
State 
CA 
 
Zip Code 
                                   

12/21/2016 1:59pm 
www.projectredcap.org 
 
Contidential 
 
 
Page 5 ot 9 
 
 
 
Orientation Sessions 
 
WHERE: 1485 Bayshore Blvd., San Francisco 94124 
in Conference Room 230 (to the left of the reception desk). 
 
WHAT: You will learn more about CHIVES Project, sign a consent form, and take a paper 
survey that will assess your annual income and gather a little more personal information. 
 
HOW LONG: The orientation sessions last about 60 minutes. 
Please select which date & time work best for you. 

Contidential 
 
 
Page 6 ot 9 
 
Which orientation works best for you to attend? 
Tuesday, 1/10/2017 at 11am 
Tuesday, 1/10/2017 at 2pm 
Tuesday, 1/10/2017 at 5:30pm 
Wednesday, 1/11/2017 at 11am 
Wednesday, 1/11/2017 at 2pm 
Wednesday, 1/11/2017 at 5:30pm 
Thursday, 1/12/2017 at 11am 
Thursday, 1/12/2017 at 2pm 
Thursday, 1/12/2017 at 5:30pm 
Friday, 1/13/2017 at 11am 
Friday, 1/13/2017 at 2pm 
Tuesday, 1/17/2017 at 11am 
Tuesday, 1/17/2017 at 2pm 
Tuesday, 1/17/2017 at 5:30pm 
Wednesday, 1/18/2017 at 11am 
Wednesday, 1/18/2017 at 2pm 
Wednesday, 1/18/2017 at 5:30pm 
Thursday, 1/19/2017 at 11am 
Thursday, 1/19/2017 at 2pm 
Thursday, 1/19/2017 at 5:30pm 
Friday, 1/20/2017 at 11am 
Friday, 1/20/2017 at 2pm 
Friday, 1/20/2017 at 5:30pm 
Thursday, 2/9/2017 at 11am 
Thursday, 2/9/2017 at 2pm 
Thursday, 2/9/2017 at 5:30pm 
Friday, 2/10/2017 at 11am 
Friday, 2/10/2017 at 2pm 
Friday, 2/10/2017 at 5:30pm 
Monday, 2/13/2017 at 11am 
Monday, 2/13/2017 at 2pm 
Monday, 2/13/2017 at 5:30pm 
Tuesday, 2/14/2017 at 11am 
Tuesday, 2/14/2017 at 2pm 
Tuesday, 2/14/2017 at 5:30pm 
Wednesday, 2/15/2017 at 11am 
Wednesday, 2/15/2017 at 2pm 
Wednesday, 2/15/2017 at 5:30pm 
Thursday, 2/16/2017 at 11am 
Thursday, 2/16/2017 at 2pm 
Thursday, 2/16/2017 at 5:30pm 
Friday, 2/17/2017 at 11am 
Friday, 2/17/2017 at 2pm 
Friday, 2/17/2017 at 5:30pm 
Tuesday, 2/21/2017 at 11am 
Tuesday, 2/21/2017 at 2pm 
Tuesday, 2/21/2017 at 5:30pm 
Thursday, 3/9/2017 at 11am 
Thursday, 3/9/2017 at 2pm 
Thursday, 3/9/2017 at 5:30pm 
Friday, 3/10/2017 at 11am 
Friday, 3/10/2017 at 2pm 
Friday, 3/10/2017 at 5:30pm 
Monday, 3/13/2017 at 11am 
Monday, 3/13/2017 at 2pm 
Monday, 3/13/2017 at 5:30pm 
Tuesday, 3/14/2017 at 11am 
Tuesday, 3/14/2017 at 2pm 
Tuesday, 3/14/2017 at 5:30pm 
Wednesday, 3/15/2017 at 11am 
Wednesday, 3/15/2017 at 2pm 
Wednesday, 3/15/2017 at 5:30pm 
Thursday, 3/16/2017 at 11am 
Thursday, 3/16/2017 at 2pm 
Thursday, 3/16/2017 at 5:30pm 
Friday, 3/17/2017 at 11am 
Friday, 3/17/2017 at 2pm 
Friday, 3/17/2017 at 5:30pm 
Tuesday, 3/21/2017 at 11am 
12/21/2016 1:59pm 
Tuesday, 3w/w2w1./p2r0oj1ec7traedtc2app.m
org 

Tuesday, 3/21/2017 at 5:30pm 
Other 
(Please write down for which orientation date & 
time you signed up.  You will receive a text 
message reminder one day before the orientation.) 
 
This is the Bayshore Business Center, or the Comcast Building, where the orientation will be held. This is next door 
to the U-Haul facilities on Bayshore Blvd. 
 
 

12/21/2016 1:59pm 
www.projectredcap.org 
 
Contidential 
 
 
Page 8 ot 9 
 
 
 
Family & Friends 
 
Finally, do you have any friends or family members 
Yes 
who do NOT live with you that would be interested in 
No 
participating in the CHIVES Project? 
 
Please pass along our contact information and invite them to participate! 

12/21/2016 1:59pm 
www.projectredcap.org 
 
Contidential 
 
 
Page 9 ot 9 
 
 
 
Not eligible at this time! 
 
I'm sorry, it looks like you are not eligible to participate in the CHIVES Project at this time. 
 
Please call us at (844) 4-CHIVES or (844) 424-4837, or e-mail us at chivesproject@stanford.edu with questions. 
Thank you! 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
V. Participant Consent Form 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

 
STANFORD UNIVERSITY   Research Consent Form 
Protocol Director: 
Sanjay Basu 
Protocol Title:  Designing Food Voucher Programs to Reduce Disparities in Healthy Diets 
 
 
1 of 6 
IRB Use Only 
Approval Date: April 6, 2017 
Expiration Date: February 28, 2018 
 
FOR QUESTIONS ABOUT THE STUDY, CONTACT: Sanjay Basu at (844) 4-CHIVES or  
(844) 424-4837. 
DESCRIPTION: You are invited to participate in a research study on whether vouchers for 
food help to improve your nutrition. You will be asked to: 
• Receive vouchers via mail every month, for six months. You will be randomly 
assigned to receive a particular type of voucher; randomly means like flipping a coin or 
like rolling a dice. Each month, you will either receive four vouchers. The vouchers will 
either last for one week, or for a month. Your vouchers will either allow you to buy 
fruits and vegetables, or to buy any CalFresh approved foods (any food or beverage, 
except hot or prepared foods, vitamins or supplements, or alcohol).   
• Use the vouchers as permitted, to help you purchase food at stores that accept the 
vouchers. 
• Complete three surveys about your nutrition. A research study staff member will 
call you to tell us about how easy or hard it was to use the voucher, how much you enjoy 
and are able to eat fruits and vegetables, and how hard it is to find money to pay for 
food. Each survey takes about 20 minutes to finish, and will be completed once when 
you enter the study, a second time in 6 months, and a third and final time 1 
year from now. Therefore, it will take about an hour of your time over the course of the 
next year to complete these surveys. 
• Tell us what you eat. A research study staff member will call you to give us a list of 
everything you ate the day before the telephone call. This is called a “food recall”, and 
takes about 30 minutes to finish. It will be conducted four times when you enter 
the study, another four times 6 months from now, and another four times 1 
year from now. Therefore, it will take about six hours of your time over the course of 
the next year to complete these food recalls. 
 
A description of this clinical trial will be available on http://www.ClinicalTrials.gov, as 
required by U.S. Law.  This Web site will not include information that can identify you.  At 
most, the Web site will include a summary of the results.  You can search this Web site at 
any time. 
 
RISKS AND BENEFITS:  
The risks associated with this study are: 
• The inconvenience of remembering to use the vouchers when you shop for food. 
• The time and inconvenience of answering surveys and describing everything that you ate. 
• The psychological discomfort of talking about whether it was difficult for you to obtain 
nutritious food or enough food. 
The benefits which may reasonably be expected to result from this study are: 

 
STANFORD UNIVERSITY   Research Consent Form 
Protocol Director: 
Sanjay Basu 
Protocol Title:  Designing Food Voucher Programs to Reduce Disparities in Healthy Diets 
 
 
2 of 6 
IRB Use Only 
Approval Date: April 6, 2017 
Expiration Date: February 28, 2018 
• You may experience benefits to your nutrition by being able to purchase more food and 
healthier foods. 
• You may experience less difficulty affording foods because of the vouchers. 
We cannot and do not guarantee or promise that you will receive any benefits from this study.   
TIME INVOLVEMENT: Your participation in this experiment will take approximately 10 hours 
of your time over the next year. 
FINANCIAL CONSIDERATIONS 
 
PAYMENTS: You will receive $20 in the form of $5 food vouchers each month for six months. 
In addition, after you complete the survey and food recall 6 months from your enrollment, you 
will receive one $20 gift card. After you complete the survey and food recall 1 year from your 
enrollment, you will receive another $20 gift card.  
COSTS: You will need to receive and send about 10 text messages as a part of this study over 
the next year.  Your message rates may apply. In other words, when you use receive and 
send text message services with CHIVES Project, the cost to you is whatever your wireless 
provider charges you to send and receive text messages. If you have an unlimited text 
messaging plan, then you don't have to worry, as this will not apply to you. 
    
PARTICIPANT’S RIGHTS 
 
If you have read this form and have decided to participate in this project, please understand 
your participation is voluntary and you have the right to withdraw your consent or discontinue 
participation at any time without penalty or loss of benefits to which you are otherwise 
entitled.  
 
The results of this research study may be presented at scientific or professional meetings or 
published in scientific journals.  However, your identity will not be disclosed. 
 
You have the right to refuse to answer particular questions.  

 
STANFORD UNIVERSITY   Research Consent Form 
Protocol Director: 
Sanjay Basu 
Protocol Title:  Designing Food Voucher Programs to Reduce Disparities in Healthy Diets 
 
 
3 of 6 
IRB Use Only 
Approval Date: April 6, 2017 
Expiration Date: February 28, 2018 
Authorization To Use Your Health Information For 
Research Purposes  
Because information about you and your health is personal and private, it 
generally cannot be used in this research study without your written authorization.  
If you sign this form, it will provide that authorization.  The form is intended to 
inform you about how your health information will be used or disclosed in the 
study.  Your information will only be used in accordance with this authorization 
form and the informed consent form and as required or allowed by law.  Please 
read it carefully before signing it.   
 
What is the purpose of this research study and how will my health 
information be utilized in the study? 
The purpose of this study is to determine what type of voucher to help people 
purchase food is most likely to improve nutrition.  To answer this question, 
information about what you eat will be collected, and statistics about how everyone 
in the study eats will be published in a scientific journal. Information in some form 
will be submitted to the National Institutes of Health, which is sponsoring the study. 
 
Do I have to sign this authorization form? 
You do not have to sign this authorization form.  But if you do not, you will not be 
able to participate in this research study, including receiving any research-related 
vouchers to help purchase food.   
Signing the form is not a condition for receiving any medical care outside the 
study. 
 
If I sign, can I revoke it or withdraw from the research later? 
If you decide to participate, you are free to withdraw your authorization regarding 
the use and disclosure of your health information (and to discontinue any other 
participation in the study) at any time.  After any revocation, your health 
information will no longer be used or disclosed in the study, except to the extent 
that the law allows us to continue using your information (e.g., necessary to 
maintain integrity of research).  If you wish to revoke your authorization for the 
research use or disclosure of your health information in this study, you must write 
to: Sanjay Basu, Medical School Office Building X322, 1265 Welch Road, Stanford 
CA 94305-5411 
 
 
 

 
STANFORD UNIVERSITY   Research Consent Form 
Protocol Director: 
Sanjay Basu 
Protocol Title:  Designing Food Voucher Programs to Reduce Disparities in Healthy Diets 
 
 
4 of 6 
IRB Use Only 
Approval Date: April 6, 2017 
Expiration Date: February 28, 2018 
What Personal Information Will Be Obtained, Used or Disclosed? 
Your health information related to this study, may be used or disclosed in 
connection with this research study, including, but not limited to, your name; your 
telephone number; your stress address, city, county and zip code; your electronic 
mail addresses; your height; your weight; whether you currently have cancer; and 
whether you currently have congestive heart failure.  
 
Who May Use or Disclose the Information? 
The following parties are authorized to use and/or disclose your health information 
in connection with this research study: 
• The Protocol Director Sanjay Basu 
• The Stanford University Administrative Panel on Human Subjects in Medical 
Research and any other unit of Stanford University as necessary 
• Research Staff 
 
Who May Receive or Use the Information? 
The parties listed in the preceding paragraph may disclose your health information 
to the following persons and organizations for their use in connection with this 
research study:  
 
• The Office for Human Research Protections in the U.S. Department of Health 
and Human Services 
• The National Institutes of Health 
•  The Food and Drug Administration 
 
Your information may be re-disclosed by the recipients described above, if they 
are not required by law to protect the privacy of the information. 
 
When will my authorization expire? 
Your authorization for the use and/or disclosure of your health information will end 
on February 28, 2030 or when the research project ends, whichever is earlier.  
 
 
________________________________             
______________ 
Signature of Adult Participant                                           Date 
 

 
STANFORD UNIVERSITY   Research Consent Form 
Protocol Director: 
Sanjay Basu 
Protocol Title:  Designing Food Voucher Programs to Reduce Disparities in Healthy Diets 
 
 
5 of 6 
IRB Use Only 
Approval Date: April 6, 2017 
Expiration Date: February 28, 2018 
WITHDRAWAL FROM STUDY 
The Protocol Director may also withdraw you from the study and stop you from receiving the 
research-related vouchers, without your consent for one or more of the following reasons:   
o Failure to follow the instructions of the Protocol Director and study staff. 
o The Protocol Director decides that continuing your participation could be 
harmful to you. 
o You need treatment not allowed in the study. 
o The study is cancelled.  
o Other administrative reasons. 
o Unanticipated circumstances. 
 
CONTACT INFORMATION:  
Questions, Concerns, or Complaints: If you have any questions, concerns or complaints about 
this research study, its procedures, risks and benefits, or alternative courses of treatment, you 
should ask the Protocol Director, Sanjay Basu. You may contact him now or later at           
(844) 4-CHIVES, or (844) 424-4837. 
 
Independent Contact: If you are not satisfied with how this study is being conducted, or if you 
have any concerns, complaints, or general questions about the research or your rights as a 
participant, please contact the Stanford Institutional Review Board (IRB) to speak to someone 
independent of the research team at (650)-723-5244 or toll free at (866) 680-2906.  You can 
also write to the Stanford IRB, Stanford University, 3000 El Camino Real, Five Palo Alto 
Square, 4th Floor, Palo Alto, CA 94306. 
The extra copy of this signed and dated consent form is for you to keep. 
________________________________  
 
 
________________ 
Signature of Adult Participant  
 
 
 
 
 
Date 
 
 
 
________________________________  
 
 
________________ 
Signature of Person Obtaining Consent  
               
   
Date 
 
 
 
 
_____________________________________           ____________       
Signature of Person Obtaining Consent  
  Date 
 
 
_____________________________________             
 
Print Name of Person Obtaining Consent 
 

 
STANFORD UNIVERSITY   Research Consent Form 
Protocol Director: 
Sanjay Basu 
Protocol Title:  Designing Food Voucher Programs to Reduce Disparities in Healthy Diets 
 
 
6 of 6 
IRB Use Only 
Approval Date: April 6, 2017 
Expiration Date: February 28, 2018 
The following witness line is to be signed only if the consent is provided as a summary form and accompanied by 
a short form foreign language consent.  
 
 
 
_____________________________________          ____________ 
Signature of Witness                              Date 
 
 
_____________________________________             
 
Print Name of Witness 
 
(e.g., staff, translator/interpreter, family member, or other person who speaks both English and the participant's 
language) 
 
•  Translated short form must be signed and dated by both the participant (or their LAR) AND the witness. 
•  The English consent form ("summary form"): 
  Must be signed by the witness AND the Person Obtaining Consent (POC). 
  The non-English speaking participant/LAR does not sign the English consent. 
  The non-English speaking participant/LAR should not sign the HIPAA participant line 
  if the participant or the LAR is non-English speaking, the Person Obtaining Consent (POC) must ensure that 1) 
the LAR's Description of Authority is completed and 2) that any questions or options presented by the consent 
form are documented and initialed by the POC on the Summary Form, per the participant's wishes, as they are 
understood during the consent process. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
VI. Self-Administered Screening Surveys 
(English & Spanish) – for orientation 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

CHIVES Screening Survey 
NAME:   
Do you prefer a Spanish form?  If so, please tell a study staff member now that you would 
like a Spanish version of this form. 
 
The purpose of this screening survey is to see if you meet the criteria for taking part in our 
research study of how food vouchers affect how many vegetables, fruits, and other foods 
you eat.  This survey will take approximately 10 minutes. You may choose not to answer 
these questions.  You also may choose to stop participating in this survey at any time; if  
you want to stop, please do so and notify the study staff present at the orientation session. 
 
The answers and information that you provide during this survey will be kept as confidential 
as possible as required by law.  It is possible that the Food and Drug Administration, and 
other federal and state authorities, may inspect this record. 
 
You can choose if you want or do not want to take part in this research screening 
procedure – it is up to you.  If you choose not to answer the questions or stop answering 
them at any time, there will be no penalty, and you will not lose any benefits to which you 
otherwise would be entitled. 
 
The risk to taking part in this survey is very small.  The screening survey is not designed to 
ask you for sensitive personal information, but it is possible that some people may feel 
uncomfortable answering these questions.  If that is the case, please stop and inform the 
study staff that you wish to stop. If you qualify to take part in the study and are interested 
in taking part, then study staff with keep your name and information; this will be kept 
confidential, but there is a small risk that people outside of the study staff could learn this 
information.  If you are not interested in the study, then study staff with destroy all the 
answers and personal information you’ve provided. 
 
The benefit to you of taking part in this survey is that you will find out whether you can 
take part in the study of how food vouchers affect how many vegetables, fruits, and other 
foods you eat.  This study involves receiving vouchers to help you purchase food over the 
next six months, and looks at how different kinds of food vouchers affect people’s nutrition 
intake. 
 
If you do not want to answer these questions, you have other choices.  You can talk to 
your doctor about nutrition.  You may also want do nothing. 
 
You will not be paid for answering questions in this survey since it is only to see whether 
you qualify to take part in the study. 
 
If you have any questions, concerns, or complaints about this interview, contact CHIVES 
study staff at 844-4CHIVES (844-424-4837).  If you want to talk to someone separate from 
the study staff about a concern, complaint, or your rights as a possible research subject, 
please contact the Stanford Institutional Review Board (IRB) to speak to an informed 
person who is separate from the study staff at 650-723-5244, or toll-free at 866-680-2906. 
Also, please call the Stanford IRB at these numbers if you cannot reach the study staff. 
 
 
 
1 of 6 
** PLEASE CONTINUE TO NEXT PAGE. ** 

NAME: ____________________ 
CHIVES Screening Survey 
 
 
Survey Questions 
Please fill out the following questions to determine whether you are eligible to 
participate in the study. You may leave any questions blank that you prefer not to state, 
but it may exclude you from the study. 
 
Full Name: 
  
 
Preferred Name: 
  
 
Mailing Address: 
  
 
 
 
 
E-mail Address: 
  
(not required) 
 
 
1. What is your age in years? 
 
  
years 
 
 
2. What is your gender? 
 
  
Male 
 
  
Female 
 
  
Other 
 
 
3. What is the highest grade or year of school you completed? 
 
  
Never attended school or only attended kindergarten 
 
  
Grades 1 through 8 (Elementary or Middle school) 
 
  
Grades 9 through 11 (Some high school) 
 
  
Grade 12 or GED (High school graduate) 
 
  
College 1 year to 3 years (Some college or technical school) 
 
  
College 4 years or more (College graduate) 
 
  
Other, please define:   
 
 
** PLEASE CONTINUE TO NEXT PAGE. ** 
2 of 6 

3 of 6 
 
CHIVES Screening Survey 
NAME:   
 
4. What race(s) do you consider yourself? (Check all that apply). 
 
  
American Indian / Alaskan Native 
 
  
Asian 
 
  
Black / African American 
 
  
Native Hawaiian / Pacific Islander 
 
  
White 
 
  
Don’t Know / Unknown 
 
  
Other, please define:   
 
 
5. Do you consider yourself Hispanic or Latino? 
 
  
Yes 
 
  
No 
 
 
 
6. What is your best estimate of your household’s monthly income before taxes, 
last year (2016)? 
 
$ 
(monthly income in 2016) 
 
 
 
7. How many people, including you, lived in your household in 2016? 
A household includes all people (adults and children) who live with you most of 
the year and are related to you by birth, marriage, or adoption. 
 
  
people 
 
 
 
 
 
 
 
** PLEASE CONTINUE TO NEXT PAGE. ** 

4 of 6 
 
CHIVES Screening Survey 
NAME:   
 
8. Are you willing to be randomly assigned (like flipping a coin) to receive a food 
voucher that could be valid for a week, or for a whole month? 
 
  
Yes 
 
  
No 
 
 
9. Are you willing to be randomly assigned (like flipping a coin) to receive food 
vouchers that could be valid for only fruits and vegetables, or food vouchers that 
could be valid for any type of food, excluding alcoholic beverages, vitamins, hot 
food, or food eaten in the store? 
 
  
Yes 
 
  
No 
 
 
10. Are you currently participating in the CalFresh program, also known as EBT, 
SNAP, or Food Stamps? 
 
  
Yes 
 
  
No 
 
 
11. Is someone in your household, other than you, currently participating in the 
CalFresh program, also known as EBT, SNAP, or Food Stamps? 
 
  
Yes 
 
  
No 
 
  
Don’t know 
 
 
 
 
 
 
 
 
 
 
** PLEASE CONTINUE TO NEXT PAGE. ** 

5 of 6 
 
CHIVES Screening Survey 
NAME:   
 
12. Do you have a reliable address where you can receive mail safely? 
 
  
Yes 
 
  
No 
 
 
13. Are you interested in participating in this study, and would you like to be 
contacted for next steps? 
 
  
Yes 
 
  
No 
 
 
If you marked “No” to Question 13 above, please inform a study staff member now 
that you would like this survey to be destroyed. 
 
If you marked “Yes” to Question 13 above, please fill out your phone number(s) and 
table on the next page: 
 
 
 
 
 
** PLEASE CONTINUE TO NEXT PAGE. ** 

6 of 6 
 
CHIVES Screening Survey 
NAME:   
14. If you are eligible to participate in the CHIVES project, we will call you during 
the next two weeks to complete 4 food recalls and 1 survey over the phone. 
 
What are the best phones numbers to reach you? 
Cell Phone: 
  
Additional Phone:   
 
Is this additional phone number your: 
  
Home 
  
Work 
  
Different Cell 
  
Other 
 
15. This study will require that receive and respond to multiple text messages 
(approximately 10) over the next year. Are you okay with this? 
 
  
Yes 
 
  
No 
 
16. What are generally good times to call you? Please mark an “X” in all boxes 
that show a good time to call you for each day of the week. 
 
Mondays 
Tuesdays 
Wednesdays 
Thursdays 
Fridays 
Saturdays 
Sundays 
8am-10am 
(early morning) 
10am-12pm 
(late morning) 
12pm-2pm 
(lunch hour) 
2pm-4pm 
(mid-day) 
4pm-6pm 
(evening) 
6pm-8pm 
(night) 
 
 
 
** End of survey. Thank you! ** 

1 of 6 
 
Encuesta de elegibilidad para participar en el ensayo clínico CHIVES
NOMBRE:  
Por la presente encuesta se busca determinar si el encuestado (usted) reúne todos 
requisitos para participar en este estudio de investigación cuyo objetivo es determinar la 
correlación entre el uso de los cupones para comida (food vouchers) y el consumo de 
verduras, frutas y otros alimentos.  Esta encuesta le llevará aproximadamente 10 minutos. 
Podrá dejar preguntas sin responder.  También podrá dejar de participar en el estudio en 
cualquier momento; si decide hacerlo, haga el favor de notificar a los responsables del 
estudio quienes estarán presentes en la sesión de orientación de hoy por la noche. 
 
Las respuestas e información que usted proporcione en esta encuesta se mantendrán 
confidenciales en la medida posible según lo exige la ley.  La Administración de 
Medicamentos y Alimentos, y otras agencias federales y estatales, podrían tener acceso a 
este registro. 
 
Está en libertad de elegir si desea o no participar en este proceso de preselección para su 
participación en este estudio —la decisión es suya.  Si opta por no responder a las 
preguntas, o por dejar de contestarlas, no se le penalizará, ni se le revocará ninguno de los 
beneficios a los que tiene derecho. 
 
El riesgo de participar en esta encuesta es muy bajo, ya que se ha diseñado de forma que 
no incluya información personal de índole delicada, aunque es posible que algunas personas 
se sientan incómodas de responder algunas de las preguntas.  De ser así, por              favor 
deje de contestar las preguntas, e informe al personal del estudio que ya no desea 
continuar. Si le interesa participar en este estudio, y califica, nuestro personal conservará  
su nombre e información personal, los cuales se mantendrán confidenciales. Aun así, hay un 
pequeño riesgo de que personas ajenas al estudio pudieran tener acceso a su    
información.  Si, por otro lado, una vez que ha completado la encuesta usted decide que no 
le interesa participar en el estudio, el personal destruirá todo el material con sus respuestas 
e información personal. 
 
El beneficio de participar en esta encuesta es que le permitirá saber si califica para 
participar en el estudio sobre la correlación entre el uso de los cupones para comida y el 
consumo de verduras, frutas y otros alimentos.  Por medio de este estudio, que examina el 
efecto de los diferentes cupones para comida en la nutrición de las personas que los 
reciben, se le darán cupones para asistirle en la compra de alimentos durante los seis 
meses próximos. 
 
Si no desea responder estas preguntas, se le darán otras alternativas entre las que se 
cuentan el que usted decida hablar con su médico sobre la nutrición o que simplemente 
decida no hacer nada nuevo. 
 
No se le remunerará por responder las preguntas en esta encuesta por la que solo se busca 
determinar si usted califica para participar en este estudio. 
 
 
 
 
 
La palabra CHIVES es un acrónimo que proviene de: Coupons for Healthy Eating Using Variable 
Economic Strategies (Cupones para comer de manera saludable mediante estrategias económicas variables). 
** CONTINÚA EN LA PÁGINA SIGUIENTE. ** 

** CONTINÚA EN LA PÁGINA SIGUIENTE. ** 
2 of 6 
 
NOMBRE:_________________________________ 
Encuesta de elegibilidad para participar en el ensayo clínico CHIVES


Si tiene alguna pregunta, inquietud, o queja sobre esta entrevista, llame al 844-4CHIVES 
(844-424-4837) para ponerse en contacto con el personal del estudio CHIVES.  Si, por otro 
lado, prefiere contactarse con una persona no involucrada directamente en el estudio sobre 
algo que le preocupa, o si tuviera alguna queja, o quisiera informarse sobre sus derechos 
como sujeto de investigación, llame al Consejo de Revisión Institucional de Stanford (IRB, 
por sus siglas en inglés) al 650-723-5244 ó al 866-680-2906 (línea telefónica gratuita), para 
hablar con una persona informada e independiente del estudio.  También llame al Consejo 
de Revisión Institucional de Stanford a cualquiera de los números telefónicos anteriores si 
no puede comunicarse con el personal del estudio. 
 
 
 
Preguntas de la encuesta 
Responda las preguntas a continuación para determinar si califica para participar en el 
estudio de investigación. Puede dejar en blanco cualquier pregunta que prefiera no 
responder; aunque esto lo podría descalificar para participar en el estudio. 
 
Nombre completo: 
  
 
Nombre por el que prefiere que lo llamen: 
  
 
Dirección: 
  
 
 
 
 
Dirección de correo electrónico:   
(no es obligatorio) 
 
 
1. ¿Cuántos años tiene? 
 
  
años 
 
 
2. ¿Con qué género se identifica? 
 
  
masculino 
 
  
femenino 
 
  
otro 

** CONTINÚA EN LA PÁGINA SIGUIENTE. ** 
3 of 6 
 
Encuesta de elegibilidad para participar en el ensayo clínico CHIVES
NOMBRE:  
3. ¿Hasta qué grado (terminado) llegó en la escuela? 
 
  
nunca fui a la escuela o sólo llegué al jardín de niños 
 
  
del primero al octavo grados (primaria o secundaria) 
 
  
del noveno al onceavo grados (algo de preparatoria) 
 
  
doceavo grado o terminé la preparatoria (recibí el GED) 
 
  
asistí a la universidad de 1 a 3 años 
(alguna experiencia universitaria o de escuela técnica) 
 
  
4 años o más de estudios universitarios (recibí mi licenciatura) 
 
  
otra, por favor explique:   
 
 
4. Favor de indicar su raza (marque todas las opciones que correspondan). 
 
  
nativo de América del Norte / nativo de Alaska 
 
  
asiático 
 
  
negro / afroamericano 
 
  
nativo de Hawái / de las islas pacíficas 
 
  
blanco 
 
  
no lo sé / se desconoce 
 
  
otra, por favor explique:   
 
 
5. ¿Se considera hispano o latino? 
 
  
Sí 
 
  
No 

4 of 6 
 
Encuesta de elegibilidad para participar en el ensayo clínico CHIVES
NOMBRE:  
6. ¿Cuál es la mejor estimación de su ingreso familiar mensual antes de impuestos 
el año anterior (2016)? 
 
$ 
(ingreso mensual in 2016) 
 
 
 
7. ¿Cuántas personas, incluyéndolo a usted, vivieron en su hogar en 2016? 
Aquí se incluyen todas las personas (adultos y niños) que viven con usted la 
mayor parte del año y que están emparentados con usted por nacimiento, 
matrimonio o adopción. 
 
  
personas 
 
 
8. ¿Estaría usted dispuesto a que se le seleccionara al azar (como se hace al tirar 
una moneda al aire) para recibir un vale de despensa que podría ser válido por 
una semana o un mes entero? 
 
  
Sí 
 
  
No 
 
 
9. ¿Estaría usted dispuesto a que se le seleccionara al azar (como se hace al tirar 
una moneda al aire) para recibir cupones para comida que fueran válidos sólo 
para comprar frutas y verduras, o cupones para comida que se podrían usar 
para comprar toda clase de alimentos, excepto bebidas alcohólicas, vitaminas, 
alimentos calientes o que se comen en la misma tienda? 
 
  
Sí 
 
  
No 
 
 
10. ¿Participa actualmente en el programa CalFresh, también conocido como EBT, 
SNAP o estampillas para comida (Food Stamps)? 
 
  
Sí 
 
  
No 
 
 
 
 
 
** CONTINÚA EN LA PÁGINA SIGUIENTE. ** 

5 of 6 
 
Encuesta de elegibilidad para participar en el ensayo clínico CHIVES
NOMBRE:  
 
11 .¿Alguien en su hogar, que no sea usted, actualmente participa en el programa 
CalFresh, también conocido como EBT, SNAP o estampillas para comida? 
 
  
Sí 
 
  
No 
 
  
No sé 
 
 
12 .¿Tiene usted una dirección confiable donde recibir correo de forma segura? 
 
  
Sí 
 
  
No 
 
 
13 .¿Le interesaría participar en este estudio, y quisiera que le contactáramos para 
dar el paso siguiente? 
 
  
Sí 
 
  
No 
 
 
Si respondió «no» a la pregunta anterior N°13, ahora es cuando debe informar a un 
encargado de este estudio que quiere que se destruya la encuesta. 
 
Si respondió «sí» a la pregunta anterior N°13, anote su(s) número(s) de teléfono y 
marque el mejor día y hora para contactarlo en la tabla a continuación. 
 
 
 
 
 
** CONTINÚA EN LA PÁGINA SIGUIENTE. ** 

Encuesta de elegibilidad para participar en el ensayo clínico CHIVES
NOMBRE:  
 
 
 
14. Si usted es elegible para participar en el proyecto CHIVES, le llamaremos en el 
curso de las próximas dos semanas para completar 4 repasos de comida y 1 
encuesta por teléfono. 
¿Cuáles son los mejores números de teléfono para contactarlo? 
Teléfono celular: 
  
Teléfono adicional:   
 
El teléfono adicional es el número de mi: 
  
Casa 
  
Trabajo 
  
Otro celular 
  
Otra 
 
 
15. 
El estudio requiere que usted reciba y mande varios mensajes de texo 
(aproximadamente 10) en el curso del próximo añoo. ¿Usted estará de acuerdo? 
 
  
Sí 
 
  
No 
 
16. 
¿Cuándo es mejor llamarle? Por favor marque con una «X» todos los 
cuadros que le resulten convenientes para cada día de la semana. 
8:00 – 10:00 
(temprano por la mañana) 
10:00 – 12:00 
(a media mañana) 
12:00 – 14:00 
(a la hora de almuerzo) 
14:00 – 16:00 
(temprano por la tarde) 
16:00 – 18:00 
(en la noche, temprano) 
18:00 – 20:00 
(en la noche) 
** Fin de la encuesta. ¡Gracias! ** 
6 of 6 
lunes 
martes 
miércoles 
jueves 
viernes 
sábados 
domingos 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
VII. Participant Handout – Expectations, 
Guidelines, & Timeline – for orientation 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

 
 
 
 
General Expectations & Guidelines: 
x Complete all phone calls. All phone calls specified in the timeline on the back 
must be completed at each time point. 
x Inform us of changes. Please inform us immediately if there are any changes in your 
contact information, especially your mailing address and phone number. 
x Look out for your vouchers. Vouchers will be mailed at the beginning of every 
month for the next 6 months. We cannot replace vouchers for any reason. 
x No EatSF vouchers for the next year. You cannot receive EatSF vouchers for the 
next 12 months (only our CHIVES project vouchers). 
x Be in touch. Let us know if you have a problem using a voucher – we’ll talk to the 
store manager & fix it! 
Questions? 
Please contact our study coordinator: Mandy Carroll 
E-mail: 
chivesproject@stanford.edu 
Call: 
(844) 4-CHIVES, or (844) 424-4837 
 
 
 
 
Food Recall Team Expectations: 
x 12 dietary recalls throughout the next year. Our team will call you to complete 4 
food recalls at each data collection time period: (1) January / February 2017, 
(2) July 2017, and (3) January 2018. 
x 3 surveys throughout the next year. This 20-minute survey will happen during one of 
the two food recalls at each data collection time period. 
x Communicate your schedule. If you will be out of town during any data collection 
period, please let us know in advance. We will try our best to work with you. 
x Food Amounts Booklet. During data collection, it is important to have this booklet 
available at all times. Without it, we are unable to complete your dietary recall. 
x Return our phone calls. If unavailable when we call, please return our phone call or 
text message on the same day, and let us know when is a good time to call. 
Questions? Please contact our lead: Sarah Farzinkhou 
E-mail: 
chivesproject@stanford.edu 
Call: 
(844) 4-CHIVES, or (844) 424-4837 
 
 
What to expect 
as a CHIVES Project participant 

Timeline: a year in the life of a CHIVES Project participant 
 
 
 
60-minute Orientation: 
- Sign study consent form 
 
1485 
 
 
Receive a text message: 
- We will send a text to let you 
 
 
Receive vouchers: 
- We will continue to mail 
 
 
30-minute Food Recalls 
- 4 total food recalls 
 
 
30-minute Food Recalls 
- 4 total food recalls 
- Complete screening survey 
know which vouchers you will 
receive for the next 6 months. 
- Please text back to let us 
know you received the text. 
you vouchers for the 
next 5 months. 
- If your address changes, 
please let us know ASAP! 
- We cannot give you 
new vouchers, and we 
cannot replace your 
- 2 food recalls during the 
1st week of July 
- 2 food recalls during the 
4th week of July 
- 2 food recalls during the 
1st week of July 
- 2 food recalls during the 
4th week of July 
Receive a text message: 
- We will send a text to let you 
know if you are eligible to 
participate in CHIVES. 
- Please text back to let us 
know you received the text. 
30-minute Food Recalls 
- 2 total food recalls 
vouchers for any reason. 
20-minute Survey: 
- food preferences 
- participation in food 
assistance programs 
- food availability 
20-minute Survey: 
- food preferences 
- participation in food 
assistance programs 
- food availability 
 
 
30-minute Food Recalls 
- 2 total food recalls 
 
 
 
20- minute Survey: 
- food preferences 
- participation in food 
assistance programs 
- food availability 
 
Receive vouchers: 
- After completing all four food 
recalls, we will mail 1st month 
of vouchers to the mailing 
address you gave us. 
 
January 2017 
February 2017 – 1st Week 
March – July 2017 
July 2017 
January 2018 
 
1485  = 1485 Bayshore Blvd. #230 
San Francisco 94124 
= receive text message 
 
= receive phone call 
 
= receive mail 
Key for Timeline 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
VIII. Food Amounts Booklet for Dietary Recalls 
– for orientation 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

 
 
 
 
 
Food 
 
Amounts 
Booklet 
 
Please, keep this near your phone. 

Squares and Rectangles 
 
 
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Adapted from: Van Horn LV, Stumbo P, Moag-Stahlberg A, Obarzanek E, Hartmuller VW, Farris RP, 
Kimm SY, Frederick M, Snetselaar L, Liu K. The Dietary Intervention Study in Children (DISC): dietary 
assessment methods for 8- to 10-year-olds. J Am Diet Assoc. 1993 Dec;93(12):1396-403. 
Modified by Alejandra Valencia, Mary Stevens, Nutrition Coordinating Center, University of Minnesota 
for the Hispanic Community Health Study, Study of Latinos, 2007. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IX. Food Resources Handout – for all 
ineligible candidates 
 
EatSF Program Referral Handout – for all 
ineligible candidates 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

* indicates important changes 
since July-September 2016 
We’d like your corrections, comments, or additions for our next update. Please call 415-648-3222, or 
email free@freeprintshop.org. Up-to-the-minute charts available at http://freeprintshop.org 
This chart may be reproduced freely (but revised 
only with permission). ©2016 Free Print Shop. 
 
October-December 
2016 
San Francisco Free Pantry Chart 
Page 1. See other side for 
  
more pantries!  
Pantries that give away free groceries or produce 
Citywide 
Bayview TLC Family Resource Center. 1601 LANE 
ST (at Quesada, in Bayview YMCA). 415-822-9404. 
Call M-F 9am-4pm for one-time-only emergency 
food box for any SF resident with photo ID 
showing SF address. Closed Oct 3-4, Nov 24-25, 
Dec  26.  6 
Food Locator.   Visit <sfmfoodbank.org/get-food> 
to find a neighborhood pantry where you can apply 
for weekly groceries. See Note at right. 
*Project Open Hand. 730 POLK (near Ellis). 
415-447-2326 or 800-551-6325 (toll-free). For SF 
residents with critical illness (including HIV, AIDS, or 
breast cancer), or recovering from trauma or major 
surgery. Call Tu-Sa 9am-4pm for interview appt. If 
accepted, pick up food Tues 9am-4pm or Wed-Sat 
11am-4pm. They’ll need your physician’s signature 
on application; plus proof of medical insurance, 
income, & address; & photo ID. Closed  Nov 24-26, 
Dec 26; limited hours Dec 24. 6 
*S.F. Rescue Mission. 140 TURK (bet. Taylor & 
Jones). Apply Wed 12-12:30pm to pick up food 
Thurs 12-12:30pm. Photo ID required. 6 
Supplemental Food Program. CALL  211 (OR  1-800- 
273-6222) for signup info. Low-income Bay Area 
seniors age 60+ can register for a monthly 35-lb 
box of dry & canned goods (proof of age, residen- 
cy & income required). 
211. CALL 211 (OR 1-800-273-6222). Any SF resident 
can call 211 for a referral to a food pantry in their 
zip code. (However, 211 pantry information may 
be incomplete or unreliable.) 6 
Neighborhood pantries 
 
Note: All neighborhood pantries listed below 
require advance registration. Bring photo ID & proof 
of SF address to any pantry during the hours listed. 
Your application will be screened by the Food Bank. 
If you qualify, they’ll assign you to a nearby pantry 
where you may pick up food weekly. 
 
 
Bayview/Hunters Point/Visitacion 
Bayview TLC Family Resource Center. 1601 LANE 
ST (at Quesada, in Bayview YMCA). 415-822-9404. 
See Note above. Apply in person Mon Tu Wed Fri 
10am-3pm. Serving mostly zip code 94124. Call 
M-F 9am-4pm for one-time-only emergency food 
box for any SF resident with photo ID showing SF 
address. Closed Oct 3-4, Nov 24-25, Dec 26.   6 
Our Lady of Lourdes. 410 HAWES (at Innes). 
415-559-2637. See Note above. Apply in person 
Sat 9:30-10am (except 1st Sat of the month). 
Serving mostly zip code 94124. English, 
Cantonese, Mandarin, Spanish. Closed Nov 26; 
Dec 24, 31. 6 
*United Council of Human Services. 2111 JENNINGS 
(at Van Dyke). 415-671-1100 (M-Th 9am-5pm). See 
Note above. Apply in person Wed 8am. Serving 
mostly zip code 94124. 6 
 
 
Mission/Potrero/Castro 
Salvation Army, Mission. 1156 VALENCIA (bet. 22nd 
& 23rd Sts). 415-648-0260. See Note above. Call 
M–Th 9am-11am for interview appointment. 
Serving mostly zip code 94107, 94110, 94114, or 
94131. English, Spanish. Closed Nov 24-25; Dec 
9, 16, 26. 6 
St. Aidan’s. 101 GOLDMINE DR (at Diamond Heights 
Blvd). See Note above. Apply in person Fri 1-2pm. 
Serving mostly zip code 94131. Closed Nov 25; 
may close Dec 23, 30. 6 
Women's Building. 3543 18TH ST. (bet. Valencia & 
Guerrero). 415-431-1180 ext. 11 (M-F 10am-5pm, 
W 10am-7pm). See Note at left. For immigrant 
SF residents. Apply in person Mon 9:30-11am, 
1-5pm; TuThFri 1-5pm; Wed 1-7pm. English, 
Cantonese, Spanish. Closed Dec 26. 6 
 
 
Ocean View/Sunset/R ichmond 
OMI Senior Ctr (Catholic Charities CYO). 65 
BEVERLY (at Shields). 415-334-5550. See Note 
above. For seniors 60+& disabled adults, with 
proof. Apply in person for weekly pantry Mon    
Tu Wed Fri 8:30am-2pm. Apply in person for 
monthly food box 9am-12pm fourth Mon of the 
month (Oct 24, Nov 28, Dec 27; closed Dec 26). 
Serving mostly zip code 94112, 94127, or 94132. 
English, Cantonese, Mandarin, Spanish, Tagalog, 
Vietnamese. Closed Nov 24-25, Dec 23, 26. 6 
 
 
Tenderloin/Chinatown/SoMa 
Salvation Army Chinatown. 1450 POWELL (near 
Broadway). 415-781-7002. See Note above. Call 
M-F 11am-4:30pm for interview appointment. 
Serving mostly zip code 94108, 94109, 94111, 94123, 
94129, 94130, 94133, or 94158. English, Cantonese, 
Mandarin. Closed Nov 24-25; Dec 9, 16, 26. 6 
Salvation Army Kroc Center. 240 TURK (near 
Jones). 415-345-3414. See Note above. Apply in 
person Fri 7:30am. Serving mostly zip code 94102, 
94103, or 94115. ID required. English, Cantonese, 
Khmer. Closed Nov 24-25; Dec 9, 16, 26. 6 
 
 

* indicates important changes 
since July-September 2016 
We’d like your corrections, comments, or additions for our next update. Please call 415-648-3222, or 
email free@freeprintshop.org. Up-to-the-minute charts available at http://freeprintshop.org 
This chart may be reproduced freely (but revised 
only with permission). ©2016 Free Print Shop. 
 
 
 
 
 

* indicates important changes 
since July-September 2016 
We’d like your corrections, comments, or additions for our next update. Please call 415-648-3222, or 
email free@freeprintshop.org. Up-to-the-minute charts available at http://freeprintshop.org 
This chart may be reproduced freely (but revised 
only with permission). ©2016 Free Print Shop. 
 
October-December 
2016 
San Francisco Free Pantry Chart 
Page 2. See other side for 
  
more pantries!  
 
 
 
Pantries that give away free groceries &/or produce 
Other ways to get free groceries 
Note: All neighborhood pantries listed below 
require advance registration. How to register: 
Bring photo ID & proof of SF address to any pantry 
during the hours listed below. Your application will 
be screened by the Food Bank. If you qualify, they’ll 
assign you to a nearby pantry where you may pick 
up food weekly. 
 
Tenderloin/Chinatown/SoMa cont. 
Salvation Army South of Market. 360 4TH ST. (nr. 
Folsom). 415-777-2677. See Note above. Call M-F 
9am-5pm for interview appt or apply in person Fri 
8am-3pm. Serving mostly zip code 94103, 94105, 
or 94107. English, Cantonese, & Mandarin. Closed 
Nov 24-25; Dec 9, 16, 26. 6 
Youth With A Mission. 357 ELLIS (near Jones). 415- 
885-6543. See Note above. Apply in person Thur 
3pm. Serving zip code 94102. Closed Nov 24, 
Dec  22. 6 
 
 
Western Addition/Haight 
*Booker T. Washington Community Service Ctr. 
1100 DIVISADERO ( btw Turk & Eddy). 415-928-6596. 
See Note above. Apply in person Thurs 10-11am. 
Serving mostly zip code 94115 or 94117. 6 
Jones Memorial United Methodist Church. 1975 
POST (at Steiner). See Note above. Apply in person 
Sat 10:30am. Serving mostly zip code 94102, 
94109, or 94115. Closed Oct 1; Nov 5, 26; Dec 24, 
31. 6 
Korean American Senior Service. 745 BUCHANAN (at 
Grove). 415-255-9371. See Note above. Apply in 
person Fri 9:30-10:30am. Serving mostly zip code 
94102, 94115, 94117, or 94118. 6 
St. Andrew Missionary Baptist Church. 2565 POST 
(near Baker). See Note above. Apply Wed 10am. 
Closed Nov 23, Dec 28. 6 
Treasure Island 
Treasure   Island   Homeless   Development  
Initiative. 850 AVENUE I ON TREASURE ISLAND (at 9th   
St, in the Shipshape Building). 415-986-4810. For 
Treasure Island residents only; ID & lease required 
at signup. Apply Tues 2:30pm. 6 
 
 
Food Stamps (CalFresh). 1235 MISSION (btw. 8th 
& 9th Sts.) or 1440 HARRISON (btw. 10th & 11th). 855-
355-5757 (toll-free) for info in English, Cantonese, 
Mandarin, Russian, Spanish, Tagalog,  or 
Vietnamese. Food vouchers for low-income 
California residents. You can check eligibility & 
apply online at <mybenefitsCalWIN.org>, or 
apply in person M–F 8am-5pm. It’s best to get 
there early (8-10am), fill out an application, & turn 
it in. You’ll get an appointment for that day or for    
a few days later. Bring ID, Green Card (if you’re    
an immigrant), & proof of your rent, expenses, & 
income. If approved before 4pm, you may get your 
card that day; otherwise you may pick it up later or 
have it mailed to you within 2 weeks. Individuals 
can get up to $194 worth of food stamps per  
month (most individuals get less; most families get 
more). The amount you get depends on income 
and how much you pay for shelter (and for out-of- 
pocket medical costs if you’re over 60 or disabled). 
People with SSI/SSP cannot get food stamps. 
People with resources (house, car, bank account, 
etc.) or SSD but limited income can still get food 
stamps, & so can homeless people. Closed Oct 
11; Nov 11, 24, 25; Dec 26. 6 
WIC. CALL 415-575-5788 (M–F 8am-12pm, 1-5pm) or 
415-621-7574 (M–F 8:30am-5pm). Food vouchers 
for children under 5. Pregnant or postpartum 
women, or guardians of children under 5 years, 
call for appointment to sign up in 1 of 6 locations. 
Bring ID, proof of income (check stubs, Medi-Cal 
card), & address (California ID/utility bill/piece of 
mail). WIC offers food vouchers, info & support  
for breastfeeding, & nutrition counseling. You can 
use vouchers at WIC-authorized grocery stores for 
produce, whole grains, beans (or peanut butter), 
cereal, eggs, milk, yogurt. cheese, juice, iron- 
fortified formula & baby food. Closed Oct 10, 19, 
25; Nov 11, 24-25; Dec 16, 23, 26. 6 
 

* indicates important changes 
since July-September 2016 
We’d like your corrections, comments, or additions for our next update. Please call 415-648-3222, or 
email free@freeprintshop.org. Up-to-the-minute charts available at http://freeprintshop.org 
This chart may be reproduced freely (but revised 
only with permission). ©2016 Free Print Shop. 
 
 
 
 

Thank you for attending the recent CHIVES Project orientation session. 
Enclosed are two $5 EatSF vouchers to thank you for your time! 
 
 
 
 
 
Since you are not eligible for CHIVES Project at this time, 
we would like to refer you to the EatSF program. 
 
For more information about EatSF: 
1) Visit their website: eatsfvoucher.org 
-OR- 
2) Call their project offices: 415) 206-4947 
 
**See reverse for more information on whether you would be eligible!** 
 
 
 
 
Thank you for attending the recent CHIVES Project orientation session. 
Enclosed are two $5 EatSF vouchers to thank you for your time! 
 
 
 
 
 
Since you are not eligible for CHIVES Project at this time, 
we would like to refer you to the EatSF program. 
 
For more information about EatSF: 
1) Visit their website: eatsfvoucher.org 
-OR- 
2) Call their project offices: 415) 206-4947 
 
**See reverse for more information on whether you would be eligible!** 

AM I ELIGIBLE for EatSF? 
To be eligible for EatSF, you must be at least 18 years of age, live in the Tenderloin, 
SOMA, or Bayview neighborhoods, and meet at least one of the following criteria: 
1. You are currently receiving Supplemental Security Income (SSI), Supplemental 
Security Income Pending (SSIP), or Social Security Disability Income (SSDI). 
2. You are an adult with obesity (BMI greater than 30) or are living with pre-diabetes, 
diabetes, high blood pressure, heart failure, HIV, hepatitis C, or tuberculosis. 
IMPORTANT: All participants for EatSF are enrolled through a participating community- 
based organization. Organizations are located in the Tenderloin, SOMA, and Bayview 
and include clinics, social service organizations, and Single Room Occupancy (SRO) 
buildings. Check to see whether your doctor, case manager, housing site, or social 
service provider participates in the EatSF program. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
AM I ELIGIBLE for EatSF? 
To be eligible for EatSF, you must be at least 18 years of age, live in the Tenderloin, 
SOMA, or Bayview neighborhoods, and meet at least one of the following criteria: 
1. You are currently receiving Supplemental Security Income (SSI), Supplemental 
Security Income Pending (SSIP), or Social Security Disability Income (SSDI). 
2. You are an adult with obesity (BMI greater than 30) or are living with pre-diabetes, 
diabetes, high blood pressure, heart failure, HIV, hepatitis C, or tuberculosis. 
IMPORTANT: All participants for EatSF are enrolled through a participating community- 
based organization. Organizations are located in the Tenderloin, SOMA, and Bayview 
and include clinics, social service organizations, and Single Room Occupancy (SRO) 
buildings. Check to see whether your doctor, case manager, housing site, or social 
service provider participates in the EatSF program. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
X. Participant Handout - How to Use 
Vouchers & List of Store Vendors – to be 
mailed with Month 1 Vouchers 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

 
 
 
 
 
How to use your CHIVES vouchers: 
1. Timeframe. Use your vouchers within the month timeframe for which they 
are valid. You have a total of four vouchers for each month, which you 
are able to use at any time during the month. 
2. Foods to purchase. Your vouchers may be used to purchase any 
CalFresh-eligible item. This means any food item, except alcoholic 
beverages, vitamins, hot food, or food eaten in the store. 
Organic foods are allowed. 
3. Dollar amount. Each voucher is worth $5. 
x If you spend over $5, you may use your own cash, credit card, 
debit card, or CalFresh/EBT card to pay the balance. 
x If you spend under $5, you will not receive any change. 
4. Where to spend. Please see the list of stores on the back to know which 
stores accept CHIVES vouchers. 
5. Questions, concerns, complaints. Please contact us at any time if you 
have any questions, concerns, or complaints whatsoever. 
We are here for you! 
x E-mail us: chivesproject@stanford.edu 
x Call us: (844) 4-CHIVES, or (844) 424-4837 
What to look for on your CHIVES vouchers: 
Valid for box: 
any CalFresh-eligible item 
First day 
to use box 
CHIVES 
Project 
Logo 
1  2017 
31 2017 
Last day 
to use box 
You will 
sign here 
when you 
purchase 
Using your CHIVES Vouchers 

 
 
 
 
 
Tenderloin & SoMa Store Locations 
Amigo’s Market 
500 Ellis Street (at Leavenworth) 
(415) 674-4145 
California Produce 
986 Polk St (at Geary St.) 
(415) 345-1700 
City Supermarket 
669 Geary St. (between Jones & Leavenworth) 
(415) 474-2126 
Heart of the City Farmers Market 
UN Plaza, 1182 Market St. (between 7th St. & 8th St., 
above Civic Center BART station) 
(415) 558-9455 
Mid-City Market 
868 Geary St. (between Larkin & Hyde) 
(415) 474-1568 
Radman’s Produce Market 
201 Turk Street (at Jones) 
(415) 674-4437 
Safeway 
2300 16th St. (at Potrero St.) 
(415) 575-1120 
SOMA Market 
1000 Howard St. (between 5th St. & 6th St.) 
(415) 553-6333 
Bayview Store Locations 
Duc Loi’s Pantry – coming soon! 
5900 3rd St. (at Carroll St.) 
(415) 551-1772 
Foods Co 
1800 Folsom St. (at 14th St.) 
(415) 558-9137 
Foods Co 
345 Williams Ave. 
(415) 330-1870 
Friendly’s Market 
1499 Thomas St. (at Keith St.) 
(415) 822-8321 
Lee’s Market 
1397 Revere St. (at Jennings St.) 
(415) 822-2818 
Palou Market 
4919 3rd St. (at Palou St.) 
(415) 822-8074 
Super Save 
4517 3rd St. (at LaSalle) 
(415) 282-3722 
Where to spend your CHIVES vouchers: 

 
 
 
How to use your CHIVES vouchers: 
1. Timeframe. Use your vouchers within the one-week timeframe for which 
they are valid. You have a total of four vouchers for each month. You will 
be able to use one voucher for each week of the month. 
2. Foods to purchase. Your vouchers may be used to purchase any 
CalFresh-eligible item. This means any food item, except alcoholic 
beverages, vitamins, hot food, or food eaten in the store. 
Organic foods are allowed. 
3. Dollar amount. Each voucher is worth $5. 
x If you spend over $5, you may use your own cash, credit card, 
debit card, or CalFresh/EBT card to pay the balance. 
x If you spend under $5, you will not receive any change. 
4. Where to spend. Please see the list of stores on the back to know which 
stores accept CHIVES vouchers. 
5. Questions, concerns, complaints. Please contact us at any time if you 
have any questions, concerns, or complaints whatsoever. 
We are here for you! 
x E-mail us: chivesproject@stanford.edu 
x Call us: (844) 4-CHIVES, or (844) 424-4837 
Using your CHIVES Vouchers 
What to look for on your CHIVES vouchers: 
Valid for box: 
any CalFresh-eligible item 
First day 
to use box 
CHIVES 
Project 
Logo 
17 2017 
24 2017 
Last day 
to use box 
You will 
sign here 
when you 
purchase 

 
 
 
 
 
Tenderloin & SoMa Store Locations 
Amigo’s Market 
500 Ellis Street (at Leavenworth) 
(415) 674-4145 
California Produce 
986 Polk St (at Geary St.) 
(415) 345-1700 
City Supermarket 
669 Geary St. (between Jones & Leavenworth) 
(415) 474-2126 
Heart of the City Farmers Market 
UN Plaza, 1182 Market St. (between 7th St. & 8th St., 
above Civic Center BART station) 
(415) 558-9455 
Mid-City Market 
868 Geary St. (between Larkin & Hyde) 
(415) 474-1568 
Radman’s Produce Market 
201 Turk Street (at Jones) 
(415) 674-4437 
Safeway 
2300 16th St. (at Potrero St.) 
(415) 575-1120 
SOMA Market 
1000 Howard St. (between 5th St. & 6th St.) 
(415) 553-6333 
Bayview Store Locations 
Duc Loi’s Pantry – coming soon! 
5900 3rd St. (at Carroll St.) 
(415) 551-1772 
Foods Co 
1800 Folsom St. (at 14th St.) 
(415) 558-9137 
Foods Co 
345 Williams Ave. 
(415) 330-1870 
Friendly’s Market 
1499 Thomas St. (at Keith St.) 
(415) 822-8321 
Lee’s Market 
1397 Revere St. (at Jennings St.) 
(415) 822-2818 
Palou Market 
4919 3rd St. (at Palou St.) 
(415) 822-8074 
Super Save 
4517 3rd St. (at LaSalle) 
(415) 282-3722 
Where to spend your CHIVES vouchers: 

 
 
 
 
 
How to use your CHIVES vouchers: 
1. Timeframe. Use your vouchers within the month timeframe for which they 
are valid. You have a total of four vouchers for each month, which you 
are able to use at any time during the month. 
2. Foods to purchase. Your vouchers may be used to purchase any fresh 
or frozen fruits and vegetables, including those that are pre-packaged 
without sugar or salt. Organic is allowed. 
3. Dollar amount. Each voucher is worth $5. 
x If you spend over $5, you may use your own cash, credit card, 
debit card, or CalFresh/EBT card to pay the balance. 
x If you spend under $5, you will not receive any change. 
4. Where to spend. Please see the list of stores on the back to know which 
stores accept CHIVES vouchers. 
5. Questions, concerns, complaints. Please contact us at any time if you 
have any questions, concerns, or complaints whatsoever. 
We are here for you! 
x E-mail us: chivesproject@stanford.edu 
x Call us: (844) 4-CHIVES, or (844) 424-4837 
What to look for on your CHIVES vouchers: 
Valid for box: 
only fruits & vegetables 
First day 
to use box 
CHIVES 
Project 
Logo 
1  2017 
31 2017 
Last day 
to use box 
You will 
sign here 
when you 
purchase 
Using your CHIVES Vouchers 

 
 
 
 
 
Tenderloin & SoMa Store Locations 
Amigo’s Market 
500 Ellis Street (at Leavenworth) 
(415) 674-4145 
California Produce 
986 Polk St (at Geary St.) 
(415) 345-1700 
City Supermarket 
669 Geary St. (between Jones & Leavenworth) 
(415) 474-2126 
Heart of the City Farmers Market 
UN Plaza, 1182 Market St. (between 7th St. & 8th St., 
above Civic Center BART station) 
(415) 558-9455 
Mid-City Market 
868 Geary St. (between Larkin & Hyde) 
(415) 474-1568 
Radman’s Produce Market 
201 Turk Street (at Jones) 
(415) 674-4437 
Safeway 
2300 16th St. (at Potrero St.) 
(415) 575-1120 
SOMA Market 
1000 Howard St. (between 5th St. & 6th St.) 
(415) 553-6333 
Bayview Store Locations 
Duc Loi’s Pantry – coming soon! 
5900 3rd St. (at Carroll St.) 
(415) 551-1772 
Foods Co 
1800 Folsom St. (at 14th St.) 
(415) 558-9137 
Foods Co 
345 Williams Ave. 
(415) 330-1870 
Friendly’s Market 
1499 Thomas St. (at Keith St.) 
(415) 822-8321 
Lee’s Market 
1397 Revere St. (at Jennings St.) 
(415) 822-2818 
Palou Market 
4919 3rd St. (at Palou St.) 
(415) 822-8074 
Super Save 
4517 3rd St. (at LaSalle) 
(415) 282-3722 
Where to spend your CHIVES vouchers: 

 
 
 
 
What to look for on your CHIVES vouchers: 
 
 
 
First day 
to use box 
 
 
 
 
 
 
17 2017 
Valid for box: 
only fruits & vegetables 
 
 
CHIVES 
Project 
Logo 
 
 
Last day 
to use box 
24 2017 
 
You will 
sign here 
when you 
purchase 
 
 
How to use your CHIVES vouchers: 
1. Timeframe. Use your vouchers within the one-week timeframe for which 
they are valid. You have a total of four vouchers for each month. You will 
be able to use one voucher for each week of the month. 
2. Foods to purchase. Your vouchers may be used to purchase any fresh 
or frozen fruits and vegetables, including those that are pre-packaged 
without sugar or salt. Organic is allowed. 
3. Dollar amount. Each voucher is worth $5. 
x If you spend over $5, you may use your own cash, credit card, 
debit card, or CalFresh/EBT card to pay the balance. 
x If you spend under $5, you will not receive any change. 
4. Where to spend. Please see the list of stores on the back to know which 
stores accept CHIVES vouchers. 
5. Questions, concerns, complaints. Please contact us at any time if you 
have any questions, concerns, or complaints whatsoever. 
We are here for you! 
x E-mail us: chivesproject@stanford.edu 
x Call us: (844) 4-CHIVES, or (844) 424-4837 
Using your CHIVES Vouchers 

 
 
 
 
 
Tenderloin & SoMa Store Locations 
Amigo’s Market 
500 Ellis Street (at Leavenworth) 
(415) 674-4145 
California Produce 
986 Polk St (at Geary St.) 
(415) 345-1700 
City Supermarket 
669 Geary St. (between Jones & Leavenworth) 
(415) 474-2126 
Heart of the City Farmers Market 
UN Plaza, 1182 Market St. (between 7th St. & 8th St., 
above Civic Center BART station) 
(415) 558-9455 
Mid-City Market 
868 Geary St. (between Larkin & Hyde) 
(415) 474-1568 
Radman’s Produce Market 
201 Turk Street (at Jones) 
(415) 674-4437 
Safeway 
2300 16th St. (at Potrero St.) 
(415) 575-1120 
SOMA Market 
1000 Howard St. (between 5th St. & 6th St.) 
(415) 553-6333 
Bayview Store Locations 
Duc Loi’s Pantry – coming soon! 
5900 3rd St. (at Carroll St.) 
(415) 551-1772 
Foods Co 
1800 Folsom St. (at 14th St.) 
(415) 558-9137 
Foods Co 
345 Williams Ave. 
(415) 330-1870 
Friendly’s Market 
1499 Thomas St. (at Keith St.) 
(415) 822-8321 
Lee’s Market 
1397 Revere St. (at Jennings St.) 
(415) 822-2818 
Palou Market 
4919 3rd St. (at Palou St.) 
(415) 822-8074 
Super Save 
4517 3rd St. (at LaSalle) 
(415) 282-3722 
Where to spend your CHIVES vouchers: 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
XI. Participant Handout – Reminder for Month 
6 Data Collection & Incentives – to be 
mailed with Month 5 Vouchers 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

 
 
 
Reminder: [m6] is your final month of receiving CHIVES vouchers. 
 
What to expect in [m6]: 
During the first week of [m6], our team will call you to complete: 
- 2 food recalls 
- 1 survey 
During the last week of [m6], our team will call you to complete: 
- 2 more food recalls 
 
 
 
Contact us: Please contact us immediately if your phone number 
has changed. Also, please contact us with any questions! 
 
E-mail us: chivesproject@stanford.edu 
Call us: (844) 4-CHIVES or (844) 424-4837 
X 1 survey 
(15 minutes) 
X 4 food recalls 
(20 - 30 minutes each) 
Thank you! To thank you for your time & effort, we will send you a 
$20 gift card in the mail when you complete all of these phone calls. 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
XII. Participant Survey Measures 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
Participant survey measures. 
 
 
Construct 
Theoretical 
Justification 
Metrics (on 5-point Likert scales 
from 1 “not at all” to 5 
“extremely”) 
Sources 
Ease of use 
Hypothesized mediator 
for the targeted versus 
untargeted voucher 
effect 
3 items such as “how hard was it 
to decide what to spend the 
voucher on?” 
Healthy incentives pilot 
study 
Food preferences and 
beliefs 
Preferences as potential 
moderator of effect 
3 items such as “I enjoy trying 
new vegetables” 
Satter inventory 
Barriers to the 
consumption of 
F&Vs and to grocery 
shopping 
Barriers as potential 
moderator of effect 
4 items such as “It is hard to eat 
vegetables because it is difficult to 
know how to prepare them” 
WIC Participant 
Characteristics Survey 
Household food 
environment 
Household environment 
as potential moderator 
of effect 
2 items such as “Have fruits 
available at home” 
CDC Flexible Consumer 
Behavior scale (used in 
NHANES) 
Food insecurity 
Scarcity theory: 
insecurity as potential 
moderator or mediator 
of effect 
6 items such as “In the last 6 
months, did you cut the size of 
meals or skip meals because there 
wasn’t enough money for food?” 
CDC Household Food 
Security Survey Module, 
Short-form (used in 
NHANES) 

CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
XIII. Month 0/Baseline Survey, Month 6 Survey, 
and Main Survey 

11/16/2016 8:41am 
www.projectredcap.org 
 
Contidential 
 
MO Survey 
 
CHIVES Screening Candidates 
Page 1 ot 1 
 
 
Record ID 
                                   
 
First, I'm going to ask you about our voucher program. Please answer yes or no. 
 
You recently completed an orientation session about 
Yes 
how the vouchers work. Do you understand how to use 
No 
the vouchers? 
 
I'm sorry to hear that. I will ask our study coordinator to call you to answer your questions about the program. 
Let me ask you a few more questions. 
Great. I'm glad you understood how to use them. 
Let me ask you a few more questions. 
NOTE to ASSESSORS: 
 
Now move onto main survey. 
 
For study coordinator to follow up with misunderstanding of vouchers. 
Contacted for follow up? 
Yes 
When contacted for follow up? 
                                   
 
Month 0 Survey Notes 
                                   

11/16/2016 8:42am 
www.projectredcap.org 
 
Contidential 
M6 Survey 
 
Please complete the survey below. 
 
 
 
Thank you! 
 
Page 1 ot 1 
 
 
First, I'm going to ask you a few questions about our voucher program. For these questions, please answer yes or no. 
 
You have been in our voucher program for several 
Yes 
months. Do you feel you understood how to use the 
No 
vouchers? 
 
The participant answered "yes." 
 
SAY: "What made it easier to understand how to use 
                                          
the vouchers?" 
 
The participant answered "no." 
 
SAY: "I'm sorry to hear that. What was the reason 
                                          
that you didn't understand how to use the vouchers? 
" 
 
Was it easy to decide which foods you are allowed to 
Yes 
spend the voucher on? 
No 
 
The participant answered "no." 
 
SAY: "I'm sorry to hear that. What was the reason why 
                                          
it was hard to know which foods you can spend the 
vouchers on?" 
 
Did you have any trouble using the vouchers at any 
Yes 
stores; that is, did any cashiers or store employees 
No 
give you a hard time or not allow you to use the 
vouchers? 
 
The participant answered "yes." 
 
I'm sorry to hear that. Would you please tell me the 
                                          
name and location of the store, and what happened? 
 
Of the food purchased using your vouchers, was some 
Yes 
of it also shared with other people in your 
No 
household?  It's absolutely okay to share it' we 
just want to know how people use their vouchers. 
 
NOTE to ASSESSORS: 
 
Now move onto main survey. 
M6 Survey Notes: 
                                           

11/16/2016 8:41am 
www.projectredcap.org 
 
Contidential 
 
Main Survey 
 
CHIVES Screening Candidates 
Page 1 ot 4 
 
 
Record ID 
                                   
 
PLEASE SAY: 
 
"Thanks for taking the time to complete this survey today.  Once we complete this survey, we won't have to do this 
again anytime soon.  We will only have to complete the remaining food recalls. 
 
So, the other phone calls we'll have should be shorter. 
 
Okay, I'm going to start by asking you a few questions about how you feel about food in general, and specifically 
about fruits and vegetables. I'm going to read several statements that people have said about food. After each 
statement please tell me whether you agree or disagree with each statement, or that you are not sure." 
 
I enjoy trying new foods. 
Agree 
Disagree 
Not sure 
 
I enjoy trying new fruits. 
Agree 
Disagree 
Not sure 
 
I enjoy trying new vegetables. 
Agree 
Disagree 
Not sure 
 
I eat enough fruits to keep me healthy. 
Agree 
Disagree 
Not sure 
 
I eat enough vegetables to keep me healthy. 
Agree 
Disagree 
Not sure 
 
I often encourage my family or friends to eat fruits 
Agree 
and vegetables. 
Disagree 
Not sure 
 
PLEASE SAY: 
 
"Next I'm going to ask you some questions about how easy or hard it is for you to eat fruits and vegetables. I'm going 
to read several statements that people have said about fruits and vegetables. After each statement please tell me 
whether you agree or disagree with each statement, or that you are not sure." 
 
It's hard for me to eat more vegetables because I 
Agree 
don't know how to prepare them. 
Disagree 
Not sure 
 
It's hard for me to eat more vegetables because they 
Agree 
are hard to find where I shop for food. 
Disagree 
Not sure 
 
It's hard for me to eat more fruits because they are 
Agree 
hard to find where I shop for food. 
Disagree 
Not sure 
 
I don't eat fruits and vegetables as much as I like 
Agree 
to because they cost too much. 
Disagree 
Not sure 

11/16/2016 8:41am 
www.projectredcap.org 
 
Contidential 
 
 
Page 2 ot 4 
 
I don't eat fruits and vegetables as much as I like 
Agree 
to because they often spoil before I get a chance to 
Disagree 
eat them. 
Not sure 
 
I don't eat fruits and vegetables because I don't 
Agree 
like them. 
Disagree 
Not sure 
 
I don't eat fruits and vegetables as much as I like 
Agree 
to because my family doesn't like them. 
Disagree 
Not sure 
 
It is hard to shop for fruits and vegetables because 
Agree 
I live far away from a store that sells them. 
Disagree 
Not sure 
 
It is hard to shop for fruits and vegetables because 
Agree 
I don't have a car or other transportation to a 
Disagree 
store that sells them. 
Not sure 
 
PLEASE SAY: 
 
"Now I am going to ask you some questions about the food you have in your home." 
 
How often do you have fruit in your home? This 
includes fresh, dried, canned, and frozen fruit. 
 
Do you have them available all the time, sometimes, 
or never? 
All the time 
Sometimes 
Never 
 
How often do you have vegetables available at home? 
This includes fresh, dried, canned, and frozen 
vegetables. 
 
Do you have them available all the time, sometimes, 
or never? 
All the time 
Sometimes 
Never 
 
PLEASE SAY: 
 
"The next questions are about whether you participate in any other programs that help you buy food." 
 
Are you currently participating in WIC, that is, the 
Women, Infants, and Children program? 
Yes 
No 
 
Is someone in your household, other than you, 
currently participating in WIC? 
Yes 
No 
Don't Know 
Refused 
 
Who is participating in WIC? 
Myself, I am pregnant 
Myself, I am breastfeeding 
An infant (0 - 12 months) 
A child (1 - 5 years) 
My partner, who is 
pregnant or breastfeeding 
Other; define in RedCap 
Don't know 
Refused 
 
Who is participating in WIC? 
An infant (0 - 12 months) 
A child (1 - 5 years) 
My partner, who is 
pregnant or breastfeeding 
Other; define in RedCap 
Don't know 
Refused 
 
Besides this CHIVES program, are you currently 
participating in the EatSF voucher program? 
Yes 
No 

11/16/2016 8:41am 
www.projectredcap.org 
 
Contidential 
 
 
Page 3 ot 4 
 
Is someone in your household, other than you, 
currently participating in the EatSF voucher 
program? 
Yes 
No 
Don't Know 
Refused 
 
Who is participating in the EatSF voucher program? 
                                  
Please specify who: 
Are you currently receiving benefits from CalFresh, 
EBT, or SNAP, formerly know as the Food Stamp 
Program? 
Yes 
No 
 
Is someone in your household, other than you, 
currently receiving benefits from CalFresh, EBT, or 
SNAP, formerly known as the Food Stamp Program? 
Yes 
No 
Don't Know 
Refused 
 
Who is participating in CalFresh, EBT, or SNAP, 
                                  
formerly know as the Food Stamp Program? 
 
Please specify who: 
 
Do you have any children in your household? 
Yes 
No 
 
Are any children in your household currently 
receiving a free or reduced-price school breakfast 
or school lunch? 
Yes 
No 
Don't Know 
Refused 
 
PLEASE SAY: 
 
"Next, I'm going to read you several statements that people have made about their food situation. For these 
statements, please tell me whether the statement was often true, sometimes true, or never true for you or your 
household in the last 12 months-that is, since last [name of current month]." 
 
The first statement is, "The food that (I/we) bought 
Often true 
just didn't last, and (I/we) didn't have money to 
Sometimes true 
get more." 
Never true 
 
 
 
Was that often, sometimes, or never true for (you or 
your household) in the last 12 months? 
 
"(I/we) couldn't afford to eat balanced meals." 
Often true 
Sometimes true 
Never true 
 
Was that often, sometimes, or never true for (you or 
your household) in the last 12 months? 
 
In the last 12 months, since last [name of current 
Yes 
month], did you (or other adults in your household) 
No 
ever cut the size of your meals or skip meals 
because there wasn't enough money for food? 
 
How often did this happen-almost every month, some 
Almost every month 
months but not every month, or in only 1 or 2 
Some months but not every month 
months? 
Only 1 or 2 months 
 
In the last 12 months, did you ever eat less than you 
Yes 
felt you should because there wasn't enough money 
No 
for food? 

11/16/2016 8:41am 
www.projectredcap.org 
 
Contidential 
 
 
Page 4 ot 4 
 
In the last 12 months, were you ever hungry but 
Yes 
didn't eat because there wasn't enough money for 
No 
food? 
 
PLEASE SAY: 
 
"Finally, I'm going to ask a few questions about you, including your height and weight. 
 
Your answers are completely confidential and will never be tied to your name.  We only ask this information to get an 
overall snapshot of CHIVES participants as an average.  No individual's height or weight is ever looked at." 
 
How tall are you without shoes, in feet and inches? 
Knows height, enter in next question 
Doesn't know 
Refused 
 
What is participant's height in inches? 
                                   
(Please write participant height in inches only. 
Remember that 1 foot equals 12 inches. 
5' = 
60" ; 6" = 72") 
 
How much do you weigh without clothes or shoes, in 
pounds? 
Knows weight, enter in next question 
Doesn't know 
Refused 
 
What is participant's weight in pounds? 
                                   
 
Are you currently pregnant? 
Yes 
No 
Don't Know 
Refused 
 
Are you currently breastfeeding? 
Yes 
No 
Refused 
PLEASE SAY: 
"This is the end of our survey. 
 
I greatly appreciate the time you have taken. Now that this survey is complete, we will only have to complete the 
remaining food recalls together.  These food recalls should be shorter phone calls. 
 
If you have any questions about this study, please contact the study coordinator at 844-4CHIVES, 844-424-4837. 
Thank you and have a great day." 
Main Survey Notes: 
 
 
Surveys completed? 
Yes 
No 
 
When were the surveys completed? 
Week 1, Recall 1 
Week 1, Recall 2 
Week 4, Recall 1 
Week 4, Recall 2 
Separate phone call 
If during a separate call, when? 
                                  
By whom? 
 
Carrie 
Lindsay 
Liz 
Mandy 
Sarah 
Other 
 
Other assessor, please specify name: 
                                   

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
XIV. 24-Hour Dietary Recall REDCap Form and 
2-item food security questions 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

Contidential 
 
Recall 1 
 
CHIVES Screening Candidates 
Page 1 ot 1 
 
 
Record ID 
                                   
 
NOTE to ASSESSORS: 
 
First complete Recall 1 using NDSR. 
 
Please remind participants NOT to reveal their voucher assignment with you throughout the phone call. 
Once you conclude the recall, please complete the rest of this form. 
NOTE to ASSESSORS: 
 
After you complete Recall 1, please end phone call with the following two food security questions. 
 
SAY:  "Finally, I'm going to read you two statements that people have made about their food situation. Your answers 
are completely confidential and will never be tied to your name.  We only ask this information to get an overall 
snapshot of CHIVES participants as an average. 
 
For these statements, please tell me whether the statement was often true, sometimes true, or never true for you or 
your household in the LAST WEEK." 
 
The first statement is: "We worried whether (my/our) 
Often true 
food would run out before (I/we) got money to buy 
Sometimes true 
more." 
Never true 
 
Was that often true, sometimes true, or never true 
for (you/your household) in the last week? 
 
"The food that (I/we) bought just didn't last and 
Often true 
(I/we) didn't have money to get more." 
Sometimes true 
Never true 
Was that often true, sometimes true, or never true 
for (you/your household) in the last week? 
 
Recall 1 completed? 
Yes 
No 
 
Was Recall 1 a weekday or weekend day? 
Weekday 
Weekend day 
When was Recall 1 completed? 
                                  
By whom? 
 
Carrie 
Lindsay 
Liz 
Mandy 
Sarah 
Other 
 
Other assessor, please specify name: 
                                  
Recall 1 Notes: 
 
 
 
 
 
 
 
 
 
 
 
12/21/2016 1:55pm 
www.projectredcap.org 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
XV. Dietary Recall Script for text messages, 
voicemails, and e-mails 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

Shared E-mail Account Basic Response 
Hi [candidate name], 
 
Thank you for your e-mail and your interest! 
 
Please take a short survey online (via your phone or computer) here to see if you qualify, or visit: 
https://is.gd.chivesproject 
 
It you are eligible to participate, the survey will ask you to sign up for an orientation session in [month] 
for more information and next steps about the study. 
Let us know if you have any further questions. 
Take Care, 
The CHIVES Project Team 
 
 
Orientation Reminder Mass Text 
Hello from the CHIVES Project! This is a reminder that you have signed up for an orientation session 
tomorrow, [day of the week], [date] at [time]. 
 
The orientation is at 1485 Bayshore Blvd., San Francisco in Conference Room 230 (to the left of the 
reception desk). This is in the Comcast Building, next to U-Haul facilities. 
 
Will you be able to attend? 
 
If participant confirms: 
Great! We look forward to seeing you tomorrow. Please call us at (844) 424-4837 with 
any questions. 
 
If participant needs to reschedule: 
Sorry to hear that. Please call us at (844) 424-4837 or e-mail us at 
chivesproject@stanford.edu to reschedule as soon as you are able. 
 
 
Data Collection Initiation Text 
Hi. This is [your name] from the CHIVES project. When would be a good time to call you and complete 
a food recall? 
 
 
Data Collection Confirmation Text 
Hi. This is [your name] from the CHIVES project. We have a food recall scheduled for [date] at [time]. 
I just wanted to check if this time still works for you? 
 
If participant confirms: 
Great! I look forward to our call (tomorrow). 
 
If participant needs to reschedule: 
That’s okay. When would be a better time to reach you? 

 Data Collection Voicemail 
Baseline Voicemail: 
Hello, this is [your name] calling from the CHIVES project to do one of your food recalls. If you get this 
message you can call or text me back at [your phone number]. Please remember in order to receive 
your food vouchers you need to complete 4 food recalls. Thank you! 
 
Baseline Text after leaving voicemail or if voicemail issues: 
Hi. This is [your name] from the CHIVES project. When would be a good time to reach you? Please 
remember you need to do all 4 recalls to receive your vouchers. 
 
6-month and 12-month Voicemail: 
Hello, this is [your name] calling from the CHIVES project to do one of your food recalls. If you get this 
message you can call or text me back at [your phone number]. Please remember that after you 
complete 4 food recalls you will receive a $20 gift card. Thank you! 
 
6-month and 12-month Text after leaving voicemail or if voicemail issues: 
Hi. This is [your name] from the CHIVES project. When would be a good time to reach you? Please 
remember that after you complete 4 food recalls you will receive a $20 gift card. Thank you! 
   Robot Voicemail or Different/Unintelligible name 
Baseline: 
Hello this message is for (participant name). Hello, this is [your name] calling from the CHIVES project 
to do one of your food recalls. If you get this message you can call or text me back at [your phone 
number]. Please remember in order to receive your food vouchers you need to complete 4 food 
recalls. Thank you! 
 
6-month and 12-month Text after leaving voicemail or if voicemail issues: 
Hello this message is for [participant name]. This is [your name] calling from the CHIVES project to do 
one of your food recalls. If you get this message you can call or text me back at [your phone number]. 
Please remember that after you complete 4 food recalls you will receive a $20 gift card. Thank you! 
 
   Data Collection Sample Email 
Subject Line: CHIVES Food Voucher Project 
 
Hello [participant name], 
 
My name is [your name] and I am contacting you from the CHIVES food voucher project. You 
attended our orientation on [orientation date] at [time] where we talked about our new food voucher 
project. 
 
After you complete 4 food recalls and one phone survey you will receive food vouchers for the next 6 
months. I tried to contact you via text and phone calls over the last few days, but have not received a 
response. If you could please update me with a number I can reach you at, that would be great! 
 
Hope to hear from you soon, 
[your name] 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
XVI. Vendor Memorandum of Understanding 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

EatSF Fruit 
Programs 
 
EatSF & The CHIVES Project: Food Voucher 
 
Vendor Agreement 
 
 
This letter of agreement marks the beginning of a partnership between the EatSF Fruit and Vegetable Voucher 
Program (referred to as EatSF), the CHIVES Project, and [XXXX] (referred to as [XXXX]). 
 
BACKGROUND 
 
EatSF: EatSF is a free fruit and vegetable voucher program for low-income San Francisco residents. Vouchers are 
distributed from clinics and community-based organizations to households that meet certain criteria. Vouchers can be 
used for fresh or frozen fruits, vegetables, and herbs (including pre-packaged). EatSF vouchers can be redeemed at 
selected stores and farmer’s markets. 
 
The CHIVES Project: The CHIVES Project is a collaboration between UCSF and Stanford University. The CHIVES 
Project is a research study that is evaluating the EatSF Program, which will be working with approximately 315 San 
Francisco residents from January 2017 through December 2018. The CHIVES Project is also a free food voucher 
program for low-income San Francisco residents, however, vouchers are distributed via mail directly to participants 
from the CHIVES Project office in Bayview. Participants will be assigned to receive one of two kinds of vouchers 
throughout their 6 months of participation: (i) Participants will be assigned to received vouchers that can be used for 
fresh or frozen fruits, vegetables, and herbs (including pre-packaged), identical to the EatSF vouchers, or (ii) 
Participants will be assigned to receive vouchers than can be used for any CalFresh-eligible (EBT / SNAP / Food 
Stamp-eligible) food items – any food or beverage, except for alcoholic beverages, vitamins / supplements, hot food, 
or prepared food eaten in the store. The CHIVES Project vouchers can be redeemed at the same selected stores 
and farmer’s markets as EatSF vouchers. 
 
[XXXX] Market: [XXXX] Market is a store located in the [Bayview] district of San Francisco. [XXXX] collaborates with 
Healthy Southeast and has shown a commitment to selling healthy groceries to the [Bayview] community. 
 
AGREEMENT 
 
EatSF, the CHIVES Project, and [XXXX] enter in to this agreement in good faith to assist eligible clients with healthy 
eating and access to free fruits and vegetables, and other food items.  [XXXX] agrees to accept EatSF and CHIVES 
Project vouchers for eligible fresh and frozen fruits and vegetables, or CalFresh-eligible (EBT / SNAP / Food Stamp- 
eligible) food items, depending on the type of food voucher. EatSF and the CHIVES Project agree to reimburse 
[XXXX] for the value of the voucher plus a convenience fee. The following section outlines the distinct responsibilities 
of the partners: 
 
RESPONSIBILITIES OF THE PARTNERS 
 
Agreed upon practices. [XXXX] agrees to: 
1. 
Accept (i) EatSF fruit and vegetable vouchers, (ii) CHIVES Project fruit and vegetable vouchers, (iii) and/or 
CHIVES Project CalFresh-eligible (EBT / SNAP / Food Stamp-eligible) vouchers, in exchange for either 
eligible fresh or frozen fruits and vegetables, or CalFresh-eligible (EBT / SNAP / Food Stamp-eligible) food 
items, depending on the type of food voucher, up to the dollar value listed on the voucher ($5); 
2. 
Train staff in the appropriate use of the vouchers; 
3. 
Take reasonable precautions to avoid voucher fraud; 
4. 
Follow the guidelines and restrictions of the EatSF program and the CHIVES Project to ensure proper use of 
the vouchers by EatSF and CHIVES Project participants (customers) and vendor staff; 
5. 
Allow EatSF / CHIVES Project staff to visit store on a monthly basis to: (i) gather any feedback, resolve any 
issues or confusion, and hear about any misuse; (ii) routinely assess product pricing (to ensure prices do not 
increase in response to the intervention); and (iii) assess the available quality, quantity, and variety of fruits 
and vegetables; 
6. 
Secure EatSF and CHIVES Project vouchers in a safe place to avoid theft; 
7. 
Ensure the participant signs the voucher at the time of purchase (and not before); 
8. 
Send completed vouchers to EatSF for reimbursement at the following address: 
a. 
EatSF Voucher Program 
P.O. Box 410330 
San Francisco, CA 94941 
9. 
Participate in a 15-minute verbal post-intervention vendor survey, conducted by EatSF / CHIVES Project 
staff sometime in late 2018. 

EatSF Fruit 
Programs 
 
EatSF & The CHIVES Project: Food Voucher 
 
Vendor Agreement 
 
 
Prohibited practices. [XXXX] agrees to: 
1. 
NOT give change or any cash back to customers (EatSF or CHIVES Project participants) for EatSF or 
CHIVES Project vouchers; 
2. 
NOT accept EatSF or CHIVES Project vouchers before the first day to use or after the last day to use as 
stated on each voucher; 
3. 
NOT buy or sell an EatSF or CHIVES Project vouchers for cash; 
4. 
NOT sell in exchange for a EatSF voucher or CHIVES Project fruit and vegetable voucher any food items 
that are not eligible, including processed foods, meats, canned goods, dried goods, dairy products, alcoholic 
beverages, tobacco products or any other non-EatSF item; 
5. 
NOT sell in exchange for a CHIVES Project CalFresh-eligible food items vouchers any food or beverages 
that are not eligible, including alcoholic beverages, vitamins / supplements, hot food, or food eaten in the 
store; 
6. 
NOT redeem EatSF or CHIVES Project vouchers in whole or in part for cash, rain checks, other items of 
value, or as a credit on accounts; 
7. 
NOT charge participants (or their proxies) prices that are higher than prices charged to other customers; 
8. 
NOT provide cash for returned food items originally purchased with EatSF or CHIVES Project vouchers; 
9. 
NOT exchange EatSF or CHIVES Project vouchers for any other certificate or product. 
 
 
Agreed upon practices. EatSF Program agrees to: 
1. 
Administer the EatSF program and CHIVES Project, and communicate to participants the eligible stores and 
farmer’s markets where EatSF and CHIVES Project vouchers can be used; 
2. 
Reimburse [XXXX] for EatSF or CHIVES Project vouchers redeemed at their store at [street address] San 
Francisco, CA. EatSF and the CHIVES Project will: 
a. 
Make payment to the vendor for the actual retail costs for EatSF and CHIVES Project vouchers 
accepted and redeemed (not to exceed $5.00 per voucher); 
b. 
Pay an additional convenience fee to vendor of $0.25 per voucher redeemed at their store 
c. 
EatSF will make every effort to reimburse the vendor within two weeks of receipt of vouchers. 
i. Note that vouchers that are incomplete may require additional processing time. 
3. 
Provide self-addressed, stamped envelopes for mailing back of vouchers; 
4. 
Offer support and training to [XXXX] staff; 
5. 
Supply promotional and other information materials; 
6. 
Be the main contact for EatSF and CHIVES Project questions, concerns, general customer service requests 
and other information 
 
 
PROCEDURE 
The vendor packet outline the general guidelines for partnership with the EatSF program and CHIVES Project. 
 
 
DURATION 
The term of this agreement will cover the period of January 2017 through July 2018 with the option to extend the 
term. Either party may cancel this agreement with a 15-day notice. 

EatSF Fruit 
Programs 
 
EatSF & The CHIVES Project: Food Voucher 
 
Vendor Agreement 
 
 
 
 
APPROVED BY: 
 
 
 
 
 
 
 
 
Hilary Seligman, MD, MAS 
Date 
EatSF Director 
UCSF’s Center for Vulnerable Populations at San Francisco General Hospital & Trauma Center 
 
 
 
 
 
 
 
 
 
 
Signature 
Date 
 
 
Name:  
 
Title:_  
 
Organization:_  
 
 
 
Both EatSF and [XXXX] are to retain signed copies of this Memorandum of Understanding for their records. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
XVII. Vendor Surveys 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

Page 1 of 7 
Participant ID: 
 
 
 
 
 
 
 
This questionnaire is to be administered in person to managers of all 
vendors participating in the voucher program. Only the participant ID 
should be entered on this form, and all paper copies are to be kept in 
the locked drawer at the study office when not in use for data entry. 
 
Please note that all managers of vendors will have completed an 
informed consent form as part of their enrollment if they agreed to 
participate in the survey. Surveys should only be sent to those 
managers with a documented informed consent form and participant 
ID. 
NOTE TO RESEARCH STAFF 
STANFORD UNIVERSITY 
Protocol Director: 
Sanjay Basu 
Protocol Title:  Designing Food Voucher Programs to Reduce Disparities in Healthy Diets 

Page 2 of 7 
Participant ID: 
 
 
 
 
 
 
 
Thank you for participating in our study of how well food vouchers 
help improve nutrition among low-income households in San 
Francisco. 
 
As part of the study, we wish to ask you questions about how our 
program could improve. Please complete the attached survey and 
place it in the included self-addressed stamped envelope by 
December 31, 2018. This survey is completely voluntary. 
 
If you have any questions about this study, or about anything else, 
you can contact me at 415-881-7030, or the Stanford IRB at 650- 
723-2480 or toll free at 1-866-680-2906. Have a good day and I look 
forward to talking with you later. 
INTRODUCTION 
STANFORD UNIVERSITY 
Protocol Director: 
Sanjay Basu 
Protocol Title:  Designing Food Voucher Programs to Reduce Disparities in Healthy Diets 

Page 3 of 7 
Participant ID: 
 
 
 
 
 
 
We want to know your experience with the voucher program and how 
voucher programs might improve in the future. Please answer all 
questions to the best of your ability. 
 
V1. Do you or your cashiers or other store employees have difficulty 
accepting any vouchers, to your knowledge? 
 
[ 
] 
YES 
[ 
] 
NO 
 
If you answered “yes”, please explain the difficulty in the space 
below. Include where the difficulty(ies) happened, e.g., “at the 
cashier’s stand”, and why, e.g., “the cashier did not know what the 
voucher was”. You can write your answer in any language and we 
will have it translated. 
STANFORD UNIVERSITY 
Protocol Director: 
Sanjay Basu 
Protocol Title:  Designing Food Voucher Programs to Reduce Disparities in Healthy Diets 

Page 4 of 7 
Participant ID: 
 
 
 
 
V2. Did you have any difficulty receiving prompt and correct 
reimbursements for the vouchers you redeemed? 
 
[ 
] 
YES 
[ 
] 
NO 
 
If you answered “yes”, please explain the difficulty in the space 
below. You can write your answer in any language and we will have 
it translated. 
STANFORD UNIVERSITY 
Protocol Director: 
Sanjay Basu 
Protocol Title:  Designing Food Voucher Programs to Reduce Disparities in Healthy Diets 

Page 5 of 7 
Participant ID: 
 
 
 
 
V3. Did you promote or advertise fruits and vegetables during the 
period of the voucher study, from January 1, 2017 through December 
31, 2017? 
 
[ 
] 
YES 
[ 
] 
NO 
 
If you answered “yes”, please explain how you promoted fruits and 
vegetables (e.g., “a mailer” or “in-store advertising”). You can write 
your answer in any language and we will have it translated. 
STANFORD UNIVERSITY 
Protocol Director: 
Sanjay Basu 
Protocol Title:  Designing Food Voucher Programs to Reduce Disparities in Healthy Diets 

Page 6 of 7 
Participant ID: 
 
 
 
 
V4. Do you think you sold more fruits and vegetables than usual 
because of the voucher program? 
 
[ 
] 
YES 
[ 
] 
NO 
 
V5. What changes or suggestions would you have for improving the 
voucher program in the future? Please answer in the space below. 
You can write your answer in any language and we will have it 
translated. 
STANFORD UNIVERSITY 
Protocol Director: 
Sanjay Basu 
Protocol Title:  Designing Food Voucher Programs to Reduce Disparities in Healthy Diets 

Page 7 of 7 
Participant ID: 
 
 
 
 
This completes all of our questions. We greatly appreciate the time 
you have taken to participate in our study. If you have any questions 
about this study, or about anything else, you can contact me or the 
study director, Sanjay Basu, at 415-881-7030, or the Stanford IRB at 
650-723-2480 or toll free at 1-866-680-2906. 
 
Thank you and have a great day. 
STANFORD UNIVERSITY 
Protocol Director: 
Sanjay Basu 
Protocol Title:  Designing Food Voucher Programs to Reduce Disparities in Healthy Diets 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
XVIII. Vendor Handout – “cheat sheet” for store 
staff on how to accept CHIVES vouchers 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

 
 
 
CHIVES Voucher Instructions at Cash Register 
Fruits & Vegetables 
 
 
 
CD 
 
 
@ 
 
 
O Check that voucher purchases are all fresh or frozen fruits 
and vegetables without added sugar, salt, or sauces. 
Pre-packaged fruits and vegetables are okay. 
 
8 Check that today’s date is between “First day to use” 
and “Last day to use.” 
 
@ Write total dollar value of the food purchased. 
Do not write an amount greater than $5.00. 
If customer spends more than $5.00, they must pay the difference. 
If customer spend less than $5.00, no change is given. 
 
O Have the customer sign and date the voucher after 
you write in the dollar amount. 
 
 
 
 
 
 
 
Questions? 
e-mail us: 
chivesproject@stanford.edu 
 
call us: 
(844) 4-CHIVES or (844) 424-4837 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
O Check that voucher purchases are all CalFresh eligible items. 
Customers cannot buy alcoholic beverages, supplements, vitamins, 
medicines, hot food, food eaten in the store, pet food, or tobacco. 
 
8 Check that today’s date is between “First day to use” 
and “Last day to use.” 
 
@ Write total dollar value of the food purchased. 
Do not write an amount greater than $5.00. 
If customer spends more than $5.00, they must pay the difference. 
If customer spend less than $5.00, no change is given. 
 
O Have the customer sign and date the voucher after 
you write in the dollar amount. 
 
 
 
 
 
Questions? 
CHIVES Voucher Instructions at Cash Register 
CalFresh Eligible Items 
CD 
 
 
@ 
e-mail us: 
chivesproject@stanford.edu 
call us: 
(844) 4-CHIVES or (844) 424-4837 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
XIX. Data Safety and Monitoring Protocol 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CHIVES Manual of Operational Procedures 
Version 2.0, December 20, 2016 

Food Vouchers DSMB Meeting Agenda and Charter 
1 
DSMB Meeting 7/15/2016 
 
Food Vouchers Project 
(NHLBI R01 HL132814) 
 
 
Data Safety Monitoring Board (DSMB) Report 
Sanjay Basu, MD, PhD, Principal Investigator 
Hilary Seligman, MA, MAS, Principal Investigator 
 
July 15, 2016, 12pm Pacific Standard Time 
 
 
 
 
I. 
Welcome and introductions 
 
II. 
Review DSMB charter 
 
III. 
Review project protocol and proposed modifications 
 
IV. 
Review DSMP and proposed data report templates for subsequent DSMB meetings 
 
V. 
Executive Session of DSMB 
 
VI. 
Review of recommendations that result from 7/15/2016 meeting 
 
 

Food Vouchers DSMB Meeting Agenda and Charter 
2 
DSMB Meeting 7/15/2016 
 
II. 
Data and Safety Monitoring Board Charter 
 
The Data and Safety Monitoring Board (DSMB) will provide oversight to the project with respect 
to issues of project progress, data quality, and participant safety. The project consists of a 2x2 
factorial design intervention trial followed by a cost-effectiveness analysis. Although the project 
does not involve greater than minimal risk, the PI assembled a DSMB as the intervention trial 
meets criteria for a Phase III clinical trial.  The DSMB will convene the initial meeting via 
conference call on Friday, July 15th, 2016. 
 
The DSBM consists of three experts not affiliated with the project: Jason Block, Harvard; 
Kristina Lewis, Wake Forest; and Arjumand Siddiqi, University of Toronto. These members 
have expertise in epidemiology, nutrition, randomized intervention trials, and community-based 
participatory research among vulnerable and low-income populations.  These three experts 
comprise the voting members of the DSMB. 
 
One of the PIs (Sanjay Basu) and designated staff are responsible for preparing and presenting 
masked data reports for the DSMB meetings. The Study Statistician (Joe Rigdon) is responsible 
for preparing unmasked data reports for the voting members of the DSMB.  Dr. Basu will  
provide overall guidance on the project’s a priori statistical analyses and report to the DSMB on 
issues related to participant safety. Only the voting members of the DSMB and the designated 
Study Statistician (Joe Rigdon) will have access to unmasked outcome data. 
 
The DSMB will have the following charges: 
 
• 
At the initial meeting, the DSMB will review the project protocol with regard to 
recruitment, randomization, intervention implementation, retention, data management 
and quality control, statistical analysis plans, and participant safety. The DSMB will 
review proposed modifications and identify any additional needed modifications. 
 
• 
At the initial meeting, the DSMB will decide on meeting frequency, expected to be at 
least annual, and identify the relevant data parameters and report format for subsequent 
meetings. The DSMB will develop any stopping rules for the project with a primary 
consideration based on participant safety. 
 
• 
At subsequent meetings, the DSMB will review data relating to recruitment including 
ethnic/racial minority inclusion, randomization, intervention adherence, retention, data 
management and quality control, statistical analyses, intervention effects, and participant 
safety including review of adverse events. 
 
• 
Over the project, the DSMB will request any needed additional data relevant to safety 
issues, inform PI Basu of any safety problems by phone and via written report, and make 
overall recommendations to the PI concerning the safety of continuing the project. 
 
• 
Following each meeting, the DSMB will send written reports to the PI that summarize 
any key concerns brought up by the DSMB.