fruit and vegetable vouchers with and without an ssb tax

Conditions: Cardiovascular Diseases

Summary: we aim to examine whether a purchasing incentive for healthy foods has the same effect on dietary intake in a community with and a community without a purchasing penalty for unhealthy foods. we will perform a randomized non-inferiority trial in two locations, san francisco (sf) and los angeles (la) to test whether a voucher for purchasing fresh fruits and vegetables has a similar effect in la and in sf, where the former does not but the latter does have a tax on sugar-sweetened beverages. participants will be recruited from 4 neighborhoods (n=312) with 2 sf neighborhoods (exposed to the ssb tax) and 2 la neighborhoods (not exposed to the ssb tax).

we will test the hypothesis that a positive incentive for healthy foods (fresh fruits and vegetables, f\&vs) will be utilized as effectively in a community without a purchasing penalty for unhealthy foods (a sugar-sweetened beverage \[ssb\] tax) as in a community with a purchasing penalty for unhealthy foods (a ssb tax). our experiment will test the empirically-driven hypothesis in a real-world setting through a noninferiority design: comparing the impact of f\&v vouchers in two counties, one without (los angeles) and one with (san francisco) a ssb tax. each study participant will receive four paper vouchers per month for a total of six months. each of these vouchers can be redeemed for fresh or frozen fruits and vegetables at a number of specified local corner stores, supermarkets, or farmer's markets. half of these participants will receive and spend these vouchers in an environment which has implemented a ssb tax (sf); the other half will receive and spend these same vouchers in a non-tax environment (la). each individual participant will be enrolled in the study for a total of seven months from initial orientation and participant consent (m0) to final data collection during final month of intervention (m6). we are using a non-inferiority trial design. we are aiming to test whether there is a significant difference in total cup-equivalents of f\&v intake in la participants as compared to sf participants when given f\&v vouchers. that is, we aim to test whether the f\&v voucher is less effective in la than in sf. this is important to test because it has been purported that sf has a unique food environment with high accessibility to fresh f\&v through farmer's markets and a plethora of corner stores, as well as a ssb tax that discourages less healthy foods, potentially leaving more funds for healthier f\&vs. thus, we aim to determine the change in consumption of f\&v in la participants is non-inferiority to that of sf participants, when both are given f\&v vouchers.

Eligibility criteria:
inclusion criteria: 1. understand english sufficiently to provide informed consent; 2. provision of signed and dated informed consent form; 3. stated willingness to comply with all study procedures and availability for the duration of the study; 4. any gender, aged 21 years or older; 5. have self-reported income ≤250% of the federal poverty level; 6. have regular access to a mobile phone; 7. have a safe and secure mailing address at which to receive vouchers; 8. be a resident of the counties of san francisco or los angeles as defined by official municipal boundaries. exclusion criteria: 1. currently participating in any other dietary or nutrition study that would impact his or her normal eating patterns; 2. currently be enrolled in and receiving eatsf, chives, or vouchers4veggies vouchers; 3. has active diagnosis of cancer or congestive heart failure; 4. is planning to move out of san francisco or los angeles in the next 12 months; 5. currently pregnant. 6. currently live with and share a food budget with a current vouchers4veggies, evidence, or chives study participant.

Keywords: nutrition fruits and vegetables sugar-sweetened beverages