Improving Nutrition among Supplemental Nutrition Assistance Program Recipients Using a Monetary Incentive Model

Improving Nutrition among Supplemental Nutrition Assistance Program Recipients Using a Monetary Incentive Model by Jezabel Urbina MPH, National University, 2015 BS, National University, 2012 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University July 2018 Abstract The Supplemental Nutrition Assistance Program (SNAP) is the United States’ largest government assistance program that aims to alleviate food insecurity. The SNAP program allows low-income individuals and families the ability to purchase nutritious foods through a monthly benefit. However, the current body of literature presents evidence of the program’s counterproductive effect. The purpose of this study was to determineThe Supplemental Nutrition Assistance Program (SNAP) is the United States’ largest government assistance program that aims to alleviate food insecurity. The SNAP program allows low-income individuals and families the ability to purchase nutritious foods through a monthly benefit. However, the current body of literature presents evidence of the program’s counterproductive effect. The purpose of this study was to determine whether incentivizing SNAP recipients to purchase additional fruits and vegetables was beneficial in increasing such purchases. Social cognitive theory was used as a theoretical framework to address research questions associated with shopping patterns and attitudes and beliefs. This quantitative study used a randomized controlled trial to study differences between incentivized and control groups. The Healthy Incentives Pilot Program (HIP) used a stratified sampling of 55,095 SNAP households receiving benefits between July, 2011, and December, 2012. Statistical analyses (t test, Pearson correlation, and multiple regression analysis) were conducted to identify changes in food shopping patterns and eating behaviors associated with the HIP intervention. Results indicated that (a) incentivizing SNAP recipients leads to an increase in fruit and vegetable purchase, and (b) a correlation exists between fruit and vegetable purchase and attitudes and beliefs. No correlation was found between the intervention and changes in food shopping patterns. Positive social change implications include the improvement of health outcomes in over 43 million people currently enrolled in the SNAP program on a national level. Improving Nutrition among Supplemental Nutrition Assistance Program Recipients Using a Monetary Incentive Model by Jezabel Urbina MPH, National University, 2015 BS, National University, 2012 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University July 2018 Dedication I dedicate this doctoral study to my family who has been supportive through all these years of my academic journey. To my brother (Ernest) who inspired me to keep reaching for the stars despite any obstacles. I still remember his first words to me in 2001 after his life-threatening car accident. After weeks of being in a coma and intensive care, he opened his eyes and asked me “How’s school? ” To my brother and sisters (Manny, Patty and Adriana) for cheering on their little sister as she reached every milestone. To my parents for always supporting me since day 1 when I decided to return to school as a single parent. Their undying support and being the best parents and grandparents is what kept me afloat through even the most challenging days of juggling work, school and parenthood. To my partner in life (Cesar) who is proud to support and walk beside (not in front or behind) a strong and ambitious woman with big dreams and big goals. Finally, I dedicate this study to my children. To my oldest daughter (Alessandra) who has been by mommy’s side since 1 year old when mommy decided to go back to school. Mommy promised you the world and my hope is that you will see how you can attain it through hard work and dedication. To my Tesla and Niko who have been my God sent blessings these past two years. I love you all. Lastly, to all those struggling to maintain a healthy diet and lifestyle with limited income: “If you think the pursuit of good health is expensive and time consuming, try illness. ” ~Lee Swanson Acknowledgments I am thankful to God for all his blessings and for giving me the strength to push through across the finish line even on the days my faith was questioned. I also want to express my sincerest gratitude to my dissertation chair, Dr. Aimee Ferraro. Thank you for being an amazing support system. Your kindness, guidance, support, and constructive feedback contributed to the finalization of this study in such a short time. To my committee chair, Dr. Mary Lou Gutierrez. Thank you for such valuable feedback and for holding me to such high standards through my revisions. A special thank you to Unidos Por La Musica, a non-profit organization I hold near and dear to my heart. Your dedication to providing food security through healthy options to those in need regardless of race, age, and income or immigration status is making a difference in your communities. I look forward to many more years of partnership and collaboration. Lastly, I want to acknowledge my family and friends who sacrificed spending less time with me so that I could finish this study. I’ve missed vacations, family trips, holidays and gatherings throughout the years because of my dedication to this study. This did not go unnoticed and I owe all of you a big vacation!