USDA Healthy Incentives Pilot

Study Overview
=================
Brief Summary
-----------------
The USDA Healthy Incentives Pilot (HIP) evaluated the impact of a 30% financial incentive on fruit and vegetable intake among adult participants in the USDA Supplemental Nutrition and Assistance Program (SNAP).

Detailed Description
-----------------
U.S. fruit and vegetable intake remains below recommendations, particularly for low-income populations. Evidence on effectiveness of financial incentives for addressing this shortfall is limited. This study examined effects of USDA's Healthy Incentives Pilot (HIP), which offered financial incentives to Supplemental Nutrition Assistance Program (SNAP) participants for purchasing targeted fruits and vegetables (TFV). A randomized controlled trial of HIP was conducted in Hampden County, Massachusetts. 7,500 randomly selected SNAP households received a 30% rebate on TFV purchased using SNAP benefits. The remaining 47,595 SNAP households in the county received benefits as usual. Adults in 5,076 households were randomly sampled to complete telephone surveys, including 24-h dietary recall interviews. Surveys were conducted at baseline-1-3 mo pre-implementation-and in two follow-up rounds, 4-6 mo and 9-11 mo post-implementation. 2,784 adults (1,388 HIP, 1,396 non-HIP) completed baseline interviews; data were analyzed for 2,009 adults (72%) also completing at least one follow-up interview.

Official Title
-----------------
USDA Healthy Incentives Pilot (HIP)

Conditions
-----------------
Dietary Modification

Intervention / Treatment
-----------------
* Other: HIP


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Households with residential or mailing address in Hampden County, Massachusetts Receiving SNAP benefits in July 2011 Exclusion Criteria: Child-only cases (households not including at least one member aged 16 or older eligible to serve as SNAP head of household) Cases with benefits signed over to residential or treatment facilities

Ages Eligible for Study
-----------------
Minimum Age: 16 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: HIP<br>Received a 30% rebate on targeted fruits and vegetables (TFV) purchased using SNAP benefits in participating retailers. TFV earning the rebate included fresh, canned, frozen, and dried fruits and vegetables without added sugars, fats, oils, or salt, excluding white potatoes, mature legumes (dried beans and peas), and 100% juice. | Other: HIP<br> <br> * Other names: Price intervention;|
| No Intervention: Non-HIP<br>Received SNAP benefits as usual. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Targeted fruit and vegetable (TFV) intake | Daily adult intake of fresh, canned, frozen, and dried fruits and vegetables without added sugars, fats, oils, or salt, excluding white potatoes, mature legumes (dried beans and peas), and 100% juice. In total and by USDA food pattern group (all targeted fruits; citrus, melon, and berries; other fruits; all targeted vegetables; dark green vegetables; red & orange vegetables (including tomatoes and other red & orange vegetables); starchy vegetables (excluding white potatoes); and other vegetables.) Assessed via computer-assisted telephone interview 24-hour dietary recall (Automated Multiple Pass Method). Measured in cup-equivalents based on USDA Food Pattern Equivalents Database (FPED). Secondary analyses assessed changes between follow-up rounds. | Intake in prior 24 hours; assessed in two follow-up rounds (4-6 mo and 9-11 mo post-implementation) with 10% replicate subsample in each round; data pooled across two follow-up rounds and replicate samples for primary analysis | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| All fruit and vegetable intake | Daily adult intake of all fruits and vegetables (fresh, canned, frozen, or dried). In total and by USDA food pattern group (all fruits; citrus, melon, and berries; other fruits; all vegetables; dark green vegetables; red & orange vegetables (including tomatoes and other red & orange vegetables); starchy vegetables (including white potatoes and other starchy vegetables); legumes; and other vegetables.) Assessed via computer-assisted telephone interview 24-hour dietary recall (Automated Multiple Pass Method). Measured in cup-equivalents based on USDA Food Pattern Equivalents Database (FPED). Secondary analyses assessed changes between follow-up rounds. | Intake in prior 24 hours; assessed in two follow-up rounds (4-6 mo and 9-11 mo post-implementation) with 10% replicate subsample in each round; data pooled across two follow-up rounds and replicate samples for main analysis | 
| Intake of other foods | Daily adult intake of other foods. By USDA food pattern group (total grains (including whole and refined grains) (ounce-equivalents); total dairy (cup-equivalents); total protein foods (ounce-equivalents); total oils (gram-equivalents); solid fats (gram-equivalents); added sugars (teaspoons); and alcoholic drinks (drinks)). Assessed via computer-assisted telephone interview 24-hour dietary recall (Automated Multiple Pass Method). Measured in servings based on units as specified in the USDA Food Pattern Equivalents Database (FPED). Secondary analyses assessed changes between follow-up rounds. | Intake in prior 24 hours; assessed in two follow-up rounds (4-6 mo and 9-11 mo post-implementation) with 10% replicate subsample in each round; data pooled across two follow-up rounds and replicate samples for main analysis | 
| HEI-2010 | Healthy Eating Index-2010 (Guenther et al. 2014). Total and component scores (total fruit; whole fruit; total vegetables; beans and greens; whole grains; dairy; total protein foods; seafood and plant proteins; fatty acids; refined grains; sodium; empty calories). Assessed via computer-assisted telephone interview 24-hour dietary recall (Automated Multiple Pass Method). Servings calculated based on units as specified in the USDA Food Pattern Equivalents Database (FPED). Estimated via population ratio method (see Freedman et al. 2010). Secondary analyses assessed changes between follow-up rounds. | Calculated based on intake in prior 24 hours; assessed in two follow-up rounds (4-6 mo and 9-11 mo post-implementation) with 10% replicate subsample in each round; data pooled across two follow-up rounds and replicate samples for main analysis | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Supplemental Nutrition Assistance Program (SNAP), fruits and vegetables, price incentive