Comparison of Produce Prescription Benefit Dosage

Study Overview
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Brief Summary
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The goal of this study is to determine the relationship between produce prescription program 'dose' on benefit redemption, food insecurity, and fruit and vegetable consumption. Participants will be randomized to receive one of three fruit and vegetable benefit dose amounts for 6 months ($40, $80, or $110/month).

Detailed Description
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Emerging evidence from the growing body of research around 'Food is Medicine' interventions shows promise that produce prescriptions (PPR) improve health by enabling purchases of healthy foods, reducing food insecurity, and improving diet quality. However, PPR amounts are often set seemingly arbitrarily, without clear connection to their intended purpose. In this study, investigators will conduct a three-armed randomized trial of 240 participants in Stockton, CA to test the impact of three 'doses' of a fruit and vegetable benefit on benefit redemption, food security, and fruit and vegetable intake. The goal of this study is to determine the relationship between PPR program 'dose' and the key intermediate outcomes of benefit redemption (primary outcome), food insecurity, and consumption of incentivized foods (secondary outcomes). Investigators will also seek to identify any 'ceiling effect' above which further increases in benefit value do not lead to further benefit redemption. This will be highly informative for subsequent PPR research. Investigators will leverage the existing infrastructure of the Vouchers 4 Veggies - EatSF produce prescription program to ensure feasibility.

Official Title
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Comparison of Produce Prescription Benefit Dosage on Redemption

Conditions
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Food Insecurity

Intervention / Treatment
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* Behavioral: Monetary benefit to purchase fruits and vegetables


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Individual receiving services at El Concilio, located in Stockton, CA Age 18+ English or Spanish speaking Literacy sufficient to complete a written survey Technologic capacity to complete an online survey Exclusion Criteria: non English or Spanish speaking cognitive impairment severe enough to interfere with understanding of the survey or consent form, whether due to cognitive delay, substance abuse, dementia, mental illness, or other etiologies

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Participants will be randomized into one of three arms. Each arm will receive a different benefit amount during the 6-month intervention period, with benefit amounts determined by a percentage of the Thrifty Food Plan (TFP) - the USDA food plan used to calculate SNAP benefit rates. For ethical reasons, participants will each receive the same total benefit amount over the course of the study, with those randomized to the lower benefit arms receiving the difference between the value of the benefits issued to them and the value of the benefits issued to the highest dose group as a lump sum payment at the end of the study.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Arm 1 - 10% TFP<br>Participants will receive $40/month in fruit and vegetable benefits for 6 months ($240 total). | Behavioral: Monetary benefit to purchase fruits and vegetables<br>* Participants will receive varying benefit amounts to purchase fruits and vegetables.<br>|
| Active Comparator: Arm 2 - 20% TFP<br>Participants will receive $80/month in fruit and vegetable benefits for 6 months ($480 total). | Behavioral: Monetary benefit to purchase fruits and vegetables<br>* Participants will receive varying benefit amounts to purchase fruits and vegetables.<br>|
| Active Comparator: Arm 3 - 30% TFP<br>Participants will receive $110/month in fruit and vegetable benefits for 6 months ($660). | Behavioral: Monetary benefit to purchase fruits and vegetables<br>* Participants will receive varying benefit amounts to purchase fruits and vegetables.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Benefit redemption | Dollar amount of benefits redeemed (numerator) over total dollar amount of benefits distributed (denominator) | Monthly for 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fruit and vegetable consumption | Measured by NCI Dietary Screener Questionnaire (DSQ) and reported in cup-equivalents, a higher score indicates greater fruit and vegetable intake (better outcome) | 0, 3, and 6 months | 
| Food security status | Measured by USDA 6-item food security module, scale of 0-6, a higher score indicates more severe food insecurity (worse outcome); Scores converted to Rasch measurement scale, scale of 0-8.48, a higher score indicates more severe food insecurity | 0, 3, and 6 months |