Clinical trial NCT02651064: USDA Healthy Incentives Pilot
Official title: USDA Healthy Incentives Pilot (HIP)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Dietary Modification
Keywords: Supplemental Nutrition Assistance Program (SNAP)
fruits and vegetables
price incentive
Lead sponsor: Abt Associates
Sponsor class: INDUSTRY
Collaborators: name: Tufts University
name: MAXIMUS
name: USDA Food and Nutrition Service
name: Massachusetts Department of Transitional Assistance
First posted: 2016-01-08
Enrollment: 55095
Sex: ALL
Minimum age (years): 16
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL

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.

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

Primary outcomes:
measure: Targeted fruit and vegetable (TFV) intake
timeFrame: 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 outcomes:
measure: All fruit and vegetable intake
timeFrame: 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
measure: Intake of other foods
timeFrame: 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
measure: HEI-2010
timeFrame: 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
Other outcomes:
measure: Family food environment
timeFrame: Assessed at baseline (1-3 mo prior to implementation) and two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis
measure: Exposure to nutrition education and promotion
timeFrame: Past 3 months; assessed at baseline (1-3 mo prior to implementation) and two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis
measure: Food preferences and beliefs
timeFrame: Assessed at baseline (1-3 mo prior to implementation) and two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis
measure: Perceived barriers to fruit and vegetable consumption
timeFrame: Assessed at baseline (1-3 mo prior to implementation) and two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis
measure: Perceived barriers to grocery shopping
timeFrame: Assessed at baseline (1-3 mo prior to implementation) and two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis
measure: Average monthly household Supplemental Nutrition Assistance Program (SNAP) food expenditures
timeFrame: Assessed for two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis
measure: Self-reported monthly household expenditures
timeFrame: Assessed at baseline (1-3 mo prior to implementation) and two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis
measure: Usual grocery shopping location
timeFrame: Assessed at baseline (1-3 mo prior to implementation) and two follow up rounds (4-6 mo and 9-11 mo post-implementation); data pooled across two follow-up rounds for main analysis
Locations:
Study officials:
affiliation: Abt Associates
name: Susan Bartlett, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Abt Associates Inc. Healthy Incentives Pilot: Updated Study Plan. USDA, Food and Nutrition Service, 2011. http://www.fns.usda.gov/sites/default/files/study_plan.pdf.
citation: Bartlett S, Beauregard M, Logan C, Komarovsky M, Wommack T, Wilde P, Owens C, Melham M, McLaughlin T. Healthy Incentives Pilot (HIP): Early Implementation Report. USDA, Food and Nutrition Service, 2013. http://www.fns.usda.gov/sites/default/files/HIP_Early_Implementation.pdf.
citation: Chu, A. Evaluation of the Healthy Incentives Pilot (HIP): Participant survey weighting methodology. Alexandria, VA: USDA, Food and Nutrition Service, Office of Policy Support, 2014.
citation: Bartlett S, Klerman J, Olsho L, Logan C, Blocklin M, Beauregard M, Enver A, Wilde P, Owens C, Melhem M. Evaluation of the Healthy Incentives Pilot (HIP): Final Report. USDA, Food and Nutrition Service, 2014. http://www.fns.usda.gov/healthy-incentives-pilot-final-evaluation-report.
citation: Wilde P, Klerman JA, Olsho LEW, Bartlett S. Explaining the impact of USDA's Healthy Incentives Pilot on different spending outcomes. Appl Econ Perspect Policy 2015 (Epub ahead of print; DOI: Epub ahead of print; DOI: doi:10.1093/aepp/ppv028).
citation: Klerman JAK, Bartlett S, Wilde P, Olsho L. The short-run impact of the Healthy Incentives Pilot Program on fruit and vegetable intake. Am J Agr Econ 2015;96:1372-82.
citation: Olsho LE, Klerman JA, Wilde PE, Bartlett S. Financial incentives increase fruit and vegetable intake among Supplemental Nutrition Assistance Program participants: a randomized controlled trial of the USDA Healthy Incentives Pilot. Am J Clin Nutr. 2016 Aug;104(2):423-35. doi: 10.3945/ajcn.115.129320. Epub 2016 Jun 22.