Daily fruit and vegetable consumption is essential for maintaining a healthy weight and preventing chronic diseases,(1) yet few U.S adults meet daily recommendations, particularly adults of low socioeconomic status.(2) Low-income and minority households are also disproportionately impacted by the burden of food insecurity,(3) which is defined as a the economic or social condition of limited or unsafe access to adequate food.(4) These social inequalities may also exacerbate health disparities among non-Hispanic Black and Hispanic households.(5) In the U.S., food insecurity is associated with higher healthcare use and costs and multiple chronic disease risk factors,(6-8) as well as limitations in activities of daily living among older adults.(9) The Supplemental Nutrition Assistance Program (SNAP) is the largest federal food assistance program in the U.S., and participants may use their SNAP benefits to purchase any food or beverage, except for alcoholic beverages, pet foods, dietary supplements, hot foods, or non-food items.(10) Participation in SNAP helps alleviate food insecurity, but may not be enough to help low-income adults purchase and consume adequate amounts of fruits and vegetables.(11)
Previous studies suggest that cost and access are the main barriers preventing SNAP participants from purchasing and consuming fresh fruits and vegetables.(12, 13) SNAP participants report that consuming healthy foods is cost-prohibitive (relative to the costs of less healthy food items),(12) especially perishable foods such as produce.(14) Qualitative research also suggests that the physical environment influences SNAP participants’ ability to access fresh produce, potentially due to a lack of transportation, time constraints, and few stores selling fruits and vegetables.(12) Mobile produce markets are portable markets designed to mitigate these financial and physical barriers to healthy diet behaviors by selling affordable fruits and vegetables in areas with limited access to fresh produce.(15) A primary goal of mobile produce markets is to support the needs and preferences of underserved communities, including low-income, minority, and older customers. Many mobile produce markets operate out of vans, trucks, or carts, and target multiple community sites in a given day or week. A recent systematic review indicates that mobile produce market use is associated with greater access to and higher consumption of fruits and vegetables, though results are not always consistent.(15)
Food on the Move (FOTM) is a mobile produce market based in Providence, RI, and has been operating for over a decade. The FOTM program was informed by the “Live Well, Viva Bien” intervention, which offered fruits and vegetables at a discounted price to residents living in low-income housing sites via bi-weekly produce markets.(17) In spite of the program’s popularity and its effectiveness at markets located in senior housing sites,(18) customers still identified cost as a barrier to shopping at the mobile markets. The Rhode Island Public Health Institute (RIPHI) drew upon these findings to create the FOTM program, intentionally targeting senior housing sites for new market locations. In an effort to increase the affordability of produce, FOTM initially offered a matching credit, which allowed SNAP customers to earn $1 on a “Rhody Bucks” gift card for every $1 spent on produce. In response to customer feedback, FOTM transitioned from the “Rhody Bucks” gift card incentive to an automatic 50% discount, thus preserving the match amount while offering a more convenient delivery method.
Financial incentives such as matching credits and discount may mitigate disparities in diet and obesity risk by making healthy food more affordable.(20) Previous studies have shown that incentive programs at farmers’ markets, such as the Double Up Food Bucks (DUFB) Program, are linked to greater food security and higher fruit and vegetable intake among SNAP participants.(21, 22) Researchers have also tested the impact of financial incentives in supermarket settings, and have found that matching credits and discounts lead to higher spending on fresh fruits and vegetables among eligible customers.(23-27) In a recent study using survey data, more than 75% of SNAP customers at FOTM reported being able to make their benefits last longer by shopping at FOTM,(19) potentially due to the incentive.
Mobile produce markets may be an acceptable setting for SNAP incentive programs because they concurrently address physical access barriers to healthy food retailers and incorporate elements of community engagement in their program design. Though mobile produce markets are a promising strategy for mitigating financial barriers to healthy food consumption, few, if any, studies have examined whether SNAP participants purchase more fruit and vegetables as a result of receiving financial incentives in a mobile produce market setting. Similarly, few studies have tested the impact of an immediate 50% discount (versus a matching credit) on fruit and vegetable purchases,(24) or analyzed the effects among low-income immigrants living at senior sites.
To address these gaps in the literature, we sought to determine whether an automatic 50% discount on fruits and vegetables was associated with higher spending on fruits and vegetables among those using SNAP benefits at mobile produce markets. We hypothesized that customers using SNAP benefits would spend more on fruits and vegetables per month compared to those not using SNAP benefits in market transactions, as a result of the FOTM program. Based on the success of previous incentive programs in supermarket and farmer’s market settings,(21-27) we hypothesized that offering financial incentives would increase fruit and vegetable purchases among customers shopping at mobile produce markets.