Social Determinants of Health: Fruit and Vegetable Incentive Programs

Community Preventive Service Task Force (CPSTF) (2023)

CPSTF - doi.org/10.15620/cdc/168585

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Evidence Categories

• Care setting: Commercial food environment
• Care setting: National, regional or local policy
• Population group: Low socioeconomic status
• Population group: Adults with poor diet
• Intervention: Policy / environmental: Taxation & subsidies
• Intervention: Intra-/Inter-personal: Food provision
• Outcome: Healthy Eating: Sugar-sweetened drinks intake
• Outcome: Healthy eating: Sugar-added food intake
• Outcome: Healthy Eating: Fruit and veg intake
• Outcome: Healthy Eating: Whole diet quality

Type of Evidence

Guidance

Overview

The systematic review, which underpins this CPSTF recommendation, provides evidence on the following topic:

• "Fruit and vegetable incentive (FVI) programs offer people financial incentives to purchase fruits and vegetables. These programs aim to improve affordability and access to fruits and vegetables for participants with lower incomes. Examples include produce prescriptions, bonus dollars, market bucks, produce coupons, and nutrition incentives. People can use incentives to help pay for fruits and vegetables at a range of venues, including farmers markets, mobile markets, or grocery stores. Incentive models may include:
  • Point-of-sale discounts (i.e., percentage off regular price)
  • Rebates (i.e., cash back for future purchases)
  • Matches (i.e., money tied to the dollar amount spent)
  • Subsidies (i.e., a fixed amount of money available to purchase fruits and vegetables)
• "Programs may be implemented by community-based organizations; local, state, territorial, or tribal governments; or health systems. Programs may also offer participants nutrition education, such as cooking lessons or demonstrations."
• "Fruit and vegetable incentive programs are expected to improve health equity across the United States by improving affordability and access to healthier foods for households with lower incomes."

The authors state:

• "The CPSTF recommendation is based on evidence from a systematic review of 30 studies conducted in the US."

• "Evidence from the included studies showed FVI programs reduced household food insecurity and improved fruit and vegetable consumption."

• "Studies did not show consistent and meaningful improvement in overall diet quality, blood pressure, or body mass index. There were not enough studies to determine whether FVI programs affected sugar sweetened beverage consumption, self-reported health, or cholesterol"

• "The CPSTF finding is applicable to participants with lower incomes."

Recommendations

Taking into consideration evidence and stakeholder input, the CPSTF recommends:

"The Community Preventive Services Task Force recommends FVI programs for households with lower incomes based on strong evidence of effectiveness in reducing household food insecurity and increasing household fruit and vegetable consumption."