Harnack Lisa, Oakes J Michael, Elbel Brian, Beatty Timothy, Rydell Sarah, French Simone
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
Department of Population Health, School of Medicine and Wagner School of Public Service, New York University, New York.
JAMA Intern Med. 2016 Nov 1;176(11):1610-1618. doi: 10.1001/jamainternmed.2016.5633.
Strategies to improve the nutritional status of those participating in the Supplemental Nutrition Assistance Program (SNAP) are of interest to policymakers.
To evaluate whether the proposed policy of incentivizing the purchase of fruits and vegetables and prohibiting the purchase of less nutritious foods in a food benefit program improves the nutritional quality of participants' diets.
DESIGN, SETTING, AND PARTICIPANTS: Lower income participants (n = 279) not currently enrolled in SNAP were randomized to 1 of 4 experimental financial food benefit conditions: (1) incentive (30% financial incentive for fruits and vegetables purchased using food benefits); (2) restriction (not allowed to buy sugar sweetened beverages, sweet baked goods, or candies with food benefits); (3) incentive plus restriction (30% financial incentive on fruits and vegetables and restriction of purchase of sugar sweetened beverages, sweet baked goods, or candy with food benefits); or (4) control (no incentive or restrictions on foods purchased with food benefits). Participants in all conditions were given a study-specific debit card where funds were added every 4 weeks for a 12-week period. Outcome measures were collected at baseline and in the final 4 weeks of the experimental period.
Primary outcomes (from 24-hour dietary recalls) included intake of energy, discretionary calories, and overall diet quality.
A number of favorable changes were observed in the incentive plus restriction condition that were significantly different from changes in the control condition. These included (1) reduced intake of energy (-96 kcal/d, standard error [SE], 59.9); (2) reduced intake of discretionary calories (-64 kcal/d, SE 26.3); (3) reduced intake of sugar sweetened beverages, sweet baked goods, and candies (-0.6 servings/d, SE 0.2); (4) increased intake of solid fruit (0.2 servings/d, SE 0.1); and (5) improved Healthy Eating Index score (4.1 points, SE 1.4). Fewer improvements were observed in the incentive only and restriction only arms.
A food benefit program that pairs incentives for purchasing more fruits and vegetables with restrictions on the purchase of less nutritious foods may reduce energy intake and improve the nutritional quality of the diet of participants compared with a program that does not include incentives or restrictions.
clinicaltrials.gov Identifier: NCT02643576.
政策制定者对改善参与补充营养援助计划（SNAP）者营养状况的策略很感兴趣。
评估在食品福利计划中激励购买水果和蔬菜并禁止购买营养较差食品的拟议政策是否能改善参与者饮食的营养质量。
设计、背景和参与者：目前未参加SNAP的低收入参与者（n = 279）被随机分配到4种实验性财务食品福利条件中的一种：（1）激励组（对使用食品福利购买的水果和蔬菜给予30%的财务激励）；（2）限制组（不允许用食品福利购买含糖饮料、甜烘焙食品或糖果）；（3）激励加限制组（对水果和蔬菜给予30%的财务激励，并限制用食品福利购买含糖饮料、甜烘焙食品或糖果）；或（4）对照组（对用食品福利购买的食品无激励或限制）。所有条件下的参与者都得到一张特定研究的借记卡，在为期12周的时间里每4周充值一次。在基线和实验期的最后4周收集结果指标。
主要结局（来自24小时饮食回顾）包括能量摄入、自由支配卡路里摄入量和总体饮食质量。
在激励加限制组观察到一些有利变化，与对照组的变化有显著差异。这些变化包括：（1）能量摄入减少（-96千卡/天，标准误[SE]，59.9）；（2）自由支配卡路里摄入量减少（-64千卡/天，SE 26.3）；（3）含糖饮料、甜烘焙食品和糖果的摄入量减少（-0.6份/天，SE 0.2）；（4）固体水果摄入量增加（0.2份/天，SE 0.1）；以及（5）健康饮食指数得分提高（4.1分，SE 1.4）。仅激励组和仅限制组观察到的改善较少。
与不包括激励或限制的计划相比，一个将购买更多水果和蔬菜的激励措施与购买营养较差食品的限制措施相结合的食品福利计划可能会减少能量摄入并改善参与者饮食的营养质量。
clinicaltrials.gov标识符：NCT02643576。
