Cohen Alicia J, Richardson Caroline R, Heisler Michele, Sen Ananda, Murphy Ellen C, Hesterman Oran B, Davis Matthew M, Zick Suzanna M
Robert Wood Johnson Foundation Clinical Scholars program, University of Michigan, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan.
Robert Wood Johnson Foundation Clinical Scholars program, University of Michigan, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan.
Am J Prev Med. 2017 Feb;52(2):154-162. doi: 10.1016/j.amepre.2016.11.008.
Diet-related disease is disproportionately concentrated in low-income communities where fruit and vegetable consumption is far below guidelines. To address financial barriers, Double Up Food Bucks (DUFB)-a statewide healthy food incentive-matches Supplemental Nutrition Assistance Program (SNAP) funds spent at farmers markets. However, incentive use is limited. This study examined the impact of a brief waiting room-based intervention about DUFB on program utilization and produce consumption.
Longitudinal, repeated measures, quasi-experimental trial.
SETTING/PARTICIPANTS: SNAP-enrolled adults at a health center in a low-income, racially and ethnically diverse area of Southeast Michigan.
Participants received a brief explanation of DUFB, written program materials, a map highlighting market locations and hours, and an initial $10 market voucher. DUFB use and produce consumption were measured through four surveys over 5 months (August 2014-January 2015).
Outcome measures included DUFB use and fruit and vegetable consumption (analyses conducted in 2015-2016).
A total of 302 eligible adults were identified, and 177 (59%) enrolled. One hundred twenty-seven (72%) completed all surveys. At baseline, 57% of participants reported shopping at a farmers market within the last year; 18% had previously used DUFB. By the end of the DUFB season, participants were significantly more likely to report DUFB use than at baseline (AOR=19.2, 95% CI=10.3, 35.5, p<0.001), with 69% of participants reporting use of DUFB at least once, and 34% reporting use of DUFB three or more times. Adjusted fruit and vegetable consumption increased from baseline by 0.65 servings/day (95% CI=0.37, 0.93, p<0.001) at 3 months, and remained 0.62 servings/day (95% CI=0.32, 0.92, p<0.001) higher than baseline 2 months post-DUFB season.
A brief clinic-based intervention was associated with a nearly fourfold increase in uptake of a SNAP incentive program, as well as clinically and statistically significant increases in produce consumption. Results suggested sustained behavior change even once the financial incentive was no longer available. Providing information about healthy food incentives is a low-cost, easily implemented intervention that may increase produce consumption among low-income patients.
与饮食相关的疾病在低收入社区中极为集中，这些社区的水果和蔬菜消费量远低于指导标准。为消除经济障碍，“双倍食品券”（DUFB）——一项全州范围的健康食品激励计划——会对在农贸市场使用的补充营养援助计划（SNAP）资金进行匹配。然而，激励措施的使用有限。本研究考察了一项在候诊室进行的关于DUFB的简短干预对该计划利用率和农产品消费的影响。
纵向、重复测量、准实验性试验。
地点/参与者：密歇根州东南部一个低收入、种族和民族多样化地区的健康中心登记参加SNAP的成年人。
参与者收到了关于DUFB的简要说明、书面计划材料、一张突出显示市场位置和营业时间的地图，以及一张初始的10美元市场代金券。通过在5个月（2014年8月至2015年1月）内进行的四项调查来测量DUFB的使用情况和农产品消费情况。
结局指标包括DUFB的使用情况以及水果和蔬菜的消费量（分析于2015 - 2016年进行）。
共确定了302名符合条件的成年人，其中177人（59%）登记参加。127人（72%）完成了所有调查。在基线时，57%的参与者报告在过去一年内在农贸市场购物；18%的人此前使用过DUFB。到DUFB季节结束时，参与者报告使用DUFB的可能性比基线时显著更高（比值比=19.2，95%置信区间=10.3，35.5，p<0.001），69%的参与者报告至少使用过一次DUFB，34%的参与者报告使用过三次或更多次。调整后的水果和蔬菜消费量在3个月时比基线增加了0.65份/天（95%置信区间=0.37，0.93，p<0.001），在DUFB季节结束后2个月仍比基线高0.62份/天（95%置信区间=0.32，0.92，p<0.001）。
一项简短的基于诊所的干预与SNAP激励计划的参与率几乎增加四倍相关，同时在农产品消费方面也有临床和统计学上的显著增加。结果表明，即使经济激励不再存在，行为改变仍能持续。提供关于健康食品激励措施的信息是一种低成本、易于实施的干预措施，可能会增加低收入患者的农产品消费量。
