Center for Primary Care, Harvard Medical School, Boston, Massachusetts.
Research and Population Health, Collective Health, San Francisco, California.
JAMA Netw Open. 2021 Mar 1;4(3):e211757. doi: 10.1001/jamanetworkopen.2021.1757.
Fruit and vegetable vouchers have been implemented by cities and counties across the US to increase fruit and vegetable intake and thereby improve overall nutritional quality.
To determine whether and why use of fruit and vegetable vouchers are associated with varied nutritional intake across different populations and environments.
DESIGN, SETTING, AND PARTICIPANTS: In a population-based pre-post cohort study of 671 adult participants with low income before and during (6 months after initiation) participation in a 6-month program, fruit and vegetable vouchers were distributed for redemption at local San Francisco and Los Angeles neighborhood grocery and corner stores between 2017 and 2019. A transportability analysis was performed to identify factors that may explain variation in voucher use between cities.
Receipt of $20 per month in produce vouchers for 6 months from 2017 to 2019.
Change in total fruits and vegetables (as defined by the US Department of Agriculture) consumed per person per day (change in cup-equivalents between month 6 and month 0).
A total of 671 adults (median age, 54.9 years [interquartile range, 45.0-65.0 years]; 61.7% female; 30.9% Black; 19.7% Hispanic) were enrolled. An increase in fruit and vegetable intake of 0.22 cup-equivalents per day overall (95% CI, 0.14-0.31 cup-equivalents; P < .001) was observed. However, the observed increase was larger in Los Angeles compared with San Francisco (0.64 cup-equivalents per day; 95% CI, 0.41-0.88 cup-equivalents vs 0.10 cup-equivalents per day; 95% CI, 0.01-0.19 cup-equivalents). When the concurrently sampled San Francisco group (n = 157) was weighted in transportability analysis to demographically match the Los Angeles group (n = 155) in observed covariates, the weighted San Francisco group had an estimated increase of 0.53 fruit and vegetable cup-equivalents per day (95% CI, 0.27- 0.79 cup-equivalents, P = .03), with income being the variable needed to allow the 95% confidence intervals to overlap between the weighted San Francisco and unweighted Los Angeles populations.
In this study, the use of fruit and vegetable vouchers appeared to be associated with greater benefit among those with lower incomes, suggesting that further investigation of flat-rate rather than income-scaled benefits is warranted.
美国各地的城市和县都实施了水果和蔬菜券计划，以增加水果和蔬菜的摄入量，从而提高整体营养质量。
确定水果和蔬菜券的使用是否以及为何与不同人群和环境中不同的营养摄入有关。
设计、设置和参与者：在一项基于人群的前后队列研究中，共有 671 名低收入成年人在参加为期 6 个月的计划之前和期间（在计划开始后的 6 个月内）接受了研究，2017 年至 2019 年期间，在旧金山和洛杉矶当地的社区杂货店和街角商店发放了用于兑换的 20 美元水果和蔬菜券。进行了一项可转移性分析，以确定可能解释券在城市之间使用差异的因素。
2017 年至 2019 年期间，每月获得 20 美元的农产品券，为期 6 个月。
每人每天食用的总水果和蔬菜量的变化（根据美国农业部定义，以杯当量计）（6 个月与 0 个月之间的变化）。
共有 671 名成年人（中位年龄，54.9 岁[四分位间距，45.0-65.0 岁]；61.7%为女性；30.9%为黑人；19.7%为西班牙裔）入组。总体上观察到水果和蔬菜摄入量增加 0.22 杯当量/天（95%置信区间，0.14-0.31 杯当量；P<0.001）。然而，与旧金山相比，洛杉矶的观察到的增加幅度更大（每天 0.64 杯当量；95%置信区间，0.41-0.88 杯当量与每天 0.10 杯当量；95%置信区间，0.01-0.19 杯当量）。在可转移性分析中，对同时采样的旧金山组（n=157）进行加权，以在观察到的协变量方面与洛杉矶组（n=155）相匹配时，加权后的旧金山组估计每天增加 0.53 份水果和蔬菜杯当量（95%置信区间，0.27-0.79 杯当量，P=0.03），收入是使加权后的旧金山组和未加权的洛杉矶组的 95%置信区间重叠的变量。
在这项研究中，使用水果和蔬菜券似乎与收入较低的人群的更大益处相关，这表明有必要进一步研究固定费率而不是按收入比例计算的益处。
