Knox Melissa A, Wallace Jamie, Baquero Barbara, Hara-Hubbard KeliAnne, Jones-Smith Jessica
Department of Economics, University of Washington, Seattle.
Department of Health Systems and Population Health, University of Washington, Seattle.
JAMA Netw Open. 2025 Aug 1;8(8):e2527601. doi: 10.1001/jamanetworkopen.2025.27601.
Diet quality, including fruit and vegetable intake, is a determinant of health, yet fresh fruits and vegetables are inaccessible to many lower-income and marginalized households. Healthy food benefit programs may reduce health disparities by increasing fruit and vegetable consumption.
To estimate the outcomes of a $40 per month healthy food benefit program on food security and diet.
DESIGN, SETTING, AND PARTICIPANTS: Cohort study with randomly assigned treatment groups composed of participants seeking enrollment in Fresh Bucks, a healthy food benefit program for lower-income populations in Seattle, Washington. Participants were randomly assigned to enrollment in the program and to a waiting list. Outcomes were examined at baseline (October 2021) and follow-up (June 2022).
Two exposure groups were examined. First, random assignment to newly receive program benefits for 6 months vs assignment to a waiting list. Second, random assignment to be disenrolled from program benefits vs continued enrollment for 6 months.
A modified version of the Behavioral Risk Factor Surveillance System Fruit and Vegetable Screening Questionnaire was used to calculate daily frequency of fruit and vegetable consumption as a continuous outcome and a binary indicator of consuming less than 3 vs 3 or more times per day. Food security was measured using the 2-item Hunger Vital Signs screener.
A total of 1973 participants were included, with 757 who received the program and 1216 who were disenrolled (1339 [68%] aged ≥60 years; 1007 [51%] Asian; 209 [11%] Black; 523 [27%] White). The program was associated with a 5.5 percentage point (pp) (95% CI, 0.05-10.91 pp) increase in food security and a 7.5 pp (95% CI, 0.39-14.52 pp) increase in the proportion of participants consuming fruit and vegetables 3 or more times per day. Continuous fruit and vegetable consumption changes were null; however, differential outcomes by income, language, and race and ethnicity were found. Examining these same outcomes in a population assigned to disenrollment, lower fruit and vegetable intake and food security were found vs those who remained in the program.
This cohort study of a healthy food benefit program found reduced food insecurity and improved fruit and vegetable consumption in a lower-income population randomly assigned to program enrollment.
饮食质量，包括水果和蔬菜摄入量，是健康的一个决定因素，但许多低收入和边缘化家庭无法获得新鲜水果和蔬菜。健康食品福利计划可能通过增加水果和蔬菜消费来减少健康差距。
评估一项每月40美元的健康食品福利计划对粮食安全和饮食的影响。
设计、地点和参与者：队列研究，随机分配治疗组，由寻求加入“新鲜美元”（Fresh Bucks）的参与者组成，这是华盛顿州西雅图市一项针对低收入人群的健康食品福利计划。参与者被随机分配到该计划的注册组和候补名单组。在基线期（2021年10月）和随访期（2022年6月）检查结果。
检查了两个暴露组。第一，随机分配为新获得6个月的计划福利与分配到候补名单组。第二，随机分配退出计划福利与继续注册6个月。
使用行为危险因素监测系统水果和蔬菜筛查问卷的修改版，将水果和蔬菜消费的每日频率计算为连续结局，并作为每天食用少于3次与3次或更多次的二元指标。使用两项饥饿生命体征筛查工具测量粮食安全。
共纳入1973名参与者，其中757名获得该计划，1216名退出（1339名[68%]年龄≥60岁；1007名[51%]为亚洲人；209名[11%]为黑人；523名[27%]为白人）。该计划与粮食安全增加5.5个百分点（pp）（95%CI，0.05 - 10.91 pp）以及每天食用水果和蔬菜3次或更多次的参与者比例增加7.5个百分点（95%CI，0.39 - 14.52 pp）相关。水果和蔬菜的连续消费变化不显著；然而，发现了按收入、语言、种族和族裔划分的不同结果。在被分配退出计划的人群中检查这些相同的结果时，发现与留在该计划中的人群相比，水果和蔬菜摄入量以及粮食安全较低。
这项关于健康食品福利计划的队列研究发现，在随机分配进入该计划的低收入人群中，粮食不安全状况有所减少，水果和蔬菜消费有所改善。
