Evaluation of a farmers' market incentive program: The New York City Health Bucks initiative

INTRODUCTION: Limited access to healthful foods may contribute to higher obesity rates in underserved urban areas. To increase access to and purchase of fruits and vegetables in three underserved New York City neighborhoods, Health Bucks distributes coupons for fresh fruits and vegetables at farmers' markets. SNAP participants receive one $2 coupon for every $5 in benefits spent at participating markets. Additionally, community organizations distribute coupons to clients. We conducted a mixed-methods process and outcome evaluation of Health Bucks. METHODS: Primary data collection activities included on-site environmental assessments and surveys of farmers' market managers, vendors, and shoppers; a web survey of community organizations; a representative telephone survey of Health Bucks neighborhood residents; key informant interviews; shopper focus groups; and vendor telephone discussions. We additionally analyzed impacts using longitudinal data from the 2002-2009 Community Health Survey. RESULTS: Health Bucks intends to influence individual-level outcomes by increasing purchases of healthful foods, and community-level outcomes by improving access and community partnerships. Program awareness is high in targeted neighborhoods, and it is popular among farmers' market staff and shoppers. Farmer/vendors report the program increases likelihood of selling at a particular farmers' market, and consumers report it increases frequency and amount of farmers' market purchases. However, while self-reported fruit and vegetable consumption rose throughout New York after Health Bucks was introduced, we did not detect a greater increase in Health Bucks neighborhoods. DISCUSSION: Health Bucks encourages farmers' market access and purchases as one component of a broader strategy to improve the New York City food environment.