Financial incentives increase fruit and vegetable intake among SNAP participants: A randomized controlled trial of the USDA Healthy Incentives Pilot

Background:  US fruit and vegetable intake remains well below recommended levels, particularly among low-income populations. Financial incentives are one recommended strategy for addressing this shortfall, but evidence on the effectiveness of this type of intervention is limited.

Objective:  The objective of this study was to examine the effects of the US Department of Agriculture’s Healthy Incentives Pilot (HIP), which offered financial incentives to Supplemental Nutrition Assistance Program (SNAP) participants for purchase of targeted fruits and vegetables (TFVs).

Design:  We conducted a randomized controlled trial of HIP in Hampden County, Massachusetts. 7,500 SNAP-participating households were randomly selected to participate in HIP, receiving a 30% incentive on TFV purchases made using their electronic benefit transfer (EBT) cards. The remaining 47,595 SNAP-participating households in the county continued to receive SNAP benefits as usual. To assess HIP impacts on dietary intake, we randomly sampled adult members of 5,076 SNAP-participating households to complete telephone survey data collection, including 24-hour recall interviews.

Results:  Regression-adjusted mean TFV intake at follow-up was 0.23 cup-equivalents (95% CI:  0.13, 0.34 cup-equivalents) higher among adults in HIP-participating households. Across all fruits and vegetables, regression-adjusted mean intake was 0.31 cup-equivalents (95% CI:  0.15, 0.46 cup-equivalents) higher among adults in HIP-participating households.

Conclusions:  The HIP incentive significantly increased fruit and vegetable intake among SNAP participants, indicating that such incentive strategies hold considerable promise for future interventions. However, more research is needed to fully understand mechanisms of action and potential long-term effects and health outcomes.