title: Increasing Use of a Healthy Food Incentive: A Waiting Room Intervention Among Low-Income Patients.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Longitudinal, repeated measures, quasi-experimental trial.
  
  
  METHODS
  SNAP-enrolled adults at a health center in a low-income, racially and ethnically diverse area of Southeast Michigan.
  
  
  METHODS
  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).
  
  
  METHODS
  Outcome measures included DUFB use and fruit and vegetable consumption (analyses conducted in 2015-2016).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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. Electronic address: calicia@umich.edu.
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Cohen
authors.affiliation: 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.
authors.forename: Caroline R
authors.initials: CR
authors.lastname: Richardson
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars program, 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; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; School of Public Health, University of Michigan, Ann Arbor, Michigan.
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; School of Public Health, University of Michigan, Ann Arbor, Michigan.
authors.forename: Ananda
authors.initials: A
authors.lastname: Sen
authors.affiliation: Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Murphy
authors.affiliation: Fair Food Network, Ann Arbor, Michigan.
authors.forename: Oran B
authors.initials: OB
authors.lastname: Hesterman
authors.affiliation: Division of Academic General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois; Mary Ann and J. Milburn Smith Child Health Research Program, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois; Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; School of Public Health, University of Michigan, Ann Arbor, Michigan.
authors.forename: Suzanna M
authors.initials: SM
authors.lastname: Zick
mesh_terms: D000328:Adult; D003920:Diabetes Mellitus / Q000517:prevention & control; D004032:Diet / Q000191:economics* / Q000523:psychology; D005247:Feeding Behavior; D005260:Female; D063105:Food Assistance; D005638:Fruit / Q000191:economics; D006293:Health Promotion / Q000191:economics / Q000379:methods*; D006331:Heart Diseases / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D008137:Longitudinal Studies; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009042:Motivation; D009765:Obesity / Q000517:prevention & control; D011203:Poverty / Q000191:economics* / Q000523:psychology; D057566:Self Report; D014675:Vegetables / Q000191:economics