Increasing Use of SNAP Fruit and Vegetable Incentive Programs for Families with Food Insecurity - The Supplemental Nutrition Assistance Program (SNAP) has financial incentive programs where families in SNAP can purchase fruits and vegetables (F&V), for half the price or less, at select sites. These programs increase F&V consumption and can save billions of dollars in healthcare costs; yet, limited awareness and uptake presents a major barrier to widespread utilization and limits potential impact. This study will leverage pediatric clinics to increase awareness and uptake of a SNAP F&V incentive program in South Carolina to improve parent- child diet quality, reduce food and nutrition insecurity, and lower disease risk. Social drivers of health screenings in pediatric clinics will be leveraged to identify of parents, with a child 2-10 years of age, who are food insecure and enrolled in SNAP. All eligible families will receive brief education on a SNAP F&V incentive program from their pediatrician during their clinic visit. After the visit, dyads (N=296) will be randomized to: 1) Veggie Vouchers (Intervention) or 2) Education-only, wait-list control group (Control). Randomization will occur on a rolling basis at the individual level. The intervention group will then receive an electronic voucher for 3 free F&V boxes at a community organization that participates in a state-wide SNAP F&V incentive program as a “free trial” of this program. Each voucher can be redeemed for a F&V box that contains a variety of produce and recipe cards. Families can redeem 1 voucher every 2 weeks, for 6 weeks of free F&Vs. After voucher redemption, parents can continue purchasing these F&V boxes for steeply discounted prices using their SNAP card. Home delivery of F&V boxes will be offered for the intervention group during the full study duration; thus, boxes provided during the 6-week “free trial” and subsequent boxes purchased using their SNAP card will be eligible for home delivery. This service is being offered to overcome prominent access barriers to participating in this SNAP program. Voucher redemption rates and subsequent F&V box purchasing will be objectively tracked via an online portal. Assessments will occur at baseline, post-voucher redemption (6 weeks), and two follow-up time periods (18 and 30 weeks). The primary outcome will be changes in child diet quality (Healthy Eating Index [HEI] scores) from baseline to 30-weeks. Secondary outcomes include changes in parent HEI, household food insecurity, nutrition insecurity, and SNAP F&V incentive program use, across timepoints. Mixed methods will systematically assess data from a detailed process evaluation, key informant interviews, and community advisory board feedback to determine barriers/facilitators to intervention implementation and sustainability and inform future dissemination. If effective, this study will yield crucial knowledge on leveraging pediatric clinics to increase knowledge of existing SNAP F&V incentive programs, while incentivizing use and minimizing access barriers. Data will inform future efforts to maximize the impact of these programs and policies to fund these strategies more broadly. This study has strong potential for substantial public health impact and directly aligns with the priorities set by the White House and the National Institutes of Health to promote nutrition security and reduce chronic disease risk.
