Performing Department
(N/A)
Non Technical Summary
Food insecurity in California affects 9.6% of California residents. However, Black and Latino communities are disproportionately affected with rates ranging from 14-20% compared to 4-7% among white residents. This inequity is driven in part by record-setting food price inflation, pandemic related supply shocks, and other market disruptions. To address this situation, the University of California San Diego, working with Northgate Gonzalez Markets and other community partners, developed the ¡Más Fresco! More Fresh Nutrition Incentive Program. The randomized control trial resulted in significant increases in the purchase of fruits and vegetables and food security levels among thousands of participating households across Los Angeles, Orange, San Diego, San Bernardino, and Riverside Counties. The primary objective of this new proposal is to optimize and further expand the impact of this already successful program by increasing access to a broader array of GusNIP-qualifying healthy foods, namely fresh, frozen, dried, and canned fruits and vegetables, while using data-driven decision making to optimize our 4:1 earn and redeem incentive model to expand and sustain its support for existing and new participants over a longer timeframe. In this way, the program will be more successful at addressing food security and increasing access to healthy foods, especially for the Latino community that Northgate Gonzalez Markets serves. Stable and continuous access to fruits and vegetables in its many forms will better address the health disparities that SNAP recipients experience, while simultaneously advancing equity, inclusion, and accessibility across Southern California.
Animal Health Component
100%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Goals / Objectives
The overarching goals of the ¡Más Fresco! More Fresh program are to: (1) increase access to healthy foods, primarily F&V, (2) improve food security and (3) improve health outcomes and quality of life for low-income SNAP participants in Southern CA.To achieve these goals, we have outlined the following objectives to optimize access and utilization of the ¡Más Fresco! More Fresh program, all of which will be implemented within the first six months of funding:Increase the types of healthy foods available to program participants by including additional frozen, dried, and canned F&V to the already eligible 800 fresh F&V offered.Ensure sustained incentive support for over 4,500 active participants for a longer period of time, including current participants and new enrollees. To do this, we will utilize the 4:1 incentive ratio for all participants but lower the monthly incentive redemption cap from $100 to $50. While lowering the maximum available monthly incentive from $100 to $50 may seem counter-intuitive to our goals, this will allow us to support ~1500 active participants per year, which is equivalent to 18,000 participant months of utilization. This will also allow us to enroll new participants while still providing a significant amount of support to our existing participants. Based on our previous data, keeping the incentive ratio at 4:1 will allow most participants to still utilize the program as they had previously (since the average redemption was $45/month among participants in this model). Our efforts will then focus on helping more participants optimize this incentive structure and redeem the full $50 per month. This change in the POS system will take place within the first six months of program funding.Augment program utilization so that a larger proportion of families are redeeming the maximum amount of F&V incentive available to them per month. We will achieve this by moving nearly 1,100 active participants who currently redeem incentives at a 2:1 ratio to a 4:1 ratio, thereby increasing their purchasing power. We will also work with our promotores partners to conduct continued cashier/store training and targeted outreach/educational activities to existing participants to improve utilization.Increase the reach of the ¡Más Fresco! More Fresh Program by initiating a new enrollment plan to enroll up to 1000 new SNAP households per year; in doing so, we will maintain a stable cohort of 4,500 active participants for the duration of the project.
Project Methods
The proposed methods to achieve key project goals and objectives are as follows:Work with Northgate Gonzalez Market to incorporate frozen, dried, and canned F&V to the already eligible fresh F&V, as part of the cloud-based POS system and databases. This will enable participants across all 43 Northgate stores to instantaneously earn and redeem nutrition incentives upon the purchase of qualifying fresh, frozen, dried, and canned F&V with their SNAP benefits. We will also modify the ¡Más Fresco! More Fresh Program incentive to lower the monthly redemption cap to $50 per month at a 4:1 incentive multiplier ratio. To ensure that this process is completed within the first 6 months of program funding, we will meet bi-weekly with the Northgate IT team to review product lists and review programming methods/plans. Once the POS system is updated, we will conduct beta-tests with several of our key participants in San Diego and LA County who have helped us pilot test the program in previous years.Continue to enhance and refine the online enrollment program that interfaces with Northgate'scloud-based POS system and databases to facilitate automated, real-time upload and integration of participant data into the cloud-based system.Develop another comprehensive nutrition incentive program training about program changes and how nutrition incentives work for cashiers, store managers, and other staff members at all 43 Northgate Gonzalez Markets across Southern California (see Attachment 2). UC San Diego will work with Northgate Gonzalez Market to ensure that the ¡Más Fresco! More Fresh Program is incorporated into the existing ongoing Northgate Gonzalez Market training for cashiers (such as their already existing WIC training).Develop a comprehensive outreach, promotion, and advertising program to promote ¡Más Fresco! throughout the region (see Attachment 3). UC San Diego has achieved significant success in working with key stakeholders across Southern California to promote enrollment into the ¡Más Fresco! More Fresh Program. This outreach includes support from local CalFresh Agencies, County Health Departments and community-based organizations resulting in the enrollment of nearly 8,000 program participants in 2022 alone. Together with these groups, we have utilized several different methods of outreach including website development, text messaging campaigns, social media presence, traditional use of flyers and letters, speaking engagements, and attendance at community fairs and events.Continue to utilize a feedback and quality control process with our program participants through our toll-free phone number, email, and reports from community and promotora partners. This will allow us to quickly address barriers to program utilization. By continuing to utilize this process, we will maintain program integrity and quickly identify methods to improve equitable access, engagement, and utilization. This work will also ensure that we are providing an inclusive and understandable program that addresses the needs of low-income and underserved communities in Southern CA.Develop and Implement Key Stakeholder Partnership Development Plan and Program. UC San Diego will work with key stakeholders across Southern California, including CalFresh Healthy Living partners, social services agencies, public health departments, food banks, Catholic Charities, and other community-based organizations to continue to support program participants in adopting healthy lifestyle activities and address other social determinants of health issues (e.g., transportation) that may be impacting their ability to access healthy foods. Furthermore, UC San Diego will devote additional program evaluation resources toward the evaluation of a collective impact model to better understand the impact of these integrated and collective efforts toward achieving key program goals and objectives.Develop and implement a comprehensive outcome evaluation. Our team has participated in several robust evaluations of the ¡Más Fresco! More Fresh Program and has partnered with the Nutrition Incentive Hub to provide several best practices and share information with them around online evaluation methods. Moving forward, we will continue to work with the Nutrition Incentive Hub to administer the required surveys. We will also continue to devote resources towards process evaluation. Efforts to obtain additional funding to support a more robust evaluation of the health impacts of this program will also be pursued.The outcomes assessment will measure the impact of expanding the array of eligible F&V in the program on the earn and redeem activities of participants, types of F&V purchased, and household food security levels. We will use POS data to assess differences in purchasing behaviors and self-report surveys to detect changes in participant F&V consumption and household food security.F&V Purchasing Data: We will collect POS transaction data from all enrolled participants. Each month, Northgate will transmit the previous months' ¡Más Fresco! transaction data (i.e., all transactions for which a ¡Más Fresco! loyalty card was scanned) to the UC San Diego data team via a secure file transfer protocol (SFTP) site. This data includes overall transaction level data such as ¡Más Fresco! card number, date, time, store, total sale amount, incentives earned/redeemed, amount paid by tender type (e.g., cash/credit/EBT), and individual item-level data including item descriptions, identification numbers, quantity, and cost.F&V Consumption and Food Security Data: Online enrollment and survey data collection will be conducted via Qualtrics, a secure online survey platform, following UC San Diego IRB requirements for research. The enrollment form will allow participants to indicate their interest in completing additional online surveys and participating in other research opportunities. Due to the large scale of the project, this "opt in" process aims to increase efficiency and minimize time and effort of survey data collection. Participants who opt-in to surveys will complete an online consent process prior to initiation of the surveys and will be asked to choose their survey preference (email or text) and provide their email or cell phone number. Then they will automatically receive a baseline survey invitation as soon as their enrollment is complete. Follow-up survey invitations will be scheduled to automatically go out 6 months after enrollment. Participants will receive 2-3 reminder texts/emails for unfinished surveys. Surveys will be available in English or Spanish. Phone surveys (i.e., surveys conducted over the phone by one of our staff members) may be offered to a subset of program participants to ensure that individuals with low literacy levels and/or with limited access to technology for email/texting are represented. Content of the baseline and follow-up survey will be determined in consultation with the Nutrition Incentive Hub and will include several core domains: sociodemographic items (e.g., age, gender, race/ethnicity, education level, household size), amount of CalFresh received per month, the USDA 6-item food security module, the Eating at America's Table Study EATS fruit and vegetable screener, and other relevant validated measures from existing surveys (e.g., NHANES). We will make minor modifications to the survey to account for changes to the incentive structure in this project, but for comparability, we will continue to use several key measures used in our previous evaluation surveys. We aim to collect baseline surveys and follow up surveys from a random subset of at least 25% of the new participants to ensure sufficient sample size for analysis, accounting for loss to follow up from baseline to 6 months.