Non Technical Summary
America spends over $1.1 trillion annually on treating diet-related chronic diseases. Poor diets are the leading cause of these chronic conditions. In Indiana, both adults and children often do not meet the fruit and vegetable intake recommendations. Participants in the Supplemental Nutrition Assistance Program (SNAP) consume even fewer fruits and vegetables than the national average. Surveys consistently show that cost is the primary barrier to accessing healthierfoods. Additionally, the number of specialty crop growers has declined over the years, negatively impacting local food economies, as a larger share of fruits and vegetables is now imported. Double Up Indiana aims to reverse these trends by promoting healthier eating habits while strengthening Indiana's local food economies.The Indiana Department of Health (IDOH) and the Division of Nutrition and Physical Activity (DNPA) Gus Schumacher Nutrition Incentive Program (GusNIP) - Nutrition Incentive large-scale project is to expand and enhance statewide SNAP-matching program, Double Up Indiana (DUIN). DUIN offers a $1-for-$1 match to purchase fresh fruits and vegetables at direct marketing sites, such as farmers' markets, as well as farm stands and grocery stores through an electronic benefit, coupon, or 50% discount model. The IDOH/DNPA is working on innovative and systematic approaches to improve redemption processes, aiming to expand DUIN to more food retailers and make the program more accessible to participants. Currently, at participating locations, SNAP beneficiaries swipe their Hoosier Works electronic benefit transfer card to receive "SNAP tokens," which can be used to purchase eligible food items. They then receive a matched amount of up to $20 at farmers' markets and between $10 to $20 in retail settings, allowing them to buy fresh fruits, vegetables, herbs, and mushrooms directly from vendors or at the point-of-sale.The goal of this project is to scale programming to provide healthier food options to Hoosiers on SNAP while supporting local economies and communities. The IDOH/DNPA will collaborate with internal state agencies and external organizations with expected outcomes toenhance communication efforts, raise awareness of the program, and increase participation. Additionally, envisions building the infrastructure and implementation processes necessary to create long-term solutions for financial stability and sustainability for DUIN with the anticipated benefits that more Hoosiers on SNAP are purchasing and consuming more fruits and vegetables and a stronger local food system.

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
703	6099	1010	100%

Knowledge Area
703 - Nutrition Education and Behavior;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
1010 - Nutrition and metabolism;

Goals / Objectives
The proposed project allows for the most fundamental healthy food to be readily accessed by families on Hoosier Works (SNAP EBT) in Indiana. Importantly, the expansion and enhancement of Double Up Indiana (DUIN)will provide even more families on SNAP the opportunity to purchase fruits and vegetables and bolster Indiana's local food economy.The IDOH's overall goal is toscale programming across the state bybuildingout the capacity and infrastructure and evolving program delivery through technological advancements to increase access and bring more awareness to DUIN.This project allows for enhancing programming with current partners and expanding it to more partners through the following goals and outcomes:Increase reach of households on SNAP by 30% by September 14, 2028. Associated GusNIP Goal: more Hoosier households on SNAP have access to nutritious food.Increase the number of firms from 51 to 100 by September 14, 2028. Associated GusNIP Goal: diversify the number of firms that have expanded hours of operation to increase access for more Hoosier households on SNAP to purchase fruits and vegetables.Explore opportunities for innovation through technological advancements by September 14, 2028.Associated GusNIP Goal: Test innovative approaches with technology to increase access to DUIN.Create a communication plan with Family Social Services Administration (FSSA), Indiana's SNAP agency,by September 14, 2028Associated GusNIP Goal: Create outreach and promotion strategies to increase awareness and utilization of DUIN.

Project Methods
Program evaluation includes process and outcome evaluation. Additionally, the evalation plan can be adapted to align with NTAE requirements for the grant.Process Evaluation: A process evaluation of the Double Up Indiana (DUIN)program will track the progress of program implementation, growth, and enhancement. Tracking the program implemen­ta­tion progress is critical to ensure it is successfully operating as intended. Process evaluation findings will be used to establish best practices and lessons learned that could positively impact future sustainability. This funding will allow for a hub and spoke pilot by placing staff within regional spokes to help address those administrative responsibilities for implementation and operations of DUIN. These regions have been identified with current programming, overallreach and participation, and can scale. Information collected for program evaluation will include the number of new firms, number of new participants, feedback on program participation from participants, firms, and venders, and feedback from region spokes on success, challenges, and opportunities. The DNPA will also be able to leverage information through monthly meetings and discussions through the Indiana Nutrition Incentive Network. Continuous monitoring and conversations with regional organizations will allow for issues and challenges to be identified and addressed in a timely manner.Outcome Evaluation: An outcome evaluation assesses the impact the program had on participants, firms, vendors and the com­munity. Participant-level outcomes include access, such as the proximity of DUIN sites to participants and food/nutrition security through the validated Six-Item Short Form of the USDA Food Security Survey Module(USDA); purchasing, the amount of incentives issued to and redeemed by participants, and to what extent the program led participants to purchase more fruits and vegetables; consumption of fruits and vegetables, have participants, including other household members, reported increased consumption of fruits and vegetables utilizing the validated 10-item Dietary Screener Questionnaire (DSQ), which is taken from the larger 26-item DSQ developed by the National Institutes of Health (NIH) National Cancer Institute (NCI) (NIH). Other measures of interest for IDOH include asking questions about behavior, knowledge, firm experiences, and relevance in selection of produce. Demographic information collected will provide better understanding of how outcomes may differ across groups and communities. Firm-level outcomes include the economic impact on the growers and firms who are participating (i.e., amount of incentives redeemed at their firm). Both quantitative and qualitative indicators, such as a thematic analysis of feedback provided by participants, will be used to assess outcomes.