Progress 05/01/16 to 04/30/21
Outputs
Target Audience:The target audience for our Big Apple Incentives project were the 1.5-1.6 million NYC residents across the city's five boroughs that participated in the SNAP program between May 2016 and April 2021. New Yorkers with SNAP accessed Health Bucks at over 120 farmers markets citywide, approximately 60% of which were located in high poverty neighborhoods. The project also targeted New Yorkers with SNAP aged 18 and older filling prescriptions for hypertension medication at independent pharmacies in Manhattan, Brooklyn and Queens, New York. A total of 1,696 individuals enrolled in the program, 60% were Latino, 69% were 45 years or older and 45% had less than a high school degree. Additionally, 57% of participants worried about having enough food to eat in the past 30 days and 77% agreed or somewhat agreed that fruits and vegetables cost too much. Since June 2019, more than 8,300 New Yorkers with SNAP enrolled in Get the Good Stuff at six supermarkets. Participants were predominantly Latino/Hispanic (50%) and Black (15%). Nearly one-third of participants reported having hypertension and about one in five reported having diabetes. The project supported the regional economy by increasing demand for locally-grown fruits and vegetables among New Yorkers with SNAP. Local farmers benefitted through increased SNAP spending on their products. The project served independent pharmacies by helping them expand beyond the traditional role of dispensing medication to providing preventative services, which can provide economic benefits through increased patient base. The project also supported independently owned and operated supermarkets participating in Get the Good Stuff by increasing the spending power of customers with SNAP on hundreds of eligible fresh, frozen, canned and dried fruits, vegetables and beans. Changes/Problems:Enrollment in Pharmacy to Farm Prescriptions and Get the Good Stuff temporarily decreased as a result of the Covid-19 pandemic. Several pharmacies that participated in Pharmacy to Farm Prescriptions lacked staff capacity to enroll new patients in the program and issue prescriptions in spring and summer 2020. Get the Good Stuff enrollment declined in March and April 2020 as people limited their time in grocery stores or avoided them all together. Partnering pharmacies and stores had staff hospitalized with the virus which contributed to staff shortages and limited capacity to enroll new participants. Due to the COVID-19 pandemic, the follow-up survey of supermarket shoppers with SNAP at three stores implementing Get the Good Stuff and a control store scheduled for March 2020 was not completed during the grant period. The Get the Good Stuff program is ongoing and we are exploring conducting the post-survey in 2022. The pandemic also contributed to delays in Pharmacy to Farm Prescriptions data entry, data cleaning and data analysis. The pandemic and work from home orders delayed hiring staff to enter and clean participant data by 5 months in mid-2020. Furthermore, Pharmacy to Farm program evaluation staff were redeployed to work on the agency's COVID-19 response as NYC Health Department personnel and between March 2020 and April 2021, had limited capacity to work on program data analysis. As of July 2021, program evaluation staff have returned to their normal roles and are analyzing data collected through the program to assess whether a pharmacy-based program is an effective method for increasing fruit and vegetable consumption among individuals at risk for poor, diet-related health outcomes. What opportunities for training and professional development has the project provided?Program staff attended the annual FINI Project Director Meeting between 2017-2019. In project year 3, the Health Bucks Project Manager participated in a 20-hour intermediate program evaluation course for NYC DOHMH staff taught by faculty from Mailman School of Public Health at Columbia University. The course provided an in-depth examination of program evaluation theory and design and informed the supermarket incentive program outcomes evaluation. How have the results been disseminated to communities of interest?Results were disseminated to communities of interest in a variety of ways during the project period including via: • Academic journals and conferences. We presented a poster with baseline results from the Pharmacy to Farm program at the Society for Nutrition Education and Behavior 51st Annual Conference in 2018. The accompanying program abstract was published in the Journal of Nutrition Education and Behavior. We also submitted two poster abstracts to the Society for Nutrition Education and Behavior 53rd Annual Conference in 2020, which were accepted. One abstract reported on fruit and vegetable consumption among people with SNAP at NYC farmers markets following the year-round extension of Health Bucks. The other abstract reported on participant characteristics and evaluated usage of incentives issued through the Get the Good Stuff program. While the conference was canceled due to the COVID-19 pandemic, the abstracts were published in the Journal of Nutrition Education and Behavior and are available: • https://www.jneb.org/article/S1499-4046(20)30237-2/fulltext • https://www.jneb.org/article/S1499-4046(20)30354-7/fulltext We are continuing to conduct process and outcome evaluations for Pharmacy to Farm Prescriptions and Get the Good stuff. We will analyze results and explore forums for dissemination. • Trade conferences and nutrition incentive practitioner convenings. In February 2020, Frank Pimentel, owner of Fine Fare Supermarket in the Bronx, presented on his store's participation in the Get the Good Stuff supermarket incentive program at the 2020 National Grocers Association's Annual Meeting. The grant PI presented on the program as part of a panel on incentive technology in grocery stores at the Nutrition Incentive Hub's Nutrition Incentive Practitioner Convening in March 2020 and at the CUNY Urban Food Policy Institute's webinar titled "Healthy Food Incentives: Scaling Niche Public Programs." • Press releases and news coverage. We issued four press releases to announce: a. Year-round availability of Health Bucks through the farmers market SNAP incentive (2016) b. Record SNAP sales at GrowNYC farmers markets in 2016 following the year-round expansion of Health Bucks (2017) c. Expansion of Pharmacy to Farm Prescriptions program to additional pharmacies (2019). The press release received coverage from local and national outlets including The Counter, AM New York, and HuffPost, as well as televised news. The Centers for Disease Control and Prevention also wrote about the program in their Field Notes webpage. d. Launch of Get the Good Stuff program (2019). The press release received coverage from local TV stations and print media in English and Spanish including on including New York Daily News, El Diario, Univision 41, Telemundo, NY1, Fox 5, ABC 7, News 12 and Impacto Latino. • Presentations and meetings with stakeholders. We presented on our nutrition incentive programming to a wide range of community stakeholders including at annual meetings of 100+ faith-based organizations, farmers market operators and hundreds of community-based organizations, and in meetings with the NYC Department of Social Services, and the New York City Housing Authority, and NYC Health + Hospitals. What do you plan to do during the next reporting period to accomplish the goals?Nothing to report
Impacts
What was accomplished under these goals?
Impact Statement Approximately 1.5 million of New York City's (NYC) 8.5 million residents relied on the Supplemental Nutrition Assistance Program (SNAP) for food in 2020 and over 1.2 million New Yorkers experienced food insecurity in 2017. With support from a USDA Food Insecurity Nutrition Incentive grant, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) increased access to fruits and vegetables for New Yorkers who participate in SNAP by issuing more than $4.1M worth of fruit and vegetable incentives to more than 26,000 New Yorkers with SNAP shopping at 120+ farmers markets and 6 supermarkets and through a novel pharmacy-based prescription program for people with hypertension. Accomplishments Goal 1: Operated a year-round farmers market incentive program and distributed $2 in Health Bucks for every $5 spent in SNAP benefits at over 120 farmers markets. • Distributed more than 1,200,000 Health Bucks worth over $2.4M in fruits and vegetables to New Yorkers with SNAP from July 2016-December 2020. On average, distributed $517,830 worth of Health Bucks through the SNAP incentive each full year of the grant period (2017-2020), of which 92% were redeemed for fruits and vegetables. Doubled the median value of Health Bucks distributed annually per person from $6 at baseline in 2014 to $12 in 2020. • Reached more than 16,500 New Yorkers with SNAP on average each full project year (2017-2020) and supported expansion of year-round markets in low-income neighborhoods. New Yorkers spent significantly more in SNAP benefits per person at NYC farmers markets during the winter and spring months (December-June) when the Health Bucks SNAP incentive was extended from seasonal (July-November) to year-round ($53.77 at baseline in 2015/2016 vs. $65.38 in 2016/2017). The number of year-round farmers markets operating in neighborhoods with high rates of poverty increased by 55% from 9 at baseline to 14 in 2020/2021. • Promoted incentive program and farmers markets. Developed a citywide Health Bucks marketing campaign. Advertised on the subway and in city busses and bus shelters, laundromats, SNAP enrollment centers, four daily newspapers, and on social media. Designed and distributed yearly farmers market maps and disseminated to over 450 community organizations. • Found that expansion of Health Bucks SNAP incentive from 5 to 12 months was associated with increased fruit and vegetable consumption among people with SNAP benefits shopping at NYC farmers markets. Designed and conducted baseline and follow-up survey with over 425 New Yorkers with SNAP at eight farmers markets. Surveyed participants about their eating and shopping behaviors before and after the year-round extension of the Health Bucks program. Compared follow-up results to baseline survey to assess program's impact and found a statistically significant increase in healthy vegetable consumption. Goal 2: Participated in nationwide randomized controlled trial (RCT) in partnership with the University of Delaware's Center for Research in Education and Social Policy (UD-CRESP), Wholesome Wave (WW) and Case Western Reserve University to investigate the impact of different SNAP incentive levels on fruit and vegetable purchases and consumption among farmers market shoppers with SNAP benefits. • Conducted RCT in NYC. In partnership with WW and farmers market operator GrowNYC, invited customers with SNAP at participating markets to complete an online survey about their diet and shopping behaviors. Randomly awarded survey participants to one of three SNAP incentive levels: spend $5 get $2; spend $5 get $4; or spend $5 get $5. Repeated survey and random assignment to an incentive level each month of the trial. Between August 2016 and October 2017, completed 126 one-month lottery rounds at 21 farmers markets. Of the 814 first-time survey respondents, 80% were female and 61% were between the ages of 18 and 47. Fifty percent of respondents were white and 40% were Hispanic. The majority of respondents (86%) reported experiencing food insecurity in the prior year. • Supported data analysis and adjusted program model in response to RCT results. Supported UD-CRESP with analysis of SNAP transaction, incentive distribution and dietary questionnaire data. Found that NYC participants averaged significantly higher SNAP spending at farmers markets at the $5:$5 and $5:$4 incentive levels. No statistically significant increases in produce consumption was observed at the higher SNAP incentive levels in the NYC subset. In 2021, with support from a USDA Gus Schumacher Nutrition Incentive Program grant, adjusted incentive to spend $2 in SNAP, get $2 in Health Bucks up to $10 in Health Bucks per day. Goal 3: Developed and launched NYC's first supermarket-based SNAP incentive program, Get the Good Stuff. • Conducted baseline outcome assessment. Surveyed more than 800 customers with SNAP at four supermarkets, including three intervention and one control store, in May 2019 prior to incentive program launch. Asked customers questions about fruit and vegetable consumption, food security status and shopping behaviors. • Identified fruits and vegetables eligible for incentives and developed incentive system infrastructure. Reviewed six supermarket inventories to identify all eligible fresh, frozen, canned and dried fruits, vegetables and beans. In partnership with two point-of-sales (POS) vendors, configured stores' customer loyalty systems to distribute and redeem incentives on SNAP purchases of eligible fruits vegetables, and beans. Vendors flagged eligible items in supermarkets' POS system, configured program loyalty cards and programmed customer receipts to show incentive account balance. Trained store staff on program enrollment and implementation. • Distributed over $1.3M in fruit and vegetable incentives at 6 supermarkets. Partnered with six supermarkets in neighborhoods with high rates of poverty to distribute $1 in incentives for every $1 spent in SNAP up to $50/day on eligible fruits, vegetables and beans. Between June 2019 and February 2021, enrolled over 8,300 New Yorkers who redeemed more than $1.2M worth of fruit and vegetable incentives. Across all stores, the average incentive redemption rate was approximately 90%. • Promoted program. Printed and displayed promotional materials in 10 languages and hired bilingual program assistants to enroll customers into the program. Goal 4: Developed and implemented Pharmacy to Farm Prescriptions, a pharmacy-based fruit and vegetable prescription program for New Yorkers with SNAP benefits and hypertension. Partnered with independent pharmacies to issue $30 a month in Health Bucks to patients filling a prescription for hypertension medication. • Completed nearly four years of Pharmacy to Farm implementation and enrolled 1,696 participants. Developed protocol for participant recruitment, enrollment, and data collection and launched Pharmacy to Farm at 3 pharmacies and farmers markets in May 2017. Secured over $200K in additional private funding to support program expansion to 16 pharmacies and 6 farmers markets between fall 2018 and spring 2019. Distributed over $356,000 worth of Health Bucks to program participants of which approximately 90% were redeemed for fruits and vegetables. On average, participants accessed 4.4 fruit and vegetable prescriptions through the program. • Promoted program. Developed promotional materials in English, Spanish and Bengali and distributed to participating pharmacies and farmers markets and nearby health centers and community organizations. • Conducted process evaluation and collected and entered data for outcome evaluation. Analyzed results of yearly process evaluations to determine program successes, challenges and lessons learned by pharmacies. Entered responses from monthly fruit and vegetable consumption surveys into program database for analysis.
Publications
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2020
Citation:
Debchoudhury, I., Adjoian Mezzacca, T., Yang, L., Luong, M., Luu, C., Andersen, N., Clapp, J. Expansion of fruit and vegetable incentives impacts people with SNAP at NYC farmers markets. In: Proceedings from the 53rd Annual Conference of the Society for Nutrition Education: July 20-24, 2020; Virtual Meeting. Abstract P25.
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2020
Citation:
Andersen, N., Debchoudhury, I., Sanchez, P. Get the Good Stuff in NYC: Baseline Survey Findings of a Supermarket-Based Nutrition Incentive Program. In: Proceedings from the 53rd Annual Conference of the Society for Nutrition Education: July 20-24, 2020; Virtual Meeting. Abstract P140. https://doi.org/10.1016/j.jneb.2020.04.187.
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2018
Citation:
Luu, C., Andersen, N., Debchoudhury, I. Pharmacy to Farm Prescriptions Pilot Program in New York City Baseline Survey Findings. In: Proceedings from the 51st Annual Conference of the Society for Nutrition Education; July 21-25, 2018; Minneapolis, MN. Abstract P179.
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Progress 05/01/19 to 04/30/20
Outputs
Target Audience:The target audience for our project in year 4 were the nearly 1.6 million NYC residents across the city's five boroughs that participated in the SNAP program. SNAP participants accessed Health Bucks at over 119 farmers markets citywide, approximately 60% of which were located in high poverty neighborhoods. In the current reporting period, the project also targeted New Yorkers with SNAP aged 18 and older filling prescriptions for hypertension medication at independent pharmacies in Manhattan, Brooklyn and Queens, New York. A preliminary evaluation found that among individuals enrolled in the program as of July 2019, 52% are Latino, 96% are over 45 and 36% have less than a high school degree. Additionally, 61% of participants worried about having enough food to eat in the past 30 days and 80% agreed or somewhat agreed that fruits and vegetables cost too much. Since June 2019, more than 4,700 New Yorkers have enrolled in Get the Good Stuff at six supermarkets, of which nearly 50% are Hispanic/Latino and nearly 20% are Black. Our project also promotes the regional economy by increasing demand for locally-grown fruits and vegetables among New Yorkers with SNAP. Local farmers are served through increased SNAP spending on their products. Our project serves independent pharmacies by helping them expand beyond the traditional role of dispensing medication to providing preventative services, which can provide economic benefits through increased patient base. The project also supports independently owned and operated supermarkets participating in Get the Good Stuff by increasing the spending power of customers with SNAP on hundreds of eligible fresh, frozen, canned and dried fruits, vegetables and beans. Changes/Problems:The follow-up survey of supermarket shoppers with SNAP at three stores implementing Get the Good Stuff and a control store was delayed due to the Covid-19 outbreak. Originally planned for May 2020, one year following the pre-survey, it will be rescheduled for later in the year or early next year. Enrollment in Pharmacy to Farm Prescriptions and Get the Good Stuff has decreased as a result of the Covid-19 pandemic. Several pharmacies that participate in Pharmacy to Farm Prescriptions have lacked staff capacity to enroll new patients in the program and issue prescriptions since March 2020. Get the Good Stuff enrollment declined in March and April 2020 as people limited their time in grocery stores or avoided them all together. Partnering pharmacies and stores have had staff hospitalized with the virus which has contributed to staff shortages and limited capacity to enroll new participants. What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?Results have been disseminated to numerous communities of interest. In February 2020, Frank Pimentel, owner of Fine Fare Supermarket in the Bronx, presented on his store's participation in the Get the Good Stuff supermarket incentive program at the 2020 National Grocers Association's Annual Meeting. The grant PI presented on the program as part of a panel on incentive technology in grocery stores at the Nutrition Incentive Hub's Nutrition Incentive Practitioner Convening in March 2020. We also submitted a poster abstract to the Society for Nutrition Education and Behavior 52nd Annual Conference reporting characteristics of Get the Good Stuff program participants and evaluating usage of the fruit and vegetable incentive program. The poster was accepted, and we plan to present it at the conference in July 2020. We are also drafting two manuscripts for submission to peer-reviewed journals. One summarizes results of two surveys of more than 850 farmers market SNAP shoppers about their fruit and vegetable consumption before and after the year-round extension of the Health Bucks SNAP incentive. The other evaluates the effect of year-round Health Bucks availability on SNAP sales at farmers markets during winter and spring months. We are continuing to conduct process and outcome evaluations for Pharmacy to Farm Prescriptions and Get the Good stuff. We will analyze results and explore forums for dissemination. What do you plan to do during the next reporting period to accomplish the goals?We plan to complete the following in the next reporting period to accomplish our goals: Continue to distribute Health Bucks at 119 or more farmers markets across NYC that accept SNAP benefits and track coupon redemption. Continue to enroll New Yorkers with SNAP in Pharmacy to Farm Prescriptions. Collect and enter fruit and vegetable consumption survey data, and conduct data analysis. Interview staff from pharmacies added in program year 3 to determine best practices, challenges encountered, and lessons learned during the second year of the program. Consider forums to disseminate findings. Continue to enroll New Yorkers with SNAP in Get the Good Stuff at six supermarkets and distribute a $1 for $1 match up to $50/day on SNAP purchases of eligible fresh, frozen, canned and dried fruits, vegetables, beans and lentils. Consider program expansion to additional supermarkets. Conduct follow-up survey of shoppers with SNAP at participating stores and one control store to assess program impact. Interview supermarket staff to determine best practices, challenges encountered and lessons learned during the first year of the program. Collect and analyze data on incentives distributed and redeemed. Consider forums to disseminate findings. Explore ways to adapt programming and evaluation to adjust to social distancing guidelines, including survey administration, participant enrollment and partner interviews.
Impacts
What was accomplished under these goals?
Impact Statement The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) achieved the four goals set for the fourth year of FINI activities: (1) DOHMH continued to operate the nation's largest municipal-run farmers market incentive program, Health Bucks, all year round. DOHMH coordinated with 119 farmers markets across the five boroughs to distribute over $418,000 worth of fruit and vegetable incentives to New Yorkers with Supplemental Nutrition Assistance Program (SNAP) benefits; (2) DOHMH collaborated on the final analysis of data collected at NYC farmers markets through a nationwide randomized controlled trial (RCT) testing different incentive levels on fruit and vegetable; (3) DOHMH expanded its pharmacy-based fruit and vegetable prescription program for New Yorkers with SNAP at risk of adverse diet-related health outcomes and issued over $178,000 worth of incentives; and (4) DOHMH partnered with two point-of-sales vendors and six supermarkets to launch NYC's first supermarket-based SNAP incentive program distributing over $260,000 in incentives. Accomplishments Goal 1: Operated a year-round farmers market incentive program. Distributed incentives. Distributed more than 209,000 Health Bucks worth over $418,000 in fruits and vegetables to New Yorkers with SNAP at 119 farmers markets from May 2019-April 2020. Over 90% of Health Bucks distributed from January-December 2019 were redeemed. Promoted farmers markets. Designed and distributed over 90,000 maps in English and Spanish listing the locations of NYC farmers markets, posted market locations on NYC Health Map, an online searchable map, and translated materials promoting the Health Bucks SNAP incentive into eight languages. Presented on the Health Bucks SNAP incentive to over 100 faith leaders at four DOHMH-sponsored Food Faith and Fitness summits. Trained farmers market operators. Convened meetings with over 20 farmers market operators who run a combined 119 farmers markets to issue Health Bucks and discuss best practices for coupon distribution, tracking and promotion. Engaged community organizations. Met with over 550 organizations and provided Health Bucks promotional materials for distribution to their clients. Implemented electronic incentive tracking system. Tracked Health Bucks distribution and calculated redemption rates using a customized .NET and SQL software database. Goal 2: Partnered with Wholesome Wave (WW), University of Delaware (UD) and Case Western Reserve University (CWRU) to finalize analysis of data collected at NYC farmers markets as part of a nationwide RCT. UD, in partnership with WW and CWRU, finalized analysis of data collected for the NYC subset of the nationwide RCT. Results indicate that participants randomized to $4 in Health Bucks for every $5 spent in SNAP and $5 in Health Bucks for every $5 spent in SNAP spent significantly more in SNAP at farmers markets than those who received $2 in Health Bucks for every $5 spent in SNAP. There were no statistically significant increases in fruit and vegetable consumption observed at the higher SNAP incentive levels in the NYC subset. Goal 3: Implemented a pharmacy-based fruit and vegetable prescription program for SNAP participants at risk of adverse diet-related health outcomes Expanded program from 10 to 16 pharmacies and prepared for further expansion to the Bronx in June 2020. Utilizing private funding secured in project year 2, developed patient materials, trained pharmacy staff and launched program at 6 new pharmacies in spring 2019. Prepared to expand the program to the Bronx in summer 2020 in partnership with a farmers market located outside a public hospital in a neighborhood where over 35% of the population live below the federal poverty line. Contacted independent pharmacies near the market and conducted site visits. Selected a pharmacy that serves a large number of patients with low incomes and has staff capacity to administer program. Developed promotional and training materials in preparation for program launch. Completed third year of Pharmacy to Farm Prescriptions implementation and enrolled over 900 patients for total enrollment of more than 1,450 participants since program launch in May 2017. Provided pharmacies and farmers markets with ongoing technical assistance to support program implementation. Collected participant fruit and vegetable consumption on a monthly basis and entered into database for analysis. Distributed over $178,000 worth of incentives from May 2019-April 2020. 91% of incentives distributed in 2019 were redeemed for fruits and vegetables. Promoted program and supported patient recruitment. Advertised program on NYC Health Department webpage and social media. Reached out to nearby health centers and community-based organizations to recruit program participants. Conducted process evaluation. Analyzed results of year 2 process evaluation to determine program successes, challenges and lessons learned by pharmacies. Prepared for process evaluation with pharmacies added in year 3 of the program. Goal 4: Launched NYC's first supermarket-based SNAP incentive program Conducted baseline outcome assessment. Surveyed more than 800 customers with SNAP at four supermarkets, including three intervention and one control store, prior to incentive program launch. Hired 6 temporary, bilingual data collectors to survey supermarket customers in May 2019. Asked customers questions about fruit and vegetable consumption, food security status and shopping behaviors. Follow-up survey planned for May 2020 was postponed due to Covid-19 outbreak. Partnered with six supermarkets and two point-of-sales (POS) vendors to develop electronic incentive system. POS vendors configured the customer loyalty systems of 6 supermarkets to distribute and redeem incentives on SNAP purchases of eligible fruits and vegetables. Vendors flagged eligible items in supermarkets' POS system, configured program loyalty cards and programmed customer receipts to show incentive account balance. Identified fruits and vegetables eligible for incentives and trained supermarket staff to implement program. Reviewed supermarket inventories to identify all eligible fruits and vegetables. Shared eligible items list with POS vendors to flag in -store systems. In partnership with stores' POS vendors, trained store staff on program enrollment and implementation. Launched incentive program, Get the Good Stuff, at six supermarkets in NYC and distributed over $260,000 in fruit and vegetable incentives. Partnered with six supermarkets in neighborhoods with high rates of poverty to distribute $1 in incentives for every $1 spent in SNAP up to $50/day on eligible fresh, frozen, canned and dried fruits, vegetables and beans. Since June 2019, enrolled over 4,700 New Yorkers who have redeemed over $180,000 in incentives. Forty-eight percent of participants are Hispanic/Latino and 19% are Black. Publicized program and assisted stores with customer enrollment. Issued a press release in November 2019 announcing the program and received coverage from local TV stations and print media in English and Spanish. Printed and displayed program promotional materials including posters, palm cards, shelf talkers and floor decals. Hired two bilingual program assistants to recruit eligible supermarket customers and enroll them in the program. Presented on program at national convenings and submitted poster abstract. Presented at the Nutrition Incentive Hub's Nutrition Incentive Practitioner Convening as part of panel on incentive technology in grocery stores. Submitted poster abstract to the 2020 Society for Nutrition Education and Behavior Annual Conference. Poster was accepted and plans are to present the poster at the annual conference in July 2020.
Publications
|
Progress 05/01/18 to 04/30/19
Outputs
Target Audience:The target audience for our project in year 3 were the nearly 1.6 million NYC residents across the city's five boroughs that participated in the SNAP program. SNAP participants accessed Health Bucks at 121 farmers markets citywide, over 60% of which were located in high poverty neighborhoods. In the current reporting period, the project also targeted SNAP participants aged 18 and older filling prescriptions for hypertension medication at independent pharmacies in Manhattan, Brooklyn and Queens, New York. A preliminary evaluation found that from May 2017 to April 2018, 167 program participants enrolled in the program across four pharmacies. Demographics showed that 78% of participants were female, 53% were Latino, 92% were aged 45+ and 47% had at least a high school degree. At baseline, participants consumed a mean of 2.6 servings of fruits and vegetables per day. Additionally, 64% of participants worried about having enough food to eat in the past 30 days, and 85% agreed or somewhat agreed that fruits and vegetables cost too much. Our project also promotes the regional economy by increasing SNAP participants' demand for locally-grown fruits and vegetables. Local farmers are served through SNAP participants' increased spending on their products. Our project serves independent pharmacies by helping them expand beyond the traditional role of dispensing medication to providing preventative services, which can provide economic benefits through increased patient base. Changes/Problems:Launch of the supermarket incentive program has been delayed due to challenges contracting with POS vendors to develop an electronic incentive system and vendors' competing priorities. We engaged in lengthy negotiations with one POS vendor before agreeing on the terms and conditions of their contract. The contract was signed in late winter 2019 and the vendor began programming in spring 2019. The second POS vendor was busy preparing for launch of eWIC in fall 2018 and not available to complete programming until spring 2019. Both vendors are now actively working on the project and are scheduled to implement the incentive system at one store by summer 2019 and three more stores by the end of 2019. What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?We presented a poster at the Society for Nutrition Education and Behavior 51st Annual Conference to share baseline results from the pharmacy-based fruit and vegetable prescription program. We are also drafting two manuscripts for submission to peer-reviewed journals. One summarizes results of two surveys of more than 850 farmers market SNAP shoppers about their fruit and vegetable consumption before and after the year-round extension of the Health Bucks SNAP incentive. The other evaluates the effect of year-round Health Bucks availability on SNAP sales at farmers markets during winter and spring months. What do you plan to do during the next reporting period to accomplish the goals?We plan to complete the following in the next reporting period to accomplish our goals: Continue to distribute Health Bucks at 119 or more farmers markets across NYC that accept SNAP benefits and track coupon redemption. Launch Pharmacy to Farm Prescription program at six additional pharmacies and farmers markets for a total of 16 pharmacies and 6 farmers markets. Continue to enroll SNAP participants, collect and enter fruit and vegetable consumption survey data, and conduct preliminary data analysis. Interview staff from pharmacies added in program year 2 to determine best practices, challenges encountered and lessons learned during the first year of the program. Consider forums to disseminate findings. Work with two point-of-sales vendors to complete programming of electronic incentive system at four supermarkets. Train supermarket staff to enroll participants and implement program. Launch program at all stores and distribute a $1 for $1 match up to $50/day on SNAP purchases of eligible fresh, frozen, canned and dried fruits, vegetables, beans and lentils. Survey SNAP shoppers to assess fruit and vegetable purchases and consumption at participating stores and one control store prior to program launch and at 3, 6, 9 and 12 months following program implementation.
Impacts
What was accomplished under these goals?
The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) largely achieved the four goals set for the third year of FINI activities: (1) DOHMH continued to operate the nation's largest municipal-run farmers market incentive program, Health Bucks, all year round. DOHMH coordinated with 117 farmers markets across the five boroughs to distribute over $420,000 worth of fruit and vegetable incentives to Supplemental Nutrition Assistance Program (SNAP) participants; (2) DOHMH collaborated on the analysis of data testing different incentive levels on fruit and vegetable consumption collected at NYC farmers markets through a nationwide randomized controlled trial (RCT); (3) DOHMH expanded its pharmacy-based fruit and vegetable prescription program for SNAP participants at risk of adverse diet-related health outcomes and issued over $50,000 worth of incentives; and (4) DOHMH made progress toward establishing NYC's first supermarket-based SNAP incentive program, including executing contracts with two point-of-sales vendors to create electronic incentive systems at four food retailers. Goal 1: Operation of year-round farmers market incentive program Distributed incentives. Distributed more than 210,000 Health Bucks worth over $420,000 in fruits and vegetables to SNAP participants at 117 farmers markets from May 2018-April 2019. 90% of Health Bucks distributed in 2018 were redeemed. Promoted farmers markets and redesigned Health Bucks coupons. Designed and distributed over 75,000 maps listing the locations of NYC farmers markets, posted market locations on NYC Health Map, an online searchable map, and translated materials promoting the Health Bucks SNAP incentive into eight languages. Displayed farmers market map in blood pressure kiosks at over 50 pharmacies. Presented on the Health Bucks SNAP incentive to over 100 faith leaders at four DOHMH-sponsored Food Faith and Fitness summits. Trained farmers market operators. Convened meetings with over 20 farmers market operators who run a combined 117 farmers markets to issue Health Bucks and discuss best practices for coupon distribution, tracking and promotion. Engaged community organizations. Met with over 500 organizations and provided Health Bucks promotional materials for distribution to their clients. Developed electronic incentive tracking system. Developed and implemented a database using .NET and SQL software to track Health Bucks distribution and calculate redemption rates. Goal 2: Partnered with Wholesome Wave (WW), University of Delaware (UD) and Case Western Reserve University (CWRU) to analyze data collected at NYC farmers markets as part of a nationwide RCT Provided administrative framework for analysis of data collected at NYC farmers markets through the RCT. Maintained subcontract with Wholesome Wave to support UD and CWRU's analysis of SNAP transaction, incentive distribution and dietary questionnaire data. Met with Wholesome Wave and the UD to discuss study findings and implications for incentive program policies. UD, in partnership with WW and CWRU, conducted additional analysis of data collected for the NYC subset of the nationwide RCT. Preliminary unpublished results indicate that among 814 survey respondents in 2016 and 2017, nearly 90% reported experiencing food insecurity in the prior year and over half had overweight or obesity based on self-reported height and weight. There were no statistically significant increases in daily fruit and vegetable consumption observed at higher incentive levels within the New York City subsample. Goal 3: Implementation of a pharmacy-based fruit and vegetable prescription program for SNAP participants at risk of adverse diet-related health outcomes Completed second year of program implementation and enrolled 383 patients for total enrollment of over 550 participants since program launch in May 2017. Provided pharmacies and farmers markets with ongoing technical assistance to support program implementation. Collected participant fruit and vegetable consumption on a monthly basis and entered into database for analysis. Distributed over $50,000 worth of incentives from May 2018-April 2019. 88% of incentives distributed in 2018 were redeemed for fruits and vegetables. Expanded program from 4 to 10 pharmacies and prepared for further expansion. Secured over $200K in additional grants from private funders to support program expansion from 4 to 16 pharmacies and from 4 to 6 farmers markets. Contacted 50 independent pharmacies and selected an additional 12 to implement the program, all of which serve large numbers of low-income patients, are located near a year-round farmers market and have staff capacity to administer the program. In addition to implementing the program at four sites, developed patient materials, trained pharmacy staff and launched the program at six new sites in fall 2018 for a total of 10 pharmacies. Prepared to launch the program at six additional sites in spring 2019. Conducted baseline analysis and presented findings at Society for Nutrition Education and Behavior annual conference in summer 2018. A preliminary evaluation of baseline survey results found that from May 2017 to April 2018, 167 program participants enrolled in the program across four pharmacies. Participants consumed a mean of 2.6 servings of fruits and vegetables per day at time of program enrollment. Additionally, 64% of participants worried about having enough food to eat in the past 30 days, and 85% agreed or somewhat agreed that fruits and vegetables cost too much. Promoted program and supported patient recruitment. Advertised program on NYC Health Department webpage and social media. Reached out to nearby health centers and community-based organizations to recruit program participants. Conducted process evaluation. Analyzed results of year 1 process evaluation to determine program successes, challenges and lessons learned by pharmacies. Prepared for process evaluation with pharmacies added in year 2 of the program. Goal 4: Prepared to launch NYC's first supermarket-based SNAP incentive program Executed contracts with two point-of-sales (POS) vendors to develop electronic incentive system at four supermarkets. Worked with stores and their POS vendors to configure customer loyalty system to distribute $1 in incentives for every $1 spent in SNAP up to $50/day on eligible fresh, frozen, canned and dried fruits, vegetables, beans and lentils.. One POS vendor programmed one store's POS system including flagging eligible items, adding incentive balance to customer receipts and register screens, and configuring customer loyalty cards. The other vendor will begin programming in late April 2019. POS vendors expect to be ready to launch the program at one store by summer 2019 and three more stores by the end of 2019. Reviewed store inventories to identify all eligible fruits and vegetables. Reviewed three store inventories with over 80,000 items to identify all fruits, vegetables, beans and lentils eligible for the incentive program. Shared eligible items list with POS vendor to flag in store systems. Developed outcome evaluation and prepared for baseline assessment to be conducted in May 2019. Finalized evaluation plan which includes surveying SNAP customers prior to program launch at four supermarkets and one control store. Following launch, SNAP customers will be surveyed every 3 months for a total of 4 follow-up surveys in the first year of the program at each of the four stores and a control store. Worked with POS vendors to develop system for generating weekly reports of stores' SNAP sales, purchases of eligible items, incentive distribution and redemption, and program enrollment. Designed program promotional materials. Contracted with a design agency to develop and design program promotional materials including posters, palm cards, shelf talkers, floor decals, customer loyalty card and images for social media.
Publications
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2018
Citation:
Citation: Pharmacy to Farm Prescriptions Pilot Program in New York CityBaseline Survey Findings
Luu, Catherine, Andersen, Nicole et al. Journal of Nutrition Education and Behavior, Volume 50, Issue 7, S163 - S164.
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Progress 05/01/17 to 04/30/18
Outputs
Target Audience:The target audience for our project in year 2 was the nearly 1.7 million NYC residents across the city's five boroughs that participated in the SNAP program. SNAP participants accessed Health Bucks at 115 farmers markets citywide, over 60% of which were located in high poverty neighborhoods. Special emphasis was placed on SNAP participants living in the South Bronx, North and Central Brooklyn and East and Central Harlem, where residents have low-incomes and high rates of poor health outcomes. In the current reporting period, the project also targeted SNAP participants aged 18 and older filling prescriptions for hypertension medication at independent pharmacies in Manhattan, Brooklyn and Queens, New York. An internal DOHMH analysis shows that neighborhoods of NYC with large Black and Hispanic populations are predominantly served by independent pharmacies. Preliminary baseline survey results as of January 2018 indicate that participants are predominantly female (78%), Latino (55%) and have at least a high school degree (57%). The majority of participants are aged 50 or older (82%) and have worried about having enough food to eat in the past 30 days (57%). Our project also promotes the regional economy by increasing SNAP participants' demand for locally-grown fruits and vegetables. Local farmers are served through SNAP participants' increased spending on their products. Our project also serves independent pharmacies by helping them expand beyond the traditional role of dispensing medication to providing preventative services, which can provide economic benefits through increased patient base. Changes/Problems:Launch of the supermarket incentive program has been delayed due to challenges encountered in developing an electronic incentive system, including the high cost. We had originally budgeted $4,000/year per store to cover POS system upgrade costs and additional store staff to implement the program. We learned that POS system upgrades are more costly than anticipated and $4,000/year per store is not sufficient to cover the cost of developing and implementing an electronic incentive system. We decided to reallocate up to $40,000 from our original budget to support POS system upgrades at up to four supermarkets and are working with the stores and their POS vendors to execute contracts to deliver the program. This process delayed program launch which is now scheduled for fall 2018. What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?We submitted an abstract to the Society for Nutrition Education and Behavior 51st Annual Conference to share baseline results from the pharmacy-based fruit and vegetable prescription program. The abstract was accepted and we will present a poster at the conference in July, 2018. We are also drafting a manuscript for submission to a peer-reviewed journal summarizing the results of the farmers market SNAP shopper survey. In additional, we are evaluating the effect of year-round Health Bucks availability on SNAP sales at farmers markets during winter and spring months. We anticipate drafting a manuscript to disseminate our findings during year 3. What do you plan to do during the next reporting period to accomplish the goals?We plan to complete the following in the next reporting period to accomplish our goals: Continue to distribute Health Bucks at 115 or more farmers markets across NYC that accept SNAP benefits and track coupon redemption. Analyze data collected through the RCT and apply results to inform future Health Bucks program operations. Work with the three supermarkets selected to participate in the fruit and vegetable incentive program and their point-of-sales vendors to develop an electronic system for distributing and redeeming incentives. Develop promotional materials to advertise the program and train store staff to administer it. Launch the program in fall 2018. Survey SNAP shoppers at the supermarkets participating in the incentive program and at control stores to assess customers' fruit and vegetable purchasing and consumption. Conduct surveys at baseline and 6 and 12 months following program launch. Launch Pharmacy to Farm Prescription program at two additional pharmacies and farmers markets for a total of 6 pharmacies and farmers markets. Collect and enter survey data and conduct initial individual-level data analysis on fruit and vegetable purchasing and consumption. Interview pharmacy staff to determine best practices, challenges encountered and lessons learned during the first year of the program. Consider forums to disseminate findings.
Impacts
What was accomplished under these goals?
Impact Statement The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) largely achieved the four goals set for the second year of FINI activities: (1) DOHMH continued to operate the nation's largest municipal-run farmers market incentive program, Health Bucks, all year round. DOHMH coordinated with 115 farmers markets across the five boroughs to distribute over $474,000 worth of fruit and vegetable incentives to Supplemental Nutrition Assistance Program (SNAP) participants; (2) DOHMH continued to participate in a nationwide randomized controlled trial (RCT) testing the effectiveness of different incentive levels on fruit and vegetable consumption. Over 1,000 surveys were completed in NYC from July-October 2017 and over $30,000 worth of fruit and vegetable incentives were distributed; (3) DOHMH implemented a pharmacy-based fruit and vegetable prescription program for SNAP participants at risk of adverse diet-related health outcomes and issued nearly $10,000 worth of incentives; and (4) DOHMH worked on developing NYC's first supermarket-based SNAP incentive program, including collaborating with food retailers and their point-of-sales vendors to develop a plan for creating an electronic incentive system. Accomplishments Goal 1: Operation of year-round farmers market incentive program Distributed incentives. One hundred fifteen farmers markets distributed more than 237,000 Health Bucks worth over $474,000 in fruits and vegetables to SNAP participants from May 2017-April 2018. Promoted farmers markets and redesigned Health Bucks coupons. Designed and distributed over 75,000 maps with NYC farmers market locations and translated promotional materials into eight languages. Ran 1,000 ads on the NYC subway and provided marketing materials to over 120 SNAP enrollment and outreach sites. Redesigned Health Bucks to accommodate distinctive year-to-year changes to prevent potential fraud. Trained farmers market operators. Convened meetings with over 20 farmers market operators to issue Health Bucks and to discuss best practices for coupon distribution, tracking and promotion. Engaged community organizations. Met with over 450 organizations and provided them with Health Bucks promotional materials to distribute to their clients. Surveyed SNAP shoppers. Conducted a follow-up survey with 453 SNAP participants at eight farmers markets about their eating and shopping behaviors following the year-round extension of the Health Bucks program. Compared results to baseline survey to assess program's impact and found a statistically significant increase in healthy vegetable consumption. Goal 2: Concluded participation in a nationwide RCT testing the impact of three incentive levels Provided administrative framework for study participation in NYC. Maintained subcontract with Wholesome Wave to train market staff, provide technical assistance and data management for the RCT, and to manage the RCT at 18 GrowNYC farmers markets in project year 2. Monitored data collection and Health Bucks distribution and redemption. Conducted third and final wave of RCT in NYC. Conducted four one-month lottery rounds at 18 farmers markets from July-October 2017. Participants completed monthly surveys and were randomly assigned to get $2, $4 or $5 in incentives for every $5 spent in SNAP. A total of 977 lottery tickets were submitted and 1,056 online surveys were completed in the final four rounds. Over $30,000 in Health Bucks were distributed through the final wave of the study. Wholesome Wave, in partnership with the University of Delaware and Case Western Reserve University, conducted preliminary analysis of data collected across all waves of the RCT. Preliminary results indicate that 80% of participants were female, 50% were white and over 20% were Hispanic. The average SNAP purchase was $22 for participants randomized to the $2:$5 arm, $38 for participants randomized to the $4:$5 arm and $41 for participants in the $5:$5 arm. Statistically significant findings indicate that NYC SNAP participants spent more at farmers markets when a $4 incentive was offered for every $5 spent in SNAP compared to $2 for every $5 spent in SNAP. Goal 3: Implementation of a pharmacy-based fruit and vegetable prescription program for SNAP participants at risk of adverse diet-related health outcomes Identified site characteristics key to program success. Used experiences with and lessons learned from the first three pharmacies to inform recruitment of new sites. Researched pharmacies that serve large numbers of low-income patients, are located near a year-round farmers market and have staff capacity to administer the program. Contacted 50 independent pharmacies and selected three new pharmacies to pilot the program. Launched program at three new pharmacies in spring 2018. Trained staff on recruitment, enrollment, and distribution and tracking of fruit and vegetable prescriptions. One pharmacy from the first three sites (launched in spring 2017) continues to participate. A total of four pharmacies and farmers markets are currently offering the program. Promoted program and supported patient recruitment. Conducted nutrition education workshops at one site. Developed mini-fliers for inclusion in patient medicine bags, outreached to nearby health centers and community-based organizations. Collaborated with partnering farmers markets to outreach to SNAP shoppers. Conducted preliminary analysis of data collected. Over 120 SNAP participants with hypertension are enrolled. Approximately 80% of fruit of vegetable prescriptions distributed to patients by pharmacies have been redeemed at farmers markets for incentives. Over $12,000 worth of incentives have been issued and about 87% have been redeemed for fruits and vegetables. Prepared for process evaluation to be conducted in project year three. This evaluation will identify program successes, challenges and lessons learned by pharmacies. Goal 4: Began development of NYC's first supermarket-based SNAP incentive program Expanded knowledge of opportunities and barriers for supermarket incentive systems. Conducted meetings with two food retailers selected in project year 1 and their point-of-sales (POS) vendors to discuss developing an electronic fruit and vegetable incentive program for SNAP customers. Learned about the high cost of developing an electronic incentive infrastructure and reallocated project budget to support POS system updates at selected supermarkets. Decided to contract directly with stores' POS vendors based on feedback received. Reissued the request for proposals (RFP) to identify retailers to pilot NYC's first supermarket-based SNAP incentive program. The RFP included funding for selected stores' POS vendors. Eligibility requirements included: do not sell tobacco; sell at least 7 types of fruits and vegetables; had at least $10,000 in SNAP sales in 2016; and use an electronic point of sales (POS) system to process and record customer transactions. Selected three supermarkets in high-poverty neighborhoods to deliver a fruit and vegetable SNAP incentive program. Assembled panel to review responses and select awardees. Four stores submitted applications and one did not meet the eligibility requirements. Review panel selected three independently owned and operated supermarkets: Fine Fare at 459 East 149th Street in Bronx, NY, Fine Fare at 8945 163rd Street, in Queens, NY and Three Guys in Brooklyn at 6502 Fort Hamilton Parkway in Brooklyn, NY. Developed infrastructure for program. Met with store staff and their POS vendors to discuss configuring their POS system to identify items eligible for the incentive program and distribute and redeem incentives. In the process of executing separate contracts with stores and their POS vendors to launch the program in fall 2018.
Publications
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Progress 05/01/16 to 04/30/17
Outputs
Target Audience:Target Audience The target audience for our project in year 1 was the nearly 1.7 million NYC residents across the city's five boroughs that participated in the SNAP program. SNAP participants accessed Health Bucks at 120 farmers' markets citywide, over 60% of which were located in high poverty neighborhoods. Special emphasis was placed on SNAP participants living in the South Bronx, North and Central Brooklyn and East and Central Harlem, where residents have low-incomes and high rates of poor health outcomes. In the current reporting period, the project also targeted SNAP participants aged 18 and older filling prescriptions for hypertension medication at an independent pharmacy in Brooklyn, New York. An internal DOHMH analysis shows that neighborhoods of NYC with large Black and Hispanic populations are predominantly served by independent pharmacies. The pharmacy participating in the Pharmacy to Farm Prescriptions program is located in a neighborhood where more than 40% of the population is Black and near a year-round farmers' market that had over $50,000 in SNAP sales in 2016. Demographic information is being collected as part of program enrollment and we will have more information on racial and ethnic makeup of the population served next reporting period. Our project also promotes the regional economy by increasing SNAP participants' demand for locally-grown fruits and vegetables. Local farmers are served through SNAP participants' increased spending on their products. Our project also serves independent pharmacies by helping them expand beyond the traditional role of dispensing medication to providing preventative services, which can provide economic benefits through increased patient base. ? Changes/Problems:Farmers' markets in NYC are managed by many different operators, some of whom are volunteers and change hands year to year. This landscape has made it challenging to conform to all data reporting requirements as requested by Westat, on behalf of the USDA. We discussed this challenge and potential solutions with Westat and the USDA, and collectively decided to request all data at each interval. As an example, we requested data from all 120 farmers' markets for reporting quarterly incentive disbursement on a market-by-market level. We were able to report on nearly 100 markets representing over 85% of NYC farmers' market SNAP sales. We continue to emphasize the importance of this reporting as a condition of our receipt of FINI funding and to urge farmers' market operators to respond with data that they have on file. What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?We issued two press releases. The first press release announced year-round availability of Health Bucks and the second touted record SNAP sales at GrowNYC farmer's markets in 2016 following year-round expansion. We spent the first year of the project designing and launching programs, recruiting program partners, and conducting a baseline survey. We anticipate disseminating initial program results in the next project period and will submit manuscripts to peer-reviewed journals. What do you plan to do during the next reporting period to accomplish the goals?We plan to complete the following in the next reporting period to accomplish our goals: Launch a two-pronged Health Bucks promotional campaign to increase the number of SNAP participants who know how to access Health Bucks by running subway ads and distributing toolkits to SNAP benefit enrollment offices, organizations with large SNAP clientele including WIC clinics, and New York City Housing Association (NYCHA) developments. Toolkits will include farmers' market maps, postcards promoting the incentive for fruits and vegetables at farmers' markets, and talking points to guide staff's conversations about Health Bucks. Continue to distribute Health Bucks at 120+ farmers' markets across NYC that accept SNAP benefits and track coupon redemption. Conduct a follow-up survey of SNAP customers at farmers' markets to explore any changes in buying patterns of fruits and vegetables following the expansion of Health Bucks to year-round availability. Analyze any differences and consider ways to disseminate findings. Conduct the third and final round of the RCT at at least 12 farmers' markets and conduct data analysis to determine impact of various incentive levels on SNAP participants' fruit and vegetable purchasing and consumption Work with the two supermarkets selected to participate in the fruit and vegetable incentive program to develop an electronic system for distributing and redeeming incentives. Develop promotional materials to advertise the program and train store staff to administer it. Launch the program at the two stores in fall 2017.Survey SNAP shoppers at the supermarkets participating in the incentive program and at control stores to assess customers' fruit and vegetable purchasing and consumption. Conduct surveys at baseline and 6 and 12 months following program launch. Launch Pharmacy to Farm Prescription program at two additional pharmacies and farmers' markets for a total of 3 pharmacies and farmers' markets. Collect and enter survey data and conduct initial individual-level data analysis on fruit and vegetable purchasing and consumption. Interview pharmacy staff to determine best practices, challenges encountered and lessons learned during the first year of the program. Consider forums to disseminate findings.
Impacts
What was accomplished under these goals?
More than 1.7 million New Yorkers rely on SNAP to buy food. Low-income New Yorkers are more likely to suffer from diet-related chronic diseases, such as heart disease, cancer and stroke, which cost lives, healthcare dollars, and lost economic productivity. Adults in low-income neighborhoods consistently consume fewer fruits and vegetables than those in high-income neighborhoods, even though eating more fruits and vegetables can decrease the risk of heart disease and some cancers. The New York City Department of Health and Mental Hygiene (DOHMH) through its fiscal agent the Fund for Public Health in New York, strives to close these gaps through the Big Apple Incentives (BAI) project. DOHMH largely achieved the goals it set for itself for the first year of FINI activities. First, DOHMH expanded the nation's largest municipal-run farmers' market incentive program, Health Bucks from 5 to 12 months. More than $400,000 worth of fruit and vegetable incentives were distributed at 120 farmers' markets in project year 1. Second, DOHMH participated in a nationwide randomized controlled trial testing the effectiveness of different incentive levels on fruit and vegetable consumption. Finally, DOHMH initiated two pilot projects to test new avenues for fruit and vegetable incentive distribution, including a pharmacy-based prescription program for SNAP participants at high risk for poor, diet-related health outcomes and a supermarket-based fruit and vegetable incentive program. During the first year that the BAI project was underway, fruit and vegetable purchases by SNAP participants increased at NYC farmers' markets. Accomplishments Goal 1: We expanded the Health Bucks (HB) program to all year-round and distributed HB at 120 farmers' markets. Below is a list of related activities accomplished. Distributed incentives. Expanded the HB program from 5 to 12 months and distributed more than 200,000 HB worth over $400,000 in fruits and vegetables at 120 farmers' markets. Promoted farmers' markets. Designed and distributed over 75,000 fold-up maps with farmers' market locations and translated promotional materials into 8 languages. Developed and launched a citywide marketing campaign to draw new SNAP customers to farmers' markets. Advertised on city busses and in bus shelters, laundromats, four daily newspapers, Facebook and Instagram. Trained farmers' market operators. Met individually with 30+ farmers' market operators to distribute HB to SNAP participants at 120 farmers' markets. Convened two meetings with operators to highlight FINI, discuss best practices for HB distribution, tracking, and promotion during the winter season. Engaged community organizations. Met with nearly 450 community-based organizations serving low-income New Yorkers and provided them with HB promotional materials to distribute to their clients. Surveyed SNAP shoppers. Designed and conducted a baseline survey of 425 SNAP participants at 8 farmers' markets. Surveyed participants about their eating and shopping behaviors prior to the extension of the HB season. Goal 2 We participated in the national randomized controlled trial testing the impact of three different incentive levels on SNAP participants' purchase and consumption of fresh fruits and vegetables. Below is a list of related activities accomplished. Established administrative framework to participate in study. Executed a subcontract with Wholesome Wave to provide training, technical assistance and data management for the RCT. Executed a subcontract with GrowNYC to implement the RCT at 12 summer farmers' markets and 6 winter markets in project years 1 and 2. Monitored data collection and HB distribution and redemption. Conducted RCT in NYC. Three one-month lottery rounds were conducted at 12 farmers' markets from August through October 2016 and at 6 markets from January through March 2017 for a total of 54 rounds. SNAP customers completed online surveys about their diet and shopping behaviors and were randomly assigned to one of three incentive levels: spend $5 get $2; spend $5 get $4; or spend $5 get $5. Survey completion and random assignment to an incentive level reoccurred each month of the trial. A total of 663 lottery tickets were submitted and over 800 online surveys completed in the first two waves of the RCT. Preliminary results indicate that the average SNAP purchase was $21 for participants randomized to the $2 for $5 arm, $36 for participants randomized to the $4 for $5 arm and $38 for participants in the $5 for $5 arm. Over $17,000 in HB were distributed through the study. Goal 3 We selected two supermarkets in high-poverty neighborhoods of NYC to deliver a fruit and vegetable SNAP incentive program. Below is a list of related activities accomplished. Explored best model for NYC. Consulted with stakeholders in NYC and other organizations implementing healthy food retail programs across the country to glean lessons learned on program planning and design, protocol development, and partner selection. Put incentive program out to bid. Developed a request for proposals (RFP) from food retailers in high poverty neighborhoods in NYC to develop and implement a fruit and vegetable incentive pilot program. Eligibility requirements included: do not sell tobacco; sell at least to sell at least 7 types of fruits and vegetables; had at least $10,000 in SNAP sales in 2016; and use an electronic point of sales (POS) system to process and record customer transactions. Preference was given to stores that do not sell hard liquor and promote healthy foods. Posted the RFP application on the Fund for Public Health's website and disseminated to stakeholders. Reviewed responses: Six stores submitted applications to participate in the pilot program. Two applications did not meet the eligibility requirements. Convened a panel to review the remaining four applications. Awardees selected by panel. Selected two independently owned and operated supermarkets to participate in the pilot program: Fine Fare at 459 East 149th Street in Bronx, NY and Fine Fare at 8945 163rd Street, in Jamaica Queens. Developed infrastructure for program. Met with store staff and their POS vendors to discuss reconfiguring their POS and customer loyalty programs to identify items eligible for the incentive program and distribute and redeem incentives. In the process of executing contracts with the two stores and reviewing stores' inventory lists to identify items eligible for the program. Discussing promotional strategies with the stores. Goal 4 We identified three pharmacies and farmers' markets to participate in a pharmacy-based fruit and vegetable prescription program. Below is a list of related activities accomplished. Set selection criteria for eligible pharmacies by identifying year-round farmers' markets that are either in low-income neighborhoods or have high SNAP sales. Contacted 15 independent pharmacies within 1-mile walking distance of the markets and selected 3 pharmacies that expressed interest in participating in the program. Developed promotional materials including posters, flyers and brochures to assist pharmacists in recruiting eligible SNAP participants to participate in the program. Translated all materials to Spanish. Designed a survey to measure participants' fruit and vegetable consumption, attitudes toward fruits and vegetables and knowledge about farmers' markets and HB. Developed data collection methods for matching survey responses to HB redemption information. Adapted existing nutrition education materials and lessons to be used in workshops at the pharmacies to compliment programming. Trained staff at three pharmacies on recruitment and enrollment, administration of dietary screener, and distribution and tracking of fruit and vegetable prescriptions. Launched the program at one pharmacy, and prepared the second and third to launch in May 2017.
Publications
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