Progress 06/01/16 to 05/31/21
Outputs
Target Audience:The Southern California Nutrition Incentive Program, also known as the ¡Más Fresco! More Fresh Program included multiple target audiences. In Federal Fiscal Year (FFY) 2017 (June 1, 2016- May 31, 2017), the primary target audience included CalFresh recipients who lived in close proximity (within 5 miles) of the six Northgate González Market financial incentive intervention sites. These sites are located in Los Angeles, Orange, and San Diego Counties. A total of 1,153 participants were enrolled in FFY2017. The majority were female (93%) and Latino (90%) with a mean age of 39.7 years (range of 18 to 95 years old). The majority also had less than a high school education (67%) or high school degree/GED (19%). Additional demographic information included: mean household size: 5.5 persons, mean CalFresh earnings per month: $329, median daily servings of fruits and vegetables (EATS Screener): 2.6, and percent facing low or very low food security (USDA Screener): 80%. During FFY 2018 (June 1, 2017, through May 31, 2018), primary target audience remained CalFresh recipients living within five miles of six Northgate Market financial incentive intervention sites. The program also expanded to include a secondary target audience connected to community based organizations providing direct outreach and assistance to CalFresh recipients. The primary target audience included 1,230 CalFresh recipients who lived in close proximity (within 5 miles) of the six Northgate Market financial incentive intervention sites. The majority were female (88%) and Latino (90%) with a mean age of 41.6 years (range of 18 to 90 years old). The majority also had less than a high school education (63%) or high school degree/GED (17%). Additional demographic information includes mean household size of 4.2 persons, mean CalFresh earnings per month of $302, median daily servings of 2.7 fruits and vegetables (EATS Screener), and 79% facing low or very low food security (USDA Screener). The secondary target audience included over 100 community-based organizations that provided direct outreach and assistance to CalFresh recipients and other low-income community members living in Los Angeles, Orange, and San Diego counties. Key community-based organization partners included the Supplemental Nutrition Assistance Program Education (SNAP-Ed) and Nutrition Education and Obesity Prevention (NEOP) program.These organizations helped us distribute ¡Más Fresco! More Fresh flyers about the ¡Más Fresco! More Fresh Program directly to low- income community residents in the three counties. In 2018, CalFresh Agencies in Orange and San Diego Counties sent letters directly to CalFresh recipients living within 5 miles of each of the Northgate Market intervention sites to promote program enrollment events. Numerous community-based organizations began participating and supporting the ongoing efforts. Key organizations included the local county health departments, food banks, faith-based organizations, community centers, school districts, WIC programs, UC Cooperative Extension, and food system alliance networks and organizations. FFY 2018 media outreach efforts resulted in media placements across the United States and key story placements in the Los Angeles Times, National Public Radio (NPR), KPBS News, Kaiser Health News, KQED News, PEW Charitable Trust News, USA News, NIFA USDA Impacts and HealthLine. In addition, media attention and coverage \promoted CNN to develop a segment on Mas Fresco More Fresh program. The segment featured interviews conducted with program director Joe Prickitt, program participants and their family. In FFY 2019 (June 1, 2018- May 31, 2019) the primary target audience remained recipients' living within 5 miles of the six Northgate Market financial incentive intervention sites. The program's third cohort included 1,093 participants. The majority remained (85%) and Latino (91%) with a mean age of 42.5 years (range of 20 to 91 years old). The majority of this cohort also had less than a high school education (58%) or high school degree/GED (80%). Additional demographic information included: Mean household size of 4.1 persons; Mean CalFresh earnings per month of $296; Median daily servings of fruits and vegetables (EATS Screener) of 3.2 servings; Percent facing low or very low food security (USDA Screener): 70.7%. A secondary target audience for the ¡Más Fresco! More Fresh Program included community-based organizations, such as theSupplemental Nutrition Assistance Program Education (SNAP-Ed) providers and Nutrition Education and Obesity Prevention (NEOP) providers that support the health and well-being of low-income community members living in Los Angeles, Orange, and San Diego Counties. In 2019, we partnered with over 100 community-based organizations that provide direct outreach to CalFresh recipients and other low-income community members living in Los Angeles, Orange, and San Diego counties. Key support included the CalFresh agencies in Orange and San Diego Counties which sent letters directly to CalFresh recipients living within 5 miles of each of the intervention sites promoting the program's in-store enrollment events taking place at the Northgate Markets in Orange and Los Angeles Counties and the opportunity to enroll in the program. During FFY 2020 (June 1, 2019-May 31, 2020), the primary target audience remained recipients' living within 5 miles of the six Northgate Market financial incentive intervention sites. The ¡Más Fresco! More Fresh program continued to implement and evaluate a Food Insecurity Nutrition Incentive (FINI) program for Supplemental Nutrition Assistance Program (SNAP) recipients who shop at 6 participating Northgate Markets in Los Angeles, Orange, and San Diego counties. We applied for and received, a no-cost extension to continue the ¡Más Fresco! More Fresh FINI program through May 31, 2021. The extension gave the program the flexibility to continue recruiting participants and providing incentives as we transitioned to our ¡Más Fresco! More Fresh Program Gus Schumacher Nutrition Incentive Program (GusNIP) grant. With GusNIP, the program will expand to include SNAP recipients at all 41 Northgate stores in Southern California and develop an automated enrollment process. From February 2017 to May 31, 2020, the program enrolled a total of 4,452 SNAP households into ¡Más Fresco! More Fresh. During 2020, we implemented COVID-19 guidelines from CDC, County health departments, and UC San Diego, to protect participants, staff, and partners. We suspended our 2020 in-store enrollment event scheduled March 9, 2020 in accordance with COVID-19 regulations.Between January to March 2020, 788 new ¡Más Fresco! More Fresh members were enrolled 18 in-store events. During FFY 2021 (June 1, 2020 - May 31, 2021), the primary target audience remained CalFresh recipients' living within 5 miles of the six Northgate Market financial incentive intervention sites. We enrolled 1,168 participants in the program in FFY 2021, for a grand total of 5,787 participants over the 5 years of the ¡Más Fresco! More Fresh FINI program; all of our participants were transitioned to our new GusNIP program on May 31 to provide member earn and redeem of nutrition incentives continuity. In addition, with funding from the San Diego County Health and Human Services Agency, ¡the Mas Fresco! More Fresh program developed and implemented a social media campaign to better support enrollment initiatives in Mid-City San Diego and Southeast San Diego, two of San Diego's most underserved communities. From April 26, 2021 through June 30, 2021 the campaign facilitated enrollment for 913 San Diego CalFresh recipients with over 70% from either Mid-City San Diego or Southeast San Diego. Changes/Problems:In FFY 2017, we did not encounter any significant problems or issues in our approach. However, we had to make adjustments to the originally proposed design to align with recommendations provided to us by our community partners. Thiskey study design change came due to input from the National Cash Register Corporation during our initial program design and development meeting with Northgate and their point-of-sale technology providers. The National Cash Register Corporation advised us that if we were looking to secure equitable data among our study groups, we would need to provide a financial incentive to all our study group participants so that each study group participant would have a reason to use their customer loyalty card at check-out and generate the transaction data needed for the study. Based on their experience, they let us know that it was unlikely that program participants who enrolled in the study and who did not receive a financial incentive would use their customer loyalty card at the store. Based on this input, our study design was revised to provide all program participants with some amount of financial incentive. The revised study design provided for a $10 a month, $20 a month and a $40 a month study groups to help ensure equitable transaction data among and between all program participants. This change was approved by NIFA. Implementation of the technical program (including the point-of-sale system and the cloud-based technology) also took longer to implement than originally planned given the complexity of the system and the need to work with additional vendors to implement the program. Therefore, we were not able to enroll participants into the program until Feb 2021, which contributed to us having funds for a no-cost extension. Another change that we made in 2017 was to hire a half-time program coordinator instead of a full-time program coordinator and use the cost savings to secure the ongoing support of a network of promotoras to support the enrollment and ongoing program participant support process. This change proved to be critical toward our successful enrollment and support of the program participants. Conducting the needs assessment with our community partners during the program design process proved to be instrumental in helping to ensure successful development and implementation of the program without incurring any significant problems or issues. In FFY 2018, we did encounter technology issues with the implementation of the Fruit and Vegetable Financial Incentive System. Since the Fruit and Vegetable Financial Incentive System represented an innovative benefit redemption system and technologies, our first year of operation represented a live beta-test. As such, we did experience and encounter hardware, software, and other technology issues that needed to be addressed and worked through with Northgate and their technology providers. At the time, this was something that had been anticipated and was therefore planned and communicated with our program participants when they enrolled into the program. FFY 2019 & 2020: In 2019 and 2020 we did have technical difficulties with the POS systems at Northgate which resulted in decreases in incentive utilization. We also began to hear from participants that they were unable to earn enough incentive dollars with our 1:1 earn and redeem model. Further investigation into this matter revealed that many of our CalFresh recipients do not feel that they can allocate their limited EBT dollars to more F&V in order to earn more incentive dollars. This has resulted in us having incentive dollars that have not been spent at this time. Nevertheless, this information was the foundation for us to develop a 2:1 and 4:1 earn and redeem model for our 2019 proposal. As a result, we are starting to see significantly increased spending of incentive dollars in our new proposal. The COVID-19 pandemic also limited our in-store enrollment in 2020. However, we were able to accelerate the launch of our online enrollment system by April of 2020 to continue to enroll participants virtually, which was critical in the first few months of the pandemic when food insecurity surged and many families faced sudden economic instability and needed additional food resources. During this year, we were also working on expanding the program to 41 stores. This resulted in additional technical difficulties which also impacted our ability to continue to run the original program in 6 stores. As a result, we were unable to distribute the remaining funds from the 2016 program in a timely manner. In FFY 2021: Despite our best efforts, we were unable to distribute all of the incentive money allocated to our FINI grant. This occurred due to several challenges. As previously mentioned, technical difficulties with the initial implementation of the Northgate point of sale and promotion system delayed our initial enrollment in the 6 stores. We also had some technical difficulties along the way which limited the earn and redeem potential of customers. A key technical difficulty included issues encountered at the check-out lanes at the Northgate Gonzalez Markets. Each check-out lane in each Northgate Gonzalez Market needed to be configured to support the Mas Fresco More Fresh Program. Unfortunately, as we learned over the years, the software supporting each of the check-out lanes experienced ongoing issues that resulted in certain check-out lanes in certain Northgate Gonzalez Markets not recognizing Mas Fresco members which caused them to not be able to earn or redeem their nutrition incentives. Due to the need to configure each check-out lane in each Northgate Gonzalez Market to enable Mas Fresco members to earn and redeem their nutrition incentives and the ongoing issues encountered with the software supporting each check-out lane, Northgate Gonzalez Market was not able to expand the Mas Fresco Program beyond the 6 stores. However, with the implementation of their new NCR Emerald point-of-sale-system, there is no need to configure each check-out lane in each store to recognize Mas Fresco members and support the earning and redeeming of Nutrition Incentives. As such, as Northgate works to implement their new NCR Emerald point-of-sale system we look forward to expanding the Mas Fresco Program to all Northgate Gonzalez Markets. We also did not anticipate that only 60-80% of participants who enrolled in the program would actually earn or redeem incentives, and only a smaller proportion went on to use the program regularly over time to earn and redeem the full amount available to them each month. Despite successful quality improvement activities to improve participant utilization from 60% to 80% (e.g., distributing pre-activated cards so they could start using them the same day) and increase participant understanding of the program (e.g., extensive workshopping of program materials and messaging in English and Spanish; 57% of the 2017 cohort said it was easy or very easy to understand the program vs. difficult/very difficult/neutral in their 6-month survey compared to 65-66% of participants in the 2018 and 2019 cohorts after we had implemented revised messaging), we still fell short of our incentive allocation. Finally, as mentioned above, we received feedback from participants that it was difficult to spend enough on F&V with their EBT dollars to earn enough incentive dollars. This also limited our ability to fully utilize all the incentive money. Nevertheless, this information has lead us to develop a new incentive model for our 2019 GusNIP proposal which will hopefully allow us to utilize all the funds allocated to nutrition incentives. What opportunities for training and professional development has the project provided?In FFY 2017, the Latino Health Access Promotora Team identified the ¡Más Fresco! More Fresh Program as one of the most rewarding and effective programs they've ever worked on. Providing them with this training and professional development opportunity directly benefits both the Promotoras and the low-income communities they serve. We also worked on the creation of the first retail-based Good Food Purchasing Program which was recognized by Food System Alliance organizations in the counties of Los Angeles, Orange, and San Diego. In FFY 2018, we developed a UC San Diego Institutional Review Board training program to help the Promotoras understand the challenges of human subjects research, and to ensure that all UC San Diego IRB guidelines were adhered to during the engagement, recruitment, and follow-up interactions with participants. The training included topics such as Participant Eligibility Screening, Informed Consent, Administration of Baseline Survey, etc. We also worked with Northgate to develop staff trainings that address the ¡Más Fresco! More Fresh Program and ensure that staff members understand how to support program participants if necessary. Additionally, the Southern California Nutrition Incentive Program led the development and implementation of a panel presentation, abstracts, and poster session about nutrition incentives at the 2018 American Public Health Association conference in San Diego, CA. These presenters provided an overview of the Gus Schumacher Nutrition Incentive Program's breadth, reach, and impact - including the program's overall economic impact within local communities and economies. They also shared key insights on innovative nutrition incentive programs, technologies, and practices. In FFY 2019, the ¡Más Fresco! More Fresh Program was invited by the Chilean Ministry of Health and the United Nations Food and Agriculture Organization to Chile's Fruit and Vegetable Access Conference. Hosted in Chile, this international conference was about programs and public policies to increase the purchase, consumption, and production of fruits and vegetables. Joe Prickitt, MS, RD, and UC San Diego Center for Community Health Senior Director of the Southern California Nutrition Incentive Program traveled to Chile to present on the ¡Más Fresco! More Fresh Program. He also spoke about the broader Food Insecurity Nutrition Incentive work that has been conducted in the United States to increase the purchase and consumption of fruits and vegetables. This conference included government health officials and produce industry leaders across Chile, Mexico, Central America, and South America. We were given the opportunity to share information about food insecurity nutrition incentive programs, address barriers to access of fruits and vegetables, and provide proven strategies to increase the accessibility and availability of fruits and vegetables to community members - all to an international audience. In FFY 2020, the ¡Más Fresco! More Fresh Program received an invitation from the Nutrition Incentive Hub to present at the National Grocer's Association meeting in San Diego. At this presentation, we shared program insights with retailers and attendees from all over the United States on the program's innovative benefit redemption system, as well as the program's evaluation efforts and results. In addition to attending the National Grocer's Association meeting, the ¡Más Fresco! More Fresh Program participated in one of the Nutrition Incentive Hub's webinars to share information about our benefit redemption system. Another notable opportunity for our program team was to provide training and professional development occurred when the UC San Diego School of Medicine Center for Community Health was asked to coordinate a nutrition incentive program presentation for the California WIC Association. Hosted as a webinar, this event allowed UC San Diego, the Ecology Center, and ALL IN Alameda County to raise awareness about nutrition incentive programs across California to all 83 WIC agencies. The UC San Diego Center for Community Health presented the ¡Más Fresco! More Fresh Program, while the Ecology Center discussed their Market Match Program at farmers markets, and ALL IN Alameda County discussed their Foodas Medicine Initiative. In FFY 2021, we collaborated with federal, state and local agencies and community-based organizations to strengthen, support and expand nutrition incentive programs. This work has included webinars, meetings, and presentations on how best to optimize existing nutrition incentive programs, including produce prescriptions programs and how best to integrate food system and health-care system partners into a more coordinated and effective nutrition incentive program at the federal, state, and local levels. Key outcomes of this work include the formation of a Point-of-Sale Nutritional Incentive Work Group with representation from the National Grocers Association, Nutrition Incentive Hub and nutrition incentive programs nationwide. How have the results been disseminated to communities of interest?In FFY 2017, the preliminary results and data for the ¡Más Fresco! More Fresh Program were shared with our key partners on an ongoing basis through quarterly reports, as well as a semi-annual and annual report format. We also presented our preliminary results at the USDA FINI Program Directors meeting in August 2017. In FFY 2018, we developed a comprehensive 23-page Progress Report that was shared with the USDA, and all of our partners at the local, state, and national level. In addition, we conducted an extensive media outreach program that resulted in information dissemination across the United States. As a member of the National Nutrition Incentive Network and other similar coalitions, we shared program information and our progress report with these partners. As a result, we were continuously invited to participate in webinars, panel discussions, and national conventions to provide further information on the ¡Más Fresco! More Fresh Program. One of the most notable events was our panel presentation at the American Public Health Association's national convention in San Diego, CA in November 2018. We were one of many partnering FINI programs that presented convention attendees with a variety of information about the ¡Más Fresco! More Fresh Program and other FINI programs. Topics included "Advancing Healthy Food Access and Affordability Through Innovative Food Insecurity Nutrition Incentive (FINI) Programs", "SNAP Incentives at California's Farmers' Markets: Enhanced Health, Food Security, and Economic Development", "Public Health Implications of a Large-Scale, Multi-Sector Produce Prescription Program", and "Utilizing the SNAP-Ed Evaluation Framework to Integrate and Maximize Results of SNAP-Ed and FINI Programming". In FFY 2019, we kept developing Progress Reports that were shared with USDA and all of our partners. We also continued to work on our media outreach program to disseminate results to communities of interest across the United States, as well as internationally. As a result, we had the opportunity to participate in an international conference in Santiago, Chile in January 2019 that focused on ways to increase the purchase, consumption, and production of fruits and vegetables. In FFY 2020, we maintained the development of ongoing progress reports to share with our partners. Additionally, we collaborated with the Ecology Center to create a nutrition incentive program video that promoted the ¡Más Fresco! More Fresh Program as well as the Ecology Center's Market Match Program. This video was shared with community members and community-based organizations to promote the opportunity that each program offered for SNAP recipients. We continued to share our progress reports and program information with other coalitions and networks as members of the Nutrition Incentive Hub. Another important outcome of our outreach was that we were able to disseminate information to communities of interest in 2020 by conducting a Nutrition Incentive Program webinar for the California WIC Association. The webinar, which consisted of all 83 WIC agencies across the state, included presentations on UCSD Center for Community Health's ¡Más Fresco! More Fresh Program, the Ecology Center's Market Match Program, and ALL IN Alameda County's Food as Medicine Initiative. In FFY 2021, with the development of our new Mas Fresco website and our subsequent enhanced social media outreach capabilities, we are now better positioned to provide Mas Fresco members and others with Mas Fresco Program information, including program reports as well as providing Mas Fresco members and others with enhanced Healthy Living information and resources. We are also in the process of developing several peer review manuscripts to be disseminated to the larger public. What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
Objective 1: Implement the Fruit and Vegetable Financial Incentive Program, Promotions and Nutrition Education 2017: Effective development, implementation, and evaluation of a retail-based, electronic, financial incentive program. Key tosuccess was the development of a cloud-based customer loyalty program that tracks dollars spent, earned, and redeemed. Enrolled 1,153 participants 2018: 30 enrollment events at 6 Northgate González Markets in Los Angeles, Orange, and San Diego Counties (2 markets per county). Enrolled 1,230 new participants (Cohort 2), 359 6-month surveys and 188 12-month surveys were collected from Cohort l for the last FFY. 2019: 30 enrollment events at 6 Northgate Markets. Enrolled 1,093 participants (Cohort 3) who received pre-set Mi Familia cards upon enrollment. 2020: From February 2017 to May 15, 2020, we enrolled 4,414 SNAP households. Due to COVID-19 we suspended in-store enrollment events on March 9, 2020. Before this date, 788 new members were enrolled at 18 in-store enrollments events (FFY 2019-2020). On March 9, 2020, due to COVID-19, the Mas Fresco Program suspended all in-store enrollment events. In order to continue to support new enrollments in Mas Fresco, we developed and implemented a new Mas Fresco online enrollment portal. This portal became operational on April 1st, resulting in 355 online enrollments during the remainder of FFY 2020, for a total of 1,143 new participants enrolled in FFY 2020. 2021: We continued online enrollment in FFY 2021, enrolling an additional 1,168 participants from June 1, 2020 to May 31, 2021 for a total of 5,787 participants since FFY 2017. In an effort to better support CalFresh recipients through the online enrollment process, the Mas Fresco Program developed and implemented a brand-new Mas Fresco website. This website became fully operational as of June, 2021. Objective 2: Create Partnerships and Leverage Resources 2017: Partnered with 100+ organizations, including SNAP agencies in charge of implementing California's NEOP and aligned with local food banks, catholic charities, faith-based organizations, and food system alliance partners. 2017: To effectively implement the program with a predominantly Latino community that shops at Northgate Markets, UCSD made partnerships with Latino Health Access (LHA) and Vision y Compromiso (VyC). 2019: The CDSS reached out to the ¡Más Fresco! More Fresh Program to serve as a technical advisor in developing and implementing a California Grown Fruit & Vegetable EBT Pilot Project. 2020: The UCSD Center for Community Health worked with 83 WIC Agencies across California to raise awareness of California-based Nutrition Incentive Programs and worked with 348 sites across California where Nutrition Incentives are available to community members. 2021: Secured $3 million in funding from the San Diego County Board of Supervisors for the further expansion of nutrition incentive programs across San Diego County, including the expansion of Produce Prescription Programs. Objective 3: Develop Marketing, Media and Promotional Campaigns and Program 2017: Developed ¡Más Fresco! More Fresh brochures and materials to aid participants and community members in their understanding of the program. Raised awareness of the program with media partners across Southern California. Secured 40 free radio PSAs on Univision Radio and an interview about how SNAP recipients can enroll in the program. Featured in newspapers like the San Diego Union Tribune, La Prensa Newspaper, Rumores News, etc. Conducted a direct mail campaign to 10,000 low-income households in Orange County. 2018: Featured in newspapers like the Los Angeles Times, National Public Radio (NPR), Kaiser Health, NIFA USDA Impacts, etc. Program director, as well as a participant and their family, were contacted and interviewed by CNN. Partnered with local social services and CalFresh to continue direct mail campaigning to SNAP recipients in Orange and LA County, which increased attendance at in-store enrollment events. 2019: Received invitation to/attended international conference by the Chilean Ministry of Health and the Food and Agriculture Organization of the United Nations. Presented on ¡Más Fresco! More Fresh and programs/policies that increase the purchase, consumption, and production of fruits and vegetables. Served as technical advisors for the development and implementation of a new CalFresh EBT pilot program, as requested by the CA Department of Social Services. 2020: UCSD Center for Community Health and the Ecology Center collaborated to create an informational video in English and Spanish about ¡Más Fresco! More Fresh and other nutrition incentive programs in CA. This video introduces SNAP recipients and other low-income community members who are eligible for SNAP to the Gus Schumacher Nutrition Incentive Program. 2021: The Mas Fresco More Fresh Program received funding from San Diego County Health and Human Services Agency to develop and implement a social media campaign to support enrollment in the Mas Fresco Program among underserved San Diego community members, with a focus on community members residing in Mid-City San Diego and Southeast San Diego. This campaign ran from April 26, 2021 through June 30, 2021. During this time, 913 San Diego CalFresh recipients enrolled in the Mas Fresco Program. Over 70% of enrollments were from either Mid-City San Diego or Southeast San Diego. Objective 4: Conduct Process and Outcomes Evaluation 2017: Enrolled 1,153 participants in the program for Year 1 (Cohort 1). 2018: Enrolled 1,230 new participants in Year 2 (Cohort 2) and analyzed baseline survey data. Administered/evaluated 359six-month and 188 12-month follow-up surveys from Cohort 1. 80.8% of Cohort 1 and 78.5% of Cohort 2 reported suffering from low to very low levels of food security. Cost was the greatest barrier to consuming more fruits and vegetables, as selected by 72% of Cohort 1 and 69.6% of Cohort 2. 2019: Gained ability to add participants to Northgate's point-of-sale system immediately upon enrollment. Observed a statistically significant increase in fruit and vegetable purchases among Cohorts 1 and 2. 2020: Administered 244 12-month surveys and 205 18-month post-intervention surveys for Cohort 2, and 299 six-month surveys and 272 12-month surveys for Cohort 3. Received monthly point-of-sale transaction data from Northgate. Participants purchased between 25-75% more fruits and vegetables due to the ¡Más Fresco! More Fresh Program, and 84% reported healthier eating habits. 2021: We enrolled a total of 5,787 participants from FFY 2017-2021; of these, 3,301 participants from the 2017-2019 cohorts were included in the formal evaluation study. In terms of process evaluation and quality improvement activities, as a result of detailed monitoring, throughout the program we implemented successful quality improvement activities to improve participant program utilization. As for outcomes evaluation data, the following analyses are being refined for publication in peer reviewed manuscripts and are subject to change pending the final statistical analysis plan. The proportion of participants with self-reported low or very low food security improved significantly from baseline (74%) to six months (70%) and 12 months (64%) post-enrollment (n=446 participants who answered all 3 surveys. Preliminary analyses indicated that adjusting for age, gender, amount of CalFresh received each month, food security level, household size, and other relevant factors, participants who redeemed at least as much as their study group monthly cap amount demonstrated an approximate 0.25 cup increase in daily fresh fruit and vegetable servings from baseline to 6 months post-enrollment, but this improvement was not sustained to 12 months.
Publications
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2018
Citation:
Rhee KE. FINI Data Collection and Program Evaluation. USDA NIFA FINI Project Directors Meeting, August 14-17,
2018, Washington DC. (Invited Presentation)
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2018
Citation:
Prickitt, J. Southern California Nutrition Incentive Program. San Diego Health and Human Services Agency Leadership
Meeting, March 12, 2018, San Diego, CA. (Invited presentation)
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2018
Citation:
Prickitt, J. Panel presentation entitled: Southern California Nutrition Incentive Program. San Diego Food System Alliance
Meeting, June 4, 2018, San Diego, CA. (Invited Presentation)
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
Food Stamp Program Makes Fresh Produce More Affordable . KPBS News, January 16, 2018.
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
Food Stamp Program Makes Fresh Produce More Affordable . NPR January 16, 2018
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
�M�s Fresco! Food Stamp Program Makes Fresh Produce More Affordable . Los Angeles Times, January 17, 2018
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
Food Stamp Program in Southern California Makes Fresh Produce More Affordable . KQED News, January 16, 2018; USA News, January 16, 2018
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
Food Stamp Program Makes Fresh Produce More Affordable . www.theparentingvillage.com, January 18, 2018
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
This Program is Helping Low-Income Californians Access Fruits and Vegetables. www.mindbodygreen.com, January 18,
2018
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
Food for Health . www.healthbusinessgroup.com, January 22, 2018
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
Food Stamp Program Makes Fresh Produce More Affordable . www.nifa.usda.gov/impacts, January 22, 2018
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
Access to Better Health Through Food Stamps . www.medicalconsultantsnetwork.com, February 2, 2018
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
When Food Stamps Pass as Tickets to Better Health? . www.communitycommons.org, February 6, 2018
- Type:
Journal Articles
Status:
Published
Year Published:
2020
Citation:
Hingle, Melanie D., Carmen Byker Shanks, Courtney Parks, Joseph Prickitt, Kyung E. Rhee, Jimmy Wright, Sarah HillerVenegas, and Amy L. Yaroch. "Examining Equitable Online Federal Food Assistance during the Severe Acute Respiratory
Syndrome Coronavirus 2 (SARS-CoV-2): A Case Study in 2 Regions." Current developments in nutrition 4, no. 10 (2020):
nzaa154.
- Type:
Journal Articles
Status:
Under Review
Year Published:
2021
Citation:
Factors associated with COVID-19 Vaccine Intent among Latino SNAP Participants in Southern California
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
https://ucsdcommunityhealth.org/work/morefresh/
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2019
Citation:
Prickitt, J. Policies and Programs to Increase Access to and Production of Fruits and Vegetables. Chilean Ministry of
Health and United Nations Food and Agriculture Meeting, January 9, 2019, Santiago, Chile (Invited Presentation)
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2019
Citation:
Prickitt, J. Southern California Nutrition Incentive Program. California Department of Social Services EBT Pilot Project
Meeting, February 11, 2019, Sacramento, CA (Invited Presentation)
- Type:
Websites
Status:
Published
Year Published:
2020
Citation:
www.masfresco.org
- Type:
Other
Status:
Published
Year Published:
2020
Citation:
�M�s Fresco! More Fresh & Market Match Nutrition Incentive Program Video
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2020
Citation:
APHA 2020 Public Health Film Festival
- Type:
Other
Status:
Published
Year Published:
2020
Citation:
GusNIP Grantee Feature: Northgate Gonz�lez Markets, Southern California, Gretchen Swanson Center for Nutrition, May
2020 Newsletter
|
Progress 06/01/20 to 05/31/21
Outputs
Target Audience:The Southern California Nutrition Incentive Program, also known as the ¡Más Fresco! More Fresh Program included multiple target audiences. In Federal Fiscal Year (FFY) 2017 (June 1, 2016- May 31, 2017), the primary target audience included CalFresh recipients who lived in close proximity (within 5 miles) of the six Northgate González Market financial incentive intervention sites. These sites are located in Los Angeles, Orange, and San Diego Counties. A total of 1,153 participants were enrolled in FFY2017. The majority were female (93%) and Latino (90%) with a mean age of 39.7 years (range of 18 to 95 years old). The majority also had less than a high school education (67%) or high school degree/GED (19%). Additional demographic information included: mean household size: 5.5 persons, mean CalFresh earnings per month: $329, median daily servings of fruits and vegetables (EATS Screener): 2.6, and percent facing low or very low food security (USDA Screener): 80%. During FFY 2018 (June 1, 2017, through May 31, 2018), primary target audience remained CalFresh recipients living within five miles of six Northgate Market financial incentive intervention sites. The program also expanded to include a secondary target audience connected to community based organizations providing direct outreach and assistance to CalFresh recipients. The primary target audience included 1,230 CalFresh recipients who lived in close proximity (within 5 miles) of the six Northgate Market financial incentive intervention sites. The majority were female (88%) and Latino (90%) with a mean age of 41.6 years (range of 18 to 90 years old). The majority also had less than a high school education (63%) or high school degree/GED (17%). Additional demographic information includes mean household size of 4.2 persons, mean CalFresh earnings per month of $302, median daily servings of 2.7 fruits and vegetables (EATS Screener), and 79% facing low or very low food security (USDA Screener). The secondary target audience included over 100 community-based organizations that provided direct outreach and assistance to CalFresh recipients and other low-income community members living in Los Angeles, Orange, and San Diego counties. Key community-based organization partners included the Supplemental Nutrition Assistance Program Education (SNAP-Ed) and Nutrition Education and Obesity Prevention (NEOP) program.These organizations helped us distribute ¡Más Fresco! More Fresh flyers about the ¡Más Fresco! More Fresh Program directly to low- income community residents in the three counties. In 2018, CalFresh Agencies in Orange and San Diego Counties sent letters directly to CalFresh recipients living within 5 miles of each of the Northgate Market intervention sites to promote program enrollment events. Numerous community-based organizations began participating and supporting the ongoing efforts. Key organizations included the local county health departments, food banks, faith-based organizations, community centers, school districts, WIC programs, UC Cooperative Extension, and food system alliance networks and organizations. FFY 2018 media outreach efforts resulted in media placements across the United States and key story placements in the Los Angeles Times, National Public Radio (NPR), KPBS News, Kaiser Health News, KQED News, PEW Charitable Trust News, USA News, NIFA USDA Impacts and HealthLine. In addition, media attention and coverage \promoted CNN to develop a segment on Mas Fresco More Fresh program. The segment featured interviews conducted with program director Joe Prickitt, program participants and their family. In FFY 2019 (June 1, 2018- May 31, 2019) the primary target audience remained recipients' living within 5 miles of the six Northgate Market financial incentive intervention sites. The program's third cohort included 1,093 participants. The majority remained (85%) and Latino (91%) with a mean age of 42.5 years (range of 20 to 91 years old). The majority of this cohort also had less than a high school education (58%) or high school degree/GED (80%). Additional demographic information included: Mean household size of 4.1 persons; Mean CalFresh earnings per month of $296; Median daily servings of fruits and vegetables (EATS Screener) of 3.2 servings; Percent facing low or very low food security (USDA Screener): 70.7%. A secondary target audience for the ¡Más Fresco! More Fresh Program included community-based organizations, such as the Supplemental Nutrition Assistance Program Education (SNAP-Ed) providers and Nutrition Education and Obesity Prevention (NEOP) providers that support the health and well-being of low-income community members living in Los Angeles, Orange, and San Diego Counties. In 2019, we partnered with over 100 community-based organizations that provide direct outreach to CalFresh recipients and other low-income community members living in Los Angeles, Orange, and San Diego counties. Key support included the CalFresh agencies in Orange and San Diego Counties which sent letters directly to CalFresh recipients living within 5 miles of each of the intervention sites promoting the program's in-store enrollment events taking place at the Northgate Markets in Orange and Los Angeles Counties and the opportunity to enroll in the program. During FFY 2020 (June 1, 2019-May 31, 2020), the primary target audience remained recipients' living within 5 miles of the six Northgate Market financial incentive intervention sites. The ¡Más Fresco! More Fresh program continued to implement and evaluate a Food Insecurity Nutrition Incentive (FINI) program for Supplemental Nutrition Assistance Program (SNAP) recipients who shop at 6 participating Northgate Markets in Los Angeles, Orange, and San Diego counties. We applied for and received, a no-cost extension to continue the ¡Más Fresco! More Fresh FINI program through May 31, 2021. The extension gave the program the flexibility to continue recruiting participants and providing incentives as we transitioned to our ¡Más Fresco! More Fresh Program Gus Schumacher Nutrition Incentive Program (GusNIP) grant. With GusNIP, the program will expand to include SNAP recipients at all 41 Northgate stores in Southern California and develop an automated enrollment process. From February 2017 to May 31, 2020, the program enrolled a total of 4,452 SNAP households into ¡Más Fresco! More Fresh. During 2020, we implemented COVID-19 guidelines from CDC, County health departments, and UC San Diego, to protect participants, staff, and partners. We suspended our 2020 in-store enrollment event scheduled March 9, 2020 in accordance with COVID-19 regulations. Between January to March 2020, 788 new ¡Más Fresco! More Fresh members were enrolled 18 in-store events. During FFY 2021 (June 1, 2020 - May 31, 2021), the primary target audience remained CalFresh recipients' living within 5 miles of the six Northgate Market financial incentive intervention sites. We enrolled 1,168 participants in the program in FFY 2021, for a grand total of 5,787 participants over the 5 years of the ¡Más Fresco! More Fresh FINI program; all of our participants were transitioned to our new GusNIP program on May 31 to provide member earn and redeem of nutrition incentives continuity. In addition, with funding from the San Diego County Health and Human Services Agency, ¡the Mas Fresco! More Fresh program developed and implemented a social media campaign to better support enrollment initiatives in Mid-City San Diego and Southeast San Diego, two of San Diego's most underserved communities. From April 26, 2021 through June 30, 2021 the campaign facilitated enrollment for 913 San Diego CalFresh recipients with over 70% from either Mid-City San Diego or Southeast San Diego. Changes/Problems:In FFY 2017, we did not encounter any significant problems or issues in our approach. However, we had to make adjustments to the originally proposed design to align with recommendations provided to us by our community partners. This key study design change came due to input from the National Cash Register Corporation during our initial program design and development meeting with Northgate and their point-of-sale technology providers. The National Cash Register Corporation advised us that if we were looking to secure equitable data among our study groups, we would need to provide a financial incentive to all our study group participants so that each study group participant would have a reason to use their customer loyalty card at check-out and generate the transaction data needed for the study. Based on their experience, they let us know that it was unlikely that program participants who enrolled in the study and who did not receive a financial incentive would use their customer loyalty card at the store. Based on this input, our study design was revised to provide all program participants with some amount of financial incentive. The revised study design provided for a $10 a month, $20 a month and a $40 a month study groups to help ensure equitable transaction data among and between all program participants. This change was approved by NIFA. Implementation of the technical program (including the point-of-sale system and the cloud-based technology) also took longer to implement than originally planned given the complexity of the system and the need to work with additional vendors to implement the program. Therefore, we were not able to enroll participants into the program until Feb 2021, which contributed to us having funds for a no-cost extension. Another change that we made in 2017 was to hire a half-time program coordinator instead of a full-time program coordinator and use the cost savings to secure the ongoing support of a network of promotoras to support the enrollment and ongoing program participant support process. This change proved to be critical toward our successful enrollment and support of the program participants. Conducting the needs assessment with our community partners during the program design process proved to be instrumental in helping to ensure successful development and implementation of the program without incurring any significant problems or issues. In FFY 2018, we did encounter technology issues with the implementation of the Fruit and Vegetable Financial Incentive System. Since the Fruit and Vegetable Financial Incentive System represented an innovative benefit redemption system and technologies, our first year of operation represented a live beta-test. As such, we did experience and encounter hardware, software, and other technology issues that needed to be addressed and worked through with Northgate and their technology providers. At the time, this was something that had been anticipated and was therefore planned and communicated with our program participants when they enrolled into the program. FFY 2019 & 2020: In 2019 and 2020 we did have technical difficulties with the POS systems at Northgate which resulted in decreases in incentive utilization. We also began to hear from participants that they were unable to earn enough incentive dollars with our 1:1 earn and redeem model. Further investigation into this matter revealed that many of our CalFresh recipients do not feel that they can allocate their limited EBT dollars to more F&V in order to earn more incentive dollars. This has resulted in us having incentive dollars that have not been spent at this time. Nevertheless, this information was the foundation for us to develop a 2:1 and 4:1 earn and redeem model for our 2019 proposal. As a result, we are starting to see significantly increased spending of incentive dollars in our new proposal. The COVID-19 pandemic also limited our in-store enrollment in 2020. However, we were able to accelerate the launch of our online enrollment system by April of 2020 to continue to enroll participants virtually, which was critical in the first few months of the pandemic when food insecurity surged and many families faced sudden economic instability and needed additional food resources. During this year, we were also working on expanding the program to 41 stores. This resulted in additional technical difficulties which also impacted our ability to continue to run the original program in 6 stores. As a result, we were unable to distribute the remaining funds from the 2016 program in a timely manner. In FFY 2021: Despite our best efforts, we were unable to distribute all of the incentive money allocated to our FINI grant. This occurred due to several challenges. As previously mentioned, technical difficulties with the initial implementation of the Northgate point of sale and promotion system delayed our initial enrollment in the 6 stores. We also had some technical difficulties along the way which limited the earn and redeem potential of customers. A key technical difficulty included issues encountered at the check-out lanes at the Northgate Gonzalez Markets. Each check-out lane in each Northgate Gonzalez Market needed to be configured to support the Mas Fresco More Fresh Program. Unfortunately, as we learned over the years, the software supporting each of the check-out lanes experienced ongoing issues that resulted in certain check-out lanes in certain Northgate Gonzalez Markets not recognizing Mas Fresco members which caused them to not be able to earn or redeem their nutrition incentives. Due to the need to configure each check-out lane in each Northgate Gonzalez Market to enable Mas Fresco members to earn and redeem their nutrition incentives and the ongoing issues encountered with the software supporting each check-out lane, Northgate Gonzalez Market was not able to expand the Mas Fresco Program beyond the 6 stores. However, with the implementation of their new NCR Emerald point-of-sale-system, there is no need to configure each check-out lane in each store to recognize Mas Fresco members and support the earning and redeeming of Nutrition Incentives. As such, as Northgate works to implement their new NCR Emerald point-of-sale system we look forward to expanding the Mas Fresco Program to all Northgate Gonzalez Markets. We also did not anticipate that only 60-80% of participants who enrolled in the program would actually earn or redeem incentives, and only a smaller proportion went on to use the program regularly over time to earn and redeem the full amount available to them each month. Despite successful quality improvement activities to improve participant utilization from 60% to 80% (e.g., distributing pre-activated cards so they could start using them the same day) and increase participant understanding of the program (e.g., extensive workshopping of program materials and messaging in English and Spanish; 57% of the 2017 cohort said it was easy or very easy to understand the program vs. difficult/very difficult/neutral in their 6-month survey compared to 65-66% of participants in the 2018 and 2019 cohorts after we had implemented revised messaging), we still fell short of our incentive allocation. Finally, as mentioned above, we received feedback from participants that it was difficult to spend enough on F&V with their EBT dollars to earn enough incentive dollars. This also limited our ability to fully utilize all the incentive money. Nevertheless, this information has lead us to develop a new incentive model for our 2019 GusNIP proposal which will hopefully allow us to utilize all the funds allocated to nutrition incentives. What opportunities for training and professional development has the project provided?In FFY 2017, the Latino Health Access Promotora Team identified the ¡Más Fresco! More Fresh Program as one of the most rewarding and effective programs they've ever worked on. Providing them with this training and professional development opportunity directly benefits both the Promotoras and the low-income communities they serve. We also worked on the creation of the first retail-based Good Food Purchasing Program which was recognized by Food System Alliance organizations in the counties of Los Angeles, Orange, and San Diego. In FFY 2018, we developed a UC San Diego Institutional Review Board training program to help the Promotoras understand the challenges of human subjects research, and to ensure that all UC San Diego IRB guidelines were adhered to during the engagement, recruitment, and follow-up interactions with participants. The training included topics such as Participant Eligibility Screening, Informed Consent, Administration of Baseline Survey, etc. We also worked with Northgate to develop staff trainings that address the ¡Más Fresco! More Fresh Program and ensure that staff members understand how to support program participants if necessary. Additionally, the Southern California Nutrition Incentive Program led the development and implementation of a panel presentation, abstracts, and poster session about nutrition incentives at the 2018 American Public Health Association conference in San Diego, CA. These presenters provided an overview of the Gus Schumacher Nutrition Incentive Program's breadth, reach, and impact - including the program's overall economic impact within local communities and economies. They also shared key insights on innovative nutrition incentive programs, technologies, and practices. In FFY 2019, the ¡Más Fresco! More Fresh Program was invited by the Chilean Ministry of Health and the United Nations Food and Agriculture Organization to Chile's Fruit and Vegetable Access Conference. Hosted in Chile, this international conference was about programs and public policies to increase the purchase, consumption, and production of fruits and vegetables. Joe Prickitt, MS, RD, and UC San Diego Center for Community Health Senior Director of the Southern California Nutrition Incentive Program traveled to Chile to present on the ¡Más Fresco! More Fresh Program. He also spoke about the broader Food Insecurity Nutrition Incentive work that has been conducted in the United States to increase the purchase and consumption of fruits and vegetables. This conference included government health officials and produce industry leaders across Chile, Mexico, Central America, and South America. We were given the opportunity to share information about food insecurity nutrition incentive programs, address barriers to access of fruits and vegetables, and provide proven strategies to increase the accessibility and availability of fruits and vegetables to community members - all to an international audience. In FFY 2020, the ¡Más Fresco! More Fresh Program received an invitation from the Nutrition Incentive Hub to present at the National Grocer's Association meeting in San Diego. At this presentation, we shared program insights with retailers and attendees from all over the United States on the program's innovative benefit redemption system, as well as the program's evaluation efforts and results. In addition to attending the National Grocer's Association meeting, the ¡Más Fresco! More Fresh Program participated in one of the Nutrition Incentive Hub's webinars to share information about our benefit redemption system. Another notable opportunity for our program team was to provide training and professional development occurred when the UC San Diego School of Medicine Center for Community Health was asked to coordinate a nutrition incentive program presentation for the California WIC Association. Hosted as a webinar, this event allowed UC San Diego, the Ecology Center, and ALL IN Alameda County to raise awareness about nutrition incentive programs across California to all 83 WIC agencies. The UC San Diego Center for Community Health presented the ¡Más Fresco! More Fresh Program, while the Ecology Center discussed their Market Match Program at farmers markets, and ALL IN Alameda County discussed their Food as Medicine Initiative. In FFY 2021, we collaborated with federal, state and local agencies and community-based organizations to strengthen, support and expand nutrition incentive programs. This work has included webinars, meetings, and presentations on how best to optimize existing nutrition incentive programs, including produce prescriptions programs and how best to integrate food system and health-care system partners into a more coordinated and effective nutrition incentive program at the federal, state, and local levels. Key outcomes of this work include the formation of a Point-of-Sale Nutritional Incentive Work Group with representation from the National Grocers Association, Nutrition Incentive Hub and nutrition incentive programs nationwide. How have the results been disseminated to communities of interest?In FFY 2017, the preliminary results and data for the ¡Más Fresco! More Fresh Program were shared with our key partners on an ongoing basis through quarterly reports, as well as a semi-annual and annual report format. We also presented our preliminary results at the USDA FINI Program Directors meeting in August 2017. In FFY 2018, we developed a comprehensive 23-page Progress Report that was shared with the USDA, and all of our partners at the local, state, and national level. In addition, we conducted an extensive media outreach program that resulted in information dissemination across the United States. As a member of the National Nutrition Incentive Network and other similar coalitions, we shared program information and our progress report with these partners. As a result, we were continuously invited to participate in webinars, panel discussions, and national conventions to provide further information on the ¡Más Fresco! More Fresh Program. One of the most notable events was our panel presentation at the American Public Health Association's national convention in San Diego, CA in November 2018. We were one of many partnering FINI programs that presented convention attendees with a variety of information about the ¡Más Fresco! More Fresh Program and other FINI programs. Topics included "Advancing Healthy Food Access and Affordability Through Innovative Food Insecurity Nutrition Incentive (FINI) Programs", "SNAP Incentives at California's Farmers' Markets: Enhanced Health, Food Security, and Economic Development", "Public Health Implications of a Large-Scale, Multi-Sector Produce Prescription Program", and "Utilizing the SNAP-Ed Evaluation Framework to Integrate and Maximize Results of SNAP-Ed and FINI Programming". In FFY 2019, we kept developing Progress Reports that were shared with USDA and all of our partners. We also continued to work on our media outreach program to disseminate results to communities of interest across the United States, as well as internationally. As a result, we had the opportunity to participate in an international conference in Santiago, Chile in January 2019 that focused on ways to increase the purchase, consumption, and production of fruits and vegetables. In FFY 2020, we maintained the development of ongoing progress reports to share with our partners. Additionally, we collaborated with the Ecology Center to create a nutrition incentive program video that promoted the ¡Más Fresco! More Fresh Program as well as the Ecology Center's Market Match Program. This video was shared with community members and community-based organizations to promote the opportunity that each program offered for SNAP recipients. We continued to share our progress reports and program information with other coalitions and networks as members of the Nutrition Incentive Hub. Another important outcome of our outreach was that we were able to disseminate information to communities of interest in 2020 by conducting a Nutrition Incentive Program webinar for the California WIC Association. The webinar, which consisted of all 83 WIC agencies across the state, included presentations on UCSD Center for Community Health's ¡Más Fresco! More Fresh Program, the Ecology Center's Market Match Program, and ALL IN Alameda County's Food as Medicine Initiative. In FFY 2021, with the development of our new Mas Fresco website and our subsequent enhanced social media outreach capabilities, we are now better positioned to provide Mas Fresco members and others with Mas Fresco Program information, including program reports as well as providing Mas Fresco members and others with enhanced Healthy Living information and resources. We are also in the process of developing several peer review manuscripts to be disseminated to the larger public. What do you plan to do during the next reporting period to accomplish the goals?NA - This is our Final Report for this FINI Grant.
Impacts
What was accomplished under these goals?
Objective 1: Implement the Fruit and Vegetable Financial Incentive Program, Promotions and Nutrition Education 2017: Effective development, implementation, and evaluation of a retail-based, electronic, financial incentive program. Key to success was the development of a cloud-based customer loyalty program that tracks dollars spent, earned, and redeemed. Enrolled 1,153 participants 2018: 30 enrollment events at 6 Northgate González Markets in Los Angeles, Orange, and San Diego Counties (2 markets per county). Enrolled 1,230 new participants (Cohort 2), 359 6-month surveys and 188 12-month surveys were collected from Cohort l for the last FFY. 2019: 30 enrollment events at 6 Northgate Markets. Enrolled 1,093 participants (Cohort 3) who received pre-set Mi Familia cards upon enrollment. 2020: From February 2017 to May 15, 2020, we enrolled 4,414 SNAP households. Due to COVID-19 we suspended in-store enrollment events on March 9, 2020. Before this date, 788 new members were enrolled at 18 in-store enrollments events (FFY 2019-2020). On March 9, 2020, due to COVID-19, the Mas Fresco Program suspended all in-store enrollment events. In order to continue to support new enrollments in Mas Fresco, we developed and implemented a new Mas Fresco online enrollment portal. This portal became operational on April 1st, resulting in 355 online enrollments during the remainder of FFY 2020, for a total of 1,143 new participants enrolled in FFY 2020. 2021: We continued online enrollment in FFY 2021, enrolling an additional 1,168 participants from June 1, 2020 to May 31, 2021 for a total of 5,787 participants since FFY 2017. In an effort to better support CalFresh recipients through the online enrollment process, the Mas Fresco Program developed and implemented a brand-new Mas Fresco website. This website became fully operational as of June, 2021. Objective 2: Create Partnerships and Leverage Resources 2017: Partnered with 100+ organizations, including SNAP agencies in charge of implementing California's NEOP and aligned with local food banks, catholic charities, faith-based organizations, and food system alliance partners. 2017: To effectively implement the program with a predominantly Latino community that shops at Northgate Markets, UCSD made partnerships with Latino Health Access (LHA) and Vision y Compromiso (VyC). 2019: The CDSS reached out to the ¡Más Fresco! More Fresh Program to serve as a technical advisor in developing and implementing a California Grown Fruit & Vegetable EBT Pilot Project. 2020: The UCSD Center for Community Health worked with 83 WIC Agencies across California to raise awareness of California-based Nutrition Incentive Programs and worked with 348 sites across California where Nutrition Incentives are available to community members. 2021: Secured $3 million in funding from the San Diego County Board of Supervisors for the further expansion of nutrition incentive programs across San Diego County, including the expansion of Produce Prescription Programs. Objective 3: Develop Marketing, Media and Promotional Campaigns and Program 2017: Developed ¡Más Fresco! More Fresh brochures and materials to aid participants and community members in their understanding of the program. Raised awareness of the program with media partners across Southern California. Secured 40 free radio PSAs on Univision Radio and an interview about how SNAP recipients can enroll in the program. Featured in newspapers like the San Diego Union Tribune, La Prensa Newspaper, Rumores News, etc. Conducted a direct mail campaign to 10,000 low-income households in Orange County. 2018: Featured in newspapers like the Los Angeles Times, National Public Radio (NPR), Kaiser Health, NIFA USDA Impacts, etc. Program director, as well as a participant and their family, were contacted and interviewed by CNN. Partnered with local social services and CalFresh to continue direct mail campaigning to SNAP recipients in Orange and LA County, which increased attendance at in-store enrollment events. 2019: Received invitation to/attended international conference by the Chilean Ministry of Health and the Food and Agriculture Organization of the United Nations. Presented on ¡Más Fresco! More Fresh and programs/policies that increase the purchase, consumption, and production of fruits and vegetables. Served as technical advisors for the development and implementation of a new CalFresh EBT pilot program, as requested by the CA Department of Social Services. 2020: UCSD Center for Community Health and the Ecology Center collaborated to create an informational video in English and Spanish about ¡Más Fresco! More Fresh and other nutrition incentive programs in CA. This video introduces SNAP recipients and other low-income community members who are eligible for SNAP to the Gus Schumacher Nutrition Incentive Program. 2021: The Mas Fresco More Fresh Program received funding from San Diego County Health and Human Services Agency to develop and implement a social media campaign to support enrollment in the Mas Fresco Program among underserved San Diego community members, with a focus on community members residing in Mid-City San Diego and Southeast San Diego. This campaign ran from April 26, 2021 through June 30, 2021. During this time, 913 San Diego CalFresh recipients enrolled in the Mas Fresco Program. Over 70% of enrollments were from either Mid-City San Diego or Southeast San Diego. Objective 4: Conduct Process and Outcomes Evaluation 2017: Enrolled 1,153 participants in the program for Year 1 (Cohort 1). 2018: Enrolled 1,230 new participants in Year 2 (Cohort 2) and analyzed baseline survey data. Administered/evaluated 359 six-month and 188 12-month follow-up surveys from Cohort 1. 80.8% of Cohort 1 and 78.5% of Cohort 2 reported suffering from low to very low levels of food security. Cost was the greatest barrier to consuming more fruits and vegetables, as selected by 72% of Cohort 1 and 69.6% of Cohort 2. 2019: Gained ability to add participants to Northgate's point-of-sale system immediately upon enrollment. Observed a statistically significant increase in fruit and vegetable purchases among Cohorts 1 and 2. 2020: Administered 244 12-month surveys and 205 18-month post-intervention surveys for Cohort 2, and 299 six-month surveys and 272 12-month surveys for Cohort 3. Received monthly point-of-sale transaction data from Northgate. Participants purchased between 25-75% more fruits and vegetables due to the ¡Más Fresco! More Fresh Program, and 84% reported healthier eating habits. 2021: We enrolled a total of 5,787 participants from FFY 2017-2021; of these, 3,301 participants from the 2017-2019 cohorts were included in the formal evaluation study. In terms of process evaluation and quality improvement activities, as a result of detailed monitoring, throughout the program we implemented successful quality improvement activities to improve participant program utilization. As for outcomes evaluation data, the following analyses are being refined for publication in peer reviewed manuscripts and are subject to change pending the final statistical analysis plan. The proportion of participants with self-reported low or very low food security improved significantly from baseline (74%) to six months (70%) and 12 months (64%) post-enrollment (n=446 participants who answered all 3 surveys. Preliminary analyses indicated that adjusting for age, gender, amount of CalFresh received each month, food security level, household size, and other relevant factors, participants who redeemed at least as much as their study group monthly cap amount demonstrated an approximate 0.25 cup increase in daily fresh fruit and vegetable servings from baseline to 6 months post-enrollment, but this improvement was not sustained to 12 months.
Publications
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2018
Citation:
Rhee K, Prickitt J, Hiller SP, Melendrez B, Edra K, Gilmer T, Murphy Zive M. An innovative nutrition incentive program utilizing point-of-sale technologies in a large-scale retail setting. American Public Health Association Annual Meeting. San Diego, CA. Nov. 13, 2018. (Oral Presentation)
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2018
Citation:
Loveless, JC, Prickitt J, Hiller SP, Melendrez B, Edra K, Gilmer T, Murphy Zive M, Rhee KE. Insight on the Promise, Realization and Potential of the Food Insecurity Nutrition Incentive Program. American Public Health Association Annual Meeting. San Diego, CA. Nov. 13, 2018. (Poster Presentation)
- Type:
Conference Papers and Presentations
Status:
Other
Year Published:
2018
Citation:
Prickitt J. FINI: Keys to Success & Lessons Learned. USDA NIFA FINI Project Directors Meeting, August 14-17, 2018, Washington DC. (Invited presentation)
- Type:
Conference Papers and Presentations
Status:
Other
Year Published:
2018
Citation:
Rhee KE. FINI Data Collection and Program Evaluation. USDA NIFA FINI Project Directors Meeting, August 14-17, 2018, Washington DC. (Invited Presentation)
- Type:
Conference Papers and Presentations
Status:
Other
Year Published:
2018
Citation:
Prickitt, J. Southern California Nutrition Incentive Program. San Diego Health and Human Services Agency Leadership Meeting, March 12, 2018, San Diego, CA. (Invited presentation)
- Type:
Conference Papers and Presentations
Status:
Other
Year Published:
2018
Citation:
Prickitt, J. Panel presentation entitled: Southern California Nutrition Incentive Program. San Diego Food System Alliance Meeting, June 4, 2018, San Diego, CA. (Invited Presentation)
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
When Food Stamps Pass as Tickets to Better Health . Kaiser Health News, January 16, 2018.
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
Food Stamp Program Makes Fresh Produce More Affordable . KPBS News, January 16, 2018.
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
Food Stamp Program Makes Fresh Produce More Affordable . NPR January 16, 2018.
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
�M�s Fresco! Food Stamp Program Makes Fresh Produce More Affordable . Los Angeles Times, January 17, 2018
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
Food Stamp Program in Southern California Makes Fresh Produce More Affordable . KQED News, January 16, 2018
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
Food Stamp Program in Southern California Makes Fresh Produce More Affordable . USA News, January 16, 2018
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
Food Stamp Program Makes Fresh Produce More Affordable . www.theparentingvillage.com, January 18, 2018
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
This Program is Helping Low-Income Californians Access Fruits and Vegetables. www.mindbodygreen.com, January 18, 2018
- Type:
Conference Papers and Presentations
Status:
Other
Year Published:
2019
Citation:
Prickitt, J. Southern California Nutrition Incentive Program. California Department of Social Services EBT Pilot Project Meeting, February 11, 2019, Sacramento, CA (Invited Presentation)
- Type:
Websites
Status:
Published
Year Published:
2020
Citation:
www.masfresco.org
- Type:
Other
Status:
Published
Year Published:
2020
Citation:
�M�s Fresco! More Fresh & Market Match Nutrition Incentive Program Video
- Type:
Conference Papers and Presentations
Status:
Awaiting Publication
Year Published:
2020
Citation:
APHA 2020 Public Health Film Festival
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
Food for Health . www.healthbusinessgroup.com, January 22, 2018
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
Food Stamp Program Makes Fresh Produce More Affordable . www.nifa.usda.gov/impacts, January 22, 2018
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
Access to Better Health Through Food Stamps . www.medicalconsultantsnetwork.com, February 2, 2018
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
When Food Stamps Pass as Tickets to Better Health? . www.communitycommons.org, February 6, 2018
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
https://ucsdcommunityhealth.org/work/morefresh/
- Type:
Conference Papers and Presentations
Status:
Other
Year Published:
2019
Citation:
Prickitt, J. Policies and Programs to Increase Access to and Production of Fruits and Vegetables. Chilean Ministry of Health and United Nations Food and Agriculture Meeting, January 9, 2019, Santiago, Chile (Invited Presentation)
- Type:
Other
Status:
Published
Year Published:
2020
Citation:
GusNIP Grantee Feature: Northgate Gonz�lez Markets, Southern California, Gretchen Swanson Center for Nutrition, May 2020 Newsletter
- Type:
Journal Articles
Status:
Published
Year Published:
2020
Citation:
Hingle, Melanie D., Carmen Byker Shanks, Courtney Parks, Joseph Prickitt, Kyung E. Rhee, Jimmy Wright, Sarah Hiller-Venegas, and Amy L. Yaroch. "Examining Equitable Online Federal Food Assistance during the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Case Study in 2 Regions." Current developments in nutrition 4, no. 10 (2020): nzaa154.
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Progress 06/01/19 to 05/31/20
Outputs
Target Audience:During our fourth year of operation, Federal Fiscal Year (FFY) June 1, 2019 to May 31, 2020, the Southern California Nutrition Incentive Program, also known as the ¡Más Fresco! More Fresh program, has continued to implement and evaluate a Food Insecurity Nutrition Incentive (FINI) program for Supplemental Nutrition Assistance Program (SNAP) recipients who shop at 6 participating Northgate Gónzalez Markets in Los Angeles, Orange, and San Diego counties. We applied for and received a no-cost extension to continue the ¡Más Fresco! More Fresh FINI program through May 31, 2021, which will give us flexibility to continue to recruit participants and provide incentives as we transition to our ¡Más Fresco! More Fresh Program Gus Schumacher Nutrition Incentive Program (GusNIP) grant. With this new funding, we will expand the program to reach SNAP recipients at all 41 Northgate stores in Southern California and develop a completely automated process for enrollment. From February 2017 to May 15, 2020 we have enrolled a total of 4,414 SNAP households into ¡Más Fresco! More Fresh. Following guidelines from the CDC, county health departments, and UC San Diego, and to do our part to prevent the spread of COVID-19 among our participants, staff, and partners, we suspended our 2020 in-store enrollment events on March 9, 2020. Prior to that date, we had enrolled 788 new ¡Más Fresco! More Fresh members during FFY 2019-2020 at 18 in-store enrollments events. An overview of enrollment activity is as follows: 2017 Enrollments: 1,153 Mas Fresco Members enrolled during 30 in-store enrollment events from January to April 2018 Enrollments: 1,230 Mas Fresco Members enrolled during 30 in-store enrollment events from January to April 2019 Enrollments: 1,093 Mas Fresco Members enrolled during 30 in-store enrollment events from January to April 2020 Enrollments: 788 Mas Fresco Members enrolled during 18 in-store enrollment events from January to March 2020 Enrollments: 150 Mas Fresco Members enrolled online from April 1, 2020 to May 29, 2020 In an effort to continue to serve our SNAP community members despite restrictions due to COVID-19, we fast-tracked the development and implementation of a modified ¡Más Fresco! More Fresh Online Enrollment Program, accessible via www.masfresco.org. This online resource enables SNAP recipients who shop at any of our 6 currently participating Northgate Gonzalez Markets to enroll in the ¡Más Fresco! More Fresh program at any time, from anywhere. Our modified online enrollment went live on April 1, 2020, and we have enrolled an additional 150 program participants into Cohort 4 as of May 29, 2020. To date, the majority of new online enrollees are located in San Diego county, where our initial outreach efforts to promote online enrollment have been concentrated. In the coming months, we plan to increase outreach in Orange and Los Angeles counties as our staff and partners adjust to the "new normal" of the COVID-19 pandemic (e.g., largely working from home, adapting programs to be "touchless," incorporating technological solutions for remote communication). To promote our new online enrollemnt capability and opportunity, we have developed a digital postcard that will be distributed via email or on social media.This post card includes links to both www.masfresco.org as well as to our new online enrollment promotional videos in English and Spanish. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided?The Más Fresco! More Fresh Program continues to provide opportunities for training and professional development. The ¡Mas Fresco! More Fresh Program received an invitation from the Nutrition Incentive Hub to present at the National Grocer's Association meeting in San Diego in February of 2020. This presentation provided the opportunity to share program insights with retailers and others from across the United States on the program's innovative benefit redemption system as well as on the program's evaluation efforts and results to date. The ¡Mas Fresco! More Fresh Program also participated in a Nutrition Incentive Hub Webinar to share insights on our innovative benefit redemption system. As part of our marketing and outreach efforts, the UC San Diego School of Medicine, Center for Community Health was asked to coordinate a nutrition incentive program presentation for the California WIC Association. This May 27, 2020 Webinar provided the opportunity for UC San Diego, the Ecology Center and ALL IN Alameda County to share information on nutrition incentive programs across California, including UCSD's ¡Mas Fresco! More Fresh Program, Ecology Center's Market Match Program and ALL IN Alameda County's Food as Medicine Initiative. How have the results been disseminated to communities of interest?For FFY 2020 we developed a comprehensive progress report and are sharing this progress report with USDA, and other partners at the local, state, and national level. In addition, during FFY 2020 we developed a nutrition incentive program video in collaboration with the Ecology Center to promote the ¡Más Fresco! More Fresh Program as well as the Ecology Center's Market Match Program. Both UCSD and the Ecology Center are sharing this video with community- based organizations and community members to promote the opportunity that each program represents for SNAP recipients. As a member of the Nutrition Incentive Hub and numerous other coalitions and networks, we share program information, including our progress report, on an ongoing basis with all our coalition and network partners. An additional outcome of our outreach and information dissemination are ongoing requests to participate in webinars, panel discussions and national conventions to provide further information on the ¡Más Fresco! More Fresh Program and GusNIP. One of the most notable outcomes of this outreach is a request by the California WIC Association to conduct a Nutrition Incentive Program Webinar for their 83 WIC Agencies across California. This Webinar included presentations on UCSD's ¡Más Fresco! More Fresh Program, the Ecology Center's Market Match Program and ALL IN Alameda County's Food as Medicine Initiative. What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period we will be focusing on the following primary objectives to achieve our goals. Enhanced Program Enrollment We are now providing the opportunity for program participants to enroll in the program online. As such, we will look to enhance our online enrollment capabilities to make the program accessible to more SNAP recipients. Part of this effort will include increased dissemination of program information through our community partners. Enhanced Program Outreach and Communication In conjunction with our new online enrollment capabilities, we will also look to further enhance our communication and outreach capabilities with our program participants. Toward this effort we are looking to conduct a Digital Access and Utilization Assessment with our program participants in June of 2020. Based on the findings of our Digital Access and Utilization Assessment, we will look to develop and implement an enhanced digital communication platform aimed at enhancing program awareness, utilization, and program participant nutrition knowledge and healthy eating self-efficacy. Enhanced Partnership Development, Integration, Coordination and Leveraging of Resources During the next reporting period we are looking to further enhance our partnership development work with both our food system partners and our health care system partners to achieve enhanced integration, coordination and leveraging of resources to better support the SNAP community members that we collectively serve.
Impacts
What was accomplished under these goals?
Objective 1: Implement the Fruit and Vegetable Financial Incentive Program, Promotions and Nutrition Education During our fourth year of operation, Federal Fiscal Year (FFY) June 1, 2019 to May 31, 2020, the Southern California Nutrition Incentive Program, also known as the ¡Más Fresco! More Fresh program, has continued to implement and evaluate a Food Insecurity Nutrition Incentive (FINI) program for Supplemental Nutrition Assistance Program (SNAP) recipients who shop at 6 participating Northgate Gonzalez Markets in Los Angeles, Orange, and San Diego counties. We applied for and received a no-cost extension to continue the ¡Más Fresco! More Fresh FINI program through May 31, 2021, which will give us flexibility to continue to recruit participants and provide incentives as we transition to our ¡Más Fresco! More Fresh Program Gus Schumacher Nutrition Incentive Program (GusNIP) grant. With this new funding, we will expand the program to reach SNAP recipients at all 41 Northgate stores in Southern California and develop a completely automated process for enrollment. From February 2017 to May 15, 2020 we have enrolled a total of 4,414 SNAP households into ¡Más Fresco! More Fresh. Following guidelines from the CDC, county health departments, and UC San Diego, and to do our part to prevent the spread of COVID-19 among our participants, staff, and partners, we suspended our 2020 in-store enrollment events on March 9, 2020. Prior to that date, we had enrolled 788 new ¡Más Fresco! More Fresh members during FFY 2019-2020 at 18 in-store enrollments events. ¡Más Fresco! More Fresh Online Enrollment As previously described, in an effort to support SNAP recipients through COVID-19 and beyond, the ¡Más Fresco! More Fresh Program fast-tracked the development and implementation of online enrollment to enable SNAP recipients to enroll in the ¡Más Fresco! More Fresh Program online from anywhere at any time. As part of our new GusNIP funding we are in the process of working with Northgate Gonzalez Market to develop and implement a fully automated, cloud-based benefit redemption system and online enrollment process for all 41 Northgate Gonzalez Markets across California; however, that system and program will not be available until 3rd quarter 2020. As such, in an effort to support SNAP recipients from April 2020 until the introduction of the new fully automated store-wide system, we implemented a modified online enrollment system as of April 1, 2020. This modified system enables SNAP recipients who live within close proximity to the currently participating 6 Northgate Gonzalez markets to enroll online. They are then mailed a ¡Más Fresco! More Fresh Mi Familia card that they can use to receive $40 a month in financial incentives when they purchase fresh fruits and vegetables with their SNAP benefits at any of those 6 participating Northgate stores. Since initiating online enrollment on April 1, 2020, approximately 150 SNAP recipients have enrolled in the ¡Más Fresco! More Fresh Program. Since we are no longer able to conduct in-store enrollments due to COVID-19, we have transitioned from promoting and conducting in-store enrollments through our promotora and partner networks to promoting online enrollment. As such, we are currently utilizing our ¡Más Fresco! More Fresh Program video, https://youtu.be/4zpGzY1keNU, digital online enrollment post card, and online enrollment outreach letter to increase awareness of and participation in the ¡Más Fresco! More Fresh Program via our new www.masfresco.org web site and enrollment portal. Objective 2: Create Partnerships and Leverage Resources California WIC Association Nutrition Incentive Program Webinar The UCSD Center for Community Health working in partnership with the California WIC Association, Ecology Center and ALL IN Alameda coordinated a Nutrition Incentive ProgramWebinar for all 83 WIC Agencies across California to raise awareness of California-based Nutrition Incentive Programs. For this webinar, in addition to the UCSD Center for Community Health providing an overview of the national Gus Schumacher Nutrition Incentive Program and the ¡Más Fresco! More Fresh Program, the Ecology Center provided an overview of their Market Match Program at Farmers' Markets across California and ALL IN Alameda County presented on their Food as Medicine Initiative. Nutrition Incentive Program Resource Directory The UCSD Center for Community Health, working in partnership with the Ecology Cetner, ALL IN Alameda County, SPUR and Mandela Partners developed a Nutrition Incentive Program Resource Directory of the 348 sites across California where Nutrition Incentives are available to community members. This resource is being shared with all WIC Agencies, local health departments and other community based organizations across California. Objective 3: Develop Marketing, Media and Promotional Campaigns and Programs Nutrition Incentive Program Promotional Video This past year, the UCSD Center for Community Health and the Ecology Center collaborated on the development of a short video to raise awareness of the ¡Más Fresco! More Fresh Program as well as other nutrition incentive programs across California. Available in English and Spanish, this video is designed to introduce SNAP recipients and other low-income SNAP eligible community members to the Gus Schumacher Nutrition Incentive Program and the opportunity it represents to increase the affordability, purchase and consumption of fruits and vegetables for better health. These videos can be viewed at www.masfresco.org or accessed at: English Language Video: https://youtu.be/4zpGzY1keNU Spanish Language Video: https://youtu.be/h6OaoEogC6c Objective 4: Conduct Process and Outcomes Evaluation During FFY 2019-2020, we collected 244 12-month surveys and 205 18-month post-intervention surveys from our Year 2 (Cohort 2) program participants, as well as 299 6-month surveys and 272 12-month surveys from our Year 3 (Cohort 3) program participants. The increased follow up survey response rates represent efforts by our team to refine and focus data collection efforts on active participants and institute scheduled reminders via text, email, and phone call. In addition, we continue to receive monthly point-of-sale transaction reports from Northgate Gonzalez Market. Together, the self reported survey data and point-of-sale transaction data provide the following insights: (1) Participants randomly assigned to receive up to $40 per moth spent $4-$6 more on average per month on fruits and vegetables than those receiving up to $20 a month, and $9-$16 more than those receiving up to $10 per month. (2) Participants are purchasing anywhere between 25-75% more fruits and vegetables as a result of their participation in the ¡Más Fresco! More Fresh Program. (3) The proportion of program participants in Cohorts 1, 2, and 3 suffering from low or very low food security decreased significantly, from 73.9% at baseline to 64.9% at 12-months post-enrollment. (4) 84% of program participants reported healthier eating habits, and 73% reported increased knowledge about healthy eating as a result of their participation in the ¡Más Fresco! More Fresh program.
Publications
- Type:
Websites
Status:
Published
Year Published:
2020
Citation:
www.masfresco.org
- Type:
Other
Status:
Published
Year Published:
2020
Citation:
Mas Fresco More Fresh & Market Match Nutrition Incentive Program Video
- Type:
Conference Papers and Presentations
Status:
Awaiting Publication
Year Published:
2020
Citation:
APHA 2020 Public Health Film Festival
- Type:
Other
Status:
Published
Year Published:
2020
Citation:
GusNIP Grantee Feature: Northgate Gonzalez Markets, Southern California, Gretchen Swanson Center for Nutrition, May 2020 Newsletter
|
Progress 06/01/18 to 05/31/19
Outputs
Target Audience:The Southern California Nutrition Incentive Program, also known as the ¡Más Fresco! More Fresh Program includes multiple target audiences. The primary target audience includes CalFresh recipients who live in close proximity (within 5 miles) of the six Northgate Gonzalez Market financial incentive intervention sites. These sites are located in Los Angeles, Orange and San Diego Counties. During FFY 2019 (June 1, 2018 through May 31, 2019), we enrolled 1,093 participants in the program's third Cohort. The majority are female (85%) and Latino (91%) with a mean age of 42.5 years (range of 20 to 91 years old). The majority also have less than a high school education (58%) or high school degree/GED (80%). Additional demographic information includes: Mean household Size of 4.1 persons; Mean CalFresh earnings per month of $296; Median daily servings of fruits and vegetables (EATS Screener) of 3.2 servings; Percent facing low or very low food security (USDA Screener): 70.7%. Additional target audiences who may benefit from the 2nd and 3rd tiers of the program include other CalFresh recipients (not consented and enrolled in the study) and non-CalFresh customers who shop at any one of the 40 Northgate Gonzalez Markets across Southern California. These participants have the opportunity to benefit from discount pricing on fresh fruits and vegetables and nutrition education provided at each of these locations. A secondary target audience for the ¡Más Fresco! More Fresh Program includes community-based organizations, such as the Supplemental Nutrition Assistance Program Education (SNAP-Ed) providers and Nutrition Education and Obesity Prevention (NEOP) providers that support the health and well-being of low-income community members living in Los Angeles, Orange and San Diego Counties. To date, we have partnered with over 100 community-based organizations that provide direct outreach to CalFresh recipients and other low-income community members living in Los Angeles, Orange and San Diego counties. In 2019, key support included the CalFresh agencies in Orange and San Diego Counties which sent letters directly to CalFresh recipients living within 5 miles of each of the intervention sites promoting the Mas Fresco! More Fresh Program in-store enrollment events taking place at the Northgate Gonzalez Markets in Orange and Los Angeles Counties and the opportunity to enroll in the program. Similar to the support provided by our local CalFresh Agencies, numerous other community-based organizations are now participating in and supporting the ongoing efforts of the program. Key organizations include the local county health departments, food banks, faith-based organizations, community centers, school districts, WIC programs, UC Cooperative Extension, and food system alliance networks and organizations. The media is also a key target audience for the ¡Más Fresco! More Fresh Program. Changes/Problems:We have not experienced any major changes/problems in our approach. What opportunities for training and professional development has the project provided?The ¡Mas Fresco! More Fresh Program continues to provide opportunities for training and professional development. The ¡Mas Fresco! More Fresh Program received an invitation from the Chilean Ministry of Health and the United Nations Food and Agriculture Organization to present on the ¡Mas Fresco! More Fresh Program at an international conference in Chile on programs and policies to increase the purchase, consumption and production for fruits and vegetables. In January of 2019, Joe Prickitt, MS, RD, UC San Diego Center for Community Health Senior Director of the Southern California Nutrition Incentive Program presented on the ¡Más Fresco! More Fresh Program, as well as the broader Food Insecurity Nutrition Incentive work being conducted in the United States to increase the purchase and consumption of fruits and vegetables. This conference included government health officials, and produce industry leaders across Chile, Mexico and from Central and South America. The key focus of this conference was to discuss programs and policies to increase the purchase, consumption and production for fruits and vegetables so as to address the obesity epidemic that is negatively impacting the lives of community members and economies in Chile, Mexico and Central and South America. As such, this conference provided the opportunity to share information to an international audience on food insecurity nutrition incentive programs that addresses barriers to access of fruits and vegetables, and which provide proven strategies to increase access to and availability of fruits and vegetables for community members. Another training and professional development opportunity was provided by the California Department of Social Services (CDSS). CDSS reached out to the ¡Mas Fresco! More Fresh Program to serve as a technical advisor to support the development and implementation of a new CalFresh EBT Pilot Program that will add nutrition incentives directly to the CalFresh EBT card of CalFresh recipients. The ¡Mas Fresco! More Fresh Program is working with CDSS and others to develop and refine a scalable model for increasing the purchase and consumption of California-grown fresh fruits and vegetables by delivering supplemental benefits to CalFresh recipients in a way that can be easily adopted by authorized retailers of various types, sizes, and locations in the future. During FFY 2019, the ¡Mas Fresco! More Fresh Program served as the lead on the development and implementation of a nutrition incentive panel presentation, abstracts and poster session for the American Public Health Association conference held in San Diego, CA in November of 2018. The panel and associated abstracts and poster session provided an overview of the national USDA Food Insecurity Nutrition Incentive Program breadth, reach and impact, including the program's overall impact on fruit and vegetable purchases and consumption, as well as the program's overall economic impact within local communities and economies. The panel also identified and discussed key lessons learned so as to better inform future nutrition incentive work moving forward. Furthermore, the panel, abstracts, and poster session shared key insights on innovative nutrition incentive programs, technologies, and practices, including loyalty-based nutrition incentive programs, fruit and vegetable prescription programs, and farmers' market-based nutrition incentive programs. During FFY 2019, the ¡Mas Fresco! More Fresh program and evaluation staff received advanced training in Qualtrics survey software design, development, and implementation. Qualtrics is the program used by the ¡Mas Fresco! More Fresh program and evaluation team to design, send and analyze surveys for the thousands of ¡Mas Fresco! More Fresh program participants. Qualtrics cloud-based survey technology provides the ¡Mas Fresco! More Fresh program and evaluation team the ability to both input and retrieve data in real-time from a large number of respondents and to carry out sophisticated research, including advanced survey functionality and analytics. This advanced training has now strengthened the program's capacity and capability to apply survey logic and custom follow-up survey collection for the ¡Mas Fresco! More Fresh Program and to facilitate data navigation to quickly assess and determine key program insights, including ways to enhance overall program utilization and satisfaction among program participants. This training proved to be particularly important for the 2019 program enrollments, where program participants were added to the program and to the Northgate Gonzalez Market point-of-sale system in real-time, upon enrollment enabling program participants to instantly utilize the nutrition incentives upon enrollment. Furthermore, this advanced training significantly enhanced the programs follow up survey collection. The program manager was able to respond to survey link requests in real time during data collection time periods. This resulted in a 29% increase in the effective collection of 12-month survey responses among Cohort 2 program participants versus Cohort 1 program participants. How have the results been disseminated to communities of interest?For FFY 2019 we developed a comprehensive Progress Report and have shared this Progress Report with USDA, and all of our partners at the local, state and national level. In addition, during FFY 2019 we conducted an extensive media outreach program. This outreach has resulted in program information dissemination across the United States and internationally. The sharing of this information has resulted in numerous opportunities for collaboration with organizations world-wide, including our participation in January of 2019 at an international conference in Santiago, Chile which focused on ways to increase the purchase, consumption and production of fruits and vegetables. As a member of the National Nutrition Incentive Network, and numerous other coalitions and networks, we share program information, including our progress report, on an ongoing basis with all our coalition and network partners. An additional outcome of our outreach and information dissemination are ongoing requests to participate in webinars, panel discussions and national conventions to provide further information on the ¡Mas Fresco! More Fresh Program and FINI. One of the most notable outcomes is our panel presentation at the American Public Health Association's national convention in San Diego, California in November of 2018. This panel presentation, in partnership with other FINI programs provided APHA convention attendees with the following information on our program and other FINI programs. Advancing Healthy Food Access and Affordability Through Innovative Food Insecurity Nutrition Incentive (FINI) Programs SNAP Incentives at California's Farmers' Markets: Enhanced Health, Food Security, and Economic Development Public Health Implications of a Large-Scale, Multi-Sector Produce Prescription Program Utilizing the SNAP-Ed Evaluation Framework to Integrate and Maximize Results of SNAP-Ed and FINI Programming What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period we will be focusing on the following primary objectives to achieve our goals: Enhanced Fruit and Vegetable Financial Incentive Program Participation In addition to in-store enrollment, we will also be providing the opportunity for program participants to enroll in the program online. As such, we will look to build an online enrollment program to complement our in-store enrollment program. Enhanced Fruit and Vegetable Financial Incentive Program Nutrition Education We will provide program participants with an electronic newsletter, along with a text messaging campaign and program aimed at enhancing their nutrition knowledge, as well as their healthy eating self-efficacy. Good Food Purchasing Program We will move forward on our Good Food Purchasing Program with Northgate Gonzalez Market.
Impacts
What was accomplished under these goals?
Objective 1: Implement the Fruit and Vegetable Financial Incentive Program, Promotions and Nutrition Education During our third year of operation from June l, 2018 to May 31, 2019, the Southern California Nutrition Incentive Program, also known as the ¡Mas Fresco! More Fresh Program, has continued to develop, implement, and evaluate a Food Insecurity Nutrition Incentive program for CalFresh recipients living in Los Angeles, Orange and San Diego Counties. In addition to providing participants greater access to more affordable fruits and vegetables, we are using a randomized control design to examine the effect of different financial incentive levels on customer purchasing behaviors. During this time frame, the ¡M as Fresco! More Fresh Program conducted 30 ¡Mas Fresco! More Fresh Program enrollment events at six Northgate Gonzalez Markets in Los Angeles, Orange and San Diego Counties (2 markets per county) and enrolled 1,093 participants in the program's third cohort. Since the inception of this program, we have enrolled 3,476 program participants. Unlike our previous two cohorts, Cohort 3 members received pre-set Mi Familia cards upon enrollment, enabling them to earn and redeem financial incentives the same day that they enrolled in the program. By introducing the pre-set Mi Familia cards,71.3% ofCohort 3 programparticipants activated and used their Mi Familia cardswithin the first 4 months of enrollment in the ¡Más Fresco! More Fresh Program and 47.3% had used their Mi Familia card more than one time per month. Incomparison, without the pre-set Mi Familia cards,it took 16 months from enrollment for65.3% of Cohort 2program participants to activate and use their Mi Familia cards, and only 26.7% had used their Mi Familia card more than one time per month during that time. Objective 2: Create Partnerships and Leverage Resources A key goal of the Southern California Nutrition Incentive Program is to support partnership development and resource leveraging to support the health and well-being of SNAP recipients. During FFY 2019, the ¡Mas Fresco! More Fresh Program had the opportunity to partner with the Chilean Ministry of Health and the United Nations Food and Agriculture Organization on an international conference in Chile on programs and policies to increase the purchase, consumption and production for fruits and vegetables. In January of 2019, Joe Prickitt, MS, RD, UC San Diego Center for Community Health Senior Director of the Southern California Nutrition Incentive Program presented on the ¡Más Fresco! More Fresh Program, as well as the broader Food Insecurity Nutrition Incentive work being conducted in the United States to increase the purchase and consumption of fruits and vegetables. This conference included government health officials, and produce industry leaders across Chile, Mexico and Central and South America. The key focus of this conference was to discuss programs and policies to increase the purchase, consumption and production for fruits and vegetables so as to address the obesity epidemic that is negatively impacting the lives of community members and economies in Chile, Mexico and Central and South America. Furthermore, the ¡Mas Fresco! More Fresh Program has partnered with the California Department of Social Services to serve as a technical advisor to support the development and implementation of a new CalFresh EBT Pilot Program that will add nutrition incentives directly to the CalFresh EBT card of CalFresh recipients. During FFY 2019, the ¡Mas Fresco! More Fresh Program collaborated with a number of nutrition incentive program partners on the development and implementation of a nutrition incentive panel presentation, abstracts and poster session for the American Public Health Association conference held in San Diego, CA in November of 2018. The panel and associated abstracts and poster session provided an overview of the national USDA Food Insecurity Nutrition Incentive Program breadth, reach and impact, including the program's overall impact on fruit and vegetable purchases and consumption, as well as the program's overall economic impact within local communities and economies. Trainings During FFY 2019, the Southern California Nutrition Incentive Program conducted a series of trainings with Latino Health Access and Vision y Compromiso and their network of Promotoras to support the program's 30 enrollment events conducted between January and April of 2019 in Orange County, Los Angeles County and in San Diego County. Since the program is a randomized control trial (RCT) study, the entire study, including the recruitment of program participants, needs to adhere to UC San Diego Institutional Review Board (IRB) standards that comply with the ethical conduct of trials involving human subjects. As such, the Promotoras need to be trained and certified to conduct human subjects research before they can interact with and enroll the program participants. The Southern California Nutrition Incentive Program conducted a UC San Diego IRB approved training program to enable the Promotoras to fully understand the unique challenges involved in human subject research and to ensure that all UC San Diego IRB guidelines and protocols were adhered to during the engagement, recruitment and follow up interactions with program participants. Objective 3: Develop Marketing, Media and Promotional Campaigns and Programs As a result of our program outreach to the media and others, the ¡Mas Fresco! More Fresh Program received an invitation from the Chilean Ministry of Health and the United Nations Food and Agriculture Organization to present on the ¡Mas Fresco! More Fresh Program at an international conference in Chile on programs and policies to increase the purchase, consumption and production for fruits and vegetables. Furthermore, as a result of our marketing, media and promotional campaigns, the California Department of Social Services reached out to the ¡Mas Fresco! More Fresh Program to serve as a technical advisor to support the development and implementation of a new CalFresh EBT Pilot Program that will add nutrition incentives directly to the CalFresh EBT card of CalFresh recipients. Objective 4: Conduct Process and Outcomes Evaluation The self-reported level of food security among the ¡Mas Fresco! More Fresh Program participants, for all three cohorts, indicates that 80.80% of Cohort 1 participants, 78.50% of Cohort 2 participants and 70.7% of Cohort 3 participants suffer from low to very low levels of food security. Furthermore, as determined from the baseline surveys, the mean household size of Cohort 1, Cohort 2 and Cohort 3 are 5.5, 4.2 and 4.1 household members respectively. Many of these households include children and senior citizens up to age 95 years (87% of Cohort 1 households, 79% of Cohort 2 households and 76.3% of Cohort 3 households include children). These results indicate that among the ¡Mas Fresco! More Fresh program participants, children, youth, adults and seniors all suffer from low to very low levels of food security. Based on the preliminary analysis of Cohort 1 and Cohort 2 data, including self-reported survey data and point-of-sale transaction data, the program appears to have had a statistically significant impact on decreasing the severity of food insecurity among program participants. Furthermore, the transaction data for Cohort 1 and Cohort 2 indicates that the program has resulted in a statistically significant increase in the purchase of fresh fruits and vegetables among program participants. This data indicates that the higher the financial incentive amount received per month ($10, $20, or $40), the higher the dollar amount of fruits and vegetables purchased each month.
Publications
- Type:
Conference Papers and Presentations
Status:
Other
Year Published:
2019
Citation:
Joe Prickitt, MS, RD, University of California San Diego School of Medicine Center for Community Health, San Diego, CA. Panel presentation entitled: Policies and Programs to Increase Access to and Production of Fruits and Vegetables, Chilean Ministry of Health and United Nations Food and Agriculture Meeting, January 9, 2019, Santiago, Chile
- Type:
Conference Papers and Presentations
Status:
Other
Year Published:
2019
Citation:
Joe Prickitt, MS, RD, San Diego School of Medicine Center for Community Health, San Diego, CA. Panel presentation entitled: Southern California Nutrition Incentive Program. California Department of Social Services EBT Pilot Project Meeting, February 11, 2019, Sacramento, CA
- Type:
Conference Papers and Presentations
Status:
Other
Year Published:
2018
Citation:
Kay Rhee, MD, MSc, MA, UC San Diego School of Medicine Center for Community Health, San Diego, CA. Panel session entitled: An Innovative Nutrition Incentive Program Utilizing Point-of-Sale Technologies in a Large-Scale Retail Setting. American Public Health Association Annual Conference; November 10 14, 2018, San Diego, CA.
|
Progress 06/01/17 to 05/31/18
Outputs
Target Audience:The Southern California Nutrition Incentive Program, also known as the ¡Más Fresco! More Fresh Program includes multiple target audiences. The primary target audience includes CalFresh recipients who live in close proximity (within 5 miles) of the six Northgate Gonzalez Market financial incentive intervention sites. These sites are located in Los Angeles, Orange and San Diego Counties. During FFY 2018 (June 1, 2017 through May 31, 2018), we enrolled 1,230 participants in the program's second Cohort. The majority are female (88%) and Latino (90%) with a mean age of 41.6 years (range of 18 to 90 years old). The majority also have less than a high school education (63%) or high school degree/GED (17%). Additional demographic information includes: mean household size of 4.2 persons; mean CalFresh earnings per month of $302; median daily servings of 2.7 fruits and vegetables (EATS Screener); and 78.5% facing low or very low food security (USDA Screener). Additional target audiences who may benefit from the 2nd and 3rd tiers of the program (which focus on nutrition education and F&V promotions) include other CalFresh recipients (not consented and enrolled in the study) and non-CalFresh customers who shop at any one of the 40 Northgate Gonzalez Markets across Southern California. These participants would have the opportunity to benefit from discount pricing on fresh fruits and vegetables and nutrition education provided at each of these locations. A secondary target audience for the ¡Más Fresco! More Fresh Program includes community-based organizations, such as the Supplemental Nutrition Assistance Program Education (SNAP-Ed) providers and Nutrition Education and Obesity Prevention (NEOP) program providers that support the health and well-being of low-income community members living in Los Angeles, Orange and San Diego Counties. To date, we have partnered with over 100 community-based organizations that provide direct outreach to CalFresh recipients and other low-income community members living in Los Angeles, Orange and San Diego counties. These organizations helped the ¡Más Fresco! More Fresh Program distribute flyers directly to low-income community members in these three counties. Furthermore, the CalFresh Agencies in Orange County and in San Diego County sent letters directly to CalFresh recipients living within 5 miles of each of the Northgate Gonzalez Market intervention sites within their county promoting the ¡Más Fresco! More Fresh Program enrollment events. Similar to the support provided by our local CalFresh Agencies, numerous other community-based organizations are now participating in and supporting the ongoing efforts of the program. Key organizations include the local county health departments, food banks, faith-based organizations, community centers, school districts, WIC programs, UC Cooperative Extension, and food system alliance networks and organizations. An additional key target audience for the ¡Más Fresco! More Fresh Program is the media. Our FFY 2018 media outreach efforts resulted in media placements across the United States. Key story placements included the Los Angeles Times, National Public Radio (NPR), KPBS News, Kaiser Health News, KQED News, PEW Charitable Trust News, USA News, NIFA USDA Impacts and HealthLine. A key outcome of this media attention and coverage included a call from CNN to develop a story on the ¡Más Fresco! More Fresh Program. CNN flew out from Washington, DC in May of 2018 to conduct interviews with the ¡Más Fresco! More Fresh Program Director, as well as to interview a ¡Más Fresco! More Fresh Program participant and their family members. This included in-store footage while they shopped at a Northgate Gonzalez Market, and footage in their home to discuss the impact of the program on the family's health and well-being. Changes/Problems:While we did not encounter any major problems during FFY 2018, as anticipated we did encounter technology issues with the implementation of the Fruit and Vegetable Financial Incentive System. Since the Fruit and Vegetable Financial Incentive System represents an innovative benefit redemption system and technologies, our first year of operation represented a live beta test. As such, we did experience and encounter hardware, software, and other technology issues that needed to be addressed and worked through with Northgate Gonzalez Market and their technology providers. Fortunately, this is something that we had anticipated, planned for and is something that we had communicated with our program participants when they enrolled into the program. It is actually thanks to the program participants and their utilization of our support network of promotoras that we were able to quickly identify, address and resolve issues in a timely manner. At the current time, the Financial Incentive System and technologies are working very well, and we do not anticipate further technology issues, and are now beyond our 1st year live beta test of the system. What opportunities for training and professional development has the project provided?As noted earlier in our FFY 2018 Progress Report, in order to support our network of promotoras in the recruitment, support and retention of our program participants, we developed a UC San Diego Institutional Review Board approved training program and protocol to enable the promotoras to understand the unique challenges involved in human subject research and to ensure that all UC San Diego IRB guidelines were adhered to during the engagement, recruitment and follow up interactions with program participants. The training program addressed the following areas: Program Participant Eligibility Screening; Informed Consent Process; Program Registration; Administration of Baseline Survey; Study Group Randomization; Overview of Program Goals and Objectives and the Usage of the Mi Familia Card; Data Capture and Entry. In addition to the trainings for our network of promotoras, we also worked with Northgate Gonzalez Market to develop an ongoing series of trainings that Northgate Gonzalez Market is conducting for all staff members at each of the participating Northgate Gonzalez Markets to ensure that all staff members, not only cashiers, are familiar with and understand the ¡Más Fresco! More Fresh Program and can help and support program participants as needed. The trainings include a variety of training materials, including videos in English and Spanish. The videos outline the specific steps needed by the Northgate Gonzalez Market cashiers to facilitate the earn and redeem process at the point-of-sale register for the ¡Más Fresco! More Fresh Program participants. How have the results been disseminated to communities of interest?For FFY 2018 we have developed a comprehensive 23-page Progress Report and have shared this Progress Report with USDA, and all of our partners at the local, state and national level. In addition, during FFY 2018 we conducted an extensive media outreach program. This outreach has resulted in program information dissemination across the United States. The sharing of this information has resulted in numerous opportunities for collaboration with organizations nationwide. As a member of the National Nutrition Incentive Network, and numerous other coalitions and networks, we share program information, including our progress report on an ongoing basis with all our coalition and network partners. An additional outcome of our outreach and information dissemination are ongoing requests to participate in webinars, panel discussions and national conventions to provide further information on the ¡Más Fresco! More Fresh Program. One of the most notable outcomes is our panel presentation at the upcoming American Public Health Association's national convention in San Diego, California in November of 2018. This panel presentation, in partnership with other FINI programs will provide APHA convention attendees with the following information on our program and other FINI programs. Advancing Healthy Food Access and Affordability Through Innovative Food Insecurity Nutrition Incentive (FINI) Programs SNAP Incentives at California's Farmers' Markets: Enhanced Health, Food Security, and Economic Development Public Health Implications of a Large-Scale, Multi-Sector Produce Prescription Program Utilizing the SNAP-Ed Evaluation Framework to Integrate and Maximize Results of SNAP-Ed and FINI Programming What do you plan to do during the next reporting period to accomplish the goals?What do you plan to do during the next reporting period to accomplish the goals? During the next reporting period we will be focusing on three primary objectives to achieve our goals: Enhanced Fruit and Vegetable Financial Incentive Program Participation For FFY 2019, in addition to in-store enrollment, we will also be providing the opportunity for program participants to enroll in the program online. As such, during, FFY 2019, we will develop, test, implement and evaluate an online enrollment program in both English and Spanish that will complement our in-store enrollment program. Enhanced Fruit and Vegetable Financial Incentive Program Nutrition Education For FFY 2019 we will be providing program participants with an electronic newsletter, along with a text messaging campaign and program aimed at enhancing their nutrition knowledge, as well as their healthy eating self-efficacy. Good Food Purchasing Program For FFY 2019, we will be looking to move forward on our Good Food Purchasing Program with Northgate Gonzalez Market.
Impacts
What was accomplished under these goals?
Objective 1: Implement the Fruit and Vegetable Financial Incentive Program, Promotions and Nutrition Education During our second year of operation, from June l, 2017 to May 31, 2018, the Southern California Nutrition Incentive Program, also known as the ¡Más Fresco! More Fresh Program, has continued to develop, implement, and evaluate a Food Insecurity Nutrition Incentive program for CalFresh recipients living in Los Angeles, Orange and San Diego Counties. During this time frame, the ¡Más Fresco! More Fresh Program conducted 30 enrollment events at six Northgate Gonzalez Markets in Los Angeles, Orange and San Diego Counties (2 markets per county) and enrolled 1,230 participants in the program's second cohort. Since the inception of this program, we have enrolled 2,383 participants. Like our first cohort of 1,153 program participants, the participants in the second cohort have been randomized to receive either $10, $20, or $40 a month for 12-months in financial incentives. This group of participants have completed their baseline surveys and have begun to earn and redeem their financial incentives. During this last federal fiscal year (FFY), we have also collected 359 six-month surveys and 188 12-month surveys from our Year l program participants (Cohort l). Objective 2: Create Partnerships and Leverage Resources A key goal of the Southern California Nutrition Incentive Program is to support partnership development and resource leveraging to support the health and well-being of SNAP recipients. Toward this effort, the Southern California Nutrition Incentive Program is working with FINI programs and partners as well as SNAP Ed Implementing Agencies at the local, state and national levels. Together, we developed and submitted a report to the Supplemental Nutrition Assistance Program (SNAP) Task Force in September of 2017. A key component of this report was a detailed description of the enhanced program integration and coordination, as well as leveraging of resources, that exists between FINI Programs and SNAP-Ed Implementing Agencies to enhance the health and well-being of SNAP recipients. The Southern California Nutrition Incentive Program working in conjunction with USDA, the Washington State Department of Health, The Food Trust, Ecology Center, University of Florida, Wholesome Wave and others, developed and submitted a full panel presentation proposal to APHA for their 2018 annual conference. The focus of the panel presentation is on innovative Food Insecurity Nutrition Incentive Programs and the many public-private sector collaboration opportunities that FINI programs provide. In order to effectively implement the Mas Fresco! More Fresh Program with a predominately Latino community that shops at Northgate Gonzalez Markets, UCSD entered into strategic partnerships with Latino Health Access and Vision y Compromiso, two large promotora networks in Southern California. During FFY 2018, the Southern California Nutrition Incentive Program conducted a series of trainings with both Latino Health Access and Vision y Compromiso and their network of promotoras to support the program's enrollment events in Orange County, Los Angeles County and in San Diego County Objective 3: Develop Marketing, Media and Promotional Campaigns and Programs In FFY 2018 the Southern California Nutrition Incentive Program continued its media outreach to a wide array of media partners. This outreach resulted in media placements across the United States. Key story placements included the Los Angeles Times, National Public Radio (NPR), KPBS News, Kaiser Health News, KQED News, PEW Charitable Trust News, USA News, NIFA USDA Impacts and HealthLine. A key outcome of this media attention and coverage included a call from CNN to develop a story on the ¡Mas Fresco! More Fresh Program. CNN flew out from Washington, DC in May of 2018 to conduct interviews with the ¡Más Fresco! More Fresh Program Director, as well as to interview a ¡Más Fresco! More Fresh Program participant and their family members. This included in-store footage while they shopped at a Northgate Gonzalez Market, and footage in their home to discuss the impact of the program on the family's health and well-being. In addition to our media outreach, thanks to our partnership with our local Social Service Agency CalFresh Programs, we were able to conduct a direct mail campaign to SNAP recipients living within a 5-mile radius of each of our retail intervention sites located in Orange County and in Los Angeles County. This outreach resulted in numerous SNAP recipients arriving at the in-store enrollment events already informed about the program and ready to enroll. Objective 4: Conduct Process and Outcomes Evaluation During this last federal fiscal year, in addition to the evaluation and analysis of the baseline survey data collected from our 1,230 Year 2 program participants (Cohort 2), we also administered and evaluated 359 six-month surveys and 188 12-month surveys from our Year l program participants (Cohort l). The self-reported level of food security among the ¡Mas Fresco! More Fresh program- participants, indicates that 80.80% of Cohort 1 participants and 78.50% of Cohort 2 participants suffer from low to very low levels of food security. An evaluation of program participant self-reported combined daily intake of fruits and vegetables reveals that the program participants fall far below the recommended 4.5 cup equivalent servings of fruits and vegetables per day. Based on an evaluation of the responses by the ¡Más Fresco! More Fresh program participants to a series of survey questions pertaining to barriers to fruit and vegetable consumption, the single greatest barrier to consuming more fruits and vegetables is the cost of fruits and vegetables. The cost of fruits and vegetables was indicated as the number one barrier by 72% of Cohort I and by 69.6% of Cohort 2. The evaluation of the 6-month and 12-month follow up surveys, indicates that the ¡Más Fresco! More Fresh Program has significantly increased the affordability of fruits and vegetables for Cohort 1 program participants.
Publications
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2018
Citation:
Kay Rhee, MD, MSc, MA, UC San Diego School of Medicine Center for Community Health, San Diego, CA. Panel session entitled: An Innovative Nutrition Incentive Program Utilizing Point-of-Sale Technologies in a Large-Scale Retail Setting. American Public Health Association Annual Conference; November 10 14, 2018, San Diego, CA.
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2018
Citation:
Jane Clary Loveless, PhD, RN, MS, MCHES, National Institute of Food and Agriculture, USDA, Washington, DC and Joe Prickitt, MS, RD, University of California San Diego School of Medicine Center for Community Health, San Diego, CA. Poster session entitled: Insight on the Promise, Realization and Potential of the Food Insecurity Nutrition Incentive Program. American Public Health Association Annual Conference; November 10 14, 2018, San Diego, CA.
- Type:
Conference Papers and Presentations
Status:
Other
Year Published:
2018
Citation:
Joe Prickitt, MS, RD, University of California San Diego School of Medicine Center for Community Health, San Diego, CA. Panel presentation entitled: FINI: Keys to Success & Lessons Learned. USDA NIFA FINI Project Directors Meeting, August 14-17, 2018, Washington DC.
- Type:
Conference Papers and Presentations
Status:
Other
Year Published:
2018
Citation:
Kay Rhee, MD, MSc, MA, UC San Diego School of Medicine Center for Community Health, San Diego, CA. Panel presentation entitled: FINI Data Collection and Program Evaluation. USDA NIFA FINI Project Directors Meeting, August 14-17, 2018, Washington DC.
- Type:
Conference Papers and Presentations
Status:
Other
Year Published:
2018
Citation:
Joe Prickitt, MS, RD, San Diego School of Medicine Center for Community Health, San Diego, CA. Panel presentation entitled: Southern California Nutrition Incentive Program. San Diego Health and Human Services Agency Leadership Meeting, March 12, 2018, San Diego, CA.
- Type:
Conference Papers and Presentations
Status:
Other
Year Published:
2018
Citation:
Joe Prickitt, MS, RD, San Diego School of Medicine Center for Community Health, San Diego, CA. Panel presentation entitled: Southern California Nutrition Incentive Program. San Diego Food System Alliance Meeting, June 4, 2018, San Diego, CA.
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
Kaiser Health News, January 16, 2018. Story Entitled: When Food Stamps Pass as Tickets to Better Health
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
KPBS News, January 16, 2018. Story Entitled: Food Stamp Program Makes Fresh Produce More Affordable
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
NPR January 16, 2018. Story Entitled: Food Stamp Program Makes Fresh Produce More Affordable
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
Los Angeles Times, January 17, 2018; Story Entitled: Mas Fresco Food Stamp Program Makes Fresh Produce More Affordable
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
KQED News, January 16, 2018; Story Entitled: Food Stamp Program in Southern California Makes Fresh Produce More Affordable
- Type:
Other
Status:
Published
Year Published:
2018
Citation:
USA News, January 16, 2018; Story Entitled: Food Stamp Program in Southern California Makes Fresh Produce More Affordable
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
www.theparentingvillage.com, January 18, 2018; Story Entitled: Food Stamp Program Makes Fresh Produce More Affordable
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
www.mindbodygreen.com, January 18, 2018; Story Entitled: This Program is Helping Low-Income Californians Access Fruits and Vegetables.
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
www.healthbusinessgroup.com, January 22, 2018; Story Entitled: Food for Health
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
www.healthbusinessgroup.com, January 22, 2018; Story Entitled: Food for Health
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
www.nifa.usda.gov/impacts, January 22, 2018: Story Entitled: Food Stamp Program Makes Fresh Produce More Affordable
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
www.medicalconsultantsnetwork.com, February 2, 2018; Story Entitled: Access to Better Health Through Food Stamps
- Type:
Websites
Status:
Published
Year Published:
2018
Citation:
www.communitycommons.org, February 6, 2018; Story Entitled: When Food Stamps Pass as Tickets to Better Health?
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Progress 06/01/16 to 05/31/17
Outputs
Target Audience:The Southern California Nutrition Incentive Program, also known as the ¡Más Fresco! More Fresh Program includes multiple target audiences. The primary target audience includes CalFresh recipients who live in close proximity (within 5 miles) of the six Northgate Gonzalez Market financial incentive intervention sites. These sites are located in Los Angeles, Orange and San Diego Counties. Currently, we have enrolled 1153 participants. The majority are female (93%) and Latino (90%) with a mean age of 39.7 years (range of 18 to 95 years old). The majority also have less than a high school education (67%) or high school degree/GED (19%). Additional demographic information include: Mean household Size: 5.5 persons Mean CalFresh earnings per month: $329 Median daily servings of fruits and vegetables (EATS Screener): 2.6 Percent facing low or very low food security (USDA Screener): 80.40% Additional target audiences who may benefit from the 2nd and 3rd tiers of the program include other CalFresh recipients (not consented and enrolled in the study) and non-CalFresh customers who shop at any one of the 40 Northgate Gonzalez Markets across Southern California. These participants have the opportunity to benefit from discount pricing on fresh fruits and vegetables and nutrition education provided at each of these locations. A secondary target audience for the ¡Más Fresco! More Fresh Program includes community-based organizations, such as the Supplemental Nutrition Assistance Program Education (SNAP-Ed) providers and Nutrition Education and Obesity Prevention (NEOP) providers that support the health and well-being of low-income community members living in Los Angeles, Orange and San Diego Counties. To date, we have partnered with over 100 community-based organizations that provide direct outreach to CalFresh recipients and other low-income community members living in Los Angeles, Orange and San Diego counties. These organizations helped the ¡Más Fresco! More Fresh Program distribute 40,000 flyers directly to low-income community members in these three counties. In addition, many of these organizations are now participating in and supporting the ongoing efforts of the program. Key organizations include the local county health departments, social service agencies, food banks, faith-based organizations, community centers, school districts, WIC programs, UC Cooperative Extension, food system alliance networks and organizations, media organizations, and other partners. Changes/Problems:We did not encounter any significant problems or issues in our approach, however, we did secure approval from NIFA to change our study design to align with recommendations provided to us by our community partners. The key study design change came as a result of input from the National Cash Register Corporation during our initial program design and development meeting with Northgate Gonzalez Market and their point of sale technology providers. At this meeting, the National Cash Register Corporation advised us that if we were looking to secure equitable data among our study groups that we would need to provide a financial incentive to all of our study group participants so that each study group participant would have a reason to use their customer loyalty card at check-out and generate the transaction data needed for the study. Based on their experience, they let us know that it was unlikely that program participants who enrolled in the study and who did not receive a financial incentive would actually use their customer loyalty card at the store. Based on this input, we revised our study design to provide all program participants with some amount of financial incentive. The revised study design provided for a $10 a month, $20 a month and a $40 a month study groups so as to help ensure equitable transaction data among and between all program participants. Another change that we made early on, again based on input from our community partners, was to hire a half-time program coordinator instead of a full-time program coordinator and use the cost savings to secure the ongoing support of a network of promotoras to support the enrollment and ongoing program participant support process. As we learned at our very first enrollment event, this change proved to be critical toward our successful enrollment and support of the program participants. Conducting the needs assessment with our community partners during the program design process proved to be instrumental in helping to ensure successful development and implementation of the program without incurring any significant problems or issues. What opportunities for training and professional development has the project provided?According to the Latino Health Access Promotora Team that is supporting the enrollment of the ¡Más Fresco! More Fresh Program and who have received extensive program training, the ¡Más Fresco! More Fresh Program is one of the most rewarding and effective programs they have ever had the opportunity to work on. The training and professional development provided to the Latino Health Access promotoras is something that directly benefits both the Latino Health Access promotoras as well as the low-income communities they serve. Furthermore, the work that we are conducting on the Good Food Purchasing Standards Program to create the first-ever retail-based Good Food Purchasing Program has caught the attention of Food System Alliance organizations in Los Angeles, Orange and San Diego Counties and is taking on a life of its own, above and beyond what we had originally envisioned. How have the results been disseminated to communities of interest?Preliminary program results and data are being shared with our key partners on an ongoing basis. This information is being sent out in quarterly reports, including a semi-annual and annual report format. Preliminary results were also presented at the USDA FINI Program Directors meeting in August 2017. What do you plan to do during the next reporting period to accomplish the goals?While the financial incentive program and the evaluation of this program is key to the entire study, and as such was of critical importance to bring on-line successfully, we are also looking to build out the other two program tiers (fruit and vegetable discount pricing and promotions, along with enhanced in-store nutrition education). During the next reporting period, we will also move forward on the development of the first-ever retail-based Good Food Purchasing Standards Program. We also anticipate the further development and enhancement of our Nutrition Incentive Network across the three counties, increasing resource leveraging, and coordinating and integrating our respective resources and activities to enhance the health and well-being of the communities that we collectively serve.
Impacts
What was accomplished under these goals?
Objective 1: Implement the Fruit and Vegetable Financial Incentive Program, Promotions and Nutrition Education The most significant accomplishment is the successful development, implementation and initial evaluation of a retail-based, electronic, financial incentive program. Key to achieving this goal was the development of a cloud-based customer loyalty program that would keep track of dollars spent, earned, and redeemed within the Mas Fresco financial incentive benefit program. Based on feedback that we have received from other FINI grantees, as well as produce and retail industry members, this cloud-based customer loyalty platform represents the future for financial incentive benefit redemption programs at retail grocery stores. Not only does this system enable program participants to instantaneously earn and redeem financial incentives at the cash-register, but the system also automatically stores earned financial incentives for subsequent purchases of fruits and vegetables. In addition, all of the transaction data is automatically stored and made available for review and analysis of all participant transactions. Thanks to incredible leadership from Northgate Gonzalez Market, and support provided by the National Cash Register Corporation, Truno Retail Technology Solutions and others, we have developed a financial incentive benefit redemption system and program that supports the needs of 1,153 SNAP recipients across Los Angeles, Orange and San Diego Counties in Year 1 of our program. As originally envisioned and proposed to USDA, this is a seamless, paperless, instantaneous process where program participants earn and redeem financial incentives simply by buying fresh fruits and vegetables with their CalFresh EBT benefits. This system can be set-up for a variety of different program types. In our case, we are providing participants with either $10, $20, or $40 a month for 12-months in financial incentives. Another key accomplishment in Year 1 was our ability to enroll 1,153 SNAP recipients into the ¡Más Fresco! More Fresh Program. We have been told by our community partners that our program enrollment process actually represents a best-practice model. Since we are working with primarily Latino communities, we utilized a promotora (Community Health Worker) model to support all aspects of enrollment and on-going participant support. This model has proven to be instrumental in both the recruitment and support of our 1,153 participants. Since this is a randomized control trial, all of the program participants needed to be provided with a Más Fresco! More Fresh Program orientation and participate in the consent process prior to enrollment. They also completed a baseline survey prior to being randomized to one of three study groups. On average, the entire enrollment process took approximately 45 minutes to complete per program participant, resulting in nearly 900 hours of program staff time. In addition, all of the promotoras needed to be trained in the details of our program design and certified as UC San Diego IRB approved research assistants qualified to enroll human subjects into research studies. Promotoras were also trained to administer the baseline surveys. Objective 2: Create Partnerships and Leverage Resources A key goal and objective of the Más Fresco! More Fresh Program is to engage the support and assistance of SNAP-Ed programs and other community-based partners and to leverage collective resources to support and enhance the health and well-being of SNAP recipients across Los Angeles, Orange and San Diego Counties. We were very successful in accomplishing this. To date, we have partnered with over 100 organizations, including SNAP agencies in charge of implementing California's Nutrition Education and Obesity Prevention Program (NEOP). Key partners include the California Department of Public Health, California Department of Social Services, UC Cooperative Extension, California Department of Food and Agriculture and all of the local health departments, social services agencies and UC Cooperative Extension offices across Southern California. In addition, we have aligned with and are working in close partnership with the local food banks, catholic charities, faith-based organizations, food system alliance partners and other NEOP community based organizations across Southern California. These partnerships helped us to distribute over 40,000 promotional flyers about the Más Fresco! More Fresh Program directly to SNAP recipients living in close proximity to the Northgate Gonzalez Market financial incentive intervention sites. In addition, these partnerships proved to be instrumental in the testing of the financial incentive program since CalFresh provided us with sample EBT cards for field testing. Objective 3: Develop Marketing, Media and Promotional Campaigns and Programs One of our key objectives during Year 1 was to develop and field test a Southern California Nutrition Incentive Program identity and then develop a suite of branded program materials which could be used during the enrollment process as well as for sharing information about the program with partners, key dignitaries and others. Working in conjunction with a graphic design and brand identity firm, we field tested a number of potential identities. The outcome of this work resulted in the Más Fresco! More Fresh Program brand. We then developed a Más Fresco! More Fresh program brochure and other materials to support both participants and others in the community to understand the Más Fresco! More Fresh Program. We also worked closely with media partners across Southern California to help raise recognition of the program. A key accomplishment of this work resulted in securing 40 free radio PSAs on Univision Radio, and a radio interview about the Mas Fresco Program and how SNAP recipients can enroll in the program. Furthermore, we conducted outreach to an array of media partners including the Los Angeles Times, Orange County Register and the San Diego Union Tribune. This outreach resulted in story Más Fresco! More Fresh story placements in the San Diego Union Tribune, La Prensa Newspaper, Rumores News and retail industry publications, including the Shelby Report of the West and Supermarket News. In addition, we also conducted a direct mail campaign to 10,000 low-income households located within a 5-mile radius of our two retail intervention sites located in Orange County. Finally, we are in the last stages of developing an informational video to help cashiers and program participants understand how to use their ¡Más Fresco! More Fresh loyalty cards. Objective 4: Conduct Process and Outcomes Evaluation One of the keys to our successful enrollment of 1,153 program participants in Year 1 was our utilization of Qualtrics, a cloud-based research survey and data management program. This program, administered in-store on iPads, proved to be instrumental in the orientation and consent process, surveys, and randomization. Based on our experience, Qualtrics is a best-practice program for the administration of large-scale research survey programs. In addition to the self-reported survey data, Northgate Gonzalez Market is also providing us with all of the transaction data generated on a daily basis by the ¡Más Fresco! More Fresh program participants. According to the UC San Diego Evaluation Team, the data being provided will enable us to evaluate the effectiveness of financial incentives upon the purchase and consumption of fruits and vegetables. This data includes dollars spent, earned, and redeemed, as well as specific products purchased.
Publications
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