Progress 09/15/19 to 09/14/24
Outputs
Target Audience:The ¡Más Fresco! More Fresh Program has a number of target audiences. First and foremost are the SNAP recipients who live within approximately 5 miles of each Northgate Gonzalez Market. We picked a 5-mile radius to ensure that participants can easily access their Northgate Gonzalez Market and not have major transportation barriers. To reach this target audience, we recruited directly from several Northgate stores. We also worked with several community-based organizations that support the health and well-being of low-income community members, including SNAP recipients, in the communities surrounding the participating Northgate Gonzalez Markets. Finally, media outlets and social media were used to help disseminate information to SNAP participants in the surrounding areas. In 2020, a key target audience included numerous community-based organizations across California to promote the new ¡Más Fresco! online enrollment and the opportunity for SNAP recipients to earn up to $100 a month in financial incentives. Key partners included Los Angeles County Public Health Department and over 100 members of their CalFresh Healthy Eating Collaborative; Orange County Health Care Agency and more than 50 members of their CalFresh Healthy Eating Collaborative; San Diego Health & Human Services Agency and their CalFresh Healthy Eating Collaborative; Los Angeles County Department of Public Social Services, Orange County Social Services Agency, San Diego County CalFresh Program, California WIC Association and all of the local WIC Agencies; San Diego Promise Zone, Los Angeles Promise Zone, San Diego Hunger Coalition, San Diego YMCA, City of Chula Vista, Chula Vista Community Collaborative, San Diego County Promotoras Coalition, and the San Diego County Childhood Obesity Initiative. With the help of our community partners, from June of 2021 through January 2023 a total of 10,125 new participants enrolled through this present funding mechanism. Of these, approximately 7,400 were enrolled as a result of a large-scale recruitment campaign undertaken in October-December of 2022. In addition to the original FINI grant participants (n=5,579), this brought the total Más Fresco! program participation to 15,704 SNAP recipients, where it remains as of 2024. The randomization to study groups was evenly distributed across the 10,125 participants who enrolled during this Expansion phase of the Mas Fresco program; 49% (4,972) of the new enrollees were randomized to the $1:$2 group, and 5,153 were randomized to the $1:$4 group. All of the 5,579 participants brought over from the original version of the program were added to the $1:$4 group. Of the 10,125 participants who enrolled during the Expansion phase of the Mas Fresco program, 4,819 responded to a brief demographic survey at the end of the online enrollment process, and a randomly selected subset of 785 completed a detailed baseline evaluation survey within one month of enrollment. Most of the 4,819 participants who completed the brief demographic survey were from San Diego (46%) or Los Angeles (41%) counties, with just 9% from Orange County and less than 1% from Riverside County. The mean age was 42.5 years (SD 14.2), most (82%) were female, and two-thirds (68%) were Hispanic/Latino. Smaller proportions were non-Hispanic white (13%), Black/African-American (6%), Asian (7%), or other/unknown (6%). Among Hispanic/Latino participants, 86% were of Mexican origin. Most participants (80%) completed the enrollment form in English, while 20% completed the form in Spanish. One-third were married or living with a partner, and 84% reported having children in the household. Three-quarters (77%) of participants had a high school diploma or higher educational attainment, and 33% reported that they were working full- or part-time. On average, participants received $358 per month (SD $258) in SNAP benefits. Using the 6-item USDA Food Security Screener (n=4,305 participants with no missing data), 23% had high food security (or marginal insecurity), 35% had low food security, and 41% had very low food security. Among the 785 participants who completed the detailed baseline survey, fruit and vegetable intake was estimated to be 2.8 cup equivalents per day. The greatest barrier to eating more fruits and vegetables was cost, with 54% of participants agreeing or strongly agreeing with the statement "I don't eat fruits and vegetables as much as I like to because they cost too much." Only half (51%) agreed that the fruits and vegetables available in their community were of high quality, and two-thirds (63%) agreed that a large selection of fruits and vegetables were available in their community. Food Security rates for the baseline survey group (n=763) were 27% high food security, 32% low food security, and 41% very low food security. We noted a shift in our demographic profile between when we were conducting in-person enrollments during the previous version of this project (FINI Award #2016-70025-25247) (i.e., before COVID) and when we shifted to online enrollment, which began in April 2020. To illustrate this difference in demographic profile, we compared some of the demographic data reported above with those of participants enrolled in-person by promotoras between 2017 and 2019 (n=3290) (Rhee,et al., 2024; under review). Nearly 1/3 of the previous cohort was from Orange County (vs. 9% in the present cohort), 90% were female (vs. 82% presently), 91% were Hispanic/Latino (vs. 68% presently), and 75% were primarily Spanish speaking (vs. 20% presently). Only 38% had graduated high school (vs. 77% presently). One of the most concerning trends is that it seemed like we were no longer reaching as many Spanish monolingual and low educational attainment participants. To address this, in late 2022 as part of a large scale recruitment effort, we enlisted the support of the Comité Organizador Latino de City Heights (COLCH), a local promotora group in San Diego county who conducted a series of in-store outreach and recruitment events. COLCH promotoras directly enrolled 719 participants and provided information that led to self-enrollment for an additional 282 participants; although educational attainment data weren't available for many of these participants, 81% were Spanish monolingual, which meant that our efforts to address this gap in our demographic recruitment profile were successful. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided?The transition from an in-store enrollment program to an online enrollment program has afforded us the opportunity to benefit from online access and utilization training and professional development. Key opportunities include securing a $10,000 COVID-19 Rapid Response Grant to assess the online access and utilization capabilities and competencies of our ¡Más Fresco! members and a $50,000 grant to build out our online access and utilization capabilities, including our social media competencies. Part of the funds from our COVID-19 Rapid Response Grant went towards professional development for our program manager to attend a training course on digital marketing. The learning objectives from the training course included: learning the importance of a strong online presence and how it is achieved through strategic digital marketing practices; learning the core digital marketing channels; understanding how to evaluate the performance of each marketing channel; and understanding how to interpret web analytics data and identifying key takeaways. These grants and the subsequent trainings and work that we have conducted around digital access and utilization have allowed us to build our teams internal capacity to understand the digital access and utilization needs of our ¡Más Fresco! Members and how best to address and meet these needs moving forward. Furthermore, based on the success of ¡Más Fresco!, San Diego County Health and Human Services provided funding for a social media campaign to expand the reach and impact of ¡Más Fresco! among underserved San Diego community members, focusing on community members in Mid City and Southeast San Diego. Our subsequent collaboration with Blueprint Interactive on the development and implementation of a social media campaign, including geofencing and other strategies to achieve enrollment in specific undeserved communities in San Diego County provides the ¡Más Fresco! team with keen insights into the development and implementation of a highly focused and targeted social media campaign. How have the results been disseminated to communities of interest?We continue to work very closely with a broad-based coalition of health care system and food system partners across Southern California. This work includes the ongoing dissemination of program information with all of our community partners. Dissemination channels have included in-person and Zoom meetings and presentations. Furthermore, we have developed a number of interactive promotional materials and social media campaigns for both community members and community partners. This work is part of our overall food-system and health system alliance to better support and enhance the health and well-being of the community members that we serve. As noted, key dissemination channels include social media, in-person and virtual meetings and presentations, as well as outreach via our promotora (community health worker) and other networks. Thispast year, Ms. Hiller-Venegas, our data and evaluation manager, also presented the ¡Más Fresco! program on June 26th 2024 at the inaugural "Community Health Stakeholder Forum" hosted by the UC San Diego Health Department of Health Justice, Equity, Diversity, and Inclusion (JEDI). What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
The Más Fresco! More Fresh program is a highly successful nutrition incentive program that has allocated over $3 million in nutrition incentives to more than 15,000 SNAP households across Southern California. In addition to achieving the program's key goals and objectives, as outlined below, the Más Fresco! More Fresh program has been very successful at securing sustained funding at the state and local levels for other nutrition incentive programs, including the leveraging of millions of dollars of funding by the California Department of Social Services,San Diego County, and the American Heart Associationfor these initiatives. This sustained funding comes as a direct result of the success and recognition of the Más Fresco! More program. 1.Develop, implement, and evaluate an integrated next generation cloud-based POS benefit redemption system and online enrollment program. To enable the opportunity for SNAP recipients across Southern California to earn and redeem nutrition incentives at all 43 Northgate Gonzalez Markets across Southern California, Northgate Gonzalez Market, working in collaboration with UC San Diego, NCR, and other technology providers developed and implemented a new cloud-based POS system. The new NCR Emerald POS system was implemented on June 1, 2021 at the original 6 Northgate Gonzalez Markets and then expanded to all Northgate markets by the end of December 2021. This new system has enabled us to provide a much better financial incentive earn-and-redeem experience for Más Fresco! Program participants, with far fewer issues being experienced at check-out when earning and redeeming nutrition incentives. This enhanced point-of-sale system and technologies has contributed to increased program utilization by the program participants, resulting in both increased nutrition incentive earning and redemption. Furthermore, this new POS system includes an Automated Protocol Interface (API) between UCSD's ¡Más Fresco! More Fresh enrollment portal and Northgate's new NCR Emerald POS System. In order to facilitate the online enrollment process, UCSD developed a new website (www.masfresco.org) and online enrollment portal. Once a new ¡Más Fresco! member enrolled online at www.masfresco.org their enrollment information, including their ¡Más Fresco! loyalty card number, phone number and other information, was automatically sent to Northgate's POS system, via the API that Northgate and UCSD developed and implemented for the ¡Más Fresco! More Fresh Program participants. Since this was a real-time, cloud-based system, once the ¡Más Fresco! members enrolled online, they were able to immediately start earning and redeeming their financial incentives. This could be done by providing their phone number to the cashier, or by providing their Más Fresco! loyalty card to the cashier. From 2021 to 2023 we also significantly expanded our ¡Más Fresco! More Fresh social media presence on Facebook, Instagram, and YouTube. In 2021 the ¡Más Fresco! Program received funding from the San Diego County Health & Human Services Agency to conduct a social media campaign to expand the reach and impact of ¡Más Fresco! among underserved San Diego community members, focusing on community members in Mid City and Southeast San Diego. This social media outreach campaign contributed to 913 new San Diego County enrollments representing a 56% increase in San Diego County program membership since the inception of the social media campaign. As intended, the majority of these enrollments were community members residing in Mid City and Southeast San Diego. Of the 913 new enrollees, 73% (n=664) lived in either Mid City or Southeast San Diego, and 33% (n=304) lived in the San Diego Promise Zone, one of our most underserved communities in our region. Late 2022 and early 2023 we initiated an extensive enrollment campaign in partnership with regional CalFresh offices. This campaign employed various channels including a text messaging campaign, social media posts, news media coverage, and in-store events by the promotora group COLCH, effectively reaching tens of thousands of potential participants. Consequently, we successfully enrolled 7,400new participants. This surge in enrollment led to a notable increase in monthly redemption of nutrition incentives, peaking at over $150,000 per month, and stabilizing around $110,000 per month. This significant uptake not only indicates the program's acceptance but also reflects its direct impact on improving nutritional access for our community members. 2.Assess the impact of different financial incentive multipliers (doses) (2:1 ratio and 4:1 ratio). All participants who were enrolled in the previous version of the program and transferred to the new program were placed into the $4 to $1 multiplier group. Participants enrolled after June 1, 2021 were randomly assigned to either the $2 or the $4 multiplier group. Between June 2021 and August 31, 2024, participants redeemed a total of $3.4 million in fruit and vegetable incentives. In total, new enrollees in the $4 to $1 multiplier group redeemed $1.391 million, more than two times as much as the $2 to $1 group, who redeemed $661,000 total. Participants who were rolled over from the previous version of the project redeemed $1.311 million during this timeframe, in addition to the $515,000 they redeemed from 2017-2021. Importantly, in the original FINI program (study groups with a $10/$20/$40 cap per month using a $1:$1 earn/redeem ratio), participants redeemed an average of just $9, $13, or $18 per month, respectively (Rhee et al., 2024; under review). In this funding period, the higher $100 per month cap and multiplier earn and redeem ratios increased monthly redemption to much higher levels. In December 2021 the mean monthly incentive redeemed per active participant was $35 ($26 for the 1:4 group, $24 for the 1:2 group, and $37 for legacy participants), and as of August 2024 it was $58 ($65 for the 1:4 group, $45 for the 1:2 group, and $59 for legacy participants). At the end of the previous phase of the program in 2021 we did not detect any meaningful difference in the percent of total purchase amount used for eligible fresh fruits and vegetables across the 3 study groups (all groups ~30-35%). Preliminary analyses suggest that this proportion grew in the 2nd phase of the program to approximately 50% of each overall purchase amount being dedicated to fresh fruits and vegetables. Outcomes: Fruit and Vegetable Consumption In preliminary analyses,adjusting for time,participants who had redeemed $100-$299 consumed 0.34 more daily cup equivalents (DCE) of fruits and vegetables than those who did not redeem any incentives(p<0.001, specifically the DSQ "predicted intake of fruits and vegetables including legumes and French fries"). Those whoredeemed $300 or more consumed0.36 DCE more than those who did not redeem any incentives(p<0.001). This translates to an estimated 2.6 DCE for those who redeemed $0 incentives, 2.9 DCE for those who redeemed $100-$299, and 3.0 DCE for those who redeemed $300 or more. This analysis included 508 participants who used their card at least once before they completed the six-month survey; those who used their card only once (n=100) only earned incentiveand did not redeem any. These findings should be considered preliminary and are subject to change; final findings will be published in peer-reviewed journals. In comparison, our recent study of the previous program version found a more modest but still significant improvement of 0.18 more DCE among participants in the $40/month group at 12 months after enrollment compared to the $10/month group (p<0.05, Rhee et al, 2024; under review).
Publications
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2021
Citation:
Community Health Workers and Promotoras as Nutrition Educators for USDAs Gus Schumacher Nutrition Incentive Programs (GusNIP), Society for Nutrition Education and Behavior
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2021
Citation:
Mas Fresco More Fresh Nutrition Incentive Program, National Grocers Association Conference
- Type:
Other
Status:
Published
Year Published:
2021
Citation:
Nutrition Incentive Program, KCRW media story
- Type:
Peer Reviewed Journal Articles
Status:
Published
Year Published:
2022
Citation:
Scott, V. P., Hiller-Venegas, S., Edra, K., Prickitt, J., Esquivel, Y., Melendrez, B., & Rhee, K. E. (2022). Factors associated with COVID-19 vaccine intent among Latino SNAP participants in Southern California. BMC public health, 22(1), 1-13.
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Progress 09/15/22 to 09/14/23
Outputs
Target Audience:During the reporting period from 9/15/22 to 9/14/23, we gained approximately 8,097 new enrollees, resulting in a total of 10,161 participants enrolled under the present grant. This large increase in enrollees was the result of an intentional enrollment campaign that took place in October/November of 2022. Our target audience continues to include 5,573 participants enrolled during our previous FINI grant who were automatically rolled over into the present grant, for a grand total of 15,734 participants as of September 2023. More generally, the ¡Más Fresco! More Fresh Program has a number of target audiences. First and foremost are SNAP recipients who live within approximately five miles of a Northgate Gonzalez Markets and receive SNAP benefits. SNAP recipients include Latino and African American community members residing in underserved communities throughout Southern CA, including Mid-City and Southeast San Diego, the San Diego Promise Zone, and the Los Angeles Promise Zone. Additional target audiences include ethnic community-based organizations that support the health and well-being of low-income community members where ¡Más Fresco! More Fresh financial incentives are made available. Changes/Problems:The key challenges this year were managing the large influx of new particpants in October/November 2022 and working with Northgate to accommodate their shift in data management systems within their organization. To address the former challenge, we partnered with South Bay Community Services to help handle the volume of calls to our "helpdesk." As previously mentioned, COLCH promotoras also continued to provide support to the participants they had enrolled in an in-person enrollment event and helped them learn how to use the program effectively. To address the latter challenge, our evaluation and data mananger, Sarah Hiller-Venegas, and our Program Manager, Kate Edra, worked closely with IT staff at Northgate to innovate solutions for our participant enrollment system and our monthly POS data reports. What opportunities for training and professional development has the project provided?We conducted our train-the-trainer event in late September 2022 to train promotora leaders with our partner, COLCH, to help support in-person enrollment events in October and November of 2022. We also conducted training meetings with South Bay Community Services so that they could assist with participant support by phone and email. Over the course of several months, our data and evaluation manager, Sarah Hiller-Venegas, and our Program Manager, Kate Edra, had the opportunity to shadow/be mentored by elite information technology staff at Northgate Gonzalez Market, primarily Revathy Venkatasamy, to innovate solutions to updating our online enrollment form and monthly POS data reports in light of Northgate's change in data management systems. How have the results been disseminated to communities of interest?Dr. Rhee provided updates on the ¡Más Fresco! program to USDA on October 19, 2022. She also presented the program to the NTAE in June 2023. What do you plan to do during the next reporting period to accomplish the goals?In our no-cost extension, we plan to continue implementing the program and maintaining at least $120,000 of monthly redeemed incentives across Southern California. We also plan to conduct data analysis and produce reports/manuscripts.
Impacts
What was accomplished under these goals?
Program Expansion and Outreach: During Fiscal Year 2023, the ¡Más Fresco! More Fresh Program experienced remarkable growth and outreach. Following our expansion to all 43 Northgate Gonzalez Markets across Southern California, we initiated an extensive enrollment campaign in partnership with regional CalFresh offices in October/November 2023. This campaign employed various channels including a text messaging campaign, social media posts, news media coverage, and in-store events by the promotora group COLCH, effectively reaching tens of thousands of potential participants. Consequently, we successfully enrolled 8,267 new participants. Impact on Nutrition Access: This surge in enrollment led to a notable increase in monthly redemption of nutrition incentives, peaking at over $150,000 per month, and stabilizing around $120,000 per month. This significant uptake not only indicates the program's acceptance but also reflects its direct impact on improving nutritional access for our community members. Digital Literacy and Participant Support: Despite a shift to predominantly online enrollment, our partnership with COLCH was instrumental in bridging the digital literacy gap among Northgate shoppers. This approach ensured that even those with limited digital or general literacy skills could enroll and benefit from our program. Furthermore, the collaboration with South Bay Community Services (SBCS) enhanced our customer service capacity, assisting new participants with inquiries and technical difficulties. Technical Adaptation and Problem-Solving: Both SBCS and COLCH have been vital in relaying participant-reported technical issues to the UCSD ¡Más Fresco! team. This feedback loop has enabled us to identify and address real-time technical issues within the point-of-sales system, ensuring smooth program operation and participant satisfaction. Data Management and Analysis: Our cooperative efforts with Northgate to integrate their new global data management system has been pivotal in data sharing and analysis. This collaboration has allowed us to monitor the health of the program and achieve our research objectives effectively. Program Evaluation Accomplishments: From 9/15/22 to 9/14/23, we completed substantial survey data collection, accumulating 788 baseline surveys and 522 follow-up surveys. Analysis of point-of-sale (POS) data for our 15,734 enrollees revealed insightful usage patterns, indicating a monthly incentive redemption average of $55 for the 1:4 group new enrollees and $38 for the 1:2 group new enrollees. User Feedback and Testimonials: We have received numerous positive testimonials from participants, which highlight the program's impact on their lives. These stories not only underscore the success of our initiatives but also inspire our team to continue improving and expanding our services. Challenges and Lessons Learned: The year also brought its share of challenges, particularly in adapting to the new digital enrollment process and managing increased participant numbers. These experiences have been invaluable in learning how to better tailor our services to meet diverse needs and handle large-scale operations efficiently. Looking Ahead: As we prepare for the upcoming year, our focus will be on finalizing reports and analyses using the extensive survey and POS data collected. These insights will guide our future strategies and help us continue making a meaningful impact on community nutrition.
Publications
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Progress 09/15/21 to 09/14/22
Outputs
Target Audience:During the reporting period from 9/15/21 to 9/14/22, we gained approximately 1,496 new enrollees, adding to the 654 enrolled between 6/1/21 and 9/14/21 for a total of 2,150 participants enrolled under the present grant. Our target audience also includes 6,022 participants enrolled during our previous FINI grant who were automatically rolled over into the present grant, for a grand total of 8,172 participants as of September 2022. More generally, the ¡Más Fresco! More Fresh Program has a number of target audiences. First and foremost are SNAP recipients who live within approximately five miles of the Northgate Gonzalez Markets and provide Más Fresco! More Fresh financial incentives. SNAP recipients include African American and Latino community members residing in underserved communities, including, but not limited to Mid-City and Southeast San Diego, as well as the San Diego Promise Zone and the Los Angeles Promise Zone. Additional target audiences include ethnic community-based organizations that support the health and well-being of low-income community members where ¡Más Fresco! More Fresh financial incentives are made available. Changes/Problems:The key challenge this year has been Emerald point-of-sale system technology issues that have negatively impacted the earning and redeeming of nutrition incentives by program participants. We have worked through these issues with Northgate and with our program participants and are now at a place where the earn and redeem issues have been resolved. What opportunities for training and professional development has the project provided?We have conducted periodic trainings with our partners to support awareness and knowledge about the ¡Más Fresco! program. We are also planning a train-the-trainer event in late September 2022 to train promotora leaders with our partner, COLCH, to help support in-person enrollment events in October and November of 2022. We also have two student volunteerswho receive training and experience supporting the ¡Más Fresco! program; one student is focused more on conducting outreach and programmatic support, while the other student is more focused on monitoring & evaluation, data management, analysis, and the dissemination of findings. How have the results been disseminated to communities of interest?We have developed various marketing and outreach materials, including ¡Más Fresco! promotional and outreach materials for underserved community members as well as ¡Más Fresco! informational materials to share with our community partners, elected officials and other stakeholders. We continue to work very closely with a broad-based coalition of community-based organizations, health care system and food system partners across Southern California, including local farmers. This work is part of our overall food-system and health system alliance to better support and enhance the health and well-being of the community partners that we collectively serve. Dissemination channels include social media, in-person virtual meetings and presentations, as well as outreach via our promotora (community health worker) and other networks. What do you plan to do during the next reporting period to accomplish the goals?Now that we have expanded our program from our existing six Northgate Gonzalez Markets to all 42 Northgate Gonzalez Markets across Southern California and have made the necessary modifications to the point of sale system to ensure a good user experience, we are now ready to fully promote the Más Fresco! program across Southern California. We are currently planning a a comprehensive Más Fresco! social media campaign, including media events in collaboration with Northgate, elected officials, county health departments, social services agencies and others to reach as many CalFresh recipients as possible across Southern California. We also plan to conduct a text messaging campaign with San Diego County Social Servies to reach out to San Diego County CalFresh recipients regarding the opportunity to enroll in the ¡Más Fresco! Program. The goal of this outreach is to increase total program participation from approximately 7,000 ¡Más Fresco! Program participants to 14,000 participants and to increase the monthly ¡Más Fresco! nutrition incentive redemptions from approximately $50,000 a month to $100,000 a month.
Impacts
What was accomplished under these goals?
The ¡Más Fresco! More Fresh Program has achieved significant success during Fiscal Year 2022. During this time we have expanded the Más Fresco! Program from our six original Northgate Gonzalez markets to all 42 Northgate Gonzalez Markets across Southern California. This expansion has resulted in a significant increase in the number of program participants (1,496 new enrollees during the reporting period; see "Target Audience" section for more detail), along with a significant increase in the monthly redemption of nutrition incentives, to over $45,000 a month. We have also achieved significant success in terms of the Northgate Gonzalez Market point-of-sale system technologies. During Fiscal Year 2022, Northgate Gonzalez Market has made, and continues to make, significant modifications and ultimately advances in the financial incentive point of sale systems and technologies. These modifications and advances have enabled us to provide a much better financial incentive earn-and-redeem experience for the Más Fresco! Program participants, with far fewer issues being experienced at check-out in terms of both the earning and redemption of the nutrition incentives. This enhanced point-of-sale system and technologies has contributed to increased program utilization by the program participants, resulting in both increased nutrition incentive earning and redemption. Along with the enhanced and improved point of sale system technologies, the UC San Diego team has also made significant advances in the development and utilization of our online enrollment platform, www.masfresco.org, along with significant advances in our Application Programming Interface (API) with and between Northgate and UC San Diego. It is thanks to the dedicated and innovative work of the UC San Diego team and the Northgate Gonzalez Market IT team that we have such a seamless interface between UC San Diego and Northgate Gonzalez Market. This seamless interface enables CalFresh recipients to easily enroll online in Mas Fresco and for their enrollment information to instantaneously be uploaded to the Northgate Gonzalez Market point-of-sale system which then enables Más Fresco! program participants to be recognized by the Northgate Gonzalez Market point-of-sale system when they purchase fresh fruits and vegetables with their CalFresh benefits. It is these systems which will now enable us to easily expand the Más Fresco! program to many more CalFresh recipients across Southern California and simultaneously significantly increase the redemptions of nutrition incentives. As noted in our grant proposal, sustainability is a key goal for Más Fresco! During Fiscal Year 2022, we achieved significant success in terms of Más Fresco! program sustainability. Based on the success of the Más Fresco! program, and our sharing of our program success with our community partners across Southern California, we were approached by the American Heart Association to request American Rescue Plan Act (ARPA) funding from the San Diego County Board of Supervisors to address pandemic-drive food insecurity. Together, with the American Heart Association, local farmers, and local health care providers, and local retailers, we submitted a $3 million, three-year food security proposal to the San Diego County Board of Supervisors to expand the Más Fresco! program beyond CalFresh recipients to include underserved community members experiencing health disparities, including food insecurity. In January of 2022, we were awarded $3 million to expand the reach of the existing Más Fresco! program to include underserved community members experiencing health disparities and to expand the availability of nutrition incentives, beyond the eight Northgate Gonzalez Markets in San Diego County. In May of 2022 we launched the Más Fresco! Plus program. This program provides underserved San Diego County community members, who are experiencing health disparities, with either a home-delivered box of farm-fresh produce from a local San Diego County farm twice a month for 12-months ($50 monthly value) or provides them with a healthy food card that can be used at 124 grocery stores across San Diego County to purchase $50 of healthy foods, including fruits and vegetables, for 12-months. This program consists of three cohorts of 844 households per year, for three years. Program Evaluation Accomplishments During the reporting period from 9/15/21 to 9/14/22, we collected 21 new baseline surveys, for a grand total of 136 baseline surveys as of September 2022. We also collected 42 6-month surveys to date. As survey data collection is staggered due to rolling enrollment, there are a number of participants who completed baseline surveys who are not yet eligible to complete follow up surveys, but will be invited in the coming year. Analyses of point-of-sale (POS) data for our 8,172 enrollees revealed that on average about 14% of participants use their card in a given month overall, with ~25% of new enrollees (i.e., since June 2021) in the 1:4 group using their card , 18% of new enrollees in the 1:2 group using their cards, and 11% of legacy participants (i.e., those enrolled during the FINI grant, all of whom were automatically put into the 1:4 group) using their card in a given month. For these same groups, we observed the following breakdown in mean incentive redeemed per active participant as of September 2022: 1:4 Group New Enrollees: $52 per month 1:2 Group New Enrollees: $34 per month 1:4 Group Legacy Enrollees: $52 per month
Publications
- Type:
Journal Articles
Status:
Published
Year Published:
2022
Citation:
Scott, V. P., Hiller-Venegas, S., Edra, K., Prickitt, J., Esquivel, Y., Melendrez, B., & Rhee, K. E. (2022). Factors associated with COVID-19 vaccine intent among Latino SNAP participants in Southern California. BMC public health, 22(1), 1-13.
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Progress 09/15/20 to 09/14/21
Outputs
Target Audience:The ¡Más Fresco! More Fresh Program has a number of target audiences. First and foremost are SNAP recipients who live within approximately five miles of the Northgate Gonzalez Markets and provide Más Fresco! More Fresh financial incentives. SNAP recipients include African American and Latino community members residing in underserved communities, including, but not limited to Mid-City and Southeast San Diego, as well as the San Diego Promise Zone and the Los Angeles Promise Zone. Additional target audiences include ethnic community-based organizations that support the health and well-being of low-income community members where ¡Más Fresco! More Fresh financial incentives are made available. Changes/Problems:The key challenge this year continues to be delays in program implementation as a result of the COVID-19 pandemic. The pandemic has continued to strain and disrupt Northgate Gonzalez Market in the development and implementation of their new NCR Emerald point-of-sale (POS) system. This disruption has subsequently delayed the expansion of the ¡Más Fresco! More Fresh Program to all Northgate Gonzalez Markets. Also, although the new NCR Emerald POS-system has now been deployed at all Northgate Gonzalez Markets, the subsequent testing and trouble-shooting of the new system, including nutrition incentive earn and redeem issues has not enabled the expansion of the ¡Más Fresco! Program beyond our original six markets. Since June 2021, we have encountered a number of earn and redeem issues with the new Emerald POS system. As of November 2021, the earn and redeem issues with the new Emerald POS system have been resolved and we are in the process of expanding ¡Más Fresco! beyond the original 6 Northgate Markets to all 42 Northgate Gonzalez Markets across Southern California. In regard to program evaluation, we have noted that while the e-gift cards are a convenient way to distribute survey stipends, some of our participants who have limited digital literacy or English language skills have had difficulties in understanding how to choose and redeem their e-gift card. We are looking into other solutions that are more user-friendly and available in more languages. In the meantime, we may limit the choice of gift cards to just the Northgate gift card. What opportunities for training and professional development has the project provided?Since last year we have secured significant social media outreach training and professional development. This has enabled us to expand our program presence on a number of social media platforms and has positioned us to fully leverage social media promotion as we expand the program for 6 Northgate Gonzalez Markets to all 42 Northgate Gonzalez Markets across southern California. How have the results been disseminated to communities of interest?We continue to work very closely with a broad-based coalition of health care system and food system partners across Southern California. This work includes the ongoing dissemination of program information with all of our community partners. Dissemination channels have included in-person meetings and presentations (pre-COVID) and Zoom meetings, and presentations (post-COVID). Furthermore, we have developed a number of interactive promotional materials that we have shared with community partners, awaiting distribution to community members once we begin the expansion of ¡Más Fresco! to additional Northgate Markets. What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period we plan to expand our program from our existing six Northgate Gonzalez Markets to all 42 Northgate Gonzalez Markets across Southern California. As such, for the next reporting period we aim to work closely with our community partners to conduct ongoing social media and other outreach campaigns and programs to promote our new www.masfresco.org online enrollment platform as well as provide significant program utilization support to our new program participants via Teletask and other outreach capabilities that we will continue to develop, enhance and refine for our program participants. With the expansion of the program, we will also secure the services and support of a fulfillment company to mail out welcome letters and ¡Más Fresco! loyalty cards to the growing number of new program participants we enroll each week.
Impacts
What was accomplished under these goals?
What was accomplished under these goals? Due to the coronavirus pandemic, the development and implementation of Northgate's new point-of-sale (POS) system to support the expansion of the ¡Más Fresco! More Fresh Program from 6 participating Northgate Gonzalez Markets to all Northgate locations across Southern California was delayed. However, starting June 1, 2021, the ¡Más Fresco! Program implemented the new GusNIP incentive model at our existing 6 Northgate Gonzalez Markets. This model randomizes program participants to receive either $2 or $4 for every SNAP benefit dollar spent of qualifying fresh fruits and vegetables, up to $100 a month. !Más Fresco! More Fresh Financial Incentive System To give SNAP recipients across Southern California the opportunity to earn and redeem nutrition incentives at all 42 Northgate locations across Southern California, Northgate Gonzalez Market, in conjunction with NCR and other technology providers has completed the necessary system changes to their current POS system (NCR ISS 45) and has successfully migrated all of their stores to the new NCR Emerald POS System. As noted previously, as of June 1, 2021, the ¡Más Fresco! More Fresh Program is currently utilizing the new NCR Emerald POS System at the original six Northgate Markets. Since its implementation, Northgate Gonzalez Market, in collaboration with NCR and their other technology partners, has been testing and trouble-shooting a number of technology related issues with this new POS system that have impacted the earning and redeeming of nutrition incentives by ¡Más Fresco! program participants at the original 6 Northgate Gonzalez Markets. This ongoing testing and trouble-shooting of nutrition incentive earn and redeem issues has delayed the expansion of the GusNIP program beyond the original 6 Northgate Markets. As of November 2021, the earn and redeem issue have been resolved and we have started expanding the ¡Más Fresco! Program to all Northgate Markets. We anticipate that the ¡Más Fresco! Program will be available at all 42 Northgate Gonzalez Markets by December 2021. Program Outreach and Utilization As part of our online enrollment system, the ¡Más Fresco! Program team developed a new website, which links to our updated enrollment form customized to the new program structure and the expansion to more stores. Enrollment in GusNIP began June 1, 2021, and our new website supported the expansion of the program to approximately 5,999 SNAP households across Southern California, which includes 5,478 households from the previous version of the program who were transferred to the new program by June 1, 2021 and an additional 521 new participants who were enrolled between June 1 and Sep. 15, 2021. As noted in our previous annual report, it was our intent during FY 2021 to further develop our social media outreach capabilities. During FY 2021, this included the further buildout of our ¡Más Fresco! More Fresh social media presence on Facebook, Instagram, and YouTube. Furthermore, in 2021 the ¡Más Fresco! Program received funding from the San Diego County Health & Human Services Agency to conduct a social media campaign to expand the reach and impact of ¡Más Fresco! among underserved San Diego community members, focusing on community members in Mid City and Southeast San Diego. This social media outreach campaign ran from April 26th, 2021 to June 30, 2021. During this period the campaign's ads were viewed 3,343,256 times and managed to receive 22,754 clicks. Furthermore, the social media campaign contributed to 913 new San Diego County enrollments (including 437 GusNIP enrollments), in the ¡Más Fresco! More Fresh Program. This represents a 56% increase in San Diego County program membership since the inception of the social media campaign. As intended, the majority of these enrollments were community members residing in Mid City and Southeast San Diego. Of the 913 new enrollees, 73% (n=664) reside in either Mid City or Southeast San Diego, and 33% (n=304) of them reside in the San Diego Promise Zone, one of our most underserved communities. Program Evaluation We continue to receive point-of-sale transaction data from Northgate and have transitioned this process as well to accommodate Northgate's new point-of-sale system. After troubleshooting various issues, we now receive the same key data that we received previously. All participants who were enrolled in the previous version of the program and transferred to the new program were placed into the $4 multiplier group. New enrollees since June 1st 2021 have been randomly assigned to either the $2 (n=250) or the $4 (n=271) multiplier group. From June 1, 2021, to September 15, 2021, participants redeemed $106,664.50. Of this amount 28% of redemptions were from newly enrolled participants ($29,879.15) and 72% of redemptions ($76,785.35) were redeemed by participants who were automatically transferred from the previous program. Further analysis of the point-of-sale transaction data is underway to understand how participants are engaging with the program and utilizing the multiplier incentive structure. We collected 66 baseline surveys from new participants between August 24 and September 6, 2021. A total of 137 participants were invited to take the survey online via email or text message. This included participants who (1) agreed to participate in surveys and (2) enrolled in the previous month (July 24-August 24) or were randomly selected from participants who had enrolled from June 1-July 23 but had not yet used their Mi Familia cards. The email invitation response rate was 67%, and the text message invite response rate was 59%. Of the respondents (n=66), 26% demonstrated very low food security in the past 30 days, 42% had low food security, and 32% had high food security, based on the USDA 6-item measure. Respondents' median number of daily fruit and vegetable servings was calculated to be 3.4 based on the 10-item fruit and vegetable screener. We developed our own measure that mimicked the fruit and vegetable screener to assess how much of participants' and their children's fruit and vegetable consumption was from fresh, frozen, canned, or dried produce. Based on adults self-reported median servings of vegetables per day, 57% was fresh, 16% was frozen, 9% was canned vegetables, 9% was dried vegetables, 4% was canned beans, and 4% was dried beans. For fruits, 72% of adults' median daily servings was fresh fruits, 12% was frozen, 12% was dried, and 5% was canned fruit. For children, 70% of their daily servings of vegetables were fresh, 12% were frozen, and about 5% each were from canned beans, dried beans, canned vegetables, and dried vegetables. Children's daily fruit servings were 87% fresh and about 4-5% each of frozen, canned, and dried fruit. Survey stipends in the form of $20 gift cards were distributed; 51 (77%) chose to receive an e-gift card via email to a variety of stores (via TangoCard Rewards Genius platform), and 15 (23%) chose to receive a Northgate Markets gift card delivered by mail. We hope to collect another round of baseline surveys in early 2022, after the program has been rolled out to all Northgate stores, and will aim to collect follow up surveys at 6 and 12 months after the baseline is completed. Follow up surveys will be limited to participants who have earned or redeemed any incentives.
Publications
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2021
Citation:
Community Health Workers and Promotoras as Nutrition Educators for USDAs Gus Schumacher Nutrition Incentive Programs (GusNIP), Society for Nutrition Education and Behavior
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2021
Citation:
Mas Fresco More Fresh Nutrition Incentive Program, National Grocers association Conference
- Type:
Other
Status:
Published
Year Published:
2021
Citation:
Nutrition Incentive Program, KCRW media story
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Progress 09/15/19 to 09/14/20
Outputs
Target Audience:The ¡Más Fresco! More Fresh Program has a number of target audiences. First and foremost are the CalFresh recipients who live within approximately 5 miles of each Northgate Gonzalez Market that provides the ¡Más Fresco! More Fresh financial incentives to CalFresh recipients when they purchase fresh fruits and vegetables with their CalFresh benefits at participating Northgate Gonzalez Markets. Additional target audiences include the community-based organizations that support the health and well-being of low-income community members, including CalFresh recipients, in the communities surrounding the participating Northgate Gonzalez Markets. Finally, media outlets and community based organizations, including social media, are used to help disseminate information to CalFresh participants in the surrounding areas. Due to the coronavirus pandemic, the development and implementation of Northgate's new point-of-sale (POS) system to support the expansion of the ¡Más Fresco! More Fresh Program from 6 participating Northgate Gonzalez Markets to all 41 Northgate Gonzalez Markets across Southern California has been delayed. Nevertheless, we are still able to distribute nutrition incentives under our previous ¡Más Fresco! grant (up to $40 a month with a 1:1 multiplier) in the 6 participating Northgate Gonzalez Markets. While we have not yet reached out to CalFresh recipients directly regarding the opportunity to enroll in the ¡Más Fresco! More Fresh Program to receive up to $100 a month in financial incentives, we have reached out to numerous community-based organizations across California to prepare for when the $100 a month in financial incentives becomes available. This outreach has included over 20 in-person and virtual meetings, in English and Spanish, with hundreds of SNAP-Ed members and the sharing of ¡Más Fresco! More Fresh outreach materials with: Los Angeles County Public Health Department and over 100 members of their CalFresh Healthy Eating Collaborative; Orange County Health Care Agency and more than 50 members of their CalFresh Healthy Eating Collaborative; San Diego Health & Human Services Agency and their CalFresh Healthy Eating Collaborative; Los Angeles County Department of Public Social Services, Orange County Social Services Agency, San Diego County CalFresh Program, California WIC Association and all of the local WIC Agencies; San Diego Promise Zone, Los Angeles Promise Zone, San Diego Hunger Coalition, San Diego YMCA, City of Chula Vista, Chula Vista Community Collaborative, San Diego County Promotoras Coalition, and the San Diego County Childhood Obesity Initiative. Changes/Problems:The key challenge this year is the COVID-19 pandemic. The pandemic has resulted in a significant strain on and disruption of services for our retail partner, Northgate Gonzalez Market. Starting in March of 2020, Northgate's IT and POS system staff were significantly impacted by a re-allocation of personnel and resources to address COVID-19 for their customers and staff. This reallocation of personnel and resources has continued from March of 2020 to the present, resulting in a significant delay in the implementation of the new NCR Emerald POS system and the expansion of the ¡Más Fresco! More Fresh Program. While we had anticipated that the development of the new point-of -sale system and technologies would take approximately 12-month to develop and validate, we are now looking at a development and validation timeframe of possibly up to 18-months due to the continuing impact of COVID-19. What opportunities for training and professional development has the project provided?The transition from an in-store enrollment program to an online enrollment program has afforded us the opportunity to benefit from online access and utilization training and professional development. Key opportunities include securing a $10,000 COVID-19 Rapid Response Grant to assess the online access and utilization capabilities and competencies of our current ¡Más Fresco! members and a $50,000 grant to build out our online access and utilization capabilities, including our social media competencies as we move forward with the expansion of ¡Más Fresco! across the 41 Northgate Markets. Part of the funds from our COVID-19 Rapid Response Grant went towards professional development for our program manager to attend a training course on digital marketing. The learning objectives from the training course included: learning the importance of a strong online presence and how it is achieved through strategic digital marketing practices; learning the core digital marketing channels; understanding how to evaluate the performance of each marketing channel; and understanding how to interpret web analytics data and identifying key takeaways. These grants and the subsequent trainings and work that we have conducted around digital access and utilization have allowed us to build our teams internal capacity to understand the digital access and utilization needs of our ¡Más Fresco! Members and how best to address and meet these needs moving forward. How have the results been disseminated to communities of interest?We continue to work very closely with a broad-based coalition of health care system and food system partners across Southern California. This work includes the ongoing dissemination of program information with all of our community partners. Dissemination channels have included in-person meetings and presentations (pre-COVID) and Zoom meetings and presentations (post-COVID). Furthermore, we have developed a number of interactive promotional materials that we have shared with community partners, awaiting distribution to community members once we implement ¡Más Fresco! across all Northgate Gonzalez Markets in the first quarter of 2021. What do you plan to do during the next reporting period to accomplish the goals?During this next reporting period we will be expanding the program from 4,500 SNAP households to 20,000 or more SNAP households. To accomplish this, we will be implementing our digital marketing plan to promote our online enrollment platform, which activities include: Development of a new website (www.masfresco.org) to improve and enhance the website experience with a particular emphasis on the mobile experience. Enhance our communication capacity and capabilities to increase outreach and engagement and support of SNAP recipients prior-to, during, and after they enroll in the ¡Más Fresco! More Fresh program. Development and implementation of messaging strategies to increase utilization of the ¡Más Fresco! via Teletask. Development and implementation of social media engagement plan and messaging. Development and implementation of social media and digital advertising plan. Development and implementation of specialized/innovative outreach strategies to promote inclusion among vulnerable populations who lack access to technology. Engagement of community members for solutions to promote inclusion among vulnerable populations. Development of our outreach toolkit to share with SNAP partners promoting ¡Más Fresco! to SNAP community members. Collaboration on social media calendars with SNAP partners, to include Facebook live events and cross promotions. Develop and implement community outreach plan with promotoras, community champions and resident leaders to promote ¡Más Fresco! among vulnerable populations who lack access to technology (i.e., outreach to churches and schools).
Impacts
What was accomplished under these goals?
To enable the opportunity for SNAP recipients across Southern California to earn and redeem nutrition incentives at any and all 41 Northgate stores across Southern California, Northgate Gonzalez Markets, NCR, and other technology providers are in the process of implementing the NCR Emerald cloud-based POS system in each store. To date, Northgate has completed the necessary technology system changes to their current POS system (NCR ISS 45) and is in the process of changing all of its stores to the new NCR Emerald POS System. As of November 2020, Northgate has migrated approximately 75% of their stores to NCR Emerald, and anticipates that all stores will be migrated to NCR Emerald during the first quarter of 2021. Once all stores are migrated to NCR Emerald, Northgate will then be ready to start a phased roll-out of the ¡Más Fresco! More Fresh Nutrition Incentive Program at all of its 41 stores. In addition to having successfully migrated approximately 75% of their stores to the new NCR Emerald POS system, Northgate has successfully developed and implemented a new Automated Protocol Interface (API) between UCSD's ¡Más Fresco! More Fresh enrollment portal and Northgate's new NCR Emerald POS System. In order to facilitate the online enrollment process UCSD has developed a new www.masfresco.org website and online enrollment portal. The new online enrollment process that we have developed is as follows. Once a new ¡Más Fresco! member enrolls online at www.masfresco.org, their enrollment information, including their Northgate Gonzalez Market Loyalty Card number (Mi Familia Card number), phone number and other information is automatically sent to Northgate's POS system, via the API that Northgate and UCSD have developed and implemented for the ¡Más Fresco! More Fresh Program participants. Since this is a real-time, cloud-based system, once the ¡Más Fresco! members enroll online, they are able to immediately start earning and redeeming their financial incentives. This can be done by providing their phone number to the cashier, or by providing their Mi Familia card to the cashier once they receive it in the mail. In an effort to improve our online enrollment program outreach and program utilization, with funding from the Fair Food Network and the Nutrition Incentive Hub, we implemented a two-phased project, consisting of a digital access and utilization survey administered to nearly 600 existing ¡Más Fresco! More Fresh participants followed by the development and implementation of a community-informed communication and outreach platform. Based on the information provided to us by the digital access and utilization survey, we secured the services of a telephone, text messaging and email communication platform to best support the needs of our current and future program participants. This two-way community member messaging platform utilizes Teletask automated text messaging, email and telephone services.
Publications
- Type:
Journal Articles
Status:
Published
Year Published:
2020
Citation:
Hingle, M, et al. 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; 2020
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