1. The
Role
of
Farmers’
Market
Incen5ves
on
the
Fruit
and
Vegetable
Intake
and
Food
Security
Status
of
Supplemental
Nutri5on
Assistance
Program
Par5cipants
Mateja
R.
Savoie
Roskos
Disserta5on
Defense
2016

2. Overview
§ Discuss
the
literature
related
to
the
nutri5onal
status
of
low-­‐income
Americans.
§ Describe
the
methods
and
results
of
the
three
studies
conducted.
§ Iden5fy
areas
of
further
research
related
to
farmers’
market
incen5ves.

3. Food
Insecurity
and
Fruit
&
Vegetable
Intake
§ Food
insecurity
is
the
inability
to
access
a
sufficient
quan5ty
of
safe,
affordable,
and
nutri5ous
foods.
§ Prevalence
rate
near
14%
in
the
U.S.1
§ Dietary
intake
of
food
insecure
individuals
is
less
nutri5ous
and
balanced.2
§ Diets
of
food
insecure
individuals
are
especially
low
in
fruit
and
vegetables
(F&V).3
1.
Coleman-­‐Jensen,
Gregory,
&
Singh,
2013;
2.Champagne
et
al.,
2007;
3.
Miedwald,
Holben,
&
Hall,
2012

4. Barriers
to
F&V
Intake
§ Commonly
reported
barriers
to
F&V
consump5on
among
low-­‐income
individuals
include1,2:
§ Cost
§ Access
§ Availability
§ Numerous
interven5ons
and
policies
have
been
implemented
to
reduce
these
barriers.
1.
Eikenberry
&
Smith,
2004;
2.
Wheeler
&
Chapman-­‐Novasofski,
2014

5. Farmers’
Market
Incen5ve
Programs
§ Farmers’
market
incen5ve
programs
have
been
established
to
increase
F&V
intake
and
food
security
status
of
low-­‐income
individuals.
§ Programs
include
but
are
not
limited
to:
§ WIC
Farmers’
Market
Nutri5on
Program
(WIC
FMNP)
§ Senior
Farmers’
Market
Nutri5on
Program
§ Wholesome
Waves’
Double
Value
Coupon
Program
§ Fair
Food
Networks’
Double
Up
Food
Bucks

6. Opportuni5es
for
Incen5ve
Programs
§ Food
Insecurity
Nutri5on
Incen5ve
(FINI)
§ $31.5
million
in
funding
provided
to
test
incen5ve
strategies
for
increasing
F&V
consump5on
among
SNAP
par5cipants.
§ Local,
state,
and
na5onal
organiza5ons
in
26
states
have
received
funding.
§ Evalua5on
of
these
programs
will
be
used
to
help
policymakers
determine
how
to
provide
incen5ves
to
SNAP
par5cipants.

7. Study
Objec5ves
§ Study
1
§ To
determine
the
feasibility
of
program
implementa5on
and
evalua5on
and
the
u5liza5on
of
benefits
among
farmers’
market
incen5ve
program
par5cipants.
§ Study
2
§ To
explore
the
experiences
of
SNAP
par5cipants
at
farmers’
markets
aher
receiving
farmers’
market
incen5ves.
§
Study
3
§ To
determine
if
par5cipa5on
in
a
farmers’
market
incen5ve
pilot
program
had
an
impact
on
food
security
and
F&V
intake
of
par5cipants.

8. Study
1:
Study
Design
§ Objec5ve:
To
determine
the
feasibility
of
program
implementa5on
and
evalua5on
and
the
u5liza5on
of
benefits
among
farmers’
market
incen5ve
program
par5cipants.
§ Recruited
SNAP
par5cipants
in
a
rural
county
in
Utah.
§ Par5cipants
were
stra5fied
into
5
groups:

9. Study
1:
Study
Design
§ Matching
and
non
matching
incen5ves
§ Redeemable
at
one
Utah
farmers’
market
for
8-­‐weeks
§ Incen5ve
amount
based
on
family
size
§ Matching
incen5ves
required
par5cipants
to
match
$1
in
SNAP
benefits
for
each
$1
in
incen5ves
§ Non-­‐matching
incen5ves
did
not
require
par5cipants
to
match
benefits
to
receive
incen5ves

10. Study
1:
Data
Collec5on
§ Four
data
collec5on
periods
§ Baseline
(0
weeks),
midpoint
(4
weeks),
endpoint
(8-­‐weeks)
§ 6
month
follow
up
§ Data
collected
§ Anthropometrics
§ Resonance
Raman
light
scajering
spectroscopy
§ Automated
Self-­‐Administered
24
hour
Recall
(ASA24)
§ Na5onal
Cancer
Ins5tute’s
Food
Frequency
Ques5onnaire

11. Study
1:
Analysis
§ Repeated
Measures
Mul5variate
Analysis
of
Variance
(MANOVA)
§ To
compare
mean
differences
in
F&V
intake
and
carotenoid
levels.
§ Pearson
Correla5on
Coefficient
§ To
determine
linear
rela5onship
between
carotenoid
levels
and
the
F&V
intake
through
the
FFQ
and
ASA24.
§ The
mean
financial
resources
spent
at
the
farmers’
market
were
calculated.
§ Drop
out
rates
of
each
group
receiving
farmers’
market
incen5ves
were
calculated.

12. Study
1:
Demographics
§ The
majority
of
par5cipants
were
white,
non-­‐Hispanic
married
females.
§ Age
range
of
18-­‐62
years
old.
§ Average
household
had
2.5
children.
§ 91%
of
households
had
an
annual
income
of
less
than
$30,000.

13. Study
1:
Results
§ No
significant
differences
in
means
of
F&V
intake
were
found
between
groups
at
any
5me
period.

14. Study
1:
Results
§ No
significant
differences
in
means
of
carotenoid
levels
were
found
between
groups
at
any
5me
period.

15. Study
1:
Results
§ Carotenoids
were
found
to
be
significantly
correlated
to
F&V
ASA24
data
at
all
data
collec5ons
points
(P<0.05)
§ Endpoint
P<0.01,
r=0.361
§ F&V
FFQ
data
was
only
significantly
correlated
with
carotenoids
at
baseline
(r=0.395,
P=0.003)
and
midpoint
(r=0.425,
p=0.001)

16. Study
1:
Results

17. Study
1:
Results
™ The
matching
incen5ve
groups
had
the
highest
drop
out
rate
and
the
lowest
incen5ve
usage.

18. Study
2:
Study
Design
§ To
explore
the
experiences
of
farmers’
market
incen5ve
program
par5cipants.
§ Qualita5ve
semi-­‐structured
interviews
were
conducted
(n=14)
among
par5cipants
from
the
previously
described
study.
§ Interviews
lasted
45-­‐60
minutes.
§ Each
interview
was
audio
recorded
and
transcribed
verba5m.

19. Study
2:
Study
Design
§ The
interview
script
included
ques5ons
about
§ self
perceived
barriers
to
F&V
intake
§ experiences
with
using
the
farmers’
market
incen5ves
§ experiences
with
nutri5on
educa5on
§ perceived
nutri5on
related
behavior
changes
§ future
SNAP
use
at
the
farmers’
market.

20. Study
2:
Analysis
§ Two
researchers
conducted
independent
coding.
§ Codes
were
generated
from
quotes
derived
from
line-­‐by-­‐line
review
of
the
transcrip5ons.
§ The
researchers
compared
codes
and
memos
as
transcrip5ons
were
being
reviewed.
§ Categories
were
developed
based
on
the
emergent
codes.
§ Each
category
was
defined
and
inclusion
and
exclusion
criteria
were
developed
and
entered
into
a
codebook.
§ Themes
were
developed
based
on
the
defined
categories.

21. Study
2:
Results
§ What
influences
the
use
of
farmers’
markets?
§ Awareness
§ Convenience
“Fruit
and
vegetables
are
so
easily
accessible
at
the
grocery
store
where
I
also
have
to
get
other
things
that
it's
just
easier
to
use
SNAP
benefits
at
the
grocery
store
instead
of
making
an
extra
trip
to
the
farmers’
market
just
for
the
few
items.”
“We
have
always
just
gone
to
the
farmer's
market
and
paid
cash.
I
didn't
even
know
that
we
could
use
SNAP
benefits
at
the
market.”

22. Study
2:
Results
§ What
were
the
benefits
of
using
farmers’
market
incen5ves?
§ F&V
exposure
for
children
§ Improved
F&V
intake
§ Local
connec5ons
“They
loved
it.
You
know,
and
my
son
would
be
like,
‘lets
get
this!’
and
‘lets
get
this!’
and
half
the
5me
I
would
say
yes
because
we
had
the
extra
money”.

23. Study
2:
Results
§ What
barriers
to
purchasing
F&V
were
overcome
as
a
result
of
the
farmers’
market
incen5ves?
§ Budge5ng
§ Cost
§ Availability
“It
was
kind
of
a
juggling
act
for
me
to
try
and
make
SNAP
benefits
last
to
that
third
and
fourth
week,
to
make
sure
I
had
$30
on
my
EBT.”

24. Study
3
§ Objec5ve:
To
determine
if
par5cipa5on
in
a
farmers’
market
incen5ve
pilot
program
had
an
impact
on
food
security
and
F&V
intake
of
par5cipants.
§ SNAP
par5cipants
were
eligible
to
receive
$1
in
incen5ves
for
every
SNAP
dollar
spent
at
the
Salt
Lake
City
Farmers’
Market.
This
study
was
published
in
the
January
2016
issue
of
the
Journal
of
Nutri5on
Educa5on
and
Behavior

25. Study
3:
Study
Design
§ Pretest
posjest
study
design
§ Compared
F&V
intake
and
food
security
status
as
baseline
and
4-­‐week
follow
up.
§ Baseline
survey
§ 28-­‐item
survey
completed
at
the
farmers’
market
§ 96
par5cipants
§ 4-­‐week
follow
up
§ 16-­‐item
survey
completed
over
the
phone
4-­‐weeks
aher
comple5on
of
the
baseline
survey
§ 54
par5cipants

26. Study
3:
Study
Design
§ Baseline
survey
§ 6-­‐item
validated
F&V
module
from
the
Behavioral
Risk
Factor
Surveillance
System
(BRFSS)
§ Response
op5ons
from
NCI
F&V
screener
were
used
for
self-­‐
administra5on1,2
§ 6-­‐item
short
form
Food
Security
Module
validated
by
the
US
Department
of
Agriculture
§ Demographics,
use
of
nutri5on
assistance,
shopping
habits,
etc.
§ 6-­‐month
follow
up
survey
§ Same
6-­‐item
food
security
and
F&V
modules
§ Farmers’
market
shopping
habits,
self-­‐reported
changes
in
F&V
intake
1.
Thompson
et
al.,
2000;
2.
Gulliford,
Mahabir,
Rocke,
2004

27. Study
3:
Analysis
§ Scale
scores
were
calculated
for
the
food
security
and
F&V
modules.
§ Wilcoxon
signed-­‐rank
test
were
used
to
compare
baseline
to
follow
up
for:
§ each
F&V
ques5on
§ the
total
F&V
score
§ total
food
security
score

28. Study
3:
Results
§ Median
food
security
score
decreased
significantly
(P<0.05)
from
3.0
to
2.0.

29. Study
3:
Results
• Consump5on
of
‘Other
Vegetables’
significantly
increased
(P=0.001).
• 86%
of
par5cipants
reported
an
increase
in
F&V
consump5on.
*

30. Future
Research
§ A
completely
randomized
design
should
be
conducted
comparing
matching
incen5ves,
matching
incen5ves
and
nutri5on
educa5on,
and
a
control
group.
§ Study
larger
sample
sizes
that
are
powered
to
determine
effect
changes.
§ Sample
size
of
144
par5cipants
per
group
with
a
power
of
0.8
and
alpha
of
0.05.
§ Compare
subjec5ve
and
objec5ve
data
among
par5cipants
with
access
to
year
around
farmers’
markets

31. Conclusion
§ Farmers’
market
incen5ves
may:
§ posi5vely
impact
food
security
status
and
F&V
intake
among
low-­‐income
par5cipants.
§ reduce
common
barriers
associated
with
purchasing
F&V
and
shopping
at
farmers’
markets.
§ improve
the
nutri5onal
status
of
federal
nutri5on
assistance
users.

32. Thank
You
§ Carrie
Durward
§ Ron
Munger
§ Heidi
Wengreen
§ Martha
Archuleta
§ Julie
Gast
§ Heidi
LeBlanc
§ Chuck
Carpenter
§ Melanie
Jewkes
§ Diete5cs
faculty
§ My
husband
Tom
Roskos
§ My
family
and
friends
§ Utahns’
Against
Hunger
§ SNAP-­‐Ed
§ Utah
State
University
§ Utah
State
University
Extension
§ Select
Health
§ USU’s
Applied
Nutri5on
Research
Clinic
A
special
thanks
to
the
following
individuals
who
trained,
assisted,
and
supported
me
during
my
work
towards
a
PhD

33. References
§ Coleman-­‐Jensen
A,
Gregory
C,
Singh
A.
Household
food
security
in
the
United
States
in
2013.
hjp://www.ers.usda.gov/
media/1565415/err173.pdf
§ Champagne
CM,
Casey
PH,
Connell
CL,
et
al.
Poverty
and
food
intake
in
rural
America:
Diet
quality
is
lower
in
food
insecure
adults
in
the
Mississippi
delta.
J
Am
Diet
Assoc.
2007;107(11):1886-­‐1894.
§ Eikenberry,
N.,
&
Smith,
C.
Healthful
ea5ng:
Percep5ons,
mo5va5ons,
barriers,
and
promoters
in
low-­‐income
Minnesota
communi5es.
J
Am
Diet
Assoc.
2004;
104(7),
1158-­‐1161.
doi:
10.1016/j.jada.20
04.04.023
§ Gulliford
MC,
Mahabir
D,
Rocke
B.
Reliability
and
validity
of
a
short
form
household
food
security
scale
in
a
Caribbean
community.
BMC
Public
Health.
2004;4(9).
§ Miewald
C,
HolbenD,
Hall
P.
Roll
of
a
food
box
program
in
fruit
and
vegetable
consump5on
and
food
security.
Can
J
Diet
Pract
Res.
2012;73:59-­‐65.
§ Thompson
F,
Kipnis
V,
Subar
A,
et
al.
Evalua5on
of
2
brief
instruments
and
a
food-­‐frequency
ques5onnaire
to
es5mate
daily
number
of
servings
of
fruit
and
vegetables.
Am
J
Clin
Nutr.
2000;71:1503-­‐1510.
§ United
States
Department
of
Agriculture.
USDA
awards
$31
million
in
grants
to
help
SNAP
par5cipants
afford
healthy
foods.
2015.
hjp://www.usda.gov/wps/portal/usda/usdahome?conten5donly=true&conten5d=2015/04/0084.xml
§ Wheeler,
A.
&
Chapman-­‐Novakofski,
K..
Farmers'
markets:
Costs
compared
with
supermarkets,
use
among
WIC
clients,
and
rela5onship
to
F&V
intake
and
related
psychosocial
variables.
J
Nutr
Educ
Behav,
2014;
43(3),
S65-­‐S70.
doi:
10.1016/j.jneb.
2013.11.016

34. Ques5ons?