Daily fruit and vegetable consumption is essential for maintaining a healthy weight and preventing chronic diseases,(1) yet few U.S adults meet daily recommendations, particularly adults of low socioeconomic status.(2) Low-income and minority households are also disproportionately impacted by the burden of food insecurity,(3) which is defined as a the economic or social condition of limited or unsafe access to adequate food.(4) These social inequalities may also exacerbate health disparities among non-Hispanic Black and Hispanic households.(5) In the U.S., food insecurity is associated with higher healthcare use and costs and multiple chronic disease risk factors,(6–8) as well as limitations in activities of daily living among older adults.(9) Participation in the Supplemental Nutrition Assistance Program (SNAP) helps alleviate food insecurity, but may not be enough to help low-income adults purchase and consume adequate amounts of fruits and vegetables.(10) Previous studies suggest that cost and access are the main barriers preventing SNAP participants from purchasing and consuming fresh fruits and vegetables.(11, 12)
Mobile produce markets are portable markets designed to mitigate financial and physical barriers to healthy diet behaviors by selling affordable fruits and vegetables in areas with limited access to fresh produce.(13) A primary goal of mobile produce markets is to support the needs and preferences of underserved communities, including low-income, minority, and older customers. Many mobile produce markets operate out of vans, trucks, or carts, and target multiple community sites in a given day or week. A recent systematic review indicates that mobile produce market use is associated with greater access to and higher consumption of fruits and vegetables, though results are not always consistent.(13) Typically, mobile produce markets are developed and strengthened by building community partnerships and involving community members in the planning process.(14) For example, seeking out input from community members is critical for understanding and accommodating cultural preferences in immigrant communities (e.g., which varieties of produce to sell) and physical impairments among adults with limited mobility (e.g., where to locate the market).
Food on the Move (FOTM) is a mobile produce market based in Providence, RI, and has been operating for over a decade. The FOTM program was informed by the “Live Well, Viva Bien” intervention, which offered fruits and vegetables at a discounted price to residents living in low-income housing sites via bi-weekly produce markets.(15) The market produce included over 70 varieties of fruits and vegetables, including staples, seasonal items, culturally-desired ethnic produce, and exotic produce. Participants in the “Live Well, Viva Bien” intervention group increased their intake of fruits and vegetables at markets located in senior housing sites, where the number of customers and sales were higher relative to family sites.(16) In spite of the program’s popularity, customers identified cost as a barrier to shopping at the mobile markets. The Rhode Island Public Health Institute (RIPHI) drew upon the intervention’s findings to create the FOTM program, which intentionally targets senior housing sites for new market locations. In a recent study using survey data, more than 75% of SNAP customers reported being able to make their benefits last longer by shopping at FOTM.(17)
With funding support from the United States Department of Agriculture (USDA), the FOTM program currently offers a 50% discount to all customers using SNAP benefits to purchase produce at markets, tendered immediately at the point-of-sale. Financial incentives may mitigate disparities in diet and obesity risk by making healthy food more affordable.(18) Previous studies have shown that incentive programs at farmers’ markets, such as the Double Up Food Bucks (DUFB) Program, are linked to greater food security and higher fruit and vegetable intake among SNAP participants.(19, 20) Researchers have also tested the impact of financial incentives in supermarket settings, and have found that matching credits and discounts lead to higher spending on fresh fruits and vegetables among eligible customers.(21–25)
Mobile produce markets may be an acceptable setting for SNAP incentive programs because they concurrently address physical access barriers to healthy food retailers and incorporate elements of community engagement in their program design. Though mobile produce markets are a promising strategy for mitigating financial barriers to healthy food consumption, few, if any, studies have examined whether SNAP participants purchase more fruit and vegetables as a result of receiving financial incentives in a mobile produce market setting. Similarly few studies have tested the impact of an immediate 50% discount (versus a matching credit) on fruit and vegetable purchases,(22) or analyzed the effects among low-income immigrants living at senior sites.
To address these gaps in the literature, we sought to determine whether an automatic 50% discount on fruits and vegetables was associated with higher spending on fruits and vegetables among SNAP recipients at mobile produce markets. We hypothesized that customers using SNAP benefits would spend more on fruits and vegetables per month compared to those not using SNAP benefits in market transactions, as a result of the FOTM program. Based on the success of previous incentive programs in supermarket and farmer’s market settings,(19–25) we hypothesized that offering financial incentives would increase fruit and vegetable purchases among customers shopping at mobile produce markets.