Adding more fruits and vegetables to the grocery cart may be as much about resources as motivation. A new study finds that households receiving monthly produce benefits were significantly more likely to eat three servings of fruits and vegetables daily and less likely to face food insecurity compared with those who didn’t get the benefit.
The research, published in JAMA Network Open, examined Seattle’s Fresh Bucks program, which provides eligible households with $40 per month to spend on produce at participating farmers markets, local grocery stores and Safeway supermarkets. Families receiving the benefit had a 31% higher rate of food security and were 37% more likely to eat at least three daily servings of fruits and vegetables than those on a waitlist.
“I would classify both of those numbers as pretty large,” said Jessica Jones-Smith, co-author and affiliate professor at the University of Washington. “We don’t routinely see interventions that work that well. It’s a pretty big impact on diet in terms of what we can do from a policy perspective and expect to make a difference in food insecurity.”
The study took advantage of a unique opportunity in 2022, when Fresh Bucks had more applicants than available funding. More than 6,900 new and returning households applied for benefits. To manage the shortfall, 4,200 were randomly chosen to receive the monthly support, while others were placed on a waitlist. Researchers then mailed follow-up surveys to all applicants, with nearly 2,000 households completing them. This design allowed researchers to compare both new recipients against waitlisted applicants and returning recipients who lost benefits against those who kept them.
The results showed nearly perfect symmetry. Families who gained Fresh Bucks saw their food security rise and produce intake climb, while those who lost benefits experienced a 29% decline in food security and were 26% less likely to eat fruits and vegetables three times a day.
“The people who gained the program saw nearly the same benefit as what was lost by the people who lost the program,” said lead author Melissa Knox, a UW teaching professor of economics. “It seems like there are two things going on: One is that the program is helping people, and the other is these effects don’t magically sustain themselves without funding.”
Food insecurity, defined as not having consistent access to enough nutritious food, is closely linked to diet-related chronic conditions such as diabetes, hypertension and cardiovascular disease. Poor diet quality also raises risks for cancer and premature mortality. For families facing these challenges, programs like Fresh Bucks provide both immediate dietary improvements and long-term health benefits.
Researchers note that Fresh Bucks differs from many healthy food benefit programs by focusing enrollment on households disproportionately affected by food insecurity and chronic disease. It also operates independently of SNAP eligibility, allows participants to use benefits at both large retail chains and smaller independent stores, and requires no “match spending” by households. These features, they say, could make it a useful model for other cities or insurers interested in “food is medicine” programs, initiatives that provide produce prescriptions or free healthy food to patients as part of health care.
“We clearly see that once this program goes away, people can no longer afford to eat these foods, as evidenced by the increase in fruits and vegetables when people are receiving the benefit, but the near symmetric decrease when benefits are lost,” Jones-Smith said. “I think that really drives home the fact that money or material resources are necessary for enacting this kind of dietary change.”
This research was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health.