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Health Aff (Millwood). 2019 Sep;38(9):1557-1566. doi: 10.1377/hlthaff.2018.05420.

Financial Incentives Increase Purchases Of Fruit And Vegetables Among Lower-Income Households With Children.

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Alyssa Moran ( ) is an assistant professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland.
Anne Thorndike is an associate professor of medicine at Harvard Medical School and the Division of General Internal Medicine, Massachusetts General Hospital, in Boston.
Rebecca Franckle is an assistant professor of health sciences at Merrimack College, in North Andover, Massachusetts.
Rebecca Boulos is a senior research associate in the Cutler Institute for Health and Social Policy, University of Southern Maine, in Portland.
Heather Doran is a research associate at the Center for Excellence in Health Innovation, University of New England, in Portland.
Aarohee Fulay is a research assistant in the Department of Nutrition, Harvard T. H. Chan School of Public Health, in Boston.
Julie Greene is director of Guiding Stars Licensing Company, a subsidiary of Ahold Delhaize, in Scarborough, Maine.
Dan Blue is marketing manager at Hannaford Supermarkets, in Portland.
Jason P. Block is an associate professor in the Department of Population Medicine, Harvard Medical School.
Eric B. Rimm is a professor in the Department of Nutrition, Harvard T. H. Chan School of Public Health.
Michele Polacsek is a professor in the Westbrook College of Health Professions, University of New England.


The high cost of fruit and vegetables can be a barrier to healthy eating, particularly among lower-income households with children. We examined the effects of a financial incentive on purchases at a single supermarket by primary shoppers from low-income households who had at least one child. Participation in an in-store Cooking Matters event was requested for incentivized subjects but optional for their nonincentivized controls. The sample included but was not limited to Supplemental Nutrition Assistance Program participants. Compared to the controls, incentivized shoppers-who were given an immediate 50 percent discount on qualifying fruit and vegetables-increased weekly spending on those items by 27 percent; this change was for fresh produce. There was no change in purchases of frozen and canned produce or unhealthful foods. Estimated annual average daily consumption of fruit and vegetables by the incentivized shoppers and by one designated child per incentivized household did not change. Attendance at Cooking Matters events was low. These findings support financial incentive programs to increase fruit and vegetable purchasing but suggest that effective complementary approaches are needed to improve diet quality.


SNAP; Supplemental Nutrition Assistance Program; children; diet; dietary consumption; dietary intake; families; fruits and vegetables; household purchases; incentive; nutrition; nutrition education; prevention; pricing; randomized controlled trial; supermarket


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