Grocery Assistance Program Study (GAPS)

University of Minnesota (UMN)

Status: Completed

Conditions: Food Assistance

Treatments: Behavioral: Restriction; Behavioral: F&V Bonus; Behavioral: Bonus & Restriction

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT02643576

R01DK098152 (U.S. NIH Grant/Contract)

DK098152

Details and patient eligibility

About

This highly innovative experimental trial is designed to examine the independent and joint effects of prohibiting the use of SNAP-like benefits to purchase foods high in discretionary calories and offering an incentive to encourage the purchase of more healthful foods.

Full description

More than 1 in 10 Americans participate in the Supplemental Nutrition Assistance Program (SNAP), a Federal food and nutrition program administered by the United States Department of Agriculture (USDA). SNAP, formerly known as the Food Stamp Program, provides funds to low-income families for the purchase of food. Benefits are provided on an electronic benefits transfer (EBT) card that is used like an debit card at stores.

In recent years there has been growing recognition that SNAP participants are disproportionately obese, with poor diet contributing to this disparity. In response, there is great interest in considering ways in which SNAP may better meet its objective to help people and families buy the food they need for good health.

Modifications to SNAP currently under evaluation involve offering incentives to encourage participants to purchase more nutritious food items. There is concern, however, that this strategy alone may be of limited usefulness in improving the nutritional quality of the diet for obesity prevention because incentivizing the purchase of more nutritious foods does not necessarily reduce the purchase of less nutritious foods (substitution effect may not occur) and may even increase the total calories purchased.

An alternative strategy that has been extensively discussed by public health advocates and policy makers in recent years is prohibiting the purchase of less nutritious food items with SNAP benefits. Commonly consumed foods that are high in discretionary calories (defined as calories from solid fats, alcohol, and added sugars) are prime targets for exclusion because SNAP participants consume far more energy from discretionary calories (43%) than recommended. This strategy may be particularly effective if implemented in conjunction with incentives for the purchase of more nutritious foods.

No studies have been conducted to evaluate whether prohibiting the purchase of foods high in discretionary calories with SNAP benefits may improve diet quality and reduce risk of obesity. Likewise research is lacking on the effect of effect of pairing restrictions with incentives. Thus, we propose to pilot a highly innovative experimental trial designed to examine the independent and joint effects of prohibiting the use of SNAP benefits to purchase foods high in discretionary calories and offering an incentive to encourage the purchase of more healthful foods. Key indicators of feasibility will include recruitment and retention (are targeted number of participants recruited and retained at a high rate?); fidelity of the intervention (are compliance measures successfully collected and do they indicate close compliance with experimental condition assignment?); and completeness of baseline and follow-up data.

Using study data, analyses will be conducted to evaluate the independent and joint effects of prohibiting the use of SNAP benefits to purchase foods high in discretionary calories and offering an incentive to encourage the purchase of more nutritious foods.

Enrollment: 296 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• ≥ 18 years of age
• Primary food shopper of household
• Not currently participating in the Supplemental Nutrition Assistance Program (SNAP)
• Not planning to apply for SNAP in the next 4 months
• Able to read and write in English
• ≤ 8 people living in household
• Have a gross monthly income level that places the household at or below 200 percent of the Federal poverty level for their household size.

Exclusion criteria

• < 18 years of age
• Not primary food shopper of household
• Currently participating in the Supplemental Nutrition Assistance Program (SNAP)
• Planning to apply for SNAP in the next 4 months
• Unable to read and write in English
• > 8 people living in household
• Have a gross monthly income level that places the household above 200 percent of the Federal poverty level for their household size

Trial design

Primary purpose: Basic Science

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: Single Blind

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296 participants in 4 patient groups

Control

No Intervention group

Description:

Usual SNAP-like food benefits

Rewards

Experimental group

Description:

Usual SNAP-like food benefits, plus a modification to this food benefit program that entails a 30% bonus on eligible fruit and vegetable purchases (i.e. F\&V bonus)

Treatment:

Behavioral: F&V Bonus

Restrictions

Experimental group

Description:

Usual SNAP-like food benefits, plus a modification that requires no sugar-sweetened beverages, candy, or sweet baked goods be purchased

Treatment:

Behavioral: Restriction

Rewards plus restrictions

Experimental group

Description:

Usual SNAP-like food benefits, plus two modifications to this food benefit program: one modification includes a 30% bonus on eligible fruit and vegetable purchases and the other modification is that sugar-sweetened beverages, candy, or sweet baked goods are not allowed to be purchased (i.e. Bonus \& Restriction)

Treatment:

Behavioral: Bonus & Restriction