Highlight
- A $40 per month healthy food benefit program was associated with improved food security among lower-income participants.
- Participants receiving benefits reported a higher proportion consuming fruits and vegetables at least three times daily.
- Benefit discontinuation corresponded with declines in food security and fruit and vegetable intake, emphasizing program importance.
- Variations in outcomes were noted according to income, language, and race/ethnicity, underscoring the need for tailored interventions.
Study Background and Disease Burden
Diet quality, particularly adequate fruit and vegetable intake, is a well-established determinant of chronic disease risk and overall health. Despite this, barriers to accessing fresh produce persist, predominantly impacting lower-income and marginalized communities. These disparities contribute to nutrition-related health inequities, including higher rates of obesity, diabetes, and cardiovascular diseases. Healthy food benefit programs aim to mitigate these inequities by financially enabling healthier dietary choices. However, rigorous evidence quantifying their impacts on diet quality and food security, especially in urban real-world settings, remains limited.
Study Design
This cohort study was conducted in Seattle, Washington, investigating the effects of Fresh Bucks, a healthy food benefit program providing $40 monthly vouchers for 6 months. The study enrolled 1,973 participants seeking Fresh Bucks enrollment, predominantly aged 60 years or older (68%), with racially diverse representation (51% Asian, 11% Black, 27% White). Participants were randomly assigned to either immediate program enrollment or placement on a waiting list. Additionally, a secondary randomization examined effects of benefit disenrollment versus continued program participation over 6 months.
Primary exposures included receiving versus not receiving the $40 monthly benefit, and continued enrollment versus disenrollment. Outcomes were assessed at baseline (October 2021) and follow-up (June 2022).
Key Findings
The Healthy Food Benefit intervention was associated with meaningful improvements in food security. Specifically, program enrollment correlated with a 5.5 percentage point (95% CI, 0.05 to 10.91 pp) increase in the proportion of participants classified as food secure using the 2-item Hunger Vital Signs screener.
Regarding dietary intake, the proportion of participants consuming fruits and vegetables three or more times daily increased by 7.5 percentage points (95% CI, 0.39 to 14.52 pp) in the benefit group compared to waiting list controls. However, analyses of continuous frequency measures of fruit and vegetable consumption did not demonstrate significant differences, suggesting improvements were primarily in crossing minimal recommended thresholds rather than large quantity increases.
In participants randomized to disenrollment, both fruit and vegetable intake and food security declined relative to those who remained enrolled, underscoring the benefit’s protective effect.
Subgroup analyses revealed heterogeneity in outcomes by income level, primary language spoken, and racial or ethnic group, highlighting disparities in program impact and potential barriers to benefit utilization.
Expert Commentary
This study provides robust evidence supporting healthy food benefit programs as effective tools to reduce food insecurity and modestly improve fruit and vegetable consumption in vulnerable urban populations. The randomized naturalistic design strengthens causal inference compared to prior cross-sectional or observational work. Importantly, findings suggest benefits extend beyond simple access to meaningful changes in eating behaviors that can contribute to chronic disease prevention.
However, the null findings on continuous consumption measures indicate that while the program helps more participants meet minimal intake recommendations, the overall quantity consumed might remain insufficient to maximize health benefits. Differences among demographic subgroups emphasize the need for culturally tailored interventions that address language barriers and socio-economic challenges. Longitudinal follow-up would clarify the impact on clinical outcomes.
The study enriches the evidence base informing public health policy on nutrition assistance programs and supports scaling such interventions to address nutrition security and health disparities.
Conclusion
The Fresh Bucks $40 monthly healthy food benefit program significantly reduced food insecurity and increased the proportion of participants consuming fruits and vegetables at least three times daily in a diverse, lower-income urban population. This intervention holds promise for improving diet quality and reducing health disparities linked to inadequate nutrition. Targeted strategies to enhance benefit uptake and address demographic-specific needs could amplify these effects. Future research should explore long-term impacts on nutritional status and chronic disease outcomes.
References
Knox MA, Wallace J, Baquero B, Hara-Hubbard K, Jones-Smith J. Healthy Food Benefit Programs, Fruit and Vegetable Consumption, and Food Security. JAMA Netw Open. 2025 Aug 1;8(8):e2527601. doi: 10.1001/jamanetworkopen.2025.27601. PMID: 40828533; PMCID: PMC12365700.
Additional References:
1. Darmon N, Drewnowski A. Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutr Rev. 2015;73(10):643-660.
2. Leung CW, Wolfson JA, Lahne J. Can fruit and vegetable incentives improve diet and health among low-income populations? A systematic review. Nutrition Policy. 2023;36(2):125-135.
3. Gundersen C, Ziliak JP. Food insecurity and health outcomes. Health Aff (Millwood). 2015 Nov;34(11):1830-1839.
4. U.S. Department of Agriculture. Food Security in the United States in 2023. Economic Research Service report. 2024. Available at: https://www.ers.usda.gov/publications/
