Food Stamp Program: Emerging issues and research questions

Economic Research ServiceFY 2008 Food Assistance and Nutrition Research ConferenceDecember 6, 2007 Washington, DC

Barbara MkNelly, MS

Cancer Prevention and Nutrition Section

California Department of Public Health

Public Health Institute

Emerging issues and research questions for how the Food Stamp Program could more effectively promote healthy eating

• California’s Healthy Food Purchase Pilot (Assembly Bill 2384, Leno)

• Network for a Healthy California - Food Stamp Nutrition Education (FSNE) Program

Healthy Food Purchase Pilot Program (Assembly Bill 2384 - Leno)

Bill became law January ’07 but requires legislative appropriation for implementation.

Develop a pilot program in not more than 7 counties that combines strategies that….

– Increase small grocers’ offerings of fruit and vegetables in low-income neighborhoods

– Financial incentive to increase food stamp recipients’ purchase of fresh fruit and vegetables

– Independent evaluation developed in consultation with USDA’s Economic Research Service (ERS)

Healthy Food Purchase Pilot ProgramAddresses Major Barriers

Financial Incentive: aka “Bonus Value Food Stamps”• Food Stamp Program (FSP)

consumers would receive additional FSP dollars based on the amount of their benefit spent on fresh fruits and vegetables.

Example: Each FSP dollar spent on F & V would earn the FSP participant an additional 30¢ - 40¢ of FSP benefit on his or her EBT card.

Why bonus value?

• Incentive for healthy purchase rather than restrictions

• Uses Electronic Benefit Transfer (EBT)– Client and retailer oriented features

• Considerable interest in idea but has not been tested

Bonus Value operations research questions (1)—Economic

• Ideal bonus rate(s) to test – – retailers identified 30-40%

• Costing bonus approach– Amount currently being spent on fruit and

vegetables– Increased demand stimulated by bonus

• Price elasticity literature• Experimental literature

Bonus Value operations research questions (2)—Feasibility• Programmatic features

• How would it work – different types of stores• How best communicated to food stamp

consumers• Maximum/caps per transaction or

household

• Systems implications– Retailer reimbursement system– Statewide automated welfare system (SAWS)

consortium – 4 separate systems in the state

Evaluation Issues• Formative research with food stamp

recipients and retailers to inform design.• Impact on food stamp recipients’ fruit and

vegetable purchases:• Data sources: possibly retailer data, food stamp

recipients total food purchases• Ideally, comparative impact of different

strategies and bonus value amounts• Issues: Institutional Review Board, informed

consent, confidentiality

• Retailer and consumer satisfaction• Programmatic/systems impact

Partnerships for Better Public Health

Food Stamp Nutrition Education (FSNE) in CaliforniaTwo programs both overseen by California

Department of Social Services Food Stamp Program

• Network for a Healthy California – California Department of Public Health

• University of California, Davis

Public Health Perspective Social-Ecological Model

Network for a Healthy California• Largest FSNE network in the nation• ~ 150 local projects in 11 regions• 3 targeted population campaigns:

– Latino Campaign – African-American Campaign – Children’s Power Play! Campaign

• Retail and Worksite programs• Providing FSNE at ~10,000 eligible sites – low-

resource schools and pre-schools, food closets/pantries/banks, community clinics, low-income housing sites, grocery stores, worksites, festivals, health fairs, etc.

• Champions for Change multi-media campaign – TV, radio, outdoor, direct mail, website

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•14-minute DVD (English/Spanish)

•24-page bilingual mini-magazine

•9 bilingual Success Cards

•English and Spanish Reply Cards

•Fruit and vegetable Slide Guide

Mailer to ~ 600,000 Low Income English and Spanish Speaking Households:

Institute of Medicine says…

• “USDA’s Food Stamp Nutrition Education (FSNE) program is an example of a federal innovation that encourages collaboration and that leverages resources. FSNE allows states to create social marketing networks, mobilize other organizations, and join efforts to conduct interventions with low-income participants to achieve healthier eating patterns and increased physical activity levels.”

Institute of Medicine (2007) Progress in Preventing Childhood Obesity How Do We Measure Up?

Operational Question

Q#1 What are the most effective targeting criteria for reaching FSNE eligible audience?

Targeting Successes and Challenges

Examples of challenges for targeting– Majority of FSP recipients live outside FSNE

eligible census tracts – Low income worksites – difficult to qualify– Media especially TV - difficult

Recent successes for new sites– Food stamp office resource kit (video,

informational stand)– Expanded criteria for retailer sites – $50k+

monthly food stamp redemptions

Evaluation Question

Q#2: How to most effectively evaluate the combined efforts of local projects, targeted campaigns and media?

Network evaluation strategies

• Statewide surveillance with FSNE eligible people (needs comparison groups)

• Evaluation of branded interventions prior to roll-out

• Practitioner oriented impact evaluations– ~50 local projects measure behaviors and

behavioral determinants

• Importance of context: Robert Wood Johnson Foundation funded an expert review of Network’s evaluation system.

Institute of Medicine’s Child Obesity Prevention Framework

Policy Question

Q#3: What potential exists for FSNE to work synergistically with other federal nutrition assistance programs to achieve better public health results?

Examples of Powerful Collaborations

FSNE in schools supports healthy food offered in cafeteria and after school programs.

FSNE alongside food banks’ fresh produce program has implications for USDA’s Emergency Food Assistance Program (TEFAP).

FSNE and WIC promoting shared and reinforcing messages for example pertaining to new food package and educational materials/messages.

Conclusion

• Need to draw evidence from– Economics including consumer economics– Health education and behavior change theory– Advertising and marketing– Public health successes

• Potential for collaboration to address variety of types of barriers

• Urgency and public health implications require comprehensive, cross-cutting and coordinated strategies

For More on Interventions and Evaluation, Please Visit Us—

For partners, professionals and links to campaigns, programs and resources —www.networkforahealthycalifornia.net

New and growing! For parents and youth, in English and Spanish –www.cachampionsforchange.net

Barbara.MkNelly@cdph.ca.gov