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Recent findings from the University of Washington indicate that the City of Seattle’s Fresh Bucks initiative can enhance fruit and vegetable consumption and food stability among low-income groups by supplying monetary assistance for procuring nutritious food.

The Fresh Bucks initiative collaborates with local allies to aid Seattle residents in obtaining wholesome food. The program accepts applications from Seattle households with earnings below 80% of the area median — $110,950 for a family of four in 2024. Beneficiaries can utilize the $40 monthly benefit to procure fruits and vegetables at over 40 retail outlets across Seattle, such as farmers markets, Safeway stores, and independently owned grocers.

The analysis, released on Aug. 19 in JAMA Network Open, reveals that households enrolled in Fresh Bucks experience a 31% greater rate of food stability and consume at least three daily servings of fruits and vegetables 37% more frequently than those placed on a program waitlist.

“I would regard both of those figures as notably significant,” stated Jessica Jones-Smith, co-author, UW associate professor of health systems and population health as well as epidemiology, and a professor of health, society and behavior at the University of California, Irvine. “Interventions that yield such effectiveness are not often observed. It’s a substantial influence on diet in terms of what can be accomplished from a policy standpoint to effectuate a change in food insecurity.”

Food insecurity, defined as the inability to access nutritionally sufficient foods, is associated with lower-income households and frequently correlates with poor nutrient consumption, diabetes, and hypertension. The quality of diet, encompassing fruit and vegetable intake, affects the likelihood of premature disability and death from cardiometabolic diseases, cancer, and other causes. Nonetheless, fresh fruits and vegetables are usually less accessible in lower-income areas and are often pricier than processed foods.

“The UW’s analysis helps clarify how the City of Seattle’s Fresh Bucks initiative influences the everyday choices of our enrolled households,” said Robyn Kumar, Fresh Bucks program manager at the City of Seattle Office of Sustainability. “Results indicate that the healthy food access initiative substantially transforms outcomes for participants, greatly enhancing food security and fruit and vegetable consumption. These lifestyle modifications offer enduring benefits, and Fresh Bucks is committed to ensuring that our most burdened community members have fair access to nutritious foods and improved quality of life.”

In October 2021, 6,900 new applicants along with current beneficiaries sought to receive benefits in 2022. The total number of applicants surpassed program funding, thus 4,200 households were randomly selected to receive benefits, while the remaining applicants were placed on a waitlist. The City of Seattle subsequently sent a follow-up survey to all 6,900 applicants in July 2022. The sample for this research includes the 1,973 households that completed and returned the survey.

Researchers analyzed new applicants who received the benefits against those who were placed on the waitlist. They also assessed the influence of losing Fresh Bucks by comparing returning applicants placed on the waitlist with those who continued receiving benefits. The loss of the benefit resulted in a 29% decrease in food security and reduced the likelihood of households consuming fruits and vegetables at least three times daily by 26%.

“The findings displayed notable symmetry,” stated Melissa Knox, lead author and UW teaching professor of economics. “Those who gained the program observed nearly the same benefits as what was lost by those who dropped out of the program. This suggests two phenomena: one being that the program is indeed beneficial, while the other indicates that these outcomes cannot be sustained without funding.”

Due to the health hazards linked to poor diets, insurers have increasingly expressed interest and invested in “food is medicine,” or FIM, initiatives, which involve produce prescriptions and programs providing complimentary, healthy food for patients. Prior to FIM initiatives, federal grants supported “nutrition incentive programs” aimed at improving access to healthy food and food stability.

However, Fresh Bucks distinguishes itself from other healthy food benefit programs in various aspects, including targeted enrollment within households that are disproportionately impacted by food insecurity and diet-related chronic illnesses, separating enrollment from SNAP participation, allowing participants to redeem benefits at larger chain retailers and smaller local shops, and the absence of required matching expenditure — where participants receive additional benefits based on how much of their own funds they utilize.

“It’s evident that once this program ceases, individuals can no longer afford to consume these foods, as demonstrated by the rise in fruit and vegetable consumption when individuals are benefiting from the program, contrasted with the almost equivalent decline when benefits are withdrawn,” Jones-Smith remarked. “This underscores the necessity of financial resources to enact this kind of dietary transformation.”

Other co-authors from the UW include Jamie Wallace, a recently graduated doctoral student of health systems and population health; Barbara Baquero, associate professor of health systems and population health; and KeliAnne Hara-Hubbard, community research coordinator. The research received funding from the National Heart, Lung and Blood Institute of the National Institutes of Health.

For additional information, contact Knox at [email protected].

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