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Evaluation of a Childhood Obesity Prevention and Control Initiative: NYC Health Bucks

In response to the growing public health crisis of childhood obesity, the Division of Nutrition, Physical Activity, and Obesity (DNPAO) at the Centers for Disease Control and Prevention (CDC), seeks to identify promising local programs and policies designed to prevent childhood obesity. Accordingly, Abt Global Inc. was contracted by the CDC to evaluate an environmental-level initiative called New York City Health Bucks

The NYC Health Bucks initiative, a joint initiative of the New York City Department of Health and Mental Hygiene (DOHMH) and the Human Resources Administration, is an innovative financial incentive program operated by the NYC DOHMH in three high-need, underserved New York City neighborhoods: South Bronx, North and Central Brooklyn, and East and Central Harlem. This program provides $2 “Health Bucks” to targeted neighborhood residents for the purchase of locally-grown, fresh fruits and vegetables at local farmers’ markets. As an added incentive for Supplemental Nutrition Assistance Program (SNAP) recipients, individuals using their Electronic Benefits Transfer card at participating farmers’ markets receive one $2 Health Buck for every $5 spent.

The intent of the NYC Health Bucks program is to build upon other citywide efforts to promote healthy nutrition and physical activity in underserved areas. The program attempts to improve households’ eating habits – in particular, children and adolescents – by giving them more purchasing power. Simultaneously, Health Bucks attracts farm vendors to areas previously thought of as “unsellable.”

Abt Global conducted an outcome evaluation, employing a quasi-experimental difference-of-differences analysis of program effects on fresh fruit and vegetable consumption and access.

Abt also conducted a process evaluation, employing qualitative and quantitative methods – including focus groups, key informant interviews, and surveys – to assess barriers and facilitators to implementation based on data collected from program administrators, farmers’ market managers and vendors, and local community organizations.

Results of the process evaluation indicate that Health Bucks is seen as a positive program model among farmers, vendors, and program administrators.  The outcome evaluation showed that Health Bucks exposure was associated with:
  • Greater awareness of farmers’ markets and perceived farmers’ market access;
  • Increased frequency and amount of farmers’ market purchases; and
  • Greater likelihood of a self-reported year-over-year increase in fruit and vegetable consumption.
However, our difference-in-differences analysis did not detect impacts on consumption. We concluded that farmers’ market incentive coupon programs are one important component of public health strategies to combat obesity, associated with higher fruit and vegetable access and purchases in low-income communities.

Abt Global also developed a toolkit to assist farmers’ market incentive programs in designing and implementing evaluations. View the toolkit at the Center for Training and Research Translation website.

Read the Abt evaluation of the Health Bucks program:
Implementing a Farmers’ Market Incentive Program: Perspectives on the New York City Health Bucks Program
North America