North Carolinians living on low incomes who received a monthly fruit and vegetable benefit during the COVID-19 pandemic enjoyed the flexibility to choose more and a greater variety of nutritious foods during a time of profound food insecurity, according to a new study in the Journal of Hunger & Environmental Nutrition.

Researchers from UNC-Chapel Hill interviewed participants in the Healthy Helping Fruit and Vegetable Program, which provided beneficiaries $40 per month to purchase fresh, frozen, or canned fruits and vegetables at a chain supermarket retailer. Funded by state allocations from the federal CARES Act and operated by Durham-based nonprofit Reinvestment Partners, the Healthy Helping program ran from June to December 2020 and was offered to adults enrolled in the Supplemental Nutrition Assistance Program (SNAP) who were experiencing additional food insecurity during the pandemic.

“We know that targeted fruit and vegetable benefit programs work to increase access and improve dietary quality, but we wanted to learn more about the program experience from participants’ points of view,” said lead study author Molly De Marco, PhD, assistant professor of nutrition with the UNC Gillings School of Global Public Health and leader of the Food, Fitness + Opportunity Research Collaborative at the UNC Center for Health Promotion and Disease Prevention.

De Marco and colleagues conducted phone interviews with 10 participants from rural and urban locations who ranged in age from 34 to 72 years old. Key themes that emerged included:

The research team also surveyed a larger group of 200 participants to examine overall dietary quality. They found that, despite high levels of food insecurity, the foods and drinks consumed in Healthy Helping households were similar to those in the typical American diet.

“Based on previous research, we might expect these lower-income households with food insecurity to be eating fewer fruits, vegetables and whole grains than higher-income households. Our finding that their diet quality was similar suggests some improvement among Healthy Helping households after enrolling in the program,” said study co-author Shu Wen Ng, PhD, Distinguished Scholar in Public Health Nutrition at the Gillings School and co-director of the Global Food Research Program. “We can’t be sure, though, since we had no dietary measures from before respondents enrolled in the program.”

This study supports previous research showing that targeted fruit and vegetable benefit programs are effective and well-liked.

“Healthy Helping is a model that offers flexibility for families to make their own decisions about what and how much healthy food to purchase,” said first author Isabel Lu, the Healthy Helping project coordinator. “With rising food costs due to inflation and ongoing supply-chain issues, low-income households continue to need greater financial access to healthier diets. Incentive programs like Healthy Helping fill this gap.”

Options for expanding programs like Healthy Helping could be made available through SNAP (as an additional benefit), or via health care settings. Some health care payers who share an interest in improving patients’ dietary intake and overall health are currently pilot testing such benefits as reimbursable “produce prescriptions.”

This research was supported by the North Carolina Department of Health and Human Services from their Coronavirus Aid, Relief, and Economic Security (CARES) Act allocation via a grant to Reinvestment Partners.

Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.