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Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments

  • Ruopeng An (a1)
  • Please note a correction has been issued for this article.
Abstract
Objective

To systematically review evidence from field interventions on the effectiveness of monetary subsidies in promoting healthier food purchases and consumption.

Design

Keyword and reference searches were conducted in five electronic databases: Cochrane Library, EconLit, MEDLINE, PsycINFO and Web of Science. Studies were included based on the following criteria: (i) intervention: field experiments; (ii) population: adolescents 12–17 years old or adults 18 years and older; (iii) design: randomized controlled trials, cohort studies or pre–post studies; (iv) subsidy: price discounts or vouchers for healthier foods; (v) outcome: food purchases or consumption; (vi) period: 1990–2012; and (vii) language: English. Twenty-four articles on twenty distinct experiments were included with study quality assessed using predefined methodological criteria.

Setting

Interventions were conducted in seven countries: the USA (n 14), Canada (n 1), France (n 1), Germany (n 1), Netherlands (n 1), South Africa (n 1) and the UK (n 1). Subsidies applied to different types of foods such as fruits, vegetables and low-fat snacks sold in supermarkets, cafeterias, vending machines, farmers’ markets or restaurants.

Subjects

Interventions enrolled various population subgroups such as school/university students, metropolitan transit workers and low-income women.

Results

All but one study found subsidies on healthier foods to significantly increase the purchase and consumption of promoted products. Study limitations include small and convenience samples, short intervention and follow-up duration, and lack of cost-effectiveness and overall diet assessment.

Conclusions

Subsidizing healthier foods tends to be effective in modifying dietary behaviour. Future studies should examine its long-term effectiveness and cost-effectiveness at the population level and its impact on overall diet intake.

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Corresponding author
*Corresponding author: Email ran@rand.org
References
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1.US Department of Agriculture & US Department of Health and Human Services (2010) Dietary Guidelines for Americans 2010, 7th ed. Washington, DC: US Government Printing Office; available at http://www.health.gov/dietaryguidelines/dga2010/dietaryguidelines2010.pdf
2.National Prevention Council (2011) National Prevention Strategy. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General; available at http://www.healthcare.gov/prevention/nphpphc/strategy/report.pdf
3.Darmon, N & Drewnowski, A (2008) Does social class predict diet quality? Am J Clin Nutr 87, 11071117.
4.Monsivais, P & Drewnowski, A (2007) The rising cost of low-energy-density foods. J Am Diet Assoc 107, 20712076.
5.Drewnowski, A & Specter, SE (2004) Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr 79, 616.
6.Drewnowski, A & Darmon, N (2005) The economics of obesity: dietary energy density and energy cost. Am J Clin Nutr 82, 1 Suppl., 265S273S.
7.Drewnowski, A (2010) The cost of US foods as related to their nutritive value. Am J Clin Nutr 92, 11811188.
8.World Health Organization (2004) Global strategy on diet, physical activity and health. http://apps.who.int/gb/ebwha/pdf_files/WHA57/A57_R17-en.pdf (accessed May 2012).
9.World Health Organization (2008) 2008–2013 Action plan for the global strategy for the prevention and control of noncommunicable diseases. http://whqlibdoc.who.int/publications/2009/9789241597418_eng.pdf (accessed May 2012).
10.Cheney, C (2011) Battling the couch potatoes, Hungary introduces ‘fat tax’. http://www.spiegel.de/international/europe/battling-the-couch-potatoes-hungary-introduces-fat-tax-a-783862.html (accessed May 2012).
11.US Department of Agriculture, Foreign Agricultural Service (2011) Danish fat tax on food. http://gain.fas.usda.gov/Recent%20GAIN%20Publications/Danish%20Fat%20Tax%20on%20Food_Stockholm_Denmark_10-6-2011.pdf (accessed May 2012).
12.Brownell, KD, Farley, T, Willett, WCet al. (2009) The public health and economic benefits of taxing sugar-sweetened beverages. N Engl J Med 361, 15991605.
13.US Senate and House of Representatives (2008) Food, Conservation, and Energy Act of 2008. http://www.usda.gov/documents/Bill_6124.pdf (accessed May 2012).
14.US Department of Agriculture (2012) Healthy Incentives Pilot. http://www.fns.usda.gov/snap/hip/ (accessed May 2012).
15.Kane, RL, Johnson, PE, Town, RJet al. (2004) A structured review of the effect of economic incentives on consumers’ preventive behavior. Am J Prev Med 27, 327352.
16.Wall, J, Mhurchu, CN, Blakely, Tet al. (2006) Effectiveness of monetary incentives in modifying dietary behavior: a review of randomized, controlled trials. Nutr Rev 64, 518531.
17.Thow, AM, Jan, S, Leeder, Set al. (2010) The effect of fiscal policy on diet, obesity and chronic disease: a systematic review. Bull World Health Organ 88, 609614.
18.Jensen, JD, Hartmann, H, de Mul, Aet al. (2011) Economic incentives and nutritional behavior of children in the school setting: a systematic review. Nutr Rev 69, 660674.
19.Wu, S, Cohen, D, Shi, Yet al. (2011) Economic analysis of physical activity interventions. Am J Prev Med 40, 149158.
20.Epstein, LH, Dearing, KK, Handley, EAet al. (2006) Relationship of mother and child food purchases as a function of price: a pilot study. Appetite 47, 115118.
21.Epstein, LH, Handley, EA, Dearing, KKet al. (2006) Purchases of food in youth. Influence of price and income. Psychol Sci 17, 8289.
22.Epstein, LH, Dearing, KK, Paluch, RAet al. (2007) Price and maternal obesity influence purchasing of low- and high-energy-dense foods. Am J Clin Nutr 86, 914922.
23.Epstein, LH, Dearing, KK, Roba, LGet al. (2010) The influence of taxes and subsidies on energy purchased in an experimental purchasing study. Psychol Sci 21, 406414.
24.Giesen, JC, Havermans, RC, Nederkoorn, Cet al. (2012) Impulsivity in the supermarket. Responses to calorie taxes and subsidies in healthy weight undergraduates. Appetite 58, 610.
25.Waterlander, WE, Steenhuis, IH, de Boer, MRet al. (2012) The effects of a 25% discount on fruits and vegetables: results of a randomized trial in a three-dimensional web-based supermarket. Int J Behav Nutr Phys Act 9, 11.
26.Waterlander, WE, Steenhuis, IH, de Boer, MRet al. (2012) Introducing taxes, subsidies or both: the effects of various food pricing strategies in a web-based supermarket randomized trial. Prev Med 54, 323330.
27.Cash, SB, Sunding, DL & Zilberman, D (2005) Fat taxes and thin subsidies: prices, diet, and health outcomes. Acta Agric Scand Sect C 2, 167174.
28.Jensen, JD & Smed, S (2007) Cost-effective design of economic instruments in nutrition policy. Int J Behav Nutr Phys Act 4, 10.
29.Lin, B, Yen, ST, Dong, Det al. (2010) Economic incentives for dietary improvement among food stamp recipients. Contemp Econ Policy 28, 524536.
30.Smed, S, Jensen, JD & Denver, S (2007) Socio-economic characteristics and the effect of taxation as a health policy instrument. Food Policy 32, 624639.
31.Yaniv, G, Rosin, O & Tobol, Y (2009) Junk-food, home cooking, physical activity and obesity: the effect of the fat tax and the thin subsidy. J Public Econ 93, 823830.
32.Nordström, J & Thunström, L (2011) Can targeted food taxes and subsidies improve the diet? Distributional effects among income groups. Food Policy 36, 259271.
33.Lowe, CF, Horne, PJ, Tapper, Ket al. (2004) Effects of a peer modeling and rewards-based intervention to increase fruit and vegetable consumption in children. Eur J Clin Nutr 58, 510522.
34.Ponza, M, Devaney, B, Ziegler, Pet al. (2004) Nutrient intakes and food choices of infants and toddlers participating in WIC. J Am Diet Assoc 104, 1 Suppl. 1, S71S79.
35.Siega-Riz, AM, Kranz, S, Blanchette, Det al. (2004) The effect of participation in the WIC program on preschoolers’ diets. J Pediatr 144, 229234.
36.Nelson, JA, Carpenter, K & Chiasson, MA (2006) Diet, activity, and overweight among preschool-age children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Prev Chronic Dis 3, A49.
37.Gentile, DA, Welk, G, Eisenmann, JCet al. (2009) Evaluation of a multiple ecological level child obesity prevention program: Switch what you Do, View, and Chew. BMC Med 7, 49.
38.Horne, PJ, Hardman, CA, Lowe, CFet al. (2009) Increasing parental provision and children's consumption of lunchbox fruit and vegetables in Ireland: the Food Dudes intervention. Eur J Clin Nutr 63, 613618.
39.Taren, DL, Clark, W, Chernesky, Met al. (1990) Weekly food servings and participation in social programs among low income families. Am J Public Health 80, 13761378.
40.Anliker, JA, Winnie, M & Drake, LT (1992) An evaluation of the Connecticut Farmers’ Market coupon program. J Nutr Educ 24, 185191.
41.Balsam, A, Webber, D & Oehlke, B (1994) The farmers’ market coupon program for low-income elders. J Nutr Elder 13, 3542.
42.Perez-Escamilla, R, Ferris, AM, Drake, Let al. (2000) Food stamps are associated with food security and dietary intake of inner-city preschoolers from Hartford, Connecticut. J Nutr 130, 27112717.
43.Swensen, AR, Harnack, LJ & Ross, JA (2001) Nutritional assessment of pregnant women enrolled in the Special Supplemental Program for Women, Infants, and Children (WIC). J Am Diet Assoc 101, 903908.
44.Kunkel, ME, Luccia, B & Moore, AC (2003) Evaluation of the South Carolina seniors farmers’ market nutrition education program. J Am Diet Assoc 103, 880883.
45.Ard, JD, Fitzpatrick, S, Desmond, RAet al. (2007) The impact of cost on the availability of fruits and vegetables in the homes of schoolchildren in Birmingham, Alabama. Am J Public Health 97, 367372.
46.Kropf, ML, Holben, DH, Holcomb, JPet al. (2007) Food security status and produce intake and behaviors of Special Supplemental Nutrition Program for Women, Infants, and Children and Farmers’ Market Nutrition Program participants. J Am Diet Assoc 107, 19031908.
47.Racine, EF, Smith Vaughn, A & Laditka, SB (2010) Farmers’ market use among African-American women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children. J Am Diet Assoc 110, 441446.
48.Freedman, DA, Bell, BA & Collins, LV (2011) The Veggie Project: a case study of a multi-component farmers’ market intervention. J Prim Prev 32, 213224.
49.Johnson, DB, Beaudoin, S, Smith, LTet al. (2004) Increasing fruit and vegetable intake in homebound elders: the Seattle Senior Farmers’ Market Nutrition Pilot Program. Prev Chronic Dis 1, A03.
50.Bere, E, Veierod, MB & Klepp, KI (2005) The Norwegian School Fruit Program: evaluating paid vs. no-cost subscriptions. Prev Med 41, 463470.
51.Bere, E, Veierod, MB, Bjelland, Met al. (2006) Free school fruit – sustained effect 1 year later. Health Educ Res 21, 268275.
52.Bere, E, Veierod, MB, Skare, Oet al. (2007) Free school fruit – sustained effect three years later. Int J Behav Nutr Phys Act 4, 5.
53.Jamelske, E, Bica, LA, McCarty, DJet al. (2008) Preliminary findings from an evaluation of the USDA Fresh Fruit and Vegetable Program in Wisconsin schools. WMJ 107, 225230.
54.Cullen, KW, Watson, KB & Konarik, M (2009) Differences in fruit and vegetable exposure and preferences among adolescents receiving free fruit and vegetable snacks at school. Appetite 52, 740744.
55.Lachat, CK, Verstraeten, R, De Meulenaer, Bet al. (2009) Availability of free fruits and vegetables at canteen lunch improves lunch and daily nutritional profiles: a randomized controlled trial. Br J Nutr 102, 10301037.
56.Jeffery, RW, Wing, RR, Thorson, Cet al. (1993) Strengthening behavioral interventions for weight loss: a randomized trial of food provision and monetary incentives. J Consult Clin Psychol 61, 10381045.
57.Jeffery, RW & Wing, RR (1995) Long-term effects of interventions for weight loss using food provision and monetary incentives. J Consult Clin Psychol 63, 793796.
58.Jeffery, RW & French, SA (1997) Preventing weight gain in adults: design, methods and one year results from the Pound of Prevention study. Int J Obes Relat Metab Disord 21, 457464.
59.Jeffery, RW, Wing, RR, Thorson, Cet al. (1998) Use of personal trainers and financial incentives to increase exercise in a behavioral weight-loss program. J Consult Clin Psychol 66, 777783.
60.Jeffery, RW & French, SA (1999) Preventing weight gain in adults: the pound of prevention study. Am J Public Health 89, 747751.
61.Galal, OM (2002) The nutrition transition in Egypt: obesity, undernutrition and the food consumption context. Public Health Nutr 5, 141148.
62.Jensen, RT & Miller, NH (2011) Do consumer price subsidies really improve nutrition? Rev Econ Stat 93, 12051223.
63.Wing, RR, Jeffery, RW, Pronk, Net al. (1996) Effects of a personal trainer and financial incentives on exercise adherence in overweight women in a behavioral weight loss program. Obes Res 4, 457462.
64.Finkelstein, EA, Linnan, LA, Tate, DFet al. (2007) A pilot study testing the effect of different levels of financial incentives on weight loss among overweight employees. J Occup Environ Med 49, 981989.
65.Volpp, KG, John, LK, Troxel, ABet al. (2008) Financial incentive-based approaches for weight loss: a randomized trial. JAMA 300, 26312637.
66.John, LK, Loewenstein, G, Troxel, ABet al. (2011) Financial incentives for extended weight loss: a randomized, controlled trial. J Gen Intern Med 26, 621626.
67.Cinciripini, PM (1984) Changing food selections in a public cafeteria. An applied behavior analysis. Behav Modif 8, 520539.
68.Mayer, JA, Brown, TP, Heins, JMet al. (1987) A multi-component intervention for modifying food selections in a worksite cafeteria. J Nutr Educ 19, 277280.
69.Jeffery, RW, French, SA, Raether, Cet al. (1994) An environmental intervention to increase fruit and salad purchases in a cafeteria. Prev Med 23, 788792.
70.Paine-Andrews, A, Francisco, VT, Fawcett, SBet al. (1996) Health marketing in the supermarket: using prompting, product sampling, and price reduction to increase customer purchases of lower-fat items. Health Mark Q 14, 8599.
71.French, SA, Jeffery, RW, Story, Met al. (1997) A pricing strategy to promote low-fat snack choices through vending machines. Am J Public Health 87, 849851.
72.French, SA, Story, M, Jeffery, RWet al. (1997) Pricing strategy to promote fruit and vegetable purchase in high school cafeterias. J Am Diet Assoc 97, 10081010.
73.Kristal, AR, Goldenhar, L, Muldoon, Jet al. (1997) Evaluation of a supermarket intervention to increase consumption of fruits and vegetables. Am J Health Promot 11, 422425.
74.Anderson, JV, Bybee, DI, Brown, RMet al. (2001) 5 a day fruit and vegetable intervention improves consumption in a low income population. J Am Diet Assoc 101, 195202.
75.French, SA, Jeffery, RW, Story, Met al. (2001) Pricing and promotion effects on low-fat vending snack purchases: the CHIPS Study. Am J Public Health 91, 112117.
76.Bamberg, S (2002) Implementation intention versus monetary incentive comparing the effects of interventions to promote the purchase of organically produced food. J Econ Psychcol 23, 573587.
77.Hannan, P, French, SA, Story, Met al. (2002) A pricing strategy to promote sales of lower fat foods in high school cafeterias: acceptability and sensitivity analysis. Am J Health Promot 17, 16.
78.Horgen, KB & Brownell, KD (2002) Comparison of price change and health message interventions in promoting healthy food choices. Health Psychol 21, 505512.
79.Herman, DR, Harrison, GG & Jenks, E (2006) Choices made by low-income women provided with an economic supplement for fresh fruit and vegetable purchase. J Am Diet Assoc 106, 740744.
80.Herman, DR, Harrison, GG, Afifi, AAet al. (2008) Effect of a targeted subsidy on intake of fruits and vegetables among low-income women in the Special Supplemental Nutrition Program for Women, Infants, and Children. Am J Public Health 98, 98105.
81.Burr, ML, Trembeth, J, Jones, KBet al. (2007) The effects of dietary advice and vouchers on the intake of fruit and fruit juice by pregnant women in a deprived area: a controlled trial. Public Health Nutr 10, 559565.
82.Michels, KB, Bloom, BR, Riccardi, Pet al. (2008) A study of the importance of education and cost incentives on individual food choices at the Harvard School of Public Health cafeteria. J Am Coll Nutr 27, 611.
83.Brown, DM & Tammineni, SK (2009) Managing sales of beverages in schools to preserve profits and improve children's nutrition intake in 15 Mississippi schools. J Am Diet Assoc 109, 20362042.
84.Bihan, H, Castetbon, K, Mejean, Cet al. (2010) Sociodemographic factors and attitudes toward food affordability and health are associated with fruit and vegetable consumption in a low-income French population. J Nutr 140, 823830.
85.Bihan, H, Mejean, C, Castetbon, Ket al. (2012) Impact of fruit and vegetable vouchers and dietary advice on fruit and vegetable intake in a low-income population. Eur J Clin Nutr 66, 369375.
86.French, SA, Hannan, PJ, Harnack, LJet al. (2010) Pricing and availability intervention in vending machines at four bus garages. J Occup Environ Med 52, Suppl. 1, S29S33.
87.French, SA, Harnack, LJ, Hannan, PJet al. (2010) Worksite environment intervention to prevent obesity among metropolitan transit workers. Prev Med 50, 180185.
88.Lowe, MR, Tappe, KA, Butryn, MLet al. (2010) An intervention study targeting energy and nutrient intake in worksite cafeterias. Eat Behav 11, 144151.
89.Ni Mhurchu, C, Blakely, T, Jiang, Yet al. (2010) Effects of price discounts and tailored nutrition education on supermarket purchases: a randomized controlled trial. Am J Clin Nutr 91, 736747.
90.Blakely, T, Ni Mhurchu, C, Jiang, Yet al. (2011) Do effects of price discounts and nutrition education on food purchases vary by ethnicity, income and education? Results from a randomized, controlled trial. J Epidemiol Community Health 65, 902908.
91.Kocken, PL, Eeuwijk, J, Van Kesteren, NMet al. (2012) Promoting the purchase of low-calorie foods from school vending machines: a cluster-randomized controlled study. J Sch Health 82, 115122.
92.An, R, Patel, D, Segal, Det al. (2013) Eating better for less: a national discount program for healthy food purchases in South Africa. Am J Health Behav 37, 5661.
93.Caraher, M & Cowburn, G (2005) Taxing food: implications for public health nutrition. Public Health Nutr 8, 12421249.
94.Kim, D & Kawachi, I (2006) Food taxation and pricing strategies to ‘thin out’ the obesity epidemic. Am J Prev Med 30, 430437.
95.Sturm, R, Powell, LM, Chriqui, JFet al. (2010) Soda taxes, soft drink consumption, and children's body mass index. Health Aff (Millwood) 29, 10521058.
96.Jacobson, MF & Brownell, KD (2000) Small taxes on soft drinks and snack foods to promote health. Am J Public Health 90, 854857.
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