摘要：Objectives. We assessed the impact of a rewards-based incentive program on fruit and vegetable purchases by low-income families. Methods. We conducted a 4-phase prospective cohort study with randomized intervention and wait-listed control groups in Philadelphia, Pennsylvania, in December 2010 through October 2011. The intervention provided a rebate of 50% of the dollar amount spent on fresh or frozen fruit and vegetables, reduced to 25% during a tapering phase, then eliminated. Primary outcome measures were number of servings of fruit and of vegetables purchased per week. Results. Households assigned to the intervention purchased an average of 8 (95% confidence interval [CI] = 1.5, 16.9) more servings of vegetables and 2.5 (95% CI = 0.3, 9.5) more servings of fruit per week than did control households. In longitudinal price-adjusted analyses, when the incentive was reduced and then discontinued, the amounts purchased were similar to baseline. Conclusions. Investigation of the financial costs and potential benefits of incentive programs to supermarkets, government agencies, and other stakeholders is needed to identify sustainable interventions. Health disparities related to poor diets constitute a growing population health concern. Changing diets to improve health outcomes requires a multipronged approach that both encourages responsibility for change and provides the tools to enable change. We evaluated the effectiveness of a rewards-based incentive program to increase the amounts of fresh and frozen fruit and vegetables purchased by low-income households. Low-income populations purchase and consume smaller amounts of fruit and vegetables than higher-income populations. 1,2 We focused on fruit and vegetables because their consumption is strongly associated with the prevention and management of obesity, type 2 diabetes, and cardiovascular diseases. 3–7 Indeed, a multicenter randomized trial conducted with persons at high cardiovascular risk recently found that the Mediterranean diet—which includes high intake of fruit and vegetables—reduced the incidence of major cardiovascular events. 7
