Courtney A. Pinard

This scoping review aimed toidentifyquantitative measures used to evaluate nutrition incentives (NIs), highlight potential evaluation gaps, and consider implications for future NI research and evaluation efforts. NIs for fruits and vegetables (FV) aim to increase fruit and vegetable intake (FVI) and food security among households with low income. Research and evaluation efforts among NIs may vary, which limits opportunities to make meaningful comparisons across programs and understand wide-scale impact. The Joanna Briggs Institute (JBI) guidelines and thePreferred Reporting Items for Systematic Reviews and Met-Analysis extension for Scoping Reviews (PRISMA-ScR) were used. Peer-reviewed and grey literature on quantitative measures used to evaluate NIs in the United States wasidentifiedamong four bibliographic databases and webpages. Data were extracted for NI measures across levels of the NI Theory of Change (TOC), including participant-level (dietary behaviors, food security status, self-efficacy, and food purchasing behaviors), site-level (eg, brick and mortar stores, farmers markets), partner-level (eg, retailers, farmers market vendors, farmers), process-level (eg, program compliance), and community-level (eg, neighborhood food environment). 127sources were included in the scoping review. Participant-level measures (n = 105) were the mostfrequentlyreported, specifically, sociodemographic characteristics (n = 86) and foodpurchasingbehaviors (n = 72). Site-level measures (n = 71) included topics ranging from participant awareness of the program to incentive redemption and distribution, with program awareness and/orutilizationthe most used (n = 34). Process (n = 9), partner (n = 16), andcommunity measures (n = 19) were the least reported. Most sources used non-psychometrically tested measurement tools. There is a need for measures that balance rigor, feasibility in practice, and alignment with NI program goals. Our findings suggest there is potential to standardizefrequentlyused quantitative measures across NI programs. Concerted efforts toidentifyshared measures may lead to increased understanding of NIs’ ability to improve food security andequitableaccess to FVs.

This paper describes the evolution of the Nutrition Incentive Program Training, Technical Assistance, Evaluation, and Information Center’s (NTAE) evaluation technical assistance (TA) model, developed to support Gus Schumacher Nutrition Incentive Program (GusNIP) grantees implementing nutrition incentive and produce prescription projects. As GusNIP grantees must contribute standardized site-level and participant-level data to a national shared measures dataset, evaluation TA is essential to ensure data quality, consistency, and comparability across diverse projects. Over its first six years, the NTAE refined its advising structure to balance scientific rigor with feasibility while meeting the needs of a rapidly expanding grantee portfolio. Initially organized around 1:1 advising, the model has transitioned to a hybrid model that maintains some 1:1 support while centralizing specialized support. Lessons learned and implications for practice include: developing and maintaining strong relationships; balancing grantee capacity and scientific priorities; offering TA in a variety of modes; tailoring TA to unique grantee needs; and providing TA in a comprehensive, integrated manner. Future directions include refining GusNIP core metrics based on grantee and funder input, expanding substudies to address evidence gaps, and strengthening grantee capacity for self-evaluation. Together, these adaptations demonstrate how a scalable, integrated TA model can enhance evaluation quality and support national learning across a large, heterogeneous public health initiative.

Background: Nutrition Incentive (NI) programs increase fruit and vegetable (FV) purchasing and consumption among Supplemental Nutrition Assistance Program (SNAP) participants by providing financial incentives at the point of sale. Through supported and sustained Farm Bill investment and bipartisan backing, NI programs operate in diverse retail settings. Discussion: Evidence indicates that NI programs generate benefits at multiple levels. At the individual and household level, they are associated with improved diet quality and enhanced food security. At the community and systems level, NI programs contribute to local economic activity by increasing FV sales in grocery and farm direct settings, supporting farmers, and reinforcing retailer participation in healthy food initiatives. This “triple-win” is dynamic, benefiting consumers, retailers, and producers and positions NI programs as a strategic mechanism for aligning public health and economic development goals. Conclusions: As a proven and scalable intervention, NI programs represent a cross-sector solution that advancas public health, strengthens local food systems, and promotes community resilience. Continued policy support and investment are critical to sustaining and expanding their impact nationwide.

Background: Produce prescription programs (PRx) have the potential to improve participants’ fruit and vegetable intake (FVI), and food security (FS), but further information is needed to understand which program characteristics contribute to these participant outcomes. Purpose: To explore the associations between PRx design characteristics, incentive redemption, and program-level participant outcomes including FVI, FS, and perceived health. Methods: An ecological, exploratory study with a quasi-experimental design (one group pre-test post-test) following the exploration, preparation, implementation, sustainment (EPIS) framework was used among Gus Schumacher Nutrition Incentive Program (GusNIP)-funded PRxs in the United States. Data were sourced from a GusNIP program operator survey (84% response rate; n = 80), PRx redemption data (n = 77), and an outcomes sample including redemption and participant outcomes data (n = 39 programs). Redemption data included program-level incentive distribution and redemption rates, measured as the dollar amount of incentives redeemed per participant per month. Participant data included changes in FVI (dietary screener questionnaire), FS (USDA household FS survey module), and perceived health (healthy days). Nonparametric and parametric comparisons were examined between program characteristics with program level-redemption rates and changes in aggregated participant-level outcomes. Results: Program-level characteristics, design, and implementation features were associated both positively and negatively with redemption data and changes in participant outcomes including FVI, FS, and perceived health. Programs that provide more funds but serve fewer participants, offer transportation assistance, and offer staff training were positively associated with improved aggregated participant outcomes. Conclusions: This exploratory research identified factors to be considered for promoting favorable program and participant outcomes in GusNIP PRx and similar initiatives.

Objectives. To examine enrollment in Gus Schumacher Nutrition Incentive Program (GusNIP) produce prescriptions and identify opportunities to expand their reach. Methods. We conducted descriptive analyses of cross-sectional baseline surveys of 21 635 participants (living in the Southern, West, North Central, or Northeast region of the United States) in GusNIP produce prescriptions between 2020 and 2024. We applied geographic information system mapping and inferential statistics to fruit and vegetable intake data. Results. At enrollment, 43.2% of participants were aged 45 to 65 years, 77% were women, 32.7% were Hispanic, 24.4% were non-Hispanic Black/African American, and 26.2% were non-Hispanic White. Mean fruit and vegetable intake was 2.39 cups (SD = 0.78) daily, varying by region. Approximately two thirds of participants reported food insecurity (67.2%). Conclusions. GusNIP produce prescriptions are reaching intended communities, including people with low fruit and vegetable intake, chronic disease risk, and food insecurity. Opportunities exist to broaden reach. Public Health Implications. GusNIP produce prescriptions offer a national lens on Farm Bill–funded policy in action. As “food is medicine” interventions, including GusNIP produce prescriptions, evolve, it is important to understand who enrolls, who is not yet represented, and who could benefit most by extending reach to individuals and their communities. ( Am J Public Health. 2025;115(12): 2015–2019. https://doi.org/10.2105/AJPH.2025.308293 )

Objectives: In this review we sought to synthesize qualitative studies incorporating perspectives of key players in nutrition incentive (NI) and produce prescription (PPR) programs to identify common qualitative themes. Background: Inadequate fruit and vegetable intake contributes to diet-related diseases, especially among low-income populations. Improved access is provided by NI and PPR programs, yet qualitative insights remain underexplored, limiting understanding of program effectiveness and impact. Methods: Qualitative studies focusing on NI and PPR programs from the past 10 years were found through key search terms on several databases. Published articles were screened by title and abstract, and then the full texts were reviewed for inclusion requirements (studies that involved qualitative findings from NI/PPR programs that were conducted in the United States). Researchers extracted data, identified themes, and categorized findings into benefits, barriers, and recommendations using an iterative coding process, ensuring rigor by including themes supported by at least 5 studies. Results: A total of 49 articles were included in this review, representing studies conducted across United States regions; 29 of the reported studies focused on PPR programs, 19 focused on NI programs, and 1 focused on both types of programs. Overall, there were 28 categories that created 3 overarching themes relating to NI and PPR programs: benefits and facilitators, barriers and challenges, and key recommendations. Conclusions: This scoping review highlights key facilitators, challenges, and opportunities for improving NI and PPR programs. The findings suggest that strong partnerships, resource alignment, and tailored support for stakeholders are essential for program success. Quantitative measures assessing implementation factors should be explored in future research in tandem with continued qualitative data collection to provide important context. By addressing these areas, NI and PPR programs can expand their impact and effectiveness in improving food access and nutrition for individuals with limited income.

The purpose of this study was to Produce prescription (PPR) programs aim to improve fruit and vegetable (FV) access and health outcomes by providing FVs and nutrition education to participants with low income. While PPRs show promise in increasing FV intake and reducing food insecurity, more research is needed to understand effective implementation. To determine how PPRs work in different settings, and to describe implementation characteristics. In-depth interviews were conducted with PPR project implementers using a semi-structured guide based on the Consolidated Framework for Implementation Research (CFIR). PPR sites were selected through maximum variation and interviewees at each site were selected using snowball sampling. Interviews were recorded, transcribed, and coded using NVivo software using a deductive codebook, with two researchers coding each interview. Interviewees included 33 individuals across 13 PPR projects. The analysis identified themes across CFIR constructs: (i) project characteristics (e.g. eligibility, nutrition education, adaptations to local context, relative advantage, cost), (ii) characteristics of individuals (e.g. participants, food retailers, healthcare staff, role delineation, networks), (iii) evidence (e.g. economic impact, FV Intake, household food security and health-related outcomes, scope and impact), (iv) implementation climate (e.g. project genesis, alignment with organization values, leadership engagement, geography, technology), and (v) challenges (e.g. COVID-19 impacts, capacity limitations). Interviewees also provided recommendations for resources that would be helpful in their PPR implementation, such as “plug and play” materials to reduce setup burden. This study highlights PPR implementation characteristics, which can elucidate which features may be most effective in particular contexts. There was also an identified need for further investigation into fostering healthcare organization buy-in and engagement.

The Gus Schumacher Nutrition Incentive Program (GusNIP), funded by the U.S. Department of Agriculture (USDA) National Institute of Food and Agriculture (NIFA), is a federal program designed to address financial barriers to fruit and vegetable (FV) purchases among consumers with a low income by using financial incentives. To fur­ther strengthen both nutrition incentive (NI) and produce prescription (PPR) GusNIP projects, the GusNIP Nutrition Incentive Training, Technical Assistance, Evalu­ation, and Information Center (NTAE) and its Nutrition Incentive Hub offer Capacity Building and Innovation Fund (CBIF) awards to GusNIP grantees and their partner organizations. The present study applies multiple methods to systematically understand the types of resources requested by CBIF applicants to expand the capacity and impact of their NI and PPR pro­jects by rigorously analyzing the CBIF proposals submitted from 2020 to 2022. Applicants (N = 130) requested funds to build capacity and innova­tion around one or more domains: leadership and staffing (n = 72); communications (n = 67); diver­sity, equity, and inclusion (DEI; n = 57); and tech­nology (n = 42). Three significant qualitative themes emerged around future needs: (1) staffing and technology to streamline applicants’ projects; (2) training, resources, and funding to enhance DEI in their projects; and (3) improved NTAE support, including improvements to the CBIF funding mechanism. Findings from this study can increase awareness about the capacity building and innovation needs of NI and PPR projects for the NTAE, policymakers, and funders to consider when supporting healthy food financial incentive projects.