Fruit and Vegetable Vouchers With and Without an SSB Tax

We will test the hypothesis that a positive incentive for healthy foods (fresh fruits and
vegetables, F&Vs) will be utilized as effectively in a community without a purchasing penalty
for unhealthy foods (a sugar-sweetened beverage [SSB] tax) as in a community with a
purchasing penalty for unhealthy foods (a SSB tax). Our experiment will test the
empirically-driven hypothesis in a real-world setting through a noninferiority design:
comparing the impact of F&V vouchers in two counties, one without (Los Angeles) and one with
(San Francisco) a SSB tax.

Each study participant will receive four paper vouchers per month for a total of six months.
Each of these vouchers can be redeemed for fresh or frozen fruits and vegetables at a number
of specified local corner stores, supermarkets, or farmer's markets.

Half of these participants will receive and spend these vouchers in an environment which has
implemented a SSB tax (SF); the other half will receive and spend these same vouchers in a
non-tax environment (LA).

Each individual participant will be enrolled in the study for a total of seven months from
initial orientation and participant consent (M0) to final data collection during final month
of intervention (M6).

We are using a non-inferiority trial design. We are aiming to test whether there is a
significant difference in total cup-equivalents of F&V intake in LA participants as compared
to SF participants when given F&V vouchers. That is, we aim to test whether the F&V voucher
is less effective in LA than in SF. This is important to test because it has been purported
that SF has a unique food environment with high accessibility to fresh F&V through farmer's
markets and a plethora of corner stores, as well as a SSB tax that discourages less healthy
foods, potentially leaving more funds for healthier F&Vs. Thus, we aim to determine the
change in consumption of F&V in LA participants is non-inferiority to that of SF
participants, when both are given F&V vouchers.

Inclusion Criteria:

1. Understand English sufficiently to provide informed consent;

2. Provision of signed and dated informed consent form;

3. Stated willingness to comply with all study procedures and availability for the
duration of the study;

4. Any gender, aged 21 years or older;

5. Have self-reported income ≤250% of the federal poverty level;

6. Have regular access to a mobile phone;

7. Have a safe and secure mailing address at which to receive vouchers;

8. Be a resident of the Counties of San Francisco or Los Angeles as defined by official
municipal boundaries.

Exclusion Criteria:

1. Currently participating in any other dietary or nutrition study that would impact his
or her normal eating patterns;

2. Currently be enrolled in and receiving EatSF, CHIVES, or Vouchers4Veggies vouchers;

3. Has active diagnosis of cancer or congestive heart failure;

4. Is planning to move out of San Francisco or Los Angeles in the next 12 months;

5. Currently pregnant.

6. Currently live with and share a food budget with a current Vouchers4Veggies, EVIDENCE,
or CHIVES study participant.