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Incentivizing Healthy Snacks During Out-of-School Time Through Grocery Store Partnerships

Anzman-Frasca, Stephanie PhD; Folta, Sara C. PhD; Angstrom, Heather M. MS; Brown, Clarissa M. MS, MPH; Beets, Michael W. PhD; Finley, Anna Marie MA; Nelson, Miriam E. PhD; Economos, Christina D. PhD

Journal of Public Health Management and Practice: February 14, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHH.0000000000000853
Research Full Report: PDF Only

Context: Volunteer-led out-of-school-time (OST) programs, such as 4-H, scouting, and youth sports, reach a large population of children and are positioned to offer opportunities for healthy eating. However, cost is a barrier to providing healthy snacks such as fruits and vegetables (FVs) during OST.

Objective: Offering discounts through grocery store partnerships has shown promise in addressing this barrier in structured, staff-led after-school programs. We tested this model in volunteer-led OST programs and evaluated it using mixed methods.

Design/Setting: The Snack It Up (SIU) intervention was designed to promote FV snacks to volunteer-led OST programs through weekly $5 grocery store discounts. Participation was limited to 1 leader per program.

Participants: Thirty-five of 36 recruited OST program leaders completed the study; 16 were enrolled in SIU and 19 in a comparison group.

Main Outcome Measures: We assessed the following: (1) discount redemption among SIU leaders; (2) snacks served by SIU and comparison group leaders via photographs from 3 to 4 OST program sessions during SIU implementation; and (3) SIU leader perspectives using key informant interviews before and after implementation.

Results: SIU leaders saved an average of $48.75 on FV snacks throughout the intervention ($2.90 per week, more than one-fifth of typical self-reported spending on snacks). SIU leaders also served a greater frequency (100% of sessions vs 75%, P < .001) and variety of FVs (an average of 3.5 types per session vs 1.3, P < .001) and fewer salty/sweet snacks (0.0 vs 1.3 types per session, P < .001) than those in the comparison group and expressed positive impressions of SIU.

Conclusions: Partnerships between OST programs and grocery stores are a promising avenue for promoting healthier snacks during OST.

Department of Pediatrics, University at Buffalo, Buffalo, New York (Dr Anzman-Frasca); Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts (Drs Folta, Economos, and Nelson); ChildObesity180 Tufts University, Boston, Massachusetts (Ms Angstrom and Dr Economos) US Department of Agriculture, Food and Nutrition Service, Boston, Massachusetts (Ms Brown); Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (Dr Beets); More Advertising, Watertown, Massachusetts (Ms Finley); and Hampshire College, Amherst, Massachusetts (Dr Nelson). Drs Anzman-Frasca and Nelson and Ms Finley were with ChildObesity180 at Tufts University when this research began.

Correspondence: Christina D. Economos, PhD, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111 (

Author Contributions: S.A-F. contributed to study design and data analysis and led the writing of the manuscript; S.C.F. led the qualitative data analysis and contributed to manuscript writing and revision; H.M.A., M.W.B., and A.M.F. contributed to study design, data collection, and manuscript revision; C.M.B. contributed to data collection, data analysis, and manuscript writing and revision; and M.E.N. and C.D.E. contributed to study design and manuscript revision, with C.D.E. also serving as Principal Investigator.

Funding for this study was provided by Newman's Own Foundation, the Robert Wood Johnson Foundation, and The JPB Foundation. The authors thank Laura Carroll and Molly Newman, for their contributions to study administration, and Falon Tilley and Jacklyn Emilo, for contributions to data collection and coding respectively. In addition, the authors are grateful to Shanti Sharma for assistance with the logistics of manuscript preparation and to the partner grocery stores and out-of-school-time leaders for their participation in this study.

Study authors have no competing interests relevant to this article. The authors declare no conflicts of interest.

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