Distribution of Health Bucks has increased greatly since program inception, from 3,000 coupons in 2005 to 138,930 coupons in 2010, a 46-fold increase (). Because CBOs were the only mechanism for distributing Health Bucks from 2005 through 2007, substantially fewer coupons were distributed in those years compared with 2008 through 2010, when the EBT incentive component of the program was introduced. Since that time, the proportion of coupons distributed as EBT incentives has risen steadily, from 51% in 2008 to 71% in 2010.
The number of Health Bucks coupons issued as Supplemental Nutrition Assistance Program (SNAP) electronic benefit transfer (EBT) incentives and through community-based organizations, New York City, 2005 through 2010.
Redemption rates are higher for coupons distributed on site as EBT incentives than for those distributed by CBOs, although CBO redemption rates have increased over time. Redemption rates for Health Bucks distributed by CBOs rose from 24% in 2005 to 69% in 2010. In comparison, EBT incentive redemption rates have ranged from approximately 85% to just below 90% from 2008 through 2010. Rising distribution and redemption rates have driven accompanying increases in total, per-farmer, and per-market revenues from Health Bucks from 2005 through 2010 ().
Health Bucks Coupons Redemptions, New York City, 2005–2010
Respondents of all types consistently suggested that Health Bucks should be allocated to markets and CBOs as early in the farmers’ market season as possible, allowing distribution over a longer period of time. One program administrator noted that providing coupons earlier in the season helps to establish healthy habits among consumers; the earlier they are introduced to the market, the longer they will benefit each season.
DOHMH employs several oversight policies and processes to standardize stakeholder roles and responsibilities (ie, DPHO coordinators, CBOs, market operators and managers, and vendors) and to enforce required practices for tracking coupon distribution. All participating market operators attended a preseason meeting and received an additional briefing from DPHO coordinators at the beginning of the season. CBOs also received a standardized information packet from DPHO coordinators at the beginning of the season.
Program monitoring systems consisted mostly of mechanisms to track coupon distribution and redemption. Unique bar codes on each Health Bucks coupon allow tracking of distribution and redemption rates. Informal tracking was based on monthly distribution logs completed by both farmers’ markets and CBOs and returned to DPHO representatives. The logs were completed from July to the end of the season and included the coupon bar code number and date for each time a coupon changes hands (eg, from the farmers’ market owner to the market manager, from the market manager to a farmers’ market customer, or from a CBO to a client). However, once the coupons were in the hands of customers, DOHMH could not track them until they were submitted by the customer as payment to the farmer/vendors at the market and returned by the farmer/vendors to FMFNY for reimbursement. At the end of each season, when all coupons used for purchase had been returned, FMFNY compiled summary information on distribution and redemption for the season.
Centralized tracking occurred only at the organizational level; the bar code was not linked to individual Health Bucks recipients. Once distributed, a coupon could be used by any individual shopper at a participating farmers’ market, regardless of whether that individual was the originally intended recipient of the coupon.
As noted above, because farmers do not necessarily redeem coupons on a regular basis, final data on redemption rates were not available until season’s end. In the absence of real-time data on redemptions, DOHMH used distribution logs and prior-year redemption rates to estimate how many coupons have been redeemed and make decisions about how many additional Health Bucks to distribute over the course of the season.
Farmer/vendors accepting Health Bucks submitted collected coupons by mail to the FMFNY for cash reimbursement. Farmer/vendors were typically reimbursed within 6 weeks after submitting Health Bucks. Farmer/vendors generally did not find the Health Bucks reimbursement process burdensome; only about a quarter of farmer/vendor survey respondents reported that the process was not easy, although subsequent farmer/vendor telephone interviews highlighted a few areas for improvement. For example, several farmers reported that they paid out-of-pocket to insure the Health Bucks they mailed to FMFNY, adding a cost of $20 to $40 to postage fees. Interviewees also noted that the smooth texture of Health Bucks made them difficult to count, increasing time required to tally coupons.
DOHMH staff accommodated CBOs by providing computer access to complete online program applications and by continuing to accept applications after the official June deadline. Before 2010, lack of resources to purchase and operate wireless EBT terminals was a major barrier to maximum farmers’ market participation. However, during the 2010 season, a USDA grant allowed all DPHO markets to obtain EBT terminals. In addition, mini-grants from the DOHMH supported staff at smaller markets to operate EBT terminals.
In DPHO areas, acceptance of Health Bucks was identified by farmer/vendors as a market characteristic influencing their decision to sell in 68% of cases. In addition, active community outreach/promotion and acceptance of Food Stamps/EBT benefits were identified as attractive characteristics in DPHO areas.
Farmer/vendors identified 4 specific market characteristics as increasing their propensity to sell at a market; more than half of farmer/vendors identified all 4 characteristics:
- Conducts cooking demonstrations or other nutrition education activities (71%)
- Engages in active outreach or promotion in community (66%)
- Operates on weekends (64%)
- Accepts Food Stamps/EBT benefits (57%)
Only 1 characteristic was selected by at least half of farmer/vendors as a deterrent to selling or operating at a market. Fifty percent of farmer/vendor respondents indicated that “High fees to sell at market” decreased their likelihood of selling at a market.
Farmers’ market managers used multiple methods to promote EBT/SNAP. Nearly all reported that they distributed flyers, brochures, or other promotional handouts (97%) and displayed posters at the farmers’ market (96%). Many engaged in community outreach (88%) or partnered with local CBOs (78%). More than half (52%) used newspaper ads or articles, 36% advertised online, 18% sent direct mailings, and 17% advertised on subways and buses.
Farmers’ market managers generally reported favorable attitudes toward SNAP/EBT. Because their markets accepted EBT, 58% agreed that “more vendors want to operate stands or stalls in this market”; 70% agreed that “new customers shop at this market more often”; and 95% agreed that “more repeat customers come to this market.”
Farmers’ market managers also reported the following attitudes because their markets accepted Health Bucks: 55% agreed that “more vendors want to operate stands or stalls in this market”; 100% agreed that “new customers shop at this market more often”; and 95% agreed that “more repeat customers come to this market.” Lastly, 59% of market managers strongly or somewhat disagreed that because their markets accepted Health Bucks “market traffic moves less smoothly.”
Health Bucks were popular among market farmer/vendors. Most farmer/vendors somewhat or strongly agreed that because they accepted Health Bucks, they made more money at the market (75%), new customers shopped more often at their stand or stall (74%), they sold more fresh fruits and vegetables (72%), they had more repeat customers (70%), and their customers bought more new or unfamiliar foods (57%) ().
Weighted percentage of farmer/vendor survey respondents (n = 141) who agreed with statements that “Because my stand or stall accepts Health Bucks, . . . ”.