Produce carts seeing increased health benefits for low-income customers

Researchers who surveilled of a handful of “Green Carts” in lower-income regions of New York are suggesting increased access to fresh produce—and the ability to pay for those fruits and vegetables with food stamps—could have a positive effect on overall health in disadvantaged areas.

Lead researcher Brian Elbel, PhD, MPH, and colleagues explained in their yearlong study that New York’s local government issued new mobile fruit and vegetable cart licenses for low-income neighborhoods without adequate healthy food access in 2008. In March of that year, Mayor Michael Bloomberg approved 1,000 permits for these mobile “Green Carts.”

Elbel and co-authors, whose study is published in the CDC’s Preventing Chronic Disease, surveyed four produce carts in the Bronx during three periods between 2013 and 2014. At that point, according to their research, almost 500 well-established Green Cart vendors existed in the city, mostly in the Bronx and Manhattan, though only a limited number of those vendors supplied electronic benefit transfer (EBT) machines, which allow shoppers to pay for their food with Supplemental Nutrition Assistance Program (SNAP) benefits.

After observing and surveying 779 adults at the stands, Elbel and colleagues found that while access to EBT machines at these carts is relatively limited, shoppers who paid for their fruits and vegetables with SNAP benefits bought on average 5.4 more cups of produce than those who paid with cash.

Low fruit and vegetable consumption is linked to an increased risk of noncommunicable diseases like cancer, diabetes, stroke and coronary heart disease, the World Health Organization (WHO) reports. WHO estimated that in 2010, around 6.7 million deaths worldwide could be attributed to poor produce consumption.

According to WHO, the potassium in fruits and vegetables can combat high blood pressure, contributing to a decreased risk for heart disease and stroke. Evidence also suggests dietary fiber, phytochemicals found in greens, flavonoids and other antioxidants present in various produce products can help keep cholesterol levels in check and reduce the risk of atherosclerosis. Fiber has also been shown to regulate insulin levels, decreasing a person’s risk of developing type 2 diabetes. The high water content in these foods is also helpful in controlling weight and obesity.

In previous research, Elbel and co-authors wrote they found cash-paying customers spent on average $4 each time they visited a Green Cart vendor. Customers who paid using SNAP benefits tended to spend more than double that amount.

In their recent study, the researchers noticed most buyers were female—74 percent of the total study population—and more than half were Hispanic and held no more than a high school degree. Fifty-three percent of respondents lived in households with an annual income of less than $25,000, and 42 percent said they received SNAP benefits, mostly due to unemployment.

While most shoppers paid for their food in cash, almost 20 percent used EBT machines at equipped carts to pay with their SNAP benefits. These customers reported that Green Carts were their most common source of produce, and 84 percent said they bought their produce with the intent to share it. Ninety percent of buyers who used SNAP benefits were female; 75 percent were Hispanic.

Elbel and colleagues found that while all surveyed customers bought an average of seven cups of fruit and nearly two cups of vegetables per trip, they were unlikely to buy more than one kind of vegetable. The authors explain this was likely due to a much more diverse selection of fruits than vegetables at the carts. Corn, onions, garlic and iceberg lettuce were much more common purchases than spinach, kale, beets, carrots, potatoes and parsnips, they reported.

It seemed clear that enabling low-income residents to pay for their produce with SNAP benefits was seeing positive results, but Elbel and co-authors wrote the “promising mechanism” of EBT machine additions at Green Carts was limited because of cost. Vendors would need to pay $900 upfront for an EBT machine, they wrote, with additional $35-a-month payments and 3.5-cent charges per individual transaction. New York has attempted to remedy the problem with a financial support program for vendors, but even so, Elbel and colleagues reported less than a third of EBT-eligible vendors had the machines by mid-2013.

“Adequate consumption of minimally processed fruits and vegetables is an important component of a healthy diet and is associated with an array of positive health outcomes,” the authors wrote. “EBT capabilities may increase fresh fruit and vegetable purchases, helping to overcome a barrier to a healthy diet. The provision of mobile produce cart permits and financial assistance for EBT machines could be sustainably scalable, although we invite additional causal research on the subject before making policy recommendations.”