Restaurant Meals Program (Hodges and Emerson, 2012). The aim of these programs is to offer elderly, homeless, and disabled SNAP participants the opportunity to use their benefits for hot prepared meals at approved restaurants. California is one of only eight states taking advantage of the long-standing option to authorize certain restaurants to accept SNAP benefits for the elderly and disabled. It has certified 1,081 establishments, compared with 106 in Arizona and 47 in Michigan. No other state has more than 9 certified (FNS, 2012c). Other allowable meal services include drug and alcohol treatment centers, communal dining facilities for the elderly, and homeless meal providers (see Chapter 2 for further background on the restrictions on hot foods).

Use of Incentives to Promote a Healthy Diet for SNAP Participants

In addition to restriction or expansion of SNAP benefits, incentives offer another mechanism for encouraging the purchase of healthy foods. Evidence suggests that the use of financial incentives to promote health behavior change is effective (Kane et al., 2004; Volpp et al., 2009a,b). Incentives can be framed as rewards or as penalties. The behavioral economics literature suggests that financial incentives framed as rewards may have smaller effects than penalties of equivalent size (Arrow, 2004) because of “loss aversion” (Conrad and Perry, 2009, p. 359). For healthy behavior changes, however, such as dieting or smoking cessation, rewards have been shown to motivate behavior change effectively (Volpp et al., 2008, 2009a,b). While penalty incentives are widely used for behavior change, moreover, there is a lack of evidence directly comparing positive and negative incentives (Volpp et al., 2009a). The Farm Bill of 200810 authorized $20 million for pilot projects (e.g., Healthy Incentives Pilot [HIP]) to evaluate health and nutrition promotion in the SNAP program and to determine whether financial incentives provided to SNAP recipients at the point of sale increase the purchase of fruits and vegetables or other healthful foods (FNS, 2012d). The evaluation data for HIP were not available as this report was being written.

Retail Food Outlets

More than 231,000 retail outlets accepted SNAP benefits by the end of FY 2011, including a small number of restaurants that served the elderly, disabled, and homeless. One of the most dramatic changes over the years has been the participation by farmers’ markets. In FY 2010, 6,132 farmers

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10Food, Conservation, and Energy Act of 2008, Public Law 110-234, Sec. 4141 (May 22, 2008).



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