Peer review

Open Access

Background: To reduce childhood hunger, the US Department of Agriculture funded several innovative demonstration projects, including the Kentucky Ticket to Healthy Food project. Objective: The study tested the hypothesis that Ticket to Healthy Food would reduce child food insecurity (FI-C) among rural, low-income households. Design: The study used a randomized controlled trial in which households were randomly assigned to treatment and control groups. Outcomes were measured using household surveys and administrative data. Survey data were collected at baseline (n=2,202) and follow-up (n=1,639) 8 to 11 months into the project. Participants/setting: Households in 17 counties in southeastern Kentucky that had at least 1 child younger than 18 years and received a Supplemental Nutrition Assistance Program (SNAP) benefit amount less than the maximum at baseline. Intervention: Between January 2017 and March 2018, treatment households on SNAP received additional monthly benefits ranging from $1 to $122 based on distance to grocery store and earned income. Main outcome measures: Key outcomes included FI-C (primary), food insecurity among adults and households, and food expenditures (secondary). Statistical analyses performed: Logistic and linear regression models were used to estimate differences between the treatment and control groups, controlling for baseline characteristics. Socioeconomic subgroups were also analyzed. Results: The Kentucky Ticket to Healthy Food project did not reduce the primary outcome, FI-C (treatment=37.1%, control=35.2%; P=0.812), or secondary outcomes of very low food security among children (treatment=3.7%, control=4.4%; P=0.204) or food insecurity among adults (treatment=53.9%, control=53.0%; P=0.654). The project increased households’ monthly food spending by $20 (P=0.030) and led more households to report that monthly benefits lasted at least 3 weeks (treatment=65%, control=56%; P=0.009). Conclusion: A demonstration project to reduce FI-C by raising SNAP benefits for Kentucky households with children did not reduce FI-C or other food insecurity measures. Future research should explore the effect of different increases in SNAP benefits and collect repeated measures of FI-C to assess whether intervention effects change over time.

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