Addressing Food and Nutrition Security Through Community Initiatives: Assessment of Healthier Food Incentive Programs in U.S. Municipalities

Background/Objectives: Healthy food incentive programs (HFIP), such as fruit and vegetable voucher incentives, can supplement other nutrition assistance programs to support food and nutrition security. However, little is known about the prevalence of HFIP, particularly at the municipal level. This study examines the prevalence of HFIP in a nationally representative sample of U.S. municipalities and the association between the availability of HFIP and municipal characteristics. Methods: Using data from the CDC’s 2021 National Survey of Community-Based Policy and Environmental Supports for Healthy and Active Living (n = 1982 municipalities), a weighted bivariate analysis and multivariable logistic regression analysis were conducted to estimate the prevalence of HFIP overall and by municipal characteristics, and to assess the relationship between municipal characteristics and HFIP. Results: Only 7.8% of municipalities reported offering HFIP in 2021. The odds of having an HFIP were higher in municipalities with a food policy council (aOR 2.8; 95%CI: 1.9, 3.9) compared to those without. Larger communities (size ≥ 50,000 reported 24.6%) and those with a higher prevalence of residents living in poverty were also more likely to offer HFIP. Conclusions: Few municipalities reported offering HFIP. Results suggested that engaging institutions and individuals (e.g., via food access coalitions) may be strategies that could support municipalities initiating and implementing HFIP to improve diet quality and reduce chronic disease risk.