Seattle’s Fresh Bucks program boosts food security and diet but benefits fade when funding ends

By Hugo Francisco de SouzaReviewed by Susha Cheriyedath, M.Sc.Aug 21 2025

Cutting off food benefits erodes hard-won dietary gains, while sustained support shows how simple subsidies can narrow health gaps and strengthen food security.

Study: Healthy Food Benefit Programs, Fruit and Vegetable Consumption, and Food Security. Image Credit: Simxa / Shutterstock

In a recent study published in the JAMA Network Open, researchers leveraged a cohort study comprising 1,973 participants to investigate the on-ground benefits of “Fresh Bucks”, a healthy food benefit program. Specifically, the study evaluated the program’s impact on participant food security and fruit/vegetable consumption.

Study findings revealed that among new enrollees, the program was associated with a 5.5 percentage-point increase in food security and a 7.5 percentage-point increase in the proportion of participants eating fruits and vegetables three or more times daily. By contrast, the study found no statistically significant effect on overall continuous daily fruit and vegetable intake. Conversely, losing the benefit was linked to a substantial decline in these outcomes.

These findings provide robust evidence from randomized program assignment that such programs can be an effective tool for reducing health disparities within America. However, the authors caution that further research is needed to confirm long-term health impacts.

Background

Poor diet quality is a major driver of chronic diseases, with a growing body of evidence identifying low intake of fruits and vegetables as a key contributor. For many low-income and marginalized communities, the high cost and limited availability of fresh produce create significant barriers to healthy eating, contributing to food insecurity and widening health disparities between the rich and the poor.

To address these disparities, “food is medicine” initiatives, including produce prescription programs, have gained popularity as a potential solution. These programs aim to make healthy foods more accessible by providing financial incentives.

Unfortunately, a combination of their relative nascency and the fact that much of the existing research on these programs has been hampered by weak study designs, often lacking a proper comparison group, has made empirical validation of these programs’ benefits hitherto impossible. This has fueled criticism of these initiatives, with a growing voice undermining their impacts.

About the study

The present study aims to address the ongoing debate on “food is medicine” initiatives’ social impacts by conducting a lottery-based cohort study evaluating the outcomes of Seattle’s Fresh Bucks program, which offers a $40 monthly benefit for fruits and vegetables.

The study design treated the program as a natural experiment, leveraging the program’s oversubscription in 2022, which required a random lottery to select participants from a pool of over 6,900 applicants. This randomization created natural treatment (initially selected) and control (waitlisted) groups.

The study simulated and examined two distinct scenarios: 1. ‘Gaining Access’, wherein 757 newly enrolled participants were compared to a waitlisted control group over 6 months, and 2. ‘Losing Access’, wherein a separate group of 1,216 prior beneficiaries was studied, comparing those randomly disenrolled (and placed on the waitlist) to those randomly selected to continue receiving benefits for an additional 6 months.

Study outcomes of interest included: 1. Food security, assessed using the validated 2-item Hunger Vital Signs screener, and 2. Fruit and vegetable consumption was measured using a modified Behavioral Risk Factor Surveillance System (BRFSS) questionnaire. Data for analysis were collected via surveys administered at baseline (October 2021) and follow-up (June 2022).

Study analyses included linear regression models (LRMs) to estimate the program’s effects, controlling for participants’ household size, presence of children, income, race/ethnicity, preferred language, age, preferred retailer, and baseline outcome values to increase statistical power and precision.

Study findings

Study outcomes revealed statistically significant evidence of the Fresh Bucks program’s benefits. Among new applicants, being randomly selected to receive the $40 monthly benefit was associated with marked improvements in both diet and food security compared to being placed on the waiting list.

Specifically, enrollment led to a 5.5 percentage point (pp) increase in food security (95% CI, 0.05-10.91 pp), representing a 31% improvement from the baseline food insecurity rate. Simultaneously, a 7.5 percentage point (pp) increase in the proportion of participants consuming fruits and vegetables three or more times per day (95% CI, 0.39-14.52 pp) was observed, representing a 37% improvement from baseline. However, the study reported that average daily fruit and vegetable intake, measured continuously, did not show a statistically significant change.

The second part of the analysis, which looked at what happens when the benefit is lost because of random participant disenrollment, reinforced these findings. Previously enrolled participants who were randomly disenrolled from the program experienced a significant decline in both outcomes.

Specifically, these participants reported a 4.97 pp reduction in food security (p = .03) and a 7.34 pp decrease in the likelihood of eating produce at least three times a day (p = .01) compared to those who continued to receive benefits for the six additional months. They also ate fruits and vegetables 0.37 fewer times per day on average.

Importantly, the study found heterogeneity in outcomes. Gains in continuous fruit and vegetable intake were significant among lower-income participants (≤200% of the federal poverty level), those identifying as White or Black, and English speakers. By contrast, effects were weaker or absent for Asian participants and Vietnamese speakers, suggesting language or cultural barriers may influence program impact.

Conclusions

The present study’s findings strongly suggest that “food is medicine” initiatives like Fresh Bucks are a powerful tool for addressing diet-related health disparities. The sharp decline in outcomes observed upon disenrollment also highlights the critical importance of sustained funding for these programs to ensure lasting benefits.

This study hence provides rigorous evidence of meaningful improvements offered by these initiatives, highlighting them as a direct and effective way to improve population health. However, given limitations such as a 28.5% survey response rate, reliance on self-reported data, and potential selection bias, the findings should be interpreted with caution and not yet generalized as a “global model.”