Increasing Access to Healthy Foods for Low-Income Residents in Santa Clara County, CA

Background: As part of a three-year Partnerships to Improve Community Health (PICH) grant from the CDC, Santa Clara County, CA has worked to increase CalFresh EBT (Supplemental Food Assistance Program, formerly known as food stamps) use at farmers’ markets among low-income residents. Focus groups and intercept surveys conducted in 2015 revealed that CalFresh recipients encountered barriers to using their benefits at farmers’ markets, including: English-only materials; lack of awareness about CalFresh/EBT acceptance at farmers’ markets; perception that prices are high; and confusion regarding the redemption process to purchase produce.

Program background: The Santa Clara County Public Health Department’s Chronic Disease & Injury Prevention Unit collaborated with John Snow, Inc. (JSI), a public health research and consulting organization, and Fresh Approach to increase awareness and incentivize CalFresh recipients to visit farmers’ markets over the past three years. SCCPHD and partners implemented educational and promotional strategies advertising CalFresh/EBT use at five markets in low-income neighborhoods. Selected markets also participated in the “Market Match” program which provides CalFresh participants a dollar-for-dollar match of up to $10 towards fruit and vegetable purchases. Strategies included bus, radio, and digital/social media ads; creation of multi-lingual flyers, posters, postcards, and signage (English, Spanish, and Vietnamese); distribution of $3 coupon incentives; informational text messages; and on-site outreach and promotions. SCCPHD partnered with the Social Services Agency and 100+ community organizations to distribute 35,000 $3 coupons to CalFresh recipients and other low-income shoppers for use at farmers’ markets. 

Evaluation Methods and Results: To evaluate the CalFresh campaign, we tracked the distribution, placement, and reach of physical materials, digital and social advertisements as well as CalFresh spending and coupon redemption at the markets. Awareness of CalFresh/EBT acceptance at markets was assessed through intercept surveys conducted at the markets in Years 1 and 2 to measure change over time. These efforts resulted in a 108% increase in CalFresh dollars spent and an 830% increase in matching dollars (Market Match) distributed to customers to purchase produce from 2014 to 2016 at participating markets. A total of 949 coupons were redeemed by market shoppers during the campaign period. Shoppers reported an 11% increase in awareness of CalFresh acceptance, and 58% of market shoppers recalled hearing or seeing campaign messages. Paid and earned media promoting CalFresh/EBT use and Market Match generated an estimated 6.7 million media impressions (non-unique). Ads were placed in three languages, including English, Spanish, and Vietnamese. Outdoor ads, social media, and radio ads generated the most impressions across channels. 

Conclusions: Using a combination of communication strategies and media outlets, Santa Clara County Public Health Department reduced barriers for CalFresh recipients in accessing and utilizing local farmers’ markets to purchase fresh produce. Multi-lingual social media and digital ads combined with on-the-ground outreach, coupon incentives, and text message reminders resulted in increased purchasing and successfully reached low-income residents and CalFresh recipients in the county.

Implications for research and/or practice: Effective partnerships with community organizations were essential to reaching the low-income target populations. Public health departments and other agencies should consider implementing social marketing strategies through digital and mobile advertisements to promote CalFresh use among low-income shoppers.