Food InsecurityNCT06992947
Impact of Healthy Food Subsidies on Diet Quality and Food Security
A study testing Healthy food subsidy: $27/household/week, Healthy food subsidy: $54/household/week and Healthy food subsidy: $81/household/week in people with Food Insecurity, run by University of Calgary at 1 site in Canada.
Trial summary
The British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) provides lower-income households with coupons to purchase healthy foods at farmers' markets. This pragmatic randomized controlled trial (RCT) will examine the effectiveness and cost-effectiveness of two higher subsidies for healthy food ($54/weeek… Read more about this study
- Who is it for?
- Ages 6 to 64 years
- Conditions the study is for
- Food Insecurity
- What is being tested?
- Healthy food subsidy: $27/household/week, Healthy food subsidy: $54/household/week and Healthy food subsidy: $81/household/week
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 538 participants
- Where
- 1 siteCanada
- Study dates
- 7 Jun 2025to 16 Dec 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 6 to 64 years
- All sexes
- No healthy volunteers
- Child, Adult
Who may be able to join
- Meet existing FMNCP-specific annual household income eligibility cut-offs that account for the local cost of living
- Have 2-5 members in the household, specifically with a parent 18-64 years and a child 6-17 years. If there are multiple eligible individuals, the parent who is the primary food shopper and the youngest child will be enrolled.
- Parent-child dyads must reside together ≥5 days/week
- Are the only dyad in their household participating in the study
- Have access to the internet and a camera
- Able to communicate in English or have someone to translate
Who cannot join
- Trying to conceive, pregnant or breastfeeding
- Participating in other trials that might interfere with the intervention
- Reside in a facility that provides meals (e.g., shelter, long-term care) or where they cannot prepare meals (e.g., hotel)
- Anticipate being outside of their community for >2 consecutive weeks during the study
- Expect to move to a non-FMNCP community during the study
- Expect a significant change in their household income or composition during the study
Trial locations and contacts
1 site in 1 country.
Canada1 site
Participants recruited in 93 communities across British Columbia, Canada
Communities Across BC, British Columbia
About this study
Official title: Does the British Columbia Farmers' Market Nutrition Coupon Program Improve the Diet Quality and Food Security of Parents and Children With Lower Incomes? A Dose-response, Pragmatic Randomized Controlled Trial
The British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) provides lower-income households with coupons to purchase healthy foods at farmers' markets. This pragmatic randomized controlled trial (RCT) will examine the effectiveness and cost-effectiveness of two higher subsidies for healthy food ($54/weeek or $81/week), compared to the usual FMNCP healthy food subsidy ($27/week), on the diet quality (primary outcome), food insecurity, and other health-related outcomes of 276 parent-child dyads with lower incomes. 276 parent-child dyads who are enrolled in the FMNCP will be randomly assigned to one of the three subsidy arms. Participants will receive 16 weeks of coupons that can be redeemed for up to 20 weeks. Outcomes will be assessed in one parent (18-64 years) and child (6-17 years) from each household pre-, mid- and post-intervention.
Read the detailed description
Background: The British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) is a healthy eating initiative designed to facilitate access to nutritious food for lower-income households. The program provides households with 16 weeks of coupons valued at $27/week to purchase healthy foods at BC farmers' markets, including fruits, vegetables, dairy, meat, poultry, fish, eggs, nuts, fruit and vegetable plants, honey and herbs. The expectation is that individuals will purchase and consume healthier foods when they are financially supported to do so, and that their overall well-being and health will improve as a result.
In a prior randomized controlled trial (RCT) in adults, the investigators found that the FMNCP did not improve adults' diet quality; however, it did reduce household food insecurity by 79%. It is hypothesized that parents in the prior RCT predominantly used their subsidies to feed their children and that higher subsidies are needed to ensure both parents and children benefit. A novel dose-response RCT among parent-child dyads is essential to examine how variations in subsidy amounts affect distinct outcomes among parents and children.
This pragmatic RCT will examine the effectiveness and cost-effectiveness of two higher subsidies for healthy food, compared to the usual FMNCP healthy food subsidy, on the diet quality (primary outcome), food insecurity, and other health-related outcomes of 276 parent-child dyads with lower incomes. The primary outcome is overall diet quality post-intervention. Secondary outcomes mid- and post-intervention include: 1) Other dietary outcomes: overall diet quality (mid-intervention only), diet quality components, food purchasing, intake of ultra-processed foods, energy intake; 2) Food insecurity: food insecurity status and severity, nutrition security, parental shielding; and 3) Self-reported health-related outcomes: mental well-being, sense of community, perceived stress, perceived health, food literacy, BMI.
Methods: In this single-blind, three-arm, parallel-group pragmatic RCT, 276 parent-child dyads in lower-income households will be randomized to receive the usual FMNCP healthy food subsidy ($27/week) or a subsidy that is two ($54/week) or three times ($81/week) higher. Participants will receive 16 weeks of coupons that can be redeemed for up to 20 weeks. Outcomes will be assessed in one parent (18-64 years) and one child (6-17 years) from each household pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons). Dietary intake will be collected via two 24-hour dietary recalls using the Automated Self-Administered 24-hour Dietary Recall at each time point to assess diet quality. Foods purchased with coupons will be assessed by analyzing pictures taken by participants. Food insecurity and other health-related outcomes will be assessed using validated self-reported instruments. Mixed effects regression will assess the effects of the interventions, relative to the usual food subsidy, on outcomes in parents and children. A full incremental analysis will quantify the cost-effectiveness ratios of the three healthy food subsidies.
- Conditions
- Food Insecurity
- Being tested
- Healthy food subsidy: $27/household/week, Healthy food subsidy: $54/household/week, Healthy food subsidy: $81/household/week, Nutrition skill-building
- Keywords
- Randomized controlled trial, diet quality, food insecurity, low-income, healthy food subsidy, adults, children, parental shielding, dose-response, farmers market
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Healthy food subsidy: $27/household/weekOther
Participants receive 16 weeks of coupons valued at $27/week to purchase healthy foods at BC farmers' markets. Eligible foods include vegetables, fruits, dairy, meat, poultry, fish, eggs, nuts, vegetable and fruit plants, honey and herbs.
Healthy food subsidy: $54/household/weekOther
Participants receive 16 weeks of coupons valued at $54/week to purchase healthy foods at BC farmers' markets. Eligible foods include vegetables, fruits, dairy, meat, poultry, fish, eggs, nuts, vegetable and fruit plants, honey and herbs.
Healthy food subsidy: $81/household/weekOther
Participants receive 16 weeks of coupons valued at $81/week to purchase healthy foods at BC farmers' markets. Eligible foods include vegetables, fruits, dairy, meat, poultry, fish, eggs, nuts, vegetable and fruit plants, honey and herbs.
Nutrition skill-buildingOther
Participants are eligible, but not required, to attend optional nutrition skill-building activities (e.g. cooking and gardening classes).
| Study group | Role | What they receive |
|---|---|---|
| SUBSIDY-2 | Experimental | Participants in this group will receive 16 weeks of coupons valued at $54/household/week, which is two times higher than the usual FMNCP subsidy. The subsidy will be provided in the form of coupons that can be used to purchase healthy foods at BC farmers' markets, including vegetables, fruits, dairy, meat, poultry, fish, eggs, nuts, vegetable and fruit plants, honey and herbs. Participants will also be invited to participate in nutrition skill-building activities (e.g. cooking and gardening classes) offered by community partners. Participation in these activities is optional, which is consistent with the existing FMNCP. Receives: Other: Healthy food subsidy: $54/household/week; Other: Nutrition skill-building |
| SUBSIDY-3 | Experimental | Participants in this group will receive 16 weeks of coupons valued at $81/household/week, which is three times higher than the usual FMNCP subsidy. The subsidy will be provided in the form of coupons that can be used to purchase healthy foods at BC farmers' markets, including vegetables, fruits, dairy, meat, poultry, fish, eggs, nuts, vegetable and fruit plants, honey and herbs. Participants will also be invited to participate in nutrition skill-building activities (e.g. cooking and gardening classes) offered by community partners. Participation in these activities is optional, which is consistent with the existing FMNCP. Receives: Other: Healthy food subsidy: $81/household/week; Other: Nutrition skill-building |
| SUBSIDY-Usual | Active comparator | Participants in this group will receive 16 weeks of coupons valued at $27/household/week, which is the usual FMNCP subsidy. The subsidy will be provided in the form of coupons that can be used to purchase healthy foods at BC farmers' markets, including vegetables, fruits, dairy, meat, poultry, fish, eggs, nuts, vegetable and fruit plants, honey and herbs. Participants will also be invited to participate in nutrition skill-building activities (e.g. cooking and gardening classes) offered by community partners. Participation in these activities is optional, which is consistent with the existing FMNCP. Receives: Other: Healthy food subsidy: $27/household/week; Other: Nutrition skill-building |
What is being measured
The primary outcome is the main question the study is designed to answer.
Overall Diet Quality in Parents
Difference between intervention groups and SUBSIDY-Usual in diet quality by Healthy Eating Food Index-2019 scores in parents. Dietary intake will be collected via two 24-hour dietary recalls at each time point to calculate diet quality. Scores can range from 0-80. A higher score indicates a higher diet quality.
Measured: Assessed pre- and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Overall Diet Quality in Children
Difference between intervention groups and SUBSIDY-Usual in diet quality by Healthy Eating Food Index-2019 scores in children. Dietary intake will be collected via two 24-hour dietary recalls at each time point to calculate diet quality. Scores can range from 0-80. A higher score indicates a higher diet quality.
Measured: Assessed pre- and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Secondary outcomes (25)
Overall Diet Quality in Parents
Difference between intervention groups and SUBSIDY-Usual in diet quality by Healthy Eating Food Index-2019 scores in parents. Dietary intake will be collected via two 24-hour dietary recalls at each time point to calculate diet quality. Scores can range from 0-80. A higher score indicates a higher diet quality.
Measured: Assessed pre- and mid-intervention (i.e., after 8 weeks of coupons have been distributed)
Overall Diet Quality in Children
Difference between intervention groups and SUBSIDY-Usual in diet quality by Healthy Eating Food Index-2019 scores in children. Dietary intake will be collected via two 24-hour dietary recalls at each time point to calculate diet quality. Scores can range from 0-80. A higher score indicates a higher diet quality.
Measured: Assessed pre- and mid-intervention (i.e., after 8 weeks of coupons have been distributed)
Diet Quality Component Scores in Parents
Difference between intervention groups and SUBSIDY-Usual in diet quality component scores by Healthy Eating Food Index-2019 in parents. Dietary intake will be collected via two 24-hour dietary recalls at each time point to calculate diet quality. Scores can range from 0-5 or 0-10 depending on the component. A higher score indicates higher intake of the specified component, with the exception of moderation components (higher score indicates lower intake).
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Diet Quality Component Scores in Children
Difference between intervention groups and SUBSIDY-Usual in diet quality component scores by Healthy Eating Food Index-2019 in children. Dietary intake will be collected via two 24-hour dietary recalls at each time point to calculate diet quality. Scores can range from 0-5 or 0-10 depending on the component. A higher score indicates higher intake of the specified component, with the exception of moderation components (higher score indicates lower intake).
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Percent Energy from Ultra-Processed Foods in Parents
Difference between intervention groups and SUBSIDY-Usual in percent of energy consumed from ultra-processed foods in parents. Two dietary recalls will be used to calculate percent energy from ultra-processed foods using the NOVA classification.
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Percent Energy from Ultra-Processed Foods in Children
Difference between intervention groups and SUBSIDY-Usual in percent of energy consumed from ultra-processed foods in children. Two dietary recalls will be used to calculate percent energy from ultra-processed foods using the NOVA classification.
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Household Food Insecurity Status
Difference between intervention groups and SUBSIDY-Usual in household food insecurity status (food secure or food insecure) in the past 30 days. Health Canada's 18-item Household Food Security Survey Module will be used to assess whether households experienced food insecurity in the past 30 days. If there are no affirmative responses to any of the 18 items households will be classified as food secure; otherwise they will be classified as food insecure (i.e., if there are 1 or more affirmative responses).
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Parental Shielding
Difference between intervention groups and SUBSIDY-Usual in parental shielding (food secure; food insecure with shielding; and food insecure without shielding) in the past 30 days. Health Canada's 18-item Household Food Security Survey will be used to assess parental shielding in the past 30 days. Shielding exists when there are one or more affirmative responses on the 10-item adult scale, but there are no affirmative responses on the 8-item child scale.
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Household Food Insecurity Severity
Difference between intervention groups and SUBSIDY-Usual in experiences of household food insecurity in the past 30 days. Health Canada's 18-item Household Food Security Survey Module will be used to assess experiences of marginal (1 affirmative response on the adult and/or child scale), moderate (2-5 affirmative responses on the adult scale or 2-4 affirmative responses on the child scale), and severe (≥6 affirmative responses on the adult scale or ≥5 affirmative responses on the child scale) household food insecurity in the past 30 days.
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Household Nutrition Security
Difference between intervention groups and SUBSIDY-Usual in nutrition security scores. Gretchen Swanson Centre's Nutrition Security Survey will be used to assess experiences of nutrition security at a household level. The scale will be modified to the past 30 days. The 4-item survey uses a 5-point Likert scale. Each item is scored from 0=always to 4=never. Total scores are reported as a mean of the item scores. A higher score indicates a greater degree of household nutrition security.
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Proportion of Coupons Spent on Foods Classified as Minimally Processed, Culinary, Ingredients, Processed, and Ultra-processed
Difference between intervention groups and SUBSIDY-Usual in proportion of coupons (based on dollar value) spent on foods classified as minimally processed, culinary, ingredients, processed, and ultra-processed. Participants will take photos of the foods purchased with coupons and report the number of coupons used to purchase the items. Foods purchased will be classified using the NOVA food classification system as minimally processed, culinary, ingredients, processed, and ultra-processed.
Measured: Assessed each time participants purchase food using FMNCP coupons from pre- to post-intervention (i.e., when the farmers' market a household shops at closes for the season)
Proportion of Coupons Spent on Foods Classified as Very Poor, Poor, Fair, Good and Excellent Choice
Difference between intervention groups and SUBSIDY-Usual in proportion of coupons (based on dollar value) spent on foods classified as very poor, poor, fair, good, and excellent choice. Participants will take photos of the foods purchased with coupons and report the number of coupons used to purchase the items. Foods purchased will be classified using the Canadian Food Scoring System as very poor, poor, fair, good, and excellent choice.
Measured: Assessed each time participants purchase food using FMNCP coupons from pre- to post-intervention (i.e., when the farmers' market a household shops at closes for the season)
Proportion of Coupons Spent on Foods Classified as Serve frequently and Serve infrequently
Difference between intervention groups and SUBSIDY-Usual in proportion of coupons (based on dollar value) classified as serve frequently and serve infrequently. Participants will take photos of the foods purchased with coupons and report the number of coupons used to purchase the items. Foods purchased will be classified using the British Columbia Food Toolkit as serve frequently and serve infrequently.
Measured: Assessed each time participants purchase food using FMNCP coupons from pre- to post-intervention (i.e., when the farmers' market a household shops at closes for the season)
Mental Well-Being in Parents
Difference between intervention groups and SUBSIDY-Usual in Warwick-Edinburgh Mental Well-Being Scale scores (range 14-70) in the past 2 weeks in parents. A higher score indicates better mental well-being.
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Mental Well-Being in Children
Difference between intervention groups and SUBSIDY-Usual in Stirling Children's Wellbeing Scale scores (range 12-60) in the past 2 weeks in children. A higher score indicates better mental well-being.
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Sense of Community in Parents
Difference between intervention groups and SUBSIDY-Usual in Brief Sense of Community Scale scores in parents. Responses range from 1 (strongly disagree) to 5 (strongly agree). Total scores range from 8-40. A higher score indicates a stronger sense of community.
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Perceived Stress in Parents
Difference between intervention groups and SUBSIDY-Usual in perceived stress in parents. The 10-item Perceived Stress Scale-10 will be used to assess perceived stress over the past month in parents. Scores can range from 0-40. Higher scores indicate higher perceived stress.
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Perceived Stress in Children
Difference between intervention groups and SUBSIDY-Usual in perceived stress in children. The 14-item Perceived Stress Scale for Children will be used to assess perceived stress in children over the previous week. Scores can range from 0-39. Higher scores indicate higher perceived stress.
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Food Literacy in Parents
Difference between intervention groups and SUBSIDY-Usual in food literacy scores in parents. Food literacy is measured via the 23-item Canadian Food Literacy Measure. Scores can range from 20-115. Higher scores indicate higher food literacy.
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Self-Rated Health in Parents
Difference between intervention groups and SUBSIDY-Usual in perceived health in parents. Single-item question from the Canadian Community Health Survey used to self-rate current health as poor, fair, good, very good or excellent.
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Self-Rated Health in Children
Difference between intervention groups and SUBSIDY-Usual in perceived health in children. Single-item question from the Canadian Community Health Survey used to self-rate current health as poor, fair, good, very good or excellent.
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Body Mass Index in Parents
Difference between intervention groups and SUBSIDY-Usual in BMI in parents. Self-reported height (cm or inches) and weight (kg or lbs) used to calculate BMI (kg per meter squared).
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Body Mass Index Z-Scores in Children
Difference between intervention groups and SUBSIDY-Usual in BMI in children. Self-reported height (cm or inches) and weight (kg or lbs) used to calculate BMI (kg per meter squared) z-scores .
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Total Energy Intake in Parents
Difference between intervention groups and SUBSIDY-Usual in total energy intake in parents. Dietary intake will be collected via two 24-hour dietary recalls at each time point to calculate total energy intake.
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons).
Total Energy Intake in Children
Difference between intervention groups and SUBSIDY-Usual in total energy intake in children. Dietary intake will be collected via two 24-hour dietary recalls at each time point to calculate total energy intake.
Measured: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons).
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 May 2025
- Study start7 Jun 2025
- Primary completion16 Dec 2025
- Study completion16 Dec 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Food InsecurityStudies of the same condition, open and under way.
- More trials run by University of CalgaryThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind
- Who is masked
- Care provider, Investigator, Outcomes assessor
- Enrolment
- 538 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Calgary
- Sponsor type
- University, hospital or other
- Collaborators
- Canadian Institutes of Health Research (CIHR), British Columbia Farmers' Market Nutrition Coupon Program, BC Association of Farmers' Markets
- Responsible party
- Principal investigator, Dana Lee Olstad, University of Calgary
- Investigators
- Dana Lee Olstad, PhD, RD, Principal investigator, University of Calgary
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06992947
- Sponsor's protocol ID
- REB24-1774
- Other IDs
- 195904
- Status last verified
- Sep 2026
- First submitted
- 9 May 2025
- Last updated
- 28 Sep 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Anonymized participant data will be available from the authors upon reasonable request.
Publications
Olstad DL, Campbell DJ, Sajobi TT, O'Hara H, Leblanc P, McCormack GR, Radin-Pereira L, Lee YY, Aktary ML, Minaker LM, Spackman E. Does the British Columbia Farmers' Market Nutrition Coupon Program improve the diet quality and food security of parents and children with lower incomes? Protocol for a dose-response, pragmatic randomized controlled trial. Nutr Health. 2026 Sep 12:2601060261473062. doi: 10.1177/02601060261473062. Online ahead of print.
PubMed 42731058
Study at a glance
From the registry record, last updated by the sponsor on 28 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Does the British Columbia Farmers' Market Nutrition Coupon Program Improve the Diet Quality and Food Security of Parents and Children With Lower Incomes? A Dose-response, Pragmatic Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT06992947
- Acronym / sponsor ID
- REB24-1774
- Conditions
- Food Insecurity
- Keywords
- Randomized controlled trial, diet quality, food insecurity, low-income, healthy food subsidy, adults, children, parental shielding
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 538 participants (actual)
- Lead sponsor
- University of CalgaryUniversity, hospital or other
- Collaborators
- Canadian Institutes of Health Research (CIHR), British Columbia Farmers' Market Nutrition Coupon Program, BC Association of Farmers' Markets
- Study start
- 7 Jun 2025 (actual)
- Primary completion
- 16 Dec 2025 (actual)
- Study completion
- 16 Dec 2025 (actual)
- First posted
- 28 May 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) provides lower-income households with coupons to purchase healthy foods at farmers' markets. This pragmatic randomized controlled trial (RCT) will examine the effectiveness and cost-effectiveness of two higher subsidies for healthy food ($54/weeek or $81/week), compared to the usual FMNCP healthy food subsidy ($27/week), on the diet quality (primary outcome), food insecurity, and other health-related outcomes of 276 parent-child dyads with lower incomes. 276 parent-child dyads who are enrolled in the FMNCP will be randomly assigned to one of the three subsidy arms. Participants will receive 16 weeks of coupons that can be redeemed for up to 20 weeks. Outcomes will be assessed in one parent (18-64 years) and child (6-17 years) from each household pre-, mid- and post-intervention.
Detailed description
Background: The British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) is a healthy eating initiative designed to facilitate access to nutritious food for lower-income households. The program provides households with 16 weeks of coupons valued at $27/week to purchase healthy foods at BC farmers' markets, including fruits, vegetables, dairy, meat, poultry, fish, eggs, nuts, fruit and vegetable plants, honey and herbs. The expectation is that individuals will purchase and consume healthier foods when they are financially supported to do so, and that their overall well-being and health will improve as a result.
In a prior randomized controlled trial (RCT) in adults, the investigators found that the FMNCP did not improve adults' diet quality; however, it did reduce household food insecurity by 79%. It is hypothesized that parents in the prior RCT predominantly used their subsidies to feed their children and that higher subsidies are needed to ensure both parents and children benefit. A novel dose-response RCT among parent-child dyads is essential to examine how variations in subsidy amounts affect distinct outcomes among parents and children.
This pragmatic RCT will examine the effectiveness and cost-effectiveness of two higher subsidies for healthy food, compared to the usual FMNCP healthy food subsidy, on the diet quality (primary outcome), food insecurity, and other health-related outcomes of 276 parent-child dyads with lower incomes. The primary outcome is overall diet quality post-intervention. Secondary outcomes mid- and post-intervention include: 1) Other dietary outcomes: overall diet quality (mid-intervention only), diet quality components, food purchasing, intake of ultra-processed foods, energy intake; 2) Food insecurity: food insecurity status and severity, nutrition security, parental shielding; and 3) Self-reported health-related outcomes: mental well-being, sense of community, perceived stress, perceived health, food literacy, BMI.
Methods: In this single-blind, three-arm, parallel-group pragmatic RCT, 276 parent-child dyads in lower-income households will be randomized to receive the usual FMNCP healthy food subsidy ($27/week) or a subsidy that is two ($54/week) or three times ($81/week) higher. Participants will receive 16 weeks of coupons that can be redeemed for up to 20 weeks. Outcomes will be assessed in one parent (18-64 years) and one child (6-17 years) from each household pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons). Dietary intake will be collected via two 24-hour dietary recalls using the Automated Self-Administered 24-hour Dietary Recall at each time point to assess diet quality. Foods purchased with coupons will be assessed by analyzing pictures taken by participants. Food insecurity and other health-related outcomes will be assessed using validated self-reported instruments. Mixed effects regression will assess the effects of the interventions, relative to the usual food subsidy, on outcomes in parents and children. A full incremental analysis will quantify the cost-effectiveness ratios of the three healthy food subsidies.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (care provider, investigator, outcomes assessor)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| SUBSIDY-2 | Experimental | Other: Healthy food subsidy: $54/household/week, Other: Nutrition skill-buildingParticipants in this group will receive 16 weeks of coupons valued at $54/household/week, which is two times higher than the usual FMNCP subsidy. The subsidy will be provided in the form of coupons that can be used to purchase healthy foods at BC farmers' markets, including vegetables, fruits, dairy, meat, poultry, fish, eggs, nuts, vegetable and fruit plants, honey and herbs. Participants will also be invited to participate in nutrition skill-building activities (e.g. cooking and gardening classes) offered by community partners. Participation in these activities is optional, which is consistent with the existing FMNCP. |
| SUBSIDY-3 | Experimental | Other: Healthy food subsidy: $81/household/week, Other: Nutrition skill-buildingParticipants in this group will receive 16 weeks of coupons valued at $81/household/week, which is three times higher than the usual FMNCP subsidy. The subsidy will be provided in the form of coupons that can be used to purchase healthy foods at BC farmers' markets, including vegetables, fruits, dairy, meat, poultry, fish, eggs, nuts, vegetable and fruit plants, honey and herbs. Participants will also be invited to participate in nutrition skill-building activities (e.g. cooking and gardening classes) offered by community partners. Participation in these activities is optional, which is consistent with the existing FMNCP. |
| SUBSIDY-Usual | Active comparator | Other: Healthy food subsidy: $27/household/week, Other: Nutrition skill-buildingParticipants in this group will receive 16 weeks of coupons valued at $27/household/week, which is the usual FMNCP subsidy. The subsidy will be provided in the form of coupons that can be used to purchase healthy foods at BC farmers' markets, including vegetables, fruits, dairy, meat, poultry, fish, eggs, nuts, vegetable and fruit plants, honey and herbs. Participants will also be invited to participate in nutrition skill-building activities (e.g. cooking and gardening classes) offered by community partners. Participation in these activities is optional, which is consistent with the existing FMNCP. |
Who may qualify
- Ages
- 6 to 64 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult
Key inclusion criteria (6 listed)
- Meet existing FMNCP-specific annual household income eligibility cut-offs that account for the local cost of living
- Have 2-5 members in the household, specifically with a parent 18-64 years and a child 6-17 years. If there are multiple eligible individuals, the parent who is the primary food shopper and the youngest child will be enrolled.
- Parent-child dyads must reside together ≥5 days/week
- Are the only dyad in their household participating in the study
- Have access to the internet and a camera
Key exclusion criteria (6 listed)
- Trying to conceive, pregnant or breastfeeding
- Participating in other trials that might interfere with the intervention
- Reside in a facility that provides meals (e.g., shelter, long-term care) or where they cannot prepare meals (e.g., hotel)
- Anticipate being outside of their community for >2 consecutive weeks during the study
- Expect to move to a non-FMNCP community during the study
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Healthy food subsidy: $27/household/weekParticipants receive 16 weeks of coupons valued at $27/week to purchase healthy foods at BC farmers' markets. Eligible foods include vegetables, fruits, dairy, meat, poultry, fish, eggs, nuts, vegetable and fruit plants, honey and herbs. | Other | SUBSIDY-Usual |
| Healthy food subsidy: $54/household/weekParticipants receive 16 weeks of coupons valued at $54/week to purchase healthy foods at BC farmers' markets. Eligible foods include vegetables, fruits, dairy, meat, poultry, fish, eggs, nuts, vegetable and fruit plants, honey and herbs. | Other | SUBSIDY-2 |
| Healthy food subsidy: $81/household/weekParticipants receive 16 weeks of coupons valued at $81/week to purchase healthy foods at BC farmers' markets. Eligible foods include vegetables, fruits, dairy, meat, poultry, fish, eggs, nuts, vegetable and fruit plants, honey and herbs. | Other | SUBSIDY-3 |
| Nutrition skill-buildingParticipants are eligible, but not required, to attend optional nutrition skill-building activities (e.g. cooking and gardening classes). | Other | SUBSIDY-2, SUBSIDY-3, SUBSIDY-Usual |
Primary outcome
Overall Diet Quality in Parents
Time frame: Assessed pre- and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Difference between intervention groups and SUBSIDY-Usual in diet quality by Healthy Eating Food Index-2019 scores in parents. Dietary intake will be collected via two 24-hour dietary recalls at each time point to calculate diet quality. Scores can range from 0-80. A higher score indicates a higher diet quality.
Overall Diet Quality in Children
Time frame: Assessed pre- and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Difference between intervention groups and SUBSIDY-Usual in diet quality by Healthy Eating Food Index-2019 scores in children. Dietary intake will be collected via two 24-hour dietary recalls at each time point to calculate diet quality. Scores can range from 0-80. A higher score indicates a higher diet quality.
25 secondary outcomes
Overall Diet Quality in Parents
Time frame: Assessed pre- and mid-intervention (i.e., after 8 weeks of coupons have been distributed)
Overall Diet Quality in Children
Time frame: Assessed pre- and mid-intervention (i.e., after 8 weeks of coupons have been distributed)
Diet Quality Component Scores in Parents
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Diet Quality Component Scores in Children
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Percent Energy from Ultra-Processed Foods in Parents
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Percent Energy from Ultra-Processed Foods in Children
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Household Food Insecurity Status
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Parental Shielding
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Household Food Insecurity Severity
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Household Nutrition Security
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Proportion of Coupons Spent on Foods Classified as Minimally Processed, Culinary, Ingredients, Processed, and Ultra-processed
Time frame: Assessed each time participants purchase food using FMNCP coupons from pre- to post-intervention (i.e., when the farmers' market a household shops at closes for the season)
Proportion of Coupons Spent on Foods Classified as Very Poor, Poor, Fair, Good and Excellent Choice
Time frame: Assessed each time participants purchase food using FMNCP coupons from pre- to post-intervention (i.e., when the farmers' market a household shops at closes for the season)
Proportion of Coupons Spent on Foods Classified as Serve frequently and Serve infrequently
Time frame: Assessed each time participants purchase food using FMNCP coupons from pre- to post-intervention (i.e., when the farmers' market a household shops at closes for the season)
Mental Well-Being in Parents
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Mental Well-Being in Children
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Sense of Community in Parents
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Perceived Stress in Parents
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Perceived Stress in Children
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Food Literacy in Parents
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Self-Rated Health in Parents
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Self-Rated Health in Children
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Body Mass Index in Parents
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Body Mass Index Z-Scores in Children
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)
Total Energy Intake in Parents
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons).
Total Energy Intake in Children
Time frame: Assessed pre-, mid- (i.e., after 8 weeks of coupons have been distributed) and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons).
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 28 Sep 2026.
- Derived from this study: PubMed 42731058Olstad DL, Campbell DJ, Sajobi TT, O'Hara H, Leblanc P, McCormack GR, Radin-Pereira L, Lee YY, Aktary ML, Minaker LM, Spackman E. Does the British Columbia Farmers' Market Nutrition Coupon Program improve the diet quality and food security of parents and children with lower incomes? Protocol for a dose-response, pragmatic randomized controlled trial. Nutr Health. 2026 Sep 12:2601060261473062. doi: 10.1177/02601060261473062. Online ahead of print.
- BC Farmers' Market Nutrition Coupon ProgramLink provided by the sponsor.
- Individual participant dataSharing planned: Yes. Anonymized participant data will be available from the authors upon reasonable request.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Dana Lee Olstad, PhD, RD principal investigator
University of Calgary
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Healthy food subsidy: $27/household/week, Healthy food subsidy: $54/household/week and Healthy food subsidy: $81/household/week in people with Food Insecurity, run by University of Calgary at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 28 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Overall Diet Quality in Parents (time frame: Assessed pre- and post-intervention (i.e., after participants have redeemed at least 14-15 weeks of coupons)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06992947, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Sep 2026.