Running Header: RESEARCH PROPOSAL

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Research Proposal
Annie Ashton
For
Husson University
BA 600 Research Methods in Business and Education
Fall, 2014
Dr. Gerald Wright
Introduction
According to the Centers for Disease control, 35.7% of adults in the United States are
obese, defined as having a body mass index (BMI) of more than 30%. Likewise, 31.7% of
children and adolescents are either overweight or obese (Gabe, 2012). The health implications
for these people are severe, as are the economic costs of treating the medical issues and indirect
factors that come along. Annually, the medical costs associated with adult obesity is $147 billion
as of 2008, an additional $14.1 billion in association with childhood obesity. By finding solutions
to childhood obesity, it can assist in resolving the issues of adult obesity.
Among studies, a prevalent challenge of parents was the cost of healthier food options,
especially in low-income households. 21% of children in the United States live in households
labeled as food insecure (Eisenmann, Gundersen, Lohman, Garasky, & Stewart, 2011), meaning
that these households lack the financial ability to purchase healthy food options. The
Supplemental Nutrition Assistance Program (SNAP) is an assistance program for qualifying
participants to help with food purchases (Andrews, Bhatta, & Ver Ploeg, 2012). SNAP,
previously named the Food Stamp Program, was renamed in 2008 to reiterate the focus on
nutrition and making healthier choices as participants of the program (Perez, 2011).
Unfortunately, there are very few food exemptions in the SNAP program, unlike the Women,
Infant, and Children (WIC) program which designates specific nutritional foods the participants
can purchase.
Title IV of the 2008 Farm Bill not only renamed the SNAP program, it also cleared the
way for farmers markets to accept SNAP benefits for payment (Perez, 2011). This addition to
the Farm Bill gave farmers the opportunity to reach more customers, but also gave SNAP
participants an opportunity to shop for locally grown foods. Unfortunately, not all farmers
markets have taken advantage of this option.
In Maine, there are 1,241 farms and 111 farmers markets (Maine Department of
Agriculture, Conservation and Forestry (DACF), 2014). Of those markets, 37 accept SNAP
benefits as payment. A handful of these farmers markets offer incentives to their SNAP
customers, usually a 25% to 100% match on their purchase (spend $10, get $2.50 extra in
product).
This study looks at the benefits of increasing the number of participating farmers
markets in SNAP to 100 percent, and increasing the matching incentives for SNAP users at
farmers markets to 100 percent as well, called Double Up Bucks. This program has been
successful in Michigan since 2009, earning $5 million by vendors and farmers. By doing this,
SNAP recipients can purchase more fresh, local food. These healthier options will in turn affect
the eating habits at home for these participants, which should decrease the obesity and
overweight rates of children. As of 2011, the annual costs associated to treating obesity-related
diseases is between $150 billion to $300 billion per year (Glickman & Veneman, 2013).
Statement of the Problem

Many factors influence childhood obesity, leading to obesity or being overweight. In
many cases, a lack of healthy food options and lack of activity are the main factors. By
introducing a program to low-income SNAP participants in which they are able to purchase more
fresh foods at farmers markets, this will in turn affect the obesity and overweight rates of
children, leading to healthy behaviors as they get older.
Purpose of the Study

The purpose of this pragmatic research study is to determine whether SNAP recipients
will shop at farmers markets given the option when matching incentives are offered. As an
extension of this determination, by purchasing healthier options, the obesity and overweight rates
of low-income children who benefit from SNAP will decrease.
Management/Research Question
For the purpose of this study, the following question were addressed:
1. Will all farmers markets participate in a Double Up Bucks program to promote healthier
food options for SNAP recipients?
2. Will more SNAP recipients participate in a Double Up Bucks program at farmers
markets?
3. By participating in Double Up Bucks programs at farmers markets, will childhood
obesity rates in SNAP recipient households decrease?
4. By participating in the Double Up Bucks programs at farmers markets, will there be a
significant economic impact (decrease) in health care costs?
As part of this study, investigation included one research hypothesis:
1. H01: There will be no decrease in obesity and overweight rates in children by replicating
the Double Up Bucks program in Maine farmers markets.
2. Ha1: There will be a decrease in obesity and overweight rates in children by replicating
the Double Up Bucks program in Maine farmers markets.
Theoretical and Conceptual Framework

31.7% of children in the United States are either obese or overweight (Gabe, 2012). For
low-income households which are food insecure, this may be because there is a lack of funds to
purchase healthier food options (Eisenmann et al, 2011). By giving these food insecure
households the availability to purchase healthier options, this can create better eating habits for
children and adolescents as they grow older. This in turn can have a positive impact on the
economic factors related to obesity-related health issues faced by those people who are obese and
overweight.
In Michigan, the Fair Food Networks Double Up Bucks program gives SNAP recipients
the opportunity to double up their spending dollars at farmers markets. By spending $20, they
get $20 in tolkens or on an electronic benefit card to spend on more food. This program has
proven since its inception in 2009 to increase farmers markets revenues, increases SNAP
participation at farmers markets, 93% of SNAP users eat more fruits and vegetables, and 83%
purchased fewer low-nutrition snacks.
In theory, by mirroring the Double Up Bucks program that has been successful in
Michigan and other states, Maine can see a decrease in childhood obesity. By proposing to
increase the number of farmers markets that accept SNAP to 100% and by offering a SNAP
incentive of 100% matching dollar-for-dollar, SNAP recipients will purchase more healthier
options, which will in turn foster better eating habits at home with children.
Literature Review
Under Title IV of Public Law 110-246, The Food, Conservation and Energy Act of 2008
(FCEA), a revision to the Food Stamp Act, section 4001, changed the name of the Food Stamp
Program to the Supplemental Nutrition Assistance Program (SNAP) (2013). According to
legislation, SNAP is intended to permit low-income households to obtain a more nutritious diet
through normal channels of trade by increasing food purchasing power for all eligible
households who apply for participation (2008). The overall goal of the program is to safeguard
the health and well-being of the Nations population by raising levels of nutrition among lowincome households. In some research models, SNAP participation is associated with food
insecurity (Ratcliffe, McKernan, & Zhang, 2011).
Food insecurity is the lack of available food, affecting 15% of all households in the
United States, and 40% of households designated as low-income according to 2009 research
(2011). Certain factors which contribute to food insecurity are distance to travel, cost of travel,
food selection, and food prices. Areas of concerns are those called food deserts, geographic
regions where affordable and nutritious food is difficult to obtain. These could be regions with
low populations or where there are no larger, affordable supermarkets or supercenters, or just the
lack of access to obtain fresh produce and healthier options.
It is estimated that 14 million people live in food deserts (Andrews, Bhatta, & Ver Ploeg,
2012). Of this estimate, approximately 82% live in urban areas. Within these urban areas, a
matter of accessibility is the largest concern. Smaller grocery and corner stores may be of
abundance, but there is very little variety of fresh produce and healthier options, and prices are
considerably higher. Populations within these areas tend to purchase less nutritious food options
and visit restaurants more frequently. According to the USDA, 83.5% of all SNAP benefits were
redeemed at supermarkets or supercenters where the price of products were lower (USDA,
2011). Among SNAP participants, the average travel distance to the nearest supermarket was
approximately 1.8 miles, whereas the average travelled to the nearest store most often used by
both participants and nonparticipants was 4.9 miles. 76% of participants and 85% of
nonparticipants reported using a car for mode of transportation, with an average travel time of
23-24 minutes per trip.
According to the CDCs Behavioral Risk Factor Surveillance System (BRFSS) (WardSmith, 2010), obesity by state ranges from 18.7% in Colorado to 32% in Mississippi. Obesity,
which is defined as a body mass index (BMI) of 30% or above, is a calculation using a persons
height and weight to measure the amount of body fat. Factors which contribute to obesity are
overeating, lack of activity, genetics, as well as food choices. Among children and adolescents in
the United States, 16% are considered to be obese, while 18% are considered overweight
(Eisenmann, Gundersen, Lohman, Garasky, & Stewart, 2011). Is it also estimated that 27% of
children 2 to 5 years old are already overweight or obese (Reynolds, Cotwwright, Polhamus,
Gertel-Rosenberg, & Chang, 2013). As these children and adolescents grow older, the eating and
activity patterns are set into place, and become routine. As adults, they develop health risks
associated with obesity, leading to higher medical expenses and health insurance (Lueke, 2011).
A lower life expectancy is also assumed due to these factors.
The Double Up Food Bucks program was created in 2009 by the Fair Food Network,
located in Michigan (fairfoodnetwork.org, 2014). The program has three goals: bring more
dollars to local farmers, local farmers increase their customer base, and families bring home
healthier food options. SNAP recipients who participate in the Double Up program are able to
purchase locally grown fresh fruits and vegetables, with a double up match in dollars spent.
This gives customers twice as much food, and in return supports the local participating farmers.
Since the inception of this program in Michigan, Fair Food Network has gathered the following
statistics:
1. Customers have purchased more than 3 million pounds of fresh fruits and vegetables
using SNAP benefit and Double Up dollars.
2. 93% of participants report eating more fruits and vegetables, with 83% reporting to
purchase less low-nutrition snacks.
3. Michigan farmers have earned more than $5 million with SNAP and Double Up Bucks.
4. 90% of farmers reported selling more fruits and vegetables, with 85% of those farmers
reporting that they made more money.
5. Sales at farmers markets reached $1.7 million in SNAP sales, which ranks among the top
5 states in the country, although less than 4% of total SNAP participants live in the state.
According to a recent report on obesity, Maine ranks 27th in the United States in adult
obesity at 28.9% as of 2013, and 42nd in children age 10 to 17 at 12.5% as of 2011 (The State of
Obesity: Better Policies for a Healthier Americ, 2014). Approximately half the State of Maine is
considered an unorganized territory, with about 1.9% of the total population, approximately
9,000 permanent residents (Maine Revenue Services - Unorganized Territories, 2014). These
unorganized territories, and many other municipalities and towns, are in what are considered
food deserts. According to the USDA in 2010, 100% of working poor people in Maine that
were eligible for SNAP were receiving benefits (State Supplemental Nutrition Program
Participation Rates in 2010, 2012). There are 140 farmers markets in Maine (Caron, 2014), of
those, 37 markets accept SNAP. Some of those markets are offering incentives to their SNAP
customers, from a 25% to 100% match in dollars spent. These matching dollars come from either
donations or from a non-profit organization called Food AND Medicine.
Methodological Approach and Research Design

The methodological approach and research design of this study is mirrored from a
previous study conducted by the United States Department of Agriculture (USDA) (USDA,
2014), but adjusted to meet the needs of this proposal.
The study is divided into two pieces: the first study is to measure participation and sales
at farmers markets, the second study is to measure health benefits of farmers markets use in
children (height, weight and age).
A confidence range of 95%, or an alpha of .05, will be used. The 2015 and 2016 seasons
have been chosen as the survey period. A sample of four different regions of Maine (Northern,
Eastern, Central, and Southern) has been chosen based on population density. It had been
decided that 3 farmers markets from each of the 4 regions, for 12 total, will become the sample.
Initially, questionnaires will be sent out to all farmers markets that currently accept SNAP
benefits to inform them of the 100% match proposal the study will be conducting. After
gathering the responses from the questionnaire, a determination will be made of which farmers
markets will be part of the study.
Partnering with the Department of Health and Human Services (DHHS), SNAP recipients
will be contacted in regards to a qualitative phone questionnaire. Information regarding the study
will be mailed to SNAP recipients, as well as notice of the phone questionnaire for study
purposes. A sample size of 500 telephone interviews and 100 surveys have been selected as the
minimum allowable to ensure statistical significance for the first stage of the study.
The second stage of the study would be conducted from 2016 to 2026. SNAP recipients
when contacted for the first stage of the study would be asked to contribute information
regarding the health benefits of their children, specifically their age, height and weight, after
yearly well-child checkups. By gathering this information yearly, it is assumed that BMI can be
determined as increasing or decreasing as the study progresses. A sample size of 500 participants
would be needed for statistical significance.
Sample
The primary goal of the sample is to collect data from farmers markets in four different
areas throughout Maine. The first sample will be from Northern Maine, specifically Aroostook
County, the second sample from Eastern Maine (Hancock and Washington counties), a third
sample from Central Maine (Hancock and Penobscot counties) and a fourth sample from
Southern Maine (Cumberland and York counties. Other counties have not been selected for this
sample based on population or distance to other factoring sample populations.
Of the areas determined for the sample, three farmers markets (12 total) will be selected
as sample sites, all having participated in SNAP previously. The following criteria will be
accounted for in the first stage of the study:
1. Duration of market season
2. The specific food items that could be purchased with the incentives (fruits, vegetables,
meat/fish/poultry, dairy products, seeds and plants that produce foods for the household
to eat, and other food items)
3. Number of vendors at the market per week
4. Number of customers shopping per week
5. Number of customers receiving SNAP benefits
For the second stage of the study, the following criteria will be accounted for:
1. Age
2. Height
3. Weight
Data Collection
The first stage of the study will be conducted through the 2015 and 2016 market farmers
seasons, beginning in March and ending in November (this will encompass the majority of the
growing season for fruits and vegetables, still factoring in fresh meat, seed and plant products
available as well). Base data will be collected in 2015, then compared to the data collected in
2016 to compare the differences at the locations. Base data will be in the form of number of
customers total, number of SNAP customers, amount of sales, amount of sales from SNAP
benefits, and amount of sales from Double Up Bucks. The first stage of this study is to prove the
economic benefits of the Double Up Bucks program.
The second stage of the study will be conducted beginning 2016 and ending 2026. This
stage of the study will determine the health benefits of farmers market use. A useful sample of
500 participants would be needed for statistical significance. These participants would be
screened using a qualitative interview questionnaire, and conducted by a qualitative interviewer.
Participants would agree to submit well-child exam information (height, weight and age) every
year for the studys purpose of tracking increases/decreases in BMI.
Data collection also includes qualitative interviews with SNAP participants. The goal is
to conduct approximately 500 telephone interviews of SNAP participants and 100 surveys at
each of the 12 farmers markets in the sample area. Information regarding the survey will be
mailed to SNAP participants with coordinated assistance from the Department of Health and
Human Services. Phone interviews will be scheduled based on participant availability and
conducted by qualitative interviewers. Surveys conducted at the farmers markets will be a 5-
point Likert scale with option of additional comments. All responses received from participants
will remain anonymous and will be stored in a secure location. All data collected will be kept for
a duration of 5 years for future reference.
Data Analysis
A Statistical Package for the Social Sciences (SPSS) software program will be used to
analyze the data collected from the surveys conducted at the farmers markets (University of
Texas at Austin, 2014). This program will take the 5-point Likert scale survey information from
the SNAP participants at the 12 farmers markets, and first check for completeness. Any surveys
that are not complete will be dismissed from the study. It will then assign numerical equivalents
to the scale (5=strongly agree, 1=strongly disagree). A KruskalWallis one-way analysis of
variance measure will be used to analyze the Likert scale responses (Likert Scales and Data
Analyses, 2014).
A thematic analysis will be performed for the telephone interview data collected (Burke
& Miller, 2001). A pre-determined script will be used for the interviews for consistency, and
specific values will be used for key phrases and code words. This form of analysis will be used to
identify themes in the participant responses.
Data gathered from the second phase of the study will be entered into an Excel
spreadsheet. Each year, SNAP participants will submit data from well-child checkups (height,
weight and age) to track BMI (weight in pounds divided by height in inches squared multiplied
by 703). This data will then be entered into a dot-plot graph to track for increases or decreases.
Ethical Considerations
All SNAP participants were informed of the research proposal, and written permission
was given to the researchers. Researchers were aware of HIPAA regulations due to the nature of
the information gathered from SNAP participants and well-child checkup data. Verbal consent
was given for telephone interviews, and all participants were made aware that data collected
would be stored in a safe and secure location.
All participants were treated fairly, and all information gathered remains anonymous (The
National Commission for the Protection of Human Subjects of Research, 1979). Because of the
delicate nature of the study, there were no judgments made on the topic of obesity. All persons
were given the opportunity to decline participation in the study.
Certain risk factors considered were the following:
1. Participants failing to report accurate data (well-child checkups)
2. Possible fraud at farmers markets
3. Incorrect data collection methods
4. Farmers not familiar with SNAP redemption may record false information
5. Participants may not give accurate/honest answers when completing questionnaires or
surveys
The benefits of this study would be the following:

1. Farmers market sales increase
2. SNAP recipients have more available fresh products
3. Overweight and obesity rates among SNAP-recipient children decrease, which in turn
should decrease adult obesity rates
References
Public Law 11024 (7 USC June 18, 2008).
(2014). Retrieved from fairfoodnetwork.org: http://www.fairfoodnetwork.org/what-wedo/projects/double-up-food-bucks
(2014). Retrieved from University of Texas at Austin: http://www.utexas.edu/its/products/spss/
Andrews, M., Bhatta, R., & Ver Ploeg, M. (2012, December 10). An Alternative to Developing
Stores in Food Deserts: Can Change in SNAP Benefits Make a Difference? Applied
Economics, Perspectives and Policy, pp. 150-170.
Burke, L. A., & Miller, M. K. (2001, May). Phone Interviewing as a Means of Data
Collection:Lessons Learned and Practical Recommendations. Retrieved from Qualitative
Social Research: http://www.qualitative-research.net/index.php/fqs/article/view/959/2094
Caron, S. W. (2014, July 28). More farmers markets accepting SNAP this season. Retrieved from
Bangor Daily News: http://bangordailynews.com/2014/07/28/living/food/more-farmersmarkets-accepting-snap-this-season/
Eisenmann, J. C., Gundersen, C., Lohman, B. J., Garasky, S., & Stewart, S. D. (2011, May). Is
Food Insecurity Related to Overweight and Obesity in children and Adolescents? A
Summary of Studies, 1995-2009. Obesity Review, pp. e73-e83.
Gabe, T. (2012). Medical Costs of Childhood Obesity in Maine. School of Economics Staff
Paper, 603.
Glickman, D., & Veneman, A. M. (2013). The Essential Role Of Food and Farm Policy in
Improving Health. Health Affairs, 32(9), 1519-1521. doi:10.1377/hlthaff.2013.0857
Likert Scales and Data Analyses. (2014). Retrieved from Quality Progress: http://asq.org/qualityprogress/2007/07/statistics/likert-scales-and-data-analyses.html
Lueke, L. (2011, April-June). Devouring Childhood Obesity by Helping Children Help

Themselves. Journal of Legal Medicine, pp. 205-220.
Maine Department of Agriculture, Conservation and Forestry (DACF). (2014). Retrieved from
Get Real Maine:
http://www.getrealmaine.com/index.cfm/fuseaction/findafarm.main/index.htm
Maine Revenue Services - Unorganized Territories. (2014). Retrieved from maine.gov:
http://www.maine.gov/revenue/propertytax/unorganizedterritory/unorganized.htm
Perez, J. L. (2011). Farmer's Markets Take Food Stamps: Making An Impact on the American
Diet? Vermont Journal of Environmental Law, 421-425.
Ratcliffe, C., McKernan, S.-M., & Zhang, S. (2011, July 1). How Much Does the Supplemental
Nutrition Assistance Program Reduce Food Insecurity? American Journal of Agricultural
Economics, pp. 1082-1098.
Reynolds, M. A., Cotwwright, C. J., Polhamus, B., Gertel-Rosenberg, A., & Chang, D. (2013).
Obesity Prevention in the Early Care and Education Setting: Successful Initiatives across
a Spectrum of Opportunities. Journal of Law, Medicine & Ethics, pp. 8-18.
State Supplemental Nutrition Program Participation Rates in 2010. (2012, December). Retrieved
from ers.usda.gov: www.fns.usda.gov/sites/default/files/Reaching2010.pdf
Supplemental Nutrition Assistance Program (SNAP). (2013, November 17). Retrieved from
www.usda.gov: http://www.fns.usda.gov/snap/2008-farm-bill
The National Commission for the Protection of Human Subjects of Research. (1979). Ethical
Principles and Guidelines for the Protection of Human Subjects of Research. Department
of Health, Education, and Welfare.
The State of Obesity: Better Policies for a Healthier Americ. (2014). Retrieved from Trust for
America's Health and Robert Wood Johnson Foundation:
http://stateofobesity.org/states/me/
USDA. (2014). Farmers Market Incentive Provider Study.
Ward-Smith, P. (2010, July/August). Obesity Americas Health Crisis. Urologic Nursing, 30(4),
pp. 242-245.

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