Maribel Martinez and her son, Ivan Monreal-Martinez, 9, at the Boulder Public Library on the night of the December coupon distribution for the Fruit & Veg program. Rachel Woolf for NPR
It's a chilly, winter evening outside the Boulder Public library, with the sun low in the sky. Inside, tucked behind a spiral staircase, a small crowd begins to file into a meeting room.
They are here for a distribution of coupons for the Fruit and Veg Boulder program, run by county health department staff and community groups. These distributions happen every three months – a family of two gets $40 a month in coupons, families of four and up get $80. They can be used pretty much anywhere in town where you can buy fresh produce – from big grocery stores to farm stands.
"On Tuesday, there was a huge line out the door," says Ana Karina Casas Ibarra, of El Centro AMISTAD, a community nonprofit. "They're willing to come in the cold, in the snow for $80 a month of fruits and veggies, which tells you a lot – people are struggling."
This program is part of a growing wave of nutrition incentive projects across the country. The goal is not just to get food to people who can't afford it, but to allow them to buy and choose their own nutritious food. The federal government pays for many of these programs, but they are often supplements for federal benefits that aren't available to everyone, including people who are undocumented. Some places, like Boulder, are generating their own funding through a local soda tax, which has the added benefit of making unhealthy food less appealing.
At the Boulder library, Casas Ibarra is the busiest person in the room. Over the course of the evening she checks in lots of people, and when she notices folks are missing, she calls them and reminds them – they'll be at the library until 6:30 p.m.
She knows these coupons can make a difference – she's even seen that in her own family. A few years ago, Casas Ibarra's mom found out she was prediabetic – then she began to get these fruit and veggie coupons.
"She started making changes, and she started eating not only more, but different kinds of veggies," Casas Ibarra says. "And she was able to change all of that. She lost 20 pounds; she's not prediabetic anymore."
Casas Ibarra's family is from a village in central Mexico, and her parents and brother have all lived in this area for many years. "People who come from where I come from, they know how to cook from scratch – what is missing is that access to the variety of fruits and veggies," she says.
A SNAP Gap
Behind this effort is a small team from the Boulder County Public Health Department. Several staffers work alongside Casas Ibarra at the folding tables helping to distribute the coupons.
Rachel Arndt, who works at the county health department, stands in the corner surveying all the activity. She says this whole thing started about 10 years ago. The health department already had lots of programs to help people with federal food benefits get extra fresh produce.
Amelia Hulbert (left) from Boulder County Public Health talks to Maribel Martinez and her son, Ivan. Rachel Woolf for NPR
"We really noticed that there were still a lot of folks that were kind of falling through the cracks," Arndt says. Often they didn't qualify for SNAP because of their immigration status, or they made a bit too much money, but they still couldn't afford to buy fresh produce.
"So we started the Fruit and Veg program in 2019 after we had passed the Boulder Sugary Drink tax," she explains.
Now, the program serves about 580 families in both Boulder and neighboring Longmont. Most families are of mixed immigration status.
Every three months, recipients come in, fill out a survey, and get their coupons in a booklet, about the size of a checkbook. Early in the pandemic, they switched to mailing them, but Amelia Hulbert, of Boulder County Public Health, says there are a lot of reasons why these in-person distributions are worthwhile.
"Having that in-person touch point for feedback is super, super valuable," she says. "It's a way to check in that things are running smoothly at the stores – we'll retrain if there are issues at specific stores." The staff even does secret shopper missions, where they try to use expired coupons or use the coupons to buy chips, to make sure everything's working as it should be.
Hulbert says, for her, the in-person distribution events are grounding. "It reminds me of the impact of what we're doing."
Just as the sun sets, Maribel Martinez and her 9-year-old son Ivan come into the library. Martinez is 34 and works in a restaurant. Ivan loves Diary of a Wimpy Kid and is a total ham. When asked his favorite fruit or vegetable, he says: "Milky Way." When his mom asks again, he says there's no contest. "Grapes," he declares. Purple grapes, to be specific.
When Ivan was younger, Martinez was on a federal food program called WIC, which stands for women, infants and children. When he turned five, she no longer qualified. Then she heard from her neighbor about this program, and after two years on the waitlist, she was able to sign up.
"It definitely helps," she says. "Especially with prices right now."
'The triple win'
Boulder Fruit and Veg is typical of what are known as nutrition incentive programs, says Jim Krieger, a professor at the University of Washington and the executive director of a nonprofit called Healthy Food America.
The Boulder County public health department designs and prints the coupons itself, and tracks where every single one is used via serial numbers. Rachel Woolf for NPR
"There's been a fair amount of research on these programs, including some randomized controlled trials, as well as other less rigorous studies," Krieger says. "And they all pretty much show that people who get the nutrition incentives will buy more and will consume more fruits and vegetables." In other words, the programs work, he says.
"There's no silver bullet to preventing diabetes or obesity or heart disease, but clearly, eating more fruits and vegetables is a good idea," Krieger says. "And the participants in the programs love them."
That's certainly true in Boulder and Longmont. The county health department tracks every coupon they hand out via a serial number, and people use them. In the third quarter of 2023, in Longmont, 97% of the coupons were redeemed.
That figure impresses Krieger: "That's a very high number – that's very good."
Nutrition incentive programs have been around for about a dozen years and are pretty widespread across the country, explains Amy Lazarus Yaroch, who runs the national Nutrition Incentive Hub. "These programs are kind of going far and wide," she says. There are new places getting these programs every year, she says. "The first couple of ones have come through for Puerto Rico."
There's broad bipartisan support for the federal grant program in Congress, which she attributes to the fact that it's a "triple win."
"It's good for the consumer who lives in that particular community because they're getting the healthy food, it's good for the farmer who is either at farmer's markets generating income or selling his or her wares at grocery stores, and then it's good for the economy," she says.
What's less common is for communities to use local soda tax revenue as Boulder has done. "I think it's a great idea and very innovative," Yaroch says. But it can't work everywhere. "There are a lot of folks that are not necessarily as happy with disincentives or sugar-sweetened beverage tax programs," she says. "You have to get that buy in."
Krieger thinks there's something kind of poetic about the programs that pair a soda tax with incentives for healthy food – and, he says, so do many recipients who've talked to researchers. "They get a real kick out of knowing it's funded by sugary drink taxes because, they say, 'Wow, so you're turning the sugar that caused my diabetes into fruits and vegetables for me. That is really cool.' "
Two big bags of produce, $45 in coupons
You can see that soda tax at work in a Boulder supermarket called King Soopers. Maribel Martinez – Ivan's mom – points to a pack of 12 cans of Dr. Pepper.
"See, like these are $9," she says. "And if you go outside of Boulder, [to] Lafayette, they're five bucks." The tax is 2 cents per fluid ounce, which works out to $2.88 for that 12 pack.
Maribel Martinez shops the produce section at King Sooper's in Boulder, Colo., the day after picking up her Fruit & Veg coupons. Rachel Woolf for NPR
But Martinez is not here for soda – she has her booklet of fruit and veg coupons. She grabs oranges, a pineapple, baby carrots, some greens, grapes (of course, for Ivan). Her cart is pretty full.
At the checkout line, everything adds up to $51 dollars, including a pack of tortillas, which Martinez can't buy with the coupons. She carefully counts out nine coupons worth $45, and then pays $6 in cash.
Those coupons will go to a regional office for the supermarket, where they'll be counted, and invoiced. The health department will pay the invoice to the grocery chain with the soda tax funds.
Martinez walks out with two big bags of produce, and she only had to pay $6 out of pocket. She has seven coupons left over for the rest of the month, and says she has no doubt she'll be using them.
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