Advancing Equity in the Farm Bill: Opportunities for the Gus Schumacher Nutrition Incentive Program (GusNIP).

The Gus Schumacher Nutrition Incentive Program (GusNIP) is a federally funded grant program that provides nutrition incentives-subsidies for purchasing fruits and vegetables (FV)-to Supplemental Nutrition Assistance Program (SNAP) participants. GusNIP currently advances nutrition equity by improving FV access for people with low incomes, yet inequities exist within GusNIP. We sought to identify inequities in GusNIP at the community, organization, partner, and individual levels and develop recommendations for farm bill provisions to make the program more equitable. In Spring 2021, a group of nutrition incentive experts (n = 11) from across the country convened to discuss opportunities to enhance equity in GusNIP. The iterative recommendation development process included feedback from key stakeholders (n = 15) and focus group participants with GusNIP lived experience (n = 12). Eleven recommendations to advance equity in GusNIP in the farm bill emerged across six categories: (1) increase total GusNIP funding, (2) increase funding and support to lower-resourced organizations and impacted communities, (3) eliminate the match requirement, (4) support statewide expansion, (5) expand and diversify retailer participation, and (6) expand program marketing. Including these recommendations in the upcoming and future farm bills would equitably expand GusNIP for SNAP participants, program grantees, and communities across the country.

How the Gus Schumacher Produce Prescription Program Works: An Adaptation of a Nutrition Incentive Theory of Change.

The United States Department of Agriculture's Gus Schumacher Nutrition Incentive Program (GusNIP) supports nutrition incentive (NI) and produce prescription programs (PPRs). PPRs allow healthcare providers to "prescribe" fruits and vegetables (FVs) to patients experiencing low income and/or chronic disease(s) and who screen positive for food insecurity. We developed a Theory of Change (TOC) that summarizes how and why PPRs work, identifies what the programs hope to achieve, and elucidates the causal pathways necessary to achieve their goals. We created the PPR TOC through an iterative, participatory process that adapted our previously developed GusNIP NI TOC. The participatory process involved food and nutrition security experts, healthcare providers, PPR implementors, and PPR evaluators reviewing the existing NI TOC and suggesting modifications to accurately reflect PPRs. The resulting TOC describes the mechanisms, assumptions, rationale, and underpinnings that lead to successful and equitable outcomes. Modifications of the NI TOC centered around equity and focused on inclusion of healthcare as an additional partner and the importance of health and healthcare utilization as outcomes. The TOC describes how the GusNIP PPR program reaches its goals. This understanding will be useful for PPR developers, implementers, funders, and evaluators for describing the pathways, assumptions, and foundations of successful PPRs.

How Does the Gus Schumacher Nutrition Incentive Program Work? A Theory of Change.

Increased fruit and vegetable (FV) intake is associated with decreased risk of nutrition-related chronic diseases. Sociodemographic disparities in FV intake indicate the need for strategies that promote equitable access to FVs. The United States Department of Agriculture's Gus Schumacher Nutrition Incentive Program (GusNIP) supports state and local programs that offer nutrition incentives (NIs) that subsidize purchase of FVs for people participating in the Supplemental Nutrition Assistance Program (SNAP). While a growing body of research indicates NIs are effective, the pathways through which GusNIP achieves its results have not been adequately described. We used an equity-focused, participatory process to develop a retrospective Theory of Change (TOC) to address this gap. We reviewed key program documents; conducted a targeted NI literature review; and engaged GusNIP partners, practitioners, and participants through interviews, workshops, and focus groups in TOC development. The resulting TOC describes how GusNIP achieves its long-term outcomes of increased participant FV purchases and intake and food security and community economic benefits. GusNIP provides NIs and promotes their use, helps local food retailers develop the capacity to sell FVs and accept NIs in accessible and welcoming venues, and supports local farmers to supply FVs to food retailers. The TOC is a framework for understanding how GusNIP works and a tool for improving and expanding the program.

The personal is scientific: Women, gender, and the production of sexological knowledge in Germany and Austria, 1900-1931.

This article addresses the roles women and gender played in the production of sexological knowledge in the early 20th century, particularly in German-speaking Europe. Although existing scholarship focuses almost exclusively on the work of "founding fathers" such as Richard von Krafft-Ebing and Magnus Hirschfeld, women in fact made important contributions to the field. Based on analysis of texts written between 1900 and 1931, this article shows how women were able to successfully mobilize their gender as a privileged form of "situated knowledge," and thereby assert their authority over and superior insights into certain subject areas, namely, female sexualities and sexual difference. At the same time, however, this article also highlights the constraints upon women's gendered standpoint. It shows that women's sexological writing was not just informed by their gender but also by their class and race. Moreover, because gender threatened to cast their work as insufficiently objective and scientific, women cleaved to sexology's rules of evidence and argumentation, and adopted the field's ideological trappings in order to participate in discursive contestations over sexual truths. By interrogating gender, this article introduces much-needed nuance into existing understandings of sexology, and reframes sexology itself as a site wherein new sexual subjectivities were imagined, articulated, and debated. However, it also raises fundamental questions about women sexologists' capacity to create knowledge about women and female sexualities that was truer, more correct, and more authentic than that produced by men.

Feasibility of voluntary menu labeling among locally owned restaurants.

In 2007, Tacoma-Pierce County Health Department launched a restaurant menu labeling project called SmartMenu. The objective was to recruit locally owned restaurants to voluntarily post basic nutrition information on their menus or menu boards. Participating restaurants submitted recipes to an independent contractor for nutritional analysis and agreed to post calorie, fat, carbohydrate, and sodium values on new menus within 90 days of receiving results. Vigorous recruitment efforts by the Health Department between June 2007 and September 2008 included free advertising, consultation with a Registered Dietitian, and free nutritional analysis. By the end of 2008, a total of 24 restaurants participated in the program. Significant barriers to participation included infrequent use of standardized recipes, perceived business risk of labeling, and low perceived customer demand for nutrition information. Key program elements, recruitment strategies, and costs are discussed. Results have important implications for future efforts to increase the adoption of menu labeling by locally owned and operated restaurants.

Evaluation of a voluntary menu-labeling program in full-service restaurants.

OBJECTIVES: We assessed whether labeling restaurant menus with information on the nutrient content of menu items would cause customers to alter their ordering patterns. METHODS: Six full-service restaurants in Pierce County, Washington, added nutrition information to their menus, and they provided data on entrée sales for 30 days before and 30 days after the information was added. We assessed the prelabeling versus postlabeling difference in nutrient content of entrées sold, and we surveyed restaurant patrons about whether they noticed the nutrition information and used it in their ordering. RESULTS: The average postlabeling entrée sold contained about 15 fewer calories, 1.5 fewer grams of fat, and 45 fewer milligrams of sodium than did the average entrée sold before labeling. Seventy-one percent of patrons reported noticing the nutrition information; 20.4% reported ordering an entrée lower in calories as a result, and 16.5% reported ordering an entrée lower in fat as a result. CONCLUSIONS: The concentration of calorie reduction among 20.4% of patrons means that each calorie-reducing patron ordered about 75 fewer calories than they did before labeling. Thus, providing nutrition information on restaurant menus may encourage a subset of restaurant patrons to significantly alter their food choices.