A Cluster Randomized Controlled Trial of a Home-Delivered Food Box on Food Security in Chickasaw Nation

Abstract

Background: The 2010 Child Nutrition reauthorization called for the independent evaluation of innovative strategies to reduce the risk of childhood hunger or improve the food security status of households with children.

Objective: The research question was whether the Packed Promise intervention reduces child food insecurity (FI-C) among low-income households with children.

Design: This study was a cluster randomized controlled trial of 40 school districts and 4,750 eligible, consented households within treatment and control schools.

Participants/setting: Data were collected at baseline (n = 2,859) and 2 follow-ups (n = 2,852; n = 2,790) from households with children eligible for free school meals in participating schools in 12 rural counties within the Chickasaw Nation territory in south central Oklahoma in 2016 to 2018.

Intervention: Each month of the 25-month intervention, for each eligible child, enrolled households could choose from 5 types of food boxes that contained shelf-stable, nutritious foods ($38 food value) and a $15 check for purchasing fruits and vegetables.

Main outcome measures: The primary outcome was FI-C. Other outcomes included household and adult food security, very low food security among children, and food expenditures.

Statistical analyses performed: Differences between the treatment and control groups were estimated by a regression model controlling for baseline characteristics.

Results: The Packed Promise project did not significantly reduce FI-C at 12 months (29.3% prevalence in the treatment group compared with 30.1% in the control group; P = 0.123) or at 18 months (28.2% vs 28.7%; P = 0.276), but reduced food insecurity for adults by 3 percentage points at 12 months (P = 0.002) but not at 18 months (P = 0.354). The intervention led to a $27 and a $16 decline in median household monthly out-of-pocket food expenditures at 12 and 18 months, respectively.

Conclusions: An innovative intervention successfully delivered nutritious food boxes to low-income households with children in rural Oklahoma, but did not significantly reduce FI-C. Improving economic conditions in the demonstration area and participation in other nutrition assistance programs among treatment and control groups might explain the lack of impact.ClinicalTrials.gov ID: NCT04316819 (http://www.clinicaltrials.gov).

Funding/support: This article is published as part of a supplement supported by the US Department of Agriculture, Food and Nutrition Service.

Keywords: Food security; Home-delivered food box; Indian tribal organization; Randomized controlled trial; Schoolchildren.