Halimatou S Alaofe

Interests

Research

Relationship between diet and disease, ethnic differences in health outcomes, and the development of nutritional and lifestyle intervention programs to promote health.

Courses

Scholarly Contributions

Journals/Publications

• Alaofe, H. S. (2021). Factors Associated with Quality of Life in Patients with Type 2 Diabetes of South Benin: A Cross-Sectional Study.. Int. J. Environ. Res. Public Health.
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  Alaofè, H.; Amoussa Hounkpatin, W.; Djrolo, F.; Ehiri, J.; Rosales, C. Factors Associated with Quality of Life in Patients with Type 2 Diabetes of South Benin: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2022, 19, 236.
• Alaofe, H. S. (2021). Factors associated with exclusive breastfeeding practices in the commune of Sakété, southern Benin: a cross-sectional study.. E3S Web Conf.
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  Amoussa Hounkpatin W, Bodjrenou S, Baba-Ode M, Lokonon J, Vissoh S, Agassounon C, Alaofè H. Factors associated with exclusive breastfeeding practices in the commune of Sakété, southern Benin: a cross-sectional study. E3S Web Conf., 319 (2021) 01100
• Alaofè, H., Hounkpatin, W. A., Djrolo, F., Ehiri, J., & Rosales, C. (2021). Knowledge, attitude, practice and associated factors among patients with type 2 diabetes in Cotonou, Southern Benin. BMC public health, 21(1), 339.
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  Type 2 diabetes (T2D) is becoming an epidemic with significant disability and premature death in Sub-Saharan Africa, including Benin. However, little is known about the level of knowledge, attitude, and practice (KAP) necessary for diabetic patients to enhance therapeutic outcomes and prevent diabetes complications. The study aimed to assess patients' KAP levels and identify the factors associated in Cotonou, southern Benin.
• Alaofè, H., Yeo, S., Okechukwu, A., Magrath, P., Amoussa Hounkpatin, W., Ehiri, J., & Rosales, C. (2021). Cultural Considerations for the Adaptation of a Diabetes Self-Management Education Program in Cotonou, Benin: Lessons Learned from a Qualitative Study. International journal of environmental research and public health, 18(16).
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  : Type 2 diabetes (T2D) poses a disproportionate burden on Benin, West Africa. However, no diabetes intervention has yet been developed for Benin's contexts. This study aimed to explore specific cultural beliefs, attitudes, behaviors, and environmental factors to help adapt a diabetes self-management program to patients with T2D from Cotonou, in southern Benin. : Qualitative data were collected through focus group discussions (FDGs) involving 32 patients with T2D, 16 academic partners, and 12 community partners. The FDGs were audio-recorded, transcribed verbatim from French to English, and then analyzed thematically with MAXQDA 2020. : Healthy food was challenging to obtain due to costs, seasonality, and distance from markets. Other issues discussed were fruits and vegetables as commodities for the poor, perceptions and stigmas surrounding the disease, and the financial burden of medical equipment and treatment. Information about local food selections and recipes as well as social support, particularly for physical activity, were identified, among other needs. When adapting the curriculum, gender dynamics and spirituality were suggested. : The study demonstrates the need for culturally sensitive interventions and a motivation-based approach to health (spiritual and emotional support). It also lays the groundwork for addressing T2D contextually in Benin and similar sub-Saharan African countries.
• Parra, K. L., Alaofe, H. S., Ehiri, J. E., Nuño, V. L., Mazariegos, M., Garcia, B., Martinez, E., Junkins, A., & Jolly, P. (2021). Prevalence and Determinants of Underweight, Overweight, and Obesity: A Cross-Sectional Study of Sociodemographic, Dietary, and Lifestyle Factors Among Adolescent Girls in Jutiapa, Guatemala. Food and nutrition bulletin, 42(4), 502-519.
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  As the incidence of overweight continues to increase among children and adolescents in Guatemala, underweight remains a prominent health problem. However, the prevalence of overweight or underweight and associated risk factors has not been investigated among adolescent girls.
• Alaofe, H., Lott, B., Kimaru, L., Okusanya, B., Okechukwu, A., Chebet, J., Meremikwu, M., & Ehiri, J. (2020). Emergency Transportation Interventions for Reducing Adverse Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review. Annals of global health, 86(1), 147.
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  To assess the effect of emergency transportation interventions on the outcome of labor and delivery in low- and middle-income countries (LMICs).
• Chebet, J. J., Kilungo, A., Alaofè, H., Malebo, H., Katani, S., & Nichter, M. (2020). Local Perceptions, Cultural Beliefs, Practices and Changing Perspectives of Handling Infant Feces: A Case Study in a Rural Geita District, North-Western Tanzania. International journal of environmental research and public health, 17(9).
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  We report on the management of infant feces in a rural village in Geita region, Tanzania. Findings discussed here emerged incidentally from a qualitative study aimed at investigating vulnerability and resilience to health challenges in rural settings. Data was gathered through semi-structured focus group discussions (FDGs) with women ( = 4; 32 participants), men ( = 2; 16 participants), and community leaders ( = 1; 8 participants). All FDGs were audio recorded, transcribed verbatim and thematically analyzed using Atlas.ti. Respondents reported feces of a child under the age of six months were considered pure compared to those of older children. Infant feces were seen as transitioning to harmful at the point when the child began to eat solid food, resulting in their stool visually changing in appearance. Caregivers reportedly used soft implements to handle infant feces due to the belief that tools with hard surfaces would physically harm the child. Infant feces were disposed in environments around the house due to the belief that disposal in latrines would prevent developmental milestones and result in other perceived negative health outcomes for the child. Changing views expressed by participants suggest a window of opportunity to implement evidence-based and culturally relevant interventions to encourage the safe disposal of infant feces.
• Alaofe, H. S., & Asaolu, I. (2019). Maternal and child nutrition status in rural communities of Kalalé District, Benin: the relationship and risk factors.. Food and Nutrition Bulletin, 40(1), 56-70. doi:10.1177/0379572118825163.
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  AbstractBACKGROUND: Double burden of malnutrition (DBM) is an emerging public health concern in urban Benin. However, an understanding of the phenomena in rural areas of the country is lacking.OBJECTIVES: To assess the prevalence of DBM and to investigate the sociodemographic and dietary characteristics that differentiate DBM from undernourished children only, overweight/obese mothers only, and normal households in Kalalé district.METHODS: A cross-sectional study was conducted on 426 mother-child pairs: nonpregnant women aged 15 to 49 years and children aged 6 to 59 months. Weight-for-age and height-for-age were used to classify underweight and stunted children, body mass index ≥25 kg/m2 to measure overweight/obese mothers, and a 24-hour recall to assess the diet diversity score (DDS).RESULTS: Overall, 37.6% of children were stunted, 10.1% wasted, and 22.8% underweight, while the rate of overweight/obese mothers was 15.5%. The DBM was present in 6.1% of the households. Overweight/obese mothers' households had better socioeconomic status (SES), greater maternal education, less food insecurity, and a more diversified diet, in contrast with undernourished children households. The DBM households shared several features with undernourished children households, except for a greater (not significant) SES, but had the lowest DDS. Logistical regression revealed that high SES, older age child, DDS, mother education, and ethnicity were associated with DBM.CONCLUSIONS: The study highlights the importance of addressing the DBM at the community level in rural Benin. However, multicenter studies in various rural parts of the country are needed to substantiate the present results, so that appropriate strategies to reduce the DBM can be planned.
• Alaofe, H. S., & Taren, D. (2019). The impact of solar market garden on dietary diversity, women’s nutritional status and micronutrients levels in Kalalé district of northern Benin.. Public Health Nutrition., 22(14), 2670-81. doi:10.1017/S1368980019001599.
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  AbstractOBJECTIVE: To examine the impacts of a Solar Market Garden 1-year solar-powered drip irrigation (SMG) programme in Kalalé district of northern Benin on mothers' nutritional status and micronutrient levels.DESIGN: Using a quasi-experimental design, sixteen villages were assigned to four groups: (i) SMG women's groups (WG); (ii) comparison WG; (iii) SMG non-WG (NWG); and (iv) comparison NWG. Difference-in-differences (DID) estimates were used to assess impacts on mothers' food consumption, diversity, BMI, prevalence of underweight (BMI < 18·5 kg/m2) and anaemia, and deficiencies of iron (ID) and vitamin A (VAD).SETTING: Kalalé district, northern Benin.PARTICIPANTS: Non-pregnant mothers aged 15-49 years (n 1737).RESULTS: The SMG programme significantly increased mothers' intake of vegetables (DID = 25·31 percentage points (pp); P < 0·01), dietary diversity (DID = 0·74; P < 0·01) and marginally increased their intake of flesh foods (DID = 10·14 pp; P < 0·1). Mean BMI was significantly increased among SMG WG compared with the other three groups (DID = 0·44 kg/m2; P < 0·05). The SMG programme also significantly decreased the prevalence of anaemia (DID = 12·86 pp; P < 0·01) but no impacts were found for the prevalence of underweight, ID and VAD.CONCLUSIONS: Improving mothers' dietary intake and anaemia prevalence supports the need to integrate gender-based agriculture to improve nutritional status. However, it may take more than a year, and additional nutrition and health programmes, to impact the prevalence of maternal underweight, ID and VAD.
• Alaofe, H. S., Taren, D. L., & Valenti, M. (2019). Consumption Pattern of Fruits and Vegetables Among Solar Market Garden Women’s Groups From Kalalé District of Northern Benin, West Africa.. J Nutr Health Sci, 6(3), 302.
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  Background: Anemia and iron (ID) and vitamin A (VAD) deficiency continue to be significant public health issues in northern Benin, despite the installation of solar market gardens (SMGs), suggesting an urgent need of implementing nutrition programs to benefit the full impact of SMG. However, for an effective nutrition promotion, it is important to identify the fruits and vegetables (F&V) consumed to determine their suitability for promotion. Objective: To assess the consumption pattern of F&V in Kalalé district of Northern Benin to identify the potential F&V that could be promoted in the district for improving anemia and micronutrients status. Methods: Cross-sectional surveys were conducted among 250 mothers/caregivers aged 19 years and above. All questionnaires assessed socio-demographic characteristics and types of staples foods consumed as well as the types of F&V consumed and their frequency of consumption. Descriptive analyses were tabulated using STATA version 14. Results: Several F&V are eaten in the district, but their frequency of daily consumption is low. However, mangoes are abundant during the two fruiting seasons and could be easily accessed by the participating women. Likewise, Moringa oleifera leaves are available all year round and could be incorporated into selected recipes. Conclusions and Implications: Mangoes and Moringa oleifera leaves are potential sources of β-carotene to be promoted on a sustainable basis among SMG women’s groups of Kalalé district of Northern Benin. However, nutrition educational messages should include behavior change campaigns that will make the women see the need for consuming F&V on a daily basis.
• Alves, C., Alaofe, H. S., & Saleh, A. (2019). Iron-containing cookware for the reduction of iron deficiency anemia among children and females of reproductive age in low- and middle-income countries: A systematic review.. PLoS ONE, 14(9), e0221094.
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  AbstractBACKGROUND & OBJECTIVE: There is limited evidence regarding the efficacy of iron-containing pots and ingots in reducing iron deficiency (ID) and iron deficiency anemia (IDA) in low- and middle-income countries (LMICs). The objective of this systematic review is to summarize the evidence regarding the effect of iron-containing cookware on ID and IDA among children and females of reproductive age (FRA) in LMICs.METHODS: Searches were last conducted in May 2019 in PubMed, Embase, Cochrane Library, Web of Science, Scopus, CAB Abstracts, POPLINE, LILACS, ProQuest Dissertations & Theses Global, WHO ICTRP and ClinicalTrials.gov. Hand searching was also conducted. Selection criteria included randomized-controlled trials (RCTs), quasi-experimental studies and observational studies with control groups that studied the effect of iron-containing cookware in children (4 months-11 years) and females of reproductive age (12-51 years).RESULTS: Eleven studies were eligible for inclusion in the review. Statistically significant increases in hemoglobin and/or iron indices (p < 0.05) were observed in 50% (4/8) of studies on pots (relative change/mean difference in Hb: -0.4-1.20 g/dL), and 33.3% (1/3) of studies on ingots (relative change/mean difference in Hb: 0.32-1.18 g/dL). Positive outcomes (p < 0.05) were observed among children in 50% (4/8) of studies and among FRA in 28.6% (2/7) of studies. Compliance ranged from 26.7-71.4% daily use of pots to 90-93.9% daily use of ingots.CONCLUSIONS: There are indications that, with reasonable compliance, iron-containing cookware could serve as a means of reducing IDA, especially among children. The potential advantages of iron-containing cookware include relative cost-effectiveness and complementary combination with other interventions. However, further research is needed regarding both the efficacy and safety of this intervention.
• Ehiri, J., & Alaofe, H. S. (2019). AIDS-related stigmatisation in the healthcare setting: a study of primary healthcare centres that provide services for prevention of mother-to-child transmission of HIV in Lagos, Nigeria.. BMJ Open, 9(5), e026322. doi:10.1136/bmjopen-2018-026322.
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  OBJECTIVE: To assess AIDS stigmatising attitudes and behaviours by prevention of mother-to-child transmission (PMTCT) service providers in primary healthcare centres in Lagos, Nigeria.DESIGN: Cross-sectional survey.SETTING: Thirty-eight primary healthcare centres in Lagos, Nigeria.PARTICIPANTS: One hundred and sixty-one PMTCT service providers.OUTCOME MEASURES: PMTCT service providers' discriminatory behaviours, opinions and stigmatising attitudes towards persons living with HIV/AIDS (PLWHAs), and nature of the work environment (HIV/AIDS-related policies and infection-control guidelines/supplies).RESULTS: Reported AIDS-related stigmatisation was low: few respondents (4%) reported hearing coworkers talk badly about PLWHAs or observed provision of poor-quality care to PLWHAs (15%). Health workers were not worried about secondary AIDS stigmatisation due to their occupation (86%). Opinions about PLWHAs were generally supportive; providers strongly agreed that women living with HIV should be allowed to have babies if they wished (94%). PMTCT service providers knew that consent was needed prior to HIV testing (86%) and noted that they would get in trouble at work if they discriminated against PLWHAs (83%). A minority reported discriminatory attitudes and behaviours; 39% reported wearing double gloves and 41% used other special infection-control measures when providing services to PLWHAs. Discriminatory behaviours were correlated with negative opinions about PLWHAs (r=0.21, p
• Alaofe, H. S. (2018). Emergency transportation interventions for reducing adverse pregnancy outcomes in low- and middle-income countries: a systematic review protocol. Syst Rev, 7(1), 65. doi:10.1186/s13643-018-0729-2.
• Asaolu, I., Alaofe, H. S., Gunn, J., Adu, A., Monroy, A., Hayden, M., Ehiri, J. E., & Ernst, K. C. (2018). Measures of Women’s Empowerment in sub-Saharan Africa: an Exploratory Factor Analysis of the Demographic and Health Surveys.. The International Journal of Maternal and Child Health (MCH) and AIDS (IJMA).
• Alaofe, H. S., Freed, N., Jones, K., & Plano, A. (2017). Farmers’ market use is associated with fruit and vegetable consumption among low-income populations: A cross-sectional study from Southern Arizona.. Journal of Nutrition and Health Sciences, 4(2), 201.
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  Background: While farmers’ markets (FM) are a potential strategy to increase access to fruits and vegetables (F&V), more information is needed regarding use of FM among low-income populations.Objective: To examine socio-demographic characteristics and frequency of F&V consumption of participants; barriers and facilitators to FM shopping and fruit and vegetable (F&V) consumption; and associations between FM use with F&V consumption in Southern Arizona.Methods: Cross-sectional surveys were conducted with two groups of SNAP recipients in Pima County, AZ: 56 FM customers and 107 primary household food shoppers. All questionnaires assessed socio-demographic characteristics, food shopping patterns, barriers to and facilitators of FM shopping and F&V consumption. Linear regression analyses determined the associations between FM use with F&V consumption, controlling for age, race, education, and gender.Results: Majority of FM customers were white, female, over 42 years of age and college graduate. Top three motivators to shopping included variety of products, fresh food, and convenient location. Common barriers to F&V consumption were price, lack of nearby options, and lack of available healthy options. F&V consumption was positively associated with use of farmers’ markets.Conclusions and Implications: Farmers’ markets may be a viable method to increase produce consumption in low-income population. However, for these programs to be successful, barriers and facilitators to farmers’ market shopping and F&V consumption should be taken into account.
• Alaofe, H. S., Freed, N., Jones, K., Plano, A., & Taren, D. L. (2017). Impacts of Double Up SNAP Farmers’ Market Incentive Program on Fruit and Vegetable Access, Purchase and Consumption. Journal of Nutrition and Health Sciences, 4(3), 304.
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  Background and Objective: In response to low consumption levels of fruits and vegetables (F&V) by Supplemental Nutrition Assistance Program (SNAP) participants, the Community Food Bank of Southern Arizona created the Double Up SNAP (DUSP) farmers’ market (FM) incentive program to examine its impact on awareness of and access to FM, and F&V purchase and consumption in Pima County, AZ.Methods: Cross-sectional surveys were conducted at early and 9-11 months after implementation of DUSP program in two groups of SNAP recipients: DUSP customers and randomized non-DUSP food shoppers. All questionnaires assessed socio-demographic characteristics, awareness of DUSP program, perceived access to FM, and purchasing patterns as well as F&V consumption. Descriptive analyses were tabulated and linear regression was used to estimate the difference in F&V consumption trends in both groups after DUSP implementation.Results: The introduction of DUSP was associated with greater awareness of FM; increased frequency and amount of F&V purchases; and increased self-reported number of F&V consumed and percentage of participants eating vegetables. However, our regression analysis did not detect impacts on frequency of F&V consumption and percentage of participants eating fruitsKeywords: Farmers’ market; Fruits and vegetables; Nutrition incentive; Low-income communitiesConclusion: While our study provides promising evidence that use of FM incentives combined with cooking demonstrations and marketing can increased awareness and use of FM, additional research is needed to better understand impacts on F&V consumption.
• Alaofè, H., Burney, J., Naylor, R., & Taren, D. (2017). Prevalence of anaemia, deficiencies of iron and vitamin A and their determinants in rural women and young children: a cross-sectional study in Kalalé district of northern Benin. Public health nutrition, 1-11.
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  To identify the magnitude of anaemia and deficiencies of Fe (ID) and vitamin A (VAD) and their associated factors among rural women and children.
• Alaofè, H., Zhu, M., Burney, J., Naylor, R., & Douglas, T. (2017). Association Between Women's Empowerment and Maternal and Child Nutrition in Kalalé District of Northern Benin. Food and nutrition bulletin, 38(3), 302-318.
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  Evidence on effectiveness of women's empowerment (WE) to reduce undernutrition is limited in sub-Sahara Africa, and few studies incorporate multidimensional measures of WE.
• Burney, J., Alaofe, H. S., Naylor, R., & Taren, D. L. (2017). Impact of a rural solar electrification project on the level and structure of women's empowerment. Environmental Research Letters, 12(9), 095007.
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  Although development organizations agree that reliable access to energyand energy services { one of the 17 Sustainable Development Goals { is likely to haveprofound and perhaps disproportionate impacts on women, few studies have directlyempirically estimated the impact of energy access on women's empowerment. This isa function of both a relative dearth of energy access evaluations in general and a lackof clarity on how to quantify gender impacts of development projects. Here we presentan evaluation of the impacts of the Solar Market Garden { a distributed photovoltaicirrigation project { on the level and structure of women's empowerment in Benin,West Africa. We use a quasi-experimental design (matched-pair villages) to estimatechanges in empowerment for project beneciaries after one year of Solar Market Gardenproduction relative to non-beneciaries in both treatment and comparison villages(n=771). To create an empowerment metric, we constructed a set of general questionsbased on existing theories of empowerment, and then used latent variable analysis tounderstand the underlying structure of empowerment locally. We repeated this analysisat follow-up to understand whether the structure of empowerment had changed overtime, and then measured changes in both the levels and likelihood of empowermentover time. We show that the Solar Market Garden signicantly positively impactedwomen's empowerment, particularly through the domain of economic independence.In addition to providing rigorous evidence for the impact of a rural renewable energyproject on women's empowerment, our work lays out a methodology that can be usedin the future to benchmark the gender impacts of energy projects.
• Alaofè, H., Burney, J., Naylor, R., & Taren, D. (2016). Solar-Powered Drip Irrigation Impacts on Crops Production Diversity and Dietary Diversity in Northern Benin. Food and nutrition bulletin, 37(2), 164-75.
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  Meeting the food needs of Africa's growing population will require innovative and appropriate technologies whose effectiveness needs to be assessed.

Presentations

• Alaofe, H. S. (2021, April). Knowledge, attitude, practice and associated factors among patients with type 2 diabetes in Cotonou, Southern Benin.. Experimental Biology. Rockville, Maryland.
• Alaofe, H. S. (2021, August). Malnutrition in Sub-Saharan Africa: Double Burden and Changing Nutrition Reality.. ICG Global Health. University of Arizona.
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  Alaofè H. Malnutrition in Sub-Saharan Africa: Double Burden and Changing Nutrition Reality. ICG Global Health, University of Arizona, Aug 2021.
• Alaofe, H. S. (2021, July). Factors associated with exclusive breastfeeding practices in the commune of Sakété, southern Benin: a cross-sectional study. VIGISAN. Kenitra-Morocco.
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  Amoussa Hounkpatin W, Bodjrenou S, Baba-Ode M, Lokonon J, Vissoh S, Agassounon C, Alaofè H. Factors associated with exclusive breastfeeding practices in the commune of Sakété, southern Benin: a cross-sectional study. VIGISAN, July 2021, Kenitra-Morocco.
• Alaofe, H. S., Taren, D. L., & Burney, J. (2020, April). Smallholder Irrigation and Pathways to Food Security.. EGU General Assembly. Vienna.

Poster Presentations

• Alaofe, H. S., & Valenti, M. (2020, April/Spring). Consumption Pattern of Fruits and Vegetables among Solar Market Garden Women’s Groups of Kalalé District of Northern Benin. Experimental Biology. Sand Diego, California..
• Alaofe, H. S., & Valenti, M. (2020, October). Perception and Use of M. oleifera among Solar Market Garden Women’s Groups of Kalalé District of Northern Benin, West Africa.. Tenth International Conference on Food Studies, at 2020. Marymount Manhattan College, New York, US..
• Alaofe, H. S., Burney, J., Naylor, R., & Taren, D. L. (2016, April). Anemia, Iron and Vitamin A Deficits are Still Public Health Issues Among Women and Young Children in Northern Benin. Experimental Biology. San Diego: American Society of Nutrition.
• Burney, J., Alaofe, H. S., Taren, D. L., Naylor, R., Burney, J., Alaofe, H. S., Taren, D. L., & Naylor, R. (2016, April). Use of Dietary Scores for Diet Quality Measurement: Relation with Nutritional Status of Women in Northern Benin. Experimental Biology. San Diego: American Society of Nutrition.
• Taren, D. L., Alaofe, H. S., Burney, J., & Naylor, R. (2016, April). Nutritional Status of Children Under Five Years and Associated Factors in Kalale District, Benin. Experimental Biology. San Diego: American Society of Nutrition.

Others

• Alaofe, H. S., Freed, N., Hulsey, D., & Taren, D. L. (2017, July). Evaluation of DOUBLE UP SNAP PROGRAM: 2016-2017 Evaluation Report. Community Food Bank of Southern Arizona.
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  Access to healthy food is a fundamental building block for a productive life. While federal food assistance benefits are critical to enabling low-income families to buy food, the lack of access to healthy, fresh food contributes to poor health outcomes and increases the risk of diet-related chronic illness. As consequence, the United States Department of Agriculture (USDA) Food Insecurity Nutrition Incentive (FINI) Grant Program awarded funds for pilot projects to determine if financial incentives provided at the point of sale to Supplemental Nutrition Assistance Program (SNAP) participants would increase their consumption of fruits and vegetables (F&V).In frame of this grant, the Community Food Bank of Southern Arizona’s (CFBSA) designed the Double Up SNAP pilot (DUSP) initiative to investigate the impact of making F&V more affordable for SNAP participants. Specifically, the DUSP program uses existing infrastructure — farmers’ markets and the SNAP Electronic Benefits Transfer (EBT) Card — to:1. improve access to and affordability of fresh fruits and vegetables for low-income families;2. grow the local economy by supporting purchases from local farmers; and3. shift public policy so that future federal nutrition assistance programs can simultaneously address health, hunger, and nutrition and support a more sustainable food system.Under DUSP, SNAP participants received an incentive of $1 dollar for every dollar of SNAP benefits ($1 yellow vouchers) that they spend on targeted F&V from participating vendors for a maximum of $20. Cooking demonstrations were also provided to increase the beneficiaries’ knowledge about healthy food options. Lastly, a strategic marketing and promotional campaign was used to narrow the knowledge gap regarding the program among SNAP customers.The pilot was implemented in two Tucson farmers markets by the CFBSA: Santa Cruz River Farmers’ Market and Community Food Bank. The study ran from May 2016 through June 2017. Located in Southern Arizona, Tucson is poorer than average: the per capita income ($20,314) and the median household income ($37,000) are considerably lower than the State average ($25,358 and $49,774, respectively). The household economic struggles faced by low-income Tucsonans have resulted in serious food security issues and 18.5% of the population is enrolled in SNAP. Tucson has a large Hispanic population which has a greater poverty rate and prevalence of food insecurity compared with their non-Hispanic counterparts.CBSA partners with a range of other organizations to develop and implement this program and contracts with the University of Arizona to lead the evaluation aspects of DUSP project with the primary objectives to:1. determine the effectiveness of monetary incentives to promote healthier food choices (as evidenced by food purchasing behavior) for SNAP customers;2. determine the impact of the DUSP project on the participating markets, vendors and the local food economy;3. determine the implications of the evaluation findings in relation to policy change and replication; and4. examine implementation processes, including social marketing strategies, and identify best practices for replicating the model.The data collection for the DUSP evaluation included two rounds of participant surveys. The first round of the survey occurred at early DUSP implementation (2 months after DUSP begins) and the second round late in DUSP implementation (9- 11 months after DUSP begins). A wide array of qualitative and quantitative data collection activities was conducted and included: DUSP and non-DUSP customer surveys, DUSP and non-DUSP vendor surveys, market managers and observations, and interviews with key stakeholders. EBT transaction data also provided detailed information on purchases, including DUSP-eligible purchases and the amount of incentives earned.Key impacts of DUSP on customers• DUSP customers had increased their daily consumption of fruits and vegetables compared with non-DUSP participants: fruits: 16.28% vs. 12.16%, and vegetables: 11.98% vs. -8.06%.• DUSP customers increased their variety of fruits by 21% compared with 8.9% for non-DUSP food shoppers over time.• Percentage decrease of consumed fruits and vegetables less than one time per day was greater among FM customers compared with non-FM food shoppers: fruits: 37.66% vs. 21.37%; vegetables: 21.72% vs. 5.53%, respectively.• 9% of customers used their benefits at farmers’ market for the first time in 2017, compared with 13% in 2016.• 89% and 95% of customers reported that because of DUSP they increased the amount of fruits and vegetables they buy, respectively.• 84% of customers tried different kinds of fruits and vegetables.