Nationally, five million children live in food-insecure households in which both children and adults are food insecure.1 Food insecurity is defined by a lack of consistent access to enough food for every person in a household to live an active, healthy lifestyle,2 whereas nutrition security is having consistent and equitable access, availability, and affordability to nutritious foods.3 Food insecurity impacts child health outcomes and is associated with increased risks of some birth defects, anemia, lower nutrient intake, cognitive problems, aggression, and anxiety.4 For adults, food insecurity is associated with increased rates of mental health problems and depression, hypertension, poor sleep outcomes, obesity, heart disease, and other chronic diseases.5,6 Food insecurity rates are highest among single-mother and low-income households, with prevalence in all states and in both urban and rural areas.7
Addressing food insecurity and improving access to affordable and nutritious food choices is critical for managing chronic health conditions and improving health outcomes. NASHP’s 2023 Annual Conference session, “Spilling the Tea: Improving Food and Housing for Maternal and Child Health (MCH) Populations,” highlighted state innovations and strategies for addressing food insecurity. One innovative initiative that state officials and other conference attendees learned about is the Double Up Oklahoma food program. This Q&A provides details on Oklahoma’s initiative for states interested in exploring similar approaches to address food insecurity, increase access to nutritious foods, and improve the health and well-being of mothers, children, and families.
What Is Double Up Oklahoma (DUO)?
DUO is an innovative partnership between Oklahoma’s Department of Human Services (DHS) and Hunger Free Oklahoma that aims to address barriers to produce consumption and support healthy food choices for people enrolled in Supplemental Nutrition Assistance Program (SNAP). DUO maximizes the state’s SNAP benefits for program participants.8 This is achieved by increasing the purchasing power of SNAP through a benefit incentive.9 SNAP is a federal program of the United States Department of Agriculture (USDA) that provides food benefits to low-income families to supplement their grocery budget so they can afford the nutritious food essential to health and well-being.10 SNAP benefits are used by individuals and families at stores to purchase food.
In addition to the Oklahoma DHS and Hunger Free Oklahoma partnership, several other partner organizations support this initiative. Partners include the University of Oklahoma Hudson College of Public Health, the Tobacco Settlement Endowment Trust, and the USDA Gus Schumacher Nutrition Incentive Program, as well as other private philanthropic foundations.11
Why Is the DUO Program Needed and Who Does It Benefit?
Oklahoma is the fifth hungriest state in the country, with 13.8 percent of Oklahoman households experiencing uncertainty about whether they will have enough food to meet the needs of all of their members (compared to the national average of 10.4% of households experiencing food insecurity).12 Oklahomans living with chronic illnesses associated with food insecurity had higher rates of diabetes (12.8 percent) and hypertension (38.9 percent) compared to the national averages of 11.1 percent and 32.2 percent respectively.13 Thirty-three percent of Oklahomans live in a low-income, low-access community, meaning they lack adequate access to nutritious food; that number increases to 42 percent for urban households and 32 percent for rural households.14 In addition to receiving support from federal food programs such as SNAP, many individuals and families who experience food insecurity in Oklahoma are served by the state’s two food banks. Regional Foodbank of Oklahoma serves 53 counties in central and western Oklahoma,15 and Food Bank of Eastern Oklahoma serves the remaining 24 counties in the eastern part of the state.16 The majority of the people served by both food banks are children, seniors living on fixed incomes, and hardworking families struggling to make ends meet.17
Similarly, most Oklahomans participating in the SNAP and DUO program are children, older people, and people with disabilities.18 Many people participating in SNAP and DUO live in low-income communities and have low access to nutritious foods.19 SNAP serves 16 percent of the state’s population, or one in six Oklahomans.20Approximately 334,000 families and 683,000 individuals in communities across Oklahoma received SNAP benefits in June 2023.21,22 Individuals and families who are enrolled in SNAP, including members of the MCH population, can also benefit from participating in the DUO program.
How Does the DUO Program Work?
The DUO program offers people enrolled in SNAP a valuable incentive for purchasing fruits and vegetables, matching a one-dollar ($1) value for each one-dollar SNAP benefit purchase of eligible food items, up to $20 per day for program participants.23 The incentive match is earned by purchasing SNAP-eligible food items at participating farmers markets and grocery stores. The incentives are referred to as “DUO tokens” at farmers markets and “DUO Bucks” (printed paper vouchers) at grocery stores.24 DUO program participants receive DUO tokens or DUO Bucks at the time of SNAP benefit purchases to be used on the next purchase of fresh fruits and vegetables.25 DUO Bucks can only be used at the grocery store in which they were earned; however, DUO tokens can be used at any participating farmers market.26
What Is the Impact of the DUO Program on Children and Families?
- “Key Statistics and Graphics,” U.S. Department of Agriculture, Economic Research Service, accessed September 20, 2023. www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/key-statistics-graphics/#children
- “Definitions of Food Security,” U.S. Department of Agriculture, Economic Research Service, accessed September 20, 2023. www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/definitions-of-food-security/
- “What is Nutrition Security?” U.S. Department of Agriculture, accessed October 12, 2023. www.usda.gov/nutrition-security
- Gunderson, C., and Ziliak, J., “Food Insecurity and Health Outcomes,” Health Affairs, November 2015. www.healthaffairs.org/doi/10.1377/hlthaff.2015.0645
- “Food Insecurity and Health Outcomes,” 2015.
- “Food Accessibility, Insecurity and Health Outcomes,” U.S. Department of Health and Human Services, National Institute of Minority Health and Health Disparities, accessed October 12, 2023. www.nimhd.nih.gov/resources/understanding-health-disparities/food-accessibility-insecurity-and-health-outcomes.html
- Coleman-Jensen, A. et al., “Household Food Security in the United States in 2021,” U.S. Department of Agriculture, Economic Research Service, September 2022. www.ers.usda.gov/webdocs/publications/104656/err-309.pdf?v=1499.5
- Shropshire, Deborah, “Feeding Oklahoma: The Double Up Program’s Impact on Fruit/Vegetable Purchasing,” slide presentation, National Academy for State Health Policy 36th Annual Conference, Boston, MA, August 16, 2023.
- Shropshire, “Feeding Oklahoma,” 2023.
- “Supplemental Nutrition Assistance Program,” U.S. Department of Agriculture, Food and Nutrition Services, accessed September 20, 2023. www.fns.usda.gov/snap/supplemental-nutrition-assistance-program
- Shropshire, “Feeding Oklahoma,” 2023.
- Coleman-Jensen, A. et al., “Household Food Security in the United States in 2021,” U.S. Department of Agriculture, Economic Research Service, September 2022. www.ers.usda.gov/webdocs/publications/104656/err-309.pdf?v=1499.5
- “BRFSS Prevalence and Trends Data,” U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, accessed October 12, 2023. www.cdc.gov/brfss/brfssprevalence/
- “Hunger in Oklahoma,” Hunger Free Oklahoma, accessed September 20, 2023. www.hungerfreeok.org/hunger-in-oklahoma/
- “Hunger in Oklahoma,” Regional Food Bank of Oklahoma, accessed October 4, 2023. www.regionalfoodbank.org/about-us/hunger-in-oklahoma/
- Food Bank of Eastern Oklahoma, accessed October 4, 2023. www.okfoodbank.org/
- “Hunger in Oklahoma,” Regional Foodbank of Oklahoma, accessed October 4, 2023. www.regionalfoodbank.org/about-us/hunger-in-oklahoma/
- Shropshire, “Feeding Oklahoma,” 2023.
- Shropshire, “Feeding Oklahoma,” 2023.
- “Oklahoma Supplemental Nutrition Assistance Program Fact Sheet,” Center on Budget and Policy Priorities, February 13, 2023. www.cbpp.org/sites/default/files/atoms/files/snap_factsheet_oklahoma.pdf
- “Supplemental Nutrition Assistance Program: Number of Households Participating,” U.S. Department of Agriculture, Food and Nutrition Services, accessed October 13, 2023. https://fns-prod.azureedge.us/sites/default/files/resource-files/snap-households-10.pdf
- “Supplemental Nutrition Assistance Program: Number of Persons Participating,” U.S. Department of Agriculture, Food and Nutrition Services, accessed October 13, 2023. https://fns-prod.azureedge.us/sites/default/files/resource-files/snap-persons-10.pdf
- “FAQs,” Double Up Oklahoma, accessed September 20, 2023. www.doubleupoklahoma.org/faqs/.
- “How Does It Work,” Double Up Oklahoma, accessed September 20, 2023. www.doubleupoklahoma.org/how-does-it-work/
- “How Does It Work,” Double Up Oklahoma, accessed September 20, 2023. www.doubleupoklahoma.org/how-does-it-work/
- “How Does It Work,” Double Up Oklahoma, accessed September 20, 2023. www.doubleupoklahoma.org/how-does-it-work/
- “Market Locations,” Double Up Oklahoma, accessed October 4, 2023, www.doubleupoklahoma.org/market-locations/
- Shropshire, “Feeding Oklahoma,” 2023.
- Shropshire, “Feeding Oklahoma,” 2023.
- Shropshire, “Feeding Oklahoma,” 2023.
Acknowledgements
This blog was written by Robin Buskey. NASHP staff contributed to this blog through input, guidance, or draft review, including Anna Lipton Galbraith and Karen VanLandeghem.
This blog is part of a project supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under the Supporting Maternal and Child Health Innovation in States Grant No. U1XMC31658. This information, content, and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, or the U.S. government.
