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Has the UK Healthy Start voucher scheme been associated with an increased fruit and vegetable intake among target families? Analysis of Health Survey for England data, 2001–2014
  1. Rachel Jane Scantlebury1,
  2. Alison Moody1,
  3. Oyinlola Oyebode2,
  4. Jennifer Susan Mindell1
  1. 1 Department of Epidemiology and Public Health, Health and Social Surveys Research Group, UCL (University College London), London, UK
  2. 2 Warwick Medical School, University of Warwick, Coventry, UK
  1. Correspondence to Rachel Jane Scantlebury, Department of Epidemiology and Public Health, Health and Social Surveys Research Group, UCL (University College London), London, WC1E 7HB, UK; rachel.scantlebury{at}


Background Healthy Start (HS) is a UK government programme, introduced in 2006, providing vouchers to pregnant women or families with children aged <4 who are in receipt of certain benefits. Vouchers can be exchanged for fruit and vegetables (F&V), milk or infant formula. We sought to identify any association between HS and F&V intake.

Methods We analysed repeated cross-sectional data from the Health Survey for England. Study participants were classified into one of four groups: one HS-eligible group and three control groups, meeting only the income or demographic or no eligibility criterion. Outcome measures were mean F&V intake and the proportions of participants consuming ≥3 and ≥1 portion/day. Outcomes were compared across the four groups over four time periods: 2001–2003, 2004–2006, 2007–2009 and 2010–2014. Regression analyses examined whether F&V intake among HS-eligible participants had a significantly different rate of change from those in the control groups.

Results The change in mean F&V consumption over time was similar in HS-eligible adults and children to that of the control groups. Likewise, the change in odds of consuming ≥3 or ≥1 portion of F&V/day over time was similar among HS-eligible participants and control groups.

Conclusion This study found that during the period 2001–2003 to 2010–2014, F&V consumption among adults and children in households deemed eligible for HS changed similarly to that of other adults and children. Potential explanations include that vouchers may have been spent on milk or infant formula, or that vouchers helped protect F&V consumption in low-income households.

  • diet
  • nutrition
  • child health
  • health behaviour
  • health policy

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  • Contributors Conceived the original research idea: OO. Planning and designing the research: all authors. Literature review: RJS, AM, OO. Conducting the analysis: AM, RJS. Cowrote the paper: all authors. Approved the final draft: all authors.

  • Funding We thank NHS Digital, which funded the survey, and Health Education England for funding RJS’s public health training post. The funders had no role in the design, analysis or interpretation of the study, nor in drafting the manuscript or the decision to submit for publication. OO is supported by the NIHR Collaboration for Leadership in Applied Health Research and Care West Midlands initiative. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Research ethics approval was obtained prior to each HSE survey. Since this paper details the secondary analysis of existing data, additional ethical approval was not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.