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Melo Herrera Y, Vadiveloo M, Blau S, Oaks BM, Quashie NT, Tovar A. Feasibility and acceptability of a personalized, pre-filled online grocery cart to improve benefit redemption and diet quality of grocery purchases among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Appetite 2024; 202:107647. [PMID: 39182850 DOI: 10.1016/j.appet.2024.107647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/14/2024] [Accepted: 08/21/2024] [Indexed: 08/27/2024]
Abstract
Most participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) do not fully redeem their benefits due to barriers like transportation, confusing product eligibility, and unclear labeling. Online food shopping enables choice architecture to promote benefit redemption and maximize diet quality. We conducted a mixed-methods pilot randomized-controlled trial to assess the feasibility and acceptability of a pre-filled online grocery shopping cart to improve WIC benefit redemption and diet quality of grocery purchases. Rhode Island WIC participants (n = 24, mean age 29.4 ± 1.1 years, 75% Hispanic, 54% had never grocery shopped online) completed a baseline questionnaire and a simulated shopping episode (SSE), buying WIC and non-WIC items. After a week, we randomized participants into the intervention (personalized, modifiable carts pre-filled with 100% of the 2022 proposed WIC packages) or control (selected their items individually) groups before the second SSE. Both groups had WIC labels. We assessed feasibility using process data and percent agreement to feasibility questions, and acceptability via percent agreement to acceptability questions and post-intervention qualitative interviews. We conducted exploratory analyses to examine differences within and between groups at each timepoint for percent WIC benefit redemption and diet quality of grocery purchases, evaluated using the Grocery Purchase Quality Index-2016 (GPQI-2016) scores. Quantitative study measures suggest that the intervention was feasible and that the personalized, modifiable pre-filled cart was acceptable. These findings were supported during qualitative interviews, where participants highlighted time-savings, flexibility, and WIC labels as facilitators of WIC online shopping. Exploratory results showed significant increases in mean percent redemption of most WIC food categories and non-significant moderate increases in most GPQI-2016 scores. These measures are vital for the future adaptation of a full-scale efficacy trial in real-life settings.
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Affiliation(s)
- Yarisbel Melo Herrera
- Department of Nutrition, University of Rhode Island, Kingston, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - Maya Vadiveloo
- Department of Nutrition, University of Rhode Island, Kingston, RI, USA
| | - Sarah Blau
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Brietta M Oaks
- Department of Nutrition, University of Rhode Island, Kingston, RI, USA
| | - Nekehia T Quashie
- Department of Public Health, University of Rhode Island, Kingston, RI, USA
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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Ports KA, Rostad WL, Coyne P, Dunning J, Gonzalez AE, Troy A. A Scoping Review to Identify Community- and Societal-Level Strategies Evaluated from 2013 to 2023 for Their Potential Impact on Child Well-Being in the United States. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1070. [PMID: 39334603 PMCID: PMC11430804 DOI: 10.3390/children11091070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/28/2024] [Accepted: 08/28/2024] [Indexed: 09/30/2024]
Abstract
There is increased recognition for solutions that address the social determinants of health (SDOHs)-the context in which families are raising children. Unfortunately, implementing solutions that address inequities in the SDOHs has proven to be difficult. Many child and family serving systems and communities do not know where to start or do not have the capacity to identify and implement upstream SDOH strategies. As such, we conducted a scoping review to assess the status of evidence connecting strategies that address the SDOHs and child well-being. A total of 29,079 records were identified using natural language processing with 341 records meeting inclusion criteria (e.g., outcomes focused on child well-being, interventions happening at a population level, and evaluations of prevention strategies in the United States). Records were coded, and the findings are presented by the SDOH domain, such as strategies that addressed economic stability (n = 94), education access and quality (n = 17), food security (n = 106), healthcare access and quality (n = 96), neighborhood and built environment (n = 7), and social and community context (n = 12). This review provides an overview of the associations between population-level SDOH strategies and the impact-good and bad-on child well-being and may be a useful resource for communities and practitioners when considering equitable solutions that promote thriving childhoods.
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Affiliation(s)
- Katie A. Ports
- American Institutes for Research, 1400 Crystal Drive, 10th Floor, Arlington, VA 22202-3289, USA; (W.L.R.); (P.C.); (J.D.); (A.E.G.); (A.T.)
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Soto Díaz CR, Taillie LS, Higgins ICA, Richter APC, Davis CR, De Marco M, Hall MG, Ng SW, Duffy EW. A Qualitative Exploration of Spanish-Speaking Latina Women's Experiences Participating in WIC Before and During the COVID-19 Pandemic. J Acad Nutr Diet 2024; 124:851-863.e5. [PMID: 38462129 PMCID: PMC11304124 DOI: 10.1016/j.jand.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 03/02/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND More than one-third of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants identify as Latino, but participation has been declining and individuals who speak predominantly Spanish face additional barriers to participation. During the COVID-19 pandemic, there were changes in WIC eligibility and benefits that may have been differentially accessible to Spanish-speaking Latina participants due to factors such as language barriers and lack of awareness of changes. Understanding Spanish-speaking Latinas' experiences with the WIC program generally and during the pandemic can inform efforts to equitably implement future emergency food response policies and improve the WIC program and Latina participant enrollment more broadly. OBJECTIVE This study aimed to understand the perceptions and experiences of Spanish-speaking Latina WIC participants with the WIC program generally and with COVID-19 pandemic-related policy changes made to the WIC program. DESIGN Qualitative in-depth interviews were conducted virtually in Spanish in August 2022 using a semi-structured guide. PARTICIPANTS/SETTING Study participants were 18 Spanish-speaking Latina adult WIC participants living in North Carolina recruited using convenience sampling. ANALYSIS All interviews were recorded, transcribed, and coded in Spanish. Thematic analysis with inductive coding was used to derive key themes. RESULTS Perceptions about the WIC program in this sample were mixed. Participants felt positively about the healthfulness of foods included in the WIC food packages but expressed concern about the monthly benefit amounts being too low and the cultural appropriateness of food options. Pandemic policy changes, such as remote appointments and the Cash Value Benefit increase were perceived positively; however, barriers to using benefits during this time included limited communication from WIC agencies, food shortages, and concerns about not being granted US citizenship or permanent resident status due to use of WIC (ie, public charge rule). Social networks played an important role in learning about and enrolling in WIC and navigating food shortages during the pandemic. CONCLUSIONS Concerns about the cultural appropriateness of foods provided, communication challenges, and the public charge rule emphasized the need for resources dedicated in the WIC program to improving Spanish-speaking Latina women's experiences with WIC.
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Affiliation(s)
- Carlos R Soto Díaz
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Isabella C A Higgins
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ana Paula C Richter
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cassandra R Davis
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Molly De Marco
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily W Duffy
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Duffy EW, Ng SW, Bercholz M, Davis CR, De Marco M, Hall MG, Maselko J, Smith Taillie L. Special Supplemental Nutrition Program for Women, Infants, and Children Participant Grocery Store Purchases during the COVID-19 Pandemic in North Carolina. Curr Dev Nutr 2024; 8:102098. [PMID: 38440362 PMCID: PMC10909627 DOI: 10.1016/j.cdnut.2024.102098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
Background Families participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) experienced barriers to accessing healthy food during the COVID-19 pandemic, but we do not yet understand how WIC participant food purchases shifted during the pandemic. Objectives We aimed to describe the association between the initial shock of the pandemic in March 2020 and WIC shoppers' food purchases and changes in purchases before and during the pandemic at a top grocery chain and examine differences in these relationships by duration of WIC use. Methods We used longitudinal food transaction data from WIC shoppers (n = 2,989,116 shopper-month observations from 175,081 unique WIC shoppers) from 496 stores in a top grocery store chain in North Carolina between October 2019 and May 2021. We used an interrupted time series design to describe the following: 1) the relationship between the initial shock of the pandemic and WIC shopper food purchases and 2) differences in purchases before and during the pandemic. To assess differences in purchases between shoppers consistently using WIC electronic benefit transfer (EBT) cards and shoppers starting or stopping WIC EBT use during the pandemic, we used models stratified by WIC group. Primary outcomes were share (%) of total calories purchased from fruits, vegetables, nuts, and legumes (FV), processed foods, and sugar-sweetened beverages (SSBs). Results We observed small decreases in the share of total calories from FV (-0.4%) and small increases in the share of calories from processed food (1.1%) and SSBs (0.5%) purchased at this retailer when comparing the pre and post March 2020 periods. Compared with shoppers that started or stopped using WIC benefits during the pandemic, shoppers that used WIC benefits consistently had slightly higher FV and lower processed food and SSB purchases at this retailer. Conclusions Future studies should examine whether additional supports for nutrient-dense food choices may be needed for families with low incomes in public health emergencies.
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Affiliation(s)
- Emily W Duffy
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Shu Wen Ng
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, Chapel Hill, NC, United States
| | | | - Cassandra R Davis
- Carolina Population Center, Chapel Hill, NC, United States
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Molly De Marco
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Marissa G Hall
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States
| | - Joanna Maselko
- Carolina Population Center, Chapel Hill, NC, United States
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lindsey Smith Taillie
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, Chapel Hill, NC, United States
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Hua SV, Collis CE, Block JP. Developing Effective Strategies for Obesity Prevention. Gastroenterol Clin North Am 2023; 52:469-482. [PMID: 37197887 DOI: 10.1016/j.gtc.2023.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Nutrition policies can work with clinical treatments to address the obesity epidemic. The United States has passed beverage taxes at the local level and calorie labeling mandates at the federal level to encourage healthier consumption. Nutritional changes to federal nutrition programs have been either implemented or suggested; evidence shows that the changes that have been implemented have resulted in improvements in diet quality and are cost-effective in decreasing the increase in obesity prevalence. A comprehensive policy agenda that addresses risk of obesity on multiple levels of the food supply will have meaningful long-term effects on obesity prevalence.
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Affiliation(s)
- Sophia V Hua
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
| | - Caroline E Collis
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, 401 Park Drive, Suite 401, Boston, MA, USA
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Lora KR, Hodges L, Ryan C, Ver Ploeg M, Guthrie J. Factors That Influence Children's Exits from the Special Supplemental Nutrition Program for Women, Infants, and Children: A Systematic Review. Nutrients 2023; 15:nu15030766. [PMID: 36771472 PMCID: PMC9919162 DOI: 10.3390/nu15030766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides supplemental foods and nutritional education to low-income women and children up to the age of five. Despite evidence that WIC improves diet and nutrition and the nationwide availability of this program, many participants exit WIC before they are no longer eligible for benefits. To date no study has systematically reviewed factors that influence participants' exits from WIC. The study systematically reviewed the relevant literature to identify factors related to discontinuing participation in WIC before children reach the age of five and 1503 citations were reviewed, 19 articles were read for full text review and eight studies met inclusion criteria. Participants' higher socioeconomic status, attitudes and behaviors around breastfeeding, having shorter prenatal participation in WIC, administrative barriers, confusion regarding program eligibility, feelings of stigma and embarrassment at the store checkout lines, personal and family challenges, dissatisfaction with insufficient fruit and vegetables benefits and living in suburban areas or in the Southern US were salient factors that influenced WIC exits. These findings will be of interest to policymakers and stakeholders as they consider ways to increase participation and retention through program modernization and innovations.
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Affiliation(s)
- Karina R. Lora
- Department of Exercise and Nutrition Science, The George Washington University, 950 New Hampshire Avenue, Washington, DC 20052, USA
- Correspondence:
| | - Leslie Hodges
- United States Department of Agriculture, Economic Research Service, 1400 Independence Avenue SW, Washington, DC 20250, USA
| | - Cayley Ryan
- Department of Sociology and Criminology, Pennsylvania State University, 211 Oswald Tower, State College, PA 16801, USA
| | - Michele Ver Ploeg
- United States Department of Agriculture, Economic Research Service, 1400 Independence Avenue SW, Washington, DC 20250, USA
| | - Joanne Guthrie
- United States Department of Agriculture, Economic Research Service, 1400 Independence Avenue SW, Washington, DC 20250, USA
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Chaney AM, Ritchie LD, Whaley SE, Tsai MM, Randel-Schreiber HR, Yepez CE, Sabatier S, Young A, Meza M, Au LE. Racial and Ethnic Comparisons in Satisfaction with Services Provided by the Special Supplemental Nutrition Program for Women, Infants, and Children in California. Nutrients 2023; 15:nu15020447. [PMID: 36678318 PMCID: PMC9866005 DOI: 10.3390/nu15020447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Understanding satisfaction of nutrition education and other services provided in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is needed to ensure the program is responsive to the needs of diverse populations. This study examined the variation of WIC participants’ perceptions and satisfaction with WIC nutrition education and services by race, ethnicity, and language preference. Phone surveys were conducted in 2019 with California WIC families with children aged 1−4 years. While most participants (86%) preferred one-on-one nutrition education, online/mobile apps were also favored (69%). The majority (89%) found nutrition education equally important to receiving the WIC food package. Racial/ethnic groups differed in which WIC service they primarily valued as 20% of non-Hispanic White people rated the food package as more important than nutrition education compared to 5% of Spanish- and 6% of English-speaking Hispanic people, respectively. More Spanish (91%) and English-speaking Hispanic people (87%) than non-Hispanic white (79%) or Black people (74%) changed a behavior because of something they learned at WIC (p < 0.001). Spanish-speaking Hispanic people (90%) had the highest satisfaction with WIC nutrition education. Preferential differences among participants suggest that providing flexible options may improve program satisfaction and emphasizes the need for future studies to examine WIC services by race and ethnicity.
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Affiliation(s)
- Alana M. Chaney
- Department of Nutrition, University of California Davis, Davis, CA 95616, USA
- Correspondence: ; Tel.: +1-706-288-6833
| | - Lorrene D. Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
| | - Shannon E. Whaley
- Public Health Foundation Enterprises WIC, 12781 Schabarum Avenue, Irwindale, CA 91706, USA
| | - Marisa M. Tsai
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
| | - Hallie R. Randel-Schreiber
- Communicable Disease Prevention Unit, San Francisco Department of Public Health, 101 Grove St, Rm 406, San Francisco, CA 94102, USA
| | - Catherine E. Yepez
- Public Health Foundation Enterprises WIC, 12781 Schabarum Avenue, Irwindale, CA 91706, USA
| | - Susan Sabatier
- WIC Division, California Department of Public Health, 3901 Lennane Drive, Sacramento, CA 95834, USA
| | - Adrian Young
- WIC Division, California Department of Public Health, 3901 Lennane Drive, Sacramento, CA 95834, USA
| | - Martha Meza
- Public Health Foundation Enterprises WIC, 12781 Schabarum Avenue, Irwindale, CA 91706, USA
| | - Lauren E. Au
- Department of Nutrition, University of California Davis, Davis, CA 95616, USA
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Borger C, Paolicelli C, Sun B, Zimmerman TP, Dixit-Joshi S. Duration of WIC Participation and Early Feeding Practices Are Associated With Meeting the Added Sugars Recommendation at Age 3 Years. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:670-676. [PMID: 35568685 DOI: 10.1016/j.jneb.2022.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To examine whether duration of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and early feeding practices are associated with the likelihood of meeting the Dietary Guidelines for Americans (DGA) recommendation for added sugars (AS) at age 3 years. METHODS Using data from the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2), logistic regression assessed associations between WIC participation patterns, early feeding practices, and whether 3-year-olds met the AS recommendation. RESULTS Children introduced to sugar-sweetened beverages (SSBs) in their first year were about half (adjusted odds ratio, 0.65; P < 0.01) as likely to meet the recommendation as those not exposed in their first 2 years. First-year-only WIC participation (adjusted odds ratio, 0.61; P < 0.04) also increased the risk of excessive consumption compared with children who participated in their third year. CONCLUSIONS AND IMPLICATIONS Duration of WIC participation is inversely associated with young children's AS intakes. Public health efforts to reduce WIC attrition and enhance education efforts focused on delaying sugar-sweetened beverage introduction are supported.
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Affiliation(s)
| | - Courtney Paolicelli
- Office of Policy Support, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
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