The Special Supplemental Nutrition Program for Women, Infants, and Children Fresh Start Randomized Controlled Trial: Baseline Participant Characteristics and Reliability of Measures

Fruit and Vegetable Purchases and Consumption among WIC Participants after the 2009 WIC Food Package Revision: A Systematic Review

To promote fruit and vegetable (FV) intake among participants, the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) implemented a comprehensive food package revision in 2009. However, to our knowledge, no studies have systematically explored the factors related to FV purchases and/or consumption among WIC participants in the post-2009 revision era. To fill this knowledge gap, we conducted a systematic literature review using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, and Web of Science using key search terms. Studies published from January 1, 2007, through February 28, 2019, were included, since an interim rule for the WIC food package revision was issued in 2007. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format. The articles were grouped based on main themes or factors, settings, design, study years, and sample size. Thirty-nine articles met the inclusion criteria. Seven main themes or factors related to FV purchases and/or consumption in WIC participants were identified in these articles. The 2009 WIC food package revision was the most-studied factor (n = 9). National and state-level studies showed a consistently positive relation between the 2009 revision and FV purchases and/or consumption. However, some studies did not find a positive relation. State-level policy variations can be exploited as natural experiments to assess the causality of state-level factors in WIC participants' FV purchases or consumption. The majority of the included studies were limited in being local (n = 26, 66.7%), cross-sectional (n = 29, 74.4%), or having sample sizes <1000 (n = 25, 64.1%), which could explain the diverse results regarding the relation between FV purchases and/or consumption and various factors, including individual, store, and program characteristics.

Relationship of food insecurity to women's dietary outcomes: a systematic review

Context

Food insecurity matters for women's nutrition and health.

Objective

This review sought to comprehensively evaluate how food insecurity relates to a full range of dietary outcomes (food groups, total energy, macronutrients, micronutrients, and overall dietary quality) among adult women living in Canada and the United States.

Data sources

Peer-reviewed databases (PubMed/MEDLINE, CINAHL, Scopus, Web of Science) and gray literature sources from 1995 to 2016 were searched.

Data extraction

Observational studies were used to calculate a percentage difference in dietary intake for food-insecure and food-secure groups.

Results

Of the 24 included studies, the majority found food-insecure women had lower food group frequencies (dairy, total fruits and vegetables, total grains, and meats/meat alternatives) and intakes of macro- and micronutrients relative to food-secure women. Methodological quality varied. Among high-quality studies, food insecurity was negatively associated with dairy, fruits and vegetables, grains, meats/meats alternatives, protein, total fat, calcium, iron, magnesium, vitamins A and C, and folate.

Conclusions

Results hold practical relevance for selecting nutritional targets in programs, particularly for nutrient-rich foods with iron and folate, which are more important for women's health.

Feasibility of a farm-to-WIC intervention

Objective:

To examine whether an intervention consisting of a WIC-based farmers’ market, nutrition education, recipe demonstrations and tastings, and handouts could be implemented as intended and the acceptability of the programme to recipients. The availability, variety and prices of fruits and vegetables (F&V) and the Farmers’ Market Nutrition Program voucher redemption rate at the site with market (relative to the rate among fourteen other WIC agency sites) also were examined.

Design:

Site-level data were used to evaluate programme implementation. Acceptability was assessed with participant data.

Setting:

A large, New Jersey-based, urban WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) agency.

Participants:

Fifty-four women who purchased F&V at the market.

Results:

Gaps in stakeholder communication and coordination, F&V selling out by midday and staffing levels affected implementation fidelity. On average, 12 (sd 3) F&V were available daily at the market (twenty-five unique F&V in total). For thirteen of nineteen items, prices were lower at the WIC-based market than area farmers’ markets. The voucher redemption rate at the site with the market (46 %) was higher than the rate among the fourteen other sites (39 %; P < 0·01). The mean rating of satisfaction with the programme was 6·9 (sd 0·6) on a 7-point scale. All participants reported intending to purchase F&V again at the market, owing to the convenient location, quality of the F&V and helpfulness of the staff. Improving F&V availability and variety were recommended.

Conclusions:

The intervention is feasible with improved stakeholder communication and coordination, F&V availability and variety, and staffing.

Poor Dietary Guidelines Compliance among Low-Income Women Eligible for Supplemental Nutrition Assistance Program-Education (SNAP-Ed)

The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program aims to improve nutritional intakes of low-income individuals (<185% poverty threshold). The objective of this study was to describe the compliance with Dietary Guidelines for Americans (DGA) recommendations for fruits, vegetables, and whole grains among SNAP-Ed eligible (n = 3142) and ineligible (n = 3168) adult women (19–70 years) nationwide and SNAP-Ed participating women in Indiana (n = 2623), using the NHANES 2007–2012 and Indiana SNAP-Ed survey data, respectively. Sensitivity analysis further stratified women by race/ethnicity and by current SNAP participation (<130% poverty threshold). Nationally, lower-income women were less likely to meet the fruit (21% vs. 25%) and vegetable (11% vs. 19%) guidelines than higher-income women, but did not differ on whole grains, which were ~5% regardless of income. The income differences in fruit and vegetable intakes were driven by non-Hispanic whites. Fewer SNAP-Ed-eligible U.S. women met fruit (21% vs. 55%) and whole grain (4% vs. 18%) but did not differ for vegetable recommendations (11% vs. 9%) when compared to Indiana SNAP-Ed women. This same trend was observed among current SNAP participants. Different racial/ethnic group relationships with DGA compliance were found in Indiana compared to the nation. Nevertheless, most low-income women in the U.S. are at risk of not meeting DGA recommendations for fruits (79%), vegetables (89%), and whole grains (96%); SNAP-Ed participants in Indiana had higher compliance with DGA recommendations. Increased consumption of these three critical food groups would improve nutrient density, likely reduce calorie consumption by replacing high calorie choices, and improve fiber intakes.

Interrelationship between food security status, home availability of variety of fruits and vegetables and their dietary intake among low-income pregnant women

OBJECTIVE

To (i) determine differences in the availability of variety of fruits and vegetables (F&V) at home by food security status; and (ii) examine the inter-associations between food security status, availability of variety of F&V at home and frequency of F&V intake, among low-income pregnant women. Design/Setting Participants were interviewed to collect food security status, home availability of variety of F&V and frequency of F&V intake. Bivariate analyses, multivariate regression and exploratory mediation analyses were conducted using IBM SPSS Statistics version 23.0 and the PROCESS macro.

SUBJECTS

Low-income pregnant women (n 198) were interviewed if they were ≥18 years of age, in the second trimester of pregnancy, and spoke English or Spanish.

RESULTS

Low/very low food security was found among 43 % of participants. Compared with fully food-secure participants, very low food-secure participants reported a lower variety of fruits (P=0·028) and vegetables (P=0·058) available at home. Mediation analyses indicated that through home availability of variety of fresh F&V, food security status was associated with the daily intake of F&V (indirect effect (95 % CI): fresh fruits, -0·039 (-0·074, -0·013); fresh vegetables, -0·048 (-0·083, -0·023)). As food security worsened, the available variety of fresh F&V decreased, which was associated with lower intake.

CONCLUSIONS

The study highlights the interlink between food security, home food environment and diet quality, and the importance of nutrition education intervention to promote a healthy home food environment and improved pregnancy outcomes among low-income women.

Outcomes of a randomized controlled trial of nutrition education to promote farmers' market fruit and vegetable purchases and consumption among women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Background

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides participants seasonal Farmers’ Market Nutrition Program (FMNP) vouchers to purchase fruits and vegetables (FV) at farmers’ markets and monthly cash value vouchers (CVV) redeemable at farmers’ markets. Despite the promise of FMNP vouchers and CVV for improving FV access among WIC participants, voucher redemption rates are low. This study evaluated WIC Fresh Start (WFS), a theory-driven, web-based lesson to promote FV intake, the redemption of CVV at farmers’ markets, FMNP voucher redemption, and farmers’ market-related knowledge, attitudes, and skills among women enrolled in WIC.

Methods

The lesson was evaluated in a four-arm randomized controlled trial. The setting was a large New Jersey-based WIC agency located in a densely populated, urban area. Participants (N = 744) were stratified based on FMNP voucher receipt and randomized to receive the WFS lesson or WIC online existing health education. Lesson effects on targeted outcomes were examined at posttest (2 weeks after the lesson) and 3 and 6 months after posttesting.

Results

Receipt of the WFS lesson was associated with FMNP voucher redemption (in the subset of participants preferring to speak Spanish); improvements in knowledge of the FMNP, locally grown seasonal items, seasonal items found at farmers’ markets in July, WIC-authorized farmers’ markets and food- and farmers’ market-specific knowledge; ever having purchased and intentions to purchase FV at a farmers’ market; FV food safety and preparation skills; and modest gains in the redemption of CVV at farmers’ markets. FV intake did not differ over time by trial arm.

Conclusions

Findings aid understanding of effective approaches to promote farmers’ market use and farmers’ market-related knowledge and skills among WIC participants. Further research is needed to explore factors that may explain the lack of lesson effects on FV intake.

Trial registration

NCT02565706