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Scott M, Qamar Z. Navigating Nutrition Inequities: BIPOC Maternal Health and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)'s Fruit and Vegetable Voucher. J Perinat Neonatal Nurs 2024; 38:18-24. [PMID: 38278640 DOI: 10.1097/jpn.0000000000000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
INTRODUCTION The proposal to administer cuts for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) could create deficiencies in nutrition for already food insecure, low-income Black, Indigenous, and Persons of Color (BIPOC) pregnant, postpartum women, and children. WIC is a US Department of Agriculturefunded nutritional program for women, infants, and children. The current proposal is to cut the funding by $800 million for the 2024 fiscal year, affecting 75% of its low-income recipients and predominantly BIPOC. METHODS Relevant websites and journal articles were analyzed to determine how the proposed cuts would create barriers within the social determinants of health that contribute to disparities in health outcomes of WIC recipients. RESULTS Many studies have demonstrated that nutrition in the first 1000 days is critical for the healthy development of newborns. Prior research suggests that maternal health outcomes for BIPOC populations are contingent upon the increased allocation of nutritional support programs such as WIC and SNAP (Supplemental Nutrition Assistance Program). Nutrients provided by the cash benefit voucher have been proven to contribute to participants' health outcomes, and allotment increases can benefit maternal and infant health outcomes. CONCLUSION AND FUTURE DIRECTIONS Neonatal nurses can help advocate for more robust policies that support the health of their patients. Future directions call for systematic changes in policies and legislation that directly affect maternal health outcomes, supportive breastfeeding policies, and applied research on solutions to improve maternal health outcomes of BIPOC populations in addition to increased awareness, education, and implementation of VeggieRx programs, investment in affordable, sustainable grassroots urban agriculture solutions.
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Affiliation(s)
- Monique Scott
- Public Health Department, San Francisco State University (SFSU), San Francisco, California; and Family, Interiors, Nutrition, and Apparel (FINA), San Francisco State University (SFSU), San Francisco, California
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Matos MS, Suzuki S, White N. Addressing Barriers to Healthy Eating Through Food as Medicine Initiatives. Am J Lifestyle Med 2023; 17:750-753. [PMID: 38511117 PMCID: PMC10948924 DOI: 10.1177/15598276231188645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Poor diet is the number one risk factor for death globally; yet, few adults meet the dietary guidelines for optimal health. Food is medicine initiatives including food pharmacies, produce prescriptions, and medically tailored meals are emerging models to improve diet and reduce diet-related disease. These initiatives target barriers to healthy eating, including access, nutrition knowledge, culinary skill, motivation, and support. The following will discuss significant barriers to healthy eating and describe the strategies employed within these initiatives to overcome such barriers.
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Affiliation(s)
- Marietta Sotomayor Matos
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
| | - Shaye Suzuki
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
| | - Nicole White
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
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Lopez MA, Fuster M, Fleckman JM, George A, Chaparro MP. The association between language use and food insecurity among Hispanic adults residing in the USA depends on nativity. Public Health Nutr 2023; 26:1887-1895. [PMID: 37248038 PMCID: PMC10478063 DOI: 10.1017/s1368980023000885] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/23/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To examine the association between language use - predominantly English, English and Spanish equally and predominantly Spanish - and food insecurity among Hispanic adults residing in the USA, 1999-2018. DESIGN Pooled cross-sectional study design. SETTING United States. PARTICIPANTS 15 073 Hispanic adults. RESULTS Compared with Hispanic adults who predominantly spoke English and after adjusting for age, sex, family income-to-poverty ratio, education level and employment status, Hispanic adults who spoke English and Spanish equally (OR = 1·28, 95 % CI = 1·05, 1·56) or predominantly Spanish (OR = 1·25, 95 % CI = 1·04, 1·49) had higher odds of food insecurity. After stratifying by country of birth, language use was associated with higher odds of food insecurity only for Hispanic adults born outside of the USA, but not for Hispanic adults born in the USA. Hispanic adults born outside of the USA who spoke English and Spanish equally (OR = 1·27, 95 % CI = 1·04, 1·55) or spoke predominantly Spanish (OR = 1·24, 95 % CI = 1·04, 1·48) had higher odds of food insecurity when compared with those who predominantly spoke English. CONCLUSION Foreign-born Hispanic adults who speak predominantly Spanish, or English and Spanish equally, have higher odds of food insecurity. Food and nutrition assistance programmes that serve Hispanic immigrants should make sure to provide linguistically and culturally appropriate services to this population.
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Affiliation(s)
- Miguel Angel Lopez
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Melissa Fuster
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Julia M Fleckman
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Amy George
- Department of Spanish and Portuguese, School of Liberal Arts, Tulane University, New Orleans, LA, USA
| | - M Pia Chaparro
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Nutritional Sciences Program, Department of Health Systems and Population Health, School of Public Health, University of Washington, 305J Raitt Hall, Box 353410, Seattle, WA98195, USA (current affiliation)
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Vercammen K, Grummon AH, Zatz LY, Gago CM, Blocksidge M, Hua SV, Bleich SN, Stone S, Kenney E, Colchamiro R, Rimm EB. A Descriptive Analysis of Redemption Patterns by Vendor Type Among: WIC Participants in Massachusetts. J Acad Nutr Diet 2023; 123:626-636.e2. [PMID: 36372729 PMCID: PMC10187795 DOI: 10.1016/j.jand.2022.09.011] [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: 09/03/2021] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The retail environment is an important determinant of food package redemption in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). OBJECTIVE The objectives of this study were to describe where Massachusetts WIC households redeemed their food benefits each month and monthly variations in benefit redemption depending on a household's most frequently used vendor type each month. DESIGN These were cross-sectional and longitudinal analyses of administrative data provided by Massachusetts WIC. PARTICIPANTS/SETTING Monthly redemption data for 209,973 households shopping at approximately 1,000 unique vendors between January 2015 and August 2019 were analyzed. MAIN OUTCOME MEASURES Outcomes were mean monthly percentage of households that relied on each vendor type when redeeming benefits and mean monthly percent redemption for each benefit category. STATISTICAL ANALYSES PERFORMED For each month, households were classified as using 1 of 8 vendor types. The monthly percentage of households redeeming at each vendor type was calculated, as well as the monthly percent redemption for each benefit category by vendor type. The averages of these monthly percentages were computed for 2015 and 2019. Data from months when households did not redeem any benefits were excluded from primary analyses because it was not possible to determine their vendor type for that month. RESULTS On average across months in 2019, the majority of Massachusetts WIC households (63%) relied on large vendors only (ie, superstores, supermarkets, and large grocery stores) when redeeming benefits, and 5% relied on small grocery or convenience stores only. Between 2015 and 2019, mean monthly reliance on small grocery and convenience stores decreased by 3.1 and 0.7 percentage points, respectively. Compared with other vendor types, households that redeemed benefits at superstores only had, in an average month, lower redemption levels for most benefit categories. For example, in the 2019 mean across months, percent redemption of breakfast cereal was 53% among households redeeming at superstores only compared with 74% for those redeeming at small grocery stores only. By contrast, households that relied on small grocery stores only had, in an average month, lower redemption levels for yogurt and cash value benefit compared with other vendor types; for example, in the 2019 mean across months, percent redemption of yogurt was 34% among households redeeming at small grocery stores only compared with 62% among those redeeming at supermarkets only. CONCLUSIONS Results suggest that retail-based efforts to increase redemption should consider vendor-type reliance. Strategies to increase redemption may be especially important for WIC shoppers relying on superstores.
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Affiliation(s)
- Kelsey Vercammen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
| | - Anna H Grummon
- Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, Massachusetts; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Laura Y Zatz
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Cristina M Gago
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Mary Blocksidge
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Sophia V Hua
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Sarah Stone
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Erica Kenney
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Eric B Rimm
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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5
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Joshi P, Van Remortel BJ, Cullen DL. Perspectives From Urban WIC-Eligible Caregivers to Improve Produce Access. Pediatrics 2023; 151:190434. [PMID: 36601707 DOI: 10.1542/peds.2022-058536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES The Farmer's Market Nutrition Program (FMNP) provides fresh, locally grown fruits and vegetables (FV) to eligible participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). However, redemption of FMNP benefits remains low. This qualitative study explores facilitators and barriers to produce access and FMNP redemption for caregivers of WIC-eligible children in Philadelphia during the COVID-19 pandemic. METHODS We conducted semistructured phone interviews with caregivers between August and December 2020 to understand experiences with produce access and programming preferences to increase benefit redemption and produce consumption. We used content analysis with constant comparison with code interviews inductively and identified emerging themes through an iterative process. RESULTS Participants (n = 30) wanted their children to eat more produce but described barriers to produce access, including limited availability, higher cost, and limited time. The Supplemental Nutrition Assistance Program and WIC benefits improved the ability to purchase produce, but difficulties with electronic benefit transfer and pandemic-related office closures limited use of WIC benefits. Similarly, lack of convenient market locations and hours prohibited use of FMNP benefits. Caregivers described that an ideal food program would be delivery based, low cost, offer a variety of FV, and provide recipes and educational activities. CONCLUSIONS WIC-eligible caregivers want their children to eat more produce; however, they face multiple barriers in redeeming their benefits to access fresh produce. Delivery-based, low-cost produce programs may lead to increased produce access as well as benefit use. Future study is needed on feasibility and acceptability of produce delivery options among WIC-eligible families.
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Affiliation(s)
- Priyanka Joshi
- Divisions of Emergency Medicine.,Contributed equally as co-first authors
| | - Brittany J Van Remortel
- Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Contributed equally as co-first authors
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6
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Varela EG, McVay MA, Shelnutt KP, Mobley AR. The Determinants of Food Insecurity Among Hispanic/Latinx Households With Young Children: A Narrative Review. Adv Nutr 2023; 14:190-210. [PMID: 36811589 PMCID: PMC10103006 DOI: 10.1016/j.advnut.2022.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022] Open
Abstract
Food insecurity has disproportionately impacted Hispanic/Latinx households in the United States, specifically those with young children. Although the literature provides evidence of an association between food insecurity and adverse health outcomes in young children, minimal research has addressed the social determinants and related risk factors associated with food insecurity among Hispanic/Latinx households with children under three, a highly vulnerable population. Using the Socio-Ecological Model (SEM) as a framework, this narrative review identified factors associated with food insecurity among Hispanic/Latinx households with children under three. A literature search was conducted using PubMed and four additional search engines. Inclusion criteria consisted of articles published in English from November 1996 to May 2022 that examined food insecurity among Hispanic/Latinx households with children under three. Articles were excluded if conducted in settings other than the US and/or focused on refugees and temporary migrant workers. Data were extracted (i.e., objective, setting, population, study design, measures of food insecurity, results) from the final articles (n = 27). The strength of each article's evidence was also evaluated. Results identified individual factors (i.e., intergenerational poverty, education, acculturation, language, etc.), interpersonal factors (i.e., household composition, social support, cultural customs), organizational factors (i.e., interagency collaboration, organizational rules), community factors (i.e., food environment, stigma, etc.), and public policy/societal factors (i.e., nutrition assistance programs, benefit cliffs, etc.) associated with a food security status of this population. Overall, most articles were classified as "medium" or higher quality for the strength of evidence, and more frequently focused on individual or policy factors. Findings indicate the need for more research to include a focus on public policy/society factors, as well as on multiple levels of the SEM with considerations of how individual and policy levels intersect and to create or adapt nutrition-related and culturally appropriate interventions to improve food security of Hispanic/Latinx households with young children.
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Affiliation(s)
- Elder Garcia Varela
- Graduate Research and Teaching Assistant, Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Megan A McVay
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Karla P Shelnutt
- Department of Family, Youth & Community Sciences, University of Florida, Gainesville, FL, USA
| | - Amy R Mobley
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA.
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Esquivel M, Higa A, Guidry A, Shelton C, Okihiro M. A Qualitative Study on the Motivators, Barriers and Supports to Participation in a Pediatric Produce Prescription Program in Hawai'i. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16682. [PMID: 36554563 PMCID: PMC9778988 DOI: 10.3390/ijerph192416682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Produce prescriptions that provide vouchers to individuals to purchase fresh FVs at a specified retail outlet have the potential to positively impact food security status, diet, and chronic disease risk. However, maximizing program participation is vital to ensuring program success. This research describes motivators, barriers, and support for participation in a child produce prescription program among a population of Native Hawaiian and Other Pacific Islanders, who are underrepresented in this field of research. This qualitative grounded theory study was nestled within a quasi-experimental pilot intervention trial and included semi-structured interviews with pediatric program participants. Twenty-five interviews were conducted, which represented one-third of program participants. The top support factors for program participation included: ease of voucher use, program convenience, health center/pediatrician endorsement and positive communications with farmers' market vendors. Key motivators for program participation were produce enjoyment, child support, financial support, and positive impacts on family. Three themes emerged consistently as barriers to participation amongst participants, (1) difficult use of vouchers, (2) conflicting schedules, and (3) online market concerns. (4) Conclusions: This research offers insight into policy implications as the number of produce prescription programs has grown. These findings suggest that key program design characteristics can enhance and support program participation.
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Affiliation(s)
- Monica Esquivel
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
| | - Alicia Higa
- Elepaio Social Services, Waianae, HI 96792, USA
| | - Andrea Guidry
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
| | | | - May Okihiro
- Waianae Coast Comprehensive Health Center, Waianae, HI 96792, USA
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8
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Rogus S, Guthrie J, Niculescu M, Xu L. The impact of a healthy checkout intervention on fruit and vegetable 'micro-pack' purchases in New Mexico. Public Health Nutr 2022; 25:1-9. [PMID: 36093640 PMCID: PMC9991551 DOI: 10.1017/s1368980022002026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 07/14/2022] [Accepted: 08/26/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Produce sold as plastic-wrapped packs of two to four individual items (i.e., produce micro-packs) that are low cost and placed at checkout may appeal to shoppers with budget constraints and provide a second chance to purchase items available elsewhere in the store. This study examined the impact of an intervention that placed produce micro-packs at checkout and promoted them in grocery stores across New Mexico, USA. DESIGN This quasi-experimental study placed produce micro-packs at checkout end-caps in thirteen stores (group 1), with eight stores serving as controls (group 2) from 1 July 2019 through 31 January 2020 (first phase). The intervention was extended to group 2 stores from 1 February 2020 through 30 June 2020 (second phase). Cashiers were directed to upsell the micro-packs to Special Supplemental Nutrition Program for Women, Infants, and Children recipients who had unspent cash value benefits for produce purchases. SETTING Twenty-one grocery stores across New Mexico. PARTICIPANTS Twenty-one produce items sold as micro-packs in stores from July 2019 through June 2020. RESULTS A random effects model showed that the daily sales of micro-packs increased by 47 % during each intervention period. Group 2 stores had lower sales than group 1 stores during the first phase of the intervention. Once extended to group 2 stores, sales of micro-packs in those stores increased and sales in group 1 stores continued at the higher level. CONCLUSIONS Placing produce micro-packs at checkout may increase produce sales and support health promotion efforts by public and private stakeholders.
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Affiliation(s)
- Stephanie Rogus
- Department of Family and Consumer Sciences, New Mexico State University, MSC 3470, P.O. Box 30003, Las Cruces, NM88003, USA
| | - Joanne Guthrie
- Economic Research Service, U.S. Department of Agriculture, Washington, DC, USA
| | - Mihai Niculescu
- Marketing Department, New Mexico State University, Las Cruces, NM, USA
| | - Lina Xu
- Marketing Department, The Pennsylvania State University, Abington, PA, USA
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9
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Halverson MM, Karpyn A. WIC Participants’ Perceptions of the Cash-Value Benefit Increase during the COVID-19 Pandemic. Nutrients 2022; 14:nu14173509. [PMID: 36079766 PMCID: PMC9460143 DOI: 10.3390/nu14173509] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Recent changes to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Cash-Value Benefit (CVB), which provides participants with money to spend on fruits and vegetables, have the potential to reduce disparities in healthy food access and food insecurity that were exacerbated by the COVID-19 pandemic. However, few studies have examined how the changes to the CVB allotment that occurred during the pandemic influenced WIC participants’ perceptions of the benefit or their fruit and vegetable purchasing and consumption. To address this gap, we conducted semi-structured interviews with 51 WIC participants in Wilmington, Delaware. Survey measures included demographic questions, the Hunger Vital Sign food insecurity screener, and open-ended questions regarding perceptions of the CVB increase and its influence on participants’ fruit and vegetable purchasing and consumption. Data were analyzed using a hybrid inductive and deductive coding approach. The results demonstrate that higher CVB allotments increased WIC participants’ purchasing and consumption of fruits and vegetables, increased the frequency of their shopping occasions, and enhanced their dietary variety. Our findings also suggest that WIC participants highly value the increased CVB. Consequently, maintaining the increased CVB allotment could improve the nutritional outcomes of low-income mothers, infants, and children participating in WIC.
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Duffy EW, Vest DA, Davis CR, Hall MG, De Marco M, Ng SW, Taillie LS. "I Think That's the Most Beneficial Change That WIC Has Made in a Really Long Time": Perceptions and Awareness of an Increase in the WIC Cash Value Benefit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8671. [PMID: 35886526 PMCID: PMC9324401 DOI: 10.3390/ijerph19148671] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023]
Abstract
During the COVID-19 pandemic, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Cash Value Benefit (CVB) for fruits and vegetables increased by roughly USD 25/month/person. We sought to understand WIC participant perceptions of this change and barriers and facilitators to using the CVB. We conducted 10 virtual focus groups (5 rural, 5 urban/suburban) with WIC participants (n = 55) in North Carolina in March 2022. Focus groups were recorded and transcribed. We open-coded the content and used thematic analysis to uncover consistencies within and between sampled groups. Participants expressed favorable perceptions of the CVB increase and stated the pre-pandemic CVB amount was insufficient. Barriers to using the increased CVB were identifying WIC-approved fruits and vegetables in stores and insufficient supply of fruits and vegetables. Barriers were more pronounced in rural groups. Facilitators of CVB use were existing household preferences for fruits and vegetables and the variety of products that can be purchased with CVB relative to other components of the WIC food package. Participants felt the CVB increase allowed their families to eat a wider variety of fruits and vegetables. The CVB increase may improve fruit and vegetable intake, particularly if made permanent, but barriers to CVB and WIC benefit use may limit the potential impact.
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Affiliation(s)
- Emily W. Duffy
- Carolina Population Center, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (S.W.N.); (L.S.T.)
| | - Daniele A. Vest
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Cassandra R. Davis
- Carolina Population Center, Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Marissa G. Hall
- Carolina Population Center, Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Molly De Marco
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Shu Wen Ng
- Carolina Population Center, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (S.W.N.); (L.S.T.)
| | - Lindsey Smith Taillie
- Carolina Population Center, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (S.W.N.); (L.S.T.)
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11
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Gago CM, Wynne JO, Moore MJ, Cantu-Aldana A, Vercammen K, Zatz LY, May K, Andrade T, Mendoza T, Stone SL, Mattei J, Davison KK, Rimm EB, Colchamiro R, Kenney EL. Caregiver Perspectives on Underutilization of WIC: A Qualitative Study. Pediatrics 2022; 149:184490. [PMID: 35039867 PMCID: PMC8934047 DOI: 10.1542/peds.2021-053889] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal program that improves the health of low-income women (pregnant and postpartum) and children up to 5 years of age in the United States. However, participation is suboptimal. We explored reasons for incomplete redemption of benefits and early dropout from WIC. METHODS In 2020-2021, we conducted semistructured interviews to explore factors that influenced WIC program utilization among current WIC caregivers (n = 20) and caregivers choosing to leave while still eligible (n = 17) in Massachusetts. By using a deductive analytic approach, we developed a codebook grounded in the Consolidated Framework for Implementation Research. RESULTS Themes across both current and early-leaving participants included positive feelings about social support from the WIC clinic staff and savings offered through the food package. Participants described reduced satisfaction related to insufficient funds for fruits and vegetables, food benefits inflexibility, concerns about in-clinic health tests, and in-store item mislabeling. Participants described how electronic benefit transfer cards and smartphone apps eased the use of benefits and reduced stigma during shopping. Some participants attributed leaving early to a belief that they were taking benefits from others. CONCLUSIONS Current and early-leaving participants shared positive WIC experiences, but barriers to full participation exist. Food package modification may lead to improved redemption and retention, including increasing the cash value benefit for fruits and vegetables and diversifying food options. Research is needed regarding the misperception that participation means "taking" benefits away from someone else in need.
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Affiliation(s)
| | | | | | | | | | - Laura Y. Zatz
- Departments of Nutrition,Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kelley May
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Tina Andrade
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Terri Mendoza
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Sarah L. Stone
- Massachusetts Department of Public Health, Boston, Massachusetts
| | | | | | - Eric B. Rimm
- Departments of Nutrition,Epidemiology,Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Erica L. Kenney
- Departments of Nutrition,Address correspondence to Erica L. Kenney, ScD, Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115. E-mail:
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12
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Craveiro D, Marques S, Bell R, Khan M, Godinho C, Peixeiro F. Behavioural change box? Applying the COM-B model to understand behavioural triggers that support consumption of fruits and vegetable among subscribers of a fruit and vegetable box scheme. Public Health Nutr 2021; 24:6488-6498. [PMID: 34482856 PMCID: PMC11374553 DOI: 10.1017/s1368980021003839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To understand the key mechanisms that support healthy dietary habits promoted by fruit and vegetable (F&V) box schemes, testing relevant behaviour change triggers identified under the COM-B model in an evaluation research study of a Portuguese F&V box scheme (PROVE). DESIGN Correlation study with a post-test-only non-equivalent group design based on survey data. The mechanisms underpinning the differences between subscribers and non-subscribers are operationalised as mediation effects. Data availability, theoretical relevance and empirical validation supported the selection and testing of four potential mediators for the effects of subscribing to the box scheme on F&V consumption. These estimations derive from the coefficients of a structural equation model combined with the product coefficient approach and Sobel test. SETTING The study is part of a wider evaluation study on the impact of the PROVE box scheme on sustainability, health and equity. PARTICIPANTS A sample of PROVE box subscribers (n 294) was compared with a matched subsample of non-subscribers (n 571) in a nationally representative survey. RESULTS Subscribing to the PROVE box correlates with an increased probability of eating at least five portions of F&V, irrespective of differences in age, education and perceived economic difficulties. Diet quality perceptions, and more robustly, the strength of meal habits and household availability were identified as relevant mediators. CONCLUSIONS The subscription to an F&V box scheme is connected with proximal context that enables the consumption of F&V by ensuring more readily available F&V and better situational conditions associated with healthier meal habits.
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Affiliation(s)
- Daniela Craveiro
- SOCIUS, Research Centre in Economic and Organizational Sociology, ISEG - School of Economics & Management,Universidade de Lisboa, Rua Miguel Lupi 20, Edifício Bento Jesus Caraça, Office 203, Lisboa1249-078, Portugal
- ISCTE-Instituto Universitário de Lisboa, CIS-IUL, Lisboa, Portugal
| | - Sibila Marques
- ISCTE-Instituto Universitário de Lisboa, CIS-IUL, Lisboa, Portugal
| | - Ruth Bell
- Institute of Health Equity, UCL, London, UK
| | - Matluba Khan
- School of Geography and Planning, Cardiff University, UK
| | - Cristina Godinho
- ISCTE-Instituto Universitário de Lisboa, CIS-IUL, Lisboa, Portugal
- Universidade Católica Portuguesa, Católica Research Centre for Psychological - Family and Social Wellbeing, Portugal
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Riemer S, Walkinshaw LP, Auvinen A, Marcinkevage J, Daniel M, Jones-Smith JC. Qualitative Study on Participant Perceptions of a Supermarket Fruit and Vegetable Incentive Program. J Acad Nutr Diet 2021; 121:1497-1506. [PMID: 33309590 PMCID: PMC9979618 DOI: 10.1016/j.jand.2020.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/23/2020] [Accepted: 10/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Complete Eats Rx is a fruit and vegetable prescription program designed to incentivize fruit and vegetable consumption among Supplemental Nutrition Assistance Program (SNAP) participants via $10 incentives distributed either weekly or per encounter to purchase fruits and vegetables at a mid-price supermarket chain in Washington State. OBJECTIVE To better understand SNAP participants' experience, and to determine perceived impacts and consequences of the program. DESIGN Qualitative analysis of nine photovoice sessions. Participants chose the topics for discussion. Sessions were audiorecorded and transcribed. Thematic content analysis was performed to identify key emergent themes using Atlas.ti. SETTING Spokane, Seattle, and Yakima, Washington. PARTICIPANTS Twenty-six individuals who received a fruit and vegetable prescription within the past 6 months, 23 of whom attended all three photovoice sessions offered at their site. Participants were recruited from three participating health care or public health organizations in Spokane, Seattle, and Yakima, Washington. ANALYSIS Transcriptions were coded using inductive methods. Coded statements were organized into major themes. Coding structures and analysis were strengthened by iterative interactions between researchers. RESULTS Participants reported Complete Eats Rx was an important resource for families and improved food security, diet quality, and the ability to purchase healthy foods, including a greater variety of fruits and vegetables. Primary barriers to food security and fruit and vegetable consumption included limited geographic accessibility and the high cost of fruits and vegetables, exacerbated by other financial constraints such as rising housing costs. Participants reported supermarket checkout difficulty because of embarrassment, stigmatization, and inability to redeem incentives. The most frequently mentioned barrier to perceived program acceptability was having only one supermarket chain as the acceptor of the incentive. CONCLUSION Partnering with supermarkets to accept fruit and vegetable incentives is a unique strategy to increase produce purchasing that can be adopted by other localities. Focus on geographic accessibility, appropriate price points, and positive shopping experiences via expansion to local grocers, improvements in staff interactions, and a transition to an electronic system may improve incentive redemption and usability.
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Zimmer M, McElrone M, Anderson Steeves ET. Feasibility and Acceptability of a "Click & Collect" WIC Online Ordering Pilot. J Acad Nutr Diet 2021; 121:2464-2474.e1. [PMID: 34219049 DOI: 10.1016/j.jand.2021.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/13/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Barriers to shopping for foods in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) have been reported. Online ordering options may improve the WIC shopping experience but are understudied. OBJECTIVE The objective of this study was to test feasibility and acceptability of a "Click & Collect" model for WIC online ordering from the perspective of WIC participants. DESIGN A Click & Collect online ordering model was adapted to the WIC program and implemented at 1 grocery store. In the Click & Collect model, WIC participants placed an online order ("click"), then completed payment and pickup at the store ("collect"). PARTICIPANTS/SETTING Twenty-five WIC participants in East Tennessee were included. MAIN OUTCOME MEASURES Feasibility was assessed by examining online order summaries and store receipts to determine whether WIC transactions were completed successfully. Acceptability was assessed by qualitative semi-structured interviews conducted with WIC participants after participating in the pilot. ANALYSES PERFORMED Descriptive statistics were used to analyze sociodemographic and purchase data in SPSS software, version 27. Qualitative interviews were transcribed and analyzed for themes using directed content analysis in NVivo, version 12.0. RESULTS All WIC participants in the study placed an online order, and 96% picked up the order, indicating a high degree of feasibility. In follow-up qualitative interviews, WIC participants reported interest in the Click & Collect model, and provided suggestions to improve practicality across the following 4 primary themes: website experience, curbside pickup, online shopping fee, and shopping preferences. CONCLUSIONS The pilot was successfully implemented at 1 store. Click & Collect online ordering was feasible and acceptable to WIC participants, although additional work is needed to make it practical. Online shopping options for the WIC program should be further explored to expand access to nutritious WIC foods in families with low income.
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Affiliation(s)
- Meghan Zimmer
- (1)National Institutes of Health, National Cancer Institute. At the time of the study, she was a student, department of public health, University of Tennessee, Knoxville
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Vasan A, Kenyon CC, Feudtner C, Fiks AG, Venkataramani AS. Association of WIC Participation and Electronic Benefits Transfer Implementation. JAMA Pediatr 2021; 175:609-616. [PMID: 33779712 PMCID: PMC8008428 DOI: 10.1001/jamapediatrics.2020.6973] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/20/2020] [Indexed: 11/14/2022]
Abstract
Importance The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an important source of nutritional support and education for women and children living in poverty; although WIC participation confers clear health benefits, only 50% of eligible women and children currently receive WIC. In 2010, Congress mandated that states transition WIC benefits by 2020 from paper vouchers to electronic benefits transfer (EBT) cards, which are more convenient to use, are potentially less stigmatizing, and may improve WIC participation. Objective To estimate the state-level association between transition from paper vouchers to EBT and subsequent WIC participation. Design, Setting, and Participants This economic evaluation of state-level WIC monthly benefit summary administrative data regarding participation between October 1, 2014, and November 30, 2019, compared states that did and did not implement WIC EBT during this time period. Difference-in-differences regression modeling allowed associations to vary by time since policy implementation and included stratified analyses for key subgroups (pregnant and postpartum women, infants younger than 1 year, and children aged 1-4 years). All models included dummy variables denoting state, year, and month as covariates. Data analyses were performed between March 1 and June 15, 2020. Exposures Statewide transition from WIC paper vouchers to WIC EBT cards, specified by month and year. Main Outcomes and Measures Monthly number of state residents enrolled in WIC. Results A total of 36 states implemented WIC EBT before or during the study period. EBT and non-EBT states had similar baseline rates of poverty and food insecurity. Three years after statewide WIC EBT implementation, WIC participation increased by 7.78% (95% CI, 3.58%-12.15%) in exposed states compared with unexposed states. In stratified analyses, WIC participation increased by 7.22% among pregnant and postpartum women (95% CI, 2.54%-12.12%), 4.96% among infants younger than 1 year (95% CI, 0.95%-9.12%), and 9.12% among children aged 1 to 4 years (95% CI, 3.19%-15.39%; P for interaction = .20). Results were robust to adjustment for state unemployment and poverty rates, population, and Medicaid expansion status. Conclusions and Relevance In this study, the transition from paper vouchers to WIC EBT was associated with a significant and sustained increase in enrollment. Interventions that simplify the process of redeeming benefits may be critical for addressing low rates of enrollment in WIC and other government benefit programs.
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Affiliation(s)
- Aditi Vasan
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Chén C. Kenyon
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Chris Feudtner
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Alexander G. Fiks
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Atheendar S. Venkataramani
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Zimmer MC, Vernarelli JA. Select Food Group Intake of US Children Aged 2 to 4 Years by WIC Participation Status and Income. J Acad Nutr Diet 2021; 120:2032-2038.e1. [PMID: 33222884 DOI: 10.1016/j.jand.2020.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 07/07/2020] [Accepted: 07/27/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Food group and nutrient priorities for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Package IV for children aged 2 to 4 years were described in the 2017 review of the WIC Food Package. Research has evaluated priority nutrient intake, but priority food group intake remains unknown. OBJECTIVES To compare mean intake of priority food groups/subgroups of WIC children to WIC-eligible nonparticipants and higher income children. Further, we hoped to assess differences in percent contribution of food subgroups to total food group intake by WIC participation status and income. DESIGN Cross-sectional study conducted using data from the 2011-14 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING One thousand forty-seven children aged 2 to 4 years. MAIN OUTCOME MEASURES Mean intake reported in cup equivalents and ounce equivalents. We also looked at mean percent that food subgroups contributed to total intake within a food group. Analyses were performed for high and low priority food groups/subgroups: high = seafood, total vegetables, dark green vegetables, red/orange vegetables, whole grains, and nuts/seeds/soy; low = total starchy vegetables, other vegetables, legumes computed as vegetables, total dairy, and total protein foods. STATISTICAL ANALYSES PERFORMED Multivariable linear regression analysis was used evaluate the relationship between income/WIC participation and mean intake/percent food subgroups contributed to total food group intake. RESULTS Among low-income WIC-eligible children, participation in WIC was associated with greater mean intake of red/orange vegetables (0.18 ± 0.03 vs 0.01 ± 0.06 c equivalents; P < 0.05) and legumes (0.07 ± 0.01 vs 0.01 ± 0.02 c equivalents; P < 0.01). No differences in mean intake were observed between WIC children and higher income children. Grain intake of WIC children was composed of a higher percentage of whole grains (19.1% ± 1.6% vs 13.2% ± 1.5%; P < 0.01) compared with higher income children. The percent vegetable subgroups contributed to total vegetable intake varied by income; no differences were observed for dairy or protein subgroups. CONCLUSIONS Among low-income children, participation in WIC was associated with greater intake of certain vegetables. Participation in WIC may also help close the diet quality gap between low-income and higher income children for priority foods targeted by the WIC food package. Future research should explore socioeconomic disparities in intake of nutrient-poor foods.
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Zimmer MC, Beaird J, Steeves EA. WIC Participants' Perspectives of Facilitators and Barriers to Shopping With eWIC Compared With Paper Vouchers. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:195-203. [PMID: 33191105 DOI: 10.1016/j.jneb.2020.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/23/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES (1) To describe facilitators and barriers to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food shopping via electronic benefits transfer (eWIC) compared with paper vouchers. (2) To explore suggestions that WIC participants had for modifying the program to enhance their overall WIC experience. DESIGN Qualitative, semistructured, in-depth interviews. SETTING WIC participants in East Tennessee. PARTICIPANTS Twenty-four primary food shoppers of WIC-participating households aged at least 18 years were recruited using a purposive sampling strategy. PHENOMENON OF INTEREST Perceived facilitators and barriers to use of eWIC as compared with paper vouchers. ANALYSIS Interview transcripts were analyzed using a grounded theory approach to identify emergent themes. RESULTS Participants identified several ways eWIC has improved their food shopping experience, including ad hoc redemption of WIC benefits and a quicker, more discrete checkout. Participants' chief complaint about eWIC was transaction errors at checkout. Participants identified other barriers to shopping for WIC foods that cannot be addressed by the card alone, such as difficulty identifying WIC items in-store. Participants reported changes to their benefit tracking behaviors and provided suggestions to improve WIC further. CONCLUSIONS AND IMPLICATIONS The transition to eWIC was viewed favorably among WIC participants, although participants identified a need for additional support in addressing transaction errors. This finding presents an opportunity to modify messages delivered to WIC participants by WIC nutrition educators and enhance collaboration between WIC agencies, retailers, and e-commerce technology providers.
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Affiliation(s)
- Meghan C Zimmer
- Department of Nutrition, The University of Tennessee, Knoxville, TN; Department of Public Health, The University of Tennessee, Knoxville, TN
| | - Jacob Beaird
- Department of Nutrition, The University of Tennessee, Knoxville, TN
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18
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Singleton CR, Wichelecki J, Weber SJ, Uesugi K, Bess S, Reese L, Siegel L, Odoms-Young A. Individual and Household-Level Factors Associated With Caregivers' Intention to Keep Their Child Enrolled in WIC. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:157-163. [PMID: 33214028 DOI: 10.1016/j.jneb.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 10/02/2020] [Accepted: 10/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Identify factors associated with caregivers' intention to keep their child enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program until age 5 years. METHODS Baseline data from a longitudinal questionnaire aiming to assess the impact of a statewide intervention to increase WIC retention in Illinois were analyzed in 2018. Data on sociodemographics and household characteristics were collected in 2015 from 174 caregiver/child dyads. Logistic regression was used to identify factors associated with caregivers' intention to keep their child enrolled in WIC until age 5 years (ie, intention). RESULTS A total of 66% of caregivers stated they were very likely to keep their child enrolled in the WIC program. Breastfeeding and homeownership status were associated with 58% (P =.03) and 72% (P =.02) lower odds of intention among caregivers, respectively. CONCLUSIONS AND IMPLICATIONS Significant inverse associations among breastfeeding, homeownership, and intention support the need for tailoring state-level WIC retention efforts to specific population characteristics and health behaviors.
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Affiliation(s)
- Chelsea R Singleton
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL.
| | - Jana Wichelecki
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, IL
| | - Summer J Weber
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Keriann Uesugi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | | | - LaShon Reese
- Illinois Department of Human Services, Springfield, IL
| | - Leilah Siegel
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Angela Odoms-Young
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL; Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL
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Zhang Q, Alsuliman MA, Wright M, Wang Y, Cheng X. Fruit and Vegetable Purchases and Consumption among WIC Participants after the 2009 WIC Food Package Revision: A Systematic Review. Adv Nutr 2020; 11:1646-1662. [PMID: 32452523 PMCID: PMC7666910 DOI: 10.1093/advances/nmaa060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/03/2020] [Accepted: 04/30/2020] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Qi Zhang
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA
| | - Mohammed A Alsuliman
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA
| | - Mia Wright
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA
| | - Youfa Wang
- Fisher Institute of Health and Well-being, Department of Nutrition and Health Sciences, College of Health, Ball State University, Muncie, IN, USA
| | - Xinzhe Cheng
- Congressional Budget Office, Washington, DC, USA
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Moran AJ, Gu Y, Clynes S, Goheer A, Roberto CA, Palmer A. Associations between Governmental Policies to Improve the Nutritional Quality of Supermarket Purchases and Individual, Retailer, and Community Health Outcomes: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7493. [PMID: 33076280 PMCID: PMC7602424 DOI: 10.3390/ijerph17207493] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 01/19/2023]
Abstract
Supermarkets are natural and important settings for implementing environmental interventions to improve healthy eating, and governmental policies could help improve the nutritional quality of purchases in this setting. This review aimed to: (1) identify governmental policies in the United States (U.S.), including regulatory and legislative actions of federal, tribal, state, and local governments, designed to promote healthy choices in supermarkets; and (2) synthesize evidence of these policies' effects on retailers, consumers, and community health. We searched five policy databases and developed a list of seven policy actions that meet our inclusion criteria: calorie labeling of prepared foods in supermarkets; increasing U.S. Department of Agriculture (USDA) Supplemental Nutrition Assistance Program (SNAP) benefits; financial incentives for the purchase of fruit and vegetables; sweetened beverage taxes; revisions to the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package; financial assistance for supermarkets to open in underserved areas; and allowing online purchases with SNAP. We searched PubMed, Econlit, PsycINFO, Web of Science, and Business Source Ultimate to identify peer-reviewed, academic, English-language literature published at any time until January 2020; 147 studies were included in the review. Sweetened beverage taxes, revisions to the WIC food package, and financial incentives for fruits and vegetables were associated with improvements in dietary behaviors (food purchases and/or consumption). Providing financial incentives to supermarkets to open in underserved areas and increases in SNAP benefits were not associated with changes in food purchasing or diet quality but may improve food security. More research is needed to understand the effects of calorie labeling in supermarkets and online SNAP purchasing.
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Affiliation(s)
- Alyssa J. Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Yuxuan Gu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (Y.G.); (S.C.)
| | - Sasha Clynes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (Y.G.); (S.C.)
| | - Attia Goheer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Anne Palmer
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
- Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21202, USA
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Kasprzak CM, Sauer HA, Schoonover JJ, Lapp MM, Leone LA. Barriers and Facilitators to Fruit and Vegetable Consumption among Lower-Income Families: Matching Preferences with Stakeholder Resources. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020. [DOI: 10.1080/19320248.2020.1802383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Christina M. Kasprzak
- Community Health and Health Behavior, School of Public Health and Health Professions, Buffalo, New York, United States
| | - Halle A. Sauer
- Rehabilitation Science, School of Public Health and Health Professions, Buffalo, New York, United States
| | - Julia J. Schoonover
- Department of Sociology, The College of Arts and Sciences, Buffalo, New York, United States
| | - Margaret M. Lapp
- Community Health and Health Behavior, School of Public Health and Health Professions, Buffalo, New York, United States
| | - Lucia A. Leone
- Community Health and Health Behavior, School of Public Health and Health Professions, Buffalo, New York, United States
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Increasing Access to WIC through Discount Variety Stores: Findings from Qualitative Research. J Acad Nutr Diet 2020; 120:1654-1661.e1. [PMID: 32565397 DOI: 10.1016/j.jand.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/03/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Many low-income neighborhoods do not include a full-service grocery store. In these communities, discount variety stores (DVS) can be convenient points of food access. However, no identified DVS are authorized to accept Special Supplemental Nutrition Program for Women, Infants, and Children Program (WIC) benefits. OBJECTIVE One national DVS retailer implemented WIC in 10 stores located in low-income communities in North Carolina over a 10-month pilot period to assess WIC feasibility. METHODS To better understand the facilitators and barriers to WIC implementation from the perspective of DVS staff, we analyzed 36 in-depth interviews with employees of this DVS chain at corporate, manager, and store clerk levels. RESULTS Most participants provided positive feedback about implementing and offering WIC. Many store employees had personal experience participating in WIC, which increased their understanding of the WIC shopping experience. Store staff's prior WIC participation and customers' proximity to DVS locations were facilitators to implementation. Primary barriers included limited choice of store products for customers, complicated or unclear labeling of WIC products, and difficulty training employees to process WIC vouchers. CONCLUSIONS These findings suggest that whereas most employees viewed WIC positively, barriers related to product selection and training must be addressed. Notably, North Carolina's recent change to an electronic system to process WIC transactions requires minimal manual employee training and should address several barriers to implementation. However, the computer system upgrades necessary to accept electronic WIC transactions may be a barrier for DVS to continued WIC acceptance. Future research is needed to evaluate implementation of electronic WIC transactions in DVS.
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Esquivel MK, Higa A, Hitchens M, Shelton C, Okihiro M. Keiki Produce Prescription (KPRx) Program Feasibility Study to Reduce Food Insecurity and Obesity Risk. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2020; 79:44-49. [PMID: 32490385 PMCID: PMC7260871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
One in 6 US children experience food insecurity, signifying that at some time during the last year their household did not have sufficient food, money, or resources to feed their family. These children experience little intake of fresh fruits and vegetables (FV), a risk factor for chronic disease, including obesity. Produce prescription programs provide vouchers to purchase fresh FV at participating retailers. The Keiki Produce Prescription (KPRx) Program feasibility study was conducted through a partnership between the Waianae Coast Comprehensive Health Center's Pediatrics and Health Promotion Department's Farmers'Market and the University of Hawai'i nutrition faculty. Pediatricians provided patients with a prescription (Rx) to purchase FV from the Farmers' Market ($24 per month for three months). Of the 193 Rx distributed, 125 patients participated in part of the program, while 34 completed the full program. Parents, pediatricians, clinic staff, and community members expressed overwhelming support of the program. Parents of participating children completed an exit interview that identified themes surrounding motivation to participate, benefits to child and family, and future recommendations. It identified the need to improve program retention efforts. Participants reported lifestyle benefits for both the child and family and recommended educational resources. Aresearch protocol was developed to address the following objectives: (1) streamline referrals, (2) enhance retention, (3) quantify program impact, and (4) identify barriers to participation. Subsidies have the potential to increase FV consumption, improve overall health, reduce chronic diseases in adulthood, and result in substantial healthcare cost savings.
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Affiliation(s)
- Monica K. Esquivel
- Department of Human Nutrition, Food and Animal Sciences College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu, HI (MKE, CS)
| | - Alicia Higa
- Wai‘anae Coast Comprehensive Health Center, Wai‘anae HI (AH, MH, MO)
| | - Moulika Hitchens
- Wai‘anae Coast Comprehensive Health Center, Wai‘anae HI (AH, MH, MO)
| | - Cherese Shelton
- Department of Human Nutrition, Food and Animal Sciences College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu, HI (MKE, CS)
| | - May Okihiro
- Wai‘anae Coast Comprehensive Health Center, Wai‘anae HI (AH, MH, MO)
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Soneji S, Beltrán-Sánchez H. Association of Special Supplemental Nutrition Program for Women, Infants, and Children With Preterm Birth and Infant Mortality. JAMA Netw Open 2019; 2:e1916722. [PMID: 31800070 PMCID: PMC6902759 DOI: 10.1001/jamanetworkopen.2019.16722] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Nearly 4 in 10 expectant mothers in the United States received Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits during pregnancy between 2011 and 2017. Despite public support for the program, empirical evidence of the success of the program varies substantially. OBJECTIVE To assess the association of WIC program participation during pregnancy by low-income expectant mothers covered by Medicaid with infant mortality by gestational age at birth and by maternal race/ethnicity in comparison with their counterparts who did not receive WIC benefits. DESIGN, SETTING, AND PARTICIPANTS This cohort study obtained data from January 1, 2011, to December 31, 2017, from US live birth certificates. Data were from 11 148 261 expectant mothers who delivered live births in states that have implemented the 2003 revision of the US live birth certificate and whose insurance coverage and receipt of WIC benefits were recorded on the birth certificates. Data analysis was performed from June 2019 to October 2019. EXPOSURES Receipt of WIC benefits during pregnancy. MAIN OUTCOMES AND MEASURES The first outcome was gestational age at birth: extremely preterm (<28 weeks), very preterm (28-32 weeks), moderate-to-late preterm (32-37 weeks), and normal term (≥37 weeks) births. The second outcome was death within the first year of life. RESULTS Among the 11 148 261 expectant mothers who delivered live births between 2011 and 2017 and were covered by Medicaid during pregnancy, the modal age at delivery was 20 to 24 years, the predominant race/ethnicity was non-Hispanic white (4 257 790 [38.2%]), and 8 145 770 (73.1%) received WIC benefits during pregnancy. The proportion of expectant mothers covered by Medicaid who also received WIC benefits decreased from 2011 to 2017 (79.3% to 67.9%; P < .001). The odds of preterm birth compared with normal term birth were lower among expectant mothers covered by Medicaid who received WIC benefits during pregnancy compared with their counterparts who did not receive WIC benefits during pregnancy (adjusted proportional odds ratio, 0.87; 95% CI, 0.86-0.87). The odds of mortality within 1 year of birth were lower for infants whose mothers were covered by Medicaid and received WIC benefits during pregnancy compared with those who did not receive WIC benefits during pregnancy (adjusted odds ratio, 0.84; 95% CI, 0.83-0.86). CONCLUSIONS AND RELEVANCE This study found that receipt of WIC benefits among expectant mothers with Medicaid coverage was associated with lower risk of preterm birth and infant mortality.
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Affiliation(s)
- Samir Soneji
- Department of Health Behavior, University of North Carolina, Chapel Hill
| | - Hiram Beltrán-Sánchez
- Department of Community Health Sciences, UCLA (University of California, Los Angeles)
- California Center for Population Research, Los Angeles
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Basu S, O'Neill J, Sayer E, Petrie M, Bellin R, Berkowitz SA. Population Health Impact and Cost-Effectiveness of Community-Supported Agriculture Among Low-Income US Adults: A Microsimulation Analysis. Am J Public Health 2019; 110:119-126. [PMID: 31725311 DOI: 10.2105/ajph.2019.305364] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objectives. To estimate the population-level effectiveness and cost-effectiveness of a subsidized community-supported agriculture (CSA) intervention in the United States.Methods. In 2019, we developed a microsimulation model from nationally representative demographic, biomedical, and dietary data (National Health and Nutrition Examination Survey, 2013-2016) and a community-based randomized trial (conducted in Massachusetts from 2017 to 2018). We modeled 2 interventions: unconditional cash transfer ($300/year) and subsidized CSA ($300/year subsidy).Results. The total discounted disability-adjusted life years (DALYs) accumulated over the life course to cardiovascular disease and diabetes complications would be reduced from 24 797 per 10 000 people (95% confidence interval [CI] = 24 584, 25 001) at baseline to 23 463 per 10 000 (95% CI = 23 241, 23 666) under the cash intervention and 22 304 per 10 000 (95% CI = 22 084, 22 510) under the CSA intervention. From a societal perspective and over a life-course time horizon, the interventions had negative incremental cost-effectiveness ratios, implying cost savings to society of -$191 100 per DALY averted (95% CI = -$191 767, -$188 919) for the cash intervention and -$93 182 per DALY averted (95% CI = -$93 707, -$92 503) for the CSA intervention.Conclusions. Both the cash transfer and subsidized CSA may be important public health interventions for low-income persons in the United States.
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Affiliation(s)
- Sanjay Basu
- Sanjay Basu is with Research and Analytics, Collective Health, San Francisco, CA, and the Center for Primary Care, Harvard Medical School, Boston, MA. Jessica O'Neill and Rochelle Bellin are with Just Roots, Greenfield, MA. Edward Sayer and Maegan Petrie are with The Community Health Center of Franklin County, Greenfield. Seth A. Berkowitz is with the Division of General Medicine and Clinical Epidemiology and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Jessica O'Neill
- Sanjay Basu is with Research and Analytics, Collective Health, San Francisco, CA, and the Center for Primary Care, Harvard Medical School, Boston, MA. Jessica O'Neill and Rochelle Bellin are with Just Roots, Greenfield, MA. Edward Sayer and Maegan Petrie are with The Community Health Center of Franklin County, Greenfield. Seth A. Berkowitz is with the Division of General Medicine and Clinical Epidemiology and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Edward Sayer
- Sanjay Basu is with Research and Analytics, Collective Health, San Francisco, CA, and the Center for Primary Care, Harvard Medical School, Boston, MA. Jessica O'Neill and Rochelle Bellin are with Just Roots, Greenfield, MA. Edward Sayer and Maegan Petrie are with The Community Health Center of Franklin County, Greenfield. Seth A. Berkowitz is with the Division of General Medicine and Clinical Epidemiology and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Maegan Petrie
- Sanjay Basu is with Research and Analytics, Collective Health, San Francisco, CA, and the Center for Primary Care, Harvard Medical School, Boston, MA. Jessica O'Neill and Rochelle Bellin are with Just Roots, Greenfield, MA. Edward Sayer and Maegan Petrie are with The Community Health Center of Franklin County, Greenfield. Seth A. Berkowitz is with the Division of General Medicine and Clinical Epidemiology and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Rochelle Bellin
- Sanjay Basu is with Research and Analytics, Collective Health, San Francisco, CA, and the Center for Primary Care, Harvard Medical School, Boston, MA. Jessica O'Neill and Rochelle Bellin are with Just Roots, Greenfield, MA. Edward Sayer and Maegan Petrie are with The Community Health Center of Franklin County, Greenfield. Seth A. Berkowitz is with the Division of General Medicine and Clinical Epidemiology and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Seth A Berkowitz
- Sanjay Basu is with Research and Analytics, Collective Health, San Francisco, CA, and the Center for Primary Care, Harvard Medical School, Boston, MA. Jessica O'Neill and Rochelle Bellin are with Just Roots, Greenfield, MA. Edward Sayer and Maegan Petrie are with The Community Health Center of Franklin County, Greenfield. Seth A. Berkowitz is with the Division of General Medicine and Clinical Epidemiology and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
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Chauvenet C, De Marco M, Leone LA, Haynes-Maslow L, Ammerman AS. The Role of Food Retailers in the Promotion of Healthful, Low-Cost Products to WIC Recipients. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2019. [DOI: 10.1080/19320248.2019.1649225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Christina Chauvenet
- UNC Center for Health Promotion and Disease Prevention, Department #4985, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, USA
| | - Molly De Marco
- UNC Center for Health Promotion and Disease Prevention, Department #4985, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina Gillings School of Global Public Health, USA
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, NC, USA
| | - Alice S. Ammerman
- UNC Center for Health Promotion and Disease Prevention, Department #4985, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina Gillings School of Global Public Health, USA
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Chauvenet C, De Marco M, Barnes C, Ammerman AS. WIC Recipients in the Retail Environment: A Qualitative Study Assessing Customer Experience and Satisfaction. J Acad Nutr Diet 2019; 119:416-424.e2. [DOI: 10.1016/j.jand.2018.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 09/04/2018] [Indexed: 12/23/2022]
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Understanding the factors influencing low-income caregivers' perceived value of a federal nutrition programme, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Public Health Nutr 2018; 22:1056-1065. [PMID: 30522548 DOI: 10.1017/s1368980018003336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Retention of participants has been an issue in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). It has been suggested that the perceived value of WIC may affect whether participants remain in the programme. The present study aimed to explore this phenomenon. DESIGN Using a constructivist approach, thirty-one individual in-depth interviews were conducted. Transcripts were analysed using constant comparative analysis. Social, cultural and environmental factors that contribute to the value of WIC were explored as the phenomenon of interest. SETTING Eight WIC clinics across the State of Illinois, USA.ParticipantsThirty-one caregivers of children enrolled in WIC for at least 6 months. RESULTS Several factors influenced perceived value of WIC at the interpersonal (level of social support), clinic (value of WIC services v. programme administration issues), vendor (shopping difficulties), community and systems levels (other programme use, stigma and restrictions on food choice). Other themes existed along continua, which overlapped several levels (continuum of perceived need and perceived value of infant formula). CONCLUSIONS Many caregivers value WIC, especially before their child turns 1 year old. Improvements are needed at the clinic, during shopping and within the food packages themselves in order to increase perceived value of WIC.
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Weber S, Uesugi K, Greene H, Bess S, Reese L, Odoms-Young A. Preferences and Perceived Value of WIC Foods Among WIC Caregivers. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:695-704. [PMID: 30047482 DOI: 10.1016/j.jneb.2018.04.280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/23/2018] [Accepted: 04/29/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate preferences for and values of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) foods and packages and understand what factors may influence these preferences and values. DESIGN Using a mixed-methods approach, surveys and individual in-depth interviews were conducted to measure and understand preferences for specific WIC foods and how much WIC food packages are worth to participants. SETTING Eight WIC clinics across Illinois. PARTICIPANTS Caregivers of infants enrolled in WIC for at least 3-6 months. PHENOMENON OF INTEREST Preferences for WIC foods, WIC food package values, and factors that influence these categories. ANALYSIS Frequencies were gathered to analyze survey data and interview transcripts were analyzed using constant comparative analysis to identify emergent themes. RESULTS Survey (n = 150) and interview (n = 31) participants valued the food packages in WIC but they valued the infant packages more. The cash value fruit and vegetable voucher increased the perceived value of the program for many participants. Restrictions on food choice preferences (eg, type of milk) detracted value from the program. CONCLUSIONS AND IMPLICATIONS This study shows that providing more choice in the program could improve satisfaction with WIC overall. More research is warranted with a more representative sample to assess whether expanded food choice would improve value of and preference for WIC foods.
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Affiliation(s)
- Summer Weber
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
| | - Keriann Uesugi
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL
| | - Haley Greene
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Stephanie Bess
- Illinois Special Supplemental Nutrition Program for Women, Infants, and Children, Springfield, IL
| | - LaShon Reese
- Illinois Special Supplemental Nutrition Program for Women, Infants, and Children, Springfield, IL
| | - Angela Odoms-Young
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL
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Solomon CA, Batada A, Zillante A, Kennedy A, Hudak KM, Racine EF. Food cost is the least of my worries: a qualitative study exploring food and beverage purchasing decisions among parents enrolled in the WIC program. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2018. [DOI: 10.1080/19320248.2018.1484313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Corliss A. Solomon
- Public Health Sciences Department, University of North Carolina Charlotte, Charlotte, NC, USA
| | - Ameena Batada
- Health and Wellness Department, University of North Carolina Asheville, Asheville, NC, USA
| | - Artie Zillante
- Chair of Economics Department, University of North Carolina Charlotte, Charlotte, NC, USA
| | - Ashley Kennedy
- Public Health Sciences Department, University of North Carolina Charlotte, Charlotte, NC, USA
| | - Katelin M. Hudak
- Public Policy Department, University of North Carolina Charlotte, Charlotte, NC, USA
| | - Elizabeth F. Racine
- Public Health Sciences Department, University of North Carolina Charlotte, Charlotte, NC, USA
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Daily distribution of free healthy school meals or food-voucher intervention? Perceptions and attitudes of parents and educators. Appetite 2017; 120:627-635. [PMID: 29061382 DOI: 10.1016/j.appet.2017.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/12/2017] [Accepted: 10/20/2017] [Indexed: 11/21/2022]
Abstract
AIMS To qualitatively evaluate the optimal intervention (food-voucher approach vs. free daily meal distribution), aimed at reducing food insecurity and promoting healthy eating among students attending public schools in socioeconomically disadvantaged areas. METHODS We randomly assigned 34 schools to one of the two interventions: students in 17 schools received a daily lunch-box and parents in the other 17 schools received a food voucher of equal value once a month. All students were offered the opportunity to participate. We conducted 30 focus groups in all participating schools (17 in the meal distribution and 13 in the food voucher schools). Eligible participants included parents (n = 106), educators (n = 66) and school principals (n = 34). We qualitatively evaluated their perceptions and attitudes towards the program. RESULTS Important differences were observed between the two approaches, with more favourable perceptions being reported for the meal distribution approach. More specifically, social stigmatization was minimized in the meal distribution approach, through the participation of all students, compared with the food-voucher participants who reported feelings of embarrassment and fear of stigmatization. Secondly, the meal distribution approach alleviated child food insecurity through the provision of the daily meal, while the food-voucher intervention helped manage household food insecurity, as vouchers were mainly used for purchasing food for family meals. Furthermore, the educational and experiential nature of the meal distribution approach intensified healthy eating promotion, while the food-voucher intervention was efficient mainly for conscious parents regarding healthy eating. CONCLUSIONS The meal distribution intervention was considered more effective than the food-voucher one. Hence, for interventions aiming at tackling food insecurity of children and adolescents, public health focus could be oriented towards school-based in kind food assistance.
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Singleton CR, Opoku-Agyeman W, Affuso E, Baskin ML, Levitan EB, Sen B, Affuso O. WIC Cash Value Voucher Redemption Behavior in Jefferson County, Alabama, and Its Association With Fruit and Vegetable Consumption. Am J Health Promot 2017; 32:325-333. [PMID: 28950724 DOI: 10.1177/0890117117730807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To examine cash value voucher (CVV) redemption behavior and its association with fruit and vegetable (FV) consumption among women who participate in the Supplemental Nutrition Program for Women, Infants, and Children (WIC). DESIGN Cross-sectional. SETTING Jefferson County, Alabama. PARTICIPANTS Between October 2014 and January 2015, 300 women (mean age: 27.6 years; 66.8% non-Hispanic black; 45.1% obese) who participated in the Birmingham WIC program were surveyed. MEASURES Self-reported information on demographics, produce shopping behaviors, and residential access to fresh produce retailers (eg, supermarkets and farmers markets) was examined. Fruit and vegetable intake was collected via the Block Fruit-Vegetable-Fiber screener. Participants who self-reported redeeming the WIC CVV in each of the 3 prior months were classified as regular redeemers. ANALYSIS Multivariable-adjusted regression models were used to examine associations between variables of interest and regular WIC CVV redemption. RESULTS There were 189 (63.0%) study participants classified as regular WIC CVV redeemers. Regular redeemers and other participants (ie, irregular redeemers and nonredeemers) were similar with respect to demographics. Regular redeemers were more likely to use grocery stores to purchase FVs ( P = .003) and consumed significantly more servings of FVs per day (β = .67; standard error = 0.24; P = .007). CONCLUSION Regular WIC CVV redemption was associated with some produce shopping behaviors and increased FV consumption and among WIC participants in Jefferson County, Alabama.
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Affiliation(s)
- Chelsea R Singleton
- 1 Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - William Opoku-Agyeman
- 2 Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ermanno Affuso
- 3 Department of Economics and Finance, University of South Alabama, Mobile, AL, USA
| | - Monica L Baskin
- 4 Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,5 Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emily B Levitan
- 5 Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA.,6 Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bisakha Sen
- 5 Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA.,7 Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olivia Affuso
- 5 Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA.,6 Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Hull P, Emerson JS, Quirk ME, Canedo JR, Jones JL, Vylegzhanina V, Schmidt DC, Mulvaney SA, Beech BM, Briley C, Harris C, Husaini BA. A Smartphone App for Families With Preschool-Aged Children in a Public Nutrition Program: Prototype Development and Beta-Testing. JMIR Mhealth Uhealth 2017; 5:e102. [PMID: 28768611 PMCID: PMC5559651 DOI: 10.2196/mhealth.7477] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/04/2017] [Accepted: 06/19/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the United States provides free supplemental food and nutrition education to low-income mothers and children under age 5 years. Childhood obesity prevalence is higher among preschool children in the WIC program compared to other children, and WIC improves dietary quality among low-income children. The Children Eating Well (CHEW) smartphone app was developed in English and Spanish for WIC-participating families with preschool-aged children as a home-based intervention to reinforce WIC nutrition education and help prevent childhood obesity. OBJECTIVE This paper describes the development and beta-testing of the CHEW smartphone app. The objective of beta-testing was to test the CHEW app prototype with target users, focusing on usage, usability, and perceived barriers and benefits of the app. METHODS The goals of the CHEW app were to make the WIC shopping experience easier, maximize WIC benefit redemption, and improve parent snack feeding practices. The CHEW app prototype consisted of WIC Shopping Tools, including a barcode scanner and calculator tools for the cash value voucher for purchasing fruits and vegetables, and nutrition education focused on healthy snacks and beverages, including a Yummy Snack Gallery and Healthy Snacking Tips. Mothers of 63 black and Hispanic WIC-participating children ages 2 to 4 years tested the CHEW app prototype for 3 months and completed follow-up interviews. RESULTS Study participants testing the app for 3 months used the app on average once a week for approximately 4 and a half minutes per session, although substantial variation was observed. Usage of specific features averaged at 1 to 2 times per month for shopping-related activities and 2 to 4 times per month for the snack gallery. Mothers classified as users rated the app's WIC Shopping Tools relatively high on usability and benefits, although variation in scores and qualitative feedback highlighted several barriers that need to be addressed. The Yummy Snack Gallery and Healthy Snacking Tips scored higher on usability than benefits, suggesting that the nutrition education components may have been appealing but too limited in scope and exposure. Qualitative feedback from mothers classified as non-users pointed to several important barriers that could preclude some WIC participants from using the app at all. CONCLUSIONS The prototype study successfully demonstrated the feasibility of using the CHEW app prototype with mothers of WIC-enrolled black and Hispanic preschool-aged children, with moderate levels of app usage and moderate to high usability and benefits. Future versions with enhanced shopping tools and expanded nutrition content should be implemented in WIC clinics to evaluate adoption and behavioral outcomes. This study adds to the growing body of research focused on the application of technology-based interventions in the WIC program to promote program retention and childhood obesity prevention.
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Affiliation(s)
- Pamela Hull
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Janice S Emerson
- Center for Prevention Research, Tennessee State University, Nashville, TN, United States
| | - Meghan E Quirk
- Center for Prevention Research, Tennessee State University, Nashville, TN, United States
- The National Academies of Sciences, Engineering, and Medicine, Washington, DC, United States
| | - Juan R Canedo
- Progreso Community Center, Nashville, TN, United States
- Meharry-Vanderbilt Alliance, Meharry Medical College, Nashville, TN, United States
| | - Jessica L Jones
- Center for Prevention Research, Tennessee State University, Nashville, TN, United States
| | - Violetta Vylegzhanina
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, United States
| | - Douglas C Schmidt
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, United States
| | | | - Bettina M Beech
- Departments of Pediatrics and Family Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Chiquita Briley
- Department of Family and Consumer Sciences, Tennessee State University, Nashville, TN, United States
| | - Calvin Harris
- Center for Prevention Research, Tennessee State University, Nashville, TN, United States
| | - Baqar A Husaini
- Center for Prevention Research, Tennessee State University, Nashville, TN, United States
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Sekhobo JP, Peck SR, Byun Y, Allsopp MAK, Holbrook MK, Edmunds LS, Yu C. Use of a mixed-method approach to evaluate the implementation of retention promotion strategies in the New York State WIC program. EVALUATION AND PROGRAM PLANNING 2017; 63:7-17. [PMID: 28319784 DOI: 10.1016/j.evalprogplan.2017.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/17/2017] [Accepted: 03/03/2017] [Indexed: 06/06/2023]
Abstract
This research assessed the implementation of strategies piloted at 10 Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics aimed at increasing retention in the program, by enhancing participants' shopping experiences. Under WIC Retention Promotion Study: Keep, Reconnect, Thrive (WIC RPS), clinics were recruited and assigned to implement one or a combination of strategies: a standardized Shopping Orientation (SO) curriculum, a Guided Shopping Tour (GST), and a Pictorial Foods Card (PFC) from November 2012 through August 2013. This paper presents results from the process evaluation of the retention strategies, using a mixed-methods comparative case study design employing WIC administrative data, interviews, and focus groups. Qualitative data were inductively coded, analyzed and mapped to the following implementation constructs: organizational capacity, fidelity, allowable adaptations, implementation challenges, and participant responsiveness, while quantitative data were analyzed using SAS to assess reach and dose. Several sites implemented the SO and PFC interventions with the necessary fidelity and dose needed to assess impact on participants' shopping experiences. Sites that were assigned the GST strategy struggled to implement this strategy. However, use of the standardized SO enabled staff to use a "consistent list of shopping tips" to educate participants about the proper use of checks, while use of the PFC increased participants' awareness of the variety of WIC-allowable foods. During follow-up telephone calls, 91 percent of participants reported the shopping tips as helpful. Future analyses will assess the impact of enhanced shopping experience on retention at intervention sites.
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Affiliation(s)
- Jackson P Sekhobo
- Division of Nutrition, New York State Department of Health, 150 Broadway, Suite 517, Menands 12204, NY, USA.
| | - Sanya R Peck
- Division of Nutrition, New York State Department of Health, 150 Broadway, Suite 517, Menands 12204, NY, USA
| | - Youjung Byun
- Division of Nutrition, New York State Department of Health, 150 Broadway, Suite 517, Menands 12204, NY, USA; Graduate Student, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer 12144, NY, USA
| | - Marie A K Allsopp
- Division of Nutrition, New York State Department of Health, 150 Broadway, Suite 517, Menands 12204, NY, USA; Graduate Student, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer 12144, NY, USA
| | - MaryEllen K Holbrook
- Division of Nutrition, New York State Department of Health, 150 Broadway, Suite 517, Menands 12204, NY, USA
| | - Lynn S Edmunds
- Division of Nutrition, New York State Department of Health, 150 Broadway, Suite 517, Menands 12204, NY, USA
| | - Chengxuan Yu
- Division of Nutrition, New York State Department of Health, 150 Broadway, Suite 517, Menands 12204, NY, USA
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Ohly H, Crossland N, Dykes F, Lowe N, Hall-Moran V. A realist review to explore how low-income pregnant women use food vouchers from the UK's Healthy Start programme. BMJ Open 2017; 7:e013731. [PMID: 28432063 PMCID: PMC5594208 DOI: 10.1136/bmjopen-2016-013731] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To explore how low-income pregnant women use Healthy Start food vouchers, the potential impacts of the programme, and which women might experience these impacts and why. DESIGN A realist review. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Primary or empirical studies (of any design) were included if they contributed relevant evidence or insights about how low-income women use food vouchers from the Healthy Start (UK) or the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) programmes. The assessment of 'relevance' was deliberately broad to ensure that reviewers remained open to new ideas from a variety of sources of evidence. ANALYSIS A combination of evidence synthesis and realist analysis techniques was used to modify, refine and substantiate programme theories, which were constructed as explanatory 'context-mechanism-outcome'-configurations. RESULTS 38 primary studies were included in this review: four studies on Healthy Start and 34 studies on WIC. Two main outcome strands were identified: dietary improvements (intended) and financial assistance (unintended). Three evidence-informed programme theories were proposed to explain how aspects of context (and mechanisms) may generate these outcomes: the 'relative value' of healthy eating (prioritisation of resources); retailer discretion (pressure to 'bend the rules'); the influence of other family members (disempowerment). CONCLUSIONS This realist review suggests that some low-income pregnant women may use Healthy Start vouchers to increase their consumption of fruits and vegetables and plain cow's milk, whereas others may use them to reduce food expenditure and save money for other things.
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Affiliation(s)
- Heather Ohly
- College of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- College of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Fiona Dykes
- College of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Nicola Lowe
- College of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Victoria Hall-Moran
- College of Health and Wellbeing, University of Central Lancashire, Preston, UK
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Singleton CR, Baskin M, Levitan EB, Sen B, Affuso E, Affuso O. Farm-to-Consumer Retail Outlet Use, Fruit and Vegetable Intake, and Obesity Status among WIC Program Participants in Alabama. Am J Health Behav 2016; 40:446-54. [PMID: 27338991 DOI: 10.5993/ajhb.40.4.6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES We studied whether use of farm-to-consumer (FTC) retail outlets (eg, farmers market, farm/roadside stand) was associated with daily fruit and vegetable (F&V) intake or obesity status among women who participate in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Birmingham, AL. METHODS We used a cross-sectional study design and recruited a convenience sample of 312 women (mean age = 27.6; 67.0% non-Hispanic black; 45.6% obese) participating in Birmingham's WIC Program. Participants were recruited between October 2014 and January 2015. Participants who self-reported purchasing produce from a FTC outlet during the 2014 farmers' market season were classified as FTC outlet users. Multivariable-adjusted regression models were used to examine associations between FTC outlet use, daily F&V intake, and obesity status (ie, body mass index ≥ 30). RESULTS Approximately 26.1% of participants were classified as FTC outlet users. After adjusting for socio-demographic factors and WIC Cash Value Voucher redemption, FTC outlet use was associated with increased odds of consuming ≥ 5 servings of F&Vs per day (OR: 2.01; 95%: 1.15 - 3.50), but not obesity status (OR: 0.68; 95% CI: 0.39 - 1.20). CONCLUSIONS FTC retail outlet use was associated with F&V intake among program participants but not obesity status.
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Affiliation(s)
- Chelsea R Singleton
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA.
| | - Monica Baskin
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bisakha Sen
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ermanno Affuso
- Department of Economics and Finance, University of South Alabama, Mobile, AL, USA
| | - Olivia Affuso
- Associate Professor, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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McLaury KC, Blue Bird Jernigan V, Johnson DB, Buchwald D, Duncan G. Variation in WIC Cash-Value Voucher Redemption among American Indian Reservation Communities in Washington State. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2016; 11:254-262. [PMID: 27453765 DOI: 10.1080/19320248.2015.1112755] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Kimberly C McLaury
- Nutritional Sciences Program, University of Washington, Box 353410, Seattle, WA 98195
| | | | - Donna B Johnson
- Nutritional Sciences Program, University of Washington, Box 353410, Seattle, WA 98195
| | - Dedra Buchwald
- University of Washington, Partnerships for Native Health, 1100 Olive Way, Suite 1200, Seattle, WA 98101
| | - Glen Duncan
- Washington State University, Department of Nutrition and Physiology, PO Box 1495, Spokane, WA 99210-1495
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Haynes-Maslow L, Auvergne L, Mark B, Ammerman A, Weiner BJ. Low-Income Individuals' Perceptions About Fruit and Vegetable Access Programs: A Qualitative Study. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:317-24.e1. [PMID: 25910929 PMCID: PMC4500669 DOI: 10.1016/j.jneb.2015.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 02/21/2015] [Accepted: 03/14/2015] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To examine how fruit and vegetable (FV) programs address barriers to FV access and consumption as perceived by low-income individuals. DESIGN From 2011 to 2012, the researchers used 13 focus groups to better understand low-income individuals' perceptions about FV programs. SETTING Five North Carolina counties at community-serving organizations. PARTICIPANTS Low-income participants aged ≥ 18 years were included in the study. A majority were African American women with a high school education or less, and received government assistance. PHENOMENON OF INTEREST Low-income individuals' perceptions about how FV access programs can reduce barriers and increase consumption. ANALYSIS A socio-ecological framework guided data analysis, and 2 trained researchers coded transcripts, identified major themes, and summarized findings. RESULTS A total of 105 participants discussed how mobile markets could overcome barriers such as availability, convenience, transportation, and quality/variety. Some were worried about safety in higher-crime communities. Participants' opinions about how successful food assistance programs were at overcoming cost barriers were mixed. Participants agreed that community gardens could increase access to affordable, conveniently located produce but worried about feasibility and implementation issues. IMPLICATIONS FOR RESEARCH AND PRACTICE Addressing access barriers through FV programs could improve consumption. Programs have the potential to be successful if they address multiple access barriers.
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Affiliation(s)
| | - Lauriane Auvergne
- Department of Anesthesiology, University of Michigan at Ann Arbor, Ann Arbor, MI
| | - Barbara Mark
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alice Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Bryan J Weiner
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Reicks M, Richardson C. WIC supplement. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:S27-S28. [PMID: 24809993 DOI: 10.1016/j.jneb.2014.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Marla Reicks
- Guest Editor, Professor and Extension Nutritionist, Department of Food Science and Nutrition, University of Minnesota
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