Additional Fruit and Vegetable Vouchers for Pregnant WIC Clients: An Equity-Focused Strategy to Improve Food Security and Diet Quality

Community-based diet and obesity-related policy, system, and environmental interventions for obesity prevention during the first 1000 days: A scoping review

Community-based policy, systems, and environmental interventions have the potential to reduce modifiable risk factors for obesity early in life. The purpose of this scoping review was to characterize the breadth, generalizability, and methodological quality of community-based diet and obesity-related policy, system, and environmental interventions during the first 1000 days of life, from pregnancy to 24 months of age. Eight databases were searched, and 83 studies (122 references) were included. Data were extracted for breadth (intervention characteristics), generalizability (reach, effectiveness, adoption, implementation, and maintenance), and study quality (Downs and Black Checklist). Systems and environmental approaches were common (> 80%), relative to policy approaches (39%). The majority (60-69%) occurred in the prenatal period and early infancy (0-3 months), assessed breastfeeding or child growth/obesity (53% for both), and included people with lower income (80%) or racial and/or ethnic minority groups (63%). Many interventions reported positive outcomes (i.e., in the expected direction) for child diet, breastfeeding, and feeding practices (> 62%). Few reported intervention maintenance or spanned the full 1000 days. Most studies were classified as good (32%) or fair (56%) methodological quality. The interventions mainly addressed pregnancy and early infancy. Rigorous and representative investigation is needed to improve intervention reach, sustainability, and application in toddlerhood.

Food security status and cardiometabolic health among pregnant women in the United States

Introduction

Pregnant women and their offspring are particularly vulnerable to food insecurity and its adverse effects during critical periods of fetal development. Racially/ethnically minoritized women in the United States (US) who are pregnant are additionally burdened by food insecurity, which may exacerbate cardiovascular health (CVH) disparities. Despite heightened social vulnerability, few studies have employed an intersectional framework, including race and gender, to assess the food insecurity and CVH relationship.

Methods

We used 2012-2018 and 2020 National Health Interview Survey data among US pregnant women aged 18-49 years old (N = 1,999) to assess the prevalence of food insecurity status by race/ethnicity and to investigate household food security status in relation to ideal CVH, using a modified ideal CVH (mICVH) metric. We categorized food security status as "very low/low", "marginal", or "high". To assess mICVH, a summary score of 7 clinical characteristics and health behaviors was dichotomized as yes [(7)] vs. no [<7]. Prevalence ratios (PRs) and 95% confidence intervals (CIs) of associations between food security status and mICVH were estimated using Poisson regression with robust variance. Models were adjusted for age, household income, educational attainment, geographic region, marital status, alcohol consumption, survey year, and race/ethnicity (in overall model).

Results

The mean age ± standard error was 29.0 ± 0.2 years. Among pregnant women, 12.7% reported "very low/low", 10.6% reported "marginal", and 76.7% reported "high" food security. "Very low/low" food security prevalence was higher among NH-Black (16.2%) and Hispanic/Latina (15.2%) pregnant women compared to NH-White (10.3%) and NH-Asian (3.2%) pregnant women. The mICVH prevalence was 11.6% overall and 14.5% for NH-White, 4.1% for NH-Black, 5.0% for Hispanic/Latina, and 26.7% for NH-Asian pregnant women. Among all pregnant women, "very low/low" and "marginal" vs. "high" food security status was associated with a lower prevalence of mICVH {[PRvery low/low = 0.26 (95% CI: 0.08-0.75)]; [PRmarginal = 0.47 (95% CI: 0.23 -0.96)]}.

Conclusion

Household food insecurity was higher among pregnant women in minoritized racial/ethnic groups and was associated with lower mICVH prevalence. Given the higher burden of food insecurity among minoritized racial/ethnic groups, food security may be an important intervention target to help address disparities in poor CVH among pregnant women.

Food Insecurity and Mental Distress Among WIC-Eligible Women in the United States: A Cross-Sectional Study

BACKGROUND

Women living in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-eligible households may be pregnant or breastfeeding. Stress during pregnancy and breastfeeding may influence women's mental health making them more vulnerable to higher rates of food insecurity (FI).

OBJECTIVE

Determine whether or not FI is associated with moderate-to-severe mental distress among women living in WIC-eligible households, and whether or not the strength of the association differs among WIC participants compared with eligible nonparticipants with low income.

DESIGN

Cross-sectional data from the 2011-2018 National Health Interview Survey were utilized.

PARTICIPANTS/SETTING

A total of 7,700 women living in WIC-eligible households with at least one child were analyzed.

MAIN OUTCOME MEASURES

Moderate-to-severe mental distress was measured using the validated K6 nonspecific psychological distress scale. FI was measured using the 10-item, US Adult Food Security Survey Module.

STATISTICAL ANALYSES PERFORMED

Multivariate logistic regression was used to examine the association between FI and mental distress. The conditional effects of WIC participation were examined by including interaction terms for FI and WIC participation as well as by stratifying the sample by WIC participation.

RESULTS

Among women in WIC-eligible households, FI was associated with moderate-to-severe mental distress in a dose-response fashion: compared with those who were food secure, the adjusted odds of moderate-to-severe mental distress were 1.8 times higher among those with marginal food security (adjusted odds ratio [AOR] 1.83, 95% CI 1.50 to 2.23), 2.1 times higher among those with low food security (AOR 2.14, 95% CI 1.76 to 2.60), and 3.7 times higher among those with very low food security (AOR 3.73, 95% CI 2.95 to 4.71). The interaction between FI and WIC participation was not significant, with similar associations between FI and mental distress among WIC participants and nonparticipants.

CONCLUSIONS

Among this nationally representative sample of women in WIC-eligible households, increasing severity of food insecurity was associated with poor mental health among WIC participants and nonparticipants. WIC participation was not observed to moderate the association between FI and mental distress. More research should consider including mental health screening at WIC clinic visits to enable early identification and referral for care.

Navigating Nutrition Inequities: BIPOC Maternal Health and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)'s Fruit and Vegetable Voucher

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.

Increased WIC Benefits for Fruits and Vegetables Increases Food Security and Satisfaction Among California Households with Young Children

BACKGROUND

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a critical source of nutrition support for young children in low-income families, providing access to healthy foods and a cash value benefit (CVB) for the purchase of fruits and vegetables (FV). In 2021, the WIC CVB increased substantially for women and children aged 1 to 5 years.

OBJECTIVE

To investigate whether or not the increased WIC CVB for purchasing FV was associated with greater redemption of the FV benefit, satisfaction, household food security, and child FV intake.

DESIGN

Longitudinal study of WIC participants receiving WIC benefits from May 2021 through May 2022. Through May 2021, the WIC CVB for children aged 1 to 4 years was $9/month. The value increased to $35/month from June through September 2021, and changed to $24/month starting October 2021.

PARTICIPANTS AND SETTING

WIC participants from seven WIC sites in California with one or more child aged 1 to 4 years during May 2021 and one or more follow-up surveys during September 2021 or May 2022 (N = 1,770).

MAIN OUTCOMES AND MEASURES

CVB redemption (in US dollars), satisfaction with the amount (prevalence), household food security (prevalence), and child FV intake (cups per day).

STATISTICAL ANALYSES

Associations of increased CVB issuance following the June 2021 CVB augmentation with child FV intake and CVB redemption were assessed using mixed effects regression, and associations with satisfaction and household food security were assessed using modified Poisson regression.

RESULTS

The increased CVB was associated with significantly greater redemption and satisfaction. At the second follow-up (May 2022), household food security increased by 10% (95% CI 7% to 12%); total FV intake decreased by 0.03 c/day (95% CI -0.06 to -0.01) in the overall sample, but increased by 0.23 c/day (95% CI 0.17 to 0.29) among children with the lowest baseline FV intake.

CONCLUSIONS

This study documented benefits of augmentation to the CVB for children. WIC policy augmenting the value of WIC food packages to increase access to FV had the intended effects, lending support to making the increased FV benefit permanent.

Healthcare-based interventions to address food insecurity during pregnancy: a systematic review

OBJECTIVE

This study was a systematic review aimed to assess published literature regarding healthcare-based interventions addressing food insecurity during pregnancy and their effects on patient-reported, pregnancy, or nutritional outcomes.

DATA SOURCES

A systematic search was performed in February 2022 (subsequently updated in August 2022) using Embase, Medline, Cochrane Library, and Scopus using terms related to food insecurity interventions during pregnancy.

STUDY ELIGIBILITY CRITERIA

Studies examining healthcare-based interventions addressing food insecurity during pregnancy with patient-reported outcomes (eg, program satisfaction), adverse pregnancy outcomes (eg, preterm birth), or nutritional outcomes (eg, dietary intake) were included. Studies using data before 1995, conducted outside the United States, or focused solely on dietary content or the Special Supplemental Nutrition Program for Women, Infants, and Children or Supplemental Nutrition Assistance Program as the intervention of interest were excluded.

METHODS

Of note, 3 authors screened the abstracts and full articles for inclusion. The final cohort included 5 studies. Moreover, 3 authors independently extracted data from each article and assessed the study quality using the Grading of Recommendations, Assessment, Development, and Evaluations and the risk of bias using the National Institutes of Health Study Quality Assessment tools.

RESULTS

Overall, 5 studies describing the interventions addressing food insecurity during pregnancy were included. Study designs included prospective cohort (n=1) and retrospective cohort (n=4) studies. There was heterogeneity in the type of intervention, with 3 using food vouchers, 1 focusing on a group prenatal service with nutrition and food management education, and 1 using a food connection program. Most studies (4 [80%]) shared patient-reported outcomes (eg, food security levels and program utilization rates), with 2 studies examining pregnancy-related outcomes (ie, glucose level, blood pressure, and preterm birth) and 2 studies examining nutritional outcomes. The interventions were associated with improved levels of food insecurity, reduced odds of preterm birth, and improved blood pressure trends; the findings demonstrated a 56% to 81% program utilization rate. All studies exhibited moderate to low study quality, with fair to good internal validity.

CONCLUSION

Although data on healthcare-based interventions targeted at food insecurity during pregnancy are limited, the few studies identified suggest that such interventions may affect pregnancy outcomes. A better understanding of the local scope and context of food insecurity and community-based organizations' efforts not captured by the literature in this area can help inform the development of interventions targeting food access during pregnancy.

Food insecurity and its socioeconomic and health determinants in pregnant women and mothers of children under 2 years of age, during the COVID-19 pandemic: A systematic review and meta-analysis

Background

The COVID-19 pandemic has reduced access to adequate food in terms of quality and quantity, especially for the most vulnerable population groups. The objective of this study was to evaluate the prevalence of Food Insecurity and its main socioeconomic and health determinants in pregnant women and mothers of children under 2 years of age, during the COVID-19 pandemic.

Methods

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021278033). The descriptors "Pregnant Woman", "Postpartum Women", "Breastfeeding Women", "COVID-19", "Food Insecurity", "Food Security" were combined in Scopus (Elsevier), Medline/PubMed (via National Library of Medicine), Embase (Elsevier), Web of Science and Science Direct independently by two researchers in September 2022. Original articles about Food Insecurity in households with pregnant women and mothers of children under 2 years of age during the COVID-19 pandemic were included. The meta-analysis of the prevalence of Food Insecurity was conducted using the RStudio software (4.0.4).

Results

The initial search resulted in 539 records, and 10 articles met the proposed criteria and were included in this review. The prevalence of Food Insecurity ranged from 11.5 to 80.3% and in the meta-analysis it was 51% (IC: 30-71) (I 2 = 100.0%). The main socioeconomic and health determinants were ethnicity, domain language, low education, low income, informal employment, unemployment, occurrence of mental disorders, domestic violence, in addition to the unavailability of food in markets and lack of transport. The inclusion of studies with data collection by telephone stands out as a limitation, due to the non-inclusion of vulnerable groups without access to this means of communication.

Conclusion

It is necessary to implement and strengthen specific public policies for the maternal and child group with the objective of protecting and strengthening the rights of women to maintain the physical and mental integrity of this group and guarantee Food Security.

WIC Participants’ Perceptions of the Cash-Value Benefit Increase during the COVID-19 Pandemic

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.