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

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.

SUBMITTER: Zhang Q

PROVIDER: S-EPMC7666910 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background:The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides participants seasonal Farmers' Market Nutrition Program (FMNP) vouchers to purchase fruits and vegetables (FV) at farmers' markets and monthly cash value vouchers (CVV) redeemable at farmers' markets. Despite the promise of FMNP vouchers and CVV for improving FV access among WIC participants, voucher redemption rates are low. This study evaluated WIC Fresh Start (WFS), a theory-driven, web-based lesson to promote FV intake, the redemption of CVV at farmers' markets, FMNP voucher redemption, and farmers' market-related knowledge, attitudes, and skills among women enrolled in WIC. Methods:The lesson was evaluated in a four-arm randomized controlled trial. The setting was a large New Jersey-based WIC agency located in a densely populated, urban area. Participants (N = 744) were stratified based on FMNP voucher receipt and randomized to receive the WFS lesson or WIC online existing health education. Lesson effects on targeted outcomes were examined at posttest (2 weeks after the lesson) and 3 and 6 months after posttesting. Results:Receipt of the WFS lesson was associated with FMNP voucher redemption (in the subset of participants preferring to speak Spanish); improvements in knowledge of the FMNP, locally grown seasonal items, seasonal items found at farmers' markets in July, WIC-authorized farmers' markets and food- and farmers' market-specific knowledge; ever having purchased and intentions to purchase FV at a farmers' market; FV food safety and preparation skills; and modest gains in the redemption of CVV at farmers' markets. FV intake did not differ over time by trial arm. Conclusions:Findings aid understanding of effective approaches to promote farmers' market use and farmers' market-related knowledge and skills among WIC participants. Further research is needed to explore factors that may explain the lack of lesson effects on FV intake. Trial registration:NCT02565706.

Project description:ImportanceFood insecurity is associated with a less healthy diet. The Supplemental Nutrition Assistance Program (SNAP) is associated with reduced food insecurity, but benefit levels may be insufficient for beneficiaries to afford healthy foods.ObjectiveTo evaluate whether participation in SuperSNAP, a program that provides an additional $40 per month for the purchase of fruits and vegetables with no added sugar, sodium, or fat to SNAP beneficiaries, is associated with changes in food purchasing.Design, setting, and participantsThis longitudinal cohort study used data from transaction records of a large supermarket chain with approximately 500 stores located across North Carolina from October 2019 to April 2020. Participants were SNAP beneficiaries.ExposureSuperSNAP participation.Main outcomes and measuresMonthly spending on all fruits, vegetables, legumes, and nuts (primary outcome); spending on less healthy food categories; and spending on sugar-sweetened beverages as 1 category of less healthy foods. Monthly data on purchases by SNAP beneficiaries before and during SuperSNAP participation were compared with data from SNAP beneficiaries not enrolled in the program who shopped at the same stores. Overlap weighting (a propensity score-based method) was used to account for confounding, and linear mixed-effects models were fitted with random effects to account for repeated measures and clustering by store.ResultsThe study included 667 SuperSNAP participants and 33 246 SNAP beneficiaries who did not use SuperSNAP but shopped in the same stores; 436 SuperSNAP participants had preintervention data and were included in the main analysis. SuperSNAP participation was associated with increased monthly purchases of fruits, vegetables, nuts, and legumes ($31.84; 95% CI, $31.27-$32.42; P < .001; 294.52 oz; 95% CI, 288.84-300.20 oz; P < .001). Only a small increase in spending on less healthy food categories compared with the SNAP beneficiaries who did not use SuperSNAP ($1.60; 95% CI, $0.67-$2.53; P < .001) was observed. As total spending increased, the proportion of total food and beverage spending on less healthy foods significantly decreased (difference, 4.51%; 95% CI, 4.27%-4.74%; P < .001). Monthly spending on sugar-sweetened beverages decreased (difference, $1.83; 95% CI, $1.30-$2.36; P < .001).Conclusions and relevanceIn this cohort study, participation in SuperSNAP was associated with meaningful increases in healthy food purchasing. Subsequent studies should investigate whether healthy food incentive programs improve health outcomes.

Project description:Outside of western countries, the study of the local food environment and evidence for its association with dietary behavior is limited. The aim of this paper was to examine the association between the local retail food environment and consumption of fruit and vegetables (FV) among adults in Hong Kong. Local retail food environment was measured by density of different types of retail food outlets (grocery stores, convenience stores, and fast food restaurants) within a 1000 m Euclidean buffer around individual's homes using a geographic information system (GIS). The Retail Food Environment Index (RFEI) was calculated based on the relative density of fast-food restaurants and convenience stores to grocery stores. Logistic regressions were performed to examine associations using cross-sectional data of 1977 adults (18 years or older). Overall, people living in an area with the highest RFEI (Q4, >5.76) had significantly greater odds of infrequent FV consumption (<7 days/week) after covariates adjustment (infrequent fruit consumption: OR = 1.36, 95% CI 1.04?1.78; infrequent vegetable consumption: OR = 1.72, 95% CI 1.11?2.68) in comparison to the lowest RFEI (Q1, <2.25). Highest density of fast food restaurants (Q4, >53) was also significantly associated with greater odds of infrequent fruit consumption (<7 days/week) (unadjusted model: OR = 1.34, 95% CI 1.04?1.73), relative to lowest density of fast food restaurants (Q1, <13). No significant association of density of grocery stores or convenience stores was observed with infrequent FV consumption regardless of the covariates included in the model. Our results suggest that the ratio of fast-food restaurants and convenience stores to grocery stores near people's home is an important environmental factor in meeting fruit and vegetable consumption guidelines. "Food swamps" (areas with an abundance of unhealthy foods) rather than "food deserts" (areas where there is limited access to healthy foods) seems to be more of a problem in Hong Kong's urban areas. We advanced international literature by providing evidence in a non-western setting.

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

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