Dataset Information

Economic evaluation of a farm-to-Special Supplemental Nutrition Programme for Women, Infants and Children intervention promoting vegetable consumption.

ABSTRACT:

Objective

To evaluate the cost and cost-effectiveness of a farm-to-Special Supplemental Nutrition Programme for Women, Infants and Children (WIC) intervention to promote vegetable intake and the redemption of WIC vouchers for produce purchases at farmers' markets.

Design

An economic analysis was undertaken using data from a pilot of the intervention. Vegetable intake was assessed with a reflection spectroscopy device (the Veggie Meter® [VM]) and via self-report. Voucher redemption was reported by WIC. Total and per participant intervention costs and cost-effectiveness ratios (expressed as cost per intervention effect) were estimated in 2019 US dollars over a 6-month period from the perspective of the agency implementing the intervention.

Setting

A large, urban WIC agency.

Participants

Participants were 297 WIC-enrolled adults.

Results

Post-intervention, VM scores, self-reported vegetable intake and voucher redemption were higher in the intervention as compared with the control study group. Over the 6-month period, intervention costs were $31 092 ($194 unit cost per participant). Relative to the control group, the intervention cost $8·10 per increased VM score per participant, $3·85 per increased cup/d of vegetables consumed per participant and $3·29 per increased percentage point in voucher redemption per participant.

Conclusions

Intervention costs and cost-effectiveness ratios compared favourably with those reported for other interventions targeting vegetable intake in low-income groups, suggesting that the programme may be cost effective in promoting vegetable purchases and consumption. As there is no benchmark against which to compare cost-effectiveness ratios expressed as cost per unit of effectiveness, conclusions regarding whether this is the case must await further research.

SUBMITTER: Di Noia J

PROVIDER: S-EPMC8373716 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundVegetable intake is below recommended levels among adults served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).ObjectiveThe aim of this study was to determine whether a novel, theory-driven, farm-to-WIC intervention to promote vegetable intake showed promise of being successful and is therefore appropriate for efficacy testing.DesignFrom June 2019 to January 2020, the intervention was piloted in three WIC agency sites (one randomized to the intervention study group and two to the control group) selected based on similarity in size and the demographics of participants served.Participants/settingRecruited between June 3, 2019 and August 1, 2019, participants were 297 primarily Hispanic adults served by a large WIC agency located in a densely populated urban area in New Jersey (160 were enrolled at the intervention site and 137 at control sites).InterventionThe intervention combined behaviorally focused instruction and handouts with the introduction of a WIC-based farmers' market, field trips to an area farmers' market, telephone coaching and support before and after trips, and recipe demonstrations and tastings.Main outcome measuresThe primary outcomes were vegetable intake (measured objectively using dermal carotenoids as a biomarker of intake and via self-report) and the redemption of vouchers provided through the WIC Farmers' Market Nutrition Program (FMNP) for fruit and vegetable purchases at farmers' markets (objectively assessed using data provided by WIC).Statistical analyses performedBetween-group differences in vegetable intake were examined at mid- and post-intervention (3 and 6 months post-baseline, respectively) with linear mixed-effects models adjusted for baseline vegetable intake and covariates. Logistic regression analysis was used to relate FMNP voucher redemption to study group and covariates.ResultsAt mid-intervention, objectively measured vegetable intake was higher among participants in the control group as compared with the intervention group; self-reported intake did not differ by group. Post-intervention, objectively measured and self-reported vegetable intake were higher among participants in the intervention group as compared with the control group. Receipt of the intervention was associated with a greater likelihood of FMNP voucher redemption. Voucher redemption rates were 87% in the intervention group and 28% in the control group (odds ratio = 17.39, 95% confidence interval [8.64, 35.02]).ConclusionsMeaningful associations found between the intervention, vegetable intake, and FMNP voucher redemption suggest that the program is appropriate for efficacy testing.

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:ImportanceNearly 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.ObjectiveTo 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 participantsThis 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.ExposuresReceipt of WIC benefits during pregnancy.Main outcomes and measuresThe 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.ResultsAmong 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 relevanceThis study found that receipt of WIC benefits among expectant mothers with Medicaid coverage was associated with lower risk of preterm birth and infant mortality.

Project description:The food retail environment has been directly linked to disparities in dietary behaviors and may in part explain racial and ethnic disparities in pregnancy-related deaths. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC), administered by the United States Department of Agriculture, is associated with improved healthy food and beverage access due to its requirement for minimum stock of healthy foods and beverages in WIC-eligible stores. The selection and authorization criteria used to authorize WIC vendors varies widely from state to state with little known about the specific variations. This paper reviews and summarizes the differences across 16 of these criteria enacted by 89 WIC administrative agencies: the 50 states, the District of Columbia, five US Territories, and 33 Indian Tribal Organizations. Vendor selection and authorization criteria varied across WIC agencies without any consistent pattern. The wide variations in criteria and policies raise questions about the rational for inconsistency. Some of these variations, in combination, may result in reduced access to WIC-approved foods and beverages by WIC participants. For example, minimum square footage and/or number of cash register criteria may limit vendors to larger retail operations that are not typically located in high-risk, under-resourced communities where WIC vendors are most needed. Results highlight an opportunity to convene WIC stakeholders to review variations, their rationale, and implications thereof especially as this process could result in improved policies to ensure and improve healthy food and beverage access by WIC participants. More work remains to better understand the value of state WIC vendor authorization authority, particularly in states that have provided stronger monitoring requirements. This work might also examine if and how streamlining WIC vendor criteria (or at least certain components of them) across regional areas or across the country could provide an opportunity to advance interstate commerce and promote an equitable supply of food across the food system, while ensuring the protection for local, community-oriented WIC vendors.