Caregivers’ Perceived Impact of WIC’s Temporary Cash-Value Benefit (CVB) Increases on Fruit and Vegetable Purchasing, Consumption, and Access in Massachusetts
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Setting, and Sample
2.2. Measures
2.2.1. Sociodemographic Characteristics
2.2.2. Access to FV
2.2.3. Primary Outcomes: Perceived Impact of CVB-Increase on FV Behavior and Satisfaction with WIC Food Package
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Ness, A.R.; Powles, J.W. Fruit and vegetables, and cardiovascular disease: A review. Int. J. Epidemiol. 1997, 26, 1–13. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Krebs-Smith, S.M.; Guenther, P.M.; Subar, A.F.; Kirkpatrick, S.I.; Dodd, K.W. Americans do not meet federal dietary recommendations. J. Nutr. 2010, 140, 1832–1838. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- U.S. Department of Agriculture; U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020–2025. Available online: https://www.dietaryguidelines.gov/ (accessed on 10 October 2022).
- Zenk, S.N.; Schulz, A.J.; Israel, B.A.; James, S.A.; Bao, S.; Wilson, M.L. Fruit and vegetable access differs by community racial composition and socioeconomic position in Detroit, Michigan. Ethn. Dis. 2006, 16, 275–280. [Google Scholar] [PubMed]
- Lee-Kwan, S.H.; Moore, L.V.; Blanck, H.M.; Harris, D.M.; Galuska, D. Disparities in state-specific adult fruit and vegetable consumption—United States, 2015. Morb. Mortal. Wkly. Rep. 2017, 66, 1241. [Google Scholar] [CrossRef]
- Larson, N.I.; Story, M.T.; Nelson, M.C. Neighborhood environments: Disparities in access to healthy foods in the US. Am. J. Prev. Med. 2009, 36, 74–81.e10. [Google Scholar] [CrossRef]
- Bhattacharya, J.; Currie, J.; Haider, S. Poverty, food insecurity, and nutritional outcomes in children and adults. J. Health Econ. 2004, 23, 839–862. [Google Scholar] [CrossRef] [Green Version]
- Food and Nutrition Service. WIC Food Packages—Regulatory Requirments for WIC-Eligible Foods. Available online: https://www.fns.usda.gov/wic/wic-food-packages-regulatory-requirements-wic-eligible-foods (accessed on 21 October 2022).
- Gago, C.M.; Wynne, J.O.; Moore, M.J.; Cantu-Aldana, A.; Vercammen, K.; Zatz, L.Y.; May, K.; Andrade, T.; Mendoza, T.; Stone, S.L. Caregiver Perspectives on Underutilization of WIC: A Qualitative Study. Pediatrics 2022, 149, e2021053889. [Google Scholar] [CrossRef]
- Schultz, D.J.; Shanks, C.B.; Houghtaling, B. The impact of the 2009 special supplemental nutrition program for women, infants, and children food package revisions on participants: A systematic review. J. Acad. Nutr. Diet. 2015, 115, 1832–1846. [Google Scholar] [CrossRef]
- Ng, S.W.; Hollingsworth, B.A.; Busey, E.A.; Wandell, J.L.; Miles, D.R.; Poti, J.M. Federal nutrition program revisions impact low-income households’ food purchases. Am. J. Prev. Med. 2018, 54, 403–412. [Google Scholar] [CrossRef]
- Tester, J.M.; Leung, C.W.; Crawford, P.B. Revised WIC food package and children’s diet quality. Pediatrics 2016, 137, e20153557. [Google Scholar] [CrossRef]
- United States Department of Agriculture. WIC and WIC FMNP Informational Memorandum: American Rescue Plan Act of 2021 (P.L. 117-2), Program Modernization. Available online: https://fns-prod.azureedge.us/sites/default/files/resource-files/WICandFMNPInfoMemo-American-Rescue-Plan-Act-Pgm-Modernization.pdf.pdf (accessed on 21 October 2022).
- Wolfson, J.A.; Leung, C.W. Food insecurity and COVID-19: Disparities in early effects for US adults. Nutrients 2020, 12, 1648. [Google Scholar] [CrossRef] [PubMed]
- Litton, M.M.; Beavers, A.W. The relationship between food security status and fruit and vegetable intake during the COVID-19 pandemic. Nutrients 2021, 13, 712. [Google Scholar] [CrossRef] [PubMed]
- Pereira, M.; Oliveira, A.M. Poverty and food insecurity may increase as the threat of COVID-19 spreads. Public Health Nutr. 2020, 23, 3236–3240. [Google Scholar] [CrossRef] [PubMed]
- Gundersen, C.; Hake, M.; Dewey, A.; Engelhard, E. Food insecurity during COVID-19. Appl. Econ. Perspect. Policy 2021, 43, 153–161. [Google Scholar] [CrossRef] [PubMed]
- Niles, M.T.; Bertmann, F.; Belarmino, E.H.; Wentworth, T.; Biehl, E.; Neff, R. The early food insecurity impacts of COVID-19. Nutrients 2020, 12, 2096. [Google Scholar] [CrossRef]
- Food and Nutrition Service. WIC 2019 Eligibility and Coverage Rates. Available online: https://www.fns.usda.gov/wic/2019-eligibility-coverage-rates (accessed on 21 October 2022).
- Weber, S.; Uesugi, K.; Greene, H.; Bess, S.; Reese, L.; Odoms-Young, A. Preferences and Perceived Value of WIC Foods Among WIC Caregivers. J. Nutr. Educ. Behav. 2018, 50, 695–704. [Google Scholar] [CrossRef] [Green Version]
- Hammad, T.A.; Havas, S.; Damron, D.; Langenberg, P. Withdrawal rates for infants and children participating in WIC in Maryland. J. Acad. Nutr. Diet. 1997, 97, 893. [Google Scholar] [CrossRef]
- Woelfel, M.L.; Abusabha, R.; Pruzek, R.; Stratton, H.; Chen, S.G.; Edmunds, L.S. Barriers to the use of WIC services. J. Am. Diet. Assoc. 2004, 104, 736–743. [Google Scholar] [CrossRef]
- Rosenberg, T.J.; Alperen, J.K.; Chiasson, M.A. Why do WIC participants fail to pick up their checks? An urban study in the wake of welfare reform. Am. J. Public Health 2003, 93, 477–481. [Google Scholar] [CrossRef]
- Liu, C.H.; Liu, H. Concerns and Structural Barriers Associated with WIC Participation among WIC-Eligible Women. Public Health Nurs. 2016, 33, 395–402. [Google Scholar] [CrossRef]
- Martinez, C.E.; Ritchie, L.D.; Lee, D.L.; Tsai, M.M.; Anderson, C.E.; Whaley, S.E. California WIC Participants Report Favorable Impacts of the COVID-Related Increase to the WIC Cash Value Benefit. Int. J. Environ. Res. Public Health 2022, 19, 10604. [Google Scholar] [CrossRef] [PubMed]
- Tsai, M.; Au, L.; Ritchie, L.; Anderson, C.; Martinez, C.; Whaley, S. Larger WIC Cash Value Benefit for Vegetables and Fruit Is Associated With Lower Food Insecurity and Improved Participant Satisfaction in WIC Families With Children. Curr. Dev. Nutr. 2022, 6, 231. [Google Scholar] [CrossRef]
- Duffy, E.W.; Vest, D.A.; Davis, C.R.; Hall, M.G.; De Marco, M.; Ng, S.W.; Taillie, L.S. “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. Int. J. Environ. Res. Public Health 2022, 19, 8671. [Google Scholar] [CrossRef] [PubMed]
- Halverson, M.M.; Karpyn, A. WIC Participants’ Perceptions of the Cash-Value Benefit Increase during the COVID-19 Pandemic. Nutrients 2022, 14, 3509. [Google Scholar] [CrossRef]
- Gattu, R.K.; Paik, G.; Wang, Y.; Ray, P.; Lichenstein, R.; Black, M.M. The hunger vital sign identifies household food insecurity among children in emergency departments and primary care. Children 2019, 6, 107. [Google Scholar] [CrossRef] [Green Version]
- Rose, D.; Richards, R. Food store access and household fruit and vegetable use among participants in the US Food Stamp Program. Public Health Nutr. 2004, 7, 1081–1088. [Google Scholar] [CrossRef] [Green Version]
- Kumanyika, S.K. A framework for increasing equity impact in obesity prevention. Am. J. Public Health 2019, 109, 1350–1357. [Google Scholar] [CrossRef]
- Food and Nutrition Service. WIC 2017 Eligibility and Coverage Rates. Available online: https://www.fns.usda.gov/wic-2017-eligibility-and-coverage-rates (accessed on 22 February 2022).
- Jun, S.; Catellier, D.J.; Eldridge, A.L.; Dwyer, J.T.; Eicher-Miller, H.A.; Bailey, R.L. Usual nutrient intakes from the diets of US children by WIC participation and income: Findings from the Feeding Infants and Toddlers Study (FITS) 2016. J. Nutr. 2018, 148, 1567S–1574S. [Google Scholar] [CrossRef] [Green Version]
- Daikeler, J.; Bošnjak, M.; Lozar Manfreda, K. Web versus other survey modes: An updated and extended meta-analysis comparing response rates. J. Surv. Stat. Methodol. 2020, 8, 513–539. [Google Scholar] [CrossRef]
- Kline, N.; Zvavitch, P.; Wroblewska, K.; Worden, M.; Mwombela, B.; Thorn, B. WIC Participant and Program Characteristics 2020; U.S. Department of Agriculture, Food and Nutrition Service: Alexandria, VA, USA, 2022.
Sociodemographic Characteristics | All | By Race/Ethnicity | By Market Travel Time | By Food Security Status e | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Hispanic | NH Black | NH White | Other d | pf | <15 min | ≥15 min | p f | Food Secure | Food Insecure | pf | ||
(n = 321) | (n = 149) | (n = 39) | (n = 88) | (n = 36) | (n = 173) | (n = 148) | (n = 153) | (n = 168) | ||||
Language a | <0.001 | 0.05 | <0.001 | |||||||||
English | 68.5 | 38.9 | 92.3 | 96.6 | 91.7 | 72.3 | 64.2 | 78.4 | 59.5 | |||
Spanish | 24.3 | 51.0 | . | . | 2.8 | 19.1 | 30.4 | 13.1 | 34.5 | |||
Portuguese | 7.2 | 10.1 | 7.7 | 3.4 | 5.6 | 8.7 | 5.4 | 8.5 | 6.0 | |||
Residence | 0.04 | 0.16 | 0.45 | |||||||||
Eastern MA | 51.1 | 44.3 | 61.5 | 60.2 | 44.4 | 56.1 | 45.3 | 49.0 | 53.0 | |||
Central MA | 29.6 | 34.2 | 33.3 | 20.5 | 27.8 | 26.6 | 33.1 | 28.8 | 30.4 | |||
Western MA | 19.3 | 21.5 | 5.1 | 19.3 | 27.8 | 17.3 | 21.6 | 22.2 | 16.7 | |||
Age (in years) | 0.32 | 0.61 | 0.01 | |||||||||
18–24 | 5.0 | 7.4 | 5.1 | 3.4 | . | 6.4 | 3.4 | 6.5 | 3.6 | |||
25–29 | 21.5 | 23.5 | 15.4 | 22.7 | 22.2 | 23.1 | 19.6 | 16.3 | 26.2 | |||
30–34 | 27.7 | 27.5 | 41.0 | 20.5 | 22.2 | 25.4 | 30.4 | 23.5 | 31.6 | |||
35–39 | 23.7 | 21.5 | 23.1 | 25.0 | 33.3 | 23.7 | 23.7 | 24.8 | 22.6 | |||
≥40 | 22.1 | 20.1 | 15.4 | 28.4 | 22.2 | 21.4 | 23.0 | 28.8 | 16.1 | |||
Gender | 0.28 | > 0.9 | > 0.9 | |||||||||
Woman | 96.3 | 98.0 | 97.4 | 96.6 | 94.4 | 97.1 | 95.3 | 96.7 | 95.8 | |||
Man | 2.5 | 2.0 | 2.6 | 1.1 | 5.6 | 2.3 | 2.7 | 2.6 | 2.4 | |||
Other | 0.6 | . | . | 2.3 | . | 0.6 | 0.7 | 0.7 | 0.6 | |||
Prefer not say | 0.6 | . | . | . | . | . | 0.86 | |||||
Marital status b | 0.17 | 0.68 | ||||||||||
Married | 44.6 | 43.6 | 30.8 | 54.6 | 47.2 | 45.7 | 43.2 | 45.1 | 44.1 | |||
Single | 44.2 | 44.3 | 56.4 | 39.8 | 47.2 | 43.4 | 45.3 | 45.8 | 42.9 | |||
Prefer not say | 11.2 | 12.1 | 12.8 | 5.7 | 5.6 | 11.0 | 11.5 | 9.2 | 13.1 | |||
Educational attainment | <0.001 | 0.004 | 0.04 | |||||||||
<High school degree | 8.7 | 16.8 | 5.1 | 1.1 | . | 4.1 | 14.2 | 8.5 | 8.9 | |||
High school degree or equivalent | 30.8 | 31.5 | 33.3 | 25.0 | 44.4 | 28.3 | 33.8 | 28.1 | 33.3 | |||
Some college (no degree) | 29.9 | 26.9 | 25.6 | 39.8 | 25.0 | 31.2 | 28.4 | 26.8 | 32.7 | |||
≥College degree | 25.6 | 20.8 | 30.8 | 33.0 | 25.0 | 30.1 | 20.3 | 33.3 | 18.5 | |||
Prefer not say | 5.0 | 4.0 | 5.1 | 1.1 | 5.6 | 6.4 | 3.4 | 3.3 | 6.6 | |||
Employment status c | 0.9 | 0.27 | 0.49 | |||||||||
Employed part time | 31.2 | 31.5 | 30.8 | 28.4 | 44.4 | 31.2 | 31.1 | 30.7 | 31.6 | |||
Employed full time | 18.4 | 18.1 | 20.5 | 20.5 | 13.9 | 20.8 | 15.5 | 16.3 | 20.2 | |||
Unemployed | 41.1 | 43.0 | 41.0 | 40.9 | 38.9 | 37.0 | 46.0 | 44.4 | 38.1 | |||
Prefer not say | 9.4 | 7.4 | 7.7 | 10.2 | 2.8 | 11.0 | 7.4 | |||||
SNAP enrollment | 0.06 | 0.75 | 0.09 | |||||||||
Never enrolled | 22.7 | 26.9 | 18.0 | 21.6 | 16.7 | 22.5 | 23.0 | 28.8 | 17.3 | |||
Past enrolled | 13.1 | 9.4 | 20.5 | 18.2 | 8.3 | 13.9 | 12.2 | 11.1 | 14.9 | |||
Enrolled (<1 year) | 14.0 | 11.4 | 15.4 | 11.4 | 30.6 | 15.6 | 12.2 | 12.4 | 15.5 | |||
Enrolled (≥1 year) | 50.2 | 52.4 | 46.2 | 48.9 | 44.4 | 48.0 | 52.7 | 47.7 | 52.4 |
FV Accessibility and Purchasing Characteristics | All | By Race/Ethnicity | By Market Travel Time | By Food Security Status b | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Hispanic | NH Black | NH White | Other c | pa | <15 min | ≥15 min | p a | Food Secure | Food Insecure | pa | |||
(n = 321) | (n = 149) | (n = 39) | (n = 88) | (n = 36) | (n = 173) | (n = 148) | (n = 153) | (n = 168) | |||||
Market & FV access | |||||||||||||
Where do you do most of your shopping? | 0.09 | 0.002 | 0.01 | ||||||||||
Supercenter | 25.2 | 28.2 | 28.2 | 20.5 | 22.2 | 17.3 | 34.5 | 24.2 | 26.2 | ||||
Supermarket | 68.9 | 62.4 | 69.2 | 78.4 | 72.2 | 76.9 | 59.5 | 73.9 | 64.3 | ||||
Other | 5.9 | 9.4 | 2.6 | 1.1 | 5.6 | 5.8 | 6.1 | 2.0 | 9.5 | ||||
How do you usually get to the store? | 0.005 | 0.14 | 0.06 | ||||||||||
Car | 69.5 | 57.7 | 66.7 | 85.2 | 80.6 | 74.0 | 64.2 | 76.5 | 63.1 | ||||
Public transit | 8.4 | 12.1 | 7.7 | 5.7 | 2.8 | 5.2 | 12.2 | 5.9 | 10.7 | ||||
Walk | 5.6 | 7.4 | 10.3 | 1.1 | 2.8 | 4.6 | 6.8 | 3.9 | 7.1 | ||||
Catch a ride | 15.6 | 22.2 | 15.4 | 8.0 | 11.1 | 15.6 | 15.5 | 13.7 | 17.3 | ||||
Other | 0.9 | 0.7 | . | . | 2.8 | 0.6 | 1.4 | . | 1.8 | ||||
Does your store sell the FV your family likes? | 0.39 | 0.37 | 0.88 | ||||||||||
Yes | 96.9 | 96.0 | 100.0 | 96.6 | 100.0 | 97.7 | 96.0 | 96.7 | 97.0 | ||||
No | 3.1 | 4.0 | . | 3.4 | . | 2.3 | 4.1 | 3.3 | 3.0 | ||||
Are the FV prices at your store reasonable? | 0.47 | 0.45 | <0.0001 | ||||||||||
Yes, reasonable | 72.0 | 77.9 | 64.1 | 68.2 | 69.4 | 76.3 | 66.9 | 83.0 | 61.9 | ||||
No, expensive | 28.0 | 22.2 | 35.9 | 31.8 | 30.6 | 23.7 | 33.1 | 17.0 | 38.1 | ||||
FV purchasing | |||||||||||||
In the past month, could you get enough FV for your family? | 0.21 | 0.06 | <0.0001 | ||||||||||
Yes | 61.7 | 62.4 | 66.7 | 62.5 | 50.0 | 63.6 | 59.5 | 73.2 | 51.2 | ||||
No | 38.3 | 37.6 | 33.3 | 37.5 | 50.0 | 36.4 | 40.5 | 26.8 | 48.8 | ||||
In the past month, how much of your own money did you spend on household groceries? | 0.009 | 0.68 | 0.0002 | ||||||||||
$0–25 | 13.4 | 10.1 | 10.3 | 22.7 | 5.6 | 14.5 | 12.2 | 20.9 | 6.6 | ||||
$26–50 | 24.9 | 24.2 | 20.5 | 28.4 | 27.8 | 24.3 | 25.7 | 28.8 | 21.4 | ||||
$51–100 | 15.6 | 18.8 | 20.5 | 14.8 | 17.9 | 12.8 | 10.5 | 20.2 | |||||
$101–200 | 31.5 | 28.9 | 35.9 | 27.3 | 44.4 | 29.5 | 33.8 | 28.1 | 34.5 | ||||
>$201 | 14.6 | 18.1 | 12.8 | 6.8 | 22.2 | 13.9 | 15.5 | 11.8 | 17.3 |
by Race/Ethnicity | by Market Travel Time | by Food Security Status c | |||||||
---|---|---|---|---|---|---|---|---|---|
How Did the CVB Increase Affect Perceived Changes in FV Behavior and Satisfaction? | All | NH Black vs. NH White | Hispanic vs. NH White | <15 min vs. ≥15 min | Food Insecure vs. Secure | ||||
% a | RR (95% CI) b | p | RR (95% CI) b | p | RR (95% CI) b | p | RR (95% CI) b | p | |
FV affordability | |||||||||
Decreased out-of-pocket FV cost | 70.4 | 0.87 (0.69, 1.09) | 0.22 | 0.86 (0.74, 1.00) | 0.05 | 1.01 (0.87, 1.16) | 0.94 | 0.96 (0.83, 1.11) | 0.57 |
FV behaviors | |||||||||
Increased amount FV offered to children | 70.1 | 0.80 (0.58, 1.09) | 0.15 | 1.11 (0.94, 1.32) | 0.22 | 1.03 (0.90, 1.19) | 0.67 | 0.97 (0.84, 1.12) | 0.70 |
Increased amount FV caregivers personally consume | 63.2 | 0.88 (0.64, 1.21) | 0.44 | 1.04 (0.85, 1.28) | 0.68 | 0.96 (0.81, 1.14) | 0.64 | 1.03 (0.87, 1.22) | 0.73 |
Increased amount FV purchased | 71.0 | 0.84 (0.63, 1.11) | 0.22 | 1.06 (0.91, 1.24) | 0.44 | 1.03 (0.89, 1.19) | 0.67 | 0.92 (0.81, 1.06) | 0.26 |
Form FV purchased | |||||||||
Increased amount fresh FV | 72.6 | 0.83 (0.63, 1.11) | 0.21 | 1.01 (0.86, 1.18) | 0.93 | 1.08 (0.94, 1.24) | 0.26 | 1.05 (0.91, 1.20) | 0.52 |
Decreased or same amount canned FV | 68.9 | 1.13 (0.92, 1.39) | 0.25 | 0.96 (0.80, 1.16) | 0.70 | 1.12 (0.95, 1.32) | 0.16 | 0.93 (0.79, 1.10) | 0.39 |
Decreased or same amount frozen FV | 65.7 | 1.10 (0.87, 1.40) | 0.41 | 1.00 (0.82, 1.20) | 0.96 | 1.08 (0.92, 1.27) | 0.35 | 0.98 (0.92, 1.16) | 0.79 |
Satisfaction | |||||||||
Increased satisfaction with FV taste and quality d | 55.5 | 0.87 (0.58, 1.31) | 0.51 | 1.07 (0.84, 1.38) | 0.58 | 1.01 (0.82, 1.25) | 0.89 | 0.98 (0.80, 1.21) | 0.85 |
Increased satisfaction with WIC food package d | 37.1 | 0.90 (0.58, 1.39) | 0.64 | 0.66 (0.47, 0.94) | 0.02 | 0.97 (0.72, 1.31) | 0.85 | 0.97 (0.72, 1.31) | 0.22 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Gago, C.; Colchamiro, R.; May, K.; Rimm, E.B.; Kenney, E.L. Caregivers’ Perceived Impact of WIC’s Temporary Cash-Value Benefit (CVB) Increases on Fruit and Vegetable Purchasing, Consumption, and Access in Massachusetts. Nutrients 2022, 14, 4947. https://doi.org/10.3390/nu14234947
Gago C, Colchamiro R, May K, Rimm EB, Kenney EL. Caregivers’ Perceived Impact of WIC’s Temporary Cash-Value Benefit (CVB) Increases on Fruit and Vegetable Purchasing, Consumption, and Access in Massachusetts. Nutrients. 2022; 14(23):4947. https://doi.org/10.3390/nu14234947
Chicago/Turabian StyleGago, Cristina, Rachel Colchamiro, Kelley May, Eric B. Rimm, and Erica L. Kenney. 2022. "Caregivers’ Perceived Impact of WIC’s Temporary Cash-Value Benefit (CVB) Increases on Fruit and Vegetable Purchasing, Consumption, and Access in Massachusetts" Nutrients 14, no. 23: 4947. https://doi.org/10.3390/nu14234947