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Review of WIC Food Packages: Proposed Framework for Revisions: Interim Report (2016)

Chapter: Appendix G: Literature Findings on Barriers and Incentives to WIC Participation and Redemption

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Suggested Citation:"Appendix G: Literature Findings on Barriers and Incentives to WIC Participation and Redemption." National Academies of Sciences, Engineering, and Medicine. 2016. Review of WIC Food Packages: Proposed Framework for Revisions: Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/21832.
×
Suggested Citation:"Appendix G: Literature Findings on Barriers and Incentives to WIC Participation and Redemption." National Academies of Sciences, Engineering, and Medicine. 2016. Review of WIC Food Packages: Proposed Framework for Revisions: Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/21832.
×

TABLE G-1 Literature Findings on Barriers and Incentives to WIC Participation and Redemption

Article Barriers Incentives/Strategies
Bertmann et al., 2014

Negative interactions in stores: annoyance or anger expressed by cashier or other shoppers

Confusion over WIC rules: fluctuation in enforcement of redemption rules store to store and week to week

Cashiers lack training: participants have to explain the rules

Feeling of embarrassment when using CVV

Find strategic choice of times and locations at which to shop

Choose particular cashiers

Pool CVV (using multiple vouchers at once)

Christie et al., 2006

Long duration of appointment wait time

Dissatisfaction with customer service

Dissatisfaction with the physical environment

Decrease wait times by extending clinic hours and/or changing clinic flow

High level of satisfaction with WIC personnel

Gleason and Pooler, 2011

Underutilization of infant food benefits

Issue a CVV for F/V for caregivers who prefer preparing own infant foods

Implement targeted nutrition education to subpopulations with high non-use of food instruments

Gleason et al., 2011

Maintaining food freshness (small WIC vendors)

Availability of products in allowable form (e.g., bread in approved size)

Continue and expand vendor training

Continue to engage food suppliers

Continue nutrition education of participants

Use state WIC data for internal program management, policy making, ongoing monitoring

Examine effect of minimum stocking requirements

Suggested Citation:"Appendix G: Literature Findings on Barriers and Incentives to WIC Participation and Redemption." National Academies of Sciences, Engineering, and Medicine. 2016. Review of WIC Food Packages: Proposed Framework for Revisions: Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/21832.
×
Article Barriers Incentives/Strategies
Gleason et al., 2014 Participants: Participants:

Gaps in knowledge (determining the amount of F/V with CVV)

Incorrect information provided by cashier

Limited selection of some WIC foods at local vendors and poor-quality produce

Lack of transportation (e.g., tribe located 30 minutes from a store)

Vendors:

Delivery of spoiled items

Difficulty anticipating demand and maintaining adequate supply of some WIC foods

Challenges in serving participants who lack knowledge

Challenges in communicating with local WIC agency

Use more than one check at a time when transportation is an issue

Vendors:

Adopt practices that will make it easier for participants to shop

WIC Staff:

Use open-ended question and probing to encourage discussion with participants

Expand nutrition education opportunities Inform participants of local vendors

Local WIC Directors:

Establish open lines of communication with vendors

Increase cross-program collaboration

State WIC Agencies:

Offer additional training opportunities to staff

Expand allowable WIC foods to include frozen and canned vegetables

Develop a formalized local vendor liaison (LVL) program (California example: LVL makes visits)

Najjar, 2013

Food package policies (e.g., container size)

Negative grocery store experiences and personal misunderstanding and embarrassment

Helpful vendors

Vendor and participant understanding about the use of CVV and other WIC benefits

Suggested Citation:"Appendix G: Literature Findings on Barriers and Incentives to WIC Participation and Redemption." National Academies of Sciences, Engineering, and Medicine. 2016. Review of WIC Food Packages: Proposed Framework for Revisions: Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/21832.
×
Article Barriers Incentives/Strategies
Phillips et al., 2014

Certain individual WIC foods have low rates of full redemption

Could not use certain foods (i.e., received too much)

Participants or their children disliked the food or did not know how to prepare them

Regardless of ethnicity, full redemption of WIC benefits is low

Implement targeted educational efforts to promote full utilization of WIC benefits

Tailor nutrition education to include foods that are commonly underused and focus on culturally relevant approaches to incorporating these foods into meals and snacks

USDA/ERS, 2010b

Program requires too much effort, or scheduling, or transportation problems

USDA/ERS, 2013

Improved national economic conditions generally reduce participation rates for WIC and other national assistance programs

Poorer economic conditions and unemployment rates tend to improve participation rates when the program is fully funded

NOTE: CVV = cash value voucher; F/V = fruits and vegetables; LVL = local vendor liaison; SSI = Supplemental Security Income.

Suggested Citation:"Appendix G: Literature Findings on Barriers and Incentives to WIC Participation and Redemption." National Academies of Sciences, Engineering, and Medicine. 2016. Review of WIC Food Packages: Proposed Framework for Revisions: Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/21832.
×

TABLE G-2 Changes in Fruit and Vegetable Availability and Selection Overall and by Vendor Type, Before Compared to After the 2009 WIC Food Package Changes

Availability or Selection Fresh Canned Frozen
Commonly Consumed FV African American FV Latino FV Vegetables Low-sodium Vegetables Fruits Vegetables Fruits
Availability
Overall change 2.14 (1.31, 3.50)b 2.53 (1.31, 5.35)b 1.72 (0.84, 3.98) NE 2.69 (1.17, 6.22)a 1.84 (0.91, 3.72) 1.97 (1.05, 3.70)a 2.15 (1.06, 4.37)a
Change by vendor type
Large 3.56 (1.22, 10.34)a 2.27 (1.31, 5.48)a 1.69 (0.94, 5.54) 1.62 (0.81, 3.25) 0.93 (0.25, 3.48) 1.01 (0.41, 2.48) 1.43 (0.91, 2.25) 2.10 (0.86, 5.12)
Small 1.07 (0.51, 2.24) 2.64 (1.09, 6.38)a 1.83 (0.65, 5.17) 1.18 (0.47, 2.94) 5.95 (1.74, 20.29)b 2.11 (0.95, 4.69) 2.80 (1.13, 6.93)a 1.93 (0.68, 5.53)
Pharmacy NE 1.38 (1.02, 1.88)a 1.25 (0.92, 1.69) NE 0.71 (0.12, 4.18) 1.06 (0.04, 25.53) 1.34 (0.34, 5.24) 2.24 (0.19, 25.74)
Selection
Overall change 1.67 (1.14, 2.47)b 1.14 (1.01, 1.42) 1.17 (1.02, 1.33) 1.22 (1.07, 1.40)b 1.13 (0.98, 1.30) 0.96 (0.77, 1.20) 1.09 (0.82, 1.46) 0.92 (0.69, 1.21)
Change by vendor type
Large 1.67 (1.03, 2.69)a 1.13 (1.01, 1.43) 1.22 (1.06, 1.36)a 0.84 (0.68, 1.04) 1.05 (0.91, 1.20) 0.88 (0.71, 1.09) 1.02 (0.74, 1.40) 0.93 (0.69, 1.25)
Small 1.71 (1.06, 2.76)a 1.17 (0.78, 2.19) 1.05 (0.73, 1.58) 1.32 (0.95, 1.85) 2.01 (1.03, 3.84)a 1.05 (0.53, 2.07) 1.34 (0.79, 2.29) 0.80 (0.33, 1.93)
Pharmacy NE 1.04 (0.93, 1.20) 1.09 (0.95, 1.21) 1.58 (1.31, 1.91)b 1.17 (0.18, 7.45) 1.35 (0.06, 30.18) 0.81 (0.32, 2.08) NE

NOTES: Data presented as odds ratio (95% confidence interval); an odds ratio of 1.0 for this contrast indicates that the post-policy change from 2009 to 2010 was greater than the pre-policy change from 2008 to 2009; NE = odds ratio not estimated due to lack of variability in outcome by year. FV = fruits and vegetables.

a P < 0.05.

b P < 0.01.

SOURCE: Zenk et al., 2012 (used with permission).

Suggested Citation:"Appendix G: Literature Findings on Barriers and Incentives to WIC Participation and Redemption." National Academies of Sciences, Engineering, and Medicine. 2016. Review of WIC Food Packages: Proposed Framework for Revisions: Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/21832.
×

REFERENCES

Bertmann, F. M., C. Barroso, P. Ohri-Vachaspati, J. S. Hampl, K. Sell, and C. M. Wharton. 2014. Women, infants, and children cash value voucher (CVV) use in Arizona: A qualitative exploration of barriers and strategies related to fruit and vegetable purchases. Journal of Nutrition Education and Behavior 46(3 Suppl):S53-S58.

Christie, C., J. A. Watkins, A. Martin, H. Jackson, J. E. Perkin, and J. Fraser. 2006. Assessment of client satisfaction in six urban WIC clinics. Florida Public Health Review 3:35-42.

Gleason, S., and J. Pooler. 2011. The effects of changes in WIC food packages on redemptions: Final report: Altarum Institute. http://naldc.nal.usda.gov/download/50613/PDF (accessed March 2, 2015).

Gleason, S., R. Morgan, L. Bell, and J. Pooler. 2011. Impact of the revised WIC food package on small WIC vendors: Insight from a four-state evaluation. Portland, ME: Altarum Institute. http://www.calwic.org/storage/FourStateWICFoodPackageEvaluation-Full_Report20May11.pdf (accessed March 2, 2015).

Gleason, S., D. McGuire, and R. Morgan. 2014. Opportunities to enhance American Indian access to the WIC food package: Evidence from three case studies. Portland, ME: Altarum Institute. http://altarum.org/sites/default/files/uploaded-publication-files/Opportunities%20to%20Enhance%20Am%20Indian%20Access%20to%20the%20WIC%20FP_fmt_04.pdf (accessed March 2, 2015).

Najjar, S. 2013. Barriers to WIC benefits redemption among participants in Washington State. Master’s thesis, School of Public Health, University of Washington, Seattle, WA.

Phillips, D., L. Bell, R. Morgan, and J. Pooler. 2014. Transition to EBT in WIC: Review of impact and examination of participant redemption patterns: Final report. Portland, ME: Altarum Institute. http://altarum.org/sites/default/files/uploaded-publication-files/Altarum_Transition%20to%20WIC%20EBT_Final%20Report_071614.pdf (accessed March 2, 2015).

USDA/ERS (U.S. Department of Agriculture/Economic Research Service). 2010a. Changing participation in food assistance programs among low-income children after welfare reform. Washington, DC: USDA/ERS. http://www.ers.usda.gov/media/136463/err92_1_.pdf (accessed March 9, 2015).

USDA/ERS. 2010b. WIC participation patterns: An investigation of delayed entry and early exit. Washington, DC: USDA/ERS. http://www.ers.usda.gov/media/134411/err109.pdf (accessed March 2, 2015).

USDA/ERS. 2013. How economic conditions affect participation in USDA nutrition assistance programs. In Economic Conditions Impact on Participation in Nutrition Assistance Programs. Washington, DC: USDA/ERS. http://www.ers.usda.gov/media/914042/eib100.pdf (accessed March 9, 2015).

Zenk, S. N., A. Odoms-Young, L. M. Powell, R. T. Campbell, D. Block, N. Chavez, R. C. Krauss, S. Strode, and J. Armbruster. 2012. Fruit and vegetable availability and selection: Federal food package revisions, 2009. American Journal of Preventive Medicine 43(4):423-428.

Suggested Citation:"Appendix G: Literature Findings on Barriers and Incentives to WIC Participation and Redemption." National Academies of Sciences, Engineering, and Medicine. 2016. Review of WIC Food Packages: Proposed Framework for Revisions: Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/21832.
×
Page 397
Suggested Citation:"Appendix G: Literature Findings on Barriers and Incentives to WIC Participation and Redemption." National Academies of Sciences, Engineering, and Medicine. 2016. Review of WIC Food Packages: Proposed Framework for Revisions: Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/21832.
×
Page 398
Suggested Citation:"Appendix G: Literature Findings on Barriers and Incentives to WIC Participation and Redemption." National Academies of Sciences, Engineering, and Medicine. 2016. Review of WIC Food Packages: Proposed Framework for Revisions: Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/21832.
×
Page 399
Suggested Citation:"Appendix G: Literature Findings on Barriers and Incentives to WIC Participation and Redemption." National Academies of Sciences, Engineering, and Medicine. 2016. Review of WIC Food Packages: Proposed Framework for Revisions: Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/21832.
×
Page 400
Suggested Citation:"Appendix G: Literature Findings on Barriers and Incentives to WIC Participation and Redemption." National Academies of Sciences, Engineering, and Medicine. 2016. Review of WIC Food Packages: Proposed Framework for Revisions: Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/21832.
×
Page 401
Suggested Citation:"Appendix G: Literature Findings on Barriers and Incentives to WIC Participation and Redemption." National Academies of Sciences, Engineering, and Medicine. 2016. Review of WIC Food Packages: Proposed Framework for Revisions: Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/21832.
×
Page 402
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The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began 40 years ago as a pilot program and has since grown to serve over 8 million pregnant women, and mothers of and their infants and young children. Today the program serves more than a quarter of the pregnant women and half of the infants in the United States, at an annual cost of about $6.2 billion. Through its contribution to the nutritional needs of pregnant, breastfeeding, and post-partum women; infants; and children under 5 years of age; this federally supported nutrition assistance program is integral to meeting national nutrition policy goals for a significant portion of the U.S. population.

To assure the continued success of the WIC, Congress mandated that the Food and Nutrition Service of the U.S. Department of Agriculture (USDA) reevaluate the program's food packages every 10 years. In 2014, the USDA asked the Institute of Medicine to undertake this reevaluation to ensure continued alignment with the goals of the Dietary Guidelines for Americans. This, the second report of this series, provides a summary of the work of phase I of the study, and serves as the analytical underpinning for phase II in which the committee will report its final conclusions and recommendations.

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