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The United States Department of Agriculture approved an increase to the Cash Value Benefit (CVB) for the purchase of fruits and vegetables issued to participants receiving an eligible Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package. In order to understand satisfaction, perceptions, and the overall impact of additional benefits for fruits and vegetables at the household level, a qualitative study consisting of structured phone interviews was conducted with families served by WIC in Southern California from November to December 2021 (n = 30). Families were selected from a large longitudinal study sample (N = 2784); the sample was restricted by benefit redemption and stratified by language and race. WIC participants were highly satisfied with the CVB increase, reporting increased purchasing and consumption of a variety of fruits and vegetables. Respondents noted the improved quality and variety of fruits and vegetables purchased due to the increased amount. Findings are expected to inform policy makers to adjust the CVB offered in the WIC food package with the potential to improve participant satisfaction and increase participation and retention of eligible families with benefits from healthy diets supported by WIC.

To conduct a pilot study to determine if improving the visibility and quality of fresh produce (choice architecture) in corner stores would increase fruit/vegetable purchases by families participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Six stores were randomly assigned to choice architecture intervention or control. Store-level WIC sales data were provided by the state. Primary outcomes were WIC fruit/vegetable voucher and non-fruit/vegetable voucher sales, comparing trends from baseline (December 2012-October 2013) with the five-month intervention period (December 2013-April 2014). Secondary outcomes were differences in customer self-reported fruit/vegetable purchases between baseline and end of the intervention. Chelsea, MA, USA, a low-income urban community. Adult customers (n 575) completing store exit interviews. During baseline, WIC fruit/vegetable and non-fruit/vegetable sales decreased in both intervention and control stores by $US 16/month. During the intervention period, WIC fruit/vegetable sales increased in intervention stores by $US 40/month but decreased in control stores by $US 23/month (difference in trends: $US 63/month; 95 % CI 4, 121 $US/month; P=0·036); WIC non-fruit/vegetable sales were not different (P=0·45). Comparing baseline and intervention-period exit interview responses by customers participating in WIC (n 134), intervention store customers reported increased fruit/vegetable purchases compared with control store customers (18 v. -2 %), but this did not achieve statistical significance (P=0·11). Placement of fruits/vegetables near the front of corner stores increased purchase of produce by customers using WIC. New policies that incentivize stores to stock and prominently display good-quality produce could promote healthier food choices of low-income families.

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants faced unprecedented challenges during the coronavirus disease 2019 (COVID-19) pandemic including financial concerns, a national infant formula shortage, and rising food costs. To mitigate these challenges, the United States Department of Agriculture implemented WIC program waivers and flexibilities aiming to simplify program operations (e.g., remote appointments and food package substitutions). However, little is known about WIC participants’ perceptions of these changes and their impact on in-store benefit redemption. As such, this study aimed to characterize how pandemic-related events impacted Delaware WIC participants’ shopping experiences and program perceptions. The authors conducted semi-structured interviews with 51 WIC participants in Wilmington, Delaware. Survey measures included demographic questions, the Hunger Vital Sign, and open-ended questions regarding WIC program participation experiences during the pandemic. Data were analyzed using a hybrid inductive and deductive coding approach. The results demonstrate that WIC participants benefitted from the pandemic program’s flexibilities. However, they continued to experience burdensome shopping trips as well as concerns about their ability to feed their families due to infant formula shortages and inflation. These findings indicate the importance of extending existing WIC flexibilities and providing continued support for both participants and WIC-authorized retailors.

Native American populations experience highly disproportionate rates of poor maternal-child health outcomes. The WIC program aims to safeguard health by providing greater access to nutritious foods, but for reasons not well understood, participation in many tribally-administered WIC programs has declined to a greater extent compared to the national average decline in participation over the last decade. This study aims to examine influences on WIC participation from a systems perspective in two tribally-administered WIC programs. In-depth interviews were conducted with WIC-eligible individuals, WIC staff, tribal administrators, and store owners. Interview transcripts underwent qualitative coding, followed by identifying causal relationships between codes and iterative refining of relationships using Kumu. Two community-specific causal loop diagrams (CLDs) were developed and compared. Findings from interviews in the Midwest yielded a total of 22 factors connected through 5 feedback loops, and in the Southwest a total of 26 factors connected through 7 feedback loops, resulting in three overlapping themes: Reservation and Food Store Infrastructure, WIC Staff Interactions and Integration with the Community, and State-level Administration and Bureaucracy. This study demonstrates the value of a systems approach to explore interconnected barriers and facilitators that can inform future strategies and mitigate declines in WIC participation.

In 2009, the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began to provide participants with cash-value vouchers to purchase fruits and vegetables ($US 10 for women and $US 6 for children per month). The present paper assesses the potential effects of the new WIC incentives on fruit and vegetable purchases among WIC households in two New England states. A pre-post assessment of changes in fruit and vegetable purchases after the WIC revisions in generalized estimating equation models. Scanner data on grocery purchases from a regional supermarket chain in New England, USA. WIC-participating households (n 2137) that regularly shopped at the chain during January-September 2009 and January-September 2010. After the WIC revisions, purchases of fresh and frozen vegetables increased in volume by 17·5 % and 27·8 %, respectively. The biggest improvements were observed for fresh fruit, an increase of 28·6 %, adding almost a kilogram of fresh fruits per household per month. WIC households spent three times more of their WIC vouchers on purchasing fresh fruits than fresh vegetables. The magnitudes of substitution effects were relatively small: between 4 % (fresh fruit) and 13 % (canned vegetables) of the amounts purchased in 2009 with non-WIC funds were replaced by purchases made using WIC vouchers in 2010. The provision of fruit and vegetable benefits in the revised WIC food packages increased overall purchases of fruits and vegetables among WIC-participating households in New England. Efforts to encourage consumption of fruits and vegetables by people receiving federal food assistance are paying off.

This study aims to describe reasons for discontinuing participation and experiences participating in the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) during the COVID-19 pandemic. We analyzed data from a cross-sectional online survey distributed to a national sample, restricted to (1) households that discontinued participating in SNAP (n = 146) or WIC (n = 149) during the pandemic and (2) households that participated in SNAP (n = 501) or WIC (n = 141) during spring 2021—approximately one year into the pandemic. We conducted thematic analyses of open-ended survey questions and descriptive statistics for Likert-scale items. Themes raised by respondents who discontinued participating in SNAP or WIC included difficulty recertifying and virus exposure concerns. Former WIC participants reported the program was not worth the effort and former SNAP participants reported failing to requalify. Respondents participating in WIC or SNAP during the pandemic mentioned transportation barriers and insufficient benefit value. WIC participants had trouble redeeming benefits in stores and SNAP participants desired improved online grocery purchasing experiences. These results suggest that enhancements to WIC and SNAP, such as expanded online purchasing options, program flexibilities, and benefit increases, can improve program participation to ensure access to critical nutrition supports, especially during emergencies.

Recent studies have assessed diet quality of low-income U.S. children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), but differences by race/ethnicity remain unknown. We assessed racial/ethnic disparities in nutrient intake from dietary sources (not supplements) among children participating in WIC, with a focus on priority nutrients and food groups for future WIC food package revisions, as described in a recent report by the National Academies of Sciences, Engineering, and Medicine (NASEM). We used data from the 2011–2014 National Health and Nutrition Examination Surveys (NHANES) and multivariable linear regression analysis to evaluate relationships between race/ethnicity and nutrient/food group intake of children participating in WIC. All data were analyzed using SAS 9.4 survey procedures, accounting for the complex survey design of the NHANES. Compared to non-Hispanic White children, Hispanic children had diets with better nutrient distribution and lower dietary energy density, while non-Hispanic Black children had diets with poorer nutrient intake. Hispanic children had higher potassium and fiber intake, and consumed more legumes, while non-Hispanic Black children had lower calcium and vitamin D intake, higher sodium intake, and lower total dairy intake, compared to non-Hispanic White children. These findings can inform WIC nutrition education messages and future food package revisions.

The Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are two of the more well-known food assistance programmes in the USA. The current study describes food consumption patterns of children aged 1-5 years living in households dually enrolled in these two programmes v. households enrolled only in WIC. Food consumption and SNAP participation were assessed using data from the 2014 Survey of Los Angeles County (LAC) WIC Participants and the Follow-Up Survey of the same households that were also SNAP beneficiaries. Telephone interviews were conducted with WIC parents regarding each child's (i.e. beneficiary's) food consumption patterns. Follow-up interviews were conducted with those who reported receiving SNAP. Multivariable regression analyses were performed to assess the relationships between food and beverage consumption and dual v. single food assistance programme participation. LAC, California. Children of WIC-enrolled households in LAC during 2014 (n 3248). This included a sub-sample of dual WIC- and SNAP-enrolled households (n 1295). Survey participants were the beneficiaries' parents. Children from dually enrolled households consumed 1·03 (P<0·05) and 1·04 (P<0·01) more servings of fruits and vegetables daily respectively, 1·07 more sugar-sweetened beverages daily (P<0·001) and ate sweets/sweetened foods 1·04 more times daily (P<0·001) than children from households participating only in WIC. Results suggest that SNAP+WIC enrolment is associated with increased consumption of both healthy foods and foods containing minimal nutritional value. Complementary nutrition education efforts across the two programmes may help beneficiaries maximize healthful food purchases with SNAP dollars.

Food Is Medicine interventions are increasingly gaining attention from policy makers, payers, and health care professionals as a promising approach to addressing diet-related chronic health conditions in the health care setting, given the increasing burden and cost of these conditions. The American Heart Association defines Food Is Medicine as the provision of healthy food such as medically tailored meals, medically tailored groceries, and produce prescriptions to treat or manage specific clinical conditions in a way that is integrated with and paid for by the health care sector. Importantly, Food Is Medicine is distinct from, yet complementary to, food and nutrition assistance programs and population-level healthy food policies and programs. In this article, we discuss the importance of this distinction and the prerequisites for successfully integrating Food Is Medicine interventions within the health care system: a standard definition of Food Is Medicine focused on medically tailored meals, medically tailored groceries, and produce prescriptions; a research base showing clinical effectiveness and cost-effectiveness; and implementation that ensures fidelity and quality.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal nutrition assistance program for low-income, food-insecure mothers and young children in the United States. Despite its intended goals, many eligible individuals forgo WIC benefits, in part due to administrative burden-defined as the complex, often frustrating processes encountered when navigating public benefit programs. In response, a range of digital interventions and policy waivers were introduced during the COVID-19 pandemic, but their effectiveness in reducing barriers remains unclear. Drawing from administrative burden theory and human-computer interaction research, this study examined user reviews of WIC smartphone apps (WIC Apps) used by local agencies. Specifically, it investigated (1) how obstacles to WIC access manifested in daily app use, (2) how user experiences shifted after the onset of the COVID-19 pandemic, and (3) how these changes were associated with app ratings. An original dataset of user reviews (Nreview=28,212) was compiled for 26 WIC Apps between 2013 and 2024. Structural topic modeling identified 8 key themes, and sentiment was examined with Robustly Optimized Bidirectional Encoder Representations From Transformers Pretraining Approach. Analyses compared topic prevalence and sentiment distributions before and after COVID-19. Mixed-effects models examined the relationship between topics, sentiment, and app ratings. Technical concerns related to account authentication and login, document upload, and app updates were among the most prevalent themes. These issues were typically expressed with negative sentiment and appeared more frequently in pre-COVID-19 reviews than in post-COVID-19 reviews. Although reliability problems (eg, outages and maintenance) persisted, post-COVID-19 reviews increasingly emphasized features that facilitated program tracking, shopping and benefit redemption, and general ease of use, which were generally described with positive sentiment. Mixed-effects analyses indicated that these post-COVID-19 topics were significantly associated with higher app ratings (program tracking: B=0.21, SE=0.06; P=.001; shopping and redemption: B=0.18, SE=0.07; P=.01; and ease of use: B=0.10, SE=0.05; P=.04), whereas pre-COVID-19 concerns were not associated with ratings (Ps>.05). When sentiment was added to the mixed-effect model, it became the dominant factor: negative sentiment was associated with lower ratings (B=-1.71, SE=0.03; P<.001), and positive sentiment was associated with higher ratings (B=1.78, SE=0.03; P<.001). After accounting for sentiment, no individual topic was significantly associated with ratings (Ps>.05), suggesting that sentiment contributed to much of the variance previously linked to topics. User-centered digital interventions, such as WIC Apps, have the potential to support WIC access and participation.