“Choices Made by Low-Income Women Provided with an Economic Supplement for Fresh Fruit and Vegetable Purchase”

In 2001, two academics from the University of California at Los Angeles, and the executive director of the Public Health Foundation Enterprices WIC Program undertook a fascinating study – “Choices Made by Low-Income Women Provided with an Economic Supplement for Fresh Fruit and Vegetable Purchase” (Journal of the American Dietetic Association).

INTRODUCTION

The nutritional problems driving their exploration were statistics that revealed the low fruit and vegetable intake among U.S. citizens as a whole; the stagnation (between 1989 and 2000) of fruit and vegetable servings per day among individuals over the age of two; and the lower consumption rates of fruits and vegetable rates among the less affluent and educated.

RESEARCH DESIGN

Their research design examined the later demographic, and a group of 602 low-income women in suburban Los Angeles enrolled to take part at several WIC offices.  According to the study’s methodology, “The study sites (two intervention and one control) were selected based on similarity with regard to caseload, distribution of ethnic backgrounds of participants, and geographic proximity of supermarkets, grocery stores, and farmers’ markets.”  The WIC sites were, for example, within walking distance of a farmers market . . . which they established as being no more than 1/2 mile away.  Three-fourths of the 602 original participants completed the study from start to finish.  No nutritional education was provided over the six month study.

The researchers collected data about each participant’s race, the types of vegetable purchased, the redemption rates (or the percent of vouchers – $10/wk – that were used).

RESULTS

Slightly more vouchers were requested for farmers markets ($44,960) than were for supermarkets ($44,000).  Redemption rates were 90.7% and 87.5% for the farmers’ market and supermarkets, respectively – again higher for those who chose to spend vouchers at farmers markets.  There was little difference in the total varieties of different fruits and vegetables between the two shopping locations.  But one of the interesting findings was that “A larger number of item purchases were reported for the farmers’ market condition (29% more fruits and 25% more vegetables).”

And of the nearly 10% of dollars distributed that went unspent, participants who were interviewed explained that they still intended to put the rest of the money to good use before receiving the next voucher.

DATA ANALYSIS

This last finding indicates the outstanding use for more fresh produce among this population.  With the exception of two vegetables, the report found that all of the different types of vegetables were high in nutrients deemed important by the WIC program.  Not only was this population of low-income women making efficient use of the economic supplement . . . they were channeling it into nutritional forms deemed a priority for this population.  As the authors put it, “The very high redemption rates for coupons in this study lead us to conclude that a fresh produce subsidy would be approximately fully used, at least at levels up to that provided in this study.”

They close the article with this plan of action, or recommendation for professional dieticians:

“…Capitalize on the ability of WIC participants to choose fresh produce and can encourage them to include it not only in their own daily diets, but also in those of other family members.”

I believe this was a particularly innovative program because the intention was to provide the target population with a larger WIC voucher for fruits and vegetables than is currently being considered by policymakers.  Currently women in suburban Los Angeles receive between $56.14 and $76.62 per month depending on breastfeeding status.

In this study, $40 in vouchers was distributed each month solely to be used for fresh fruit and vegetables.  Although there was little reporting on how much of the produce purchased by vouchers was utilized, and how much spoiled before preparation, the researchers were able to push the bar upwards.  They showed a target population that was not overwhelmed by good chow.  Instead they searched it out, and took full (~90% between farmers market and supermarket sites) advantage of it!

And now, for a little fun: check out what happens when you surround good kids with a tribe of elders and a good food environment to grow up in!

A Better Way

Community nutrition is a pathway for professionals seeking to improve the nutritional status and health of society from different angles.

As described in Community Nutrition in Action, practitioners assist in the development of people (individual diets), policy, and programs.  Community nutritionists impact people through the application of science-based, dietetic advice (a form of primary prevention) that is often provided to individuals at fitness centers, worksites and day care centers.  They collaborate with policymakers to produce policy documents, laws, and regulation that address the issues that affect citizens at the local (e.g. public policies that affect gleaning activities and community garden sites), state, national (e.g. the Health People publication and the SNAP program) and international (e.g. the World Health Organization’s policies related to sustainable development that relate to the health of people) levels.  And they have the initiative to propel programs that may focus on certain population demographics or food related issues of concern to society, such as cardiovascular disease.

People in the field of community nutrition perform a function that is strikingly similar to a process employed by land managers.  A rancher, for example, may always have an eye at soil level observing the impact of her/his cattle’s hooves and the time it takes for their forage to rejuvenate when subjected to different seasons or grazing strategies.  

What may strike some as a romantic fondness for life, or a futile curiosity, may actually be used to develop a productive system of management.  To my mind, there’s a sense that true progress follows adaptations that are made after observing the patterns of nature.

And so it is with the nutritionist who edits their practices after analyzing the scientific literature or the results of surveys they’ve conducted.

Whether making a determination on how a patient’s newly adopted lifestyle produces the desired result (or not), or measuring participation in a new policy that has created farmers market currency for WIC clients, the process of evaluation is integral to the improvement of health among the population being studied.  In three areas noted above (people, policy, and programs), the challenging work of designing methods for assessing successes and pitfalls allows nutritionists to keep their communities moving forward.

In this manner, mistakes can be identified and transmitted to colleagues so that the complex web of interactions each community nutritionist must interpret – heredity, the food environment, societal inequity, etc. – becomes ever clearer.  This is a good thing.  Because the role of nutritionists is to perform miracles through the marketing of healthy lifestyles in the public and/or private sectors.  To put it simply, they are responsible for communicating a better way.