Income and Voucher Provision

Greater consumption of fruit and vegetable intake is associated with reduced risk of cancer1,2, , stroke, and perhaps other cardiovascular diseases3. Given this evidence, why is it that consumption of produce is often lower than recommended, particularly among low-income individuals?

The WIC Program and its Contribution to Dietary Quality

In the United States, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a governmentally funded, locally administered public health program that provides supplemental foods of high nutritional quality, nutrition education, and referrals to health care for low-income and nutritionally at-risk women during pregnancy and the postpartum period and to their infants and young children up to the age of five years4. When the program was first implemented, undernutrition was the predominant concern. Legislation directed the program to focus on providing foods that were good sources of calcium, iron, vitamin A, vitamin C, and protein primarily through energy-dense sources including milk, cheese, eggs, infant formula, fortified cheeses, fruit juice, peanut butter and dry beans5. Over the last several years there has been considerable discussion of the possibility of adding fresh fruits and vegetables to the WIC food packages for women and children, given the evidence of their value in the construction of optimal diets6.

Increasing Economic Access to Fresh Fruits and Vegetables

In August 2001, 602 postpartum, WIC-participant, women and their families were recruited to participate in two interventions and one control (200 per site) designed to measure the effectiveness of providing vouchers to increase the consumption of fresh fruits and vegetables. Participants were issued $10.00 (U.S.) worth of vouchers per week to buy produce of the participant’s choice at either a supermarket or farmer’s market. Vouchers were issued bimonthly and could be spent over the ensuing 2-month period at any time. The intervention participants received these coupons for six months for a total of $240.00 (U.S.) per participant (family). At the control site, no fruit and vegetable subsidy was given but participants received a lesser-value set of vouchers to redeem disposable diapers.

Participants’ consumption of fruits and vegetables was tracked over the 14-month time period of the study, monitoring intake both before and after the intervention and in comparison to the community control. Participants were asked what they bought with the fruit and vegetable vouchers they received and voucher redemption rates were tracked.

Participant Purchases Reflected Good Nutritional
Choices and a Wide Variety of Fresh Produce

In all, $44,000 (U.S.) of vouchers were issued for the supermarket and $44,960 (U.S.) for the farmer’s market. Redemption rates were 90.7% for the farmer’s market and 87.5% for the supermarket. Five fruits and vegetables accounted for approximately 70% of the items reported for each group. The ten most frequently reported items were oranges, apples, bananas, peaches, grapes, tomatoes, carrots, lettuce, broccoli, and potatoes. However, participants also purchased a wide variety of items including blueberries, pomegranates, artichokes, and mustard greens showing a full range of seasonal variation in purchase patterns. While a larger number of items was reported in the farmers market condition the total number of types of fruits and vegetables did not differ between the two conditions7.

Conclusion

Low-income consumers make wise, varied, and nutritious choices from available produce when presented with an economic supplement. With the exception of lettuce and grapes, all of the most frequently purchased items were significant sources of potassium, vitamin C, vitamin A, and/or dietary fiber – food components determined to be of high priority in revising WIC food packages by a recent Institute of Medicine study6. The potential for dietary improvement for low-income women and their families when provided with a targeted subsidy that allows free choice within the fresh produce category is significant.