Increasing consumption of fruits and vegetables is one of the main recommendations in the Dietary Guidelines for Americans (DGA)¹. Only 32.5% of American adults meet government recommendations for fruit and 26.3% for vegetables². Policies to encourage consumption of fruits and vegetables have long shaped the agenda of public health nutrition, including through changes in public food assistance programs. One of these programs, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides a set of nutrient-dense foods, nutrition education and health care referrals to almost half of the infants born in the United States, a quarter of children age five and under, 29% of pregnant women and 26% of postpartum women. The program reached a total of almost 8.7 million people at a cost of $6.4 billion in 20133. In 2009, WIC began to provide participants with cash-value vouchers to purchase fruits and vegetables, including a monthly payment of $10 for women and $6 for children.

New WIC incentives on fruit and vegetable purchases among WIC households in two New England states, in America

The study was based on scanner data on grocery purchases from a regional supermarket chain in New England. The analysis was a comparison of all fruit and vegetable purchases among 2,137 WIC participating households before and after the WIC food package revisions, which provided new financial incentives for fruit and vegetable purchases. The pre-revision period was January-September 2009 and the postrevision was January-September 2010. Fruits and vegetables were categorized into fresh, canned, frozen, and dried varieties. The outcomes were total amounts (grams) of fruit and vegetables purchased by a WIC household in a given month, cup-equivalent servings, and dollar expenditure. Fruit and vegetable purchases were distinguished by payment type, including purchases made with WIC benefi ts, non-WIC funds, and total purchases. Average monthly net sale prices for fruit/vegetable categories were used to account for changes in prices over time. The analysis was completed using generalized estimating equation models.

Biggest improvements were observed for fresh fruit

Fruit spending accounted for about 4.6% of WIC household grocery expenditure in 2009 (before the new WIC incentives) and 6.2% in 2010 (after the new incentives). The share of vegetable spending increased accordingly from 5.4% to 6.3%. The most purchased vegetables were fresh and canned varieties, with fresh vegetables accounting for 60% of total vegetable cup-equivalent servings and expenditure. Most fruit purchases were for fresh fruits (~90%). In 2010, WIC benefi ts accounted for about a quarter of all fruit purchases among WIC households and about 10-19% of vegetable purchases.

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. An average WIC household purchased an additional 906 grams and spent $3.12 more on fresh fruits per month; more than double the increases seen for fresh vegetables.

With the exception of fresh vegetables, the amounts of fruits and vegetables purchased with non-WIC funds declined after implementation of the WIC revisions. WIC households used their new WIC fruit and vegetable benefits to pay for some of these purchases. 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.

Efforts to encourage consumption of fruit and vegetables are paying off

The provision of fruit and vegetable benefits in the WIC food packages increased overall purchases of fruit and vegetables (particularly fresh fruit) among WIC participating households in New England. Efforts to encourage consumption of fruit and vegetables by people receiving federal food assistance are paying off. If the observed improvements reflect changes in fruit and vegetable consumption among WIC participants nationwide in the United States, the effects on public health could be significant. Similar results on the effectiveness of food policy changes are available elsewhere, including the provision of financial incentives at the point of sale for purchases of fruit and vegetables by low-income households⁴. Additional efforts to encourage fruit and vegetable consumption are necessary as fruit and vegetable purchases remain relatively low.