N° 71 | October 2012

Positive Influence of the Revised WIC Food Packages on Access to Healthy Foods

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The New WIC Packages

The Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides healthy foods (via WIC food packages), nutrition education, and medical referrals to approximately 50% of all infants born in the United States, 25% of American children under five years of age, 29% of pregnant women and 26% of postpartum women in the US. Because of its broad reach and targeted impact on young high-risk children, WIC has considerable potential for early intervention to prevent excessive weight gain in low-income children.

Following recommendations from the Institute of Medicine, the United States Department of Agriculture recently revised WIC food packages to offer foods that better reflect dietary recommendations and promote healthy weight in WIC participants. The main changes included the provision of cashvalue vouchers for fruits and vegetables, new whole grain products, lower fat content of dairy foods, and reduced juice quantities. The revisions reflected the most significant WIC package change since the program’s inception in 1972. It has also provided a unique natural experiment to assess the ability of food assistance policy to improve diet quality in low-income children.

Connecticut Study of WIC Revisions Impact on
Access to Healthy Foods

There is substantial policy interest in how the WIC package revisions influenced access to healthy foods in low-income populations. This study was designed to measure the impact of the revised WIC packages on the provision of healthy foods in convenience and grocery stores in the state of Connecticut, US. The study included all food stores from five Connecticut towns that were selected to represent communities of diverse income and food store densities.

A systematic inventory of 252 non-chain grocery and convenience stores was completed before and after implementation of the WIC package revisions (spring 2009 and spring 2010). Trained raters used a standardized inventory tool to assess food availability, price, variety, and produce quality. The list of 65 products included cow’s milk, fresh/canned/frozen fruit and vegetables, juice, bread, cereal, baby foods, tofu, soy milk, rice, eggs, peanut butter, dry beans, cheese, and canned fish. Changes in food availability, variety, prices and quality were summarized in a composite score of the healthy food supply. It was heavily weighed to reflect availability and variety of whole grains, fruits and vegetables. Fresh fruit and vegetables were weighed greater than frozen and canned fruit and vegetables because lack of produce, not canned vegetables, is a common problem in convenience stores.

Estimating the Effects of the WIC Package Revisions

The effect of the WIC food package revisions was measured by differential changes in the scores for WIC stores and stores not participating in WIC, including differences by neighborhood income. A three-level linear random intercept model was estimated to assess the effect of the WIC revisions on healthy food supply scores. The model controlled for store size, participation in the Supplemental Nutrition Assistance Program (SNAP) and WIC, and the food environment surrounding each store, including supermarket proximity, population density, census tract household income, and competition among food stores and fast food outlets in the area.

Significant Improvements in Access to Healthy
Foods duet to the WIC Revisions

In the state of Connecticut, the implementation of the revised WIC food packages led to a significant increase in the provision of healthy foods, such as whole grain products and fruit and vegetables, in WIC-approved stores but also non-WIC stores. The increase in the composite score of healthy food supply varied from 16% in WIC stores in higher-income neighborhoods to 39% in lower-income areas. Better improvement in underserved communities is a welcome change that might reduce disparities in food access across communities. While many of the assessed healthy foods (including fresh fruits and vegetables) had better availability following the WIC revisions, the most substantial gains were for whole grain products.

One of the beneficial consequences of the WIC food package revisions was improved access to new WIC foods in supply chains for all stores. The change occurred shortly after the new WIC policy took effect (6-7 months after implementation) suggesting that WIC stores have found ways to deliver new healthy foods when they were required to do so. If the experience in Connecticut is typical of other states, national food policy that promotes consumption of healthy foods, but also requires changes in stores, can help to improve local food environments for program participants and non-participants alike. This can occur at no additional cost to taxpayers as the WIC food package revisions were designed to be cost-neutral.

Andreyeva T, Luedicke J, Middleton AE, Long MW, Schwartz MB. Positive influence of the revised Special Supplemental Nutrition Program for Women, Infants and Children food packages on access to healthy foods. Journal of the Academy of Nutrition and Dietetics 2012: 112:850-858.

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