The rapid increase in overweight and obesity in the United States over the past several decades, particularly among children, has prompted discussions about the role of public policy in addressing this rising epidemic. Although the causes of obesity are clearly multifactorial, unhealthful dietary patterns have caused many of these discussions to focus on modifying or developing food and nutrition policy to ensure adequate access to healthy foods. Consistent with these efforts, USDA’s Food and Nutrition Service (FNS) published a final interim rule that would revise regulations governing the food packages provided in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on December 6, 2007. WIC is one of the largest food assistance programs in the United States, with expenditures exceeded only by the Supplemental Nutrition Assistance Program (formerly the Food Stamp Program) and National School Lunch Program. WIC serves over 8 million women, infants and children, with an estimated one-half of all infants and one-quarter of all U.S. children 1-4 years of age participating in the program.
A noteworthy revision is the addition of cash vouchers to the food packages of women and children to purchase fresh fruits ($8 per month) and vegetables ($6 per month) that can be redeemed at participating retailers, or “WIC vendors.” While WIC participants receive a variety of benefits, supplemental foods are viewed as an important aspect of the benefit package and constitute a significant portion (about 73 percent) of WIC program costs. Despite overwhelming support from WIC stakeholders regarding the addition of a fruit and vegetable benefit, several concerns have been raised related to vendor burden, including the potential need for vendors to purchase additional equipment, obtain a new business license, and receive training in special handling of fresh produce. Other concerns center on limitations in participant access, particularly for those living in areas with scarce produce, higher fruit and vegetable costs, or inadequate selection. These concerns could impact the number of vendors that participate in the program and the type and amount of fruits and vegetables available, thus limiting the benefits of this important policy for particular subgroups of the WIC population.
In preparation for the proposed policy, this study examined current neighborhood WIC vendor access and fruit and vegetable availability in selected areas in northern Illinois. Specific aims were to (1) describe current availability, selection, price, and quality of fruits and vegetables offered by WIC authorized vendors in selected areas in northern Illinois, (2) examine variations in WIC vendor and fruit and vegetable access by neighborhood characteristics, including geographic (percentage rural), racial/ethnic (percentage African-American), and socioeconomic (percentage in poverty), and (3) understand factors that influence fruit and vegetable availability, selection, price, and quality from the perspective of retailers participating in the WIC program.
Current fruit and vegetable characteristics were assessed at 338 authorized WIC vendors across a 7-county area in northern Illinois. WIC vendor assessments were conducted using an in-person audit tool adapted from prior work that evaluates the availability of 150 commonly consumed and culturally specific fresh, frozen, and canned fruits and vegetables, as well as the price of 26 and quality of 10 of these items. To determine variations in WIC vendor and fruit and vegetable access by neighborhood characteristics, data on neighborhood attributes in the study area were obtained from the 2000 Census (percentage race, poverty, and urban). Vendors were classified by type and size and addresses were matched to a location-indexed street file using geographic information system (GIS) software. Descriptive statistics, Chi-square, and logistic regression were used in data analysis.
Of the 338 authorized WIC vendors in the sample, 120 were classified as pharmacies, 115 national/regional chain supermarkets, and 109 small chain/independent grocery stores. Consistent with previous neighborhood food environment studies, larger national/regional chain supermarkets were less likely to be located in predominately minority versus non-Hispanic White neighborhoods and high-poverty versus low-poverty neighborhoods. No relationships were found between neighborhood characteristics and other vendor types. As expected, national and regional chain supermarkets had the greatest availability of fresh or frozen fruits and vegetables and pharmacies had the lowest availability. None of the pharmacies in the study area supplied fresh fruits or vegetables, and only about 2.3 percent carried frozen selections.
Availability of fresh fruits and vegetables was positively correlated with the percentage of neighborhood residents with a college degree and households earning over $75,000 and negatively associated with the percentage in poverty or unemployment and residents without access to a car. The availability of canned fruits and vegetables did not differ by vendor type. However, chain supermarkets and vendors in predominately non-Hispanic White neighborhoods were more likely to supply canned fruits and vegetables without added salt, sugar, or fat than small chain/independent grocery stores, pharmacies, and vendors in predominately minority neighborhoods. Preliminary analysis revealed limited differences in price across different vendor and neighborhood types; however, indepth analyses of fruit and vegetable price and quality were incomplete. Similar to previous studies, these findings suggest that vendors provide less access to fresh fruits and vegetables and canned fruits and vegetables without added salt, sugar, or fat in minority and high-poverty neighborhoods than in non-Hispanic White and more affluent neighborhoods. Small/independent grocery stores, pharmacies, and WIC vendors in minority communities may need more support to expand their availability of fruits and vegetables to meet the needs of WIC participants.
Direct inquiries about this study to the Project Contact listed above.