Effects of a 2014 policy change on cash value voucher redemptions for fruits/vegetables among participants in the New Jersey Special Supplemental Nutrition Program for Women, Infants, and Children

BACKGROUND:  Multiple research studies have observed associations between a lack of access to nutritious food choices and increased susceptibility to chronic disease risk factors.  However, the actual effects of living in an underserved area on healthy food access are largely unknown. Understanding these associations are essential to informing public health programs that strive to improve nutrition, particularly among underserved populations.  This study assessed the effect of living in an underserved area on fruit and vegetable (F&V) purchases among New Jersey WIC households.  Additionally we evaluated a 2014 New Jersey WIC policy, mandating all WIC-authorized vendors stock a minimum of two fruits and two vegetables, to determine whether this policy change resulted in an increase in F&V purchases among New Jersey WIC households.

METHODS:  An underserved area was defined, using CDC’s Modified Retail Food Environment Index (mRFEI), as a census tract with no healthy food retailers (supermarket, larger grocery store, supercenter, or produce store).  F&V purchases were measured using cash value vouchers (CVVs), a monthly check WIC participants use to purchase F&Vs.  Logistic regression was used to assess the association between living in an underserved area and complete CVV redemption, which was defined as a redemption proportion ≥90%.  We also analyzed changes in complete CVV redemption among WIC households in relation to the 2014 policy change using a conditional logistic regression model.

RESULTS:  Prior to the policy change, the odds of complete CVV redemption for F&Vs was 30% lower for WIC households in areas with no healthy food retailer relative to those in areas with at least one healthy food retailer (p<0.0001).  There was a 10% increase in the odds of complete CVV redemption after the WIC policy change for WIC households living in a New Jersey census tract with at least one healthy food retailer (OR:  1.1, 95% CI:  1.0-1.2), while no detectable difference was observed among WIC households in underserved areas (OR:  0.9, 95% CI:  0.8-1.1).

CONCLUSIONS:  The odds of complete CVV redemption were significantly lower for WIC households in underserved areas.  Additionally, the statewide policy did not have a significant impact on complete CVV redemption for F&Vs among WIC households in these areas.  Our study shows that Public health policy alone may not be sufficient to increase healthy food access in underserved areas.  New Jersey is already addressing this through technical assistance interventions targeting WIC-authorized small stores in communities without access to healthy food retailers.