The Evaluation of Fruit & Vegetable Incentive Programs on Childhood Obesity Prevalence in the Special Supplemental Nutrition Program for Women, Infants and Children

Author: ORCID icon
Constantoulakis, Leeza, Nursing - Graduate School of Arts and Sciences, University of Virginia
Siega-Riz, Anna Maria, NR-Nursing: Faculty, University of Virginia

Childhood obesity remains a significant public health crisis. One way to combat obesity is through diet, in particular one rich in fruits and vegetables. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has two incentive programs that help increase access to fruits and vegetables for participants, which could help mitigate obesity. Those programs include the Farmers Market Nutrition Program (FMNP) and the Cash Value Voucher (CVV) program.
This research evaluated associations of childhood obesity prevalence with county and state level factors related to farmers markets, food access and the WIC program. Additional associations between state factors and state’s participation in the FMNP were investigated. Further analysis explored the effect of the CVV on childhood obesity prevalence in states with and without the FMNP, and barriers and challenges within the FMNP from the lens of program administrators.
Data were extracted from the United States Department of Agriculture Food Environment Atlas, WIC Funding reports and WIC Program Characteristics. Qualitative data collection included a semi-structured guide administered to FMNP stakeholders in participating states. Analysis revealed mixed results across state associations with farmers markets and products sold, with only six states having significant associations. Regression analysis found farmers markets accepting WIC, percent of WIC redemption and number of grocery stores at the county level to be significantly associated with childhood obesity prevalence. At the state level, only participation in the FMNP was significantly associated with childhood obesity prevalence. Exploring state factors associated with participation in the FMNP, only childhood obesity prevalence proved to be a significant correlate. A difference-in-difference analysis showed no effect of the CVV on childhood obesity prevalence in states with the FMNP compared to states not participating. Finally, analysis from stakeholders revealed six themes of challenges and barriers perceived to be affecting success of the FMNP program: policy limitations, coupon logistics, market factors, competition, farmer challenges, and participant challenges.
In conclusion, this research found mixed results among farmers markets and sales to childhood obesity prevalence in states, no consistent county and state level associations with childhood obesity prevalence, the CVV did not have an effect on childhood obesity prevalence, and the FMNP has significant barriers hindering success of the voucher program. Future research should incorporate longitudinal studies to understand the effects of WIC program’s on child obesity prevalence and continue to rigorously evaluate the ability of federal programs to address health outcomes. These findings should be used to promote future work to improve programmatic aspects that may help alleviate childhood obesity prevalence.

PHD (Doctor of Philosophy)
Childhood obesity, Farmers markets, WIC, FMNP, CVV
All rights reserved (no additional license for public reuse)
Issued Date: