Maternal and Child Health Journal

, Volume 21, Issue 10, pp 1874–1879 | Cite as

Effects of a 2014 Statewide Policy Change on Cash-Value Voucher Redemptions for Fruits/Vegetables Among Participants in the Supplemental Nutrition Program for Women, Infants, and Children (WIC)

  • Janice O. Okeke
  • Ruwani M. Ekanayake
  • Melissa L. Santorelli
From the Field


Purpose In 2014, the New Jersey Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began requiring WIC-authorized stores to stock at least two fresh fruits and two fresh vegetables. We aimed to evaluate the effect of this policy change on fruit and vegetable purchases among WIC-participating households and to assess variation by household access to a healthy food store such as a supermarket or large grocery store. Description Households with continuous WIC enrollment from June 2013 to May 2015 were included (n = 16,415). Participants receive monthly cash-value vouchers (CVVs) to purchase fruits and vegetables. For each household, the CVV redemption proportion was calculated for the period before and after the policy by dividing the total dollar amount redeemed by the total dollar amount issued. Complete redemption was defined as a proportion ≥90% and the change in complete redemption odds was assessed after adjusting for Supplemental Nutrition Assistance Program participation. Assessment We observed a small increase following the policy change [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.04–1.17]; however, the effect varied by healthy food access (p = 0.03). The odds increased for households with access to at least one healthy food store (OR 1.13, 95% CI 1.06–1.20) while no effect was observed for households without such access (OR 0.91, 95% CI 0.76–1.10). Conclusion Policy change was associated with a small increase in purchasing, but only among households with healthy food access. The state is addressing this gap through technical assistance interventions targeting WIC-authorized small stores in communities with limited access.


Nutrition policy Fruits Vegetables Food Public assistance 



The authors gratefully acknowledge the New Jersey Department of Health’s Women, Infants, and Children (WIC) Services Unit for their support in providing the data necessary for statistical analysis. We would also like to thank The Food Trust for the evaluation findings they provided. The first author was funded by a fellowship appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists and funded by the Centers for Disease Control and Prevention Cooperative Agreement Number 1U38OT000143-03. The second author was fully funded by the Centers for Disease Control and Prevention under Cooperative Agreement Number CDC-RFA-DP13-1305. The third author is funded by the New Jersey Department of Health and the Centers for Disease Control and Prevention under Cooperative Agreement Numbers NU58DP004822-03-01 and NU58DP003931-04-00. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the New Jersey Department of Health, the United States Department of Health and Human Services, the Centers for Disease Control and Prevention, or the Council of State and Territorial Epidemiologists.

Supplementary material

10995_2017_2339_MOESM1_ESM.pdf (82 kb)
Supplementary material 1 (PDF 81 KB)


  1. Andreyeva, T., & Luedicke, J. (2015). Incentivizing fruit and vegetable purchases among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children. Public Health Nutrition, 18(1), 33–41.CrossRefPubMedGoogle Scholar
  2. Cowie, C. C., & Eberhardt, M. S. (1995). Sociodemographic characteristics of persons with diabetes. In Diabetes in America (2nd ed., pp. 85–116). Bethesda: National Diabetes Data Group of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.Google Scholar
  3. Epstein, L., Gordy, C., Raynor, H., Beddome, M., Kilanowski, C., & Paluch, R. (2001). Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity. Obesity Research, 9(3), 171–178.CrossRefPubMedGoogle Scholar
  4. Ford, E. S., & Mokdad A. H. (2001). Fruit and vegetable consumption and diabetes mellitus incidence among U.S. adults. Preventive Medicine, 32(1), 33–39.CrossRefPubMedGoogle Scholar
  5. Grimm, K. A., Moore, L. V., & Scanlon, K. S. (2013). Access to healthier food retailers—United States, 2011. Morbidity and Mortality Weekly Report (MMWR), 62, 20–26.Google Scholar
  6. He, K., Hu, F., Colditz, G., Manson, J., Willett, W., & Liu, S. (2004). Changes in intake of fruits and vegetables in relation to risk of obesity and weight gain among middle-aged women. International Journal of Obesity, 28, 1569–1574.CrossRefPubMedGoogle Scholar
  7. Hung, H., Joshipura, K., Jiang, R., Hu, F., Hunter, D., Smith-Warner, S., et al. (2004). Fruit and vegetable intake and risk of major chronic disease. Journal of the National Cancer Institute, 96(21), 1577–1584.CrossRefPubMedGoogle Scholar
  8. Lin, B. -H., & Morrison, R. M. (2012). Food and Nutrient Intake Data: Taking a look at the nutritional quality of foods eaten at home and away from home. Washington: United States Department of Agriculture Economic Research Service.Google Scholar
  9. Maty, S. C., Everson-Rose, S. A., Haan, M. N., Raghunathan, T. E., & Kaplan, G. A. (2005). Education, income, occupation, and the 34-year incidence (1965–99) of Type 2 diabetes in Alameda County Study. International Journal of Epidemiology, 34, 1274–1281.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Parsons, T., Power, C., Logan, S., & Summerbell, C. (1999). Childhood predictors of adult obesity: A systematic review. International of Obesity Related Metabolic Disorders, 23(8), S1–107.Google Scholar
  11. Rogers, R., Eagle, T., Sheetz, A., Woodward, A., Leibowitz, R., Song, M., et al. (2015). The relationship between childhood obesity, low socioeconomic status, and race/ethnicity: Lessons from Massachusetts. Childhood Obesity, 11(6), 1–5.CrossRefGoogle Scholar
  12. Scheirer Consulting, Paragon Applied Research and Evaluation, The Food Trust, and Robert Wood Johnson Foundation. (2014). Report of findings from post-training survey of store personnel after WIC training by The Food Trust. Unpublished report.Google Scholar
  13. Sharkey, J. R., Horel, S., & Han, D. H. (2009). Association between neighborhood need and spatial access to food stores and fast food restaurants in neighborhoods of Colonias. International Journal of Health Geographics, 8, 9.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Wang Y. (2001). Cross-national comparison of childhood obesity: The epidemic and the relationship between obesity and socioeconomic status. International Journal of Epidemiology, 30(5), 1129–1136.CrossRefPubMedGoogle Scholar
  15. Wedick, N., Ma, Y., Olendzki, B. C., Procter-Gray, E., Cheng, J., Kane, K. J., et al. (2015). Access to healthy food stores modifies effect of a dietary intervention. American Journal of Preventive Medicine, 48(3), 309–317.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Janice O. Okeke
    • 1
    • 2
  • Ruwani M. Ekanayake
    • 1
  • Melissa L. Santorelli
    • 1
  1. 1.Community Health and Wellness UnitNew Jersey Department of HealthTrentonUSA
  2. 2.Centers for Disease Control and Prevention (CDC)/Council of State and Territorial Epidemiologists (CSTE) Applied Epidemiology FellowshipAtlantaUSA

Personalised recommendations