ABSTRACT
Background: Emergency changes to food assistance programs can prevent widening nutrition disparities during societal shocks such as pandemics. Understanding whether and how COVID altered the nutritional quality of food assistance program participant food purchases can inform future emergency food response policies. We described the relationship between the shock of COVID and Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) participant food purchases. Methods: We used a longitudinal dataset from October 2019 to December 2020 of transaction data from a large grocery store chain with 496 stores in North Carolina. This dataset includes all items purchased and payment type(s) used in transactions. WIC participants were identified by using WIC as a payment type. Our sample includes >1.2 million shopper-month observations from 187,005 unique WIC shoppers. We grouped food items into nutritionally relevant food groups. We used fixed effects models adjusted for time-varying covariates with a variable for pre/post March 2020 interacted with a linear time trend. We used robust standard errors. Outcomes were calories/shopper/day and share (%) of total calories purchased from each food group. Results: Among WIC shoppers, mean calories per day from fruits, vegetables, nuts and legumes (FVNL) were higher after March 2020 (+7.2 kcal/day);however, the share of total calories purchased from FVNL decreased (-0.6%) (both p<0.01). Similar trends were observed for FVNL without added salt, sugar, or fat. Mean calories per day from sugar-sweetened beverages (SSB) were higher after March 2020 (+37.4 kcal/day), as was the share of total calories purchased from SSBs (+0.5%) (both p<0.01). The calories per day from junk foods increased after March 2020 (+60.1 kcal/day, p<0.01) and the share of total calories from junk foods remained stable at about 25% of total calories purchased. Conclusions: Understanding how purchasing patterns shift during societal shocks is important in designing emergency food policies that reduce existing diet-related disease disparities. Emergency food policies that support nutrient-dense food groups may be particularly needed under these conditions.
ABSTRACT
Background: Addressing disparities in fruit and vegetable (FV) consumption in childhood is important for chronic disease prevention. During COVID, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) increased the Cash Value Benefit (CVB) for FV by ~$25/person/month. Our objectives were to understand barriers and facilitators to participants' uptake of this policy change and whether and how it influenced WIC households' FV consumption. Methods: We conducted 10 virtual focus groups with WIC participants (n=56) in North Carolina in March 2022. Sampled participants represented two subgroups: (1) rural WIC participants (5 focus groups) (2) urban/suburban (5 focus groups). We used a semi-structured focus group guide to assess perceptions and awareness of the CVB change, barriers to using CVB, and perceived influence of the CVB change on FV consumption. Focus groups were recorded, transcribed, and open-coded. We used thematic analysis informed by social constructionist grounded theory to uncover consistencies within and between sampled groups. Results: Participants expressed favorable perceptions of the CVB increase and felt CVB was one of the most valued parts of the WIC food package. Participants stated the pre-COVID CVB amount was insufficient. Barriers to utilizing the increased CVB were finding WIC-eligible FV in stores, insufficient supply of appealing FV, and preferred stores for FV not accepting WIC. Facilitators were household preferences for FV and the variety of FV that can be purchased with the CVB. Many participants felt the CVB increase allowed them and their children to eat a wider variety of FV, serve FV more often, and worry less about food waste associated with trying new FV. Conclusions: The CVB increase was positively perceived by WIC participants in North Carolina and may reduce FV intake disparities, but barriers to CVB and WIC benefit utilization must be addressed. This study can inform future efforts to improve the WIC food package and access to FV.