Caregivers' Perceived Impact of WIC's Temporary Cash-Value Benefit (CVB) Increases on Fruit and Vegetable Purchasing, Consumption, and Access in Massachusetts.

Responding to the COVID-19 pandemic, the American Rescue Plan (2021) allowed state agencies of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) the option of temporarily increasing the Cash-Value Benefit (CVB) for fruit and vegetable (FV) purchases. To examine the impact of this enhancement on WIC caregiver experience, the MA WIC State Office invited 4600 randomly selected MA WIC caregivers to complete an online survey (February-March 2022). Eligible adults had at least one child, had been enrolled at least a year, and were aware of the increase. Of those who opened the screener (n = 545), 58.9% completed it (n = 321). We calculated the frequencies of reporting increased FV outcomes and tested whether responses differed by race/ethnicity, market access, and food security. Most caregivers perceived the CVB increase to benefit FV purchasing (amount and quality, 71.0% and 55.5%), FV consumption (offered to children and personally consumed, 70.1% and 63.2%), and satisfaction with the WIC food package (37.1% reported improved satisfaction, pre- vs. post-increase). Probability of reporting improved outcomes was not found to differ by race/ethnicity, market access, or food security. CVB increases may pose important implications for dietary behaviors and satisfaction with WIC. Policymakers should consider making this increase permanent.

Changes in frequency of park/playground utilization among children aged 4-59 months in Los Angeles County, California 2008-2020.

Child physical activity and play are critical for healthy development, and parks/playgrounds are important public spaces that provide physical activity/play opportunities. This study was conducted to assess changes in park/playground utilization by Special Supplemental Nutrition Program for Women, Infants and Children (WIC)-participating children from 2008 to 2020, and whether the COVID-19 pandemic was associated with lower park/playground utilization and racial/ethnic disparities in park/playground utilization. Cross-sectional data from the 2008-2020 triennial Los Angeles County WIC Survey (n = 21,886) were used, and analyses stratified by child age (4-23 months, 24-59 months). Odds ratios (OR) and 95 % confidence intervals (CI) for the relationship between year and park/playground utilization frequency were determined from multinomial logistic regression, and racial/ethnic disparities were assessed by interacting year with race/ethnicity. Among children 24-59 months of age, park/playground utilization increased compared to never from 2011 to 2017 compared to 2008 (Every day, 2011-2017: OR [95 % CI]: 2.69 [1.93, 3.75], 4.71 [3.23, 6.86], 10.20 [6.91, 15.06]; 3-6 days/week 2011-2017: 1.54 [1.13, 2.10], 3.11 [2.18, 4.45], 3.94 [2.71, 5.72]; 1-2 days/week, 2014-2017; 1.53 [1.08, 2.18], 1.63 [1.13, 2.37]). Associations reversed in 2020, with 36 % lower odds of every day (OR [95 % CI]: 0.64 [0.48, 0.85]), 85 % lower odds of 3-6 days/week (0.15 [0.11, 0.20]) and 89 % lower odds of 1-2 days/week (0.11 [0.09, 0.15]) park/playground utilization compared to never than in 2008. Park/playground utilization frequency increased from 2008 to 2017, but progress reversed during the COVID-19 pandemic in 2020. Results for children ages 4-23 months were similar. Future public health restrictions to public recreation facilities should consider realistic limitations to potential benefits and the potential for unintended consequences before implementation.

WIC Participants' Perceptions of COVID-19-Related Changes to WIC Recertification and Service Delivery.

Many Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics implemented alternatives to in-person service delivery in response to the COVID-19 pandemic, including virtual visits and electronic document sharing. The objective of this cross-sectional study was to describe WIC participants' experiences with remote service delivery and recertification during the pandemic. Participants included mothers and infants who participated in a WIC-based intervention between June 2019-August 2020. All participants (N = 246) were invited to complete a follow-up survey between November 2020-February 2021; 185 mothers completed the survey. The survey assessed sociodemographics, employment, food security, experiences with remote WIC recertification and service delivery, and experiences with obtaining WIC foods during the pandemic. Average age for mothers was 29.2 ± 6.3 years and for infants was 17.7  ± .2 months; 80% (n = 147) identified as Hispanic. Approximately 34% (n = 62) of participants reported very low or low food security and 40% (n = 64) had difficulties buying WIC foods during the pandemic. Among participants who recalled providing documentation of income and address virtually, the majority felt comfortable providing information via email (60%) and text messaging (72%). Participants reported high levels of satisfaction with remote methods of service delivery, as well as overall satisfaction with the WIC program during the pandemic. While ~ 25% of study participants preferred for all WIC services to remain remote, 75% still desired at least some in-person contact with WIC staff after the pandemic. In conclusion, remote methods of WIC service delivery addressed existing barriers to WIC participation and were well-received by study participants.

Feasibility and Acceptability of a "Click & Collect" WIC Online Ordering Pilot.

BACKGROUND: Barriers to shopping for foods in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) have been reported. Online ordering options may improve the WIC shopping experience but are understudied. OBJECTIVE: The objective of this study was to test feasibility and acceptability of a "Click & Collect" model for WIC online ordering from the perspective of WIC participants. DESIGN: A Click & Collect online ordering model was adapted to the WIC program and implemented at 1 grocery store. In the Click & Collect model, WIC participants placed an online order ("click"), then completed payment and pickup at the store ("collect"). PARTICIPANTS/SETTING: Twenty-five WIC participants in East Tennessee were included. MAIN OUTCOME MEASURES: Feasibility was assessed by examining online order summaries and store receipts to determine whether WIC transactions were completed successfully. Acceptability was assessed by qualitative semi-structured interviews conducted with WIC participants after participating in the pilot. ANALYSES PERFORMED: Descriptive statistics were used to analyze sociodemographic and purchase data in SPSS software, version 27. Qualitative interviews were transcribed and analyzed for themes using directed content analysis in NVivo, version 12.0. RESULTS: All WIC participants in the study placed an online order, and 96% picked up the order, indicating a high degree of feasibility. In follow-up qualitative interviews, WIC participants reported interest in the Click & Collect model, and provided suggestions to improve practicality across the following 4 primary themes: website experience, curbside pickup, online shopping fee, and shopping preferences. CONCLUSIONS: The pilot was successfully implemented at 1 store. Click & Collect online ordering was feasible and acceptable to WIC participants, although additional work is needed to make it practical. Online shopping options for the WIC program should be further explored to expand access to nutritious WIC foods in families with low income.