The United States Department of Agriculture approved an increase to the Cash Value Benefit (CVB) for the purchase of fruits and vegetables issued to participants receiving an eligible Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package. In order to understand satisfaction, perceptions, and the overall impact of additional benefits for fruits and vegetables at the household level, a qualitative study consisting of structured phone interviews was conducted with families served by WIC in Southern California from November to December 2021 (n = 30). Families were selected from a large longitudinal study sample (N = 2784); the sample was restricted by benefit redemption and stratified by language and race. WIC participants were highly satisfied with the CVB increase, reporting increased purchasing and consumption of a variety of fruits and vegetables. Respondents noted the improved quality and variety of fruits and vegetables purchased due to the increased amount. Findings are expected to inform policy makers to adjust the CVB offered in the WIC food package with the potential to improve participant satisfaction and increase participation and retention of eligible families with benefits from healthy diets supported by WIC.

Objective: In 2019, California and Wilmington, Delaware implemented policies requiring healthier default beverages with restaurant kids’ meals. This study assessed restaurant beverage offerings and manager perceptions. Design: Pre-post menu observations were conducted in California and Wilmington. Observations of cashiers/servers during orders were conducted pre-post implementation in California and post-implementation in Wilmington. Changes in California were compared using multilevel logistic regression and paired t-tests. Post-implementation, managers were interviewed. Setting: Inside and drive-through ordering venues in a sample of quick-service restaurants in low-income California communities and all restaurants in Wilmington subject to the policy, the month before and 7-12 months after policy implementation. Participants: Restaurant observations (California n=110; Wilmington n=14); managers (California n=75; Wilmington n=15). Results: Pre-implementation, the most common kids’ meal beverages on California menus were unflavored milk and water (78.8%, 52.0%); in Wilmington, juice, milk, and sugar-sweetened beverages were most common (81.8%, 66.7%, 46.2%). Post-implementation, menus including only policy-consistent beverages significantly increased in California (9.7% to 66.1%, p<0.0001), but remained constant in Wilmington (30.8%). During orders, cashiers/servers offering only policy-consistent beverages significantly decreased post-implementation in California (5.0% to 1.0%, p=0.002). Few managers (California 29.3%; Wilmington 0%) reported policy knowledge, although most expressed support. Most managers wanted additional information for customers and staff. Conclusions: While the proportion of menus offering only policy-consistent kids’ meal default beverages increased in California, offerings did not change in Wilmington. In both jurisdictions managers lacked policy knowledge and few cashiers/servers offered only policy-consistent beverages. Additional efforts are needed to strengthen implementation of kids’ meal beverage policies.

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Objectives In response to the COVID-19 pandemic, the USDA announced a temporary augmentation of the cash value benefit (CVB) for vegetables and fruits across all Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) agencies nationally, increasing the child CVB from $9 to $35/month for 4 months in the summer of 2021. The augmentation has continued since October 2021, with children ages 1 to 4 years receiving a CVB of $24/month. This study aimed to understand if augmenting the value of the WIC CVB for vegetables and fruits is associated with access to fruits and vegetables, fruit and vegetable intake (FVI), household food insecurity, and WIC program satisfaction among WIC participants from Los Angeles County, California. Methods This longitudinal, observational study of the 2021 CVB augmentation involved data collection using surveys at three time points: baseline (May 2021), midpoint (September 2021, before the CVB reduced from $35 to $24/month) and endpoint (May 2022, to be conducted). Detailed data on child FVI (using the NHANES Dietary Screener Questionnaire), household food security (using the USDA 6-item food security screener), and parental perception of the CVB changes were collected. Descriptive statistics and changes in study outcomes for respondents from baseline to midpoint were calculated in the full sample and stratified by race and ethnicity. Results 1,673 families completed both baseline and midpoint surveys. Following the increased CVB amount ($9 to $35), the proportion of families reporting the benefit was ‘not enough’ decreased (89% to 23%) and the proportion saying the benefit was ‘just right’ increased (7% to 73%) (p &lt; 0.0001). Household food insecurity decreased following the increase in CVB (55% to 44%, p &lt; 0.0001). Child FVI decreased between baseline and midpoint surveys (2.43 vs 2.37 cups/day, p &lt; 0.01). Baseline to midpoint change in FVI did not differ significantly by race and ethnicity (p = 0.19). Conclusions A short-term increase in WIC CVB was associated with improved participant experience and higher food security in California WIC participants. Longer-term increases in CVB may be needed to improve child fruit and vegetable intake. Funding Sources Robert Wood Johnson Foundation Healthy Eating Research Program and The David and Lucile Packard Foundation.

Objective: To examine associations between household food insecurity and children’s physical activity and sedentary behaviors. Design: Secondary analysis was conducted on the Healthy Communities Study, an observational study from 2013-2015. Household food insecurity was assessed by two items from the US Department of Agriculture’s 18-item US Household Food Security Survey Module. Physical activity was measured using the 7-day Physical Activity Behavior Recall instrument. Data were analyzed using multilevel statistical modeling. Setting: 130 communities in the US. Participants: 5,138 US children ages 4-15 years. Results: No associations were found for the relationship between household food insecurity and child physical activity. A significant interaction between household food insecurity and child sex for sedentary behaviors was observed (P=0.03). Conclusions: Additional research capturing a more detailed assessment of children’s experiences of food insecurity in relation to physical activity is warranted. Future studies may consider adopting qualitative study designs or utilizing food insecurity measures that specifically target child-level food insecurity. Subsequent research may also seek to further explore sub-group analyses by sex.

Objective: To increase understanding about healthfulness of school lunch and participation, this study measured 3 school lunch variables: students' perception of healthfulness, objective healthfulness, and participation and examined associations between each pair of variables (3 associations). Methods: Multilevel models were used for a secondary analysis of data from the Healthy Communities Study, a 2013-2015 observational study of schools (n=423) and children (n=5,106) from 130 U.S. communities. Results: Students who reported that school lunches were sometimes, often, or very often healthy ate school lunches more frequently per week (β=0.71, p<0.0001) than students who responded never or rarely. No associations were found with objective school lunch healthfulness. Conclusions and Implications: Student perception of healthfulness of school lunch is positively associated with participation, but not with objective school lunch healthfulness. Understanding how student perception is associated with participation can inform effective communications to students to increase participation in the school lunch program.

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