Farmers' Market Nutrition Program Research Articles

Analysis of the food and medicines provision in the northern regions of the USA and Canada

The article is devoted to the analysis of foreign experience in ensuring the availability of medicines and food products for the population of the northern regions of the United States and Canada. The author considers in detail the work of support mechanisms in hard-to-reach places in Alaska and the Northwest Territories of Canada, where there is no transport communication all year round. The content of the U.S. government programs on drug coverage (Medicare and Medicaid), mechanisms of subsidizing food and essential commodities (Supplemental Nutrition Assistance Program (SNAP), Women/Infants and Children Program (WIC), Commodity Supplemental Food Program (CSFP), Farmers’ Market Nutrition Program (FMNP), Senior Farmers’ Market Nutrition Program (SFMNP)) were analyzed. The delivery of food by the Alaska ByPass mail program, which delivers food and necessary goods to hard-to-reach settlements where there are no roads, was studied. The article also pays attention to the state policy on a healthy lifestyle, which includes proper and balanced nutrition, considers state programs and recommendations on nutrition for Americans (Dietary Guidelines for Americans) and Canadians (Canada’s Food Guide). The results of the work can be used in the development of programs and proposals for improving measures to support and provide Arctic regions of the Russian Federation with food products and medicines.

An Evaluation of the Implementation of the Women, Infants, and Children (WIC) Farmers Market Nutrition Program at Four Chicago WIC Sites

The Farmers Market Nutrition Program (FMNP), a program of the U.S. Department of Agriculture (USDA), provides coupons to individuals/families enrolled in the Special Supplemental Nutrition program for Women, Infants, and Children (WIC) to purchase fresh produce from approved farmers markets. While some studies suggest FMNP may improve nutrition for WIC clients, there is limited research on program implementation in practice. A mixed-methods equitable evaluation framework was utilized to: (1) better understand the FMNP in practice at four WIC clinics on Chicago's west and southwest sides that serve predominately Black and Latinx families; (2) detail facilitators and barriers to participation in the FMNP; and (3) describe the potential impact on nutrition. In this manuscript, we present qualitative findings from Aim 1. We identified six steps for how the FMNP has been implemented in our study setting and opportunities to improve the implementation of the program. Findings suggest that well-defined and consistent guidelines on: (1) how to seek state approval for farmers markets; and (2) coupon distribution and redemption, are necessary to optimize utilization. Future research should explore the impact of newly offered electronic coupons on redemption rates and fresh fruit and vegetable purchasing behaviors.

Perspectives From Urban WIC-Eligible Caregivers to Improve Produce Access.

The Farmer's Market Nutrition Program (FMNP) provides fresh, locally grown fruits and vegetables (FV) to eligible participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). However, redemption of FMNP benefits remains low. This qualitative study explores facilitators and barriers to produce access and FMNP redemption for caregivers of WIC-eligible children in Philadelphia during the COVID-19 pandemic. We conducted semistructured phone interviews with caregivers between August and December 2020 to understand experiences with produce access and programming preferences to increase benefit redemption and produce consumption. We used content analysis with constant comparison with code interviews inductively and identified emerging themes through an iterative process. Participants (n = 30) wanted their children to eat more produce but described barriers to produce access, including limited availability, higher cost, and limited time. The Supplemental Nutrition Assistance Program and WIC benefits improved the ability to purchase produce, but difficulties with electronic benefit transfer and pandemic-related office closures limited use of WIC benefits. Similarly, lack of convenient market locations and hours prohibited use of FMNP benefits. Caregivers described that an ideal food program would be delivery based, low cost, offer a variety of FV, and provide recipes and educational activities. WIC-eligible caregivers want their children to eat more produce; however, they face multiple barriers in redeeming their benefits to access fresh produce. Delivery-based, low-cost produce programs may lead to increased produce access as well as benefit use. Future study is needed on feasibility and acceptability of produce delivery options among WIC-eligible families.

Implementing Locally Tailored Strategies to Promote Redemption of Farmers' Market Nutrition Program Vouchers Among WIC Participants in Central Pennsylvania.

The Pennsylvania Farmers' Market Nutrition Program (FMNP) provides vouchers to participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to purchase locally grown fruits, vegetables (F&V), and herbs every year from June to November. Voucher redemption is suboptimal among WIC participants in Lebanon County, a community with high numbers of low-income and Hispanic families. Supported by a Racial and Ethnic Approaches to Community Health (REACH) award, our community-academic coalition partnered with the local WIC provider to implement locally tailored strategies to promote redemption of FMNP vouchers. In 2019, we surveyed FMNP participants (n = 100) to examine opportunities for improved voucher redemption. Increasing sites for voucher use (47%) and a larger variety of F&V (27%) were the most commonly selected improvements participants identified. Participants also supported improvements to increase awareness of available seasonal produce (14%), text/phone reminders to redeem vouchers (13%), and having recipes to cook meals with FMNP-approved F&V (12%). These findings led us to implement a weekly, Farm-to-WIC "grab bag" program in 2020/2021. We partnered with a local farmer to offer a variety of FMNP-approved produce in $3 and $6 grab bags at the local WIC provider. Each grab bag included healthy recipes using the included produce. In 2021, we launched a text/phone reminder intervention to encourage voucher redemption among FMNP participants (n = 57). Our work demonstrates the value of community-academic partnerships to identify and implement feasible strategies that are responsive to local needs as well as supporting existing programs providing greater access to affordable produce.

Identifying Cofactors Contributing to Food Insecurity in Elderly Maine Residents Living at Home

ObjectivesThe purpose of this study was to identify cofactors that contribute to food insecurity in Maine’s older adults living at home, examine how the COVID-19 pandemic affected access to nutritious food, and make recommendations for program expansion and development. MethodsThis study was a cross-sectional survey design of older adults aged 65 years and older participating in the Meals on Wheels program in Maine (n = 58) in early 2021. Research participants were compensated with grocery store gift cards. The DETERMINE Nutrition Checklist total nutrition scores and USDA Six-Item Food Security scores were compared to self-reported access to food to see how accurately older adults view their nutritional status. Chi-squared analysis was used to examine associations among food insecurity and demographic traits. A probability of p ≤ 0.05 was chosen for significance. ResultsRegion of residence and food security score were significantly associated; 55.2% (n = 32) of participants had scores (0–1) indicating they were food secure. One-quarter of participants had low food security, and 11 persons had very low food security. DETERMINE scores were not statistically significant for either age range or region, suggesting that risk of malnutrition functioned independently from region and age range. However, 75.9% (n = 44) of participants received scores indicating that they were at high risk of malnutrition. Only 20 persons regularly used SNAP benefits, and few people took advantage of other food programs such as the Senior Farmers Market Nutrition Program and food pantries. ConclusionsFood security among Maine seniors is not necessarily related to finances, especially during the COVID-19 pandemic. The most common cofactors influencing access to food were physical access and ability, and fear or guilt of asking for help. Future work should seek to survey older adults, especially those in the most rural and impoverished counties, who are not currently using food support services such as Meals on Wheels to better evaluate food insecurity among older Maine residents. Funding SourcesMaine Top Scholar Award and NIFA Hatch funds were used in this study.

An Investigation of Social Ecological Barriers to and Facilitators of WIC Farmers Market Nutrition Program Voucher Redemption.

In the United States, many communities lack sufficient access to fresh produce. To improve access to fresh fruits and vegetables, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides eligible participants vouchers through the Farmers Market Nutrition Program (FMNP) that can be redeemed directly from farmers at markets or farm stands. However, FMNP voucher redemption rates in New Jersey remain lower than those in neighboring states. This article used the social ecological model to examine differences between FMNP participants who redeem vouchers (Redeemers) and those who do not (non-Redeemers) in the areas of: produce procurement practices and consumption frequency, and barriers to and facilitators of FMNP voucher redemption. This cross-sectional study included WIC FMNP participants (N = 329) in northern New Jersey, USA. Analyses were conducted using descriptive statistics, independent sample t-tests, and one-way ANOVA. Compared to Redeemers, non-Redeemers consumed fewer average daily vegetable servings, were more likely to shop at small grocery/corner stores, and encountered significant barriers to FMNP redemption, e.g., difficulty finding time to redeem vouchers.

Farmers’ Market Nutrition Program Educational Events Are Broadly Accepted and May Increase Knowledge, Self-Efficacy and Behavioral Intentions

The Farmers’ Market Nutrition Program (FMNP) in the U.S. provides coupons for the purchase of fruit and vegetables (FV) to pregnant women and children enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and to income-eligible adults 60+ years of age. The New York State FMNP Education Event Guide was developed to support cooperative extension educators in providing information, food tastings, and cooking demonstrations at farmers’ markets (FM) to encourage consumption of FV. This paper describes implementation at seven FM in New York City, and shopping and eating behaviors in a cross-sectional survey of FM shoppers (n = 377). Three of nine lessons were implemented more than once, typically with food sampling (78.9%). FM shoppers were primarily women (81.5%), racially diverse (30.5% Black, 23.1% White), frequent shoppers (2.4 times/month), and had high FV consumption (2.24 cups fruit; 2.44 cups vegetables daily). Most FM shoppers participated in the FM education event (84%), and participants and non-participants had equivalent shopping and eating behaviors. More than 70% of FM education participants believed that the event positively impacted their knowledge, self-efficacy, and behavioral intentions. FMNP education events at FM were broadly accepted by FM shoppers of all characteristics, and may improve knowledge, self-efficacy, and behavioral intention.

Pilot Study of a Farm-to-Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Intervention Promoting Vegetable Consumption

BackgroundVegetable intake is below recommended levels among adults served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). ObjectiveThe aim of this study was to determine whether a novel, theory-driven, farm-to-WIC intervention to promote vegetable intake showed promise of being successful and is therefore appropriate for efficacy testing. DesignFrom June 2019 to January 2020, the intervention was piloted in three WIC agency sites (one randomized to the intervention study group and two to the control group) selected based on similarity in size and the demographics of participants served. Participants/settingRecruited between June 3, 2019 and August 1, 2019, participants were 297 primarily Hispanic adults served by a large WIC agency located in a densely populated urban area in New Jersey (160 were enrolled at the intervention site and 137 at control sites). InterventionThe intervention combined behaviorally focused instruction and handouts with the introduction of a WIC-based farmers’ market, field trips to an area farmers’ market, telephone coaching and support before and after trips, and recipe demonstrations and tastings. Main outcome measuresThe primary outcomes were vegetable intake (measured objectively using dermal carotenoids as a biomarker of intake and via self-report) and the redemption of vouchers provided through the WIC Farmers’ Market Nutrition Program (FMNP) for fruit and vegetable purchases at farmers’ markets (objectively assessed using data provided by WIC). Statistical analyses performedBetween-group differences in vegetable intake were examined at mid- and post-intervention (3 and 6 months post-baseline, respectively) with linear mixed-effects models adjusted for baseline vegetable intake and covariates. Logistic regression analysis was used to relate FMNP voucher redemption to study group and covariates. ResultsAt mid-intervention, objectively measured vegetable intake was higher among participants in the control group as compared with the intervention group; self-reported intake did not differ by group. Post-intervention, objectively measured and self-reported vegetable intake were higher among participants in the intervention group as compared with the control group. Receipt of the intervention was associated with a greater likelihood of FMNP voucher redemption. Voucher redemption rates were 87% in the intervention group and 28% in the control group (odds ratio = 17.39, 95% confidence interval [8.64, 35.02]). ConclusionsMeaningful associations found between the intervention, vegetable intake, and FMNP voucher redemption suggest that the program is appropriate for efficacy testing.

Increasing WIC Farmers’ Market Nutrition Program Redemption Rates: Results and Policy Recommendations

WIC Farmers' Market Nutrition Program (FMNP) aims to increase consumption of fresh produce among Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participants while supporting local farmers. Area stakeholders are addressing the existing barriers to FMNP use that keep participation low. Increase FMNP check redemption by participants in a Pittsburgh WIC office. Quasiexperimental design including cooking demonstrations, tours of FMs, and community garden visits. Program participation and check redemption rates were tracked. The redemption rate of FMNP checks among research participants and nonparticipants was 46.5% and 39.0% (P < .001), respectively. Lessons learned point to needed changes on the local, state, and federal levels. Barriers to the use of WIC FMNP checks were consistent with the literature. Allowing mobile markets to accept FMNP checks may address barriers to FM shopping while supporting the local farmer. Our stakeholder group continues to recommend multilevel policy changes to improve the redemption rate.

Social Ecological Factors in WIC Farmers Market Nutrition Program Usage

Upon completion, participants will be able to identify social ecological factors that influence WIC FMNP voucher redemption.

P111 - Examining WIC Farmers Market Nutrition Program Voucher Redemption in New Jersey

P111 - Examining WIC Farmers Market Nutrition Program Voucher Redemption in New Jersey

Evaluating the Implementation of a Farmers' Market Targeting WIC FMNP Participants.

The present study planned and implemented a new farmers' market (FM) at a WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) clinic in North Carolina, of which WIC FM Nutrition Program (FMNP) participants were the main priority population. The purpose of this FM was to provide convenience and improve access to locally grown fresh fruits and vegetables in the community and to increase the FMNP coupon redemption rate. The main objective of this study was to describe the overall process and key strategies involved in implementing a FM at a WIC clinic. A community-based participatory research design using different formative methods documented the process and key inputs in FM implementation. Local farmers, program administrators, and community advocates were involved in documenting the implementation process. Multiple formative methods included direct observation and semistructured interviews with staff and farmers (n = 13). A community partnership was key in implementing the FM. The market operated weekly over the course of 24 weeks, involved 12 WIC-approved farmers, and featured over 50 types of fresh fruits and vegetables. The FMNP coupon redemption rate at the county level increased from 51.3% to 62.9%. The results demonstrate that a FM can be successfully located near a WIC clinic with positive effects of increasing availability to fresh fruits and vegetables for a low-income population and revenue for local farmers.

Multifaceted Intervention Increases WIC Farmers Market Nutrition Program Check Redemption and Suggests Policy Changes

Increase WIC Farmers Market Nutrition Program (FMNP) check redemption rate. Target audience was WIC participants in a low income 47.6% white, 46.9% African American neighborhood adjacent to the city of Pittsburgh. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) FMNP aims to increase consumption of fresh fruits and vegetables for WIC families while supporting local farmers who sell at area farmers markets (FM). Yet, FMNP check utilization in PA is just over 50% and is lower in the targeted neighborhood. Barriers as well as aids to FMNP utilization and produce consumption are well documented and informed the intervention, CRUNCH!: Eat Fresh, Eat Healthy, Move More. A review of FMNP procedures in several states is informing policy recommendations for PA. Using a quasi-experimental research design, the June through early November intervention included cooking demonstrations in the WIC clinic; informal tours of FMs; and community garden visits. State data provided check redemption rates. Baseline and follow-up questionnaires explored barriers to FMNP check redemption, aids to fruit and vegetable consumption and pre- and post-intervention consumption data. Participation in the intervention activities were tracked. The intervention significantly (p < .001) increased the FMNP check redemption rate by program participants (46%) compared to non-participants (39%). Participation in the intervention activities was lower than expected. Barriers were consistent with the literature and there was no change in fruit or vegetable consumption. Program findings led to discussion of local issues and state policies regarding interpretation of federal FMNP regulations. A local stakeholder group is currently exploring policy recommendations.

USDA’s Food, Nutrition and Consumer Services Helps Bring Regional and Local Foods to Consumers

USDA’s Food, Nutrition and Consumer Services Helps Bring Regional and Local Foods to Consumers

The Georgia WIC Farmers’ Market Nutrition Program’s Influence on Fruit and Vegetable Intake and Nutrition Knowledge and Competencies Among Urban African American Women and Children

Objective: Evaluate the impact of Farmers’ Market Nutrition Program (FMNP) among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants.Methods: Prospective study enrolling non-FMNP and FMNP (received $30 of FMNP coupons for fresh fruits and vegetables [F&V]) WIC recipients. Three surveys collected F&V intake for mother and child and nutrition knowledge/competencies. FMNP groups were compared on main outcomes using bivariate analyses and logistic regression.Results: Among participants using all coupons upon issuance, F&V intake significantly increased across surveys. In addition, intake significantly increased among >50% of FMNP participants reporting learned competencies (P = .03).Conclusions: WIC FMNP may be more effective with requirement to use all FMNP coupons upon issuance. F&V intakes may increase with nutrition education on competencies.

A randomized controlled trial of nutrition education to promote farmers’ market fruit and vegetable purchases and consumption among women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC): rationale and design of the WIC Fresh Start program

This report describes the protocol guiding the design and evaluation of a theory-driven, web-based lesson to promote farmers’ market fruit and vegetable (FV) purchases and consumption among women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Designed to leverage vouchers provided to WIC participants for FV purchases through the Farmers’ Market Nutrition Program (FMNP) and monthly cash value vouchers (CVVs) redeemable at farmers’ markets, the lesson is conceptually grounded in formative research on knowledge, attitudes and skills influencing farmers’ market FV purchases and consumption and theoretical understanding of approaches for modifying them. The setting is a large WIC agency serving three New Jersey counties. Separate samples of women were recruited to participate in 1) focus groups for guiding lesson content development (N = 56) and pretesting the resulting content (N = 52), 2) cognitive testing to assess the clarity and interpretability of items and response formats in measures of knowledge, attitudes and skills developed for the study (N = 15), 3) one-on-one sessions to assess reactions to initial versions of video segments developed for the lesson (N = 20), and 4) the outcome evaluation (N = 744). Stratified based on FMNP voucher receipt, participants are randomized to receive the lesson or existing online health education. Outcome measures (administered orally to reduce literacy demands of the response task) are completed at pretest (immediately before the lesson), posttest (2 weeks after the lesson), and 3 and 6 months after posttesting. Short- and long-term lesson effects on FV intake, FMNP voucher redemption and the redemption of CVVs at farmers’ markets will be evaluated. Evidence for mediation by knowledge, attitudes and skills of lesson effects on FV intake and voucher redemption, dose-response relationships, and user satisfaction with the lesson also will be examined. Theory-driven, web-based nutrition education expressly designed for WIC to promote farmers’ market use is lacking. The WIC Fresh Start program addresses the paucity of programs of this type. Findings will advance understanding of effective approaches for promoting farmers’ market FV purchases and consumption among WIC participants. NCT02565706 (registered September 30, 2015)

Implementation and Outcome of a Farmers' Market Targeting WIC Farmers' Market Nutrition Program (FMNP) Participants: A Case Study Using CBPR Approach

The main objectives of this study are: 1) to describe the overall process and key strategies involved in implementing a farmers' market at a WIC office; and, 2) to assess improvement in redemption rate of FMNP coupons among WIC participants by improving farmers' market access. A case study design using different formative methods documented the process and key inputs in farmers' market implementation. Catawba County Public Health (CCPH) WIC clinic served as the farmers' market site. Local farmers, program administrators, and community advocates were reached in documenting the implementation process. FMNP participants were the target audience. All study protocols were approved by the UNCG IRB. Multiple measurement methods included direct observation and semi structured interviews with staff and farmers (n=13). Grounded theory informed interview analysis. The primary outcome measure was FMNP coupon redemption rate. Rates from 2007-2013 were averaged and compared using a weighted ranking system (% redemption * % eligible individuals). A community partnership among WIC, Eat Smart Move More, local farmers, UNCG, and CCPH was key in implementing an onsite farmers' market. The market occurred Thursdays from May-October 2013, and farmers offered a variety of local produce. The average redemption rate from 2007-2013 was 51.4% (rank of 10). The 2013 redemption rate increased from 51.3% to 62.9% (rank of 3). This study highlights the importance of leveraging resources at the community level to address barriers to FMNP redemption. Locating farmers' markets at WIC clinics, in particular, can reduce barriers for FMNP participants and increase redemption.

Farmers’ Market Use among Families in North Carolina

BackgroundThe number of farmers’ markets (FM) has more than tripled in the last 15 years. Little is known about factors that influence FM use.ObjectiveTo examine the relationship between FM use, dietary behavior, participation in supplemental nutrition programs, and demographic characteristics.DesignWe conducted a cross‐sectional analysis using the 2008 North Carolina Child Health Assessment and Monitoring Program (CHAMPS) data (n= 2,932). We examined the relationship between use of FM 12+ times in the past year by WIC participation, Supplemental Nutrition Assistance Program (SNAP) participation, Farmers’ Market Nutrition Program (FMNP) participation, fruit consumption, vegetable consumption, and race/ethnicity.ResultsFamilies with children who eat 3+ servings of vegetables a day were more likely to use FM (p&lt;.0001). FM use among families participating in WIC or SNAP was not significantly different from FM use among those who did not participate. Children in families enrolled in WIC and living in counties that offer the FMNP were more likely to eat 3+ servings of fruit a day compared with those not enrolled in WIC and not in a county participating in FMNP (34.3% vs. 18.2%; p=.007).ConclusionsFM use and availability of FM subsidies in the form of FMNP vouchers may positively impact fruit and vegetable consumption among children.This analysis was not funded.

Cookin' the Market Nutrition Education Project

The objectives of this project are to increase fruit and vegetable consumption among low-income populations, increase the number of farmers' market transactions conducted with Electronic Benefit Transfer (EBT/SNAP/food stamp) cards, and increase the redemption rate of WIC Farmers' Market Nutrition Program (FMNP) coupons.

A Pilot Study to Examine the Impact of the Farmers' Market Nutrition Program

This pilot study examined WIC participants' use of farmers' markets. As well as evaluating the impact of the Farmers' Market Nutrition Program (FMNP) on the consumption of fruits and vegetables.Participants were American born, Black, pregnant women in Washington, DC (DC) and Charlotte, NC who enrolled in WIC. The sample included women who completed the pre and post survey at their WIC offices in DC (n=44) and Charlotte (n=39) during the spring/summer 2007 and fall/winter 2007. In addition to receiving the standard WIC vouchers, women in DC also received $30 in FMNP vouchers while women in Charlotte did not.Paired t test was used to examine differences in intake from spring to fall. A two sample independent t test was used to compare the difference in intake and sociodemographic characteristics between women in Charlotte and DC.Women in DC were more likely to ever use farmers' markets; 56.8% in DC vs. 33.3% in Charlotte (p= 0.008). Two thirds (66%) of women in DC used their FMNP vouchers; these women were older than those who did not use their vouchers. Fruit and vegetable intake decreased from pre to post test among both groups, there was no difference in this decrease between groups.This study demonstrated that women in a city with the FMNP were more likely to use farmers' markets. It also found that nutrition education to encourage fruit and vegetable consumption in the fall/winter is warranted.