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Title: Outcomes of 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,

Author
item DI NOIA, JENNIFER - William Patterson University
item MONICA, DOROTHY - St Joseph'S Health Center
item SIKORSKII, ALLA - University Of Arizona
item CULLEN, KAREN - Children'S Nutrition Research Center (CNRC)

Submitted to: Biomedical Central Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/14/2017
Publication Date: 6/21/2017
Citation: Di Noia, J., Monica, D., Sikorskii, A., Cullen, K.W. 2017. Outcomes of 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). Biomedical Central Nutrition. 3:48.

Interpretive Summary: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides vouchers to participants to purchase fruits and vegetables (FV) at farmers' markets [Farmers' Market Nutrition Program (FMNP)] and monthly cash value vouchers (CVV) redeemable at farmers' markets, but voucher redemption rates are low. This study tested a web-based lesson, called WIC Fresh Start (WFS), to promote FV intake, the redemption of CVV at farmers' markets, FMNP voucher redemption, and farmers' market-related knowledge, attitudes, and skills among women enrolled in WIC. The lesson was evaluated in a large New Jersey-based WIC agency. Participants received the WFS lesson or an existing WIC online health education lesson and answered evaluation questions 2 weeks after the lesson and 3 and 6 months later. In the subset of participants preferring to speak Spanish, those receiving the WFS lesson redeemed more FMNP vouchers. All receiving the WFS lesson had improvements in knowledge of the FMNP, locally grown seasonal items, seasonal items found at farmers' markets in July, WIC-authorized farmers' markets and food- and farmers' market-specific knowledge; FV food safety and preparation skills; and modest gains in the redemption of CVV at farmers' markets. FV intake did not change. These results help identify effective approaches to promote farmers' market use and farmers' market-related knowledge, attitudes, and skills among WIC participants.

Technical Abstract: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides participants seasonal Farmers' Market Nutrition Program (FMNP) vouchers to purchase fruits and vegetables (FV) at farmers' markets and monthly cash value vouchers (CVV) redeemable at farmers' markets. Despite the promise of FMNP vouchers and CVV for improving FV access among WIC participants, voucher redemption rates are low. This study evaluated WIC Fresh Start (WFS), a theory-driven, web-based lesson to promote FV intake, the redemption of CVV at farmers' markets, FMNP voucher redemption, and farmers' market-related knowledge, attitudes, and skills among women enrolled in WIC. The lesson was evaluated in a four-arm randomized controlled trial. The setting was a large New Jersey-based WIC agency located in a densely populated, urban area. Participants (N = 744) were stratified based on FMNP voucher receipt and randomized to receive the WFS lesson or WIC online existing health education. Lesson effects on targeted outcomes were examined at posttest (2 weeks after the lesson) and 3 and 6 months after post testing. Receipt of the WFS lesson was associated with FMNP voucher redemption (in the subset of participants preferring to speak Spanish); improvements in knowledge of the FMNP, locally grown seasonal items, seasonal items found at farmers’ markets in July, WIC-authorized farmers' markets and food- and farmers' market-specific knowledge; ever having purchased and intentions to purchase FV at a farmers' market; FV food safety and preparation skills; and modest gains in the redemption of CVV at farmers' markets. FV intake did not differ over time by trial arm. Findings aid understanding of effective approaches to promote farmers' market use and farmers' market-related knowledge and skills among WIC participants. Further research is needed to explore factors that may explain the lack of lesson effects on FV intake.