WIC-Based Intervention to Promote Healthy Eating Among Low-Income Mothers

NCT04038385 | Completed Results

• 1 other identifier: 1R21CA230476-01
• Study Type: interventional
• Target: 297
• Locations: 1 country
• Sites: 1

Brief Summary

Whole grains, non-starchy vegetables, fruit, and beans are a consistent feature of diets associated with a lower risk of cancer and other diet-related diseases. For cancer risk reduction, the American Cancer Society recommendation is to consume at least 2.5 cups of a variety of fruits and vegetables daily. Other than dietary choices, weight control and physical activity levels are important modifiable determinants of cancer risk. This study finalized a novel, theory-driven farm-to-WIC intervention developed in preliminary work to promote vegetable intake among low-income adults served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). In New Jersey (the location of the study), WIC provides participants up to $30 in seasonal Farmers' Market Nutrition Program (FMNP) vouchers and monthly cash value vouchers or CVV (valued at $11 for adults and $8 for children at the time of the study) redeemable at farmers' markets. The program combined behaviorally focused nutrition education with the establishment of a WIC-based farmers' market (implemented in the summer of 2019 during the FMNP voucher issuance period). Content to address other modifiable determinants of cancer risk was added. To create additional opportunities for experiential and hands-on learning, monthly trips to an area farmers' market were held (between September 1, 2019 \[after the WIC-based market was discontinued\] and November 30, 2019 \[the end of the local growing season\]). The research employed an experimental design to initially test the intervention in 3 WIC agency sites (1 intervention and 2 control sites) with 297 urban, primarily Hispanic adults. Program effects on primary outcomes of vegetable intake (measured objectively using dermal carotenoids as a biomarker of intake and via self-report) and FMNP voucher redemption (objectively assessed using data provided by WIC) were examined at mid- and post-intervention (3 and 6 months post-baseline, respectively). Intervention effects on potential hypothesized mediators and the redemption of CVV at farmers' markets, participant satisfaction with the program, and the cost-effectiveness of the intervention also were examined.

Conditions

Cancer Prevention; Diet Modification; Vegetable Intake

Outcome Measures

Primary Outcomes (5)

• Vegetable Intake Carotenoid Scores at 3 Months

  Vegetable intake was objectively assessed using a reflection spectroscopy device (the Veggie Meter) to measure the level of carotenoid pigments in participants' skin (scores can range from 0 to 800). Higher scores indicate a better outcomes (higher carotenoid levels).

  3 months

• Vegetable Intake Carotenoid Scores at 6 Months

  Vegetable intake was objectively assessed using a reflection spectroscopy device (the Veggie Meter) to measure the level of carotenoid pigments in participants' skin (scores can range from 0 to 800). Higher scores indicate a better outcomes (higher carotenoid levels).

  6 months

• Self-Reported Vegetable Intake at 3 Months

  Assessed with one of two items in a screening instrument developed by the National Cancer Institute. Participants reported the number of cups of vegetables (including 100% vegetable juice) they ate or drank each day (range 0-7). Higher numbers represent a better outcome (higher cups/day of vegetables consumed).

  3 months

• Self-Reported Vegetable Intake at 6 Months

  Assessed with one of two items in a screening instrument developed by the National Cancer Institute. Participants reported the number of cups of vegetables (including 100% vegetable juice) they ate or drank each day (range 0-7). Higher numbers represent a better outcome (higher cups/day of vegetables consumed).

  6 months

• Number of Participants Who Redeemed Any Farmers' Market Nutrition Program (FMNP) Vouchers at 6 Months

  Objectively assessed using data provided by the collaborating WIC agency. WIC reported whether participants redeemed any FMNP vouchers (yes or no) from baseline to 6 months.

  6 months

Secondary Outcomes (20)

• Knowledge of Vegetable Intake Recommendations at 3 Months

  3 months

• Knowledge of Vegetable Intake Recommendations at 6 Months

  6 months

• Home Vegetable Availability (Quantity) at 3 Months

  3 months

• Home Vegetable Availability (Quantity) at 6 Months

  6 months

• Home Vegetable Availability (Variety) at 3 Months

  3 months

Other Outcomes (3)

• Number of Participants Who Redeemed Any Cash Value Vouchers or CVV at Farmers' Markets at 6 Months

  6 months

• Overall Satisfaction With Intervention

  6 months

• Satisfaction With Intervention

  6 months

Study Arms (2)

Intervention

EXPERIMENTAL

This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period \[June 19 to August 19\]), and 2) monthly trips to an area farmers' market (between September 1, 2019 and November 30, 2019 \[the end of the local growing season\]).

Behavioral: Multilevel Behavioral Intervention

Control

NO INTERVENTION

This group will receive routine services provided by WIC only.

Interventions

Multilevel Behavioral Intervention BEHAVIORAL

Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers at farmers' markets.

Intervention

Eligibility Criteria

• Age: 18 Years - 99 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• English- or Spanish-speaking
• Farmers' Market Nutrition Program (FMNP) voucher recipient or caregiver of a child FMNP voucher recipient
• Not less than 3 months from expected delivery date (pregnant women)
• Eligible to receive WIC benefits for 6 months after study entry

You may not qualify if:

• ● Restrictions of food intake (has food allergies or foods that cannot be eaten)

Sponsors & Collaborators

• William Paterson University of New Jersey: lead

Study Sites (1)

Saint Joseph's WIC Program

Paterson, New Jersey, 07524, United States

Location

Related Publications (4)

• Di Noia J, Gellermann W. Use of the Spectroscopy-Based Veggie Meter(R) to Objectively Assess Fruit and Vegetable Intake in Low-Income Adults. Nutrients. 2021 Jun 30;13(7):2270. doi: 10.3390/nu13072270.

  PMID: 34209048 BACKGROUND

• Di Noia J, Monica D, Jensen HH, Sikorskii A. Economic evaluation of a farm-to-Special Supplemental Nutrition Programme for Women, Infants and Children intervention promoting vegetable consumption. Public Health Nutr. 2021 Aug;24(12):3922-3928. doi: 10.1017/S1368980021001981. Epub 2021 May 11.

  PMID: 33972002 RESULT

• Di Noia J, Monica D, Sikorskii A, Nelson J. Pilot Study of a Farm-to-Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Intervention Promoting Vegetable Consumption. J Acad Nutr Diet. 2021 Oct;121(10):2035-2045. doi: 10.1016/j.jand.2020.12.020. Epub 2021 Jan 22.

  PMID: 33487590 RESULT

• Di Noia J, Monica D, Sikorskii A. Process Evaluation of a Farm-to-WIC Intervention. J Acad Nutr Diet. 2021 Oct;121(10):2021-2034. doi: 10.1016/j.jand.2021.05.014. Epub 2021 Jun 16.

  PMID: 34144918 RESULT

Results Point of Contact

• Title: Jennifer Di Noia, PhD, Principal Investigator
• Organization: William Paterson University, Sociology Department

dinoiaj@wpunj.edu

19737203714

Study Officials

• Jennifer Di Noia, PhD

  William Paterson University

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, CARE PROVIDER
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor, Department of Sociology

Study Record Dates

• First Submitted: July 14, 2019
• First Posted: July 30, 2019
• Study Start: June 3, 2019
• Primary Completion: January 31, 2020
• Study Completion: August 31, 2021
• Last Updated: December 23, 2021
• Results First Posted: December 23, 2021

Record last verified: 2021-11

Locations

US (1)