Farmers' Markets: Costs Compared With Supermarkets, Use Among WIC Clients, and Relationship to Fruit and Vegetable Intake and Related Psychosocial Variables

doi:10.1016/j.jneb.2013.11.016

Journal of Nutrition Education and Behavior

Volume 46, Issue 3, Supplement, May–June 2014, Pages S65-S70

https://doi.org/10.1016/j.jneb.2013.11.016 Get rights and content

Abstract

Objective

To determine fruit and vegetable (FV) costs at farmers' markets (FMs) and grocery stores, determine Special Supplemental Nutrition Program for Women, Infants, and Children participants' FV intake and psychosocial predictors, and compare FM users and nonusers.

Methods

Prices were collected biweekly from grocery stores and FM vendors. Participants were recruited from Special Supplemental Nutrition Program for Women, Infants, and Children clinic to complete a survey of FV intake, psychosocial variables, and FM usage.

Results

The FM cost was greater. A total of 377 participants (51%) used FMs. The FM users more often ate vegetables as snacks and > 1 vegetable per day (P < .05).

Conclusions and Implications

Despite higher costs, FMs were often used. The FM users had a better vegetable intake pattern.

Introduction

The Dietary Guidelines for Americans 2010¹ recommends increased intake for fruit and vegetables, which is based on modestly positive evidence supporting a benefit from increased fruit and vegetable intake with regard to body weight and cardiovascular disease.² Unfortunately, the intake of these foods remains low; only an estimated 33% of adults in the US consume the recommended servings of fruit and 26% consume the suggested amount of vegetables.3, 4, 5, 6 In particular, many studies indicate that women, infants, and children do not consume adequate fruits and vegetables.5, 6, 7, 8, 9

There are several reasons for low intake of fruits and vegetables; availability, access, and cost have been found to be barriers.10, 11, 12 To overcome these barriers, several studies have used the Farmers' Market Nutrition Program (FMNP) as an intervention to increase intake.13, 14 Herman et al¹³ found that FMNP participants showed an increase of 1.4 servings/1,000 kcal from baseline to the end of the intervention compared with controls, whereas supermarket participants showed an increase of only 0.8 servings/1,000 kcal. However, that study was conducted in California, where there is a longer growing season, which limits applicability of the results to other areas. Currently, research evaluating intake patterns of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants after the 2009 provision of fruit and vegetable cash value vouchers (CVVs) and promotion of the FMNP shows that consumption of fruits and vegetables was still lower than the national recommendation.13, 14, 15, 16

Although availability and access are presumed to be promoted by FMNP and alleviate the cost of fruit and vegetables as a barrier to intake, conflicting data have been published concerning the cost comparison between farmers' markets (FMs) and grocery stores.17, 18 With only 4 studies published concerning fruit and vegetable intake of WIC participants, only 1 of which was in the Midwest, additional data are needed to evaluate the effect of FMNP on fruit and vegetable intakes and motivators and barriers to consuming these foods. Therefore, the objectives of this study were to determine whether there was a difference in cost of fruits and vegetables sold at FMs and those sold in commercial grocery stores, to determine WIC participants' psychosocial predictors of fruit and vegetable intake, and to estimate actual fruit and vegetable intake for those participating in the FMNP vs those choosing not to participate.

Section snippets

Cost of Fruits and Vegetables

Farmers' markets (n = 3 vendors; range, 1–11 vendors) and grocery stores (n = 5) in the city limits were surveyed. These 3 markets were promoted in the WIC Farm to Table promotion, and fliers with locations and bus routes to the markets were distributed with the FMNP vouchers. Each grocery store was within 3.5 miles of the WIC clinic and was also accessible by bus.

Commonly consumed fruits and vegetables¹⁹ as well as those popular in area FMs were selected for analysis. Prices were collected

Results

Slightly more of the surveyed participants said they received FM vouchers (n = 194) than had not received vouchers (n = 183). The median number of coupons received by the FM voucher was 2. Because each FM voucher had a value of $3.00, the average value of coupons received by a WIC participant was $6.00. Of those surveyed, 93.5% said they would use FM vouchers if available to them next year. A total of 57% of participants who used the vouchers had never shopped at an FM before participating in

Discussion

These results show that the FMNP in this area motivated WIC participants to use FMs, with slightly more than half having received and used the vouchers. This is a much higher usage percentage than was found in a survey in Washington, DC, and Charlotte, NC, where 82% (n = 179) had not received or used FM vouchers in the past.²⁶

The higher use of FMNP occurred even though the FM cost more than a grocery store. The financial cost difference between FMs and grocery stores has been a growing topic

Implications for Research and Practice

Farmers' market vouchers facilitate purchasing more vegetables than a family might otherwise be able to afford, especially when FM produce is more expensive than grocery stores. The FMNP also motivates more WIC participants to go to FMs. This may be a teachable moment for educators to demonstrate purchasing, storage, cooking, and preservation skills as well as nutrition. Future research should also investigate how much of the produce purchased at the FMs are eaten by the family, as well as

Acknowledgments

The authors thank Brandon Meline, MD, RD, and the Champaign Urbana WIC Clinic for assistance in this work, as well as the WIC clients who completed the surveys. The research was completed as part of the first author's master's thesis. Publication of the supplement in which this article appears was supported by General Mills. However, the research in this article was not funded by General Mills.

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Cited by (21)

Impact of a farmers’ market healthy food subsidy on the diet quality of adults with low incomes in British Columbia, Canada: a pragmatic randomized controlled trial
2023, American Journal of Clinical Nutrition
Adults with low incomes have lower diet quality than their higher income counterparts. In Canada, the British Columbia Farmers’ Market Nutrition Coupon Program (FMNCP) provides coupons to low-income households to purchase healthy foods in farmers’ markets.
The objective of this study was to examine the impact of the FMNCP on the diet quality of adults with low incomes.
In a pragmatic randomized controlled trial conducted in 2019, adults with low incomes (≥18 y) were randomly assigned either to an FMNCP intervention (n = 143) or a no-intervention control group (n = 142). The FMNCP group received 16 coupon sheets valued at $21 per sheet over 10–15 wk to purchase healthy foods from farmers’ markets. Participants completed a questionnaire and 2 24-h dietary recalls at baseline (0 wk), immediately post-intervention (10–15 wk), and 16-wk post-intervention (26–31 wk). Diet quality was calculated using the Healthy Eating Index-2015 (HEI-2015). Linear mixed-effects regression assessed differences in HEI-2015 total (primary outcome) and component scores (secondary outcomes) between the FMNCP and control groups at post-intervention and 16-wk post-intervention. Subgroup analyses examined program impacts by sex and age group (18–59 y, ≥60 y).
There were no significant differences in HEI-2015 total scores between the FMNCP and control groups at post-intervention (−0.07; 95% CI: −4.07, 3.93) or 16-wk post-intervention (1.22; 95% CI: −3.00, 5.44) overall or between subgroups. There were no significant between-group differences in HEI-2015 component scores at post-intervention, although there were significant differences in component scores for dairy and fatty acids at 16-wk post-intervention.
The FMNCP did not significantly improve diet quality among adults with low incomes over the study period. Further research is needed to explore whether higher subsidy amounts or a longer intervention period is needed to meaningfully improve diet quality among adults with low incomes.
This trial was registered at [clinicaltrials.gov] as [NCT03952338].
Fruit and Vegetable Purchases and Consumption among WIC Participants after the 2009 WIC Food Package Revision: A Systematic Review
2020, Advances in Nutrition
To promote fruit and vegetable (FV) intake among participants, the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) implemented a comprehensive food package revision in 2009. However, to our knowledge, no studies have systematically explored the factors related to FV purchases and/or consumption among WIC participants in the post-2009 revision era. To fill this knowledge gap, we conducted a systematic literature review using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, and Web of Science using key search terms. Studies published from January 1, 2007, through February 28, 2019, were included, since an interim rule for the WIC food package revision was issued in 2007. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format. The articles were grouped based on main themes or factors, settings, design, study years, and sample size. Thirty-nine articles met the inclusion criteria. Seven main themes or factors related to FV purchases and/or consumption in WIC participants were identified in these articles. The 2009 WIC food package revision was the most-studied factor (n = 9). National and state-level studies showed a consistently positive relation between the 2009 revision and FV purchases and/or consumption. However, some studies did not find a positive relation. State-level policy variations can be exploited as natural experiments to assess the causality of state-level factors in WIC participants' FV purchases or consumption. The majority of the included studies were limited in being local (n = 26, 66.7%), cross-sectional (n = 29, 74.4%), or having sample sizes <1000 (n = 25, 64.1%), which could explain the diverse results regarding the relation between FV purchases and/or consumption and various factors, including individual, store, and program characteristics.
WIC Recipients in the Retail Environment: A Qualitative Study Assessing Customer Experience and Satisfaction
2019, Journal of the Academy of Nutrition and Dietetics
Citation Excerpt :
WIC-only stores account for approximately 7.7% of total WIC sales,25 and in this sample, only participants from Illinois and Texas had shopped at WIC-only stores. Although WIC-only stores can help reduce the decision fatigue of identifying eligible items and stigma experienced at checkout, these stores are not always economically viable.26,27 Participants were satisfied with the CVV for fruits and vegetables, but also noted challenges in utilizing the voucher to its maximum value.
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program is an important intervention for prevention and treatment of obesity and food insecurity, but participation has dropped among eligible populations from 2009 to 2015. Program satisfaction is integral to participant retention, and the retail experience is a vital component of program satisfaction.
This article applies behavioral economics principles to explore the retail experience of WIC participants and ways in which it may be improved.
The authors designed and conducted semistructured interviews and focus groups with WIC participants.
A convenience sample of WIC participants aged 18 years and older were recruited through WIC clinics in Texas, North Carolina, Oregon, and Illinois (n=55, 27 participants from four focus groups and 28 individual interviews).
Responses were analyzed qualitatively using principles of content analysis.
Challenges in identifying WIC-allowable items throughout the store as well as perceived stigmatization during the checkout process were the chief complaints. Study participants described a learning curve in successful use of WIC in retail environments over time. Study participants also reported acceptance of restrictions, such as a requirement to purchase the least expensive brand.
Dissatisfaction with the retail experience may lead to the underutilization of WIC benefits or program exit. Behavioral economics strategies that facilitate a better shopping experience, such as creating a section for WIC items in the store or improving in-store education, may improve the retail experience for WIC customers. Further research is needed to ensure such strategies are effective and do not contribute to stigma.
How strong is the demand for food through direct-to-consumer outlets?
2018, Food Policy
Citation Excerpt :
McGuirt et al. (2011) and Low et al. (2015) find that fruits and vegetables cost less at DTC outlets. By contrast, Wheeler and Chapman-Novakofski (2014) find that DTC outlets charge higher prices. Valpiani et al. (2016) find that farmers markets and roadside stands do not charge consistently higher or lower prices than supermarkets.
Reducing Food Insecurity and Improving Fruit and Vegetable Intake Among Farmers' Market Incentive Program Participants
2016, Journal of Nutrition Education and Behavior
To determine whether participation in a farmers' market incentive pilot program had an impact on food security and fruit and vegetable (F&V) intake of participants.
Participants in the Supplemental Nutrition Assistance Program were eligible to receive a dollar-per-dollar match up to $10/wk in farmers' market incentives. The researchers used a pretest-posttest design to measure F&V intake and food security status of 54 adult participants before and after receiving farmers' market incentives. The 6-item Behavior Risk Factor Surveillance System questionnaire and US Household Food Security Survey Module were used to measure F&V intake and food security, respectively. Wilcoxon signed-rank test was used to compare scores of F&V intake.
After receiving incentives, fewer individuals reported experiencing food insecurity–related behaviors. A significantly increased intake (P < .05) was found among selected vegetables.
Participation in a farmers' market incentive program was positively related to greater food security and intake of select vegetables among participants in the Supplemental Nutrition Assistance Program.
Urban farmers' markets: Accessibility, offerings, and produce variety, quality, and price compared to nearby stores
2015, Appetite
Citation Excerpt :
First, it considered all FMs in an urban county rather than a more select sample in a smaller area. Second, investigators performed a comprehensive assessment of all foods offered at all FMs, as opposed to focusing on just select produce items (Larsen & Gilliland, 2009; Lee et al., 2010; Millichamp & Gallegos, 2013; Pearson et al., 2014; Wheeler & Chapman-Novakofski, 2014) or predominant produce varieties (McGuirt et al., 2011); analyses in the current study included almost twice as many distinct fresh-produce items as the next largest study to date (430 items vs. 230 items) (McGuirt et al., 2011). Third, analyses compared FMs to the one or two nearest stores selling fresh produce within walking distance, and considered separately the dimensions of accessibility, variety, quality, and price.
Most food-environment research has focused narrowly on select stores and restaurants. There has been comparatively less attention to non-storefront food sources like farmers' markets (FMs), particularly in urban communities. The objective of the present study was to assess FMs' potential contribution to an urban food environment in terms of specific foods offered, and compare FM accessibility as well as produce variety, quality, and price to that of nearby stores. Investigators conducted a detailed cross-sectional assessment of all FMs in Bronx County, NY, and of the nearest store(s) selling produce within a half-mile walking distance (up to two stores per FM). The study included 26 FMs and 44 stores. Investigators assessed accessibility (locations of FMs and stores relative to each other, and hours of operation for each), variety (the number and type of all food items offered at FMs and all fresh produce items offered at stores), quality (where produce items were grown and if they were organic), and price (including any sales prices or promotional discounts). Analyses included frequencies, proportions, and variable distributions, as well as mixed-effect regressions, paired t-tests, and signed rank tests to compare FMs to stores. Geographic information systems (GIS) allowed for mapping of FM and store locations and determining street-network distances between them. The mean distance between FMs and the nearest store selling fresh produce was 0.15 miles (range 0.02–0.36 miles). FMs were open substantially fewer months, days, and hours than stores. FMs offered 26.4 fewer fresh produce items on average than stores (p values <0.02). FM produce items were more frequently local and organic, but often tended toward less-common/more-exotic and heirloom varieties. FMs were more expensive on average (p values <0.001 for pairwise comparisons to stores) – even for more-commonplace and “conventional” produce – especially when discounts or sales prices were considered. Fully, 32.8% of what FMs offered was not fresh produce at all but refined or processed products (e.g., jams, pies, cakes, cookies, donuts, juice drinks). FMs may offer many items not optimal for good nutrition and health, and carry less-varied, less-common fresh produce in neighborhoods that already have access to stores with cheaper prices and overwhelmingly more hours of operation.

View all citing articles on Scopus

: The second author of this article (Chapman-Novakofski) served on the JNEB staff as Editor-in-Chief. Review of this article was handled, exclusively, by a Guest Editor to minimize conflict of interest.

: The authors have no conflict of interest to report with the sponsor of this supplement article or products discussed in this article.

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Research BriefFarmers' Markets: Costs Compared With Supermarkets, Use Among WIC Clients, and Relationship to Fruit and Vegetable Intake and Related Psychosocial Variables

Abstract

Objective

Methods

Results

Conclusions and Implications

Introduction

Section snippets

Cost of Fruits and Vegetables

Results

Discussion

Implications for Research and Practice

Acknowledgments

Am J Prev Med

J Nutr

J Nutr Educ Behav

J Nutr Educ Behav

J Nutr Educ Behav

J Nutr Educ Behav

J Am Diet Assoc

J Nutr Educ Behav

J Am Diet Assoc

J Nutr Educ Behav

J Am Diet Assoc

Dietary Guidelines for Americans, 2010

Fruit juice intake predicts increased adiposity gain in children from low-income families: weight status-by-environment interaction

Pediatrics

Research Brief
Farmers' Markets: Costs Compared With Supermarkets, Use Among WIC Clients, and Relationship to Fruit and Vegetable Intake and Related Psychosocial Variables