PERCEPTIONS OF THE USAGE OF THE SPECIAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM FOR WOMAN, INFANTS, AND CHILDREN (WIC) BY RETAILERS
By Hannah Spencer
December 9, 2012
Objective: The cooperation and support of retailers is crucial to the success of the Special Supplemental Nutrition Assistance Program for Woman, Infants, and Children (WIC). This research sought to gain a better understanding of a diverse group of retailers’ perspectives on their patrons’ usage of the program three years after new guidelines for vouchers were implemented. Method: Three in-depth, qualitative interviews with managers or directors of a large chain supermarket, a small local cooperative market, and a local farmer’s market were conducted over a month time period. Results: The retailers spoke overall highly of WIC’S current guideline and its usage by their patrons, which is consistent with findings of previous studies. However, while enthusiastic about wanting to become more involved with WIC, both the cooperative market and farmer’s market felt there were challenges due to the rigid nature of the voucher requirements. Conclusion: This research provides a diverse group of retailers’ perspectives on WIC usage and may enhance knowledge on how to integrate WIC into more types of stores.
Why low socioeconomic status individuals continue to remain in the same class generation after generation is a fundamental question in the field of public health. In order to ensure that this vulnerable population has a chance of living of a higher quality of life, they must reach adulthood in good health. Children of low-income families and minority populations have a disproportionally high risk of childhood morbidity, obesity, cardiovascular disease, diabetes, anemia and other adverse health conditions (El-Bastawissi, Peters, Sasseen, Bell, & Manolopoulos, 2007; Sparks, 2010; Swanson, Roman-Shriver, Shriver & Goodell, 2007; Whaley, McGregor, Gomez,, Harrison, & Jenks, 2010). This is largely due to their poor dietary intakes early on in life (Andreyeva, Luedicke, Middleton, Long, & Schwartz, 2012).
There are large disparities in the nutrition quality of low socioeconomic children’s diets compared with the rest of the population. These children are more likely to be deficient in key nutrients such as vitamin A, vitamin B, calcium, zinc, and iron due to a lack of fruits, vegetables, whole grains and dairy products in their diets (Hillier, McLaughlin, Cannuscio, Chilton, Krasny, S., & Karpyn, A., 2012). Not starting life eating well hinders the health and proper development of these children’s bodies and denies them the knowledge to understand how to make proper lifelong dietary patterns (Andreyeva et al., 2012).
For more than four decades, the Special Supplemental Nutrition Assistance Program for Woman, Infants, and Children (WIC) has been helping to improve the nutritional status low-income households’ infants, children up to five years of age, and pregnant, breastfeeding, and postpartum women who are determined to be at nutritional risk (for example, because they are obese, underweight, or have anemia). These individuals must be within 185% of the poverty line to be eligible for the program, which for the 2012-2013 fiscal year meant having an income under $42,643 for a household of four (US Department of Agriculture, Food and Nutrition Service, Nutrition Assistance Programs WIC program eligibility, 2012). In 2012, 8.9 million individuals participated in WIC and the program’s annual cost was upwards of $68 million, which equals out to around $48 per person (US Department of Agriculture, Food and Nutrition Service, Nutrition Assistance Programs WIC Program 2012 Participation and Costs, 2012).
WIC functions not only by providing food to participants each month, but also nutrition counseling, breastfeeding education and access to other health and social services. The fundamental goal of the program is to ensure later Medicaid and healthcare savings by helping low socioeconomic children at a critical stage in their lives have better dietary habits (Lee & Mackey-Bilaver, 2007).
Federal food and nutrition assistance programs have a valuable role in helping low socioeconomic and minority children obtain better access to healthy and fresh food. The food vouchers implemented by WIC have major consequences on how 49,000 authorized WIC retailers stock their stores nationwide. The substantial effect that the 2009 WIC guideline revisions had on the availability of fresh foods in low-income areas highlights how critical these retailers cooperation is to the success of the program (Hillier et al., 2012).
Although WIC is a relatively small, it is one of the most studied government programs. The consensus of most of the research supports the claim that WIC participation does in fact accomplish the public health goal of decreasing healthcare costs long-term (Havens, Martin, Yan, Dauser-Forrest, & Ferris, 2012). While there are a multitude of studies on how WIC usage affects the health of participants, there is an overall lack of research completed on how retailers perceive participant usage of the program. The minimal number of studies that have been completed on retailers’ perspectives focus only large chain and small supermarkets, not other types of retailers such as farmer’s market or cooperative supermarkets.
In order to best understand how WIC is being used, it is important for more research to be completed on retailers’ perceptions of usage. Their cooperation and support of the program is vital to its success. The goal of this research study is to explore the perceptions of a wide-ranging group of store owners in a small Midwestern town on WIC usage through qualitative interviews. In order for WIC to be most effective, patrons must be able to redeem vouchers at a wide variety of locations. The USDA must be willing to adapt and work with a variety of stores. By examining different types of retailers’ perceptions, insight can be gained into how WIC can be implemented most effectively at a larger variety of stores.
In order to best understand managers’ perceptions on current WIC program usage, it is important to realize how the new 2009 guidelines have affected retailers and their patrons across the country over the last three years. The literature review conducted for this study examines previous studies’ findings on the effects of the 2009 food package revisions as well as studies’ on retailers’ perceptions of the changes.
Studies on new 2009 WIC Guidelines
Prior to the 2009 revisions, the food voucher options offered by WIC were coming under attack by nutrition and public health community. They had remained unchanged since 1980 despite increased understanding of nutrition and increased racial and ethnic diversity of participants (IOM, 2005). The packages up until 2009, contained no fruit or vegetables (except for a bag of carrots for nursing mothers) and contained large quantities of dairy products (milk and cheese) and juice (Havens et al., 2012).
The 2009 revisions of the WIC package had major effects on food retailers nationwide. The USDA updated the food package to minimize its added sugars, fats, oils, and salt while increasing fiber and other key nutrients including vitamin E and iron. Vouchers for six to ten dollars’ worth of fresh fruit and vegetables were added. While the amount of vouchers for fruit juice milk, cheese and eggs were all reduced. In addition, a requirement was placed on milk that it must be low-fat or skim, unless it is for toddlers under the age of two and a requirement was put on cheese that it must be unprocessed. To address the concerns over the food packages not accommodating cultural differences in food selection, vouchers for whole-wheat bread can now be substituted for tortillas, brown rice, oats and other grains. (Andreyeva et al., 2012).
There has been overwhelming praise for the new package guidelines. Research shows that the new food packages have resulted in increased consumption of whole grains, lower fat milk, and fruits and vegetables (Andreyeva et al., 2012; Whaley, Ritchie, Spector, & Gomez, 2012; WIC vouchers promote fruit and vegetable consumption, 2011). In addition, there have been substantial increases in consumption of potassium, iron and fiber (Yen, 2010).
It is important to note that these revisions mean that all authorized WIC retailers nationwide are now required to stock fresh produce, whole grains and lower-fat milk. This is resulting in low-income areas having better access to fresh foods (Hillier et al., 2012). The disparity between access to healthy food in low-income versus high-income areas has been decreased substantially by WIC now requiring stores to offer more healthy options, which is very valuable for children in low-income areas (Tester, Yen, Pallis, & Laraia, 2011). In addition, a study found that overall the obtainability and choice of frequently consumed fresh produce and availability of African-American culturally specific fresh produce has improved and that availability of low-sodium canned and frozen fruits and vegetables has modestly improved (Zenk, Odoms-Young, Powell, Campbell, Block, Chavez, & Armbruster, 2012).
Studies on retailers’ perceptions of the new WIC guidelines
While there has been ample research conducted on how these revisions have affected the health of WIC participants over the last three years, there has been little research on how it has affected retailers. This study was able to locate three published studies on vendor’s perspectives of the current WIC program.
A 2010 study of 52 Connecticut grocery store managers found that 71% of them reported to be “happy or very happy” to participate in the new WIC-program because of the additional sales from the products. The managers revealed that they feel the demand for healthy foods is not as high as for unhealthy foods and that unhealthy foods are more profitable and more desired by customers. They reported that there decisions on what to stock is most heavily influenced by what customers want, which is why they stock many unhealthy products. Despite reporting that integrating the new guidelines was at first somewhat challenging due to the perishable nature of the fresh produce, the WIC-authorized retailers surveyed said that they were able to adapt to the new requirements and stock the healthier foods. This study concluded that without policy change, these retailers would have never stocked these fresher and healthier options since they felt the demand and profitability of them was low. Researchers of this study concluded its results prove that WIC’s new guidelines created change in access to healthy foods and helped break down a barrier of accessibility low-income individuals have to face when shopping for food (Andreyeva, Middleton, Long, Luedicke & Schwartz, 2011).
Another 2011 study on 78 small-store owners from New Hampshire, Colorado, Pennsylvania and Wisconsin found that despite having some issues with refrigeration and perishability of certain WIC foods, these retailers also had an overall positive perception of the program. They felt the challenges presented by the new guidelines were somewhat easily overcome (Gleason, Mogan, Bel & Pooler, 2011).
A 2012 study done across seven states on 52 store owners and retailers revealed that they also were happy with the current WIC program and that after three years they have been able to adapt easily to the new guidelines. The retailers overall reported that the new WIC package did increase their number of customers, sales, and generally improved the “store atmosphere”. In addition, they reported that the increased selection of healthier foods seem to “please customers”. The retailers did report, however, that it was challenging to explain the new guidelines to customers at times and keep a steady supply of perishable food (Gittelsohn, Laska, Andreyeve, Foster, Rose, Tester, & Ayala, 2012).
Altogether these studies reported that while retailers first did experience some challenges integrating the new WIC guidelines in there stores at first, they currently are happy with the changes to the WIC program and have a positive perception of WIC overall. While these studies did all accomplish the goal of examining the usage of the new WIC packages from the perspective of the retailers, they did not take into account how different types of stores have adjusted to the changes. As mentioned earlier, this paper’s goal is to explore the perceptions of a more diverse group of store owners.
The method chosen to use for this research was qualitative interviewing. This allowed for a better and more in-depth grasp of managers’ perceptions and opinions to be had. The interview model was loosely based off of the 2012 Gittelsohn study on Small Retailer Perspectives of the 2009 Women, Infants and Children Program Food Package Changes (Gittelsohn et al.,). The Gittelsohn study is currently the only published research on retailers’ perspectives of the WIC program conducted by qualitative interviewing. While similar in methods to the Gittelsohn study, due to time and resources constraints this research was not as in-depth and large as the Gittelsohn study.
The point of using qualitative is to be able to obtain more in-depth responses from the sources. Also, it allows for more personalized follow-up questions and explanations of sources’ answers. By using this type of analysis, information can be extracted from the sources’ answers and themes can be categorized.
Nine different food retailers in a large, diverse Midwestern town were asked to participate in this study. The food retailers were solicited through emails and phone calls. When solicited all retailers were assured that there name and the name of their business would remain anonymous in the study in accordness with IRB human subject guidelines. It also was explained that the purpose of this research is for academic reasons.
Three of these food retailers responded to the interview requests. These three were from a diverse group of stores, one being a local farmers market, one a small local cooperative supermarket, and the last being a large supermarket.
The supermarket was large in size and located in a higher socioeconomic area of the town. (It should be noted that managers from supermarkets in a lower socioeconomic area of town was also asked to be interviews, but did respond). The supermarket is a large national chain, not local to the area.
The farmers market that participated is quite large in size and has been accepting food stamp vouchers since 2007. It works closely with the national WIC farmer’s market initiative. It is only open on Saturdays morning and Wednesday afternoons from April to November, which obviously limits patrons’ access to use the vouchers. It has vendors that sell a wide variety of good including local fresh produce, eggs, milk and meat.
The small cooperative supermarket that was in the study is local to the town and has three locations. It is has been in the area for 34 years and prides itself on giving back to the community. Its selection of food focuses on organic and locally grown foods.
Similar to the Gittelsohn study, the interviews consisted of four questions total and lasted from nine to twenty-three minutes. They were all conducted over the telephone.
The key research questions asked were: 1. How abundant is the usage of WIC at your establishment? 2. How is the new program being used (are all of the vouchers being used/how are they being used) 3. Do your patrons often ask you questions about how to use the program? If yes, do you have resources available to help them? 4. Do you feel WIC usage has a positive effect on your store and on society?
Question 1: How abundant is the usage of WIC at your establishment?
Overall, all of the retailers spoke in positive tone about WIC. While the large supermarket did claim to have the most usage of the program, the local farmer’s market has an impressive amount of vouchers being used for its size. All of the managers seemed eager to have more participation with the program. [Excerpts from the interviews are given below.]
LARGE SUPERMARKET MANAGER- “The use of WIC is EXTREMELY abundant in my store. While I have no specific statistic to give you I can say that the vouchers are constantly being used by patrons.”
LOCAL FARMER’S MARKET DIRECTOR- “We were the first market in the state to pilot the use of WIC benefits in 2007 and have continued since. Last year we issued $5,373 worth of SNAP benefits vouchers for use at Market. We call these vouchers Market Bucks.”
LOCAL COOPERATIVE GROCERY STORE- WIC is not heavily used at our store because of the selection of brands we supply. I think in the future WIC should become more used at co-ops since we do offer fresh produce and other products… We are centrally located in the area, which would help individuals that do not have cars.
Question 2: How is the program being used?
The purpose of this question is to address how the vouchers are actually being used. It is important that participants are redeeming all of vouchers in order to achieve a well-rounded and healthy diet. The cooperative supermarket manager was not included in this question because he was unsure how it is being used.
LARGE SUPERMARKET MANAGER- Almost always all of the vouchers are used. It used to be that the dried beans were not as often bought, but now with the option of peanut butter or beans that is not an issue as much….Substitutions of tortillas or oats for bread are something I rarely see. I don’t think a lot of patrons understand that they can do that…. The vegetable most often bought are carrots and the fruit are strawberries. Frozen fruits and vegetables are sometimes purchased too.
FARMER’S MARKET DIRECTOR- Vouchers may be used to purchase fruits and vegetables, meat and dairy, breads and other baked goods, cereal and edible grains, packaged food not for on-site consumption, and food-producing plants or seeds. It is up to the WIC client to choose and we do not track their purchases.
Question 3: Do your patrons often ask you questions about how to use the program?
The purpose of this question was to identify any confusion participants of WIC may have about the requirements. It also served as a way to find out how managers help participants understand how to use their vouchers.
LARGE SUPERMARKET MANAGER- I am asked questions about WIC every day, multiple times a day. I think the guidelines are clear and explained well. It’s just that first time users need a little help figuring out where in the store the products are located. We actually put up signs identifying WIC products to help shoppers We also have brochures up at all the registers identifying the product guidelines. The questions I am asked the most are about cheese, milk and fruits and vegetables … People often try to buy the whole milk and processed cheeses.
LOCAL FARMER’S MARKET DIRECTOR- I get asked questions every week… Information is available for people to read regarding how to use their benefits. We also train the vendors selling the product so that they correctly accept vouchers for eligible product.
LOCAL COOPERATIVE GROCERY STORE – I or someone else in the store gets asked a question about once a week. We usually can assist but not always.
Question 4: Do you feel WIC usage has a positive effect on your store and a positive effect on society?
Before this question was asked, the interviewer gave a brief statement about the intended purpose of the WIC program being to help enrich the nutritional status of low income families so that later healthcare problems can be avoided. The purpose of asking this question is to identify whether or not managers feel WIC is a worthwhile program to have at their store.
LARGE SUPERMARKET MANAGER- I think WIC is a good program. People using their vouchers generally have a wider range and healthier selection of groceries than the average customer. I think the amount of food patrons get is not a lot though and definitely not enough to make up an entire diet… I am glad my store has WIC available and is able to help shoppers use it.
FARMER’S MARKET DIRECTOR- Yes. It seems that every week new people are using SNAP benefits at Market. A hidden benefit is that people who are drawn to Market by the ability to use SNAP also become regular shoppers. My only suggestion for improvement is that it would be nice for the state of Indiana to institute a doubling program so clients can get extra value if they use their SNAP benefits at farmers‘ markets. This has been happening in Michigan, for example, for two seasons.
LOCAL COOPERATIVE GROCERY STORE – My store is not a big participant in the program so I am not exactly sure about the effects. I think it would be great to become more involved in the future.
The findings of this research are unique because such a diverse group of stores were interviewed. It is now three years since the new package has been introduced, so all of the retailers should be very familiar with the new guidelines. Overall, the retailers spoke highly of WIC and feel it benefits the community which is consistent with similar research on retailers’ perceptions of the program.
These results prove that a wide range of retailers are interested in integrating WIC use in the stores. The farmer’s market director has really taken initiative on implementing the program because of his belief in the strength of the program and its potential to help the community. Despite many challenges the more store might have to face, the cooperative store manager also is eager to learn how WIC can be integrated in the store.
It is important to note that according to the local supermarket, all of the vouchers are being used. This is critical to the success of the program. Also, critical is the fact that both the supermarket and farmers market have ways to help patrons understand how they can use their vouchers. This type of participation is also crucial to the success of the program.
Most of the initial challenges brought up by managers in previous studies used in the literature review (such as finding it hard to consistently stock perishable foods) were not an issue for any of these managers. None of them had a problem with stocking fresh produce and keeping it fresh. The biggest challenge brought up was by the cooperative store and that is figuring out how to work with the state and better identify the products from their stores that can potentially used for vouchers. As seen with the farmer’s market, this task can be accomplished.
There were several limitations in this study that need to be addressed. The largest limitation was the small response rate. While a diverse group of vendors were interviewed, a larger and diverse number of vendors would be most ideal to obtain accurate results. Also, vendors only in one small area of the country were interviewed. WIC is a national program so assessing only one area does not give a large enough scope of how the program is overall working.
Recommendations for future research would be to have qualitative interviews with a large number of managers from a diverse group of stores from multiple states. Also, having hard statistical data on how the vouchers are being used at each store over a year would be very beneficial since it would give the best picture of how the vouchers are actually being used. In addition, it would interesting to see how managers’ perceptions of how vouchers are being used correlate with actual usage. It also would be beneficial to see how fresh fruit and vegetable consumption changes throughout the seasons. Further research also can also potentially conduct to find out how the new guidelines have affected the supply of fresh produce at stores.
In conclusion, a qualitative study of a diverse group of retailers revealed that WIC usage is strongest in traditional supermarkets, but has the potential to grow in places such as cooperative supermarkets and farmers markets. Both the farmer’s market and supermarket retailers were informed and knowledgeable on WIC and eager to help patrons. Three years after the implementation of the new package guidelines, the traditional supermarket manager who receives the most business is very happy with the program and reports that the vouchers are being used as intended as congruent with similar studies’ findings. The farmer’s market by working with WIC has been able to assist vendors with integrating the program and desires to participate more in the future. Even the local cooperative store that has the most challenges to face in order to become more WIC user friendly is interested in doing so.
More efforts should be taken to help retailers, like this cooperative store manager, better understand how to work with WIC so as many people as possible can easily use their vouchers. It is by directly seeking out and communicating with vendors that this federal program can continue to improve. Without support from vendors this program cannot work. It is important to continue to emphasize the importance of these positive results and how influential food policy is to our food supply. By doing this, the health and well-being of the next generation will be safeguarded.
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