UCCE efforts improve quality of and demand for fresh produce at

UCCE efforts improve quality of and demand for fresh produce at

Research Article
UCCE efforts improve quality of and demand for fresh produce
at WIC A-50 stores
by Lucia L. Kaiser, Cathi Lamp, Chutima Ganthavorn, Lucrecia Farfan-Ramirez, Maya Behar, Marita Cantwell and Shermain Hardesty
In 2005, the Institute of Medicine recommended major revisions in the food packages
provided by the federal Special Supplemental Nutrition Program for Women, Infants,
and Children (WIC), leading to new regulations that allow participants to purchase
a wide variety of fruits and vegetables with their vouchers. In support of this policy
change, UC Agriculture and Natural Resources Cooperative Extension (UCCE) developed
educational materials to promote fresh produce among WIC participants and offered
postharvest handling training at WIC-only stores, known as A-50 vendors, in order to
improve produce quality. A survey conducted after the educational sessions found that
WIC participants had increased knowledge of produce and A-50 vendors showed improved postharvest handling after the education sessions. This research demonstrates
that combining nutrition education with postharvest handling curriculum can lead to
a successful educational program that supports increased demand among WIC participants for fresh produce.
I
n 2005, the Institute of Medicine (IOM)
recommended major revisions in the
food packages provided by the federal
Special Supplemental Nutrition Program
for Women, Infants, and Children (WIC)
(IOM 2005). These recommendations resulted in the first comprehensive changes
since 1980 in the foods provided by WIC,
a food assistance program that serves
low-income pregnant, breastfeeding or
postpartum women; infants; and children
up to 60 months of age with a nutritional
risk (USDA 2007). Revisions to the WIC
food packages (the specific foods and
amounts that may be purchased with
vouchers each month) were needed to
help this vulnerable group of participants
achieve dietary intakes in accordance
EXTEN
SIÓN
COOP
E R AT I VA
TENSION
TIVE EX
DE LA
with the Dietary Guidelines for
A
R
E
P
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NIA CO
CALIFOR
ITY OF
brinda I V E R S I D A D D E C A L I F O R N I A
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Americans
(USDHHS and USDA
w
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a
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h
a
W
Primav
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Based on evidence that WIC
Summer
populations
do not consume
Verano
sufficient amounts of fruit and
Spring
vegetables (IOM 2005), interim
federal regulations were implemented to allow WIC to issue
cash-value produce vouchers for $10
a month in the women’s packages
and $6 a month in the children’s
packages (USDA 2007). WIC vendors
are required to stock a minimum
of two different types of fruit and
Inviern
o
Autumn
vegetables, although the intent is that
Otoño
WIC participants will have access to
Winter
Conozc
a a su gr
a
wide variety of fruit and vegetables.
anjero
local
cal?
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Why Buy Lo
The
expectation is that participants
ar de pr
oductore
er
s locales
local farm
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Meet your
will receive nutrition education at WIC
sites on how to shop for produce to get
the maximum nutrition for their WIC
vouchers.
By October 2009, WIC agencies in all
50 states, tribal lands and U.S. territories had implemented the revised WIC
food packages. The impact of this policy
Manuel
rnia.
in Indio, Califo
lo was born
Manuel Pab he worked in the fields
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Manu
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Today, Manuel
state job. Manu
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ic produce. He
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ets, roadside
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companies. He
et and private
ables, fruits,
Angeles Mark
veget
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. Manuel is proud s to enjoy.
nuts and dates
produce for other
highest quality
ia
of Californ
University
Cooperative
rs:
n, UC Davis
Project Directo
st, Dept. of Nutritio
Extension Speciali
Lucia Kaiser,
Small Farm Program
Davis
Sciences, UC
ty, Director, UC
st, Dept. of Plant
Shermain Hardes
ll, Extension Speciali
Marita Cantwe
Department
the California
is funded by
This project
Pablo
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cultivados
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localmente
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Se requiere
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tos en el mis as granjas locales
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In support of the revised federal policy on WIC fruit and vegetable vouchers, UC ANR Cooperative
Extension researchers created posters and fact sheets to promote nutrition education and increase
demand for fresh produce among WIC participants.
Online: http://californiaagriculture.ucanr.edu/
landingpage.cfm?article=ca.v069n02p105&fulltext=yes
doi: 10.3733/ca.v069n02p105
http://californiaagriculture.ucanr.edu • APRIL–JUNE 2015 105
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Fact sheets
developed by
UCCE researchers
provide nutrition
information and tips on how
to choose, store, prepare and
serve different fruits and vegetables.
change on the retail environment where
WIC shoppers use their vouchers appears to be positive, albeit modest — A-50
vendors, for example, installed coolers
and began to carry a wider variety of
produce (Hardesty et al. 2015). One study
has published data on the revised policy’s
impact on dietary intake of WIC participants. In that study, small but significant
increases in fruit and vegetable intakes
were documented among WIC participants, as determined by cross-sectional
phone surveys conducted in California in
September 2009 and March 2010 (Whaley
et al. 2012).
About half of the more than 5,500 WICauthorized vendors in California are large
grocery stores that already carry a variety
of produce and therefore are not affected
by the federal requirement of stocking a
minimum of two different types of fruit
and vegetables. The other half includes
smaller stores as well as the WIC vendors
that have over 50% of their food sales
from WIC items, known as A-50 vendors.
Prior to the implementation of the new
WIC produce vouchers, the A-50 vendors
were not required to carry any fresh produce except carrots.
In 2010, a team of researchers from UC
Cooperative Extension (UCCE) exploring
the feasibility of a farm-to-WIC program
conducted a survey in three California
counties (Tulare, Alameda and Riverside)
to determine interest among WIC clientele in purchasing locally produced fruits
and vegetables, as well as the factors
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influencing produce choices (Kaiser et al.
2012). WIC participants reported a preference for fresh, good-quality produce,
demonstrating the demand-side viability
of a farm-to-WIC program. A companion
paper in this issue discusses the challenges of meeting this demand through
small-scale local farmers (Hardesty et al.
2015, page 98).
In this paper, we examine UCCE efforts to increase the demand for fresh
produce among WIC participants through
point-of-purchase education and to improve the quality of produce offered by
A-50 vendors through postharvest handling training. In addition, we review the
results of a small qualitative study we
conducted in 2012 on WIC clientele shopping behavior to assess the WIC population’s purchasing needs. The protocol for
this study was approved by the UC Davis
ea
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un emple
Institutional Review Board under exempt
status.
Educational materials
The UCCE nutrition researchers developed educational materials primarily
for use at the point of purchase (i.e., the
cash register or counter where customers pay) in A-50 stores, but also for use in
reinforcing nutrition education delivered
at WIC offices. Based on the findings of
the 2010 survey, the UCCE team identified
the following 18 produce items to target
for promotion and nutrition education
via single-page fact sheets in English and
Spanish: bell peppers, broccoli, cabbage,
cactus leaves (nopales), cantaloupe, carrots,
collard greens, grapes, green beans, lettuce, mustard greens, oranges, spinach,
strawberries, sweet potatoes, tomatillos,
tomatoes and watermelon.
TABLE 1. What WIC participants in Tulare and Riverside counties learned from the fact sheets
Theme
No. of comments Examples of participants’ comments*
Preparation
40
“I didn’t know spinach could go in a sandwich. I’ve never eaten spinach.”
“Oranges can be added to salad. It looks good.”
“How to cook it (mustard greens). You can stir-fry it.”
Storage
25
“Strawberries need to be used within 3 days.”
“How long nopales (cactus leaves) last — they need to be used in 1 week.”
“Store watermelon in the refrigerator if it is cut.”
Nutritional
value
21
“Vitamin C — I didn’t know that broccoli had it.”
“The nutrition cantaloupe has — it is good for you!”
Serving
17
“Different ways to serve grapes, like freezing them.”
“Mix puree (tomatillo) with sweet potatoes for babies.”
“Steam (green beans) until soft and serve with a little bit of butter.”
* n = 14–21 participants for each of the 18 fact sheets.
106 CALIFORNIA AGRICULTURE • VOLUME 69, NUMBER 2
available during each season. It can be
used as an activity for WIC participants to
pair up and brainstorm how they can use
seasonally available fruits and vegetables
to prepare meals for their families.
Postharvest handling training
Since produce quality is an important
factor affecting WIC customer purchases,
and handling perishable fresh produce
was a new task for many A-50 store employees, UCCE gave produce-handling
trainings to WIC distribution center
personnel and A-50 vendors. Between
2010 and 2012, a UCCE specialist visited
15 A-50 vendors in Alameda, Tulare and
Riverside counties to assess the need for
employee training. Based on the specialist’s observations and discussions with
A-50 store personnel, the project team
developed workshops that focused on
produce handling scenarios and how to
minimize losses. Although the main focus
was on handling the produce received by
the stores, the trainings also addressed
produce handling from harvest through
distribution to the stores. UCCE staff
covered topics such as temperature management with limited cold room space
available in the stores, control of water
loss, compatibility issues with a focus on
ethylene-sensitive produce (those damaged by exposure to ethylene gas, such as
lettuce and carrots), minimizing decay,
managing product turnover and maintaining postharvest conditions to retain
nutrients, among others.
The one-day workshop trainings at
WIC distribution centers involved mostly
female employees. Multiple trainings
were held: one session with five employees, two sessions with 25 employees each,
and a final session involving over 70
employees, with some attending via remote access. At the trainings, UCCE staff
distributed photos with examples of good
and poor handling practices occurring in
the A-50 stores and facilitated discussions
with store employees. For these sessions,
PowerPoint presentations, handouts and
thermometers were provided. To stimulate problem solving and discussion, the
presentations incorporated some of the
photos taken during the UCCE specialist’s
store visits.
Proper fruit and vegetable storage
is an example of the type of challenges
faced by A-50 vendors that UCCE staff
addressed in the trainings. In most of the
Marita Cantwell
Each fact sheet is designed for a limited-literacy audience and features a single fruit or vegetable with tips on how to
choose, store, prepare and serve the food
in ways that appeal to young children
(ucanr.edu/sites/comnut/mothersyoungchildren/Fact_Sheets/). UCCE researchers and assistants conducted cognitive
testing of the fact sheets at the WIC sites
in Tulare and Riverside counties, interviewing in person, one-on-one, between
14 and 21 different WIC participants in
English or Spanish for each of the 18 fact
sheets. UCCE staff used open-ended questions to probe for understanding of the
words, concepts and pictures used in the
fact sheets and to determine what new
information was gleaned. During the interviews, participants shared their ideas
and provided additional kid-friendly tips
for preparing or cooking the vegetable or
fruit.
Table 1 shows what the participants
learned from the fact sheets (in rank
order) about preparation, storage, nutritional value and serving of the produce
items. Most participants found the fact
sheets useful, especially the nutrition information and the tips on how to choose,
store and prepare produce. Most said
they learned something new from the fact
sheets; in particular, several people were
surprised at the differences in the shelf
life of various fruits and vegetables. Many
participants mentioned that they had
never eaten the vegetable before (collard
greens, mustard greens, cactus leaves,
sweet potatoes and spinach) but liked the
tips on how to prepare them. Some were
surprised that the fruits or vegetables can
be served to infants, particularly bell peppers, green beans, collard greens, tomatillos and watermelon.
Like the California WIC program,
UCCE has found that a learner-centered
approach (one in which instructors use
a variety of teaching methods to facilitate student learning) is more effective
in improving fruit and vegetable intake
(Gerstein et al. 2010; Kaiser et al. 2007)
than a traditional lecture-oriented approach. The produce fact sheets can be
used to provide information that is immediately useful to a WIC participant
who expresses interest in introducing that
food to her child. The “What’s In Season
Now?” poster, another educational resource created by the UCCE project team,
is a colorful visual showing produce
As a result of the new policy on WIC produce
vouchers, many A-50 vendors in California began
to carry a wider variety of fruits and vegetables.
A-50 stores, there are two temperature
options: refrigerated shelf space at about
41°F (5°C) or holding at room conditions,
59°F to 86°F (15°C to 30°C), depending on
the season and the store’s location. The
proper option for cool season vegetables
and packaged salads and other fresh-cut
products is the refrigerated cabinet. But
for chilling sensitive products, such as
tomatoes, there is no single correct option,
as ripeness, time and ambient temperature will be considerations. Another problem for stores is that fruit may arrive at
the store mature, but not ripe or ripened
and ready to eat. Managing the ripening process if needed, and then holding
ripe fruit in refrigerated shelf space, was
discussed as a strategy to prevent fresh
produce losses. Limes, which do not require ripening, can be problematic for
a different reason: in refrigeration they
turn brown due to chilling injury, while at
ambient conditions they turn yellow. The
UCCE specialist suggested that employees
use a technique of intermittent warming,
or switching the limes back and forth between the two temperature options. These
examples illustrate some of the problems
that were discussed with the objective of
finding workable solutions to minimize
fresh produce losses.
Over the 2-year period, an increased
level of knowledge was noticeable among
http://californiaagriculture.ucanr.edu • APRIL–JUNE 2015 107
employees who participated in repeat
discussions at the stores or the formal
training offerings. Their questions about
fresh produce handling became more
detailed and specific as their experience
and understanding grew. The UCCE specialist prepared four narrated PowerPoint
presentations using A-50 vendor produce
examples and answers to common postharvest handling questions for continuing
18
$6–$10
$11–$20
$21–$30
$31+
16
Number of survey respondents
14
12
10
8
6
4
2
0
All at once
One to two shopping
trips per week
Spread throughout
the month
Fig. 1. Frequency of WIC fruit and vegetable voucher spending in Alameda, Tulare and Riverside
counties based on dollar value of vouchers received the previous month (n = 62).
Highest quality produce (n = 23)
5
Can see, smell, touch before I buy (n = 19)
Ranking
4
Best bargains on produce (n = 14)
3
Convenience (n = 5)
2
Clearly displayed prices (n = 1)
1
0
5
10
15
Number of survey respondents
Fig. 2. WIC participants’ ranking of factors affecting their purchasing decisions.
108 CALIFORNIA AGRICULTURE • VOLUME 69, NUMBER 2
20
25
employee trainings (postharvest.ucdavis.
edu/libraries/video/PHVideosWIC/).
Survey of produce purchasing habits
To assess the need for future WIC
education sessions, UCCE researchers
conducted a qualitative survey in March
and April 2012 on the spending habits of
WIC shoppers. Data was collected from
WIC participants in Alameda, Riverside
and Tulare counties, who were recruited
while they waited to pick up WIC vouchers. Inclusion criteria were having at least
one child aged 12 to 47 months currently
enrolled in WIC; being the main WIC
shopper in the household; and being sufficiently fluent in Spanish or English to
complete the study. UCCE staff members
read aloud the surveys, which lasted 15 to
20 minutes, to participants in the waiting
areas of WIC offices or in a closed WIC
classroom, depending on the preferences
of the participant. Surveys conducted in
Spanish were translated into English and
qualitatively analyzed for purchasing
trends.
The sample included a total of 62 WIC
participants. Of the 62 respondents, five
identified as white/non-Hispanic and 56
identified as Latino/Hispanic (missing
data on one participant). In California as
a whole, roughly 80% of WIC participants
report Hispanic ethnicity (Whaley 2012).
The mean age of respondents was 29.2
years. A trend was observed towards a
positive relationship between the dollar
value of the produce voucher and frequency of spending: the smaller the dollar
value of the voucher, the more likely that
the entire voucher is spent in a single visit
(fig. 1). For participants receiving between
$6 and $10, this single point of spending
suggests a peak period of fruit and vegetable purchasing and subsequent consumption. However, this is not dependent
on when the vouchers are issued during
the month. When participants were asked
how soon they spent the vouchers after
they received them, those receiving $6
to $10 (65% of survey respondents) most
frequently replied, “it varies.” Eighty-five
percent of participants reported spending
their fruit and vegetable vouchers at the
same store where they spend other WIC
vouchers.
Based on their observations of the
store layout of the local A-50 vendors
and conversations with WIC staff, UCCE
nutrition researchers generated a list of
Over the 2-year period, an increased level of knowledge was
noticeable among employees who participated in repeat
discussions at the stores or the formal training offerings.
five factors that might influence WIC participants’ produce purchasing decisions.
Participants were given this list and asked
to rank the factors, with 5 being most important and 1 least important. Responses
from a total of 62 participants were
summed and the results show that quality
of produce received the highest ranking
and clearly displayed prices received the
lowest (fig. 2).
Overall, the quality of fruits and vegetables consistently ranked as very important to WIC participants. When asked to
list the five fruit and/or vegetable items
bought for the family most weeks and
used most often, participants reported
that they spend WIC vouchers more
frequently on fruits than on vegetables,
with bananas (77%) and apples (66%) being more frequent than carrots (45%) and
broccoli (37%) (table 2). Seven of the top 11
items purchased were produce items featured on the fact sheets.
Participants were shown examples of
the fruit and vegetable fact sheets. When
asked if they would like to receive this
kind of information, all but three (92%)
participants responded yes. Following a
“yes” response, participants were asked
TABLE 2. Fruits and vegetables purchased most
often with WIC produce vouchers
Respondents (n = 62) who
reported this item as one
of their five most common
produce purchases
Item
no.
%*
Bananas
48
77.4
Apples
41
66.1
Carrots
28
45.2
Broccoli
23
37.1
Tomatoes
20
32.3
Oranges
18
29.0
Lettuce
16
25.8
Strawberries
13
21.0
Grapes
12
19.4
Mangoes
7
11.3
Summer squash
7
11.3
Bolded items are featured in the fact sheets.
* Items for which % < 10 are not shown.
in what format they would like to receive
the sheets; 77% preferred paper handouts,
while the rest preferred other formats
such as Facebook, websites and mail.
Future education and research needs
The research described here demonstrates the success educational efforts can
have in support of the revised federal
policy on WIC produce vouchers. These
educational approaches should be seen
as individually effective and complementary. For example, availability of fresh
fruits and vegetables has the strongest influence on where WIC participants decide
to shop, and they reported spending fruit
and vegetable vouchers where they spend
other WIC vouchers. If produce in A-50
stores is unappealing due to poor handling, for example, WIC participants may
avoid the store altogether. A-50 vendors
would then lose both produce voucher
and other WIC food voucher profits.
Additionally, the results of our survey
on produce shopping habits show that
many of those receiving limited fruit
and vegetable vouchers spend them
all at once, suggesting produce is not
eaten immediately after purchasing, but
rather may sit for days in the home. This
highlights the necessity of postharvest
handling training to maintain the highest possible quality at purchase to ensure
needed shelf life in the home refrigerator
or cabinet. If educational efforts continue
or expand to other A-50 vendor locations,
the distribution of the fruit and vegetable
fact sheets should remain, combined with
postharvest handling training.
To further support and evaluate implementation of the WIC produce voucher
policy, additional research is needed in
the following areas: (1) Examining fruit
and vegetable purchasing behaviors in the
WIC population with earned income; (2)
determining the perceived value of different locally sourced produce items found
in A-50 stores; and (3) identifying changes
in produce purchasing habits and dietary
intake attributable to enrollment in WIC.
Educational approaches should provide guidance specifically tailored to the
needs of the target population. The pointof-purchase educational materials and
postharvest training of WIC A-50 store
employees in this study were designed
to respond to the food preferences and
dietary patterns of WIC participants in
California. This project demonstrated that
UCCE programs, specifically teaming up
nutrition with postharvest handling, can
lead to a successful educational program
that supports increased demand for fresh
produce. c
L.L. Kaiser is UC Agriculture and Natural Resources
Cooperative Extension (UCCE) Nutrition Specialist in the
Department of Nutrition at UC Davis; C. Lamp is UCCE
Nutrition, Family, and Consumer Sciences Advisor in
Tulare County; C. Ganthavorn is UCCE Nutrition, Family,
and Consumer Sciences Advisor in Riverside County;
L. Farfan-Ramirez is former UCCE Nutrition, Family,
and Consumer Sciences Advisor and County Director
in Alameda County; M. Behar was Graduate Student
Intern, Tufts University; M. Cantwell is UCCE Postharvest
Specialist in the Department of Plant Sciences at UC
Davis; and S. Hardesty is UCCE Small Farm Specialist in
the Department of Agricultural and Resource Economics
at UC Davis.
References
Gerstein DE, Martin AC, Crocker N, et al. 2010. Using
learner-centered education to improve fruit and vegetable intake in California WIC participants. J Nutr Educ
Behav 42:216–4.
Hardesty S, Leff P, Baameur A, et al. 2015. WIC fruit and
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[IOM] Institute of Medicine. 2005. WIC Food Packages:
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Packages. Washington, D.C.: National Academy Press.
415 p.
Kaiser LL, McMurdo TJ, Joy AB. 2007. The Food Stamp
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Extension 45(2). joe.org/joe/2007april/rb5.shtml (accessed Jan. 11, 2013).
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[USDA] US Department of Agriculture, Food and Nutrition Service. 2007. Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Revisions
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[USDHHS/USDA] US Department of Health and Human
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http://californiaagriculture.ucanr.edu • APRIL–JUNE 2015 109