Mixed methods evaluation of the COVID-19 changes to the WIC cash-value benefit for fruits and vegetables

Introduction

Recent cash-value benefit (CVB) increases are a positive development to help increase WIC participant fruits and vegetables (FV) access. Little is known about the impacts of the CVB changes on FV redemptions or about implementation successes and challenges among WIC State and local agencies. This mixed method study aimed to evaluate (a) the CVB changes' impact on FV access among WIC child participants measured by CVB redemption rates, (b) facilitators and barriers to CVB changes' implementation, and (c) differences in FV redemption and facilitators and barriers by race/ethnicity.

Methods

We requested redemption data from all 89 State agencies for April 2020 to September 2022 and utilized descriptive statistics, interrupted time series analysis (ITS), and generalized linear regression analysis. Additionally, we recruited State agencies, local agencies, and caregivers across the U.S. for interviews and used rapid qualitative analysis to find emerging themes anchored in policy evaluation and implementation science frameworks.

Results

We received redemption data from 27 State agencies and interviewed 23 State agencies, 61 local agencies, and 76 caregivers of child WIC participants. CVB monthly redemptions increased at $35/child/month compared to $9/child/month; however, adjusted ITS analyses found a decrease in redemption rates at $35/child/month. The decrease was not significant when the transition/first implementation month was excluded with rates progressively increasing over time. Differences were found among racial/ethnic groups, with lower redemption rates observed for non-Hispanic Black caregivers. Overall, WIC caregivers reported high satisfaction and utilization at the $35/child/month. The frequent and quick turnaround CVB changes strained WIC agency resources with agencies serving higher caseloads of diverse racial and ethnic populations experiencing greater issues with implementing the CVB changes.

Conclusion

Despite implementation challenges, the increased CVB shows promise to improve WIC participant FV access and satisfaction with WIC. WIC agencies need adequate lead time to update the CVB amounts, and resources and support to help ensure equitable distribution and utilization of the FV benefits.

Impact of price reductions, subsidies, or financial incentives on healthy food purchases and consumption: a systematic review and meta-analysis

Poor diets are a global concern and are linked with various adverse health outcomes. Healthier foods such as fruit and vegetables are often more expensive than unhealthy options. This study aimed to assess the effect of price reductions for healthy food (including fruit and vegetables) on diet. We performed a systematic review and meta-analysis on studies that looked at the effects of financial incentives on healthy food. Main outcomes were change in purchase and consumption of foods following a targeted price reduction. We searched electronic databases (MEDLINE, EconLit, Embase, Cinahl, Cochrane Library, and Web of Science), citations, and used reference screening to identify relevant studies from Jan 1, 2013, to Dec 20, 2021, without language restrictions. We stratified results by population targeted (low-income populations vs general population), the food group that the reduction was applied to (fruit and vegetables, or other healthier foods), and study design. Percentage price reduction was standardised to assess the effect in meta-analyses. Study quality was assessed using the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. 34 studies were eligible; 15 took place in supermarkets and eight took place in workplace canteens in high-income countries, and 21 were targeted at socioeconomically disadvantaged communities. Pooled analyses of 14 studies showed a price reduction of 20% resulted in increases in fruit and vegetable purchases by 16·62% (95% CI 12·32 to 20·91). Few studies had maintained the price reduction for over 6 months. In conclusion, price reductions can lead to increases in purchases of fruit and vegetables, potentially sufficient to generate health benefits, if sustained.

Linking a sugar-sweetened beverage tax with fruit and vegetable subsidies: A simulation analysis of the impact on the poor

BACKGROUND

US individuals, particularly from low-income subpopulations, have very poor diet quality. Policies encouraging shifts from consuming unhealthy food towards healthy food consumption are needed.

OBJECTIVES

We simulate the differential impacts of a national sugar-sweetened beverage (SSB) tax and combinations of SSB taxes with fruit and vegetable (FV) subsidies targeted to low-income households on SSB and FV purchases of lower and higher SSB purchasers.

METHODS

We considered a 1-cent-per-ounce SSB tax and 2 FV subsidy rates of 30% and 50% and used longitudinal grocery purchase data for 79,044 urban/semiurban US households from 2010-2014 Nielsen Homescan data. We used demand elasticities for lower and higher SSB purchasers, estimated via longitudinal quantile regression, to simulate policies' differential effects.

RESULTS

Higher-SSB-purchasing households made larger reductions (per adult equivalent) in SSB purchases than lower SSB purchasers due to the tax (e.g., 4.4 oz/day at SSB purchase percentile 90 compared with 0.5 oz/day at percentile 25; P < 0.05). Our analyses by household income indicated low-income households would make larger reductions than higher-income households at all SSB purchase levels. Targeted FV subsidies induced similar, but nutritionally insignificant, increases in FV purchases of low-income households, regardless of their SSB purchase levels. Subsidies, however, were effective in mitigating the tax burdens. All low-income households experienced a net financial gain when the tax was combined with a 50% FV subsidy, but net gains were smaller among higher SSB purchasers. Further, low-income households with children gained smaller net financial benefits than households without children and incurred net financial losses under a 30% subsidy rate.

CONCLUSIONS

SSB taxes can effectively reduce SSB consumption. FV subsidies would increase FV purchases, but nutritionally meaningful increases are limited due to low purchase levels before policy implementation. Expanding taxes beyond SSBs, providing larger FV subsidies, or offering subsidies beyond FVs, particularly for low-income households with children, may be more effective.

Association of a Fruit and Vegetable Subsidy Program With Food Purchases by Individuals With Low Income in the US

IMPORTANCE

Food insecurity is associated with a less healthy diet. The Supplemental Nutrition Assistance Program (SNAP) is associated with reduced food insecurity, but benefit levels may be insufficient for beneficiaries to afford healthy foods.

OBJECTIVE

To evaluate whether participation in SuperSNAP, a program that provides an additional $40 per month for the purchase of fruits and vegetables with no added sugar, sodium, or fat to SNAP beneficiaries, is associated with changes in food purchasing.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal cohort study used data from transaction records of a large supermarket chain with approximately 500 stores located across North Carolina from October 2019 to April 2020. Participants were SNAP beneficiaries.

EXPOSURE

SuperSNAP participation.

MAIN OUTCOMES AND MEASURES

Monthly spending on all fruits, vegetables, legumes, and nuts (primary outcome); spending on less healthy food categories; and spending on sugar-sweetened beverages as 1 category of less healthy foods. Monthly data on purchases by SNAP beneficiaries before and during SuperSNAP participation were compared with data from SNAP beneficiaries not enrolled in the program who shopped at the same stores. Overlap weighting (a propensity score-based method) was used to account for confounding, and linear mixed-effects models were fitted with random effects to account for repeated measures and clustering by store.

RESULTS

The study included 667 SuperSNAP participants and 33 246 SNAP beneficiaries who did not use SuperSNAP but shopped in the same stores; 436 SuperSNAP participants had preintervention data and were included in the main analysis. SuperSNAP participation was associated with increased monthly purchases of fruits, vegetables, nuts, and legumes ($31.84; 95% CI, $31.27-$32.42; P < .001; 294.52 oz; 95% CI, 288.84-300.20 oz; P < .001). Only a small increase in spending on less healthy food categories compared with the SNAP beneficiaries who did not use SuperSNAP ($1.60; 95% CI, $0.67-$2.53; P < .001) was observed. As total spending increased, the proportion of total food and beverage spending on less healthy foods significantly decreased (difference, 4.51%; 95% CI, 4.27%-4.74%; P < .001). Monthly spending on sugar-sweetened beverages decreased (difference, $1.83; 95% CI, $1.30-$2.36; P < .001).

CONCLUSIONS AND RELEVANCE

In this cohort study, participation in SuperSNAP was associated with meaningful increases in healthy food purchasing. Subsequent studies should investigate whether healthy food incentive programs improve health outcomes.

Agricultural cooperatives participating in vegetable supply chain integration: A case study of a trinity cooperative in China

Supply chain integration plays an important role in the development of the vegetable industry in terms of vegetable quality, vegetable safety, and vegetable security in rural China. This paper explores how agricultural cooperatives integrate the vegetable supply chain by taking a trinity cooperative as an example in China. It explains the translation concatenation of supply chain integration for this cooperative by constructing actor networks in four development stages, including the seed stage, start-up stage, development stage, and mature stage. The findings show that supply chain integration in production cooperation, supply & sales cooperation, and credit cooperation is a useful trinity cooperative model of supply chain integration for investigating vegetable supply chain integration through internal integration and external integration. This paper suggests that cooperatives in the vegetable supply chain should facilitate close coordination among different shareholders and further improve the efficiency of supply chain integration. The government should provide training opportunities and funding to encourage cooperatives to participate in supply chain integration within the vegetable industry.

Impact of COVID-19 on vegetable supply chain and food security: Empirical evidence from Bangladesh

In Bangladesh, the COVID-19 pandemic is likely to have substantial effects on the livelihood of people, but smallholder vegetables growers will be even more affected because of the perishability nature of the product. The first case of COVID-19 was confirmed in Bangladesh on 8th March, 2020 and consequently the country went into lockdown on 26 March, 2020. This study has made a survey of vegetables farmers through a mobile phone to understand the impact of COVID-19 on vegetables supply chain, gross margin and the future production plan of the growers. In Bangladesh, the lockdown has disrupted the food supply chain and increases the likelihood of food insecurity. Lockdown has impeded vegetable farmers’ access to markets, thus limiting their productive and sales capacities. The price of yield has dropped by more than half resulting in huge loss for vegetable growers. The loss incurred by the farmers for producing Brinjal, Cucumber, Pointed gourd, Yardlong beans and Bottle gourd are BDT 4900, BDT 10900, BDT 57400, BDT 52500 and BDT 18500 per acre respectively as a result of COVID-19. The decreased income increases farmers’ likelihood of vulnerability and food insecurity and poses a challenge to continued produce. ‘Cash support’ is more important than ‘food support’ in order to keep vegetable farmers in farming, to ensure a ready supply of necessary low-cost resources, and to help fight against the upcoming food shortage.

Exploring Influential Factors Including COVID-19 on Green Food Purchase Intentions and the Intention-Behaviour Gap: A Qualitative Study among Consumers in a Chinese Context

This study applied a qualitative approach to investigate the underlying influences on consumers' green food consumption from the intention generation phase to intention execution phase in the perspectives of purchase intention and the intention-behaviour gap (IBG). Additionally, the impact of the "Coronavirus Disease 2019" (COVID-19) pandemic on consumers' green food purchases was explored. Research data were derived from semi-structured in-depth interviews with 28 consumers and analyzed using grounded theory. The findings identified factors that influenced intentions and the IBG in the process of consumers' green food purchases. Specifically, these findings reported that health consciousness, perceived attributes, environmental consciousness, social influence, family structure, and enjoyable shopping experiences were identified as major drivers for generating consumers' green food purchase intentions. High prices of green food, unavailability issues, mistrust issues, and limited knowledge were factors triggering the gap between green food purchase intentions and behaviours. In addition, the results revealed that the COVID-19 crisis increased consumers' green food purchase intentions, whereas the IBG widens as a result of issues of unavailability, price, and panic. These findings will help stakeholders build future policy and suitable strategies to better promote green food consumption in the Chinese context.

Quantifying risk factors associated with light-induced potato tuber greening in retail stores

Light conditions in retail stores may contribute to potato greening. In this study, we aimed to develop a potato tuber greening risk rating model for retail stores based on light quality and intensity parameters. This was achieved by firstly exposing three potato varieties (Nicola, Maranca and Kennebec) to seven specific light wavelengths (370, 420, 450, 530, 630, 660 and 735 nm) to determine the tuber greening propensity. Detailed light quality and intensity measurements from 25 retail stores were then combined with the greening propensity data to develop a tuber greening risk rating model. Our study showed that maximum greening occurred under blue light (450 nm), while 53%, 65% and 75% less occurred under green (530 nm), red (660 nm) and orange (630 nm) light, respectively. Greening risk, which varied between stores, was found to be related to light intensity level, and partially explained potato stock loss in stores. Our results from this study suggested that other in-store management practices, including lighting duration, average potato turnover, and light protection during non-retail periods, likely influence tuber greening risk.

State-level income inequality and the odds for meeting fruit and vegetable recommendations among US adults

Background

Previous research indicates that income inequality is associated with risk for mortality, self-rated health status, chronic conditions, and health behavior, such as physical activity. However, little is known about the relationship between income inequality and dietary intake, which is a major risk factor for common chronic diseases including heart disease, stroke, diabetes, and certain types of cancers. The objective of this study is to determine the association between US state income inequality and fruit and vegetable consumption among adults.

Methods

Cross-sectional data on 270,612 U.S. adults from the U.S. 2013 Behavioral Risk Factor Surveillance System was used. Fruit and vegetable consumption was assessed from the six-item fruit and vegetable frequency questionnaire, which is part of the Behavioral Risk Factor Surveillance System. Multilevel modeling was used to determine whether US state-level income inequality (measured by the z-transformation of the Gini coefficient) was associated with fruit and vegetable consumption adjusting for individual-level and state-level covariates.

Results

In comparison to men, women were more likely to consume fruits and vegetables ≥5 times daily, fruits ≥2 times daily, vegetables ≥3 times of daily, and less likely to consume fruit juice daily. Among both men and women, a standard deviation increase in Gini coefficient was associated with an increase in consuming fruit juice daily (OR = 1.07, 95% CI = 1.03, 1.11). However, among women, a standard deviation increase in Gini coefficient was associated with a decreased likelihood in meeting daily recommended levels of both fruits and vegetables (OR = 0.93; 0.87–0.99), fruits only (OR = 0.95; 95% CI, 0.92–0.99) and vegetables only (OR = 0.92; 95% CI, 0.89–0.96).

Conclusions

This study is one of the first to show the relationship between income inequality and fruit and vegetable consumption among U.S. adults empirically. Women’s health is more likely to be detrimentally affected when living in a state with higher income inequality.

Analysis of Glyphosate Residues in Foods from the Canadian Retail Markets between 2015 and 2017

Underlying the risk management of pesticides to protect human health and to facilitate trade among nations are sound scientific data on the levels of compliance with standards set by governments and internationally from monitoring of the levels of pesticides in foods. Although glyphosate is among the universally used pesticides in the world, monitoring has been hampered by the analytical difficulties in dealing with this highly polar compound. Starting in 2015, using liquid chromatography/tandem mass spectrometry (LC-MS/MS) that permits accurate and reproducible determination of glyphosate, the prevalence, concentrations, and compliance rates were determined. In this work, the glyphosate residues contents of 7955 samples of fresh fruits and vegetables, milled grain products, pulse products, and finished foods collected from April 2015 to March 2017 in the Canadian retail market are reported. A total of 3366 samples (42.3%) contained detectable glyphosate residues. The compliance rate with Canadian regulations was 99.4%. There were 46 noncompliant samples. Health Canada determined that there was no long-term health risk to Canadian consumers from exposure to the levels of glyphosate found in the samples of a variety of foods surveyed. The high level of compliance (99.4% of samples with the Canadian regulatory limits) and the lack of a health risk for noncompliant samples indicate that, with respect to glyphosates, the food available for sale in Canada is safe.

Fruit and Vegetable Purchases in Farmer's Market Stands: Analysing Survey and Sales Data

Farmers' market implementation holds promise for increasing access to healthy foods. Although rarely measured, purchase data constitute an intermediate outcome between food environment and actual consumption. In a study conducted with two seasonal Fruits and Vegetables (FV) stands in a disadvantaged area of Montréal (Canada), we analysed how accessibility, perception, and mobility-related factors were associated with FV purchase. This analysis uses a novel measure of FV purchasing practices based on sales data obtained from a mobile application. A 2016 survey collected information on markets' physical access, perceived access to FV in the neighbourhood, usual FV consumption and purchases. Multivariate models were used to analyse three purchasing practice indicators: number of FV portions, FV variety and expenditures. Average shoppers purchased 12 FV portions of three distinct varieties and spent 5$. Shoppers stopping at the market on their usual travel route spent less (p = 0.11), bought fewer portions (p = 0.03) and a lesser FV variety (p < 0.01). FV stands may complement FV dietary intake. Individuals for whom the market is on their usual travel route might make more frequent visits and, therefore, smaller purchases. The novel data collection method allowed analysis of multiple purchase variables, is precise and easy to apply at unconventional points of sales and could be transposed elsewhere.

"You Guys Really Care About Me…": a Qualitative Exploration of a Produce Prescription Program in Safety Net Clinics

BACKGROUND

Although research shows produce prescription (PRx) programs increase fruit and vegetable (FV) consumption, little is known about how participants experience them.

OBJECTIVE

To better understand how participants experience a PRx program for hypertensive adults at 3 safety net clinics partnered with 20 farmers' markets (FMs) in Cleveland, OH.

DESIGN

We conducted semi-structured interviews with 5 program providers, 23 patient participants, and 2 FM managers.

PARTICIPANTS

Patients interviewed were mainly middle-aged (mean age 62 years), African American (100%), and women (78%). Providers were mainly middle-aged men and women of diverse races/ethnicities.

INTERVENTION

Healthcare providers enrolled adult patients who were food insecure and diagnosed with hypertension. Participating patients attended monthly clinic visits for 3 months. Each visit included a blood pressure (BP) check, dietary counseling for BP control, a produce prescription, and produce vouchers redeemable at local FMs.

APPROACH

Patient interviews focused on (1) beliefs about food, healthy eating, and FMs; (2) clinic-based program experiences; and (3) FM experiences. Provider and market manager interviews focused on program provision. All interviews were audio-taped, transcribed, and analyzed thematically.

KEY RESULTS

We identified four central themes. First, providers and patients reported positive interactions during program activities, but providers struggled to integrate the program into their workflow. Second, patients reported greater FV intake and FM shopping during the program. Third, social interactions enhanced program experience. Fourth, economic hardships influenced patient shopping and eating patterns, yet these hardships were minimized in some participants' views of patient deservingness for program inclusion.

CONCLUSIONS

Our findings highlight promises and challenges of PRx programs for economically disadvantaged patients with a chronic condition. Patient participants reported improved interactions with providers, increased FV consumption, and incorporation of healthy eating into their social networks due to the program. Future efforts should focus on efficiently integrating PRx into clinic workflows, leveraging patient social networks, and including economic supports for maintenance of behavior change.

Manager Perspectives on Implementation of a Farmers' Market Incentive Program in Maryland

OBJECTIVE

A growing number of farmers' markets offer incentive programs to increase access to fresh produce in low-income communities and support local farmers, yet program implementation has not been widely studied. This qualitative study explored market manager perspectives on implementing a Maryland statewide farmers' market incentive program.

DESIGN

Semistructured interviews with market managers.

SETTING

Participating farmers' markets across Maryland.

PARTICIPANTS

Managers of participating farmers' markets (n = 19).

PHENOMENON OF INTEREST

Barriers and facilitators to program implementation and recommendations for improvement.

ANALYSIS

Interviews were analyzed using a phronetic iterative approach and themes were organized using an adapted version of a multilevel implementation framework.

RESULTS

Managers reported overall favorable attitudes toward the incentive program. They identified barriers to implementation such as vendor buy-in and funding uncertainties, facilitators such as private fund-raising and local champions, and opportunities for improvement such as strengthening promotion and increasing the use of technology to reduce the data collection burden.

CONCLUSIONS AND IMPLICATIONS

Managers identified implementation barriers (eg, customer confusion) and facilitators (eg, ease of staff training) that may be shared by other incentive programs. Based on these findings, barriers and recommendations may be addressed through collaborative problem-solving with managers, vendors, and customers, and facilitators can be amplified broadly. Future research is warranted to explore incentive program implementation in other settings.

Profit Analysis of Papaya Crops under Greenhouses as an Alternative to Traditional Intensive Horticulture in Southeast Spain

The high-yield agricultural model in Almería is based on eight different crops. Having led fruit and vegetable exports in Spain for more than 50 years, a decrease in melon and watermelon growing areas in Almería caused a change in supply that affected the model's profit. Papaya cultivation could reactivate the profit of the agricultural model in Almería and also improve the available product range. The papaya crop needs greenhouse infrastructures high enough to contain the growth and size of the plants during a cycle crop, which is possible in most of the greenhouses of the Horticultural production model of Almería. The papaya harvests obtained in the region meet the quality requirements demanded by European markets. Furthermore, yields obtained are equal or higher than yields obtained by other producing countries. This crop improves profit compared with the profit obtained from the rotation of other horticultural crops that have been traditionally grown in the region.

Low intake of commonly available fruits and vegetables in socio-economically disadvantaged communities of South Africa: influence of affordability and sugary drinks intake

BACKGROUND

Consumption of fruits and vegetables reduces the risk of obesity, diabetes, cancer, cardiovascular mortality and all-cause mortality. The study assessed the pattern of intake and the factors that influence daily intake of commonly available fruits and vegetables in economically disadvantaged South African communities.

METHODS

This is a cross-sectional study nested on an ongoing longitudinal study in South Africa. Two communities (a rural and urban) of low socio-economic status were purposely selected from two of the nine provinces. A sample of 535 participants aged 30-75 years was randomly selected from the longitudinal cohort of 1220; 411 (78%) women. Data were collected using validated food frequency and structured interviewer-administered questionnaires. Descriptive and multivariate regression analysis were undertaken.

RESULTS

A higher proportion of participants in the urban township compared to their rural community counterparts had purchased fruits (93% vs. 51%) and vegetables (62% vs. 56%) either daily or weekly. Only 37.8% of the participants consumed at least two portions of commonly available fruits and vegetables daily, with no differences in the two communities. Daily/weekly purchase of sugar sweetened beverages (SSBs) was associated with daily intake of fruits and vegetables (p = 0.014). Controlling for age and gender, analysis showed that those who spent R1000 (USD71.4) and more on groceries monthly compared to those who spent less, and those who travelled with a personal vehicle to purchase groceries (compared to those who took public transport) were respectively 1.6 times (AOR, 95% CI: 1.05-2.44; p = 0.030) and 2.1 times (AOR, 95% CI: 1.06-4.09; p = 0.003) more likely to consume at least two or more portions of fruits and vegetables daily. Those who purchased SSBs daily or weekly were less likely (AOR, 95% CI: 0.54, 0.36-0.81, p = 0.007) to consume two or more portions of fruits and vegetables daily. The average household monthly income was very low (only 2.6% of households earned R5000 (US$357.1); and education level, attitude towards fruits and vegetables and owning a refrigerator had no significant association with fruits and vegetable daily intake.

CONCLUSION

These findings indicate that affordability and frequency of purchase of sugary drinks can influence daily intake of fruits and vegetables in resource-limited communities.

Knowledge, Attitudes, Beliefs and Behaviors regarding Fruits and Vegetables among Cost-offset Community-Supported Agriculture (CSA) Applicants, Purchasers, and a Comparison Sample

Community-supported agriculture (CSA) participation has been associated with high fruit and vegetable (FV) consumption, which may be due to better access to FV for CSA purchasers, or to positive knowledge, attitudes, and beliefs (KAB) regarding healthy eating among CSA applicants. The objective of this study was to examine KAB and consumption, in association with application to a cost-offset CSA (CO-CSA) program, and with CO-CSA purchase among applicants. We conducted a cross-sectional survey of CO-CSA applicants and a comparison sample in August 2017. All respondents were English-reading adults with a child 2–12 years old and household income of ≤185% of the federal poverty level. Among CO-CSA applicants, some were CO-CSA purchasers (n = 46) and some were not (n = 18). An online comparison sample met equivalent eligibility criteria, but had not participated in CSA for three years (n = 105). We compared CO-CSA applicants to the comparison sample, and compared purchasers and non-purchaser sub-groups, using Mann-Whitney U tests and chi-square analysis. CO-CSA applicants reported better knowledge, self-efficacy, home habits, and diet than the comparison sample. Among applicants, CO-CSA purchasers and non-purchasers had equivalent KAB, but children in purchaser households had higher FV consumption than in non-purchaser households (4.14 vs. 1.83 cups, p = 0.001). Future research should explore associations between CO-CSA participation and diet using experimental methods.

Market vegetable hygiene practices and health risk perceptions of vegetable sellers in urban Ghana

The paper examines the hygiene practices and health risk perception of vegetable sellers in urban Ghana. Based on a qualitative in-depth study of vegetable sellers drawn from five purposively sampled markets in Kumasi Metropolis, the study found that the vegetable sellers have generally low risk perception. Consequently, the vegetable handling practices by these market women remain largely unsafe presenting potential health risks to consumers. Regular monitoring by relevant agencies and sustained public education are therefore key for reducing market contamination which is critical for maintaining a healthy population.

One-Year Follow-Up Examination of the Impact of the North Carolina Healthy Food Small Retailer Program on Healthy Food Availability, Purchases, and Consumption

We examined the short-term impact of the North Carolina Healthy Food Small Retailer Program (HFSRP), a legislatively appropriated bill providing funding up to $25,000 to small food retailers for equipment to stock and promote healthier foods, on store-level availability and purchase of healthy foods and beverages, as well as customer dietary patterns, one year post-policy implementation. We evaluated healthy food availability using a validated audit tool, purchases using customer bag-checks, and diet using self-reported questionnaires and skin carotenoid levels, assessed via Veggie Meter™, a non-invasive tool to objectively measure fruit and vegetable consumption. Difference-in-difference analyses were used to examine changes in HFSRP stores versus control stores after 1 year. There were statistically significant improvements in healthy food supply scores (availability), with the Healthy Food Supply HFS score being -0.44 points lower in control stores and 3.13 points higher in HFSRP stores pre/post HFSRP (p = 0.04). However, there were no statistically significant changes in purchases or self-reported consumption or skin carotenoids among customers in HFSRP versus control stores. Additional time or other supports for retailers (e.g., marketing and promotional materials) may be needed for HFSRP implementation to influence purchase and consumption.

The effect of an extra piece of fruit or vegetables at school on weight status in two generations - 14 years follow-up of the Fruit and Vegetables Makes the Marks study

BACKGROUND

The obesity epidemic presents a major public health challenge, and a poor diet quality has been identified as one of the most important contributing factors. Whereas a sufficient fruit and vegetable consumption has been associated with several positive health outcomes, the long-term effect on overweight and obesity is unclear. Thus, the aims of this study were to investigate if one year with free school fruit had any effect on weight status 14 years later, and if it affected the birth weight of the participants' children.

METHODS

In 2001, 10 -12-year old Norwegian children, received one year of free school fruit in the intervention study "Fruits and Vegetables Make the Marks" (FVMM) and in 2016, a total of 1081 participants of 2049 eligible responded to a follow-up survey. Multilevel logistic regression was used to investigate if one year of free school fruit was associated with weight status and with birthweight status of the offspring. The analyses were adjusted for gender, educational level, and the offspring analysis also for parents' weight status, and the nested design (child/parent).

RESULTS

The odds ratios of being overweight (OR: 0.93, 95% CI: 0.70, 1.24) or having a child with high or low birth weight (OR: 0.52, 95% CI: 0.21, 1.30) in the intervention group compared to the control group were not statistically significant, 14 years after the intervention period.

CONCLUSIONS

One year of free school fruit did not have an effect on weight status on the participants or birth weight of their offspring, 14 years after the intervention period. Although, results from the present study contribute to fill the knowledge gaps concerning long-term effects of public health efforts on weight status, more follow-up studies with larger samples are warranted.

The cost-effectiveness of a 20% price discount on fruit, vegetables, diet drinks and water, trialled in remote Australia to improve Indigenous health

This paper estimates the cost-effectiveness of a 20% price discount on healthy food and beverages with and without consumer nutrition education, as trialled in remote Northern Australia. Changes in actual store sales, from the pre-discount baseline period, were analysed for population impact on consumption of fruit and vegetables, water and artificially sweetened soft drinks, in addition with total dietary weight (grams), energy (Mega Joules), and sodium (milligrams). Disability Adjusted Life Years (DALYs), arising from changes in dietary risk factor prevalence in the population, were estimated as the primary health outcome in a multi health-state Markov model. The costs of the strategies were sourced from paid invoices and time estimates of staff providing store-based discount promotion and consumer education. The incremental cost-effectiveness ratio adopted a partial societal perspective, (including health and retail sector costs), as cost per DALY averted and was presented in 2011 Australian dollars. The price discount, helped address a gap in food price equity for residents of remote communities. However, the discount strategy, with or without consumer education led to a net loss of population health –36 95%CI (-47,-25) or -21(-28, -15) DALYs respectively, at increased cost to the retail and health sectors, of AUD860000 95%CI (710000, 1million) or AUD500000 (410000, 590000). The strategies trialled were thereby categorised as dominated by current practice while acknowledging considerable uncertainty surrounding the health outcome estimates. The 20% discount on limited targeted products appeared to need to be considered in conjunction with other marketing strategies to support healthy food choices, if remote Australian Indigenous population health is to be improved.

Seasonal variability of the vitamin C content of fresh fruits and vegetables in a local retail market

BACKGROUND

Seasonal variation of vitamin C in fresh fruits and vegetables is not reflected in food composition database average values, yet many factors influence content and retention.

RESULTS

Fresh fruits and vegetables were sampled on three occasions in each season, from the same local retail outlets, for 1 or 2 years. Vitamin C was significantly higher in winter-sampled spinach (436 mg kg^-1 ) compared with spring (298 mg kg^-1 ) and summer/fall (180 mg kg^-1 ); in potatoes in summer/fall (156 mg kg^-1 ) versus winter/spring (106 mg kg^-1 ); and in oranges in winter (616 mg kg^-1 ), spring (592 mg kg^-1 ), and summer (506 mg kg^-1 ). Ranges were dramatic among sampling occasions for broccoli, oranges, potatoes, and spinach (700-1210 mg kg^-1 , 420-780 mg kg^-1 , 70-280 mg kg^-1 , and 90-660 mg kg^-1 respectively). Mean values for apples, bananas, tomatoes, and potatoes differed from the USDA National Nutrient Database for Standard Reference (SR) average by ≥10% of the daily recommended intake (90 mg). For broccoli, oranges, and spinach, vitamin C was substantially above or below the SR range in 50-100% of the samples. For spinach, the average content did not differ from SR, but vitamin C in winter was 55% higher than SR.

CONCLUSION

Database average values for vitamin C in fresh produce can significantly over- or underestimate the content in a specific food supply. © 2018 Society of Chemical Industry.

Impact on Dietary Choices After Discount Supermarket Opens in Low-Income Community

OBJECTIVE

To examine (1) the association of a new supermarket opening with dietary intake and perceptions of healthy food availability, and (2) associations of distance to the primary food store and mean prices of fruits, vegetables, and sugary beverages with levels of consumption of these foods and body mass index in a low-income, southeastern community.

METHODS

The researchers used cross-sectional, self-administered questionnaire data and supermarket audit data collected in the supermarket community and comparison community before (2015) and after (2016) the supermarket opening. A difference-in-difference analysis employed propensity scores to compare pretest and posttest differences between communities.

RESULTS

There were no significant differences between communities on dietary behaviors. There was a significant cross-sectional, inverse association between distance to the primary food store and fruit and vegetable consumption among all respondents in 2016.

CONCLUSIONS AND IMPLICATIONS

The results suggest that adding a new discount supermarket is not necessarily associated with improvements in residents' fruit, vegetable, or sugary beverage consumption, or in their perceptions of the availability of healthy food in the neighborhood. However, distance to the store may be important.

A Cluster-Randomized Trial of a Mobile Produce Market Program in 12 Communities in North Carolina: Program Development, Methods, and Baseline Characteristics

BACKGROUND

Mobile markets are an increasingly popular method for providing access to fresh fruits and vegetables (F/V) in underserved communities; however, evaluation of these programs is limited, as are descriptions of their development, study designs, and needs of the populations they serve.

OBJECTIVE

Our aim was to describe the development and theoretical basis for Veggie Van (VV), a mobile produce market intervention, the study design for the VV evaluation, and baseline characteristics of the study population.

DESIGN

The protocol and sample for a cluster-randomized controlled trial with 12 sites are described.

PARTICIPANTS/SETTING

Community partner organizations in the Triangle region of North Carolina that primarily served lower-income families or were located in areas that had limited access to fresh produce were recruited. Eligible individuals at each site (older than 18 years of age, self-identified as the main shoppers for their household, and expressed interest in using a mobile market) were targeted for enrollment. A total of 201 participants at 12 sites participated in the VV program and evaluation, which was implemented from November 2013 to March 2016.

MAIN OUTCOME MEASURES

Change in F/V intake (cups/day), derived from self-reported responses to the National Cancer Institute F/V screener, was the main outcome measure.

STATISTICAL ANALYSES PERFORMED

We performed a descriptive analysis of baseline sample characteristics.

RESULTS

Mean reported F/V intake was 3.4 cups/day. Participants reported generally having some access to fresh F/V, and 57.7% agreed they could afford enough F/V to feed their family. The most frequently cited barriers were cost (55.7%) and time to prepare F/V (20.4%). Self-efficacy was lowest for buying more F/V than usual and trying new vegetables.

CONCLUSIONS

By addressing cost and convenience and building skills for purchasing and preparing F/V, the VV has the potential to improve F/V consumption in underserved communities.

Consumption of vegetables and their relation with ultra-processed foods in Brazil

OBJECTIVE To characterize the household purchase and the individual consumption of vegetables in Brazil and to analyze their relation with the consumption of ultra-processed foods. METHODS We have used data on the purchase of food for household consumption and individual consumption from the 2008-2009 Brazilian Household Budget Survey. The Brazilian Household Budget Survey studied the purchase of food of 55,970 households and the food consumption of 34,003 individuals aged 10 years and over. The foods of interest in this study were vegetables (excluding roots and tubers) and ultra-processed foods. We have described the amount of vegetables (grams) purchased and consumed by all Brazilians and according to the quintiles of caloric intake of ultra-processed food. To this end, we have calculated the crude and predicted values obtained by regression models adjusted for sociodemographic variables. We have analyzed the most commonly purchased types of vegetables (% in the total amount) and, in relation to individual food consumption, the variety of vegetables consumed (absolute number), the participation (%) of the types of culinary preparations based on vegetables, and the time of consumption. RESULTS The adjusted mean household purchase of vegetables was 42.9 g/per capita/day. The adjusted mean individual consumption was 46.1 g. There was an inverse relation between household purchase and individual consumption of vegetables and ultra-processed foods. Ten types of vegetables account for more than 80% of the total amount usually purchased. The variety consumed was, on average, 1.08 type/per capita/day. Approximately 60% of the vegetables were eaten raw, and the amount consumed at lunch was twice that consumed at dinner; individuals with higher consumption of ultra-processed foods tended to consume even less vegetables at dinner. CONCLUSIONS The consumption of vegetables in Brazil is insufficient, and this is worse among individuals with higher consumption of ultra-processed foods. The most frequent habit was to consume raw vegetables at lunch and with limited variety.

Incentivizing Fruit and Vegetable Purchasers at Fresh Markets in Lower 9th Ward, New Orleans

Objective

Disparities in fruit and vegetable consumption have been observed across income and race-ethnicity and shown to be associated with both access to fresh food venues and price. This study assesses the feasibility of increasing produce consumption by incentivizing fruit and vegetable purchases at local markets.

Design

We conducted analyses of a cross-sectional survey of program participants and point-of-sale reports on fruit and vegetable purchases at the fresh food markets.

Setting

Five fresh food markets in the Lower Ninth Ward (LNW) of New Orleans, Louisiana.

Participants

A total of 176 participants were enrolled in the "Veggie Dollars" program (VDP).

Intervention

From January to July 2016, Sankofa, our community partner, recruited patrons at its markets into the VDP, a fresh food incentive program. Participants received coupons worth $4 per week for fruit and vegetables over a six-week period.

Main Outcome Measures

Total monthly gross, VDP, and SNAP benefit sales at the markets measured program participation. A survey (N=96) assessed the demographics and fruit and vegetable purchasing practices of participants.

Results

Participants were predominantly women (81%), African American (94%) and raising children at home (53%). Point-of-sales data indicated that VDP sales nearly doubled over the intervention period. Total market sales and SNAP benefit purchases also increased. The majority (63%) of VDP participants reported their produce purchases increased and 89% reported increasing their consumption of fruit and vegetables since entering the program.

Conclusions

Monetary incentives were associated with increased fruit and vegetable purchases at local fresh food markets in a low-income minority community.

Checking the detail in retail: Occurrence of Cryptosporidium and Giardia on vegetables sold across different counters in Chandigarh, India

Fresh produce has been recognized as a vehicle of infection for protozoan parasites, particularly Cryptosporidium, and, to a lesser extent, Giardia. For both parasites, outbreaks associated with fresh produce have been documented. Although documented outbreaks tend to be from industrialized countries, contamination of fresh produce with these parasites is a global issue. In developing countries, infections with these parasites are often endemic in the community, and basic infrastructure and hygiene measures may be inadequate, thus the likelihood of contamination of fresh produce with these parasites may be higher. Realization of the importance of this transmission route comes against a backdrop of raw salads and more Western culinary habits gaining a foothold, and fresh produce being encouraged as part of the diet due to their associated health benefits. However, if consumption of uncooked fresh produce is going to increase its market sector in India, it is important that it is safe. In this study, various types of fresh produce obtained from three types of vendors in Chandigarh, a major city in Northern India, were analyzed for contamination with Cryptosporidium oocysts and Giardia cysts using a method that has been previously validated in inter-laboratory spiking experiments. A total of 284 samples of different fresh produce items were analyzed, obtained from the different retailers situated in different societal layers of the city. The overall prevalence of contamination of fresh produce with these parasites was just under 11%, with 6% of the vegetables contaminated with Cryptosporidium oocysts, and 5% with Giardia cysts. Contaminated vegetables included turnip, cabbage, carrot, chili, coriander, cucumber, radishes, and tomatoes. Molecular analyses identified contamination with Cryptosporidium parvum and Giardia duodenalis of Assemblage A and Assemblage D, indicating that contamination from animals may be of relevance. Although the prevalence of contamination is similar to those reported in previous studies, the levels of contamination on some items of fresh produce were relatively high. Although the different socioeconomic areas of Chandigarh from which the samples were obtained was not associated with likelihood of contamination, fresh produce from supermarkets had heavier contamination with Cryptosporidium oocysts than fresh produce purchased through other sales outlets. The results are discussed in relation to the fresh produce chain and sales models in Chandigarh, both in terms of where contamination may occur and the potential importance of fresh produce as a transmission vehicle.

Psychosocial Influences on Fruit and Vegetable Intake Following a NYC Supermarket Discount

OBJECTIVE

To assess the effect of a 50% discount on fruits and vegetables (F&V) on the purchase and intake of F&V and on psychosocial determinants of F&V intake: self-efficacy (SE), stages of change (SOC), and perceived barriers (PB).

METHODS

This randomized controlled trial was conducted in local supermarkets over 16 weeks, including a 4-week baseline, 8-week discount intervention, and 4-week follow-up. Shoppers with overweight or obesity (BMI > 25) were randomized to receive a discount or no discount via their reward scan card after the baseline. Twenty-four-hour recalls and psychosocial measures were obtained for each study period.

RESULTS

Purchases (P < 0.0005) and intakes (P = 0.019) of F&V increased significantly during the intervention, while only F&V intake was sustained at follow-up. The discount intervention increased SE (P < 0.01) and SOC (P < 0.05) and did not decrease PB (P = 0.057) during the intervention. SOC mediated the discount intervention effect on F&V intake (P < 0.05) during the intervention, explaining 43% of variance.

CONCLUSIONS

A supermarket discount intervention led to increases in purchases and intakes of F&V and increases in the psychosocial factors SE and SOC and did not decrease PB. The discount intervention prompted participants to move from the preparation to action stage of SOC, which acted as a mediator for increased F&V intake.

Increasing Use of a Healthy Food Incentive: A Waiting Room Intervention Among Low-Income Patients

INTRODUCTION

Diet-related disease is disproportionately concentrated in low-income communities where fruit and vegetable consumption is far below guidelines. To address financial barriers, Double Up Food Bucks (DUFB)-a statewide healthy food incentive-matches Supplemental Nutrition Assistance Program (SNAP) funds spent at farmers markets. However, incentive use is limited. This study examined the impact of a brief waiting room-based intervention about DUFB on program utilization and produce consumption.

STUDY DESIGN

Longitudinal, repeated measures, quasi-experimental trial.

SETTING/PARTICIPANTS

SNAP-enrolled adults at a health center in a low-income, racially and ethnically diverse area of Southeast Michigan.

INTERVENTION

Participants received a brief explanation of DUFB, written program materials, a map highlighting market locations and hours, and an initial $10 market voucher. DUFB use and produce consumption were measured through four surveys over 5 months (August 2014-January 2015).

MAIN OUTCOME MEASURES

Outcome measures included DUFB use and fruit and vegetable consumption (analyses conducted in 2015-2016).

RESULTS

A total of 302 eligible adults were identified, and 177 (59%) enrolled. One hundred twenty-seven (72%) completed all surveys. At baseline, 57% of participants reported shopping at a farmers market within the last year; 18% had previously used DUFB. By the end of the DUFB season, participants were significantly more likely to report DUFB use than at baseline (AOR=19.2, 95% CI=10.3, 35.5, p<0.001), with 69% of participants reporting use of DUFB at least once, and 34% reporting use of DUFB three or more times. Adjusted fruit and vegetable consumption increased from baseline by 0.65 servings/day (95% CI=0.37, 0.93, p<0.001) at 3 months, and remained 0.62 servings/day (95% CI=0.32, 0.92, p<0.001) higher than baseline 2 months post-DUFB season.

CONCLUSIONS

A brief clinic-based intervention was associated with a nearly fourfold increase in uptake of a SNAP incentive program, as well as clinically and statistically significant increases in produce consumption. Results suggested sustained behavior change even once the financial incentive was no longer available. Providing information about healthy food incentives is a low-cost, easily implemented intervention that may increase produce consumption among low-income patients.

High Occurrence Rate and Contamination Level of Bacillus cereus in Organic Vegetables on Sale in Retail Markets

Organic foods have risen in popularity recently. However, the increased risk of bacterial contamination of organic foods has not been fully evaluated. In this study, 100 samples each of organic and conventional fresh vegetables (55 lettuce samples and 45 sprout samples) sold in South Korea were analyzed for aerobic bacteria, coliforms, Escherichia coli, and Bacillus cereus. Although the aerobic bacteria and coliform counts were not significantly different between the two farming types (p > 0.05), the occurrence rate of B. cereus was higher in organically cultivated vegetables compared with those grown conventionally (70% vs. 30%, respectively). The mean contamination level of B. cereus-positive organic samples was also significantly higher (1.86 log colony-forming unit [CFU]/g vs. 0.69 log CFU/g, respectively) (p < 0.05). In addition, six samples of organic vegetables were found to be contaminated with B. cereus at over 4 log CFU/g categorized as unsatisfactory according to Health Protection Agency guideline. The relatively higher occurrence rate of B. cereus in organic vegetables emphasizes the importance of implementing control measures in organic vegetable production and postharvest processing to reduce the risk of food poisoning.

The healthfulness of food and beverage purchases after the federal food package revisions: The case of two New England states

OBJECTIVE

In 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) implemented new food packages to improve dietary intake among WIC participants. This paper examines how the healthfulness of food purchases among low-income households changed following this reform.

METHODS

Point-of-sale data for 2137 WIC-participating and 1303 comparison households were obtained from a regional supermarket chain. The healthfulness of purchased foods and beverages was determined per their saturated fat, sugar, and sodium content. A pre-post assessment (2009-2010) of the product basket healthfulness was completed using generalized estimating equation models. Data were analyzed in 2015.

RESULTS

At baseline, healthy products accounted for most of the food volume purchased by WIC participants, but beverages were dominated by moderation (less healthy) items. With new subsidies for fruit, vegetables and whole grains, the WIC revisions increased the volume of healthy food purchases of WIC-participating households by 3.9% and reduced moderation foods by 1.8%. The biggest improvements were reductions in moderation beverages (down by 24.7% in volume), driven by milk fat restrictions in the WIC food package revisions. The healthfulness of the product basket increased post-WIC revisions; mainly due to a reduction in the volume of moderation food and beverages purchased (down by 15.5%) rather than growth in healthy products (up by 1.9%). No similar improvements were seen in a comparison group of low-income nonparticipants.

CONCLUSIONS

After the WIC revisions, the healthfulness of participant purchases improved, particularly for beverages. Efforts to encourage healthy eating by people receiving federal food assistance are paying off.

Sustainability assessment of greenhouse vegetable farming practices from environmental, economic, and socio-institutional perspectives in China

To provide growing population with sufficient food, greenhouse vegetable production has expanded rapidly in recent years in China and sustainability of its farming practices is a major concern. Therefore, this study assessed the sustainability of greenhouse vegetable farming practices from environmental, economic, and socio-institutional perspectives in China based on selected indicators. The empirical data were collected through a survey of 91 farm households from six typical greenhouse vegetable production bases and analysis of environmental material samples. The results showed that heavy fertilization in greenhouse vegetable bases of China resulted in an accumulation of N, P, Cd, Cu, Pb, and Zn in soil, nutrient eutrophication in irrigation water, and high Cd in some leaf vegetables cultivated in acidic soil. Economic factors including decreased crop yield in conventional farming bases, limited and site-dependent farmers' income, and lack of complete implementation of subsidy policies contributed a lot to adoption of heavy fertilization by farmers. Also, socio-institutional factors such as lack of unified management of agricultural supplies in the bases operated in cooperative and small family business models and low agricultural extension service efficiency intensified the unreasonable fertilization. The selection of cultivated vegetables was mainly based on farmers' own experience rather than site-dependent soil conditions. Thus, for sustainable development of greenhouse vegetable production systems in China, there are two key aspects. First, it is imperative to reduce environmental pollution and subsequent health risks through integrated nutrient management and the planting strategy of selected low metal accumulation vegetable species especially in acidic soil. Second, a conversion of cooperative and small family business models of greenhouse vegetable bases to enterprises should be extensively advocated in future for the unified agricultural supplies management and improved agricultural extension service efficiency, which in turn can stabilize vegetable yields and increase farmers' benefits.

Food Price Policies May Improve Diet but Increase Socioeconomic Inequalities in Nutrition

Unhealthy eating is more prevalent among women and people with a low socioeconomic status. Policies that affect the price of food have been proposed to improve diet quality. The study's objective was to compare the impact of food price policies on the nutritional quality of food baskets chosen by low-income and medium-income women. Experimental economics was used to simulate a fruit and vegetable subsidy and a mixed policy subsidizing healthy products and taxing unhealthy ones. Food classification was based on the Score of Nutritional Adequacy of Individual Foods, Score of Nutrients to Be Limited nutrient profiling system. Low-income (n = 95) and medium-income (n = 33) women selected a daily food basket first at current prices and then at policy prices. Energy density (ED) and the mean adequacy ratio (MAR) were used as nutritional quality indicators. At baseline, low-income women selected less healthy baskets than medium-income women (less fruit and vegetables, more unhealthy products, higher ED, lower MAR). Both policies improved nutritional quality (fruit and vegetable quantities increased, ED decreased, the MAR increased), but the magnitude of the improvement was often lower among low-income women. For instance, ED decreased by 5.3% with the fruit and vegetable subsidy and by 7.3% with the mixed subsidy, whereas decreases of 13.2 and 12.6%, respectively, were recorded for the medium-income group. Finally, both policies improved dietary quality, but they increased socioeconomic inequalities in nutrition.

Feasibility and Acceptability of Brighter Bites: A Food Co-Op in Schools to Increase Access, Continuity and Education of Fruits and Vegetables Among Low-Income Populations

Intake of fruits and vegetables (F&V) continues to be low in children in the United States. The purpose of this study was to conduct a pilot feasibility evaluation of Brighter Bites, a school-based food co-op to provide access to fresh F&V and nutrition education to low-income children and their families. Brighter Bites is a 16-week school-based food co-op consisting of: (1) Weekly distribution of 50-60 servings of fresh F&V; (2) Weekly bilingual parent handouts and recipe demonstrations; and (3) implementing CATCH, a coordinated school health program in schools. Brighter Bites was pilot tested using a pre-post evaluation design in one charter school in Houston, TX, USA (n = 57 3rd grade parent-child dyads; 94.1 % Hispanic, 91 % low-income). Evaluation, at baseline, midpoint, and post-intervention, included self-reported child and parent surveys on psychosocial factors, dietary habits and mealtime practices. Pearson's Chi square test, Fisher's exact-test or paired t test were used to determine changes pre- to post-intervention (at p < 0.05). Process data using parent surveys, teacher surveys, attendance logs, and produce cost data were used to determine feasibility and acceptability of program. Participants received on average 61 servings of F&V weekly for 16 weeks at the cost of $4.31/family/week. Results showed significant increases in child reported self-efficacy, outcome expectations and attitudes towards consuming F&V (p < 0.05). We found significant increases in child exposure to F&V and child preference of various F&V from baseline to post-intervention (p < 0.05). Parent surveys showed significant improvements in mealtime practices at home: decrease in children eating while watching TV, increase in eating dinner with the family, less fast food, less sugary drinks with meals, more children asking for F&V as snacks. Process data showed 98 % retention rate and high parent acceptability of program components. Brighter Bites is a promising strategy to increase F&V access and education in low-income populations using existing infrastructure of schools and food banks.

Is there willingness to buy and pay a surcharge for agro-ecological products? Case study of the production of vegetables in Xochimilco, Mexico

BACKGROUND

Around the world there are approximately 2.5 trillion small-scale farmers, most of them subsistence farmers. In the 1970s the green revolution unfolded, which brought benefits to some producers, but it also brought costs, especially for small producers. Agro-ecology is presented as an alternative, but it is necessary to examine whether it is accepted in the markets, especially in developing countries.

RESULTS

This study proves that there is a potential market, in this case in Mexico, but that it will depend on some socio-economic variables such as age, income, gender, product information, among others. Similarly, it is evident that buyers are willing to make an additional payment as compensation.

CONCLUSION

Agro-ecology should not be considered as subsistence farming incompatible with the markets. It offers good prospects for increasing production and improving the sustainability of agriculture in marginal areas with few economic resources.

Effects of financial incentives for the purchase of healthy groceries on dietary intake and weight outcomes among older adults: A randomized pilot study

Providing financial incentives can be a useful behavioral economics strategy for increasing fruit and vegetable intake among consumers. It remains to be determined whether financial incentives can promote intake of other low energy-dense foods and if consumers who are already using promotional tools for their grocery purchases may be especially responsive to receiving incentives. This randomized controlled trial tested the effects of offering financial incentives for the purchase of healthy groceries on 3-month changes in dietary intake, weight outcomes, and the home food environment among older adults. A secondary aim was to compare frequent coupon users (FCU) and non-coupon users (NCU) on weight status, home food environment, and grocery shopping behavior. FCU (n = 28) and NCU (n = 26) were randomly assigned to either an incentive or a control group. Participants in the incentive group received $1 for every healthy food or beverage they purchased. All participants completed 3-day food records and a home food inventory and had their height, weight, and waist circumference measured at baseline and after 3 months. Participants who were responsive to the intervention and received financial incentives significantly increased their daily vegetable intake (P = 0.04). Participants in both groups showed significant improvements in their home food environment (P = 0.0003). No significant changes were observed in daily energy intake or weight-related outcomes across groups (P < 0.12). FCU and NCU did not differ significantly in any anthropometric variables or the level at which their home food environment may be considered 'obesogenic' (P > 0.73). Increased consumption of vegetables did not replace intake of more energy-dense foods. Incentivizing consumers to make healthy food choices while simultaneously reducing less healthy food choices may be important.

Nutrient Density and the Cost of Vegetables from Elementary School Lunches

Vegetables are the major source of the dietary fiber, magnesium, potassium, and vitamins A and C that are crucial in the diets of children. This study assessed the nutrient content of vegetables offered through the National School Lunch Program and examined the relation between the overall nutrient density of vegetable subgroups and the costs of nutrients offered and wasted before and after the changes in school meal standards. Using data collected from 3 elementary schools before and after the changes in school meal standards, we found that vegetable plate waste increased from 52% to 58%. Plate waste for starchy vegetables, exclusive of potatoes, was relatively high compared with other subgroups; however, plate waste for white potatoes was the lowest among any type of vegetable. Energy density; cost per 100 g, per serving, and per 100 kcal; and percentage daily value were calculated and used to estimate nutrient density value and nutrient density per dollar. Cost per 100 kcal was highest for red/orange vegetables followed by dark green vegetables; however, nutrient density for red/orange vegetables was the highest in the group and provided the most nutrients per dollar compared with other subgroups. Given that many vegetables are less energy dense, measuring vegetable costs per 100 g and per serving by accounting for nutrient density perhaps is a better way of calculating the cost of vegetables in school meals.

Challenges in devising economic spray thresholds for a major pest of Australian canola, the redlegged earth mite (Halotydeus destructor)

BACKGROUND

A key component for spray decision-making in IPM programmes is the establishment of economic injury levels (EILs) and economic thresholds (ETs). We aimed to establish an EIL for the redlegged earth mite (Halotydeus destructor Tucker) on canola.

RESULTS

Complex interactions between mite numbers, feeding damage and plant recovery were found, highlighting the challenges in linking H. destructor numbers to yield. A guide of 10 mites plant(-1) was established at the first-true-leaf stage; however, simple relationships were not evident at other crop development stages, making it difficult to establish reliable EILs based on mite number. Yield was, however, strongly associated with plant damage and plant densities, reflecting the impact of mite feeding damage and indicating a plant-based alternative for establishing thresholds for H. destructor. Drawing on data from multiple field trials, we show that plant densities below 30-40 plants m(-2) could be used as a proxy for mite damage when reliable estimates of mite densities are not possible.

CONCLUSION

This plant-based threshold provides a practical tool that avoids the difficulties of accurately estimating mite densities. The approach may be applicable to other situations where production conditions are unpredictable and interactions between pests and plant hosts are complex.

Fruit and vegetable consumption and food values: National patterns in the United States by Supplemental Nutrition Assistance Program eligibility and cooking frequency

BACKGROUND

More frequent cooking at home may help improve diet quality and be associated with food values, particularly for individuals participating in the Supplemental Nutrition Assistance Program (SNAP).

OBJECTIVE

To examine patterns of fruit and vegetable consumption and food values among adults (aged 20 and older) in the United States, by SNAP participation and household cooking frequency.

METHODS

Analysis of cross-sectional 24-hour dietary recall data obtained from the National Health and Nutrition Examination Survey 2007-2010 (N=9560).

RESULTS

A lower percentage of SNAP participants consumed fruit (total: 35% vs. 46%, p=0.001; fresh: 30% vs. 41%, p<0.001) and vegetables (total: 49% vs. 58%, p=0.004; fresh: 35% vs. 47%, p<0.001) than those ineligible for SNAP. Among SNAP participants, cooking >6times/week was associated with greater vegetable consumption compared to cooking <2times/week (175g vs. 98g, p=0.003). SNAP-eligible individuals who cooked ≥2times/week were more to report price (medium cookers: 47% vs. 33%, p=0.001; high cookers: 52% vs. 40%, p<0.001), ease of preparation (medium cookers: 36% vs. 28%, p=0.002; high cookers: 36% vs. 24%, p<0.001) and how long food keeps (medium cookers: 57% vs. 45%, p<0.001; high cookers: 61% vs. 50%, p<0.001) as important compared to SNAP-ineligible individuals.

CONCLUSIONS

Fruit and vegetable consumption in the United States is low regardless of cooking frequency. Efforts to improve diet quality should consider values on which food purchases are based.

School- and family-level socioeconomic status and health behaviors: multilevel analysis of a national survey in wales, United Kingdom

BACKGROUND

Interventions to address inequalities in adolescent health behaviors often target children from less affluent families, or schools in poorer areas. Few studies have examined whether school- or family-level affluence predicts health behaviors independently, or in combination.

METHODS

This article reports secondary analysis of the Welsh Health Behavior in School-aged Children (HBSC) survey. Mixed-effects logistic regression models test associations of school and family socioeconomic status (SES) with smoking, fruit and vegetable consumption, alcohol consumption, and physical activity.

RESULTS

Higher family SES was associated with healthier behaviors, except in relation to alcohol consumption. For all behaviors except physical activity, school-level SES was independently associated with healthier behaviors. In higher SES schools, a stronger association of family SES with health behavior was observed, particularly in relation to smoking and physical activity.

CONCLUSIONS

School and family SES may exert independent and combined influences upon adolescent health behaviors. Targeting interventions toward deprived schools may fail to address substantial inequalities within more affluent schools. Targeting deprived families may fail to address behaviors of children from affluent families, attending more deprived schools. Identifying universal health improvement interventions which have greater effects among children from poorer backgrounds may be a more effective means of reducing inequalities.

Salty or sweet? Nutritional quality, consumption, and cost of snacks served in afterschool programs

BACKGROUND

Snacks served in afterschool programs (ASPs, 3-6 pm) represent an important opportunity to promote healthy eating. ASP policies suggest a fruit/vegetable is served daily, while sugar-sweetened foods/beverages and artificially flavored snacks are eliminated. Limited information exists on the types of snacks served in ASPs, if snacks meet existing nutrition policies, whether children eat the snacks, and their cost.

METHODS

Direct observation of snacks served and consumed was collected in 20 ASPs serving over 1700 elementary age children. The number of days that snacks were served/week was evaluated for compliance with nutrition policies. Costs of snacks were collected via receipts.

RESULTS

Programs served desserts and artificially flavored salty snacks on 2.7 and 2.1 days/week. Fruits and vegetables were served 0.6 and 0.1 days/week, respectively. Sugar-sweetened beverages were served 1.8 days/week. Of the children (N = 383) observed, 75% to 100% consumed the snack served, with 95% and 100% of served fruits/vegetables consumed. No ASP served fruit/vegetables daily, 18 served sugar-sweetened foods, 16 served artificially flavored snacks, and 14 served sugar-sweetened beverages. Desserts and salty snacks cost $0.27-$0.32/snack vs $0.38-$0.40/snack for vegetables/fruits.

CONCLUSIONS

The quality of snacks failed to meet nutrition policies and consists of predominately high-sugar and artificially flavored options. Strategies to improve snack offerings in ASPs while addressing price barriers are required.

Eat Smart, Live Strong intervention increases fruit and vegetable consumption among low-income older adults

This study evaluated the impact of a four-session interactive nutrition education program-Eat Smart, Live Strong (ESLS)-on the consumption of fruit and vegetables by low-income older adults. A pre-post quasi-experimental design study was conducted with a longitudinal sample of 614 low-income Supplemental Nutrition Assistance Program (SNAP) participants and those eligible for SNAP, aged 60 to 80 years, in 17 intervention and 16 comparison senior centers in Michigan. The study compared participants' self-reports of their consumption of fruit and vegetables using a modified version of the University of California Cooperative Extension Food Behavior Checklist. ESLS increased participants' average daily consumption of fruit by 0.2 cups (P < 0.05) and vegetables by 0.31 cups (P < 0.01). ESLS, a four-session, cognitive-behavioral nutrition education program is an effective curriculum for helping low-income older adults eat more fruit and vegetables.

Small RNA profiles from virus-infected fresh market vegetables

Functional small RNAs, such as short interfering RNAs (siRNAs) and microRNAs (miRNAs), exist in freshly consumed fruits and vegetables. These siRNAs can be derived either from endogenous sequences or from viruses that infect them. Symptomatic tomatoes, watermelons, zucchini, and onions were purchased from grocery stores and investigated by small RNA sequencing. By aligning the obtained small RNA sequences to sequences of known viruses, four different viruses were identified as infecting these fruits and vegetables. Many of these virally derived small RNAs along with endogenous small RNAs were found to be highly complementary to human genes. However, the established history of safe consumption of these vegetables suggests that this sequence homology has little biological relevance. By extension, these results provide evidence for the safe use by humans and animals of genetically engineered crops using RNA-based suppression technologies, especially vegetable crops with virus resistance conferred by expression of siRNAs or miRNAs derived from viral sequences.

[The nutrition transition and the double burden of malnutrition: changes in dietary patterns 1961-2009 in the Mexican socioeconomic context]

The purpose of this study was to identify whether there were changes in the composition of dietary patterns from 1961 to 2009, if food patterns by income level and the increase in the price of certain basic foods of the diet in the socioeconomic Mexican context, could explain the nutrition transition and the double burden of malnutrition. We conducted an ecological study with data from FAO balance sheets. To construct eating patterns cluster analysis was performed. Engel curves were developed with data from the 2012 INEGI ENGH survey and evolution of the relative price of some foods was calculated. The diet was defined in three dietary patterns. The increase in the total availability of energy increased from 2316 kcal/person/day in 1961 to 3146 in 2009. Dietary pattern modifications are in line with the nutrition transition and the double burden of malnutrition. It was observed that the energy derived from cereals and from legume (common beans) was significantly reduced, and simultaneously, the energy from sugars, animal foods and vegetable fats had a dramatic increase. Spending on food was differential according to income level. Malnutritionis mediated by the unequal distribution of income, the relatively low cost of energy-dense foods, the increased cost of nutritious foods, and limited support to agriculture.

Food prices and obesity: a review

In response to rising rates of obesity in the United States due in part to excess food consumption, researchers and policy makers have argued that levying food taxes on obesity-promoting foods, perhaps combined with subsidies on healthier options, would be an effective tool to stem the obesity epidemic. The extent to which overall energy intake or weight outcomes will improve as a result of these policies is ultimately an empirical question. This review examines the link between food or beverage price changes and energy intake or weight outcomes among U.S. consumers. Current evidence indicates that, by themselves, targeted food taxes and subsidies as considered to date are unlikely to have a major effect on individual weight or obesity prevalence. While research suggests that the effects are modest, food taxes and subsidies may play an important role in a multifaceted approach to reducing obesity incidence.

Obesity and economic environments

This review summarizes current understanding of economic factors during the obesity epidemic and dispels some widely held, but incorrect, beliefs. Rising obesity rates coincided with increases in leisure time (rather than increased work hours), increased fruit and vegetable availability (rather than a decline in healthier foods), and increased exercise uptake. As a share of disposable income, Americans now have the cheapest food available in history, which fueled the obesity epidemic. Weight gain was surprisingly similar across sociodemographic groups or geographic areas, rather than specific to some groups (at every point in time; however, there are clear disparities). It suggests that if one wants to understand the role of the environment in the obesity epidemic, one needs to understand changes over time affecting all groups, not differences between subgroups at a given time. Although economic and technological changes in the environment drove the obesity epidemic, the evidence for effective economic policies to prevent obesity remains limited. Taxes on foods with low nutritional value could nudge behavior toward healthier diets, as could subsidies/discounts for healthier foods. However, even a large price change for healthy foods could close only part of the gap between dietary guidelines and actual food consumption. Political support has been lacking for even moderate price interventions in the United States and this may continue until the role of environmental factors is accepted more widely. As opinion leaders, clinicians play an important role in shaping the understanding of the causes of obesity.