title: Evaluating the Influence of the Revised Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Allocation Package on Healthy Food Availability, Accessibility, and Affordability in Texas.
abstract: BACKGROUND
  The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was implemented to improve the health of pregnant women and children of low socioeconomic status. In 2009, the program was revised to provide a wider variety of healthy food choices (eg, fresh fruits, vegetables, and whole-grain items).
  
  
  OBJECTIVE
  The purpose of this study was to evaluate (1) the impact of the revised WIC Nutrition Program's food allocation package on the availability, accessibility, and affordability of healthy foods in WIC-authorized grocery stores in Texas; and (2) how the impact of the policy change differed by store types and between rural and urban regions.
  
  
  METHODS
  WIC-approved stores (n=105) across Texas were assessed using a validated instrument (88 items). Pre- (June-September 2009) and post-new WIC package implementation (June-September 2012) audits were conducted. Paired-sample t tests were conducted to compare the differences between pre- and post-implementation audits on shelf width and number of varieties (ie, availability), visibility (ie, accessibility), and inflation-adjusted price (ie, affordability).
  
  
  RESULTS
  Across the 105 stores, post-implementation audits showed increased availability in terms of shelf space for most key healthy food options, including fruit (P<0.001), vegetables (P<0.01), cereal (P<0.001), and varieties of vegetables (P<0.001). Food visibility increased for fresh juices (P<0.001). Visibility of WIC labeling improved for foods such as fruits (P<0.05), WIC cereal (P<0.05), and whole-grain or whole-wheat bread (P<0.01). Inflation-adjusted prices decreased only for bread (P<0.001) and dry grain beans (P<0.001). The positive effects of the policy change on food availability and visibility were observed in stores of different types and in different locations, although smaller or fewer effects were noted in small stores and stores in rural regions.
  
  
  CONCLUSIONS
  Implementation of the revised WIC food package has generally improved availability and accessibility, but not affordability, of healthy foods in WIC-authorized stores in Texas. Future studies are needed to explore the impact of the revised program on healthy food option purchases and consumption patterns among Texas WIC participants.
authors.forename: Wenhua
authors.initials: W
authors.lastname: Lu
authors.forename: E Lisako J
authors.initials: ELJ
authors.lastname: McKyer
authors.forename: Diane
authors.initials: D
authors.lastname: Dowdy
authors.forename: Alexandra
authors.initials: A
authors.lastname: Evans
authors.forename: Marcia
authors.initials: M
authors.lastname: Ory
authors.forename: Deanna M
authors.initials: DM
authors.lastname: Hoelscher
authors.forename: Suojin
authors.initials: S
authors.lastname: Wang
authors.forename: Jingang
authors.initials: J
authors.lastname: Miao
mesh_terms: D002675:Child, Preschool; D005260:Female; D063105:Food Assistance / Q000639:trends; D005515:Food Labeling / Q000639:trends; D005523:Food Supply / Q000191:economics; D005638:Fruit / Q000191:economics / Q000600:supply & distribution*; D062489:Health Impact Assessment; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018673:Nutrition Policy; D011203:Poverty; D011247:Pregnancy; D012423:Rural Health; D011795:Surveys and Questionnaires; D013781:Texas; D014504:Urban Health; D014675:Vegetables / Q000191:economics / Q000600:supply & distribution*; D000067348:Whole Grains / Q000191:economics / Q000600:supply & distribution*
keywords: Food accessibility; Food affordability; Food availability; Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package