A locally-driven fruit and vegetable voucher pilot program implemented through WIC

Background: There are significant cost barriers to increasing fruit and vegetable (F&V) intake in low-income households. In collaboration with San Francisco's WIC program, we implemented a pilot project to evaluate the feasibility of a locally-driven F&V voucher intervention to reduce systolic blood pressure among young, low-income women. Methods: We recruited non-pregnant women participating in the Supplemental Nutrition Assistance Program for Women, Infants and Children (WIC). All participants had pre-hypertension or stage 1 hypertension (SBP 120-159 and/or DBP 80-99 mmHg). Participants received vouchers redeemable for $40 in fresh F&V's ($10 per week for 4 weeks) from participating vendors. The goals of this project were to 1)assess the feasibility of leveraging the WIC program's infrastructure to implement a locally-driven voucher initiative, and 2)develop preliminary estimates of change in F&V consumption and blood pressure resulting from the intervention. Results: All except one of the vendors (n=28)approached joined the program. Of the 196 women screened, 24% had pre-hypertension or Stage 1 hypertension. We enrolled 30 of these women into the 4-week pilot. Most participants (86%) reported little or no trouble redeeming vouchers. Using a validated F&V screener, 70% of women reported an increase, 9% no change, and 22% a decrease in their F&V intake. SBP decreased in 65% of participants, with mean SBP decreasing from 121.7 mmHg (SD 10.6) at baseline to 121.3 mmHg (SD 7.9) at follow-up (intent-to-treat analysis). Discussion: Among WIC participants, a community-based F&V voucher program is feasible to implement and has the potential to improve F&V intake and blood pressure.