Abstract 03: Choice Architecture Increases WIC Fruit and Vegetable Purchases in a Latino Community: Randomized, Controlled Corner Store Intervention

Abstract

Background: In 2009, the Special Supplemental Nutrition program for Women, Infants, and Children (WIC) increased access to healthy foods by providing cash-value vouchers for fruit/vegetables, but improving access alone is not sufficient to reduce disparities in food choices and obesity among low-income families. We hypothesized that making fresh produce more visible and of better quality in corner stores would increase their WIC fruit/vegetable sales. Methods: We conducted a randomized, controlled trial of 6 WIC-certified corner stores in a low-income, Latino community. Three stores were assigned to “choice architecture” intervention that increased visibility and quality of fresh fruit/vegetables. Primary outcome was WIC fruit/vegetable voucher (FVV) sales, comparing changes in sales trends from baseline (Dec. 2012-Oct. 2013) to follow-up (Dec. 2013-Apr. 2014) for intervention vs. control stores. Secondary outcomes, from customer exit surveys at all 6 stores (N=575), were changes between baseline and follow-up in self-reported fresh fruit/vegetable purchases by customers on WIC or Supplemental Nutrition Assistance Program (SNAP). Results: WIC FVV sales decreased in both intervention and control stores during baseline but increased in the 3 intervention stores after implementing choice architecture (Figure). In exit surveys, 23% of all corner store customers reported using WIC, and 37% used SNAP. Compared to baseline, intervention store customers on SNAP increased purchase of fruit/vegetables at follow-up more than SNAP customers at control stores (6% vs. -15%, p=0.007). For WIC customers, there was a similar but not statistically significant difference between intervention and control (18% vs. -2%, p=0.11). Conclusion: A simple choice architecture intervention increased purchases of fruit/vegetables by corner store customers using WIC. Policies that incentivize WIC-certified stores to stock and prominently display good quality fresh produce could improve healthy choices of low-income families.