1. Amber France MPH 515 2/26/2014 Increasing Fruit and Vegetable Voucher Redemption and Consumption Among WIC Participants

2. INTRODUCTION  Fruits and vegetables are essential to a healthy diet  Fruit and vegetable intake is less than ideal, especially among the low- income population  WIC participants will be offered additional nutrition education methods to increase fruit and vegetable intake  Transtheoretical Model and Social Cognitive theories of change will be used to develop a better understanding  Current literature uses these theories to develop health promotion programs  Use of innovative technology along with TMC and SCT can increase fruit and vegetable intake

3. BACKGROUND INFORMATION  Fruits and vegetables are essential to a healthy diet but most 2-5 year olds consume only 80% of the recommended fruit and only 25% of vegetables – 2-3 and 4-8 year olds are even lower (Dennison et al, 2012)  Even more common in low-income populations  Behavioral interventions have increased intake by 0.97 servings/day (Thomson & Ravia, 2011).  Multiple strategies recommended to increase intake (Thomson & Ravia, 2011)

4. POPULATION CHOSEN  WIC program provides health and nutrition services to low-income  $6-$10 in fruit and vegetable vouchers are given per month + $17 in farmers market vouchers per summer  In 2012, only 58% of fruit and vegetable vouchers and 70.5% farmers market vouchers redeemed  Pilot study:  97% felt they received adequate education  99% felt the education was helpful  94% said they use their fruit and vegetable vouchers  87% use text messaging  68% have a smartphone,  94% have access to the internet  Further data must be collected due to the difference in actual redemption vs. reported redemption

5. THEORY, MODEL OR FRAMEWORK  Transtheoretical Model and Social Cognitive theories of change  To develop interview question for focus groups and individual interviews to gather information on  Self-efficacy for fruit and vegetable purchasing, prep, and intake  Self-efficacy for fruit and vegetable voucher redemption  Stage of change for fruit and vegetable intake  Social determinants  Used to implement program strategies with WIC participants

6. USE OF THEORY IN PRACTICE (LITERATURE REVIEW SUMMARY)  Treiman et al (1996) utilized focus groups and interviews with WIC participants to find barriers to fruit and vegetable consumption.  Used the TMC to guide behavior change  Molaison et al (2005) identified personal, behavioral, and environmental factors influencing fruit and vegetable consumption.  Utilized the SCT to guide focus group questions and analysis  Henry et al (2006) looked at the relationship between stage of change and decisional balance, process of change, and self-efficacy  Utilized the TMC to increase fruit and vegetable consumption by low income African American mothers

7. BASIC CONSTRUCTS OF PROPOSED HP PROGRAM

8. CONCLUSION AND RECOMMENDATIONS  TMC and SCT utilized to identify barriers and move towards behavior change  Increase fruit and vegetable consumption by using innovative, effective models of nutrition education  Multifaceted education program to enforce change

9. REFERENCES  (2013) Vegetables and Fruits. Harvard School of Public Health. Retrieved from http://www.hsph.harvard.edu/nutritionsource/vegetables-and-fruits/ http://www.hsph.harvard.edu/nutritionsource/vegetables-and-fruits/  Dennison, B.A., Rockwell, H.L, and Baker, S.L. (2012). Fruit and Vegetable Intake in Young Children. Journal of The American College of Nutrition (5). Retrieved from http://www.jacn.org/content/17/4/371.abstracthttp://www.jacn.org/content/17/4/371.abstract  Henry, H., Reimer, K., Smith, C., Reicks,M. (2006). Associations of Decisional Balance, Processes of Change, and Self-Efficacy with Stages of Change for Increased Fruit and Vegetable Intake among Low-Income, African- American Mothers. Journal of the American Dietetic Association;106(6):841-849. Retrieved from http://www.sciencedirect.com/science/article/pii/S0002822306003117 http://www.sciencedirect.com/science/article/pii/S0002822306003117  Krebs-Smith, S.M., Guenther, P.M., Subar, A.F., Kirkpatrick, S.I., & Dodd, K.W. (2010). Americans do not meet federal dietary recommendations. Journal of Nutrition;140(10):1832-8.  Molaison, E.F., Connel, C.L., Stuff, J.E., Yadrick, M.K., Bogle, M. (2005). Influences on Fruit and Vegetable Consumption by Low-Income Black American Adolescents. Journal of Nutrition Education Behavior;37:246-251. Retrieved from http://www.ars.usda.gov/SP2UserFiles/Place/62510500/Services/165840.pdfhttp://www.ars.usda.gov/SP2UserFiles/Place/62510500/Services/165840.pdf  Thomson, C.A. & Ravia, J. (2011). A systematic review of behavioral interventions to promote intake of fruit and vegetables. Journal of American Dietetic Association;111(10):1523- 35.  Treiman, K., Freimuth, V., Damron, D., Lasswell, A., Anliker, J., Havas, S., Langenberg, P., & Feldman. (1996). Attitudes and Behaviors Related to Fruits and Vegetables among Low-income Women in the WIC Program. Journal of Nutrition Education;28(3):149-156. Retrieved from http://www.sciencedirect.com/science/article/pii/S002231829670050X http://www.sciencedirect.com/science/article/pii/S002231829670050X