WIC-Based Intervention to Promote Healthy Eating Among Low-Income Mothers

• Sponsor: William Paterson University of New Jersey (Other)
• Overall Status: Completed
• CT.gov ID: NCT04038385
• Collaborator: (none)
• Enrollment: 297
• Location: 1
• Arms: 2
• Actual Duration (Months): 26.9
• Patients Per Site Per Month: 11

Study Details

Study Description

Brief Summary

Whole grains, non-starchy vegetables, fruit, and beans are a consistent feature of diets associated with a lower risk of cancer and other diet-related diseases. For cancer risk reduction, the American Cancer Society recommendation is to consume at least 2.5 cups of a variety of fruits and vegetables daily. Other than dietary choices, weight control and physical activity levels are important modifiable determinants of cancer risk. This study finalized a novel, theory-driven farm-to-WIC intervention developed in preliminary work to promote vegetable intake among low-income adults served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). In New Jersey (the location of the study), WIC provides participants up to $30 in seasonal Farmers' Market Nutrition Program (FMNP) vouchers and monthly cash value vouchers or CVV (valued at $11 for adults and $8 for children at the time of the study) redeemable at farmers' markets. The program combined behaviorally focused nutrition education with the establishment of a WIC-based farmers' market (implemented in the summer of 2019 during the FMNP voucher issuance period). Content to address other modifiable determinants of cancer risk was added. To create additional opportunities for experiential and hands-on learning, monthly trips to an area farmers' market were held (between September 1, 2019 [after the WIC-based market was discontinued] and November 30, 2019 [the end of the local growing season]). The research employed an experimental design to initially test the intervention in 3 WIC agency sites (1 intervention and 2 control sites) with 297 urban, primarily Hispanic adults. Program effects on primary outcomes of vegetable intake (measured objectively using dermal carotenoids as a biomarker of intake and via self-report) and FMNP voucher redemption (objectively assessed using data provided by WIC) were examined at mid- and post-intervention (3 and 6 months post-baseline, respectively). Intervention effects on potential hypothesized mediators and the redemption of CVV at farmers' markets, participant satisfaction with the program, and the cost-effectiveness of the intervention also were examined.

Condition or Disease	Intervention/Treatment	Phase
Cancer Prevention; Diet Modification; Vegetable Intake	Behavioral: Multilevel Behavioral Intervention	N/A

Study Design

• Study Type: Interventional
• Actual Enrollment: 297 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Double (Participant, Care Provider)
• Primary Purpose: Prevention
• Official Title: WIC-Based Intervention to Promote Healthy Eating Among Low-Income Mothers
• Actual Study Start Date: Jun 3, 2019
• Actual Primary Completion Date: Jan 31, 2020
• Actual Study Completion Date: Aug 31, 2021

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Intervention This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market (between September 1, 2019 and November 30, 2019 [the end of the local growing season]).	Behavioral: Multilevel Behavioral Intervention; Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers at farmers' markets.
No Intervention: Control This group will receive routine services provided by WIC only.

Outcome Measures

Primary Outcome Measures

1. Vegetable Intake Carotenoid Scores at 3 Months [3 months]

   Vegetable intake was objectively assessed using a reflection spectroscopy device (the Veggie Meter) to measure the level of carotenoid pigments in participants' skin (scores can range from 0 to 800). Higher scores indicate a better outcomes (higher carotenoid levels).

2. Vegetable Intake Carotenoid Scores at 6 Months [6 months]

   Vegetable intake was objectively assessed using a reflection spectroscopy device (the Veggie Meter) to measure the level of carotenoid pigments in participants' skin (scores can range from 0 to 800). Higher scores indicate a better outcomes (higher carotenoid levels).

3. Self-Reported Vegetable Intake at 3 Months [3 months]

   Assessed with one of two items in a screening instrument developed by the National Cancer Institute. Participants reported the number of cups of vegetables (including 100% vegetable juice) they ate or drank each day (range 0-7). Higher numbers represent a better outcome (higher cups/day of vegetables consumed).

4. Self-Reported Vegetable Intake at 6 Months [6 months]

   Assessed with one of two items in a screening instrument developed by the National Cancer Institute. Participants reported the number of cups of vegetables (including 100% vegetable juice) they ate or drank each day (range 0-7). Higher numbers represent a better outcome (higher cups/day of vegetables consumed).

5. Number of Participants Who Redeemed Any Farmers' Market Nutrition Program (FMNP) Vouchers at 6 Months [6 months]

   Objectively assessed using data provided by the collaborating WIC agency. WIC reported whether participants redeemed any FMNP vouchers (yes or no) from baseline to 6 months.

Secondary Outcome Measures

1. Knowledge of Vegetable Intake Recommendations at 3 Months [3 months]

   Assessed via self-report with an item from the National Cancer Institute's Food, Attitudes, and Behaviors (FAB) survey. Based on their responses, participants were classified as knowledgeable of the recommended cups per day (yes or no).

2. Knowledge of Vegetable Intake Recommendations at 6 Months [6 months]

   Assessed via self-report with an item from the National Cancer Institute's Food, Attitudes, and Behaviors (FAB) survey. Based on their responses, participants were classified as knowledgeable of the recommended cups per day (yes or no).

3. Home Vegetable Availability (Quantity) at 3 Months [3 months]

   Assessed with items from the Healthy Home Survey. Participants reported the number of fresh, frozen, and canned vegetables they had at home. Responses were summed across items to derive a total score (range 0-23). Higher scores indicate a better outcome (a higher number of vegetables at home).

4. Home Vegetable Availability (Quantity) at 6 Months [6 months]

   Assessed with items from the Healthy Home Survey. Participants reported the number of fresh, frozen, and canned vegetables they had at home. Responses were summed across items to derive a total score (range 0-23). Higher scores indicate a better outcome (a higher number of vegetables at home).

5. Home Vegetable Availability (Variety) at 3 Months [3 months]

   Assessed with items from the Healthy Home Survey. Participants reported the number of fresh, frozen, and canned vegetables they had at home. The number of different (unique) vegetables reported was summed across items to derive a total score (range 0-21). Higher scores indicate a better outcome (a greater variety of vegetables at home).

6. Home Vegetable Availability (Variety) at 6 Months [6 months]

   Assessed with items from the Healthy Home Survey. Participants reported the number of fresh, frozen, and canned vegetables they had at home. The number of different (unique) vegetables reported was summed to derive a total score (range 0-21). Higher scores indicate a better outcome (a greater variety of vegetables at home).

7. Vegetable Taste Preferences at 3 Months [3 months]

   Assessed with a single item (the Preference Rating Measure) querying overall, how much the participant likes the taste of vegetables (on a 7-point scale ranging from not at all to a lot). Scores can range from 1 to 7. Higher scores represent a better outcome (stronger vegetable taste preferences).

8. Vegetable Taste Preferences at 6 Months [6 months]

   Assessed with a single item (the Preference Rating Measure) querying overall, how much the participant likes the taste of vegetables (on a 7-point scale ranging from not at all to a lot). Scores can range from 1 to 7. Higher scores represent a better outcome (stronger vegetable taste preferences).

9. Vegetable Preparation Practices at 3 Months [3 months]

   Assessed via items from the Eating Among Teens and Young Adults Study (EAT)-II Survey (Laska et al., 2011). Participants reported how often, in the past month, they 1) bought fresh vegetables, 2) prepared a vegetable salad, and 3) prepared a dinner with vegetables. Responses were on a 5-point scale ranging from never to more than once a week. Ratings were summed across items to derive a total score. Scores can range from 1 to 15. Higher scores represent a better outcome (frequent use of the practices).

10. Vegetable Preparation Practices at 6 Months [6 months]

    Assessed via items from the Eating Among Teens and Young Adults Study (EAT)-II Survey (Laska et al., 2011). Participants reported how often, in the past month, they 1) bought fresh vegetables, 2) prepared a vegetable salad, and 3) prepared a dinner with vegetables. Responses were on a 5-point scale ranging from never to more than once a week. Ratings were summed across items to derive a total score. Scores can range from 1 to 15. Higher scores represent a better outcome (frequent use of the practices).

11. Vegetable Preparation Skills at 3 Months [3 months]

    Assessed via a single item (the Preparation Skills Rating Measure) querying how the participant would rate his or her overall skill in preparing vegetables (on a 7-point scale ranging from poor to excellent). Scores can range from 1 to 7. Higher scores represent a better outcome (greater vegetable preparation skills).

12. Vegetable Preparation Skills at 6 Months [6 months]

    Assessed via a single item (the Preparation Skills Rating Measure) querying how the participant would rate his or her overall skill in preparing vegetables (on a 7-point scale ranging from poor to excellent). Scores can range from 1 to 7. Higher scores represent a better outcome (greater vegetable preparation skills).

13. Social Support for Vegetable Consumption at 3 Months [3 months]

    Assessed via a single item (the Social Support Rating Measure) querying how much others support the participant to consume vegetables (on a 7-point scale ranging from not at all to a lot). Scores can range from 1 to 7. Higher scores represent a better outcome (greater social support for vegetable consumption).

14. Social Support for Vegetable Consumption at 6 Months [6 months]

    Assessed via a single item (the Social Support Rating Measure) querying how much others support the participant to consume vegetables (on a 7-point scale ranging from not at all to a lot). Scores can range from 1 to 7. Higher scores represent a better outcome (greater social support for vegetable consumption).

15. Self-efficacy for Vegetable Consumption at 3 Months [3 months]

    Assessed with a validated measure used to evaluate the Stellar Farmers' Market program (Dannefer et al., 2015). Participants rated how much they agreed or disagreed with statements designed to measure confidence in the ability to prepare and consume fresh produce. Item ratings are on a 4-point scale ranging from strongly disagree (1) to strongly agree (4). Ratings were summed across items to derive a total score. Scores can range from 5 to 20. Higher scores represent a better outcome (greater self-efficacy for vegetable consumption).

16. Self-efficacy for Vegetable Consumption at 6 Months [6 months]

    Assessed with a validated measure used to evaluate the Stellar Farmers' Market program (Dannefer et al., 2015). Participants rated how much they agreed or disagreed with statements designed to measure confidence in the ability to prepare and consume fresh produce. Item ratings are on a 4-point scale ranging from strongly disagree (1) to strongly agree (4). Ratings were summed across items to derive a total score. Scores can range from 5 to 20. Higher scores represent a better outcome (greater self-efficacy for vegetable consumption).

17. Body Mass Index at 3 Months [3 months]

    Height and weight were measured by trained research staff with participants wearing light clothing without shoes. Body mass index was calculated as weight in kilograms divided by height in square meters.

18. Body Mass Index at 6 Months [6 months]

    Height and weight were measured by trained research staff with participants wearing light clothing without shoes. Body mass index was calculated as weight in kilograms divided by height in square meters.

19. Number of Participants Who Met Physical Activity Guidelines at 3 Months [3 months]

    Assessed with a validated 2-item measure (the Brief Physical Activity Assessment Tool or BPAAT [Marshall et al., 2005]). The instrument consists of two questions, one that assesses the frequency and duration of vigorous intensity physical activity and one that assesses the frequency and duration of moderate intensity physical activity undertaken in a usual week. A scoring algorithm is used to derive a total score (scores can range from 0 to 8). Participants are classified as meeting current physical activity guidelines (yes or no) based on the scores (a score greater than or equal to 4 indicates that the participant is meeting current physical activity guidelines, whereas a score between 0 and 3 indicates that the participant is not).

20. Number of Participants Who Met Physical Activity Guidelines at 6 Months [6 months]

    Assessed with a validated 2-item measure (the Brief Physical Activity Assessment Tool or BPAAT [Marshall et al., 2005]). The instrument consists of two questions, one that assesses the frequency and duration of vigorous intensity physical activity and one that assesses the frequency and duration of moderate intensity physical activity undertaken in a usual week. A scoring algorithm is used to derive a total score (scores can range from 0 to 8). Participants are classified as meeting current physical activity guidelines (yes/no) based on the scores (a score greater than or equal to 4 indicates that the participant is meeting current physical activity guidelines, whereas a score between 0 and 3 indicates that the participant is not).

Other Outcome Measures

1. Number of Participants Who Redeemed Any Cash Value Vouchers or CVV at Farmers' Markets at 6 Months [6 months]

   Objectively assessed using data provided by the collaborating WIC agency. WIC reported whether participants redeemed any cash value vouchers at farmers' markets (yes or no) between baseline and 6 months.

2. Overall Satisfaction With Intervention [6 months]

   Assessed via a single item (the Overall Satisfaction Rating Measure) querying how satisfied intervention recipients were with the intervention (on a 7-point scale ranging from very dissatisfied to very satisfied). Scores can range from 1 to 7. Higher scores represent a better outcome (greater overall satisfaction).

3. Satisfaction With Intervention [6 months]

   Assessed with a 5-item measure developed by the investigators querying how satisfied intervention recipients were with the intervention. Item responses were on a 7-point scale ranging from strongly disagree to strongly agree. Scores were averaged across items to derive a total score. Scores can range from 1 to7. Higher scores represent a better outcome (greater satisfaction with the intervention).

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years to 99 Years
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Inclusion Criteria:

• English- or Spanish-speaking

• Farmers' Market Nutrition Program (FMNP) voucher recipient or caregiver of a child FMNP voucher recipient

• Not less than 3 months from expected delivery date (pregnant women)

• Eligible to receive WIC benefits for 6 months after study entry

Exclusion Criteria:

● Restrictions of food intake (has food allergies or foods that cannot be eaten)

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Saint Joseph's WIC Program	Paterson	New Jersey	United States	07524

Sponsors and Collaborators

• William Paterson University of New Jersey

Investigators

• Principal Investigator: Jennifer Di Noia, PhD, William Paterson University

Study Documents (Full-Text)

• Study Protocol and Statistical Analysis Plan - Oct 19, 2021

More Information

Publications

• Di Noia J, Gellermann W. Use of the Spectroscopy-Based Veggie Meter(®) to Objectively Assess Fruit and Vegetable Intake in Low-Income Adults. Nutrients. 2021 Jun 30;13(7). pii: 2270. doi: 10.3390/nu13072270.

• Responsible Party: Jennifer Di Noia, Professor, Department of Sociology, William Paterson University of New Jersey
• ClinicalTrials.gov Identifier: NCT04038385
• Other Study ID Numbers: 1R21CA230476-01
• First Posted: Jul 30, 2019
• Last Update Posted: Dec 23, 2021
• Last Verified: Nov 1, 2021

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Study Results

Participant Flow

Recruitment Details	Recruitment occurred from June 3, 2019, to August 1, 2019. Participants were recruited via telephone (prior to forthcoming appointments with WIC) and in person at collaborating WIC agency sites.

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Period Title: Overall Study
STARTED	160	137
COMPLETED	143	130
NOT COMPLETED	17	7

Baseline Characteristics

Arm/Group Title	Intervention	Control	Total
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.	Total of all reporting groups
Overall Participants	160	137	297
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	30.5 (7.2)	33.1 (6.9)	31.7 (7.2)
Sex: Female, Male (Count of Participants)
Female	159 99.4%	137 100%	296 99.7%
Male	1 0.6%	0 0%	1 0.3%
Ethnicity (NIH/OMB) (Count of Participants)
Hispanic or Latino	115 71.9%	102 74.5%	217 73.1%
Not Hispanic or Latino	45 28.1%	35 25.5%	80 26.9%
Unknown or Not Reported	0 0%	0 0%	0 0%
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native	0 0%	1 0.7%	1 0.3%
Asian	12 7.5%	6 4.4%	18 6.1%
Native Hawaiian or Other Pacific Islander	0 0%	1 0.7%	1 0.3%
Black or African American	26 16.3%	16 11.7%	42 14.1%
White	7 4.4%	29 21.2%	36 12.1%
More than one race	4 2.5%	5 3.6%	9 3%
Unknown or Not Reported	111 69.4%	79 57.7%	190 64%
Region of Enrollment (participants) [Number]
United States	160 100%	137 100%	297 100%
Nativity (Count of Participants)
US-born	52 32.5%	36 26.3%	88 29.6%
Foreign-born	108 67.5%	101 73.7%	209 70.4%
Place of Birth (Foreign-Born) (Count of Participants)
Dominican Republic	57 35.6%	12 8.8%	69 23.2%
Ecuador	2 1.3%	25 18.2%	27 9.1%
Mexico	7 4.4%	19 13.9%	26 8.8%
Other birthplace	42 26.3%	45 32.8%	87 29.3%
Language Preference (Foreign-Born) (Count of Participants)
English	24 15%	22 16.1%	46 15.5%
Spanish	78 48.8%	76 55.5%	154 51.9%
Other	6 3.8%	3 2.2%	9 3%
Years in U.S. (Foreign-Born) (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	10.4 (8.0)	11.3 (7.3)	10.9 (7.6)
Pregnancy Status (Count of Participants)
Not pregnant	130 81.3%	113 82.5%	243 81.8%
Pregnant	30 18.8%	24 17.5%	54 18.2%
Breastfeeding Status (Count of Participants)
Not breastfeeding	131 81.9%	93 67.9%	224 75.4%
Breastfeeding	29 18.1%	44 32.1%	73 24.6%
Educational Attainment (Count of Participants)
Some high school or less	25 15.6%	36 26.3%	61 20.5%
High school diploma or equivalent	57 35.6%	46 33.6%	103 34.7%
More than high school	78 48.8%	55 40.1%	133 44.8%
Car Ownership (Count of Participants)
Did not own a reliable car	70 43.8%	52 38%	122 41.1%
Owned a reliable car	90 56.3%	85 62%	175 58.9%
Car Access: Ease of Borrowing a Car (If Not Owned) (Count of Participants)
Very difficult	41 25.6%	14 10.2%	55 18.5%
Difficult	14 8.8%	18 13.1%	32 10.8%
Medium	4 2.5%	7 5.1%	11 3.7%
Easy	9 5.6%	10 7.3%	19 6.4%
Very Easy	2 1.3%	3 2.2%	5 1.7%
Car Access: How Often Can Use Car (If Owned) (Count of Participants)
Never	10 6.3%	6 4.4%	16 5.4%
Rarely	3 1.9%	6 4.4%	9 3%
Sometimes	14 8.8%	12 8.8%	26 8.8%
Often	8 5%	14 10.2%	22 7.4%
Always	55 34.4%	47 34.3%	102 34.3%
Supplement Use (Count of Participants)
Not taking supplements	84 52.5%	61 44.5%	145 48.8%
Taking supplements	76 47.5%	76 55.5%	152 51.2%
Smoking Status (Count of Participants)
Not at all	147 91.9%	127 92.7%	274 92.3%
Some days	7 4.4%	2 1.5%	9 3%
Every day	3 1.9%	4 2.9%	7 2.4%
Not reported	3 1.9%	4 2.9%	7 2.4%
Past 7-Day Exposure to Secondhand Smoke (Count of Participants)
No	127 79.4%	124 90.5%	251 84.5%
Yes	33 20.6%	11 8%	44 14.8%
Not reported	0 0%	2 1.5%	2 0.7%
Food Security Status (Count of Participants)
Food secure	91 56.9%	83 60.6%	174 58.6%
Food insecure	65 40.6%	53 38.7%	118 39.7%
Not reported	4 2.5%	1 0.7%	5 1.7%
Meeting Physical Activity Guidelines (Count of Participants)
No	59 36.9%	64 46.7%	123 41.4%
Yes	101 63.1%	73 53.3%	174 58.6%
Body Mass Index (kg/m2) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [kg/m2]	29.5 (6.8)	29.4 (6.8)	29.4 (6.8)
Weight Status (Count of Participants)
Underweight (BMI < 18.5)	4 2.5%	3 2.2%	7 2.4%
Normal (BMI 18.5 to < 25)	28 17.5%	26 19%	54 18.2%
Overweight (BMI 25 to < 30)	44 27.5%	44 32.1%	88 29.6%
Obese (BMI ≥ 30)	53 33.1%	40 29.2%	93 31.3%
Social Desirability Trait (units on a scale) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [units on a scale]	1.41 (1.75)	3.22 (1.51)	2.25 (1.88)
Children in the Household Aged 2-5 Years (Count of Participants)
None	28 17.5%	28 20.4%	56 18.9%
One	119 74.4%	97 70.8%	216 72.7%
Two	13 8.1%	12 8.8%	25 8.4%
Vegetable Intake Carotenoid Scores (units on a scale) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [units on a scale]	265.17 (87.57)	274.61 (105.5)	269.54 (96.24)
Self-Reported Vegetable Intake (Cups per day of vegetables consumed) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [Cups per day of vegetables consumed]	1.46 (1.07)	1.52 (1.07)	1.49 (1.07)

Outcome Measures

1. Primary Outcome

Title	Vegetable Intake Carotenoid Scores at 3 Months
Description	Vegetable intake was objectively assessed using a reflection spectroscopy device (the Veggie Meter) to measure the level of carotenoid pigments in participants' skin (scores can range from 0 to 800). Higher scores indicate a better outcomes (higher carotenoid levels).
Time Frame	3 months

Outcome Measure Data

Analysis Population Description

For vegetable intake carotenoid scores, analysis sample sizes were 137 in the intervention group and 124 in the control group. In the intervention group, 13 of the original 160 participants competed the baseline assessment only, 4 moved out of the area, and 6 discontinued their study involvement. In the control group, 10 of the original 137 participants completed the baseline assessment only, 2 moved out of the area, and 1 discontinued their study involvement).

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	137	124
Least Squares Mean (Standard Error) [units on a scale]	227.11 (9.91)	269.98 (10.06)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.001
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	-42.87
	Confidence Interval	(2-Sided) 95%; -65.25 to -20.49
	Parameter Dispersion	Type: Value:
	Estimation Comments

2. Primary Outcome

Title	Vegetable Intake Carotenoid Scores at 6 Months
Description	Vegetable intake was objectively assessed using a reflection spectroscopy device (the Veggie Meter) to measure the level of carotenoid pigments in participants' skin (scores can range from 0 to 800). Higher scores indicate a better outcomes (higher carotenoid levels).
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

For vegetable intake carotenoid scores, sample sizes were 137 in the intervention group and 124 in the control group. In the intervention group, 13 of the original 160 participants competed the baseline assessment only, 4 moved out of the area, and 6 discontinued their study involvement. In the control group, 10 of the original 137 participants completed the baseline assessment only, 2 moved out of the area, and 1 discontinued their study involvement.

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	137	124
Least Squares Mean (Standard Error) [units on a scale]	236.01 (9.77)	212.10 (9.79)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.031
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Median Difference (Net)
	Estimated Value	23.91
	Confidence Interval	(2-Sided) 95%; 2.21 to 45.62
	Parameter Dispersion	Type: Value:
	Estimation Comments

3. Primary Outcome

Title	Self-Reported Vegetable Intake at 3 Months
Description	Assessed with one of two items in a screening instrument developed by the National Cancer Institute. Participants reported the number of cups of vegetables (including 100% vegetable juice) they ate or drank each day (range 0-7). Higher numbers represent a better outcome (higher cups/day of vegetables consumed).
Time Frame	3 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [Cups per day]	1.78 (0.11)	1.84 (0.12)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.662
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Median Difference (Net)
	Estimated Value	-0.06
	Confidence Interval	(2-Sided) 95%; -0.33 to 0.21
	Parameter Dispersion	Type: Value:
	Estimation Comments

4. Primary Outcome

Title	Self-Reported Vegetable Intake at 6 Months
Description	Assessed with one of two items in a screening instrument developed by the National Cancer Institute. Participants reported the number of cups of vegetables (including 100% vegetable juice) they ate or drank each day (range 0-7). Higher numbers represent a better outcome (higher cups/day of vegetables consumed).
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [Cups per day]	1.83 (0.11)	1.55 (0.12)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.047
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	0.28
	Confidence Interval	(2-Sided) 95%; 0.00 to 0.55
	Parameter Dispersion	Type: Value:
	Estimation Comments

5. Primary Outcome

Title	Number of Participants Who Redeemed Any Farmers' Market Nutrition Program (FMNP) Vouchers at 6 Months
Description	Objectively assessed using data provided by the collaborating WIC agency. WIC reported whether participants redeemed any FMNP vouchers (yes or no) from baseline to 6 months.
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	160	137
Count of Participants [Participants]	139 86.9%	38 27.7%

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	<0.01
	Comments
	Method	Regression, Logistic
	Comments
Method of Estimation	Estimation Parameter	Odds Ratio (OR)
	Estimated Value	17.39
	Confidence Interval	(2-Sided) 95%; 8.64 to 35.02
	Parameter Dispersion	Type: Value:
	Estimation Comments

6. Secondary Outcome

Title	Knowledge of Vegetable Intake Recommendations at 3 Months
Description	Assessed via self-report with an item from the National Cancer Institute's Food, Attitudes, and Behaviors (FAB) survey. Based on their responses, participants were classified as knowledgeable of the recommended cups per day (yes or no).
Time Frame	3 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Count of Participants [Participants]	10 6.3%	4 2.9%

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.056
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Odds Ratio (OR)
	Estimated Value	3.9
	Confidence Interval	(2-Sided) 95%; 1.0 to 16.1
	Parameter Dispersion	Type: Value:
	Estimation Comments

7. Secondary Outcome

Title	Knowledge of Vegetable Intake Recommendations at 6 Months
Description	Assessed via self-report with an item from the National Cancer Institute's Food, Attitudes, and Behaviors (FAB) survey. Based on their responses, participants were classified as knowledgeable of the recommended cups per day (yes or no).
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Count of Participants [Participants]	10 6.3%	4 2.9%

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.050
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Odds Ratio (OR)
	Estimated Value	4.0
	Confidence Interval	(2-Sided) 95%; 1.0 to 16.3
	Parameter Dispersion	Type: Value:
	Estimation Comments

8. Secondary Outcome

Title	Home Vegetable Availability (Quantity) at 3 Months
Description	Assessed with items from the Healthy Home Survey. Participants reported the number of fresh, frozen, and canned vegetables they had at home. Responses were summed across items to derive a total score (range 0-23). Higher scores indicate a better outcome (a higher number of vegetables at home).
Time Frame	3 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [Number of vegetables at home]	5.3 (0.3)	7.1 (0.3)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.001
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	-1.7
	Confidence Interval	(2-Sided) 95%; -2.5 to -1.0
	Parameter Dispersion	Type: Value:
	Estimation Comments

9. Secondary Outcome

Title	Home Vegetable Availability (Quantity) at 6 Months
Description	Assessed with items from the Healthy Home Survey. Participants reported the number of fresh, frozen, and canned vegetables they had at home. Responses were summed across items to derive a total score (range 0-23). Higher scores indicate a better outcome (a higher number of vegetables at home).
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [Number of vegetables at home]	5.6 (0.3)	6.3 (0.3)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.082
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Median Difference (Net)
	Estimated Value	-0.7
	Confidence Interval	(2-Sided) 95%; -1.4 to 0.1
	Parameter Dispersion	Type: Value:
	Estimation Comments

10. Secondary Outcome

Title	Home Vegetable Availability (Variety) at 3 Months
Description	Assessed with items from the Healthy Home Survey. Participants reported the number of fresh, frozen, and canned vegetables they had at home. The number of different (unique) vegetables reported was summed across items to derive a total score (range 0-21). Higher scores indicate a better outcome (a greater variety of vegetables at home).
Time Frame	3 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [Number of different vegetables at home]	5.0 (0.3)	6.5 (0.3)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.001
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	-1.5
	Confidence Interval	(2-Sided) 95%; -2.2 to -0.8
	Parameter Dispersion	Type: Value:
	Estimation Comments

11. Secondary Outcome

Title	Home Vegetable Availability (Variety) at 6 Months
Description	Assessed with items from the Healthy Home Survey. Participants reported the number of fresh, frozen, and canned vegetables they had at home. The number of different (unique) vegetables reported was summed to derive a total score (range 0-21). Higher scores indicate a better outcome (a greater variety of vegetables at home).
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [Number of different vegetables at home]	5.2 (0.3)	5.9 (0.3)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.039
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Median Difference (Net)
	Estimated Value	-0.7
	Confidence Interval	(2-Sided) 95%; -1.4 to -0.0
	Parameter Dispersion	Type: Value:
	Estimation Comments

12. Secondary Outcome

Title	Vegetable Taste Preferences at 3 Months
Description	Assessed with a single item (the Preference Rating Measure) querying overall, how much the participant likes the taste of vegetables (on a 7-point scale ranging from not at all to a lot). Scores can range from 1 to 7. Higher scores represent a better outcome (stronger vegetable taste preferences).
Time Frame	3 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [score on a 7-point scale]	6.3 (0.1)	6.3 (0.1)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.962
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	-0.0
	Confidence Interval	(2-Sided) 95%; -0.3 to 0.3
	Parameter Dispersion	Type: Value:
	Estimation Comments

13. Secondary Outcome

Title	Vegetable Taste Preferences at 6 Months
Description	Assessed with a single item (the Preference Rating Measure) querying overall, how much the participant likes the taste of vegetables (on a 7-point scale ranging from not at all to a lot). Scores can range from 1 to 7. Higher scores represent a better outcome (stronger vegetable taste preferences).
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [score on a 7-point scale]	6.3 (0.1)	6.5 (0.1)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	.277
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	-0.2
	Confidence Interval	(2-Sided) 95%; -0.4 to 0.1
	Parameter Dispersion	Type: Value:
	Estimation Comments

14. Secondary Outcome

Title	Vegetable Preparation Practices at 3 Months
Description	Assessed via items from the Eating Among Teens and Young Adults Study (EAT)-II Survey (Laska et al., 2011). Participants reported how often, in the past month, they 1) bought fresh vegetables, 2) prepared a vegetable salad, and 3) prepared a dinner with vegetables. Responses were on a 5-point scale ranging from never to more than once a week. Ratings were summed across items to derive a total score. Scores can range from 1 to 15. Higher scores represent a better outcome (frequent use of the practices).
Time Frame	3 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [units on a scale]	12.6 (0.2)	13.0 (0.2)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.155
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Median Difference (Net)
	Estimated Value	-0.4
	Confidence Interval	(2-Sided) 95%; -1.0 to 0.2
	Parameter Dispersion	Type: Value:
	Estimation Comments

15. Secondary Outcome

Title	Vegetable Preparation Practices at 6 Months
Description	Assessed via items from the Eating Among Teens and Young Adults Study (EAT)-II Survey (Laska et al., 2011). Participants reported how often, in the past month, they 1) bought fresh vegetables, 2) prepared a vegetable salad, and 3) prepared a dinner with vegetables. Responses were on a 5-point scale ranging from never to more than once a week. Ratings were summed across items to derive a total score. Scores can range from 1 to 15. Higher scores represent a better outcome (frequent use of the practices).
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [units on a scale]	12.5 (0.2)	12.4 (0.2)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.740
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	0.1
	Confidence Interval	(2-Sided) 95%; -0.5 to 0.7
	Parameter Dispersion	Type: Value:
	Estimation Comments

16. Secondary Outcome

Title	Vegetable Preparation Skills at 3 Months
Description	Assessed via a single item (the Preparation Skills Rating Measure) querying how the participant would rate his or her overall skill in preparing vegetables (on a 7-point scale ranging from poor to excellent). Scores can range from 1 to 7. Higher scores represent a better outcome (greater vegetable preparation skills).
Time Frame	3 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [units on a scale]	5.7 (0.1)	6.0 (0.1)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	.122
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Median Difference (Net)
	Estimated Value	-0.2
	Confidence Interval	(2-Sided) 95%; -0.5 to 0.1
	Parameter Dispersion	Type: Value:
	Estimation Comments

17. Secondary Outcome

Title	Vegetable Preparation Skills at 6 Months
Description	Assessed via a single item (the Preparation Skills Rating Measure) querying how the participant would rate his or her overall skill in preparing vegetables (on a 7-point scale ranging from poor to excellent). Scores can range from 1 to 7. Higher scores represent a better outcome (greater vegetable preparation skills).
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [units on a scale]	5.6 (0.1)	5.8 (0.1)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	.177
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	-0.2
	Confidence Interval	(2-Sided) 95%; -0.5 to 0.1
	Parameter Dispersion	Type: Value:
	Estimation Comments

18. Secondary Outcome

Title	Social Support for Vegetable Consumption at 3 Months
Description	Assessed via a single item (the Social Support Rating Measure) querying how much others support the participant to consume vegetables (on a 7-point scale ranging from not at all to a lot). Scores can range from 1 to 7. Higher scores represent a better outcome (greater social support for vegetable consumption).
Time Frame	3 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [units on a scale]	5.9 (0.2)	5.8 (0.2)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.514
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Median Difference (Net)
	Estimated Value	0.1
	Confidence Interval	(2-Sided) 95%; -0.3 to 0.5
	Parameter Dispersion	Type: Value:
	Estimation Comments

19. Secondary Outcome

Title	Social Support for Vegetable Consumption at 6 Months
Description	Assessed via a single item (the Social Support Rating Measure) querying how much others support the participant to consume vegetables (on a 7-point scale ranging from not at all to a lot). Scores can range from 1 to 7. Higher scores represent a better outcome (greater social support for vegetable consumption).
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [units on a scale]	6.0 (0.2)	5.9 (0.2)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.335
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Median Difference (Net)
	Estimated Value	0.2
	Confidence Interval	(2-Sided) 95%; -0.2 to 0.6
	Parameter Dispersion	Type: Value:
	Estimation Comments

20. Secondary Outcome

Title	Self-efficacy for Vegetable Consumption at 3 Months
Description	Assessed with a validated measure used to evaluate the Stellar Farmers' Market program (Dannefer et al., 2015). Participants rated how much they agreed or disagreed with statements designed to measure confidence in the ability to prepare and consume fresh produce. Item ratings are on a 4-point scale ranging from strongly disagree (1) to strongly agree (4). Ratings were summed across items to derive a total score. Scores can range from 5 to 20. Higher scores represent a better outcome (greater self-efficacy for vegetable consumption).
Time Frame	3 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [units on a scale]	15.4 (0.2)	15.3 (0.2)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.750
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	0.1
	Confidence Interval	(2-Sided) 95%; -0.4 to 0.6
	Parameter Dispersion	Type: Value:
	Estimation Comments

21. Secondary Outcome

Title	Self-efficacy for Vegetable Consumption at 6 Months
Description	Assessed with a validated measure used to evaluate the Stellar Farmers' Market program (Dannefer et al., 2015). Participants rated how much they agreed or disagreed with statements designed to measure confidence in the ability to prepare and consume fresh produce. Item ratings are on a 4-point scale ranging from strongly disagree (1) to strongly agree (4). Ratings were summed across items to derive a total score. Scores can range from 5 to 20. Higher scores represent a better outcome (greater self-efficacy for vegetable consumption).
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Mean (Standard Error) [units on a scale]	15.8 (0.2)	16.0 (0.2)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.455
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	-0.2
	Confidence Interval	(2-Sided) 95%; -0.7 to 0.3
	Parameter Dispersion	Type: Value:
	Estimation Comments

22. Secondary Outcome

Title	Body Mass Index at 3 Months
Description	Height and weight were measured by trained research staff with participants wearing light clothing without shoes. Body mass index was calculated as weight in kilograms divided by height in square meters.
Time Frame	3 months

Outcome Measure Data

Analysis Population Description

For weight status, sample sizes were 137 in the intervention group and 124 in the control group. In the intervention group, 13 of the original 160 participants competed the baseline assessment only, 4 moved out of the area, and 6 discontinued their study involvement. In the control group, 10 of the original 137 participants completed the baseline assessment only, 2 moved out of the area, and 1 discontinued their study involvement.

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	137	124
Mean (Standard Error) [kg/m2]	30.3 (0.4)	29.4 (0.4)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.053
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	0.9
	Confidence Interval	(2-Sided) 95%; -0.0 to 1.8
	Parameter Dispersion	Type: Value:
	Estimation Comments

23. Secondary Outcome

Title	Body Mass Index at 6 Months
Description	Height and weight were measured by trained research staff with participants wearing light clothing without shoes. Body mass index was calculated as weight in kilograms divided by height in square meters.
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

For weight status, sample sizes were 137 in the intervention group and 124 in the control group. In the intervention group, 13 of the original 160 participants competed the baseline assessment only, 4 moved out of the area, and 6 discontinued their study involvement. In the control group, 10 of the original 137 participants completed the baseline assessment only, 2 moved out of the area, and 1 discontinued their study involvement.

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	137	124
Mean (Standard Error) [kg/m2]	29.9 (0.4)	29.9 (0.4)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	.986
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	0.0
	Confidence Interval	(2-Sided) 95%; -0.9 to 0.9
	Parameter Dispersion	Type: Value:
	Estimation Comments

24. Secondary Outcome

Title	Number of Participants Who Met Physical Activity Guidelines at 3 Months
Description	Assessed with a validated 2-item measure (the Brief Physical Activity Assessment Tool or BPAAT [Marshall et al., 2005]). The instrument consists of two questions, one that assesses the frequency and duration of vigorous intensity physical activity and one that assesses the frequency and duration of moderate intensity physical activity undertaken in a usual week. A scoring algorithm is used to derive a total score (scores can range from 0 to 8). Participants are classified as meeting current physical activity guidelines (yes or no) based on the scores (a score greater than or equal to 4 indicates that the participant is meeting current physical activity guidelines, whereas a score between 0 and 3 indicates that the participant is not).
Time Frame	3 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Count of Participants [Participants]	94 58.8%	83 60.6%

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.810
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Odds Ratio (OR)
	Estimated Value	1.1
	Confidence Interval	(2-Sided) 95%; 0.6 to 2.2
	Parameter Dispersion	Type: Value:
	Estimation Comments

25. Secondary Outcome

Title	Number of Participants Who Met Physical Activity Guidelines at 6 Months
Description	Assessed with a validated 2-item measure (the Brief Physical Activity Assessment Tool or BPAAT [Marshall et al., 2005]). The instrument consists of two questions, one that assesses the frequency and duration of vigorous intensity physical activity and one that assesses the frequency and duration of moderate intensity physical activity undertaken in a usual week. A scoring algorithm is used to derive a total score (scores can range from 0 to 8). Participants are classified as meeting current physical activity guidelines (yes/no) based on the scores (a score greater than or equal to 4 indicates that the participant is meeting current physical activity guidelines, whereas a score between 0 and 3 indicates that the participant is not).
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	143	130
Count of Participants [Participants]	97 60.6%	91 66.4%

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention, Control
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.591
	Comments
	Method	Mixed Models Analysis
	Comments
Method of Estimation	Estimation Parameter	Odds Ratio (OR)
	Estimated Value	0.8
	Confidence Interval	(2-Sided) 95%; 0.4 to 1.7
	Parameter Dispersion	Type: Value:
	Estimation Comments

26. Other Pre-specified Outcome

Title	Number of Participants Who Redeemed Any Cash Value Vouchers or CVV at Farmers' Markets at 6 Months
Description	Objectively assessed using data provided by the collaborating WIC agency. WIC reported whether participants redeemed any cash value vouchers at farmers' markets (yes or no) between baseline and 6 months.
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	160	137
Count of Participants [Participants]	12 7.5%	0 0%

27. Other Pre-specified Outcome

Title	Overall Satisfaction With Intervention
Description	Assessed via a single item (the Overall Satisfaction Rating Measure) querying how satisfied intervention recipients were with the intervention (on a 7-point scale ranging from very dissatisfied to very satisfied). Scores can range from 1 to 7. Higher scores represent a better outcome (greater overall satisfaction).
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

Satisfaction was measured among the subgroup of participants who received the intervention (n = 160). Of this number, 128 completed the measure of overall satisfaction with program.

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	128	0
Mean (Standard Deviation) [units on a scale]	6.8 (0.6)

28. Other Pre-specified Outcome

Title	Satisfaction With Intervention
Description	Assessed with a 5-item measure developed by the investigators querying how satisfied intervention recipients were with the intervention. Item responses were on a 7-point scale ranging from strongly disagree to strongly agree. Scores were averaged across items to derive a total score. Scores can range from 1 to7. Higher scores represent a better outcome (greater satisfaction with the intervention).
Time Frame	6 months

Outcome Measure Data

Analysis Population Description

Satisfaction was measured among the subgroup of participants who received the intervention (n = 160). Of this number, 128 completed the satisfaction measure.

Arm/Group Title	Intervention	Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.	This group will receive routine services provided by WIC only.
Measure Participants	128	0
Mean (Standard Deviation) [units on a scale]	6.8 (0.5)

Adverse Events

Time Frame	Adverse events were monitored over the course of participants' involvement in the study (the 34-week period beginning June 3, 2019, and ending January 31, 2020).
Arm/Group Title	Intervention		Control
Arm/Group Description	This group will receive routine services provided by WIC and an intervention that will combine behaviorally-focused nutrition education with 1) the establishment of a WIC-based farmers' market (implemented in 2019 during the WIC Farmers' Market Nutrition Program voucher issuance period [June 19 to August 19]), and 2) monthly trips to an area farmers' market and local supermarket (between September 1, 2019 and November 30, 2019 [the end of the local growing season]). Multilevel Behavioral Intervention: Behaviorally-focused intervention grounded in the Social Ecological Model and Social Cognitive Theory to promote vegetable intake and the redemption of seasonal Farmers' Market Nutrition Program vouchers and monthly Cash Value Vouchers provided to WIC participants to purchase fruits and vegetables.		This group will receive routine services provided by WIC only.
All Cause Mortality
	Intervention		Control
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/160 (0%)		0/137 (0%)
Serious Adverse Events
	Intervention		Control
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/160 (0%)		0/137 (0%)
Other (Not Including Serious) Adverse Events
	Intervention		Control
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/160 (0%)		0/137 (0%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.