Johnson, Donna BMcLaury, Kimberly C.2014-04-302014-04-302014-04-302014McLaury_washington_0250O_12798.pdfhttp://hdl.handle.net/1773/25445Thesis (Master's)--University of Washington, 2014Background: In 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package was revised to include a cash-value voucher (CVV) for fresh fruits and vegetables. While this supplement to the WIC food package provides participants with the resources to purchase healthier foods, there is a potential mismatch to using CVVs when access to fresh fruits and vegetables is limited. Our past research reveals that access to fresh fruits and vegetables on American Indian reservations in Washington State is limited. This study, therefore, evaluated differences in the CVV redemption rate among Washington State participants by comparing the redemption rate of WIC clinics located on federally recognized tribal reservations with non-reservation based WIC clinics. Furthermore, the study evaluated redemption rates for Washington State tribes with low-access to fresh fruits and vegetables compared to those with high access, using proximity of a supermarket to the tribe's reservation land as a measure of access. Methods: Data were obtained for 212 clinics that provided WIC services in Washington State during 2011. The number of CVVs issued and number of CVVs cashed was divided to obtain the mean percent of CVV redemption for each WIC clinic for both tribal and non-tribal WIC clinics. Amongst tribal clinics, percent CVV redeemed was compared in tribal clinics with supermarkets located within the bounds of the reservation to those without supermarkets. Results: The redemption rates for WIC clinics located on federally recognized tribal reservations was lower than the rate for clinics located off tribal reservations (p<0.0001). Among tribal WIC clinics, there were no significant differences in CVV redemption rates between tribes who had or did not have a supermarket located within the bounds of the reservation. Conclusions: Our results indicate that tribal WIC CVV redemption in Washington State is significantly lower than non-tribal CVV redemption. However, it does not demonstrate that tribal WIC clinics have lower CVV redemption rates when a supermarket is located within the bounds of the reservation, compared to not on the reservation. Results of this study suggest the need to address barriers to CVV redemption, specifically in the tribal WIC population.application/pdfen-USCopyright is held by the individual authors.American Indian; Food Access; Food Package; Washington State; WICNutritionPublic healthnutritional sciencesThesis