non-WIC Participants Research Articles

Maternal and infant predictors of infant mortality in California, 2007-2015.

ObjectiveTo identify current maternal and infant predictors of infant mortality, including maternal sociodemographic and economic status, maternal perinatal smoking and obesity, mode of delivery, and infant birthweight and gestational age.MethodsThis retrospective study analyzed data from the linked birth and infant death files (birth cohort) and live births from the Birth Statistical Master files (BSMF) in California compiled by the California Department of Public Health for 2007–2015. The birth cohort study comprised 4,503,197 singleton births including 19,301 infant deaths during the nine-year study period. A subpopulation to study fetal growth consisted of 4,448,300 birth cohort records including 13,891 infant deaths.ResultsThe infant mortality rate (IMR) for singleton births decreased linearly (p <0.001) from 4.68 in 2007 to 3.90 (per 1,000 live births) in 2015. However, significant disparities in IMR were uncovered in different population groups depending upon maternal sociodemographic and economic characteristics and maternal characteristics during pregnancy. Children of African American women had almost twice the risk of infant mortality when compared with children of White women (AOR 2.12; 95% CI, 1.98–2.27; p<0.001). Infants of women with Bachelor’s degrees or higher were 89% less likely to die (AOR 1.89; 95% CI, 1.76–2.04; p<0.001) when compared to infants of women with education less than high school. Infants of maternal smokers were 75% more likely to die (AOR 1.75; 95% CI, 1.58–1.93; p<0.001) than infants of nonsmokers. Infants of women who were overweight and obese during pregnancy accounted for 55% of IMR over all women in the study. More than half of the infant deaths were to children of women with lower socioeconomic status; infants of WIC participants were 59% more likely to die (AOR 1.59; 95% CI, 1.52–1.67; p<0.001) than infants of non-WIC participants. With respect to infant predictors, infants born with LBW or PTB were more than six times (AOR 6.29; 95% CI, 5.90–6.70; p<0.001) and almost four times (AOR 3.95; 95% CI, 3.73–4.19; p<0.001) more likely to die than infants who had normal births, respectively. SGA and LGA infants were more than two times (AOR 2.03; 95% CI, 1.92–2.15; p<0.001) and 41% (AOR 1.41; 95% CI, 1.32–1.52; p<0.001) more likely to die than AGA infants, respectively.ConclusionsWhile the overall IMR in California is declining, wide disparities in death rates persist in different groups, and these disparities are increasing. Our data indicate that maternal sociodemographic and economic factors, as well as maternal prepregnancy obesity and smoking during pregnancy, have a prominent effect on IMR though no causality can be inferred with the current data. These predictors are not typically addressed by direct medical care. Infant factors with a major effect on IMR are birthweight and gestational age—predictors that are addressed by active medical services. The highest value interventions to reduce IMR may be social and public health initiatives that mitigate disparities in sociodemographic, economic and behavioral risks for mothers.

Prenatal Vitamin Use in Rhode Island According to Women, Infants, and Children (WIC) Participation

Abstract Objectives To examine prenatal vitamin (PNV) use between Women, Infants, and Children (WIC) and non-WIC pregnant women and explore food security and sociodemographic characteristics associated with each group. Methods A cross-sectional study was conducted among a convenience sample of Rhode Island pregnant women 18 years of age or older. Women were recruited from WIC offices, OB-GYN offices, and pregnant women known to the research team. All women that participated in the study completed an anonymous 21-question survey in-person or online that asked about PNV use, sociodemographic characteristics, and food security. We conducted t -testsand chi-square tests in this data analysis using SPSS. T-tests were used for continuous variables and chi-square was used for categorical variables. Results Out of 96 pregnant women, 61% were WIC participants. WIC participants were more likely to be Hispanic (47% vs 16%, P = 0.00), identify as a race other than white (35% vs 8%, P = 0.02), and were less likely to have a bachelor's degree (7% vs 59%, P &amp;lt; 0.001). WIC participants had a higher prevalence of food security than non-WIC participants (56% vs 27%, P = 0.01). There was no significant difference in PNV use between WIC and non-WIC participants (P = 0.91), with 92% of women from both groups consuming PNVs during pregnancy. However, WIC participants were more likely to obtain PNVs through a prescription than non-WIC participants (53% vs 24%, P = 0.003). Conclusions This study indicates that there is high use of prenatal vitamins in both WIC and non-WIC participants, which is contrary to previous published studies on prenatal vitamin use among low-income women. In addition, we found that WIC participants are obtaining prescription prenatal vitamins more than non-WIC women. This is worth further attention as the composition of prescription and non-prescription prenatal vitamins differ. Funding Sources University of Rhode Island startup grant.

Effect of Maternal Health Literacy and WIC Participation on Selection of Sugar-Sweetened Beverages and Energy Dense Foods

Background: In the United States almost a quarter of children 2-5 years of age are considered overweight or obese. Many potential causes have been implicated including low maternal health literacy and high intake of sugar-sweetened beverages (SSBs). The effects of maternal health literacy, Women, Infant, and Children (WIC) participation, on selection of SSBs and energy dense foods needs to be examined. Aims: To examine correlations between maternal health literacy and selection of SSBs and energy dense foods during a feeding simulation (FS) for their children. WIC participation and SSB (or 100% juice) selection was also examined. Methods: Thirty-two mothers of 2 and 3-year-old children completed a demographic survey, and health literacy assessment (Newest Vital Sign, NVS) and a child feeding simulation (FS). For the FS, participants were presented with 37 discreet food and beverage choices with representation from each food group and some non-food group (e.g. soda, non-carbonated sugar-sweetened beverage, butter). The outcome variable comprised ratings of respondents from the NVS scale. The scale was dichotomized into two separate groups, representing “low-health-literacy” and “high-health-literacy”. Stratified analyses were conducted to examine whether percentage of calories as well as total number of calories selected daily varied by caloric density grouping of foods and beverages into “Go” (‘Almost Anytime’ foods), “Slow” (‘Sometimes’ foods), and “Whoa” (‘Once in a While’ foods). Results: Results indicate about a third of mothers had either high likelihood/possible limited health literacy. Mothers with lower scores on a health literacy assessment were not more likely to select less healthy choices. Examination of distribution of the percentage of calories consumed in three different caloric density groups were not statistically significant, indicating that there is no difference in the types of calories which are dense, or healthy by how health literate a respondent was. In addition, there was a not statistically significant difference among mean total number of daily calories consumed by health literacy level. Parents who were more likely to choose an SSB or juice during breakfast had a lower rating on the NVS questionnaire (p=0.108), whereas parents who choose a sugar-sweetened beverage or juice for lunch (p=0.305) or dinner (p=0.323) actually had a higher NVS score. However, none of these findings were statistically significant. WIC participants were significantly more likely to choose a SSB or juice for breakfast than were non-WIC participants (p=0.004). There were no significant differences in whether parents chose sugar-sweetened beverages or juice for lunch (p=0.427), dinner (p=0.433), or snack time (p=1.000). Conclusions: Health literacy and WIC participation does not appear to have an impact on selection of energy-dense foods and SSBs. Clinical implications: Health literacy is an important parameter to consider when educating patients but dietary implications may not be relevant.

Determinants of vitamin D status among Black and White low-income pregnant and non-pregnant reproductive-aged women from Southeast Louisiana

BackgroundVitamin D deficiency is a growing public health problem, with pregnant women being particularly vulnerable due to its influences on maternal and neonatal outcomes. However, there are limited data published about mediators of vitamin D status in Louisiana women. We aimed to assess the vitamin D status and its determinants among low-income pregnant and non-pregnant reproductive-aged women from southeast Louisiana.MethodsThis study was conducted using data from the Gulf Resilience on Women’s Health (GROWH) research consortium cohort of pregnant and non-pregnant women which contained sociodemographic and dietary variables as well as blood and salivary element concentrations. Serum 25-hydroxy vitamin D was measured using an enzyme-linked immunosorbent assay in 86 pregnant and 98 non-pregnant women with an even distribution of race in both groups.ResultsThe prevalence of deficient vitamin D levels in the total cohort (184 women) was 67% and the mean 25(OH) vitamin D3 was 24.1 ng/mL (SD 10.7). Self-identifying as White, being pregnant, autumn season, young age and high exposure to tobacco smoke measured by cotinine were significantly associated with higher serum levels of vitamin D. Visiting Women and Infant clinics (WIC) was an important determinant in improving 25(OH) vitamin D3 levels for Black women but not for White women and concentrations varied more among Black women across seasons compared to White women.ConclusionsSerum vitamin D levels are inadequate among a high proportion of Black and White low-income pregnant and reproductive-aged women living in Southeast Louisiana who were enrolled in the GROWH study. Black women who are over 35 years old and non-WIC participants constitute the subpopulation most at risk for vitamin D deficiency, especially during the winter. As an overall higher level of deficiency exists in Black women, if even small behavioral and dietary modifications are produced by WIC, this can lead to a comparatively greater improvement in vitamin D status in women from Southeast Louisiana who self-identify as Black.

Implementation of a WIC clinic farmers’ market improves accessibility and consumption of fresh fruits and vegetables among WIC farmers’ market nutrition program participants

ABSTRACTFew data are available concerning the socio-demographic characteristics and fruit and vegetable (F&V) purchasing behaviors of visitors attending the farmers’ markets sponsored by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Farmers’ Market Food and Nutrition Program (FMNP). The objectives of this cross-sectional study were to compare socio-demographics, food purchasing behaviors, and motivators for visiting a new WIC-based farmers’ market among convenience samples of WIC FMNP participants (n = 124, 30%) and non-participants (n = 291, 70%) using a customer survey (n = 415). Frequency counts and percentages were obtained while independent t-tests and Chi-square were carried out to compare WIC FMNP participants to non-WIC participants (p ≤ 0.05). The age range of most (62%) of the visitors was 25–54 and the majority were female (91%). The primary motivators for market attendance included variety of F&V (76%), quality of F&V (55%), and to purchase food grown locally (59%). The majority of the total sample agreed (88%) that shopping at the WIC-based farmers’ market increased their F&V consumption. WIC FMNP participants were further motivated by low prices (44%) and the ability to easily spend FMNP coupons (75%). Additionally, the study finds that location and convenience play a critical role in increasing FMNP coupon redemption rates.

WIC and non-WIC Infants and Children Differ in Usage of Some WIC-Provided Foods

BackgroundUSDA's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides expert-chosen supplemental foods to improve the diets and health of low-income infants and children <5 y of age, but dietary behaviors of WIC participants are not well characterized. ObjectiveThe purpose of this analysis was to examine differences in food consumption patterns between WIC participants and nonparticipants. MethodsFITS 2016 is a nationwide cross-sectional study of children <4 y (n = 3235). Data were weighted to provide US population–representative results. Children were categorized as WIC participants or nonparticipants, with the latter divided into lower- and higher-income nonparticipants. Group differences were assessed via the Wald test (demographics) and Rao-Scott modified chi-square test (breastfeeding prevalence). Differences in percentage consuming WIC-provided and selected other foods between WIC participants and nonparticipants were evaluated with the use of ORs and 95% CIs. ResultsWIC infants were less likely to breastfeed than were higher-income nonparticipants at 0–5.9 mo (45% compared with 74%) and less likely than both nonparticipant groups at 6–11.9 mo (30% compared with 49–60%). WIC 6- to 11.9-mo-olds were more likely to consume infant cereals and vegetables than were lower-income nonparticipants. WIC 12 to 23.9-mo-olds were more likely to drink whole milk (which WIC provides at this age) than were nonparticipants (72% compared with 59–64%), whereas WIC participants 24–47.9 mo were more likely to drink low- and nonfat milks (which WIC provides at this age) than were nonparticipants (45% compared with 13–22%). WIC participants 6–47.9 mo were more likely to drink juice than were nonparticipants. ConclusionsContinued improvements in early dietary patterns are warranted for WIC and non-WIC children. Breastfeeding among WIC participants is a continuing challenge. Findings suggest that baby-food cereals, vegetables, and fruits (all provided by WIC) contribute importantly to WIC infants’ diets, whereas WIC children are more likely to use lower-fat milks after 2 y of age than are non-WIC participants.

Intent vs. Implementation—Food Allocation to Adult Males in WIC Households

The intent of the Special Supplemental Food and Nutrition Program for Women, Infants and Children (WIC) program is found in its name—to increase the health status of a targeted group through supplemental food. Households often contain multiple members who are categorically ineligible, including older ineligible children and adult males. This paper focuses on potential spillover of benefits to adult males. Comparing multiple outcomes across treated and untreated households, the author finds evidence that consumption of certain WIC foods is higher among men in WIC households compared to the most appropriate comparison group: income eligible non-WIC participants. The author also finds evidence that this difference is attributable to food-sharing and not an income effect as there is no increase in the consumption of other, non-WIC foods. The increased consumption of cereal, milk and juice is only remarkable among married men in WIC households and not among single fathers. Additional evidence looking at the differences between married and single women’s food consumption suggests that food is siphoned from the mother and not from the children; this finding supports the altruistic parent food allocation hypothesis. Most of the results are not robust to full controls, indicating that unobservable propensity to consume WIC foods may be driving entry into the program. If the findings of this study are a true representation of WIC implementation, policy makers should weigh whether this outcome is desirable in terms of the program mission. Citation: Martin-Anderson S (2014) Intent vs. Implementation—Food Allocation to Adult Males in WIC Households. J Nutr Health Sci 1(3): 307. doi: 10.15744/2393-9060.1.307 The Special Supplemental Food and Nutrition Program for Women, Infants and Children (WIC) is a federal transfer program that provides vouchers for the purchase of approved foods. The program is funded and administered by the United States Department of Agriculture (USDA) and run at the local level by various agents, both public and private not-for-profit. In 2006, the year before this study period, federal expenditures for the WIC program totaled 6.2 billion dollars accounting for 11% of the USDA’s 53 billion dollar food assistance budget. The 2006 program enrollment was approximately 8 million women, infants and children. The ultimate objective of the WIC program is to improve the health status of the country’s nutritionally at-risk by increasing the consumption of healthy foods. Pregnant and nursing women, as well as their children age zero to five, are eligible pending income qualification and designation of nutritional “at-risk” status. Eligible women who enroll in the WIC program take paper or electronic vouchers to participating stores and purchase approved foods; unlike food stamps (SNAP), there is little or no flexibility in food purchases. By restricting purchases to WIC-approved foods, this policy avoids the potential for the negative behaviors associated with SNAP; SNAP participants consume more added sugars than income-eligible non-SNAP participants [1]. WICapproved foods during the study period included infant formula, infant cereal, milk, cheese, eggs, dried beans and juice [1]. Since the study period, bread, fresh fruit and vegetables have been added to the food basket [2]. The market value of the WIC food package is roughly 35 dollars per person for this paper’s study period and averaged 90 dollars per WIC household [3].

Assessing immunization interventions in the Women, Infants, and Children (WIC) program.

Vaccination promotion strategies are recommended in Women, Infants, and Children (WIC) settings for eligible children at risk for under-immunization due to their low-income status. To determine coverage levels of WIC and non-WIC participants and assess effectiveness of immunization intervention strategies. The 2007-2011 National Immunization Surveys were used to analyze vaccination histories and WIC participation among children aged 24-35 months. Grantee data on immunization activities in WIC settings were collected from the 2010 WIC Linkage Annual Report Survey. Coverage by WIC eligibility and participation status and grantee-specific coverage by intervention strategy were determined at 24 months for select antigens. Data were collected 2007-2011 and analyzed in 2013. Of 13,183 age-eligible children, 5,699 (61%, weighted) had participated in WIC, of which 3,404 (62%, weighted) were current participants. In 2011, differences in four or more doses of the diphtheria, tetanus toxoid, and acellular pertussis (DTaP) vaccine by WIC participation status were observed: 86% (ineligible); 84% (current); 77% (previous); and 69% (never-eligible). Children in WIC exposed to an immunization intervention strategy had higher coverage levels than WIC-eligible children who never participated, with differences as great as 15% (DTaP). Children who never participated in WIC, but were eligible, had the lowest vaccination coverage. Current WIC participants had vaccination coverage comparable to more affluent children, and higher coverage than previous WIC participants.

A Qualitative Study to Understand Cultural Factors Affecting a Mother’s Decision to Breast or Formula Feed

The presence of barriers is not sufficient to explain breastfeeding rate disparities. A relatively unexplored area in coping with breastfeeding barriers is culture. This research aims to better understand the role of culture in a woman's infant feeding decision by using race and socioeconomic status as indicators of culture. Focus groups and individual interviews were conducted with 42 pregnant women or mothers of infants younger than 12 months. Focus group composition was determined by self-identified African American or white race and self-reported eligibility for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or ineligibility (non-WIC). Most participants acknowledged that breastfeeding was best, yet differences arose between groups in the perception of, and reaction to, breastfeeding barriers. WIC and non-WIC participants of both races indicated that some circumstances necessitated formula use. WIC participants felt that this was personally and socially acceptable due to need, whereas non-WIC participants felt that this was personally and socially unacceptable. When a barrier arose, WIC participants of both races felt that the infant feeding choice was not theirs and formula use might be inevitable. In contrast, non-WIC participants of both races expressed that they persevered to continue breastfeeding and did so by establishing small, achievable goals and seeking mentors. Educational and public health efforts to reduce breastfeeding disparities may be enhanced if support is tailored to acknowledge cultural differences among women and address factors that make either breastfeeding or formula feeding acceptable, or even preferable, within their communities.

WIC Participation and Breastfeeding in South Carolina: Updates from PRAMS 2009–2010

Few studies examined breastfeeding initiation and duration among mothers who were eligible for the Women Infants Children (WIC) program and did not participate. This study is sought to understand the role of WIC participation and poverty level in breastfeeding initiation and duration in South Carolina. The data came from the 2009-2010 South Carolina Pregnancy Risk Assessment Monitoring System (unweighted N = 1,796). All participants were classified as WIC participants, income-eligible non-WIC participants, and income-ineligible non-WIC participants. Logistic regression models were used to analyze the association between breastfeeding initiation and WIC participation. The Kaplan-Meier method and Cox proportional hazards models were used to determine whether the continuation of breastfeeding and hazards of discontinuing breastfeeding differed by WIC participation groups. In South Carolina, two out of three women (67.2%) initiated breastfeeding. The breastfeeding initiation rate was higher among income-ineligible (84.0%) and income-eligible (78.9%) non-WIC participants than among WIC participants (55.5%). Compared to WIC participants, both income-ineligible [odds ratio (OR) = 2.1, 95% confidence interval (CI) 1.2-4.0] and income-eligible (OR = 2.6, 95% CI 1.1-4.3) non-WIC participants were more likely to initiate breastfeeding. Among mothers who already initiated breastfeeding, after adjusting covariates, the hazard ratios for weaning within 34 weeks postpartum were not significantly different by WIC participation groups. This study confirmed WIC participants were less likely to initiate breastfeeding. Once initiated, WIC participation did not significantly impact breastfeeding duration in the early postpartum period. Poverty status may not play an important role in explaining disparities in breastfeeding initiation between WIC and non-WIC participants.

Unintended Consequences of the WIC Formula Rebate Program on Infant Feeding Outcomes: Will the New Food Packages Be Enough?

Approximately half of all mothers of infants born in the United States receive services through the Special Supplemental Nutrition Program for Woman, Infants and Children (WIC). Although WIC promotes breastfeeding, data suggest that, despite advances in the last 2 decades, WIC participants are less likely to initiate breastfeeding, and much less likely to continue, than non-WIC participants, including the non-WIC participants who are eligible for WIC. WIC recently revised their food packages and enhanced the monetary value of the breastfeeding packages. While these changes are an important step in supporting WIC's efforts to promote breastfeeding, other major factors, such as participants' perceptions of the value of the packages and WIC's dependency on rebates from formula companies to fund a portion of the program, may dampen WIC's breastfeeding promotion and support efforts. There is great need for additional research on these issues.

The Impact of Prenatal WIC Participation on Infant Mortality and Racial Disparities

We assessed the value of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services as a public health intervention seeking to improve birth outcomes and reduce racial disparities. We compared the infant mortality rate (IMR) per 1000 live births and percentage of preterm births overall and by race for prenatal WIC versus non-WIC participants in Hamilton County, Ohio, from 2005 to 2008. The IMR was lower for WIC participants than for non-WIC participants (8.0 vs 10.6; P = .04). For African Americans, the IMR of WIC participants was much lower than that of non-WIC participants (9.6 vs 21.0; P < .001). For Whites, IMR and preterm birth rates were not improved by WIC participation; however, there was a higher rate of maternal smoking among Whites. The racial disparity in IMR was dramatically reduced in WIC participants (9.6 for African Americans vs 6.7 for Whites; P = .14) as compared with non-WIC participants (21.0 for African Americans vs 7.8 for Whites; P < .001). Prenatal WIC participation is associated with significant improvements in African American IMR. WIC participation reduces racial disparities in IMR between African Americans and Whites.

The changing association between prenatal participation in WIC and birth outcomes in New York City

We analyze the relationship between prenatal WIC participation and birth outcomes in New York City from 1988-2001. The analysis is unique for several reasons. First, we have over 800,000 births to women on Medicaid, the largest sample ever used to analyze prenatal participation in WIC. Second, we focus on measures of fetal growth distinct from preterm birth, since there is little clinical support for a link between nutritional supplementation and premature delivery. Third, we restrict the primary analysis to women on Medicaid who have no previous live births and who initiate prenatal care within the first four months of pregnancy. Our goal is to lessen heterogeneity between WIC and non-WIC participants by limiting the sample to highly motivated women who have no experience with WIC from a previous pregnancy. Fourth, we analyze a large sub-sample of twin deliveries. Multifetal pregnancies increase the risk of anemia and fetal growth retardation and thus may benefit more than singletons from nutritional supplementation. We find no relationship between prenatal WIC participation and measures of fetal growth among singletons. We find a modest pattern of association between WIC and fetal growth among U.S.-born Black twins. Our findings suggest that prenatal participation in WIC has had a minimal effect on adverse birth outcomes in New York City.

Vaccination status of children in the Women, Infants, and Children (WIC) Program : Are we doing enough to improve coverage?

Background: Vaccination-promoting strategies in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) have been shown to produce dramatic improvements in coverage and other health outcomes. Objectives: To determine national and state-specific population-based vaccine coverage rates among preschool children who participate in the WIC program, and to describe the strategies for promoting vaccination in WIC. Design/ Methods: Demographic data, WIC participation, and vaccination histories for children aged 24 to 35 months in 1999 were collected from parents through the National Immunization Survey. The healthcare providers for the children in the survey were contacted to verify and complete vaccination information. We defined children as up-to-date (UTD) if they had received four doses of diphtheria and tetanus toxoids and pertussis vaccine (DPT), three doses of poliovirus vaccine, one dose of measles-mumps-rubella vaccine (MMR), and three doses of Haemophilus influenzae type b vaccine (Hib) by 24 months. Description of state-level vaccination-promoting activities in WIC was collected through an annual survey completed by the state WIC and immunization program directors. Results: Complete data were collected on 15,766 children, of whom 7783 (49%) participated in WIC sometime in their lives. Nationally, children who had ever participated in WIC were less well-immunized at 24 months compared to children who had not: 72.9% UTD (95% CI, 71.3–74.5) versus 80.8% UTD (95% CI, 79.5–82.1), respectively. In 42 states, 24-month coverage among WIC participants was less than among non-WIC participants, including 13 states where the difference was ≥10%. Vaccination activities linked with WIC were reported from 76% of 8287 WIC sites nationwide. States conducting more-frequent interventions and reaching a higher proportion of WIC participants had 40% higher vaccination coverage levels for the WIC participants in that state ( p<0.05). Conclusions: Children served by WIC remain less well-immunized than the nation’s more-affluent children who do not participate in WIC. Thus, WIC remains a good place to target these children. This study provides evidence that fully implemented WIC linkage works to improve vaccination rates. Strategies that have been shown to improve the vaccination coverage levels of WIC participants should be expanded and adequately funded to protect these children.

Georgia's Breastfeeding Promotion Program for Low-Income Women

Beginning in 1990, Georgia's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) initiated 5 new strategies to promote breastfeeding among its pregnant and postpartum clients. These strategies were implemented in 1991, each to be provided as an addition to its standard program of counseling on breastfeeding and distributing appropriate literature: 1) enhanced breastfeeding education, 2) breast pump loans, 3) hospital-based programs, 4) peer counseling, and 5) community coalitions. The enhanced breastfeeding education strategy provides access to a hotline as well as periodic training of staff, and the breast pump loan provides free breast pumps to mothers who want to use them. The hospital-based strategy provides bedside support and counseling to women who have just given birth and includes staff training, as well as a hotline number for women to call after they leave the hospital. The peer-counseling strategy focuses on identifying former WIC participants who have successfully breastfed their infants; these women are recruited to provide support and encouragement to current WIC participants. Finally, the community coalitions approach is designed to identify existing community attitudes about breastfeeding, establish plans to address gaps in breastfeeding services, to develop resource guides on breastfeeding for the community, and to advocate at the community level to support breastfeeding women. The objective of our research was to evaluate the impact of breastfeeding promotion strategies on breastfeeding initiation among WIC participants in Georgia. Using data from the Pregnancy Nutrition Surveillance System (PNSS) for 1992-1996, we examined breastfeeding initiation rate during this period and compared rates among 6 different intervention strategies. Also, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to assess breastfeeding initiation and duration among WIC enrollees. We conducted 13 focus groups to understand the experiences of program participants. Ten focus groups were conducted with women who were breastfeeding their infants, 3 each with women from the community coalitions, hospital-based programs, and standard education programs, and 1 with women from the breast pump loan program. Three focus groups were conducted with women who were feeding their infants formula. PNSS data show that breastfeeding initiation increased in the Georgia WIC program from 31.6% in 1992 to 39.5% in 1996. PRAMS data confirmed the increase in breastfeeding initiation from 33.6% (standard error [SE]: 2.2) in 1993 to 42.1% (SE: 2.4) in 1996 among WIC participants. Both datasets (PRAMS and PNSS) showed breastfeeding initiation to be well below the year 2000 goal of 75%. Overall, PRAMS data show a high breastfeeding initiation among non-WIC participants (range: 64.7% [SE: 2.2]) for 1994 to 70.1% (SE: 2.2) in 1996. The percent change between 1993 and 1996 was 8% for non-WIC participants, and it was 25% for the WIC participants among those responding to the PRAMS questionnaire. Data from PRAMS indicated no statistical change in the percentage of WIC enrollees who breastfed their infants for 8 weeks or more; this estimate was 18.3% (95% confidence interval (CI): 14.9-21.8) in 1993 and 19.4% (95% CI: 15.7-23.2) in 1996, well below the Healthy People 2000 objective of 50% at 6 months. According to PNSS data, the largest increases in breastfeeding initiation for 1992 to 1996 were among younger women (</=19 and 20-24 years old), those with no college (less than high school and high school only), unmarried, and black women (see Table 1). The smallest increases during this period were among older women (30+), those with more than a high school education, and women who were white, Hispanic, or from other ethnic or racial groups. The PRAMS data (1993-1996) generally display similar results, but the pattern by marital status demonstrated larger increases for married women than for unmarried women.

Intake of Food Guide Pyramid Servings: A Comparison of WIC Children in Wisconsin and Children from 1994 CSFII

The purpose of this study was to determine if foods provided by the Special Supplemental Food Program for Women, Infants and Children (WIC) affect selected indicators of diet quality among WIC participants. Recall data from 179 Wisconsin WIC children ages 2 to 5 years were converted to Food Guide Pyramid servings and compared to the 1994 Continuing Survey of Food Intakes of Individuals (CSFII) Food Guide Pyramid servings data. Three comparison groups were identified from CSFII for children ages 2 to 5 years in the mid-west region: WIC participants and non-WIC participants above and below 185% of the federal poverty level. Means and standard errors for the Wisconsin data were computed with SPSS for Windows; WesVarPC was used to obtain weighted means and standard errors for CSFII data. The number of Food Guide Pyramid servings were compared among groups using a z-test. In general, WIC participants consumed more of some dairy products and vegetables and less added sugar than the children not participating in WIC, suggesting a significant contribution of WIC supplemental foods and nutrition education to the dietary quality of its participants. These findings should be of particular interest to practitioners involved in program planning for WIC and persons who allocate funding to the WIC program.

Missed opportunities to improve immunization status among high-risk children in the WIC program.

An investigation of a recent pertussis outbreak in Idaho showed that WIC participants were less well immunized than non-WIC participants. Conducting immunization status assessment and referral to a provider for vaccination (A/R) in WIC has been shown to significantly improve immunization. WIC files were abstracted to obtain immunization and visit histories. More frequent A/R at WIC has potential to improve the immunization status of preschool age WIC participants.

Evaluation of the effect of WIC supplemental feeding on birth weight

This study examined the impact of pregnant women's participation in a WIC supplemental feeding program on the birth weight of infants. Data on 1,328 WIC and non-WIC participants were collected from a retrospective review of medical and/or nutrition records. Participation of women in WIC was associated with a positive and significant increment in birth weight of their infants.