WIC Participants Research Articles

The effects of the 2010 Affordable Care Act dependent care provision on family structure and public program participation among young adults

We use difference-in-difference methods and data from the 2008 Survey of Income and Program Participation to test whether the ACA dependent care provision is associated with family structure and public program participation among young adults. Findings indicate that implementation of the provision is associated with reductions in the likelihoods of being married and cohabitating, respectively, and an increase in the likelihood of being single. The provision is associated with a reduction in being a single parent, as well as reductions in young adults’ participation in SNAP, TANF and WIC.

WIC Participation and Breastfeeding after the 2009 WIC Revision: A Propensity Score Approach.

In this study, we examined the association between participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and breastfeeding outcomes before and after the 2009 revisions. Four-thousand-three-hundred-and-eight WIC-eligible children younger than 60 months were included from the 2005–2014 National Health and Nutrition Examination Survey (NHANES). We compared two birth cohorts with regard to their associations between WIC participation and being ever-breastfed and breastfed at 6 months. We estimated the average effect of the treatment for the treated to assess the causal effect of WIC participation on breastfeeding based on propensity score matching. The results showed that WIC-eligible participating children born between 2000 and 2008 were significantly less likely than WIC-eligible nonparticipating children to ever receive breastfeeding (p < 0.05) or to be breastfed at 6 months (p < 0.05). Among children born between 2009 and 2014, WIC-eligible participating children were no longer less likely to ever receive breastfeeding compared to WIC-eligible nonparticipating children; the gap remained in breastfeeding at 6-months (p < 0.05). The disparities in prevalence of ever breastfed between WIC-eligible participants and nonparticipants have been eliminated since the 2009 WIC revision. More efforts are needed to improve breastfeeding persistence among WIC-participating mother–infant dyads.

Qualitative Research on the Real-Time Decision Making of WIC Participants While Food Shopping: Use of Think-Aloud Methodology

BackgroundPeople of lower socioeconomic status often experience disparities related to dietary intake as compared with People of higher socioeconomic status. Foods purchased influence the availability of foods in the home environment, and availability of foods in the home environment is associated with dietary intake. ObjectiveTo identify what factors influence food purchasing decisions of low-income parents while food shopping. DesignA qualitative study using think-aloud methodology, the processing of information through verbalization concurrent with task performance, was used to verbally capture real-time decision making. Participants and settingTwenty-eight parents with a preschool-aged child enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Study visits took place at the WIC clinic office and local grocery stores. Main outcomesReasons for making decisions while food shopping. AnalysisAudio recordings were transcribed, and thematic analysis was used to analyze the data. Descriptive statistics were used to characterize demographics and shopping behaviors. ResultsA parent’s decision in a food purchase was based on child preference, value, need of an item, or the parent choice for a product. In addition, themes emerged related to participant shopping behavior included the influence of participation in WIC on food and beverage purchases, multiple trips to the store, and a frequent focus on purchasing bottled water and juice. The average shopping trip was 31.5±15.7 minutes, and the median amount spent was $38.61. ConclusionUnderstanding the influences of parent decisions while making food purchases can better help inform the nutrition education provided as part of WIC.

P91 Transforming Food Systems Sustainability: An Opportunity for Online Nutrition Education

Background WIC provides nutrition education and support during critical periods of growth and development to participants. However, little has been reported on WIC participants’ existing awareness of food sustainability issues. Objective The purpose of this study was to determine the effect of attitudes, perceptions and behaviors around food sustainability on the adoption of three new behaviors; willingness to increase intake of fresh fruits and vegetables, increase breastfeeding initiation and duration and reduce food waste to maximize food dollar. Study Design, Settings, and Participants A cross-sectional design included three online surveys. WIC participants completed surveys at the end of lessons delivered through wichealth.org, a well established parent-child feeding behavior intervention used by WIC agencies in 32 states. Participants from seven wichealth.org partner states self-selected completion of the breastfeeding (n = 612), or two food waste (n = 1,178 and n = 773) surveys. Measurable Outcome/Analysis Surveys were comprised of binary or nominal and Likert scale items. Data were analyzed using descriptive statistical analysis. Results Breastfeeding survey respondents were twice as likely to agree sustainability knowledge would impact breastfeeding choices. More than half (53%) of food waste survey respondents believed food waste is a problem for most households, with big portion sizes the most often answered (30%) reason for food waste. Respondents estimated 80% of food waste is thrown away, with leftovers more than twice as likely than fruits and vegetables to be thrown away. Only 12% correctly estimated the monetary value of food waste, while 80% underestimated the national average. Finally, 71% of respondents were interested in decreasing food waste. Conclusion Findings show a need for providing online knowledge, tools and skills for food sustainability, which may influence WIC participant behaviors surrounding healthy food supplies. Practical applications include incorporating food sustainability concepts and behavior into WIC nutrition education, especially participants using wichealth.org, as a well as further research.

P138 Increasing Access to the Special Supplemental Nutrition Program for Women, Infants & Children Through Discount Variety Stores

Background The Special Nutrition Assistance Program for Women, Infants, and Children (WIC) increases access to nutritious foods for low-income pregnant, postpartum, and breastfeeding women and their children under five. Participation in WIC has declined for the past six years. Discount variety stores (DVS) can be useful points of food access for low-income communities. Objective To identify facilitators and barriers to WIC implementation in multiple DVS locations. Identifying the facilitators and barriers associated with WIC implementation may lead to more successful program adoption, allowing more families to benefit from WIC and increase DVS revenues. Study Design, Settings, Participants We conducted in-depth interviews with 30 staff at corporate (n = 6), managerial (n = 22), and store clerk (n = 8) levels at ten DVSs in low-income communities in North Carolina. These stores implemented WIC over a 10-month pilot study to access WIC feasibility; nine stores were located in food deserts. Measurable Outcome/Analysis Interviews were coded, and an inductive approach was used to identify qualitative themes. Results All except one participant provided positive feedback about being involved in the WIC program. Many DVSs store employees had previous experience participating in the WIC program which gave them a good understanding of the WIC shopping experience. Previous WIC experience and proximity to store location for DVS customers were facilitators of WIC implementation. The primary barriers included limited choice in store products for customers, complicated or unclear labeling for WIC-eligible products, and difficulty training store employees to process WIC payments. Conclusion Most employees have a positive view of WIC but barriers related to product selection and training must be addressed to improve future WIC implementation. Notably, WIC's new electronic benefit transfer system (eWIC), which does not require as much detailed and manual employee training, should address several barriers to implementation. Future studies should evaluate implementation of eWIC in DVSs.

NP22 Development of the Children Eating Well (CHEW) Mobile Application for WIC Families in Tennessee

Objective Mobile applications (‘apps’) for WIC families are becoming increasingly prevalent, especially in states that have transitioned from paper vouchers to electronic benefits transfer (EBT) for WIC. Apps and other digital technologies can improve the WIC experience by helping participants check their benefit balance, scan food items to determine WIC eligibility, streamline service delivery, and provide additional nutrition education. The Children Eating Well (CHEW) app aims to maximize redemption of WIC foods and improve overall diet quality of preschool-aged participants by facilitating benefit redemption at the store and providing easy, practical ways for parents to increase consumption of healthy foods through healthy recipes, quizzes, and goal setting features. The objective is to report on the findings of user testing and development during the preparation of version 2.0 of the CHEW app. Description Our team conducted qualitative interviews families of WIC children aged 2-4 years in an iterative process to inform user-centered development of version 2.0 and to maximize usability of the app. Evaluation Using a sorting activity, participants were asked to rank potential in-app features by importance then place the cards into natural groupings of similar features. Participants were also asked to form mental models about using recipes, shopping lists, using WIC benefits, and checking their WIC balance. We will report on qualitative findings that informed the user interface, improvement of shopping tools, and format of nutrition education features. We will also describe how we are collaborating with partners and outline ways that potential partners can collaborate with the CHEW team to disseminate existing nutrition education content to WIC participants through the CHEW app in the future. Conclusion and Implications The CHEW 2.0 app will be implemented in WIC clinics across the state of Tennessee as a supplemental education tool for families to use at home, with plans for future dissemination to other states. These formative findings can also inform the development of other technology applications for the WIC program. Funding 2017-68001-26352.

Increasing Access to the Special Supplemental Nutrition Program for Women, Infants, and Children Program Through Discount Variety Stores (P04-164-19)

ObjectivesThe Special Nutrition Assistance Program for Women, Infants, and Children (WIC) increases access to nutritious foods for low-income pregnant, postpartum, and breastfeeding women and their children under five. Participation in WIC has declined for the past 6 years. Discount variety stores (DVS) can be useful points of food access for low-income communities. We conducted in-depth interviews with staff at corporate, managerial, and store clerk levels at ten DVSs in North Carolina. These stores implemented WIC over a 10-month pilot study to assess WIC feasibility. Our study goal was to identify facilitators and barriers to WIC implementation in DVS. Learning more about facilitators and barriers associated with WIC implementation may lead to more successful program adoption, allowing more families to benefit from WIC and increase DVS revenues. MethodsThe design was an inductive approach to identify themes in qualitative in-depth interviews of employees of DVS at corporate, managerial, and store clerk levels. The interviews were uploaded into NVivo software. Thirty DVS employees were interviewed: six worked at the corporate level, 22 were in-store managers, and eight were store staff; 22 participants were women; eight were men. Ten DVS in low-income communities participated; nine of these stores were located in areas that were classified as a food desert. ResultsAll except one participant provided positive feedback about being involved in the WIC program. Many DVSs store employees had previous experience participating in the WIC program which gave them a good understanding of the WIC shopping experience. Previous WIC experience and proximity to store location for DVS customers were facilitators of WIC implementation. The primary barriers included limited choice in store products for customers, complicated or unclear labeling for WIC-eligible products, and difficulty training store employees to process WIC payments. ConclusionsBased on the WIC implementation, DVS found that selling WIC-eligible products, especially infant formula, was associated with selling more non-WIC items. The North Carolina WIC program moved from a paper-based system to an electronic benefit transfer system (eWIC); therefore, several of the barriers to successful WIC implementation should be addressed through the new electronic system that does not require as much detailed and manual employee training. Increased infant formula sales to both WIC and non-WIC customers drove increased sales in other products. Funding SourcesRobert Wood Johnson Foundation.

WIC Participation Associated With Improved Nutrition in Children

Research Article| June 01 2019 WIC Participation Associated With Improved Nutrition in Children AAP Grand Rounds (2019) 41 (6): 69. https://doi.org/10.1542/gr.41-6-69 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation WIC Participation Associated With Improved Nutrition in Children. AAP Grand Rounds June 2019; 41 (6): 69. https://doi.org/10.1542/gr.41-6-69 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: food, science of nutrition Source: Hamner HC, Paolicelli C, Casavale KO, et al. Food and beverage intake from 12 to 23 months by WIC status. Pediatrics. 2019; 143(3): e20182274; doi: https://doi.org/10.1542/peds.2018-2274T-19Google Scholar Investigators from the CDC, US Department of Agriculture (USDA), and Department of Health and Human Services reviewed NHANES data from 2011–2014 to compare dietary intake among US children 12–23 months old by status in the Women, Infants, and Children (WIC) nutrition program. NHANES is an ongoing survey of the US population that includes a household interview and physical examination of participants. The survey is designed to produce nationally representative data and is conducted in 2-year cycles. For the current study, data collected during the 2011–2012 and 2013–2014 cycles were analyzed. Study participants were children 12–23 months old on whom an adult respondent (typically a parent) provided a 24-hour dietary recall. Information on food and beverage consumption by the study child was included into 1 of 18 food groups using the USDA What We Eat in America categories. For each category, consumption was defined as any or none. Participant WIC status was classified as currently in WIC, eligible for WIC but not receiving benefits, and ineligible for WIC. Children not enrolled in WIC, but eligible, had family incomes/poverty ratios ≤1.85, received Medicaid, or participated in the Supplemental Nutrition Assistance Program (previously known as food stamps). Types of food and beverages consumed among children receiving WIC benefits were compared with those eligible but not receiving, and ineligible, using t-tests. Analyses were weighted to provide nationally representative estimates. Data on 468 children were used to generate national estimates. Among US children 12–23 months old, 38.1% received WIC, 19.6% were eligible but did not receive WIC, and 42.2% were ineligible. Overall, 49.0% of children receiving WIC were of Hispanic ethnicity, 24.6% were non-Hispanic white, and 16.7% non-Hispanic African American. The percentage of children receiving WIC who consumed 100% juice was significantly higher than that of either those eligible but not receiving WIC or those ineligible (70.6%, 51.6%, and 50.8%, respectively). Compared to those eligible but not receiving WIC, children currently enrolled in WIC were significantly more likely to have consumed vegetables (excluding white potatoes; 60.4% vs 42.3%) and grains (85.5% vs 76.5%). Children ineligible for WIC were significantly more likely to have consumed fruit (86.4% vs 70.6%), protein foods (90.0% vs 80.5%), dairy (97.2% vs 91.7%), and snacks (69.1% vs 48.5%) than those receiving WIC benefits. The authors conclude that WIC participation could impact diet-related disparities among eligible children. Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The WIC program has been an important and widely used intervention among vulnerable children. One-half of all infants and nearly one-quarter of all 1–4 year olds in the United States participated in WIC.1 WIC participation results in short-term nutritional gains, as well as a greater likelihood of eating... You do not currently have access to this content.

Duration of WIC Participation Is Associated with Higher Dietary Quality at 24 Months (P11-048-19)

ObjectivesThis study examined how duration of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is associated with dietary quality at age 24 months using Healthy Eating Index-2015 (HEI-2015) scores. MethodsData from the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2), a longitudinal study on WIC caregivers and their children, was used to examine WIC participation and diet quality. A weighted sample of 407,416 caregivers (unweighted = 1,349) from 80 WIC sites nationwide was included. Duration of WIC participation reflects the number of interviews during which caregivers responded that they were receiving WIC benefits (9 interviews occurred between 3 and 24 months). Responses were categorized into low (< 4 interviews), intermediate (5-7 interviews), and high (8-9 interviews) duration groups. Dietary intake was assessed using 24-h dietary recalls administered to caregivers. One-way ANOVA was used to compare average HEI component and total scores by WIC duration. Multivariate linear regression was used to examine independent effects of WIC participation duration on HEI-2015 total score, controlling for maternal race, ethnicity, and education, and household poverty status. ResultsThe mean total HEI-2015 score of all children at 24 months was 60.5 (SE = 0.4). Total unadjusted HEI-2015 scores were statistically different across WIC duration categories, with more favorable scores among those in the high duration group [Low duration = 55.2 (SE = 1.8), Intermediate duration = 59.2 (SE = 0.8), High duration = 60.9 (SE = 0.4)]. After controlling for sociodemographic factors, high WIC duration was associated with a significantly higher HEI-2015 total score compared with the low WIC duration group (b = 4.06, P < 0.05). Ethnicity was also significantly associated with total HEI; Hispanic participants had higher mean HEI-2015 scores compared with non-Hispanic Whites (b = 6.25, P < 0.05). ConclusionsHigher dietary quality was significantly positively associated with WIC duration, as reflected in higher scores for total HEI-2015 and in key categories such as total vegetables, refined grains, and saturated fat. Findings suggest that longer participation in WIC contributes to continued nutritional benefits. Funding SourcesWIC ITFPS-2 is a federally funded study under the direction of the Office of Policy Support in the Food and Nutrition Service, U.S. Department of Agriculture.

Changes in Food Consumption of WIC-Participating Infants and Children, 2008 vs. 2016 (P11-066-19)

ObjectivesThe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritionally at-risk low-income pregnant women, infants and children up to 5 years of age with foods tailored to their nutritional needs, along with nutrition education. In 2009, USDA made major revisions to WIC food packages to better conform to expert dietary guidance. Notable changes included increased fruits and vegetables, and lower-fat milk for children 2 years and older. This study uses data from the 2008 and 2016 Feeding Infants and Toddlers Study (FITS) to compare foods consumed by children participating in WIC to foods consumed by children not participating in WIC before and after the food package changes. MethodsFITS 2008 (n = 3273) and 2016 (n = 3235) are cross-sectional nationally-representative surveys of caregivers of children < 4 years living in the U.S. Trained telephone interviewers collected 24-hour dietary data. Tests of interaction were used to determine whether the trends in consumption of select foods between 2008 and 2016 differed between children who participate in WIC compared to those who do not, while controlling for income and household size. ResultsThe percentage of WIC infants (6-11.9 months) eating vegetables increased from 2008 to 2016, but the % eating fruit (including 100% juice) was unchanged. WIC infants shifted from being less likely than non-WIC infants to eat babyfood fruits and vegetables in 2008 to being more likely to eat them in 2016; at the same time, the % of WIC participants consuming non babyfood fruit and vegetables declined. The percentage of WIC children (12-23.9 months) drinking whole milk increased and drinking reduced fat (2%) milk decreased in 2016 compared to 2008; whereas older WIC children (24-47.9 months) were more likely to drink low or nonfat milk and less likely to drink reduced-fat milk. ConclusionsBabyfood fruits and vegetables, added to the WIC food package in 2009, have become important contributors to WIC infants’ fruit and vegetable intakes. In 2016, WIC children were more likely to follow expert advice to shift to lower fat milks at ages 2 and above. Significant changes in the relationship of these food patterns to WIC participation between 2008 and 2016 suggest an important public health role of the revised WIC food packages. Funding SourcesFITS 2008 and 2016 supported by Nestlé Research Center, Lausanne Switzerland.

Toddler Feeding Among Low-income Families Shows Need for Nutrition Education to Address Sweetened Beverages, Unhealthy Snacks, and Responsive Feeding (P11-108-19)

ObjectivesTo assess low-income parents’ understanding and conformity with expert guidance on feeding young toddlers and identify targeted messages to address gaps. MethodsSurvey of parents of toddlers (12-36 months) living in a low-income urban city to assess foods/beverages served in the previous week; responsive feeding practices; attitudes about expert guidance; food acculturation and security; and trusted information sources. Participants were recruited primarily from WIC offices and took the survey online. The survey was designed for a low reading level and pretested for understanding and content validity. ResultsParticipants included 134 parents of diverse race/ethnicity (19% White non-Hispanic; 27% foreign born) and 83% WIC participants. Over 60% reported serving a variety of fruits/vegetable and serving them 5 or more times in the past week, 81% said their toddlers ate with the family, and 93% enjoyed mealtimes with their toddler. Yet some common practices did not follow recommendations. For example, 54% reported serving sweetened drinks to toddlers and 17% served sweetened milks. One-half served them in sippy cups for easy consumption and 63% in 8 + oz cups. The majority also served their toddler unhealthy snacks, including sweets (55%), salty snacks (52%) and crackers (78%). Nonresponsive feeding was also common. Only 13% reported that their child mostly/only decides how much to eat, and 55% reported that they make their child finish all food served sometimes/always. Most parents (68%) agreed that they knew best what to feed their child, but the majority also used health professionals and family as sources of nutrition information. The majority would be interested in getting information from doctors/nurses and dietitians, and would like to receive communications via email, handouts, in-person and/or texts. Although 81% used Facebook regularly, they were least interested in receiving health information through social media. ConclusionsThese results suggest that nutrition education messages focusing on healthier beverages and snacks for toddlers and responsive feeding would benefit low-income parents. Messages from health professionals, including dietitians, would be well-received. Funding SourcesChild Health & Development Institute of Connecticut.

Exploring Parents’ Satisfaction with Infant and Toddler Feeding Information: A Repeated-Measures Analysis of Information Need and Acquisition Characteristics (P17-006-19)

ObjectivesInformation satisfaction is an essential component of the acceptability and efficacy of nutrition education programming. However, few studies have explicitly sought to identify factors associated with consumer information satisfaction, particularly regarding infant feeding information. This is a critical gap given the urgent need for evidence-based nutrition and obesity prevention guidance for infants 0–24 months old. This study explored how parents’ satisfaction with infant feeding information was associated with information need and information acquisition characteristics. MethodsFirst-time parents (N = 423; 89% Female; 75% White; 26% WIC participants) of infants ≤24 months of age completed an online survey on their most recent search for advice or information about infant feeding. Participants reported their search topic, information need (i.e., information urgency, topic interest), and the information channels they accessed during this search. Participants then reported on information acquisition characteristics (i.e., perceived utility, trust, clarity, ease of information acquisition) and information satisfaction for up to two randomly selected information channels, which constituted the repeated measures aspect of this cross-sectional study. Linear mixed models estimated parents’ information satisfaction from information need and information acquisition characteristics, controlling for education. ResultsDescriptive information on search topics and information channels is presented in Table 1. As shown in Table 2, all information acquisition characteristics were positively associated with information satisfaction, with the strongest associations observed for perceived utility and trust. Information need characteristics were not associated with information satisfaction. ConclusionsParents’ satisfaction with infant feeding information was strongly and positively associated with perceived information utility and trust. Future research on nutrition education programming development should explore how content and delivery approaches promote consumers’ perceived utility and trust by drawing on existing research on common elements of effective evidence-based interventions and cognitive heuristics of trust. Funding SourcesNational Science Foundation (NSF); USDA; College-level dissertation award. Supporting Tables, Images and/or Graphs▪▪

Household Food Insecurity Is Associated with Higher BMI in a US Cohort of Infants (OR02-03-19)

ObjectivesInfancy represents a critical period for growth and development, and food insecurity during this time may impact later health. Few previous studies have assessed food insecurity and obesity in young children in the US, and even fewer have targeted infants. Moreover, the ability of federal food assistance programs to affect this relation remains unclear. MethodsWe examined 666 infants in the US-based Nurture birth cohort. We conducted home visits when infants were 3, 6, 9, and 12 months. We measured household food insecurity via maternal report using the US Household Food Security Survey Module: Six-Item Short Form. We categorized infants as living in full, marginal, low, or very low food security households. We calculated infant body mass index (BMI) z-score from measured lengths and weights using World Health Organization reference standards. We documented participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) at each home visit. We used repeated-measures linear regression models with imputed data to examine covariate-adjusted associations between household food security and BMI z-score throughout infancy. ResultsNearly 70% of infants were black and 49% were female. At 3 months, 32.8% of infants were from households with low or very low food security. Infant BMI increased from months 3 to 12 in all food security groups (Figure). However, after adjustment for potential confounders, low household food insecurity (0.18; 95% CI 0.05, 0.32; P = 0.01) and very low household food insecurity (0.22; 95% CI 0.05, 0.38; P = 0.01) were associated with higher infant BMI z-score throughout infancy but marginal household food security was not (0.001; 95% CI −0.13, 0.13; P = 0.99). There was no evidence of effect modification by participation in either WIC (P = 0.36) or SNAP (P = 0.67). ConclusionsInfants from food insecure households had higher BMIs throughout infancy, and this association was not attenuated by WIC or SNAP participation. About one-third of infants in this cohort were living in food insecure households, which raises substantial concern from both a public health and obesity prevention perspective. Funding SourcesNIDDK, National Institutes of Health. Supporting Tables, Images and/or Graphs▪

Translation of Nutrition Science for the WIC Program and the Impact of Organizational Readiness for Change on Successful Translation (P17-008-19)

ObjectivesTo understand the process of translating nutrition science for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and to identify key organizational readiness constructs that will aid in future successful knowledge translation. MethodsWIC food packages translate nutrition evidence into government program practices. In a public health decision-making setting, Knowledge Translation (KT) can be understood as action plans that promote evidence use and facilitate evidence-informed decision-making. A scoping review was conducted to conceptually map 38 available KT strategies with evidence-informed decisions made in public health settings. Next, building on this scoping review, a semi-structured interview guide was developed to analyze KT process and KT success at the state organizational level in the WIC program. Retrospective semi-structured interviews were conducted with 12 key informants from 7 WIC state agencies. ResultsInterviewees shared the steps they undertook in order to implement the 2009 WIC regulation changes, and discussed the roles WIC state agencies played in helping to align WIC food packages with the 2005 Dietary Guidelines for Americans. In addition, thematic coding revealed key constructs of Organizational Readiness for Knowledge Translation in the WIC program. A WIC state agency could assess its level of readiness for knowledge translation, and implementing evidence-informed regulation changes, in terms of: 1) innovation readiness; 2) personal readiness; and 3) institutional readiness. Innovation readiness refers to the fit between a WIC regulation change and existing WIC program processes and practices. Personal readiness encompasses WIC participant and stakeholder readiness, while institutional readiness incorporates organizational values and goals, organizational contextual factors, and organizational information channels. ConclusionsDecision-makers can use the constructs discovered in this study to understand the KT process of implementing evidence-informed WIC regulation changes, identify factors that could influence states’ ability to be prepared, and gauge “practicality” of future proposed federal rules. Funding SourcesTufts University/University of Connecticut RIDGE Program Grant.

Investigating Treatment Effects of Participating Jointly in SNAP and WIC when the Treatment Is Validated Only for SNAP

The U.S. Department of Agriculture operates several food assistance programs aimed at alleviating food insecurity. We study whether participation in both participation in both SNAP and WIC alleviates food insecurity compared with participation in SNAP alone. We bound underlying causal effects by applying nonparametric treatment effect methods that allow for endogenous selection and underreported program participation when validation data are available for one program (treatment) but not the other. We estimate average treatment effects using data from the National Household Food Acquisition and Purchase Survey (FoodAPS). FoodAPS includes administrative data to validate SNAP participation. Information on local food prices allows us to construct a food expenditure‐based monotone instrumental variable that does not require a typical instrumental variable exclusion restriction. Under relatively weak monotonicity assumptions, we identify that the impact of participating in both programs relative to SNAP alone is strictly positive, suggesting that the programs are nonredundant. This evidence can support improved design and targeting of food programs.

WIC Food Package Changes: Trends in Childhood Obesity Prevalence.

To evaluate the association of the 2009 changes to the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package and childhood obesity trends. We hypothesized that the food package change reduced obesity among children participating in WIC, a population that has been especially vulnerable to the childhood obesity epidemic. We used an interrupted time-series design with repeated cross-sectional measurements of state-specific obesity prevalence among WIC-participating 2- to 4-year-old children from 2000 to 2014. We used multilevel linear regression models to estimate the trend in obesity prevalence for states before the WIC package revision and to test whether the trend in obesity prevalence changed after the 2009 WIC package revision, adjusting for changes in demographics. In a secondary analysis, we adjusted for changes in macrosomia and high prepregnancy BMI. Before the 2009 WIC food package change, the prevalence of obesity across states among 2- to 4-year-old WIC participants was increasing by 0.23 percentage points annually (95% confidence interval: 0.17 to 0.29; P < .001). After 2009, the trend was reversed (-0.34 percentage points per year; 95% confidence interval: -0.42 to -0.25; P < .001). Changes in sociodemographic and other obesity risk factors did not account for this change in the trend in obesity prevalence. The 2009 WIC food package change may have helped to reverse the rapid increase in obesity prevalence among WIC participants observed before the food package change.

WIC Participation and Relative Quality of Household Food Purchases: Evidence from FoodAPS

We examine the effect of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on the quality of household food purchases using the National Household Food Acquisition and Purchase Survey (FoodAPS) and propensity score matching. A healthy purchasing index (HPI) is used to measure nutritional quality of household food purchases. WIC foods explain the improvement in quality of food purchases, not self‐selection of more nutrition‐conscious households into the program. The improvement in purchase quality was driven entirely by WIC participating households who redeemed WIC foods during the interview week. There was no significant difference between WIC participants who did not redeem WIC foods and eligible nonparticipants. In this sample, there is no evidence that lack of access to clinics has adverse effects on participation nor is there evidence that HPI depends on supermarket access. A supervised machine learning process supports our main conclusion on the importance of WIC foods.

Food and Beverage Intake From 12 to 23 Months by WIC Status.

Dietary data from the 2011-2014 NHANES were used to estimate the percentage of children who were aged 12 to 23 months consuming selected food and beverage categories on any given day by age and WIC status (children who were on WIC, those who were eligible for but not receiving WIC benefits, and those who were not eligible for WIC). Consumption of food and beverage categories differed by WIC status. On a given day, a lower percentage of children who were eligible for but did not receive WIC benefits consumed vegetables (excluding white potatoes; 42.3%) and grains (76.5%) compared with children who were participating in WIC (vegetables [excluding white potatoes]: 60.4%; grains: 85.5%) and those who were not eligible for WIC benefits (vegetables [excluding white potatoes]: 58.1%; grains: 87.2%; P < .05). A lower percentage of both children who were eligible for but not receiving WIC benefits and those who were participating in WIC consumed fruits (57.6% and 70.6%, respectively) and snacks (45.9% and 48.5%, respectively) than those who were not eligible for WIC (fruits: 86.4%; snacks: 69.1%; P < .05). A lower percentage of children who were receiving WIC consumed dairy than children who were not eligible for WIC (91.7% and 97.2%, respectively; P < .05). A higher percentage of those who were receiving WIC consumed 100% juice (70.6%) than children who were eligible for but not receiving WIC (51.6%) and children who were not eligible for WIC (50.8%; P < .05). Improving early WIC participation and retention could positively impact some diet-related disparities among young children who are eligible for WIC.

Maternal Perceptions of Self-Weight and Child Weight May Influence Milk Choice of Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Objective To examine the association between maternal perceptions of self-weight and child weight status and milk consumption behavior of Hispanic WIC participants. Methods Mixed methods design with phone survey (n=529) and one-on-one interviews (n=35). Demographic characteristics, Chi-square, and thematic analyses were conducted. Results More than half of overweight mothers misperceived their own weight status as well as those of their children. Mothers who perceived their child to be overweight were more likely to make a healthier food choice for their family, namely, choosing reduced-fat milk instead of whole milk. Qualitative interviews revealed a cultural preference for larger size children, and mothers defined healthy weight for their child as a function of (1) the child's ability to be as active as other children their age, regardless of child's BMI, and (2) the pediatrician's opinion of the child's weight status. Conclusions Maternal perception of self-weight and child weight status seems to guide milk choices. Mothers may have some level of recognition of overweight in themselves and their child, thus adopting healthier milk choices. Culturally related perceptions should be considered when designing obesity prevention strategies, and the role of a pediatrician cannot be understated when developing obesity prevention programs for Hispanic families.

The 2016 Feeding Infants and Toddlers Study (FITS): Dietary Intakes and Practices of Children in the United States from Birth to 48 Months.

FITS (the Feeding Infants and Toddlers Study) 2016 is a national, cross-sectional survey to evaluate the diets and feeding practices of US infants and children <48 months (n = 3,235). Dietary intakes were assessed using 24-h recalls, including a replicate subsample (n = 799), to estimate usual intake distributions and compliance with dietary reference intakes using the National Cancer Institute method. Infant feeding practices and 1-day food group consumption were assessed by age and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Initiation and duration of breastfeeding were higher in 2016 compared to previous FITS surveys. Nutrient intakes of infants were largely adequate, except for vitamins D and E and iron (18% did not meet the iron recommendations at 6-11.9 months). WIC-participating infants were more likely to meet iron recommendations, potentially due to higher use of infant formula. More nutrient inadequacies were noted among toddlers and preschoolers, including low intakes of potassium (12+ months), fiber (12+ months), and vitamins D and E (12+ months), combined with high intakes of sodium and added sugars, especially among WIC participants, and saturated fat among those 24-36 months. These imbalances result from low intakes of vegetables and whole grains, and high intakes of processed meats, sweetened bakery foods, and sugar-sweetened beverages.