Special Supplemental Nutrition Program Research Articles

Proportional Contribution of the Women, Infant and Children's Special Supplemental Nutrition Program on Pregnant Women's Diet Quality

Objective: The purpose of this study was to identify the proportional contribution of the special Women’s Infant and Children Food Package V for pregnant women (WIC) supplementation on pregnant women’s diet quality. Methods: Image-based diet data collection using FoodFoto™ from 63 primigravid women with singleton pregnancies in Baltimore, Maryland receiving the special WIC Food Package V for pregnant women was converted to Healthy Eating Index - 2015 (HEI-2015) total and component diet quality scores. Descriptive statistics were used to describe the total and component HEI diet quality scores. Independent t-tests and linear regression models were used to assess the contributions that the percent of WIC food in the diet and sociodemographic and health characteristics had on the components and the overall HEI score. Results: The data showed a 1% rise in WIC approved foods in the diet was associated with a significant increase in the on the HEI-2015 score (b=0.77, t=6.35, p<0.001). Higher diet quality scores were accounted for by increased consumption of four HEI components representing healthy foods and significantly lower sodium intake. Furthermore, the healthy food component scores and fatty acids ratio were at or above the 50th percentile. Conclusion: Small increases in consumption of WIC approved foods significantly improved diet quality among pregnant women in the program.

Exploring Factors Affecting Breastfeeding: Insights From Hispanic and Black Mothers and Healthcare Providers in El Paso, Texas

Objective:Breastfeeding has been shown to have many health benefits to both the infant and the mother. However, there are racial and ethnic disparities in breastfeeding rates across all U.S. states and territories. This study sought to understand the support needed to improve breastfeeding rates and address disparities in El Paso County, Texas using the socioecological model framework for analysis.Methods:We conducted focus groups involving 16 Hispanic and Black mothers. During these sessions, we asked them about the environmental and social factors that influenced their decisions to either start or stop breastfeeding. Additionally, we interviewed six health professionals to gain insights into the support activities they provide to breastfeeding women and identify potential gaps in care.Results:The study found several themes that align with prior research on breastfeeding support: (a) Breastfeeding is recognized as being healthy, but misconceptions exist about formula. (b) Some mothers find public breastfeeding or pumping inappropriate, but opinions vary. (c) Family members significantly influence the decision to breastfeed; their support varies. (d) Although aid from healthcare professionals (HCPs) in breastfeeding is appreciated and valued, it is not always available. (e) HCPs are not uniformly perceived as knowledgeable or helpful, occasionally providing conflicting information. (f) Prenatal classes featuring breastfeeding are appreciated, but the depth of information provided varies. (g) Women seek increased postdischarge support from hospitals. (h) The transition back to work introduces various challenges. (i) Community norms and attitudes toward breastfeeding can be unsupportive. (j) Demand exists for updated, accessible local breastfeeding resources. (k) The Special Supplemental Nutrition Program for Women, Infants, and Children is valued, but there is confusion about services and eligibility requirements. (l) Undocumented immigrants might hesitate to access public services due to concerns about their status.Conclusions:Breastfeeding support programs should take into account the cultural context, the influence of healthcare providers, and the availability of community support. Addressing these aspects can be key to promoting breastfeeding and reducing disparities in breastfeeding rates.

Caregiver Perspectives on Improving Government Nutrition Benefit Programs.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) provide essential nutrition support for low-income families. However, many eligible families do not receive or fully redeem these benefits. We aimed to understand current and former WIC and SNAP beneficiaries' perceptions of and suggestions for improving both programs. We conducted semistructured phone interviews with caregivers of pediatric patients who were current or former WIC and SNAP beneficiaries at 2 academic pediatric primary care clinics. Interviews were recorded, transcribed, and coded by 2 independent coders using thematic analysis, resolving discrepancies by consensus. Interviews continued until data saturation was reached. We interviewed 40 caregivers who were predominantly Black (88%) mothers (90%), with 53% and 83% currently using WIC and SNAP, respectively. We identified 4 themes related to participation barriers: (1) limited product variety available through WIC, (2) inconvenience and stigma associated with purchasing WIC products, (3) SNAP income-based eligibility criteria, and (4) burdensome SNAP enrollment and recertification processes. We identified 3 themes related to suggestions for improvement: (a) decreasing stigma associated with participation, (b) allowing online or phone-based enrollment, and (c) improving coordination with health care systems. WIC and SNAP beneficiaries identified several modifiable barriers to enrollment and benefits redemption. Pediatric providers should advocate for programmatic improvements that make it easier for families to access and redeem benefits and should consider implementing innovative cross-sector interventions like medical-financial partnerships, direct WIC and SNAP referrals, and data sharing with government assistance offices.

Long-Run Impacts of an Early-life Nutrition Program: Evidence from the Introduction of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

To study how access to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during the prenatal and early childhood periods affects long-term health outcomes of the affected cohorts. In order to identify the effects of the WIC program, we exploit variations in the timing of its introduction in different counties and analyze future health indicators of affected cohorts. We use the restricted version of the Panel Study of Income Dynamics, which includes county-level identifiers through the interview year 2019. Our findings suggest that extending WIC access by one month correlates with a 0.2-0.3% point decrease in asthma incidence (p < 0.1 to p < 0.01) of affected cohorts. Although the connection between WIC and asthma is not fully understood, existing studies suggest potential pathways. Micronutrient deficiencies during early life can impact immune function and inflammation, both relevant to asthma. Moreover, adopting healthier dietary habits may improve microbiome composition, lowering asthma risk. Other indirect benefits of WIC, such as increased use of preventive healthcare services, may also contribute to the prevention of asthma. Despite uncertainties, these estimates remain robust across various model specifications. Our study implies that early-life nutritional support programs such as WIC may alleviate the burden of asthma, although the specific mechanisms and effect sizes remain unclear. Given the substantial impact of asthma in the U.S., our findings underscore the potential long-term benefits of early-life nutritional support programs for lifelong health.

The effect of immigration policy regime change on state-level participation rates of the special supplemental nutrition program for women, infants, and children in the United States

AbstractThe change in immigration policy in state-level participation rates of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the United States by citizenship and ethnicity was estimated over the period 2013-2018 using the Triple Difference estimate method. The principal finding was that the state-level WIC participation rate for Hispanic non-citizens was lower by 8.6% relative to all other groups (Hispanic citizens, non-Hispanic citizens, and non-Hispanic non-citizens). This study then not only provides quantitative evidence concerning the ongoing debate about the impact of the immigration policy changes under the Trump administration but also extends the extant literature by estimating the causal effects of immigration policy regime change on WIC participation of non-citizens.

Associations Between Infant Formula Exposure, Housing Instability and Postneonatal Mortality Among Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

To quantify infant mortality rates (IMR) using expanded racial categories, and to examine associations between infant formula exposure, housing instability and postneonatal mortality among Minnesota WIC Participants. Births in Minnesota from 2014 through 2019 (n = 404,102) and associated infant death records (n = 2034) were used to calculate neonatal and postneonatal rates using expanded racial categories. Those births that participated in the WIC program (n = 170,011) and their linked death records (n = 853) were analyzed using logistic regression to examine associations between formula exposure, housing instability, and postneonatal death. Postneonatal IMR was more than twice as prevalent among Black (African American) as East African immigrant infants (IMR = 3.9 vs 1.5). After adjustment for confounding (term status and nativity of mother (U.S. vs foreign born), infants exposed to formula by 28days were four times as likely to die in the postneonatal period as those without formula exposure (aOR = 4.0; 95% CI 3.2-4.9). WIC participants who experienced housing instability at birth were 1.7 times as likely to lose an infant in the postneonatal period (28 to 364days of age) as those in stable housing (aOR = 1.7; 95% CI 1.2, 2.4). Disaggregating Black mortality rates revealed inequities in infant mortality among Black families of varied backgrounds. Formula exposure and housing instability are modifiable risk factors associated with postneonatal mortality. Appropriate interventions to reduce barriers to breastfeeding and provide housing stability for vulnerable families could reduce disparities in postneonatal mortality.

Baby-Friendly Hospitals, Social Determinants of Health, and Disparities in Breastfeeding Initiation in a Low-Income Population, 2017-2020.

Organizational-level interventions (i.e., Baby-Friendly Hospital Initiative) that support breastfeeding and target breastfeeding initiation are critical to reducing breastfeeding disparities and promoting breastfeeding equity. To determine the association between delivery in a Baby-Friendly accredited hospital and breastfeeding initiation among United States recipients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Washington DC, the majority of whom report their race as Black. We conducted a secondary analysis of de-identified program data collected as part of routine WIC visits from the Washington DC WIC program, 2017-2020. Women who delivered a firstborn, singleton infant were included (N = 8,225). Multivariable logistic regression models accounted for social determinants of health and other factors. One set of models included a binary exposure variable (Baby-Friendly accredited vs. non-accredited hospitals), and another set included a categorical exposure variable for hospitals (1) Baby-Friendly accredited, (2) Baby-Friendly activities but not accredited, and (3) neither Baby-Friendly activities nor accredited. Breastfeeding initiation was 57.4% (n = 1988) for women delivering in accredited hospitals versus 55.4% (n = 2540) in non-accredited hospitals and multivariable model results were non-significant (OR = 0.95, 95% CI [0.86, 1.05]). However, more women initiated breastfeeding who delivered in either accredited hospitals (57.4%, n = 1988) or hospitals with Baby-Friendly activities but not accredited (55.9%, n = 2430) compared to those delivering in hospitals with neither (45.3%, n = 110), and multivariable models results concurred (Baby-Friendly accredited hospitals OR = 1.44, 95% CI [1.07, 1.94]; Baby-Friendly activities but not accredited, (OR = 1.55, 95% CI [1.16, 2.09]). Organizational-level interventions that create hospital environments supportive of breastfeeding initiation are important to promote equity in breastfeeding, but underlying social determinants of breastfeeding outcomes must be addressed.

Utilization of Real-World Data in the Intervention to Reduce Early Peanut Allergy in Children (iREACH) Trial

ObjectiveTo demonstrate the use of linked, real-world data in the context of a pediatric practice-based clinical trial. ApproachThe Intervention to Reduce Early Peanut Allergy in Children (iREACH) is a two-arm, cluster randomized, controlled trial. The intervention included clinician education and clinical decision support to increase pediatric clinician adherence to the NIAID’s 2017 Prevention of Peanut Allergy guidelines during infants’ 4- and 6-month well child care visits. Electronic health record (EHR) data were shared with the data coordinating center under a Health Insurance Portability and Accountability Act (HIPAA) waiver. All caregivers of eligible infants were invited to complete two surveys via REDCap, an online survey platform. The consents included an optional HIPAA authorization to link EHR data with survey responses and authorization to collect and link administrative data from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program, if applicable. ResultsOverall, 30 Illinois pediatric practices participated. EHR data was collected for 18,480 infants of whom 4,331 had any caregiver survey data (23.4% response rate). Permission to link survey responses to EHR data was obtained for 3,950 infants among those with any survey data (91.2%). Consent for linking WIC data with study data was obtained for 229 infants and 194 mothers. ConclusionsAuthorization for data linkage in the consent forms allowed investigators to amass data to compare caregiver and clinician responses, generate hypotheses, and propose future research outside the scope of the main trial. ImplicationsMultiple real-world data sources can be effectively combined to extend the findings of clinical trials.

Impact of Inpatient Patient-Provider Language Concordance on Exclusive Breastfeeding Rates Postpartum.

Studies outside of obstetrics suggest that patient-provider language concordance may impact the efficacy of educational interventions and overall patient satisfaction. Many pregnant patients who present to the hospital for delivery with initial plans to exclusively breastfeed ultimately leave the hospital supplementing with formula. We aim to examine the impact of language concordance between patients and their primary bedside nurse during the delivery hospitalization period on the relationship between intended and actual feeding practices for term newborns of primiparous patients at a single institution. This is a single-center, prospective cohort of primiparous patients with term, singleton gestations admitted for delivery between February 2022 and January 2023. Participants completed a predelivery survey on arrival and a postpartum survey before hospital discharge. The primary outcome was the association between nurse-patient language concordance and postpartum exclusive breastfeeding. Multiple logistic regression analysis was performed to assess the primary outcome, and p-values < 0.05 were considered significant. Overall, 108 participants were surveyed, of which 84 (77.8%) noted language concordance with their primary nurse and 24 (22.2%) reported language discordance. The race/ethnicity, language spoken at home, reported plans to return to work, WIC (special supplemental nutrition program for women, infants, and children) enrollment, and prenatal feeding plan variables revealed significant differences in reported language concordance. Following adjustment for patient-reported prenatal feeding plan, patients who reported language concordance with their primary nurse were significantly more likely to exclusively breastfeed in the immediate postpartum period (adjusted odds ratio, 5.60; 95% confidence interval, 2.06-16.2). Patients who reported language concordance with their primary nurse were significantly more likely to breastfeed exclusively in the immediate postpartum period. These findings highlight that language concordance between patients and bedside health care providers may contribute to initiating and continuing exclusive breastfeeding during the peripartum period. · Patients who reported language concordance with their primary nurse were more likely to breastfeed.. · Patient-Provider language concordance may impact infant feeding decisions in the postpartum period.. · More research is needed to further explore the impact of language concordance with other providers..

Feasibility and acceptability of a personalized, pre-filled online grocery cart to improve benefit redemption and diet quality of grocery purchases among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Most participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) do not fully redeem their benefits due to barriers like transportation, confusing product eligibility, and unclear labeling. Online food shopping enables choice architecture to promote benefit redemption and maximize diet quality. We conducted a mixed-methods pilot randomized-controlled trial to assess the feasibility and acceptability of a pre-filled online grocery shopping cart to improve WIC benefit redemption and diet quality of grocery purchases. Rhode Island WIC participants (n = 24, mean age 29.4 ± 1.1 years, 75% Hispanic, 54% had never grocery shopped online) completed a baseline questionnaire and a simulated shopping episode (SSE), buying WIC and non-WIC items. After a week, we randomized participants into the intervention (personalized, modifiable carts pre-filled with 100% of the 2022 proposed WIC packages) or control (selected their items individually) groups before the second SSE. Both groups had WIC labels. We assessed feasibility using process data and percent agreement to feasibility questions, and acceptability via percent agreement to acceptability questions and post-intervention qualitative interviews. We conducted exploratory analyses to examine differences within and between groups at each timepoint for percent WIC benefit redemption and diet quality of grocery purchases, evaluated using the Grocery Purchase Quality Index-2016 (GPQI-2016) scores. Quantitative study measures suggest that the intervention was feasible and that the personalized, modifiable pre-filled cart was acceptable. These findings were supported during qualitative interviews, where participants highlighted time-savings, flexibility, and WIC labels as facilitators of WIC online shopping. Exploratory results showed significant increases in mean percent redemption of most WIC food categories and non-significant moderate increases in most GPQI-2016 scores. These measures are vital for the future adaptation of a full-scale efficacy trial in real-life settings.

Prenatal intention to human milk feed in the native Hawaiian population: predictors of any human milk feeding from birth to six months postpartum

BackgroundRates of non-communicable diseases are disproportionately high among Native Hawaiian (NH) people, and the proportion of NH infants being fed human milk (HM) is the lowest among all ethnicities within the state of Hawaiʻi. The aim of this study was to explore biological, socio-economic, and psychosocial determinants of the initiation and duration of human milk feeding (HMF) among a study of NH mothers and infants.MethodsA sample of 85 NH mother-infant dyads who were participating in a larger prospective study were involved in this research. Recruitment for the parent was delayed due to the COVID-19 pandemic. Recruitment started in November 2020 and continued until April 2022. Questionnaires were distributed at birth, two-months, four-months, and six-months postpartum. Questionnaires addressed topics relating to maternal and infant characteristics and infant feeding practices. Descriptive statistics, comparative analysis, and multivariate logistic regression tests were conducted.ResultsThe majority of participating mothers were aged between 31 and 35 years, had some college education or more, were employed, and multiparous. The majority of infants were receiving HM at each timepoint (94% at birth, 78% at two-months postpartum, and 76% at four and six-months postpartum). Factors found to be significantly associated with HMF initiation and duration were prenatal intention to HMF, maternal educational attainment, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation, and Supplemental Nutrition Assistance Program (SNAP) recipiency. A prenatal intention to HMF was found to be a strong predictor of HMF at birth (aOR = 64.18, 95% CI 2.94, 1400.28) and at two-months postpartum (aOR = 231.55, 95% CI 2.18, 2418.3). Participants not involved with WIC were more likely to be HMF at four-months postpartum (aOR = 6.83, 95% CI 1.01, 46.23).ConclusionThis research supports existing evidence that prenatal intention to HMF and higher maternal educational attainment are positive predictors of HMF. WIC participation and being a SNAP recipient were found to be negatively associated with HMF which suggests a need for more culturally tailored support. Further research is required to reduce the gap in knowledge related to the determinants of HMF in NH.

Long COVID and the Higher Risk of Food Insecurity Among Participants and Nonparticipants of Food Assistance Programs in the United States

BackgroundIn the aftermath of the COVID-19 public health emergency, it is important to understand the extent of socioeconomic burdens of long COVID, defined as continuation of symptoms after initial infection, including food insecurity. ObjectiveThis study aimed to assess the association between long COVID and family food insecurity among low-income individuals (or any of their family members living with them) who were participants and nonparticipants in public food assistance programs (Supplemental Nutrition Assistance Program [SNAP], Special Supplemental Nutrition Program for Women, Infants, and Children [WIC], and National School Lunch Program [NSLP]) in the United States. DesignThe study used an observational cross-sectional design. Participants/settingData on 7151 adults (aged 18+ years), with family income of < 200% of the Federal Poverty line, from the 2022 National Health Interview Survey, were analyzed. Main outcome measuresLevel of family food security, based on responses to a set of 10 questions measuring family’s food security during the past 30 days. Statistical analyses performedMultinomial logistic regression models were estimated to obtain relative risk ratios of marginal and low/very low food security, relative to the base outcome of high food security, for long COVID status. Multivariable models were estimated separately for the full sample and for subgroups of food assistance participants and nonparticipants. A seemingly unrelated regression (SUR) specification was estimated to assess whether the estimates were different across the participant and nonparticipant subgroups. ResultsCompared with individuals who never had COVID-19, the adjusted relative risks of experiencing marginal and low/very low food security were 1.42 (95% CI, 1.00–2.02) and 1.43 (95% CI, 1.08–1.91) times higher, respectively, for individuals who had long COVID. Although the adjusted risks were not observed to be statistically significant in the participant subgroup, among nonparticipants, adjusted relative risk ratios were 2.34 (95% CI, 1.43–3.82) and 1.56 (95% CI, 1.02–2.39), respectively. SUR results showed that relationships between long COVID and food insecurity were only different for marginal and not low/very low levels of food security between food assistance participant and nonparticipant groups. ConclusionsStudy findings highlight a significantly higher risk of marginal and low/very low- food security among low-income adults who had long COVID, especially those who were nonparticipants in public food assistance programs. Further research is warranted to explore the causal pathways of this relationship for informing policies to mitigate the burden of long COVID.

Special Supplemental Nutrition Program for Women, Infants, and Children Enrollment and Adverse Pregnancy Outcomes Among Nulliparous Individuals.

To evaluate the relationship between changes in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) enrollment during pregnancy from 2016 to 2019 and rates of adverse pregnancy outcomes in U.S. counties in 2019. We conducted a serial, cross-sectional ecologic study at the county level using National Center for Health Statistics natality data from 2016 to 2019 of nulliparous individuals eligible for WIC. The exposure was the change in county-level WIC enrollment from 2016 to 2019 (increase [more than 0%] vs no change or decrease [0% or less]). Outcomes were adverse pregnancy outcomes assessed in 2019 and included maternal outcomes (ie, gestational diabetes mellitus [GDM], hypertensive disorders of pregnancy, cesarean delivery, intensive care unit [ICU] admission, and transfusion) and neonatal outcomes (ie, large for gestational age [LGA], small for gestational age [SGA], preterm birth, and neonatal intensive care unit [NICU] admission). Among 1,945,914 deliveries from 3,120 U.S. counties, the age-standardized rate of WIC enrollment decreased from 73.1 (95% CI, 73.0-73.2) per 100 live births in 2016 to 66.1 (95% CI, 66.0-66.2) per 100 live births in 2019, for a mean annual percent change decrease of 3.2% (95% CI, -3.7% to -2.9%) per year. Compared with individuals in counties in which WIC enrollment decreased or did not change, individuals living in counties in which WIC enrollment increased had lower rates of maternal adverse pregnancy outcomes, including GDM (adjusted odds ratio [aOR] 0.71, 95% CI, 0.57-0.89), ICU admission (aOR 0.47, 95% CI, 0.34-0.65), and transfusion (aOR 0.68, 95% CI, 0.53-0.88), and neonatal adverse pregnancy outcomes, including preterm birth (aOR 0.71, 95% CI, 0.56-0.90) and NICU admission (aOR 0.77, 95% CI, 0.60-0.97), but not cesarean delivery, hypertensive disorders of pregnancy, or LGA or SGA birth. Increasing WIC enrollment during pregnancy at the county level was associated with a lower risk of adverse pregnancy outcomes. In an era when WIC enrollment has decreased and food and nutrition insecurity has increased, efforts are needed to increase WIC enrollment among eligible individuals in pregnancy.

Experiences participating in federal nutrition assistance programs during the early months of the COVID-19 pandemic: an investigation in Vermont

BackgroundFederal nutrition assistance programs serve as safety nets for many American households, and participation has been linked to increased food security and, in some instances, improved diet quality and mental health outcomes. The COVID-19 pandemic brought new and increased economic, social, and psychological challenges, necessitating inquiry into how nutrition assistance programs are functioning and associated with public health outcomes.MethodsUsing data from a representative statewide survey administered in Vermont (n = 600) between July and September 2020, we examined participant experiences with major federal nutrition assistance programs: the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and school meal programs. We explored quantitative and qualitative responses regarding perceptions of program utility, and used nearest neighbors matching analyses in combination with bivariate statistical tests to assess associations between program participation and food insecurity, perceived stress, and fruit and vegetable intake as indicators of dietary quality.ResultsOne in four respondents (27.3%) used at least one federal nutrition assistance program. As compared to non-participants, we found higher rates of food insecurity among program participants (57.5% vs. 18.1%; p < 0.001), an association that persisted even when we compared similar households using matching techniques (p ≤ 0.001). From matched analyses, we found that, compared to low-income non-participants, low-income program participants were less likely to meet fruit intake recommendations (p = 0.048) and that low-income SNAP and WIC participants were less likely to meet vegetable intake recommendations (p = 0.035). We also found lower rates of perceived stress among low-income school meal participant households compared to low-income non-participants (p = 0.039). Despite these mixed outcomes, participants broadly valued federal nutrition assistance programs, characterizing them as helpful or easy to use.ConclusionsWe found that federal nutrition assistance programs as a group were not sufficient to address food insecurity and stress or increase fruit and vegetable intake in the state of Vermont during the early months of the COVID-19 pandemic. Nonetheless, participants perceived benefits from participation in these programs. Optimizing the utility of nutrition assistance programs depends on critical examination of their functioning under conditions of great stress.

Examining the 2021 Cash Value Benefit Increase and WIC Participant Food Purchases

IntroductionThe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritious foods to more than six million low-income families. In June 2021, WIC increased the amount of money provided for fruits and vegetables (FV), but studies have not investigated whether this increase changed WIC participant FV purchases. The objective was to estimate the association between the FV funding increase and WIC shopper FV purchases. MethodsThis evaluation uses longitudinal food transaction data from 496 stores in a grocery store chain in North Carolina between June 2020 and April 2022 and a propensity score weighted difference-in-differences (DID) approach to estimate the association between the FV funding increase and FV and other food group purchases. Analyses were conducted in 2023 and 2024. ResultsWIC shoppers’ WIC-eligible FV purchases increased by $12.4 per shopper per month (Adjusted Confidence Interval (ACI), $12.0 to $12.9) after the FV benefit increase, which was $9.3 (ACI, $8.7 to $10.0) more than non-WIC shoppers. The monthly volume and unique varieties of FV purchased also increased more among WIC shoppers relative to non-WIC shoppers (DID 67.1 ounces (ACI, 61.9 to 72.3) and DID 2.1 varieties (ACI, 2.0 to 2.3)). There were also increases in the volume of processed foods (DID 22.0 ounces (ACI, 17.2, 26.9)) and sugar-sweetened beverages (DID 49.1 ounces (ACI, 33.4, 64.9)) purchased among WIC shoppers relative to non-WIC shoppers. ConclusionsIncreased WIC FV funding was associated with greater FV purchases. Research is needed to understand the effects of this policy on total dietary intake.

A WIC Agency Drip Marketing Campaign Is Well Received and Improves Program Participation and Retention: A Quasi-Experimental Study

BackgroundLittle is known about text messaging’s influence on child retention in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). ObjectiveThis study aimed to evaluate the influence of WICBuzz, a WIC agency drip marketing texting campaign, on retention and participation compared with a comparison WIC agency and to assess WIC participants’ perceptions of the campaign’s added value. DesignA quasi-experimental design, with pre- and postimplementation measurement, was used to compare innovation and comparison groups’ outcomes. Outcome evaluation integrated quantitative analysis of WIC management information system data and survey data of WICBuzz recipients’ perceptions. Participants/settingData obtained for baseline (2019 calendar year) and implementation periods (March 1, 2020, to February 28, 2021), included WIC participation for children who were WIC active at the beginning of each period. WIC agency sample sizes were 6780 to 7452 children from 5189 to 5832 households (baseline) and 4599 to 5004 children from 3186 to 4297 households (implementation). InterventionWICBuzz, a drip marketing text message campaign with targeted nutrition education and WIC brand awareness messages was the intervention. The comparison agency received standard WIC care. Main outcome measuresMain outcome measures included recertification (re-enrollment during the implementation period), timely recertification (within 60 days of prior certification’s termination), retention (WIC active at the study period’s end), household WIC participation (continuous benefit issuance), and WICBuzz recipients’ WIC perceptions. Statistical analyses performedStatistical analysis included propensity score weighting and difference-in-difference modeling. Thematic analysis using a deductive approach was used to analyze the process evaluation findings. ResultsThe influence of WICBuzz on outcomes included 6.7% (95% CI 3.8% to 9.5%) higher recertification, 7.4% (95% CI 4.5% to 10.3%) higher retention, and 10.9% (95% CI 8.0% to 13.8%) higher participation compared with the comparison agency. Most WICBuzz recipients reported added value regarding WIC knowledge and perceptions. ConclusionsWIC text message campaigns can improve participation and retention and improve participant perceptions of WIC’s value.

Differences in Farmers’ Market Patronage among Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Differences in Farmers’ Market Patronage among Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Cross-sectional associations of Special Supplemental Nutrition Program for Women, Infants, and Children benefit redemption and diet among children ages 1–4 years in California

BackgroundThe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides supplemental healthy foods to children aged <5 y in low-income households. ObjectivesThe objectives of this study were to characterize WIC benefit redemption, identify associations between benefit redemption and child dietary intake, and whether child age modifies these associations. MethodsThe cross-sectional 2023 California Statewide WIC Survey, conducted with caregivers of WIC-participating children aged 1–4 y, was analyzed for this study. Included children had complete benefit redemption data, a complete National Health and Nutrition Examination Survey Dietary Screener Questionnaire (DSQ), and complete covariate data (weighted n = 2244). Monthly household category-specific benefit redemption percentage was averaged across 6 and 3 mo preceding survey completion. Associations between household redemption and child dietary intake (servings or amount/day) were assessed with multivariable linear regression and expressed as estimates and 95% confidence intervals (CI). ResultsTwenty-five percent higher redemption of breakfast cereal, whole grain bread, yogurt and whole milk in the 6 mo prior to the survey were associated with higher child intake frequency for cereal (0.02 servings/d; 95% CI: 0.00, 0.04), whole grain bread (0.02 servings/d; 95% CI: 0.00, 0.03), yogurt (0.04 servings/d; 95% CI: 0.02, 0.06), and whole milk (0.09 servings/d; 95% CI: 0.01, 0.16). Significant effect modification by child age (12 to <24 mo, 24–59 mo) was found for redemption of cheese/tofu and 100% juice (P-interaction = 0.02 and 0.001, respectively), and 25% higher redemption of these benefits were associated with lower intake frequency for cheese (−0.05 servings/d; 95% CI: −0.09, −0.02) and higher intake frequency for juice (0.12 servings/d; 95% CI: 0.06, 0.18), but only among children ages 12 to <24 mo. ConclusionsHigher redemption was associated with higher child intake of select WIC foods. Pairing the promotion of benefit redemption among program participants with nutrition education efforts may enhance dietary impacts of WIC participation.

Differential Changes in Benefits Use During Pregnancy Across Demographic Groups Following Benefits Digitization

This cross-sectional study examines differential changes in participation in the Special Supplemental Nutrition Program for Women, Infants, and Children during pregnancy across demographic groups, following the transition to electronic benefit transfer.

Occupational therapy's role in promoting the "Learn the Signs. Act Early." developmental monitoring program to public health employees.

Occupational therapists can play a key role in early identification of delay at the population health level by providing education to public health employees on how to implement developmental monitoring with caregivers of children birth to age 5. A pretest posttest design was utilized to assess the online education and training that was provided to Department of Public Health employees (N = 339), including Head Start, Special Supplemental Nutrition Program for Women, Infants and Children, Home Visiting, and Early Intervention. Analysis of pretest-posttest survey data showed significant results for all 12 key learning outcomes. Six out of 12 outcomes were found to have a large effect size (d > 0.8), 4 outcomes indicated a medium effect size (d > 0.5), and 2 outcomes had a small effect size (d > 0.2). Participants gained knowledge of the "Learn the Signs. Act Early." (LTSAE) developmental monitoring program, the difference between developmental monitoring and screening, the state's referral system and age-appropriate parental engagement activities through knowledge of child development. Occupational therapists are child development specialists who can provide education on developmental monitoring and activities for parental engagement. The online course proved to be an effective platform to promote LTSAE within state agencies.