WIC Agencies Research Articles

Mixed methods evaluation of the COVID-19 changes to the WIC cash-value benefit for fruits and vegetables.

Recent cash-value benefit (CVB) increases are a positive development to help increase WIC participant fruits and vegetables (FV) access. Little is known about the impacts of the CVB changes on FV redemptions or about implementation successes and challenges among WIC State and local agencies. This mixed method study aimed to evaluate (a) the CVB changes' impact on FV access among WIC child participants measured by CVB redemption rates, (b) facilitators and barriers to CVB changes' implementation, and (c) differences in FV redemption and facilitators and barriers by race/ethnicity. We requested redemption data from all 89 State agencies for April 2020 to September 2022 and utilized descriptive statistics, interrupted time series analysis (ITS), and generalized linear regression analysis. Additionally, we recruited State agencies, local agencies, and caregivers across the U.S. for interviews and used rapid qualitative analysis to find emerging themes anchored in policy evaluation and implementation science frameworks. We received redemption data from 27 State agencies and interviewed 23 State agencies, 61 local agencies, and 76 caregivers of child WIC participants. CVB monthly redemptions increased at $35/child/month compared to $9/child/month; however, adjusted ITS analyses found a decrease in redemption rates at $35/child/month. The decrease was not significant when the transition/first implementation month was excluded with rates progressively increasing over time. Differences were found among racial/ethnic groups, with lower redemption rates observed for non-Hispanic Black caregivers. Overall, WIC caregivers reported high satisfaction and utilization at the $35/child/month. The frequent and quick turnaround CVB changes strained WIC agency resources with agencies serving higher caseloads of diverse racial and ethnic populations experiencing greater issues with implementing the CVB changes. Despite implementation challenges, the increased CVB shows promise to improve WIC participant FV access and satisfaction with WIC. WIC agencies need adequate lead time to update the CVB amounts, and resources and support to help ensure equitable distribution and utilization of the FV benefits.

A Qualitative Exploration of Spanish-Speaking Latina Women’s Experiences Participating in WIC Before and During the COVID-19 Pandemic

BackgroundMore than one-third of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants identify as Latino, but participation has been declining and individuals who speak predominantly Spanish face additional barriers to participation. During the COVID-19 pandemic, there were changes in WIC eligibility and benefits that may have been differentially accessible to Spanish-speaking Latina participants due to factors such as language barriers and lack of awareness of changes. Understanding Spanish-speaking Latinas’ experiences with the WIC program generally and during the pandemic can inform efforts to equitably implement future emergency food response policies and improve the WIC program and Latina participant enrollment more broadly. ObjectiveThis study aimed to understand the perceptions and experiences of Spanish-speaking Latina WIC participants with the WIC program generally and with COVID-19 pandemic–related policy changes made to the WIC program. DesignQualitative in-depth interviews were conducted virtually in Spanish in August 2022 using a semi-structured guide. Participants/settingStudy participants were 18 Spanish-speaking Latina adult WIC participants living in North Carolina recruited using convenience sampling. AnalysisAll interviews were recorded, transcribed, and coded in Spanish. Thematic analysis with inductive coding was used to derive key themes. ResultsPerceptions about the WIC program in this sample were mixed. Participants felt positively about the healthfulness of foods included in the WIC food packages but expressed concern about the monthly benefit amounts being too low and the cultural appropriateness of food options. Pandemic policy changes, such as remote appointments and the Cash Value Benefit increase were perceived positively; however, barriers to using benefits during this time included limited communication from WIC agencies, food shortages, and concerns about not being granted US citizenship or permanent resident status due to use of WIC (ie, public charge rule). Social networks played an important role in learning about and enrolling in WIC and navigating food shortages during the pandemic. ConclusionsConcerns about the cultural appropriateness of foods provided, communication challenges, and the public charge rule emphasized the need for resources dedicated in the WIC program to improving Spanish-speaking Latina women’s experiences with WIC.

Vendors’ Perceptions and Experiences with WIC Online Shopping Implementation

BackgroundOnline shopping (OS) holds promise for improving the shopping experience for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). However, little is known about vendors’ perspectives on implementing OS in the context of WIC. ObjectivesThe present study aimed to understand vendors’ experiences, needs, and barriers to WIC OS implementation. MethodsWe recruited vendors at various stages of WIC OS planning and implementation (n = 16). Semistructured interviews were conducted, transcribed, and coded using subconstructs of the i-PARIHS framework domains (e.g., Characteristics of the Innovation, recipient, context, and facilitation) to assess determinants related to adoption and implementation of WIC OS among vendors. ResultsInterviewees represented various organizations, including local (n = 5), regional (n = 4), and national (n = 5) entities, along with enablement platforms (n = 2). The interviews yielded themes related to experiences planning and implementing a WIC OS system (n = 7) and perceived needs and barriers (n = 3). Vendors drew on prior experiences with Supplemental Nutrition Assistance Program (SNAP) OS to inform WIC OS projects, stressing the importance of building relationships and collaborating, particularly in technical partnerships, during WIC OS implementation. They also highlighted the value of leveraging existing OS systems to implement WIC OS projects, discussed WIC OS perceived benefits, emphasized the role of educating staff and participants on its usage, and valued WIC OS implementation guidance provided by WIC agencies. Needs and barriers for vendors contemplating WIC OS implementation included the need for evidence of successful implementation of WIC OS projects, understanding current regulatory implications, and appraising existing priorities and financial considerations for adopting and implementing WIC OS. ConclusionsWIC OS innovations are integral to modernizing the federal food assistance program. The present study highlights the role of vendor engagement, collaboration, guidance from WIC agencies, and knowledge sharing in ensuring WIC OS success. These insights can inform how WIC State agencies engage vendors to implement WIC OS.

Effects of Breastfeeding Peer Counseling on County-Level Breastfeeding Rates Among WIC Participants in Greater Minnesota

ObjectiveU.S. breastfeeding outcomes consistently fall short of public health targets, with lower rates among rural and low-income people, as well as participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The U.S. Department of Agriculture funded a subset of local WIC agencies in Minnesota to implement Breastfeeding Peer Counseling Programs (BFPCs) aimed at improving breastfeeding rates. We examined the impact of BFPCs on breastfeeding rates among WIC participants in Greater Minnesota (outside the Minneapolis–St. Paul metropolitan area). MethodsWe used data from the Minnesota WIC Information System for the years 2012 through 2019 to estimate the impact of peer counseling on breastfeeding duration using difference-in-differences models. Additionally, we examined results among rural counties and assessed the possibility of spillover effects by stratifying whether a county without BFPCs bordered one with BFPCs. ResultsAvailability of BFPCs resulted in a 3.1 to 3.4 percentage-point increase in breastfeeding rates at 3 months and a 3.2 to 3.7 percentage-point increase in breastfeeding rates at 6 months among WIC participants in Greater Minnesota. Among rural counties, results showed a statistically significant 4.1 to 5.2 percentage-point increase in breastfeeding duration rates. Both border and nonborder counties experienced positive impacts of BFPCs on breastfeeding rates, suggesting wide-ranging program spillover effects. ConclusionsBFPCs had a significant positive impact on breastfeeding duration. Findings indicate an opportunity for improving rural breastfeeding rates through increased funding for WIC BFPCs.

Trends in Severe Obesity Among Children Aged 2 to 4 Years in WIC: 2010 to 2020.

To examine the prevalence and trends in severe obesity among 16.6 million children aged 2 to 4 years enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) from 2010 to 2020. Severe obesity was defined as a sex-specific BMI for age ≥120% of the 95th percentile on the Centers for Disease Control and Prevention growth charts or BMI ≥35 kg/m2. Joinpoint regression was used to identify when changes occurred in the overall trend. Logistic regression was used to compute the adjusted prevalence differences between years controlling for sex, age, and race and ethnicity. The prevalence of severe obesity significantly decreased from 2.1% in 2010 to 1.8% in 2016 and then increased to 2.0% in 2020. From 2010 to 2016, the prevalence decreased significantly among all sociodemographic subgroups except for American Indian/Alaska Native (AI/AN) children. The largest decreases were among 4-year-olds, Asian/Pacific Islander and Hispanic children, and children from higher-income households. However, from 2016 to 2020, the prevalence increased significantly overall and among sociodemographic subgroups, except for AI/AN and non-Hispanic white children. The largest increases occurred in 4-year-olds and Hispanic children. Among 56 WIC agencies, the prevalence significantly declined in 17 agencies, and 1 agency (Mississippi) showed a significant increase from 2010 to 2016. In contrast, 21 agencies had significant increases, and only Alaska had a significant decrease from 2016 to 2020. Although severe obesity prevalence in toddlers declined from 2010 to 2016, recent trends are upward. Early identification and access to evidence-based family healthy weight programs for at-risk children can support families and child health.

Use of interactive texting is associated with higher odds of continued WIC participation during the COVID-19 pandemic.

In Los Angeles County (LAC), California, the demand for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services increased during the COVID-19 pandemic, concurrent with the shift to fully remote WIC service delivery in March, 2020. Technologies for facilitating remote services were critical for accommodating increases in participation during the COVID-19 pandemic. The objective of this study was to quantify patterns of remote-service utilization, and to determine whether use of remote services (phone, interactive texting, email, online education, video appointments) was associated with higher rates of recertification among WIC participants early in the COVID-19 pandemic. Cross-sectional survey with administrative data for follow-up. This study used data from the 2020 LAC WIC Survey and WIC administrative data to evaluate remote service utilization across LAC WIC agencies (unweighted n=3,510, weighted n=3,540). Recertification on WIC, determined by the issuance of a food package in the first two months following the end-date of the prior certification period. Survey data were merged to WIC administrative data to determine whether participants completed a recertification; the association of utilization of each remote service with the odds of recertification among WIC-participating children 0-3 years of age was assessed with multivariable logistic regression. Most survey respondents reported using phone appointments (95.5%), interactive texting (77.3%), email (60.1%), and online education (71.2%) to access WIC services during 2020, and over 82% of children successfully recertified. Interactive texting utilization was associated with 27% higher recertification odds (95% confidence interval 1% to 59%); associations between all other remote services and odds of recertification were not statistically significant. These results suggest that WIC investment in interactive texting technological infrastructure, and appropriate staff training, can help local WIC agencies successfully reach and provide high quality services to WIC participants.

Breastfeeding among Hispanic and Black Women: Barriers and Support

We describe barriers and supports for the practice of breastfeeding, with particular focus on Black and Hispanic women in the United States. We note that breastfeeding patterns reported by WIC agencies is highly variable across the country and within states. The global campaign to support breastfeeding, Baby Friendly Hospital Initiative, and its implementation in the US is described, as well as Healthy People goals and the mixture of policies across the US that provide incomplete support for breastfeeding mothers.

Integrating Administrative and Survey Data to Estimate WIC Eligibility and Access

Abstract The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides benefits to low-income, nutritionally at-risk women, infants, and children. To administer WIC, officials and program managers at the federal and state levels want to understand who is eligible for the program, who among the eligible population chooses to participate, and who is not accessing the program despite their eligibility. Novel individual-level data linkages between restricted-use WIC Administrative Records and the American Community Survey provide WIC access rates estimated at the state and county levels, as well as estimates disaggregated by the demographic and socioeconomic characteristics of individuals and their households. These estimates are developed by the Census-FNS-ERS Joint Project, a research partnership among the US Census Bureau, the US Department of Agriculture’s Food and Nutrition Service and Economic Research Service, and state WIC agencies that provide the requisite WIC administrative data to the Census Bureau. This article details and evaluates our current data linkage and estimation methods, reports results, and identifies areas for improvement and further research.

Anemia Among Pregnant Women Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children - United States, 2008-2018.

Among pregnant women, anemia, a condition of low hemoglobin concentration, can increase risk for maternal and fetal morbidity and mortality, including premature delivery, and other adverse outcomes (1). Iron deficiency is a common cause of anemia, and during pregnancy, iron requirements increase (2). Surveillance of anemia during pregnancy in the United States is limited. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participant and Program Characteristics (PC) data provide an opportunity to establish national and WIC state agency-level* anemia surveillance for WIC participants. National and state agency anemia prevalences among pregnant WIC participants at enrollment were examined using 2008-2018 WIC-PC data. Across all 90 WIC agencies (50 states, the District of Columbia [DC], five territories, and 34 Indian Tribal Organizations), anemia prevalence among pregnant WIC participants at enrollment increased significantly, from 10.1% in 2008 to 11.4% in 2018 (13% increase). Anemia prevalence increased significantly in 36 (64%) of the 56 agencies in states, DC, and territories, and decreased significantly in 11 (20%). Prevalence of anemia overall and by pregnancy trimester were higher among non-Hispanic Black or African American (Black) women than among other racial or ethnic groups. Anemia prevalence was higher among women assessed during the third trimester of pregnancy than among those assessed during first or second trimesters. Routine anemia surveillance using WIC enrollment anemia data can identify groups at higher risk for iron deficiency. Findings from this report indicate that anemia continues to be a problem among low-income women and reinforces the importance of efforts that ensure these women have access to healthier, iron-rich foods before and during pregnancy. This includes ensuring that eligible women are enrolled in WIC early during pregnancy.

Retracted: Identifying Strategies to Improve Enrollment and Participation in Three Rural Native American WIC Programs

Abstract Objectives The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has a strong track record of improving birth and health outcomes in high-risk populations. For the past decade and a half, WIC enrollment among Native American women and children has declined by approximately 40% for reasons that have not yet been elucidated. The objectives of this work are to 1) Understand the individual-, household-, and community-level factors that facilitate and impede participation in three rural tribal WIC programs, and 2) Identify strategies for addressing significant unexplained declines in WIC participation. Methods We partnered with three tribal WIC agencies – two in the Southwest and one in the Midwest – to plan and conduct this formative research. In-depth qualitative interviews (n = 35) were conducted with current and former WIC participants, eligible non-participants, WIC staff, tribal health administrators, and managers of food store that accept WIC in each study community. Interview transcripts were inductively coded and crosscutting emergent themes across communities were identified by four researchers. Results Tribal WIC agencies are highly valued for their culturally-competent staff and the integration of traditional knowledge and values into their services. However, participation barriers related to internet and telephone connectivity have become amplified during the COVID-19 pandemic, and a complicated and often embarrassing food shopping experience is a major obstacle to WIC benefit redemption in small rural food stores. Dominant themes differed greatly by community, indicating that intervention strategies to address declines in WIC participation should be tailored to community-level infrastructure, policy, and cultural values, which are unique to each community. Conclusions This work represents an important step toward improving understanding of the strengths and weaknesses of the WIC program in rural Native communities and identifying key focus areas for future interventions. Funding Sources Robert Wood Johnson Foundation Healthy Eating Research Grant #77,235.

WIC Participants’ Perspectives of Facilitators and Barriers to Shopping With eWIC Compared With Paper Vouchers

Objectives(1) To describe facilitators and barriers to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food shopping via electronic benefits transfer (eWIC) compared with paper vouchers. (2) To explore suggestions that WIC participants had for modifying the program to enhance their overall WIC experience. DesignQualitative, semistructured, in-depth interviews. SettingWIC participants in East Tennessee. ParticipantsTwenty-four primary food shoppers of WIC-participating households aged at least 18 years were recruited using a purposive sampling strategy. Phenomenon of InterestPerceived facilitators and barriers to use of eWIC as compared with paper vouchers. AnalysisInterview transcripts were analyzed using a grounded theory approach to identify emergent themes. ResultsParticipants identified several ways eWIC has improved their food shopping experience, including ad hoc redemption of WIC benefits and a quicker, more discrete checkout. Participants’ chief complaint about eWIC was transaction errors at checkout. Participants identified other barriers to shopping for WIC foods that cannot be addressed by the card alone, such as difficulty identifying WIC items in-store. Participants reported changes to their benefit tracking behaviors and provided suggestions to improve WIC further. Conclusions and ImplicationsThe transition to eWIC was viewed favorably among WIC participants, although participants identified a need for additional support in addressing transaction errors. This finding presents an opportunity to modify messages delivered to WIC participants by WIC nutrition educators and enhance collaboration between WIC agencies, retailers, and e-commerce technology providers.

Knowledge Translation and WIC Food Package Regulation Change

Objective Knowledge Translation (KT) is the exchange, synthesis, and ethically-sound application of knowledge. A case study methodology is used to examine KT at the organizational level of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program. Method The study used purposeful sampling to select WIC informants from state WIC agencies to participate in semi-structured interviews about their individual experiences during the 2009 WIC regulation change process. Thematic coding of retrospective semi-structured interviews with key informants from WIC state agencies revealed key components of the state-level WIC regulation implementation process, and key constructs of Organizational Readiness for Knowledge Translation in the WIC program. Results WIC informants highlight that decisions made by WIC state agencies regarding how to appraise, synthesize, and adapt evidence or regulation change are constrained by the KT decisions made by federal agencies. WIC state agencies should assess their level of readiness for KT in terms of 1) innovation readiness; 2) personal readiness; and 3) institutional readiness. Conclusions This WIC case study can help decision-makers to understand the KT process of implementing evidence-informed regulation changes, identify factors that could influence states’ ability to be prepared for implementing changes, and gauge “practicality” of future WIC regulation changes.

Effects of United States WIC infant formula contracts on brand sales of infant formula and toddler milks.

The United States (US) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides free infant formula to low-income families with infants. State WIC agencies periodically solicit bids from manufacturers for the exclusive contract to provide infant formula in exchange for considerable rebates. Using Nielsen 2006-2015 retail scanner data, we estimated a difference-in-difference model to examine how winning a WIC infant formula contract affects sales of the new (winning) and former brands, including effects on sales of products not eligible for WIC (spillover). One year following a contract change, volume sales of WIC infant formula increased 322% (p < 0.01) for the new brand and decreased 77% (p < 0.01) for the former brand. Spillover effects included a 43% increase in sales of toddler milks for the new brand 2 years after the contract change. State WIC contracts allow manufacturers to market formula directly to consumers and may reduce breastfeeding policy effectiveness.

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.

Workplace Lactation Programs in Small WIC Service Sites: A Potential Model

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has an opportunity to protect, promote, and support breastfeeding by implementing and modeling workplace lactation programs in small WIC agencies that may have barriers regarding the lack of both human and financial resources. The goal of this article was to describe effective strategies for agency administrators in small WIC service sites so that they can reduce barriers, successfully implement workplace lactation policies and programs, and model successful strategies for other small employers.

Breastfeeding Outcomes in Washington State: Determining the Effect of Loving Support Peer Counseling Program and Characteristics of Participants at WIC Agencies

ObjectiveDetermining the effect of the Loving Support Peer Counseling Program (LSPCP), and characteristics of participants on breastfeeding (BF) outcomes at Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) agencies in Washington State. DesignNonrandomized treatment vs control. SettingPublic Health–Seattle and King County (PHSKC), Catholic Health Initiatives Franciscan Medical Group (CHIFMG). ParticipantsWomen enrolled in WIC (intervention: PHSKC, n = 15,290; CHIFMG, n = 3,582). InterventionsClinics with a LSPCP. Main Outcome MeasuresBF initiation and BF duration of all infants who turned 8 months old during the reported period. AnalysisTwo-tailed binomial test and tree-based regression. ResultsBoth PHSKC and CHIFMG clinics with a LSPCP expressed significant (P < .001) improvement in BF initiation and BF duration for >6 months. The likelihood that women enrolled in WIC would initiate BF at PHSKC clinics increased by 3%, whereas those in CHIFMG clinics increased by 6.8%. Women receiving services in smaller PHSKC clinics (n < 60 women) were likely to breastfeed their infants at >1 week. The proportionalities of non-Hispanic and black participants in PHSKC clinics were the primary and secondary predictors of the likelihood of BF discontinuing between 7 and 28 days' duration. In addition, clinics serving participants who spoke Tigrigna had increased rates of BF for a minimum of 6 months. Conclusions and ImplicationsFindings may be used to reevaluate funding allocations, secure grants to reduce program constraints to stabilize LSPCP, develop strategies to reduce BF cessation at larger clinics, and improve peer counseling and other BF support to black and non-Hispanic women in the early postpartum period. The findings contribute to the study of the effects of LSPCP on BF initiation and duration while furthering a scholarly understanding of the way in which the WIC program interacts with participant characteristics at 2 local WIC agencies in Washington State.

The Impact of Federal Policy Changes and Initiatives on Breastfeeding Initiation Rates and Attitudes Toward Breastfeeding Among WIC Participants

To explore the effects of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on participants' breastfeeding (BF) practices, studies that use large national samples are warranted. The US Department of Agriculture's Food and Nutrition Service funded several studies that leveraged national samples of WIC agencies, sites, and participants to evaluate how WIC affects BF outcomes among its participants. This report integrates findings across multiple Food and Nutrition Service–funded studies to describe important program benefits and how the program and its benefits supported positive attitudes and beliefs toward BF, as well as higher rates of BF initiation. The report concludes with policy implications and suggestions for future research.

Low-Income Mothers’ Misconceptions about Child Feeding Practices that May Lead to Obesity: Preliminary Findings

To explore New Jersey's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants’ misconceptions about child feeding practices that might lead to obesity. Semi-structured, open-ended interviews were conducted with nutrition educators (nutritionists and breastfeeding counselors) at 9 NJ WIC agencies. Researchers asked staff, “What misconceptions do you think that mothers and caregivers have about child feeding and obesity.” Data were coded using computer assisted qualitative data analysis software (NVIVO). Themes, grounded both empirically and conceptually, emerged. Seven themes regarding misconception about child feeding practices emerged from the data. These included: a fat baby is a healthy baby; the baby is big because of genetics; cereal in the bottle helps the child sleep; a crying baby is a hungry baby; breast milk is not enough; juice is good for babies and children; and children need to drink a lot of milk. Future nutrition education delivered to NJ WIC participants should offer content that considers invalid beliefs. Also, these findings should be replicated and explored in other locations.

Telephone Peer Counseling of Breastfeeding Among WIC Participants: A Randomized Controlled Trial

The US Surgeon General has recommended that peer counseling to support breastfeeding become a core service of the Supplemental Nutrition Program for Women, Infants, and Children (WIC). As of 2008, 50% of WIC clients received services from local WIC agencies that offered peer counseling. Little is known about the effectiveness of these peer counseling programs. Randomized controlled trials of peer counseling interventions among low-income women in the United States showed increases in breastfeeding initiation and duration, but it is doubtful that the level of support provided could be scaled up to service WIC participants nationally. We tested whether a telephone peer counseling program among WIC participants could increase breastfeeding initiation, duration, and exclusivity. We randomly assigned 1948 WIC clients recruited during pregnancy who intended to breastfeed or were considering breastfeeding to 3 study arms: no peer counseling, 4 telephone contacts, or 8 telephone contacts. We combined 2 treatment arms because there was no difference in the distribution of peer contacts. Nonexclusive breastfeeding duration was greater at 3 months postpartum for all women in the treatment group (adjusted relative risk: 1.22; 95% confidence interval [CI]: 1.10-1.34) but greater at 6 months for Spanish-speaking clients only (adjusted relative risk: 1.29; 95% CI: 1.10-1.51). The likelihood of exclusive breastfeeding cessation was less among Spanish-speaking clients (adjusted odds ratio: 0.78; 95% CI: 0.68-0.89). A telephone peer counseling program achieved gains in nonexclusive breastfeeding but modest improvements in exclusive breastfeeding were limited to Spanish- speaking women.

Cell Phones, Internet, and Apps: Who’s Using What in WIC?

ObjectiveAssess cell phone, internet, and app usage among WIC participants.Theory, Prior Research, RationaleEmail, internet, smart phones, and apps all provide an opportunity to connect WIC participants with the program as well as enhance program evaluation. Understanding how many participants use each technology and under what circumstances will help WIC optimize future technology-based education and administrative projects.Study Design, Setting, Participants, and InterventionA representative sampling of 17 Oregon Local WIC Agencies administered a hard copy survey (HC) to participants (English/Spanish) during a 1-week period. An email link to an electronic version of the survey (ES) was sent to participants having an email address in the data system.Outcome, Measures and AnalysisSurvey results were analyzed for differences between ES and HC respondents.ResultsMore than 30% of respondents had either a basic cell phone or no cell phone at all. While only 3% of ES respondents said they hardly ever look things up on the internet, 18% of English HC respondents and 50% of Spanish respondents reported this. Only 7% of HC and 13% of ES respondents used a grocery or nutrition app. Even among ES respondents fewer than 8% reported using their cell phone to scan UPC’s or QR codes. The ES survey yielded a non representative sample.Conclusions and ImplicationsElectronic technologies hold great potential for connecting WIC with program participants. However, relying solely on email addresses to gather information from WIC families may skew results. Additionally, while some WIC families are ready to use smart phone or internet tools to interact with WIC, a significant number still have limited contact with these technologies.FundingUSDA. ObjectiveAssess cell phone, internet, and app usage among WIC participants. Assess cell phone, internet, and app usage among WIC participants. Theory, Prior Research, RationaleEmail, internet, smart phones, and apps all provide an opportunity to connect WIC participants with the program as well as enhance program evaluation. Understanding how many participants use each technology and under what circumstances will help WIC optimize future technology-based education and administrative projects. Email, internet, smart phones, and apps all provide an opportunity to connect WIC participants with the program as well as enhance program evaluation. Understanding how many participants use each technology and under what circumstances will help WIC optimize future technology-based education and administrative projects. Study Design, Setting, Participants, and InterventionA representative sampling of 17 Oregon Local WIC Agencies administered a hard copy survey (HC) to participants (English/Spanish) during a 1-week period. An email link to an electronic version of the survey (ES) was sent to participants having an email address in the data system. A representative sampling of 17 Oregon Local WIC Agencies administered a hard copy survey (HC) to participants (English/Spanish) during a 1-week period. An email link to an electronic version of the survey (ES) was sent to participants having an email address in the data system. Outcome, Measures and AnalysisSurvey results were analyzed for differences between ES and HC respondents. Survey results were analyzed for differences between ES and HC respondents. ResultsMore than 30% of respondents had either a basic cell phone or no cell phone at all. While only 3% of ES respondents said they hardly ever look things up on the internet, 18% of English HC respondents and 50% of Spanish respondents reported this. Only 7% of HC and 13% of ES respondents used a grocery or nutrition app. Even among ES respondents fewer than 8% reported using their cell phone to scan UPC’s or QR codes. The ES survey yielded a non representative sample. More than 30% of respondents had either a basic cell phone or no cell phone at all. While only 3% of ES respondents said they hardly ever look things up on the internet, 18% of English HC respondents and 50% of Spanish respondents reported this. Only 7% of HC and 13% of ES respondents used a grocery or nutrition app. Even among ES respondents fewer than 8% reported using their cell phone to scan UPC’s or QR codes. The ES survey yielded a non representative sample. Conclusions and ImplicationsElectronic technologies hold great potential for connecting WIC with program participants. However, relying solely on email addresses to gather information from WIC families may skew results. Additionally, while some WIC families are ready to use smart phone or internet tools to interact with WIC, a significant number still have limited contact with these technologies. Electronic technologies hold great potential for connecting WIC with program participants. However, relying solely on email addresses to gather information from WIC families may skew results. Additionally, while some WIC families are ready to use smart phone or internet tools to interact with WIC, a significant number still have limited contact with these technologies.