WIC Program Research Articles

Patterns of Food Assistance Program Participation, Food Insecurity, and Pantry Use among U.S. Households with Children during the COVID-19 Pandemic.

This study aims to describe differences in participation in the Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women and Children (WIC), and school meal programs by household characteristics prior to and during the pandemic, and to examine the association of program participation with food security status and food pantry use. We analyze secondary data (n = 470) from an online survey collected in July/August 2020 using weighted multiple logistic regression models. Participation in SNAP declined among households with children in the first four months of the pandemic, while participation in WIC increased slightly, and participation in school meals remained unchanged. There were significant differences in SNAP, WIC, and school meal programs use by race/ethnicity, income, and urbanicity before and during the pandemic. Food insecurity prevalence was higher among SNAP participants at both periods but the gap between participants and non-participants was smaller during the pandemic. Pantry use and food insecurity rates were consistently higher among federal nutrition assistance program participants, possibly suggesting unmet food needs. These results highlight the need for increased program benefits and improved access to food, particularly during periods of hardship.

‘I don’t know nothing about that’: How “learning costs” undermine COVID-related efforts to make SNAP and WIC more accessible

Scholars have focused on administrative burden or the costs of claiming public benefits. Learning, psychological, and compliance costs can discourage program participation and benefit redemption. Using 60 in-depth qualitative interviews with participants of the SNAP and WIC programs, we offer thick descriptions of how beneficiaries experience compliance, learning, and redemption costs—a subset of learning costs regarding how to redeem benefits—amidst COVID-19 policy changes. Although policy changes were poised to reduce compliance costs and ease conditions that create redemption costs in each program, the learning costs of policy changes prevented many program participants from experiencing the benefits of these policy transformations.

Promoting Responsive Bottle-Feeding Within WIC: Evaluation of a Policy, Systems, and Environmental Change Approach.

Bottle-fed infants are at greater risk for overfeeding and rapid weight gain (RWG); evidence-based strategies for promoting healthy bottle-feeding practices are needed. Our aim was to assess whether policy, systems, and environmental (PSE) strategies for promoting responsive bottle-feeding practices within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were associated with lower risk for RWG. We conducted a matched-pair cluster randomized trial. PSE strategies were implemented at 3 WIC clinics in Los Angeles County. PSE clinics were compared with 3 matched control clinics. Mothers and infants were assessed when infants were newborn and 3 months and 6 months of age. Participants were mothers (n= 246) who enrolled their newborn infants (younger than 60 days) into WIC between May and August2019. Infant weight was assessed and standardized to sex- and age-specific z scores. RWG was defined as weight-for-age z score change > 0.67. Mothers completed questionnaires assessing responsive and pressuring feeding styles, breast- and bottle-feeding patterns, and perceptions of WIC experiences. Logistic regression with estimation via generalized estimating equations and linear mixed models with repeated measures assessed effects of PSE strategies on categorical and continuous outcomes, respectively. Infants in PSE clinics had significantly lower likelihood of exhibiting RWG (P= .014) than infants in control clinics. Mothers in PSE and control clinics reported similar levels of responsive and pressuring feeding style and similar prevalence of breastfeeding and bottle-feeding. Mothers in PSE clinics trended toward feeling better supported with respect to their decision to bottle-feed (P= .098) and had more stable intentions to stay in the WIC program (P= .002) compared with mothers in control clinics. PSE strategies focused on promoting more inclusive assessment of infant feeding, tailored bottle-feeding counseling, and increased education and support for responsive bottle-feeding were associated with lower risk for RWG among WIC infants.

Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children and Dietary Intake in Children: Associations With Race and Ethnicity

Establishing healthy dietary intake in pediatric populations is important for prevention of chronic disease across the lifespan. Federal nutrition assistance programs can support the dietary intake of U.S. children. The objective of this study was to assess the relationship between Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation status and dietary intake within racial and ethnic groups. Dietary intake of children aged 2-4 years in the cross-sectional National Health and Nutrition Examination Survey 2011-2016 was analyzed in 2021. Multivariable linear regression was used to compare stratum-specific mean estimates for nutrient and food group intake of children participating in Special Supplemental Nutrition Program for Women, Infants, and Children (reference group) with those of nonparticipants who were income eligible and income ineligible (i.e., above income limits) for the WIC program. Significance was set to Bonferroni-corrected p-values. Hispanic WIC participants consumed less added sugar (8.9 [SE=0.5] teaspoons) than their higher-income counterparts (14.6 [SE=1.5] teaspoons, p<0.001). Hispanic WIC participants also consumed more fiber (13.0 [SE=0.6] grams) than income-eligible (11.4 [SE=0.7] grams, p=0.032) and income-ineligible (i.e., higher-income, 9.4 [SE=1.3] grams, p=0.019) nonparticipants, but this was not significant at the Bonferroni-adjusted p-value of 0.01. No differences in dietary intake were observed by WIC participation status for non-Hispanic White and non-Hispanic Black children. Participation in WIC was associated with healthier dietary outcomes among Hispanic children; however, dietary intake of White and Black children was comparable by WIC participation status. Federal nutrition assistance programs should support sound nutrition, an important factor in reducing the risk of chronic disease, in all groups.

The Impact of COVID-19 on Breastfeeding Rates in a Low-Income Population.

Objective: To examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on breastfeeding outcomes among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Southern California. Materials and Methods: Data from the 2020 Los Angeles County triennial WIC Survey were used to examine the impact of COVID-19 on breastfeeding outcomes among WIC participants. Chi-square tests were used to explore the association between the COVID-19 pandemic and breastfeeding outcomes along with hospital-friendly practices. Results: Compared with infants born before March 2020, the percentage of infants who received any breastfeeding at 1 month decreased from 79.66% to 76.96% (p = 0.139). The percentage of infants who received any breastfeeding at 3 and 6 months significantly decreased from 64.57% to 56.79% (p = 0.001) and from 48.69% to 38.62% (p = 0.0035), respectively. The percentage of infants fully breastfed at 1, 3, and 6 months significantly decreased at all time points. Examining hospital practices, there were no differences between the before and during COVID-19 groups. Conclusions: The prevalence of any breastfeeding at 3 and 6 months and fully breastfeeding at 1, 3, and 6 months was significantly lower among mothers who gave birth during the pandemic compared with mothers who gave birth before the pandemic. The shift to remote services delivery and the corresponding reduction in live support of WIC services owing to the pandemic may explain the decline in the breastfeeding rate. As the nation and the WIC program prepare for the postpandemic life, it is critical to ensure that breastfeeding support is met in a hybrid of remote and face-to-face settings.

Caregivers' report of preventive dental care visits and services for US WIC-participating and non-participating children.

To determine whether children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) had more caregiver-reported preventive dental care visits (PDCVs) and preventive dental services (PDS) than nonparticipating children. A secondary data analysis was performed utilizing the National Survey of Children's Health 2017 and 2018 combined datasets. The analytic sample included 10,356 children aged 1-4 years. It was further stratified into three groups by WIC eligibility and participation to include WIC participation, income-eligible nonparticipants, and higher-income nonparticipants. The independent variables included child-level characteristics (age, sex, race/ethnicity, and insurance) and caregiver-level characteristics (age of mother and the highest level of education in the household). The dependent variable was the report of PDCV and PDS (dental cleaning, toothbrushing instructions, and fluoride treatment) in the past 12 months. Of the 10,356 children aged 1-4 years, 3025 were eligible for WIC and nearly half of those eligible (49.5%) reported participating in the WIC program. Caregivers of WIC-participating children had a higher reported prevalence of PDCV for their children than those of income-eligible nonparticipants (57.6% vs. 49.6%, respectively) (p < 0.05). In addition, caregivers of WIC-participating children reported their children receiving more PDS than income-eligible nonparticipants, including dental cleanings (38.5% vs. 33.6%), toothbrushing instructions (25.5% vs. 22.7%), and fluoride treatments (22.7% vs. 21.2%) (p < 0.05). WIC-participating children had a higher reported prevalence of PDCVs and PDS than income-eligible nonparticipating children. Further research is needed to understand differences in the reports of specific PDSs received.

Relationships Among Neighborhood Poverty, Access to Healthy Food, and Diabetes Self-Management in Women Who Received Perinatal Nurse Home Visits

ObjectiveTo examine the relationships among neighborhood poverty, access to healthy food, and diabetes self-management in pregnant women in an urban setting who received perinatal nurse home visits. DesignExploratory descriptive secondary analysis of existing individual-level and neighborhood-level data. SettingPhiladelphia, Pennsylvania, United States. ParticipantsWomen who were pregnant, had diabetes, and were enrolled in the citywide perinatal nurse home visiting program because of their diabetes (N = 264). MethodsWe retrieved neighborhood-level aggregated data on poverty and access to healthy food from PolicyMap, a geographic information system. We retrieved individual-level data from a clinical research database. Access to healthy food was operationalized at the individual level by reported use of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). We operationalized diabetes self-management as good or poor glycemic control. We conducted descriptive and logistic regression analyses. ResultsWe found no relationship between neighborhood-level poverty and neighborhood-level access to healthy food with women’s glycemic control. However, at the individual level, use of the WIC program was associated with glycemic control (p = .034). Participants who reported not using this program were two times more likely to have poor glycemic control than those who did (OR = 2.045, 95% confidence interval [1.003, 2.045]). ConclusionIt is important to understand how the complex interplay between neighborhoods and individual factors of poverty and access to healthy food influences health outcomes among pregnant women. The WIC program may mediate neighborhood influence on diabetes self-management. Future research is warranted on how this program and nurse home visiting services can optimize maternal health outcomes among women who have diabetes during pregnancy.

Putting out the ‘unwelcome mat:’ The Announced Public Charge Rule reduced safety net enrollment among exempt noncitizens

Government action shapes the perceived and actual costs of citizens’ interactions with the state. By manipulating these costs, policymakers can affect citizens’ willingness to engage with the state, strongly impacting short- and long-term wellbeing. In September 2018, the Trump administration announced its intention to change how an immigrant’s likelihood of becoming a “public charge” would be evaluated. Once adopted, the rule would penalize certain classes of noncitizens for using safety net programs, potentially jeopardizing their application for permanent residence. We hypothesize that this proposed change increased psychological and learning burdens for low-income immigrants well beyond those directly impacted by the rule. Specifically, we used difference-in-differences models to analyze whether the announcement reduced safety net use among two groups exempt from the rule’s provisions: any WIC enrollee and noncitizen SNAP enrollees that are already legal permanent residents, refugees, or asylees. Even though the WIC program was excluded from the proposed rule, we find reductions in overall WIC use after the announcement. In addition, we show that SNAP enrollment decreased differentially after the announcement for noncitizens, nearly all of whom were likely exempt from the rule.

Implementation of Postpartum Depression Screening for Women Participating in the WIC Program.

The national average for the occurrence of postpartum depression (PPD) is 11.5%. Women enrolled in the Women, Infants, and Children (WIC) program are at an elevated risk for PPD symptoms due to risk factors such as a low income, unemployment, low education level, and younger maternal age. To implement screening for PPD symptoms using the Edinburgh Postnatal Depression Scale (EPDS) (1987) for women participating in the local WIC program with an infant <12 months old and compare results of positive screenings to the national average. The second goal was to provide community resources to those women with a positive score. Of 72 women screened, 69 scores were used in the comparison of the positive scores to the national Centers for Disease Control and Prevention average of 11.5%. Women were offered community resources after completion of the EPDS. There were 13 positive scores out of the sample size of 69. The percentage of positive scores obtained from these data were 18.84% for the WIC population, which is higher than the national average of 11.5%. This was significant with p = .0494. One limitation of this project was a small sample size. It would be beneficial for the WIC program to screen women for PPD symptoms in this high-risk population, so that recommendations for follow-up care could be made and quality of life could be increased.

WIC Participants' Perceptions of COVID-19-Related Changes to WIC Recertification and Service Delivery.

Many Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics implemented alternatives to in-person service delivery in response to the COVID-19 pandemic, including virtual visits and electronic document sharing. The objective of this cross-sectional study was to describe WIC participants’ experiences with remote service delivery and recertification during the pandemic. Participants included mothers and infants who participated in a WIC-based intervention between June 2019-August 2020. All participants (N = 246) were invited to complete a follow-up survey between November 2020-February 2021; 185 mothers completed the survey. The survey assessed sociodemographics, employment, food security, experiences with remote WIC recertification and service delivery, and experiences with obtaining WIC foods during the pandemic. Average age for mothers was 29.2 ± 6.3 years and for infants was 17.7 ± .2 months; 80% (n = 147) identified as Hispanic. Approximately 34% (n = 62) of participants reported very low or low food security and 40% (n = 64) had difficulties buying WIC foods during the pandemic. Among participants who recalled providing documentation of income and address virtually, the majority felt comfortable providing information via email (60%) and text messaging (72%). Participants reported high levels of satisfaction with remote methods of service delivery, as well as overall satisfaction with the WIC program during the pandemic. While ~ 25% of study participants preferred for all WIC services to remain remote, 75% still desired at least some in-person contact with WIC staff after the pandemic. In conclusion, remote methods of WIC service delivery addressed existing barriers to WIC participation and were well-received by study participants.

Prioritization of Features for Mobile Apps for Families in a Federal Nutrition Program for Low-Income Women, Infants, and Children: User-Centered Design Approach.

BackgroundThe Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) is a federal nutrition program that provides nutritious food, education, and health care referrals to low-income women, infants, and children up to the age of 5 years. Although WIC is associated with positive health outcomes for each participant category, modernization and efficiency are needed at the clinic and shopping levels to increase program satisfaction and participation rates. New technologies, such as electronic benefits transfer (EBT), online nutrition education, and mobile apps, can provide opportunities to improve the WIC experience for participants.ObjectiveThis formative study applies user-centered design principles to inform the layout and prioritization of features in mobile apps for low-income families participating in the WIC program.MethodsTo identify and prioritize desirable app features, caregivers (N=22) of the children enrolled in WIC participated in individual semistructured interviews with a card sorting activity. Interviews were transcribed verbatim and analyzed using constant comparative analysis for themes. App features were ranked and placed into natural groupings by each participant. The sum and average of the rankings were calculated to understand which features were prioritized by the users. Natural groupings of features were labeled according to participant descriptions.ResultsNatural groupings focused on the following categories: clinics/appointments, shopping/stores, education/assessments, location, and recipes/food. Themes from the interviews triangulated the results from the ranking activity. The priority app features were balance checking, an item scanner, and appointment scheduling. Other app features discussed and ranked included appointment reminders, nutrition training and quizzes, shopping lists, clinic and store locators, recipe gallery, produce calculator, and dietary preferences/allergies.ConclusionsThis study demonstrates how a user-centered design process can aid the development of an app for low-income families participating in WIC to inform the effective design of the app features and user interface.

Feasibility and Acceptability of a “Click & Collect” WIC Online Ordering Pilot

BackgroundBarriers to shopping for foods in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) have been reported. Online ordering options may improve the WIC shopping experience but are understudied. ObjectiveThe objective of this study was to test feasibility and acceptability of a “Click & Collect” model for WIC online ordering from the perspective of WIC participants. DesignA Click & Collect online ordering model was adapted to the WIC program and implemented at 1 grocery store. In the Click & Collect model, WIC participants placed an online order (“click”), then completed payment and pickup at the store (“collect”). Participants/settingTwenty-five WIC participants in East Tennessee were included. Main outcome measuresFeasibility was assessed by examining online order summaries and store receipts to determine whether WIC transactions were completed successfully. Acceptability was assessed by qualitative semi-structured interviews conducted with WIC participants after participating in the pilot. Analyses performedDescriptive statistics were used to analyze sociodemographic and purchase data in SPSS software, version 27. Qualitative interviews were transcribed and analyzed for themes using directed content analysis in NVivo, version 12.0. ResultsAll WIC participants in the study placed an online order, and 96% picked up the order, indicating a high degree of feasibility. In follow-up qualitative interviews, WIC participants reported interest in the Click & Collect model, and provided suggestions to improve practicality across the following 4 primary themes: website experience, curbside pickup, online shopping fee, and shopping preferences. ConclusionsThe pilot was successfully implemented at 1 store. Click & Collect online ordering was feasible and acceptable to WIC participants, although additional work is needed to make it practical. Online shopping options for the WIC program should be further explored to expand access to nutritious WIC foods in families with low income.

App Usage Associated With Full Redemption of WIC Food Benefits: A Propensity Score Approach

ObjectiveTo examine the relationship between WICShopper application (app) usage and full redemption of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food benefits. DesignA cross-sectional study. SettingWest Virginia WIC program. ParticipantsA total of 23,050 West Virginia WIC households in 2019. Main Outcome MeasuresFull redemptions were defined as the redemption rate of ≥ 90% for a given food benefit. AnalysisApp/non-app users were defined as households with someone using/not using the WICShopper app. Multivariate logistic regressions were applied. To address the potential self-selection bias in app usage, the propensity score (PS) of app usage was estimated. The regressions were rerun with the balanced sample by matching the PS. ResultsWith PS matching, the prevalence of full redemption at the household level was 7.2% for app users vs 4.7% for nonapp users (odds ratio, 1.64; 95% confidence interval, 1.40–1.92; P < 0.001). App users had a higher prevalence of full redemption in most food categories, even with PS matching. Conclusions and ImplicationsUse of the WICShopper app was associated with a higher prevalence of full redemptions in most food benefits after controlling the self-selection bias.

The Risk of Homemade Infant Formulas: Historical and Contemporary Considerations

It is the position of the Academy of Nutrition and Dietetics (Academy) that exclusive breastfeeding provides optimal nutrition and health protection for the first 6 months of life; from 6 months until at least 12 months, breastfeeding should continue with the introduction of complementary foods. 1 Centers for Disease Control and Prevention, Department of Health and Human ServicesProposed data collection submitted for public comment and recommendations. https://www.federalregister.gov/documents/2020/05/15/2020-10412/proposed-data-collection-submitted-for-public-comment-and-recommendationsDate accessed: February 9, 2021 Google Scholar This position is similar statements from the World Health Organization (WHO) 2 World Health OrganizationPromoting proper feeding for infants and young children. http://www.who.int/nutrition/topics/infantfeeding/en/Date accessed: June 26, 2020 Google Scholar and the American Academy of Pediatrics (AAP). 3 Gartner L.M. Morton J. Lawrence R.A. et al. Breastfeeding and the use of human milk. Pediatrics. 2005; 115: 496-506https://doi.org/10.1542/peds.2004-2491 Crossref PubMed Scopus (2144) Google Scholar ,4 Section on BreastfeedingBreastfeeding and the use of human milk. Pediatrics. 2012; 129: e827-e841https://doi.org/10.1542/peds.2011-3552 Crossref PubMed Scopus (3197) Google Scholar Breastfeeding initiation rates have been increasing in the United States: from 35% of infants in 2000 to 82% in 2020. 5 Centers for Disease Control and PreventionFacts about nationwide breastfeeding goals. https://www.cdc.gov/breastfeeding/data/facts.htmlDate accessed: June 23, 2020 Google Scholar But disparities exist: 74% of non-Hispanic Black infants have been breastfed compared with 87% of non-Hispanic white infants. 5 Centers for Disease Control and PreventionFacts about nationwide breastfeeding goals. https://www.cdc.gov/breastfeeding/data/facts.htmlDate accessed: June 23, 2020 Google Scholar Income-eligible infants participating in the US Department of Agriculture (USDA) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which is about 44.6% of all infants born in the United States, are 17% more likely to use infant formula than infants who are not WIC eligible. 5 Centers for Disease Control and PreventionFacts about nationwide breastfeeding goals. https://www.cdc.gov/breastfeeding/data/facts.htmlDate accessed: June 23, 2020 Google Scholar ,9 Gray K. Trippe C. Tadler C. Perry C. Johnson P. Betson D. National- and state-level estimates of WIC eligibility and WIC program reach in 2017 final report: volume I. https://fns-prod.azureedge.net/sites/default/files/resource-files/WICEligibles2017-Volume1.pdfDate accessed: March 19, 2021 Google Scholar Mothers participating in WIC differ from eligible nonparticipants who are more likely to have characteristics associated with increased breastfeeding. 7 Gregory E.F. Gross S.M. Nguyen T.Q. Butz A.M. Johnson S.B. WIC participation and breastfeeding at 3 months postpartum. Matern Child Health J. 2016; 20: 1735-1744https://doi.org/10.1007/s10995-016-1977-1 Crossref PubMed Scopus (12) Google Scholar Women of color and those living below the federal poverty level face barriers hindering breastfeeding initiation and duration. 8 Schreck P.K. Solem K. Wright T. Schulte C. Ronnisch K.J. Szpunar S. Both prenatal and postnatal interventions are needed to improve breastfeeding outcomes in a low-income population. Breastfeed Med. 2017; 12: 142-148https://doi.org/10.1089/bfm.2016.0131 Crossref PubMed Scopus (17) Google Scholar , 6 Office of the Surgeon General (US); Centers for Disease Control and Prevention (US); Office on Women's Health (US)The Surgeon General's Call to Action to Support Breastfeeding. Office of the Surgeon General (US), Rockville, MD2011 Google Scholar , 10 US Dept of Agriculture, Food and Nutrition ServiceWIC food packages - maximum monthly allowances. https://www.fns.usda.gov/wic/wic-food-packages-maximum-monthly-allowancesDate accessed: February 9, 2021 Google Scholar , 11 Kim J.H. Fiese B.H. Donovan S.M. Breastfeeding is natural but not the cultural norm: a mixed-methods study of first-time breastfeeding, African American mothers participating in WIC. J Nutr Educ Behav. 2017; 49: S151-S161.e1https://doi.org/10.1016/j.jneb.2017.04.003 Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar Increased investments in WIC breastfeeding support helped reduce disparities in breastfeeding initiation and increased breastfeeding initiation rates by 30% between 1998 (42%) 12 US Department of Agriculture, Food and Nutrition ServiceWIC program and participants characteristics, 1998. https://www.fns.usda.gov/wic/wic-program-and-participants-characteristics-1998Date accessed: March 19, 2021 Google Scholar through 2018 (72%). 13 Kline N. Thorn B. Bellows D. Wroblewska K. Wilcox-Cook E. WIC participant and program characteristics 2018 final report. https://fns-prod.azureedge.net/sites/default/files/resource-files/WICPC2018.pdfDate accessed: March 19, 2021 Google Scholar CorrigendumJournal of the Academy of Nutrition and DieteticsVol. 122Issue 8PreviewCorrigendum to: The Risk of Homemade Infant Formulas: Historical and Contemporary Considerations Full-Text PDF

Revisiting the relationship between WIC participation and breastfeeding among low-income children in the U.S. after the 2009 WIC food package revision

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides breastfeeding support and free formula to low-income participating infants in the U.S. Literature has consistently documented worse breastfeeding outcomes in WIC infants and children than in non-participants, although self-selection bias poses a challenge in examining the relationship between WIC participation and breastfeeding in low-income mother-child dyads. The WIC program adopted a comprehensive food package revision in 2009, the first one in four decades. Since that time, few national studies have examined the relationship between WIC participation and breastfeeding while controlling for the endogeneity of WIC participation with the propensity score method. This paper applied an instrumental variable (IV) approach on a large, nationally representative survey sample of children, the National Immunization Surveys (NIS), to examine the relationship between WIC participation and breastfeeding among children born between 2005 and 2014. We identified state Supplemental Nutrition Assistance Program (SNAP) enrollment rates and SNAP Policy Indices as valid IVs to address WIC participation endogeneity. Without the IVs, WIC participation had a significantly negative relationship with breastfeeding. After addressing endogeneity using the IVs, the relationship became insignificant in the whole sample and in the subpopulations across race/ethnicity and child gender. The neutrality of WIC participation on breastfeeding is important for policy makers to understand in seeking to improve breastfeeding among WIC participants.

Association of WIC Participation and Electronic Benefits Transfer Implementation

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an important source of nutritional support and education for women and children living in poverty; although WIC participation confers clear health benefits, only 50% of eligible women and children currently receive WIC. In 2010, Congress mandated that states transition WIC benefits by 2020 from paper vouchers to electronic benefits transfer (EBT) cards, which are more convenient to use, are potentially less stigmatizing, and may improve WIC participation. To estimate the state-level association between transition from paper vouchers to EBT and subsequent WIC participation. This economic evaluation of state-level WIC monthly benefit summary administrative data regarding participation between October 1, 2014, and November 30, 2019, compared states that did and did not implement WIC EBT during this time period. Difference-in-differences regression modeling allowed associations to vary by time since policy implementation and included stratified analyses for key subgroups (pregnant and postpartum women, infants younger than 1 year, and children aged 1-4 years). All models included dummy variables denoting state, year, and month as covariates. Data analyses were performed between March 1 and June 15, 2020. Statewide transition from WIC paper vouchers to WIC EBT cards, specified by month and year. Monthly number of state residents enrolled in WIC. A total of 36 states implemented WIC EBT before or during the study period. EBT and non-EBT states had similar baseline rates of poverty and food insecurity. Three years after statewide WIC EBT implementation, WIC participation increased by 7.78% (95% CI, 3.58%-12.15%) in exposed states compared with unexposed states. In stratified analyses, WIC participation increased by 7.22% among pregnant and postpartum women (95% CI, 2.54%-12.12%), 4.96% among infants younger than 1 year (95% CI, 0.95%-9.12%), and 9.12% among children aged 1 to 4 years (95% CI, 3.19%-15.39%; P for interaction = .20). Results were robust to adjustment for state unemployment and poverty rates, population, and Medicaid expansion status. In this study, the transition from paper vouchers to WIC EBT was associated with a significant and sustained increase in enrollment. Interventions that simplify the process of redeeming benefits may be critical for addressing low rates of enrollment in WIC and other government benefit programs.

Moving Beyond Breastfeeding Initiation: A Qualitative Study Unpacking Factors That Influence Infant Feeding at Hospital Discharge Among Urban, Socioeconomically Disadvantaged Women

BackgroundFactors that influence breastfeeding initiation and duration have been well established; however, there is limited understanding of in-hospital exclusive breastfeeding (EBF), which is critical for establishing breastfeeding. Grady Memorial Hospital, which serves a high proportion of participants receiving Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and racial/ethnic minorities, had an in-hospital EBF rate in 2018 by the Joint Commission’s definition of 29% and sought contextualized evidence on how to best support breastfeeding mothers. ObjectiveThe objectives were to (1) identify facilitators and barriers to in-hospital EBF and (2) explore breastfeeding support available from key stakeholders across the social-ecological model. DesignIn-depth, semistructured interviews were conducted and analyzed using thematic analysis. ParticipantsThe sample included a total of 38 purposively sampled participants from Grady Memorial Hospital (10 EBF mothers, 10 non-EBF, and 18 key stakeholders such as clinicians, community organizations’ staff, and administrators). ResultsKey themes included that maternal perception of inadequate milk supply was a barrier to in-hospital EBF at the intrapersonal level. At the interpersonal level, a personable and individualized approach to breastfeeding counseling may be most effective in supporting EBF. At the institutional level, key determinants of EBF were gaps in prenatal breastfeeding education, limited time to provide comprehensive prenatal education to high-risk patients, and practical help with latching and positioning. Community-level WIC services were perceived as a facilitator due to the additional benefits provided for EBF mothers; however, the distribution of WIC vouchers for formula to mothers while they are in the hospital undermines the promotion of EBF. Cultural norms and a diverse patient population were reported as barriers to providing support at the macrosystem level. ConclusionMultipronged approaches that span the social-ecological model may be required to support early EBF in hospital settings.

The impact of WIC participation on tobacco use and alcohol consumption

AbstractThe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program provides food coupons and health benefits to foster in utero and postpartum development of the child. However, due to these benefits, households might reallocate income from food and healthcare services toward other goods. Utilizing data from the Pregnancy Risk Assessment Monitoring System, this article investigates the effects of participation in the WIC program on cigarette and alcohol consumption. Our results indicate that the program has no effect on prenatal smoking but increases postpartum cigarette consumption per day by 6%. WIC also has preventive benefits as it decreases prenatal alcohol consumption on the extensive and intensive margins.

Individual and Household-Level Factors Associated With Caregivers' Intention to Keep Their Child Enrolled in WIC

ObjectiveIdentify factors associated with caregivers’ intention to keep their child enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program until age 5 years. MethodsBaseline data from a longitudinal questionnaire aiming to assess the impact of a statewide intervention to increase WIC retention in Illinois were analyzed in 2018. Data on sociodemographics and household characteristics were collected in 2015 from 174 caregiver/child dyads. Logistic regression was used to identify factors associated with caregivers’ intention to keep their child enrolled in WIC until age 5 years (ie, intention). ResultsA total of 66% of caregivers stated they were very likely to keep their child enrolled in the WIC program. Breastfeeding and homeownership status were associated with 58% (P =.03) and 72% (P =.02) lower odds of intention among caregivers, respectively. Conclusions and ImplicationsSignificant inverse associations among breastfeeding, homeownership, and intention support the need for tailoring state-level WIC retention efforts to specific population characteristics and health behaviors.

Are Children of Welfare Recipients at a Heightened Risk of Bullying and Peer Victimization?

Children who come from families on welfare or government assistance might be at risk for bullying involvement. As research has shown, children living in poverty and experiencing family economic hardship are significantly likely to be involved in bullying in school. This study investigates whether welfare assistance is associated with children’s bullying victimization and perpetration, controlling for the covariates including mother (educational level, marital status, employment status, perceived parenting) and child (sex, age, race/ethnicity) characteristics. The study also explores whether various kinds of welfare assistance programs, such as Medicaid, Cash Assistance, SNAP, free/reduced breakfasts or lunches at school and the WIC program are independently associated with children’s bullying victimization and perpetration, controlling for the covariates. Participants were 15,010 caregivers of children, ages 6–11 years, who completed the National Survey of Children’s Health (NSCH). Results suggest that children receiving welfare assistance were more likely to be victims and perpetrators of bullying than children not on assistance. All of the welfare assistance variables were associated with increased odds of bullying perpetration, and three out of five welfare assistance programs—Medicaid, SNAP, and free/reduced breakfasts or lunches at school were statistically significantly associated with increased odds of bullying victimization. Children in families receiving welfare assistance appear to be at an increased risk of being both victims and perpetrators of bullying, which suggests a need for bullying programming for this population.