WIC Program Research Articles

The Effect of the WIC Program on Consumption Patterns in the Cereal Category

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federally-funded food assistance program for low income participants who are at nutritional risk. Beneficiaries receive vouchers for specific foods and brands, selected for their nutritional value. While the program is designed to improve nutrition, it may also induce changes in consumption behavior that persist beyond participation in the program. In this paper, we study how participation in WIC impacts the consumption patterns and preferences during and after the program. Our analysis focuses on the cereal category, in which the subsidized brands must meet certain nutritional guidelines. As expected, during the program households increase cereal consumption volume and shift their choices towards the WIC-approved brands. More interesting is that once households exit the program, the higher category consumption rate and elevated share of WIC brands persist. To understand the behavioral mechanism underlying these consumption patterns, we estimate a choice model and find an increased preference for WIC brands after controlling for state dependence. The evidence suggests that this targeted food subsidy program is effective in creating behavior change that persists even after the incentive is withdrawn.

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

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

P196 Chat with WIC: Innovating WIC Services with a Chatbot

Background WIC serves low income pregnant, postpartum, and breastfeeding women and infants and children at nutritional risk by providing food packages and nutrition education. Texas WIC enrollment has declined by 24.1% since 2015. By offering continual availability to answer questions regarding eligibility and schedule appointments, an online chatbot has potential to improve enrollment and retention. Objective To inform the development of a Texas WIC Chatbot prototype by engaging WIC stakeholders and staff. Study Design, Settings, Participants This study involved three sets of group interviews conducted using Zoom with state-level stakeholders, WIC directors, and clinic staff. Participation was invited via email. Demographic surveys were completed before interviews. An interview guide prompted discussion regarding how a chatbot could expedite the WIC flow of services, what desirable chatbot features would be, and how barriers to successful implementation could be overcome. Measurable Outcome/Analysis Interview data were recorded, transcribed, and themed using the classic analysis strategy. Themes informed WIC Chatbot design. Results A total of 11 group interviews with 32 participants were conducted. Themes included support that a chatbot: could improve WIC services by adding flexibility so that clients could determine eligibility and be better prepared for clinic visits; would be most effective with a friendly, personable interface; and could potentially connect clients to other WIC information, such as nutrition education. Participants expressed concern that no chatbot could be a one-size-fits-all solution. Conclusion The prospect of a Texas WIC Chabot was well-received. A chatbot could ideally provide a logical interface aligned with the WIC flow of services, with a friendly and professional interface. Next steps will involve the development of a live-chat launched through the Texas WIC website to investigate user preferences. Collectively, these data will inform WIC Chatbot 1.0. After implementation of WIC Chatbot 1.0, the effect on enrollment and retention can be assessed. Funding Texas Health and Human Services Commission, WIC Program.

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

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

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

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

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

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

WIC Participation Associated With Improved Nutrition in Children

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

DO TARGETED VOUCHERS INSTILL HABITS? EVIDENCE FROM WOMEN, INFANTS, AND CHILDREN

We examine whether programs that provide vouchers to households continue to influence behavior after the household leaves the program. Using detailed scanner data, we test whether benefit vouchers received through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) change household purchasing decisions and whether these changes persist even after households are no longer eligible to participate in the program. In 2009, the package of goods available through WIC vouchers changed. Examining variation due to this package change, we show that the WIC vouchers change purchasing decisions during eligibility, but that effects fade after eligibility ends. (JEL I38, I18, J13)

Nutrition provider confidence in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study.

ObjectiveThe multi-sector, multi-level Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study resulted in improvements in obesity risk factors among children age 2–4 years enrolled in the Special Supplemental Nutrition program for Women, Infants, and Children (WIC). The goal of this study was to examine whether the MA-CORD intervention increased WIC provider confidence in their ability to identify childhood obesity and obesity-related behaviors.MethodsAs part of the MA-CORD intervention conducted from 2012 to 2015, we implemented WIC practice changes focused on childhood obesity prevention within two Massachusetts communities. We examined changes in provider confidence to assess childhood obesity risk factors and practice frequency among WIC practices located in MA-CORD intervention communities over a 3-year period, compared to non-intervention sites. We measured provider confidence on a continuous scale using questions previously developed to assess provider and parent confidence to make weight-related behavior change (range 0 to 24).ResultsThere were 205 providers at baseline and 165 at follow-up. WIC providers at intervention sites reported greater confidence in their ability to identify childhood obesity and obesity-related behaviors compared to the usual care sites (β = 1.01, standard error = 0.13). These findings persisted after adjusting for provider gender, years in practice, highest education level, and WIC position.ConclusionsThe MA-CORD intervention was associated with increased WIC provider confidence to assess children's obesity risk. Interventions that increase confidence in assessing obesity-related behaviors may have salutary effects within WIC programs that serve low-income families.

Refugee Children's Participation in the Women, Infants, and Children Supplemental Nutrition (WIC) Program in Massachusetts, 1998-2010.

To (1) describe prevalence of growth abnormalities and anemia in refugee children; (2) describe the proportion of age-eligible refugee children enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and (3) identify risk factors for lack of enrollment in WIC. Data were collected from 1731 health screenings for refugee children younger than 5 years in Massachusetts in 1998-2010 and matched to WIC program records. Risk factors for lack of WIC enrollment were analyzed in SAS using multivariate logistic regression. Massachusetts. Refugee children under age 5 years. (1) prevalence of growth abnormalities and anemia in refugee children, (2) proportion of age-eligible refugee children enrolled in WIC, and (3) association of risk factors with lack of WIC enrollment. Overall, 33% of refugee children under age 5 in Massachusetts had at least 1 growth and nutrition problem, including anemia (31%), stunting (10%), wasting (8%), and low weight for age (10%). WIC enrollment among refugee children under 5 years of age was only 62%, lower than that of all eligible children under 5 in Massachusetts (86%). Risk factors for lack of WIC enrollment among refugee children included age, world region of origin, and arrival cohort. Although many refugee children under age 5 experience growth or nutrition problems, one-third of refugee children in Massachusetts were not enrolled in WIC for nutrition assistance, representing a failure of the system. Agencies providing services at the local level should be supported to facilitate enrollment and participation for shared clients.

WIC Recipients in the Retail Environment: A Qualitative Study Assessing Customer Experience and Satisfaction

BackgroundThe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program is an important intervention for prevention and treatment of obesity and food insecurity, but participation has dropped among eligible populations from 2009 to 2015. Program satisfaction is integral to participant retention, and the retail experience is a vital component of program satisfaction. ObjectiveThis article applies behavioral economics principles to explore the retail experience of WIC participants and ways in which it may be improved. DesignThe authors designed and conducted semistructured interviews and focus groups with WIC participants. Participants/settingA convenience sample of WIC participants aged 18 years and older were recruited through WIC clinics in Texas, North Carolina, Oregon, and Illinois (n=55, 27 participants from four focus groups and 28 individual interviews). Statistical analysis conductedResponses were analyzed qualitatively using principles of content analysis. ResultsChallenges in identifying WIC-allowable items throughout the store as well as perceived stigmatization during the checkout process were the chief complaints. Study participants described a learning curve in successful use of WIC in retail environments over time. Study participants also reported acceptance of restrictions, such as a requirement to purchase the least expensive brand. ConclusionsDissatisfaction with the retail experience may lead to the underutilization of WIC benefits or program exit. Behavioral economics strategies that facilitate a better shopping experience, such as creating a section for WIC items in the store or improving in-store education, may improve the retail experience for WIC customers. Further research is needed to ensure such strategies are effective and do not contribute to stigma.

Evaluating the Impact of the Revised Special Supplemental Nutrition Program for Women, Infants, and Children Fruit Juice Allotment on Fruit Intake, Dietary Quality, and Energy/Nutrient Intakes among Children 1-4 Years of Age

Objective: The goals of this study were to assess the impact of recent changes in the WIC allotment on fruit intake, dietary quality/adequacy, energy/nutrient intakes, and potential impact of the complete removal of 100% fruit juice (FJ) from the package. Methods: 24-hour recalls from children 1-4 years who were WIC participants or income-eligible nonparticipants in the NHANES 2007-2008 and 2011-2014 (before and after WIC package changes) were analyzed. Results: There were no differences in the Healthy Eating Index-2015 total score; subcomponent scores for “greens and beans” and for “fatty acid ratio” were higher in 2011-2014 than in 2007-2008 in children participating in WIC; scores for “sodium” were higher in 2011-2014 than in 2007-2008 in children not participating in WIC but income-eligible. In WIC participants mean intakes of riboflavin, vitamins B12 and C, and zinc were significantly (p<0.01) lower, and intake of vitamin E was significantly (p<0.01) higher in 2011-2014 compared to 2007-2008. One significant difference in nutrient adequacy in children was that of a lower (p<0.01) percentage of inadequacy for WIC participants for vitamin E and a higher (p<0.01) percentage of inadequacy for WIC participants for vitamin A in 2011-2014 as compared to those in 2007-2008. The elimination of FJ from the WIC food packages resulted in a 38-50% lower total fruit intake and a 4-5% reduction in total HEI-2015 score. Conclusion: Changes in the WIC program resulted in potential adverse effects on mean intakes of some nutrients but not on the nutrient adequacy or overall diet quality. Confirmatory studies are needed.

P150 - Dietary and Health Related Behaviors of WIC-Enrolled Pregnant Women

Background (Background, Rationale, Prior Research, and/or Theory): Pregnancy is a critical period in a woman's lifecycle, during which good maternal nutrition can positively impact the health of both the mother and the fetus. Objective: The objective of this study was to evaluate the effect of pregnancy on dietary and health related behaviors of WIC-enrolled women, the quantity of food consumed, and the perceived quality of the diet. Study Design, Setting, Participants, Intervention: A cross-sectional study using a self-reported questionnaire was conducted. Sixty pregnant women between 12 and 24 weeks of gestation and carrying a single fetus were recruited from the WIC program at a community health center. Outcome Measures and Analysis: The self- reported questionnaire consisted of open-ended questions that evaluated changes in participants' dietary and other health related behaviors, and frequency of consumption of foods from the different food groups before and after pregnancy. Demographic data were also collected. Descriptive statistics were used to compare changes in the frequency of consumption of specific foods (WIC allowable and others), and smoking habits before and after pregnancy. Responses to open-ended questions addressing changes in quantity and quality of the diet before and after pregnancy were analyzed qualitatively using content analysis. Results: Sixty-seven percent of women reported experiencing morning sickness, and 60% stated that it affected their food intake. Despite this, 60% reported healthier eating behaviors, and higher average intakes of fruits, milk, and breakfast cereals. Twenty-two percent of participants stopped smoking. Conclusions and Implications: Participants improved their food choices after becoming pregnant and majority reported adopting healthier behaviors. This indicates that these women were committed to improving their health habits to ensure positive pregnancy outcomes. This shows pregnant women are a particularly receptive group for nutrition education interventions. Funding: None.

NP10 - CHEW 2.0: User Testing of the Children Eating Well (CHEW) Smartphone Application for WIC Families

Objective: Despite the vast benefits and positive health outcomes associated with WIC participation, enrollment in the program has continued to decline over the past five years. Barriers that limit ease of use of the program exist for many participants, including the WIC shopping experience. The Children Eating Well (CHEW) smartphone application (“app”) aims to increase redemption of WIC foods and improve overall diet quality of preschool-aged participants by facilitating benefit redemption and providing easy, practical ways for parents to increase consumption of healthy foods. The objective is to report on the findings of user testing during the preparation of version 2.0 of the CHEW app. Description: Building on the original CHEW prototype app, our team is conducting qualitative interviews and focus groups with WIC staff and families of WIC children in an iterative process to inform user-centered development of version 2.0 and to maximize usability of the app. Evaluation: Data collection and analysis are in progress. We will report on qualitative findings related to the user interface, user experience, improvement of shopping tools, and topics and format of nutrition education features. Conclusions and Implications: After completing development and field testing, the CHEW 2.0 app will be implemented in WIC clinics across the state of Tennessee as a supplemental education tool for families to use at home, with the potential for future dissemination to other states. These formative findings can also inform the development of other technology applications for the WIC program. Funding: 2017-68001-26352.

Interdisciplinary Community-Based Oral Health Program for Women and Children at WIC.

Objectives To evaluate the women, infants, and children (WIC) Oral Health Program in a county in Florida. Methods The non-traditional interdisciplinary program of the current study was designed to reach at-risk populations with untreated dental diseases and limited access to care; it provides oral health education, dental screenings, preventive dental services, and referrals for women, children, and families at WIC offices. We evaluated the health status of patients enrolled in the program and the services provided. Results From 2013 to 2016, the program provided dental screenings for 576 children and 180 women. Caries prevalence for 3-5year olds was 46.0%. Only 6.6% (12/114) of pregnant women were eligible for comprehensive dental care under Medicaid (< 21years). Further, 71.2% (47/66) of all pregnant women had unmet dental care needs. Conclusions for Practice Our results suggested that many children and women had untreated dental diseases and need preventive services and dental care. Also, many pregnant women were not covered by Medicaid. This program demonstrates that collaboration with the WIC program can improve access to oral health services for underserved populations.

100% Juice, Fruit, and Vegetable Intake Among Children in the Special Supplemental Nutrition Program for Women, Infants, and Children and Nonparticipants

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides monthly food packages to low-income children (aged 1-4 years) in the U.S., including 128 ounces of 100% fruit juice and an $8 cash value voucher for purchasing fruits and vegetables. The fruit juice allowance translates to 71%-107% of the maximum intake recommended by the American Academy of Pediatrics (4-6 ounces/day). Careful examination of WIC food package allocations is necessary because overconsumption of fruit juice among young children has been linked to weight gain and juice lacks important nutrients found in whole fruit (e.g., fiber). A total of 1,576 children aged 2-4 years were assessed using the 2009-2014 National Health and Nutrition Examination Surveys. Multiple linear regressions were conducted in 2017 to analyze the association between WIC program participation and intake of 100% fruit juice, whole fruits, and vegetables. Logistic regression was used to examine the association between WIC program participation and the odds of exceeding the American Academy of Pediatrics maximum intake for juice. Adjusting for child and parent/caregiver characteristics, WIC participants consumed significantly more 100% fruit juice (β=0.22 cup equivalents/day, 95% CI=0.04, 0.40) compared with income-eligible nonparticipants, but not more whole fruits or total vegetables. WIC participants had 1.51-times greater odds (95% CI=1.06, 2.14) of exceeding the age-specific American Academy of Pediatrics maximum intake for juice compared with income-eligible nonparticipants. These findings support recommendations to reduce 100% fruit juice allowances in the WIC program and reallocate those funds to the cash value voucher to increase whole fruit and vegetable consumption.

Food cost is the least of my worries: a qualitative study exploring food and beverage purchasing decisions among parents enrolled in the WIC program

ABSTRACTAddressing barriers to the Women, Infants and Children [WIC] food purchasing experience may lead to interventions to help manage WIC food costs; allowing more qualified families to enroll in WIC without compromising costs. To examine factors that influence food purchasing decisions among WIC participants, an inductive approach was used to identify themes in qualitative data gathered from semi-structured interviews and focus groups. Twenty-six parents, from WIC clinics and childcare centers in the Southeast Region, participated in this study. Meal planning, store selection, price consideration, and voucher usage, all emerged as themes related to WIC food purchasing behavior among this sample.

Effect of a Multi-Site Trial using Short Message Service (SMS) on Infant Feeding Practices and Weight Gain in Low-Income Minorities

ABSTRACTObjective: To test the effects of weekly SMS for improving infant feeding practices and infant weight.Methods: This was a multi-site randomized clinical trial in a convenience sample of 202 caregivers of healthy term infants 0–2 months participating in the WIC program in Puerto Rico and Hawaii. Participants were randomized to receive SMS about infant's general health issues (control) or SMS for improving feeding practices (intervention) for four months. Weight, length and infant feeding practices were assessed at baseline and four months later.Results: A total of 170 participants completed the study (n = 86 control and n = 84 intervention). Baseline characteristics were similar between groups. At the end, exclusive breastfeeding rates were similar between groups (67.4% control and 59.1% intervention). Introduction of other foods and beverages, addition of foods to the bottle, placing infants to sleep with milk bottles, caregiver's method and response to feeding infants and distractions while feeding infants were similar between groups. Also, weight status or rate of weight gain was similar between groups.Conclusion: There were no significant improvements in feeding practices or in weight with the intervention. The timeline of the messages in relation to the targeted behavior may have affected the effectiveness of the intervention. Earlier dissemination of messages, higher level of intensity, longer intervention, additional contacts and inclusion of other caregivers may be needed to achieve the desired effects.

Spatial and Temporal Variation in the Value of the Women, Infants, and Children Program's Fruit and Vegetable Voucher

AbstractIncreasing the consumption of fresh fruits and vegetables among children and low‐income households is a public health policy priority in the United States. We investigate temporal and spatial price patterns for fresh fruits and vegetables to evaluate the extent to which the value of the fruit and vegetable Cash‐Value‐Voucher (CVV) of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may be affected by unequal price levels and changes in price levels across the United States. Our findings show that price differences over space and time have real and consequential impacts on the purchasing power of the CVV. A WIC Program participant in the highest‐cost Metropolitan Statistical Area (MSA) can buy significantly fewer fruits and vegetables than a participant who receives the same benefit in the lowest‐cost MSA. Further, we find that the value of the CVV has substantially declined across all MSAs since 2009. We discuss the nutritional implications of the variation in the value of the CVV and evaluate potential mechanisms that could be implemented to maintain equal CVV benefits across time and space.

Association of Maternal Depressive Symptoms and Offspring Physical Health in Low-Income Families.

Objectives The present study sought to examine the association between maternal depressive symptoms and characteristics of offspring physical health, including health status, health behaviors, and healthcare utilization, among low-income families. Maternal engagement was explored as a mediator of observed effects. Methods Cross-sectional survey data from a community sample of 4589 low-income women and their preschool-age children participating in the WIC program in Los Angeles County were analyzed using logistic, Poisson, and zero-inflated negative binomial regression. Mediation was tested via conditional process analyses. Results After controlling for the effects of demographic characteristics including maternal health insurance coverage, employment status, education, and preferred language, children of depressed women (N = 1025) were significantly more likely than children of non-depressed women (N = 3564) to receive a "poor" or "fair" maternal rating of general health (OR 2.34), eat fewer vegetables (IRR: 0.94) more sweets (IRR: 1.20) and sugary drinks daily (IRR: 1.32), and consume fast food more often (OR 1.21). These children were also less likely to have health insurance (OR 1.59) and more likely to receive medical care from a public medical clinic or hospital emergency room (OR 1.30). Reduced maternal engagement partially mediated associations between maternal depressive symptoms and several child health outcomes including poor diet, health insurance coverage, and use of public medical services. Conclusions for Practice Maternal depressive symptoms are associated with poor health among preschool-age children in low-income families. Prevention, screening, and treatment efforts aimed at reducing the prevalence of maternal depression may positively affect young children's health.