Women, Infants And Children Participants Research Articles

"What Matters to You?": A Participant-Centered Approach to Needs Identification and Referral to Community Resources.

Referral to social and health services is a core process of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). We evaluate the feasibility and acceptability of a referral innovation implemented at two New York City WIC sites. This program aimed to improve retention by increasing WIC's perceived value by addressing unmet needs of WIC families. The two main components were needs assessment via conversation and a closed-loop referral process for WIC families with children aged 6-9 months and 18-21 months. Referral outcomes from Unite Us and program data were tracked and assessed using descriptive univariate analyses. We conducted 29 in-depth interviews with caregivers and six focus groups with WIC and CBO staff. Qualitative data were analyzed using thematic framework analysis. From February 2020 through January 2021, 1,675 WIC caregivers participated in a conversation about their family's needs. Four hundred sixty-one caregivers were referred to at least one service. 95 received services or benefits. In interviews, caregivers viewed referrals to other services positively but were not aware WIC could address needs holistically. In focus groups, WIC staff liked the conversation script but highlighted barriers to making referrals. CBO partners valued network participation as it increased their reach to new families. Our approach facilitated targeted referrals for WIC participants. It is an acceptable enhancement of the WIC referral process with potential to strengthen WIC as a community provider.

A Mixed-Methods Study of Perceived Implementation Challenges for WIC Online Ordering and Transactions.

Federal food assistance programs are working towards online grocery shopping. Online ordering in Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is emerging following successful implementation in Supplemental Nutrition Assistance Program (SNAP). To identify anticipated challenges, potential solutions, and expected costs of WIC online ordering. Cross-sectional, mixed-methods, web-based, survey research. Data were collected from December 2020 to January 2021. Purposeful and snowball sampling included WIC stakeholders involved in developing processes and systems required for WIC online ordering. Respondents represented diverse geographic areas, levels of intraorganizational authority, and WIC benefit card types. The research team used a rapid analysis and lean coding approach to identify emergent themes from open-ended survey responses. Descriptive statistics were used to describe the distribution of responses across themes and stakeholder types. Respondents (n= 145) described 812 anticipated challenges within 20 themes grouped into five topic areas: rules and regulations; shopping experience; security, confidentiality, fraud, and WIC State agency processes; training, assistance, and education; and equitable access and buy-in. Addressing anticipated regulatory issues were among the few concrete potential solutions described. The two most frequent costs reported were increased staff time and start-up and ongoing technology costs. This study identified several, critical anticipated challenges and considerations that will help prepare WIC state agencies for opportunities to expand online ordering to WIC participants.

Racial and Ethnic Comparisons in Satisfaction with Services Provided by the Special Supplemental Nutrition Program for Women, Infants, and Children in California.

Understanding satisfaction of nutrition education and other services provided in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is needed to ensure the program is responsive to the needs of diverse populations. This study examined the variation of WIC participants’ perceptions and satisfaction with WIC nutrition education and services by race, ethnicity, and language preference. Phone surveys were conducted in 2019 with California WIC families with children aged 1−4 years. While most participants (86%) preferred one-on-one nutrition education, online/mobile apps were also favored (69%). The majority (89%) found nutrition education equally important to receiving the WIC food package. Racial/ethnic groups differed in which WIC service they primarily valued as 20% of non-Hispanic White people rated the food package as more important than nutrition education compared to 5% of Spanish- and 6% of English-speaking Hispanic people, respectively. More Spanish (91%) and English-speaking Hispanic people (87%) than non-Hispanic white (79%) or Black people (74%) changed a behavior because of something they learned at WIC (p < 0.001). Spanish-speaking Hispanic people (90%) had the highest satisfaction with WIC nutrition education. Preferential differences among participants suggest that providing flexible options may improve program satisfaction and emphasizes the need for future studies to examine WIC services by race and ethnicity.

Food insecurity and food consumption among children who receive federal food assistance

The objective of this study was to investigate the association between household food insecurity and food intake among children who participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), including a sub-sample who also participated in the Supplemental Nutrition Assistance Program (SNAP). Data came from the 2014 and 2017 Los Angeles County WIC Surveys, involving a random sample of WIC participating families in Los Angeles, California. Outcome variables were average daily consumption of fruit, 100% fruit juice, vegetables, milk, other juice, other sweetened drinks, and sweet foods, and frequency of fast-food consumption, as reported by the child's caregiver. Our predictor was household food insecurity, obtained from the 6-item Household Food Security Survey Module. Poisson regression (fruit, 100% fruit juice, vegetables, and milk), Negative Binomial regression (other juice, other sweetened drinks, and sweet foods) and multinomial logistic regression (frequency of fast food) models were run, adjusting for child's age and sex; maternal age, ethnicity and language, education, and employment; and type of WIC participation (WIC only vs. WIC + SNAP). In fully adjusted models, household food insecurity was associated with higher consumption of 100% fruit juice (RR = 1.08, 95%CI = 1.03–1.11), milk (RR = 1.04, 95%CI = 1.01–1.07), other juice (RR = 1.16, 95%CI = 1.08–1.26), other sweetened drinks (RR = 1.28, 95%CI = 1.12–1.46), and sweet foods (RR = 1.09, 95%CI = 1.04–1.14). No significant associations were found between household food insecurity and fruit and vegetable consumption. Nutrition education provided by WIC should continue to emphasize the importance of consuming fresh foods, while limiting foods high in sugar for this young population. Efforts should be made to identify food insecure families at the point of service delivery for enhanced nutrition education and social services referrals.

A Participatory Systems Approach to Understanding WIC Participation in Rural Native American Communities

ObjectivesParticipation of eligible Native American women and children in the Special Supplemental Nutrition Program for Women Infants and Children (WIC) has been declining for over a decade. The objective of this research was to identify the complex system of constraints and facilitators contributing to this decline in WIC enrollment among Native women and children. MethodsIn-person community level engagement was not possible with COVID-19 restrictions, so we developed causal loop diagrams (CLDs) by adapting a novel methodology of participatory system dynamics modeling based on key stakeholder interviews. Semi-structured in-depth interviews (n = 35) were conducted via Zoom or phone with current and former WIC participants, eligible non-participants, WIC staff, tribal/health administrators, and WIC food store vendors. A codebook was developed based on open coding by four different researchers, and interviews were coded by identifying causal relationships and polarity between factors. Kumu software was used to merge interview results, resulting in three CLDs, one per community. CLDs were shared with tribal WIC staff for member checking and additional feedback. ResultsDespite similar enrollment declines across the three communities, the CLDs reveal important differences in systems-level enrollment obstacles to WIC participation. Cross-cutting key themes included the following structural elements: transportation, connectivity, and local policy/protocol barriers. Transportation feedback loops incorporated the accessibility of WIC offices and grocery stores, vehicle sharing practices, and travel times. Connectivity feedback loops incorporated virtual WIC services, re-enrollment certification processing, and generational technology gaps. While similar themes emerged across each community, the degrees to which and pathways through which the variables impacted enrollment varied significantly. ConclusionsThis is one of the first studies to map systems of constraints and facilitators influencing WIC participation in rural Native American communities. The application of systems thinking in this context is an important step towards addressing structural and systems level factors that are more likely to support WIC enrollment in rural Native American communities. Funding SourcesHealthy Eating Research Grant from RWJF #77,235.

Baby Friendly Hospital Designation and Breastfeeding Outcomes Among Maryland WIC Participants.

The Baby-Friendly HospitalInitiative is an effective intervention to support maternal practices around breastfeeding. However, little is known about its impact on participants of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The purpose of this study was to evaluate whether Baby Friendly Hospital (BFH) designation in Maryland improved breastfeeding practices among Special Supplemental Nutrition Program forWomen, Infants and Children (WIC) participants. Breastfeeding practices of WIC participants (22,543 mother-infant dyads) were analyzed utilizing WIC management information system de-identified data from four Maryland WIC agencies during 2010-12 and 2017-19. Participants lived in areas served by a hospital that became BFH in 2016 or remainednon-BFH. Pre-post implementation breastfeeding practices (breastfeeding initiation, at 3months and 6months) of women associated with a BFH were compared to women associated with a non-BFH usingpropensity score weighting and a difference-in-difference modeling. From pre to post interventionno differences in breastfeeding initiation or any breastfeeding at 6 months were attributable to BFH status. There was some evidence that BFH designation in 2016 was associated with an absolute percent change of 2.4% (P=0.09) for any breastfeeding at 3months. Few differences in breastfeeding outcomes among WIC participants were attributable to delivery in a BFH.Results from this study inform policy about maternity practices impacting WIC breastfeeding outcomes. More study needed to determine the impact of BFH delivery on differences in breastfeeding outcomes between sub-groups of women.

Longer Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children Is Not Associated with Reduced Sugar-Sweetened Beverage Intake among Black Participants.

This study assessed relationships of duration of family Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participation with racial/ethnic disparities in child sugar-sweetened beverage (SSB) and water intake. Child beverage intake and family duration on WIC were collected during three cross-sectional surveys of WIC-participating families in Los Angeles County, California (2014, 2017 and 2020; n = 11,482). The associations of family duration of WIC participation, a proxy for the amount of WIC services received, with daily intake of total SSBs, fruit-flavored SSBs and water were assessed in race/ethnicity strata with multivariable negative binomial and Poisson regression models. Among English-speaking Hispanic children, those of families reporting 10 years of WIC participation consumed 33% and 27% fewer servings of total and fruit-flavored SSBs compared to those of families reporting 1 year on WIC. Among Black children, those from families reporting 5 and 10 years of participation in WIC consumed 33% and 45% more daily servings of fruit-flavored SSBs than those from families reporting 1 year on WIC. Disparities in daily total and fruit-flavored SSB intake between Black and White children increased with longer family duration on WIC. Duration of family WIC participation is associated with healthier beverage choices for infants and children, but does not appear to be equally beneficial across racial/ethnic groups in Los Angeles County.

WIC Is Critical During the COVID-19 Pandemic: Lessons Learned From Los Angeles County Participants

ObjectivesThe COVID-19 pandemic has changed the way that the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) delivers services. The USDA granted multiple waivers to allow flexibility in WIC operations during the pandemic. The objective of this study was to hear from WIC participants about the impact of changes due to COVID-19.MethodsIn the summer of 2020, 60 semi-structured interviews were completed, half with English-speaking and half with Spanish-speaking WIC participants in the Los Angeles area. Interviews were recorded, transcribed, and analyzed using a deductive content analysis approach to describe responses and identify themes.ResultsFour themes emerged: 1) The pandemic has exacerbated the ckhallenges facing low-income families; 2) WIC continues to be avalued resource especially under the challenging circumstances; 3) WIC's transition to remote service delivery has ensured that families continue to receive not only critical WIC food benefits, but also nutrition education and support; 4) Lessons learned during COVID-19 can inform needed WIC modernizations to maximize WIC's proven benefits post-pandemic. Nearly 75% of WIC participants faced reductions in income due to job loss or reduced work hours. Nearly 60% of households reported experiencing food insecurity. Early in the pandemic, many reported challenges accessing WIC-eligible foods, resulting in lost food benefits. Approximately 43% reported getting food from a food pantry or church, with most (77%) reporting first time usage. Participants shared that even with the change to only remote education, they valued the information and were very satisfied with WIC services. The majority (83%) found the California WIC App helpful in informing what WIC foods they could purchase. Participants also reported that enrolling in WIC remotely was easier than coming in-person and they were comfortable providing documents related to income and eligibility determination remotely.ConclusionsWIC has been essential in helping families cope with COVID. WIC's transition to remote service delivery has ensured seamless and safe delivery of services, helping families with young children during an unprecedented time of need.Funding SourcesThe David and Lucile Packard Foundation

USDA Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Vendor Criteria: An Examination of US Administrative Agency Variations.

The food retail environment has been directly linked to disparities in dietary behaviors and may in part explain racial and ethnic disparities in pregnancy-related deaths. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC), administered by the United States Department of Agriculture, is associated with improved healthy food and beverage access due to its requirement for minimum stock of healthy foods and beverages in WIC-eligible stores. The selection and authorization criteria used to authorize WIC vendors varies widely from state to state with little known about the specific variations. This paper reviews and summarizes the differences across 16 of these criteria enacted by 89 WIC administrative agencies: the 50 states, the District of Columbia, five US Territories, and 33 Indian Tribal Organizations. Vendor selection and authorization criteria varied across WIC agencies without any consistent pattern. The wide variations in criteria and policies raise questions about the rational for inconsistency. Some of these variations, in combination, may result in reduced access to WIC-approved foods and beverages by WIC participants. For example, minimum square footage and/or number of cash register criteria may limit vendors to larger retail operations that are not typically located in high-risk, under-resourced communities where WIC vendors are most needed. Results highlight an opportunity to convene WIC stakeholders to review variations, their rationale, and implications thereof especially as this process could result in improved policies to ensure and improve healthy food and beverage access by WIC participants. More work remains to better understand the value of state WIC vendor authorization authority, particularly in states that have provided stronger monitoring requirements. This work might also examine if and how streamlining WIC vendor criteria (or at least certain components of them) across regional areas or across the country could provide an opportunity to advance interstate commerce and promote an equitable supply of food across the food system, while ensuring the protection for local, community-oriented WIC vendors.

The impact of safety net programs on early-life developmental outcomes

Existing scholarly evidence suggests that early-life environments play a critical role in shaping an individual’s long-term socioeconomic outcomes. The impact of safety net programs on early-life environments and outcomes is largely unknown.This study uses novel data to estimate the impact of the Women, Infants and Children (WIC), the Supplemental Nutrition Assistance Program (SNAP) and home visitation (HV) programs on cognitive and language outcomes in children up to 24 months. Repeated measurements on participation in public programs and early-life outcomes for a large sample of children and mothers in Memphis, Shelby county, TN were collected. Within this dataset the exposure-outcome relationship is directly observable over time. The specific structure of the data enables us to address endogeneity concerns via the use of first-difference estimators combined with a rich set of time-varying covariates.We provide empirical evidence to conclude that WIC participation is associated with a positive and statistically significant impact of 0.32 and 0.16 standard deviations in receptive communication and expressive communication scores. Overall, participation in these safety net programs is shown to have meaningfully contributed to improving developmental outcomes among children up to two years of age. Presented empirical evidence might be critical at a time when funding for WIC, SNAP or other safety-net programs is in peril.

Severe Housing-Cost Burden and Low-Income Young Children's Exposure to Adverse Experiences: A Cross-Sectional Survey of WIC Participants in Los Angeles County.

Substantial literature has documented adverse childhood experiences' (ACEs) link with poor health in childhood and adulthood. Despite many American low-income families spending more than a third of their income toward housing costs, little research has been published about a link between severe housing-cost burden and ACEs. The objective of this study was to examine the association of severe housing-cost burden to the ACEs to which young, low-income children are exposed. Participants were 2-5-year-olds who participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Los Angeles County. We used data from the 2017 Los Angeles County WIC Survey, a survey of a random sample of all WIC participants living in Los Angeles County. Separate multiple logistic regression analyses were conducted to examine the association of severe housing-cost burden (very difficult to pay for housing) with the ACEs of financial hardship (household food insecurity, extreme poverty, parent's unemployment and underemployment), household dysfunction (parent's poor mental well-being and parent's separation), housing insecurity (doubled up and residential instability), and parent's experience with homelessness. Sixteen percent of children lived in severe housing-cost burdened households and 14% experienced at least 4 ACEs. After adjusting for sociodemographic characteristics and social support, severe housing-cost burden was associated with an increase in the odds of each of the ACEs. While further research is needed, findings highlight the need for policymakers to provide resources and support for housing-cost burdened children. Also, service providers should identify ACEs among housing cost-burdened children.

Potential overfeeding among formula fed Special Supplemental Nutrition Program for Women, Infants and Children participants and associated factors.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides enough formula to meet the known nutritional needs of infants up to 6 months of age whose mothers report not breastfeeding, but many mothers report WIC providing insufficient formula, indicating potential overfeeding. To estimate the prevalence of potential overfeeding among formula-feeding WIC participants and identify associated factors. Potential overfeeding was identified among participants of the longitudinal Infant and Toddler Feeding Practices Study-2 (ITFPS-2) receiving the fully formula-feeding WIC infant package at 1 month of age (n = 1235, weighted n = 197 079). Associations of potential overfeeding with caloric intake, weight and participant characteristics were assessed. Potential overfeeding was identified among 37.41% (95% CI = 33.57-41.25%) of fully formula-feeding infants. Potentially overfed infants were 0.18 kg heavier (P-value = .01), consumed 26 more calories daily (P-value = .004) and were more likely Non-Hispanic White or English-speaking Hispanic (P-value = .007) and highly active at 5 months of age (P-value = .01). Mothers of potentially overfed infants were less likely to agree that breastfeeding is easier than bottle feeding, only mothers can feed breastfed infants, turning away from the bottle indicates satiation, and crying always indicates hunger (P-values .04, .002, .04 and .04 respectively), and more likely to report WIC provides insufficient formula early (1-5 months, P-value <.0001) and late (6-13 months, P-value = .007) in infancy. Potential overfeeding occurs in 37% of fully formula-feeding infant WIC-participants <6 months old. Mothers of these infants may benefit from additional education about the formula needs of their infants and how to recognize infant satiation cues.

The new child food package is associated with reduced obesity risk among formula fed infants participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Los Angeles County, California, 2003\u20132016

BackgroundThe Special Supplemental Nutrition Program for Women, Infants and Children (WIC) changed the food packages provided to its participants in 2009, to better align them with the Dietary Guidelines for Americans. Previous research found that the 2009 WIC food package change was associated with reduced obesity risk, particularly among breastfed infants but also among those who were never breastfed. The objective of this study was to determine if the new child food package introduced in 2009, including more produce and whole grains for 1–4-year old children, was associated with healthier growth trajectories and reduced obesity risk at age 4 years among children who were exclusively formula fed during infancy.MethodsAdministrative data on WIC-participating children in Los Angeles County, 2003–2016, were used (N = 74,871), including repeated measures of weight and length (or height); child’s age, gender, and race/ethnicity; maternal education and language; and family poverty. Gender-stratified spline mixed models were used to examine weight-for-height z-score (WHZ) growth trajectories from 0 to 4 years and Poisson regression models were used to assess obesity (BMI-for-age > 95th percentile) at age 4. The main independent variable was duration of receipt (dose) of the new child package, categorized as 0, > 0 to < 1, 1 to < 2, 2 to < 3, 3 to < 4, and 4 years.ResultsWHZ growth trajectories were similar for children across new child package dose groups. Boys and girls who were fully formula fed during infancy but received the new child food package for 4 years had a 7% (RR = 0.93; 95%CI = 0.89–0.98) and a 6% (RR = 0.94; 95%CI = 0.89–0.99) lower obesity risk, respectively, compared to children who received the new child food package for 0 years. There were no differences in obesity risk for children receiving < 4 years of the new child package vs. 0 years.ConclusionsProviding healthy foods during childhood to children who were exclusively formula fed as infants was associated with modest improvements in obesity outcomes. While breastfeeding promotion should still be prioritized among WIC participants, providing healthy foods during childhood may provide health benefits to formula fed children, who comprise a sizeable proportion of children served by WIC.

Food Purchasing Behaviors of WIC Participants: What Non-WIC Eligible Foods Items Are Being Purchased.

To describe items purchased during a shopping trip by families enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Cross-sectional, quantitative, observational study. Grocery stores in the Newark, Delaware area. A convenience sample of mothers (n = 35) were recruited from a local WIC Clinic waiting room. The number of items categorized into 12 food groups, (baby food, beverages, dairy, fats/oils, fruit, vegetables, grains, protein, preprepared, seasonings, sweets, and other) extracted from grocery receipts. Means and frequencies were used to analyze continuous and categorical data, respectively, for receipt data and demographics. The most common foods purchased not included as part of the WIC food package included protein (1.0 [standard deviation, SD 3.0]), preprepared foods (0.9 [SD 2.0]), and other foods (1.0 [SD 1.9]). The most frequent foods purchased included as part of the WIC food package included fruit (2.3 [SD 1.5]), grains (1.7 [SD 1.6]), and dairy (1.5 [SD 0.8]). Further investigation of foods purchased that were not part of the WIC food package is warranted, as understanding food purchases particularly among low-income mothers may inform nutrition education practices.

Association of WIC Participation and Growth and Developmental Outcomes in High-Risk Infants.

The objective of this study was to describe the association of enrollment in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the Supplemental Nutrition Assistance Program (SNAP), and infant growth and neurodevelopmental outcomes. Z scores and Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) and Vineland Adaptive/Behavior Scale-II (VABS-II) scores represented primary outcomes. We conducted bivariate analyses and linear regression. Children who were enrolled in WIC or WIC/SNAP had weight z scores U (95% confidence interval [CI]) that were 1.32 (0.42-2.21) or 1.19 (0.16-2.23) units higher. Enrollment in WIC or WIC/SNAP was associated with a higher score (95% CI) of 11.7 U (1.2-22.2 U) or 11.5 (0.1-22.9) for Bayley-III cognitive score and 10.1 U (1.9-19.1 U) or 10.3 (0.9-19.7) for the VABS-II composite score. These findings support increased advocacy for participation in WIC or WIC/SNAP for families with high-risk infants.

Effects of Maternal Homelessness, Supplemental Nutrition Programs, and Prenatal PM2.5 on Birthweight.

Few studies examined the impact of maternal socioeconomic status and of its combined effects with environmental exposures on birthweight. Our goal was to examine the impact of maternal homelessness (mothers ever homeless or who lived in shelters during pregnancy) and participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) during pregnancy in conjunction with air pollution exposure on birthweight in the Boston-based Children’s HealthWatch cohort from 2007 through 2015 (n = 3366). Birthweight was obtained from electronic health records. Information on maternal homelessness and WIC participation during pregnancy were provided via a questionnaire. Prenatal fine particulate matter (PM2.5) exposures, estimated at the subject’s residential address, were calculated for each trimester. We fit linear regression models adjusting for maternal and child characteristics, seasonality, and block-group-level median household income and examined the interactions between PM2.5 and each covariate. Prenatal maternal homelessness was associated with reduced birthweight (−55.7 g, 95% CI: −97.8 g, −13.7 g), while participating in WIC was marginally associated with increased birthweight (36.1 g, 95% CI: −7.3 g, 79.4 g). Only average PM2.5 during the second trimester was marginally associated with reduced birthweight (−8.5 g, 95% CI: −19.3, 2.3) for a 1 µg/m3 increase in PM2.5. The association of PM2.5 during the second trimester with reduced birthweight was stronger among non-Hispanic Black mothers and trended toward significance among immigrants and single mothers. Our study emphasizes the independent and synergistic effects of social and environmental stressors on birthweight, particularly the potentially protective effect of participating in WIC for vulnerable populations.

Effects of maternal homelessness, Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and prenatal PM2.5 exposure on birthweight in a multi-ethnic and low-income urban community

TPS 741: Adverse birth outcomes 2, Exhibition Hall, Ground floor, August 28, 2019, 3:00 PM - 4:30 PM Background/Aim: Low birthweight is a leading cause of neonatal morbidity and mortality. Maternal factors, socioeconomic status, and ambient air pollution have been independently associated with low birthweight, but no studies have examined homelessness and Special Supplemental Nutrition Program for Women, Infants and Children (WIC) with air pollution. Our aim was to examine the associations and interactions between prenatal maternal homelessness, participation in WIC, and exposure to fine particulate matter (PM2.5) on birthweight in an urban cohort of low-income children in Boston. Methods: We included children recruited to the Boston-based Children’s HealthWatch cohort from 2007 through 2015 (n=3,619). Birthweight was obtained from electronic medical records. Information on maternal homelessness and WIC participation during pregnancy were provided via questionnaire. Prenatal PM2.5 exposures were calculated for each trimester. We built linear regression models adjusting for maternal age, body mass index (BMI), race/ethnicity, nativity, education, smoking, insurance, marital status, child gestational age and sex, seasonality, and median household income. We also examined interactions between PM2.5 and each of the covariates. Results: Being homeless during pregnancy was significantly associated with reduced birthweight (-45.5g, 95% CI: -85.4g, -5.5g), while participating in WIC was associated with increased birthweight (22.7g, 95% CI: -18.4g, 63.7g). Average PM2.5 during the second trimester was the most significant risk factor for reduced birthweight (-14g, 95% CI: -24.3, -3.6) compared to other PM2.5 exposure windows. The effect of PM2.5 during the second trimester on lower birthweight was stronger among immigrants, Hispanic or non-Hispanic Black mothers, single mothers, and mothers with lower educational attainment. Conclusions: Our study emphasizes the individual and synergistic roles of social and environmental stressors on birthweight, particularly the potential protective effect of participating in WIC. These findings can be used to direct interventions and policy to maximize a healthy start in life.

Maternal Anxiety Symptoms and Mother-toddler Diet Quality Among WIC Participants (OR03-08-19)

ObjectivesTo evaluate the longitudinal association between maternal anxiety and diet quality among low-income mothers and toddlers. MethodsLongitudinal study of data collected from 267 mother-toddler dyads in an obesity prevention trial recruited from Maryland Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and pediatric clinics between 2007 and 2010. Dyads were assessed at 3-time points (baseline, 6-, 12-mo follow-up). Healthy Eating Index (HEI-2015, dependent variable) estimated maternal and toddler diet quality obtained from a 24-h dietary recall (one day). Anxiety (time-variant independent variable) was assessed via State-Trait Anxiety Inventory. Mixed models assessed the longitudinal associations between maternal anxiety and maternal and toddler diet quality, separately, controlling for sociodemographic, maternal body mass index (BMI), and household food security. No significant effect by intervention group was found, thus intervention was treated as a covariate. An interaction term assessed the variation between anxiety and diet quality by time. ResultsMothers mean age was 27.1 (SD ± 6.2) years and anxiety 1.7 (± 0.6). Toddlers were on average 20.2 months old (± 5.6). Mean HEI at baseline was 47.9 (± 12.1) and 54.1 (± 10.5) for mothers and toddlers, respectively. Maternal anxiety was negatively related to toddler HEI score (β = −2.7, 95% CI: −4.9; −0.5) with no significant variation over time. There was a significant negative variation between maternal anxiety and maternal diet at baseline (β = −3.9, 95% CI: −6.2; −1.6) and 6-mo (β = −3.2, 95% CI: −5.9; −0.5), but not at 12-mo (β = −0.4, 95% CI: −2.9; 2.0). The relationship differed significantly only between baseline and 12-mo (β = 3.5, 95% CI: 0.3; 6.7). ConclusionsFindings suggest that mothers and toddlers exhibited similar dietary patterns, they are of low diet quality, and that diet quality decreased with maternal anxiety. Toddlerhood is often characterized by food neophobia and pickiness, which are common sources of maternal anxiety. Therefore, promoting anxiety-reducing strategies into maternal and toddler care and feeding behaviors guideline may be necessary. Funding SourcesNational Institute of Health (NIH), Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD). Supporting Tables, Images and/or Graphs▪▪▪

Economic evaluation of California prenatal participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) to prevent preterm birth

There is growing evidence that prenatal participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) reduces the risk of adverse birth outcomes. With recent changes in health care, rising health care costs, and increasing rates of prematurity in the U.S., there is urgency to estimate the potential cost savings associated with prenatal WIC participation. A cost-benefit analysis from a societal perspective with a time horizon over the newborn's life course for a hypothetical cohort of 500,000 Californian pregnant women was conducted in 2017. A universal coverage, a status quo (‘business as usual’) and a reference scenario (absence of WIC) were compared. Total societal costs, incremental cost savings, return on investment, number of preterm births prevented, and incremental net monetary benefits were reported. WIC resulted in cost-savings of about $349 million and the prevention of 7575 preterm births and would save more if it were universal. Spending $1 on prenatal WIC resulted in mean savings of $2.48 (range: $1.24 to $6.83). Decreasing prenatal WIC enrollment by 10% would incur additional costs (i.e. loss) of about $45.3 million to treat the resulting 981 preterm babies. In contrast, a 10% increase in prenatal WIC enrollment would prevent 141 preterm births and achieve additional cost-savings of $6.5 million. The findings confirm evaluations from the early 1990s that prenatal WIC participation is cost-saving and cost-effective. Further savings could be achieved if all eligible women were enrolled in WIC. Substantial preterm birth-related costs would result from reductions in WIC participation.

Abstract P212: Higher Rates of Breastfeeding Mediate the Association Between the 2009 Wic Food Package Change and BMI Z-score at Age 4

Background: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a federal nutrition assistance program which provides supplemental food and nutrition services to children 0-5 years and their mothers, living in low-income households. In October of 2009, WIC food packages were changed to be better aligned to the Dietary Guidelines of Americans. Objective: The objective of this study was to evaluate whether observed differences in children’s BMI z-scores (BMIz) at age 4 years between WIC participants enrolled before and after the 2009 policy change could be attributable to changes in the type of infant feeding package they were exposed to. Methods: Our sample is based on children enrolled in WIC in Los Angeles County, CA between 2003 and 2016, from birth to age 5, with infant package issuance data for 11 or more of the first 13 months of life. Infant package exposure was quantified by the number of months receiving the fully breastfeeding infant package (a proxy for exclusive breastfeeding). A mediation analysis was performed in which BMIz at age 4 was the outcome, WIC package (new vs. old) was the exposure, and the number of months receiving the fully breastfeeding infant package was the mediator. Mediation was assessed by a product of coefficients method, and confidence limits for the mediated effect were based on the non-normal distribution of the mediated effect, using the PRODCLIN program in SAS. Models were gender-stratified and adjusted for child race/ethnicity, maternal education and language preference, household poverty status, initial weight status, and whether the child had a sibling in the sample. Results: The sample consisted of 140,204 children. Boys and girls exposed to the new WIC package received the fully breastfeeding infant package for 1.40 and 1.45 months longer than boys and girls exposed to the old WIC package. Among boys, the new WIC package was associated with a 0.12 standard deviation lower BMIz at age 4 (SE 0.01, p &lt;0.0001), whereas the corresponding number for girls was 0.07 (SE 0.01, p&lt;0.0001). Number of months exposed to the fully breastfeeding infant package partially mediated the association between exposure to the new WIC food package (vs. old) and BMIz at age 4, explaining 22.1% of the total effect (95% CI 19.1-25.1) for boys and 34.4% of the total effect (95% CI 29.9-38.9) for girls. Conclusions: Longer exposure to the fully breastfeeding infant package seemed to explain part of the association between BMIz at age 4 and receiving the new (vs. old) WIC food package. The percent of the total effect mediated by months of fully breastfeeding exposure was greater in girls than in boys. Future revisions to the WIC packages that continue to support women to fully breastfeed are likely to have significant effects on childhood obesity.