Women, Infants And Children Participants Research Articles

Screening for iron deficiency.

1. Ann Chen Wu, MD* 2. Leann Lesperance, MD, PhD* 3. Henry Bernstein, DO*† 1. *Pediatric Health Associates, Hunnewell Ground Children’s Hospital 2. †Associate Professor of Pediatrics, Harvard Medical School, Boston, MA After completing this article, readers should be able to: 1. Determine the most common cause of iron deficiency in the United States. 2. Describe the pathogenesis of iron deficiency. 3. List populations at high risk for iron deficiency. 4. Outline the common signs and symptoms of iron deficiency. 5. Specify the American Academy of Pediatrics recommendations for screening for iron deficiency. In the March and April issues of Pediatrics in Review, we published a two-part article on managing anemia in a pediatric office practice. This article expands on the various tests for iron deficiency, including some relatively new ones. These articles should be read as complementary.—RJH Iron deficiency is the most common nutritional deficiency in the world, responsible for a staggering amount of ill health, lost productivity, and premature death. Although its prevalence in the United States has declined since the late 1960s, iron deficiency with or without anemia still is seen frequently in infants, toddlers, adolescent females, and women of childbearing age. In fact, iron deficiency anemia remains the most common hematologic disease of infants and children. Anemia is defined as a low hemoglobin (Hgb) concentration or red blood cell (RBC) mass compared with age-specific norms. Anemia may be caused by decreased RBC production, increased RBC destruction, or blood loss. Based on the size of the RBC, hematologists categorize anemia as macrocytic, normocytic, or microcytic. Iron is found in different compartments within the body. Total body iron (measured by ferritin), transport iron (measured by transferrin saturation), serum iron, and other hematologic and biochemical markers are used to describe the degrees of iron deficiency. Iron depletion refers to the earliest stage of diminishing iron stores in the setting of insufficient iron supply. Iron deficiency (without anemia) develops as these iron stores are depleted further and begin to impair Hgb synthesis. Finally, iron deficiency anemia results …

Client Satisfaction with the Nutrition Education Component of the California WIC Program

Past evaluation research has documented improved nutritional outcomes resulting from participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). However, these evaluations have not examined the program from the clients' perspective, nor have they examined the independent effect of the nutrition education component. The purpose of this study was to quantitatively and qualitatively examine client satisfaction with the nutrition education component of the California WIC program. The methodology consisted of two phases. During phase I of the study (the quantitative component), participants completed Client Satisfaction Surveys immediately following attendance of one nutrition class. During phase II (the qualitative component), four focus groups were conducted. All subjects were participants in the California WIC program. Client Satisfaction Surveys were completed by 2138 participants, and the focus groups included 29 participants. Results from both phases of the study indicated that client satisfaction with the nutrition education component of the California WIC program was high. Between 80% and 95% of participants responded positively to five satisfaction questions, and focus group participants unanimously agreed that the nutrition education was an essential component of the program. Hispanic participants were more likely than non-Hispanic Caucasians, Asians, or African Americans to respond positively to three of the five satisfaction questions. For two of the questions, the frequency of positive responses increased as age increased and decreased as education level increased. A small segment of clients reported some dissatisfaction by responding negatively to one or more of the satisfaction questions (4% to 20% of respondents). Some suggestions for improvement were made by survey respondents. Identification of some WIC participants who are not completely satisfied with the nutrition education that they have received, paired with differences in satisfaction across demographic variables, suggests the need for a personalized approach to WIC nutrition education.

Intake of Food Guide Pyramid Servings: A Comparison of WIC Children in Wisconsin and Children from 1994 CSFII

The purpose of this study was to determine if foods provided by the Special Supplemental Food Program for Women, Infants and Children (WIC) affect selected indicators of diet quality among WIC participants. Recall data from 179 Wisconsin WIC children ages 2 to 5 years were converted to Food Guide Pyramid servings and compared to the 1994 Continuing Survey of Food Intakes of Individuals (CSFII) Food Guide Pyramid servings data. Three comparison groups were identified from CSFII for children ages 2 to 5 years in the mid-west region: WIC participants and non-WIC participants above and below 185% of the federal poverty level. Means and standard errors for the Wisconsin data were computed with SPSS for Windows; WesVarPC was used to obtain weighted means and standard errors for CSFII data. The number of Food Guide Pyramid servings were compared among groups using a z-test. In general, WIC participants consumed more of some dairy products and vegetables and less added sugar than the children not participating in WIC, suggesting a significant contribution of WIC supplemental foods and nutrition education to the dietary quality of its participants. These findings should be of particular interest to practitioners involved in program planning for WIC and persons who allocate funding to the WIC program.

Indicators of Poorer Nutritional Status Associated with Homelessness in a Sample of Children Participating in the Special Supplemental Food Program for Women, Infants and Children in Wisconsin

Currently homeless, previously homeless and never homeless children were identified through screening at 15 Special Supplemental Food Program for Women, Infants and Children (WIC) sites in southeastern Wisconsin. Two hundred twenty one currently or previously homeless children were identified and age and sex matched to never homeless WIC participants. Height, weight, hemoglobin and socioeconomic and health history data were recorded from WIC records. The currently homeless were significantly shorter than the never homeless children. Regression analysis indicated that current homelessness, large family size and presence of chronic health problems were negatively associated with height for age. Higher birth weight, Hispanic ethnicity and prior WIC participation were positively associated with height for age. Currently homeless children under the age of 2 had significantly lower hemoglobin levels when compared with both never homeless and previously homeless children. In this study, homeless children exhibited poorer nutritional status than either their never homeless or previously homeless counterparts.

Trends in pregnancy weight gain within and outside ranges recommended by the Institute of Medicine in a WIC population.

To examine the proportion of women with a pregnancy weight gain below, within, and above ranges recommended by the Institute of Medicine from 1990 to 1996. Our study population included women attending Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics in five states who delivered a liveborn singleton infant at term (N = 120,531). Pregnancy weight gain was self-reported at the postpartum visit. Only 34% of women gained weight within recommended ranges and there was little change in this proportion from 1990 to 1996. The proportion of women gaining less than their recommended weight decreased from 23.4% to 22.0%, and the proportion gaining more than recommended increased from 41.5% to 43.7% during the study period. Stratified analyses revealed similar trends within all race-ethnicity, age, parity, trimester of WIC initiation, and trimester of prenatal care initiation strata and among women in low, average, and high prepregnancy body mass index categories. There was no change in the weight gain distribution among obese women. Absolute and relative increases in the proportion of women gaining more weight than recommended were greatest among women who were underweight, Asian or Native American, less than 20 years of age, multiparous, and who initiated WIC and prenatal care in the third trimester. Pregnancy weight gain increased among this population of WIC participants from 1990 to 1996.

The Supplemental Nutrition Program for Women, Infants and Children (WIC) and Cooperative Extension Partner with In-Home Breastfeeding Support

LEARNING OUTCOME: To describe how in-home support by trained paraprofessionals increases breastfeeding rates and duration among low-income WIC participants. Low breastfeeding incidence and duration among low-income women are of concern. In-home support was provided by Extension paraprofessionals who were trained as breastfeeding counselors. Breastfeeding duration was tracked for babies born to WIC mothers during a three year period. The intervention resulted in significant increases in numbers and percent still breastfeeding at two weeks and eight weeks postpartum. In thirteen counties with the lowest breastfeeding rates, WIC Coordinators and Extension Home Economists collaborated to hire paraprofessionals to be trained as Breastfeeding Peer Counselors by the state WIC Lactation Consultant. Wearing pagers, the counselors are available to provide support to low-income WIC participants prenatally, postpartum hi the hospital, and after discharge when breastfeeding concerns typically surface. The state WIC Lactation Consultant provides technical support to breastfeeding counselors by phone and site visits. Among the 2,250+ participants seen since 1993, both breastfeeding initiation and duration rates are more than double that of statewide WIC rates. The greatest effect is seen at two weeks, when only 16% of those receiving peer support quit breastfeeding, compared with 58% of those without support. Fifty-four percent are still breastfeeding at two months postpartum compared with 18% of women in the general WIC population. One unexpected finding was that African American mothers breastfed the longest compared to all racial groups. Participants cite the home visit as the most helpful aspect of the program.

Attitudes and Behaviors Related to Fruits and Vegetables among Low-income Women in the WIC Program

This article describes formative research conducted as part of a study aimed at increasing fruit and vegetable consumption among low-income women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Focus group discussions and central location intercept interviews were conducted with WIC participants to answer questions such as (1) What are their food shopping, preparation, and eating habits? (2) What perceptions do they have about fruits and vegetables? (3) What barriers do they face to increased consumption of fruits and vegetables? and (4) What motivations and messages might be effective in promoting increased consumption? Results indicated that these women, while generally responsible for food shopping and preparation, did not cook extensively.They reported many positive perceptions of fruits and vegetables, but also identified barriers to increasing consumption, including lack of availability, time and effort to prepare, and preference for other foods. Several implications for nutrition interventions were suggested. First, a key motivation for these women was being a good role model for their children, suggesting a persuasive appeal to use in interventions. Second, review of the women's current eating behaviors led to an identification of five specific behaviors that had the most potential for increasing overall consumption. Finally, the findings suggested ways in which nutrition interventions could address each of the barriers identified.

WIC AND SOMATIC AND PSYCHOLOGICAL DEVELOPMENT OF PRE SCHOOL CHILDREN: THE NATIONAL WIC EVALUATION

We related age of onset of benefits from the Special Supplemental Food Program for Women, Infants and Children (WIC) to height, weight, Quetelet's index (wt/length2), head circumference, mid-arm circumference and triceps and subscapular skinfold thickness among 2142 representative poor children under five from 59 areas nationwide and behavior and cognition among 486 four and five year olds. We used Schaeffer's Infant Behavior Inventory, the Peabody Picture Vocabulary test and the forward and backward digit memory tests from the McCarthy Scale of Infant Development. We controlled for age and sex, and then for a wide range of additional social, demographic and somatic covariates.Highly significant improvements in children's diets by WIC were not reflected by advantages in linear growth. WIC participants were significantly shorter than controls (0.8 cm). Early WIC recruits had no parallel decrease in head circumference. We conclude that a) the WIC program is targeted to appropriate (short and deprived) children; b) identifying adequate controls for WIC recipients may now be impossible, with the wide diffusion of the program; c) it is unlikely that WIC benefits had any effect on linear growth; d) early WIC benefits had some beneficial effect on later head, and presumably, brain growth. Prenatal WIC recipients had significantly better performance on the PPVT, and later recruits had significantly better (backward) digit memory. There were no significant differences in child behavior. The implications of these observations will be discussed.

The recent trend in milk feeding among WIC infants.

The type of milk fed infants from birth to six months of age was ascertained by quarterly surveys of a national sample of births. WIC (Women, Infants and Children Program) participants were identified from this sample, and trend data indicate that an increased percentage of WIC mothers ae choosing to breastfeed their infants. Infant formula use has declined in the early months of life, but increased at the expense of cow's milk toward the middle of the first year.