Women, Infants And Children Research Articles

Empowering Global Health Systems to Protect, Promote and Support Optimal Breastfeeding.

Breastfeeding is a critical public health strategy for optimal child development and maternal health across the life course. The 2021 Global Burden of Diseases, Injuries and Risk Factors Study reveals that, despite reductions in mortality and disability-adjusted life years (DALYs) attributed to suboptimal breastfeeding practices-namely, non-exclusive breastfeeding during the first 6 months or early discontinuation within the first 2 years-low- and middle-income countries (LMICs) continue to bear a staggering 50-fold higher burden compared to high-income nations. This inequity signals a pressing global health priority. Hence, we propose to address these challenges by first, expanding the Baby-Friendly Hospital Initiative (BFHI) reach through community-driven efforts such as the Baby-Friendly Community Initiative (BFCI) to enhance breastfeeding support in both clinical and community settings; second, embedding breastfeeding counselling within national health and social protection programmes to fill in gaps in culturally competent care, drawing on large scale breastfeeding peer counselling programme experiences like the one being implemented by the US Supplemental Nutrition Program for Women, Infants and Children (WIC); third, improving maternity leave policies and workplace accommodations for breastfeeding women and fourth, stringent regulation of exploitative commercial milk formula (CMF) marketing to combat misinformation and reduce health inequities. Governments must implement strong, evidence-driven policies-such as strict monitoring and regulation of product labelling and digital media marketing-to establish safeguards against the powerful influence of the CMF industry. Collectively, these strategies will enhance breastfeeding outcomes, reduce health disparities and drive progress across countries towards meeting the UN Sustainable Development Goals.

Social Determinants of Preterm Birth amongst Non-Hispanic Black Individuals.

Non-Hispanic Black individuals are disproportionately affected by preterm birth (PTB), a major driver of the racial disparity in infant mortality in the United States. The objective of this study is to identify indicators of social determinants of health (SDoH) that contribute to preterm birth amongst non-Hispanic Black individuals. Population-based retrospective case-control study of U.S. birth records (2012-2016). Factors potentially associated with PTB and considered indicators of SDoH were compared between singleton live births of non-Hispanic Black individuals delivering preterm (<37 weeks of gestation) and term (≥37 weeks of gestation). Logistic regression quantified the association between SDoH and PTB such as insurance, education, and prenatal care visits and reported as odds ratios (ORs; 95% confidence interval, CI). Of 2,763,235 live births to Black individuals, 340,480 (12%) occurred <37 weeks of gestation. Factors most strongly associated with PTB (p < 0.001), presented as OR (95% CI), included no prenatal care 3.0 (95% CI: 2.9-3.1) or insufficient prenatal care 2.7 (95% CI: 2.7-2.8), smoking during pregnancy 1.4 (95% CI: 1.43-1.47), unmarried 1.18 (95% CI: 1.17-1.19), lack of high school diploma 1.1 (95% CI: 1.12-1.40), lack of father of baby listed on birth certificate 1.22 (1.21-1.23), and Black paternal race 1.10 (1.08-1.12). Receipt of WIC (women, infants, and children) during the pregnancy had a protective effect on PTB risk in Black individuals, OR 0.83 (0.83-0.84). Pregnancies in Black individuals who are ≥35 years old, smoke tobacco, utilize Medicaid insurance, have less than a high school education, are unmarried, have little to no prenatal care, Black paternal race, and lack of father of baby listed on birth record had increased risk of PTB. Understanding the lived experience of Black pregnant people and these selected indicators of SDoH that contribute to the risk of PTB may inform development of interventions to address the racial disparity in PTB in the United States. · Preterm birth disproportionately affects Black individuals.. · SDoH are contributors to preterm birth.. · This study investigates social determinant influences on preterm birth among Black individuals..

Standardizing Patient and Provider Education to Address Breastfeeding Inequity

Introduction: Breastfeeding provides many infant, maternal and societal benefits. Breastfeeding reduces maternal and infant risks for a number of diseases, encourages maternal-infant bonding, is more environmentally friendly and lowers healthcare costs. Based on the most recent Women, Infants and Children (WIC) program data, the obstetrical patient population served by the Department of Ob/Gyn at Southern Illinois University School of Medicine (SIU-SM) was significantly lacking in breastfeeding initiation rates (~16% in 2020) when compared to the Healthy People 2020 goal for ever breastfed infants of 81.9%. We aimed to assess areas of patient care that could be improved upon when counseling our patients about breastfeeding. Purpose: Our primary goal was to evaluate current breastfeeding initiation rates and whether these improved after implementation of the standardized breastfeeding education materials that were to be provided to both healthcare professionals and patients. Methods: In partnership with the Illinois Public Health Institute (IPHI), all patients who received prenatal care at SIU-SM, Department of Ob/Gyn were offered standardized brochures that supplemented our prenatal counseling regarding breastfeeding. Nurses, residents, and other healthcare providers were also provided information on counseling patients. Breastfeeding rates were assessed in our prenatal population prior to and after implementing standardized breastfeeding educational materials (IRB# 22-133) and compared with Chi-square tests. Results: Patient demographics were as follows: 55.9% White, 31.8% Black/African American; 95.7% non-Hispanic; 93.4% utilized Medicaid services for insurance; the mean age was 26.8 ± 6.1 years of age. Baseline breastfeeding initiation rates of ever breastfed infants were significantly higher in the interventional group compared to the control group (75% vs.60%; p=0.002). Breastfeeding rates at the first postpartum visit were also significantly increased after the intervention (65% vs. 43%; p=0.008). A significant increase in the percentage of breast pumps provided in the prenatal clinic was also noted (28.4% vs. 0%; p&lt;0.0001). Conclusions: Breastfeeding rates in our patient population were significantly lower than the Healthy People’s 2020 goal. Raising awareness through this initiative and improving our educational tools via the partnership with IPHI improved breastfeeding initiation rates. As obstetrical providers, we are optimistic about this data, but acknowledge additional interventions may be necessary to improve health equity across our disadvantaged patient population. Future directions include looking at data for ever breastfed infants vs. continuation of breastfeeding through the American Academy of Pediatrics recommended 6 months of exclusive breastfeeding. We would also like to explore how partner involvement and occupation type might impact breastfeeding initiation rates.

The neighborhood food environment modifies the association between infant feeding and childhood obesity

BackgroundThe Special Supplemental Nutrition Program for Women, Infants and Children (WIC) issues infant formula to infants who are not fully breastfed, and prior research found elevated obesity risk among children receiving lactose-reduced infant formula with corn syrup solids (CSSF) issued by WIC. This study was conducted to evaluate associations between a broader set of specialty infant formulas issued by WIC and child obesity risk, whether neighborhood context (e.g. neighborhood food environment) modifies associations, and whether racial/ethnic disparities in obesity are partly explained by infant formula exposure and neighborhood context.MethodsWIC administrative data, collected from 2013–2020 on issued amount (categorical: fully formula fed, mostly formula fed, mostly breastfed, fully breastfed) and type of infant formula (standard cow’s milk formula, and three specialty formulas: any CSSF, any soy-based formula, and any cow's milk-based formula with added rice starch) and obesity at ages 2–4 years (defined as a Body Mass Index z-score ≥ 95th percentile according to World Health Organization growth standard) were used to construct a cohort (n = 59,132). Associations of infant formula exposures and race/ethnicity with obesity risk were assessed in Poisson regression models, and modification of infant feeding associations with obesity by neighborhood context was assessed with interaction terms.ResultsAny infant formula exposure was associated with significantly higher obesity risk relative to fully breastfeeding. Receipt of a CSSF was associated with 5% higher obesity risk relative to the standard and other specialty infant formulas (risk ratio 1.05, 95% confidence interval 1.02, 1.08) independent of breastfeeding duration and receipt of other specialty infant formulas. The association between CSSF and obesity risk was stronger in neighborhoods with healthier food environments (10% higher risk) compared to less healthy food environments (null). Racial/ethnic disparities in obesity risk were robust to adjustment for infant formula exposure and neighborhood environment.ConclusionsAmong specialty infant formulas issued by WIC, only CSSFs were associated with elevated obesity risk, and this association was stronger in healthier food environments. Future research is needed to isolate the mechanism underlying this association.

Enrollment and use of a peer counselor mHealth texting program to support breastfeeding in low-income people: A pilot study in the District of Columbia.

To describe the characteristics of postpartum people who did and did not enroll in a breastfeeding peer-counselor mobile health (mHealth) texting program as well as the issues raised through 2-way texting with peer counselors. Pilot intervention study involving two Special Supplemental Nutrition Programs for Women Infants and Children (WIC) sites in the District of Columbia over 1 year. WIC recipients. Descriptive statistics, comparison of recipients who enrolled or not and qualitative content analysis of text messages. A breastfeeding peer counselor texting program entitled BfedDC involving routine 1-way programmed messages and 2-way texting capacity for recipients to engage with peer counselors. Among our sample (n=1642), nearly 90% initiated breastfeeding. A total of 18.5% (n=304) enrolled in the BfedDC texting program, of whom 19.7% (n=60) utilized the 2-way texting feature. Message content covered seven content themes and included inquiries about expressing human milk, breastfeeding difficulties, breastfeeding frequency and duration, appointments and more. Although enrollment was relatively low in BfedDC, benefits included 1-way supportive texts for breastfeeding and the ability to 2-way text with peer counselors. This program aligns with the Surgeon General's Call to Action to Support Breastfeeding and promotes breastfeeding equity in low-income people.

The Economic Impacts of COVID-19 on Autistic Children and Their Families.

We used data from the National Survey of Children's Health to (1) examine differences in economic hardship and safety net program use after the implementation of federal relief efforts, and (2) assess whether the COVID-19 pandemic exacerbated autism-based disparities in hardship and program use. We examined five dimensions of economic hardship (poverty, food insecurity, medical hardship, medical costs, and foregone work) and four safety net programs (cash assistance, Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and free or reduced-cost meals). First, we calculated adjusted prevalence and odds ratios to compare pre-COVID (2018-2019) and during COVID (2021) outcomes by autism status. Next, we calculated the adjusted odds of each outcome among autistic children compared to those of children with and without other special healthcare needs at both time points. COVID-19 exacerbated autism-based disparities in food insecurity, SNAP, and public health insurance, but alleviated inequities in medical hardship, foregone work, and cash assistance. Autistic children did not experience declines in food insecurity or increases in SNAP like other children; medical hardship and foregone work decreased more for autistic children; and the magnitude of autism-based differences in public coverage significantly increased during the pandemic. Federal relief efforts likely improved economic outcomes of children; however, these effects varied according to type of hardship and by disability group. Efforts to promote economic well-being among autistic populations should be tailored to the financial challenges most salient to low-income autistic children, like food insecurity.

Sleep Duration Is Associated with Household Food Insecurity and Sugar-Sweetened Beverage Intake Among Women, Infants and Children Participating Children Ages 0-5.

To determine associations between child and household characteristics and sleep duration among low-income children in Los Angeles County. Cross-sectional study. Survey data collected in 2017 and 2020 in Los Angeles County, California. Special Supplemental Nutrition Program for Women, Infants and Children (WIC) households with children ages 4-60months. Sleep duration for children 4-60months old (less than recommended (LTR), recommended range, more than recommended (MTR)), household food insecurity (HFI), sociodemographics, and daily servings of sugar-sweetened beverages (SSB). Multinomial logistic regression, stratified by child age, was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for associations between household/child characteristics and LTR or MTR sleep compared to recommended duration among WIC participating children 4-60months old. The final sample included 3512 children ages 4-23months and 6035 children ages 24-60months. In the study population, 32% (3-5years old) to 44% (4-11months) of children under 5 did not meet the recommended hours of sleep per night. HFI was associated with higher odds of LTR (OR 1.27, CI 1.12-1.45) and MTR (OR 1.46, CI 1.15-1.87) sleep among 24-60month-old children. Each additional daily SSB serving was associated with higher odds of LTR sleep (4-23months: OR 1.10, CI 1.02-1.19; 24-59months: OR 1.12, CI 1.08-1.17). HFI and SSB intake are associated with not getting the recommended amount of sleep among low-income WIC participating children. Nutrition assistance program participants may benefit from receiving information about recommended sleep duration for young children and how to establish sleep routines to optimize sleep duration.

Predictors of early life residential mobility in urban and rural Pennsylvania children with acute lymphoblastic leukemia and implications for environmental exposure assessment.

Residential mobility can introduce exposure misclassification in pediatric epidemiology studies using birth address only. We examined whether residential mobility varies by sociodemographic factors and urbanicity/rurality among children with cancer. Our study included 400 children born in Pennsylvania during 2002-2015 and diagnosed with leukemia at ages 2-7 years. Addresses were obtained from state registries at birth and diagnosis. We considered three aspects of mobility between birth and diagnosis: whether a child moved, whether a mover changed census tract, and distance moved. We evaluated predictors of these aspects in urban- and rural-born children using chi-square, t-tests, and regression analyses. Overall, 58% of children moved between birth and diagnosis; suburban/rural-born children were more likely to move than urban-born children (67% versus 57%). The mean distance moved was 16.7 km in suburban/rural-born and 14.8 km in urban-born movers. In urban-born children, moving between birth and diagnosis was associated with race, education, participation in the Nutrition Program for Women, Infants and Children (WIC), and census tract-level income (all χ2 p < 0.01). Urban-born movers tended to be born in a census tract with a higher Social Vulnerability Index than non-movers (t-test p < 0.01). No factors were statistically significantly associated with any of the residential mobility metrics in suburban/rural-born children, although the sample size was small. In this study of a vulnerable population of children with cancer, we found that rural-born children were more likely to move than urban-born children, however, the frequency of movers changing census tracts was equivalent. Mobility in urban-born children, but not rural-born, was associated with several social factors, although the sample size for rural-born children was small. Mobility could be an important source of misclassification depending on the spatial heterogeneity and resolution of the exposure data and whether the social factors are related to exposures or health outcomes. Our results highlight the importance of considering differences in mobility between urban and rural populations in spatial research.

"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.

Early introduction of complementaryfoods/drinks and milk feeding type in the Special Supplemental Nutrition Program for Women, Infantsand Children (WIC).

Infants younger than 4 months are not ready for complementary foods/drinks (any solid or liquid other than breast milk or infant formula). Almost half of USinfants participate in the Special Supplemental Nutrition Program for Women, Infantsand Children (WIC), which provides nutrition education and support to low-income families. We describe the prevalence of early introduction (<4 months) of complementary foods/drinks and examine the association of milk feeding type (fully breastfed, partially breastfedor fully formula fed) with early introduction of complementary foods/drinks. We used data from 3310 families in the longitudinal WIC Infant and Toddler Feeding Practices Study-2.We described the prevalence of early introduction of complementary foods/drinks and modeled the association of milk feeding type at Month 1 with early introduction of complementary foods/drinks using multi-variable logistic regression. Thirty-eight percent of infants were introduced early to complementary foods/drinks (<4 months). In adjusted models, infants who were fully formula fed or partially breastfed at Month 1 were 75% and 57%, respectively, more likely to be introduced early to complementary foods/drinks compared with fully breastfed infants. Almost twoin fiveinfants were given complementary foods/drinks early. Formula feeding at Month 1 was associated with higher odds of early introduction of complementary foods/drinks. There are opportunities to support families participating in WIC to prevent early introduction of complementary foods/drinks and promote child health.

Breastfeeding moderates childhood obesity risk associated with prenatal exposure to excessive gestational weight gain.

Gaining excessive gestational weight may increase obesity risk in the offspring, while breastfeeding lowers that risk. Using data from the Special Supplemental Nutrition Programme for Women, Infants and Children (WIC) in Southern California, we examined the associations between gestational weight gain (GWG), breastfeeding during infancy and childhood obesity at 2-4 years, and determined whether breastfeeding moderated the association between GWG and childhood obesity. GWG was based on weight measurements collected during the first trimester and within a month before delivery. GWG values were standardized by gestational age (GWG z-scores), per maternal prepregnancy body mass index (BMI) and categorized into tertiles. Fully breastfeeding duration was determined by WIC infant package data indicating the amount of infant formula received monthly. Children's length (or height) and weight measurements were used to calculate BMI-for-age z-scores and identify obesity (z-score ≥ 95th percentile). Multivariable linear and modified Poisson regression analyses were conducted. Fully breastfeeding moderated the association between GWG z-scores tertile and obesity in the offspring. Each additional month of fully breastfeeding was associated with 3%-5% obesity risk reduction for each age group and GWG z-scores tertile, except at age 4 years for children whose mothers had low GWG z-scores (tertile 1). Shorter fully breastfeeding duration was associated with greater obesity risk among children of mothers with high GWG z-scores (tertile 3), but not for those whose mothers had low GWG z-scores. Longer fully breastfeeding duration may provide greater protection against obesity among children at higher risk due to intrauterine exposure to high gestational weight gain.

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.

WIC Staff Views and Perceptions on the Relationship between Food Insecurity and Perinatal Depression.

Food insecurity and perinatal depression are significant public health concerns for perinatal services, however descriptive research examining their association is limited. The purpose of this study was to examine the views and perspectives of staff from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program on the relationship between food insecurity and perinatal depression among their WIC clients. Four, semi-structured focus groups with WIC staff (n = 24) were conducted across four diverse nonmetropolitan public health districts in Midwestern counties in the United States. WIC staff included social workers, nurses, nutritionists and ancillary staff. All interviews were audio-recorded, transcribed, and verified, and data were organized using NVivo 11.4.2. Thematic networking analysis was employed as the qualitative analysis to identify organizing themes. Three themes emerged including (1) depression experienced by clients; (2) food insecurity experienced by clients; and (3) barriers preventing clients from accessing services for themselves and their children. Research on food insecurity and perinatal depression is sparse, with fewer studies having included health staff of low-income women. Our findings suggest that the association between food insecurity and mental health needs among WIC clients is a significant public health issue to which policy change and interventions are required.

How Does Consistency of Food and Nutrition Support Effect Daily Food Consumption among Children Living in Poverty? Recession-Era Implications.

Underutilization of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and the Supplemental Nutrition Assistance (SNAP) food safety net programs may compromise child nutritional benefits for families with limited incomes. Using a sample of children surveyed before (2003−2006) and after the Great Recession (2007−2009), we examine whether consistent access to WIC and SNAP during times of increased economic stress moderated the association between poverty level (i.e., income-needs ratio [INR]) and fruits and vegetables (FV) or foods high in saturated fats and added sugars (SFAS). Fragile Families and Child Wellbeing Study income-eligible mothers/children (≤185% of poverty) with available FV and SFAS data at the 5- (2003−2006) and 9-year (2007−2010) waves (n = 733) were included. Main effects of INR and interaction effects of consistency of WIC, SNAP, and dual WIC and SNAP support from birth through age 5 were examined. INR was associated with decreased FV consumption frequency from age 5 to 9, conditional upon consistency of dual WIC/SNAP enrollment. FV declined when there was low consistency (<1 year) of dual support. FV consumption was stable across INR when combined WIC/SNAP support lasted at least 2 years. Results can inform strategies for optimizing the nutritional impact of WIC and SNAP by focusing on those most at risk for underutilization of multiple benefits.

How Does Nutritional Knowledge of Postpartum Women Participants of the Special Supplemental Nutrition Program for Women Infants and Children (WIC) Program Relate to BMI?

Upon completion, participants will be able to understand the relationship between nutrition knowledge of WIC-participants and Body Mass Index (BMI) in women postpartum in a nationally represented secondary data set.

Changes in frequency of park/playground utilization among children aged 4–59 months in Los Angeles County, California 2008–2020

Child physical activity and play are critical for healthy development, and parks/playgrounds are important public spaces that provide physical activity/play opportunities. This study was conducted to assess changes in park/playground utilization by Special Supplemental Nutrition Program for Women, Infants and Children (WIC)-participating children from 2008 to 2020, and whether the COVID-19 pandemic was associated with lower park/playground utilization and racial/ethnic disparities in park/playground utilization. Cross-sectional data from the 2008–2020 triennial Los Angeles County WIC Survey (n = 21,886) were used, and analyses stratified by child age (4–23 months, 24–59 months). Odds ratios (OR) and 95 % confidence intervals (CI) for the relationship between year and park/playground utilization frequency were determined from multinomial logistic regression, and racial/ethnic disparities were assessed by interacting year with race/ethnicity. Among children 24–59 months of age, park/playground utilization increased compared to never from 2011 to 2017 compared to 2008 (Every day, 2011–2017: OR [95 % CI]: 2.69 [1.93, 3.75], 4.71 [3.23, 6.86], 10.20 [6.91, 15.06]; 3–6 days/week 2011–2017: 1.54 [1.13, 2.10], 3.11 [2.18, 4.45], 3.94 [2.71, 5.72]; 1–2 days/week, 2014–2017; 1.53 [1.08, 2.18], 1.63 [1.13, 2.37]). Associations reversed in 2020, with 36 % lower odds of every day (OR [95 % CI]: 0.64 [0.48, 0.85]), 85 % lower odds of 3–6 days/week (0.15 [0.11, 0.20]) and 89 % lower odds of 1–2 days/week (0.11 [0.09, 0.15]) park/playground utilization compared to never than in 2008. Park/playground utilization frequency increased from 2008 to 2017, but progress reversed during the COVID-19 pandemic in 2020. Results for children ages 4–23 months were similar. Future public health restrictions to public recreation facilities should consider realistic limitations to potential benefits and the potential for unintended consequences before implementation.

Identification of positive parenting practices among parents of young children living in low-income and racially, ethnically, and culturally diverse households

Using the positive deviance approach, the purpose of this study was to identify parent feeding practices that might be protective against early childhood obesity among children with lower weight status (BMI percentile ≥5th-<85th) relative to higher weight status (BMI percentile ≥85th). Qualitative interviews were conducted with 71 parents of children aged 2–5 years old (48% girls) enrolled in the Minnesota Special Supplemental Nutrition Program for Women Infants and Children (WIC). Children were identified as having lower weight status (defined as ‘positive deviants’) (n = 36) or ‘higher weight status’ (n = 35), and were African American [n = 22], Hispanic [n = 23], or Hmong [n = 26]). Parents were asked about approaches to child feeding and health- and weight-related practices. Findings indicated that relative to caregivers of children with higher weight status, parents of children identified as positive deviant were more likely to report having a consistent routine for providing meals, using a guided choices approach, serving small portions of food during mealtimes, and trusting their child hunger and satiety cues. Moreover, parents of children identified as positive deviant were more likely to promote healthful eating and physical activity engagement and implement clear rules and limits for screen time than parents of children with higher weight status. Results suggest specific parent feeding behaviors and health-related practices that may influence child weight status among children living in low-income and racialized households. The findings of this study also provide research evidence and support the tenets of the Satter Division of Responsibility in Feeding framework. Parenting practices and strategies among parents of children identified as positive deviant are expected to be feasible and should be explored and communicated in future interventions to support age- and sex-recommended weight and health-related outcomes among young children to promote health equity.

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.