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Nutrition Policy for Women, Infants, and Children (WIC) Program

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (15 December 2022) | Viewed by 32374

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Dr. Beth Racine

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Texas A&M AgriLife Research, Texas A&M University, El Paso, TX 79927, USA
Interests: food assistance; childhood obesity; food security; breastfeeding; evaluation of nutrition and physical activity policies and programs; healthy food retail; nutrition assistance programs; food sales data

Special Issue Information

Dear Colleagues,

Approximately half of all children born in the United States participate in The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). WIC provides pregnant women, post-partum women, and children up to the age of 6 with nutritious foods, in order to promote health and growth in these individuals.

There are a number of policies imbedded within the WIC program that can influence the nutritional status of the participants. These include nutrition policies related to breastfeeding promotion, nutrition education programming, nutrition education delivery, the nutritional value of the approved food items, and food store authorization.

The WIC program is modified periodically by the US Congress. The COVID-19 pandemic made it difficult for WIC participants to utilize WIC services. In response to this problem, the US Congress allowed drastic changes to WIC operations, including a change in the amount of funds WIC participants could use to purchase fruits and vegetables.

There are a number of opportunities to study the influence of WIC nutrition policies (traditional policies and COVID-19 response policies) on the nutritional status, dietary behavior, and health outcomes of the participants.

Dr. Beth Racine
Guest Editor

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Keywords

breastfeeding
infant formula
maternal and child health
iron fortified foods
nutrition education
obesity
anemia
dietary intake
food purchases
WIC authorized stores
nutrition policy
WIC

Published Papers (13 papers)

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Research

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11 pages, 1666 KiB

Open AccessFeature PaperArticle

A Systems Approach to Identify Factors Influencing Participation in Two Tribally-Administered WIC Programs

by Michelle Estradé, Samantha Grace Alarcon Basurto, Abbegayle McCarter, Joel Gittelsohn, Takeru Igusa, Siyao Zhu, Lisa Poirier, Susan Gross, Marla Pardilla, Martha Rojo, Kevin Lombard, Henry Haskie, Veronica Clark, Jacqueline Swartz and Yeeli Mui

Nutrients 2023, 15(5), 1210; https://doi.org/10.3390/nu15051210 - 28 Feb 2023

Cited by 1 | Viewed by 1627

Abstract

Native American populations experience highly disproportionate rates of poor maternal-child health outcomes. The WIC program aims to safeguard health by providing greater access to nutritious foods, but for reasons not well understood, participation in many tribally-administered WIC programs has declined to a greater extent compared to the national average decline in participation over the last decade. This study aims to examine influences on WIC participation from a systems perspective in two tribally-administered WIC programs. In-depth interviews were conducted with WIC-eligible individuals, WIC staff, tribal administrators, and store owners. Interview transcripts underwent qualitative coding, followed by identifying causal relationships between codes and iterative refining of relationships using Kumu. Two community-specific causal loop diagrams (CLDs) were developed and compared. Findings from interviews in the Midwest yielded a total of 22 factors connected through 5 feedback loops, and in the Southwest a total of 26 factors connected through 7 feedback loops, resulting in three overlapping themes: Reservation and Food Store Infrastructure, WIC Staff Interactions and Integration with the Community, and State-level Administration and Bureaucracy. This study demonstrates the value of a systems approach to explore interconnected barriers and facilitators that can inform future strategies and mitigate declines in WIC participation. Full article

(This article belongs to the Special Issue Nutrition Policy for Women, Infants, and Children (WIC) Program)

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10 pages, 241 KiB

Open AccessArticle

An Evaluation of the Implementation of the Women, Infants, and Children (WIC) Farmers Market Nutrition Program at Four Chicago WIC Sites

by Jacquelyn Jacobs, Jennifer Holcomb, Helen Margellos-Anast, Linda Martinez and Cindy San Miguel

Nutrients 2023, 15(5), 1122; https://doi.org/10.3390/nu15051122 - 23 Feb 2023

Viewed by 1770

Abstract

The Farmers Market Nutrition Program (FMNP), a program of the U.S. Department of Agriculture (USDA), provides coupons to individuals/families enrolled in the Special Supplemental Nutrition program for Women, Infants, and Children (WIC) to purchase fresh produce from approved farmers markets. While some studies suggest FMNP may improve nutrition for WIC clients, there is limited research on program implementation in practice. A mixed-methods equitable evaluation framework was utilized to: (1) better understand the FMNP in practice at four WIC clinics on Chicago’s west and southwest sides that serve predominately Black and Latinx families; (2) detail facilitators and barriers to participation in the FMNP; and (3) describe the potential impact on nutrition. In this manuscript, we present qualitative findings from Aim 1. We identified six steps for how the FMNP has been implemented in our study setting and opportunities to improve the implementation of the program. Findings suggest that well-defined and consistent guidelines on: (1) how to seek state approval for farmers markets; and (2) coupon distribution and redemption, are necessary to optimize utilization. Future research should explore the impact of newly offered electronic coupons on redemption rates and fresh fruit and vegetable purchasing behaviors. Full article

(This article belongs to the Special Issue Nutrition Policy for Women, Infants, and Children (WIC) Program)

14 pages, 281 KiB

Open AccessArticle

Forming the Perception of WIC Infant Feeding Recommendations: A Qualitative Study

by Emily Fisher, Kathryn Wouk, Priyanka Patel, Chuanyi Tang and Qi Zhang

Nutrients 2023, 15(3), 527; https://doi.org/10.3390/nu15030527 - 19 Jan 2023

Viewed by 2224

Abstract

Nearly half of newborns in the United States are enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Promoting breastfeeding is a programmatic priority, although formula vouchers are provided for those who do not exclusively breastfeed. Previous literature suggests that participant perception of WIC’s breastfeeding recommendations is a significant factor predicting breastfeeding initiation, duration, and exclusivity outcomes. However, little is known about how participants’ perceptions of WIC’s breastfeeding recommendations are formed. To address this knowledge gap, we conducted a qualitative pilot study in Nevada, interviewing 10 postpartum WIC mothers and 12 WIC staff who had interacted with participants regarding infant feeding. Results showed participants and staff reported various perceptions of what WIC recommends, the factors that contribute to these perceptions, and how these perceptions affect breastfeeding practices. Respondents also described that WIC has a negative legacy as the “free formula program,” and that environmental factors, such as the recent formula recall, have had an impact on participants’ infant feeding practices. More effective public campaigns and programmatic strategies are needed to target participants’ prenatal self-efficacy and to communicate the availability of skilled lactation support in the early postpartum period to improve participants’ perceptions of WIC’s position on breastfeeding. Full article

(This article belongs to the Special Issue Nutrition Policy for Women, Infants, and Children (WIC) Program)

13 pages, 285 KiB

Open AccessArticle

Pandemic-Era WIC Participation in Wilmington, Delaware: Participants’ Experiences and Challenges

by McKenna M. Halverson and Allison Karpyn

Nutrients 2023, 15(3), 520; https://doi.org/10.3390/nu15030520 - 19 Jan 2023

Cited by 2 | Viewed by 2481

Abstract

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants faced unprecedented challenges during the coronavirus disease 2019 (COVID-19) pandemic including financial concerns, a national infant formula shortage, and rising food costs. To mitigate these challenges, the United States Department of Agriculture implemented WIC program waivers and flexibilities aiming to simplify program operations (e.g., remote appointments and food package substitutions). However, little is known about WIC participants’ perceptions of these changes and their impact on in-store benefit redemption. As such, this study aimed to characterize how pandemic-related events impacted Delaware WIC participants’ shopping experiences and program perceptions. The authors conducted semi-structured interviews with 51 WIC participants in Wilmington, Delaware. Survey measures included demographic questions, the Hunger Vital Sign, and open-ended questions regarding WIC program participation experiences during the pandemic. Data were analyzed using a hybrid inductive and deductive coding approach. The results demonstrate that WIC participants benefitted from the pandemic program’s flexibilities. However, they continued to experience burdensome shopping trips as well as concerns about their ability to feed their families due to infant formula shortages and inflation. These findings indicate the importance of extending existing WIC flexibilities and providing continued support for both participants and WIC-authorized retailors. Full article

(This article belongs to the Special Issue Nutrition Policy for Women, Infants, and Children (WIC) Program)

11 pages, 612 KiB

Open AccessArticle

Evaluation of WIC Online Ordering during the COVID-19 Pandemic: Evidence from an Oklahoma Grocery Store Chain

by Qi Zhang, Junzhou Zhang, Kayoung Park and Chuanyi Tang

Nutrients 2023, 15(3), 478; https://doi.org/10.3390/nu15030478 - 17 Jan 2023

Cited by 1 | Viewed by 1925

Abstract

The COVID-19 pandemic is worsening the disparities in food access in the United States. As consumers have been increasingly using grocery online ordering services to limit their exposure to the COVID-19 virus, participants of federal nutrition assistance programs lack the online benefit redemption option. With the support of the US Department of Agriculture (USDA), retailers are pilot-testing online food benefit ordering in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). By combining the Oklahoma WIC administrative data, the online ordering data from a grocery store chain in Oklahoma, and the COVID-19 data in Oklahoma, this study examines how WIC participants responded to the online food benefit ordering option and how their adoption of online ordering was associated with the COVID-19 incidence. Results show that from July to December 2020, 15,171 WIC households redeemed WIC benefits at an Oklahoma chain store, but only 819 of them adopted online ordering. They together completed 102,227 online orders, which accounted for 2.7% of the store visits and 2.6% of the monetary value of WIC redemptions at these stores. There was no significant relationship between WIC online ordering adoption and COVID-19 incidence in Oklahoma. Full article

(This article belongs to the Special Issue Nutrition Policy for Women, Infants, and Children (WIC) Program)

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11 pages, 569 KiB

Open AccessArticle

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

by Alana M. Chaney, Lorrene D. Ritchie, Shannon E. Whaley, Marisa M. Tsai, Hallie R. Randel-Schreiber, Catherine E. Yepez, Susan Sabatier, Adrian Young, Martha Meza and Lauren E. Au

Nutrients 2023, 15(2), 447; https://doi.org/10.3390/nu15020447 - 14 Jan 2023

Cited by 3 | Viewed by 2098

Abstract

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. Full article

(This article belongs to the Special Issue Nutrition Policy for Women, Infants, and Children (WIC) Program)

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16 pages, 1259 KiB

Open AccessArticle

Feasibility, Acceptability, and Initial Efficacy of a Digital Intervention to Improve Consumption of Foods Received within a National Nutrition Assistance Program

by Melissa C. Kay, Nour M. Hammad, Tracy Truong, Sharon J. Herring and Gary G. Bennett

Nutrients 2023, 15(2), 438; https://doi.org/10.3390/nu15020438 - 14 Jan 2023

Cited by 3 | Viewed by 2241

Abstract

Many mothers are vulnerable to poor diet quality, particularly those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrient-rich foods through its benefits packages, but many WIC participants are not redeeming them. We assessed the feasibility and acceptability of a digital intervention to support redemption and consumption of WIC-approved foods to ultimately improve diet quality. We enrolled 54 maternal–child dyads receiving WIC benefits to receive three to four weekly text messages for 12 weeks focused on behavioral goals to improve consumption of WIC-approved foods. We assessed engagement with weekly tracking messages and satisfaction and collected 24 h dietary recalls to assess preliminary efficacy on dietary intake. Participants were mostly non-Hispanic white (63%) and working (63%), and responded to 7.4 (standard deviation: 4.6) of the 12 weekly messages. Half (n = 27) were high engagers (responded to 80% or more of weekly messages), with 28% (n = 15) responding to all messages. Most felt the feedback (94%) and tips (87%) were helpful and would recommend the program (91%). More were consuming leafy green vegetables compared to baseline (p = 0.01). Mothers of children enrolled in WIC found a text messaging intervention focused on consumption of WIC-approved foods enjoyable and helpful. Full article

(This article belongs to the Special Issue Nutrition Policy for Women, Infants, and Children (WIC) Program)

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14 pages, 323 KiB

Open AccessArticle

A Quasi-Experimental Assessment of the Effect of the 2009 WIC Food Package Revisions on Breastfeeding Outcomes

by Kelly Kogan, Priyanka Anand, Sina Gallo and Alison Evans Cuellar

Nutrients 2023, 15(2), 414; https://doi.org/10.3390/nu15020414 - 13 Jan 2023

Viewed by 1610

Abstract

Breastfeeding rates among infants participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are consistently lower than those of WIC nonparticipants. The 2009 WIC food package revisions were intended to incentivize breastfeeding among the WIC population. To examine the effectiveness of this policy change, we estimated an intent-to-treat regression-adjusted difference-in-difference model with propensity score weighting, an approach that allowed us to control for both secular trends in breastfeeding and selection bias. We used novel data from the Feeding Infants and Toddlers Survey from 2008 and 2016. We defined our treatment group as infants eligible for WIC based on household income and our control group as infants in households with incomes just above the WIC eligibility threshold. The breastfeeding outcomes we analyzed were whether the infants were ever breastfed, breastfed through 6 months, and breastfed exclusively through 6 months. We observed significant increases in infants that were ever breastfed in both the treatment group (10 percentage points; p < 0.01) and the control group (15 percentage points; p < 0.05); however, we did not find evidence that the difference between the two groups was statistically significant, suggesting that the 2009 revisions may not have had an effect on any of these breastfeeding outcomes. Full article

(This article belongs to the Special Issue Nutrition Policy for Women, Infants, and Children (WIC) Program)

11 pages, 463 KiB

Open AccessArticle

Caregivers’ Perceived Impact of WIC’s Temporary Cash-Value Benefit (CVB) Increases on Fruit and Vegetable Purchasing, Consumption, and Access in Massachusetts

by Cristina Gago, Rachel Colchamiro, Kelley May, Eric B. Rimm and Erica L. Kenney

Nutrients 2022, 14(23), 4947; https://doi.org/10.3390/nu14234947 - 22 Nov 2022

Cited by 4 | Viewed by 2479

Abstract

Responding to the COVID-19 pandemic, the American Rescue Plan (2021) allowed state agencies of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) the option of temporarily increasing the Cash-Value Benefit (CVB) for fruit and vegetable (FV) purchases. To examine the impact of this enhancement on WIC caregiver experience, the MA WIC State Office invited 4600 randomly selected MA WIC caregivers to complete an online survey (February–March 2022). Eligible adults had at least one child, had been enrolled at least a year, and were aware of the increase. Of those who opened the screener (n = 545), 58.9% completed it (n = 321). We calculated the frequencies of reporting increased FV outcomes and tested whether responses differed by race/ethnicity, market access, and food security. Most caregivers perceived the CVB increase to benefit FV purchasing (amount and quality, 71.0% and 55.5%), FV consumption (offered to children and personally consumed, 70.1% and 63.2%), and satisfaction with the WIC food package (37.1% reported improved satisfaction, pre- vs. post-increase). Probability of reporting improved outcomes was not found to differ by race/ethnicity, market access, or food security. CVB increases may pose important implications for dietary behaviors and satisfaction with WIC. Policymakers should consider making this increase permanent. Full article

(This article belongs to the Special Issue Nutrition Policy for Women, Infants, and Children (WIC) Program)

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13 pages, 259 KiB

Open AccessArticle

WIC Participants’ Perceptions of the Cash-Value Benefit Increase during the COVID-19 Pandemic

by McKenna M. Halverson and Allison Karpyn

Nutrients 2022, 14(17), 3509; https://doi.org/10.3390/nu14173509 - 26 Aug 2022

Cited by 9 | Viewed by 2837

Abstract

Recent changes to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Cash-Value Benefit (CVB), which provides participants with money to spend on fruits and vegetables, have the potential to reduce disparities in healthy food access and food insecurity that were exacerbated by the COVID-19 pandemic. However, few studies have examined how the changes to the CVB allotment that occurred during the pandemic influenced WIC participants’ perceptions of the benefit or their fruit and vegetable purchasing and consumption. To address this gap, we conducted semi-structured interviews with 51 WIC participants in Wilmington, Delaware. Survey measures included demographic questions, the Hunger Vital Sign food insecurity screener, and open-ended questions regarding perceptions of the CVB increase and its influence on participants’ fruit and vegetable purchasing and consumption. Data were analyzed using a hybrid inductive and deductive coding approach. The results demonstrate that higher CVB allotments increased WIC participants’ purchasing and consumption of fruits and vegetables, increased the frequency of their shopping occasions, and enhanced their dietary variety. Our findings also suggest that WIC participants highly value the increased CVB. Consequently, maintaining the increased CVB allotment could improve the nutritional outcomes of low-income mothers, infants, and children participating in WIC. Full article

(This article belongs to the Special Issue Nutrition Policy for Women, Infants, and Children (WIC) Program)

Review

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17 pages, 428 KiB

Open AccessReview

Factors That Influence Children’s Exits from the Special Supplemental Nutrition Program for Women, Infants, and Children: A Systematic Review

by Karina R. Lora, Leslie Hodges, Cayley Ryan, Michele Ver Ploeg and Joanne Guthrie

Nutrients 2023, 15(3), 766; https://doi.org/10.3390/nu15030766 - 02 Feb 2023

Viewed by 2370

Abstract

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides supplemental foods and nutritional education to low-income women and children up to the age of five. Despite evidence that WIC improves diet and nutrition and the nationwide availability of this program, many participants exit WIC before they are no longer eligible for benefits. To date no study has systematically reviewed factors that influence participants’ exits from WIC. The study systematically reviewed the relevant literature to identify factors related to discontinuing participation in WIC before children reach the age of five and 1503 citations were reviewed, 19 articles were read for full text review and eight studies met inclusion criteria. Participants’ higher socioeconomic status, attitudes and behaviors around breastfeeding, having shorter prenatal participation in WIC, administrative barriers, confusion regarding program eligibility, feelings of stigma and embarrassment at the store checkout lines, personal and family challenges, dissatisfaction with insufficient fruit and vegetables benefits and living in suburban areas or in the Southern US were salient factors that influenced WIC exits. These findings will be of interest to policymakers and stakeholders as they consider ways to increase participation and retention through program modernization and innovations. Full article

(This article belongs to the Special Issue Nutrition Policy for Women, Infants, and Children (WIC) Program)

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16 pages, 309 KiB

Open AccessReview

Protecting Low-Income Consumers in the Era of Digital Grocery Shopping: Implications for WIC Online Ordering

by Qi Zhang, Priyanka Patel and Caitlin M. Lowery

Nutrients 2023, 15(2), 390; https://doi.org/10.3390/nu15020390 - 12 Jan 2023

Cited by 2 | Viewed by 2494

Abstract

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is now expected to allow participants to redeem their food benefits online, i.e., via online ordering, rather than only in-store. However, it is unclear how this new benefit redemption model may impact participants’ welfare since vendors may have an asymmetric information advantage compared with WIC customers. The WIC online ordering environment may also change the landscape for WIC vendors, which will eventually affect WIC participants. To protect WIC consumers’ rights in the new online ordering model, policymakers need an appropriate legal and regulatory framework. This narrative review provides that framework by reviewing the literature, legal treatises, and reports on enforceable laws and regulations in the U.S. relevant to digital marketing. The results identify key issues that may arise with adopting WIC online ordering. This paper suggests “privacy, transparency, and fairness” as guiding principles to protect the welfare of WIC participants in WIC online ordering. Full article

(This article belongs to the Special Issue Nutrition Policy for Women, Infants, and Children (WIC) Program)

Other

Jump to: Research, Review

27 pages, 778 KiB

Open AccessSystematic Review

A Systematic Review of Marketing Practices Used in Online Grocery Shopping: Implications for WIC Online Ordering

by Leslie Hodges, Caitlin M. Lowery, Priyanka Patel, Joleen McInnis and Qi Zhang

Nutrients 2023, 15(2), 446; https://doi.org/10.3390/nu15020446 - 14 Jan 2023

Viewed by 4125

Abstract

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) plans to allow participants to redeem their food package benefits online, i.e., online ordering. As grocery shopping online has become more common, companies have developed strategies to market food products to customers using online (or mobile) grocery shopping platforms. There is a significant knowledge gap in how these strategies may influence WIC participants who choose to shop for WIC foods online. This review examines the relevant literature to (1) identify food marketing strategies used in online grocery shopping platforms, (2) understand how these strategies influence consumer behavior and consumer diet, and (3) consider the implications for WIC participants. A total of 1862 references were identified from a systematic database search, of which 83 were included for full-text screening and 18 were included for data extraction and evidence synthesis. The included studies provide policymakers and other stakeholders involved in developing WIC online order processes with valuable information about the factors that shape healthy food choices in the online food retail environment. Findings indicate that some marketing interventions, such as nutrition labeling and food swaps, may encourage healthier food choices in the online environment and could potentially be tailored to reinforce WIC messaging about a healthy diet. Full article

(This article belongs to the Special Issue Nutrition Policy for Women, Infants, and Children (WIC) Program)

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