Longer Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participation Duration Is Associated with Higher Diet Quality at Age 5 Years

Abstract

Background The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides supplemental healthy foods and nutrition education to children under age 5 years in low-income households. Objective To identify characteristics associated with duration of WIC participation and assess how participation duration relates to household food insecurity (HFI), child diet quality, and child weight status at age 60 months. Methods This analysis of the WIC Infant and Toddler Feeding Practices Study-2, a prospective cohort of WIC-participating children enrolled in 2013, includes children with complete baseline-60 month data (n, 836). Outcomes assessed with WIC-participation duration in multivariable regression were HFI (US Department of Agriculture 6-item Household Food Security Screener), child diet quality on a given day (Healthy Eating Index (HEI)-2015) and obesity (Centers for Disease Control and Prevention BMI-for-age ≥95th percentile). Results Factors associated with longer WIC participation included male sex, lower household income, reported diet changes in response to WIC nutrition education, household SNAP participation, English-speaking Hispanic, Spanish-speaking Hispanic and Non-Hispanic Other maternal race/ethnicity-language preference, an ever-married mother, lower maternal education, higher maternal age, earlier enrollment during pregnancy, and reporting a subsequent pregnancy. Longer WIC participation was associated with lower HFI odds (OR, 0.69, 95%CI, 0.51-0.95), higher total HEI-2015 (β, 0.73, 95%CI, 0.20-1.25), and higher obesity odds (OR, 1.20, 95%CI, 1.05-1.37) in multivariable adjusted regression models. Conclusions Longer WIC participation was associated with reduced HFI and higher diet quality, and unexpectedly with higher obesity odds at 60 months. Further research is needed to confirm and understand mechanisms underlying unexpected associations identified with longer WIC participation (e.g. male sex, obesity). Groups with shorter participation durations may benefit from targeted WIC retention efforts to maximize nutrition security.

Lower redemption of monthly Special Supplemental Nutrition Program for Women, Infants and Children benefits associated with higher risk of program discontinuation

“…Race/ethnicitylanguage preference is associated with rates of recertification and duration of WIC participation (14) and with different perception of and preferences regarding the contents of WIC food packages (21) . The similarity of the association between redemption and failure to recertify across race/ ethnicity-language preference strata in the present study suggests that differences in redemption (non-Hispanic Black participants redeeming a smaller percent of WIC food benefits, Spanish-speaking Hispanic participants redeeming a higher percent of WIC food benefits) may contribute to race/ethnicity patterns in participation (14) . Further research is needed to understand factors contributing to observed differences in the distribution of redemption by race/ethnicity-language preference (22)(23)(24) , which may include availability of culturally appropriate substitutions within the WIC food packages (21,25) and structural barriers to WIC benefit redemption including access to WIC-participating vendors with desired WIC foods (26)(27)(28)(29) , and whether individual-and vendor-level interventions to increase redemption can reduce disparities in WIC retention.…”

“…These prior results suggest that families of older children may identify lower value for the specific contents of child WIC food packages, leading to higher rates of failure to recertify at all levels of food benefit redemption. Finally, a weaker association between redemption and failure to recertify among older children may be due to greater relative value of other program components, including WIC nutrition education, among families of children who remain on the program past age 2 years (14,30) . WIC food packages support the purchase of select healthy foods and beverages among participating households (6) .…”

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

“…Due to evidence of associations between child and parent characteristics with child diet, household income, and participation in WIC and SNAP, covariates included several maternal and child control variables [ 72 , 85 , 86 , 87 , 88 ]. Child sex and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic) were included.…”

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

“…Previous research has shown that WIC improves diet and nutrition. Longer WIC participation has been associated with higher diet quality among children, measured by total Healthy Eating Index (HEI) scores at age 2 [ 4 ] and at age 5 [ 5 ]. Additionally, older infants in the program are more likely to eat vegetables, and children in the program were more likely to drink non-fat or low-fat milk compared to their low-income non-participant counterparts [ 6 ].…”

“…Finally, self-selection into WIC is a barrier to understanding the impact of WIC on mothers and their children, since those who exit the program differ systematically from those who remain enrolled in ways that may be linked to diet and health outcomes. To date, many studies have attempted to account for selection bias in analyses of WIC program effects by including socio-demographic characteristics, which differ between the participant and non-participant groups and may contribute to differences in outcomes of interest, as controls or covariates in multivariate regressions [ 5 , 11 , 12 ]. From a methodological standpoint, this comprehensive account of the characteristics of those who stay in the program and those who exit lays the groundwork for better empirical identification of WIC’s impacts on participants.…”