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Venkatesh KK, Huang X, Cameron NA, Petito LC, Garner J, Headings A, Hanks AS, Grobman WA, Khan SS. Special Supplemental Nutrition Program for Women, Infants, and Children Enrollment and Adverse Pregnancy Outcomes Among Nulliparous Individuals. Obstet Gynecol 2024; 144:223-232. [PMID: 38935972 PMCID: PMC11257805 DOI: 10.1097/aog.0000000000005660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/18/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE To evaluate the relationship between changes in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) enrollment during pregnancy from 2016 to 2019 and rates of adverse pregnancy outcomes in U.S. counties in 2019. METHODS We conducted a serial, cross-sectional ecologic study at the county level using National Center for Health Statistics natality data from 2016 to 2019 of nulliparous individuals eligible for WIC. The exposure was the change in county-level WIC enrollment from 2016 to 2019 (increase [more than 0%] vs no change or decrease [0% or less]). Outcomes were adverse pregnancy outcomes assessed in 2019 and included maternal outcomes (ie, gestational diabetes mellitus [GDM], hypertensive disorders of pregnancy, cesarean delivery, intensive care unit [ICU] admission, and transfusion) and neonatal outcomes (ie, large for gestational age [LGA], small for gestational age [SGA], preterm birth, and neonatal intensive care unit [NICU] admission). RESULTS Among 1,945,914 deliveries from 3,120 U.S. counties, the age-standardized rate of WIC enrollment decreased from 73.1 (95% CI, 73.0-73.2) per 100 live births in 2016 to 66.1 (95% CI, 66.0-66.2) per 100 live births in 2019, for a mean annual percent change decrease of 3.2% (95% CI, -3.7% to -2.9%) per year. Compared with individuals in counties in which WIC enrollment decreased or did not change, individuals living in counties in which WIC enrollment increased had lower rates of maternal adverse pregnancy outcomes, including GDM (adjusted odds ratio [aOR] 0.71, 95% CI, 0.57-0.89), ICU admission (aOR 0.47, 95% CI, 0.34-0.65), and transfusion (aOR 0.68, 95% CI, 0.53-0.88), and neonatal adverse pregnancy outcomes, including preterm birth (aOR 0.71, 95% CI, 0.56-0.90) and NICU admission (aOR 0.77, 95% CI, 0.60-0.97), but not cesarean delivery, hypertensive disorders of pregnancy, or LGA or SGA birth. CONCLUSION Increasing WIC enrollment during pregnancy at the county level was associated with a lower risk of adverse pregnancy outcomes. In an era when WIC enrollment has decreased and food and nutrition insecurity has increased, efforts are needed to increase WIC enrollment among eligible individuals in pregnancy.
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Affiliation(s)
- Kartik K. Venkatesh
- The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (Columbus, OH)
| | - Xiaoning Huang
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine (Chicago, IL)
| | - Natalie A. Cameron
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics (Chicago, IL)
| | - Lucia C. Petito
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine (Chicago, IL)
| | - Jennifer Garner
- The Ohio State University School of Health and Rehabilitation Sciences (Columbus, OH)
- The Ohio State University John Glenn College of Public Affairs (Columbus, OH)
| | | | - Andrew S. Hanks
- The Ohio State University, College of Education and Human Ecology, Department of Human Sciences (Columbus, OH)
| | - William A. Grobman
- The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (Columbus, OH)
| | - Sadiya S. Khan
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine (Chicago, IL)
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Cardiology (Chicago, IL)
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Benson J, DeVries M, McLaurin-Jiang S, Garner CD. Experiences accessing nutritious foods and perceptions of nutritional support needs among pregnant and post-partum mothers with low income in the United States. MATERNAL & CHILD NUTRITION 2024:e13660. [PMID: 38812121 DOI: 10.1111/mcn.13660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 04/05/2024] [Accepted: 04/25/2024] [Indexed: 05/31/2024]
Abstract
Access to nutritious foods, a social determinant of health, contributes to disparities in maternal and infant health outcomes such as mental health, breastfeeding intensity and cardiometabolic risk. This study explored perceived nutrition access and intake among pregnant or post-partum women eligible for Medicaid. Qualitative, semistructured interviews were conducted with 18 women who were either currently pregnant (n = 4) or up to 12 months post-partum (n = 14) in 2021-2022. Mothers spoke English (n = 11) or Spanish (n = 7) and lived in the Texas Panhandle. Interviews were audio-recorded, transcribed, translated (Spanish to English) and verified. Two or more researchers coded each interview until consensus was reached using thematic analysis with ATLAS.ti software. The study revealed five drivers for nutrition access. (1) Social factors influenced nutrition; those with less support expressed limited ability to eat healthfully. (2) The Women, Infants and Children program was perceived as a helpful resource for some, while others faced challenges obtaining it. (3) Stress was bidirectionally related to unhealthy food choices, with food sometimes used as a coping mechanism. (4) Mothers prioritized their babies and others and had limited ability and time to prepare healthy meals. (5) Most participants felt they received inadequate nutrition guidance from their healthcare providers. Participants provided positive responses to a proposed nutritious home-delivered meal intervention. Low-income women may experience nutritional challenges specific to this life stage. Interventions that reduce stress and burden of household tasks (e.g. cooking) and improve education and access to nutritious foods may improve mothers' ability to consume nutritious foods.
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Affiliation(s)
- Jessie Benson
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Matthew DeVries
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
- Phoenix Children's Pediatric Residency Program Alliance, Phoenix, Arizona, USA
| | - Skye McLaurin-Jiang
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Christine D Garner
- InfantRisk Center, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Amarillo, Texas, United States
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Sanchez S, Zuelch M, Funderburk K. Reimagining the Role of the Registered Dietitian Nutritionist in Food Pantry Sites and Settings. J Acad Nutr Diet 2024:S2212-2672(24)00247-8. [PMID: 38763463 DOI: 10.1016/j.jand.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024]
Affiliation(s)
- Sofia Sanchez
- Alabama Cooperative Extension System, Supplemental Nutrition Assistance Program-Education, Auburn University, Auburn, Alabama.
| | - Michelle Zuelch
- Department of Nutrition, University of California, Davis, California
| | - Katie Funderburk
- Alabama Cooperative Extension System, Supplemental Nutrition Assistance Program-Education, Auburn University, Auburn, Alabama
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Haynes LA, Casareno C, Fatema S, Augustyn M, Eppes E, Mclean M, Hennessey Z. "What Matters to You?": A Participant-Centered Approach to Needs Identification and Referral to Community Resources. Matern Child Health J 2024; 28:905-914. [PMID: 38113011 DOI: 10.1007/s10995-023-03865-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE 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. DESIGN 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. RESULTS 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. CONCLUSIONS AND IMPLICATIONS 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.
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Affiliation(s)
- Lauren A Haynes
- Public Health Solutions, 40 Worth Street, 4th Floor, 10013, New York, NY, USA
| | - Camille Casareno
- Public Health Solutions, 40 Worth Street, 4th Floor, 10013, New York, NY, USA.
| | - Soalihin Fatema
- Public Health Solutions, 40 Worth Street, 4th Floor, 10013, New York, NY, USA
| | | | - Elisabet Eppes
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mireille Mclean
- Public Health Solutions, 40 Worth Street, 4th Floor, 10013, New York, NY, USA
| | - Zachariah Hennessey
- Public Health Solutions, 40 Worth Street, 4th Floor, 10013, New York, NY, USA
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Goldstein B, Steiner A, VanderWielen L, Bennett K, Tomcho M. Integration of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Primary Care Settings. J Community Health 2024; 49:330-337. [PMID: 37945779 DOI: 10.1007/s10900-023-01287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 11/12/2023]
Abstract
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been shown to improve food and economic security, advance health and educational outcomes, and reduce health costs. Despite proven benefits, 54% of those eligible for WIC in Denver County are not enrolled, likely due to documented barriers including stigma, psychological costs, administrative resources, and physical access. In partnership with Denver County WIC, Denver Health's Federally Qualified Health Centers collaborated to create a Specialized WIC Co-Enrollment program to integrate WIC services into pediatric well-child and obstetric visits. WIC Co-Enrollment programmatic data were collected using a REDCap database. Program participant feedback and experiences were gathered through a bilingual survey after visits were completed. Program staff feedback and experiences were collected through third-party interviews and anonymous surveys. Data were analyzed using descriptive statistics and inductive thematic analysis. Between March 2021 and December 2022, 1,870 families were served in Specialized WIC Co-Enrollment appointments, serving a total of 3,347 individuals. Participants noted positive experiences and that receiving WIC services during healthcare visits saved them time, money, childcare, and transportation. Staff and providers noted the program was convenient for families and offered system-level benefits such as improved interprofessional collaboration and clinic efficiency. Specialized WIC Co-Enrollment has been popular among participants, providers, and staff. Integrating WIC services in a health system leverages existing touchpoints with Medicaid beneficiaries and eliminates barriers to accessing the WIC program, which could be beneficial in other communities where assistance program enrollment gaps exist.
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Affiliation(s)
| | | | | | - Kate Bennett
- Denver Health and Hospital Authority, Denver, CO, USA
- Denver WIC, Denver, CO, USA
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McCall A, Strahley AE, Martin-Fernandez KW, Lewis KH, Pack A, Ospino-Sanchez B, Greene I, de la Vega G, Taxter AJ, Eagleton SG, Montez KG. WIC staff and healthcare professional perceptions of an EHR intervention to facilitate referrals to and improve communication and coordination with WIC: A qualitative study. J Clin Transl Sci 2024; 8:e47. [PMID: 38510692 PMCID: PMC10951923 DOI: 10.1017/cts.2024.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Objectives Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has numerous benefits, yet many eligible children remain unenrolled. This qualitative study sought to explore perceptions of a novel electronic health record (EHR) intervention to facilitate referrals to WIC and improve communication/coordination between WIC staff and healthcare professionals. Methods WIC staff in three counties were provided EHR access and recruited to participate. An automated, EHR-embedded WIC participation screening and referral tool was implemented within 8 healthcare clinics; healthcare professionals within these clinics were eligible to participate. The interview guide was developed using the Consolidated Framework for Implementation Research to elicit perceptions of this novel EHR-based intervention. Semi-structured interviews were conducted via telephone. Interviews were recorded, transcribed, coded, and analyzed using thematic analysis. Results Twenty semi-structured interviews were conducted with eight WIC staff, seven pediatricians, four medical assistants, and one registered nurse. Most participants self-identified as female (95%) and White (55%). We identified four primary themes: (1) healthcare professionals had a positive view of WIC but communication and coordination between WIC and healthcare professionals was limited prior to WIC having EHR access; (2) healthcare professionals favored WIC screening using the EHR but workflow challenges existed; (3) EHR connections between WIC and the healthcare system can streamline referrals to and enrollment in WIC; and (4) WIC staff and healthcare professionals recommended that WIC have EHR access. Conclusions A novel EHR-based intervention has potential to facilitate healthcare referrals to WIC and improve communication/coordination between WIC and healthcare systems.
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Affiliation(s)
- Abigail McCall
- Section on General Academic Pediatrics, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ashley E. Strahley
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Kristina H. Lewis
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Angelina Pack
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Beatriz Ospino-Sanchez
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ivy Greene
- Section on General Academic Pediatrics, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Gabriela de la Vega
- Section on General Academic Pediatrics, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Alysha J. Taxter
- Division of Rheumatology, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA
- Division of Clinical Informatics, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Sally G. Eagleton
- Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kimberly G. Montez
- Section on General Academic Pediatrics, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Zinga J, van der Pligt P, McKay FH. Views and preferences of food-insecure pregnant women regarding food insecurity screening and support within routine antenatal care. Health Expect 2024; 27:e13956. [PMID: 39102650 PMCID: PMC10771804 DOI: 10.1111/hex.13956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Food insecurity is a public health concern that has profound impact on physical and mental health, and on social well-being. Pregnancy is a period in which food insecurity is likely to be particularly deleterious, due to the serious impact on both mother and child. Food insecurity is not routinely screened in antenatal healthcare settings, and the preferences of pregnant women regarding food insecurity screening and support are poorly understood. This study aimed to determine the views and preferences of food-insecure pregnant women regarding food insecurity screening and support within antenatal healthcare. METHODS This qualitative descriptive study used face-to-face semi-structured interviews, conducted in February and March 2023, to gain the views of purposively sampled food-insecure, pregnant women in Melbourne, Australia. Food insecurity was evidenced by an affirmative response to at least one of three assessment items in a screening questionnaire. Qualitative content analysis was conducted to summarise the views and preferences of women. RESULTS Nineteen food-insecure pregnant women were interviewed. Three themes were identified: (1) acceptability of being screened for food insecurity, (2) concerns about the consequences of disclosure and (3) preferences regarding food insecurity screening and supportive strategies that could be offered within an antenatal healthcare setting. CONCLUSION Women were accepting of food insecurity screening being conducted within routine healthcare. Women identified potential benefits of routine screening, such as feeling supported by their clinician to have a healthy pregnancy and less pressure to voluntarily ask for food assistance. Women gave suggestions for the implementation of food insecurity screening to optimise their healthcare experience, maintain their dignity and feel able to disclose within a safe and caring environment. These results indicate that food insecurity screening in the antenatal setting is likely to have support from pregnant women and is urgently needed in the interest of promoting optimal nutrition for women and children. PATIENT CONTRIBUTION Pregnant women with lived experience of food insecurity were purposively sampled to obtain their insights regarding screening and support within a pregnancy healthcare setting. Member-checking occurred following data collection, whereby all participants were offered the opportunity to review their interview transcript to ensure trustworthiness of the data.
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Affiliation(s)
- Julia Zinga
- School of Health and Social Development, Institute for Health Transformation, Faculty of HealthDeakin UniversityMelbourneVictoriaAustralia
- Department of Nutrition and DieteticsRoyal Women's HospitalParkvilleVictoriaAustralia
| | - Paige van der Pligt
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN)Deakin UniversityGeelongVictoriaAustralia
- Department of Nutrition and DieteticsWestern HealthFootscrayVictoriaAustralia
| | - Fiona H. McKay
- School of Health and Social Development, Institute for Health Transformation, Faculty of HealthDeakin UniversityMelbourneVictoriaAustralia
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Lundmark EB, Demerath E, McCoy M, Stang J. Race, Ethnicity, and Cultural Identity Modify Postpartum Participation in the Minnesota WIC Program. Matern Child Health J 2024; 28:135-143. [PMID: 37924419 DOI: 10.1007/s10995-023-03818-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE To examine the racial, ethnic and cultural differences in postpartum participation of women who participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) during pregnancy by completing a retrospective analysis of observational data on 35,903 women who enrolled in Minnesota WIC during pregnancy, from April 2018 to March 2020. METHODS Descriptive analyses were completed using chi-square tests of association to show differences in postpartum WIC participation by maternal demographics and health risk codes of the WIC participants. Binary logistic regression and multivariate logistic regression were used to obtain odds ratios to compare the likelihood of postpartum WIC participation across different races, ethnicities and cultural groups. RESULTS Asian/Pacific Islander, East African, Hispanic, Hmong, Multigenerational Black, and Other Black pregnant participants were more likely than White participants to return to WIC postpartum (adjusted odds ratio (AOR) 2.54, 95% confidence interval (CI) 1.87-3.46; AOR 3.35, 95% CI 2.40-4.66; 1.30, 95% CI 1.10-1.54; AOR 6.76, 95% CI 4.39-10.42; AOR 1.40, 95% CI 1.11-1.77, AOR 1.52, 95% CI 1.26-1.83, respectively). American Indian pregnant participants were less likely than White participants to return to WIC postpartum (AOR 0.70, 95% CI 0.54-0.92). CONCLUSIONS FOR PRACTICE These findings can help the Minnesota WIC program, as well as other WIC programs, better understand which cultural groups may need more specific outreach strategies to keep women participating in the program after giving birth. Further research is needed to understand why postpartum women choose to participate, or choose not to participate, in WIC.
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Affiliation(s)
| | - Ellen Demerath
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Marcia McCoy
- Minnesota Department of Health, St. Paul, MN, USA
| | - Jamie Stang
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Bai Y, Ciecierski A. Participants' Underlying Beliefs of Using WIC Electronic Benefit Transfer (EBT) Cards in Stores in New Jersey. J Community Health 2023; 48:1038-1043. [PMID: 37531045 DOI: 10.1007/s10900-023-01262-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/03/2023]
Abstract
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an essential nutrition assistance program that has led to successful health outcomes and healthcare access. To alleviate discomfort associated with WIC shopping at stores, the Congress mandated the transition to electronic benefit transfer (EBT) card system from paper vouchers. This study aimed to explore the experiences of WIC recipients in using EBT cards in stores. WIC recipients from one WIC clinic in northern New Jersey (N = 220) participated in this study. An online survey was framed under the theory of planned behavior to probe their underlying behavioral, normative, and control beliefs of using EBT cards. Using content analyses, dominating themes of each belief were extracted. Participants composed of Hispanic (91.2%) with mean age of 31.68 (SD = 7.69). Most frequently mentioned advantages of using EBT cards were convenience and ease (34.3%) followed by fast and efficient (28.5%). Participants noted that most people would approve of using EBT cards (70%), especially those who receive the benefits and approve of the public assistance (16.7%). They stated that having improved store inventory and an increase in WIC-authorized stores (17.2%) would make the EBT cards use easy. The transition to EBT cars allowed purchase flexibility, alleviated stigma and the purchase process burdens, but the challenges associated with WIC app usage and store specific issues remained. These challenges should be addressed in future intervention to enable WIC recipients more engaged in using the EBT cards.
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Affiliation(s)
- Yeon Bai
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ, USA.
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Ganacias K, Rethy JA. Women, Infants, and Children (WIC) Enrollment: Learning From Key Informants to Enhance Utilization. Am J Public Health 2023; 113:S220-S223. [PMID: 38118102 PMCID: PMC10733875 DOI: 10.2105/ajph.2023.307443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 12/22/2023]
Abstract
Enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is suboptimal, particularly for eligible children aged 1 to 4 years. We used converged data from key informants from October 2021 to January 2023 to understand the barriers to and opportunities for WIC utilization and the role of the health care provider in links to WIC. Families and WIC staff identified gaps in provider knowledge and an expressed need for improved collaboration between health providers and WIC. (Am J Public Health. 2023;113(S3):S220-S223. https://doi.org/10.2105/AJPH.2023.307443).
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Affiliation(s)
- Karen Ganacias
- Karen Ganacias and Janine A. Rethy are with the Department of Pediatrics, Georgetown University School of Medicine and the Division of Community Pediatrics, Medstar Georgetown University Hospital, Washington, DC
| | - Janine A Rethy
- Karen Ganacias and Janine A. Rethy are with the Department of Pediatrics, Georgetown University School of Medicine and the Division of Community Pediatrics, Medstar Georgetown University Hospital, Washington, DC
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Herman DR, Kimmel R, Shodahl S, Vargas JH. Examination of an Online Cooking Education Program to Improve Shopping Skills, Attitudes toward Cooking, and Cooking Confidence among WIC Participants. Nutrients 2023; 15:4177. [PMID: 37836462 PMCID: PMC10574281 DOI: 10.3390/nu15194177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
The present study examined if adapting the Cooking Matters (CM) curriculum to be used in an online format would improve participants' shopping skills, attitudes toward cooking, and feelings of cooking confidence, similar to the traditionally offered method, which is conducted in person. Results from factor analyses indicated that the online CM program demonstrated construct and content reliability compared to in-person (Cronbach's α ≥ 0.70). Repeated-measures ANOVA revealed a decrease in shopping skills overall (F = 5.91; p ≤ 0.05), consistent across age groups (F = 3.2; p ≤ 0.05) and food security status (F = 7.48; p < 0.01), with larger impacts on the food insecure (FI). Positive cooking attitudes increased with income (F = 2.86; p ≤ 0.05), especially among the <$20,000 and $30-39,000 income brackets. Cooking confidence increased post-intervention (F = 27.2, p < 0.001), with an interaction effect for food security status (F = 7.45; p ≤ 0.01), with greater improvement for households with food insecurity. These findings provide evidence to program and policymakers that virtual nutrition and cooking education services for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) should continue to be supported beyond the pandemic as they reduce barriers to receiving program benefits, nutrition education, and may lead to reductions in household food insecurity.
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Affiliation(s)
- Dena R. Herman
- Department of Family and Consumer Sciences, California State University, 18111 Nordhoff Street, Northridge, CA 91330, USA
| | - Rachel Kimmel
- Department of Family and Consumer Sciences, California State University, 18111 Nordhoff Street, Northridge, CA 91330, USA
| | - Skye Shodahl
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Suite 16-035 CHS, P.O. Box 951772, Los Angeles, CA 90095, USA
| | - Jose H. Vargas
- Department of Psychology, California State University Northridge, 18111 Nordhoff Street, Northridge, CA 91330, USA
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Frank TL, Jabbari J, Roll S, Ferris D, Terada T, Gilbert A, McDermott L. Connecting the Dots between Barriers to W.I.C. Access and Adult and Child Food Insecurity: A Survey of Missouri Residents. Nutrients 2023; 15:2496. [PMID: 37299459 PMCID: PMC10255678 DOI: 10.3390/nu15112496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Background. Previous research has explored the impact of W.I.C. on recipients' health, but less is known about the connection between barriers to W.I.C. access and health outcomes. We fill in a gap in the literature by studying the relationship between barriers to Special Supplemental Nutrition Program for Women, Infants, and Children (W.I.C.) access and adult and child food insecurity. Methods. After survey administration, we analyzed a cross-sectional sample of 2244 residents in Missouri who have used W.I.C. or lived in a household with a W.I.C. recipient in the past three years. We ran logistic regression models to understand the relationships among barriers to W.I.C. utilization, adult food insecurity, and child food insecurity. Results. Having special dietary needs (for adults), lacking access to technology, encountering inconvenient clinic hours of operation, and experiencing difficulties taking off work were associated with increased adult food insecurity. Difficulties finding WIC-approved items in the store, technological barriers, inconvenient clinic hours, difficulties taking off work, and finding childcare were associated with increased child food insecurity. Conclusion. Barriers to accessing and utilizing W.I.C. are associated with adult and child food insecurity. However, current policies suggest promising approaches to curbing these barriers.
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Affiliation(s)
- Tyler L. Frank
- Social Policy Institute, Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA; (T.L.F.); (S.R.); (D.F.); (T.T.); (A.G.)
| | - Jason Jabbari
- Social Policy Institute, Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA; (T.L.F.); (S.R.); (D.F.); (T.T.); (A.G.)
| | - Stephen Roll
- Social Policy Institute, Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA; (T.L.F.); (S.R.); (D.F.); (T.T.); (A.G.)
| | - Dan Ferris
- Social Policy Institute, Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA; (T.L.F.); (S.R.); (D.F.); (T.T.); (A.G.)
| | - Takeshi Terada
- Social Policy Institute, Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA; (T.L.F.); (S.R.); (D.F.); (T.T.); (A.G.)
| | - Amanda Gilbert
- Social Policy Institute, Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA; (T.L.F.); (S.R.); (D.F.); (T.T.); (A.G.)
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Lora KR, Hodges L, Ryan C, Ver Ploeg M, Guthrie J. Factors That Influence Children's Exits from the Special Supplemental Nutrition Program for Women, Infants, and Children: A Systematic Review. Nutrients 2023; 15:nu15030766. [PMID: 36771472 PMCID: PMC9919162 DOI: 10.3390/nu15030766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
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.
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Affiliation(s)
- Karina R. Lora
- Department of Exercise and Nutrition Science, The George Washington University, 950 New Hampshire Avenue, Washington, DC 20052, USA
- Correspondence:
| | - Leslie Hodges
- United States Department of Agriculture, Economic Research Service, 1400 Independence Avenue SW, Washington, DC 20250, USA
| | - Cayley Ryan
- Department of Sociology and Criminology, Pennsylvania State University, 211 Oswald Tower, State College, PA 16801, USA
| | - Michele Ver Ploeg
- United States Department of Agriculture, Economic Research Service, 1400 Independence Avenue SW, Washington, DC 20250, USA
| | - Joanne Guthrie
- United States Department of Agriculture, Economic Research Service, 1400 Independence Avenue SW, Washington, DC 20250, USA
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