SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN PARTICIPATION AND INFANTS' GROWTH AND HEALTH: A MULTISITE SURVEILLANCE STUDY

Authors: BLACK, M - UNIV MARYLAND SCH OF MED; CUTTS, DIANA - HENNEPIN COUNTY MED CTR; FRANK, DEBORAH - BU SCH OF MED/PUB HEALTH; GEPPERT, JONI - HENNEPIN COUNTY MED CTR; SKALICKY, ANNE - BU SCH OF MED/PUB HEALTH; LEVENSON, SUZETTE - BU SCH OF MED/PUB HEALTH; CASEY, PATRICK - DELTA NIRI; BERKOWITZ, CAROL - HARBOR-UCLA; ZALDIVAR, NIEVES - MARY'S CTR MATERNAL&CHILD; COOK, JOHN - BU SCH OF MED/PUB HEALTH; MEYERS, ALAN - BU SCH OF MED/PUB HEALTH; HERREN, TIM - BU SCH OF MED/PUB HEALTH; C-SNAP STUDY GROUP - CHILD SENTINEL NUTR ASSES

Submitted to: Journal of Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/10/2004
Publication Date: 7/20/2004
Citation: Black, M.M., Cutts, D.B., Frank, D.A., Geppert, J., Skalicky, A., Levenson, S., Casey, P.H., Berkowitz, C., Zaldivar, N., Cook, J.T., Meyers, A.F., Herren, T., C-SNAP Study Group. 2004. Special supplemental nutrition program for women, infants, and children participation and infants' growth and health: A multisite surveillance study. Pediatrics. 114:169-176.

Interpretive Summary: Evaluations conducted postnatally have shown that Women, Infants, and Children (WIC) participants demonstrate faster weight gain during infancy, better diets, and lower rates of anemia, compared with nonparticipants. However, there is no evidence linking WIC participation and infants' linear growth, health status, or household food security. Household food insecurity, defined as 'limited or uncertain availability of adequate or safe foods,' has been associated with inadequate intake of important nutrients. This study examines the relationship of WIC participation to infant growth, caregiver perception of infant health, and household food security among a geographically diverse sample of low-income urban infants. Results of this study show that the growth of infants receiving WIC assistance is consistent with national normative values. They also show no differences in the perceived health status of the infants between families that received WIC assistance and families that felt no need for WIC assistance. Results of the current study also show that families with WIC assistance recipients were more likely to be food-insecure than those that reported no need for WIC assistance. Evidence is accumulating that WIC protects young children of low-income families from negative health and growth consequences, not only through direct provision of age-appropriate food and nutritional advice but also through better utilization of the health care system. Our data suggest that waiting lists and logistic barriers to WIC participation should be eliminated, to ensure adequate growth and health of our nation's low-income infants.

Technical Abstract: Context: The Special Supplemental Nutritional Program of Women, Infants, and Children (WIC) is the largest food supplement program in the United States, serving almost 7,500,000 participants in 2002. Because the program is a grant program, rather than an entitlement program, Congress is not mandated to allocate funds to serve all eligible participants. Little is known about the effects of WIC on infant growth, health, and food security. Objective: To examine associations between WIC participation and indicators of underweight, overweight, length, caregiver-perceived health, and household food security among infants <=12 months of age, at 6 urban hospitals and clinics. Design and Setting: A multisite study with cross-sectional surveys administered at urban medical centers in 5 states and Washington, DC, from August 1998 through December 2001. Participants: A total of 5923 WIC-eligible caregivers of infants <=12 months of age were interviewed at hospital clinics and emergency departments. Main Outcome Measures: Weight-for-age, length-for-age, weight-for-length, caregiver's perception of infant's health, and household food security. Results: Ninety-one percent of WIC-eligible families were receiving WIC assistance. Of the eligible families not receiving WIC assistance, 64% reported access problems and 36% denied a need for WIC. The weight and length of WIC assistance recipients, adjusted for age and gender, were consistent with national normative values. With control for potential confounding family variables (site, housing subsidy, employment status, education, and receipt of food stamps or Temporary Assistance for Needy Families) and infant variables (race/ethnicity, birth weight, months breastfed, and age), infants who did not receive WIC assistance because of access problems were more likely to be underweight (weight-for-age z score = -0.23 vs. 0.009), short (length-for-age z score = -0.23 vs -0.02), and perceived as having fair or poor health (adjusted odds ratio: 1.92; 95% confidence interval: 1.29-2.87), compared with WIC assistance recipients. Rates of overweight, based on weight-for-length of >95th percentile, varied from 7% to 9% and did not differ among the 3 groups but were higher than the 5% expected from national growth charts. Rates of food insecurity were consistent with national data for minority households with children. Families that did not receive WIC assistance because of access problems had higher rates of food insecurity (28%) than did WIC participants (23%), although differences were not significant after covariate control. Caregivers who did not perceive a need for WIC services had more economic and personal resources than did WIC participants and were less likely to be food-insecure, but there were no differences in infants' weight-for-age, perceived health, or overweight between families that did not perceive a need for WIC services and those that received WIC assistance. Conclusions: Infants <=12 months of age benefit from WIC participation. Health care providers should promote WIC utilization for eligible families and advocate that WIC receive support to reduce waiting lists and eliminate barriers that interfere with access.