Background Bottle-fed infants are at greater risk for overfeeding and rapid weight gain (RWG); evidence-based strategies for promoting healthy bottle-feeding practices are needed.Objective Our aim was to assess whether policy, systems, and environmental (PSE) strategies for promoting responsive bottle-feeding practices within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were associated with lower risk for RWG.Design We conducted a matched-pair cluster randomized trial. PSE strategies were implemented at 3 WIC clinics in Los Angeles County. PSE clinics were compared with 3 matched control clinics. Mothers and infants were assessed when infants were newborn and 3 months and 6 months of age.Participants/setting Participants were mothers (n ¼ 246) who enrolled their newborn infants (younger than 60 days) into WIC between May and August 2019.Main outcome measures Infant weight was assessed and standardized to sex-and age-specific z scores. RWG was defined as weight-for-age z score change > 0.67. Mothers completed questionnaires assessing responsive and pressuring feeding styles, breastand bottle-feeding patterns, and perceptions of WIC experiences. Statistical analyses performed Logistic regression with estimation via generalizedestimating equations and linear mixed models with repeated measures assessed effects of PSE strategies on categorical and continuous outcomes, respectively.Results Infants in PSE clinics had significantly lower likelihood of exhibiting RWG (P ¼ .014) than infants in control clinics. Mothers in PSE and control clinics reported similar levels of responsive and pressuring feeding style and similar prevalence of breastfeeding and bottle-feeding. Mothers in PSE clinics trended toward feeling better supported with respect to their decision to bottle-feed (P ¼ .098) and had more stable intentions to stay in the WIC program (P ¼ .002) compared with mothers in control clinics.Conclusions PSE strategies focused on promoting more inclusive assessment of infant feeding, tailored bottle-feeding counseling, and increased education and support for responsive bottle-feeding were associated with lower risk for RWG among WIC infants.
Many Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics implemented alternatives to in-person service delivery in response to the COVID-19 pandemic, including virtual visits and electronic document sharing. The objective of this cross-sectional study was to describe WIC participants' experiences with remote service delivery and recertification during the pandemic. Participants included mothers and infants who participated in a WIC-based intervention between June 2019-August 2020. All participants (N = 246) were invited to complete a follow-up survey between November 2020-February 2021; 185 mothers completed the survey. The survey assessed sociodemographics, employment, food security, experiences with remote WIC recertification and service delivery, and experiences with obtaining WIC foods during the pandemic. Average age for mothers was 29.2 ± 6.3 years and for infants was 17.7 ± .2 months; 80% (n = 147) identified as Hispanic. Approximately 34% (n = 62) of participants reported very low or low food security and 40% (n = 64) had difficulties buying WIC foods during the pandemic. Among participants who recalled providing documentation of income and address virtually, the majority felt comfortable providing information via email (60%) and text messaging (72%). Participants reported high levels of satisfaction with remote methods of service delivery, as well as overall satisfaction with the WIC program during the pandemic. While ~ 25% of study participants preferred for all WIC services to remain remote, 75% still desired at least some in-person contact with WIC staff after the pandemic. In conclusion, remote methods of WIC service delivery addressed existing barriers to WIC participation and were well-received by study participants.
The United States Department of Agriculture approved an increase to the Cash Value Benefit (CVB) for the purchase of fruits and vegetables issued to participants receiving an eligible Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package. In order to understand satisfaction, perceptions, and the overall impact of additional benefits for fruits and vegetables at the household level, a qualitative study consisting of structured phone interviews was conducted with families served by WIC in Southern California from November to December 2021 (n = 30). Families were selected from a large longitudinal study sample (N = 2784); the sample was restricted by benefit redemption and stratified by language and race. WIC participants were highly satisfied with the CVB increase, reporting increased purchasing and consumption of a variety of fruits and vegetables. Respondents noted the improved quality and variety of fruits and vegetables purchased due to the increased amount. Findings are expected to inform policy makers to adjust the CVB offered in the WIC food package with the potential to improve participant satisfaction and increase participation and retention of eligible families with benefits from healthy diets supported by WIC.
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.
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