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WIC Research and Evaluation
Published research and evaluation of the WIC program is available on program implementation, participant, and health outcomes. Select one of the topic dropdown menus to view past studies and key findings.
This study looked at the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the USA, which provides food and nutritional support to low-income pregnant or postpartum women, infants, and children. The study identified strategies used by states with high WIC coverage rates that could help increase enrollment and retention rates in regions with low WIC coverage. These strategies include using data to identify eligible non-participants, increasing public awareness of WIC, implementing a smartphone app, and using technology for online applications and remote communication. The study suggests that these strategies could be used to improve the utilization of similar food assistance programs globally for low-income women and children.
Kuhn AG, Ganacias KG, Rethy JA. Strategies to improve enrollment in The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): examining high coverage states and leveraging successful COVID-19 pandemic adjustments. Public Health Nutrition. 2022 Oct;25(10):2952-6. https://www.cambridge.org/core/journals/public-health-nutrition/article/strategies-to-improve-enrollment-in-the-special-supplemental-nutrition-program-for-women-infants-and-children-wic-examining-high-coverage-states-and-leveraging-successful-covid19-pandemic-adjustments/BFC3BC456D684B1B2D752DB100766384
Predictors of WIC Participation Through Age Two: WIC Infant and Toddler Feeding Study (July 2020)
Key findings:
- Infants in households with incomes <e; 100% of Federal Povery Level (FPL) were 120% more likely to participate.
- Infants fully breastfed for 6 months or longer were 180% more likely to participate then infants not breastfed or breastfed less than 6 months.
- Infants in households in which caregivers reported they made a change in how they fed their family based on something they learned from WIC were 160% more likely to participate.
Whaley SE, et al. Whaley SE, Martinez CE, Paolicelli C, Ritchie LD, Weinfield NS. Predictors of WIC participation through 2 years of age. Journal of nutrition education and behavior. 2020 Jul 1;52(7):672-9. https://www.sciencedirect.com/journal/journal-of-nutrition-education-and-behavior
Women, Infants, and Children (WIC): Awareness, experience, and Access (May 2013)
Focus groups and phone surveys were conducted with 70 WIC-eligible families, including those who had never participated, those who had participated in the past, and current participants. The study found that confusion about enrollment status and language barriers were among the factors preventing families from participating. The study found that the WIC program has been successful in reaching a high percentage of eligible families; however, outreach and retention could be improved. The study also identified unmet needs, barriers to accessing WIC, and cultural issues for the target populations.
Huynh D. Women, Infants, and Children (WIC): Awareness, Experience, and Access. Wilder Research; 2013. Available from: https://www.wilder.org/sites/default/files/imports/MDH_WIC_Study_Report_5-13.pdf (PDF)
The study aimed to identify feeding practices of parents that may protect children with lower weight status from early childhood obesity. They interviewed 71 parents of children aged 2-5 years and found that parents of children with lower weight status were more likely to have a consistent routine for providing meals, use a guided choices approach, serve small portions of food, and trust their child's hunger and satiety cues compared to parents of children with higher weight status. The study provides evidence for specific parent-feeding behaviors that may influence child weight status and suggests that future interventions should promote these practices to support healthy outcomes among young children in low-income and racialized households.
de Brito JN, Matsumoto M, Bonilla Z, Loth KA, Geppert J, McCoy MB, et al. Identification of positive parenting practices among parents of young children living in low-income and racially, ethnically, and culturally diverse households. Appetite. 2022 Nov;178:106281. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0195666322003725
WIC report - Indicators of Diet Quality, Nutrition, and Health for Americans by Program Participation Status, 2011-16 (October 2021)
WIC participants have a healthier diet: they consume fewer calories from added sugars and saturated fats than nonparticipants.
Gleason, S., Hansen, D., & Wakar, B. (2021). Indicators of diet quality, nutrition, and health for Americans by program participation status, 2011–2016: WIC report. Prepared by Insight Policy Research, Contract No. GS-10F-0136X. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, Project Officer: Michael Burke. https://www.fns.usda.gov/wic/indicators-diet-quality-nutrition-and-health-americans-program-participation-status-2011
Longer participation in WIC is associated with better diet quality in 24-month-old children (June 2020)
WIC participation duration was positively associated with diet quality at 24 months of age. Children in the high duration group had significantly higher Health Eating Index 2015 total scores (adjusted mean 59.3, 95% DI 58.6 – 60.1) then children in the low duration group (adjusted mean 55.3, 95% DI 51.6 – 59.0)
Weinfield NS, Borger C, Au LE, Whaley SE, Berman D, Ritchie LD. Longer participation in WIC is associated with better diet quality in 24-month-old children. Journal of the Academy of Nutrition and Dietetics. 2020 Jun 1;120(6):963-71. https://www.sciencedirect.com/science/article/abs/pii/S2212267219317654
Does Prenatal WIC Participation Improve Child Outcomes? (2020)
Compared to siblings not receiving WIC benefits, participating infants:
- Had 5% lower rates of ADHD
- Had lower rates of other common childhood mental health conditions
- Were less likely to repeat grades.
Chorniy A, Currie J, Sonchak L. Does prenatal WIC participation improve child outcomes?. American Journal of Health Economics. 2020 Mar 1;6(2):169-98. https://www.journals.uchicago.edu/doi/abs/10.1086/707832?journalCode=ajhe
The study investigated how family stressors (household food insecurity and/or caregiver depressive symptoms) relate to child health and whether participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) reduces stress-related child health risks. The researchers found that as stressors increased, the odds of poor child health, hospitalizations, and developmental risk increased, and the odds of having a well-child status decreased. However, WIC participation reduced but did not eliminate child health risks in families facing dual stressors.
Quigg AM. WIC Participation and Attenuation of Stress-Related Child Health Risks of Household Food Insecurity and Caregiver Depressive Symptoms. Arch Pediatr Adolesc Med. 2012 May 1;166(5):444. Available from: https://jamanetwork.com/journals/jamapediatrics/fullarticle/1151633?resultclick=1
Prevalence of childhood lead poisoning in rural Minnesota (November 2003)
Researchers studied lead poisoning in a rural area of Minnesota with many old homes and low-income families. They tested the blood lead levels of all children up to 48 months old in a three-county area and found that 2.1% of children had elevated blood lead levels, and 0.5% had very high levels. Children who lived in pre-1950 housing and received Medicaid or WIC assistance were more likely to have elevated blood lead levels.
Erik W. Zabel, Myron Falken, Michele Sonnabend, Daniel Symonik. Prevalence of childhood lead poisoning in rural Minnesota. Available from: https://apha.confex.com/apha/131am/techprogram/paper_55354.htm
This study aimed to determine the prevalence of cigarette smoking among low-income pregnant women and to evaluate their smoking cessation patterns. The results showed that some pregnant women admitted to smoking before knowing they were pregnant, but many made an effort to quit when they found out. The study found that a small percentage of women denied smoking when they had positive serum cotinine levels, indicating passive smoke exposure. The data suggest that many women are generally truthful when reporting their smoking habits during pregnancy.
Ross JA, Swensen AR, Murphy SE. Prevalence of cigarette smoking in pregnant women participating in the special supplemental nutrition programme for Women, Infants and Children (WIC) in Minneapolis and Saint Paul, Minnesota, USA. Paediatric and Perinatal Epidemiology. 2002 Jul;16(3):246–8. https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-3016.2002.00421.x
The study investigated why Hmong toddlers attending Special Supplemental Food Program for Women, Infants, and Children (WIC) sites in St. Paul, Minnesota, have high rates of iron-deficiency anemia. In-depth interviews and focus-group interviews with Hmong parents and healthcare professionals revealed that Hmong refugee families choose to bottle-feed rather than breastfeed their infants to successfully adjust to American lifestyle demands. This leads to infants being given too much milk at the expense of solid food, which can cause toddlers to have a preference for milk over food. Hmong caregivers' child-raising philosophy of "hlu" contributes to difficulties in weaning toddlers off milk, which further contributes to iron-deficiency anemia in Hmong toddlers.
Culhane-Pera KA, Naftali ED, Jacobson C, Xiong ZB. Cultural Feeding Practices and Child-Raising Philosophy Contribute to Iron-Deficiency Anemia in Refugee Hmong Children. Ethnicity & Disease. 2002 Spring;Vol. 12, No. 2(Minority Children: The Future Health of Minority Populations):199–205. https://www.jstor.org/stable/45410348
Postneonatal IMR was more than twice as prevalent among Black (African American) as East African immigrant infants (IMR = 3.9 vs 1.5). After adjustment for confounding (term status and nativity of mother (U.S. vs foreign born), infants exposed to formula by 28 days were four times as likely to die in the postneonatal period as those without formula exposure (aOR = 4.0; 95% CI 3.2–4.9). WIC participants who experienced housing instability at birth were 1.7 times as likely to lose an infant in the postneonatal period (28 to 364 days of age) as those in stable housing (aOR = 1.7; 95% CI 1.2, 2.4)
Castillo N, McCoy M. Associations Between Infant Formula Exposure, Housing Instability and Postneonatal Mortality Among Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Maternal and Child Health Journal. 2024 Aug 20:1-0. https://link.springer.com/article/10.1007/s10995-024-03981-9
Minnesota Breastfeeding Coalition 2022 Infant Feeding Practices Survey and In-depth Interviews (October 2022)
The Minnesota Breastfeeding Coalition and the Minnesota Department of Health conducted their eighth Infant Feeding Practices Survey (IFPS) in 2022, which asked 94 birthing facilities in the state about their maternity care and infant feeding practices. Many evidence-based best practices in maternity care services improved from 2014 to 2022. Although some facilities had received Baby-Friendly certification, many reported various barriers to pursuing certification, including a lack of reimbursement for lactation services, client preferences, lack of administrative and physician support, lack of information about the initiative, and staff resistance. Fewer facilities reported working on the Ten Steps to Successful Breastfeeding compared to 2014.
The use of Pasteurized Donor Human Milk (PDHM) for newborn babies doubled from 2016 to 2022, with 44% of birthing facilities providing PDHM in 2022. Of the 62 facilities surveyed, 27 used PDHM, with five of the six Level II nurseries and six of the eight Level III nurseries in Minnesota reporting that they offer donor milk. The main funding for PDHM comes from hospital budget funds, while only one in ten facilities recoup costs through insurance reimbursement, internal grants, and/or patient self-pay.
https://www.health.state.mn.us/docs/people/wic/localagency/reports/bf/info/2022survey.pdf
Advancing Health Equity To Achieve Diversity And Inclusion (AHEAD) in WIC Case Study: Hennepin County WIC (August 2022)
Hennepin County's Women, Infants, and Children (WIC) program has implemented a project to create a career pathway for Black, Indigenous, and People of Color (BIPOC) peer counselors to receive tuition reimbursement for courses to become an International Board-Certified Lactation Consultant (IBCLC). The goal is to increase cultural and linguistic representation in advanced lactation support and services within WIC and to address racial disparities in breastfeeding rates. All 7 participants completed personalized learning plans and made progress toward becoming an IBCLC. 72% of the participants were interested in advancing their careers to help more people, make more money, and receive personal fulfillment. 29% of them were interested in learning new skills to stay marketable, for promotion, or for more mental stimulation. Overall, participants were satisfied with the program and reported high levels of agreement with statements about how the program impacted their views on career advancement.
https://s3.amazonaws.com/aws.upl/nwica.org/hennepin-county-wicfinal.pdf
Leveraging Limited Resources Through Cross-Jurisdictional Sharing: Influences on Breastfeeding Rates (October 2020)
The study looked at the rate of breastfeeding initiation in a certain area and compared it to neighboring areas. They found that while there was a slight increase in the rate of breastfeeding initiation in the area they were studying, it was not significantly different from the neighboring areas. However, when they looked at the data from the individual health departments within that area, they found that one of them had a significantly higher rate of increase in breastfeeding initiation compared to the neighboring areas.
Gyllstrom ME, McCoy MB, Pezzini G, Atherly A. Leveraging Limited Resources Through Cross-Jurisdictional Sharing: Influences on Breastfeeding Rates. J Hum Lact. 2021 Aug;37(3):547–55. Available from: https://journals.sagepub.com/doi/abs/10.1177/0890334420963638
In-Hospital Formula Feeding and Breastfeeding Duration (July 2020)
This study looked at how giving formula to breastfed babies in the hospital affects how long they breastfeed. They found that babies given formula in the hospital were more likely to stop breastfeeding earlier than babies who were exclusively breastfed. The risk of early weaning was higher for babies who were given formula, and this risk increased as the baby got older. The study suggests that educating parents and hospital staff about the benefits of breastfeeding and providing support, such as counseling and skin-to-skin contact, can help reduce the use of formula in the hospital and improve breastfeeding rates.
McCoy MB, Heggie P. In-Hospital Formula Feeding and Breastfeeding Duration. Pediatrics. 2020 Jul 1;146(1):e20192946. Available from: https://publications.aap.org/pediatrics/article/146/1/e20192946/77021/In-Hospital-Formula-Feeding-and-Breastfeed
Traditional Breastfeeding Practices of the Ojibwe of Northern Minnesota (June 2010
This study explored traditional infant feeding practices among the Ojibwe people, who have transitioned from being woodland nomads to being confined on rural reservations or living in inner-city poverty. Ethnographic methods were used to gather information from 44 Ojibwe women, and many of their traditional practices had not been documented before. Learning about these traditions can help create services that are consistent with Ojibwe values for those who work with indigenous people in various settings./p>
Dodgson J, Struthers R. Traditional Breastfeeding Practices of the Ojibwe of Northern Minnesota. Health Care for Women International. 2003 Jan;24(1):49–61. https://www.tandfonline.com/doi/abs/10.1080/07399330390170033
Availability of BFPCs resulted in a 3.1 to 3.4 percentage-point increase in breastfeeding rates at 3 months and a 3.2 to 3.7 percentage-point increase in breastfeeding rates at 6 months among WIC participants in Greater Minnesota. Among rural counties, results showed a statistically significant 4.1 to 5.2 percentage-point increase in breastfeeding duration rates. Both border and nonborder counties experienced positive impacts of BFPCs on breastfeeding rates, suggesting wide-ranging program spillover effects.
Interrante JD, Fritz AH, McCoy MB, Kozhimannil KB. Effects of Breastfeeding Peer Counseling on County-Level Breastfeeding Rates Among WIC Participants in Greater Minnesota. Women's Health Issues. 2024 Jan 8 Available from: https://www.sciencedirect.com/science/article/abs/pii/S1049386723002128?via%3Dihub
Researchers analyzed the effectiveness of peer counseling (PC) in promoting breastfeeding initiation and continuation through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) model in Minnesota. They found that women who received PC services were more likely to initiate breastfeeding and had a lower risk of discontinuing breastfeeding during the first year after birth. The positive association between PC and breastfeeding initiation and continuation was not significantly affected by race or ethnicity. Making peer services available to more women, particularly in communities with low initiation and duration rates, could improve maternal and child health in Minnesota.
McCoy MB, Geppert J, Dech L, Richardson M. Associations Between Peer Counseling and Breastfeeding Initiation and Duration: An Analysis of Minnesota Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Matern Child Health J. 2018 Jan;22(1):71–81. Available from: https://link.springer.com/article/10.1007/s10995-017-2356-2
Use of Electronic and Social Media to Promote Equity in Breastfeeding Support: Perceptions of Minnesota WIC Peer Counselors (November 2018)
This study explored how the Special Supplemental Nutrition Program for W
omen, Infants, and Children (WIC) in Minnesota can use text messaging and other electronic communication methods to better support breastfeeding among its clients. The study found that clients prefer texting and social media to connect with peers, but are concerned about privacy and confidentiality. Program managers need to adapt to these social changes and maintain client-centered services while ensuring data security and confidentiality.
Leslie Kummer, Linda Dech, Claire Cunningham, Joni Geppert, Marcia McCoy. Use of Electronic and Social Media to Promote Equity in Breastfeeding Support: Perceptions of Minnesota WIC Peer Counselors. APHA’s 2018 Annual Meeting & Expo.
The Code for America Benefits Enrollment Field Guide (2023)
The Field Guide assessment evaluated online benefits enrollment across states, showcasing best practices for online safety net benefits applications. It highlights successful paths to equitable, human-centered experiences.
A Descriptive Analysis of Redemption Patterns by Vendor Type Among: WIC Participants in Massachusetts (September 2022)
The majority of Massachusetts WIC households (63%) relied on large vendors only (i.e, superstores, supermarkets, and large grocery stores) when redeeming benefits, and 5% relied on small grocery or convenience stores only. Compared with other vendor types, households that redeemed benefits at superstores only had, in an average month, lower redemption levels for most benefit categories. For example, in 2019, redemption of breakfast cereal was 53% among households redeeming only at superstores compared with 74% for those redeeming only at small grocery stores. By contrast, households that relied only on small grocery stores had, in an average month, lower redemption levels for yogurt and cash value benefit compared with other vendor types; for example, in 2019, redemption of yogurt was 34% among households redeeming only at small grocery stores compared with 62% among those redeeming only at supermarkets.
Strategies to increase redemption may be especially important for WIC shoppers relying on superstores.
Evaluating Changes to the WIC Program at a Local Public Health Division (Executive Summary) (April 2019)
The Bloomington, MN WIC program transitioned from paper vouchers to Electronic Benefits Transfer (EBT) cards called eWIC, which clients find more flexible, easy to use, and with fewer stigmas. A field experience evaluated the satisfaction of clients, vendors, and staff after implementing the eWIC program. Feedback showed that the clients were excited to have less paperwork, more flexibility, and an improved checkout experience. BPH WIC Staff believed the eWIC was more user-friendly, and vendors believed the change eliminated common sources of errors and vendor violations. All stakeholders felt that eWIC reduced the stigma experienced by WIC clients at the store.
Emily Larson. Evaluating Changes to the WIC Program at a Local Public Health Division (Executive Summary). 2019 Apr 26; Available from: https://mch.umn.edu/abstract/executive-summary-evaluating-changes-to-the-wic-program-at-a-local-public-health-division/
This study looked at how many healthy foods were stocked in small to mid-sized stores that accept SNAP benefits. The study found that while more than half of these stores carried healthy milk, fruit, and whole-grain cereal, only one-third stocked fresh vegetables and only one-quarter had whole-grain products like bread and rice. The study suggests that minimum stocking requirements should be improved for SNAP-authorized retailers to increase access to healthy food.
Laska MN, Caspi CE, Pelletier JE, Friebur R, Harnack LJ. Lack of Healthy Food in Small-Size to Mid-Size Retailers Participating in the Supplemental Nutrition Assistance Program, Minneapolis–St. Paul, Minnesota, 2014. Prev Chronic Dis. 2015 Aug 27;12:150171. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4556107/
Improving Service Delivery in a County Health Department WIC Clinic: An Application of Statistical Process Control Techniques (August 2011)
This study looked at how quality improvement methods, like statistical process control, could be used to improve the delivery of public health services in settings with limited resources. The study analyzed a project at a local WIC clinic aimed at reducing waiting times and improving client satisfaction with the nutrition education service. The use of statistical process control techniques resulted in a significant reduction in waiting time and improvement in client satisfaction with the service.
Boe DT, Riley W, Parsons H. Improving Service Delivery in a County Health Department WIC Clinic: An Application of Statistical Process Control Techniques. Am J Public Health. 2009 Sep;99(9):1619–25. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2008.138289
Code of Federal Regulations 246.14: Program Costs
7 CFR 246.14(c) Specified allowable nutrition services and administration costs
(iv) The cost of conducting evaluations of nutrition education or breastfeeding promotion and support activities, including evaluations conducted by contractors;
(vi) The cost of monitoring nutrition education and breastfeeding promotion and support activities.
Code of Federal Regulations 246.14: Other provisions
7 CFR 246.26(d) Confidentiality of applicant and participant information
(1) WIC purposes.
(i) Confidential applicant and participant information is any information about an applicant or participant, whether it is obtained from the applicant or participant, another source, or generated as a result of WIC application, certification, or participation, that individually identifies an applicant or participant and/or family member(s). Applicant or participant information is confidential, regardless of the original source and exclusive of previously applicable confidentiality provided in accordance with other Federal, State or local law.
(ii) Except as otherwise permitted by this section, the State agency must restrict the use and disclosure of confidential applicant and participant information to persons directly connected with the administration or enforcement of the WIC Program whom the State agency determine have a need to know the information for WIC Program purposes. These persons may include, but are not limited to: personnel from its local agencies and other WIC State or local agencies; persons under contract with the State agency to perform research regarding the WIC Program, and persons investigating or prosecuting WIC Program violations under Federal, State or local law.