Review of WIC Food Packages Proposed Framework for Revisions: Interim Report (2016) / Chapter Skim
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2 The WIC Participant Experience
2 The WIC Participant Experience
Pages 45-78
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From page 45... ...
A better understanding of these factors can help to ensure that WIC food packages are culturally suitable, efficient for nationwide distribution, and nonburdensome to administration. This chapter reviews available evidence relevant to these factors in relation to the WIC participant experience.
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46 WIC participant experience NutriƟon counseling, Knowledge educaƟon, BF support, Food preferences Storage about WIC referral to health care available WIC foods WIC-eligible WIC foods issuedc WIC shopper WIC foods Certifiedb consumed by individual (EBT/vouchers) in store purchased target person MoƟvaƟons/ WIC foods Food barriersa available in store preferences MoƟvaƟons/ Never barriersa WIC shopper WIC foods WIC foods not cerƟfied doesn't use not purchased consumed by EBT/voucherd target person Product on EBT/voucher Manufacturer makes Vendor stocks WIC-compliant food WIC foods State decides Retail food Vendor product requirements environment authorizaƟon State WIC regulaƟons USDA WIC regulaƟons WIC administrative process IOM 2006 report recommendaƟons Figure 2-1 Broadside
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a Potential participant barriers may include lack of access to transportation to the WIC site and/or the vendor, time required to visit a WIC site, inconvenient WIC clinic hours, lack of knowledge about the program or lack of preference for WIC foods, among other barriers. b Certification for WIC requires the individual to be categorically eligible (pregnant, postpartum woman; infant; child up to age 5)
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(2009) conducted interviews and focus groups with WIC participants and caregivers throughout Maryland to assess perceptions of the proposed food package changes and examine differences in food preferences by race and ethnicity.
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Racial and Ethnic Differences in Provision of Foods to Young Children Evidence suggests that cultural variations in infant and child feeding practices may affect the use of specific WIC foods.
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From page 50... ...
However, redemption of jarred infant foods declined at similar rates with increasing infant age across all ethnic groups. BARRIERS AND INCENTIVES TO WIC PARTICIPATION AND REDEMPTION The extent to which the WIC food packages can affect food and nutrient intake is dependent on whether eligible individuals elect to participate and how participants make use of the food benefit.
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Duration of appointment wait time, customer service, and to a lesser extent facility environments, were identified by WIC participants as potential areas for improvement in a smaller study in Florida conducted by Christie et al.
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From page 52... ...
From January through March 2012, full redemption2 of issued food packages ranged from 9.5 to 16.4 percent, partial redemption ranged from 75.6 to 84.4 percent, and nonredemption ranged from 4.1 to 8.0 percent. Differences in redemption were related to race and ethnicity, geography, household size, and the number of WIC family members.
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Differences in household size: • larger number of household A Differences in household size: members was associated • Greater monthly nonredemption with greater food package was associated with smaller redemption rates. household size.
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From page 54... ...
Barriers to Redemption of WIC Foods Although studies are limited, qualitative work among WIC programs nationwide suggests that the participant shopping experience can be a key barrier to redemption of WIC foods. Prior to the food package revisions, a survey administered to parents and caretakers of WIC participants in New York State found that issues with food procurement (e.g., store policies, food availability)
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. With respect to the CVV, several small studies were carried out after implementation of the 2009 food package changes to evaluate the perception and use of the CVV by WIC participants.
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People also exhibit a tendency to remain within the status quo, even if choosing an alternative action seems clearly better. The implication for WIC is that there may be ways to frame food package choices to influence participant decisions, for example to make the breastfeeding package the status quo or "default" choice, or alternatively, to make it clear that when one chooses the partial or nonbreastfeeding package, the mother receives less food.
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In the context of WIC, making better food choices in the food packages more salient through advertising might increase purchase and consumption of those foods.
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This section summarizes findings from the literature on factors that affect availability and access to food in low-income populations. Studies have examined where WIC participants shop for WIC foods; means of transportation; employment; food prices; and the effect of the 2009 food package changes.
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committee issued its recommendations, data from the National Survey of WIC Participants (NSWP) had been used to determine that approximately 25 percent of women were employed when applying to WIC and about 28 percent of WIC mothers were employed, with the highest employment rate among pregnant WIC women (32 percent)
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Effect of the 2009 Food Package Changes on Food Availability Several research groups have examined the effects of the 2009 changes to the WIC food packages on food availability, and therefore access. In a study of Illinois WIC vendors, Zenk et al.
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, changes to the WIC food packages must not unduly add to the burden of the numerous state and local agencies responsible for WIC program administration. Nor should they unduly add to WIC vendor burden, given 4 The"healthy food supply" score was a composite of data on availability, variety, quality, and prices of foods, including cow's milk; soy milk; tofu; fresh, canned, and frozen fruit and vegetables; canned sardines and salmon; whole grain bread and tortillas; brown rice; and whole-grain cereals (Andreyeva et al., 2012)
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From page 62... ...
The complexity of the challenges with administering the WIC food package is perhaps best illustrated with an example. The 2006 IOM report recommended the inclusion of 1 to 2 pounds of whole wheat or whole grain bread in the food packages for women and children and specified that other whole grain foods, including brown rice, bulgur, oatmeal, barley, and soft corn or whole wheat tortillas, could substitute for whole wheat bread on an equal weight basis.
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From page 63... ...
WIC state agencies have the option to allow organic options for all foods except fruits and vegetables covered under the CVV, for which state agencies must allow organic purchases. Thirty-nine percent of WIC state agencies, covering 15 percent of WIC participants, allow infants to receive a $4 CVV and 64 ounces of jarred infant fruits and vegetables instead of 128 ounces of jarred fruits and vegetables.
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64 REVIEW OF WIC FOOD PACKAGES TABLE 2-3 Substitutions Allowed by WIC State Agencies, Fiscal Year 2015 All WIC State Agencies Percentage Number Percentage of WIC Authorized Forms of Agencies of Agencies Participants Milk and milk substitutesa Soy beverages 82 95 99.9 Tofu 54 63 72.7 Nonfat, 1%, and 2% milk 61 71 69.1 Nonfat and 1% milk 22 26 28.8 Cheese Low sodium 22 26 48.3 Fat free 16 19 37.1 Low cholesterol 11 13 18.3 Peanut butter Low sodium 25 29 45.3 Low sugar 17 20 34.4 Reduced fat 17 20 15.6 Beans and peasb Canned beans 73 85 84.9 Whole grainsc Brown rice 83 97 99.8 Tortillas 77 90 99.6 Oats 66 77 85.9 Bulgur and/or barley 22 26 22.8
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From page 65... ...
. Addition of the CVV marked the first time the WIC food package included a food item with a specified dollar value, meaning states had to decide if participants would be able to use their own funds or SNAP benefits to pay the difference.
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The October 2015 change to the mother's CVV from $10 to $11 is unlikely to pose an administrative burden, with the exception of food package VII for women who are exclusively breastfeeding twins.5 These women are prescribed 1.5 times the maximum allowance, which will result in a CVV benefit of $16.50; some state systems do not allow programming of cents and will therefore be required to average the benefit over a 2-month period until their systems can be modified to accommodate cents. Finally, the final rule's allowance for states to substitute a CVV for fruits and vegetables in lieu of a portion of infant food for the 9–11-monthold infant (USDA/FNS, 2014a)
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From page 67... ...
The decision about which method to employ is based on a variety of factors, including each state agency's unique regulations and information systems capacity, technology costs and benefits, and the impact on WIC vendors and participants. Cost Containment All states must balance diversity and availability of WIC foods with cost, and cost-containment strategies are often viewed as limiting consumers' choice.
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From page 68... ...
, as well as how to provide and prepare WIC foods for the family in alignment with the DGA. The introduction of new foods in the food package is facilitated at the local agency level by staff training and participant education prior to the changes.
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. The 2009 WIC Food Package Changes and Vendor Sales Despite challenges to ensuring WIC foods were available, most evidence suggests that the food package revisions were beneficial for vendors.
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These "WIC-only" stores offered only WIC-approved foods and were usually located in the vicinity of WIC offices. Because these stores catered only to WIC participants, they were unconcerned about sales to non-WIC participants.
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in California redeemed food packages at the maximum allowable level 81 to 94 percent of the time. The "WIC-only" experience highlights the importance of competitive pricing to contain costs to the WIC program.
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2012. Positive influence of the revised Special Supplemental Nutrition Program for Women, Infants, and Children food packages on access to healthy foods.
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2015. Review of WIC food packages: An evaluation of white potatoes in the cash value voucher: Letter report.
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2013. Mothers prefer fresh fruits and vegetables over jarred baby fruits and vegetables in the new Special Supplemental Nutrition Program for Women, Infants, and Children food package.
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2015. The impact of the 2009 Special Supplemental Nutrition Program for Women, Infants, and Children food package revi sions on participants: A systematic review.
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: Revisions in the WIC food packages; final rule, 7 C.F.R.
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2012. Fruit and vegetable availability and selec tion: Federal food package revisions, 2009.
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