The WIC Program: Recommended Readings

ERS Reports

The WIC Program: Background, Trends, and Issues—This report presents comprehensive background information on the WIC program—operations, history, program trends, and the characteristics of the population served. Issues related to program outcomes and administration are also examined.

Effects of Food Assistance and Nutrition Programs on Nutrition and Health: Volume 3, Literature Review—This report provides a comprehensive review and synthesis of published research on the impact of USDA’s food and nutrition assistance programs, including WIC, on participants’ diet and health outcomes. The report is one of four volumes produced by a larger study, including Volume 1, Research Design; Volume 2, Data Sources; and Volume 4, Executive Summary of the Literature Review.

Review of the Dietary Reference Intakes for Selected Nutrients: Application Challenges and Implications for Federal Food and Nutrition Policy—Dietary Reference Intakes (DRIs) are the most recent set of nutrient-based reference values, which, together with recommended dietary assessment methods, are being used to update estimates of nutrient adequacy. Recent estimates suggest both dramatic dietary deficiencies and excesses for selected nutrients among some population subgroups. This report takes a critical look at the studies and methods used to set DRIs. The findings show that errors in dietary recall data—either underreporting or overreporting of intakes—may partially explain the results. Because the DRIs are used by food and nutrition assistance programs to set nutritional objectives, establish program benefits, and evaluate program outcomes, it is important to understand how DRIs are derived and how to interpret the results of dietary assessments.

Using Point-of-Purchase Data To Evaluate Local WIC Nutrition Education Interventions: Feasibility Study—The effect of nutrition education—an important component of many Federal food assistance programs—on participants’ food consumption behavior is difficult to ascertain. This study finds that combining point-of-purchase data with State data on the WIC program is a feasible method to assess behavioral changes in WIC participants. The major obstacle to using these data to evaluate WIC participant food-purchasing behaviors is the recruitment of enough stores to include a representative sample of WIC participants. The study found that nutrition education intervention directed at encouraging the purchase of 1-percent and skim milk, as well as low-fat cheese, did not significantly influence purchasing patterns among WIC participants.

Nutrition and Health Characteristics of Low-Income Populations: Volume II, WIC Program Participants and Nonparticipants—Data from the Third National Health and Nutrition Examination Survey (NHANES-III), conducted in 1988-94, were used to compare the nutrition and health characteristics of participants and nonparticipants in the WIC program. This research was designed to establish a baseline from which to monitor the nutritional and health characteristics of WIC participants and nonparticipants over time. Variables compared included measures of usual intake of food energy and nutrients, Healthy Eating Index scores, health-related behaviors, health status, conditions and risks, and access to health insurance coverage.

Assessing the Nutrient Intakes of Vulnerable Subgroups—This study is a comprehensive analysis of the nutrient adequacy of segments of the population at risk of inadequate nutrient intake, excessive intake, or dietary imbalances, based on the Continuing Survey of Food Intakes by Individuals conducted in 1994-96 and 1998. Population subgroups include adolescent females, older adults, children and adults at risk of overweight, individuals living in food-insufficient households, low-income individuals, and individuals targeted by and participating in food and nutrition assistance programs such as WIC. The study adds to a growing literature that uses current, improved knowledge of nutrient requirements and recommended nutrient assessment methods to analyze nutrient intakes. The study indicates generally inadequate intakes of key micronutrients, especially magnesium, calcium, folate, and vitamin E; energy intakes less than recommended energy requirements for adults; consumption of too much food energy from fat and not enough from carbohydrates; and inadequate intakes of fiber. Children—especially infants and young children—have diets that are more nutritionally adequate than those of adolescents and adults.

Children's Consumption of WIC-Approved Foods—This study compared consumption patterns of WIC children with those of three different comparison groups: eligible nonparticipating children living in non-WIC households, eligible nonparticipating children living in WIC households, and children living in households whose income is too high to be eligible for WIC. The study provides strong evidence that participation in the WIC program increases consumption of at least some types of WIC-approved foods.

The Food Assistance Landscape—This periodical provides a brief overview of USDA's domestic food and nutrition assistance programs. Each issue contains recent program statistics, such as expenditure, participation, and benefit levels, as well as information on related economic and social indicators, such as unemployment rates, income growth, and food price inflation. It also discusses a recent ERS study that examined patterns of entry into and exit from the Food Stamp Program.

WIC and the Retail Price of Infant Formula—Rebates from infant formula manufacturers to State WIC agencies support over one-quarter of all WIC participants. However, WIC and its infant formula rebate program may significantly affect the infant formula prices faced by non-WIC consumers. This report presents findings from the most comprehensive national study of infant formula prices at the retail level. For a given set of wholesale prices, WIC and its infant formula rebate program resulted in modest increases in the supermarket price of infant formula, especially in States with a high percentage of WIC formula-fed infants. However, lower priced infant formulas are available to non-WIC consumers in most areas of the country, and the number of lower priced alternatives has increased.

Innovative WIC Practices: Profiles of 20 Programs—WIC provides supplemental food, nutrition education, and social service referrals to low-income pregnant, breastfeeding, and postpartum women, infants, and children younger than age 5. With its rapid expansion, the WIC program has come under increased scrutiny and new directions have been suggested. This study examines a range of innovative practices at 20 State or local WIC agencies. The study focuses on practices in three main areas: breastfeeding promotion and support (including peer counseling and programs for high-risk groups), nutrition and health education (including obesity prevention, preventive health care, and staff training), and service delivery (such as home and workplace visits). For each innovative program, the report provides background information and discusses the source of the innovation, key challenges, implementation lessons learned, evidence of success, and the feasibility of replicating the practice.

Interstate Variation in WIC Food Package Costs: The Role of Food Prices, Caseload Composition, and Cost-Containment Practices—Food prices within States affect average monthly costs of State food benefits packages provided by the WIC program more than variations in WIC caseload composition do. In addition, cost-containment practices by State WIC agencies provide different levels of cost savings in different areas, contributing to interstate variation in benefits package costs. This study is one of the few to examine the degree to which food prices, caseloads, and cost-containment practices influence costs of State WIC food benefits packages. Because limited data exist on the actual food items that WIC participants purchase, the study used a scanner dataset of supermarket transactions and other sources to estimate the average monthly cost of WIC food benefits in several areas.

Assessment of WIC Cost-Containment Practices: Final Report—WIC provides both nutrition education and supplemental foods for pregnant, breastfeeding, and postpartum women, infants, and children. State WIC agencies have implemented practices designed to reduce the cost of food packages containing these prescribed foods. One such practice is negotiating rebate contracts with manufacturers of infant formula. Additional practices include limiting authorized vendors to stores with lower food prices; limiting approved brands, package sizes, forms, or prices; and negotiating rebates with food manufacturers or suppliers. These cost-saving practices may inadvertently counter the program's goal of providing supplemental foods and nutrition education. Based on a review of cost-containment practices in six States, the study concludes that (1) cost-containment practices reduced average food package costs by 0.2 to 21.4 percent, depending on practices implemented and local conditions; (2) the cost-containment practices had few adverse outcomes for WIC participants; and (3) administrative costs of the practices were low, averaging about 1.5 percent of food package savings.

Linking WIC Program Data to Medicaid and Vital Records Data: Phase II Report, Data Development Initiatives for Research on Food Assistance and Nutrition Programs, Final Report—This report follows up on a proposal to create a national database that links State data from the WIC program with Medicaid and vital records data. The linked information would create new opportunities for Federal and State program administrators, as well as independent researchers, to examine a number of factors related to program participation and dynamics. The report provides an implementation plan for creating a national database, including potential costs, benefits, and alternatives. The initiative is one of three that have the potential to improve the usefulness and cost-effectiveness of research on Federal food assistance and nutrition programs.

Amber Waves

Amber Waves, ERS’s magazine, is a window into the agency’s broad research program, covering production agriculture, food safety and nutrition, the food industry, rural economies, agricultural trade, and farm-related environmental issues. Published five times a year in web and print editions, Amber Waves contains in-depth feature articles, research findings, previews of research in the works, and statistics, including a variety of articles related to WIC and other food and nutrition assistance programs. The following articles relate specifically to WIC:

• Cost of Infant Formula for the WIC Program Rising, November 2006

• Adjusting for Living Costs Can Change Who Is Considered Poor, November 2006
  
  
• Food Assistance: How Strong Is the Safety Net?, September 2006
  
  
• Children’s Diets and WIC, June 2006
  
  
• Prices Dominate Interstate Variations in WIC Food Costs, February 2005
  
  
• Sharing the Economic Burden: Who Pays for WIC’s Infant Formula?, September 2004
  
  

RIDGE (formerly Small Grants) WIC Projects

FANRP’s RIDGE Program has funded several research projects of relevance to WIC, including those listed below:

Bitler, M., and J. Currie. Medicaid at Birth, WIC Take Up, and Children’s Outcomes. A Final Report to the IRP/USDA Small Grants Program.

Chatterji, P., K. Bonuck, S. Dhawan, and N. Deb. WIC Participation and the Initiation and Duration of Breastfeeding.

Dewey, K.G., M.J. Heinig, and K. Kavanagh-Prochaska. Educational Intervention to Modify Bottle-feeding Behaviors Among Formula Feeding Mothers in the WIC Program: Impact on Infant Formula Intake, Weight Gain, and Fatness.

Herman, D., G. Harrison, A. Afifi, and E. Jenks. Are Economic Incentives Useful for Improving Dietary Quality Among WIC Participants and Their Families?

Ishdorj, A., H.H. Jensen, and J. Tobias. Intra-Household Allocation and Consumption of WIC Approved Foods.

Joyce, T., and D. Gibson. The Use of Twins to Understand the Effect of WIC on Birth Outcomes.

Kranz, S., and J. Findeis. Policy Implications of WIC or Food Stamp Program Participation on Children’s Diet Quality and the Risk for Childhood Obesity.

Swann, C. The Dynamics of WIC Prenatal Participation.

Journal Articles