Overview

The time has come to initiate a new program of research on the Special Supplemental Nutrition Program for Women, Infants, and Children (commonly referred to as WIC). WIC is the third-largest food assistance program administered by the U.S. Department of Agriculture (USDA) (USDA/ERS, 2009). The program’s scope is large: During the final quarter of fiscal year (FY) 2009, approximately 9.3 million low-income women,1 infants, and children younger than 5 years who were at nutritional risk received WIC benefits each month. Through federal grants to states, participants receive three types of benefits: (1) a supplemental food package tailored to specific age groups for infants and children and to physiological status for women; (2) nutrition education, including breastfeeding support; and (3) referrals to health services and social services. WIC is available in all 50 states and the District of Columbia, 34 Indian Tribal Organizations, Guam, American Samoa, the Commonwealth Islands of the Northern Marianas, Puerto Rico, and the Virgin Islands. Ninety state agencies administer the program through approximately 2,200 local agencies and 9,000 clinic sites. To cover program costs for FY 2010, Congress appropriated $7.252 billion. Congress also appropriated $15 million for research related to the program for FY 2010, which ended a long period in which there was very little funding for WIC research.

The timing of the funding for WIC research is propitious. In October 2009, USDA issued regulations that made substantial revisions to the WIC food package. These revisions are the first major change in the food pack-

1

To be categorically eligible, a woman must be pregnant or post partum or be breastfeeding.



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Overview The time has come to initiate a new program of research on the Special Supplemental Nutrition Program for Women, Infants, and Children (com- monly referred to as WIC). WIC is the third-largest food assistance program administered by the U.S. Department of Agriculture (USDA) (USDA/ERS, 2009). The program’s scope is large: During the final quarter of fiscal year (FY) 2009, approximately 9.3 million low-income women,1 infants, and children younger than 5 years who were at nutritional risk received WIC benefits each month. Through federal grants to states, participants receive three types of benefits: (1) a supplemental food package tailored to specific age groups for infants and children and to physiological status for women; (2) nutrition education, including breastfeeding support; and (3) referrals to health services and social services. WIC is available in all 50 states and the District of Columbia, 34 Indian Tribal Organizations, Guam, Ameri- can Samoa, the Commonwealth Islands of the Northern Marianas, Puerto Rico, and the Virgin Islands. Ninety state agencies administer the program through approximately 2,200 local agencies and 9,000 clinic sites. To cover program costs for FY 2010, Congress appropriated $7.252 billion. Con- gress also appropriated $15 million for research related to the program for FY 2010, which ended a long period in which there was very little funding for WIC research. The timing of the funding for WIC research is propitious. In October 2009, USDA issued regulations that made substantial revisions to the WIC food package. These revisions are the first major change in the food pack- 1To be categorically eligible, a woman must be pregnant or post partum or be breastfeeding. 

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 PLANNING A WIC RESEARCH AGENDA age since the program’s inception in 1972 (Public Law 92-433, section 17 amendment to the Child Nutrition Act of 1966). The development of the new food package regulations relied heavily on the Institute of Medicine report WIC Food Packages: Time for a Change (IOM, 2006). The revi- sions bring the packages into alignment with the current recommendations from the Dietary Guidelines for Americans (HHS/USDA, 2005) for more fruits and vegetables and whole grains. The revisions also place a priority on breastfeeding. The new funding for WIC research is timely for several additional reasons. Much of the research on the outcomes of WIC participation was conducted at least 20 years ago. For example, the seminal WIC–Medicaid Study sponsored by the Food and Nutrition Service (USDA/FNS, 1990), which used data from the years 1987 and 1988, was published in 1990. Over the intervening years WIC has expanded greatly, Medicaid coverage has increased, large changes have occurred in the racial and ethnic back- grounds and socioeconomic status of WIC participants as well as in public health services, and obesity rates have increased substantially among the general population. To guide its planning for the use of the $15 million allocated for WIC research, the Food and Nutrition Service of USDA asked the Institute of Medicine to convene an ad hoc committee to plan and conduct a 2-day public workshop on emerging research needs for WIC. As requested, the workshop was planned to include presentations and discussions that would illuminate issues related to future WIC research issues and methodological challenges and solutions as well as the planning of a program of research to determine the effects of WIC on maternal and child health outcomes and costs. The Food and Nutrition Board of the Institute of Medicine held a workshop called “Health Impacts of WIC—Planning a Research Agenda” on July 20–21, 2010. The workshop agenda appears in Appendix A. The seven planning committee members, who are listed in the front matter of this report, served as moderators for the sessions. The workshop opened with remarks by three key figures in the administration and history of the program. This was followed by nine themed sessions featuring 33 expert researchers from multiple fields of study who gave formal presentations or served as discussants or moderators. Information on these researchers is provided in Appendix B. Each session included a period for discussion that was open to all those in attendance. To prepare for the workshop, present- ers were given the following guidance: 1. Considering previous research and research that is currently under way, identify direction(s) for future research related to the session topic.

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 OvERvIEW 2. State the rationale and significance of each specified direction for future research. 3. Specify a time frame for proposed study or series of studies. 4. Discuss methodological approaches and challenges. 5. Discuss or suggest potential data sources. The moderator of each session held a conference call with the present- ers and discussants to clarify the five parts of the guidance and to coordi- nate preparations for the workshop. Presenters were asked not to present a comprehensive review of the published research on a topic. However, each presenter and discussant was asked in advance to identify independently the research topic that he or she thought should receive the highest priority. In advance of the workshop, the discussants were provided with copies of the slides for their session to help them prepare their response to the pre- sentations made during the session. To help prepare for the methodology presentations, the presenters received, in advance, separate sets of slides covering the previous sessions and were asked to comment on methods as appropriate. From June 11, 2010, through August 2, 2010, the website http://iom. edu/Activities/Nutrition/WICResearchAgenda/2010-JUL-20.aspx was open to receive comments about the workshop and about research needs related to WIC. During the workshop, all attendees were invited to contribute fur- ther comments to the website, and presenters and discussants were asked to submit their top three research priorities to the website. THE WORKSHOP This report is a summary of the workshop presentations and discus- sions and has been prepared from workshop transcripts and slides. In some instances, content has been reorganized for greater clarity. Presenters and discussants made specific recommendations or suggestions, as requested. However, none of the statements in this workshop summary, including those made during the closing session (Chapter 10), represent a consensus regarding conclusions or recommendations. To provide more details about the workshop and its participants, Appendix A contains the workshop agenda, Appendix B contains the bio- graphical sketches of the presenters, Appendix C lists the workshop at- tendees and their affiliations, and Appendix D identifies acronyms and abbreviations. Appendix E summarizes comments that were posted on the website for the workshop, some of which address points made in response to workshop presentations. Appendix F is an abbreviated compilation of suggested research topics and methods.

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 PLANNING A WIC RESEARCH AGENDA REFERENCES HHS/USDA (U.S. Department of Health and Human Services/U.S. Department of Agriculture). 2005. Dietary Guidelines for Americans. 6th ed. Washington, DC: U.S. Government Printing Office. http://www.health.gov/DietaryGuidelines/dga2005/document/ (accessed September 16, 2010). IOM (Institute of Medicine). 2006. WIC Food Packages: Time for a Change. Washington, DC: The National Academies Press. USDA/ERS (U.S. Department of Agriculture/Economic Research Service). 2009. Economic Linkages Between the WIC Program and the Farm Sector: Economic Brief Number . Washington, DC: USDA/ERS. http://www.ers.usda.gov/Publications/EB12/EB12.pdf (ac- cessed August 24, 2010). USDA/FNS (U.S. Department of Agriculture/Food and Nutrition Service). 1990. The Saings in Medicaid Costs for Newborns and Their Mothers from Prenatal Participation in the WIC Program, volume . Alexandria, VA: USDA/FNS.