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Planning a WIC Research Agenda: Workshop Summary (2011)

Chapter: Appendix E: Excerpts from Comments Received on the Institute of Medicine's Website for the Workshop to Plan a Research Agenda for WIC

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Suggested Citation:"Appendix E: Excerpts from Comments Received on the Institute of Medicine's Website for the Workshop to Plan a Research Agenda for WIC." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
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E
Excerpts from Comments Received on the Institute of Medicine’s Website for the Workshop to Plan a Research Agenda for WIC

The Institute of Medicine set up a website for the workshop “Health Impacts of WIC—Planning a Research Agenda” and invited interested parties to submit comments between June 11, 2010, and August 2, 2010. During the workshop, the URL for the website was shown several times, and all persons in attendance were encouraged to submit their top three research priorities and other comments. Eight comments were received, one of which was submitted jointly by two individuals from the same company and two of which were identical. Some of the comments have been shortened (to focus on the research priorities) and copy edited. The complete set of unedited comments was forwarded to the Food and Nutrition Service of the U.S. Department of Agriculture for its consideration.

TOP RESEARCH PRIORITIES

Commenters A and B

Identical but separate suggestions from Laurie Kaiser and Laurie True of the California WIC Association:

  1. Dedicate a portion of the available funds to a small, innovative demonstration research grants pool administered by a research institution with strong WIC experience and expertise. The grants pool should be distributed to test and evaluate “WIC Plus” projects in partnership with state or local programs. These funds should be

Suggested Citation:"Appendix E: Excerpts from Comments Received on the Institute of Medicine's Website for the Workshop to Plan a Research Agenda for WIC." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×

leveraged by partnering with health foundations, which should be asked to match funding for important WIC research.

  1. The California WIC Association strongly supports Robert Whitaker’s proposal to coordinate nutrition education and communication strategies around a series of WIC interventions. California WIC has had great success using the Sesame Healthy Habits messages in a unified messaging and education intervention that is described in a Journal of Nutrition Education and Behavior article.

  2. Pilot and evaluate WIC breastfeeding interventions, including the distribution of generically labeled formula, in order to document what works to increase the rates and duration of exclusive breastfeeding.

Commenter C

Joanne Arsenault, Nutrition Policy Analyst, RTI International:

  1. Increase breastfeeding rates; identify why rates are lower among WIC participants than among income-eligible non-participants; identify what works for promotion; and implement/standardize across the program.

  2. Conduct detailed dietary surveys to determine which WIC foods are actually consumed by the target individuals, and conduct longitudinal studies to determine if nutritional risk factors decrease over time on WIC because of the consumption of WIC foods.

  3. Conduct longitudinal studies to determine if WIC has an impact on overall diet quality and food insecurity.

Commenters D and E

Melanie Hall, M.S., R.D., Nutrition Marketing-WIC; and Nelson Almeida, Ph.D., F.A.C.N., V.P, US/Global Nutrition, Science, Labeling & Marketing, Kellogg Company:

  1. Work with the Supplemental Nutrition Assistance Program (SNAP) to evaluate a variety of nutrition education methods.

  2. Find ways to study and communicate the benefits of including produce in the new food package, for both WIC participants and retailers.

  3. Investigate how the WIC program (including nutrition education and food package options) influences WIC participants’ purchasing habits outside of the food package. Consider a longitudinal study that compares participants’ actual buying behavior before, during,

Suggested Citation:"Appendix E: Excerpts from Comments Received on the Institute of Medicine's Website for the Workshop to Plan a Research Agenda for WIC." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×

and after participation in WIC. A longitudinal pantry study in a sample of WIC households would help WIC understand:

Commenter F

Betsy Frazao, Economic Research Service:

  1. Expand the availability of data for WIC research

    1. Enhance administrative data for research and evaluation For example, a contractor might assist in determining the types of data to be collected and made available, in what format, and how it might be linked to other data. Possible linkages include those with the Pregnancy and the Pediatric Nutrition Surveillance systems, Medicaid, and vital records. The standardization of data collection procedures across states would allow national-level analysis. Such standardization might be possible by providing states with “best practices” suggestions, financial resources, and technical assistance. The maintenance of an up-to-date state WIC policy database would be essential in interpreting and understanding the findings of the research.

    2. Enhance state and national survey data for WIC research Possible ways to ensure the collection of relevant data on WIC participation and outcomes include (1) the development of standardized questions on WIC participation, breastfeeding, eating behaviors, and other outcomes measures; (2) the development of supplemental WIC modules to be included in state and national surveys; and (3) the funding of the supplemental WIC modules in state and national surveys. Funding sentinel sites might also be considered as a source of data for WIC research.

Suggested Citation:"Appendix E: Excerpts from Comments Received on the Institute of Medicine's Website for the Workshop to Plan a Research Agenda for WIC." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
  1. Provide funds to increase the sample size of current surveys, such as the National Health and Nutrition Examination Survey or the National Children’s Survey, to include more WIC participants.

  1. Evaluate which WIC option yields the highest return: (1) enhancing WIC package and services to a more targeted group, or (2) expanding WIC to more people (perhaps pre-conception women).

  2. Develop a cost–benefit analysis justification for breastfeeding in WIC, including estimates of the costs and benefits based on different durations and intensities of breastfeeding and depending on whether the infant is fed at the breast or fed breast milk in a bottle. Consider the costs and benefits from

    1. an individual perspective (e.g., morbidity, obesity, dietary intake, and nutritional status),

    2. the WIC perspective (e.g., participation rates, food costs, and costs of breastfeeding promotion, peer counselors, lactation consultants, and breast pumps), and

    3. a national health perspective (e.g., short-term and long-run health care costs).

Commenter G

Elizabeth Metallinos-Katsaras, Associate Professor, Nutrition Department, Simmons College:

As a prerequisite to any implementation of a research agenda, USDA needs to provide guidance and leadership to facilitate state release of individual-level WIC data that can be used to establish linkages. The three priorities for a WIC research agenda that are listed below assume that USDA can assist states to successfully develop and implement policies of collaborative data sharing, and they address the most common nutrition-related problems (overweight and obesity) that are amenable to prevention within the WIC program. The third priority addresses how best to intervene within the WIC environment to affect health-related attitudes, behaviors, and outcomes.

  1. WIC and maternal and child obesity What is the effect of WIC participation on maternal weight status, child weight gain velocity, and status in infancy and childhood? Which predictors (e.g., breastfeeding initiation and duration, household food insecurity) are affected by WIC and may interact with WIC to affect these outcomes?

Suggested Citation:"Appendix E: Excerpts from Comments Received on the Institute of Medicine's Website for the Workshop to Plan a Research Agenda for WIC." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
  1. The impact of the new WIC food package What is the effect of the new WIC food package on changes in maternal health behaviors (i.e., foods purchased, breastfeeding) and child health outcomes (i.e., weight status, weight gain velocity, food intake).

  2. Effective approaches to effecting positive health-related attitude and behavior change How effective are the current counseling strategies to inform, encourage, and support positive health-related attitudes, behaviors, and outcomes in the WIC population; and how can they be improved to be more effective in an ethnically diverse, high-risk population?

Commenter H

Jennifer McGuire, M.S., R.D., Manager, Nutrition Communication, National Fisheries Institute:

Research: “to better understand how best to increase the consumption of seafood, the only natural source of essential omega-3s, in the diets of WIC participants for the best possible pregnancy outcomes for both mother and child.”

Studies Cited in Support of This Suggestion Appear Below

Choiniere, C. B., B. Timbo, D. Street, P. Trumbo, and S. B. Fein. 2008. Fish consumption by women of childbearing age, pregnant women and mothers of infants. Poster presented at the International Association for Food Protection 95th Annual Meeting, Columbus, Ohio, August 3–6.

Danaei, G., E. L. Ding, D. Mozaffarian, B. Taylor, J. Rehm, C. J. Murray, and M. Ezzati. 2009. The preventable causes of death in the United States: Comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 6(4):e1000058.

Golding, J., C. Steer, P. Emmett, J. M. Davis, and J. R. Hibbeln. 2009. High levels of depressive symptoms in pregnancy with low omega-3 fatty acid intake from fish. Epidemiology 20(4):598–603.

Koletzko, B., I. Cetin, J. Thomas Brenna, G. Alvino, J. von Berlepsch, H. K. Biesalski, T. Clandinin, H. Debertin, T. Decsi, H. Demmelmair, G. Desoye, V. Dietz, P. Dodds, P. Emmett, F. Facchinetti, M. W. Gillman, J. Heinrich, E. Herrera, W. C. Heird, M. Hyde, K. Laitinen, J. Laws, E. L. Daza, I. Lopez-Soldado, M. Makrides, K. F. Michaelsen, S. Olsen, H. Ortega, G. Putet, I. Rogers, P. Roggero, L. Sobotka, H. Szajewska, and H. Weiler. 2007. Dietary fat intakes for pregnant and lactating women. British Journal of Nutrition 98(5):873–877.

Suggested Citation:"Appendix E: Excerpts from Comments Received on the Institute of Medicine's Website for the Workshop to Plan a Research Agenda for WIC." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×

Lammi-Keefe, C. J. Pregnancy as a risk factor for decreased macular pigment and macular degeneration: Protective potential for DHA/fish consumption. Manuscript in preparation.

Leung, B. M. Y., and B. J. Kaplan. 2009. Perinatal depression: Prevalence, risks, and the nutrition link––A review of the literature. Journal of the American Dietetic Association 109(9):1566–1575.

Makrides, M. 2008. Outcomes for mothers and their babies: Do n-3 long-chain polyunsaturated fatty acids and seafoods make a difference? Journal of the American Dietetic Association 108(10):1622–1626.

Oken, E., M. L. Østerdal, M. W. Gillman, V. K. Knudsen, T. I. Halldorsson, M. Strøm, D. C. Bellinger, M. Hadders-Algra, K. F. Michaelsen, and S. F. Olsen. 2008. Associations of maternal fish intake during pregnancy and breastfeeding duration with attainment of developmental milestones in early childhood: A study from the Danish National Birth Cohort. American Journal of Clinical Nutrition 88(3):789–796.

ANALYSIS OF THE RELATIONSHIP BETWEEN PRENATAL WIC PARTICIPANTS AND BIRTH OUTCOMES

Commenter I

Barbara Devaney, Mathematica Policy Research, Inc.:

A major limitation with some previous analyses of birth weight is that they did not account for gestational age bias. It is possible to control for gestational age bias by looking at full-term births only. If we know the timing of WIC enrollment or, alternatively, if we restrict the sample to one in which gestational age bias has been removed, then it is possible to estimate the relationship between prenatal WIC participation and birth weight without concern for gestational age bias.

Some argue that there may be limited potential for WIC to affect birth weight. While it is useful to think carefully through a logic model for designing studies of WIC effectiveness, it seems premature to rule out an important line of analysis. The point of a research agenda is to identify research topics of interest, conduct the analysis, and let the results provide the answer, not to dismiss a set of results before doing the analysis.

In summary, given the objectives of the WIC program to address the critical development periods of pregnancy, infancy, and early childhood, a research agenda should include questions related to the effects of prenatal WIC participation on birth outcomes. Rather than reducing the focus on birth outcomes, think carefully about the range of birth outcomes that should be examined. In addition to the important ones identified at the workshop, newborn birth weight should also be considered.

Suggested Citation:"Appendix E: Excerpts from Comments Received on the Institute of Medicine's Website for the Workshop to Plan a Research Agenda for WIC." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 153
Suggested Citation:"Appendix E: Excerpts from Comments Received on the Institute of Medicine's Website for the Workshop to Plan a Research Agenda for WIC." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 154
Suggested Citation:"Appendix E: Excerpts from Comments Received on the Institute of Medicine's Website for the Workshop to Plan a Research Agenda for WIC." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 155
Suggested Citation:"Appendix E: Excerpts from Comments Received on the Institute of Medicine's Website for the Workshop to Plan a Research Agenda for WIC." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 156
Suggested Citation:"Appendix E: Excerpts from Comments Received on the Institute of Medicine's Website for the Workshop to Plan a Research Agenda for WIC." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 157
Suggested Citation:"Appendix E: Excerpts from Comments Received on the Institute of Medicine's Website for the Workshop to Plan a Research Agenda for WIC." Institute of Medicine. 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13014.
×
Page 158
Next: Appendix F: Compilation of Proposed Research Topics and Methodological Issues Covered During the Workshop »
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The time has come to initiate a new program of research on the 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). The program's scope is large, serving approximately 9.3 million low-income women, infants, and children at nutritional risk. 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; 2) nutrition education, including breastfeeding support; and 3) referrals to health services and social services. To cover program costs for fiscal year (FY) 2010, Congress appropriated $7.252 billion. Congress also appropriated $15 million for research related to the program for FY 2010.

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 package since the program's inception in 1972. Over the intervening years WIC has expanded greatly, Medicaid coverage has increased, large changes have occurred in the racial and ethnic backgrounds 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 conduct a two-day public workshop on emerging research needs for WIC. As requested, the workshop included presentations and discussions to illuminate issues related to future WIC research issues, methodological challenges, and solutions. The workshop also planned for a program of research to determine the effects of WIC on maternal and child health outcomes.

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