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Opening Session

This workshop provided the participants with the opportunity to inform the Food and Nutrition Service of the U.S. Department of Agriculture (USDA) about the priorities and needs for research related to the Special Supplemental Nutrition Program for Women, Infants, and Children (commonly called WIC). In her opening remarks, Gail Harrison, chair of the planning committee and workshop moderator, said that the workshop represents an unprecedented opportunity in that USDA currently has some substantial funds to allocate to WIC research—funds that need to be committed rather quickly.

The workshop was organized to cover eight topics:

  1. WIC and birth outcomes;

  2. WIC and overweight and obesity;

  3. WIC and breastfeeding;

  4. Food insecurity and hunger;

  5. Dietary intake and nutritional status;

  6. Nutrition education;

  7. Health care and systems costs, benefits, and effectiveness; and

  8. The reach of WIC.

Although methodology was discussed in the sessions covering each of these topics, the closing session was planned to include two presentations specifically addressing methodological issues raised during the workshop.

The opening session featured brief presentations from three persons who have played key roles in support of WIC over time: Jay Hirschman, Reverend Douglas Greenaway, and David Page.



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1 Opening Session This workshop provided the participants with the opportunity to in- form the Food and Nutrition Service of the U.S. Department of Agriculture (USDA) about the priorities and needs for research related to the Special Supplemental Nutrition Program for Women, Infants, and Children (com- monly called WIC). In her opening remarks, Gail Harrison, chair of the planning committee and workshop moderator, said that the workshop represents an unprecedented opportunity in that USDA currently has some substantial funds to allocate to WIC research—funds that need to be com- mitted rather quickly. The workshop was organized to cover eight topics: 1. WIC and birth outcomes; 2. WIC and overweight and obesity; 3. WIC and breastfeeding; 4. Food insecurity and hunger; 5. Dietary intake and nutritional status; 6. Nutrition education; 7. Health care and systems costs, benefits, and effectiveness; and 8. The reach of WIC. Although methodology was discussed in the sessions covering each of these topics, the closing session was planned to include two presentations specifically addressing methodological issues raised during the workshop. The opening session featured brief presentations from three persons who have played key roles in support of WIC over time: Jay Hirschman, Reverend Douglas Greenaway, and David Page. 

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 PLANNING A WIC RESEARCH AGENDA PERSPECTIVES FROM THE U.S. DEPARTMENT OF AGRICULTURE Presenter: Jay Hirschman WIC was conceived as a national program during the White House Conference on Nutrition in 1969 and was first operated as a pilot program under a different name beginning in 1972. Since then, it has grown to serve more than one-third of all pregnant women, half of all infants, and 30 per- cent of all children younger than 5 years of age in the United States. Figure 1-1 illustrates the program’s steady growth. Hirschman said that USDA is seeking the best ideas and most impor- tant research questions relating to the impacts of WIC in its current form and in potential future forms, being respectful of funding realities regarding benefits. In fiscal year (FY) 2010, WIC received up to $15 million for stud- ies and evaluations, and the President’s budget request for FY 2011 asks for a similar amount. These amounts are substantially higher than those received in previous years. WIC is intended to foster growth and development among those U.S. women, infants, and children with the lowest incomes and greatest need. It does so through a regular supply of nutritious foods, nutrition education, breastfeeding support, and referrals. Over the years, WIC has relied on scientifically based research and evaluations to guide policy development and provide justification for improved program coverage. Nonetheless, because a wide variety of changes have occurred in WIC and in the environ- ment in which WIC operates (see Box 1-1), Hirschman said a new program of research is needed to provide a basis for adapting and improving WIC. Hirschman asked that all attendees consider the information presented at the workshop and then submit to the workshop website hosted by the Institute of Medicine their recommendations and rationale for three proj- ects that should receive funding priority. PERSPECTIVES FROM THE NATIONAL WIC ASSOCIATION Presenter: Reerend Douglas Greenaway The National WIC Association (NWA) recognizes, Greenaway said, that the scientific evidence supporting the benefits of WIC is outdated; and NWA welcomes the support for WIC research provided by the 111th 1 Hirschmanexpressed thanks to Congress; the National WIC Association; the Centers for Disease Control and Prevention; all WIC’s partners at the state, territorial, tribal, and local levels; vendors; food manufacturers; and many others for helping make WIC one of the best programs that the nation has to offer.

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Year FIGURE 1-1 Average monthly participation in the Special Supplemental Nutrition Program for Women, In- Figure 1-1 Hirschman.eps fants, and Children, 1974–2009.  SOURCE: Hirschman (2010).bitmap with vector x-axis label--landscape

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 PLANNING A WIC RESEARCH AGENDA BOX 1-1 Changes in WIC and the Environment in Which WIC Operates Changes to WIC – Revised WIC food packages (October 2009) – Increased size of the participating population – Full funding (no wait lists) – arlier enrollment during pregnancy (now 50 percent enroll during the first E trimester) (USDA/FNS, 2006) – Changed ethnic distribution of the WIC-eligible population (more Hispanics) – ncreased focus on breastfeeding promotion and support (and more I funding) – Increased length of certification period for infants – ransition from paper vouchers to electronic benefit transfer (EBT) (in T process) Changes to the Environment in Which WIC Operates – xpansion of other programs––Medicaid and similar programs, State Chil- E dren’s Health Insurance Program (SCHIP), Head Start, Early Head Start, and the Supplemental Nutrition Assistance Program (SNAP) – The new health care legislation – shift in nutrition education from the “traditional medical model” to client- A centered, motivational methods – The economic recession that began in 2007 – New technology – hanges in the food supply, including expansion of the foods meeting WIC C criteria – hanges in the health risks of the U.S. population (especially increased C obesity) – Development of new growth charts – hanges in social norms relating to food, nutrition, and eating (including a C growing demand for local sustainable foods) Congress. Greenaway said that the current study of the impact of WIC participation on Medicaid costs will provide valuable cost–benefit data. NWA’s Evaluation Committee has identified the following four research priorities for consideration: 1. Examine the most effectie strategies for WIC to use in support of exclusie breastfeeding and in the promotion of the initiation and duration of breastfeeding. This examination is to include peer coun- seling serices in addition to other breastfeeding support serices and strategies that WIC proides. Despite clear evidence of the health benefits of breastfeeding and improved initiation rates (currently 74 percent), the rates of exclusive breastfeeding drop off quickly, and only 23 percent of infants are breastfed for 12 months.

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 OPENING SESSION 2. Identify and assess preention and interention strategies that WIC uses to reduce the risk of oerweight and obesity, and ealuate their effectieness. The President’s Task Force Report on Child- hood Obesity (White House Task Force on Childhood Obesity, 2010) summarizes evidence that one in five children is overweight or obese before the age of 6 years and that more than half of obese children have become overweight by the age of 2 years. 3. Examine the modes of nutrition education deliery, ealuate their effectieness, and identify best practices that can be shared easily. WIC requires two nutrition education contacts per certification period. The purpose of the contacts is to assist participants in achieving a positive change in dietary and physical activity habits and thereby improving their nutritional status and decreasing their risks of nutrition-related problems. 4. Ealuate how the recent changes to the WIC food packages hae in- fluenced the dietary behaiors of WIC mothers and young children. In addition, NWA recommends that the use of functional food additives (such as nucleotides, docosahexaenoic acid, pre-biotics, and pro-biotics) be evaluated to determine potential benefits and drawbacks in foods that are part of the WIC food package. NWA is concerned that such products increase costs and may provide little, if any, benefit. Anticipated changes in WIC under the Affordable Care Act include the implementation of electronic benefit delivery systems by 2020, the updating of related systems, and the release of health data in more useable formats. Such changes could give WIC the opportunity to examine data collection methods and to determine future data needs and capacities. Improved WIC data collection, in turn, could lead to substantial contributions to the knowledge base of maternal and child health outcomes and costs. OPENING REMARKS Presenter: Daid Paige Scientific data provided a foundation for WIC and have guided its programmatic decisions. Research has been at the heart of the program. According to Paige, the continuing evolution of the program requires that attention be paid to a new set of research questions and some new ap- proaches. These include consideration of the following: • Critical periods of discrete risks and varying levels of vulnerability, such as those relating to folic acid deficiency, fetal alcohol syn- drome, and infant feeding choices • Clear definitions of birth outcomes

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0 PLANNING A WIC RESEARCH AGENDA • The heterogeneity of the obesity problem in terms of its origins, impacts, adaptations, and relationship to the environment • New factors that may affect breastfeeding initiation, duration, and exclusivity, including the new food packages, personnel (espe- cially peer counselors), mixed rather than unified messages, and the medicalization of breastfeeding • Additives to infant formula • Effective targeting of foods to food-insecure families and careful follow-up • Ways to improve outreach • Development of an electronic system to exchange key information about the client, aid in the integration of WIC services into the health care system, and reduce client burden A restructured, reinvigorated, and cost-efficient approach to delivering WIC services would focus on prevention (e.g., trying to make the pregnancy “the best that there is”), integrate WIC into a comprehensive health system, increase partnering with the community, and exploit social networking and other new technologies to enhance nutrition education and give WIC clients a voice in the services they receive. REFERENCES Hirschman, J. 2010. Health impacts of WIC: Planning a WIC research agenda. Presented at the Institute of Medicine Workshop on Health Impacts of WIC–Planning a Research Agenda, Washington, DC, July 20–21. USDA/FNS (U.S. Department of Agriculture/Food and Nutrition Service). 2006. WIC Partici- pant and Program Characteristics 00. Alexandria, VA: USDA/FNS. http://www.fns. usda.gov/ora/MENU/Published/WIC/FILES/pc2004.pdf (accessed November 10, 2010). White House Task Force on Childhood Obesity. 2010. Soling the Problem of Childhood Obesity Within a Generation. Washington, DC: White House Task Force on Childhood Obesity. http://www.letsmove.gov/pdf/TaskForce_on_Childhood_Obesity_May2010_ FullReport.pdf (accessed September 16, 2010).