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PLANNING A WIC RESEARCH AGENDA WORKSHOP SUMMARY Carol West Suitor, Rapporteur Food and Nutrition Board

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This study was supported by Contract No. AG-3198-C-10-0004 between the National Acad- emy of Sciences and the U.S. Department of Agriculture. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not neces- sarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number 0-13: 978-0-309-16179-4 International Standard Book Number 0-10: 0-309-16179-4 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www. iom.edu. Copyright 2011 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2011. Planning a WIC Research Agenda: Workshop Summary. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” — Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding en- gineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE FOR WIC RESEARCH NEEDS: A WORKSHOP* GAIL G. HARRISON (Chair), Professor, School of Public Health, and Director, Center for Global and Immigrant Health, University of California, Los Angeles MAUREEN BLACK, Scholl Family Professor of Pediatrics, University of Maryland, School of Medicine, Baltimore, MD PATRICIA B. CRAWFORD, Co-Director, Center for Weight and Health and Adjunct Professor, School of Public Health, Department of Nutritional Sciences and Technology, University of California, Berkeley BARBARA DEVANEY, Senior Vice President and Director, Human Services Research, Mathematica Policy Research, Inc., Princeton, NJ MIRIAM LABBOK, Professor of the Practice of Public Health, Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, University of North Carolina, Chapel Hill JACKSON P. SEKHOBO, Director, Evaluation and Analysis Unit, Bureau of Administration and Evaluation, Division of Nutrition, New York State Department of Health, Albany, NY SHANNON E. WHALEY, Director of Research and Evaluation, Public Health Foundation Enterprise WIC Program, Irwindale, CA Study Staff SHEILA MOATS, Study Director CAROL WEST SUITOR, Consultant and Rapporteur SAUNDRA LEE, Senior Program Assistant (until October 15, 2010) ANTON L. BANDY, Financial Associate GERALDINE KENNEDO, Administrative Assistant LINDA D. MEYERS, Director, Food and Nutrition Board *Institute of Medicine planning committees are solely responsible for organizing the work- shop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. 

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report: Janet Currie, Department of Economics, Columbia University Philip M. Gleason, Senior Fellow, Mathematica Policy Research, Inc. Julie Reeder, Senior Research Analyst, WIC Program, Oregon Department of Human Services Jamie S. Stang, Department of Food Science and Nutrition, University of Minnesota School of Public Health Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the report before its release. The review of this report was overseen by Melvin Worth (retired), Institute of Medicine. Appointed by the National Research Coun- cil he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the author and the institution. ii

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Contents OVERVIEW 1 1 Opening Session 5 2 WIC and Birth Outcomes 11 3 WIC and Obesity 25 4 Research Needed to Improve Breastfeeding Protection, Promotion, and Support Within WIC 37 5 Food Insecurity and Hunger 51 6 Dietary Intake and Nutritional Status 61 7 Nutrition Education in WIC 73 8 Health Care and Systems Costs, Benefits, and Effectiveness 87 9 The Reach of WIC 99 10 Closing Session: Wrap-Up and Methodological Issues and Data Considerations 111 APPENDIXES A Workshop Agenda 125 B Biographical Sketches of the Presenters 129 C Workshop Attendees 145 ix

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x CONTENTS D Abbreviations and Acronyms 151 E Excerpts from Comments Received on the Institute of Medicine’s Website for the Workshop to Plan a Research Agenda for WIC 153 F Compilation of Proposed Research Topics and Methodological Issues Covered During the Workshop 159