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conditions." Each state, territorial, or tribal WIC agency uses specific criteria for nutrition risk assessment within these guidelines.1
The criteria (nutrition risk indicators and their cutoff points) used for nutrition risk assessments vary widely across states. Over the years, concerns have been expressed about this variation and the resulting potential for unequal access to the program on the basis of geographic residence (GAO, 1979, 1980; USDA, 1986). As a result, the U.S. Congress in 1989 mandated that the U.S. Department of Agriculture (USDA), in consultation with state WIC agency directors and other nutrition experts, conduct a review of the nutrition risk criteria used by the WIC program (Public Law 101-147). USDA then reviewed a selected group of 14 existing nutrition risk criteria and published a compilation of these reviews in 1991 to fulfill this legislative mandate (USDA, 1991). In its 1992 report, the National Advisory Council on Maternal, Infant, and Fetal Nutrition commented on the 1991 reviews and made recommendations regarding existing nutrition risk criteria. In particular, it recommended that homelessness, migrancy, and alcohol and drug abuse be included as independent nutrition risk criteria (USDA, 1992).
Charge To The Committee
With continued concern over the variation among nutrition risk criteria across state WIC programs, the Food and Nutrition Service (FNS; now the food and Consumer Service [FCS], USDA) requested that the Institute of Medicine (IOM) review the scientific basis for the nutrition risk criteria used in the WIC program. In October 1993, the Food and Nutrition Board of the IOM established the Committee on the Scientific Evaluation of WIC Nutrition Risk Criteria. The committee was charged with conducting a study to include the following:
Performing a critical review of the literature surrounding the various nutrition risk criteria used by the WIC program.
Developing scientific consensus (where possible) regarding the nutrition risk criteria used by the WIC program, taking into account the preventive nature of the program.
Identifying specific segments of the WIC population at risk for each criterion.
Identifying gaps in the scientific knowledge base for current nutrition risk criteria used by the WIC program.
Throughout this report, the generic terms state WIC agency and state agency are used to denote programs or program requirements that apply uniformly to state, territorial, or tribal WIC programs.