The Special Supplemental Food Program for Women, Infants, and Children (WIC) provides supplemental food, nutrition and health education, and social services referral to pregnant, breastfeeding, and post-partum women, and their infants and young children who are both low-income and at nutritional risk. A number of statistically controlled evaluations that compared prenatal women who received WIC services with demographically similar women who did not receive WIC services have found WIC enrollment associated with decreased levels of low birth weight among enrolled women's infants. Several also have found lower overall maternal and infant hospital costs among women who had received prenatal WIC services compared with similar women who did not receive prenatal WIC services. A meta-analysis of the studies shows that providing WIC benefits to pregnant women is estimated to reduce low birth weight rates 25 percent and reduce very low birth weight births by 44 percent. Using these data to estimate costs, prenatal WIC enrollment is estimated to have reduced first year medical costs for U.S. infants by $1.19 billion in 1992. Savings from a reduction in estimated Medicaid expenditures in the first year post-partum more than offset the cost of the Federal prenatal WIC Program. Even using more conservative assumptions, providing prenatal WIC benefits was cost-beneficial. Because of the estimated program cost-savings, the U.S. General Accounting Office has recommended that all pregnant women at or below 185 percent of Federal poverty level be eligible for the program.
Public health nutrition programs are intended to serve low-income families who are at greater nutritional risk than the general population. Not all persons who are program-eligible are at equal risk, however. It would be desirable to evaluate a program's ability to enroll persons from higher risk backgrounds in the population (coverage) and, conversely, the extent to which those enrolled in this program are at higher risk (targeting). A method for the evaluation of coverage and targeting was developed using data from the Tennessee Women, Infants, and Children Special Supplemental Food Program (WIC) linked with birth certificates. The linked computer file was created by matching the name and date of birth in both record files. The birth records were the common source of information used to characterize the risk background for both the WIC and non-WIC participants. Maternal sociodemographic information on the birth records was used to define the health risk background of each child. The coverage and targeting of "at-risk" children were computed and compared for 50 counties or county-aggregates in Tennessee. Considerable variation in the coverage and targeting rates of at-risk children was observed among Tennessee counties, although the counties within each WIC administrative region tended to have similar coverage and targeting patterns. Using the existing data in linked program and vital records provides a direct evaluation of a program. Coverage and targeting evaluation can be used to detect underserved populations within small geographic areas.
The Special Supplemental Food Program for Women, Infants, and Children (WIC) provides supplemental food, nutrition education, and referrals to available health and welfare services. Recipients are income-eligible pregnant and postpartum women, their infants, and their children who are younger than 5 years of age. Although studies have documented the nutritional benefits of the program, the extent to which WIC nutritionists help eligible women to obtain available health and welfare services, and the degree to which this referral activity promotes health, is largely unknown. The researchers examined the referral activity at one urban WIC clinic, but did not evaluate the outcomes. Of 1,850 persons seen, there were 762 referrals by WIC nutritionists for 597 persons at the Lawrence, MA, clinic during a 2-month period. Of the 597 persons, 494 (83 percent) were WIC participants and 103 (17 percent) were nonparticipants. The rate of referrals for WIC participants was 27 percent. Multiple referrals were common, with 127 people receiving more than one referral. WIC nutritionists at this site offered a variety of referrals to their clients. The majority of referrals (61.7 percent) were for supplemented food. Nonnutrition-related referrals were to medical and dental services (20.5 percent), developmental and educational services (12.5 percent), and social services (5.4 percent). Nonnutrition-related referrals for women included referrals for family planning, substance abuse, job training, teenaged parenting, and high school equivalency programs. Infants and children were referred for dental care, growth failure, the Head Start Program, kindergarten enrollment, early intervention, and protective services.(ABSTRACT TRUNCATED AT 250 WORDS)
Women's access to prenatal nutrition services was explored using a nationally representative sample of pregnant participants in the Special Supplemental Food Program for Women, Infants, and Children (WIC) in 1984. The probability was examined of the participant entering the program during her first trimester, rather than the second or third trimester. Other research has suggested that length of participation in the program during pregnancy is associated with increased birth weight. The data were adjusted for various personal and local operational factors, such as prior WIC participation, race, age, income, household size, WIC priority level, availability of prenatal or other health services, targeted outreach policies, years of local operation, and local agency size. Previous participation in the WIC Program was the only factor significantly associated with early enrollment (adjusted odds ratio 2.1). Race was marginally significant. Neither the presence of local policies of outreach targeted to pregnant women, nor co-location of WIC services with prenatal or other health services, showed significant effects on early enrollment.
The United States' Special Supplemental Nutrition Program for Women, Infants and Children (WIC) distributes about half the infant formula used in the United States at no cost to the families. This is a matter of concern because it is known that feeding with infant formula results in worse health outcomes for infants than breastfeeding.
The evidence that is available indicates that the WIC program has the effect of promoting the use of infant formula, thus placing infants at higher risk. Moreover, the program violates the widely accepted principles that have been set out in the International Code of Marketing of Breast-milk Substitutes and in the human right to adequate food.
There is no good reason for an agency of government to distribute large quantities of free infant formula. It is recommended that the large-scale distribution of free infant formula by the WIC program should be phased out.
Active Families is a program developed to increase outdoor play and decrease television viewing among preschool-aged children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Our objective was to assess its feasibility and efficacy.
We implemented Active Families in a large WIC clinic in New York State for 1 year. To this end, we incorporated into WIC nutrition counseling sessions a community resource guide with maps showing recreational venues. Outcome measures were children's television viewing and time playing outdoors and parents' behaviors (television viewing, physical activity), self-efficacy to influence children's behaviors, and parenting practices specific to television viewing. We used a nonpaired pretest and posttest design to evaluate the intervention, drawing on comparison data from 3 matched WIC agencies.
Compared with the children at baseline, the children at follow-up were more likely to watch television less than 2 hours per day and play outdoors for at least 60 minutes per day. Additionally, parents reported higher self-efficacy to limit children's television viewing and were more likely to meet physical activity recommendations and watch television less than 2 hours per day.
Results suggest that it is feasible to foster increased outdoor play and reduced television viewing among WIC-enrolled children by incorporating a community resource guide into WIC nutrition counseling sessions. Future research should test the intervention with a stronger evaluation design in multiple settings, with more diverse WIC populations, and by using more objective outcome measures of child behaviors.
Childhood psychological conditions including depression and substance abuse are a growing concern among American children, but their long-term economic costs are unknown. This paper uses unique data from the US Panel Study of Income Dynamics (PSID) following groups of siblings and their parents for up to 40 years prospectively collecting information on education, income, work, and marriage. Following siblings offers an opportunity to control for unobserved family and neighborhood effects. A retrospective child health history designed by the author was placed into the 2007 PSID wave measuring whether respondents had any of 14 childhood physical illnesses or suffered from depression, substance abuse, or other psychological conditions.
Large effects are found on the ability of affected children to work and earn as adults. Educational accomplishments are diminished, and adult family incomes are reduced by 20% or $10,400 per year with $18,000 less family household assets. Lost income is a partly a consequence of seven fewer weeks worked per year. There is also an 11 percentage point lower probability of being married. Controlling for physical childhood diseases shows that these effects are not due to the co-existence of psychological and physical diseases, and estimates controlling for within-sibling differences demonstrate that these effects are not due to unobserved common family differences.
The long-term economic damages of childhood psychological problems are large—a lifetime cost in lost family income of approximately $300,000, and total lifetime economic cost for all those affected of 2.1 trillion dollars.
children; economic cost; psychological health; USA; family incomea
Positive parental attitudes towards infant feeding are an important component in child nutritional health. Previous studies have found that participants in the Special Supplemental Women, Infants, and Children (WIC) Program have lower breastfeeding rates and attitudes that do not contribute towards healthy infant feeding in spite of breastfeeding and nutrition education programs targeting WIC participants. The objective of this study was to assess the frequency of exclusive breastfeeding in the early postpartum period and maternal attitudes towards breastfeeding in a population of mothers at two San Francisco hospitals and in relation to WIC participation status.
We interviewed women who had recently delivered a healthy newborn using a structured interview.
A high percentage (79.8%) of our sample was exclusively breastfeeding at 1–4 days postpartum. We did not find any significant differences in rates of formula or mixed feeding by WIC participant status. Independent risk factors for mixed or formula feeding at 1–3 days postpartum included Asian/Pacific Islander ethnicity (odds ratio [OR] 2.90, 95% confidence interval [CI] 1.17–7.19). Being a college graduate was associated with a decreased risk of formula/mixed feeding (OR 0.28, 95% CI 0.10–0.79). We also found that thinking breastfeeding was physically painful and uncomfortable was independently associated with not breastfeeding (OR 1.41, 95% CI 1.06–1.89).
Future studies should be conducted with Asian-Americans and Pacific Islanders to better understand the lower rates of exclusive breastfeeding in this population and should address negative attitudes towards breastfeeding such as the idea that breastfeeding is painful or uncomfortable.
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) serves 50% of infants and 25% of preschool-aged children in the U.S. and collects height and weight measurements from eligible children every six months, making WIC data a valuable resource for studying childhood growth and obesity. We assessed the accuracy of measurements collected by WIC staff by comparing them to “gold standard” measurements collected by trained research staff. At seven WIC clinics in southern California, 287 children ages 2–5 years measured by WIC staff using WIC standard protocol were re-measured by research staff using a research protocol (duplicate measurements with shoes and outerwear removed taken by trained personnel). Intraclass correlation coefficients measuring agreement between WIC and research protocol measurements for height, weight and body mass index (BMI) were 0.96, 0.99 and 0.93, respectively. Although WIC measurements overestimated height by 0.6 cm and weight by 0.05 kg on average, BMI was underestimated by only 0.15 kg/m2 on average. WIC BMI percentiles classified children as overweight/obese versus underweight/normal with 86% sensitivity and 92% specificity. We conclude that height, weight and BMI measurements of children aged 2–5 years collected by trained WIC staff are sufficiently accurate for monitoring and research purposes.
A significant improvement in the quality of births by low-income women can be achieved by implementing a low-cost screening procedure and by coordinating private and public sector services that these women may already be receiving. This proposal outlines a screening program for gestational diabetes, coupled with multidisciplinary team management of this disorder through cooperative efforts of private sector medical practitioners and the public sector nutrition program for Women, Infants, and Children (WIC). The investment in this proposal is catalytic: the long-term intent is to persuade those in the medical community in the targeted geographic area to adopt the screening procedure and coordination with the WIC Program as a standard part of their prenatal care. If this proposed program is successful, it could be replicated in other parts of the country.
Recent evaluation studies have described the benefits accruing to low-income women and children who participate in the Special Supplemental Food Program for Women, Infants, and Children (WIC). However, participation is not uniform among all groups of eligible persons. This study examines the geographic variation in WIC participation rates of eligible pregnant women in Rhode Island to determine whether the program is effective in reaching the neediest segments of the population. Eight groups of small geographic areas in Rhode Island (census tracts) were formed on the basis of need for maternal and child health services, as determined from a statistical method employing factor and cluster analysis of existing health and sociodemographic data. Among these eight groups, participation rates in WIC during 1983-84 ranged from 46 percent to more than 100 percent of estimated eligible pregnant women. The rates were positively correlated with measures of need, strongly (r = 0.92) with an index of maternal risk, and less strongly (r = 0.79) with an index of birth outcomes. The results of this study have enabled the Rhode Island WIC Program to direct its outreach efforts more specifically to geographic areas where the need for the program's assistance is greatest. The procedures described in this report comprise a technique that can be generally applied to measure program effectiveness in marketing and outreach where relevant data are available by small geographic areas. The data requirements are (a) population-based estimates of program need and (b) program utilization measures. If these data can be aggregated to a common set of small geographic areas, the use of marketing analysis techniques becomes possible, and program benefits in the area of outreach and recruitment can be realized.
An examination of length, weight, and birth weight data routinely collected from the clinics supported by the Navajo Nation Special Supplemental Program for Women, Infants, and Children (WIC) showed an association between birth weight and subsequent growth status. Navajo children less than 2 years of age entering the WIC Program were divided into low, normal, and high birth weight groups, and their growth patterns were plotted when they returned periodically for reassessment. Overall, the children tended to have low length-for-age and high weight-for-length measures, relative to the reference population, that suggest suboptimal nutritional status. Children with birth weights less than 2,500 grams (g) were consistently shorter, lighter, and thinner than children with birth weights greater than 2,500 g. Although the overall growth status of the children improved between 1975 and 1980, the growth among the children with low birth weights never fully caught up with that of the other Navajo children. Moreover, during that period, the normal birth weight group had a modest improvement in length-for-age relative to the reference population, but the low birth weight group did not. These findings suggest that prenatal interventions to improve the birth weight status of Navajo infants may result in improving the growth status of Navajo children.
To assess the accuracy of maternally reported birth weights, we compared birth weights reported by mothers in the Tennessee Women, Infants, and Children Supplemental Feeding Program (WIC) from 1975 to 1984 with the birth weights recorded on the corresponding Tennessee birth certificate file. Differences in birth weights between these two sources were compared for the total group and were also stratified by sociodemographic and medical variables that might influence the accuracy of birth weight recall. An accurate birth weight was defined as one reported within 1 ounce of the birth certificate birth weight. We also calculated the proportion of birth weights that would be incorrectly classified as low or normal by maternal reporting. A total of 72,245 WIC records were matched with their corresponding birth certificates. Of these, 46,637 had WIC birth weights recorded within the specified birth weight range. Eighty-nine percent of birth weights were reported within 1 ounce of birth certificate birth weights. Lower accuracy of birth weight reporting was associated with the infant's low birth weight, preterm delivery, and low Apgar scores, and with the mother's grand multiparity, less than a high school education, black race, single marital status, and young age. Only 1.1 percent of birth weights would have been incorrectly classified into low or normal birth weight categories based on maternal reporting. Overall, our results suggest that maternally reported birth weights are sufficiently accurate for research and programmatic purposes when birth certificate information is not readily available.
The Panel Study of Income Dynamics (PSID) is a nationally representative longitudinal survey of approximately 9,000 families and their descendants that has been ongoing since 1968. Since 1969, families have been sent a mailing asking them to update or verify their contact information to keep track of their whereabouts between waves. Having updated contact information prior to data collection is associated with fewer call attempts and refusal conversion efforts, less tracking, and lower attrition. Given these apparent advantages, a study was designed in advance of the 2009 PSID field effort to improve the response rate of the contact update mailing. Families were randomly assigned to the following conditions: mailing design (traditional versus new), $10 as a prepaid versus postpaid incentive, timing and frequency of the mailing (July 2008 versus October 2008 versus both times) and whether or not they were sent a study newsletter. This paper reports on findings with regards to response rates to the mailing and the effect on production outcomes including tracking rates and number of calls during 2009 by these different conditions, examines whether the treatment effects differ by key characteristics of panel members including likelihood of moving and anticipated difficulty in completing an interview, and provides some recommendations for the use of contact update strategies in panel studies.
Panel study; non-response; contact strategies; survey methods; attrition; tracking; field effort; respondent burden
Great progress on key issues in maternal nutrition has been made in the past few years, mainly because of the legislative requirements of the U.S. Department of Agriculture's Special Supplemental Food Program for Women, Infants, and Children (WIC Program). These advances are most timely because of the general recognition that, in this period of finite resources, we will need to make optimal use of resources such as the food package, nutrition education, and health services that together make up the WIC Program benefits. Major progress has been made in the following critical areas: (a) agreement on nutritional risk criteria; (b) identification of dietary risk factors; (c) increased availability of a variety of computer-assisted techniques for collecting, managing, and analyzing dietary intakes on large numbers of patients; and (d) recognition of the need for and availability of a variety of alternative dietary standards in the provision of overall services to pregnant women.
Of even greater importance is the recognition that we can no longer treat nutrition as a single variable, independent of the many other forces that together influence the course and outcome of a pregnancy. Rather, we recognize that there is a seamless web of influences, all of which need to be taken into account in attempts to provide for the needs of pregnant women at risk of poor pregnancy outcomes.
The timely application of all of these advances will greatly facilitate a more efficient and effective use of resources such as are provided by the WIC Program. They will also provide both the patients and their health care providers with more realistic expectations of what might be accomplished towards improving the outcomes of pregnancies at nutritional risk.
This study estimated the prevalence of twenty-two 12-month and lifetime psychiatric disorders in a sample of 744 low-income pregnant women and the frequency that women with psychiatric disorders received treatment.
To identify psychiatric disorders, the Diagnostic Interview Schedule (DIS) was administered to Medicaid or Medicaid-eligible pregnant women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The sample was stratified by the rural or urban location of the WIC sites in southeastern Missouri and the city of St. Louis. Eligible women were enrolled at each site until their numbers were proportional to the racial distribution of African American and Caucasian pregnant women served there.
The 12-month prevalence of one or more psychiatric disorders was 30.9%. Most common were affective disorders (13.6%), particularly major depressive disorder (8.2%) and bipolar I disorder (5.2%). Only 24.3% of those with a psychiatric disorder reported that they received treatment in the past year. Lifetime prevalence of at least one disorder was 45.6%, with affective disorders being the most frequent (23.5%). Caucasian women were more likely than African Americans to have at least one 12-month disorder, with the difference largely accounted for by nicotine dependence. Higher prevalence of lifetime disorders was also found in Caucasian women, particularly affective disorders and substance use disorders. There were no differences in the prevalence of 12-month or lifetime psychiatric disorders by the urban or rural residence of subjects.
With nearly one third of pregnant women meeting criteria for a 12-month psychiatric disorder and only one fourth receiving any type of mental health treatment, comprehensive psychiatric screening during pregnancy is needed along with appropriate treatment.
Low childhood immunization rates have been a challenge in Colorado, an issue that was exacerbated by a diphtheria-tetanus-acellular pertussis (DTaP) vaccine shortage that began in 2001. To combat this shortage, the locally based Tri-County Health Department conducted a study to assess immunization-related barriers among children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a population at risk for undervaccination.
This study assessed characteristics and perceptions of WIC mothers in conjunction with their children's immunization status in four clinics.
Results indicated poor immunization rates, which improved with assessment and referral. The uninsured were at higher risk for undervaccination. DTaP was the most commonly missing vaccine, and discrepancies existed between the children's perceived and actual immunization status, particularly regarding DTaP. Targeted interventions were initiated as a result of this study.
Local health departments should target immunization-related interventions by assessing their own WIC populations to identify unique vaccine-related deficiencies, misperceptions, and high-risk subpopulations.
We examined the associations of oral health literacy (OHL) with oral health status (OHS) and dental neglect (DN), and explored whether self-efficacy (SE) mediated or modified these associations, among a sample of female clients of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).
We used interview data that were collected from 1280 female WIC clients as part of the Carolina Oral Health Literacy (COHL) Project between 2007 and 2009. OHL was measured with a validated word recognition test (REALD-30) and oral health status with the self-reported NHANES item. Analyses relied upon descriptive, bivariate, and multivariate methods.
Less than one-third of participants rated their oral health as very good or excellent. Higher OHL was associated with better oral health status (multivariate PR=1.29; 95% CL=1.08, 1.54, for 10-unit REALD increase). OHL was not correlated with DN but SE showed a strong negative correlation with DN. SE remained significantly associated with DN in a fully-adjusted model that included OHL.
Increased OHL was associated with better OHS but not DN. Self-efficacy was a strong correlate of DN and may mediate the effects of literacy on oral health status.
Cognitive data were obtained on 19 of the 21 pairs of siblings who had been in the authors' earlier study of behavioral outcomes associated with participation in the Special Supplemental Food Program for Women, Infants, and Children (WIC). The timing of WIC participation differed for the members of the sibling pairs, beginning in the perinatal period for one sibling and after 1 year of age for the other. The perinatally supplemented siblings received WIC services for an average of 22 months longer than the siblings whose supplementation began at 1 year of age. The present study determined that enhancements in IQ scores proved stable on blind retesting 32 months after the original study, with those siblings who were supplemented perinatally (and for a longer duration) continuing to exhibit higher scores. The group differences in school grade point averages were in the expected direction at followup, but fell short of statistical significance.
The purpose of this study was to assess whether providing a breastfeeding support team (BST) results in higher breastfeeding rates at 6, 12, and 24 weeks postpartum among urban low-income mothers.
Design: A randomized controlled trial with mother-infant dyads recruited from two urban hospitals. Participants: Breastfeeding mothers of full term infants who were eligible for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (n=328) were randomized to intervention (n=168) or usual care group (n=160). Intervention: The 24 week intervention included hospital visits by a breastfeeding support team (BST), home visits, telephone support, and 24 hour pager access. The usual care group received standard care. Outcome Measure: Breastfeeding status was assessed by self report at 6, 12, and 24 weeks postpartum.
There were no differences in the sociodemographic characteristics between the groups: 87% were African American, 80% single, and 51% primiparous. Compared to the usual care group, more women reported breastfeeding in the intervention at 6 weeks postpartum, 66.7% vs. 56.9% OR 1.71 (95% CI 1.07, 2.76). The difference in rates at 12 weeks postpartum, 49.4% versus 40.6%, and 24 weeks postpartum, 29.2% versus 28.1%, were not statistically significant.
The intervention group was more likely to be breastfeeding at six weeks postpartum compared with usual care group, a time that coincided with the most intensive part of the intervention.
breastfeeding; low-income mothers; randomized controlled trial; community intervention
To examine whether socioeconomic status (SES) gradients emerge in health outcomes as early as birth and to examine the magnitude, potential sources, and explanations of any observed SES gradients.
The National Maternal and Infant Health Survey conducted in 1988.
A multinomial logistic regression of trichotomized birth-weight categories was conducted for normal birth-weight (2,500–5,500 grams), low birth-weight (LBWT; <2,500 grams), and heavy birth-weight (>5,500 grams). Key variables included income, education, occupational grade, state-level income inequality, and length of participation in Women-Infants-Children (WIC) for pregnant mothers.
A socioeconomic gradient for low birth-weight was discovered for an adjusted household income measure, net of all covariates in the unrestricted models. A gross effect of maternal education was explained by maternal smoking behaviors, while no effect of occupational grade was observed, net of household income. There were no significant state-level income inequality effects (Gini coefficient) for any of the models. In addition, participation in WIC was discovered to substantially flatten income gradients for short-term participants and virtually eliminate an income gradient among long-term participants.
Although a materialist explanation for early-life SES gradients seems the most plausible (vis-à-vis psychosocial and occupational explanations), more research is needed to discover potential interventions. In addition, the notion of a monotonic gradient in which income is salutary across the full range of the distribution is challenged by these data such that income may cease to be beneficial after a given threshold. Finally, the success of WIC participation in flattening SES gradients argues for either: (a) the experimental efficacy of WIC, or (b) the biasing selection characteristics of WIC participants; either conclusion suggests that interventions or characteristics of participants deserves further study as a potential remedy for socioeconomic disparities in early-life health outcomes such as LBWT.
Socioeconomic status gradients; low birth-weight
Studies using community-based breastfeeding counselors (CBBCs) have repeatedly shown positive impact on breastfeeding initiation, exclusivity and duration, particularly among low-income mothers. To date, there has not been a comprehensive study to determine the impact of CBBC attributes such as educational background and training, on the type of care that CBBCs provide.
This was a cross-sectional study of a convenience sample of CBBCs to ascertain the influence of counselor education and type of training on type of support and proficiency of CBBCs in communities across the United States. Invitations to participate in this online survey of CBBCs were e-mailed to program coordinators of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), La Leche League, and other community-based health organizations, who in turn invited and encouraged their CBBCs to participate. Descriptive analysis was used to describe participants (N = 847), while bivariate analysis using χ2 test was used to examine the differences between CBBC education, training received and breastfeeding support skills used. Multivariate logistic regression was used to assess the independent determinants of specific breastfeeding support skills.
The major findings from the research indicate that overall, educational attainment of CBBCs is not a significant predictor for the curriculum used in their training and type of support skills used during counseling sessions, but initial training duration was positively associated with the use of many breastfeeding support skills. Another major influence of counselor support to clients is the type of continuing education they receive after their initial training, with higher likelihood of use of desirable support skills associated with counselors continuing their breastfeeding education at conferences or trainings away from their job sites.
Our results show that different programs use different training curricula to train their CBBCs varying in duration and content. Counselor education is not a significant predictor of the type of training they receive. Continuing breastfeeding education is a significant determinant of type of counseling techniques used with clients. Further research is therefore needed to critically examine the content of the various training curricula of CBBC programs. This may show a need for a standardized training curriculum for all CBBC programs worldwide to make CBBCs more proficient and efficient, ensuring successful and optimum breastfeeding experiences for mothers and their newborns.
Early childhood caries is a challenging public health problem in the United States and elsewhere; however, there is limited information concerning risk factors in very young children. The purpose of this study was to assess baseline risk factors for 18-month caries prevalence as part of a longitudinal study of high-risk children.
212 children 6–24 months of age were recruited from a rural community in Iowa. Subjects were enrolled in the WIC program, which provides nutritional support for low-income families with children. Dental examinations using d1d2-3 criteria were conducted at baseline and after 18 months. Caries prevalence was determined at the frank decay level (d2-3 or filled surfaces), as well as at the non-cavitated level (d1), and combined (d1, d2-3 or f surfaces). Risk factor data were collected at baseline and after 9- and 18- months. These data included beverage consumption data, presence of visible plaque, and use of fluoride toothpaste for children as well as mutans streptococci (MS) levels of mothers and children and family socio-demographic factors.
128 children (60%) remained in the study after 18 months. Among these children, prevalence of d-1d2-3/f level caries increased from 9% to 77%, while d2-3/f level caries increased from 2% to 20%. Logistic regression models for baseline predictors of d2-3f caries at the 18-month follow-up found presence of MS in children (OR=4.4; 95% CI: 1.4, 13.9) and sugar-sweetened beverages (OR=3.0; 95% CI: 1.1, 8.6) to be the only significant risk factors. Socio-demographic factors and use of fluoride toothpaste were not significant in these models.
Results suggest that early colonization by MS and consumption of sugar-sweetened beverages are significant predictors of early childhood caries in high-risk populations.
Dental caries; primary dentition; children; risk factors; mutans streptococci
The objective of this study was to evaluate the relationship between maternal nutrition knowledge and maternal socio-demographics including participation in the Special Supplemental Women, Infants and Children’s (WIC) Program. A cross-sectional study of new mothers at two San Francisco hospitals was conducted using some of the American Academy of Pediatrics’ guidelines in a structured questionnaire to assess maternal nutritional knowledge. Maternal nutritional attitudes towards product nutrient labels were also assessed in a questionnaire format. Logistic regression models were used to evaluate the odds of having high maternal nutrition knowledge and of infrequently reading nutrition labels. In multivariate logistic regression models, higher maternal nutrition knowledge (defined as answering all four nutrition questions correctly) was associated with higher income levels defined as ≥$25 000/year, odds ratio (OR) 10.03 95% confidence interval (CI) (1.51–66.74), and in linear models, higher nutritional knowledge was associated with having more children (P < 0.01), a higher income (P = 0.01) and not being a WIC participant (P < 0.01). Mothers with higher incomes were also more likely to read product nutritional labels OR 4.24, 95% CI (1.24–14.51), compared with mothers with lower incomes as were mothers with higher education levels OR 3.32, 95% CI (1.28–8.63). In San Francisco, lower income mothers are at greatest risk for low maternal nutrition knowledge and not reading product nutritional labels. Higher household income was independently associated with increased maternal nutrition knowledge and likelihood of reading nutritional labels. More comprehensive interventions need to target low-income mothers including current WIC participants to help close the nutritional advantages gap conferred by income and education.
maternal nutrition knowledge; nutrient labels; WIC Program
This study replicates a 1980 evaluation of WIC prenatal participation in Missouri by using a file of 9,086 Missouri Medicaid records matched with the corresponding birth records. This file was divided into a WIC group containing 3,261 records and a non-WIC group of 5,825 records. The 1982 results generally confirm the 1980 results, with the 1982 findings showing slightly improved pregnancy outcomes for WIC participants and slightly reduced benefit-to-cost ratios compared with the 1980 findings. In 1982, WIC participation was found to be associated with an increase in mean birth weight of 31 grams and reductions in low birth weight rates (statistically significant) and in neonatal death rates (not statistically significant). The reduction in each rate was 23 percent. WIC participation was also associated with a reduction in Medicaid costs for newborns reported within 45 days of birth amounting to $76 per participant. For every dollar spent on WIC, about 49 cents in Medicaid costs were apparently saved. However, wide 95 percent confidence intervals ($.07, $.90) make it difficult to determine precisely what impact WIC has on Federal and State budget outlays.