The Benefits and Challenges of Providing School Meals during the First Year of California's Universal School Meal Policy as Reported by School Foodservice Professionals.

States in the U.S. are newly implementing universal school meal (USM) policies, yet little is known about the facilitators of their success and the challenges they confront. This study evaluated the challenges and facilitators faced by school food authorities (SFAs) implementing California's universal school meal (USM) policy during its inaugural year (2022-2023) using an online survey. In March 2023, 430 SFAs reported many benefits, including increased meal participation (64.2% of SFAs) and revenues (65.7%), reduced meal debt (41.8%) and stigma (30.9%), and improved meal quality (44.3%) and staff salaries (36.9%). Reported challenges include product/ingredient availability (80.9%), staffing shortages (77.0%), vendor/distributor logistics issues (75.9%), and administrative burden (74.9%). Top facilitators included state funding (78.2%) and increased federal reimbursement (77.2%). SFAs with fewer students eligible for free or reduced-price meals (as opposed to SFAs with more) reported greater increases in meal participation and reductions in stigma but also more administrative burdens. Larger SFAs reported greater increases in revenues, staff salaries, and improvements in meal quality than smaller SFAs but also more challenges. Overall, California's USM policy has enhanced student access to healthy meals while mitigating social and financial barriers. Understanding California's experience can inform other jurisdictions considering or implementing similar policies.

Associations of Increased WIC Benefits for Fruits and Vegetables With Food Security and Satisfaction by Race and Ethnicity.

Introduction: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition support for racially and ethnically diverse populations. In 2021, the monthly cash value benefit (CVB) for the purchase of fruits and vegetables increased from $9 to $35 and was later adjusted to $24. This study investigated, by racial and ethnic groups, whether CVB increases were associated with increases in CVB redemption, household food security, child fruit and vegetable intake, satisfaction with CVB amount, and likelihood of continued participation in WIC if the CVB returned to $9 per month. Methods: We conducted a longitudinal study of WIC participants (N = 1,770) in southern California at 3 time points, from April 2021 through May 2022; the CVB amount was $9 at baseline, $35 at Survey 2, and $24 at Survey 3. Racial and ethnic groups were Hispanic English-speakers, Hispanic Spanish-speakers, non-Hispanic Asian, non-Hispanic Black, non-Hispanic Other, and non-Hispanic White. We used mixed-effect and modified Poisson regressions to evaluate outcomes by group. Results: At baseline, groups differed significantly in dollars of CVB redeemed, percentage of CVB redeemed, household food security, and satisfaction with CVB amount. After the increase in CVB, we found increases in all groups in CVB redemption, household food security, and satisfaction. Non-Hispanic Black and Hispanic English-speaking groups, who had low levels of satisfaction at baseline, had larger increases in satisfaction than other groups. Reported likelihood of continued WIC participation if the monthly CVB returned to $9 also differed significantly by group, ranging from 62.5% to 90.0%. Conclusion: The increase in CVB for children receiving WIC benefited all racial and ethnic groups. Continued investment in an augmented CVB could improve health outcomes for a racially and ethnically diverse WIC population.

Differences in Infant Diet Quality Index by Race and Ethnicity Predict Differences in Later Diet Quality.

BACKGROUND: Racial and ethnic disparities in infant-feeding practices may negatively influence diet quality and health. OBJECTIVES: This study investigated the racial, ethnic, and language (English or Spanish) differences in infant diet quality, later diet quality, and weight status at 2-5 y, and whether these differences were explained through infant diet quality among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). METHODS: Using the WIC Infant and Toddler Feeding Practices Study-2 (unweighted n = 2663; weighted n = 362,712), relationships between the Infant Dietary Quality Index (IDQI; range 0-1) and Healthy Eating Index-2020 (HEI-2020; range 0-100) and BMI z-score (BMIz) at 2-5 y were analyzed by race, ethnicity, and language preference [Hispanic Spanish-speaking, Hispanic English-speaking, non-Hispanic (NH) White, and NH Black participants]. Statistical interaction between IDQI and each group was evaluated in multivariable models. The mediation of each group through the IDQI was assessed using causal mediation methods. RESULTS: Differences in IDQI [mean (standard deviation)] were observed between Hispanic Spanish-speaking participants [0.41 (0.10)], Hispanic English-speaking participants [0.37 (0.10)], NH White participants [0.36 (0.10)], and NH Black participants [0.35 (0.09)], P < 0.001. Differences in HEI-2020 occurred at 2-5 y, with the Hispanic Spanish-speaking participants having consistently higher HEI-2020 scores. Differences in BMIz were observed at 5 y, with higher scores among Hispanic Spanish-speaking participants. Interaction between race, ethnicity, and IDQI was observed for all outcomes except for BMIz at 3 y. Through mediation, IDQI explained 13%-20% of the difference in HEI-2020 scores between Hispanic Spanish-speaking and NH White participants at 2-5 y. IDQI explained 22%-25% of the difference in HEI-2020 scores between the Hispanic Spanish-speaking and NH Black participants at 4 y and 5 y. CONCLUSIONS: Higher infant diet quality scores observed in Hispanic Spanish-speaking participants explain some of the racial and ethnic differences observed in later diet quality, suggesting that improving infant diet quality may help reduce diet disparities during early childhood.

Increased WIC Benefits for Fruits and Vegetables Increases Food Security and Satisfaction Among California Households with Young Children.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a critical source of nutrition support for young children in low-income families, providing access to healthy foods and a cash value benefit (CVB) for the purchase of fruits and vegetables (FV). In 2021, the WIC CVB increased substantially for women and children aged 1 to 5 years. OBJECTIVE: To investigate whether or not the increased WIC CVB for purchasing FV was associated with greater redemption of the FV benefit, satisfaction, household food security, and child FV intake. DESIGN: Longitudinal study of WIC participants receiving WIC benefits from May 2021 through May 2022. Through May 2021, the WIC CVB for children aged 1 to 4 years was $9/month. The value increased to $35/month from June through September 2021, and changed to $24/month starting October 2021. PARTICIPANTS AND SETTING: WIC participants from seven WIC sites in California with one or more child aged 1 to 4 years during May 2021 and one or more follow-up surveys during September 2021 or May 2022 (N = 1,770). MAIN OUTCOMES AND MEASURES: CVB redemption (in US dollars), satisfaction with the amount (prevalence), household food security (prevalence), and child FV intake (cups per day). STATISTICAL ANALYSES: Associations of increased CVB issuance following the June 2021 CVB augmentation with child FV intake and CVB redemption were assessed using mixed effects regression, and associations with satisfaction and household food security were assessed using modified Poisson regression. RESULTS: The increased CVB was associated with significantly greater redemption and satisfaction. At the second follow-up (May 2022), household food security increased by 10% (95% CI 7% to 12%); total FV intake decreased by 0.03 c/day (95% CI -0.06 to -0.01) in the overall sample, but increased by 0.23 c/day (95% CI 0.17 to 0.29) among children with the lowest baseline FV intake. CONCLUSIONS: This study documented benefits of augmentation to the CVB for children. WIC policy augmenting the value of WIC food packages to increase access to FV had the intended effects, lending support to making the increased FV benefit permanent.

Racial and Ethnic Comparisons in Satisfaction with Services Provided by the Special Supplemental Nutrition Program for Women, Infants, and Children in California.

Understanding satisfaction of nutrition education and other services provided in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is needed to ensure the program is responsive to the needs of diverse populations. This study examined the variation of WIC participants' perceptions and satisfaction with WIC nutrition education and services by race, ethnicity, and language preference. Phone surveys were conducted in 2019 with California WIC families with children aged 1−4 years. While most participants (86%) preferred one-on-one nutrition education, online/mobile apps were also favored (69%). The majority (89%) found nutrition education equally important to receiving the WIC food package. Racial/ethnic groups differed in which WIC service they primarily valued as 20% of non-Hispanic White people rated the food package as more important than nutrition education compared to 5% of Spanish- and 6% of English-speaking Hispanic people, respectively. More Spanish (91%) and English-speaking Hispanic people (87%) than non-Hispanic white (79%) or Black people (74%) changed a behavior because of something they learned at WIC (p < 0.001). Spanish-speaking Hispanic people (90%) had the highest satisfaction with WIC nutrition education. Preferential differences among participants suggest that providing flexible options may improve program satisfaction and emphasizes the need for future studies to examine WIC services by race and ethnicity.

California WIC Participants Report Favorable Impacts of the COVID-Related Increase to the WIC Cash Value Benefit.

The United States Department of Agriculture approved an increase to the Cash Value Benefit (CVB) for the purchase of fruits and vegetables issued to participants receiving an eligible Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package. In order to understand satisfaction, perceptions, and the overall impact of additional benefits for fruits and vegetables at the household level, a qualitative study consisting of structured phone interviews was conducted with families served by WIC in Southern California from November to December 2021 (n = 30). Families were selected from a large longitudinal study sample (N = 2784); the sample was restricted by benefit redemption and stratified by language and race. WIC participants were highly satisfied with the CVB increase, reporting increased purchasing and consumption of a variety of fruits and vegetables. Respondents noted the improved quality and variety of fruits and vegetables purchased due to the increased amount. Findings are expected to inform policy makers to adjust the CVB offered in the WIC food package with the potential to improve participant satisfaction and increase participation and retention of eligible families with benefits from healthy diets supported by WIC.

A Qualitative Examination of California WIC Participants' and Local Agency Directors' Experiences during the Coronavirus Disease 2019 Pandemic.

BACKGROUND: The US Department of Agriculture granted waivers to allow flexibility in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) operations during the coronavirus disease 2019 (COVID-19) pandemic; however, research examining the associations between waiver introduction and changes in perceptions, practices, and challenges of WIC participants' and agency directors' experiences is limited. OBJECTIVE: The objective of this study was to assess California WIC participants' and agency directors' perceptions and practices of remote WIC services during the COVID-19 pandemic. A secondary aim was to understand other COVID-19 challenges related to maintaining access to healthy foods by WIC participants. DESIGN: A qualitative study that included semistructured interviews was conducted between June 2020 and March 2021. PARTICIPANTS AND SETTING: One hundred eighty-two WIC participants with a child aged 0 to 5 years from three regions of California (Southern, Central, and Northern) and 22 local WIC agency directors across the state were interviewed. MAIN OUTCOME MEASURES: WIC participants' and agency directors' perceptions, practices, and other challenges during COVID-19. STATISTICAL ANALYSES PERFORMED: Interviews were recorded, transcribed, and analyzed using a grounded theory approach. RESULTS: Participants shared that they valued the information received from WIC and were very satisfied with remote WIC services. Participants reported that enrolling in WIC remotely was easier than coming in person. All waivers and changes to WIC operations, namely the physical presence, remote benefit issuance, and separation of duties waivers, and remote work and remote delivery of nutrition education, were largely viewed by WIC agency directors as options that should be continued postpandemic. Further, a majority (63%) of households reported experiencing food insecurity, and half of respondents received food from a food bank or pantry during the pandemic. CONCLUSIONS: Findings suggest WIC will attract and retain the most families by offering a hybrid model of services, incorporating both onsite services and remote options to work more efficiently and effectively.

Longer Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participation Duration Is Associated with Higher Diet Quality at Age 5 Years.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides supplemental healthy foods and nutrition education to children under age 5 y in low-income households. OBJECTIVES: We aimed to identify characteristics associated with duration of WIC participation and assess how participation duration relates to household food insecurity (HFI), child diet quality, and child weight status at age 60 mo. METHODS: This analysis of the WIC Infant and Toddler Feeding Practices Study-2, a prospective cohort of WIC-participating children enrolled in 2013, included children with complete baseline-60 mo data (n = 836). Outcomes assessed with WIC participation duration in multivariable regression were HFI (USDA 6-item Household Food Security Screener), child diet quality on a given day [Healthy Eating Index (HEI)-2015], and obesity (CDC BMI-for-age ≥95th percentile). RESULTS: Factors associated with longer WIC participation included male sex; lower household income; reported diet changes in response to WIC nutrition education; household Supplemental Nutrition Assistance Program participation; English-speaking Hispanic, Spanish-speaking Hispanic, and non-Hispanic other maternal race-ethnicity and language preference; an ever-married mother; lower maternal education; higher maternal age; earlier enrollment during pregnancy; and reporting a subsequent pregnancy. Longer WIC participation was associated with lower HFI odds (OR: 0.69; 95% CI: 0.51, 0.95), higher total HEI-2015 (ß: 0.73; 95% CI: 0.20, 1.25), and higher obesity odds (OR: 1.20; 95% CI: 1.05, 1.37) in multivariable-adjusted regression models. CONCLUSIONS: Longer WIC participation was associated with reduced HFI and higher diet quality, and unexpectedly with higher obesity odds, at 60 mo. Further research is needed to confirm and understand mechanisms underlying the unexpected associations identified with longer WIC participation (e.g., male sex, obesity). Groups with shorter participation durations may benefit from targeted WIC retention efforts to maximize nutrition security.

Helping College Students Get Supplemental Nutrition Assistance Program: Facilitators of and Barriers to Students Accessing the Federal Nutrition Assistance Program.

OBJECTIVE: To identify effective practices for assisting college students with Supplemental Nutrition Assistance Program (SNAP) applications and explore challenges in student SNAP enrollment. DESIGN: In-depth interviews with key informants on experiences assisting college students with SNAP applications. SETTING: University of California campuses. PARTICIPANTS: Twenty-one key informants, including staff from the University of California on-campus Basic Needs Centers, campus financial aid offices, county agencies, and food banks. PHENOMENON OF INTEREST: Facilitators and barriers of college student SNAP enrollment. ANALYSIS: Transcripts were coded to identify emerging themes. RESULTS: Two of the most frequently mentioned facilitators were county staff presence on campus for application assistance and a strong relationship between campus staff and the county SNAP agency. A common barrier was inconsistent student SNAP eligibility information and procedures across county offices. CONCLUSION AND IMPLICATIONS: Federal coordination with state agencies on student SNAP policy is much needed. This approach could help to eliminate heterogeneous interpretations of student exemptions across counties and between county staff. Future research is warranted to identify policy leverage points at the county, state, and federal levels, such as eliminating the student rule, to ensure equitable access to SNAP among college students.

Longer Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children Is Not Associated with Reduced Sugar-Sweetened Beverage Intake among Black Participants.

This study assessed relationships of duration of family Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participation with racial/ethnic disparities in child sugar-sweetened beverage (SSB) and water intake. Child beverage intake and family duration on WIC were collected during three cross-sectional surveys of WIC-participating families in Los Angeles County, California (2014, 2017 and 2020; n = 11,482). The associations of family duration of WIC participation, a proxy for the amount of WIC services received, with daily intake of total SSBs, fruit-flavored SSBs and water were assessed in race/ethnicity strata with multivariable negative binomial and Poisson regression models. Among English-speaking Hispanic children, those of families reporting 10 years of WIC participation consumed 33% and 27% fewer servings of total and fruit-flavored SSBs compared to those of families reporting 1 year on WIC. Among Black children, those from families reporting 5 and 10 years of participation in WIC consumed 33% and 45% more daily servings of fruit-flavored SSBs than those from families reporting 1 year on WIC. Disparities in daily total and fruit-flavored SSB intake between Black and White children increased with longer family duration on WIC. Duration of family WIC participation is associated with healthier beverage choices for infants and children, but does not appear to be equally beneficial across racial/ethnic groups in Los Angeles County.

Earlier Introduction to Sugar-Sweetened Beverages Associated With Lower Diet Quality Among WIC Children at Age 3 Years.

OBJECTIVE: Examine the association between the timing of sugar-sweetened beverages (SSBs) and 100% juice introduction with subsequent diet quality at age 3 years. DESIGN: Secondary analysis of a publicly available, national longitudinal dataset. PARTICIPANTS: A total of 2,218 children from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). MAIN OUTCOME MEASURE: Dietary intakes were assessed using a 24-hour dietary recall completed by caregivers of children aged 3 years. Diet quality was assessed using the Healthy Eating Index Score-2015 (HEI-2015). ANALYSIS: Linear regression was used to assess the relationship between the timing of introduction to 100% juice and SSBs with HEI-2015. Adjustments were made for child- and maternal-related factors. RESULTS: Delayed introduction of SSBs during the first 2 years of life was associated with an increased HEI-2015 score. In adjusted analyses, for every 1-month delay in the introduction, there was a 0.09-point increase (95% confidence interval, 0.04-0.13) in the HEI-2015 score at 3 years. CONCLUSIONS AND IMPLICATIONS: Earlier introduction to SSBs may be associated with subsequent lower diet quality in WIC participants. This association may be driven by total fruit, whole grains, and added sugars HEI component scores. Further research is needed to support changes to existing WIC nutrition practices regarding SSBs and 100% juice.

Alignment of California WIC Participant Preferences With Proposed WIC Food Package Recommendations.

OBJECTIVE: Assess alignment of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participant preferences with the National Academies of Sciences, Engineering, and Medicine WIC child food package recommendations and compare differences by race/ethnicity. METHODS: Cross-sectional examination of survey responses collected between January and May 2019 from 2,993 California WIC families with children aged 1-4 years. RESULTS: Over half of WIC participants (56.1%) wanted an increase in the amount allocated for fruits and vegetables. Many WIC participants (69.6%) thought the amount of juice offered by WIC was just right. Overall, the majority (91.0%) wanted to substitute more fruits and vegetables for juice. Most were satisfied with the amount of beans (78.4%), peanut butter (78.7%), and milk (88.3%). Preferences differed by race/ethnicity. CONCLUSIONS AND IMPLICATIONS: Preferences of California WIC participants are highly aligned with the proposed National Academies of Sciences, Engineering, and Medicine changes for increasing fruits and vegetables. Notable differences by race/ethnicity suggest the need for more flexibility.

Healthy default beverage policies for kids' meals: A statewide baseline assessment of restaurant managers' perceptions and knowledge in Delaware.

The consumption of sugar-sweetened beverages (SSBs) has been linked to obesity, diabetes, and other negative health outcomes among children. In response, many government entities have enacted healthy default beverage policies that require restaurants offering bundled kids' meals-food and drink items combined and sold as a single unit-to include only healthier drinks. Despite growing interest in these policies, little is known about their potential reach, restaurant management perceptions, and possible implementation challenges. This study evaluated restaurant managers' knowledge and support of a policy in Delaware that had passed, but not yet gone into effect. We conducted structured in-person interviews with managers (n = 50) from full-service and quick-service chain and non-chain restaurants (QSRs) using a stratified random sample. Managers were interviewed about the number of bundled meals sold, beverage sales with those meals, and awareness and perceptions of the policy. On average, QSRs sold significantly more bundled kids' meals per week (281) compared to full-service restaurants (111), and managers from chain restaurants reported selling significantly more bundled kids' meals per week (233) compared to non-chain restaurants (91). Managers reported 72.5% of those meals were sold with a healthier beverage (water, milk, or 100% juice), consistent with the forthcoming policy, while 28% were sold with SSBs. Furthermore, although only three managers (6%) reported knowing about the policy, the majority supported it when it was explained. Our findings indicate general support for the intent of the policy, but suggest the need for tailored implementation approaches and additional education for restaurant manager's and staff.

Longer Participation in WIC Is Associated with Better Diet Quality in 24-Month-Old Children.

BACKGROUND: Little is known about duration of exposure to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in relation to children's diet quality. OBJECTIVE: The objective of the study was to examine the association between duration of WIC participation and diet quality of 24-month-old children. DESIGN: A national longitudinal observational study was conducted with participants initially enrolled in WIC in 2013. Telephone interviews were conducted with study mothers from 2013 to 2016. Duration of WIC participation was categorized as high, medium, or low based on the number of interviews during which participants reported receiving WIC benefits. PARTICIPANTS: Participants in the WIC Infant and Toddler Feeding Practices Study 2 who had completed a baseline interview and all interviews through 24 months were included; participants who reported discontinuing WIC due to perceived program ineligibility were excluded from analyses (N=1,250). Data were weighted to represent the study-eligible population. MAIN OUTCOME MEASURE: Healthy Eating Index 2015 scores of children at age 24 months were calculated based on 24-hour dietary recalls. STATISTICAL ANALYSES PERFORMED: Unadjusted analysis of variance examined Healthy Eating Index 2015 scores by WIC participation duration. Multivariate linear regression analysis tested independent effects of WIC duration on Healthy Eating Index 2015 total scores, controlling for sociodemographic factors. RESULTS: After controlling for covariates, WIC participation duration was significantly associated with diet quality. Children in the high duration group had significantly higher Healthy Eating Index 2015 total scores (adjusted mean 59.3, 95% CI 58.6 to 60.1) than children in the low duration group (adjusted mean 55.3, 95% CI 51.6 to 59.0) (P=0.035). CONCLUSIONS: Children who received WIC benefits during most of the first 2 years of life had better diet quality at age 24 months than children who, despite remaining eligible for benefits, discontinued WIC benefits during infancy. Findings suggest nutritional benefits for eligible children who stay in the program longer.

Predictors of WIC Participation Through 2 Years of Age.

OBJECTIVE: To examine factors associated with Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation through 2 years of age. DESIGN: Longitudinal data from the WIC Infant and Toddler Feeding Practices Study-2. SETTING: Eighty WIC sites. PARTICIPANTS: The WIC Infant and Toddler Feeding Practices Study-2 participants interviewed through 2 years of age (n = 1,250). MAIN OUTCOME MEASURE: WIC participation through 2 years of age. ANALYSIS: Multivariate logistic regression and odds ratios. RESULTS: Infants in households with incomes ≤100% of the federal poverty level (FPL) were more than twice as likely as those with incomes above 100% FPL to continue WIC participation through 2 years (odds ratio = 2.22; 95% confidence interval [CI], 1.34-3.66). The odds of WIC participation through 2 years were 2.84 times higher for infants fully breastfed for 6 months or longer compared with infants breastfed for less than 6 months (95% CI, 1.43-5.66). Infants in households in which caregivers reported they made a change in how they fed their family on the basis of something they learned from WIC had 2.60 higher odds of continued WIC participation than infants in households in which caregivers did not report making a change (95% CI, 1.67-4.07). CONCLUSIONS AND IMPLICATIONS: In addition to lower household income, longer breastfeeding duration and application of WIC nutrition education are important predictors of WIC participation through 2 years of age.

Contribution of WIC-Eligible Foods to the Overall Diet of 13- and 24-Month-Old Toddlers in the WIC Infant and Toddler Feeding Practices Study-2.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides supplemental foods to assist participants in meeting their dietary needs. Few studies have described the extent to which WIC-eligible foods contribute to the overall diet of children who were enrolled in WIC prenatally or in early infancy. OBJECTIVE: Our aims were to examine commonly consumed foods and estimate the proportion of dietary intake contributed by WIC-eligible foods among 13- and 24-month-old children, and to assess differences by WIC participation status at 24-months. DESIGN: This was a national observational study. PARTICIPANTS/SETTING: Children participating in the WIC Infant and Toddler Feeding Practices Study-2 were included (13 months old [n=2,777] and 24 months old [n=2,450]) from 2013 to 2016. MAIN OUTCOME MEASURES: Dietary intakes were assessed using 24-hour dietary recalls at 13 and 24 months. The 10 most commonly consumed foods were described using the What We Eat in America food category classification system. WIC-eligible foods were defined as meeting the WIC nutrient criteria set forth in the Federal regulation. STATISTICAL ANALYSES PERFORMED: The estimated proportion (mean±standard error) of WIC-eligible foods to total daily intake was calculated for energy, macronutrients, and select micronutrients. Multiple linear regression, adjusted for confounders, was conducted to compare the estimated proportion of nutrient intake from WIC-eligible foods by WIC participation at 24 months. RESULTS: At 13 and 24 months, most (60% and 63%, respectively) of the commonly consumed foods were eligible for purchase as part of the child WIC food package. WIC-eligible foods provided >40% of calories and close to 50% or more of other nutrients, and the contribution of WIC-eligible foods to overall micronutrient intake increased between 13 and 24 months. Children still on WIC at 24 months obtained a larger proportion of calories and most other nutrients from WIC-eligible foods than children no longer on WIC. CONCLUSIONS: WIC-eligible foods could contribute to the overall diet of toddlers who were enrolled in WIC prenatally or in early infancy. Further, there may be additional nutritional benefits of staying on the program through 24 months.

Food Insecurity Is Associated with Body Dissatisfaction among Children in California.

BACKGROUND: Food insecurity affects 13 million children in the United States. Body dissatisfaction is also prevalent, affecting up to 46% of children. Both food insecurity and body dissatisfaction are associated with poor health outcomes, and both are associated with body weight and racial/ethnic disparities. The association between food insecurity and body dissatisfaction among children has not been examined. OBJECTIVE: The purpose of this study was twofold: to examine, in a sample of children in grades 4 through 8, the relationship of child food insecurity with body dissatisfaction and to gain an understanding of the interactive roles of body mass index (BMI), race/ethnicity, and sex in the relationship between food insecurity and body dissatisfaction. DESIGN: This was a cross-sectional study. PARTICIPANTS/SETTING: This study examined data obtained from 14,768 children in grades 4 through 8 from 54 public schools in California between 2014 and 2016. MAIN OUTCOME MEASURES: The primary outcome of interest was body dissatisfaction (five items converted to a binary indicator), and the exposure of interest was child-reported food insecurity (three items converted to a binary indicator). Subsets of validated questionnaires were used to assess body dissatisfaction and food insecurity. STATISTICAL ANALYSES PERFORMED: Data were analyzed using multivariable logistic regression, and effect modification was examined by BMI category (underweight, normal, overweight, obese), race/ethnicity, and sex. RESULTS: In this large and diverse sample, after adjusting for cofounders, children experiencing food insecurity, in all BMI categories and from all racial/ethnic backgrounds, had higher odds of body dissatisfaction than their food-secure counterparts. The strength of the relationship differed by BMI and race/ethnicity, with the strongest associations observed for African-American children (odds ratio=2.32; P<0.001) and children with a normal children (odds ratio=1.76; P<0.001). CONCLUSIONS: Experiencing food insecurity was associated with greater body dissatisfaction, with the magnitude of the association modified by BMI and race/ethnicity.

Diet Quality of US Infants and Toddlers 7-24 Months Old in the WIC Infant and Toddler Feeding Practices Study-2.

Background: Despite the important implications of childhood dietary intakes on lifelong eating habits and health, data are lacking on the diet quality of low-income infants and toddlers. Objective: The objective of this study was to characterize diet quality in low-income US infants and toddlers. Methods: A national observational study was conducted of 7- to 12-mo-old (n = 1261), 13-mo-old (n = 2515), and 24-mo-old (n = 2179) children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) prenatally/at birth from 2013 to 2016. The study used a 24-h dietary recall and survey questions. For 7- to 12-mo-olds, an adapted Complementary Feeding Utility Index (CFUI) was used, and for 13- and 24-mo-olds, the Healthy Eating Index-2015 (HEI-2015) was used. Descriptive statistics were calculated for CFUI and HEI-2015 scores. Results: For 7- to 12-mo-olds, the CFUI score (mean ± SE) was 0.56 ± 0.003 (range: 0.34-0.90, maximum possible 1.0). Most children met CFUI standards for exposure to iron-rich cereal (86.7%), and low exposure to energy-dense nutrient-poor foods (72.2%) and teas/broths (67.5%). Conversely, at 7-12 mo of age, exposure was low for vegetables (7.0%), fruits (14.4%), any sugary drinks (14.0%), and 12-mo breastfeeding duration (23.8%). At 13 and 24 mo of age, the HEI-2015 total score (maximum possible 100), on average, was 64.0. At both 13 and 24 mo of age, participants achieved, on average, maximal HEI-2015 component scores for total and whole fruits and dairy; however, scores for total vegetables, greens and beans, whole grains, seafood and plant proteins, fatty acids, and saturated fats were relatively low. Scores for refined grains, sodium, and added sugar were lower at 24 than at 13 mo of age, representing higher consumption, on average, over time. Conclusions: Although findings demonstrate that young children are doing well on some dietary components, there is room for improvement, especially as children age. Findings may be used to inform the Pregnancy and Birth to 24-mo (P/B-24) Project. This trial was registered at clinicaltrials.gov as NCT02031978.

Breastfeeding Is Associated With Higher Retention in WIC After Age 1.

OBJECTIVE: Examine factors associated with retention on the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) after 1 year of age. SETTING: A large California WIC program. PARTICIPANTS: WIC participants 14 months old (9,632) between July and September, 2016. MAIN OUTCOME MEASURE: Recertification in WIC by 14 months of age. ANALYSIS: Multivariate logistic regression was performed and odds ratios (ORs) and 95% confidence intervals (CIs) were computed to examine factors associated with child retention in WIC at age 14 months. RESULTS: Mothers performing any amount of breastfeeding from 6 to 12 months were more likely than mothers not breastfeeding to recertify their children in WIC at age 14 months. The odds of retention for children fully breastfed from 6 to 12 months was about 3 times higher than for fully formula-fed children (95% CI, 2.46-3.59). The odds of retention for mostly breastfed children and children fed some breast milk but mostly formula were 1.95 (95% CI, 1.57-2.43) and 1.72 (95% CI, 1.41-2.10) times higher than fully formula-fed children. Prenatal intention to breastfeed (OR = 1.34; 95% CI, 1.16-1.55), online education (OR = 1.08; 95% CI, 1.03-1.13), missing benefits (OR = 0.19; 95% CI, 0.17-0.21), underredemption of WIC benefits (OR = 0.51, 95% CI, 0.45-0.58), early enrollment in WIC (OR = 1.11; 95% CI, 1.09-1.14), number of family members receiving WIC (OR = 1.29, 95% CI, 1.14-1.46), English language preference (OR, 0.55; 95% CI, 0.47-0.64), and participation in Medicaid (OR = 1.29; 95% CI, 1.14-1.47) were also associated with retention. CONCLUSIONS AND IMPLICATIONS: Results from this study suggested there are a number of areas WIC programs may target to promote ongoing participation in the program. These include support for both breastfeeding and non-breastfeeding women, technology-based strategies, and targeted outreach to pregnant women, participants who have missed benefits, and participants who have not redeemed their benefits. Research that examines the impact of targeted interventions directed at ≥1 of these areas is essential to help WIC programs maintain contact with children into early childhood.