Sleep Duration Is Associated with Household Food Insecurity and Sugar-Sweetened Beverage Intake Among Women, Infants and Children Participating Children Ages 0-5.

PURPOSE: To determine associations between child and household characteristics and sleep duration among low-income children in Los Angeles County. DESIGN: Cross-sectional study. SETTING: Survey data collected in 2017 and 2020 in Los Angeles County, California. SAMPLE: Special Supplemental Nutrition Program for Women, Infants and Children (WIC) households with children ages 4-60 months. MEASURES: Sleep duration for children 4-60 months old (less than recommended (LTR), recommended range, more than recommended (MTR)), household food insecurity (HFI), sociodemographics, and daily servings of sugar-sweetened beverages (SSB). ANALYSIS: Multinomial logistic regression, stratified by child age, was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for associations between household/child characteristics and LTR or MTR sleep compared to recommended duration among WIC participating children 4-60 months old. RESULTS: The final sample included 3512 children ages 4-23 months and 6035 children ages 24-60 months. In the study population, 32% (3-5 years old) to 44% (4-11months) of children under 5 did not meet the recommended hours of sleep per night. HFI was associated with higher odds of LTR (OR 1.27, CI 1.12-1.45) and MTR (OR 1.46, CI 1.15-1.87) sleep among 24-60 month-old children. Each additional daily SSB serving was associated with higher odds of LTR sleep (4-23 months: OR 1.10, CI 1.02-1.19; 24-59 months: OR 1.12, CI 1.08-1.17). CONCLUSIONS: HFI and SSB intake are associated with not getting the recommended amount of sleep among low-income WIC participating children. Nutrition assistance program participants may benefit from receiving information about recommended sleep duration for young children and how to establish sleep routines to optimize sleep duration.

Breastfeeding moderates childhood obesity risk associated with prenatal exposure to excessive gestational weight gain.

Gaining excessive gestational weight may increase obesity risk in the offspring, while breastfeeding lowers that risk. Using data from the Special Supplemental Nutrition Programme for Women, Infants and Children (WIC) in Southern California, we examined the associations between gestational weight gain (GWG), breastfeeding during infancy and childhood obesity at 2-4 years, and determined whether breastfeeding moderated the association between GWG and childhood obesity. GWG was based on weight measurements collected during the first trimester and within a month before delivery. GWG values were standardized by gestational age (GWG z-scores), per maternal prepregnancy body mass index (BMI) and categorized into tertiles. Fully breastfeeding duration was determined by WIC infant package data indicating the amount of infant formula received monthly. Children's length (or height) and weight measurements were used to calculate BMI-for-age z-scores and identify obesity (z-score ≥ 95th percentile). Multivariable linear and modified Poisson regression analyses were conducted. Fully breastfeeding moderated the association between GWG z-scores tertile and obesity in the offspring. Each additional month of fully breastfeeding was associated with 3%-5% obesity risk reduction for each age group and GWG z-scores tertile, except at age 4 years for children whose mothers had low GWG z-scores (tertile 1). Shorter fully breastfeeding duration was associated with greater obesity risk among children of mothers with high GWG z-scores (tertile 3), but not for those whose mothers had low GWG z-scores. Longer fully breastfeeding duration may provide greater protection against obesity among children at higher risk due to intrauterine exposure to high gestational weight gain.

Prevalence and Predictors of Substantial Postpartum Weight Retention Among Participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Southern California.

PURPOSE: Identify the prevalence and predictors of substantial postpartum weight retention (SPPWR) among WIC mothers in Southern California during their first postpartum year. DESIGN: Secondary data analysis. SETTING: The 2020 Los Angeles County WIC Survey. SUBJECTS: Mothers of children up to 1-year-old (N = 1019). MEASURES: Outcome variable: SPPWR (≥5 kg above pre-pregnancy weight). Predictors: child's age, mother's age, race, education, employment status since having child, healthcare coverage, food insecurity, depressed mood, instrumental support, emotional support, spouse's participation in child's life, gestational weight gain (GWG), pre-pregnancy BMI, any breastfeeding, and gestational diabetes. ANALYSIS: Weighted descriptive statistics and binary logistic regression. RESULTS: The prevalence of SPPWR was 31%. We found that for every 1 month increase in the child's age (proxy for postpartum duration), the likelihood of SPPWR increased by 9% (AOR = 1.09, CI = 1.04-1.15). Mothers were more likely to have SPPWR when they exceeded GWG guidelines (AOR = 3.43, CI = 2.46-4.79). Compared to mothers with normal pre-pregnancy BMIs, mothers with overweight (AOR = .64, CI = .44-.94) and obese (AOR = .39, CI = .26-.58) pre-pregnancy BMIs were less likely to experience SPPWR. CONCLUSION: Postpartum duration and maternal anthropometric characteristics were associated with SPPWR during the first postpartum year. Extending WIC eligibility for postpartum mothers to 2 years through the Wise Investment in Children Act may give WIC providers the opportunity to work closely with Southern California WIC mothers to achieve a healthy weight after pregnancy.

The Impact of COVID-19 on Breastfeeding Rates in a Low-Income Population.

Objective: To examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on breastfeeding outcomes among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Southern California. Materials and Methods: Data from the 2020 Los Angeles County triennial WIC Survey were used to examine the impact of COVID-19 on breastfeeding outcomes among WIC participants. Chi-square tests were used to explore the association between the COVID-19 pandemic and breastfeeding outcomes along with hospital-friendly practices. Results: Compared with infants born before March 2020, the percentage of infants who received any breastfeeding at 1 month decreased from 79.66% to 76.96% (p = 0.139). The percentage of infants who received any breastfeeding at 3 and 6 months significantly decreased from 64.57% to 56.79% (p = 0.001) and from 48.69% to 38.62% (p = 0.0035), respectively. The percentage of infants fully breastfed at 1, 3, and 6 months significantly decreased at all time points. Examining hospital practices, there were no differences between the before and during COVID-19 groups. Conclusions: The prevalence of any breastfeeding at 3 and 6 months and fully breastfeeding at 1, 3, and 6 months was significantly lower among mothers who gave birth during the pandemic compared with mothers who gave birth before the pandemic. The shift to remote services delivery and the corresponding reduction in live support of WIC services owing to the pandemic may explain the decline in the breastfeeding rate. As the nation and the WIC program prepare for the postpandemic life, it is critical to ensure that breastfeeding support is met in a hybrid of remote and face-to-face settings.

Perceived barriers to and suggested interventions for physical activity during pregnancy among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Southern California.

BACKGROUND: The American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant women engage in at least 20 to 30 min of moderate-intensity physical activity on most days of the week. Regular exercise during pregnancy is associated with many benefits for the mother and the developing fetus; yet, a large number of pregnant women do not engage in the recommended amounts. This study aimed to investigate barriers to and interventions for physical activity among pregnant WIC participants in Southern California. METHODS: We conducted four focus groups (FGs) with pregnant low-income women aged 18 years or older in either their second or third trimester. FGs were conducted at a WIC center in Southern California. The FGs were held according to language (English vs. Spanish-speaking) and BMI category (normal weight vs. overweight and obese). A total of 28 women participated. We used ATLAS. ti. to analyze the focus group transcripts. The study adhered to the Consolidated Criteria for Reporting Qualitative Research. RESULTS: The mean age of focus group participants was 28.9 years (SD = 6.6), and the majority were Latina. Intrapersonal barriers to physical activity were fatigue and lack of energy, pain and swelling, lack of childcare, medical restrictions and safety concerns, lack of knowledge about exercise safety, and lack of time. Interpersonal barriers included concerns and lack of support from partners and families, conflicting advice from friends and neighbors, and lack of advice on safe exercise from physicians. Women in all four groups suggested a community-based intervention where they can mingle with each other and share their challenges and concerns. Other suggestions to interventions differed among groups and reflected the women's experiences and backgrounds. Specifically, to promote education, English-speaking women preferred a brochure while Spanish-speaking women preferred a video. Overweight women emphasized including children in their exercise activities to promote healthy behavior in youth. CONCLUSIONS: Interventions should be tailored to pregnant women's needs. Primary care providers should provide reassurance and information to pregnant women and their partners on the type and frequency of safe exercise.

Perceived Motivators, Barriers and Intervention Strategies Related to Weight Loss After Childbirth Among WIC Participants in Southern California.

PURPOSE: To explore perceived motivators and barriers to weight loss after childbirth and ideas for postpartum weight loss interventions among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). APPROACH: Four (2 with English-speaking and 2 with Spanish-speaking participants) focus groups were conducted. SETTING: A WIC clinic in Southern California. PARTICIPANTS: Of 22 participants, the majority were Hispanic/Latina. The mean age of the mothers' infants was 6.18 months. MEASURES: A structured focus group guide was used. ANALYSIS: Audio-recordings were transcribed verbatim. The Spanish transcriptions were reviewed for discrepancies by a bilingual coinvestigator and translated into English for analysis. Transcriptions of the focus group audio-recordings were organized in ATLAS.ti version 8.0. and analyzed using content analysis. RESULTS: Participants had a mean age of 30.5 and a mean prepregnancy body mass index of 32.4. Motivators for weight loss after childbirth included modeling healthy behavior for children and a fear of developing chronic illness. Barriers to weight loss included lack of knowledge, self-efficacy, time, child care and support, postpartum depression, the 40-day rule, and having a c-section. Intervention ideas included providing accountability and peer support for weight loss, providing nutrition/exercise weight loss strategies, and integrating mobile phone technologies into weight loss programs. CONCLUSIONS: Weight loss strategies for postpartum WIC participants should provide knowledge, support, accountability, and preferably integrate technology.

The Impact of Food Insecurity on the Home Emotional Environment Among Low-Income Mothers of Young Children.

Objectives Household stressors, such as food insecurity, contribute to the home emotional environment and negatively affect child development. Little research on this topic has been conducted among very young children. This study aimed to examine the relationship between food insecurity and the home emotional environment, as well the extent to which the relationship may be mediated by maternal symptoms of depression. Frequency of praise, affection, and discipline of young children by mothers were examined as markers of the home emotional environment. Methods Data were collected in a cross-sectional study of mothers of children under the age of five (N = 4231). Logistic regression was used to assess the relationship between level of food security and frequency of praise and discipline of children. Mediation analysis using the KHB method was conducted to test whether maternal mental health mediated the relationship between food insecurity and each outcome. Results Low and very low food security were significantly associated with higher odds of disciplining children with high frequency. Controlling for all covariates, frequency of praise was not significantly associated with level of household food insecurity. Differences in praise and discipline frequency were found by language of interview, maternal education, and employment. Conclusions for Practice Parent-child interactions, specifically related to discipline, are related to food insecurity. Further research should consider cultural patterns and mechanisms behind the relationship between food insecurity and the home environment. Household stressors begin affecting children at young ages, and early intervention is essential to prevent further negative sequelae as children grow older.

Breastfeeding Is Associated With Reduced Obesity in Hispanic 2- to 5-Year-Olds Served by WIC.

OBJECTIVE: To examine the relationship between breastfeeding (BF) and odds of childhood obesity in a large, primarily Hispanic Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) population. SETTING: A large urban WIC program in California. PARTICIPANTS: Infants enrolled in WIC born between 2004 and 2007 and observed to age 5 years (N = 39,801; 88.6% Hispanic). INTERVENTION: Level of BF: fully BF, fully formula feeding, or combination feeding. MAIN OUTCOME MEASURE: Obesity at age 2-5 years, measured by body mass index (BMI) ≥ 95th percentile. ANALYSIS: Logistic regression analyses to evaluate the association between initiation, duration, and exclusivity of BF and odds of obesity at age 2-5 years, controlling for ethnicity, preferred language, family size, poverty level, and maternal BMI. RESULTS: Infants exclusively formula fed at birth were significantly more likely than fully breastfed infants to be obese at age 2-5 years (χ2 [2, N = 39,801] = 123.31; P < .001). For every additional month of any BF, obesity risk at age 2-5 years decreased by 1%. Every additional month of full BF conferred a 3% decrease in obesity risk. Ethnicity, preferred language, family size, poverty level, and maternal BMI were also significantly related to obesity risk. CONCLUSIONS AND IMPLICATIONS: Breastfeeding may have a role in the attenuation of obesity in early childhood among Hispanic children. The BF promotion and support offered at WIC may have a significant role in reducing rates of early childhood obesity.

A Qualitative Study to Examine Perceptions and Barriers to Appropriate Gestational Weight Gain among Participants in the Special Supplemental Nutrition Program for Women Infants and Children Program.

Women of reproductive age are particularly at risk of obesity because of excessive gestational weight gain (GWG) and postpartum weight retention, resulting in poor health outcomes for both mothers and infants. The purpose of this qualitative study was to examine perceptions and barriers to GWG among low-income women in the WIC program to inform the development of an intervention study. Eleven focus groups were conducted and stratified by ethnicity, and each group included women of varying age, parity, and prepregnancy BMI ranges. Participants reported receiving pressure from spouse and family members to "eat for two" among multiple barriers to appropriate weight gain during pregnancy. Participants were concerned about gaining too much weight but had minimal knowledge of weight gain goals during pregnancy. Receiving regular weight monitoring was reported, but participants had inconsistent discussions about weight gain with healthcare providers. Most were not aware of the IOM guidelines nor the fact that gestational weight gain goals differed by prepregnancy weight status. Results of these focus groups analyses informed the design of a pregnancy weight tracker and accompanying educational handout for use in an intervention study. These findings suggest an important opportunity for GWG education in all settings where pregnant women are seen.

Reliability and Validity of Food Frequency Questions to Assess Beverage and Food Group Intakes among Low-Income 2- to 4-Year-Old Children.

BACKGROUND: Fruits, vegetables, sweetened foods, and beverages have been found to have positive and negative associations with obesity in early childhood, yet no rapid assessment tools are available to measure intake of these foods among preschoolers. OBJECTIVE: This study examines the test-retest reliability and validity of a 10-item Child Food and Beverage Intake Questionnaire designed to assess fruits, vegetables, and sweetened foods and beverages intake among 2- to 4-year-old children. METHODS: The Child Food and Beverage Intake Questionnaire was developed for use in periodic phone surveys conducted with low-income families with preschool-aged children. Seventy primary caregivers of 2- to 4-year-old children completed two Child Food and Beverage Intake Questionnaires within a 2-week period for test-retest reliability. Participants also completed three 24-hour recalls to allow assessment of validity. Intraclass correlations were used to examine test-retest reliability. Spearman rank correlation coefficients, Bland-Altman plots, and linear regression analyses were used to examine validity of the Child Food and Beverage Intake Questionnaire compared with three 24-hour recalls. RESULTS: Intraclass correlations between Child Food and Beverage Intake Questionnaire administrations ranged from 0.48 for sweetened drinks to 0.87 for regular sodas. Intraclass correlations for fruits, vegetables, and sweetened food were 0.56, 0.49, and 0.56, respectively. Spearman rank correlation coefficients ranged from 0.15 to 0.59 for beverages, with 0.46 for sugar-sweetened beverages. Spearman rank correlation coefficients for fruits, vegetables, and sweetened food were 0.30, 0.33, and 0.30, respectively. Although observation of the Bland-Altman plots and linear regression analyses showed a slight upward trend in mean differences, with increasing mean intake for five beverage groups, at least 90% of data plots fell within the limits of agreement for all food/beverage groups. CONCLUSIONS: The Child Food and Beverage Intake Questionnaire exhibited fair to substantial test-retest reliability and moderate to strong validity in ranking fruits, vegetables, sweetened food, and the majority of beverages consumed by children aged 2 to 4 years old. Although the Child Food and Beverage Intake Questionnaire might not be able to assess the absolute intake of foods and beverages, given the scarcity of an easily administered, valid, and reliable questionnaire to assess nutritional intake among 2- to 4-year-old low-income children, this tool is a useful means for measuring trends in dietary intake among low-income preschoolers.

Depressive symptoms mediate the association between fear of crime and higher body mass index.

PURPOSE: To investigate pathways in the association between fear of crime and obesity. DESIGN: A cross-sectional survey was administered among residents aged 18 years and older across all Census tracts. SETTING: Genesee County, Michigan. SUBJECTS: A total of 3192 residents. MEASURES: Body mass index (BMI) was calculated by using the respondents' reported height and weight. Composite fear-of-crime and depressive symptoms scores were calculated by using several survey items. ANALYSIS . Path analysis examined the effects of fear of crime on BMI. RESULTS . Fear of crime was associated with higher BMI. Depressive symptoms mediated the relationship between fear of crime and BMI (p < .001). Moderate exercise mediated the association between depressive symptoms and BMI (p < .001). CONCLUSION: Fear of crime was associated with depressive symptoms, which in turn were associated with reduced exercise and subsequently higher BMI.

Influences of the neighbourhood food environment on adiposity of low-income preschool-aged children in Los Angeles County: a longitudinal study.

BACKGROUND: Few studies have examined the association between the food environment and adiposity in early childhood, a critical time for obesity prevention. The objective of this study was to examine the longitudinal association between neighbourhood food environment and adiposity among low-income preschool-aged children in a major metropolitan region in the USA. METHODS: The study sample was 32 172 low-income preschool-aged children in Los Angeles County who had repeated weight and height measurements collected between ages 2 and 5 years through a federal nutrition assistance programme. We conducted multilevel longitudinal analyses to examine how spatial densities of healthy and unhealthy retail food outlets in the children's neighbourhoods were related to adiposity, as measured by weight-for-height z-score (WHZ), while controlling for neighbourhood-level income and education, family income, maternal education, and child's gender and race/ethnicity. RESULTS: Density of healthy food outlets was associated with mean WHZ at age 3 in a non-linear fashion, with mean WHZ being lowest for those exposed to approximately 0.7 healthy food outlets per square mile and higher for lesser and greater densities. Density of unhealthy food outlets was not associated with child WHZ. CONCLUSIONS: We found a non-linear relationship between WHZ and density of healthy food outlets. Research aiming to understand the sociobehavioural mechanisms by which the retail food environment influences early childhood obesity development is complex and must consider contextual settings.

The new food package and breastfeeding outcomes among women, infants, and children participants in Los Angeles County.

OBJECTIVES: We assessed the effect of the new Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package, implemented in October 2009, on breastfeeding outcomes among a predominately Latina sample of WIC participants in Los Angeles County, California. METHODS: We used data from 5020 WIC participants who were interviewed in a series of repeated cross-sectional surveys conducted in 2005, 2008, and 2011. Participants were randomly selected from Los Angeles County residents who received WIC services during those years. RESULTS: Consistent with the WIC population in Los Angeles, participants were mostly Latina and had low levels of income and education; more than half were foreign-born. We found small but significant increases from pre- to postimplementation of the new WIC food package in prevalence of prenatal intention to breastfeed and breastfeeding initiation, but no changes in any breastfeeding at 3 and 6 months. The prevalence of exclusive breastfeeding at 3 and 6 months roughly doubled, an increase that remained large and significant after adjustment for other factors. CONCLUSIONS: The new food package can improve breastfeeding outcomes in a population at high risk for negative breastfeeding outcomes.

Association of infant feeding and dietary intake on obesity prevalence in low-income toddlers.

OBJECTIVE: This cross-sectional study assesses the independent and combined effects of breastfeeding (BF) and dietary intake, specifically sugar-sweetened beverages (SSB), on obesity prevalence in low-income, primarily Hispanic toddlers. METHODS: The following data were collected in 2011 via phone surveys with caregivers of 2295 low-income children (2-4 years) from Los Angeles County Women, Infants, and Children (WIC) programs: infant feeding, dietary intake, gestational diabetes status, birth weight, gestational age, and mother's BMI. WIC staff measured children's height and weight. Chi-square tests and binary logistic regressions assessed the independent and combined effects of BF and dietary intake on obesity prevalence. RESULTS: Compared to no BF, BF ≥ 12 mos was associated with a 47% reduction in obesity prevalence (AOR = 0.53, 95% CI 0.4-0.8, P = 0.004). Compared to 2 + SSB/d, no SSB/d intake was associated with a 28% reduction in obesity prevalence (AOR = 0.72, 95% CI 0.5-1.0, P = 0.03). High intake of soda, diet soda, and fruit drinks were linked to increases in obesity prevalence. There was no effect of 100% juice, milk (plain or flavored) fruit, vegetable, fast food, or sweetened grain intake on obesity prevalence. CONCLUSIONS: These findings support encouragement of BF ≥ 12 mos and no SSB intake to prevent obesity in low-income, primarily Hispanic, toddlers.

Immigrant enclaves and obesity in preschool-aged children in Los Angeles County.

While neighborhood environments are increasingly recognized as important contributors to obesity risk, less has been reported on the socio-cultural aspects of neighborhoods that influence obesity development. This is especially true among immigrants, who may lack the necessary language skills to navigate their new living environments. In this study, we tested the hypothesis that young children of immigrants would be at lower obesity risk if they lived in neighborhoods where neighbors share the same language and culture. Using 2000 Census data and 2003-2009 data from the Special Supplemental Nutrition Program for Women, Infants and Children in Los Angeles County, we examined the relation between BMI z-scores in low-income children aged 2-5 years (N = 250,029) and the concentration of neighborhood residents who spoke the same language as the children's mothers. Using multi-level modeling and adjusting for child's gender and race/ethnicity, household education, neighborhood socioeconomic status, and year the child was examined, we found that percent of neighborhood residents who spoke the same language as the child's mother was negatively associated with BMI z-scores. This relation varied by child's race/ethnicity and mother's preferred language. The relation was linear and negative among children of English-speaking Hispanic mothers and Chinese-speaking mothers. However, for Hispanic children of Spanish-speaking mothers the relation was curvilinear, initially exhibiting a positive relation which reversed at higher neighborhood concentrations of Spanish-speaking residents. Our findings suggest that living in neighborhoods where residents share the same language may influence obesity-related behaviors (namely diet and physical activity) possibly through mechanisms involving social networks, support, and norms.

Trends and predictors of excessive gestational weight gain among hispanic WIC participants in Southern California.

The objectives of this study were to describe gestational weight gain (GWG) trends and identify predictors of GWG among WIC participants in Southern California, 84 % of whom are Hispanic. Using descriptive statistics and multiple logistic regression, we examined WIC data on 23,840 Hispanic women with full term pregnancies who enrolled in WIC at first trimester and had their last prenatal WIC visit within 1 month or less of their delivery date. Overall, 23.9 % of women exceeded IOM recommendations. Among Hispanic English speakers (HES), 30 % exceeded IOM recommendations compared to 18.7 % of Hispanic Spanish speakers (HSS). Among Hispanic mothers who are less than 20 years of age, 28.9 % exceeded IOM guidelines compared to 19.8 % of Hispanic mothers 35 or older. Among those who started pregnancy overweight or obese, 30.5 % exceeded IOM recommendations versus 12.1 % of those with normal BMI. Multiple logistic regression showed that the odds of exceeding the IOM recommendations were 42 % lower for HSS versus HES, decreased by 2 % for every 1 year increase in age, and increased by 5 % for every one unit increase in BMI at first trimester. Poverty level and health care coverage were also significant predictors of GWG. Given the wide reach and high quality of height/weight measurements taken by the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Program, WIC administrative data have significant potential to help fill the existing gaps in GWG surveillance, a much needed step for forming policy and designing effective interventions.

Impact of policy changes on infant feeding decisions among low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children.

OBJECTIVES: We present infant feeding data before and after the 2009 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package change that supported and incentivized breastfeeding. We describe the key role of California WIC staff in supporting these policy changes. METHODS: We analyzed WIC data on more than 180,000 infants in Southern California. We employed the analysis of variance and Tukey (honestly significant difference) tests to compare issuance rates of postpartum and infant food packages before and after the changes. We used analysis of covariance to adjust for poverty status changes as a potential confounder. RESULTS: Issuance rates of the "fully breastfeeding" package at infant WIC enrollment increased by 86% with the package changes. Rates also increased significantly for 2- and 6-month-old infants. Issuance rates of packages that included formula decreased significantly. All outcomes remained highly significant in the adjusted model. CONCLUSIONS: Policy changes, training of front-line WIC staff, and participant education influenced issuance rates of WIC food packages. In California, the issuance rates of packages that include formula have significantly decreased and the rate for those that include no formula has significantly increased.

WIC infant food package issuance data are a valid measure of infant feeding practices.

BACKGROUND: Multiple datasets collect breastfeeding data in the United States (US), but a coordinated monitoring and surveillance system does not currently exist. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) reaches over 50% of all infants in the US and provides a potential wealth of administrative data about the breastfeeding practices of low-income women. OBJECTIVE: The objective of this research was to assess whether WIC administrative data are a valid source of information about breastfeeding practices. METHODS: A phone survey of 2015 postpartum WIC mothers in Southern California was conducted to assess the feeding practices of mothers with infants 2-12 months old. Survey data were linked with WIC administrative records from the same month in order to assess the percent agreement between feeding behavior as reported by survey methods and as documented in WIC administrative records. RESULTS: The unweighted κ test statistic was used to test the agreement between survey responses and WIC administrative data. Substantial to almost perfect agreement was found between the two measures. CONCLUSIONS: WIC administrative data are a valid source of information about breastfeeding. With appropriate funding support, WIC administrative data should be considered for use in nationwide breastfeeding surveillance and monitoring systems.

Preschool enrollment is associated with lower odds of childhood obesity among WIC participants in LA County.

The prevalence of obesity among children in the United States has increased rapidly during the past few decades. Research into social and behavioral determinants of obesity could lead to innovative strategies for prevention. The objective of the present study was to examine the association between childhood obesity and preschool enrollment and number of hours in child care among low-income preschool-aged children who were participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). We conducted a case-control study including 556 3- to 4-year-old children who were either obese (BMI > 95th percentile of reference standard) or normal-weight (BMI 25-75th percentile). The population was largely (96%) Hispanic, an ethnic group that has one of the highest rates of overweight and obesity in adults and children in the US. In multiple logistic regression analysis, controlling for a variety of psychosocial and cognitive home environment variables, key demographics and maternal variables, the odds ratio of being obese was 0.61 for children who attended preschool more than 4 days a week (95% CI: 0.41-0.90). Watching television or videos for an hour or more on a typical day (odds ratio 1.71 (95% CI 1.07-2.75)), and higher maternal BMI (odds ratio 1.08 (95% CI 1.05-1.11)) were independently related to odds of obesity. The impact of preschool attendance and TV viewing are potentially instructive in terms of preventive interventions for children at this age.