Recipient Organization
PUBLIC HEALTH FOUNDATION ENTERPRISES, INC.
13300 CROSSROADS PKWY N
CITY OF INDUSTRY,CA 91746
Performing Department
(N/A)
Non Technical Summary
Low early childhood diet quality is common among children in the US, and diet patterns persist into adulthood, contributing to obesity and chronic disease risk across the life course. To support healthy diets during pregnancy, the postpartum period, and early childhood, the US Department of Agriculture (USDA) manages the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), serving 6.2 million participants living in low-income households monthly in 2021. WIC provides four core services including supplemental food packages redeemable for specific healthy foods at approved vendors, nutrition education, breastfeeding support, and health and social service referrals. WIC participation has been linked to positive nutritional outcomes. Diet quality of WIC-participating children improved after WIC food packages were aligned with the Dietary Guidelines for Americans in 2009, and additional revision of WIC food packages will occur by April 2026.The healthy foods in WIC food packages could improve diets throughout early childhood given the wide reach of the program into low-income households, but incomplete food benefit utilization may limit WIC's impact on improving nutritional outcomes. Barriers to accessing healthy foods, such as limited geographic access to grocery stores, have been proposed as a source of underlying disparities in diet quality and diet-related chronic diseases. The association between the 2009 WIC food package change and reduced child obesity was modified by the neighborhood food environment, suggesting that barriers to WIC benefit redemption - like limited geographic access to WIC vendors - could limit WIC participation's impact on outcomes including household food security and child diet quality via associations of vendor access with benefit utilization. Data on relationships between WIC vendor access, household food security, and child diet among participants have not been evaluated. Our overall goal is to maximize WIC's impact on nutritional outcomes among children in the US, by informing evidence-based interventions to optimize household food security and healthy dietary behaviors among WIC participants.Objective 1 will use existing data of WIC-participating children to explore associations between access to WIC vendors around the residence (including proximity, density and vendor type) with benefit utilization, how vendor access and benefit utilization contribute to household food security and child dietary behaviors, and how vendor access contributes to group-level differences in WIC benefit utilization, household food security, and child dietary behaviors. Cross-sectional data on household food security and child diet that were collected as part of the 2023 California Statewide WIC Survey will be merged with WIC administrative data on WIC benefit redemption and the location of the residence to assess these relationships in a representative sample of WIC-participating families in California from 2023. Geographic information systems data on the location of WIC-approved vendors will be used to determine participant access to WIC vendors around the home. Descriptive statistics and regression analysis will be used to assess these relationships.Objective 2 will use prospectively collected longitudinal data on WIC-participating children in Southern California to explore associations of the 2026 WIC food package revisions with WIC benefit redemption, household food security and child diet, and whether access to WIC vendors around the residence (including proximity, density and vendor type) modifies these associations. The baseline and follow-up surveys will be administered online in January-February 2026 and January-February 2027, respectively. WIC administrative data on benefit redemption and the location of the residence of respondents will be merged with survey data. Geographic information systems data on the location of WIC-approved vendors will be used to determine participant access to WIC vendors around the home. Descriptive statistics and regression analysis will be used to assess these relationships.Objective 3 will encompass seeking interpretation from WIC participants and staff- as key stakeholders - of the project findings, enabling the development of evidence-based recommendations for WIC program interventions that are responsive to participant and staff needs to optimize household food security and diet quality among participants. This will be accomplished via qualitative analysis of transcripts of three focus groups completed with caregivers of a WIC-participating children and two focus groups with WIC local agency staff.The overall goal of this project is toconduct research that will inform the design of evidence-based interventions to improve household food security and dietary behaviors among WIC participants. This project will develop evidence about how access to WIC-approved vendors varies among participating households andhow it contributes to benefit redemption, household food security, and child diet quality. This evidence will be disseminated in peer-reviewed publications, conference proceedings, and a non-technical report of project findings to share with practitioners and policy makers. This project will provide high quality evidence to facilitate the identification of areas of opportunity for improving access to WIC food benefits among participants, potentially by expanding access to WIC vendors. If this goal is met, the WIC program will have stronger tools at its disposal to address incomplete benefit redemption among participants and to support improvements in child diet and household food security among WIC-participating families. This could have a substantial impact on the burden of low early childhood diet quality in the US, as a substantial proportion of children participate in the WIC program before age 5 years.
Animal Health Component
50%
Research Effort Categories
Basic
50%
Applied
50%
Developmental
(N/A)
Goals / Objectives
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a nutrition assistance program of the United States federal government. WIC provides core services including health and social service referrals, nutrition education, breastfeeding support, and food benefits redeemable for select healthy foods and beverages at program approved vendors. Prior research has reported that WIC participation is associated with lower householdfood insecurity and higher child diet quality. Higher utilization of WIC food benefits is associated with longer continued WIC participation and higher child intake of WIC foods, which is thought to be beneficial for the long term health of WIC-participating children. WICfood benefits are often not fully redeemed, and it is not known whether geographic access to WIC-approved vendors is associated with WIC benefit redemption rates.This project has the following overarching goal: to conduct research that will inform the design of evidence-based interventions to improve household food security and dietary behaviors among WIC participants. This global goal can be partitioned into 5 more explicit goals:1) to measure geographic access to WIC-approved vendors among WIC participants in California,2) to determine if geographic access to WIC-approved vendors is associated with WIC benefit redemption,3) to determine how geographic access to WIC-approved vendors contributes to household food securityand 4) child diet,and 5) to determine if the associations between the introduction of a revised WIC food package in 2026 and household food security and child diet vary by geographic access to WIC-approved vendors.Findings for goals 1-5 will then be used to inform the design of evidence-based interventions to improve household food secuirty and dietary behaviors among WIC participants.
Project Methods
This project will use multiple methods to achieve the project goals. Secondary data analyses will be conducted for Objective 1 using the cross-sectional data from the 2023 California Statewide WIC Survey, a multi-modal (telephone and internet) survey conducted in March-August 2023, and linked WIC program administrative data. Respondents were randomly selected from those with a WIC-participating child age 1-4 years and able to complete the interview in English or Spanish. Data from the survey include child diet from the validated National Health and Nutrition Examination Survey Dietary Screener Questionnaire and household food security assessed with the USDA 6-item Household Food Security Survey Module (n=2,244). These data will be linked to a geographic database of WIC-approved vendors in California to determine geographic access to WIC-vendors around the residence of respondents. Descriptive statistics and regression analysis will then be used to assess the relationships between the WIC vendor environment around the residence and WIC benefit redemption with child diet and household food security. Objective 2 will involve a prospective study of WIC participants in Southern California to study the 2026 introduction of revised WIC food benefits. To do this, we will recruit WIC-participating families with a child 1 to <3.5 years of age in December 2025 to complete an online baseline survey on household food security and child dietary intake (using the 6-item USDA Household Food Security Survey Module and National Health and Nutrition Examination Survey Dietary Screener Questionnaire), and WIC shopping experiences in January/February 2026 (sample size n=1,800). An online follow-up survey will be completed one year later in January/February 2027 by families who responded to the baseline survey (sample size n=1,200). These data will be paired to WIC administrative data on household WIC benefit redemption, and geographic information about the WIC vendor context around the residence. Descriptive statistics and regression analysis will then be used to assess how the WIC vendor environment around the residence is associated with changes in WIC benefit redemption, child diet, and household food security from before to after the 2026 WIC food package revisions.Objective 3 will involve virtual focus groups with caregivers of WIC-participating children, and separate focus groups with WIC staff. Caregivers will be recruited to be representative of WIC participants served by the program in Southern California. We anticipate 3 1-hour focus groups of 6-10 WIC participants (1 focus group taking place in Spanish). Results of Objectives 1 and 2 will be shared, and caregiver interpretations and recommendations will be recorded, transcribed, and translated to English. An experienced PHFE WIC staff member who is a former WIC participant and speaks fluent English and Spanish will moderate focus groups. We will conduct 2 virtual focus groups with WIC staff.