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Duffy EW, Ng SW, Bercholz M, Davis CR, De Marco M, Hall MG, Maselko J, Smith Taillie L. Special Supplemental Nutrition Program for Women, Infants, and Children Participant Grocery Store Purchases during the COVID-19 Pandemic in North Carolina. Curr Dev Nutr 2024; 8:102098. [PMID: 38440362 PMCID: PMC10909627 DOI: 10.1016/j.cdnut.2024.102098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
Background Families participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) experienced barriers to accessing healthy food during the COVID-19 pandemic, but we do not yet understand how WIC participant food purchases shifted during the pandemic. Objectives We aimed to describe the association between the initial shock of the pandemic in March 2020 and WIC shoppers' food purchases and changes in purchases before and during the pandemic at a top grocery chain and examine differences in these relationships by duration of WIC use. Methods We used longitudinal food transaction data from WIC shoppers (n = 2,989,116 shopper-month observations from 175,081 unique WIC shoppers) from 496 stores in a top grocery store chain in North Carolina between October 2019 and May 2021. We used an interrupted time series design to describe the following: 1) the relationship between the initial shock of the pandemic and WIC shopper food purchases and 2) differences in purchases before and during the pandemic. To assess differences in purchases between shoppers consistently using WIC electronic benefit transfer (EBT) cards and shoppers starting or stopping WIC EBT use during the pandemic, we used models stratified by WIC group. Primary outcomes were share (%) of total calories purchased from fruits, vegetables, nuts, and legumes (FV), processed foods, and sugar-sweetened beverages (SSBs). Results We observed small decreases in the share of total calories from FV (-0.4%) and small increases in the share of calories from processed food (1.1%) and SSBs (0.5%) purchased at this retailer when comparing the pre and post March 2020 periods. Compared with shoppers that started or stopped using WIC benefits during the pandemic, shoppers that used WIC benefits consistently had slightly higher FV and lower processed food and SSB purchases at this retailer. Conclusions Future studies should examine whether additional supports for nutrient-dense food choices may be needed for families with low incomes in public health emergencies.
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Affiliation(s)
- Emily W Duffy
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Shu Wen Ng
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, Chapel Hill, NC, United States
| | | | - Cassandra R Davis
- Carolina Population Center, Chapel Hill, NC, United States
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Molly De Marco
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Marissa G Hall
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States
| | - Joanna Maselko
- Carolina Population Center, Chapel Hill, NC, United States
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lindsey Smith Taillie
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, Chapel Hill, NC, United States
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Kelley K, Campbell E, Steiber A, Yakes Jimenez E. Repeated Cross-Sectional Surveys of Registered Dietitian Nutritionists Demonstrate Rapid Practice Changes to Address Food Insecurity During the Coronavirus Disease 2019 Pandemic. J Acad Nutr Diet 2024; 124:268-278.e13. [PMID: 35963532 PMCID: PMC9364914 DOI: 10.1016/j.jand.2022.08.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 07/08/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic had worldwide economic impact, exacerbating food insecurity risk for vulnerable populations. OBJECTIVE To describe changes in practice and challenges and areas of need related to addressing food insecurity during the coronavirus disease 2019 pandemic for registered dietitian nutritionist survey respondents. DESIGN A cross-sectional, anonymous, online survey distributed via the Academy of Nutrition and Dietetics e-mail communication platform and social media accounts from April through May 2020 (Wave 1 [W1]) and December 2020-February 2021 (Wave 2 [W2]). PARTICIPANTS AND SETTING Participants were US-based registered dietitian nutritionists practicing in community-based settings to address food insecurity (W1: n = 454; W2: n = 331). STATISTICAL ANALYSES Responses were descriptively summarized using means ± SD, medians and interquartile ranges, or number of observations and percentages. Open-ended responses were manually reviewed and organized into major themes. RESULTS Respondents had about 10 years of experience in addressing food insecurity and were most commonly involved with the Special Supplemental Nutrition Program for Women, Infants and Children, federal school nutrition programs, or food banks. Participants described increased demand for food security assistance (W1: 68%; W2: 60%). Among respondents involved in food preparation and handling (W1: n = 183; W2: n = 110), supply chain (W1: 61%; W2: 56%) and staffing (W1: 37%; W2: 50%) challenges were commonly reported. Child nutrition program professionals (W1: n = 143; W2: n = 84) reported widespread implementation of optional program waivers, with the most commonly implemented waivers allowing noncongregate meal service (W1: 83%; W2: 81%), caregivers to pick up meals (W1: 69%; W2: 85%), and flexibility in mealservice times (W1: 75%; W2: 87%). CONCLUSIONS Respondents quickly adapted programs to ensure staff and client safety while continuing to provide essential food security services. They identified the need for ongoing nutrition program policy advocacy and timely access to best practice resources during public health emergencies.
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Affiliation(s)
- Kathryn Kelley
- Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois.
| | - Elizabeth Campbell
- Legislative and Government Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Alison Steiber
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Elizabeth Yakes Jimenez
- Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois; Department of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Au LE, Arnold CD, Ritchie LD, Lin SK, Frongillo EA. Differences in Infant Diet Quality Index by Race and Ethnicity Predict Differences in Later Diet Quality. J Nutr 2023; 153:3498-3505. [PMID: 37858725 PMCID: PMC10843900 DOI: 10.1016/j.tjnut.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/15/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023] Open
Abstract
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.
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Affiliation(s)
- Lauren E Au
- Meyer Hall, Department of Nutrition, University of California, Davis, CA, United States.
| | - Charles D Arnold
- Meyer Hall, Department of Nutrition, University of California, Davis, CA, United States
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA, United States
| | - Sarina K Lin
- Meyer Hall, Department of Nutrition, University of California, Davis, CA, United States
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
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Anderson CE, Whaley SE. Use of Interactive Texting Is Associated With Higher Odds of Continued WIC Participation During the COVID-19 Pandemic. J Acad Nutr Diet 2023; 123:1461-1469. [PMID: 37178999 PMCID: PMC10174723 DOI: 10.1016/j.jand.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND In Los Angeles County (LAC), California, the demand for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services increased during the COVID-19 pandemic, concurrent with the shift to fully remote WIC service delivery in March 2020. Technologies for facilitating remote services were critical for accommodating increases in participation during the COVID-19 pandemic. OBJECTIVE The objective of this study was to quantify patterns of remote-service utilization and to determine whether use of remote services (phone, interactive texting, e-mail, online education, video appointments) was associated with higher rates of recertification among WIC participants early in the COVID-19 pandemic. DESIGN Cross-sectional survey with administrative data for follow-up PARTICIPANTS AND SETTING: This study used data from the 2020 LAC WIC Survey and WIC administrative data to evaluate remote service utilization across LAC WIC agencies (unweighted n = 3,510; weighted n = 3,540). MAIN OUTCOME MEASURES Recertification on WIC, determined by the issuance of a food package in the first 2 months after the end-date of the prior certification period. STATISTICAL ANALYSIS Survey data were merged to WIC administrative data to determine whether participants completed a recertification; the association of utilization of each remote service with the odds of recertification among WIC-participating children 0 to 3 years of age was assessed with multivariable logistic regression. RESULTS Most survey respondents reported using phone appointments (95.5%), interactive texting (77.3%), e-mail (60.1%), and online education (71.2%) to access WIC services during 2020, and over 82% of children successfully recertified. Interactive texting utilization was associated with 27% higher recertification odds (95% confidence interval, 1%-59%); associations between all other remote services and odds of recertification were not statistically significant. CONCLUSIONS These results suggest that WIC investment in interactive texting technological infrastructure, and appropriate staff training, can help local WIC agencies successfully reach and provide high-quality services to WIC participants.
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Herman DR, Kimmel R, Shodahl S, Vargas JH. Examination of an Online Cooking Education Program to Improve Shopping Skills, Attitudes toward Cooking, and Cooking Confidence among WIC Participants. Nutrients 2023; 15:4177. [PMID: 37836462 PMCID: PMC10574281 DOI: 10.3390/nu15194177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
The present study examined if adapting the Cooking Matters (CM) curriculum to be used in an online format would improve participants' shopping skills, attitudes toward cooking, and feelings of cooking confidence, similar to the traditionally offered method, which is conducted in person. Results from factor analyses indicated that the online CM program demonstrated construct and content reliability compared to in-person (Cronbach's α ≥ 0.70). Repeated-measures ANOVA revealed a decrease in shopping skills overall (F = 5.91; p ≤ 0.05), consistent across age groups (F = 3.2; p ≤ 0.05) and food security status (F = 7.48; p < 0.01), with larger impacts on the food insecure (FI). Positive cooking attitudes increased with income (F = 2.86; p ≤ 0.05), especially among the <$20,000 and $30-39,000 income brackets. Cooking confidence increased post-intervention (F = 27.2, p < 0.001), with an interaction effect for food security status (F = 7.45; p ≤ 0.01), with greater improvement for households with food insecurity. These findings provide evidence to program and policymakers that virtual nutrition and cooking education services for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) should continue to be supported beyond the pandemic as they reduce barriers to receiving program benefits, nutrition education, and may lead to reductions in household food insecurity.
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Affiliation(s)
- Dena R. Herman
- Department of Family and Consumer Sciences, California State University, 18111 Nordhoff Street, Northridge, CA 91330, USA
| | - Rachel Kimmel
- Department of Family and Consumer Sciences, California State University, 18111 Nordhoff Street, Northridge, CA 91330, USA
| | - Skye Shodahl
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Suite 16-035 CHS, P.O. Box 951772, Los Angeles, CA 90095, USA
| | - Jose H. Vargas
- Department of Psychology, California State University Northridge, 18111 Nordhoff Street, Northridge, CA 91330, USA
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Pandemic-Era WIC Participation in Wilmington, Delaware: Participants' Experiences and Challenges. Nutrients 2023; 15:nu15030520. [PMID: 36771226 PMCID: PMC9921907 DOI: 10.3390/nu15030520] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants faced unprecedented challenges during the coronavirus disease 2019 (COVID-19) pandemic including financial concerns, a national infant formula shortage, and rising food costs. To mitigate these challenges, the United States Department of Agriculture implemented WIC program waivers and flexibilities aiming to simplify program operations (e.g., remote appointments and food package substitutions). However, little is known about WIC participants' perceptions of these changes and their impact on in-store benefit redemption. As such, this study aimed to characterize how pandemic-related events impacted Delaware WIC participants' shopping experiences and program perceptions. The authors conducted semi-structured interviews with 51 WIC participants in Wilmington, Delaware. Survey measures included demographic questions, the Hunger Vital Sign, and open-ended questions regarding WIC program participation experiences during the pandemic. Data were analyzed using a hybrid inductive and deductive coding approach. The results demonstrate that WIC participants benefitted from the pandemic program's flexibilities. However, they continued to experience burdensome shopping trips as well as concerns about their ability to feed their families due to infant formula shortages and inflation. These findings indicate the importance of extending existing WIC flexibilities and providing continued support for both participants and WIC-authorized retailors.
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Chaney AM, Ritchie LD, Whaley SE, Tsai MM, Randel-Schreiber HR, Yepez CE, Sabatier S, Young A, Meza M, Au LE. Racial and Ethnic Comparisons in Satisfaction with Services Provided by the Special Supplemental Nutrition Program for Women, Infants, and Children in California. Nutrients 2023; 15:nu15020447. [PMID: 36678318 PMCID: PMC9866005 DOI: 10.3390/nu15020447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
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.
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Affiliation(s)
- Alana M. Chaney
- Department of Nutrition, University of California Davis, Davis, CA 95616, USA
- Correspondence: ; Tel.: +1-706-288-6833
| | - Lorrene D. Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
| | - Shannon E. Whaley
- Public Health Foundation Enterprises WIC, 12781 Schabarum Avenue, Irwindale, CA 91706, USA
| | - Marisa M. Tsai
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
| | - Hallie R. Randel-Schreiber
- Communicable Disease Prevention Unit, San Francisco Department of Public Health, 101 Grove St, Rm 406, San Francisco, CA 94102, USA
| | - Catherine E. Yepez
- Public Health Foundation Enterprises WIC, 12781 Schabarum Avenue, Irwindale, CA 91706, USA
| | - Susan Sabatier
- WIC Division, California Department of Public Health, 3901 Lennane Drive, Sacramento, CA 95834, USA
| | - Adrian Young
- WIC Division, California Department of Public Health, 3901 Lennane Drive, Sacramento, CA 95834, USA
| | - Martha Meza
- Public Health Foundation Enterprises WIC, 12781 Schabarum Avenue, Irwindale, CA 91706, USA
| | - Lauren E. Au
- Department of Nutrition, University of California Davis, Davis, CA 95616, USA
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