Appendix V Study Extension Webinar Slides

Study Extension Webinar       

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Greetings from the         Feeding My Baby Study Team!

• Westat 

• Altarum  Institute  

• Public Health Foundation Enterprises WIC Program   

• Nutrition Policy Institute of the University of California   

• USDA Food and Nutrition Service  

       

Greetings from the Feeding My Baby Study team.  Our team includes…..

We are pleased you are joining us today for updates on the study and we very much appreciate your continued cooperation and support for this important and unique study.  

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Webinar Agenda

• Study objectives  

• Study timelines 

• Study activities  

• Highlights from study reports  

• Study activities during the extension   

• Role of State Agencies and sites during study extension period    

• Questions from State Agencies and sites  

 

Our agenda today is going to cover 7 topics starting with a brief review of the study objectives, timelines and activities.  We’ll share highlights from study reports that have been produced to date.  Then, we’ll talk about the future study activities to take place during the study extension period up to the time the children in the study turn age 5 and describe how we’ll be asking state agencies and WIC sites to assist.

We’ll end with time to answer your questions, and, over the next few weeks, we’ll also be having phone calls with each state agency and its sites in the study to talk about the assistance needed and address your questions.

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Study Objectives

• Update results of WIC infant feeding practices study conducted in 1994-95 

• Compare new findings with previous WIC study and other studies of infant and toddler feeding practices  

• Assess conditions of overfeeding and overconsumption 

• Identify nutrition education influences on infant and child feeding practices 

• Assess the impact of WIC on nutrition, health and developmental outcomes 

• Determine changes in feeding practices and behaviors as infants transition to toddlers and preschoolers  

• Identify factors that lead to continued, discontinued, or renewed participation in WIC through age 5 years  

The Feeding My Baby Study is designed to answer many questions regarding nutrition and feeding practices for infants and young children.  Because it is a nationally representative, longitudinal study of children up to age 5, we have the opportunity to gain a tremendous amount of information about these topics. Major study objectives include…..

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How will the findings be used?

• Provide insight on the factors and influences that impact feeding practices—useful for planning nutrition education 

• Describe food and nutrient intake from infancy through age 5 years—useful for assessing WIC food packages   

• Identify factors associated with movement in and out of WIC—useful for addressing program retention and outreach  

• Inform the nation about the important role WIC plays in early childhood nutrition 

The findings from this study will be useful for WIC program policy and planning, and it will provide insights regarding infant and child feeding practices that will be valuable for health and nutrition practices outside of WIC.   Examples of how the findings may be useful include…..

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Study Timeline

This snapshot of the timeline shows 4 points in time starting in 2013 when prenatal women and parents of young infants were recruited for the study through 2020 when the study will end with the publication of the final report.  

Last year, we talked with you about a one year extension of the study through age 36 months; today we’re sharing information regarding a second extension to age 60 months.  

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Study States and Sites

This map shows the states and sites that are participating in the study.  The 27 states are shown in green and the red dots indicate where the 80 study sites are located.  There have been changes in some of the site locations since 2013, however in most cases, replacement sites are in the same vicinity.

Webinar Poll: How many of webinar attendees have participated in the study activities since it began in 2013?

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Study Activities

• 2013: Recruitment of prenatal women and infants into study; WIC staff interviews and survey  

• 2013-2015: Interviews of prenatal women and infants from birth through 24 months; infant measurements at 6, 12 and 24 months    

• 2015-2016: Interviews for children at 30 and 36 months; measurements at 36 months  

• 2016-2019: Interviews for children at 42 through 60 months; measurements at 48 and 60 months  

• 2020: Final report  

Study activities during each of the time periods include…..

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Recruitment of Study Participants  

• Recruited 4,367 participants 

• • Prenatal women  

  • Mothers of infants up to 2.5 months old 

With help from all of you, we recruited 4,367 participants for the study.  This met our recruitment goal.

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Interviews with Parents/Caregivers

• [add table of status of interviews at time of webinar] 

Since 2013, we have conducted  a total of XXXXXXX interviews with the prenatal women and with the parents/caregivers of the infants and children.  We have finished all of the interviews for children through age XX and we are currently conducting interviews for children age XX.  

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Measurements of Infants/Children

• WIC data requests to State Agencies for measurements at 6, 12, and 24 months to date  

• Feeding My Baby measurement cards— beginning when children turn 36 months  

• Requests to healthcare providers  

• Home health agencies  

• [add bullet point on status of receiving  measurement data] 

We are obtaining weight and height measurements through several sources.  Most of the measurements to date have  come via WIC administrative data requests to state agencies. The states have provided measurements from the WIC records for those in the study that continue to participate in WIC including  measurements for ages 6, 12 and 24 months.

We are beginning to request measurements for children at age 36 months via a Feeding My Baby  measurement card.

We also obtain measurements from children’s healthcare providers, and we offer parents the option of sending a home health care person to their home to conduct the measurements.  

We’ve been successful in obtaining the measurements for …..

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Study Highlights: Prenatal

• 2,649 women who enrolled in WIC prenatally (73%) 

• Topics 

• • Beliefs about breastfeeding 

  • Experience and advice about infant feeding 

  • WIC Program knowledge 

  • Intentions to breastfeed 

So, what have we learned from the study so far?  The first report from the study—the Prenatal Report--was published in May, 2015 and is posted on the USDA FNS website. This report shares findings from interviews conducted with 2,649 of the prenatal mothers enrolled in the study who were interviewed on topics including…….

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Participant Socio-demographics

Demographics of mothers	Percent
Race: White/Black	59% and 25%
Ethnicity: Hispanic/Latino	40%
Unmarried	70%
≤ 75% poverty threshold	63%
Food security: Low/Very low	31% and 17%
History of breastfeeding	54%
Weight:  Overweight/Obese	26% and 28%
Enroll: 1st-2nd trimester/1st child	67% and 40%

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This is a brief look at the socio-demographics of the mothers.

Of interest:

1 – 17% of cohort of HHs have very low food security upon recruitment (which is when women enrolled in WIC)1. This is quite a bit higher than the ERS 2013 report which found 11.9% of HHs that had been on WIC in past 30 days were food insecure

2 – 54% have history of breastfeeding

3 – 40% enrolled for 1st child

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Breastfeeding Beliefs--
More Positive

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Breastfeeding is…….

 

WIC women’s acceptance of breastfeeding has greatly increased since the last study of WIC infant feeding practices.

Orange bars represent the responses of the mothers in our study and green represent the responses in the last study conducted in 1994-95.

As you can see with all items, the women in this study are more positive about breastfeeding than the past cohort.

We didn’t have enough data from the first study to determine whether the differences were statistically significant, but we can assume they represent real shifts in beliefs

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Breastfeeding Beliefs--
Less Negative

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Breastfeeding…

 

Same patterns are seen with barriers to breastfeeding.  Fewer women in the current study believed these were barriers to breastfeeding.

 

Note the last item.  A higher percentage of women said BF was painful compared to the past study.

As I mentioned, we could not determine whether it was statistically significant, but it does suggest there is a shift in thinking.

This may be an area of education that you can focus on.

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Breastfeeding Beliefs
by Socio-demographics

• Race: African Americans least positive 

• Ethnicity: Hispanics most positive 

• Education: Less educated less positive 

We looked at beliefs by socio-demographics.  Here are the results…..

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Infant Feeding Advice

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We asked the prenatal women who they talk to about infant feeding with the question:

Have you talked with any of the following people about whether you plan to breastfeed, formula feed, or both breastfeed and formula feed your baby?

Note that 68% of women said that they talk to WIC staff; second only to talking to their husband or boyfriend.  WIC staff are an important source of  information about infant feeding choice for WIC women.

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Advice Important to Decision

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Irrespective of who they turned to for advice, over 80% said the advice was important to making a decision.  The discussions you have about breastfeeding with WIC mothers are influential.

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Infant Feeding Intention(IFI) Scale*

• I am planning to only formula feed my baby and do not plan to breastfeed at all. 

• I am planning to breastfeed my baby or at least try. 

• When my baby is 1 month old, I will be breastfeeding without using any formula or other milk. 

• When my baby is 3 months old, I will be breastfeeding my baby without using any formula or other milk. 

• When my baby is 6 months old, I will be breastfeeding my baby without using any formula or other milk. 

*developed by Nommsen-Rivers (2010)

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Mean IFI Score

• All prenatal women in study = 9.8 

• Prenatal women in study pregnant          with 1st child = 10.2 

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The score for all prenatal women in the study was 9.8.

The score for prenatal women pregnant with their 1st child was 10.2.

As a comparison, the researcher who developed the score calculated 11.8 in sample of low-income women having 1st child.

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Higher Intention to Breastfeed

• Hispanic  

• Married  

• >75% of poverty guidelines 

• Breastfed previously for >3 months 

• More education 

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Then we looked at intention to breastfeed by socio-demographics.  

Participants with these characteristics had a higher intention to breastfeed.

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Lower Intention to Breastfeed

• African American  

• Pregnant with a third or subsequent child  

• Having been on WIC previously  

• Not living with the baby’s father 

• Engaging in discussions about infant feeding plans with no more than one person 

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And participants with these characteristics had a lower intention to breastfeed.

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No Impact on Intention to Breastfeed

• Food security 

• Pregnancy trimester joined WIC 

• Weight before pregnancy 

• Born in the US 

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Interestingly, these characteristics had no effect on intention to breastfeed.

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Intention to Breastfeed:
Regression Model

Socio-demographics + Beliefs + Advice/experiences → Intentions to Breastfeed

Regression model explains nearly 34% of the variability in IFI scores.

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Then we hypothesized that socio-demographic characteristics + beliefs + advice may influence BF intentions.

 

But some of the demographics and beliefs may be correlated with each other.  

So we used regression analysis to estimate the independent effect of these variables on intention.

We found the regression model explains nearly 34% of the variability in IFI scores.

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Socio-demographics (SD)+                  Beliefs + Advice = Intention

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Explanatory variable	Coefficient sign	Significance
SD: Some BF history	Positive	Significant
SD: >High School education	Positive	Significant
SD: Mother living with father of baby	Positive	Significant
SD: Second/subsequent born	Negative	Significant
Belief: Benefits Index	Positive	Significant
Belief: Barriers Index	Negative	Significant
Advice: Spoke with >1 person about feeding plans	Positive	Significant

Here are the highly significant variables.

Sociodemographics: Having some history of BF, >HS education, and mother living with father of baby all have positive effect on intention to BF.

Having a 2nd or subsequent born has a negative effect on intention to BF.

Benefit index is positively correlated with intention to BF

Barrier index is negatively correlated with the intention to BF

Lastly:  speaking with >1 person about feeding plans has a positive effect on intention to BF

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Summary

• Breastfeeding is viewed much more favorably   than 20 years ago 

• Views on Benefits drive intention to breastfeed;   vary by race, ethnicity and education level  

• Advice from more than one person  impacts intention 

Study reports available at http://www.fns.usda.gov/wic/wic-studies

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Summary of findings in Prenatal Report……

You can find the reports from the study on the FNS website at the address shown.  

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Study Highlights: Infant

• [include 5-6 slides of findings for infants if approved by FNS] 

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Study Activities during Extension

• Obtain State/local IRB approvals 

• Notify parents/caregivers and ask them to continue with study  

• Stay in contact with parents/caregivers 

• Conduct four additional interviews—42, 48, 54, 60 months  

• Obtain weight and height measurements at 48 and 60 months 

Now we want to turn our attention to the future….the study activities during the extension to age 5.  The key activities include…..

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Study Participation during Extension

	Number in Study	Percent Interviews Completed
42 Months	2,319	57%
48 Months	2,200	54%
54 Months	2,087	52%
60 Months	1,980	49%

Here are our estimates of the number of children who will continue in the study and the percent of their parents who will participate in the 4 interviews during the study extension.  

We started with a little over 4,000 infants and expect to have about half of them in the study at the end of 5 years, with about half of their parents completing the last interview at 60 months.  Note that children remain in the study even if they are no longer participating in WIC.

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Keeping Parents/Caregivers Engaged  

• Extension flyer, birthday cards, thank you notes, phone calls, text messages 

• Incentives  

• • $45 - $60 (plus $10 for use of cell phone) for interviews 42, 58, 54 and 60 months 

  • $50 (plus $10 for transportation) for obtaining measurements at 48 months  

  • $60 (plus $10 for transportation) for obtaining measurements at 60 months  

One of our biggest challenges is to keep parents/caregivers engaged in the study—participating in the interviews and providing the measurements.  We use several methods to keep in touch with them including….  

During the study extension to age 5, we are increasing the amount the parent/caregiver will receive for participating in interviews and providing measurements.  The amounts for interviews range from $45 at 42 months to $60 at 60 months and we provide an additional $10 if the parent uses their own cell phone.

For parents who obtain the measurements and send them in to  us, they will receive  $50 for the measurements at 48 months and $60  at 60 months, plus $10  to cover transportation costs.

The parents/caregivers will also be provided with small incentives for returning HIPPA consent forms and updating their contact information with us.  

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Assistance from States and Sites

• Obtaining measurements at 48 and 60 months (age 4 and 5 years)  

• All parents/caregivers will be asked to take child to WIC site or healthcare provider for measurements  

• Measurement cards will be provided to all parents/caregivers to obtain measurements and return to Westat  

During the study extension, we’ll need help from you to obtain the weight and height measurements for the children at 48 and 60  months.  The amount of assistance we’ll need is fairly small but it will have a large impact on the study results.  We believe measurements taken at WIC sites are one of the most accurate sources available.

We will ask all parents/caregivers of the children in the study at those times to…..

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Measurement Card

This is what the measurement card looks like.  Some of you have probably seen this because we are currently sending it to parents of the children in the study who are reaching their third birthday if they are no longer participating in WIC.  We are asking them to take the child to a WIC site or healthcare provider for the measurements and to return the card to us.  We will be using this same card for the 4 and 5 year old children.

Our experience to date with the 3 year old children is limited but most parents are choosing to take their child to [WIC sites? Healthcare providers?]

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Measurements at WIC Sites

• All children in the study—some on WIC and some not on WIC  

• All parents/caregivers will be offered incentive to have measurement card completed and returned  

• • On WIC at 48 months: recertification  

  • Not on WIC at 48 and 60 months: identify convenient WIC site for parent/caregiver  

All parents/caregivers of children in the study will receive the measurement card near the time of the child’s fourth and fifth birthdays.  Some of these children will still be on WIC when they turn 4 but most are likely to be no longer receiving WIC.  

All parents will be offered the incentives to return the completed measurement cards.

For children on WIC at age 4, they will be advised to take the card to their next WIC appointment which may be around the time of their recertification appointment.  We would like WIC sites to complete it with the measurements taken around age 4.

For children not on WIC at age 4, and for all children at age 5, the parents will be asked to take the child to a WIC site or their healthcare provider for the measurements and to return the completed measurement card.  For the parents who choose to go to WIC for the measurements, we will suggest the WIC site where they were enrolled in the study if they still live in the area where it is located.  If the family or the site has relocated, we will assist them with identifying a site that is convenient for them.  

We’ll discuss the best approach for identifying sites with the state agencies in our upcoming calls.  

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Measurement Data Alternatives

• WIC data request for 48 month measurements 

• •  only if child is on WIC and measurement card not returned  

• Request for measurements from healthcare provider  

• Parent/caregiver sends in copy of record from healthcare provider  

• Home health agency  

If the measurement card is not returned…..

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Other Assistance from WIC

• Help with locating parents/caregivers of children in the study if…. 

• • They can’t be located through other means 

  • They are believed to be participating in WIC 

If we cannot get in touch with parents/guardians using the contact information we will contact the site or, if preferred, the state agency where they were enrolled in the study but only if…..  

We will ask for updated contact information if you have information that is more current that what we have.  We have been making these requests of WIC sites or state agencies since the study began and appreciate the cooperation we’ve received.  

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What are your questions?

Now we’d like to hear your questions about the study or the activities during the extension to age 5.  

As mentioned earlier, we’ll be setting up calls with each state and the sites in their state to have a chance to talk about the specifics and logistics for the assistance we’ll need through the end of the study.  

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Thank you for your support!

Opportunity for all on team to make comments of thanks.  

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