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OMB Approval No.: 0584-0580
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Appendix O
Study extension
webinar slides

Year 9
Extension
Webinar
[Insert Date]

Greetings from the
Feeding My Baby Study Team!
 Westat
 Public Health Foundation Enterprises WIC Program

 Nutrition Policy Institute of the University of California

 USDA Food and Nutrition Service

Webinar Agenda
 Study background, objectives, timeline
 Role of State Agencies and sites during

study extension period

 Study report highlights
 Questions from State Agencies and sites

Original Study Objectives
 Update findings from the last study, the WIC infant feeding

practices study, conducted in 1994-95

 Identify nutrition education influences on infant and child

feeding practices

 Assess the impact of WIC on nutrition, health, and

developmental outcomes

 Examine changes in feeding practices and behaviors as infants

transition to toddlers and preschoolers and early childhood

 Identify factors that lead to continued, discontinued, or

renewed participation in WIC through age 5 years

Year 9 Extension Objectives
Two
studies
Year 9 Followup Study

Lost-to-Followup
Study

How does WIC participation
influence the health and
nutrition trajectories of
school-aged children who
previously received
program benefits?

What are the characteristics
of WIC ITFPS-2 participants
who left the study during
the first five years and how
do they compare with those
who stayed in the study?

Study Recap
 80 WIC service sites in 27 State agencies

sampled
 Recruited 4,367 mother/child dyads
between July and November, 2013
 Follow up telephone interviews from
Prenatal to child age six (2013 – 2020)
 Dietary Recall
 Survey questions

Caregiver Participation
Has Been High
 90 percent completed the prenatal

interview
 70 percent completed the interview when
the child was 72-months-old
 Average completion rate 77 percent over

18 interviews from prenatal through 72months.

Measurements of
Infants/Children
 WIC data requests to State Agencies for

measurements at 6, 12, 24, 36 and 48
months
 Started using Feeding My Baby
measurement card at 36 months
 Also accepted copies of recent health care
provider reports with height and weight

How will the findings be used?
 The Year 9 Extension findings will be used to inform

the nation about the important role WIC plays in early
childhood nutrition even beyond the period of
eligibility.

Along with the base study, the extension study findings
may also be used to:
 Inform nutrition education
 Assess the role of WIC in children’s food and nutrient

intakes

 Identify factors associated with movement in and out

of WIC

Study Activities during
Extension
 Obtain State/local IRB approvals
 Stay in contact with parents/caregivers
 Conduct one additional interview at age 9
 Obtain measurements at age 9
 Obtain administrative data on study

participants who left the study in the first five
years.

Study Participation during Extension
 4,032 active participants at the end of the

72-month interview
 1,098 expected to complete the final age 9
interview.
 Interview time period April, 2022 – August,
2023

Keeping Parents/Caregivers
Engaged
 Extension letter, birthday cards, thank you

notes, phone calls, text messages
 Proposed incentives

 $70 gift card (plus $10 for use of cell phone)

for age nine interview
 $70 gift card (plus $10 for transportation) for
obtaining measurements at age nine.

Assistance from States
and Sites – Age 9 Measurements
 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

Measurement Card

Measurements
at WIC Sites
 All children in the study who choose to

come to WIC for measurements
 All parents/caregivers will be offered
incentive to have measurement card
completed and returned
 Identify convenient WIC site for

parent/caregiver

What if……?
 Original study site has closed?
 Family has relocated within study site area?
 Family has relocated outside of study site

area?

Measurement Card
Alternatives
 Parent/caregiver sends in copy of record

from healthcare provider within 4 months of
child’s 9th birthday.

Assistance from WIC –
Participant contact information
 Help with locating parents/caregivers of

children in the study if….

 They can’t be located through other means

Administrative Data from
State Agencies – Lost to Followup Study
 Similar to the previous administrative data

requests.
 Westat will provide a list of participants
who left the study in the first five years.
 State agencies fill in the requested
variables and return the list
 $1,000 grant offered towards the extra
effort.

Typical Report Topics
Work, child care, and feeding beliefs
 Feeding practices
 Food intake
 Energy and nutrient intake
 Weight and growth
 Correlates of WIC participation


Positive Prenatal Perceptions of
Breastfeeding Generally Increased
Percentage of Study Mothers Agreeing
53%

75%

Breastfeeding helps women lose weight
Breastfeeding reduces the risk of a child become overweight

50%
71%
71%

Breastmilk along gives a new baby all he/she needs to eat

81% Breastfeeding brings a mother closer to her baby
88%
50%
55%

61%

Breastfeeding is easier than formula feeding
77%
81%

Breastfeeding helps protect baby from diseases

80%

Breastfed babies are healthier

IFPS-1

WIC ITFPS-2

Negative Prenatal Perceptions
of Breastfeeding Evidenced
Some Decline
Percentage of Study Mothers Agreeing
76%
67% With bottle feeding, mother knows the baby is getting enough to eat
48%
51%
39%
44%
37%
46%

27%
15%
17%

34%
41%

Breastffeeding means no one else can feed the baby
Breastfeeding is painful

61%

Breastfeeding in public is not something that I want to do
Breastmilk leaking onto my clothes worries me
Breastfeeding takes too much time
Breastfeeding ties you down

IFPS-1

WIC ITFPS-2

Breastfeeding Initiation Rates
and Duration Increased
Percentage of Study Mothers Breastfeeding
83%
61%
42%

56%

32%
33%
21%

Initiation

Month 1

Month 3
WIC ITFPS-2

16%

Month 5
IFPS-1

26%

12%

Month 7

Increasing percentages of
study mothers are working or
attending school
The percentage of study mothers working and/or going to
school

48%

53%

51%

56%

55%

58%

61%

39%

Month 3 Month 7 Month 13 Month 18 Month 24 Month 30 Monrth Month 54
42

Study Child Age

Mothers who work full-time
are less likely to be
breastfeeding than are mothers who are not
employed at each time point
Breastfeeding rates by employment status groups (Months 3, 7,
and 13)
44%
41%

34%
20%

26%

28%

10%
Month 3

Month 7

Full-time

Part-time

15%

19%

Month 13

Not employed

26

WIC is a Trusted Source
for Infant Feeding Information
Doctor or health
professional

66%

WIC office or clinic

59%

Family member

56%

Internet or parenting
websites

34%

Husband/boyfriend

32%

Books or magazines

25%

A friend
Mom's group or class

23%
9%

Reasons for Leaving WIC the
First Time

Though Some Leave WIC, Many
Return after a Short Break
Percentage by Length of
Time They Stopped
17%

Percentage of Study
Participants by Reason
They Return to WIC

15%

Re-enroll after a move

15%

Missed recertification

Became pregant again
Less than 1 month
More than 12 months

75%

53%
1 to 6 months 7 to 12 months

Income changed

55%

43%

42%

People Stay with WIC for Several
Reasons
Reasons Why People Stay with WIC
93%

94%

91%
67%

Food you get

Education,
information, and
advice you get

WIC staff listen to
your thoughts about
your child's health

To talk with other
parents about
parenting and
feeding

Participation in Benefit
Programs
Percentage of caregivers participating in benefit
programs
73%

63%
52%

50%

73%

50%

46%
35%

WIC
30 months

SNAP

NSLP, SBP, or
SFSP

36 months

42 months

Medicaid
54 months

Energy intakes rises
with age
Median Energy Intake of Study Children by
Gender
1,324

1,484

1,588

1,685
1,277

Males
24 months

1,398

1,453

Females
36 months

48 months

60 months

1,571

Prevalence of Picky
Eating Rises
Percentage of study children

Caregiver perception of the child’s pickiness
68%
47%
35%
26%
18%
6%

18 months 24 months 30 months 42 months 54 months
Very picky

Somewhat picky

Not picky

Study Children’s Diet Quality
as Good as a National Sample
of US Children
Mean 2015 Healthy Eating Index Scores
60.9

61.4

58.7

59.0

60.1

24 months

36 months

48 months

60 months

National
(NHANES)
sample ages
2 to 5

Study child’s age

Longer WIC Participation is
Positively Associated with Diet Quality
Adjusted Mean HEI-2015 Total Scores by
Duration of WIC Participation
59.8

59.8

59.5

Intermittently*

Year 1 only*

Years 2 or 3
only*

60.7

Years 4 or 5 only

61.7

Consistently

The asterisk (*) indicates that each mean differs significantly from the mean for the
group who participated consistently with WIC through the 54-month interview.

Percent of study children with
inadequate intakes

A Few Nutrients with
Inadequacies
78%

82%

84%
73%

55%

1%
24 months

27%

36%

33%

27%
13%

1%
26 months

48 months

60 months

Vitamin D

Vitamin E

Calcium

Percentage of study children
consuming on a given day

Consumption of Desserts,
Sugar-sweetened Beverages,
and Salty Snacks Rises Over Time
Trends in Consumption of Select Sugary and
Salty Foods
60%
36%
31%
3

5

7

9

11

13

15

18

24

36

Child age in months
Desserts and candy
Salty snacks

Sugar sweetened beverages

48

60

Sodium Intake is Excessive
2,200

1,915

1,200

1,200

24 months

36 months

2,411

2,648

1,500

1,500

48 months

60 months

CDRR
Median intake in excess of CDRR

Percentage of Overweight
and Obese Children Rising
65%

61% 60%

14% 15% 16%

17% 18%

19%

4% 5% 5%

Underweight

Normal/Healthy
weight*
3rd Year

Overweight

4th Year

5th year

Obese

Next Report (Age 6)
 Work, child care, medical care, federal food

benefit receipt
 Healthy food purchasing, feeding beliefs,
rules, and practices
 Food intake
 Energy and nutrient intake
 Weight and growth
 Correlates of past WIC participation

Thank you for your support!

What are your questions?

The Food and Nutrition Service (FNS) is collecting this information to investigate (1) the dietary practices and the health and nutritional status of the WIC ITFPS-2 children during the ninth year of
life; (2) if participants who left the study were systematically different than those who continued in the study and if these study participants left WIC at the same rate as their counterparts who
remained in the study. This is a voluntary collection and FNS will use the information to s inform WIC service delivery. The collection does request personally identifiable information under the
Privacy Act of 1974. Responses will be kept private to the extent provided by law and FNS regulations. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor,
and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0580.
The time required to complete this information collection is estimated to average 1.0 hours (60 minutes) per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, 1320 Braddock Place, 5th Floor,
Alexandria, VA 22314. ATTN: PRA (0584-0580). Do not return the completed form to this address.