National WIC Association

Fall 2017 WIC Research To Practice


Working with WIC state agencies should be based on shared goals, shared interests, and shared views about the WIC program. If researchers can have the same view of helping WIC participants that the state agencies have, they are more likely to be able to identify partners in the state agency.

This edition of Research to Practice celebrates the importance of collaborations and partnerships to support effective research within WIC. We start with the final evaluation of Community Partnerships for Healthy Mothers and Children project, followed by updates on the current development of NWA’s Research, Policy and Practice Hub. This edition also includes updates from colleagues at USDA’s Economic Research Service and the Food and Nutrition Service. The Researcher Spotlight is Dr. Harry Zhang who describes the importance of common goals and objectives for both researchers and WIC staff and how he developed productive partnerships with Virginia WIC. As always, we will have information on upcoming conferences and links to new publication abstracts.

Thanks for reading WIC Research to Practice! If there are studies or reports you would like us to highlight in our Winter edition, please contact Georgia Machell,

Community Partnerships for Healthy Mothers and Children: Cohort 2 Evaluation Report

From 2014 – 2017, NWA implemented the Community Partnerships for Healthy Mothers and Children (CPHMC) project to engage local agencies in efforts in building and strengthening capacity to conduct community-based strategies to improve health. With funding from the Centers for Disease Control, NWA supported 30 local agencies in 18 states in performing community needs assessments and working with local coalitions to develop and implement a community action plan to improve food environments and promote chronic disease prevention services. Local agencies were selected in two cohorts with each cohort working on a wide range of strategies over a period of about one year. Altarum partnered with NWA to conduct an evaluation of the CPHMC project experience of the two cohorts. The evaluation aimed to describe the local agency project experience and identify factors that facilitated or hindered implementation of the project activities and achievement of objectives. The report for the second cohort of agencies shares the project experience of this group and includes a comparison with the first cohort. Across both cohorts, WIC agencies reported increased capacity to engage with coalitions and partners and lead local efforts that promote healthy families and communities. Nearly all agencies also reported that coalitions, partnerships and project activities would continue after the project funding ended. The project evaluation report is available here.

WIC Research, Policy and Practice Hub – It’s Happening!

NWA is in the process of developing an online, searchable (by topic and geographic location) platform for sharing examples of WIC best practices, research, research tools, resources, videos and more. At this time, we would like to collect research tools that our members have used and would be happy to share. Examples of research tools include surveys and interview guides. If you have a research tool that you would like to share, please contact Georgia Machell

New WIC Researcher at ERS

Xinzhe Cheng recently joined the Food Assistance Branch of USDA’s Economic Research Service. Her research focuses on WIC and economics of other food and nutrition programs. She is currently examining the Economic Benefits of Breastfeeding, and the Benefit Redemption Patterns and Cost of WIC Food Package. Xinzhe is finishing up her PhD in agricultural economics at UC Davis.


WIC Research Released by the Food and Nutrition Service between January and September of 2017

The Office of Policy Support at the Food and Nutrition Service (FNS) conducts research and analysis to inform and evaluate the 15 food and nutrition assistance programs administered by FNS, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Since January of 2017, four studies on WIC have been released by FNS. The four reports are described below along with a link to the complete final report, 2-page summary of the main findings, and interactive graphics for the most recent study release.

The Infant Year Report of the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2 or “Feeding My Baby”), released in January, is the second in a series of reports from a longitudinal study of infants enrolled in WIC during early infancy and followed until 5 years of age. The Infant Year Report focuses on infant feeding practices, including breastfeeding initiation and duration and introduction of complementary foods, comparing the new study findings to the first WIC Infant Feeding Practices Study conducted in 1994-95.

The WIC Vendor Peer Group Study, released in May, provides important information about cost-savings measures used by State agencies in their vendor management practices. The report includes an appendix with State agency guidelines on how to develop and empirically test peer group systems based on the approach used in this study.

Planning for Future Data Collection Needs within WIC, released in June, provides information on WIC State agencies’ ability to collect, store, retrieve, and report data to meet policy and program management needs now and in the future. The report includes information on the perspectives and needs of WIC Stakeholders.

National and State-Level Estimates of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Eligibles and Program Reach in 2014, and Updated Estimates for 2005-2013, released in September, is the latest in a series of annual reports on the number of women, infants, and children eligible for WIC and the percent of the eligible population receiving WIC benefits. The report provides estimates by participant category, region, State, U.S. territory, and race and ethnicity, as well as updated estimates for years 2005–2013 that incorporate new methods implemented in the 2014 report. The updated estimates replace the 2005-2013 estimates published in earlier reports. The new release also includes a series of interactive graphics for communication of new estimates from 2005 through 2014.

Reported by the Office of Policy Support, Food and Nutrition Service, USDA.

New NSA Cost Study

Last week a fifth report was released by the Office of Policy Support, Food and Nutrition Service, USDA. The WIC Nutrition Services and Cost Study (NSA) assesses how NSA funds are spent, including amounts and categories of costs and their variation across state and local agencies. The study found that in 2013, 79% of NSA expenditures were for local agency costs and 21% were allocated for state agency costs. Nearly one third of NSA funds were spent providing nutrition and breastfeeding services. Nearly 80% of NSA funds were for personnel/labor costs. Local agencies spent 91% of NSA funds on direct costs and 9% on indirect costs. The transition to EBT and new MIS systems has had mixed effects on program operation costs. The full report can be found here.

Researcher Spotlight: Dr. Harry Zhang

Dr. Harry Zhang is an Associate Professor in the School of Community and Environmental Health at Old Dominion University in Norfolk, Virginia. He started WIC-related research in 2015 and his research focuses on understanding the economic behaviors among WIC participants and developing innovative interventions to improve WIC participation and benefit redemptions. He is working closely with Virginia WIC and other WIC stakeholders at national and regional levels. His WIC research has been supported by USDA, National Institutes of Health (NIH), and Duke – University of North Carolina USDA Center for Behavioral Economics and Health Food Choice Research (Duke-UNC USDA BECR Center). Dr. Zhang has become a regular attendee at NWA conferences and is serving on NWA's planning committee for the education and training conference in 2018. Harry shared with us about his experience and passion for WIC.

I was very curious about almost everything in the WIC program, but I lacked real-world experience with it. As a result, I just treated everybody in the program as my mentor. I'm still very happy whenever any WIC staff can teach me one more new thing about the program.

What drew you to study WIC?

I'm always interested in applying the principles of behavioral economics to areas with high policy significance. In 2015, I was invited by Duke-UNC USDA BECR Center to write a white paper on controlling WIC program costs using a behavioral economics approach. This project was strongly supported by the Virginia WIC Director at that time, Dr. Michael Welch, who opened the door to the "WIC wonderland" for me. Since then, I have been totally attracted by WIC-related research.

What was the goal of your research on WIC?

My goal is pretty simple: helping WIC stakeholders in any way research can help. For example, helping WIC participants by making the WIC program more user-friendly, helping WIC staff by making their jobs easier with innovative technology, and helping WIC policy makers by providing more effective policy tools to achieve their goals.

What were the main methods used?

I prefer a three-pronged, mixed-method approach, which is a combination of qualitative, field experiment, and quantitative approaches in WIC-related studies. The qualitative method helps me identify significant knowledge gaps in the real WIC world. The field experiment is used to test innovative interventions. The quantitative method is mainly driven by big data analyses of the recently available Electronic Benefit Transfer (EBT) data in the WIC program, which can help evaluate the interventions or test hypotheses.

Based on your research, what did you learn about how WIC participants use smartphones?

Smartphone usage is prevalent among WIC participants, so they are a promising platform to nudge WIC participants' behaviors and therefore to improve program outcomes. Some technical barriers we identified are frequent phone changes, small memory size, and limited data access in rural areas.

How can WIC participants be “nudged” to change behavior when it comes to purchasing more fruits and vegetables?

A carefully built reminder system can be a nice nudge for WIC participants to redeem fruits and vegetables benefits. Compared with infant formula or other higher-valued benefits, fruits and vegetables benefits may not be on the top of a participant’s redemption list. It is often challenging for them to remember the balance of their fruits and vegetables benefits and to redeem it. If we can build a timely nudge that reminds them about their fruits and vegetable benefits and the expiration dates for those benefits, they may redeem more fruits and vegetables.

What additional research would help us to better understand the potential role of client facing technology in WIC?

There's a significant knowledge gap in this area. I would highly encourage multi-disciplinary, mixed-method research in the field. More solid research is needed to get a clear picture of participants' behaviors in the WIC program. At this point in time, I would suggest that we may want to change the "WIC program-centered" perspective to a more "WIC participant-centered" perspective to guide our client-facing technology development.

If you had to recommend that a State or Local Agency focus resources on app development or text message reminders, which would it be and why?

WIC agencies may want to aim to develop a "smart" system that will identify participants with particular behavioral barriers in the WIC program and deliver tailored nudges to these target populations by app or text. We found that WIC participants had different behavioral patterns and thus different barriers to full benefit redemption while participating in the WIC program. Thus, a single, universal app or text approach may not work very effectively, just as prescribing aspirin to every sick person would not work. While it would be demanding for WIC staff to achieve the goal of reaching out to this varied range of participants and nudging them, given the limited human power in the WIC program, a data-driven automatic app or text message reminders could be a cost-effective approach to achieve the goal.

Describe your experiences as a researcher working with a state WIC agency.

My experience might be considered a dream come true for a researcher working with any state agency. We have formed a very healthy and productive research collaboration to work on our common goal: how to make Virginia WIC a better program to serve participants. I always feel I'm so fortunate to work with so many of the nicest and best people in this society to help a highly vulnerable population. Past Virginia State Director Dr. Michael Welch really led me into the WIC world and willingly shared his extensive experience. The current State Director, Dr. Mandeep Virk-Baker, who has a strong research and academic background, really has the passion to improve the Virginia WIC program with innovative research. I always enjoy chatting with them and other WIC staff in a local clinic or in the state office. Their extensive experience and knowledge often reshape my understanding of the WIC program and inform my research designs. They never ask what they can get out of helping researchers, and they always try to help others to build a better WIC program. I do owe them a lot.

How did you build rapport with the State WIC agency you were working with?

Actually everything developed naturally because we shared the same goal and built up mutual trust gradually. At the starting point, I was very curious about almost everything in the WIC program, but I lacked real-world experience with it. As a result, I just treated everybody in the program as my mentor. I'm still very happy whenever any WIC staff can teach me one more new thing about the program. I also provide whatever support or ideas I can give to help them, in return. In this way, we have built up a healthy relationship based upon a sincere desire to understand each other and help each other.

What advice do you have for other researchers hoping to work with WIC state agencies and vice-versa?

Since I contribute many volunteer hours to serve in the communities in which I live and work, I often treat my WIC research as another form of community-based service instead of pure research or scholarly activities. This "service-oriented" research approach might be important in setting the basis for collaboration. Working with WIC state agencies should be based on shared goals, shared interests, and shared views about the WIC program. If researchers can have the same view of helping WIC participants that the state agencies have, they are more likely to be able to identify partners in the state agency. Mutual respect and mutual understanding are also important. WIC state agencies may not have the same priorities as researchers, and researchers need to understand this and be patient as they try to make sure that every party is on the same page. Research topics should be highly policy-relevant, but must also be feasible given WIC state agencies' resources. It is never easy to form a collaboration like this, and whether researchers can sacrifice themselves enough to serve the common good might be a major key to success.

Upcoming Conferences

March 4-7, 2018: Washington, DC, Washington Leadership Conference.

April 22-25, 2018: Chicago, IL, NWA Annual Education and Training Conference and Exhibits.

September 24-27, 2018: New Orleans, LA, Nutrition Education and Breastfeeding Promotion Conference and Exhibits.


Food Package

Review of WIC Food Packages: Improving Balance and Choice: Final Report.
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee to Review WIC Food Packages, National Academies Press (US), 2017.

The Effect of the WIC Program on Consumption Patterns in the Cereal Category
Khan R, Zhu T, & Dhar S, 2017, Quantitative Marketing and Economics.

Fruit Juice and Fruit in the Special Supplemental Nutrition Program for Women, Infants, and Children Food Packages
Rasmussen, K, Pérez-Escamilla, R, & Baker, S, 2017, JAMA Pediatrics, MEDLINE, EBSCOhost, viewed November 17, 2017.


Implementation of Best Practices in Obesity Prevention in Child Care Facilities: The Arizona Empower Program, 2013–2015
Papa, J, Agostinelli, J, Rodriguez, G, & Robinson, D, 2017, Preventing Chronic Disease, 14.

Trends in Severe Obesity Among 23 Million U.S. Children Aged 2–4 Years Who Enrolled in WIC — United States, 2000–2014
Pan, L, Park, S, Scanlon, K, Slayton, R, Goodman, A, & Blanck, H, 2017, Annals Of Epidemiology, 27, 8, p. 528.

A Community-Based Intervention Program's Effects on Dietary Intake Behaviors
Chang M, Brown R & Nitzke S, 2017, Obesity.

Coordinated Care

A Whooping Cough Education Module for WIC Clients in Utah
Luthey, K, Anderson, A, Macintosh, J, Beckstrand, R, Eden, L, Amy, R, & Macintosh, C, 2017, The American Journal of Maternal Child Nursing, 42, 5.

Perspectives on HIV Testing Among WIC-Enrolled Postpartum Women: Implications for Intervention Development
Washio Y, Wright E, Flores D, Davis A, Chittams J, Anagnostopulos C, Kilby L, & Teitelman A, 2017, AIDS Education and Development, 29, 5, pp. 457-474.

Timeliness of Receipt of Early Childhood Vaccinations Among Children of Immigrants — Minnesota, 2016
Leeds, M, & Muscoplat, M, 2017, Centers for Disease Control and Prevention.


Breastfeeding Is Associated With Higher Retention in WIC After Age 1
Whaley, S, Whaley, M, Au, L, Gurzo, K, & Ritchie, L, 2017, Journal Of Nutrition Education And Behavior.

Strengths and Challenges of the Alaska WIC Breastfeeding Peer Counselor Program: A Qualitative Study of Program Implementation
Cueva, K, Shimer, S, Kent, D, Geller, A, Viswanath, K, & Fung, T, 2017, Journal Of Nutrition Education And Behavior.

Breastfeeding Outcomes in Washington State: Determining the Effect of Loving Support Peer Counseling Program and Characteristics of Participants at WIC Agencies
Lee, C, O'Leary, J, Kirk, P, & Lower, T, 2017, Journal Of Nutrition Education And Behavior.

Food Access

The Influence of Foodstore Access on Grocery Shopping and Food Spending
Ploeg M, Larimore E, & Wilde P, 2017, The United States Department of Agriculture.

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As always, if there are topics you would like to see covered in WIC Research to Practice or know someone who would be great to feature in our WIC Researcher Spotlight, please email Georgia Machell, Research and Evaluation Manager at