National WIC Association

Summer 2016 WIC Research To Practice


Welcome to the summer edition of WIC Research to Practice! It’s been a busy few months and there is a lot to update you on. In this edition, we’ll cover a new report from California on the reasons why eligible pregnant women do not enroll in WIC, a change to New Hampshire's PRAMS questions that is very helpful for WIC, the Phase 1 Report from the USDA Food and Nutrition Service funded Nutrition Education Study and the role of behavioral economics to better understand WIC participants’ food choices. Our research spotlight is on Prof. Carolyn Barnes, who was inspired by her own experiences on WIC to help identify barriers and opportunities for program improvement through her research. As always we have links to upcoming conferences and recently published WIC research abstracts.

Why don't eligible women participate in WIC? New report from California

This summer, California WIC and the California Department of Health released their report Making Connections: Understanding Women’s Reasons for Not Enrolling in WIC During Pregnancy. The report speaks to the pressing issue of caseload, recruitment and retention. Research that helps to explain the reasons why WIC isn’t reaching all eligible participants is hugely beneficial for informing local, state and even national level recruitment and retention strategies.

The report from California uses 2010-2012 data from the California Department of Public Health’s Maternal and Infant Health Assessment (MIHA) survey. In the survey, the following questions in Figure 1 were asked.

The main reasons identified from the survey for not participating in WIC are: Did not think they would qualify (40%) and perceived lack of need (35%). See the chart below for more reasons for not enrolling in WIC.

The characteristics of eligible non-participants who did not think they would qualify for WIC were mainly white women (34%) with private insurance (51%) who were not receiving CalFresh (91%). Because the report explored not only why pregnant women do not enroll in WIC, but the characteristics of who these women are, this report provides the state of California with a road map for recruitment and retention activities.

While this report demonstrates reasons why women in California are not participating in WIC, reasons may be different in other states. If your state conducts regular surveys with low income women who are eligible for WIC, you may wish to consider replicating the questions asked in this study?

The National WIC Association joined by 45 state agencies, representing 4.2 million participants is leading a WIC national recruitment and retention campaign to improve WIC participation. It will target eligible non-participants through new WIC branding and messaging by utilizing a range of print and digital advertisements. For more information about the campaign, contact NWA’s Hannah Shultz at

New Hampshire WIC aligns PRAMS data with WIC income eligibility 

Congratulations to New Hampshire who recently made their Pregnancy Risk Assessment Monitoring System (PRAMS) data more relevant to WIC by aligning an income question with the income guidelines for WIC participation. Instead of asking if survey participants were >100% to 200% of the Federal Poverty Level (FPL), New Hampshire changed the question to >100%-185% of FPL. This gives clearer insights into the number of eligible non-participants. It’s also a great example of how small changes to data questions can have enormous relevance to WIC. Nice work New Hampshire! More information on PRAMS can be found here. The New Hampshire PRAMS Data Book can be found here.

Does your state stratify PRAMS data with WIC participation and create a specific WIC report? We’d love to know! Please contact Georgia Machell,

The WIC Nutrition Education Study - Phase 1 Report

The WIC Nutrition Education Study is a three phased research project that aims to develop a framework for evaluating WIC nutrition education. The USDA Food and Nutrition Service recently published the Phase 1 Report which was completed by RTI, Altarum and the University of California Agriculture and Natural Resources,Nutrition Policy Institute. The first phase report is a comprehensive description of nutrition education across WIC.

Key findings concluded that:

The report provides valuable context on nutrition education -- a core feature of WIC services. We thank everyone in the WIC community who participated in this research. It is impressive that 893 Local Agencies and 1,401 WIC sites completed web-based surveys as part of this initial phase of the study. The second phase will explore the impact of WIC nutrition education across 6 local agencies and the final phase will design a national level evaluation study. There was a presentation on this study at the NWA Annual Conference in Cincinnati. The PowerPoint can be found here. The second and final phase of the plan will be completed in the Fall of 2017.

Using Behavioral Economics to better Understand WIC participants and food choice

Behavioral Economics uses insights from both economics and psychology to better understand what influences people’s choices and what drives their behavior as consumers. Why is this of value to WIC?

WIC participants make choices about their purchasing and consumption of WIC foods -- these  choices are influenced by a number of factors. Insights into WIC consumer behavior can help us better understand challenges and opportunities for program development and improvement.

In 2015, Duke University and the University of North Carolina (UNC) Chapel Hill received a grant from the USDA to develop the BECR Center to explore healthy food choices, particularly among Americans who participate in Federal Nutrition Assistance Programs. Dr. Peter Ubel has recently been named the new Director of the BECR Center, replacing Dr. Matt Harding. Dr. Ubel’s background is in medicine, business and behavioral science. The UNC team is led by Dr. Alice Ammerman and Dr. Molly DeMarco. The collaboration between the two institutions has created opportunities for interdisciplinary learning between public health, business, medicine, behavioral science and economics.

BECR has supported a number of activities that have elevated discussions around the role of behavioral economics and WIC. Activities included a roundtable event held in Washington, DC last summer. A report from this event can be accessed here. In addition, BECR has funded 5 white papers on the specific topic of WIC and behavioral economics:

Details on all BECR funded projects can be found here. Publications from these projects are due to be published in the coming months. We look forward to reading them and sharing them with you.

Researcher Spotlight: Prof. Carolyn Barnes

Prof. Carolyn Barnes is a New Perspectives fellow and faculty affiliate with the BECR Center at Duke University. Carolyn’s role at the BECR center is unique, unlike other researchers working through BECR, Carolyn is not an economist. With a PhD in Public Policy and Political Science, Prof. Carolyn primarily conducts qualitative research. Her current project is titled: WIC Program Experiences. In her own words:

I try to capture the stories behind the numbers we see in the quantitative work.

As a former WIC participant herself, Carolyn’s personal experience has fueled her desire to better understand and document the challenges that face low-income families who access nutrition programs.

I grew up in a low-income household that was dependent on social programs for survival. I waited with my mother at social service agencies, food pantries, and free health clinics. I accompanied her to the grocery store when she used WIC vouchers and food stamps. I was well aware of the stigma of public assistance. I also observed the stress of navigating complex private and public social supports. As a researcher, I take those personal experiences and use them to ask different kinds of questions. I am especially interested in developing new ways of implementing social policy on the ground in a manner that supports clients and buffers the stress of economic hardship.

The focus of Carolyn’s project with BECR is on strengthening systems for policy implementation and identifying aspects of service delivery that either promote or obstruct policy objectives. Carolyn summarized here approach:

I do this through “organizational ethnography,” a qualitative research technique that couples long-term observations with staff and client interviews. I go into offices, observe, and interview clients who have stayed and left the program to determine why. The in-depth qualitative approach helps uncover aspects of program experiences that may be overlooked by administrators and staff. This kind of research helps identify what is most important for clients during their office visits and barriers to accessing and using WIC benefits.

Through her work, which is focused mainly in North Carolina, Carolyn has worked extensively with local WIC agencies and participants. Carolyn’s focus on improving the program through research has helped her engage participants in her research process and is a reminder to other researchers on the importance of communicating the value of research to all stakeholders involved:

When conducting studies, you often encounter hesitancy and fear, but explaining the vital importance of “participant voice” in improving the program can really encourage participants to open up and engage in the process. That said, be clear with participants about the objectives of the study and how they are contributing by participating.

Carolyn has a number of publications on her work that are currently under review. We’ll be sure to keep you updated on Carolyn’s valuable contributions to WIC through research.

Conference Calendar

2016 NWA Nutrition Education and Breastfeeding Promotion Conference and Exhibits Denver, CO, September 8th-10th

APHA Annual Conference Denver, CO, October 29th – November 2nd

9th Bienniel Childhood Obesity Conference San Diego, CA, May 30th – June 2nd 2017

Journal of Nutrition Education and Behavior- WIC Special Supplements

JNEB is soliciting manuscripts for a supplemental issue on breastfeeding and the WIC Program.

All manuscript types currently accepted by JNEB are suitable for this special supplementincluding Research Articles, Research Briefs, Perspectives, Systematic Reviews, Methods, Reports, GEMs, and New Resources for review. Please see their guidelines for authors for more details.

To be considered for publication, manuscripts must be submitted by December 1, 2016, through our peer-review site for a targeted publication date of July 2017. The cover letter should indicate that the submission is for this supplemental issue related to WIC.

For questions about this supplemental issue, please contact the Guest Editor, Madeleine Sigman-Grant, PhD, RD ( or Karen Chapman-Novakofski, RD, PhD (


Fruit and vegetable Consumption

Effects of a 2014 policy change on cash value voucher redemptions for fruits/vegetables among participants in the New Jersey Special Supplemental Nutrition Program for Women, Infants and Children
JO Okeke - 2016 CSTE Annual Conference, 2016

Farm-to-Consumer Retail Outlet Use, Fruit and Vegetable Intake, and Obesity Status among WIC Program Participants in Alabama
CR Singleton, M Baskin, EB Levitan, B Sen, E Affuso, G Damio, - American Journal of Health Behavior, 2016

Barriers and Facilitators to Improve Fruit and Vegetable Intake Among WIC-Eligible Pregnant Latinas: An Application of the Health Action Process Approach Framework
A Hromi-Fiedler, D Chapman, S Segura-Pérez, P Clark, J Martinez, R Pérez-Escamilla - Journal of Nutrition Education and Behavior, 2016


Barriers to Human Milk Feeding at Discharge of Very Low–Birthweight Infants: Evaluation of Neighborhood Structural Factors
B Riley, M Schoeny, L Rogers, IV Asiodu, HR Bigger, PP Meier, L Patel Aloka - Breastfeeding Medicine, 2016

Moving National Breastfeeding Policies into Practice A Plea to Integrate Lactation Education and Training into Nutrition and Dietetics Programs in the United States
MA Theurich, ME McCool - Journal of Human Lactation, 2016

Reasons for Infant Feeding Decisions in Low-Income Families in Washington, DC
O Oniwon, JAF Tender, J He, E Voorhees, RY Moon - Journal of Human Lactation, 2016

Racial and Ethnic Differences in Breastfeeding
CO McKinney, J Hahn-Holbrook, PL Chase-Lansdale, S Ramey, J Krohn, M Reed-Vance, T Raju, M Shalowitz - Pediatrics, 2016

Retail and Food Choice

Healthy store programs and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), but not the Supplemental Nutrition Assistance Program (SNAP), are associated with corner store healthfulness.
RS DeWeese, M Todd, A Karpyn, MJ Yedidia, M Kennedy, M Bruening, C Wharton, P Vachaspati - Preventive Medicine Reports, 2016

USDA Economic Research Service-Recent Evidence on the Effects of Food Store Access on Food Choice and Diet Quality
M Ver Ploeg, I Rahkovsky – 2016

WIC Household Food Purchases Using WIC Benefits or Paying Out of Pocket: A Case Study of Cold Cereal Purchases
D Dong, H Stewart, E Frazão, A Carlson, J Hyman – 2016


Internal and External Stigmas of Program Participation: A Longitudinal Study of Children, Tweens, and Teens
C Robinson - 6th Biennial Conference of the American Society of Health Economics, 2016

A Qualitative Study to Examine Perceptions and Barriers to Appropriate Gestational Weight Gain among Participants in the Special Supplemental Nutrition Program for Women Infants and Children
LP Kim, M Koleilat, SE Whaley - Journal of Pregnancy, 2016

Nutrition Education

Online and In-Person Nutrition Education Reduces Sodium Intake: A Randomized Trial to Assess Knowledge, Self-Efficacy and Behaviors in WIC Participants
L Au, S Whaley, NJ Rosen, M Meza, LD Ritchie - The FASEB Journal, 2016

Care Coordination Associated with Improved Timing of Newborn Primary Care Visits
NK Goyal, ES Hall, RS Kahn, SL Wexelblatt, Greenberg J, Samaan Z, Brown C - Maternal and Child Health Journal, 2016

Oral Health

Advancing Oral Health through the Women, Infants, and Children Program: A New Hampshire Pilot Project
J Lipper

A Multi-level, Multi-Sector Oral Health Literacy Initiative to Reduce Oral Health Disparities and Achieve Health Equity: Early Lessons from the Maryland Model
AM Horowitz, DV Kleinman, HS Goodman, J Welby - Current Oral Health Reports, 2016


Improving Immunization Rates Through Community-Based Participatory Research: Community Health Improvement for Milwaukee's Children Program
E Willis, S Sabnis, C Hamilton, F Xiong, K Coleman, M Dellinger, M Watts, R Cox, J Harrell, D Smith, M Nugent, P Simpson

Food Access

Juggling the five dimensions of food access: Perceptions of rural low income residents
L Andress, C Fitch - Appetite, 2016

Food Access, Food Deserts, and the Women, Infants, and Children Program
Q Wu, TL Saitone, RJ Sexton – 2016

Gestational Weight Gain

A Qualitative Study to Examine Perceptions and Barriers to Appropriate Gestational Weight Gain among Participants in the Special Supplemental Nutrition Program for Women, Infants and Children
LP Kim, M Koleilat, SE Whaley - Journal of Pregnancy, 2016

Thanks for reading WIC Research to Practice! If there are studies or reports you would like us to highlight, please contact Georgia Machell, Research and Evaluation Manager