Happy New Year and welcome to the winter edition of WIC Research to Practice!
We rounded out 2015 with a busy few months: the Institute of Medicine (IOM) Expert Committee published their interim report on the Review of WIC Food Packages: Proposed Framework for Revisions; the USDA Food and Nutrition Service released the 2014 WIC Program and Participant Characteristics Report; and a number of WIC related research papers spanning topics from the impact of maternal depression on WIC caseload to influences of fruit and vegetable intake on Texas WIC were also published in peer reviewed journals. See links to abstracts at the end of this newsletter. In addition, WIC research was also featured at the 2015 American Public Health Association Annual Meeting in Chicago, IL in November. This meeting was attended by over 13,000 in diverse areas of public health. With over 20 presentations on WIC, it hammers home the point that WIC is, above all, an important public health program.
In this edition of WIC Research to Practice, our Hot Topic is the latest IOM report for which we will provide an overview and share a top tip on how to make the 500+ page report more manageable. We’ll introduce some new basic guidance on planning, conducting and communicating a WIC research project. Our Spotlight is on the Minnesota WIC team who takes an epidemiological approach to using data to inform programmatic decision-making. As always, we include information on upcoming conferences and calls for abstracts.
Within WIC, there are three main policy areas: the appropriations process, Child Nutrition Reauthorization, and the Institute of Medicine (IOM) Review of the WIC Food Packages. Each process involves examining the latest research and data on WIC; however, the process for reviewing the WIC food package is, perhaps, the most scientific as it involves looking at the science behind the nutritional needs of the WIC population and the evidence on the impacts of the current package. The WIC food package is reviewed every 10 years by an IOM expert committee. Central to the review is that recommendations are “grounded in the most recently available science” and meet the nutritional needs of the WIC population.
Since the last review in 2006 and the subsequent 2009 food package changes, there have been a number of studies that consider how the changes have influenced dietary intake, the availability of healthy foods and beverages, and breastfeeding outcomes. A recent paper published by the Academy of Nutrition and Dietetics reviewed 20 studies that explored these themes. A common trait recognized both by the authors of the paper and the latest IOM report is that research within WIC tends to focus on the impact of the food package change on a specific population in a specific geographical location. The IOM Committee is, therefore, tasked with the job of developing a national picture of the impact of the food package changes, based largely on local studies and national-level survey data.
On November 20th, the Committee published an interim report, Review of WIC Food Packages: Proposed Framework for Revisions. This report does not make any food package recommendations, rather, it presents the large body of evidence that is being considered in the review and the framework that the Committee will use to make final recommendations. The length reflects the robust analysis of research, survey data, observations, workshops and public comments the dedicated IOM Committee members reviewed.
The report provides a detailed account of the most up-to-date research relating to the WIC food package. You may think that this would be mainly focused on nutritional science, but in fact the report takes a broad look at the issues associated with not just the nutrition provided in the WIC food packages, but also the ease of use from a number of different perspectives. This is a crucial component of the review as it acknowledges both the cultural diversity and geographic diversity of the WIC program. To explore these differences, members of the IOM Expert Committee were all required to visit different WIC programs and “shop” for WIC foods to experience WIC from the perspective of the client. The ‘Committee Perceptions of the WIC Experience’ can be found in Appendix N of the report. To get through the content of this long report, we recommend reading Chapter 11, which contains summaries of each chapter and provides a sense of the breadth of evidence considered.
It is important that WIC administrators and frontline staff feed into the IOM review process. There are opportunities throughout the IOM review process to let your voice be heard. If you have thoughts on the current food package or anything in the most recent report, please submit comments online. There is also an opportunity to make comments in person on April 1, 2016 in Irvine, CA at a workshop and public comments session entitled ‘Informing WIC Food Package Recommendations: State, Vendor and Manufacturer Considerations – A Workshop and Public Comments Session’. We strongly encourage those of you who can participate in the meeting to attend.
Everyone on the IOM Expert Committee is a volunteer. We thank them for their dedication and commitment to a process that is central to the WIC program success.
WIC is one of the most researched federal nutrition programs. There are often multiple stakeholders involved in a WIC research project such as a government agency, contractor, university research department, local WIC agency, state WIC agency and/or WIC participants. Depending on the scale of the research, planning, conducting and communicating a WIC research project can be complex. NWA has published some basic guidance designed to help researchers and those participating in research to get the most out of their project. The guidance was made with input from the both the WIC community and the research community.
“We had a couple of epidemiologists working in MCH and a number of epidemiologists working in other programs, and I was thinking -- WIC is our biggest program and has the most data. We need epidemiological expertise as well.” Betsy Clarke, Minnesota State WIC Director.
If you work in a WIC clinic or local agency, you’ll be very familiar with the amount of data you are required to collect on every participant. You use those data to assess the individual’s needs and to make sure each individual receives the WIC services needed, to track progress and to keep in touch. At the state level, the same data can be used to tell a bigger story and answer questions about community health that can help inform programmatic decisions and practice. More and more, WIC agencies are working with or employing epidemiologists to help them get the most out of their data.
The World Health Organization describes epidemiology in the following way:
“The study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems.”
In 2011, the Minnesota WIC program hired a nutrition epidemiologist, Joni Geppert, who is both an epidemiologist and a registered dietitian. We spoke with Minnesota State WIC Director, Betsy Clarke, and WIC Nutrition Epidemiologist, Joni Geppert, to learn how taking an epidemiological approach to WIC program data has helped them identify problems, spot trends over time, respond with appropriate interventions and measure and understand the health outcomes across different racial ethnic, age and type populations participating in the MN WIC program.
When asked what instigated the shift to an epidemiological approach, Betsy responded:
“Data analysis was something our local agencies and local agency administrators had asked for. They were saying we give WIC all of these data. Why can’t we get more of it back in ways that we could use it? The idea was to take the data collected over time and find ways of analyzing it to inform practice.”
The shift was to make epidemiological analysis of MN WIC data a regular part of practice. A clear benefit of this approach to data is that it provides information to more precisely target interventions. For example, MN WIC has used their data to determine at which age children prematurely dropped off the program. The precision of the data collected enables a very accurate picture to be developed as to who is dropping off the program and where specific retention efforts are needed. Joni described this process:
“We looked at retention of children and found that 51% of the participation decline happened when children were between 12 and 17 months of age. The data/epidemiology team is tracking these data across time by geography and race/ethnicity to provide data that can be used to inform interventions aimed at increasing retention.”
A central feature to the MN WIC program’s success is the ad hoc query tool used with their MN HuBeRT (SPIRIT) system to construct data files and specialized reports. Because queries are done internally by the WIC data and epidemiology team, MN WIC can track and analyze the health of the populations served in a very timely basis.
Another reason why the epidemiological approach is working well in MN is that they have a team of state level WIC professionals who come together to determine which questions their program needs to be asking, then their data and epidemiological team analyzes data to find answers to inform policy and practice. Joni talked enthusiastically about the value of using data to prioritize issues within MN WIC.
“Part of the discussion here is what data to look at first and also taking a look at it together to say this is what we’re seeing, these are the trends. This is what is important to WIC, and this is what we can do about it.”
Epidemiology is an important tool to look at health indicators across time. Breastfeeding, obesity and anemia are three key areas that Minnesota WIC is using data to surveil health outcomes. Data are used to help identify potential health inequities, target geographic regions that may benefit from additional interventions, develop benchmarks to track progress, and evaluate the efficacy of interventions such as the Minnesota Peer Breastfeeding Support program.
The amount of high quality data the MN WIC program produces has been enhanced by a positive partnership with the University of Minnesota, School of Public Health. The Program worked with masters-level students in need of projects or field experience. This collaboration has been mutually beneficial as students have helped utilize longitudinal databases that are “rich with opportunities” but often without enough analysts to optimize its usage. Joni added that the relationship with the university is helping to develop a WIC practice community of WIC analysts and researchers.
“The partnership with the university allows us to do more with the data that we have. It brings to our program not just the students, but the gifted professors behind them.”
In a nutshell the epidemiological approach that MN WIC is taking enables the foundations of their decision-making to be founded in the strongest evidence possible, as summed up by Betsy:
“We look at data to identify and quantify what health indicators are improving, which are staying the same and which are declining. When we can quantify and track health status indicators, we can follow how nutrition interventions are working and evaluate outcomes for the WIC population as a whole and for various groups.”
To see some examples of what MN has been able to accomplish with their data, check out their online ‘data wheel’.
Does your state work with or employ a WIC epidemiologist? If so, we’d love to hear from you and explore opportunities for connecting WIC focused epidemiologists from different states.
American Public Health Association, deadline February 9th – 20th (depending on section)
Sharing your research at conferences outside of the immediate WIC community is a great way to develop support for the program from a broader audience. We encourage you to consider submitting an abstract to the American Public Health Association Annual meeting. Please reach out to NWA if you would like support in developing an abstract.
NBER Project on the Economics of Food Security, Nutrition, and Health: Insights from FoodAPS
With the support of the USDA Economic Research Service, the Food and Nutrition Service, the National Bureau of Economic Research (NBER) is organizing a new two-year research initiative consisting of ten distinct projects that will leverage USDA’s new National Household Food Purchase and Acquisitions Survey (FoodAPS) dataset to address issues related to food security, nutrition, and health in the United States.
The last few months have seen a number of new publications in peer reviewed journals on the topic of WIC. Below is a collection of some of our favorite articles. To view an abstract, click on the title of a paper.
WIC Food Package
Rural and Urban Experiences
Improving Pregnancy Outcomes through Maternity Care Coordination: A Systematic Review
AR Kroll-Desrosiers, SL Crawford, TAM Simas, Rosen A, Mattocks K - Women's Health Issues, 2015