Several individual- and state-level factors are associated with the level of participation in nutrition assistance for women, infants, and children

1. In this longitudinal cohort study, individual-level factors such as age >35, more than high school education, English language proficiency, being married, White race, smaller family size, and higher income were associated with lower odds of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

2. State-level factors such as higher earned income tax credit rates were associated with lower rates of WIC participation, while other factors such as higher gross domestic product (GDP) per capita, unemployment rates, and Medicaid caseloads, were associated with higher participation rates.

Evidence Rating Level: 2 (Good)

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) works to safeguard low-income pregnant individuals and their children from poor nutrition during and after pregnancy. Despite the association between WIC participation and both maternal and infant health benefits, WIC participation has been in decline for the last decade. However, the factors that contribute to low rates of WIC participation are unclear. Therefore, the purpose of the present study was to examine individual- and state-level predictors associated with WIC participation.

This longitudinal cohort study included 288,531 individuals from 45 states who recently gave birth and were surveyed between 2004-2019 as part of the Pregnancy Risk Assessment Monitoring System (PRAMS) study. Individuals who were WIC-eligible based on self-reported income and had survey information on WIC receipt during pregnancy were included. The potential predictors of outcome that were examined included age, race, education, family size, household income, language, pre-pregnancy diabetes, and yearly state-level variables such as gross domestic product (GDP) per capita, unemployment rate, state earned income tax credit (EITC) rate, the political party of the governor, and measures of state caseloads for other social programs. The primary outcome was whether the respondent utilized WIC.

The results showed that several individual- and state-level factors influenced WIC participation. Individual-level factors that were associated with lower odds of WIC participation included age >35, English language proficiency, being married, White race, smaller family size, and higher income. State-level factors such as higher GDP per capita, higher unemployment rates, higher Medicaid caseloads, and having a Democrat governor were associated with higher odds of WIC uptake. This study was limited by the use of self-reporting for income to determine WIC eligibility, which may have led to misclassification. Nonetheless, this study highlighted variables that influence WIC participation.

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Click to read the study in The American Journal of Clinical Nutrition

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