Mothers of low socioeconomic status are less likely to breastfeed and more likely to formula feed. In addition, low socioeconomic status is associated with a premature introduction of cow’s milk, juice and solid foods. Negative outcomes such as asthma, diabetes and obesity later in life may result from improper child feeding practices. The aim of this study was to determine if WIC participants in Gwinnett County, Georgia are practicing child feeding recommendations set forth by the American Academy of Pediatrics (AAP) as well as following the Division of Responsibility in feeding developed by Ellyn Satter. Ninety-six WIC participants (92% mothers) primarily African American (39%) and Hispanic (35%) from Gwinnett County, Georgia were surveyed in March of 2011. Participants completed one of three surveys based on their method of feeding (breastfeeding, formula feeding or solid foods) after a nutrition education class. Compliance to feeding recommendations was determined among the entire survey population and by survey subgroups. Frequency distributions by method of feeding were calculated by age and race. Trends in feeding practices and the feeding environment were determined. Ten percent of participants surveyed reported breastfeeding, 22% reported formula feeding and 68% reported feeding solid foods. Participants who were not following AAP guidelines reported that they received advice primarily from health care professionals. Our results are consistent with previous research in that breastfeeding rates were low, the introduction of solids was early, and caregivers reported controlling feeding behaviors. Future research should focus on understanding the child feeding practices and beliefs of health care professionals.

Objective: The purpose of this study was to assess the attitudes of WIC Nutritionists regarding current WIC breastfeeding programs as well as their suggestions for potential interventions to promote breastfeeding within WIC. Methods: WIC Nutritionists from three counties in Georgia were emailed a link to a brief survey regarding their demographics, breastfeeding promotion at their clinics, and perceived barriers and interventions for discussing breastfeeding in their clinics. Data was analyzed using descriptive statistics. Results: Twenty-seven WIC Nutritionists from Gwinnett, Newton, and Rockdale counties and the District Office completed the survey. All of the respondents indicated that they believed breastfeeding is important and that their clinics are providing breast pumps and peer support groups for mothers who have chosen to breastfeed. The vast majority (92.6%) indicated that they are very likely to discuss breastfeeding with pregnant mothers during their initial session. Lack of interest was reported by 37% to be the primary barrier to discussing breastfeeding with mothers, and the most popular intervention reported was educational programs for family members of the mother (26%). Conclusion: WIC Nutritionists in Gwinnett, Newton, and Rockdale counties have positive attitudes toward breastfeeding and provide support for mothers seeking it in the form of education and resources early in pregnancy. Each clinic should have the opportunity to determine the key barriers to breastfeeding in their clinic population and find evidence-based interventions that will best serve their clients.

Indiana University-Purdue University Indianapolis (IUPUI) / The incidence of overweight and obesity in children and adolescence is a global health concern. The long term health implications of overweight or obesity include respiratory issues, mobility joint issues, cardiovascular disease, type II diabetes, and certain types of cancer. The incidence of overweight and obesity is more common in low socioeconomic populations. Though there are many factors influencing children who become overweight or obese, beverage consumption is of particular interest since it is hypothesized that the energy supplied by beverages is not compensated by energy intake from the rest of the diet.

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WIC food packages are undergoing major revisions to accommodate the unique requirements of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the twenty-first century. This dissertation is an evaluation of the impact of the revised WIC food packages through national-level surveys obtaining data before and after food package changes. In addition, a community-level metabolic/dietary study of obese women consuming either the original or revised food packages was performed. Since WIC has never revamped its entire program before, this is an opportunity to learn more about the impact of the revisions on WIC participants across the country, including Native Americans from Indian Tribal Organizations (ITOs). The National Food and Nutrition food frequency questionnaire (NATFAN) evaluates food and consumption practices of WIC participants, including Native Americans, for both the original and revised WIC food packages. The baseline surveys (NATFAN') were administered before the 2009 rollout of the revised WIC food packages (dates varied by state program). The post-rollout surveys (NATFAN'') were administered spring through winter of 2010-2011, and at least six months after the implementation of the revised WIC food packages. Hierarchical linear modeling, with restricted maximum likelihood approximation, was used to evaluate 100% juice, fruit, and vegetable frequency of consumption based upon NATFAN' and NATFAN'', including samples from states, territories, and ITOs. This research is important because it was national in scope and analyzed nutritional behaviors of a Native American subpopulation of WIC that is seldom documented in national nutrition research. For the metabolic/diet study, obese women 185% of the poverty level were given the original or revised WIC food packages (n=3). Three venous blood serum collections (0, 6, 12 weeks) were biomarker tested (cholesterol, glucose, C-reactive protein, etc.) in lipid and metabolic panels. Three, seventy-two hour dietary recalls were also assessed to determine fruit and vegetable consumption changes over the course of the study. This phase was important because it focused on the individual's actual consumption behaviors of specific WIC foods dispensed in the WIC food packages and assessed how such consumption affected the health of the individual.

This thesis considers how potentially vulnerable populations are affected by various economic and policy shocks. In the first chapter, I investigate the impact of natural resource booms on crime by estimating the effect of the coal boom and bust of the 1970s and 1970s on reported crime rates. I begin by demonstrating that changes in the value of coal reserves affected local economic conditions and population composition, both of which have theoretical and empirical links to crime. The net effect is theoretically ambiguous. The estimates suggest that the immediate impact of increasing the value of natural resources is to depress crime rates, primarily through changes in property crime, but these changes erode over time. My findings are consistent with an initial change in criminal activity in response to local labor market conditions that is subsequently offset by selective migration. Individuals who are charged with committing a crime often find themselves behind bars while their case is adjudicated. In the United States, over 400,000 individuals are in jail each day waiting for their criminal cases to be resolved. The majority of these individuals are detained pretrial due to the inability to post low levels of bail (less than $3,000). In chapter 2, my coauthor and I estimate the impact of being detained pretrial on the likelihood of an individual being convicted or pleading guilty, and their sentence length, using data on nearly a million misdemeanor and felony cases in New York City from 2009 to 2013. Causal effects are identified using variation across arraignment judges in their propensities to detain defendants. We find that being detained increases the probability of conviction by over seven percentage points by causing individuals to plead guilty more often. Because pretrial detention is driven by failure to post bail, these adverse effects disproportionately hurt low-income individuals. While some public policies create burdens that fall most heavily on low-income people and households, the public safety net is comprised of programs intended to protect and support this vulnerable population. In chapter three, my coauthors and I examine whether programs that provide vouchers to households can continue to influence behavior even after the household leaves the program. Using detailed scanner data, we test whether benefit vouchers received through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) change household purchasing decisions and whether these changes continue to persist even after households are no longer eligible to participate in the program. In 2009, the package of goods available through WIC vouchers changed to include additional items and place nutritional restrictions on other items. Examining variation due to this package change, we show that the WIC vouchers change purchasing decisions consistent with the nutritional guidelines of the program. However, we find evidence of limited persistence post-eligibility, and that households exposed longer to the revised package are generally not more likely to continue to purchase these items after eligibility ends.

The Special Supplemental Nutrition Program for Women, Infants, and Children (The WIC Program), began in 1974, and has not seen any major changes to its food packages since then. In 2009, the WIC Program began implementing changes that mandated the inclusion of whole grains, fruits and vegetables, and low-fat dairy, among other changes. These changes aim to better align the food package benefits of the WIC Program with the Dietary Guidelines for Americans, 2005, and the American Academy of Pediatrics Child Feeding Recommendations. The objective of this research was to develop a culturally appropriate original questionnaire for The Texas WIC Program, which aimed to assess the dietary/feeding behaviors of Texas WIC participants both before and after the new WIC food package was implemented. The present study aims to present the methodology of how said survey was developed including pilot study and literature review. A mixed methods, biphasic approach was used to draft, edit and finalize the survey. The first phase consisted of item development, which involved literature review, and expert panel (n= 14) review to refine the instrument prior to piloting. Phase 2 of this research included recruitment of participants, a timed classroom administration of the survey, data collection, analysis and substantive reasoning based on the results of items to be included in the final survey. Quantitative data from survey piloting at two WIC local agency offices was used. Participants (n=54) completed two survey versions during piloting. The final questionnaire included measures of behaviors, attitudes and self-efficacy. Results from piloting showed that the "bubble" survey format had fewer errors and was more easily understood by participants. Incorporating relevant and recent scientific literature as related to survey design within a diverse population with social behavioral theory and mixed methods study design yielded a psychometrically sound instrument that has been used on a large scale and provided relevant data.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is one of the food assistance programs targeted at low-income women, infants and children up to age five by providing foods, nutrition education and other services. Recent updates in food packages provided by WIC include the addition of fruits, vegetables and whole wheat products as well as the removal of whole milk for women and children two years and older. This thesis concentrates on preschool children participants in the WIC program and their milk consumption habits prior to programmatic changes. Analyzing diet preferences of these children is crucial since a quarter of the population of children aged one thorough five participates in the WIC program; as well, they are not eligible to receive whole milk with WIC food packages after the implementation of revisions. The objective is to describe the profile of preschool WIC children and their milk consumption attributes based on the National Food and Nutrition (NATFAN) questionnaire designed and conducted by the Institute for Obesity Research and Program Evaluation at Texas A & M University before the release of the revised WIC food packages. Additionally, findings of the study are compared with the National Health and Nutrition Examination Survey (NHANES) 2005-2006 dataset results. Milk consumption preferences of WIC children are analyzed nationwide and impacts of race, ethnicity, regional, and other demographic characteristics are observed. Using both NATFAN and NHANES datasets provides a comparison of actual and self-reported participation outcomes. Discrete choice models were used in this analysis, in particular binary logit and multinomial logit models. The results of the thesis indicate that WIC preschool children mostly drink whole milk (36.17 percent) and 2 percent fat milk (49.94 percent). Two year old participants, children located in the South and participants whose caregivers are younger and less educated are more likely to consume whole milk. Caucasian children are less likely to choose whole milk and more likely to choose reduced fat milk; African Americans are more likely to select whole milk. Furthermore, diet preferences and knowledge of parents/caregivers play a major role on milk consumption of children. Children whose caregivers are willing to give low-fat milk to children aged two to five are less likely to drink whole milk.

The USDA’s “My Plate” recommends that preschool-aged children consume specific amounts of fruits, vegetables, and whole grains. These foods contain essential nutrients that children and adults alike require to maintain good health. Researchers have shown, however, that a significant number of children do not consume the recommended amounts of these foods, specifically vegetables and whole grains. Investigators have become increasingly interested in food deserts and whether living in these areas results in lower consumption of healthy foods. Food deserts by definition are areas where inhabitants have limited access to nutritious food. This study investigated the fruit, vegetable and whole grain consumption levels for preschool age children living in food desert or non-food desert areas. The NATFAN (National Food and Nutrition Questionnaire) survey of WIC participants was compared to the USDA’s food desert location data in order to learn the impact of living in a food desert. Using IBM SPSS to test the hypothesis, separate two-sample t-tests were conducted to determine if the mean difference between frequencies of fruit, vegetable, and whole grain consumption equaled zero. The data showed no difference in consumption of fruits and vegetables between food desert residing children and their non-food desert counterparts. There was, however, a difference in means for the consumption of whole grains. Specifically, food desert residing participants were consuming less brown rice. Using consumption amounts estimated from frequency data, it was discovered that, overall, WIC participants were under consuming fruits, vegetables, and whole grains.

abstract: Objective: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a federally-funded program that provides supplemental food packages, nutrition education, and healthcare referrals to low-income women, infants, and children under 5, who are at the highest nutritional risk. This study explores if household WIC participation is associated with healthier dietary behaviors among age-ineligible children (5-18-years-old) in WIC households. Consumption frequency of fruits, vegetables, 100% juice, sugar-sweetened beverages (SSBs), and energy-dense snacks (sweet and salty snacks) among children from WIC and income-qualifying non-WIC households were compared. Methods: Data were obtained from two cross-sectional panels (2009-10 and 2014) of the New Jersey Child Health Study conducted in four low-income New Jersey cities. Questions from previously validated surveys assessed consumption frequency of fruits, vegetables, SSBs, and sweet and salty snacks. Analyses were confined to 570 children between 5-18 yrs; of which 365 (5-11 yrs: 237, 12-18 yrs: 128) resided in WIC participating households and 205 (5-11 yrs: 138, 12-18 yrs: 67) in income-qualifying non-WIC households. Over half of the sample was African American and 43% were Hispanic. Multivariable analyses were conducted to compute incidence rate ratios (IRRs) using negative binomial regression to compare the differences in eating behaviors of children in WIC vs. Non-WIC households Results: Household WIC participation was associated with a slightly higher frequency of vegetable consumption among 12-18-year-old children (IRR= 1.25, p=.05); differences were significant among older males (12-18-years-old) (p=.006), and not in females. Frequency of 100% juice consumption was significantly higher among younger females (5-11-years-old) in WIC households who consumed juice about 44% more frequently (p=.02) compared to similar age girls in non-WIC households. Hispanic children in WIC households reported a lower frequency of SSBs consumption (p=.01); this association was only true among males (p=.02). Conclusions: Household WIC participation is associated with healthier dietary behaviors among age-ineligible children living in the households, suggesting a positive spillover effect of the program. Proposed changes to WIC packages are likely to have dietary implications not only for WIC participants but also for non-participating children residing in WIC households, / Dissertation/Thesis / Masters Thesis Nutrition 2019