A comprehensive survey of more than 1,500 former participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) along with more than 300 semi-structured interviews with former WIC participants were designed and conducted in order to identify the barriers influencing eligible program participants to leave the program prematurely. Results from the two phases of data collection were used to determine why eligible families are leaving the WIC program, to better understand the program participation barriers cited by former program participants in order to facilitate the development of a typology of program "leavers," and to identify the policy and organizational components that provide context for premature WIC program departure by participants. A narrative approach to organizational understanding and Symbolic Interactionism are utilized to provide a theoretical framework for highlighting program areas which may contribute to the participation barriers discovered in this research. Implications for public administration and policy evaluation are provided. / Ph. D.

L'objectif de cette thèse est de s'interroger sur la nature de la présence portugaise en Angola au 16e et au 17e siècles. Cette période correspond au début de l'essor du commerce transatlantique des esclaves dans l'Atlantique sud. Nous insistons sur les spécificités de cette présence : premièrement, nous mettons l'accent sur son caractère territorial, par opposition à la plupart des autres régions d'Afrique où la présence européenne s'est limitée à l'établissement de comptoirs commerciaux sur la côte ; deuxièmement, nous accordons une importance particulière à la rivalité luso-néerlandaise qui s'est déroulée dans la première moitié du 17e siècle et qui a correspondu à un des premiers affrontements territoriaux inter-européens en Afrique sub-saharienne. Dans les quatre premiers chapitres, qui recouvrent la période allant de 1483 – date de l'arrivée des Portugais à l'embouchure du Congo – à 1671 – date de la victoire décisive des Portugais sur le Ndongo pour le contrôle de l'hinterland de Luanda – , nous abordons la question de l'espace colonial. Il s'agit d'analyser les étapes de la formation de cet espace en nous centrant sur les interactions entre les différents pouvoirs politiques, aussi bien africains qu'européens. Nous nous intéressons ainsi aux efforts de délimitation spatiale de la part des pouvoirs coloniaux, conséquence aussi bien de la présence physique des agents coloniaux que de la production d'un savoir géographique. Dans le cinquième et dernier chapitre, nous mettons l'accent sur l'émergence de la nouvelle société que nous qualifions de coloniale, en analysant les caractéristiques et des dynamiques sociales des agents qui la composent. / This thesis aims to question the nature of the Portuguese presence in Angola during the 16th and 17th centuries, a period which corresponds to the rise of the transatlantic slave trade in the South Atlantic Ocean. We pay particular attention to the distinctive features of the Portuguese presence: firstly, we insist on its territorial nature, that differentiates it from other African areas where Europeans went no further than setting up trading posts on the coastline; secondly, we focus on the Luso-Dutch rivalry that took place during the first half of the 17th century, leading to one of the first intra-European confrontations on sub-Sahara African soil. The first four chapters address the question of the colonial territory: they cover the period from 1483, when the Portuguese reached the mouth of the Congo River, to 1671, date of the decisive Portuguese victory over the Ndongo kingdom for the control of the Luanda hinterland. We analyse the stages in the formation of this territory by focusing on the interactions between African and European political powers. This focus leads us to take a special interest in the colonial powers' attempts at delimiting the colonial territory, a delimitation based on both the action of the colonial agents and the production of new geographical knowledge. In the fifth and final chapter, we analyse the social dynamics and characteristics of the agents that constitute what we see as a new emerging colonial society.

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Objective The purpose of the mixed methods study was to compare barriers and facilitators encountered by low-income African American women who engaged in different infant feeding practices. Methods Using the positive deviance approach and modified Integrated Model as theoretical frameworks, the research began with a qualitative study that informed a survey examining intention, skills, and environmental factors differentiating women’s infant feeding practices. Results Twenty-eight and 190 low-income African American adult women participated in focus groups or interviews and a survey, respectively. In the qualitative study, positive deviants, who breastfed for at least four months, seemed to have stronger breastfeeding intentions, self-efficacy and breastfeeding support than other women. In the final multinomial multiple logistic regression, for a one unit increase in the PBC scale of the revised Breastfeeding Attrition Prediction Tool, there was a 50% (OR 1.5[1.3-1.7]) and an 18% (OR 1.18 [1.03-1.3]) increase in the odds of breastfeeding at least three months (positive deviance) compared to only formula-feeding and breastfeeding for less than three months, respectively. Women who did not smoke postpartum were 4.3 [1.5-12.3] and 5.6 [2.1-15.1] times as likely to be positive deviants; women who had C-sections were 3.6 [1.3-9.6] and 2.9 [1.0-7.8] times as likely to be positive deviants compared to only formula-feeding and breastfeeding for less than three months, respectively. Women who ranked WIC full breastfeeding packages as most valuable were 14.9 [4.8-45.5] and 16.1 [5.3-50.0] times as likely to be positive deviants compared to only formula-feeding and breastfeeding for less than three months, respectively. Discussion High breastfeeding self-efficacy was associated with positive deviance, although the qualitative study findings suggested that general self-efficacy may also influence breastfeeding success. The likelihood of not smoking being associated with longer duration of breastfeeding is consistent with previous research. The C-section results may reflect a longer length of hospital stay leading to increased mastery of breastfeeding prior to discharge. Analysis of participants’ valuation of WIC infant feeding incentives led to the suggestion that WIC incentives be re-examined. Further exploration of these findings and subsequent interventions may lead to improved breastfeeding rates among low-income African American women.

INTRODUCTION: One out of every 100 deaths from an obesity-related disease is caused by sugary drink consumption. The National Center for Health Statistics reported in 2010, sugary beverages like soda, fruit drinks, sports drinks, sweet tea, and energy drinks accounted for 46% of all added sugars in the American diet. According to the Youth Risk Behavior Surveillance in 2013, 27% of teens drank one or more soda per day, 19% drank two or more, and 11% drank three or more. Research has shown each additional 12 ounce soda a child consumes each day, attributes to an increased 60% chance of becoming obese during one and a half years of follow up time. Sugary drink consumption, childhood obesity, and low socio-economic status have been linked to increased likelihood of obesity during adulthood. Woman, Infants, and Children (WIC) is a special supplemental nutrition program hoping to improve the health of low income pregnant, postpartum, and breastfeeding mothers and their infants and children up to the age of 5. WIC provides food, nutrition education, breastfeeding promotion and referrals to health services at no charge. The WIC program is designed to supplement the participant’s diet. According to food packages in Tennessee, mothers are allowed to buy 100% fruit juice in the form of two 64 ounce bottles, 48 ounces shelf stable or frozen reconstitute, three 48 ounce bottles, or one 96 ounce bottle. This study compares sugary drink consumption of WIC-participating infants and mothers to non WIC participants and aims to identify any disparities. METHODS: Data were obtained through ReadNPlay for a Bright Future, a program advocating for healthy active living among families with young children. Surveys were generated to assess the health and demographics of mothers and their children living in the area. A convenience sample was utilized by voluntary and anonymous submission of surveys by mothers with babies aged 9-24 months, who visited a local pediatric clinic. Collection of 320 surveys was achieved during four separate time frames within 2013-2015. The association between sugary drink consumption in children and WIC is being examined using linear regression. RESULTS: Preliminary data analysis revealed 69.3% of the total sample (n=226) was enrolled in WIC. 89% of mothers reported having a high school degree during the most recent data collection. Mothers reported their infants consumed an average of 4.6 ounces of sugary drinks daily (range 1-15 ounces). 66.4% of mothers reported consuming at least one sugary drink daily, while 27.1% reported consuming 3 or more daily. CONCLUSION: The American Academy of Pediatrics recommends infants and children should be given milk or water instead of 100% fruit juice to reduce the amount of unneeded calories and sugar. If juice is given it is recommended to limit consumption to 4-6 ounces per day. Some types of 100% fruit juice, such as grape juice, have more sugar per ounce than soda. The results of this analysis may help to evaluate the healthfulness of the current WIC food package and identify high risk groups for counseling on sugary drink consumption.

Lack of accessibility to healthy foods is a factor associated with the increase in obesity, diabetes, and other negative health consequences. While programs such as WIC (Women, Infants, and Children) provide supplemental nutritional access to healthy foods, few organic food items are included in the WIC authorized food list. Government programs and policy makers that provide to the most vulnerable populations are concerned about equal availability of healthy foods. The purpose of this study was to compare variability and cost of organic food items in 24 large chain grocery stores located in high- and low-income areas. The theoretical concepts of social production of disease and political economy of health guided the study. The study used a quantitative research design to investigate the relationship between neighborhood income level and the consumer nutrition environment. Organic food scores were compared by neighborhood income level using t test and ANOVA. There were significant differences in availability and variability scores of healthy organic foods between high- and low-income neighborhood stores. Organic food items, specifically 15% fat content ground beef, peanut butter, apple juice, and eggs were priced significantly higher than conventional items (p < 0.05). Pricing of organic foods varied and no significant pricing trends were noted between neighborhood income levels. This study may contribute to social change by enhancing the conversation on organic food availability and affordability. Social change may be promoted through identification of the need to expand WIC authorization of organic food items and increasing produce voucher amount to allow WIC participants to purchase higher amounts of organic produce.

Low-income populations in the United States consume less healthful diets than higher-income populations, specifically relating to fruit and vegetable consumption. The supplemental nutrition program Women, Infants, and Children (WIC) is intended to bridge this gap by providing nutrition education and vouchers for nutritious foods. The purpose of this study was to determine if the 2009 WIC food package revisions impacted fruit and green vegetable consumption in 18 to 24-year-old females in California. Using the social ecological model as a guide, a population of WIC (N = 115) and non-WIC (N = 276) participants from the California Behavioral Risk Factor Surveillance System survey were analyzed for trends on daily fruit and green vegetable consumption over the period of years 2009, 2011, 2013, and 2015. ANCOVA analysis showed that WIC and non-WIC populations did not consume significantly different amounts of green vegetables, but did consume significantly different amounts of fruits, p = .120 and p = .028 respectively. Additionally, WIC participant fruit consumption did not significantly increase over the years, p = .376. However, a decrease of .031 (95%CI [.019,.584], p = .037) was identified in green vegetable consumption between 2009 and 2015. Due to mean differences between samples and years it is evident that there are influencing factors driving fruit and vegetable consumption outside of income barriers, such as possible social or environmental factors. This study adds to the literature regarding the WIC food package revisions and may promote positive social change by encouraging future researchers to identify barriers to healthful diets in WIC populations and determine if additional food package revisions may be needed to increase healthful diets in low-income populations.

Our nation’s youth face health challenges today that are drastically different from the health problems of youth in generations past. The drastic rise in childhood obesity rates prompted the 108th Congress to look for an innovative solution to the problem, mandating that each school district receiving federal funding for Free and Reduced Lunch must create and adopt a local wellness policy. This study examines whether relationships exist between Georgia’s school districts’ wellness policies and specific demographic characteristics of the district. Dependent variables include compliance, phase of implementation, and presence of a school health council. This study conducted univariate analysis using chi square and odds ratio coupled with binary logistic regression. Analysis shows that percent of minority students, as an independent variable, is significantly associated with compliance with the Child Nutrition and WIC Reauthorization Act.

Obesity, diabetes, cardiovascular disease, and poor dietary habits are major healthcare problems in the United States. These issues are especially prevalent in the state of Kentucky and among at-risk populations such as Women, Infants, and Children (WIC) participants. Studies have found that whole grains play a role in weight maintenance, protection against type 2 diabetes, and lowering cholesterol. Interventions aimed at improving WIC participant dietary behavior and intake has been successful as well. This study assessed Kentucky WIC participants’ knowledge of the benefits of consuming grains, attitudes and beliefs regarding food purchasing and grains, and identified grains consumed in a two-week period. A survey, created with the input of Registered Dietitians and WIC staff, examined these factors. Results from the survey found that WIC participants might benefit from education on: purchasing nutrient-dense foods (especially whole grains), the nutrition facts panel, types of grains, nutrients such as calories, fat, sugar, and fiber, serving sizes, and how to get children to eat whole grains.

Vital statistics data were statistically analyzed to determine who is breastfeeding in central Kentucky and if factors differ between those in a WIC and non-WIC population. The sample consisted of 479 postpartum women aged 18-44 in central Kentucky. Participants in the study were analyzed as a whole, then divided by their participation in the WIC program (n=304) or non-participation in the WIC program (n=175). Variables recorded in the vital statistics form were analyzed. These variables included age, education level, marital status, and ethnicity of the mother, household income status, and gender, gestational age, and birth weight of the infant. In the population studied, education level, ethnicity, marital status, household income status, and gestational age of the infant were significantly different between mothers who initiated breastfeeding and those who did not. In the WIC population, mothers were more likely to initiate breastfeeding if they were of non-white ethnicity or if the infant was born at greater than 37 weeks gestation; whereas, in the non-WIC population, mothers were more likely to initiate breastfeeding if they had some college or a college degree or if they were not enrolled in Medicaid. WIC participants were significantly less likely to initiate breastfeeding than non-WIC participants.