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.

Abstract is available in Pediatrics.

Breastfeeding has been shown to protect both the mother and infant, and health care professionals consider it to be the best choice for feeding an infant. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides food, referrals to other social service programs, and nutrition and breastfeeding education for enrolled families. However, community support for the breastfeeding woman once she leaves the hospital is limited, especially in Philadelphia, PA. The purpose of this mixed-methods study was to explore the impact of prenatal breastfeeding education and understand the role that members of the community play in the infant feeding decision-making process. A purposive, convenience sample of 36 postpartum breastfeeding women enrolled for WIC benefits completed a survey and an in-depth interview about infant feeding choices and their support system at their return WIC appointment. The quantitative survey data were analyzed using Spearman's rank correlation coefficient and multiple regressions while the qualitative data were analyzed using Moustakas' modification of two methods, referred to as MVKMAP. The analysis of data showed that the postpartum breastfeeding education given at the WIC office had the most influence on participants' decision to breastfeed followed by prenatal education. Some participants reported receiving overwhelming breastfeeding support from the WIC peer counselor, which indicates that members of the WIC community play a role in the infant feeding decision making process. The study findings help to contribute to social change by identifying the need for breastfeeding support by medical providers, hospitals, and WIC offices at the prenatal period not only at the postpartum appointment.

Indiana University-Purdue University Indianapolis (IUPUI) / This pilot study examines the use of the Women, Infants, and Children (WIC) program by the Burmese population in Indianapolis, Indiana. A significant number of Burmese people migrated to the Indianapolis area starting in 2004. Many of them are families with young children and are enrolled in the WIC program. Language barriers and cultural differences make it more difficult for the WIC program to meet the needs of these families. To what extent is the WIC program meeting their needs? To answer this question, Burmese WIC participants enrolled in the Marion County WIC program were invited to participate in this study. Study participants received a survey at the time of their appointment at the WIC office. The survey included questions that focus on how the Burmese people feel about the foods provided and the nutrition education they receive on the program. Of the 30 study participants, 28 of them or 93.3% reported WIC as being very helpful. Some foods were reported as not being utilized as frequently by the Burmese population on the WIC program, including tortillas, brown rice, and whole wheat pasta. In addition, twenty six of the 30 participants or 86.7% reported the nutrition education they receive on WIC as being very helpful. Participants reported learning many new things through WIC nutrition education including how best to feed their infants and children, as well as breastfeeding being the best for their babies.

The dissertation includes two projects. The first one studies the product market segmentation and output collusion within substitutes; the second one examines the effects of WIC program and peers on breastfeeding activities. In Chapter I, we extend the differentiated product model, first developed by Bowley (1924), by relaxing the assumption that each firm produces only one differentiated product. By doing so, we are able to analyze the potential for collusive market segmentation in a two stage decision framework, first in product space and second in output. We find that when firms cannot coordinate on output, the required discount factor that supports collusive market segmentation is strictly decreasing in product substitutability and is greater than partial output and full collusion. Overall we find that output collusion alone is easier to sustain than collusive product market segmentation. In Chapter II, we first use duration analysis techniques to estimate the effects of WIC participation on breastfeeding activities using a nationwide data. Income ineligible participants are excluded from the sample. The models with and without peer effects variables are both estimated. We find that the prenatal WIC participation status does not have significant effect on breastfeeding activities. Peer effects have significant positive effects on both partial and exclusive breastfeeding durations but not on breastfeeding initiation. The magnitude of the peer effects on each individual is different and depends on the individual’s propensity to breastfeed. The results on peer effects based on the full sample are consistent with the findings from restricted sample. Knowing more than five peers who breastfed increases the probability of initiating by 3.7% and the likelihood of breastfeeding at months 3 and 6 by more than 15%. It also increases the partial and exclusive breastfeeding durations by 9 and 3 weeks, respectively. The results suggest the presence of a social multiplier in breastfeeding. Any exogenous change in breastfeeding behavior due to policy interventions would result in an even greater change due to the bidirectional influences within peer groups. Peer effects play a more important role for breastfeeding duration than initiation.

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.

The purpose of this study was to determine the role of acculturation in the food consumption patterns of low income Hispanic women living in Texas and enrolled in the Women, Infants, and Children (WIC) Program by testing the following hypotheses: a) There are significant differences in consumption of fruit and vegetables by selected socio-demographic variables; and, b) less healthy food consumption patterns are associated with higher levels of acculturation in health-related research involving low-income Hispanic women living in Texas. A secondary-data analysis of the responses to the Texas Food & Nutrition (TEXFAN) questionnaire was performed. TEXFAN is a 122-item survey designed to measure WIC participants' consumption behaviors and to assess the impact of new food packages in Texas' WIC program. A total of 3,336 adult, non-pregnant women self-identified as having Hispanic ethnic background of all races were considered for this study. Analysis of Variance and Kruskal-Wallis tests showed significant differences in nutritional practices among Hispanic women for age, educational attainment, employment status, race, area of residence, and acculturation. Logistic Regression analysis confirmed the hypothesis that lower levels of acculturation are associated with healthier food consumption patterns. The majority of respondents (70.7%, N=2,358) did not consume the recommended five servings of fruits and vegetables a day; therefore, do not have healthy patterns of food consumption. Consequently, the majority of respondents (70.0%, N= 1,709) has a weight statuses above normal and at a higher proportion than women in the State of Texas and the nation. Acculturation continues to interest social and behavioral researchers but variations on conceptualization, definition, operationalization, and measurement negatively impact generalizability and applicability of results. Interventions not considering acculturation are not likely to be successful. Research has to include community, ecological, cultural and contextual factors (e.g., machismo, accessibility to sidewalks, availability of fresh healthy foods, etc.). Development of effective intervention programs should be aimed to increase consumption of healthy food and an adherence to the recommendations of the "Healthy Plate" and the "Dietary Guidelines for Americans 2010" among Hispanics. Also, interventions should generate necessary skills among Hispanics for empowering them to sustain proper nutritional behaviors and overcome barriers.