Another Player has Entered the Game:

UM Collaboration & Partnership with the Miami-Dade County WIC Program

UM Grand Rounds2.24.17

Eriko Grover, MS-MPH, RD, LD/NPublic Health Nutrition Program Director

What is WIC?

• WIC = The Special Supplemental Nutrition Program for Women, Infants and Children

• Federally funded and administered by the USDA Food and Nutrition Service

• Funds dispersed to states via State Health Departments or other organizations

• Florida Department of Health

WIC Provides:

• Healthy Foods• Nutrition Assessment• Breastfeeding Support • Nutrition Counseling and

Education• Referrals to Health Care and

community programs

WIC Facts

• Nationwide - 8.9 million participants– WIC serves 53% of ALL infants born in US

• 41.6% Hispanic• 20.3% non-Hispanic black

• WIC Miami-Dade: ~72,000 participants– 17 WIC clinics throughout Miami-Dade County– ~ 250 vendors currently accept WIC – 75 nutrition staff work for WIC in Miami-Dade

• 29 Registered Dietitian/Nutritionist

Who is Eligible?

• Women – pregnant, breastfeeding & non-breastfeeding postpartum women

• Infants – up to 1st birthday• Children – up to 5 years old• Current Florida Residents –

undocumented immigrants are eligible to apply as long as they live in Florida

Who is Eligible?

• Be at nutrition risk – assessment completed by WIC nutrition staff member

• Be income eligible – At or below 185% of poverty level– Medicaid, Temporary Cash Assistance or

Food Stamps automatically qualifies

Income Guidelines Effective May 2016

Food Package & EBT Card

WIC HAS GONE EBT!EBT = Electronic Benefits Transfer

Services @ WIC

• Nutrition Counseling and Education–Registered Dietitian Nutritionist or Nutrition Educator– Medically High Risk clients are only seen by RD– Every certification visit requires a one on one

counseling session with a nutritionist to teach optimal nutrition for growth and development

– Goals are set with client at each certification period or at different times depending on situation

– Extensive nutrition questionnaire is completed, reviewed and assessed with each family

• Breastfeeding Promotion and Support–by Breastfeeding Peer Counselors and International Board Certified Lactation Consultants (IBCLC)

Services @ WIC

Services @ WIC

Breastfeeding Services and Support Services: – Breastfeeding education and support groups– One on one counseling and follow up by IBCLC– Extensive Breast Pump Program – Breastfeeding 101 outreach– Breastfeeding Peer Counselor Program

Services @ WIC

Services @ WIC

• Healthy Start Coalition of Miami-Dade

• Nurse Family Partnership

• Legal Services (State Attorney’s Office, Legal Services of Miami-Dade)

• Early Learning Coalition

• Human Trafficking• Family Planning

Services• Bereavement

Services/Organizations• Early Steps• Food Banks• Hospitals• Read to Learn

Extensive Referral Network & Partnerships

Does it Work?

Does it Work?

Does it Work?

May, L., Borger, C., Weinfield, N., et. al (2016). WIC Infant and Toddler Feeding Practices Study 2: Infant Year Report. Prepared by Westat, Contract No. AG-3198-K-11-0073. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, Project Officer: Allison Magness. Available online at: www.fns.usda.gov/research-and-analysis.

Does it Work?

May, L., Borger, C., Weinfield, N., et. al (2016). WIC Infant and Toddler Feeding Practices Study 2: Infant Year Report. Prepared by Westat, Contract No. AG-3198-K-11-0073. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, Project Officer: Allison Magness. Available online at: www.fns.usda.gov/research-and-analysis.

Does it Work?

Does it Work?

WIC Works!!

Indicators/Data

• Breastfeeding Data– Initiation

• All infants• Non-Hispanic Black infants

– Duration• Any breastfeeding at 3, 6 months• Exclusivity at 3, 6 months

• WIC Participation/Enrollment– By client category, breastfeeding status, age, site

Indicators/Data

• Healthy Weight– Overweight/Obesity in

WIC Children

• Access to Care– First Trimester Entry

into WIC

• Productivity/Process Indicators– Services by Employee– Nutrition Contacts– Processing Standards

• Assessment/Behavioral data– Anthropometrics– Nutrition behaviors– Breastfeeding behaviors– Sociodemographic

information – Select medical history

(birth hx, prenatal hx, current diagnosis, etc.)

WIC Caseload

62,000

64,000

66,000

68,000

70,000

72,000

74,000

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Febr

uary

Mar

ch

Apr

il

May

June

July

Aug

ust

Sept

embe

r

Cas

eloa

d

Months

2012-2013

2013-2014

2014-2015

2015-2016

2016-2017

SourceFL-WiSE Closeout Priority Status by Category

GOOD

State & DadeTarget70,000

Breastfeeding Duration

Breastfeeding Duration

Sep-15 Dec-15 Mar-16 Jun-16 Sep-16 Dec-16South Average 37.9 39.6 38.9 41.2 44.0 46.4Central Average 43.6 47.7 50.5 47.8 49.1 45.3North Average 42.8 44.5 45.9 44.3 41.7 44.0

30.0

35.0

40.0

45.0

50.0

55.0

% B

reas

tfee

ding

Percentage of WIC Infants Breastfeeding (Any)for 26 Weeks or More by Area - FFY 2016 Good

HP 2020Target 60.6%

Breastfeeding Duration

Goulds Perrine S.Miami W.DadeF. Wilson &

JuanitaMann

N.Miami Homestead Carol City L.River JMH Main Unity University Hialeah NMB Naranja PeñalverJMH

Mother-Baby

State

Sep-15 36.5 34.9 60.2 37.8 29.1 40.2 48.1 37.9 49.9 36.3 48.8 38.3 47.5 32.2 43.4 32.1

Dec-15 38.1 40.8 69.6 36.6 26.0 39.8 53.1 38.4 54.0 40.1 58.6 39.5 50.8 29.3 44.1 37.6 33.4

Mar-16 39.7 33.2 71.5 37.0 29.9 44.9 53.9 40.8 49.7 51.0 57.9 38.7 55.5 30.5 42.0 39.8 34.5

Jun-16 41.9 35.5 72.2 39.2 31.9 42.8 52.9 38.0 47.1 44.5 54.2 55.1 37.5 56.0 36.5 43.3 33.3 33.8

Sep-16 48.0 42.0 66.0 41.3 31.8 36.2 50.0 34.3 47.4 45.1 53.0 54.2 37.3 53.1 38.5 44.3 0.0 43.6

20.0

30.0

40.0

50.0

60.0

70.0

% B

reas

tfee

ding

Percentage of WIC Infants Breastfeeding (Any)for 26 Weeks or More by Site - FFY 2016

(BF Duration)

Good

HP 2020Target 60.6%

Childhood Overweight & Obesity

UM/ WICCOLL ABORATION

C Y N T H I A L E B R O N

EARLY CHILDHOOD OBESITY

• 1 in 4 children are overweight or obese

– Obesity: Hispanics 15.6%, NH Blacks 10.4%, NH Asians 5.0%, NH Whites 5.2%1

• Children who are overweight during early childhood are at least 5 times more likely than non-obese children to be overweight or obese as adults2

• Higher prevalence estimates of obesity among ethnic minority groups are often underscored by low socioeconomic status3-4

1Ogden et al, 2014, 2Reilly et al, 2005, 3Bell et al, 2008

4Larson et al, 2009

RISK FACTORS

• gestational weight gain and gestational diabetes

• maternal smoking during pregnancy

• accelerated infant weight gain

• Breastfeeding

• sleep duration and quality

• television viewing and television sets in bedrooms

• responsiveness to infant hunger &

satiety cues

• parental feeding practices

• eating in the absence of hunger

• portion size

• fast food intake

• ingestion of sugar-sweetened beverages

• physical activity

• sociocultural factors, including the availability of opportunities for recreation

Olson et al, 2016

HEALTH DISPARITY

• Studies show that Hispanics and NHBs are disproportionately affected by higher prevalence estimates of6:

– gestational diabetes

– non-breastfeeding exclusivity

– poor bottle feeding practices/very early introduction of solid foods

– television sets in child’s bedroom

• The role of SES in the relationship between race/ethnicity and obesity is unclear6 Taveras et al, 2013

SCIENTIFIC INEQUITY

• Although childhood obesity disparities by race/ethnicity have been identified, the majority of studies took place in high-income populations with predominantly NHW participants making generalizability near impossible7

• Yet 44% of US children currently live in lower economic environments, and another 22% live in poverty, making it especially pertinent to investigate early life risk factors for obesity which can lead to a life of chronic morbidity. 8

7Woo Baidal et al, 2016

8 Jiang et al, 2015

WIC

• The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is the largest supplemental food program in the US.

• WIC provides health care referrals and nutrition education to – low-income/resource pregnant, breastfeeding and non-breastfeeding postpartum women

– infants and children up to age five who are at nutritional risk.

• WIC currently serves 53% (41.6% of whom are Hispanic and another 20.3% NHB) of all infants born in the United States.

• MDC there are 17 sites with a total caseload of over 72,000 women, infants, and children per month.

– collects comprehensive data at intake on

– nutritional behaviors

– weight/body mass index

– dietary intake of the mother during pregnancy and then during the child’s first five years of life

SPECIFIC AIMS

Aim 1: To quantify via the 2011-2016 Miami-Dade County WIC perinatal and early childhood database which pregnancy factors (gestational diabetes, smoking and other detrimental behaviors) are predictive of child healthy weight at age 5.

– Specific hypothesis1: Children of mothers who develop gestational diabetes during pregnancy will be less likely to be at a healthy weight at age 5.

– Specific hypothesis2: Children of mothers who smoke and/or engage in other detrimental prenatal behaviors will be less likely to be at a healthy weight at age 5.

SPECIFIC AIMS

Aim 2: To quantify via the 2011-2016 Miami-Dade County WIC perinatal and early childhood (EC) database which perinatal/EC behaviors (food choices/feeding practices) are predictive of healthy weight at age 5.

– Specific hypothesis3: Children who were not exclusively breastfed for the first 6 months of life will be less likely to be at a healthy weight at age 5.

– Specific hypothesis4: Children introduced to solid foods before 4 months of age will be less likely to be at a healthy weight at age 5.

SPECIFIC AIMS

• Aim 3: To determine if there is a direct effect of race/ethnicity and SES or if race/ethnicity and SES mediates or moderates aim 1 and 2 findings.

• Aim 4: To utilize cross-validation techniques to ensure the external reliability and validity of the statistical models since the dataset contains a large number of women and children (> 1000).

C L E B R O N @ M I A M I . E D U

THANK

Thank you!

Contacts:Eriko M. Grover, MS-MPH, RD, LD/NPublic Health Nutrition Program DirectorEriko.Grover@flhealth.gov(786) 336-1333

Carla Munoz, MPH, RD, LD/N, CLCWIC Program Outreach CoordinatorCarla.munoz@flhealth.gov(786) 336-1333 x 14719