WIC WORKS: Baby Food for Older Infants – How About a Fresh Option ? California WIC Association Webinar February 19,

1. WIC WORKS: Baby Food for Older Infants – How About a Fresh Option?California WIC Association WebinarFebruary 19, 2012 Presented by: Lorrene Ritchie, PhD, RD Loan P. Kim, PhD, RD

2. Loan Kim1, Shannon Whaley2Pat Gradziel3, Nancy Crocker3Lorrene Ritchie4 & Gail Harrison11 Pepperdine University, Malibu, CA2 Public Health Foundation Enterprises WIC, Irwindale, CA3 California Department of Public Health, WIC Program, Sacramento, CA4 Dr. Robert C. and Veronica Atkins Center for Weight and Health, University of California, Berkeley, CA5 University of California, Los Angeles, School of Public Health, Los Angeles, CAFunding for the NEFPI study: U.S. Department of AgricultureFunding for the qualitative study: American Heart Association

3. Revised WIC Food Package in 2009 • Significant improvement in dietary quality including the addition of fruit and vegetables

4. Objectives • Examine participant utilization and satisfaction with jarred baby foods • Assess preference for fruit and vegetable vouchers versus jarred baby foods • Examine whether preferences varied among selected ethnic groups

5. Study Design • Multiple methods • Data drawn from three sources: • California Nutrition Education and Food Package Impact (NEFPI) study survey of WIC participants statewide • California WIC redemption data • Interviews with subset of WIC participants and staff in LA County

6. NEFPI Study • Phone survey (Mar–May 2010) • Participants: 2996 women • 9% pregnant, 14% breastfeeding • ~29 years old • 81% Latino • Questions: • “How satisfied are you with the voucher for fruit and vegetables?” • “How satisfied are you with the WIC checks for jarred baby food?” • “If you had a choice of either continuing to receive WIC checks for jarred baby food or receiving a voucher to buy fruit and vegetables for your baby, which would you choose?”

7. CA Redemption Data • Examined all infant food checks which contained jarred fruit/vegetables • Calculated as a percentage of checks redeemed to checks issued (Mar-Oct 2010) • 200,000 infants per month: • 74.8% Latino • 9.2% White • 6.5% African-American • 5.1% Asian • 4.4% other • Examined by ethnic group & age of infants

8. Qualitative Interview Data • One-on-one interviews (Oct 09-Jun 10) • 20 WIC Participants: • ~26 years old • Enrolled in WIC for more than 1 year • All Mexican; half born in the U.S. • 16 WIC Staff: • ~29 years old • All Latino; 65% born in the U.S. • Topics: • 1) using the cash vouchers to purchase fruit & vegetables • 2) using jarred baby food • 3) preference for cash vouchers or jarred baby foods

9. High Satisfaction with F/V Vouchers

10. Also High Satisfaction with Jarred Baby Foods

11. Given a choice, 2/3 of all participants prefer more F/V vouchers over jarred baby foods

12. Preference for Jarred Decreased and Preference for Vouchers Increases with Child Age

14. Participant Narratives: Mothers like being able to buy their own fruits & vegetables • "Families can always use more fruit and vegetables.” • "I wish they would give more checks for fruit and vegetables.” • "They are good. When I go to the store, my daughter can choose which fruits she wants. “

15. Participant Narratives: Mothers like the convenience of jarred baby foods, but would still prefer vouchers for F/V • "When I am out, it's so easy to have [jarred baby foods]. But they give us too many. I can never finish them and sometimes they expire." • "Can I have more money to buy fruit and vegetables? I like to make my own food for my kids. It's better I think.”

16. Staff Narratives: Culturally, these mothers prefer to make their own baby foods than feed jarred baby foods to their child. • "They like the vouchers for the fruit and vegetables. Jar baby foods – they don’t use them; they make their own baby foods and they don’t want it. I would suggest they give the women the option of fruit and vegetable vouchers so they can make their own baby food.” • "For a long time we were telling them it was better to make their own baby food…But now we’re telling them to get baby food. It’s mixed messages. In Hispanic culture we’re not big on jar food. If they got more money for the fruit and vegetables, it would be much better. “

17. Implications • Addition of jarred baby foods to the infant food package has been well received overall by participants • As babies get older, mothers want the option to choose between jarred baby foods and cash vouchers for fruit and vegetables in order to prepare their own baby foods • Pilot study is needed to explore the feasibility of allowing states to offer older infants the choice of fruit and vegetable checks instead of jarred baby foods

18. Thank you! & Questions??? Loan.kim@pepperdine.edu Lorrene_ritchie@sbcglobal.net