Texas WIC Program Food Package Research and Nutrition Education Implications

1. Texas WIC ProgramFood Package Research and Nutrition Education Implications

2. Texas WIC Program Texas WIC Context: • 900,000+ WIC Participants • 2200+ WIC Staff • 2300+ WIC Vendors • 80 contracted local agencies • Numerous partners and stakeholders

3. Additional Challenges • Statewide EBT rollout will occur right before food package implementation • Food package implementation will occur statewide August 1, 2009 • Delay between when participants receive education and the actual food package change

4. What are we going to do? 1. Get Help! Selected Burson-Marsteller a leading advertising firm through a competitive bid process 2. Started with research to • Establish benchmark of overall knowledge • Gage current perceptions of WIC and food package • Gage potential perceptions of coming changes • Identify potential barriers to success

5. We started with research 5

6. What research told us WIC staff focus group • Positive about all of the changes • See the changes as aligning with dietary guidelines • Recognize the need to educate staff, partner agencies, vendors and WIC participants on the changes • Most concerned about educating on whole grains and infant formula “…Everything is going to be easy and wonderful, except explaining to mamas why they’re getting less formula.” – WIC Staff

7. Vendor in-depth interviews WIC Vendors • Are positive but concerned about their bottom line • Asked for DVDs and online training for cashiers • Want participants to be educated at clinic • Think brochures and posters are a must to help educate participants • Like labeling WIC products that are least expensive brand “…I think our profits will actually go down because we have a smaller profit level on produce.” – WIC Vendor, McAllen “…They’ll have to educate them; it’s not up to us to educate the customers when they come in.” – WIC Vendor, Tyler

8. WIC partner in-depth interviews WIC partners and stakeholders • Welcome the changes • See opportunities to encourage breastfeeding and healthy eating habits • Want to work hand in hand with WIC to help educate clients and families about nutrition • Concerned that some participants may not know how to use the new foods “…For us as educators, it gives us the opportunity to educate and have a deeper discussion about it.” –Nutrition Manager, San Antonio Food Bank “…It would be nice if we had training or the same written material WIC is going to have…If we have that we can reemphasize what WIC is telling them” –Pediatrician, Midland

9. Participant focus groups Participants • Very positive about fruits and vegetables • Mostly positive about lower fat milk • Some uncertainty about whole grains • Negative reaction to reductions in milk, eggs, cheese and juice! “…Cheese is expensive. And the eggs are going up too.” – WIC Participant “…there is not enough to begin with so why decrease?” – WIC Participant

10. Participant focus groups Baby Foods • Most English speakers purchased jarred baby foods, but Spanish speakers were more likely to make their own • Confusion about why moms and breastfed babies get more food than formula fed infants • Fluctuations in the amount of formula were confusing to participants 10

11. Telephone survey with 600+ participants % of WIC Participants that “Strongly Like” each of the changes

12. Likes and Dislikes of Food Package Changes Some differences among Hispanic participants and males on whole foods, baby food and reducing milk, cheese and eggs (shown as % strongly like) 12

13. Likelihood to Use Food Package Changes Now please tell me how likely you are to use your WIC food package to add the following items to your grocery shopping. Are you... 13

14. Perceptions of WIC Changes Which is closer to your view?

15. Fruits and vegetables Top fruits and vegetables • Participants requested fresh, frozen and canned • Top fresh fruit • Apples, bananas, grapes, and watermelon • Top fresh veggies • Broccoli, carrots, potatoes, and tomatoes • Avocados ranked first among Hispanics and Spanish speakers

16. Fruits and vegetables • Top frozen fruit • Strawberries, mixed fruit, peaches, pineapple, and mangos • Top frozen veggies • Broccoli, mixed vegetables, and corn • Top canned fruits • Applesauce, fruit cocktail, peaches, and pineapple • Top canned veggies • Corn, green beans and tomatoes

17. Baby Foods Among participants with infants between the ages of 6 and 12 months a majority currently purchase baby foods for their infant AMONG THOSE WITH INFANTS 6-12 MONTHS: Do you regularly buy baby foods for your baby?

18. Soy Milk / Tofu Two thirds say they would not use soy milk or tofu and would continue to use only cow’s milk. More Hispanic participants said they would be likely to add soy milk or tofu to replace some cow’s milk.

19. Whole Grains • When it comes to whole grains, two-thirds or more say they are very confident in choosing whole grain products and nearly more than 3 in 4 say they already consume whole wheat or whole grain bread at least once a week. Confidence In Choosing Whole Grains Current Usage of Whole Grains

20. Choosing New Food Items – Whole Grains • To get more in-depth information we surveyed participants via TexasWIC.org • Most prevalent responses by grain. • Whole wheat or whole grain bread (daily-45.6%) • Reason: “It is healthy for me and my family” (74%) • White bread (weekly-38.0%) • Reason: “My family likes the taste” (41.6%) • Brown rice (never -38.6%) • Reason: “I have never tried it” (56.4%) • Oatmeal (weekly-33.5) • Reason: “It is healthy for me and my family (52.6%) • Whole wheat tortillas (never-54.4%) • Reason: “I have never tried it” (54.6%) • Corn tortillas (monthly-31.2%) • Flour tortillas (monthly-37%) • Many significant differences in frequency related to ethnicity

21. Change from whole to lower fat milk

22. Educating Participants Please tell me how helpful each of the following would be to learn about changes. Would this be...Showing % Very Helpful

23. Educating Participants • Spanish speaking participants see internet tools such as online classes and information via the web as less helpful. Alternatively these audiences are more welcoming to learning through in-store tastings, group classes and cooking demonstrations.

24. Supplemental Materials Welcomed

25. Interest in Children’s Materials • DVDs, coloring sheets, story books and stickers get the most positive response in terms of children’s materials.

26. Summary of research findings Overall Findings • WIC staff and partners welcome the changes • WIC participants are positive but are concerned about decreases and are somewhat resistant to lower fat milk • WIC vendors see the changes as positive for participants but are concerned about their bottom line • There are cultural differences for some food items Food Specific Findings • Over 50% of participants drink whole milk • WIC participants are somewhat familiar with whole grains • Changes in the infant food package are confusing

27. After the research Brand platform/messaging • Using research to develop brand platform and key messages • Next step is to develop communications plan and materials • Materials will be tested with vendors, partners, staff and participants

28. Overall Takeaways Key Challenges • Explaining the changes and reasons behind the changes • Creating culturally specific and relevant materials • Ensuring our staff, partners and vendors are all on the same page and have similar materials to use with participants Key Opportunities • Recast WIC as a modern program that provides the foundation for a healthy lifestyle • Broader outreach to WIC partners and vendors to amplify healthy diet and nutrition messages • Impact beyond the food package 28

29. For more information • contact Amanda Hovis at amanda.hovis@dshs.state.tx.us or (512) 458-7111 ext 3411