|
 |
|
|||||||
|
|||||||||
© 2004 American Public Health Association
RESEARCH AND PRACTICE |
Pinka Chatterji is with the Center for Multicultural Mental Health Research, Cambridge Health Alliance/Harvard Medical School, Somerville, Mass. Jeanne Brooks-Gunn is with Teachers College and the College of Physicians and Surgeons, Columbia University, New York, NY.
Correspondence: Requests for reprints should be sent to Pinka Chatterji, PhD, Center for Multicultural Mental Health Research at Cambridge Health Alliance/Harvard Medical School, 120 Beacon St, 4th Floor, Somerville, MA 02143 (e-mail: pchatterji{at}charesearch.org).
 |
ABSTRACT |
|---|
 TOP ABSTRACT INTRODUCTIONMETHODSRESULTSReferences |
|---|
We estimated the effect of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation in 1999 to 2000 on breastfeeding initiation and duration and well-child care. We applied multivariate regression to a sample of 2136 unmarried, low-income, urban mothers from the Fragile Families and Child Wellbeing Study. WIC participation was associated with small increases in the probabilities of initiating breastfeeding and having had at least 4 well-child visits since birth—behaviors that benefit infants beyond the newborn period—but not with breastfeeding duration.
|
INTRODUCTION |
|---|
|
TOPABSTRACTINTRODUCTIONMETHODSRESULTSReferences |
|---|
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides low-income, nutritionally vulnerable pregnant and postpartum women, infants, and young children with nutrient-dense food packages, nutritional counseling (including breastfeeding support), and linkage to medical and social services. Numerous studies indicate that WIC participation during pregnancy is associated with better birth outcomes.1–10 However, with the notable exception of the Rush et al.11 evaluation, little research has focused on the benefits of WIC participation that extend beyond the newborn period.12
We estimated the association between WIC participation and 2 maternal health behaviors that benefit infants—breastfeeding and well-child care. The study used 1999 to 2000 survey data on low-income, unmarried, urban mothers from the Fragile Families and Child Wellbeing Study. WIC participation may have mixed effects on breastfeeding because of the competing effects of activities that promote breastfeeding and the valuable infant formula provided in food packages. However, we expect that WIC participation is associated with greater use of well-child care because of WIC’s emphasis on medical referrals.
|
METHODS |
|---|
|
TOPABSTRACTINTRODUCTIONMETHODSRESULTSReferences |
|---|
Data were from a subsample of the Fragile Families and Child Wellbeing Study, a longitudinal survey of 3712 unmarried couples and 1186 married couples, all of whom had newborn infants at baseline. Respondents resided in 20 cities across the United States. We used data from the baseline survey, which was conducted between June 1999 and October 2000 in the hospital after the child’s birth, and from the first follow-up survey, which was conducted in person or by telephone approximately 12 to 15 months after the birth. To limit the analysis to mothers who were most likely eligible for WIC participation, we limited the sample to 2136 mothers who were unmarried and living at or below 250% of the federal poverty line at the time of the child’s birth.
Our sample included women who were most likely eligible for WIC and who were able to provide fairly complete information for the study. We excluded from the original 4898 respondents: (1) mothers who did not respond to the follow-up survey (n = 533), (2) mothers whose children were aged younger than 12 months or older than 24 months at the time of the follow-up survey (n = 383), (3) mothers with incomes greater than 250% of the poverty line at the time of the child’s birth (n = 1173), (4) mothers married at the time of the birth (n = 378), (5) mothers with multiple births or with missing information on the child’s sex (n = 49), and (6) mothers who were not living with their children by the time of the follow-up survey (n = 65). We also excluded mothers with missing information on any dependent variable (n = 181). However, we did include respondents with missing information on independent variables used in the analysis. For these respondents, missing information was replaced with sample means.
We used probit and ordinary least squares models to analyze the 3 outcomes: (1) whether the mother initiated breastfeeding; (2) the logarithm of the number of weeks the mother breastfed, among those who initiated breastfeeding; and (3) whether the child received at least 4 well-child evaluations during his or her first year. We measured maternal WIC status with a dummy variable indicating whether the mother participated in WIC since the child was born; mothers were not asked about prenatal participation. The models also included detailed information about the child (e.g., age in weeks, low birthweight), the mother (e.g., race/ethnicity, education, age, living arrangements, health behaviors), and the household (e.g., size, health insurance, income, city of residence).
We estimated parsimonious models (which included only demographic covariates) and more fully specified models (which included all of the covariates) to gauge the sensitivity of the WIC participation coefficient to the inclusion of additional factors. Compared with the national data sets used in previous work, our sample included a fairly homogeneous sample of mothers. Nevertheless, we lacked information on the timing of WIC participation, and it is still possible that mothers may have self-selected into WIC along unobserved factors that also affect health investments, which may have led to biased estimates.
|
RESULTS |
|---|
|
TOPABSTRACTINTRODUCTIONMETHODSRESULTSReferences |
|---|
About half of the mothers reported breastfeeding initiation, and the average duration of breastfeeding was about 18 weeks among mothers who initiated (Table 1
). Breastfeeding initiation rates in the analysis samples were similar to those in other recent national surveys of low-income women.13,14 Approximately 91% of the mothers reported that their child had at least 4 well-child evaluations since birth, and 86% of the mothers reported WIC participation, which is consistent with WIC’s high participation rate among eligible persons.
|
In both the parsimonious model (Table 2
, column 1) and the larger model (Table 2, column 2), WIC participation was associated with a statistically significant increased probability of breastfeeding initiation of about 0.07 at the sample means (i.e., approximately 52% WIC vs 45% comparison, P < .05). The magnitude of the estimate was almost identical in the parsimonious model and the larger model. We did not find any evidence that WIC participation was associated with breastfeeding duration among mothers who initiated breastfeeding (Table 2, columns 3–4), but WIC participation had a statistically significant positive association with the receipt of at least 4 well-child visits (Table 2, columns 5–6). Including additional covariates did not reduce this estimate, and the increase in probability was about 0.06 at the sample means (i.e., approximately 93% WIC vs 87% comparison, P < .05).
|
The positive association between WIC participation and well-child care and breastfeeding initiation is consistent with the WIC goals of linking participants to medical services and promoting breastfeeding, a health behavior that is associated with numerous benefits for infants.15–19 Previous WIC evaluations indicated that participation improves pregnancy outcomes. These findings add to existing research by suggesting that WIC participation also may be associated with health behaviors that benefit infants beyond the newborn period.
|
Acknowledgments |
|---|
The Fragile Families and Child Wellbeing Study is funded by the National Institute of Child Health and Human Development (grant R01HD36916), the California Healthcare Foundation, the Center for Research on Religion and Urban Civil Society at the University of Pennsylvania, the Commonwealth Fund, the Ford Foundation, the Foundation for Child Development, the Fund for New Jersey, the William T. Grant Foundation, the Healthcare Foundation of New Jersey, the William and Flora Hewlett Foundation, the Hogg Foundation, the Christina A. Johnson Endeavor Foundation, the Kronkosky Charitable Foundation, the Leon Lowenstein Foundation, the John D. and Catherine T. MacArthur Foundation, the A. L. Mailman Family Foundation, the Charles S. Mott Foundation, the National Science Foundation, the David and Lucile Packard Foundation, the Public Policy Institute of California, the Robert Wood Johnson Foundation, the St. David’s Hospital Foundation, the St. Vincent Hospital and Health Services, and the US Department of Health and Human Services. P. Chatterji additionally acknowledges support from a K01 award (AA00032803) from the National Institute on Alcohol Abuse and Alcoholism.
J. Brooks-Gunn would like to thank the National Institute of Child Health and Human Development Research Network on Child and Family Well-Being and the Center for Health and Well-Being at Princeton University.
Human Participant Protection
The Fragile Families and Child Wellbeing Study was reviewed and approved by the Princeton University and the Columbia University internal review boards.
|
Footnotes |
|---|
Contributors
Both authors developed the study hypotheses, analyzed the data, and wrote the brief.
Accepted for publication June 18, 2003.
|
References |
|---|
|
TOPABSTRACTINTRODUCTIONMETHODSRESULTSReferences |
|---|
1. Moss NE, Carver K. The effect of WIC and Medicaid on infant mortality in the United States. Am J Public Health. 1998;88:1354–1361.
2. Ahluwalia IB, Hogan V, Grummer-Strawn L, Colville WR, Peterson A. The effect of WIC participation on small-for-gestational-age births: Michigan, 1992. Am J Public Health. 1998;88:1374–1377.
3. Heimedinger J, Laird N, Austin JE, Timmer P, Gershoff S. The effects of the WIC program on the growth of infants. Am J Clin Nutr. 1984;40:1250–1257.
4. Kotelchuck M, Schwatrz JB, Anderka M, Finison KS. WIC participation and pregnancy outcomes: Massachusetts Statewide Evaluation Project. Am J Public Health. 1984;74:1086–1092.
5. Buescher PA, Larson LC, Nelson MD, Lenihan AJ. Prenatal WIC participation can reduce low birth weight and newborn medical costs: a cost benefits analysis of WIC participation in North Carolina. J Am Diet Assoc. 1993;93:163–166.[Web of Science][Medline]
6. Buescher PA, Horton SJ, Devaney BL, et al. Child participation in WIC: Medicaid costs and use of health care services. Am J Public Health. 2003;93:145–150.
7. Kennedy ET, Kotelchuck M. The effect of WIC supplemental feeding on birthweight: a case–control analysis. Am J Clin Nutr. 1984;40:579–585.
8. Stockbauer JW. WIC prenatal participation and its relation to pregnancy outcomes in Missouri: a second look. Am J Public Health. 1987;77:813–818.
9. Schramm WF. WIC prenatal participation and its relationship to newborn Medicaid costs in Missouri: a cost/benefit analysis. Am J Public Health. 1985;75:851–857.
10. Stockbauer JW. Evaluation of the Missouri WIC program: prenatal components. J Am Diet Assoc. 1986;86:61–67.[Web of Science][Medline]
11. Rush D, Leighton J, Sloan NL, et al. The National WIC Evaluation: evaluation of the Special Supplemental Food Program for Women, Infants, and Children, VI, study of infants and children. Am J Clin Nutr. 1988;48:484–511.
12. Besharov DJ, Germanis P. Evaluating WIC. Eval Rev. 2000;24:123–190.
13. Baydar N, McCann M, Williams R, Vesper E. Final Report: WIC Infant Feeding Practices Study, November 1997. Contract 53-3198-3-003 to the USDA. Washington, DC: Office of Analysis and Evaluation, Food and Consumer Service, US Dept of Agriculture; 1997.
14. Pediatric Nutrition Surveillance, 1997 Full Report. Atlanta, Ga: Centers for Disease Control and Prevention; 1998.
15. Howie PW, Forsyth JS, Ogston SA, et al. Protective effects of breast-feeding against infection. BMJ. 1990;300:11–16.
16. Beaudry M, Dufour R, Marcoux S. Relation between infant feeding and infections during the first six months of life. J Pediatr. 1995;126:191–197.[Web of Science][Medline]
17. Shu XO, Linet MS, Steinbuch M, et al. Breastfeeding and risk of childhood acute leukemia. J Natl Cancer Inst. 1999;91:1765–1772.
18. Chandra RK. Five-year follow-up of high-risk infants with family history of allergy who were exclusively breast-fed or fed partial whey hydrolysate, soy, and conventional cow’s milk formulas. J Pediatr Gastroenterol Nutr. 1997;24:380–388.[Web of Science][Medline]
19. Kramer MS, Chalmers B, Hodnett ED, et al. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA. 2001;285:413–420.
This article has been cited by other articles:
|
|
 |
|
  A. C. McKechnie, A. Tluczek, and J. B. Henriques Maternal Variables Influencing Duration of Breastfeeding Among Low-Income Mothers ICAN: Infant, Child, & Adolescent Nutrition, June 1, 2009; 1(3): 126 - 132. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Jacknowitz, D. Novillo, and L. Tiehen Special Supplemental Nutrition Program for Women, Infants, and Children and Infant Feeding Practices Pediatrics, February 1, 2007; 119(2): 281 - 289. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. A. Hanks Community Empowerment: A Partnership Approach to Public Health Program Implementation Policy Politics Nursing Practice, November 1, 2006; 7(4): 297 - 306. [Abstract] [PDF]
|
|
|
|
 |
|
 J Stolzer and P. Zeece Low income women and physician breastfeeding advice: A regional assessment Health Education Journal, June 1, 2006; 65(2): 126 - 134. [Abstract] [PDF]
|
|
|
|
 |
|
 C. M. Gibson-Davis and J. Brooks-Gunn Couples' Immigration Status and Ethnicity as Determinants of Breastfeeding Am J Public Health, April 1, 2006; 96(4): 641 - 646. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Ryan and W. Zhou Lower Breastfeeding Rates Persist Among the Special Supplemental Nutrition Program for Women, Infants, and Children Participants, 1978-2003 Pediatrics, April 1, 2006; 117(4): 1136 - 1146. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Wambach, S. H. Campbell, S. L. Gill, J. E. Dodgson, T. C. Abiona, and M. J. Heinig Clinical Lactation Practice: 20 Years of Evidence J Hum Lact, August 1, 2005; 21(3): 245 - 258. [Abstract] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |