WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County. August 2010

Transcription

1 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County August 2010

2 Foreword We are pleased to present this report on low-income families with young children in Los Angeles County. The Special Supplemental Nutrition Program for Women, Infants and Children, commonly referred to as WIC, is available nationwide to all low-income pregnant and postpartum women, infants and children up to the age of five. In Los Angeles County, the WIC Program reaches over two-thirds of all infants, and about half of all children up to age five. This broad reach makes WIC a valuable source of health information about lowincome young families. The vision for this project began in 1999, when First 5 was established following California voters passage of ballot initiative Proposition 10. First 5 Commissions were established in every county in California and the target population of both First 5 and WIC are similar pregnant women and families with young children. In Los Angeles, a formalized Research Partnership between First 5 LA and PHFE WIC was established in 2002 and staff from both entities have worked closely to track indicators of health of this population. These indicators are compiled in this report. Thanks to seven dedicated local agency WIC Directors in Los Angeles County, significant support from the California WIC Program and funding from First 5 LA, we are now able to present this report. Following introductory material about data sources and methodology, data are presented in 4 main topical areas: Feeding and Nutrition, Health of Women and Children, Early Care and Education, and Home and Community Environments. In the Appendix, readers will find a User s Guide to gain access to WIC administrative data at On this platform, users can query WIC administrative data elements for any geography within the County (e.g. City, Census Tract). Given the current national focus on utilizing community health data to improve services and health outcomes for families and communities, we hope the data in this report help readers better understand the current health and community needs of low-income families in Los Angeles County. We also hope readers outside of Los Angeles County find this report useful as a tool for considering how WIC data might be utilized in other regions of the U.S. Throughout the report, we avoid going beyond the data to make interpretations or causal inferences about what these data mean, and leave these interpretations to the reader. We encourage readers to access the data themselves on the HealthyCity.org platform and to contact us directly with any comments or questions at datamining@phfewic.org. Shannon E. Whaley, Ph.D. Director of Research and Evaluation PHFE WIC Program Los Angeles County, California

3 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County Table of Contents 2 Introduction 4 Methods WIC Administrative Data ( ) WIC Survey Data (2008) Results 8 Section 1: Feeding and Nutrition 1 8 Section 2: Health of Women and Children 28 Section 3: Early Care and Education 34 Section 4: Home and Community Environments 40 Conclusion/References Appendices 42 User s Guide (for obtaining WIC data at 46 Service Planning Area Map 47 Index of Figures and Tables 48 Acknowledgements WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 1

4 Introduction Introduction This report provides information about low-income families with young children in Los Angeles County (LAC) who participate in the WIC Program. The body of the report is divided into four sections that summarize indicators and key findings for the WIC population in the areas of feeding and nutrition, health of women and children, early care and education, and the home and community environments of young children and families. This report is made possible by a unique collaboration between the Public Health Foundation Enterprises WIC Program (PHFE WIC) and First 5 LA. Formed in 2002, this research partnership makes available demographic and health indicators for low-income children and families from pregnancy through a child s 5th birthday. WIC The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a food and nutrition education program for pregnant, breastfeeding, and postpartum women, infants and children under age five who are low-income (up to 185% of the Federal Poverty Level) and at nutritional risk. Funded by the United States Department of Agriculture (USDA), WIC provides nutrition education, breastfeeding promotion and support, medical and social service referrals, and supplemental foods tailored to eligible families. WIC is a short-term intervention program designed to influence lifetime nutrition and health behaviors in this targeted, high-risk population. Nationwide, approximately 25% of the individuals served are women, 25% are infants and the remaining 5 are children ages one to five. WIC services are available in every state and US territory, and currently WIC services are delivered to over 9 million participants each month. In Los Angeles County (LAC), WIC currently serves approximately 67% of all infants and about half of all children ages one to five, translating into approximately 600,000 individuals and 400,000 families each month. WIC organizations are devoted to improving nutrition and health among pregnant women and young children. The following seven local agency WIC Programs provide these services in LAC in over 90 sites virtually every low-income neighborhood across the County: Antelope Valley Hospital WIC Program City of Long Beach Department of Health and Human Services WIC Program Los Angeles Biomedical Research Institute WIC Program Northeast Valley Health Corporation WIC Program Pasadena Public Health Department WIC Program PHFE WIC Program Watts Healthcare Corporation WIC Program First 5 LA First 5 LA is a child advocacy organization created by California voters to invest tobacco tax revenues in programs for improving the lives of children in Los Angeles County, from pregnancy through age 5. First 5 LA champions health, education and safety causes concerning young children and families. For additional information about First 5 LA, its partners and projects, visit 2 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

5 Introduction History of a Unique Research Partnership In the past, obtaining data about this large and important segment of the LAC population expectant families and those with young children was challenged by limited access to County-wide WIC data. Extensive information about WIC families is collected regularly in the Integrated Statewide Information System (ISIS), including socio-demographic and health information. While ISIS has enabled the analysis of WIC Administrative Data at either the State level or local WIC agency level, it was not electronically aggregated at the County level. In addition, no surveys had been conducted to collect information to better understand health outcomes and factors associated with the well-being of WIC families. In 2002, First 5 LA funded PHFE WIC to address the critical gap in information about low-income families in LAC. With the support of all 7 local agency WIC Programs and the California WIC Program, a system was created to electronically aggregate LAC WIC data. This partnership funded both the aggregation of WIC Administrative Data (ISIS) across the County as well as the Los Angeles County WIC Survey. These two ventures have enabled the collection and examination of in-depth data about low-income WIC families. In addition, beginning in 2007, an innovative partnership with The Advancement Project s Healthy City staff resulted in the availability of LAC WIC data on the Healthy City website ( ). On this platform, demographic and health data on WIC participants are available by multiple geographies within LAC (e.g., City, ZIP, Census Tract) with a variety of mapping and charting features. Instructions for how to obtain these data can be found in the Appendix (see User s Guide on p. 42), or by visiting or ing datamining@phfewic.org. WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 3

6 Introduction Methods WIC Administrative Data WIC Administrative Data provide trends from for a variety of measures including health during pregnancy, at birth, and early infancy for over 600,000 individuals served monthly by WIC in LAC. Most of the indicators are presented by race/ethnicity (plus preferred language for Hispanic or Latino participants). Table 1 shows the data elements that are used in this report. TABLE 1 WIC Administrative Data Elements for all WIC Participants Overweight/obesity Infant/child age Parental educational attainment Race/ethnicity of child/parent Ethnicity and preferred language Percentage of 3 and 4 year olds who are obese a Body Mass Index (BMI) at or above the 95th percentile for their age and gender. BMI is defined as a function of weight and height where BMI = (weight in pounds x 703)/(height in inches 2 ). There is current debate about whether young children should be labeled overweight or obese. In this report either term refers to a BMI > 95th percentile. Infants (birth to 12 months) and children (1 to 5 years). Five year old children receive WIC services only in the month of their 5th birthday. Years of education completed by the adult WIC recipient. Self-reported by the participant: Asian, Black, Hispanic, Native American, Pacific Islander, White, Other, Multi-Race or refused. Ethnicity-language breakdowns available for this report include Hispanic- English speaking (Hispanic En) and Hispanic-Spanish speaking (Hispanic Sp). Other ethnicity-language breakdowns are not included in this report due to comparatively small numbers of individuals. Percent of Federal Poverty Level (FPL) Based on documented income and family size; federal poverty level (FPL) is grouped by <10, %, and >133%. Service Planning Area (SPA) in LAC Low birthweight Prematurity Fully breastfeeding Any breastfeeding Closely spaced pregnancies Source: All WIC participants ( ) LAC is divided into 8 SPAs. ZIP codes are assigned to each LAC SPA. Birthweight less than 5 pounds, 8 ounces (2,500 grams). Infant born at less than 37 weeks gestation. Mother reports fully breastfeeding and does not receive any formula from WIC for her infant (birth to 12 months). Mother reports fully breastfeeding OR reports any breastfeeding and receives a limited supply of formula from WIC for her infant (birth to 12 months). Conception before 16 months postpartum. Note: The following descriptive terms and race/ethnicity categories are used in the tables and text in this report. They were standardized for consistency and based upon the following ISIS classifications: Asian describes persons having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Black describes persons having origins in the black racial groups of Africa. Hisp. En (Hispanic English) describes persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin regardless of race whose preferred language is English. Hisp. Sp (Hispanic Spanish) describes persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin regardless of race whose preferred language is Spanish. White describes Caucasian individuals who are non-hispanic, and persons having origins in any of the original peoples of Europe, North Africa, or the Middle East. Persons reporting to be of American Indian, Alaskan Native, Pacific Islander, or two or more races, did not have sufficient numbers to be included in the race/ethnicity breakdowns provided in this report. 4 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

7 Methods WIC Administrative Data are obtained from the Integrated Statewide Information System (ISIS) for all WIC participants in California. As previously stated, the seven local agency WIC Programs in LAC and the California WIC Program entered into an agreement to create an aggregate LAC WIC dataset for all WIC participants served in March of every year. March was selected as it is a long month with no closures due to holidays, resulting in high levels of stable WIC participation. Protection of client confidentiality was central in the data sharing agreements, recognizing that at no time could confidential client information be shared outside of the partnership. After receiving the yearly March data downloads from the State, the WIC Administrative Data are geocoded with a matching success rate of about 92%, and made available to users on the platform. On this platform, the Administrative Data can be queried by multiple geographies, including County, Service Planning Area, City, ZIP, Census Tract or any user-created geography within LAC. Any indicator with fewer than 5 participants, which happens most often when looking at very small geographies or high-income neighborhoods with few WIC participants, is suppressed to protect client confidentiality. (See User s Guide on page 42 for instructions.) Table 2 shows selected demographic characteristics for all WIC participants based on the WIC Administrative Data used in this report. Throughout the report all WIC Administrative Data are presented with headings in blue. TABLE 2 Demographic Characteristics of WIC Participants, Los Angeles County (2009) Number Percentage Total Participants 598,504 Total Women 1 3 1, Total Infants (birth to 12 months) 1 1 1, % Total Children (1 5 years) 354, % Child Age Infants 1 1 1, % 1 year 105, % 2 years 90, % 3 years 80, % 4 years 74, years* 3,600 <1. *Five year old children receive WIC services only in the month of their 5th birthday Race/Ethnicity Asian 25, % Black 42, % Hispanic-English 212, % Hispanic-Spanish 289, % White (non-hispanic) 23, % Other 5, Education (total years completed) <8 years 96, % 8-11 years 130, % 12 years 133, % >12 years 50, % Income relative to Poverty Level <10 275, % % 68, % >133% 67, % Source: All WIC participants ( ) WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 5

8 Methods The Los Angeles County WIC Survey The Los Angeles County WIC Survey is a periodic telephone survey that provides in-depth information about the health of women and children, parenting practices, early care and education, and home and community environments. It is conducted among a randomly-selected sample of pregnant and breastfeeding mothers and mothers of children up to their fifth birthday who are enrolled in WIC. The LAC WIC Survey was first conducted in 2005 (n=5,015) and again in 2008 (n=4,998). Data in this report are primarily based upon data collected from the 2008 WIC Survey; brief reports of the 2005 Survey data are available at The survey was designed and commissioned by PHFE WIC and conducted by Field Research Corporation (Field), an independent public opinion research organization. Approval was granted by the Institutional Review Board. Table 3 shows the data elements that are included in this report. Most of the indicators are presented by race/ethnicity and by the County s eight Services Planning Areas or SPAs. (See page 46 for a map of the SPAs in LAC.) TABLE 3 Data Elements from Los Angeles County WIC Survey (2008) Demographics Feeding/nutrition Health and health care Maternal mental health Early care and education Home environment and parenting Community environment Child age, race/ethnicity; adult preferred language and educational attainment. Breastfeeding; healthy food intake (fruits and vegetables, milk); unhealthy food intake (soda, fast food); food sufficiency. Child s health status; health insurance coverage; visits to dentist; developmental concerns. Self-reported depressive symptoms; level of concern about symptoms and support seeking behaviors. Preschool enrollment; child care and type of child care used. Reading to child; books in home; visits to library with child; praise and show of affection. Ties to neighborhood; use of local parks and libraries. Note: Specific information about data elements are provided in the body of the report. Several steps were implemented to maximize participation, assure the representativeness of the sample, and protect the confidentiality of WIC participants in the WIC Survey. A random sample was drawn from a download of all WIC participants in LAC provided by the California WIC Program in January This sample was then augmented with randomly-selected WIC participants from the less populated Antelope Valley Service Planning Area (SPA 1) to obtain a sample large enough to support analyses for that SPA. All selected WIC participants received a postcard from PHFE WIC informing them about the survey in advance of the telephone call, and were provided a phone number to call for more information. Participants were contacted by Field using auto-dialers and then transferred to interviewers with the telephone number masked to the interviewer as a means of protecting the confidentiality of each respondent. Interviewers were only provided with the first name of the participant being called. All interviews were conducted in English or Spanish by trained interviewers using Computer Assisted Telephone Interviewing (CATI) software. Up to sixteen attempts were made to reach and interview eligible respondents from each telephone listing dialed. On the last attempt, an 800 number was provided (on voice mail when available) for participants to call back to participate in the survey. 6 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

9 Methods For the 2008 WIC Survey, 5,005 respondents completed the interview (seven participants were later excluded because they lived outside LAC boundaries producing a valid sample of 4,998) for a total cooperation rate of 90.3%. This cooperation rate is computed using the standard measure of household-level cooperation American Association for Public Opinion Research s (AAPOR s) cooperation rate 1 (COOP1), or minimum cooperation rate. All participants who completed the survey received thank you letters and a $10 gift card in appreciation. Table 4 describes the demographic characteristics of the sample of WIC participants responding to the 2008 WIC Survey. Throughout this report all WIC Survey Data are presented with headings in green. TABLE 4 Demographic Characteristics of Los Angeles County WIC Survey Respondents (2008) Number Percentage Total Participants * 4,998 Child Age Infants (birth to 12 months) 1, % Children age 1 1, % Children age % Children age % Children age % Children age 5 ** % Race/Ethnicity Asian*** % Black % Hispanic-English 1, % Hispanic-Spanish 3, % White (non-hispanic) % Other % Education (total years/levels completed) <9yrs 1, % 9-12 yrs (not high school graduate) 1, High school graduate 1, % Some college % College graduate or post graduate % (Did not answer) % * Total sample includes parents of 4,830 infants and children plus 168 pregnant women ** Five year old children receive WIC services only in the month of their 5th birthday. *** Asian respondents were those able to complete the survey in English. WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 7

10 Section 1: Feeding and Nutrition 8 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

11 Section 1: Feeding and Nutrition TABLE 1.1 Indicators: Feeding and Nutrition Overweight/obesity Any breastfeeding (birth to 12 months) Full breastfeeding (birth to 12 months) Percentage of 3 and 4 year olds who are obese a Body Mass Index (BMI) at or above the 95th percentile for their age and gender. BMI is defined as a function of weight and height where BMI = (weight in pounds x 703)/(height in inches 2 ). Women presumed to be fully breastfeeding (received no formula from WIC) or combination breastfeeding and formula feeding (received fewer than 5 cans of formula per month from WIC, depending on age). Women presumed to be fully breastfeeding (received no formula from WIC). Breastfeeding at birth, Percentage of women who report breastfeeding their infants at birth, 2 months, 2, 6, and 12 months 6 months and 12 months. Includes fully breastfeeding and combination feeding. Intention to breastfeed Postpartum hospital experiences related to breastfeeding Healthy food intake Unhealthy food intake Food sufficiency/worries Percentage of women who, while still pregnant, knew that they would breastfeed their infant; thought they might breastfeed; knew they would not breastfeed; or had no plan for how they would feed their infant. While in the hospital after delivering their baby, the percentage of women who reported receiving free infant formula samples; staying in the hospital room with their newborn; and receiving a phone number to call for information or support about breastfeeding. Fruit and vegetable intake: Number of servings of fruits and vegetables eaten by children (6 months to 5 years) on a typical day. Milk intake: Number of times per day that the child drinks any kind of milk. Percentage of children (6 months to 5 years) who drink soda or sugar-sweetened drinks on a typical day. Percentage of children that ate meals or snacks at a fast food restaurant in a typical week. Percentage of families that had enough food, had enough food but not the kind they wanted, and did not have enough food. Data source: Blue = All WIC participants ( ); Green = WIC Survey (2008) WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 9

12 Section 1: Feeding and Nutrition Childhood Obesity Obesity among 3 year olds increased steadily for all racial/ethnic groups, with the exception of Asian children a rate of about 1% annually from Rates of obesity were significantly higher in Hispanic children as compared to other race/ ethnicities. FIGURE 1.1 Obesity among 3 year olds by race/ethnicity ( ) 25% 2 15% 1 5% Asian Black Hispanic En Hispanic Sp White Asian Black Hisp. En Hisp. Sp White TOTAL % 1 7.3% 1 7.4% % % 11. 1% 18.8% 18.2% 13.4% 17.4% % 11.3% 19.8% 19. 1% 13.9% 18.2% % 12.3% 20.5% 20.5% 15.3% 19.4% % 11.6% 20.7% 20.8% 14. 1% 19.6% % 13.3% 21.7% 22.5% % 13.3% % Source: All WIC participants ( ) Similarly, obesity among 4 year olds increased steadily for all groups, with the exception of Asian children, from FIGURE 1.2 Obesity among 4 year olds by race/ethnicity ( ) 25% 2 15% 1 5% Asian Black Hispanic En Hispanic Sp White Note: BMI for children is plotted on the CDC BMI-forage growth charts (for either girls or boys) to obtain a percentile ranking. The data presented here reflect the proportion of 3 and 4 year olds in WIC whose BMI was at or above the 95th percentile for their age and gender. BMI formula is defined in Table Asian Black Hisp. En Hisp. Sp White TOTAL % 11.4% 1 7.9% 1 8.4% 13.7% 1 7.2% % 13.2% 20. 1% % % 14.2% 21.3% % 19.9% % 13.7% 21.2% 22.2% 15.4% 20.8% % 21.9% 22.6% 14.2% 21.2% % 15.2% 22.5% 23.6% 16.3% 22. 1% % 22.8% 24.2% 15.4% 22.4% Source: All WIC participants ( ) 10 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

13 Section 1: Feeding and Nutrition Breastfeeding FIGURE 1.3 Infants (birth to 12 months) that were breastfed (any) by race/ethnicity ( ) 75% 6 45% 3 15% Asian Black Hispanic En Hispanic Sp White The proportion of infants that were breastfed increased markedly for all race/ ethnicities from to a total of 64% overall. Largest percentage increases were noted among Asians and English-speaking Latinas. These data reflect breastfeeding practices of mothers of all infants (birth to 12 months) served by WIC in March of each year Asian Black Hisp. En Hisp. Sp White TOTAL % % 61.2% 55.3% % 45.3% 38.6% 62.3% 52.5% % % 60.5% % % 51.2% 43.4% 65.9% 54.2% 62.3% % 45.5% 66.9% 64.5% 64.4% % 51.7% 50. 1% 68.2% 64.6% 64.3% % 48.8% 56.2% 70.3% 64. 1% 64. Source: All WIC participants ( ) FIGURE 1.4 Infants (birth to 12 months) that were fully breastfed by race/ethnicity ( ) Asian Black Hispanic En Hispanic Sp White Note: Any breastfeeding refers to infants (less than 12 months of age) who were fully breastfed (received no formula from WIC) or combination breastfed and formula-fed (received fewer than 5 cans of formula per month). The proportion of infants that were fully breastfed was relatively low, ranging from 18.1% among Asians to 27.7% of Spanish-speaking Hispanics in However, rates of infants fully breastfed increased for all race/ ethnicities from Asian Black Hisp. En Hisp. Sp White TOTAL % 15.6% 1 1.7% 23. 1% 28.6% 16.3% % 11.6% 9.8% 20.7% 21.9% % 14. 1% 9.8% 20. 1% 29.3% 14.2% % 13. 1% 1 1.9% 22.9% % % % 25.8% 36.4% 16.3% % 15.6% 15.3% 26.9% 33.6% 18. 1% % 18.2% 21.3% 27.7% 42.7% 21.6% Source: All WIC participants ( ) Note: Fully breastfed infants (less than 12 months of age) are defined as infants that received no formula from WIC. WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 11

14 Section 1: Feeding and Nutrition While a large proportion of infants were breastfed at birth, the proportion breastfed for 2 months, 6 months, and 12 months declined markedly. The most precipitous declines occurred among White, Asian, and Black women. FIGURE 1.5 Infants that were breastfed at birth and at 2, 6, and 12 months of age by race/ethnicity (2008) Asian Black Hispanic En Hispanic Sp White Birth 2 months 6 months 12 months Note: Self-reported breastfeeding includes fully breastfeeding and combination breast/formula feeding. Birth 2 months 6 months 12 months Asian 89.9% 68.4% 47.2% 27.9% Black 80.5% 54.2% 32.2% 1 7. Hispanic En 84.1% 58.9% 36.2% 20.9% Hispanic Sp 89.3% 76.8% 59.5% 39.1% White 88.4% 60.8% 40.9% 32.7% Total 87.7% 71.4% 52.8% 34. 1% Women across the County initiated breastfeeding at similar levels, although women in SPAs 4 and 5 were most likely to continue to breastfeed to 6 months. FIGURE 1.6 Infants breastfed at birth and at 6 months of age by SPA (2008) Birth 6 months SPA 1 SPA 2 SPA 3 SPA 4 SPA 5 SPA 6 SPA 7 SPA 8 Note: Self-reported breastfeeding includes fully breastfeeding and combination breast/formula feeding. Birth 6 months SPA % 48.6% SPA % 52.8% SPA % 49.6% SPA % 61.7% SPA % 64.4% SPA % 50.7% SPA % 50.5% SPA % 53.3% 12 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

15 Section 1: Feeding and Nutrition FIGURE 1.7 Intention to breastfeed thoughts about breastfeeding while pregnant (2008) Would breastfeed Might breastfeed Would not breastfeed No plan A woman s intentions while pregnant about whether or not to breastfeed is an important predictor of breastfeeding initiation and duration. The proportion of women who knew they would breastfeed ranged from 55% among Black women to 71% among Hispanic Spanish-speaking women. Asian Black Hispanic En Hispanic Sp White Would Might Would not No breastfeed breastfeed breastfeed plan Asian Black Hispanic En Hispanic Sp White TOTAL 68.4% 17.2% % TABLE 1.2 Postpartum hospital experiences related to breastfeeding (2008) You were given free infant formula samples in the hospital 85.4% Your baby stayed in the same room with you in the hospital 80.4% In spite of the strong evidence of the health benefits of breastfeeding for infants and mothers, 85% of women reported receiving free infant formula samples in the hospital. You were given phone number(s) to call for breastfeeding information/help 78.5% WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 13

16 Section 1: Feeding and Nutrition Child Nutrition Healthy food intake is represented by the average number of servings of fruits and vegetables eaten and the average number of times a child drinks milk each day. Overall, children eat 5.2 servings of fruits and vegetables and drink milk 3 times per day. FIGURE 1.8 Healthy food intake: Consumption of fruits and vegetables and milk by children on a typical day by race/ethnicity (2008) Servings of fruits and vegetables per day Times child drinks milk per day Asian Black Hispanic En Hispanic Sp White Consumption of fruits and vegetables and milk by child age (2008) Servings of fruits and vegetables per day Times child drinks milk per day 6m 2 years 3 5 years Consumption of fruits and vegetables and milk by SPA (2008) Servings of fruits and vegetables per day Times child drinks milk per day SPA 1 SPA 2 SPA 3 SPA 4 SPA 5 SPA 6 SPA 7 SPA 8 Note: Included are children age 6 months to 5 years. 14 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

17 Section 1: Feeding and Nutrition FIGURE 1.9 Unhealthy food intake: Consumption of any soda/sugar-sweetened drinks and fast food by race/ethnicity (2008) 6 45% 3 15% 28% 21% 28% 38% 13% % Children who drink soda on a typical day 47% 48% 47% 39% 27% % Children who eat fast food in a typical week Asian Black Hispanic En Hispanic Sp White Unhealthy food intake is represented by the proportion of children that drink soda or sugar-sweetened drinks on a typical day, and the proportion of children who eat fast food once per week or more often. Overall, one-third (34.3%) of children drank soda or sugarsweetened drinks in a typical day. Forty-seven percent (47%) of children ate fast food in a typical week. Consumption of any soda/sugar-sweetened drinks and fast food by child age (2008) 58% 6 45% 3 15% 29% 43% 39% 6m 2 years 3 5 years % Children who drink soda on a typical day % Children who eat fast food in a typical week Consumption of any soda/sugar-sweetened drinks and fast food by SPA (2008) 6 45% 3 15% 35% 36% 34% 34% 19% 38% 36% 29% % Children who drink soda on a typical day 42% 47% 51% 48% 45% 47% 46% 38% % Children who eat fast food in a typical week SPA 1 SPA 2 SPA 3 SPA 4 SPA 5 SPA 6 SPA 7 SPA 8 Note: Included are children age 6 months to 5 years. WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 15

18 Section 1: Feeding and Nutrition Food Sufficiency/Worries Nearly 9% of WIC survey respondents reported that their family did not have enough food, and for the vast majority this was due to lack of money. TABLE 1.3 Percentage of families with sufficient/insufficient food with reasons (2008) Family had enough food 68.2% Family had enough food, but not the kind they wanted 22.7% Because of money 63.4% Because food was not available 29. Family did not have enough food 8.9% Because of money WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

19 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 17

20 Section 2: Health of Women and Children 18 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

21 Section 2: Health of Women and Children TABLE 2.1 Indicators: Health of Women and Children Conditions of pregnancy and birth Women with closely spaced pregnancies Premature birth Low birthweight Conception before 16 months postpartum. Infants born at less than 37 weeks gestation. Birthweight less than 5 pounds 8 ounces (2,500 grams). Health in early childhood Health insurance coverage Dental care General health status Developmental concerns Children currently covered by health insurance. Children 2 years and older who ever visited the dentist. Children whose parents report their child s health to be poor or fair. Other choices included excellent, very good or good. Children whose parents mention any concern about child s development, type of concern, and whether that concern is big or small. Maternal mental health Depressive symptoms Support seeking for depressive symptoms Mothers who report having depressive symptoms (depressed, crying spells or feeling sad or lonely) while pregnant, after child was born through age 6 months, and at age 6 months to 2 years. Being bothered by any depressive symptoms (mild or severe) and corresponding support seeking behaviors. Data source: Blue = all WIC participants ( ); Green = WIC Survey (2008) WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 19

22 Section 2: Health of Women and Children Conditions of Pregnancy and Birth The percentage of women with closely spaced pregnancies has increased slightly for all race/ethnicities. Rates were highest among Black and White women. FIGURE 2.1 Women with closely spaced pregnancies by race/ethnicity ( ) 25% 2 15% 1 5% Asian Black Hispanic En Hispanic Sp White Note: A subsequent pregnancy that occurs before 16 months postpartum is defined as closely spaced. Asian Black Hisp. En Hisp. Sp White TOTAL % 22.9% 20.2% 16.6% 22.3% 18.5% % 22.5% 20.8% 16.6% 22. 1% 18.6% % 21.8% % % % 22.5% 21. 1% 16.6% 23.5% 18.9% % 22.4% 21.2% 17.2% 23.7% 19.2% % 22.3% 21.6% 17.9% 23.4% 19.7% % 23.7% 21.4% 18.3% 23.7% 20.1% Source: All WIC participants ( ) The percentage of infants that were born prematurely increased slightly for all race/ ethnicities. Rates were highest among Black infants. FIGURE 2.2 Premature births by race/ethnicity ( ) 1 8% 6% 4% 2% Asian Black Hispanic En Hispanic Sp White Note: A birth at less than 37 weeks gestation is defined as premature. Asian Black Hisp. En Hisp. Sp White TOTAL % 8.8% 5.7% 4.4% 6.9% 5.4% % % 6.8% 5.7% % 9.4% 6.3% 4.8% 7.4% 5.9% % 9.6% 6.8% 5.3% 7.7% 6.3% % 9.3% 6.8% 5.2% 6.8% 6.2% % 8.7% 6.7% 5. 1% 7.7% 6. 1% % 9.9% 6.6% 5.2% 7.3% 6.3% Source: All WIC participants ( ) 20 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

23 Section 2: Health of Women and Children FIGURE 2.3 Low birth weight by race/ethnicity ( ) 1 8% 6% 4% 2% Asian Black Hispanic En Hispanic Sp White The proportion of low weight births among WIC participants stayed fairly flat over the observed period and was higher overall for Black infants Asian Black Hisp. En Hisp. Sp White TOTAL % 8.9% 4.9% 4. 1% 6. 1% % 9.6% 5.2% 4.3% 5.6% 5.2% % 9.2% 5. 1% 4.3% 5.8% 5.2% % 5.3% 4.6% 5.2% 5.3% % 9.3% 5.6% 4.5% 5.8% 5.4% % 9.5% 5.4% 4.5% 6. 1% 5.4% % 9.2% 5.2% 4.4% % Source: All WIC participants ( ) Note: A weight of less than 5 pounds 8 ounces (2,500 grams) is defined as low birth weight. WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 21

24 Section 2: Health of Women and Children Health in Early Childhood Health Insurance Coverage Overall, 93.2% of WIC children ages birth through 4 years were covered by some type of health insurance in 2008; coverage rates were similar for children of all ages and race/ethnicities. FIGURE 2.4 Children with health insurance coverage by age (2008) % 93.3% 93.2% 93.7% 93. Health Insurance 4 2 Age < 1 year Age 1 year Age 2 years Age 3 years Age 4 years Children with health insurance coverage by race/ethnicity (2008) % 91.8% 93.8% 93.1% 92.6% Asian Black Hispanic En Hispanic Sp White % Health insurance coverage Children with health insurance coverage by SPA (2008) Note: Current health insurance coverage was reported by WIC survey participants and included any kind of health care plan % 94.3% 92.2% 92.3% 93.2% 93.2% % % Health insurance coverage SPA 1 SPA 2 SPA 3 SPA 4 SPA 5 SPA 6 SPA 7 SPA 8 22 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

25 Section 2: Health of Women and Children Dental Care FIGURE 2.5 Children 2 years and older that have ever visited the dentist by race/ethnicity (2008) Overall, 60.2% of children age 2 and older in WIC have visited the dentist. 75% 6 45% 3 15% 59.1% 58.7% 55.1% 61.7% 48.6% Asian Black Hispanic En Hispanic Sp White % Visited dentist Children 2 years and older ever visited the dentist by SPA (2008) 75% 68.8% % 61.7% 61.7% % 55.3% 56.8% 45% 3 15% % Visited dentist SPA 1 SPA 2 SPA 3 SPA 4 SPA 5 SPA 6 SPA 7 SPA 8 Note: Among those children age 2 and older with a dental visit, for most (85%) the reason provided was a routine checkup or cleaning. WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 23

26 Section 2: Health of Women and Children General Health Status of Child The percentage of children reported as being in fair or poor health was 6.1% overall, with the highest rates among Spanish-speaking Hispanics (8.1%) and Asians (5.1%). This same indicator ranged from 4.3% in SPA 1 to 8.6% in SPA 3. Note: Parent-reported health status is a proxy for health-related quality of life (HRQoL) based on a single item response. Lower levels of HRQoL using more fully developed indices of health related quality of life in children are correlated with medical conditions and their impact/severity (e.g., asthma, overweight), unmet medical needs (e.g., no health insurance) and lower socio-economic status (e.g., poverty, parental educational attainment). (Simon et al., 2008) FIGURE 2.6 Children ages birth to 5 years in fair or poor health as reported by parent by race/ethnicity (2008) 1 8% 6% 4% 2% Children ages birth to 5 years in fair or poor health by SPA (2008) 1 8% 6% 4% 2% 5.1% 4.3% 4.5% 1.1% 1.5% % Fair or poor health 8.6% 8.1% 7.1% 7.1% 6.9% 7.5% % Fair or poor health 4.7% Asian Black Hispanic En Hispanic Sp White SPA 1 SPA 2 SPA 3 SPA 4 SPA 5 SPA 6 SPA 7 SPA 8 24 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

27 Section 2: Health of Women and Children Developmental Concerns FIGURE 2.7 Any developmental concerns, as reported by a parent, by child age (2008) Age 1 through 2 years 48.5% Age 3 to 5 years 54.8% Any developmental concerns by race/ethnicity (2008) 75% 6 45% 3 15% 60.7% 48.9% 50.4% 51.6% 47.5% Asian Black Hispanic En Hispanic Sp White Overall 51.4% of parents of children age 1 to 5 years old expressed having a concern about their child s development. Nearly 49% of parents of children 1 through 2 years and 55% of parents of children 3 to 5 years expressed having a concern about their child s development. % Developmental concerns Any developmental concerns by SPA (2008) 75% % 53.2% 49.9% 54.2% 49.9% 52.7% 50.2% 45% 3 15% % Developmental concerns SPA 1 SPA 2 SPA 3 SPA 4 SPA 5 SPA 6 SPA 7 SPA 8 Note: Includes children 1 to 5 years of age. The American Academy of Pediatrics states that early identification of developmental disorders is critical to the well-being of children and their families and an integral function of the primary care medical home. The eliciting parent concerns and the use of good quality assessment tools by health care professionals are effective means of identifying developmental problems, and are recommended at routine well-child visits. (See p. 41 for citation.) WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 25

28 Section 2: Health of Women and Children Those concerns most often mentioned included social and emotional development (how well child gets along with others and feelings/moods), cognitive development (how well child understands or learns), and speech (making sounds and words). TABLE 2.2 Specific developmental concerns mentioned and whether that concern is big or small (2008) Big Small Area Specific concern problem problem Speech: How child makes sounds (less than 15 months) 1.9% 10.4% How child talks/makes words (15 months or older) 3.9% 17. Sensory: How well child can see or hear 0.4% 2.5% Social: How child gets along with others 1.5% 18.7% Emotional: Child s feelings/moods 1.9% 15.4% Note: The extent of parent concerns are an important indicator for the need for early developmental screening and educational/developmental services. (See p. 41, AAP.) General: How child is learning to do things for him/her self % Whether child can do what other kids his/her age can do 1.4% 7.7% Cognitive: How well child understands what parent says 1.5% 14.5% How child is learning preschool or school skills 1.1% 1 3.5% 26 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

29 Section 2: Health of Women and Children Maternal Mental Health FIGURE 2.8 Maternal depressive symptoms while pregnant and after birth, by child age (2008) 25% 2 15% 1 5% % 12.9% % Depressive symptoms Prenatal Infant age birth to 6 months Child age 6 months to 2 years Nearly 2 of mothers enrolled in WIC experienced depressive symptoms prenatally; nearly 13% reported experiencing such symptoms after the child was born up to 6 months post partum, and 13% when the child was 6 months up to 2 years. Overall, 13.1% of mothers experienced depressive symptoms. FIGURE 2.9 Maternal depressive symptoms by race/ethnicity (2008) 15% 12% 9% 6% 3% 10.1% 13.2% % % Depressive symptoms 11.6% Asian Black Hispanic En Hispanic Sp White Depressive symptom measures included feelings of depression, feelings of lonliness, crying spells and feelings of sadness. Respondents were classified as having depressive symptoms based on a point score >8 depending upon how frequently or how severely they experienced the 4 symptom measures. For example, a respondent classified as having depressive symptoms (>8 points) could either experience ALL symptoms some of the time or 2 symptoms most of the time. TABLE 2.3 Any mention of a depressive symptom and support seeking behaviors (2008) Among those women who mentioned having any depressive symptoms, 15% talked to no one about their feelings. Talk to no one 1 5.2% Talk to a doctor/mental health professional 21.2% Talk to others (e.g., friends/family) 63.6% WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 27

30 Section 3: Early Care and Education 28 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

31 Section 3: Early Care and Education TABLE 3.1 Indicators: Early Care and Education Parental educational attainment Preschool enrollment Child care use Reasons for not using child care Percentage of adult WIC participants that completed 12 years of education or more. Percentage of 4 year olds enrolled in preschool and type of preschool (Head Start/ State-sponsored Preschool or other). Proportion of children in child care (child care center, child s home, or someone else s home) and not in child care. Reasons for not using child care (as provided by parents of children not in care). Data source: Blue = All WIC participants ( ); Green = WIC Survey (2008) WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 29

32 Section 3: Early Care and Education Education Completion of 12 years of education among adults receiving WIC services (for themselves or child) stayed relatively flat between 2003 and FIGURE 3.1 Adult WIC participants that completed 12 years of education or more by race/ethnicity ( ) 75% 6 45% 3 15% Asian Black Hispanic En Hispanic Sp White Note: The adult family member that receives WIC services for themselves or their child is most often the mother. Asian Black Hisp. En Hisp. Sp White TOTAL % 70.6% 55.8% 24. 1% % % 69.9% 55.9% % 41.8% % 69.8% 56.6% 25.8% 64. 1% 42.3% % 70.3% 57. 1% 26.5% 68.9% 42.9% % 67.6% 55.6% 26.2% % % 67.7% 55.6% 26.9% 65.8% 42.8% % 68.9% 56.8% 27.9% 67.6% 44.7% Source: All WIC participants ( ) Seventy percent of children participating in WIC were enrolled in preschool. Preschool Enrollment FIGURE 3.2 Children age 4 years enrolled in preschool by type (2008) Other local 24% Not in preschool 3 Note: Approximately twothirds (65%) of those four year olds who attend preschool are enrolled in Head Start or State-sponsored Preschool. Head Start or State-sponsored 46% 30 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

33 Section 3: Early Care and Education FIGURE 3.3 Children age 4 years enrolled in preschool by race/ethnicity (2008) 10 Preschool enrollment among 4 year olds was highest among the Spanish-speaking Hispanic group. Preschool enrollment was highest in SPAs 8 and 4 and lowest in SPA % 58.5% 72. Black Hispanic En Hispanic Sp 2 % Children enrolled in preschool Children age 4 years enrolled in preschool by SPA (2008) % 66.7% 76.4% 65.8% 70.3% 68.6% 77.8% N/A % Children enrolled in preschool SPA 1 SPA 2 SPA 3 SPA 4 SPA 5 SPA 6 SPA 7 SPA 8 Note: The survey sample did not include enough 4 year old children in the Asian and White groups or in SPA 5 to be included. WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 31

34 Section 3: Early Care and Education Child Care Use Overall 32% of children age birth to 5 years are in child care. FIGURE 3.4 Children age birth to 5 years in child care by race/ethnicity (2008) 6 45% 44% 56% 49% 38% Asian Black 3 15% 23% Hispanic En Hispanic Sp White % Children enrolled in child care 32% of children birth to 5 in WIC are in some type of child care. Most often, the child is cared for in another person s home or someone in the child s own home. Note: Total exceeds 10 because respondents could report more than one type of child care arrangement. TABLE 3.2 Children age birth to 5 years in child care (including type) and not in child care (2008) Total percentage of children birth to 5 years in childcare 32% Of those in child care, care is provided by...a child care center 22% someone in another person s home 56% someone in child s own home 34% Total percentage of children birth to 5 years not in child care 68% 32 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

35 Section 3: Early Care and Education TABLE 3.3 Reasons for not using child care, as reported by parents of children birth to 5 years (2008) Parent prefers to stay at home 88% Parent not working 65% Childcare costs too much 29% Parents work different hours 25% Parent works at home 2 Childcare full or unavailable 11 % Transportation problem 11 % Child has disability or special needs 2% The reason most often cited for not using child care is that the mother prefers to stay at home (88%) and/or is not working (65%); 29% say that child care costs too much. Note: Total exceeds 10 because survey repondents could select multiple reasons. WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 33

36 Section 4: Home and Community Environments 34 WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County

37 Section 4: Home and Community Environments TABLE 4.1 Indicators: Home and Community Environments Parent support Percentage of parents who report that it is very easy or somewhat easy to find someone to talk to about child. Parenting practices Frequency of parent praise of child. Frequency of parent shows of affection toward child. Frequency of parent telling others positive things about child. Frequency of parent needing to discipline child. Early literacy practices Daily reading to children: The proportion of children who were read to daily by parent or other family member in the past month. Initiation of reading to child: Percentage of children first read to before age 1 year. Books in the home: Over 10 children s books in the home. Visits to library with child: Whether child has visited a library with a parent or family member in the past month. TV watching above recommended levels Child visits to park or playground to play Percentage of all children who watch 2 or more hours of TV daily. Percentage of children under 2 years who watch any TV. Percentage of children age 2 years or older who watch 2 or more hours of TV daily. How frequently the child visits the park or playground to play at least 3 times/week, 1-2 times/week, or never visits a park or playgound. Housing stability Percentage of parents who report having lived in 3 or more different places during the past 3 years. Neighborhood social environment Percentage of parents reporting that they have strong neighborhood ties. Data source: WIC Survey (2008) WIC Data : A Report on Low-Income Families with Young Children in Los Angeles County 35