WIC Participant and Program Characteristics 2012 Final Report

Transcription

1 WIC Prticipnt nd Progrm Chrcteristics 2012 Finl Report Office of Policy Support Food nd Nutrition Service U.S. Deprtment of Agriculture 3101 Prk Center Drive Alexndri, VA December 2013

2 WIC Prticipnt nd Progrm Chrcteristics 2012 Finl Report December 11, 2013 Authors: Bryn Johnson Betsy Thorn Brittny McGill Alexndr Suchmn Michele Mendelson (Abt) Kelly Lwrence Ptln (Abt) Brin Freemn (Abt) Rebecc Gotlieb (Abt) Ptty Connor (Abt) Submitted to: Office of Policy Support Food nd Nutrition Service U.S. Deprtment of Agriculture 3101 Prk Center Drive Alexndri, VA Submitted by: Insight Policy Reserch 1901 N. Moore Street Suite 204 Arlington, VA This study ws conducted under Contrct No. AG-3198-C with the Food nd Nutrition Service. This report is vilble on the Food nd Nutrition Service Web site t Suggested Cittion: Johnson, B., Thorn, B., McGill, B., Suchmn, A., Mendelson, M., Ptln, K.L., Freemn, B., Gotlieb, R., & Connor, P. (2013). WIC Prticipnt nd Progrm Chrcteristics Prepred by Insight Policy Reserch under Contrct No. AG-3198-C Alexndri, VA: U.S. Deprtment of Agriculture, Food nd Nutrition Service.

3 TABLE OF CONTENTS EXECUTIVE SUMMARY... i THE 2012 REPORT... i THE 2012 WIC PROGRAM... III PARTICIPANT CHARACTERISTICS IN III I. INTRODUCTION... 1 A. PROGRAM OPERATIONS... 2 B. PARTICIPANT BENEFITS... 5 C. ELIGIBILITY FOR WIC BENEFITS... 6 D. PREVIOUS REPORTS ON WIC PARTICIPANT AND PROGRAM CHARACTERISTICS... 7 E. REPORT ON WIC PARTICIPANT AND PROGRAM CHARACTERISTICS F. ORGANIZATION OF THE REPORT II. OVERVIEW OF WIC PARTICIPATION AND DEMOGRAPHICS OF WIC PARTICIPANTS A. ENROLLMENT B. AGE C. TRIMESTER OF ENROLLMENT D. REGION E. RACE AND ETHNICITY III. INCOME OF WIC PARTICIPANTS A. PARTICIPATION IN OTHER BENEFIT PROGRAMS B. HOUSEHOLD SIZE AND INCOME C. POVERTY STATUS IV. NUTRITIONAL RISK CHARACTERISTICS A. NUTRITIONAL RISK CRITERIA B. NUTRITIONAL RISKS BY DEMOGRAPHIC AND ECONOMIC CHARACTERISTICS C. ANTHROPOMETRIC VALUES D. BLOOD MEASURES V. RISK PRIORITY LEVELS A. OVERVIEW OF RISK PRIORITY LEVELS B. RISK PRIORITY LEVELS OF WIC PARTICIPANTS IN C. SHIFTS IN PRIORITY LEVELS BETWEEN 2010 AND VI. BREASTFEEDING OF WIC INFANTS A. BREASTFEEDING INITIATION RATES B. BREASTFEEDING DURATION VII. CHARACTERISTICS OF MIGRANT WIC PARTICIPANTS A. DEMOGRAPHIC CHARACTERISTICS OF MIGRANT WIC PARTICIPANTS B. INCOME OF MIGRANT WIC PARTICIPANTS C. NUTRITIONAL RISK CHARACTERISTICS OF MIGRANT WIC PARTICIPANTS D. PRIORITY LEVELS OF MIGRANT WIC PARTICIPANTS

4 REFERENCES... R-1 APPENDIX A: CHAPTER II SUPPLEMENTAL TABLES...A-1 APPENDIX B: CHAPTER III SUPPLEMENTAL TABLE... B-1 APPENDIX C: CHAPTER VI SUPPLEMENTAL TABLES... C-1 APPENDIX D: CHAPTER VII SUPPLEMENTAL TABLE... D-1 APPENDIX E: SUPPLEMENTAL DATA SET... E-1

5 LIST OF TABLES Chpter I Tble I.1. Tble I.2. Tble I.3. Distribution of Locl WIC Agencies nd WIC Prticipnts by Stte WIC Agency...3 Minimum Dt Set Vribles nd Definitions: Guidnce to Stte WIC Agencies...9 Supplementl Dt Set Vribles nd Definitions: Guidnce to Stte WIC Agencies...12 Chpter II Tble II.1. Tble II.2. Tble II.3. Tble II.4. Percent of Distribution of WIC Prticipnts by Prticipnt Ctegory: 2010, Distribution of WIC Prticipnts by Prticipnt Ctegory: Distribution of Age of WIC Prticipnts t Certifiction by WIC Prticipnt Ctegory: 2008, 2010, Distribution of Pregnnt WIC Prticipnts by Trimester of Enrollment: 2008, 2010, Tble II.5. Distribution of WIC Prticipnts by Region: 2008, 2010, Tble II.6. Tble II.7. Percent Distribution of Rce nd Ethnicity of WIC Prticipnts (2012) nd the U.S. Popultion (2010)...27 Percent Distribution of Rce nd Ethnicity of WIC, Infnts, nd Children: 2010, Tble II.8. Percent Distribution of Ethnicity by Rce of WIC Prticipnts...29 Tble II.9. Percent Distribution of Rce nd Ethnicity of WIC Prticipnts by Prticipnt Ctegory...30 Tble II.10. Percent Distribution of Rce nd Ethnicity of WIC Prticipnts by Region...31 Chpter III Tble III.1. Tble III.2. Tble III.3. Number nd Percent of WIC Prticipnts With Reported Prticiption in Other Progrms t Certifiction...35 Distribution of the Size of Fmilies or Economic Units of WIC Prticipnts by Prticipnt Ctegory...38 Men nd Medin Annulized Fmily or Economic Unit Income of WIC Prticipnts by Prticipnt Ctegory...39

6 Tble III.4. Tble III.5. Averge Annulized Fmily or Economic Unit Income of WIC Prticipnts by Prticipnt Ctegory nd Rce...40 Averge Annulized Fmily or Economic Unit Income of WIC Prticipnts by Prticipnt Ctegory nd Ethnicity...42 Tble III.6. Poverty Sttus of WIC Prticipnts: 2008, 2010, Tble III.7. Tble III.8. Tble III.9. Tble III.10. Tble III.11. Chpter IV Distribution of Income s Percent of Federl Poverty Level of WIC Prticipnts by Prticipnt Ctegory...46 Distribution of Income s Percent of Federl Poverty Level of WIC Prticipnts by Prticipnt Ctegory nd Rce...47 Distribution of Income s Percent of Federl Poverty Level of WIC Prticipnts by Prticipnt Ctegory nd Ethnicity...51 Distribution of Income s Percent of Federl Poverty Level t Certifiction for WIC Prticipnts Reporting No Other Benefit Receipt...53 Comprison of Poverty Levels of WIC Prticipnts to Persons in the U.S. Popultion: Tble IV.1. Brod Ctegories of FNS-Issued Nutritionl Risk Criteri...57 Tble IV.2. Tble IV.3. Tble IV.4. Tble IV.5. Tble IV.6. Tble IV.7. Tble IV.8. Tble IV.9. Tble IV.10. Distribution of Number of Nutritionl Risk Fctors for WIC Prticipnts Reported t Certifiction: 2008, 2010, Number nd Percent of WIC Prticipnts With Specific Nutritionl Risks Reported t Certifiction...63 Number nd Percent of WIC Prticipnts by Prticipnt Ctegory, Age t Certifiction, nd Brod Ctegory of Nutritionl Risk Reported...64 Number nd Percent of Infnt nd Child WIC Prticipnts by Age t Certifiction nd Brod Ctegory of Nutritionl Risk Reported...65 Number nd Percent of WIC Prticipnts by Prticipnt Ctegory With Specific Nutritionl Risks Reported...66 Number nd Percent of Infnt WIC Prticipnts With Specific Nutritionl Risks Reported by Age t Certifiction...67 Number nd Percent of Child WIC Prticipnts With Specific Nutritionl Risks Reported by Age t Certifiction...68 Nutritionl Risks Reported in t Lest 15 Percent of WIC Prticipnts: 2008, 2010, Nutritionl Risks Reported in t Lest 15 Percent of Pregnnt WIC Prticipnts by Age t Certifiction...71

7 Tble IV.11. Tble IV.12. Tble IV.13. Tble IV.14. Tble IV.15. Tble IV.16. Tble IV.17. Tble IV.18. Tble IV.19. Tble IV.20. Tble IV.21. Tble IV.22. Tble IV.23. Tble IV.24. Tble IV.25. Tble IV.26. Tble IV.27. Number nd Percent of Americn Indin or Alsk Ntive Only WIC Prticipnts With Specific Nutritionl Risks Reported by Prticipnt Ctegory...72 Number nd Percent of Asin Only WIC Prticipnts With Specific Nutritionl Risks Reported by Prticipnt Ctegory...74 Number nd Percent of Blck or Africn Americn Only WIC Prticipnts With Specific Nutritionl Risks Reported by Prticipnt Ctegory...76 Number nd Percent of Ntive Hwiin or Other Pcific Islnder Only WIC Prticipnts With Specific Nutritionl Risks Reported by Prticipnt Ctegory...78 Number nd Percent of White Only WIC Prticipnts With Specific Nutritionl Risks Reported by Prticipnt Ctegory...80 Number nd Percent of WIC Prticipnts Reporting Two or More Rces With Specific Nutritionl Risks Reported by Prticipnt Ctegory...82 Number nd Percent of Hispnic/Ltino WIC Prticipnts With Specific Nutritionl Risks Reported by Prticipnt Ctegory...84 Number nd Percent of Not Hispnic/Ltino WIC Prticipnts With Specific Nutritionl Risks Reported by Prticipnt Ctegory...86 Nutritionl Risks Reported in t Lest 15 Percent of Americn Indin or Alsk Ntive Only WIC Prticipnts by Prticipnt Ctegory...88 Nutritionl Risks Reported in t Lest 15 Percent of Asin Only WIC Prticipnts by Prticipnt Ctegory...89 Nutritionl Risks Reported in t Lest 15 Percent of Blck or Africn Americn Only WIC Prticipnts by Prticipnt Ctegory...90 Nutritionl Risks Reported in t Lest 15 Percent of Ntive Hwiin or Other Pcific Islnder Only WIC Prticipnts by Prticipnt Ctegory...91 Nutritionl Risks Reported in t Lest 15 Percent of White Only WIC Prticipnts by Prticipnt Ctegory...92 Nutritionl Risks Reported in t Lest 15 Percent of WIC Prticipnts Reporting Two or More Rces by Prticipnt Ctegory...93 Nutritionl Risks Reported in t Lest 15 Percent of Hispnic/Ltino WIC Prticipnts by Prticipnt Ctegory...94 Nutritionl Risks Reported in t Lest 15 Percent of Not Hispnic/ Ltino WIC Prticipnts by Prticipnt Ctegory...95 Number nd Percent of WIC Prticipnts With Specific Nutritionl Risks Reported t Certifiction by Income s Percent of Federl Poverty Level...96

8 Tble IV.28. Tble IV.29. Tble IV.30. Tble IV.31. Tble IV.32. Tble IV.33. Tble IV.34. Tble IV.35. Tble IV.36. Tble IV.37. Tble IV.38. Tble IV.39. Tble IV.40. Tble IV.41. Tble IV.42. Number nd Percent of Infnt WIC Prticipnts With Specific Nutritionl Risks Reported t Certifiction by Income s Percent of Federl Poverty Level...98 Number nd Percent of Child WIC Prticipnts With Specific Nutritionl Risks Reported t Certifiction by Income s Percent of Federl Poverty Level Number nd Percent of 1-Yer-Old Child WIC Prticipnts With Specific Nutritionl Risks Reported t Certifiction by Income s Percent of Federl Poverty Level Number nd Percent of 2-Yer-Old Child WIC Prticipnts With Specific Nutritionl Risks Reported t Certifiction by Income s Percent of Federl Poverty Level Number nd Percent of 3-Yer-Old Child WIC Prticipnts With Specific Nutritionl Risks Reported t Certifiction by Income s Percent of Federl Poverty Level Number nd Percent of 4-Yer-Old Child WIC Prticipnts With Specific Nutritionl Risks Reported t Certifiction by Income s Percent of Federl Poverty Level Distribution of Infnt WIC Prticipnts According to Selected Anthropometric Mesures: 2008, 2010, Distribution of Infnt WIC Prticipnts by Rce According to Selected Anthropometric Mesures Distribution of Infnt WIC Prticipnts by Ethnicity According to Selected Anthropometric Mesures Number nd Percent of Infnt nd 1-Yer-Old Child WIC Prticipnts t Risk According to FNS-Issued Nutrition Risk Criteri for Anthropometric Mesures Distribution of Child WIC Prticipnts by Age According to Selected Anthropometric Mesures: 2008, 2010, Distribution of Child WIC Prticipnts by Age nd Rce According to Selected Anthropometric Mesures Distribution of Child WIC Prticipnts by Age nd Ethnicity According to Selected Anthropometric Mesures Number nd Percent of Child WIC Prticipnts Age 2 Yers or Older t Risk According to FNS-Issued Nutrition Risk Criteri for Anthropometric Mesures Number nd Percent of Brestfeeding nd Postprtum WIC Prticipnts t Risk According to FNS-Issued Nutrition Risk Criteri for Anthropometric Mesures...122

9 Tble IV.43. Tble IV.44. Tble IV.45. Tble IV.46. Tble IV.47. Tble IV.48. Tble IV.49. Tble IV.50. FNS-Issued Nutrition Risk Eligibility for Hemoglobin nd Hemtocrit Levels Avilbility of Hemtologicl Dt for WIC Prticipnts: Percent of WIC Prticipnts by Prticipnt Ctegory With Specific Types of Hemtologicl Mesures Number nd Percent of WIC Prticipnts Flling Below FNS-Issued Nutrition Risk Criteri for Hemtologic Stndrds Number nd Percent of Child WIC Prticipnts Flling Below FNS-Issued Nutrition Risk Criteri for Hemtologic Stndrds Number nd Percent of Anemic WIC Prticipnts by Prticipnt Ctegory nd Rce Number nd Percent of Anemic WIC Prticipnts by Prticipnt Ctegory nd Ethnicity Number nd Percent of Anemic Child WIC Prticipnts by Age t Time of Blood Mesurement nd Rce Number nd Percent of Anemic Child WIC Prticipnts by Age t Time of Blood Mesurement nd Ethnicity Chpter V Tble V.1. WIC Priorities Tble V.2. Priority of All WIC Prticipnts by Prticipnt Ctegory Tble V.3. Priority of Infnt WIC Prticipnts by Age t Certifiction Tble V.4. Priority of Child WIC Prticipnts by Age t Certifiction Tble V.5. Priority by Prticipnts Ctegory: 2010, Chpter VI Tble VI.1. Tble VI.2. Tble VI.3. Tble VI.4. Brestfeeding Initition Rtes for WIC Infnts nd Children Ages 6 13 Months in April 2012 by Stte Chnges in Brestfeeding Initition Rtes for WIC Infnts in April: Brestfeeding Durtion for WIC Infnts nd Children Ages 6 13 Months in April 2012 by Stte Estimted Brestfeeding Durtion by Stte: Number nd Percent of WIC Infnts nd Children Ages 6 13 Months in April 2012 Brestfeeding for 6 Months or More...151

10 Chpter VII Tble VII.1. Tble VII.2. Tble VII.3. Tble VII.4. Tble VII.5. Tble VII.6. Tble VII.7. Tble VII.8. Tble VII.9. Tble VII.10. Distribution of WIC Prticipnts by Migrnt Sttus nd WIC Certifiction Ctegory Distribution of Migrnt Frmworker WIC Prticipnts by Prticipnt Ctegory nd Age t Certifiction Distribution of Migrnt Pregnnt WIC Prticipnts by Trimester of Enrollment Number nd Percent of Migrnt WIC Prticipnts With Reported Prticiption in Other Progrms t Certifiction Men nd Medin Annulized Fmily or Economic Unit Income of WIC Prticipnts by Prticipnt Ctegory nd Migrnt Sttus Distribution of Income s Percent of Poverty Level of WIC Prticipnts by Prticipnt Ctegory nd Migrnt Sttus Nutritionl Risks Reported in t Lest 15 Percent of Migrnt WIC Prticipnts by Prticipnt Ctegory Number nd Percent of Migrnt WIC Prticipnts With Specific Nutritionl Risks Reported by Prticipnt Ctegory Number nd Percent of Anemic Migrnt WIC Prticipnts by Prticipnt Ctegory Distribution of Infnt nd Child Migrnt WIC Prticipnts According to Selected Anthropometric Mesures Tble VII.11. Priority of Migrnt WIC Prticipnts by Prticipnt Ctegory APPENDICES Appendix A Tble A.II.1. Tble A.II.6. Number nd Percent of WIC Prticipnts by Prticipnt Ctegory by Stte... A-1 Distribution of Rce for WIC Prticipnts Reporting Two or More Rces... A-6 Tble A.II.7b. Distribution of Rcil nd Ethnic Chrcteristics of WIC, Infnts, nd Children: 2008, 2010, A-7 Tble A.II.8. Distribution of Rce nd Ethnicity of WIC Prticipnts... A-9 Tble A.II.9. Distribution of Rce nd Ethnicity of WIC Prticipnts by Prticipnt Ctegory... A-10

11 Appendix B Tble B.III.7. Distribution of Percent of Federl Poverty Level of WIC Prticipnts by Prticipnt Ctegory: 2008, 2010, B-1 Appendix C Tble C.VI.1. Tble C.VI.3. Tble C.VI.4. Tble C.VI.5. Brestfeeding Initition Rtes for WIC Infnts Ages 7 11 Months in April 2012 by Stte...C-1 Chnges in Brestfeeding Initition Rtes for WIC Infnts Ages 7 11 Months in April, C-12 Brestfeeding Durtion for WIC Infnts Ages 7 11 Months in April 2012 by Stte...C-13 Estimted Brestfeeding Durtion by Stte: Number nd Percent of WIC Infnts Ages 7 11 Months in April 2012 Brestfeeding for 6 Months or More...C-16 Appendix D Tble D.VII.1. Distribution of Migrnt WIC Prticipnts by Stte... D-1 Appendix E Tble E.1. Sttes Reporting Supplementl Dt Set Items... E-1 Tble E.2. Tble E.3. Distribution of Birth Weights for Infnt nd Child WIC Prticipnts by Stte... E-3 Distribution of Birth Weights for Infnt nd Child Migrnt WIC Prticipnts by Stte... E-6 Tble E.4 Men Birth Weight in Grms of WIC Infnts by Rce by Stte... E-8 Tble E.5. Men Birth Weight in Grms of WIC Infnts by Ethnicity by Stte... E-18 Tble E.6. Men Birth Weight in Grms of WIC Children by Rce by Stte... E-27 Tble E.7. Men Birth Weight in Grms of WIC Children by Ethnicity by Stte... E-36 Tble E.8. Tble E.9. Tble E.10. Tble E.11. Length of Enrollment in WIC for WIC Prticipnts for Most Recent Pregnncy From First WIC Certifiction to April 30, 2012 by Prticipnt Ctegory by Stte... E-43 Length of Enrollment in WIC for Infnt nd Child WIC Prticipnts From First WIC Certifiction to April 30, 2012 by Age nd by Stte... E-57 Yers of Eduction Reported by WIC Prticipnts by Prticipnt Ctegory by Stte... E-72 Distribution of Totl Number of Pregnncies for Pregnnt WIC Prticipnts by Stte... E-82

12 Tble E.12. Tble E.13. Tble E.14. Tble E.15. Tble E.15b. Tble E.16. Tble E.17. Tble E.18. Distribution of Totl Number of Live Births for Pregnnt WIC Prticipnts by Stte... E-85 Short Stture t Birth Among WIC Infnts nd Children by Stte: Number nd Percent t or Below Fifth Percentile for Birth Length... E-88 Number of Household Members Receiving WIC Benefits by Prticipnt Ctegory by Stte... E-91 Pre-Pregnnt Body Mss Index (BMI) for Pregnnt WIC by Stte: Weight Ctegories in Effect Prior to Revision 10 to the Nutrition Risk Criteri... E-102 Pre-Pregnnt Body Mss Index (BMI) for Pregnnt WIC by Stte: Weight Ctegories s Defined in Revision 10 to the Nutrition Risk Criteri... E-106 Men Weight Gin During Pregnncy for WIC Mothers by Rce by Stte... E-109 Men Weight Gin During Pregnncy for WIC Mothers by Ethnicity by Stte... E-119 Lpsed Time in Months Between Lst nd Current Pregnncies for Pregnnt WIC Prticipnts by Stte... E-126

13 LIST OF FIGURES Executive Summry Figure E.1. Figure E.2. Figure E.3. Figure E.4. Figure E.5. Numbers of WIC Prticipnts by Ctegory nd Age of Children, April iii Distribution of Individuls Enrolled in the WIC Progrm... iv Comprison of Poverty Levels of WIC Prticipnts Reporting Income to Persons in the U.S. Popultion... vi Distribution of Migrnt WIC Prticipnts by Stte, April viii Brestfeeding Initition Rtes by Stte for WIC Infnts Ages 6 13 Months in April, ix Chpter I Figure I.1 WIC Enrollment, April Chpter II Figure II.1. Totl WIC Prticipnts: Figure II.2. Distribution of Rce nd Ethnicity of WIC Prticipnts...24 Chpter III Figure III.1. Percent of WIC Prticipnts With Reported Prticiption in Other Progrms t Certifiction: 2008, 2010, Chpter VII Figure VII.1. Distribution of Migrnt WIC Prticipnts by Stte, April Figure VII.2. APPENDICES Appendix A Percent of U.S. nd Migrnt WIC Prticipnts With Reported Prticiption in Other Progrms Figure A.II.7. Distribution of Rcil nd Ethnic Chrcteristics of WIC Prticipnts: A-8 Appendix C Figure C.VI.2. Brestfeeding Initition Rtes by Stte for WIC Infnts Ages 7 11 Months in April, C-4

14 ACKNOWLEDGMENTS This report ws prepred by Insight Policy Reserch, Inc. (Insight) under Contrct Number AG-3198-C from the U.S. Deprtment of Agriculture, Food nd Nutrition Service. It represents tem effort in which mny individuls mde key contributions in ddition to the uthors. We grtefully cknowledge their ssistnce. In prticulr, we would like to recognize Jnis Johnston, Project Officer, for her ledership nd guidnce. We would lso like to thnk the numerous FNS stff who hve provided support, expert dvice, nd encourgement to the Insight tem. Their insightful comments on the interim deliverbles nd throughout the study gretly improved this reserch. The uthors would lso like to express our pprecition to the representtives in ech of the 90 Stte WIC gencies tht prticipted in the PC2012. Through the efforts of these dedicted individuls, we obtined complete nd ccurte dt files within shorter dt collection period thn ws previously performed. The uthors would like to cknowledge numerous individuls from Insight nd Abt Assocites, Inc. (Abt) who provided vluble ssistnce throughout this study. In prticulr, we would like to thnk Nicole Trsi (Insight), Jonthn Jckson (Insight), nd Molly Jcobs (Insight), whose work with the dt clening nd editing ws invluble. Don Lliberty s (Abt) progrmming expertise ws essentil to the comprehensive nlysis of these dt. We would lso like to thnk Dr Hddix (Insight) for editing this report nd Pul Downs (Insight) for her ssistnce with formtting. Anne Peterson (Insight), Susn Brtlett (Abt), Stéphne Bldi (Insight), Alise Ncson (Insight), nd Meg Tucker (Insight) ll provided useful suggestions on the content of this report.

15 WIC Prticipnt nd Progrm Chrcteristics: 2012 Finl Report EXECUTIVE SUMMARY The Specil Supplementl Nutrition Progrm for, Infnts, nd Children (WIC) is dministered by the Food nd Nutrition Service (FNS) of the U.S. Deprtment of Agriculture (USDA). WIC benefits include nutritious supplementl foods; nutrition eduction; counseling, including brestfeeding promotion nd support; nd referrls to helth cre, socil service, nd other community providers for pregnnt, brestfeeding, nd postprtum women, infnts, nd children up to the ge of 5 yers. 1 For women nd their unborn children, WIC seeks to improve fetl development nd reduce the incidence of low birth weight, short gesttion, nd nemi through intervention during the prentl period. For infnts nd children, WIC seeks to provide nutritious foods during criticl times of growth nd development in n effort to prevent helth problems nd to improve the helth sttus of these children. To receive WIC benefits, n individul must be ctegoriclly eligible: pregnnt, brestfeeding, or postprtum womn; n infnt up to the ge of 1 yer; or child ge 1 through his or her fifth birthdy. In ddition, ech pplicnt must be found to be income eligible nd t nutritionl risk. Eligible pplicnts receive supplementl food, usully in the form of vouchers, checks, or Electronic Benefits Trnsfer (EBT) crds tht llow them to obtin specific types of food (for exmple, milk, juice, nd cerel) from prticipting retil vendors t no chrge. WIC ws estblished in 1972 by n mendment to the Child Nutrition Act of In April 2012, 9.7 million prticipnts were enrolled in WIC. The full fiscl yer 2012 cost of the progrm ws $6.8 billion. WIC is not n entitlement progrm. Since 1988, FNS hs produced biennil reports on prticipnt nd progrm chrcteristics in WIC. This informtion is used for generl progrm monitoring s well s for mnging the informtion needs of the progrm. FNS uses this regulrly updted WIC informtion to estimte budgets, submit civil rights reporting, identify needs for reserch, nd review current nd proposed WIC policies nd procedures. The biennil reports include: Demogrphic, income, nd nutritionl risk chrcteristics of WIC prticipnts Brestfeeding initition nd durtion by Stte WIC prticiption for migrnt frm worker fmilies Other topics tht re deemed pproprite by the Secretry of Agriculture This publiction is the 13th report in the WIC Prticipnt nd Progrm Chrcteristics (PC) study series. THE 2012 REPORT Like ll biennil WIC PC reports since 1992, the 2012 report (PC2012) employs the prototype reporting system developed by FNS tht uses prticipnt informtion compiled from 1 Children my prticipte in WIC through 4 yers of ge, but re no longer eligible upon their fifth birthdys. Pge i

16 WIC Prticipnt nd Progrm Chrcteristics: 2012 Finl Report Stte WIC gencies. The reports, including PC2012, contin informtion on census of WIC prticipnts in April of the reporting yer. 2 In this report, the term prticipnts is defined s persons on WIC mster lists or persons listed in WIC operting files who re certified to receive WIC benefits in April This definition differs from WIC s regultory definition of prticipnts, which is bsed on n ctul clim of WIC benefits tht generlly includes receipt of WIC food instrument. The regultory definition of prticipnts lso includes prtilly brestfeeding women who receive no WIC foods or food instruments but who re prtilly brestfeeding their infnts who re receiving WIC foods or food instruments. In ddition, it includes infnts who receive no WIC foods or food instruments but re being fully brestfed by their mothers who re receiving WIC food or food instruments. This definitionl difference, coupled with prticipnts who fil to pick up food instruments, results in count of PC2012 WIC prticipnts tht is pproximtely 10 percent greter thn the number of prticipnts in regulr progrm ccounting reports for April This percentge difference is similr to previously reported differences in these biennil sttistics. Prticipnt Records. The current system for reporting prticipnt dt is bsed on the utomted trnsfer of n greed-upon set of dt elements. Stte WIC gencies downlod routinely collected informtion from their existing utomted client nd mngement informtion systems. Stte nd locl WIC stff use these dt to certify pplicnt eligibility for WIC benefits nd to issue food vouchers nd checks. This set of 20 greed-upon items is clled the Minimum Dt Set (MDS) nd ws developed by FNS working with the Informtion Committee of the Ntionl WIC Assocition (formerly the Ntionl Assocition of WIC Directors) nd the Centers for Disese Control nd Prevention (CDC). For this report, 90 Stte WIC gencies submitted MDS dt on census of WIC prticipnts. The Stte-mintined utomted informtion systems from which PC2012 dt were drwn do not lwys contin complete informtion on every vrible for every individul enrolled in WIC, though overll reporting hs improved substntilly over time. Unreported PC2012 dt my be unvilble for vriety of resons, some of which my indicte tht prticipnts in the not-reported ctegory my be different from those individuls with dt reported. Assumptions regrding missing dt vry by the nture of the vrible nd by ctegory of WIC prticipnt. To ccount for these nomlies, uniform strtegy hs been dopted for prepring ll tbles in this report. Dt not reported re included in the clcultion of percentge distributions for ech chrcteristic. While including missing dt in the denomintors for ll clcultions tends to plce estimtes for ech chrcteristic t lower bound, this pproch hs llowed consistent presenttion of tbultions throughout the report. Further, it ssures tht ll informtion needed to clculte upper-bound estimtes is redily vilble in every tble. Cution should be used in compring results cross groups or over time. Missing dt must lwys be considered in guging differences mong groups or ctegories of WIC prticipnts or in nlyzing trends cross yers. For PC2012, reporting pproched 100 percent on ll but few vribles; unreported dt were more prevlent in erlier reports. 2 Due to mngement informtion system constrints, three Stte gencies provided dt for Mrch 2012 rther thn April These Stte gencies re Mine, Alsk, nd Michign. Pge ii

17 WIC Prticipnt nd Progrm Chrcteristics: 2012 Finl Report THE 2012 WIC PROGRAM In 2012, WIC services were delivered in ech of the 50 Sttes, Americn Smo, the District of Columbi, Gum, the Northern Mrin Islnds, Puerto Rico, nd the U.S. Virgin Islnds in ddition to 34 Indin Tribl Orgniztions (ITOs). The 90 Stte WIC gencies reporting PC2012 dt operted nerly 1,900 locl WIC gencies where stff delivered WIC services. Ten Sttes served nerly three-fifths (57.8 percent) of ll WIC prticipnts; two Sttes Cliforni nd Texs provided services to more thn qurter (27.7 percent) of WIC prticipnts. PARTICIPANT CHARACTERISTICS IN 2012 In April 2012, 9,734,468 women, infnts, nd children were enrolled in WIC (Figure E.1). Although WIC prticiption hs grown stedily since the progrm begn, prticiption in 2012 ws 2.9 percent lower thn in The only other decrese in WIC enrollment since WIC PC dt collections begn occurred between 1998 nd FIGURE E.1 NUMBERS OF WIC PARTICIPANTS BY CATEGORY AND AGE OF CHILDREN, APRIL 2012 Pregnnt Brestfeeding Postprtum Infnt 1 Yer Old 2 Yers Old 3 Yers Old 4 Yers Old Age not reported 2, , , ,347 1,314,117 1,210, ,184 1,809,781 2,240,045 Notes 0 500,000 1,000,000 1,500,000 2,000,000 2,500,000 Totl WIC Enrollment: 9,734,468 Dt presented in this chrt for pregnnt, brestfeeding, nd postprtum women nd infnts re found in Tble II.1. Totl number of children by ge group is found in Tble IV.8. Approximtely hlf (53.4 percent) of WIC prticipnts in April 2012 were children (Figure E.2). Infnts ccounted for 23.0 percent of prticipnts nd women 23.6 percent. These distributions re similr to those from 2010 nd hve remined essentilly unchnged since were further divided into three ctegories: pregnnt (10.1 percent of ll prticipnts), brestfeeding (6.8 percent of ll prticipnts), nd postprtum (6.7 percent of ll prticipnts) ws the first yer tht the proportion of brestfeeding women ws higher thn the proportion of postprtum women. Pge iii

18 WIC Prticipnt nd Progrm Chrcteristics: 2012 Finl Report FIGURE E.2 DISTRIBUTION OF INDIVIDUALS ENROLLED IN THE WIC PROGRAM Brestfeeding women Postprtum women 6.7% 6.8% 18.6% 1 yer old Children Pregnnt women 10.1% 13.5% 2 yers old Infnts 23.0% 8.8% 12.4% 3 yers old 4 yers old Notes Dt for pregnnt, brestfeeding, nd postprtum women nd for infnts is presented in Tble II.2. The percent of children by ge group is clculted from the totl number of children by ge group presented in Tble IV.8 s percent of totl WIC enrollment. Most (86.0 percent) of the pregnnt women prticipting in WIC in April 2012 were between 18 nd 34 yers of ge, s were 84.5 percent of brestfeeding nd 87.1 percent of postprtum women. Only 4.4 percent of women WIC clients were 17 yers of ge or younger. Most (92.5 percent) infnt WIC prticipnts were certified for WIC benefits during their first 3 months of life. Child prticiption decresed s ge incresed 34.8 percent of child prticipnts were 1 yer of ge nd only 16.5 percent were 4 yers of ge t time of most recent certifiction. In 2012, more thn hlf (56.9 percent) of pregnnt WIC prticipnts enrolled in the progrm during their first trimester, n increse of more thn 5 percentge points. Most of the reminder (34.7 percent) of pregnnt women enrolled in their second trimester. Only 7.8 percent enrolled in the third trimester. The percentge of women enrolled during their first trimester incresed from 2010 to 2012, fter holding stedy from 2008 to This suggests tht erly enrollment of pregnnt prticipnts, which hd stedily incresed between 1992 nd 2006 nd then stbilized, my gin be incresing. Rce nd Ethnicity. The Office of Mngement nd Budget (OMB) requires rce nd ethnicity to be reported seprtely. One mesure records whether or not the individul is Hispnic/Ltino nd the second records rcil ctegory or ctegories; multiple rcil identifictions re permitted. In 2012, 58.2 percent of ll WIC prticipnts reported their rce s White Only, 19.8 percent reported s Blck or Africn Americn Only, 12.2 percent reported s Americn Indin or Alsk Ntive Only, nd 3.9 percent of prticipnts reported s either Asin Pge iv

19 WIC Prticipnt nd Progrm Chrcteristics: 2012 Finl Report Only or Ntive Hwiin or Other Pcific Islnder Only. Two or more rces were reported for 5.1 percent of WIC prticipnts. For ethnicity, 41.5 percent of prticipnts reported s Hispnic/Ltino. Rce nd ethnicity reporting chnged slightly from 2010 to 2012 (Tble II.7). The percentge of White Only prticipnts decresed from 60.9 percent to 58.2 percent. In ddition, there ws n increse of 1.7 percentge points in Americn Indin or Alsk Ntive Only prticipnts nd n increse of 0.9 percentge points in prticipnts reporting two or more rces. Prticiption in Other Progrms. WIC legisltion llows income eligibility requirements to be met by prticiption in mens-tested progrms such s Medicid, Temporry Assistnce to Needy Fmilies (TANF), nd the Supplementl Nutrition Assistnce Progrm (SNAP). In April 2012, 74.6 percent of WIC enrollees reported receiving benefits from t lest one public ssistnce progrm tht clssified them s djunctively income eligible for WIC, up from 69.2 percent in With regrd to ech progrm, 70.8 percent of WIC clients received Medicid benefits, n increse of more thn 5 percentge points from 2010; 35.8 percent received SNAP benefits, n increse of lmost 5 percentge points; nd 8.6 percent of WIC prticipnts reported receiving TANF benefits, n increse of less thn 1 percentge point since 2010, following yers of decline in TANF prticiption following the pssge of the Personl Responsibility nd Work Opportunity Act of Only 6.9 percent received benefits from ll three progrms. These findings likely underestimte prticiption in these progrms. One potentil reson for underreporting is tht the informtion ws recorded t the time of certifiction for WIC. Stff t mny locl WIC service sites refer WIC enrollees to other progrms, nd ny enrollment subsequent to certifiction my not be cptured in the estimtes presented here. Another considertion is tht constrints in vrious WIC mngement informtion systems, s well s required procedures for documenting income nd prticiption in other progrms, my hve limited the number of progrms entered into computer systems by locl WIC stff. Household Size. The men household size of WIC prticipnts in April 2012 ws 4.1 persons. Averge size hs remined stble since the first WIC PC census dt collection in Income. Among WIC prticipnts reporting some income, the verge nnulized income of fmilies/economic units of persons enrolled in WIC in April 2012 ws $16,842, n increse of $393 (2.4 percent) since This smll increse is consistent with broder economic dt showing slow rte of economic growth since Across prticipnt ctegories, brestfeeding women reported the highest verge household income t $17,958; postprtum women exhibited the lowest verge household income t $14,749. Blck or Africn Americn WIC enrollees displyed the lowest verge household income $12,962 for fmilies or economic units. Asin prticipnts hd the highest verge nnulized household income t $19,903. Findings bout income must be interpreted with cution given tht household income is not reported for 8.3 percent of WIC enrollees. Poverty Sttus. WIC prticipnts come from some of the Ntion s poorest households. In 2012, two-thirds (66.6 percent) of ll WIC prticipnts reported incomes t or less thn the Pge v

20 WIC Prticipnt nd Progrm Chrcteristics: 2012 Finl Report Federl poverty level, nd one-third (33.4 percent) reported incomes t or less thn 50 percent of the Federl poverty level. To compre, in the 2010 Census, 15.0 percent of the generl popultion hd incomes tht were less thn the Federl poverty level. The shrp contrst between WIC clients nd the generl popultion cn be seen in Figure E.3, which compres the poverty sttus of WIC prticipnts reporting income with the generl U.S. popultion. (More detiled figures pper in Chpter III of this report.) FIGURE E.3 COMPARISON OF POVERTY LEVELS OF WIC PARTICIPANTS REPORTING INCOME TO PERSONS IN THE U.S. POPULATION 80.0% 70.0% 60.0% 50.0% 73.1% 68.5% 40.0% 30.0% 20.0% 10.0% 0.0% 15.0% 18.5% 9.8% 6.7% 6.9% 1.5% Below 100% 100-Below 150% 150-Below 185% 185% nd Over U.S WIC April 2012 Notes Dt presented in this chrt re found in Tble III.6. Nutritionl Risk. For PC2012, Sttes could report up to 10 nutritionl risks for ech prticipnt. For women, high weight for height nd inpproprite (both high nd low) weight gin during pregnncy were the predominnt risks reported. Children showed inpproprite nutrition prctices nd the nthropometric risk high weight for height s their most frequently recorded risks. Eighty-two percent of WIC infnts were recorded to be t risk due, t lest in prt, to the WIC eligibility of their mothers or becuse their mothers were t risk during pregnncy. At lest one nutritionl risk ws reported for lmost 100 percent of WIC enrollees in April WIC Policy Memorndum 98-9, Revision 10 ws implemented between PC2010 nd PC2012 (USDA, 2009). This revision included two new llowble risk criteri, history of preeclmpsi nd pre-dibetes. The revision lso revised nd updted number of existing risk criteri. Following slow increse in the percent of children 2 yers of ge nd older considered overweight, this percentge decresed slightly from 14.7 percent in 2008 to 14.0 percent in Similrly, in 2012 the percent of 1-yer-old children in high weight for height percentiles decresed. Pge vi

21 WIC Prticipnt nd Progrm Chrcteristics: 2012 Finl Report Brestfeeding Rtes. PC2012 brestfeeding estimtes re bsed on dt from 86 Stte WIC gencies. In the 86 Stte gencies tht reported brestfeeding dt, 67.1 percent of ll 6- to 13-month-old infnts nd children were currently brestfed or were brestfed t some time. Nerly hlf of the Stte gencies (46.5 percent) hd brestfeeding initition rtes between 60 nd 79 percent (Figure E.4). Only 7.0 percent of gencies hd initition rtes of less thn 40 percent nd only 1.2 percent of gencies hd n initition rte of more thn 90 percent. The PC1998 benchmrk estimte of brestfeeding initition ws 41.5 percent. With the exception of , the brestfeeding initition rte incresed pproximtely 4 percentge points between ech PC reporting period from 1998 to For PC2012, brestfeeding initition incresed by 3.8 percentge points, from 63.1 percent in PC 2010 to Migrnt Sttus. Figure E.5 shows migrnt prticiption cross the Sttes. In April 2012, there were 35,972 migrnt WIC prticipnts identified on Stte WIC enrollment files. Migrnt WIC prticipnts mde up less thn hlf of 1 percent of the popultion receiving WIC services. More thn three-qurters (77.9 percent) of the migrnt prticipnts were from Cliforni, Florid, Michign, New York, nd Texs. The certifiction ctegories of migrnt WIC prticipnts did not differ gretly from other WIC prticipnts. A somewht greter portion of migrnts were women (26.3 percent versus 23.7 percent) nd children (55.3 percent versus 53.2 percent), nd there were fewer infnts mong migrnts thn the non-migrnt WIC popultion (18.4 percent versus 23.1 percent). Migrnt WIC prticipnts hd similr levels of prticiption in other mens-tested progrms to non-migrnt prticipnts, nd migrnt WIC prticipnts reported medin nnul incomes tht were 2.9 percent less thn non-migrnt prticipnt medin incomes ($16,363 nd $16,831, respectively), smller gp thn the 7.2- percent difference reported in Food Pckge Dt. Sttes were required to provide food prescription dt nd n FNS Food Pckge Type descriptor s prt of the WIC MDS. These dt will be included in supplementry report. Pge vii

22 WIC Prticipnt nd Progrm Chrcteristics: 2012 Finl Report Pge viii

23 WIC Prticipnt nd Progrm Chrcteristics: 2012 Finl Report Pge ix

24 WIC Prticipnt nd Progrm Chrcteristics: 2012 Finl Report I. INTRODUCTION The Specil Supplementl Nutrition Progrm for, Infnts, nd Children (WIC) is dministered by the Food nd Nutrition Service (FNS) of the U.S. Deprtment of Agriculture (USDA). WIC ws estblished to counterct the negtive effects of poverty on prentl nd peditric helth nd provides benefits tht include nutritious supplementl foods; nutrition eduction; counseling, including brestfeeding promotion nd support; nd referrls to helth cre, socil service, nd other community providers for pregnnt, brestfeeding, nd postprtum 3 women, infnts, nd children up to the ge of 5 yers. By intervening during the prentl period, WIC seeks to improve fetl development nd reduce the incidence of low birth weight, short gesttion, nd mternl nemi. Infnts nd children who re t nutritionl risk cn receive supplementl foods, nutrition eduction, brestfeeding support, nd referrls to helth cre nd socil services to mintin nd improve their helth nd development. The WIC progrm ws estblished in 1972 by n mendment to the Child Nutrition Act of In April 2012, WIC enrolled 9.7 million prticipnts. In FY 2012, $6.618 billion dollrs were pproprited by Congress for WIC. Since 1988, FNS hs produced biennil reports on WIC prticipnt nd progrm chrcteristics. FNS uses this regulrly updted informtion for generl progrm monitoring s well s for mnging WIC s informtion needs such s estimting budgets, submitting civil rights reports, identifying needs for reserch, nd reviewing current nd proposed WIC policies nd procedures. The biennil reports include informtion on: Demogrphic, income, nd nutritionl risk chrcteristics of WIC prticipnts Brestfeeding initition nd durtion by Stte WIC prticiption for migrnt frm worker fmilies Other topics tht re deemed pproprite by the Secretry of Agriculture For purposes of the biennil reports, WIC prticipnt is defined s person who is certified to receive WIC benefits in April, including individuls who do not clim or use the food instruments issued during the time period. Further, in ccordnce with WIC guidelines, this includes fully brestfeeding infnts who re certified for WIC benefits but do not receive food pckges. It lso includes prtilly brestfeeding women who do not receive food pckges, provided tht their infnts receive WIC food instruments. This introduction provides brief history of the WIC progrm nd progrm reports. This chpter explins the motivtion for estblishing the WIC progrm, describes WIC benefits nd eligibility requirements, nd summrizes 2012 prticipnt nd progrm chrcteristics. Finlly, this chpter outlines the orgniztion of the remining chpters in this report. 3 Postprtum women re defined s non-brestfeeding women up to 6 months fter termintion of pregnncy. Pge 1

25 WIC Prticipnt nd Progrm Chrcteristics: 2012 Finl Report A. PROGRAM OPERATIONS WIC services re delivered in ech of the 50 Sttes, Americn Smo, the District of Columbi, Gum, the Commonwelth of the Northern Mrin Islnds, Puerto Rico, nd the U.S. Virgin Islnds. Additionlly, in April 2012, there were 34 Indin tribl orgniztions (ITOs) tht served s Stte WIC gencies, resulting in totl of 90 Stte WIC gencies ntionwide. Almost 1,900 locl gencies (defined s the orgniztions one level below Stte WIC gencies) provided services to prticipnts. Tble I.1 presents informtion on the number of locl service delivery gencies operted by the 90 Stte WIC gencies. Ten Sttes served nerly three-fifths (57.8 percent) of ll WIC prticipnts. 4 Two Sttes Cliforni nd Texs provided services to more thn qurter (27.7 percent) of WIC prticipnts. At the Federl level, FNS nd its seven dministrtive regionl offices provide csh grnts to Stte WIC gencies for nutrition services nd progrm dministrtion, set nutritionl risk eligibility stndrds, issue regultions nd monitor complince with these regultions, offer technicl ssistnce to Stte gencies, nd conduct studies of progrm opertion nd performnce. Stte WIC gencies llocte funds to locl WIC sponsoring gencies, monitor complince with Federl nd Stte regultions, nd supply technicl ssistnce to locl WIC gency stff. Since 1987, Stte gencies hve negotited rebtes provided by mnufcturers of infnt formul nd juice to reduce food costs. These rebtes re used by Stte nd locl WIC gencies to provide WIC services to lrger numbers of eligible individuls. 4 The 10 Sttes re Cliforni, Texs, New York, Florid, Georgi, Illinois, Ohio, North Crolin, Michign, nd Pennsylvni. Pge 2

26 WIC Prticipnt nd Progrm Chrcteristics: 2012 Finl Report Tble I.1 Distribution of Locl WIC Agencies nd WIC Prticipnts by Stte WIC Agency Number of Locl Agencies Percent of All Locl Agencies Percent of U.S. WIC Prticipnts Stte Northest Connecticut Mine Msschusetts New Hmpshire New York Rhode Islnd Vermont Indin Township (ME) b Plesnt Point (ME) b Senec Ntion (NY) b Mid-Atlntic Delwre District of Columbi Mrylnd New Jersey Pennsylvni Puerto Rico Virgini Virgin Islnds West Virgini Southest Albm Florid Georgi Kentucky Mississippi North Crolin South Crolin Tennessee Estern Bnd-Cherokee (NC) Mississippi Choctw Midwest Illinois Indin Michign Minnesot Ohio Wisconsin Southwest Arknss Louisin New Mexico Oklhom Texs ACL (NM) Cherokee Ntion (OK) Chicksw Ntion (OK) Choctw Ntion (OK) Citizen-Potwtomi (OK) Eight Northern Pueblos (NM) b Five Sndovl Pueblos (NM) b Pge 3

27 WIC Prticipnt nd Progrm Chrcteristics: 2012 Finl Report Tble I.1 (continued) Distribution of Locl WIC Agencies nd WIC Prticipnts by Stte WIC Agency Number of Locl Agencies Percent of All Locl Agencies Percent of U.S. WIC Prticipnts Stte Southwest (continued) ITC-Oklhom Muscogee Creek Ntion (OK) Osge Ntion (OK) Otoe-Missouri (OK) Pueblo of Islet (NM) Pueblo of Sn Felipe (NM) b Pueblo of Zuni (NM) Snto Domingo (NM) b WCD (OK) Mountin Plins Colordo Iow Knss Missouri Montn Nebrsk North Dkot South Dkot Uth Wyoming Cheyenne River Sioux (SD) Estern Shoshone (WY) b Northern Arphoe (WY) Omh Ntion (NE) b Rosebud Sioux (SD) Sntee Sioux (NE) b Stnding Rock Sioux (ND) Three Affilited (ND) b Ute Mountin Ute (CO) b Winnebgo (NE) b Western Alsk Americn Smo Arizon Cliforni Gum Hwii Idho Nevd Northern Mrin Islnds Oregon Wshington ITC-Arizon ITC-Nevd Nvjo Ntion (AZ) Totl 1, Notes Percents my not dd to % due to rounding. The count of locl WIC gencies is derived from Stte enrollment files contining identifiers for locl gencies chrged with dministering WIC services. b Indictes gencies serving less thn 0.005% of U.S. WIC. Pge 4

28 WIC Prticipnt nd Progrm Chrcteristics: 2012 Finl Report B. PARTICIPANT BENEFITS WIC seeks to improve the helth of progrm prticipnts by providing nutritious food nd nutrition eduction, including brestfeeding promotion nd support, s djuncts to good helth cre. The benefits provided by WIC re described below. Food Pckges. Most Stte gencies issue food instruments (vouchers, checks, or in some Stte gencies, EBT crds) to prticipnts who use them to purchse set of prescribed foods tht provide specific nutrients known to be lcking in the diets of trget popultions. FNS regultions specify WIC food pckges tht re designed for different ctegories of prticipnts. These pckges contin foods tht re good sources of specific nutrients protein, iron, clcium, nd vitmins A nd C. Infnt food pckges reflect the developmentl needs of infnts s well s the infnt feeding prctice guidelines of the Americn Acdemy of Peditrics. Other food pckges lign with the recommendtions of the Dietry Guidelines for Americns 5 nd incorporte the recommended eting ptterns for preschool children nd the specil dditionl nutritionl requirements of pregnnt nd brestfeeding women into their contents. In April 2005, the Institute of Medicine (IOM) of the Ntionl Acdemies relesed its report tht reviewed WIC food pckges in reltion to the most recent knowledge of humn nutritionl needs nd recommended chnges in the pckges. FNS developed chnges to the food pckges bsed on the IOM recommendtions; these chnges were published s n interim finl rule in the Federl Register in December 2007, with finl implementtion dte of October The Interim Rule ligns the food pckges more closely with updted nutrition science, promotes long-term brestfeeding, nd dded optionl substitutions to some food ctegories to meet better the needs of WIC s diverse popultion. Optionl food substitutions included different types of cnned fish; cnned bens s substitute for dried bens or penut butter; vrious whole grins, including brown rice nd otmel, s substitute for whole-whet bred; nd soy-bsed beverges nd tofu s milk lterntives. New foods offered included whole grin cerels nd bred; infnt food fruit, vegetbles, nd met; nd the ddition of csh-vlue voucher for fruits nd vegetbles in fresh, frozen, or cnned form to food pckges for children nd women. Reductions in food llownces included milk, eggs, nd juice for women nd children; the elimintion of juice from infnt pckges; nd reduction in the formul llownce for brestfeeding nd older infnts. Most Stte gencies operte delivery systems through which WIC clients receive food instruments to purchse their supplementl foods t uthorized locl grocery stores. These checks or vouchers cn be used only for food prescribed by helth or nutrition professionls t locl WIC gencies. The prescribed food items re specified on ech WIC food instrument. In few geogrphic res, food is delivered to prticipnt homes, or prticipnts pick up food t specified distribution points. A smll number of Stte gencies operte both types of delivery systems. Over the pst 10 yers, FNS hs worked with volunteer WIC Stte gencies in designing nd testing electronic benefit trnsfer (EBT) for WIC benefits by using smrtcrds nd online rel-time telecommunictions. As of November 2012, 10 Stte gencies hve 5 Dietry Guidelines for Americns, published jointly by USDA nd HHS, provides recommendtions for ttining nd mintining helthy weight, reducing risks of chronic disese, nd promoting overll helth. This report is revised every 5 yers (USDA, 2010). Pge 5

29 WIC Prticipnt nd Progrm Chrcteristics: 2012 Finl Report implemented EBT sttewide nd severl others hve plns to implement EBT in the ner future (USDA, 2012b). Nutrition Eduction nd Counseling. Nutrition eduction plys crucil role in the WIC progrm nd is viewed s n essentil benefit directed towrd chieving positive chnges in prticipnt knowledge, ttitudes, nd behviors bout food consumption. FNS regultions require WIC service gencies to offer prticipnts (or their mothers or other cre providers) t lest two nutrition eduction sessions during ech certifiction period. Prticipnts my be counseled in one-on-one settings or ttend group clsses on vriety of helth nd nutritionrelted topics. As prt of nutrition eduction nd counseling, brestfeeding is promoted s the optiml source of infnt nutrition. Access to Helth Cre nd Socil Services. Ech WIC gency refers prticipnts to pproprite helth cre nd socil services. Through either the provision of onsite helth services or referrl to other gencies, the WIC progrm serves s link between prticipnts nd pproprite helth cre providers or systems. Most locl WIC gencies refer clients to vriety of socil services, including but not limited to income support, child support, nd child cre services, nd substnce buse counseling. Coordintion between WIC nd socil service progrms incresed fter 1989 when Federl lw creted djunctive income eligibility for WIC benefits. Under djunctive income eligibility, Stte gencies re ble to use documenttion of prticiption in other mens-tested progrms s evidence of income eligibility for WIC. C. ELIGIBILITY FOR WIC BENEFITS Eligibility for receipt of WIC benefits is bsed on four fctors: ctegoricl eligibility, residency, income eligibility, nd nutritionl risk. First, prticipnt must be member of certin ctegoriclly eligible groups: women during pregnncy nd up to the first 6 weeks fter delivery; women up to 1 yer postprtum if brestfeeding or up to 6 months postprtum if not brestfeeding; infnts up to 1 yer old; nd children up to the ge of 5 yers. Second, pplicnts must pply for nd receive benefits in the Stte in which they reside; e.g., Knss resident cnnot be certified to receive WIC benefits in Nebrsk. Third, prticipnt must be income-eligible ccording to the income limit for eligibility set by the Stte of residency. This income limit my not exceed 185 percent or be less thn 100 percent of the U.S. Deprtment of Helth nd Humn Services (HHS) poverty income guidelines, which re bsed on household size nd Stte of residence. As of July 2011, person from fmily of four living within the 48 contiguous Sttes with n nnul household income of $41,348 or less would be income-eligible for WIC benefits t the 185-percent threshold. 6 All Stte WIC gencies used the 185 percent of poverty threshold in April 2012 (USDA, 2012). Stte WIC gencies cn determine tht n pplicnt is djunctively income eligible for WIC benefits through documenttion of his/her or certin fmily members prticiption in Medicid, Temporry Assistnce to Needy Fmilies (TANF), or the Supplementl Nutrition 6 Poverty guidelines estblished in July 2011 were in effect through June 2012, so these guidelines cover most of the period for which WIC prticipnts ctive in April 2012 were certified. Pge 6