Identifying Strategies to Improve Enrollment and Participation in Three Rural Native American WIC Programs

Objectives The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has a strong track record of improving birth and health outcomes in high-risk populations. For the past decade and a half, WIC enrollment among Native American women and children has declined by approximately 40% for reasons that have not yet been elucidated. The objectives of this work are to 1) Understand the individual-, household-, and community-level factors that facilitate and impede participation in three rural tribal WIC programs, and 2) Identify strategies for addressing significant unexplained declines in WIC participation. Methods We partnered with three tribal WIC agencies – two in the Southwest and one in the Midwest – to plan and conduct this formative research. In-depth qualitative interviews (n = 35) were conducted with current and former WIC participants, eligible non-participants, WIC staff, tribal health administrators, and managers of food store that accept WIC in each study community. Interview transcripts were inductively coded and crosscutting emergent themes across communities were identified by four researchers. Results Tribal WIC agencies are highly valued for their culturally-competent staff and the integration of traditional knowledge and values into their services. However, participation barriers related to internet and telephone connectivity have become amplified during the COVID-19 pandemic, and a complicated and often embarrassing food shopping experience is a major obstacle to WIC benefit redemption in small rural food stores. Dominant themes differed greatly by community, indicating that intervention strategies to address declines in WIC participation should be tailored to community-level infrastructure, policy, and cultural values, which are unique to each community. Conclusions This work represents an important step toward improving understanding of the strengths and weaknesses of the WIC program in rural Native communities and identifying key focus areas for future interventions. Funding Sources Robert Wood Johnson Foundation Healthy Eating Research Grant #77,235.

Acquisition, mobility and food insecurity: integrated food systems opportunities across urbanicity levels highlighted by COVID-19.

OBJECTIVE: To investigate acquisition and mobility experiences of food-insecure individuals across urbanicity levels (i.e., urban, suburban, rural) in the early months of the COVID-19 pandemic. DESIGN: Cross-sectional study using a nationally representative online panel to measure where food-insecure individuals acquired food, food acquisition barriers and mobility to food sources, which were evaluated across urbanicity levels using chi-squared tests and 95 % CI. SETTING: USA. PARTICIPANTS: 2011 adults (18 years or older). RESULTS: Food insecurity impacted 62·3 % of adults in urban areas, 40·5 % in rural areas and 36·7 % in suburban areas (P < 0·001). Food acquisition barriers that were significantly more prevalent among food-insecure adults in urban areas were a change in employment status (34·2 %; 95 % CI 27·2 %, 41·1 %; P < 0·0001) and limited availability of food in retailers (38·8 %; 95 % CI 31·7 %, 45·9 %; P < 0·001). In rural areas, food-insecure adults primarily acquired food for the household from supercentres (61·5 %; 95 % CI 50·4 %, 72·5 %; P < 0·05), while locally sourced foods were less common among food-insecure adults in rural areas (6·9 %; 95 % CI 0·01 %, 13·0 %) compared to urban areas (19·8 %; 95 % CI 14·3 %, 25·4 %; P < 0·01). Transportation as a barrier did not vary significantly by urbanicity, but food-insecure adults across urbanicity levels reported utilising a range of transportation modes to acquire food. CONCLUSIONS: A planning approach that links urban and rural areas could address food insecurity by enhancing the integration of food production, transportation and food distribution, building towards a more resilient and equitable food system for all Americans.

Mobility Patterns Before, During, and Anticipated After the COVID-19 Pandemic: An Opportunity to Nurture Bicycling.

INTRODUCTION: The purpose of this study is to quantify the immediate and anticipated effect of the COVID-19 pandemic on local travel in the U.S. METHODS: A national survey of a representative sample of U.S. adults was conducted using The Harris Poll panel. The online survey was conducted from June 17 to 29, 2020. Respondents reported the frequency of travel before the pandemic, during the pandemic, and anticipated travel when normal activities resume for walking, bicycling, personal vehicle use, and public transit. Analyses were conducted in July and August 2020. RESULTS: During the pandemic, local travel significantly decreased (-10.36%, 95% CI= -16.26, -4.02) relative to prepandemic levels. Within travel modes, significant decreases were reported for public transit, personal vehicle use, and walking. There was no change in reported bicycle use during the pandemic period relative to prepandemic levels. When normal activities resume, respondents anticipated a significant increase in bicycling (24.54%, 95% CI=3.24, 50.24). Anticipated travel using personal vehicles, public transit, and walking were not significantly different from the prepandemic levels. CONCLUSIONS: Unlike the other local travel modes, bicycling did not decrease during the pandemic and is anticipated to significantly increase. Investment in bicycle-safe infrastructure could sustain the anticipated increase in bicycling.