Evaluating the Influence of the Revised Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Allocation Package on Healthy Food Availability, Accessibility, and Affordability in Texas.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was implemented to improve the health of pregnant women and children of low socioeconomic status. In 2009, the program was revised to provide a wider variety of healthy food choices (eg, fresh fruits, vegetables, and whole-grain items). OBJECTIVES: The purpose of this study was to evaluate (1) the impact of the revised WIC Nutrition Program's food allocation package on the availability, accessibility, and affordability of healthy foods in WIC-authorized grocery stores in Texas; and (2) how the impact of the policy change differed by store types and between rural and urban regions. DESIGN: WIC-approved stores (n=105) across Texas were assessed using a validated instrument (88 items). Pre- (June-September 2009) and post-new WIC package implementation (June-September 2012) audits were conducted. Paired-sample t tests were conducted to compare the differences between pre- and post-implementation audits on shelf width and number of varieties (ie, availability), visibility (ie, accessibility), and inflation-adjusted price (ie, affordability). RESULTS: Across the 105 stores, post-implementation audits showed increased availability in terms of shelf space for most key healthy food options, including fruit (P<0.001), vegetables (P<0.01), cereal (P<0.001), and varieties of vegetables (P<0.001). Food visibility increased for fresh juices (P<0.001). Visibility of WIC labeling improved for foods such as fruits (P<0.05), WIC cereal (P<0.05), and whole-grain or whole-wheat bread (P<0.01). Inflation-adjusted prices decreased only for bread (P<0.001) and dry grain beans (P<0.001). The positive effects of the policy change on food availability and visibility were observed in stores of different types and in different locations, although smaller or fewer effects were noted in small stores and stores in rural regions. CONCLUSIONS: Implementation of the revised WIC food package has generally improved availability and accessibility, but not affordability, of healthy foods in WIC-authorized stores in Texas. Future studies are needed to explore the impact of the revised program on healthy food option purchases and consumption patterns among Texas WIC participants.

Analysis of Multivariate Disease Classification Data in the Presence of Partially Missing Disease Traits.

In modern cancer epidemiology, diseases are classified based on pathologic and molecular traits, and different combinations of these traits give rise to many disease subtypes. The effect of predictor variables can be measured by fitting a polytomous logistic model to such data. The differences (heterogeneity) among the relative risk parameters associated with subtypes are of great interest to better understand disease etiology. Due to the heterogeneity of the relative risk parameters, when a risk factor is changed, the prevalence of one subtype may change more than that of another subtype does. Estimation of the heterogeneity parameters is difficult when disease trait information is only partially observed and the number of disease subtypes is large. We consider a robust semiparametric approach based on the pseudo-conditional likelihood for estimating these heterogeneity parameters. Through simulation studies, we compare the robustness and efficiency of our approach with that of the maximum likelihood approach. The method is then applied to analyze the associations of weight gain with risk of breast cancer subtypes using data from the American Cancer Society Cancer Prevention Study II Nutrition Cohort.

Food-shopping environment disparities in Texas WIC vendors: a pilot study.

OBJECTIVE: To identify differences in food-shopping environments of Texas WIC vendors using a culturally adapted instrument. METHODS: A survey tool was developed for measuring food availability, accessibility, and affordability in 111 WIC vendors in Texas. Two-tailed t-tests and Mann-Whitney tests were used for rural/urban and Texas-Mexico border/non-border area comparisons. RESULTS: Prices were higher in rural areas than in urban areas for 2 key foods, fruits (p = .024) and milk (p = .007); non-border vendors had overall better food availability than border vendors; non-border vendors had better accessibility for fruits (p = .007) than border vendors. CONCLUSION: In Texas, disparities in food-shopping environments are evident and can be assessed using a culturally adapted survey tool.