Breastfeeding Is Associated With Higher Retention in WIC After Age 1.

OBJECTIVE: Examine factors associated with retention on the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) after 1 year of age. SETTING: A large California WIC program. PARTICIPANTS: WIC participants 14 months old (9,632) between July and September, 2016. MAIN OUTCOME MEASURE: Recertification in WIC by 14 months of age. ANALYSIS: Multivariate logistic regression was performed and odds ratios (ORs) and 95% confidence intervals (CIs) were computed to examine factors associated with child retention in WIC at age 14 months. RESULTS: Mothers performing any amount of breastfeeding from 6 to 12 months were more likely than mothers not breastfeeding to recertify their children in WIC at age 14 months. The odds of retention for children fully breastfed from 6 to 12 months was about 3 times higher than for fully formula-fed children (95% CI, 2.46-3.59). The odds of retention for mostly breastfed children and children fed some breast milk but mostly formula were 1.95 (95% CI, 1.57-2.43) and 1.72 (95% CI, 1.41-2.10) times higher than fully formula-fed children. Prenatal intention to breastfeed (OR = 1.34; 95% CI, 1.16-1.55), online education (OR = 1.08; 95% CI, 1.03-1.13), missing benefits (OR = 0.19; 95% CI, 0.17-0.21), underredemption of WIC benefits (OR = 0.51, 95% CI, 0.45-0.58), early enrollment in WIC (OR = 1.11; 95% CI, 1.09-1.14), number of family members receiving WIC (OR = 1.29, 95% CI, 1.14-1.46), English language preference (OR, 0.55; 95% CI, 0.47-0.64), and participation in Medicaid (OR = 1.29; 95% CI, 1.14-1.47) were also associated with retention. CONCLUSIONS AND IMPLICATIONS: Results from this study suggested there are a number of areas WIC programs may target to promote ongoing participation in the program. These include support for both breastfeeding and non-breastfeeding women, technology-based strategies, and targeted outreach to pregnant women, participants who have missed benefits, and participants who have not redeemed their benefits. Research that examines the impact of targeted interventions directed at ≥1 of these areas is essential to help WIC programs maintain contact with children into early childhood.

Breastfeeding Is Associated With Reduced Obesity in Hispanic 2- to 5-Year-Olds Served by WIC.

OBJECTIVE: To examine the relationship between breastfeeding (BF) and odds of childhood obesity in a large, primarily Hispanic Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) population. SETTING: A large urban WIC program in California. PARTICIPANTS: Infants enrolled in WIC born between 2004 and 2007 and observed to age 5 years (N = 39,801; 88.6% Hispanic). INTERVENTION: Level of BF: fully BF, fully formula feeding, or combination feeding. MAIN OUTCOME MEASURE: Obesity at age 2-5 years, measured by body mass index (BMI) ≥ 95th percentile. ANALYSIS: Logistic regression analyses to evaluate the association between initiation, duration, and exclusivity of BF and odds of obesity at age 2-5 years, controlling for ethnicity, preferred language, family size, poverty level, and maternal BMI. RESULTS: Infants exclusively formula fed at birth were significantly more likely than fully breastfed infants to be obese at age 2-5 years (χ2 [2, N = 39,801] = 123.31; P < .001). For every additional month of any BF, obesity risk at age 2-5 years decreased by 1%. Every additional month of full BF conferred a 3% decrease in obesity risk. Ethnicity, preferred language, family size, poverty level, and maternal BMI were also significantly related to obesity risk. CONCLUSIONS AND IMPLICATIONS: Breastfeeding may have a role in the attenuation of obesity in early childhood among Hispanic children. The BF promotion and support offered at WIC may have a significant role in reducing rates of early childhood obesity.

Impact of policy changes on infant feeding decisions among low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children.

OBJECTIVES: We present infant feeding data before and after the 2009 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package change that supported and incentivized breastfeeding. We describe the key role of California WIC staff in supporting these policy changes. METHODS: We analyzed WIC data on more than 180,000 infants in Southern California. We employed the analysis of variance and Tukey (honestly significant difference) tests to compare issuance rates of postpartum and infant food packages before and after the changes. We used analysis of covariance to adjust for poverty status changes as a potential confounder. RESULTS: Issuance rates of the "fully breastfeeding" package at infant WIC enrollment increased by 86% with the package changes. Rates also increased significantly for 2- and 6-month-old infants. Issuance rates of packages that included formula decreased significantly. All outcomes remained highly significant in the adjusted model. CONCLUSIONS: Policy changes, training of front-line WIC staff, and participant education influenced issuance rates of WIC food packages. In California, the issuance rates of packages that include formula have significantly decreased and the rate for those that include no formula has significantly increased.