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Objective To describe the postpartum health of predominantly Hispanic participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and identify how health characteristics differ between mothers who delivered preterm or low birth weight infants and those who did not. Design Cross-sectional survey among postpartum WIC mothers. Setting Los Angeles and Orange Counties, CA. Participants WIC participants within 1 year of delivery (n = 1,420). Main Outcome Measures Postpartum health behaviors, health characteristics, and birth spacing intentions and behaviors. Analysis Frequencies of health characteristics were estimated using analyses with sample weights. Differences were assessed with chi-square and Fisher exact tests with Bonferroni correction for pairs of tests. Results Many women exhibited postpartum risk factors for future adverse health events, including overweight or obesity (62.3%), depressive symptoms (27.5%), and no folic acid supplementation (65.5%). Most characteristics did not differ significantly ( P > .025) between mothers of preterm infants and full-term infants or between mothers of low birth weight and normal birth weight infants. Conclusions and Implications Despite few differences between postpartum characteristics of mothers who delivered preterm or low birth weight infants and those who did not, a high percentage of mothers had risk factors that need to be addressed. Current postpartum educational activities of WIC programs should be evaluated and shared.

This cross-sectional study assesses the independent and combined effects of breastfeeding (BF) and dietary intake, specifically sugar-sweetened beverages (SSB), on obesity prevalence in low-income, primarily Hispanic toddlers.The following data were collected in 2011 via phone surveys with caregivers of 2295 low-income children (2-4 years) from Los Angeles County Women, Infants, and Children (WIC) programs: infant feeding, dietary intake, gestational diabetes status, birth weight, gestational age, and mother's BMI. WIC staff measured children's height and weight. Chi-square tests and binary logistic regressions assessed the independent and combined effects of BF and dietary intake on obesity prevalence.Compared to no BF, BF ≥ 12 mos was associated with a 47% reduction in obesity prevalence (AOR = 0.53, 95% CI 0.4-0.8, P = 0.004). Compared to 2 + SSB/d, no SSB/d intake was associated with a 28% reduction in obesity prevalence (AOR = 0.72, 95% CI 0.5-1.0, P = 0.03). High intake of soda, diet soda, and fruit drinks were linked to increases in obesity prevalence. There was no effect of 100% juice, milk (plain or flavored) fruit, vegetable, fast food, or sweetened grain intake on obesity prevalence.These findings support encouragement of BF ≥ 12 mos and no SSB intake to prevent obesity in low-income, primarily Hispanic, toddlers.

The aim of this study was to examine the association between the local food environment and obesity proportions among 3- to 4-year-old children who were participants in the WIC program in Los Angeles County using spatial analyses techniques. ArcGIS, spatial analysis software, was used to compute the retail food environment index (RFEI) per ZIP code. GeoDa, spatial statistics software was employed to check for spatial autocorrelation and to control for permeability of the boundaries. Linear regression and ANOVA were used to examine the impact of the food environment on childhood obesity. Fast-food restaurants represented 30% and convenience stores represented 40% of the sum of food outlets in areas where WIC participants reside. Although there was no statistically significant association between RFEI and 3- to 4-year-old obesity proportions among WIC children, analysis of variance (ANOVA) tests demonstrated statistically significant positive associations between obesity and the number of convenience stores and the number of supermarkets. Our findings suggest that RFEI, as currently constructed, may not be the optimal way to capture the food environment. This study suggests that convenience stores and supermarkets are a likely source of excess calories for children in low-income households. Given the ubiquity of convenience stores in low-income neighborhoods, interventions to improve availability of healthy food in these stores should be part of the many approaches to addressing childhood obesity. This study adds to the literature by examining the validity of the RFEI and by demonstrating the need and illustrating the use of spatial analyses, using GeoDA, in the environment/obesity studies.

To examine satisfaction with in-person group and online nutrition education and compare findings based on language preference by Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants.A total of 1,170 WIC participants were randomly assigned to 2 nutrition education modalities between March, 2014 and October, 2015 in Los Angeles, CA. Logistic regressions compared differences between groups in satisfaction outcomes.Participants in both education groups were highly satisfied regardless of modality of nutrition education (89% and 95%; P = .01). The online group reported a stronger preference for online education than did the in-person group (P .001). In the in-person group, Spanish-speaking participants were less likely than were English-speaking participants to prefer online education (P .001). A training video improved access to online education.Online delivery of education can be an acceptable addition for WIC participants with online access. High-quality online education platforms represent an important avenue to promote continued satisfaction with nutrition education.

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.

Background: Nearly two million California children regularly spend time in child care. surprisingly little is known about the nutrition environments of these settings. the aim of this study was to compare foods and beverages served to 2- to 5-year-olds by type of child care and participation in the federally funded Child and Adult Care Food Program (CACFP). Methods: A statewide survey of child care providers ( n = 429) was administered. Licensed child care was divided into six catego - ries: Head start centers, state preschools, centers that participate in CACFP, non-CACFP centers, homes that participate in CACFP, and non-CACFP homes. Results: CACFP sites in general, and Head start centers in particular, served more fruits, vegetables, milk, and meat/meat alterna - tives, and fewer sweetened beverages and other sweets and snack-type items than non-CACFP sites. Reported barriers to providing nutritious foods included high food costs and lack of training. Conclusions: CACFP participation may be one means by which reimbursement for food can be increased and food offerings improved. Further research should investigate whether promoting CACFP participation can be used to provide healthier nutrition environments in child care and prevent obesity in young children.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides nutritious food and nutrition and breastfeeding education to low-income pregnant and postpartum women, and ...

Objective This study examined Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participant use and satisfaction with jarred baby foods, assessed preference for cash value vouchers (CVVs) for fruits and vegetables vs jarred baby foods, and examined whether preferences varied among selected ethnic groups. Methods A survey of California WIC participants and statewide redemption data were used. Results Participants reported high satisfaction with the CVV for fruits and vegetables and jarred baby foods, with statistically significant variation across ethnic groups. About two thirds of all participants reported a preference for CVVs for fruits and vegetables over jarred baby foods. Redemption data indicated declining redemption rates for jarred fruits and vegetables with increasing age of the infant across all ethnic groups. Conclusions and Implications Although the addition of jarred fruits and vegetables to the food package for infants ages 6–11 months was well received, many caregivers want the option to choose between jarred foods and fresh fruits and vegetables.

The prevalence of obesity among children in the United States has increased rapidly during the past few decades. Research into social and behavioral determinants of obesity could lead to innovative strategies for prevention. The objective of the present study was to examine the association between childhood obesity and preschool enrollment and number of hours in child care among low-income preschool-aged children who were participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). We conducted a case–control study including 556 3- to 4-year-old children who were either obese (BMI > 95th percentile of reference standard) or normal-weight (BMI 25–75th percentile). The population was largely (96%) Hispanic, an ethnic group that has one of the highest rates of overweight and obesity in adults and children in the US. In multiple logistic regression analysis, controlling for a variety of psychosocial and cognitive home environment variables, key demographics and maternal variables, the odds ratio of being obese was 0.61 for children who attended preschool more than 4 days a week (95% CI: 0.41–0.90). Watching television or videos for an hour or more on a typical day (odds ratio 1.71 (95% CI 1.07–2.75)), and higher maternal BMI (odds ratio 1.08 (95% CI 1.05–1.11)) were independently related to odds of obesity. The impact of preschool attendance and TV viewing are potentially instructive in terms of preventive interventions for children at this age.

OBJECTIVE: This article describes the impact of a bilingual literacy intervention conducted with nearly 118 000 children in Special Supplemental Nutrition Program for Women, Infants and Children (WIC) sites in Los Angeles County, California. METHODS: All WIC participants at 6 WIC sites in Los Angeles County participated in the literacy intervention. Three cohorts of participants were selected to participate in the evaluation of the intervention. A control group of 200 families received no intervention, 103 families received 2 years of intervention, and 102 families received 4 years of intervention. Participants were predominantly Hispanic (92%), 3- to 4-year-old children and their parents. All families had low income levels, and more than one-half were Spanish-speaking. School readiness assessments were conducted with the children; parent literacy resources and activities at home were observed. Structural equation modeling was used to allow for simultaneous testing of relationships between variables. RESULTS: The Spanish-speaking subset showed a strong intervention effect. Among Spanish speakers, the 4-year intervention group (P < .001) and the 2-year intervention group (P < .05) had significantly higher school readiness scores, compared with the control group. The structural equation model revealed that exposure to the intervention significantly enhanced literacy resources and activities at home, which in turn led to greater school readiness. CONCLUSION: WIC-based literacy intervention significantly increased low-income, Spanish-speaking children's school readiness.

The purpose of this research was to examine relationships between eating behaviors and the cognitive environment in primarily Hispanic low-income households with young children receiving WIC benefits in Los Angeles County. Survey data were collected from 3645 low-income families with children age 12-65 mo in Los Angeles County. Eating behaviors were measured through questions about fruit, vegetable, milk, soft drink, and fast food intake. The cognitive environment was evaluated through questions on the home literacy environment (HLE), reading frequency, and preschool enrollment. All healthy eating behaviors measured were significantly and positively associated with reading frequency and HLE scores after adjustment for confounders. HLE and reading frequency scores were 18% and 14% higher, respectively, in children eating two or more servings of fruit per day and 12% and 9% higher, respectively, in children eating three or more servings of vegetables per day. Preschool enrollment was not significantly associated with any eating behavior. Outcomes varied by language-ethnic groups and child sex. Results suggest that healthy eating behaviors are positively associated with stronger cognitive environments in low-income Hispanic families with young children. Interventions to prevent childhood obesity in this group may therefore benefit from including a home literacy component.

Objective To explore the impact of the new Special Supplemental Nutrition Program for Women, Infants and Children (WIC) food package on WIC participant consumption of fruit, vegetables, whole-grain food, and lower-fat milk. Design Telephone surveys of cross-sectional samples of California WIC families before and after the changes to the food package. Participants Random samples of pregnant or postpartum women and/or caregivers of children enrolled in WIC: 3,004 in September, 2009; 2,996 in March, 2010. Main Outcome Measures Consumption of fruit, vegetables, whole-grain food, and lower-fat milk. Analysis Comparisons of outcome variables were made by examining the differences by time point, adjusted for sociodemographic variables, using ANOVA (for means) or logistic regression (for percentages). Results Following the changes to the WIC food package, consumption of whole-grain food increased by 17.3 percentage points, a 51% increase over baseline. Caregivers and children who usually consumed whole milk decreased by 15.7 and 19.7 percentage points, respectively, a 60%-63% reduction over baseline. Accompanying increases in lower-fat milk consumption were demonstrated. Small but significant increases in consumption of fruits and vegetables were also observed. Conclusions and Implications Federal policy changes to the WIC program had the intended effect of increasing consumption of the prescribed food items.

Objectives. We examined the efficacy of brief intervention as a technique to help pregnant women achieve abstinence from alcohol. A second aim was to assess newborn outcomes as a function of brief intervention. Methods. Two hundred fifty-five pregnant women who were participants in the Public Health Foundation Enterprises Management Solutions Special Supplemental Nutrition Program for Women, Infants, and Children and who reported drinking alcohol were assigned to an assessment-only or a brief intervention condition and followed to their third trimester of pregnancy. Brief intervention consisted of 10- to 15-minute sessions of counseling by a nutritionist, who used a scripted manual to guide the intervention. Newborn outcomes of gestation, birth-weight, birth length, and viability were assessed. Results. Women in the brief intervention condition were 5 times more likely to report abstinence after intervention compared with women in the assessment-only condition. Newborns whose mothers received brief intervention had higher birthweights and birth lengths, and fetal mortality rates were 3 times lower (0.9%) compared with newborns in the assessment-only (2.9%) condition. Conclusions. The success of brief intervention conducted in a community setting by nonmedical professionals has significant implications for national public health policies.

This study, an expansion of an earlier study of parenting behaviors of anxious mothers, examined the relationship of both mother and child anxiety disorders to mother behavior in parent--child interactions. Participants were 68 mother--child dyads with children ranging in age from 7 to 15 years. Mothers and children completed diagnostic evaluations and engaged in conversational tasks; behaviors were rated by coders who were blind to diagnosis. Mothers of anxious children, regardless of their own anxiety, were less warm (p

The present study had two aims: (1) to examine the prevalence rates of prenatal alcohol consumption in a group of women participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Southern California, with special emphasis on Hispanic women, and (2) to identify variables associated with postconception drinking in low-income minority women.The study employed a cross-sectional survey that assessed alcohol use rates, demographic variables, and alcohol risk status. Participants were 826 pregnant women enrolled in the Public Health Foundation Enterprises (PHFE) WIC Program in Los Angeles and Orange counties, California. Pregnant women who enrolled self-administered a specially designed alcohol screener.Findings were that 24% of sample women were consuming alcohol post conception. Of that percentage, approximately two thirds drank prior to pregnancy recognition, and one third continued to drink after pregnancy was confirmed. Approximately 30% of white non-Hispanic, black non-Hispanic and English-speaking Hispanic women were found to drink post conception compared with 15.8% of Spanish-speaking Hispanic women. This finding supported recent research that suggests more acculturated Hispanic women tend to incorporate the drinking patterns of the larger U.S. population to a greater extent than less acculturated Hispanic women. Although a number of demographic variables differentiated women who were abstinent from those who were postconception drinkers, the best predictor of postconception alcohol consumption was the woman's high-risk drinking score as measured by the TWEAK (sensitivity = 70.1%, specificity = 88.5%).Results suggest the importance of screening low-income minority pregnant women in a community setting so that interventions can be initiated to prevent fetal alcohol syndrome and related conditions.

A previous longitudinal three-country study in Egypt, Kenya and Mexico found significant positive associations between intake of animal source foods (ASF) and growth, cognitive development and physical activity. To test for a causal relationship, a controlled school feeding intervention study was designed to test the hypotheses that ASF would improve micronutrient status, growth and cognitive function in Kenyan primary school children. Twelve rural Kenyan schools with 554 children were randomized to four feeding interventions using a local vegetable stew as the vehicle. The groups were designated as Meat, Milk, Energy and Control, who received no feedings. Feeding was carried out on school days for seven terms during 21 mo. Preintervention baseline measures included nutritional status, home food intake, anthropometry, biochemical measures of micronutrient status, malaria, intestinal parasites, health status and cognitive and behavioral measures. The measurements of each child were repeated at intervals over 2 y. Baseline data revealed stunting and underweight in approximately 30% of children and widespread inadequate intakes and/or biochemical evidence of micronutrient deficiencies, particularly of iron, zinc, vitamins A and B-12, riboflavin and calcium. Little or no ASF were eaten and fat intake was low. Malaria was present in 31% of children, and hookworm, amebiasis and giardia were widely prevalent. The outcomes measured were rates of change or increase during the intervention in cognitive function, growth, physical activity and behavior and micronutrient status. Hierarchical linear random effects modeling was used for analysis of outcomes.

Purpose. To increase the report of prenatal alcohol use in a community setting. Methods. A self-administered alcohol screening tool was developed and introduced at 12 randomly selected sites that administer the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). A matched sample of 12 WIC sites continued to use the existing verbal standard of care for assessing alcohol use. Results. Rates of reported prenatal alcohol consumption at the 12 WIC intervention sites were compared with rates at 12 control WIC sites using a repeated-measures analysis of variance (ANOVA) and independent-samples t-tests. Within 8 months of study commencement, rates of reported prenatal alcohol consumption were significantly higher at the intervention sites than at the control sites. Discussion. Use of a brief, self-administered screening tool in the WIC setting significantly increased reports of prenatal alcohol use, a key first step in the reduction of prenatal alcohol use. The WIC setting represents an excellent place to address the significant public health issue of prenatal alcohol exposure.

Multiple studies have documented significant IQ gains over time, a phenomenon labeled the Flynn effect. Data from 20 industrialized nations show massive IQ gains over time, most notably in culturally reduced tests like the Raven's Progressive Matrices. To our knowledge, however, this is the first study to document the Flynn effect in a rural area of a developing country. Data for this project were collected during two large studies in Embu, Kenya, in 1984 and 1998. Results strongly support a Flynn effect over this 14-year period, with the most significant gains found in Raven's matrices. Previously hypothesized explanations (e.g., improved nutrition; increased environmental complexity; and family, parental, school, and methodological factors) for the Flynn effect are evaluated for their relevance in this community, and other potential factors are reviewed. The hypotheses that resonate best with our findings are those related to parents' literacy, family structure, and children's nutrition and health.

The purpose of this study was to describe psychiatric disorders exhibited by children with prenatal alcohol exposure. Twenty-three children between the ages of 5 and 13 years who were referred to the UCLA Fetal Alcohol and Related Disorders Clinic because of heavy exposure to alcohol in utero were evaluated. Children with intelligence quotients of 70 and above and their families were interviewed by the study child psychiatrist and psychologist and psychiatric diagnoses were based upon DSM-IV diagnostic criteria. Inter-observer reliability of diagnosis was established comparing clinical diagnoses with diagnoses made using the "best-estimate" procedure. For the best estimate method, items from the Child Behavior Checklist, the Fetal Alcohol Behavior Scale, the Child Symptom Inventory-4, the Conners' Rating Scale, as well as information from historical records were reviewed by two experienced clinicians who were blind to the diagnostic and alcohol exposure status of the children. Approximately 87% of the sample met criteria for a psychiatric disorder. The majority of the children (61%) were assigned a mood disorder diagnosis. Twenty-six percent were diagnosed with major depressive disorder or adjustment disorder with depressed mood and 35% met criteria for bipolar disorder. Psychiatric disorders are common in children with prenatal alcohol exposure. In particular, these children seem to be highly vulnerable to mood disorders. There is a need for training in how to recognize the physical and behavioral phenotypes of children with prenatal alcohol exposure so that appropriate treatment can be initiated early.

The present study assessed interactions between anxious mothers and their children, using observational techniques to elucidate potential mechanisms of anxiety transmission. Results revealed that anxious mothers were less warm and positive in their interactions with their children, less granting of autonomy, and more critical and catastrophizing in comparison with normal control mothers. Maternal anxiety status appeared to be the primary predictor of maternal warmth during interactions. Child anxiety status was most predictive of maternal granting of autonomy behavior. Maternal behaviors exhibited during interactions were the most salient predictors of child anxiety, contributing more than maternal psychopathology or ongoing strain to the development of child anxiety. Interventions focusing on family interactions that take into account the contributions of both members of the dyad may be more effective in curbing transmission than interventions that solely address maternal or child symptomatology.

Assessments of infant sociability motoric capacities and nutritional factors were performed to elucidate early influences on infant development in an undernourished Kenyan population. In this longitudinal study infant social skills were assessed using both the Bayley Behavior Record and home observations during the first 6 months of the infants lives. Abilities were measured using an adapted version of the Bayley scales of infant development at 6 and 30 months and a short battery of cognitive measures at 5 years. Infant size measurements were used as indicators of infant nutritional status. Shorter and lighter infants and those infants showing growth faltering in weight attainment were significantly less sociable at 6 months than infants who were taller and maintained heavier weights. Infants with smaller arm circumferences displayed lower motor scores at 6 months and lower Bayley mental scores at 30 months than infants with greater arm circumferences. Furthermore infants who were more motorically able and socially adept at 6 months had higher Bayley scores at 30 months and higher verbal comprehension scores at 5 years. (authors)

Objective: To conduct the Master Food Volunteer (MFV) Program to address obesity. Use of Theory or Research: In Virginia, obesity has increased 100% in the last decade, and research shows that 62% of adults and 30% of youths are overweight or obese. Because of high rates of obesity and chronic diseases, there is a need for educating consumers. Target Audience: Adults interested in promoting nutrition and physical activity in their communities. Description: With limited staff and need for programming to address obesity, the MFV Program fills the gap in service by training volunteers for program delivery. Volunteers received 30 hours of training through lecture series, cooking classes, demonstrations, and learning stations. Evaluation: Volunteer knowledge was evaluated through a competency examination. A postsurvey was conducted, and 78% indicated they plan to increase the quantity/number of fruits, and 74% indicated they plan to increase the quantity/number of vegetables and whole grains they eat daily. Fifty-six percent plan to increase physical activity to at least 30 minutes on most days of the week. Conclusions and Implications: Volunteers reached 744 participants through wellness programs. Volunteers are reciprocating 30 hours of service, which will extend program delivery by nearly 900 hours. This program is a model for community outreach to benefit thousands of families. A $1,500 grant was received and the training facility was an in-kind donation valued at $1,000. Financial support of food was secured from Virginia Beef Council, Virginia Egg Council, U.S. Apple Association, Ukrop’s Supermarkets, and Whole Foods.

With the exception of iodine and Fe, there is still very limited information on the effect of micronutrients on cognitive function, especially among school-age children. The present analysis evaluates the relationship between dietary Fe, Zn and B vitamins (B12, B6, folate and riboflavin) and gains in cognitive test scores among school children in rural Kenya. Data for the present study were obtained from The Child Nutrition Kenya Project, a 2-year longitudinal, randomised controlled feeding intervention study using animal source foods. Dietary nutrient values were based on monthly and bimonthly 24 h recall data collected during the study period. In longitudinal regression analyses, available Fe, available Zn, vitamin B12 and riboflavin showed significant relationships with improved cognitive test scores, after controlling for confounders such as energy intake, school, socio-economic status and morbidity. Available Fe intake was associated with significantly higher gains in Raven's Coloured Progressive Matrices test scores over time. Available Zn intake was associated with significantly higher gains in digit span-total test scores over time, while vitamin B12 and riboflavin intakes were each associated with significantly higher gains in digit span-forward test scores over time. This analysis demonstrates the influence of improved dietary micronutrient status on school children's cognitive function.