Table Of Content

Historic, Archive Document Do not assume content reflects current scientific knowledge, policies, or practices. WIC ysg^ Nutrition Education Assessment Study United States Departmentof Agriculture Foodand Nutrition Service Officeof Analysisand Final Report Evaluation United States Department of Agriculture I 1 National Agricultural Library WIC Nutrition Education Assessment Study Final Report February 1999 Preparedfor: Janet Tognetti Schiller U.S. Dept. ofAgriculture Food and Nutrition Service 3101 Park Center Drive Alexandria, VA 22302 Preparedby: Mary Kay Fox Nancy Burstein Jenny Golay Cristofer Price Abt Associates Inc. 55 Wheeler Street MA Cambridge, 02138 Table of Contents Page List ofExhibits iii Acknowledgments vi Executive Summary vii Chapter 1: Introduction 1-1 The WIC Program 1-1 Overview of the Study 1-4 The Study Sample 1-10 Organization ofThis Report 1-12 Chapter 2: Characteristics ofWIC Nutrition Education Offered in Study Sites 2-1 Nutrition Education Observations 2-1 General Characteristics of Nutrition Education Contacts 2-2 Nutrition Education Staff 2-6 Breastfeeding Promotion Programs 2-8 Staff/Participant Interactions 2-9 Physical Environment 2-12 Topics Covered in WIC Nutrition Education Contacts 2-15 Referrals to Health and Social Services 2-17 Chapter 3: Participants' Receipt ofNutrition Education Contacts 3-1 Number ofWIC Nutrition Education Contacts Received 3-1 Information and Advice Provided by WIC Staff 3-5 Relationship Between Nutrition Education Offered and Received 3-13 Chapter 4: Changes in Participants' Knowledge, Attitudes, and Behaviors Over Time 4-1 Data Sources and Variables 4-1 Nutrition Knowledge 4-2 Nutrition-related Attitudes and Perceptions 4-10 Nutrition-related Behaviors 4-15 Other Behaviors 4-24 Changes Among Selected Subgroups 4-28 AbtAssociates Inc. Table ofContents i Table of Contents (continued) Page Chapter 5: Participants' Satisfaction with WIC Nutrition Education 5-1 Satisfaction with Components ofWIC Nutrition Education 5-1 Knowledge Gained from WIC 5-4 Best and Worst Aspects ofthe WIC Program 5-7 Suggestions for Improvement 5-11 Overall Satisfaction with WIC Nutrition Education 5-13 Relationship Between Satisfaction and Nutrition Education Experiences .... 5-15 Chapter 6: Attitudinal and Social Influences on Selected Behaviors 6-1 Factors Influencing Women's Breastfeeding Intentions and Behaviors 6-1 Influence of Social Support on Behaviors During Pregnancy 6-7 References Appendix A Prenatal Survey Appendix B WIC Record Abstraction Form Appendix C Nutrition Education Observation Forms Appendix D Supplementary Exhibits AbtAssociates Inc. Table ofContents ii List of Exhibits Page Exhibit 1.1 Data Collection Components, Timing, and Schedule 1-8 Exhibit 1.2 Sample Sizes and Response Rates by Data Collection Component 1-11 Exhibit 1.3 Demographic Characteristics ofBaseline Sample 1-13 Exhibit 1.4 Household Characteristics of Baseline Sample 1-15 Exhibit 1.5 Characteristics of Baseline Sample Members in Comparison to Data from 1994 Census ofWIC Participants 1-17 Exhibit 2.1 Characteristics of Prenatal Nutrition Education Contacts in Study Sites .... 2-3 Exhibit 2.2 Characteristics of Postpartum Nutrition Education Contacts in Study Sites 2-7 . . Exhibit 2.3 Characteristics ofBreastfeeding Promotion Programs in Study Sites 2-9 Exhibit 2.4 Quality of Staff/Participant Interactions in Observed Nutrition Education Contacts 2-11 Exhibit 2.5 Quality ofStaff/Participant Interactions Related to Breastfeeding Promotion 2-13 . Exhibit 2.6 Environmental Characteristics ofObserved Nutrition Education Contacts 2-14 Exhibit 2.7 Topics Covered in Prenatal Certifications 2-16 Exhibit 2.8 Referrals Made During Observed Nutrition Education Contacts 2-18 Exhibit 3.1 Prenatal Nutrition Education Contacts: Opportunity For and Receipt ofTwo Contacts 3-2 Exhibit 3.2 Reported Frequency of Proxy Voucher Pick-ups Between Certification and the Prenatal Survey 3-4 Exhibit 3.3 Frequency and Timing ofPostpartum Certification 3-6 Exhibit 3.4 Receipt ofTwo Postpartum Nutrition Education Contacts 3-7 Exhibit 3.5 Nutrition Education Topics Assessed in Prenatal and Postpartum Surveys 3-8 . . Exhibit 3.6 Participant Self-Reports About Referrals Received From WIC Staff 3-12 Exhibit 3.7 Participant Self-Reports About Follow-up on Referrals Received from WIC Staff 3-13 AbtAssociates Inc. Listof Exhibits iii List of Exhibits (continued) Page Exhibit 4.1 Sample Sizes for Analyses Comparing Baseline and Follow-up Measures ofKnowledge, Attitudes, and Behaviors 4-2 Exhibit 4.2 Items Used to Assess Nutrition Knowledge 4-3 Exhibit 4.3 Overall Nutrition Knowledge Scores 4-5 Exhibit 4.4 Knowledge About Breastfeeding 4-6 Exhibit 4.5 Knowledge About Recommended Infant Feeding Practices 4-7 Exhibit 4.6 General Nutrition Knowledge 4-8 Exhibit 4.7 Knowledge About Healthy Practices During Pregnancy 4-9 Exhibit 4.8 Mean Baseline Knowledge Scores by Prior WIC Participation 4-11 Exhibit 4.9 Nutrition Attitude Measures: Mean Scores 4-12 Exhibit 4.10 Use ofPrenatal Vitamins 4-16 Exhibit 4.11 Use ofPrenatal Iron Supplements 4-17 Exhibit 4.12 Reported Daily Consumption ofWIC Foods 4-18 Exhibit 4.13 Reported Daily Consumption ofNon-WIC Foods 4-21 Exhibit 4.14 Breastfeeding Intentions and Behaviors 4-22 Exhibit 4.15 Food Items Included in Infant Feeding Inventory 4-24 Exhibit 4.16 Prevalence ofUndesirable Infant Feeding Practices Before Two Months ofAge 4-25 Exhibit 4.17 Prevalence ofUndesirable Infant Feeding Practices Before Four Months ofAge 4-26 Exhibit 4.18 Self-Reported Use ofCigarettes and Alcohol 4-27 Exhibit 4.19 Reported Use ofOver-the-Counter Medications 4-29 Exhibit 4.20 Summary of Significant Changes for Key Subgroups 4-31 AbtAssociates Inc. ListofExhibits iv