# Presentation: 748120

## Health and CaseloadEvaluation of 1995 WIC Prenatal Program

**Presented by: Victoria Lazariu-Bauer **
**                         ****vgl01@health.state.ny.us**
**Authors: Victoria Lazariu-Bauer, **M.Sc.,** Howard Stratton, **Ph.D.,**                                     ****	****    Robert Pruzek, **Ph.D.,** Mary Lou Woelfel, **M.A.

## Conclusions

**Outline for this presentation:**

**Introduction**

**Description of data and variables**

**Results**

##  Introduction

- WIC participants are a self-selected group.
- Factors associated with  birth outcomes influence the decision to enroll on WIC ‘early’ or ‘late’ during the pregnancy.
- Selection bias: “bias introduced by the nonrandom 			        process of selecting participants”.
-                                                        Paul R. Rosenbaum, “Observational Studies”, Springer-Verlag 1995

**Notes:**
1. Some pregnant women might decide to enroll on WIC soon after they find out that they are pregnant for different reasons such as they are very concerned about the health of their baby and they know they need the better nutrition that WIC foods and recommendations ensures. 
Other women end up enrolling in the program a few months after they find out that they are pregnant. This could be because WIC services are not easily accessible in the area they live.
Such differences between participants increase or decrease their chances of enrolling and remaining in the program.

2. Direct comparisons between the two types of participants provide biased information about the effect of the program. The mothers that stayed longer could be a healthier group and might have had better outcomes than the mothers that stayed for a shorter period of time even in the absence of the program. 
The goal of the program is to improve the nutritional status of of high-risk low-income women. Therefore, if the early participants are more likely to have poor birth outcomes in the absence of the program then the direct comparison with the late participants will understate the effect of the program.

## Introduction

- Present preliminary results of the
- effects of WIC participation on the
- outcome of the pregnancy:
**birth weight of the baby.**

**Notes:**
In this study all subjects are WIC prenatal participants.

## Description of the data

- Prenatal WIC records were matched to:
- 		 NYS 1995 birth records
- 		 WIC check redemption records
- 		 WIC administrative records
-  Criteria to include participants in the study:
- 		Participant cashed at least one check before delivery
- 		Participant did not skip cashing checks for more than
-     	            three months.
- 77,601 prenatal WIC participants who delivered in 1995.

**Notes:**
Three months because this is one third of the pregnancy and we considered that any effect due to WIC benefits will wash out in three months; also if participant missed the appointment for picking up the checks the process of rescheduling and reissuing new checks could take three months.

## Variables explored :

**	****Number of  months of WIC prenatal participation**
**Organizational characteristics****    **
**	****	**1. NYS WIC region
- 		2. Average caseload per certified professional authority  in WIC agencies
- 		3. Farmers market participation
** ****Socio-economic characteristics of the neighborhood**
- 1. Unmet need : 	county level % of people eligible to receive WIC services 	            	but not enrolled on WIC.
- 2. % children age 0-4 in families with incomes under 185% poverty level 		for 1995.
- 3. % related children age 0-4 in families with incomes under 100% poverty 		level for 1995.

**Notes:**
Number of months on WIC is measured as number of months when the participant cashed checks in order to ensure that the people included in this study received the WIC benefits.

## Variables explored :

**Mother’s demographic and medical characteristics**
**	****	**Age
- 		Level of education
- 		**Race/Ethnicity**
- 		Inferred marital status
- 		Parity
- 		Prepregnancy BMI
- 		Employment during pregnancy
- 		Alcohol, tobacco, drug use during pregnancy
- 		Medical history
- 		Number of family members on WIC
- 		**Adequacy of prenatal care utilization** (Kotelchuck Index)

**  ****Travel distance from participant residence to the WIC site**

## Number of  months of WIC prenatal participation

**                                 ****Cumulative    Cumulative**
**   ****#    Frequency     Percent     Frequency      Percent**
**_________________________________________________________**
**   ****1        4182        5.39          4,182         5.39**
**   ****2        6982        9.00         11,164        14.39**
**   ****3        8554       11.02         19,718        25.41**
**   ****4       10122       13.04         29,840        38.45**
**   ****5       12444       16.04         42,284        54.49**
**   *****6       13496       17.39         55,780        71.88***
**   ****7       11978       15.44         67,758        87.32**
**   ****8        6626        8.54         74,384        95.85**
**   ****9        1937        2.50         76,321        98.35**
**  ****10        1278        1.65         77,599       100.00**
**  ****11           2        0.00         77,601       100.00**

**Notes:**
The largest category of participants stay on WIC for 6 months which represents almost two trimesters of pregnancy. 

## 3 months or less      2145        35.99    late

**Participants who had Preterm Babies (born 28-36 weeks of gestation)**
**          ****enroll    Frequency     Percent **
**_________________________________________**
**6 months or more      1762        29.56     ****early**
**4-5 months            2053        34.45 **
**3 months or less      2145        35.99****    ****late**

**Participants who had Full Term Babies (born 37-44 weeks of gestation)**
-           **enroll    Frequency     Percent**
**_________________________________________**
**7 months or more       18379       30.05****	****     ****early**
**5-6 months             20694       33.84**
**4 months or less       22087       36.11****	****     ****late**

##  Organizational characteristics:

**a. NYS WIC Region:**** **
**	**
**	****region         Frequency     Percent**
**	****____________________________________**
**	****Albany             8,799       11.34          **
**	****Syracuse           5,866        7.56**
**	****Western           10,045       12.94**
**	****New York City     44,547       57.41**
**	****Suburban NYC       8,344       10.75**

## b. Average Caseload per Certified Professional      Authority (CPA) in WIC Agencies

##  Travel distance from participant residence       to WIC site

## Results	

** ****Race/Ethnicity Groups on WIC**

**Results****	**

** ****WIC and Prenatal Care**

##  WIC Effect by Duration of Pregnancy

**Participants with full term pregnancies:**
**	****	****Early - Late = 68 grams**
**	****	****	****	**** ****2.4 oz**
**Participants with preterm pregnancies:**
**	****	****Early - Late = 129 grams**
**	****	****	****	**** ****4.5 oz**

##   Race/Ethnicity Groups on WIC

**Participants with full term pregnancies:**
-   White, Non-Hispanic 	N= 14,938
-   Black, Non-Hispanic   	N= 11,099
-   Hispanic                      	N= 12,214

##  WIC and Prenatal Care

**Kotelchuck’s Index of Adequacy of Prenatal Care Utilization**

##  WIC and Prenatal Care

** ****WIC and Prenatal Care**

## Conclusion

- Outreach is **critically** important:
- 	women with longer participation have better outcomes.
- This analysis reveals new aspects of WIC data:
- The participation patterns and participants characteristics differ across regions in NYS in the following way:
**New York City** resembles **Western**** **and **Suburban NYC** regions, but is different from the similar
**Albany** and **Syracuse** regions.