Economic 

Research 

Service

Electronic Publications from the Food Assistance & Nutrition Research Program

Nutrition and Health Characteristics

of Low-Income Populations

Volume II, WIC Participants 

and Nonparticipants

By Nancy Cole and Mary Kay Fox, Abt Associates Inc.

ERS project representative: Biing-Hwan Lin, 202-694-5458,

blin@ers.usda.gov

Abstract

Data from the Third National Health and Nutrition Examination Survey (NHANES-III),

conducted in 1988-94, were used to compare the nutrition and health characteristics of 

participants and nonparticipants in the Special Supplemental Nutrition Program for

Women, Infants, and Children (WIC). This research was designed to establish a baseline

from which to monitor the nutritional and health characteristics of WIC participants and

nonparticipants over time. Because of age-based variations in the survey protocols and

small samples of pregnant and postpartum women, data were not consistently available

among women, infants, and children. Data availability was the richest for children and

most limited for pregnant women.

E-FAN-04-010-2

December 2004

This report was prepared by Abt Associates Inc., under a research 

contract for the Economic Research Service. The views expressed are

those of the authors and not necessarily those of ERS or USDA.
ii

Acknowledgments

The authors wish to acknowledge the invaluable contributions of Ellie Lee, who completed all of the 

special programming required to estimate usual dietary intakes, and Nancy Burstein, who served as 

technical reviewer and offered many comments that improved the report. We also acknowledge Andrew 

McLaughlin, who diligently checked and proofed the report, and Linda Hatcher of the Economic 

Research Service, who completed the final copy edit. Thanks are also due to our project officer at the 

Economic Research Service, Biing-Hwan Lin, who along with colleagues Betsy Frazao, David 

Smallwood, Margaret Andrews, and Joanne Guthrie, generated the idea that resulted in this series of 

reports. Kevin Dodd at the National Cancer Institute and Alicia Carriquiry at the University of Iowa are 

also acknowledged for the consultation and advice they provided to staff at ERS and Abt Associates in 

conceptualizing and implementing the approach used to estimate usual dietary intakes. Finally, the report 

benefited from thoughtful review and critique by Betsy Frazao of the Economic Research Service, Andi 

Carlson of the Center for Nutrition Policy and Promotion, and Jay Hirschman of the Food and Nutrition 

Service. 
iii

Contents

Acknowledgments............................................................................................................................... ii

Executive Summary............................................................................................................................ ix

Chapter One: Introduction .................................................................................................................... 1

The WIC Program................................................................................................................... 2

Program Eligibility ............................................................................................................. 2

Program Participation......................................................................................................... 3

Program Benefits............................................................................................................... 3

Supplemental Foods..................................................................................................... 3

Nutrition Education...................................................................................................... 4

Referrals to Health Care and Social Services ................................................................... 5

The Third National Health and Nutrition Examination Survey ........................................................ 5

Analytic Approach................................................................................................................... 5

Age and Population Adjustment........................................................................................... 6

Statistical Tests................................................................................................................. 8

Chapter Two: Usual Intake of Food Energy and Nutrients Among Children Ages 1 to 4............................. 11

Participation in the Food Stamp Program.................................................................................. 11

Household Food Sufficiency................................................................................................... 12

Meals and Snacks Consumed.................................................................................................. 13

Number of Meals Consumed............................................................................................. 13

Consumption of Breakfast ................................................................................................ 13

Number of Snacks Consumed........................................................................................... 14

Usual Intake of Food Energy and Key Nutrients........................................................................ 14

Standards Used To Assess Adequacy of Usual Intake .......................................................... 14

Food Energy ................................................................................................................... 15

Vitamin C, Iron, and Zinc ................................................................................................. 15

Calcium.......................................................................................................................... 16

Consumption of Milk and Soft Drinks.......................................................................... 17

Use of Dietary Supplements.................................................................................................... 17

Chapter Three: Healthy Eating Index Scores and Usual Intake of Dietary Fiber Among Children 

Ages 2 to 4........................................................................................................................... 19

Healthy Eating Index Scores .................................................................................................. 19

Total HEI Scores............................................................................................................. 20

Food-based Component Scores......................................................................................... 20

Nutrient-based Component Scores..................................................................................... 23

Percentage of Children Meeting Standards for HEI Nutrients: Usual Intakes vs.24-Hour 

Intakes ................................................................................................... 24

Percent of Energy from Total Fat ...................................................................... 24

Percent of Energy from Saturated Fat ................................................................ 26

Cholesterol...................................................................................................... 27
iv

Sodium........................................................................................................... 27

Usual Intake of Dietary Fiber .................................................................................................. 29

Chapter Four: Health-Related Behaviors............................................................................................... 31

Breastfeeding and Other Infant Feeding Practices...................................................................... 31

Breastfeeding .................................................................................................................. 31

Initiation and Duration of Breastfeeding........................................................................ 32

Use of Supplemental Formula Among Breastfed Infants....................................................... 33

Use of Cow’s Milk Before 12 Months of Age ..................................................................... 33

Use of a Baby Bottle......................................................................................................... 34

Introduction of Solid Foods .............................................................................................. 34

Physical Activity Among Pregnant and Postpartum Women........................................................ 35

Walking36

Weekly Frequency of Physical Activity .............................................................................. 36

Alcohol and Tobacco Consumption ......................................................................................... 36

Alcohol Consumption....................................................................................................... 37

Tobacco Consumption ..................................................................................................... 37

Exposure to Second-hand Smoke ............................................................................................ 38

Chapter Five: Health Status, Conditions, and Risks ................................................................................ 41

General Health Status ............................................................................................................. 41

Women’s Health Conditions and Risks ..................................................................................... 42

Chronic Health Conditions ............................................................................................... 42

Pregnancy and Childbirth History ...................................................................................... 42

Birth Characteristics of Infants and Children............................................................................. 43

Maternal Age................................................................................................................... 43

Maternal Smoking During Pregnancy................................................................................. 44

Birthweight (Self-Report) ................................................................................................. 44

Neonatal Intensive Care Stays ........................................................................................... 45

Health Status of Children and Infants....................................................................................... 45

Weight Status of Children................................................................................................. 46

Growth Retardation Among 2-4-year-old Children............................................................... 47

Prevalence of Iron Deficiency, Iron-Deficiency Anemia, and Anemia Among Children ............ 47

Hospitalizations Since Birth ............................................................................................... 49

Accidents, Injuries, and Poisonings Requiring Medic al Attention ........................................... 49

Chronic Respiratory Conditions......................................................................................... 50

Lead Poisoning Among Children........................................................................................ 50

Dental Health......................................................................................................................... 52

Visits to a Dentist or Dental Hygienist ................................................................................ 52

Chapter Six: Access to Health Care Services......................................................................................... 55

Health Insurance Coverage ..................................................................................................... 55

Regular Source of Health Care ................................................................................................ 56

Use of Health Care Services in the Past Year............................................................................. 57
v

References........................................................................................................................................ 59

Appendix A: NHANES-III Data Files

Appendix B: Reference Standards

Appendix C: Statistical and Reporting Guidelines

Appendix D: Detailed Tables
vi

List of tables and figures

Table 1—Number of NHANES-III respondents: WIC participants and nonparticipants................................ 7

Table 2—Age distribution of WIC participants and nonparticipants in NHANES-III sample frame and year 

2000 population ..................................................................................................................... 9

Figure 1—Percent of income-eligible 1-4-year-old children participating in the Food Stamp Program.......... 12

Figure 2—Distribution of 1-4-year-old children by household food sufficiency status................................ 13

Figure 3—Percent of 1-4-year-old children consuming fewer than three meals per day ............................. 13

Figure 4—Percent of 1-4-year-old children consuming breakfast every day ............................................. 14

Figure 5—Mean usual intake of food energy as a percent of the 1989 Recommended Energy 

Allowance: 1-4-year-old children.......................................................................................... 16

Figure 6—Mean usual intake of calcium as a percent of Adequate Intake: 1-4-year-old children.................. 16

Figure 7—Mean daily servings of milk and soft drinks: 1-4-year-old children ........................................... 17

Figure 8—Percent of 1-4-year-old children using dietary supplements in the past month............................ 18

Figure 9—Mean Healthy Eating Index (HEI) scores: 2-4-year-old children ............................................... 20

Figure 10—Distribution of total HEI scores: 2-4-year-old children........................................................... 21

Figure 11—Mean scores for HEI food-based components: 2-4-year-old children ...................................... 22

Figure 12—Percent of 2-4-year-old children meeting HEI standards for food-based components................ 22

Figure 13—Mean scores for HEI nutrient-based components: 2-4-year-old children.................................. 24

Figure 14—Percent of 2-4-year-old children meeting Dietary Guidelines recommendation for total fat: 

One-day (HEI) estimates vs. usual intake estimates............................................................... 25

Figure 15—Percent of 2-4-year-old children meeting Dietary Guidelines recommendation for saturated 

fat: One-day (HEI) estimates vs. usual intake estimates ......................................................... 26

Figure 16—Percent of 2-4-year-old children meeting Dietary Guidelines recommendation for cholesterol:

One-day (HEI) estimates vs. usual intake estimates............................................................... 27

Figure 17—Percent of 2-4-year-old children meeting Dietary Guidelines recommendation for sodium:

One-day (HEI) estimates vs. usual intake estimates............................................................... 28

Figure 18—Mean usual intake of dietary fiber: 2-4-year-old children........................................................ 29

Figure 19—Percent of infants and children ever breastfed...................................................................... 32

Figure 20—Percent of infants and children breastfed at least 6 months, among those ever breastfed........... 32

Figure 21—Percent of infants and children fed cow’s milk before 12 months of age................................. 33

Figure 22—Percent of pregnant and postpartum women engaging in physical activity ............................... 36

Figure 23—Percent of pregnant and postpartum women who consumed 12 or more alcoholic

beverages, in their lifetime and in the past year ..................................................................... 37

Figure 24—Percent of infants and children exposed to cigarette smoke at home ....................................... 38

Figure 25—Percent of nonsmoking women with high serum cotinine levels ............................................. 39

Figure 26—Self- or caregiver-reported general health status ................................................................... 42

Figure 27—Physician-assessed general health status.............................................................................. 42

Figure 28—Mean number of pregnancies and mean number of live births................................................ 43

Figure 29—Mean age of mother at birth .............................................................................................. 44

Figure 30—Percent of infants and children born to teenage mothers........................................................ 44

Figure 31—Percent of infants and children whose mothers smoked during pregnancy .............................. 44

Figure 32—Reported mean birthweight of infants and children ............................................................... 45

Figure 33—Percent of infants and children born low birthweight, based on reported birthweight................ 45

Figure 34—Percent of infants and children receiving neonatal intensive care ............................................ 46

Figure 35—Percent of children overweight and at risk of overweight ...................................................... 47

Figure 36—Percent of children with growth retardation......................................................................... 48

Figure 37—Percent of children with iron deficiency and percent with anemia/low hemoglobin ................... 49

Figure 38—Percent of infants and children with at least one hospitalization since birth .............................. 50
vii

Figure 39—Percent of children ever screened for lead poisoning............................................................. 50

Figure 40—Percent of children with high blood lead levels .................................................................... 51

Figure 41—Percent of children with high blood lead levels: NHANES-III, Phase I and Phase II.................. 52

Figure 42—Percent of children who have visited a dentist or dental hygienist........................................... 53

Figure 43—Percent of persons with private health insurance and percent with Medicaid............................ 56

Figure 44—Percent of women and children with a regular source of health care....................................... 56

Figure 45—Percent of persons with a regular physic ian or other health care provider................................ 57

ix

Executive Summary

This report describes the nutrition and health characteristics of participants and nonparticipants in the Special 

Supplemental Nutrition Program for Women, Infants, and Children (WIC), using data from the Third National 

Health and Nutrition Examination Survey (NHANES-III).1 The NHANES survey is the primary source of 

information used in monitoring the Nation’s nutrition and health status. NHANES-III was completed between 

1988 and 1994 and provides data for a large nationally representative sample of individuals.2

Data were examined for three groups that comprise the three major categories of WIC participants: pregnant 

and postpartum women, infants, and children (1-4 years of age).3 WIC participants are compared to two 

groups of nonparticipants: low-income individuals who were income-eligible for WIC (household income at or 

below 185 percent of poverty) and higher-income individuals who were not income-eligible for WIC 

(household income above 185 percent of poverty). These comparisons provide useful insights into policyrelevant questions about program targeting, for example: are low-income individuals with the greatest 

nutritional and health needs receiving WIC services? And what are the nutrition- and health-related disparities 

between WIC participants and individuals who are not constrained by low incomes? These comparisons also 

provide information on whether WIC participants do as well as other groups with respect to outcomes that 

WIC might be expected to improve. 

It should be noted that this research was not designed to assess program impacts or in any way attribute 

differences between WIC participants and nonparticipants to an effect of the program. Rather, this research 

provides a baseline from which to monitor the nutrition and health characteristics of WIC participants and 

nonparticipants over time and to generate questions and hypotheses for future research. 

A broad array of measures is used to describe the nutrition and health characteristics of WIC participants and 

nonparticipants.4 These measures include dietary intake, health-related behaviors, measures of health status, 

health conditions, and risks, and access to health care services. In reviewing findings, it is important to realize 

that many of the characteristics examined are used (or were used at the time the NHANES-III data were 

collected) as nutritional risks that qualify individuals for WIC participation. Therefore, differences observed 

between WIC participants and nonparticipants may be a reflection of criteria for selection into the program. 

All reported population estimates have been population-adjusted, or standardized according to the year 2000 

distribution of pregnant and postpartum women, infants, and children 1-4 years of age. Population adjustment 

eliminates between-group differences that are due solely to differences in the sample distribution across the 

three categories of WIC participants (women, infants, and children). Similarly, estimates reported for all 

______

1

Similar reports have been prepared for participants and nonparticipants in the Food Stamp Program (FSP) (Fox and Cole, 2004a), for school-age children 

(Fox and Cole, 2004b), and for older adults (Cole and Fox, 2004).

2Beginning in 1999, NHANES became a continuing survey. Data for the first two continuous years of the ongoing NHANES (1999-2000) have been 

released since the time the tabulations presented in this report were prepared. Data for subsequent years are expected in mid-2005. 

3

The sample of women was limited to pregnant women, nonbreastfeeding women who gave birth within the past 6 months, and breastfeeding women who 

gave birth within the past 12 months. 

4Because of age-based variations in NHANES-III data collection protocols and small samples of pregnant and postpartum women, data were not 

consistently available for the three major categories of WIC participants (pregnant and postpartum women, infants, and children). Data availability was 

greatest for children and most limited for women.
x

children have been age adjusted (based on year 2000 Census data) to eliminate between-group differences that 

are due solely to differences in the age distributions of the groups. 

Dietary Intakes of Children

Dietary intake was assessed using data from a single 24-hour recall. In addition to energy intake, the analysis 

examined intakes of nine key nutrients and dietary components: vitamin C, iron, zinc, calcium, total fat, 

saturated fat, cholesterol, sodium, and fiber. Estimates of usual intake were generated using the personal 

computer version of the Software for Intake Distribution Estimation.5 Healthy Eating Index (HEI) scores 

(Kennedy et al., 1995) were also examined. Both of these analyses were limited to children. The HEI analysis 

was limited to 2-4-year-old children because the standards used in the HEI to assess intakes of total fat, 

saturated fat, cholesterol, and sodium are not applicable to 1-year-olds. 

• Meal Consumption. Most children consume three meals per day. WIC children were more likely 

than higher-income children to consume fewer than three meals per day (16% vs. 10) and less likely 

to eat breakfast on a daily basis (88% vs. 94%). These differences were largely attributable to 

differences among 2-year-olds. 

• Energy. Usual food energy consumption was significantly higher for WIC children compared with 

nonparticipants. WIC children consumed an average of 107% of the 1989 Recommended Energy 

Allowance vs. 101% and 99% for income-eligible and higher-income nonparticipant children, 

respectively. 

• Vitamin C, Iron, and Zinc. The usual diets of virtually all 1-4-year-old children provided adequate 

amounts of vitamin C, iron, and zinc, relative to defined Estimated Average Requirements (EARs). 

There were statistically significant differences between WIC partic ipants and nonparticipants for the 

percentage of children with adequate intakes of vitamin C and iron; however, the differences were 

substantively negligible. 

• Calcium. It was not possible to assess the prevalence of adequate calcium intakes among children 

because the required dietary standard—the EAR—has not been established for calcium. The mean 

usual calcium intake of 1-4-year-old children exceeded the defined Adequate Intake (AI), suggesting 

that, overall, children’s calcium intakes were adequate.6 On average, the usual calcium intake of WIC 

children was significantly greater than the usual calcium intakes of both groups of nonparticipant 

children. In all cases, however, mean intakes exceeded the AI by a substantial margin. 

• Percent of Energy from Fat. On average, the usual diets consumed by 2-4-year-old children 

provided 33 percent of energy from fat. This level of fat intake exceeded the Dietary Guidelines for 

Americans recommendation of no more than 30 percent of total energy (U.S. Departments of 

Agriculture and Health (USDA) and Human Services (DHHS), 2000) but fell within the more recently 

defined Acceptable Macronutrient Distribution Ranges (AMDRs) for fat intake (30-40% of total 

energy for 2-3-year-olds and 25-35% for 4-year-olds) (Institute of Medicine (IOM), 2002b). Among 

______

5Because NHANES-III included a very small sample of second dietary recalls, which are needed to estimate intraindividual variation in intake, variance 

components were derived from the Continuing Survey of Food Intake of Individuals (CSFII), 1994-96 (see appendix C). 

6Mean usual intakes that exceed the AI suggest that the likelihood of inadequate intake is low. 
xi

2- and 3-year-olds, usual intakes that fell outside the AMDR tended to be lower than the 

recommended range rather than higher. In contrast, roughly 15 to 25 percent of 4-year-olds had 

usual fat intakes that exceeded the upper end of the AMDR. 

Distributions of usual fat intake showed no significant differences between WIC children and 

income-eligible nonparticipant children. In contrast, fat intakes of WIC children were significantly 

greater than those of higher-income nonparticipant children, particularly for 2-year-olds and 4-yearolds. For 2-year-olds, these differences affected the proportion of children who had usual fat intakes 

within the AMDR. For 4-year-olds, significant between-group differences were concentrated at the 

lower end of the distribution and intakes of both groups fell within the AMDR. 

• Percent of Energy from Saturated Fat. Saturated fat intake was evaluated relative to the Dietary 

Guidelines recommendation that saturated fat provide less than 10 percent of total energy (USDA and 

U.S. DHHS, 2000). On average, the usual diets of 2-4-year-old children in all three groups exceeded 

this standard. WIC children consumed significantly more saturated fat, on average, than 

nonparticipating children in the higher-income group (12.9% of usual energy intake vs. 12.1%) and 

were significantly less likely to have usual saturated fat intakes that were consistent with the Dietary 

Guidelines recommendation (6% of children vs. 17%). 

• Cholesterol. Mean usual cholesterol intakes of 2-4-year-old children in all three groups were 

consistent with the Dietary Guidelines recommended maximum of 300 mg. (USDA and U.S. DHHS, 

2000). WIC children, however, consumed significantly more cholesterol than both groups of 

nonparticipant children and were less likely than higher-income children to meet the Dietary 

Guidelines recommendation for cholesterol (82% of children vs. 96%).

• Sodium. The Dietary Guidelines recommend a maximum daily sodium intake of 2,400 mg (USDA 

and U.S. DHHS, 2000). On average, usual sodium intakes of all three groups of 2-4-year-old children 

came close to this goal, but only higher-income children actually met it. The mean usual sodium 

intake of WIC children was 2,513 mg. compared with 2,460 mg. for income-eligible nonparticipant 

children and 2,277 mg. for higher-income nonparticipant children. The difference between WIC 

children and higher-income children was statistically significant. 

Children’s usual sodium intakes exceeded the more recently defined Tolerable Upper Intake Levels 

(UL) by a substantial margin. The ULs are notably more stringent than the Dietary Guidelines 

recommendation—1,500 mg. for 2-3-year-olds and 1,900 mg. for 4-year-olds (IOM, 2004). Few 

children consumed diets that did not exceed the UL. There were few significant differences in the 

distributions of usual sodium intake of WIC children and income-eligible nonparticipant children. 

However, significant differences in the usual sodium intakes of WIC children and higher-income 

children were noted at every percentile of the distribution. In all cases, usual intake was greater for 

WIC children. Differences were concentrated among 3-year-olds. In this age group, the difference in 

usual intakes at the 10th percentile (1,637 mg. vs. 1,584 mg.) suggests that a greater proportion of 

higher-income children than WIC children consumed diets that were consistent with the sodium UL. 
xii

Healthy Eating Index Scores

• On average, 2-4-year-old children scored 70.4 out of a possible 100 on the HEI. Slightly more than a 

quarter (26%) had “good” diets, 8 percent had “poor” diets, and the majority (66%) had diets needing 

improvement. These general patterns were observed for all three groups of 2-4-year-old children and 

none of the differences in total HEI scores between WIC participants and nonparticipants was 

statistically significant. The HEI is a composite score constructed from 10 individual scores: five 

food groups (grains, vegetables, fruits, dairy, and meat), four nutrient-based components, and a 

variety score. 7

• The HEI food consumption goal that presented the greatest difficulty for 2-4-year-old children was 

the goal for vegetable consumption. Mean scores for the vegetable component of the HEI ranged 

from 4.8 to 5.1, compared with a perfect score of 10, and less than one-quarter of the children in 

each group consumed the recommended number of daily vegetable servings. 

• The only difference in food-based HEI component scores of WIC children and income-eligible 

nonparticipant children was observed for the fruit component (WIC children scored significantly 

higher with a score of 6.4 vs. 5.3). WIC food packages include 100% fruit juices, which are counted 

in the fruit component of the HEI. 

• Differences in food-based HEI component scores of WIC children and higher-income nonparticipant 

children were observed for the dairy and meat scores. WIC children had significantly lower mean 

scores for the dairy component, although the size of the difference was relatively small (7.8 vs. 8.2). 

WIC children had significantly higher scores for the meat component and the difference in scores 

was substantial (7.0 vs. 5.7). WIC food packages include eggs, peanut butter, and dried beans and 

peas—all foods that are considered in the meat component of the HEI. 

Health-Related Behaviors

Breastfeeding

Official WIC policy has always encouraged breastfeeding, while at the same time providing access to infant 

formula for nonbreastfeeding infants. The focus on breastfeeding promotion increased during the late 1980s 

and early 1990s. Therefore, NHANES-III data were collected during a time when WIC breastfeeding 

promotion strategies were evolving and do not reflect current program policies and procedures in this area. 

For this reason, NHANES-III breastfeeding data for WIC participants must be interpreted with caution. 

• At the time NHANES-III data were collected, 54 percent of all infants and children under the age of 5 

had been breastfed for some period of time. Among those ever breastfed, 41 percent had been 

breastfed for at least 6 months and 16 percent had been breastfed for at least a year. 

• WIC infants were significantly less likely to have ever been breastfed than either income-eligible or 

higher-income nonparticipant infants (39% vs. 51% and 71%). Among infants ever breastfed, WIC 

______

7

The nutrient-based components compare intakes to recommendations included in the Dietary Guidelines for Americans and in the National Research 

Council’s Diet and Health report (NRC, 1989b).
xiii

infants were significantly less likely than higher-income infants to have been breastfed for 6 months 

(31% vs. 42%).

• WIC children 1-4 years of age were significantly less likely than higher-income children to have ever 

been breastfed (41% vs. 67%). Among children who were breastfed as infants, however, there were 

no differences between WIC participants and nonparticipants in the percentage breastfed for 6 

months or more, the percentage breastfed for a year or more, or in the mean duration of 

breastfeeding. 

• Overall, breastfed WIC infants were significantly more likely to receive supplemental formula than 

breastfed infants in either of the nonparticipant groups (91% vs.81% and 78%). In addition, breastfed 

WIC infants were fed formula on a daily basis at a significantly younger age than higher-income 

breastfed infants (6.6 weeks vs. 9.1 weeks). 

• Among 1-4-year-old children who had been breastfed, there were no significant differences, overall, 

between WIC participants and either group of nonparticipants in the percentage who never received 

supplemental formula or in the age at which formula was first fed on a daily basis. 

Infant Feeding Practices

• WIC infant feeding guidelines, as well as guidelines issued by the American Academy of Pediatrics 

(AAP), recommend that cow’s milk not be introduced until 12 months of age (USDA, FNS, 2003c 

and AAP, 2003). Early introduction of cow’s milk was significantly less common for WIC infants 

and children than for infants and children in either of the nonparticipant groups (11% vs. 27% and 

18% for infants and 31% vs. 46% and 41% for children). 

• It is recommended that infants be fed beverages from cups rather than bottles as soon as they are 

able to sit erectly on their own. At about a year of age, there was a noteworthy decline in use of baby 

bottles in all three groups of children. However, the rate of decline was significantly slower for WIC 

children than for higher-income children. At each year of age, the proportion of children using a baby 

bottle was significantly greater for WIC participants than for higher-income nonparticipants. 

• Recommended infant feeding practices suggest that infants not receive solid foods before they are 4 

months old (USDA, FNS, 2003c and AAP, 2003). WIC infants and children were no more or less 

likely than nonparticipant infants and children to be fed solid foods before they were 4 months of age. 

On average, however, WIC children were significantly older than higher-income children (6.3 months 

vs. 5.5 months) when they began to eat solid foods on a daily basis.

Physical Activity Practices of Pregnant and Postpartum Women

• Pregnant and postpartum women enrolled in WIC were about as physically active as income-eligible 

nonparticipants, but less physically active than higher-income nonpartic ipants.8 Twenty-seven 

percent of WIC women engaged in some physical activity at least three times per week, and 15 

______

8

Sample sizes were too small to support separate analyses for pregnant and postpartum women. 
xiv

percent engaged in physical activity at least five times per week. This compares with 45 percent and 

34 percent of higher-income nonparticipants, respectively. 

Women’s Use of Alcohol and Tobacco

• Patterns of alcohol consumption among pregnant and postpartum women were comparable for WIC 

partic ipants and income-eligible nonparticipants. WIC participants, however, were less likely than 

higher-income nonparticipants to have consumed 12 or more alcoholic drinks in their lifetime (72% 

vs. 85%) or during the past year (21% vs. 46%). Among women who consumed alcohol during the 

past year, the mean number of drinks consumed on an average drinking day was significantly greater

for WIC participants than for higher-income nonparticipants.

• There were no significant differences between WIC participants and either group of nonparticipants 

in the prevalence of smoking (ever or in the past 5 days) or in the mean number of cigarettes smoked 

by current smokers. However, WIC women reportedly started smoking at a younger age than higherincome women. 

Health Status, Conditions, and Risks

General Health Status

• WIC participants and income-eligible nonparticipants had approximately equivalent health status, as 

measured by both self-reports and physician assessments. Roughly 63 percent of WIC participants 

and income-eligible nonparticipants rated their health as very good or excellent, 30 percent rated their 

health as good, and about 7 percent rated their health as fair or poor. According to physician 

assessments, which tended to be more positive, more than 85 percent of both WIC participants and 

income-eligible nonparticipants were in very good or excellent health and 12 percent of both groups 

were in good health.

• WIC participants were significantly less likely than higher-income nonpartic ipants to rate their health 

status as very good or excellent (62% vs. 84%) and were significantly more likely to rate their health 

status as fair or poor (8% vs. 2%). These between-group differences were consistently observed for 

women, infants, and children. Physician assessments revealed the same pattern of differences 

between WIC participants and higher-income nonparticipants; however, the magnitude of the 

between-group differences was smaller and only the difference in the percentage considered to be in 

excellent or very good health was statistically significant (87% vs. 91%). The between-group 

difference was concentrated among women. 

Pregnancy and Childbirth History

• There were no significant differences between WIC women and income-eligible women in the mean 

number of pregnancies, mean number of live births, mean age at time of first live birth, or the percent 

of women who were teenagers or more than 35 years of age at the time of their first live birth. In 

comparison with higher-income nonparticipants, however, WIC participants had a significantly 

greater number of live births (1.6 vs. 1.1), were significantly younger at the time of their first live 

birth, and were more likely to have been teenagers. 
xv

Birth Characteristics of Infants and Children

• WIC infants were born to younger mothers, on average, than either income-eligible infants or higherincome infants (mean age of 24.1 years vs. 25.7 years and 28.9 years). In addition, WIC children 

were born to younger mothers than higher-income children (24.8 years vs. 28.2 years). 

• WIC infants were also significantly more likely than infants in either nonparticipant group to be born 

to teenage mothers (23% vs. 14% and 3%). A similar pattern was observed among children; 

however, the difference between WIC children and income-eligible children was not statistically 

significant. 

• Both WIC infants and WIC children were less likely than their higher-income nonparticipant 

counterparts to be born to mothers over age 35 (4% vs. 11% for infants and 4% vs. 9% for 

children). 

• There was no significant difference between WIC infants and children and income-eligible infants and 

children in the percentage born to women who smoked during the pregnancy. In comparison with 

higher-income infants and children, however, WIC infants and children were significantly more likely 

to have been born to mothers who smoked (27% vs. 17% for infants and 29% vs. 19% for children).

• WIC infants and children had significantly lower mean birthweights (as reported by parents and 

caregivers) and were more likely to be low birthweight (less than 2,500 gm. or 5.5 pounds), than 

nonparticipant infants and children. The prevalence of low birthweight among WIC infants was twice 

that of income-eligible infants and three times that of higher-income infants (12% vs. 6% and 4%). 

Children showed a comparable pattern, but the between-group disparities were smaller (12% vs. 8% 

and 5%). These results are not surprising, given that low birthweight is a nutritional risk criteria used 

to establish program eligibility. Moreover, low birthweight infants may stay on WIC longer than 

normal weight infants because they tend to have more problems. 

Children’s Weight Status

• Among 1-4-year-old children, there was no significant difference between WIC participants and 

income-eligible nonparticipants in the prevalence of overweight (defined as being at or above the 95th

percentile on CDC weight-for-height growth charts). However, WIC children were significantly more 

likely to be overweight than higher-income children (7% vs. 4%). There were no statistically 

significant differences between WIC participants and either group of nonparticipants in the 

percentage of children at risk of overweight (at or above the 85th percentile on the weight-for-height

growth charts). 

• WIC children were significantly more likely than income-eligible children to be underweight (weightfor-height below the 5th percentile) (7% vs. 3%). There was no significant difference between WIC 

children and higher-income children in the prevalence of underweight. 

• WIC children had a greater prevalence of growth retardation (height-for-age below the 5th percentile) 

than either group of nonparticipant children (9% vs. 5% and 2%); however, only the difference 

between WIC children and higher-income children was statistically significant. 
xvi

Iron Deficiency, Iron Deficiency Anemia, and Anemia 

• Iron Deficiency. The overall prevalence of iron deficiency among 1-4-year-old children was about 6 

percent. Prevalence was greatest among 1-year-olds (13%) and was substantially lower for older 

children. Overall, WIC children were significantly less likely than income-eligible children to be iron 

deficient (5% vs. 10%). Overall, there was no significant difference between WIC children and 

higher-income children in the prevalence of iron deficiency. 

• Iron Deficiency Anemia. Iron-deficiency anemia (defined as being iron-deficient and having a low 

hemoglobin) was observed in about 2 percent of all 1-4-year-old children. WIC children were 

significantly more likely than higher-income children to have iron-deficiency anemia, although this 

was a relatively uncommon finding for all children, particularly those older than 2.

• Anemia. The prevalence of anemia, defined on the basis of low hemoglobin or hematocrit, was 

substantially greater than the prevalence of iron-deficiency anemia, as assessed in this analysis. Low 

hemoglobin levels may be caused by factors unrelated to iron status, including infection, 

inflammation, deficiencies of other nutrients (unlikely with this age group), and hereditary anemias. 

WIC children were no more or less likely than income-eligible nonparticipant children to have anemia 

(low hemoglobin). In comparison with higher-income children, however, WIC children were more 

likely to be anemic (9% vs. 6%). 

Lead Poisoning

The problem of lead poisoning has been declining sharply in recent years. Between NHANES-II (1976-80) 

and the first phase of NHANES-III (1988-91), the overall prevalence of lead poisoning in the population as a 

whole decreased from 77.8 percent to 4.4 percent (CDC, 1997). Between Phase I (1988-91) and Phase II 

(1991-94) of NHANES-III, the overall prevalence of high blood lead levels continued to decline, with 

percentage point decreases generally being greater among groups with the highest prevalence of elevated lead 

levels during Phase I (CDC, 1997).

• According to data from Phase II of the NHANES-III data collection, WIC children were significantly 

more likely than either group of nonparticipating children to have elevated levels of blood lead. 

Exposure to Second-hand Smoke

• WIC participants were no more or less likely than income-eligible nonparticipants to be exposed to 

second-hand smoke produced by smokers living in the same household. In comparison with their 

higher-income nonparticipant counterparts, however, WIC participants were more likely to be 

exposed to second-hand smoke. This was true for all three categories of WIC participants (women, 

infants, and children). 

• NHANES-III measured serum cotinine in all respondents 4 years of age and older. Serum cotinine is 

a breakdown product of nicotine that is used as a biological marker for tobacco use and exposure to 

environmental tobacco smoke. There were no significant differences between WIC participants and 

income-eligible nonparticipants in the prevalence of high serum cotinine levels, but WIC participants 

had higher prevalence when compared with higher-income nonparticipants (78% vs. 52%). 
xvii

Dental Health

• WIC women and income-eligible women had comparable numbers of missing, decayed, and filled 

teeth. In comparison with higher-income women, however, WIC women had fewer teeth that were 

missing, decayed, or filled.9 

• Children 2 to 4 years of age had, on average, about one missing, decayed, or filled tooth. Although 

differences between groups were small, WIC children and significantly fewer missing, decayed, or 

filled teeth than higher-income children. This difference was observed for each age-specific cohort 

except 3-year-olds. 

• Close to 100 percent of pregnant and postpartum women reported visiting a dentist or dental 

hygienist at least once in their lifetime, and 63 percent reported visiting a dental health professional in 

the past year. There were no statistically significant differences between WIC women and either 

group of nonparticipating women in these health practices.

• Among children 2-4 years old, 38 percent visited a dental health professional at least once and 36 

percent visited a dental health professional in the past year. WIC children were no more or less likely 

to have had dental care visits than higher-income children. However, WIC children were significantly 

more likely than income-eligible children to have visited a dental health practitioner, ever (41% vs. 

30%) or in the past year (39% vs. 29%). 

Access to Health Care Services

Health Insurance Coverage

• Among women, there was no difference between WIC participants and income-eligible 

nonparticipants in the rate of health insurance coverage (79% vs. 80%). However, in comparison 

with higher-income women, women partic ipating in WIC were significantly less likely to have health 

insurance. 

• Among infants and children, WIC participants were more likely than income-eligible nonparticipants 

and less likely than higher-income nonparticipants to have health insurance.

• WIC participants were significantly less likely than individuals in either of the nonparticipant groups to 

have private health insurance coverage and were more likely to be receiving Medicaid benefits. These 

patterns were observed separately for women, infants, and children; however, among women, the 

difference between WIC participants and income-eligible nonparticipants in the receipt of private 

health insurance was not statistically significant. 

______

9Reasons for differences between WIC participants and higher-income nonparticipants in the number of missing, decayed, and filled teeth could not be 

explored in this report. It is possible that the difference is due to better dental care for higher-income nonparticipants. For example, higher-income 

nonparticipants may have more filled teeth than WIC participants, resulting from attention to caries detected by x-ray rather than those causing pain or 

clearly visible on the exterior of a tooth. 
xviii

Regular Source of Health Care

• More than 8 out of 10 pregnant and postpartum women reported having a regular source of health 

carethat is, a clinic, health center, or doctor’s office that was usually used for health care needs or 

to obtain health-related advice and information. There were no significant differences between WIC 

participants and nonparticipants in this regard. 

• Overall, 97 percent of all infants and 95 percent of children had a regular source of health care. 

Nonetheless, WIC infants were significantly more likely than income-eligible nonparticipant infants 

and just as likely as higher-income nonparticipant infants to have a regular source of health care. 

Among children, WIC participants were more likely than income-eligible nonparticipants and less

likely than higher-income nonpartic ipants to have a regular source of health care. 

• WIC participants were no more or less likely to have a regular health care provider than their 

counterparts in the income-eligible nonparticipant group. However, in comparison with higher-income 

nonparticipants, all three categories of WIC participants were less likely to have a regular health care 

provider. Between-group differences were most substantial for women and children. Just over half 

(53%) of WIC women reported having a regular provider, compared with 82 percent of higherincome women. Similarly, 69 percent of WIC children had a regular health care provider, compared 

with 87 percent of higher-income children.
1

Chapter One

Introduction

This report describes the nutrition and health

characteristics of participants and nonparticipants in the Special Supplemental Nutrition

Program for Women, Infants, and Children

(WIC), using data from the Third National

Health and Nutrition Examination Survey

(NHANES-III).1

 The NHANES survey is the

primary source of information used in monitoring the Nation’s nutrition and health status.

NHANES-III was completed between 1988 and

1994 and provides data for a large nationally

representative sample of individuals.2

A broad array of measures is used to describe the

nutrition and health characteristics of WIC

participants and two groups of nonparticipants:

low-income individuals who were incomeeligible for WIC (household income at or below

185 percent of poverty) and higher-income

individuals who were not income-eligible for

WIC (household income above 185 percent of

poverty). Because of age-based variations in

NHANES-III data collection protocols and small

samples of pregnant and postpartum women,

data were not consistently available for the three

major categories of WIC participants (pregnant

and postpartum women, infants, and children).

Data availability was greatest for children and

most limited for women.

For children, data are provided on dietary intake,

breastfeeding and infant feeding history, birth

characteristics, weight status, nutritional biochemistries, general measures of childhood

health, and dental health. For infants, information is provided on breastfeeding and infant

feeding practices, birth characteristics, and

hospitalizations, accidents, and injuries since

birth. Data reported for women include physical

activity, use of alcohol and tobacco, pregnancy

history, and dental health. Finally, data on

general health status, exposure to second hand

smoke, health insurance coverage, and access to

a regular source of health care are provided for

all three groups (women, infants, and children).

This research was not designed to assess program impacts or in any way attribute differences

observed between WIC participants and either

group of nonparticipants to an effect of the

program. Rather, it was designed to establish a

baseline from which to monitor the nutrition and

health characteristics of WIC participants and

nonparticipants over time and to generate

questions and hypotheses for future research.

The data presented in this report provide useful

background information for researchers interested in studying the nutrition and health characteristics of low-income populations and/or the

impact of participation in food assistance

programs, or other variables, on nutrition and

health characteristics. The data also provide

important insights for individuals who plan and

implement nutrition or health programs for

preschool children, infants, and pregnant and

postpartum women.

This introductory chapter provides an overview

of the WIC Program as well as a brief descrip1

Similar reports have been prepared for participants and nonparticipants in the Food Stamp Program (FSP) (Fox and Cole, 2004a), for

school-age children (Fox and Cole, 2004b), and for older adults

(Cole and Fox, 2004).

2 Beginning in 1999, NHANES became a continuing survey,

without breaks between data collection cycles. Similar sampling

and data collection procedures are used, although at least two years

of data are necessary to have adequate sample sizes for subgroup

analyses (Flegal et al., 2002). Data for the first two continuous

years of the ongoing NHANES (1999-2000) have been released

since the tabulations presented in this report were prepared. Data

for subsequent years are expected in mid-2005.
2

percent postpartum nonbreastfeeding women,

and 5.7 percent breastfeeding women (Bartlett et

al., 2003 and Kresge, 2003).

Income-eligibility criteria are defined by each

State WIC agency according to Federal guidelines. The income limit may not exceed 185

percent or be less than 100 percent of Federal

poverty guidelines, which are based on household size. As of April 2000, all State agencies

defined income eligibility for WIC as less than

or equal to 185 percent of poverty (Bartlett et

al., 2002).

Income eligibility may also be established by

participation in other means-tested programs.

FNS regulations require WIC agencies to accept

applicants as adjunctively income-eligible for

WIC if they document participation in Medicaid,

Temporary Assistance for Needy Families

(TANF), or the Food Stamp Program (FSP).3

 As

of October 1998, applicants not certified under

adjunctive income-eligibility provisions must

present documentation of income at certification

(P.L. 105-336). Before P.L. 105-336 went into

effect, some States allowed applicants to selfreport income without documentation.

Finally, each WIC participant must be determined to be at nutritional risk, based on assessment by a competent professional authority such

as a physician, nutritionist, nurse, or other health

professional. For participants over 9 months of

age, assessment of nutritional risk must include,

at a minimum, measurement of height (or

tion of the NHANES-III data and the general

approach to the analysis. The five chapters that

follow present data on the nutrition and health

characteristics listed previously. Details on data

and methodology may be found in appendices

referenced throughout the report.

The WIC Program

The WIC program, administered by the U.S.

Department of Agriculture’s (USDA) Food and

Nutrition Service (FNS), provides supplemental

foods, nutrition education, and health and social

service referrals to eligible pregnant women,

breastfeeding and nonbreastfeeding postpartum

women, infants, and children up to 5 years of

age. In FY 2002, WIC served 7.5 million participants per month and accounted for approximately 11.4 percent of the $38 billion Federal

expenditure for food assistance and nutrition

programs (FANPs) (USDA, FNS, 2003a).

Program Eligibility

WIC eligibility is based on four factors: State

residence, categorical eligibility, income eligibility, and nutritional risk. WIC participants must

be residents of the State or other jurisdiction

(U.S. territory or Indian Tribal Organization)

supplying the WIC benefits, unless they are part

of a migrant farm worker family.

Participants must also belong to one of five

categorically eligible groups—women during

pregnancy and up to 6 weeks after delivery,

breastfeeding women (who may participate for

up to a year after giving birth), postpartum

women who are not breastfeeding (who may

participate for up to 6 months after giving birth

or other termination of pregnancy), infants (0-12

months), and children up to the age of 5 years.

Children and infants comprise the majority of

WIC participants. In April 2002, 50 percent of

all WIC participants were children and 26

percent were infants. The remaining 24 percent

were women—11 percent pregnant women, 7.5

3

Since the mid-1980s, several legislative actions have expanded

Medicaid income eligibility for pregnant women, infants, and

children. As a result, some States have adopted Medicaid incomeeligibility limits that exceed the WIC maximum of 185 percent of

poverty. Although the number of States using such incomeeligibility requirements has been increasing in recent years, this

situation was relatively uncommon when the NHANES-III data

were being collected. In 1990, the earliest year for which data are

available, Medicaid eligibility guidelines in all States were

consistent with WIC eligibility guidelines (National Governor’s

Association (NGA), 1990). In 1994, the last year of NHANES-III

data collection, two States had Medicaid income- eligibility limits

for pregnant women and infants that exceeded the WIC cutoff

(NGA, 1994).
3

In addition, there has been a slight shift in the

composition of the WIC participant population

since the early 1990s. This shift occurred largely

as a result of increased funding that allowed

local programs to serve lower-priority participant groups, such as children.4

 Specifically, the

number of children has increased, relative to the

number of women and infants. In 1990, children

comprised 46.3 percent of WIC participants. In

2002, children comprised 50.1 percent of all

WIC participants. Over the same time period,

the percentage of WIC participants who were

pregnant or postpartum women remained

relatively constant (23.9% in 1990 vs. 24.1% in

2002), and the percentage of WIC participants

who were infants decreased (29.8% in 1990 vs.

25.7% in 2002) (Randall and Boast, 1994 and

Bartlett et al., 2003).

Program Benefits

WIC seeks to improve the health of program

participants by serving as an adjunct to good

health care and by providing supplemental

foods, nutrition education, and referral to needed

health and social services.

Supplemental Foods

The supplemental foods provided by WIC are

good sources of nutrients that research has

identified as typically lacking in the diets of

low-income pregnant women and children—

protein, iron, calcium, and vitamins A and C.

Foods available in WIC food packages include

milk, eggs, cheese, dried beans and peas, peanut

butter, full-strength (100%) fruit or vegetable

juices, breakfast cereals that are high in iron and

low in sugar, and, for certain breastfeeding

women, carrots and canned tuna. Infant packages include iron-fortified infant formula and

length) and weight and a hematological test for

anemia.

Prior to 1999, State agencies established their

own nutritional risk criteria following broad

guidelines in Federal regulations. This autonomy

meant that the criteria used to define nutritional

risk and, consequently, program eligibility,

varied across State agencies. This variability

raised concerns about equity. To address these

concerns, FNS asked the Institute of Medicine

(IOM) to review the scientific basis for the risk

criteria used in the program. The IOM reviewed

nutritional risk criteria being used by States and

made recommendations about appropriate

criteria for future use (IOM, 1996). The IOM

report formed the basis for a standardized list of

nutritional risk criteria to be used in all WIC

programs nationwide. States are still free to

define the specific criteria used to determine

program eligibility but, since April 1, 1999,

criteria must be selected from the approved list.

Some of the measures examined in this report

are indicators of nutritional risk that may qualify

individuals for WIC participation. Consequently,

the prevalence of these characteristics may be

greater among WIC participants than nonparticipants. To the extent feasible, text discussions

point out nutritional risk criteria that may have

been used by States during the NHANES-III

data collection period (based on mention in the

IOM (1996) report).

Program Participation

The number of individuals participating in WIC

increased steadily from the program’s inception

in 1975 through the late 1990s. Since then, WIC

participation has leveled off. Average monthly

WIC participation increased from 4.5 million in

1990 to 7.5 million in 2002. However, during

this period the annual percentage increase in

participation declined from an average of 9

percent during 1990 to 1995 to only 1 percent

during 1996 to 2002 (USDA, FNS, 2003a).

4

WIC employs a priority system for filling vacancies that occur

after a local agency has reached its maximum caseload (based on

available funding). Children have a lower priority in this system

than pregnant women, breastfeeding women, and infants with

specific types of nutritional risks.
4

infant cereals as well as infant juices that are

high in vitamin C.

The type and quantity of foods provided vary

according to participants’ eligibility category,

nutritional needs, and, to the extent possible,

personal preferences. Most WIC participants

receive vouchers or checks to use in purchasing

supplemental foods at local grocery stores. In a

limited number of geographic areas, foods are

delivered to participants’ homes or participants

pick up foods at warehouses. In recent years,

several States have conducted pilot tests on the

use of electronic benefits transfer (EBT) systems

in disbursing WIC benefits. At least one State

has implemented EBT Statewide and several

other States are considering Statewide EBT

systems.

Nutrition Education

The WIC food package does not meet participants’ total nutrient needs. Therefore, nutrition

education is an essential part of the WIC Program. It provides a mechanism for ensuring that

WIC participants learn about healthy eating

practices and that they are encouraged to adopt

positive food-related attitudes and behaviors.

Program regulations define two broad goals for

WIC nutrition education:

 to stress the relationship between proper

nutrition and good health, with special

emphasis on the nutritional needs of the

program’s target populations; and

 to assist individuals at nutritional risk in

achieving a positive change in food habits,

resulting in improved nutritional status and

the prevention of nutrition-related problems.

In practice, WIC nutrition education encompasses many other topics such as breastfeeding

promotion, the need to avoid cigarettes, alcohol,

illicit drugs, and over-the-counter medications

during pregnancy, and the importance of childhood immunizations.

Each year, State agencies are required to use for

nutrition education activities an amount that is

equal to at least one-sixth of their annual

expenditures for nutrition services and administrative (NSA) costs. Local WIC agencies are

required to offer all adult participants and

caretakers of infant and child participants at

least two nutrition education contacts during

each certification period. Participants are

generally certified for periods of 6 months;

however, infants may be certified for 1 year and

pregnant women are certified for the duration of

their pregnancy and up to 6 weeks postpartum.

For infants with certifications that extend

beyond 6 months, nutrition education must be

offered to parents or caregivers on a quarterly

basis.

Although local WIC agencies are required to

offer nutrition education, participants are free to

decline these services without affecting receipt

of other program benefits. There is evidence that

some WIC participants do not take advantage of

the nutrition education opportunities provided

by WIC (Fox et al., 1999). To maximize participation, local agencies tend to schedule nutrition

education activities to coincide with issuance of

WIC vouchers.

State and local WIC agencies have broad

autonomy to develop plans and procedures for

providing nutrition education to WIC participants. Consequently, WIC nutrition education is

quite diverse and may vary both in quantity and

quality from one site to the next. A variety of

different methods may be used to provide

nutrition education. For example, participants

may be counseled one-on-one, may attend

classes, or may view videos, filmstrips, or slide

presentations on a variety of nutrition- and

health-related topics. Providers are encouraged

to ensure that nutrition education messages take
5

into account participants’ educational levels,

nutritional needs, household situations, and

cultural preferences.

Referrals to Health Care and Social Services

Local WIC agencies are expected to promote

routine use of preventive health care services.

Through co-location with health service providers or referrals to other agencies, WIC service

delivery sites serve as a link between the participant and the health care system. Coordination

between WIC and social service programs has

increased since 1989, when Federal law created

adjunctive income-eligibility for WIC benefits

based on eligibility for other programs. Local

WIC staff are encouraged to provide referrals, as

needed, to appropriate social services, such as

the FSP, Medicaid, TANF, and other programs

relevant to participants’ needs (such as smoking

cessation programs, alcohol and drug treatment

programs, parenting classes). The degree to

which local WIC agencies facilitate access and

referrals to other services varies, depending on

the adequacy of health and social service infrastructures at the State and local level and the

extent to which participants are already linked

into health and social service networks before

coming to WIC (Fox et al., 1999).

The Third National Health and Nutrition

Examination Survey

NHANES-III was conducted by the National

Center for Health Statistics (NCHS), Centers for

Disease Control and Prevention (CDC) between

1988 and 1994. The survey included interviews

and physical examinations and was designed to

provide national estimates of the health and

nutrition status of the civilian, noninstitutionalized population in the 50 United States.

NHANES-III was based on a complex multistage probability sample design (NCHS, 1994).

Persons were selected on the basis of sex, age,

and race or ethnicity. Children under 6 years of

age, adults over 60 years of age, and black and

Mexican American persons were oversampled.

NHANES-III collected data from 33,994 persons

2 months of age and older. Response rates were

85.6 percent for the household interviews and

78.8 percent for the physical examinations

(NCHS, 1996). Total NHANES-III samples for

the population subgroups served by WIC are

4,744 children under 5 years of age, 1,961

infants, and 667 pregnant and postpartum

women.

Interviews were conducted in respondents’

homes and physical examinations and measurements were completed in a Mobile Exam Center

(MEC). The MEC examination included a

physical exam, dietary interview, health interview, blood tests, body measurements, and a

dental exam. The dietary interview included a

single 24-hour recall that collected quantitative

data on foods and beverages consumed during

the preceding 24 hours.5

 NCHS staff used these

data to calculate nutrient intakes, using food

composition data from the Survey Nutrient

Database maintained by USDA’s Agricultural

Research Service (ARS).

Analytic Approach

WIC participants and nonparticipants in the

NHANES-III sample were identified by response to a question that asked about current

WIC participation: “(Are you/is [infant/child])

now receiving benefits from the WIC program?”

This question was asked during the MEC

interview, which included a subsample of all

NHANES-III respondents. Consequently, the

analyses presented in this report are based on the

MEC-examined subsample. (The other volumes

in this series use the NHANES-III household

5

For adults (17 years and older), NHANES-III also included a food

frequency questionnaire, administered as part of the household

interview. The food frequency had a 1-month reference period and

was designed to collect qualitative information about dietary

patterns. Data from the food frequency were not analyzed for this

report.
6

interview sample or MEC sample, depending on

the analysis variable being examined).

Respondents who reported current WIC participation were considered WIC participants. Those

who did not report current participation were

considered nonparticipants.6

 Nonparticipants

were further subdivided into those who were

income-eligible for WIC (household income at

or below the WIC cutoff of 185 percent of

poverty) and those whose income exceeded

eligibility requirements (income above 185

percent of poverty).7

Participants and nonparticipants were divided

into three subgroups corresponding to the three

major categories of WIC participants: pregnant

and postpartum women, infants (2-12 months of

age), and children (1-4 years of age). To accurately reflect categorical-eligibility criteria, the

sample of women was limited to pregnant

women, nonbreastfeeding women who gave

birth within the past 6 months, and breastfeeding

women who gave birth within the past 12

months.

For each variable examined, detailed tables were

produced showing estimates for each of the

subgroups for which data were available. Data

for children were also broken down by year of

age. Readers interested in comparing data for

women, infants, or children to the population as

a whole, or to other subgroups of the population,

are referred to volume I in this series (Fox and

Cole, 2004a). The detailed tables that accompany that volume include data for the entire

population as well as for 72 gender-and-agespecific subgroups.

Table 1 illustrates the format used in the detailed

tabulations. Table columns show data for all

persons as well as for WIC participants and the

two groups of nonparticipants. Table rows show

data for the specific subgroups included in the

tabulation. Table 1 also shows the maximum

sample size for each table cell. For comparison

purposes, sample sizes for the full NHANES-III

household interview are provided as well

(column 1). (As noted previously, this report

used the MEC-examined sample because the

question on current WIC participation was

collected as part of the MEC interview).

All detailed tables include footnotes that clearly

identify data source(s). Brief descriptions of the

various NHANES-III data files are provided in

appendix A. Tables also include footnotes, as

appropriate, that identify reference standards

used in interpreting NHANES-III data. Reference standards are described in appendix B. To

the extent possible, standards are based on those

used in the Healthy People 2010 objectives

(U.S. Department of Health and Human Services

(U.S. DHHS), 2000a).

Age and Population Adjustment

Detailed tables that show data for children by

year of age also present data for the total population of children. These “Total, age-adjusted”

estimates are standardized according to the age

distribution of the U.S. population in the year

6

Some nonparticipants may have participated in WIC previously.

For example, nonparticipant women may have participated in WIC

during a previous pregnancy or, for postpartum women, during

their pregnancy. Nonparticipating infants and children may have

participated at some point prior to the time data were collected.

NHANES-III data on WIC participation are not adequate to

examine patterns of WIC participation over time. Burstein et al.

(2000) analyzed data from the 1993 panel of the Survey of Income

and Program Participation (SIPP) and found that most infants and

children who enter the WIC program (70 percent) do so during

infancy. Most infants (81 percent) go on to participate as children,

but participation declines sharply as children age.

7

NHANES-III data include individuals who reported participation

in WIC and reported household income above the 185 percent of

poverty cutoff used to define income-eligibility for WIC. This was

true for 9.6 percent of those reporting WIC participation. Several

factors may contribute to these situations: NHANES-III measures

income as a range rather than as an exact value and uses the

midpoint of the range to compare household income to the poverty

line; WIC eligibility is based on contemporaneous measures of

household income, while NHANES-III measured income

retrospectively (over the past 12 months); NHANES-III interviewers and WIC staff may have used different probes or techniques to

ascertain household income; and, as noted above, during the last 2

years of NHANES-III data collection two states used an incomeeligibility cutoff for Medicaid that exceeded 185 percent of

poverty. Individuals who reported WIC participation are included

in the WIC participant group, regardless of reported household

income.
7

Table 1—Number of NHANES-III respondents: WIC participants and nonparticipants

Household Interview MEC Examined

Total persons Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants 

Women1 ....................... 1,050 667 181 247 Infants ........................... 2,107 1,961 787 348 Children

1 year old ................ 1,339 1,258 419 391 2 years old .............. 1,350 1,269 253 545 3 years old .............. 1,186 1,119 201 513 4 years old .............. 1,169 1,098 137 547 All children .............. 5,044 4,744 1,010 1,996 

Total .............................. 8,201 7,372 1,978 2,591 

1 Pregnant women responded yes to ’Are you now pregnant? Pregnant women identified only by urinalysis results are not included in table.

Source: NHANES-III, 1988-94. WIC participation is asked during the MEC exam.
8

tum woman.9

 Use of year 2000 population

estimates facilitates comparison of NHANES-III

estimates with estimates from NHANES 1999-

2000.

Population estimates are shown in table 2. The

year 2000 population distribution shown in

column 1 of table 2 was used to weight participant categories (W-I-C) in the NHANES-III

sample frame, for WIC participants and each

group of nonparticipants, so that totals reflect

the year 2000 population distribution.

Statistical Tests

In addition to descriptive tabulations, the

statistical significance of differences between

WIC participants and each group of nonparticipants was tested using t-tests. When multiple

outcome categories were examined simultaneously, the Bonferroni adjustment was used to

adjust for multiplicity (Lohr, 1999). Nonetheless, because of the large number of t-tests

conducted, caution must be exercised in interpreting results. In general, findings discussed in

the text are limited to those with strong statistical significance (1 percent level or better) or

those that are part of an obvious trend or pattern

in the data.

Text discussions generally focus on differences

between WIC participants and one or both

groups of nonparticipants. Reference may be

made to other between-group differences when

the differences are noteworthy, for example,

differences among children by year of age. The

statistical significance of these secondary

comparisons has not been tested, and this fact is

2000. Age-adjustment is important for comparisons between subgroups and for trend analyses

between NHANES surveys. When comparing

subgroups such as WIC participants and nonparticipants at a point in time, age-adjustment

eliminates between-group differences that are

due solely to differences in the age distributions

of the groups (U.S. DHHS, 2000b).

Detailed tables that show data for each of the

three participant categories (women, infants, and

children, or W-I-C) also present data for the total

population. These “Total, population-adjusted”

estimates are standardized according to the year

2000 distribution of pregnant and postpartum

women, infants, and children 1-4 years of age.

Population adjustment eliminates between-group

differences that are due solely to differences in

the sample distribution across categories (W-IC).

It is important to understand that age- and

population-adjusted estimates do not represent

the true or raw estimates for a given population

or subgroup. Rather, the adjusted estimates

should be viewed as constructs or indices that

provide information on the relative comparability of two or more populations (in this case,

WIC participants and nonparticipants) on a

particular measure (U.S. DHHS, 2000b).8

The choice of a standard population to use in

making age and population adjustments is

somewhat arbitrary. For this report, adjustments

are based on year 2000 Census estimates and

year 2000 Vital Statistics data for the number of

births, with the number of births used to derive

the estimated number of pregnant and postpar8

Separate estimates for children by year of age, infants, and women

do represent true or raw estimates for these population subgroups.

9

Table 2 shows Census 2000 population estimates for infants and

children (by year of age and total) in April 2000. The estimated

population of women (pregnant, breastfeeding, and

nonbreastfeeding postpartum) in April 2000 is based on the number

of births in the year 2000 adjusted by the following multipliers:

number of pregnant women with gestation > 3 months = # births *

7/12; number of postpartum women (breastfeeding and

nonbreastfeeding) who gave birth in past 6 months = # births * 0.5;

number of breastfeeding women between 6 and 12 months

postpartum = # births * 0.2.
9

Table 2—Age distribution of WIC participants and nonparticipants in NHANES-III sample frame and year 2000 population

Year 2000 population distribution NHANES-III sample frame

Total Persons Total Persons1 Currently Receiving WIC Benefits Income-eligible Nonparticipants 

Population

(thousands) Percent Population (thousands) Percent Population (thousands) Percent Population (thousands) Percent 

Women ......................... 5,208 21.6 5,233 23.8 865 20.5 1,518 21.9 Infants ........................... 3,815 15.8 2,987 13.6 1,133 26.9 527 7.6 Children

1 year old ................ 3,789 15.7 3,406 15.5 915 21.7 904 13.0 2 years old .............. 3,757 15.6 3,572 16.2 518 12.3 1,310 18.9 3 years old .............. 3,753 15.5 3,525 16.0 488 11.6 1,352 19.5 4 years old .............. 3,825 15.8 3,271 14.9 293 7.0 1,321 19.1 All children .............. 15,124 62.6 13,773 62.6 2,214 52.6 4,887 70.5 

Total .............................. 24,147 100.0 21,994 100.0 4,212 100.0 6,931 100.0 

1 Total includes persons with missing income.

Source: NHANES-III, 1988-94. Year 2000 population of infants and children is from U.S. Census Bureau, Monthly Estimates of the United States Population, April 2000.

The estimated population of pregnant, breastfeeding, and nonbreastfeeding postpartum women for April 2000 is based on the number of births in the year 2000 adjusnumber of pregnant women = # births * 7/12; number of postpartum women (breastfeeding and nonbreastfeeding) who gave birth in past 6 months = # births * 0.5; nubetween 6 and 12 months postpartum = # births * 0.2. It is assumed that pregnant women self-report their pregnancy status only after the second month of pregnanc
10

noted in the text. Statistical tests were not

performed on these second-level differences

because of the expansive number of statistical

tests performed in the main analysis and because

these comparisons are not the focus of the

report.

Additional information about the analytic

approach, including use of NHANES-III sampling weights, calculation of standard errors, age

standardization, and guidelines used to flag

point estimates deemed to be statistically

unreliable, is provided in appendix C. Individual

point estimates may be deemed statistically

unreliable because of small sample size or a

large coefficient of variation. In keeping with

NHANES-III reporting guidelines, such estimates are reported in detailed tables and are

clearly flagged.

The chapters that follow summarize key findings. Graphics are used to illustrate observed

differences between WIC participants and

nonparticipants. Differences that are statistically

significant at the 5 percent level or better are

highlighted. Detailed tables provided in appendix D differentiate three levels of statistical

significance (p <.001, .01, and .05). It is important to note that differences between WIC

participants and nonparticipants may be statistically significant even if point estimates are

unreliable. When this occurs, the text describes

the existence and direction of the significant

difference and identifies the group(s) for which

point estimates are unreliable.

Comparisons between WIC participants and

income-eligible nonparticipants are of primary

interest. These comparisons provide useful

insights into policy-relevant questions about

program targeting, for example: are low-income

individuals with the greatest nutritional and

health needs receiving WIC services? Comparisons between WIC participants and higherincome nonparticipants are also of interest.

These comparisons provide information on

nutrition- and health-related disparities between

WIC participants and individuals who are not

constrained by low incomes. Both sets of

comparisons also provide information on

whether WIC participants do as well as other

groups with respect to outcomes that WIC might

be expected to improve.

As noted previously, however, this research was

not designed to measure program impacts. Thus,

significant differences that are observed between

participants and nonparticipants cannot be

attributed to participation in the WIC program;

and similarly, the absence of a significant

difference cannot be interpreted as evidence that

WIC participation has no effect. Accurate

assessment of WIC impacts requires specially

designed studies or, at a minimum, complex

analytical models that require a variety of

measures that are not available in the NHANESIII dataset. It is also important to remember that,

for characteristics used to define nutritional risk,

differences observed between participants and

nonparticipants may simply be a reflection of

criteria for selection into the program.
11

This chapter describes usual intakes of food

energy and four key nutrients and, to the extent

possible, the prevalence of adequate intakes

among WIC participants and nonparticipants.

Nutrients included in the analysis are vitamin C,

iron, zinc, and calcium. Usual intakes of fat,

saturated fat, cholesterol, sodium, and fiber were

also examined. These data are presented in

Chapter Three.

The analysis is limited to children who were ageeligible for WIC (1 through 4 years of age).

Women were excluded because of small sample

sizes and infants were excluded because of

differences in the nutrient standards defined for

children and infants.1

To provide some context for these discussions,

the chapter begins with information on several

factors that may influence the relative adequacy

of children’s dietary intakes. These include

participation in the Food Stamp Program (FSP),

household food sufficiency status, and meal and

snacking patterns.

Participation in the Food Stamp Program

NHANES-III provides information on household

participation in the FSP. The survey question

used to define FSP participation for this analysis

measured current participation: “(Are you/Is

any member of this family) receiving food

stamps at the present time?”

In reviewing data on FSP participation, it is

important to bear two facts in mind. First,

household survey data tend to yield lower

estimates of program participation than estimates

derived from program administrative data. For

example, data from the Survey of Income and

Program Participation (SIPP), which is generally

recognized as the optimal source of survey data

on program participation, underestimates participation in most programs by 10 to 15 percentage

points (Trippe, 2000). Second, data reflect

participation rates at the time the NHANES-III

data were collected (1988-94) and therefore are

not expected to be representative of current

program participation rates.

The FSP uses a more stringent cutoff for income

eligibility than the WIC program: 130 percent of

the Federal poverty guideline rather than 185

percent. Therefore, to obtain the most useful

information on FSP participation among WIC

children and nonparticipant children, the analysis

was limited to children who were income-eligible

for the FSP.

Overall, 63 percent of 1-4-year-old children who

were income-eligible for the FSP resided in

households that participated in the FSP (table D1). Given the expected underreporting in survey

data, this estimate is consistent with historical

data on child participation in the FSP during the

Chapter Two

Usual Intake of Food Energy and Nutrients

 Among Children Ages 1 to 4

1The NHANES-III sample of women categorically eligible for

WIC includes 294 pregnant women, 86 breastfeeding women,

and 287 nonbreastfeeding postpartum women. These

subgroups had to be examined separately because of differing

nutritional requirements and had to be further divided into

WIC participants and two groups of nonparticipants. Seven of

nine cells in the stratified sample had fewer than 100 women.

The reference standard used in estimating the prevalence of

inadequate intakes of vitamin C, iron, and zinc—the Estimated Average Requirement (EAR)—has either not been

defined for infants (vitamin C), or has been defined only for

infants 7-11 months of age (iron and zinc).
12

of the WIC program, which is designed to

ensure that participating families receive needed

health and social services.

Household Food Sufficiency

NHANES-III data were collected before

dissemination of the 18-item Federal food

security module, the currently accepted standard

for measuring household and individual food

security (Price et al., 1997 and Bickel et al.,

2000). NHANES-III included a question that

asked whether the household had enough to eat,

sometimes did not have enough to eat, or often

did not have enough to eat. Respondents who

indicated that their household sometimes or often

did not have enough to eat were asked how

many days this occurred during the past month

and why it occurred.3 This measure has been

used in NHANES-III as well as in other studies

to identify households with food insufficiency

(defined as households that report that there is

“sometimes” or “often” not enough food to eat)

(Alaimo et al., 1998).

The data indicate that the majority (87% or

more) of 1-4-year-old children in all three groups

resided in households that were food sufficient

(households that always had enough to eat)

(figure 2 and table D-2). Eleven percent of WIC

children and 12 percent of income-eligible

nonparticipant children lived in households that

sometimes did not have enough food to eat. This

problem was reported for less than 1 percent

(0.5%) of higher-income nonparticipant children,

but the difference between WIC participants and

higher-income nonparticipants was not statistically significant.

Approximately two percent of WIC children

lived in households that often did not have

relevant time period (1988-94) (Cody and Trippe,

1997).2

Among 1-4-year-old children who were incomeeligible for the FSP, WIC participants were

significantly more likely to participate in the FSP

than nonparticipants. Overall, 72 percent of FSPeligible WIC children resided in households that

participated in the FSP, compared with 55

percent of FSP-eligible nonparticipant children

(figure 1 and table D-1). This difference was

concentrated among the youngest children (1-

year-olds and 2-year-olds). A potential explanation for the increased rate of FSP participation

among WIC children is the referral component

Figure 1 - Percent of income-elgible 1-4-year-old

children participating in the Food Stamp Program

*Statistically significant difference from WIC participants at

the .05 level or better.

Note: “All children” includes 1-4-year- old children; 4-yearolds are not shown separately because the point estimate for

4-year-old WIC participants is statistically unreliable.

Source: NHANES-III, 1988-94.

72% 73%

78%

71%

59% 57%*

48%*

 55%*

0%

20%

40%

60%

80%

100%

All children 1-year-olds 2-year-olds 3-year-olds

Percent of children

WIC participants Income-eligible nonparticipants

2Studies of FSP participation over time indicate that participation rates for income-eligible preschoolers were lower in the

earliest years of NHANES-III (1988-91) than in later years

(1992-94) (Cody and Trippe, 1997 and Stavrianos, 1997).

The biennial WIC Participant and Program Characteristics

Studies (for example, Bartlett et al., 2003) do not report FSP

participation by WIC participant category, and the FSP

participation rates that are reported apply to all WIC

participants rather than to those who are income-eligible for

the FSP.

3Versions of the questionnaires used in the last two rounds of

data collection included additional followup questions about

whether children or adults in the household had decreased the

size of their meals because there was not enough food. These

questions were not tabulated for this report because of the

restricted nature of the sample.
13

separate survey question about daily breakfast

consumption were also tabulated.

Number of Meals Consumed

Overall, 13 percent of 1-4-year-old children

consumed fewer than three meals per day (table

D-3).4 The percentage of WIC children who

consumed fewer than three meals per day was

comparable to that of income-eligible nonparticipants (15-16%) (figure 3). In comparison with

higher-income nonparticipants, however, WIC

children were more likely to consume fewer than

three meals per day (16% vs. 10%). This

difference was largely attributable to a difference among 2-year-olds (table D-3). In this age

group, the proportion consuming fewer than

three meals per day was twice as high for WIC

participants than for higher-income nonparticipants (12% vs. 6%).

Consumption of Breakfast

NHANES-III included a separate question about

usual breakfast consumption habits: “How often

enough food to eat. The same was true for one

percent of income-eligible nonparticipant children

and zero higher-income nonparticipant children.

Neither of the differences between WIC participants and nonparticipants was statistically

significant.

Because so few children in the various subgroups examined in this report resided in households that sometimes or often did not have

enough to eat, the followup questions on how

often and why households experienced these

problems were not analyzed. Sample sizes were

too small to produce reliable subgroup estimates.

Meals and Snacks Consumed

This analysis examined the number of meals and

snacks consumed by 1-to-4-year-old children in

the preceding 24 hours. Data from the 24-hour

dietary recall were used to compute, for each

child, the total number of meals and snacks

consumed. (As dietary intakes were reported,

respondents were asked to identify eating

occasions as meals (breakfast, brunch, lunch, or

dinner/supper) or snacks.) Responses to a

Figure 2 - Distribution of 1-4-year-old children by

household food sufficiency status

11%

2%

100%

88%

12%

1%

87%

<1% 0%

0%

20%

40%

60%

80%

100%

Enough to eat Sometimes not

enough to eat

Often not

enough to eat

Percent of children

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants

No statistically significant differences between WIC participants and either group of nonparticipants.

Source: NHANES-III, 1988-94.

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

Figure 3 - Percent of 1-4-year-old children consuming fewer than three meals per day

16% 15%

10%*

0%

20%

40%

60%

80%

100%

WIC participants Income-eligible

nonparticipants

Higher-income

nonparticipants

Percent of children

4Data on the mean number of meals consumed is presented in

table D-4.
14

does [child] eat breakfast?” Response options

were every day, on some days, rarely, never, and

on weekends only. Overall, the percentage of 1-

4-year-old children who consumed breakfast

every day was high—92 percent (table D-5).

Among WIC children, 88 percent consumed

breakfast every day. This compares with 91

percent of income-eligible nonparticipants and

94 percent of higher-income nonparticipants

(figure 4). The difference between WIC participants and higher-income nonparticipants was

statistically significant and may account for at

least part of the difference in the percentage of

WIC children and higher-income-nonparticipant

children who consumed fewer than three meals

per day.

Number of Snacks Consumed

Ninety-five percent of all 1-4-year-old children

consumed at least one snack per day (table D6). On average, children in all three groups

consumed about three snacks per day (table D7). WIC children consumed significantly more

snacks per day, on average, than income-eligible

nonparticipating children, but the difference was

small (2.8 vs. 2.6).

Usual Intake of Food Energy and Key

Nutrients

This section describes usual intakes of food

energy, vitamin C, iron, zinc, and calcium among

1-4-year-old WIC participants and nonparticipants. Tabulations are based on the single 24-

hour recall collected in NHANES-III. The data

have been adjusted, however, to account for

within-person variation using variance estimates

from the Continuing Survey of Food Intake of

Individuals (CSFII). (The procedures used in

making these adjustments are described in

appendix C.) As such, the data presented are

indicative of children’s usual dietary intakes,

exclusive of vitamin and mineral supplements,

and can be used to assess the prevalence of

adequate intakes.5

Standards Used To Assess Adequacy of Usual

Intake

Children’s usual nutrient intakes were assessed

relative to Estimated Average Requirements

(EARs) and Adequate Intakes (AIs). EARs and

AIs are part of a newly established set of

dietary standards—the Dietary Reference

Intakes (DRIs) (Institute of Medicine (IOM),

1999, 2000a, 2000b, 2002a, 2002b, 2004). The

DRIs replace the Recommended Dietary

Allowances (RDAs) used in most previous

research (National Research Council (NRC),

1989a).6 When adequate scientific evidence is

available, an EAR is established. The EAR is

Figure 4 - Percent of 1-4-year-old children consuming breakfast every day

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

88% 91%

94%*

0%

20%

40%

60%

80%

100%

WIC participants Income-eligible

nonparticipants

Higher-income

nonparticipants

Percent of children

5Data on usual nutrient intakes do not include contributions

from vitamin and mineral supplements. At the time this

report was being prepared, other investigators were working

on methods for incorporating supplement data into estimates

of usual nutrient intake. In the NHANES-III data, the issue is

not straightforward because of a lack of congruence in recall

period—the preceding 24 hours for food and beverage intake

vs. the preceding month for supplements.

6

In addition to EARs and AIs, the DRIs define two other

reference standards: Recommended Dietary Allowances

(RDAs) and Tolerable Upper Intake Levels (ULs) (see

appendix B).
15

the level of intake that is estimated to meet the

requirement of half of the healthy individuals in a

particular life stage and gender group. When the

available data are insufficient to estimate requirements, an AI is established rather than an

EAR. The AI is the level of intake that is

assumed to be adequate, based on observed or

experimentally determined estimates of intake.

EARs have been defined for three of the four

nutrients examined in this chapter (vitamin C,

iron, and zinc). For the fourth nutrient (calcium),

AIs have been defined. For nutrients that have

EARs and a symmetrical requirement distribution, the IOM recommends that usual nutrient

intakes be assessed using the “EAR-cutpoint

method” (IOM, 2001). This approach compares

the distribution of usual intakes in a population

with a population-specific EAR. The proportion

of the population with usual intakes below the

EAR is an estimate of the proportion of the

population with inadequate intakes—intakes that

do not meet nutrient requirements.

For nutrients with AIs, methods for assessing

usual intakes are more limited. AIs cannot be

used to determine the proportion of a population

with inadequate intakes. Instead, assessment

focuses on comparison of mean usual intakes to

the AI. Populations with a mean usual intake

equivalent to or greater than the populationspecific AI can be assumed to have adequate

intakes.

At the time the analyses presented in this report

were completed, DRIs had not been established

for food energy. 7 Therefore, assessment of usual

energy intakes also focuses on comparison of

mean intakes, expressed as a percentage of the

1989 Recommended Energy Allowance (REA)

(NRC, 1989a).

Because the EARs and the calcium AI are

relatively new reference standards, appendix B

includes a table that shows the 1989 RDAs for

vitamin C, iron, zinc, and calcium—the reference

standards used in most previous research. The

interested reader can compare data on mean

usual intakes with the most appropriate RDA to

obtain a reasonable approximation of how these

data compare with previously published data. In

addition, appendix D includes tables that show

means and the full distribution of usual intakes

(the 5th, 10th, 15th, 25th, 50 th, 75th, 85th, 90th, and

95th percentiles) for food energy and each of the

four nutrients.

Food Energy

On average, the diets consumed by 1-4-year-old

children provided roughly 100 percent of the

1989 REA (table D-9).8 WIC children consumed

a significantly greater percentage of the 1989

REA than either income-eligible nonparticipant

children or higher-income nonparticipant children

(107% vs. 101% and 99%) (figure 5). Differences were concentrated among 2-year-olds

(WIC children vs. income-eligible children) and

3-year-olds (WIC children vs. higher-income

children).

Vitamin C, Iron, and Zinc

Virtually all 1-4-year-old children consumed

adequate amounts of vitamin C, iron, and zinc

(tables D-12, D-15, and D-18).9 For vitamin C

and iron, there were statistically significant

differences between WIC participants and one

or both groups of nonparticipants in the percentage of children with adequate usual intakes;

however, the differences were substantively

7DRIs for food energy have subsequently been released (IOM,

2002b).

8Data on mean usual energy intakes (in kilocalories) are

presented in table D-8 and the full distribution of usual energy

intakes is presented in table D-10.

9Data on mean usual intakes (in mg.) and the full distribution

of usual intakes are presented in tables D-11 and D-13

(vitamin C), D-14 and D-16 (iron), and D-17 and D-19 (zinc).
16

AI by a substantial margin. The difference

between WIC participants and income-eligible

nonparticipants was concentrated among 2-yearolds (167% of the AI vs. 147%) (table D-21).

negligible (100% vs. 99.8% and 99.9% (vitamin

C) and 99.7% vs. 99.9% (iron)).

Calcium

As noted in the introduction to this section, it is

not possible to determine the percentage of

children with adequate intakes of calcium

because EARs for calcium have not been

established. Therefore, in comparing calcium

intakes across groups of children, the analysis

examined mean intakes, expressed as a percentage of the AI. Populations with mean intakes

that meet or exceed the population-specific AI

can be assumed to have adequate intakes.

The mean usual calcium intake of 1-4-year-old

children exceeded the AI (table D-21).10 This

suggests that, overall, 1-4-year-old children had

adequate calcium intakes. On average, the usual

calcium intake of WIC children was significantly

greater than the usual calcium intakes of both

groups of nonparticipant children (figure 6). In

all cases, however, mean intakes exceeded the

*Statistically significant difference from WIC participants at the .05 level or better.

Source: NHANES-III, 1988-94.

Figure 5 - Mean intake of food energy as a percent of the 1989 Recommended Energy Allowance: 1-4-year-old

children

94%

114%

92%

98%

92% 92% 88%

107%

120%

101%* 105%*

116%

99%*

113%*

108%

0%

20%

40%

60%

80%

100%

120%

All children 1-year-olds 2-year-olds 3-year-olds 4-year-olds

Mean percent of 1989 REA

WIC participants Income-eligible nonparticipants Higher-income nonparticipants

10Data on mean usual calcium intakes (in mg.) are presented in

table D-20 and the full distribution of usual calcium intakes is

presented in table D-22.

Figure 6 - Mean intake of calcium as a percent of

Adequate Intake: 1-4-year-old children

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

158%

140%*

149%*

0%

20%

40%

60%

80%

100%

120%

140%

160%

WIC participants Income-eligible

nonparticipants

Higher-income

nonparticipants

Mean percent of AI
17

Consumption of Milk and Soft Drinks

Data on trends in the national food supply

indicate that Americans are consuming substantially less milk and substantially more soft drinks

than they were 25 years ago (Putnam and

Gerrior, 1999). On average, Americans consume

more soft drinks per day than milk. Concerns

have been raised about the potential impact of

this trend on calcium intake, particularly among

children (Yen and Lin, 2002).

To determine whether the relative consumption

of soft drinks and milk differed for WIC children

and nonparticipant children, 24-hour recall data

were used to compute the total grams of fluid

milk consumed and the total grams of soft drinks

consumed in the preceding 24-hour period. Both

carbonated and noncarbonated soft drinks were

included in the tabulations. Coffee and tea were

not included. For ease in interpretation, gram

weights were translated into 8-ounce equivalent

servings.

The data, presented in tables D-23 to D-26,

reveal that differences in the consumption of

milk and soft drinks reported by others (Yen and

Lin, 2002) and observed in this series of reports

among older children and most other age groups

(Fox and Cole, 2004a and Fox and Cole 2004b)

do not hold for 1-4-year-olds. On average, 1-4-

year-old children consumed more milk per day

than soft drinks—1.2 servings of milk per day

vs. 0.8 servings of soft drinks.

This pattern was observed for WIC participants

and both groups of nonparticipants (figure 7).

Overall, there were no significant betweengroup differences in mean consumption of milk

or soft drinks. Among 2-year-olds, however,

WIC participants consumed more milk, on

average, than income-eligible nonparticipants

(1.2 servings vs.1.0 serving) (table D-24). This

is consistent with the previously described

difference between these two groups of 2-yearolds in mean calcium intake.

Use of Dietary Supplements

As noted earlier in this chapter, NHANES-III

dietary intake data do not include nutrients

provided by dietary supplements. To provide

some insight into the potential contribution of

dietary supplements, data on reported supplement use were analyzed. The available data do

not permit a detailed analysis of this issue by

specific nutrient, but provide information on the

prevalence of supplement use among 1-4-yearold children and general information on the

number and type of supplements taken.

Parents and caregivers were asked whether

children received vitamin or mineral supplements

during the preceding month. If supplements

were used, respondents were asked to show the

actual bottles or jars to interviewers so the type

of supplement and associated dosage information could be recorded. Respondents were not

asked specifically about use of other types of

dietary supplements, such as herbs, botanicals,

and fish oils; however, many respondents

volunteered information about these types of

supplements (CDC, 2001).

No statistically significant differences between WIC participants and either group of nonparticipants.

Source: NHANES-III, 1988-94.

Figure 7 - Mean daily servings of milk and soft

drinks: 1-4-year-old children

1.3

0.8

1.2

0.9

1.3

0.7

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

Milk Soft drinks

Mean number of 8-ounce servings

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants
18

Overall, 46 percent of children between the ages

of 1 and 4 took some type of dietary supplement

during the preceding month (table D-27). WIC

children were significantly less likely than

higher-income children to have taken a dietary

supplement (figure 8). Thirty-nine percent of

WIC children took a dietary supplement, compared with 55 percent of higher-income children.

This pattern was noted for each age-specific

cohort (table D-27).

There was no significant difference between

WIC participants and income-eligible nonparticipants in the prevalence of supplement use,

overall. However, among 2-year-olds, WIC

participants were significantly more likely to

have taken a supplement than income-eligible

nonparticipants (48% vs. 32%) (table D-27).

Among 1-4-year-old children who had used

dietary supplements in the past month, the vast

majority (91%) used only one supplement (table

D-28). There were no significant differences

between WIC participants and either group of

nonparticipants in the number of dietary supplements used during the past month.

The most common type of supplement used was

a multi-vitamin. Fifty-three percent of all 1-4-

year-old children who used a supplement during

the past month took a multi-vitamin supplement

(table D- 29). The next most common type of

supplement was a multi-vitamin and mineral

combination (40% of all children).

This pattern was observed for all three groups

of children. There were a handful of significant

differences between WIC children and higherincome children in the prevalence of specific

types of dietary supplements; however, the

pattern of these differences was consistent with

the general pattern described above.

Figure 8 - Percent of 1-4-year-old children taking

dietary supplements in past month

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

39% 37%

55%*

0%

20%

40%

60%

80%

100%

WIC participants Income-eligible

nonparticipants

Higher-income

nonparticipants

Percent of children
19

This chapter describes the nutritional quality of

diets consumed by WIC participants and nonparticipants. The analysis focuses on the Healthy

Eating Index (HEI), a summary measure of

overall nutritional quality developed by USDA’s

Center for Nutrition Policy and Promotion

(CNPP) (Kennedy et al., 1995). Usual intake of

dietary fiber is also examined. The analysis is

limited to children between the ages of 2 and 4.

Children under 2 are excluded because the HEI

is designed to assess the nutritional quality of

diets consumed by individuals 2 years of age

and older.

Healthy Eating Index Scores

The HEI provides an overall picture of the types

and quantities of food individuals consume and

their compliance with recommended dietary

practices (Basiotis et al., 2002). The index

includes an overall score as well as 10 component scores, all of which are weighted equally in

the overall score. The 10 component scores

measure different aspects of a healthy diet,

relative to current public health recommendations. The HEI scores used in this analysis were

computed by NCHS staff, following USDA

guidelines, and were included in a public-release

data file (NCHS, 2000).

Six of the component scores are food-based and

evaluate food consumption in comparison with

Food Guide Pyramid recommendations for

intake of grains, vegetables, fruits, dairy, and

meat, as well as the level of variety in the diet

(USDA, CNPP, 1996). Four component scores

are nutrient-based and assess compliance with

Dietary Guidelines for Americans recommendations for daily intake of fat, saturated fat, cholesterol, and sodium (USDA and U.S. DHHS,

2000).1 The specific reference standards used

for each HEI component are described in the

following discussions and are listed in appendix

B. The appendix also provides technical details

about how food consumption data needed to

estimate HEI scores were derived from the

NHANES-III 24-hour recall data.

The HEI data are based on the single 24-hour

recall collected in NHANES-III. It was not

possible to develop HEI scores that reflect usual

intakes, as was done for the nutrients assessed

in the preceding chapter. There were two major

impediments to such an analysis. First, the HEI

scoring algorithm is applied at the individual

level but the adjustment technique used to

generate estimates of usual nutrient intakes

adjusts distributions (see appendix C) rather

than individual observations. Second, the HEI

includes six food-based components and it is

not possible to generate estimates of usual food

intake (as opposed to usual nutrient intake)

because distributions of daily food intake tend

to be highly skewed and to include a large

proportion of zeros (Dodd, 2001).

Although it was not possible to incorporate

information on usual nutrient intakes into HEI

scores, usual intake distributions were estimated

for the nutrients considered in the HEI. These

include the percentage of food energy (calories)

Chapter Three

Healthy Eating Index Scores and Usual Intake

of Dietary Fiber Among Children Ages 2 to 4

1When the HEI was first developed, the standards for cholesterol

and sodium were based on recommendations made in the NRC’s

Diet and Health report (NRC, 1989b) because the version of the

Dietary Guidelines in effect at the time did not include quantitative standards for these nutrients (USDA and U.S. DHHS, 1995).

Since that time, the NRC standards for sodium and cholesterol

have been incorporated into both the Nutrition Facts section of

food labels and the most recent version of the Dietary Guidelines

(USDA and U.S. DHHS, 2000).
20

Researchers at CNPP have defined cutoffs that

can be used to interpret what HEI scores say

about the overall quality of the diet (Basiotis et

al., 2002). Total HEI scores over 80 imply a

“good” diet. Scores between 51 and 80 indicate

a “need for improvement.” And scores below 51

are indicative of a “poor” diet. Using these

criteria, a majority of 2-4-year-old children in all

three groups needed to make improvements in

their diets. Overall, 66 percent of children had

HEI scores that indicated a need for improvement (table D-31). Slightly more than a quarter

(26%) had “good” diets and 8 percent had

“poor” diets. Diet quality decreased markedly

with age. The percentage of 2-year-olds and 3-

year-olds with good diets was substantially

greater than the percentage of 4-year-olds with

good diets (32% and 30% vs. 15%) (statistical

significance of age-based differences not tested).

Likewise, the percentage of 2-year-olds and 3-

year-olds with poor diets was substantially lower

than the percentages of 4-year-olds with poor

diets (7% and 5% vs. 13%).

These general patterns were observed for all

three groups of 2-4-year-old children (figure 10),

and none of the differences between WIC

participants and nonparticipants was statistically

significant.

Food-based Component Scores

Standards for the food-based HEI component

scores reflect daily goals for consumption of

foods from each of the five good groups specified in the Food Guide Pyramid (USDA, CNPP,

1996). Serving guidelines are associated with

recommended energy intake. For 2-4-year-old

children, the recommended numbers of daily

servings are:

ß Grains: 6 servings for 2-3-year-olds and

7 servings for 4-year-olds

ß Vegetables: 3 servings for 2-3-year-olds

and 3.3 servings for 4-year-olds

from fat and saturated fat as well as total intakes

of cholesterol and sodium. In addition, a separate analysis was conducted to compare HEI

data and usual intake data on estimates of the

percentage of 2-4-year-old children who consumed diets consistent with the various reference

standards.

Total HEI Scores

On average, 2-4-year-old children scored 70.4,

out of a possible 100, on the HEI (table D-30).

Mean scores were consistently greater for 2-

year-olds than 4-year-olds (statistical significance of age-based differences not tested).

Mean HEI scores indicate that the diets consumed by WIC children were comparable in

nutritional quality to those consumed by both

income-eligible and higher-income nonparticipants. WIC children scored, on average, 69.7 on

the 100-point scale, compared with 68.6 for

income-eligible nonparticipants and 72.2 for

higher-income nonparticipants (figure 9).

No statistically significant differences between WIC participants

and either group of nonparticipants.

Source: NHANES-III, 1988-94.

Figure 9 - Mean Healthy Eating Index (HEI) scores:

2-4-year-old children

69.7 68.6

72.2

0.0

20.0

40.0

60.0

80.0

100.0

WIC participants Income-eligible

nonparticipants

Higher-income

nonparticipants

Mean HEI score
21

The food-based HEI component scores (tables

D-32 to D-37) indicate that the food consumption goal that presented the greatest difficulty

for 2-4-year-old children was the goal for

vegetable consumption. Mean scores for the

vegetable component ranged from 4.8 to 5.1,

compared with a perfect score of 10, and less

than one-quarter of the children in each group

consumed the recommended number of vegetable servings (figures 11 and 12 and table D33).

The food consumption goals that appeared to be

the least problematic for 2-4-year-old children,

although there was still room for improvement,

were the goals for dairy foods and overall

dietary variety. Mean scores for the dairy

component ranged from 7.7 to 8.2 and the

percentage of children in each group who

consumed the recommended number of servings

of dairy foods approximated or exceeded 50

percent (figures 11 and 12 and table D-35).

Results for the variety component were equally

positive. Mean scores for the variety component

ranged from 7.3 to 7.8 and the percentage of

individuals in each group who satisfied the HEI

standard for dietary variety approximated or

exceeded 50 percent (figures 11 and 12 and

table D-37).

Overall, the only significant difference in foodbased HEI component scores of WIC children

and income-eligible nonparticipant children was

observed for the fruit component. WIC children

scored significantly higher on this component of

the HEI than income-eligible children (6.4 vs.

5.3) (figure 11). This pattern was observed for

all three age-specific cohorts, but the difference

was not statistically significant for 2-year-olds

(table D-34). Among 3-year-olds, WIC participants were also significantly more likely than

income-eligible nonparticipants to consume the

recommended number of fruit servings (58% vs.

42%) and to consume more fruit servings

overall (3.2 servings vs. 2.1 servings). WIC food

ß Fruits: 2 servings for 2-3-year-olds and

2.3 servings for 4-year-olds

ß Milk: 2 servings for both 2-3-year-olds

and 4-year-olds

ß Meat: 2 servings for 2-3-year-olds and

2.1 servings for 4-year-olds 2

The HEI also includes a food-based score for

dietary variety. Although the need for variety in

the diet is a theme in all major public health

nutrition guidelines, there are no specific

quantitative recommendations. For purposes of

the HEI, dietary variety is assessed by totaling

the number of different types of food a person

consumes in a day. Similar foods are grouped

together and tabulations consider only food

components that contribute at least one-half

serving toward any food group. Fats, sweets,

seasonings, and similar foods are not included

(NCHS, 2000). A perfect score of 10 is assigned

when a person consumes at least one-half

serving of eight different foods.

2One serving of meat is equivalent to 2.5 ounces of lean meat.

Dried beans and peas, peanut butter, eggs, nuts, seeds, and tofu are

also included in the meat group (see appendix B).

Figure 10 - Distribution of total HEI scores: 2-4-

year-old children

No statistically significant differences between WIC participants

and either group of nonparticipants.

Source: NHANES-III, 1988-94.

13% 10% 6%

59% 69%

66%

28% 21%

29%

0%

20%

40%

60%

80%

100%

WIC

participants

Income-eligible

nonparticipants

Higher-income

nonparticipants

Percent of children

Poor Needs improvement Good
22

*Statistically significant difference from WIC participants at the .05 level or better.

Source: NHANES-III, 1988-94.

Figure 12 - Percent of 2-4-year-old children meeting HEI standards for food-based components

44%

40%

20%

37% 34%

17%

49%

57%

50%

36%

48%

19%

43% 46% 46%

54%

42%

20%*

0%

20%

40%

60%

80%

100%

Grains Vegetables Fruit Dairy Meat Variety

Percent of children

WIC participants Income-eligible nonparticipants Higher-income nonparticipants

*Statistically significant difference from WIC participants at the .05 level or better.

Source: NHANES-III, 1988-94.

Figure 11 - Mean scores for HEI food-based components: 2-4-year-old children

8.0

5.1

6.4

7.8

7.0

7.6 7.8

5.3

7.7

6.8

7.3

8.0

4.8

6.9

7.8

5.3*

5.7*

8.2*

0

1

2

3

4

5

6

7

8

9

10

Grains Vegetables Fruit Dairy Meat Variety

Mean score

WIC participants Income-eligible nonparticipants Higher-income nonparticipants
23

packages include 100% fruit juices, which are

counted in the fruit component of the HEI.

In comparison with higher-income children,

WIC children had significantly lower scores for

the dairy component and significantly higher

scores for the meat component (figure 11). The

size of the difference in scores on the dairy

component was relatively small (7.8 vs. 8.2) and

was concentrated among 3-year-olds (table D35). There was no significant difference between

the two groups in the percentage of children who

actually consumed the recommended number of

dairy servings (figure 12).

The difference between WIC children and

higher-income children in mean scores for the

meat component was more substantial (7.0 vs.

5.7) (figure 11). Moreover, a significant difference was also observed in the percentage of

children who consumed the recommended

number of meat servings (36% vs. 20%) (figure

12) and in the mean number of meat servings

consumed (1.7 servings vs. 1.3 servings) (table

D-36). These patterns were observed for each of

the three age-specific cohorts, but betweengroup differences were not always statistically

significant. None of the differences were statistically significant for 4-year-olds. Among 3-yearolds, only the difference in mean HEI scores for

the meat component was statistically significant.

WIC food packages include eggs, peanut butter,

and dried beans and peas—all foods that are

considered in the meat component of the HEI.

Nutrient-based Component Scores

The four nutrient-based component scores of the

HEI assess nutritional quality on the basis of

how well individuals’ diets conform to recommendations for intake of total fat, saturated fat,

cholesterol, and sodium. The standards used in

making these assessments are based on recommendations included in the Dietary Guidelines

for Americans (USDA and U.S. DHHS, 2000).3

The standards for total fat, saturated fat, and

sodium are also included in the Healthy People

2010 objectives (U.S. DHHS, 2000a). Standards

for total fat and saturated fat are no more than 30

percent of total energy and less than 10 percent

of total energy, respectively. The standard for

cholesterol is less than 300 mg. and the standard

for sodium is 2,400 mg.

Since the time HEI scores were computed by

NCHS staff and the tabulations presented in this

report were prepared, new reference standards

have been established for fat (IOM, 2002b) and

sodium (IOM, 2004) intake. These new standards are discussed in the text that follows. The

IOM report in which the new standard for fat

intake is defined also discusses intake of saturated fat and cholesterol, but does not define

specific standards for intake of these dietary

components.

There were relatively few differences between 2-

4-year-old WIC participants and either group of

comparably aged nonparticipants on mean

scores for the nutrient-based HEI components

(figure 13 and tables D-38 to D-41). There were

no significant differences between scores of

WIC children and income-eligible nonparticipant children. In comparison with higher-income

nonparticipant children, however, WIC children

had significantly lower mean scores for the total

fat component of the HEI (6.6 vs. 7.4), as well

as for the cholesterol component (8.1 vs. 9.3).

The difference in mean scores for the fat component was concentrated among 2-year-olds (table

D-38). A significant difference in mean scores

for the cholesterol component was observed for

both 2-year-olds and 3-year-olds (table D-40).

3As noted previously, HEI standards for cholesterol and sodium

were initially based on recommendations made in the NRC’s Diet

and Health report (NRC, 1989b). These recommendations have

subsequently been incorporated into the Nutrition Facts section on

food labels and the most recent version of the Dietary Guidelines.
24

Guidelines recommendation of no more than 30

percent (table D-42). This was true for all three

age-specific cohorts.

There was no significant difference between

WIC children and income-eligible nonparticipant children in the percent of energy provided

by fat (33.6% vs. 33.8%). In comparison with

higher-income nonparticipant children, however,

WIC children consumed a significantly greater

amount of fat, relative to total energy intake

(33.6% vs. 31.7%). This significant difference

was noted for all three of the age-specific

cohorts.

According to the HEI data, which are based on a

single 24-hour recall, the percentage of 2-4-

year-old children who satisfied the Dietary

Guidelines recommendation for fat intake

ranged from a low of 28 percent to a high of 41

percent (figure 14 and table D-38). Overall,

there were no significant differences between

WIC participants and either group of nonparticipants in this regard. Among 2-year-olds, however, WIC children were significantly less likely

than higher-income nonparticipant children to

consume the recommended amount of fat (27%

of children vs. 46%) (table D-38).

Percentage of Children Meeting Standards

for HEI Nutrients: Usual Intakes vs. 24-hour

Intakes

As noted in the introduction to this chapter,

usual intakes of fat, saturated fat, cholesterol,

and sodium were estimated, as described in

Chapter Two and appendix C, even though these

data could not be incorporated into HEI scores.

The following sections describe findings from

the usual intake analyses, particularly with

respect to estimates of the percentages of

children who satisfied the Dietary Guidelines

recommendations considered in the HEI. These

findings are contrasted with those from the HEI

analysis. Estimates based on usual intake

analyses are more reliable than those available

from the HEI because the former have been

adjusted to remove within-person variation (see

appendix C).

Percent of Energy from Total Fat

On average, the usual diets of 2-4-year-old

children were high in fat compared with the

Dietary Guidelines recommendation. Overall,

children’s usual diets provided 33 percent of

energy from fat, compared with the Dietary

*Statistically significant difference from WIC participants at the .05 level or better.

Source: NHANES-III, 1988-94.

Figure 13 - Mean scores for HEI nutrient-based components: 2-4-year-old children

6.6

4.8

8.1 8.2

6.6

4.9

8.6

8.2

5.5

8.7

9.3*

7.4*

0

1

2

3

4

5

6

7

8

9

10

Total fat Saturated fat Cholesterol Sodium

Mean score

WIC participants Income-eligible nonparticipants Higher-income nonparticipants
25

The more reliable estimates of usual intake

indicate that the proportion of children who

satisfied the Dietary Guidelines recommendation for fat intake was substantially lower than

suggested by the HEI data. This was particularly

true for WIC participants and income-eligible

nonparticipants: fewer than 20 percent of

children in these two groups had usual fat

intakes that satisfied the recommendation

(figure 14 and table D-43). Moreover, estimates

of usual intake indicate that WIC children were

significantly less likely than higher-income

children to consume the recommended amount

of fat (17% of children vs. 33%). This pattern

was observed for all three age-specific cohorts,

and between-group differences were statistically

significant for 2-year-olds and 4-year-olds (table

D-43).

As mentioned in the introduction to this section,

a new reference standard has been established

for fat intake since the time HEI scores were

computed by NCHS staff and the tabulations

presented in this report were prepared. This

standard, referred to as an Acceptable Macronutrient Distribution Range (AMDR), defines a

range of acceptable intakes for different lifestage groups. The AMDR for fat is 30-40

percent of total energy for 2-3-year-olds and 25-

35 percent of total energy for 4-year-olds. By

comparison, the Dietary Guidelines recommendation (no more than 30% of energy from fat)

defines a more stringent upper bound for fat

intake, particularly for young children (who

make up the majority of WIC children), and

does not define a lower bound.

Mean usual fat intakes for all groups of children

fell within defined AMDRs (table D-42).

Distributions of usual intake provide some

information about the percentage of children

whose usual fat intakes were consistent with the

AMDR. Among 2- and 3-year-olds (AMDR =

30-40 percent of total energy), usual intakes that

fell outside the AMDR tended to be lower than

the recommended range rather than higher. For

these two age groups, the 25th percentiles of the

distribution of usual fat intake were 29.9 and

30.4 percent of total energy intake, respectively,

while the 95th percentiles were 39.8 and 39.6

percent, respectively (table D-44).

The situation was notably different for 4-yearolds, who have an AMDR of 25-35 percent of

total energy. The data suggest that relatively few

4-year-olds had usual fat intakes that fell below

the lower end of the AMDR. The 5th percentile

of the distribution was 26.7 percent of total

energy. In contrast, somewhere between 15 and

25 percent of 4-year-olds had usual fat intakes

that exceeded the upper end of the AMDR (75th

percentile = 34.9% and 85th percentile = 36.2%).

There were no significant differences between

WIC children and income-eligible nonparticipant children in distributions of usual fat intake.

In contrast, there were significant differences

*Statistically significant difference from WIC participants at the .05

level or better.

Note: Dietary Guidelines recommendation has been replaced by

AMDR (see text and appendix B).

Source: NHANES-III, 1988-94.

Figure 14 - Percent of 2-4-year-old children

meeting Dietary Guidelines recommendation for

total fat: One-day (HEI) estimates vs. usual intake

estimates

34%

17%

28%

15%

41%

33%*

0%

20%

40%

60%

80%

100%

One-day Usual

Percent of children

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants
26

tween-group difference was statistically significant for both 2-year-olds and 4-year-olds.

According to the single-day recall used to

compute HEI scores, the percentage of children

who satisfied the Dietary Guidelines recommendation for saturated fat intake varied from 21

percent to 32 percent, and there were no statistically significant differences between WIC

children and either group of nonparticipant

children (figure 15 and table D-39). The more

reliable estimates of usual intake indicate that

the proportion of children who satisfied the

recommendation for saturated fat intake was

actually quite a bit lower, ranging from a low of

6 percent to a high of 17 percent (figure 15 and

table D-46). In addition, WIC children were

significantly less likely than higher-income

children to consume the recommended amount

of saturated fat (6% of children vs. 17%). This

difference was noted for all three age-specific

cohorts.

between WIC children and higher-income

nonparticipant children at every percentile of the

distributions. Differences were concentrated

among 2-year-olds and 4-year-olds and, in all

cases, fat intakes of WIC children were significantly greater than those of higher-income

nonparticipant children.

Among 2-year-olds, usual fat intakes of WIC

participants were significantly greater than those

of higher-income nonparticipants at the 25th,

50th, 75th, 85th, 90th, and 95th percentiles. At the

25th percentile, the usual fat intake of WIC

participants fell within the AMDR, while the

usual intake of higher-income nonparticipants

was below the AMDR (30.8% and 28.6%,

respectively, vs. AMDR of 30-40%). At the 95th

percentile, the opposite was true. At this end of

the distribution, the usual fat intake of WIC

participants exceeded the AMDR, while the

usual intake of higher-income nonparticipants

fell within the acceptable range (40.6% vs.

38.0%).

Among 4-year-olds, usual fat intakes of WIC

participants were significantly greater than those

of higher-income nonparticipants at the 5th, 10th,

15th, and 25th percentiles. In all cases, however,

intakes of both groups fell within the AMDR.

Percent of Energy from Saturated Fat

On average, the usual diets of WIC children and

both groups of nonparticipant children exceeded

the Dietary Guidelines recommendation of less

than 10 percent of energy from saturated fat.4 In

all three groups, saturated fat contributed an

average of 12-13 percent of total energy (table

D-45). WIC children consumed significantly

more saturated fat, on average, than nonparticipating children in the higher-income group

(12.9% vs. 12.1%). This pattern was observed

for all three age-specific cohorts and the beFigure 15 - Percent of 2-4-year-old children

meeting Dietary Guidelines recommendation for

saturated fat: One-day (HEI) estimates vs. usual

intake estimates

*Statistically significant difference from WIC participants at the .05

level or better.

Source: NHANES-III, 1988-94.

27%

6%

21%

7%

32%

17%*

0%

20%

40%

60%

80%

100%

One-day Usual

Percent of children

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants

4The full distribution of usual saturated fat intakes (as a percent of

usual energy intakes) is presented in table D-47.
27

Cholesterol

The Dietary Guidelines recommend that cholesterol intake not exceed 300 mg. per day. Mean

usual cholesterol intakes of all three groups of

children were consistent with this goal (table D48).5

 However, the usual diets of WIC children

provided significantly more cholesterol than the

usual diets of children in either of the nonparticipant groups (231 mg. vs. 208 mg. and 166

mg.). The difference between WIC children and

income-eligible children was concentrated

among 2-year-olds. The difference between

WIC children and higher-income children was

observed for all three age-specific cohorts.

The HEI data and usual intake data lead to

relatively comparable conclusions about the

proportion of children who satisfied the recommendation for cholesterol intake. Both datasets

indicate that 75 percent or more of the children

in all three groups met the recommendation for

cholesterol intake (figure 16 and tables D-40

and D-49). Moreover, both datasets indicate that

WIC children were significantly less likely than

higher-income children to meet the recommendation. According to the usual intake data, 82

percent of WIC children met the Dietary Guidelines recommendation for cholesterol intake,

compared with 96 percent of higher-income

children.

Sodium

The Dietary Guidelines recommend a maximum

daily sodium intake of 2,400 mg. On average,

usual sodium intakes of all three groups of

children came close to this goal, but only

higher-income children actually met it (table D51). The mean usual sodium intake of WIC

children was 2,513 mg. compared with 2,460

mg. for income-eligible nonparticipant children

and 2,277 mg. for higher-income children. The

difference between WIC children and higherincome children was statistically significant.

This pattern was observed for all three agespecific cohorts, and the between-group difference was statistically significant for 2-year-olds

and 3-year-olds.

The HEI data indicate that 55 to 65 percent of

children satisfied the Dietary Guidelines recommendation for sodium, and that WIC children

were no more or less likely than nonparticipant

children to meet this goal (figure 17 and table

D-41). Data on usual sodium intakes indicate

that the percentage of children who satisfied the

recommendation for sodium was actually lower,

in all three groups, than suggested by the HEI

data. The usual intake data also indicate that

WIC children were significantly less likely than

higher-income children to satisfy the recommendation for sodium (figure 17 and table D-52).

Fewer than half (48%) of WIC children had

usual sodium intakes that were consistent with

the Dietary Guidelines recommendation,

compared with 62 percent of higher-income

Figure 16 - Percent of 2-4-year-old children

meeting Dietary Guidelines recommendation for

cholesterol: One-day (HEI) estimates vs. usual

intake estimates

*Statistically significant difference from WIC participants at the

.05 level or better.

Source: NHANES-III, 1988-94.

75%

82% 79%

88%

96%*

88%*

0%

20%

40%

60%

80%

100%

One-day Usual

Percent of children

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants

5The full distribution of usual cholesterol intakes is presented in

table D-50.
28

children. In keeping with previously noted

differences in mean usual sodium intakes, this

pattern was observed for all three age-specific

cohorts and the between-group difference was

statistically significant for 2-year-olds and 3-

year-olds.

As noted previously, new reference standards

have been established for sodium intake since

the time HEI scores were computed by NCHS

staff and the tabulations presented in this report

were prepared. Standards have been defined for

both Adequate Intake (AI) and the Tolerable

Upper Intake Level (UL) (IOM, 2004). Given

that the major concern about sodium is the

potential for excess consumption, the standard

of greatest interest for this analysis is the UL.6

The UL is the highest intake likely to pose no

adverse health effects; chronic consumption

above the UL may increase adverse effects. In

the case of sodium, the primary potential

adverse effect is the development of high blood

pressure (IOM, 2004). The UL for sodium has

been set at 1,500 mg. (1.5 gm.) for 2-3-year-olds

and 1,900 mg. (1.9 gm.) for 4-year-olds. Thus,

the UL is notably more stringent than the

Dietary Guidelines recommendation, particularly for the youngest children (who make up

the majority of WIC participant children).

Mean usual sodium intakes of all three groups

of children, as described previously and shown

in table D-51, exceeded the UL by a substantial

margin. Moreover, detailed distributions of

usual sodium intake indicate that few children

consumed diets that did not exceed the UL

(table D-53). For 2-year-olds (UL = 1,500 mg),

usual sodium intake was 1,450 mg. at the 10th

percentile of the distribution and 1,559 mg at the

15th percentile. For 3-year-olds, who have the

same UL as 2-year-olds, usual intake was 1,472

mg. at the 5th percentile and 1,637 mg. at the 10th

percentile. Finally, for 4-year-olds, who have a

higher UL (1,900 mg.), usual sodium intake was

1,808 mg. at the 10th percentile and 1,926 mg. at

the 15th percentile.

There were few significant differences in the

distributions of usual sodium intake of WIC

children and income-eligible nonparticipant

children. Among 2-year-olds, there were significant differences at the 5th, 10th, and 15th percentiles, and in each case, intake was greater for

WIC participants than income-eligible nonparticipants. The difference at the 15th percentile

(1,559 mg. vs. 1,505 mg.) suggests that the

percentage of 2-year-olds with usual intakes

consistent with the UL for sodium may be

greater for income-eligible nonparticipants than

for WIC participants.

4The AI is 1,000 mg. (1.0 gm.) for 2-3-year-olds and 1,200 mg. (1.2

gm.) for 4-year-olds. Given the mean usual intakes of sodium

described in the preceding text and shown in table D-51, sodium

intakes of all three groups of children can be assumed to be

“adequate.”

Figure 17 - Percent of 2-4-year-old children

meeting Dietary Guidelines recommendation for

sodium: One-day (HEI) estimates vs. usual intake

estimates

*Statistically significant difference from WIC participants at the

.05 level or better.

Note: Dietary Guidelines recommendation has been replaced by

UL (see text and appendix B).

Source: NHANES-III, 1988-94.

57%

48%

55%

50%

65% 62%*

0%

20%

40%

60%

80%

100%

One-day Usual

Percent of children

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants
29

Significant differences in usual sodium intakes

of WIC children and higher-income children

were noted at every percentile of the distribution. In all cases, usual intake was greater for

WIC children. Differences were concentrated

among 3-year-olds. In this group, the difference

in usual intakes at the 10th percentile (1,637 mg.

vs. 1,584 mg) suggests that a greater proportion

of higher-income children than WIC children

may consume diets that are consistent with the

sodium UL.

It is important to note that NHANES-III estimates of sodium intake include only sodium

found in foods and beverages reported by

respondents. Sodium from table salt is not

included in nutrient calculations because its use

cannot be measured (estimated) reliably. To get

some insight into additional sources of sodium,

the NHANES-III dietary intake interview

included a question about use of table salt.

These data indicate that, overall, there were no

significant differences between WIC children

and either group of nonparticipant children in

the use of table salt (table D-54).

Among 2-year-olds, however, WIC children

were significantly more likely to use table salt

than either group of nonparticipant children

(37% vs. 26% and 19%). Therefore, actual

between-group differences in usual sodium

intake are likely to be greater for this age group

than observed in the preceding analysis.

Usual Intake of Dietary Fiber

On average, 2-4-year-old children usually

consumed 10.5 gm. of dietary fiber per day

(table D-55).7 Overall, there were no significant

differences between WIC participants and either

group of nonparticipants in mean usual intake of

dietary fiber (figure 18). However, among 2-

year-olds, WIC participants consumed significantly more dietary fiber per day than incomeeligible nonparticipants (10.5 gm. vs. 9.6 gm.).

In contrast, among 4-year-olds, WIC participants consumed significantly less dietary fiber

per day than income-eligible nonparticipants

(10.3 gm. vs. 12.0 gm.).

Figure 18 - Mean usual intake of dietary fiber: 2-4-year-old children

*Statistically significant difference from WIC participants at the .05 level or better.

Source: NHANES-III, 1988-94.

10.6 10.5 10.9

10.3 10.6 10.2 10.4 10.5

9.9

10.8

12.0*

9.6*

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

All children 2-year-olds 3-year-olds 4-year-olds

Mean usual fiber intake (gm.)

WIC participants Income-eligible nonparticipants Higher-income nonparticipants

5The full distribution of usual fiber intakes is presented in table D57.
30

At the time the analyses presented in this report

were completed, there was no established

standard for intake of dietary fiber. To assess the

adequacy of fiber intakes, the analysis used a

standard referred to as the “age-plus-five rule.”

This standard, originally developed by Williams

et al. (1995), was adapted by the American

Heart Association (AHA) (Van Horn, 1997) and

has been used in previous research (Gleason and

Suitor, 2001). Using the “age-plus-five rule,”

recommended intake of dietary fiber (in gm.) is

equivalent to age in years plus five, up to a

maximum of 25 gm.

More than three-quarters of children in all three

groups had usual fiber intakes that were consistent with this standard (table D-56). Overall,

there were no significant differences between

WIC participants and nonparticipants in this

regard. However, in keeping with differences

noted in the mean usual intake of dietary fiber,

as described above, 2-year-old WIC children

were significantly more likely than their counterparts in the income-eligible nonparticipant

group to meet the “age-plus-five” standard (84%

vs. 76%). And 4-year-old WIC children were

significantly less likely to meet the standard

than 4-year-old, income-eligible nonparticipants

(65% vs. 80%).

Since this analysis was completed, AIs have

been defined for fiber (IOM, 2002b). The AIs

have been defined for total fiber, which includes

dietary fiber as well as fructo-oligosaccharides,

compounds which are destroyed in the current

analytic methods used to quantitate fiber in

foods (IOM, 2002b). Although fructo-oligosaccharides are assumed to make up a relatively

small percentage of total fiber, it is estimated

that, on average, American adults consumed

approximately 5.1 gm. more fiber per day than

estimated in the most recent Continuing Survey

of Food Intakes of Individuals (CSFII) because

CSFII data, like the data used in this analysis,

include only dietary fiber (IOM, 2002b).

The AIs for total fiber are shown in appendix B.

The AIs are substantially greater than standards

based on the “age-plus-five rule.” The AI for 2-3

year-olds is 19 gm., compared with “age-plusfive” standards of 7 gm. for 2-year-olds and 8

gm. for 3-year-olds. The discrepancy is even

greater for 4-year-olds, where the AI is 25 gm.

and the “age-plus-five” standard is 9 gm.

As noted in Chapter Two, AIs cannot be used to

assess the prevalence of adequate intakes, so

assessment of usual intakes must focus on

comparison of mean intakes to age-appropriate

AIs. As the data in figure 18 indicate, mean

usual intakes of dietary fiber among 2-4-yearolds fell short of the new AIs. Indeed, for all

three groups of children, usual fiber intakes fell

below the AI even at the 95th percentile of usual

intake (table D-57). Some of this disparity is due

to the differences in fiber data (dietary fiber vs.

total fiber). However, even if one were to

assume that mean usual intakes of dietary fiber

were actually 5 gm. higher (the average increment estimated for American adults, overall, to

account for fructo-oligosaccharides, as described previously—a generous assumption for

this age group), mean intakes for all groups of

children would still fall substantially short of the

AI.

The differences observed between WIC participants and nonparticipants in mean usual intakes

of dietary fiber are real, regardless of which

reference standard is used to assess intakes.

However, the advent of the AIs for fiber means

that results of the analysis that assessed usual

intakes of dietary fiber relative to the “age-plusfive rule” must be interpreted with caution.

These estimates cannot be interpreted as valid

estimates of the percentage of 2-4-year-old

children consuming adequate amounts of fiber.
31

This chapter presents information on healthrelated behaviors of WIC participants and

nonparticipants. Topics covered for infants and

children include breastfeeding and other infant

feeding practices and exposure to second-hand

smoke. For pregnant and postpartum women,

topics include physical activity, alcohol consumption, tobacco use, and exposure to second-hand

smoke.

Breastfeeding and Other

 Infant Feeding Practices

NHANES-III included, for infants and children

under the age of 6 years, a detailed set of

questions on infant feeding practices. The

questions asked about initiation and duration of

breastfeeding, use of formula and cow’s milk,

use of baby bottles, and introduction of solid

foods. This section summarizes these data for

infants and 1-4-year-old children.

Breastfeeding

Official WIC policy has always encouraged

breastfeeding, while at the same time providing

access to infant formula for nonbreastfeeding

infants. The focus on breastfeeding promotion

increased during the late 1980s and early 1990s,

largely in response to a national survey that

showed that rates of breastfeeding were declining as the WIC program was expanding. During

the NHANES-III data collection period (1988-

94), several important changes in WIC

breastfeeding policies were implemented

(USDA, FNS, 2003b). For example, in 1989,

P.L. 101-147 required that USDA develop

standards for breastfeeding promotion and

support and targeted $8 million for State-level

efforts in this area. In 1992, P.L. 102-342

required that USDA establish a national

breastfeeding promotion program. That same

year, USDA instituted an enhanced food package for women who exclusively breastfeed. The

enhanced package has additional amounts of

juice, cheese, and legumes, and also includes

carrots and canned tuna. Finally, in 1994, P.L.

103-448 increased the amount of money each

State was required to devote to breastfeeding

promotion and required that all States collect

data on the incidence and duration of

breastfeeding among WIC participants.

More recently, P.L. 105-336 authorized the use

of State administrative funds for the purchase or

rental of breast pumps. USDA has also implemented several breastfeeding promotion demonstration projects and has disseminated findings

and recommendations to State and local WIC

agencies.

Clearly, the NHANES-III data were collected

during a time when WIC breastfeeding promotion strategies were evolving and do not reflect

current program policies and procedures in this

area. For this reason, NHANES-III

breastfeeding data for WIC participants must be

interpreted with caution. This is especially true

for data on WIC children, some of whom were

infants before 1988 and who may or may not

have participated in WIC as infants or had

mothers who participated in WIC during pregnancy. (NHANES-III does not include information on prior WIC participation).

It is also important to note that research on the

determinants of breastfeeding has demonstrated

that women who are minority, less educated,

lower-income, and younger are less likely to

Chapter Four

Health-Related Behaviors
32

for 6 months or more (31% vs. 39%) (figure 20

and table D-59). However, in comparison with

higher-income infants, WIC infants were significantly less likely to have been breastfed for this

length of time (31% vs. 42%).

Among children who were breastfed as infants,

there were no differences between WIC participants and nonparticipants, overall, in the percentage breastfed for 6 months or more (figure 20

and table D-59), the percentage breastfed for a

year or more (table D-60), or in the mean

duration of breastfeeding (table D-61).1 Among

4-year-olds, however, WIC participants were

significantly less likely than either group of

nonparticipants to have been breastfed for a

year or longer (table D-60) (the point estimate

for WIC children is statistically unreliable). In

addition, the mean duration of breastfeeding was

significantly shorter for 4-year-old WIC children

breastfeed than other women (U.S. DHHS,

2000a). These demographic characteristics also

describe WIC participants.

Initiation and Duration of Breastfeeding

At the time NHANES-III data were collected,

54 percent of all infants and 1-4-year-old children had been breastfed for some period of time

(table D-58). Among those ever breastfed, 41

percent had been breastfed for at least 6 months

(tables D-59) and 16 percent had been breastfed

for at least a year (table D-60).

WIC infants were significantly less likely to have

ever been breastfed than either income-eligible

or higher-income nonparticipant infants (39% vs.

51% and 71%) (figure 19 and table D-58). In

addition, WIC children were significantly less

likely than higher-income children to have ever

been breastfed (41% vs. 67%).

Among infants who had ever been breastfed,

there was no significant difference between

WIC participants and income-eligible nonparticipants in the percentage who had been breastfed

Figure 19 - Percent of infants and children ever

breastfed

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

39% 41%

44%

51%*

67%*

71%*

0%

20%

40%

60%

80%

100%

Infants Children

Percent of infants and children

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants

1Mean duration of breastfeeding was not tabulated for infants

because some infants were still breastfeeding.

Figure 20 - Percent of infants and children

breastfed at least 6 months, among those ever

breastfed

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

31%

39% 40% 39%

42%* 44%

0%

20%

40%

60%

80%

100%

Infants Children

Percent of infants and children

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants
33

not be introduced until 12 months of age (USDA,

FNS, 2003c and AAP, 2003). The rationale for

this recommendation is that, relative to infants’

special nutritional needs, cow’s milk is low in iron

and other essential nutrients and high in protein,

sodium, and potassium. In addition, the type of

protein and fat found in cow’s milk may be

difficult for infants to digest and absorb.

At the time the NHANES-III data were collected, many parents and caregivers did not

adhere to this recommendation. Overall, 17

percent of infants 2-11 months of age were

being fed cow’s milk on a daily basis (table D64). Among children 1-4 years of age, 41

percent had been fed cow’s milk on a daily basis

before their first birthday.

Early introduction of cow’s milk was significantly

less common among WIC participants than

either group of nonparticipants. This was true for

both infants and children. Eleven percent of

WIC infants were receiving cow’s milk on a

daily basis, compared with 27 percent of incomeeligible infants and 18 percent of higher-income

infants (figure 21). Similarly, 31 percent of WIC

than for comparably aged children in the higherincome group (table D-61) (the point estimate

for WIC children is statistically unreliable).

Use of Supplemental Formula Among

Breastfed Infants

Among infants and children who were ever

breastfed, 17 percent never received supplemental formula (table D-62). For infants and 1-4-

year-old children who received both breastmilk

and formula, formula was first fed on a daily

basis at about 12 weeks of age, on average

(table D-63).

Overall, breastfed WIC infants were significantly more likely to receive supplemental

formula than breastfed infants in either of the

nonparticipant groups. Only 9 percent of

breastfed WIC infants had never received

formula, compared with 19 percent of incomeeligible breastfed infants and 22 percent of

higher-income breastfed infants (table D-62). In

addition, breastfed WIC infants were fed formula on a daily basis at a significantly younger

age than higher-income breastfed infants (6.6

weeks vs. 9.1 weeks) (table D-63).

Among 1-4-year-old children who had been

breastfed, there were no significant differences,

overall, between WIC participants and either

group of nonparticipants in the percentage who

never received supplemental formula (table D62) or in the age at which formula was first fed

on a daily basis (table D-63). However, among

4-year-olds who were breastfed as infants, WIC

participants were significantly more likely than

either group of nonparticipants to have received

supplemental formula (table D-62) (the point

estimate for WIC children is statistically unreliable).

Use of Cow’s Milk Before 12 Months of Age

WIC infant feeding guidelines, as well as guidelines issued by the American Academy of

Pediatrics (AAP), recommend that cow’s milk

Figure 21 - Percent of infants and children fed

cow’s milk before 12 months of age

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

11%

31%

46%*

27%*

41%*

18%*

0%

20%

40%

60%

80%

100%

Infants Children

Percent of infants and children 

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants
34

children reportedly received cow’s milk on a

daily basis before 12 months of age, compared

with 46 percent of income-eligible children and

41 percent of higher-income children.

Among infants 7 months of age and older, the

mean age at which cow’s milk was first fed on a

daily basis was 32.1 weeks or 7.6 months (table

D-65). (This estimate may be biased by the

large percentage of infants who had not yet

been fed cow’s milk.) Among children, the mean

age at which cow’s milk was first fed on a daily

basis was 47.9 weeks or 11.4 months.

Overall, there were no significant differences

between WIC participants and either group of

nonparticipants in the mean age at which cow’s

milk was first fed on a daily basis. Among 1-

year-olds, however, WIC participants were

significantly older than income-eligible nonparticipants when they were first fed cow’s milk on

a daily basis (47.8 weeks (11.4 months) vs. 44.2

weeks (10.5 months)) (table D-65).

Use of a Baby Bottle

It is recommended that infants be fed beverages

from cups rather than bottles as soon as they

are able to sit erectly on their own. Infants can

generally drink from a cup, with assistance, by

4-6 months and can hold a cup on their own by

10-12 months (USDA, FNS, 2003c and AAP,

2003). A major reason for discouraging prolonged use of baby bottles is that it increases the

risk of “baby-bottle-caries,” a syndrome in

which infant teeth are excessively decayed

(USDA, FNS, 2003c and AAP, 2003). In

extreme cases, underlying permanent teeth may

also be affected. Another concern is that infants

who consume too much formula or other beverages from a bottle may crowd out other essential nutrients found in solid foods.

The vast majority of infants and children (96%)

used a baby bottle at some point in time (table

D-66). Among infants, WIC participants were

significantly more likely than either group of

nonparticipants to have used a baby bottle (the

point estimate for WIC infants is statistically

unreliable). The higher rate of breastfeeding

among nonparticipant infants may contribute to

this pattern.

At the time data were collected, 95 percent of

all infants were using baby bottles (table D-67).

Again, WIC infants were significantly more

likely than either group of nonparticipant infants

to be using bottles (the point estimate for WIC

infants is statistically unreliable). This pattern

was also observed when data were tabulated

separately for infants who were between 7 and

11 months of age (99% vs. 92% for both groups

of nonparticipants) (data not shown).

At about a year of age, there was a noteworthy

decline in use of baby bottles. Overall, 61

percent of 1-year-olds were still using a bottle.

This percentage decreased to 23 percent for 2-

year-olds and to 9 percent and 4 percent for 3-

and 4-year-olds, respectively. This general

pattern was noted for all three groups of children. However, the rate of decline was significantly slower for WIC children than for higherincome children. At each year of age, the

proportion of children using a baby bottle was

significantly greater for WIC participants than

for higher-income nonparticipants (table D-67).

Among children who were no longer using a

baby bottle, there were no significant differences

between WIC participants and either group of

nonparticipants in the percentage of children

who stopped using a bottle before 1 year of age

(table D-68) or in the mean age at which baby

bottles were discontinued (table D-69).

Introduction of Solid Foods

Recommended infant feeding practices suggest

that solid foods be introduced as children become physically and physiologically able to

handle these foods. Signs of readiness include
35

the ability to sit erectly in a supported position

(for example, in a high chair), to draw in the

lower lip when being fed with a spoon, to

swallow food rather than reflexively push it out

with the tongue, and to express satiety (USDA,

FNS, 2003c and AAP, 2003). These developmental milestones usually occur between 4 and 6

months of age. Consequently, infants should

generally not receive solid foods until they are at

least 4 months old.

Overall, almost a quarter (23%) of infants and

children were fed solid foods before 4 months of

age (table D-70). WIC infants and children were

no more or less likely than nonparticipant infants

and children to be fed solid foods at an early

age. According to parent and caregiver reports,

20 percent of WIC infants and children received

solid foods before 4 months of age, compared

with 24 percent of income-eligible nonparticipants and 23 percent of higher-income nonparticipants.

Among infants, the mean age at which solid

foods were first fed on a daily basis was 4.1

months (table D-71). (This estimate may be

biased by the large percentage of infants who

were not yet eating solids.) There were no

differences between WIC infants and either

group of nonparticipant infants in the mean age

at which solids were introduced. Children 1-4

years of age were reportedly first fed solid foods

on a daily basis at 5.9 months. On average, WIC

children were significantly older than higherincome children (6.3 months vs. 5.5 months)

when they began to eat solid foods on a daily

basis.

Physical Activity Among

Pregnant and Postpartum Women

Increasing leisure-time physical activity among

adults is one of the Healthy People 2010 goals

in the area of physical activity (U.S. DHHS,

2000a). Specific goals call for decreasing the

percentage of adults who engage in no leisuretime activity and increasing the percentage of

adults who participate in moderate and vigorous

physical activity.

Healthy People 2010 does not include specific

physical activity goals for pregnant and postpartum women. The guidelines of the American

College of Obstetrics and Gynecologists

(ACOG), however, say that there are no data to

indicate that pregnant women should limit

exercise during pregnancy. ACOG recommends

that pregnant women “engage in 30 minutes or

more of moderate exercise on most, if not all,

days of the week” (ACOG, 2001).

As discussed below, NHANES-III data lack

sufficient information about levels of exertion to

evaluate compliance with Healthy People 2010

goals for vigorous and moderate activity or

ACOG recommendations for moderate activity. 2

However, the available data provide some

information about the extent to which women

participated in leisure-time physical activities

during and after pregnancy.

NHANES-III asked adult respondents (17 years

and older) whether they participated in a number

of different physical activities during the preceding month and, if so, how often they engaged in

the activity. The specific activities included in the

query were walking a mile or more without

stopping, jogging or running, riding a bike or an

exercise bike, swimming, aerobics or aerobic

dance, other types of dancing, calisthenics,

gardening or yard work, and weight lifting.

Respondents were also asked to identify any

other type of physical activity they engaged in

during the preceding month. The reported

prevalence of many activities was too low to

support detailed analyses. However, data were

analyzed separately for walking.

2Healthy People 2010 used data from the National Health

Interview Survey (NHIS), rather than NHANES-III, to

establish baselines for goals related to physical activity among

adults, and will use NHIS data to monitor trends in this area

over time (U.S. DHHS, 2000b).
36

least three times per week, and 15 percent

engaged in physical activity at least five times

per week. This compares with 34 percent and

15 percent of income-eligible nonparticipants,

respectively, and 45 percent and 34 percent of

higher-income nonparticipants, respectively.

Both of the differences between WIC women

and higher-income women were statistically

significant.

Alcohol and Tobacco Consumption

Women are advised to avoid alcoholic beverages

and tobacco during pregnancy. Alcohol consumption during pregnancy is associated with

adverse effects on fetal growth, ranging from

subtle developmental problems to fetal alcohol

syndrome. Smoking during pregnancy is associated with increased risk of premature membrane

rupture and a modest increase in risk of preterm

delivery and low birthweight (U.S. DHHS,

2001). Consequently, Healthy People 2010 set

targets for pregnant women of nearly 100

percent abstinence from alcohol and cigarettes

during pregnancy (U.S. DHHS, 2000a).

Walking

Overall, 51 percent of pregnant and postpartum

women reported walking a mile or more without

stopping at least once during the preceding

month (table D-72). There were no significant

differences between WIC participants and either

group of nonparticipants on this measure. Fortynine percent of WIC women walked a mile or

more without stopping, compared with 48

percent of income-eligible women and 54

percent of higher-income women.

Weekly Frequency of Physical Activity

As noted in the introduction to this section,

NHANES-III data cannot be used to examine

compliance with Healthy People 2010 goals for

frequency of vigorous and moderate activity or

with ACOG guidelines for frequency of moderate activity. This is because NHANES-III lacks

information on the intensity and duration of bouts

of physical activity. 3

As an alternative, available data on the reported

frequency of physical activity were used to

assess the proportion of women who engaged in

physical activity three or more times per week

and the proportion who engaged in physical

activity five or more times per week. All reported activities were included in these tabulations.

The data indicate that pregnant and postpartum

women enrolled in WIC were about as physically active as income-eligible nonparticipants,

but were significantly less physically active than

higher-income nonparticipants (figure 22 and

table D-72). Twenty-seven percent of WIC

women engaged in some physical activity at

Figure 22 - Percent of pregnant and postpartum

women engaging in physical activity

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

27%

15%

34%

15%

34%*

45%*

0%

20%

40%

60%

80%

100%

Three times per week Five times per week

Percent of women

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants

3NHANES-III physical activity data include intensity codes

that were assigned to all queried activities and to all additional

(“other”) activities reported by respondents. However,

because all queried activities received the same intensity

rating, these data could not be used to identify individuals who

engaged in specific activities at greater and lesser levels of

intensity.
37

NHANES-III did not ask sampled women about

alcohol and tobacco consumption during pregnancy. Rather, respondents were asked if they

ever smoked or consumed alcohol and if they

smoked or consumed alcohol in the recent past

(past 5 days for cigarettes, past year for alcohol). These data provide some information on

the percentage of WIC women and nonparticipant women who may need education about the

dangers of alcohol and tobacco consumption

during pregnancy. (The next chapter presents

information about the percentage of infants and

children born to women who smoked during

pregnancy.) Data are not tabulated separately

for pregnant women and postpartum women

because of limited samples.

Alcohol Consumption

Respondents were asked whether they had

consumed at least 12 alcoholic beverages, not

counting small sips, over their lifetime and during

the past 12 months. Overall, 78 percent of

pregnant and postpartum women reported

consuming at least 12 alcoholic drinks during

their lifetime (table D-73). The percentage

consuming that number of alcoholic drinks

during the past year was notably lower, at 37

percent.

Patterns of alcohol consumption among pregnant

and postpartum women were comparable for

WIC participants and income-eligible nonparticipants (figure 23). However, in comparison with

higher-income nonparticipants, WIC participants

were significantly less likely to have consumed

12 or more alcoholic drinks in their lifetime (72%

vs. 85%) or to have consumed this amount of

alcohol during the past year (21% vs. 46%).

Among women who consumed alcohol during

the past year, the mean number of drinks

consumed on an average drinking day was

significantly greater for WIC participants than

for higher-income nonparticipants (point estimates for both groups of women are statistically

unreliable) (table D-73).

Tobacco Consumption

Overall, 38 percent of pregnant and postpartum

women reported that they were or had been

smokers (table D-74). This includes all women

who reported having smoked at least 100

cigarettes (5 packs) in their lifetime. More than

one in five (22%) pregnant and postpartum

women reported having smoked in the past 5

days. The mean number of cigarettes smoked by

current smokers in the past 5 days was 52.6, or

about 2.6 packs. There were no significant

differences between WIC participants and either

group of nonparticipants on any of these measures.

There was a significant difference, however,

between WIC women and higher-income

women in the reported mean age at which

smoking was initiated. Specifically, WIC women

Figure 23 - Percent of pregnant and postpartum

women who consumed 12 or more alcoholic

beverages, in their lifetime and in the past year

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

72%

21%

73%

33%

46%*

85%*

0%

20%

40%

60%

80%

100%

In lifetime In past year

Percent of women

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants
38

The exposure of infants and young children to

second-hand smoke is of special concern.

Among infants, WIC participants were twice as

likely as higher-income nonparticipants to be

exposed to smoke in the home (47% vs. 23%).

The trend was similar for children, although the

disparity between the two groups was smaller

(44% vs. 29%).

Although a significantly greater percentage of

nonsmoking WIC participants than nonsmoking,

higher-income nonparticipants were exposed to

second-hand smoke in their homes, the average

“dose” for those exposed was comparable

across groups. That is, for all groups of nonsmokers, the mean number of cigarettes smoked

by smokers in the household was approximately

the same: 15-16 cigarettes per day (table D-76).

NHANES-III measured serum cotinine in all

respondents 4 years of age and older. Cotinine is

a breakdown product of nicotine, and is used as

a biological marker for tobacco use and exposure to environmental tobacco smoke. Overall,

62 percent of nonsmoking women and 4-yearold children had high serum cotinine levels (table

D-77). The prevalence of this problem was

notably greater for 4-year-old children than for

pregnant and postpartum women (76% vs. 52%)

(statistical significance of age-based difference

not tested).

There were no differences between WIC

participants and income-eligible nonparticipants

in the prevalence of high serum cotinine levels.

In comparison with higher-income nonparticipants, however, the prevalence of high serum

cotinine was significantly greater for WIC

participants (figure 25 and table D-77). This is

consistent with the previous finding that nonsmoking WIC participants were more likely than

nonsmoking, higher-income nonparticipants to

reside with one or more smokers. Overall, 78

percent of WIC participants had high a high

serum cotinine, compared with 52 percent of

started smoking at a younger age than higherincome women (the point estimate for WIC

women is statistically unreliable) (table D-74).

Exposure to Second-Hand Smoke

NHANES-III collected information on the

number of smokers living in each household and

the number of cigarettes smoked by those

individuals. These data reveal that exposure to

second-hand smoke was comparable for nonsmoking WIC participants and nonsmoking,

income-eligible nonparticipants. However,

nonsmoking WIC participants were significantly

more likely than nonsmoking, higher-income

nonparticipants to be exposed to second-hand

smoke produced by other household members

(figure 24 and D-75). This was true for all three

categories of WIC participants (women, infants,

and children). Data for women are not presented in figure 24 because the point estimate

for higher-income women is statistically unreliable.

Figure 24 - Percent of infants and children exposed

to cigarette smoke at home

*Statistically significant difference from WIC participants at

the .05 level or better.

Note: Women are not shown because the point estimate is

statistically unreliable for higher-income women.

Source: NHANES-III, 1988-94.

47% 44% 48%

44%

29%*

23%*

0%

20%

40%

60%

80%

100%

Infants Children

Percent of infants and children

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants
39

higher-income nonparticipants. This pattern was

noted separately for both women and 4-yearolds. Data are not reported separately in figure

25 because the point estimate for 4-year-old

WIC participants is statistically unreliable.

Figure 25 - Percent of nonsmoking women and 4-

year-old children with high serum cotinine levels

*Statistically significant difference from WIC participants at

the .05 level or better.

Note: Data are not shown separately for women and 4-yearold children because the point estimate is statistically

unreliable for 4-year-old WIC participants.

Source: NHANES-III, 1988-94.

78%

71%

52%*

0%

20%

40%

60%

80%

100%

WIC participants Income-eligible

nonparticipants

Higher-income

nonparticipants

Percent of women and 4-year-old children 

41

This chapter describes the health status of WIC

participants and nonparticipants. The discussion

is divided into several topic areas: general health

status, women’s health conditions and risks,

children’s birth characteristics, health status of

children and infants, and dental health.

Several of the measures examined in this

chapter are indicators of nutritional risk that may

qualify individuals for participation in WIC.

Consequently, a greater prevalence of these

characteristics among WIC participants than

nonparticipants may simply be a reflection of

criteria for selection into the program. Risk

criteria that were in use at the time of the

NHANES-III data collection, based on mention

in the IOM (1996) report on WIC nutrition risk

criteria (see Chapter One), are noted in the text.

General Health Status

General health status was measured in

NHANES-III by self-report as well as by direct

physician assessment.1 In both cases, response

options were: excellent, very good, good, fair,

and poor.

Overall, women’s self-reported health status was

less positive than the health status reported for

infants and children (table D-78 and D-79). Only

a little more than half (56%) of women rated

their health as excellent or very good. In contrast, more than three-quarters of infants and 1-

4-year-old children were reported to be in

excellent or very good health (statistical significance of age-based difference not tested).

Physicians tended to rate health status more

positively than survey respondents (table D-80

and D-81).

WIC participants and income-eligible nonparticipants had approximately equivalent health

status, as measured by both self-reports and

physician assessments (figure 26 and tables D78 and D-79). Roughly 63 percent of WIC

participants and income-eligible nonparticipants

rated their health as very good or excellent, 30

percent rated their health as good, and about 7

percent rated their health as fair or poor.

According to the more-positive physician

assessments, more than 85 percent of both WIC

participants and income-eligible nonparticipants

were in very good or excellent health and 12

percent of both groups were in good health

(figure 27 and tables D-80 and D-81).

In comparison with higher-income nonparticipants, WIC participants rated their health status

more negatively. WIC participants were significantly less likely than higher-income nonparticipants to rate their health status as very good or

excellent (62% vs. 84%) and significantly more

likely to rate their health status as fair or poor

(8% vs. 2%) (figure 26). These significant

between-group differences were noted consistently for women, infants, and children (tables

D-78 and D-79).

Physician assessments revealed the same

pattern of differences between WIC participants

and higher-income nonparticipants, but the

between-group differences were smaller. The

difference in the percentage considered to be in

excellent or very good health was statistically

significant (87% vs. 91%); while the difference

Chapter Five

Health Status, Conditions, and Risks

1For ease in discussion, the term “self-report” is used to

describe data reported by sampled women as well as data

provided by mothers or other caregivers for sampled infants

and children.
42

congestive heart failure, and cancer other than

skin cancer.

With the exception of high blood pressure, which

was reported by 10 percent of women overall,

the reported prevalence of the health conditions

queried in NHANES-III was low among pregnant and postpartum women (table D-82). In

reality, high blood pressure was also rare in this

group of women. Physician-measured blood

pressure revealed that very few women actually

had high blood pressure (table D-82). No

statistically significant differences were found

between WIC women and either group of

nonparticipating women on any of these measures.

Pregnancy and Childbirth History

NHANES-III collected a detailed reproductive

history for all female respondents 12 years of

age and older. Tabulations prepared for this

report include the mean number of pregnancies,

mean number of live births, mean age at time of

first live birth, and the percent of women who

were teenagers or more than 35 years of age at

in the percentage considered to be in fair or poor

health (a very rare event) was not (figure 27).

The between-group difference in physicianassessed health status was concentrated among

women (table D-80). In addition, there was a

significant difference between WIC infants and

higher-income infants in the percentage considered to be in fair or poor health (although this

was a rare occurrence in both groups) (table D81).

Women’s Health Conditions and Risks

This section provides information on selected

health conditions and risks of pregnant and

postpartum women. Topics include the prevalence of chronic health conditions and pregnancy

and childbirth history.

Chronic Health Conditions

NHANES-III asked adult respondents (17 years

and older) if a physician had ever told them that

they had specific types of health conditions.

Queried conditions include high blood pressure,

diabetes, heart attack, stroke, emphysema,

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

12% 12% 8%

87% 88% 91%*

0%

20%

40%

60%

80%

100%

WIC participants Income-eligible

nonparticipants

Higher-income

nonparticipants

Percent of population 

Fair or poor Good Very good or excellent

Figure 26 - Self- or caregiver-reported general

health status

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

30% 30%

62% 64%

6% 2%* 8%

14%*

84%*

0%

20%

40%

60%

80%

100%

WIC participants Income-eligible

nonparticipants

Higher-income

nonparticipants

Percent of population

Fair or poor Good Very good or excellent

Figure 27 - Physician-assessed general health status
43

Birth Characteristics of Infants and

Children

For infants and children under the age of 12,

NHANES-III collected data on a number of

characteristics of both mother and child at the

time of birth. This includes information on

maternal age, maternal smoking during pregnancy, the child’s birthweight (reported by

mother or other caregiver), and receipt of

neonatal intensive care services.

The following sections summarize data on birth

characteristics for infants and 1-4-year-old

children. During the period of the NHANES-III

data collection, all of these characteristics were

employed by some States to establish eligibility

for WIC participation (IOM, 1996).

Maternal Age

WIC infants were born to younger mothers, on

average, than either income-eligible infants or

higher-income infants (mean age of 24.1 years

vs. 25.7 years and 28.9 years) (figure 29 and

table D-84). In addition, WIC children were born

to younger mothers, on average, than higherincome children (24.8 years vs. 28.2 years).

WIC infants were also significantly more likely

than infants in either nonparticipant group to be

born to teenage mothers (23% vs. 14% and 3%)

(figure 30 and table D-85). A similar pattern was

observed among children; however, the difference between WIC children and income-eligible

children was not statistically significant.

Finally, both WIC infants and WIC children were

less likely than their higher-income nonparticipant counterparts to be born to mothers over age

35 (table D-86). Four percent of WIC infants

and 4 percent of WIC children were born to

women over the age of 35. This compares with

11 percent of higher-income nonparticipant

infants and 9 percent of higher-income nonparticipant children.

the time of their first live birth. Although high

parity (having many pregnancies) was not

recommended as a nutritional risk criterion by

the IOM in its 1996 report, some States were

using this characteristic to define WIC eligibility

during the time the NHANES-III data were

collected. Young maternal age and advanced

maternal age were also used as nutritional risk

criteria by some States (IOM, 1996).

There were no significant differences between

WIC women and income-eligible women for any

of the pregnancy and childbirth measures

examined in this analysis (table D-83). In

comparison with higher-income women, however, women who were participating in WIC had

a significantly greater number of live births (1.6

vs. 1.1) (figure 28). In addition, at the time of the

first live birth, WIC women were significantly

younger than higher-income women and were

significantly more likely to have been teenagers

(point estimates for WIC participants are statistically unreliable for both of these measures)

(table D-83).

Figure 28 - Mean number of pregnancies and mean

live births

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

2.5

1.6

2.7

1.5

2.3

1.1*

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Pregnancies Live births

Mean number

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants
44

Maternal Smoking During Pregnancy

Overall, 24 percent of infants and 1-4-year-old

children were born to women who smoked

during the pregnancy (table D-87). There were

no significant differences between WIC infants

and children and income-eligible infants and

children in this regard (figure 31). WIC infants

and children were, however, significantly more

likely than higher-income infants and children to

have been born to women who smoked during

the pregnancy. This was true for 27 percent of

WIC infants and 29 percent of WIC children,

compared with 17 percent of higher-income

infants and 19 percent of higher-income children.

Birthweight (Self-Report)

According to data reported by parents and

caregivers, infants and children participating in

WIC had a significantly lower mean birthweight

than either income-eligible or higher-income

infants and children. The reported mean

birthweight for WIC infants was 3,258 gm. (7.2

pounds), compared with 3,343 gm. (7.4 pounds)

for income-eligible infants and 3,470 gm. (7.7

pounds) for higher-income infants (figure 32 and

table. D-88). Reported mean birthweights for

children showed similar between-group differences.

WIC infants and children were also more likely

than infants and children in either of the nonparFigure 30 - Percent of infants and children born to

teenage mothers

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

23%

20%

18%

14%*

5%*

3%*

0%

10%

20%

30%

40%

50%

Infants Children

Percent of infants and children

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants

Figure 31 - Percent of infants and children whose

mothers smoked during pregnancy

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

27% 30% 29% 28%

19%* 17%*

0%

20%

40%

60%

80%

100%

Infants Children

Percent of population

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants

Figure 29 - Mean age of mother at birth

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

24.8

24.1

24.7

 25.7 *

 28.2 *

 28.9 *

21

22

23

24

25

26

27

28

29

30

Infants Children

Mean maternal age (years)

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants
45

ticipant groups to have been low birthweight

(less than 2,500 gm. or 5.5 pounds) (figure 33

and table D-89). According to reported

birthweights, the prevalence of low birthweight

among WIC infants was twice that of incomeeligible infants and three times that of higherincome infants (12% vs. 6% and 4%). A comparable pattern was noted for children, but the

between-group disparities were smaller (12% vs.

8% and 5%).

These results are not surprising, given that low

birthweight is a nutritional risk criteria used to

establish program eligibility. Moreover, low

birthweight infants may stay on WIC longer than

normal weight infants because they tend to have

more problems.

There were no statistically significant betweengroup differences in the prevalence of very-low

birthweight (less than 1,500 gm. or 3.3 pounds)

(table D-90).

Neonatal Intensive Care Stays

Approximately 11 percent of all infants and 1-4-

year-old children were reportedly hospitalized in

neonatal intensive care units (NICUs) at the

time of their birth (table D-91). The reported

prevalence of NICU stays was greater for WIC

infants and children than for infants and children

in either of the nonparticipant groups (15% vs.

10% and 11%). Although this general pattern

was observed for both infants and children, the

between-group differences were not consistently

significant (figure 34).

Health Status of Children and Infants

This section presents data on a number of

measures of child health and well being. For

children, topics include weight status, growth

retardation (stunted linear growth), iron status,

hospitalizations since birth, accidents, injuries,

and poisonings requiring medical attention,

chronic respiratory conditions, and lead poisoning.2

 For infants, data availability was limited to

information on hospitalizations since birth,

accidents, injuries and poisonings requiring

Figure 32 - Reported mean birthweight of infants

and children

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

3,187

3,258

 3,312 *

 3,343 *

 3,428 *

 3,470 *

2,950

3,000

3,050

3,100

3,150

3,200

3,250

3,300

3,350

3,400

3,450

3,500

Infants Children

Mean birthweight (gm.)

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants

Figure 33 - Percent of infants and children born low

birthweight, based on reported birthweight

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

12% 12%

8%*

6%* 5%* 4%*

0%

10%

20%

30%

40%

50%

Infants Children

Percent of infants and children

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants

2Caregivers were also asked whether children had several other

health conditions, including high cholesterol, diabetes, and

high blood pressure. However, because the percentages of

children reported to have any of these conditions were very

low, the data were not tabulated for this report.
46

medical attention, and chronic respiratory

conditions. The data presented are drawn from

both physical examinations and interviews with

parents/caregivers.

Weight Status of Children

The prevalence of overweight and obesity in the

U.S. has increased dramatically since the first

Health Examination Survey (a precursor to the

present NHANES survey) was conducted in

1963-65 (Flegal et al., 1998). This is especially

true for children and adolescents, for whom the

prevalence of overweight has more than doubled

(Troiano and Flegal, 1998).

Healthy People 2010 includes goals to decrease the proportion of children who are

overweight. Classifying children as overweight

is fundamentally different from classifying adults

as overweight (Cole, 2001). Adults have traditionally been categorized on the basis of life

insurance mortality data and data relating weight

status to morbidity and mortality (Troiano and

Flegal, 1998). Such criteria cannot be used to

define overweight in childhood, however,

Figure 34 - Percent of infants and children receiving neonatal intensive care

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

15% 15%

11% 11% 9%* 10%*

0%

10%

20%

30%

40%

50%

Infants Children

Percent of infants and children

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants

because childhood mortality is not associated

with weight and weight-related morbidity in

childhood is too low to define meaningful cutoffs

(Barlow and Dietz, 1998). Therefore, the

approach used to classify children as overweight

relies on comparing children’s weights and

heights to appropriate reference populations.

A series of growth charts has been developed

by the CDC for different anthropometric measures and different age groups (Kuczmarski et

al., 2002). Three different growth charts can be

used to assess weight status in very young

children: the BMI-for-age chart (designed for

ages 2 and over), the weight-for-length chart

(birth through 3 years), and the weight-for-height

chart (2-5 years). Because this analysis included

children between 1 and 4 years of age, the

weight-for-length and weight-for-height charts

were used. These two charts are parallel in the

overlapping ages of 24-36 months so that, within

this age group, recumbent length and standing

height (when used with the appropriate chart)

yield the same percentile.3

In assessing weight status among children, use

of the word “obesity” is avoided because of

potential negative connotations (CDC, 2003).

Instead, assessment of weight status focuses on

the prevalence of overweight (defined as

weight-for-height at or above the 95th percentile), the prevalence of being at risk of overweight (defined as weight-for-height between

the 85th and 95th percentiles), and the prevalence

of underweight (defined as weight-for-height

below the 5th percentile) (see appendix B).

Overweight and underweight are included in the

nutritional risk criteria recommended by the

IOM for qualifying children for WIC participation; these criteria were in widespread use at the

3

In children under 2 years of age, recumbent length rather than

standing height is used to assess stature. For ease in discussion,

the term “weight-for-height” is used in this chapter to refer to

the appropriate use of either the weight-for-length or weightfor-height charts.
47

time NHANES-III data were collected (IOM,

1996).

Among 1-4-year-old children, there was no

significant difference between WIC participants

and income-eligible nonparticipants in the

prevalence of overweight (7-8%) (figure 35 and

table D-92). However, WIC children were

significantly more likely to be overweight than

higher-income children (7% vs. 4%). There

were no differences between WIC participants

and either group of nonparticipants in the

percentage of children at risk of overweight

(11%, overall).

WIC children were significantly more likely than

income-eligible children to be underweight (table

D-92). Seven percent of WIC children were

underweight, compared with 3 percent of

income-eligible children. There was no significant difference between WIC children and

higher-income children in the prevalence of

underweight.

Growth Retardation Among 2-4-year-old

Children

Young children are susceptible to growth

problems that can affect stature. Retardation of

linear growth in preschool children may reflect

inadequate maternal weight gain or other

prenatal problems, dietary inadequacy, infectious

or chronic disease, or poor healthcare (U.S.

DHHS, 2000a). The Healthy People 2010

objectives include a goal to decrease the prevalence of (linear) growth retardation among lowincome children under the age of 5. Retarded

growth is defined as height-for-age below the

5th percentile on the CDC height-for-age growth

charts (U.S. DHHS, 2000a). This condition

(commonly referred to as short stature) is

among the nutritional risk criteria recommended

by the IOM for determining WIC eligibility and

was in common use at the time the NHANESIII data were collected (IOM, 1996). Because

the height-for-age growth chart is designed for

children 2 to 5 years of age, tabulations related

to growth retardation are limited to 2-4-yearolds.

Overall, the prevalence of growth retardation

among 2-4-year-old children was relatively low,

at about 4 percent (table D-93). WIC children

had a greater prevalence of growth retardation

than either group of nonparticipant children (9%

vs. 5% and 2%); however, only the difference

between WIC children and higher-income

children was statistically significant (figure 36).

Prevalence of Iron Deficiency, Iron-Deficiency Anemia, and Anemia Among Children

Iron deficiency is the most common known form

of nutritional deficiency (CDC, 1998). Iron

deficiency can lead to developmental delays,

behavioral problems, and decreases in verbal

learning and memory, and can affect immune

function, energy metabolism, and work performance (U.S. DHHS, 2000a, CDC, 1998, and

Looker et al., 1997). The prevalence of iron

Figure 35 - Percent of children overweight and at

risk of overweight

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

7%

11%

8%

13%

9%

4%*

0%

10%

20%

30%

40%

50%

Overweight At risk of overweight

Percent of children

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants
48

This analysis assessed the prevalence of iron

deficiency using the criterion defined in Healthy

People 2010 (U.S. DHHS, 2000a). This

criterion defines iron deficiency as abnormal

results on two or more of the following measures of iron status: serum transferrin saturation,

erythrocyte protoporphorin, and serum ferritin.

Iron-deficiency anemia was defined as documented iron deficiency (as defined above) plus

abnormally low hemoglobin (Looker et al.,

1997). Cutoff values used in the analysis are

shown in appendix B. The analysis sample was

limited to children with data for all relevant

variables.

Anemia, defined on the basis of low hemoglobin

or hematocrit, was used as a nutrition risk

criterion by a majority of WIC State agencies at

the time the NHANES-III data were collected

(IOM, 1996).

Overall, the prevalence of iron deficiency among

1-4-year-old children was about 6 percent (table

D-94).4 Prevalence was greatest among 1-yearolds (13%) and was substantially lower for older

children (statistical significance of age-based

differences not tested).

WIC children were significantly less likely than

income-eligible children to be iron deficient

(figure 37). In fact, income-eligible children

were twice as likely as WIC children to be iron

deficient (10% vs. 5%). This difference was

largely concentrated among 3-year-olds (table

D-94). WIC children in this age-specific cohort

were also less likely to be iron deficient than

higher-income children. But, overall, there was

no significant difference between WIC children

and higher-income children in the prevalence of

iron deficiency.

deficiency has decreased dramatically over the

past three decades, in part because of increased

iron intake among infants and young children

and the influence of the WIC program (Yip et

al., 1987). Nonetheless, iron deficiency remains

a problem for young children, particularly those

who are low-income. Healthy People 2010

includes a goal to decrease the prevalence of

iron deficiency among preschool children (ages

1 to 4) (U.S. DHHS, 2000a).

The terms anemia, iron deficiency, and irondeficiency anemia are often used interchangeably, but are not equivalent (U.S. DHHS,

2000a). Although iron deficiency can contribute

to anemia, anemia can also be caused by other

factors, including other nutrient deficiencies,

infection, inflammation, and hereditary anemias.

When the prevalence of iron deficiency is high,

anemia is a good predictor of iron deficiency.

However, when the prevalence of iron deficiency is low, the majority of anemia is due to

other causes (U.S. DHHS, 2000a).

Figure 36 - Percent of 2-4-year-old children with

growth retardation

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

9%

5%

2%*

0%

10%

20%

30%

40%

50%

WIC participants Income-eligible

nonparticipants

Higher-income

nonparticipants

Percent of children

4Results for each of the three measures of iron status

considered in defining iron deficiency (serum ferritin, free

erythrocyte protoporphorin, and transferrin saturation) are

presented in tables D-96 to D-98.
49

anemia generally decreased with age; however,

differences between 1-year-olds and other age

groups were not as dramatic as the differences

observed for iron deficiency (statistical significance of age-based differences not tested).

WIC children were no more or less likely than

income-eligible nonparticipant children to have

anemia, based on a low level of hemoglobin

(figure 37). In comparison with higher-income

children, however, WIC children were more

likely to be anemic (9% vs. 6%).

Hospitalizations Since Birth

Overall, 17 percent of infants and 1-4-year-old

children were hospitalized at least one time since

birth (table D-101). WIC infants were significantly more likely to have been hospitalized than

higher-income infants (14% vs. 6%) (figure 38).

The difference in rates of hospitalization for

WIC infants and income-eligible infants was not

significant (14% vs. 10%).

The percent of children with hospitalizations

since birth is a cumulative measure that increases with age. By the time children were 1

year of age, the difference between WIC

participants and higher-income nonparticipants

observed among infants had narrowed significantly. At that point, WIC children had a hospitalization rate of 19 percent, compared with 17

percent for higher-income children, and the

difference was not statistically significant (table

D-101). Similarly for 2-, 3-, and 4-year-olds and

for children overall, there were no significant

differences between WIC participants and either

group of nonparticipants in the percent of

children with one or more hospitalizations since

birth.

Accidents, Injuries, and Poisonings Requiring Medical Attention

Parents and caregivers were asked whether

infants or children had experienced, anytime

Iron-deficiency anemia was observed in about 2

percent of 1-4-year-old children, overall (table

D-98). Because of low prevalence, the point

estimates for most subgroups are unreliable.

However, it is clear that the prevalence of irondeficiency anemia, like the prevalence of iron

deficiency, was greatest among 1-year-olds. The

data also indicate that WIC children were

significantly more likely than higher-income

children to have iron-deficiency anemia, although this was a relatively uncommon finding

for all children, particularly those older than 2.

The prevalence of anemia, defined on the basis

of low hemoglobin or hematocrit, was substantially greater than the prevalence of irondeficiency anemia, as assessed in this analysis.

(As noted previously, low hemoglobin levels may

be caused by factors unrelated to iron status,

including infection, inflammation, deficiencies of

other nutrients (unlikely with this age group), and

hereditary anemias). Eight percent of all children

between the ages of 1 and 4 had low levels of

hemoglobin and 7 percent had low hematocrits

(tables D-99 and D-100). The prevalence of

Figure 37 - Percent of children with iron deficiency

and percent with anemia/low hemoglobin

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

5%

9% 10%* 11%

4%

6%*

0%

10%

20%

30%

40%

50%

Iron deficiency Anemia (low hemoglobin)

Percent of children

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants
50

higher-income nonparticipants to have reported

asthma (7% vs. 4%). This difference was

observed for both infants and children.

Lead Poisoning Among Children

The NHANES-III interview asked parents and

caregivers whether children had been screened

for lead poisoning. Caregivers of children who

had been screened were asked whether the

results indicated that the child had “high lead or

lead poisoning.”

Overall, 10 percent of 1-4-year-old children had

reportedly been screened for lead poisoning

(table D-106). Children participating in WIC

were significantly more likely than either group

of nonparticipating children to have been

screened (figure 39). In fact, WIC children were

almost twice as likely as income-eligible children

and 3.5 times as likely as higher-income children

to have been screened for lead poisoning (21%

vs. 11% and 6%). This pattern was observed for

each age-specific cohort (table D-106).

during the preceding 12 months, an accident,

injury, or poisoning that was serious enough to

require medical attention. Overall, 10 percent of

infants and 1-4-year-old children had at least one

such experience (table D-102). Not surprisingly,

the percentage of children experiencing such

medical emergencies was substantially greater

than the percentage of infants (12% vs. 2%)

(statistical significance of age-based difference

not tested). No significant differences were

observed between WIC participants and either

group of nonparticipants on this measure.

Chronic Respiratory Conditions

Parents and caregivers were asked whether a

health professional had ever told them that their

infant or child had asthma, chronic bronchitis, or

hay fever. The reported prevalence of all of

these conditions was relatively low, overall

(tables D-103 – D-105).

The only significant difference noted between

WIC participants and nonparticipants, overall,

was in the reported prevalence of asthma. WIC

participants were significantly more likely than

Figure 39 - Percent of children ever screened for

lead poisoning

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

21%

6%*

11%*

0%

10%

20%

30%

40%

50%

WIC participants Income-eligible

nonparticipants

Higher-income

nonparticipants

Percent of children

Figure 38 - Percent of infants and children with at

least one hospitalization since birth

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

14%

21%

10%

19% 18%

6%*

0%

10%

20%

30%

40%

50%

Infants Children

Percent of infants and children

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants
51

NHANES-III. (The data reported in table D-108

and figure 40 reflect the complete NHANES-III

sample). The overall prevalence of elevated

blood lead levels in this group of children decreased from 8.9 percent in Phase I to 5.2

percent in Phase II, a decrease of 42 percent.

Figure 41 illustrates the decrease in the prevalence of high blood lead levels over the period of

the NHANES-III data collection for WIC

children and income-eligible nonparticipant

children. The decrease for WIC children was

approximately 23 percent, from a prevalence of

about 17 percent in Phase I to about 13 percent

in Phase II. The decrease for income-eligible

children was approximately 45 percent (from

about 11% to about 6%). The decrease for

higher-income children can not be determined

reliably because the point estimate for higherincome children in Phase II is statistically

unreliable (table D-110).

Because of declining prevalence over time, the

Phase II data offer the most representative data

on lead poisoning available from NHANES-III.

According to caregiver reports, the percentage

of children found to have lead poisoning at any

point in time was very low, less than 1 percent

overall (table D-107). Nonetheless, the percentage of WIC children reported to have been

diagnosed with lead poisoning was significantly

greater than the percentage of higher-income

children (the point estimate for higher-income

children is statistically unreliable).

Based on NHANES-III laboratory tests and

CDC-defined standards for elevated blood lead

levels, the actual prevalence of lead poisoning

was substantially greater than reported by

caregivers. Overall, 7 percent of children were

found to have blood lead levels indicative of lead

poisoning (table D-108). Moreover, the prevalence of high blood lead levels was significantly

greater for WIC children than for either group of

nonparticipating children (figure 40). Fourteen

percent of WIC children had abnormally high

blood lead levels. Comparable statistics for

nonparticipant children were 8 percent for

income-eligible children 3 percent for higherincome children. Lead poisoning was being used

as a nutritional risk criteria for WIC at the time

NHANES-III data were collected.

The problem of lead poisoning has been declining sharply in recent years. Between NHANESII (1976-80) and the first phase of NHANES-III

(1988-91), the overall prevalence of lead poisoning in the population as a whole decreased from

77.8 percent to 4.4 percent (CDC, 1997).

Between Phase I (1988-91) and Phase II (1991-

94) of NHANES-III, the overall prevalence of

high blood lead levels continued to decline, with

percentage point decreases generally being

greater among groups with the highest prevalence of elevated lead levels during Phase I

(CDC, 1997).

Tables D-109 and D-110 present data on the

prevalence of elevated blood lead levels among

1-4-year-old children in Phase I and Phase II of

Figure 40 - Percent of children with high blood lead

levels

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

14%

3%*

8%*

0%

10%

20%

30%

40%

50%

WIC participants Income-eligible

nonparticipants

Higher-income

nonparticipants

Percent of children
52

higher-income women, however, WIC women

had fewer teeth that were missing, decayed, or

filled.5

Children 2 to 4 years of age had, on average,

about one missing, decayed, or filled tooth.

Differences between groups were small, but the

difference between WIC children and higherincome children was statistically significant,

overall and for each of the age-specific cohorts

except 3-year-olds.

Visits to a Dentist or Dental Hygienist

Overall, close to 100 percent of pregnant and

postpartum women reported visiting a dentist or

dental hygienist at least once in their lifetime

(table D-112). Sixty-three percent reported

visiting a dental health professional in the past

year (table D-113). There were no statistically

significant differences between WIC women

and either group of nonparticipating women in

these health practices.

Among children 2-4 years old, 38 percent visited

a dental health professional at least once and 36

percent visited a dental health professional in the

past year (tables D-112 and D-113). WIC

children were no more or less likely to have had

dental care visits than higher-income children.

However, WIC children were significantly more

likely than income-eligible children to have

visited a dental health practitioner (figure 42).

Forty-one percent of WIC children visited a

These data indicate that WIC children were

significantly more likely than either group of

nonparticipating children to have lead poisoning.

About 13 percent of WIC children had elevated

blood lead levels, compared with 6 percent of

income-eligible children. The difference between

WIC children and higher-income children was

also statistically significant. However, as noted,

the point estimate for higher-income children is

statistically unreliable.

Dental Health

All NHANES-III respondents 2 years of age

and older received a dental exam as part of the

physical examination component. In this exam,

all decayed, missing, and filled teeth were

charted.

Overall, pregnant and postpartum women had an

average of 8.6 missing, decayed, or filled teeth

(table D-111). WIC women and income-eligible

women had comparable numbers of missing,

decayed, and filled teeth. In comparison with

5

It was not possible, for this report, to examine the difference

between the dental health status of WIC women and higherincome women in more detail. The NHANES-III exam file

does not provide separate totals for decayed, missing, and

filled teeth. Nor does it provide information on these

characteristics for each tooth. Rather, the file provides

separate variables that describe the status of four different

surfaces for each tooth. These detailed data can be used in

future analyses to elucidate the underlying cause of the

difference observed between the two groups of women. For

example, higher-income women may have more filled teeth

than WIC women. This may indicate attention to caries

detected by x-ray—rather than those causing pain or clearly

visible on the exterior of a tooth—resulting from higher

quality dental care.

Figure 41 - Percent of children with high blood lead

levels: NHANES-III, Phase I and II

*Statistically significant difference from WIC participants at

the .05 level or better.

Note: Point estimate for higher-income nonparticipants in

Phase II is statistically unreliable.

Source: NHANES-III, 1988-94.

17%

13%

11%

6%*

0%

10%

20%

30%

40%

50%

Phase I (1988-91) Phase II (1991-94)

Percent of children

WIC participants Income-eligible nonparticipants
53

dental health professional at least once in their

lives. In contrast, only 30 percent of incomeeligible children had had a dental care visit. A

comparable pattern was noted for reported

dental visits during the past year (39% vs. 29%).

Figure 42 - Percent of children who have visited a

dentist or dental hygienist

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

41% 39%

44% 42%

30%* 29%*

0%

20%

40%

60%

80%

100%

Ever visited Visited in past year

Percent of children

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants

55

This chapter focuses on issues that affect

individuals’ access to and use of health care

services—health insurance coverage, the

availability of a regular source (location) of

health care, and the availability of a regular

physician or other health care provider. The

chapter also describes utilization of health care

services in the past year.

Many WIC local agencies are co-located with

public health clinics or other health care delivery

sites. In addition, as noted in Chapter One, under

adjunctive-eligibility rules, Medicaid recipients

are automatically income-eligible for WIC.

Health Insurance Coverage

NHANES-III asked all respondents about

sources of health insurance coverage. Survey

questions considered Medicare, Medicaid,

Veteran’s Administration (VA) benefits,

CHAMPUS, CHAMPVA, and private health

insurance.1

During the survey period, four different versions

of the survey instrument were used and health

insurance questions varied across versions. The

major difference was the time frame referenced;

for example, “now” vs. “in the last month.” In

addition, some questions had slight variations in

wording across versions.2 When differences in

versions were considered slight, NHANES-III

staff created the variable for the full survey time

period. All variables used in this analysis were

available for the full survey sample except the

question about receipt of CHAMPUS,

CHAMPVA, Veteran’s Administration (VA)

benefits, and military health care. The prevalence of this type of insurance coverage was

calculated using data for respondents who

answered that question. These data were not

tabulated separately because of very low

prevalence, but contributed to overall estimates

of health insurance coverage.

Overall, 88 percent of pregnant and postpartum

women, 94 percent of infants, and 92 percent of

1-4-year-old children had some type of health

insurance coverage (table D-113). Among

women, there was no difference between WIC

participants and income-eligible nonparticipants

in the rate of health insurance coverage (79%

vs. 80%). However, in comparison with higherincome women, women participating in WIC

were significantly less likely to have health

insurance (point estimate for higher-income

women is statistically unreliable).

Among infants and children, WIC participants

were more likely than income-eligible nonparticipants and less likely than higher-income nonparticipants to have health insurance. Ninety-three

percent of WIC infants had health insurance,

compared with 84 percent of income-eligible

infants. The percentage of higher-income infants

with health insurance was significantly greater

Chapter Six

Access to Health Care Services

1CHAMPUS (now known as TRICARE) is a health care

benefits program for active duty and retired members of the

military. CHAMPVA is a health care benefits program for

permanently disabled veterans and their dependents.

2Version differences for health insurance questions varied for

different sources of health insurance. Two versions of the

Medicare and Medicaid questions were asked: “At any time

DURING THE LAST 12 MONTHS were you covered by

Medicare/Medicaid?” and “DURING THE LAST MONTH

were you covered by Medicare/Medicaid?”

Three versions of the private health insurance question were

asked: “Are you NOW covered by a health insurance plan?”,

“Are you covered by a health insurance plan?” and “During

the LAST MONTH were you covered by a health insurance

plan obtained privately or through an employer or union?”
56

ence between WIC participants and incomeeligible nonparticipants in the receipt of private

health insurance was not statistically significant

(table D-115).

Regular Source of Health Care

More than 8 out of 10 pregnant and postpartum

women reported having a regular source of

health carethat is, a clinic, health center, or

doctor’s office that was usually used for health

care needs or to obtain health-related advice and

information (table D-117). There were no

significant between-group differences in the

percentage of pregnant and postpartum women

who had a regular source of health care (figure

44).

Overall, 97 percent of all infants and 95 percent

of 1-4-year-old children had a regular source of

health care (table D-117). WIC infants were

significantly more likely than income-eligible

nonparticipant infants and just as likely as higherthan the percentage of WIC infants, but the point

estimate for higher-income infants is unreliable.

Among 1-4-year-old children, 94 percent of WIC

children had health insurance, compared with 86

percent of income-eligible children and 96

percent of higher-income children.

WIC participants were significantly less likely

than comparable individuals in either of the

nonparticipant groups to have private health

insurance coverage and were more likely to be

receiving Medicaid benefits (figure 43 and tables

D-115 and D-116). Overall, only 35 percent of

WIC participants had private health insurance

coverage, compared with 51 percent of incomeeligible nonparticipants and 93 percent of higherincome nonparticipants. In contrast, almost

three-quarters of WIC participants received

Medicaid benefits, compared with 48 percent of

income-eligible nonparticipants and 5 percent of

higher-income nonparticipants. These patterns

were observed separately for each participant

category. However, among women, the differFigure 43 - Percent of persons with private health

insurance and Medicaid

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

35%

74%

51%* 48%*

93%*

5%*

0%

20%

40%

60%

80%

100%

Private insurance Medicaid

Percent of population

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants

Figure 44 - Percent of women and children with a

regular source of health care

*Statistically significant difference from WIC participants at

the .05 level or better.

Note: Infants are not shown because the point estimates for

WIC infants and higher-income infants are statistically

unreliable.

Source: NHANES-III, 1988-94.

88%

78%

95%

80%

91%* 98%

0%

20%

40%

60%

80%

100%

Women Children

Percent of population

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants
57

income nonparticipant infants to have a regular

source of health care (point estimates for WIC

infants and higher-income infants are statistically

unreliable). Among 1-4-year-old children, WIC

participants were more likely than incomeeligible nonparticipants and less likely than

higher-income nonparticipants to have a regular

source of health care (95% vs. 91% and 98%)

(figure 44).

Overall, 78 percent of women, infants, and 1-4-

year-old children had a regular physician or other

health care provider (table D-118). WIC participants were no more or less likely to have a

regular health care provider than their counterparts in the income-eligible nonparticipant group

(figure 45). However, in comparison with higherincome nonparticipants, all three categories of

WIC participants were less likely to have a

regular health care provider. Differences between WIC participants and higher-income

nonparticipants were most substantial for women

and children. Just over half (53%) of WIC

women reported having a regular provider,

compared with 82 percent of higher-income

women. Similarly, 69 percent of WIC children

had a regular health care provider, compared

with 87 percent of higher-income children.

Use of Health Care Services

In the Past Year

Overall, 95 percent of pregnant and postpartum

women, infants, and 1-4-year-old children saw a

physician or other health care provider at least

once during the preceding 12 months (excluding

overnight hospital stays) (table D-119). WIC

participants were more likely than incomeeligible nonparticipants to have seen a health

care provider during the past year (96% vs.

91%). This difference was concentrated among

women and children. There was no difference

between WIC participants and higher-income

nonparticipants in the use of health care services

in the past year.

Figure 45 - Percent of persons with a regular

physician or health care provider

*Statistically significant difference from WIC participants at

the .05 level or better.

Source: NHANES-III, 1988-94.

53%

80%

69%

52%

79%

74%

87%*

91%*

82%*

0%

20%

40%

60%

80%

100%

Women Infants Children

Percent of population

WIC participants

Income-eligible nonparticipants

Higher-income nonparticipants

59

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Panel on Blood Cholesterol in Children and 

Adolescents. Bethesda, MD: National Institutes of 

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National Research Council (1989a). Recommended 

Dietary Allowances, 10th edition. Washington, DC: 

National Academy Press.

National Research Council (1989b). Diet and 

Health: Implications for Reducing Chronic 

Disease. Washington, DC: National Academy 

Press.

Nusser, S.M., A. L. Carriquiry, and W. A. Fuller 

(1996). “A semiparametric transformation 

approach to estimating usual daily intake 

distributions.” Journal of the American Statistical 

Association, Vol. 91, pp. 1440.

Price, C., W. L. Hamilton, and J. C. Cook (1997). 

Guide to Implementing the Core Food Security 

Module. Alexandria, VA: U.S. Department of 

Agriculture, Food and Nutrition Service. (The 

guide was revised and updated in 2000; see Bickel 

et al., 2000).

Putnam, J. and S. Gerrior (1999). “Trends in the 

U.S. food supply.” In Frazao, E. (ed). America’s 

Eating Habits: Changes and Consequences.” 

Washington, DC: U.S. Department of Agriculture, 

Economic Research Service, Agricultural 

Information Bulletin No. 750. 

Randall, B. and L. Boast (1994). Study of WIC 

Participant and Program Characteristics 1992. 

Alexandria, VA: U.S. Department of Agriculture, 

Food and Nutrition Service.

Stavrianos, M. (1997). Food Stamp Program 

Participation Rates: January 1994. Alexandria, 

VA: U.S. Department of Agriculture, Food and 

Nutrition Service.

Troiano, R.P. and Flegal, K.M. (1998). 

“Overweight children and adolescents: 

Description, epidemiology, and demographics.” 

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Trippe, C. (2000). “Patterns of Multiple Program 

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A-1

NHANES-III included a number of different

interviews as well as a comprehensive physical

examination. Most interview data were collected

through ‘household interviews,’ which were

conducted in respondents’ homes. Physical

exams were generally conducted in Mobile

Exam Centers (MEC), although home examinations were offered if the sample person was 2-11

months, 60 years or older and wheelchair-bound,

or primarily bedridden. The home examination

included a subset of the measures collected in

the MEC. Additional interview data were

collected at the time of the exam. The content of

these interviews varied for adults and youth and

included questions about use of alcohol and

tobacco, physical activity, reproductive health,

and selected aspects of diet.

The organization of NHANES-III data files

corresponds to the origin of the data—household

interviews or examinations. The four main data

files are:

• Household adult data file—contains data from

the household interview on individual

demographics, household composition,

family background, family characteristics,

health insurance, health services, selected

health conditions, reproductive health,

functional impairment, physical activity, use

of tobacco and alcohol, and vitamin and

mineral supplements.

• Household youth data file—parallels the adult

data file, with the exception of questions that

cover physical activity, use of tobacco and

alcohol, reproductive health, and selected

diet-related topics (e.g., dieting). These

topics were included as part of the MEC

youth interview, which was completed by

youth 8 years of age and older, generally

without caregiver involvement. In addition,

the youth file contains data on some topics

not included in the adult file. This includes

data on birth characteristics, infant feeding

practices, and television viewing.

• Examination data file—contains results of

the physical examinations conducted in the

MEC or at home, and data from interviews

conducted in the MEC.

• Laboratory data file—contains results of

laboratory tests on blood samples collected

in the MEC.

The origin of each data item determines the

sample for analysis. NHANES-III provides

sample weights for three samples: interviewonly, MEC-examined, and home-examined.

The sample sizes for these samples are shown in

Chapter One, table 1. The sample weight used

for each tabulation is specific to the data item

tabulated. Source notes at the bottom of each

detailed table (appendix D) identify the

NHANES-III data file used in the tabulation.

In addition to the four main data files,

NHANES-III released several dietary recall data

files and supplementary files containing constructed variables or raw data unavailable at the

initial release date. The additional files used for

this series of reports are:

• Dietary recall data files—contain information

about individual foods, combination foods,

and ingredients reported during 24-hour

recalls. The file includes nutrient values

from two different nutrient databases—the

USDA Survey Nutrient Data Base and the

nutrient data base maintained by the University of Minnesota’s Nutrition Coordinating

Center (NCC). All of the nutrient analyses

presented in this series of reports are based

on nutrient values from the USDA Survey

Nutrient Data Base.

Appendix A

NHANES-III Data Files
A-2

• Healthy Eating Index (HEI) file—contains

HEI scores (based on NHANES-III 24-hour

dietary recalls) based on the measure

developed by the U.S. Department of

Agriculture to measure overall dietary

quality (Kennedy et al., 1995).

Subgroups Used for Tabulations

Each volume of this report examines specific

subgroups of the low-income population (volume I: Food Stamp Program participants and

nonparticipants; volume II: WIC Program

participants and nonparticipants; volume III:

school-age children; and volume IV: older

adults.) In the detailed tables provided in each

volume (appendix D), table columns correspond

to subgroups defined by program participation

and/or income level, and table rows present

information for gender- and age-specific subgroups. The subgroup definitions used for each

volume of the report, and the NHANES-III

variables used to identify persons in each

subgroup, are summarized in table A-1.

Survey questions about program participation

and income level each suffered some degree of

nonresponse. Table A-2 shows cell sizes for the

various age/gender/income or program participation subgroups reported on in this particular

volume. Cell sizes are shown for all subgroups,

including those with missing income or program

participation. In appendix D tables, the final

column is suppressed due to small cell sizes,

although the “Total Persons” or “All Children”

columns include individuals with missing

program participation or income.
A-3

Table A-1⎯Subgroup definitions

 Definition Data Itemsa

Groups included in volume 

Volume I: Food Stamp 

Program participants and 

nonparticipants 

Total population 

Children 12 ≤ HSAITMOR < 60 

Infants 2 ≤ HSAITMOR < 12 

Postpartum w omen 

Breastfeeding up to 12 months postpartum (MYPC25 = 1 or MA PF20 = 1) and 

(1 ≤ MYPC20 ≤ 4 or 1 ≤ MAPF15 ≤ 4) 

Non-lactating up to 6 months postpartum (MYPC25 = 2 and MAPF20= 2) and 

(1 ≤ MYPC20 ≤ 2 or 1 ≤ MAPF15 ≤ 2) 

Volume II: WIC Program 

participants and 

nonparticipants 

Pregnant w omen MYPC17 = 1 or MAPF12 = 1 

Volume III: School-age 

children and adolescents 

Age 5-18 years and in school (5 ≤ HSAGEIR ≤ 16 & 1 ≤ HYJ7 ≤ 2) or 

(17 ≤ HSAGEIR ≤ 18 & HAS22 = 4 & 0 <

HFA8R < 12) 

Volume IV: Older Adults Age 60 years and older HSAGEIR ≥ 60 

Column definitions 

Volume I Currently receiving food stamps HFF11 = 1 

 Income-eligible nonparticipant HFF11 = 2 and 0 ≤ DMPPIR ≤ 130 

 Higher-income nonparticipant HFF11 = 2 and DMPPIR > 130 

 

Volume II Current WIC participantc MAPF17 = 1 or MYPC22 = 1 or MPPB6 = 1 

 Income-eligible nonparticipant (MAPF17 = 2 & MYPC22 = 2 & MPPB6 = 2) 

and 0 < DMPPIR ≤ 185 

 Higher-income nonparticipant (MAPF17 = 2 & MYPC22 = 2 & MPPB6 = 2) 

and DMPPIR > 185 

 

Volumes III and IV Income ≤ 130% poverty or current FSP 

participant 

HFF11=1 or 

(HFF11=2 and 0 ≤ DMPPIR ≤130) 

 Income 131-185% poverty HFF11=2 and 130 < DMPPIR ≤ 185 

Income > 185% poverty HFF11=2 and DMPPIR > 185 

 

Row definitions 

 Genderb HSSEX 

 Age HSAGEIR (Age at household interviewb ) 

 

a Program participation and income variables:

HFF11 = "(Are you / Is your family) receiving food stamps at the present time?" (Household interview) 

MAPF17, MYPC22, MPPB6 = "Are you now receiving benefits from the WIC program?" (MEC-adult, MEC-youth, MEC-proxy) 

If WIC participation is missing, and response to household interview question (HFF9) "Did you or any member of this family 

receive benefits from the WIC program LAST MONTH?" is "no" then sampled person is assumed to be a nonparticipant. 

DMPPIR = Poverty income ratio (Household interview)

b

 Gender not tabulated in Volume II.

c

 Age at household interview defines table rows; age in months at the MEC examination was used to assess children’s height and weight 

relative to growth curves. 

d WIC participation of the sampled person is measured during the MEC examination interview and all WIC tables are limited to MEC 

respondents. The household interview included a question about WIC participation by any member of the family (HFF9), and this

question was used to establish nonparticipation in the case of nonresponse to the MEC WIC question. 
A-4

Table A-2—Number of NHANES-III respondents categorically eligible for WIC, grouped by WIC participation

and income 

NHANES-III respondents to MEC interview

Total Persons Currently Receiving

WIC Benefits

Income-eligible

Nonparticipants

Higher-income

Nonparticipants

WIC participation or

income missing

Women1 ....................... 667 181 247 185 54

Infants ........................... 1,961 787 348 731 95

Children

1 year old ................ 1,258 419 391 357 91

2 years old .............. 1,269 253 545 387 84

3 years old .............. 1,119 201 513 325 80

4 years old .............. 1,098 137 547 342 72

All children .............. 4,744 1,010 1,996 1,411 327

Total .............................. 7,372 1,978 2,591 2,327 476

1 Pregnant women responded yes to ’Are you now pregnant? Pregnant women identified only by urinalysis results are not included in table.

Source: NHANES-III, 1988-94: Examination File. WIC participation is asked during the MEC exam.
B-1

Appendix B

Reference Standards

Some of the variables included in this report

required variable construction based on outside

reference standards. This appendix describes the

variables that were constructed, the standards

that were used, and the manner in which the

standards were applied. To the extent possible,

standards used are those defined in the Healthy

People 2010 objectives (U.S. DHHS, 2000a).

The appendix covers all four volumes of the

report; some variables are used only in selected

volumes. With the exception of Healthy Eating

Index (HEI) variables, which were constructed

by staff at the National Center for Health

Statistics (NCHS), all variable construction was

carried out by the authors.

Body Weight and Height

NHANES-III examinations included measurement of body weight and stature (or recumbent

length).1 These data were used to determine

Body Mass Index (BMI)2 for both adults and

children and to assess children’s anthropometric

status relative to reference growth charts.

Table B-1 shows the reference standards used in

these analyses. As shown, BMI is interpreted

differently for children, depending on age,

because normal body fatness changes as children

age. For children, overweight and underweight

status is determined by comparing BMI to

gender- and age-specific growth charts developed by the Centers for Disease Control and

Prevention (CDC).3 In addition, stature-for-age

growth charts are used to assess children’s linear

growth. Copies of the CDC growth charts used

in these analyses are provided at the end of the

appendix.

Bone Density Measures

NHANES-III measured bone density for all men

and non-pregnant women age 20 and over. Bone

density of the proximal femur was measured

during the MEC exam using dual energy x-ray

absorptiometry (DXA).

Volumes I (FSP participants and nonparticipants)

and IV (the elderly) present the prevalence of

normal, reduced, and severely reduced bone

mineral density. Standards used to define these

conditions are those specified by NCHS (NCHS,

1999):

ß Reduced bone mass, or osteopenia, is

defined as bone mineral density 1–2.5

standard deviations below the mean of nonHispanic white women 20–29 years of age

as measured in NHANES-III.

ß Severely reduced bone mass, or osteoporosis, is defined as bone mineral density more

than 2.5 standard deviations below the

mean of non-Hispanic white women 20–29

years of age as measured in NHANES-III.

The latter standard is used in the Healthy People

2010 objectives.

Coronary Heart Disease Risk

The National Cholesterol Education Program

(NCEP), sponsored by the National Institutes of

Health (NIH), provides a methodology for

estimating individuals’ 10-year risk for coronary

heart disease (NIH, 2001). The 10-year risk

1Recumbent length was measured for infants and children up to age

3; stature was measured for persons age 2 and over. Both length

and height were measured for children age 24 to 36 months.

2BMI is equal to [weight in kilograms] / [height in meters] 2

.

3Reference charts for assessing children’s anthropometric status

were originally developed by NCHS in 1977. Revised charts were

released in May 2000, based on pooled data from five national U.S.

health examination surveys including NHANES-III (Kuczmarski et

al., 2002).
B-2

estimate is based on six factors: gender, age,

total cholesterol, smoking status, HDL cholesterol, and systolic blood pressure. In Volumes I

(FSP participants and nonparticipants) and IV

(the elderly), the NCEP methodology was used

to estimate the 10-year- risk of coronary heart

disease among adults.

Nutrient Intake Standards

In recent years, the Institute of Medicine (IOM)

has issued a comprehensive set of Dietary

Reference Intakes (DRIs), reference values for

use in planning and assessing nutrient intake.

DRIs replace the Recommended Dietary Allowances (RDAs), first developed by the Food and

Nutrition Board in 1941 (National Research

Council (NRC), 1989a). The DRIs were released

in a series of nutrient-specific reports; the first

report was released in 1999 and the most recent

in late 2004 (IOM, 1999, 2000a, 2000b, 2002a,

2002b, 2004).4 The DRIs specify up to four

different reference values for each nutrient for

age- and gender-specific subgroups of the

population. These reference values include:

ß Estimated Average Requirement (EAR).

The EAR is the daily level of intake estimated to meet the requirements of 50

percent of healthy individuals in a specific

age- and gender subgroup. EAR values are

4

 With the exception of the 2004 reports, dates are final publication

dates. Pre-publication copies of all reports were available two or

more years prior to final publication.

Table B-13⁄4Reference Standards Used to Assess Body Mass Index and Linear Growth

Measure Standard Source

Adults

Underweight BMI < 18.5 Healthy People 2010 (U.S. DHHS, 2000a)1

Healthy weight BMI ≥ 18.5 and < 25 Healthy People 2010 (U.S. DHHS, 2000a)

Overweight BMI ≥ 25 and < 30 National Institutes of Health (NIH) and 

World Health Organization (WHO) 

guidelines (NIH, 1998 and WHO, 1998)

Obese BMI ≥ 30 Healthy People 2010 (U.S. DHHS, 2000a)

Children age 2 and over

Underweight < 5th percentile on BMI-for-age chart CDC guidelines on using BMI-for-age 

growth charts (CDC, 2003)

At-risk of overweight ≥ 85th and < 95th percentile on BMIfor-age chartCDC guidelines on using BMI-for-age 

growth charts (CDC, 2003)

Overweight ≥ 95th percentile on BMI-for-age chart Healthy People 2010 (U.S. DHHS, 2000a)

Growth retarded < 5th percentile on stature-for-age 

chart

Healthy People 2010 (U.S. DHHS, 2000a)

Children age 1-4-years-old (WIC volume)

Underweight < 5th percentile on weight-for-height 

chart 

CDC guidelines on using weight-for-height 

growth charts (CDC, 2003)

At-risk of overweight ≥ 85th and < 95th percentile on 

weight-for-height chart

CDC guidelines on using weight-for-height 

growth charts (CDC, 2003)

Overweight ≥ 95th percentile on weight-for-height 

chart

CDC guidelines on using weight-for-height 

growth charts (CDC, 2003)

1

Adapted from Health People 2010 goal, which specifies BMI ≥ 18.5 as a healthy weight.
B-3

used to set RDAs and may be used to assess

the adequacy of intake of groups of individuals.

ß Recommended Dietary Allowance (RDA).

The RDA is the daily level of intake sufficient to meet the nutrient requirements of

nearly all (97-98 percent) healthy individuals in a specific subgroup. RDAs are based

on EARs.

ß Adequate Intake (AI). An AI is defined

when the available data are insufficient to

estimate requirements and establish an EAR

and an RDA. The AI is the daily level of

intake that is assumed to be adequate, based

on observed or experimentally determined

estimates of intake.

† Tolerable Upper Intake Level (UL). The

UL is the maximum daily level of intake

that is safe for nearly all members of a

group. Intake above the UL increases risk

of toxicity.

At the time the analyses presented in this series

of reports were completed, DRIs had been

established for four of the nutrients examined:

vitamin C, iron, zinc, and calcium. For vitamin

C, iron, and zinc, EARs were used to assess

prevalence of adequate usual intake (the methodology used in estimating usual intake and in

determining the prevalence of adequate intake is

described in appendix C). It is not possible to

assess the prevalence of adequate calcium

intake, however, because the DRI committee

established an AI for calcium rather than an

EAR (IOM, 1999). Consequently, analysis of

calcium intakes focuses on comparing mean

intakes for each subgroup to age- and genderspecific AIs.

Because DRIs had not yet been established,

intakes of food energy and the other nutrients

and food components examined (total fat,

saturated fat, cholesterol, sodium, and fiber)

were assessed relative to then-current standards.

Data on usual energy intake were compared to

the 1989 Recommended Energy Allowance

(REA) (NRC, 1989a). The prevalence of appropriate usual intakes of total fat, saturated fat,

cholesterol, and sodium was assessed relative to

the recommended maximum intakes defined in

the Dietary Guidelines for Americans (U.S.

Departments of Agriculture and Health and

Human Services, 2000). (The standards for total

fat, saturated fat, and sodium intake are also

included in the Healthy People 2010 objectives).

Finally, the prevalence of adequate fiber intake

was assessed on the basis of the “age-plus-5”

standard. This standard, originally developed by

Williams (1995), was adapted by the American

Heart Association (AHA) (Van Horn, 1997) and

was used in other research that preceded establishment of the DRIs for fiber (Gleason and

Suitor, 2001). Under this standard, recommended fiber intake (in gm.) is equivalent to age

in years plus five, up to a maximum of 25 gm.

Prior to the time the reports were to be published, DRIs were released for energy, total fat,

sodium, and fiber. While it was not possible to

re-do the analyses to incorporate these new

standards, the text was expanded, to the extent

possible, to assess usual nutrient intakes in light

of the new standards. Specifically, discussions of

total fat, sodium, and fiber intakes were updated

by comparing means and distributions of usual

intake to the new standards. It was not possible

to update discussions of energy intake because

the new energy standards (Estimated Energy

Requirements or EERs) incorporate information

on individuals’ weight, height, and level of

physical activity (IOM, 2002b).

Tables B-2 – B-4 show the nutrient standards

used in the analysis as well as other relevant

standards. Table B-2 lists EARs for vitamin C,

iron, and zinc, and AIs for calcium, all of which

were used in the main analysis. It also shows
B-4

Table B-2—Dietary Reference Intakes for Individuals

Estimated Average Requirements Adequate Intakes1

Vitamin C

(mg/day)

Iron

(mg/day)

Zinc

(mg/day)

Calcium

(mg/day)

Total fiber

(g/day)

Children

1-3 yrs ........... 13 3.0 2.2 500 194-8 yrs ........... 22 4.1 4.0 800 25

Males

9-13 yrs ......... 39 5.9 7.0 1,300 3114-18 yrs ....... 63 7.7 8.5 1,300 3819-30 yrs ....... 75 6.0 9.4 1,000 3831-50 yrs ....... 75 6.0 9.4 1,000 3851-70 yrs ....... 75 6.0 9.4 1,200 30>70 yrs .......... 75 6.0 9.4 1,200 30

Females

9-13 yrs ......... 39 5.7 7.0 1,300 2614-18 yrs ....... 56 7.9 7.5 1,300 3619-30 yrs ....... 60 8.1 6.8 1,000 2531-50 yrs ....... 60 8.1 6.8 1,000 2551-70 yrs ....... 60 5.0 6.8 1,200 21>70 yrs .......... 60 5.0 6.8 1,200 28

Pregnant Women

14-18 yrs ....... 66 23.0 10.5 1,300 2219-30 yrs ....... 70 22.0 9.5 1,000 2831-50 yrs ....... 70 22.0 9.5 1,000 28

Lactating Women

14-18 yrs ....... 96 7.0 11.6 1,300 2919-30 yrs ....... 100 6.5 10.4 1,000 29

1 Estimated Average Requirements have not been set for calcium, sodium, or fiber.

Source: Dietary Reference Intakes. Institute of Medicine, Food and Nutrition Board (1999, 2000b, 2002a,2002b, 2004).

Table B-3—1989 Recommended Dietary Allo

Energy

allowance

(REA)

(kcal)

Vitamin C

(mg)

Iron

(mg)

Children

1-3 yrs ........... 1,300 40 10 4-6 yrs ........... 1,800 45 10 7-10 yrs ......... 2,000 45 10 

Males

11-14 yrs ....... 2,500 50 12 15-18 yrs ....... 3,000 60 12 19-24 yrs ....... 2,900 60 10 25-50 yrs ....... 2,900 60 10 51+ yrs .......... 2,300 60 10 

Females

11-14 yrs ....... 2,200 50 15 15-18 yrs ....... 2,200 60 15 19-24 yrs ....... 2,200 60 15 25-50 yrs ....... 2,200 60 15 51+ yrs .......... 1,900 60 10 

Pregnant

1st trimester .. +0 70 30 2nd trimester +300 70 30 3rd trimester +300 70 30 

Lactating

1st 6 months +500 95 15 2nd 6 months +500 90 15 

Source: Recommended Dietary Allowances, 10th edition. Na(1989b).
B-5

newly established AIs for fiber.5 Table B-3

shows the 1989 RDAs for vitamin C, iron, zinc,

and calcium (the precursors to the DRIs), as well

as the 1989 REA. Table B-4 shows the Dietary

Guidelines for Americans recommendations for

total fat, saturated fat, cholesterol, and sodium,

as well as the newly-defined Acceptable Macronutrient Distribution Range (AMDR) for total

fat and ULs for sodium.

Healthy Eating Index

The Healthy Eating Index (HEI), developed by

USDA’s Center for Nutrition Policy and Promotion (CNPP), is a summary measure of the

overall quality of people’s diets (Basiotis, et al.,

2002). The HEI is based on 10 component

scores, all of which are weighted equally in the

total score. The 10 component scores measure

different aspects of a healthy diet based on

accepted public health recommendations. Five of

the component scores are food-based and

evaluate food consumption in comparison with

recommendations of the USDA Food Guide

Pyramid (grains, vegetables, fruits, dairy, and

meat) (USDA, CNPP, 1996). A sixth component

is also food-based and measures the level of

dietary variety. The remaining four component

scores are nutrient-based and assess compliance

with the Dietary Guidelines for Americans

recommendations for intake of fat, saturated fat,

cholesterol, and sodium.6

Table B-5 shows the criteria used for scoring the

five food-group-based components. Criteria vary

by age, depending on total energy intake.

Because the Food Guide Pyramid presents

serving recommendations for only three levels

of energy intake (1,600, 2,200, and 2,800

kilocalories) (USDA, CNPP, 1996), interpolation

techniques were used to estimate the recom5

It is important to note that the fiber AIs have been defined for total mended number of servings for gender and age

fiber and that the data presented in this report reflect dietary fiber.

Total fiber includes dietary fiber as well as fructo-oligosaccharides,

compounds which are destroyed in the current analytical methods

used to quantitate fiber in foods (IOM, 2002b). Although fructooligosaccharides are assumed to make up a relatively small

percentage of total fiber, authors of the DRI report estimated that,

on average, American adults were consuming approximately 5.1

gm. more fiber per day than estimated in the most recent Continuing Survey of Food Intakes of Individuals (CSFII), because CSFII

data, like the data used in this analysis, include only dietary fiber

(IOM, 2002b).

6When the HEI was first developed, the standards for cholesterol

and sodium were based on recommendations made in the NRC’s

Diet and Health report (NRC, 1989b) because the version of the

Dietary Guidelines in effect at the time did not include quantitative

standards for these nutrients (USDA and U. S. DHHS, 1995). Since

that time, the NRC standards for sodium and cholesterol have been

incorporated into both the Nutrition Facts section of food labels and

the most recent version of the Dietary Guidelines (USDA and U.S.

DHHS, 2000).

Table B-43⁄4Standards Used to Assess Usual Intake of Fat, Saturated Fat, Cholesterol, 

and Sodium

Nutrient/Food 

Component

Dietary Guidelines

Standard1

DRI Standard

AMDRs

1-3 years 30-40% of total energy

4-18 years 25-35% of total energy

Total fat ≤ 30% of total energy2

19+ years 20-35% of total energy

Saturated fat < 10% of total energy2 N/A

Cholesterol ≤ 300 mg. N/A

ULs

1-3 years 1,500 mg. (1.5 g.)

4-8 years 1,900 mg. (1.9 g.)

9-13 years 2,200 mg. (2.2 g.)

Sodium ≤ 2,400 mg.2

14+ years 2,300 mg. (2.3 g.)

1Dietary Guidelines standards apply to all individuals 2 years of age and older.

2Also included as objective in Healthy People 2010 (U. S. DHHS, 2000a).
B-6

groups with other recommended energy allowances.

Two exceptions were made to the straight

interpolation. The first involved 2-3-year-old

children. The 1989 REA for 2-3 year-olds is less

than the lowest level of energy intake (1,600

kilocalories) referenced in the Food Guide

Pyramid.7 Extrapolation of the Food Guide

Pyramid’s recommended number of servings to a

lower calorie level would result in smaller

numbers of servings than the minimums defined

in the Pyramid. Rather than use these minimal

numbers of servings, NCHS staff set the numbers of servings to be equivalent with defined

minimums, but reduced reference portion sizes

for food groups other than milk to two-thirds of

the adult reference (NCHS, 2000). This is

consistent with Pyramid guidance (i.e., that

individuals with lower energy needs eat smaller

servings) as well as with the approach used by

other researchers (Basiotis et al., 2002).

The second exception was made for males

between 15 and 50 years of age. The 1989 REA

for this group is slightly higher than the highest

level of energy intake (2,800 kilocalories)

references in the Food Guide Pyramid. Simple

extrapolation would have resulted in greater

numbers of servings than the maximums defined

in the Pyramid. Because the Food Guide Pyramid provides no guidance on how to accommodate greater energy needs, NCHS researchers

truncated the number of servings at the maximums defined in the Pyramid. This is consistent

with the approach used by other researchers

(Basiotis et al., 2002). Moreover, preliminary

analyses completed by NCHS indicated that

truncation did not have a significant impact on

HEI scores (NCHS, 2000).

The methodology used to determine serving

definitions for counting servings in each of the

five major food groups is the same as that used

in the initial research that calculated the HEI

using data from the 1989-90 Continuing Survey

of Food Intake of Individuals (CSFII) (USDA,

CNPP, 1995). It differs, however, from the

methodology used in subsequent research to

Table B-53⁄4Scoring criteria for food-based components of the Healthy Eating Index (HEI)

Criteria for maximum score of 10 (number of servings per day) 

Age Grains Vegetables Fruits Milk Meat

2-3 years 6.0 3.0 2.0 2.0 2.0

4-6 years 7.0 3.3 2.3 2.0 2.1

7-10 years 7.8 3.7 2.7 2.0 2.3

Males

11-14 years 9.9 4.5 3.5 3.0 2.6

15-18 years 11.0 5.0 4.0 3.0 2.8

19-24 years 11.0 5.0 4.0 3.0 2.8

25-50 years 11.0 5.0 4.0 2.0 2.8

51+ years 9.1 4.2 3.2 2.0 2.5

Females

11-24 years 9.0 4.0 3.0 3.0 2.4

25-50 years 9.0 4.0 3.0 2.0 2.4

51+ years 7.4 3.5 2.5 2.0 2.2

Notes: The minimum score of 0 was assigned only when zero servings were consumed. 

For the variety component, the maximum score of 10 was assigned if 8 or more different items were consumed; the minimum score of 

0 was assigned if 3 or fewer different items were consumed. 

Scores were assigned proportionately for consumption between the minimum and maximum criteria.

Source: NHANES-III documentation for the HEI file. NCHS (2000).

7HEI computations were completed be NCHS staff prior to the

release of the new REEs (see discussion on Dietary Reference

Intakes), so the reference standard used for energy intake was the

1989 REAs.
B-7

calculate the HEI using the 1994-96 CSFII data

(USDA, ARS, 1998) as well as recent research

that calculated the HEI using data from

NHANES 1999-2000 (Basiotis et al., 2002).

In particular, milk serving definitions in the

NHANES-III data used in this report were based

on grams of nonfat milk solids contained in a

food divided by the amount of grams of nonfat

milk solids contained in 1 cup of milk (NCHS,

2000). The alternative methodology used in the

two analyses noted above based milk serving

definitions on calcium equivalents. This approach defines a milk serving as one that provides the same amount of calcium as 1 cup of

skim milk (302 mg). In choosing to use the

“nonfat milk solids” approach rather than the

“calcium equivalents” approach, NCHS researchers cited concerns that the latter may lead

to low milk group component scores because of

the omission of foods such as butter and cream

cheese nonfat milk solids but small to negligible

amounts of calcium (NCHS, 2000).

For the four other food groups, serving definitions used by NCHS researchers are similar to

those used by USDA researchers and were

designed to be as consistent as possible with the

serving definitions used in the Food Guide

Pyramid (USDA, ARS, 2003). Servings of

breads and grains are defined on the basis of

“flour equivalents,” using the flour content of a

typical slice of bread (16 gm) as the base.

Servings of most vegetables are counted as 1⁄2

cup cooked or 1 cup raw. Fruits are treated

similarly.

Servings of meat are based on “lean meat

equivalents.” The base serving is 2.5 oz. of lean

meat, fish, or poultry, with a specified minimum

amount of fat.8 Numbers of servings for nonlean-meats are assigned based on fat content. As

an example, 2 oz. of cooked sausage has the

equivalent of 1.5 oz. of cooked lean meat, or .61

servings of meat. (For a more detailed explanation of how meat servings are determined, see

USDA, ARS, 2003).

Several non-meat foods are also included in the

meat group. Serving equivalents for these items

are defined as 1⁄2 cup cooked dry beans or peas, 1

egg, 2 Tbsp. peanut butter, 1/3 cup nuts, 1⁄4 cup

seeds, and 1⁄2 cup of tofu (USDA, ARS, 2003).

The Food Guide Pyramid considers dried beans

and peas (legumes) to be considered contributors

to the meat group, but they may also be counted

toward vegetable intake. In computing the HEI,

NCHS investigators applied any legume consumption that was not “needed” in the meat

group toward the vegetable group (NCHS,

2000).

Variety Score

Both The Food Guide Pyramid and the Dietary

Guidelines for Americans recommend consuming a variety of foods, but neither provides

guidance on how to measure dietary variety.

Following the protocols established in the initial

HEI research (USDA, CNPP, 1995), variety

scores were assigned based on the total number

of different types of food a person consumed in

a day. Similar foods were grouped together and

the totals were computed for each individual.

Fats, sweets, seasonings, and similar foods were

not included in the calculations (for a complete

list of excluded foods see NCHS, 2000), and

neither were food components that contributed

less than one-half of a serving.

A maximum score of 10 points was assigned for

variety scores of 8 or more (indicating that the

person consumed at least half a serving of 8 or

more different types of food in the preceding 24-

hour period). A minimum score of 0 was assigned for variety scores of 3 or less. Intermediate scores were assigned proportionately.

8Two different definitions have been used to define lean meats – no

more than 2.65 gm. fat per oz. and no more than 2.4 gm. fat per oz.

(USDA, ARS, 2003). The NCHS documentation does not specify

which of these definitions was used in computing lean meat

equivalents in the NHANES-III database (NCHS, 2000).
B-8

Nutrient-based Scores

The four nutrient-based component scores of the

HEI assess compliance with the Dietary Guidelines for Americans recommendations for intake

of total fat, saturated fat, cholesterol, and sodium

(USDA and U.S. DHHS, 2000). The manner in

which these recommendations were used to

determine HEI component scores is summarized

in table B-6.

Rating Total Scores

As noted in the preceding discussion, the

maximum score for the full HEI (all ten components combined) is 100 and the minimum score

is zero. Using standards defined by USDA’s

CNPP, individuals with total HEI scores of more

than 80 were considered to have good diets.

Those with scores between 51 and 80 were

considered to have diets that need improvement.

And those who scored below 51 on the HEI

were considered to have poor diets (Basitotis et

al., 2002).

Serum and Blood Measurements

Several serum and blood measurements are

examined in this series of reports. Most reflect

serum levels of nutrients or assess iron or lipid

status. In addition, levels of blood lead were

examined to assess the prevalence of lead

poisoning. Serum cotinine levels were also

analyzed to examine exposure to second-hand

Table B-63⁄4Scoring criteria for nutrient-based components of the Healthy 

Eating Index (HEI)

Component

Standard for maximum 

score of 10

Standard for minimum

 score of 0

Total fat ≤ 30% of total calories ≥ 45% of total calories

Saturated fat < 10 percent of total calories ≥ 15 percent of total calories

Cholesterol ≤ 300 mg per day ≥ 450 mg per day

Sodium ≤ 2,400 mg per day ≥ 2,400 mg per day 

Note: Standards for nutrient-based components apply to all age groups.

Source: NHANES-III documentation for the HEI file. NCHS (2000).

smoke. Cotinine, a breakdown product of

nicotine, is used as a biological marker for

tobacco use and exposure to environmental

tobacco smoke.

Table B-7 lists the serum and blood measures

examined, the reference standards used in

assessing them, and the source of the standard.

The prevalence of iron deficiency was assessed

using the Healthy People 2010 definition:

abnormal results on two of three specific measures of iron status (serum ferritin, free erythrocyte protoporphorin, and transferring saturation)

(U.S. DHHS, 2000a). Iron deficiency anemia

was defined as the presence of iron deficiency

plus an abnormally low hemoglobin. Cutoffs

used to define abnormal values are summarized

in table B-7.
B-9

Table B-73⁄4Reference values for serum and blood measures

Abnormal range

Measure Age group Male Female Source

Hemoglobin (g/dL)11-2 years < 11.0 < 11.0

2-5 years < 11.1 < 11.1

5-8 years < 11.5 < 11.5

CDC Recommendations to Prevent 

and Control Iron Deficiency in the 

U.S. (CDC, 1998)

8-12 years < 11.9 < 11.9

12-15 years < 12.5 < 11.8

15-18 years < 13.3 < 12.0

≥ 18 years < 13.5 < 12.0

Hematocrit (%) 11-2 years < 32.9 < 32.9

2-5 years < 33.0 < 33.0

5-8 years < 34.5 < 34.5

CDC Recommendations to Prevent 

and Control Iron Deficiency in the 

U.S. (CDC, 1998)

8-12 years < 35.4 < 35.4

12-15 years < 37.3 < 35.7

15-18 years < 39.7 < 35.9

≥ 18 years < 39.9 < 35.7

Serum ferritin (mcg/mL) 1-4 years < 10 < 10

5-11 years < 15 < 15

12-49 years < 15 < 12

≥ 50 years < 15 < 15

Healthy People 2010 (U.S. DHHS, 

2000a) and CDC Recommendations 

to Prevent and Control Iron 

Deficiency in the U.S. (CDC, 1998)

Free erythrocyte 

protoporphorin (mcg/dL) 1-2 year > 80 > 80 Healthy People 2010 (U.S. DHHS, 

2000a)

> 2 years > 70 > 70

Transferrin saturation (%) 1-2 years < 10 < 10

3-4 years < 12 < 12

12-15 years < 16 < 14

≥ 16 years < 16 < 15

Healthy People 2010 (U.S. DHHS, 

2000a) and CDC Recommendations 

to Prevent and Control Iron 

Deficiency in the U.S. (CDC, 1998)

Total cholesterol (mg/dL) 2-19 years High: ≥ 200

Borderline: 170-199

20 years and 

over

High: ≥ 240

Borderline: 200-239

National Institutes of Health, National 

Cholesterol Education Program 

(2001 (adults) and 1991 (children))

LDL cholesterol (mg/dL) 2-19 years High: ≥ 130

Borderline: 110-129

20 years and 

over

High: ≥ 160

Borderline: 130-159

National Institutes of Health, National 

Cholesterol Education Program 

(2001 (adults) and 1991 (children))

HDL cholesterol (mg/dL) 2-19 years < 35 

20 years and 

over

< 40

National Institutes of Health, National 

Cholesterol Education Program, 

2001 (adults) and American Heart 

Association, 2002 (children)

Triglycerides (mg/dL) 12-19 years ≥ 150

20 years and 

over

High: ≥ 200

Borderline: 150-199

National Institutes of Health, National 

Cholesterol Education Program, 

2001 (adults) and American Heart 

Association, 2002 (children)

RBC folate (ng/mL)2All ages < 95 Dietary Reference Intakes (IOM, 

2000a)

Serum vitamin B12 (pg/mL) All ages < 200 Dietary Reference Intakes (IOM, 

2000a)

Serum albumin (g/dL) 60 years and 

over

< 3.8 (liberal definition)

< 3.5 (conservative)

Institute of Medicine, Committee on 

Nutrition Services for Medicare 

Beneficiaries (2000)

3⁄4Continued
B-10

Table B-73⁄4Reference values for serum and blood measures (continued)

Abnormal range

Measure Age group Male Female Source

Lead exposure

Lead (mcg/dL) All ages ≥ 10.0

CDC Report on Blood Levels in the 

U.S.: 1991-1994. (CDC, 1997)

Exposure to second-hand smoke Healthy People 2010 (U.S. DHHS, 

2000a)

Cotinine (ng/dL) All ages > 0.10

1

Hemoglobin and hematocrit cutoffs were adjusted for smokers, per CDC recommendations (1998). Adjustment for high altitudes is also 

suggested, but data on the altitude at which respondents live is not available in NHANES-III. Hemoglobin cutoffs for smokers were adjusted 

based on reported daily cigarette use, as follows: +0.3 for 0.5 to less than 1 pack per day; +0.5 for 1 to less than 2 packs per day; +0.7 for 2 or 

more packs per day. Parallel adjustments for hematocrit were +1.0, +1.5, and +2.0. 

2

The cutoff of 95 ng/mL is specific to the radioassay kit used by NHANES-III beginning in December 1993, and is applied to all NHANES-III 

RBC folate measures because NCHS adjusted the data for comparability (Wright, et al., 1998). This cutoff differs from that recommended 

based on NHANES-II data (less than 140 ng/mL) due to use of the revised test kit.
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Age (years)

50th

25th

10th

5th

75th

90th

95th

85th

kg/m2

12

14

16

18

20

22

24

26

28

30

32

34

kg/m2

12

14

16

18

20

22

24

26

28

30

32

34

BMI BMI

CDC Growth Charts: United States

SOURCE: Developed by the National Center for Health Statistics in collaboration with

the National Center for Chronic Disease Prevention and Health Promotion (2000).

Published May 30, 2000.
2 3 4 5 6 7 8 9 10 11 12 13

Age (years)

14 15 16 17 18 19 20

50th

25th

10th

5th

75th

90th

95th

85th

kg/m2

12

14

16

18

20

22

24

26

28

30

32

34

kg/m2

32

34

12

14

16

18

20

22

24

26

28

30

BMI BMI

CDC Growth Charts: United States

SOURCE: Developed by the National Center for Health Statistics in collaboration with

the National Center for Chronic Disease Prevention and Health Promotion (2000).

Published May 30, 2000.
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Age (years)

50th

25th

10th

5th

75th

90th

95th

cm

75

80

85

90

95

100

105

110

115

120

125

130

135

140

145

150

155

160

165

170

175

180

185

190

195

200

cm

76

70

74

66

68

60

62

64

56

58

50

52

54

46

48

44

40

42

34

36

38

30

32

78

in

in

72

76

78

70

74

66

68

60

62

64

56

58

50

52

54

46

48

40

42

34

36

38

30

32

44

in

in

72

CDC Growth Charts: United States

SOURCE: Developed by the National Center for Health Statistics in collaboration with

the National Center for Chronic Disease Prevention and Health Promotion (2000).

Published May 30, 2000.
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Age (years)

50th

25th

10th

5th

75th

90th

95th

70

72

74

76

66

68

60

62

64

56

58

50

52

54

46

48

44

40

42

34

36

38

30

32

78

75

80

85

90

95

100

105

110

115

120

125

130

135

140

145

150

155

160

165

170

175

180

185

190

195

200

cm

cm in

70

72

74

76

66

68

60

62

64

56

58

50

52

54

46

48

44

40

42

34

36

38

30

32

78

in

in

in

CDC Growth Charts: United States

SOURCE: Developed by the National Center for Health Statistics in collaboration with

the National Center for Chronic Disease Prevention and Health Promotion (2000).

Published May 30, 2000.
CDC Growth Charts: United States

cm

Length

45 50 55 60 65 70 75 80 85 90 95 100

50th

25th

10th

5th

75th

90th

95th

kg

2

1

4

3

6

5

8

7

10

9

12

14

13

11

16

15

18

17

19

20

21

22

23

kg

2

4

6

8

10

12

14

16

18

20

22

24

26

28

30

32

34

36

38

40

42

46

48

50

lb

lb

44

2

4

6

8

10

12

14

16

18

20

22

24

26

28

30

32

34

36

38

40

42

46

48

50

lb

lb

44

in 18 20 19 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

SOURCE: Developed by the National Center for Health Statistics in collaboration with

the National Center for Chronic Disease Prevention and Health Promotion (2000).

Published May 30, 2000 (modified 6/8/00).
cm

Length

45 50 55 60 65 70 75 80 85 90 95 100

kg

2

1

4

3

6

5

8

7

10

9

12

14

13

11

16

15

18

17

19

20

21

22

23

kg

4

6

8

10

12

14

16

18

20

22

24

26

28

30

32

34

36

38

40

42

46

48

50

2

lb

lb

44

2

4

6

8

10

12

14

16

18

20

22

24

26

28

30

32

34

36

38

40

42

46

48

50

lb

lb

44

in 18 20 19 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 40 39

50th

25th

10th

5th

75th

90th

95th

CDC Growth Charts: United States

SOURCE: Developed by the National Center for Health Statistics in collaboration with

the National Center for Chronic Disease Prevention and Health Promotion (2000).

Published May 30, 2000 (modified 6/8/00).
cm 80 90 95 100 105 110 115 120 85

Stature

kg

11

10

9

8

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

kg

24

20

28

32

36

40

44

48

52

56

60

64

68

72

76

lb

lb

72

76

64

68

56

60

44

48

52

32

36

40

24

20

28

lb

lb

in 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47

50th

25th

10th

5th

75th

90th

85th

95th

CDC Growth Charts: United States

SOURCE: Developed by the National Center for Health Statistics in collaboration with

the National Center for Chronic Disease Prevention and Health Promotion (2000).

Published May 30, 2000 (modified 11/21/00).
cm 80 90 95 100 105 110 115 120 85

Stature

kg

11

10

9

8

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

kg

24

20

28

32

36

40

44

48

52

56

60

64

68

72

76

lb

lb

72

76

64

68

56

60

44

48

52

32

36

40

24

20

28

lb

lb

in 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47

25th

50th

10th

5th

75th

90th

85th

95th

CDC Growth Charts: United States

SOURCE: Developed by the National Center for Health Statistics in collaboration with

the National Center for Chronic Disease Prevention and Health Promotion (2000).

Published May 30, 2000 (modified 11/21/00).
C-1

Appendix C

Statistical and Reporting Guidelines

This report presents population means and

proportions, standard errors of estimates, and

percentiles of dietary intake distributions. Sample

weights were used to account for sample design

and nonresponse. Information about the

NHANES-III survey design was used in estimating variances and testing for statistical

significance.

Several software packages were used to produce the tabulations:

· C-SIDE: Software for Intake Distribution

Estimation (Version 1.0)—used to estimate

means, percentiles, and standard errors for

nutrient intake tables.

· SUDAAN (Version 7.5)—used to calculate

means, standard errors, and tests of statistical significance for non-nutrient tables, using

the DESCRIPT procedure.

· SAS (Version 8.2)—used to read the

NHANES-III data files, call SUDAAN

procedures, process SUDAAN output, and

write SUDAAN results to ASCII files.

· TPL (Table Producing Language)—this

software produced all data tables in appendix D.

General Procedures

NHANES-III sample weights account for the

fact that each sample person does not have an

equal probability of selection into the sample.

NHANES-III provides sample weights for three

samples: the interviewed sample weight

(WTPEQX6), the MEC-examined sample

weight (WTPFEX6), and the MEC and homeexamined sample weight (WTPFHX6). The

sampling weight used for each table in this report

was specific to the data item presented in the

table, and is indicated by the source of data listed

in the table footnote.

Variance is generally underestimated in a

complex survey when information about the

survey design is not used in variance estimation.

For this report, two alternate methods were used

to account for the sample design.

• Balance repeated replication (BRR)—this

method was specified when using C-SIDE

software to obtain estimates for nutrient

tables. The BRR method used the 52

replicate weights provided in the NHANESIII data.

• Taylor series linearization—this method is

used in SUDAAN procedures. The complex

survey design is accounted for by specifying

strata and PSU in the “nest” statement of

SUDAAN procedures.

Coefficients of variation (CVs) and t-statistics

were generated and examined, but are not

provided in the tables. CVs were examined to

determine the statistical reliability of estimates,

as described below in the section on Reporting

Guidelines. T-statistics were examined to determine the statistical significance of differences in

means and proportions. When examining categorical data, t-statistics were used and the

Bonferroni adjustment was applied to adjust for

multiplicity of tests.

All tests for statistical significance are tests for

differences between two independent samples

defined by program participation and/or incomelevel. In volumes I and II, differences between
C-2

program participants and income-eligible nonparticipants are denoted by symbols on values for

income-eligible nonparticipants; differences

between program participants and higher-income

nonparticipants are denoted by symbols on

values for higher-income nonparticipants. In

volumes III and IV, differences between the

lowest-income group and the low-income group

are denoted by symbols on values for the lowincome group; differences between the lowestincome group and high-income group are denoted by symbols on values for the high-income

group.

Differences in means and proportions were

tested for statistical significance using α levels

of 0.01, 0.05, and 0.001. For categorical data,

differences involve multiple non-independent

comparisons and were tested using α levels of

0.01, 0.05, and 0.001 adjusted using the

Bonferroni method, by dividing α levels by the

number of comparisons.

Age Standardization

Tables presented in appendix A include ageadjusted estimates for the total population (i.e.,

all age groups), calculated using the direct

method (Klein, 2001). The age-adjusted estimates were obtained by weighting estimates for

each age category by the year 2000 population

distribution.

The population distribution used for age-adjustment is from Monthly Estimates of the United

States Population: April 2000. Age-adjusted

estimates were calculated by the SUDAAN

software.

Nutrient Analyses

A primary goal for the analysis of dietary intake

was to estimate the proportion of individuals

whose intake is inadequate. Reference standards

used to define adequate intake reflect expectations for usual intake. To apply these standards

appropriately, it is necessary to have information

about the distribution of intake in the population

of interest. The variance of the distribution of

observed intake is too large to produce reliable

estimates of the prevalence of inadequate intake.

This is because the variance of observed intake

includes both within-person (day-to-day) and

between-person variation. Methods have been

established for adjusting observed intake distributions to estimate distributions of usual intake by

removing within-person variation (NRC, 1986

and Nusser et al, 1996). These adjustments

require two or more days of intake data for at

least some subjects.

NHANES-III collected replicate 24-hour recalls

on a convenience sample of approximately 5

percent of respondents. The nonrandom nature

and small size of the replicate recall sample

prohibited its use in estimating usual dietary

intake. Instead, we used the Continuing Survey

of Food Intake of Individuals (CSFII) 1994-96, to

obtain estimates of within-person variation.

CSFII is a nationally representative survey that

includes two days of dietary intake data for all

subjects.

CSFII data were used to estimate variance

components for 96 demographic cells defined by

age group (8), gender (male, female, both), and

program participation or income (3 plus overall).1

The variance components from CSFII were

used to adjust observed intakes collected in the

NHANES-III single-day dietary recalls. Estimation for all nutrients was done using C-SIDE:

Software for Intake Distribution Estimation

(Iowa State University, 1996). Because iron

requirements for menstruating females are

known to be asymmetrical, the adjustments

performed by the C-SIDE software (using this

“Iowa State Method”) were not appropriate.

1

 Age groups correspond to the DRI age groups for volumes I,

III, IV. CSFII used to estimate variance components for

volume II (WIC participants and nonparticipants) were

aggregated by year of age (4) and program participation or

income (3 plus overall), but not by gender.
C-3

Therefore, distributions of iron intake were

adjusted using the full probability approach as

described in the IOM report Dietary Reference

Intakes: Applications in Dietary Assessment

(IOM, 2001). CSFII variance components are

shown in table C1.

Reporting Guidelines

This report follows the recommendations in the

NHANES-III Analytic Guidelines in the appendix titled “Joint Policy on Variance Estimation

and Statistical Reporting Standards for

NHANES-III and CSFII Reports: HNIS/NCHS

Analytic Working Group Recommendations”

(NCHS, 1996). The recommendations for

presentation of statistical data call for estimates

to be flagged if any of the following conditions

are met:

1. Inadequate sample size for normal

approximation. For means and for proportions based on commonly occurring events

(where 0.25 < P < 0.75), an estimate is

flagged if it is based on a cell size of less

than 30 times a “broadly calculated average

design effect.”

2. Large coefficient of variation. Estimates

are flagged if the coefficient of variation

(ratio of the standard error to the mean

expressed as a percent) is greater than 30.

3. Inadequate sample size for uncommon

or very common events. For proportions

below 0.25 or above 0.75, the criteria for

statistical reliability is that the cell size be

sufficiently large that the minimum of nP and

n(1-P) be greater than or equal to 8 times a

broadly calculated average design effect,

where n is the cell size and P is the estimated proportion. (I.e., an estimate is

flagged when n< 8 * (avg design effect) /

min(P,(1-P)).) The coefficient of variation is

not used in these cases.

For each data item, the design effect was

calculated for each table cell as the ratio of the

complex sampling design variance calculated by

SUDAAN, to the simple random sample variance. The average design effect for a data item

is the average of estimated design effects across

age groups (pooled genders) within a demographic group, where demographic groups

correspond to the columns of tables (groups

defined by program participation and income).
Table C-1—CSFII variance components for 10 nutrients

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Within-individual variance Sample size Within-individual variance Sample size Within-individual variance Samp

Total energy

1 year old .................. 1,084 0.48900 306 0.45850 260 0.45459 52 years old ................ 1,107 0.54948 229 0.57212 328 0.51634 53 years old ................ 1,836 0.60511 348 0.50637 525 0.61904 94 years old ................ 1,859 0.60330 297 0.56819 644 0.60647 8Total, populationadjusted .................... 5,886 0.52208 1,180 0.46875 1,757 0.53582 2,8

Vitamin C

1 year old .................. 1,084 0.59405 306 0.67637 260 0.58360 52 years old ................ 1,107 0.58606 229 0.62189 328 0.61011 53 years old ................ 1,836 0.62624 348 0.66059 525 0.67436 94 years old ................ 1,859 0.68635 297 0.79624 644 0.67490 8Total, populationadjusted .................... 5,886 0.62978 1,180 0.69246 1,757 0.64240 2,8

Iron

1 year old .................. 1,084 0.51455 306 0.53153 260 0.50188 52 years old ................ 1,107 0.57238 229 0.69597 328 0.53098 53 years old ................ 1,836 0.66739 348 0.64471 525 0.74547 94 years old ................ 1,859 0.68272 297 0.73055 644 0.69444 8Total, populationadjusted .................... 5,886 0.59208 1,180 0.60402 1,757 0.61692 2,8

Zinc

1 year old .................. 1,084 0.57894 306 0.54355 260 0.62037 52 years old ................ 1,107 0.64335 229 0.62776 328 0.70489 53 years old ................ 1,836 0.70109 348 0.68978 525 0.74988 94 years old ................ 1,859 0.71539 297 0.72768 644 0.76057 8Total, populationadjusted .................... 5,886 0.64428 1,180 0.60555 1,757 0.70509 2,8

Calcium

1 year old .................. 1,084 0.42758 306 0.45101 260 0.39886 52 years old ................ 1,107 0.53634 229 0.59965 328 0.59377 53 years old ................ 1,836 0.57302 348 0.60608 525 0.67964 94 years old ................ 1,859 0.65281 297 0.70747 644 0.70275 8Total, populationadjusted .................... 5,886 0.55554 1,180 0.57100 1,757 0.61130 2,8

Total fat

2 years old ................ 1,107 0.67828 229 0.67482 328 0.71323 53 years old ................ 1,836 0.73212 348 0.70363 525 0.77072 94 years old ................ 1,859 0.75730 297 0.82016 644 0.73778 8Total, populationadjusted .................... 4,802 0.72671 874 0.72620 1,497 0.73859 2,3

Saturated fat

2 years old ................ 1,107 0.63957 229 0.71438 328 0.65009 53 years old ................ 1,836 0.70018 348 0.70013 525 0.72726 9

Source: Variance components were estimated from two days of 24-hour recalls from the Continuing Survey of Food Intakes by Individuals (CSFII) using C-SIDE: Software for 
Table C-1—CSFII variance components for 10 nutrients — Continued

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Within-individual variance Sample size Within-individual variance Sample size Within-individual variance Samp

Saturated fat

4 years old ................ 1,859 0.75756 297 0.79536 644 0.76249 8Total, populationadjusted .................... 4,802 0.70320 874 0.73021 1,497 0.72061 2,3

Cholesterol

2 years old ................ 1,107 0.71330 229 0.74672 328 0.75802 53 years old ................ 1,836 0.70328 348 0.76400 525 0.66716 94 years old ................ 1,859 0.70384 297 0.77765 644 0.72813 8Total, populationadjusted .................... 4,802 0.70743 874 0.75450 1,497 0.71139 2,3

Sodium

2 years old ................ 1,107 0.61045 229 0.67490 328 0.55385 53 years old ................ 1,836 0.66354 348 0.60198 525 0.66535 94 years old ................ 1,859 0.69900 297 0.71507 644 0.70761 8Total, populationadjusted .................... 4,802 0.64772 874 0.63806 1,497 0.64339 2,3

Fiber

2 years old ................ 1,107 0.57529 229 0.57157 328 0.59539 53 years old ................ 1,836 0.68310 348 0.58998 525 0.76087 94 years old ................ 1,859 0.66612 297 0.66567 644 0.70181 8Total, populationadjusted .................... 4,802 0.64212 874 0.60212 1,497 0.68989 2,3

Source: Variance components were estimated from two days of 24-hour recalls from the Continuing Survey of Food Intakes by Individuals (CSFII) using C-SIDE: Software for 
Appendix D

Detailed Tables

Chapter Two

Usual Intake of Food Energy and Nutrients 

Among Children Ages 1-4

Table D-1 - Percent of income-eligible 1-4-year-old children receiving benefits from the Food Stamp Program

Table D-2 - Distribution of 1-4-year-old children by household food sufficiency status

Table D-3 - Percent of 1-4-year-old children eating fewer than three meals per day

Table D-4 - Average number of meals consumed per day: Children 1-4 years old

Table D-5 - Percent of 1-4-year-old children who eat breakfast every day

Table D-6 - Percent of 1-4-year-old children eating at least one snack per day

Table D-7 - Average number of snacks consumed per day: Children 1-4 years old

Table D-8 - Mean usual intake of food energy in kilocalories: Children 1-4 years old

Table D-9 - Mean usual intake of food energy as a percent of the 1989 Recommended Energy Allowance: Children 

1-4 years old

Table D-10 - Distribution of usual food energy intake in kilocalories: Children 1-4 years old

Table D-11 - Mean usual intake of Vitamin C in milligrams: Children 1-4 years old

Table D-12 - Percent of 1-4-year-old children with adequate usual intake of Vitamin C

Table D-13 - Distribution of usual Vitamin C intake in milligrams: Children 1-4 years old

Table D-14 - Mean usual intake of iron in milligrams: Children 1-4 years old

Table D-15 - Percent of 1-4-year-old children with adequate usual intake of iron

Table D-16 - Distribution of usual iron intake in milligrams: Children 1-4 years old

Table D-17 - Mean usual intake of zinc in milligrams: Children 1-4 years old

Table D-18 - Percent of 1-4-year-old children with adequate usual intake of zinc

Table D-19 - Distribution of usual zinc intake in milligrams: Children 1-4 years old

Table D-20 - Mean usual intake of calcium in milligrams: Children 1-4 years old

Table D-21 - Mean usual intake of calcium as a percent of Adequate Intake (AI): Children 1-4 years old

Table D-22 - Distribution of usual calcium intake in milligrams: Children 1-4 years old

Table D-23 - Mean daily intake of milk (grams) by 1-4-year-old children

Table D-24 - Mean number of 8-ounce servings of milk consumed per day by 1-4-year-old children

Table D-25 - Mean daily intake of soft drinks (grams) by 1-4-year-old children

Table D-26 - Mean number of 8-ounce servings of soft drinks consumed per day by 1-4-year-old children

Table D-27 - Prevalence of dietary supplement use in the past month among 1-4-year-old children 

Table D-28 - Number of dietary supplements taken by 1-4-year-old children using dietary supplements in past month

Table D-29 - Types of dietary supplements taken by 1-4-year-old children using dietary supplements in past month

Chapter Three

Healthy Eating Index Scores and Usual Intake of Dietary Fiber 

Among Children Ages 2-4

Table D-30 - Total Healthy Eating Index score: Children 2-4 years old

Table D-31 - Percent of 2-4-year-old children by Healthy Eating Index ratings

Table D-32 - Healthy Eating Index component scores and food pyramid servings for grains: Children 2-4 years old

Table D-33 - Healthy Eating Index component scores and food pyramid servings for vegetables: Children 2-4 years 

old

Table D-34 - Healthy Eating Index component scores and food pyramid servings for fruit: Children 2-4 years old

Table D-35 - Healthy Eating Index component scores and food pyramid servings for dairy: Children 2-4 years old

Table D-36 - Healthy Eating Index component scores and food pyramid servings for meat: Children 2-4 years old
Table D-37 - Healthy Eating Index component scores for variety: Children 2-4 years old

Table D-38 - Healthy Eating Index component scores for total fat: Children 2-4 years old

Table D-39 - Healthy Eating Index component scores for saturated fat: Children 2-4 years old

Table D-40 - Healthy Eating Index component scores for cholesterol: Children 2-4 years old

Table D-41 - Healthy Eating Index component scores for sodium: Children 2-4 years old

Table D-42 - Mean percent of usual energy intake from total fat: Children 2-4 years old

Table D-43 - Percent of 2-4-year-old children meeting Dietary Guidelines recommendation for usual intake of total fat

Table D-44 - Distribution of usual intake of total fat as a percent of usual energy intake: Children 2-4 years old

Table D-45 - Mean percent of usual energy intake from saturated fat: Children 2-4 years old

Table D-46 - Percent of 2-4-year-old children meeting Dietary Guidelines recommendation for usual intake of 

saturated fat

Table D-47 - Distribution of usual intake of saturated fat as a percent of usual energy intake: Children 2-4 years old

Table D-48 - Mean usual intake of cholesterol in milligrams: Children 2-4 years old

Table D-49 - Percent of 2-4-year-old children meeting Dietary Guidelines recommendation for usual intake of 

cholesterol

Table D-50 - Distribution of usual intake of cholesterol in milligrams: Children 2-4 years old

Table D-51 - Mean usual intake of sodium in milligrams: Children 2-4 years old

Table D-52 - Percent of 2-4-year-old children meeting Dietary Guidelines recommendation for usual intake of sodium

Table D-53 - Distribution of usual sodium intake in milligrams: Children 2-4 years old

Table D-54 - Percent of 2-4-year-old children using table salt

Table D-55 - Mean usual intake of dietary fiber in grams: Children 2-4 years old

Table D-56 - Percent of 2-4-year-old children with usual intake of dietary fiber at or above reference standard

Table D-57 - Distribution of usual dietary fiber intake in grams: Children 2-4 years old

Chapter Four

Health-Related Behaviors

Table D-58 - Percent of infants and children ever breastfed

Table D-59 - Percent of infants and children breastfed for at least 6 months, among those ever breastfed: Ages 7 

months and older

Table D-60 - Percent of children breastfed for at least one year, among those ever breastfed

Table D-61 - Mean duration of breastfeeding among children ever breastfed

Table D-62 - Percent of breastfed infants and children who were never fed formula 

Table D-63 - Mean age when first fed formula on a daily basis, among breastfed infants and children 

Table D-64 - Percent of infants and children fed cow's milk on a daily basis before 12 months of age

Table D-65 - Mean age when first fed cow's milk on a daily basis: Ages 7 months and older

Table D-66 - Percent of infants and children who ever used a baby bottle

Table D-67 - Percent of infants and children still using a baby bottle

Table D-68 - Percent of children who stopped using a baby bottle before 1 year of age

Table D-69 - Mean age when stopped using a baby bottle

Table D-70 - Percent of infants and children fed solid foods on a daily basis before 4 months of age

Table D-71 - Mean age when first fed solid foods on a daily basis

Table D-72 - Physical activity reported by pregnant and postpartum women for past month 

Table D-73 - Percent of pregnant and postpartum women consuming at least 12 alcoholic beverages, in their lifetime 

and in past year

Table D-74 - Percent of pregnant and postpartum women smoking cigarettes, in their lifetime and in past 5 days

Table D-75 - Percent of nonsmoking women, infants, and children exposed to second hand smoke at home

Table D-76 - Mean number of cigarettes smoked per day in households where nonsmoking women, infants, and 

children reside with smokers

Table D-77 - Percent of nonsmoking women and 4-year-old children with high serum cotinine levels 
Chapter Five

Health Status, Conditions, and Risks

Table D-78 - Percent of women, infants, and children with self-reported general health status of very good or excellent

Table D-79 - Percent of women, infants, and children with self-reported general health status of fair or poor

Table D-80 - Percent of women, infants, and children with physician-reported general health status of very good or 

excellent

Table D-81 - Percent of women, infants, and children with physician-reported general health status of fair or poor

Table D-82 - Prevalence of specific health conditions among pregnant and postpartum women

Table D-83 - Pregnancy histories of pregnant and postpartum women

Table D-84 - Mean age of mothers at time of birth: Infants and children up to 4 years old

Table D-85 - Percent of infants and children born to adolescent mothers

Table D-86 - Percent of infants and children born to mothers over age 35

Table D-87 - Percent of infants and children born to mothers who smoked during pregnancy

Table D-88 - Mean birthweight of infants and children

Table D-89 - Percent of infants and children born low birthweight

Table D-90 - Percent of infants and children born very low birthweight

Table D-91 - Percent of infants and children receiving neonatal intensive care (NICU)

Table D-92 - Mean weight-for-height, and percent of children overweight, at risk of overweight, and underweight

Table D-93 - Percent of 2-4-year-old children with growth retardation

Table D-94 - Percent of children with iron deficiency

Table D-95 - Percent of children with low serum ferritin

Table D-96 - Percent of children with high free erythrocyte protoporphorin 

Table D-97 - Percent of children with low transferrin saturation

Table D-98 - Percent of children with low iron deficiency anemia

Table D-99 - Percent of children with low hemoglobin

Table D-100 - Percent of children with low hematocrit

Table D-101 - Percent of infants and children with any hospital stays since birth

Table D-102 - Percent of infants and children with accident, injury, or poisoning requiring medical attention in past 12 

months

Table D-103 - Percent of infants and children ever diagnosed by doctor to have asthma

Table D-104 - Percent of infants and children ever diagnosed by doctor to have chronic bronchitis

Table D-105 - Percent of infants and children ever diagnosed by doctor to have hay fever

Table D-106 - Percent of children ever tested for lead poisoning

Table D-107 - Percent of children ever reported to have high lead levels or lead poisoning

Table D-108 - Percent of children with high blood lead levels

Table D-109 - Percent of children with high blood lead levels, NHANES-III Phase I (1988-1991)

Table D-110 - Percent of children with high blood lead levels, NHANES-III Phase II (1991-1994)

Table D-111 - Mean number of decayed, missing, and filled teeth for women and 2-4-year-old children

Table D-112 - Percent of women and 2-4-year-old children who ever visited a dentist or dental hygienist

Table D-113 - Percent of women and 2-4-year-old children who visited a dentist or dental hygienist within the past year

Chapter Six

Access to Health Care Services

Table D-114 - Percent of women, infants, and children with any health insurance

Table D-115 - Percent of women, infants, and children with Medicaid

Table D-116 - Percent of women, infants, and children with private health insurance

Table D-117 - Percent of women, infants, and children with a regular source of health care

Table D-118 - Percent of women, infants, and children who see a particular doctor

Table D-119 - Percent of women, infants, and children who saw a doctor within the past year
Table D-1—Percent of income-eligible 1-4-year-old children receiving benefits from the Food Stamp Program

Total Children Currently Receiving WIC Benefits Income-elig

Sample size Percent Standard Error Sample size Percent Standard Error Sample size 

Children

1 year old ................ 659 61.4 3.4 335 72.8 3.9 287 ›

2 years old .............. 652 65.6 2.6 215 78.4 3.0 413 ›3 years old .............. 614 63.8 3.4 174 71.0 7.3 407 4 years old .............. 592 59.7 3.9 118 65.4 * 6.4 445 

Total, age-adjusted ....... 2,517 62.6 2.4 842 71.9 3.4 1,552 ›

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview files. ’Total’ column includes children with missing WIC participation or income.
Table D-2—Distribution of 1-4-year-old children by household food sufficiency status

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample

size

Enough

food to

eat

Sometimesnot enough

Often not

enough

Sample

size

Enough

food to

eat

Sometimesnot enough

Often not

enough

Sample

size

Enough

food to

eat

Sometimesnot enough

Often not

enough

Sample

size

Percent distribution

Children

1 year old ................ 1,253 93.1 6.6 0.3 418 88.9 11.0 0.1 389 85.4 13.6 1.1 357 2 years old .............. 1,268 92.6 6.7 0.7 253 83.4 15.3 1.3 545 86.5 11.9 1.6 387 3 years old .............. 1,119 93.9 5.7 0.4 201 90.9 7.5 1.7 513 88.3 11.3 0.4 325 4 years old .............. 1,098 93.0 6.5 0.5 137 87.2 9.0 3.8 547 88.0 11.7 0.3 342 

Total, age-adjusted ....... 4,738 93.2 6.4 0.5 1,009 87.6 10.7 1.7 1,994 87.1 12.1 0.8 1,411 

Standard errors

Children

1 year old ................ 1,253 0.9 0.9 0.1 418 2.2 2.2 0.1 389 2.1 2.1 0.5 357 2 years old .............. 1,268 1.0 1.0 0.3 253 4.6 4.4 0.8 545 2.0 2.1 0.9 387 3 years old .............. 1,119 0.7 0.8 0.2 201 2.4 1.7 1.5 513 2.1 2.1 0.2 325 4 years old .............. 1,098 0.9 1.0 0.2 137 4.0 2.7 2.8 547 1.9 1.9 0.2 342 

Total, age-adjusted ....... 4,738 0.7 0.7 0.1 1,009 1.7 1.7 0.8 1,994 1.2 1.2 0.3 1,411 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences, compared to WIC participants, are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). The Bonferroni adjustment was used to adjust for the 

examining multiple outcome categories.

Source: NHANES-III, 1988-94: Youth interview files. ’Total’ column includes children with missing WIC participation or income.
Table D-3—Percent of 1-4-year-old children eating fewer than three meals per day

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 1,105 13.1 1.53 367 15.1 2.14 347 14.8 1.96 308 2 years old .............. 1,174 10.2 1.06 241 12.0 2.00 513 15.5 2.35 344 

3 years old .............. 998 14.2 1.54 181 20.2 3.77 474 15.1 2.42 272 4 years old .............. 998 14.3 1.70 130 18.4 5.04 492 14.7 1.90 314 

Total, age-adjusted ....... 4,275 13.0 0.76 919 16.4 1.96 1,826 15.0 1.13 1,238 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Table D-4—Average number of meals consumed per day: Children 1-4 years old

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard Error Sample size Mean Standard Error Sample size Mean Standard Error Sample si

Children

1 year old ................ 1,105 3.0 0.03 367 3.0 0.05 347 3.0 0.04 308 2 years old .............. 1,174 3.0 0.02 241 3.0 0.04 513 2.9 0.04 344 3 years old .............. 998 3.0 0.03 181 2.9 0.07 474 3.0 0.04 272 4 years old .............. 998 2.9 0.02 130 3.0 0.09 492 3.0 0.03 314 

Total, age-adjusted ....... 4,275 3.0 0.02 919 3.0 0.04 1,826 3.0 0.03 1,238 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Exam file, 24-hour dietary recall. ’Total’ column includes children with missing WIC participation or income.
Table D-5—Percent of 1-4-year-old children who eat breakfast every day

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 1,255 95.0 0.8 417 92.9 * 1.7 390 93.9 * 1.8 357 

2 years old .............. 1,269 91.3 0.9 253 85.7 3.8 545 89.6 1.9 387 3 years old .............. 1,119 90.3 1.4 201 88.5 * 2.7 513 90.7 2.1 325 4 years old .............. 1,096 91.9 1.5 137 85.0 * 7.2 547 88.8 2.7 341 

Total, population

adjusted .................. 4,739 92.2 0.6 1,008 88.0 2.2 1,995 90.8 1.3 1,410 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview files. ’Total’ column includes children with missing WIC participation or income.
Table D-6—Percent of 1-4-year-old children eating at least one snack per day

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 1,105 97.0 0.6 367 96.6 * 1.2 347 94.5 1.7 308 2 years old .............. 1,174 96.3 0.7 241 97.0 * 1.0 513 93.4 1.8 344 3 years old .............. 998 94.1 1.1 181 92.7 * 3.0 474 92.0 1.7 272 4 years old .............. 998 93.4 1.2 130 96.9 * 2.1 492 92.7 1.3 314 

Total, age-adjusted ....... 4,275 95.2 0.5 919 95.8 1.0 1,826 93.2 1.0 1,238 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Table D-7—Average number of snacks consumed per day: Children 1-4 years old

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard Error Sample size Mean Standard Error Sample size Mean Standard Error Sample si

Children

1 year old ................ 1,105 3.2 0.09 367 3.2 0.14 347 › 2.9 0.12 308 

2 years old .............. 1,174 2.9 0.06 241 3.0 0.15 513 › 2.7 0.09 344 

3 years old .............. 998 2.6 0.08 181 2.4 0.13 474 2.4 0.14 272 

4 years old .............. 998 2.4 0.06 130 2.6 0.15 492 2.4 0.09 314 

Total, age-adjusted ....... 4,275 2.8 0.04 919 2.8 0.08 1,826 ›› 2.6 0.07 1,238 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Exam file, 24-hour dietary recall. ’Total’ column includes children with missing WIC participation or income.
Table D-8—Mean usual intake of food energy in kilocalories: Children 1-4 years old

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard error Sample size Mean Standard error Sample size Mean Standard error Sample si

Children

1 year old .................. 1,135 1,218 12.2 380 1,215 21.5 355 1,268 21.8 315 2 years old ................ 1,175 1,398 11.9 242 1,480 36.4 513 ›› 1,370 14.1 344 

3 years old ................ 999 1,487 15.2 181 1,556 28.3 475 1,502 29.1 272 

4 years old ................ 1,000 1,603 22.5 130 1,659 40.3 494 1,654 27.5 314 Total, age-adjusted ... 4,309 1,428 8.7 933 1,473 17.2 1,837 1,449 15.0 1,245 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.

Table D-9—Mean usual intake of food energy as a percent of the 1989 Recommended Energy Allowance: Children 1-4 years old

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard error Sample size Percent Standard error Sample size Percent Standard error Sample si

Children

1 year old .................. 1,135 93.7 0.9 380 93.5 1.6 355 97.5 1.7 315 2 years old ................ 1,175 107.6 0.9 242 113.9 2.8 513 ›› 105.4 1.1 344 

3 years old ................ 999 114.4 1.2 181 119.7 2.2 475 115.5 2.2 272 

4 years old ................ 1,000 89.0 1.2 130 92.2 2.2 494 91.9 1.5 314 Total, age-adjusted ... 4,309 100.6 0.6 933 107.2 1.2 1,837 ›››101.0 1.0 1,245 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-10—Distribution of usual food energy intake in kilocalories: Children 1-4 years old

1989

REA

(kcal)

Percentiles Standard errors 

5th 10th 15th 25th 50th 75th 85th 90th 95th 5th 10th 15th 25th 50

Total Children

1 year old .................. 1,300 773 856 914 1,004 1,188 1,400 1,525 1,614 1,758 8.42 7.81 7.98 8.89 112 years old ................ 1,300 945 1,035 1,097 1,192 1,378 1,580 1,698 1,784 1,920 9.61 9.34 9.20 9.13 103 years old ................ 1,300 1,024 1,115 1,178 1,274 1,460 1,670 1,798 1,892 2,042 14.30 14.00 13.90 13.80 144 years old ................ 1,800 1,100 1,198 1,266 1,370 1,578 1,808 1,943 2,040 2,192 21.40 20.40 20.20 20.70 22Total, age-adjusted ... na 921 1,018 1,086 1,190 1,398 1,630 1,771 1,873 2,038 6.80 6.77 6.91 7.28 8

Receiving WIC Benefits

1 year old .................. 1,300 725 820 885 983 1,186 1,416 1,551 1,648 1,804 28.60 22.70 20.20 18.90 202 years old ................ 1,300 1,009 1,098 1,159 1,253 1,443 1,665 1,804 1,908 2,080 26.90 25.50 25.00 25.30 303 years old ................ 1,300 1,060 1,147 1,209 1,306 1,508 1,752 1,907 2,024 2,218 27.00 29.30 30.30 30.10 264 years old ................ 1,800 1,191 1,286 1,353 1,453 1,641 1,847 1,971 2,059 2,193 31.30 33.00 34.60 36.50 40Total, age-adjusted ... na 925 1,031 1,107 1,221 1,440 1,687 1,841 1,955 2,139 13.80 12.50 12.30 12.80 16

Income-eligibleNonparticipant

1 year old .................. 1,300 751 841 908 1,015 1,236 1,479 1,621 1,725 1,894 13.70 14.50 15.50 17.50 222 years old ................ 1,300 ›››880 ›››973 ›››1,040 ›› 1,143 1,352 1,575 1,697 1,782 1,917 16.30 16.70 16.80 16.70 15

3 years old ................ 1,300 1,030 1,122 1,186 1,283 1,477 1,694 1,823 1,915 2,060 24.50 23.00 22.40 22.20 254 years old ................ 1,800 1,101 1,210 1,285 1,401 1,629 1,879 2,026 2,131 2,296 35.20 32.30 30.60 28.50 26Total, age-adjusted ... na 912 1,014 1,086 1,198 1,421 1,668 1,813 1,918 2,084 12.80 12.80 13.00 13.40 14

Higher-incomeNonparticipant

1 year old .................. 1,300 › 823 894 944 1,022 1,176 1,346 1,449 1,526 1,654 14.10 15.40 16.20 17.20 19

2 years old ................ 1,300 987 1,068 1,125 1,213 1,389 1,581 1,690 1,767 1,885 16.60 16.10 15.70 15.20 163 years old ................ 1,300 1,031 1,111 1,168 1,257 1,438 1,642 › 1,761 › 1,846 › 1,979 19.10 19.60 19.80 19.90 19

4 years old ................ 1,800 1,118 1,206 1,269 1,365 1,559 1,772 1,896 1,983 2,117 29.30 27.00 26.40 26.70 30Total, age-adjusted ... na 949 1,036 1,097 1,191 › 1,382 ›› 1,599 ›› 1,730 ›› 1,825 ›› 1,977 9.85 9.60 9.64 9.94 11

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

The Bonferroni adjustment was used to adjust levels of significant and control for multiplicity in the number of tests.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-11—Mean usual intake of Vitamin C in milligrams: Children 1-4 years old

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard error Sample size Mean Standard error Sample size Mean Standard error Sample si

Children

1 year old .................. 1,135 86 2.2 380 87 3.0 355 85 3.5 315 2 years old ................ 1,175 96 1.9 242 102 6.1 513 90 3.6 344 3 years old ................ 999 93 2.4 181 129 11.0 475 ›››89 3.8 272 

4 years old ................ 1,000 101 2.3 130 103 6.2 494 107 3.9 314 Total, age-adjusted ... 4,309 94 0.9 933 105 3.4 1,837 ›› 93 2.2 1,245 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.

Table D-12—Percent of 1-4-year-old children with adequate usual intake of Vitamin C1

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard error Sample size Percent Standard error Sample size Percent Standard error Sample si

Children

1 year old .................. 1,135 99.8 0.03 380 100.0 0.05 355 › 99.8 0.06 315 

2 years old ................ 1,175 99.9 0.04 242 100.0 0.00 513 › 99.9 0.06 344 

3 years old ................ 999 99.9 0.03 181 100.0 0.00 475 100.0 0.03 272 

4 years old ................ 1,000 99.8 0.04 130 100.0 0.08 494 › 99.8 0.07 314 

Total, age-adjusted ... 4,309 99.9 0.02 933 100.0 0.02 1,837 ›››99.9 0.03 1,245 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Estimated Average Requirements (EARs) were used to assess the adequacy of intake in groups, using the EAR cut-point method described in IOM, Dietary Referen

Assessment, Chapter 4. EARs are defined separately for age groups as listed in appendix B.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-13—Distribution of usual Vitamin C intake in milligrams: Children 1-4 years old

EAR

(mg/dy)

Percentiles Standard errors 

5th 10th 15th 25th 50th 75th 85th 90th 95th 5th 10th 15th 25th 50

Total Children

1 year old .................. 13 30 37 43 53 76 108 130 147 177 0.84 0.97 1.07 1.26 12 years old ................ 13 34 43 49 60 86 121 143 161 189 1.00 1.09 1.17 1.31 13 years old ................ 13 36 45 52 62 87 117 136 150 173 1.20 1.39 1.54 1.77 24 years old ................ 22 44 53 60 71 96 125 143 157 178 1.16 1.25 1.33 1.50 1Total, age-adjusted ... na 36 44 51 62 87 118 139 154 179 0.54 0.59 0.63 0.70 0

Receiving WIC Benefits

1 year old .................. 13 34 42 48 59 81 108 125 137 158 1.53 1.71 1.85 2.13 22 years old ................ 13 39 48 55 66 92 128 151 169 198 2.04 2.48 2.85 3.54 53 years old ................ 13 59 71 78 90 117 154 181 202 237 4.93 5.34 5.57 6.10 94 years old ................ 22 53 61 68 78 100 125 140 150 167 5.14 5.46 5.64 5.85 6Total, age-adjusted ... na 45 54 61 73 98 130 150 165 190 2.08 2.34 2.47 2.63 3

Income-eligibleNonparticipant

1 year old .................. 13 29 36 42 › 51 74 106 129 148 181 1.26 1.35 1.43 1.61 2

2 years old ................ 13 33 40 46 57 81 113 134 150 177 1.52 1.65 1.76 2.03 23 years old ................ 13 ›››37 ›››45 ›››51 ›››61 ›› 83 › 111 129 142 164 2.08 2.34 2.54 2.88 3

4 years old ................ 22 46 56 63 75 101 133 153 167 190 1.91 2.16 2.40 2.83 3Total, age-adjusted ... na ›››36 ›› 44 ›› 51 ›››61 ›› 85 116 136 152 178 1.02 1.12 1.22 1.43 2

Higher-incomeNonparticipant

1 year old .................. 13 29 36 42 51 75 109 132 151 184 1.30 1.54 1.73 2.06 32 years old ................ 13 35 44 50 62 89 125 148 167 197 1.54 1.66 1.77 1.95 23 years old ................ 13 ›››34 ›››42 ›››48 ›››58 ›› 81 › 110 › 127 › 140 160 1.53 1.73 1.87 2.13 2

4 years old ................ 22 42 51 58 69 94 122 140 153 174 1.88 2.02 2.15 2.41 3Total, age-adjusted ... na ›››35 ›››43 ›››49 ›››60 ›››85 › 117 137 152 177 0.76 0.84 0.90 0.99 1

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

The Bonferroni adjustment was used to adjust levels of significant and control for multiplicity in the number of tests.

na EAR is specified for particular age groups, but is not applicable to pooled data.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-14—Mean usual intake of iron in milligrams: Children 1-4 years old

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard error Sample size Mean Standard error Sample size Mean Standard error Sample si

Children

1 year old .................. 1,135 9.5 0.15 380 10.1 0.27 355 ›› 9.0 0.24 315 

2 years old ................ 1,175 10.6 0.13 242 11.6 0.43 513 ›››10.0 0.24 344 3 years old ................ 999 10.9 0.14 181 12.4 0.43 475 ›››10.7 0.25 272 

4 years old ................ 1,000 12.2 0.26 130 12.2 0.38 494 12.3 0.27 314 Total, age-adjusted ... 4,309 10.8 0.09 933 11.6 0.20 1,837 ›››10.5 0.13 1,245 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.

Table D-15—Percent of 1-4-year-old children with adequate usual intake of iron1

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard error Sample size Percent Standard error Sample size Percent Standard error Sample si

Children

1 year old .................. 1,135 99.3 0.10 380 98.8 0.35 355 99.2 0.16 315 

2 years old ................ 1,175 100.0 0.00 242 100.0 0.00 513 ›››99.8 0.07 344 3 years old ................ 999 100.0 0.00 181 100.0 0.00 475 100.0 0.00 272 4 years old ................ 1,000 100.0 0.02 130 100.0 0.00 494 100.0 0.05 314 Total, age-adjusted ... 4,309 99.8 0.03 933 99.7 0.09 1,837 99.7 0.05 1,245 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Estimated Average Requirements (EARs) were used to assess the adequacy of intake in groups, using the EAR cut-point method described in IOM, Dietary Referen

Assessment, Chapter 4. EARs are defined separately for age groups as listed in appendix B.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-16—Distribution of usual iron intake in milligrams: Children 1-4 years old

EAR

(mg/dy)

Percentiles Standard errors 

5th 10th 15th 25th 50th 75th 85th 90th 95th 5th 10th 15th 25th 50

Total Children

1 year old .................. 3.0 4.5 5.2 5.8 6.7 8.7 11.4 13.2 14.6 17.1 0.09 0.10 0.10 0.11 0.2 years old ................ 3.0 5.9 6.7 7.2 8.1 10.0 12.4 14.1 15.3 17.5 0.09 0.09 0.09 0.09 0.3 years old ................ 3.0 6.6 7.3 7.8 8.7 10.5 12.7 14.1 15.2 16.9 0.11 0.11 0.11 0.11 0.4 years old ................ na 7.4 8.1 8.7 9.6 11.7 14.2 15.8 16.9 18.9 0.13 0.14 0.14 0.16 0.2Total, age-adjusted ... na 5.8 6.6 7.2 8.2 10.2 12.8 14.4 15.7 17.9 0.06 0.06 0.06 0.06 0.0

Receiving WIC Benefits

1 year old .................. 3.0 4.3 5.2 5.8 6.8 9.0 12.1 14.3 16.1 19.3 0.20 0.20 0.20 0.22 0.22 years old ................ 3.0 6.6 7.5 8.1 9.0 11.1 13.6 15.2 16.4 18.4 0.27 0.29 0.31 0.33 0.43 years old ................ 3.0 7.3 8.2 8.8 9.8 12.0 14.6 16.1 17.3 19.2 0.35 0.36 0.37 0.38 0.44 years old ................ na 8.3 9.1 9.6 10.4 12.0 13.8 14.9 15.7 16.9 0.28 0.30 0.31 0.32 0.3Total, age-adjusted ... na 6.1 7.0 7.7 8.7 10.9 13.6 15.4 16.8 19.3 0.14 0.15 0.15 0.16 0.

Income-eligibleNonparticipant

1 year old .................. 3.0 4.2 5.0 5.5 6.4 8.4 11.0 12.7 › 13.9 ›› 15.9 0.10 0.11 0.12 0.15 0.2

2 years old ................ 3.0 ›››5.0 ›››5.8 ›››6.3 ›››7.2 ›››9.2 › 11.8 13.6 15.0 17.4 0.14 0.14 0.14 0.15 0.

3 years old ................ 3.0 7.0 7.6 8.1 8.8 ›› 10.4 ›››12.2 ›››13.3 ›››14.2 ›››15.5 0.20 0.20 0.20 0.20 0.2

4 years old ................ na 7.4 8.3 8.9 9.9 11.8 14.2 15.7 16.8 18.5 0.21 0.20 0.20 0.20 0.2Total, age-adjusted ... na 5.7 6.5 ›› 7.1 ›› 8.0 ›››10.0 ›››12.4 ›› 14.0 ›› 15.2 ›››17.1 0.11 0.11 0.11 0.10 0.

Higher-incomeNonparticipant

1 year old .................. 3.0 4.8 5.5 6.1 7.0 9.1 11.7 13.4 14.7 16.8 0.12 0.13 0.13 0.15 0.22 years old ................ 3.0 6.5 7.3 7.8 8.6 10.4 12.8 14.3 15.5 17.5 0.16 0.15 0.15 0.16 0.23 years old ................ 3.0 6.3 › 7.0 › 7.6 ›› 8.4 ›› 10.3 ›› 12.6 › 14.1 › 15.2 17.0 0.15 0.16 0.16 0.18 0.2

4 years old ................ na 7.5 8.2 8.8 9.7 11.7 14.4 16.2 17.5 19.7 0.20 0.21 0.23 0.26 0.4Total, age-adjusted ... na 6.1 6.8 7.4 8.3 10.3 12.9 14.6 15.9 18.1 0.07 0.07 0.08 0.09 0.

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

The Bonferroni adjustment was used to adjust levels of significant and control for multiplicity in the number of tests.

na EAR is specified for particular age groups, but is not applicable to pooled data.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-17—Mean usual intake of zinc in milligrams: Children 1-4 years old

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard error Sample size Mean Standard error Sample size Mean Standard error Sample si

Children

1 year old .................. 1,135 6.4 0.08 380 6.5 0.15 355 6.6 0.15 315 2 years old ................ 1,175 7.1 0.09 242 7.8 0.22 513 ›› 7.1 0.12 344 

3 years old ................ 999 7.3 0.10 181 7.9 0.26 475 7.6 0.16 272 

4 years old ................ 1,000 8.1 0.19 130 8.4 0.43 494 8.6 0.28 314 Total, age-adjusted ... 4,309 7.2 0.07 933 7.6 0.15 1,837 7.5 0.11 1,245 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.

Table D-18—Percent of 1-4-year-old children with adequate usual intake of zinc1

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard error Sample size Percent Standard error Sample size Percent Standard error Sample si

Children

1 year old .................. 1,135 99.9 0.05 380 99.6 0.20 355 100.0 0.00 315 2 years old ................ 1,175 100.0 0.00 242 100.0 0.00 513 100.0 0.00 344 3 years old ................ 999 100.0 0.00 181 100.0 0.00 475 100.0 0.00 272 4 years old ................ 1,000 99.4 0.17 130 100.0 0.08 494 99.8 0.10 314 Total, age-adjusted ... 4,309 99.8 0.04 933 99.9 0.05 1,837 99.9 0.03 1,245 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Estimated Average Requirements (EARs) were used to assess the adequacy of intake in groups, using the EAR cut-point method described in IOM, Dietary Referen

Assessment, Chapter 4. EARs are defined separately for age groups as listed in appendix B.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-19—Distribution of usual zinc intake in milligrams: Children 1-4 years old

EAR

(mg/dy)

Percentiles Standard errors 

5th 10th 15th 25th 50th 75th 85th 90th 95th 5th 10th 15th 25th 50

Total Children

1 year old .................. 2.2 3.9 4.3 4.6 5.1 6.2 7.4 8.1 8.6 9.5 0.05 0.05 0.05 0.06 02 years old ................ 2.2 4.5 4.9 5.2 5.7 6.8 8.2 9.0 9.6 10.7 0.07 0.07 0.07 0.07 03 years old ................ 2.2 4.8 5.3 5.6 6.1 7.2 8.4 9.1 9.6 10.5 0.08 0.08 0.08 0.09 04 years old ................ 4.1 5.1 5.7 6.0 6.6 7.8 9.3 10.3 11.0 12.2 0.12 0.12 0.13 0.14 0Total, age-adjusted ... na 4.5 5.0 5.3 5.8 7.0 8.3 9.2 9.8 10.9 0.04 0.04 0.04 0.05 0

Receiving WIC Benefits

1 year old .................. 2.2 3.6 4.1 4.5 5.1 6.2 7.6 8.4 9.1 10.1 0.14 0.12 0.12 0.12 02 years old ................ 2.2 4.7 5.2 5.5 6.1 7.3 8.9 10.0 10.8 12.3 0.16 0.16 0.16 0.16 03 years old ................ 2.2 5.3 5.7 6.0 6.6 7.7 9.0 9.8 10.4 11.3 0.17 0.18 0.19 0.21 04 years old ................ 4.1 5.6 6.1 6.4 7.0 8.2 9.6 10.5 11.1 12.2 0.25 0.28 0.30 0.34 0Total, age-adjusted ... na 4.5 5.1 5.4 6.0 7.3 8.8 9.8 10.6 11.9 0.07 0.07 0.08 0.10 0

Income-eligibleNonparticipant

1 year old .................. 2.2 4.0 4.4 4.8 5.3 6.4 7.7 8.4 9.0 9.8 0.08 0.09 0.10 0.11 02 years old ................ 2.2 4.5 5.0 5.3 5.8 6.9 8.1 8.9 9.4 10.2 0.10 0.10 0.10 0.10 03 years old ................ 2.2 5.2 5.6 6.0 6.5 7.5 8.6 9.3 9.8 10.6 0.14 0.14 0.14 0.14 04 years old ................ 4.1 5.6 6.2 6.5 7.2 8.4 9.9 10.8 11.4 12.4 0.19 0.19 0.20 0.21 0Total, age-adjusted ... na 4.7 5.2 5.6 6.1 7.3 8.6 9.4 10.0 11.0 0.07 0.07 0.08 0.08 0

Higher-incomeNonparticipant

1 year old .................. 2.2 4.1 4.5 4.8 5.2 6.0 7.1 7.7 8.2 8.9 0.08 0.08 0.08 0.09 02 years old ................ 2.2 4.4 4.9 5.2 5.7 6.8 8.0 8.8 9.4 10.4 0.11 0.11 0.11 0.12 03 years old ................ 2.2 4.5 5.0 5.4 5.9 6.9 8.0 8.7 9.1 9.9 0.10 0.10 0.09 0.10 04 years old ................ 4.1 5.0 5.5 5.8 6.3 7.5 8.9 9.8 10.6 11.7 0.17 0.17 0.17 0.17 0Total, age-adjusted ... na 4.4 4.9 5.2 5.7 6.8 8.0 8.8 9.4 10.4 0.05 0.05 0.05 0.05 0

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

The Bonferroni adjustment was used to adjust levels of significant and control for multiplicity in the number of tests.

na EAR is specified for particular age groups, but is not applicable to pooled data.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Food intake does not account for vitamin/mineral supplements. Usual intake was estimated using C-SIDE: So

Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intake of Individuals (CSFII).
Table D-20—Mean usual intake of calcium in milligrams: Children 1-4 years old

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard error Sample size Mean Standard error Sample size Mean Standard error Sample si

Children

1 year old .................. 1,135 903 15.8 380 899 21.5 355 887 32.7 315 2 years old ................ 1,175 783 11.5 242 833 27.8 513 ›› 734 11.5 344 

3 years old ................ 999 824 15.1 181 849 27.6 475 783 25.8 272 4 years old ................ 1,000 843 15.2 130 842 30.0 494 832 21.9 314 Total, age-adjusted ... 4,309 838 8.1 933 854 16.6 1,837 811 15.1 1,245 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.

Table D-21—Mean usual intake of calcium as a percent of Adequate Intake (AI): Children 1-4 years old

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard error Sample size Percent Standard error Sample size Percent Standard error Sample si

Children

1 year old .................. 1,135 180.7 3.2 380 179.7 4.3 355 177.3 6.5 315 2 years old ................ 1,175 156.6 2.3 242 166.6 5.6 513 ›› 146.8 2.3 344 

3 years old ................ 999 164.8 3.0 181 169.7 5.5 475 156.6 5.2 272 4 years old ................ 1,000 105.4 1.9 130 105.2 3.8 494 104.0 2.7 314 Total, age-adjusted ... 4,309 146.7 1.4 933 157.5 3.0 1,837 ›››139.9 2.6 1,245 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-22—Distribution of usual calcium intake in milligrams: Children 1-4 years old

AI

(mg/dy)

Percentiles Standard errors 

5th 10th 15th 25th 50th 75th 85th 90th 95th 5th 10th 15th 25th 50

Total Children

1 year old .................. 500 418 507 571 670 870 1,101 1,242 1,345 1,507 9.58 10.60 11.30 12.40 152 years old ................ 500 400 467 516 594 757 945 1,055 1,133 1,254 8.24 8.36 8.65 9.52 123 years old ................ 500 431 501 551 630 793 983 1,099 1,185 1,322 9.02 10.10 10.80 12.00 144 years old ................ 800 479 546 594 671 826 996 1,093 1,162 1,268 11.10 12.10 12.80 13.90 15Total, age-adjusted ... na 432 504 557 640 812 1,007 1,122 1,206 1,336 4.70 5.16 5.52 6.12 7

Receiving WIC Benefits

1 year old .................. 500 414 501 562 659 864 1,107 1,250 1,349 1,499 20.90 18.90 18.10 18.40 222 years old ................ 500 421 498 554 640 814 1,005 1,115 1,192 1,310 24.40 25.40 25.80 26.60 293 years old ................ 500 464 529 578 657 822 1,011 1,121 1,200 1,323 21.10 22.90 23.60 24.50 284 years old ................ 800 555 608 646 705 824 959 1,039 1,098 1,190 18.50 20.80 22.50 25.30 30Total, age-adjusted ... na 450 524 576 659 829 1,023 1,137 1,218 1,342 11.90 12.60 13.30 14.80 17

Income-eligibleNonparticipant

1 year old .................. 500 346 437 506 618 853 1,113 1,263 1,372 1,544 15.50 18.30 20.30 22.50 282 years old ................ 500 401 461 504 572 › 713 ›› 874 ›› 968 ›› 1,035 ›› 1,140 9.65 9.93 10.10 10.40 11

3 years old ................ 500 441 499 542 610 753 921 1,025 1,102 1,230 16.90 18.00 18.60 19.60 224 years old ................ 800 487 548 593 663 813 981 1,076 1,142 1,243 17.80 19.10 20.00 21.40 23Total, age-adjusted ... na 425 491 540 618 782 970 1,083 1,166 1,297 8.76 9.75 10.50 11.60 14

Higher-incomeNonparticipant

1 year old .................. 500 456 537 594 684 868 1,082 1,213 1,310 1,466 15.60 16.20 16.60 17.60 202 years old ................ 500 408 478 529 610 784 981 1,095 1,176 1,299 15.70 16.10 16.90 18.80 233 years old ................ 500 432 508 563 648 821 1,018 1,134 1,218 1,351 15.20 16.10 17.00 18.30 204 years old ................ 800 488 561 613 693 853 1,027 1,126 1,195 1,300 19.40 20.00 20.40 21.30 23Total, age-adjusted ... na 445 520 573 658 832 1,029 1,144 1,226 1,353 7.67 7.81 8.08 8.71 10

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

The Bonferroni adjustment was used to adjust levels of significant and control for multiplicity in the number of tests.

na Adequate Intake (AI) is specified for particular age groups, but is not applicable to pooled data.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Food intake does not account for vitamin/mineral supplements. Usual intake was estimated using C-SIDE: So

Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intake of Individuals (CSFII).
Table D-23—Mean daily intake of milk (grams) by 1-4-year-old children

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard Error Sample size Mean Standard Error Sample size Mean Standard Error Sample si

Children

1 year old ................ 1,105 414.8 18.9 367 404.8 24.2 347 423.0 33.2 308 2 years old .............. 1,174 273.2 12.0 241 300.6 25.2 513 › 246.8 12.4 344 

3 years old .............. 998 268.9 15.0 181 261.8 32.3 474 251.1 26.3 272 4 years old .............. 998 234.0 12.6 130 241.7 42.0 492 228.8 18.3 314 

Total, age-adjusted ....... 4,275 297.7 7.8 919 302.2 19.5 1,826 287.5 15.1 1,238 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Table D-24—Mean number of 8-ounce servings of milk consumed per day by 1-4-year-old children

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard Error Sample size Mean Standard Error Sample size Mean Standard Error Sample si

Children

1 year old ................ 1,105 1.7 0.08 367 1.7 0.10 347 1.8 0.14 308 2 years old .............. 1,174 1.1 0.05 241 1.2 0.10 513 › 1.0 0.05 344 

3 years old .............. 998 1.1 0.06 181 1.1 0.13 474 1.0 0.11 272 4 years old .............. 998 1.0 0.05 130 1.0 0.18 492 1.0 0.08 314 

Total, age-adjusted ....... 4,275 1.2 0.03 919 1.3 0.08 1,826 1.2 0.06 1,238 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Exam file, 24-hour dietary recall. ’Total’ column includes children with missing WIC participation or income.
Table D-25—Mean daily intake of soft drinks (grams) by 1-4-year-old children

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard Error Sample size Mean Standard Error Sample size Mean Standard Error Sample si

Children

1 year old ................ 1,105 109.8 7.26 367 116.9 12.96 347 128.4 13.63 308 2 years old .............. 1,174 181.2 9.66 241 180.3 26.59 513 225.3 17.46 344 3 years old .............. 998 207.3 14.78 181 223.4 31.02 474 234.7 19.56 272 4 years old .............. 998 250.8 17.31 130 248.5 44.05 492 288.3 19.42 314 

Total, age-adjusted ....... 4,275 187.4 7.68 919 192.4 16.72 1,826 219.3 10.49 1,238 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Table D-26—Mean number of 8-ounce servings of soft drinks consumed per day by 1-4-year-old children

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard Error Sample size Mean Standard Error Sample size Mean Standard Error Sample si

Children

1 year old ................ 1,105 0.5 0.03 367 0.5 0.05 347 0.5 0.06 308 2 years old .............. 1,174 0.8 0.04 241 0.8 0.11 513 0.9 0.07 344 3 years old .............. 998 0.9 0.06 181 0.9 0.13 474 1.0 0.08 272 4 years old .............. 998 1.0 0.07 130 1.0 0.18 492 1.2 0.08 314 

Total, age-adjusted ....... 4,275 0.8 0.03 919 0.8 0.07 1,826 0.9 0.04 1,238 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Exam file, 24-hour dietary recall. ’Total’ column includes children with missing WIC participation or income.
Table D-27—Prevalence of dietary supplement use in the past month among 1-4-year-old children 

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 1,254 37.1 2.2 416 28.4 3.4 391 36.4 3.7 356 

2 years old .............. 1,267 46.9 1.9 253 47.8 3.8 543 ›› 32.4 2.9 387 

3 years old .............. 1,113 50.7 3.3 201 40.9 6.0 510 44.6 4.0 322 

4 years old .............. 1,093 47.2 2.6 136 38.3 8.0 546 36.3 3.7 340 

Total, age-adjusted ....... 4,727 45.5 1.4 1,006 38.8 3.3 1,990 37.4 1.8 1,405 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview files. ’Total’ column includes children with missing WIC participation or income.
Table D-28—Number of dietary supplements taken by 1-4-year-old children using dietary supplements in past month

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants Hig

Sample

size

Number supplements used Sample

size

Number supplements used Sample

size

Number supplements used Sample

size

One Two Three + One Two Three + One Two Three + 

Percent distribution

Children

1 year old ................ 423 91.9 6.7 1.4 * 112 93.7 6.3 0.0 126 94.4 5.2 0.4 * 159 2 years old .............. 524 93.4 5.5 1.0 * 96 92.3 7.7 0.0 173 94.5 4.3 1.3 * 216 3 years old .............. 458 87.8 11.3 0.8 * 62 97.4 2.3 0.3 * 192 92.2 7.6 0.2 * 183 4 years old .............. 435 92.4 7.3 0.4 * 43 95.2 4.8 0.0 * 183 95.7 4.3 0.0 191 

Total, age-adjusted ....... 1,840 91.4 7.7 0.9 * 313 94.6 5.3 0.1 * 674 94.2 5.3 0.5 * 749 

Standard errors

Children

1 year old ................ 423 1.8 1.7 0.7 112 2.7 2.7 0.0 126 2.4 2.3 0.4 159 2 years old .............. 524 1.5 1.4 0.8 96 3.3 3.3 0.0 173 2.0 1.7 1.1 216 3 years old .............. 458 1.9 1.9 0.6 62 1.4 1.4 0.3 192 3.4 3.4 0.2 183 4 years old .............. 435 1.8 1.8 0.4 43 3.1 3.1 0.0 183 2.0 2.0 0.0 191 

Total, age-adjusted ....... 1,840 0.9 0.9 0.3 313 1.7 1.6 0.1 674 1.2 1.2 0.3 749 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Source: NHANES-III, 1988-94: Youth interview files. ’Total’ column includes children with missing WIC participation or income.
Table D-29—Types of dietary supplements taken by 1-4-year-old children using dietary supplements in past month1

Sample size

Single vitamin Multiple vitamin Single mineral Vitamin/mineral combo 

Percent Std Error Percent Std Error Percent Std Error Percent Std Error 

Total Children

Children

1 year old ................ 423 2.6 * 1.0 54.7 3.0 8.8 1.7 39.5 3.3 2 years old .............. 524 3.4 * 1.1 48.1 3.2 8.6 2.1 43.0 2.9 3 years old .............. 458 7.4 1.9 55.5 3.2 6.1 1.8 41.2 3.2 4 years old .............. 435 6.4 1.8 53.9 3.0 5.1 1.5 37.9 2.3 

Total, age-adjusted ....... 1,840 5.0 0.9 53.1 1.6 7.1 1.2 40.4 1.6 

Receiving WIC Benefits

Children

1 year old ................ 112 2.8 * 2.7 57.6 5.8 12.2 * 2.9 29.8 6.7 2 years old .............. 96 1.1 * 1.0 45.5 7.1 9.8 * 3.1 45.7 6.4 3 years old .............. 62 2.5 * 1.5 37.3 * 8.8 4.5 * 2.5 57.4 * 9.7 4 years old .............. 43 0.0 * 0.0 59.0 * 9.6 12.7 * 4.1 17.0 * 8.2 

Total, age-adjusted ....... 313 1.6 * 0.8 49.9 3.5 9.8 1.7 37.4 3.8 

Income-eligible Nonparticipants

Children

1 year old ................ 126 0.0 0.0 50.0 6.8 14.0 4.4 38.4 6.3 2 years old .............. 173 3.7 * 1.2 57.2 4.4 7.4 * 2.9 34.9 4.0 3 years old .............. 192 2.0 * 1.3 56.1 5.3 2.6 * 1.0 44.6 6.8 4 years old .............. 183 8.6 * 5.0 54.6 5.4 4.5 * 1.6 35.0 4.9 

Total, age-adjusted ....... 674 3.6 1.3 54.5 3.4 7.1 1.8 38.2 3.1 

Higher-income Nonparticipants

Children

1 year old ................ 159 3.0 * 1.4 56.1 4.9 › 4.1 * 1.6 42.2 5.0 

2 years old .............. 216 4.2 * 1.8 44.2 4.6 9.2 3.5 45.7 4.2 3 years old .............. 183 › 12.0 3.5 › 57.2 4.4 8.6 * 3.0 37.4 4.4 

4 years old .............. 191 ›››6.2 * 1.8 52.4 3.6 4.5 * 1.9 ›› 42.4 3.6 

Total, age-adjusted ....... 749 ›› 6.4 1.3 52.5 2.3 6.6 1.6 41.9 2.4 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Percents do not sum to 100 because some respondents took two or more supplements.

>0 Value to small to display.

Source: NHANES-III, 1988-94: Youth interview files.
Table D-30—Total Healthy Eating Index score: Children 2-4 years old

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard Error Sample size Mean Standard Error Sample size Mean Standard Error Sample si

Children

2 years old .............. 1,175 72.6 0.6 242 71.6 1.6 513 69.5 0.8 344 

3 years old .............. 999 71.9 0.6 181 71.8 2.3 475 70.9 0.9 272 4 years old .............. 1,000 66.8 0.8 130 65.9 1.6 494 65.4 1.0 314 

Total, age-adjusted ....... 3,174 70.4 0.5 553 69.7 1.3 1,482 68.6 0.7 930 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

HEI scores were not computed for children under 2 years old because dietary guidelines are not applicable to those ages.

Source: NHANES-III, 1988-94: Healthy Eating Index Data File. ’Total’ column includes children with missing WIC participation or income.
Table D-31—Percent of 2-4-year-old children by Healthy Eating Index ratings

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants Hig

Sample

size Poor

Needs

Improvement Good Sample size Poor Needs Improve- ment Good Sample size Poor Needs Improve- ment Good Sample size 

Percent distribution

Children

2 years old .............. 1,175 6.5 61.2 32.2 242 9.3 60.3 30.4 513 10.4 64.9 24.7 344 3 years old .............. 999 5.0 65.0 29.9 181 7.1 58.6 34.4 475 5.7 69.9 24.3 272 4 years old .............. 1,000 13.0 72.1 14.9 130 23.5 57.0 19.5 494 15.0 70.9 14.1 314 

Total, age-adjusted ....... 3,174 8.2 66.2 25.6 553 13.4 58.6 28.0 1,482 10.4 68.6 21.0 930 

Standard errors

Children

2 years old .............. 1,175 1.0 2.0 2.2 242 2.9 3.8 3.8 513 1.8 3.1 2.8 344 3 years old .............. 999 1.0 2.4 2.4 181 3.6 5.8 6.8 475 1.6 3.2 3.1 272 4 years old .............. 1,000 1.9 2.5 1.8 130 5.5 7.1 5.9 494 2.8 3.9 2.4 314 

Total, age-adjusted ....... 3,174 0.9 1.5 1.4 553 3.1 3.8 3.6 1,482 1.5 2.2 1.9 930 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

HEI scores were not computed for children under 2 years old because dietary guidelines are not applicable to those ages.

Source: NHANES-III, 1988-94: Healthy Eating Index Data File. ’Total’ column includes children with missing WIC participation or income.
Table D-32—Healthy Eating Index component scores and food pyramid servings for grains: Children 2-4 years old1

Mean HEI score Mean # food pyramid servings Percent meeting 

Total persons

Currently

Receiving

WIC

Income

eligible nonparticipant

Higher

income nonparticipant Total persons

Currently

Receiving

WIC

Income

eligible nonparticipant

Higher

income nonparticipant Total persons

Currently

Receivin

WIC

Children

2 years old .............. 8.2 7.9 7.9 › 8.6 6.3 6.2 6.1 6.7 46.9 47.6 

3 years old .............. 8.6 8.8 8.7 8.5 7.1 7.2 7.3 7.1 57.2 56.9 4 years old .............. 6.8 7.2 6.9 6.7 5.1 5.6 5.2 5.1 19.3 25.7 * 

Total, age-adjusted ....... 7.9 8.0 7.8 8.0 6.2 6.3 6.2 6.3 41.0 43.3 

Standard errors

Children

2 years old .............. 0.10 0.25 0.17 0.16 0.13 0.36 0.19 0.22 2.2 5.0 3 years old .............. 0.10 0.18 0.16 0.16 0.16 0.31 0.29 0.25 2.5 5.8 4 years old .............. 0.13 0.25 0.21 0.21 0.13 0.30 0.17 0.20 2.3 8.3 

Total, age-adjusted ....... 0.07 0.14 0.13 0.11 0.09 0.21 0.14 0.12 1.4 4.0 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 See Table D-30 for sample sizes.

HEI scores were not computed for children under 2 years old because dietary guidelines are not applicable to those ages.

Source: NHANES-III, 1988-94: Healthy Eating Index Data File. ’Total’ column includes children with missing WIC participation or income.
Table D-33—Healthy Eating Index component scores and food pyramid servings for vegetables: Children 2-4 years old1

Mean HEI score Mean # food pyramid servings Percent meeting 

Total persons

Currently

Receiving

WIC

Income

eligible nonparticipant

Higher

income nonparticipant Total persons

Currently

Receiving

WIC

Income

eligible nonparticipant

Higher

income nonparticipant Total persons

Currently

Receivin

WIC

Children

2 years old .............. 5.4 6.0 5.5 5.2 2.0 2.2 2.0 › 1.9 21.9 29.1 

3 years old .............. 5.4 5.8 5.8 5.0 2.1 2.2 2.3 1.8 23.7 21.8 4 years old .............. 4.2 3.7 4.5 4.1 1.6 1.4 1.7 1.5 10.7 6.0 * 

Total, age-adjusted ....... 5.0 5.1 5.3 4.8 1.9 1.9 2.0 1.7 18.7 18.9 

Standard errors

Children

2 years old .............. 0.15 0.38 0.25 0.25 0.07 0.15 0.11 0.11 1.9 4.3 3 years old .............. 0.22 0.50 0.30 0.34 0.10 0.22 0.14 0.16 2.4 4.8 4 years old .............. 0.20 0.52 0.33 0.23 0.09 0.17 0.14 0.11 1.3 1.3 

Total, age-adjusted ....... 0.12 0.27 0.22 0.15 0.06 0.11 0.10 0.07 1.2 2.4 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 See Table D-30 for sample sizes.

HEI scores were not computed for children under 2 years old because dietary guidelines are not applicable to those ages.

Source: NHANES-III, 1988-94: Healthy Eating Index Data File. ’Total’ column includes children with missing WIC participation or income.
Table D-34—Healthy Eating Index component scores and food pyramid servings for fruit: Children 2-4 years old1

Mean HEI score Mean # food pyramid servings Percent meeting 

Total persons

Currently

Receiving

WIC

Income

eligible nonparticipant

Higher

income nonparticipant Total persons

Currently

Receiving

WIC

Income

eligible nonparticipant

Higher

income nonparticipant Total persons

Currently

Receivin

WIC

Children

2 years old .............. 6.9 6.7 5.8 ›› 7.8 3.0 2.9 2.4 3.6 55.2 54.3 

3 years old .............. 6.5 7.1 ›› 5.6 7.2 2.7 3.2 › 2.1 3.2 49.0 57.8 

4 years old .............. 5.2 5.6 › 4.6 5.7 1.7 1.7 1.5 1.9 28.0 21.2 * 

Total, age-adjusted ....... 6.2 6.4 ›› 5.3 6.9 2.5 2.6 › 2.0 2.9 44.0 44.3 

Standard errors

Children

2 years old .............. 0.19 0.40 0.29 0.26 0.12 0.33 0.16 0.20 2.2 4.7 3 years old .............. 0.25 0.49 0.35 0.37 0.20 0.41 0.20 0.34 3.1 5.8 4 years old .............. 0.26 0.36 0.31 0.40 0.13 0.16 0.13 0.23 2.9 5.0 

Total, age-adjusted ....... 0.17 0.28 0.22 0.22 0.11 0.21 0.11 0.17 1.8 3.5 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 See Table D-30 for sample sizes.

HEI scores were not computed for children under 2 years old because dietary guidelines are not applicable to those ages.

Source: NHANES-III, 1988-94: Healthy Eating Index Data File. ’Total’ column includes children with missing WIC participation or income.
Table D-35—Healthy Eating Index component scores and food pyramid servings for dairy: Children 2-4 years old1

Mean HEI score Mean # food pyramid servings Percent meeting 

Total persons

Currently

Receiving

WIC

Income

eligible nonparticipant

Higher

income nonparticipant Total persons

Currently

Receiving

WIC

Income

eligible nonparticipant

Higher

income nonparticipant Total persons

Currently

Receivin

WIC

Children

2 years old .............. 7.8 7.7 7.7 8.0 2.3 2.4 2.1 2.4 51.8 55.2 3 years old .............. 7.9 7.6 7.6 › 8.3 2.4 2.3 2.3 2.5 50.3 46.8 

4 years old .............. 8.0 7.9 7.8 8.2 2.5 2.2 2.3 2.7 52.5 43.2 

Total, age-adjusted ....... 7.9 7.8 7.7 › 8.2 2.4 2.3 2.2 2.5 51.5 48.3 

Standard errors

Children

2 years old .............. 0.12 0.29 0.17 0.20 0.06 0.16 0.07 0.11 1.9 4.5 3 years old .............. 0.14 0.25 0.28 0.19 0.08 0.16 0.16 0.13 2.9 4.8 4 years old .............. 0.11 0.24 0.22 0.20 0.10 0.19 0.09 0.21 2.1 8.4 

Total, age-adjusted ....... 0.06 0.16 0.15 0.10 0.05 0.11 0.07 0.09 1.5 3.7 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 See Table D-30 for sample sizes.

HEI scores were not computed for children under 2 years old because dietary guidelines are not applicable to those ages.

Source: NHANES-III, 1988-94: Healthy Eating Index Data File. ’Total’ column includes children with missing WIC participation or income.
Table D-36—Healthy Eating Index component scores and food pyramid servings for meat: Children 2-4 years old1

Mean HEI score Mean # food pyramid servings Percent meeting 

Total persons

Currently

Receiving

WIC

Income

eligible nonparticipant

Higher

income nonparticipant Total persons

Currently

Receiving

WIC

Income

eligible nonparticipant

Higher

income nonparticipant Total persons

Currently

Receivin

WIC

Children

2 years old .............. 6.5 7.5 7.1 ›››5.8 1.5 1.8 1.7 ›››1.3 29.8 42.0 

3 years old .............. 7.0 7.7 7.3 ›› 6.5 1.7 2.0 1.8 1.6 35.4 39.3 

4 years old .............. 5.5 5.8 6.1 4.9 1.3 1.4 1.4 1.1 17.0 25.7 * 

Total, age-adjusted ....... 6.3 7.0 6.8 ›››5.7 1.5 1.7 1.6 ›› 1.3 27.4 35.6 

Standard errors

Children

2 years old .............. 0.13 0.28 0.24 0.17 0.05 0.12 0.08 0.05 1.6 4.7 3 years old .............. 0.16 0.33 0.20 0.29 0.07 0.20 0.08 0.11 2.5 5.9 4 years old .............. 0.16 0.70 0.19 0.21 0.05 0.21 0.06 0.07 1.8 7.8 

Total, age-adjusted ....... 0.09 0.32 0.16 0.09 0.03 0.12 0.05 0.04 1.3 4.4 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 See Table D-30 for sample sizes.

HEI scores were not computed for children under 2 years old because dietary guidelines are not applicable to those ages.

Source: NHANES-III, 1988-94: Healthy Eating Index Data File. ’Total’ column includes children with missing WIC participation or income.
Table D-37—Healthy Eating Index component scores for variety: Children 2-4 years old1

Mean HEI score Percent meeting HEI recomme

Total persons Currently Receiving WIC Income eligible non- participant Higher income non- participant Total persons Currently Receiving WIC Income el

partic

Children

2 years old .............. 7.5 7.3 7.1 7.9 49.8 50.2 403 years old .............. 7.4 7.6 7.3 7.4 46.6 43.9 454 years old .............. 7.8 7.8 7.6 8.1 53.8 55.0 50

Total, age-adjusted ....... 7.6 7.6 7.3 7.8 50.1 49.8 45

Standard errors

Children

2 years old .............. 0.12 0.33 0.17 0.22 1.8 4.4 23 years old .............. 0.18 0.36 0.24 0.33 2.5 5.6 34 years old .............. 0.18 0.30 0.33 0.24 2.8 5.0 4

Total, age-adjusted ....... 0.11 0.20 0.18 0.18 1.6 3.0 2

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 See Table D-30 for sample sizes.

HEI scores were not computed for children under 2 years old because dietary guidelines are not applicable to those ages.

Source: NHANES-III, 1988-94: Healthy Eating Index Data File. ’Total’ column includes children with missing WIC participation or income.
Table D-38—Healthy Eating Index component scores for total fat: Children 2-4 years old1

Mean HEI score Percent meeting HEI recomme

Total persons Currently Receiving WIC Income eligible non- participant Higher income non- participant Total persons Currently Receiving WIC Income el

partic

Children

2 years old .............. 7.0 6.5 6.4 ›› 7.7 35.8 26.7 28

3 years old .............. 6.8 6.4 6.7 7.0 31.4 35.3 284 years old .............. 7.2 7.1 6.8 7.6 36.8 39.7 27

Total, age-adjusted ....... 7.0 6.6 6.6 › 7.4 34.7 33.9 28

Standard errors

Children

2 years old .............. 0.14 0.39 0.21 0.20 2.1 5.2 23 years old .............. 0.16 0.49 0.27 0.23 2.0 6.3 24 years old .............. 0.20 0.38 0.25 0.29 3.4 6.3 4

Total, age-adjusted ....... 0.11 0.31 0.17 0.14 1.5 3.7 2

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 See Table D-30 for sample sizes.

HEI scores were not computed for children under 2 years old because dietary guidelines are not applicable to those ages.

Source: NHANES-III, 1988-94: Healthy Eating Index Data File. ’Total’ column includes children with missing WIC participation or income.
Table D-39—Healthy Eating Index component scores for saturated fat: Children 2-4 years old1

Mean HEI score Percent meeting HEI recomme

Total persons Currently Receiving WIC Income eligible non- participant Higher income non- participant Total persons Currently Receiving WIC Income el

partic

Children

2 years old .............. 5.2 4.9 4.6 5.7 26.5 27.0 193 years old .............. 5.0 4.7 5.1 5.0 24.5 27.0 214 years old .............. 5.4 4.9 5.0 5.7 28.5 26.6 22

Total, age-adjusted ....... 5.2 4.8 4.9 5.5 26.5 26.8 21

Standard errors

Children

2 years old .............. 0.20 0.43 0.26 0.37 2.0 4.9 23 years old .............. 0.20 0.56 0.30 0.33 1.6 6.0 34 years old .............. 0.25 0.56 0.28 0.46 2.6 6.4 3

Total, age-adjusted ....... 0.13 0.36 0.17 0.21 1.3 4.3 1

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 See Table D-30 for sample sizes.

HEI scores were not computed for children under 2 years old because dietary guidelines are not applicable to those ages.

Source: NHANES-III, 1988-94: Healthy Eating Index Data File. ’Total’ column includes children with missing WIC participation or income.
Table D-40—Healthy Eating Index component scores for cholesterol: Children 2-4 years old1

Mean HEI score Percent meeting HEI recomme

Total persons Currently Receiving WIC Income eligible non- participant Higher income non- participant Total persons Currently Receiving WIC Income el

partic

Children

2 years old .............. 9.1 8.5 8.8 ›››9.6 85.2 77.2 81

3 years old .............. 8.8 8.1 8.5 ›› 9.2 80.9 76.7 75

4 years old .............. 8.7 7.8 8.5 9.0 82.6 71.3 80

Total, age-adjusted ....... 8.9 8.1 8.6 ›››9.3 82.9 75.0 79

Standard errors

Children

2 years old .............. 0.09 0.23 0.16 0.10 1.4 2.7 23 years old .............. 0.14 0.34 0.30 0.18 1.9 3.5 34 years old .............. 0.17 0.70 0.19 0.24 2.0 7.7 2

Total, age-adjusted ....... 0.09 0.32 0.14 0.12 1.2 3.3 1

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 See Table D-30 for sample sizes.

HEI scores were not computed for children under 2 years old because dietary guidelines are not applicable to those ages.

Source: NHANES-III, 1988-94: Healthy Eating Index Data File. ’Total’ column includes children with missing WIC participation or income.
Table D-41—Healthy Eating Index component scores for sodium: Children 2-4 years old1

Mean HEI score Percent meeting HEI recomme

Total persons Currently Receiving WIC Income eligible non- participant Higher income non- participant Total persons Currently Receiving WIC Income el

partic

Children

2 years old .............. 9.0 8.6 8.7 › 9.2 69.8 65.2 62

3 years old .............. 8.4 8.0 8.2 8.6 60.1 51.5 55

4 years old .............. 8.1 8.1 7.7 8.2 54.0 55.1 48

Total, age-adjusted ....... 8.5 8.2 8.2 8.7 61.2 57.2 55

Standard errors

Children

2 years old .............. 0.09 0.27 0.15 0.13 1.4 4.5 33 years old .............. 0.16 0.27 0.29 0.24 2.6 5.7 34 years old .............. 0.18 0.59 0.26 0.20 2.8 9.5 4

Total, age-adjusted ....... 0.09 0.22 0.15 0.10 1.4 4.5 2

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 See Table D-30 for sample sizes.

HEI scores were not computed for children under 2 years old because dietary guidelines are not applicable to those ages.

Source: NHANES-III, 1988-94: Healthy Eating Index Data File. ’Total’ column includes children with missing WIC participation or income.
Table D-42—Mean percent of usual energy intake from total fat: Children 2-4 years old

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard error Sample size Mean Standard error Sample size Mean Standard error Sample si

Children

2 years old ................ 1,175 32.8 0.24 242 33.7 0.56 513 34.0 0.41 344 

3 years old ................ 999 33.1 0.23 181 34.3 0.80 475 33.8 0.31 272 

4 years old ................ 1,000 32.5 0.28 130 33.2 0.54 494 33.6 0.41 314 

Total, age-adjusted ... 3,174 32.8 0.17 553 33.6 0.41 1,482 33.8 0.28 930 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.

Table D-43—Percent of 2-4-year-old children meeting Dietary Guidelines recommendation for usual intake of total fat1

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard error Sample size Percent Standard error Sample size Percent Standard error Sample si

Children

2 years old ................ 1,175 26.0 1.88 242 19.8 3.87 513 17.2 2.59 344 

3 years old ................ 999 21.8 1.69 181 17.5 4.32 475 13.7 1.90 272 4 years old ................ 1,000 23.8 2.71 130 14.3 4.16 494 15.0 2.97 314 Total, age-adjusted ... 3,174 23.9 1.24 553 17.2 2.38 1,482 15.3 1.46 930 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Recommended intake of total fat is less than or equal to 30 percent of total calories.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-44—Distribution of usual intake of total fat as a percent of usual energy intake: Children 2-4 years old

Percentiles Standard errors of percent

5th 10th 15th 25th 50th 75th 85th 90th 95th 5th 10th 15th 25th 50th 75t

Total Children

2 years old ................ 25.6 27.2 28.3 29.9 32.8 35.7 37.2 38.2 39.8 0.32 0.29 0.27 0.26 0.24 0.23 years old ................ 26.2 27.8 28.9 30.4 33.2 35.9 37.3 38.2 39.6 0.29 0.26 0.25 0.24 0.23 0.24 years old ................ 26.7 28.0 28.9 30.1 32.5 34.9 36.2 37.0 38.3 0.30 0.30 0.31 0.30 0.29 0.2Total, age-adjusted ... 26.2 27.7 28.7 30.1 32.8 35.5 36.9 37.8 39.2 0.20 0.18 0.18 0.17 0.17 0.1

Receiving WIC Benefits

2 years old ................ 26.1 27.9 29.1 30.8 33.9 36.8 38.3 39.2 40.6 0.74 0.71 0.69 0.65 0.57 0.53 years old ................ 27.0 28.5 29.5 31.2 34.4 37.5 38.9 39.9 41.3 0.83 0.79 0.79 0.80 0.83 0.94 years old ................ 28.5 29.4 30.1 31.1 33.1 35.2 36.4 37.2 38.4 0.49 0.51 0.52 0.53 0.56 0.5Total, age-adjusted ... 27.0 28.4 29.4 30.8 33.6 36.4 37.9 38.8 40.2 0.43 0.44 0.44 0.45 0.44 0.4

Income-eligibleNonparticipant

2 years old ................ 26.7 28.5 29.6 31.2 34.1 37.0 38.5 39.5 41.0 0.59 0.52 0.48 0.43 0.38 0.33 years old ................ 28.0 29.3 30.2 31.5 33.8 36.2 37.4 38.3 39.5 0.35 0.32 0.31 0.30 0.31 0.34 years old ................ 27.7 29.1 30.0 31.3 33.7 36.0 37.2 38.0 39.2 0.51 0.49 0.47 0.45 0.42 0.3Total, age-adjusted ... 27.5 29.0 30.0 31.4 33.9 36.4 37.7 38.6 39.9 0.36 0.33 0.32 0.30 0.28 0.2

Higher-incomeNonparticipant

2 years old ................ 24.8 26.2 27.2 › 28.6 ›››31.3 ›››34.0 ›››35.5 ›››36.5 ›››38.0 0.41 0.36 0.35 0.33 0.33 0.3

3 years old ................ 25.1 26.9 28.0 29.7 32.6 35.4 36.8 37.7 39.1 0.48 0.46 0.45 0.43 0.39 0.34 years old ................ ›››25.8 ›› 27.0 ›› 27.8 › 29.0 31.3 33.6 34.9 35.8 37.1 0.39 0.38 0.38 0.38 0.39 0.4

Total, age-adjusted ... ›› 25.2 ›› 26.6 ›› 27.6 ›› 29.1 ›› 31.7 ›››34.4 ›››35.8 ›››36.7 ›››38.1 0.21 0.20 0.20 0.20 0.21 0.2

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

The Bonferroni adjustment was used to adjust levels of significant and control for multiplicity in the number of tests.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-45—Mean percent of usual energy intake from saturated fat: Children 2-4 years old

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard error Sample size Mean Standard error Sample size Mean Standard error Sample si

Children

2 years old ................ 1,175 12.6 0.13 242 12.9 0.30 513 13.1 0.18 344 

3 years old ................ 999 12.5 0.12 181 12.9 0.38 475 12.5 0.15 272 4 years old ................ 1,000 12.3 0.14 130 12.9 0.31 494 12.7 0.16 314 

Total, age-adjusted ... 3,174 12.5 0.08 553 12.9 0.21 1,482 12.8 0.11 930 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.

Table D-46—Percent of 2-4-year-old children meeting Dietary Guidelines recommendation for usual intake of saturated fat1

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard error Sample size Percent Standard error Sample size Percent Standard error Sample si

Children

2 years old ................ 1,175 13.6 1.21 242 8.5 2.24 513 8.7 1.55 344 

3 years old ................ 999 11.4 1.13 181 8.2 2.71 475 7.9 1.16 272 

4 years old ................ 1,000 9.1 1.48 130 2.4 1.31 494 4.2 0.96 314 Total, age-adjusted ... 3,174 11.3 0.74 553 6.4 1.25 1,482 6.9 0.72 930 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Recommended intake of saturated fat is less than 10 percent of total calories.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-47—Distribution of usual intake of saturated fat as a percent of usual energy intake: Children 2-4 years old

Percentiles Standard errors of percent

5th 10th 15th 25th 50th 75th 85th 90th 95th 5th 10th 15th 25th 50th 75t

Total Children

2 years old ................ 8.8 9.6 10.1 10.9 12.5 14.1 15.0 15.6 16.5 0.13 0.13 0.12 0.12 0.13 0.13 years old ................ 9.1 9.8 10.4 11.1 12.5 13.9 14.7 15.2 15.9 0.13 0.12 0.12 0.12 0.12 0.14 years old ................ 9.5 10.1 10.5 11.1 12.2 13.4 14.1 14.5 15.2 0.14 0.14 0.14 0.14 0.14 0.1Total, age-adjusted ... 9.2 9.9 10.4 11.1 12.4 13.8 14.6 15.1 15.9 0.08 0.08 0.08 0.07 0.07 0.0

Receiving WIC Benefits

2 years old ................ 9.5 10.2 10.7 11.4 12.8 14.3 15.1 15.6 16.5 0.26 0.27 0.28 0.29 0.31 0.33 years old ................ 9.5 10.2 10.7 11.4 12.8 14.3 15.1 15.6 16.4 0.38 0.36 0.36 0.35 0.37 0.44 years old ................ 10.4 10.9 11.3 11.8 12.8 13.9 14.4 14.8 15.4 0.30 0.32 0.33 0.34 0.33 0.3Total, age-adjusted ... 9.8 10.5 10.9 11.6 12.9 14.2 14.9 15.4 16.1 0.21 0.22 0.22 0.22 0.22 0.2

Income-eligibleNonparticipant

2 years old ................ 9.4 10.2 10.7 11.5 13.1 14.7 15.5 16.1 17.0 0.24 0.21 0.20 0.18 0.17 0.13 years old ................ 9.6 10.2 10.7 11.3 12.5 13.7 14.4 14.9 15.6 0.15 0.14 0.14 0.14 0.15 0.14 years old ................ 10.1 10.7 11.0 11.6 12.6 13.7 14.3 14.7 15.3 0.15 0.15 0.15 0.15 0.17 0.1Total, age-adjusted ... 9.7 10.4 10.8 11.5 12.7 14.0 14.7 15.2 16.0 0.13 0.12 0.11 0.11 0.10 0.1

Higher-incomeNonparticipant

2 years old ................ ›››8.2 ›› 9.0 ›› 9.5 › 10.3 11.9 13.6 14.5 15.2 16.2 0.20 0.19 0.19 0.19 0.21 0.2

3 years old ................ 8.6 9.4 10.0 10.9 12.4 13.9 14.7 15.2 16.0 0.22 0.20 0.20 0.19 0.19 0.14 years old ................ ›››9.0 ›› 9.6 ›› 10.0 › 10.6 11.8 13.0 13.7 14.1 14.8 0.21 0.22 0.22 0.23 0.25 0.2

Total, age-adjusted ... ›››8.6 ›››9.3 ›››9.9 ›››10.6 ›› 12.0 › 13.5 14.3 14.8 15.6 0.12 0.11 0.11 0.11 0.11 0.1

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

The Bonferroni adjustment was used to adjust levels of significant and control for multiplicity in the number of tests.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-48—Mean usual intake of cholesterol in milligrams: Children 2-4 years old

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard error Sample size Mean Standard error Sample size Mean Standard error Sample si

Children

2 years old ................ 1,175 176 3.7 242 221 7.0 513 ›› 195 5.9 344 

3 years old ................ 999 196 4.2 181 228 11.7 475 216 5.5 272 4 years old ................ 1,000 202 5.4 130 240 17.3 494 214 7.6 314 

Total, age-adjusted ... 3,174 191 2.9 553 231 8.1 1,482 › 208 4.6 930 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.

Table D-49—Percent of 2-4-year-old children meeting Dietary Guidelines recommendation for usual intake of cholesterol1

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard error Sample size Percent Standard error Sample size Percent Standard error Sample si

Children

2 years old ................ 1,175 95.1 0.7 242 85.4 2.3 513 ›› 92.8 1.5 344 

3 years old ................ 999 90.3 1.1 181 82.4 4.0 475 83.9 1.9 272 4 years old ................ 1,000 89.0 1.5 130 79.6 7.2 494 87.4 2.3 314 Total, age-adjusted ... 3,174 91.4 0.6 553 82.4 2.9 1,482 88.0 1.1 930 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 National Research Council’s Diet and Health recommendation for intake of cholesterol is less than or equal to 300 milligrams.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-50—Distribution of usual intake of cholesterol in milligrams: Children 2-4 years old

Percentiles Standard errors of percent

5th 10th 15th 25th 50th 75th 85th 90th 95th 5th 10th 15th 25th 50th 75t

Total Children

2 years old ................ 87 101 111 128 165 212 242 264 299 2.09 2.21 2.35 2.67 3.72 4.63 years old ................ 95 110 121 140 184 239 274 298 337 2.60 2.80 2.98 3.35 4.30 5.34 years old ................ 98 114 126 145 189 244 279 306 350 3.02 3.27 3.48 3.85 4.92 6.9Total, age-adjusted ... 93 108 120 138 179 231 265 290 330 1.48 1.61 1.74 2.02 2.77 3.7

Receiving WIC Benefits

2 years old ................ 117 133 145 166 211 265 299 322 360 4.58 4.99 5.31 5.78 6.76 8.43 years old ................ 118 135 148 169 216 275 311 338 380 7.01 7.95 8.54 9.45 11.50 14.34 years old ................ 134 151 164 185 230 286 320 345 382 8.58 9.77 10.80 12.70 17.30 22.5Total, age-adjusted ... 121 139 152 173 220 278 313 338 378 4.08 4.74 5.22 6.02 7.91 10.3

Income-eligibleNonparticipant

2 years old ................ 103 118 129 146 › 185 › 233 › 262 283 318 3.56 3.87 4.11 4.55 5.59 7.2

3 years old ................ 100 117 131 153 205 268 305 330 370 2.83 3.18 3.53 4.21 5.89 7.34 years old ................ 110 127 140 160 204 257 290 314 353 4.87 5.35 5.69 6.11 7.09 8.8Total, age-adjusted ... ›› 103 ›› 120 ›› 132 › 152 197 252 286 311 351 2.54 2.85 3.12 3.61 4.68 5.6

Higher-incomeNonparticipant

2 years old ................ ›››75 ›››86 ›››95 ›››108 ›››138 ›››174 ›››196 ›››212 ›››238 2.99 3.07 3.13 3.27 3.92 5.2

3 years old ................ ›› 91 ›› 104 ›› 113 ›› 129 ›››163 ›››204 ›››230 ›››249 ›››279 3.98 4.22 4.43 4.87 6.16 7.7

4 years old ................ ›››88 ›››102 ›››113 ›››130 ›› 168 220 254 282 329 3.84 4.12 4.46 5.22 7.37 10.6

Total, age-adjusted ... ›››84 ›››97 ›››107 ›››122 ›››156 ›››200 ›››228 ›››249 ›››283 1.73 1.89 2.04 2.39 3.52 5.3

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

The Bonferroni adjustment was used to adjust levels of significant and control for multiplicity in the number of tests.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-51—Mean usual intake of sodium in milligrams: Children 2-4 years old

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard error Sample size Mean Standard error Sample size Mean Standard error Sample si

Children

2 years old ................ 1,175 2,147 21.8 242 2,334 79.2 513 2,197 43.7 344 

3 years old ................ 999 2,373 37.0 181 2,644 65.8 475 › 2,453 53.9 272 4 years old ................ 1,000 2,567 45.3 130 2,596 121.3 494 2,720 69.1 314 Total, age-adjusted ... 3,174 2,362 20.7 553 2,513 56.4 1,482 2,460 37.3 930 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.

Table D-52—Percent of 2-4-year-old children meeting Dietary Guidelines recommendation for usual intake of sodium1

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard error Sample size Percent Standard error Sample size Percent Standard error Sample si

Children

2 years old ................ 1,175 70.2 1.4 242 59.7 5.0 513 64.5 2.6 344 

3 years old ................ 999 55.8 2.4 181 42.3 3.4 475 50.1 3.4 272 4 years old ................ 1,000 43.9 2.8 130 40.8 8.6 494 35.0 3.9 314 Total, age-adjusted ... 3,174 56.6 1.3 553 47.5 3.5 1,482 49.8 1.9 930 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 National Research Council’s Diet and Health recommendation for intake of sodium is less than or equal to 2400 milligrams.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-53—Distribution of usual sodium intake in milligrams: Children 2-4 years old

Percentiles Standard errors of percent

5th 10th 15th 25th 50th 75th 85th 90th 95th 5th 10th 15th 25th 50th 75t

Total Children

2 years old ................ 1,299 1,450 1,559 1,733 2,089 2,491 2,732 2,910 3,199 17.00 16.40 16.50 17.30 20.40 27.03 years old ................ 1,472 1,637 1,754 1,936 2,311 2,745 3,006 3,194 3,488 27.90 28.00 28.60 30.40 35.70 42.84 years old ................ 1,640 1,808 1,926 2,110 2,493 2,945 3,222 3,425 3,749 32.60 33.60 34.60 37.10 45.30 54.4Total, age-adjusted ... 1,444 1,611 1,728 1,911 2,289 2,733 3,005 3,206 3,529 15.30 15.40 15.70 16.50 19.40 24.7

Receiving WIC Benefits

2 years old ................ 1,453 1,606 1,715 1,888 2,251 2,687 2,961 3,164 3,497 52.50 54.10 55.00 58.20 73.50 98.43 years old ................ 1,687 1,841 1,951 2,127 2,525 3,032 3,355 3,598 4,001 44.60 43.50 43.50 46.00 58.30 79.44 years old ................ 1,874 1,989 2,073 2,209 2,515 2,902 3,144 3,319 3,594 54.10 64.80 73.20 87.30 118.00 154.0Total, age-adjusted ... 1,614 1,766 1,874 2,044 2,412 2,874 3,171 3,393 3,755 26.50 28.70 31.50 37.60 53.00 71.5

Income-eligibleNonparticipant

2 years old ................ ›››1,183 ›› 1,370 › 1,505 1,715 2,144 2,621 2,896 3,091 3,391 37.50 37.00 37.50 39.30 44.50 52.4

3 years old ................ 1,520 1,694 1,817 2,007 2,398 2,844 3,105 3,290 3,573 45.90 44.30 44.30 45.50 51.60 65.64 years old ................ 1,701 1,888 2,020 2,226 2,647 3,132 3,426 3,642 3,988 64.60 63.70 63.70 64.70 68.70 77.0Total, age-adjusted ... ›› 1,453 › 1,638 1,769 1,972 2,390 2,873 3,164 3,374 3,708 33.40 33.00 32.90 33.30 36.50 43.2

Higher-incomeNonparticipant

2 years old ................ 1,334 1,464 1,557 › 1,704 › 2,011 › 2,366 › 2,583 › 2,742 2,998 25.90 26.20 27.10 29.90 38.70 46.6

3 years old ................ ›››1,425 ›››1,584 ›››1,695 ›››1,867 ›››2,214 ›››2,607 ›››2,842 ›› 3,011 ›› 3,280 39.40 39.90 40.70 42.70 50.40 64.2

4 years old ................ ›› 1,605 1,772 1,889 2,070 2,437 2,861 3,119 3,310 3,617 44.40 44.30 45.40 47.90 55.00 66.2

Total, age-adjusted ... ›››1,427 ›››1,582 ›››1,691 ›››1,861 ›› 2,211 ›› 2,621 › 2,871 › 3,056 › 3,352 17.60 17.90 18.60 20.00 23.80 29.6

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

The Bonferroni adjustment was used to adjust levels of significant and control for multiplicity in the number of tests.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-54—Percent of 2-4-year-old children using table salt

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample

size Percent Ordinary salt Sample size Percent Ordinary salt Sample size Percent Ordinary salt Sample size 

Children

2 years old .............. 1,159 23.9 2.2 238 37.1 5.0 503 › 25.9 3.1 342 

3 years old .............. 989 28.8 2.7 180 27.2 5.6 469 31.5 3.6 269 4 years old .............. 988 29.5 2.7 128 26.0 5.8 486 29.1 3.9 313 

Total, age-adjusted ....... 3,136 27.4 1.6 546 30.1 3.6 1,458 28.8 2.4 924 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Exam file, 24-hour dietary recall. ’Total’ column includes children with missing WIC participation or income.
Table D-55—Mean usual intake of dietary fiber in grams: Children 2-4 years old

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard error Sample size Mean Standard error Sample size Mean Standard error Sample si

Children

2 years old ................ 1,175 10.0 0.14 242 10.5 0.40 513 › 9.6 0.18 344 

3 years old ................ 999 10.2 0.20 181 10.9 0.61 475 10.2 0.35 272 4 years old ................ 1,000 11.2 0.23 130 10.3 0.45 494 ›› 12.0 0.31 314 

Total, age-adjusted ... 3,174 10.5 0.11 553 10.6 0.32 1,482 10.6 0.19 930 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.

Table D-56—Percent of 2-4-year-old children with usual intake of dietary fiber at or above reference standard1

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard error Sample size Percent Standard error Sample size Percent Standard error Sample si

Children

2 years old ................ 1,175 81.1 1.12 242 83.6 2.82 513 › 76.0 1.56 344 

3 years old ................ 999 76.2 1.83 181 79.4 3.77 475 78.9 3.39 272 4 years old ................ 1,000 72.9 2.26 130 65.2 6.79 494 › 80.1 2.67 314 

Total, age-adjusted ... 3,174 76.7 1.04 553 76.0 2.77 1,482 78.4 1.53 930 

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Recommended fiber intake (in gm) is equivalent to age in years plus five

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-57—Distribution of usual dietary fiber intake in grams: Children 2-4 years old

Std1

(g/dy)

Percentiles Standard errors 

5th 10th 15th 25th 50th 75th 85th 90th 95th 5th 10th 15th 25th 50

Total Children

1 year old .................. 6.0 – – – – – – – – – – – – – – 2 years old ................ 7.0 5.2 6.0 6.6 7.6 9.6 12.0 13.5 14.6 16.4 0.09 0.10 0.11 0.12 0.3 years old ................ 8.0 6.0 6.7 7.3 8.1 9.9 11.9 13.1 13.9 15.3 0.14 0.13 0.13 0.14 0.4 years old ................ 9.0 6.2 7.1 7.8 8.8 10.9 13.2 14.5 15.6 17.1 0.17 0.18 0.19 0.20 0.2Total, age-adjusted ... na – – – – – – – – – – – – – – 

Receiving WIC Benefits

1 year old .................. 6.0 – – – – – – – – – – – – – – 2 years old ................ 7.0 5.3 6.2 6.8 7.9 10.1 12.8 14.4 15.5 17.2 0.29 0.30 0.31 0.33 0.43 years old ................ 8.0 6.1 6.9 7.5 8.4 10.4 12.9 14.4 15.5 17.4 0.29 0.30 0.32 0.36 0.54 years old ................ 9.0 6.2 6.9 7.5 8.3 10.0 12.0 13.2 14.1 15.5 0.42 0.44 0.45 0.46 0.4Total, age-adjusted ... na 5.7 6.6 7.2 8.1 10.2 12.5 14.0 15.1 16.8 0.20 0.22 0.22 0.24 0.3

Income-eligibleNonparticipant

1 year old .................. 6.0 – – – – – – – – – – – – – – 2 years old ................ 7.0 4.8 5.6 6.2 7.1 9.1 11.5 13.1 14.2 16.1 0.14 0.14 0.14 0.14 0.3 years old ................ 8.0 6.2 7.0 7.5 8.3 10.0 11.8 12.9 13.6 14.8 0.22 0.22 0.23 0.26 0.34 years old ................ 9.0 6.9 7.8 8.5 9.5 › 11.7 ›› 14.2 ›› 15.6 ›› 16.7 ›› 18.3 0.28 0.28 0.28 0.29 0.3

Total, age-adjusted ... na 5.9 6.7 7.3 8.3 10.3 12.6 14.0 15.0 16.6 0.15 0.14 0.15 0.15 0.

Higher-incomeNonparticipant

1 year old .................. 6.0 – – – – – – – – – – – – – – 2 years old ................ 7.0 5.8 6.6 7.2 8.1 10.1 12.4 13.8 14.8 16.4 0.18 0.18 0.19 0.20 0.23 years old ................ 8.0 6.0 6.8 7.3 8.1 9.7 11.5 12.6 13.4 14.6 0.21 0.20 0.19 0.19 0.24 years old ................ 9.0 6.1 7.0 7.6 8.6 10.6 12.9 14.1 15.0 16.4 0.24 0.26 0.27 0.29 0.3Total, age-adjusted ... na 5.9 6.7 7.3 8.2 10.2 12.3 13.6 14.5 16.0 0.12 0.13 0.14 0.15 0.

Notes: Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

The Bonferroni adjustment was used to adjust levels of significant and control for multiplicity in the number of tests. 1 Recommended fiber intake (in gm) is equivalent to age in years plus five

– Estimate of usual intake could not be obtained for the age group cell. The cell was pooled with a neighboring age group to determine its contribution to the ’Total, age

na Fiber standard is specific to year of age and is not shown for the pooled age group.

Source: NHANES-III, 1988-94 Exam file, 24-hour dietary recall. Data reflect nutrient intake from foods. Does not include the contribution of vitamin and mineral supplements. 

using C-SIDE: Software for Intake Distribution Estimation, accounting for within-person variance as estimated from the Continuing Survey of Food Intakes by Individu

’Total’ column includes children with missing WIC participation or income.
Table D-58—Percent of infants and children ever breastfed

Total Infants and Children Receiving WIC Benefits Income-eligible Nonparticipants High

Number Percent Standard Error Number Percent Standard Error Number Percent Standard Error Number 

Infants ........................... 1,961 55.4 2.3 787 38.8 2.8 348 ›››51.4 2.5 731 

Children

1 year old ................ 1,256 54.3 2.4 419 37.4 3.7 391 › 47.5 3.4 355 

2 years old .............. 1,268 53.3 1.8 253 41.4 4.8 545 44.2 2.6 386 3 years old .............. 1,114 54.2 2.8 200 40.4 5.7 509 44.2 4.2 325 4 years old .............. 1,096 53.6 1.9 136 45.2 8.8 546 41.8 3.9 342 

All children .............. 4,734 53.9 1.4 1,008 41.1 3.3 1,991 44.4 2.2 1,408 

Total, age-adjusted ....... 6,695 54.2 1.5 1,795 40.6 2.9 2,339 45.8 2.0 2,139 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.

Table D-59—Percent of infants and children breastfed for at least 6 months, among those ever breastfed: Ages 7 months and o

Total Infants and Children Receiving WIC Benefits Income-eligible Nonparticipants High

Number Percent Standard Error Number Percent Standard Error Number Percent Standard Error Number 

Infants ........................... 512 38.5 3.2 141 31.3 5.6 97 38.7 5.0 246 

Children

1 year old ................ 578 41.3 3.2 152 31.4 6.1 157 34.4 6.3 224 

2 years old .............. 594 39.6 2.5 95 39.1 6.8 214 31.8 4.4 239 3 years old .............. 494 46.0 3.0 69 57.9 8.7 192 48.5 5.8 201 4 years old .............. 492 41.4 3.8 48 30.1 * 7.4 212 41.6 5.6 200 All children .............. 2,158 42.1 1.9 364 39.6 4.1 775 39.1 3.0 864 

Total, age-adjusted ....... 2,670 41.4 1.8 505 37.9 3.6 872 39.0 2.6 1,110 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-60—Percent of children breastfed for at least one year, among those ever breastfed

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Number Percent Standard Error Number Percent Standard Error Number Percent Standard Error Number 

Children

1 year old ................ 578 13.7 2.2 152 14.0 4.6 157 7.9 * 3.2 224 2 years old .............. 594 17.5 1.9 95 21.2 5.0 214 14.2 3.2 239 3 years old .............. 494 16.5 3.0 69 26.8 * 9.9 192 16.5 3.9 201 4 years old .............. 492 16.2 2.1 48 2.6 * 1.9 212 ›››17.6 4.0 200 

Total, age-adjusted ....... 2,158 16.0 1.4 364 16.1 3.0 775 14.0 1.8 864 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.

Table D-61—Mean duration of breastfeeding among children ever breastfed1

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Number

Breastfed

Mean

Duration

(weeks)

Standard

Error

Number

Breastfed

Mean

Duration

(weeks)

Standard

Error

Number

Breastfed

Mean

Duration

(weeks)

Standard

Error

Number

Breastfe

Children

1 year old ................ 578 22.9 1.4 152 20.9 2.4 157 18.3 2.1 224 2 years old .............. 592 25.7 1.3 94 25.6 3.4 213 21.7 2.2 239 3 years old .............. 489 29.1 2.1 68 33.3 * 6.1 190 28.8 3.6 199 4 years old .............. 487 25.8 1.9 47 17.3 * 2.9 209 25.2 2.5 199 

Total, age-adjusted ....... 2,146 25.9 1.0 361 24.2 2.3 769 23.5 1.3 861 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Mean duration of breastfeeding is not shown for infants under 1 year old because estimates are biased by the large percent still breastfeeding.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-62—Percent of breastfed infants and children who were never fed formula 

Total Infants and Children Receiving WIC Benefits Income-eligible Nonparticipants High

Number

Breastfed Percent Standard Error Number Breastfed Percent Standard Error Number Breastfed Percent Standard Error Number Breastfe

Infants ........................... 1,015 18.6 1.7 294 9.3 1.9 174 ›› 19.0 2.8 491 

Children

1 year old ................ 575 14.4 1.9 151 9.7 * 3.5 157 10.0 * 3.4 222 2 years old .............. 591 16.3 2.0 93 13.3 * 3.6 213 14.4 2.9 239 3 years old .............. 490 20.7 3.0 69 29.6 * 9.6 189 21.1 6.0 200 4 years old .............. 483 15.0 2.2 47 2.1 * 1.8 209 › 16.4 4.6 197 

All children .............. 2,139 16.6 1.2 360 13.6 2.6 768 15.5 1.8 858 

Total, age-adjusted ....... 3,154 17.0 1.0 654 12.8 2.3 942 16.2 1.6 1,349 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.

Table D-63—Mean age when first fed formula on a daily basis, among breastfed infants and children 

Total Infants and Children Receiving WIC Benefits Income-eligible Nonparticipants High

Number Fed

Formula

Mean Age

(weeks)

Standard

Error

Number Fed

Formula

Mean Age

(weeks)

Standard

Error

Number Fed

Formula

Mean Age

(weeks)

Standard

Error

Number F

Formula

Infants ........................... 844 7.9 0.4 264 6.6 0.7 143 6.5 0.8 394 

Children

1 year old ................ 502 12.3 0.8 134 10.8 1.7 139 11.8 1.4 189 2 years old .............. 498 13.2 0.9 81 12.7 2.3 179 9.4 1.0 200 3 years old .............. 402 13.3 0.9 55 12.1 1.9 156 12.6 1.3 166 4 years old .............. 409 12.5 1.2 45 11.3 * 1.8 177 13.0 2.7 163 All children .............. 1,811 12.8 0.5 315 11.7 0.9 651 11.7 0.8 718 

Total, age-adjusted ....... 2,655 11.8 0.4 579 10.7 0.8 794 10.7 0.7 1,112 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-64—Percent of infants and children fed cow’s milk on a daily basis before 12 months of age

Total Infants and Children Receiving WIC Benefits Income-eligible Nonparticipants High

Number Percent Standard Error Number Percent Standard Error Number Percent Standard Error Number 

Infants ........................... 1,961 17.1 0.9 787 11.4 1.2 348 ›››26.8 2.8 731 

Children

1 year old ................ 1,258 45.9 2.2 419 32.4 3.1 391 ›››54.1 3.4 357 

2 years old .............. 1,269 38.6 2.0 253 31.4 4.1 545 › 43.7 2.7 387 

3 years old .............. 1,119 40.1 2.6 201 26.5 6.2 513 ›› 42.6 4.8 325 

4 years old .............. 1,098 38.8 3.1 137 33.6 9.0 547 43.3 3.5 342 All children .............. 4,744 40.9 1.4 1,010 31.0 2.6 1,996 ›››45.9 2.1 1,411 

Total, age-adjusted ....... 6,705 36.1 1.2 1,797 27.0 2.1 2,344 ›››42.1 1.8 2,142 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.

Table D-65—Mean age when first fed cow’s milk on a daily basis: Ages 7 months and older1,2

Total Infants and Children Receiving WIC Benefits Income-eligible Nonparticipants High

Number

Drinking Milk

Mean Age

(weeks)

Standard

Error

Number

Drinking Milk

Mean Age

(weeks)

Standard

Error

Number

Drinking Milk

Mean Age

(weeks)

Standard

Error

Number

Drinking M

Infants ........................... 353 32.1 0.6 95 32.5 1.4 100 30.2 1.1 134 Children

1 year old ................ 1,188 46.0 0.4 392 47.8 0.6 370 ›››44.2 0.8 335 

2 years old .............. 1,225 48.2 0.6 246 49.5 1.5 532 46.2 0.9 368 3 years old .............. 1,089 48.2 0.9 194 48.9 1.4 502 48.2 1.6 314 4 years old .............. 1,057 49.2 1.2 131 50.0 4.2 529 47.9 1.0 330 All children .............. 4,559 47.9 0.5 963 49.0 1.3 1,933 46.6 0.6 1,347 

Total, age-adjusted ....... 4,912 44.7 0.4 1,058 45.7 1.0 2,033 › 43.3 0.5 1,481 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Estimates of mean age for infants under 1 year old may be biased by the large percent of infants not yet drinking cow’s milk. 2 Table excludes infants not reported to have been fed cow’s milk on a daily.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-66—Percent of infants and children who ever used a baby bottle

Total Infants and Children Receiving WIC Benefits Income-eligible Nonparticipants High

Number Percent Standard Error Number Percent Standard Error Number Percent Standard Error Number 

Infants ........................... 1,961 95.9 0.6 787 98.8 * 0.4 348 ›› 93.1 1.9 731 

Children

1 year old ................ 1,258 96.6 0.8 419 99.1 * 0.5 391 98.5 * 0.8 357 

2 years old .............. 1,269 96.4 0.6 253 96.6 * 1.7 545 97.1 * 0.7 387 3 years old .............. 1,117 94.7 1.5 201 91.9 * 4.6 511 94.8 1.7 325 4 years old .............. 1,098 96.4 0.8 137 94.6 * 4.5 547 96.8 * 1.1 342 All children .............. 4,742 96.0 0.5 1,010 95.6 1.5 1,994 96.8 0.6 1,411 

Total, age-adjusted ....... 6,703 96.0 0.5 1,797 96.2 1.2 2,342 96.1 0.6 2,142 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.

Table D-67—Percent of infants and children still using a baby bottle

Total Infants and Children Receiving WIC Benefits Income-eligible Nonparticipants High

Number Percent Standard Error Number Percent Standard Error Number Percent Standard Error Number 

Infants ........................... 1,960 94.5 0.8 787 98.3 * 0.5 347 ›› 91.3 2.3 731 

Children

1 year old ................ 1,258 60.5 2.7 419 67.3 2.9 391 67.8 3.9 357 

2 years old .............. 1,264 22.9 1.7 252 28.3 4.4 544 26.4 2.3 384 

3 years old .............. 1,113 8.5 1.9 201 11.7 * 3.4 508 11.2 3.4 324 

4 years old .............. 1,088 4.0 1.2 134 6.5 * 1.8 542 5.5 2.1 340 

All children .............. 4,723 24.0 1.3 1,006 28.4 1.8 1,985 27.7 1.9 1,405 

Total, age-adjusted ....... 6,683 38.2 1.1 1,793 42.5 1.4 2,332 40.5 1.5 2,136 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-68—Percent of children who stopped using a baby bottle before 1 year of age1

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Number Percent Standard Error Number Percent Standard Error Number Percent Standard Error Number 

Children

1 year old ................ 1,143 9.3 1.1 378 8.8 1.8 358 10.3 1.8 321 2 years old .............. 1,216 12.0 1.3 244 12.1 2.8 527 12.2 2.1 367 3 years old .............. 1,072 13.2 1.8 193 13.8 4.6 492 10.6 2.8 312 4 years old .............. 1,050 13.3 1.8 132 10.1 * 2.4 524 › 17.2 3.2 325 

Total, age-adjusted ....... 4,481 12.0 0.9 947 11.2 1.5 1,901 12.6 1.2 1,325 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Sample for table includes children who ever used a bottle.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.

Table D-69—Mean age when stopped using a baby bottle1

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Number Mean age (mos) Standard Error Number Mean age (mos) Standard Error Number Mean age (mos) Standard Error Number 

Children

1 year old ................ 386 13.5 0.3 113 14.5 1.1 113 13.7 0.9 141 2 years old .............. 888 15.8 0.4 181 15.4 0.5 370 15.8 0.4 296 3 years old .............. 959 17.7 0.4 170 16.7 0.8 434 17.6 0.7 293 4 years old .............. 1,007 18.0 0.6 122 16.0 1.1 498 17.5 0.6 320 

Total, age-adjusted ....... 3,240 16.3 0.3 586 15.6 0.5 1,415 16.1 0.4 1,050 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Sample for table includes children who ever used a bottle, were not still using a bottle, and reported age when stopped.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-70—Percent of infants and children fed solid foods on a daily basis before 4 months of age

Total Infants and Children Receiving WIC Benefits Income-eligible Nonparticipants High

Number Percent Standard Error Number Percent Standard Error Number Percent Standard Error Number 

Infants ........................... 1,961 26.9 1.2 787 27.0 2.0 348 28.2 2.0 731 Children

1 year old ................ 1,258 22.1 2.0 419 19.8 2.7 391 26.2 2.9 357 2 years old .............. 1,269 21.5 1.8 253 19.7 3.6 545 24.0 2.1 387 3 years old .............. 1,119 23.8 2.4 201 15.5 4.3 513 23.1 3.4 325 

4 years old .............. 1,098 21.0 1.6 137 18.2 5.5 547 19.7 2.1 342 All children .............. 4,744 22.1 1.2 1,010 18.3 2.3 1,996 23.2 1.6 1,411 

Total, age-adjusted ....... 6,705 23.1 1.1 1,797 20.0 2.0 2,344 24.2 1.5 2,142 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.

Table D-71—Mean age when first fed solid foods on a daily basis1

Total Infants and Children Receiving WIC Benefits Income-eligible Nonparticipants High

Number Fed

Solids

Mean Age

(mos)

Standard

Error

Number Fed

Solids

Mean Age

(mos)

Standard

Error

Number Fed

Solids

Mean Age

(mos)

Standard

Error

Number F

Solids

Infants ........................... 1,546 4.1 0.1 596 4.1 0.1 277 4.4 0.2 596 Children

1 year old ................ 1,247 5.5 0.1 415 6.0 0.2 390 5.6 0.2 352 

2 years old .............. 1,258 6.0 0.1 249 6.3 0.4 542 6.2 0.2 386 3 years old .............. 1,102 6.0 0.2 197 6.5 0.2 506 6.4 0.3 320 4 years old .............. 1,081 6.0 0.2 131 6.5 0.6 539 6.1 0.2 339 All children .............. 4,688 5.9 0.1 992 6.3 0.2 1,977 6.1 0.2 1,397 

Total, age-adjusted ....... 6,234 5.5 0.1 1,588 5.9 0.2 2,254 5.7 0.1 1,993 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Estimates of mean age for infants under 1 year old may be biased by the large percent of infants not yet eating solid foods.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-72—Physical activity reported by pregnant and postpartum women for past month 

Total Pregnant and Postpartum Women Currently Receiving WIC Benefits Income-eligible Nonparticipants Hig

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample 

Percent of pregnant andpostpartum women:

Walked a mile or more inpast month without stopping 630 51.0 3.5 165 49.0 7.2 233 47.7 6.4 18

Exercised at least 3 timesper week ............................. 630 39.7 4.2 165 27.1 6.4 233 34.2 7.1 18Exercised at least 5 timesper week ............................. 630 26.4 3.0 165 14.8 3.9 233 14.7 3.4 18

Number of different physicalactivities in the past month1

None ................................... 630 19.5 2.7 165 20.2 3.6 233 29.3 4.5 18

One ..................................... 630 28.5 3.4 165 30.6 6.6 233 22.9 4.6 18Two ..................................... 630 17.6 2.9 165 21.0 4.9 233 19.3 5.1 18Three or more ..................... 630 34.3 3.7 165 28.0 7.6 233 28.5 7.0 18

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 The Bonferroni adjustment was used to adjust for the multiplicity of tests when examining multiple outcome categories.

Source: NHANES-III, 1988-94: Adult interview file. ’Total’ column includes women with missing WIC participation or income.
Table D-73—Percent of pregnant and postpartum women consuming at least 12 alcoholic beverages, in their lifetime and in pas

Total Pregnant and Postpartum Women Currently Receiving WIC Benefits Income-eligible Nonparticipants Hig

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample 

Percent of pregnant andpostpartum women consumingalcoholic beverages

In their lifetime .................... 664 78.1 3.2 181 72.4 5.2 246 72.8 5.4 18

In past year ......................... 664 37.0 3.8 181 21.4 6.1 246 33.1 6.9 18

Among pregnant andpostpartum women consumingalcohol in past year

Mean number drinksconsumed on averagedrinking day ........................ 156 2.6 0.23 24 3.7 * 0.74 64 3.2 0.54 6

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Examination file. ’Total’ column includes women with missing WIC participation or income.
Table D-74—Percent of pregnant and postpartum women smoking cigarettes, in their lifetime and in past 5 days

Total Pregnant and Postpartum Women Currently Receiving WIC Benefits Income-eligible Nonparticipants Hig

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample 

Percent of all pregnant andpostpartum women:

Ever smoked ....................... 667 38.0 3.0 181 42.8 6.3 247 38.0 6.7 18

Smoked in past 5 days ....... 665 22.4 3.5 179 27.0 4.9 247 30.1 6.3 18

Among smokers:

Mean number cigarettessmoked in past 5 days ........ 145 52.6 6.0 38 40.8 * 6.1 64 52.6 * 11.4 3

Mean age became regularsmoker ................................ 188 16.4 0.3 49 15.4 * 0.3 68 15.4 0.4 6

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Persons are identified as "ever smoking" if they report smoking at least 100 cigarettes during their entire life.Persons who smoked in past 5 days may include persons having smoked less than 100 cigarettes in entire life.Persons are identified as smokers if they reported smoking cigarettes, cigars, or pipes, or chewing tobacco in the past 5 days.

Source: NHANES-III, 1988-94: Adult Interview file and Examination file. Sample for table contains women completing an MEC exam. ’Total’ column includes women with mis
Table D-75—Percent of nonsmoking women, infants, and children exposed to second hand smoke at home

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Pregnant and

postpartum women 519 14.0 2.2 141 26.4 6.6 182 18.3 6.0 152 

Infants ........................... 1,960 35.7 1.7 787 47.2 2.2 348 43.8 2.6 731 Children

1 year old ................ 1,256 36.8 2.4 419 50.5 4.1 391 46.9 2.6 357 

2 years old .............. 1,268 39.5 1.9 253 42.9 4.3 545 47.7 3.1 387 

3 years old .............. 1,119 37.0 2.5 201 39.4 5.1 513 44.1 4.7 325 4 years old .............. 1,098 39.6 2.8 137 41.4 7.3 547 51.5 3.3 342 All children .............. 4,741 38.2 1.7 1,010 43.6 3.8 1,996 47.6 2.1 1,411 

Total, population

adjusted .................. 7,220 32.6 1.5 1,938 40.4 3.2 2,526 40.7 2.2 2,294 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Table D-76—Mean number of cigarettes smoked per day in households where nonsmoking women, infants, and children reside 

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean # Cigarettes Standard Error Sample size Mean # Cigarettes Standard Error Sample size Mean # Cigarettes Standard Error Sample si

Pregnant and

postpartum women 124 15.4 2.9 46 18.1 * 6.3 46 12.6 * 4.5 21 

Infants ........................... 741 15.8 0.6 372 15.4 0.8 157 18.0 1.8 177 Children

1 year old ................ 459 15.5 0.9 178 16.4 1.3 168 15.1 1.3 84 2 years old .............. 481 15.3 0.7 103 14.8 1.2 235 17.9 1.4 112 3 years old .............. 422 15.6 1.1 81 12.0 * 1.8 215 › 17.6 1.8 100 

4 years old .............. 421 16.9 0.8 48 15.8 * 2.7 240 18.6 0.9 108 All children .............. 1,783 15.8 0.5 410 14.8 1.2 858 17.3 0.7 404 

Total, population

adjusted .................. 2,648 15.7 0.8 828 15.6 1.6 1,061 16.4 1.2 602 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Examination sample. Smokers are identified from the MEC file; exposure is determined from the adult and youth interview files. ’Total’ column 

missing WIC participation or income. Women are identified as nonsmokers if they answered no to all four types of nicotine exposure in past 5 days: cigarettes, cigars snuff, and nicotine gum. Persons reside with smokers if they reside with persons reported to have smoked cigarettes in the past 5 days.
Table D-77—Percent of nonsmoking women and 4-year-old children with high serum cotinine levels 1,2

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Pregnant and

postpartum women 478 51.8 4.9 132 67.4 7.0 168 60.8 8.4 140 

Children

4 years old .............. 614 75.6 4.0 91 91.9 * 3.1 311 86.0 3.9 182 

Total, population

adjusted .................. 1,092 61.9 3.9 223 77.8 3.9 479 71.4 5.7 322 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Women are identified as nonsmokers if they answered no to all four types of nicotine exposure in past 5 days: cigarettes, cigars or pipes, chewing tobacco or snuff, a

2 High serum cotinine level is defined as > 0.10 ng/dL. Source: Healthy People 2010 (U.S. DHHS, 2000a).

Source: NHANES-III, 1988-94: Examination sample. Smokers are identified from the MEC file; exposure is determined from the adult and youth interview files. ’Total’ column 

with missing WIC participation or income.
Table D-78—Percent of women, infants, and children with self-reported general health status of very good or excellent

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Pregnant and

postpartum women 667 56.2 3.6 181 49.1 7.3 247 42.5 6.1 185 

Infants ........................... 1,961 82.0 1.0 787 72.7 1.7 348 › 80.1 2.6 731 

Children

1 year old ................ 1,258 79.0 1.7 419 64.4 3.3 391 › 73.7 3.3 357 

2 years old .............. 1,268 78.0 1.6 253 62.6 4.0 545 69.8 3.0 386 3 years old .............. 1,119 74.6 1.9 201 64.3 4.6 513 68.6 3.2 325 4 years old .............. 1,098 73.6 1.9 137 62.4 6.2 547 60.0 3.2 342 All children .............. 4,743 76.3 1.2 1,010 63.4 2.7 1,996 68.0 1.8 1,410 

Total, population

adjusted .................. 7,371 72.8 1.2 1,978 61.8 2.2 2,591 64.4 2.0 2,326 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Table D-79—Percent of women, infants, and children with self-reported general health status of fair or poor

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Pregnant and

postpartum women 667 6.3 1.2 181 10.9 2.6 247 6.8 * 1.9 185 

Infants ........................... 1,961 3.6 0.6 787 5.8 1.2 348 4.5 * 1.0 731 Children

1 year old ................ 1,258 3.4 0.4 419 6.9 1.2 391 5.6 1.1 357 

2 years old .............. 1,268 4.4 0.5 253 6.5 * 2.1 545 6.4 1.3 386 3 years old .............. 1,119 4.9 1.0 201 8.5 * 3.2 513 7.6 1.8 325 

4 years old .............. 1,098 4.7 0.8 137 9.8 * 3.0 547 5.5 1.2 342 All children .............. 4,743 4.3 0.4 1,010 7.9 1.4 1,996 6.2 0.6 1,410 

Total, population

adjusted .................. 7,371 4.6 0.4 1,978 8.2 1.2 2,591 6.1 0.6 2,326 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Adult and youth interview files. ’Total’ column includes persons with missing WIC participation or income.
Table D-80—Percent of women, infants, and children with physician-reported general health status of very good or excellent

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Pregnant and

postpartum women 640 87.0 * 2.6 169 77.7 * 5.9 236 87.1 * 4.4 183 

Infants ........................... 1,921 87.5 3.1 772 85.7 3.2 339 86.4 * 3.6 720 Children

1 year old ................ 1,221 90.0 * 2.5 408 90.1 * 2.8 378 86.7 * 3.9 345 2 years old .............. 1,230 89.4 * 2.4 246 89.4 * 2.6 528 88.4 * 2.7 378 3 years old .............. 1,092 89.6 * 2.7 199 84.0 * 6.2 500 89.1 * 3.0 316 4 years old .............. 1,078 90.4 * 2.4 135 96.4 * 1.6 534 ›› 87.9 * 3.2 338 

All children .............. 4,621 89.8 2.4 988 90.0 2.4 1,940 88.0 2.8 1,377 

Total, population

adjusted .................. 7,182 88.8 2.3 1,929 86.7 2.8 2,515 87.6 2.8 2,280 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Table D-81—Percent of women, infants, and children with physician-reported general health status of fair or poor

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Pregnant and

postpartum women 640 1.4 * 0.9 169 2.6 * 1.1 236 0.5 * 0.3 183 

Infants ........................... 1,921 0.7 * 0.2 772 1.4 * 0.5 339 1.2 * 0.6 720 

Children

1 year old ................ 1,221 0.1 * 0.1 408 0.2 * 0.2 378 0.3 * 0.2 345 2 years old .............. 1,230 0.3 * 0.2 246 0.0 0.0 528 0.5 * 0.4 378 3 years old .............. 1,092 0.4 * 0.2 199 1.8 * 1.4 500 0.5 * 0.4 316 4 years old .............. 1,078 0.6 * 0.4 135 0.6 * 0.6 534 0.3 * 0.2 338 All children .............. 4,621 0.4 * 0.1 988 0.6 * 0.4 1,940 0.4 * 0.2 1,377 

Total, population

adjusted .................. 7,182 0.6 0.2 1,929 1.2 * 0.3 2,515 0.5 * 0.2 2,280 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

>0 Value to small to display.

Source: NHANES-III, 1988-94: Examination file. ’Total’ column includes persons with missing WIC participation or income.
Table D-82—Prevalence of specific health conditions among pregnant and postpartum women

Total Pregnant and Postpartum Women Currently Receiving WIC Benefits Income-eligible Nonparticipants Hig

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample 

Percent reporting:

High blood pressure ........... 629 9.7 3.32 165 4.2 * 1.82 232 5.3 * 1.76 18

Diabetes ............................. 629 0.3 * 0.19 164 0.8 * 0.64 233 0.8 * 0.60 18Heart attack ........................ 618 >0 0.04 158 0.3 * 0.33 228 0.0 0.00 18Stroke ................................. 630 0.4 * 0.35 165 0.0 0.00 233 0.0 0.00 18Emphysema or CHF1 ......... 630 0.1 * 0.1 165 0.3 * 0.3 233 0.4 * 0.3 18Cancer other than skincancer ................................. 630 1.8 * 0.9 165 1.5 * 1.2 233 1.5 * 1.1 18

Percent with measured highblood pressure ........................ 626 1.1 * 0.4 163 1.8 * 1.1 231 1.3 * 0.6 18

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 CHF is congestive heart failure

>0 Value to small to display.

Source: NHANES-III, 1988-94: Adult interview file. ’Total’ column includes women with missing WIC participation or income.
Table D-83—Pregnancy histories of pregnant and postpartum women

Total Pregnant and Postpartum Women Currently Receiving WIC Benefits Income-eligible Nonparticipants Hig

Sample size Mean Standard Error Sample size Mean Standard Error Sample size Mean Standard Error Sample 

Mean number of pregnancies 630 2.5 0.10 165 2.5 0.16 233 2.7 0.17 18Mean number of live births ..... 630 1.3 0.09 165 1.6 0.12 233 1.5 0.14 18At time of first live birth:

Mean age .......................... 496 22.4 0.6 145 20.5 * 0.6 187 19.3 0.4 12

Percent teenagers .............. 496 36.2 4.2 145 53.7 * 7.9 187 58.3 7.1 12Percent older than 35 yrs ... 496 1.7 * 1.1 145 0.4 * 0.4 187 0.4 * 0.3 12

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Examination file. ’Total’ column includes women with missing WIC participation or income.
Table D-84—Mean age of mother at birth: Infants and children up to 4 years old

Total Infants and Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard Error Sample size Mean Standard Error Sample size Mean Standard Error Sample si

Infants ........................... 1,961 26.4 0.19 787 24.1 0.20 348 ›››25.7 0.29 731 

Children

1 year old ................ 1,255 26.4 0.25 418 24.5 0.35 390 24.3 0.40 356 

2 years old .............. 1,259 26.5 0.20 250 24.5 0.52 540 25.2 0.31 385 3 years old .............. 1,110 26.8 0.35 199 25.6 0.74 507 25.3 0.43 324 

4 years old .............. 1,088 26.0 0.31 136 24.4 0.97 540 24.2 0.36 341 

All children .............. 4,712 26.4 0.18 1,003 24.8 0.39 1,977 24.7 0.18 1,406 

Total, age-adjusted ....... 6,673 26.4 0.16 1,790 24.6 0.32 2,325 24.9 0.15 2,137 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-85—Percent of infants and children born to adolescent mothers

Total Infants and Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Infants ........................... 1,961 12.8 0.8 787 22.6 1.9 348 ›› 14.3 1.7 731 

Children

1 year old ................ 1,255 13.0 1.3 418 18.6 2.7 390 21.4 2.8 356 

2 years old .............. 1,259 11.3 1.0 250 23.8 5.0 540 13.3 1.6 385 

3 years old .............. 1,110 12.1 1.7 199 18.6 5.2 507 17.6 3.1 324 

4 years old .............. 1,088 13.2 1.5 136 19.8 8.0 540 21.3 2.1 341 All children .............. 4,712 12.4 0.8 1,003 20.2 3.5 1,977 18.4 1.2 1,406 

Total, age-adjusted ....... 6,673 12.5 0.7 1,790 20.7 2.8 2,325 17.6 1.0 2,137 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Table D-86—Percent of infants and children born to mothers over age 35

Total Infants and Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Infants ........................... 1,961 7.1 0.8 787 3.7 0.7 348 4.8 1.2 731 Children

1 year old ................ 1,255 5.4 0.9 418 4.2 1.2 390 3.6 * 1.0 356 2 years old .............. 1,259 6.1 0.8 250 6.8 2.5 540 2.9 1.1 385 3 years old .............. 1,110 6.6 1.4 199 5.0 * 1.7 507 3.3 1.0 324 4 years old .............. 1,088 6.1 1.4 136 1.5 * 0.6 540 3.6 1.3 341 

All children .............. 4,712 6.1 0.6 1,003 4.4 0.8 1,977 3.4 0.6 1,406 

Total, age-adjusted ....... 6,673 6.3 0.5 1,790 4.2 0.6 2,325 3.7 0.6 2,137 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-87—Percent of infants and children born to mothers who smoked during pregnancy

Total Infants and Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Infants ........................... 1,957 23.2 1.4 787 27.4 1.9 348 30.4 2.8 727 Children

1 year old ................ 1,253 22.9 2.0 418 31.4 3.8 391 28.0 3.3 353 

2 years old .............. 1,259 22.9 1.4 251 25.3 4.5 542 28.9 2.1 382 3 years old .............. 1,112 21.8 2.0 198 26.1 4.9 510 21.7 3.7 324 4 years old .............. 1,090 26.6 2.0 135 32.9 7.4 544 32.2 3.3 339 All children .............. 4,714 23.6 1.1 1,002 29.0 3.7 1,987 27.7 1.9 1,398 

Total, age-adjusted ....... 6,671 23.5 0.9 1,789 28.6 3.1 2,335 28.3 1.8 2,125 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Table D-88—Mean birthweight of infants and children

Total Infants and Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard Error Sample size Mean Standard Error Sample size Mean Standard Error Sample si

Infants ........................... 1,929 3,371 15.6 771 3,258 20.8 341 › 3,343 32.2 724 

Children

1 year old ................ 1,216 3,354 27.6 405 3,209 46.5 376 3,308 36.4 352 

2 years old .............. 1,219 3,399 22.6 241 3,208 48.7 514 › 3,333 26.7 383 3 years old .............. 1,044 3,332 36.0 186 3,263 39.7 470 3,305 60.4 316 4 years old .............. 1,036 3,300 28.6 128 3,069 115.6 511 3,301 47.2 335 All children .............. 4,515 3,346 15.9 960 3,187 28.6 1,871 ›› 3,312 23.1 1,386 

Total, age-adjusted ....... 6,444 3,351 13.9 1,731 3,201 23.3 2,212 ›››3,318 21.7 2,110 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-89—Percent of infants and children born low birthweight1

Total Infants and Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Infants ........................... 1,939 7.0 0.7 774 11.7 1.3 345 ›› 5.9 1.3 727 

Children

1 year old ................ 1,231 7.2 1.1 412 13.3 2.0 381 ›› 5.3 1.2 353 

2 years old .............. 1,236 6.0 0.8 248 8.6 2.0 521 7.4 1.4 386 3 years old .............. 1,075 8.7 1.4 191 9.4 * 2.8 487 11.6 3.3 321 4 years old .............. 1,068 8.9 1.3 134 14.9 5.3 529 8.5 1.8 341 All children .............. 4,610 7.7 0.5 985 11.6 1.3 1,918 › 8.2 1.0 1,401 

Total, age-adjusted ....... 6,549 7.6 0.4 1,759 11.6 1.0 2,263 ›› 7.7 0.8 2,128 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Low birthweight is less than 2500 grams, or 5.5 pounds

Table D-90—Percent of infants and children born very low birthweight1

Total Infants and Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Infants ........................... 1,929 0.8 0.2 771 1.2 * 0.6 341 1.2 * 0.7 724 Children

1 year old ................ 1,216 0.8 * 0.3 405 0.6 * 0.3 376 0.9 * 0.6 352 2 years old .............. 1,219 1.0 * 0.4 241 2.2 * 1.0 514 0.4 * 0.3 383 3 years old .............. 1,044 1.4 0.5 186 0.8 * 0.4 470 0.8 * 0.4 316 4 years old .............. 1,036 1.2 * 0.4 128 3.6 * 2.5 511 2.1 * 1.0 335 All children .............. 4,515 1.1 0.2 960 1.8 0.7 1,871 1.1 0.3 1,386 

Total, age-adjusted ....... 6,444 1.0 0.2 1,731 1.7 0.6 2,212 1.1 0.2 2,110 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Very low birthweight is less than 1500 grams, or 3.3 pounds

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-91—Percent of infants and children receiving neonatal intensive care (NICU)

Total Infants and Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Infants ........................... 1,960 11.5 0.8 787 15.2 1.6 348 11.0 2.0 730 

Children

1 year old ................ 1,256 12.2 1.6 419 16.0 3.0 391 9.5 2.0 355 2 years old .............. 1,266 10.3 0.9 251 11.1 2.6 545 8.5 1.8 386 3 years old .............. 1,117 11.5 2.6 201 13.2 3.7 511 9.6 3.4 325 4 years old .............. 1,094 10.6 1.4 136 19.9 5.4 545 10.4 1.9 341 All children .............. 4,733 11.2 1.0 1,007 15.1 1.8 1,992 › 9.5 1.1 1,407 

Total, age-adjusted ....... 6,693 11.2 0.8 1,794 15.1 1.5 2,340 ›› 9.8 1.1 2,137 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-92—Mean weight-for-height, and percent of children overweight, at risk of overweight, and underweight1

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard Error Sample size Mean Standard Error Sample size Mean Standard Error Sample si

Mean weight-for-height

Children

1 year old ................ 1,230 53.1 1.22 409 54.6 2.05 385 58.5 1.79 351 

2 years old .............. 1,224 53.2 1.25 244 49.9 2.01 527 53.2 2.06 376 3 years old .............. 1,095 51.6 1.47 198 50.2 3.48 504 56.0 1.92 323 4 years old .............. 1,079 54.4 1.04 136 53.1 4.18 533 55.1 1.12 339 

Total, age-adjusted ....... 4,628 53.1 0.74 987 52.0 1.82 1,949 55.7 0.85 1,389 

Percent of children overweight

Children

1 year old ................ 1,230 7.5 1.07 409 7.9 1.52 385 10.1 2.05 351 2 years old .............. 1,224 5.6 0.79 244 5.4 * 1.75 527 6.8 1.15 376 3 years old .............. 1,095 5.4 1.15 198 6.5 * 2.17 504 8.5 2.45 323 4 years old .............. 1,079 4.6 1.08 136 6.6 * 2.18 533 5.8 2.10 339 

Total, age-adjusted ....... 4,628 5.8 0.61 987 6.6 1.02 1,949 7.8 1.13 1,389 

Percent of children at risk of overweight

Children

1 year old ................ 1,230 10.9 1.06 409 12.9 2.36 385 16.7 2.23 351 

2 years old .............. 1,224 11.4 1.26 244 11.1 2.43 527 13.3 2.53 376 3 years old .............. 1,095 9.7 1.41 198 12.9 4.52 504 10.1 2.24 323 4 years old .............. 1,079 11.4 1.47 136 8.2 * 2.50 533 12.9 2.11 339 

Total, age-adjusted ....... 4,628 10.8 0.63 987 11.3 1.58 1,949 13.2 1.03 1,389 

Percent underweight

Children

1 year old ................ 1,230 4.5 0.63 409 5.8 * 1.42 385 2.7 * 1.09 351 2 years old .............. 1,224 3.8 0.53 244 4.9 * 1.42 527 5.0 1.32 376 3 years old .............. 1,095 4.3 0.84 198 8.1 * 2.43 504 › 2.2 * 0.94 323 

4 years old .............. 1,079 4.3 1.01 136 7.0 * 3.77 533 3.2 * 1.07 339 

Total, age-adjusted ....... 4,628 4.2 0.30 987 6.5 1.20 1,949 › 3.3 0.44 1,389 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Weight for height is based on standing height for children age 2 years and over, and recumbent length for infants and children under age 2. Overweight is defined as 

weight-for-height growth chart; risk of overweight is defined as between the 85th and 95th percentile of the weight-for-height growth chart; underweight is defined as < 

-height growth chart, as determined by age at measurement.

Source: NHANES-III, 1988-94: Examination file. ’Total’ column includes children with missing WIC participation or income.
Table D-93—Percent of 2-4-year-old children with growth retardation1

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Std Error Sample size Percent Std Error Sample size Percent Std Error Sample si

Children

2 years old .............. 1,229 4.9 0.69 244 6.9 1.85 529 6.5 1.14 377 3 years old .............. 1,104 3.5 * 1.12 198 10.0 * 5.41 510 3.8 * 1.45 323 4 years old .............. 1,088 4.2 1.24 136 11.1 * 4.62 540 3.3 * 1.56 341 

Total, age-adjusted ....... 3,421 4.2 0.69 578 9.3 2.74 1,579 4.5 0.99 1,041 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Growth retardation is identified as < 5th percentile of the CDC height-for-age growth chart.

Source: NHANES-III, 1988-94: Examination file. ’Total’ column includes children with missing WIC participation or income.
Table D-94—Percent of children with iron deficiency1

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 631 13.2 1.8 219 14.2 3.2 214 20.6 4.5 172 2 years old .............. 708 5.0 1.1 145 4.7 * 2.5 317 8.4 * 2.1 211 3 years old .............. 659 5.8 1.9 135 0.0 0.0 310 › 8.1 * 3.7 182 

4 years old .............. 856 1.7 * 0.6 117 2.8 * 1.2 447 2.3 * 0.9 249 

Total, age-adjusted ....... 2,854 6.4 0.7 616 5.4 1.2 1,288 › 9.8 1.6 814 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Iron deficiency is indicated by at least 2 of the following: low serum transferrin saturation, high erythrocyte protoporphorin (EPP), and low serum ferritin. See append

Source: NHANES-III, 1988-94: Examination file. ’Total’ column includes children with missing WIC participation or income.

Table D-95—Percent of children with low serum ferritin1

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 858 17.3 1.5 291 13.8 4.4 282 › 26.2 3.5 237 

2 years old .............. 947 9.0 1.3 189 6.3 * 2.3 427 11.2 2.1 276 3 years old .............. 876 4.4 0.9 159 2.4 * 1.7 412 7.0 1.7 251 4 years old .............. 899 2.2 * 0.6 119 3.4 * 2.1 467 3.2 * 1.2 265 

Total, age-adjusted ....... 3,580 8.2 0.6 758 6.5 1.4 1,588 ›› 11.9 1.2 1,029 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Low serum ferritin is identified by < 10 mcg/mL. Source: Healthy People 2010 (U.S. DHHS, 2000a).

Source: NHANES-III, 1988-94: Examination file. ’Total’ column includes children with missing WIC participation or income.
Table D-96—Percent of children with high free erythrocyte protoporphorin 1

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 899 15.6 1.71 304 17.9 3.50 291 20.0 4.22 252 2 years old .............. 978 6.6 1.02 198 5.5 * 1.62 438 8.8 1.79 287 3 years old .............. 889 8.0 1.79 163 3.0 * 0.99 419 ›› 13.7 3.61 251 

4 years old .............. 919 6.2 1.24 121 6.3 * 2.11 476 6.7 * 1.24 274 

Total, age-adjusted ....... 3,685 9.1 0.70 786 8.2 0.99 1,624 › 12.3 1.66 1,064 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 High free erythrocyte protoporphorin is identified as > 80 (age 1-2) and > 70 (age 3-4). Source: Healthy People 2010 (U.S. DHHS, 2000a).

Source: NHANES-III, 1988-94: Examination file. ’Total’ column includes children with missing WIC participation or income.

Table D-97—Percent of children with low transferrin saturation1

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 671 24.7 2.4 229 20.9 2.7 227 34.9 5.8 182 2 years old .............. 757 18.0 1.8 154 18.6 4.7 339 22.3 3.2 226 3 years old .............. 699 22.7 3.4 138 21.6 4.4 329 23.4 4.3 195 4 years old .............. 879 13.9 1.6 118 19.4 * 9.1 460 17.9 2.9 255 

Total, age-adjusted ....... 3,006 19.8 1.2 639 20.1 3.3 1,355 24.6 2.2 858 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Low transferrin saturation is identified as < 10% (age 1-2) and < 12% (age 3-4). Source: Healthy People 2010 (U.S. DHHS, 2000a).

Source: NHANES-III, 1988-94: Examination file. ’Total’ column includes children with missing WIC participation or income.
Table D-98—Percent of children with low iron deficiency anemia1

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 631 3.7 1.0 219 3.4 * 1.3 214 7.4 * 2.6 172 2 years old .............. 708 1.8 * 0.5 145 2.9 * 2.3 317 2.5 * 1.0 211 3 years old .............. 659 0.5 * 0.3 135 0.0 0.0 310 1.3 * 0.9 182 4 years old .............. 856 0.3 * 0.2 117 1.0 * 0.8 447 0.5 * 0.4 249 

Total, age-adjusted ....... 2,854 1.6 0.3 616 1.8 * 0.6 1,288 2.9 0.7 814 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Iron deficiency anemia is defined as iron deficiency and low hemoglobin. See appendix B.

>0 Value to small to display.

Source: NHANES-III, 1988-94: Examination file. ’Total’ column includes children with missing WIC participation or income.
Table D-99—Percent of children with low hemoglobin1

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 855 12.2 1.6 298 12.7 2.2 275 19.3 3.4 239 2 years old .............. 934 9.7 1.0 188 8.2 * 2.7 417 12.6 2.1 276 3 years old .............. 852 5.8 1.0 157 13.0 * 3.1 405 6.7 1.6 242 

4 years old .............. 898 4.9 0.9 119 3.0 * 1.2 466 5.0 1.2 267 

Total, age-adjusted ....... 3,539 8.1 0.8 762 9.2 1.3 1,563 10.9 1.4 1,024 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Criteria for low hemoglobin varies by age, gender, and smoking status. See appendix B.

Source: NHANES-III, 1988-94: Examination file. ’Total’ column includes children with missing WIC participation or income.

Table D-100—Percent of children with low hematocrit1

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 855 10.3 1.6 298 11.4 2.2 275 15.5 3.4 239 2 years old .............. 934 7.2 0.9 188 6.9 * 2.8 417 8.9 1.6 276 3 years old .............. 852 6.0 1.2 157 10.8 * 3.5 405 8.0 1.9 242 

4 years old .............. 898 5.9 1.2 119 2.2 * 1.6 466 5.6 * 1.4 267 

Total, age-adjusted ....... 3,539 7.4 0.7 762 7.8 1.5 1,563 9.5 1.3 1,024 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Criteria for low hematocrit varies by age, gender, and smoking status. See appendix B.

Source: NHANES-III, 1988-94: Examination file. ’Total’ column includes children with missing WIC participation or income.
Table D-101—Percent of infants and children with any hospital stays since birth

Total Infants and Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Infants ........................... 1,961 9.8 0.8 787 13.5 1.4 348 9.7 2.0 731 Children

1 year old ................ 1,256 17.2 1.7 419 19.3 2.8 390 15.6 2.5 356 2 years old .............. 1,267 17.8 1.5 251 21.3 4.2 545 20.1 2.3 387 3 years old .............. 1,118 18.9 2.1 201 21.1 3.7 512 18.8 3.6 325 4 years old .............. 1,096 21.7 3.0 136 24.0 4.7 546 23.2 3.0 342 All children .............. 4,737 18.9 1.3 1,007 21.4 1.6 1,993 19.4 1.8 1,410 

Total, age-adjusted ....... 6,698 17.1 1.1 1,794 19.8 1.3 2,341 17.5 1.6 2,141 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.

Table D-102—Percent of infants and children with accident, injury, or poisoning requiring medical attention in past 12 months

Total Infants and Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Infants ........................... 1,960 1.8 0.4 787 1.6 * 0.5 348 1.5 * 0.8 730 Children

1 year old ................ 1,258 12.8 1.4 419 10.1 2.0 391 12.6 2.6 357 2 years old .............. 1,269 13.7 1.0 253 16.6 4.0 545 9.3 1.6 387 3 years old .............. 1,119 10.1 1.7 201 10.9 * 3.7 513 8.6 2.1 325 4 years old .............. 1,098 12.5 2.1 137 24.2 8.7 547 13.4 2.8 342 All children .............. 4,744 12.3 0.8 1,010 15.5 3.1 1,996 11.0 1.2 1,411 

Total, age-adjusted ....... 6,704 10.2 0.6 1,797 12.7 2.4 2,344 9.1 1.0 2,141 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-103—Percent of infants and children ever diagnosed by doctor to have asthma

Total Infants and Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Infants ........................... 1,961 2.0 0.4 787 3.0 0.7 348 3.5 * 1.1 731 

Children

1 year old ................ 1,258 4.7 0.7 419 4.7 1.2 391 8.2 1.5 357 2 years old .............. 1,267 6.4 0.8 253 9.1 2.2 544 7.5 1.3 386 3 years old .............. 1,119 5.6 1.0 201 3.7 * 1.2 513 7.3 1.7 325 4 years old .............. 1,097 7.6 1.4 137 14.8 6.2 547 7.9 1.6 341 All children .............. 4,741 6.1 0.5 1,010 8.1 1.6 1,995 7.7 0.8 1,409 

Total, age-adjusted ....... 6,702 5.3 0.4 1,797 7.0 1.3 2,343 6.9 0.7 2,140 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.

Table D-104—Percent of infants and children ever diagnosed by doctor to have chronic bronchitis

Total Infants and Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Infants ........................... 1,961 2.2 0.4 787 2.8 0.5 348 1.5 * 0.6 731 Children

1 year old ................ 1,258 4.0 0.6 419 4.0 1.2 391 5.6 1.4 357 2 years old .............. 1,268 4.2 0.6 253 7.9 2.2 544 3.7 0.7 387 

3 years old .............. 1,119 2.8 0.7 201 1.9 * 0.9 513 2.9 0.8 325 4 years old .............. 1,097 4.0 0.8 137 4.9 * 2.5 546 6.6 1.5 342 All children .............. 4,742 3.8 0.4 1,010 4.7 1.1 1,994 4.7 0.6 1,411 

Total, age-adjusted ....... 6,703 3.5 0.3 1,797 4.3 0.8 2,342 4.1 0.5 2,142 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-105—Percent of infants and children ever diagnosed by doctor to have hay fever

Total Infants and Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Infants ........................... 1,961 0.7 * 0.2 787 0.6 * 0.3 348 1.9 * 1.0 731 Children

1 year old ................ 1,258 1.4 0.5 419 0.7 * 0.7 391 0.6 * 0.6 357 2 years old .............. 1,269 2.0 0.5 253 1.0 * 0.6 545 1.8 * 1.0 387 3 years old .............. 1,119 0.9 * 0.3 201 0.3 * 0.2 513 0.3 * 0.2 325 4 years old .............. 1,097 3.8 1.1 137 10.8 * 5.6 547 4.0 1.7 341 All children .............. 4,743 2.1 0.4 1,010 3.2 1.5 1,996 1.7 0.5 1,410 

Total, age-adjusted ....... 6,704 1.8 0.3 1,797 2.7 1.2 2,344 1.7 0.4 2,141 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-106—Percent of children ever tested for lead poisoning

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 1,232 10.2 1.4 409 16.6 2.3 388 ›› 8.3 2.0 345 

2 years old .............. 1,245 9.8 1.5 252 22.4 3.2 534 ›››10.8 2.1 375 

3 years old .............. 1,101 8.7 1.1 197 17.3 3.4 506 › 9.3 1.8 320 

4 years old .............. 1,081 10.5 1.2 136 26.3 4.6 539 › 14.1 2.8 338 

Total, age-adjusted ....... 4,659 9.8 1.0 994 20.7 1.7 1,967 ›››10.6 1.6 1,378 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.

Table D-107—Percent of children ever reported to have high lead levels or lead poisoning1

Total Children Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 1,228 0.56 * 0.30 408 1.25 * 1.06 387 0.84 * 0.55 344 2 years old .............. 1,239 0.31 * 0.13 250 1.22 * 0.72 531 0.41 * 0.24 374 3 years old .............. 1,096 0.62 * 0.37 195 4.17 * 3.10 503 0.24 * 0.17 320 4 years old .............. 1,077 0.71 * 0.23 135 0.66 * 0.67 538 1.14 * 0.29 336 

Total, age-adjusted ....... 4,640 0.55 0.14 988 1.82 0.87 1,959 0.66 * 0.16 1,374 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Percent is calculated over all children, including those not tested for lead poisoning.

Source: NHANES-III, 1988-94: Youth interview file. ’Total’ column includes those with missing WIC participation or income.
Table D-108—Percent of children with high blood lead levels1

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 918 8.9 1.74 311 16.5 4.11 295 8.9 * 2.39 258 

2 years old .............. 993 7.1 1.27 201 10.6 * 2.53 443 9.2 1.77 293 

3 years old .............. 901 5.2 0.95 163 14.1 * 4.23 426 6.7 * 1.44 255 

4 years old .............. 926 5.7 1.67 122 15.1 * 5.12 480 8.7 2.44 275 

Total, age-adjusted ....... 3,738 6.7 1.14 797 14.1 2.78 1,644 › 8.4 1.24 1,081 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 High lead is identified as ≥ 10.0 mcg/dL. Source: CDC Report on Blood Levels in the U.S.: 1991-94. (CDC, 1997) 

Source: NHANES-III, 1988-94: Examination file. ’Total’ column includes children with missing WIC participation or income.
Table D-109—Percent of children with high blood lead levels, NHANES-III Phase I (1988-1991)1

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 446 10.9 2.4 128 20.1 7.1 154 › 8.0 * 2.7 126 

2 years old .............. 478 11.2 2.1 80 14.6 * 4.7 223 16.1 3.4 141 3 years old .............. 426 5.1 * 1.3 52 8.0 * 3.3 213 7.3 * 2.1 120 4 years old .............. 444 8.5 3.3 43 23.4 * 9.3 233 13.4 5.0 138 

Total, age-adjusted ....... 1,794 8.9 2.0 303 16.6 4.7 823 11.2 2.2 525 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 High lead is identified as ≥ 10.0 mcg/dL. Source: CDC Report on Blood Levels in the U.S.: 1991-94. (CDC, 1997) 

Source: NHANES-III, 1988-94: Examination file. ’Total’ column includes children with missing WIC participation or income.

Table D-110—Percent of children with high blood lead levels, NHANES-III Phase II (1991-1994)1

Total Children Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Children

1 year old ................ 472 7.9 2.2 183 14.3 4.3 141 9.9 * 3.9 132 

2 years old .............. 515 4.1 1.1 121 9.0 * 3.2 220 3.6 * 1.0 152 3 years old .............. 475 5.4 1.5 111 16.9 * 5.6 213 6.3 * 2.6 135 

4 years old .............. 482 3.5 1.0 79 10.9 * 4.4 247 4.7 * 1.6 137 

Total, age-adjusted ....... 1,944 5.2 1.1 494 12.8 2.8 821 › 6.1 1.6 556 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 High lead is identified as ≥ 10.0 mcg/dL. Source: CDC Report on Blood Levels in the U.S.: 1991-94. (CDC, 1997) 

Source: NHANES-III, 1988-94: Examination file. ’Total’ column includes children with missing WIC participation or income.
Table D-111—Mean number of decayed, missing, and filled teeth for women and 2-4-year-old children1

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Mean Standard Error Sample size Mean Standard Error Sample size Mean Standard Error Sample si

Pregnant and

postpartum women 651 8.6 0.4 178 6.2 0.5 240 7.6 0.6 181 

Children

2 years old .............. 1,152 0.3 >0 233 0.3 0.1 495 0.5 0.1 347 

3 years old .............. 1,057 0.7 0.1 188 0.9 0.2 482 1.1 0.3 316 

4 years old .............. 1,061 1.2 0.1 130 1.2 0.3 533 1.7 0.2 329 All children .............. 3,270 0.7 0.1 551 0.8 0.1 1,510 1.1 0.1 992 

Total, population

adjusted .................. 3,921 3.2 0.1 729 2.5 0.2 1,750 › 3.1 0.2 1,173 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 For adults, table shows the sum of decayed, missing, and filled primary teeth due to any cause. For children, count includes the number of decayed and filled decidu

>0 Value to small to display.

Source: NHANES-III, 1988-94: Examination file. The dental exam was administered in the Mobile Exam Center; 2.8 percent of MEC respondents did not have a dental exam

missing food stamp participation or income.
Table D-112—Percent of women and 2-4-year-old children who ever visited a dentist or dental hygienist

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Pregnant and

postpartum women 660 97.2 * 0.7 178 97.1 * 1.0 244 95.2 * 1.7 184 

Children

2 years old .............. 1,248 15.2 1.6 246 14.0 2.8 537 11.6 1.8 385 3 years old .............. 1,108 38.2 2.5 199 52.1 4.7 506 ›››23.6 3.1 323 

4 years old .............. 1,091 60.0 2.7 136 55.2 7.7 546 55.4 4.6 338 All children .............. 3,447 37.9 1.2 581 40.5 3.4 1,589 ›› 30.4 2.1 1,046 

Total, population

adjusted .................. 4,107 56.6 0.9 759 58.3 2.3 1,833 ›› 50.8 1.6 1,230 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Adult and youth interview files. ’Total’ column includes persons with missing WIC participation or income.

Table D-113—Percent of women and 2-4-year-old children who visited a dentist or dental hygienist within the past year

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Pregnant and

postpartum women 660 63.1 3.2 178 54.9 6.2 244 62.2 5.3 184 

Children

2 years old .............. 1,248 14.5 1.5 246 14.0 2.8 537 11.1 1.7 385 3 years old .............. 1,108 36.3 2.5 199 51.8 4.7 506 ›››22.5 3.2 323 

4 years old .............. 1,091 57.4 2.7 136 51.6 7.6 546 53.4 4.6 338 All children .............. 3,447 36.2 1.3 581 39.2 3.4 1,589 ›› 29.2 2.1 1,046 

Total, population

adjusted .................. 4,107 44.7 1.3 759 44.2 3.2 1,833 39.6 2.4 1,230 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Adult and youth interview files. ’Total’ column includes persons with missing WIC participation or income.
Table D-114—Percent of women, infants, and children with any health insurance1

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard error Sample size Percent Standard error Sample size Percent Standard error Sample si

Pregnant and

postpartum women 627 88.3 1.8 166 79.0 5.6 235 80.1 4.2 179 

Infants ........................... 1,843 94.1 0.8 738 93.4 1.1 311 ›››84.3 2.6 715 

Children

1 year old ................ 1,151 92.6 1.2 384 93.8 * 1.3 344 ›››86.5 2.3 351 

2 years old .............. 1,156 92.6 0.9 240 92.7 * 1.9 474 › 86.8 2.0 377 

3 years old .............. 1,030 91.5 1.5 192 91.0 * 3.1 456 85.1 2.7 319 

4 years old .............. 1,003 91.7 1.2 127 96.4 * 1.3 494 ›››84.9 2.4 330 All children .............. 4,340 92.1 0.9 943 93.5 1.0 1,768 ›››85.9 1.7 1,377 

Total, population

adjusted .................. 6,810 91.6 0.8 1,847 90.4 1.4 2,314 ›› 84.4 1.7 2,271 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants. 1 Health insurance includes any of Medicare, Medicaid, CHAMPUS/CHAMPVA/VA/military, or private health insurance.

Source: NHANES-III, 1988-94: Adult and youth interview files. ’Total’ column includes persons with missing WIC participation or income.

Percents may sum to more than 100 because some persons have multiple sources of health insurance. Sample size varies slightly by source.
Table D-115—Percent of women, infants, and children with private health insurance

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Private Sample size Percent Private Sample size Percent Private Sample si

Pregnant and

postpartum women 607 66.4 3.2 158 28.5 * 5.7 224 44.2 6.9 179 

Infants ........................... 1,681 69.9 3.4 614 38.6 4.2 287 ›››58.5 5.1 709 

Children

1 year old ................ 1,044 69.3 3.6 332 36.1 5.6 306 ›››56.3 4.1 349 

2 years old .............. 1,062 72.3 2.7 200 31.9 * 5.1 426 ›››52.7 5.0 375 

3 years old .............. 950 70.1 3.9 171 32.6 * 7.4 412 › 49.3 6.0 318 

4 years old .............. 934 71.7 3.6 114 42.9 * 9.0 441 49.5 5.8 328 All children .............. 3,990 70.9 2.8 817 35.9 4.6 1,585 ›››52.0 4.2 1,370 

Total, population

adjusted .................. 6,278 69.8 2.6 1,589 34.7 3.6 2,096 ›››51.3 3.9 2,258 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Adult and youth interview files. ’Total’ column includes persons with missing WIC participation or income.

Table D-116—Percent of women, infants, and children with Medicaid

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Medicaid Sample size Percent Medicaid Sample size Percent Medicaid Sample si

Pregnant and

postpartum women 584 24.6 3.0 154 60.0 6.7 229 ›› 34.9 4.4 155 

Infants ........................... 1,297 48.0 2.9 644 79.2 1.8 210 ›››46.0 4.5 391 

Children

1 year old ................ 878 42.4 3.6 344 77.8 2.7 282 ›››51.4 4.4 200 

2 years old .............. 895 34.8 2.9 216 77.4 3.7 395 ›››51.8 4.0 235 3 years old .............. 823 35.5 2.7 175 73.8 5.9 385 ›› 56.4 3.8 211 

4 years old .............. 812 34.7 3.7 118 77.8 4.8 427 ›››54.2 4.7 225 

All children .............. 3,408 36.9 2.6 853 76.7 2.9 1,489 ›››53.4 3.0 871 

Total, population

adjusted .................. 5,289 36.0 2.2 1,651 73.5 2.2 1,928 ›››48.2 2.6 1,417 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Adult and youth interview files. ’Total’ column includes persons with missing WIC participation or income.
Table D-117—Percent of women, infants, and children with a regular source of health care

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Pregnant and

postpartum women 667 84.4 2.2 181 77.7 5.0 247 79.7 3.7 185 

Infants ........................... 1,961 96.8 0.5 787 97.8 * 0.5 348 ›› 91.3 2.2 731 

Children

1 year old ................ 1,258 96.4 0.7 419 96.8 * 0.8 391 ›› 93.0 1.6 357 

2 years old .............. 1,269 94.1 0.7 253 93.1 * 2.2 545 90.8 1.5 387 3 years old .............. 1,119 95.1 0.8 201 93.8 * 1.7 513 91.4 2.3 325 

4 years old .............. 1,098 93.3 0.9 137 96.0 * 1.2 547 ›››88.7 2.1 342 All children .............. 4,744 94.7 0.5 1,010 94.9 0.9 1,996 ›› 91.0 1.2 1,411 

Total, population

adjusted .................. 7,372 92.8 0.6 1,978 91.7 1.2 2,591 › 88.6 1.2 2,327 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Table D-118—Percent of women, infants, and children who see a particular doctor

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Pregnant and

postpartum women 667 68.0 2.8 181 52.8 6.0 247 52.2 5.2 185 

Infants ........................... 1,961 84.7 1.0 787 80.0 1.8 348 79.3 2.6 731 Children

1 year old ................ 1,258 81.8 1.6 419 74.4 3.6 391 76.9 2.6 357 

2 years old .............. 1,269 79.6 1.8 253 68.4 4.5 545 74.2 2.6 387 3 years old .............. 1,118 77.0 2.9 201 60.8 5.8 512 › 73.9 3.3 325 

4 years old .............. 1,098 78.5 2.0 137 70.8 9.4 547 72.4 2.8 342 All children .............. 4,743 79.3 1.4 1,010 68.6 3.6 1,995 74.4 1.8 1,411 

Total, population

adjusted .................. 7,371 77.7 1.3 1,978 67.0 2.7 2,590 70.4 1.6 2,327 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Adult and youth interview files. ’Total’ column includes persons with missing WIC participation or income.
Table D-119—Percent of women, infants, and children who saw a doctor within the past year

Total Persons Currently Receiving WIC Benefits Income-eligible Nonparticipants High

Sample size Percent Standard Error Sample size Percent Standard Error Sample size Percent Standard Error Sample si

Pregnant and

postpartum women 666 97.6 * 0.6 181 99.3 * 0.4 246 ›› 93.9 * 1.7 185 

Infants ........................... 1,961 99.7 * 0.1 787 99.8 * 0.1 348 98.6 * 0.8 731 Children

1 year old ................ 1,253 98.6 0.4 418 99.3 * 0.2 388 › 95.9 * 1.4 356 

2 years old .............. 1,269 95.0 0.8 253 95.8 * 1.6 545 ›› 89.9 1.7 387 

3 years old .............. 1,118 91.6 1.2 201 85.8 6.4 512 87.6 2.4 325 4 years old .............. 1,097 87.2 1.6 137 96.2 * 1.1 546 ›››79.2 2.5 342 All children .............. 4,737 93.1 0.6 1,009 94.3 1.6 1,991 ›› 88.1 1.1 1,410 

Total, population

adjusted .................. 7,364 95.1 0.4 1,977 96.2 1.0 2,585 ›››91.0 0.8 2,326 

Notes: * Denotes individual estimates not meeting the standards of reliability or precision due to inadequate cell size or large coefficient of variation.

Significant differences in means and proportions are noted by › (.05 level), ›› (.01 level), or ››› (.001 level). Differences are tested in comparison to WIC participants.

Source: NHANES-III, 1988-94: Adult and youth interview files. ’Total’ column includes persons with missing WIC participation or income.