1XWULWLRQ$VVLVWDQFH3URJUDP5HSRUW6HULHV

7KH2IILFHRI$QDO\VLV1XWULWLRQDQG(YDOXDWLRQ

6SHFLDO1XWULWLRQ3URJUDPV 5HSRUW1R:,&16:3

1$7,21$/6859(<2):,&

3$57,&,3$176

)LQDO

5HSRUW

8QLWHG6WDWHV )RRGDQG

'HSDUWPHQWRI 1XWULWLRQ

$JULFXOWXUH 6HUYLFH

2FWREHU
Non-Discrimination Policy

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the

basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and

marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who

require alternative means for communication of program information (Braille, large print, audiotape, etc.)

should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten

Building, 14th and Independence Avenues, SW, Washington, DC 20250-9410 or call (202) 720-5964 (voice

and TDD). USDA is an equal opportunity provider and employer.
United States Food and October 2001

Department of Nutrition Special Nutrition Programs

Agriculture Service Report No. WIC-01-NSWP

NATIONAL SURVEY OF

WIC PARTICIPANTS

Authors:

Nancy Cole

David Hoaglin

John Kirlin

Submitted by: Submitted to:

Abt Associates Inc. Office of Analysis, Nutrition and Evaluation

55 Wheeler Street USDA, Food and Nutrition Service

Cambridge, MA 02138 3101 Park Center Drive

Project Director: Project Officer:

John Kirlin Julie Kresge

Alexandria, VA 22302-1500

This study was conducted under Contract No. 53-3198-6-011 with the Food and Nutrition

Service.

This report is available on the Food and Nutrition Service website: 

http://www.fns.usda.gov/oane. 

Suggested Citation:

U.S. Department of Agriculture, Food and Nutrition Service, Office of Analysis Nutrition and

Evaluation, National Survey of WIC Participants, 2001 Final Report, by Nancy Cole et al. Project

Officer, Julie Kresge. Alexandria, VA: 2001.
Acknowledgements

The authors wish to express their gratitude to the many individuals who helped with this study and

assisted with the production of this final report.

First and foremost, we express our extreme gratitude to the WIC participants who responded to our

surveys and to the WIC staff who provided invaluable cooperation during the study. The National

Survey of WIC Participants and Their Local Agencies (NSWP) was conducted in 178 WIC service sites

from 79 local agencies throughout the country. These sites served as the location for over 3,000 interviews conducted with WIC enrollees. Local WIC personnel provided information at several stages of the

study, and welcomed our data collectors into their clinics to conduct interviews.

This project has been guided from the start by Julie Kresge, the project officer at the Food and Nutrition

Service (FNS). Her contributions have been invaluable throughout the project, but especially in her

review and comments on early drafts of this final report. We also wish to thank all the FNS staff who

reviewed the draft material and provided comments on its substance and format. Particular thanks go to

Jay Hirschman, Donna Hines, and Clara French.

At Abt Associates, Bonnie Randall led the project at the beginning and served as its technical advisor at

the end. We wish to thank her and all the in-house survey staff, field managers, and data collectors—now

under her guidance—who helped make the NSWP a success. We also thank Martin Frankel for

managing the study’s sample design, with assistance from David Hoaglin. Ellen Lee assisted with

computer programming, and Sheila Kennedy provided general background research and data management skills. Finally, Susan Byers Paxson ably managed the production of this lengthy report.
Abt Associates Inc. Contents i

Contents

Executive Summary ............................................................... 1

Purpose of the Study ..................................................... 1

Study Methods ......................................................... 1

Findings ............................................................. 2

Participant Characteristics ................................................ 3

WIC Caseload Composition and Growth, 1988 to 1998 .................... 3

Characteristics of WIC Participants .................................... 3

Characteristics of the WIC Economic Unit .............................. 5

Income of the WIC Economic Unit ..................................... 5

Food Assistance, Food Spending, and Food Security ...................... 6

Nutritional Risk Factors ............................................. 7

Incidence and Duration of Breastfeeding ................................ 7

Health Insurance Coverage ........................................... 8

Factors Affecting Enrollment and Continued Participation .................. 8

WIC Income-Eligibility Determination and Errors in Income Certification ......... 10

WIC Income Eligibility Guildelines ................................... 10

Estimates of WIC Income Certification Error for the Contiguous United States 11

Chapter 1: Introduction .......................................................... 13

1.1 Overview of the WIC Program ....................................... 13

Program Eligibility ............................................. 13

Benefits ...................................................... 14

1.2 The National Survey of WIC Participants .............................. 15

Provision of Supplemental Data .................................. 15

Estimates of Case and Dollar Error Rates ........................... 17

1.3 Organization of the Report .......................................... 18

Chapter 2: NSWP Sample Design, Survey Operations, and Sample Representativeness .... 19

2.1 Sample Design ................................................... 20

First Stage ................................................... 22

Second Stage ................................................. 22

Third Stage ................................................... 22

Fourth Stage .................................................. 23

2.2 Response Rates ................................................... 24

2.3 Weighting ....................................................... 24

2.4 Calculations of Variances ........................................... 25

2.5 Data Collection ................................................... 26

In-Person Interviews ............................................ 26

In-Home Interviews ............................................ 28

Telephone Follow-up Survey ..................................... 29

Nutritional Risk Checklist ....................................... 29

Certification Forms ............................................ 29
ii Contents Abt Associates Inc.

Local Agency Survey ........................................... 30

2.6 Sample Representativeness .......................................... 30

Representativeness of Sampled WIC Service Sites .................... 31

Representativeness of Sampled Participants/Enrollees ................. 32

Representativeness of Survey Respondents .......................... 33

Overall Sample Representativeness ................................ 33

Chapter 3: Characteristics of WIC Participants and Households ....................... 39

3.1 Caseload Composition and Growth .................................... 40

3.2 Characteristics of WIC Participants ................................... 44

3.3 Characteristics of the WIC Economic Unit .............................. 51

3.4 Income of WIC Participants ......................................... 61

Measuring Family Income ....................................... 61

Adjunctive and Automatic Income Eligibility ........................ 62

Sources of Income and Reporting of Income Data ..................... 63

Total Family Income and Income as a Percentage of Poverty Guidelines ... 71

Changes in Employment Status and Adjunct Program Participation Four

Months after Certification ........................................ 82

3.5 Nutritional Risk Factors ............................................ 86

Response Rate to Nutritional Risk Checklists ........................ 90

Number and Types of Nutrition Risks Prevalent Among WIC Participants . 90

Assessment of Nutrition Risks .................................... 92

3.6 Food Assistance, Food Spending, and Food Security ..................... 100

Participation in Other Food and Nutrition Assistance Programs ......... 100

Average Weekly Food Spending of WIC Families .................... 100

Reported Food Security of WIC Families .......................... 105

3.7 Health Insurance Coverage ......................................... 118

Medicaid .................................................... 118

Health Insurance Services ....................................... 123

3.8 Participants’ History with the WIC Program ........................... 125

3.9 Incidence and Duration of Breastfeeding .............................. 131

3.10 Factors Affecting Enrollment and Continued Participation ................ 135

Referrals to WIC .............................................. 136

Perceived Barriers to WIC Participation ........................... 136

Satisfaction with Prescribed Foods ................................ 141

WIC Benefits Ratings .......................................... 141

WIC Appointments ............................................ 145

Shopping and Benefit Redemption ................................ 145

Chapter 4: WIC Income-Eligibility Determination and Errors in Income Certification .... 149

4.1 WIC Income Eligibility ............................................ 150

Federal Regulations ............................................ 150

USDA Guidance to State WIC Agencies ........................... 154

Summary of Federal Regulations and Guidance ..................... 157

4.2 Review of State WIC Agency Income Eligibility Guidelines ............... 158

WIC Policies and Procedures Manuals ............................. 159
Abt Associates Inc. Contents iii

Adjunct and Automatic Income Eligibility ......................... 159

Income Guidelines ............................................ 159

The WIC Economic Unit ....................................... 160

WIC Countable Income ........................................ 165

Timeframes for Determining Income .............................. 168

Implications of Variation in Guidelines Across States ................ 168

4.3 Methodology for the NSWP In-Home Survey .......................... 170

Overview of the Survey ........................................ 170

The Sample .................................................. 172

Response Rates .............................................. 172

The Survey Instrument ......................................... 176

Verification of Income-Eligibility Information ...................... 177

Provision of Income Documents ................................. 179

Provision of Documents and Income Reporting by Type of Income ...... 184

4.4 Estimates of WIC Income-Certification Error .......................... 187

Methodology for Determining WIC Income Eligiblity ................ 189

Certification Error Rate for the Contiguous United States ............. 193

Dollar Error in the Contiguous United States ....................... 194

Characteristics Associated with Income-Eligibility Error .............. 195

Appendix A Sample Design, Weights, and Standard Errors

Sample Design ....................................................... A-1

First-Stage Selection .............................................. A-3

Second-Stage Selection ............................................ A-6

Third-Stage Selection ............................................. A-8

Fourth-Stage Selection ............................................ A-9

Weights ........................................................... A-9

Variances and Standard Errors .......................................... A-11

Appendix B Imputation of Unreported Data Items

Imputation Based on Within-Household Data ............................... B-1

Items Imputed Based on Within-Household Data ....................... B-2

Imputation Based on Estimates .......................................... B-3

Wage and Salary Income ........................................... B-3

Methods of Imputation ............................................ B-5

Regression Specifications .......................................... B-6

Appendix C Food Security Measurement and Food Spending per Adult Male Equivalent

Procedures for Calculating the Food Security Scale and Assigning Food Security 

Food Security Status to Households ....................................... C-1

Households with Complete Data .................................... C-2

Households with Incomplete Data ................................... C-2

Procedures for Calculating Food Spending per Adult Male Equivalent ........... C-4
iv Contents Abt Associates Inc.

Appendix D Survey Instruments

In-Person Survey ...................................................... D-1

In-Home Survey ...................................................... D-15

Appendix E Supplemental Exhibits

The Standard Error of a Difference ........................................ E-1

Multiplicity .......................................................... E-2

Comparison of Distributions ............................................. E-3
Abt Associates Inc. Executive Summary 1

Executive Summary

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is administered

by the Food and Nutrition Service of the U.S. Department of Agriculture (USDA). WIC was

established in 1972 to counteract the negative effects of poverty and poor nutrition on prenatal and

pediatric health. WIC provides a combination of direct nutritional supplementation, nutrition

education and counseling, and increased access to health care and social service providers for

pregnant, breastfeeding, and postpartum women; infants; and children up to age five.

Since 1992, FNS has produced biennial reports on WIC participant and program characteristics based

on the WIC Minimum Data Set (MDS) compiled from state management information systems. The

20 items included in the MDS are collected as part of ongoing WIC operations and consist primarily

of information related to participant eligibility.

This report presents findings from the National Survey of WIC Participants and Their Local Agencies

(NSWP). The NSWP was fielded in spring of 1998 and collected information about WIC participants

and their families, through interviews conducted in WIC service sites throughout the country. The

NSWP was the first national survey of WIC enrollees since 1988. Over that ten-year period, the WIC

program vastly expanded, with the number of enrollees growing from approximately 3.4 million in

1988 to over 8 million in 1998.

Purpose of the Study

The NSWP had two primary goals: to provide demographic information about WIC participants and

their families, and to provide national estimates of the case error rate and dollar error within the WIC

program.

To achieve the first goal, NSWP interviewed approximately 3,000 WIC participants at 178 WIC

service sites throughout the country. These interviews collected information about household

composition, family income, nutrition and health risks, participation in other food assistance

programs, food security, health insurance coverage, and the family’s history of WIC enrollment.

Estimates of the WIC case error rate are based on a second, follow-up survey conducted in the homes

of approximately 900 WIC participants. This second survey collected detailed information about

family income and sought documentation of family income for verification.

Study Methods

The NSWP was designed to provide information on the characteristics of a nationally representative

sample of WIC participants in the contiguous United States, certified for WIC during spring 1998.

The sample is based on a multi-stage sample design, with 50 geographic primary sampling units

(PSUs) selected at the first stage, 79 local WIC agencies selected at the second stage, and 178 WIC

service sites selected at the third stage. WIC participants were randomly sampled for the study at the

178 WIC service sites as they appeared for WIC certification.
2 Executive Summary Abt Associates Inc.

The NSWP consists of three surveys of WIC participants and a survey of the local WIC agencies

certifying those WIC participants:

ß In-person survey. In-person interviews were completed with 3,114 WIC participants at

178 WIC service sites throughout the contiguous United States. WIC participants were

randomly sampled at the time of their WIC certification and most interviews were

conducted in WIC clinics following certification. This survey achieved a response rate of

77 percent and provides most of the information for the first goal of the study to

describe the demographic characteristics of WIC participants and their families.

ß In-home survey. Approximately one out of every three persons selected for in-person

interviews was also selected for a follow-up interview in their home. The in-home

survey was designed to verify income information through review of household income

documents. In-home interviews were completed with 931 respondents. Data from this

survey were used to estimate WIC certification error rates the second goal of the study.

ß Telephone follow-up. Approximately two-thirds of respondents to both the in-person

and in-home surveys were chosen for telephone follow-up interviews. The telephone

follow-up survey collected information about employment status and participation in

adjunct programs four months into the WIC certification period. This survey was

completed with 558 respondents.

ß Local agency survey. The local agency survey was conducted with the 79 agencies

certifying WIC participants selected for the in-person survey. This mail survey collected

information about local WIC agency organization and operations.

In addition to these surveys, WIC clinic staff completed nutritional risk checklists for each WIC

participant with a completed in-person interview.

Findings

Key findings of the study are summarized here in an order corresponding to the structure of the

report. A summary of caseload composition and growth is based on administrative data, followed by

key findings from the NSWP surveys for the following topics:

Participant Characteristics

ß Characteristics of WIC women and mothers of WIC infants and children

ß Characteristics of the WIC economic unit

ß Income of WIC participants

ß Food assistance, food spending, and food security

ß Nutritional risk factors

ß Incidence and duration of breastfeeding

ß Health insurance coverage

ß Factors affecting enrollment and continued participation

WIC Income-Eligibility Determination and Errors in Income Certification

ß Review of state WIC agency income eligibility guidelines

ß Estimates of WIC income certification error
Abt Associates Inc. Executive Summary 3

NSWP findings should be interpreted with the knowledge that a substantial number of WIC

participants had prior WIC participation. Determining WIC's potential influence on patterns of

participant characteristics is outside the scope of the NSWP report.

The NSWP sample is a nationally representative sample of WIC participants in spring 1998,

interviewed at the time of WIC certification. Most WIC participants are certified for periods of 6

months; States may certify infants for up to one year and pregnant women for the duration of their

pregnancy. Administrative data for spring 1998 show that 88 percent of WIC infants were certified

for WIC within three months of birth; however, only 79 percent of WIC infants in the NSWP sample

were certified within three months of birth. The characteristics of infants described in this report

should be viewed in this context.

Participant Characteristics

WIC Caseload Composition and

Growth, 1988 to 1998

The NSWP provides the first detailed

picture of WIC participant characteristics

and family circumstances since 1988.

Over the ten years from 1988 to 1998,

the WIC program more than doubled in

size. As shown in Figure 1, average

monthly WIC enrollment grew from

about 3.4 million in 1988 to 8.0 million

in 1998; over the same period annual

WIC food expenditures grew from about

$1.4 billion to $2.8 billion.

Along with caseload growth, there were

substantial changes in the composition of

the WIC caseload, as documented

throughout the period by WIC

administrative data.1 A disproportionate

amount of WIC caseload growth occurred

in the Western states, which accounted for

13 percent of total WIC participants in

1988, and 24 percent of WIC participants

in 1998.2 This regional shift is reflected in

the racial/ethnic distribution of WIC

participants, with Hispanics becoming a

larger proportion of the caseload

(Hispanics were 21 percent of the caseload

in 1988 and 32 percent in 1998).

 

1 USDA, Food and Nutrition Service, WIC Participant and Program Characteristics (bienially: 1988, 1990, 1992, 1994, 1996, 1998).

2

The Western region, as defined by FNS for program administration, includes Alaska, Arizona, California, Hawaii, Idaho, Nevada,

Oregon, Washington, the territories of American Samoa and Guam, and three Indian Tribal Organizations.

Figure 1. WIC Caseload Growth, 1988 to 1998

0

2

4

6

8

1988 1990 1992 1994 1996 1998

Enrollment (millions)

Figure 2. Distribution of Caseload by Category

0%

10%

20%

30%

40%

50%

Pregnant Breastfeeding Postpartum Infants Children

1988 1998
4 Executive Summary Abt Associates Inc.

From 1988 to 1998, pregnant women and infants decreased slightly as a percent of all WIC

participants; breastfeeding women more than doubled; and children rose as a percentage of all WIC

participants, from 47 percent in 1988 to 51 percent in 1998 (Figure 2).3

Characteristics of WIC Participants

The strength of the NSWP, in contrast to data available from WIC administrative files, is the detailed

picture it provides of WIC participants and their families. This report describes the characteristics of

WIC families in a consistent manner regardless of whether the sampled WIC participant was a

woman, infant, or child. In particular, the report describes the characteristics of the mothers and

mothers-to-be who come to the WIC program that is, the WIC women (pregnant, breastfeeding, or

postpartum) and mothers of WIC infants and

children.

Most women enrolled in WIC are in the

prime childbearing years, ages 18 to 34. In

1998, less than 10 percent of women in WIC

were under age 18 years, and only 7 percent

were over age 35. Mothers of WIC infants

and children were somewhat older, with less

than 5 percent under age 18 and about 16

percent over age 35 (Figure 3). Only 44

percent of women enrolled in WIC were

married, whereas 51 percent of mothers of

WIC infants and children were married.

The majority of WIC women and mothers

have completed 12 years of education, but

approximately 30 percent are beyond high

school age and have not completed high

school (Figure 4). Approximately 13

percent of WIC women are enrolled in

college full-time or part-time at the time

they enroll in WIC; and 15 percent of

mothers of infants and children are enrolled

in college full-time or part-time.

Approximately one-quarter of WIC women

are employed at the time that they apply to

the WIC program, and about 28 percent of

WIC mothers are employed. The

employment rate is highest among WIC

pregnant women, with 32 percent employed.

 

3

The distributions of WIC participants by certification category in 1988 and 1998 are shown in Exhibit 3-1 of Chapter 3.

Figure 3. Age of WIC Women and WIC Moms

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

WIC Women WIC Moms

<18 yrs

18-34 yrs

35+ yrs

Figure 4. Education of WIC Women and WIC Moms

0%

10%

20%

30%

40%

50%

60%

70%

WIC Women WIC Moms

Teen, in school

<12 yrs

12 + yrs
Abt Associates Inc. Executive Summary 5

Figure 6. Number WIC Participants Per Family 

one 

participant

41%

two 

participants

41%

three

15%

four

3%

For both WIC women and WIC

mothers, more than half of those not

employed were employed in the past

year (Figure 5). The most common

reason for not working is “keeping

house” (this reason was given by 44

percent of pregnant women who were

not working and over 60 percent of

breastfeeding women, postpartum

women, and mothers of infants and

children who were not working).

Characteristics of the WIC Economic

Unit

The average size of the WIC family or

economic unit is 4.0 persons. Most WIC

participants reside in single-family households,

but 15 percent reside with extended family in

multi-family households.

The number of WIC participants per family is

shown in Figure 6. The majority of WIC

participants (58 percent) have at least one other

family member also participating in WIC.

Evidence shows that WIC provides continuity

of care for participants and their families.

Nearly 80 percent of mothers of WIC infants and children participated in WIC when pregnant with

their children (first two columns of Figure 7). When pregnant women participate in WIC while

pregnant, both mother and child benefit; additionally, prenatal WIC enrollment is associated with

earlier WIC enrollment for infants. Enrollment of infants within the first month of life is twice as

likely to occur when the mother participated

in WIC while pregnant.

Slightly less than half (45 percent) of WIC

infants and children have siblings who are

also age-eligible for WIC. Most ageeligible siblings also participate in WIC.

The likelihood of a sibling’s participation,

however, declines with the sibling’s age:

94 percent of siblings under 1 year old

participate in WIC, compared to 70 percent

of siblings who are 4 years old.

Figure 7. Mothers' WIC Participation

0%

20%

40%

60%

80%

100%

Infants Children

pregnant only

pregnant & postpartum

postpartum only

no WIC

Figure 5. Employment Status of WIC Women/Moms 

0%

10%

20%

30%

40%

50%

60%

70%

WIC Women WIC Moms

Employed

Not employed now, employed in last 12 mos

Not employed in last 12 mos
6 Executive Summary Abt Associates Inc.

Income of the WIC Economic Unit

The income cutoff for WIC eligibility is

185 percent of the federal poverty level.

Nearly two-thirds of WIC participants

reside in families with income below the

poverty level and 23 percent have income

between 100 and 150 percent of the poverty

level (Figure 8). Six percent of WIC

participants have income above 185 percent

of poverty; some of these participants

qualify for WIC on the basis of established

eligibility for Medicaid, whereas others

were certified in error, as is discussed

further in a later section.

Although WIC families are low-income, nearly three-fourths of all WIC participants reside in

families with wage earners. In addition to wages, the most common sources of income for WIC

families are TANF (received by 15 percent of families) and alimony or child support (received by 11

percent). As shown in Figure 9, income from unemployment insurance, social security, Supplemental

Security Income (SSI), or other welfare programs is received by fewer than 6 percent of WIC

families.

On average, WIC families with wage

income receive about $1,400 per month

in wage income. For other income

sources, the average amounts received

by those with income are: TANF

($386), alimony ($289), Social Security

($635), other welfare ($385), and SSI

($529). Due to the low rates of receipt

of non-wage income, the average receipt

of non-wage income is less than $200

per month when measured across all

WIC families.

Food Assistance, Food Spending,

and Food Security

The NSWP found that nearly one-half (47 percent) of families with WIC participants received some

other source of food assistance at the time that they enrolled in WIC. USDA programs were the most

common source of assistance, with 33 percent of families receiving food stamps, 27 percent

participating in the National School Lunch Program, and 21 percent participating in the School

Breakfast Program. Local food pantries were a source of food assistance for fewer than 5 percent of

WIC families.

Figure 8. Income as Percent of Poverty Level

0%

10%

20%

30%

40%

50%

0-50 51-100 101-150 151-185 >185

Percent of poverty level

Percent of WIC participants

Figure 9. Percent of Families with Income Source

0%

20%

40%

60%

80%

100%

Wages TANF Alimony,

child

support

Social

Security

Other

welfare

SSI UI 
Abt Associates Inc. Executive Summary 7

On average, WIC families spend 25

dollars per person on food each week,

with the great majority (85 percent) of

food spending for food at home. Based

on their experiences in the 12 months

prior to WIC certification, slightly less

than one-fourth of WIC families lack

food security. Food security is a new

composite measure based on responses

to 18 survey questions developed by

USDA.4 Fifteen percent of WIC

participants are “food insecure without

hunger,” 7 percent are “food insecure

with hunger, moderate” and about 2

percent are “food insecure with hunger,

severe” (Figure 10).

Nutritional Risk Factors

Applicants to the WIC program must demonstrate nutritional risk, defined by detrimental or abnormal

nutritional conditions, nutritionally related medical conditions, dietary deficiencies that impair or

endanger health, or conditions that predispose persons to inadequate nutritional patterns or

nutritionally related medical conditions. One of the goals of NSWP was to collect comparable data

on the incidence of nutrition risks for

all sampled persons.

NSWP found that the majority of

WIC participants have more than one

nutrition risk at the time they enroll in

the program. The number of nutrition

risks varies substantially, however, by

participant category. Figure 11 shows

the distribution of participants by

number of risks. Only 15 percent of

all women have a single risk, whereas

42 percent have four or more risks. In

contrast, 44 percent of infants and

children have a single risk, and 13

percent have four or more risks.

By far, the most prevalent nutrition risk among all WIC enrollees is the failure to meet dietary

guidelines. More than two-thirds of all women and children who enroll in WIC are at dietary risk

(Figure 12). Other common risks for women are overweight (43 percent) and risk of anemia (30

percent). The risks most common among children, other than failure to meet dietary guidelines, are

risk of anemia (24 percent), overweight (17 percent), and short stature (14 percent). Many infants do

 

4 The survey questions identify specific conditions of household food insufficiency, reduced quality and variety of foods, patterns of

reduced food intake, and direct hunger for adults and children.

Figure 11. Percent of WIC Participants By Number of 

Nutritional Risks

0%

20%

40%

60%

80%

100%

Pregnant Breastfeeding Postpartum Infants Children

One risk

Three risks Two risks

Four risks

Figure 10. Food Security Status of WIC Families 

Food secure

76%

Food insecure 

with hunger, 

severe

2%

Food insecure 

with no hunger

15%

Food insecure 

with hunger, 

moderate

7%
8 Executive Summary Abt Associates Inc.

not exhibit a specific nutrition risk but

are enrolled in WIC on the basis of

their mother’s current enrollment and

documented risk; 42 percent of all

infants have no other risk.

Incidence and Duration of

Breastfeeding

NSWP examined the breastfeeding

experience of WIC participants and

their siblings. One-half of WIC

children and 56 percent of WIC

infants had been breastfed for at least

some period of time. Among WIC

children who were breastfed, the median duration of breastfeeding was about 4 months and 85

percent were breastfed at least one month. The median duration of breastfeeding among infants was

not determined because 60 percent of infants who were breastfed were still breastfeeding at the time

of the NSWP interview.

NSWP found that the decision to breastfeed carries over multiple children in a family. Among WIC

infants with siblings, 78 percent of breastfed infants had siblings who were breastfed, wheras only 17

percent of non-breastfed infants had siblings who were breastfed. Similarly, among WIC children

with siblings, 86 percent of breastfed children had siblings who were breastfed, whereas only 18

percent of non-breastfed children had siblings who were breastfed.

Health Insurance Coverage

WIC is not a health care provider, but to ensure that WIC participants receive health care, WIC

provides screening and referrals to other health, welfare and social service agencies. NSWP found

that 83 percent of WIC enrollees had health insurance at the time that they applied to WIC. Most

WIC enrollees receive health insurance from the government’s Medicaid program (58 percent); about

one-fourth have employer-provided

insurance.

Because Medicaid eligibility varies

across states, all WIC enrollees are

not eligible for Medicaid. At the

time NSWP was fielded, Medicaid

income-eligibility was at or above

the WIC income limit in 29 of the 50

states.5 NSWP found that even in

states where all WIC participants are

eligible for Medicaid, 14 percent of

WIC participants have no health

insurance.

 

5 Thirty-eight percent of the NSWP sample lived in states with a Medicaid income limit equal to or greater than the WIC income limit.

Figure 12. Percent not Meeting Dietary Guidelines

0%

20%

40%

60%

80%

100%

Pregnant Breastfeeding Postpartum Children

Figure 13. Health Insurance Coverage

0%

20%

40%

60%

80%

100%

Pregnant Breastfeeding Postpartum Infants Children

Medicaid

Employer

Other
Abt Associates Inc. Executive Summary 9

The potential impact of WIC referrals on health insurance coverage can be seen in the different rates

of health insurance for NSWP respondents enrolling in WIC for the first time, compared to those recertifying in WIC. In states where all WIC participants are Medicaid-eligible, prior WIC experience

is associated with a statistically significant ten-percentage point increase in the Medicaid enrollment

rate; 57 percent of first-time WIC participants were enrolled in Medicaid, compared to 67 percent of

WIC re-enrollees.

Factors Affecting Enrollment and Continued Participation

NSWP included a “customer satisfaction” module to ask respondents how they learned about the

WIC program and whether they perceived barriers to WIC participation. Respondents with prior

WIC experience were also asked about their satisfaction with WIC food benefits, their rating of the

value of WIC services, whether they ever missed WIC appointments, and their experience shopping

for WIC foods.6

Most WIC enrollees learn about WIC from friends, family members, and doctors (each was cited by

about one-third of respondents). Relatively few WIC participants cited program advertisements as a

source of information referring them to the WIC program.

Few NSWP respondents perceived

“big problems” or barriers to WIC

participation. Respondents were

asked about several categories of

potential problems, shown in Figure

14. Only “transportation to the

clinic” was perceived as a big

problem by more than 5 percent of

respondents. Between 10 and 15

percent of respondents reported

“somewhat of a problem” with

factors affecting access to WIC

clinics, but overall, the majority of

respondents did not perceive barriers

to WIC participation.

NSWP respondents who had prior WIC experience were asked about satisfaction with WIC foods.

Figure 15 shows the distribution of satisfaction with brands of foods. Except for breakfast cereals,

more than 80 percent reported being “very satisfied” with brands, and less than 15 percent reported

they were only “fairly satisfied.” Breakfast cereals received the greatest dissatisfaction response, with

10 percent of respondents “not satisfied” with brands of cereals, and 28 percent only “fairly satisfied.”

 

6 Questions about WIC food satisfaction were not administered to a random sample of all WIC participants. Because of the sample

design, these questions were administered to a random sample of WIC participants who recertified in the program. These participants

may be expected to have higher levels of satisfaction than participants who voluntarily withdraw from the program or fail to apply for

recertification.

Figure 14. Perceived Barriers to WIC Participation

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Transport to

clinic

Clinic hrs Length of

time in clinic

Child care Language Qualifying for

benefits

Big problem

Somewhat of a problem

Not a problem
10 Executive Summary Abt Associates Inc.

The distribution of satisfaction

with food quantities was

consistent across all food

categories. More than 80

percent of respondents were

“very satisfied” with quantities

of food, including breakfast

cereal.

These high levels of

satisfaction with brands and

quantities of food correlate

well with respondents’

answers to questions of

whether they usually

purchased all food items listed

on the food voucher. Nearly 93 percent of respondents said they usually purchased all items. No

single WIC food category was identified as being particularly prone to being not purchased.

With respect to prior use of food vouchers at the store, 83.9 percent of respondents said it was “easy”

to use the vouchers, 14.2 percent said “sometimes confusing,” and 1.9 percent said shopping with

vouchers was “often confusing.”

The WIC program may yield many intangible benefits for participants in addition to the tangible

benefits of supplemental foods, nutrition education, and referrals to other health and social service

agencies. NSWP asked those respondents with prior WIC experience to rate the value of potential

WIC benefits on a scale of 0 to 5. Of the 12 potential benefits presented to respondents, only 2

received an average rating below 4: “time to talk with other mothers” and “taught me about

breastfeeding.” The highest rated benefits are “vouchers for foods I know are nutritious” (4.7),

“money saved on grocery bills” (4.5), “nutrition information”(4.4), and “checking blood, height, and

weight” (4.4).

In an effort to operate efficiently, most WIC service sites schedule appointments with participants for

measurement of health and nutrition status, nutrition education, and voucher pickup. Nearly one-half

(45.6 percent) of prior WIC participants said they had missed one or more appointments at the WIC

clinic, although 19.3 percent said that they had missed only one appointment. The most common

reasons given for missing an appointment were “forgot to go” (42.5 percent) and “trouble finding

transportation” (29.9 percent).

WIC Income-Eligibility Determination and Errors in Income

Certification

The NSWP provided data for estimating the national case error rate in WIC certification. Incidence

of errors in income eligibility were determined by collecting information about participants’ family

income and comparing income to WIC income-eligibility guidelines. The report reviews WIC

income-eligibility guidelines for the 26 states and 79 local WIC agencies represented in the NSWP

sample, and presents estimates of certification error.

Figure 15. Satisfaction with Brands of WIC Foods

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Breakfast

cereal

Juices Baby

formula

Milk Cheese Eggs Beans or

peanut

butter

Not satisfied

Fairly satisfied

Very satisfied
Abt Associates Inc. Executive Summary 11

WIC Income Eligibility Guidelines

In 1988, the WIC Income Verification Study reviewed policies and procedures for WIC incomeeligibility determination in 25 states. That study found policies and procedures for determining WIC

countable income showed near complete agreement across states, but policies and procedures for

determining an applicant’s economic unit (family size) indicated significant state-to-state variation,

sometimes due to contradictory guidelines.

In 1998, the NSWP found that policies for determining WIC countable income remained nearly

unchanged since 1988, still showing near complete agreement across states. Policies for determining

an applicant’s economic unit (family size) again showed state-to-state variation. In contrast to 1988,

however, most of the variation across states stems from rules regarding households with separate

economic units and applicants who are minors, and remaining variation is due to differences in the

comprehensiveness of guidelines and not from contradictory guidelines.

In 1998, state WIC agency policies did not reveal contrary guidelines, as they had in 1988. Most of

the uniformity in guidelines that developed during the ten-year period between studies appears to be

due to FNS instructions and written guidelines, which are evident in state WIC manuals.

Estimates of WIC Income Certification Error for the Contiguous United States

The WIC case error rate is the percentage of enrollees certified to receive, but not eligible for, WIC

benefits; the dollar error is the amount of total WIC food funds spent on ineligible participants.

Estimates of certification error are based on in-home interviews with a national sample of WIC

participants in the contiguous United States in spring 1998. In FY98, the contiguous United States

accounted for 96 percent of WIC participants and 95 percent of federal WIC food expenditures.

NSWP in-home interviews were designed to verify income information through review of income

documents, when available. This survey preceded implementation of provisions requiring WIC

participants to document income at WIC certification as provided in the William F. Goodling Child

Nutrition Reauthorization Act of 1998.

Analysis of WIC certification case

error yielded an estimate of the error

rate for the contiguous United States of

4.5 percent. This estimate is associated

with a 95 percent confidence interval,

as shown in Figure 16. The confidence

interval indicates that we are 95

percent confident that the national WIC

income-eligibility error rate falls

between 2.8 and 6.2 percent, with the

most likely value at 4.5 percent.

The estimate of the case error rate

yields a corresponding estimate of

annual dollar error for the contiguous

Figure 16. Estimate of WIC Case Error Rate

4.5%

0%

5%

10%

15%

20%

25%

Case Error Rate

Percent of caseload

95% 

confidence 

interval
12 Executive Summary Abt Associates Inc.

U.S. of $120 million, out of a total of

$2.6 billion in WIC food benefits

disbursed in FY98. This estimate,

together with the 95 percent

confidence interval, is displayed in

Figure 17. (The scale of this exhibit

represents one-fourth of annual WIC

food expenditures.) The 95 percent

confidence interval extends from

$68.9 to $171.9 million dollars, or

from 2.3 to 5.7 percent of annual

WIC food costs.

NSWP findings show that most

applicants certified for WIC are

correctly determined to be income-eligible. For those found ineligible, it is not possible to make

statements about sources of error because the sample size of ineligible participants is not large enough

to yield statistical precision.

An important finding of this study is that the WIC certification error rate estimate for FY98 is not

statistically different from the error rate estimate for FY88. During this ten-year period the WIC

program experienced enormous growth. For FY88 the last time that WIC certification error was

analyzed findings revealed a case error rate of 5.7 percent and dollar error of $84 million out of

total WIC food costs of $1.5 billion. For FY98, we estimate a case error rate of 4.5 percent for the

contiguous United States and dollar error of $120 million out of total WIC food costs of $2.6 billion.

In addition, this study found a statistically significant relationship between the case error rate and the

income documentation policy of WIC agencies. The error rate among cases enrolled at agencies

requiring income documentation was 2.9%, compared to 6.4% for those enrolled at agencies that did

not require income documentation. The provisions of the William F. Goodling Child Nutrition

Reauthorization Act of 1998, requiring income documentation at all WIC agencies, became effective

in 2000.

Figure 17. Estimate of Annual WIC Dollar Error

120.3

0

100

200

300

400

500

600

Dollar error

Dollars (millions)

95% 

confidence 

interval
1 Bartlett, Susan, Melanie Brown-Lyons, Douglas Moore, and Angela Estacion, WIC Participant and Program Characteristics 1998,

WIC-00-PC, Alexandria, VA: USDA/ FNS/Office of Analysis, Nutrition and Evaluation, 2000, Julie Kresge, Project Officer.

Abt Associates Inc. Chapter 1: Introduction 13

Chapter 1

Introduction

1.1 Overview of the WIC Program

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is administered by

the Food and Nutrition Service of the US Department of Agriculture (USDA). WIC was established in

1972 to counteract the negative effects of poverty on prenatal and pediatric health, and it provides a

combination of direct nutritional supplementation, nutrition education and counseling, and increased

access to health care and social service providers for pregnant, breastfeeding, and postpartum women;

infants; and children up to the age of five years. By intervening during the prenatal period, WIC seeks to

improve fetal development and reduce the incidence of low birthweight, short gestation, and anemia. 

Infants and children who are at nutritional or health risk can receive food supplements, nutrition education, and access to health care to maintain and improve their health and development.

An amendment to the Child Nutrition Act of 1966 established the WIC Program in 1972. WIC has

vastly expanded since its inception; in April 1998, WIC had approximately eight million enrolled participants and dispersed 2.8 billion dollars of food benefits.

At the federal level, the WIC Program is administered by USDA’s Food and Nutrition Service (FNS). 

FNS headquarters staff establish program policy, write program regulations, and provide program

information to the Secretary of USDA and the Congress. FNS has seven regional offices, whose staff

have responsibility for direct communication with 88 state WIC agencies. These WIC agencies are

located in each of the 50 states and in American Samoa, the District of Columbia, Guam, Puerto Rico,

and the American Virgin Islands. In addition, 33 Indian Tribal Organizations (ITOs) serve as state WIC

agencies. Approximately 2,200 local WIC agencies provide services to participants at about 9,000

service sites.1

Program Eligibility

To be eligible for WIC benefits, applicants must meet three types of eligibility criteria: categorical,

nutritional, and income.

Categorical eligibility is limited to five groups of applicants:

• pregnant women up to six weeks postpartum

• breastfeeding women up to one year after childbirth

• non-breastfeeding women up to six months after delivery

• infants up to one year old

• children aged one through four years (i.e., until their fifth birthday)
2 The National Academy of Sciences Institute of Medicine examined the scientific basis for nutritional risk criteria and made recommendations to the WIC Program. Together, FNS and representatives of the National Association of WIC Directors identified a set of uniformly

defined criteria that may be employed by state WIC agencies.

3 42 USC Sec. 1786 (b)(8).

14 Chapter 1: Introduction Abt Associates Inc.

To be nutritionally eligible, each applicant must be determined to be at nutritional risk. The determination must be based on a medical or nutritional assessment conducted by a competent professional authority, such as a physician, nutritionist, registered nurse, dietitian, or other health professional. In 1998, at

the time data were collected for this study, individual state WIC agencies established their own nutritional

risk criteria, following broad guidelines published in federal regulations. Since 1998, the WIC Program

has identified a set of specific nutrition risk criteria that may be employed uniformly by state WIC agencies in determining nutrition risks of WIC applicants. At the time this study was fielded, however, nutri- 2

tion risk included the following broad categories of risk, as specified in the implementing legislation:3

• detrimental or abnormal nutritional conditions detectable by biochemical or anthropometric

measurements

• other documented nutritionally related medical conditions

• dietary deficiencies that impair or endanger health

• conditions that directly affect the nutritional health of a person, such as alcoholism or drug

abuse

• conditions that predispose persons to inadequate nutritional patterns or nutritionally related

medical conditions, including, but not limited to, homelessness and migrancy.

As with nutritional risk criteria, income-eligibility criteria are set by each state agency. Per federal

regulations, a state WIC agency may adopt federal income guidelines for reduced-price school meals

under the National School Lunch Act (currently legislated at 185 percent of the Federal Poverty Income

Guidelines), or establish income guidelines identical to state or local guidelines for free or reduce-price

health care. The income limit may not exceed 185 percent or be less than 100 percent of the Federal

Poverty Income Guidelines.

Benefits

WIC participants receive supplemental food, nutrition education, and referral to health and social

services.

Supplemental food is provided in the form of food, food vouchers or food checks and is designed to

provide specific nutrients known to be lacking in the diets of low-income and nutritionally at-risk

populations. Seven different food packages are defined by federal WIC regulations: two for infants who

are age-dependent; one for children or women with special dietary needs; one for children aged one

through four years; one for pregnant and breastfeeding women; one for non-breastfeeding postpartum

women; and an enhanced package for breastfeeding women. FNS regulations specify the maximum
4 The full citation is Bartlett, Susan, Melanie Brown-Lyons, Douglas Moore, and Angela Estacion, WIC Participant and Program

Characteristics 1998, WIC-00-PC, Alexandria, VA: USDA/ FNS/Office of Analysis, Nutrition and Evaluation, 2000, Julie Kresge,

Project Officer.

Abt Associates Inc. Chapter 1: Introduction 15

amount of food allowed in each food package. Tailoring of food packages is allowed to improve

administrative efficiency or to meet the nutritional needs of individual WIC participants.

Nutrition education is provided to participants when they come to the local service site to pick up their

food vouchers or checks. Nutrition education may be provided in individual or group sessions; it is

designed to improve the health status of participants by promoting a positive change in dietary habits and

by emphasizing the relationships between good nutrition and good health. When applicable, breastfeeding practices are explained and promoted.

Referrals to health and social services also occur when participants come to service sites to pick up their

food vouchers or checks. Program staff provide participants with information about the Medicaid

program and other assistance programs for which the participant may be eligible. Information about

local resources for substance abuse counseling and treatment is provided as needed.

1.2 The National Survey of WIC Participants

The National Survey of WIC Participants and Their Local Agencies (NSWP) has two main goals. The

first goal is to provide, for a nationally-representative sample of WIC participants, supplemental data

about WIC household composition, income, and other information that allow FNS to understand better

characteristics of WIC participants that are not typically part of WIC information management systems. 

The second goal is to provide a nationally-representative estimate of case error rates and dollar error rates

within the WIC Program.

The entire NSWP, which is described in more detail in Chapter 2, includes four separate surveys

conducted in 1998: an in-person interview with 3,114 participants as they were being certified for WIC

benefits; a mail-out survey of the 79 local WIC agencies serving these participants; an in-home survey of

a sample of about one-third of the participants who responded to the in-person survey; and follow-up

telephone interviews of a sample of in-home survey respondents who reported earnings or an earnings

history. Together, responses to these four surveys address the study’s two main goals.

Provision of Supplemental Data

FNS compiles biennial reports on WIC participant and program characteristics based on information

contained in state WIC management information systems. The data, referred to as WIC’s Minimum Data

Set, are used for general program monitoring as well as for managing the information needs of the

program. FNS uses this regularly-updated WIC Program information to estimate budgets, identify needs

for research, and review current and proposed WIC policies and procedures.

Collectively, these WIC participant and program characteristics reports are referred to as the “PC

reports.” For instance, “PC98" refers to the report, based on 1998 data, which was released in 2000.4
5 The earlier PC reports—those in 1984, 1988, and 1990—were based on field interviews with nationally-representative samples of WIC

participants. FNS did not conduct a study in 1986.

16 Chapter 1: Introduction Abt Associates Inc.

Recent PC reports are based on administrative data files provided by state WIC agencies. These data 5

files provide information on nearly all WIC participants in April of each data collection year. Their

strength lies in the uniformity and near-census attributes of the data collected. With data from the PCs,

FNS can report, with virtually no estimation error, age, gender (for infants and children), size of

economic unit, race/ethnicity, up to three nutrition risks, blood measures (for women and children),

height, weight, trimester of enrollment (for pregnant women), and participation in other programs for the

universe of WIC participants.

As powerful a reporting tool as the PCs have become, they still have limitations:

• PC information on nutrition risks may underestimate the incidence of risk for two reasons: a

maximum of three risks is reported, even if the participant has more than three nutrition

risks; and some WIC service sites may not assess all relevant risks after a single risk is

identified and eligibility thus confirmed.

• The PCs include no information on the composition of the WIC economic unit; only the size

of the economic unit is reported.

• The PCs report total income of the WIC economic unit and participation in government

assistance programs, but they provide no information on specific sources of income or the

amount received from each source. Furthermore, income amounts are typically not reported

for approximately 10 to 15 percent of all WIC participants, in part because WIC applicants

participating in the Food Stamp Program (FSP), the Temporary Assistance for Needy

Families (TANF) program, or Medicaid are adjunctively income-eligible for WIC

participation and are not required to provide income information to WIC.

To enhance FNS’ ability to monitor the WIC Program and respond to information requests, the agency

sponsored the NSWP. The information collected by the NSWP’s in-person survey is broader and more

detailed than the data available in the PC reports. The in-person survey was conducted in WIC clinics

and collected information about:

• All persons living with the WIC participant, including age, gender, relationship to

participant, financial support provided or received, and WIC participation status.

• Each child living with the WIC participant, including date of birth, mother’s receipt of WIC

during pregnancy, each child’s breastfeeding history, each child’s history of enrollment in

WIC, and each child’s attendance of Head Start.

• Each adult living with the WIC participant, including marital status, employment status,

reason for not working (if not employed), enrollment in the Armed Forces, educational level,

and the amounts and sources of earned income and unearned income.
6 USDA/FNS, WIC Income Verification Study: Final Report, undated.

7 The dollar error rate is defined as the estimated value of food packages issued to ineligible participants divided by the total value of all

issued food packages.

8 The Western region, as defined by FNS for program administration, includes Alaska, Arizona, California, Hawaii, Idaho, Nevada, Oregon,

Washington, the territories of American Samoa and Guam, and three Indian Tribal Organizations.

Abt Associates Inc. Chapter 1: Introduction 17

• For the entire WIC household, the amounts and sources of investment income and income

from alimony, child support, lump sum payments, public assistance, and the value of

benefits from the FSP.

• Food spending for the WIC family, participation in food assistance programs other than the

FSP, and food security.

• Health insurance for the WIC participant; services provided by the health plan; for those

with no health insurance, reason(s) for not having insurance; and household enrollment in

Medicaid.

• How the participant learned about WIC, the degree to which certain factors make WIC

participation difficult, satisfaction with the WIC food prescription (brands and quantities),

perceived benefits of WIC participation, problems with missed WIC appointments, and

description of WIC shopping patterns.

In addition, service site staff completed forms indicating all nutrition risks that were assessed and

identified for each sampled participant.

Estimates of Case and Dollar Error Rates

The second goal of the NSWP is to provide new estimates of case error and dollar error rates within the

WIC Program. In 1990 FNS released findings from its WIC income verification (WIV) study. That 6

study estimated a national certification error rate of 5.7 percent; the estimated dollar error rate was 5.8

percent. The estimates were based on in-home audits of a national sample of WIC participants. This 7

dollar error rate translated into $84 million spent on ineligible participants out of a total food expenditure

of about $1.4 billion in FY88. The audits found income misreporting at certification to be high—over 43

percent of participants under-reported their income, and 22 percent over-reported their income. Due to

the actual low level of participant incomes, however, most misreporting did not translate directly into

errors of eligibility.

The WIC Program and caseload have changed greatly since the last income verification study, so there is

an increasing need for current information about case and dollar error rates. In 1988, the WIC Program

spent about $1.4 billion for food supplementation and served an average monthly enrollment of about 3.4

million. Ten years later, the average monthly enrollment had more than doubled to over 8.0 million, and

total food expenditures had increased to $2.8 billion. With this growth, there have been major changes in

the composition of the caseload, reflecting changes in the overall population. For instance, a

disproportionate amount of WIC caseload growth occurred in the Western states, which accounted for 13

percent of total WIC participants in 1988, and 24 percent of WIC participants in 1998. This regional 8
9 The distributions of WIC participants by certification category in 1988 and 1998 are shown in Exhibit 3-1 of Chapter 3.

18 Chapter 1: Introduction Abt Associates Inc.

shift is reflected in the racial/ethnic distribution of WIC participants, with Hispanics becoming a larger

proportion of the caseload (Hispanics were 21 percent of the caseload in 1988 and 32 percent in 1998).

Other changes also are evident from the PC reports. As a percentage of all WIC participants, pregnant

women and infants decreased slightly, whereas postpartum women more than doubled; children rose as a

percentage of all WIC participants, from 47 percent in 1988 to 51 percent in 1998. Other factors, such 9

as the distribution of income among WIC participants measured relative to the federal poverty guidelines,

showed only slight changes over the ten-year period.

1.3 Organization of the Report

The remainder of this report is divided into three chapters. Chapter 2 addresses methodological issues,

providing a general description of the NSWP sample design, survey operations, and sample representativeness. Chapter 2 is supplemented by three appendices that deal with survey and analysis methods. 

Appendix A provides detailed information about sample design and weighting procedures for survey

data. Appendix B describes procedures followed for the imputation of unreported data items, and

Appendix C describes the study’s procedures for calculating the food security index.

Chapter 3 of the report addresses the study’s first goal, that of providing supplemental information about

WIC participants and their households. Chapter 3 provides over 60 tables of information about participant characteristics; the size and composition of the WIC economic unit; income sources and amounts;

participants’ nutritional risks; food assistance, food spending, and food security; health insurance coverage; participants’ history with the WIC Program; and participants’ view of the program. The data are

based on the in-person survey of 3,114 WIC participants as they applied for WIC certification or recertification. In addition, the stability of WIC economic units’ employment status and participation in adjunct

programs (TANF and food stamps) is examined based on a follow-up telephone survey of a sample of

558 respondents to the in-person survey. A copy of the in-person survey instrument is included in

Appendix D. Appendix E provides supplementary information (standard errors of the estimates) about

the tables presented in Chapter 3.

Chapter 4 of the report addresses the NSWP’s second goal of estimating case and dollar error rates

within WIC. Chapter 4 includes a review of WIC income eligibility criteria and the results of in-home

interviews with a random sample of 931 respondents to the in-person survey. In-home interviews

provided an opportunity to verify respondents’ income reports through review of income documents. The

major sections of this chapter address derivation of the size and composition of the WIC economic unit,

calculation of total income for the economic unit, and derivation of case and dollar error rates.
Abt Associates Inc. Chapter 2: NSWP Sample Design 19

Chapter 2

NSWP Sample Design, Survey Operations, and

Sample Representativeness

The NSWP was designed to provide information on the characteristics of a representative sample of WIC

participants certified for WIC benefits during spring 1998. The NSWP sample of participants was

selected through a multi-stage sample design with coverage in the contiguous United States. Approximately 4,000 WIC participants were selected for the main NSWP sample; interviewers were able to

obtain interviews with 3,114 sampled participants or their parents/guardians.

The NSWP consists of three surveys of WIC participants and a survey of the local WIC agencies certifying those WIC participants:

• In-person survey. In-person interviews were conducted with 3,114 WIC participants, certified in 79 local WIC agencies, at 178 WIC service sites throughout the contiguous United

States. WIC participants were randomly sampled for interviews at the time of their WIC

certification. In-person interviews collected information about household composition,

demographics, individual and household income, nutrition risks, participation in public

assistance programs, history of family participation in WIC, food security, health insurance

status, and satisfaction with WIC benefits.

• In-home survey. Approximately one out of every three persons selected for in-person interviews was also selected for follow-up interviews in their homes. The in-home survey was

designed to verify income information through review of household income documents. Inhome interviews were completed with 931 respondents.

• Telephone follow-up. Approximately two-thirds of respondents to both the in-person and

in-home surveys were chosen for telephone follow-up interviews, conducted approximately

four months after their initial in-person interview. The telephone follow-up survey collected

information about employment status and participation in adjunct programs four months into

the WIC certification period. Telephone follow-up interviews were completed with 558

respondents.

• Local agency survey. The local agency survey was conducted with the 79 agencies certifying WIC participants selected for the in-person survey. This mail survey collected information about local WIC agency organization and operations.

In addition, WIC administrative data were collected for WIC participants responding to the surveys.

This chapter contains a description of the sample design for the NSWP, a description of data collection

activities, and an examination of the representativeness of the NSWP sample.
1 7CFR246.2.

20 Chapter 2: NSWP Sample Design Abt Associates Inc.

The NSWP sample is a survey of WIC “participants” in the strictest sense of the word. Interview data

were weighted so that the counts of certifications matched the population caseload counts reported in the

1998 Study of WIC Participants and Program Characteristics (PC98), based on state submission of

administrative data for all WIC enrollees (despite its title).

Throughout this report, the NSWP sample is referred to as a sample of WIC participants. In fact, the

NSWP sample frame included all WIC applicants who were certified during the sample period in spring

1998. It is therefore a sample of WIC enrollees. WIC regulations strictly define program participants as

those individuals “who are receiving supplemental foods or food instruments under the Program, and the

breastfed infants of participant breastfeeding women.” Under this definition, WIC participants are a 1

subset of WIC enrollees. Enrollees include all individuals who have applied and been certified for

program benefits, but enrollees who fail to pick up their current food instruments are not considered

participants.

At the time of certification, all enrollees are participants because WIC clinic staff issue food instruments

at certification.

2.1 Sample Design

The NSWP used hierarchical cluster sampling to obtain a national probability sample of WIC participants. The present section sketches the design of that sample. Appendix A describes the sample design

in detail.

Sampling proceeded in four stages:

Primary sampling units

\

Local agencies

\

Service sites

\

WIC participants

At the first stage the sampling frame consisted of primary sampling units (PSUs), defined as metropolitan statistical areas (MSA) or non-MSA clusters of counties. Local agencies were sampled within PSUs;

an average of two service sites were sampled for each local agency; finally, random samples of WIC

certifications and recertifications were drawn (by participant category) at each chosen service site. At the

first three stages of sampling, units were selected with probability proportional to a measure of size. The

goal was to interview 3,000 WIC participants overall, with 600 from each of the five WIC participant

categories (pregnant women, breastfeeding women, postpartum women, infants, and children). Exhibit

2-1 summarizes the overall structure of the sample design.
Abt Associates Inc. Chapter 2: NSWP Sample Design 21

Exhibit 2-1

Summary of the Final Sample Design for NSWP

First stage

46 PSUs

(3 self-representing,

43 non-self-representing)

\

Second stage 100 local agency selections

(80 distinct local agencies)

\

Third stage 200 service site selections

(181 distinct service sites)

\

Fourth stage 3,114 completed interviews

for WIC participants

\ \ \ \ \

639 completed

interviews for

pregnant women

627 completed

interviews for

breastfeeding

women

587 completed

interviews for

postpartum

women

614 completed

interviews for

infants

647 completed

interviews for

children

Data from the 1996 Study of WIC Participant and Program Characteristics (PC96) were used to

construct the sampling frame. The PC96 census counted the number of participants in each of the five

certification categories in each local agency in April 1996. PC96 provided estimates of current numbers

of WIC participants, and these estimates served as the measure of size for the first two stages of
22 Chapter 2: NSWP Sample Design Abt Associates Inc.

sampling. For the third stage, the numbers of participants came from information on service-site caseloads provided by the local agencies selected at the second stage.

First Stage

Construction of the sampling frame of PSUs began by determining the county location of each local WIC

agency. County location determined the agency’s inclusion in an MSA PSU, or in a predefined non-MSA

cluster of counties. The PC96 data on local agency caseloads were then aggregated to the PSU level.

The original design called for selection of 50 PSUs. Against this target, however, three PSUs (New York

City, Chicago, and Los Angeles) had large enough numbers of participants to be selected with certainty. 

Indeed, New York City and Los Angeles were so large that, if only two local agencies had been selected

from each city, their participants would have been seriously under-represented. We made the three

certainty PSUs self-representing by allocating local-agency selections to them in proportion to their

combined size, accounting for 14 of the 100 local agencies to be selected at the second stage of sampling. 

In preparation for obtaining the remaining 86 local agencies (a target of two per PSU), we completed the

first-stage sample by selecting 43 non-self-representing PSUs. Thus, the number of PSUs totaled 46.

Second Stage

The design called for 100 local-agency selections. As mentioned above, we allocated 14 of these selections among the three self-representing PSUs and two selections to each of the 43 non-self- representing

PSUs selected at the first stage. The sampling process assigned five selections to New York City, two to

Chicago, and seven to Los Angeles. In Los Angeles one local agency was so large that it received five of

the seven selections. Thus, we actually selected ten local agencies from the three self-representing PSUs.

In 16 of the 43 non-self-representing PSUs a single local agency received both of the selections, either

because it accounted for more than half of the participants in the PSU or because it was the only local

agency in that PSU. In these situations (parallel to the allocation of local agencies among the self-representing PSUs) we doubled the numbers of service sites and participants to be selected from that local

agency (at the third and fourth stages). A total of 70 distinct local agencies were selected from the nonself-representing PSUs.

The total number of local agencies selected was 80.

Third Stage

To construct the sample frame for the third stage, we contacted each local agency selected at the second

stage and obtained a list of its service sites and the expected number of monthly certifications. (Some

local agencies provided average monthly caseloads, which we divided by 6 to obtain expected certifications—using 6 months as the typical certification period.) We then used the expected number of monthly

certifications as the measure of size in selecting two service sites for each local-agency selection. If a

local agency had only a single service site, or if a site was sufficiently large, the sampling process selected

only one site for that local agency.

Exhibit 2-2 summarizes the sampling results in the first through third stages of selection. Where the

actual number of local agencies or sites selected is smaller than the target number of selections, the
Abt Associates Inc. Chapter 2: NSWP Sample Design 23

difference is accounted for by agencies or sites that received more than one selection in the sampling

process.

Exhibit 2-2

Summary of Sampling Results through the Third Stage

Self-Representing Non-Self-Representing

PSUs PSUs Total

First-stage selections 3 PSUs 43 PSUs 46 PSUs

Second-stage selections 14 local agency hits 86 local agency hits 100 hits

(10 local agencies) (70 local agencies) (80 agencies)

Third-stage selections 28 site hits 172 site hits 200 hits

(27 sites) (154 sites) (181 sites)

We completed selection of the first-stage and second-stage sampling units in November 1997 and

collected data for the site-level measures of size during December 1997 and January 1998, just prior to

the field period beginning in March 1998.

Three of the 181 selected sites did not participate in the study. Two sites closed just prior to the start of

the field period, and one site declined to take part in the study. Because of time constraints we could not

replace these sites. The lost sites accounted for approximately 5 percent of the expected sample of participants at the fourth stage.

One of the three lost sites was the only selected site within its local agency, so the final number of

selected local agencies is 79. The final number of selected sites is 178.

Fourth Stage

For the final stage of sampling in a selected local agency, we randomly assigned the two selected service

sites to the planned March and April 1998 data collection periods. For those sites selected twice, we

planned to collect data during both months.

During each site’s assigned data collection period, we drew five random samples of participants (one

sample per certification category) as they arrived for WIC certification or recertification. The number of

participants sampled in each category at each site was a function of the site’s caseload information, as

previously reported by the local agencies. The overall target number of sampled participants was 800 per

certification category, or 4,000 in total. With an expected survey response rate of 75 percent, the goal

was 600 completed interviews per certification category for the in-person survey, or 3,000 total interviews. We completed interviews for 3,114 participants.

The samples of WIC participants were drawn at the selected service sites concurrent with field interviewing. The sampling frames of certifications in the five categories were constructed from sign-in
24 Chapter 2: NSWP Sample Design Abt Associates Inc.

sheets maintained at each sample site. Systematic random sampling was used to draw the sample of

certifications in each category, with the total number sampled in each category being proportional to the

site’s average monthly caseload within that category.

2.2 Response Rates

At the fourth stage of sampling, the numbers of persons selected allowed for non-response. For the five

certification categories, Exhibit 2-3 shows total number of persons in the sample, the number of respondents, and the response rate. Response rates were reasonably uniform across certification categories,

varying from 73.6 percent for infants to 79.0 percent for pregnant women. The overall average was 76.5

percent.

Exhibit 2-3

Summary of Sampling Results at the Fourth Stage of Sampling

Certification Category Sample Persons Respondents Response Rate

Pregnant women 809 639 79.0%

Breastfeeding women 814 627 77.0

Postpartum women 787 587 74.6

Infants 834 614 73.6

Children 825 647 78.4

Total 4,069 3,114 76.5%

The response rates in Exhibit 2-3 reflect the loss of sampled persons for two reasons: non-response to

the survey and ineligibility for the survey. Of the 955 persons sampled but not interviewed, 241 (25.2

percent) were ineligible for the survey for one of three reasons: (1) they were put on the sign-in sheets in

error (they were not at the WIC service site for certification); (2) they were at the service site for certification but were ineligible; or (3) they were put on the wrong sign-in sheet. After accounting for these ineligible persons, the overall survey response rate (defined as completed interviews as a proportion of eligible persons) was 81.3 percent.

2.3 Weighting

For each participant who had a completed interview, the base sampling weight equaled the reciprocal of

the probability of selection, taking into account the four stages of sampling. (Appendix A gives the
2 A few cells defined by site and certification category (4.7 percent) had no respondents. These cells were combined with cells from the other

site for their local agency to calculate a non-response adjustment at the local agency level. For the 1.8 percent of cells that still had no

respondents, we made the non-response adjustment at the PSU level. Although it may seem surprising that a cell would contain no

respondents, the average number of completed interviews per cell was only 3.4 (i.e., 3,114 interviews divided by five certification

categories divided by 181 service sites).

3 STATA Statistical Software, Release 6.0, College Station, TX: STATA Corporation, 1999.

Abt Associates Inc. Chapter 2: NSWP Sample Design 25

details of these weights.) We made a multiplicative adjustment to these base weights to compensate for

non-response among the sampled certifications within cells defined by site and certification category.2

A further adjustment, using the iterative procedure known as raking, then brought the weighted counts of

certifications into agreement with the population caseload counts for the contiguous United States, as

reported in the 1998 Study of WIC Participant and Program Characteristics (PC98). Raking was done on

three variables: certification category, FNS region, and MSA location. That is, for each of these three

variables separately, the weighted sample total in each category equals the corresponding PC98 caseload

count.

No weights have been calculated for the local agency survey. Data from this survey have been merged

with the responses to the in-person survey to allow additional analysis of the in-person data. For any

proposed studies in which local agencies are the unit of analysis, we recommend accessing the larger

database of local agency data collected as part of PC98.

2.4 Calculation of Variances

The variances (and standard errors) of estimates calculated from the NSWP data are determined by the

sample design and by the sampling weights of the individual participants. Appendix A discusses the

relation of variances to the details of the sample design.

For all tables in this report, we used the STATA statistical software package to obtain point estimates

and standard errors that took into account the sample design and the final sampling weights. The survey 3

estimation procedures in STATA account for stratification and clustering of the sample. The presence of

certainty PSUs at the first stage of sampling led us to specify two strata for STATA: one contained the

certainty PSUs, and the other contained the non-certainty PSUs. These two strata involve different levels

of clustering, according to the stage at which the first random selection occurred. For STATA, in the

stratum of certainty PSUs the primary sampling unit is the local agency; in the stratum of non-certainty

PSUs it is the PSU. For a multistage cluster sample the variance-estimation procedures in STATA allow

arbitrary clustering within the primary sampling units, but they do not distinguish among possible

degrees of clustering (or lack of clustering) at lower levels. For the NSWP these lower-level clusters are

the service sites in the stratum of certainty PSUs and the local agencies in the stratum of non-certainty

PSUs. The inability to account for the effects of lower-level clustering on variance estimates is a limitation of the STATA software. The software’s documentation says that these limitations produce variance estimates that generally will be approximately unbiased or, if biased, will be biased toward more

conservative estimates. That is, the estimated standard errors will be larger than the true standard errors.

We cannot estimate the size of the possible bias in the estimated variances, but we expect any bias to be

small because the first-stage selections sampled a small portion of all PSUs (on the order of 6 percent). 
26 Chapter 2: NSWP Sample Design Abt Associates Inc.

Further, we note that this conservative approach reduces the chance of reporting a statistically significant

effect or difference when none actually exists.

2.5 Data Collection

This section describes data collection procedures for each component of the NSWP. All data collection

activities occurred between March and August 1998; the separate components of data collected are listed

in Exhibit 2-4. The main sample of respondents for NSWP was the sample drawn for in-person interviews; the in-home and telephone follow-up samples were subsamples of the main sample.

Exhibit 2-4

NSWP Data Collection Activities in 1998

Data Collection

Component Location / Method of Data Collection Datesa

In-person interviews WIC service sites or scheduled telephone interviews / Mar 9 – Apr 11

Paper-and-pencil survey Apr 13 – May 9

In-home interviews WIC participants’ homes / Paper-and-pencil survey Mar 19 – Jun 17

Telephone follow-up Computer-assisted telephone interviewing (CATI) Aug – Sep

Nutritional risk checklist WIC service sites / Form completed by nutritionist Concurrent with inperson interviews

Certification forms WIC service sites / Photocopying of certification forms Concurrent with inperson interviews

Local agency survey Mail survey to local WIC agencies selected at Stage 2 of Apr – May

sampling

a Dates listed for in-person interviews are the dates during which sampling was conducted in WIC service sites. When sampled

persons were unable to complete an interview in WIC clinics on the day of sampling, in-person interviews were schedule to occur

during a subsequent clinic visit or by telephone. Some of the telephone interviews fell outside the period of data collection listed.

In-Person Interviews

The in-person interviews collected detailed demographic information about WIC participants and their

families, and these interviews are the source of the tabulations presented in Chapter 3 of this report.

In-person interviews were conducted at WIC service sites. The WIC service sites selected during the

third stage of sampling were randomly divided into two groups, with each group assigned a survey period
4 The original survey design included a total field period of eight weeks. After the first four weeks in the field, we extended the initial survey

period by one week to meet required sample size. For the second survey period (beginning April 13), sampling rates were revised to ensure

sufficient sample from a four-week field period.

5 Sampling rates varied among sites and among certification categories within site.

6 This number is a slight overestimate because some interviews began while respondents waited to see clinic personnel, and the NSWP

interview was stopped and restarted to accommodate clinic functions. The length of the interview is calculated as the difference between

the start and stop times.

7 Sampled persons were ineligible for the survey if they were sampled under the wrong certification category, were at the service site for

services unrelated to certification when sampled, or were not subsequently certified for WIC.

Abt Associates Inc. Chapter 2: NSWP Sample Design 27

of 4 or 5 weeks. The sample was divided within local WIC agency (the second stage of sampling) so 4

that each local agency contributed sample during the entire survey period. As previously mentioned,

when only one site was selected within a local agency, that site contributed sample for the full survey

period.

Sampling

Sampling of WIC participants for in-person interviews occurred on a rolling basis as persons appeared in

WIC clinics for certification. Interviewers, with the help of clinic staff, maintained sign-in sheets on

which persons appearing for certification entered their names and checked-off certification category

(pregnant, breastfeeding, postpartum, infants, children). Interviewers transcribed names from the sign-in

sheets to a sampling book, maintaining the order of persons from the sign-in sheet but entering names

onto separate sampling pages for each certification category. The sampling books were pre-marked with 5

sample selections for both the in-person interview and the in-home interview. Approximately one-third

of persons sampled for the in-person interview were also simultaneously sampled for the in-home interview.

Interview

For the most part, in-person interviews were conducted at WIC service sites following sampling. When

sampled persons were unable to complete an interview in WIC clinics on the day of sampling, because of

time constraints, in-person interviews were scheduled to occur during a subsequent clinic visit or by telephone. Seventy percent of sampled persons were interviewed on the day of sampling, and 87 percent

were interviewed within one week of sampling. Nine percent of in-person interviews were conducted by

telephone, 8 percent were conducted in Spanish, and three interviews were conducted in Chinese. The

average completed length of the in-person interview was 39 minutes.6

The in-person interview was administered as a paper-and-pencil survey consisting of nine sections,

shown in Exhibit 2-5. The household enumeration was the backbone of the survey, collecting information about each member of the sampled person's household, including financial support arrangements. 

Household members sharing financial support with the sampled person were the focus of subsequent

questions regarding income, food security, and food spending.

The response rate for the in-person interview was 81.3 percent: 4,069 persons were sampled, 241 were

found ineligible for the survey, and 3,114 completed the interview. Respondents completing in-person 7

interviews received T-shirts for their children to acknowledge their cooperation.
28 Chapter 2: NSWP Sample Design Abt Associates Inc.

Exhibit 2-5

Main Sections of the In-Person and In-Home Interviews

Sections of the In-Person Interview Sections of the In-Home Interview

Introduction and WIC history Introduction

A. Household enumeration A. Household enumeration

B. Child roster B. Employment history

C. Adult roster C. Income review form: Individual income

D. Individual income and earnings D. Household income review form

E. Household income and food spending E. Immunizations

F. Food security F. Contact information

G. Health insurance

H. Customer satisfaction

I. Contact information

In-Home Interviews

The in-home interview was designed to collect income information through review of source documentation such as pay stubs, check stubs, income tax returns, and other financial records. The data from these

interviews provide the basis for determining WIC-income-eligibility error rates presented in Chapter 4 of

this report.

As noted above, approximately one-third of persons sampled for in-person interviews were also simultaneously sampled for an in-home interview. Notification of this dual selection was withheld until

completion of the in-person interview to eliminate possible effects of the dual selection on response to the

in-person interview. Following completion of in-person interviews, persons sampled for the in-home

interview were asked to participate in follow-up interviews in their homes, and interview dates were

scheduled. At the time of scheduling respondents received brochures advising them that they would

receive $20 certificates for completing in-home interviews, and listing the types of documents they

should have on hand for in-home sessions.

The study design called for scheduling the in-home interview within three weeks of the in-person interview to maximize recall. The reference period was the same for both interviews: during the in-person

interview, the respondent was asked about income received last month; during the in-home interview, the

respondent was asked about the reference period that was the calendar month prior to the in-person interview. Forty percent of in-home interviews were completed within three weeks of in-person interviews,

and a total of 87 percent were completed within six weeks of in-person interviews. The largest lag

between in-person and in-home interviews was 89 days.
Abt Associates Inc. Chapter 2: NSWP Sample Design 29

The in-home interview was administered as a paper-and-pencil survey consisting of six sections, shown

in Exhibit 2-5. Responses from the in-person interview were pre-printed on the survey instrument to

facilitate probing by interviewers when reviewing income documents, although these pre-printed amounts

were not incorporated in the questions administered by interviewers. The average length of a completed

in-home interview was 29 minutes.

Telephone Follow-up Survey

The telephone follow-up survey was designed to collect information about employment status and

participation in adjunct programs, for WIC participants’ families, four months into their WIC certification period. Approximately two-thirds of respondents to both the in-person and in-home interviews

were selected for a telephone follow-up interview (593 out of 931 in-home respondents were randomly

selected).

Interviews were conducted using computer-assisted-telephone-interviewing (CATI), and the response rate

for the telephone follow-up survey was 94 percent. Information from the telephone follow-up survey is

used to estimate rates of change in employment status and adjunct program participation four months

into the WIC certification period. This information is presented in Chapter 3.

Nutritional Risk Checklist

NSWP interviewers, working in WIC service sites, asked WIC clinic staff to complete a nutritional risk

checklist for each person sampled for NSWP. The nutritional risk checklist was developed for this study

to provide a standard format for collecting nutritional risk information across all WIC service sites. The

goal of the nutritional risk checklist was to collect information about both the total number of risks assessed and found for each sampled person. Completed forms were returned for 3,508 out of 4,069 sampled

persons (86 percent response). Among sampled persons with a completed in-person interview, nutritional risk checklists were returned for 3,004 out of 3,114 persons (96.5 percent).

Certification Forms

WIC certification forms contain information collected by WIC clinic staff during the certification

process. The design of the NSWP called for collection of WIC certification forms for all sampled

persons in order to reduce interview burden and eliminate from the in-person interview all items that

could be collected from the certification forms.

Information collected on WIC certification forms includes basic demographic information and information used to determine eligibility for the program, including the applicant’s name, address, date of birth,

age, race, sex, family size, family income, participation in adjunct programs, height and weight measurements, blood iron measurement, nutritional risks present at certification, and migrant status. Additional

information pertaining to WIC participation is recorded on certification forms of certified applicants: 

date of certification, certification category, WIC priority status, food package codes, trimester of enrollment for pregnant women.

Collection of certification forms proved difficult. Each state WIC agency has a unique certification form;

some are a single page, some are multiple pages, and some do not exist in paper form because
8 PC98 collected electronic data from all state WIC agencies comprising certification records for all persons enrolled in WIC as of April

1998. Persons sampled for NSWP prior to May 1 had a high probability of being found in the PC98 data, although some were not found

in PC98 because of variations in the timing of state WIC agency data delivery to PC98 and the timeliness with which certifications at local

WIC sites are uploaded to state data systems. PC98 does not include individual identifiers; to identify NSWP respondents in the PC98

data, we entered a limited number of data items from hardcopy certification forms and performed a match on local agency, certification

category, date of birth, family size, income, and certification date.

30 Chapter 2: NSWP Sample Design Abt Associates Inc.

certification is processed through computer programs. NSWP interviewers collected WIC certification

forms by photocopying them at WIC service sites or by requesting computer printouts from clinic staff.

Although the study attempted to obtain WIC certification forms for all 4,000 persons sampled for an inperson interview, WIC certification forms were obtained for only 2,955 sampled persons; forms were

obtained for 2,716 of the 3,114 persons with completed in-person interviews. The rate of successful

retrieval of certification forms was 77 percent for all sampled persons (excluding those found ineligible

for the survey) and 87 percent for completed interviews. Because of the difficulties retrieving certification forms in 25 different formats, some forms were incomplete. In addition, the certification forms are

complex and costly to convert to an electronic format. To minimize costs, certification data for persons

with completed in-person interviews were retrieved from PC98, when available. Among sampled 8

persons with completed in-person interviews, 61 percent have certification data retrieved from PC98, 26

percent have complete or partial certification data entered from hard-copy forms, and 13 percent have no

certification data from any source.

Local Agency Survey

The local agency survey was a mail survey of all local WIC agencies selected at the second stage of

sampling for NSWP. The survey instrument was nearly identical to the instrument administered to local

WIC agencies as part of the biennial 1996 and 1998 studies of WIC participant and program characteristics, conducted by USDA FNS.

The survey collected information about service delivery sites, income determination, nutritional education, food instrument issuance, health services, and staffing. Only two of the 79 local WIC agencies in

the NSWP sample failed to respond to the survey. Information collected from local agencies is used in

this report to tabulate participant characteristics by type of local agency, and to examine income-eligibility error rates by local agency characteristics.

2.6 Sample Representativeness

At the point in time of the in-person interview, each individual was enrolled in WIC and had received the

first month’s vouchers for WIC food items, thereby meeting the regulatory definition of being a participant in WIC. The NSWP was designed to represent WIC participants certified for WIC benefits during

spring 1998. We expect, however, that the NSWP findings will often be interpreted as representing the

entire WIC caseload at a point in time. Is this interpretation reasonable? Can NSWP be used in this

way? Does the NSWP sample of 3,114 participants at certification resemble the overall WIC caseload,

as measured by PC98? Does it resemble only all WIC certifications in March and April 1998?

The above questions are difficult to answer, for the reasons described below. Available evidence does

suggest that some population groups within WIC are under- or over-represented in the NSWP. Most
9 In 1998, states had the option to extend Medicaid eligibility to pregnant women and children up to age 5 with incomes above 185 percent

of poverty. In spring 1998, the Medicaid limit for these groups exceeded 185 percent of poverty in Arkansas, California, Hawaii,

Minnesota, Rhode Island, Tennessee, Vermont, and Washington. Source: National Governors Association, Health Policy Studies

Division, NGA Reports Online: State Medicaid Coverage of Pregnant Women and Children.

10 Only one inconsistency arose in applying sampling procedures. After the second stage of sampling, some sampled WIC agencies provided

WIC caseload data, rather than the number of monthly WIC certifications, as the measure of size of their sites. This approach did not

affect procedures for sampling service sites within the sampled agencies because both caseload size and the number of certifications are

reasonable measures of size.

Abt Associates Inc. Chapter 2: NSWP Sample Design 31

importantly, households with income greater than 185 percent of the poverty level appear to be overrepresented in the NSWP, as do households receiving Medicaid. These findings are related, however,

because households receiving Medicaid are adjunctively income-eligible for WIC, and some states use a

higher income threshold than 185 percent of poverty to determine Medicaid eligibility. In 1998, eight

states had a Medicaid income limit that exceeded 185 percent of poverty, and five of these states are in

the NSWP sample.9

Conceptually, the following four factors could cause the NSWP sample to differ from the overall WIC

caseload:

• The sample of WIC service sites selected for the survey could differ systematically from the

universe of WIC service sites in the contiguous United States.

• Some WIC participants coming to the sampled service sites for certification might have been

missed in the sampling logs, and these participants could differ systematically from the

participants who did sign in on the sampling logs.

• Among individuals sampled, the persons who refused to be interviewed could differ systematically from individuals who were interviewed.

• For infants, a sample of certificants at a point in time does not represent all enrollees at a

point in time because all infants are not certified for identical time periods. Infants are

certified for either a six-month period (and then recertified) or for one year. A sample of

certificants taken at a point in time under-represents infants with longer certification periods

relative to infants with shorter certification periods.

Any differences between the NSWP sample and the overall caseload must come from the contributions of

these four factors. It is possible, of course, that the effect of one factor could be fully or partially offset

by the contribution of another factor.

Representativeness of Sampled WIC Service Sites

As discussed earlier in this chapter, WIC service sites were selected at the third stage of sampling. We

have no reason to suspect that the first-, second-, and third-stage sampling procedures produced a nonrepresentative sample. The sampling process itself went smoothly. (Ordinarily, proper operation of the

probability sampling mechanism ensures the absence of sampling bias.) By chance, no Indian Tribal 10

Organizations (ITOs) were selected during the second stage of sampling, even though they were in the

sample frame.
11 For agencies that provided caseload data, we divided the caseload figures by a factor to account for the difference in average length of

certification period within separate certification categories. For instance, because children, breastfeeding women, and post-partum women

are all certified for six-month periods, we divided their caseload figures by 6 to estimate the number of monthly certifications. We assumed

an average certification period of 9 months for infants and 7.4 months for pregnant women.

12 The lost sites represent 3.6 percent of the unweighted sample and 4.9 percent of the weighted sample.

32 Chapter 2: NSWP Sample Design Abt Associates Inc.

Of the 181 individual sites sampled, two sites closed before the survey began, and one refused to participate once the survey began. These three WIC service sites, which together represented about 5 percent of

the expected weighted sample of participants, were not replaced. Rather, all sampled participants from

the remaining 178 service sites received larger sampling weights to compensate for the loss of sample

from the three sites.

Representativeness of Sampled Participants/Enrollees

Every applicant for WIC certification coming to a sampled WIC office in either March or April 1998

(depending on office) was supposed to sign a sheet maintained by NSWP interviewers at each site. The

sign-in sheet included space for date and name, and it asked that the person’s certification category be

checked. Interviewers transcribed names from the sign-in sheets to sampling logs specific to each of the

five certification categories. To the extent that some applicants who were subsequently certified failed to

sign in, bias could have been introduced into the NSWP sample.

It is difficult to obtain a precise estimate of the total number of people actually certified in the sampled

WIC offices during the period of survey operations, which extended from March 9 to April 11 in one set

of offices and from April 13 to May 9 in the second group of offices. The certification data provided by

the states as part of PC98 include local agency identifiers rather than service site identifiers, so the certification dates in the PC98 data could not be used to count the number of certifications in the selected

offices during the sample period.

The only readily available source of data on the number of certifications in specific WIC service sites is

the data collected by NSWP to conduct the third-stage sampling. In December 1997, current caseload

information was collected for each service site operated by local agencies selected at the second stage of

sampling. We requested that local agencies provide information on the average number of certifications,

by certification category, for each local office or clinic within the agency. Some agencies provided the

requested information, but others provided caseload data. In many instances we were told that the data

were estimates because many local agencies did not have information systems that could provide a count

of monthly certifications; data systems were designed to provide total caseload counts.

Using the data provided by the local agencies, we estimate that 77,450 people were certified in the

NSWP service sites during the period of survey operations. The loss of the three sites reduced the 11

estimate to about 74,700 for the remaining sites.12

The total number of persons who signed in at the NSWP sites during the survey period was about

66,900. Thus, we estimate that approximately 10 percent of all WIC participants in the sampled sites

failed to sign in. The reasons for missing these individuals are unclear. NSWP interviewers asked WIC

staff in the local sites to sign in all persons requesting certification. The interviewers themselves monitored the sign-in process. When the interviewers were on break or were interviewing other participants
13 Because PC98 captures active participants in April 1998, the distribution of infants' age-at-certification is subject to what statisticians call

length bias: longer spells of certification are over-represented and the age distribution is biased downward relative to the age distribution

that would be observed from certifications occurring in a typical month. This happens because PC98 captures certification information

about all currently certified infants who were certified during the previous 12 months. (Infants may be certified immediately after birth,

and the certification period is 6 months or up to their first birthday, at the discretion of local WIC agencies.) Most infants certified during

the prior year at age 6 months or older, however, will end their certification as infants and be captured in PC98 as children.

Abt Associates Inc. Chapter 2: NSWP Sample Design 33

they could not monitor the sign-in process. If the missed sign-ins occurred during these breaks, then

there is little reason to suspect bias in the sample, as the break periods would have been uncorrelated with

the characteristics of people arriving at the WIC service site. That is, the missed applicants would be

randomly distributed among all applicants.

Representativeness of Survey Respondents

As noted previously, 4,069 people were sampled for in-person interviews. Of this number, 241 were

later found to be ineligible for the sample, either because they were at the service site for services

unrelated to certification, they were not certified, or they were sampled in the wrong certification

category; this left 3,828 people eligible for interviews. With 3,114 completed interviews, the response

rate was 81.3 percent.

To examine the representativeness of respondents relative to sampled participants, we attempted to use

certification data collected from the offices to compare the characteristics of those who were interviewed

with the 714 participants who were sampled but refused to be interviewed. The frequency of missing

certification data among the 714 non-respondents was so high (74 percent) that this comparison could

not be pursued.

Overall Sample Representativeness

Despite the limitations on examining each possible component of sample bias, we are able to examine the

overall representativeness of the NSWP sample of 3,114 WIC participants by comparing the NSWP to

the PC98 census of WIC enrollees. Because the NSWP was not designed to be representative of WIC

enrollees in Alaska, Hawaii, or the U.S. territories, enrollees in these areas were dropped from the PC98

data before comparisons were made.

Exhibit 2-6 shows the distribution of selected characteristics for three groups of WIC participants: 

respondents to the NSWP in-person interviews; all WIC enrollees included in PC98, except those persons

in Alaska, Hawaii, and the U.S. territories; and those PC98 enrollees who were certified in either March

or April 1998. For comparisons between the NSWP and PC98, we focus primarily on the full PC98 data,

as opposed to just those enrollees certified in March or April. For age of infant at certification, however,

it is more appropriate to compare the NSWP only to those PC98 infants certified in March or April.13

The NSWP data reflect the weighting procedure described in Section 2.3.

It is difficult to say with certainty whether the NSWP is representative of the WIC population with

respect to race and ethnicity. The data in Exhibit 2-6 suggest that the NSWP over-represents white WIC

participants and under-represents minority groups; only the difference for American Indians, however, is

statistically significant. The under-representation of American Indians is not surprising, because of the

absence of any Indian Tribal Organizations (ITOs) in the sample of local WIC agencies. The overall
14 For pregnant women in the NSWP sample, the size of the economic unit does not include the fetus. The WIC program counts the fetus in

the size of the economic unit only if an income-ineligible pregnant woman would be income-eligible after adding the fetus to family size. 

PC98 data do not identify whether or not the fetus is counted in the family size of individual pregnant women.

34 Chapter 2: NSWP Sample Design Abt Associates Inc.

comparison of the racial distribution in NSWP and PC98 is hampered, however, because information on

race and ethnicity is missing for 17.2 percent of the NSWP sample. It is likely that the true percentage of

whites in the NSWP sample is overstated because a large percentage (24 percent) of cases with missing

race information are cases in California, and the WIC caseload in California is heavily Hispanic.

The NSWP appears to under-represent WIC families receiving Temporary Assistance for Needy Families

(TANF), whereas it over-represents WIC families receiving Medicaid. This lack of representativeness

may indeed be true, but there is some uncertainty about the accuracy of the PC98 data in this regard. 

WIC applicants receiving TANF, food stamps, or Medicaid are adjunctively income-eligible for WIC. It

is possible that some WIC agencies, once they ascertain that an applicant participates in one of these

three programs, do not ask about participation in the other two programs. This information would not

explain why PC98 shows a higher percentage of TANF participants than NSWP, so we conclude that

WIC families receiving TANF are indeed under-represented in the NSWP.

Turning to the size of the WIC economic unit, two-person families are under-represented in the NSWP. 

As discussed in Chapter 4, WIC agencies have some discretion in determining which household members

are part of the WIC economic unit. Thus, this particular difference is not strong evidence of sample

bias.14

The NSWP appears to under-represent the very poorest WIC families and over-represent families with

incomes above the 185 percent of poverty threshold. This situation would be consistent with the finding

that WIC families receiving TANF are under-represented in the NSWP. It is also consistent with the

possible over-representation of families receiving Medicaid. Rather than sample bias, however, these

differences may reflect differences in how income is measured, particularly if the NSWP was more

successful in capturing income data than are WIC staff during the certification process. Furthermore,

14.7 percent of the PC98 records have missing income data, making comparisons more difficult. This

rate of missing income data in the PCs has persisted throughout their history, and as a result, one of the

goals of the NSWP was to provide more complete measurement of the income distribution of WIC participants. Thus, income is not an appropriate measure on which to judge the representativeness of the

NSWP sample.

Examination of the participant’s age at certification shows the two datasets to be virtually identical on

this factor. The only significant differences in Exhibit 2-6 are for infants, and these differences disappear

when the NSWP is compared to PC98 participants certified in March or April of 1998.

On the one variable (age) that is neither difficult to measure nor missing from a sizable percentage of

either dataset, the NSWP closely matches the PC98 data. The apparent over-representation of higherincome families may be an artifact of differences in income measurement, or it may reflect an underlying

difference between the NSWP sample and the overall WIC caseload. The over-representation of higherincome families is consistent with the under-representation of families receiving TANF and the apparent

over-representation of families receiving Medicaid.
Abt Associates Inc. Chapter 2: NSWP Sample Design 35

Before turning to the next chapter, it is useful to refer again to Exhibit 2-6 and to compare the full PC98

caseload to the PC98 families certified in March and April of 1998. With the exception of age of infant

at certification, none of the differences is statistically significant. This lack of significant differences

suggests that the WIC caseload was relatively stable in April 1998, with the characteristics of new participants being similar to those already certified. In turn, this buttresses the NSWP’s use of a sample of

WIC families at certification to represent all WIC families in March and April of 1998.
_____________________________________________________________________________________

Exhibit 2-6

Percent Distributions of Participant Characteristics in NSWP In-Person Interviews and

PC98

_____________________________________________________________________________________

 PC98 PC98

 NSWP (All Months) (Mar!Apr)

_____________________________________________________________________________________

Race or ethnic characteristics

 American Indian 0.51 1.47 1.50 a

 (0.27)

 Asian 2.37 2.84 2.78

 (0.72)

 Black 19.47 23.87 23.37

 (3.24)

 Hispanic 25.96 30.97 31.29

 (4.03)

 White 51.68 40.85 41.05

 (5.05)

Adjunctive income eligibility

 TANF 13.35 19.03 18.95 a

 (1.59)

 Food Stamps 32.67 29.67 29.84

 (1.76)

 Medicaid 61.63 53.79 53.55 a

 (2.54)

Economic unit size

 1 2.65 2.27 2.41

 (0.47)

 2 10.95 14.45 14.29 a

 (0.94)

 3 25.99 26.92 26.37

 (1.10)

 4 28.22 26.85 26.97

 (1.21)

 5 17.37 16.17 16.42

 (1.11)

 6 or more 14.82 13.34 13.54

 (1.16)

Percent of poverty level 

 0-50 27.35 34.75 33.70 a

 (1.63)

 51-100 36.33 34.29 34.30

 (1.47)

 101-130 14.82 14.88 15.03

 (0.98)

 131-150 7.77 7.30 7.53

 (0.81)

 151-185 7.34 7.95 8.48

 (0.82)

 186-200 1.94 0.34 0.43 a

 (0.36)

 201-225 1.90 0.20 0.21 a

 (0.32)

 226-250 0.94 0.11 0.12

 (0.31)

 Over 250 1.61 0.19 0.19 a

 (0.33)

_____________________________________________________________________________________

NOTES: PC98 data exclude Alaska, Hawaii, and U.S. territories (American Samoa, Guam, 

Puerto Rico, and the U.S. Virgin Islands). "All months" includes the full PC98 file 

of certifications: May 1997 to April 1998. "Mar ! Apr 1998" includes PC98 records of 

certifications occurring in March and April 1998. Standard errors are shown in 

parentheses.

a The difference between NSWP and PC98 values is statistically significant.
_____________________________________________________________________________________

Exhibit 2-6 (cont.)

Percent Distributions of Participant Characteristics in NSWP In-Person Interviews and

PC98

_____________________________________________________________________________________

 PC98 PC98

 NSWP (All Months) (Mar!Apr)

_____________________________________________________________________________________

Pregnant women

 0 - 17 years 9.22 10.91 10.74

 (1.12)

 18 - 34 years 84.29 83.33 83.26

 (1.34)

 35 or more years 6.49 5.76 6.00

 (1.24)

Breastfeeding women

 0 - 17 years 3.78 4.19 4.48

 (0.78)

 18 - 34 years 84.68 85.05 85.17

 (1.84)

 35 or more years 11.53 10.76 10.35

 (1.63)

Postpartum women

 0 - 17 years 10.93 9.46 9.59

 (2.62)

 18 - 34 years 82.55 84.49 84.41

 (2.61)

 35 or more years 6.53 6.05 5.99

 (1.10)

Total women

 0 - 17 years 8.63 9.06 9.00

 (0.88)

 18 - 34 years 83.82 84.05 84.03

 (1.25)

 35 or more years 7.54 6.89 6.97

 (0.76)

Infants

 0 - 3 months 75.51 88.50 79.08 a

 (2.98)

 4 - 5 months 8.67 2.70 4.23 a

 (2.05)

 6 - 8 months 11.49 6.43 12.45 a

 (1.88)

 9 - 11 months 4.33 2.37 4.24

 (1.26)

Children

 1 year 33.99 34.77 33.72

 (1.91)

 2 years 23.84 25.68 25.25

 (1.47)

 3 years 25.81 22.84 22.59

 (1.97)

 4 years 16.37 16.70 18.44

 (1.56)

_____________________________________________________________________________________

NOTES: PC98 data exclude Alaska, Hawaii, and U.S. territories (American Samoa, Guam, 

Puerto Rico, and the U.S. Virgin Islands). "All months" includes the full PC98 file 

of certifications: May 1997 to April 1998. "Mar ! Apr 1998" includes PC98 records of 

certifications occurring in March and April 1998. Standard errors are shown in 

parentheses.

a The difference between NSWP and PC98 values is statistically significant.
Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 39

Chapter 3

Characteristics of WIC Participants and Households

The in-person survey component of the NSWP interviewed 3,114 program participants or their parents/

guardians as they applied for WIC certification. One of the primary goals of the survey was to supplement the basic demographic information about WIC participants assembled biennially in reporting of

WIC participant and program characteristics (the PCs). The NSWP covered a large number of topics for

which current information is unavailable from other sources. This wealth of information allows us to

characterize more fully the social and economic circumstances of WIC participants and their families.

The topics included in the in-person survey are:

• The participant’s prior experience with WIC.

• An enumeration of all persons living with the WIC participant, with information collected

about age, gender, relationship to participant, and financial support provided or received.

• For each child living with the WIC participant, their date of birth, whether the child’s mother

received WIC while pregnant, whether the child was breast-fed and for how long, the child’s

history of enrollment in WIC, and whether the child attends Head Start.

• For each adult living with the participant, their marital status, their employment status, their

reason for not working (if not employed), whether they are in the Armed Forces, and their

educational level.

• For every adult in the WIC economic unit, information about the amounts and sources of

earned income and unearned income.

• For the entire WIC household, information about the amounts and sources of investment

income and income from alimony, child support, lump sum payments, public assistance, and

the value of benefits from the FSP.

• For the WIC economic unit, information about food spending, participation in food

assistance programs other than the FSP, and food security.

• For the sampled person, information about health insurance and services provided by their

health plan; for those with no health insurance, reason(s) for not having insurance and

whether anybody in the household is currently enrolled in Medicaid.

• For the participant, information about how they learned about WIC, the degree to which

certain factors make WIC participation difficult, satisfaction with the WIC food prescription

(brands and quantities), the perceived benefits of WIC participation, problems with missed

WIC appointments, and description of WIC shopping patterns.
1 The biennial reporting of WIC Participant and Program Characteristics (the PCs) has been conducted since 1988. In 1988 and 1990, the

PCs drew nationally representative samples of WIC participants; the 1988 study sampled persons as they were certified, whereas the 1990

study drew a sample of all persons currently participating. Since 1992, the biennial PC studies have collected data on the universe of WIC

participants at a point in time, thus providing a snapshot of the caseload. 

40 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

A copy of the NSWP in-person survey instrument is presented in Appendix D.

This chapter includes over 60 exhibits presenting information about the topics listed above. Although

these provide extensive information, the exhibits only begin to plumb the wealth of new information

provided by the NSWP. Each topic covered by the exhibits could easily be the subject of a separate

monograph or report, with detailed examination of interrelationships among survey variables and testing

of hypotheses. Such analyses cannot be conducted within the scope of this study. Rather, the intent of

this report is to provide descriptive statistics that can help program officials understand the characteristics of WIC participants and their families. These descriptors, it is hoped, will also engender further use

of the NSWP for research purposes.

For the above reasons, this chapter offers few significance tests of differences between groups of participants. There are simply too many possible comparisons for this to be meaningful, especially because the

likelihood of erroneously concluding that a statistically significant difference exists increases as the

number of tests conducted increases. Nevertheless, it is recognized that readers may be interested in

determining whether certain values within a given exhibit are significantly different from other values

within the exhibit. For these readers, hypothesis tests may be conducted using the exhibits in Appendix

E. The exhibits in Appendix E mirror those in this chapter, but the appendix exhibits include the

standard error for each value presented in the exhibits. The introduction to Appendix E indicates how

these values and standard errors may be used to test for significant differences between pairs of values. 

Patterns noted in the text have taken into account the relevant standard errors.

A convention used throughout this chapter is to show rates of item non-response at the bottom of each

exhibit. The rates of item non-response show the percentage of respondents who failed to answer individual survey questions. The percentage distributions in the body of each exhibit have been “normalized” to account for item non-response. That is, the percentage distributions indicate the percentage of

respondents with a particular characteristic, based on respondents who answered the survey question. 

Respondents who did not answer the question are excluded from the distributions. By normalizing, we

implicitly assume that those who failed to respond are randomly distributed across response categories. 

This is a reasonable assumption, especially given the low rates of item non-response. This practice of

presenting normalized distributions and rates of item non-response is used throughout all exhibits within

the chapter.

3.1 Caseload Composition and Growth

The WIC caseload has grown considerably during the 1990s. Exhibit 3-1 shows total WIC caseload, by

participant category, as reported in the biennial PC studies. Over the ten years covered by the exhibit, 1

total caseload grew by nearly 134 percent, with the largest growth (316 percent) occurring for breastfeeding women. Although the caseload more than doubled, however, the rate of growth of the caseload

has steadily declined. From 1988 to 1990, caseload growth was 32 percent; in each of the subsequent

two-year time periods, rates of growth were 27 percent, 20 percent, 12 percent, and 4 percent.
____________________________________________________________________________________________________________________________________

Exhibit 3-1

Distribution of WIC Certifications by Participant Category, Census of WIC Participants, 1988 to 1998

____________________________________________________________________________________________________________________________________

 1988 1990 1992 1994 1996 1998 a a

____________________________________________________________________________________________________________________________________

Percent by participant category

 Pregnant women 13.1 13.5 13.6 12.0 11.3 11.1

 Breastfeeding women 2.7 10.4 3.6 4.0 4.3 4.8

 Postpartum women 5.5 b 5.2 7.2 7.3 7.3

 Total Women 21.3 23.9 22.4 23.1 22.9 23.3

 Infants 31.2 29.8 30.1 26.9 25.7 25.5

 Children 47.4 46.3 47.5 50.2 51.4 51.2

 Total 100.0 100.0 100.0 100.0 100.0 100.0

 Total WIC 3,440,089 4,538,112 5,754,003 6,907,849 7,747,441 8,042,758

____________________________________________________________________________________________________________________________________

Source: Study of WIC Participant and Program Characteristics, 1988-1998.

a Data for 1988 and 1990 reflect the contiguous United States and exclude Alaska, Hawaii, and outlying territories.

b In 1990, breastfeeding and postpartum women were combined into one reporting category because of small sample size of participants

 in 1990 study.
2 The PC data report age at certification, not age at first certification. Infants certified at 6 to 8 months of age are likely to be infants who are

being recertified after an initial six-month certification period. State WIC agencies have discretion in determining whether infants are to be

certified for six-month periods or for a period up until their first birthday. Because PC98 takes a snapshot of the caseload at a point in

time, infants with longer certification periods (certified at 0 to 3 months for a period up until their first birthday) are over-represented. In

contrast, PC88 (like NSWP) sampled participants as they were certified and recertified, thus avoiding the over-representation of infants

with long certification periods.

42 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

The declining rates of growth reflect a stabilization of the WIC caseload as WIC appropriations have

increased to near full-funding.

WIC caseload growth is most often measured from the biennial PC studies. The methodology for the PC

studies has changed over time, however, from a nationally representative survey of the contiguous United

States in 1988 to the full census of WIC participants conducted since 1992. As a result, caseload growth

measured from these numbers is slightly overstated. Exhibit 3-2 therefore compares the WIC caseload in

1988 and 1998, with Alaska, Hawaii, and the U.S. Territories excluded from the 1998 data for comparability.

The total WIC caseload in the contiguous United States, shown in Exhibit 3-2, increased 125 percent

between 1988 and 1998. By certification category, growth rates were:

• Pregnant women 91%

• Breastfeeding women 304%

• Postpartum women 202%

• Infants 84%

• Children 142%

Within the group of all children, a disproportionate share of the growth was for 3- and 4-year-old

children (173 and 188 percent growth rates, respectively).

The age distributions in Exhibit 3-2 also show that women served by the WIC program in 1998 were

somewhat older, on average, than women served by the program in 1988. In addition, it appears that the

program was more successful in enrolling infants at a younger age in 1998 than in 1988; this difference,

however, may be due to data differences in the two years.2

The above information on caseload size and the age distribution of WIC participants is available from the

biennial PC studies. The rest of this chapter examines NSWP information about WIC participants that is

generally not available from the PC studies.
_____________________________________________________________________________________

Exhibit 3-2

Distribution of Age of WIC Participants at Certification, by WIC Participant Category 

_____________________________________________________________________________________

 -- 1988 -- -- 1998 --

 Number Percent Number Percent

_____________________________________________________________________________________

Pregnant women

 0 - 17 years 51,919 11.52 93,610 10.91

 18 - 34 years 381,076 84.57 714,773 83.33

 35 or more years 17,605 3.91 49,387 5.76

 Total 450,600 100.00 859,381 100.00

Breastfeeding women

 0 - 17 years 2,798 3.00 15,687 4.19

 18 - 34 years 79,423 85.27 318,508 85.05

 35 or more years 10,921 11.73 40,307 10.76

 Total 93,142 100.00 376,463 100.00

Postpartum women

 0 - 17 years 20,803 10.94 53,929 9.46

 18 - 34 years 160,469 84.38 481,779 84.49

 35 or more years 8,898 4.68 34,486 6.05

 Total 190,170 100.00 573,899 100.00

Total women

 0 - 17 years 75,520 10.29 163,226 9.06

 18 - 34 years 620,968 84.60 1,515,060 84.05

 35 or more years 37,424 5.10 124,180 6.89

 Total 733,964 100.00 1,809,743 100.00

Infants

 0 - 3 months 629,696 59.81 1,744,930 88.81

 4 - 5 months 83,226 7.90 53,241 2.71

 6 - 8 months 221,170 21.01 126,803 6.45

 9 - 11 months 118,791 11.28 46,629 2.37

 Total 1,075,010 100.00 1,978,410 100.35

 Age not reported 22,126 2.06 6,806 0.34

Children

 1 year 654,781 40.25 1,347,308 34.77

 2 years 423,419 26.03 995,146 25.68

 3 years 323,973 19.92 885,201 22.84

 4 years 224,480 13.80 647,344 16.71

 Total 1,631,115 100.00 3,952,924 100.00

 Age not reported 4,462 0.27 77,925 1.97

 Total WIC 3,440,089 7,741,078 

_____________________________________________________________________________________

Age is missing for less than 2% of women in each year and each certification category. 

Source: Study of WIC Participant and Program Characteristics, 1988 (sample frame

included contiguous United States, including ITOs).

Study of WIC Participant and Program Characteristics, 1998 (excluding Alaska, Hawaii, 

and territories, to be comparable to PC88).
3 Of the 2,956 families represented in the NSWP, 154 contain multiple sampled persons. In 142 of these 154 families, the mother and at

least one infant or child was sampled for the survey. In the remaining 12 families, more than one participant in the infant and child

categories was sampled. When multiple family members were sampled for the survey, the survey was conducted once and the record was

duplicated for the other sampled members of the family. The rate at which NSWP sampled multiple persons in the same family does not

reflect the rate of WIC participation by multiple family members because multiple family members were eligible for sampling only if they

applied to WIC during the survey period. Survey results, presented later in the chapter, provide estimates of WIC participation by multiple

family members.

44 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

3.2 Characteristics of WIC Participants

The WIC program serves five categories of WIC participants: pregnant women, breastfeeding women,

postpartum women, infants, and children. These five categories are not independent. As presented in

later sections of this chapter, a large percentage of breastfeeding and postpartum women previously participated in WIC as pregnant women, a large percentage of WIC infants are born to women participating in

WIC when pregnant and continuing in WIC postpartum, and a large number of WIC children participate

first as WIC infants.

Because WIC provides continuity of care for women and their children, this section begins by examining

the demographic characteristics of WIC women and the mothers of WIC infants and children. Exhibits

3-3 and 3-4 present demographic characteristics of WIC women and WIC mothers, respectively. 

Throughout this chapter we distinguish between these two groups of women. “WIC women” refer to

WIC participants who are either pregnant, breastfeeding, or postpartum. “WIC mothers,” in contrast, are

the mothers of infants or children who are WIC participants. Many WIC mothers, of course, are also

WIC participants themselves. When both mother and infant (or child) were sampled for the survey, the

characteristics of the mother appear under both the WIC women and WIC mothers columns throughout

the exhibits in this chapter.3

Within Exhibits 3-3 and 3-4, the following information is provided about the survey respondent (participant or mother/guardian): marital status; whether an adult male resides in the household; education level;

whether the respondent attends college; employment status; if respondent not currently working, whether

employed in last year and reason for not working currently; and number of biological children. This

information is presented separately for each participant category and for the group of women as a whole. 

Then, at the right side of each exhibit, the same demographic information is presented, only this time

broken out by age of respondent (less than 18 years, 18-34 years, greater than 34 years).

Note that, for “reason not working,” the base for the presented distributions is those participants not

currently employed. Among WIC women, 75.1 percent were not currently employed at the time of the

survey, representing a WIC population of 1,359,117 participants. For WIC mothers, 72.5 percent were

not employed. The reason given most often by both WIC women and WIC mothers for not being

employed is that they are taking care of the house. Of those not currently employed, 52.4 percent of WIC

women and 50.2 percent of WIC mothers had been employed within the last 12 months.
____________________________________________________________________________________________________________________________________

Exhibit 3-3

Demographic Characteristics of WIC Women by Participant Category: Percent Distribution

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Age of Women 

 Women Women Women Women < 18 years 18-34 years > 34 years

____________________________________________________________________________________________________________________________________

Marital status

 Married 40.1 60.8 38.9 44.1 8.5 46.1 56.4

 Widowed, separated, or divorced 10.2 9.5 12.2 10.7 0.4 10.3 24.1

 Never married 49.6 29.7 48.9 45.2 91.1 43.6 19.4

Adult male present 69.5 79.0 60.1 68.5 57.0 70.1 70.6

Highest grade of education

 Less than 8 years 5.8 9.5 3.9 6.0 0.0 5.9 14.0

 8 - 11 years 26.2 19.9 25.1 24.5 0.0 28.0 16.8

 12 years 38.5 31.2 40.1 37.5 0.0 42.0 35.5

 13 or more years 19.9 33.9 18.3 22.3 0.0 24.0 32.5

 Schooling incomplete, age <18 9.6 5.0 12.2 9.4 100.0 0.0 0.0

Attending college

 Full time 3.6 4.1 1.8 3.1 0.0 3.7 0.0

 Part time 2.4 3.2 1.3 2.2 0.0 2.2 4.6

Employment status

 Currently employed 31.9 19.5 17.7 24.9 12.1 25.8 27.0

 Not currently employed 68.1 80.5 82.3 75.1 87.9 74.2 73.0

If not currently employed

 Employed in last 12 months 58.9 48.5 45.2 52.4 29.6 54.5 51.8 a

 Reasons not workinga

 Unemployed 21.7 9.3 11.6 15.4 7.9 16.3 16.0

 Keeping house 44.2 71.5 62.1 56.5 21.8 59.7 58.0

 Going to school 16.7 7.9 10.9 12.7 65.7 7.9 4.7

 Unable to work 12.8 7.6 9.8 10.6 4.7 10.8 16.2

 On temporary layoff 4.6 3.6 5.5 4.7 0.0 5.2 5.1

 Retired 0.0 0.0 0.1 0.1 0.0 0.1 0.0

Number of biological children

 None 48.5 0.0 1.3 23.5 46.2 22.7 7.4

 One 31.9 39.4 47.4 38.4 50.0 38.4 25.8

 Two 11.9 32.1 27.9 21.1 3.1 22.6 25.4

 Three 5.8 18.3 14.3 11.1 0.6 11.6 16.7

 Four or more 1.9 10.2 9.1 5.9 0.0 4.7 24.7

Rates of item non-response

 Marital status 2.9 0.5 4.5 2.9 14.8 1.8 1.7

 Highest grade of education 1.2 0.6 0.4 0.8 0.0 0.9 1.2

 Employment status 1.0 0.4 3.6 1.7 14.3 0.4 0.8

 Reasons not working 6.3 6.8 3.7 5.5 4.8 5.7 4.5 a

Sample size 639 627 587 1,853 140 1,548 149

Population 859,381 376,463 573,899 1,809,743 154,982 1,504,823 135,430

____________________________________________________________________________________________________________________________________

Respondents with missing data are excluded from percent distributions. Rates of item non-response are shown separately.

a Percent of those not currently employed.
____________________________________________________________________________________________________________________________________

Exhibit 3-4

Demographic Characteristics of Mothers of WIC Infants and Children: Percent Distribution

____________________________________________________________________________________________________________________________________

 Mothers of Mothers of Total Age of Mothers 

 Infants Children WIC Mothers < 18 years 18-34 years > 34 years

____________________________________________________________________________________________________________________________________

Marital status

 Married 49.4 51.9 51.1 22.8 52.6 51.7

 Widowed, separated, or divorced 11.3 17.9 15.7 2.7 13.2 32.1

 Never married 39.3 30.2 33.2 74.5 34.3 16.2

Adult male present 69.4 69.8 69.7 60.3 71.4 66.6

Highest grade of education

 Less than 8 years 6.0 5.1 5.4 0.0 5.1 8.7

 8 - 11 years 25.3 26.7 26.2 0.0 28.7 22.6

 12 years 35.2 41.3 39.2 0.0 41.7 40.3

 13 or more years 24.5 23.3 23.7 0.0 24.4 28.3

 Schooling incomplete, age <18 8.8 3.5 5.3 100.0 0.0 0.0

Attending college

 Full time 1.5 4.9 3.7 3.4 4.6 0.0

 Part time 2.0 3.1 2.7 0.0 2.9 2.4

Employment status

 Currently employed 18.0 32.2 27.5 14.9 26.8 34.4

 Not currently employed 82.0 67.8 72.5 85.1 73.2 65.6

If not currently employed

 Employed in last 12 months 52.3 49.2 50.2 32.4 51.9 46.5 a

 Reasons not workinga

 Unemployed 13.0 11.6 12.1 4.2 11.4 18.8

 Keeping house 63.9 68.8 66.9 56.8 68.4 63.1

 Going to school 6.5 8.4 7.7 28.9 7.2 2.5

 Unable to work 12.0 7.9 9.4 7.0 9.3 11.7

 On temporary layoff 4.2 2.8 3.3 3.2 3.6 1.9

 Retired 0.4 0.5 0.5 0.0 0.2 2.1

Number of biological children

 One 43.0 26.9 32.3 87.7 32.8 15.1

 Two 28.8 36.6 34.0 11.2 37.6 22.7

 Three 14.4 18.4 17.0 1.1 17.1 20.2

 Four or more 12.0 13.9 13.3 0.0 12.1 23.6

____________________________________________________________________________________________________________________________________

a Percent of those not currently employed.
____________________________________________________________________________________________________________________________________

Exhibit 3-4 (cont.)

Demographic Characteristics of Mothers of WIC Infants and Children: Percent Distribution

____________________________________________________________________________________________________________________________________

 Mothers of Mothers of Total Age of Mothers 

 Infants Children WIC Mothers < 18 years 18-34 years > 34 years

____________________________________________________________________________________________________________________________________

Rates of item non-response

 Marital status 1.5 1.8 1.7 4.2 1.7 0.0

 Highest grade of education 0.7 0.6 0.7 0.0 0.8 0.0

 Employment status 0.8 0.9 0.8 4.2 0.6 0.0

 Reasons not working 4.1 4.8 4.6 2.2 5.0 3.3 a

Sample size 614 647 1,261 64 1,015 169

Population 1,978,411 3,952,924 5,931,335 257,585 4,685,675 934,750

____________________________________________________________________________________________________________________________________

Exhibit reports demographic characteristics of mothers of sampled infants and children. Percents of infants and children with no

mother in household are 2.1% and 4.6%, respectively. If no mother is in household, characteristics of father or guardian are used 

for exhibit.

Respondents with missing data are excluded from percent distributions. Rates of item-nonresponse are shown separately.

a Percent of those not currently employed.
4 As described in Chapter 2, the NSWP stratified its primary sampling units into metropolitan statistical areas (MSAs) and non-MSA

clusters of counties. Throughout this chapter, “metropolitan” refers to the participant being served by a local agency located in an MSA.

5 The traditional Head Start program serves children ages three to five, and the NSWP asked about Head Start participation only for children

in this age group. Early Head Start is a new program begun in 1995 and serving low-income children from birth to age three, but this

program is only available in a limited number of communities.

48 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

Exhibit 3-5 repeats the demographic information presented in the previous two exhibits, but this time

divides WIC women and WIC mothers into those living within and outside of “metropolitan areas.”4

Based on the population counts at the bottom of the exhibit, just over 79 percent of all WIC participants

represented by the NSWP live in a metropolitan area. Compared to WIC participants living outside of

metropolitan areas, those living in metropolitan areas are somewhat less likely to be married, are less

likely to have an adult male present in the household, have completed fewer years of education, and are

about equally likely to be employed. The average number of biological children (not shown in the

exhibit) is virtually identical for the two groups—1.97 for participants in metropolitan areas and 2.03 for

participants in non-metropolitan areas.

Exhibit 3-6 presents a number of characteristics of WIC infants and children, including gender, birth

order, whether or not the biological mother and father are present in the household, whether this was the

infant or child’s first WIC certification, the mother’s WIC experience, whether the infant or child is in a

household receiving TANF or food stamps, and whether the WIC child also participates in Head Start.5

Interesting findings from this exhibit include:

• For both WIC infants and children, the biological father is present in approximately 58

percent of the households.

• Approximately 78 percent of mothers of WIC infants and 80 percent of mothers of WIC

children participated in WIC while pregnant. Similarly, 79 percent of WIC children’s

mothers participated postpartum, as did 91 percent of infants’ mothers. Approximately 5.7

percent of the mothers of WIC infants never participated in WIC in conjunction with the

sampled infant, compared to 8.7 percent of the mothers of WIC children.
_____________________________________________________________________________________

Exhibit 3-5

Demographic Characteristics of WIC Women and WIC Mothers by Metro-Nonmetro Location 

_____________________________________________________________________________________

 

 Metropolitan Nonmetropolitan

_____________________________________________________________________________________

Age

 <18 years 5.1 6.2

 18-34 years 80.0 79.7

 >34 years 13.8 14.0

Marital status

 Married 48.6 52.6

 Widowed, separated, or divorced 14.7 14.0

 Never married 36.7 33.4

Adult male present 67.8 75.8

Highest grade of education

 Less than 8 years 6.7 1.3

 8 - 11 years 26.7 22.6

 12 years 37.3 44.9

 13 or more years 23.0 24.9

 Schooling incomplete, age <18 6.2 6.3

Attending college

 Full time 3.5 3.8

 Part time 2.9 1.3

Employment status

 Currently employed 26.1 29.6

 Not currently employed 73.9 70.4

If not currently employed

 Employed in last 12 months 49.2 56.6 a

 Reasons not workinga

 Unemployed 12.0 16.6

 Keeping house 65.5 60.1

 Going to school 8.9 8.8

 Unable to work 9.2 11.9

 On temporary layoff 3.9 2.5

 Retired 0.5 0.0

Number of biological children

 None 5.3 6.1

 One 32.9 36.9

 Two 31.9 27.2

 Three 14.8 18.8

 Four or more 12.1 9.6

Rates of item non-response

 Age 1.1 0.1

 Marital status 2.2 1.3

 Highest grade of education 0.9 0.1

 College attendance 3.9 2.2

 Employment status 1.2 0.3

 Reasons not working, if not employed 4.3 6.9

Sample size 2,387 727

Population 6,143,639 1,597,439

_____________________________________________________________________________________

WIC women include pregnant, breastfeeding, and postpartum WIC certifications sampled 

for NSWP; WIC mothers include mothers of those infants and children sampled for NSWP 

at certification.

a Percent of those not currently employed.
_____________________________________________________________________________________

Exhibit 3-6

Demographic Characteristics of WIC Infants and Children at Certification: Percent

Distribution

_____________________________________________________________________________________

 WIC WIC

 Infants Children

_____________________________________________________________________________________

Gender

 Male 49.9 47.9

 Female 50.1 52.1

Birth order

 First 43.8 46.8

 Second 29.5 27.4

 Third or more 26.7 25.8

Household characteristics

 Biological mother present 97.9 95.2

 Biological father present 58.3 57.9

 Foster child 1.3 2.7

WIC experience

 First WIC certification 86.5 0.9

 WIC recertification 13.5 99.1

Mother's WIC experience with sampled child

 Mother in WIC when pregnant only 3.2 12.4

 Mother in WIC when pregnant & postpartum 74.5 67.7

 Mother in WIC postpartum only 16.6 11.3

 Mother not in WIC with sampled child 5.7 8.7

Other public assistance

 Receiving TANF 12.5 14.1

 Receiving Food Stamps 31.4 35.5

 Attending Head Start NA 6.6

Rates of item non-response

 Gender 1.7 0.9

 Birth order indeterminant 1.8 4.1

 WIC experience 3.1 7.6

 Mother's WIC experience 2.2 5.6

 Receiving TANF 1.6 1.9

 Receiving Food Stamps 1.0 1.6

 Attending Head Start 0.0 0.0

Sample size 614 647

Population 1,978,411 3,952,924

_____________________________________________________________________________________

Birth order is indeterminant for foster children (n=22) and children residing with 

guardians (n=11). These children are not counted among respondents to ‘mother’s WIC 

experience.’
6 FNS Guidance to States: Instruction 803-3, revised 1988.

7 See Chapter 4 for specific FNS guidance regarding the definition of family units.

8 The size and composition of the WIC economic unit are determined on the basis of responses to questions about financial support

arrangements within the household (see Section A of the in-person interview instrument in Appendix D). Use of survey responses to

determine economic unit size imposes consistent criteria across all survey sites.

9 Adults are defined as individuals aged greater than 18. For pregnant women, the size of the economic unit does not include the fetus. WIC

regulations stipulate that the economic unit be increased to reflect the fetus when a woman is found income-ineligible but would be eligible

with the fetus included in the measure of family size. We make this adjustment when measuring poverty levels later in the chapter.

10 Exhibit 3-8 shows a small percentage (3.9 percent) of postpartum women in units with only themselves as participants. Approximately

one-third of these women miscarried. The remaining two-thirds did not indicate WIC receipt for their children.

Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 51

3.3 Characteristics of the WIC Economic Unit

When participants apply for WIC, the local WIC office collects information about family size and family

income in order to determine program eligibility. The WIC program uses the terms “family” and

“economic unit” interchangeably and defines the economic unit as “a person or group of persons, related

or non-related, who usually (although not necessarily) live together, and whose production of income and

consumption of goods or services are related.”6

In most cases, the “family” consists of everyone living with the WIC participant—in other words, the

family contains everyone in the household. In some circumstances, however, a household may contain

more than one family unit, and WIC regulations define the WIC economic unit as an individual family

unit in these cases. Local WIC agencies have some discretion in determining the size of the economic 7

unit, depending on the composition of the household and the particular circumstances of the applicant

(see Chapter 4). In the PC studies, only the size and income of the economic unit are reported because

this is the information contained in state WIC information systems. For this study, we report on both the

size and composition of the WIC economic unit.8

Exhibit 3-7 presents summary statistics for the size of the economic unit, the number of adults in the unit,

and the number of WIC participants in the unit, by participant category. The average size of a WIC 9

economic unit is just over four persons, with an average of 1.77 adults and 1.81 WIC participants in the

unit. Exhibit 3-8 provides further information about the characteristics of WIC economic units by giving

the percentage distributions of values for the variables contained in Exhibit 3-7.

Exhibit 3-8 shows that the majority (59 percent) of WIC economic units contain more than one WIC

participant. This is not surprising because, by definition, breastfeeding and postpartum women are

mothers to WIC infants. Exhibit 3-8 shows, however, that more than 30 percent of breastfeeding and 10

postpartum women have one or more WIC participants in the family in addition to themselves and their

infant. Furthermore, about 30 percent of WIC pregnant women have one or more other WIC participants

in the family in addition to themselves.
____________________________________________________________________________________________________________________________________

Exhibit 3-7

WIC Economic Unit Composition by Participant Category: Mean, Median, Mode, and Standard Deviation for Economic Unit Size, Numbers

of Adults Present, and Number of WIC Participants

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Economic unit size 

 Mean 3.12 4.17 3.94 3.60 4.14 4.16 4.02

 Standard deviation 1.43 1.37 1.38 1.47 1.59 1.56 1.56 

 Median 3 4 4 3 4 4 4 

Adults in unit

 Mean 1.86 1.94 1.71 1.83 1.76 1.75 1.77

 Standard deviation 0.77 0.67 0.70 0.74 0.73 0.71 0.72 

 Median 2 2 2 2 2 2 2 

WIC participants in unit

 Mean 1.35 2.45 2.35 1.90 2.14 1.60 1.81

 Standard deviation 0.58 0.65 0.66 0.81 0.74 0.81 0.82 

 Median 1 2 2 2 2 1 2 

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________

Size of WIC economic unit is determined by number of persons who share financial support with WIC participant, as reported in survey,

except WIC participants who are foster children are assigned an economic unit size of one. There is no item non-response for variables

used to construct size of economic unit.
___________________________________________________________________________________________________________________________________

Exhibit 3-8

WIC Economic Unit Composition by Participant Category: Distribution of Economic Unit Size, Numbers of Adults Present, and Number of

WIC Participants

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Economic unit size

 1 7.7 0.0 0.4 3.8 1.3 2.7 2.6

 2 30.9 7.5 9.4 19.2 9.2 8.1 11.0

 3 30.3 25.7 32.9 30.2 26.8 23.7 26.0

 4 14.3 32.3 29.2 22.8 29.6 30.0 28.2

 5 10.3 21.1 17.4 14.8 16.6 18.9 17.4

 6 or more 6.4 13.5 10.7 9.2 16.5 16.5 14.8

Adults in unita

 None 1.2 0.6 1.7 1.2 3.9 3.3 3.0

 1 29.3 20.1 36.6 29.7 27.1 27.8 28.1

 2 56.0 67.4 52.2 57.2 59.9 61.2 59.9

 3 9.9 9.0 8.0 9.1 7.2 6.2 7.1

 4 2.9 2.4 1.4 2.3 1.5 1.0 1.5

 5 0.7 0.5 0.0 0.4 0.2 0.5 0.4

 6 or more 0.0 0.0 0.0 0.0 0.1 0.0 0.0

WIC participants in unit 

 1 69.5 0.0 3.9 34.2 16.0 56.6 41.0

 2 26.1 62.7 64.0 45.7 58.1 30.1 40.9

 3 3.9 30.3 26.1 16.4 21.8 10.6 14.8

 4 or more 0.5 7.0 6.1 3.6 4.1 2.7 3.3

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________

Size of WIC economic unit is determined by number of persons who share financial support with WIC participant, as reported in survey. 

The only exception is for WIC participants who are foster children: foster children who are WIC pregnant women, infants, or children

are assigned an economic unit size of one; foster children who are WIC breastfeeding or postpartum women are assigned an economic unit

size of two if they reside with their infant.

Approximately one-third of postpartum women with only one WIC participant in the family are women who miscarried; remaining two-thirds

did not indicate WIC receipt for their infant. There is no item non-response for variables used to construct size of economic unit.

a Adults are identified as persons over age 18 years. Of the WIC economic units with no adults, 60% contain a WIC participant who is

 a foster child, and the remainder contain a WIC mother age 18 years or younger.
11 Data collected for the biennial PC reports do not include the family identifiers needed to identify multiple WIC participants within a

family. Furthermore, WIC administrative data do not include information on non-participating family members, and could not be used to

examine rates of participation among categorically-eligible family members.

12 USDA FNS, Instruction 803-3 (1988). See Chapter 4 for more information about the definition of the economic unit.

54 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

Exhibit 3-9 shows the same basic information as Exhibit 3-8, again by participant category, but broken

out as well by whether or not the respondent’s local WIC office is located in a metropolitan area. For the

entire WIC caseload (“Total WIC” column), the distributions of the size of the WIC economic unit, the

number of adults in the family, and the number of WIC participants per family are about the same in

metropolitan and non-metropolitan areas.

The previous three exhibits reported on the incidence of WIC participation by multiple members of the

WIC economic unit. It is not surprising that multiple members of a family participate in WIC: if an

individual meets the WIC income-eligibility criteria, then all members of the individual’s family also

meet those criteria. Additional members of the family may be enrolled in WIC as long as they are categorically eligible and are at nutritional risk. The next exhibits in this section examine the rates of participation among age-eligible siblings of sampled WIC infants and children.11

The top portion of Exhibit 3-10 shows the percentage of sampled WIC infants and children with siblings

who are age-eligible for WIC. Approximately 42 percent of WIC infants and 47 percent of WIC children

have siblings younger than 5. The mean number of age-eligible siblings is about 0.55. Many WIC

infants and children also have siblings too old for WIC. As shown in the bottom of the exhibit, about 28

percent of WIC infants and 44 percent of WIC children have siblings older than 5.

Exhibits 3-11 and 3-12 focus on those sampled WIC infants and children with age-eligible siblings. 

These exhibits show that most age-eligible siblings also participate in WIC. For instance, Exhibit 3-11

shows that, for WIC infants and children with one age-eligible sibling, 80.8 percent of these siblings

participate in WIC. For those with two age-eligible siblings, in 66.7 percent of the families both ageeligible siblings also participate, and in 20.7 percent of the families one of the two age-eligible siblings

participates in WIC.

Within the group of age-eligible siblings, however, older siblings are less likely to participate in WIC

than young siblings. As shown in Exhibit 3-12, 92.8 percent of infant siblings of sampled WIC infants

and children participate in WIC, whereas 90.6 percent of one-year-old siblings participate. For fouryear-olds, the participation rate drops to 69.9 percent. Because all of these siblings are income-eligible,

the decline in WIC participation with age may indicate a decline in nutritional need among older children.

The final exhibit on WIC families (Exhibit 3-13) looks at the relationship between the economic unit and

the entire household, and the extent to which WIC households are multi-generational. The WIC economic unit is defined as a “group of related or non-related individuals who usually, although not necessarily, live together, and whose production of income and use of goods and services are related. For 12

nearly 85 percent of the NSWP’s sampled participants, the economic unit comprises the entire household. 

In the remaining 15 percent of cases, the household contains related or unrelated individuals who are not

part of the economic unit. Overall, about 4 percent of households contain individuals unrelated to the
____________________________________________________________________________________________________________________________________

Exhibit 3-9

WIC Economic Unit Composition by Metro-Nonmetro Location: Distribution of Economic Unit Size, Numbers of Adults Present, and Number

of WIC Participants

____________________________________________________________________________________________________________________________________

 Pregnant Women Breastfeeding Women Postpartum Women Total Women

 Metro Nonmetro Metro Nonmetro Metro Nonmetro Metro Nonmetro

____________________________________________________________________________________________________________________________________

Economic unit size

 1 7.4 8.8 0.0 0.0 0.3 0.8 3.5 4.7

 2 33.0 23.9 7.9 4.9 9.9 7.6 20.2 15.4

 3 30.3 30.3 25.3 27.5 32.4 34.7 29.9 31.3

 4 13.7 16.5 32.6 31.2 30.7 23.8 23.2 21.3

 5 10.1 11.1 20.9 21.8 15.0 25.9 14.0 17.8

 6 or more 5.5 9.4 13.3 14.6 11.7 7.1 9.2 9.5

Adults in unit

 None 1.0 2.1 0.7 0.0 1.3 3.1 1.0 2.1

 1 29.4 29.0 20.4 18.5 39.4 26.9 30.5 26.6

 2 56.5 54.3 66.5 72.2 49.8 60.9 56.6 59.4

 3 8.7 14.1 9.8 4.5 8.4 6.6 8.8 10.0

 4 3.6 0.5 2.3 2.6 1.2 2.5 2.6 1.5

 5 0.9 0.0 0.2 2.1 0.0 0.0 0.5 0.3

 6 or more 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

WIC participants in unit

 1 69.8 68.7 0.0 0.0 4.3 2.4 33.9 35.4

 2 26.2 25.6 60.9 72.4 62.1 70.6 45.0 48.2

 3 3.4 5.7 31.8 22.2 27.4 21.6 17.2 13.7

 4 or more 0.6 0.0 7.3 5.4 6.3 5.4 3.9 2.7

Sample size 481 158 514 113 442 145 1,437 416

Population 668,251 191,130 315,918 60,545 446,008 127,891 1,430,17 379,566

____________________________________________________________________________________________________________________________________

Size of WIC economic unit is determined by number of persons who share financial support with WIC participant, as reported in survey. 

The only exception is for WIC participants who are foster children: foster children who are WIC pregnant women, infants, or children

are assigned an economic unit size of one; foster children who are WIC breastfeeding or postpartum women are assigned an economic unit

size of two if they reside with their infant. There is no item non-response for variables used to construct size of economic unit.
____________________________________________________________________________________________________________________________________

Exhibit 3-9 (cont.)

WIC Economic Unit Composition by Metro-Nonmetro Location: Distribution of Economic Unit Size, Numbers of Adults Present, and Number 

of WIC Participants

____________________________________________________________________________________________________________________________________

 Infants Children Total WIC

 Metro Nonmetro Metro Nonmetro Metro Nonmetro

____________________________________________________________________________________________________________________________________

Economic unit size

 1 1.5 0.6 3.0 1.7 2.7 2.2

 2 8.7 11.2 8.1 7.9 11.1 10.5

 3 27.8 22.7 24.8 19.6 26.7 23.1

 4 29.5 30.1 29.8 30.8 28.2 28.4

 5 15.9 19.4 18.4 20.8 16.8 19.7

 6 or more 16.6 16.0 15.8 19.1 14.5 16.1

Adults in unit

 None 4.4 2.1 3.9 1.7 3.3 1.9

 1 27.9 23.9 29.2 22.5 29.2 23.8

 3 6.8 8.8 6.4 5.5 7.1 7.4

 4 1.8 0.4 0.9 1.6 1.5 1.3

 6 or more 0.1 0.0 0.0 0.0 0.0 0.0

WIC participants in unit

 1 16.2 15.3 55.0 62.5 40.0 44.7

 3 22.4 19.6 11.6 6.8 15.7 11.5

 4 or more 4.6 2.1 2.6 2.9 3.4 2.7

Population 1,593,475 384,936 3,119,987 832,937 6,143,639 1,597,439

____________________________________________________________________________________________________________________________________

The only exception is for WIC participants who are foster children: foster children who are WIC pregnant women, infants, or children

are assigned an economic unit size of one; foster children who are WIC breastfeeding or postpartum women are assigned an economic unit
_____________________________________________________________________________________

Exhibit 3-10

Distribution of WIC Infants and Children, by Number of Siblings Age-Eligible for WIC

_____________________________________________________________________________________

 Infants Children Total

_____________________________________________________________________________________

Percent with any siblings 42.2 46.6 45.1

 age-eligible for WIC

Number siblings age-eligible for WIC

 None 57.8 53.4 54.9

 One 32.8 39.3 37.1

 Two 7.4 6.5 6.8

 Three 1.9 0.6 1.0

 Four or more 0.1 0.2 0.2

Mean number siblings age-eligible for WIC 0.54 0.55 0.55

Percent with any siblings 28.4 43.9 38.7

 age 5 years or older

Number siblings age 5 years or older

 None 71.6 56.1 61.3

 One 14.9 25.1 21.7

 Two 9.0 12.4 11.3

 Three 2.4 4.2 3.6

 Four or more 2.0 2.2 2.1

Mean number siblings age 5 years or older 0.52 0.72 0.66

Sample size 614 647 1,261

Population 1,978,411 3,952,924 5,931,335

_____________________________________________________________________________________
_________________________________________________________________________________________________

Exhibit 3-11

Percent of WIC Infants and Children, by Number of Siblings Age-Eligible for WIC and Number of

Siblings Receiving WIC

_________________________________________________________________________________________________

 Number of Siblings Currently Receiving WIC

 __________________________________________

 None One Two Sample Size Population

_________________________________________________________________________________________________

Number siblings ageeligible for WIC

 One 19.2 80.8 -- 474 2,298,070

 Two 12.6 20.7 66.7 111 503,105

_________________________________________________________________________________________________

The number of WIC infants and children with age-eligible siblings is 600 (44% of infants and 51%

of children). Thirteen sampled persons have three age-eligible siblings and two sampled persons

have four age-eligible siblings; they are not shown in the exhibit due to the small cell sizes.

__________________________________________________________________________________________

Exhibit 3-12

Percent of Siblings of WIC Infants and Children Who Are Also Certified in WIC, by Age of

Siblings

_____________________________________________________________________________________________

 Percent Percent Number Siblings

 Currently in WIC Not in WIC in Age Group

_____________________________________________________________________________________________

Age of siblings

 Less than 1 year 92.8 7.1 182

 1 year old 90.6 9.4 139

 2 years old 82.6 17.4 144

 3 years old 78.6 21.4 140

 4 years old 69.9 30.1 123

 Total 83.8 16.2 728

_____________________________________________________________________________________________

There are 728 age-eligible siblings among the 600 sampled WIC infants and children with ageeligible siblings. Population counts are not provided on this exhibit because the unit of

analysis is not the sampled WIC participant.
____________________________________________________________________________________________________________________________________

Exhibit 3-13

Characteristics of WIC Households, by Participant Category

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Household relationship to economic unit

 Percent of WIC economic units 83.5 86.1 81.1 83.3 84.1 85.7 84.7

 residing by themselves

 Percent of WIC economic units 16.5 13.9 18.9 16.7 15.9 14.3 15.3

 residing in larger households

 Percent of households containing 6.6 5.4 3.7 5.4 4.4 3.5 4.2

 unrelated individualsa

WIC economic units by number of household members not counted in unit

 None 83.5% 86.1% 81.1% 83.3% 84.1% 85.7% 84.7%

 One 6.5 5.2 8.9 7.0 4.1 6.1 5.8

 Two 3.6 3.5 5.0 4.0 4.8 1.9 3.1

 Three 3.6 3.2 1.7 2.9 3.0 3.1 3.0

 Four or more 2.8 2.0 3.4 2.8 4.0 3.3 3.3

Multigenerational households

 Percent of households that 25.7 16.4 29.3 24.9 23.1 15.3 19.5

 are multigenerational

 Percent of multigenerational 63.4 45.6 51.3 56.4 59.5 51.6 55.4

 households in which all household

 members are in WIC economic unit

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________

Household, by definition, is equal to or larger than WIC economic unit. WIC economic unit consists of all individuals residing with

and sharing income with WIC participant. Household, however, consists of individuals residing with WIC participant, regardless of

financial support arrangements.

Multigenerational households are indicated by presence of more than one generation of adults in household. These are predominantly 

WIC women and WIC mothers residing with their parents.

a Unrelated individuals are persons reported to be "roomer/boarder" or "other non-relative." Persons reported as "partner" (e.g.,

 boyfriends) are not considered unrelated individuals.
60 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

WIC participant. The middle portion of the exhibit indicates the distribution of the number of individuals

who are in the household, but who are not counted in the WIC economic unit.

The bottom portion of Exhibit 3-13 shows that 19.5 percent of WIC households are multi-generational,

in the sense that the adults in the households represent more than one generation (e.g., a WIC mother and

her parents or grandparents). Multi-generational households are more common for young mothers: the

percentage of WIC women/mothers in multi-generational households is 56 percent for teens, 21 percent

for 20- to 24-year-olds, and 9 percent for all others (not shown in exhibit). In 86 percent of multi-generational households, the WIC woman/mother resides with her parents, step-parents, or in-laws; an additional 6 percent live with grandparents, and the remainder live with other relatives. Exhibit 3-13 indicates that 55.2 percent of all respondents in multi-generational households report that financial support is

shared across generations, and that all household members are part of the WIC economic unit.
13 This is consistent with the methodology used by the Study of WIC Participant and Program Characteristics, 1988, which was based on a

national survey of WIC participants.

Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 61

3.4 Income of WIC Participants

Federal regulations require WIC participants to meet income-eligibility criteria specified by state WIC

agencies. According to state income eligibility standards in place at the time of this survey, all applicants

to WIC must have family income at or below 185 percent of the federal poverty guidelines, or be adjunct

eligible by demonstrating certification for food stamps, TANF, or Medicaid. Information about WIC

income eligibility is captured in WIC information systems and reported in the biennial PC reports.

The NSWP supplements existing information about WIC family income in two important ways. First,

whereas the PCs report on total family income, the NSWP collected data on the components of family

income to gain a better understanding of the economic circumstances of WIC families. Second, the

income data presented in the PC reports may be incomplete for families determined to be WIC-eligible

due to participation in other means-tested programs. PC reporting guidelines instruct states to record the

self-declared income of these families for general estimation purposes; the 1998 PC data files, however,

are missing family income data for 21 percent of adjunct-eligible participants (income was missing for

14.6 percent of all participants).

This section of the report presents detailed information about the income of WIC participants, including

those who were certified as adjunct eligible. In the tables that follow, we report rates of adjunctive and

automatic income-eligibility, sources of family income and amounts by source, and total family income

by participant characteristics. Income information is based on the full NSWP sample of 3,114 WIC

participants. In addition, we show rates of change in employment status and adjunct program participation, as measured approximately four months after WIC certification by a telephone follow-up survey. 

(Chapter 4 of the report presents findings from the in-home income verification portion of this study,

based on a one-third sample of respondents to the NSWP in-person survey.)

Measuring Family Income

The NSWP collected data on all sources of income within each WIC family and determined total family

income using a uniform procedure across all survey sites. Each respondent was asked a series of ques- 13

tions that identified members of the WIC participant’s economic unit (see Section A of the in-person

interview instrument in Appendix D). The economic unit was determined to be all persons who shared

financial support with the WIC participant. The respondent was then asked to report on the income

received by each member of this economic unit during the month prior to certification. For each family

member, the interviewer presented a list of potential income sources to elicit a yes/no response about

receipt of income from each source. If receipt of income was indicated, respondents were asked the

amount of income received.
14 Adults are generally identified by age greater than 18 (school attendance information was not collected, so we could not implement a more

precise definition of adults as age 18 or older and not attending high school). WIC participants and their spouse/partner who are age 18

were classified as adults as well.

15 Respondents were asked to report the amounts of income received “last month.” If respondents reported amounts as received on a weekly

or bi-weekly basis, interviewers were instructed to multiply these amounts by 4.3 and 2.15, respectively.

16 FNS Instruction 803-3, WIC Program Certification: Income Eligibility.

17 A more complete description of income-eligibility regulations and procedures may be found in Chapter 4.

18 If a WIC applicant participates in more than one of the programs listed in Exhibit 3-14, he or she is represented in the exhibit under each

program.

62 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

Total family income was calculated to be the sum of income received by all adult members of the WIC

economic unit, reported for the month prior to WIC certification. Annual income was calculated by 14

multiplying monthly income by twelve.15

Family income as measured by the NSWP may differ from family income determined at WIC certification. This is because WIC staff may exercise some discretion in defining the WIC economic unit (which

determines whose income to count), and WIC staff may measure income over a different time period than

that used by NSWP. For example, federal guidelines state that “agencies should exercise flexibility in

deciding whether to use an applicant’s current or annual rate of income.” Furthermore, agencies are 16

encouraged to define current income as income received during the month prior to application, but

measurement differences could result if applicants report income in weekly, biweekly, or annual figures

to the WIC clinic, which then converts it to a monthly amount.

The goal of NSWP was to measure income in a consistent manner for all sampled WIC participants, and

to describe the income characteristics of WIC participants based on that consistent measure. Chapter 4

considers income verification, and compares income measured by NSWP to certification income for the

one-third sample for which income was verified during an in-home follow-up interview.

Adjunctive and Automatic Income Eligibility

Federal regulations require state WIC agencies to accept applicants as adjunctively income eligible if

they are certified eligible to receive food stamps, or certified as fully eligible or presumptively eligible to

receive TANF or Medicaid. The adjunct eligibility provisions are designed to speed the application

process for both participants and WIC staff; applicants who are adjunctively income eligible are not

required to provide information about family income and are “not subject to the income limitations” of

the program (7CFR246). In addition, states have the option to accept applicants as automatically

income eligible if they participate in state-administered programs that routinely document income and

have income-eligibility guidelines at or below WIC income guidelines.17

Exhibit 3-14 shows the percentage of WIC participants, by certification category, who participate in

programs that confer adjunctive or automatic income eligibility. Nearly 65 percent of all WIC parti- 18

cipants are adjunctive or automatically income eligible, as shown by the right-most column indicating

that 35.7 percent of participants do not participate in adjunct or automatic programs. In descending
19 There has been general decline in TANF and food stamp caseloads since Congress passed the Personal Responsibility and Work

Opportunity Reconciliation Act (PL104-193) in 1996, so the stability of the findings in Exhibit 3-14 is uncertain. That is, the percentage

of WIC participants participating in these three programs today may be quite different from the percentage in 1998.

20 Use of automatic eligibility was determined from the NSWP local agency survey.

21 Study of WIC Participant and Program Characteristics, 1988.

22 Data were collected for each adult family member and aggregated to the family level. When aggregating information to the family level,

we consider information about receipt of a source to be missing only when information is missing for all family members; we consider

information about amounts of income to be missing if receipt was indicated and amount is missing for any family member.

Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 63

order, the most common adjunct programs are Medicaid (61.6 percent), food stamps (32.7 percent), and

TANF (15.0 percent).19

The percentage of WIC participants certified as automatically income-eligible depends on local agency

use of automatic income eligibility and the rate of participation in the relevant programs. Thirty-four

percent of WIC participants are enrolled at local agencies using one or more programs to determine automatic eligibility. Exhibit 3-14 shows the percentage of WIC participants who are enrolled in programs 20

used by their local agency to determine automatic income eligibility. For example, although 6.6 percent

of WIC children participate in Head Start (see Exhibit 3-6), none of them are enrolled in WIC through

agencies using Head Start enrollment to determine automatic income eligibility (see Exhibit 3-14).

Sources of Income and Reporting of Income Data

Exhibits 3-15 through 3-18 present information regarding sources of income received by WIC families/

economic units and mean values of reported income by source. The most common sources of income for

WIC families, shown in Exhibit 3-15, are wages and salary (received by 73.7 percent of families), TANF

(15 percent), and alimony and child support (11.2 percent). These three sources of income were also the

most common in 1988, the last time detailed income information was collected for WIC participants on a

national basis. In 1988, however, WIC families were more reliant on welfare income and less likely to 21

receive wages: wages and salary were received by 58 percent of WIC families, AFDC was received by

32 percent, and alimony or child support were received by 8.7 percent.

Exhibit 3-15 also shows the success of NSWP in collecting income information from respondents. As

discussed above, the NSWP survey separately recorded whether or not income was received from a

source and, conditional upon receipt, the amount of income received. For all sources of income, rates of 22

missing data for income receipt are low, ranging from 0.4 to 3.3 percent (third column of Exhibit 3-15). 

Rates of missing data for amounts of income, however, vary considerably by source of income (fifth

column). For the three most common sources of income the percent of respondents providing dollar

amounts was high (86 percent for wages and salaries, 90 percent for TANF benefits, and 94 percent for

alimony or child support). For less-common sources of income, however, respondents were often unable

to recall dollar amounts, and the percentage of participants providing dollar amounts was low (about 18

percent for veteran’s benefits; 31 percent for dividends, royalties, and trusts; 43 percent for worker’s

compensation). Each of these latter income sources was reported as received by less than 2.6 percent of

WIC families. Thus, the NSWP income data appear to be fairly complete for the most common sources

of income for WIC families.
____________________________________________________________________________________________________________________________________

Exhibit 3-14

Percent of WIC Participants with Reported Participation in Adjunct Programs at Certification

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Adjunctive income eligibility 

 TANF 9.3 13.8 21.7 14.2 14.0 16.0 15.0

 Food Stamp Program 23.3 22.4 38.4 27.8 31.4 35.5 32.7

 Medicaid 51.1 57.2 69.3 58.2 65.3 61.4 61.6

Automatic income eligibility 

 Food Distribution Program 0.2 0.0 0.0 0.1 0.0 0.0 0.0

 on Indian Reservationsa

 Supplemental Security Income 4.3 4.1 4.0 4.2 3.6 7.2 5.6

 Free or reduced-price NSLP meals 0.0 0.0 0.0 0.0 0.0 0.7 0.3

 Head Start 0.0 0.0 0.0 0.0 0.0 0.0 0.0

 General Assistance 1.5 0.2 1.0 1.0 1.4 0.3 0.8

 Home Energy Assistance 0.6 0.4 0.2 0.4 0.0 0.0 0.1

Overall

No participation in adjunct 45.2 40.1 28.2 38.8 31.3 36.6 35.7

 or automatic programs

Adjunct/automatic eligibility 4.4 2.7 6.6 4.7 4.1 4.1 4.2

 status could not be determined

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________

Responses are not mutually exclusive, so percents add up to more than 100.

Adjunct income eligibility is provided by TANF, food stamps, and Medicaid, according to federal WIC regulations. State and local WIC

agencies determine programs conferring automatic income-eligibility, within federal guidelines. For this table, participation in each

program conferring automatic income eligibility is counted only among participants enrolled through local WIC agencies using that

program to determine eligibility.

Information about programs used for automatic income eligibility comes from the NSWP Local Agency Survey.

a The Food Distribution Program on Indian Reservations is a USDA program operated as an alternative to the FSP and serving Native

 Americans residing on or near Indian lands.
____________________________________________________________________________________________________________________________________

Exhibit 3-15

Sources of Monthly Income, All WIC Economic Units

____________________________________________________________________________________________________________________________________

 Among Those with Source

 _____________________________________

 Percent with Percent without Percent not Percent with Percent with

 Source Source Reported Amount Reported Amount not Reported

____________________________________________________________________________________________________________________________________

Source of income

 Unemployment insurance 4.9 95.1 2.2 87.4 12.6

 Worker's compensation 1.6 98.4 2.3 43.0 57.0

 SSI 5.4 94.6 2.4 87.3 12.7

 Other welfare program 5.8 94.2 2.4 87.0 13.0

 Veteran's benefits 0.8 99.2 2.5 17.6 82.4

 Pensions or annuities 1.3 98.7 2.5 63.7 36.3

 Interest on savings 9.5 90.5 1.7 62.5 37.5

 Dividends, royalties, trusts 1.1 98.9 2.0 31.1 68.9

 Other 5.7 94.3 3.3 92.2 7.8

Sample size 3,114 3,114 3,114

____________________________________________________________________________________________________________________________________

Percent with source is based on receipt during the month prior to certification for all income sources except wages and salary. 

Percent with amount reported is calculated prior to imputation of missing income amounts.

First eight items (wages or salary ... veteran’s benefits) were collected for each adult member of the family. For these income

Appendix B for person-level incidence of missing and imputed data.

"Other" income includes regular contributions from other sources, and lump sum income.

Temporary Disability Insurance.
23 Moore, Jeffrey, Linda Stinson, and Edward Welniak, “Income Measurement Error in Surveys: A Review,” U.S. Bureau of Census,

December 1997, submitted for publication.

24 All families reporting no income sources are shown in subsequent exhibits as having zero income.

25 The difference is statistically significant at the 5 percent level.

66 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

It should be noted that this chapter presents information about total income of the WIC economic unit,

aggregated over all members of the WIC economic unit. To gain a full understanding of the patterns of

income reporting in the NSWP, Appendix B presents information about income reported for individual

family members. As with other household surveys, the incidence of missing income data in the NSWP

follows a predictable pattern: the amounts of respondents’ own income and spousal income have low

rates of item non-response; the amounts of income received by other family members have higher rates of

non-response. In addition, for all family members, amounts of unearned income have higher rates of 23

non-response than amounts of earned income. The dollar amount of a reported income source has been

imputed when missing due to item non-response. In addition, a small number of wage observations were

imputed for those persons “currently employed’ but reporting no wage income last month. Appendix B

describes the imputation procedures; imputation had only a small effect on estimated means.

Exhibit 3-16 takes the overall “percentage with source” information from Exhibit 3-15 and breaks it out

by WIC certification category. Similarly, Exhibit 3-17 presents the mean amount received by source of

income and certification category. The same three sources of income—wages and salary, TANF, and

alimony and child support—are the most common sources across all certification categories. Overall,

wages and salary account for the largest portion of WIC family income, with an average monthly amount

of $1,369 received by 73.7 percent of WIC families. TANF has a mean amount of $386 received by 15.0

percent of families; alimony and child support has a mean amount of $289 received by 11.2 percent of

families. The mean amounts reported for pensions/annuities ($747) and Social Security ($635) are also

relatively high. Only 1.3 percent of WIC participants report receipt of pension or annuity income. 

Nearly 6 percent of WIC families report receipt of Social Security benefits (based on the age of recipients, it appears that 2 percent of families receive old age retirement benefits and 4 percent receive death

or disability benefits).

The bottom of Exhibit 3-16 shows the percentage of WIC families receiving any of the income sources

shown in the table, and the percentage of families with no source of income. Overall, 6.6 percent of

families reported no income from any source. Among families reporting no income, one-third have a

family member who became unemployed during the month of WIC certification, and an additional 45

percent are adjunct-eligible through participation in food stamps and/or Medicaid. Thus, less than 2

percent of families reported having no income, nor did they provide any indication of adjunct eligibility.24

The distributions of income sources for WIC families in metropolitan and non-metropolitan areas are

presented in Exhibit 3-18, a two-page exhibit that also breaks out income sources by certification category. Overall, WIC families in non-metropolitan areas are somewhat more likely (95.6 percent compared

to 92.4 percent) to have an income source than WIC families in metropolitan areas. For each individual 25

source of income, however, there is no statistically significant difference in rates of receipt by area of

residence.
____________________________________________________________________________________________________________________________________

Exhibit 3-16

Sources of Monthly Income for WIC Economic Units, by Participant Category: Percent with Source

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Source of income

 Wages or salary 77.1 77.2 67.4 74.0 74.6 73.0 73.7

 Unemployment insurance 3.9 5.6 4.5 4.5 4.9 5.2 4.9

 Worker's compensation 1.6 1.2 2.1 1.7 2.2 1.3 1.6

 TANF 9.3 13.8 21.7 14.2 14.0 16.0 15.0

 SSI 5.1 3.9 4.0 4.5 4.6 6.2 5.4

 Other welfare program 5.2 3.8 5.3 4.9 5.5 6.4 5.8

 Social Security 5.9 3.0 6.1 5.3 6.6 5.8 5.9

 Veteran's benefits 1.5 0.4 1.0 1.1 0.4 0.9 0.8

 Pensions or annuities 1.0 0.3 0.6 0.7 1.0 1.7 1.3

 Rental income 1.6 2.3 0.5 1.4 0.2 0.7 0.8

 Interest on savings 8.8 8.2 7.5 8.3 9.0 10.4 9.5

 Dividends, royalties, trusts 1.2 0.9 1.4 1.2 0.4 1.4 1.1

 Alimony or child support 10.5 7.4 11.7 10.2 9.8 12.3 11.2

 Other 6.7 7.3 4.9 6.2 8.3 4.2 5.7

Total 

 Percent receiving any source 92.9 93.1 93.4 93.1 93.2 93.6 93.4

 Percent with no source of income 7.0 6.9 6.6 6.9 6.8 6.4 6.6

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________

Based on income received for the month prior to certification for all income sources except wages and salary. Percent with wages and

salary income is based on reported current employment status. Percent with source is calculated among respondents responding to each

item. Item non-response ranged from 0.4% non-response for wage income to 3.3% non-response for "other" income.

"Other" income includes regular contributions from other sources, and lump sum income.

"Other welfare programs" include General Public Assistance, Black Lung Benefits, foster care, Section 8 housing assistance, and

Temporary Disability Insurance.
____________________________________________________________________________________________________________________________________

Exhibit 3-17

Mean Amount of Monthly Income for WIC Economic Units, by Participant Category

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Source of income

 Wages or salary $1,400 $1,425 $1,324 $1,383 $1,372 $1,360 $1,369

 Unemployment insurance 348 529 563 463 579 459 490

 Worker's compensation 333 298 297 313 374 281 324

 TANF 354 384 345 356 368 408 386

 SSI 444 472 397 435 450 601 529

 Other welfare program 327 443 388 366 350 409 385

 Social Security 662 751 584 645 553 679 635

 Veteran's benefits 293 272 272 286 201 288 276

 Pensions or annuities 1,285 381 611 1026 683 706 747

 Rental income 312 241 121 265 330 326 286

 Interest on savings 17 35 24 23 27 26 26

 Dividends, royalties, trusts 55 88 106 79 44 128 110

 Alimony or child support 206 264 247 230 278 317 289

 Other 341 352 205 310 207 349 287

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

___________________________________________________________________________________________________________________________________

Mean amount is calculated among households with reported income source after imputation of missing amounts. Sample size and population reflect the entire sample; the percent of the population with each income source is shown in Exhibit 3-16.

Amounts were reported based on income received for month prior to certification. Wages are imputed for those persons "currently

employed" but having no wage income "last month." See Appendix B for information about imputation of missing income amounts.

"Other income" includes regular contributions from other sources and lump sum income.

"Other welfare programs" include General Public Assistance, Black Lung Benefits, foster care, Section 8 housing assistance, and

Temporary Disability Insurance.
____________________________________________________________________________________________________________________________________

Exhibit 3-18

Sources of Income for WIC Economic Units, by Participant Category and Metro-Nonmetro Location: Percent with Source

____________________________________________________________________________________________________________________________________

 Pregnant Women Breastfeeding Women Postpartum Women Total Women

 Metro Nonmetro Metro Nonmetro Metro Nonmetro Metro Nonmetro

____________________________________________________________________________________________________________________________________

Source of income

 Wages or salary 76.9 77.6 76.2 82.4 64.8 76.3 73.0 77.9

 Unemployment insurance 3.9 4.1 4.8 10.0 3.6 7.7 4.0 6.3

 Worker's compensation 1.4 2.4 1.0 2.4 2.6 0.4 1.7 1.7

 TANF 10.0 6.7 13.8 13.8 22.8 18.0 14.8 11.7

 SSI 5.3 4.3 4.1 3.3 4.8 1.4 4.9 3.1

 Other welfare program 5.7 3.2 4.3 1.3 4.9 6.6 5.1 4.1

 Social Security 5.3 8.0 3.2 1.9 5.6 7.8 4.9 7.0

 Veteran's benefits 1.7 0.5 0.4 0.6 1.3 0.0 1.3 0.4

 Pensions or annuities 1.3 0.0 0.4 0.0 0.6 0.5 0.9 0.2

 Rental income 1.6 1.6 2.8 0.0 0.7 0.0 1.6 0.8

 Interest on savings 7.7 12.4 7.4 12.6 7.6 7.1 7.6 10.6

 Dividends, royalties, trusts 1.2 1.2 0.9 1.3 1.4 1.1 1.2 1.2

 Alimony or child support 8.0 19.1 7.1 9.2 13.3 6.4 9.5 13.1

 Other 7.0 5.6 7.1 8.5 5.3 3.6 6.5 5.4

Percent receiving any source 92.5 94.4 92.7 95.3 92.1 97.7 92.4 95.6

Percent with no source of income 7.5 5.6 7.3 4.7 7.9 2.3 7.6 4.4

Sample size 481 158 514 113 442 145 1,437 416

Population 668,251 191,130 315,918 60,545 446,008 127,891 1,430,177 379,566

____________________________________________________________________________________________________________________________________

Based on income received for the month prior to certification for all income sources except wages and salary. Percent with wages and

salary income is based on reported current employment status. Percent with source is calculated among respondents responding to each

item. Item non-response ranged from 0.4% non-response for wage income to 3.3% non-response for "other" income.

"Other" income includes regular contributions from other sources, and lump sum income.

"Other welfare programs" include General Public Assistance, Black Lung Benefits, foster care, Section 8 housing assistance, and

Temporary Disability Insurance.
____________________________________________________________________________________________________________________________________

Exhibit 3-18 (cont.)

Sources of Income for WIC Economic Units, by Participant Category and Metro-Nonmetro Location: Percent with Source

____________________________________________________________________________________________________________________________________

 Infants Children Total WIC

 Metro Nonmetro Metro Nonmetro Metro Nonmetro

____________________________________________________________________________________________________________________________________

Source of income

 Wages or salary 75.2 72.3 72.1 76.5 73.1 75.8

 Unemployment insurance 4.3 7.1 5.7 3.3 4.9 4.9

 Worker's compensation 2.2 2.1 1.4 0.9 1.7 1.4

 TANF 14.4 12.4 16.6 13.7 15.6 12.9

 SSI 5.2 2.2 6.8 3.7 5.9 3.2

 Other welfare program 4.1 11.3 6.2 7.2 5.4 7.4

 Social Security 6.0 9.2 5.5 6.7 5.5 7.4

 Veteran's benefits 0.3 0.8 0.9 0.8 0.8 0.7

 Pensions or annuities 0.8 1.8 1.9 0.8 1.4 0.9

 Rental income 0.3 0.0 0.8 0.4 0.9 0.4

 Interest on savings 8.5 11.0 10.6 9.5 9.3 10.1

 Dividends, royalties, trusts 0.3 0.7 1.4 1.3 1.1 1.1

 Alimony or child support 9.9 9.2 11.0 17.2 10.4 14.3

 Other 8.8 6.1 3.1 8.3 5.3 7.1

Percent receiving any source 92.5 95.9 92.5 97.7 92.5 96.8

Percent with no source of income 7.5 4.1 7.5 2.3 7.5 3.2

Sample size 474 140 476 171 2,387 727

Population 1,593,475 384,936 3,119,987 832,937 6,143,639 1,597,439

____________________________________________________________________________________________________________________________________

Based on income received for the month prior to certification for all income sources except wages and salary. Percent with wages and

salary income is based on reported current employment status. Percent with source is calculated among respondents responding to each

item. Item non-response ranged from 0.4% non-response for wage income to 3.3% non-response for "other" income.

"Other" income includes regular contributions from other sources, and lump sum income.

"Other welfare programs" include General Public Assistance, Black Lung Benefits, foster care, Section 8 housing assistance, and

Temporary Disability Insurance.
26 Imputation procedures are described in Appendix B.

Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 71

Exhibit 3-19 displays the mean amount received, broken out by source of income, certification category,

and location. At this level of disaggregation, some cells contain fewer than ten WIC participants, and cell

values are not reported. Over the entire caseload (the Total WIC columns) the mean income received

from most income sources, conditional on receipt, is approximately the same in metropolitan areas and

non-metropolitan areas. The mean amounts of income differ by location for only two income sources: 

unemployment insurance income (greater in non-metropolitan areas) and alimony and child support

(greater in metropolitan areas).

Total Family Income and Income as a Percent of Poverty Guidelines

Exhibit 3-20 presents summary statistics (average income, median income, and per capita income) for

total annualized income for WIC families, by certification category. Across all WIC families, the mean

annual income is $14,739, with a median income of $13,212. Average per capita income is $3,774. In

some instances we have imputed income amounts in order to develop income figures at the family level.26

As indicated in the exhibit, we were not able to impute missing data for 2.5 percent of the sample.

The middle and lower portions of Exhibit 3-20 present summary income statistics broken out by the

economic unit’s adjunct-eligibility status. The average income of adjunctively-eligible families is

considerably lower ($12,924) than that for units not adjunctively-eligible ($17,769). The difference in

median income levels is slightly lower, with adjunctively-eligible families having a median income of

$11,936 and non-adjunctively-eligible families having a median income of $16,200. Exhibit 3-21

repeats these statistics, but breaks them out between participants in metropolitan and non-metropolitan

areas. The difference in mean income between metropolitan and non-metropolitan areas is small

($14,603 versus $15,259), and is not statistically significant.

Exhibit 3-22 presents median annual income for demographic subgroups within each certification category. (For WIC infants and children, the characteristics of the mother are used for classification.) It is

difficult to make comparisons of total family income between different subgroups, however, because

family size may not be distributed equally across subgroups. Therefore, using the same demographic

subgroups, Exhibit 3-23 presents per capita annual income figures. Within the entire caseload (Total

WIC column), per capita income does not vary significantly with age of the WIC woman/mother. Per

capita income, however, varies significantly with all other demographic characteristics shown in the

exhibit (marital status, adult male present, education level, size of the economic unit, and employment

status).
____________________________________________________________________________________________________________________________________

Exhibit 3-19

Mean Amount of Monthly Income for WIC Economic Units, by Participant Category and Metro-Nonmetro Location

____________________________________________________________________________________________________________________________________

 Pregnant Women Breastfeeding Women Postpartum Women Total Women

 Metro Nonmetro Metro Nonmetro Metro Nonmetro Metro Nonmetro

____________________________________________________________________________________________________________________________________

Source of income

 Wages or salary $1,381 $1,468 $1,398 $1,555 $1,335 $1,291 $1,372 $1,424

 Unemployment insurance 389 * 566 437 681 350 517 324

 TANF 365 294 381 399 361 278 366 305

 SSI 453 * 418 * 391 * 428 482

 Other welfare program 350 * 434 * 396 362 379 297

 Social Security 690 596 714 * 547 675 643 648

 Interest on savings 23 5 44 6 30 * 30 5

 Alimony or child support 221 183 281 196 253 * 245 188

 Other 360 253 399 151 228 * 336 189

Sample size 481 158 514 113 442 145 1,437 416

Population 668,251 191,130 315,918 60,545 446,008 127,891 1,430,177 379,566

____________________________________________________________________________________________________________________________________

Mean amount is calculated among households with reported income source after imputation of missing amounts. Sample size and population reflect the entire sample; the percent of the population with each income source is shown in Exhibit 3-16.

Amounts were reported based on income received for month prior to certification. Wages are imputed for those persons "currently

employed" but having no wage income "last month." See Appendix B for information about imputation of missing income amounts.

"Other income" includes regular contributions from other sources and lump sum income.

"Other welfare programs" include General Public Assistance, Black Lung Benefits, foster care, Section 8 housing assistance, and

Temporary Disability Insurance.

* Denotes cells with fewer than 10 WIC participants.
____________________________________________________________________________________________________________________________________

Exhibit 3-19 (continued)

Mean Amount of Monthly Income for WIC Economic Units, by Participant Category and Metro-Nonmetro Location

____________________________________________________________________________________________________________________________________

 Infants Children Total WIC

 Metro Nonmetro Metro Nonmetro Metro Nonmetro

____________________________________________________________________________________________________________________________________

Source of income

 Wages or salary $1,364 $1,410 $1,365 $1,346 $1,366 $1,379

 Unemployment insurance 527 * 409 * 457 621

 TANF 371 354 416 372 394 353

 SSI 436 * 634 * 542 429

 Other welfare program 413 * 411 399 404 329

 Social Security 563 * 703 615 649 597

 Interest on savings 33 8 27 22 29 14

 Alimony or child support 280 272 350 235 310 230

 Other 205 225 150 * 226 465

Sample size 474 140 476 171 2,387 727

Population 1,593,475 384,936 3,119,987 832,937 6,143,639 1,597,439

____________________________________________________________________________________________________________________________________

Mean amount is calculated among households with reported income source after imputation of missing amounts. Sample size and population reflect the entire sample; the percent of the population with each income source is shown in Exhibit 3-16.

Amounts were reported based on income received for month prior to certification. Wages are imputed for those persons "currently

employed" but having no wage income "last month." See Appendix B for information about imputation of missing income amounts.

"Other income" includes regular contributions from other sources and lump sum income.

"Other welfare programs" include General Public Assistance, Black Lung Benefits, foster care, Section 8 housing assistance, and

Temporary Disability Insurance.

* Denotes cells with fewer than 10 WIC participants.
____________________________________________________________________________________________________________________________________

Exhibit 3-20

Mean and Median Annualized Family or Economic Unit Income of WIC Participants, by Participant Category and Adjunct Eligibility Status

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

All economic units

 Average (mean) income 15,100 15,483 13,254 14,594 14,708 14,822 14,739

 Per capita income 5,184 3,737 3,372 4,308 3,671 3,575 3,774 a

 Median income 12,171 13,980 12,000 12,171 13,500 13,423 13,212

 Percent with income not reported 0.6 0.6 0.6 0.6 2.2 3.5 2.5

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

Adjunctively-eligible 

 Average (mean) income 12,362 13,483 12,116 12,495 13,430 12,839 12,924

 Per capita income 4,341 3,286 3,072 3,650 3,395 3,119 3,317 a

 Median income 10,150 12,000 10,428 10,680 12,000 12,000 11,936 

 Percent with income not reported 0.8 0.3 0.7 0.6 2.4 5.2 3.4

Sample size 342 374 426 1,142 405 414 1,961

Population 458,522 217,868 410,318 1,086,708 1,341,504 2,460,773 4,888,984

Not adjunctively-eligible 

 Average (mean) income 18,218 18,249 16,097 17,744 17,385 17,943 17,769

 Per capita income 6,144 4,360 4,120 5,296 4,249 4,294 4,539 a

 Median income 14,400 16,800 15,300 15,456 16,200 16,800 16,200 

 Percent with income not reported 0.4 1.0 0.3 0.5 1.9 0.6 0.9

Sample size 297 253 161 711 209 233 1,153

Population 400,859 158,595 163,581 723,035 636,907 1,492,151 2,852,094

____________________________________________________________________________________________________________________________________

Mean, median, and per capita income are calculated over households with non-missing income, after imputation. Number and percent 

with missing income are excluded from previous percents. See Appendix B for information about imputation of missing income amounts.

a Per capita income is calculated as total income of the WIC economic unit divided by the size of the WIC economic unit. For pregnant

 women, the unborn child is not counted in the size of the WIC economic unit for this calculation.
____________________________________________________________________________________________________________________________________

Exhibit 3-21

Mean and Median Annualized Family or Economic Unit Income of WIC Participants, by Participant Category and Metro-Nonmetro Location

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

All economic units 

 Average (mean) income 15,100 15,483 13,254 14,594 14,708 14,822 14,739

 Per capita income 5,184 3,737 3,372 4,308 3,671 3,575 3,774 a

 Median income 12,171 13,980 12,000 12,171 13,500 13,423 13,212

 Percent with income not reported 0.6 0.6 0.6 0.6 2.2 3.5 2.5

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

Metro areas

 Average (mean) income 15,135 15,100 13,093 14,490 14,661 14,626 14,603

 Per capita income 5,296 3,647 3,342 4,323 3,657 3,542 3,758 a

 Median income 12,171 13,980 12,000 12,171 13,500 13,423 13,212 

 Percent with income not reported 0.4 0.7 0.4 0.5 2.5 3.6 2.6

Sample size 481 514 442 1,437 474 476 2,387

Population 668,251 315,918 446,008 1,430,177 1,593,475 3,119,987 6,143,639

Nonmetro areas

 Average (mean) income 14,975 17,468 13,818 14,988 14,900 15,553 15,259

 Per capita income 4,787 4,205 3,477 4,252 3,726 3,699 3,838 a

 Median income 12,600 17,352 12,000 13,792 14,400 14,400 14,400

 Percent with income not reported 1.2 0.0 1.2 1.0 1.0 2.9 2.0

Sample size 158 113 145 416 140 171 727

Population 191,130 60,545 127,891 379,566 384,936 832,937 1,597,439

____________________________________________________________________________________________________________________________________

Mean, median, and per capita income are calculated over households with non-missing income, after imputation. Number and percent 

with missing income are excluded from previous percents. See Appendix B for information about imputation of missing income amounts.

a Per capita income is calculated as total income of the WIC economic unit divided by the size of the WIC economic unit. For pregnant

 women, the unborn child is not counted in the size of the WIC economic unit for this calculation.
____________________________________________________________________________________________________________________________________

Exhibit 3-22

Median Annualized Economic Unit Income of WIC Participants, by Category and Selected Maternal Characteristics

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Age

 Less than 18 11,760 16,623 12,654 12,000 13,210 13,200 13,200

 18-34 12,420 14,400 11,670 12,171 13,500 13,200 13,200

 35 or older 12,000 15,515 18,000 14,400 14,400 15,168 14,460

Marital status

 Married 14,990 15,600 14,400 15,028 15,168 16,174 15,600

 Widowed, divorced, or separated 9,828 8,256 7,734 9,264 9,600 8,808 9,600

 Never married 11,712 9,933 9,600 10,428 11,047 12,000 11,520

 Not reported 13,440 23,569 14,400 14,400 14,400 4,887 12,285

Adult male present

 Yes 14,400 15,600 14,400 14,415 14,472 15,325 15,072

 No 8,543 7,320 6,521 7,536 8,424 8,520 8,364

Highest grade of education

 Less than 8 years 11,048 12,000 10,906 11,048 11,754 13,189 12,000

 8-11 years 10,200 12,000 11,897 11,280 10,800 12,000 11,664

 12 years 12,600 15,600 10,860 12,600 13,759 13,356 13,500

 13 or more years 16,500 15,600 14,580 15,941 16,707 17,988 16,800

 Schooling incomplete, age <18 12,000 16,623 12,396 12,000 12,880 12,000 12,396

Size of economic unit

 1 person 6,000 -- -- 6,000 -- -- 6,000

 2 persons 9,600 2,400 4,704 8,543 5,760 6,060 7,056

 3-5 persons 14,400 14,400 12,000 14,056 14,400 13,800 14,070

 5 or more persons 19,824 19,200 17,520 19,200 15,120 16,800 16,800

Currently employed

 Yes 16,200 19,200 16,800 16,500 18,000 17,948 17,520

 No, employed in last 12 mos. 10,200 14,784 10,800 11,404 14,016 12,000 12,168

 No, not employed in last 12 mos. 12,000 12,000 10,680 12,000 12,000 12,000 12,000

Overall 12,360 14,400 12,000 12,396 13,500 13,440 13,432

____________________________________________________________________________________________________________________________________

Maternal characteristics are the characteristics of WIC women or the characteristics of the mothers of WIC infants and children. 

Median annualized income is measured over economic units with non-missing reported income.
___________________________________________________________________________________________________________________________________

Exhibit 3-23

Per Capita Economic Unit Income of WIC Participants, by Category and Selected Maternal Characteristics

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Age 

 Less than 18 4,327 4,075 3,319 3,905 3,737 4,324 3,945

 18-34 5,286 3,748 3,350 4,364 3,734 3,593 3,819

 35 or older 5,048 3,685 3,994 4,323 3,082 3,545 3,587

Marital status 

 Married 5,185 4,131 3,776 4,490 3,963 3,840 4,010

 Widowed, divorced, or separated 5,248 2,901 2,510 3,826 2,712 2,858 3,003

 Never married 5,199 3,207 3,211 4,248 3,528 3,612 3,772

 Not reported 4,896 3,414 4,176 4,480 5,776 3,571 4,371

Adult male present 

 Yes 5,450 4,013 4,042 4,715 4,161 3,814 4,116

 No 4,594 2,695 2,392 3,443 2,578 3,097 3,050

Highest grade of education 

 Less than 8 years 3,397 2,626 2,635 2,983 2,558 2,765 2,764

 8-11 years 4,183 3,160 2,938 3,604 3,171 2,807 3,077

 12 years 5,294 4,218 3,522 4,503 3,748 3,548 3,816

 13 or more years 7,256 3,978 3,988 5,370 4,439 4,694 4,780

 Schooling incomplete, age <18 4,406 3,670 3,255 3,854 3,652 3,973 3,812

 Not reported 3,948 4,613 1,189 3,934 2,095 8,090 4,763

Size of economic unit 

 1 person 6,512 -- 6,897 6,520 -- -- 6,520

 2 persons 5,633 2,247 2,348 4,874 2,734 3,495 3,897

 3-5 persons 4,974 3,985 3,504 4,185 4,023 3,720 3,902

 6 or more persons 3,289 3,098 3,243 3,213 2,685 3,102 2,998

Currently employed 

 Yes 7,570 5,080 5,192 6,630 5,083 4,948 5,346

 No, employed in last 12 mos. 4,036 3,898 2,907 3,653 3,617 2,930 3,384

 No, not employed in last 12 mos. 4,173 3,143 2,997 3,518 3,248 2,979 3,169

Overall 5,190 3,737 3,381 4,314 3,679 3,597 3,790

___________________________________________________________________________________________________________________________________

Maternal characteristics are the characteristics of WIC women or the characteristics of the mothers of WIC infants and children. Per

capita income is measured over economic units with non-missing reported income.
27 Updates of the poverty guidelines are published each March by the US Department of Health and Human Services. WIC agencies adopt

the new guidelines each year between April and July, with adoption schedules varying by site.

28 In 1998, eight states had Medicaid income-eligibility limits above 185 percent of poverty for pregnant women and children under five

years old; the NSWP sample included WIC participants from five of these eight states. In addition, several Medicaid eligibility rules and

practices enable enrollment of persons with incomes above 185 percent of poverty. These practices include the flexible definition of the

family unit; relatively long certification periods; eligibility redetermination practices; Medicaid waiver programs; presumptive eligibility

for pregnant women; transitional coverage for working poor families; and guaranteed enrollment periods (Kimball Lewis and Marilyn

Ellwood, Medicaid Policies and Eligibility for WIC, Alexandria, VA: USDA/FNS/OANE, 1998.

78 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

The next set of exhibits examine the poverty level of WIC economic units. These exhibits take size of

economic unit into consideration as well as annual income. In April 1998, the poverty level and 185-

percent poverty thresholds for families of different size were as follows:27

Family Size Monthly Annual Monthly Annual

Poverty Income 185 Percent Poverty Income

1 658 7,890 1,216 14,597

2 884 10,610 1,636 19,629

3 1,111 13,330 2,055 24,661

4 1,338 16,050 2,474 29,693

5 1,564 18,770 2,894 34,725

6 1,791 21,490 3,313 39,757

Source: U.S. Department of Health and Human Services, 1997 HHS Poverty Guidelines.

Exhibit 3-24 presents the distribution of WIC participants across poverty level ranges. Overall, 27.3

percent of WIC economic units have income at or below 50 percent of the poverty level, and another 36.5

percent have income between 51 and 100 percent of poverty. There are differences by certification

category, with pregnant women most broadly distributed across poverty categories, and all other

certification categories (families with infants and children) more heavily concentrated at the lowest levels

of the poverty distribution.

The distribution of WIC participants by cumulative percent of poverty is shown in Exhibit 3-25 (by

certification category) and Exhibit 3-26 (by adjunct-eligibility status). Exhibit 3-25 shows that 94.2

percent of WIC participants are in economic units with reported income at or below 185 percent of the

poverty level. Exhibit 3-26 shows the corresponding percentages for those adjunctively income-eligible

(95.4 percent have income at or below the 185 percent threshold) and non-adjunctively eligible (92.2

percent have income at or below the 185 percent threshold). With 185 percent of poverty being the

income limit for WIC participation, one might expect this figure to be closer to 100 percent. The only

WIC participants who may legitimately have income above 185 percent of poverty are adjunctivelyeligible WIC participants enrolled in Medicaid. For non-adjunctively eligible participants with income 28

above 185 percent of poverty, income measured by the survey may differ from income measured at WIC

certification due to discretion exercised by WIC staff, slight differences in measurement methodology, or

measurement error, as previously discussed. The income verification analysis presented in Chapter 4

looks more closely at WIC families whose reported income exceeds the income eligibility thresholds.
____________________________________________________________________________________________________________________________________

Exhibit 3-24

Distribution of Percent of Poverty Level of WIC Participants, by Participant Category 

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Percent of poverty level 

 0-50 24.8 26.4 34.8 28.3 26.0 27.6 27.3

 51-100 28.4 35.1 33.0 31.3 39.0 37.7 36.5

 101-130 14.6 17.4 15.6 15.5 16.4 13.9 14.9

 131-150 11.2 7.5 6.5 8.9 5.7 8.4 7.8

 151-185 14.0 7.7 6.1 10.2 6.8 6.8 7.6

 186-200 1.4 1.8 0.6 1.2 1.1 2.6 1.9

 201-225 1.5 1.8 1.3 1.5 2.4 1.5 1.7

 226-250 1.2 1.1 0.5 1.0 1.2 0.8 0.9

 Over 250 3.0 1.2 1.5 2.2 1.4 0.8 1.3

 Not reported 0.7 0.6 0.6 0.7 2.4 4.1 2.9 a

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________

a Number respondents with poverty status "not reported" are excluded from previous percents.
____________________________________________________________________________________________________________________________________

Exhibit 3-25

Distribution of Cumulative Percent of Poverty Level of WIC Participants, by Participant Category

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Percent of poverty level 

 0-50 24.8 26.4 34.8 28.3 26.0 27.6 27.3

 51-100 53.2 61.5 67.8 59.6 65.0 65.3 63.9

 101-130 67.8 78.9 83.4 75.0 81.5 79.2 78.8

 131-150 79.0 86.4 89.9 84.0 87.1 87.6 86.6

 151-185 93.0 94.1 96.0 94.2 93.9 94.3 94.2

 186-200 94.4 95.9 96.6 95.4 95.0 96.9 96.1

 201-225 95.8 97.7 97.9 96.9 97.4 98.4 97.8

 226-250 97.0 98.8 98.5 97.8 98.6 99.2 98.7

 Over 250 100.0 100.0 100.0 100.0 100.0 100.0 100.0

 Not reported 0.7 0.6 0.6 0.7 2.4 4.1 2.9 a

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________

a Number respondents with poverty status "not reported" are excluded from previous percents.
____________________________________________________________________________________________________________________________________

Exhibit 3-26

Distribution of Cumulative Percent of Poverty Level of WIC Participants, by Adjunctive Income Eligibility

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

Percent of Poverty Level Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Adjunctively income eligible 

 0-50 33.3 33.0 40.6 36.0 29.9 36.2 34.4

 51-100 62.1 71.7 74.1 68.6 73.5 74.9 73.1

 101-130 77.2 87.7 88.6 83.6 86.2 87.3 86.1

 131-150 85.6 91.0 92.7 89.4 89.4 91.8 90.6

 151-185 95.4 95.9 97.2 96.2 94.9 95.3 95.4

 186-200 96.4 97.1 97.2 96.8 95.9 97.2 96.8

 201-225 97.4 98.6 98.0 97.9 97.6 98.7 98.2

 226-250 98.7 99.1 98.4 98.7 98.6 98.8 98.7

 Over 250 100.0 100.0 100.0 100.0 100.0 100.0 100.0

 Not reported 0.8 0.3 0.7 0.6 2.4 5.2 3.4 a

Sample size 342 374 426 1,142 405 414 1,961

Population 458,522 217,868 410,318 1,086,708 1,341,504 2,460,773 4,888,984

Not adjunctively income eligible 

 0-50 15.2 17.4 20.2 16.8 17.7 13.9 15.5

 51-100 43.0 47.4 52.0 46.0 47.2 49.9 48.3

 101-130 57.0 66.8 70.3 62.2 71.3 66.2 66.3

 131-150 71.4 80.0 82.7 75.8 82.4 80.7 79.9

 151-185 90.2 91.7 92.8 91.1 92.0 92.8 92.2

 186-200 92.1 94.3 95.1 93.2 93.1 96.5 94.9

 201-225 94.0 96.4 97.7 95.4 97.2 98.0 97.2

 226-250 95.0 98.3 98.6 96.5 98.6 99.8 98.7

 Over 250 100.0 100.0 100.0 100.0 100.0 100.0 100.0

 Not reported 0.6 1.0 1.2 0.8 2.6 2.2 1.9 a

Sample size 297 253 161 711 209 233 1,153

Population 400,859 158,595 163,581 723,035 636,907 1,492,151 2,852,094

____________________________________________________________________________________________________________________________________

a Number respondents with poverty status "not reported" are excluded from previous percents. Applicants to WIC are adjunctively 

 income eligible if they participate in AFDC/TANF, FSP, or Medicaid.
29 In contrast, the FSP disburses benefits that vary by income level, and FSP requires monthly reporting (of at least some portion of the

caseload) to allow for adjustment of benefits.

30 Earning data suffered high rates of non-response on this survey and are not reported.

82 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

Exhibit 3-27 presents the cumulative percentage-of-poverty distributions for participants living within

and outside of metropolitan areas. The distributions are generally similar to one another, with 64.4

percent of metropolitan participants at or below the 100 percent poverty level, compared to 61.8 percent

of non-metropolitan participants.

Changes in Employment Status and Adjunct Program Participation Four Months after

Certification

In 1988, the WIC Income Verification Study reported changes in WIC economic unit income four to five

months after certification. In 1988 it was found that 37 percent of WIC economic units experienced

increases in monthly income during the certification period, whereas 63 percent experienced decreases in

income.

Unlike other public assistance programs, WIC does not require reporting of changes in income or adjunct

program participation during the WIC certification period. Income reporting after certification is not

mandated because WIC benefits are not dependent on income level. Although WIC uses income to determine WIC program eligibility at certification, after certification, all participants receive benefit packages

with specific foods in quantities meant to address their nutritional risks, which are also established at

certification. Nonetheless, changes in WIC family resources are important in determining re-certifica- 29

tion rates.

Although there was interest in having NSWP report changes in WIC family income four months after

certification, comparable to the 1988 study, the different study design for the NSWP put this task outside

the scope of the study. (In 1988, in-home interviews were conducted four months after certification, and

both the in-home audit and the four-month follow-up data were collected concurrently. In contrast,

NSWP completed most in-home interviews within six weeks of certification.) To allow some indication

of the change in WIC family circumstances during the certification period, NSWP added a brief telephone

follow-up component to the survey.

The telephone follow-up was conducted with a random sample of 593 persons who had previously completed both the in-person and in-home surveys (558 persons completed the telephone follow-up interview). Respondents were contacted approximately four months after WIC certification and asked to

report current participation in adjunct programs and current employment status and earnings for each

member of the WIC economic unit.

Exhibit 3-28 shows the change in adjunct program participation and employment status for WIC economic units. Over the four-month period following WIC certification the overall percentage of WIC 30

families receiving TANF declined, the overall percent receiving food stamps increased slightly, and the

percentage of families with employed family members remained at about 75 percent.
____________________________________________________________________________________________________________________________________

Exhibit 3-27

Distribution of Cumulative Percent of Poverty Level of WIC Participants, by Metro-Nonmetro Location

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

Percent of Poverty Level Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Metropolitan location 

 0-50 23.6 27.9 35.9 28.4 26.1 27.9 27.5

 51-100 52.8 64.5 67.5 60.0 65.4 66.0 64.4

 101-130 67.7 80.4 83.7 75.5 81.8 79.3 79.0

 131-150 78.0 86.7 89.6 83.5 87.3 86.9 86.2

 151-185 92.6 94.4 96.1 94.1 94.0 93.9 94.0

 186-200 94.0 95.7 96.7 95.2 95.0 96.6 95.9

 201-225 95.7 97.3 97.8 96.7 97.2 98.4 97.7

 226-250 97.0 98.6 98.5 97.8 98.4 99.3 98.7

 Over 250 100.0 100.0 100.0 100.0 100.0 100.0 100.0

 Not reported 0.5 0.7 0.7 0.6 2.8 4.4 3.1 a

Sample size 481 514 442 1,437 474 476 2,387

Population 668,251 315,918 446,008 1,430,177 1,593,475 3,119,987 6,143,639

Non-metropolitan location

 0-50 29.0 18.8 30.8 28.0 25.5 26.5 26.6

 51-100 54.5 46.2 68.9 58.0 63.6 62.6 61.8

 101-130 68.2 70.9 82.3 73.4 80.2 78.9 77.9

 131-150 82.2 85.1 90.9 85.6 86.5 89.9 88.0

 151-185 94.1 92.7 95.3 94.3 93.8 95.8 95.0

 186-200 95.7 97.0 96.1 96.1 94.9 98.2 96.9

 201-225 96.4 99.4 98.5 97.6 98.5 98.6 98.3

 226-250 96.9 99.4 98.5 97.8 99.4 98.6 98.6

 Over 250 100.0 100.0 100.0 100.0 100.0 100.0 100.0

 Not reported 1.2 0.0 1.2 1.0 1.0 2.9 2.0 a

Sample size 158 113 145 416 140 171 727

Population 191,130 60,545 127,891 379,566 384,936 832,937 1,597,439

____________________________________________________________________________________________________________________________________

a Number respondents with poverty status "not reported" are excluded from previous percents. Applicants to WIC are adjunctively 

 income eligible if they participate in AFDC/TANF, FSP, or Medicaid.
_____________________________________________________________________________________

Exhibit 3-28

Status of WIC Economic Units in Adjunct Programs and Employment, at Certification and

Four Months Later

_____________________________________________________________________________________

 TANF FSP Employment

_____________________________________________________________________________________

Sample size 433 436 441

Percent of WIC economic units

 Partipating at WIC certification 12.0 30.7 75.1

 Exited 7.6 7.1 10.7

 Entered 3.5 8.7 9.8

 Participating four months later 7.9 32.3 74.2

_____________________________________________________________________________________

Source: NSWP In-Person Survey, March-May 1998; NSWP Telephone Follow-up Survey, JulyAugust 1998. Unweighted data.

Sample size includes respondents with non-missing program participation status on both

surveys. The total number of respondents to the Telephone Follow-up Survey was 558.
Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 85

The net changes in adjunct participation and employment status over the four-month period mask significant changes within the population. The percentage of families changing participation status was 11.1

percent for TANF and 15.8 percent for food stamps. Entries and exits were approximately offsetting for

food stamps, whereas twice as many WIC families exited TANF as entered during the four-month period. 

Twenty percent of WIC families experienced a change in employment status, with about 10 percent both

entering and 10 percent exiting employment status over the four-month period.
31 Federal regulations also allow nutritional risk to be established based on referral data from a competent professional authority not on the

staff of the local WIC agency.

32 Nutrition risk assessment in the WIC program uses a risk criterion consisting of a risk indicator and a cutoff point. This chapter presents

information about risk indicators only.

33 Beginning April 1, 1999, state agencies use WIC nutrition risk criteria from a list established for the WIC program, developed by FNS in

conjunction with state and local WIC agency experts. WIC state agencies are not required to use all of the nutritional risk criteria on the

new list.

34 Most state WIC agencies map their risk codes into standard codes before submitting data to the PC studies. Less aggregated codes are

therefore not available for study.

35 This committee was formed in 1993 by the IOM under the sponsorship of USDA FNS. The Committee conducted a comprehensive review

of the scientific basis for the nutrition risk criteria used by state WIC agencies. Their findings were published in WIC Nutrition Risk

Criteria: A Scientific Assessment, IOM, 1996.

86 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

3.5 Nutritional Risk Factors

In addition to meeting income-eligibility guidelines, a WIC applicant must be found to be at nutritional

risk. For each WIC applicant, nutritional risk is determined through a medical and/or nutritional assessment by a competent professional authority on staff at the local WIC agency.31

Federal regulations define four broad categories of nutritional risks:

(1) Detrimental or abnormal nutritional conditions detectable by biochemical or anthropometric

measurements;

(2) Other documented nutritionally related medical conditions;

(3) Dietary deficiencies that impair or endanger health; and

(4) Conditions that predispose persons to inadequate nutritional patterns or nutritionally-related

medical conditions (CFR 246.2).

In 1998, when the NSWP was fielded, the WIC Program did not have a uniform set of nutrition risk

criteria in use by all state WIC agencies. For reporting purposes, state WIC agencies map their nutri- 32

tion risks into a standard categorization scheme used for the biennial WIC Participant and Program

Characteristics reports. This categorization scheme captures information about risks in 23 categories: 33

18 specific risks plus five categories of “other” risk in broad categories (other anthropometric, other

biochemical, other health, other dietary, and other nutritional risk).34

Since 1998, the WIC Program has adopted a standard list of nutrition risk criteria to be used by all states. 

The list of risk criteria now in use is based on the recommendations of the Committee on Scientific Evaluation of WIC Nutrition Risk Criteria, formed by the Institute of Medicine (IOM).35

The NSWP had three goals in collecting nutrition risk information for sampled WIC participants: (1) to

collect comparable data on the incidence of specific nutrition risks for all sampled persons, spread across

25 states; (2) to report on the incidence of specific risks that are aggregated within the broad reporting
36 The specific criteria for determining anemia and some anthropometric risks (underweight, overweight, and short stature) varied by state

prior to adoption of standard crtieria in 1999.

37 The reasons include being at risk due to detrimental or abnormal nutritional conditions detectable by biochemical or anthropometric

measurements or other documented nutritionally-related medical conditions.

Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 87

categories of the PC reports; and (3) to collect information about whether the risks recommended by the

IOM (and subsequently adopted by WIC) were being assessed in practice.

The NSWP collected nutrition risk information for sampled WIC participants using a structured checklist

containing up to 47 risks recommended for use in the WIC Program by the IOM Committee. (The exact

number of risks varied by certification category.) NSWP interviewers, working in WIC clinics, asked

clinic staff to complete a checklist for each WIC participant sampled for the NSWP survey. The checklist was structured so that, for each risk listed, WIC staff indicated whether a risk was present, not

present, or not assessed. It is important to note, however, that the indication of a “risk present” depended

on state-specific criteria for WIC eligibility in place in 1998.36

The specific risk criteria listed on the NSWP checklist, in the four broad categories of risk, are shown in

Exhibit 3-29. Because this list was taken from the recommendations of the IOM Committee, the list does

not necessarily correspond to risk criteria used by each state in 1998 when NSWP was fielded. As a

result, some WIC clinic staff entered risks in response to an open-ended “other” question; these

responses were post-coded and categorized as “other risks” to distinguish them from the risks recommended by the IOM committee.

In addition to the four categories of risk, federal regulations specify two other means of satisfying the

nutritional risk requirement for WIC certification—“conferred” risk and “regression.” These risks were

not included on the NSWP checklist.

Conferred risk may apply in either of two situations. First, for breastfeeding mothers and their infants,

only one individual needs to demonstrate risk in order for both to be certified as WIC eligible. Second,

infants under six months of age need not demonstrate risk if either their mother participated in WIC when

pregnant or medical records document that their mother was at nutritional risk when pregnant for one or

more specified reasons. The category of conferred risk was not included on the NSWP checklist; con- 37

ferred risk was post-coded for infants in the NSWP sample based on their mothers’ reported participation

in WIC.

Regression refers to a situation in which a competent professional authority determines that a previouslycertified applicant may be at risk of regression in nutritional status without the supplemental foods

offered by WIC. Regression was not included on the NSWP checklist. According to the PC98 report, 3

percent of children had a risk of regression, and less than 1 percent of women and infants had this risk. 

Only 2.3 percent of all WIC participants in 1998 were certified with a risk of regression and no other

risk, according to PC98 data.
Exhibit 3-29

Nutritional Risk Criteria Recommended by the Committee on Scientific Evaluation of WIC

Nutrition Risk Criteria, Institute of Medicine, 1996

Pregnant Breastfeeding Postpartum

Women Women Women Infants Children

Anthropometric risk criteria

Prepregnancy underweight T T T

Low maternal weight gain T

Maternal weight loss during pregnancy T

Prepregnancy overweight T

High gestational weight gain T T T

Postpartum underweight T T

Postpartum overweight T T

Low birth weight T T

Small for gestational age T

Short stature T T

Underweight T T

Low head circumference T

Overweight T T

Slow growth T T

Biochemical and other medical risk criteria

Criteria Related to Nutrient Deficiencies

Anemia (by state criteria) T T T T T

Failure to thrive T T

Nutrient deficiency diseases T T T T T

Medical Conditions Applicable to Entire WIC Population

Gastrointestinal disorders T T T T T

Nausea and vomiting during pregnancy T T T T T

Diabetes mellitus T T T T T

Gestational diabetes T

Thyroid disorders T T T T T

Chronic hypertension T T T T T

Renal disease T T T T T

Cancer T T T T T

Central nervous system disorders T T T T T

Genetic and congenital disorders T T T T T

Inborn errors of metabolism (for women, T T T T T

history of errors)

Chronic or recurrent infections T T T T T

HIV infections and AIDS T T T T T

Recent major surgery, trauma, burns, or T T T T T

severe acute infections

Other medical conditions T T T T T

Conditions Related to the Intake of Specific Foods

Food allergies T T T T T

Celiac disease T T T T T

Lactose intolerance T T T T T

Conditions Specific to Pregnancy

Pregnancy at a young age T

Closely spaced pregnancies T

History of preterm delivery T

History of low birth weight T
Exhibit 3-29 (cont.)

Nutritional Risk Criteria Recommended by the Committee on Scientific Evaluation of WIC

Nutrition Risk Criteria, Institute of Medicine, 1996

Pregnant Breastfeeding Postpartum

Women Women Women Infants Children

History of birth with congenital or birth T

defect

Lack of prenatal care T

Multifetal gestation T T T

Fetal growth restriction T

Conditions Specific to Infants and/or Children

Prematurity T

Hypoglycemia T T

Potentially Toxic Substances

Long-term drug-nutrient interactions T T

Maternal smoking T T

Alcohol and illegal drug use T T

Lead poisoning T T T T T

Dietary risk criteria

Failure to meet Dietary Guidelines T T T T T

Vegan diets T T T T

Highly restrictive diets T T T T T

Pica T T

Food insecurity T T T T T

Inappropriate infant feeding T

Early introduction of solid foods T

Feeding cow milk during first T2 months T

No dependable source of iron after 4-6 T

months

Improper dilution of formula T

Feeding other foods low in essential T

nutrients

Lack of sanitation in preparation of T

nursing bottles

Infrequent breastfeeding as sole source of T

nutrients

Inappropriate use of nursing bottle T

Predisposing risk criteria

Homelessness T T T T T

Migrancy T T T T T

Low level of maternal education or T T T T T

illiteracy

Maternal depression T T T T T

Battering T T T

Child abuse or neglect T T

Child of a young caregiver T T

Child of a mentally retarded parent T T

T indicates subgroup to which the recommendation applies.

Source: Institute of Medicine, Committee on Scientific Evaluation of WIC Nutrition Risk

Criteria. WIC Nutrition Risk Criteria: A Scientific Assessment, 1996.
38 According to the PC98 data, two-thirds of infants with conferred risk have no other risk.

39 “Other risks” are added to the four main categories; biochemical risks are broken up into three categories.

90 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

Response Rate to Nutritional Risk Checklists

Nutritional risk checklists were completed by WIC clinic staff for 96 percent of NSWP sampled persons. 

For 15 percent of sampled persons, however, the checklists were incomplete. The incomplete checklists

indicated that some risks were not present or not assessed, but did not indicate any risks as present. Twothirds of incomplete checklists were for infants who were post-coded as having conferred risk (which was

not included on the checklist). After assigning conferred risk, nutrition risk data were missing or 38

incomplete for 9 percent of the sample. It is important to note, however, that the 9 percent of participants

with missing or incomplete data had nutrition risks present at certification. The risks determined at

certification were recorded on certification forms (which were collected as part of NSWP), but were not

comparable to the NSWP checklist and were not used for analysis.

The nutrition risk information presented in this section is based on the 91 percent of the sample with

completed nutrition risk checklists or conferred risk. The 9 percent of the sample with missing checklists

are excluded from all exhibits in this section. We did not use nutrition risk information recorded on

certification forms to fill in missing checklists because the data were not comparable. Most certification

forms indicate only up to three risks present, and for risks not indicated there is no way to determine

whether the risks were “not present” or “not assessed.” In addition, in most states, the risk codes used on

certification forms correspond to broad categories that do not map to the specific risks on the NSWP

checklist.

Number and Types of Nutrition Risks Prevalent Among WIC Participants

Exhibit 3-30 shows the distribution of the number of nutrition risks, for participants in each certification

category, overall and in each broad category of risk. As shown under “total risks” near the bottom of 39

the exhibit, 37.1 percent of participants have only one nutrition risk, 26.4 percent have two risks, 16.7

percent have three risks, and 19.8 percent have four or more risks. The distribution of the number of

risks varies by certification category. Over 40 percent of infants and children have a single nutrition risk,

but less than 15 percent of women have just one risk. Nearly one-fourth of all WIC women enroll in WIC

with three nutrition risks, and nearly one-half of pregnant women and over one-third of breastfeeding and

postpartum women have four or more risks.

The distribution of the number of risks in each broad category shows that the most common type of risk

for infants is conferred risk (94 percent), which shows up in the “other risk” category. The most common

types of risk for children are dietary risks (78 percent). Dietary risks are also most common among

women (73 percent), but in addition, more than half of women have anthropometric and biochemical/

medical risks, and 46 percent of pregnant women have risks specific to pregnancy. The co-occurrence of

multiple risks within a single risk category happens most often with anthropometric risks (33.6 percent of

women, 9.6 percent of infants, and 10.3 percent of children have two or more anthropometric risks). 

Although women and children rarely have more than one dietary risk, 12 percent of infants have two or

more dietary risks due to the complexities of infant feeding.
____________________________________________________________________________________________________________________________________

Exhibit 3-30

Distribution of Number of Nutritional Risk Factors, by Participant Category 

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Anthropometric risks 

 None 25.7 37.5 42.1 33.1 75.2 61.5 58.4

 One 39.7 32.4 23.6 33.3 15.2 28.2 26.0

 Two or more 34.6 30.1 34.3 33.6 9.6 10.3 15.6

Conditions specific to pregnancy 

 None 53.8 NA NA 77.3 NA NA 94.7

 One 34.0 NA NA 16.7 NA NA 3.9

 Two or more 12.3 NA NA 6.0 NA NA 1.4

Potentially toxic substances 

 None 76.1 89.7 77.8 79.3 99.9 99.5 94.9

 One 21.2 9.6 19.9 18.5 0.1 0.5 4.6

 Two or more 2.7 0.7 2.3 2.2 0.0 0.0 0.5

Biochemical and other medical risks 

 None 45.9 52.6 42.2 46.1 79.1 64.6 64.0

 One 39.2 32.5 40.3 38.2 16.1 28.5 27.6

 Two or more 14.9 14.9 17.5 15.7 4.8 7.0 8.4

Dietary risks 

 None 25.5 23.0 32.2 27.1 73.3 22.3 36.5

 One 71.8 75.4 67.0 71.0 14.8 75.7 58.9

 Two or more 2.6 1.6 0.9 1.9 12.0 2.0 4.5

Predisposing risks 

 None 90.0 91.7 87.8 89.7 82.4 88.7 87.3

 One 8.5 7.4 9.6 8.6 14.7 9.1 10.4

 Two or more 1.5 0.9 2.5 1.7 2.9 2.3 2.3

Other risks 

 None 95.8 83.6 86.6 90.5 6.1 97.5 72.4

 One 3.9 7.3 11.3 6.9 91.5 2.3 26.3

 Two or more 0.3 9.1 2.0 2.6 2.4 0.2 1.3

Total risks 

 One 10.9 16.9 17.7 14.2 43.2 44.6 37.1

 Two 16.2 23.9 21.2 19.3 24.2 30.8 26.4

 Three 24.1 24.6 23.8 24.1 13.4 15.0 16.7

 Four or more 48.8 34.6 37.3 42.4 19.2 9.6 19.8

Sample size 613 569 541 1,723 571 586 2,880

Population 815,949 332,539 514,259 1,662,748 1,819,440 3,605,613 7,087,801

____________________________________________________________________________________________________________________________________

Within each category of risk, column percents sum to 100%. "Other risks" were not listed as categories on the checklist, but include

conferred risks and risks provided in response to open-ended question about presence of other risks. Persons with missing or incomplete checklists are excluded from the exhibit.
40 WIC clinic staff assess nutritional risks through administration of diet and health history questionnaires (whereby applicants self-report

conditions diagnosed by physicians), and 24 hour dietary recalls or food frequency checklists.

41 Item non-response is not reflected in the exhibits. Item non-response occurs when a checklist for a participant indicates risks that are

present but data are missing with respect to whether other individual risks are not present or not assessed. The percent of cases with no

item non-response is 86.7; an additional 8.5 percent of cases were missing data for only one or two risks. Only 4.8 percent of cases were

92 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

Exhibits 3-31 through 3-35 present detailed information about the specific nutritional risk factors indicated for participants in each certification category. By far the most common risk factor for pregnant

women is failure to meet dietary guidelines (74.2 percent). After that, the most common risk factors, in

descending order, are being overweight prior to pregnancy (39.6 percent), nausea and vomiting during

pregnancy (30.5 percent), high gestational weight gain (28.4 percent), risk of anemia (25.1 percent),

pregnancy at a young age (22.6 percent), and maternal smoking (20.5 percent).

For breastfeeding women (Exhibit 3-32), failure to meet dietary guidelines, at 76.6 percent, is again the

most common risk factor noted, except for the definitional risk of having a breastfeeding infant. Thereafter, the most common risk factors, in descending order, are being overweight postpartum (46.4

percent), risk of anemia (29.7 percent), and being overweight prior to pregnancy (26.0 percent). The

distribution is somewhat similar for postpartum women (Exhibit 3-33). Failure to meet dietary

guidelines is indicated for 67.8 percent of all postpartum women, followed by being overweight

postpartum (46.1 percent), risk of anemia (36.8 percent), and being overweight prior to pregnancy (31.6

percent).

Turning to infants (Exhibit 3-34), 14.8 percent are listed as failing to meet dietary guidelines. The next

most common nutritional risk factors are inappropriate infant feeding (13.8 percent), short stature (11.0

percent), and low birth weight (10.8 percent). Ninety-four percent of infants have conferred risk because

their mothers are currently enrolled in WIC or received WIC when pregnant; 45 percent of infants with

conferred risk have no other risk reported. (Overall, conferred risk is the only risk reported for 42 percent

of WIC infants.) For WIC children (Exhibit 3-35), failure to meet dietary guidelines is the most common

risk (77.6 percent), followed by risk of anemia (24.1 percent), being overweight (17.2 percent), and being

of short stature (13.8 percent).

Assessment of Nutrition Risks

One of the reasons for collecting detailed information about nutrition risks as part of NSWP was to help

evaluate concerns that existing data about nutrition risks may underestimate risk prevalence. One

concern is that, because presence of one nutrition risk is sufficient for WIC certification, additional risks

might not be assessed. A second concern is that underestimation of nutrition risks may occur because of

the particular guidelines used for the data collection that underlies the PC reports—the main source of

information on nutrition risk prevalence.

To evaluate these concerns, NSWP collected information about the number and types of risks assessed at

certification. In Exhibits 3-30 to 3-35, the second and third columns show the percentage of partici- 40

pants for whom each risk was not present, and the percentage for whom the risk was not assessed (together with the first column, “risk present,” the three columns sum to 100 percent). Comparison of the

second and third columns shows that when a risk is not indicated, the risk is more likely to be “not

present” than “not assessed.”41
_____________________________________________________________________________________

Exhibit 3-31

Percent of WIC Pregnant Women with Specific Nutritional Risk Factors 

_____________________________________________________________________________________

 Risk Risk not Risk not

 Present Present Assessed

_____________________________________________________________________________________

Anthropometric risk criteria 

 Prepregnancy underweight 14.3 79.1 6.6

 Low maternal weight gain 18.5 70.0 11.5

 Maternal weight loss during preg. 12.9 75.4 11.7

 Prepregnancy overweight 39.6 55.1 5.4

 High gestational weight gain 28.4 61.9 9.6

Biochemical and other medical risk criteria

 Anemia (by state criteria) 25.1 63.7 11.3

 Nutrient deficiency diseases 2.8 75.5 21.6

 Gastrointestinal disorders 3.3 73.9 22.8

 Nausea and vomiting during pregnancy 30.5 58.8 10.7

 Diabetes mellitus 1.3 80.3 18.3

 Gestational diabetes 2.4 78.4 19.1

 Thyroid disorders 0.6 73.5 25.9

 Chronic hypertension 2.1 76.4 21.5

 Renal disease 0.5 73.3 26.2

 Cancer 0.6 72.3 27.2

 Central nervous system disorders 1.1 71.8 27.1

 Genetic and congenital disorders 0.9 72.0 27.1

 Inborn errors of metabolism 0.7 73.3 26.0

 Chronic or recurrent infections 0.8 73.1 26.1

 HIV infections and AIDS 0.6 68.9 30.5

 Recent major surgery/trauma/etc. 1.0 73.9 25.2

 Other nutritionally-related cond. 2.5 75.3 22.2

 Food allergies 1.7 81.2 17.1

 Celiac disease 0.4 73.6 26.0

 Lactose intolerance 1.8 79.7 18.5

Conditions specific to pregnancy 

 Pregnancy at a young age 22.6 70.4 6.9

 Closely spaced pregnancies 19.7 74.6 5.6

 History of preterm delivery 7.9 80.6 11.5

 History of low birth weight 4.1 84.5 11.4

 History of birth with congenital 1.0 86.0 13.0

 or birth defect

 Lack of prenatal care 7.9 84.5 7.7

 Multifetal gestation 1.9 86.4 11.7

 Fetal growth restriction 0.7 81.2 18.1

Potentially toxic substances 

 Long-term drug-nutrient interactions 0.9 79.6 19.4

 Maternal smoking 20.5 73.8 5.7

 Alcohol and illegal drug use 5.5 87.5 7.1

 Lead poisoning 0.5 68.0 31.6

Dietary risk criteria 

 Failure to meet Dietary Guidelines 74.2 20.6 5.2

 Vegan diets 1.1 86.8 12.1

 Highly restrictive diets 1.5 87.0 11.5

 Pica 0.9 88.1 11.1

Predisposing risk criteria 

 Homelessness 0.6 89.4 10.0

 Migrancy 0.6 88.4 11.0

 Low level of maternal education 8.4 72.2 19.4

 Maternal depression 1.9 67.6 30.5

 Battering 0.7 65.7 33.6

Other risks 

 Pregnancy at age >=34 1.2 NA NA 

Sample size 613 613 613

Population 815,949 815,949 815,949

_____________________________________________________________________________________

5.1% of pregnant women have incomplete or missing Nutritional Risk Checklists and are 

not reflected in table. See note about "other risks" in Exhibit 3-29.
_______________________________________________________________________________________________

Exhibit 3-32

Percent of WIC Breastfeeding Women with Specific Nutritional Risk Factors 

_______________________________________________________________________________________________

 Risk Risk not Risk not

 Present Present Assessed

_______________________________________________________________________________________________

Anthropometric risk criteria 

 Prepregnancy overweight 26.0 55.5 18.5

 High gestational weight gain 21.5 63.3 15.2

 Postpartum underweight 6.1 82.6 11.4

 Postpartum overweight 46.4 46.6 7.0

Biochemical and other medical risk criteria

 Anemia (by state criteria) 29.7 60.0 10.3

 Nutrient deficiency diseases 5.1 75.3 19.6

 Gastrointestinal disorders 0.7 75.8 23.5

 Nausea and vomiting during pregnancy 15.2 58.4 26.4

 Diabetes mellitus 1.8 78.5 19.7

 Thyroid disorders 0.5 70.9 28.5

 Chronic hypertension 1.4 75.5 23.1

 Renal disease 0.1 71.0 28.9

 Cancer 0.1 70.8 29.1

 Central nervous system disorders 0.3 69.2 30.6

 Genetic and congenital disorders 0.1 69.2 30.6

 Inborn errors of metabolism 0.0 69.9 30.1

 Chronic or recurrent infections 0.9 70.5 28.6

 HIV infections and AIDS 0.0 68.9 31.1

 Recent major surgery/trauma/etc. 3.4 69.9 26.6

 Other nutritionally-related cond. 1.5 78.6 19.9

 Food allergies 1.9 84.5 13.6

 Celiac disease 0.0 72.9 27.1

 Lactose intolerance 1.9 82.3 15.8

 Multifetal gestation 1.0 79.4 19.5

Potentially toxic substances 

 Long-term drug-nutrient interaction 0.1 76.5 23.3

 Maternal smoking 9.3 81.4 9.3

 Alcohol and illegal drug use 1.5 88.8 9.7

 Lead poisoning 0.0 66.8 33.2

Dietary risk criteria 

 Failure to meet Dietary Guidelines 76.6 16.9 6.5

 Vegan diets 1.0 83.4 15.6

 Highly restrictive diets 1.3 83.9 14.8

Predisposing risk criteria 

 Homelessness 0.7 88.8 10.5

 Migrancy 0.8 87.2 12.0

 Low level of maternal education 5.8 72.6 21.6

 Maternal depression 2.0 65.5 32.6

 Battering 0.0 63.3 36.7

Other risks 

 Pregnancy at young age 3.1 NA NA 

 Pregnancy at age >=34 1.5 NA NA 

 Breastfeeding infant 100.0 NA NA 

 Miscarriage 0.7 NA NA 

 Closely spaced pregnancies 5.1 NA NA 

Sample size 569 569 569

Population 332,539 332,539 332,539

_______________________________________________________________________________________________

11.7% of breastfeeding women have incomplete or missing Nutritional Risk Checklists and are not

reflected in table. See note about "other risks" in Exhibit 3-29. NA = not applicable.
_____________________________________________________________________________________

Exhibit 3-33

Percent of WIC Postpartum Women with Specific Nutritional Risk Factors

_____________________________________________________________________________________

 Risk Risk not Risk not

 Present Present Assessed

_____________________________________________________________________________________

Anthropometric risk criteria 

 Prepregnancy overweight 31.6 54.5 13.9

 High gestational weight gain 18.3 66.2 15.6

 Postpartum underweight 4.6 84.7 10.7

 Postpartum overweight 46.1 47.2 6.7

Biochemical and other medical risk criteria

 Anemia (by state criteria) 36.8 56.4 6.8

 Nutrient deficiency diseases 3.0 75.7 21.2

 Gastrointestinal disorders 1.5 72.3 26.2

 Nausea and vomiting during pregnancy 17.9 55.6 26.6

 Diabetes mellitus 3.2 75.3 21.6

 Thyroid disorders 1.3 71.0 27.7

 Chronic hypertension 4.3 72.4 23.3

 Renal disease 0.5 71.2 28.3

 Cancer 0.5 69.8 29.6

 Central nervous system disorders 1.1 69.4 29.6

 Genetic and congenital disorders 0.9 68.7 30.4

 Inborn errors of metabolism 0.5 68.9 30.6

 Chronic or recurrent infections 1.4 69.0 29.6

 HIV infections and AIDS 0.5 68.6 30.9

 Recent major surgery/trauma/etc. 4.0 68.2 27.8

 Other nutritionally-related cond. 4.3 71.3 24.3

 Food allergies 2.4 76.6 21.0

 Celiac disease 0.0 71.8 28.2

 Lactose intolerance 1.7 78.1 20.2

 Multifetal gestation 1.9 76.9 21.2

Potentially toxic substances 

 Long-term drug-nutrient interaction 0.9 73.0 26.1

 Maternal smoking 20.2 72.3 7.5

 Alcohol and illegal drug use 3.5 85.9 10.6

 Lead poisoning 0.2 61.4 38.4

Dietary risk criteria 

 Failure to meet Dietary Guidelines 67.8 25.0 7.2

 Vegan diets 0.4 84.9 14.7

 Highly restrictive diets 0.7 84.9 14.4

Predisposing risk criteria 

 Homelessness 1.7 87.9 10.4

 Migrancy 0.9 84.5 14.6

 Low level of maternal education 8.4 70.2 21.4

 Maternal depression 4.2 61.5 34.3

 Battering 0.9 61.4 37.6

Other risks 

 Pregnancy at young age 5.5 NA NA 

 Pregnancy at age >=34 1.6 NA NA 

 Miscarriage 0.9 NA NA 

 Closely spaced pregnancies 5.7 NA NA 

Sample size 541 541 541

Population 514,259 514,259 514,259

_____________________________________________________________________________________

10.4% of postpartum women have incomplete or missing Nutritional Risk Check-lists and 

are not reflected in table. See note about "other risks" in Exhibit 3-29. NA = not 

applicable.
_____________________________________________________________________________________

Exhibit 3-34

Percent of WIC Infants with Specific Nutritional Risk Factors

_____________________________________________________________________________________

 Risk Risk not Risk not

 Present Present Assessed

_____________________________________________________________________________________

Anthropometric risk criteria 

 Low birth weight 10.8 83.5 5.8

 Small for gestational age 3.6 86.4 10.0

 Short stature 11.0 81.2 7.8

 Underweight 5.9 87.0 7.1

 Low head circumference 1.2 55.8 43.1

 Overweight 6.2 85.7 8.1

 Slow growth 2.8 83.1 14.1

Biochemical and other medical risk criteria

 Anemia (by state criteria) 3.6 49.1 47.3 a

 Failure to thrive 0.5 80.7 18.9

 Nutrient deficiency diseases 0.6 74.8 24.6

 Gastrointestinal disorders 3.5 69.2 27.3

 Diabetes mellitus 0.4 69.0 30.6

 Thyroid disorders 0.1 67.3 32.5

 Chronic hypertension 0.2 67.2 32.5

 Renal disease 0.0 67.4 32.6

 Cancer 0.0 66.8 33.2

 Central nervous system disorders 0.3 67.9 31.8

 Genetic and congenital disorders 0.7 68.9 30.4

 Inborn errors of metabolism 0.3 69.1 30.7

 Chronic or recurrent infections 1.4 69.1 29.5

 HIV infections and AIDS 0.0 66.3 33.7

 Recent major surgery/trauma/etc. 1.2 72.1 26.7

 Other nutritionally-related cond. 1.2 75.1 23.8

 Food allergies 2.0 73.0 25.0

 Celiac disease 0.0 70.0 30.0

 Lactose intolerance 3.8 72.9 23.3

 Prematurity 8.5 74.8 16.7

 Hypoglycemia 0.1 63.3 36.6

Potentially toxic substances 

 Lead poisoning 0.1 54.9 45.0

Dietary risk criteria 

 Failure to meet Dietary Guidelines 14.8 72.9 12.3

 Highly restrictive diets 0.8 82.9 16.3

 Inappropriate infant feeding 13.8 75.8 10.4

 Early introduction of solid foods 5.9 81.9 12.2

 Feeding cow milk during first yr 2.3 85.2 12.5

 No dependable source of iron 1.3 79.0 19.7

 after 4-6 months

 Improper dilution of formula 1.9 85.7 12.4

 Feeding other foods low in nutrients 1.2 85.6 13.2

 Lack of sanitation prep of bottles 0.9 78.7 20.4

 Infreq breastfeeding as sole 1.7 82.7 15.6

 source of nutrients

 Inappropriate use of nursing bottle 4.3 79.9 15.9

Predisposing risk criteria 

 Homelessness 0.7 89.1 10.1

 Migrancy 0.9 87.6 11.5

 Low level of maternal education 6.7 74.0 19.3

 Maternal depression 2.5 66.3 31.2

 Child abuse or neglect 1.9 67.9 30.1

 Child of a young caregiver 9.4 75.2 15.4

 Child of a mentally retarded parent 0.3 82.8 16.8
_____________________________________________________________________________________

Exhibit 3-34 (cont.)

Percent of WIC Infants with Specific Nutritional Risk Factors

_____________________________________________________________________________________

 Risk Risk not Risk not

 Present Present Assessed

_____________________________________________________________________________________

Other risks (response to open-ended question)

 Second-hand smoke 2.3 NA NA 

 Drug exposure 0.5 NA NA 

Conferred risk 

 Breastfeeding infant 31.0 NA NA 

 Not breastfeeding; Mom on WIC 58.9 NA NA 

 Not breastfeeding; Mom on WIC preg 3.8 NA NA 

Sample size 571 571 571

Population 1,819,440 1,819,440 1,819,440

_____________________________________________________________________________________

8.0% of infants have incomplete or missing Nutritional Risk Checklists and are not 

reflected in table. See note about "other risks" in Exhibit 3-29. NA = not 

applicable.

a Hematological tests are not required for infants under 6 months of age (7CFR246(e)(1)).
_____________________________________________________________________________________

Exhibit 3-35

Percent of WIC Children with Specific Nutritional Risk Factors 

_____________________________________________________________________________________

 Risk Risk not Risk not

 Present Present Assessed

_____________________________________________________________________________________

Anthropometric risk criteria 

 Low birth weight 6.2 71.8 22.1

 Short stature 13.8 78.7 7.5

 Underweight 8.9 84.2 6.9

 Overweight 17.2 76.4 6.4

 Slow growth 8.3 80.8 10.9

Biochemical and other medical risk criteria

 Anemia (by state criteria) 24.1 65.8 10.0 a

 Failure to thrive 1.1 85.8 13.1

 Nutrient deficiency diseases 1.6 78.9 19.4

 Gastrointestinal disorders 0.7 75.4 23.9

 Diabetes mellitus 0.2 74.9 24.9

 Thyroid disorders 0.4 71.7 27.9

 Chronic hypertension 0.0 71.8 28.2

 Renal disease 0.0 71.5 28.5

 Cancer 0.0 70.4 29.6

 Central nervous system disorders 0.0 71.0 29.0

 Genetic and congenital disorders 1.1 72.0 26.9

 Inborn errors of metabolism 0.1 72.9 27.0

 Chronic or recurrent infections 7.6 68.3 24.1

 HIV infections and AIDS 0.0 68.0 32.0

 Recent major surgery/trauma/etc. 1.8 74.2 24.0

 Other nutritionally-related cond. 2.0 76.9 21.2

 Food allergies 1.7 82.2 16.1

 Celiac disease 0.0 72.5 27.5

 Lactose intolerance 1.1 81.1 17.8

 Hypoglycemia 0.0 72.9 27.1

Potentially toxic substances 

 Lead poisoning 0.5 69.4 30.1

Dietary risk criteria 

 Failure to meet Dietary Guidelines 77.6 17.7 4.7

 Vegan diets 0.2 86.8 13.0

 Highly restrictive diets 0.5 87.9 11.6

 Pica 1.4 82.4 16.2

Predisposing risk criteria 

 Homelessness 0.6 88.3 11.1

 Migrancy 1.0 87.1 11.9

 Low level of maternal education 7.5 70.9 21.7

 Maternal depression 0.2 65.7 34.0

 Child abuse or neglect 0.9 68.6 30.5

 Child of a young caregiver 3.6 74.6 21.8

 Child of a mentally retarded parent 0.3 79.6 20.2

Sample size 586 586 586

Population 3,605,613 3,605,613 3,605,613

_____________________________________________________________________________________

8.8% of children have incomplete or missing Nutritional Risk Checklists and are not 

reflected in table. See note about "other risks" in Exhibit 3-29.

a At the state or local agency’s discretion, hematological tests are not required for 

 children who were determined to be within the normal range at their last WIC certi-

 fication (7CFR246.7).
42 The PC reports state that “whenever multiple risks within the same classification are reported for one person, these risks are combined and

counted one time in order to accurately calculate the number and percent of WIC participants with a specific type (or category) of risk”

(PC98, p. 83).

Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 99

The rates of non-assessment for individual risks vary considerably. The risk with the lowest assessment

rate is low head circumference for infants (not assessed for 43 percent of infants). Among risks common

to all certification categories, lead poisoning and the predisposing condition of maternal depression have

low assessment rates (over 30 percent of participants in each category are not assessed for these risks),

and infants and children have low assessment rates for child abuse and neglect.

Overall, 41 percent of WIC participants with completed Nutrition Risk Checklists had all risks assessed

(this percentage varies from 28 percent for infants to 46 percent for children); an additional 9.3 percent

of participants were assessed for all but one risk. On the other hand, 15 percent of participants’ checklists indicated that they were not assessed for more than half of the risks listed on the checklist. Although

these data indicate incomplete risk assessment for some participants, they also show that a large percentage of WIC participants received comprehensive risk assessment prior to the time that the IOM risk

recommendations were formalized in WIC guidelines in April 1999.

The second concern regarding measurement of risk prevalence among WIC participants is that the PC

reports may underestimate risks. Underestimation in the PC reports may be due to two factors. First, the

PCs collect information on up to three risks per WIC participant, rather than all risks per WIC participant. Second, the categorization scheme used by the PCs results in loss of information whenever more

than one specific risk is mapped into the same reporting category. For example, an individual with 42

several health problems will be counted by the PC reports as having one “other health risk,” rather than

several health risks. The number and types of health problems are not fully reflected in the final

reporting.

Results from the NSWP indicate that the PC reports underestimate the number of nutrition risks that

participants have at certification. This underestimation is partly due to the limit on the number of risks

reported to the PCs; NSWP found that 20 percent of all participants have four or more risks. It is

apparent, however, that underestimation in the PCs also comes from the practice of combining multiple

risks into the same reporting category because NSWP found fewer participants with only one or two risks

than was found in PC98. (The percentage with one risk is 44.7 in PC98 and 37.1 in NSWP; the

percentage with two risks is 33.0 in PC98 and 26.4 in NSWP.)
43 The difference is statistically significant at the 1 percent level.

100 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

3.6 Food Assistance, Food Spending, and Food Security

The primary benefit of the WIC program is the provision of supplemental food to low-income participants at nutritional risk. WIC provides nutrient-dense foods in five food categories: milk/cheese, eggs,

fortified breakfast cereal, 100 percent fruit juice, and legumes (peanut butter or beans). WIC also

provides support for breastfeeding, and a special food package for breastfeeding mothers that includes

tuna, carrots, and infant formula. The WIC program and its forerunner, the Commodity Supplemental

Food Program, are unique among government food assistance programs in targeting food benefits to

specific nutritional needs.

It is important to remember, however, that WIC is designed to supplement the diet and not to provide for

all dietary needs. Other food assistance programs are available to low-income families, and the FSP in

particular is designed to provide a safety net against hunger. Nonetheless, as discussed in the last section, the majority of individuals who enroll in WIC demonstrate a failure to meet dietary guidelines. It is

therefore of interest to examine the extent to which WIC families use other forms of food assistance, the

amount of money they spend on food, and their reported food security at the time of their current WIC

certification.

NSWP collected information about participation in other food and nutrition assistance programs, weekly

food spending, and the food security status of the WIC participant’s family. The survey questions for

each of these topics were designed to reference only members of the WIC participant’s economic unit.

Participation in Other Food and Nutrition Assistance Programs

Exhibit 3-36 shows that nearly one-half (46.8 percent) of families with WIC participants receive some

form of non-WIC food assistance at the time of their current application for WIC certification. Nearly

one-third (32.7 percent) of WIC families receive food stamps (FSP), 26.6 percent of families include

older children participating in the National School Lunch Program (NSLP), and 21.0 percent include

older children participating in the School Breakfast Program (SBP). Receipt of other food assistance is

more common outside of metropolitan areas (55.8 percent) than in metropolitan areas (44.5 percent), as

shown in Exhibit 3-37.43

Average Weekly Food Spending of WIC Families

Food spending information was collected by NSWP through a series of questions about the amount of

money spent by the WIC family on food for use at home in an average week, and the amount of money

spent on food consumed away from home in an average week. (Spending with food stamp benefits was

included in food-at-home spending.) Together, spending at home and away from home yield the average

weekly total food spending.
____________________________________________________________________________________________________________________________________

Exhibit 3-36

Percent of WIC Participants in Families Receiving Non-WIC Food Assistance, by Participant Category

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Receiving any non-WIC food 36.5 36.9 46.2 39.7 41.8 52.6 46.8

assistance

Receipt by program:

 Food Distribution Program 0.5 0.1 0.1 0.3 0.4 0.0 0.2

 on Indian Reservationsa

 Food Stamp Program 23.3 22.4 38.4 27.8 31.4 35.5 32.7

 School Breakfast Program 16.5 15.1 15.5 15.9 15.2 26.3 21.0

 National School Lunch Program 18.9 19.2 19.9 19.3 20.3 33.2 26.6

 Temporary Emergency Food 0.5 0.3 0.2 0.4 1.0 0.5 0.6

 Assistance Program

 Commodity Supplemental Food Program 0.8 0.7 0.9 0.8 0.8 1.2 1.0 b

 Local food pantries 4.3 3.2 4.1 4.0 3.1 3.3 3.4

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________

Column percents do not sum to 100 due to participation in multiple programs. Percents are calculated among respondents with nonmissing data. Rates of item non-response among all WIC participants range from 1.5% non-response for participation in the FSP to 

2.4% non-response for participation in TEFAP.

a The Food Distribution Program on Indian Reservations is a USDA program operated as an alternative to the FSP and serving Native

 Americans residing on or near Indian lands.

b The Commodity Supplemental Food Program (CSFP) distributes food to low-income women, infants, and children. The CSFP and WIC may

 operate in the same geographic area, but simultaneous participation in CSFP and WIC is prohibited.
_____________________________________________________________________________________

Exhibit 3-37

Percent of WIC Participants in Families Receiving Non-WIC Food Assistance, by 

Location

_____________________________________________________________________________________

 Metropolitan Nonmetropolitan

_____________________________________________________________________________________

Receiving any non-WIC food assistance 44.5 55.8

Receipt by program:

 Food Distribution Program 0.2 0.0

 on Indian Reservationsa

 Food Stamp Program 30.6 40.6

 School Breakfast Program 19.5 26.7

 National School Lunch Program 25.4 31.1

 Temporary Emergency Food Assistance 0.5 0.7

 Program

 Commodity Supplemental Food Program 0.7 2.3

 Local food pantries 2.3 7.8

Sample size 2,387 727

Population 6,143,639 1,597,439

_____________________________________________________________________________________

Column percents do not sum to 100 due to participation in multiple programs. Number 

in metropolitan and nonmetropolitan areas sum to total WIC participants. Percents 

are calculated among respondents with non-missing data. Rates of item non-response 

among nonmetropolitan WIC participants were less than 2% for all items; rates of nonresponse among metropolitan WIC participants were less than 3% for all items.

a The Food Distribution Program on Indian Reservations is a USDA program operated as an

 alternative to the FSP and serving Native Americans residing on or near Indian lands.

b The Commodity Supplemental Food Program (CSFP) distributes food to low-income women,

 infants, and children. The CSFP and WIC may operate in the same geographic area, but

 simultaneous participation in CSFP and WIC is prohibited.
44 Source: Bureau of Labor Statistics, Consumer Expenditures in 1998. Average annual expenditures on food were $4,810 for households

with an average size of 2.5 persons.

45 For comparison, USDA’s Thrifty Food Plan provides an estimate of the actual cost of providing a household with nutritious but inexpensive meals. The 1998 Thrifty Food Plan amount for one month was $122 for a one-person household ($28 per week); $224 for a twoperson household ($26 per person per week); and $408 for a four-person household ($24 per person per week).

46 One AME is equal to an adult male’s recommended daily energy allowance, measured in kilocalories. To calculate food spending per

AME, each family member is assigned a recommended daily energy allowance based on age and gender (and adjusted for pregnancy and

lactation). The total energy allowance of the family is added, and that total is then divided by the energy allowance of an adult male to

yield the family’s number of AMEs. See Appendix C for details.

Weekly food spending at home and weekly food spending away from home were imputed for 4.2 and 6.4 percent of WIC families,

respectively. See Appendix B for imputation procedures.

47 There are no comparable data on food spending per AME for all U.S. households.

48 This broad comparison of food stamp and non-food stamp households cannot be used to estimate an effect of food stamp receipt on

spending in WIC families. Such a study would require a multivariate analysis that also considered income level and the size of the food

stamp allotment, which is beyond the scope of the current study.

Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 103

In 1998, average weekly food spending for all U.S. households was approximately $37 per capita

(including food at home and food away from home), with 57 percent of total food spending for food at

home. In contrast, NSWP respondents reported an average weekly food spending of $25 per capita, 44

with 85 percent of total food spending for food at home.45

Lower food spending by WIC families is not surprising, in light of the fact that WIC provides benefits to

low-income individuals. Aside from having lower income, however, WIC families may also have lower

food expenditures due to the age and composition of WIC families.

 To account for the age and composition of WIC families, and allow for comparisons of food spending

among subgroups of NSWP respondents, total weekly food spending for each family was converted to an

amount of spending per adult male equivalent (AME). Average weekly food spending per AME is 46

presented in Exhibit 3-38, for each WIC participant category. Across all WIC families, food spending

per AME averages $37.02 per week; average spending per AME for food eaten at home is $31.32 per

week.47

Within the WIC population there is significant variation in food spending across WIC participant categories; families with breastfeeding women and families with children, on average, spend less money on

food than other WIC families. This difference, however, is entirely due to differences in spending within

the group of families not receiving food stamps. For WIC families receiving food stamps, there is no

significant difference in average food spending per AME across WIC participant categories.

Although food stamp benefits are associated with reduced variability in food spending across WIC families, there is little difference in the levels of food spending by WIC families receiving food stamp benefits

and those not receiving food stamp benefits. Food stamp families spend an average of $36.18 per AME

per week compared to $37.43 per AME in non-food stamp families, but this difference is not statistically

significant.48
____________________________________________________________________________________________________________________________________

Exhibit 3-38

Average Weekly Food Spending of WIC Economic Units per Adult Male Equivalent, by Participant Category and Participation in the Food

Stamp Program

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

All economic units

 Average weekly food spending

 Food at home $30.75 $26.08 $33.68 $30.71 $33.03 $30.75 $31.32

 Total 38.11 30.50 39.48 36.96 39.39 35.87 37.02

 Sample size 639 627 587 1,853 614 647 3,114

 Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

Food Stamp Program recipients

 Average weekly food spending

 Food at home 30.93 28.45 33.14 31.46 32.41 32.13 32.07

 Total 35.43 31.36 37.33 35.55 36.33 36.34 36.18

 Sample size 159 153 227 539 178 239 956

 Population 197,219 83,597 212,182 492,999 614,875 1,382,731 2,490,604

Non-Food Stamp Program recipients

 Average weekly food spending

 Food at home 30.70 25.40 34.00 30.43 33.32 30.01 30.97

 Total 38.92 30.25 40.73 37.48 40.78 35.62 37.43

 Sample size 480 474 360 1,314 436 408 2,158

 Population 662,162 292,866 361,717 1,316,744 1,363,536 2,570,193 5,250,474

Rates of nonresponse before imputation

Average weekly food spending, food at home

 All WIC economic units 8.0 6.0 9.0 7.9 5.7 4.3 5.5

 Food Stamp Program recipients 3.5 0.0 2.2 2.3 1.9 0.0 0.9

 Non-Food Stamp Program recipients 9.3 7.7 13.1 10.0 7.4 6.7 7.7

Average weekly food spending, total

 All WIC economic units 12.2 9.8 14.3 12.4 9.4 9.0 9.9

 Food Stamp Program recipients 8.0 4.6 7.2 7.1 6.2 6.2 6.4

 Non-Food Stamp Program recipients 13.4 11.3 18.5 14.3 10.8 10.4 11.5

____________________________________________________________________________________________________________________________________

Average weekly food spending is measured per adult male equivalent and includes redemptions of food stamp program benefits. Rates 

of item non-response are shown prior to imputation of missing food spending amounts; average weekly food spending is calculated after

imputation of missing data. After imputation, fewer than 2% of cases are missing data in any table cell. See Appendix B for information about imputation of missing food spending amounts.
49 William L. Hamilton et al., Household Food Security in the United States in 1995: Summary Report of the Food Security Measurement

Project, Washington, DC: USDA, September 1997.

50 Mark Nord, “Problems with Estimating the Prevalence of Child Hunger,” Second Food Security Measurement and Research

Conference, Volume I: Proceedings, USDA,/ERS/FANRR-11-1, February 2001.

51 Gary Bickel et al., Guide to Measuring Household Food Security, Revised 2000, Alexandria, VA: USDA/FNS/OANE, March 2000.

52 Analysis conducted by USDA ERS of CPS Food Security Supplement data (which includes WIC and non-WIC households) shows that

the food security scale substantially understates the prevalence of hunger in households in which the oldest child is two years or younger. 

In these households the ten-item scale (excluding the child items—the same scale used for households without children) finds about 45

percent more households with hunger than does the 18-item scale. This is not true of households that include older children. Overall, for

households with children, the two scales find exactly the same prevalence of hunger. (Per Mark Nord, USDA ERS.)

Approximately 30 percent of WIC households contain children with the oldest child two years or younger. Appendix C presents analysis

suggested by Mark Nord (USDA ERS), which shows that the current food security scale may understate hunger among WIC households.

Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 105

Reported Food Security of WIC Families

The next set of exhibits looks at a relatively new composite measure called “food security.” This

measure is a composite scale based on responses to 18 survey questions identifying specific conditions of

household food insufficiency, reduced quality and variety of foods, patterns of reduced food intake, and

direct hunger indicators for adults and children. The literature reports on two food security scales: one

based on experiences over the past month and the other on experiences over the past year. The NSWP 49

used questions about experiences over the past 12 months, which is reported to be the more stable of the

two scales. Food security questions were administered by NSWP with the WIC economic unit as the

referenced “household.”

The four levels of the food security scale, in order of decreasing food security, are:

• food secure

• food insecure without hunger

• food insecure with hunger, moderate

• food insecure with hunger, severe.

The food security scale measures the condition of household members as a group, and not necessarily the

condition of any particular household member. Thus, a household identified as food insecure with hunger

is a household with at least one member experiencing hunger.

There is some concern that the current food security scale does not “optimally identify households in

which there are hungry children.” Originally, the scale’s severe hunger category was intended to serve 50

as a proxy for households in which children are hungry because, in most households, “adults undergo

comparatively severe levels of hunger for themselves before the first indications of hunger appear among

the children.” On the other hand, because the food security scale measures the condition of the 51

household as a group, in households with very young children (who are likely to be protected from

hunger) the scale may understate hunger among other household members.52
53 Bickel et al., 2000.

54 WIC certification periods are 6 months for breastfeeding and postpartum women and for children. Pregnant women are certified up until 6

weeks after delivery (yielding an average certification period of 9 months). Infants are certified for 6 months, or up until their first birthdays; infants so certified, by definition, can have had no prior WIC experience. Most, however, had mothers in WIC during pregnancy.

106 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

The food security measurements presented in this section are based on the current food security scale.53

The construction of the food security scale is described in Appendix C.

Exhibit 3-39 shows that about three-quarters (76.4 percent) of all WIC participants are “food secure” at

the time of WIC certification, with another 15.3 percent “food insecure without hunger.” Slightly less

than 7 percent are “food insecure with moderate hunger,” and 1.7 percent are “food insecure with severe

hunger.” Among all WIC participants, pregnant women are most likely to be food insecure with

moderate or severe hunger at the time of WIC certification. Roughly 8 percent of WIC infants and WIC

children also fall within one of these two categories of food insecurity.

Food security status is, not surprisingly, related to the poverty status of the WIC economic unit. As

shown in Exhibit 3-40, 10.5 percent of WIC participants at or below the poverty level are food insecure

with moderate or severe hunger. In contrast, only 5.2 percent of WIC economic units above the poverty

level are food insecure with moderate or severe hunger.

The distribution of food security status is shown in Exhibit 3-41 for groups of WIC economic units

categorized by their participation in other food assistance programs. A family’s receipt of other food

assistance—such as food stamps, the NSLP, SBP, and assistance from local food pantries—is an

indication of the food available to the family. Participation in other food assistance programs, however,

is also an indication of the income level of the families, because other food assistance programs have

lower income eligibility limits than WIC. It appears that these forces are offsetting, because participation

in non-WIC food assistance programs is not significantly related to food security.

The distribution of food security is also not significantly related to whether the sampled person had prior

WIC experience (not shown in exhibit). It is not possible, however, to determine whether problems with

food security (which may have occurred any time in the last 12 months) preceded WIC experience (which

might have extended back only six to nine months prior to the interview).54

Exhibit 3-42 displays the variation in food security by selected characteristics of WIC participants. 

Neither household type nor age of the WIC participant/mother are correlated with food security; young

women (less than 18 years old) appear more likely to be food secure, but the sample size is too small for

this relationship to be statistically significant. There is a statistically significant relationship between

maternal education and food security, but this is entirely due to the difference in food security for those

with less than eight years of education. Among those with eight or more years of education, food security

is not significantly related to the level of education.

Exhibit 3-43 examines the distribution of food security by geographic location. WIC participants in nonmetropolitan areas appear somewhat more likely to be food secure than participants in metropolitan

areas, but this difference is not statistically significant; neither are there statistically significant differences in the distribution of food security across the seven FNS regions.
____________________________________________________________________________________________________________________________________

Exhibit 3-39

Distribution of Food Security Status, by Participant Category

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Food security status

 Food secure 73.1 71.6 75.4 73.5 77.5 77.1 76.4

 Food insecure without hunger 15.0 19.6 18.5 17.0 13.9 15.2 15.3

 Food insecure with hunger, moderate 8.9 8.1 4.0 7.2 6.9 6.3 6.7

 Food insecure with hunger, severe 3.0 0.7 2.1 2.2 1.6 1.4 1.7

Not reported 0.6 0.5 3.2 1.4 1.2 0.9 1.1

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________

Food security measure is composite scale based on responses to 18 survey questions identifying specific conditions of household food

insufficiency, reduced quality and variety of foods, patterns of reduced food intake, and direct hunger indicators for adults and

children. See Appendix C for information on construction of food security status, and potential bias in the current food security

scale for households in which the oldest child is two years of age or younger.

Number and percent with food security status not reported is excluded from previous percents.
___________________________________________________________________________________________________________________________________

Exhibit 3-40

Distribution of Food Security Status by Participant Category and Poverty Level 

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Food security status of WIC units 

with income # 100% of poverty level 

 Food secure 68.0 69.7 74.8 70.8 76.4 72.5 73.1

 Food insecure without hunger 15.5 19.4 19.0 17.6 12.9 17.7 16.4

 Food insecure with hunger, moderate 13.2 9.7 3.9 9.1 8.8 8.2 8.6

 Food insecure with hunger, severe 3.3 1.2 2.2 2.5 1.9 1.6 1.9

 Not reported 0.6 0.9 0.6 0.7 0.4 0.4 0.5

Sample size 338 381 398 1,117 370 398 1,885

Population 454,001 230,301 385,903 1,070,204 1,254,949 2,476,422 4,801,575

Food security status of WIC units 

with income > 100% of poverty level 

 Food secure 79.0 74.2 76.2 77.3 79.0 84.0 81.0

 Food insecure without hunger 14.1 20.0 17.8 16.2 16.3 11.3 13.8

 Food insecure with hunger, moderate 4.1 5.8 4.3 4.5 3.7 3.4 3.8

 Food insecure with hunger, severe 2.8 0.0 1.7 2.0 1.1 1.3 1.4

 Not reported 0.0 0.0 8.0 2.0 2.0 0.0 1.0

Sample size 296 243 182 721 230 225 1,176

Population 399,373 143,999 183,175 726,547 675,158 1,316,167 2,717,872

____________________________________________________________________________________________________________________________________

The food security measure is a composite scale based on responses to 18 survey questions identifying specific conditions of household

food insufficiency, reduced quality and variety of foods, patterns of reduced food intake, and direct hunger indicators for adults and

children. See Appendix C for information on construction of food security status, and potential bias in the current food security

scale for households in which the oldest child is two years of age or younger.

Number and percent with food security status not reported is excluded from previous percents.
____________________________________________________________________________________________________________________________________

Exhibit 3-41

Distribution of Food Security Status, by Reported Food Program Participation

____________________________________________________________________________________________________________________________________

 WIC and Other

 WIC WIC and Food Benefits WIC, FSP,

 Only Food Stamps (No Food Stamps) and Other

____________________________________________________________________________________________________________________________________

Food security status

 Food secure 77.8 77.7 76.2 69.9

 Food insecure without hunger 15.6 12.7 15.0 17.3

 Food insecure with hunger, moderate 5.9 7.0 6.1 9.8

 Food insecure with hunger, severe 0.7 2.6 2.7 3.0

Not reported 1.9 0.2 0.0 0.1

Sample size 1,740 572 418 384

Population 4,116,283 1,320,800 1,134,191 1,169,804

____________________________________________________________________________________________________________________________________

Food security measure is composite scale based on responses to 18 survey questions identifying specific conditions of household food

insufficiency, reduced quality and variety of foods, patterns of reduced food intake, and direct hunger indicators for adults and

children. See Appendix C for information on construction of food security status, and potential bias in the current food security

scale for households in which the oldest child is two years of age or younger.

Number and percent with food security status not reported is excluded from previous percents.

Other food benefits include: SBP, NSLP, TEFAP, CSFP, and local food pantries.

For this exhibit, if information about participation in a food program is not reported, no participation is assumed. Rates of

non-response are less than 3% for all food program participation items.
____________________________________________________________________________________________________________________________________

Exhibit 3-42

Food Security Status of WIC Families, by Selected Characteristics

____________________________________________________________________________________________________________________________________

 -------------- Food Insecure ------------

 Food without with Hunger, with Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

____________________________________________________________________________________________________________________________________

Household type

 Single family unit, single parent 76.1 16.7 4.8 2.4 602 1,533,53

 Single family unit, dual parent 75.5 16.9 6.6 1.0 1,554 3,952,15

 Multi-family unit, single parent 79.1 9.4 8.9 2.6 654 1,512,18

 Multi-family unit, dual parent 75.7 16.0 6.8 1.5 279 659,877

Maternal age

 Less than 18 years 85.5 10.0 1.8 2.6 201 388,509

 18 - 34 years 76.0 15.1 7.2 1.7 2,546 6,146,60

 More than 43 years 75.3 17.7 5.6 1.3 316 1,064,47

Maternal education

 Less than 8 years 57.9 18.1 21.4 2.7 158 423,776

 8-11 years 74.9 15.1 7.9 2.1 764 1,968,44

 12 years 78.2 14.7 5.9 1.2 1,149 2,984,09

 13 or more years 77.5 16.5 4.4 1.6 767 1,791,24

 Schooling incomplete, age<18 83.3 11.6 2.8 2.3 227 446,667

 Not reported 87.1 11.0 0.0 1.9 16 31,221

____________________________________________________________________________________________________________________________________

Single-family unit is defined as households containing only respondent, spouse, partner, and biological or step-children; all other

households are categorized as "multi-family." Maternal education is the education of WIC pregnant, breastfeeding, or postpartum women,

or mothers of WIC infants or children. Exhibit does not include the 1.1% of WIC families with food security status not determined.
____________________________________________________________________________________________________________________________________

Exhibit 3-43

Food Security Status of WIC Families, by Geographic Area

____________________________________________________________________________________________________________________________________

 ------------- Food Insecure -------------

 Food without with Hunger, with Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

____________________________________________________________________________________________________________________________________

Location

 Non-metropolitan area 80.4 14.4 4.5 0.6 725 1,585,93

 Metropolitan area 75.3 15.5 7.3 1.9 2,364 6,071,81

FNS region

 Northeast 78.3 13.5 7.4 0.8 395 803,845

 Mid-Atlantic 84.1 10.0 5.2 0.6 340 749,863

 Southeast 76.4 13.5 7.5 2.6 446 1,485,98

 Midwest 77.3 14.6 7.3 0.8 457 1,140,85

 Mountain Plains 72.4 21.2 5.2 1.2 233 514,709

 Southwest 77.6 14.4 4.5 3.5 602 1,149,66

 Western 72.0 18.9 7.8 1.3 616 1,812,83

 Total WIC 76.4 15.3 6.7 1.7 3,114 7,741,078

____________________________________________________________________________________________________________________________________

Residence in metropolitan areas is determined by location of local WIC agency at which participant is certified. Local WIC agencies

located within MSAs are coded as metro. Exhibit does not include the 1.1% of WIC families with food security status not determined.
55 See Exhibit 3-31 for the specific risks that are prevalent within these broad categories.

56 The most prevalent predisposing risk among children is low maternal education (see Exhibit 3-35).

112 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

The next five exhibits (Exhibits 3-44 through 3-48) complete the examination of food security status. 

There is one exhibit for each WIC certification category. Each exhibit looks at the relationship between

food security status and the number and type of nutritional risks present at certification.

Among pregnant women, three categories of nutritional risk are significantly related to food security

status: women with conditions specific to pregnancy, risks due to potentially toxic substances, and

predisposing risks are less likely to be food secure than women without those risks. Among breast- 55

feeding women, postpartum women, and infants there are no risk categories in which the number of risks

is statistically associated with food security status. Among children, those with predisposing risks are

statistically more likely to have moderate or severe hunger.56

The overall number of nutrition risks has a statistically significant correlation with food security status

only for breastfeeding women and children, with a greater number of risks related to a greater likelihood

of food insecurity.
____________________________________________________________________________________________________________________________________

Exhibit 3-44

Distribution of Food Security Status by Number of Nutritional Risk Factors: Pregnant Women

____________________________________________________________________________________________________________________________________

 ------------- Food Insecure -------------

 Food Without With Hunger, With Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

____________________________________________________________________________________________________________________________________

Anthropometric risks 

 None 68.4 15.2 12.9 3.6 145 204,527

 One 76.6 13.6 5.9 3.9 254 322,363

 Two or more 71.9 15.7 10.1 2.2 208 281,373

Conditions specific to pregnancy 

 None 75.2 15.6 8.5 0.8 331 428,657

 One 66.8 16.0 10.6 6.6 197 274,697

 Two or more 78.6 8.5 8.5 4.4 75 100,065

Potentially toxic substances 

 None 74.0 13.5 10.5 2.0 452 606,511

 One 68.9 20.3 5.1 5.7 136 173,355

 Two or more 71.8 5.5 6.5 16.2 14 21,975

Other biochemical and medical risks 

 None 70.7 16.9 10.1 2.3 272 363,465

 One 73.7 15.2 8.6 2.5 237 318,646

 Two or more 76.3 7.8 8.0 7.9 94 120,685

Dietary risks 

 None 64.5 21.8 12.3 1.3 144 202,336

 One 75.9 12.5 8.1 3.5 447 582,238

 Two or more 62.0 16.3 7.3 14.4 15 21,583

Predisposing risks 

 None 73.6 15.4 8.7 2.3 539 712,074

 One 67.3 10.9 11.8 10.0 49 69,226

 Two or more 66.0 15.3 0.0 18.6 9 11,997

Total risks 

 One 61.4 13.5 25.1 0.0 62 87,491

 Two 74.5 19.3 6.1 0.0 99 132,322

 Three 75.5 15.2 6.6 2.7 146 196,370

 Four or more 73.6 13.4 7.8 5.2 303 395,880

Overall 

 Total pregnant 72.9 14.8 9.1 3.2 610 812,063

____________________________________________________________________________________________________________________________________

Table excludes pregnant women with food security status not determined (0.6%) and pregnant women with incomplete or missing Nutritional Risk Checklists (5.1%).
____________________________________________________________________________________________________________________________________

Exhibit 3-45

Distribution of Food Security Status by Number of Nutritional Risk Factors: Breastfeeding Women

____________________________________________________________________________________________________________________________________

 ------------- Food Insecure -------------

 Food without with Hunger, with Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

____________________________________________________________________________________________________________________________________

Anthropometric risks

 None 74.5 14.0 10.9 0.5 221 120,990

 One 71.6 20.5 7.0 0.9 174 106,617

 Two or more 74.4 19.3 5.8 0.5 164 99,254

Potentially toxic substances

 None 74.3 17.6 7.4 0.7 497 294,494

 One 66.8 18.5 14.6 0.0 58 31,080

 Two or more 78.0 22.0 0.0 0.0 5 2,179

Other biochemical and medical risks

 None 75.4 15.7 8.3 0.6 284 170,171

 One 69.8 19.9 9.9 0.5 192 107,260

 Two or more 75.1 20.2 3.4 1.3 84 49,450

Dietary risks

 None 75.7 16.6 7.7 0.0 134 74,386

 One 73.4 17.6 8.2 0.8 419 249,175

 Two or more 53.4 40.1 6.5 0.0 9 4,793

Predisposing risks

 None 73.1 18.5 8.0 0.4 513 298,197

 One 75.8 10.4 9.9 3.9 39 24,456

 Two or more 83.4 16.6 0.0 0.0 6 3,050

Total risks

 One 81.1 13.4 5.5 0.0 107 56,193

 Two 71.5 12.1 16.4 0.0 133 79,524

 Three 72.9 17.7 7.3 2.0 128 80,441

 Four or more 72.4 23.3 3.8 0.4 197 114,340

Overall

 Total breastfeeding 73.8 17.6 8.0 0.6 565 330,499

____________________________________________________________________________________________________________________________________

Table excludes breastfeeding women with food security status not determined (0.5%) and breastfeeding women with incomplete or missing

Nutritional Risk Checklists (11.7%).
____________________________________________________________________________________________________________________________________

Exhibit 3-46

Distribution of Food Security Status by Number of Nutritional Risk Factors: Postpartum Women

____________________________________________________________________________________________________________________________________

 ------------- Food Insecure -------------

 Food without with Hunger, with Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

____________________________________________________________________________________________________________________________________

Anthropometric risks 

 None 77.5 16.2 5.2 1.1 212 197,408

 One 74.6 20.2 3.7 1.5 131 120,587

 Two or more 76.7 15.6 3.4 4.3 190 175,032

Potentially toxic substances 

 None 77.0 15.8 4.6 2.6 412 378,225

 One 74.7 22.6 2.1 0.6 105 101,558

 Two or more 62.4 25.0 5.6 7.0 13 11,635

Other biochemical and medical risks 

 None 77.8 17.0 2.8 2.4 224 214,405

 One 75.2 17.2 6.7 0.8 211 191,211

 Two or more 73.1 19.6 2.1 5.2 98 89,004

Dietary risks 

 None 77.0 20.1 2.5 0.4 143 145,940

 One 75.9 16.2 5.0 2.9 384 343,624

 Two or more 40.1 37.8 0.0 22.0 5 3,803

Predisposing risks 

 None 75.7 17.5 4.6 2.2 471 426,940

 One 74.8 21.6 1.1 2.4 47 49,578

 Two or more 93.5 0.0 0.0 6.5 9 12,915

Total risks 

 One 80.2 11.2 7.3 1.4 76 75,876

 Two 76.4 16.7 4.7 2.1 129 109,048

 Three 70.1 23.7 4.2 1.9 127 121,476

 Four or more 77.7 16.7 2.6 3.0 204 190,230

Overall 

 Total postpartum 75.9 17.6 4.2 2.3 536 496,629

____________________________________________________________________________________________________________________________________

Table excludes postpartum women with food security status not determined (3.2%) and postpartum women with incomplete or missing 

Nutritional Risk Checklists (10.4%).
____________________________________________________________________________________________________________________________________

Exhibit 3-47

Distribution of Food Security Status by Number of Nutritional Risk Factors: Infants

____________________________________________________________________________________________________________________________________

 ------------- Food Insecure -------------

 Food without with Hunger, with Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

____________________________________________________________________________________________________________________________________

Anthropometric risks 

 None 78.6 13.6 6.2 1.6 429 1,344,97

 One 70.8 16.3 11.5 1.4 79 268,869

 Two or more 70.6 20.4 7.3 1.7 54 174,645

Potentially toxic substances 

 None 76.8 14.5 7.1 1.6 557 1,770,16

 One 100.0 0.0 0.0 0.0 1 1,688

Other biochemical and medical risks 

 None 76.7 14.2 7.4 1.8 442 1,416,88

 One 73.3 18.9 6.5 1.3 93 293,542

 Two or more 85.6 11.7 2.7 0.0 30 87,194

Dietary risks 

 None 77.9 14.4 6.4 1.3 408 1,300,48

 One 74.7 14.7 6.3 4.3 93 268,832

 Two or more 72.2 15.7 12.1 0.0 61 217,650

Predisposing risks 

 None 76.7 14.3 7.2 1.8 469 1,471,76

 One 77.5 16.3 6.3 0.0 75 259,660

 Two or more 72.6 14.4 8.9 4.0 17 52,008

Total risks 

 One 77.7 15.4 5.5 1.4 245 779,770

 Two 79.4 14.3 4.3 2.0 138 428,994

 Three 76.6 7.5 13.5 2.4 79 243,483

 Four or more 70.8 19.1 9.2 0.8 105 349,417

Overall 

 Total infants 76.6 14.8 7.0 1.6 567 1,801,66

____________________________________________________________________________________________________________________________________

Table excludes infants with food security status not determined (1.2%) and infants with incomplete or missing Nutritional Risk Checklists (8.0%).
____________________________________________________________________________________________________________________________________

Exhibit 3-48

Distribution of Food Security Status by Number of Nutritional Risk Factors: Children

____________________________________________________________________________________________________________________________________

 ------------- Food Insecure -------------

 Food without with Hunger, with Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

____________________________________________________________________________________________________________________________________

Anthropometric risks 

 None 80.7 12.3 5.2 1.8 356 2,165,80

 One 73.4 19.9 5.0 1.7 165 1,007,67

 Two or more 66.8 14.6 18.7 0.0 54 362,264

Potentially toxic substances 

 None 76.9 14.8 6.7 1.6 564 3,450,84

 One 100.0 0.0 0.0 0.0 3 18,160

Other biochemical and medical risks 

 None 79.2 14.2 5.1 1.5 380 2,275,84

 One 71.6 16.7 10.1 1.6 159 1,001,75

 Two or more 82.1 10.1 5.2 2.5 37 250,688

Dietary risks 

 None 72.0 15.8 9.8 2.4 108 731,480

 One 78.1 14.6 5.9 1.4 461 2,727,92

Predisposing risks 

 One 77.1 10.0 12.8 0.0 50 326,866

 Two or more 80.3 3.7 4.3 11.7 11 82,210

Total risks 

 One 80.6 14.8 3.2 1.4 273 1,603,13

 Two 75.6 15.4 7.3 1.8 181 1,100,77

 Three 82.7 9.1 5.7 2.6 81 531,024

 Four or more 60.9 18.9 20.2 0.0 48 345,395

Overall 

 Total children 77.5 14.5 6.5 1.6 583 3,580,32

____________________________________________________________________________________________________________________________________

Checklists (8.8%).
57 Previously we cited that 61.6 percent of WIC participants were adjunct eligible for WIC due to participation in Medicaid. The percentage

adjunct eligible due to Medicaid is higher than the percentage of WIC participants enrolled in Medicaid because adjunct eligibility is

conferred by Medicaid enrollment of either the WIC applicant or a pregnant woman or infant in the applicant’s family.

58 Omnibus Reconciliation Act, 1989.

118 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

3.7 Health Insurance Coverage

The WIC program is concerned with the health and nutrition of women, infants, and children, but WIC is

not a health care provider. To ensure that WIC participants receive health care and other needed services,

WIC provides screening and referrals to other health, welfare and social service agencies.

NSWP respondents were asked about health insurance coverage at the time of their current certification

for WIC. Because many had previous personal or family experience with WIC, patterns of health

insurance incorporate an unknown degree of response to previous WIC referrals. Exhibit 3-49 shows

that 83.1 percent of WIC participants had health insurance coverage at the time of their current WIC

certification. Pregnant women had the lowest rate of health insurance coverage (70.6 percent) and infants

had the highest coverage (86.1 percent); these differences across certification categories are statistically

significant.

Overall, 58.1 percent of WIC participants had health insurance from the government’s Medicaid

program. Among those with some form of health insurance coverage, 70 percent had Medicaid and 30 57

percent had employer-provided coverage. Across certification categories, the differences in the distributions of source of health insurance, among those with health insurance, are not statistically significant.

NSWP respondents who reported no health insurance were asked the reasons for lack of insurance. 

These responses are shown in Exhibit 3-49. Multiple reasons were given by 44 percent of those with no

health insurance, so that the sum of responses exceeds 100 percent. Across all certification categories,

the most common reason for lack of health insurance was Medicaid ineligibility or a belief that they could

not get Medicaid (57.4 percent). Unemployment status was cited as a reason for lack of health insurance

by 43.9 percent of respondents; 41.8 percent of respondents said they were employed, but their employer

did not offer insurance or they could not afford it. Nearly all respondents stating “Don’t think I can get

private health insurance” or “Been refused insurance due to poor health” also cited one of the three main

reasons (Medicaid, unemployment, employed but can’t afford it). About 3 percent of respondents said

they had no health insurance because they had not needed it.

Medicaid

Persons enrolled in Medicaid are automatically income-eligible for WIC, so it is easy to forget that the

reverse is not true—all WIC participants are not eligible for Medicaid. Applicants to WIC are income -

eligible for WIC if their income is at or below 185 percent of the federal poverty level (FPL). At the time

of the NSWP survey (spring 1998), federal law required states to provide Medicaid to all pregnant

women, and children below age six, living in families with incomes at or below 133 percent of FPL.58
____________________________________________________________________________________________________________________________________

Exhibit 3-49

Percentage of WIC Participants by Health Insurance Coverage and Reasons for Lack of Health Insurance

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Percent covered by health insurance

 Yes 70.6 76.7 85.5 76.7 86.1 84.5 83.1

 No 29.4 23.3 14.5 23.3 13.9 15.5 16.9

Percent by source of insurance

 Employer 18.3 30.1 22.9 22.2 24.6 26.0 24.8

 Medicaid 49.9 47.7 62.0 53.3 61.3 58.8 58.1

 Other 3.8 3.1 2.2 3.2 1.8 2.9 2.7

 Source not reported 0.3 0.6 0.5 0.4 0.5 0.4 0.4

 No health insurance 29.1 23.1 14.5 23.2 13.9 15.5 16.9

Reasons for no health insurance, if nonea

 Not eligible for or don't 42.2 69.1 65.0 52.7 56.7 60.8 57.4

 think I can get Medicaid

 Not employed, coverage discontinued 55.4 52.8 58.4 55.5 50.4 33.2 43.9

 or can't afford it

 Employed, insurance not offerred 40.8 34.9 21.0 35.3 47.8 43.7 41.8

 or can't afford it

 Don't think I can get private insur. 13.0 22.7 24.1 17.4 21.0 10.1 14.7

 Haven't needed health insurance 5.2 4.3 3.8 4.7 2.7 1.7 2.9

 Been refused insurance due to health 3.4 0.9 1.0 2.4 1.1 0.0 1.0

Item nonresponse

 Health insurance coverage 2.0 0.5 0.5 1.2 0.6 1.0 0.9

 Reasons for no health insurance 10.8 7.4 0.6 8.0 13.6 7.5 9.0

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________

NOTE: Percent by source does not sum to 100 due to multiple sources of health insurance for 3.5 percent of respondents with health

insurance.

a The sum of responses to "reasons for no health insurance" exceeds 100 percent because 44 percent of respondents with no health 

insurance cited multiple reasons.
59 Section 1902(2)(2) option of the Social Security Act. As of October 1997, the Medicaid income-eligibility standard for pregnant women

and infants was 185 percent of FPL in 21 states, and exceeded 185 percent of FPL in eight states. At the same time, the Medicaid incomeeligibility standard for children below age six was 185 percent of FPL in five states, and exceeded 185 percent of FPL in seven states. 

(Source: National Governors Association, State Medicaid Coverage of Pregnant Women and Children, September 1997.)

60 Based on PC98, 42.8 percent of women, infants, and children enrolled in WIC lived in states with a Medicaid income limit equal to or

greater than the WIC income limit. The estimate of 37.6 percent from NSWP has a standard error of 4.96 and a 95 percent confidence

interval from 27.7-47.5 percent.

61 In states with an income limit for Medicaid at or above 185 percent FPL, WIC and Medicaid may nonetheless apply different definitions of

family or family income, so the eligibility standards of the two programs may not be exactly the same.

 "WIC experience" is determined by the prior WIC enrollment by any member of the sampled person's family. 62

120 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

States could expand eligibility for Medicaid beyond federal requirements using a variety of mechanisms

available under federal law. As a result of state expansions of Medicaid, 37.6 percent of the NSWP 59

sample lived in states with a Medicaid income limit equal to or greater than the WIC income limit.60

Exhibit 3-50 shows that health insurance coverage and Medicaid enrollment for WIC participants is

slightly higher in states with a Medicaid income-limit at or above the WIC income limit. These differences, however, are not statistically significant. This exhibit also shows that, even in states where all

WIC participants are likely to be eligible for Medicaid, 13.8 percent of WIC participants have no health

insurance, and one-half of those with no health insurance believe that they are ineligible for Medicaid.61

The NSWP interviewed WIC participants at the time that they were certified in WIC, and before they had

an opportunity to follow-up on referrals to Medicaid that they may have received at the current WIC

certification. As a result, the impact of WIC referrals may be seen in the different rates of Medicaid

enrollment for respondents with prior WIC experience versus those without prior WIC experience. 

62

Exhibit 3-51 shows that prior WIC experience (compared to no prior WIC experience) is associated with

slightly higher rates of Medicaid enrollment (59.4 versus 55.0 percent) and slightly higher rates of health

insurance (84.3 versus 80.1 percent), but the difference is not statistically significant. These differences

are also shown separately for WIC participants in states with a Medicaid income limit below the WIC

income limit (less than 185 percent FPL) and for those in states with a Medicaid income limit equal to or

greater than the WIC income limit (at or above 185 percent FPL). In states with a Medicaid income limit

at or above the WIC income limit, the difference in Medicaid enrollment and health insurance coverage

for those with and without prior WIC experience is statistically significant. Prior WIC experience is

associated with a ten-percentage point increase in the Medicaid enrollment rate (67.4 versus 57.6

percent).
_____________________________________________________________________________________

Exhibit 3-50

Health Insurance Coverage and Reasons for Lack of Health Insurance, by Medicaid Income

Eligibility Limit of State of Residence

_____________________________________________________________________________________

 Medicaid Income Limit Medicaid Income Limit

 Less than 185% FPL 185% FPL or higher

_____________________________________________________________________________________

Percent covered by health insurance 

 Yes 81.2 86.2

 No 18.8 13.8

Percent by source of insurance 

 Employer 25.0 24.3

 Medicaid 55.5 62.6

 Other 3.0 2.2

 Source not reported 0.4 0.5

 No health insurance 18.7 13.8

Reasons for no health insurance, 

if none 

 Not eligible for or don't 60.4 49.9

 think I can get Medicaid

 Not employed, coverage discontinued 39.6 54.6

 or can't afford it

 Employed, insurance not offerred 46.1 31.1

 or can't afford it

 Don't think I can get private 14.7 14.5

 health insurance

 Haven't needed health insurance 1.6 6.0

 Been refused insurance due to health 0.3 2.7

Item nonresponse 

 Health insurance coverage 0.9 1.0

 Reasons for no health insurance 6.5 14.7

Sample size 1,469 1,645

Population 4,833,931 2,907,147

_____________________________________________________________________________________

NOTE: Percent by source does not sum to 100 due to multiple sources of health insurance

cited by 3.5 percent of respondents with health insurance.

In 1998, federal law mandated Medicaid coverage for pregnant women, infants, and children 

up to age six with incomes up to 133% of poverty level. States had the option to provide

Medicaid coverage to persons with incomes above the mandated level. In the NSWP sample, 

37 percent of sampled persons resided in states with Medicaid income limits at or above 

185% of poverty level.
_____________________________________________________________________________________

Exhibit 3-51

Health Insurance Coverage by WIC Experience and Medicaid Income Eligibility Limit of 

State of Residence 

_____________________________________________________________________________________

 First WIC experience Family has WIC

 for family experience

_____________________________________________________________________________________

Wic Participants in All States

Percent covered by health insurance 

 Yes 80.1 84.3

 No 19.9 15.7

Percent by source of insurance 

 Employer 23.7 25.1

 Medicaid 55.0 59.4

 Other 2.7 2.9

 Source not reported 0.6 0.4

 No health insurance 19.9 15.7

Sample size 1,075 1,979

Population 2,355,274 5,024,068

State Medicaid Income Limit < 185% FPL 

Percent covered by health insurance 

 Yes 76.6 82.2

 No 23.4 17.8

Percent by source of insurance 

 Employer 25.5 24.7

 Medicaid 50.5 56.6

 Other 2.0 3.4

 Source not reported 0.1 0.5

 No health insurance 23.4 17.8

Sample size 403 1,024

Population 867,085 3,687,451

State Medicaid Income Limit >= 185% FPL 

Percent covered by health insurance 

 Yes 82.2 90.2

 No 17.8 9.8

Percent by source of insurance 

 Employer 22.7 26.3

 Medicaid 57.6 67.4

 Other 3.0 1.5

 Source not reported 0.9 0.1

 No health insurance 17.8 9.8

Sample size 672 955

Population 1,488,189 1,336,616

_____________________________________________________________________________________

NOTE: Percent by source does not sum to 100 due to multiple sources of health insurance

cited by 3.5 percent of respondents with health insurance.

In 1998, federal law mandated Medicaid coverage for pregnant women, infants, and children 

up to age six with incomes up to 133% of poverty level. States had the option to provide 

Medicaid coverage to persons with incomes above the mandated level. In the NSWP sample, 

37 percent of sampled persons resided in States with Medicaid income limits at or above 

185% of poverty level.
63 Although Medicaid is a jointly funded federal-state program, states determine the types of services available and service-availability may

vary across states.

Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 123

Health Insurance Services

NSWP respondents who reported health insurance coverage at the time of their WIC certification were

asked about the health care services available under their health plan. Exhibit 3-52 shows the distributions of responses for Medicaid recipients and for WIC enrollees with private health insurance plans.63

Most Medicaid recipients reported that immunizations, well baby care, and well child care were services

available under Medicaid at no charge; only 8 to 15 percent of Medicaid recipients did not know about

the availability of these services, and few reported these services as unavailable or requiring a fee. In

contrast, only about one-half of Medicaid recipients reported that breastfeeding nutrition support and

nutrition education were available from Medicaid, and more than one-third reported that they did not

know whether or not these services were available.

About 30 percent of those with private health insurance reported that immunizations, well baby care, and

well child care were available from their health plan for a fee; a slightly higher percent reported these

services to be free of charge. Persons with private health insurance were similar to Medicaid recipients in

their lack of knowledge about the availability of nutrition services from their health plans (about 40

percent did not know). Persons with private health insurance were less likely than Medicaid recipients to

report that nutrition services were available for free, and they were more likely to report that the services

were not available from their health plan.

For all health services that we asked about, persons with private health insurance were more likely than

Medicaid recipients to report that they did not know about the availability of the service under their

health plan. This differential knowledge could be cause for concern if it reflects a differential utilization

of health care services.
_____________________________________________________________________________________

Exhibit 3-52

Distribution of Reported Service Availability from WIC Participants' Health Insurance

Plans 

_____________________________________________________________________________________

 Other Total with

 Medicaid insurance insurance

_____________________________________________________________________________________

Breastfeeding nutrition support 

 Available for free 50.8 22.3 42.3

 Available at extra charge 0.9 7.5 2.9

 Not available 11.5 27.4 16.2

 Don't know 36.8 42.8 38.6

Nutrition education 

 Available for free 54.0 23.3 44.8

 Available at extra charge 0.7 9.2 3.2

 Not available 13.1 26.5 17.1

 Don't know 32.2 41.0 34.8

Immunizations 

 Available for free 86.2 47.6 74.6

 Available at extra charge 3.0 31.0 11.4

 Not available 2.3 10.9 4.9

 Don't know 8.5 10.4 9.1

Well baby care 

 Available for free 79.5 37.6 66.9

 Available at extra charge 2.9 32.8 11.9

 Not available 3.0 11.8 5.6

 Don't know 14.6 17.8 15.5

Well child care 

 Available for free 78.2 35.8 65.5

 Available at extra charge 2.9 31.2 11.4

 Not available 3.7 13.3 6.5

 Don't know 15.3 19.7 16.6

Item nonresponse 

 Breastfeeding nutrition support 1.4 1.9 1.5

 Nutrition education 1.4 1.6 1.5

 Immunizations 1.1 1.7 1.3

 Well baby care 1.5 1.5 1.5

 Well child care 1.5 2.1 1.7

Sample size 1,731 789 2,520

Population 4,457,630 1,915,470 6,373,100

_____________________________________________________________________________________

NOTE: Table excludes WIC participants with no health insurance.
64 State data systems vary with respect to whether they maintain identifiers to link family members and whether they maintain the date of first

WIC enrollment.

65 It is possible that data about gestation and expected date of delivery are entered into the certification records after NSWP collected those

records from WIC sites. The overall distribution by trimester is similar to that shown in census data in WIC Participant and Program

Characteristics, 1998, Exhibit 3-1.

66 This difference is statistically significant at the 10 percent level. All other tests of significance have been done at the 5 percent level.

Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 125

3.8 Participants’ History with the WIC Program

Little information exists about the duration of WIC participation for individuals over multiple certification periods, or the extent to which WIC provides continuity of service to families from the prenatal

period through early childhood. Just as it is difficult to use WIC administrative records to examine the

extent to which multiple persons in a family participate (or have participated) in WIC, it is difficult to

examine the longitudinal participation behavior of WIC participants. This section uses the NSWP to 64

examine the timing and continuity of WIC participation.

Earlier in this chapter, Exhibit 3-6 showed that most mothers of WIC infants and children were enrolled

in WIC when pregnant with their children and during the postpartum period. Exhibit 3-53 consolidates

information from Exhibit 3-6, and presents information about prenatal WIC participation for mothers of

infants and children alongside the same information for breastfeeding and postpartum women. As shown

in this exhibit, across all certification categories (breastfeeding, postpartum, infants, and children) a high

percentage of WIC participants are continuing WIC participation that began in the prenatal period. The

rate of prenatal participation ranges from 77.6 to 84.1 percent across WIC women and WIC mothers,

depending on certification category (the differences across certification category are not statistically

significant).

For those women who do enroll in WIC while pregnant, when do they enroll? Exhibit 3-54 shows that

41.5 percent of pregnant WIC participants enroll during their first trimester, another 39.5 percent enroll

during their second trimester, and 19.0 percent enroll during the third trimester. There is an unusually

high rate of missing information on trimester of enrollment (19.0 percent) because this variable is taken

from the certification forms collected at local service sites, not from the NSWP survey itself. Despite 65

high rates of missing data, the comparable rates of missing data across groups of women with and

without WIC experience suggests that comparison across these groups is valid. Somewhat surprisingly,

pregnant women with prior WIC experience enroll in WIC later during pregnancy than those without

prior experience (e.g., 21.1 percent of women with prior WIC experience wait until the third trimester to

enroll, versus 17.8 percent of women without prior WIC experience).66

Another question regarding timing of enrollment is when do infants get certified? The cumulative distributions in Exhibit 3-55 show that 25.9 percent of WIC infants are certified when less than one week old. 

Slightly more than one half (50.6 percent) are certified within two weeks of birth, and 71.3 percent are

certified during their first month. Here, however, the prior WIC experience of the mother does affect

when infants are certified; that is, infants are more likely to be certified at a younger age if the mother

participates in WIC. For instance, 79.5 percent of infants of mothers in WIC while pregnant are enrolled

in the first month, compared to only 43.1 percent of WIC infants whose mothers were not on WIC during

pregnancy.
_________________________________________________________________________________________________

Exhibit 3-53

Percent of WIC Women and WIC Mothers in WIC When Their Children Were Born

_________________________________________________________________________________________________

 Breastfeeding Postpartum Mothers of Mothers of

 Women Women Infants Children

_________________________________________________________________________________________________

On WIC as pregnant woman

 Yes 84.1 82.1 77.6 80.1

 No 15.9 17.9 22.4 19.9

Not reported 0.8 3.3 3.1 7.9

Sample size 627 587 614 647

Population 376,463 573,899 1,978,411 3,952,924

_________________________________________________________________________________________________

WIC mothers include mothers of infants and children sampled for NSWP at certification.

_____________________________________________________________________________________

Exhibit 3-54

Distribution of Pregnant Women WIC Participants, by Trimester of Current Enrollment

_____________________________________________________________________________________

 No Prior WIC Prior WIC Total Pregnant

 Experience Experience Women

_____________________________________________________________________________________

Trimester of enrollment

 First trimester 44.0 37.2 41.5

 Second trimester 38.2 41.7 39.5

 Third trimester 17.8 21.1 19.0

Trimester not reported 18.5 19.7 19.0 a

Sample size 394 245 639

Population 532,798 326,583 859,381

_____________________________________________________________________________________

Number of respondents with information "not reported" are excluded from previous 

percents. Information on prior WIC experience is missing for 1.3% of pregnant women.

a Information about trimester of enrollment was taken from certification forms. Cer-

 tification forms are missing for 13% of pregnant women, and an additional 6% had 

 incomplete certification forms that did not indicate trimester of enrollment.
____________________________________________________________________________________________________________________________________

Exhibit 3-55

Distribution of Age at First WIC Certification, by Whether Mother Participated in WIC When Pregnant: Infants

____________________________________________________________________________________________________________________________________

 Mother in WIC When Pregnant Mother not in WIC When Pregnant Total Infants

 Percent Cum Pct Percent Cum Pct Percent Cum Pct

____________________________________________________________________________________________________________________________________

Age at first certification

 Less than 1 week 30.6 30.6 6.5 6.5 25.9 25.9

 1-2 weeks 28.4 59.0 14.3 20.7 24.7 50.6

 2-4 weeks 20.5 79.5 22.4 43.1 20.7 71.3

 5-8 weeks 11.8 91.3 18.2 61.3 13.5 84.7

 9-12 weeks 2.4 93.6 8.5 69.8 3.6 88.4

 13-25 weeks 4.6 98.2 21.3 91.2 8.2 96.6

 26-40 weeks 1.6 99.8 8.1 99.2 3.1 99.7

 > 10 months 0.2 100.0 0.8 100.0 0.3 100.0

Sample size 465 465 132 132 614 614

Population 1,488,706 1,488,706 429,321 429,321 1,978,411 1,978,411

____________________________________________________________________________________________________________________________________

Information on mother's prior WIC experience is missing for 3.1% of infants. As a result, the sample size in first two columns does

not sum to the total column.
67 Federal WIC regulations specify that “infants shall be certified at intervals of approximately six months, except that the State agency may

permit local agencies under its jurisdiction to certify infants under six months of age for a period extending up to the first birthday.”

128 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

Exhibit 3-56 offers parallel information for the age at which WIC children are first enrolled in WIC

(including enrollment as an infant). Overall, 36.1 percent of WIC children first enrolled when less than

one week old, and 95.5 percent enrolled before their first birthday. Again, as with WIC infants, this

exhibit shows that WIC children are enrolled much sooner if their mother participated in WIC when

pregnant.

Exhibit 3-57 examines the prior WIC experience of WIC women. For most pregnant women (62.0

percent), this is their first enrollment in WIC. In contrast, 91.6 of breastfeeding women have prior

experience with WIC, as do 82.5 percent of postpartum women (based on the 8.4 and 17.5 percent of

these women, respectively, having their first WIC certification). For a large majority of these breastfeeding and postpartum women, their prior experience with WIC was while pregnant, as evidenced by the

large percentages who received WIC last month (i.e., just prior to being certified as breastfeeding or

postpartum).

Information about the prior WIC experience of infants and children is presented in Exhibit 3-58. In this

exhibit, WIC infants and children are characterized by whether they are new to WIC (being certified for

the first time) or receiving recertification. WIC certification periods vary by participant category, with

children certified for six-month periods and infants certified for six months or, at the discretion of local

agencies, for a period up to their first birthday.67

As seen in Exhibit 3-58, less than 1 percent of children are new to WIC; nearly all children had participated in WIC prior to the current certification. This high rate of recertification is not surprising, because

children may be continuing certification as a child, or being newly-certified as a child after prior enrollment as an infant. On the other hand, because we do not count prenatal enrollment of infants as “prior

WIC enrollment,” we expect a high percentage of infants to be receiving their first WIC certification. For

infants, 86.5 percent were receiving their first WIC certification and 13.5 percent of those sampled were

being recertified.
____________________________________________________________________________________________________________________________________

Exhibit 3-56

Distribution of Age at First WIC Certification, by Whether Mother Participated in WIC When Pregnant: Children

____________________________________________________________________________________________________________________________________

 Mother in WIC When Pregnant Mother Not in WIC When Pregnant Total Children

 Percent Cum Pct Percent Cum Pct Percent Cum Pct

____________________________________________________________________________________________________________________________________

Age at first certification

 Less than 1 week 39.7 39.7 21.2 21.2 36.1 36.1

 1-2 weeks 34.1 73.7 12.1 33.2 28.3 64.4

 2-4 weeks 3.3 77.1 4.9 38.1 3.7 68.1

 5-8 weeks 11.9 88.9 18.1 56.2 12.8 80.9

 9-12 weeks 4.3 93.3 10.4 66.6 5.3 86.1

 13-25 weeks 3.6 96.9 11.4 78.0 5.6 91.7

 26-40 weeks 1.9 98.7 5.4 83.4 2.7 94.4

 41-52 weeks 0.5 99.3 1.2 84.6 1.1 95.5

More than one year:

 13-18 months 0.9 99.7 4.9 89.1 2.3 96.9

 19-24 months 0.3 100.0 5.9 94.9 1.3 98.2

 25-36 months 0.0 100.0 4.3 99.2 1.1 99.2

 37-48 months 0.0 100.0 0.8 100.0 0.8 100.0

 49-51 months 0.0 100.0 0.0 100.0 0.0 100.0

Sample size 481 481 114 114 647 647

Population 2,915,040 2,915,040 726,029 726,029 3,952,924 3,952,924

____________________________________________________________________________________________________________________________________

WIC children may have received first WIC certification as infants. Information on mother's prior WIC experience is missing for 7.9% 

of children; as a result, sample size in the first two columns does not sum to the total column.
_________________________________________________________________________________________________

Exhibit 3-57

Prior WIC Experience of WIC Women

_________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total

 Women Women Women Women

_________________________________________________________________________________________________

Certification history

 First WIC certification 62.0 8.4 17.5 36.8

 Received WIC last month 1.1 89.2 75.5 43.0

 Received WIC at earlier time 36.9 2.4 7.0 20.2

Sample Size 639 627 587 1,853

Population 859,381 376,463 573,899 1,809,743

_________________________________________________________________________________________________

Certification history is based on mothers' responses about WIC participation when pregnant or

postpartum, for each of her children.

_____________________________________________________________________________________

Exhibit 3-58

Prior WIC Experience of WIC Infants and Children

_____________________________________________________________________________________

 WIC WIC

 Infants Children

_____________________________________________________________________________________

Certification history

 First WIC certification 86.5 0.9

 Recertification 13.5 99.1

 Indeterminant 3.1 7.6

Ever leave and reenter the WIC program?

 Yes NA 24.6

 No NA 75.4

 Not reported 12.5

Sample size 614 647

Population 1,978,411 3,952,924

_____________________________________________________________________________________

Number and percent with information indeterminant or not reported are excluded from 

previous percents. Certification history is indeterminant in cases for which "age 

when WIC began" was not reported.

Some WIC agencies choose to certify infants at 6-month intervals, whereas most choose to

certify infants for a period up until their first birthday.
68 American Academy of Pediatrics, “Policy Statement: Breastfeeding and the Use of Human Milk (RE9729),” Pediatrics 100(6):

1035-1039, 1977.

69 U.S. Department of Health and Human Services, Healthy People 2010, 2nd ed., Vol. II, Chapter 16, Washington, DC: U.S. Government

Printing Office, November 2000.

70 The baseline for the FNS strategic plan is from PC98. The methodologies differ in sample definition. NSWP represents only the

continental U.S.; data were collected from all infants at the time of WIC certification via interviews with WIC mothers. PC98 data are

from WIC information management systems. PC98 contains the entire WIC population, but the breastfeeding estimate excludes those

states failing to report breastfeeding data for at least 75 percent of all 7- to 11-month-old infants. As a result, “the national estimates are

based on 81 percent of all WIC infants aged seven-to-eleven months” (PC98, p.140). By measuring breastfeeding initiation among infants

aged 7 to 11 months, this estimate excludes infants who enrolled in WIC but did not remain in WIC through age 7 months.

71 WIC-IFPS was a one-year longitudinal survey of the infant feeding practices of mothers who participated in WIC while pregnant. WICIFPS found that by the time of hospital discharge the percentage of infants breastfeeding dropped to 45 percent. Among breastfed infants,

the median duration of breastfeeding was 57 days; 75 percent breastfed 2 or more weeks; and 14 percent breastfed for at least 6 months.

Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 131

3.9 Incidence and Duration of Breastfeeding

This section examines the frequency and duration of breastfeeding among WIC infants. Breastfeeding is

defined as exclusive use of human breast milk, or use of human milk with bottle supplements of formula

or cow’s milk. Breast milk has been shown to provide nutritional, immunologic, and developmental

benefits for infants; in addition, breastfeeding is associated with improved maternal health.68

The importance of breastfeeding places it among the objectives in the U.S. Department of Health and

Human Services (HHS) Healthy People 2000 and Healthy People 2010. The Healthy People 2010 goals

for mothers in the general U.S. population are 75 percent breastfeeding in early postpartum, 50 percent at

six months, and 25 percent at one year.69

As part of its strategic plan, FNS has set an ongoing objective to increase the rate of breastfeeding among

WIC mothers. The current goal for FNS is to raise the percent of WIC mothers initiating breastfeeding

from a 1997-1998 baseline of 41.5 percent (estimated from WIC management information system data

for infants 7 to 11 months of age) to 50 percent by 2003-2004.

NSWP provides estimates of breastfeeding incidence and duration, as well as information about breastfeeding patterns within families. NSWP estimates are based on a sample of WIC participants from the

continental U.S. who were surveyed at the time of WIC certification. This methodology, however, differs

from that used to obtain the baseline for the FNS strategic plan. Because differences in the point esti- 70

mate may be due to its differing methodology, the NSWP estimate of breastfeeding incidence should not

be interpreted as a change from the FNS strategic plan baseline, nor as a move toward achievement of

FNS breastfeeding goals.

Exhibit 3-59 shows that 31.0 percent of WIC infants were breastfeeding at the time of WIC certification,

and another 25.1 percent had been breastfed previously. In total, 56.1 percent of WIC infants had ever

been breastfed. This finding is consistent with that of the WIC Infant Feeding Practices Study (WICIFPS, data from 1994-95), which found that 56 percent of WIC infants with mothers in WIC prenatally

were ever breastfed. Among NSWP infants ever breastfed, the median duration of breastfeeding was 71

21 days, and at least 18.9 percent had been breastfed for at least three months.
_____________________________________________________________________________________

Exhibit 3-59

Breastfeeding Status Reported at WIC Certification Among WIC Infants and Children

_____________________________________________________________________________________

 Infants Children

_____________________________________________________________________________________

Breastfeeding experience 

 Currently breastfeeding 31.0 0.4

 Previously breastfed 25.1 50.0

 Never breastfed 43.9 49.6

Not reported 1.2 4.2 a

Sample size 614 647

Population 1,978,411 3,952,924

Cumulative distribution of 

breastfeeding duration among

those ever breastfed

 26 or more weeks 7.3 42.7

 21 or more weeks 10.1 46.4

 13 or more weeks 18.6 62.8

 8 or more weeks 24.4 70.4

 4 or more weeks 44.1 84.7

 3 or more weeks 52.1 87.2

 2 or more weeks 71.6 92.8

 1 or more weeks 89.1 94.6

 1 or more days 100.0 100.0

Not reported 5.7 10.3 a

Median duration (days) 21 121

Sample size 340 306

Population 1,095,895 1,906,828

_____________________________________________________________________________________

a Number and percent with data not reported are excluded from previous percents.
72 Baydar, N., M. McCam, R. Williams, and E. Vesper, “The WIC Infant Feeding Practices Study,” Alexandria, VA: USDA/FNS,

November 1997.

73 Baydar et al., p. 62.

Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 133

Because NSWP measured breastfeeding incidence and duration at the time of WIC certification, the

information about breastfeeding duration for infants is not particularly useful. For those currently breastfeeding, the data are truncated because one does not know how long they will be breastfed ultimately. For

those no longer breastfeeding, the sample is skewed towards those infants with short breastfeeding histories.

NSWP data also allow analyses of breastfeeding patterns for WIC children, but this too has limitations. 

Breastfeeding information was collected retrospectively and, compared to infants, data for children may

suffer more recall error because their breastfeeding history is further in the past. In addition, WIC children

sampled at ages one through four are not necessarily representative of their cohort due to attrition of

children who were in WIC at an earlier point and who have now left the WIC Program.

NSWP shows that just over one-half of all WIC children (50.4 percent) were reported as ever breastfed. 

Among children ever breastfed, the median duration of breastfeeding was 121 days, or about four months. 

The cumulative distribution shows that 84.7 percent were breastfed for longer than one month, 62.8 percent

were breastfed at least three months, and 42.7 percent were reported to have been breastfed six months or

more.

One can take the product of the cumulative percentages and the percent ever breastfed (e.g., 15.3 percent

times 50.4 percent ever breastfed) to learn that 7.7 percent of all WIC children were breastfed for a least

one day but less than one month. Similarly, we learn that 21.5 percent of all WIC children were breastfed

for six months or longer (e.g., 42.7 percent times 50.4 percent ever breastfed). Among WIC children, only

0.4 percent were described as currently breastfeeding, i.e., potentially breastfeeding for one year or longer.

Exhibit 3-60 examines NSWP breastfeeding patterns within families. As might be expected, the survey

results indicate that the decision to breastfeed carries over multiple children. WIC infants who were ever

breastfed and those not breastfed were equally likely to have siblings (53.6 vs. 52.7 percent), but infants

who were breastfed were more likely to have siblings who were breastfed. Among WIC infants with

siblings, 78 percent of breastfed infants had siblings who were breastfed, whereas only 17.3 percent of nonbreastfed infants had siblings who were breastfed.

The results are similar for WIC children. WIC children who were ever breastfed and those not breastfed

were equally likely to have siblings (64.7 vs. 63.0 percent). Among WIC children with siblings, 86.4

percent of breastfed children had siblings who were breastfed, whereas only 18.3 percent of non-breastfed

children had siblings who were breastfed.

The NSWP findings reveal a pattern within WIC families: the decision to breastfeed carries over multiple

children. Breastfeeding only one child in a house with siblings is uncommon. These NSWP findings are

consistent with earlier findings from the WIC Infant Feeding Practices Study (WIC-IFPS). WIC-IFPS 72

found that, “One of the most important predictors of breastfeeding is the previous breastfeeding history. 

Mothers who breastfed previous children have predicted odds of initiation of breastfeeding that are over

eight times larger than those for mothers who did not breastfeed previous children.”73
_____________________________________________________________________________________

Exhibit 3-60

Distribution of WIC Infants and Children by Own Breastfeeding Status and Presence of 

Siblings Ever Breastfed

_____________________________________________________________________________________

 Infants Children 

_____________________________________________________________________________________

WIC participants who breastfed

Percent with siblings 53.6 64.7 

Among those with siblings: 

 No siblings ever breastfed 21.8 13.5 

 One sibling ever breastfed 62.0 61.9 

 Two siblings ever breastfed 15.2 19.3 

 More than two siblings ever breastfed 1.0 5.2 

Sample size 340 306 

Population 1,095,895 1,906,828 

WIC participants who did not breastfeed

Percent with siblings 52.7 63.0 

Among those with siblings: 

 No siblings ever breastfed 82.7 81.7 

 One sibling ever breastfed 14.2 17.1 

 Two siblings ever breastfed 3.1 1.2 

 More than two siblings ever breastfed 0.0 0.0 

Sample size 265 311 

Population 858,278 1,879,370 

_____________________________________________________________________________________
74 Exhibits 3-65 through 3-69 show the percentage of families with prior WIC experience (eligible for the customer satisfaction “experience”

questions), the percentage administered the questions, and the non-response rates among those administered the questions.

Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 135

3.10 Factors Affecting Enrollment and Continued Participation

How do women learn about the WIC program? What are the barriers to WIC participation? How satisfied

are participants with WIC food benefits? The NSWP addressed each of these questions by including a

brief “customer satisfaction” module as part of the survey.

Questions about referrals to WIC are straightforward to administer and to interpret. In contrast, questions

about barriers to participation and satisfaction with food benefits are complicated by the fact that respondents’ knowledge on these topics depends on having participated in WIC. To collect information about

barriers to participation, the NSWP included two sets of questions. The first set of questions was about

perceived barriers (“things that might make it difficult to participate in the WIC program”), and these

questions were administered to all respondents. A second set of questions about barriers, or difficulties,

actually encountered during WIC participation was administered only when the sampled person’s family

had prior WIC experience. In the latter case, when the family had prior WIC experience, respondents were

also asked about the value of WIC benefits, frequency of missed WIC appointments, food shopping experience, and benefit redemption.

Two caveats are necessary before presenting the results of the customer satisfaction questions. First, the

data presented on perceived barriers to WIC participation are a mix of responses based on perceptions

(from those new to the program) and experiences (from those with WIC experience). Moreover, the

responses are representative only of persons who enrolled in WIC, and do not reflect the perceptions of

individuals who may have been deterred from applying. Nonetheless, it was believed that data on perceived

barriers to participation were sufficiently important to collect and present, despite limitations on the

representative nature of the data.

The second caveat is that the questions administered to respondents with prior WIC experience were not

administered to a random sample of all WIC participants; these questions were administered to a random

sample of WIC participants who recertified in the program. These participants can be expected to have

higher levels of satisfaction, and fewer difficulties with participation, than participants who voluntarily

withdraw from the program or fail to apply for recertification. The results of these questions are therefore

valuable mainly insofar as they may point out problems; high levels of satisfaction must be discounted and

should be reexamined through survey methods designed specifically to address these issues.

Administration of customer satisfaction questions to respondents with prior WIC experience relied on

identification of prior WIC experience within the flow of the interview. Respondents with prior WIC

experience represented 90.3 percent of the total sample; of these, 90.7 percent were administered the

second portion of the customer satisfaction module.74
75 Respondents answering “other” as the source of referral were not asked for more specific information.

136 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

Referrals to WIC

The top portion of Exhibit 3-61 shows the distribution of referral sources for the categories of WIC

participants. The middle and bottom portions of the exhibit provide separate distributions for participants

living in and outside of metropolitan areas, respectively. Friends, family members, and doctors or other

health professionals are by far the most common sources of referral to the WIC program. Relatively few

participants mentioned program advertisements as a source of information. Within the advertising 75

categories, however, printed materials (e.g., billboards and posters, and pamphlets) seem to be somewhat

more effective at reaching participants than electronic media (e.g., television and radio). These findings

generally hold true in both metropolitan and non-metropolitan areas, with no statistically significant

differences in the rates of referrals, by source, in metro and non-metro areas.

Exhibit 3-62 breaks out source of WIC referral by local agency sponsorship. As before, friends, family

members, and doctors or other health professionals are the most common sources of referrals, regardless of

local agency sponsorship. The rate of referrals from each source varies somewhat according to local

agency sponsorship, but the differences across local agency sponsorship are statistically significant only for

referrals from HMO doctors.

Perceived Barriers to WIC Participation

To examine potential barriers to participation, the NSWP asked respondents whether a number of different

potential barriers were perceived to be a problem. The potential barriers under consideration include lack

of transportation, inconvenient clinic hours, time-consuming services, limited waiting space at the clinic,

lack of child care, language barriers, and problems qualifying for benefits.

The responses, broken out by certification category, are presented in Exhibit 3-63. By far the most

common response to each potential barrier is that it is “not a problem.” It is evident, however, that some

respondents perceive some problems. Lack of transportation to the WIC clinic was cited by 6.4 percent of

all participants as “a big problem,” with another 14.5 percent saying that lack of transportation is

“somewhat of a problem.” Thus, nearly 21 percent of the WIC caseload cites transportation as a perceived

barrier to WIC participation. A larger percentage (23.7 percent) perceives that services taking too much

time will be a problem. Of all the potential barriers referenced by the NSWP, language barriers and

problems qualifying for benefits were perceived least often as creating problems, affecting 3.7 and 4.7

percent of the caseload, respectively. Across certification categories, the rates of perceived barriers do not

differ significantly, with the exception of “lack of child care.”

Exhibit 3-64 presents the responses about perceived barriers tabulated by type of local agency sponsorship. 

Inconvenient hours, services taking too long, lack of child care and language barriers are cited as perceived

problems relatively more often when the local agency is sponsored by a state agency or a municipal agency

than otherwise (these differences across local agency sponsorship are statistically significant). Except for

transportation problems, community agency sponsorship is associated with some of the lowest frequencies

of perceived problems. Based on the population sizes shown at the bottom of the exhibit, 10.8 percent of

all WIC participants are served at local agencies with community agency sponsorship.
____________________________________________________________________________________________________________________________________

Exhibit 3-61

Distribution of Referrals to WIC Program, by Participant Category and Metro-Nonmetro Location

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

Source of Referral Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Total

 Friend 35.0 40.1 33.4 35.5 37.7 33.3 34.9

 Family member 32.2 34.2 38.4 34.6 32.4 33.6 33.5

 Doctor/Health professional 37.8 35.0 32.8 35.6 33.3 35.7 35.1

 Television advertisement 4.9 4.8 4.5 4.8 6.0 5.5 5.4

 Radio advertisement 1.7 2.4 2.3 2.0 2.2 2.6 2.4

 Newspaper advertisement 2.1 2.3 1.8 2.1 2.5 2.6 2.4

 Billboard/Poster advertisement 6.6 7.5 9.0 7.6 7.2 8.3 7.8

 Pamphlet 8.4 13.1 10.7 10.1 10.4 10.5 10.4

 Other 9.5 10.5 9.8 9.8 10.9 9.3 9.8

 No referral received 5.9 4.3 7.4 6.0 6.9 7.4 7.0

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

Metro residents

 Friend 35.9 39.6 35.6 36.6 38.7 32.6 35.1

 Family member 31.9 34.2 34.8 33.3 30.8 33.4 32.7

 Doctor/Health professional 37.7 36.5 35.9 36.9 34.4 36.2 35.9

 Television advertisement 5.4 5.0 4.5 5.0 7.0 5.3 5.7

 Radio advertisement 2.2 2.7 2.8 2.5 2.7 2.6 2.6

 Newspaper advertisement 2.6 2.1 1.5 2.1 2.5 2.2 2.3

 Billboard/Poster advertisement 7.4 8.5 9.5 8.3 8.5 8.8 8.6

 Pamphlet 9.1 13.8 12.5 11.2 11.7 11.2 11.4

 Other 9.2 8.8 9.8 9.3 11.1 9.9 10.1

 No referral received 5.7 3.6 7.1 5.7 6.9 6.4 6.3

Sample size 481 514 442 1,437 474 476 2,387

Population 668,251 315,918 446,008 1,430,177 1,593,475 3,119,987 6,143,639

Nonmetro residents

 Friend 31.8 42.8 25.7 31.5 33.6 35.8 34.2

 Family member 33.3 34.3 51.1 39.5 39.3 34.4 36.8

 Doctor/Health professional 38.0 27.1 21.9 30.9 28.7 33.7 31.8

 Television advertisement 3.1 3.9 4.4 3.7 2.0 6.0 4.5

 Radio advertisement 0.0 0.9 0.5 0.3 0.0 2.5 1.4

 Newspaper advertisement 0.6 3.3 2.6 1.7 2.2 4.1 3.1

 Billboard/Poster advertisement 4.0 2.2 7.4 4.9 1.5 6.4 4.9

 Pamphlet 6.1 9.5 4.2 6.0 4.8 7.8 6.7

 Other 10.5 19.2 9.5 11.6 10.0 6.9 8.7

 No referral received 6.6 8.4 8.2 7.4 7.2 11.4 9.4

Sample size 158 113 145 416 140 171 727

Population 191,130 60,545 127,891 379,566 384,936 832,937 1,597,439

____________________________________________________________________________________________________________________________________

Responses are not mutually exclusive, so percents may add up to more than 100%. Less than 2% of respondents failed to respond to

questions about referrals. Respondents answering "other" were not asked for more specific information.
____________________________________________________________________________________________________________________________________

Exhibit 3-62

Distribution of Referrals to WIC Program, by Local Agency Sponsorship

____________________________________________________________________________________________________________________________________

 State District County Municipal Community Total

 Agency Agency Agency Agency Agency Hospital WIC

____________________________________________________________________________________________________________________________________

Source of Referral

 Friend 32.1 35.3 36.3 40.3 26.6 36.7 34.9

 Family member 26.3 31.2 34.6 32.6 46.0 30.7 33.5

 Doctor/Health professional 31.5 30.6 36.0 34.0 33.0 38.0 35.1

 Doctor from Medicaid 11.5 7.4 16.2 15.0 9.6 16.6 14.2

 Doctor from HMO 0.3 6.1 3.9 0.9 3.0 4.5 3.6

 Private doctor 8.8 9.1 9.8 4.9 9.6 12.3 9.9

 Not specified 10.9 8.0 6.1 13.2 10.8 4.6 7.4 

 Television advertisement 5.1 3.9 4.6 7.2 7.6 6.4 5.4

 Radio advertisement 1.3 1.3 2.3 3.6 2.0 3.4 2.4

 Newspaper advertisement 2.3 2.0 1.7 1.5 4.7 3.1 2.4

 Billboard/Poster advertisement 8.4 9.5 4.9 6.2 12.0 10.5 7.8

 Pamphlet 8.9 9.3 7.5 9.9 19.7 12.4 10.4

 Other 12.2 14.5 8.1 4.9 11.1 10.0 9.8

 No referral received 11.8 5.9 6.0 0.9 7.5 7.6 7.0

Sample size 375 276 1,227 147 376 713 3,114

Population 918,183 708,232 3,152,368 323,414 825,792 1,813,088 7,741,078

____________________________________________________________________________________________________________________________________

The following types of sponsorship were combined for tabulation: (1) County agencies and multi-county agencies are combined as 

"county agencies"; (2) community action agencies and community health agencies are combined as "community agencies"; (3) public and

private non-profit hospitals are combined as hospitals (97% of participants enrolled through hospitals were enrolled at public

hospitals).

Eleven agencies indicated state sponsorship in addition to other sponsorship, and state sponsorship is ignored for purposes of categorizing the agency to avoid double-counting in the table: one agency reported county and municipal sponsorship and is categorized 

as a municipal agency; one agency reported multi-county sponsorship and hospital sponsorship and is categorized as a hospital.
____________________________________________________________________________________________________________________________________

Exhibit 3-63

Distribution of Perceived Barriers to WIC Participation, by Participant Category

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

Perceived Barrier Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Lack of transportation to clinic

 A big problem 5.3 7.1 7.2 6.3 4.3 7.5 6.4

 Somewhat of a problem 16.0 16.8 18.4 16.9 15.7 12.8 14.5

 Not a problem 78.7 76.2 74.3 76.8 80.0 79.7 79.1

Inconvenient hours/days clinic is open

 A big problem 3.2 1.8 5.0 3.5 2.6 4.3 3.7

 Somewhat of a problem 12.9 12.5 10.9 12.2 14.0 10.7 11.9

 Not a problem 83.9 85.7 84.1 84.4 83.4 85.0 84.5

Services take too much time

 A big problem 3.6 6.0 7.9 5.4 4.3 4.4 4.6

 Somewhat of a problem 15.2 22.2 18.0 17.6 17.7 20.4 19.1

 Not a problem 81.2 71.8 74.2 77.0 78.0 75.2 76.3

Waiting space at clinic is limited

 A big problem 3.8 3.8 2.7 3.4 3.7 3.8 3.7

 Somewhat of a problem 6.3 11.2 11.7 9.0 9.6 11.2 10.3

 Not a problem 90.0 85.0 85.6 87.5 86.7 85.0 86.0

Lack of child care

 A big problem 2.6 5.0 3.4 3.4 3.7 6.0 4.8

 Somewhat of a problem 7.3 8.0 9.3 8.1 8.2 11.1 9.7

 Not a problem 90.1 87.0 87.2 88.6 88.1 82.9 85.5

Language barriers

 A big problem 1.7 3.5 0.7 1.8 1.5 2.1 1.9

 Somewhat of a problem 3.1 2.9 1.8 2.6 1.8 1.4 1.8

 Not a problem 95.3 93.6 97.4 95.6 96.7 96.5 96.3

Problems qualifying for benefits

 A big problem 0.7 1.8 0.5 0.9 1.5 0.9 1.0

 Somewhat of a problem 3.3 3.8 3.7 3.5 2.7 4.3 3.7

 Not a problem 96.0 94.4 95.8 95.6 95.8 94.9 95.3

Rates of item non-response

 Lack of transportation to clinic 2.0 2.1 4.2 2.7 2.7 2.4 2.6

 Inconvenient hours/days clinic open 2.1 2.3 4.1 2.8 2.7 2.6 2.7

 Services take too much time 2.3 2.4 4.1 2.9 2.9 2.4 2.6

 Waiting space at clinic is limited 2.3 2.3 4.2 2.9 3.1 2.8 2.9

 Lack of child care 4.8 3.5 4.3 4.4 3.3 2.7 3.2

 Language barriers 2.3 2.1 4.1 2.8 3.0 2.6 2.7

 Problems qualifying for benefits 2.5 2.3 4.1 3.0 3.1 2.6 2.8

Sample size 375 276 1,227 147 376 713 3,114

Population 918,183 708,232 3,152,368 323,414 825,792 1,813,088 7,741,078

____________________________________________________________________________________________________________________________________

Distribution of response to each item is calculated over respondents to item; item non-response is shown separately.
____________________________________________________________________________________________________________________________________

Exhibit 3-64

Distribution of Perceived Barriers to WIC Participation, by Local Agency Sponsorship

____________________________________________________________________________________________________________________________________

 State District County Municipal Community Total

Perceived Barrier Agency Agency Agency Agency Agency Hospital WIC

____________________________________________________________________________________________________________________________________

Lack of transportation to clinic

 A big problem 6.0 2.5 6.0 9.6 6.3 8.2 6.4

 Somewhat of a problem 10.7 16.3 14.6 21.7 15.2 13.8 14.5

 Not a problem 83.3 81.2 79.4 68.7 78.5 78.0 79.1

Inconvenient hours/days clinic is open

 A big problem 7.7 0.9 4.5 1.6 1.5 2.5 3.7

 Somewhat of a problem 11.1 17.7 13.4 17.2 5.9 9.3 11.9

 Not a problem 81.2 81.4 82.1 81.2 92.6 88.2 84.5

Services take too much time

 A big problem 7.5 4.2 4.6 3.1 0.8 5.4 4.6

 Somewhat of a problem 25.0 17.5 21.5 39.9 4.4 15.4 19.1

 Not a problem 67.6 78.3 73.9 57.0 94.8 79.2 76.3

Waiting space at clinic is limited

 A big problem 2.7 2.3 3.7 1.5 1.9 6.0 3.7

 Somewhat of a problem 7.6 13.4 11.9 12.9 4.1 9.8 10.3

 Not a problem 89.7 84.3 84.4 85.6 94.0 84.2 86.0

Lack of child care

 A big problem 9.3 4.0 5.5 2.1 0.9 4.0 4.8

 Somewhat of a problem 11.3 9.0 11.1 18.2 2.5 8.5 9.7

 Not a problem 79.3 87.0 83.5 79.7 96.6 87.5 85.5

Language barriers

 A big problem 5.8 0.4 1.1 0.3 0.4 2.8 1.9

 Somewhat of a problem 0.7 1.6 2.8 3.6 0.6 1.0 1.8

 Not a problem 93.5 98.0 96.1 96.0 99.0 96.3 96.3

Problems qualifying for benefits

 A big problem 1.4 1.9 1.1 1.8 0.6 0.5 1.0

 Somewhat of a problem 3.2 2.9 3.6 2.8 3.5 4.7 3.7

 Not a problem 95.4 95.2 95.3 95.5 95.9 94.8 95.3

Rates of item non-response

 Lack of transportation to clinic 4.8 1.8 2.8 0.0 1.6 2.1 2.6

 Inconvenient hours/days clinic open 4.8 1.8 3.1 0.0 1.6 2.2 2.7

 Services take too much time 4.8 1.8 2.9 0.1 1.6 2.4 2.6

 Waiting space at clinic is limited 5.4 1.8 3.1 0.2 1.9 2.5 2.9

 Lack of child care 6.1 1.8 3.2 0.4 2.3 3.3 3.2

 Language barriers 4.8 1.8 3.0 0.0 1.6 2.4 2.7

 Problems qualifying for benefits 4.8 1.8 3.0 0.3 2.3 2.6 2.8

Sample size 375 276 1,227 147 376 713 3,114

Population 918,183 708,232 3,152,368 323,414 825,792 1,813,088 7,741,078

____________________________________________________________________________________________________________________________________

Distribution of response to each item is calculated over respondents to item; item non-response is shown separately.
76 We identified participants with prior WIC experience as: (a) sampled persons who had previously been certified for WIC; (b) sampled

infants and children with mothers who had participated in WIC while pregnant or postpartum; and (c) sampled person with a family

member (sibling or child) who had prior WIC experience.

Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 141

The NSWP then asked those participants with prior WIC experience about actual areas of difficulty during

program participation. Questions were asked about transportation to do shopping, problems using WIC 76

vouchers or checks, being treated negatively by WIC staff members, and being treated negatively in grocery

stores. As shown in Exhibit 3-65, in all cases and for all certification categories, the most common

response was that the identified factor was “not a problem.” Obtaining transportation to do shopping was

cited as a problem less often (14.6 percent) than the perceived barrier of obtaining transportation to the

WIC clinic (20.9 percent, as reported in Exhibit 3-63). Problems using WIC vouchers or checks were

reported by 6.4 percent of the participants, with negative treatment in WIC offices and in grocery stores

being reported by 4.0 percent and 15.1 percent of participants, respectively.

Satisfaction with Prescribed Foods

The NSWP asked those respondents with prior WIC experience about their level of satisfaction with the

brands and quantities of prescribed foods. Their responses are reported in Exhibit 3-66. In all food

categories the majority of respondents expressed satisfaction with the brands and quantities of foods

prescribed by WIC. Lowest levels of satisfaction were recorded for brands of breakfast cereal; only 62.3

percent of respondents were “very satisfied” with the brands of breakfast cereal offered, and 9.7 percent

were “not satisfied.”

In categories other than breakfast cereal, satisfaction with food brands exceeded satisfaction with food

quantities. Those “very satisfied” with quantities of foods ranged from 79.6 to 83.9 percent of respondents, and those “not satisfied” with quantities of foods ranged from 3.3 to 6.4 percent. Only 0.5 to 2.9

percent were “not satisfied” with food brands, whereas 81.4 to 90.0 percent of respondents were “very

satisfied” with food brands.

WIC Benefits Ratings

The WIC program provides three main benefits: supplemental foods, nutrition education (including

breastfeeding promotion and support), and referrals to other health and social service agencies. These

benefits are tangible and their cost can be measured—for example, in dollars of food or hours of education. 

The value of WIC benefits to participants, however, is more difficult to measure and may vary over

participants. In addition, the experience of WIC participation may include many intangible benefits.

NSWP asked those respondents with prior WIC experience to rate the value of potential WIC benefits on a

scale of 0 to 5, with 5 being extremely valuable and 0 being not valuable at all. The responses are shown in

Exhibit 3-67. Of the 12 potential benefits presented to respondents, only two received an average rating

below 4: “time to talk with other mothers” and “taught me about breastfeeding.” (Even breastfeeding

mothers gave “taught me about breastfeeding” an average rating of less than 4.) The highest rated benefits

are “vouchers for foods I know are nutritious” (4.7), “money saved on grocery bills” (4.5), “nutrition

information”(4.4), and “checking blood, height, and weight” (4.4).
____________________________________________________________________________________________________________________________________

Exhibit 3-65

Distribution of Reported Difficulties with WIC Program Among Respondents with Prior WIC Experience

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

Reported Difficulty Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Lack of transportation to get groceries

 A big problem 4.1 3.1 4.5 4.0 2.8 3.9 3.7

 Somewhat of a problem 11.4 11.9 15.3 13.2 13.4 9.3 10.9

 Not a problem 84.5 85.0 80.2 82.9 83.8 86.8 85.4

Problems using WIC vouchers/checks

 A big problem 0.8 0.4 0.3 0.5 1.5 1.7 1.4

 Somewhat of a problem 6.4 6.4 3.5 5.2 3.2 5.6 5.0

 Not a problem 92.8 93.1 96.1 94.3 95.3 92.7 93.6

Treated negatively by staff member

 A big problem 0.0 0.2 0.0 0.0 0.2 1.2 0.8

 Somewhat of a problem 2.3 1.8 1.8 2.0 2.2 3.9 3.2

 Not a problem 97.7 98.0 98.2 98.0 97.7 94.9 96.1

Treated negatively in grocery store

 A big problem 2.1 2.3 1.6 2.0 2.8 2.6 2.5

 Somewhat of a problem 11.3 13.9 12.1 12.4 11.1 13.3 12.6

 Not a problem 86.5 83.8 86.3 85.7 86.1 84.1 84.9

Rates of item non-response

 Lack of transportation to 0.9 1.0 1.8 1.3 2.0 1.4 1.5

 get groceries

 Problems using WIC vouchers/check 1.9 1.1 5.4 3.2 2.7 1.7 2.2

 Treated negatively by staff membe 1.2 0.4 4.1 2.2 2.2 0.8 1.4

 Treated negatively in grocery sto 1.9 1.5 5.3 3.2 2.6 2.0 2.3

Sample

 Percent of families with 42.9 94.8 93.4 69.7 95.3 97.3 90.3

 prior WIC experience

 Of families with WIC experience, 

 percent administered customer 79.1 77.6 78.2 78.3 84.6 97.7 90.7

 satisfaction section

Sample size 277 593 547 1,417 587 628 2,632

Population 368,670 356,805 535,811 1,261,286 1,884,471 3,846,741 6,992,499

____________________________________________________________________________________________________________________________________

Sample includes families with prior WIC experience, by any family member, at time of NSWP survey. Prior WIC experience is defined 

by a completed certification period. 90% of sampled WIC participants were in families having prior WIC experience at time of survey.

Distribution of satisfaction within each category is calculated over those responding to the item; extent of non-response is shown

separately. See text for discussion of sample definition and response rates.
_____________________________________________________________________________________

Exhibit 3-66

Distribution of Reported Overall Satisfaction with WIC Foods Among Respondents with 

Prior WIC Experience

_____________________________________________________________________________________

 Satisfied with Satisfied with

 Food Brands Food Quantities

_____________________________________________________________________________________

Breakfast cereals

 Very satisfied 62.3 79.0

 Fairly satisfied 28.1 16.0

 Not satisfied 9.7 5.0

Juices

 Very satisfied 81.4 79.9

 Fairly satisfied 15.7 13.9

 Not satisfied 2.9 6.2

Baby formula

 Very satisfied 85.7 79.6

 Fairly satisfied 12.4 14.5

 Not satisfied 1.9 5.9

Milk

 Very satisfied 89.1 80.9

 Fairly satisfied 10.0 12.7

 Not satisfied 0.9 6.4

Cheese

 Very satisfied 87.5 80.9

 Fairly satisfied 10.6 13.7

 Not satisfied 1.9 5.5

Eggs

 Very satisfied 90.0 82.8

 Fairly satisfied 9.5 13.0

 Not satisfied 0.5 4.2

Beans or peanut butter

 Very satisfied 86.6 83.9

 Fairly satisfied 11.9 12.8

 Not satisfied 1.5 3.3

Percent nonresponse to each item

 Breakfast cereal 1.4 1.4

 Juices 1.3 1.5

 Baby formula 12.9 13.3

 Milk 1.6 2.0

 Cheese 1.7 1.9

 Eggs 1.8 2.0

 Beans or peanut butter 2.2 2.4

Sample

 Percent of families with WIC 90.3 90.3

 experience

 Of families with WIC experience, 

 percent administered customer 90.7 90.7

 satisfaction section

Sample size 2,632 2,632

Population 6,992,499 6,992,499

_____________________________________________________________________________________

Sample includes families with prior WIC experience, by any family member, at time of 

NSWP survey. Prior WIC experience is defined by a completed certification period. 

90% of sampled WIC participants were in families having prior WIC experience at time 

of survey.

Satisfaction with baby formula was asked only if sampled person was WIC infant receiving

recertification. 

Distribution of satisfaction with each food group is calculated over those responding 

to item; extent of non-response is shown separately. See text for discussion of sample 

definition and response rates.
____________________________________________________________________________________________________________________________________

Exhibit 3-67

Mean Ratings of the Value of WIC Benefits Among Respondents with Prior WIC Experience 

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Mean rating on a scale of 0 to 5 

 Time to talk with other mothers 2.0 2.2 2.2 2.2 2.3 2.4 2.3

 Money saved on grocery bills 4.4 4.8 4.6 4.6 4.6 4.5 4.5

 Health information 4.3 4.3 4.3 4.3 4.3 4.3 4.3

 Nutrition information 4.3 4.4 4.4 4.4 4.4 4.5 4.4

 Checking blood, height, and weigh 4.1 4.2 4.4 4.2 4.4 4.5 4.4

 Advice from WIC staff 4.1 4.3 4.2 4.2 4.3 4.2 4.2

 Vouchers for foods I know 4.8 4.7 4.7 4.8 4.7 4.7 4.7

 are nutritious

 Helps me stay on time with 3.9 3.9 4.2 4.0 4.1 4.0 4.0

 shots for my child

 Taught me about breastfeeding 3.0 3.8 2.8 3.1 3.0 2.9 3.0

 Taught me about the foods babies need 4.1 4.1 4.2 4.2 4.2 4.1 4.2

 Taught me about the foods 4.0 4.0 4.1 4.1 4.1 4.2 4.2

 children need

 Taught me about foods I need 4.1 4.3 4.3 4.3 4.3 3.9 4.1

Rates of item nonresponse 

 Time to talk with other mothers 1.7 1.3 5.3 3.1 2.2 3.2 2.9

 Money saved on grocery bills 1.7 1.2 4.6 2.8 1.7 2.1 2.1

 Health information 1.7 0.9 5.3 3.0 1.7 2.0 2.1

 Nutrition information 1.7 0.9 5.1 2.9 2.0 2.0 2.1

 Checking blood, height, and weight 1.7 1.3 4.6 2.8 1.9 2.6 2.4

 Advice from WIC staff 1.7 0.9 4.8 2.8 2.3 2.0 2.2

 Vouchers for foods I know are 1.7 1.4 6.0 3.4 2.6 2.7 2.8

 nutritious

 Helps me stay on time with shots 4.1 3.7 7.4 5.4 5.3 2.1 3.4

 for my child

 Taught me about breastfeeding 2.8 1.2 7.5 4.3 4.0 4.8 4.5

 Taught me about foods babies need 1.7 1.8 6.4 3.7 2.4 2.4 2.6

 Taught me about foods children need 1.7 3.3 7.6 4.6 3.5 2.1 2.9

 Taught me about foods I need 2.0 1.5 6.2 3.6 2.0 2.8 2.7

Of families with WIC experience, 

 percent administered customer 79.1 77.6 78.2 78.3 84.6 97.7 90.7

 satisfaction section

Sample size 277 593 547 1,417 587 628 2,632

Population 368,670 356,805 535,811 1,261,286 1,884,471 3,846,741 6,992,499

____________________________________________________________________________________________________________________________________

Respondents were read the list of potential WIC benefits and asked to indicate the value of the benefit on a scale of 0 to 5, with

5 meaning extremely valuable and 0 being not valuable at all.
77 Respondents were not asked about the ways in which they “stopped using WIC,” and their responses may reflect a combination of

behaviors, including failure to redeem all WIC checks or vouchers and failure to attend nutrition education classes.

78 The survey asked, “Have you ever stopped using WIC even though you (or any of your children) were still qualified for WIC?”

Abt Associates Inc. Chapter 3: Characteristics of WIC Participants and Households 145

WIC Appointments

WIC service sites perform many functions for participants: certification of eligibility, measurement of

health and nutrition status, referrals to other agencies, nutrition education and breastfeeding support, and

voucher issuance. To operate efficiently, most service sites schedule appointments with participants. 

Exhibit 3-68 shows responses to questions about the incidence and frequency of missed WIC appointments. Nearly one-half (45.6 percent) of WIC participants said they missed at least one appointment at the

WIC clinic; 19.3 percent missed “just once,” 22.9 percent missed “sometimes,” and 3.1 percent missed

“often.” WIC participants responding to these questions had “prior WIC experience” but no attempt was

made to standardize the rate of missed appointments according to the length of prior experience because of

the qualitative nature of responses on frequency of missed appointments.

The most common reasons for missed appointments were “forgot to go” (42.5 percent) and “trouble

finding transportation” (29.9 percent). In addition, 20.4 percent of respondents missed appointments

because they could not get off work and 12.8 percent could not find childcare. Less than 10 percent of

respondents who missed appointments said that it was because the “clinic is too far from home” or because

“it takes too long at the clinic.” (Respondents could give multiple responses.)

Shopping and Benefit Redemption

The final set of questions in the customer satisfaction module concerns WIC participation, shopping for

WIC foods, and redemption of vouchers. All of the estimates must be interpreted carefully. Questions

were asked only of respondents with prior WIC experience, and questions addressed experiences during any

time during prior participation. Because the duration of prior participation varies among respondents, it is

not possible to generalize these responses as average rates within the caseload. This data is shown in

Exhibit 3-69.

Approximately one-fourth (25.7 percent) of respondents with prior WIC experience said that they had, in

the past, stopped using WIC while still eligible for benefits. Respondents were not asked about the ways 77

in which they “stopped using WIC,” and their responses may reflect a combination of behaviors, including

failure to redeem all WIC checks or vouchers and failure to attend nutrition education classes.

The percentage of participants who experience breaks in WIC participation is significantly higher for

pregnant women (39.6 percent) than for other participant categories. It is important to remember that a

break in participation may have occurred during any prior certification—for example, pregnant respondents

may be reporting breaks in participation during prior WIC experience as a breastfeeding or postpartum

woman, or during prior experience as a pregnant woman.78

Respondents with prior WIC experience were asked if they found it “easy,” “sometimes confusing,” or

“often confusing” to use WIC vouchers. In each participant category, over 80 percent of respondents found

it easy to use vouchers, and less than 4 percent found it “often confusing.” Overall, 83.9 percent found it

easy, 14.2 percent found it sometimes confusing, and 1.9 percent found it often confusing.
____________________________________________________________________________________________________________________________________

Exhibit 3-68

Incidence of Missed WIC Appointments Among Respondents with Prior WIC Experience 

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

 Percent ever missed appointment 38.0 39.1 42.2 40.1 37.0 50.6 45.6

 at WIC clinic

Distribution of frequency 

of missed appointments 

 Sometimes 21.7 16.3 15.4 17.5 16.5 27.0 22.9

 Often 3.5 1.7 3.8 3.1 3.4 2.9 3.1

 Just once 12.7 21.1 22.5 19.2 16.7 20.4 19.3

 Never 62.2 60.9 58.3 60.2 63.4 49.7 54.7

Distribution of reasons for 

missed appointments 

 Forget to go 44.7 35.2 43.0 41.4 38.3 44.0 42.5

 Trouble finding transportation 39.8 34.7 38.3 37.7 29.3 28.6 29.9

 Cannot get off work 21.9 13.4 12.0 15.1 17.8 22.3 20.4

 Cannot find child care 12.0 13.3 14.9 13.6 12.7 12.7 12.8

 Clinic is too far from home 11.9 10.8 8.9 10.2 11.8 8.2 9.2

 It takes too long at the WIC clin 10.2 10.4 11.3 10.7 8.1 8.2 8.5

Rates of item nonresponse 

 Ever missed appoinment 0.6 0.7 3.5 1.9 0.8 0.1 0.6

 Frequency of missed appointments 0.9 0.8 4.3 2.3 1.6 0.5 1.1

 Reasons for missed appointments 3.0 3.6 6.0 4.5 4.0 4.5 4.4

Of families with WIC experience, 

 percent administered customer 79.1 77.6 78.2 78.3 84.6 97.7 90.7

 satisfaction section

Sample size 277 593 547 1,417 587 628 2,632

Population 368,670 356,805 535,811 1,261,286 1,884,471 3,846,741 6,992,499

____________________________________________________________________________________________________________________________________

The distribution of reasons for missed appointments is measured among respondents who missed appointments; the distribution sums

to more than 100 due to multiple responses.
____________________________________________________________________________________________________________________________________

Exhibit 3-69

Distribution of Shopping Experiences and Food Benefit Redemption Among Respondents with Prior WIC Experience 

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Overall WIC participation 

 Percent who ever stopped 39.6 23.0 24.0 28.4 24.1 25.7 25.7

 using WIC while still eligiblea

Experience shopping with

WIC vouchers

 Easy 81.5 80.2 89.3 84.3 81.9 84.6 83.9

 Sometimes confusing 15.2 18.8 9.7 14.0 17.1 13.0 14.2

 Often confusing 3.3 1.0 1.0 1.7 1.0 2.4 1.9

Percent of respondents who usually

purchase all WIC food items

 Overall 91.7 88.6 91.0 90.5 90.9 94.3 92.8

 Breakfast cereals 96.5 97.1 96.9 96.8 96.0 97.1 96.8

 Juices 97.0 98.3 98.1 97.9 98.8 98.9 98.7

 Baby formula 95.6 91.2 99.4 96.2 96.4 92.0 93.8

 Milk 96.3 95.6 95.6 95.8 96.0 96.5 96.3

 Cheese 98.5 97.4 98.1 98.0 98.0 99.2 98.7

 Eggs 97.1 94.8 97.4 96.6 95.9 97.8 97.1

 Beans or peanut butter 94.2 94.9 94.2 94.4 93.0 95.6 94.8

Rates of item nonresponse 

 Ever stopped using WIC 1.4 1.5 4.7 2.8 1.2 1.0 1.4

 Experience using WIC vouchers 1.5 2.0 5.8 3.5 2.4 2.3 2.5

Item nonresponse to "Usually 

purchase all WIC foods" 

 Overall 6.5 5.9 8.9 7.4 7.0 8.3 7.8

 Breakfast cereals 1.3 1.4 4.5 2.7 3.8 2.9 3.1

 Juices 1.7 2.3 4.5 3.1 3.7 3.1 3.2

 Baby formula 0.0 0.0 0.0 0.0 12.7 0.0 3.2

 Milk 2.1 2.9 4.5 3.4 4.3 3.1 3.4

 Cheese 1.7 2.6 4.5 3.2 4.4 3.0 3.4

 Eggs 2.2 2.5 4.7 3.4 4.3 3.1 3.4

 Beans or peanut butter 2.6 3.0 4.7 3.6 5.0 3.0 3.6

Sample size 277 593 547 1,417 587 628 2,632

Population 368,670 356,805 535,811 1,261,286 1,884,471 3,846,741 6,992,499

____________________________________________________________________________________________________________________________________

a The survey asked, "Have you ever stopped using WIC even though you (or any of your children) were still qualified for WIC?"
148 Chapter 3: Characteristics of WIC Participants and Households Abt Associates Inc.

With respect to actual voucher use, 92.8 percent of respondents with prior WIC experience said that they

usually purchased all WIC foods on their vouchers. Rates of redemption vary by participant category, from

a low of 88.6 percent purchasing all foods in the breastfeeding category to a high of 94.3 percent

purchasing all foods in the children category. There is some variation in voucher redemption across food

categories.
1 In all state agencies except Indian Tribal Organizations (ITOs), applicants must also meet residency requirements. An applicant must live

within the jurisdiction of the state.

Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 149

Chapter 4 

WIC Income-Eligibility Determination and Errors in

Income Certification

This chapter examines WIC income-eligibility determination and errors in income certification based on

data collected in spring 1998. Changes in WIC operations have occurred since that time. The field work

for the study occurred prior to implementation of provisions requiring WIC participants to document

income at WIC certification as provided in the William F. Goodling Child Nutrition Reauthorization Act

of 1998. Effective January 2000, the FNS issued an interim rule requiring all participants who were not

adjunctively income eligible for WIC through participation in the Temporary Emergency Food Program,

the FSP, or Medicaid to provide income documentation for WIC records as part of all WIC certifications.

Income-eligibility is one of three primary factors determining eligibility for WIC Program benefits: applicants to WIC must be categorically eligible, income eligible, and at nutritional risk. This chapter 1

examines WIC income eligibility criteria and estimates the incidence and magnitude of error in WIC

income certification as WIC was operated in spring 1998. Topics and sections presented in this chapter

are: 

• 4.1 WIC Income Eligibility

– A summary of WIC income eligibility guidelines drawn from federal regulations and

USDA guidance to states.

• 4.2 Review of State WIC Agency Income Eligibility Guidelines

– A review of state WIC policies and procedures for WIC income eligibility determination.

– A discussion of the areas in which local WIC staff may exercise discretion in

determining WIC income eligibility.

• 4.3 Methodology for the NSWP In-Home Survey

– The methodology for the NSWP in-home survey, which provides data for estimating

WIC income certification error rates.

• 4.4 Estimates of WIC Income-Certification Error

– The estimated WIC income certification case error rate and dollar error rate.

– The estimated variability of WIC family income during the certification period.

A review of state WIC agency income eligibility guidelines and an analysis of errors in WIC income

certification was last performed in 1988. The WIC Income Verification Study (WIV, 1988) found that:
2 In most cases, WIC applicants must meet the income-eligibility standards set by state WIC agencies, although in some cases, within states,

“different guidelines may be prescribed for different local agencies” (7 CFR §246.7(d)(1)(i)).

150 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

• State policies and procedures for determining an applicant’s economic unit (family size)

indicated significant state-to-state variation, sometimes reflecting contradictory guidelines.

• State policies and procedures for determining WIC countable income revealed nearly

complete agreement across states.

• The 1988 national WIC income certification error rate (defined as the percentage of

enrollees certified to receive, but not eligible for WIC benefits) was 5.7 percent. The 1988

national WIC certification dollar error (defined as the amount of total WIC food funds spent

on ineligibles) was $84 million.

The 1998 review of state WIC agency income eligibility guidelines and analysis of errors in WIC income

certification shows that:

• As was found in 1988, state policies and procedures for determining the applicant’s

economic unit (family size) indicated significant state-to-state variation. In contrast to 1988,

however, most of the variation stems from rules regarding households with separate

economic units and applicants who are minors, and remaining variation is due to differences

in the comprehensiveness of guidelines and not from contradictory guidelines.

• As WIV reported in 1988, state policies and procedures for determining WIC countable

income revealed nearly complete agreement.

• Analysis of the national WIC certification error rate in 1998 (defined as the percentage of

enrollees certified to receive, but ineligible for, WIC benefits) yielded an estimate of 4.5

percent. The 1998 national WIC certification dollar error (defined as the amount of annual

WIC food funds spent on ineligibles) was $120 million.

4.1 WIC Income Eligibility

Federal regulations and guidance provide the framework for determining income eligibility for the WIC

Program. Within the federally prescribed framework, state WIC agencies establish policies and

procedures for determining an individual applicant’s eligibility. These procedures are applied during the 2

certification process at local WIC service sites.

Federal Regulations

Federal regulations require state WIC agencies to establish income guidelines, definitions, and procedures

to be used in determining an applicant’s income eligibility for the program (7CFR 246.7(d)).
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 151

• Income guidelines establish maximum income limits according to family size, such that

families with income below the limits are income-eligible for WIC.

• Definitions and procedures provide methods for measuring family size and family income.

Federal regulations provide precise guidelines for some aspects of WIC income-eligibility determination,

whereas state agencies have discretion over other aspects. The primary components of the federal

regulations are described below.

Income Guidelines

Federal regulations stipulate two options available to states in establishing income guidelines for the

WIC Program: state agencies may use the income guidelines of the National School Lunch Act for

reduced-price meals, or the state or local guidelines for free or reduced-price health care. The National

School Lunch Program (NSLP) certifies participants with income at or below 185 percent of the federal

poverty guidelines; if a state chooses to use the reduced-price health care guidelines for WIC, the income

guidelines must fall between 100 and 185 percent of the federal poverty guidelines. In 1998, all state

WIC agencies used the income guidelines of the NSLP.

Definition of Family Size

To determine total countable WIC income for applicants to the program, the certification process must

identify the members of the applicant’s family and sum the income of each family member. Federal WIC

regulations define a family as:

A group of related or non-related individuals who are living together as one economic

unit, except that residents of a homeless facility or an institution shall not all be considered as members of a single family (7 CFR § 246.2).

Federal regulations offer no further definition of family membership, but FNS provides guidance to the

states (discussed later in this section).

Definition of Income

States opting to use the NSLP income guidelines for WIC income eligibility must use the following

definition of income specified in federal WIC regulations: “gross cash income before deductions for

income taxes, employee’s social security taxes, insurance premiums, bonds, etc.” The definition of

income goes on to enumerate 12 categories of countable sources of income and three broad categories of

income exclusions (see Exhibit 4-1). States choosing to use state or local guidelines for free or reducedprice health care in determining WIC income-eligibility must use the state or local health care definition

of income.
152 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

Exhibit 4-1

WIC Definition of Income—Federal

Countable sources of income

Monetary compensation for services, including wages, salary, commissions, or fees

Net income from farm and non-farm self-employment

Social Security benefits

Dividends or interest on savings or bonds, income from estates or trusts, or net rental income

Public assistance or welfare payments

Unemployment compensation

Government civilian employee or military retirement or pensions or veterans' payments

Private pensions or annuities

Alimony or child support payments

Regular contributions from persons not living in the household

Net royalties

Other cash income. Other cash income includes, but is not limited to, cash amounts received or

withdrawn from any source including savings, investments, trust accounts, and other resources

that are readily available to the family.

Income exclusions

1. State agencies may choose to exclude from consideration as income any basic allowance for

quarters received by military services personnel residing off military installations

2. The value of in-kind housing and other in-kind benefits

3. By law, payments or benefits provided under certain federal programs or acts are excluded from

consideration as income. Some examples of these excluded payments are:a

• Reimbursements from the Uniform Relocation Assistance and Real Property Acquisition

Act

• Payments to volunteers under Title I (VISTA and others) and Title II (RSVP, foster

grandparents, and others)

• Payments to volunteers under the Small Business Act (SCORE and ACE)

• Income derived from certain submarginal land of the United States that is held in trust for

certain Indian tribes

• Payments received under the Job Training Partnership Act

a The regulations list an additional 27 federal programs.

Source: 7 CFR § 246.7 (d) (2) (ii)-(iv)

Federal regulations provide flexibility in terms of the timeframe for determining income. Regulations

allow (but do not require) state agencies to:

. . . instruct local agencies to consider the income of the family during the past 12

months and the family’s current rate of income to determine which indicator more

accurately reflects the family’s status. However, persons from families with adult

members who are unemployed shall be eligible based on income during the period of

unemployment.
3 The NSWP sample frame for selecting local agencies was stratified by income documentation policy, as discussed in Chapter 2.

4 The William F. Goodling Child Nutrition Reauthorization Act of 1998 was designed to strengthen the integrity of the WIC certification

process and required that all WIC applicants document family income at certification unless individual eligibility is based on adjunctive

income eligibility. This legislation was passed after the field period for the NSWP. An interim rule regarding the legislative change in

verification policy was issued by FNS in January 2000.

5 The Food Stamp Program income-eligibility limit is 130 percent of federal poverty guidelines. Income-eligibility for TANF varies by

state; in 1998 the earnings eligibility limit for TANF was below the poverty level in all states except Hawaii.

Federal law mandates Medicaid eligibility for all pregnant women and children below age six, living in families with incomes at or below

133 percent of the federal poverty level (FPL) (Omnibus Reconciliation Act, 1989). Forty-one states, however, have expanded eligibility

for Medicaid beyond federal requirements, using a variety of mechanisms available under federal law (e.g., Section 1902(2)(2) option of

the Social Security Act). As of October 1997, the Medicaid income-eligibility standard for pregnant women and infants was 185 percent

of FPL in 21 states, and exceeded 185 percent of FPL in eight states. At the same time, the Medicaid income-eligibility standard for

children below age six was 185 percent of FPL in five states, and exceeded 185 percent of FPL in seven states. (Source: National

Governors Association, State Medicaid Coverage of Pregnant Women and Children, September 1997.)

Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 153

Verification of Information

Federal regulations in 1988 did not require verification of information for determining an applicant’s

income eligibility for WIC, but gave state and local agencies the option to require verification. In 1998, 3

state WIC agencies could be categorized in one of four income verification groups. Fifty percent of state

agencies (enrolling 47 percent of WIC participants) required income documentation; 28 percent of

agencies (16 percent of participants) allowed applicants to self-declare income; 14 percent of agencies

(34 percent of participants) gave local agencies discretion with respect to income verification; and 8

percent of agencies (3 percent of participants) preferred documentation but did not require it.4

Adjunct or Automatic Income Eligibility

Federal regulations provide for adjunct or automatic income eligibility. Adjunct or automatic income

eligibility is conferred on applicants on the basis of participation in other public assistance programs. 

Adjunct income-eligibility was adopted by the WIC Program to streamline the certification process and

ease the burden of determining eligibility.

• Adjunct eligibility. State WIC agencies are required to accept as adjunctively incomeeligible any applicant who is certified eligible for food stamps, or certified as fully eligible or

presumptively eligible to receive Temporary Assistance for Needy Families (TANF) or

Medicaid. In addition, an applicant must be accepted as income-eligible for WIC if s/he is a 5

member of a family certified eligible for TANF, or a member of a family in which a pregnant

woman or an infant is certified eligible for Medicaid.

• Automatic income eligibility. States have the option to accept as automatically incomeeligible applicants participating in state-administered programs that routinely document

income and have income-eligibility guidelines at or below WIC income guidelines. 

Programs used for automatic income eligibility in some states include the NSLP, Head Start,

Home Energy Assistance Act, and General Relief.

Special Cases

Special procedures for determining WIC income eligibility are specified in federal regulations for three

types of applicants:
6 Special treatment of family size for pregnant women was codified in federal regulations in 1999; these provisions were part of FNS

guidance prior to that date and were found in state policies and procedures, as discussed below. This provision, however, was specifically

prohibited in 1988 at the time of the WIV.

Throughout this report, exhibits showing economic unit size do not reflect addition of the unborn child. In calculating income as a

percentage of poverty level, however, the size of the economic unit was increased by one if income exceeded 185 percent of poverty and the

family contained a pregnant woman.

7 WIC regulations define a migrant farmworker as an individual “whose principal employment is in agriculture on a seasonal basis, who has

been so employed within the last 24 months, and who establishes, for the purposes of such employment, a temporary abode” (7 CFR

246(2)). An instream migrant farmworker is a worker who has left his home base and entered the stream for a particular agricultural

season.

8 Some of the changes in state WIC agencies’ policies and procedures over the past ten years—reflected in a comparison of the results of the

1988 WIV and this study—are due to the 1988 revisions of FNS 803-3. Those revisions were not incorporated in state WIC agencies’

policies and procedures prior to data collection for the WIV.

154 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

• Pregnant women. A pregnant woman who is not income eligible shall have her family size

increased by the number of embryos or fetuses in utero, and her income-eligibility shall be

reevaluated with the increased family size. The same increased family size may also be used

for any of the pregnant woman’s categorically eligible family members.6

• Indian applicants. State WIC agencies may use an abbreviated certification procedure to

establish income-eligibility for Indian applicants at local agencies serving areas in which at

least 51 percent of Indian households have income at or below the state agency’s income

eligibility criterion. This abbreviated certification procedure allows Indian applicants to

self-declare family income to be below the maximum allowable criterion, without stating

their level of household income or providing documentation. To use this abbreviated

procedure, state agencies must apply to FNS regional offices with documentation, such as

census data, confirming the income distribution of the Indian population.

• Instream migrant farm workers. Although WIC participants are generally required to 7

satisfy income-eligibility criterion at each certification and re-certification, migrant farm

workers and their families are considered WIC income-eligible for 12 months following a

WIC income-eligibility determination. When migrant farm workers and their families

transfer between WIC service sites (when they move to new job locations), WIC Verification

of Certification (VOC) cards are used to confirm eligibility at new sites.

Adjunct and automatic eligibility determination streamlines the income-eligibility determination process. 

When these methods do not apply, income-eligibility determination can sometimes be a complex process. 

Two main factors complicate income-eligibility determination: (1) complex household circumstances

may make it difficult to define the “family,” and (2) recent changes in household circumstances (which

often lead families to seek help from the WIC Program) may make it difficult to determine household

income. To assist states in determining income-eligibility in the face of complex circumstances, USDA

has supplemented federal regulations with guidance and instructions.

USDA Guidance to State WIC Agencies

FNS has clarified the definition of WIC income and provided guidance to states in defining the“WIC

family” in instructions and consolidation of WIC regulations.8
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 155

Between 1988 and 1998, FNS issued the following instructions and policy memoranda clarifying WIC

income eligibility:

FNS Instructions

803-3 (rev. 1988), WIC Program Certification: Income Eligibility

803-14 (1988), WIC Program Certification: Eligibility of Special Populations

803-13 (1988), WIC Program Certification: Eligibility of Persons Affiliated with Institutions

WIC Policy Memoranda

Family Size and Income Determinations for Military Families (un-numbered, March 1991)

Lump Sum Payments as Income (WIC Policy Memorandum 92-14)

WIC Income Eligibility and Natural Disasters (WIC Policy Memorandum 93-1)

Documentation of Food Stamp Program Participation in an Electronic Benefit Transfer (EBT)

Environment (WIC Policy Memorandum 98-4)

FNS Instruction 803-3, first issued in 1982 and revised in 1988, includes a general definition of the WIC

economic unit and specific guidance for handling complex household situations. Instruction 803-14

addresses WIC income eligibility for Indian populations and instream migrant farm workers; this

instruction is now codified in federal regulations (discussed in the previous section). Each of the remaining instructions clarifies WIC income eligibility in specific circumstances. During the past ten years, the

guidance provided through these memoranda has increased uniformity in state WIC agency policies and

procedures.

Definition of Family Size

FNS Instruction 803-3 provides the following general definition of the WIC economic unit:

For the purposes of the WIC Program, the terms “economic unit” and “family” can be

used interchangeably. We perceive a family to be a household or an economic unit

composed of a person or group of persons who usually (although not necessarily) live

together, and whose production of income and consumption of goods or services are

related.

The specific complex household situations for which FNS has provided guidance are:

• Two separate economic units residing under the same roof (FNS Instruction 803-3)

• Child of divorced parents (FNS Instruction 803-3)

• Child residing in a school or institution (FNS Instruction 803-3)

• Foster child under legal responsibility of the state (FNS Instruction 803-3)

• Adopted child (FNS Instruction 803-3)

• Persons affiliated with institutions (FNS Instruction 803-3)

• Members of armed forces serving overseas (WIC Policy Memorandum, March 1991)

Most FNS instructions for special circumstances are straightforward and consistent with the general

definition of the WIC economic unit. A child of divorced parents should be counted in the family size of

the parent with whom he or she lives. A child in a school or institution should not be excluded from

family size if the parents provide financial support to the child. A foster child under the legal
156 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

responsibility of the state should be considered a family of one (and countable income includes only

foster child payments from the state). Adopted children are counted in the family adopting them. 

Persons or families residing in an institution (e.g., homeless shelter) are considered separate economic

units from other residents of the institution. Military personnel who are not living with their families are

nonetheless included in the determination of family size.

The most complex family situation is that of two separate economic units living under the same roof. For

example, when a young mother lives with her parents, she and her child may be considered an economic

unit separate from her parents. In Chapter 3 we reported that 19.5 percent of all WIC participants reside

in households that are multigenerational (Exhibit 3-13), in that the “WIC mom” resides with her parents

or other adults of a different generation.

When two economic units reside under the same roof, FNS instructs WIC staff to use two rules in

determining the economic unit of the WIC applicant. First, the economic unit must have its own source

of income, and second, the income must be adequate to sustain the economic unit. In other words, a

young mother and her child who reside with her parents can be considered an economic unit separate

from her parents only if the young mother demonstrates a source of income adequate to support herself

and her child. The determination of income adequacy, however, is subject to judgement. According to

FNS Instruction 803-3:

State agencies may wish to establish guidelines to determine the “adequacy of income”

or delegate this responsibility to their local agencies. In any event, this definition should

consider the actual living costs for the economic unit in that environment. . . . The State

may require a determination that the purported family unit does, in fact, pay all of its

living expenses. However, this process may be prohibitively time-consuming, and the

result is almost inevitably inconclusive.

FNS instructions specifically state that it is not the intent of FNS to make the income determination

process a complicated or lengthy procedure. Furthermore, “there will be times when State and local

agency workers will need to use their discretion in determining income eligibility within the general

framework of regulatory requirements and basic program policy.” Clearly, one of the times when

discretion may be needed is when multiple families reside within the same household—as is the case

when a young mother who is no longer legally dependent on her parents resides with them. In Section 4.2

we discuss state policies and guidelines for exercising discretion in these cases.

Definition of Family Income

With respect to determination of WIC family income, FNS has provided clarification on the following

issues:

• Calculation of income from farm and non-farm self-employment (FNS Instruction 803-3)

• Counting cash allowances received by military personnel (FNS Instruction 803-3)

• Determination of gross income for military personnel not living with their families (WIC

Policy Memorandum, March 1991)

• Lump sum payments (WIC Policy Memorandum 92-14)

• Income exclusions (FNS Instruction 803-3)

• Use of current versus annual rates of income (FNS Instruction 803-3)
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 157

• Determination of “current” income (FNS Instruction 803-3).

• Documenting adjunct income eligibility based on FSP participation in an EBT transfer

environment (WIC Policy Memorandum 98-4)

The income of self-employed persons is calculated as the net of operating expenses. Income of military

personnel is counted only when received as cash income—in-kind benefits, such as on-base housing, are

not counted as income, but housing allowances received as cash are counted as income. FNS gives state

agencies the option to exclude military off-base housing allowances from income. Furthermore, FNS has

specified that when military personnel are temporarily absent from their homes their total gross incomes

are counted in family incomes, not just the portion of income allotted to the family.

FNS guidance on the treatment of lump sum income recognizes that some lump sum payments may be

reimbursements for lost assets or for injuries, whereas other lump sum payments may be “new” money

intended as income (lottery winnings, severance pay, inheritance). Lump sum payments that are

reimbursements are not to be counted as income for WIC eligibility purposes, whereas lump sum

payments that are “new” money should be considered “other cash income” for WIC eligibility purposes,

and should be considered annual income or divided by 12 to estimate monthly income.

Income exclusions, although enumerated in the federal regulations, are further clarified in FNS guidance

as “all non-cash income,” including in-kind benefits, income from federal programs, and loans (“since

these funds are only temporarily available and must be repaid”).

FNS guidance (Instruction 803-3) addresses the fact that “The WIC regulations do not define ‘current

income.’ Therefore, state agencies have the flexibility to establish what is to be considered current

income.” FNS encourages state agencies to define current income as income received during the month

prior to application, and to apply consistent multipliers when income is reported as other than a monthly

figure. Suggested multipliers for determining monthly income are weekly income × 4.3, bi-weekly

income × 2.15, and semi-monthly income × 2.

Summary of Federal Regulations and Guidance

The review of federal WIC regulations and FNS guidance shows that state WIC agencies have no

discretion over the following aspects of WIC income eligibility determination:

• Use of adjunct eligibility

• Definition of the family in circumstances addressed by federal guidance

• Definition of countable income

States do have discretion over:

• Use of automatic eligibility

• Definition of the family in circumstances not addressed by federal guidance

• Definition of the family when separate economic units may be present
158 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

Exhibit 4-2

States Represented in the 1988 WIV and the 1998 National Survey of WIC Participants

and Their Local Agencies

• Timeframes for determining income (except for unemployed persons and instream migrant

farm workers)

• Definition of current income and multipliers for converting reported income to monthly or

annual values

4.2 Review of State WIC Agency Income Eligibility Guidelines

This section summarizes findings from a review of state agency guidelines from the 25 states represented

in the NSWP sample, and compares this information with 1988 findings. The findings from 1988 and

1998 are based on two different but overlapping groups of states. The states represented in the 1988

WIV sample and the 1998 NSWP sample are shown in Exhibit 4-2. The 15 states common to both

samples account for 64 percent of the total WIC caseload in 1998.

Between 1988 and 1998, FNS issued instructions to clarify many aspects of WIC income-eligibility. Our

review of 1998 state WIC agency guidelines shows almost complete agreement among states on definitions of WIC countable income and more uniformity among states in their definition of the WIC economic unit than that found in 1988. In addition, compared with 1988, more states now include precise

guidelines for handling special cases, giving less discretion to local staff.
9 Federal regulations allow for different guidelines to be used in different local agencies within a state only when agencies adopt income

eligibility guidelines used for free or reduced-price health care (7 CFR §246.7(d)(1)(i)). In 1998, however, all states used the income

guidelines from NSLP, and none authorized use of income guidelines used for free or reduced-price health care.

10 In 1988, adjunct eligibility was not yet codified in federal regulations, and the practice of adjunct eligibility was known as “presumptive

eligibility.”

11 This statement is true for all 88 state agencies, not just the 25 states represented in the NSWP sample. (Source: WIC Participant and

Program Characteristics, 1998.)

Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 159

WIC Policies and Procedures Manuals

Our review of WIC income-eligibility guidelines is based on information abstracted from WIC manuals. 

Each state WIC agency (25) and local WIC agency (79) in the NSWP sample provided copies of sections

of their WIC manuals containing guidelines for determining the income eligibility of WIC applicants. 

Local WIC agencies in 22 of 25 states use the state agency policies without revision or supplementation.9

Local agencies in three states (Arizona, California and Illinois) provided manual extracts consisting of

state policy plus local supplements, with the supplements providing only additional clarification of state

rules.

State WIC agency guidelines generally include most federal regulations and FNS instructions verbatim. 

We found, however, that every state manual does not include the federal instructions for every topic. In

reviewing state WIC agency manuals, it was apparent that differences between state manuals were not

due to the presence of contradictory information; state manuals differ because they vary in the comprehensiveness of instruction. For example, the FNS instruction on determining the economic unit for

military families was included in the guidelines of 10 out of 25 states.

Adjunct and Automatic Income Eligibility

Exhibit 4-3 shows that, in 1998, all states, in accordance with federal regulations, confer adjunct eligibility on applicants participating in food stamps, TANF, and Medicaid. In addition, five of the 25 states

accept applicants as automatically income eligible for WIC on the basis of participation in either the

NSLP (three states) or General Public Assistance (two states). In contrast, only 21 of 25 states surveyed

in1988 used adjunct eligibility to streamline the WIC application process.10

Income Guidelines

In 1998, all state WIC agencies used the income guidelines of the NSLP for applicants not adjunct or

automatically income-eligible. Participants were certified for WIC if family income was at or below 185

percent of the federal poverty guidelines. In contrast, the 1988 WIV found that 21 of 25 states used the 11

income guidelines of the NSLP; the four remaining states defined their income limits at levels below 185

percent of poverty. The uniform use of NSLP income guidelines in 1998 indicates less-restrictive income

guidelines in WIC than were present ten years earlier.

The federal poverty guidelines are updated on an annual basis and issued each year in the Federal

Register by the U.S. Department of Health and Human Services (DHHS). The timing of release varies

but is generally in February or March. WIC regulations require that revised guidelines be implemented

by July 1 of each year. Among the 25 states in the NSWP sample, 13 states implement revised
12 Because states do not implement revised poverty guidelines concurrently, the timing of implementing revised guidelines had to be taken

into account when evaluating the income-eligibility of respondents to the NSWP (which was fielded from March to May 1998). 

160 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

guidelines on July 1, and 12 states implement revised guidelines on dates that range between mid-March

and May 1.12

Exhibit 4-3

Means-Tested Programs Used to Determine WIC Income-Eligibility by State Agencies, 1988

and 1998

NSWP Sample, PC88 Sample,

1998 1988

Number Percent Number Percent

States States States States

Adjunctive income-eligibility

AFDC/TANF 25 100% 12 48%

Food Stamps 25 100 10 40

Medicaid 25 100 16 64

Automatic income-eligibility

Supplemental Security Income 0 0 2 8

NSLP 3 12 5 20

Head Start 1 4 0 –

Food Distribution Program on Indian Reservations 5 25 0 –

Home Energy Assistance 1 4 0 –

General Public Assistance 3 12 0 –

Refugee Resettlement Program 1 4 0 –

Total state WIC agencies 25 100 25 100

Source: State WIC Agencies’ policies and procedures manuals, 1998; WIV, Final Report, 1990.

The WIC Economic Unit

All state WIC agency manuals include a general definition of the WIC economic unit and procedures for

determining the economic unit in special cases. There is some variation in the general definition of the

WIC economic unit, but most of the across-state variation in WIC guidelines is in special case definitions.

Among the 25 state WIC agencies, five general definitions of the “WIC economic unit” are specified in

state agency manuals. These definitions are listed in Exhibit 4-4. Four of the five definitions are

consistent in meaning and vary only in terminology, defining the WIC economic unit as a group of related

or unrelated individuals who generally live together and share income. Most state agencies use definitions taken verbatim from federal regulations or federal guidance (definitions 1 or 2). Only one state,

among the 25 in our sample, used a more restrictive general definition of the WIC economic unit than the
13 An emancipated minor is an adolescent, under 18 years of age, who is legally married or divorced.

Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 161

definition specified in federal regulations, restricting the economic unit to consist of persons “related by

blood, marriage, adoption, or guardianship.”

Exhibit 4-4

General Definitions of the WIC Economic Unit in Use by State WIC Agencies, 1998

Definition States Source

Number

Main definitions

Group of related or non-related individuals who 13 FNS Instruction 803-3 (1988)

usually, although not necessarily, live together,

and whose production of income and use of

goods and services are related.

Group of related or non-related individuals who 8 7 CFR245, Determining Eligibility for Free

are living together as one economic unit. and Reduced-Price Meals and Free Milk

in Schools

Variations

All related or non-related persons who share 2

income as the economic unit.

All persons, related and/or unrelated, living 1

together in the same dwelling, with the exception

of the following special situations: pregnant

women, foster child, and individuals who qualify

as a separate economic unit.

State-specific definition

Must be related by blood, marriage, adoption, or 1

guardianship.

All state WIC manuals discuss special cases—that is, household circumstances that require special

consideration when determining the WIC economic unit. The number of states providing guidance for

each type of special case is shown in Exhibit 4-5. In both 1988 and 1998, three types of special cases 

were discussed in a majority of state manuals: minors, foster children, and students living apart. In

1998, additional special cases were specified by most states: adopted children, institutionalized persons,

children of divorce/joint custody arrangements, military families, and separate economic units within

households. All of these special cases had been addressed by FNS guidance to states, as discussed in the

previous section. The one exception is minors; the special case of emancipated minors was addressed in

the 1982 version of FNS Instruction 803-3, but does not appear in the 1988 version of 803-3, perhaps

because this case falls within the realm of “two separate economic units within a household.”13
14 It is unclear why this special instruction is needed, because the general definition of the WIC economic unit encompasses cases of

unmarried couples living together.

162 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

Exhibit 4-5

Special Case Procedures for Determining Economic Unit Membership, 1988 and 1998

NSWP Sample, 1998 PC88 Sample, 1988

Number Percent Number Percent

States States States States

Has special case proceduresa 25 100% 25 100%

Absent parent 2 8 0 0

Adopted children 16 64 0 0

Emancipated or non-emancipated minors 15 60 16 64

Foster child 24 96 23 92

Infant breastfed by woman other than birth mother 1 4 0 0

Institutionalized persons 19 76 9 36

Joint custody arrangements 13 52 2 8

Military persons serving overseas 10 40 0 0

Pregnant woman (unborn child) 24 96 1 4

b

Separate economic unit 19 76 4 16

Student living apart 13 52 15 60

Temporary living arrangements 4 16 4 16

Unmarried couples 2 8 0 0

Total state WIC agencies 25 100 25 100

a States having special case procedures do not necessarily have the same procedures.

b Including the unborn child in the economic unit of pregnant women was specifically prohibited by FNS guidance issued in 1988 (FNS

Instruction 803-3). The policy changed in 19?? with FNS Policy Memorandum ?? and was codified in federal regulations in 1999.

Source: State WIC agencies’ policies and procedures manuals, 1998; WIV, Final Report, 1990.

Other special cases are addressed in only a few state WIC manuals: absent parent due to job-related

assignment (2); infant breastfed by woman other than the birth mother (1); temporary living arrangements (4); and unmarried couples (2). In addition, one state WIC manual explicitly says that persons in

prison should not be counted in the WIC economic unit.

Special cases addressed by FNS guidance are found in all state manuals in a manner consistent with FNS

guidance, and often in language taken verbatim from FNS guidance. Special cases addressed by state

policy but not addressed by FNS guidance are, for the most part, consistent with the general definition of

the WIC economic unit as a group of persons who usually live together and who share financial

resources. For example, the policy on unmarried couples (two states) is that an unmarried couple living

together should be considered a single economic unit. Two special cases receive inconsistent treatment 14

across states: policies regarding separate economic units and policies regarding applicants who are

minors.
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 163

As discussed in the previous section, FNS guidance defines separate economic units within households as

economic units with separate sources of income adequate to sustain the unit. Some states specify exact

resource requirements to define “adequacy” in establishing separate economic units (“must pay room and

board,” “must pay all their own expenses,” “usually purchase and prepare their food separately”). On the

other hand, one state simply reiterates the vague guidance to “treat two economic units that reside under

the same roof as separate units,” thereby giving local agencies full discretion. Different state policies

regarding separate economic units are shown in Exhibit 4-6.

Exhibit 4-6

Examples of State WIC Agency Policies for Identifying Separate Economic Units within

Households

• Groups of persons living in same house may declare themselves "separate economic units"

provided they can demonstrate that their income is sufficient to provide for the majority of their living

expenses.

• Subfamilies are considered separate economic units if they have their own source of income and if

the members of each subfamily usually and separately purchase and prepare their own food (or

intend to after certification). (Minor children and spouses cannot be in separate economic units.)

• The key is sharing a "common income." If each household has its own source of adequate income

(rent, food, utilities, and other), that entity is considered and evaluated as a separate household/

economic unit.

• Subfamilies are considered separate households only if they pay room and board.

• If applicant is currently eligible for TANF/FSP/Medicaid, then family size should match the

determination of the adjunct program.

• Subfamilies must pay ALL of their own expenses.

• Related individuals who live together but have no legal responsibility (grandparents, adult sister/

brother, parents and adult children) are separate economic units unless applicant states that they all

live together as one unit.

• Non-related individuals are a separate economic unit unless applicant states that they are all part of

the same economic unit. Unmarried couples who live together and are expecting a child, however,

are considered to be a single economic unit, along with anyone else living with the unmarried couple

for whom either or both have legal responsibility.

• "If the applicant is living without economic support from other persons in the same residence, the

applicant is a separate economic unit. However, if the applicant receives from other persons of the

residence any support for which s/he does not pay, the applicant must be counted in the family size

of the residence."

• "Anyone who doesn't share income and expenses with others, regardless of living situation."

• Separate economic unit status requires: (a) must pay min of $68.17 per month for room and board

for adult, $95.33 for child under 12, $117 for child over 12; (b) applicant's production of income and

consumption of goods and services are not related to anyone else in household; (c) applicant is not

a spouse of a member of household or a child under 18 or a financial dependent of anyone in

household; (d) supplemental foods are purchased and consumed separate and apart from others in

household.

• Treat two economic units that reside under the same roof as separate units.

• If applicant exchanges work for room and board, then that individual is in a separate household.
164 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

Examples of state policies regarding WIC applicants who are minors are shown in Exhibit 4-7. Of the 25

states in the sample, eight states have no explicit policy on the treatment of minors, and the remaining 17

states have one or more of the following policies: treat minors who reside with their parents as part of

their parents’ household (8); treat pregnant teens as separate economic units when they are in need of

confidential services or self-declare emancipation (3); determine whether the minor is a separate economic unit based on a resource test (9); or determine the eligibility of pregnant teens on a case-by-case

basis (1). In the case of minors, there are clearly different policies across states.

Exhibit 4-7

Examples of State WIC Agency Policies for Treating Applicants Who Are Minors

• Court-declared emancipated minor is separate economic unit (MUST show court declaration).

• Eligibility of pregnant teen is to be determined on a case-by-case basis.

• Pregnant adolescent (conception prior to 18th birthday) is counted as separate family unit.

• A minor (and children), not emancipated, residing with parents/guardian is considered part of

parents' household.

• A non-emancipated minor may be considered a separate economic unit when living as a separate

household without any economic support from other persons in household (when living separate

from parents and not supported by parents).

• A minor (and children), that resides separately from parents, and living within another economic unit,

should be counted in the family size of the non-parental unit.

• If a pregnant minor or minor mother lives with her parents, she is in her parent's economic unit

regardless of statements of self-sufficiency.

• Single teenager or college student through age 22, male or female, living with parents and in need

of confidential services, may be considered a family unit of one when seeking WIC and when family

income cannot be obtained without breaching patient confidentiality.

• A pregnant minor or minor mother who receives public assistance is treated according to the policy

in the section headed Income Eligibility for Public Assistance Recipients (that is, she is adjunct

eligible).

• When minor mother lives with her parents, infant/child of minor mother may be considered an

economic unit of one if grandparents say they are not providing support for infant/child and if

infant/child has a verifiable source of financial support such as child support payments, public

assistance, or minor mother's earned income.

• An emancipated minor, supported by the parent or guardian, is considered a part of that family or

economic unit.

• Minors who pay all expenses for their support may be considered a separate household even

though they reside under the same roof with the parent, guardian, caretaker.

• Teen is not part of her parent's household when: (a) lives with parents but is working and paying

room/board; (b) lives with parents and does chores or child care in exchange for room/board; (c)

receives TANF, Medicaid, food stamps; (d) lives apart from her parents and is working.

• "If the applicant is at least 15 years old and lives outside the home of her parents or legal guardian

and is self-supporting then she is an ‘emancipated minor’ and considered to be her own household."

• "For a minor who considers herself emancipated but has no Court declaration, document why she is

considered emancipated on the financial eligibility form."
Exhibit 4-7

Examples of State WIC Agency Policies for Treating Applicants Who Are Minors

15 Although only 21 of 25 states enumerate “public assistance or welfare payments” as countable income, for the most part, recipients of

public assistance are adjunct eligible (when the public assistance is TANF). They are not subject to the income limits based on countable

income.

Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 165

• A minor may be considered a separate economic unit when living as a separate household without

any economic support from other persons in the household. If residing with parents and not claimed

as a tax deduction, then applicant may be considered a separate economic unit. (She may receive

TANF, or have earnings to support herself and contribute toward payment of expenses.)

• Pregnant teen living with friend or family—If teen has her own income (TANF, work, . . .) and

supports herself, the teen is counted as a family of two and only her income is used to determine

income eligibility.

WIC Countable Income

All state WIC agency manuals include an enumeration of countable sources of income and income

exclusions. These enumerations mostly agree with Exhibit 4-1, which contains the 12 countable sources

of income and three broad categories of income exclusions specified in federal regulations. Exhibit 4-8

shows that 25 states specify seven of the 12 main categories of income, and the remaining five categories

of income are specified by 21 or more states.15

The main source of variation in state WIC guidelines for countable income is the degree to which states

define “other cash income.” Federal regulations specify that “other cash income” includes all sources of

income not specifically excluded. Some states specifically enumerate sources of income that would be

included in the category of “other cash income,” as shown in Exhibit 4-8, resulting in state-to-state

variation in the specificity of guidelines. This variation in the specificity of guidelines, however, does not

constitute different definitions of income.

Compared to countable income sources, there is greater variation among states in enumeration of income

exclusions, as shown in Exhibit 4-9. The regulations include three main categories of income exclusions: 

states may choose to exclude military housing allowances (24); states must exclude the value of in-kind

housing and in-kind benefits (18 explicitly specify this exclusion); and payments or benefits under certain

federal programs are to be excluded. (32 federal programs or acts are listed in the regulations). There is

great variation among states in the number of exclusions enumerated in their state guidelines. Seventeen

states refer to the federal regulations instead of including a full enumeration of exclusions in their state

WIC manuals.

In addition to the three categories of exclusions specified in regulations, three states exclude tax refunds

and the Earned Income Tax Credit, two states explicitly exclude income earned by family members under

age 18, and one state excludes capital gains. These additional exclusions are categories of income that

are unlikely to be reported in response to typical questions about income and earnings.
166 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

Exhibit 4-8

Sources of Countable Income Specified by State WIC Agencies

1988 1998

Source of Income Number Number Percent

Components of income specified in regulations

1 Wages, salary, tips, commissions or fees 25 25 100%

2 Net income from farm and non-farm self-employment 25 23 92

3 Social Security benefits 25 25 100

4a Dividends; interest on savings or bonds; income from estates

or trusts 25 25 100

4b Net rental income 24 23 92

5 Public assistance or welfare payments 25 21 84

6 Unemployment compensation 25 25 100

7a Government, civilian employee, or military pensions 25 25 100

7b Veteran’s payments 24 22 88

8 Private pensions or annuities 25 25 100

9 Alimony and child support payments 25 24 96

10 Regular contributions from persons not living in household 25 24 96

11 Net royalties NA 23 92

12 Other cash income 25 25 100

Specified components of other cash income

Worker’s compensation for lost income 24 16 64

Lump sum payments 14 56

Severance pay 14 56

Portion of student aid used for room and board 2 12 48

Strike benefits 6 24

Disability benefits 23 4 16

Military cash allowances, such as food allowances 4 16

Military allotments 3 12

Sick pay 2 8

Stipend for foster care 2 8

All other sources of cash income except those specifically

excluded 2 8

Other cash income includes cash withdrawn from savings, investments, and trust accounts. Lump sum payments include “new money” such as

gifts, inheritances, and lottery winnings, but do not include reimbursements for loss.

Source: State WIC agencies’ policies and procedures manuals, 1998; WIV, Final Report, 1990.
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 167

Exhibit 4-9

Income Exclusions Specified by State WIC Agencies, 1998

State Agencies

Source of Income Number Percent

Military Housing Allowance (BAQ) or VHA 24 96

Value of in-kind benefits (any benefit not provided in cash) 18 72

Subsidized housing 5 20

Military benefits received in lieu of money 1 4

Benefits received under the National School Lunch Act and Child Nutrition Act

(SBP, CCFP, SFSP, Milk Program) 25 100

Benefits received under the Food Stamp Act 25 100

Student financial assistance funded through Title IV used for tuition, books, fees 25 100

Volunteers under Title I (RSVP, Foster Grandparents, VISTA) 24 96

Home Energy Assistance (Low-income Home Energy Assistance Program,

LEAP) 23 92

JTPA benefits 22 88

Small Business Act Section 8 (SCORE, ACE) 20 80

Uniform Relocation Assistance and Real Property Acquisition Policies Act 20 80

Child care benefits provided under AFDC, JOBS, At-Risk Child Care Program 19 76

Indian claims (from submarginal lands held in trust) 16 64

Federal payments to Native Americans 13 52

Payments under Disaster Relief Act 12 48

Federal Distribution Program on Indian Reservations 2 8

Additional federal programs listed explicitly or by reference to federal

regulations 17 68

Income exclusions not specified in federal regulations

Bank loans 10 40

Tax refunds 3 12

Earned Income Tax Credit (EITC) 3 12

All income earned by family members under 18 years of age who are students

at least half-time 2 8

Capital gains 1 4

College/University assistanceships 1 4

Source: State WIC agencies’ policies and procedures manuals.
16 One state requires documentation dated within 30 days; by this rule, current income may be measured for the period two months prior to

certification.

17 The multiplier for converting weekly income to monthly income is 4.3 in ten states and 4.33 in three states. The multiplier for converting

biweekly income to monthly income is 2.15 in 12 states, 2.17 in one state, and 2.165 in one state.

168 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

Timeframes for Determining Income

In addition to specifying guidelines for defining WIC countable income, state WIC manuals specify the

time period over which income is to be measured. As discussed in Section 4.1, federal regulations

encourage consideration of income during the past 12 months and comparison with the current rate of

income to determine which indicator most accurately reflects the family’s status, though the current rate

of income must be used when persons are unemployed. In addition, FNS guidance suggests that current

income be measured as income received during the month prior to WIC certification.

Most states (22 of 25) in the NSWP reflect the federal regulations in their WIC manuals and require use

of current income or income for the past 12 months, whichever most accurately reflects status. The

remaining three states require use of current income or, when income fluctuates, an average over the

previous three months.

States differ only slightly in their definitions of current income, defining it as either income during the

month prior to certification or income over the past four weeks. Only 13 states explicitly specify 16

multipliers for converting weekly or biweekly income amounts to monthly amounts. (Some state computer systems may perform this conversion so that specification in the state manual is unnecessary.)17

States differ with respect to whether or not they specify the circumstances under which it is appropriate to

use income of the past 12 months, or whether they leave this determination completely to the discretion

of local agencies. When specified, local workers are instructed to measure income over the past 12

months when hours fluctuate (due to seasonal work or overtime) or when earnings are from self-employment. In addition, ten states specifically instruct that lump sum income should be considered as annual

income and divided by 12 to get a monthly amount.

Implications of Variation in Guidelines Across States

As discussed above, WIC income eligibility guidelines vary across states in the treatment of minors and

households with separate economic units. In addition, there is some variation in the explicit enumeration

of countable income sources, income exclusions, and guidance for treatment of special family situations. 

The impact of variation in WIC income eligibility guidelines across states, and in the complexity of rules

that must be applied by local WIC clinics, is that persons determined to be income eligible at one WIC

clinic may not be determined to be income eligible at another WIC clinic, even within the same state. In

situations of complex household circumstances, identification of the WIC economic unit requires that

WIC clinic staff ask probing questions, make decisions, and use discretion in determining the number of

persons in the WIC economic unit.

The scope for discretion and differential application of guidelines in determining the size of WIC

economic units depends on the distribution of household types among applicants to the program. Exhibit

4-10 shows the percentage of WIC participants in complex household situations based on the NSWP in-
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 169

home sample of nearly 1,000 WIC participants. The “special case” that occurs with greatest frequency is

separate economic units within a household, reported by 26.6 percent of respondents to the in-home

survey.

Exhibit 4-10

WIC Economic Units, by Type of Household and Composition

Percent of WIC Standard

Economic Units Error

Type of household

Single economic unit under one roof 73.4 (2.3)

Separate economic units under one roof 26.6 (2.3)

Relationships within economic unit

Immediate family only 80.4 (2.3)

Immediate family and other relatives 18.1 (2.1)

Immediate family and non-relatives 1.2 (0.5)

Immediate family, other relatives and non-relatives 0.4 (0.1)

Multigenerational economic unit

No 81.4 (1.9)

Yes, WIC mom less than 20 years old, living with parents 6.7 (0.9)

Yes, WIC mom 20 years or older, living with parents 8.0 (1.5)

Yes, other 3.8 (0.9)

Economic unit characterized by

Absent parent 36.0 (2.8)

Absent spouse 2.0 (0.6)

Special cases

Emancipated minor 2.7 (0.6)

Foster child 1.3 (0.6)

Joint custody arrangements 3.4 (0.9)

Military personnel 2.9 (0.8)

Student living apart 0.4 (0.2)

Temporary living arrangements 1.7 (0.5)

Sample size 931 

Population 7,741,078 

“Absent spouse” is defined as the absence of a spouse, when WIC mom indicates she is married (not widowed or divorced). “Absent parent” is

defined as the absence of a biological father when WIC mom has children.

Further evidence of the complexity of WIC households is seen in the fact that 19.7 percent of economic

units contain persons who are not immediate family members, and 18.5 percent of economic units are

multigenerational, in the sense that the “WIC mom” resides with her parents or other adults of a different
170 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

generation. In addition, 36 percent of economic units are absent a parent (i.e., only one biological parent

is present). The high rate of absent parents is consistent with findings of marital status presented in

Chapter 3; only 44 percent of WIC women and 51 percent of WIC mothers are married.

Other “special cases” have low incidence: less than 2 percent of WIC families have an absent spouse,

foster child, student living apart, or person away in temporary living arrangements. In addition, only 2.7

percent of WIC moms are emancipated minors, 3.4 percent of WIC families contain children in joint

custody arrangements, and 2.9 percent of WIC families contain military personnel.

In defining countable income, there is little effective difference across states in types of countable

income. The sources of income accounting for most income in WIC families are wages and salaries and

public assistance. Although four states fail to enumerate public assistance income as countable WIC

income, the receipt of TANF (which accounts for most public assistance income for WIC families) makes

those households adjunct eligible and not subject to limits on countable income. Other sources of income

for which states fail to show complete agreement (alimony and child support, regular contributions from

persons outside the household, income from self-employment, net rental income, net royalties, and

veterans payments) together account for only 4.5 percent of total WIC income.

4.3 Methodology for the NSWP In-Home Survey

The NSWP in-home survey was a follow-up to the NSWP in-person survey, conducted with approximately one-third of respondents to the in-person survey. The purpose of the in-home survey was to

provide data for estimation of the national error rate in income-eligibility determination, or the “income

certification error rate.” The main design features of the in-home survey were:

• A nationally representative sample of WIC participants

• Interviews conducted in the homes of respondents

• Detailed interviews on financial status and household size, with documents requested for all

income sources

• Interviews conducted soon after WIC certification, to reduce recall error and increase the

likelihood that documents were available

• A reference period for income information that matched the reference period used by most

WIC clinics (the month prior to WIC certification)

This section presents the methodology for the in-home survey, including descriptions of the sample, the

survey instrument, and response rates.

Overview of the Survey

The in-home survey provides data for estimation of the WIC “income certification error rate,” which is

presented in Section 4.4. The certification error rate is calculated as the percent of respondents not
18 This approach was also taken in the 1988 WIV.

19 Respondents were told that their answers would not be shared with WIC staff, and the information they provided would not affect the

benefits or services received from WIC or any other government agency.

20 Indeed, the purpose of adjunct eligibility is to streamline the application process and relieve clinic workers from the burden of collecting

these data.

Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 171

income-eligible for WIC based on the WIC income-eligibility rules of their respective states, and on

family size and family income as determined during in-home interviews.

For the most part, the in-home interview collected the same measures of family size and family income as

were collected in the NSWP in-person interview. As a result, in practice it was the goal of the in-home

interview to verify data collected during the in-person interview and revise it as necessary.

It is important to note that the purpose of the in-home interview was to verify information that determined WIC income-eligibility, but data collectors did not directly verify the information reported to WIC

clinics. WIC clinics often recorded only total family size, total family income, and/or participation in

adjunct programs, and the information in WIC clinic records was not sufficiently detailed for data collectors to verify without thorough training in WIC income-eligibility rules. Instead, data collectors verified

the detailed information collected during the in-person survey, and verification of WIC income-eligibility

was based on those detailed data. Respondents were provided assurances of confidentiality at the start 18

of both the in-person and in-home interviews.19

It was generally expected, and borne out by the data, that measures of family income from the in-person

survey would, on average, exceed family income reported to WIC clinics. There are two reasons for this

expectation. First, WIC clinics do not evaluate family income for applicants who are adjunct eligible so

we would expect incomplete income information for adjunct-eligible applicants. Second, methods for 20

questioning applicants about family income may vary across WIC clinics, whereas the NSWP survey

consistently administered income questions in all survey sites using a survey designed to minimize the

opportunity for under-reporting income. (Respondents were asked separately about the income of each

adult household member in each of 18 specific income categories.)

As discussed in detail below, one reason to conduct interviews in respondents’ homes was to ensure

access to documents to verify income data. In addition, respondents could request assistance from other

family members, especially regarding income that was not a respondent’s own income.

During in-home interviews, approximately one-half of respondents provided income documents for

review by data collectors, and an additional 19 percent provided undocumented revisions to the income

amounts reported during the in-person survey. In both of these cases, income reported during the inhome interviews reflects both under-reporting and over-reporting during in-person interviews, and

suggests some common sources of measurement error in income reporting, which are discussed below.
21 The sampling rate was one-third for the first month of the field period and two-fifths for the second month. Sampling rates for the second

month were revised because the flow of applicants into WIC sites was below expectations.

22 The 1988 WIV that is cited throughout this chapter was similarly based on in-home interviews with WIC participants. For the 1988 study,

however, in-home interviews took place an average of about five months after WIC certification.

172 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

The Sample

The samples for the in-person and in-home surveys were drawn simultaneously in the field at 181 WIC

service sites. Sampling for both surveys is discussed in detail in Chapter 2 and Appendix A.

At each WIC service site, approximately one-third of persons sampled for in-person interviews were also

simultaneously sampled for in-home interviews. This sample design resulted in an in-home sample that 21

retained the structure of the in-person sample and its national representativeness. Persons sampled for

both surveys were not told of the dual selection until they completed the in-person interviews, so that

response to these interviews would not be affected by the dual selection. Sampled persons who did not

complete in-person interviews were not pursued for in-home interviews.

After completion of in-person interviews, persons sampled for in-home interviews were scheduled for inhome appointments. The goal was to schedule in-home interviews within three weeks of certification. 

Scheduling conflicts and rescheduling often pushed the in-home interview beyond the three-week

window. More than one-half of in-home interviews were completed within one month of sampling, and

nearly all (96 percent) were completed within two months of sampling. The largest lag between the date

of sampling (which occurred at certification) and an in-home interview was 99 days. In-home interviews

were conducted from mid-March 1998 through mid-June 1998.22

Response Rates

Response to the in-home survey depended in part on response to the in-person survey. The samples were

drawn simultaneously, but persons who failed to respond to the in-person survey were not pursued for inhome interviews. The response rate to the in-home survey should be examined both as an unconditional

and a conditional rate.

Exhibit 4-11 shows the response rates to the in-person and in-home surveys. The response rate to the inperson survey is equal to the number of respondents as a percent of sampled persons. Similarly, the

unconditional response rate to the in-home survey is equal to the number of in-home respondents as a

percentage of the total number sampled for the in-home survey. The in-person survey attained a response

rate of 81.3 percent and the in-home survey attained an unconditional response rate of 66.5 percent (931

respondents divided by 1,401 sampled persons). The unconditional response rate to the in-home survey

reflects nonresponse to both surveys.

Because persons who failed to respond to the in-person survey were not pursued for in-home interviews,

response to the in-home survey can also be characterized by the conditional response rate. The conditional rate of response to the in-home survey (shown in Exhibit 4-12) is computed only among persons

sampled for the in-home survey who completed in-person interviews. The conditional response rate was

78.8 percent.
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 173 Exhibit 4-11 Response to the National Survey of WIC Participants and Their Local Agencies Certification Category Number Sampled for In-Person Interviewa Sampled for In-Home Interview Completed In-Person Interviews Comp

I

Number Percent of In- Person Sample Number Response Rate Number 

Pregnant 779 278 35.7 639 82.0 182 Breastfeeding 767 281 36.6 627 81.7 200 Postpartum 736 267 36.3 587 79.8 173 Infants 756 282 37.3 614 81.2 186 Children 790 293 37.1 647 81.9 190 Total 3,828 1401 36.6 3,114 81.3 931 a “Number sampled” excludes persons sampled but found to be ineligible for the survey. Persons were found ineligible if they were not at the WIC service site for certific

under the wrong certification category. b “Unconditional response rate” is the number of respondents to the in-home survey as a percentage of all sampled persons for the in-home survey, including both respondin-person survey.
174 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

Exhibit 4-12

In-Home Interview Sample Response Rates by Participant Category

Certification Category Interviews Interview Respondents Response Rate

Number of

Completed Number Selected

In-Person for In-Home Number of Conditional

a b

Pregnant 639 238 182 76.5

Breastfeeding 627 242 200 82.6

Postpartum 587 223 173 77.6

Infant 614 236 186 78.8

Child 647 242 190 78.5

Total 3,114 1,181 931 78.8

a Selection for in-home interview is conditional upon completion of in-person interview. See Exhibit 4-11 for response rates to the inperson interview.

b The 931 respondents to in-home survey include 20 partial interviews.

Although the in-home survey achieved a high rate of response among those completing in-person interviews, there must be concern about response bias whenever respondents are aware of the nature of a

survey prior to their agreement to participate. In this case, persons sampled for the in-home survey were

told that they would have to receive interviewers into their homes and they would be asked to produce

income documentation. The extra burden of this survey could alone be responsible for nonresponse.

Systematic patterns of nonresponse, however, could bias survey results if, for example, persons who

misreported their income to WIC were more likely to refuse in-home interviews than those persons who

correctly reported income to WIC.

To test for response bias to the in-home survey among respondents to the in-person survey, we compared

the characteristics of respondents and nonrespondents based on data from the in-person survey. Exhibit

4-13 shows this comparison. There are no statistically significant differences between respondents and

non-respondents with respect to participant category, adjunct-eligibility status, family size, maternal

characteristics (education, marital status, age), mean income, and whether the WIC family is part of a

larger household or is multigenerational.

The only statistically significant differences between respondents and nonrespondents are for

“certification history” and “income verification policy of WIC agency”. Nonrespondents were more

likely to have failed to report certification history on the in-person survey, perhaps demonstrating a

general lack of cooperation with surveys. Among those persons reporting certification history,

respondents and nonrespondents are equally likely to have been certified for the first time. The other

difference is that nonrespondents were more likely to be enrolled through WIC agencies requiring income

documentation. This is the opposite of what we might expect if WIC documentation policies are related

to certification error.
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 175

Exhibit 4-13

Characteristics of Respondents and Non-Respondents to the In-Home Survey

Respondents Respondents

NonParticipant category

Pregnant 11.0 11.4

Breastfeeding 5.2 3.8

Postpartum 7.4 7.4

Infant 24.9 27.5

Child 51.5 49.8

Income-eligibility

Adjunct-eligible 64.7 62.1

Non-adjunct eligible 35.3 37.9

Certification history*

First certification 30.6 32.8

Re-certification 66.4 58.7

Not reported 3.0 8.6

Size of economic unit

One or two 10.8 15.2

Three 28.3 23.4

Four 28.8 33.6

Five or more 32.2 27.8

Education of mother

Not high school graduate 28.2 26.6

High school graduate or more 63.3 60.5

Marital status

Married 52.8 49.8

Widowed, divorced, separated 12.1 14.0

Never married 35.1 36.2

Age of WIC mom

<18 years 6.8 7.5

18-34 years 81.7 78.8

>34 years 11.5 13.7

Characteristics of economic units

WIC economic units residing in larger households (%) 26.7 28.8

WIC economic units that are multigenerational (%) 19.1 22.7

WIC mom lives with parents 15.3 18.0

Mean monthly income of WIC economic unit reported to in- 1,261 1,221 

person survey

Income verification policy of WIC agency*

Documentation required 50.4 65.9

Documentation not required 49.6 34.1

Sample size 931 250 

Population 5,909,053 1,832,025 

Non-respondents to the in-home survey are identified among respondents to the in-person survey. All characteristics are measured from

response to the in-person survey.

For this exhibit, weights for respondents and non-respondents sum to the WIC population; for all subsequent exhibits, weights of respondents

sum to the WIC population, after adjustment to account for non-response.

* denotes a statistically significant difference in the distribution of respondent and non-respondent characteristics.
23 The change in sampling rates midway through the sample period is reflected in the sampling weights.

24 The in-home weights did not receive the final “raking” applied to in-person weights (which brought the in-person weights into alignment

with population counts for each selected stratum) because the in-home sample was designed to support only national estimates.

176 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

Sampling weights for the in-home sample were based on the weights constructed for the in-person

sample. For the in-person sample, each sampled person received a base sampling weight equal to the

inverse of the probabilities of selection at each stage of the sample design (see Appendix A). At the final

stage of sampling, approximately one-third of persons sampled for the in-person survey were also

sampled for the in-home survey, so the probability of selection for an in-home interview was equal to the

probability of selection for an in-person interview multiplied by a constant. This constant was applied 23

to the in-person weights, and the sample weights were adjusted to account for nonresponse. A final ratio

adjustment was made so that the sample weights sum to total WIC participation in the contiguous United

States in 1998. These procedures are analogous to the procedures applied to the in-person data and are

discussed in detail in Appendix A.24

The Survey Instrument

In-home interviews were conducted in respondents’ homes and lasted an average of 30 minutes. The

survey instrument included five distinct survey sections:

• Section A: Household Enumeration

• Section B: Employment History

• Section C: Income Review Form–Individual Income and Earnings

• Section D: Household Income Review Form

• Section E: Immunizations

The main purpose of the in-home interview was to obtain accurate data for reviewing the income-eligibility of each sampled WIC participant. Sections A through D address this goal. The final section of the

survey collected data on immunization histories for children in the household and was included to serve

data needs outside the scope of this study. (The survey instrument is in Appendix F.)

The household enumeration section provided data for establishing the size of the WIC economic unit; this

section included a household roster and a module for determining financial relationships within the

household. The income review forms provided data for establishing the income of the WIC economic

unit. In addition, the employment history section provided a source of verification for the earnings information provided on the income review form.

Three strategies were employed for obtaining accurate data on the in-home survey. First, Sections A, C,

and D of the instrument (the household roster and income review forms) were pre-printed with data

collected and processed from in-person interviews. Pre-printing of data speeded the interview process

and allowed data collectors to verify information, revise the pre-printed data, and resolve discrepancies. 

The second strategy (which was also employed for the in-person interview) was to minimize the opportunity for under-reporting income by separately asking about the income of each adult household

member. In Section C of the survey, for each adult in the household, the respondent was asked if that
25 It was also expected that the in-home interview would benefit from the two-survey design of the project. Respondents were expected to be

less likely to commit errors of omission during the in-home interview for sources of income previously reported during the in-person

interview, relative to a survey design in which respondents were contacted only once in their homes with a request for income information

and documentation.

26 Recall that purpose of the in-home interview was to verify information that determines WIC income-eligibility, but data collectors did not

directly verify the information reported to WIC clinics.

Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 177

individual had any of 18 specific sources of income. In Section D, the respondent was asked if the

household received any of four types of public assistance. Data collectors asked about receipt of each

income source during the month preceding WIC certification, regardless of whether receipt was indicated

during the in-person survey. With this approach, there is little opportunity for errors of omission, and the

specificity of questions reduces the potential for misinterpretations of what is included in “income.”25

The third strategy for obtaining accurate data was to request documentation of all sources of income. 

Respondents were notified, in advance, that documentation would be requested during in-home

interviews. Each person scheduled for an in-home interview was provided a brochure listing acceptable

documentation for each income source. Respondents were told that the in-home interviews would go

more quickly if documentation were assembled and ready at the start. Because of this extra burden,

respondents were also informed that they would receive $25 gift certificates at the conclusion of the inhome interviews.

Verification of Income-Eligibility Information

The in-home survey instrument was pre-printed with information from the in-person survey, and data

collectors were trained to check off pre-printed data without using it to prompt respondents. In this way,

the in-home interview verified data collected during the in-person interview and revised it as necessary. 

Respondents were asked to report on “current” household membership and income for the reference

period (the month prior to WIC certification), and data collectors revealed pre-printed information only to

resolve discrepancies.26

There are a number of reasons why data collected during the in-person survey might be revised during the

in-home survey. Respondents may have made mistakes during in-person interviews (for example, by

misinterpreting questions), or errors may have occurred in processing the data. In addition, the detailed

income information collected in the in-person interview was subject to recall error, rounding, and simple

lack of knowledge. (The respondent may not have had knowledge of the income of all adult family

members when approached in the WIC clinic for an in-person interview.) It was expected that in-home

interviews would yield many revisions to the income data because respondents had advance warning of

the nature of these interviews and could assemble documents and consult with family members to obtain

relevant information. Household membership data, on the other hand, was not expected to need much

revision during in-home interviews, particularly because in-home interviews occurred within a few weeks

of in-person interviews.

Verification of the WIC Economic Unit

For the 931 cases, in-home interviews verified information about household membership from the inperson interviews in all cases. The only revisions to household rosters involved persons entering or

leaving households during the time between interviews. New members entered the household of 3.2
27 On the in-person survey, the respondent was asked three brief questions about each household member: does this person provide financial

support to the sampled person, receive support from the sampled person, or share common support with the sampled person?

On the in-home survey, each household member was assigned to a family unit based on age and relationship consistent with the definition

of an immediate family. A module of five questions addressed to each unit determined the financial independence of that unit from other

family units within the household. The financial relationships module used for the in-home survey was taken from the Consumer

Expenditure Survey administered for the Bureau of Labor Statistics.

28 Twenty-nine cases are excluded from analyses. These respondents either failed to respond to all income questions for some adult members

of the WIC economic unit, or they reported receipt of wages/salary during the in-home interview but failed to report an amount on either

the in-person or in-home interview.

178 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

percent of WIC participants, mainly as a result of the birth of infants to pregnant women. Persons left

the household in 0.3 percent of cases. These changes did not affect the measured size of the household at

the time of certification.

Information collected during in-home interviews, however, did result in revision of the size of the

economic unit (which could be a subset of the household) for 14.4 percent of sampled persons. 

Economic unit sizes increased for 5.1 percent of sampled persons (usually extending the economic unit to

the full household), whereas economic unit size decreased for 9.3 percent of sampled persons (limiting

the economic unit to the immediate family). Revision resulted from use of a more detailed instrument for

determining financial relationships within the household for the in-home survey, compared to the inperson survey. Financial relationships within the household establish the size of the WIC economic unit

because the economic unit may be a subset of the household—i.e., the household may contain separate

economic units. NSWP deliberately used two different methods to determine the economic unit on the inperson and in-home surveys in order to reduce burden on the in-person survey. All cases returning 27

different results from the two surveys were manually reviewed to confirm the legitimacy of the in-home

response, and in Section 4.5 we report the sensitivity of case error results to this change in definition of

the economic unit.

Verification of Income

For the 931 cases responding to the in-home interview, 74.3 percent revised some income information

previously reported during the in-person interview, 23.3 percent provided no new information, and 2.4

percent failed to respond to the income questions during the in-home interview and are excluded from all

analyses in this section.28

New information provided during the in-home interview can be classified into three types of changes to

previously reported data:

• Added income—additional sources of income were reported

• Denied income—previously reported sources of income were not confirmed

• Dollar revisions—positive dollar amounts of income were reported but differed from the

amounts reported on the in-person survey

All three types of revisions were evident among respondents providing documentation, and among those

not providing documentation. (More detail is provided in later sections.)
29 For example, 61 percent of reported spouse/partner wage amounts on the in-person survey were amounts reported in even $100 amounts,

whereas only 18 percent of reported spouse/partner wages on the in-home survey reported in even $100 amounts.

Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 179

Many of the revisions to income data can probably be attributed to measurement issues. The measurement issues result from three inconsistencies in the way income was reported on the two surveys:

• The in-person survey relied on respondent recall of income receipt and amounts (own income

and income of other adults in the family), whereas the in-home survey used income documents to supply income amounts and the interview was conducted in the home where other

household members might be available to supply information.

It is reasonable to expect that some “misreporting” on the in-person survey was the result of

an honest effort to supply the best guess, especially when asked about other adults in the

family. Recall problems may have resulted in misidentification of income sources during the

in-person interview, followed by subsequent denial or addition of income sources during the

in-home interview. Recall problems also result in less precise responses, as evidenced by the

fact that income amounts reported during the in-person interview were more likely to be

rounded numbers, compared to the amounts reported during the in-home interview.29

• The in-person survey imposed a computational burden on respondents and interviewers

because all income amounts were recorded as monthly amounts. (For example, respondents

receiving weekly paychecks had to convert weekly amounts to monthly amounts.) The inhome survey did not impose this computational burden because interviewers reviewed

income documents, recorded dollar amounts shown on the document, and recorded the period

of time covered by the documents (weekly, monthly, two weeks, annual).

• For eight types of income, the in-person survey asked for the total amount of income

received by all household members, whereas the in-home survey asked for income received

by each adult household member. This inconsistency in survey design was adopted for

infrequently received income sources to reduce respondent burden on the in-person survey. 

The eight types of income are interest on savings, regular income from dividends, pensions

and annuities, income from rental units, regular contributions from other sources such as

gifts from relatives or friends, alimony, child support, and lump sum income.

Before discussing the magnitude of difference in reported income amounts, the next section describes the

ability of respondents to provide income documents.

Provision of Income Documents

Respondents were asked to provide income documents during in-home interviews so that data collectors

could verify income information provided during in-person interviews. The interview was voluntary,

however, and provision of documents, although requested, was also voluntary. Exhibit 4-14 shows the

percentage of respondents who provided documents, overall and by adjunct-eligibility status.
30 A request to provide private and confidential income documents is uncommon in government surveys. The percentage of respondents

providing income documents during the 1988 WIV was not documented in that report, so we have no basis on which to judge the relative

success of the present study.

180 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

Exhibit 4-14

Percentage of Respondents Providing Documents, by Adjunct-Eligibility Status

Adjunct Non-Adjunct Total

Provided documents 59.7 64.0 61.2

(3.9) (5.1) (3.7)

Did not provide documents 40.3 36.0 38.8

(3.9) (5.1) (3.7)

Sample size 568 334 902

Population 4,917,163 2,636,221 7,553,384

Standard errors are shown in parentheses. The chi-square test indicates that there is no statistically significant difference in the provision of

documents by adjunct and non-adjunct participants.

Excludes 2.4 percent of respondents who did not respond to the income sections of the in-home interview.

Sixty-one percent of respondents provided income documents for some of all sources of income. Those

who did not provide income documentation can be categorized in three groups: 10.2 percent provided

undocumented revisions to the income amounts reported during the in-person survey, 22.3 percent

provided no documents and no revisions, and 6.3 percent reported zero income (and had no need to

provide documents). Altogether, 70 percent of respondents provided additional information (documented

or undocumented) during the in-home interview.

The provision of income documents was lower than expected, and initially called into question the

validity of the income-verification portion of the study. In determining whether to proceed with 30

analyses, we considered two questions. First, were there systematic differences in the characteristics of

respondents who provided documents and those who did not? Second, did those without documents

provide systematically different types of changes to previously reported income (i.e., additional income

sources, denial of income sources, revisions to amounts)? Third, when updated income amounts were

provided without documentation, was the effect systematically different from when documents were

provided, in the sense that the updated amount was higher or lower than the amount reported during the

in-person interview?

Exhibit 4-15 compares the characteristics of respondents who did and did not provide income documents. 

There are no statistically significant differences between groups with respect to participant category,

adjunct-eligibility status, WIC certification history, family size, maternal characteristics (education, marital status, age), mean income reported on the in-person survey, and whether the WIC family is part of a

larger household. The only statistically significant difference in respondent characteristics is that those
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 181

Exhibit 4-15

Characteristics of In-Home Respondents by Whether They Provided Income Documents

Documents No Documents

Provided Provided

Participant category

Pregnant 9.4 12.8

Breastfeeding 5.2 4.3

Postpartum 7.2 7.3

Infant 23.2 29.6

Child 54.9 46.0

Income-eligibility

Adjunct-eligible 63.5 67.6

Non-adjunct eligible 36.5 32.4

Certification history*

First certification 28.5 35.5

Re-certification 69.3 58.4

Not reported 2.2 6.2

Size of economic unit

One or two 8.9 12.3

Three 28.5 25.1

Four 28.8 27.7

Five or more 33.8 34.9

Education of mother

Not high school graduate 24.9 31.1

High school graduate or mo 67.0 61.4

Marital status

Married 58.7 48.6

Widowed, divorced, separated 12.0 9.9

Never married 29.3 41.6

Age of WIC mom

<18 years 5.1 6.7

18-34 years 81.3 83.7

>34 years 13.6 9.6

Characteristics of economic units

WIC economic units residing in larger households (%) 24.6 26.8

WIC economic units that are multigenerational (%)* 13.6 22.0

WIC mom lives with parents 11.1 16.5

Mean monthly income of WIC economic unit reported to inperson survey

1,278 1,200 

Income verification policy of WIC agency*

Documentation required 54.8 54.2

Documentation not required

Sample size 540 362 

Population 4,624,147 2,929,237 

Excludes 2.4 percent of respondents who did not respond to the income sections of the in-home interview.

* denotes a statistically significant difference in the distribution of those who did and did not provide documents.
31 We also estimated logistic regressions for the probability of providing documents. Included as covariates were all the characteristics shown

in Exhibit 4-15, plus whether a partner is present in the family, and number of income sources reported on in-person survey. None of the

covariates was significant at the 5 percent level; at the 10 percent level, WIC mom’s age was positively associated with provision of

documents, and the number of income sources reported on the in-person survey was negatively associated with provision of documents.

32 The high rate of revision among those providing documents is not surprising given the high rate of “rounding” off dollar amounts reported

in footnote 28.

33 The total number of reported income sources was 1,506 for the in-person survey and 1,257 for the in-home survey. The number of sources

“denied” was 407, and the number of sources “added” was 158. 

182 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

respondents who failed to provide documents were more likely to be in multigenerational families. In 31

addition, respondents who did and did not provide documents during the in-home survey were similarly

distributed across WIC agencies that did and did not require documentation of income at certification.

Next we examined whether those with and without documents provided systematically different types of

changes to previously reported income. This is an important consideration because one of the dangers in

requesting documentation from respondents is that they may deny receipt of income to avoid being asked

for documentation that they are unable to produce. The two-survey design of the study provides us with a

means of gauging the reliability of income information provided during the second interview when documents were requested.

For each source of income, information provided during the in-home interview was compared to

information provided during the in-person interview. If the information did not match, the change in

information could be classified into one of three mutually exclusive categories:

• Added income—the source of income was not previously reported

• Denied income—previously reported source of income was not confirmed

• Dollar revision—positive dollar amount of income was reported but differed from the

amount reported on the in-person survey

Respondents with multiple sources of income may be classified with multiple types of changes.

Exhibit 4-16 shows the percentage of respondents with each type of change in reported income. 

Compared to respondents who failed to provide documents, those providing documents were more likely

to add income sources (15.1 versus 4.1 percent), and were much more likely to revise reported dollar

amounts (87.9 versus 26.3 percent). The difference in the percent of respondents denying previously 32

reported income is not statistically significant.33

The bottom of Exhibit 4-16 shows the average amounts of monthly income reported on each survey,

along with the average amount of income added, denied, or revised when comparing the second survey to

the first. (Averages are calculated over all respondents, by provision of documents). Those providing

documents added more income and denied less income, on average, than those not providing documents. 

Although the rate of denials between the two groups was not statistically significant, the magnitude of

denied income was statistically significant: those failing to provide documents denied much larger

amounts of income. There is no statistically significant difference between the two groups in the magnitude of “dollar revisions.”
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 183

Exhibit 4-16

Changes in Income Reporting: In-Home Interview Responses Compared to In-Person

Interview Responses

Characteristic Provided not Provided Total

Documents Documents

Percent of respondents

Added income sources 15.1 4.1 10.8

(2.8) (1.3) (2.0)

Denied income sources 30.2 39.7 33.8

(3.5) (4.2) (2.6)

Revised dollar amounts 87.9 26.3 64.0

(2.4) (4.3) (3.6)

Mean amount of

Monthly income: in-person survey $1,187 $1,111 $1,158

(57) (69) (49)

Additions $97 $19 $67

(31) (11) (21)

Denials !$139 !$303 !$203

(23) (63) (28)

Revisions $91 $86 $89

(27) (45) (23)

Monthly income: in-home survey $1,244 $912 $1,116

(64) (68) (51)

Sample size 540 362 902

Population 4,624,147 2,929,237 7,553,384 

Standard errors in parentheses.

In-person interviews were conducted in WIC clinics at the time of WIC certification. In-home interviews were conducted in respondent

homes and documentation of income was requested. Both surveys requested information about income received during the month prior

to WIC certification.

Mean amount of revisions is calculated for sources of income with receipt indicated on both surveys; revision is equal to in-home

amount minus in-person amount.

This analysis shows that respondents who did and did not provide income documentation differ in their

reporting of income on the in-home survey. The primary difference is in the magnitude of previously

reported income that was denied on the second survey. It seems unlikely that all occurrences of denied

income were valid corrections to mistakes made during the in-person survey, although certainly some

may have been. It seems more likely that respondents denied income when they were unable to produce

documentation.

Although it was disappointing that nearly 40 percent of respondents failed to provide income documents

for in-home interviews, it was encouraging that nearly 70 percent provided either documents or undocumented revised amounts when interviewed in their homes. In addition, the primary difference between

those who did and did not provide documents was the magnitude of “denied income.” The two-survey
184 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

design of the study, however, provides us the luxury of “adding back” denied income for all respondents

and examining the sensitivity of the certification error rate to different assumptions about denied income.

In Section 4.4 we calculate the WIC income certification error rate using the full sample of respondents to

the in-home survey, regardless of whether they provided income documentation. We use two ways of

handling denied income sources: first, we assume the report on the in-home survey (zero income) is

correct; second, we assume the denials were related to the inability to provide documents and use the

unverified report from the in-person survey. These two alternate assumptions about the validity of

denied income yield two alternate estimates of certification error.

Provision of Documents and Income Reporting by Type of Income

Exhibit 4-17 shows that provision of income documents varied considerably across type of income. The

most common income sources for WIC families are wages and salary of respondent and spouse/partner. 

Respondents’ own wage and salary income was verified by documents in 65.5 percent of cases, and a

total of 78.7 percent of cases provided either documents or undocumented revisions. Spouse/partner

income was similarly documented in over 60 percent of cases, and overall it was documented or revised

in a total of 75.5 percent of cases. The wages and salary of other family members was documented in

only 29.7 percent of cases and received undocumented revision in an additional 26.9 percent of cases. 

The lack of documentation for the income of other family members is perhaps not surprising in light of

the confidentiality of such information.

Other earned income includes self-employment income and military income. These income sources were

documented less often than respondent or spouse/partner wages, but they were documented or revised in

over 50 percent of cases. Unearned income is received by fewer than 10 percent of WIC families, and

documentation of unearned income varied greatly.

TANF and food stamp benefits had relatively low rates of documentation; TANF was documented in 56

percent of cases, and food stamp benefits were documented in 45 percent of cases. TANF and food

stamp benefits also had low rates of undocumented revision (6.8 percent for TANF and 7.4 percent for

food stamps), but the low rates of revision are likely due to the regularity of TANF and food stamp

benefits, which makes them less prone to reporting errors.

Exhibit 4-18 shows, for each category of income, the rate at which in-person reports of income receipt

were confirmed on the in-home interview. Among respondents who reported own wage income on the inperson survey, 16.4 percent denied earning any wage income when questioned on the in-home survey. 

Spouse/partner wages, which are more common, had a much lower rate of denial (7.0 percent). Some

categories of unearned income, which may be more difficult to document, had very high rates of denial. 

For example, 84.2 percent of respondents reporting interest or dividend income on the in-person survey

denied receipt of interest or dividend income on the in-home survey. The final column of Exhibit 4-18

shows the percentage of WIC families receiving each income source, based on their confirmation of

receipt during in-home interviews.
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 185

Exhibit 4-17

Provision of Income Documents During In-Home Interview, by Income Source

Percent with Provided Total

Receipt of Provided Undocumented Documents

Income Source Documents Revisions or Revisions

of Those Reporting Receipt:

Wages and salary received by

Respondent 24.0% 65.5% 13.2% 78.7%

Spouse/Partner 49.2 60.6 14.9 75.5

Other family member 8.0 29.7 26.9 56.6

Income received by any family 

member

Self-employment non-farm income 3.5 43.6 22.8 66.4

Self-employment farm income 0.5 52.2 0.0 52.2

Military income 2.0 51.9 18.5 70.4

Unemployment compensation 3.3 59.6 20.8 80.4

Worker’s compensation 2.2 46.1 0.0 46.1

Net rental income 0.7 77.5 0.0 77.5

Interest or dividends 2.9 65.4 16.3 81.7

Social security benefits 3.5 49.8 0.9 50.7

Private pensions or annuities 0.5 44.1 0.0 44.1

Veterans’ benefits 0.5 2.6 15.7 18.3

Educational benefits 2.2 30.2 46.6 76.8

Alimony 0.2 90.0 0.0 90.0

Child support payments 5.8 51.0 32.1 83.1

Regular contributions from persons

not living in household 1.0 3.4 31.6 35.0

Other cash income 0.9 61.8 38.2 100.0

Public assistance income

TANF 14.7 55.7 6.8 62.5

SSI 3.7 42.4 4.9 47.3

Other public assistance 1.5 71.0 2.1 73.1

Food stamp benefits 33.6 44.9 7.4 52.3

Sample size 902 

Population 7,553,384 

The percentage of households providing documentation is calculated among households with that income source. Respondents who “Provided

Undocumented Revisions” were unable to provide documentation, but revised the income amount reported during in-person interviews.

Excludes 2.4 percent of respondents who did not respond to the income sections of the in-home interview.
Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc. 186Exhibit 4-18 Confirmation of Receipt of Income Sources During In-Home Interview Reported Receipt on In-Person Of Those with Receipt Reported on In-Person: Add

Rece

on I

Hom

Confirmed Receipt on In-Home Denied Receipt on In-Home Missing Data on In-Home Wages and salary received by Respondent Spouse/Partner Other family member 28.2% 53.5 9.6 81.3% 91.0 78.9 16.4% 7.0 16.1 2.3 2.0 5.0 1.

0.0.

Income received by any family member Self-employment non-farm income Self-employment farm income Military income Unemployment compensation Worker’s compensation Net rental income Interest or dividends Social security benefits Private pensions or annuities Veterans benefits Educational benefits Alimony Child support payments Regular contributions from persons not living in household Other cash income 2.4 0.4 2.8 3.6 2.3 0.8 9.0 3.7 1.0 0.5 2.4 0.2 9.6 4.1 1.4 74.0 61.6 55.5 78.5 85.6 29.8 11.3 80.6 47.5 91.0 53.5 100.0 52.2 13.1 4.0 26.0 38.4 43.3 20.6 13.3 67.9 84.2 3.6 49.3 0.0 45.3 0.0 43.3 86.5 89.6 0.0 0.0 1.2 0.9 1.0 2.3 4.5 15.9 3.2 9.0 1.2 0.0 4.5 0.3 6.4 1.

0.0.0.0.0.1.0.0.0.0.0.0.0.0.

Public assistance income TANF SSI Other public assistance Food stamp benefits 14.1 4.8 5.5 32.6 83.0 73.0 4.9 92.0 16.5 20.9 82.3 7.2 0.5 6.1 12.8 0.8 3.

0.1.3.

Sample size Population 902 7,553,384 The percentage of families with wage and salary incomes, reported in Chapter 3, included families reporting wages and salary, self-employment income, and military income. separately here to correspond with each individual survey question.
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 187

Finally, Exhibit 4-19 shows, for each type of income, the rate at which in-person amounts of income

were confirmed among the 71 percent of respondents providing documentation or undocumented revision

of income amounts during the in-home survey. Wage income was most often under-reported on the inperson interview. Nearly 50 percent of respondent wages and spouse/partner wages were under-reported,

approximately 20 percent were reported accurately, and just over 30 percent were over-reported on the

in-person survey. Unearned income and public assistance income were reported accurately more often

than they were under-reported or over-reported, but when not reported accurately, they were more likely

to be under-reported. Exhibit 4-19 does not include respondents providing no documentation or

revisions, or reporting zero income on the in-home survey.

The overall differences in income reported on the in-person and in-home surveys are shown in Exhibit

4-20. This exhibit shows the mean total monthly family income reported during the in-person and inhome surveys, the percentage of households with variances in those two reports, and the mean amount of

the variance. The top panel shows the subsample of families who provided documents, and the bottom

panel repeats the same statistics, calculated over the full sample.

Exhibit 4-20 shows that, among families providing documentation, monthly family income was, on

average, revised upward during in-home interviews. The average upward revision was $45 for adjunct

families and $78 for non-adjunct families, although both of these estimates have large standard errors

that reflect high variability across the sample. For the full sample (bottom panel), monthly family income

was on average revised downward during the in-home interview, as a result of income denied by respondents who did not provide documentation.

It is important to remember that positive income variance does not necessarily imply that a family is

ineligible for WIC. The magnitude of the variance, together with the family’s level of income, determines

the effect of misreporting on WIC income-eligibility. The determination of WIC income-eligibility is the

subject of the next section.

4.4 Estimates of WIC Income-Certification Error

This section presents estimates of WIC income certification error based on the NSWP in-home survey. 

For each sampled WIC participant, information from the in-home survey was compared to WIC income

eligibility guidelines to determine the participant’s income-eligibility status. These individual eligibility

determinations were then used to calculate:

Certification error rate. The percentage of WIC enrollees who are enrolled in violation of incomeeligibility guidelines.

Dollar error. The amount of WIC food funding that is spent on individuals having a certification

error.
Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc. 188 Exhibit 4-19 Reliability of Reported Income Amounts Among Those Providing Documentation or Revisions, by Income Source Number Families with Source Mean Amount In- Person Mean Amount In-Home Variances in Inc

Percent Under- Reported Percent Accurate

a

P

Re

Wages and salary received byRespondentSpouse/PartnerOther family memberMilitary income

151308

5119

$ 757

1,155

959

1,610

$ 855

1,2701,6711,544

45.949.163.538.0

23.320.924.138.6

Unearned Income Unemployment compensationSocial security benefitsChild support payments

241532

467455293

505467275

27.0

6.64.2

37.792.081.4

Public assistance incomeTANFSSIFood stamp benefits

822035

282678190

378722252

32.028.830.1

50.761.264.1

Sample sizePopulation

 644 

5,395,815 

Income sources received by fewer than ten families are excluded from the table.a Amount is considered accurately reported if the monthly amounts reported on the in-person and in-home surveys are within $50.
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 189

Exhibit 4-20

Variances in Reported Total Monthly Family Income, by Adjunct Eligibility Status

Adjunct Non-Adjunct

Eligible Eligible Total

Families providing documentation

Mean income reported in in-person interview 1,004 1,505 1,187

(66) (92) (57)

Mean income reported in in-home interview 1,049 1,583 1,244

(87) (74) (64)

Percentage of families with variances 73.2 85.3 77.7

 (4.0) (3.1) (2.9)

Mean amount of variance 45 78 57

(68) (58) (50)

Sample size 330 210 540

Population 2,936,589 1,687,559 4,624,147

Full sample

Mean income reported in in-person interview 983 1,483 1,158

(53) (74) (49)

Mean income reported in in-home interview 946 1,432 1,116

(65) (71) (51)

Percentage of families with variances 61.3 75.4 66.2

 (3.7) (4.0) (3.2)

Mean amount of variance -37 -51 !42

(53) (74) (45)

Sample size 568 334 902

Population 4,917,163 2,636,221 7,553,384

The percentage of families with variances is measured as the percentage with a difference in total monthly family income

measured at the in-person and in-home interviews in excess of $50.

The mean amount of variances is measured over the full sample, including variances of less than $50.

Excludes 2.4 percent of respondents who did not respond to the income sections of the in-home interview.

Methodology for Determining WIC Income Eligibility

As discussed in prior sections, applicants are income-eligible for WIC if they participate in adjunct

programs or programs used for automatic eligibility in their state, or have family income below 185

percent of the federal poverty guidelines. Operationally, local WIC sites determine each applicant’s WIC

income-eligibility status according to the following procedure:
34 Most state manuals contain the certification standards organized into separate sections and do not specify the order in which these three sets

of information should be collected.

35 Federal guidance specifies use of current income except in cases when income fluctuates due to self-employment or seasonal work, but in

all cases, current income should be used for persons who are unemployed. In practice, the NSWP in-home survey accepted any available

documentation of income. In most cases, documentation was for the reference period (month prior to certification), which ranged from

February to April 1998 or the month of the in-home interview. Of the documents provided, 86 percent had dates between February and

May 1998; 10 percent were dated in December 1997 to January 1998, and most of those were year-end documents such as tax returns. 

When tax returns were provided, we checked the consistency of documented annual income, reported wage rate (Section B of the in-home

survey), and monthly earnings reported on the in-person survey, and we used the amount consistent in two of three reports. In addition,

when earnings statements contained a year-to-date amount, we used the lower of the implied monthly amount from the current period and

the year-to-date amount to account for fluctuating earnings.

190 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

Step 1: Request that all applicants report family income, family size, and participation in

adjunct/automatic programs.34

Step 2: If applicant is not adjunct/automatic income-eligible, compare income of the economic unit to

the poverty guidelines.

To characterize the complete income distribution of WIC participants, we compared income to the

poverty guidelines for every WIC participant in the sample (regardless of adjunct/automatic program

participation).

Determining adjunct/automatic eligibility, family size, and family income for the NSWP in-home sample

was initially computer-modeled in terms of the federal regulations and guidance. State-specific policies

were added to the model using “if state-then” exceptions to the basic model. As discussed in Section 4.2,

state income-eligibility policies may differ according to:

• Use of automatic eligibility

• Timing of when annual revised federal poverty guidelines are adopted

• Timeframes for determining income—i.e., current income versus income of past 12 months

• Definition of the family in circumstances not addressed by federal guidance

• Definition of current income (month prior to certification or past four weeks) and multipliers for

converting reported income to monthly or annual values

The computer model specified the programs used for automatic income eligibility in each state. The

model also specified the state-specific timing of adopting revised poverty guidelines (FY97 or FY98

poverty guidelines applied to each case depending on certification date and state timing of adopting new

guidelines).

All states represented in the NSWP sample follow federal guidance in using “current income or past

income, whichever more accurately reflects circumstances.” States differ in defining “past income,” with

23 of 25 states defining it as income over the past 12 months (as in federal guidance), and the remaining

two states defining it as income over the past three months. State-specific programming was not used in

this instance, because the NSWP survey collected only income of “past month” and “past year” and, in

practice, availability of “past income” depended on the documentation provided by survey respondents.35

The computer model determined the definition of the family according to the “general definition” of the

WIC economic unit, discussed in Section 4.2 and shown in Exhibit 4-4. For all states except one, the
36 For the 1988 WIV, “the income-eligibility determination process was modeled for each of the state agencies in the sample, and any local

agency variations were also noted.” This suggests development of a section of code for each state. In contrast, there was less variation

across states in 1998, and the records for each sampled person were processed through a single section of code, with variations made

explicit with “if state = then do” statements. Both studies used a manual review of ineligible cases as the final step in the process, to

implement the discretion allowed to local WIC staff.

37 Determination of separate economic units was based on relationships within the household, even though respondents reported sharing of

income by all household members.

38 Ineligible cases in this state were reviewed; none would be eligible if current income were to be defined as four weeks rather than one

month (4.3 weeks).

39 Use of automatic eligibility varies by state (see Section 3.4). In the in-home sample, 42 cases reported receipt of NSLP and resided in

states using NSLP for automatic WIC income-eligibility; one case reported receipt of general assistance and resided in a state using general

assistance for automatic WIC income-eligibility; no cases received SSI and lived in a state using SSI for automatic income eligibility.

40 Medicaid eligibility is verified by many WIC clinics through a phone verification procedure.

Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 191

WIC economic unit was determined according to the self-reported measures of financial relationships

within the household. An exception was one state restricting the family to those “related by blood,

marriage, adoption, or guardianship.” State policies defining the family in situations not addressed by

federal guidance were usually complex (e.g., rules for adequacy of income for separate economic units) or

required the discretion of local WIC staff. Because of their discretionary nature, these rules were not

implemented in the computer model. As a final step in the process, all cases found ineligible were

manually reviewed to determine if household circumstances allowed for discretion in determining the

economic unit and, if so, eligibility was re-evaluated. This manual review reversed the eligibility of 11 36

cases found ineligible by the computer model; these cases were determined eligible because the household

contained separate economic units, allowing for a re-evaluation of income.37

Differences across states in the definition of current income and specification of multipliers were not

significant, and were not accounted for in the model. Only one state used a definition of “past 4 weeks”

rather than “past month” for current income; differences in multipliers were primarily do to a lack of 38

specification of multipliers by some states. We assumed that states not specifying multipliers followed

federal guidance.

Verification of Adjunct and Automatic Income Eligibility

Adjunct eligibility is established by receipt of TANF or food stamp benefits, or eligibility for Medicaid. 

In addition, some sampled persons in the NSWP in-home sample may have automatic income-eligibility

due to receipt of general public assistance, or eligibility of a family member for the NSLP.39

Adjunct eligibility due to receipt of TANF or food stamp benefits was verified through documentation of

benefit receipt during the in-home interview. Receipt of benefits was documented for 44 percent of those

reporting these benefits. When receipt of benefits was not documented, income eligibility was determined by comparing the size and income of the economic unit to the WIC guidelines. Of those reporting

TANF or food stamps and failing to document, none was found income ineligible for WIC based on the

income guidelines.

Documentation of Medicaid eligibility was not requested during the in-home interview because Medicaid

eligibility is difficult to verify. Medicaid cards are not dated and cannot be used to verify current

Medicaid eligibility status. Persons reporting Medicaid eligibility (and no other adjunct program) were 40
41 In 1998, states had the option to extend Medicaid eligibility to pregnant women and children up to age 5 with incomes above 185 percent

of poverty. In spring 1998, the Medicaid limit for these groups exceeded 185 percent of poverty in eight states, and five of those states

were in the NSWP sample. Source: National Governors Association, Health Policy Studies Division, NGA Reports Online: State

Medicaid Coverage of Pregnant Women and Children.

42 Of all participants reporting Medicaid, 3.9 percent were found to have income above the Medicaid income-eligibility limit of their states,

85 percent were found income-eligible, and 11 percent were missing income data and eligibility could not be determined.

43 Lewis, K., and Ellwood, M., Medicaid Policies and Eligibility for WIC, Alexandria, VA: USDA/FNS/OANE, 1998.

44 For example, Exhibit 4-17 shows that 90 percent of persons reporting receipt of “other cash income” in the in-person survey denied receipt

of that income in the in-home survey. Denial rates for wages and salary ranged from 6.9 percent for spouse/partner wages to 17.3 percent

for wages of other family members.

192 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

determined income-eligible for WIC by comparing the income of their economic unit to the poverty

guidelines. In 1998, Medicaid and WIC shared the same income eligibility guidelines for pregnant

women and children under age 5 in most states—that is, pregnant women and children were incomeeligible for Medicaid if their income was at or below 185 percent of the poverty guidelines. In five 41

states in the NSWP sample, the Medicaid income eligibility level exceeded the WIC income eligibility

level, and this higher limit was used to determine WIC income eligibility of NSWP-sampled persons

reporting Medicaid eligibility in those states.

Among sampled persons reporting Medicaid eligibility, 4.4 percent of those for whom eligibility could be

determined were found to have income above the Medicaid eligibility limit of their states. Those found 42

income-ineligible for Medicaid, however, were not identified as income-ineligible for WIC. This is

because several Medicaid eligibility rules and practices enable enrollment of persons with incomes above

185 percent of poverty. Those practices include the flexible definition of the family unit, relatively long

certification periods, eligibility redetermination practices, Medicaid waiver programs, presumptive eligibility for pregnant women, transitional coverage for working poor families, and guaranteed enrollment

periods.43

Documentation of participation in NSLP was not requested during the in-home survey. It was thought

that NSLP documentation would be difficult to produce in April to June at the end of the school year, and

few persons would qualify for WIC solely on the basis of participation in NSLP by a family member. All

of the participants reporting family participation in NSLP were found income-eligible for WIC based on

income.

Comparison of Economic Unit Income to the Poverty Guidelines

Total economic unit income was measured as the sum of income reported for all household members

determined to be part of the economic unit. Income reported on the in-home survey was counted regardless of whether the respondent provided documentation to verify the amount. As discussed in Section

4.4, some respondents provided undocumented revisions of income on the in-home survey, and these

amounts, in the aggregate, were not significantly different from documented revisions.

In comparing economic unit income to the poverty guidelines, the analysis is complicated by the fact that

some respondents denied receipt of income during the in-home survey for categories of income for which

they reported receipt during the in-person survey. We proceeded by estimating two alternate certifica- 44

tion error rates. The first estimate is based on the assumption that all income denials of previously

reported income are valid (we counted zero income in the category for which income was denied and
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 193

ignored the previous report of positive income on the in-person survey). The second estimate is based on

the assumption that all income denials of previously reported income are invalid (we counted the income

amount reported on the in-person survey and ignored the denial on the in-home survey).

Certification Error Rate for the Contiguous United States

The sample frame for the NSWP was designed to yield national estimates of WIC certification error for

the contiguous United States. In fiscal year 1998, the contiguous United States accounted for 96 percent

of WIC participants and 95 percent of federal WIC food expenditures.

The procedures discussed above result in two alternate estimates of the WIC certification error rate for

the contiguous United States of 2.6 percent and 4.5 percent. The lower estimate is based on the assumption that denials of previously reported income were valid denials; the higher estimate is based on the

assumption that all income denials were invalid. 

Exhibit 4-21 shows these two alternate certification error rate estimates. The error rate estimate of 2.6

percent means that 2.6 percent of WIC enrollees are enrolled in error and the 95 percent confidence

interval suggests that the true value lies between 1.5 and 3.7 percent. (We are 95 percent confident that

the national WIC income-eligibility error rate falls between 1.5 and 3.7 percent, with the most likely

value at 2.6 percent.) For the error rate estimate of 4.5 percent, we are 95 percent confident that the true

value lies between 2.8 and 6.2 percent.

Exhibit 4-21

WIC Income-Eligibility Error

Estimate #1 Estimate #2

Estimate Interval Estimate Interval

95% Confidence 95% Confidence

Error rate

Total 2.6% 1.5 – 3.7 4.5% 2.8 – 6.2

Adjunct — 0.0 0.0 —

Non-adjunct 7.5 4.2 – 10.7 12.9 8.6 – 17.3

Persons enrolled in

error

201,000 103,000 – 300,000 349,000 200,000 – 499,000

Dollar errora

Per month $ 5.8 million $ 3.0 – $ 8.6 million $ 10.0 million $ 5.7 – $ 14.3 million

Per year $69.6 million $36.0 – $103.2 million $120.0 million $68.4 – $171.6 million

a Dollar error is equal to the average WIC food cost per participant months ($31.21), multiplied by the number of enrollees found in error,

adjusted for attrition in participation (see text).

Based on the evidence presented in Section 4.3, however, it appears that denials of income were related to

an inability to provide documents. As a result, we conclude that estimate #2 in Exhibit 4-21 is the best
45 It is clear that the estimate of WIC income certification error obtaining from survey data lacks precision, first because only 61 percent of

respondents provided documentation to verify their income, and second because respondents provided sometimes widely divergent income

information in two interviews that were held only 4 weeks apart, on average.

46 Source: USDA/FNS, WIC Program: Summary of Closeout Data, Fiscal Year 1998. These food package costs are reported in PC98.

47 It was not within the scope of this study to obtain sample-specific estimates of the participation rate, nor to determine whether participation

rates differed for eligible and ineligible enrollees.

48 Dollar error is calculated by multiplying the average food cost by the number of ineligible enrollees, adjusted for attrition: $31.21 ×

349,000 × 0.92.

49 Derived from USDA/FNS, WIC Program: Summary of Closeout Data, Fiscal Year 1998.

194 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

estimate of the WIC income certification error rate for the contiguous United States, based on this study

design.45

In terms of total enrollees, the certification error rate estimate of 4.5 percent translates to a total number

of ineligible enrollees within the contiguous United States, at a point in time, of 349,000. The total

enrollee population in the contiguous United States during the sample period was 7.7 million.

Dollar Error in the Contiguous United States

The WIC dollar error is defined as the cost of WIC food benefits provided to individuals who are certified

in error. To calculate the dollar error, we applied the national average WIC food cost per participant to

all persons in the in-home sample (national averages are not available by certification category) and

summed this cost for ineligible participants. The average food cost per month per participant for the

entire caseload in April 1998 was $31.76; the average WIC food cost per month per participant in the

contiguous United States was $31.21. The NSWP represents the contiguous United States, so we use 46

the latter number for estimates of the dollar error rate. 

In calculating the dollar error, we adjusted sampling weights to account for attrition in participation. This

adjustment is necessary because the sampling weights, by design, sum to the population of WIC enrollees

in April 1998 (as measured by PC98). Average WIC food costs, however, are calculated for the month

of April 1998 based on the number of participants—i.e., the number of WIC enrollees who received food

benefits in that month. The ratio of participants to enrollees in April 1998 was 0.92, and reflects an

average monthly rate of attrition.47

The certification error rate estimate of 4.5 percent yields an dollar error of 10.0 million dollars per month,

or 120.3 million dollars per year. The 95 percent confidence interval suggests that the true value may 48

lie between 68.9 million and 171.9 million dollars per year.

Expanded Dollar Error Rate

The dollar error estimate presented above includes only the costs of providing WIC food benefits to

individuals who are certified in error. The WIC Program also incurs per participant costs for providing

nutrition education and breastfeeding promotion and support. In 1998, the WIC Program spent an

average of $3.73 per month, per case, on nutrition education, including breastfeeding promotion and

support. The average cost per month, per case within the contiguous United States was $3.75. Based 49

on the estimate of an average of 349,000 ineligible enrollees within the contiguous U.S., the nutrition
50 The average number of ineligible enrollees is adjusted for attrition in participation, as discussed above.

Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 195

education costs expended on ineligible enrollees is $1.2 million per month, and $14.4 million annually. 50

Adding these costs to the food costs expended on ineligible cases results in a total cost of serving

ineligible cases equal to $134.4 million for fiscal year 1998.

Characteristics Associated with Income-Eligibility Error

Exhibits 4-22 and 4-23 show the estimated certification error rate by characteristics of WIC participants,

their households, and their local WIC agencies. Despite some difference in the point estimates of the

percent eligible by characteristics—certification category, size of economic unit, age, marital status, and

whether the WIC mom resides with her parents—none of these differences are statistically significant. 

The difference in error rates by mothers’ education is statistically significant.

Exhibit 4-23 shows the estimated error rates by local WIC agency size and income verification method. 

The difference in error rates for local agencies of different sizes is not statistically significant. There is,

however, a statistically significant difference in WIC income certification error rates for agencies

requiring documentation at certification and those not requiring documentation. (In 1998, documentation

policy was set by state WIC agencies; the William F. Goodling Child Nutrition Reauthorization Act of

1998 required income documentation by all WIC participants, and FNS issued regulations regarding this

rule in 2000.) As shown in Exhibit 4-23, WIC participants enrolled through agencies requiring documentation had an error rate of 2.9 percent; respondents enrolled through agencies with no documentation

requirement had an error rate of 6.4 percent.

The number and percentage of ineligible enrollees, by percent of poverty, is shown in Exhibit 4-24. Onethird of income-ineligible enrollees have income at or below 200 percent of the poverty guidelines, and

87 percent have income at or below 250 percent of the poverty guidelines. The nearness of many

ineligibles to the income cutoff is seen in the graph in Exhibit 4-25 (overall distribution). The bands of

the income distribution immediately above and below 185 percent of poverty are approximately equal.

The remaining graphs in Exhibit 4-25 separately show the income distributions of adjunct and nonadjunct enrollees. The distribution of income for participants reporting adjunct program participation is

skewed to the left, as is expected due to the lower income limits of TANF and FSP relative to WIC. The

distribution for those not reporting adjunct program participation is more normally distributed.
196 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc.

Exhibit 4-22

Certification Error Rates by Enrollee and Household Characteristics

Characteristic Persons Enrollment Standard Error

Number Percent

Sampled Ineligible at

Participant category

Pregnant 172 6.3 (2.5)

Breastfeeding 194 6.2 (2.2)

Postpartum 166 3.4 (1.4)

Infant 182 4.4 (1.7)

Child 188 4.2 (1.6)

Certification history

First certification 312 6.5 (1.6)

Re-certification 577 3.8 (1.2)

Size of economic unit

One or two 143 5.6 (2.1)

Three 264 5.4 (1.8)

Four 262 3.9 (1.3)

Five or more 233 3.8 (2.0)

Education of mother*

Not high school graduate 307 0.6 (0.3)

High school graduate or more 595 6.5 (1.2)

Marital status

Married 446 4.4 (1.3)

Widowed, divorced, separated 100 4.7 (3.1)

Never married 346 4.8 (1.6)

Age of WIC mom

<18 years 54 3.6 (2.3)

18-34 years 750 4.2 (0.8)

>34 years 98 7.1 (3.4)

Multigenerational household

Yes 184 7.4 (3.3)

No 718 3.9 (0.9)

WIC mom lives with parents

Yes 149 9.4 (4.1)

No 753 3.8 (0.8)

Total 902 4.5 (0.8)

* denotes a statistically significant difference in error rates by characteristic.
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 197

Exhibit 4-23

Certification Error Rates by Local Agency Characteristics

Characteristic Respondents Enrollment Standard Error

Number Ineligible at

Percent

Local agency caseload

Less than 1,200 71 8.8 (2.5)

1,201 - 5,000 252 4.6 (2.0)

5,001 - 10,000 187 2.8 (1.3)

Over 10,000 392 4.2 (1.4)

Local agency income verification method*

Documentation required 461 2.9 (0.9)

Documentation not required 441 6.4 (0.8)

* denotes a statistically significant difference in error rates by characteristic.

Exhibit 4-24

Income Distribution of Ineligible WIC Enrollees Relative to the Poverty Guidelines

Percent of Poverty Enrollees Enrollees Percent

Number Percent of

Ineligible Ineligible Cumulative

 0 – 50 0 0 0

 51 – 100 0 0 0

101 – 150 0 0 0

151 – 185 0 0 0

186 – 200 14 32.9 32.9

201 – 250 21 53.9 86.8

Over 250 8 13.3 100.0
198 Chapter 4: WIC Income-Eligibility Determination Abt Associates Inc

Exhibit 4-25

Income Distribution of WIC Participants

Overall

Adjunct
Abt Associates Inc. Chapter 4: WIC Income-Eligibility Determination 199

Exhibit 4-25

Income Distribution of WIC Participants

Non-Adjunct

a The distribution is based on income reported and verified during the NSWP In-home survey.
1 This sample design eliminates the need for a complete enumeration of the sampling frame in order to draw the sample. That is, lists of

WIC applicants and participants are not required to draw a sample.

2 A four-stage nested sample design was similarly used to select national probability samples for PC88 and the 1988 WIC Income

Verification Study. The 1988 studies selected state WIC agencies at the first stage of sampling. NSWP samples PSUs rather than states at

the first stage because sampling PSUs yields a second-stage sampling unit that is geographically smaller, on average, than the typical state. 

The geographic size of the second-stage sampling unit affects interviewer assignments and total interview costs.

Abt Associates Inc. Sample Design, Weights, and Standard Errors A-1

Appendix A

Sample Design, Weights, and Standard Errors

This appendix provides supporting and technical detail for the discussion, in Chapter 2, of the sample

design, weighting methodology, and standard errors of estimates.

Sample Design

The sample frame for the NSWP was designed to yield national estimates of WIC participant

characteristics for each WIC certification category. Thus, the sample frame contained all WIC

participants in the continental United States. Abt Associates designed a large national probability sample

of WIC participants using hierarchical cluster sampling. The sample was constructed in four stages: 1

Primary sampling units

\

Local agencies

\

Service sites

\

WIC participants

The first stage of sampling used a sampling frame of primary sampling units (PSUs) defined as a

metropolitan statistical area (MSA) or a non-MSA cluster of counties. Local agencies were sampled

within PSUs; an average of two service sites were sampled for each local agency; and finally, a random

sample of WIC certifications and recertifications is being drawn at the chosen service sites. At the first

three stages of sampling, units were selected with probability proportional to a measure of size. The goal

is to interview 3,000 WIC participants overall, with 600 from each of the five WIC participant categories

(pregnant women, breastfeeding women, postpartum women, infants, and children). A sample size of

600 per category provides the required precision of ±0.05 in a 95 percent confidence interval for

estimates of participant characteristics within each category. Exhibit A-1 summarizes the overall

structure of the initial sample design.2
A-2 Appendix A Abt Associates Inc.

Exhibit A-1

Summary of the Initial Sample Design for NSWP

First stage 50 PSU selections

\

Second stage 100 local agency selections

(average of two per PSU selection)

\

Third stage 200 service site selections

(average of two per local agency selection)

\

Fourth stage 3000 completed interviews

with WIC participants

(average of 15 completed per site selection)

\ \ \ \ \

600 completed

interviews for

pregnant women

600 completed

interviews for

breastfeeding

women

600 completed

interviews for

postpartum

women

600 completed

interviews for

infants

600 completed

interviews for

children

The sample frame was constructed using data from the 1996 Study of WIC Participant and Program

Characteristics (PC96). The PC96 census counted the number of participants in each of the five

certification categories in each local agency in April 1996. PC96 provides estimates of current numbers

of WIC participants, thus providing the measure of size for the first two stages of sampling.
3 An MSA contains one or more counties and is defined by a population nucleus of 50,000 or more and adjacent communities that have a

high degree of economic and social integration with the nucleus. Metropolitan areas are defined and revised by the Office of Management

and Budget (OMB). Non-MSA PSUs were constructed by grouping contiguous non-MSA counties within states, using the 1993 Bureau

of Census Contiguous County File.

4 Thirty MSAs cross state boundaries and were split into state-specific components.

Abt Associates Inc. Sample Design, Weights, and Standard Errors A-3

As Exhibit A-1 shows, a single sample frame generates samples for each of the five participant

categories. An ideal design—from the standpoint of efficiency of estimation—would have used

independent surveys for each of the five categories, with separate selections of PSUs, local agencies, and

service sites for each category, using the estimated number of participants in the category as the

corresponding measure of size. Such a design, however, was economically impractical. The actual

design drew samples from all five participant categories from each service site selected in the third stage

of sampling. Below, we discuss each stage of selection.

First-Stage Selection

At the first stage, the unit of selection is the PSU, consisting of an MSA or a group of contiguous nonMSA counties. To ensure representation of subdomains that are likely to be of policy interest, the first 3

stage of sampling used three stratification variables: the state WIC agency’s income documentation

policy (two levels: documentation required, documentation not required), FNS region, and MSA status

(MSA, non-MSA). Because income documentation policy and FNS region were to serve as stratification

variables, the process of constructing PSUs took state boundaries into account. The total sample frame 4

consisted of 658 PSUs (with non-zero measure of size): 339 metropolitan PSUs and 319 nonmetropolitan PSUs.

To select the sample of PSUs, we listed the PSUs in order of the three stratification variables and the

PSU measure of size (total number of WIC participants). That is, we first sorted the PSUs in POLICY

(the primary stratifier). Then, within each of the two values of POLICY, we sorted the PSUs on FNS

region (the secondary stratifier). Next, within each combination of POLICY and FNS region, we sorted

the PSUs on MSA/non-MSA (the tertiary stratifier). Finally, within each combination of POLICY, FNS

region, and MSA status, we sorted the PSUs on total number of participants, alternating the order

(increasing, decreasing, increasing, decreasing,...). Sorting on size in this way gives better control over

size. For example, if it becomes necessary to replace a PSU, the procedure of taking an adjacent PSU in

the list will yield a PSU similar in size to the one being replaced.

The distribution of PSUs and WIC population by state WIC agency income documentation policy, FNS

region and MSA/non-MSA area is shown in Exhibit A-2. Exhibit A-3 shows the distribution of sampled

PSUs. The number of PSUs selected from each stratum was (roughly) proportional to the total number

of WIC participants in the stratum.
A-4 Appendix A Abt Associates Inc.

Exhibit A-2

Count of PSUs and Total Participation by Sampling Stratifiers

Number of PSUs Participation Participation

Total Percent of

FNS Region MSA Non-MSA MSA Non-MSA MSA Non-MSA

Income Documentation Required

Northeast 26 15 587,211 83,291 7.9% 1.1%

Mid-Atlantic 34 17 646,955 91,801 8.7 1.2

Midwest 50 41 628,165 161,272 8.4 2.2

Mountain Plains 19 52 170,790 146,661 2.3 2.0

Southwest 28 20 711,507 102,110 9.5 1.4

Western 3 5 20,415 23,539 0.3 0.3

Total 160 150 2,765,043 608,674

Income Documentation Not Required

Northeast 10 2 122,914 7,110 1.6% 0.1%

Mid-Atlantic 2 1 11,757 3,846 0.2 0.1

Southeast 71 67 1,007,481 465,584 13.5 6.2

Midwest 16 20 254,071 86,561 3.4 1.2

Mountain Plains 17 33 109,963 93,061 1.5 1.2

Southwest 18 25 220,799 118,907 3.0 1.6

Western 45 21 1,465,572 123,903 19.6 1.7

Total 179 169 3,192,557 898,971

Total WIC 339 319 5,957,600 1,507,645
Abt Associates Inc. Sample Design, Weights, and Standard Errors A-5

Exhibit A-3

Selected PSUs by State WIC Income Documentation Policy, FNS Region, and MSA Status

FNS Region MSA Non-MSA Total

Income Documentation Required

Northeast 2 1 3

a

Mid-Atlantic 4 1 5

Southeast 0 0 0

Midwest 4 1 5

a

Mountain Plains 1 1 2

Southwest 5 1 6

Western 0 0 0

Income Documentation Not Required

Northeast 1 0 1

Mid-Atlantic 0 0 0

Southeast 7 3 10

Midwest 1 1 2

Mountain Plains 1 1 2

Southwest 2 0 2

Western 7 1 8

a

Total 35 11 46

a Includes one self-representing PSU.

Dividing the total number of participants by the number of PSUs to be selected (50) yielded a systematic

probability-proportional-to-size selection interval, K. Relative to this initial interval, three PSUs (New

York City, Chicago, and Los Angeles) were large enough to be selected with certainty. Indeed, in both

New York City and Los Angeles the total number of participants is several times as large as the selection

interval. This situation has the consequence that, if we selected only two local agencies from such a PSU,

its participants would be seriously under-represented. Thus, we made the three certainty PSUs selfrepresenting by allocating local-agency selections (for the second stage of sampling) to the three selfrepresenting PSUs in proportion to their combined size, accounting for 14 of the 100 local agencies to be

selected. To obtain the remaining 86 local agencies (a target of two per PSU), we completed the firststage sample by selecting 43 non-self-representing PSUs. To select the non-self-representing PSUs, we

removed the certainty PSUs from the list and recalculated the interval K as the ratio of the total number
A-6 Appendix A Abt Associates Inc.

of participants in non-self-representing PSUs to the number to be selected (43). We then calculated a

cumulative measure of size from the beginning of the list to the end. We selected the first non-selfrepresenting PSU by generating a random start, R, between 0 and K, and we determined successive

selections by repeatedly adding K to R. When one of these systematic selection numbers fell in the range

of cumulative size corresponding to a particular PSU, then that PSU was “hit” by the sampling process. 

For non-self-representing PSUs (with fewer than K participants), the probability of selection was

proportional to size.

Separating the selection of self-representing PSUs from the selection of non-self-representing PSUs in

effect creates two strata for the purpose of calculating selection rates and selecting the second-stage

sample. Selection rates for the self-representing PSUs are discussed below under Second-Stage

Selection. The selection rate for a non-self-representing PSU is defined as:

f = S /K First-stage selection rate, 12j 2j

non-self-representing PSUs

where S is the estimated size of PSU j (in stratum 2). This probability of selection at the first stage is a 2j

component of the overall sampling weight for each WIC participant in our sample.

The 43 non-self-representing PSUs selected for the sample were distributed among 25 states. These 43

PSUs, along with the three certainty PSUs, are shown in Exhibit A-4.

Second-Stage Selection

At the second stage we allocated a total of 100 local-agency hits among the PSUs selected at the first

stage: 14 hits among the three self-representing PSUs, and two hits to each of the 43 non-selfrepresenting PSUs. For the three self-representing PSUs we formed a single, combined list of local

agencies, and sorted the list in order of increasing size within PSU. The selection interval equaled the

total size of these three PSUs divided by 14. Systematic sampling with this interval and a controlled

random start produced five local-agency hits in New York City, two in Chicago, and seven in Los

Angeles. In Los Angeles, one local agency was so large (326,337 total participants of the 524,889 in the

PSU) that it received five of the seven hits. Otherwise, each hit corresponded to a distinct local agency.

To select two local agencies within each non-self-representing PSU, we formed a separate list of local

agencies for each PSU, sorted the lists in order of increasing size, calculated the selection interval for

each PSU (equal to the size of the PSU divided by 2), and generated a controlled random start for each

PSU. In 16 of these PSUs a single local agency received both of the local-agency hits, because it

accounted for more than half of the WIC participants in the PSU (in some instances, because it was the

only local agency in that PSU). As we discuss later, when this occurred, it produced a corresponding

increase in the numbers of service sites and participants to be selected from that local agency. For

example, when a local agency received two hits, its target number of service sites for the third stage was

increased from two to four. A similar modification applied to the local agency that received five hits in

the self-representing Los Angeles PSU.
 Exhibit A-4

 Selected PSUs for the NSWP
5 The local agency refusal was requested by the state WIC director because of a recent local agency reorganization.

6 Approximately 40 percent of the local agencies provided the average number of certifications; the remaining local agencies provided

average monthly caseloads. Caseload numbers were converted to expected numbers of certifications by dividing the caseload by the length

of the certification period. The certification period is 6 months for breastfeeding women, postpartum women and children. The

certification periods for pregnant women and infants depend on the timing of enrollment and on state policies regarding certification

periods for infants (some states recertify infants at 6 months of age, and others certify infants until their first birthday). We assumed an

average certification period of 7.4 months for pregnant women and 9 months for infants.

A-8 Appendix A Abt Associates Inc.

To derive the second-stage selection rate in the stratum of non-self-representing PSUs (i=2), we let Aijk

be the estimated size of the local agency receiving the kth subhit within the PSU that received hit (i,j). 

Define Zij=Sij/2 to be the selection interval for hit (i,j). Then

f2ijk=Aijk/Zij Second-stage selection rate

is the second-stage rate of selection for local agency (i,j,k). For local agencies within the three selfrepresenting PSUs, the selection interval was Z = (S + S + S )/14; with this change the above 1j 11 12 13

definition of f continues to apply. 2ijk

Among the 80 initially-selected local agencies, only one agency refused to participate in the study. A5

one-to-one replacement scheme was used to maintain exactly two local agency selections for the PSU.

Third-Stage Selection

To interview participants, we visited two randomly-selected service sites for each local agency selected in

the second stage. To select service sites, we first defined the sampling frame of service sites for each

selected local agency. Through telephone contacts we obtained lists of service sites at each selected local

agency and information on the expected number of monthly certifications at each of those sites for each

certification category.6

Selection of the two sites per agency was made with probability proportional to size and, as in the other

stages, with the possibility that a site was selected more than one time if a local agency was hit two or

more times. Let Cijkl be the estimated size of the lth site (l = 1,2) that is selected within the local agency

receiving subhit (i,j,k). We define Z , the selection interval for subhit (i,j,k), to be one-half the sum of all ijk

the possible C . Then, the third-stage rate of selection was ijkl

f = C /Z . 3ijkl ijkl ijk

If a local agency had only one site, it was impossible to select two sites. Among the 70 local agencies

selected in non-self-representing PSUs, eight had only one site. Our approach was to double the number

of participants selected at the single site.

Exhibit A-5 summarizes the sampling results in the first through third stages of selection. The target

number of hits is shown along with the number of selected local agencies or sites—the difference is

accounted for by agencies or sites hit more than once by the sampling process.
Abt Associates Inc. Sample Design, Weights, and Standard Errors A-9

Exhibit A-5

Summary of Sampling Results

Self-Representing Non-Self-Representing

PSUs (strata 1) PSUs (strata 2) Total

First-stage selections 3 PSUs 43 PSUs 46 PSUs

Second-stage selections 14 local agency hits 86 local agency hits 100 hits

(10 local agencies) (70 local agencies) (80 agencies)

Third-stage selections 28 site hits 172 site hits 200 hits

(27 sites) (154 sites) (181 sites)

Fourth-Stage Selection

We planned to complete in-person interviews with an average of 15 participants from each certification

site (i.e., per hit), for a total of 3,000 interviews with participants. With five categories, this approach

results in an expected sample size of three sample participants from each category at the site level, and a

total sample size of 600 completed interviews per category. Allowing for an anticipated response rate of

75 percent produced a target sample size of 800 participants per category.

For the local agency and site receiving subhit (i,j,k,l), the sampling of participants involved a final-stage

selection rate for each of the five categories, f4ijklg in category g. For each category separately, these

selection rates were determined (via an iterative calculation) so that they approximately equalized the

overall rate of selection,

f = f · f · f · f ijklg 1ij 2ijk 3ijkl 4ijklg

over the selected sites and, when applied to the site-level estimates of the number of monthly

certifications, yielded an expected total sample size (over all sites) of 800 participants.

Because the actual numbers of certifications in each category during each month of the field period would

not necessarily equal the estimated numbers, we monitored the number of completed in-person interviews

in each category and modified the sampling scheme. The first modification consisted of extending the

data collection period for March 1998 from four weeks to five weeks. A second modification, in effect

for the April 1998 data collection, increased the target sample size from 800 to 1,040 for infants and

from 800 to 1,000 for the other four categories. The third (and final) modification, in mid-April 1998,

further increased the target sample size for infants by 67 percent, from 1,040 to 1,737.

Weights

Each participant in the sample received a base sampling weight, equal to the reciprocal of the overall

selection rate for the appropriate category, fijklg. For a participant in category g from site l of local agency

k in PSU j of stratum i, the base sampling weight is:
Nˆ

h

' j

i

j

j

j

k

j

l

j

g

wijklgh.

w(ijklgh ' (Nh/Nˆ

h

)wijklgh.

A-10 Appendix A Abt Associates Inc.

w = 1/f ijklg ijklg

= 1/(f · f · f · f ). 1ij 2ijk 3ijkl 4ijklg

Because some participants declined to be interviewed, we reallocated their base weight among the

participants with completed interviews. Specifically, within a set of cells, this adjustment for unit nonresponse involved multiplying the base weight of each participant with a completed interview by an

adjustment factor, equal to the ratio of the sum of weights for all sampled participants in the cell to the

corresponding sum of weights for all participants with a completed interview. Initially, each combination

of site and certification category formed a cell. Three sites yielded no data. Of the 890 (= 178 × 5)

potential cells, 66 contained no sampled persons (this was to be expected because the estimated numbers

of certifications in some categories at some sites were small or even zero). Of the remaining 824 cells,

103 contained no respondents. Where possible (83 cells), an empty cell was combined with the cell for

the other site in its local agency (and the same certification category). For 20 cells, however, that other

cell also contained no respondents, and the non-response adjustment was then made at the level of the

PSU. This process yielded a non-response-adjusted base sampling weight for each respondent.

At the first two stages of sampling the measure of size was the number of enrollees for the contiguous

U.S. in April 1996 (from PC96). Because those counts did not necessarily match either the number of

participants or the number of certifications in the spring of 1998, we further adjusted the non-responseadjusted base sampling weights so that their totals on certification category, FNS region, and MSA

location (separately) matched the corresponding totals of enrollees for the contiguous U.S. from the WIC

Participant and Program Characteristics, 1998 (PC98). This process is known as “poststratification,”

and the individual categories of the variables involved are known as “poststrata.” For example, in this

instance pregnant women formed one poststratum. Let the subscript h designate a poststratum. Then

w is the non-response-adjusted base sampling weight for a respondent in stratum i, PSU j, local ijklgh

agency k, site l, and certification category g, who is also a member of poststratum h. The sample

estimate of the poststratum total is

Let N be the universe total for poststratum h. We can now compute the adjusted weight h

Because the poststrata were defined separately by three variables (i.e., not by the cross-classification of

those variables), we carried out the poststratification by a standard procedure of iterative ratio adjustment

known as raking. The calculation took each of the variables in turn, applying the above formula for each

of the appropriate values of h, and repeated the cycle until the changes in the weights were sufficiently

small. Analyses of weighted data for this report used the resulting weights.
7 STATA Statistical Software, release 6.0, College Station, Texas: STATA Corporation, 1999.

Abt Associates Inc. Sample Design, Weights, and Standard Errors A-11

Variances and Standard Errors

In calculating point estimates and, especially, their variances or standard errors, it is necessary to take

into account the sample design and the weights of the individual respondents. For these calculations we

used the STATA statistical software package. To account for the presence of the certainty PSUs at the 7

first stage, we specified two strata: one for the certainty PSUs and the other for the non-certainty PSUs. 

In the first stratum (certainty PSUs) the primary sampling unit (which indicates the level of clustering for

STATA) was the local agency, and in the second stratum (non-certainty PSUs) the primary sampling unit

was the PSU. More specifically, in the NSWP datasets the variable PSUTYPE identifies the stratum, and

PSUID identifies the primary sampling unit:

PSUTYPE = 1 for certainty PSUs

= 2 for non-certainty PSUs

PSUID = local agency ID if PSUTYPE = 1

= PSU ID if PSUTYPE = 2.

In addition the variable WGT gives the weight developed in the previous section. To illustrate the use of

STATA with these data, the following commands produced the estimate of mean annual income for WIC

participant families (accompanied by its standard error):

use ‘stata dataset name’

svyset strata PSUTYPE

svyset psu PSUID

svyset pweight WGT

svymean ANNUAL

The STATA commands are in lowercase, and variable names are in uppercase. For a multistage cluster

sample the variance-estimation procedures in STATA allow arbitrary clustering within the PSUs, but

they do not distinguish among possible degrees of clustering (or lack of clustering) at lower levels (here,

the service sites in the stratum of certainty PSUs or the local agencies in the stratum of non-certainty

PSUs). Hence, the variance estimates may be somewhat conservative (i.e., the standard errors may be

larger than if the structure of the clustering at the lower levels were taken into account).
1 Missing data in the NSWP resulted from item non-response or, in a small number of cases, from centralized re-coding of out-of-range

values to missing data.

2 Names were removed from the data files only after final cleaning.

3 The in-home interview was designed to validate the income information provided during the in-person interview, through review of income

documents. Because the in-home interview was conducted with only one-third of in-person respondents, however, the in-home data were

not used as a source for cleaning the in-person data.

4 The high rate of missing data for sex may be due to instrument design; interviewers were instructed to “ask if not apparent” on the “sex”

item.

Abt Associates Inc. Imputation of Unreported Data Items B-1

Appendix B

Imputation of Unreported Data Items

The central component of the NSWP is the in-person interview. Review of data from the in-person

survey indicated a modest amount of missing data. This appendix describes the two types of methods

used to impute missing data in the NSWP:

1. Imputation of missing or inconsistent data items using within-household data, and

2. Imputation of unreported data items using sample estimates.

The first type of imputation was primarily used to impute missing data regarding individual

characteristics. For example, missing data for “sex” or inconsistencies between “sex” and “relationship 1

to respondent” could usually be resolved based on the individual’s name. The second type of 2

imputation, relying mainly on regression methods, was used to impute missing data for income and food

spending.3

Imputation Based on Within-Household Data

The main NSWP interviews were administered as paper and pencil surveys, due to the wide variety of

environments experienced in WIC local service delivery sites. This limited the number of checks that

could be built into the data collection instruments. As a result, edit checks were performed after the data

were received from the interviewers, processed through data entry, and compiled on a central computer.

A centralized review of data resolved inconsistent responses and replaced missing data with imputed data

inferred from other data items within the survey. Many data inconsistencies were resolved based on

review of the hard-copy instruments; these revisions were due to data-entry errors and are not flagged in

the final data files. Imputation was limited to a few data items, and revisions based on imputation are

flagged in the final data files. The highest rate of imputation was for “sex,” which was imputed for 5.2

percent of persons appearing on household enumerations; all other rates of imputation are under 1

percent.4

Items imputed based on within-household data are listed below. The numbers in brackets refer to the

question number on the survey instrument. See Appendix D for the in-person instrument.
5 It was apparent from the data that “Receiving WIC now?” was misinterpreted by many people who were interviewed on the day that they

were certified.

6 Sampling books were maintained at all WIC service sites participating in NSWP, and all persons appearing at the WIC service sites for

certification were logged in the sampling books.

B-2 Imputation of Unreported Data Items Abt Associates Inc.

Items Imputed Based on Within-Household Data

• Relationship to respondent [A3]. (Imputed to be consistent with sex [A5].)

• Status as biological parent [A7]. (Imputation based on relationship [A3].)

• Child’s age [A6]. (Age made consistent with date of birth [B2].)

• Is child receiving WIC now? [B8]. (Response coded as “Yes” for all sampled persons.)5

• Financial support shared with respondent [A12]. (Responses within the household were

made consistent based on the assumption that immediate family members share support. 

Thus, if a pregnant woman reported that her mother provided her with support but her father

did not share support with her, then her father was coded as sharing support based on the

fact that mother and father are in the same immediate family.)

• Average weekly food spending at home, is that per week or per month? [A14b]. (Time

period on which response is based was imputed based on the distribution of average weekly

food spending for observations with non-missing time periods.)

• Average weekly food spending eating out, is that per week or per month? [A15b]. (Same

method as above.)

Two data items were imputed based on the sampling lists. As noted above, responses to the question “Is

child receiving WIC now” [B8] were re-coded for many sampled persons who received certification on

the date of the interview. This question was probably misinterpreted because WIC benefits had not yet

been received at the time of the interview. When the sampled person was a postpartum woman, there was

some question as to whether “receiving WIC now” was answered correctly for her infant; likewise, when

the sampled person was an infant, did the mother correctly respond to the question about her WIC receipt

in the postpartum period [B5b]? The sampling lists were used to impute WIC status for mother or infant

in these cases. If both the mother and infant were on the sampling list, we assumed that both received 6

WIC certification.

Finally, information about WIC history (Q10, Is this your first WIC certification?) for pregnant,

breastfeeding, and postpartum women was found to be inconsistent with information reported on the

child rosters in regard to WIC participation by mothers when pregnant and postpartum with their

children. Q10 was not used for any analyses; estimates of ‘WIC experience’ for sampled women were

based on responses from the child roster [B4, B5b].
7 Moore, Jeffrey, Linda Stinson, and Edward Welniak, “Income Measurement Error in Surveys: A Review,” U.S. Bureau of Census,

December 1997, submitted for publication.

8 These statistics are calculated over all adults in WIC families.

9 This imputation is consistent with WIC guidelines instructing clinic staff to “consider income of the family during the past 12 months and

the family’s current rate of income to determine which indicator more accurately reflects the family’s status.” In addition, WIC guidelines

specifically instruct staff to use current income to determine eligibility when persons are unemployed (USDA, FNS Instruction 803-3).

Abt Associates Inc. Imputation of Unreported Data Items B-3

Imputation Based on Estimates

Regression estimates were used to impute most missing data for monetary items: income and food

spending. Monetary data were collected in two sections of the in-person survey. The “individual income

and earnings” section asked about income received by each adult member of the family from 12 sources

(e.g., wages and salary, self-employment income, social security income, etc.). The “household income

and food spending” section asked about the aggregate receipt of income by the family in eight categories

(mostly earnings from assets and public assistance receipt), and the average weekly food spending at

home and away from home.

As with other household surveys, the incidence of missing income data follows a predictable pattern: 

own income and spousal income have low rates of item non-response; income of other family members

has high rates of non-response. In addition, for all family members, unearned income has higher rates of 7

non-response than earned income. Exhibit B-1 shows the incidence of missing data for each component

of family income and for food spending. This exhibit shows the incidence of missing data for the Yes/No

question regarding receipt of income and the incidence of missing data for income amounts, conditional

on receipt. The mean amounts shown in Exhibit B-1 are reported amounts prior to imputation.

For all income items except wages, missing data for amounts were imputed (as discussed below), but

missing data for receipt were not imputed.

Wage and Salary Income

For wage and salary income, we had two indicators of income receipt: current employment status and the

question “During last month did you receive any wages?” These two indicators are not in agreement

because they reference different time periods: 11.7 percent of persons reporting wage income “last

month” were currently unemployed; 9.6 percent of persons currently employed reported no wage income

“last month.” In calculating total income for the family, we used current employment status to indicate 8

persons with wage income at the time of certification. In other words, we imputed data for “was wage

income received?” based on employment status at certification, and this imputation is reflected in the

“percent with source received” shown in Exhibit B-1. As a result, non-reporting of wage income shown 9

in Exhibit B-1 is much higher than the actual item non-response to the question “How much did you earn

in wages and salary last month?” In addition, prior to implementing the imputation methods described

below, we imputed missing data for “wage and salary income last month” using “wage and salary income

last year,” divided by twelve, if the latter measure was present.
B-4 Imputation of Unreported Data Items Abt Associates Inc.

Exhibit B-1

Incidence of Missing Data for Income and Food Spending

Source Received? Amount Reported?

If Source Recieved,

Mean

Amount

n Yes No NR n Yes No Reported

Household income % % % % %

Interest on savings/bonds 3,114 9.4 89.0 1.7 265 62.5 37.5 38

Dividends/royalties/trusts 3,114 1.1 96.9 2.0 36 31.1 68.9 224

Any pensions/annuities 3,114 1.3 96.2 2.5 31 63.7 36.3 1,282

Rental income 3,114 0.8 97.5 1.7 28 80.3 19.7 652

Income from other sources 3,114 5.5 91.1 3.3 195 92.2 7.8 1,284

Alimony or child support 3,114 11.0 87.0 2.0 323 94.2 5.8 289

TANF benefits 3,114 14.8 83.4 1.8 480 90.4 9.6 387

Respondent income

Respondent wages 3,054 26.9 72.3 0.7 767 81.0 19.0 764

Unemployment comp. 3,054 2.2 94.5 3.3 67 91.5 8.5 353

Workers compensation 3,054 0.6 96.1 3.3 19 100.0 0.0 309

Veterans benefits 3,054 0.1 95.9 4.0 3 81.1 18.9 138

Social security income 3,054 2.6 94.0 3.3 76 97.1 2.9 422

SSI 3,054 2.9 93.7 3.4 82 99.3 0.7 441

General assistance 3,054 4.7 90.6 4.8 132 84.5 15.5 343

Black lung benfits 3,054 0.2 95.8 4.1 4 45.8 54.2 54

Other public assistance 3,054 0.8 93.0 6.2 21 56.8 43.2 439

Spouse/Partner income

Spouse/Partner 1,829 79.7 20.0 0.3 1,485 85.8 14.2 1,209

Unemployment comp. 1,829 4.0 92.7 3.4 61 91.1 8.9 615

Workers compensation 1,829 1.3 95.1 3.5 24 0.0 100.0 0

Veterans benefits 1,829 0.5 95.4 4.1 5 0.0 100.0 0

Social security income 1,829 1.4 95.1 3.4 18 83.8 16.2 575

SSI 1,829 2.1 94.4 3.5 28 83.4 16.6 662

General assistance 1,829 0.7 94.7 4.6 11 56.3 43.7 410

Black lung benfits 1,829 0.1 96.2 3.7 2 0.0 100.0 0

Other public assistance 1,829 0.0 93.7 6.3 0 — — —

(continued)
Exhibit B-1

Incidence of Missing Data for Income and Food Spending

Source Received? Amount Reported?

If Source Recieved,

Mean

Amount

n Yes No NR n Yes No Reported

Abt Associates Inc. Imputation of Unreported Data Items B-5

Other family member

Wages and salary 1,087 64.4 34.3 1.3 705 47.2 52.8 1,248

Unemployment comp. 1,087 1.2 88.5 10.4 18 30.6 69.4 385

Workers compensation 1,087 0.4 89.6 10.0 7 0.0 100.0

Veterans benefits 1,087 1.3 88.8 9.9 19 11.0 89.0 525

Social security income 1,087 8.7 81.2 10.0 89 61.5 38.5 706

SSI 1,087 3.5 85.9 10.6 45 61.4 38.6 477

General assistance 1,087 0.8 87.5 11.7 14 67.1 32.9 181

Black lung benfits 1,087 0.0 90.1 9.9 —

Other public assistance 1,087 0.7 87.3 12.0 5 74.7 25.3 1,009

Average weekly food

spending Percent not reported Mean amount 

At home 3,114 6.6 125

Away from home 3,114 7.3 20

Percentages are weighted. All income questions refer to “income last month.” NR = not reported.

Methods of Imputation

Two methods of imputation were used for the income and food spending items shown in Exhibit B-1. To

impute most of the missing data for dollar amounts, we estimated separate linear regression equations for

each source of income. The coefficient estimates from the regressions were used to calculate estimated

income for persons with missing data.

Regression estimates were not used for household income items (interest on savings, dividends, pensions

and annuities, contributions from other sources, income from alimony, income from child support, lump

sum income, rental income), with the exception of TANF amounts. Missing data for these items were

imputed by the median amount observed in non-missing observations. Medians were used because these

items showed a wide distribution, low R in regressions, and represented a small percentage of household 2

income.

In addition, for individual income items with fewer than 20 non-missing observations, the sample was not

large enough to support regression estimates and we imputed missing data using the mean value of non-
10 Most responses to the question about “other public assistance” duplicated information about TANF or food stamp benefits reported in

response to other questions on the survey, or were about in-kind benefits (and the amount received was missing). These responses were

cleaned out of the data, leaving only 26 reports of other public assistance. Of the eight reports that were missing amounts, only one

reported the type of assistance, and it was imputed based on the mean amount of other reports of that type.

11 Because households differ in size and composition, the number of “male equivalents” provides a single measure for comparing aggregate

household consumption requirements. The number of male equivalents in the family is calculated by assigning equivalence values to each

family member on the basis of calorie requirements by age and gender. One male equivalent is equal to an adult male able body’s daily

consumption requirement (in kcal).

B-6 Imputation of Unreported Data Items Abt Associates Inc.

missing observations. Mean values were used to impute workers compensation, veteran’s benefits, and

Black Lung benefits, and “other public assistance.”10

Regression Specifications

The regression estimates for individual income items had the following general specification:

Income amount = f [age, age , sex, education dummies (3), marital status dummies (2), 2

relationship to respondent dummies (4), military, seasonal worker, selfemployed, in college, metro area, region dummies (6)]

For individual income amounts, all covariates are the characteristics of the family member with missing

income data; age is a continuous variable and all other covariates are represented as dummy variables. 

Regressions for “wages and salary income” were run separately for males and females, regressions for all

other individual income amounts pooled males and females.

To impute missing TANF amounts, the following regression was estimated:

TANF amount = f [respondent age, age , family size, spouse present, number of children, 2

respondent parent in household, wages, social security income, SSI income,

other public assistance income, metro area, region dummies]

In the TANF regression, age, wages, and income amounts are continuous variables and all other

covariates are represented as dummy variables.

To impute missing food spending amounts, the following regression specification was separately

estimated for average weekly food spending at home and away from home:

Food spending = f [respondent age, number of male equivalents in family, education dummies

(3) marital status dummies (2), adjunctively eligible for WIC, family has

wage income, total monthly income, metro area, region dummies]

In the food spending regression, age, number male equivalents, and total monthly income are continuous

variables, and all other covariates are represented as dummy variables.11

For each data item imputed by this method, Exhibit B-2 shows the number of observations with nonmissing data, the number of observations with data imputed from the regression estimates, the R-square

from the regression equation, the mean value before and after imputation, and the percentage of missing
Abt Associates Inc. Imputation of Unreported Data Items B-7

data after imputation. Missing data remained after imputation for individuals missing data for covariates

on which imputation was based. In this exhibit, individual income is not shown separately for

respondents, spouses, and other family members because these individuals were pooled for obtaining

regression estimates.

Exhibit B-2

Incidence of Missing Data for Income and Food Spending

Number Percentage

with Non- Before After Missing

missing Number R from Impu- Impu- After

Data Imputed Regression tation tation Imputation

2

Mean Amount

Household income %

TANF benefits 440 40 0.4349 387 381 0.0

Individual income and earnings

Wages and salary–males 1,428 362 0.1429 1,239 1,240 2.4

Wages and salary–females 770 377 0.2122 782 795 4.8

Unemployment comp. 130 16 0.4395 486 499 0.0

Social security income 137 45 0.5249 540 565 1.0

SSI 136 19 0.3508 498 491 0.6

General assistance 121 35 0.3899 340 334 1.8

Average weekly food spending

At home 2,957 131 0.2643 75 76 0.8

Away from home 2,888 198 0.0745 13 13 0.9

Percentages are weighted. All income questions refer to “income last month.” 
Abt Associates Inc. Food Security Measurement C-1

Appendix C

Food Security Measurement and Food Spending per

Adult Male Equivalent

Section F of the NSWP in-person survey instrument implemented the food security module developed by

the food security measurement project, a cooperative undertaking of federal government agencies under

the leadership of the Food and Nutrition Service (FNS) of the U.S. Department of Agriculture (USDA). 

The food security module was first implemented on a national basis as a supplement to the U.S. Bureau

of Census’ Current Population Survey (CPS) to provide national statistics on household food security

and hunger.

The food security module contains 18 questions. Use of the module requires that responses to the 18

questions be combined in a composite scale measure of food security, according to an algorithm developed by USDA. The composite scale is then used to assign respondent households to one of four food

security status categories:

• Food secure

• Food insecure without hunger

• Food insecure with hunger, moderate

• Food insecure with hunger, severe.

The food security scale measures the condition of household members as a group, and not necessarily the

condition of any particular household member. Thus, a household identified as food insecure with hunger

is a household with at least one member experiencing hunger.

The algorithm for the composite scale was originally presented in the Guide to Implementing the Food

Security Module (USDA/FNS, 1997). The Economic Research Service (ERS) of USDA issued “Updated Procedures and Corrections to the Guide to Implementing the Food Security Module” in July 1999,

which were incorporated in Guide to Measuring Household Food Security, Revised 2000 (USDA/FNS,

March 2000). These procedures are summarized below, with reference to NSWP questionnaire items.

Procedures for Calculating the Food Security Scale and Assigning

Food Security Status to Households

The core food security module consists of 18 questions for households with children, and ten questions

for households without children. The questions are grouped as follows (with NSWP question numbers

shown and an asterisk denoting questions asked only of households with children):

• Screener questions – F1, F2, F3 [not included in the composite scale]

• Stage 1 questions – F4(a), F4(b), F4(c), F4(e)*, F4(f)*

• Stage 2 questions – F4(g)*, F5, F5(a) F6, F7, F8

• Stage 3 questions – F9, F9(a), F10*, F11*, F11(a)*, F12*, F13*
1 All questions in the food security module are yes/no questions or questions eliciting information on the frequency of reduced food intake. 

Allowable responses to the frequency questions are “often,” “sometimes,” and “never;” both “often” and “sometimes” were considered

affirmative responses.

NSWP administration of six of the eight questions for households with children differs from the CPS module. NSWP questions F4g, F10,

F11, F11a, F12, and F13 appear in the CPS as questions referencing “your child” or “the children.” NSWP addressed each of these

questions with reference to each child in the family, so that each question appears as a set of questions. In constructing the food security

scale, each set of questions contributes a single affirmative response if an affirmative response was obtained for any child in the family.

C-2 Food Security Measurement Abt Associates Inc.

The screener question asks about household food sufficiency over the past 12 months. Respondents

indicating that their household had “enough to eat and the kinds of food wanted” are skipped out of the

food security module and categorized as “food secure.”

Stage 1 questions measure the presence of anxiety or perception that the household food budget or food

supply was inadequate, and perceptions that the food eaten in the household was inadequate in quantity

or quality. Stage 2 questions measure instances of moderately reduced food intake. Stage 3 questions

measure instances of severely reduced food intake.

The procedure for assigning a composite scale value to each household depends on whether the household had any missing responses to the questions in the module.

Households with Complete Data

For households with no missing data, the composite scale is calculated by counting the number of affirmative responses to the questions in the module. This number may range from zero to 18 for house- 1

holds with children, and from zero to 10 for households without children. The scale value assigned to

each number of affirmative responses is shown in Exhibit C-1. The correspondence between scale value

and food security category is shown in Exhibit C-2.

Among NSWP households, complete data were obtained from 88.4 percent of households with children

and 93.6 percent of households without children.

Households with Incomplete Data

For households with partially missing data—i.e., item non-response to some but not all items in the core

module—a procedure for imputing missing data has been prescribed by ERS. The methodology appears

in the Guide to Measuring Household Food Security, Revised 2000.

The imputation procedure prescribed by ERS imputes responses for missing items based on valid

responses the same household gave to other items. The imputation procedure is “based on the ordered

character of the items in the Food Security Module. That is, the items vary in severity across a wide

range, and their severity ordering tends to be stable across households. As a result, a household that

affirms an item will generally affirm all less severe items, and a household that denies an item will

generally deny all more severe items.” After imputation of data missing due to non-response, households

are scored using the same methods as are used for households with complete responses.

The ordering of items prescribed by ERS, listed from least severe to most severe, is as follows:
Abt Associates Inc. Food Security Measurement C-3

F4a, F4b, F4e, F4c, F4f, F5, F6, F5a, F4g, F7, F8, F10, F9, F12, F9a, F11, F11a, F13

Imputation instructions are:

• Impute “yes” to a missing item if, for that household, there is a valid affirmative response to

at least one item more severe than the missing item and no negative response to any item less

severe than the missing item.

• Impute all other missing items as “no.”

After imputation of individual items, count the number of affirmative responses and determine the

composite scale and food security category according to Exhibits C-1 and C-2.

Exhibit C-1

Food Security Scale Values for Households with no Missing Data

Number of Affirmative

Responses Households with Children Households without Children

Scale Value

0 0.0 0.0

1 1.0 1.2

2 1.8 2.2

3 2.4 3.0

4 3.0 3.7

5 3.4 4.4

6 3.9 5.0

7 4.3 5.7

8 4.7 6.4

9 5.1 7.2

10 5.5 7.9

11 5.9

12 6.3

13 6.6

14 7.0

15 7.4

16 8.0

17 8.7

18 9.3

Source: Guide to Measuring Household Food Security, Rrevised 2000, USDA/FNS, 2000.
2 Gary Bickel et al., Guide to Measuring Household Food Security, Revised 2000, Alexandria, VA: USDA/FNS/OANE, March 2000.

C-4 Food Security Measurement Abt Associates Inc.

Exhibit C-2

Correspondence Between Food Security Scale Values and Food Security Status

Scale Value Food Security Status Category

0.0 to 2.2 Food secure

2.4 to 4.4 Food insecure without hunger

4.7 to 6.4 Food insecure with hunger, moderate

6.6 to 9.3 Food insecure with hunger, severe

Source: Guide to Measuring Household Food SecurityGuide to Measuring Household Food Security, Revised

2000, USDA/FNS, 2000.

ERS suggests that imputation is appropriate if there are valid responses to three or more questions.

Among NSWP households, incomplete data were obtained for 11.6 percent of households with children

and 6.4 percent of households without children. After implementing the procedures described above,

food security status was determined for all households without children, and for 98.9 percent of

households with children.

Food Security Measurement for Households with Young Children

As noted in Chapter 3, there is some concern that the food security scale may understate hunger in

households with very young children. This concern arises because the food security scale measures the

condition of the household as a group, taking into account the responses to questions about both adult

and child food security.

To determine household food security, households without children are administered ten survey items,

whereas households with children are administered 18 survey items. A household without children is

identified as hungry if it responds affirmatively to six of ten questions in the food security module; a

household with children is identified as hungry if it responds affirmatively to eight of 18 questions (see

Exhibits C-1 and C-2).

Research shows, however, that very young children are generally protected from hunger whereas “adults

undergo comparatively severe levels of hunger for themselves before the first indications of hunger

appear among the children.” As a result, if there are two households—one with children and one without 2

children—that respond identically with six affirmative responses to the ten adult survey items, the household without children will be identified as hungry and the household with children will be identified as

food insecure without hunger. The adult hunger will appear as household hunger only when two affirmative responses are obtained from among the eight child questions.
3 Per conversations with Mark Nord, USDA ERS.

4 Mark Nord, “Problems with Estimating the Prevalence of Child Hunger,” Second Food Security Measurement and Research

Conference, Volume I: Proceedings, USDA/ERS/FANRR-11-1, February 2001.

Abt Associates Inc. Food Security Measurement C-5

Analysis conducted by USDA ERS (of CPS Food Security Supplement data) shows that the food security

scale substantially understates the prevalence of hunger in households in which the oldest child is two

years or younger. In these households the ten-item scale (excluding the child items) finds about 45 3

percent more households with hunger than does the 18-item scale. In other words, the measure of adult

hunger is inconsistent with the measure of household hunger. This is not true of households that include

older children—when households contain older children the measure of household hunger (18-item scale)

and adult hunger (ten-item scale) are generally consistent. Overall, for households with children, the two

scales find exactly the same prevalence of hunger.

The food security measurements presented in Chapter 3 are based on the current guidelines for the food

security scale, using the ten-item scale for households without children and the 18-item scale for households with children. Because the WIC population contains a disproportionate number of families with

very young children, we also examined the potential bias in the food security scale, as suggested by Mark

Nord of USDA ERS. Exhibit C-3 presents the distribution of food security status among WIC families,

based on the ten-item scale regardless of whether children are present in the household.

Exhibit C-3 shows estimates of hunger (food insecure with moderate hunger plus food insecure with

severe hunger) that are nearly identical to that shown in Exhibit 3-39, for the entire WIC population. 

Families of postpartum women and infants, however, are identified with slightly higher rates of hunger

when the ten-item scale is used for all households. This difference is consistent with findings of potential

bias for families with young children obtained by USDA ERS from the CPS supplement. Efforts are

currently underway to refine the food security module to provide better indicators of child hunger and to

better define hunger among households with children.4

Procedures for Calculating Food Spending per Adult Male

Equivalent

NSWP collected information from each respondent about total weekly food spending. Because food

spending varies with family size and ages of family members, total weekly food spending for each family

was converted to an amount of spending per adult male equivalent (AME).
____________________________________________________________________________________________________________________________________

Exhibit C-3

Distribution of Adult Food Security Status, by Participant Category

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Food security status 

 Food secure 74.5 75.1 78.8 75.9 80.3 80.4 79.3

 (2.7) (3.7) (2.6) (2.6) (2.5) (2.5) (2.2)

 Food insecure without hunger 12.9 15.3 13.2 13.5 10.5 12.1 12.0

 (1.5) (3.3) (2.2) (1.7) (1.6) (2.3) (1.7)

 Food insecure with moderate hunge 10.0 8.8 6.2 8.5 7.1 6.1 6.9

 (1.8) (1.6) (1.3) (1.2) (1.4) (1.4) (1.1)

 Food insecure with severe hunger 2.7 0.8 1.9 2.0 2.1 1.4 1.7

 (0.9) (0.3) (0.7) (0.6) (0.8) (0.5) (0.4)

Not reported 0.6 0.5 3.2 1.4 1.2 0.9 1.1

 (0.3) (0.3) (2.5) (0.8) (0.5) (0.4) (0.4)

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________

The food security measure is a composite scale based on responses to the ten adult survey questions.
Abt Associates Inc. Food Security Measurement C-7

One AME is equal to an adult male’s daily recommended energy allowance, measured in kilocalories. To

calculate food spending per AME, the size of the family is expressed in terms of “adult male equivalents”

as follows:

• Each family member is assigned the recommended daily energy allowance based on age and

gender, as shown in Exhibit C-4.

• The recommended energy allowances of all family members are totaled.

• The total energy allowance for the family is divided by the recommended energy allowance

of an adult male (1,800) to yield family size in terms of AMEs.

• Total weekly food spending per AME is equal to total weekly food spending divided by

family size expressed as AMEs.

Exhibit C-4

Daily Recommended Energy Allowance, by Gender and Age

Recommended Energy Allowance

Age Males Females

Less than 1 year 500 500

1-3 years 740 740

4-6 years 950 950

7-10 years 1,130 1,130

11-14 years 1,440 1,310

15-18 years 1,760 1,370

19-24 years 1,780 1,350

25-50 years 1,800 1,380

51 years and older 1,530 1,280

Pregnant women +300

Lactating women +300

If gender is missing, the average of male and female values is used.

Source: National Resource Council, Recommended Dietary Allowances. Washington, DC: National Academy

Press, 1989.
Appendix D

Survey

Instruments
PLACE CASE ID LABEL HERE

NATIONAL SURVEY OF WIC PARTICIPANTS

AND THEIR LOCAL AGENCIES

In-Person Interview

1. Field Data Collector _________________________________2. Sampled Person ___________________________________

Copy name from Sampling Worksheet.

3. Certification Category P BF PP I C

Circle category on Sampling Worksheet.

4. Today’s date ____________ / /____________ 5. Time at start of interview ________: _________ a.m.

hr min p.m.

7. CERTIFICATION CATEGORY

6. RESPONDENT NAME

1 Yes - Go to item 8.

Enter respondent’s name on line 1 of household roster, next page. Go to 7. 2 No - See note below.8. INTERVIEWER CHECK - Is sampled person a WIC infant or child? 9. GUARDIANSHIP

1 Yes - Go to Item 9.2 No - Go to Item 10. 1 Yes - Go to next page.

2 No - See note

10. WIC HISTORY 11. LAST ENROLLED 12. WHY LEFT WIC Is this your first certification in WIC?

1 Yes - Go to next page. 1 Not eligible any more2 No, received WIC foods last month Go to item 13. month 2 No longer needed the food benefit 3 No, was in WIC at an earlier time Go to item 11. 3 The program was too much effort 

year 4 I went back to work 

5 Other _____________________ 

CHECK ALL THAT APPLY

Do you and (NAME OF CHILD) live in the same 

household? 

When were you last enrolled in WIC?

PLACE LOCAL AGENCY/SITE LABEL HERE

What were the reasons for your leaving the WIC program?

NOTICE - Public reporting burden for this collection of information is estimated to average thirty minutes per response, includ

searching for existing data sources, gathering and maintaining the data needed, and completing and reviewing the collecnot conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this bOfficer, OIRM, AG Box 7630, Washington, DC 20250.

INTERVIEWER- IF RESPONDENT DOES NOT LIVE IN SAME HOCHILD, SAY,

_________

YEARS

13. FIRST WIC CERTIFICATIONHow old were yowhen first enrolleWIC?

Survey Instruments                       D-1Abt Associates Inc.

Thank you for your time. I need to talk with sohousehold as (NAME OF CHILD).

mm dd

INTERVIEWER- Confirm with respondent the certification category from the Sampling Worksheet.(YOU / NAME OF CHILD) are (is) here to be certified as [PREGNANT / BREASTFEEDING / POSTPARTUM 

INFANT / CHILD] WIC participant. Is that correct? To be sure that we can match this questionnaire with (YOUR / 

CHILD’S) WIC records, please tell me your name.

 INTERVIEWER - READ INTRODUCTION CARD

If there is a discrepancy between certification category on Sampling Worksheet and reported by respondent, follow instructions on RESOLVING DISCREPANCIES IN CERTIFICATIOcard.
Section A - Household Enumeration COMPLETE ITEMS 2-12 FOR ALL PERSONS LIVING OR STAYING WITH RESPONDENT.

11. FINANCIAL SUPPORT

Ask if not apparent.

(HAND CARD)Enter code below.

If YES, go 

If YES, go to item 12.

Enter first name and last name. Male Female Years Mos YES NO YES NO DK YES 

01 1 0 12 1 2 

02 1 1 2 1 2 128103 1 1 2 1 2 128104 1 1 2 1 2 128105 1 1 2 1 2 128106 1 1 2 1 2 128107 1 1 2 1 2 128108 1 1 2 1 2 128109 1 1 2 1 2 1281

YES NO 10. INTE

1 21 2 1 YES

2 NO

1 11 2 Go to Item 10.

11b. RECSUPPOR

11a. PROVIDE SUPPORT

Last moreceive financiafrom yo

Ask if age 16 or olderLast month, did ... provide (YOU / 

CHILD) with any 

financial support or pay any household 

expenses?

If respondent answers YES to any item (a)-(d), ask for name of 

household member and enter name in roster (item 2) above. Go to 

item 5.

9. Do all the persons in this household live or eat together? a. any babies or small children? . . . . . . . . . . . . . . . . . . . . . . . . . .

b. anyone who usually lives with you but is away now traveling, at school, or in a hospital? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

4. I have listed ... (Read names from item 2.) Have I missed-

 PERSON NUMBER

Check if Sampled Person

What are the names of all persons who live or stay with you? Start with the names of your immediate family members, then other relatives, and then persons who usually live with you who are not related to you.

If YES, ask- Where is that?

d. anyone else staying with you? . . . . . . . . . . . . . . . . . . . . . . 

5. SEX

What is ...’s relationship to you? 

Ask if not apparent.

8. USUAL RESIDENCE

Enter code in 8a.

c. any lodgers, boarders, or persons you employ who live with you? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Does ... have a usual residence somewhere else?

6. AGE

Record number 

of months if age 

under one year.

3. RELATIONSHIP TO 7. BIOLOGICAL PARENT

RESPONDENT

What was (YOUR / ...’s) age on (YOUR 

/HIS/ HER) last 

birthday?

8a.

GO TO ITEM 9.

USUAL RESIDENCE CODE 

(HAND CARD)

Now I have some questionamong household membe

Ask itan "XEnter with r

Abt Associates Inc.D-2                       Survey Instruments

INTERVIEWER - Complete each question for all members of household then move to next question. In reading each question, replace"..." with name in item 2. 

Is ... male or female?

GO TO ITEM 4. (ARE YOU / IS ...) the biological parent of any children in this household?

If YES,. enter person numbers of 

. . .’s children from Column 1 to 

boxes below.

1. 2. HOUSEHOLD ROSTER 2a.

RELATIONSHIP

0 Respondent1 Spouse 

 2 Partner  3 Son/daughter 4 Step-child 5 Foster child  6 Mother  7 Step-mother 8 Foster mother 9 Father 

10 Step-father 

CODES12 Brother/sister 13 Grandparent14 Uncle/aunt15 Cousin16 Nephew/niece17 Father-in-law18 Mother-in-law19 Bro/sis-in-law20 Other-in-law21 Roomer/ boarder22 Other non-relative

 USUAL RESIDENCE 1 Military quarters 5 Working away from home 2 School or institution 6 Separate residence  3 Vacation or in hospital 7 Jail/prison  4 At college 9 Other 

*** Complete the HOUSEHOLD ENUMERATION WORKSHE
Section B - Child Roster

INTERVIEWER - Complete all items for each child then go to next child. In reading each question, replace "..." with name in item 1.1. CHILD ROSTER 2. DATE OF BIRTH 3. 5a. WIC 

START

7.

What is ...’s date of

birth?

NAME AGE Mos MONTH / DAY/ YEAR YES NO YES NO YES NO YES NO AGE YES NO YES NO AGE 

____days ____d

 / / 1 2 1 21212 ____wks 1212 ____w

____mos ________days ____d

 / / 1 2 1 21212 ____wks 1212 ____w

____mos ________days ____d

 / / 1 2 1 21212 ____wks 1212 ____w

____mos ________days ____d

 / / 1 2 1 21212 ____wks 1212 ____w

____mos ________days ____d

 / / 1 2 1 21212 ____wks 1212 ____w

____mos ________days ____d

 / / 1 2 1 21212 ____wks 1212 ____w

____mos ____

3. INTERVIEWER CHECK ITEM 7. INTERVIEWER CHECK ITEMIs respondent the biological mother of (NAME OF CHILD)?Check for relationship code 3 for child in Item 3 of Section A. 

1 1 2 2 

INTERVIEWER - Copy person number, name, and age from GREEN section of 

Household Enumeration Worksheet.

If no children in GREEN section of 

worksheet, go to Section C.

If age under one year, record number of months and enter (X) in "Mos" column.

6a. BREASTFED NOW?Is ... currently being breastfed? Enter age a

check if ag

in days, we

or months.

Enter age and check if age is 

in days, weeks, 

or months.

8a. WIC EVER

9. AGE WIC BEGANHow old w... when ... enrolled in WIC?

No- Go to item 7.Yes- Go to item 4. Yes- Go to item 8.

No- Go to item 8a.

Is (NAME OF CHILD) less than 5 years old?

If YES, go to If YES, ask 9.

9.

Is ... receiving WIC now?

Was ... ever enrolled in WIC?

8. WIC NOW

If NO, go to 

7.

Was ... ever breastfed? 

I f NO, ask 

8a.

If NO, go to 

next child.

6b. BREASTFEEDING DURATIONHow old was ... when breastfeeding ended?

During which month of pregnancy

did you enroll in WIC when you were pregnant with ... ?

INTERVIEWER CHECK

6. BREASTFEEDING

INTERVIEWER CHECK

Abt Associates Inc.Survey Instruments                       D-3

If age less 

than 1 

year, askPERSON #

5b. POSTPARTUM WICDid you receive WIC benefits for yourself after ... was born?

4. WIC REC’D WHEN PREGNANTDid you receive WIC while you were pregnant 

with ...?If NO, go to 

item 5b.

Enter month

(1 to 9)
Section B - Child Roster - Continued

14. HEAD START

13. INTERVIEWER CHECK ITEM 1 YES

2 NO

1 YES-Go to item 14.2 NO- Go to item 15.

15. INTERVIEWER CHECK ITEM

1 YES-Go to item 16.2 NO- Go to Section C.

16. FOSTER CHILDREN

PERSON # PERSON # PERSON # PERSON #NAME NAME NAME NAME

17.

1 Person in household 1 Person in household 1 Person in household 1 Person in household2 Person outside household 2 Person outside household 2 Person outside household 2 Person outside househ3 Agency 3 Agency 3 Agency 3 Agency

17a.

PERSON # PERSON # PERSON # PERSON #

Do any children in your household

attend Head Start?

Are any children on the Household Enumeration Worksheet age 3-5?Are any relationship codes equal to 5? (See Item 3 in Section A.)

If YES,Who is that?INTERVIEWER- Enter person numbers 

from Household Enumeration 

Worksheet.

Abt Associates Inc.D-4                       Survey Instruments

Who has legal responsibilityfor (NAME OF CHILD)?INTERVIEWER - If PERSON IN 

HOUSEHOLD, record person 

number of guardian in box.

(READ CHOICES AND CHECK ONE)

INTERVIEWER - For each person with relationship code equal to 5, copy person number and name to space at right.
Section C - Adult Roster

INTERVIEWER- Complete all items for each adult then go to next adult. In reading each question, replace "..." with name in item 1.1. ADULT ROSTER 2. 5. MARITAL STATUS 6b. REASON NOT 

WORKING

8. EDUCATION LEVEL

1 - Married? 1. Unemployed2 - Widowed? 2. Keeping house3 - Divorced? 3. Going to school 1 - Fu4 - Separated? 4. Unable to work Enter code from below. 2 - Pa

5 - Never If YES, go to 6a. Go to item 7. 5. On temporary layoff 3 - No

 married? If NO, ask 6b. 6. Retired Enter c

Person (HAND CARD) (HAND CARD) If "1" oNumber Name Enter code below. YES NO YES NO Enter code below. YES NO If "3," g

1 212 1 2 1 212 1 2 1 212 1 2 1 212 1 2 1 212 1 2 1 212 1 2 

2. INTERVIEWER CHECK 4. Who is that? EDUCATION LEVEL

Never attended 

Is sampled person a pregnant woman? 1 YES- Go to 4. Elementary school 

2 NO- Go to 5. High School 

1 YES - Go to 3a. 3b. Is anyone in your household pregnant? Years 1-4 of college 2 NO - Go to 3b. 1 YES- Go to 4. 1st year of graduate school 

2 NO- Go to 5. 2+ years of graduate schoo

GO TO ITEM 2.

6. EMPLOYMENT STATUS

6a. ARMED FORCES

7. SEASONAL WORK 9a. C

ATTENAre yoenrollunive

Are you (is ...) currentlyAre you (is ... ) now -

3a. Are any other women in your household pregnant? INTERVIEWER - ENTER PERSON NUMBERS FOR 

PREGNANT WOMEN IN BOXES BELOW.

Abt Associates Inc.Survey Instruments                       D-5

If 12 or more, go to 

item 9a.

If less than 12, go to 

next person.

I now have some questions about each adult in your household.INTERVIEWER - Copy person number and name from BLUE section of Household 

Enumeration Worksheet.

What is the highest grade or year of regular school you (...) completed?

Are you (is ... ) currently working fulltime or part-time, 

not counting work around the house?

Are you (is ...) now in the

Armed Forces?

During the past 24 months, have you (has ... ) been employed as a seasonal farm 

worker either here or in some other place?
Section D - Individual Income and Earnings a. RESPONDENT PERSON NUMBER: 01 b. RESPONDENT NAME: 

INTERVIEWER - COPY RESPONDENT NAME TO SPACE AT RIGHT.

8. PUBLIC ASSISTANCE

$ _______________.00

INTERVIEWER - CHECK BOX IF LOSS. 1 LOSS

OR 14. General Assistance? 

1 NONE 

1. UNEARNED INCOME 

1 YES 2 NO 15. 

16. Non-military housing subsid

9. Unemployment compensation? 1 YES 2 NO 

$ _______________.00 17. Emergency Assistance? 

2. 

$ _______________.00 18. Black Lung benefits? 

$ _______________.00 10. Worker’s compensation? 1 YES 2 NO 

OR 

1 NONE 19. Other public assistance? 

3. 1 YES- Go to 4. $ _______________.00 

2 NO- Go to 5. 11. Income from veteran’s benefits? 1 YES 2 NO If YES, ask4. Which program is that from? __

How much did you receive las

$ _______________.00 20 INTERVIEWER CHECK ITEM 

$ _______________.00 

5.

1 YES 2 NO 12a. From Social Security checks? 1 YES 2 NO EDUCATION BENEFITS

12b. From Railroad Retirement checks? 1 YES 2 NO 21a.

If YES in item 12a and/or 12b,ask- 

$ _______________.00 12c. 

INTERVIEWER - CHECK BOX IF LOSS. 1 LOSS 21b.

$ _______________.00 

During last month did you receive - 

$ _______________.00 If YES to 21a or 21b, askINTERVIEWER - CHECK BOX IF LOSS. 1 LOSS 13a. 1 YES 2 NO 22a. How much educational aid 

OR 22b. 

1 NONE 13b. 1 YES 2 NO 

7. 1 YES 2 NO 22c. 

If YES in item 13a and/or 13b, ask- 

$ _______________.00 13c. $ _______________.00

INTERVIEWER - CHECK BOX IF LOSS. 1 LOSS Go to item 14. 

Last month, were you receieducational benefits for vethe GI Bill or VEAP?How much of that money was expenses- that is, excluding mtuition, fees, and books?

If YES, What was the total amount you 

received last month?

Last month, were you receieducational benefits such afellowships, or grants?

What was the amount of Social Security orRailroad Retirement payments you received last month?Any Supplemental Security Income checks from the State or local Government?

For what time period did th

Besides food stamps and TANF (which we will talk about a little l

receive any public assistance fr

If YES- How much did you rece

Check Section C, item 9a. Is recurrently enrolled in college fu

time?

My next questions are all about income that you received during last month.

If YES- What was the total amount of 

unemployment compensation you received last month?

If YES- How much did you rece

During last month did you receive from 

the U.S. Government any moneyLow Income Energy Assista

During the past 12 months how much 

income or loss did you receive from your own farm?

During the past 12 months, did you receive any 

income from service in the military?

If YES, What was the total amount of you 

received last month? 

What was the total received last month in Supplemental Security Income checks?

How much of the wages and salary you received during the past 12 months was from military pay? 

Please include money received from special pays, allowances, and bonuses. Do not include military 

housing allowance. During last month did you receive income or 

loss from your own nonfarm business, partnership, or professional practice?

If YES- What was the amount of income or loss after 

expenses last month?

During last month did you receive income or 

loss from your own farm ?During the past 12 months how much income or 

loss did you receive from your own nonfarm business, partnership, or professional practice? 

Abt Associates Inc.D-6                       Survey Instruments

During last month, did you receive any income from -

6.My next questions are about income received by your household. I’m first going to ask you about your income, and then about the income of each other adult in your household. I realize that these questions may seem intrusive, but they are important in understanding the financial needs of WIC participants. As with other questions in this survey, I want toreassure you that the information you provide to us is kept confidential.

During last month did you receive wages or 

salary? Include commissions, tips, Armed Forces

pay and allowances.How about during all of last year? How much did you receive in wages or salary during the past 12 months? Include commissions, tips, 

Armed Forces pay and allowances.

If YES- What was the amount of wages or salary that 

you received last month before any deductions for taxes or anything else?

If YES, What was the amount of income or loss after 

expenses last month?

Any Supplemental Security Income checks from the U.S. Government?

INTERVIEWER INSTRUCTIONS- Comember listed in BLUE section of When Section D is complete for Section E.
Section D - Individual Income and Earnings a. PERSON NUMBER: b. NAME:

8. PUBLIC ASSISTANCE

Use additional sheets as necessary. $ _______________.00

INTERVIEWER - CHECK BOX IF LOSS. 1 LOSS

Now I’m going to ask you about (READ NAME FROM ABOVE)’s income. OR 14. General Assistance? INTERVIEWER- Replace "..." with NAME OF PERSON. 1 NONE 

1. UNEARNED INCOME 

1 YES 2 NO 15. 

16. Non-military housing subsid

9. Unemployment compensation? 1 YES 2 NO 

$ _______________.00 17. Emergency Assistance? 

2. 

$ _______________.00 18. Black Lung benefits? 

$ _______________.00 10. Worker’s compensation? 1 YES 2 NO 

OR 

1 NONE 19. Other public assistance? 

3. 1 YES- Go to 4. $ _______________.00 

2 NO- Go to 5. 11. Income from veteran’s benefits? 1 YES 2 NO If YES, ask4. Which program is that from? __

How much did . . . receive last 

$ _______________.00 20 INTERVIEWER CHECK ITEM 

$ _______________.00 

5.

1 YES 2 NO 12a. From Social Security checks? 1 YES 2 NO EDUCATION BENEFITS

12b. From Railroad Retirement checks? 1 YES 2 NO 21a.

If YES in item 12a and/or 12b, ask- 

$ _______________.00 12c. 

INTERVIEWER - CHECK IF LOSS. 1 LOSS 21b.

$ _______________.00 

During last month did ... receive - 

$ _______________.00 If YES to 21a or 21b askINTERVIEWER - CHECK BOX IF LOSS. 1 LOSS 13a. 1 YES 2 NO 22a. How much educational aid 

OR 22b. 

1 NONE 13b. 1 YES 2 NO 

7. 1 YES 2 NO 22c. 

If YES in item 13a and/or 13b, ask- 

$ _______________.00 13c. $ _______________.00

INTERVIEWER - CHECK BOX IF LOSS. 1 LOSS Go to item 14. 

6. During the past 12 months how much income or 

loss did you receive from your own nonfarm business, partnership, or professional practice? During last month did you receive income or 

loss from your own farm ?

If YES, What was the amount of income or loss after 

expenses last month?

During the past 12 months how much 

income or loss did you receive from your own farm?

INTERVIEWER - This page must be completed for each adult listed in the BLUE section of the Household Enumeration Worksheet. Start with person listed after respondent. Copy person number and name to space at right.

During last month did ... receive wages or 

salary? Include commissions, tips, Armed Forces

pay and allowances.How about during all of last year? How much did ... receive in wages or salary during the past12 months? Include commissions, tips, Armed 

Forces pay and allowances.

If YES- What was the amount of wages/salary 

received last month before any deductions for taxes or anything else?

My next questions are all about income that ... received during last month.

During last month, did ... receive any income from -

During the past 12 months, did ... receive any 

income from service in the military?

What was the total received last month in Supplemental Security Income checks?

How much of the wages and salary received duringthe past 12 months was from military pay? Please 

include money received from special pays, allowances, and bonuses. Do not include military 

housing allowance. During last month did ... receive income or loss 

from ...’s own nonfarm business, partnership, or professional practice?

If YES- What was the amount of income or loss after 

expenses last month?

If YES- What was the total amount of 

unemployment compensation ... received last month?

If YES- How much did . . . rece

If YES, What was the total amount 

received last month? 

During last month did ... receive from the 

U.S. Government any moneyLow Income Energy Assista

If YES- How much did . . . rece

Check Section C, item 9a. Is penrolled in college full-time or 

If YES, What was the total amount received last month? 

Survey Instruments                       D-7Abt Associates Inc.

Last month, was . . . receivinbenefits such as scholarshipor grants?

What was the amount of Social Security orRailroad Retirement payments received last month?Any Supplemental Security Income checks from the State or local Government?

For what time period did thLast month, was . . . receivineducational benefits for vethe GI Bill or VEAP?

How much of that money was expenses- that is, excluding mtuition, fees, and books?

Any Supplemental Security Income checks from the U.S. Government?

Besides food stamps and TANF (which we will talk about a little l

receive any public assistance fr

INTERVIEWER INSTRUCTIONS- Comember listed in BLUE section of When Section D is complete for Section E.
Section E - Household Income and Food Spending

1. INTERVIEWER CHECK ALIMONY FOOD SPENDING

7. 13a.

1 YES 

1 YES - Go to 2. 2 NO 

2.

$ _____________.00 INTERVIEWER- PROBE IF NEC

If YES, askCHILD SUPPORT b. How much? 

8a. c. Is that per week or the ent

14.

REGULAR INCOME SOURCES 1 YES

2 NO 

If YES, ask (b) and (c)-

b.

2. Interest on savings accounts or bonds? 1 YES $ _____________.00 Is that per week or per mo

2 NO 1 monthly

2 lump sum 15.

$ _____________.00 LUMP SUM INCOME

3. 1 YES 9. Now I have a question about the past year. 

2 NO 1 YES

2 NO Is that per week or per mo

$ _____________.00 FOOD AND OTHER ASSISTANC

4. 1 YES If YES- What was the total amount received? $ _____________.00

2 NO PUBLIC ASSISTANCE 

10. 

1 YES 16.

$ _____________.00 2 NO 

5a. 1 YES

2 NO 11. 

If YES, ask- 1 YES

b. $ _____________.00 2 NO 

c. INTERVIEWER- CHECK IF LOSS. 1 Loss 19. 

$ _____________.00 $ _____________.00 20.

e. INTERVIEWER- CHECK IF LOSS. 1 Loss 12. 1 YES 

2 NO

6. 1 YES 21.

2 NO If NO, skip to 14. 

$ _____________.00 

$ _____________.00

Local food pantries?Temporary Emergency Assistance Program (TEF

(2) How much net income or loss was received from other rental units last month?

The Summer Feeding ProSummer Food Service P

(1) How much net income or loss was received from roomers or boarders last month?

If YES- What was the total amount received last 

month by all household members? 

The Commodity SuppleProgram (CSFP)?

22.

Regular contributions from other sources such asgifts from relatives or friends?

If YES- How many dollars worth of food stampbenefits did your household receive last month? Last month, did you (or any member of your 

household) receive any food stamp benefits from the government’s Food Stamp 

program?

In the next set of questions, I will ask you about your household - that is, the persons with whom you share major expenses. The persons I’m including in your household are (READ NAMES OF ALL PERSONS LISTED ON 

THE HOUSEHOLD ENUMERATION WORKSHEET.)

d.

If YES- What was the total amount received by 

all household members last month? 

Regular income from dividends, royalties, estates, or trusts?

Was this a monthly payment or a lump sum payment?If YES- What was the total amount of TANF 

received by ALL household members last month? During the past year, did you (or any 

member of your household) receive any property or money, valued at over $100, from

estates, trusts, prizes, lottery winnings, severence pay or any other source?

If YES- What was the total amount of interest 

received by all household members last month?

c.

If YES- What was the total amount of alimony 

received by ALL household members last month? 

During last month, did you (or any member 

of your household) receive any payments from TANF (Temporary Aid for Needy Families)? This is the program that replaced 

AFDC.

The National School LunThe School Breakfast pro

18.17.

Is anyone in your housereceiving benefits fromFood Distribution PrograReservations (FDPIR)?In addition to what your bought with food stamphousehold spend any mthat you used at home l

During last month, did you (or any member 

of your household) receive any money from someone living outside your household for alimony?

In an average week, ab

much does your househeating out, not counting work or at school?

Do you live in public housing or do you (and your family) receive a rent subsidy or pay a lower rent because the federal, state, or local government is paying part of the cost?

In an average week, hodoes your household spthat you use at home? 

[INTERVIEWER - this includepurchases and non-food spurchases.]

During last month, did you (or any member 

of your household) receive any money from someone living outside your household for child support?

What was the total amount received by ALL household members last month? 

D-8                       Survey Instruments

Net income or loss from any type of rental of rooms or living units?

Abt Associates Inc.

Do all persons on the household roster have an (X) marked in item 12 in Section A?

Income from pensions or annuities from private companies, military, Government, IRA, or Keogh?

During last month, did you (or any member of your household) receive any money, even if only a small amount, from any of the followingIf YES- What was the total amount received by 

all household members last month? 
Section F - Food Security - Ask these items for entire household as a group. INTERVIEWER CHECK

 FOOD SECURITY 4d. 

4. (continued)

1.

CHECK ONE ITEM. Have enough to eat and the kinds of food you wanted 1 Go to Section G.Have enough to eat, but not always the kinds of food you wanted 2 Skip to item 3. Sometimes not have enough to eat 3 Go to item 2.Often not have enough to eat 4 Go to item 2.

g. PERSON# NAME

2. 

YES NO

PERSON# NAME

a. Not enough money for food 128 b. Too hard to get to the store 128 PERSON# NAME

c. On a diet 128 

d. Not able to cook or eat because of health problems 128 PERSON# NAME

e. No working stove 128 

PERSON# NAME

3. 

YES NO 5. 

a. Not enough money for food 128b. Too hard to get to the store 128 

c. On a diet 128

d. Not able to cook or eat because of health problems 128 a.

e. No working stove 128 Was it ... (READ CHOICES) 

6. 

4. 

7. 8. 

a. 

123 9. 

b. 

123

c. We couldn’t afford to eat balanced meals.

123 a.

Alm

Was it ... (READ CHOICES) 

Alm

(NAME OF CHILD) was not 

eating enough because we

just couldn’t afford food.

INTERVIEWER - Copy person number and name from RED section 

Worksheet to spaces below. Ask question (g) for each child.

In the last 12 months, did you ever eat less than you felt you sbecause there wasn’t enough money to buy food?

In the last 12 months, did you or other adults in your househocut the size of your meals or skip meals because there wasn’enough money for food?

OFTEN

We worried whether our food would run out before we got money to buy more.

SOMETIMES

If YES- How often did this happen? (HAND CARD)In the last 12 months, were you ever hungry but didn’t eat beyou couldn’t afford enough food?In the last 12 months, did you lose weight because you didn’enough money to buy food?In the last 12 months, did you or other adults in your househonot eat for a whole day because there wasn’t enough money food?

Do the following reasons why people don’t always have the kinds of 

food they want or need apply to your household?

We relied on only a few kinds of low-cost food to feed the chbecause we were running out of money to buy food.We couldn’t feed the children a balanced meal because we couldn’t afford that.

f.

e.

Which of the following statements best describes the food eaten in your household during the last 12 months? Did your householdDo the following reasons why people don’t always have enough to 

eat apply to your household? Don’t Know

Abt Associates Inc.Survey Instruments                       D-9

The next questions ask about your household and access to food. The persons I’m including in yourhousehold are (READ NAMES OF ALL PERSONS LISTED ON HOUSEHOLD ENUMERATION WORKSHEET).

Are there any children listed in the RED section of the Househ

Enumeration Worksheet?If YES - How often did this happen? (HAND CARD)

Considering the past 12 

months, please tell me 

whether or not the following

statement was OFTEN, SOMETIMES, or NEVER trueNEVER Considering the past 12 months, please tell me whether or not the following statements were OFTEN, SOMETIMES, or NEVER true of your household. Don’t Know

The food that we bought just didn’t last and we didn’t have money to get more.
Section F - Food Security (continued) Complete each question for all children then move to next question. In reading each question, replace . . . with nam

10. CUT MEALS 11. SKIP MEALS 11a. FREQUENCY OF SKIPPED MEALS 12. EVER HUNGRY 

PERSON# NAME YES NO Don’t Know YES NO Don’t Know YES NO Don

1 2 8 1 2 8 1 2 3 8 1 2 1 2 8 1 2 8 1 2 3 8 1 2 1 2 8 1 2 8 1 2 3 8 1 2 1 2 8 1 2 8 1 2 3 8 1 2 1 2 8 1 2 8 1 2 3 8 1 2 1 2 8 1 2 8 1 2 3 8 1 2 1 2 8 1 2 8 1 2 3 8 1 2 1 2 8 1 2 8 1 2 3 8 1 2 

Don’t 

Know

Almost 

every 

month

Some 

months 

but not 

every 

month

Only 1 or 

2 months

Abt Associates Inc.D-10                      Survey Instruments

How often did this happen? (READ 

CHOICES) In the last 12 months

(NAME OF CHILD) ever 

hungry but you just couldn’t afford more 

INTERVIEWER - Copy person number and name from RED section of Household Enumeration Worksheet to spaces below.If there are no children in the household, go to Section G.

In the last 12 months, did you ever cut the size of 

(NAME OF CHILD)’s meals 

because there wasn’t enough money for food?

In the last 12 months, did 

(NAME OF CHILD) ever skip 

meals because there wasn’t enough money for food? If No, go to item 12.
Section G - Health Insurance - Ask these items for sampled person.

1. INTERVIEWER CHECK ITEMIs sampled person an infant or child? (SEE ITEM 3 ON PAGE 1)

 1 YES - Questions in this section refer to infant/child. Write name of child here ____________________ and substitute NAME OF CHILD in all questions below.  2 NO - Questions in this section refer to respondent. Read "YOU" in questions below.

2.

1 YES- Go to 3. 2 NO- Go to 7. 8 Don’t Know- Go to 7.

3. 7.

a. Policy from own/SPOUSE’S current employer 1b. Policy from own/SPOUSE’S previous employer 2c. Policy bought directly from a medical insurance company 3 a. Not eligible for Medicaid or Welfare d. Medicaid/Medi-Cal/Medical Assistance/Welfare/Medical Services 4 b. Not employed - can’t afford premiums e. Other, SPECIFY _______________________________________ 5 c. Not employed - lost job, did not continue coverage 

4. d. Employed, but employer does not offer insurance 

e. Employed - employer offers insurance and you are 

 eligible, but cannot afford the premiums 

f. Don’t believe in or haven’t needed health insurance 

a. Breastfeeding nutrition/support . . . . . 1238 g. Don’t think you can get private health insurance b. Nutrition education . . . . . . . . . . . 1238 h. Don’t think you can get Medicaid c. Immunizations . . . . . . . . . . . . . . 1238 i. Been refused health insurance due to poor health d. Well baby care . . . . . . . . . . . . . . 1238e. Well child care . . . . . . . . . . . . . . 1238 Go to item 8.

5. INTERVIEWER CHECK ITEM 1 YES - Go to item 6.

 Is item 3d (box 4) checked? 2 NO - Go to item 8.

8. 1 YE

6. 1 YES 2 NO

2 NO

IF YES, ask - Who is that?

Go to Section H, next page.

Go to Section H, next page.

Now we have a few questions about health care and hospitalization plans. We are interested in all kinds of health insurance plans except plans that pay only for accidents.

What is the source of (YOUR / NAME OF CHILD’s) health or hospitalization 

plan? READ LIST. CHECK ALL THAT APPLY.

PROBE IF NECESSARY. Examples of health and hospitalization 

insurance plans include Blue Cross, Blue Shield, Medicaid, MediCal, Medical Assistance, Welfare, Medical Services.

From (YOUR / NAME OF CHILD’S) health 

insurance plan, are the following services available for free, at additional charge, or not at allC

TH

Many people do not carry health insurance for various reasons. Which of these statements describes the reasons (YOU / NAME OF 

CHILD) do not have health insurance? READ LIST. CHECK ALL 

THAT APPLY.

[Are you / Is NAME OF CHILD] covered by any kind of private or 

government health or hospitalization plans or health maintenance organization (HMO) plans? 

Abt Associates Inc.Survey Instruments                      D-11

Is anyone in your household currently enrolled in Medicaid?INTERVIEWER- Enter person numbers from 

Household Enumeration Worksheet to 

boxes.

CHECK ALL

THAT APPLY

Don’t 

Know

Do (YOU / NAME OF CHILD) receive Medicaid services 

from a managed care program?

Not 

Available

Available

at extra 

charge

Available

for free
Section H - Customer Satisfaction

1. WIC REFERRAL DON’T 2. DIFFICULTIES WITH WIC Who referred/sent you to WIC? YES NO KNOW

a. A friend 

If YES,ask- 128 Does friend receive WIC? 128 BIG SOME NONE

b. Family member 128 a. Lack of transportation to the clinic 123

If YES, ask- Does family member receive WIC? 128 b. Inconvenient hours/days clinic is open 123

c. Doctor/Health professional c. Services take too much time 123

If YES,ask- 128 Is doctor from- d. Waiting space at the clinic is limited 123 Medicaid? 128 HMO? 128 e. Lack of child care 123 Private doctor? 128

d. No one. f. Language barriers 123

128

e. Television advertisement g. Problems qualifying for benefits 123

128

f. Radio advertisement

128

g. Newspaper advertisement 3. INTERVIEWER CHECK ITEM

128

h. Billboard/poster advertisement IF SAMPLED PERSON IS PREGNANT, POSTPARTUM, OR BREASTFEEDING WOMAN128

i. Pamphlet 1 YES- Go to Section I (Contact 

128 2 NO- Go to item 4 on next pag

j. Other (specify)____________________

128

IF SAMPLED PERSON IS INFANT OR CHILD1 YES- Go to item 4 on next pag

2 NO- Go to Section I (Contact 

D-12                      Survey Instruments

I’m going to read a list of things that might make it difficult to participate in the WIC Program. For each one, please tell me if it is a BIG PROBLEM, SOMEWHAT OF A PROBLEM, or NOT A PROBLEM for you.

Is YES checked for Section B, item 8 or item 8a (receiving WIC now or ever enrolled in WIC)?Is YES checked for item 10 on page 1 (first WIC certification)?

Abt Associates Inc.
Section H - Customer Satisfaction - Continued

4. DIFFICULTIES WITH WIC 7. WIC BENEFITS 9. MISSED APPOINTMENTS (C

or NOT A PROBLEM. BIG 

PROBLEM

SOME 

PROBLEM

NO PROBLEM d. Cannot find child care 

a. SCALE 0-5 e. It’s too far away from h

123 a. Time to talk with other mothers

b. b. Money saved on grocery bills 

123 c. Health information g. Other (specify) 

c. d. Nutrition information

123 e. Checking blood, height, and weight _____________________

d. f. Advice from WIC staff

_____________________

123 g. Vouchers for foods I know are nutritious 10. STOPPED WIC

5. WIC FOOD BRANDS h. Helps me stay on time with shots for my child 

i. Taught me about breastfeeding 

j. Taught me about the foods babies need

provides for- VERY 

SATISFIED

FAIRLY 

SATISFIED

 NOT 

SATISFIED k. Taught me about the foods children need SHOPPING

a. breakfast cereals 1 2 3 l. Taught me about foods I need

b. juices 1 2 3 m. Other (specify) __________________________

c. baby formula 1 2 3 ______________________________________________ 

d. milk 1 2 3 WIC APPOINTMENTS

e. cheese 1 2 3 8a. 1 Yes

f. eggs 1 2 3 2 No- Go to 10. 

g. beans or peanut butter 1 2 3 12. 

6. WIC FOOD QUANTITIES 8b. 1 Sometimes 

2

Often 

3 Just once 13.

of foods WIC provides for- VERY 

SATISFIED

FAIRLY 

SATISFIED

 NOT 

SATISFIED

9. MISSED APPOINTMENTS 

a. breakfast cereals 1 2 3 a. breakfast cereals b. juices 1 2 3 YES NO DON’T KNOW b. juices 

c. baby formula 1 2 3 c. baby formula 

d. milk 1 2 3 a. Forget to go 1 2 8 d. milk 

e. cheese 1 2 3 b. e. cheese 

f. eggs 1 2 3

12 8 f. eggs 

g. beans or peanut butter 1 2 3 c. Cannot get off work 1 2 8 g. beans or peanut butte

It takes too long at the 

f.

Have you missed appo

I’m going to read another list of difficulties that you might have had participating in the WIC Program. For each one, please tell 

me if it is a BIG PROBLEM, SOMEWHAT OF A PROBLEM, 

I am going to read you a list of potential benefits of the WIC program. Please indicate how valuable they are to you (or your child) by giving me a number from 0 to 5, with 5 meaningextremely valuable and 0 being not valuable to you at all.Have trouble finding transportation

By the end of the monpurchase all of the WIC prescribed for you?Do you find it is EASY, S

CONFUSING, or OFTEN C

to shop with WIC food vouchers/checks?

11.

Have you missed appointments because youNow I have just a few q

about shopping with Wvouchers/checks.Have you ever stoppeWIC even though you your children) were stilfor WIC?

Have you ever missed an appointmentat the WIC clinic?Would you say that you miss appointments SOMETIMES or OFTEN?

Do you typically purchthe (READ CATEGORY) preyou?

Survey Instruments                      D-13Abt Associates Inc.

Treated negatively in grocery storeLack of transportation to get groceriesProblems using WIC vouchers/checksTreated negatively by staff membersWIC food vouchers or checks are for particular brands of foods . Are you VERY SATISFIED, FAIRLY SATISFIED, or NOT SATISFIED with the 

brands of foods WIC WIC food vouchers or checks are for particular quantities of foods.

Are you VERY SATISFIED, FAIRLY SATISFIED, or NOT SATISFIED with the 

quantities 
Section I - Contact Information 8. Do you expect to change your name in the next year or so? 

INTERVIEWER - BEGIN HERE WHEN SKIPPING FROM ITEM 9 ON PAGE 1, ELSE BEGIN WITH Thank you. What will your new name be? FIRST NAME LAST 1. What is the name of (NAME OF CHILD)’s parent or guardian?

FIRST NAME LAST NAME 9. Do you expect to move in the next year or so? 

Approximately when do you expect to move?

MON

INTERVIEWER -GO TO ITEM 2 AND ENTER FULL CONTACT INFORMATION FOR PARENT/GUARDIAN. Do you know your new address?RECORD RESPONDENT’S CONTACT INFORMATION IN ITEM 10. STREET ADDRESS (House No., Street, Apt. No., or other identification)

CITY/PLACE STATE ZIP C

2. What is your (the) exact address? 10. Please tell me the name and address of a relative or friend wh

STREET ADDRESS (House No., Street, Apt. No., or other identification) FIRST NAME LAST NAME

STREET ADDRESS (House No., Street, Apt. No., or other identification)

CITY/PLACE STATE ZIP CODE CITY/PLACE STAT

3. Is this also your (the) mailing address? 1 Yes 2 No - Specify below. And what is (his/her) phone number? ( ) 

STREET ADDRESS (House No., Street, Apt. No., or other identification)

________________

11.

CITY/PLACE STATE ZIP CODE FIRST NAME LAST NAME

4. What is your (the) phone number? ( ) - STREET ADDRESS (House No., Street, Apt. No., or other identification)5. Under what name is the phone FIRST NAME LAST NAME

listed? CITY/PLACE STAT

INTERVIEWER - IS RESPONDENT OR SPOUSE/PARTNER EMPLOYED? 1 YES- Go to item 6 .

 (CHECK SECTION C, ITEM 6.) 2 NO- Go to item 8.

6. ( ) -

What is (his/her) relationship to you? ________________

7. What is (your / spouse / partner’s) employer’s name and address? 12. ( ) 

EMPLOYER NAME

b. Where is that?

________________

STREET ADDRESS (House No., Street, Apt. No., or other identification) INTERVIEW STATUS CODES 

 1 Complete Interview 4 Unable to intercept 2 Partial Interview 5 Refused -time constraint  3 Inconsistent cert cat 6 Refused-doesn’t want to participate 

 7 Refused-other reason 

 Status Cod

Thank you for answering my questions. We may need to contact you at a later date to ask you some additional questions. I’d like to ask you some questions concerning ways to contact you.

What is (his/her) relationship to you?And what is (his/her) phone number? ( )Please tell me the name and address of a second relative or fyou.Is there another phone number where you can usually be reached?

CITY/PLACE STATE

D-14                      Survey InstrumentsAbt Associates Inc.

What is (your / spouse / partner’s) phone 

number at work?

ZIP CODE
1. Case ID

2. Local Agency3. Site4. Site ID5. Sampled person In-Home Interview6. Sampled Person Certification Category7. Respondent’s name 8. Respondent’s phone number 9. Respondent’s address

12. Field Data Collector ______________________________________________________________

TIME NOTES

ACTIVITY Began

a.m.

10. Reference Month p.m.

Abt Associates Inc.Survey Instruments                      D-15

INTERVIEW TIME

O

DATE 

(mm/dd/yy)

NOTICE - Public reporting burden for this collection of information is estimated to average 45 minutes per response, including the searching for existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control nthis burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: DepaBox 7630, Washington, DC 20250.

NATIONAL SURVEY OF WIC PARTICIPANTS

AND THEIR LOCAL AGENCIES
Section A - Household Enumeration INTERVIEWER - Complete each question for all persons listed in item 1, then move to next question. Replace MONTH wit

Part 1- Household roster preprinted from In-Person interview.

4. INTERVIEWER CHECK ITEM 5a.

1. 2. HOUSEHOLD ROSTER

(HAND CA

If YES, check name in item 2. If YES, ask - Where is that?

(HAND CARD)

Confirm with check Enter age in years.or enter code in item 5a.

AGE 

01 1 1 1 RESPONDE

02 1 11 03 1 11 04 1 11 05 1 11 06 1 11 07 1 11 08 1 11 09 1 11 

YES NO

1 21 21 21 21 2

If respondent answers YES in(a)-(d), ask for name of household member. If name is preprinted in the roster, place a check next to name. 

If name is not preprinted, write name in Item 2 on next page.

D-16                      Survey InstrumentsAbt Associates Inc.

b. anyone who usually lives with you but is away now travelling, at school, or in a hospital? . . . . . . . . . . . . . . . . . . . . . . . . . .If name is preprinted, check box.d. anyone who is part of the household but is away on full-time active duty with the Armed Forces? . . . . . . . . . . . . . . . . . . . . . . e. anyone else staying with you? . . . . . . . . . . . . . . . . . . . . .c. any lodgers, boarders, or persons you employ who live with you? a. any babies or small children? . . . . . . . . . . . . . . . . . . . . . .

3. I have listed ... (Read names from item 2.) Have I missedIf name is not preprinted, enter name in Item 2 on next page. PRE-PRINTED NAMES

PERSON NUMBER

CHECK 

HERE

CHECK 

HERE

PRE-PRINT

PRE-PRINTED RESIDENCE PRINTED 

AGE RELATIONS

CHECK EXPLANATION HERE

USUAL RESIDENCE CODE

I will begin by reviewing with you some information about your household. 

GO TO ITEM 3. Please tell me the names of all persons who lived in your household during MONTH. Just tell me their first names. Did ... live in your household last month? If NO, enter explanation of discrepancy below. 

If name in Item 2 is not checked, ask

Does ... have a usual residence somewhere

else?

7. RELATIONSHWhat is ...’s re

5. USUAL RESIDENCE

How old was ... on his/her last birthday?Confirm with check 

or enter correct age. Confirm with c

from below.

6. AGE

RELATIONSHIP

1 Spouse 

 2 Partner  3 Son/daughte 4 Step-child 5 Foster child  6 Mother  7 Step-mother 8 Foster mother 9 Father 10 Step-father 11 Foster father 

USUAL RESIDENCE

1 Military quarters

 2 School or institution 3 Vacation or in hospital 

 4 At college 5 Working away from home 6 Separate residence 7 Jail/prison 9 Other
Section A - Household Enumeration (continued) INTERVIEWER - Complete each question for all persons listed in item 1, then move to next question. Repla

Part 2- Household members NOT preprinted from In-Person interview. 

1. 2. HOUSEHOLD ROSTER (continued) 6. AGE

(HAND CARD) 

FIRST NAME LAST NAME YES NO CODE AGE MALE FEMALE

10 12 1 211 12 1 2

12 12 1 2

13 12 1 214 12 1 215 12 1 2

16 12 1 2 

17 12 1 2

18 12 1 219 12 1 2

Abt Associates Inc.Survey Instruments                      D-17

 ITEMS 3 AND 4 

INTENTIONALLY 

LEFT OFF THIS 

PAGE.

9. BIOL

If YES,. e

number

children 

Is ... thparenchildrehouse

6b. SEXIs . . . male or female?

8. INT CHECK

ITEM

What is ...’s relationship to you?

Mark (X) if relationship

code (Item7) is greater than 5.

Ask if not 

apparent.

INTERVIEWER - IF NO NAMES HAVE BEEN ADDED, GO TO NEXT PAGE.

PERSON NUMBER

7. RELATIONSHIP TO RESPONDENT How old was 

... on his/her last birthday?

Enter age in years. Enter code from list 

below.

5. USUAL RESIDENCEDoes ... have a usual residence somewhere else?If YES, ask - Where is 

that? (HAND CARD)

Enter code from list below.

RELATIONSHIP

1 Spouse 

 2 Partner  3 Son/daughter 4 Step-child 5 Foster child  6 Mother  7 Step-mother 8 Foster mother 9 Father 

10 Step-father 

CODES12 Brother/sister 13 Grandparent14 Uncle/aunt15 Cousin16 Nephew/niece17 Father-in-law18 Mother-in-law19 Bro/sis-in-law20 Other-in-law21 Roomer/ 

USUAL RESIDENCE1 military quarters2 school or institution3 vacation or in hospital 4 at college5 working away from home6 separate residence7 Jail/prison9 other
Section A - Household Enumeration (continued) 

Part 3- FINANCIAL RELATIONSHIPS

INTERVIEWER- Names of household members are printed below according to relationship to sampled person. Add names from Page 3 according to the following rul

a) If relationship code is greater than 4 enter person number and name in LIST OF ADDITIONAL HOUSEHOLD MEMBERS.b) If relationship code is 4 or less, enter person number and name in COLUMN 1

 If there are no names in LIST OF ADDITIONAL HOUSEHOLD MEMBERS, go to item 12; otherwise, go to INTERVIEWER INSTRUCTIONS below LIST OF ADDITIONAL HOUSEHO

12. FINANCIAL RESPONSIBILITY COLUMN 1 COLUMN 2 

PERSON NUMBER NAME

PERSON NUMBER NAME

PERSON NUMBER NAME

PERSONUMBE

Replace ... with names in COLUMN.

1 YES 1 YES 2 NO 2 NO 

INTERVIEWER INSTRUCTIONS 1 YES 1 YES 

2 NO 2 NO 1 YES 1 YES 2 NO 2 NO 1 YES - Go to 12a for COLUMN 2. 1 YES - Go to 12a for COLUMN 3. 2 NO- Ask item (d). 2 NO- Ask item (d). 1 YES- Ask item (e). 1 YES- Ask item (e). 2 NO 2 NO 

Go to item 12.

D-18                      Survey InstrumentsAbt Associates Inc.

LIST OF ADDITIONAL HOUSEHOLD

(d) Does all or part of the money to pay for ... (Specify expenses with "No" marked in items 12(a)-(c)) come from someone else in this household? If YES, enter names of immediate family 

members in COLUMN 3 and cross names off LIST.Copy first name from LIST OF ADDITIONAL HOUSEHOLD MEMBERS to COLUMN 2, cross the

name off LIST and ask,Is anyone in this household the spouse, partner, son, daughter, or step-child of ...?If YES, enter names of immediate family members in COLUMN 2 and cross names off LIST.

(PRE-PRINTED)

If all names are not crossed off LIST then copy next name to COLUMN 3, cross this name off LIST and ask,Is anyone in this household the spouse, partner, son, daughter, or step-child of ...?

(PRE-PRINTED) Ask (a)-(e) for group of persons 

listed in COLUMN 1. Then ask (a)-(e) 

for person or group of persons listed in COLUMN 2. Then ask (a)-(e) for person or group of persons in 

COLUMN 3.(b) Do(es) ... pay for all food expenses with (YOUR/THEIR) own 

money?(c) Do(es) ... pay for all other living expenses such as clothing, transportation, etc., with (YOUR/THEIR) own money?INTERVIEWER CHECK ITEM Are two or more "Yes" boxes marked in items 12(a)-(c)?

MEMBERS

(a) Do(es) ... pay for all housing expenses with (YOUR/THEIR) own 

money?(e) Who is (are) these persons? Enter person numbers. 
Section A - Household Enumeration - Continued

Part 4- CHILD INFORMATION - Complete all items for first child listed, then go to next child. In reading each question, replace . . . with name in item 13.

14. PARENT 15. DEPENDENT

1 2- Other parent

3- Other 

2 NO- Go to next page. Record code below Record code below Record code below

PERSON # NAME PERSON NUMBER

Abt Associates Inc.Survey Instruments                      D-19

17. CHILD’S HOUSEHOLD

Enter person numbers 

from Section A.

2 - The other parent’s household1 - This household

16. TIME SPENT IN HOUSEHOLD

Which household does (his/her) parents agree ... lives?

Who are ...'s parents?For each child listed in 

item 13, ask

CODE CODE

How much time does ...spend living here? 2- Exactly half of the time3- Less than half 1- More than half of the time

Who claims ... as a dependent on income tax 

YES- Enter children’s person numbers and 

names below.

Are any children in this household under a joint custody arrangement where one parent lives elsewhere?

CODE

13. JOINT CUSTODY

1- Parent living in the household
Section B - Employment History INTERVIEWER - Complete questions 2-12 for first person listed, then go to next person. Replace ... with nam

1. ADULT ROSTER 5. TENURE 9. WHY 

LEFT

10. WAGE 

How long did ... work at that job before leaving?

Why did ... leave ...’s last job?

What was most receon that job

Enter number 

of months.

Go to item 

6.

PERSONNUMBER NAME YES NO YES NO MONTH /YEAR MONTH /YEAR YES NO MONTH /YEAR 

1212 / / 1 2 / $ ________

1212 / / 1 2 / $ ________1212 / / 1 2 / $ ________1212 / / 1 2 / $ ________1212 / / 1 2 / $ ________1212 / / 1 2 / $ ________1212 / / 1 2 / $ ________1212 / / 1 2 / $ ________

D-20                      Survey InstrumentsAbt Associates Inc.

INTERVIEWER - Listed below are names of all household members age 16 years and older. Check page 3 to see if names were added to the roster and copy person numbers and names of household members age 16 years and older from page 3 to list below.

4. JOB START 6. JOB START 8. WHEN LEFT

When did ... start working for that employer?

When did ... start working for ...’s current employer?

2. ANY WORK 3. SAME JOB

If YES, go to item 

3.

Is ... still employedat the same job aslast month?If YES, go to item 

4.

Has ... ever worked for pay?

When did ... leave ...’s last job?

7. EVER WORK

HAND CARD

Enter code from below.

If NO, go to item 

7.

If NO, go to item 

5.

Go to item 10. Go to item 10. If YES, go to 

item 8.

If NO, go to 

next person.

During last month, did ... do any work at all for which ... was paid?

WHY LEFT JOB1 Layoff or plant closin2 End of temporary/se3 Discharged or fired4 Program ended5 Quit for pregnancy oreasons
Section C - Income Review Form

PART 1 - INDIVIDUAL INCOME AND EARNINGSINTERVIEWER - A separate pre-printed Section C is provided for each adult member of household reported at certification. Use additonal sheets for adults added to hous

REPEAT CONFIDENTIALITY STATEMENT

1. INCOME SOURCE 2. TYPE OF DOCUMENT 3. INTERVIEWER CHECK 4. UPDATED AMOUNT 5. FREQUE

If YES, go to item 5.

If No, go to item 4.

IF NO, GO TO NEXT INCOME ITEM. next income item. DOCUMENT

YES NO NOT AVAIL

1 Earnings statement/pay stub 1 We2 W-2 Form 2 2 W

1 YES 3 1997 Income tax return (IRS 1040A, line 7; IRS 1040EZ, line 1) 3 Mo2 NO 4 Receipts for cash jobs 12 3 $ .00 4 Qua

5 Other ___________________________________________

1 Yes - Go to item ab 2 No - Go to item b. 2 wages fluctuate 

1 Leave and Earnings Statement (LES) 1 We5 Other ___________________________________________ 2 2 W

1 YES 3 Mo2 NO 12 3 $ .00 4 Qua

1 1997 Income tax return, IRS 1040A line 12 1 We

1 YES 2 Business records 2 2 W2 NO 3 Expense receipts 3 Mo

4 Other ___________________________________________ 12 3 $ .00 4 Qua1 1997 Income tax return, IRS 1040A line18 1 We

1 YES 2 Business records 2 2 W2 NO 3 Expense receipts 3 Mo

4 Other ___________________________________________ 12 3 $ .00 4 Qua1 Notice of determination or redetermination (award letter) 1 We

1 YES 2 Copy of check or check stub 2 2 W2 NO 3 1997 Income tax return (IRS 1040A, line 19; IRS 1040EZ, line 3) 3 Mo

4 Other ___________________________________________ 12 3 $ .00 4 Qua

Abt Associates Inc.Survey Instruments                      D-21

INTERVIEWER- Enter amount of income shown on document. 

What pthis co

ac. INTERVIEWER CHECK ITEMIf document type is an earnings stapay stub, record the YEAR-TO-DATE 

INTERVIEWER - RECORD AMOUNT OF BASE PAY, excluding BAQ (Basic 

Allowance for Military Quarters), LQA (Living Quarters Allowance), VHA (Variable Housing Allowance).

same every week

I now have some detailed questions about your household income. Last month when we interviewed you, we asked about all the sources of income that your household sometimes, to recall all of the information during an interview, we scheduled this followup meeting in your home where you can check your income records.I’m going to read a list of income sources. Most people have only a few sources of income, but to help people remember income they may have forgotten, I will read thincome records as we go along. I’ll begin with your income. INTERVIEWER- FOR EACH INCOME SOURCE (a)-(r), WORK ACROSS THE PAGE READING ITEMS 1-7.

Does amount on documentation match preprinted amount?

If no document available, go to

Amount 

reported during 

InPerson 

Interview

Do you have any paper documents showing that income? For example (READ FROM LIST BELOW)

e. Unemployment compensationd. Net income from farm. a. Wages and salary, except military incomeDid (YOU / ...) receive income from

INCOME SOURCE during REFERENCE 

MONTH?

b. Military incomec. Net income from nonfarm business or other selfemploymentaa. Is WEEK or 2 WEEKS checked in column 5 for item a?

a. PERSON NUMBER: 01 b. RESPONDEN

 INTERVIEWER CHECK ITEM

ab. Are (YOU / ...) paid the same amount every week 1or do (YOUR / ...'s) wages fluctuate?

INTERVIEWER- Record information from first available type of document from the list below. Note that if respondent does not have documentation for income during the reference month, then income tax return should be reviewed and ANNUAL income should be 

recorded in item 4.
Section C - Income Review Form

PART 1 - INDIVIDUAL INCOME AND EARNINGSINTERVIEWER - A separate pre-printed page is provided for each adult member of household reported at certification. Use additonal sheets for adults added to househo1. INCOME SOURCE 2. TYPE OF DOCUMENT 3. INTERVIEWER CHECK 4. UPDATED AMOUNT 5. FREQUE

If YES, go to item 5.

If No, go to item 4.

IF NO, GO TO NEXT INCOME ITEM. next income item. DOCUMENT

YES NO NOT AVAIL

1 Award notice 1 We

1 YES 2 Copy of check or check stub 2 2 W2 NO 3 Statement/letter from insurance company 3 Mo

4 Other ___________________________________________ 12 3 $ .00 4 Qua1 SSA award letter 1 We

1 YES 2 Statement of benefits 2 2 W2 NO 3 1997 Income tax return (IRS 1040A, line 20a) 3 Mo

4 Other ___________________________________________ 12 3 $ .00 4 Qua1 Notice of benefits 1 We

1 YES 2 Copy of check or check stub 2 2 W2 NO 3 1997 Income tax return, IRS 1040A, line 17 3 Mo

3 Copy of check or check stub 12 3 $ .00 4 Qua1 Copy of check or check stub 1 We

1 YES 2 1997 Income tax return, IRS 1040A, line 17 2 2 W2 NO 3 Other ___________________________________________ 3 Mo

12 3 $ .00 4 Qua

1 Notice of benefits 1 We

1 YES 2 Copy of check or check stub 2 2 W2 NO 3 Other ___________________________________________ 3 Mo

12 3 $ .00 4 Qua

1 Copy of check 1 We2 Support agreement 2 2 W

k. Alimony 1 YES 3 Divorce/separation decree 3 Mo

2 NO 4 Court order 12 3 $ .00 4 Qua

5 Other ___________________________________________1 Copy of check 1 We2 Support agreement 2 2 W

l. Child support 1 YES 3 Divorce/separation decree 3 Mo

2 NO 4 Court order 12 3 $ .00 4 Qua

5 Other ___________________________________________

D-22                      Survey InstrumentsAbt Associates Inc.

Do you have any paper documents showing that income? For example (READ FROM LIST BELOW)INTERVIEWER- Record information from first available type of document from the list below. Note that if respondent does not have documentation for income during the reference month then income tax return should be reviewed and ANNUAL income should be rec

Does amount on documentation match preprinted amount?

Amount 

reported during 

InPerson 

Interview

h. Private pensions, annuities, or survivor’s benefitsg. Social Security (green checks)Did (YOU / ...) receive income fromINCOME SOURCE during REFERENCE 

MONTH?

f. Worker’s compensationi. Veteran’s benefitsj. SSI (Supplemental Security Income)

a. PERSON NUMBER: b. RESPONDEN

INTERVIEWER- Enter amount of income 

shown on document. 

What pthis co

If no document available, go to
Section C - Income Review Form

PART 1 - INDIVIDUAL INCOME AND EARNINGSINTERVIEWER - A separate pre-printed page is provided for each adult member of household reported at certification. Use additonal sheets for adults added to househo1. INCOME SOURCE 2. TYPE OF DOCUMENT 3. INTERVIEWER CHECK 4. UPDATED AMOUNT 5. FREQUE

If YES, go to item 5.

If No, go to item 4.

IF NO, GO TO NEXT INCOME ITEM. next income item. DOCUMENT

YES NO NOT AVAIL

1 1997 Income tax return, IRS 1040A, line 8 or 9 1 We

1 YES 2 Other ___________________________________________ 2 2 W2 NO 3 Mo

12 3 $ .00 4 Qua

1 Rental agreement/lease 1 We

1 YES 2 Copy of rent check 2 2 W2 NO 3 1997 Income tax return, IRS 1040A, line 18 3 Mo

4 Other ___________________________________________ 12 3 $ .00 4 Qua1 Student eligibility report and information sheet 1 We

1 YES 2 Financial Aid Transcript 2 2 W2 NO 3 Other ___________________________________________ 3 Mo

12 3 $ .00 4 Qua

1 Bank statement 1 We

1 YES 2 Savings book 2 2 W2 NO 3 Other ___________________________________________ 3 Mo

12 3 $ .00 4 Qua

1 Copy of check or check stub 1 We

1 YES 2 Other ___________________________________________ 2 2 W2 NO 3 Mo

12 3 $ .00 4 Qua

1 Copy of check or check stub 1 We

1 YES 2 Other ___________________________________________ 2 2 W2 NO 3 Mo

12 3 $ .00 4 Qua

Abt Associates Inc.Survey Instruments                      D-23

a. PERSON NUMBER: b. RESPONDEN

n. Net rental incomem. Interest and dividends

Amount 

reported during 

InPerson 

Interview

Did (YOU / ...) receive income fromINCOME SOURCE during REFERENCE 

MONTH?

Do you have any paper documents showing that income? For example (READ FROM LIST BELOW)

INTERVIEWER- Record information from first available type of document from the list below. Note that if respondent does not have documentation for income during the reference month then income tax return should be reviewed and ANNUAL income should be rec

What pthis co

Does amount on documentation match preprinted amount?

If no document available, go to

q. Regular contributions from persons outside the household (e.g. cash gifts from friends or family)r. Other cash income, net royalties, income from trusts, prize winnings, bonuseso. Financial aid for college students (exclude money used for tuition, books, fees; include money used forroom and board)p. Money withdrawn from savings

INTERVIEWER- Enter amount of income shown on document. 
Section C - Income Review Form

PART 1 - INDIVIDUAL INCOME AND EARNINGSINTERVIEWER - A separate pre-printed Section C is provided for each adult member of household reported at certification. Use additonal sheets for adults added to hous1. INCOME SOURCE 2. TYPE OF DOCUMENT 3. INTERVIEWER CHECK 4. UPDATED AMOUNT 5. FREQUE

If YES, go to item 5.

If No, go to item 4.

IF NO, GO TO NEXT INCOME ITEM. next income item. DOCUMENT

YES NO NOT AVAIL

1 Earnings statement/pay stub 1 We2 W-2 Form 2 2 W

1 YES 3 1997 Income tax return (IRS 1040A, line 7; IRS 1040EZ, line 1) 3 Mo2 NO 4 Receipts for cash jobs 12 3 $ .00 4 Qua

5 Other ___________________________________________

1 Yes - Go to item ab 2 No - Go to item b. 2 wages fluctuate 

1 Leave and Earnings Statement (LES) 1 We5 Other ___________________________________________ 2 2 W

1 YES 3 Mo2 NO 12 3 $ .00 4 Qua

1 1997 Income tax return, IRS 1040A line 12 1 We

1 YES 2 Business records 2 2 W2 NO 3 Expense receipts 3 Mo

4 Other ___________________________________________ 12 3 $ .00 4 Qua1 1997 Income tax return, IRS 1040A line18 1 We

1 YES 2 Business records 2 2 W2 NO 3 Expense receipts 3 Mo

4 Other ___________________________________________ 12 3 $ .00 4 Qua1 Notice of determination or redetermination (award letter) 1 We

1 YES 2 Copy of check or check stub 2 2 W2 NO 3 1997 Income tax return (IRS 1040A, line 19; IRS 1040EZ, line 3) 3 Mo

4 Other ___________________________________________ 12 3 $ .00 4 Qua

D-24                      Survey InstrumentsAbt Associates Inc.

INTERVIEWER- Record information from first available type of document from the list below. Note that if respondent does not have documentation for income during the reference month, then income tax return should be reviewed and ANNUAL income should be reDo you have any paper documents showing that income? For example (READ FROM LIST BELOW)

e. Unemployment compensationd. Net income from farm. a. Wages and salary, except military income

ab. Are (YOU / ...) paid the same amount every week same every weekor do (YOUR / ...'s) wages fluctuate?

1

c. Net income from nonfarm business or other selfemploymentb. Military income INTERVIEWER CHECK ITEMaa. Is WEEK or 2 WEEKS checked in column 5 for item a?

INTERVIEWER - RECORD AMOUNT OF BASE PAY, excluding BAQ (Basic 

Allowance for Military Quarters), LQA (Living Quarters Allowance), VHA (Variable Housing Allowance).

INTERVIEWER- Enter amount of income shown on document. 

What pthis co

ac. INTERVIEWER CHECK ITEMIf document type is an earnings stapay stub, record the YEAR-TO-DATE 

a. PERSON NUMBER: b. NAME:

Does amount on documentation match preprinted amount?

Now I’m going to ask you about (READ NAME)’s income. I’m going to read a whole list of income sources to you, just as we did for your income, to help you remember inc

can look at (READ NAME)’S income records as we go along.

If no document available, go to

Amount 

reported during 

InPerson 

Interview

Did (YOU / ...) receive income fromINCOME SOURCE during REFERENCE 

MONTH?
Section C - Income Review Form

PART 1 - INDIVIDUAL INCOME AND EARNINGSINTERVIEWER - A separate pre-printed page is provided for each adult member of household reported at certification. Use additonal sheets for adults added to househo1. INCOME SOURCE 2. TYPE OF DOCUMENT 3. INTERVIEWER CHECK 4. UPDATED AMOUNT5. FREQUENC

If YES, go to item 5.

If No, go to item 4.

IF NO, GO TO NEXT INCOME ITEM. next income item. DOCUMENT

YES NO NOT AVAIL

1 Award notice 1 Week 

1 YES 2 Copy of check or check stub 2 2 Week2 NO 3 Statement/letter from insurance company 3 Month 

4 Other ___________________________________________ 12 3 $ .00 4 Quarte1 SSA award letter 1 Week 

1 YES 2 Statement of benefits 2 2 Week2 NO 3 1997 Income tax return (IRS 1040A, line 20a) 3 Month 

4 Other ___________________________________________ 12 3 $ .00 4 Quarte1 Notice of benefits 1 Week 

1 YES 2 Copy of check or check stub 2 2 Week2 NO 3 1997 Income tax return, IRS 1040A, line 17 3 Month 

3 Copy of check or check stub 12 3 $ .00 4 Quarte1 Copy of check or check stub 1 Week 

1 YES 2 1997 Income tax return, IRS 1040A, line 17 2 2 Week2 NO 3 Other ___________________________________________ 3 Month 

12 3 $ .00 4 Quarte

1 Notice of benefits 1 Week 

1 YES 2 Copy of check or check stub 2 2 Week2 NO 3 Other ___________________________________________ 3 Month 

12 3 $ .00 4 Quarte

1 Copy of check 1 Week 2 Support agreement 2 2 Week

k. Alimony 1 YES 3 Divorce/separation decree 3 Month 

2 NO 4 Court order 12 3 $ .00 4 Quarte

5 Other ___________________________________________1 Copy of check 1 Week 2 Support agreement 2 2 Week

l. Child support 1 YES 3 Divorce/separation decree 3 Month 

2 NO 4 Court order 12 3 $ .00 4 Quarte

5 Other ___________________________________________

Abt Associates Inc.Survey Instruments                      D-25

i. Veteran’s benefits

INTERVIEWEREnter amount of income shown on document. 

What periothis cover?

j. SSI (Supplemental Security Income)

Amount 

reported during 

InPerson 

Interview

h. Private pensions, annuities, or survivor’s benefitsg. Social Security (green checks)Did (YOU / ...) receive income fromINCOME SOURCE during REFERENCE 

MONTH?

f. Worker’s compensation

a. PERSON NUMBER:

Do you have any paper documents showing that income? For example (READ FROM LIST BELOW)

INTERVIEWER- Record information from first available type of document from the list below. Note that if respondent does not have documentation for income during the reference month then income tax return should be reviewed and ANNUAL income should be 

recorded in item 4.

Does amount on documentation match preprinted amount?

If no document available, go to
Section C - Income Review Form

PART 1 - INDIVIDUAL INCOME AND EARNINGSINTERVIEWER - A separate pre-printed page is provided for each adult member of household reported at certification. Use additonal sheets for adults added to househo1. INCOME SOURCE 2. TYPE OF DOCUMENT 3. INTERVIEWER CHECK 4. UPDATED AMOUNT5. FREQUENC

If YES, go to item 5.

If No, go to item 4.

IF NO, GO TO NEXT INCOME ITEM. next income item. DOCUMENT

YES NO NOT AVAIL

1 1997 Income tax return, IRS 1040A, line 8 or 9 1 Week 

1 YES 2 Other ___________________________________________ 2 2 Week2 NO 3 Month 

12 3 $ .00 4 Quarte

1 Rental agreement/lease 1 Week 

1 YES 2 Copy of rent check 2 2 Week2 NO 3 1997 Income tax return, IRS 1040A, line 18 3 Month 

4 Other ___________________________________________ 12 3 $ .00 4 Quarte1 Student eligibility report and information sheet 1 Week 

1 YES 2 Financial Aid Transcript 2 2 Week2 NO 3 Other ___________________________________________ 3 Month 

12 3 $ .00 4 Quarte

1 Bank statement 1 Week 

1 YES 2 Savings book 2 2 Week2 NO 3 Other ___________________________________________ 3 Month 

12 3 $ .00 4 Quarte

1 Copy of check or check stub 1 Week 

1 YES 2 Other ___________________________________________ 2 2 Week2 NO 3 Month 

12 3 $ .00 4 Quarte

1 Copy of check or check stub 1 Week 

1 YES 2 Other ___________________________________________ 2 2 Week2 NO 3 Month 

12 3 $ .00 4 Quarte

D-26                      Survey InstrumentsAbt Associates Inc.

a. PERSON NUMBER:

q. Regular contributions from persons outside the household (e.g. cash gifts from friends or family)r. Other cash income, net royalties, income from trusts, prize winnings, bonuseso. Financial aid for college students (exclude money used for tuition, books, fees; include money used forroom and board)p. Money withdrawn from savings

Do you have any paper documents showing that income? For example (READ FROM LIST BELOW)

INTERVIEWER- Record information from first available type of document from the list below. Note that if respondent does not have documentation for income during the reference month then income tax return should be reviewed and ANNUAL income should be rec

Does amount on documentation match preprinted amount?

If no document available, go to

n. Net rental incomem. Interest and dividends

Amount 

reported during 

InPerson 

Interview

Did (YOU / ...) receive income fromINCOME SOURCE during REFERENCE 

MONTH?

INTERVIEWEREnter amount of income shown on document. 

What periothis cover?
Section D - Household Income Review Form

PART 2 - HOUSEHOLD INCOME 1. INCOME SOURCE 2. TYPE OF DOCUMENT 3. INTERVIEWER CHECK 4. UPDATED AMOUNT 

If YES, go to item 5.

If No, go to item 4.

IF NO, GO TO NEXT INCOME ITEM.

next income item. DOCUMENT

YES NO NOT AVAIL

1 Explanation of grant acceptance

1 YES 2 Notice of Eligibility2 NO 3 Copy of TANF check 

4 Letter from social worker 12 3 $ .00 1 Food Stamp Program certification letter

1 YES 2 Authorization to Participate (ATP) notice2 NO 3 Other ___________________________________________ 

12 3 $ .00 

1 Explanation of grant acceptance

1 YES 2 Award notice2 NO 3 Other ___________________________________________ 

12 3 $ .00 

1 Award notice

1 YES 2 Other ___________________________________________2 NO 

12 3 $ .00 

Abt Associates Inc.Survey Instruments                      D-27

c. Emergency Assistanced. Other public assistancea. AFDC/TANFb. Food Stamps

Does amount on documentation match preprinted amount?

If no document available, go to

The next questions are about public assistance income. I’ll ask you about income received by anyone in your household, that is by- READ NAMES OF PERSONS UNDER C

Monthly benefit 

amount 

reported during 

In-Person Interview

INTERVIEWEREnter amount of monthly benefit receipt shown on document. 

ITEM 

INTENTIO

LEFT O

PAG

Did your household receive benefits from INCOME SOURCE during MONTH?

Do you have any paper documents showing the amount of benefits that you received? For example (READ FROM LIST BELOW)
Section E - Immunizations INTERVIEWER - Ask questions 1-8 for each child (questions continue on next page), then move to next colum

INTERVIEWER Add names of children age 5 and under from page 3.1. ANY SHOT 1 YES 1 YES 1 YES 1 YES

2 NO 2 NO 2 NO 2 NO8 DON’T KNOW 8 DON’T KNOW 8 DON’T KNOW 8 DON’T KN

2. RECORDS

1 YES 1 YES 1 YES 1 YES2

NO

2

NO

2

NO

2

NO

Do you have a written record of ...’s immunizations or shots? 8

DON’T KNOW

8

DON’T KNOW

8

DON’T KNOW

8

DON’T KN

3. DTP 1 YES 1 YES 1 YES 1 YES

2 NO- Go to 4 . 2 NO- Go to 4 . 2 NO- Go to 4 . 2 NO- Go to 8 DK- Go to 4 . 8 DK- Go to 4 . 8 DK- Go to 4 . 8 DK- Go to 

 3b. What was date of most recent D-T-P shot?4. POLIO 1 YES 1 YES 1 YES 1 YES

2 NO- Go to 5. 2 NO- Go to 5. 2 NO- Go to 5. 2 NO- Go to 8 DK- Go to 5. 8 DK- Go to 5. 8 DK- Go to 5. 8 DK- Go to 

 4b. What was date of most recent polio shot?5. M-M-R 1 YES 1 YES 1 YES 1 YES

2 NO- Go to 6 (next 

page).

2 NO- Go to 6 (next 

page).

2 NO- Go to 6 (next 

page).

2 NO- Go to 

page). 8 DK- Go to 6 ( next 

page).

8 DK- Go to 6 ( next 

page).

8 DK- Go to 6 ( next 

page).

8 DK- Go to 

page).

 5b. What was date of most recent M-M-R shot? If # of shots=1, ask- 5c. Was that shot measles or M-M-R only? 1 Measles only 1 Measles only 1 Measles only 1 Measles o

2 M-M-R only 2 M-M-R only 2 M-M-R only 2 M-M-R on8 Don’t Know 8 Don’t Know 8 Don’t Know 8 Don’t Kno

D-28                      Survey InstrumentsAbt Associates Inc.

Has ... ever received a D-T-P shot - sometimes called a D-P-T shot, diphtheria-tetanus-pertussis shot, baby shot, or three-in-one shot? If YES- 3a. How many D-T-P shots did ... ever receive? If YES- 4a. How many polio shots did ... ever receive?  If YES- 5a. How many M-M-R shots did ... ever receive?

Has ... ever received a polio vaccine by mouth, pink drops, or by a polio shot?Has ... ever received a measles or M-M-R (measlesmumps-Rubella) shot?

___________

NUMBER

_____/_____/______

 mm dd yy 

___________

NUMBER

_____/_____/______

 mm dd yy 

___________

NUMBER

_____/_____/______

 mm dd yy 

_______

NUMB

_____/_____

 mm dd 

NUMBER

_____/_____/______

 mm dd yy 

_______

NUMB

_____/_____

 mm dd 

___________

NUMB

_____/_____

 mm dd 

___________ ___________

NUMBER

_____/_____/______

 mm dd yy 

NUMBER

_____/_____/______

___________

_____/_____/______

 mm dd yy 

___________

________ ________________ 

PERSON # NAME

________ ________________ 

PERSON # NAME

NUMBER

_____/_____/______

 mm dd yy 

NUMBER

_____/_____/______

 mm dd yy  mm dd yy 

NUMBER

Child #1 Child #2 Child #3 Child 

________ ______

PERSON # NAME

___________ _______

PERSON # NAME

The next questions may be easier if you look at your records of (NAME OF CHILD)’s shots.

________ ________________ 

Has ... ever received an immunization, that is a shot or drops?My final questions are health-related and concern immunizations for infants and children in your household.

Go to 

next 

page.

Go to 

next 

page.

Go to 

next 

page.
Section E - Immunizations INTERVIEWER - Ask questions 1-8 for each child (questions continue on next page), then move to next colum

6. H-I-B 1 YES 1 YES 1 YES 1 YES

2 NO- Go to 7. 2 NO- Go to 7. 2 NO- Go to 7. 2 NO- Go to 8 DK- Go to 7. 8 DK- Go to 7. 8 DK- Go to 7. 8 DK- Go to 

 6b. What was date of most recent H-I-B shot?7. HEPATITIS B 1 YES 1 YES 1 YES 1 YES

2 NO- Go to 8. 2 NO- Go to 8. 2 NO- Go to 8. 2 NO- Go to 8 DK- Go to 8. 8 DK- Go to 8. 8 DK- Go to 8. 8 DK- Go to 

 7b. What was date of most recent Hepatitis  shot? 8. CHICKEN POX 1 YES 1 YES 1 YES 1 YES

2 NO 2 NO 2 NO 2 NO8 DK 8 DK 8 DK 8 DK

 8b. What was date of the most recent shot?

Go to Item E1 for next child. Go to Item E1 for next child. Go to Item E1 for next child. Go to Item E1 for n

INTERVIEWER CHECK ITEM 1 YES 1 YES 1 YES 1 YESDid respondent provide information from written records?

2

NO

2

NO

2

NO

2

NO

Abt Associates Inc.Survey Instruments                      D-29

Child #1 Child #2 Child #3 Child 

___________

NUMBER

_____/_____/______

 mm dd yy 

___________

NUMBER

_____/_____/______

 mm dd yy 

___________

NUMBER

_____/_____/______

 mm dd yy 

NUMBER

_____/_____/______

 mm dd yy 

___________

NUMBER

_____/_____/______

 mm dd yy 

___________ _______

NUMB

_____/_____

 mm dd 

_______

NUMB

_____/_____

 mm dd 

___________

NUMBER

_____/_____/______

 mm dd yy 

___________

NUMBER

_____/_____/______

 mm dd yy 

___________

NUMBER

_____/_____/______

 mm dd yy 

___________

NUMBER

_____/_____/______

 mm dd yy 

_______

NUMB

_____/_____

 mm dd 

 If YES- 8a. How many shots did ... ever receive?

Has ... ever received an H-I-B shot. This shot is for meningitis and is called Haemophilus Influenzae, H-I-B vaccine, or H flu vaccine. Has ... ever received a chicken pox (or Varicella) shot?Has ... ever received a Hepatitus B shot?

 If YES- 6a. How many H-I-B shots did ... ever receive? If YES- 7a. How many Hepatitis shots did ... ever receive?
Section F - Contact Information 8. Do you expect to change your name in the next year or so? 

 What will your new name be? FIRST NAME LAST 

9. Do you expect to move in the next year or so? 

Approximately when do you expect to move?

MON

Do you know your new address?

STREET ADDRESS (House No., Street, Apt. No., or other identification)

INTERVIEWER - Verify printed information collected during In-Person interview. CITY/PLACE STATE ZIP C

2. What is your (the) exact address? 10. Please tell me the name and address of a relative or friend wh

STREET ADDRESS (House No., Street, Apt. No., or other identification) FIRST NAME LAST NAME

STREET ADDRESS (House No., Street, Apt. No., or other identification)

CITY/PLACE STATE ZIP CODE CITY/PLACE STAT

3. Is this also your (the) mailing address? 1 Yes 2 No - Specify below. And what is (his/her) phone number? ( ) 

STREET ADDRESS (House No., Street, Apt. No., or other identification)

________________

11.

CITY/PLACE STATE ZIP CODE FIRST NAME LAST NAME

4. What is your (the) phone number? ( ) - STREET ADDRESS (House No., Street, Apt. No., or other identification)5. Under what name is the phone FIRST NAME LAST NAME

listed? CITY/PLACE STAT

6. ( ) -

What is (his/her) relationship to you? ________________

7. What is (your / spouse / partner’s) employer’s name and address? 12. ( ) 

EMPLOYER NAME

b. Where is that?

________________

STREET ADDRESS (House No., Street, Apt. No., or other identification) INTERVIEW STATUS CODES 

 1 Complete Interview 3 Unable to contact 2 Partial Interview 4 Refused 

D-30                      Survey InstrumentsAbt Associates Inc.

 Status Cod

What is (his/her) relationship to you?And what is (his/her) phone number? ( )Please tell me the name and address of a second relative or fyou.Is there another phone number where you can usually be reached?

Thank you for answering my questions. We may need to contact you at a later date to ask you some additional questions. I’d like to verify somecontact information with you.

What is (your / spouse / partner’s) phone 

number at work?

CITY/PLACE STATE ZIP CODE
Abt Associates Inc. Supplemental Exhibits E-1

Appendix E

Supplemental Exhibits

With the exception of Exhibits 3-1 and 3-2, each exhibit in Chapter 3 appears in this appendix in an

expanded form that gives the standard error for each entry. For convenience of access the numbering

scheme for these tables simply replaces the “3” with “E”; thus, for example, Exhibit E-3 corresponds to

Exhibit 3-3.

The presence of standard errors allows some comparisons to be made more formally, with statements of

statistical significance. For example, in Exhibit E-3 one might ask whether the percentage of

breastfeeding women who are married differs significantly from the corresponding percentage for

pregnant women. As we explain below, it is straightforward to calculate the standard error of the

difference between these two percentages from the standard errors of the percentages themselves. That

approach is not valid for all pairs of percentages in an exhibit, even when the comparison might be

meaningful. For example, if one wanted to test the significance of the difference (also in Exhibit E-3)

between the percentage of pregnant women with 8 to 11 years of education and the percentage of

pregnant women with 12 years of education, the calculation of the standard error would be more

complicated, because those two percentages come from categories of the same categorical variable, in the

same sample.

More generally, in order to calculate the standard error of the difference between two estimates by the

formula given below, the estimates must come from independent samples. In the comparison of marital

status between pregnant women and breastfeeding women mentioned above, the sampling for these two

certification categories was separate (by design—see Chapter 2 and Appendix A). In the example

involving highest grade of education, however, the two percentages came from classification of the same

sample, the sample of pregnant women.

In the exhibits of this appendix the certification categories are not the only source of independent

samples. As one example in Exhibit E-3, the three categories of Age of Women are non-overlapping. 

This feature produces independent samples for those categories, even though they are determined by

information collected in the interview. A more complicated example arises in Exhibit E-22, which

reports per capita income. Within each certification category (and also in the columns for “Total

Women” and “Total WIC”), the three age categories are non-overlapping, and hence they yield

independent samples of per capita income. The same statement applies to the categories of the other

maternal characteristics that make up the rows of Exhibit E-22. The distinction is that per capita income

is an additional variable (as opposed to the percentage distribution over the given categories).

The Standard Error of a Difference

When two estimates, Y and Y , come from independent samples, the standard error of the difference, 1 2

Y !Y , equals the square root of the sum of the squares of the respective standard errors: 1 2
s.e.(Y1

& Y2) ' [{s.e.(Y1)}

2 % {s.e.(Y2

)}

2

]

1/2

.

[(3.1)

2 % (2.7)2

]

1/2 ' 4.1 percentage points.

20.7 ± 1.96 × 4.1 or (12.6%, 28.8%).

[(20)

2 % (51)2

]

1/2 ' $55,

$959 ± $107.

E-2 Supplemental Exhibits Abt Associates Inc.

In the example mentioned earlier, 60.8% (s.e. 3.1 percentage points) of breastfeeding women were

married, and 40.1% (s.e. 2.7 percentage points) of pregnant women were married (Exhibit E-3). The

standard error of the difference, 60.8% ! 40.1% = 20.7%, is 

The usual 95 percent confidence interval for the population difference (based on the normal distribution)

is

This interval does not include 0, so the difference is statistically significant at the (two-sided) 0.05 level.

Similarly, in Exhibit E-22 pregnant women under 18 years of age reported a mean per capita income of

$4,327 (s.e. $51), and pregnant women age 18 to 34 reported a mean per capita income of $5,286 (s.e.

$20). The standard error of the difference, $5,286 ! $4,327 = $959, is

and the 95 percent confidence interval is

Multiplicity

In a table such as Exhibit E-22, where almost all the maternal characteristics have more than two

categories, comparisons often go beyond a single pair of categories (as in the preceding example). If one

judges the significance of each individual comparison at the 0.05 level, one expects a larger number of

comparisons that are “significant” by chance alone (quantitatively, 0.05 times the number of

comparisons). To guard against such an increased rate of “false positives,” one common procedure

(based on Bonferroni’s inequality) divides the 0.05 by the total number of comparisons and uses this

more stringent level for each individual comparison. As a result, the probability of getting one or more

false-positive comparisons by chance alone cannot exceed 0.05 (now referred to as a “simultaneous 0.05

level”).

For example, in Exhibit E-22 Age has three categories: Less than 18, 18 to 34, and 35 or older. There

are three possible pairwise comparisons:
Abt Associates Inc. Supplemental Exhibits E-3

Less than 18 vs. 18 to 34

Less than 18 vs. 35 or older

18 to 34 vs. 35 or older.

Making allowance for the multiplicity, one would use the 0.05/3 = 0.0167 level for each of these three

comparisons. The resulting (simultaneous) confidence intervals would use 2.394 times the standard error

of the difference (rather than 1.96).

Comparison of Distributions

When a percentage distribution involves more than two categories, as Marital Status does (Exhibit E-3),

it may be desired to compare the whole distribution between two certification categories (or among three

or more certification categories), rather than focusing on a single category (as in the example discussed

above). The customary statistical technique for such comparisons is the chi-squared test. In order to

carry out this test, one must use the weighted individual-level data in the NSWP public-use data set and

rely on software (such as SUDAAN, STATA, or SAS [Version 8]) that can take the sample design and

the survey weights into account. Appendix A gives the necessary information on the sample design.
___________________________________________________________________________________________________________________________________

Exhibit E-3

Demographic Characteristics of WIC Women by Participant Category: Percent Distribution 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Age of Women 

 Women Women Women Women < 18 years 18-34 years > 34 years

___________________________________________________________________________________________________________________________________

Marital status 

 Married 40.1 60.8 38.9 44.1 8.5 46.1 56.4

 (2.7) (3.1) (2.9) (2.2) (2.3) (2.4) (5.4)

 Widowed, separated, or divorced 10.2 9.5 12.2 10.7 0.4 10.3 24.1

 (1.4) (1.3) (1.6) (0.8) (0.4) (0.9) (5.2)

 Never married 49.6 29.7 48.9 45.2 91.1 43.6 19.4

 (2.7) (2.8) (2.9) (2.0) (2.4) (2.4) (4.4)

Adult male present 69.5 79.0 60.1 68.5 57.0 70.1 70.6

 (2.3) (2.3) (3.4) (1.9) (6.8) (2.1) (4.5)

Highest grade of education 

 Less than 8 years 5.8 9.5 3.9 6.0 0.0 5.9 14.0

 (1.8) (1.9) (1.4) (1.3) (0.0) (1.4) (3.5)

 8 to 11 years 26.2 19.9 25.1 24.5 0.0 28.0 16.8

 (2.2) (2.0) (2.6) (1.7) (0.0) (1.8) (3.8)

 12 years 38.5 31.2 40.1 37.5 0.0 42.0 35.5

 (2.7) (2.2) (2.4) (1.9) (0.0) (2.1) (4.1)

 13 or more years 19.9 33.9 18.3 22.3 0.0 24.0 32.5

 (1.9) (2.8) (1.9) (1.6) (0.0) (1.6) (4.0)

 Schooling incomplete, age <18 9.6 5.0 12.2 9.4 100.0 0.0 0.0

 (1.1) (0.9) (2.6) (0.9) (0.0) (0.0) (0.0)

Attending college 

 Full time 3.6 4.1 1.8 3.1 0.0 3.7 0.0

 (0.7) (2.1) (0.6) (0.5) (0.0) (0.6) (0.0)

 Part time 2.4 3.2 1.3 2.2 0.0 2.2 4.6

 (0.6) (0.7) (0.4) (0.4) (0.0) (0.4) (1.7)

Employment status 

 Currently employed 31.9 19.5 17.7 24.9 12.1 25.8 27.0

 (2.2) (2.0) (2.3) (1.6) (3.5) (1.7) (5.0)

 Not currently employed 68.1 80.5 82.3 75.1 87.9 74.2 73.0

 (2.2) (2.0) (2.3) (1.6) (3.5) (1.7) (5.0)

If not currently employed 

 Employed in last 12 months 58.9 48.5 45.2 52.4 29.6 54.5 51.8

 (2.7) (2.8) (2.9) (2.2) (5.3) (2.3) (4.8)
___________________________________________________________________________________________________________________________________

Exhibit E-3 (cont.)

Demographic Characteristics of WIC Women by Participant Category: Percent Distribution 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Age of Women 

 Women Women Women Women < 18 years 18-34 years > 34 years

___________________________________________________________________________________________________________________________________

Reasons not working 

 Unemployed 21.7 9.3 11.6 15.4 7.9 16.3 16.0

 (2.9) (1.5) (1.8) (1.6) (3.1) (1.9) (5.8)

 Keeping house 44.2 71.5 62.1 56.5 21.8 59.7 58.0

 (3.3) (3.1) (3.7) (2.6) (4.1) (2.9) (5.2)

 Going to school 16.7 7.9 10.9 12.7 65.7 7.9 4.7

 (2.1) (2.3) (1.4) (1.0) (4.6) (1.0) (2.0)

 Unable to work 12.8 7.6 9.8 10.6 4.7 10.8 16.2

 (2.0) (1.8) (2.2) (1.5) (2.4) (1.6) (4.2)

 On temporary layoff 4.6 3.6 5.5 4.7 0.0 5.2 5.1

 (1.2) (1.0) (1.2) (0.9) (0.0) (1.0) (2.3)

 Retired 0.0 0.0 0.1 0.1 0.0 0.1 0.0

 (0.0) (0.0) (0.2) (0.1) (0.0) (0.1) (0.0)

Number of biological children 

 None 48.5 0.0 1.3 23.5 46.2 22.7 7.4

 (2.4) (0.0) (0.5) (1.2) (6.2) (1.2) (2.3)

 One 31.9 39.4 47.4 38.4 50.0 38.4 25.8

 (1.7) (2.8) (3.0) (1.5) (6.2) (1.6) (5.5)

 Two 11.9 32.1 27.9 21.1 3.1 22.6 25.4

 (1.3) (2.6) (2.4) (1.0) (1.9) (1.3) (4.2)

 Three 5.8 18.3 14.3 11.1 0.6 11.6 16.7

 (1.0) (1.6) (1.8) (0.9) (0.7) (0.9) (4.0)

 Four or more 1.9 10.2 9.1 5.9 0.0 4.7 24.7

 (0.6) (1.4) (1.3) (0.6) (0.0) (0.6) (4.5)

Rates of item non-response 

 Marital status 2.9 0.5 4.5 2.9 14.8 1.8 1.7

 (1.0) (0.3) (2.6) (0.9) (8.7) (0.6) (1.1)

 Highest grade of education 1.2 0.6 0.4 0.8 0.0 0.9 1.2

 (0.4) (0.3) (0.2) (0.2) (0.0) (0.3) (1.2)

 Employment status 1.0 0.4 3.6 1.7 14.3 0.4 0.8

 (0.4) (0.3) (2.5) (0.8) (8.7) (0.2) (0.8)

 Reasons not working 6.3 6.8 3.7 5.5 4.8 5.7 4.5

 (2.3) (1.9) (1.5) (1.7) (3.8) (1.8) (2.8)

Sample size 639 627 587 1,853 140 1,548 149

Population 859,381 376,463 573,899 1,809,743 154,982 1,504,823 135,430

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-4

Demographic Characteristics of Mothers of WIC Infants and Children: Percent Distribution 

___________________________________________________________________________________________________________________________________

 Mothers of Mothers of Total Age of Mothers 

 Infants Children WIC Mothers < 18 years 18-34 years > 34 years

___________________________________________________________________________________________________________________________________

Marital status 

 Married 49.4 51.9 51.1 22.8 52.6 51.7

 (2.8) (2.7) (2.3) (8.2) (2.5) (4.0)

 Widowed, separated, or divorced 11.3 17.9 15.7 2.7 13.2 32.1

 (1.6) (2.0) (1.6) (2.5) (2.1) (3.5)

 Never married 39.3 30.2 33.2 74.5 34.3 16.2

 (2.8) (2.3) (1.9) (9.0) (2.1) (3.8)

Adult male present 69.4 69.8 69.7 60.3 71.4 66.6

 (3.0) (3.0) (2.6) (8.2) (2.8) (3.5)

Highest grade of education 

 Less than 8 years 6.0 5.1 5.4 0.0 5.1 8.7

 (1.7) (1.3) (1.2) (0.0) (1.3) (2.5)

 8 to 11 years 25.3 26.7 26.2 0.0 28.7 22.6

 (2.1) (2.5) (1.9) (0.0) (2.0) (4.3)

 12 years 35.2 41.3 39.2 0.0 41.7 40.3

 (2.7) (2.1) (1.8) (0.0) (1.7) (6.1)

 13 or more years 24.5 23.3 23.7 0.0 24.4 28.3

 (2.7) (2.3) (2.1) (0.0) (2.1) (4.5)

 Schooling incomplete, age <18 8.8 3.5 5.3 100.0 0.0 0.0

 (1.3) (0.9) (0.8) (0.0) (0.0) (0.0)

Attending college 

 Full time 1.5 4.9 3.7 3.4 4.6 0.0

 (0.6) (1.0) (0.7) (3.3) (0.8) (0.0)

 Part time 2.0 3.1 2.7 0.0 2.9 2.4

 (0.5) (0.7) (0.5) (0.0) (0.6) (1.1)

Employment status 

 Currently employed 18.0 32.2 27.5 14.9 26.8 34.4

 (2.0) (2.0) (1.6) (5.5) (1.8) (4.4)

 Not currently employed 82.0 67.8 72.5 85.1 73.2 65.6

 (2.0) (2.0) (1.6) (5.5) (1.8) (4.4)

If not currently employed 

 Employed in last 12 months 52.3 49.2 50.2 32.4 51.9 46.5

 (2.0) (2.3) (2.0) (7.6) (2.4) (4.4)
___________________________________________________________________________________________________________________________________

Exhibit E-4 (cont.)

Demographic Characteristics of Mothers of WIC Infants and Children: Percentage Distribution

___________________________________________________________________________________________________________________________________

 Mothers of Mothers of Total Age of Mothers 

 Infants Children WIC Mothers < 18 years 18-34 years > 34 years

___________________________________________________________________________________________________________________________________

Reasons not working 

 Unemployed 13.0 11.6 12.1 4.2 11.4 18.8

 (2.1) (2.0) (1.7) (2.0) (1.8) (4.4)

 Keeping house 63.9 68.8 66.9 56.8 68.4 63.1

 (3.4) (3.5) (3.0) (8.7) (3.2) (4.8)

 Going to school 6.5 8.4 7.7 28.9 7.2 2.5

 (1.2) (1.7) (1.1) (6.3) (1.3) (1.6)

 Unable to work 12.0 7.9 9.4 7.0 9.3 11.7

 (1.9) (2.4) (1.8) (4.4) (1.9) (3.2)

 On temporary layoff 4.2 2.8 3.3 3.2 3.6 1.9

 (1.0) (0.8) (0.6) (3.0) (0.8) (1.1)

 Retired 0.4 0.5 0.5 0.0 0.2 2.1

 (0.3) (0.4) (0.2) (0.0) (0.2) (1.5)

Number of biological children 

 One 43.0 26.9 32.3 87.7 32.8 15.1

 (2.5) (1.8) (1.6) (5.7) (1.9) (4.2)

 Two 28.8 36.6 34.0 11.2 37.6 22.7

 (2.3) (2.5) (1.8) (5.8) (1.9) (4.7)

 Three 14.4 18.4 17.0 1.1 17.1 20.2

 (1.5) (1.8) (1.2) (1.0) (1.3) (3.6)

 Four or more 12.0 13.9 13.3 0.0 12.1 23.6

 (2.0) (1.4) (1.2) (0.0) (1.1) (4.3)

Rates of item non-response 

 Marital status 1.5 1.8 1.7 4.2 1.7 0.0

 (0.6) (0.6) (0.5) (3.3) (0.5) (0.0)

 Highest grade of education 0.7 0.6 0.7 0.0 0.8 0.0

 (0.3) (0.4) (0.3) (0.0) (0.3) (0.0)

 Employment status 0.8 0.9 0.8 4.2 0.6 0.0

 (0.4) (0.4) (0.3) (3.3) (0.3) (0.0)

 Reasons not working 4.1 4.8 4.6 2.2 5.0 3.3

 (1.3) (2.2) (1.7) (1.8) (2.1) (1.6)

Sample size 614 647 1,261 64 1,015 169

Population 1,978,411 3,952,924 5,931,335 257,585 4,685,675 934,750

____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________

Exhibit E-5

Demographic Characteristics of WIC Women and WIC Mothers, by Metro-Nonmetro Location 

_____________________________________________________________________________________

 

 Metropolitan Nonmetropolitan

_____________________________________________________________________________________

Age 

 <18 years 5.1 6.2

 (0.7) (1.1)

 18-34 years 80.0 79.7

 (1.3) (2.9)

 >34 years 13.8 14.0

 (1.1) (3.1)

Marital status 

 Married 48.6 52.6

 (2.3) (2.8)

 Widowed, separated, or divorced 14.7 14.0

 (1.5) (2.3)

 Never married 36.7 33.4

 (2.0) (3.5)

Adult male present 67.8 75.8

 (2.6) (3.0)

Highest grade of education 

 Less than 8 years 6.7 1.3

 (1.4) (1.1)

 8 to 11 years 26.7 22.6

 (1.8) (2.9)

 12 years 37.3 44.9

 (1.5) (3.7)

 13 or more years 23.0 24.9

 (2.3) (1.9)

 Schooling incomplete, age <18 6.2 6.3

 (0.8) (1.1)

Attending college 

 Full time 3.5 3.8

 (0.7) (1.0) 

 Part time 2.9 1.3

 (0.5) (0.7) 

Employment status 

 Currently employed 26.1 29.6

 (1.6) (3.3)

 Not currently employed 73.9 70.4

 (1.6) (3.3)

Employment history, if not employed 

 employed in last 12 months 49.2 56.6

 (2.0) (3.7)

Reasons not working, if not employed 

 Unemployed 12.0 16.6

 (1.6) (4.6)

 Keeping house 65.5 60.1

 (3.1) (5.9)

 Going to school 8.9 8.8

 (1.1) (1.4)

 Unable to work 9.2 11.9

 (1.8) (2.7)

 On temporary layoff 3.9 2.5

 (0.7) (0.8)

 Retired 0.5 0.0

 (0.2) (0.0)
_____________________________________________________________________________________

Exhibit E-5 (cont.)

Demographic Characteristics of WIC Women and WIC Mothers, by Metro-Nonmetro Location 

_____________________________________________________________________________________

 

 Metropolitan Nonmetropolitan

_____________________________________________________________________________________

Number of biological children 

 None 5.3 6.1

 (0.4) (0.7)

 One 32.9 36.9

 (1.3) (3.1)

 Two 31.9 27.2

 (1.6) (3.0)

 Three 14.8 18.8

 (1.0) (1.7)

 Four or more 12.1 9.6

 (1.0) (1.6)

Rates of item non-response 

 Age 1.1 0.1

 (0.4) (0.1)

 Marital status 2.2 1.3

 (0.5) (0.4)

 Highest grade of education 0.9 0.1

 (0.3) (0.1)

 College attendence 3.9 2.2

 (0.7) (0.8)

 Employment status 1.2 0.3

 (0.4) (0.2)

 Reasons not working 4.3 6.9

 (2.0) (2.7)

Sample size 2,387 727

Population 6,143,639 1,597,439

_____________________________________________________________________________________
_____________________________________________________________________________________

Exhibit E-6

Demographic Characteristics of WIC Infants and Children at Certification: Percent

Distribution 

_____________________________________________________________________________________

 WIC WIC

 Infants Children

_____________________________________________________________________________________

Gender 

 Male 49.9 47.9

 (2.3) (2.2)

 Female 50.1 52.1

 (2.3) (2.2)

Birth order 

 First 43.8 46.8

 (2.4) (2.4)

 Second 29.5 27.4

 (2.3) (2.1)

 Third or more 26.7 25.8

 (2.3) (2.5)

Household characteristics 

 Biological mother present 97.9 95.2

 (0.7) (1.1)

 Biological father present 58.3 57.9

 (3.4) (2.7)

 Foster child 1.3 2.7

 (0.6) (0.7)

WIC experience 

 First WIC certification 86.5 0.9

 (2.3) (0.4)

 WIC recertification 13.5 99.1

 (2.3) (0.4)

Mother's WIC experience with sampled child

 Mother in WIC when pregnant only 3.2 12.4

 (0.9) (2.1)

 Mother in WIC when pregnant & postpartum 74.5 67.7

 (1.9) (2.0)

 Mother in WIC postpartum only 16.6 11.3

 (1.9) (1.6)

 Mother not in WIC with sampled child 5.7 8.7

 (1.2) (1.5)

Other public assistance 

 Receiving TANF 12.5 14.1

 (1.8) (1.9)

 Receiving Food Stamps 31.4 35.5

 (2.4) (2.6)

 Attending Head Start NA 6.6

 (1.0)
_____________________________________________________________________________________

Exhibit E-6 (cont.)

Demographic Characteristics of WIC Infants and Children at Certification: Percent 

Distribution 

_____________________________________________________________________________________

 WIC WIC

 Infants Children

_____________________________________________________________________________________

Rates of item non-response 

 Gender 1.7 0.9

 (0.6) (0.4)

 Birth order indeterminant 1.8 4.1

 (0.7) (0.9)

 WIC experience 3.1 7.6

 (0.8) (1.6)

 Mother's WIC experience 2.2 5.6

 (0.6) (1.0)

 Receiving TANF 1.6 1.9

 (0.7) (0.5)

 Receiving Food Stamps 1.0 1.6

 (0.5) (0.6)

 Attending Head Start 0.0 0.0

 (0.0) (0.0)

Sample size 614 647

Population 1,978,411 3,952,924

_____________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-7

WIC Economic Unit Composition by Participant Category: Mean Economic Unit Size, Number of Adults Present, and Number of WIC

Participants

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Economic unit size 3.12 4.17 3.94 3.60 4.14 4.16 4.02

 (0.07) (0.08) (0.09) (0.05) (0.10) (0.07) (0.05)

Adult in unit 1.86 1.94 1.71 1.83 1.76 1.75 1.77

 (0.04) (0.04) (0.04) (0.03) (0.04) (0.04) (0.03)

WIC participants in unit 1.35 2.45 2.35 1.90 2.14 1.60 1.81

 (0.03) (0.04) (0.04) (0.03) (0.04) (0.04) (0.03)

Sample size 639 627 587 1853 614 647 3114

Population 859381 376463 573899 1809743 1978411 3952924 7741078

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-8

WIC Economic Unit Composition by Participant Category: Distribution of Economic Unit Size, Numbers of Adults Present, and Number of

WIC Participants

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Economic unit size 

 1 7.7 0.0 0.4 3.8 1.3 2.7 2.6

 (1.1) (0.0) (0.3) (0.5) (0.6) (0.7) (0.5)

 2 30.9 7.5 9.4 19.2 9.2 8.1 11.0

 (2.0) (2.2) (2.1) (1.5) (1.3) (1.1) (0.9)

 3 30.3 25.7 32.9 30.2 26.8 23.7 26.0

 (1.9) (2.0) (3.3) (1.4) (2.4) (1.8) (1.1)

 4 14.3 32.3 29.2 22.8 29.6 30.0 28.2

 (1.3) (1.6) (2.3) (0.9) (2.1) (1.9) (1.2)

 5 10.3 21.1 17.4 14.8 16.6 18.9 17.4

 (1.7) (2.4) (2.2) (1.3) (1.6) (1.8) (1.1)

 6 or more 6.4 13.5 10.7 9.2 16.5 16.5 14.8

 (1.3) (1.6) (1.8) (0.8) (2.2) (1.8) (1.2)

Adults in unit 

 None 1.2 0.6 1.7 1.2 3.9 3.3 3.0

 (0.4) (0.3) (0.5) (0.3) (1.0) (0.8) (0.5)

 1 29.3 20.1 36.6 29.7 27.1 27.8 28.1

 (1.9) (2.6) (2.9) (1.8) (2.6) (2.5) (1.9)

 2 56.0 67.4 52.2 57.2 59.9 61.2 59.9

 (2.4) (2.6) (2.8) (1.8) (2.5) (2.3) (1.8)

 3 9.9 9.0 8.0 9.1 7.2 6.2 7.1

 (1.3) (2.2) (1.5) (0.9) (1.4) (1.1) (0.9)

 4 2.9 2.4 1.4 2.3 1.5 1.0 1.5

 (0.7) (0.7) (0.5) (0.4) (0.6) (0.4) (0.3)

 5 0.7 0.5 0.0 0.4 0.2 0.5 0.4

 (0.5) (0.3) (0.0) (0.2) (0.2) (0.5) (0.3)

 6 or more 0.0 0.0 0.0 0.0 0.1 0.0 0.0

 (0.0) (0.0) (0.0) (0.0) (0.1) (0.0) (0.0)

WIC participants in unit 

 1 69.5 0.0 3.9 34.2 16.0 56.6 41.0

 (2.2) (0.0) (1.0) (1.4) (1.9) (2.7) (1.6)

 2 26.1 62.7 64.0 45.7 58.1 30.1 40.9

 (2.0) (3.0) (3.2) (1.4) (2.2) (2.2) (1.3)

 3 3.9 30.3 26.1 16.4 21.8 10.6 14.8

 (0.7) (2.6) (2.5) (1.2) (1.7) (1.7) (1.1)

 4 or more 0.5 7.0 6.1 3.6 4.1 2.7 3.3

 (0.3) (1.4) (1.1) (0.5) (1.1) (0.6) (0.5)

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-9

WIC Economic Unit Composition by Metro-Nonmetro Location: Distribution of Economic Unit Size, Numbers of Adults Present, and Number of

WIC Participants

___________________________________________________________________________________________________________________________________

 Pregnant Women Breastfeeding Women Postpartum Women Total Women

 Metro Nonmetro Metro Nonmetro Metro Nonmetro Metro Nonmetro

___________________________________________________________________________________________________________________________________

Economic unit size 

 1 7.4 8.8 0.0 0.0 0.3 0.8 3.5 4.7

 (1.3) (1.7) (0.0) (0.0) (0.2) (0.8) (0.6) (0.7)

 2 33.0 23.9 7.9 4.9 9.9 7.6 20.2 15.4

 (2.3) (2.8) (2.5) (3.1) (2.6) (2.3) (1.7) (2.1)

 3 30.3 30.3 25.3 27.5 32.4 34.7 29.9 31.3

 (2.2) (3.9) (2.2) (4.9) (3.9) (5.7) (1.7) (2.0)

 4 13.7 16.5 32.6 31.2 30.7 23.8 23.2 21.3

 (1.3) (3.5) (1.8) (2.7) (2.7) (2.8) (1.0) (1.8)

 5 10.1 11.1 20.9 21.8 15.0 25.9 14.0 17.8

 (2.1) (2.2) (2.7) (4.2) (2.2) (5.3) (1.5) (1.9)

 6 or more 5.5 9.4 13.3 14.6 11.7 7.1 9.2 9.5

 (1.4) (2.7) (1.8) (2.9) (2.1) (3.1) (0.9) (1.4)

Adults in unit 

 None 1.0 2.1 0.7 0.0 1.3 3.1 1.0 2.1 

 (0.4 ) (1.3 ) (0.3 ) (0.0 ) (0.5 ) (1.4 ) (0.3 ) (0.8 )

 1 29.4 29.0 20.4 18.5 39.4 26.9 30.5 26.6

 (2.2) (4.1) (2.8) (6.7) (3.5) (2.6) (2.2) (2.1)

 2 56.5 54.3 66.5 72.2 49.8 60.9 56.6 59.4

 (2.9) (3.4) (2.9) (6.7) (3.3) (3.8) (2.2) (2.4)

 3 8.7 14.1 9.8 4.5 8.4 6.6 8.8 10.0

 (1.4) (2.4) (2.5) (2.3) (1.8) (1.9) (1.0) (1.6)

 4 3.6 0.5 2.3 2.6 1.2 2.5 2.6 1.5

 (0.9) (0.5) (0.8) (1.4) (0.5) (1.3) (0.5) (0.5)

 5 0.9 0.0 0.2 2.1 0.0 0.0 0.5 0.3

 (0.6) (0.0) (0.2) (1.4) (0.0) (0.0) (0.3) (0.3)

 6 or more 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

 (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0)

WIC participants in unit 

 1 69.8 68.7 0.0 0.0 4.3 2.4 33.9 35.4

 (2.6) (3.7) (0.0) (0.0) (1.2) (1.5) (1.6) (2.6)

 2 26.2 25.6 60.9 72.4 62.1 70.6 45.0 48.2

 (2.5) (2.8) (3.1) (8.2) (3.8) (5.4) (1.7) (2.2)

 3 3.4 5.7 31.8 22.2 27.4 21.6 17.2 13.7

 (0.8) (1.6) (2.6) (6.3) (2.9) (5.0) (1.3) (2.7)

 4 or more 0.6 0.0 7.3 5.4 6.3 5.4 3.9 2.7

 (0.4) (0.0) (1.5) (3.1) (1.3) (1.8) (0.6) (1.0)

Sample size 481 158 514 113 442 145 1,437 416

Population 668,251 191,130 315,918 60,545 446,008 127,891 1,430,17 379,566

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-9 (cont.)

WIC Economic Unit Composition by Metro-Nonmetro Location: Distribution of Economic Unit Size, Numbers of Adults Present, and Number of

WIC Participants

___________________________________________________________________________________________________________________________________

 Infants Children Total WIC

 Metro Nonmetro Metro Nonmetro Metro Nonmetro

___________________________________________________________________________________________________________________________________

Economic unit size 

 1 1.5 0.6 3.0 1.7 2.7 2.2

 (0.8) (0.6) (0.9) (1.0) (0.6) (0.6)

 2 8.7 11.2 8.1 7.9 11.1 10.5

 (1.3) (4.1) (1.4) (1.9) (1.1) (1.1)

 3 27.8 22.7 24.8 19.6 26.7 23.1

 (2.9) (4.9) (2.2) (2.2) (1.4) (1.3)

 4 29.5 30.1 29.8 30.8 28.2 28.4

 (2.4) (3.7) (2.4) (2.0) (1.4) (1.8)

 5 15.9 19.4 18.4 20.8 16.8 19.7

 (1.8) (3.9) (2.1) (3.5) (1.3) (1.9)

 6 or more 16.6 16.0 15.8 19.1 14.5 16.1

 (2.6) (2.7) (1.9) (4.5) (1.3) (2.2)

Adults in unit 

 None 4.4 2.1 3.9 1.7 3.3 1.9

 (1.2 ) (1.0 ) (1.0 ) (1.0 ) (0.6 ) (0.6 )

 1 27.9 23.9 29.2 22.5 29.2 23.8

 (3.0) (5.5) (3.0) (3.5) (2.3) (2.7)

 2 58.7 64.9 59.1 68.8 58.4 65.6

 (2.9) (3.6) (2.7) (3.2) (2.1) (1.9)

 3 6.8 8.8 6.4 5.5 7.1 7.4

 (1.5) (3.2) (1.3) (2.3) (1.0) (2.0)

 4 1.8 0.4 0.9 1.6 1.5 1.3

 (0.7) (0.4) (0.4) (1.2) (0.4) (0.7)

 5 0.3 0.0 0.7 0.0 0.5 0.1

 (0.3) (0.0) (0.7) (0.0) (0.3) (0.1)

 6 or more 0.1 0.0 0.0 0.0 0.0 0.0

 (0.1) (0.0) (0.0) (0.0) (0.0) (0.0)

WIC participants in unit 

 1 16.2 15.3 55.0 62.5 40.0 44.7

 (2.2) (3.7) (2.9) (5.8) (1.7) (3.4)

 2 56.9 62.9 30.7 27.8 40.8 41.1

 (2.5) (3.7) (2.4) (5.4) (1.4) (2.7)

 3 22.4 19.6 11.6 6.8 15.7 11.5

 (1.6) (5.1) (2.0) (2.3) (1.1) (2.3)

 4 or more 4.6 2.1 2.6 2.9 3.4 2.7

 (1.4) (0.9) (0.6) (1.8) (0.5) (0.9)

Sample size 474 140 476 171 2,387 727

Population 1,593,475 384,936 3,119,987 832,937 6,143,639 1,597,439

____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________

Exhibit E-10

Distribution of WIC Infants and Children, by Number of Siblings Age-Eligible for WIC

_____________________________________________________________________________________

 Total

 Infants Children WIC

_____________________________________________________________________________________

Percent with any siblings 42.2 46.6 45.1

 age-eligible for WIC (2.9) (2.5) (2.1)

Number siblings age-eligible for WIC 

 None 57.8 53.4 54.9

 (2.9) (2.5) (2.1)

 One 32.8 39.3 37.1

 (2.6) (2.7) (2.0)

 Two 7.4 6.5 6.8

 (1.2) (1.1) (0.8)

 Three 1.9 0.6 1.0

 (1.0) (0.3) (0.4)

 Four or more 0.1 0.2 0.2

 (0.1) (0.2) (0.1)

Mean number siblings age-eligible 0.54 0.55 0.55

for WIC (0.04) (0.03) (0.03)

Percent with any siblings 28.4 43.9 38.7

 age 5 years or older (2.2) (1.9) (1.3)

Number siblings age 5 years or older

 None 71.6 56.1 61.3

 (2.2) (1.9) (1.3)

 One 14.9 25.1 21.7

 (1.3) (1.7) (1.1)

 Two 9.0 12.4 11.3

 (1.3) (1.5) (1.1)

 Three 2.4 4.2 3.6

 (0.6) (0.8) (0.5)

 Four or more 2.0 2.2 2.1

 (0.9) (0.7) (0.6)

Mean number siblings age 0.52 0.72 0.66

5 years or older (0.07) (0.04) (0.04)

Sample size 614 647 1,261

Population 1,978,411 3,952,924 5,931,335

_____________________________________________________________________________________
_______________________________________________________________________________________________

Exhibit E-11

Percent of WIC Infants and Children, by Number of Siblings Age-Eligible for WC and Number of

Siblings Receiving WIC

_______________________________________________________________________________________________

 Number of Siblings Currently Receiving WIC Sample

 None One Two Size Population

_______________________________________________________________________________________________

Number Siblings Age-Eligible for WIC 

 One 19.2 80.8 -- 474 2,298,070

 (1.8) (1.8)

 Two 12.6 20.7 66.7 111 503,105

 (3.2) (3.9) (4.5)

_________________________________________________________________________________________________

_______________________________________________________________________________________________

Exhibit E-12

Percent of Siblings of WIC Infants and Children who are also Certified in WIC, by Age of Siblings

_______________________________________________________________________________________________

 Percent Percent Number Siblings

 Currently in WIC Not in WIC in Age Group

_______________________________________________________________________________________________

Age of siblings 

 Less than 1 year 92.8 7.1 182

 (1.9) (1.9)

 1 year old 90.6 9.4 139

 (2.5) (2.5)

 2 years old 82.6 17.4 144

 (3.2) (3.2)

 3 years old 78.6 21.4 140

 (3.5) (3.5)

 4 years old 69.9 30.1 123

 (4.1) (4.1)

 Total 83.8 16.2 728

 (1.4) (1.4)

_________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-13

Characteristics of WIC Households, by Participant Category

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Household realtionship to economic unit

 Percent of WIC economic 83.5 86.1 81.1 83.3 84.1 85.7 84.7

 units residing by themselves (1.7) (2.7) (3.1) (1.6) (1.9) (2.0) (1.5)

 Percent of WIC economic units 16.5 13.9 18.9 16.7 15.9 14.3 15.3

 residing in larger households (1.7) (2.7) (3.1) (1.6) (1.9) (2.0) (1.5)

 Percent of households containing 6.6 5.4 3.7 5.4 4.4 3.5 4.2

 unrelated individuals (2.0) (1.4) (1.1) (1.3) (1.2) (1.0) (0.7)

WIC economic units by number of

household members not in unit 

 None 83.5 86.1 81.1 83.3 84.1 85.7 84.7

 (1.7) (2.7) (3.1) (1.6) (1.9) (2.0) (1.5)

 One 6.5 5.2 8.9 7.0 4.1 6.1 5.8

 (1.2) (1.3) (2.5) (0.9) (1.0) (1.5) (1.0)

 Two 3.6 3.5 5.0 4.0 4.8 1.9 3.1

 (0.8) (0.7) (1.1) (0.5) (1.1) (0.6) (0.5)

 Three 3.6 3.2 1.7 2.9 3.0 3.1 3.0

 (1.0) (1.6) (0.6) (0.5) (0.7) (0.8) (0.5)

 Four or more 2.8 2.0 3.4 2.8 4.0 3.3 3.3

 (0.8) (0.5) (1.0) (0.6) (1.3) (0.9) (0.6)

Multigenerational households 

 Percentage of households that 25.7 16.4 29.3 24.9 23.1 15.3 19.5

 are multigenerational (2.0) (2.5) (2.7) (1.3) (2.2) (1.8) (1.3)

 Percentage of multigenerational 63.4 45.6 51.3 56.4 59.5 51.6 55.4

 households in which all household (4.1) (7.8) (6.9) (4.0) (5.8) (7.0) (4.3)

 members are in WIC economic unit

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-14

Percentage of WIC Participants with Reported Participation in Adjunct Programs at Certification

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Adjunctive income eligibility 

 TANF 9.3 13.8 21.7 14.2 14.0 16.0 15.0

 (1.9) (2.3) (3.1) (1.9) (2.2) (2.3) (1.9)

 Food Stamp Program 23.3 22.4 38.4 27.8 31.4 35.5 32.7

 (2.2) (2.4) (2.9) (1.9) (2.4) (2.6) (1.8)

 Medicaid 51.1 57.2 69.3 58.2 65.3 61.4 61.6

 (3.0) (2.8) (2.8) (2.1) (3.5) (3.2) (2.5)

Automatic income eligibility 

 Food Distribution Program 0.2 0.0 0.0 0.1 0.0 0.0 0.0

 on Indian Reservations (0.2) (0.0) (0.0) (0.1) (0.0) (0.0) (0.0)

 Supplemental Security Income 4.3 4.1 4.0 4.2 3.6 7.2 5.6

 (1.5) (1.3) (1.7) (1.4) (1.2) (2.8) (2.0)

 Free or reduced-price NSLP meals 0.0 0.0 0.0 0.0 0.0 0.7 0.3

 (0.0) (0.0) (0.0) (0.0) (0.0) (0.4) (0.2)

 Head Start 0.0 0.0 0.0 0.0 0.0 0.0 0.0

 (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0)

 General Assistance 1.5 0.2 1.0 1.0 1.4 0.3 0.8

 (0.7) (0.2) (0.5) (0.5) (1.2) (0.3) (0.4)

 Home Energy Assistance 0.6 0.4 0.2 0.4 0.0 0.0 0.1

 (0.6) (0.3) (0.2) (0.4) (0.0) (0.0) (0.1)

Overall

 No participation in adjunct 45.2 40.1 28.2 38.8 31.3 36.6 35.7

 or automatic programs (2.7) (2.9) (2.8) (2.2) (2.9) (2.9) (2.3)

 Adjunct/automatic eligibility 4.4 2.7 6.6 4.7 4.1 4.1 4.2

 status could not be determined (0.9) (0.6) (2.6) (1.1) (1.0) (0.9) (0.7)

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

_____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-15

Sources of Monthly Income, All WIC Economic Units 

___________________________________________________________________________________________________________________________________

 Among Those with Source

 __________________________________ 

 Percent with Percent without Percent not Percent with Mean Amount

 Source Source Reported Amount Reported Reported

___________________________________________________________________________________________________________________________________

Source of Income 

 Wages or salary 73.7 26.3 0.4 85.9 14.1

 (1.8) (1.8) (0.2) (1.4) (1.4)

 Unemployment insurance 4.9 95.1 2.2 87.4 12.6

 (0.8) (0.8) (0.6) (4.7) (4.7)

 Worker's compensation 1.6 98.4 2.3 43.0 57.0

 (0.3) (0.3) (0.6) (10.7) (10.7)

 TANF 15.0 85.0 1.8 90.4 9.6

 (1.9) (1.9) (0.4) (2.2) (2.2)

 SSI 5.4 94.6 2.4 87.3 12.7

 (0.8) (0.8) (0.6) (4.2) (4.2)

 Other welfare program 5.8 94.2 2.4 87.0 13.0

 (1.0) (1.0) (0.6) (4.3) (4.3)

 Social Security 5.9 94.1 2.3 85.1 14.9

 (0.7) (0.7) (0.6) (3.7) (3.7)

 Veteran's benefits 0.8 99.2 2.5 17.6 82.4

 (0.3) (0.3) (0.6) (12.3) (12.3)

 Pensions or annuities 1.3 98.7 2.5 63.7 36.3

 (0.3) (0.3) (0.4) (11.1) (11.1)

 Rental income 0.8 99.2 1.7 80.3 19.7

 (0.3) (0.3) (0.4) (9.9) (9.9)

 Interest on savings 9.5 90.5 1.7 62.5 37.5

 (0.8) (0.8) (0.4) (4.8) (4.8)

 Dividends, royalties, trusts 1.1 98.9 2.0 31.1 68.9

 (0.3) (0.3) (0.4) (14.5) (14.5)

 Alimony or child support 11.2 88.8 2.0 94.0 6.0

 (1.2) (1.2) (0.4) (1.9) (1.9)

 Other 5.7 94.3 3.3 92.2 7.8

 (0.8) (0.8) (0.6) (1.8) (1.8)

Sample size 3,114 3,114 3,114 

Population 7,741,078 7,741,078 7,741,078 

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-16

Sources of Monthly Income for WIC Economic Units, by Participant Category: Percent with Source 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

Source of Income Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

 Wages or salary 77.1 77.2 67.4 74.0 74.6 73.0 73.7

 (2.0) (2.7) (2.7) (1.8) (2.0) (2.7) (1.8)

 Unemployment insurance 3.9 5.6 4.5 4.5 4.9 5.2 4.9

 (1.0) (1.3) (0.9) (0.7) (1.0) (1.3) (0.8)

 Worker's compensation 1.6 1.2 2.1 1.7 2.2 1.3 1.6

 (0.5) (0.5) (0.7) (0.4) (0.6) (0.4) (0.3)

 TANF 9.3 13.8 21.7 14.2 14.0 16.0 15.0

 (1.9) (2.3) (3.1) (1.9) (2.2) (2.3) (1.9)

 SSI 5.1 3.9 4.0 4.5 4.6 6.2 5.4

 (0.9) (0.8) (0.9) (0.6) (1.1) (1.3) (0.8)

 Other welfare program 5.2 3.8 5.3 4.9 5.5 6.4 5.8

 (1.0) (0.8) (1.3) (0.8) (1.5) (1.3) (1.0)

 Social Security 5.9 3.0 6.1 5.3 6.6 5.8 5.9

 (1.0) (0.8) (1.1) (0.7) (1.4) (1.0) (0.7)

 Veteran's benefits 1.5 0.4 1.0 1.1 0.4 0.9 0.8

 (0.4) (0.2) (0.4) (0.3) (0.2) (0.5) (0.3)

 Pensions or annuities 1.0 0.3 0.6 0.7 1.0 1.7 1.3

 (0.4) (0.2) (0.3) (0.2) (0.4) (0.5) (0.3)

 Rental income 1.6 2.3 0.5 1.4 0.2 0.7 0.8

 (0.5) (1.7) (0.3) (0.4) (0.2) (0.5) (0.3)

 Interest on savings 8.8 8.2 7.5 8.3 9.0 10.4 9.5

 (1.6) (1.5) (1.4) (1.1) (1.5) (1.3) (0.8)

 Dividends, royalties, trusts 1.2 0.9 1.4 1.2 0.4 1.4 1.1

 (0.6) (0.5) (0.5) (0.5) (0.3) (0.6) (0.3)

 Alimony or child support 10.5 7.4 11.7 10.2 9.8 12.3 11.2

 (1.5) (1.3) (1.7) (1.0) (1.5) (1.7) (1.2)

 Other 6.7 7.3 4.9 6.2 8.3 4.2 5.7

 (1.0) (1.3) (1.1) (0.7) (1.4) (1.3) (0.8)

 Percent receiving any source 92.9 93.1 93.4 93.1 93.2 93.6 93.4

 (1.4) (2.2) (1.2) (0.9) (1.2) (1.9) (1.2)

 Percent with no source of income 7.1 6.9 6.6 6.9 6.8 6.4 6.6

 (1.4) (2.2) (1.2) (0.9) (1.2) (1.9) (1.2)

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-17

Mean Amount of Monthly Income for WIC Economic Units, by Participant Category 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Source of Income 

 Wages or salary 1,400 1,425 1,324 1,383 1,372 1,360 1,369

 (67) (44) (59) (40) (40) (46) (34)

 Unemployment insurance 348 529 563 463 579 459 490

 (54) (88) (85) (44) (108) (49) (46)

 Worker's compensation 333 298 297 313 374 281 324

 (0) (42) (31) (15) (38) (34) (18)

 TANF 354 384 345 356 368 408 386

 (39) (21) (27) (25) (28) (36) (27)

 SSI 444 472 397 435 450 601 529

 (43) (61) (45) (29) (44) (63) (43)

 Other welfare program 327 443 388 366 350 409 385

 (40) (35) (38) (30) (84) (36) (33)

 Social Security 662 751 584 645 553 679 635

 (57) (121) (45) (33) (28) (139) (69)

 Pensions or annuities 1,285 381 611 1,026 683 706 747

 (490) (233) (48) (353) (21) (245) (168)

 Rental income 312 241 121 265 330 326 286

 (31) (40) (180) (36) (18) (263) (64)

 Interest on savings 17 35 24 23 27 26 26

 (8) (24) (11) (8) (10) (11) (8)

 Alimony or child support 206 264 247 230 278 317 289

 (20) (27) (25) (17) (23) (27) (17)

 Other 341 352 205 310 207 349 287

 (78) (119) (38) (48) (44) (140) (63)

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-18

Sources of Income for WIC Economic Units, by Participant Category and Metro-Nonmetro Location: Percent with Source 

___________________________________________________________________________________________________________________________________

 Pregnant Women Breastfeeding Women Postpartum Women Total Women

 Metro Nonmetro Metro Nonmetro Metro Nonmetro Metro Nonmetro

___________________________________________________________________________________________________________________________________

Source of Income 

 Wages or salary 76.9 77.6 76.2 82.4 64.8 76.3 73.0 77.9

 (2.3) (4.1) (3.1) (2.2) (3.1) (5.0) (2.0) (3.3)

 Unemployment insurance 3.9 4.1 4.8 10.0 3.6 7.7 4.0 6.3

 (1.2) (1.4) (1.2) (3.7) (0.9) (1.5) (0.8) (1.3)

 Worker's compensation 1.4 2.4 1.0 2.4 2.6 0.4 1.7 1.7

 (0.6) (1.1) (0.5) (1.2) (0.9) (0.4) (0.4) (0.6)

 TANF 10.0 6.7 13.8 13.8 22.8 18.0 14.8 11.7

 (2.3) (2.5) (2.7) (3.3) (3.7) (5.3) (2.3) (3.1)

 SSI 5.3 4.3 4.1 3.3 4.8 1.4 4.9 3.1

 (1.0) (1.4) (0.8) (2.1) (1.1) (0.8) (0.7) (0.7)

 Other welfare program 5.7 3.2 4.3 1.3 4.9 6.6 5.1 4.1

 (1.3) (1.4) (0.9) (0.8) (1.5) (2.6) (1.0) (1.1)

 Social Security 5.3 8.0 3.2 1.9 5.6 7.8 4.9 7.0

 (1.2) (2.2) (1.0) (1.4) (1.3) (2.0) (0.7) (1.6)

 Veteran's benefits 1.7 0.5 0.4 0.6 1.3 0.0 1.3 0.4

 (0.5) (0.5) (0.3) (0.6) (0.5) (0.0) (0.4) (0.3)

 Pensions or annuities 1.3 0.0 0.4 0.0 0.6 0.5 0.9 0.2

 (0.5) (0.0) (0.2) (0.0) (0.3) (0.5) (0.2) (0.2)

 Rental income 1.6 1.6 2.8 0.0 0.7 0.0 1.6 0.8

 (0.6) (0.9) (2.0) (0.0) (0.3) (0.0) (0.5) (0.4)

 Interest on savings 7.7 12.4 7.4 12.6 7.6 7.1 7.6 10.6

 (1.4) (4.7) (1.7) (2.9) (1.5) (3.4) (1.2) (2.4)

 Dividends, royalties, trusts 1.2 1.2 0.9 1.3 1.4 1.1 1.2 1.2

 (0.8) (0.8) (0.6) (0.8) (0.6) (1.1) (0.6) (0.7)

 Alimony or child support 8.0 19.1 7.1 9.2 13.3 6.4 9.5 13.1

 (1.2) (5.2) (1.5) (2.0) (2.0) (2.3) (1.0) (3.1)

 Other 7.0 5.6 7.1 8.5 5.3 3.6 6.5 5.4

 (1.2) (1.2) (1.4) (3.4) (1.2) (1.9) (0.8) (1.4)

 Percent receiving any source 92.5 94.4 92.7 95.3 92.1 97.7 92.4 95.6

 (1.7) (1.7) (2.5) (3.2) (1.5) (1.0) (1.1) (0.9)

 Percent with no source of income 7.5 5.6 7.3 4.7 7.9 2.3 7.6 4.4

 (1.7) (1.7) (2.5) (3.2) (1.5) (1.0) (1.1) (0.9)

Sample size 481 158 514 113 442 145 1,437 416

Population 668,251 191,130 315,918 60,545 446,008 127,891 1,430,177 379,566

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-18 (cont.)

Sources of Income for WIC Economic Units, by Participant Category and Metro-Nonmetro Location: Percent with Source 

___________________________________________________________________________________________________________________________________

 Infants Children Total WIC

 Metro Nonmetro Metro Nonmetro Metro Nonmetro

___________________________________________________________________________________________________________________________________

Source of Income 

 Wages or salary 75.2 72.3 72.1 76.5 73.1 75.8

 (2.2) (4.6) (3.2) (4.1) (2.1) (2.5)

 Unemployment insurance 4.3 7.1 5.7 3.3 4.9 4.9

 (1.0) (2.6) (1.5) (2.1) (1.0) (1.0)

 Worker's compensation 2.2 2.1 1.4 0.9 1.7 1.4

 (0.7) (1.6) (0.5) (0.8) (0.4) (0.5)

 TANF 14.4 12.4 16.6 13.7 15.6 12.9

 (2.5) (3.4) (2.6) (5.0) (2.2) (3.9)

 SSI 5.2 2.2 6.8 3.7 5.9 3.2

 (1.3) (1.1) (1.6) (2.1) (1.0) (1.1)

 Other welfare program 4.1 11.3 6.2 7.2 5.4 7.4

 (1.0) (5.2) (1.2) (3.8) (0.9) (2.8)

 Social Security 6.0 9.2 5.5 6.7 5.5 7.4

 (1.3) (4.1) (1.1) (2.1) (0.8) (1.7)

 Veteran's benefits 0.3 0.8 0.9 0.8 0.8 0.7

 (0.2) (0.8) (0.6) (0.8) (0.4) (0.4)

 Pensions or annuities 0.8 1.8 1.9 0.8 1.4 0.9

 (0.4) (1.0) (0.7) (0.5) (0.3) (0.4)

 Rental income 0.3 0.0 0.8 0.4 0.9 0.4

 (0.2) (0.0) (0.7) (0.4) (0.4) (0.2)

 Interest on savings 8.5 11.0 10.6 9.5 9.3 10.1

 (1.8) (2.8) (1.5) (2.9) (0.8) (2.1)

 Dividends, royalties, trusts 0.3 0.7 1.4 1.3 1.1 1.1

 (0.3) (0.5) (0.7) (0.8) (0.4) (0.6)

 Alimony or child support 9.9 9.2 11.0 17.2 10.4 14.3

 (1.7) (2.5) (1.7) (4.3) (1.2) (2.6)

 Other 8.8 6.1 3.1 8.3 5.3 7.1

 (1.7) (1.9) (0.8) (4.7) (0.8) (2.5)

 Percent receiving any source 92.5 95.9 92.5 97.7 92.5 96.8

 (1.2) (3.4) (2.4) (1.2) (1.5) (1.0)

 Percent with no source of income 7.5 4.1 7.5 2.3 7.5 3.2

 (1.2) (3.4) (2.4) (1.2) (1.5) (1.0)

Sample size 474 140 476 171 2,387 727

Population 1,593,475 384,936 3,119,987 832,937 6,143,639 1,597,439

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-19

Mean Amount of Monthly Income for WIC Economic Units, by Participant Category and Metro-Nonmetro Location 

___________________________________________________________________________________________________________________________________

 Pregnant Women Breastfeeding Women Postpartum Women Total Women

 Metro Nonmetro Metro Nonmetro Metro Nonmetro Metro Nonmetro

___________________________________________________________________________________________________________________________________

Source of Income 

 Wages or salary 1,381 1,468 1,398 1,555 1,335 1,291 1,372 1,424

 (81) (101) (50) (108) (73) (83) (47) (79)

 Unemployment insurance 389 * 566 437 681 350 517 324

 (60) (114) (75) (103) (108) (51) (46)

 TANF 365 294 381 399 361 278 366 305

 (43) (28) (25) (11) (31) (27) (29) (20)

 SSI 453 * 418 * 391 * 428 482

 (50) (41) (47) (32) (62)

 Other welfare program 350 * 434 * 396 362 379 297

 (42) (34) (38) (102) (31) (78)

 Social Security 690 596 714 * 547 675 643 648

 (63) (122) (127) (61) (51) (40) (58)

 Interest on savings 23 5 44 6 30 * 30 5

 (11) (1) (31) (2) (14) (10) (1)

 Alimony or child support 221 183 281 196 253 * 245 188

 (28) (25) (32) (31) (26) (18) (28)

 Other 360 253 399 151 228 * 336 189

 (94) (58) (138) (80) (43) (56) (38)

Sample size 481 158 514 113 442 145 1,437 416

Population 668,251 191,130 315,918 60,545 446,008 127,891 1,430,177 379,566

____________________________________________________________________________________________________________________________________

* Denotes fewer than 10 WIC participants in cell.
___________________________________________________________________________________________________________________________________

Exhibit E-19 (cont.)

Mean Amount of Monthly Income for WIC Economic Units, by Participant Category and Metro-Nonmetro Location 

___________________________________________________________________________________________________________________________________

 Infants Children Total WIC

 Metro Nonmetro Metro Nonmetro Metro Nonmetro

___________________________________________________________________________________________________________________________________

Source of Income 

 Wages or salary 1,364 1,410 1,365 1,346 1,366 1,379

 (46) (82) (53) (90) (38) (72)

 Unemployment insurance 527 * 409 * 457 621

 (125) (47) (53) (59)

 TANF 371 354 416 372 394 353

 (33) (33) (41) (53) (31) (36)

 SSI 436 * 634 * 542 429

 (45) (65) (47) (65)

 Other welfare program 413 * 411 399 404 329

 (101) (44) (41) (36) (63)

 Social Security 563 * 703 615 649 597

 (35) (189) (64) (93) (43)

 Interest on savings 33 8 27 22 29 14

 (13) (2) (13) (18) (10) (9)

 Alimony or child support 280 272 350 235 310 230

 (23) (63) (35) (32) (19) (27)

 Other 205 225 150 * 226 465

 (51) (43) (62) (42) (137)

Sample size 474 140 476 171 2,387 727

Population 1,593,475 384,936 3,119,987 832,937 6,143,639 1,597,439

____________________________________________________________________________________________________________________________________

* Denotes fewer than 10 WIC participants in cell.
___________________________________________________________________________________________________________________________________

Exhibit E-20

Mean Annualized Family or Economic Unit Income of WIC Participants by Participant Category and Adjunct-Eligibility Status

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

All Economic Units 

 Average (mean) income 15,100 15,483 13,254 14,594 14,708 14,822 14,739

 (65) (59) (62) (44) (50) (67) (44)

 Per capita income 5,184 3,737 3,372 4,308 3,671 3,575 3,774

 (20) (12) (13) (12) (12) (14) (10)

 Percent with income not reported 0.6 0.6 0.6 0.6 2.2 3.5 2.5

 (0.3) (0.3) (0.3) (0.2) (0.9) (0.8) (0.6)

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

Adjunctively eligible 

 Average (mean) income 12,362 13,483 12,116 12,495 13,430 12,839 12,924

 (63) (81) (62) (38) (60) (63) (39)

 Per capita income 4,341 3,286 3,072 3,650 3,395 3,119 3,317

 (24) (17) (14) (11) (15) (13) (9)

 Percent with income not reported 0.8 0.3 0.7 0.6 2.4 5.2 3.4

 (0.4) (0.3) (0.3) (0.2) (1.0) (1.3) (0.7)

Sample size 342 374 426 1,142 405 414 1,961

Population 458,522 217,868 410,318 1,086,708 1,341,504 2,460,773 4,888,984

Not adjunctively eligible 

 Average (mean) income 18,218 18,249 16,097 17,744 17,385 17,943 17,769

 (135) (75) (149) (94) (92) (127) (80)

 Per capita income 6,144 4,360 4,120 5,296 4,249 4,294 4,539

 (34) (17) (34) (26) (23) (23) (17)

 Percent with income not reported 0.4 1.0 0.3 0.5 1.9 0.6 0.9

 (0.4) (0.7) (0.3) (0.3) (1.8) (0.6) (0.7)

Sample size 297 253 161 711 209 233 1,153

Population 400,859 158,595 163,581 723,035 636,907 1,492,151 2,852,094

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-21

Mean Annualized Family or Economic Unit Income of WIC Participants by Participant Category and Metro-Nonmetro Location

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

All Economic Units 

 Average (mean) income 15,100 15,483 13,254 14,594 14,708 14,822 14,739

 (65) (59) (62) (44) (50) (67) (44)

 Per capita income 5,184 3,737 3,372 4,308 3,671 3,575 3,774

 (20) (12) (13) (12) (12) (14) (10)

 Percent with income not reported 0.6 0.6 0.6 0.6 2.2 3.5 2.5

 (0.3) (0.3) (0.3) (0.2) (0.9) (0.8) (0.6)

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

Metro areas 

 Average (mean) income 15,135 15,100 13,093 14,490 14,661 14,626 14,603

 (79) (69) (75) (53) (56) (81) (53)

 Per capita income 5,296 3,647 3,342 4,323 3,657 3,542 3,758

 (24) (14) (16) (15) (14) (17) (12)

 Percent with income not reported 0.4 0.7 0.4 0.5 2.5 3.6 2.6

 (0.3) (0.4) (0.2) (0.2) (1.0) (1.0) (0.7)

Sample size 481 514 442 1,437 474 476 2,387

Population 668,251 315,918 446,008 1,430,177 1,593,475 3,119,987 6,143,639

Nonmetro areas 

 Average (mean) income 14,975 17,468 13,818 14,988 14,900 15,553 15,259

 (98) (89) (104) (74) (120) (98) (63)

 Per capita income 4,787 4,205 3,477 4,252 3,726 3,699 3,838

 (32) (27) (19) (21) (24) (21) (14)

 Percent with income not reported 1.2 0.0 1.2 1.0 1.0 2.9 2.0

 (0.9) (0.0) (0.9) (0.5) (0.8) (1.4) (0.9)

Sample size 158 113 145 416 140 171 727

Population 191,130 60,545 127,891 379,566 384,936 832,937 1,597,439

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-23

Per Capita Economic Unit Income of WIC Participants by Category and Selected Maternal Characteristics 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Age 

 Less than 18 4,327 4,075 3,319 3,905 3,737 4,324 3,945

 (51) (44) (48) (31) (31) (85) (26)

 18-34 5,286 3,748 3,350 4,364 3,734 3,593 3,819

 (20) (14) (14) (13) (13) (16) (10)

 35 or older 5,048 3,685 3,994 4,323 3,082 3,545 3,587

 (55) (45) (44) (29) (36) (24) (19)

Marital status 

 Married 5,185 4,131 3,776 4,490 3,963 3,840 4,010

 (21) (13) (20) (11) (17) (13) (9)

 Widowed,divorced, or separated 5,248 2,901 2,510 3,826 2,712 2,858 3,003

 (54) (31) (30) (32) (22) (41) (25)

 Never married 5,199 3,207 3,211 4,248 3,528 3,612 3,772

 (32) (30) (18) (20) (22) (19) (15)

 Not reported 4,896 3,414 4,176 4,480 5,776 3,571 4,371

 (97) (104) (57) (57) (124) (107) (58)

Adult male present 

 Yes 5,450 4,013 4,042 4,715 4,161 3,814 4,116

 (24) (16) (17) (15) (13) (13) (10)

 No 4,594 2,695 2,392 3,443 2,578 3,097 3,050

 (33) (16) (20) (16) (21) (32) (20)

Highest grade of education 

 Less than 8 years 3,397 2,626 2,635 2,983 2,558 2,765 2,764

 (40) (26) (48) (19) (42) (28) (19)

 8-11 years 4,183 3,160 2,938 3,604 3,171 2,807 3,077

 (24) (18) (16) (14) (22) (22) (13)

 12 years 5,294 4,218 3,522 4,503 3,748 3,548 3,816

 (32) (22) (16) (18) (17) (18) (13)

 13 or more years 7,256 3,978 3,988 5,370 4,439 4,694 4,780

 (59) (28) (22) (31) (18) (23) (15)

 Schooling incomplete, age <18 4,406 3,670 3,255 3,854 3,652 3,973 3,812

 (50) (37) (44) (30) (26) (73) (24)

 Not reported 3,948 4,613 1,189 3,934 2,095 8,090 4,763

 (108) (73) (0) (86) (39) (0) (136)
___________________________________________________________________________________________________________________________________

Exhibit E-23 (continued)

Per Capita Economic Unit Income of WIC Participants by Category and Selected Maternal Characteristics 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Size of economic unit 

 1 person 6,512 -- 6,897 6,520 -- -- 6,520

 (74) (536) (73) (73)

 2 persons 5,633 2,247 2,348 4,874 2,734 3,495 3,897

 (35) (78) (30) (34) (41) (45) (28)

 3-5 persons 4,974 3,985 3,504 4,185 4,023 3,720 3,902

 (30) (11) (14) (14) (12) (14) (9)

 6 or more persons 3,289 3,098 3,243 3,213 2,685 3,102 2,998

 (45) (25) (41) (19) (29) (27) (19)

Currently Employed 

 Yes 7,570 5,080 5,192 6,630 5,083 4,948 5,346

 (40) (28) (28) (28) (19) (19) (16)

 No, employed in last 12 mos. 4,036 3,898 2,907 3,653 3,617 2,930 3,384

 (29) (16) (18) (15) (18) (21) (9)

 No, not employed in last 12 mos. 4,173 3,143 2,997 3,518 3,248 2,979 3,169

 (30) (18) (16) (16) (18) (18) (13)

 Overall 5,190 3,737 3,381 4,314 3,679 3,597 3,790

 (20) (12) (13) (13) (12) (14) (10)

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-24

Distribution of Percent of Poverty Level of WIC Participants, by Participant Category 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Percent of Poverty Level 

 0-50 24.8 26.4 34.8 28.3 26.0 27.6 27.3

 (1.9) (2.4) (2.6) (1.3) (2.0) (2.6) (1.5)

 51-100 28.4 35.1 33.0 31.3 39.0 37.7 36.5

 (2.2) (2.3) (2.2) (1.3) (2.5) (2.4) (1.5)

 101-130 14.6 17.4 15.6 15.5 16.4 13.9 14.9

 (1.3) (2.1) (2.8) (1.0) (1.6) (1.5) (1.0)

 131-150 11.2 7.5 6.5 8.9 5.7 8.4 7.8

 (1.2) (1.2) (1.4) (0.9) (0.9) (1.3) (0.8)

 151-185 14.0 7.7 6.1 10.2 6.8 6.8 7.6

 (1.8) (1.2) (1.0) (1.1) (1.4) (1.1) (0.8)

 186-200 1.4 1.8 0.6 1.2 1.1 2.6 1.9

 (0.5) (0.5) (0.3) (0.3) (0.4) (0.6) (0.4)

 201-225 1.5 1.8 1.3 1.5 2.4 1.5 1.7

 (0.5) (0.4) (0.5) (0.3) (0.7) (0.5) (0.3)

 226-250 1.2 1.1 0.5 1.0 1.2 0.8 0.9

 (0.4) (0.4) (0.3) (0.2) (0.4) (0.6) (0.3)

 Over 250 3.0 1.2 1.5 2.2 1.4 0.8 1.3

 (0.8) (0.5) (0.5) (0.5) (0.5) (0.5) (0.3)

Not reported* 0.7 0.6 0.6 0.7 2.4 4.1 2.9

 (0.3) (0.3) (0.3) (0.2) (0.9) (0.9) (0.6)

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-25

Distribution of Cumulative Percent of Poverty Level of WIC Participants, by Participant Category 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Percent of Poverty Level 

 0-50 24.8 26.4 34.8 28.3 26.0 27.6 27.3

 (1.9) (2.4) (2.6) (1.3) (2.0) (2.6) (1.5)

 51-100 53.2 61.5 67.8 59.6 65.0 65.3 63.9

 (2.3) (2.6) (3.2) (1.6) (2.5) (2.5) (1.8)

 101-130 67.8 78.9 83.4 75.0 81.5 79.2 78.8

 (2.5) (1.6) (2.0) (1.5) (1.9) (2.0) (1.6)

 131-150 79.0 86.4 89.9 84.0 87.1 87.6 86.6

 (2.1) (1.4) (1.4) (1.3) (1.7) (1.5) (1.1)

 151-185 93.0 94.1 96.0 94.2 93.9 94.3 94.2

 (1.1) (1.1) (0.9) (0.7) (0.9) (0.9) (0.7)

 186-200 94.4 95.9 96.6 95.4 95.0 96.9 96.1

 (1.0) (0.9) (0.8) (0.7) (0.8) (0.9) (0.6)

 201-225 95.8 97.7 97.9 96.9 97.4 98.4 97.8

 (0.9) (0.7) (0.5) (0.6) (0.6) (0.7) (0.4)

 226-250 97.0 98.8 98.5 97.8 98.6 99.2 98.7

 (0.8) (0.5) (0.5) (0.5) (0.5) (0.5) (0.3)

 Over 250 100.0 100.0 100.0 100.0 100.0 100.0 100.0

 

Not reported* 0.7 0.6 0.6 0.7 2.4 4.1 2.9

 (0.3) (0.3) (0.3) (0.2) (0.9) (0.9) (0.6)

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-26

Distribution of Cumulative Percent of Poverty Level of WIC Participants, by Adjunctive Income Eligibility 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

Percent of Poverty Level Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Adjunctively income eligible 

 0-50 33.3 33.0 40.6 36.0 29.9 36.2 34.4

 (3.2) (3.3) (3.0) (1.7) (2.3) (3.0) (1.7)

 51-100 62.1 71.7 74.1 68.6 73.5 74.9 73.1

 (3.0) (3.5) (3.8) (1.5) (3.0) (2.0) (1.3)

 101-130 77.2 87.7 88.6 83.6 86.2 87.3 86.1

 (2.5) (1.7) (1.8) (1.5) (2.4) (1.9) (1.5)

 131-150 85.6 91.0 92.7 89.4 89.4 91.8 90.6

 (2.2) (1.6) (1.3) (1.2) (2.2) (1.6) (1.2)

 151-185 95.4 95.9 97.2 96.2 94.9 95.3 95.4

 (1.2) (1.0) (0.9) (0.6) (1.1) (1.1) (0.7)

 186-200 96.4 97.1 97.2 96.8 95.9 97.2 96.8

 (1.0) (0.8) (0.9) (0.6) (0.9) (1.0) (0.6)

 201-225 97.4 98.6 98.0 97.9 97.6 98.7 98.2

 (0.8) (0.5) (0.7) (0.5) (0.7) (0.7) (0.4)

 226-250 98.7 99.1 98.4 98.7 98.6 98.8 98.7

 (0.6) (0.4) (0.6) (0.4) (0.6) (0.7) (0.4)

 Over 250 100.0 100.0 100.0 100.0 100.0 100.0 100.0

 

Not reported* 0.8 0.3 0.7 0.6 2.4 5.2 3.4

 (0.4) (0.3) (0.3) (0.2) (1.0) (1.3) (0.7)

Sample size 342 374 426 1,142 405 414 1,961

Population 458,522 217,868 410,318 1,086,708 1,341,504 2,460,773 4,888,984
___________________________________________________________________________________________________________________________________

Exhibit E-26 (cont.)

Distribution of Cumulative Percent of Poverty Level of WIC Participants, by Adjunctive Income Eligibility 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

Percent of Poverty Level Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Not adjunctively income eligible 

 0-50 15.2 17.4 20.2 16.8 17.7 13.9 15.5

 (2.2) (3.1) (6.2) (2.2) (4.1) (3.6) (2.4)

 51-100 43.0 47.4 52.0 46.0 47.2 49.9 48.3

 (4.0) (3.7) (6.9) (3.4) (4.5) (5.0) (3.6)

 101-130 57.0 66.8 70.3 62.2 71.3 66.2 66.3

 (4.2) (2.8) (4.9) (3.2) (3.1) (4.1) (2.8)

 131-150 71.4 80.0 82.7 75.8 82.4 80.7 79.9

 (3.6) (2.4) (3.5) (2.7) (2.7) (2.9) (1.8)

 151-185 90.2 91.7 92.8 91.1 92.0 92.8 92.2

 (2.1) (2.1) (1.9) (1.5) (2.0) (2.0) (1.2)

 186-200 92.1 94.3 95.1 93.2 93.1 96.5 94.9

 (1.9) (1.8) (1.5) (1.3) (1.9) (1.6) (1.0)

 201-225 94.0 96.4 97.7 95.4 97.2 98.0 97.2

 (1.7) (1.3) (0.9) (1.1) (1.3) (1.5) (0.9)

 226-250 95.0 98.3 98.6 96.5 98.6 99.8 98.7

 (1.7) (0.8) (0.7) (1.0) (1.1) (0.2) (0.5)

 Over 250 100.0 100.0 100.0 100.0 100.0 100.0 100.0

 

Not reported* 0.6 1.0 1.2 0.8 2.6 2.2 1.9

 (0.4) (0.7) (0.7) (0.3) (1.8) (1.0) (0.8)

Sample size 297 253 161 711 209 233 1,153

Population 400,859 158,595 163,581 723,035 636,907 1,492,151 2,852,094

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-27

Distribution of Cumulative Percent of Poverty Level of WIC Participants, by Metro-Nonmetro Location 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

Percent of Poverty Level Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Metropolitan Location 

 0-50 23.6 27.9 35.9 28.4 26.1 27.9 27.5

 (2.1) (2.6) (3.1) (1.6) (2.1) (3.2) (1.8)

 51-100 52.8 64.5 67.5 60.0 65.4 66.0 64.4

 (2.6) (2.9) (4.0) (1.8) (2.9) (2.9) (2.1)

 101-130 67.7 80.4 83.7 75.5 81.8 79.3 79.0

 (3.0) (1.5) (2.4) (1.8) (2.2) (2.2) (1.8)

 131-150 78.0 86.7 89.6 83.5 87.3 86.9 86.2

 (2.6) (1.5) (1.6) (1.5) (2.1) (1.8) (1.3)

 151-185 92.6 94.4 96.1 94.1 94.0 93.9 94.0

 (1.4) (1.2) (1.0) (0.9) (1.0) (1.1) (0.7)

 186-200 94.0 95.7 96.7 95.2 95.0 96.6 95.9

 (1.2) (1.0) (0.9) (0.8) (0.9) (1.1) (0.7)

 201-225 95.7 97.3 97.8 96.7 97.2 98.4 97.7

 (1.1) (0.8) (0.6) (0.7) (0.8) (0.9) (0.5)

 226-250 97.0 98.6 98.5 97.8 98.4 99.3 98.7

 (1.0) (0.6) (0.6) (0.6) (0.7) (0.5) (0.3)

 Over 250 100.0 100.0 100.0 100.0 100.0 100.0 100.0

 

Not reported* 0.5 0.7 0.7 0.6 2.8 4.4 3.1

 (0.3) (0.4) (0.3) (0.2) (1.0) (1.1) (0.7)

Sample size 481 514 442 1,437 474 476 2,387

Population 668,251 315,918 446,008 1,430,177 1,593,475 3,119,987 6,143,639

 
___________________________________________________________________________________________________________________________________

Exhibit E-27 (cont.)

Distribution of Cumulative Percent of Poverty Level of WIC Participants, by Metro-Nonmetro Location 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

Percent of Poverty Level Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Nonmetropolitan Location 

 0-50 29.0 18.8 30.8 28.0 25.5 26.5 26.6

 (4.1) (4.2) (4.6) (1.8) (5.4) (3.9) (2.6)

 51-100 54.5 46.2 68.9 58.0 63.6 62.6 61.8

 (4.4) (4.9) (4.6) (2.9) (4.1) (4.1) (2.7)

 101-130 68.2 70.9 82.3 73.4 80.2 78.9 77.9

 (3.6) (6.8) (3.6) (2.8) (4.1) (4.9) (3.6)

 131-150 82.2 85.1 90.9 85.6 86.5 89.9 88.0

 (2.3) (4.3) (3.0) (2.1) (2.8) (2.8) (1.9)

 151-185 94.1 92.7 95.3 94.3 93.8 95.8 95.0

 (1.5) (2.8) (1.8) (1.4) (2.0) (1.9) (1.5)

 186-200 95.7 97.0 96.1 96.1 94.9 98.2 96.9

 (1.6) (1.4) (1.7) (1.3) (1.6) (1.0) (1.0)

 201-225 96.4 99.4 98.5 97.6 98.5 98.6 98.3

 (1.5) (0.6) (0.8) (1.0) (0.8) (1.0) (0.8)

 226-250 96.9 99.4 98.5 97.8 99.4 98.6 98.6

 (1.5) (0.6) (0.8) (1.0) (0.6) (1.0) (0.7)

 Over 250 100.0 100.0 100.0 100.0 100.0 100.0 100.0

 

Not reported* 1.2 0.0 1.2 1.0 1.0 2.9 2.0

 (0.9) (0.0) (0.9) (0.5) (0.8) (1.4) (0.9)

Sample size 158 113 145 416 140 171 727

Population 191,130 60,545 127,891 379,566 384,936 832,937 1,597,439

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-30

Distribution of Number of Nutritional Risk Factors, by Participant Category 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Anthropometric risks 

 None 25.7 37.5 42.1 33.1 75.2 61.5 58.4

 (2.8) (3.1) (3.6) (2.0) (2.7) (2.8) (1.4)

 One 39.7 32.4 23.6 33.3 15.2 28.2 26.0

 (2.6) (2.5) (2.8) (1.7) (1.9) (2.1) (1.3)

 Two or more 34.6 30.1 34.3 33.6 9.6 10.3 15.6

 (2.8) (2.9) (2.8) (1.6) (1.6) (2.1) (1.2)

Conditions specific to pregnancy 

 None 53.8 NA NA 77.3 NA NA 94.7

 (2.4) (1.2) (0.3)

 One 34.0 NA NA 16.7 NA NA 3.9

 (2.1) (1.0) (0.3)

 Two or more 12.3 NA NA 6.0 NA NA 1.4

 (1.7) (0.9) (0.2)

Potentially toxic substances 

 None 76.1 89.7 77.8 79.3 99.9 99.5 94.9

 (2.7) (1.8) (2.9) (2.1) (0.1) (0.3) (0.5)

 One 21.2 9.6 19.9 18.5 0.1 0.5 4.6

 (2.3) (1.8) (2.6) (1.8) (0.1) (0.3) (0.5)

 Two or more 2.7 0.7 2.3 2.2 0.0 0.0 0.5

 (0.9) (0.3) (0.7) (0.5) (0.0) (0.0) (0.1)

Biochemical and other medical risks 

 None 45.9 52.6 42.2 46.1 79.1 64.6 64.0

 (2.8) (3.0) (2.8) (2.3) (2.1) (2.7) (1.9)

 One 39.2 32.5 40.3 38.2 16.1 28.5 27.6

 (2.5) (2.2) (2.8) (2.0) (1.9) (2.7) (1.8)

 Two or more 14.9 14.9 17.5 15.7 4.8 7.0 8.4

 (2.0) (1.9) (2.2) (1.5) (1.2) (1.5) (0.9)
___________________________________________________________________________________________________________________________________

Exhibit E-30 (cont.)

Distribution of Number of Nutritional Risk Factors, by Participant Category 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Dietary risks 

 None 25.5 23.0 32.2 27.1 73.3 22.3 36.5

 (3.8) (3.1) (4.9) (3.6) (2.1) (3.8) (2.8)

 One 71.8 75.4 67.0 71.0 14.8 75.7 58.9

 (3.7) (3.1) (4.9) (3.5) (1.8) (3.8) (2.8)

 Two or more 2.6 1.6 0.9 1.9 12.0 2.0 4.5

 (0.9) (0.7) (0.4) (0.5) (2.0) (0.8) (0.7)

Predisposing risks 

 None 90.0 91.7 87.8 89.7 82.4 88.7 87.3

 (1.4) (1.6) (2.3) (1.2) (2.2) (1.6) (1.3)

 One 8.5 7.4 9.6 8.6 14.7 9.1 10.4

 (1.3) (1.5) (1.9) (1.0) (1.8) (1.4) (0.9)

 Two or more 1.5 0.9 2.5 1.7 2.9 2.3 2.3

 (0.5) (0.4) (1.2) (0.4) (0.8) (0.8) (0.5)

Other risks 

 None 95.8 83.6 86.6 90.5 6.1 97.5 72.4

 (1.1) (2.9) (2.8) (1.6) (1.2) (0.9) (1.1)

 One 3.9 7.3 11.3 6.9 91.5 2.3 26.3

 (0.9) (1.4) (2.6) (1.1) (1.4) (0.9) (1.1)

 Two or more 0.3 9.1 2.0 2.6 2.4 0.2 1.3

 (0.2) (2.4) (0.7) (0.6) (0.9) (0.2) (0.4)

Total risks 

 One 10.9 16.9 17.7 14.2 43.2 44.6 37.1

 (2.2) (1.9) (3.2) (1.6) (2.2) (2.2) (1.5)

 Two 16.2 23.9 21.2 19.3 24.2 30.8 26.4

 (1.7) (2.1) (2.4) (1.4) (1.7) (2.2) (1.4)

 Three 24.1 24.6 23.8 24.1 13.4 15.0 16.7

 (2.0) (2.3) (1.9) (1.3) (1.4) (1.5) (1.0)

 Four or more 48.8 34.6 37.3 42.4 19.2 9.6 19.8

 (2.9) (2.0) (3.1) (1.9) (1.9) (2.3) (1.4)

Sample size 613 569 541 1,723 571 586 2,880

Population 815,949 332,539 514,259 1,662,748 1,819,440 3,605,613 7,087,801

____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________

Exhibit E-31

Percent of WIC Pregnant Women with Specific Nutritional Risk Factors 

_____________________________________________________________________________________

 Risk Risk Not Risk Not

 Present Present Assessed

_____________________________________________________________________________________

Anthropometric Risk Criteria 

 Prepregnancy underweight 14.3 79.1 6.6

 (1.5) (2.2) (1.8)

 Low maternal weight gain 18.5 70.0 11.5

 (1.9) (2.6) (2.4)

 Maternal weight loss during preg. 12.9 75.4 11.7

 (1.6) (2.5) (2.3)

 Prepregnancy overweight 39.6 55.1 5.4

 (2.7) (2.6) (1.6)

 High gestational weight gain 28.4 61.9 9.6

 (2.6) (2.7) (2.0)

Biochemical and Other Medical Risk Criteria 

 Anemia 25.1 63.7 11.3

 (2.5) (3.0) (2.2)

 Nutrient deficiency diseases 2.8 75.5 21.6

 (0.9) (3.3) (3.4)

 Gastrointestinal disorders 3.3 73.9 22.8

 (0.9) (3.9) (4.0)

 Nausea and vomiting during preg. 30.5 58.8 10.7

 (2.5) (2.4) (2.2)

 Diabetes mellitus 1.3 80.3 18.3

 (0.6) (3.1) (3.2)

 Gestational diabetes 2.4 78.4 19.1

 (0.9) (3.1) (3.2)

 Thyroid disorders 0.6 73.5 25.9

 (0.3) (4.1) (4.2)

 Chronic hypertension 2.1 76.4 21.5

 (0.7) (3.9) (3.8)

 Renal disease 0.5 73.3 26.2

 (0.3) (4.1) (4.2)

 Cancer 0.6 72.3 27.2

 (0.3) (4.1) (4.2)

 Central nervous system disorders 1.1 71.8 27.1

 (0.5) (4.1) (4.2)

 Genetic and congenital disorders 0.9 72.0 27.1

 (0.4) (4.3) (4.4)

 Inborn errors of metabolism 0.7 73.3 26.0

 (0.3) (4.3) (4.4)

 Chronic or recurrent infections 0.8 73.1 26.1

 (0.4) (4.2) (4.2)

 HIV infections and AIDS 0.6 68.9 30.5

 (0.3) (4.1) (4.2)

 Recent major surgery/trauma/etc. 1.0 73.9 25.2

 (0.4) (4.2) (4.2)

 Other nutritionally-related cond. 2.5 75.3 22.2

 (0.7) (3.7) (3.7)

 Food allergies 1.7 81.2 17.1

 (0.6) (2.9) (3.0)

 Celiac disease 0.4 73.6 26.0

 (0.3) (3.9) (3.9)

 Lactose intolerance 1.8 79.7 18.5

 (0.7) (3.6) (3.4)
_____________________________________________________________________________________

Exhibit E-31 (cont.)

Percent of WIC Pregnant Women with Specific Nutritional Risk Factors 

_____________________________________________________________________________________

 Risk Risk Not Risk Not

 Present Present Assessed

_____________________________________________________________________________________

Conditions Specific to Pregnancy 

 Pregnancy at a young age 22.6 70.4 6.9

 (2.4) (2.7) (1.8)

 Closely spaced pregnancies 19.7 74.6 5.6

 (2.0) (2.3) (1.2)

 History of preterm delivery 7.9 80.6 11.5

 (1.2) (2.2) (2.1)

 History of low birth weight 4.1 84.5 11.4

 (0.8) (2.5) (2.2)

 History of birth with congenital 1.0 86.0 13.0

 or birth defect (0.4) (2.4) (2.4)

 Lack of prenatal care 7.9 84.5 7.7

 (1.2) (2.0) (1.7)

 Multifetal gestation 1.9 86.4 11.7

 (0.5) (2.0) (2.0)

 Fetal growth restriction 0.7 81.2 18.1

 (0.4) (2.8) (2.8)

Potentially Toxic Substances 

 Long-term drug-nutrient interactions 0.9 79.6 19.4

 (0.4) (3.4) (3.4)

 Maternal smoking 20.5 73.8 5.7

 (2.5) (2.8) (1.6)

 Alcohol and illegal drug use 5.5 87.5 7.1

 (1.5) (2.4) (1.9)

 Lead poisoning 0.5 68.0 31.6

 (0.3) (4.0) (4.1)

Dietary Risk Criteria 

 Failure to meet Dietary Guidelines 74.2 20.6 5.2

 (3.9) (3.2) (1.6)

 Vegan diets 1.1 86.8 12.1

 (0.7) (2.5) (2.5)

 Highly restrictive diets 1.5 87.0 11.5

 (0.5) (2.4) (2.4)

 Pica 0.9 88.1 11.1

 (0.4) (2.6) (2.7)

Predisposing Risk Criteria 

 Homelessness 0.6 89.4 10.0

 (0.4) (1.8) (1.8)

 Migrancy 0.6 88.4 11.0

 (0.4) (1.9) (1.9)

 Low level of maternal education 8.4 72.2 19.4

 (1.3) (3.4) (3.6)

 Maternal depression 1.9 67.6 30.5

 (0.6) (3.8) (3.8)

 Battering 0.7 65.7 33.6

 (0.3) (4.2) (4.2)

Other Risks 

 Pregnancy at age >=34 1.2 NA NA

 (0.4) 

Sample size 613 613 613

Population 815,949 815,949 815,949

_____________________________________________________________________________________
_____________________________________________________________________________________

Exhibit E-32

Percent of WIC Breastfeeding Women with Specific Nutritional Risk Factors 

_____________________________________________________________________________________

 Risk Risk Not Risk Not

 Present Present Assessed

_____________________________________________________________________________________

Anthropometric Risk Criteria 

 Prepregnancy overweight 26.0 55.5 18.5

 (2.4) (2.7) (2.9)

 High gestational weight gain 21.5 63.3 15.2

 (3.3) (3.2) (2.8)

 Postpartum underweight 6.1 82.6 11.4

 (1.0) (2.2) (2.0)

 Postpartum overweight 46.4 46.6 7.0

 (2.9) (2.4) (2.0)

Biochemical and Other MedicalRisk Criteria 

 Anemia 29.7 60.0 10.3

 (3.3) (3.9) (2.0)

 Nutrient deficiency diseases 5.1 75.3 19.6

 (1.2) (4.0) (3.8)

 Gastrointestinal disorders 0.7 75.8 23.5

 (0.5) (4.1) (4.0)

 Nausea and vomiting during preg. 15.2 58.4 26.4

 (2.3) (3.8) (3.7)

 Diabetes mellitus 1.8 78.5 19.7

 (0.5) (3.4) (3.4)

 Thyroid disorders 0.5 70.9 28.5

 (0.4) (4.2) (4.3)

 Chronic hypertension 1.4 75.5 23.1

 (0.5) (3.6) (3.8)

 Renal disease 0.1 71.0 28.9

 (0.1) (4.1) (4.1)

 Cancer 0.1 70.8 29.1

 (0.1) (3.9) (3.9)

 Central nervous system disorders 0.3 69.2 30.6

 (0.2) (4.0) (4.0)

 Genetic and congenital disorders 0.1 69.2 30.6

 (0.1) (4.1) (4.1)

 Inborn errors of metabolism 0.0 69.9 30.1

 (0.0) (4.1) (4.1)

 Chronic or recurrent infections 0.9 70.5 28.6

 (0.3) (4.2) (4.1)

 HIV infections and AIDS 0.0 68.9 31.1

 (0.0) (3.7) (3.7)

 Recent major surgery/trauma/etc. 3.4 69.9 26.6

 (0.9) (3.7) (3.8)

 Other nutritionally-related cond. 1.5 78.6 19.9

 (0.9) (3.7) (3.7)

 Food allergies 1.9 84.5 13.6

 (0.6) (3.4) (3.3)

 Celiac disease 0.0 72.9 27.1

 (0.0) (3.9) (3.9)

 Lactose intolerance 1.9 82.3 15.8

 (0.7) (3.3) (3.4)

 Multifetal gestation 1.0 79.4 19.5

 (0.4) (3.8) (3.8)

Potentially Toxic Substances 

 Long-term drug-nutrient interaction 0.1 76.5 23.3

 (0.2) (3.8) (3.8)

 Maternal smoking 9.3 81.4 9.3

 (1.7) (2.4) (2.4)

 Alcohol and illegal drug use 1.5 88.8 9.7

 (0.6) (2.4) (2.3)
_____________________________________________________________________________________

Exhibit E-32 (cont.)

Percent of WIC Breastfeeding Women with Specific Nutritional Risk Factors 

_____________________________________________________________________________________

 Risk Risk Not Risk Not

 Present Present Assessed

_____________________________________________________________________________________

 Lead poisoning 0.0 66.8 33.2

 (0.0) (4.0) (4.0)

Dietary Risk Criteria 

 Failure to meet Dietary Guidelines 76.6 16.9 6.5

 (3.2) (2.3) (2.4)

 Vegan diets 1.0 83.4 15.6

 (0.4) (3.3) (3.2)

 Highly restrictive diets 1.3 83.9 14.8

 (0.6) (3.2) (3.2)

Predisposing Risk Criteria 

 Homelessness 0.7 88.8 10.5

 (0.3) (2.5) (2.4)

 Migrancy 0.8 87.2 12.0

 (0.4) (2.6) (2.5)

 Low level of maternal education 5.8 72.6 21.6

 (1.5) (4.0) (4.1)

 Maternal depression 2.0 65.5 32.6

 (0.6) (3.9) (3.9)

 Battering 0.0 63.3 36.7

 (0.0) (4.0) (4.0)

Other Risks 

 Pregnancy at young age 3.1 NA NA

 (1.0) 

 Pregnancy at age >=34 1.5 NA NA

 (0.6) 

 Breastfeeding infant 100.0 NA NA

 (0.0) 

 Miscarriage 0.7 NA NA

 (0.5) 

 Closely spaced pregnancies 5.1 NA NA

 (1.1) 

Sample size 569 569 569

Population 332,539 332,539 332,539

_____________________________________________________________________________________
_____________________________________________________________________________________

Exhibit E-33

Percent of WIC Postpartum Women with Specific Nutritional Risk Factors 

_____________________________________________________________________________________

 Risk Risk Not Risk Not

 Present Present Assessed

_____________________________________________________________________________________

Anthropometric Risk Criteria 

 Prepregnancy overweight 31.6 54.5 13.9

 (2.5) (2.7) (2.5)

 High gestational weight gain 18.3 66.2 15.6

 (2.4) (3.1) (2.7)

 Postpartum underweight 4.6 84.7 10.7

 (0.9) (2.5) (2.4)

 Postpartum overweight 46.1 47.2 6.7

 (3.6) (3.1) (2.3)

Biochemical and Other MedicalRisk Criteria 

 Anemia 36.8 56.4 6.8

 (3.4) (3.8) (1.8)

 Nutrient deficiency diseases 3.0 75.7 21.2

 (0.8) (4.0) (4.0)

 Gastrointestinal disorders 1.5 72.3 26.2

 (0.7) (4.4) (4.4)

 Nausea and vomiting during preg. 17.9 55.6 26.6

 (2.5) (3.9) (3.6)

 Diabetes mellitus 3.2 75.3 21.6

 (0.9) (3.8) (3.5)

 Thyroid disorders 1.3 71.0 27.7

 (0.7) (4.4) (4.3)

 Chronic hypertension 4.3 72.4 23.3

 (1.3) (4.2) (4.1)

 Renal disease 0.5 71.2 28.3

 (0.5) (4.5) (4.4)

 Cancer 0.5 69.8 29.6

 (0.5) (4.4) (4.3)

 Central nervous system disorders 1.1 69.4 29.6

 (0.6) (4.5) (4.4)

 Genetic and congenital disorders 0.9 68.7 30.4

 (0.6) (4.5) (4.3)

 Inborn errors of metabolism 0.5 68.9 30.6

 (0.5) (4.6) (4.5)

 Chronic or recurrent infections 1.4 69.0 29.6

 (0.6) (4.4) (4.3)

 HIV infections and AIDS 0.5 68.6 30.9

 (0.5) (4.5) (4.4)

 Recent major surgery/trauma/etc. 4.0 68.2 27.8

 (0.9) (4.3) (4.1)

 Other nutritionally-related cond. 4.3 71.3 24.3

 (0.9) (4.2) (4.2)

 Food allergies 2.4 76.6 21.0

 (0.7) (4.1) (4.1)

 Celiac disease 0.0 71.8 28.2

 (0.0) (4.1) (4.1)

 Lactose intolerance 1.7 78.1 20.2

 (0.6) (3.8) (3.9)

 Multifetal gestation 1.9 76.9 21.2

 (0.7) (3.4) (3.2)

Potentially Toxic Substances 

 Long-term drug-nutrient interaction 0.9 73.0 26.1

 (0.4) (4.1) (4.1)

 Maternal smoking 20.2 72.3 7.5

 (2.8) (3.1) (2.1)

 Alcohol and illegal drug use 3.5 85.9 10.6

 (1.1) (2.4) (2.4)
_____________________________________________________________________________________

Exhibit E-33 (cont.)

Percent of WIC Postpartum Women with Specific Nutritional Risk Factors 

_____________________________________________________________________________________

 Risk Risk Not Risk Not

 Present Present Assessed

_____________________________________________________________________________________

 Lead poisoning 0.2 61.4 38.4

 (0.2) (4.2) (4.2)

Dietary Risk Criteria 

 Failure to meet Dietary Guidelines 67.8 25.0 7.2

 (4.9) (4.7) (2.9)

 Vegan diets 0.4 84.9 14.7

 (0.2) (3.3) (3.3)

 Highly restrictive diets 0.7 84.9 14.4

 (0.4) (3.3) (3.3)

Predisposing Risk Criteria 

 Homelessness 1.7 87.9 10.4

 (1.0) (2.4) (2.3)

 Migrancy 0.9 84.5 14.6

 (0.5) (2.7) (2.6)

 Low level of maternal education 8.4 70.2 21.4

 (1.9) (4.0) (3.6)

 Maternal depression 4.2 61.5 34.3

 (1.5) (4.3) (4.6)

 Battering 0.9 61.4 37.6

 (0.8) (4.6) (4.6)

Other Risks 

 Pregnancy at young age 5.5 NA NA 

 (1.4) 

 Pregnancy at age >=34 1.6 NA NA 

 (0.5) 

 Breastfeeding infant 0.0 NA NA 

 (0.0) 

 Miscarriage 0.9 NA NA 

 (0.5) 

 Closely spaced pregnancies 5.7 NA NA 

 (1.6) 

Sample size 541 541 541

Population 514,259 514,259 514,259

_____________________________________________________________________________________
_____________________________________________________________________________________

Exhibit E-34

Percent of WIC Infants with Specific Nutritional Risk Factors 

_____________________________________________________________________________________

 Risk Risk Not Risk Not

 Present Present Assessed

_____________________________________________________________________________________

Anthropometric Risk Criteria 

 Low birth weight 10.8 83.5 5.8

 (1.8) (2.6) (2.0)

 Small for gestational age 3.6 86.4 10.0

 (0.9) (2.9) (2.6)

 Short stature 11.0 81.2 7.8

 (1.7) (2.6) (2.4)

 Underweight 5.9 87.0 7.1

 (1.3) (2.8) (2.3)

 Low head circumference 1.2 55.8 43.1

 (0.5) (4.8) (4.8)

 Overweight 6.2 85.7 8.1

 (1.2) (2.5) (2.5)

 Slow growth 2.8 83.1 14.1

 (1.0) (2.9) (3.0)

Biochemical and Other Medical Risk Criteria 

 Anemia 3.6 49.1 47.3

 (1.0) (3.3) (3.3)

 Failure to thrive 0.5 80.7 18.9

 (0.3) (3.1) (3.0)

 Nutrient deficiency diseases 0.6 74.8 24.6

 (0.4) (4.1) (4.1)

 Gastrointestinal disorders 3.5 69.2 27.3

 (1.1) (4.5) (4.7)

 Diabetes mellitus 0.4 69.0 30.6

 (0.3) (4.2) (4.2)

 Thyroid disorders 0.1 67.3 32.5

 (0.1) (4.5) (4.5)

 Chronic hypertension 0.2 67.2 32.5

 (0.2) (4.5) (4.5)

 Renal disease 0.0 67.4 32.6

 (0.0) (4.6) (4.6)

 Cancer 0.0 66.8 33.2

 (0.0) (4.6) (4.6)

 Central nervous system disorders 0.3 67.9 31.8

 (0.3) (4.6) (4.6)

 Genetic and congenital disorders 0.7 68.9 30.4

 (0.3) (4.6) (4.7)

 Inborn errors of metabolism 0.3 69.1 30.7

 (0.2) (4.7) (4.7)

 Chronic or recurrent infections 1.4 69.1 29.5

 (0.5) (4.6) (4.7)

 HIV infections and AIDS 0.0 66.3 33.7

 (0.0) (4.6) (4.6)

 Recent major surgery/trauma/etc. 1.2 72.1 26.7

 (0.4) (4.8) (4.7)

 Other nutritionally-related cond. 1.2 75.1 23.8

 (0.5) (4.1) (4.2)

 Food allergies 2.0 73.0 25.0

 (0.6) (3.8) (4.0)

 Celiac disease 0.0 70.0 30.0

 (0.0) (4.7) (4.7)

 Lactose intolerance 3.8 72.9 23.3

 (1.3) (3.9) (4.1)
_____________________________________________________________________________________

Exhibit E-34 (cont.)

Percent of WIC Infants with Specific Nutritional Risk Factors 

_____________________________________________________________________________________

 Risk Risk Not Risk Not

 Present Present Assessed

_____________________________________________________________________________________

 Prematurity 8.5 74.8 16.7

 (1.2) (3.1) (3.3)

 Hypoglycemia 0.1 63.3 36.6

 (0.1) (4.6) (4.6)

Potentially Toxic Substances 

 Lead poisoning 0.1 54.9 45.0

 (0.1) (4.5) (4.5)

Dietary Risk Criteria 

 Failure to meet Dietary Guidelines 14.8 72.9 12.3

 (2.1) (3.2) (3.0)

 Highly restrictive diets 0.8 82.9 16.3

 (0.4) (2.8) (2.8)

 Inappropriate infant feeding 13.8 75.8 10.4

 (2.0) (3.1) (2.6)

 Early introduction of solid foods 5.9 81.9 12.2

 (1.5) (2.8) (2.8)

 Feeding cow milk during first yr 2.3 85.2 12.5

 (0.9) (3.1) (2.8)

 No dependable source of iron 1.3 79.0 19.7

 after 4-6 months (0.7) (3.4) (3.1)

 Improper dilution of formula 1.9 85.7 12.4

 (1.0) (2.9) (2.8)

 Feeding other foods low in nutrients 1.2 85.6 13.2

 (0.6) (2.8) (2.8)

 Lack of sanitation prep of bottles 0.9 78.7 20.4

 (0.5) (3.5) (3.5)

 Infreq breastfeeding as sole 1.7 82.7 15.6

 source of nutrients (0.6) (2.8) (2.8)

 Inappropriate use of nursing bottle 4.3 79.9 15.9

 (1.5) (3.1) (2.9)

Predisposing Risk Criteria 

 Homelessness 0.7 89.1 10.1

 (0.4) (2.7) (2.6)

 Migrancy 0.9 87.6 11.5

 (0.5) (2.8) (2.7)

 Low level of maternal education 6.7 74.0 19.3

 (1.5) (4.1) (3.8)

 Maternal depression 2.5 66.3 31.2

 (0.8) (4.5) (4.4)

 Child abuse or neglect 1.9 67.9 30.1

 (0.7) (4.2) (4.1)

 Child of a young caregiver 9.4 75.2 15.4

 (1.4) (3.2) (2.8)

 Child of a mentally retarded parent 0.3 82.8 16.8

 (0.3) (3.0) (2.9)

Other risks 

 Second-hand smoke 2.3 NA NA 

 (0.9) 

 Drug exposure 0.5 NA NA 

 (0.3) 
_____________________________________________________________________________________

Exhibit E-34 (cont.)

Percent of WIC Infants with Specific Nutritional Risk Factors 

_____________________________________________________________________________________

 Risk Risk Not Risk Not

 Present Present Assessed

_____________________________________________________________________________________

Conferred risk 

 Breastfeeding infant 31.0 NA NA 

 (3.0) 

 Not breastfeeding; Mom on WIC 58.9 NA NA 

 (3.1) 

 Not breastfeeding; Mom on WIC preg 3.8 NA NA 

 (0.9) 

Sample size 571 571 571

Population 1,819,440 1,819,440 1,819,440

_____________________________________________________________________________________
_____________________________________________________________________________________

Exhibit E-35

Percent of WIC Children with Specific Nutritional Risk Factors 

_____________________________________________________________________________________

 Risk Risk Not Risk Not

 Present Present Assessed

_____________________________________________________________________________________

Anthropometric Risk Criteria 

 Low birth weight 6.2 71.8 22.1

 (1.9) (3.4) (3.1)

 Short stature 13.8 78.7 7.5

 (2.2) (2.7) (2.1)

 Underweight 8.9 84.2 6.9

 (1.8) (2.8) (2.3)

 Overweight 17.2 76.4 6.4

 (2.1) (3.0) (1.8)

 Slow growth 8.3 80.8 10.9

 (1.7) (3.0) (2.6)

Biochemical and Other Medical 

Risk Criteria 

 Anemia 24.1 65.8 10.0

 (3.1) (3.4) (2.1)

 Failure to thrive 1.1 85.8 13.1

 (0.5) (2.4) (2.3)

 Nutrient deficiency diseases 1.6 78.9 19.4

 (0.5) (3.6) (3.6)

 Gastrointestinal disorders 0.7 75.4 23.9

 (0.4) (4.2) (4.1)

 Diabetes mellitus 0.2 74.9 24.9

 (0.2) (4.2) (4.1)

 Thyroid disorders 0.4 71.7 27.9

 (0.3) (4.3) (4.3)

 Chronic hypertension 0.0 71.8 28.2

 (0.0) (4.4) (4.4)

 Renal disease 0.0 71.5 28.5

 (0.0) (4.3) (4.3)

 Cancer 0.0 70.4 29.6

 (0.0) (4.3) (4.3)

 Central nervous system disorders 0.0 71.0 29.0

 (0.0) (4.3) (4.3)

 Genetic and congenital disorders 1.1 72.0 26.9

 (0.5) (4.4) (4.3)

 Inborn errors of metabolism 0.1 72.9 27.0

 (0.1) (4.3) (4.3)

 Chronic or recurrent infections 7.6 68.3 24.1

 (1.8) (4.1) (4.4)

 HIV infections and AIDS 0.0 68.0 32.0

 (0.0) (4.3) (4.3)

 Recent major surgery/trauma/etc. 1.8 74.2 24.0

 (0.5) (4.4) (4.3)

 Other nutritionally-related cond. 2.0 76.9 21.2

 (0.6) (4.0) (4.1)

 Food allergies 1.7 82.2 16.1

 (0.5) (3.4) (3.5)

 Celiac disease 0.0 72.5 27.5

 (0.0) (4.3) (4.3)

 Lactose intolerance 1.1 81.1 17.8

 (0.4) (3.9) (3.9)

 Hypoglycemia 0.0 72.9 27.1

 (0.0) (4.3) (4.3)

Potentially Toxic Substances 

 Lead poisoning 0.5 69.4 30.1

 (0.3) (4.0) (4.1)
_____________________________________________________________________________________

Exhibit E-35 (cont.)

Percent of WIC Children with Specific Nutritional Risk Factors 

_____________________________________________________________________________________

 Risk Risk Not Risk Not

 Present Present Assessed

_____________________________________________________________________________________

Dietary Risk Criteria 

 Failure to meet Dietary Guidelines 77.6 17.7 4.7

 (3.8) (3.5) (1.5)

 Vegan diets 0.2 86.8 13.0

 (0.2) (2.6) (2.6)

 Highly restrictive diets 0.5 87.9 11.6

 (0.3) (2.5) (2.5)

 Pica 1.4 82.4 16.2

 (0.8) (3.3) (3.3)

Predisposing Risk Criteria 

 Homelessness 0.6 88.3 11.1

 (0.3) (2.5) (2.5)

 Migrancy 1.0 87.1 11.9

 (0.5) (2.5) (2.5)

 Low level of maternal education 7.5 70.9 21.7

 (1.4) (3.5) (3.3)

 Maternal depression 0.2 65.7 34.0

 (0.2) (4.1) (4.1)

 Child abuse or neglect 0.9 68.6 30.5

 (0.4) (3.9) (3.8)

 Child of a young caregiver 3.6 74.6 21.8

 (1.0) (3.9) (3.8)

 Child of a mentally retarded parent 0.3 79.6 20.2

 (0.2) (3.5) (3.6)

Sample size 586 586 586

Population 3,605,613 3,605,613 3,605,613

_____________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-36

Percent of WIC Participants in Families Receiving Non-WIC Food Assistance, by Participant Category 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Receiving any non-WIC food 36.5 36.9 46.2 39.7 41.8 52.6 46.8

assistance (2.3) (2.9) (3.3) (2.2) (1.8) (2.6) (1.9)

Receipt by program:

 Food Distribution Program 0.5 0.1 0.1 0.3 0.4 0.0 0.2

 on Indian Reservations (0.3) (0.1) (0.1) (0.1) (0.4) (0.0) (0.1)

 Food Stamp Program 23.3 22.4 38.4 27.8 31.4 35.5 32.7

 (2.2) (2.4) (2.9) (1.9) (2.4) (2.6) (1.8)

 School Breakfast Program 16.5 15.1 15.5 15.9 15.2 26.3 21.0

 (1.6) (2.1) (1.9) (1.4) (2.0) (2.7) (1.9)

 National School Lunch Program 18.9 19.2 19.9 19.3 20.3 33.2 26.6

 (1.7) (2.2) (2.2) (1.5) (2.2) (2.4) (1.7)

 Temporary Emergency Food 0.5 0.3 0.2 0.4 1.0 0.5 0.6

 Assistance Program (0.3) (0.2) (0.1) (0.1) (0.4) (0.3) (0.2)

 Commodity Supplemental Food Progr 0.8 0.7 0.9 0.8 0.8 1.2 1.0

 (0.3) (0.3) (0.4) (0.2) (0.4) (0.5) (0.3)

 Local food pantries 4.3 3.2 4.1 4.0 3.1 3.3 3.4

 (1.3) (0.9) (1.4) (0.9) (1.4) (0.8) (0.7)

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________

Exhibit E-37

Percent of WIC Participants in Families Receiving Non-WIC Food Assistance, by Location 

_____________________________________________________________________________________

 

 Metropolitan Nonmetropolitan

_____________________________________________________________________________________

Receiving any non-WIC food 44.5 55.8

assistance (1.9) (3.6)

Receipt by program:

 Food Distribution Program 0.2 0.0

 on Indian Reservations (0.1) (0.0)

 Food Stamp Program 30.6 40.6

 (1.7) (4.0)

 School Breakfast Program 19.5 26.7

 (2.0) (4.1)

 National School Lunch Program 25.4 31.1

 (1.9) (2.9)

 Temporary Emergency Food Assistance 0.5 0.7

 Program (0.2) (0.3)

 Commodity Supplemental Food Program 0.7 2.3

 (0.3) (0.7)

 Local food pantries 2.3 7.8

 (0.5) (2.2)

Sample size 2,387 727

Population 6,143,639 1,597,439

_____________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-38

Average Weekly Food Spending of WIC Economic Units per Adult Male Equivalent, by Participant Category and Participation in the Food

Stamp Program

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

All economic units 

 Food at home $30.75 $26.08 $33.68 $30.71 $33.03 $30.75 $31.32

 (0.84) (0.65) (1.02) (0.64) (1.19) (0.91) (0.62)

 Total 38.11 30.50 39.48 36.96 39.39 35.87 37.02 

 (1.27) (0.72) (1.14) (0.84) (1.55) (1.14) (0.78)

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

Food Stamp Program recipients 

 Food at home 30.93 28.45 33.14 31.46 32.41 32.13 32.07

 (1.26) (1.95) (1.38) (1.02) (1.64) (1.24) (0.81)

 Total 35.43 31.36 37.33 35.55 36.33 36.34 36.18

 (1.45) (1.96) (1.33) (0.98) (1.81) (1.34) (0.83)

Sample size 159 153 227 539 178 239 956

Population 197,219 83,597 212,182 492,999 614,875 1,382,731 2,490,604

Non-Food Stamp Program recipients 

 Food at home 30.70 25.40 34.00 30.43 33.32 30.01 30.97

 (1.01) (0.69) (1.37) (0.78) (1.54) (1.15) (0.82)

 Total 38.92 30.25 40.73 37.48 40.78 35.62 37.43

 (1.54) (0.86) (1.61) (1.11) (2.09) (1.51) (1.07)

Sample size 480 474 360 1,314 436 408 2,158

Population 662,162 292,866 361,717 1,316,744 1,363,536 2,570,193 5,250,474

Rates of nonresponse before imputation 

Average weekly food spending, food at home

 All WIC economic units 8.0 6.0 9.0 7.9 5.7 4.3 5.5

 (1.2) (2.2) (2.8) (1.1) (1.2) (1.6) (1.2)

 Food Stamp Program recipients 3.5 0.0 2.2 2.3 1.9 0.0 0.9

 (1.4) (0.0) (1.1) (0.8) (1.1) (0.0) (0.3)

 Non-Food Stamp Program recipients 9.3 7.7 13.1 10.0 7.4 6.7 7.7

 (1.6) (2.8) (4.2) (1.4) (1.7) (2.3) (1.7)

Average weekly food spending, total

 All WIC economic units 12.2 9.8 14.3 12.4 9.4 9.0 9.9

 (1.4) (2.2) (3.4) (1.3) (1.6) (1.9) (1.3)

 Food Stamp Program recipients 8.0 4.6 7.2 7.1 6.2 6.2 6.4

 (2.4) (1.6) (1.6) (1.3) (1.9) (2.4) (1.4)

 Non-Food Stamp Program recipients 13.4 11.3 18.5 14.3 10.8 10.4 11.5

 (1.8) (2.8) (5.2) (1.7) (2.1) (2.5) (1.7)

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-39

Distribution of Food Security Status, by Participant Category 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Food security status 

 Food secure 73.1 71.6 75.4 73.5 77.5 77.1 76.4

 (2.9) (3.6) (2.7) (2.7) (3.0) (2.6) (2.4)

 Food insecure without hunger 15.0 19.6 18.5 17.0 13.9 15.2 15.3

 (1.7) (3.1) (2.4) (1.8) (2.0) (2.0) (1.6)

 Food insecure with hunger, moderate 8.9 8.1 4.0 7.2 6.9 6.3 6.7

 (1.9) (1.3) (0.9) (1.1) (1.3) (1.3) (1.1)

 Food insecure with hunger, severe 3.0 0.7 2.1 2.2 1.6 1.4 1.7

 (1.2) (0.4) (0.8) (0.7) (0.6) (0.5) (0.4)

Not reported 0.6 0.5 3.2 1.4 1.2 0.9 1.1

 (0.3) (0.3) (2.5) (0.8) (0.5) (0.4) (0.4)

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-40

Distribution of Food Security Status by Participant Category and Poverty Level 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Food security status of WIC units 

with income <= 100% of poverty level 

 Food secure 68.0 69.7 74.8 70.8 76.4 72.5 73.1

 (3.3) (3.8) (3.2) (2.8) (3.1) (3.1) (2.6)

 Food insecure without hunger 15.5 19.4 19.0 17.6 12.9 17.7 16.4

 (2.3) (2.7) (3.1) (1.8) (1.8) (2.6) (1.7)

 Food insecure with hunger, moderate 13.2 9.7 3.9 9.1 8.8 8.2 8.6

 (3.0) (1.9) (1.1) (1.6) (1.6) (2.0) (1.5)

 Food insecure with hunger, severe 3.3 1.2 2.2 2.5 1.9 1.6 1.9

 (1.2) (0.6) (0.8) (0.7) (0.9) (0.6) (0.4)

 Not reported 0.6 0.9 0.6 0.7 0.4 0.4 0.5

 (0.4) (0.5) (0.3) (0.2) (0.3) (0.4) (0.2)

Sample size 338 381 398 1,117 370 398 1,885

Population 454,001 230,301 385,903 1,070,204 1,254,949 2,476,422 4,801,575

 

Food security status of WIC units 

with income > 100% of poverty level 

 Food secure 79.0 74.2 76.2 77.3 79.0 84.0 81.0

 (3.1) (5.2) (4.1) (2.7) (4.1) (3.4) (2.6)

 Food insecure without hunger 14.1 20.0 17.8 16.2 16.3 11.3 13.8

 (2.3) (5.2) (3.2) (2.2) (3.5) (2.7) (1.9)

 Food insecure with hunger, moderate 4.1 5.8 4.3 4.5 3.7 3.4 3.8

 (1.3) (1.9) (1.7) (0.9) (1.3) (1.3) (0.8)

 Food insecure with hunger, severe 2.8 0.0 1.7 2.0 1.1 1.3 1.4

 (1.5) (0.0) (1.2) (0.9) (0.8) (0.8) (0.5)

 Not reported 0.0 0.0 8.0 2.0 2.0 0.0 1.0

 (0.0) (0.0) (7.5) (2.0) (1.4) (0.0) (0.9)

Sample size 296 243 182 721 230 225 1,176

Population 399,373 143,999 183,175 726,547 675,158 1,316,167 2,717,872

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-41

Distribution of Food Security Status, by Reported Food Program Participation 

___________________________________________________________________________________________________________________________________

 WIC and Other 

 WIC WIC and Food Benefits WIC, FSP,

 Only Food Stamps (No Food Stamps) and Other

___________________________________________________________________________________________________________________________________

Food security status 

 Food secure 77.8 77.7 76.2 69.9

 (3.7) (3.2) (3.2) (4.1)

 Food insecure without hunger 15.6 12.7 15.0 17.3

 (2.3) (2.3) (2.6) (2.4)

 Food insecure with hunger, moderate 5.9 7.0 6.1 9.8

 (2.1) (1.4) (1.4) (2.2)

 Food insecure with hunger, severe 0.7 2.6 2.7 3.0

 (0.3) (1.2) (0.9) (1.2)

Not reported 1.9 0.2 0.0 0.1

 (0.6) (0.1) (0.0) (0.1)

Sample size 1,740 572 418 384

Population 4,116,283 1,320,800 1,134,191 1,169,804

 

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-42

Food Security Status of WIC Families, by Selected Characteristics 

___________________________________________________________________________________________________________________________________

 -------------- Food Insecure --------------

 Food Without With Hunger, With Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

___________________________________________________________________________________________________________________________________

Household type 

 Single family unit, single parent 76.1 16.7 4.8 2.4 602 1,533,53

 (2.6) (1.9) (1.4) (0.8) 

 Single family unit, dual parent 75.5 16.9 6.6 1.0 1,554 3,952,15

 (2.8) (2.3) (0.8) (0.4) 

 Multi-family unit, single parent 79.1 9.4 8.9 2.6 654 1,512,18

 (3.5) (1.5) (3.9) (0.8) 

 Multi-family unit, dual parent 75.7 16.0 6.8 1.5 279 659,877

 (4.7) (4.2) (2.2) (1.1) 

Maternal age 

 Less than 18 years 85.5 10.0 1.8 2.6 201 388,509

 (2.7) (2.6) (0.7) (1.3) 

 18 - 34 years 76.0 15.1 7.2 1.7 2,546 6,146,60

 (2.6) (1.7) (1.2) (0.4) 

 More than 43 years 75.3 17.7 5.6 1.3 316 1,064,47

 (4.0) (3.3) (1.9) (0.8) 

Maternal education 

 Less than 8 years 57.9 18.1 21.4 2.7 158 423,776

 (7.7) (6.2) (6.7) (1.3) 

 8-11 years 74.9 15.1 7.9 2.1 764 1,968,44

 (3.3) (1.9) (2.7) (0.7) 

 12 years 78.2 14.7 5.9 1.2 1,149 2,984,09

 (2.3) (1.8) (0.9) (0.6) 

 13 or more years 77.5 16.5 4.4 1.6 767 1,791,24

 (3.7) (3.3) (1.0) (0.8) 

 Schooling incomplete, age<18 83.3 11.6 2.8 2.3 227 446,667

 (3.1) (3.0) (1.0) (1.1) 

 Not reported 87.1 11.0 0.0 1.9 16 31,221

 (8.6) (8.0) (0.0) (2.1) 

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-43

Food Security Status of WIC Families, by Geographic Area 

___________________________________________________________________________________________________________________________________

 -------------- Food Insecure --------------

 Food Without With Hunger, With Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

___________________________________________________________________________________________________________________________________

Location 

 Non-metropolitan area 80.4 14.4 4.5 0.6 725 1,585,93

 (1.8) (1.8) (0.9) (0.2) 

 Metropolitan area 75.3 15.5 7.3 1.9 2,364 6,071,81

 (2.9) (1.9) (1.3) (0.4) 

FNS region 

 Northeast 78.3 13.5 7.4 0.8 395 803,845

 (1.5) (1.8) (1.9) (0.6) 

 Mid-Atlantic 84.1 10.0 5.2 0.6 340 749,863

 (2.5) (1.9) (1.3) (0.3) 

 Southeast 76.4 13.5 7.5 2.6 446 1,485,98

 (6.8) (2.8) (4.7) (0.9) 

 Midwest 77.3 14.6 7.3 0.8 457 1,140,85

 (3.0) (2.4) (1.0) (0.3) 

 Mountain Plains 72.4 21.2 5.2 1.2 233 514,709

 (4.7) (3.3) (1.4) (0.7) 

 Southwest 77.6 14.4 4.5 3.5 602 1,149,66

 (3.6) (2.7) (1.3) (1.2) 

 Western 72.0 18.9 7.8 1.3 616 1,812,83

 (6.8) (4.8) (1.7) (0.8) 

 Total WIC 76.4 15.3 6.7 1.7 3,114 7,741,078

 (2.4) (1.6) (1.1) (0.4) 

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-44

Distribution of Food Security Status by Number of Nutritional Risk Factors : Pregnant Women 

___________________________________________________________________________________________________________________________________

 -------------- Food Insecure ------------ 

 Food Without With Hunger, With Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

___________________________________________________________________________________________________________________________________

Anthropometric risks 

 None 68.4 15.2 12.9 3.6 145 204,527

 (7.0) (3.4) (6.6) (3.0) 

 One 76.6 13.6 5.9 3.9 254 322,363

 (3.2) (2.4) (1.6) (1.5) 

 Two or more 71.9 15.7 10.1 2.2 208 281,373

 (3.3) (2.5) (2.1) (1.0) 

Conditions specific to pregnancy 

 None 75.2 15.6 8.5 0.8 331 428,657

 (2.6) (2.3) (2.0) (0.5) 

 One 66.8 16.0 10.6 6.6 197 274,697

 (5.2) (2.7) (4.1) (2.8) 

 Two or more 78.6 8.5 8.5 4.4 75 100,065

 (5.0) (2.9) (2.8) (2.7) 

Potentially toxic substances 

 None 74.0 13.5 10.5 2.0 452 606,511

 (3.2) (1.8) (2.6) (0.9) 

 One 68.9 20.3 5.1 5.7 136 173,355

 (4.8) (3.7) (1.7) (2.5) 

 Two or more 71.8 5.5 6.5 16.2 14 21,975

 (12.1) (5.6) (6.1) (10.8) 

Other biochemical and medical risks 

 None 70.7 16.9 10.1 2.3 272 363,465

 (4.5) (2.7) (3.4) (1.0) 

 One 73.7 15.2 8.6 2.5 237 318,646

 (2.9) (2.5) (3.4) (1.3) 

 Two or more 76.3 7.8 8.0 7.9 94 120,685

 (5.6) (2.6) (3.0) (3.9) 
___________________________________________________________________________________________________________________________________

Exhibit E-44 (cont.)

Distribution of Food Security Status by Number of Nutritional Risk Factors : Pregnant Women 

___________________________________________________________________________________________________________________________________

 -------------- Food Insecure ------------ 

 Food Without With Hunger, With Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

___________________________________________________________________________________________________________________________________ 

Dietary risks 

 None 64.5 21.8 12.3 1.3 144 202,336

 (7.0) (3.2) (5.7) (0.9) 

 One 75.9 12.5 8.1 3.5 447 582,238

 (2.3) (2.0) (1.6) (1.2) 

 Two or more 62.0 16.3 7.3 14.4 15 21,583

 (12.2) (9.8) (6.9) (9.5) 

Predisposing risks 

 None 73.6 15.4 8.7 2.3 539 712,074

 (2.7) (1.8) (1.9) (0.9) 

 One 67.3 10.9 11.8 10.0 49 69,226

 (7.9) (4.3) (6.3) (4.5) 

 Two or more 66.0 15.3 0.0 18.6 9 11,997

 (18.3) (14.0) (0.0) (16.3) 

Total risks 

 One 61.4 13.5 25.1 0.0 62 87,491

 (13.2) (4.0) (11.5) (0.0) 

 Two 74.5 19.3 6.1 0.0 99 132,322

 (5.7) (5.3) (3.5) (0.0) 

 Three 75.5 15.2 6.6 2.7 146 196,370

 (3.7) (3.4) (2.0) (1.5) 

 Four or more 73.6 13.4 7.8 5.2 303 395,880

 (3.1) (1.8) (1.5) (2.0) 

Overall 

 Total pregnant 72.9 14.8 9.1 3.2 610 812,063

 (2.8) (1.7) (2.0) (1.3) 

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-45

Distribution of Food Security Status by Number of Nutritional Risk Factors : Breastfeeding Women 

___________________________________________________________________________________________________________________________________

 -------------- Food Insecure ------------

 Food Without With Hunger, With Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

___________________________________________________________________________________________________________________________________

Anthropometric risks 

 None 74.5 14.0 10.9 0.5 221 120,990

 (4.1) (3.0) (3.5) (0.5) 

 One 71.6 20.5 7.0 0.9 174 106,617

 (5.2) (5.6) (1.7) (0.9) 

 Two or more 74.4 19.3 5.8 0.5 164 99,254

 (4.9) (4.2) (1.4) (0.5) 

Potentially toxic substances 

 None 74.3 17.6 7.4 0.7 497 294,494

 (3.4) (2.6) (1.4) (0.4) 

 One 66.8 18.5 14.6 0.0 58 31,080

 (5.2) (4.2) (4.3) (0.0) 

 Two or more 78.0 22.0 0.0 0.0 5 2,179

 (20.1) (20.1) (0.0) (0.0) 

Other biochemical and medical risks 

 None 75.4 15.7 8.3 0.6 284 170,171

 (3.1) (2.3) (1.8) (0.5) 

 One 69.8 19.9 9.9 0.5 192 107,260

 (5.1) (3.3) (3.3) (0.5) 

 Two or more 75.1 20.2 3.4 1.3 84 49,450

 (6.9) (7.0) (1.6) (1.3) 

Dietary risks 

 None 75.7 16.6 7.7 0.0 134 74,386

 (5.2) (4.4) (2.1) (0.0) 

 One 73.4 17.6 8.2 0.8 419 249,175

 (3.9) (2.9) (1.7) (0.5) 

 Two or more 53.4 40.1 6.5 0.0 9 4,793

 (19.2) (18.2) (6.6) (0.0) 
___________________________________________________________________________________________________________________________________

Exhibit E-45 (cont.)

Distribution of Food Security Status by Number of Nutritional Risk Factors : Breastfeeding Women 

___________________________________________________________________________________________________________________________________

 -------------- Food Insecure ------------

 Food Without With Hunger, With Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

___________________________________________________________________________________________________________________________________

Predisposing risks 

 None 73.1 18.5 8.0 0.4 513 298,197

 (3.4) (2.5) (1.4) (0.3) 

 One 75.8 10.4 9.9 3.9 39 24,456

 (8.2) (5.5) (5.2) (3.7) 

 Two or more 83.4 16.6 0.0 0.0 6 3,050

 (15.3) (15.3) (0.0) (0.0) 

Total risks 

 One 81.1 13.4 5.5 0.0 107 56,193

 (3.5) (3.5) (1.9) (0.0) 

 Two 71.5 12.1 16.4 0.0 133 79,524

 (5.2) (2.1) (4.7) (0.0) 

 Three 72.9 17.7 7.3 2.0 128 80,441

 (5.2) (3.6) (2.8) (1.4) 

 Four or more 72.4 23.3 3.8 0.4 197 114,340

 (4.5) (4.7) (1.0) (0.4) 

Overall 

 Total breastfeeding 73.8 17.6 8.0 0.6 565 330,499

 (3.2) (2.4) (1.4) (0.4) 

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-46

Distribution of Food Security Status by Number of Nutritional Risk Factors : Postpartum Women 

___________________________________________________________________________________________________________________________________

 -------------- Food Insecure ------------

 Food Without With Hunger, With Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

___________________________________________________________________________________________________________________________________

Anthropometric risks 

 None 77.5 16.2 5.2 1.1 212 197,408

 (3.8) (3.5) (1.9) (0.7) 

 One 74.6 20.2 3.7 1.5 131 120,587

 (3.7) (3.8) (1.7) (1.4) 

 Two or more 76.7 15.6 3.4 4.3 190 175,032

 (4.2) (3.3) (1.4) (1.6) 

Potentially toxic substances 

 None 77.0 15.8 4.6 2.6 412 378,225

 (2.7) (2.3) (1.2) (1.2) 

 One 74.7 22.6 2.1 0.6 105 101,558

 (5.1) (5.1) (1.2) (0.6) 

 Two or more 62.4 25.0 5.6 7.0 13 11,635

 (14.4) (13.7) (5.7) (6.5) 

Other biochemical and medical risks 

 None 77.8 17.0 2.8 2.4 224 214,405

 (3.6) (3.0) (1.5) (1.2) 

 One 75.2 17.2 6.7 0.8 211 191,211

 (4.7) (4.2) (1.9) (0.6) 

 Two or more 73.1 19.6 2.1 5.2 98 89,004

 (3.5) (3.3) (1.2) (2.5) 

Dietary risks 

 None 77.0 20.1 2.5 0.4 143 145,940

 (4.9) (4.9) (1.6) (0.4) 

 One 75.9 16.2 5.0 2.9 384 343,624

 (2.8) (2.1) (1.2) (1.3) 

 Two or more 40.1 37.8 0.0 22.0 5 3,803

 (16.8) (26.0) (0.0) (14.7) 
___________________________________________________________________________________________________________________________________

Exhibit E-46 (cont.)

Distribution of Food Security Status by Number of Nutritional Risk Factors : Postpartum Women 

___________________________________________________________________________________________________________________________________

 -------------- Food Insecure ------------

 Food Without With Hunger, With Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

___________________________________________________________________________________________________________________________________

Predisposing risks 

 None 75.7 17.5 4.6 2.2 471 426,940

 (2.7) (2.2) (1.1) (1.0) 

 One 74.8 21.6 1.1 2.4 47 49,578

 (8.7) (8.4) (1.1) (1.7) 

 Two or more 93.5 0.0 0.0 6.5 9 12,915

 (4.5) (0.0) (0.0) (4.5) 

Total risks 

 One 80.2 11.2 7.3 1.4 76 75,876

 (5.7) (3.9) (4.2) (1.4) 

 Two 76.4 16.7 4.7 2.1 129 109,048

 (4.9) (4.3) (2.0) (1.7) 

 Three 70.1 23.7 4.2 1.9 127 121,476

 (5.6) (4.9) (1.8) (1.5) 

 Four or more 77.7 16.7 2.6 3.0 204 190,230

 (3.5) (3.8) (1.0) (1.3) 

Overall 

 Total postpartum 75.9 17.6 4.2 2.3 536 496,629

 (2.5) (2.1) (1.0) (0.9) 

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-47

Distribution of Food Security Status by Number of Nutritional Risk Factors : Infants 

___________________________________________________________________________________________________________________________________

 -------------- Food Insecure ------------

 Food Without With Hunger, With Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

___________________________________________________________________________________________________________________________________

Anthropometric risks 

 None 78.6 13.6 6.2 1.6 429 1,344,97

 (3.9) (2.6) (1.7) (0.9) 

 One 70.8 16.3 11.5 1.4 79 268,869

 (6.4) (4.8) (4.7) (1.3) 

 Two or more 70.6 20.4 7.3 1.7 54 174,645

 (5.6) (5.6) (3.7) (1.6) 

Potentially toxic substances 

 None 76.8 14.5 7.1 1.6 557 1,770,16

 (3.2) (2.0) (1.4) (0.7) 

 One 100.0 0.0 0.0 0.0 1 1,688

 (0.0) (0.0) (0.0) (0.0) 

Other biochemical and medical risks 

 None 76.7 14.2 7.4 1.8 442 1,416,88

 (4.1) (2.5) (1.7) (0.8) 

 One 73.3 18.9 6.5 1.3 93 293,542

 (6.2) (5.1) (2.9) (1.2) 

 Two or more 85.6 11.7 2.7 0.0 30 87,194

 (6.2) (5.1) (2.7) (0.0) 

Dietary risks 

 None 77.9 14.4 6.4 1.3 408 1,300,48

 (3.7) (2.6) (1.3) (0.7) 

 One 74.7 14.7 6.3 4.3 93 268,832

 (5.3) (3.7) (3.4) (3.3) 

 Two or more 72.2 15.7 12.1 0.0 61 217,650

 (5.5) (5.3) (4.9) (0.0) 
___________________________________________________________________________________________________________________________________

Exhibit E-47 (cont.)

Distribution of Food Security Status by Number of Nutritional Risk Factors : Infants 

___________________________________________________________________________________________________________________________________

 -------------- Food Insecure ------------

 Food Without With Hunger, With Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

___________________________________________________________________________________________________________________________________

Predisposing risks 

 None 76.7 14.3 7.2 1.8 469 1,471,76

 (3.7) (2.1) (1.6) (0.8) 

 One 77.5 16.3 6.3 0.0 75 259,660

 (6.2) (5.5) (2.8) (0.0) 

 Two or more 72.6 14.4 8.9 4.0 17 52,008

 (14.0) (13.0) (8.6) (3.9) 

Total risks 

 One 77.7 15.4 5.5 1.4 245 779,770

 (5.1) (3.3) (1.9) (1.0) 

 Two 79.4 14.3 4.3 2.0 138 428,994

 (4.8) (3.9) (1.9) (2.0) 

 Three 76.6 7.5 13.5 2.4 79 243,483

 (5.5) (3.4) (4.1) (1.7) 

 Four or more 70.8 19.1 9.2 0.8 105 349,417

 (5.5) (4.4) (3.6) (0.8) 

Overall 

 Total infants 76.6 14.8 7.0 1.6 567 1,801,66

 (3.2) (2.0) (1.4) (0.7) 

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-48

Distribution of Food Security Status by Number of Nutritional Risk Factors : Children 

___________________________________________________________________________________________________________________________________

 -------------- Food Insecure ------------

 Food Without With Hunger, With Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

___________________________________________________________________________________________________________________________________

Anthropometric risks 

 None 80.7 12.3 5.2 1.8 356 2,165,80

 (3.1) (2.5) (1.1) (0.8) 

 One 73.4 19.9 5.0 1.7 165 1,007,67

 (3.7) (3.3) (1.7) (1.0) 

 Two or more 66.8 14.6 18.7 0.0 54 362,264

 (9.5) (6.0) (11.1) (0.0) 

Potentially toxic substances 

 None 76.9 14.8 6.7 1.6 564 3,450,84

 (2.6) (2.0) (1.5) (0.5) 

 One 100.0 0.0 0.0 0.0 3 18,160

 (0.0) (0.0) (0.0) (0.0) 

Other biochemical and medical risks 

 None 79.2 14.2 5.1 1.5 380 2,275,84

 (2.7) (2.1) (1.1) (0.5) 

 One 71.6 16.7 10.1 1.6 159 1,001,75

 (4.9) (3.3) (4.4) (0.9) 

 Two or more 82.1 10.1 5.2 2.5 37 250,688

 (7.4) (6.1) (3.2) (2.6) 

Dietary risks 

 None 72.0 15.8 9.8 2.4 108 731,480

 (6.3) (3.6) (6.0) (1.3) 

 One 78.1 14.6 5.9 1.4 461 2,727,92

 (2.8) (2.2) (1.0) (0.5) 

 Two or more 100.0 0.0 0.0 0.0 8 72,983

 (0.0) (0.0) (0.0) (0.0) 
___________________________________________________________________________________________________________________________________

Exhibit E-48 (cont.)

Distribution of Food Security Status by Number of Nutritional Risk Factors : Children 

___________________________________________________________________________________________________________________________________

 -------------- Food Insecure ------------

 Food Without With Hunger, With Hunger, Sample 

 Secure Hunger Moderate Severe Size Population

___________________________________________________________________________________________________________________________________

Predisposing risks 

 None 77.0 15.5 6.0 1.5 511 3,096,09

 (2.8) (2.0) (1.6) (0.6) 

 One 77.1 10.0 12.8 0.0 50 326,866

 (5.4) (4.1) (4.9) (0.0) 

 Two or more 80.3 3.7 4.3 11.7 11 82,210

 (10.3) (3.8) (4.2) (8.7) 

Total risks 

 One 80.6 14.8 3.2 1.4 273 1,603,13

 (2.9) (2.5) (1.0) (0.6) 

 Two 75.6 15.4 7.3 1.8 181 1,100,77

 (4.2) (3.2) (1.9) (1.0) 

 Three 82.7 9.1 5.7 2.6 81 531,024

 (4.0) (3.6) (2.3) (1.6) 

 Four or more 60.9 18.9 20.2 0.0 48 345,395

 (8.3) (7.4) (10.7) (0.0) 

Overall 

 Total children 77.5 14.5 6.5 1.6 583 3,580,32

 (2.6) (2.0) (1.4) (0.5) 

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-49

Percentage of WIC Participants by Health Insurance Coverage and Reasons for Lack of Health Insurance 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Percent covered by health insurance 

 Yes 70.6 76.7 85.5 76.7 86.1 84.5 83.1

 (3.3) (2.8) (2.8) (2.6) (3.0) (2.1) (2.0)

 No 29.4 23.3 14.5 23.3 13.9 15.5 16.9

 (3.3) (2.8) (2.8) (2.6) (3.0) (2.1) (2.0)

Percent by source of insurance 

 Employer 18.3 30.1 22.9 22.2 24.6 26.0 24.8

 (2.1) (2.6) (2.1) (1.5) (2.5) (2.1) (1.6)

 Medicaid 49.9 47.7 62.0 53.3 61.3 58.8 58.1

 (3.1) (3.3) (3.0) (2.4) (3.8) (3.2) (2.7)

 Other 3.8 3.1 2.2 3.2 1.8 2.9 2.7

 (0.8) (0.9) (0.7) (0.5) (0.5) (0.8) (0.5)

 Source not reported 0.3 0.6 0.5 0.4 0.5 0.4 0.4

 (0.2) (0.3) (0.4) (0.2) (0.3) (0.2) (0.2)

 No health insurance 29.1 23.1 14.5 23.2 13.9 15.5 16.9

 (3.3) (2.9) (2.8) (2.6) (3.0) (2.1) (2.0)

Reasons for no health insurance, if none 

 Not eligible for or don't 42.2 69.1 65.0 52.7 56.7 60.8 57.4

 think I can get Medicaid (7.9) (5.8) (9.2) (7.0) (11.8) (7.8) (7.2)

 Not employed, coverage discontinued 55.4 52.8 58.4 55.5 50.4 33.2 43.9

 /can't afford it (4.7) (4.6) (6.1) (2.8) (6.8) (6.0) (3.4)

 Employed, insurance not offerred 40.8 34.9 21.0 35.3 47.8 43.7 41.8

 or can't afford it (5.2) (5.4) (4.6) (2.8) (11.5) (6.5) (4.4)

 Don't think I can get private 13.0 22.7 24.1 17.4 21.0 10.1 14.7

 health insurance (4.8) (8.8) (8.2) (6.1) (8.5) (5.7) (6.2)

 Haven't needed health insurance 5.2 4.3 3.8 4.7 2.7 1.7 2.9

 (2.3) (2.1) (2.3) (1.4) (2.1) (1.2) (0.8)

 Been refused insurance due 3.4 0.9 1.0 2.4 1.1 0.0 1.0

 to health (2.1) (0.9) (1.0) (1.3) (1.2) (0.0) (0.5)

Item nonresponse 

 Health insurance coverage 2.0 0.5 0.5 1.2 0.6 1.0 0.9

 (0.7) (0.3) (0.3) (0.3) (0.3) (0.4) (0.3)

 Reasons for no health insurance 10.8 7.4 0.6 8.0 13.6 7.5 9.0

 (3.3) (3.8) (0.6) (2.4) (4.9) (2.6) (2.5)

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

___________________________________________________________________________________________________________________________________
_____________________________________________________________________________________

Exhibit E-50

Health Insurance Coverage and Reasons for Lack of Health Insurance, by Medicaid Income

Eligibility Limit of State of Residence

_____________________________________________________________________________________

 Medicaid Income Limit Medicaid Income Limit

 Less than 185% FPL 185% FPL or higher

_____________________________________________________________________________________

Percent covered by health insurance 

 Yes 81.2 86.2

 (2.8) (2.3)

 No 18.8 13.8

 (2.8) (2.3)

Percent by source of insurance 

 Employer 25.0 24.3

 (1.8) (2.2)

 Medicaid 55.5 62.6

 (3.1) (3.6)

 Other 3.0 2.2

 (0.7) (0.5)

 Source not reported 0.4 0.5

 (0.2) (0.3)

 No health insurance 18.7 13.8

 (2.8) (2.3)

Reasons for no health insurance, 

if none 

 Not eligible for or don't 60.4 49.9

 think I can get Medicaid (9.1) (5.4)

 Not employed, coverage discontinued 39.6 54.6

 or can't afford it (4.4) (4.6)

 Employed, insurance not offerred 46.1 31.1

 or can't afford it (5.2) (5.5)

 Don't think I can get private 14.7 14.5

 health insurance (8.6) (3.5)

 Haven't needed health insurance 1.6 6.0

 (0.8) (2.0)

 Been refused insurance due to health 0.3 2.7

 (0.3) (1.4)

Item nonresponse 

 Health insurance coverage 0.9 1.0

 (0.4) (0.3)

 Reasons for no health insurance 6.5 14.7

 (2.1) (4.3)

Sample size 1,469 1,645

Population 4,833,931 2,907,147

_____________________________________________________________________________________

 
_____________________________________________________________________________________

Exhibit E-51

Health Insurance Coverage by WIC Experience and Medicaid Income Eligibility Limit of 

State of Residence 

_____________________________________________________________________________________

 First WIC experience Family has WIC

 for family experience

_____________________________________________________________________________________

WIC Participants in All States

Percent covered by health insurance 

 Yes 80.1 84.3

 (3.2) (1.9)

 No 19.9 15.7

 (3.2) (1.9)

Percent by source of insurance 

 Employer 23.7 25.1

 (1.9) (1.9)

 Medicaid 55.0 59.4

 (3.0) (2.9)

 Other 2.7 2.9

 (0.6) (0.7)

 Source not reported 0.6 0.4

 (0.3) (0.2)

 No health insurance 19.9 15.7

 (3.2) (1.9)

Sample size 1,075 1,979

Population 2,355,274 5,024,068

 

State Medicaid Income Limit < 185% FPL 

Percent covered by health insurance 

 Yes 76.6 82.2

 (7.2) (2.2)

 No 23.4 17.8

 (7.2) (2.2)

Percent by source of insurance 

 Employer 25.5 24.7

 (3.5) (2.2)

 Medicaid 50.5 56.6

 (5.3) (3.2)

 Other 2.0 3.4

 (0.8) (0.9)

 Source not reported 0.1 0.5

 (0.1) (0.2)

 No health insurance 23.4 17.8

 (7.2) (2.2)

Sample size 403 1,024

Population 867,085 3,687,451

 
_____________________________________________________________________________________

Exhibit E-51 (cont.)

Health Insurance Coverage by WIC Experience and Medicaid Income Eligibility Limit of 

State of Residence 

_____________________________________________________________________________________

 First WIC experience Family has WIC

 for family experience

_____________________________________________________________________________________

State Medicaid Income Limit >= 185% FPL 

Percent covered by health insurance 

 Yes 82.2 90.2

 (2.7) (2.0)

 No 17.8 9.8

 (2.7) (2.0)

Percent by source of insurance 

 Employer 22.7 26.3

 (2.3) (2.8)

 Medicaid 57.6 67.4

 (3.4) (4.2)

 Other 3.0 1.5

 (0.8) (0.5)

 Source not reported 0.9 0.1

 (0.5) (0.1)

 No health insurance 17.8 9.8

 (2.7) (2.0)

Sample size 672 955

Population 1,488,189 1,336,616

_____________________________________________________________________________________
____________________________________________________________________________________

Exhibit E-52

Distribution of Reported Service Availability from WIC Participants' Health Insurance 

Plans 

_____________________________________________________________________________________

 Medicaid Other Total with

 insurance insurance

_____________________________________________________________________________________

Breastfeeding nutrition support 

 Available for free 50.8 22.3 42.3

 (3.0) (3.0) (2.6)

 Available at extra charge 0.9 7.5 2.9

 (0.4) (1.4) (0.5)

 Not available 11.5 27.4 16.2

 (2.3) (3.2) (2.3)

 Don't know 36.8 42.8 38.6

 (2.9) (3.0) (2.5)

Nutrition education 

 Available for free 54.0 23.3 44.8

 (3.2) (3.2) (2.8)

 Available at extra charge 0.7 9.2 3.2

 (0.3) (1.6) (0.5)

 Not available 13.1 26.5 17.1

 (2.5) (3.2) (2.4)

 Don't know 32.2 41.0 34.8

 (2.8) (3.6) (2.6)

Immunizations 

 Available for free 86.2 47.6 74.6

 (2.1) (4.0) (2.2)

 Available at extra charge 3.0 31.0 11.4

 (0.9) (3.2) (1.4)

 Not available 2.3 10.9 4.9

 (0.6) (2.2) (0.8)

 Don't know 8.5 10.4 9.1

 (1.5) (1.8) (1.2)

Well baby care 

 Available for free 79.5 37.6 66.9

 (2.9) (3.2) (2.6)

 Available at extra charge 2.9 32.8 11.9

 (1.1) (3.0) (1.3)

 Not available 3.0 11.8 5.6

 (0.7) (2.2) (0.9)

 Don't know 14.6 17.8 15.5

 (2.2) (2.1) (1.8)

Well child care 

 Available for free 78.2 35.8 65.5

 (3.0) (3.3) (2.7)

 Available at extra charge 2.9 31.2 11.4

 (1.0) (2.8) (1.2)

 Not available 3.7 13.3 6.5

 (0.9) (2.4) (1.0)

 Don't know 15.3 19.7 16.6

 (2.3) (2.1) (1.9)
____________________________________________________________________________________

Exhibit E-52 (cont.)

Distribution of Reported Service Availability from WIC Participants' Health Insurance 

Plans 

_____________________________________________________________________________________

 Medicaid Other Total with

 insurance insurance

_____________________________________________________________________________________

Item nonresponse 

 Breastfeeding nutrition support 1.4 1.9 1.5

 (0.5) (0.9) (0.4)

 Nutrition education 1.4 1.6 1.5

 (0.4) (0.8) (0.4)

 Immunizations 1.1 1.7 1.3

 (0.4) (0.9) (0.4)

 Well baby care 1.5 1.5 1.5

 (0.5) (0.8) (0.4)

 Well child care 1.5 2.1 1.7

 (0.4) (0.9) (0.4)

Sample size 1,731 789 2,520

Population 4,457,630 1,915,470 6,373,100

_____________________________________________________________________________________

 
_____________________________________________________________________________________

Exhibit E-53

Percent of WIC Women and WIC Mothers in WIC When Their Children Were Born 

_____________________________________________________________________________________

 Breastfeeding Postpartum Mothers of Mothers of

 Women Women Infants Children

_____________________________________________________________________________________

On WIC as pregnant woman 

 Yes 84.1 82.1 77.6 80.1

 (1.5) (2.2) (1.8) (2.0)

 No 15.9 17.9 22.4 19.9

 (1.5) (2.2) (1.8) (2.0)

 Not reported* 0.8 3.3 3.1 7.9

 (0.4) (0.9) (0.9) (1.4)

Sample size 627 587 614 647

Population 376,463 573,899 1,978,411 3,952,924

 

_______________________________________________________________________________________

_____________________________________________________________________________________

Exhibit E-54

Distribution of Pregnant Women WIC Participants, by Trimester of Current Enrollment 

_____________________________________________________________________________________

 No Prior WIC Prior WIC Total Pregnant

 Experience Experience Women

_____________________________________________________________________________________

Trimester of Enrollment 

 First trimester 44.0 37.2 41.5

 (3.7) (3.9) (2.9)

 Second trimester 38.2 41.7 39.5

 (3.2) (3.5) (2.6)

 Third trimester 17.8 21.1 19.0

 (2.4) (3.2) (1.9)

 Trimester not reported* 18.5 19.7 19.0

 (2.8) (3.5) (2.5)

Sample size 394 245 639

Population 532,798 326,583 859,381

 

_____________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-55

Distribution of Age at First WIC Certification, by Whether Mother Participated in WIC When Pregnant: Infants 

___________________________________________________________________________________________________________________________________

 Mother in WIC When Pregnant Mother Not in WIC When Pregnant Total Infants

 Percent Cum Pct Percent Cum Pct Percent Cum Pct

___________________________________________________________________________________________________________________________________

Age at First Certification 

 Less than 1 week 30.6 30.6 6.5 6.5 25.9 25.9

 (4.2) (4.2) (2.3) (2.3) (3.2) (3.2)

 1-2 weeks 28.4 59.0 14.3 20.7 24.7 50.6

 (3.4) (3.9) (3.2) (3.4) (2.8) (3.3)

 2-4 weeks 20.5 79.5 22.4 43.1 20.7 71.3

 (3.0) (2.7) (4.3) (6.2) (2.3) (2.8)

 5-8 weeks 11.8 91.3 18.2 61.3 13.5 84.7

 (2.1) (1.5) (4.9) (6.0) (2.3) (1.8)

 9-12 weeks 2.4 93.6 8.5 69.8 3.6 88.4

 (0.8) (1.2) (2.8) (5.7) (0.8) (1.7)

 13-25 weeks 4.6 98.2 21.3 91.2 8.2 96.6

 (1.0) (0.7) (5.9) (3.0) (1.6) (0.9)

 26-40 weeks 1.6 99.8 8.1 99.2 3.1 99.7

 (0.6) (0.2) (2.7) (0.5) (0.8) (0.2)

 > 10 months 0.2 100.0 0.8 100.0 0.3 100.0

 (0.2) (0.0) (0.5) (0.0) (0.2) (0.0)

Sample size 465 465 132 132 614 614

Population 1,488,706 1,488,706 429,321 429,321 1,978,411 1,978,411

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-56

Distribution of Age at First WIC Certification, by Whether Mother Participated in WIC When Pregnant: Children 

___________________________________________________________________________________________________________________________________

 Mother in WIC When Pregnant Mother Not in WIC When Pregnant Total Children

 Percent Cum Pct Percent Cum Pct Percent Cum Pct

___________________________________________________________________________________________________________________________________

Age at First Certification 

 Less than 1 week 39.7 39.7 21.2 21.2 36.1 36.1

 (4.9) (4.9) (3.9) (3.9) (4.1) (4.1)

 1-2 weeks 34.1 73.7 12.1 33.2 28.3 64.4

 (3.7) (2.6) (3.3) (5.5) (3.1) (2.6)

 2-4 weeks 3.3 77.1 4.9 38.1 3.7 68.1

 (0.9) (2.5) (2.0) (5.5) (0.9) (2.4)

 5-8 weeks 11.9 88.9 18.1 56.2 12.8 80.9

 (2.0) (2.0) (5.2) (6.0) (1.7) (2.0)

 9-12 weeks 4.3 93.3 10.4 66.6 5.3 86.1

 (1.8) (1.4) (2.8) (5.8) (1.4) (1.8)

 13-25 weeks 3.6 96.9 11.4 78.0 5.6 91.7

 (0.9) (1.0) (3.7) (4.7) (1.0) (1.3)

 26-40 weeks 1.9 98.7 5.4 83.4 2.7 94.4

 (0.6) (0.7) (2.5) (3.8) (0.8) (1.0)

More than one year:

 41-52 weeks 0.5 99.3 1.2 84.6 1.1 95.5

 (0.4) (0.6) (0.9) (3.7) (0.4) (1.0)

 13-18 months 0.9 99.7 4.9 89.1 2.3 96.9

 (0.4) (0.3) (1.7) (3.3) (0.5) (0.8)

 19-24 months 0.3 100.0 5.9 94.9 1.3 98.2

 (0.3) (0.0) (2.9) (1.8) (0.6) (0.7)

 25-36 months 0.0 100.0 4.3 99.2 1.1 99.2

 (0.0) (0.0) (1.7) (0.8) (0.4) (0.5)

 37-48 months 0.0 100.0 0.8 100.0 0.8 100.0

 (0.0) (0.0) (0.8) (0.0) (0.5) (0.0)

 49-51 months 0.0 100.0 0.0 100.0 0.0 100.0

 (0.0) (0.0) (0.0) (0.0) (0.0) (0.0)

Sample size 481 481 114 114 647 647

Population 2,915,040 2,915,040 726,029 726,029 3,952,924 3,952,924

____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________

Exhibit E-57

Prior WIC Experience of WIC Women 

_____________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total

 Women Women Women Women

_____________________________________________________________________________________

Certification history 

 First WIC certification 62.0 8.4 17.5 36.8

 (2.3) (1.4) (1.8) (1.2)

 Received WIC last month 1.1 89.2 75.5 43.0

 (0.4) (1.5) (2.5) (1.2)

 Received WIC at earlier time 36.9 2.4 7.0 20.2

 (2.2) (0.6) (1.4) (1.3)

Sample size 639 627 587 1,853

Population 859,381 376,463 573,899 1,809,743

_______________________________________________________________________________________

____________________________________________________________________________________

Exhibit E-58

Prior WIC Experience of WIC Infants and Children 

_____________________________________________________________________________________

 WIC WIC

 Infants Children

_____________________________________________________________________________________

Certification history 

 First WIC certification 86.5 0.9

 (2.3) (0.4)

 Recertification 13.5 99.1

 (2.3) (0.4)

 Indeterminant 3.1 7.6

 (0.8) (1.6)

Ever leave and reenter the WIC program? 

 Yes NA 24.6

 (2.0)

 No NA 75.4

 (2.0)

 Not reported NA 12.5

 (2.5)

Sample size 614 647

Population 1,978,411 3,952,924

 

_____________________________________________________________________________________
_____________________________________________________________________________________

Exhibit E-59

Breastfeeding Status Reported at WIC Certification Among WIC Infants and Children 

_____________________________________________________________________________________

 Infants Children

_____________________________________________________________________________________

Breastfeeding experience 

 Currently breastfeeding 31.0 0.4

 (2.8) (0.2)

 Previously breastfed 25.1 50.0

 (2.6) (2.8)

 Never breastfed 43.9 49.6

 (3.6) (2.8)

 Not reported* 1.2 4.2

 (0.4) (0.9)

Sample size 614 647

Population 1,978,411 3,952,924

 

Cumulative distribution of 

breastfeeding duration among

those ever breastfed 

 26 or more weeks 7.3 42.7

 (1.9) (3.8)

 21 or more weeks 10.1 46.4

 (1.9) (4.0)

 13 or more weeks 18.6 62.8

 (3.5) (4.3)

 8 or more weeks 24.4 70.4

 (3.6) (4.3)

 4 or more weeks 44.1 84.7

 (4.2) (3.0)

 3 or more weeks 52.1 87.2

 (3.6) (2.7)

 2 or more weeks 71.6 92.8

 (3.5) (1.7)

 1 or more weeks 89.1 94.6

 (2.1) (1.5)

 1 or more days 100.0 100.0

 Not reported* 5.7 10.3

 (1.5) (2.0)

Sample size 340 306

Population 1,095,895 1,906,828

_____________________________________________________________________________________
_____________________________________________________________________________________

Exhibit E-60

Distribution of WIC Infants and Children by Own Breastfeeding Status and Presence of

Siblings Ever Breastfed 

_____________________________________________________________________________________

 

 Infants Children 

_____________________________________________________________________________________

WIC participants who breastfed: 

Percent with no siblings 46.3 35.3 

 (4.0) (3.4) 

Among those with siblings: 

 No siblings ever breastfed 21.8 13.5 

 (3.7) (2.9) 

 One sibling ever breastfed 62.0 61.9 

 (4.4) (3.8) 

 Two siblings ever breastfed 15.2 19.3 

 (3.3) (3.2) 

 More than two siblings ever 1.0 5.2 

 breastfed (0.6) (1.5) 

Sample size 340 306 

Population 1,095,895 1,906,828 

 

WIC participants who did not breastfeed 

Percent with no siblings 47.3 37.0 

 (4.2) (3.2) 

Among those with siblings: 

 No siblings ever breastfed 82.7 81.7 

 (3.8) (3.1) 

 One sibling ever breastfed 14.2 17.1 

 (3.4) (3.0) 

 Two siblings ever breastfed 3.1 1.2 

 (1.5) (0.8) 

 More than two siblings ever 0.0 0.0 

 breastfed (0.0) (0.0) 

Sample size 265 311 

Population 858,278 1,879,370 

_____________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-61

Distribution of Referrals to the WIC Program, by Participant Category and Metro-Nonmetro Location 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Total 

 Friend 35.0 40.1 33.4 35.5 37.7 33.3 34.9

 (2.3) (3.0) (2.4) (1.6) (2.5) (2.5) (1.8)

 Family member 32.2 34.2 38.4 34.6 32.4 33.6 33.5

 (2.5) (2.7) (2.9) (2.0) (2.4) (2.5) (1.9)

 Doctor/Health professional 37.8 35.0 32.8 35.6 33.3 35.7 35.1

 (2.4) (3.0) (2.7) (1.9) (2.9) (2.6) (2.1)

 Television advertisement 4.9 4.8 4.5 4.8 6.0 5.5 5.4

 (1.1) (1.1) (1.1) (1.0) (1.4) (1.0) (0.9)

 Radio advertisement 1.7 2.4 2.3 2.0 2.2 2.6 2.4

 (0.5) (1.0) (0.7) (0.4) (0.6) (0.8) (0.5)

 Newspaper advertisement 2.1 2.3 1.8 2.1 2.5 2.6 2.4

 (0.7) (0.7) (0.7) (0.5) (0.8) (0.8) (0.6)

 Billboard/Poster advertisement 6.6 7.5 9.0 7.6 7.2 8.3 7.8

 (1.5) (2.1) (1.7) (1.3) (1.7) (1.7) (1.3)

 Pamphlet 8.4 13.1 10.7 10.1 10.4 10.5 10.4

 (1.6) (2.8) (2.0) (1.6) (2.2) (1.9) (1.7)

 Other 9.5 10.5 9.8 9.8 10.9 9.3 9.8

 (1.3) (2.2) (1.7) (1.1) (1.6) (1.6) (1.2)

 No referral received 5.9 4.3 7.4 6.0 6.9 7.4 7.0

 (1.1) (1.1) (1.4) (0.8) (1.3) (1.2) (0.9)

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

 

Metro residents 

 Friend 35.9 39.6 35.6 36.6 38.7 32.6 35.1

 (2.6) (3.5) (2.8) (1.8) (2.4) (2.3) (1.6)

 Family member 31.9 34.2 34.8 33.3 30.8 33.4 32.7

 (2.9) (3.0) (3.3) (2.4) (2.6) (3.0) (2.2)

 Doctor/Health professional 37.7 36.5 35.9 36.9 34.4 36.2 35.9

 (2.7) (3.3) (3.1) (2.2) (3.1) (3.0) (2.4)

 Television advertisement 5.4 5.0 4.5 5.0 7.0 5.3 5.7

 (1.4) (1.2) (1.2) (1.1) (1.7) (1.1) (1.1)

 Radio advertisement 2.2 2.7 2.8 2.5 2.7 2.6 2.6

 (0.6) (1.2) (0.9) (0.5) (0.7) (0.9) (0.6)

 Newspaper advertisement 2.6 2.1 1.5 2.1 2.5 2.2 2.3

 (0.9) (0.7) (0.6) (0.6) (1.0) (0.9) (0.6)

 Billboard/Poster advertisement 7.4 8.5 9.5 8.3 8.5 8.8 8.6

 (1.8) (2.5) (2.0) (1.7) (2.1) (2.0) (1.5)
__________________________________________________________________________________________________________________________________

Exhibit E-61 (continued)

Distribution of Referrals to the WIC Program, by Participant Category and Metro-Nonmetro Location 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

 Pamphlet 9.1 13.8 12.5 11.2 11.7 11.2 11.4

 (1.9) (3.3) (2.5) (2.0) (2.6) (2.1) (2.0)

 Other 9.2 8.8 9.8 9.3 11.1 9.9 10.1

 (1.5) (1.8) (2.0) (1.2) (1.7) (1.8) (1.2)

 No referral received 5.7 3.6 7.1 5.7 6.9 6.4 6.3

 (1.3) (1.1) (1.7) (0.9) (1.6) (1.2) (1.0)

Sample size 481 514 442 1,437 474 476 2,387

Population 668,251 315,918 446,008 1,430,177 1,593,475 3,119,987 6,143,639

 

Nonmetro residents 

 Friend 31.8 42.8 25.7 31.5 33.6 35.8 34.2

 (4.6) (4.4) (3.9) (3.1) (8.7) (8.2) (6.5)

 Family member 33.3 34.3 51.1 39.5 39.3 34.4 36.8

 (5.3) (6.2) (3.9) (3.3) (4.8) (4.5) (3.4)

 Doctor/Health professional 38.0 27.1 21.9 30.9 28.7 33.7 31.8

 (5.3) (7.8) (4.4) (3.1) (7.2) (5.3) (3.9)

 Television advertisement 3.1 3.9 4.4 3.7 2.0 6.0 4.5

 (1.1) (2.2) (3.1) (1.7) (1.7) (2.7) (2.1)

 Radio advertisement 0.0 0.9 0.5 0.3 0.0 2.5 1.4

 (0.0) (0.8) (0.5) (0.2) (0.0) (1.8) (1.0)

 Newspaper advertisement 0.6 3.3 2.6 1.7 2.2 4.1 3.1

 (0.6) (1.6) (2.2) (1.0) (1.3) (2.1) (1.5)

 Billboard/Poster advertisement 4.0 2.2 7.4 4.9 1.5 6.4 4.9

 (1.6) (1.5) (3.1) (1.2) (1.2) (3.1) (1.9)

 Pamphlet 6.1 9.5 4.2 6.0 4.8 7.8 6.7

 (2.0) (2.9) (2.4) (1.9) (2.5) (4.0) (3.0)

 Other 10.5 19.2 9.5 11.6 10.0 6.9 8.7

 (3.0) (10.6) (2.8) (3.0) (4.5) (3.4) (3.3)

 No referral received 6.6 8.4 8.2 7.4 7.2 11.4 9.4

 (2.5) (3.7) (2.0) (2.0) (2.2) (3.3) (2.4)

Sample size 158 113 145 416 140 171 727

Population 191,130 60,545 127,891 379,566 384,936 832,937 1,597,439

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-62

Distribution of Referrals to the WIC Program, by Local Agency Sponsorship 

___________________________________________________________________________________________________________________________________

 State District County Municipal Community Total

 Agency Agency Agency Agency Agency Hospital WIC

___________________________________________________________________________________________________________________________________

Source of referral 

 Friend 32.1 35.3 36.3 40.3 26.6 36.7 34.9

 (4.5) (3.1) (3.7) (7.1) (4.4) (2.6) (1.8)

 Family member 26.3 31.2 34.6 32.6 46.0 30.7 33.5

 (4.6) (4.9) (2.6) (5.6) (6.4) (2.3) (1.9)

 Doctor/Health professional 31.5 30.6 36.0 34.0 33.0 38.0 35.1

 (4.7) (4.4) (3.6) (7.1) (5.2) (6.0) (2.1)

 Doctor from Medicaid 11.5 7.4 16.2 15.0 9.6 16.6 14.2

 (2.8) (4.4) (2.6) (4.2) (3.2) (4.3) (1.8)

 Doctor from HMO 0.3 6.1 3.9 0.9 3.0 4.5 3.6

 (0.2) (2.0) (0.8) (0.6) (0.7) (1.0) (0.5)

 Private doctor 8.8 9.1 9.8 4.9 9.6 12.3 9.9

 (2.4) (1.0) (1.8) (3.1) (3.5) (2.5) (1.1)

 Television advertisement 5.1 3.9 4.6 7.2 7.6 6.4 5.4

 (1.9) (1.7) (1.2) (5.9) (4.0) (2.3) (0.9)

 Radio advertisement 1.3 1.3 2.3 3.6 2.0 3.4 2.4

 (0.9) (0.6) (0.8) (2.9) (1.2) (1.4) (0.5)

 Newspaper advertisement 2.3 2.0 1.7 1.5 4.7 3.1 2.4

 (1.0) (1.0) (0.7) (1.1) (2.5) (1.6) (0.6)

 Billboard/Poster advertisement 8.4 9.5 4.9 6.2 12.0 10.5 7.8

 (4.3) (3.6) (1.5) (5.1) (5.1) (3.1) (1.3)

 Pamphlet 8.9 9.3 7.5 9.9 19.7 12.4 10.4

 (3.6) (5.1) (2.0) (7.0) (8.2) (4.0) (1.7)

 Other 12.2 14.5 8.1 4.9 11.1 10.0 9.8

 (2.9) (2.4) (1.9) (2.0) (4.3) (2.0) (1.2)

 No referral received 11.8 5.9 6.0 0.9 7.5 7.6 7.0

 (2.3) (2.5) (1.3) (0.3) (1.5) (1.7) (0.9)

Sample size 375 276 1,227 147 376 713 3,114

Population 918,183 708,232 3,152,368 323,414 825,792 1,813,088 7,741,078

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-63

Distribution of Perceived Barriers to WIC Participation, by Participant Category 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

Perceived Barrier Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Lack of transportation to clinic 

 A big problem 5.3 7.1 7.2 6.3 4.3 7.5 6.4

 (1.6) (1.3) (1.3) (1.2) (0.9) (1.4) (0.9)

 Somewhat of a problem 16.0 16.8 18.4 16.9 15.7 12.8 14.5

 (1.5) (2.7) (2.3) (1.4) (2.1) (1.5) (1.3)

 Not a problem 78.7 76.2 74.3 76.8 80.0 79.7 79.1

 (2.3) (3.4) (3.0) (2.2) (2.2) (2.1) (1.7)

Inconvenient hours/days clinic is open 

 A big problem 3.2 1.8 5.0 3.5 2.6 4.3 3.7

 (0.9) (0.6) (1.1) (0.7) (0.7) (1.0) (0.7)

 Somewhat of a problem 12.9 12.5 10.9 12.2 14.0 10.7 11.9

 (1.5) (1.7) (1.6) (1.1) (2.1) (1.5) (1.0)

 Not a problem 83.9 85.7 84.1 84.4 83.4 85.0 84.5

 (1.9) (2.0) (1.9) (1.3) (2.1) (1.9) (1.2)

Services take too much time 

 A big problem 3.6 6.0 7.9 5.4 4.3 4.4 4.6

 (1.1) (1.5) (1.4) (0.8) (1.0) (1.0) (0.8)

 Somewhat of a problem 15.2 22.2 18.0 17.6 17.7 20.4 19.1

 (2.1) (2.2) (2.2) (1.5) (2.8) (2.4) (1.7)

 Not a problem 81.2 71.8 74.2 77.0 78.0 75.2 76.3

 (2.3) (2.9) (3.0) (2.0) (3.1) (2.6) (2.0)

Waiting space at clinic is limited 

 A big problem 3.8 3.8 2.7 3.4 3.7 3.8 3.7

 (1.1) (1.2) (1.0) (0.8) (1.1) (0.9) (0.7)

 Somewhat of a problem 6.3 11.2 11.7 9.0 9.6 11.2 10.3

 (1.2) (1.8) (2.4) (1.3) (1.6) (2.0) (1.4)

 Not a problem 90.0 85.0 85.6 87.5 86.7 85.0 86.0

 (1.5) (1.9) (2.5) (1.3) (1.9) (2.1) (1.6)

Lack of child care 

 A big problem 2.6 5.0 3.4 3.4 3.7 6.0 4.8

 (0.7) (1.1) (1.0) (0.6) (1.0) (1.4) (0.8)

 Somewhat of a problem 7.3 8.0 9.3 8.1 8.2 11.1 9.7

 (1.2) (1.3) (1.7) (1.0) (1.4) (1.7) (1.1)

 Not a problem 90.1 87.0 87.2 88.6 88.1 82.9 85.5

 (1.5) (1.9) (2.1) (1.3) (1.4) (2.3) (1.5)
___________________________________________________________________________________________________________________________________

Exhibit E-63 (cont.)

Distribution of Perceived Barriers to WIC Participation, by Participant Category 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

Perceived Barrier Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Language barriers 

 A big problem 1.7 3.5 0.7 1.8 1.5 2.1 1.9

 (0.6) (1.4) (0.4) (0.5) (0.7) (1.0) (0.7)

 Somewhat of a problem 3.1 2.9 1.8 2.6 1.8 1.4 1.8

 (0.7) (0.9) (0.6) (0.5) (0.6) (0.5) (0.4)

 Not a problem 95.3 93.6 97.4 95.6 96.7 96.5 96.3

 (0.9) (2.0) (0.7) (0.8) (0.9) (1.1) (0.9)

Problems qualifying for benefits 

 A big problem 0.7 1.8 0.5 0.9 1.5 0.9 1.0

 (0.5) (0.7) (0.2) (0.3) (0.5) (0.4) (0.3)

 Somewhat of a problem 3.3 3.8 3.7 3.5 2.7 4.3 3.7

 (0.8) (1.0) (1.0) (0.6) (0.8) (0.7) (0.5)

 Not a problem 96.0 94.4 95.8 95.6 95.8 94.9 95.3

 (0.9) (1.3) (1.0) (0.6) (1.1) (1.0) (0.7)

Rates of item non-response 

 Lack of transportation to clinic 2.0 2.1 4.2 2.7 2.7 2.4 2.6

 (0.9) (0.7) (1.4) (0.9) (1.2) (1.0) (0.8)

 Inconvenient hours/days clinic 2.1 2.3 4.1 2.8 2.7 2.6 2.7

 is open (0.9) (0.7) (1.3) (0.8) (1.2) (1.0) (0.8)

 Services take too much time 2.3 2.4 4.1 2.9 2.9 2.4 2.6

 (0.9) (0.7) (1.3) (0.8) (1.2) (1.0) (0.8)

 Waiting space at clinic is limite 2.3 2.3 4.2 2.9 3.1 2.8 2.9

 (0.9) (0.7) (1.3) (0.8) (1.2) (1.1) (0.9)

 Lack of child care 4.8 3.5 4.3 4.4 3.3 2.7 3.2

 (1.7) (1.1) (1.3) (1.0) (1.2) (1.0) (0.8)

 Language barriers 2.3 2.1 4.1 2.8 3.0 2.6 2.7

 (0.9) (0.7) (1.3) (0.8) (1.2) (1.1) (0.9)

 Problems qualifying for benefits 2.5 2.3 4.1 3.0 3.1 2.6 2.8

 (0.9) (0.7) (1.3) (0.8) (1.2) (1.0) (0.8)

Sample size 639 627 587 1,853 614 647 3,114

Population 859,381 376,463 573,899 1,809,743 1,978,411 3,952,924 7,741,078

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-64

Distribution of Perceived Barriers to WIC Participation, by Local Agency Sponsorship 

___________________________________________________________________________________________________________________________________

 State District County Municipal Community Total

Perceived Barrier Agency Agency Agency Agency Agency Hospital WIC

___________________________________________________________________________________________________________________________________

Lack of transportation to clinic 

 A big problem 6.0 2.5 6.0 9.6 6.3 8.2 6.4

 (1.6) (1.7) (1.1) (2.6) (2.7) (2.3) (0.9)

 Somewhat of a problem 10.7 16.3 14.6 21.7 15.2 13.8 14.5

 (4.0) (3.6) (1.7) (3.7) (3.4) (2.3) (1.3)

 Not a problem 83.3 81.2 79.4 68.7 78.5 78.0 79.1

 (5.2) (2.4) (2.4) (2.7) (5.9) (2.2) (1.7)

Inconvenient hours/days clinic is open 

 A big problem 7.7 0.9 4.5 1.6 1.5 2.5 3.7

 (2.4) (0.8) (1.0) (1.3) (0.8) (1.2) (0.7)

 Somewhat of a problem 11.1 17.7 13.4 17.2 5.9 9.3 11.9

 (2.4) (3.2) (1.7) (4.8) (2.2) (1.6) (1.0)

 Not a problem 81.2 81.4 82.1 81.2 92.6 88.2 84.5

 (2.4) (3.0) (1.8) (6.1) (2.9) (2.0) (1.2)

Services take too much time 

 A big problem 7.5 4.2 4.6 3.1 0.8 5.4 4.6

 (2.8) (3.1) (1.1) (1.4) (0.8) (1.1) (0.8)

 Somewhat of a problem 25.0 17.5 21.5 39.9 4.4 15.4 19.1

 (4.5) (2.7) (3.0) (6.9) (1.5) (2.3) (1.7)

 Not a problem 67.6 78.3 73.9 57.0 94.8 79.2 76.3

 (5.7) (5.4) (3.3) (6.9) (1.7) (2.4) (2.0)

Waiting space at clinic is limited 

 A big problem 2.7 2.3 3.7 1.5 1.9 6.0 3.7

 (1.6) (1.5) (1.0) (1.5) (0.7) (2.1) (0.7)

 Somewhat of a problem 7.6 13.4 11.9 12.9 4.1 9.8 10.3

 (2.9) (3.0) (2.7) (2.7) (1.6) (2.3) (1.4)

 Not a problem 89.7 84.3 84.4 85.6 94.0 84.2 86.0

 (4.1) (4.3) (2.8) (2.5) (2.2) (3.7) (1.6)

Lack of child care 

 A big problem 9.3 4.0 5.5 2.1 0.9 4.0 4.8

 (3.6) (2.6) (1.1) (1.1) (0.8) (1.3) (0.8)

 Somewhat of a problem 11.3 9.0 11.1 18.2 2.5 8.5 9.7

 (2.3) (1.6) (2.1) (2.6) (0.8) (2.0) (1.1)

 Not a problem 79.3 87.0 83.5 79.7 96.6 87.5 85.5

 (5.4) (2.0) (2.6) (2.3) (1.1) (2.0) (1.5)
___________________________________________________________________________________________________________________________________

Exhibit E-64 (cont.)

Distribution of Perceived Barriers to WIC Participation, by Local Agency Sponsorship 

___________________________________________________________________________________________________________________________________

 State District County Municipal Community Total

Perceived Barrier Agency Agency Agency Agency Agency Hospital WIC

___________________________________________________________________________________________________________________________________

Language barriers 

 A big problem 5.8 0.4 1.1 0.3 0.4 2.8 1.9

 (5.0) (0.2) (0.5) (0.3) (0.4) (1.2) (0.7)

 Somewhat of a problem 0.7 1.6 2.8 3.6 0.6 1.0 1.8

 (0.5) (1.0) (0.8) (1.6) (0.2) (0.3) (0.4)

 Not a problem 93.5 98.0 96.1 96.0 99.0 96.3 96.3

 (5.5) (0.9) (0.9) (1.6) (0.5) (1.4) (0.9)

Problems qualifying for benefits 

 A big problem 1.4 1.9 1.1 1.8 0.6 0.5 1.0

 (0.8) (1.6) (0.4) (1.3) (0.4) (0.3) (0.3)

 Somewhat of a problem 3.2 2.9 3.6 2.8 3.5 4.7 3.7

 (1.0) (1.8) (0.9) (1.2) (1.3) (1.6) (0.5)

 Not a problem 95.4 95.2 95.3 95.5 95.9 94.8 95.3

 (1.1) (3.3) (1.1) (2.4) (1.5) (1.6) (0.7)

Rates of item non-response 

 Lack of transportation to clinic 4.8 1.8 2.8 0.0 1.6 2.1 2.6

 (2.9) (0.7) (1.7) (0.0) (0.7) (0.8) (0.8)

 Inconvenient hours/days clinic 4.8 1.8 3.1 0.0 1.6 2.2 2.7

 is open (2.9) (0.7) (1.6) (0.0) (0.7) (0.8) (0.8)

 Services take too much time 4.8 1.8 2.9 0.1 1.6 2.4 2.6

 (2.9) (0.7) (1.6) (0.1) (0.7) (0.8) (0.8)

 Waiting space at clinic is limite 5.4 1.8 3.1 0.2 1.9 2.5 2.9

 (2.9) (0.7) (1.8) (0.2) (0.5) (0.8) (0.9)

 Lack of child care 6.1 1.8 3.2 0.4 2.3 3.3 3.2

 (3.1) (0.7) (1.6) (0.3) (0.4) (1.0) (0.8)

 Language barriers 4.8 1.8 3.0 0.0 1.6 2.4 2.7

 (2.9) (0.7) (1.8) (0.0) (0.7) (0.8) (0.9)

 Problems qualifying for benefits 4.8 1.8 3.0 0.3 2.3 2.6 2.8

 (2.9) (0.7) (1.6) (0.3) (0.6) (0.9) (0.8)

Sample size 375 276 1,227 147 376 713 3,114

Population 918,183 708,232 3,152,368 323,414 825,792 1,813,088 7,741,078

____________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________

Exhibit E-65

Distribution of Reported Difficulties with the WIC Program Among Respondents with Prior WIC Experience 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

Reported Difficulty Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Lack of transportation to get groceries 

 A big problem 4.1 3.1 4.5 4.0 2.8 3.9 3.7

 (1.3) (0.7) (1.3) (0.7) (0.9) (1.4) (0.8)

 Somewhat of a problem 11.4 11.9 15.3 13.2 13.4 9.3 10.9

 (2.0) (1.6) (2.3) (1.3) (2.0) (1.3) (1.1)

 Not a problem 84.5 85.0 80.2 82.9 83.8 86.8 85.4

 (2.3) (1.8) (2.4) (1.5) (2.2) (2.0) (1.4)

Problems using WIC vouchers/checks 

 A big problem 0.8 0.4 0.3 0.5 1.5 1.7 1.4

 (0.6) (0.3) (0.2) (0.2) (0.6) (0.6) (0.4)

 Somewhat of a problem 6.4 6.4 3.5 5.2 3.2 5.6 5.0

 (1.8) (1.0) (0.9) (0.8) (0.8) (1.1) (0.7)

 Not a problem 92.8 93.1 96.1 94.3 95.3 92.7 93.6

 (1.8) (1.1) (0.9) (0.8) (1.1) (1.2) (0.8)

Treated negatively by staff member 

 A big problem 0.0 0.2 0.0 0.0 0.2 1.2 0.8

 (0.0) (0.2) (0.0) (0.0) (0.2) (0.5) (0.3)

 Somewhat of a problem 2.3 1.8 1.8 2.0 2.2 3.9 3.2

 (1.0) (0.7) (0.8) (0.5) (0.7) (0.8) (0.6)

 Not a problem 97.7 98.0 98.2 98.0 97.7 94.9 96.1

 (1.0) (0.8) (0.8) (0.5) (0.8) (0.9) (0.7)

Treated negatively in grocery store 

 A big problem 2.1 2.3 1.6 2.0 2.8 2.6 2.5

 (1.1) (0.8) (0.9) (0.5) (0.9) (0.7) (0.5)

 Somewhat of a problem 11.3 13.9 12.1 12.4 11.1 13.3 12.6

 (2.3) (2.0) (2.0) (1.5) (1.9) (1.7) (1.3)

 Not a problem 86.5 83.8 86.3 85.7 86.1 84.1 84.9

 (2.5) (2.0) (2.2) (1.6) (2.1) (1.9) (1.5)

Rates of item non-response 

 Lack of transportation to 21.6 23.2 23.2 22.7 17.1 3.7 10.7

 get groceries (3.8) (3.1) (2.9) (2.4) (3.1) (1.5) (1.7)

 Problems using WIC vouchers/check 22.4 23.3 26.1 24.2 17.6 4.0 11.3

 (3.8) (3.2) (4.0) (2.7) (3.1) (1.8) (1.9)

 Treated negatively by staff membe 21.8 22.7 25.0 23.4 17.2 3.2 10.6

 (3.7) (3.1) (3.9) (2.6) (2.8) (1.1) (1.3)

 Treated negatively in grocery sto 22.4 23.6 25.9 24.2 17.6 4.3 11.5

 (3.8) (3.2) (4.0) (2.7) (2.9) (1.8) (1.8)
___________________________________________________________________________________________________________________________________

Exhibit E-65 (cont.)

Distribution of Reported Difficulties with the WIC Program Among Respondents with Prior WIC Experience 

___________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

Reported Difficulty Women Women Women Women Infants Children WIC

___________________________________________________________________________________________________________________________________

Sample 

 Percent of families with 82.8 94.8 94.4 90.8 95.8 97.7 95.8

 prior WIC experience (3.3) (1.0) (1.2) (1.1) (0.9) (0.7) (0.5)

 Of families WIC experience, 

 percent administered customer 79.1 77.6 78.2 78.3 84.6 97.7 90.7

 satisfaction section (3.7) (3.0) (2.6) (2.2) (2.6) (0.7) (1.1)

Sample size 277 593 547 1,417 587 628 2,632

Population 368,670 356,805 535,811 1,261,286 1,884,471 3,846,741 6,992,499

____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________

Exhibit E-66

Distribution of Reported Overall Satisfaction with WIC Foods Among Respondents with

Prior WIC Experience 

_____________________________________________________________________________________

 Satisfied with Satisfied with

 Food Brands Food Quantities

_____________________________________________________________________________________

Breakfast cereals 

 Very satisfied 62.3 79.0

 (2.7) (1.9)

 Fairly satisfied 28.1 16.0

 (2.0) (1.3)

 Not satisfied 9.7 5.0

 (1.6) (1.0)

Juices 

 Very satisfied 81.4 79.9

 (2.2) (2.0)

 Fairly satisfied 15.7 13.9

 (2.1) (1.4)

 Not satisfied 2.9 6.2

 (0.5) (1.0)

Baby formula 

 Very satisfied 85.7 79.6

 (3.4) (2.7)

 Fairly satisfied 12.4 14.5

 (3.3) (2.5)

 Not satisfied 1.9 5.9

 (0.8) (1.4)

Milk 

 Very satisfied 89.1 80.9

 (2.2) (2.1)

 Fairly satisfied 10.0 12.7

 (2.2) (1.3)

 Not satisfied 0.9 6.4

 (0.3) (1.3)

Cheese 

 Very satisfied 87.5 80.9

 (2.1) (2.2)

 Fairly satisfied 10.6 13.7

 (2.0) (1.6)

 Not satisfied 1.9 5.5

 (0.4) (1.0)

Eggs 

 Very satisfied 90.0 82.8

 (2.2) (2.0)

 Fairly satisfied 9.5 13.0

 (2.2) (1.6)

 Not satisfied 0.5 4.2

 (0.2) (0.8)

Beans or peanut butter 

 Very satisfied 86.6 83.9

 (2.2) (2.1)

 Fairly satisfied 11.9 12.8

 (2.1) (1.8)

 Not satisfied 1.5 3.3

 (0.3) (0.7)
_____________________________________________________________________________________

Exhibit E-66 (cont.)

Distribution of Reported Overall Satisfaction with WIC Foods Among Respondents with

Prior WIC Experience 

_____________________________________________________________________________________

 Satisfied with Satisfied with

 Food Brands Food Quantities

_____________________________________________________________________________________

Percent nonresponse to each item 

 Breakfast cereal 10.6 10.6

 (1.2) (1.2)

 Juices 10.5 10.7

 (1.1) (1.1)

 Baby formula 26.3 26.6

 (3.0) (3.0)

 Milk 10.8 11.2

 (1.2) (1.2)

 Cheese 10.8 11.1

 (1.2) (1.2)

 Eggs 11.0 11.2

 (1.2) (1.2)

 Beans or peanut butter 11.3 11.5

 (1.2) (1.2)

Sample

 Percent of families with WIC 95.8 95.8

 experience (0.5) (0.5)

 Of families WIC experience, 

 percent administered customer 90.7 90.7

 satisfaction section (1.1) (1.1)

Sample size 2,632 2,632

Population 6,992,499 6,992,499

_____________________________________________________________________________________
____________________________________________________________________________________________________________________________________

Exhibit 3-67

Incidence of Missed WIC Appointments Among Respondents with Prior WIC Experience 

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

 Percent ever missed appointment 38.0 39.1 42.2 40.1 37.0 50.6 45.6

 at WIC clinic (3.0) (3.0) (3.5) (2.2) (3.2) (2.9) (2.1)

Distribution of frequency 

of missed appointments 

 Sometimes 21.7 16.3 15.4 17.5 16.5 27.0 22.9

 (2.9) (2.5) (2.1) (1.6) (2.1) (1.9) (1.5)

 Often 3.5 1.7 3.8 3.1 3.4 2.9 3.1

 (1.4) (0.5) (1.2) (0.8) (1.0) (0.7) (0.6)

 Just once 12.7 21.1 22.5 19.2 16.7 20.4 19.3

 (2.4) (2.9) (2.9) (1.8) (2.1) (2.5) (1.4)

 Never 62.2 60.9 58.3 60.2 63.4 49.7 54.7

 (3.0) (3.0) (3.5) (2.2) (3.2) (2.9) (2.1)

Distribution of reasons for 

missed appointments 

 Forget to go 44.7 35.2 43.0 41.4 38.3 44.0 42.5

 (6.3) (5.5) (6.0) (4.2) (3.8) (5.0) (3.9)

 Trouble finding transportation 39.8 34.7 38.3 37.7 29.3 28.6 29.9

 (4.6) (5.8) (5.1) (3.0) (3.4) (3.6) (2.9)

 Cannot get off work 21.9 13.4 12.0 15.1 17.8 22.3 20.4

 (5.9) (3.9) (2.4) (2.3) (3.2) (2.7) (2.1)

 Cannot find child care 12.0 13.3 14.9 13.6 12.7 12.7 12.8

 (4.0) (2.7) (4.3) (2.2) (2.9) (2.8) (2.2)

 Clinic is too far from home 11.9 10.8 8.9 10.2 11.8 8.2 9.2

 (3.5) (2.4) (2.4) (1.7) (2.4) (1.6) (1.3)

 It takes too long at the WIC clin 10.2 10.4 11.3 10.7 8.1 8.2 8.5

 (3.2) (2.4) (4.7) (2.5) (2.3) (1.9) (1.6)

Rates of item nonresponse 

 Ever missed appoinment 21.4 22.9 24.6 23.2 16.1 2.4 9.8

 (3.7) (3.1) (3.9) (2.6) (2.5) (0.7) (1.0)

 Frequency of missed appointments 21.6 23.0 25.2 23.5 16.7 2.9 10.3

 (3.7) (3.1) (3.9) (2.5) (2.5) (0.7) (1.0)

 Reasons for missed appointments 23.3 25.2 26.5 25.2 18.8 6.7 13.3

 (3.6) (3.1) (3.8) (2.5) (2.6) (1.0) (1.2)

____________________________________________________________________________________________________________________________________

NOTES: The distribution of reasons for missed appointments is measured among respondents who missed appointments; the distribution sums

 to more than 100 due to multiple responses. 
____________________________________________________________________________________________________________________________________

Exhibit 3-68

Distribution of Shopping Experiences and Food Benefit Redemption Among Respondents with Prior WIC Experience 

____________________________________________________________________________________________________________________________________

 Pregnant Breastfeeding Postpartum Total Total

 Women Women Women Women Infants Children WIC

____________________________________________________________________________________________________________________________________

Overall WIC participation 

 Percent who ever stopped 39.6 23.0 24.0 28.4 24.1 25.7 25.7

 using WIC while still eligible (3.1) (3.1) (2.8) (2.2) (2.4) (2.1) (1.5)

Experience shopping with 

WIC vouchers 

 Easy 81.5 80.2 89.3 84.3 81.9 84.6 83.9

 (3.4) (2.9) (1.9) (1.9) (2.1) (2.2) (1.8)

 Sometimes confusing 15.2 18.8 9.7 14.0 17.1 13.0 14.2

 (3.0) (2.6) (1.7) (1.6) (2.1) (1.8) (1.5)

 Often confusing 3.3 1.0 1.0 1.7 1.0 2.4 1.9

 (1.3) (0.6) (0.5) (0.6) (0.4) (0.8) (0.5)

Percent of respondents who 

usually purchase all WIC food items 

 Overall 91.7 88.6 91.0 90.5 90.9 94.3 92.8

 (2.1) (2.1) (1.6) (1.2) (1.4) (0.8) (0.6)

 Breakfast cereals 96.5 97.1 96.9 96.8 96.0 97.1 96.8

 (1.4) (0.7) (1.0) (0.6) (1.1) (0.8) (0.7)

 Juices 97.0 98.3 98.1 97.9 98.8 98.9 98.7

 (1.2) (0.5) (0.7) (0.4) (0.6) (0.5) (0.4)

 Baby formula 95.6 91.2 99.4 96.2 96.4 92.0 93.8

 (1.9) (3.1) (0.4) (1.1) (1.1) (2.1) (1.4)

 Milk 96.3 95.6 95.6 95.8 96.0 96.5 96.3

 (1.2) (1.1) (1.2) (0.8) (1.0) (1.4) (0.8)

 Cheese 98.5 97.4 98.1 98.0 98.0 99.2 98.7

 (0.7) (0.7) (0.7) (0.4) (0.8) (0.4) (0.3)

 Eggs 97.1 94.8 97.4 96.6 95.9 97.8 97.1

 (1.5) (1.8) (0.8) (0.8) (1.0) (0.7) (0.6)

 Beans or peanut butter 94.2 94.9 94.2 94.4 93.0 95.6 94.8

 (1.9) (1.4) (1.4) (0.9) (1.5) (1.3) (1.0)

Rates of item nonresponse 

 Ever stopped using WIC 22.0 23.6 25.5 23.9 16.4 3.3 10.6

 (3.8) (3.2) (3.9) (2.6) (2.5) (1.0) (1.2)

 Experience using WIC vouchers 22.1 24.0 26.3 24.4 17.4 4.6 11.6

 (3.8) (3.2) (4.1) (2.8) (3.0) (1.9) (1.9)

Item nonresponse to "Usually 

purchase all WIC foods" 

 Overall 26.1 27.0 28.8 27.5 21.3 10.5 16.5

 (3.8) (3.2) (3.8) (2.9) (3.2) (2.5) (2.2)
 Breakfast cereals 21.9 23.5 25.4 23.8 18.6 5.1 12.1

 (3.7) (3.1) (3.9) (2.6) (3.0) (1.4) (1.6)

 Juices 22.3 24.2 25.4 24.1 18.5 5.3 12.3

 (3.7) (3.1) (3.9) (2.6) (3.0) (1.4) (1.6)

 Baby formula 0.0 0.0 0.0 0.0 26.1 0.0 7.0

 (0.0) (0.0) (0.0) (0.0) (3.4) (0.0) (0.9)

 Milk 22.6 24.7 25.4 24.4 19.0 5.3 12.4

 (3.8) (3.1) (3.9) (2.6) (2.9) (1.4) (1.6)

 Cheese 22.3 24.5 25.4 24.2 19.1 5.2 12.4

 (3.7) (3.1) (3.9) (2.6) (3.0) (1.4) (1.6)

 Eggs 22.7 24.4 25.5 24.3 19.1 5.3 12.5

 (3.8) (3.1) (3.9) (2.6) (3.0) (1.4) (1.6)

 Beans or peanut butter 23.0 24.7 25.5 24.5 19.6 5.2 12.6

 (3.8) (3.0) (3.9) (2.6) (3.0) (1.4) (1.6)

____________________________________________________________________________________________________________________________________