Nutrition Assistance Program Report Series 

The Office of Analysis, Nutrition and Evaluation 

Special Nutrition Programs 

Survey of the Public Health Nutrition 

Workforce: 1999-2000 

United States Food and 

Department of Nutrition 

Agriculture Service 

January 2003
Survey of the Public Health Nutrition Workforce 

1999-2000 

Prepared for: 

U.S. Department of Agriculture 

Food and Nutrition Service 

3101 Park Center Drive 

Alexandria, VA 22302 

Project Officer: Ed Herzog 

Prepared by: 

Mary McCall and Barbara Keir for 

Association of State and Territorial Public Health Nutrition Directors 

P.O. Box 1001 

Johnstown, PA 15907-1001 

This research was funded, in part, through Cooperative Agreement No. 59-3198-8-027, with the 

Food and Nutrition Service, U.S. Department of Agriculture. The opinions or conclusions expressed 

herein do not, however, necessarily reflect those of the Food and Nutrition Service, U.S. Department 

of Agriculture. 
ii
iii

Table of Contents 

Executive Summary 1 

Background 5 

 USDA’s Objectives 6 

 Nutrition Objectives and Healthy People 2010 6 

Goals 11 

Study Methods 13 

Study Findings 17 

WIC’s Presence in the Public Health Nutrition Workforce 17 

Agency of Employment and Primary Work Location of the 

Public Health Nutrition Workforce 17 

Job Classification of the Public Health Nutrition Workforce 18 

 Years of Practice in Nutrition/Dietetics, Public Health Nutrition, and WIC 20 

 Personnel Management and Budget Responsibilities of the Workforce 22 

Major Areas of Practice 25 

 Employment Status 30 

Salaries 31 

Sources of Funding for the Public Health Nutrition Workforce 34 

Academic Preparation, Credentials, Training, and Training Needs 37 

 Affiliation with Professional Organizations 51 

 Geographical Distribution of the WIC Workforce 53 

 Diversity 55 

Conclusions 61 

Limitations of the Study 65 

Appendix A – ASTPHND Data and Epidemiology Committee 67 

Appendix B – Instructions for Data Collection 71 

Appendix C – Questionnaires 83 

Appendix D – Study Design 101 

Appendix E – Table 38 - Expanded 115 

 
iv
1

Executive Summary 

The Association of State and Territorial Public Health Nutrition Directors (ASTPHND), with 

support from a cooperative agreement with the U.S. Department of Agriculture (USDA), 

conducted a census of the professional and paraprofessional public health nutrition workforce in 

the states and territories. ASTPHND has conducted periodic profiles of the public health 

nutrition workforce since 1985. Members of ASTPHND in their respective states and territories 

conducted the census reported in this paper during 1999-2000. Prior to this, ASTPHND’s last 

survey was conducted in 1994. 

The goals of the workforce census were: 

• To collaborate with USDA to identify trends in the public health (PH) and community 

nutrition workforce. 

• To determine the capacity of the public health and community nutrition workforce in 

accomplishing program goals and meeting priority needs. 

• To assist USDA and state public health agencies in planning and evaluating their recruitment 

and retention efforts. 

• To identify training needs of public health nutrition personnel working in the Special 

Supplemental Nutrition Program for Women, Infants and Children (WIC) in relation to their 

job responsibilities, credentials, education, and longevity.1

• To measure qualifications of WIC nutrition staff in all states and territories. 

The study was designed as a census of persons who work as nutrition professionals or nutrition 

paraprofessionals in a public health nutrition program such as WIC or in other public health 

programs or services under the purview of the state health agency. It is important to note that 

there is considerable variation between states with regard to the programs administered by their 

state health agencies. For example, state health agencies may or may not have oversight 

responsibility for Medicaid, the regulation of health facilities, and/or the Child and Adult Care 

Food Program (CACFP). As a result, some state nutrition directors included nutrition personnel 

working within these programs in their survey because in their states these personnel are 

classified as public health nutrition positions. In states where these programs are not 

administered by the state health agency, nutritionists working within the programs were not 

surveyed because they were not considered a part of the public health workforce. Although this 

variation has implications for the conclusions and generalizations that can be made concerning 

the public health nutrition workforce, ASTPHND has encountered this variability in all of its 

previous workforce surveys. 

ASTPHND designed a 30-item fixed response instrument that required 10-20 minutes to 

complete. The final questionnaire included questions about the type and location of practice, job 

classification, source of funding, annual salary, training, education, certification or credentials, 

 

1

 Administered by USDA Food and Nutrition Service, the WIC Program provides nutritious foods, nutrition education, 

and health care referrals to meet the special nutrition needs of low-income pregnant, postpartum, and breastfeeding 

women and their infants and children (up to age 5) who are at nutritional risk. For information, visit 

www.fns.usda.gov/wic/
2

perceived training needs, participation in professional organizations, and personal characteristics 

(gender, race and ethnicity, primary and secondary languages). Ease of administration and 

burden of response, as well as applicability and comparability across states and time, were 

primary criteria for selection of items. Starting with the instrument used in ASTPHND’s 1994 

census, the questionnaire was revised, reviewed by stakeholder organizations, pretested and 

fielded in October 1999. State nutrition directors completed the collection and processing of data 

by September 2000. 

Data were collected on 10,904 positions of which 595 were vacant at the time of data collection. 

Each state submitted data files to a central location for analysis. The overall estimated response 

rate for the filled positions, based on transmittal forms supplied by the state directors, was 88 

percent (10,309/11,718). The reported state-specific response rates ranged from 45.9 percent 

(Washington) and 53.4 percent (New Mexico) to 100 percent (Arkansas, Guam, Iowa, Maine, 

Nevada, Oregon, Puerto Rico, South Dakota, Tennessee, Utah). The most significant difference 

in state participation compared to the 1994 survey was the participation of California in 1999. 

With a reported 2,640 public health nutrition professionals and paraprofessionals, California 

employs nearly 24 percent of the entire workforce surveyed, considerably more than New York 

(667), Florida (504), or Texas (486). 

Highlights 

These highlights and other findings are described in greater detail in the section on study 

findings. 

• The majority of public health nutrition workers are government employees. 

Nearly 68 percent of public health nutrition workers are employees of state or local government 

health agencies. WIC workers are more likely to be employed in local health agencies (49.3 

percent) than in other types of agencies, while the non-WIC workers are most frequently 

employed by state health agencies (36.6 percent) and local health agencies (34.5 percent). More 

than one-fourth of the workforce (28.4 percent) is employed by the private sector in not-forprofit organizations. Seventy-five percent of the WIC workers reported their location of work to 

be local health agencies, community health centers or other government field offices. There is no 

indication that privatization from public agencies to private nonprofits and for-profits or the use of 

contract workers increased between 1994 and 2000. 

• WIC is the primary funding source for the public health nutrition workforce. 

Ninety percent of the respondents (9,853/10,904) are employed in WIC programs. This represents 

81 percent of the total 9,951.5 full-time equivalents (FTEs), and this has not changed significantly 

since the 1994 census, when 81.7 percent of the FTEs were funded by WIC.2

 In addition to WIC, 

other USDA programs such as the Food Stamps Program and the CACFP account for an additional 

129 FTEs. State and local funds account for 4.2 percent and 2.6 percent of FTE funding, 

 

2

 Data on both full-time equivalents and positions were collected and used in data analysis. Respondents were asked 

whether they worked full- or part-time, and if part-time, to indicate the percent of time. This information was used 

to calculate full-time equivalents. For example, a full-time position equals one full-time equivalent. Two half-time 

positions equal one full-time equivalent. The total number of positions, therefore, is greater than the number of fulltime equivalents. Each respondent represents one position, but not necessarily one full-time equivalent.
3

respectively. The U.S. Department of Health and Human Services is the source of funding for 

another 4.7 percent of FTEs. 

• More than two-thirds (69.2 percent) of the public health nutrition positions are 

classified as professional, and 30.7 percent are classified as paraprofessional/other. 

Overall, the WIC nutrition workforce includes a higher proportion of paraprofessional positions than 

does the non-WIC nutrition workforce. Among the WIC nutrition workforce, 67.2 percent indicated 

they held professional positions, 30.7 percent held paraprofessional positions, and 1.9 percent were 

breastfeeding peer counselors or other classifications. Among the non-WIC respondents, 87.6 

percent were classified in professional positions, but there were very few paraprofessionals — only 

4.9 percent. 

• Public health nutrition workers constitute a very experienced workforce. 

More than two-thirds of the non-WIC nutrition workforce indicated 10 or more years of 

experience in the field of nutrition. Nearly half (47.3 percent) of the WIC nutrition workforce 

has been practicing nutrition for a similar length of time. Less than 4 percent of the entire 

workforce had been employed in the nutrition profession for less than one year at the time of 

data collection. Although their overall tenure in nutrition is less, the WIC workforce and the nonWIC workforce have a comparable amount of long-term experience in public health nutrition 

with 34 percent and 38 percent, respectively, having 10 or more years of work experience. 

• The proportion of registered dietitians (RDs) and registered dietetic technicians 

(DTRs) in the public health nutrition workforce did not increase between 1994 and 1999. 

In ASTPHND’s 1994 survey of the workforce, RDs made up 42.1 percent of the workforce and 

DTRs 2.4 percent. In 2000, 41 percent of the public health nutrition workforce reported being an 

RD, and 2.3 percent reported being a DTR. Among the WIC nutrition workforce, 37.6 percent 

are RDs, and 2.5 percent are DTRs. The proportion of the workforce with a nutrition-related 

bachelor’s degree is higher than the proportion of RDs in the workforce. More than half of the 

public health nutrition workforce have at least a bachelor’s degree in nutrition or dietetics, with 

the proportion being somewhat higher among non-WIC workers compared to WIC workers (69.5 

percent and 53.7 percent, respectively). 

• The public health nutrition workforce is diverse but seemingly less so than WIC 

participants. 

More than 95 percent of the workers are female. The racial/ethnic identity of WIC workers is 

more diverse than the non-WIC workforce but less diverse than the WIC participant population. 

Nineteen percent of the workforce reported being Latino, 11 percent African American, and 8 

percent Asian, American Indian, Alaskan Native, Hawaiian, and other Pacific Islanders. Twothirds of the workforce indicated race as white. Fourteen percent of respondents did not respond 

to the question — a nonresponse that is considerably higher than expected — making 

comparisons across time and with other populations difficult. Very few (0.5 percent) indicated 

multiple categories of race. 

 

• Eighty-three percent of the nutrition workforce report English as their primary 

language. 
4

Many other languages are also spoken. Nearly 30 percent (29.2 percent) speak Spanish as either 

their primary or secondary language. Thirty-eight percent speak more than one language. 
5

Background 

This is a report on the census of the public health (PH) workforce conducted by the Association of 

State and Territorial Public Health Nutrition Directors (ASTPHND) with partial support from the 

Food and Nutrition Service, United States Department of Agriculture (FNS, USDA). ASTPHND is 

a 501(c)(3) professional membership organization founded in 1952 to provide national and state 

leadership for achieving optimal health through optimal nutrition for the U.S. population. The 

Association works to strengthen policy, programs and services related to food, nutrition and health 

through communication, education, and research. The Association’s membership is composed of 

the nutrition director or designee appointed by the chief health official of each U.S. state, 

territory, possession, and the District of Columbia. A director is defined as the nutrition 

professional functionally responsible for the direction of the nutrition program of the state health 

agency. In addition to the directors, the Association’s membership includes additional members 

employed by the state health agency and charged with administrative and/or consultative 

responsibilities for some aspect of the agency’s nutrition program(s). ASTPHND is affiliated 

with the Association of State and Territorial Health Officials and its family of related state 

director organizations.3

 

The USDA, FNS administers the Special Supplemental Nutrition Program for Women, Infants 

and Children (WIC), which was created by Congress in 1972 to provide nutritious food, nutrition 

education, and health care referrals to meet the special nutritional needs of low-income pregnant, 

postpartum, and breastfeeding women, and their infants and children (up to age five) who are at 

nutritional risk. The program seeks to meet the special nutritional needs of these individuals and 

to prevent health and developmental problems associated with poor nutrition during pregnancy 

and early childhood. 

State public health nutrition directors provide leadership in the assessment and development of 

the public health nutrition workforce in their respective states and territories. They are 

responsible for coordination of publicly supported nutrition programs, services and policies 

across funding streams. They serve as an interface with local, state and federal nutrition 

programs, including WIC. State nutrition directors use descriptive information about the public 

health nutrition workforce in their respective states and territories to support recruitment and 

retention efforts, design training programs, and advise on licensure and certification policy. In 

many state health agencies, the state nutrition director also functions as the state WIC director. In 

other state health agencies, the state nutrition directors provide expert assistance to WIC officials 

in implementation of the program. 

In part, the state nutrition directors are responsible for ensuring a trained workforce to carry out 

state public health nutrition programs and policies. To assist in carrying out this responsibility, 

ASTPHND has conducted periodic surveys and censuses to describe the training, qualifications 

and practice areas of the public health nutrition workforce. From 1985 through 1994, ASTPHND, 

working through its membership of state public health nutrition directors, completed five biennial 

census-profiles of the state public health nutrition workforce. Reports described the workforce in 

terms of place and length of employment, source of support and compensation, formal education, 

 

3

 For information on other ASTPHND activities, visit www.astphnd.org
6

certification, training received and needed, and type of position. Information on race, ethnicity and 

language was first gathered in the census of 1994. These descriptive data were aggregated across the 

responding states and territories to provide a national profile of the public health nutrition workforce. 

 ASTPHND received support from the U.S. Department of Health and Human Services, Heath 

Resources and Services Administration, Maternal and Child Health Bureau 

(USDHHS/HRSA/MCHB) to assist with the costs of conducting the profiles in 1991 and 1994. 

Before that, ASTPHND worked collaboratively with the University of North Carolina at Chapel Hill 

School of Public Health to collect and analyze the data. 

Because 85 percent of the 1994 workforce was WIC-supported, the ASTPHND leadership 

approached the USDA-FNS seeking cooperation and support for the most recent survey. USDAFNS and ASTPHND entered into a cooperative agreement on September 30, 1998, which resulted in 

the study reported here. The 1999-2000 study is the first to be conducted under the auspices of the 

USDA-FNS. Although data collection began in 1999 and concluded in 2000, throughout this report, 

the year 2000 is used to refer to the time period of the study. 

USDA’s Objectives 

In its support of this project, USDA-FNS sought to meet several objectives and needs. Officials 

wished to monitor trends in the education and credentialing, work experience, areas of practice, and 

the training needs of the public health nutrition workforce at the state and local government levels. A 

profile describing the public health nutrition workforce was expected to supplement other 

assessments and assist the FNS in determining the extent to which the current and future workforces 

have the qualifications to help carry out the mission of the WIC Program. 

A very specific objective of the study, therefore, was based upon objective 3.3 of the USDA 

strategic plan for 1997-2002 — improved nutritional qualifications of state and local WIC staff, with 

the performance measure being to increase the percent of registered dietitians (RD) or RD-eligible 

persons in WIC programs from 48 to 50 and the percent of registered dietetic technicians (DTR) 

from 2 to 4.4

 

Nutrition Objectives and Healthy People 2010 

“Healthy People 2010” is the prevention agenda for the United States. It is a statement of 

national health objectives designed to identify the most significant preventable threats to health 

and to establish national goals to reduce these threats. Of the more than 400 health objectives 

delineated in “Healthy People 2010,”5

 there are 18 in Focus Area 19 – Nutrition and Overweight, 

and numerous nutrition-related objectives in other Focus Areas. Public health nutrition 

professionals and paraprofessionals have multiple roles in helping the nation achieve these 

objectives. Registered dietitians and other practitioners may affect health outcomes through 

nutrition screening, assessment, and primary and secondary prevention. Public health 

 

4

 According to ASTPHND’s 1994 survey, 44.3 percent of the WIC nutrition workforce was either RD or RDeligible. USDA-FNS has subsequently acknowledged that the baseline percentage for RDs and RD-eligibles in this 

particular objective (48 percent) was in error and should have been the percentage identified in ASTPHND’s 1994 

survey. 

5

 For information, visit www.healthypeople.gov
7

nutritionists, working with policymakers and program planners at the national, state, and 

community levels, must provide leadership in fostering healthy diets and improving physical 

activity patterns among people in the United States at schools, work sites, institutional food 

services, and at home. 

Although not explicitly addressed in “Healthy People 2010,” the nutrition-related objectives 

cannot be accomplished without a trained public health nutrition workforce with the knowledge, 

skills, and resources to plan and implement effective programs and services, and to develop the 

appropriate policies to affect change across population segments. Of particular concern is the 

extent to which nutritionists are being prepared to promote the prevention of obesity and 

nutrition-related chronic diseases. Public health nutritionists also have a role in the elimination 

of racial, ethnic, gender, age and income disparities affecting health status. 

Also receiving attention in “Healthy People 2010” is the need to strengthen the public health 

infrastructure. The 1997 report, “The Public Health Workforce: An Agenda for the 21st 

Century,” identifies five areas to be strengthened: national leadership, state and local leadership, 

workforce composition, curriculum development, and distance learning. The report also points 

out that data systems are needed to track the extent to which the workforce has the knowledge, 

skills, and abilities to carry out its functions. In addition to expertise in their disciplines and 

specialties, public health workers, including nutritionists, must be able to carry out the essential 

public health services as they apply to their specific functions. The public health nutrition 

workforce must be able to use information technology for networking, communication, and 

locating current information. The workforce is expected to be culturally and linguistically 

competent. Workers need to be technically competent in areas such as biostatistics, 

environmental and occupational health, the social and behavioral aspects of health and disease, 

and the practice of prevention. 

Toward these ends, the U.S. Department of Health and Human Services Health Resources and 

Services Administration (HRSA) and Centers for Disease Control and Prevention (CDC), in 

partnership with national public health associations, are undertaking efforts to improve training 

and continuing and distance education of the public health workforce, as well as to establish 

credentialing and systems performance standards. For example, the National Public Health 

Performance Standards Program is an effort to develop performance standards for state and local 

health systems and local boards of health.6 In conjunction with these activities, an effort is also 

under way to make recommendations on the enumeration of the public health workforce and to 

identify approaches to an enumeration. “Enumerating the Public Health Workforce,” prepared 

for HRSA by the Public Health Society and the Center for Health Leadership and Practice 

(unpublished, June 1, 2001), became available to ASTPHND as this report was being written.7

The enumeration report discusses the need for and the difficulties in enumerating the public 

health workforce. It delineates four approaches to enumeration. The ASTPHND census contains 

some elements of each of the four: 

 

6

 For information, visit the National Association of City and County Health Organizations and Centers for Disease 

Control and Prevention sites at www.naccho.org or 

www.phppo.cdc.gov/takesurvey/WebBasedToolInstructions.asp#

7

 For information about the enumeration of the public health workforce initiative, visit 

www.nursing.hs.columbia.edu/dept/nursing/institute-centers/chphsr For information about the health professional 

workforce by discipline and for state profiles, visit http://bhpr.hrsa.gov/healthworkforce/profiles/default.htm
8

♦ Work setting/employing entity – The ASTPHND census focuses on WIC programs and 

government health agencies as employing/funding entities. Information was collected on 

both employing entity and work setting or location. 

♦ Job title – The ASTPHND census was intended to include persons/positions with the term 

nutrition or nutritionist in the job title, although it was not entirely restricted to those 

positions. 

♦ Function – The ASTPHND census focused on persons/positions who performed the work of 

professional and paraprofessional public health nutritionists. 

♦ Occupation and professional training – The ASTPHND census collected information on the 

professional training and certification of each member of the public health nutrition 

workforce. However, it was not restricted to registered dietitians or licensed nutritionists. 

The enumeration report also delineated core data that would be useful for any enumeration. 

Although it was not an intended goal of the ASTPHND census, in retrospect it appears that most 

of the recommended minimum data set has been collected for this report. ASTPHND is pleased 

to have made a contribution in this regard to the important task of enumerating the public health 

workforce. Data elements collected for this report are compared with recommended elements in 

Table 1. 
9

Table 1 

Core Data Elements Recommended in “Enumerating the Public Health Workforce” Compared to Data 

Collected in the ASTPHND Survey 

Recommendations from 

“Enumerating the Public 

Health Workforce” Data Elements in ASTPHND’s Survey 

Total Number of staff Yes, by state, agency, job class and other variables 

FTEs Yes, by funding source 

Occupation class Yes, 9-category scheme 

Job function Yes, 10 categories of practice, percent time in direct service, type of client 

population, budget responsibilities, FTEs supervised or line responsibility 

Location Yes, state, type of agency of employment, type of work-setting 

Age No 

Education level Yes, degrees completed, public health degrees completed, degrees working 

toward, completion of 5 core public health courses 

Credentials Yes, 12 certifications relevant to nutrition, steps toward RD or DTR 

Experience Yes, years in nutrition, public health nutrition, WIC programs 

Salary range Yes, but high nonresponse, by job classification 

Ethnicity Yes, Latino 

Race Yes, OMB8 approved categories 

Gender Yes 

Language Yes, primary and any secondary, sufficient fluency to do job 

 

8

 The Federal Office of Management and Budget at www.whitehouse.gov/omb/fedreg/directive_15.html 
10
11

Goals 

Within this framework, the goals of ASTPHND’s workforce study were: 

• To collaborate with USDA to identify trends in the public health and community nutrition 

workforce. 

• To determine the capacity of the public health and community nutrition workforce in 

accomplishing program goals and meeting priority needs. 

• To assist USDA and state public health agencies in planning and evaluating their recruitment 

and retention efforts. 

• To identify training needs of WIC personnel in relation to their job responsibility, 

credentials, education, and longevity. 

• To measure qualifications of WIC nutrition staff in all states and territories. 
12
13

Study Methods 

The study was designed as a census of persons who worked as nutrition professionals or 

nutrition paraprofessionals in a public health nutrition program such as WIC or in other public 

health programs or services under the purview of the state health agencies and Indian Tribal 

Organizations. Full- and part-time employees as well as contract positions were included. Persons 

who worked in a support capacity or in another profession in a public health nutrition program, such 

as nurses who functioned as certifying officials in WIC clinics, were not included. 

States vary with regard to the programs administered by the state health agency, a feature that 

had many advantages, but diminished central control of data collection and contributed to 

variation in inclusion, response rates, and data quality across states. 

A 30-item fixed response instrument that required 10-20 minutes to complete was designed, 

using the experience with the 1994 ASTPHND workforce study, as well as the expertise of the 

ASTPHND Data and Epidemiology Committee and reviewers representing various national 

organizations. (See Appendix A for a list of the ASTPHND committee members.) Ease of 

administration and response burden, as well as applicability and comparability across states and 

time, were primary criteria for inclusion/exclusion of items. An abbreviated version consisting of 

nine items was constructed to collect information on vacant positions. A protocol and tracking 

form was developed to collect information from state nutrition directors to use in calculating 

state specific and overall response rates. 

The survey was built upon state-centralized data collection, as well as state-level editing and data 

entry. Hard-copy packets of survey administration materials were mailed to 55 state and 

territorial nutrition directors/designees on September 5, 1999, and electronic copies were emailed the following week.9

 These directors were then responsible for distributing the uniform 

questionnaire to nutrition workers within their respective states and territories. The package 

consisted of: 

• Five-page instructions for conducting the survey (Appendix B). 

• Two forms (Transmittal to State form and Transmittal to ASTPHND form) to assist with 

record keeping and tracking response rates (Appendix B). 

• The questionnaire for copying and distribution (Appendix C). 

• A vacant-position questionnaire for copying and distribution (Appendix C). 

In October 1999, hard-copy packets of survey administration materials were mailed to the 33 

Indian Tribal Organizations (ITOs) that administer WIC Programs. The packet included survey 

instructions, questionnaires, vacant-position questionnaires, and transmittal forms. Because the 

survey was to be administered to WIC personnel working in the ITOs, training sessions were not 

deemed necessary, however, the project consultant was available for technical assistance by 

telephone.10 Questionnaires from the ITOs were returned to a central location for data entry. 

The state nutrition directors were also responsible for data entry, so instructions for data entry and 

 

9 In Idaho and American Samoa there were no designees, so packets were mailed to WIC directors. 10 The project consultant was Mary McCall, co-author of this report, Washington, D.C. 
14

EpiInfo programs for data entry and editing were distributed the following month by diskette or 

the Internet.11 Upon request, technical assistance was provided via telephone by the project 

consultant throughout the data collection and entry period.

The surveys were administered between November 1999 and June 2000, however, one state did 

not submit its data until September 22, 2000. Although the state nutrition directors had the option 

of distributing the questionnaire by mail, fax or e-mail, or a combined approach, most chose to 

survey the workforce by mail. State nutrition directors sent data files by Internet or disk to the 

project consultant who conducted various edit checks and worked with them or their 

representatives to resolve problems and inconsistencies. 

Forty-nine states participated.12 Guam, District of Columbia, the Virgin Islands and Puerto Rico 

also participated. Twenty of the 33 Indian Tribal Organizations responded, and of those, the 

worker response rate was approximately 50 percent. Vacant positions were not included in 

computations of response rates. 

As indicated in Table 2, the overall estimated response rate, based on transmittal forms supplied 

by the state directors, was 88 percent (10,309/11,718). The reported state-specific response rates 

ranged from 45.8 to 100 percent. Although a process for estimation of the state-specific and 

overall response rates was provided, initial submissions suggested that not all state survey 

administrators had maintained the required records. The most significant improvement in 

participation over the 1994 survey was the participation of the state of California. With a 

reported 2,640 public health nutrition professionals and paraprofessionals, California employs 

nearly 24 percent of the entire workforce surveyed, considerably more than any other state – a 

factor that was taken into account in describing changes in the workforce since 1994. 

EpiInfo was also used for data analysis. Data analysis is univariate or bivariate and descriptive, 

relying on percentages and, for several variables, measures of central tendency. It is suggested 

that the reader refer to the questionnaire in Appendix C and consider the phrasing of questions 

and the response categories when interpreting findings. For some workforce characteristics, 

including employing agency and location, findings include the vacant positions. Other 

characteristics, including academic preparation, training and certification, only apply to the 

position incumbents (i.e., “filled” positions). Findings are presented for the PH nutrition 

workforce in WIC (WIC workforce) and compared to the PH nutrition workforce not involved 

with the WIC program (i.e., the non-WIC workforce). 

Because item nonresponse was generally high, and very high for several variables including 

salary and race, the nonresponses have been retained in the denominators and the percentages of 

nonrespondents are shown in the tables. In addition to variation in nonresponse across 

questionnaire items, there is considerable difference in item nonresponse by job category, with 

response rates being higher at the upper levels of the job classification categories. 

A more detailed description of the study design can be found in Appendix D. 

 

11 For information on EpiInfo visit www.cdc.gov 12 Idaho was the exception.
15

Table 2 

Response Rates Reported by States 

State 

Responses/ 

Total 

Workforce 

Response 

Rate State 

Responses/ 

Total 

Workforce 

Response 

Rate 

Alabama 77/78 98.7% Montana 34/46 73.9% 

American Samoa None Nebraska 88/99 88.9% 

Alaska 31/3513 88.6% Nevada 71/71 100.0% 

Arizona 289/350 82.6% New Hampshire 40/60 66.7% 

Arkansas 55/55 100.0% New Jersey 103/104 99.0% 

California 2513/2640 95.2% New Mexico 94/176 53.4% 

Colorado 235/306 76.8% New York 638/667 95.7% 

Connecticut 90/132 68.2% North Carolina 365/401 91.0% 

Delaware 23/27 85.2% North Dakota 91/92 98.9% 

District of Columbia 38/39 97.4% Ohio 387/455 85.1% 

Florida 414/504 82.1% Oklahoma 82/99 82.8% 

Georgia 195/214 91.1% Oregon 198/198 100.0% 

Guam 23/23 100.0% Pennsylvania 342/39414 86.8% 

Hawaii 43/47 91.5% Puerto Rico 94/94 100.0% 

Idaho None Rhode Island 36/56 64.3% 

Illinois 323/326 99.1% South Carolina 161/172 93.6% 

Indiana 192/201 95.5% South Dakota 33/33 100.0% 

Iowa 112/112 100.0% Tennessee 175/175 100.0% 

Kansas 91/110 82.7% Texas 421/486 86.6% 

Kentucky 100/117 85.5% Utah 64/64 100.0% 

Louisiana 128/142 90.1% Virgin Islands 16/17 94.1% 

Maine 70/70 100.0% Vermont 18/18 100.0% 

Maryland 159/180 88.3% Virginia 206/221 93.2% 

Massachusetts 329/377 87.3% Washington 60/131 45.8% 

Michigan 130/179 72.6% West Virginia 82/87 94.3% 

Minnesota 254/31715 >80.0% Wisconsin 189/199 95.0% 

Mississippi 69/105 65.7% Wyoming 21/28 75.0% 

Missouri 164/284 57.7% ITOs (20/33)16 53/105 50.5% 

 Total 10309/11718 88.0% 

 

13 The designee estimated that there were 35 licensed nutritionists in WIC. 14 Three local agencies did not respond. The number of workers in those agencies was not reported so they are not 

reflected in the denominator.

15 The designee was not able to report on the number of workers to whom the questionnaire was distributed, but 

believed that more than 80 percent had responded; therefore, 317 was estimated as the denominator. 16 Only 20 of the 33 ITOs participated. Of those 20 responding, the questionnaire was distributed to 105 workers. 

Fifty-three completed the questionnaire. 
16
17

Study Findings 

WIC’s Presence in the Public Health Nutrition Workforce 

More than 90 percent of the respondents indicated they worked in WIC at the time of the survey 

(Table 3). In the 1994 ASTPHND workforce survey, 85.4 percent reported WIC as an area of 

practice. Because California did not participate in the 1994 survey and because California’s data 

represent 24 percent of the 2000 workforce, analyses were performed to determine the impact of 

California’s data on the percentage of the workforce working in WIC in 2000. It was determined 

that without California’s data, the percentage of the total public health nutrition workforce 

working in WIC in 2000 was 89.4.17 

Table 3 

WIC and Non-WIC Job Functions (Question 7) 

Working in WIC* 9853 90.4%

Not Working in WIC 1026 9.4%

No Response 25 0.2%

Total ** 10904 100%

*Includes non-WIC funded persons and positions. 

**Includes information on vacant and part time positions. 

Agency of Employment and Primary Work Location of the Public Health Nutrition 

Workforce 

Nearly 70 percent (67.8 percent) of public health nutrition workers were employed by state or 

local government health agencies, and nearly half (47.9 percent) at the local level (Table 4). 

Non-WIC workers were slightly more likely to be employed by state health agencies (36.6 

percent) than local agencies (34.5 percent) while the WIC component of the workforce more 

typically worked for local health agencies (49.3 percent). The private sector—primarily 

nonprofit organizations—accounted for the employment of 29.1 percent of the total workforce. 

WIC workers, compared to their non-WIC counterparts, were somewhat more likely to be 

working for nonprofit organizations (29.5 vs. 18.5 percent). Few public health nutrition workers 

were employed by for-profit organizations. 

Work location may differ from place of employment as shown in Table 5. One-third (33.5 

percent) of the WIC respondents indicated that their primary work location was a central office 

of either the state health agency, a subunit of the state health agency, or a local health agency. 

Only 3.8 percent of the WIC nutrition workforce actually worked in the central office of the state 

health agency. One-fourth (25.5 percent) of the WIC respondents worked in a health center or 

clinic run by a community, rural, or migrant agency; and one-fifth (20.5 percent) worked in a 

field office or clinic of a government health agency. Only 18.5 percent of the non-WIC positions 

had work locations in the central office of the state health agency. More than one-half (54.1 

percent) of the non-WIC nutrition positions had a primary work location in the central office of 

either the state health agency, a sub-unit of the state health agency, or a local health agency. 

Table 4 

 

17 The California workforce reported consisted of 2,448 WIC workers and 169 non-WIC workers.
18

Agency of Employment (Question 1)* 

Type of Agency WIC Non-WIC Total** 

State Health Agency 1794 18.2% 376 36.6% 2172 19.9% 

Local Health Agency 4859 49.3% 354 34.5% 5225 47.9% 

Indian Tribal Organization 125 1.3% 28 2.7% 153 1.4% 

Nonprofit 2909 29.5% 190 18.5% 3101 28.4% 

For-Profit 55 0.6% 17 1.7% 72 0.7% 

Other 88 0.9% 59 5.8% 148 1.4% 

No Response 23 0.2% 2 0.2% 33 0.3% 

Total 9853 100.0% 1026 100.0% 10904 100.0% 

*Includes information on vacant positions. 

**The totals are greater than WIC and non-WIC combined due to nonresponse to Question 7. 

Table 5 

Primary Work Location (Question 2)* 

Location WIC Non-WIC Total** 

State Health Agency (SHA) Central Office 378 3.8% 190 18.5% 569 5.2% 

Sub-SHA Central Office 238 2.4% 85 8.3% 324 3.0% 

Local Health Agency Central Office 2694 27.3% 280 27.3% 2978 27.3% 

Community Health Center 2508 25.5% 96 9.4% 2604 23.9% 

Field Office / Clinic of Govt. Agency 2024 20.5% 119 11.6% 2149 19.7% 

HMO*** or Managed Care Setting 43 0.4% 2 0.2% 45 0.4% 

Hospital 456 4.6% 112 10.9% 570 5.2% 

IHS, ITO , or Tribal Health Center 131 1.3% 25 2.4% 156 1.4% 

Other Private Entity 1045 10.6% 40 3.9% 1086 10.0% 

Other 305 3.1% 73 7.1% 380 3.5% 

No Response 31 0.3% 4 0.4% 43 0.4% 

Total**  9853 100% 1026 100% 10904 100% 

*Includes information on vacant positions. 

**The total is greater than WIC and non-WIC combined due to nonresponse to Question 7. 

*** Health Maintenance Organization 

****Indian Health Service, Indian Tribal Organization 

Job Classification of the Public Health Nutrition Workforce 

Respondents were asked to classify their jobs using the position titles and responsibilities 

delineated in “Personnel in Public Health Nutrition for the 1990s” (Table 6). A description of 

each job classification was included in the questionnaire. This classification system includes 

both professional job classifications (public health nutrition director, assistant public health 

nutrition director, public health nutrition supervisor, public health nutrition consultant, public 

health nutritionist, clinical nutritionist, and nutritionist) and paraprofessional job classifications 

(nutrition technician and nutrition assistant or aide). As described in Appendix D (Study Design 

– Completion of Data Analysis), the category of “breastfeeding counselor” was not included in 

the questionnaire as a fixed-response choice, but was added as a result of recoding the responses, 
19

which were written in the “other” category. Thus the number of responses may under-represent 

the actual number of workers in this category. 

Table 6 

Titles and Descriptions of Public Health Nutrition Job Classifications From “Personnel in Public Nutrition for the 

1990s” 

Title of 

Job Classification Description 

Public Health 

Nutrition Director 

The highest-level nutrition position in a state, large city, county or voluntary public health 

agency. Major functions of this position are policy-making, planning/evaluation, fiscal 

control, management and supervision. The position is usually the head of a nutrition 

program unit, where the director is responsible for conducting a needs assessment, 

developing a comprehensive plan and budget for the nutrition services of the agency and 

has line authority over staff. 

Assistant Public 

Health Nutrition 

Director 

The second highest administrative and policy-making public health nutrition position in a 

state, large city, county or voluntary public health agency. The assistant director may 

participate in several delegated functions or be assigned primary responsibility for 

managing the nutrition component of one or more major program areas. The person in this 

position serves as Acting Director in the director's absence. 

Public Health 

Nutrition Supervisor 

Supervises the work of an assigned number of other nutritionists, nutrition technicians, 

and nutrition assistants that deliver nutrition services and nutritional care in the public 

health agency. Supervision includes training, delegating, directing, coordinating, 

evaluating and reporting the work of subordinates. 

Public Health 

Nutrition Consultant 

Includes both generalized and specialized nutrition consultants who provide expert 

technical assistance, professional guidance, and in-service education in program 

development or case management. Consultation may be given to the administrator, other 

nutritionists or other health professionals. Consultants include those who work out of a 

central headquarters office or in the health agency’s regional or district offices. 

Public Health 

Nutritionist 

A nutrition professional with academic training in public health who is employed by the 

state or local public health agency to assess the community's nutrition needs and to plan, 

direct and evaluate community nutrition intervention programs that meet these needs. 

Interventions promote health and prevent disease among the population at large. 

Clinical Nutritionist A professional with expertise in the complex nutritional management of medically high 

risk individuals requiring physician-prescribed dietary and nutrition regimens including 

enteral and parenteral nutrition support. In public health agencies, clinical nutritionists 

work as case managers and/or care coordinators and nutrition counselors. They also may 

work as educators in programs where more in-depth expertise in therapeutic nutrition is 

required, including high-risk pregnancy, neonatal and pediatric clinics; children's special 

services; AIDS; and home health and home hospice services. 

Nutritionist A nutrition professional employed in a public health agency primarily to provide nutrition 

education to the public and to coordinate and provide direct nutritional care to agency 

clients in health and disease throughout the life span. 

Nutrition Technician A paraprofessional who works under the close supervision of a nutritionist to provide 

routine technical support services in public health agency clinics. This work includes 

normal nutrition education, screening using prescribed protocols, record keeping, and 

outreach. 

Nutrition Assistant or 

Nutrition Aide 

An auxiliary nutrition worker from the indigenous community who is trained on-the-job 

to work under the close supervision of nutrition professionals to provide routine nutrition 

education, including interpretation for clients who do not speak English. Assistants and 

aides also carry out assigned tasks in client outreach and screening. 

Overall, the WIC workforce includes a higher proportion of paraprofessional positions than does 
20

the non-WIC workforce. Among the WIC nutrition workforce, 67.2 percent indicated they held 

professional positions, 30.7 percent held paraprofessional positions, and 1.9 percent were 

breastfeeding peer counselors or other classifications. The nutritionist classification — which is 

typically an entry-level professional position — was the most frequently reported classification, 

with 33.7 percent of all WIC respondents selecting it (Table 7). 

Among the non-WIC respondents, 87.6 percent indicated they were classified in professional 

positions. Very few non-WIC paraprofessional classifications were reported — only 4.9 percent. 

Clinical nutritionist was the most frequently reported classification, with 24.8 percent of all nonWIC respondents selecting it (Table 7). 

Table 7 

Job Classifications (Question 4)* 

Classification WIC Non-WIC Total** 

PH Nutrition Director 400 4.1% 43 4.2% 443 4.1% 

Asst PH Nutrition Director 118 1.2% 22 2.1% 140 1.3% 

PH Nutrition Supervisor 1011 10.3% 59 5.8% 1070 9.8% 

PH Nutrition Consultant 366 3.7% 181 17.6% 547 5.0% 

PH Nutritionist 918 9.3% 193 18.8% 1111 10.2% 

Clinical Nutritionist 487 4.9% 254 24.8% 743 6.8% 

Nutritionist 3323 33.7% 151 14.7% 3476 31.9% 

Nutrition Technician 1295 13.1% 17 1.7% 1316 12.1% 

Nutrition Assistant 1734 17.6% 33 3.2% 1769 16.2% 

BF Counselor 37 0.4% 0 0% 41 0.4% 

Other 146 1.5% 69 6.7% 218 2.0% 

No Response 18 0.2% 4 0.4% 30 0.3% 

Total 9853 100% 1026 100% 10904 100% 

*Includes information on vacant positions. 

**The total is greater than WIC and non-WIC combined due to nonresponse to Question 7. 

Years of Practice in Nutrition/Dietetics, Public Health Nutrition, and WIC 

The public health nutrition workforce represents many years of experience in nutrition, public 

health nutrition, and the WIC program. Approximately one-third (30.1 percent) of the WIC 

nutrition workforce has more than 10 years of experience working in WIC (Table 8). A slightly 

higher proportion — 33.7 percent — has worked in public health nutrition for a similar period. 

Nearly half (47.3 percent) have worked in nutrition for more than 10 years. 

More than one-third (38.2 percent) of the WIC nutrition workforce has worked in WIC for less 

than five years (Table 10). It is interesting to note that 3,417 of the WIC respondents (36.6 

percent) indicated they had worked in public health nutrition (including WIC) for less than five 

years, yet more (3,564 or 38.2 percent) indicated they had worked in WIC for less than five 

years. 

Among respondents that do not work in WIC, about two-thirds (67.7 percent) have more than 10 
21

years of experience in nutrition, while only 38.4 percent have more than 10 years of experience 

in public health nutrition (Table 8). A large proportion of the non-WIC nutrition workforce (35.1 

percent) has less than five years of experience in the field of public health nutrition, but only 17 

percent have less than five years of experience in the field of nutrition/dietetics including public 

health nutrition. This might indicate that nutrition personnel do not enter the field of public 

health early in their careers. 

Because the job classification compositions of the WIC and non-WIC workforce are very 

different, the years of practice of WIC paraprofessionals (nutrition assistant, nutrition technician, 

breastfeeding counselor and other) were compared with WIC professionals (Table 9). The results 

indicate that among the WIC workforce, persons classified as nutrition professionals tend to have 

more years of experience in both general nutrition and public health nutrition than do 

paraprofessionals and “others.” About 35 percent of the WIC professional workers have less than 

five years of experience in public health nutrition, compared to nearly 40 percent of WIC 

paraprofessionals; 24 percent of WIC professionals and more than 35 percent of WIC 

paraprofessionals have less than five years of experience in general nutrition. Likewise, the 

upper categories of years of practice also have higher proportions of WIC professionals 

compared to WIC paraprofessionals. For example, 55.4 percent of professionals have more than 

10 years of experience in nutrition compared to 31.2 percent of paraprofessionals. Also, more 

WIC professionals have more than 10 years of experience in public health nutrition compared to 

WIC paraprofessionals. 

When examining years of practice in WIC, differences between WIC professionals and WIC 

paraprofessionals are somewhat less pronounced. Table 10 shows that 32.5 percent of 

professional WIC workers have been working in WIC for 10 years or more compared to 25.2 

percent of their paraprofessional colleagues. A similar proportion of WIC professionals and WIC 

paraprofessionals have less than five years of WIC experience, 37.9 percent and 39 percent, 

respectively. 

Table 8 

Years of Practice in Nutrition and Public Health Nutrition (Questions 5 and 6) – A Comparison of 

WIC and Non-WIC Positions 

 WIC Non-WIC 

Years Nutrition PHN Nutrition PHN 

<1 339 3.6% 512 5.5% 36 3.8% 98 10.3% 

1-4 2275 24.4% 2905 31.1% 126 13.2% 237 24.8% 

5-9 2226 23.9% 2675 28.7% 145 15.2% 243 25.4% 

10-19 2944 31.6% 2565 27.5% 352 36.9% 269 28.2% 

 ≥20 1469 15.7% 580 6.2% 294 30.8% 97 10.2% 

No response 77 0.8% 93 1.0% 2 0.2% 11 1.2% 

Total 9330 100% 9330 100% 955 100% 955 100% 
22

Table 9 

Years of Practice in Nutrition and Public Health Nutrition (Questions 5 and 6) – A Comparison of WIC 

Professionals and WIC Paraprofessionals

WIC Professionals WIC Paraprofessionals 

Years Nutrition PHN Nutrition PHN 

<1 185 3.0% 340 5.5% 154 4.9% 172 5.5% 

1-4 1299 21.0% 1840 29.7% 975 31.3% 1064 34.2% 

5-9 1270 20.5% 1700 27.4% 950 30.5% 969 31.1% 

10-19 2160 34.8% 1867 30.1% 777 25.0% 691 22.2% 

≥20 1277 20.6% 437 7.0% 192 6.2% 143 4.6% 

No Response 8 0.1% 15 0.2% 66 2.1% 75 2.4% 

Total 6199 100.0% 6199 100.0% 3114 100.0% 3114 100.0% 

Table 10 

Years of WIC Experience (Question 7) – A Comparison of WIC Professionals and WIC 

Pararpofessionals* 

Years Professionals Paraprofessionals** Total 

<1 390 6.3% 183 5.9% 573 6.1% 

1-4 1961 31.6% 1027 33.0% 2991 32.1% 

5-9 1684 27.2% 912 29.3% 2600 27.9% 

10-19 1699 27.4% 650 20.9% 2355 25.2% 

≥20 316 5.1% 135 4.3% 451 4.8% 

No Response 149 2.4% 207 6.6% 360 3.9% 

Total 6199 100.0% 3114 100.0% 9330 100.0% 

*Filled positions currently working in WIC. 

** Includes the following job categories (Question 4): nutritionist technician, nutrition aide, breastfeeding 

counselor, and others. 

Personnel Management and Budget Responsibilities of the Workforce 

“Personnel in Public Health Nutrition for the 1990s” identifies three professional job 

classifications with management and budgetary responsibilities: public health nutrition director, 

assistant public health nutrition director, and public health nutrition supervisor. The degree to 

which the public health nutrition workforce resembles this classification system is quite high.18 

Ninety-three percent of the public health nutrition directors, 79 percent of assistant public health 

nutrition directors, and 95 percent of the public health nutrition supervisors reported some 

supervisory responsibilities including both nutrition and non-nutrition positions (Table 11). 

Ninety percent of the public health nutrition directors, 74 percent of the assistant public health 

nutrition directors, and 88 percent of the public health nutrition supervisors supervised one or 

more nutrition positions (Table 12). 

Only 20 percent of the other four professional job classifications — public health nutrition 

consultant, public health nutritionist, clinical nutritionist, and nutritionist — reported supervisory 

 

18 See Table 6 for descriptions of the position titles included in the questionnaire. 
23

responsibilities (Table 11). And only 12 percent of these four classifications reported supervising 

one or more nutrition positions (Table 12). 

Of the 437 respondents who classified themselves as public health nutrition directors, two-thirds 

(65.7 percent) indicated they had responsibility over their agency’s entire nutrition budget, while 

one-fourth (26.3 percent) had responsibility only for a specific budget (Table 13). Respondents 

in other classifications with budget responsibilities typically were responsible only for specific 

budgets (e.g., 40.1 percent of the assistant public health nutrition directors were responsible for 

specific budgets).19

 

19 It should be noted that if the only public health nutrition service offered by an agency was WIC, then a 

respondent who was responsible for the WIC budget might have indicated responsibility for the entire agency’s 

nutrition budget. 
24

Table 11 Total FTEs (including nutrition and non-nutrition positions) Supervised by Professional Job Classifications (Question 8) 

Number of FTEs Supervised 

Job Classification None 1-4 5-9 10-19 ≥20 NR* PHN Director 16 3.7% 77 17.6% 121 27.7% 108 24.7% 100 22.9% 15 3.4% Asst. PHN Director 21 15.3% 31 22.6% 33 24.1% 21 15.3% 23 16.8% 8 5.8% PHN Supervisor 40 3.9% 346 33.6% 343 33.3% 209 20.3% 75 7.3% 16 1.6% PHN Consultant 414 80.2% 44 8.5% 8 1.6% 2 0.4% 8 1.6% 40 7.8% PH Nutritionist 735 72.9% 145 14.4% 51 5.1% 19 1.9% 1 0.1% 57 5.7% Clinical Nutritionist 551 81.8% 60 8.9% 24 3.6% 0 0.0% 4 0.6% 35 5.2% Nutritionist 2354 72.7% 472 14.6% 179 5.5% 49 1.5% 13 0.4% 170 5.3% 

 *Nonresponse to Question 8 may also indicate no FTEs supervised. 

Table 12 Nutrition FTEs Supervised by Professional Job Classifications (Question 9) 

Number of FTEs Supervised 

Job Classification None 1-4 5-9 10-19 ≥20 NR* PHN Director 15 3.4% 176 40.3% 113 25.9% 54 12.4% 50 11.4% 29 6.6% Asst. PHN Director 10 7.3% 41 29.9% 35 25.5% 15 10.9% 11 8.0% 25 18.2% PHN Supervisor 44 4.3% 510 49.6% 266 25.9% 106 10.3% 28 2.7% 75 7.3% PHN Consultant 86 16.7% 31 6.0% 6 1.2% 1 0.2% 4 0.8% 388 75.2% PH Nutritionist 218 21.6% 106 10.5% 19 1.9% 8 0.8% 0 0.0% 657 65.2% Clinical Nutritionist 103 15.3% 50 7.4% 8 1.2% 1 0.1% 1 0.1% 511 75.8% Nutritionist 579 17.9% 344 10.6% 72 2.2% 7 0.2% 0 0.0% 2235 69.0% 

 *Nonresponse to Question 8 may also indicate no FTEs supervised. 
25

Table 13 

Budget Responsibility by Job Classification (Question 10) 

Job Classification 

Over 

Entire Agency’s 

Nutrition Budget 

 Over 

 Specific 

 Budget 

No 

Budget 

Responsibility 

No 

Response Total 

PHN Director 287 65.7% 115 26.3% 32 7.3% 3 0.7% 437 

Asst. PHN Director 15 10.9% 55 40.1% 66 48.2% 1 0.7% 137 

PHN Supervisor 100 9.7% 243 23.6% 675 65.6% 11 1.1% 1029 

PHN Consultant 4 0.8% 91 17.6% 411 79.7% 10 1.9% 516 

PH Nutritionist 19 1.9% 104 10.3% 866 85.9% 19 1.9% 1008 

Clinical Nutritionist 6 0.9% 37 5.5% 624 92.6% 7 1.0% 674 

Nutritionist 40 1.2% 173 5.3% 2988 92.3% 36 1.1% 3237 

Nutrition Technician 6 0.5% 16 1.3% 1224 96.5% 22 1.7% 1268 

Major Areas of Practice 

Previous workforce surveys conducted by ASTPHND did not collect data on the major areas of 

public health practice as defined by the core public health functions — assessment, assurance, 

and population-based services, including policy development.20 But because public health 

systems in many states have moved away from the provision of direct services over the last five 

to 10 years and are now focusing more on population-based services, including policy 

development and epidemiologic assessment, the collection of this information is important in 

profiling the workforce’s capacity to provide public health services other than direct client 

services (i.e., the core public health function of assurance). 

More the three-fourths (78.7 percent) of the public health nutrition workforce indicated their 

primary area of practice as assurance, primarily direct client services; 9.3 percent indicated 

management or administration; 5.4 percent indicated assessment; and 2.4 percent indicated 

population-based interventions, including community organization, advocacy, and policy 

development (Table 14). Because WIC is perhaps the largest public health nutrition program that 

continues to provide direct client services on a national basis, and because 90.4 percent of the 

public health nutrition workforce is working in WIC, it is not unexpected to see such a large 

proportion of the public health nutrition workforce with assurance as a primary area of practice. 

Both public health nutrition directors and assistant directors most frequently describe their 

primary area of practice as management and administration, 69 and 62 percent respectively. All 

other job classifications most frequently selected assurance (Table 14).

 

20 For information on the core functions, and the more current essential public health services, visit 

http://www.apha.org/ppp/science/10ES.htm#phpurpose. 
26

Table 14 Primary Area of Public Health Practice According to Category of Core Public Health Functions — Number of Respondents in Filled Positions (Question 17) 

Job Classification Assessment Assurance 

PopulationBased 

Interventions 

Management 

and 

Administration Other No Respon

PHN Director 26 5.9% 86 19.7% 8 1.8% 302 69.1% 2 0.5% 13 3.Asst. PHN Director 9 0.7% 35 25.5% 3 2.2% 85 62.0% 0 0.0% 5 3.PHN Supervisor 64 6.2% 568 55.2% 14 1.4% 358 34.8% 7 0.7% 18 1.PHN Consultant 89 17.2% 268 51.9% 75 14.5% 51 9.9% 25 4.8% 8 1.PH Nutritionist 114 11.3% 767 76.1% 51 5.1% 35 3.5% 26 2.6% 15 1.Clinical Nutritionist 24 3.6% 616 91.4% 3 0.4% 7 1.0% 10 1.5% 14 2.Nutritionist 124 3.8% 2963 91.5% 45 1.4% 47 1.5% 10 0.3% 48 1.Nutrition Technician 37 2.9% 1143 90.1% 18 1.4% 9 0.7% 5 0.4% 56 4.Nutrition Assistant 53 3.1% 1487 86.4% 22 1.3% 22 1.3% 23 1.3% 115 6.BF Counselor 0 0.0% 36 87.8% 0 0.0% 0 0.0% 1 2.4% 4 9.Other 17 8.1% 117 55.5% 6 2.8% 35 16.6% 12 5.7% 24 11.

Total* 557 5.4% 8086 78.7% 245 2.4% 951 9.3% 121 1.2% 320 3.

*Totals do not include nonresponders for Question 4 regarding job classification
27

Table 15 Estimated Time Spent in Direct Services Per Month for Filled Positions (Question 11)  None <25% 25-49% 50-74% 75-99% 100% PHN Director 142 32.5% 157 35.9% 40 9.2% 40 9.2% 35 8.0% 1 0.2% Asst. PHN Director 55 40.1% 37 27.0% 8 5.8% 15 10.9% 12 8.8% 2 1.5% PHN Supervisor 80 7.8% 230 22.4% 130 12.6% 195 19.0% 272 26.4% 75 7.3% PHN Consultant 262 50.8% 91 17.6% 18 3.5% 26 5.0% 49 9.5% 19 3.7% PH Nutritionist 72 7.1% 74 7.3% 45 4.5% 105 10.4% 479 47.5% 179 17.8% Clinical Nutritionist 1 0.1% 20 3.0% 22 3.3% 80 11.9% 420 62.3% 113 16.8% Nutritionist 18 0.6% 77 2.4% 101 3.1% 364 11.2% 1758 54.3% 801 24.7% Nutrition Technician 8 0.6% 34 2.7% 40 3.2% 114 9.0% 564 44.5% 441 34.8% Nutrition Assistant 21 1.2% 51 3.0% 74 4.3% 105 6.1% 649 37.7% 693 40.2% BF Counselor 1 2.4% 6 14.6% 0 0.0% 5 12.2% 13 31.7% 9 22.0% Other 29 13.7% 55 26.1% 10 4.7% 39 18.5% 33 15.6% 20 9.5% Total* 689 6.7% 832 8.1% 488 4.7% 1088 10.6% 4284 41.7% 2353 22.9% 

*Does not include nonresponders to Question 2 regarding job classification. 
28

Direct client services include such activities as assessment of a client’s nutritional status, 

individual counseling, group education, and developing individual care plans. Among the WIC 

workforce, 89.8 percent spend time providing direct client services, while 70.9 percent of the 

non-WIC nutrition workforce spend some time providing direct services (Table 16). Overall, 

75.1 percent of the workforce spends more than half of their work time in direct services (Table 

16). Public health nutrition consultants appear to be less involved in direct services than persons 

in other position categories: More than half the consultants do not spend any time in direct 

services (Table 15). 

It is interesting to note that more than 60 percent of the respondents who categorized themselves 

as public health nutrition directors indicated they spend some time each month in direct client 

services (Table 15). While “Personnel in Public Health Nutrition” describes the public health 

nutrition director’s position as one of management and administration, in reality, nutrition 

directors must often assume the dual responsibilities of direct-service provider and 

manager/administrator. Nutrition directors of local health agencies are also called upon to back 

up direct-care staff, especially in the WIC program, when they have the qualifications of 

certifying officials (i.e., competent professional authorities). 

The comparison of the direct-service activity of WIC and non-WIC workers (Table 17) indicates 

that paraprofessionals are more involved in direct services. Some 84.9 percent of 

paraprofessionals and 74.9 percent of persons in professional job categories spend 50 percent or 

more of their work time in direct services, including 37.2 percent of paraprofessionals and 18 

percent of professionals who spend all of their time in direct services. While there is variation by 

job category in the provision of direct services, overall, the entire public health nutrition 

workforce is heavily involved in direct client services. Nevertheless, the majority of workers, 

including 56.6 percent of paraprofessionals, are devoting some time to indirect services. 

Not surprisingly, the efforts of the WIC workforce are concentrated on one category of clients, in 

contrast to non-WIC workers who report working with a greater variety of client populations. As 

presented in Table 18, most WIC workers whose primary area of practice is direct service 

categorize their client population as “general women, infants and children” (86.9 percent). The 

non-WIC workforce is somewhat less involved in direct services; however, for those workers 

who report their primary area of practice is direct service, only 14.5 percent categorize their 

client population as “general women, infants and children.” The most frequently selected client 

population category served by non-WIC workers was “children with special health care needs” 

(CSHCN) (28.2 percent). One-third served primarily adult non-maternal populations, which 

accounted for only about 3 percent of WIC workers’ primary client groups. 
29

Table 16 

Percent of Time Spent in Direct Services (Question 11)* 

Time WIC Non-WIC Total** 

100% 2285 24.5% 78 8.2% 2363 23.0% 

75-99% 4032 43.2% 253 26.5% 4285 41.7% 

50-74% 971 10.4% 117 12.3% 1088 10.6% 

25-49% 426 4.6% 62 6.5% 488 4.7% 

<25% 665 7.1% 167 17.5% 832 8.1% 

None 484 5.2% 209 21.9% 693 6.7% 

No Response 467 5.0% 69 7.2% 536 5.2% 

Total 9330 100% 955 100% 10285 100% 

*Unit of analysis is “worker’s reported time” and includes part time workers. A part time worker who reported 

spending 100% time in direct services and a full time worker who reported spending 100% time in direct services 

are both included in the category “100%.” 

**Total does not include nonresponders to Question 7. 

Table 17 

Percent of Time in Direct Services by WIC Professionals and Paraprofessionals 

(Question 11)* 

Time Professional Paraprofessional 

100% 1119 18.1% 1158 37.2% 

75-99% 2784 44.9% 1245 40.0% 

50-74% 730 11.8% 241 7.7% 

25-49% 314 5.1% 112 3.6% 

<25% 544 8.8% 121 3.9% 

None 439 7.1% 43 1.4% 

No Response 269 4.3% 194 6.2% 

Total 6199 100.0% 3114 100.0% 

*Unit of analysis is “worker’s reported time” and includes part time workers. A part time worker who reported 

spending 100% time in direct services and a full time worker who reported spending 100% time in direct services 

are both included in the category “100%.” 
30

Table 18 

Client Population Seen by Workforce (Filled Positions) Whose Primary Area of Practice is Direct Service 

(Question 18) 

Category WIC Non-WIC Total 

General/Comprehensive nutrition 149 2.0% 58 13.0% 207 2.7% 

General women, infants and children 6354 86.9% 53 11.9% 6407 82.6% 

General women’s nutrition and health 187 2.6% 65 14.5% 252 3.2% 

General infant nutrition 40 0.5% 4 0.9% 44 0.6% 

General child health or pediatric 110 1.5% 14 3.1% 124 1.6% 

School and/or adolescent health 11 0.2% 16 3.6% 27 0.3% 

CSHCN21, developmental disabilities, chronic 

illnesses, high-risk pediatrics 179 2.4% 126 28.2% 305 3.9% 

Breastfeeding 139 1.9% 2 0.4% 141 1.8% 

Adult health promotion, chronic disease prevention, 

or healthy aging 14 0.2% 54 12.1% 68 0.9% 

Seniors, geriatrics, adult disabilities, or adult 

chronic disease control 20 0.3% 51 11.4% 71 0.9% 

No Response 108 1.5% 4 0.9% 112 1.4% 

Total 7311 100% 447 100% 7758 100% 

Employment Status 

Budgeted employees accounted for more than 95 percent of the workforce, and there has been 

little increase in the use of contracted workers since 1994. Among WIC nutrition workers, 96.1 

percent were in budgeted positions compared to the non-WIC nutrition workers at 89.6 percent 

(Table 19). Slightly more than 80 percent of the WIC workers were in full-time positions, and 

about 72 percent of the non-WIC workers were in full-time positions (Table 20).22 Of the 

contracted workers, the primary method of payment (91.8 percent) was an hourly rate (Table 21). 

Employment status in 2000 was very similar to what was seen in ASTPHND’s 1994 workforce 

survey, when 94 percent of the public health nutrition workers were in budgeted positions and 78 

percent were full-time workers. 

Table 19 

Employment Status of Filled Positions (Question 12) 

 WIC Non-WIC Total Workforce* 

Budgeted Position 8970 96.1% 856 89.6% 9826 95.5% 

On Contract 292 3.1% 85 8.9% 377 3.7% 

No Response 68 0.7% 14 1.5% 82 0.8% 

 9330 100% 955 100% 10285 100% 

* Does not include nonrespondents to Question 7 (working in a WIC program). 

 

 

21 Children with Special Health Care Needs 22 Organizations may differ in regard to the number of hours defined as full-time. The questionnaire instructed 

respondents: “Full-time is the number of hours per week defined by your personnel system.” 
31

 Table 20 

Proportion of Workforce in Full-Time and Part-Time Positions (Question 13)* 

Position WIC Non-WIC Total Workforce 

100% 8032 81.5% 741 72.2% 8773 80.6% 

Part-time: 

80-99% 364 3.7% 50 4.9% 414 3.8% 

60-79% 496 5.0% 78 7.6% 574 5.3% 

40-59% 600 6.1% 78 7.6% 678 6.2% 

20-39% 213 2.2% 34 3.3% 247 2.3% 

< 20% 100 1.0% 27 2.6% 127 1.2% 

No Response 48 0.5% 18 1.8% 66 0.6% 

Total** 9853 100% 1026 100% 10879 100% 

*Includes information on vacant positions. Does not include nonrespondents to Question 7. 

Table 21 

Method of Payment for Contract Workers in Filled Positions (Question 14) 

 Filled Positions 

Hourly rate 346 91.8% 

Daily rate 8 2.1% 

Per service or product 19 5.0% 

Retainer 1 0.3% 

No response 3 0.8% 

Total 377 100.0% 

Salaries 

Survey responses to questions on salary were analyzed by comparing median annual salaries 

across job categories and over time. No attempts have been made to compare salaries according 

to other relevant variables such as presence of unions, city size, labor supply or region. As a 

measure of central tendency, the median is less sensitive to extreme values than is the arithmetic 

mean; therefore, it was selected to describe “average” salaries of the workforce. 

Respondents were asked to provide the salary range for their position and were given two spaces 

to record their response — minimum or first-step salary and maximum or highest-step salary 

(Question 15). They were instructed to record their current salary in the “minimum space” if 

their employer did not have or disclose a salary range. The analyses presented in Table 22 and 23 

are based on those responses that provided a salary range. The median range shown in the 

respective tables reflects the calculation of the median minimum salary and the median 

maximum salary for each category. 

Responses that provided only the minimum have not been included in this analysis. 

Consequently, there is considerable missing data or no responses on the salary variable. In 

addition, the job categories of “other” and breastfeeding counselor are not included — the 

former because responses to this and other questions indicated it was a very heterogeneous 
32

category and the latter because of the small number of observations. Part-time positions, as well 

as the few contracted positions (nonemployees), are not included. Salaries for vacant positions, 

when provided, are included. 

Public health nutrition directors and public health nutrition consultants had the highest median 

annual salary ranges (Table 22). While one might expect salaries to be highest for administrative 

or management classifications (public health nutrition directors, assistant public health nutrition 

directors, and public health nutrition supervisors), other classifications, especially public health 

nutrition consultants, have salaries higher than many management positions because of the 

technical nature of their jobs. Public health nutrition consultant positions are typically located in 

the central office of a state or local government health agency, and they may specialize in a 

particular area of nutrition (e.g., children with special health care needs, communications, or 

diabetes). They are also responsible for developing, implementing, and evaluating programs at 

either the state or community level. The specialization of their jobs, and the additional skills 

required for program development and evaluation generally command higher salaries. 

The lowest paid of the seven professional classifications is nutritionist, which typically is an 

entry-level position that has little or no management or administrative responsibilities, and in 

many state health agencies does not require credentialing as an RD. The categories of public 

health nutritionist and clinical nutritionist have very similar median salary ranges. 

Because the public health nutrition workforce of California accounts for almost 25 percent of the 

2000 census but was not included in 1994, additional analyses were made to determine the effect 

of California’s data on the increase in median salary ranges. As indicated in Table 23, the 

inclusion of California’s data did have an impact on the median salaries for the nation. Without 

California’s data, the median minimum of the salary range (entry level) for professionals was 

$1442 lower and the median maximum of the salary range was $384 lower. The median salary 

range of the clinical nutritionist again exceeded that of the public health nutritionist. For 

paraprofessionals, the median minimum of the salary range was $1,379 lower without 

California’s data. There was no difference in the nutrition technician’s median maximum of the 

salary range, but the nutrition assistant’s median maximum was $387 lower. 

To determine whether or not the PH nutrition workforce’s salaries had kept up with inflation, the 

1994 salary ranges were adjusted for inflation (Table 24) and compared to the 2000 salaries that 

excluded California’s data (Table 23). After weighting the data, the median annual minimum of 

the 2000 salary range for professionals ($28,453) was $198 lower than the adjusted 1994 

minimum ($28,651), and the median maximum was $469 higher ($43,476 and $43,007, 

respectively). For paraprofessionals, the median annual minimum of the 2000 salary range 

($18,718) was $271 higher than the adjusted 1994 minimum ($18,447), and the maximum was 

$1859 higher ($27,544 and $25,685, respectively). There was considerable variation among the 

job classifications. 
33

Table 22 

1999-2000 Median Annual Salary Ranges for Workers who Reported their Salaries as a Range (Question 15) 

Classification Observations* Median ($) 

PH Nutrition Director 292 ( 443) 35264 - 54260 

Asst PH Nutrition Director 99 ( 140) 34992 - 53435 

PH Nutrition Supervisor 621 (1070) 33021 - 48287 

PH Nutrition Consultant 353 ( 547) 35100 - 49914 

PH Nutritionist 638 (1111) 29858 - 43496 

Clinical Nutritionist 359 ( 743) 29661 - 43968 

Nutritionist 1531 (3476) 26352 - 39000 

Nutrition Technician 755 (1316) 20736 - 29163 

Nutrition Assistant 898 (1769) 18804 - 25251 

*Observations are the number of respondents to Question 15. Numbers in parenthesis are total respondents, 

including information on vacant positions.

Table 23 

1999-2000 Median Annual Salary Ranges for Workers who Reported their Salaries as a Range — Excluding 

California’s Data (Question 15) 

Classification Observations* Median ($) 

PH Nutrition Director 239 ( 323) 34451 - 53435 

Asst PH Nutrition Director 81 ( 109) 33196 - 53435 

PH Nutrition Supervisor 482 ( 750) 30829 - 48308 

PH Nutrition Consultant 291 ( 360) 33862 - 49668 

PH Nutritionist 483 ( 682) 26645 - 42404 

Clinical Nutritionist 307 ( 427) 28111 - 43968 

Nutritionist 1384 (2339) 25881 - 38454 

Nutrition Technician 523 ( 739) 19718 - 29163 

Nutrition Assistant 316 ( 656) 17064 - 24864 

*Observations are the number of respondents to Question 15. Numbers in parenthesis are total respondents, 

including information on vacant positions. 
34

Table 24 

1994 - Median Annual Salary Ranges for Workers who Reported

Salaries as a Range, Adjusted for 2000 Inflation* 23

Classification Median ($) 

PH Nutrition Director 34742 – 50221 

Asst PH Nutrition Director 32450 – 48725 

PH Nutrition Supervisor 30927 – 47900 

PH Nutrition Consultant 35414 – 50764 

PH Nutritionist 28319 – 43903 

Clinical Nutritionist 27611 – 41781 

Nutritionist 25233 – 37464 

Nutrition Technician 20447 – 27820 

Nutrition Assistant 16591 – 23704 

* Includes information on vacant positions. 

Sources of Funding for the Public Health Nutrition Workforce 

Tables 25 and 25 present a comparison of funding sources for all full-time equivalents (FTEs) 

between 1994 and 2000. To calculate FTEs, all full-time and part-time positions were combined 

according to funding source. It should be noted that there was a nonresponse rate of 4.1 percent 

on funding source (Question 16) despite the fact that both instructions and training encouraged 

all supervisors who administered the survey to make sure their staff had correct information 

about their source(s) of funding. Many paraprofessionals and also professionals at the local level 

are not involved in the budget process and are therefore unaware of the funding source for their 

positions. Because of this, they may not realize the funding for their positions comes from a 

federal program even though their paychecks are cut by a local agency. 

USDA continued to be the primary funding source of the public health nutrition workforce in 

2000, funding 82.3 percent of the FTEs (Table 25). WIC continues to fund 81 percent of the 

FTEs (Table 26). According to information provided by USDA, Food Stamp Nutrition 

Education funding was increased substantially from $5 million in 1994 to $99 million in 2000; 

since data on the number of FTEs funded by the Food Stamp Program were not collected in the 

1994 survey, there is no way to determine how this may have affected the number of FTEs 

attributed to USDA funding.

The percent of FTEs funded with state money decreased slightly between 1994 and 2000, as did 

the proportion of FTEs funded through the U.S. Department of Health and Human Services. Of 

particular significance was the decrease in both numbers and percentage of FTEs funded through 

the MCH Block Grant (Title V). In 1994, there were approximately 226 FTEs funded by Title V 

 

23 These figures were inflated using the State and Local Price Deflator (S&LP). This index is published by the 

Department of Commerce, Bureau of Economic Analysis in the National Income and Product Accounts as a 

component of the Gross Domestic Product. FNS uses the S&LP to inflate the national administrative grant per 

person (AGP). The AGP is used in the WIC funding formula to determine the amount of funds allocated for food 

benefits and nutrition services and administration. Between 1994 and 2000, the S&LP increased 18%. 
35

(3.5 percent of the total FTEs). In 2000, only 185.85 FTEs were funded by Title V (1.9 percent 

of the total FTEs). This decrease occurred despite the fact that total FTEs increased by 3,487 

from 1994 to 2000. ASTPHND members in many states report that Title V funding is no longer 

being used to support public health nutrition positions. 

Although the number of FTEs funded by the CDC Preventive Health and Health Services Block 

Grant (PHHSBG) remained essentially the same—60.60 in 1994 and 61.34 in 2000, this 

represented a proportional decrease from 0.9 percent in 1994 to 0.6 percent in 2000. The 

PHHSBG has historically funded chronic-disease prevention and control programs in state health 

agencies; however, its contribution to public health nutrition personnel involved in prevention 

activities did not increase between 1994 and 2000. 

Table 25 

Full-time Equivalents Per Funding Source — A Comparison of 1994 and 1999-2000* 

(Question 16) 

 1999-2000 1994-2000 

USDA 8189.22 82.3% 5345.46 82.7% 

DHHS 470.73 4.7% 423.49 6.6% 

State 420.16 4.2% 331.54 5.1% 

Local 256.87 2.6% 143.42 2.2% 

Other 186.27 1.9% 211.33 3.3% 

DOE 19.67 0.2% 9.20 0.1% 

Not specified 408.58 4.1% 0.00 0.0% 

Total 9951.5 100.0% 6464.44 100% 

** Includes information on vacant positions. Idaho did not participate in 2000 survey. 

California did not participate in 1994 survey. Although the large number of respondents in 

1999-2000 from California may have affected comparability between the two surveys, 

California’s responses were included in the comparison in order to provide the most complete 

information about sources of funding. 
36

Table 26 

Full-time Equivalents Per Funding Source — A Comparison of 1994 and 1999-2000* (Question 16) 

 FTEs 1999-2000 Funding Source FTEs 1994 

State 

326.28 3.3% Non-specified state funds 238.38 3.7% 

90.85 0.9% State funds legislatively earmarked for nutrition 93.16 1.4% 

3.03 <0.1% Tobacco settlement monies 

Local 

256.87 2.6% Local funds (city/county general revenue) 143.42 2.2% 

USDA 

8060.14 81.0% WIC 5284.52 81.7% 

43.25 0.4% Food Stamps 

47.32 0.5% Child Nutrition (CACFP or NET) 

38.51 0.4% Other USDA 60.94 0.9% 

DHHS 

185.85 1.9% MCH Block Grant (Title V) 226.07 3.5% 

61.34 0.6% Preventive Health & Health Services Block Grant 60.60 0.9% 

41.72 0.4% Indian Health Services 

40.44 0.4% Medicaid — Non EPSDT (Title XIX) 45.81 0.7% 

17.78 0.2% EPSDT Medicaid (Title XIX) 11.80 0.2% 

18.96 0.2% CDC Diabetes Control 14.23 0.2% 

18.21 0.2% Older Americans Act (Title III) 7.82 0.1% 

14.37 0.1% Family Planning (Titles X and XX) 9.59 0.1% 

11.65 0.1% Ryan White HIV/AIDS 

4.30 <0.1% National Institute of Health 4.55 0.1% 

56.11 0.6% Other DHHS Funding 43.02 0.7% 

DOE 

8.12 0.1% Early Childhood Intervention (IDEA) 9.20 0.1% 

11.55 0.1% Other DOE 

Other Funding Sources 

76.69 0.8% Fees, patient charges, or third party reimbursement 18.34 0.3% 

31.11 0.3% Foundations or corporate grants 

78.47 0.8% Other 192.99 3.0% 

408.58 4.1% Did not specify funding source 0.0 0.0% 

9951.50 100% Total FTEs 6464.44 100% 

** Includes information on vacant positions. Idaho did not participate in 2000 survey. California did not 

participate in 1994 survey. Although the large number of respondents in 1999-2000 from California may have 

affected comparability between the two surveys, California’s responses were included in the comparison in order to 

provide the most complete information about sources of funding. 

 
37

Academic Preparation, Credentials, Training, and Training Needs 

Academic Preparation — Issues relating to the preparation of the public health workforce as a 

whole, and of the WIC workforce in particular, are of interest to federal and state officials. 

Questionnaire respondents were asked to indicate from a list of academic levels and 

concentrations whether they had earned a certain degree and/or were working on a specific type 

of degree. Multiple responses were possible; that is, the question referred to all degrees earned 

and/or working toward. The analysis shown in Table 27 assumes that a “no” response indicates 

no degree. Percentages are based on the total number of respondents for filled positions — 9,330 

for WIC and 955 for non-WIC. 

More than half of the public health nutrition workers indicated they have at least bachelor’s 

degrees in nutrition or dietetics. Among the WIC workforce, 53.7 percent reported having a 

degree in nutrition or dietetics, and among the non-WIC workers it was 69.5 percent (Table 27). 

The WIC workforce has a higher percent of bachelor’s degrees in public health or community 

nutrition than does the non-WIC workforce (2.3 percent and 1.8 percent respectively). However, 

a higher percentage of the non-WIC workforce reported having advanced degrees, with 28 

percent having a master’s degree in nutrition or dietetics and 14 percent having a master’s degree 

in public health or community nutrition, compared to 12 percent and 4 percent of the WIC 

respondents. 

Most WIC professionals (77.9 percent) have completed at least the bachelor’s degree in nutrition 

or dietetics (Table 28) and nearly all—96.6 percent (Table 29) have at least a bachelor’s degree. 

In addition, 17.3 percent of WIC professional workers have a master’s degree in nutrition or 

dietetics and 6.6 percent report a master’s degree in public health or community nutrition (Table 

28). Comparable degrees are uncommon among the paraprofessional categories of nutritionist 

technician, nutrition aide and breastfeeding counselor (Table 28). 

Only a very small percentage of public health nutrition workers indicated they are actively 

pursuing bachelor’s degrees in nutrition/dietetics or public health/community nutrition (Table 

27). Responses suggest the preparation of the workforce in the area of nutrition and dietetics is 

not being enhanced by academic work toward a degree undertaken during their employment. 

A number of strategies are being considered for maintaining and upgrading the skills of the 

public health nutrition workforce. The feasibility of strategies such as distance learning, selfstudy and tuition assistance for graduate work is limited by the number of workers who have the 

basic academic qualifications to take advantage of these opportunities. Examination of the 

highest degree obtained (Table 29) suggests that certification and upward mobility will be 

difficult for the paraprofessional WIC workforce because 69.1 percent of these workers do not 

have a college degree, including the associate degree. Among the professional workers, the 66 

percent whose highest degree is at the bachelor’s level could reasonably be expected to have the 

background for additional specialized training in public health nutrition. 
38

Table 27 

Academic Preparation of the PH Nutrition Workforce (Question 19)* 

WIC Non-WIC 

Degree Earned Working On Earned Working On 

Associate 

 Nutrition / dietetics 581 6.2% 84 0.9% 68 7.1% 3 0.3% 

 Other 885 9.5% 151 1.6% 68 7.1% 4 0.4% 

Bachelor’s 

 Nutrition / dietetics 5009 53.7% 51 0.5% 664 69.5% 4 0.4% 

 PH nutrition / community nutrition 213 2.3% 13 0.1% 17 1.8% 1 0.1% 

 Home economics / 

 family consumer science 764 8.2% 5 0.1% 94 9.8% 0 0.0% 

 Health education 107 1.1% 23 0.2% 18 1.9% 3 0.3% 

 Other 876 9.4% 125 1.3% 135 14.1% 12 1.3% 

Master’s 

 Nutrition / dietetics 1089 11.7% 237 2.5% 267 28.0% 27 2.8% 

 PH nutrition / community nutrition 415 4.4% 100 1.1% 133 13.9% 5 0.5% 

 Home economics / 

 family consumer science 106 1.1% 17 0.2% 24 2.5% 6 0.6% 

 PH — other concentration 125 1.3% 83 0.9% 36 3.8% 16 1.7% 

 Health education 90 1.0% 29 0.3% 22 2.3% 1 0.1% 

 Other 224 2.4% 124 1.3% 58 6.1% 18 1.9% 

Doctoral 

 Nutrition / dietetics 19 0.2% 11 0.1% 12 1.3% 2 0.2% 

 PH nutrition / community nutrition 6 0.1% 5 0.1% 2 0.2% 2 0.2% 

 Home economics / 

 family consumer science 2<0.1% 0 0.0% 0 0.0% 1 0.1% 

 PH — other concentration 7 0.1% 4<0.1% 1 0.1% 2 0.2% 

 Health education 5 0.1% 6 0.1% 0 0.0% 0 0.0% 

 Other 42 0.5% 32 0.3% 8 0.8% 6 0.6% 

Total Respondents 9330 955 

*Individual respondents may have marked multiple responses (i.e., all degrees they had earned and/or were working 

toward). 
39

Table 28 

Academic Preparation of WIC Paraprofessionals and Professionals (Question 19)* 

WIC 

Degree Professionals Paraprofessionals** 

Associate 

 Nutrition / dietetics 355 5.7% 221 7.4% 

 Other 529 8.5% 322 10.8% 

Bachelor’s 

 Nutrition / dietetics 4830 77.9% 150 5.0% 

 PH nutrition / community nutrition 195 3.1% 12 0.4% 

 Home econ. / family consumer science 702 11.3% 60 2.0% 

 Health education 69 1.1% 33 1.1% 

 Other 641 10.3% 203 6.8% 

Master’s 

 Nutrition / dietetics 1070 17.3% 10 0.3% 

 PH nutrition / community nutrition 407 6.6% 1 <0.1% 

 Home econ. / family consumer science 103 1.7% 3 0.1% 

 PH — other concentration 121 2.0% 3 0.1% 

 Health education 85 1.4% 5 0.2% 

 Other 197 3.2% 21 0.7% 

Doctorate 

 Nutrition / dietetics 18 0.3% 0 0.0% 

 PH nutrition / community nutrition 5 0.1% 0 0.0% 

 Home econ. / family consumer science 2 <0.1% 0 0.0% 

 PH — other concentration 5 0.1% 2 0.1% 

 Health education 3 <0.1% 2 0.1% 

 Other 32 0.5% 9 0.3% 

Total Respondents 6199 2973 

*Individual respondents may have marked multiple responses (i.e., all degrees they had earned and/or 

were working toward). 

**Nutrition technicians, nutrition aides and breastfeeding counselors; “others” and nonresponders to 

job classification are excluded. 
40

Table 29 

Highest Academic Degree Reported by WIC Workers (Question 19)* 

Degree Professionals Paraprofessionals** 

Associate 114 1.8% 464 15.6% 

Bachelor’s 4089 66.0% 404 13.6% 

Master’s 1838 29.6% 39 1.3% 

Doctorate 61 1.0% 11 0.4% 

None or No Response 97 1.6% 2055 69.1% 

Total Respondents 6199 100% 2973 100% 

*Individual respondents may have marked multiple responses (i.e., all degrees they had earned 

and/or were working toward). 

**Nutrition technician, nutrition aide and breastfeeding counselor. 

Core Public Health Course Work — The lack of training in public health among the public 

health workforce is an issue of concern across the public health professions, and public health 

nutrition is not an exception. Less than 10 percent of this workforce reports having a public 

health-related degree, with the prevalence of a public health degree being greater among nonWIC workers than among WIC workers. In both groups, however, significant proportions of 

workers have completed some course work relevant to the field of public health. 

To determine the extent to which workers had some exposure to public health academic work, 

survey respondents who had not completed a degree in public health were asked if they had 

course work in one or more of the core courses — environmental health, epidemiology, health 

services administration, social and behavioral sciences and/or statistics. Eighty-one percent of 

the non-WIC workers did not report having a PH-related degree (770/955), and 92 percent of the 

WIC workers did not report having a PH-related degree (8,608/9,330). However, some have 

completed at least one of the five core public health courses as indicated in Table 30. 

Completion of the core public health course work also varies across WIC professional and 

paraprofessional classifications as presented in Table 30. Completion rates are higher among 

professionals than paraprofessionals. These analyses suggest that in all cases the courses most 

unique to public health — epidemiology and environmental health — were most infrequently 

completed in comparison to a behavioral or social science course, which is included in most 

degree programs, and statistics, which is common in a number of fields. 
41

Table 30 

Core Public Health Course Work Among Personnel Without a Public Health Degree (Question 20) 

WIC 

Course Non-WIC Total* Professionals Paraprofessionals** 

Environmental 

Health 78 10.1% 560 6.5% 474 8.6% 86 2.8% 

Epidemiology 68 8.8% 421 4.9% 374 6.8% 47 1.5% 

Health 

Administration 66 8.6% 461 5.4% 393 7.1% 66 2.1% 

Behavioral 

Sciences 324 42.1% 2418 28.1% 1989 36.1% 424 13.8% 

Statistics 319 41.4% 2069 24.0% 1850 33.6% 215 7.0% 

Total in 

Category 770 8608 5509 3082 

*Total includes nonrespondents to Question 4 (job classification).

** Includes nutrition technicians, nutrition aides, breastfeeding counselor, and others 

Credentials of Workforce — A little more than 40 percent of the workforce surveyed said they 

were RDs. Among WIC respondents, 37.6 percent indicated they were RDs (Table 31), and 

another 1 percent indicated they were RD-eligible, meaning they had completed all required 

steps to become a registered dietitian and had received a letter from the Commission on Dietetic 

Registration verifying their eligibility to take a qualifying examination (Table 33). Also among 

WIC respondents, 2.5 percent indicated they were DTRs (Table 31) and only 0.1 percent were 

DTR-eligible (Table 34). Two-thirds (66.5 percent) of those WIC workers with DTR 

credentialing were classified in paraprofessional rather than professional positions (Table 32). 

Twenty-seven percent of the entire workforce reported being state licensed or certified dietitians. 

Increasing the proportion of RDs and DTRs within the WIC program is consistent with USDA’s 

strategic plan for 1997-2002 to improve the nutrition qualifications of state and local WIC staff. 

In ASTPHND’s 1994 survey, 42.1 percent of the total public health nutrition workforce reported 

they had RD credentialing and another 6.3 percent indicated they were RD-eligible. The 1994 

survey also showed that 38.4 percent of the WIC workers were RDs and another 5.9 percent 

were RD-eligible. Again, analyses were completed to determine the impact of the California 

workforce on the national data related to RDs and DTRs. Looking at 2000 data without 

California, 38.9 percent of the WIC nutrition workforce indicated they were RDs and 3.2 percent 

were DTRs. 

In general, it must be concluded that neither the proportion of the public health nutrition 

workforce nor the WIC workforce with the basic RD credential has increased over this time 

period, nor are there significant numbers of WIC workers who are RD-eligible. The lower 

proportion of RD-eligible and DTR-eligible respondents in 2000 may be the result of a change in 

the questions used to measure eligibility. In 1994, respondents were asked if they were RDeligible, and RD-eligible was defined.24 In 2000, respondents were asked to indicate which of 

 

24 Definition from 1994 survey — “Completed the course work prescribed to meet the Minimum Academic 

Requirements of the American Dietetic Association (ADA) and completed a preprofessional practice program 
42

several steps toward eligibility had been completed. The percentages in Tables 33 and 34 

represent consecutive steps toward receipt of a letter from the Commission on Dietetic 

Registration stating eligibility to take the qualifying exam. 

Between 1994 and 2000, minimal observable progress has been made to increase the percentage 

of RDs, RD-eligibles, and DTRs working in WIC. Objective 3.3 of the USDA strategic plan for 

1997-2002 calls for improved nutritional qualifications of state and local WIC staff, with the 

performance measure being to increase the percentage of RDs or RD-eligible persons in WIC 

programs from 48 to 50 and the percentage of DTRs from 2 to 4.25 Nevertheless, the number of 

RDs in WIC programs increased from 2514 in 1994 to 3509 in 2000, which includes the 835 in 

California. And the number of DTRs increased from 158 in 1994 to 232 in 2000, including 20 from 

California. These increases correspond to increases in funding and participation in the WIC 

program between 1994 and 2000. 

Results of the 1994 study indicated than 19.4 percent of the entire workforce and 21.5 percent of 

the WIC workforce consisted of paraprofessionals, compared to 30.7 percent and 32.6 percent 

respectively in 2000. This increase is most likely the result of a combination of factors. As 

previously mentioned, there is always variability from state to state in the population covered by 

a survey of the public health nutrition workforce and, in 2000, states may have made a greater 

effort to ensure the inclusion of paraprofessionals and breastfeeding peer counselors. The 

participation of California in 2000 may have affected the distribution as well. Informal verbal 

reports suggest that many state WIC programs have turned to paraprofessionals because of tight 

administrative funding and because of difficulties recruiting nutrition professionals. It is 

important to remember however, that paraprofessionals are not simply substitutes for less 

academically qualified, better-compensated workers. In many areas of the nation, 

paraprofessionals enhance the cultural and linguistic competency of the workforce, and their 

effectiveness as breastfeeding peer counselors is well documented.26 Consequently, setting goals 

on credentials for specific types of workers rather than for the entire workforce may be more 

realistic. 

A breakdown of the credentials reported by WIC professionals and WIC paraprofessionals is 

presented in Table 32. More than half (56.0 percent) of WIC professional workers report being 

an RD, and more than a third (37.5 percent) are licensed/certified in their respective states; 

however, 23.6 % did not report having a specific certification or credential. Many have more 

than one recognized credential. However, nearly one-quarter (23.6 percent) of WIC professional 

report no certification or credentials. Nationally recognized credentials are extremely rare 

among the responding paraprofessionals, although 11.5 percent report other certification in 

 

(dietetic internship, coordinated program, or an AP4 program) accredited/approved by the ADA.” 25 According to ASTPHND’s 1994 survey, 44.3 percent of the WIC nutrition workforce was either RD or RDeligible. USDA-FNS has subsequently acknowledged that the baseline percentage for RDs and RD-eligibles in this 

particular objective (48 percent) was in error and should have been the percentage identified in ASTPHND’s 1994 

survey. 

26 Schafer E, Vogel MK, Viegas S, Hausafus C. Volunteer peer counselors increase breastfeeding duration among 

rural, low-income women. Birth 1998 June;25(2):101-6. Arlotti JP, Cottrell BH, Lee SH, Curtain JJ. 

Breastfeeding among low-income women with and without peer support. J Community Health Nurs. 1998; 

15(3):163-78. 
43

lactation or breastfeeding. 

Progress has been made over the last five years within the WIC community to increase the 

capacity of the workforce in the area of breastfeeding (Table 31). In 2000, 160 (1.7 percent) of 

WIC respondents indicated they were International Board Certified Lactation Consultants 

(IBCLC) compared to 56 (0.9 percent) in 1994.27 About 80 percent of the workers with this 

credential are classified as professionals rather than paraprofessionals (Table 32). 

 

Table 31 

Certifications and Credentials of Filled Positions (Question 21) 

Certifications and Credentials WIC Non-WIC Total* 

Registered Dietitian 3509 37.6% 736 77.1% 4247 41.2% 

Licensed or Certified Dietitian 2349 25.2% 434 45.4% 2783 27.0% 

Dietetic Technician Registered 232 2.5% 10 1.0% 242 2.3% 

Certified Diabetes Educator 65 0.7% 46 4.8% 111 1.1% 

International Board Certified Lactation Consultant 160 1.7% 11 1.2% 171 1.7% 

Other Certification in Breastfeeding or Lactation 1302 14.0% 41 4.3% 1343 13.0% 

CDR Certification as Specialist in Pediatric Nutrition 15 0.2% 13 1.4% 28 0.3% 

Certified Health Education Specialist 47 0.5% 10 1.0% 57 0.6% 

Registered Nurse 189 2.0% 40 4.2% 229 2.2% 

Licensed Practical Nurse 72 0.8% 2 0.2% 74 0.7% 

State Certified Teacher 184 2.0% 30 3.1% 214 2.1% 

Certified in Family & Consumer Sciences (AAFCS) 55 0.6% 13 1.4% 68 0.7% 

Other 566 6.1% 65 6.8% 631 6.1% 

Total 9330 100% 955 100% 10309 100% 

*Respondents may have reported multiple certifications and credentials, or no certifications or credentials. The total 

is greater than the number of WIC respondents and non-WIC respondents combined due to inclusion of 

nonresponders to Question 7. 

 

27 The participation of California in the 1999-2000 survey may have contributed to the increase. 
44

Table 32 

Certifications and Credentials of the WIC Nutrition Workforce (Question 21) 

Certifications and Credentials* WIC Professionals WIC Paraprofessionals** 

Registered Dietitian 3473 56.0% 30 1.0% 

Licensed or Certified Dietitian 2325 37.5% 24 0.8% 

Dietetic Technician Registered 77 1.2% 153 4.9% 

Certified Diabetes Educator 57 0.9% 8 0.3% 

International Board Certified Lactation Consultant 129 2.1% 31 1.0% 

Other Certification in Breastfeeding or Lactation 941 15.2% 358 11.5% 

CDR Certification as Specialist in Pediatric Nutrition 15 0.2% 0 0.0% 

Certified Health Education Specialist 25 0.4% 22 .7% 

Registered Nurse 128 2.1% 61 2.0% 

Licensed Practical Nurse 24 0.4% 48 1.5% 

State Certified Teacher 147 2.4% 37 1.2% 

Certified in Family and Consumer Sciences (AAFCS) 52 0.8% 3 0.1% 

Other 249 4.0% 317 10.2% 

None Reported 1464 23.6% 2183 70.1% 

Total on which percentages are calculated 6199 3114 

*Includes multiple responses. 

** Includes job categories of nutrition technician, nutrition assistant, breastfeeding counselor and others; 

nonresponders to job category are excluded.

Table 33 

Steps Taken to Become Registered Dietitians by Non-RDs (Question 22) 

Steps to RD WIC Non-WIC 

Completed a bachelor’s degree 2483 42.7% 100 45.7% 

Completed didactic program approved by CAADE28 673 11.6% 23 10.5% 

Completed a CAADE supervised practice program 118 2.0% 8 3.7% 

Have CDR letter of eligibility to take exam 94 1.6% 5 2.3% 

No steps toward RD 2453 42.1% 83 37.9% 

Total 5821 100% 219 100% 

 

28 Commission on Accreditation-Approval for Dietetic Education 
45

Table 34 

Steps Taken to Become DTRs by Non-DTRs and Non-RDs (Question 23) 

Steps to DTR WIC Non-WIC 

Completed an associate degree 668 11.9% 36 17.0% 

Completed didactic program approved by CAADE 143 2.6% 1 0.5% 

Completed a CAADE-approved DT program 15 0.3% 0 0.0 

Completed CAADE supervised practice program 13 0.2% 0 0.0 

Have CDR letter of eligibility to take exam 9 0.2% 0 0.0 

No steps toward DTR 4751 84.9% 175 82.5% 

Total 559929 100% 212 100% 

Attendance at MCHB-Sponsored Courses – The Maternal Child Health Bureau (MCHB) at the 

U.S. Department of Health and Human Services has been sponsoring nutrition courses for the 

professional public health workforce for more than 50 years. Courses during the last 20 years 

have focused on nutrition for children with special health care needs including developmental 

disabilities. The current workforce continues to assign a high ranking to this area as a training 

need (Table 38). Although only 9.2 percent of the survey respondents indicated they had 

attended one or more of the MCHB-sponsored courses since January 1995, persons who 

complete the training often serve as trainers (either formal or informal) so that the information 

they obtain from the courses is disseminated among other workers. The MCHB-sponsored 

training is not limited to public health professionals or to nutritionists and dietitians, so the 

numbers presented in Tables 34-36 do not represent the total number of health professionals that 

completed the MCHB-sponsored training. 

Comparing the distribution of the training participants or attendees across type of employing 

agency (Table 35) with the distribution of the entire workforce (Table 4), it appears that state 

health agency employees are much more likely to participate in MCHB training than are 

employees of local health agencies and nonprofit organizations. This is consistent with the role 

of state agencies in providing training and information to their grantees and other agencies 

within their respective states, as well as the variation in the distribution of job classifications by 

agency types. 

Table 36 shows the rate of attendance by job classification.30 Not surprisingly, employees 

classified as public health nutrition consultants and clinical nutritionists were most likely (24.6 

percent and 21.4 percent, respectively) to have participated in the training. Major duties of both 

PHN consultants and clinical nutritionists typically include training and technical assistance for 

other health care professionals about current nutrition care for CSHCN, as well as care 

coordination for their families. In addition, clinical nutritionists often provide counseling for the 

families of CSHCN. Only 8 percent of the workers categorized as nutritionist, and less than 1 

percent of paraprofessionals (nutrition technicians and nutrition assistants), received the 

 

29 Ten WIC workers and three non-WIC workers have both the RD and the DTR; they are reflected in the column 

total in Table 26. 30 No adjustments have been made for length of employment. 
46

federally sponsored training. Twenty-three percent (216/948) of the respondents who 

participated indicated attendance at more than one of the nine courses. Table 37 shows the 

number of respondents who have attended each of the nine MCHB-sponsored courses since 

1995. 

Table 35

Agency of Employment of Participants in MCHB-Sponsored 

Nutrition Courses (Question 24) 

Type of Agency * 

Number and Percent of 

 Attendees 

SHA (19.9%) 332 35.0% 

LHA (47.9%) 368 38.8% 

ITO (1.4%) 28 3.0% 

Nonprofit Agency (28.4%) 206 21.7% 

For-Profit Agency (0.7%) 6 0.6% 

Other (1.4%) 8 0.8% 

Total 948 100% 

*Numbers in parentheses represent percent of total respondents, 

including vacant positions. 

Table 36 

Proportion of Each Job Classification that Attended the 

 MCHB-sponsored Nutrition Courses (Question 24) 

Job Classification 

Number and Percent 

 Attended 

PHN Directors (n=437) 75 17.2% 

Asst. PHN Director (n=137) 23 16.8% 

PHN Supervisor (n=1029) 159 15.5% 

PHN Consultant (n=516) 127 24.6% 

PH Nutritionist (n=1008) 119 11.8% 

Clinical Nutritionist (n=674) 144 21.4% 

Nutritionist (n=3237) 262 8.1% 

Nutrition Technician (n=1268) 18 1.4% 

Nutrition Assistant (n=1722) 10 0.6% 

Other (n=218) 11 0.5% 

Total participants 948 
47

Table 37 

Number of Respondents Indicating Attendance at Each of the MCHB-Sponsored Courses 

(Total = 1164 includes duplicate attendees) (Question 24) 

198 Intensive Course in Maternal Nutrition, University of Minnesota 

182 Intensive Course in Nutrition for Infants, Children and Adolescents, University of Alabama at 

Birmingham 

431 Intensive Course in Pediatric Nutrition, University of Iowa 

73 Neonatal Nutrition Training, Medical University of South Carolina 

10 Neonatal Nutrition and Leadership Education in Pediatric Nutrition, James Whitcomb Hospital for 

Children, Indianapolis, Indiana 

96 Nutrition Concerns of the Child with Special Health Care Needs, Cincinnati Center for Developmental 

Disorders, Cincinnati, Ohio 

66 Nutrition for Children with Special Health Care Needs: Nutrition Makes a Difference Center for Child 

Development and Developmental Disorders, Los Angeles, CA 

74 Nutrition for Children with Special Health Care Needs: Nutrition Makes a Difference, Sparks Center 

for Developmental and Learning Disorders, Birmingham, AL 

34 Professional Training Course in Nutrition and Developmental Disabilities, Boling Center for 

Developmental Disabilities, Memphis TN 

Training Needs – The results of Question 25, which asked respondents to indicate areas in which 

they need training for their current work by checking up to three of 35 topics listed, should be 

interpreted with caution. Approximately 15 percent of the data were missing or unusable; 

questionnaires with more than three topics marked were not included in the analysis. 

Respondents were also asked to indicate their need for advanced training or basic training by 

marking an “A” for advanced or a “B” for basic next to a topic, but not to mark more than three 

topics altogether. Respondents were much more likely to identify their training needs as 

advanced rather than basic. In Table 38, which compares the 10 most frequently selected training 

needs of the WIC and non-WIC, professional and paraprofessional components of the workforce, 

advanced and basic responses were collapsed and all three of each respondent’s choices were 

counted. The table also includes the responses of those workers who selected less than three 

areas. The numbers in Table 38 indicate the number of choices made and the proportion of the 

total respondents choosing a specific topic.31 The paraprofessional non-WIC workers category is 

not shown due to the small number of respondents in that group. 

As indicated in Table 38, the top five perceived training needs of the entire workforce were 

nutrition for CSHCN; breastfeeding; infant and preschool nutrition; prenatal nutrition; and 

nutrition counseling, behavior change, and client education. These are quite similar to the 

training needs identified by the workforce in 1994. Considering the 10 highest-ranked needs, 

only one — information technology — is not within the general category of “client and 

population groups” (i.e., not directly related to the provision of direct client services). The WIC 

and the non-WIC workers differ in the rank ordering of their training needs. Only four topics 

ranked among the top 10 of both groups: nutrition for CSHCN, nutrition counseling, 

supplementary dietary therapies, and information technology. Like their WIC counterparts, non-

 

31 For information on the frequency with which all 37 topics were selected, see Appendix E for an expanded version 

of Table 37. 
48

WIC workers most frequently selected nutrition for CSHCN, but the topics of adult health 

promotion and senior/geriatric nutrition were also among their top 10 choices. 

The rank order of training needs also differs for WIC paraprofessionals and WIC professionals. 

Nutrition for CSHCN, selected by 35 percent of the respondents, was the highest training priority 

for professionals. Among paraprofessionals, breastfeeding was identified as the highest priority 

for training. Comparing the top 10 training needs identified by WIC professionals with the top 

10 training needs of WIC paraprofessionals, eight of the top 10 were the same for both groups. 

A comparison of the responses of non-WIC professionals and WIC professionals, two groups 

that are similar in education, certification and years of practice, found that workers in both 

categories selected nutrition for CSHCN more frequently than any other topic. The 10 highestranked needs of non-WIC professionals included six that were also among the top 10 for WIC 

professionals: CSHCN, high-risk clients, eating disorders, nutrition counseling and education, 

alternative therapies, and information technology. Four of the six were also priorities of the WIC 

paraprofessionals. Thus it appears there are many similarities across different segments of the 

public health nutrition workforce in the general topics in which training is desired. 

Despite these similarities, the training needs also reflect the varying roles of this workforce 

within the scope of public health practice. The training needs of WIC respondents in general and 

paraprofessionals in particular are directly related to the provision of direct client services that 

comes under the category of “public health assurance.” This is consistent with the finding that 90 

percent of the WIC workforce is involved in the delivery of direct client services (Table 15). 

Only one of the WIC paraprofessionals’ 10 top training needs, information technology, was in 

the category of public health assessment. Similarly, among the 10 highest-ranking needs of WIC 

professionals, two were not related to direct client services — information technology, and 

leadership and team building. Although topics related to direct client services also predominate 

in the choices of professional non-WIC workers, four topics related to public health assessment 

ranked among their top 10 needs: surveillance, proposal and grant writing, program planning and 

evaluation, and information technology. 

There is less variation in the training needs of WIC professionals than non-WIC professionals: 

The most frequently selected need for both WIC and non-WIC professionals (nutrition for 

CSHCN) was the choice of 35 percent of WIC professionals but only 16 percent of non-WIC 

professionals. And the difference in the proportion of respondents selecting the first and the 10th 

ranked need was 35 percent and 9 percent among WIC professionals and 16 percent and 8 

percent among non-WIC professionals. 

Perceived training needs changed very little since 1994. The top four topics marked by WIC 

workers in 2000 were the same as the top four topics identified in 1994: nutrition for CSHCN, 

infant and child nutrition, prenatal nutrition, and breastfeeding — even though the choice of 35 

topics in 2000 was much more extensive that the 16 choices offered in 1994.32 

 

32 In 1994, respondents were not asked to differentiate between advanced and basic needs.
49

Table 38. Perceived Training Needs – Top 10 Choices Identified by the Numbers of Parentheses (Question 25) 

WIC Nutrition Workforce Non-W

Topic Total Workforce All Professional Paraprofessional All 

Nutrition for CSHCN* (1) 29% 2976 (1) 30% 2829 (1) 35% 2184 (4) 21% 644 (1) Breastfeeding (2) 26% 2636 (2) 28% 2586 (2) 25% 1551 (1) 33% 1033 Infant and preschool nutrition (3) 22% 2303 (3) 24% 2231 (3) 21% 1303 (2) 30% 926 Prenatal nutrition (4) 17% 1752 (4) 18% 1699 (4) 16% 987 (3) 22% 683 Nutrition counseling, behavior change, client education (5) 16% 1676 (5) 17% 1551 (5) 16% 987 (5) 18% 562 (3) Hihg-risk clients, including HIV and addiction (6) 12% 1234 (6) 12% 1161 (6) 14% 867 (8) 9% 294 Childhood nutrition (7) 9% 952 (7) 10% 894 (6) 16% 497 Eating disorders (7) 9% 952 (8) 9% 870 (9) 9% 554 (7) 10% 315 Supplemental and alternative dietary therapies (9) 9% 928 (9) 9% 795 (7) 11% 687 (2) Use of current IT, including computers (10) 9% 898 (10) 8% 792 (8) 10% 629 (10) 5% 163 (5) Adulth health promotion, chronic disease, healthy aging (4) Senior, geriatric nutrition (9) Communication with low literacy populations (9) 6% 200 Data management, surveillance, monitoring systems (8) Fund raising, proposals, and grant writing (7) Program planning and evaluation (10) 
50

Table 38. Perceived Training Needs – Top 10 Choices Identified by the Numbers of Parentheses (Question 25) 

WIC Nutrition Workforce Non-W

Topic Total Workforce All Professional Paraprofessional All 

Leadership and team building (10) 9% 541 No response or missing 

15% 

1591 

15% 

1432 

12% 

724 

22% 

700 

Total respondents (does not equal choices) 10309 9330 6199 3114 *Children with Special Health Care Needs 
51

Affiliation with Professional Organizations 

 

Participation in professional organizations is an indicator that the workforce is linked to groups 

that will afford them opportunities for professional growth and development. Among public 

health nutrition workers in professional job classifications, there is considerable participation in 

national organizations. Participation is much greater in the American Dietetic Association 

(ADA) than in any other organization. As depicted in Table 39, 69.8 percent of the non-WIC 

workforce reported membership in ADA, and approximately one-third (36.8 percent) of the WIC 

respondents indicated they were ADA members. The workforce also had significant numbers of 

members in the American Public Health Association, the International Lactation Consultant 

Association, and the Society for Nutrition Educators. 

An analysis of the participation of WIC paraprofessional and WIC professional workers (Table 

40) confirms that persons in professional job classifications have a much higher level of 

membership in national professional organizations than do workers in paraprofessional job 

classification. More than half (53.2 percent) of professional workers report membership in ADA, 

and 11.1 percent are members of the National Association of WIC Directors (NAWD).33

Otherwise, membership in any one organization is less than five percent of the respondents. 

Paraprofessional workers rarely report participation in one of the national organizations listed, 

although for those who do, the most frequent participation is in ADA (4.2 percent). Insofar as the 

organizations listed are primarily oriented toward professionals rather than paraprofessionals, 

there is less opportunity for paraprofessionals to join organizations. Registered dietetic 

technicians (DTRs) can become members of ADA, but less than 2.5 percent of the workforce are 

DTRs. 

Given WIC’s educational mission, and the numbers of respondents who indicate the need for 

training in nutrition counseling, behavior change and client education, increased participation in 

national organizations that sponsor and support training opportunities should be encouraged. 

 

33 NAWD is now known as the National WIC Association NWA). 
52

Table 39 

Membership in Professional Organizations for WIC and Non-WIC Workers (Question 26)* 

Organization WIC Non-WIC 

American Association of Diabetes Educators 127 1.4% 63 6.6% 

American Association of 

Family and Consumer Sciences 88 0.9% 18 1.9% 

American Dietetic Association 3437 36.8% 667 69.8% 

American Public Health Association 274 2.9% 71 7.4% 

American Public Human Services Association 2 <0.1% 0 0.0% 

American School Food Service Association 20 0.2% 20 2.1% 

ASTPHND 55 0.6% 42 4.4% 

International Lactation Consultant Association 212 2.3% 13 1.4% 

National Association of WIC Directors 715 7.7% 5 0.5% 

National Association. Of Child And 

Adult Care Food Program Professionals 5 0.1% 17 1.8% 

Society for Nutrition Education 165 1.8% 54 5.7% 

Society of Public Health Educators 18 0.2% 16 1.7% 

Other national professional associations 402 4.3% 98 10.3% 

Total Respondents 9330 955 

*Numbers include multiple responses per respondent.
53

Table 40 

Membership in Professional Organizations (Question 26) for WIC Professionals and 

Paraprofessionals* 

Organization 

 WIC 

 Professionals 

WIC 

Paraprofessionals** 

American Association of Diabetes Educators 122 2.0% 5 0.2% 

American Association of 

Family and Consumer Sciences 83 1.3% 5 0.2% 

American Dietetic Association 3300 53.2% 131 4.2% 

American Public Health Association 264 4.3% 10 0.3% 

American Public Human Services Association 1 <0.1% 1 <0.1% 

American School Food Service Association 18 0.3% 2 0.1% 

ASTPHND 55 0.9% 0 0% 

International Lactation Consultant Association 177 2.9% 35 1.1% 

National Association of WIC Directors 689 11.1% 24 0.8% 

National Association of Child and 

Adult Care Food Program Professionals 5 0.1% 0 0.0% 

Society for Nutrition Education 154 2.5% 9 0.3% 

Society of Public Health Educators 10 0.2% 8 0.3% 

Other national professional associations 337 5.4% 65 2.1% 

Total Respondents 6199 3144 

*Numbers include multiple organizations per respondent.

**Includes nutrition technician, nutrition assistant, breastfeeding counselor, and other. 

Geographical Distribution of the WIC Workforce Respondents 

Table 41 shows the distribution of the WIC workforce respondents across the states and 

territories in comparison to the distribution of WIC participants/clients. California had the largest 

proportion of both the WIC workforce respondents (24.8 percent) and WIC participants (17.1 

percent).34 Six (6.3) percent of the total workforce worked in New York, which accounted for 

6.5 percent of WIC participants in FY 2000. Another large state, Texas, provided services to 

10.3 percent of WIC participants and accounted for only 4.5 percent of the workforce. 

 

34 The distribution of the WIC workforce and WIC participants are not directly comparable because of the different 

workforce response rates across the states. 
54

Table 41 Distribution of WIC Workforce Respondents* and WIC Participants by State 

WIC 

Workforce 

WIC 

Participants 

WIC 

Workforce 

Pa

State N Percent Percent State N Percent Alabama 76 0.8 1.4 Montana 32 0.3 Alaska 32 0.3 0.3 Nebraska 54 0.5 American Samoa NR Nevada 74 0.8 Arizona 287 2.9 1.7 New Hampshire 27 0.3 Arkansas 50 0.5 1.2 New Jersey 90 0.9 California 2,488 24.8 17.1 New Mexico 101 1.0 Colorado 223 2.3 1.0 New York 616 6.3 Connecticut 56 0.6 0.7 North Carolina 327 3.3 Delaware 17 0.2 0.2 North Dakota 82 0.8 District of Columbia 29 0.3 0.2 Ohio 356 3.6 Florida 405 4.1 4.2 Oklahoma 80 0.8 Georgia 202 2.1 3.0 Oregon 193 2.0 Guam 24 0.2 0.1 Pennsylvania 350 3.6 Hawaii 36 0.4 0.5 Puerto Rico 94 1.0 Idaho NR Rhode Island 30 0.3 Illinois 310 3.1 3.4 South Carolina 139 1.4 Indiana 192 1.9 1.7 South Dakota 23 0.2 Iowa 117 1.2 0.9 Tennessee 178 1.8 Kansas 85 0.9 0.7 Texas 439 4.5 Kentucky 86 0.9 1.6 Utah 61 0.6 Louisiana 132 1.3 1.8 Vermont 18 0.2 Maine 65 0.7 0.3 Virgin Islands 16 0.2 Maryland 161 1.6 1.3 Virginia 227 2.3 Massachusetts 308 3.1 1.6 Washington 45 0.5 Michigan 112 1.1 3.0 West Virginia 89 0.9 Minnesota 198 2.0 1.3 Wisconsin 182 1.8 Mississippi 72 0.7 1.3 Wyoming 20 0.2 Missouri 131 1.3 1.7 Indian Tribal Orgs. 56 0.6 

Total 9,853 7,1

 *Refers to respondents, including vacant positions, which is not necessarily the total number of WIC workers. Responses r states as described in Table 2. 
55

Diversity 

The elimination of ethnic, racial, and class disparities is one of the two overarching goals for 

“Healthy People 2010.” The development of a culturally-competent health services workforce is one 

strategy toward the accomplishment of that goal.35 Another objective (1-8) is to increase 

representation of ethnic and racial minorities in the health professions. Toward those ends, the 

question on training needs included the topics of “communicating with low-literacy populations” 

and “cultural competency.” 

Analysis revealed that these two topics were selected rather infrequently, considering the extent to 

which they are discussed in the public health literature. As shown in Table 37, neither topic was 

among the 10 most frequently perceived training needs out of the possible 35 areas. Among the 

entire workforce, 615 respondents (6 percent) selected communicating with low-literacy populations 

as one of up to three possible training needs, and 504 (3.9 percent) selected cultural competency. 

However, a comparison of the choices of WIC paraprofessionals and professionals indicates that 

communication with low-literacy populations ranked as the ninth most frequently selected training 

need among paraprofessionals. 

In 1994, 10.9 percent of respondents selected cultural competency as one of their training needs, 

ranking it 12th in a list of 17 fixed-choice training needs. Communicating with low-literacy 

populations was not included in the list from which respondents were able to select in 1994. Why 

the workforce assigned a relatively low priority to cultural competency and communication with 

low-literacy populations cannot be determined. Possible reasons might be – perceived competency, 

lack of awareness, and/or greater needs in other areas. 

The workforce census also collected information on the ethnicity, race and gender of public health 

nutrition workers, as well as their primary and secondary languages. These data can be compared in 

several ways. Tables 42-45 show the characteristics of the workforce, by WIC and non-WIC. The 

lack of diversity is most evident in gender.36 Over 95 percent of the responding workers were female 

(Table 42), and in this regard they are very much like the WIC client population. 

Ethnicity and racial diversity is generally greater among WIC workers than among the non-WIC 

workforce, as shown in Tables 43-45: 

• 20.8 percent Latino/Hispanic compared to 5.8 percent 

• 11.5 percent African American compared to 7.4 percent 

• 6.6 percent Asian compared to 5 percent 

The high nonresponse to the question on racial identification (Table 44) is difficult to interpret. 

Nonresponse was not randomly distributed. It was considerably higher among WIC respondents 

(15.2 percent) than among non-WIC workers (4.4 percent) as well as in comparison to the 

nonresponse of 7.8 percent in 1994. Almost two-thirds (63 percent) of the nonrespondents to 

 

35 For information on standards for cultural competency and increasing minority recruitment and retention in the health 

professions, visit www.omhrc.gov 36 According to 1998 Bureau of Labor Statistics information, 84 percent of U.S. dietitians and nutritionists are 

female: ftp://158.72.84.9/ftp/bhpr/workforceprofiles/DC.pdf
56

race were from the state of California (933/1,482) — or, stated another way, 37.1 percent of 

California respondents did not respond to this item.37

In Table 45, racial categories include respondents who indicated they were one race only, as well 

as respondents who indicated they were two or more races. 

Table 42 

Gender of the Workforce (Question 27) 

Gender WIC Non-WIC 

Male 305 3.3% 33 3.5% 

Female 8877 95.1% 907 95.0% 

No Response 148 1.6% 15 1.6% 

Total 9330 100% 955 100% 

 

Table 43 

Ethnicity of the Workforce (Question 28) 

Ethnicity WIC Non-WIC 

Latino / Hispanic 1944 20.8% 55 5.8% 

Not Latino / Hispanic 4576 49.0% 629 65.9% 

No Response 2810 30.1% 271 28.4% 

Total 9330 100% 955 100% 

 

 

Table 44 

Racial Background of the Workforce (Question 29) 

Race* WIC Non-WIC 

One race reported: 

American Indian or 

Alaska Native 79 0.8% 7 0.7% 

Asian 602 6.5% 48 5.0% 

Black or 

African American 1055 11.3% 69 7.2% 

Native Hawaiian or 

 Other Pacific Islander 29 0.3% 4 0.4% 

White 6095 65.3% 779 81.6% 

Two or more races 

reported 48 0.5% 6 0.6% 

No Response 1422 15.2% 42 4.4% 

Total 9330 100% 955 100% 

*See questionnaire, Question 29, in Appendix C. 

 

37 While it was beyond the scope of this study to examine fully this issue, it is of interest to note that California 

residents had a much higher (19.4%) response of “some other race” to the 2000 U.S. Census than did the total 

population (6.6%). U.S. Census Bureau, Census 2000, Table DP 1. Profile of General Demographic Characteristics. 

See http://www.census.gov/ The “some other race” was not a response choice in the ASTPHND workforce survey.
57

Table 45 

Racial Background of the Workforce (Question 29) 

Race alone or in 

combination with one or 

more other races* WIC Non-WIC 

American Indian or 

Alaska Native 108 1.2% 12 1.2% 

Asian 619 6.6% 48 5.0% 

Black or 

African American 1069 11.4% 71 7.4% 

Native Hawaiian or 

Other Pacific Islander 32 0.3% 4 0.4% 

White 6131 65.4% 784 81.6% 

No Response 1422 15.2% 42 4.4% 

Total Respondents ** 9381 100.0% 961 100.0% 

* Respondents may select more than one race. 

**The categories in this table are not mutually exclusive. Respondents selecting two or more racial categories are 

included in each of the categories selected, so column totals are greater than the total number of respondents. 

Table 46 shows the racial and ethnic composition of the U.S. population, the public health nutrition 

workforce, the WIC nutrition workforce, and WIC participants. Different treatments of nonresponse 

and variation in fixed response categories limit the comparisons that can be made.38 Although a 

higher proportion of the U.S. population reporting one race categorizes itself “white” than does the 

public health nutrition workforce, (75.4 percent and 66.7 percent, respectively), there is not a 

corresponding higher proportion of reported minority races among the workforce respondents. 

Relatively few of the workforce respondents (0.5 percent) selected two or more races compared to 

2.4 percent in the total population in the U.S. 2000 Census. 

The ethnicity and racial composition of the WIC workforce has yet to reflect the characteristics of 

the WIC participants themselves. For example, African Americans are underrepresented in the WIC 

workforce (11.3 percent) both in comparison to their representation in the general population (12.3 

percent) and among WIC participants (22.9 percent), while Latinos, who constitute 20.8 percent of 

the WIC workforce, make up 32.3 percent of WIC participants but less than 13 percent of the U.S. 

population (Table 46). This difference is particularly deserving of further analysis in that a 

compilation of information on the representation of minorities in the health professions indicated 

that 18.2 percent of dietitians were Black and 4.3 percent were Hispanic.39

Table 46 

 

38 For example, the National Survey of WIC Participants considered Hispanic (Latino), non-Hispanic whites and 

non-Hispanic Blacks as mutually exclusive classifications. The U.S. Census and the 2000 ASTPHND survey 

collected data on ethnicity (Hispanic/Latino) and race in two separate questions. 39 ftp://158.72.84.9/ftp/bhpr/workforceprofiles/DC.pdf
58

Diversity of the U.S. Population, PH Nutrition Workforce, and WIC Participants 

Race 

U.S. 

Population 

200040

PH Nutrition 

Workforce 

2000 

WIC 

Workforce 

2000 

WIC 

Participants 

200141

One race reported 97.6% 85.1% 84.2% 

American Indian/ 

Alaskan Native 

 

 0.9% 

 

 0.8% 

 

 0.8% 1.5% 

Asian 3.6% 6.3% 6.5% 3.2%** 

Black or African American 12.3% 10.9% 11.3% 

 22.9% 

Non-Hispanic 

Hawaiian/Pacific Islander 0.1% 0.3% 0.3% Not reported 

White 75.4% 66.7% 65.3% 

 39.2% 

Non-Hispanic 

Other race 5.5% *** *** 

Two or more races 2.4% 0.5% 0.5% 

Not collected 

for this time period 

No response race Not shown 14.4% 15.2% 0.8% 

Ethnicity 

Latino/Hispanic 12.5% 19.4% 20.8% 32.3% 

*Non-Hispanic/Latino 

**Includes Pacific Islanders 

***Question did not include “other race” response choice. 

Like cultural competency, linguistic competency is important for the achievement of 2010 

objectives. Eighty-three percent of the nutrition workforce reported English as the primary 

language. English predominates somewhat more in the non-WIC workforce (91 percent) than 

among WIC workers (83 percent). Nearly 30 (27.6) percent report Spanish as either the primary 

or secondary language, including 28.9 percent of the WIC workers. More than one-third (36 

percent) speaks more than one language. Although many languages are spoken, with the 

exception of Spanish, Tagalog, (1.6 percent), and African-based languages (1.3 percent), and 

French (1.3 percent), no other languages were reported as primary or secondary by more than 1 

percent of the national workforce (Table 47). 

In 1994, 80 percent of all respondents and 82 percent of WIC respondents said their primary 

language was English. More than 15 percent (15.7 percent) said they spoke Spanish as either 

their primary or secondary language. The increase since 1994 in the numbers of Spanishspeaking workers appears to be primarily due to the inclusion of the California workforce in 

2000. In states other than California, 18.6 percent of the respondents reported speaking Spanish 

as their primary or secondary language. 

One of several efforts under way to improve the diversity of the public health nutrition workforce is 

a project of the American Public Health Association, Food and Nutrition Section targeting 

undergraduate nutrition programs. Marketing materials are being developed to teach these 

 

40 U.S. Census Bureau, Census 2000, Table DP 1. Profile of General Demographic Characteristics. See 

http://www.census.gov/ 41 National Survey of WIC Participants, Abt Associates, Inc., USDA, FNS, Report No. WIC-01-NSWP, October 

2001 http://www/fns.usda.gov/oane
59

undergraduates about opportunities in public health.42

Table 47 

Primary and Secondary Languages Reported by WIC and Non-WIC Respondents 

 WIC Non-WIC Total 

Language Primary Secondary Primary Secondary Primary Secondary 

African 

Languages 106 1.1% 21 0.2% 11 1.2% 2 0.2% 117 1.1% 23 0.2% 

Cambodian 

or Khmer 22 0.2% 53 0.6% 0 0.0% 9 0.9% 22 0.2% 62 0.6% 

Chinese 61 0.7% 44 0.5% 6 0.6% 2 0.2% 67 0.6% 46 0.4% 

Eastern 

European 

Languages 4 

<0.1

% 13 0.1% 0 0.0% 1 0.1% 4 

<0.1

% 14 0.1% 

English 7704 82.6% 1127 12.1% 870 91.1% 38 4.0% 8578 83.2% 1165 11.3% 

French 17 0.2% 99 1.1% 4 0.4% 13 1.4% 21 0.2% 112 1.1% 

Haitian or 

Creole 9 0.1% 15 0.2% 2 0.2% 0 0.0% 11 0.1% 15 0.1% 

Hmong 40 0.4% 6 0.1% 0 0.0% 0 0.0% 40 0.4% 6 0.1% 

Korean 4 

<0.1

% 2 

<0.1

% 0 0.0% 0 0.0% 4 

<0.1

% 2

<0.1

% 

Laotian 9 0.1% 10 0.1% 0 0.0% 0 0.0% 9 0.1% 10 0.1% 

Native 

American 

Languages 7 0.1% 6 0.1% 0 0.0% 1 0.1% 7 0.1% 7 0.1% 

Portuguese 11 0.1% 21 0.2% 1 0.1% 3 0.3% 12 0.1% 24 0.2% 

Russian 9 0.1% 9 0.1% 0 0.0% 1 0.1% 9 0.1% 10 0.1% 

Sign 1 

<0.1

% 34 0.4% 0 0.0% 3 0.3% 1 

<0.1

% 37 0.4% 

Spanish 881 9.4% 1820 19.5% 27 2.8% 116 12.1% 908 8.8% 1940 18.8% 

Tagalog 119 1.3% 54 0.6% 9 0.9% 5 0.5% 128 1.2% 59 0.6% 

Thai 9 0.1% 6 0.1% 0 0.0% 0 0.0% 9 0.1% 6 0.1% 

Vietnamese 38 0.4% 10 0.1% 0 0.0% 0 0.0% 42 0.4% 10 0.1% 

Other 69 0.7% 113 1.2% 5 0.5% 14 1.5% 74 0.7% 127 1.2% 

No 

Response 

or None 210 2.3% 5867 62.9% 20 2.1% 747 78.2% 246 2.4% 6634 64.4% 

Total 9330 9330 955 955 10309 10309 

 

42 Food and Nutrition Section exposes students to public health careers, The Nation’s Health, vol. XXXII, February 

2002. For more information, contact Annie B. Carr < abc1@cdc.gov > 
60
61

Conclusions

Since 1994, the public health nutrition workforce has increased in full-time equivalents as well 

as number of positions. The USDA, primarily through the WIC Program, is increasingly the 

main support for the public health nutrition workforce. USDA was the funding source for 82.3 

percent of the total full-time equivalents constituting the workforce, with WIC providing the 

funds for 81 percent. Other federal funding as well as state support appears to have declined 

proportionately since 1994. Ninety percent of the public health nutrition workers spend some or 

all of their time working in the WIC Program, and the great majority of WIC nutrition staff is 

located at the community level, where direct client services are provided. Two-thirds of the WIC 

nutrition workers are in professional job classifications and about one-third are classified as 

paraprofessionals, an increase in the proportion of paraprofessionals from 19.4 percent in 1994. 

Efforts to increase the overall academic qualifications of the WIC workforce have yet to be 

realized. 

Direct client services include such activities as assessment of a client’s nutritional status, 

individual counseling, group education, and developing individual care plans. Overall, 75.3 

percent of the entire workforce spends more than half of their work time in direct services. 

Although WIC paraprofessionals (84.9 percent) are considerably more involved in direct 

services than are professional workers, 74.9 percent of persons in professional job categories 

spend 50 percent or more of their work time in direct services. One-third (37.2 percent) of 

paraprofessionals and 18 percent of professionals spend all of their time in direct services. While 

there is variation by job classification, overall, the entire public health nutrition workforce is 

heavily involved in direct client services. Nevertheless, the majority of workers, including 56.8 

percent of paraprofessionals, are devoting some time to public health functions other than direct 

client care. It should be of considerable concern to public health officials that the public health 

nutrition workforce has become increasingly dependent upon a single source of support (USDA 

WIC) and is primarily focused upon direct client services during a period when the achievement 

of national health objectives require population-based environmental approaches.43

Public health nutrition workers constitute a very experienced workforce. Among those in WIC, 

47.3 percent have worked in the nutrition profession for more than 10 years, including 30.1 

percent with at least an equivalent period in the WIC program. At the other end of the spectrum, 

38.2 percent of the WIC nutrition workforce have worked in the program for less than five years 

and 28.0 percent have less than five years of experience in the field of nutrition. Compared to 

paraprofessionals, WIC professionals tend to have somewhat more years of experience in WIC 

as well as in public health nutrition and in the field of nutrition. Non-WIC workers report even 

longer tenures in comparison to their WIC counterparts: 67.7 percent have worked in nutrition 

for more than 10 years, and 38.4 percent in public health nutrition for a similar period. Data on 

age of the workforce were not collected, but the proportion of respondents that have been 

working in the field for 20 years and longer suggests that the eventual replacement of workers as 

they retire is an issue requiring consideration by public health officials. 

 

43 See Guidelines for Comprehensive Programs to Promote Healthy Eating and Physical Activity: A publication of 

the Nutrition and Physical Activity Work Group, Susanne Gregory, Editor, 2002, www.astphnd.org accessed July 

17, 2002. 

 
62

To the extent that data were reported, median salary ranges for all public health nutrition job 

classifications appear to have increased from 1994 to the period during which this survey was 

conducted in late 1999 and early 2000. However, it is unclear whether the increases have kept up 

with inflation. 

Overall, the academic preparation of the public health nutrition workforce appears to be 

commensurate with registration and licensure requirements, as well as general job classifications 

and expectations for professional and paraprofessional work in the field of nutrition. However, 

the workforce as a whole has very limited formal training in public health, including public 

health nutrition. Half of the WIC nutrition workforce has a bachelor’s degree in nutrition or 

dietetics and 11.7 percent have a master’s degree in the same. Two-thirds (37.6 percent) of the 

respondents in the 2000 survey indicated they are RDs. Only 1.6 percent of those who are not 

registered are RD-eligible. The proportion of RDs among the WIC nutrition workforce has not 

increased since 1994, when it was 38.4 percent, nor has the proportion of DTRs within the WIC 

workforce increased. Non-WIC workers, who in comparison to the WIC workforce are more 

likely to be classified as professionals rather than paraprofessionals, have a higher proportion of 

persons who are RDs (77.1 percent) and have advanced training. 

Excluding the state of California for purposes of comparability, the number of WIC workers 

responding that they are RDs increased from 2514 in 1994 to 2674 in 2000 (approximately 6.0 

percent), a period of time during which funding and numbers of recipients also increased. The 

proportion of the WIC workforce with RDs in comparison to workers without this certification 

appears to have remained constant, a period of time during which funding and numbers of 

recipients also increased. The proportion of the WIC workforce with RDs in comparison to 

workers without this certification appears to have remained constant. 

Information reported on academic training, both completed and in-process, the steps taken 

toward certification, and completion of core public health courses suggests that upgrading and 

enhancement of the skills and qualifications of this workforce cannot be expected to occur 

automatically as a result of trends that are under way. Only a small proportion of currently 

employed paraprofessional workers can be described as having the academic background 

necessary for mobility into positions classified as professional. 

Likewise, only a very small percentage of public health nutrition workers indicated they are 

actively pursuing bachelor’s degrees in nutrition/dietetics or public health/community nutrition. 

Responses suggest the preparation of the workforce in the area of nutrition and dietetics is not 

being enhanced by academic work toward a degree undertaken during their employment. 

Strategies to enhance the skills of the workforce are limited by the number of workers who have 

the basic academic qualifications to take advantage of distance learning, self-study and 

continuing education. Examination of the highest degree obtained by these workers suggests that 

certification and upward mobility will be difficult for the paraprofessional WIC workforce; 69.1 

percent of these workers do not have a college degree, including the associate degree. Among 

the professional workers, the 66 percent whose highest degree is at the bachelor’s level could 

reasonably be expected to have the background for additional specialized training in public 
63

health nutrition. 

The lack of training in public health and/or public health nutrition among the workforce is of 

concern. Less than 10 percent of all workforce respondents report having a public health-related 

degree. Although significant proportions of those workers who do not have a public healthrelated degree have completed one or more of the five core public health courses, only a 

relatively small proportion reported course work in epidemiology (5 percent) or environmental 

health sciences (7 percent). 

When asked to identify their training needs, respondents’ choices clustered in the general area of 

client and population groups, which would tend to enhance their skills in direct client services 

rather than in skill areas focusing upon assessment, environmental change and policy 

development. WIC workers continue to request training on the nutritional concerns of infants, 

children, and pregnant women, as well as on the subject of breastfeeding. As in 1994, the topic 

of nutrition for children with special health care needs remains one of the top perceived training 

needs. 

The dedication of high proportions of time of WIC and non-WIC workers, paraprofessionals and 

professionals to the provision of direct client services and the concentration of perceived training 

needs around client and population issues raises questions about the extent to which the public 

health nutrition workforce will be able to contribute to the critical environmental and populationbased approaches to the improvement of the nation’s health. 

Overall, the WIC nutrition workforce is somewhat more diverse than the overall U.S. population, 

but the racial and ethnic composition of the workforce does not reflect the racial or ethnic 

characteristics of the WIC participants themselves, nor is it clear that the workforce has become 

more diverse. Nearly 30 percent of the nutrition workforce speak Spanish as either their primary 

or secondary language, and 36 percent speak more than one language. 
64
65

Limitations of the Study 

Although ASTPHND as an organization and its members as individuals had considerable 

experience in survey data collection, many things were learned and/or reinforced throughout the 

data collection and analysis. Many of the study limitations are inherent in the design and were 

discussed or implied in the section on study design. Any approach has its own unique strengths 

and weaknesses; modifications of this design would have introduced other limitations. 

Because of the decentralized data collection, the study did not incorporate quality-control 

features that are typically used in large-scale surveys. For example, the study did not resurvey a 

sample of respondents or include a process for assuring that questionnaires were actually 

distributed and completed as intended. 

Data entry at the state level affected data quality. Although the instructions suggested that 

standard duplicate data entry (for which EpiInfo does provide) be used, this was not emphasized, 

primarily because ASTPHND believed it would be too burdensome. Calls for assistance 

indicated that persons assigned to complete data entry were not always well prepared. The 

EpiInfo data-entry program is not conducive to viewing data-entry errors. 

While the overall response rate was excellent, item nonresponse posed limitations. ASTPHND is 

unable to determine whether the item responses could have been improved by modifying 

instructions and/or response categories. More extensive pretesting possibly would have been 

helpful. Pretesting was not sufficient to gauge variations in interpretations of items due to 

differences in the structure of public health programs. The three pretest states may not have 

provided a sufficient range of experience. Responses appeared not to capture the varying 

interpretations of questions later encountered in survey administration. 

Variation across states in interpretation of study directions concerning inclusion of various 

categories of workers, in addition to differences in state program structure and response rates, 

was discussed in the section on study design. The lack of comparability across states limits 

comparisons and affects the validity of generalizations concerning the public health nutrition 

workforce. 

Although a process for estimation of the state-specific and overall response rates was provided, 

initial submissions suggested that not all state survey administrators had maintained the required 

records. 

Data collection took much longer than planned by ASTPHND or by individual states. This is 

perhaps a reflection of the decreasing resources in state health agencies, which increases the 

burden of work for each individual public health worker. Also, the burden of response was 

probably underestimated. Lack of adherence to the study schedule affected the analysis and the 

provision of state-specific profiles to the state directors. Additional resources to provide more 

assistance to states will need to be considered in future surveys, along with methods to 

streamline data entry, including online surveys. 
66

Given the time and effort of the state and local nutritionists to complete the survey, the study 

would have benefited from more resources for data analysis. Procedures for estimation of 

missing values and multivariate analysis may have been appropriate to address certain analysis 

objectives. 
67

Appendix A 
68
69

ASTPHND Data and Epidemiology Committee 

Barbara Keir, Chair, Texas 

Nancy Berger, Connecticut 

Joyce Dougherty, Washington 

Denise Ferris, West Virginia 

Carole Garner, Arkansas 

Linda Peterson, Wisconsin 

Ruth Shrock, Ohio 

Annie Siu-Norman, Missouri 
70
71

Appendix B 
72
73

Instructions for Data Collection 

1999 PUBLIC HEALTH NUTRITION WORKFORCE SURVEY 

INSTRUCTIONS FOR ASTPHND DESIGNEES 

In this file/packet you will find the instructions and forms to conduct the 1999 Public Health 

Nutrition Workforce Survey in your state. These instructions are being sent to you by regular mail 

as well as by e-mail. The survey questionnaire is not being sent electronically: It is in the mailed 

packet. Otherwise, the contents are the same. 

As you know from numerous preceding communiqués and discussions at the annual conference in 

June in Indianapolis, ASTPHND has received support from the USDA to conduct a census of the 

public health nutrition workforce. Many of you have experience administering the biennial 

workforce surveys during the period 1989-1994. As in past years, the survey is designed for 

administration, editing and data entry to be conducted at the state level. The questionnaire is a fixed 

response format that can easily be completed in 15 minutes by most respondents. Data analysis and 

report preparation will be completed by ASTPHND. 

Step 1—Review enclosed survey administration materials and participate in orientation 

conference call. 

We are scheduling a choice of conference call times during the period September 21—29 to orient 

you to conducting the survey in your state. Next week we will e-mail you the schedule and 

directions for calling in. If you cannot participate in one of scheduled calls, we will arrange another 

time. During the conference call, these instructions will be reviewed and your questions answered. 

It is important that you or the person carrying out the survey in your behalf participate in the call 

and that there is consistent management throughout the survey process. In the event that someone 

is “acting designee” for any period during the next few months, please arrange for that person to 

have access to your e-mail, or leave instructions with your secretary for forwarding e-mail messages 

to that person. We ask that you do this so that we can establish a consistent mechanism of 

communication with your state. 

Please review these materials, as well as the August 9 e-mail update from ASTPHND, in 

preparation for the conference call. If you have immediate questions, contact Mary McCall at 

cubammc@aol.com.

The complete survey instruction packet contains: 

1. Instructions for conducting the survey. 

2. 2 forms (Transmittal to State Form and Transmittal to ASTPHND Form) to assist with record 

keeping and tracking response rates. 

3. The questionnaire for you to copy and distribute in your state. (in mailed packet only) 

4. A “vacant position” questionnaire for you to copy and distribute. 

5. Instructions for data entry using EpiInfo (to be sent next month) 

6. A disk with the EpiInfo data entry and editing programs. (to be sent next month) 
74

Step 2—Decide which program/nutrition workers to survey. 

This is a census of the public health nutrition workforce in your state. All persons who work as 

nutrition professionals or nutrition paraprofessionals in public health nutrition programs, such as 

WIC, OR in other public health programs or services under the purview of the state health agency, 

should complete the questionnaire—the1999 PUBLIC HEALTH NUTRITION WORKFORCE 

SURVEY. This would include, for example, for-profit, non-profit and local health agencies that 

carry out public health nutrition activities under a contractual or grantee relationship with the state. 

These individuals may work as a contractor or employee, full or part time. Persons who work in a 

support capacity or in another profession (for example, an accountant, nurse, or physician) in a 

public health nutrition program are NOT to be included. For example, the survey should not be 

administered to nurses who function as certifying officials in WIC clinics – even if they are the 

primary person providing counseling and education to WIC participants. 

Persons who are nutritionists or dietitians by education or training, but who are in non-nutrition 

related positions are NOT to be included. Likewise, nutritionists who work in clinical or academic 

programs or institutions are not included. 

ASTPHND is mailing questionnaires directly to WIC Programs operated by Indian Tribal 

Organizations. However, if there are other public health nutrition professionals or paraprofessional 

working with Indian Health Service programs in your state, please include them in your survey. 

The scope of public health nutrition services varies considerably from state to state, making it 

impossible to explicitly define or list each position that should be included in your state. Each 

ASTPHND designee will need to decide based upon her/his knowledge of programs and position 

classification schemes. To resolve issues on inclusion, including which tribal organizations have 

been surveyed, contact Barbara Keir (Barbara.Keir@TDH.State.TX.US) 

Step 3—Communicate in advance with public health nutrition programs and prospective 

respondents about the upcoming survey. 

Advance notification of and request for participation in a survey is known to boost response rates. 

Use whatever communication mechanisms you have—newsletters, staff meetings, broadcast fax, 

list serves, web sites, e-mail and bulletins—to inform people of the upcoming survey and when it 

will be distributed. This will help program managers to incorporate it into their schedules and will 

increase cooperation. When you publicize the survey, you can include a few sentences about its 

purpose and how it will be used. Afterwards, you can thank them for their participation and give 

them information on the responses and summary findings. 

WAIT UNTIL AFTER YOU HAVE COMPLETED THE ORIENTATION CONFERENCE 

CALL TO COMPLETE THE REMAINING STEPS. 

Step 4—Prepare cover letter and distribute questionnaire, vacant position questionnaire and 

other materials. 

Use colored paper to make as many copies of the questionnaire as needed for your state. A color 
75

will get the respondent’s attention and makes the questionnaires easier to track. Before making 

copies, fill in the blank space on page 1 about who to contact for help. Because we were required to 

obtain clearance from the Office of Management and Budget, as indicated by the OMB number on 

its first page, the questionnaire cannot be modified. That is, you cannot attach additional questions 

to the body of the survey itself. 

It’s OK to use two-sided copies. 

Each state ASTPHND representative should attach a cover page or letter to the questionnaire. 

The cover page or letter should contain at least the following information: 

1. To whom the questionnaire should be distributed (which agencies, programs, and 

categories of personnel), using terminology with which persons in the state are familiar. 

After you have reviewed each of the questions and fixed responses, you may need to “translate” 

some of the terms and concepts into language that workers in your state are familiar with. For 

example, the functional names for different categories of nutrition workers (see the attachment on 

the last page of these instructions) may be different from the job titles and/or personnel 

classifications used in your programs. In addition to the instructions on the first page of the 

questionnaire, you may need to explain who should, and should not, participate in the survey. 

2. Suggestions for how the survey should be distributed and completed, including how to 

obtain a high response rate. For example, if it can be distributed, completed and collected at a 

staff meeting or at the conclusion of a training event or conference, or if you yourself can administer 

it during a site visit, the response rate will be higher and less follow up time will be required for the 

coordinator. Staff should be given work time to complete it. You can also tell respondents that you 

will give them a summary of survey findings or do a presentation after the final report has been 

prepared. 

Also, clarify responsibility for follow up on nonresponses. A MINIMUM of two contacts is to be 

made with each nonresponder. You can establish your own protocol for follow up. 

3. Deadline for completion (allow enough time for distribution but not so much time that it 

gets put aside). Your deadline will depend upon your schedule, the mechanism for distribution, 

your resources and the size of your workforce. You should allow enough time for state-level data 

editing and entry. We are asking that you submit the completed data file to Barbara Keir by January 

10, 2000. 

4. How and where to submit completed questionnaires (batched, regular mail, fax or whatever 

works best in your situation), and directions for completion of the Transmittal to State Form. 

(See below.) 

5. Who to contact (and how) to answer any questions respondents may have, particularly 

about sources of funding for positions. You can write the contact information in on page 1 of the 

questionnaire before it is copied. 
76

6. Instructions for dealing with vacant positions (see vacant position form). A program manager 

will need to complete this form for each public health nutrition position that is currently vacant. 

7. Instructions for obtaining more copies. 

8. Instructions for dealing with unique situations in your state (federal/state WIC funds split, 

enhanced Medicaid). It will made data editing much easier if you take a few minutes to instruct 

respondents on how to answer certain items. You should also provide guidance with the items 

(question #16) on sources of funding because local staff often may not know the origin of funds. 

Step 5—Maintain records of number of questionnaires distributed and collected. 

In past workforce surveys some state nutrition directors have directly distributed the questionnaire 

to individual public health nutrition workers in the state. This will work well in smaller states, 

and/or if you can allocate administrative resources to the effort, if there is an accurate mailing list, or 

if the questionnaire can be distributed at training events, conferences or during site visits. Many of 

you will rely on staff in local agencies to distribute and collect the questionnaires. Most states will 

use a combination of direct distribution and distribution via local agencies. 

Make a list of the persons, agencies, programs and/or offices to which you are distributing 

questionnaires. The list should include the contact person, date of distribution, number of 

questionnaires sent, and space for comments and notes. You can use the list to record dates and 

results of follow-up contacts and final results. 

If you distribute multiple copies of the questionnaire for someone else to distribute and collect, 

attach a copy of the Transmittal to State Form to each bundle of questionnaires. You can make 

copies of the transmittal form, using a color different from the color of the questionnaire. Before 

making copies, fill in your name, address and contact information at the bottom of the form. For 

each group of questionnaires that you send out, fill out the information at the top of the form at to 

where you are sending the questionnaires. For best results, you will need to communicate 

personally regarding the importance of completing this form. When the completed questionnaires 

are sent back to your office, the completed Transmittal to State Form must be attached. Otherwise, 

you will have no way of knowing how complete the participation has been. 

The Transmittal to State Form requires accounting for all questionnaires distributed: how many 

distributed in the program, how many returned from ineligibles, how many completed and returned, 

how many refusals, how many vacant positions. 

Whatever method you use to administer the survey, it is important to maintain accurate records for 

follow up and calculation of response rates. The Transmittal to ASTPHND Form will help you 

with record keeping. When you submit the state questionnaire data file, include this completed 

form. ASTPHND will use the information to calculate and compare response rates. 

We realize the transmittal forms constitute additional steps not required and reported in previous 

surveys, however, standard survey procedures require accounting for responses and refusals. 
77

Step 6—Protect Confidentiality and Privacy of Responses throughout the Survey Process 

Participation in the survey is voluntary—employees and contractors are requested to participate. 

They are requested to give their names. They are given work time to participate. In this survey, 

respondents are asked to record their name and contact information on page 1 of the questionnaire. 

The reason for this is to allow you to go back to the respondent to obtain any missing information 

and/or to clarify incomplete or inconsistent information. Names are also obtained to facilitate 

follow up reminders to nonresponders. 

Although the questions are not of a highly sensitive nature, OMB considers that some items request 

some “fairly confidential personnel information”. Therefore, you and your office, as well as any 

persons who are involved in the distribution and collection of questionnaires in your behalf, 

including secretaries and data entry clerks, need to implement protocols for handing confidential 

personnel records. You also need to assure that no personnel actions or intervention could result 

from information obtained through participation. 

The instructions for data entry and preparation of the survey data file (to be sent later) will specify 

that the respondent’s name and contact information are NOT to be entered into the data file. The 

editing and data entry instructions will delineate steps for separating the contact information from 

the responses and storing them separately, as well as how long to keep the hard copies. 

All completed questionnaires, both before and after submission to you, should be maintained in a 

locked area. 

End of General Instructions—Forms Follow
78
79

Transmittal to ASTPHND Form—1999 Public Health Nutrition Workforce Survey 

Please complete this form and include it when you send the state data file disk (or for those 

states that have arranged for ASTPHND to complete data entry, put the form on top of the 

questionnaires) to ASTPHND. 

State ____________ 

Name of State Nutrition Director/Designee _____________ 

Phone/Fax/E-mail __________________________________ 

Date of submission to ASTPHND ________ 

In order to calculate the response rate for this national census, we need to know the number of 

public health nutrition workers in your state that responded to the survey and also the number that 

did not respond. Please note that many states use a combination of direct distribution to 

individuals and distribution to agencies. If this is the case in your state, you will need to supply 

numbers for both # 1 and 2 below.

1. Did you give or send the questionnaire directly to any public health nutrition personnel in 

your state? 

___no 

___ yes If yes: Write the numbers in the spaces below. 

A. How many workers did you send/give it to? 

 ____ 

B. How many workers completed and returned the questionnaire? ____ 

C. How many workers received the questionnaire and returned it 

 because they did not meet the criteria? (question 4, #11) ____ 

D. How many workers did not complete and return the questionnaire? ____ 

The sum of the numbers in lines B through D should equal the number in line A. 

 E. How many forms were filled out for vacant positions? ____ 

2. Did you give or send the questionnaires to any agencies or organizations and ask them to 

distribute questionnaires to all their public health nutrition personnel? 

___ no 

___ yes If yes: Use the Transmittal to State Forms submitted to you by organizations in your 

state to compile this information. Write the numbers in the spaces below. 

How many organizations/agencies did you send/give questionnaires to? ____ 

A. In total, how many workers received the questionnaire? ____ 

B. In total, how many workers completed and returned the questionnaire? ____ 

C. In total, how many questionnaires were returned for ineligibility? 

(question 4, #11) ____ 

D. In total, how many workers did not complete and return the questionnaire?____ 

The sum of the numbers in lines B through D should equal the number in line A. 

E. In total, how many forms were filled out for vacant positions? ____ 
80
81

TRANSMITTAL TO STATE FORM 

1999 PUBLIC HEALTH NUTRITION WORKFORCE SURVEY 

Complete and return this form when you return questionnaires. 

 

Name _______________________ Phone ____________________ 

Organization _______________________________ Date _________ 

In case there are questions during the data entry process, who should be contacted? 

_________________________________ 

A. How many public health nutrition workers did you send/give the questionnaire to? 

 Write the number here. _________ 

B. (Of the number distributed) How many workers filled out and returned the questionnaire? 

Write the number here. _________ 

C. (Of the number distributed) How many workers received the questionnaire and returned it 

because they were ineligible, that is, they did not work in public health nutrition? (question 

4, #11) 

Write the number here. ____ 

 

D. (Of the number distributed) How many workers did not fill out and return the 

questionnaire? 

Write the number here. _________ 

The sum of lines B through D should equal the number in line A. 

E. How many “vacant position forms” are included in your submission? 

Write the number here. _________ 

Return this form and the completed questionnaire to: 

(To be completed by state nutrition director) 

_________________________ 

_________________________ 
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83

Appendix C 
84
85

1999 PUBLIC HEALTH NUTRITION WORKFORCE SURVEY 

WHY? The Association of State and Territorial Public Health Nutrition Directors with support from the United States 

Department of Agriculture is conducting a survey of public health nutrition personnel, including WIC staff, in all US 

states and territories. The purpose of the survey is to have current information on work responsibilities, areas of practice, 

training, and compensation and to use the information to support recruitment and retention. Several similar surveys have 

been conducted during the period 1989 through 1994. According to the Paperwork Reduction Act of 1995, no persons 

are required to respond to a collection unless it displays a valid OMB control number. The valid OMB control number 

for this information collection is O584-0497. The time required to complete this questionnaire is estimated to be 15-20 

minutes for individual respondents and 20 hours for each state nutrition director to review procedures, compile lists of 

employees, distribute and collect questionnaires, edit and enter data, and maintain records. 

WHO SHOULD COMPLETE THE SURVEY? – Every person classified or functioning as a nutritionist or 

paraprofessional in a public health program, which includes WIC, should answer each question as completely as 

possible. Please complete the questionnaire if you work in a nutrition position, even if your job currently encompasses 

additional responsibilities. 

Persons who are nutritionists or dietitians by education or training, but who are in non-nutrition related positions should 

not complete the questionnaire. If you work in a support capacity or in another specialty (e.g. accountant, computer 

specialist, nurse, physician or receptionist), do not complete the questionnaire. Because the questions are being asked of 

nearly 8,000 nutrition personnel throughout the US and territories, the job titles, names of programs and examples may 

be somewhat different from your own work experience. Nevertheless, choose the answer that is closest to your own 

situation. 

HELP? If you have questions about this survey or how to answer specific questions, contact your supervisor or 

__________. Use the definitions and job descriptions on the last page to answer question # 4. 

USE OF INFORMATION? Please complete the individual contact information on this page and submit it with the 

completed questionnaire. The purpose for the contact information is to help the state nutrition director to edit and input 

the data. She/he may need to contact you to follow up on any incomplete items or to clarify some answers. Your name 

and contact information will NOT be entered into the database. Your responses are to be used for assessment purposes 

only. Your responses will not be maintained in personnel files, rather they will be used confidentially in our national 

efforts to improve recruitment and retention of nutrition workers. 

Name _____________________Phone ________________Fax ________________E-mail _____ 

Name and Address of Program _________________________________________________ 

The Association of State and Territorial Public Health Nutrition Directors thanks you for your participation. 
86

1999 PUBLIC HEALTH NUTRITION WORKFORCE SURVEY 

Current Public Health Nutrition Practice 

1. Check the type of agency where you are employed (or contracted). Check only one. 

 ____ 1 State government health agency 

 ____ 2 Local government (city, county) health agency 

 ____ 3 Indian Health Services, tribal agency or tribal health center 

 ____ 4 Non-profit organization 

 ____ 5 For-profit organization 

 ____ 6 Other, describe ______ 

2. Check the primary location where you work. Check only one. 

 ____ 1 Central office of state government health agency 

 ____ 2 Central office of district or regional (sub-state) government health agency 

 ____ 3 Central office of local (county, city or multi-county) government health agency 

 ____ 4 Community/rural/migrant health center or clinic 

 ____ 5 Field office or clinic of a government health agency 

 ____ 6 HMO or other managed care setting 

 ____ 7 Hospital 

 ____ 8 Indian Health Services, tribal agency or tribal health center 

 ____ 9 Other private/independent entity/office 

 ____ 10 Other, describe ____________ 

3. Write in the blank your current position or job classification title. ________________. 

4. Read the Attachment on the last page for a description of job classifications. Check the job classification 

below that is most similar to your position. Check only one. 

 ____ 1 Public health nutrition director 

 ____ 2 Assistant public health nutrition director 

 ____ 3 Public health nutrition supervisor 

 ____ 4 Public health nutrition consultant 

 ____ 5 Public health nutritionist 

 ____ 6 Clinical nutritionist 

 ____ 7 Nutritionist 

 ____ 8 Nutritionist technician 

 ____ 9 Nutrition assistant/aide 

 ____ 10 Other, describe ______________ 

 ____ 11 No public health nutrition responsibilities Stop here. Return the questionnaire. 

5. How many years, including part time employment, have you practiced/been employed in the field of dietetics 

and/or nutrition? Write in the total number of years, rounding to the nearest year. If less than six months, write 

"0". ____ Years

6. Of the total number of years recorded in #5 above, for how many years have you practiced public health 

nutrition, including WIC? _____ Years. 
87

7. Are you currently working in a WIC program? 

 ___ Yes: How many years have you been working in the WIC program? ___ Years

 

 ___ No 

8. How many full time equivalent employees (FTE), positions, and/or consultants do you currently supervise or 

have line authority for? Include any positions that are currently vacant. Write in the number converted to full 

time equivalents. Round to a whole number. If you do not have supervisory responsibilities, enter “0” and go 

to question 10. ____FTEs

9. Of the number reported in #8 above, how many FTE nutrition positions do you currently supervise or have 

line authority for? Write in the number here. If you do not have supervisory responsibility for nutrition 

positions, enter “0”. ____FTEs

10. How much fiscal and budgetary responsibility and control do you have in your current position? Check only 

one. 

 ____ 1 None 

 ____ 2 Responsible for a specific budget 

 ____ 3 Responsible for entire agency nutrition program budget 

11. In a typical month, what percent of your time do you spend in direct client services, such as nutritional 

assessments, individual counseling, group education, or developing care plans? (Do not include working with 

health professionals or other organizations.) 

 Write in the number. ___ Percent 

 

12. Are you currently employed by your agency or contracted to your agency? 

 ____1 Employed ____2 Contracted 

 

13. Is this full or part time? (Full time is the number of hours per week defined by your personnel system.) 

 ____ Full time--100% 

 ____ Part time: write in the current percent time ____% 

14. If you are a contract worker or consultant (instead of an employee), how are you paid? 

 ____ 1 hourly rate ____ 2 Daily rate ____ 3 for specific services or products 

____ 4 Retainer Skip to # 16. 

15. If you are a full time employee, please record the ANNUAL salary range for your job classification as 

established by your agency's personnel system. Round to nearest dollar. If your employer does not have or 

disclose an established salary range for your position, record your current annual salary in the minimum space 

below.

 Minimum or first step $ ________________ per year 

 Maximum or highest step $ ________________ per year 

 

 If you are a part time employee, record your current annual salary in the space below. 

 

 Current $________________ per year 
88

16. Check all sources of funding for your position and write in the percent of your time from each funding source. If 

you are not sure about sources of funds for your position, ask your program manager or the contact listed on 

the cover page. Your answers should add up to the total percent time reported in question #13. For example, if 

you are employed full time and have more than one funding source, your response should add up to 100%. If you 

are employed part time, your responses should add up to the percent time you specified in #13. 

 1st Example: You work half time (50%). You are funded by WIC. Check "WIC" and write in 

"50%". 

 2nd Example: You work halftime. You are funded half by WIC and half by the Maternal and Child 

Health Block Grant. In question #13, indicate you work 50% time. Then check both WIC and MCH 

Block Grant and write in 25% for each. 

 3rd Example: You work full time. Your position is paid for by a grant from a local foundation. Write 

“100%” in Foundation or corporate grants. 

State Government Funding

 ____ % Non-specified State funds 

 ____ % State funds legislatively earmarked for nutrition 

 ____ % Tobacco settlement monies 

Federal Government Funding--Department of Agriculture (USDA) 

 ____ % WIC 

 ____ % Food Stamps 

 ____ % Child Nutrition (Child and Adult Care Food Program and/or NET) 

____ % Other USDA, e.g., Commodity Supplemental Food Program

Federal Government Funding--Department of Health and Human Services 

 ____ % CDC diabetes control 

 ____ % Family Planning (Title X and Title XX) 

 ____ % Indian Health Services 

 ____ % Maternal and Child Health Block Grant (Title V) 

 ____ % Medicaid non EPSDT (Title XIX) 

 ____ % Medicaid EPSDT 

 ____ % Older Americans Act (Title III) 

 ____ % National Institutes of Health 

 ____ % Preventive Health and Health Services Block Grant 

 ____ % Ryan White HIV/AIDS 

 ____ % Other, describe ____________ 

Federal Government Funding-Education 

____ % Early Childhood Intervention, Individuals with Disabilities Education Act (IDEA)(PL105-17) 

 ____ % other, describe ____________ 

Local Government Funding 

 ____ % Local funds (city/county general revenue) 

Other revenue, funding sources 

 ____ % Fees, patient charges, or third party reimbursement

 ____ % Foundation or corporate grants 

 ____ % Other, describe _________________
89

17. Put “1” in the area of public health nutrition practice listed below in which you spend the majority of your 

time. If you have 2 major areas of practice, place a “1” next to the primary area and a “2” next to the secondary area. 

If you have 3 areas of practice, place a “1” next to the 1st, a “2” next to the 2nd, and a “3” next to the 3rd area. Do not 

mark more than 3. 

 

 Assessment 

 ____ 1 Data management, nutrition surveillance, or research 

 ____ 2 Community assessments, program planning, or evaluation 

Assurance 

 ____ 3 Health facilities regulation 

 ____ 4 Environmental health and/or food safety 

 ____ 5 Program monitoring and/or quality assurance 

 ____ 6Direct Client Services (Answer #18 below) 

Population-based Interventions 

 ____ 7 Community organization, advocacy, or policy development 

 ____ 8 Communication, mass media, or social marketing 

____ 9 Emergency food, hunger, food security, Commodity Supplemental Foods Program Management 

and administration 

____10 General management and administration 

Other 

____11 Please specify __________ 

18. If you selected Direct Client Services as a major area of your practice, which category below best 

describes the majority of your client work? Place a “1” by that category. If the majority of your client 

caseload is mixed, put a “1” by those you see the most, a “2” for second and “3” for third. Do not mark 

more than 3. 

 ____ 1 General/comprehensive nutrition 

 ____ 2 General women, infants and children 

 ____ 3 General women’s nutrition and health 

 ____ 4 General infant nutrition

 ____ 5 General child health or pediatric nutrition 

 ____ 6 School and/or adolescent health 

____ 7 Children with special health care needs, developmental disabilities, chronic illnesses, or high-risk 

infants and children 

 ____ 8 Breastfeeding 

 ____ 9 Adult health promotion, chronic disease prevention, or healthy aging 

 ____ 10 Seniors, geriatrics, adult disabilities, or adult chronic disease control 
90

Education and Training 

19. Please check ALL degrees, and related majors and concentrations you have earned. Also check any degree(s), and 

related majors and concentrations you are currently working toward. 

Type of Degree/Concentration 9 Earned 9 Working 

Toward 

Associate Degree 

 Nutrition/dietetics 

 Other 

Bachelor’s degree 

 Nutrition/dietetics 

 Public health nutrition/community nutrition 

 Home economics/family consumer science/human ecology 

 Health education 

 Other 

Master’s degree 

 Nutrition/dietetics 

 Public health nutrition/community nutrition 

 Home economics/family consumer science/human ecology 

 Public health, concentration ____________________ 

 Health education 

 Other 

Doctoral degree 

 Nutrition/dietetics 

 Public health nutrition/community nutrition 

 Home economics/family consumer science/human ecology 

 Public health, concentration ____________________ 

 Health education 

 Other 

 

20. If you do NOT have a degree in public health, public health nutrition or community nutrition, which of these 

five courses have you completed? Check all that you completed. 

 ___ Environmental health sciences 

 ___ Epidemiology 

 ___ Health services administration 

 ___ Social and behavioral sciences 

 ___ Statistics 

20. Please check all certifications that apply to you. 

 ____ Registered dietitian (RD) with Commission on Dietetic Registration (CDR) 

 ____ Licensed or certified dietitian in your state 

 ____ Dietetic technician registered (DTR) with CDR 

 ____ Certified diabetes educator (CDE) with American Association of Diabetics Education 

 ____ International board certified lactation consultant (IBCLC) 

____ Other certification in lactation or breastfeeding 

 ____ Board certification as a specialist in pediatric nutrition (CSP) with CDR 

 ____ Certified health education specialist (CHES) (continued next page) 
91

 ____ Registered nurse (RN) 

 ____ Licensed practical nurse (LPN) 

 ____ State certified teacher 

____ Certified in Family & Consumer Sciences (CFCS), with American Association for Family & Consumer 

Sciences 

 ____ Other, please specify: ____________ 

21. If you are NOT a RD, have you taken any of the following steps to become a registered dietitian? (Check all 

that apply.) 

___ Yes ___ No Completed at least a baccalaureate degree 

 ___ Yes ___ No Completed a didactic program approved by Commission on 

Accreditation-Approval for Dietetic Education (CAADE) 

 ___ Yes ___ No Completed a supervised practice program accredited by CAADE 

 ___ Yes ___ No Received a letter from CDR verifying eligibility to take exam 

22. If you are NOT a RD OR DTR, have you taken any of the following steps to become a dietetic technician? 

(Check all that apply.) 

___ Yes ___ No Completed at least an associate degree 

 ___ Yes ___ No Completed a didactic program approved by CAADE 

 ___ Yes ___ No Completed a dietetic Technician Program approved by CAADE 

 ___ Yes ___ No Completed a Dietetic Technician Program supervised practice 

program accredited by CAADE 

 ___ Yes ___ No Received a letter from CDR verifying eligibility to take exam 

23. Which of these courses have you completed? Check all completed after January 1995. 

 ____ Intensive Course in Maternal Nutrition – University of Minnesota

____ Intensive Course in Nutrition for Infants, Children and Adolescents – University of Alabama, 

Birmingham, Alabama 

____ Intensive Course in Pediatric Nutrition – University of Iowa, Iowa City 

____ Neonatal Nutrition Training – Medical University of South Carolina, Charleston, South Carolina or at the 

Indiana University School of Medicine, Indianapolis, Indiana 

____ Neonatal Nutrition and Leadership Education in Pediatric Nutrition – James Whitcomb Hospital for 

Children, Indianapolis, Indiana 

____Nutrition Concerns of the Child with Special Health Care Needs – Cincinnati Center for Developmental 

Disorders, Cincinnati, Ohio 

____ Nutrition for Children with Special Health Care Needs: Nutrition Makes a Difference – Center for Child 

Development and Developmental Disorder, Los Angeles, California 

____ Nutrition for Children with Special Health Care Needs: Nutrition Makes a Difference– Sparks Center for 

Developmental and Learning Disorders, Birmingham, Alabama 

____ Professional Training course in Nutrition and Developmental Disabilities – Boling Center for 

Developmental Disabilities, Memphis, Tennessee 

 ____ Others, describe _____________________________________________________ 
92

24. Mark up to 3 areas in which you need training for your current work. Use a “B” if you need basic training. 

Use an “A” if you have had training and now need advanced or specialized training. Mark no more than 3 in 

total. 

Client and Population Groups 

 ____ 1 Infant and pre-school age nutrition 

 ____ 2 Childhood nutrition 

 ____ 3 Adolescent nutrition 

 ____ 4 Nutrition for children with special needs, developmental disabilities or high risk 

 ____ 5 Prenatal nutrition 

 ____ 6 Breastfeeding 

 ____ 7 Women’s health 

 ____ 8 Adult health promotion, chronic disease control, or healthy aging 

 ____ 9 Seniors, geriatric nutrition 

 ____ 10 High risk clients, including HIV positive, addictions 

 ____ 11 Assessment of nutritional status 

 ____ 12 Case management/care coordination 

 ____ 13 Communicating with low literacy populations 

 ____ 14 Cultural competency 

 ____ 15 Eating disorders 

 ____ 16 Nutrition counseling, behavioral change, client education 

 ____ 17 Supplemental and alternative dietary therapies 

 Assessment Skills

 ____ 18 Applied research, data collection and analysis 

 ____ 19 Community assessments 

____ 20 Data management, surveillance and monitoring systems (including biostatistics/epidemiology) 

 ____ 21 Fund raising, proposals and grantwriting 

 ____ 22 Program planning and evaluation 

 ____ 23 Use of current information technology, including computers 

Population-based Interventions 

 ____ 24 Advocacy and policy development 

 ____ 25 Building coalitions and working in partnerships 

 ____ 26 Communications, mass media, distance learning 

 ____ 27 Environmental health and/or food safety 

 ____ 28 Environmental and policy changes to support nutrition 

 ____ 29 Hunger and food security 

 ____ 30 Practice guidelines: development and use 

 ____ 31 Social marketing 

 Management 

 ____ 32 Cost effectiveness/benefit analysis 

 ____ 33 Financial management 

 ____ 34 General management 

 ____ 35 Leadership and team building 

 36 Other, please be as specific as possible ____________________ 
93

25. Do you belong to any of the following professional organizations? Check all that apply. 

 ____ 1 American Association of Diabetes Educators 

 ____ 2 American Association of Family and Consumer Sciences 

 ____ 3 American Dietetic Association 

 ____ 4 American Public Health Association 

 ____ 5 American Public Human Services Association 

 ____ 6 American School Food Service Association 

 ____ 7 Association of State and Territorial Public Health Nutrition Directors 

 ____ 8 International Lactation Consultant Association 

 ____ 9 National Association of WIC Directors 

 ____ 10 National Association of Child and Adult Care Food Program Professionals 

 ____ 11 Society for Nutrition Education 

 ____ 12 Society of Public Health Educators 

 ____ 13 Other national professional organization ________________ 

 Personal 

26. Gender: ___Female ___Male 

27. Ethnicity: ____Hispanic or Latino ____not Hispanic or Latino 

 

28. Race: Select one or more. 

 _____1 American Indian or Alaska Native 

 _____2 Asian 

 _____3 Black or African American 

 _____4 Native Hawaiian or Other Pacific Islander 

 _____5 White 

30. From the list below mark a “1” for your primary language. In addition to your primary language, are you 

sufficiently fluent to use any other language(s) in your work in nutrition? Check that secondary language or 

languages with a “2”. 

 _____ 1 African language, specify which ________________ 

 _____ 2 Cambodian/Khmer 

 _____ 3 Chinese, specify dialect ________ 

 _____ 4 An Eastern European language, specify which __________________ 

 _____ 5 English 

 _____ 6 French 

 _____ 7 Haitian/Creole 

 _____ 8 Hmong 

 _____ 9 Korean 

 _____ 10 Laotian 

 _____ 11 Native American or American Indian language, specify which ________________ 

 _____ 12 Portuguese 

 _____ 13 Russian 

 _____ 14 Sign language 

 _____ 15 Spanish 

 _____ 16 Tagalog—Filipino language 

 _____ 17 Thai 

 _____ 18 Vietnamese 

 _____ 19 Other, specify _______________; ____________________; 

Thanks for your participation in this survey. 
94
95

FORM FOR EACH VACANT PUBLIC HEALTH NUTRITION POSITION 

If your agency currently has one or more vacancies for a professional or paraprofessional public health nutritionist, 

please take a few minutes to provide information on each vacant public health nutrition position. Consider a position 

currently vacant even if an offer has been made or if an individual has been hired but that person has not yet started 

work. Fill out a form for each vacant position. 

Name of person completing this form ________________________________Phone ______________________ 

Fax _______________________ E-mail ____________________________ 

Name and Address of Program _________________________________________________________________ 

Date completed__________ 

1. Check the type of agency with the vacant position(s). 

 ____ 1 State government health agency 

 ____ 2 Local government (city, county) health agency 

 ____ 3 Indian Health Services, tribal agency or tribal health center 

 ____ 4 Non-profit organization 

 ____ 5 For-profit organization 

 ____ 6 Other, describe ______ 

2. Check the primary location of the vacant position. Check only one. 

 ____ 1 Central office of state government health agency 

 ____ 2 Central office of district or regional (sub-state) government health agency 

 ____ 3 Central office of local (county, city or multi-county) government health agency 

 ____ 4 Community/rural/migrant health center or clinic 

 ____ 5 Field office or clinic of a government health agency 

 ____ 6 HMO or other managed care setting 

 ____ 7 Hospital 

 ____ 8 Indian Health Services, tribal agency or tribal health center 

 ____ 9 Other private/independent entity/office 

 ____ 10 Other, describe ____________ 

4. Read the Attachment on the last page for a description of job classifications. Check the job classification 

below that best describes the vacant position. 

 ____ 1 Public health nutrition director 

 ____ 2 Assistant public health nutrition director 

 ____ 3 Public health nutrition supervisor 

 ____ 4 Public health nutrition consultant 

 ____ 5 Public health nutritionist 

 ____ 6 Clinical nutritionist 

 ____ 7 Nutritionist 

 ____ 8 Nutritionist technician 

 ____ 9 Nutrition assistant/aide 

 ____ 10 Other, describe ______________ 

 ____ 11 No public health nutrition responsibilities Stop here. Return the questionnaire. 

7. Is the vacancy in the WIC program? 

 ___Yes 

 ___ No 
96

13. Is the vacant position full or part time? (Full time is the number of hours per week defined by your personnel 

system.) 

 ____ Full time--100% 

 ____ Part time: write in the current percent time ____% 

15. If the vacant position is full time, please record the ANNUAL salary range for the job classification as 

established by the agency's personnel system. Round to nearest dollar. If the employer does not have or 

disclose an established salary range for the position, write in “not disclosed”. 

 Minimum or first step $ ________________ per year 

 Maximum or highest step $ ________________ per year 

 

16. Check all sources of funding for the vacant position and write in the percent of time from each funding source. 

If you are not sure about sources of funds for the position, ask your program manager or the contact 

listed on the cover page. The answer should add up to the total percent time reported in question #13. For 

example, if the position is full time and has more than one funding source, your response should add up to 

100%. If the position is part time, the responses should add up to the percent time you specified in #13. 

 1st Example: The position is half time (50%). It is funded by WIC. Check "WIC" and write in 

"50%". 

 2nd Example: The position is halftime. It is funded half by WIC and half by the Maternal and Child 

Health Block Grant. In question #NN, indicate part time 50%. Then check both WIC and MCH 

Block Grant and write in 25% for each. 

 3rd Example: The position is full time. The position is paid for by a grant from a local foundation. 

Write “100%” in Foundation or corporate grants. 

State Government Funding

 ____ % Non-specified State funds 

 ____ % State funds legislatively earmarked for nutrition 

 ____ % Tobacco settlement monies 

Federal Government Funding--Department of Agriculture (USDA) 

 ____ % WIC 

 ____ % Food Stamps 

 ____ % Child Nutrition (Child and Adult Care Food Program and/or NET) 

____ % Other USDA, e.g., Commodity Supplemental Food Program

Federal Government Funding--Department of Health and Human Services 

 ____ % CDC diabetes control 

 ____ % Family Planning (Title X and Title XX) 

 ____ % Indian Health Services 

 ____ % Maternal and Child Health Block Grant (Title V) 

 ____ % Medicaid non EPSDT (Title XIX) 

 ____ % Medicaid EPSDT 

 ____ % Older Americans Act (Title III) 

 ____ % National Institutes of Health 

 ____ % Preventive Health and Health Services Block Grant 

 ____ % Ryan White HIV/AIDS 

 ____ % Other, describe ____________ 

Federal Government Funding-Education 

____ % Early Childhood Intervention, Individuals with Disabilities Education Act (IDEA)(PL105-17) 

 ____ % other, describe ____________ 

Local Government Funding 

 ____ % Local funds (city/county general revenue) 

Other revenue, funding sources 

 ____ % Fees, patient charges, or third party reimbursement

 ____ % Foundation or corporate grants 

 ____ % Other, describe _________________ 
97

17. Put “1” in the area of public health nutrition practice listed below in which the person in the position will 

spend the majority of her/his time. If the person in the position will have 2 major areas of practice, place a 

“1” next to the primary area and a “2” next to the secondary area. If the person will have 3 areas of practice, 

place a “1” next to the 1st, a “2” next to the 2nd, and a “3” next to the 3rd area. Do not mark more than 3. 

Assessment 

 ____ 1 Data management, nutrition surveillance, or research 

 ____ 2 Community assessments, program planning, or evaluation 

Assurance 

 ____ 3 Health facilities regulation 

 ____ 4 Environmental health and/or food safety 

 ____ 5 Program monitoring and/or quality assurance 

 ____ 6Direct Client Services (Answer #18 below) 

Population-based Interventions 

 ____ 7 Community organization, advocacy, or policy development 

 ____ 8 Communication, mass media, or social marketing 

____ 9 Emergency food, hunger, food security, Commodity Supplemental Foods Program Management 

and administration 

____10 General management and administration 

Other 

____11 Please specify __________ 

18. If Direct Client Services is a major area of practice, which category below best describes the majority of 

client work? Place a “1” by that category. If the majority of the client caseload is mixed, put a “1” by those 

the person in the position will see the most, a “2” for second and “3” for third. Do not mark more than 3 in 

total. 

 ____ 1 General/comprehensive nutrition 

 ____ 2 General women, infants and children 

 ____ 3 General women’s nutrition and health 

 ____ 4 General infant nutrition

 ____ 5 General child health or pediatric nutrition 

 ____ 6 School and/or adolescent health 

____ 7 Children with special health care needs, developmental disabilities, chronic illnesses, or high-risk 

infants and children 

 ____ 8 Breastfeeding 

 ____ 9 Adult health promotion, chronic disease prevention, or healthy aging 

 ____ 10 Seniors, geriatrics, adult disabilities, or adult chronic disease control
98
99

ATTACHMENT--Position Titles for Public Health Nutrition Personnel—use in responding to question 4 

 (From: Personnel in Public Nutrition) 

Nutrition Assistant/Aide is an auxiliary nutrition worker from the indigenous community who is trained on-the-job 

to work under the close supervision of nutrition professionals to provide routine nutrition education, including 

interpretation for clients who do not speak English. Assistants and aides also carry out assigned tasks in client 

outreach and screening. 

Nutrition Technician is a paraprofessional who works under the close supervision of a nutritionist to provide 

routine technical support services in public health agency clinics. This work includes normal nutrition education; 

screening using prescribed protocols, record keeping, and outreach. 

Nutritionist is a nutrition professional employed in a public health agency primarily to provide nutrition education 

to the public, and to coordinate and provide direct nutritional care to agency clients in health and disease throughout 

the life span. 

Clinical Nutritionist is a professional with expertise in the complex nutritional management of medically high risk 

individuals requiring physician prescribed dietary and nutrition regimens including enteral and parenteral nutrition 

support. In public health agencies, clinical nutritionists work as case managers and/or care coordinators, and 

nutrition counselors. They also may work as educators in programs where more in-depth expertise in therapeutic 

nutrition is required, including high-risk pregnancy, neonatal and pediatric clinics; children's special services; AIDS; 

and home health and home hospice services 

Public Health Nutritionist is a nutrition professional with academic training in public health who is employed by 

the state or local public health agency to asses the community's nutrition needs, and to plan, direct and evaluate 

community nutrition intervention programs that meet these needs. Interventions promote health and prevent disease 

among the population at large. 

Public Health Nutrition Consultant includes both generalized and specialized nutrition consultants who provide 

expert technical assistance, professional guidance, and in-service education in program development or case 

management. Consultation may be given to the administrator, other nutritionists or other health professionals. 

Consultants include those who work: out of a central headquarters office or in the health agency's regional or district 

offices. 

Public Health Nutrition Supervisor supervises the work of an assigned number of other nutritionists, nutrition 

technicians, and nutrition assistants that deliver nutrition services and nutritional care in the public health agency. 

Supervision includes training, delegating, directing, coordinating, evaluating and reporting the work of subordinates. 

Assistant Public Health Nutrition Director is the second highest administrative and policy making public health 

nutrition position in a state, large city, county or voluntary public health agency. The assistant director may 

participate in several delegated functions or be assigned primary responsibility for managing the nutrition 

component of one or more major program areas. The person in this position serves as Actin8 Director in the 

director's absence. 

Public Health Director-Nutrition is the highest-level nutrition position in a state, large city, county or voluntary 

public health agency. Major functions of this position are policy making, planning/evaluation, fiscal control, 

management and supervision. The position is usually the head of a nutrition program unit, where the director is 

responsible for conducting a needs assessment, developing a comprehensive plan and budget for the nutrition 

services of the agency and has line authority over staff. 
100
101

Appendix D 
102
103

Study Design 

As in past years, the survey of the state public health nutrition workforce was built upon statecentralized data collection, as well as state-level editing and data entry using an EpiInfo program. A 

uniform questionnaire was designed and used across states. Data files were sent to a central location 

for analysis and reporting. 

These design features have important implications for comparability of findings across states and 

time. State and territorial public health nutrition directors were responsible for distributing the 

uniform questionnaire to nutrition workers within their respective states and territories. They 

identified the sub-state and local programs that employed and/or contracted public health 

nutritionists, set up a system for distributing and collecting questionnaires, and gained the 

cooperation of local and regional program administrators, who in turn were expected to distribute 

the questionnaire within their own programs. This data-collection system allowed the state directors 

flexibility in scheduling and making the best use of available resources. Moreover, it decentralized 

decision making about inclusion of appropriate programs and workers to the state level, where 

decisions were made in the context of the overall structure of the state’s nutrition program and 

public health system. This design aspect shifted a considerable share of the cost of the survey to the 

state level. However, diminished central control of data collection contributed to variation in 

response rates and data quality across states. Additional advantages and disadvantages of this 

approach are discussed in other sections of this report. In the following pages, the population 

surveyed, the questionnaire, data-collection process, participation and response, data processing and 

analysis are described. 

The Population — Public Health Nutrition Workers 

ASTPHND expended considerable effort in defining the population to be surveyed — public 

health nutrition professionals and paraprofessionals — to ensure uniformity in inclusion and still 

allow flexibility for state variation in program structure. The study was designed as a census of 

persons who work as nutrition professionals or nutrition paraprofessionals in a public health 

nutrition program such as WIC or in other public health programs or services under the purview 

of the state health agency (SHA). 

It is important to note, however, that there is considerable variation among states with regard to 

the programs administered by the state health agency. For example, some state health agencies 

may have administrative responsibilities for Medicaid, regulation of health facilities, or the Child 

and Adult Care Food Program (CACFP), while others do not. As a result, some state nutrition 

directors surveyed the nutrition-related positions in these programs because in their states the 

positions are classified as public health nutritionists. In other states, the nutrition personnel from 

these programs were not included in the survey because they are not considered to be a part of 

the public health nutrition workforce. Also, a few states included USDA-supported extension 

service nutritionists who worked in conjunction with public health nutrition education programs, 

but most states did not. In another state, only registered dietitians were surveyed. 

One way to view this is that some state nutrition directors cast a wider net than did others as they 

determined which programs and workers to survey, in part because of the way public health 
104

nutrition efforts are administered in their respective state health agencies. There may have been 

variation in interpretation of and adherence to instructions as well. This variation in the 

administration of the survey is not unique to the 2000 survey. ASTPHND has recognized the 

variability between states in all of its previous workforce surveys. 

Full- and part-time employees as well as contract positions were included in this census. 

ASTPHND instructed that persons who work in a support capacity or in another profession — 

for example, an accountant, nurse, health educator or physician in a public health nutrition 

program — not be surveyed. Instructions specified that the survey should not be administered to 

nurses who function as certifying officials in WIC clinics — even if they were the primary 

person providing counseling and education to WIC participants. The extent to which these 

instructions were carried out by local programs may have varied. For example, for the 

questionnaire on job classification, the category “other” was checked by a number of respondents 

who described their job as nurse, WIC administrator, accounting clerk and lab technician. Such 

variation in interpretation of instructions probably affected results, making it more difficult to 

draw definitive conclusions about differences in size of the workforce or to make other 

comparisons across states. 

 

Advance instructions, however, could not anticipate the nuances encountered in the organization 

of state health agency nutrition programs and services. During the data-collection phase, state 

nutrition directors raised questions about the inclusion or exclusion of specific personnel and 

programs. The answers were disseminated by e-mail to the state nutrition directors in each state 

and territory in order to obtain as much consistency as possible across states in the administration 

of the survey. For example, states were told to include nutritionists and dietitians who were 

specifically required to perform nutrition work in their professional capacity as a “health 

facilities surveyor” under the auspices of the state health agency. However, if a “health facilities 

surveyor” happened to be a registered dietitian or have a degree in nutrition but was not hired to 

perform nutrition work, that person was not to be included. Similar questions were raised 

regarding nutritionists who provided services under the Medicaid and/or Title V children with 

special needs programs and the Commodity Supplemental Foods Program. 

The Questionnaire 

ASTPHND designed a 30-item fixed response instrument that required 10-20 minutes to 

complete. The final questionnaire included items on type and location of practice, job 

classification, source of funding and salary, training, education, certification or credentials, 

perceived training needs, participation in professional organizations, and personal characteristics 

(gender, race and ethnicity, primary and secondary languages). Ease of administration and 

response burden, as well as applicability and comparability across states and time, were primary 

criteria for inclusion/exclusion of items. Starting with the instrument used in ASTPHND’s 1994 

study, several steps were taken to revise and update the questionnaire items for the 2000 census. 

The ASTPHND grantee administrator, who chairs the ASTPHND Data and Epidemiology 

Committee and also serves as the state nutrition director for the state of Texas, applied her 

experiences in directing the 1994 survey to make improvements in the current effort, taking into 

account the application of results in that state. A consultant obtained by ASTPHND to direct the 
105

2000 survey reviewed prior ASTPHND studies, ongoing U.S. DHHS Public Health Services (PHS) 

surveillance systems and recent surveys, and studies of WIC participants and program 

characteristics to reduce duplication of effort and ensure comparability of response categories to the 

extent possible. 

Responses to the 1994 survey had previously been examined to identify items for which 

nonresponse was high and for which interpretation had been difficult. The experiences of the 

state nutrition directors in administering the 1994 survey had been collected and compiled at the 

conclusion of data collection, and their comments were reexamined during the design phase of 

the current study. The ASTPHND Data and Epidemiology and the Executive Committees 

reviewed the questionnaire in view of recent changes in the practice of public health nutrition — 

in particular, the shift from direct services to core functions — and funding streams. They also 

considered potential uses of the findings. 

During the design phase, the ASTPHND Data and Epidemiology Committee and the project 

consultant convened a series of five conference calls to discuss and review the workforce 

questionnaire to ensure that it included all data items to meet the project objectives, and that 

response categories were applicable across states. In addition to the eight-member committee, the 

questionnaire was reviewed by and comments were received from representatives of USDA-FNS 

staff, National Association of WIC Directors (NAWD), U.S. DHHS/HRSA/MCHB staff, 

American Public Health Association (APHA) Food and Nutrition Section, and faculty of 

graduate public health nutrition programs. USDA-FNS staff identified several additional needs 

based upon program objectives of improving the professional qualifications of state and local 

WIC staff. Subsequently, items were added to describe the steps respondents had taken that 

would qualify them to sit for the examination to become either a registered dietitian (RD) or a 

registered dietetic technician (DTR) with the Commission on Dietetic Registration, if the 

respondent did not as yet have those credentials. 

After 12 revisions, a 10-page questionnaire was prepared for pretesting. The draft survey 

questionnaire was pretested in April 1999 with nine respondents, three in each of three states — 

Connecticut, Missouri and Wisconsin. The sites and respondents were identified and selected by 

the ASTPHND Data and Epidemiology Committee to obtain a range of job classifications and 

educational levels, from paraprofessionals with little formal training to master’s level 

nutritionists. Responses and comments were analyzed by the project consultant and discussed 

with the Data and Epidemiology Committee in a subsequent conference call, as well as with the 

government project officer (GPO). Respondents made a few suggestions about formatting fixed 

responses; otherwise, it was found that the questionnaire could be administered and responded to 

in a short period of time. Results also indicated that, to the extent possible to determine with a 

sample of nine people — the maximum number allowed prior to Office of the Management and 

Budget (OMB) clearance — the questions and fixed responses categories were applicable across 

states, in different types of public health nutrition programs, and to nutrition workers of varying 

levels of training and experience. 

Once the questionnaire was finalized, an abbreviated version consisting of nine items was 

constructed to collect information on vacant positions. Supervisors for each public health 

nutrition position that was currently vacant were asked to complete the vacant position 
106

questionnaire. A protocol and tracking form was developed to collect information from state 

nutrition directors to use in calculating state specific and overall response rates. 

Clearance from the Office of Management and Budget 

As part of the agreement with USDA, ASTPHND was required to adhere to the Paperwork 

Reduction Act of 1980, Public Law 96-511, OMB Circular A-40, revised, which prohibits 

federal agencies from conducting or sponsoring the collection of information on identical items, 

from 10 or more persons without prior approval from OMB. In accordance with the Paperwork 

Reduction Act of 1995, the FNS published a notice in the Federal Register February 18, 1999 

(volume 64, number 32, page 8054) announcing the intent to request an OMB review of the Survey 

of State Public Health Nutrition Workforce data collection activities. The notice provided a 60-day 

period for public comments. 

Two comments were received, both from state WIC offices. Both stated that the study would 

benefit the WIC program, but they commented that the reporting burden on state and local WIC 

agencies had not been taken into account. In addition, one responder suggested other approaches 

to data collection and made recommendations to the USDA on the future use of the information. 

The responses were discussed with the FNS project officer prior to fielding the survey. 

The project consultant submitted the draft OMB clearance application to USDA May 10, 1999. 

During the next few weeks, the consultant worked with the GPO to respond to questions raised 

during the internal USDA review and made necessary revisions. USDA submitted the 

application to OMB June 23, 1999. Final OMB approval was obtained August 25 after a few 

minor changes to ensure protections of privacy and confidentiality were made. 

Preparation of the ASTPHND Membership to Conduct the Study 

The involvement of and input from the state nutrition directors was sought throughout the project 

with the recognition that their participation was key to the successful completion of the study. An 

estimated 66 to 75 percent of the current directors had been involved in the 1994 and earlier 

surveys and were generally aware of how to collect the data. The ASTPHND leadership had kept 

the membership informed throughout the USDA application and award process. Volunteers for 

the Data and Epidemiology Committee were sought. Procedures and a tentative schedule for the 

survey were presented for discussion at the ASTPHND annual conference in June 1999. 

Frequent e-mails informed directors who were not participants in the Data and Epidemiology 

Committee or the Executive Committee of the status of plans for the survey. 

As members of a relatively small organization, the directors have long-term and strong 

relationships across states, and peer pressure and support was an important factor in obtaining 

participation. At the June 1999 meeting, all attendees agreed to participate, including California, 

the only state that was not able to participate in 1994. However, not all states and territories had a 

designated nutrition director, making it necessary for the ASTPHND president to identify 

someone in the Nevada and Pennsylvania WIC programs to take responsibility for conducting 

the survey. ASTPHND was eventually able to obtain participation from all states with the 

exception of Idaho. Guam, District of Columbia, the Virgin Islands and Puerto Rico also 
107

participated. Contact could not be established with public health nutrition staff in American 

Samoa. Although American Samoa is a WIC State agency, it does not participate in ASTPHND. 

Indian Tribal Organizations 

Indian and Native American WIC programs, also known as Indian Tribal Organization (ITO) 

WIC programs, function as State agencies for the Indian Nations, administering WIC programs 

primarily on tribal lands. State health agencies vary in the extent to which they coordinate and 

communicate with ITOs within their states. In the 1994 study, state directors had been expected 

to identify and survey ITO programs located within their states; however, the response was low. 

The Data and Epidemiology Committee members therefore decided to attempt to improve 

responses by mailing questionnaires directly to the WIC programs operated by the ITOs. 

In 1999, ASTPHND obtained a listing of current state WIC programs from USDA-FNS (list 

updated May 21, 1999). In August, the grant administrator faxed letters to 31 Indian tribal 

organizations that administer WIC programs advising them of the upcoming survey, asking for 

their cooperation and requesting notification of address changes. Nonresponses were followed up 

with telephone calls and the mailing list was corrected and updated for the mailing of 

questionnaires. In October 1999, the project consultant mailed packets consisting of survey 

instructions, the questionnaire, the vacant-position questionnaire and transmittal form to 33 

ITOs1

 that administer WIC programs. At least three telephone calls were made to nonresponding 

organizations in November and December. Twenty of the 33 ITOs eventually responded, and of 

those, the worker response rate was approximately 50 percent. 

Schedule and Process of Data Collection 

Immediately upon receipt of the OMB approval, the ASTPHND members were informed by email that survey packets were to be mailed so that the survey could begin after Labor Day 1999. 

Hard-copy packets of survey administration materials were mailed to 55 state and territorial 

nutrition directors/designees on September 5, 1999.2

 The package consisted of: 

• Five-page instructions for conducting the survey. 

• Two forms (Transmittal to State form and Transmittal to ASTPHND form) to assist with 

record keeping and tracking response rates. 

• The questionnaire for copying and distribution. 

• A vacant-position questionnaire for copying and distribution. 

On September 10, 1999, e-mail versions of the instructions and forms were sent as a follow-up 

mailing. The directors were told to expect instructions for data entry and a program for EpiInfo 

data entry and editing to arrive by mail the following month. The instructions called for data files 

to be submitted to ASTPHND no later than January 11, 2000, giving the state directors up to four 

months to administer the survey and complete data entry. The ASTPHND leadership believed 

this gave each state director the necessary flexibility to coordinate the survey with other priorities 

and workloads. 

 

1

The 33 includes the 31 to which a fax was sent in August plus 2 additional ITOs identified during the period 

September-October.

2 In Idaho and American Samoa there were no designees, so packets were mailed to WIC directors.
108

The transmittal forms were designed to assist directors with accurate record keeping on the 

distribution of questionnaires and the number of respondents, refusals and vacant positions. 

ASTPHND used the information submitted on these forms to calculate state-specific and U.S. 

response rates. 

The survey instructions called for each state nutrition director to attach a cover letter to the standard 

questionnaire, informing persons when and where to return it and whom to contact for assistance. 

Preparation of the cover letter allowed each state director to add instructions and/or explanations 

for any special or unique circumstances in that state. This feature was of particular importance 

because of the great variation across states in funding, staffing and operation of public health 

nutrition programs. The need for a uniform questionnaire eliminated the option of tailoring 

questions or response categories to specific state or local situations; however, the cover-letter 

instructions provided an opportunity to interpret items in the context of local or state structure. 

Funding source, for instance, was one area in which the state nutrition directors needed to make a 

concerted effort to clarify fixed-choice responses. Another was job classification: State directors 

were cautioned that the functional names for different categories of nutrition workers may be 

different from the job titles and/or personnel classifications used in their programs.3

 They were 

encouraged to carefully and repeatedly explain who should, and should not, participate in the 

survey. 

Although the state nutrition directors had the option of distributing the questionnaire by mail, fax or 

e-mail, or a combined approach, most workers were surveyed by paper, distributed to them at their 

worksite by their program managers. 

Training in Conducting the Survey 

The survey instructions asked the directors to participate in a two-hour training conference call 

before they began distribution of the questionnaire in their states. The purpose of the training 

call, led by the grant administrator and the project consultant, was to review the instructions and 

forms to ensure uniform interpretation and use, and to anticipate and resolve in advance any 

problems that were likely to occur. The schedule was distributed via e-mail on September 14, 

1999. Each director or designee was asked to participate in one call. Calls were completed as 

scheduled on September 21, 23, 27 and 28. Since only 29 of the 53 states and territories that 

eventually participated in the survey completed a training call in September, three “makeup 

calls” were held in October. Nonparticipants in the first round of calls were contacted several 

times by telephone to enlist their participation, and the importance of the training call was 

emphasized. 

Eventually, 89 percent of the state nutrition directors, or a person from their staff, completed the 

training call. Several of those who were unable to participate contacted the project administrator 

or consultant and indicated that they had reviewed the instructions and, due to their involvement 

with previous surveys, were comfortable in proceeding without the training. The telephonic 

training dealt primarily with how to identify public health nutritionists, procedures for 

distribution and collection, maintaining records on responses, and completion of the 

 

3

See Table 7 for a list of job classifications and their descriptions.
109

questionnaire. Since the editing and data entry instructions and program had yet to be distributed, 

they were not reviewed. 

Participation and Response Rate 

Frequent communication was used to maintain high visibility for the survey during the data 

collection phase. The grant administrator continued to report on the status of the survey to the 

ASTPHND Executive Committee during monthly conference calls. The ASTPHND president 

sent a letter to the NAWD president describing the purpose of and schedule for conducting the 

survey. NAWD was requested to inform WIC programs and ask for their cooperation. The grant 

administrator distributed information on the survey to WIC directors via NAWD’s weekly 

bulletin. The grant administrator and the project consultant disseminated e-mail bulletins to all 

state nutrition directors to keep them abreast of issues arising with the survey during the period 

of data collection. The bulletins were disseminated on a monthly basis, or more frequently if 

necessary. 

In addition to the efforts described above to enlist the cooperation of the state nutrition directors, 

additional avenues were used to enhance the response rate. State directors were urged to use 

newsletters, staff meetings, broadcast fax, Internet mailing lists, Web sites, e-mail and fax 

bulletins to inform public health nutrition workers of the upcoming survey, the distribution 

schedule and, later, the progress made. They were asked to personalize the appeal by giving a 

few examples of how the information may be useful in the respective states. It was suggested 

that setting aside time during staff meetings and conferences for the completion of questionnaires 

was an effective way of ensuring responses. ASTPHND also anticipated giving the state nutrition 

directors feedback on survey findings. Such feedback is typically given to organizations when 

they assist with surveys and is considered to be an important factor in ensuring participation in 

future surveys.4

 

As of the January 11, 2000, due date, approximately 25 percent of the states had completed data 

collection; fewer had actually submitted data. The last state submitted its workforce data on 

September 22, 2000. 

Table 2 on page 13 depicts the state-specific response rates. Although a process for estimation of 

the state-specific and overall response rates was provided, initial submissions suggested that not 

all state survey administrators had maintained the required records. The overall estimated 

response rate, based on transmittal forms supplied by the state directors, was 88 percent 

(10,309/11,718). The reported state-specific response rates ranged from 45.8 percent 

(Washington) and 53.4 percent (New Mexico) to 100 percent (Arkansas, Guam, Iowa, Maine, 

Nevada, Oregon, Puerto Rico, South Dakota, Tennessee, Utah). In 2000, the most significant 

improvement in participation over the 1994 survey was the participation of the state of 

California. With a reported 2,640 public health nutrition professionals and paraprofessionals, 

California employs nearly 24 percent of the entire workforce surveyed, considerably more than 

New York (667), Florida (504), or Texas (486). Vacant positions were not included in 

computations of response rates. 

 

4

Due to delays in completing data collection and analysis, feedback was not provided in a timely manner.
110

Data Entry 

In addition to their role in data collection, the state nutrition directors were also responsible for data 

entry. ASTPHND used EpiInfo, software developed by the U.S. Centers for Disease Control and 

Prevention (CDC) and used at many state and territorial health agencies, for editing; processing; 

computing measures of central tendency; dispersion and percentages; and creating tables.5

 As with 

the 1994 survey, EpiInfo was used to write a program for data entry and editing, which was 

distributed to each state nutrition director by diskette or via the Internet. ASTPHND expected that 

edits near the source of data collection would enhance the accuracy and completeness of the 

information. Instructions called for directors to be particularly attentive to accuracy of job 

classification, location of employment, work site and funding source. 

In November 1999, the EpiInfo data entry and editing program, which was written by the project 

consultant, was tested in two states, Texas and North Dakota. Using feedback from the test sites, 

the program was revised to address problems, and the accompanying instructions were rewritten 

according to comments from the two participating state nutrition directors. The 16-page data 

entry and editing instructions were mailed to the states November 28, 1999.6

 To ensure that all 

state agencies received the materials, they were e-mailed the following week. The EpiInfo data 

entry and editing program were e-mailed later that week. 

Recognizing that some state nutrition directors did not have the capability or resources to 

complete data entry, on September 2, 1999, ASTPHND polled the state nutrition directors to 

identify those states that could not complete data entry for their state survey responses. Five 

states responded that they did not have sufficient resources to do their own data entry. 

ASTPHND made arrangements for the five states and the ITOs to mail their completed, edited 

questionnaires to the grant administrator who contracted with an individual to complete the data 

entry. Later, two additional state directors proved to be unable to complete data entry and the 

grant administrator arranged for it to be done through the contractor. This arrangement reduced 

the number of persons involved in actual data entry and may have improved the quality of the 

data files from the respective states. 

The data entry program was structured so as to require entry on a number of fields considered to 

be essential to the analysis objectives — work in a WIC program, work site, level of 

responsibility, job classification, RD and DTR. Blanks or missing data were accepted in other 

fields. Although the data entry and edit files worked as intended in the two-state pretest, in a 

number of states the required entry was overridden. This may have happened in several ways: 

EpiInfo is structured so that two separate files — a “.rec” file and a “.chk” file interact to restrict 

or edit entries, for example, the .chk file can be constructed so as to designate certain fields as 

required and/or to integrate skip patterns. But if the .chk file is not loaded, data can be entered 

into the .rec file without the operation of field requirements and ranges. Another possibility is 

that persons entering data were able to override the required fields. Although EpiInfo is used by 

state agencies, nutrition staff do not necessarily have training or skills in its use. The extent of 

technical support within the state agencies also varied. Consequently, the use of the software and 

the entire data entry process was not without problems. 

 

5

 For information on EpiInfo, visit www.cdc.gov 6

 This was a delay from original expectations of distribution in mid-October.
111

Throughout the period of data collection and data entry, the project consultant and the project 

administrator provided technical assistance by responding to telephone and e-mail queries. Many 

of the queries suggested that responsibilities had been delegated to persons without the provision 

of much information or instruction. In fact, some calls came from employees who had been 

given questionnaires to distribute but who had not been given the instructions. For those state 

agencies that did not already have or use EpiInfo, installation was sometimes difficult given the 

multitude of operating systems. A lack of basic computer skills on the part of state agency 

nutrition staff and the lack of technical support for their offices were also evident in some states. 

Problems also occurred when data entry was delegated to employees, interns or temporary staff 

who had not been sufficiently oriented. In a few cases, data entry was assigned to persons who 

were not given the instructions. The project consultant provided assistance upon request by 

telephone and/or e-mail. The EpiInfo technical support personnel provided assistance by e-mail 

and telephone to the consultant as well as to several states. The provision of assistance was 

dependent upon the initiative of the person responsible for data entry. In retrospect, more timely 

and intensive assistance would have improved the quality of the survey data. 

Completion of Data Analysis 

State data files were sent by Internet or disk to the grant administrator at the Texas Department 

of Health, where they were copied and forwarded to the project consultant. As each file was 

received, the consultant compared the number of records in the file with the information on the 

transmittal form, including the number of vacant positions for which information was submitted, 

and examined the file for duplicate record identification numbers. She immediately 

communicated with the state director or contact person to resolve inconsistencies. Thirty-seven 

of the state files required resolution of initial inconsistencies. The project consultant edited 

records for internal consistencies, including years of work experience in nutrition; public health 

nutrition and WIC; persons supervised; minimum, maximum and part-time salaries; and 

inappropriate fields for vacant positions. Outliers of salary, years of experience, and FTEs 

supervised were examined and discussed with the project administrator and/or the state director 

for clarification and resolution. The consultant maintained a grid to track e-mail and telephonic 

queries and responses with state directors on editing issues. 

A number of respondents selected more than three training needs (Question 25), contrary to 

instruction. In those cases in which this was not resolved prior to state-level data entry and the 

state file contained more than three selections for a respondent, it was not possible to determine 

which of the selections were the three priorities. To include the excess responses in the analysis 

would have created a bias favoring those respondents who did not follow instructions and 

selected more than three areas. Therefore, those respondents who selected more than three were 

excluded from the analysis. As a result, findings are qualified by a high nonresponse for this 

item. 

After the more obvious problems were addressed, the consultant prepared a state-specific 

frequency count of 13 variables, including the required fields. The frequency file was e-mailed to 

the state director within a maximum of two weeks for review and to flag any questionable 
112

findings. Only three states made corrections. Many did not respond, in which case the 

assumption was made that no corrections were necessary. 

All questionnaire items were fixed response; however, a number of items allowed for the choice 

of “other” and a “write-in” explanation. ASTPHND expected that these responses would be 

examined during the state-level editing, and to the extent possible coded to a fixed category. For 

example, if for Question 1, the respondent checked the type of agency worked in as “other,” and 

wrote in “homeless shelter,” the state director could, with knowledge about the work setting, 

reclassify the response (e.g., nonprofit organization, local government agency). The data entry 

instructions described these options. However, in examining the submitted data files, the 

consultant found that a number of the questionnaire items had a large proportion of “other” 

responses. Although some of these could have been recoded across the existing categories, the 

grant administrator and the consultant agreed to retain them as submitted. There was one 

exception to this decision: during telephone training calls, it became evident that Question 4 on 

job classification should have included a choice for, or instructions on, classification of 

breastfeeding peer counselors and lactation counselors. Records were searched for other, 

breastfeeding and assigned a specific code (11). This job classification is presented in the 

analysis, however, an unknown number of “breastfeeding counselors” may not have responded 

in a way that permitted the assigning of the specific code. 

After the state file had been cleaned and a frequency report of required fields had been sent to 

each state nutrition director for review, the state files were merged for analysis, resulting in a file 

of 10,904 records that represents information on more than 10,000 public health nutrition 

workers. 

The ASTPHND Data and Epidemiology Committee met via conference call November 30, 2000, 

to delineate priorities for the analysis of survey data. Five members participated. Several 

problems and inconsistencies were discussed. It was noted that a significant number of records 

contained inconsistencies, with regard to source of funding information and full-/part-time work 

responses. 

Following the conference call, the project consultant prepared and circulated an analysis plan to 

committee members. No comments were received. Upon request, the plan was submitted to the 

USDA project officer, who approved it. After consultation with the grant administrator, the 

consultant undertook additional editing, using information on the full- and part-time, income and 

total full-time equivalents fields to eliminate internal inconsistencies. Following a presentation of 

preliminary findings at the annual ASTPHND conference in June 2001, committee members 

made several additional recommendations, and they reviewed and commented on the draft report 

prior to its initial submission to USDA. 

The analysis is univariate or bivariate and descriptive, relying on percentages and, for several 

variables, measures of central tendency. The analysis plan forms the basis for this final report. It 

is suggested that the reader refer to the questionnaire and consider the phrasing of questions and 

the response categories when interpreting findings. For some workforce characteristics, including 

employing agency and location, findings include the vacant positions. Five-and-one-half percent 

(595) of the responses apply to vacant positions. Other characteristics, including academic 
113

preparation, training and certification, only apply to the position incumbents (i.e., “filled” 

positions). Findings are presented for the WIC workforce and compared to the workforce not 

involved with the WIC program (i.e., the non-WIC workforce). 

Some characteristics are examined both with and without the California responses. As described 

in this section of the report, data on the California public health nutrition workforce were not 

collected in 1994. In 2000, California workers constituted nearly 24 percent of the total 

respondents. Therefore, in describing changes in the workforce from 1994 to 2000, it was 

necessary to take into account the effect of the inclusion of California. In the case of Idaho, data 

were collected on the workforce in 1994 but not in 2000. However, with only 94 public health 

nutrition workers responding in 1994, Idaho constituted only 1.2 percent of the total workforce 

and had very little effect on the overall findings. For this reason, comparisons of the two time 

periods were made without regard to the inclusion of Idaho data in only one of the surveys. 

Because item nonresponse was generally high, and very high for several variables including 

salary, the nonresponses have been retained in the denominators and the percentages of 

nonrespondents are shown in the tables. In addition to variation in nonresponse across 

questionnaire items, there is considerable difference in item nonresponse by job category, with 

response rates being higher at the upper levels of the job classification categories. 
114
115

Appendix E 
116
117 

Table 38 Expanded – Perceived Training Needs – Number of Times Each Topic was Marked with the Top 10 Choices Identified by 

Parentheses (Question 25) 

WIC Nutrition Workforce 

N

Topic 

Total 

Workforce All Workers Professional 

Paraprofessionals All W

Client and Population Groups 

1.Infant & preschool nutrition (3) 2303 (3) 2231 (3) 1303 (2) 926 2. Childhood nutrition (7) 952 (7) 894 397 (6) 497 3. Adolescent nutrition 345 296 139 157 4. Nutrition for CSHCN (1) 2976 (1) 2829 (1) 2184 (4) 644 (15.Prenatal nutrition (4) 1752 (4) 1699 (4) 1014 (3) 683 6.Breastfeeding (2) 2636 (2) 2586 (2) 1551 (1) 1033 7.Women’s health 373 330 173 157 8. Adult health promotion, chronic disease, healthy aging 370 259 198 61 (49. Seniors, geriatric nutrition 192 114 100 14 (910.High-risk clients, including HIV & addiction (6) 1234 (6) 1161 (6) 867 (8) 294 11.Assessment of nutrition status 434 371 233 138 12. Case management / care coordination 206 186 128 56 13. Communication with low literacy populations 615 556 354 (9) 200 14. Cultural competency 504 458 309 149 15. Eating disorders (7) 952 (8) 870 (9) 554 (7) 315 16. Nutrition counseling, behavior change, client education (5) 1676 (5) 1551 (5) 987 (5) 562 (317. Supplemental & alternative dietary therapies (9) 928 795 (7) 687 108 (2
118 

Assessment Skills 

18. Applied research, data collection & analysis 304 237 202 33 19. Community assessments 258 204 183 21 20. Data management, surveillance, monitoring systems 360 272 253 17 (821. Fund raising, proposals, and grant writing 664 566 503 63 (722. Program planning & evaluations 323 246 228 18 (1023. Use of current IT, including computers (10) 898 (9) 792 (8) 629 (10) 163 (5Population-Based Interventions 24. Advocacy and policy development 175 121 117 4 25. Building coalitions & working in partnerships 285 215 194 21 26. Communications, mass media, distance learning 171 125 110 13 27. Environmental health and/or food safety 116 96 64 32 28. Environment and policy change to support nutrition 194 141 125 16 29. Hunger and food security 109 91 68 22 30. Practice guidelines: development and use 69 53 50 3 31. Social marketing 225 154 136 16 Management 32. Cost Effectiveness / benefit analysis 255 202 187 13 33. Financial management 228 192 176 14 34. General management 252 235 213 22 35. Leadership and team building 680 (10) 635 (10) 541 94 

Other 41 30 25 5 

No response /missing 15.4% 1591 15.3% 1432 11.7% 724 22.5% 700 14.6Total Respondents (does not equal choices)* 10309 9330 6199 3114 

*The total workforce includes nonresponses to Question7. The total WIC workforce includes nonresponses to Question 4.