Smoking cessation in the WIC program.

To the Editor, In their recent paper, Yunzal-Butler et al. [1] report an analysis of the association between the timing of enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and cigarette smoking among prenatal WIC participants. Based on the finding that women who enroll in WIC early during pregnancy experience only modestly higher quit rates than women who enroll late, Yunzal-Butler et al. conclude that there ‘‘is ample room to improve WIC’s performance,’’ suggesting the WIC program consider intensifying its role in smoking cessation, perhaps through ‘‘more frequent and more focused’’ counseling. The purpose of this letter is twofold: first, we wanted to clarify the goals and approach of WIC in an effort to better contextualize smoking cessation efforts in the program. Second, we wanted to comment on issues that were not raised or adequately discussed by the authors, namely statistical issues regarding the smoking data and covariates utilized in the analysis. WIC is the only federally sponsored public health nutrition program whose mission is ‘‘to safeguard the health of low-income women, infants, and children up to age 5 who are at nutrition risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care’’ services [2]. Contrary to popular belief, WIC is not an entitlement program. This means that available funds do not cover all eligible applicants. With the funds that are available, and the recognition that the epidemic of obesity leads to numerous poor health outcomes, the primary goal of the WIC program is to provide nutritional education, counseling and nutritious foods to supplement participants’ diets. The WIC program provides grants to states to administer the program. States, in turn, fund contracts to local agencies to deliver WIC nutrition services. The scope of services provided by WIC local agencies is broad and includes nutrition education, nutrition risk assessment, breastfeeding support and promotion, immunization screening, referrals to health care and drug and substance abuse services and programs, and promotion of good nutrition for good health, including promotion of physical activity. Participation in nutrition education is voluntary; referrals to health care and other services are offered but not enforced. The positive results presented by Yunzal-Butler et al. suggest that WIC successfully goes beyond its primary goal of improving participants’ nutritional status and education by encouraging healthier lifestyle changes, in this case impacting smoking quit rates. While the authors are correct that the quit rates are modest compared to targeted smoking cessation programs, we believe this comparison is quite inappropriate, due to the aforementioned primary goal of the WIC program as a public health nutrition and education program. Although the WIC program offers participants referrals to smoking cessation programs, it is unrealistic to expect this public health nutrition program to achieve quit rates as high as a focused tobacco cessation program. In C. F. Davis (&) School of Public Health, Department of Epidemiology and Biostatistics, George Education Center 125, University at Albany SUNY, One University Place, Rensselaer, NY 12144, USA e-mail: cd5341@albany.edu