Health and Caseload Evaluation of 1995 WIC Prenatal Program Presented by: Victoria Lazariu-Bauer Authors: Victoria Lazariu-Bauer, M.Sc., Howard Stratton, Ph.D., Robert Pruzek, Ph.D., Mary Lou Woelfel, M.A.

Conclusions Outline for this presentation: Introduction Description of data and variables Results

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

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

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

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

Variables explored :  Mother’s demographic and medical characteristics Age Level of education Race/Ethnicity Inferred marital status Parity Prepregnancy BMI Employment during pregnancy Alcohol, tobacco, drug use during pregnancy Medical history Number of family members on WIC Adequacy of prenatal care utilization (Kotelchuck Index)  Travel distance from participant residence to the WIC site

Number of months of WIC prenatal participation Cumulative Cumulative # Frequency Percent Frequency Percent _________________________________________________________ , , , , , , , , , , ,

Participants who had Preterm Babies (born weeks of gestation) enroll Frequency Percent _________________________________________ 6 months or more early 4-5 months months or less late Participants who had Full Term Babies (born weeks of gestation) enroll Frequency Percent _________________________________________ 7 months or more early 5-6 months months or less late

 Organizational characteristics: a. NYS WIC Region: region Frequency Percent ____________________________________ Albany 8, Syracuse 5, Western 10, New York City 44, Suburban NYC 8,

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

 Travel distance from participant residence to WIC site

WIC Effect by Duration of Pregnancy Race/Ethnicity Groups on WIC Results WIC and Prenatal Care

WIC Effect by Duration of Pregnancy Participants with full term pregnancies: Early - Late = 68 grams 2.4 oz Participants with preterm pregnancies: Early - Late = 129 grams 4.5 oz

Race/Ethnicity Groups on WIC Participants with full term pregnancies: White, Non-Hispanic N= 14,938 Black, Non-Hispanic N= 11,099 Hispanic N= 12,214

WIC and Prenatal Care Kotelchuck’s Index of Adequacy of Prenatal Care Utilization

WIC and Prenatal Care

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