1. Access to Healthy Foods Among WIC Families UW Community Nutrition 531 January 7, 2011 Kari Fisher MPH, RD, CD Nicole Flateboe MPH, RD, CD Public Health-Seattle & King Co.

2. “WIC” The Special Supplemental Nutrition Program for Women, Infants and Children Federal Program –Also dependant upon State and local government funding One of the most cost effective federal preventive health programs in existence

3. WIC Provides Health screening Nutrition and health education Breastfeeding promotion and support Referrals to health care and social service organizations Vouchers for nutritious foods

4. Who is Eligible? Low income (On Medicaid or 185% of FPL or less) Women who are pregnant, breastfeeding (up to 12 mo), post-partum women (up to 6 mo), Infants, and Children under age 5 Have a medical or nutritional need

5. Washington State Income Guidelines through March 2011 Household or Gross Income** Gross Income** Family Size* Per Year Per Month 2 $26,955 $2,247 3 $33,874 $2,823 4 $40,793 $3,400 5 $47,712 $3,976 * A household is defined as a group of related or non-related individuals, who usually, although not necessarily, are living together and share income. WIC includes unborn baby. **Gross income is income before taxes and deductions.

6. Outcomes of WIC participation Longer pregnancies Reduction in infant mortality, low birth weight babies and premature births Greater likelihood of accessing prenatal care Increased nutrient density of children’s diet Reduced incidence of iron-deficiency anemia Increase in breastfeeding rates Improved childhood immunization rates and regular medical care Improved cognitive development Savings in health care costs http://www.fns.usda.gov/wic/aboutwic/howwichelps.htm

7. A WIC appointment Eligibility review –Income –Health/Nutrition Assessment –Anthropometrics and assessment of growth –Screening for anemia Client-centered nutrition and health education Referrals to health care and social services Vouchers for nutritious foods “checks”

8. WIC Foods Support Good Nutrition Aligned with dietary recommendations for infants and the Dietary Guidelines for Americans Aim to reduce inadequate and excessive nutrient intakes in participants Take into account cultural food preferences Suitable for those who may have limited transportation, cooking and storage resources

9. WIC Approved Foods for Women and Children Fresh fruits and vegetables Whole wheat bread, brown rice, bulgur, oatmeal, soft corn tortillas Peanut butter Dried beans and lentils Cereal, iron fortified Eggs Reduced-fat milk (Whole milk for children under 2 years) Cheese Soy beverage Tofu 100% juice Canned tuna or salmon (Breastfeeding only)

10. WIC Approved Foods for Infants For the first 12 months: –Breastfeeding promoted as healthiest feeding method –Iron fortified formula for non-breastfed infants 6-12 mo of age: –Jarred baby food vegetables and fruits –Jarred baby food meats (breastfed infants) –Iron/zinc fortified infant cereal

11. WIC in Washington State 2009 51% of all infants born participated in WIC 69% of WIC Families are employed 63% of WIC participants live at or below the poverty line WIC Food Dollars: $134 million Dollars directly to local farmers of fruits and vegetables: $796,000 63 community and public health agencies provide WIC, employing 1000 people 2009 Washington WIC Annual Report

12. WIC in King County 38,500 monthly caseload served by Public Health - Seattle & King County WIC Program WIC services provided at 24 hospital, community clinic and public health sites and other satellite sites 37% Infants born in KC on WIC http://www.doh.wa.gov/cfh/wic/reports.htm

13. Nutrition 531 Access to Healthy Foods Among WIC Families Goal: Improve access to healthy foods in WIC families in targeted areas of south King County. Objectives: Students will assess the ability of WIC families to access healthy foods. Students will develop recommendations for policy changes to improve food access for the WIC families.

14. What is CPPW grant? Public Health – Seattle & King County was awarded a federal stimulus money grant in 2010 for Obesity Prevention and Tobacco Cessation. The name of this grant is “Communities Putting Prevention to Work”—referred to as CPPW

15. Healthy Foods Here project This is one of the CPPW-funded projects with the goal of working with small grocery stores and convenience stores to sell fresh and healthy foods. This grant focuses on areas of the county with limited access to healthy foods in supermarkets (food deserts)

16. Healthy Foods Here cont. These areas of the county have higher rates of health disparities and poverty. Many of the supermarkets do not carry specific cultural foods representing the population who lives there. Individuals often prefer to shop at small grocery stores where the operators speak their language and carry familiar foods.

17. What Healthy Food Here is doing Providing store owners with training and technical assistance to carry healthier array of foods. Working to change the state regulations for stores to become WIC authorized vendors. Partnering with WIC Administration to gather information and educate staff in the WIC clinics in their catchment area.

18. WIC regulations Public comment is being gathered at this time. New recommendations will be adopted in Spring, 2011 Healthy Foods Here is proposing policy changes to make it easier for small grocery stores to meet WIC authorized retail rules.

19. WIC Clinics in our focus area High Point WIC—part of Neighborcare Health 6020 35 th Avenue SW, Seattle, 98126 Highline WIC –next to Highline Hospital 13030 Military Rd. S, #108, Tukwila White Center Public Health WIC 10821 8 th Avenue SW, Seattle, 98146

20. High Point Neighbor Care WIC Located in the High Point neighborhood of West Seattle within a “food desert” 50% on Basic Food Client’s Ethnic/Racial makeup: 45% Black or African American; 21% Hispanic/Latino; 18% White; 16% American Indian or Alaska Native; 11% Multi-Race; 9% Asian; 2% Pacific Islander Language: English primarily, Spanish and Somali. 3 staff serve a WIC caseload of 825

21. Highline WIC Serves very diverse population that includes many new immigrants to US Located just east of Burien and north of SeaTac airport in Tukwila Multi-racial staff that speak Spanish, Somali, Hindi and Punjabi. Small clinic that serves a high volume of clients very efficiently. Community clinic site

22. Highline WIC demographics Caseload of 1450 45% clients are on Basic Food Ethnic/Racial make-up: 33% Black or African-American; 31% Hispanic; 19% White; 9% Asian and 9% Multi-race. Languages: Many Spanish speaking, Somali, Russian and Burmese (new immigrant families)

23. White Center WIC Very diverse client population WIC staff speaks English and several bi- lingual Spanish speaking staff. Located just south of City of Seattle limits in White Center-Burien area White Center Food Bank is located across the parking lot from WIC clinic Public Health WIC site

24. White Center WIC demographics Caseload of 2225 37% on Basic Food Client’s Ethnic/Racial Make-up: 41% Hispanic, 25% White, 16% Black or African American; 20% Multi-racial. Languages: Mainly Spanish speaking, also Vietnamese, Somali and Arabic.

25. What WIC Administration gets from this project: Improved knowledge of the shopping habits and access issues affecting our WIC clients Updated information about the degree of food insecurity affecting WIC clients Data to share with Healthy Foods Here project about WIC clients’ use of corner stores that could impact state policy.

26. Carrying out the Study Students will work with WIC staff at clinics to interview clients in a confidential and respectful manner. Interviews will be conducted in English only. Information will not have client identifying information associated with it. Students will sign confidentiality agreements at the clinic and agree to keep information private.

27. Any Questions? ?