Improving nutritional well-being of the low-income population is 1 of the primary objectives of 15 U.S. food assistance programs. The third largest of these in terms of total expenditure is the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC), which targets low-income pregnant, breastfeeding and postpartum women, infants, and children up to age 5. The WIC program provides supplemental foods, nutrition education, breastfeeding support and referrals to health and social services for its participants. To expand the selection of foods the program offered, as well as to help combat the problem of obesity, WIC food packages were revised in 2009. The revised food packages were designed to contribute to an overall dietary pattern that is consistent with the Dietary Guidelines for Americans as well as to insure that foods are readily acceptable, widely available, and commonly consumed by the target population.
One of the main changes in the revised WIC food packages was the reduction in the total amount of milk and the removal of whole milk from food packages offered to WIC participants. In addition, 100 percent juice continued to be included in the food packages but offered in a somewhat reduced amount. Although it is well known that some of the most commonly consumed beverages have a high caloric content and may contribute to the current obesity epidemic, relatively few studies have examined dietary patterns of children in regard to beverage consumption. It is critical to understand the descriptive patterns of beverage consumption in children in order to help design intervention strategies to promote healthier beverage consumption in specific higher risk subgroups.
The objective of this paper is to better understand the food preferences and consumption behaviors of children residing in low-income households. The study centers attention on whole, 2 percent, 1 percent, and skim milk; 100 percent juices; and artificially and sugar-sweetened beverages consumed by Texas WIC participating children aged 2-5. This study contributes to the existing literature by conducting the analysis of pre- and post-implementation of revised WIC food packages and exploring the differences across rural and urban areas. Specifically, using data from the Texas Food and Nutrition Survey for WIC (TEXFAN), the study analyzes the effect of the removal of whole milk and reduction in the total amount of milk provided by WIC on the type and amount of milk consumed by WIC children. The study also checks if the changes in WIC food packages affected the consumption frequency of 100 percent juices, and artificially and sugar-sweetened beverages consumed by WIC children.
The study makes use of two cross-sectional datasets of Texas WIC participating children aged 2-5. The first dataset provides information on WIC participating children before the changes in food packages, the 2008-09 Texas Food and Nutrition (TEXFAN) survey, and the second dataset more than 6 months after the changes, the 2010-11 Texas Food and Nutrition survey. The TEXFAN data were collected under the auspices of the Institute for Obesity Research and Program Evaluation at Texas A&M University in collaboration with Texas WIC and the U.S. Department of Agriculture. The State administered surveys using samples of WIC participants who attended WIC clinics during the data collection periods. The data provide detailed information on the amount and type of milk most often consumed and the frequency that children participating in the WIC program consumed 100 percent juices and sugar-sweetened and artificially sweetened beverages. Detailed sociodemographic information on ethnicity/race, gender, age of a child, language spoken at home, age, employment status and education level of caregivers and the ZIP Code of residence were available from the data.
With respect to WIC households in the sample, roughly 50 percent of the respondents reported having one infant/child currently receiving WIC benefits and 40 percent reported having two infants/children receiving WIC benefits. Of all the households which have a child over 1 year on WIC, 75 percent reported having an infant who received WIC foods in the past 30 days. Almost 100 percent of respondents in the sample were primary caregivers of WIC children and about 85 percent of caregivers reported receiving WIC foods themselves in the past 30 days. In addition, 60 percent reported receiving food benefits through the Supplemental Nutrition Assistance Program (SNAP). These findings are consistent with current statistics of Texas. In 2010, Texas had the highest birth rate in the country behind Utah and Alaska. Texas children account for 1 of every 11 U.S. children. However, over 27 percent of Texas children were food insecure and food assistance programs were, and still are, primary ways many Texas families access food.
After the implementation of the new food packages, there was a significant shift away from whole milk and toward reduced fat milk. The percentage of children consuming whole milk decreased from 61.4 percent to 8.7 percent whereas the percentage of children consuming reduced fat milk increased from 32.6 percent to 81.5 percent. There was a significant increase in the percentage of children consuming low fat/skim milk (5.6 to 9.8 percent). The amount of milk consumed per day slightly decreased from 2.63 to 2.33 cups, suggesting that the decrease in the amount of whole milk in the pre-survey was replaced by the increase in the amount of lower fat milk in the post-survey. No significant differences were found for rural and urban areas and in border and nonborder regions with respect to amount of milk consumed per day, except a slightly higher percentage of children consumed whole milk in rural areas compared to urban areas after WIC revisions. As expected, some amount of whole milk consumed was reported for the post-WIC changes period since variables in the data measured total milk consumption provided by WIC and purchased by households. Significantly more children consumed 100 percent juices two or more times per day compared with artificially and sugar-sweetened beverages both before and after WIC revisions. Although there was a reduction in the total amount of juices offered by WIC, significantly more children consumed 100 percent juices two or more times/day after the revisions in both rural and urban areas.