Health and CaseloadEvaluation of 1995 WIC Prenatal Program

Presented by: Victoria Lazariu-Bauer

vgl01@health.state.ny.us

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 region2. Average caseload per certified professional authority in WIC

agencies3. Farmers market participation

Socio-economic characteristics of the neighborhood1. 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 1995.3. % related children age 0-4 in families with incomes under 100% poverty

level for 1995.

Variables explored :

Mother’s demographic and medical characteristicsAge Level of education Race/Ethnicity Inferred marital status ParityPrepregnancy BMI Employment during pregnancy Alcohol, tobacco, drug use during pregnancy Medical history Number of family members on WICAdequacy 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_________________________________________________________ 1 4182 5.39 4,182 5.39 2 6982 9.00 11,164 14.39 3 8554 11.02 19,718 25.41 4 10122 13.04 29,840 38.45 5 12444 16.04 42,284 54.49 6 13496 17.39 55,780 71.88 7 11978 15.44 67,758 87.32 8 6626 8.54 74,384 95.85 9 1937 2.50 76,321 98.35 10 1278 1.65 77,599 100.00 11 2 0.00 77,601 100.00

Participants who had Preterm Babies (born 28-36 weeks of gestation)

enroll Frequency Percent

_________________________________________

6 months or more 1762 29.56 early

4-5 months 2053 34.45

3 months or less 2145 35.99 late

Participants who had Full Term Babies (born 37-44 weeks of gestation)

enroll Frequency Percent

_________________________________________

7 months or more 18379 30.05 early

5-6 months 20694 33.84

4 months or less 22087 36.11 late

Organizational characteristics:

a. NYS WIC Region:

region Frequency Percent____________________________________

Albany 8,799 11.34 Syracuse 5,866 7.56Western 10,045 12.94

New York City 44,547 57.41Suburban NYC 8,344 10.75

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

Race/Ethnicity Estimate of WICParticipation Effect

Black, Non-HispanicHispanicWhite, Non-Hispanic

79 grams (2.78 oz)75 grams (2.6 oz)41 grams (1.4 oz)

WIC and Prenatal Care

Kotelchuck’s Index of Adequacy of Prenatal Care Utilization

APNCUI Month of FirstVisit

Number of VisitsAccording to ACOG

Adequate Plus

Adequate

Intermediate

Inadequate

1st or 2nd

3rd or 4th

1st or 2nd

3rd or 4th

1st or 2nd

3rd or 4th

any

Too many

Recommended range

Less than recommended.

Too few.

APNCUI Countand

Percent

Estimated Effect ofWIC Participation

Adequate Plus

Adequate

Intermediate

Inadequate

5,98315%

13,25233%

6,58316%

9,63524%

71 grams2.5 oz

38 grams1.3 oz

67 grams2.3 oz

83 grams2.9 oz

Note: 12% of participants had incomplete information for computation of APNCUI.

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.