NYS DOH, Division of Nutrition Evaluation and Analysis Unit

2. NYS DOH, Division of NutritionEvaluation and Analysis Unit • Barriers to Retention • NYS WIC Infants and Children* • Presented by: Mary Lou Woelfel • Authors: Mary L. Woelfel, Howard Stratton, Robert Pruzek, Donald Hernandez, Gene Shackman, ShuGuang Chen • * A USDA WIC Special Project Grant. Awarded to the NYS DOH DON by the U.S. Department of Agriculture, Food and Nutrition Service, Office of Analysis and Evaluation, under grant 59-3198-7-525. Study results are sole responsibility of authors and may not reflect the view of the funding agency.

3. Barriers to retention, NYS WIC • Introduction • In U.S. and NYS WIC caseload declining slightly • In NY, older the child, lower the retention • Many eligible children do not receive WIC services

4. Barriers to retention, NYS WIC • Background • NY 999: WIC provided services to 469,000 clients on average each month • Approximately 290,000 are infants or children • NYS provider network: 99 agencies with oversight of 570 sites

5. Barriers to retention, NYS WIC • Objectives • Identify barriers to retention among WIC infants and children • Identify barriers specific to check redemption patterns • Present barriers by race/ethnicity

6. Barriers to retention, NYS WIC • Methods • Focus groups with WIC participants, guidance team, lit. review used to identify potential barriers • Identified barriers used to design 20-minute survey • Survey administered one-on-one at WIC sites • Outsourced to ensure candid response • From perspective of WIC participant • 11 volunteer agencies; 41 sites • 3167 parents/caretakers of WIC infants/children

7. Barriers to retention, NYS WIC Data collection and data analysis • Response rate 80%; completion rate; 94% • Data collected March through Dec 1999 • Informed consent obtained • Representative of 11 agencies • Chi-square, logistic regression

8. Barriers to retention, NYS WIC • Measured variables • Demographic and economic • Public assistance programs • Fast food consumption • Food insecurity • Employed due to welfare reform • Benefits of WIC • 68 individual level barriers Dependent variables • Cashing or picking up checks

9. Figure 1. Barriers by organization category Scheduling Getting there Facility Waiting GeneralBureaucracy NutritionEducation Certifi-cation Agency staff Food procurement Food package

10. Scheduling. Inconvenient times, work problems, rescheduling, no specific appointment time, separate family appointments. Getting there. Parking, neighborhood safety, transportation Facility. Overcrowding, noisy, lack of children’s activities. Waiting - Too long, > 1 hr for checks; > 1 hr to recert. Bureaucracy.Rules unclear, rigid, changing food package, bringing child, paperwork, replacing checks, blood work, proxy. Nutrition Education. Long, boring, repetitive, useful Agency staff. Negative treatment, customer friendly, speaking your language, insensitive to culture, not listening, giving conflicting info. Food procurement. Store policy diff. than WIC policy, negative treatment by store staff; food availability-finding food, food not in stock, not getting all WIC food. Food package size-matching check to container in store, cereal box size, milk size. Food package. Variety, quantity (too little, too much of each item) Specific barrier items by organization category

11. (%) < 1 year 26 1 year old 22 2 year olds 19 3 year olds 18 4 year olds 15 White non-H 46 Black non-H 34 Hispanic 15 (%)Rent 78 Single 65 Employed 45 < 50% pov 28 < 100% pov 64 HS or less 64 Food insecure 10 Table 1. Demographic/economic characteristics of study participants

12. (%) Medicaid 57 TANF 30 Food stamps* 40 Head Start* 8 Free/Reduced lunch* 18 WIC and other food programs WIC only 51 WIC plus 1 35 WIC plus 2 11 WIC plus 3 3 Table 2. Public assistance

13. Table 3. Number and participant type on WIC • (%) • Number in household on WIC • 1 on WIC 56 • 2 on WIC 33 • 3 on WIC 9 • 4 or more 2 • WIC composition • Infant only 24 • Child only 60 • Infant & child 16 • Missed pickup/cash checks 46

14. Table 4. Socio-demographics by race/ethnicity. NYS WIC • WBH (%) (%) (%) • Rent 69 85 91 • Single 54 79 72 • < 50% poverty 22 32 28 • < 100% poverty 58 67 72 • Employed 45 50 34 • HS or less 63 61 71 • Medicaid 52 61 63 • TANF 19 39 46 • Food stamps 31 49 51 • Free/Red lunch 17 21 15 • Food insecurity 8 8 18 • Missed pickup/cash checks 44 50 41

15. Barriers to retention, NYS WIC Results GO LA STAFF! In upstate and NYC, across all organization categories, local WIC agency staff received the highest ratings.

16. Barriers to retention, NYS WIC • The most important benefit of WIC participation from participant’s perspective In Upstate: Good nutrition and formula In NYC: Formula and milk

17. Table 5. Barriers to retention • Barrier Percent reporting barrier • Waiting too long 48 • Waiting area/no child activities 42 • Waiting area/overcrowded/noisy 36 • Waiting more than 1 hr to recertify 27 • Cereal box size 41 • Matching check to foods 23 • Too little WIC formula 38 • Too little WIC juice 27 • Nutrition education repetitive 33 • Nutrition education boring 27 • Different policies WIC/Vendor 29

18. Table 6. Most frequently cited barriers to retention by Race • Barrier White Black Hisp. Other • Waiting too long 47% 50% 46% 51% • Waiting area lacking children’s activities 38% 50% 39% 41% • Not getting right cereal box size 43% 41% 35% 41% • Too little formula 36% 40% 43% 40% • Waiting room overcrowded and noisy 31% 40% 41% 35% • Nutrition education repetitive 34% 35% 29% 23% • Stores having different WIC policies 26% 35% 25% 28% • Too little juice 24% 29% 26% 30% • Waiting more than one hour to re-certify 25% 27% 34% 29% • Nutrition education boring 26% 29% 25% 22% • Matching check amount to food container 24% 24% 17% 26%

19. Table 7.Barriers by race/ethnicityStatistically significant differences among less cited barriers • W(%) B(%) H(%) • Language barrier 0 0 7 • Inconsistent w/culture diet 3 6 10 • Too little milk 13 10 18 • Too little dry beans 4 10 9 • Getting off work 12 19 15 • Transportation 7 11 14 • Safety 4 3 8

20. Figure 1. Barriers by organization category Overcrowded, noisy nothing for kids to do Wait too long Schedule Getting there Facility Waiting Boring, repetitive NutritionEducation Certifi-cation Agency staff GeneralBureaucracy Cereal box size Too little food Food procurement Food package

21. Table 8. Barriers and check patterns Failure to pick-up or cash checks reported by • 46% of parent/caretakers Variables asso. w/failure to pick-up/cash chks • Child’s age • As child’s ages, failure to pick-up/cash checks increases • Parent’s age • Younger parents more likely to fail to pick up/cash checks. • Problems getting checks replaced • Problems rescheduling • Too much milk

22. Highlights • Barriers to retention - participant’s perspective • Long waits, overcrowded, noisy facilities with nothing for kids to do • Nutrition education boring and repetitive • Cereal box size; problems matching voucher to cereal box size (Cost containment effort) • Too little formula • Too little juice

23. Highlights Race/ethnic similarities • Whites, Blacks, Hispanics cite same top barriers Race/ethnic differences • Inconvenient hrs for employed Blacks • More Blacks work than whites and Hispanics. • Language and food barriers for Hispanics Failure to pick up/cash checks • Children’s food package • Young mothers

24. Thank you