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.
• 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
WIC Provides
Health screening
Nutrition and health education
Breastfeeding promotion and support
Referrals to health care and social service
• Vouchers for nutritious foods
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
Washington State Income
Guidelines through March 2011
Household or
Family Size*
Gross Income**
Per Year
Gross Income**
Per Month
* 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.
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
• Reduced incidence of
iron-deficiency anemia
• Increase in
breastfeeding rates
• Improved childhood
immunization rates and
regular medical care
• Improved cognitive
• Savings in health care
A WIC appointment
• Eligibility review
– Income
– Health/Nutrition Assessment
– Anthropometrics and assessment of growth
– Screening for anemia
• Client-centered nutrition and health
• Referrals to health care and social
• Vouchers for nutritious foods “checks”
WIC Foods Support Good Nutrition
• Aligned with dietary recommendations for
infants and the Dietary Guidelines for
• Aim to reduce inadequate and excessive
nutrient intakes in participants
• Take into account cultural food
• Suitable for those who may have limited
transportation, cooking and storage
WIC Approved Foods for Women
and Children
• Fresh fruits and
• 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
• Cheese
• Soy beverage
• Tofu
• 100% juice
• Canned tuna or salmon
(Breastfeeding only)
WIC Approved Foods for Infants
• For the first 12 months:
– Breastfeeding promoted as healthiest feeding
– 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
WIC in Washington State
51% of all infants born participated in WIC
69% of WIC Families are employed
63% of WIC participants live at or below the poverty
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
WIC in King County
• 38,500 monthly caseload served by Public
Health - Seattle & King County WIC
• WIC services provided at 24 hospital,
community clinic and public health sites
and other satellite sites
• 37% Infants born in KC on WIC
Nutrition 531
Access to Healthy Foods Among
WIC Families
• Goal: Improve access to healthy foods in
WIC families in targeted areas of south King
• 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.
What is CPPW grant?
• Public Health – Seattle & King County was
awarded a federal stimulus money grant in
2010 for Obesity Prevention and Tobacco
• The name of this grant is “Communities
Putting Prevention to Work”—referred to
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)
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.
What Healthy Food Here is doing
• Providing store owners with training and
technical assistance to carry healthier array of
• 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.
WIC regulations
• Public comment is being gathered at this
• 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.
WIC Clinics in our focus area
High Point WIC—part of Neighborcare
6020 35th Avenue SW, Seattle, 98126
Highline WIC –next to Highline Hospital
13030 Military Rd. S, #108, Tukwila
White Center Public Health WIC
10821 8th Avenue SW, Seattle, 98146
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
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
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)
White Center WIC
• Very diverse client population
• WIC staff speaks English and several bilingual 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
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.
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.
Carrying out the Study
• Students will work with WIC staff at clinics to
interview clients in a confidential and respectful
• 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.
Any Questions?

Access to Healthy Foods Among WIC Families