E
COST CALCULATIONS

For the cost analyses presented in this report, the committee conducted detailed analyses of nationally representative pricing data for foods in the current and revised WIC food packages. The details, not presented in body of the report, are presented in this appendix.

A large part of the methodology for cost calculations involves the assumptions necessary for the analyses. Tables E-1 and E-2 show a side-by-side comparison of the assumptions used for the nutrient analyses and the cost analyses. Table E-3 is an easy reference guide of the costs used in the cost calculations. Details of the calculations used for program costs of the current and revised food packages are presented in Tables E-4 and E-5. These tables can be found at the end of this appendix.

List of tables:

Table E-1

 

Bases of Assumptions Used in Nutrient and Cost Analyses of Food Packages for Infants,

 

318

Table E-2

 

Bases of Assumptions Used in Nutrient and Cost Analyses of Food Packages for Children and Women,

 

324

Table E-3

 

Calculated Costs of Representative Amounts of Foods in Revised Packages (2002)

 

 

A

 

Infants,

 

342

B

 

Children and Women,

 

344

Table E-4

 

Estimated Program Costs for Food per Month Using Current Packages (2002),

 

350



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WIC Food Packages: Time for a Change E COST CALCULATIONS For the cost analyses presented in this report, the committee conducted detailed analyses of nationally representative pricing data for foods in the current and revised WIC food packages. The details, not presented in body of the report, are presented in this appendix. A large part of the methodology for cost calculations involves the assumptions necessary for the analyses. Tables E-1 and E-2 show a side-by-side comparison of the assumptions used for the nutrient analyses and the cost analyses. Table E-3 is an easy reference guide of the costs used in the cost calculations. Details of the calculations used for program costs of the current and revised food packages are presented in Tables E-4 and E-5. These tables can be found at the end of this appendix. List of tables: Table E-1   Bases of Assumptions Used in Nutrient and Cost Analyses of Food Packages for Infants,   318 Table E-2   Bases of Assumptions Used in Nutrient and Cost Analyses of Food Packages for Children and Women,   324 Table E-3   Calculated Costs of Representative Amounts of Foods in Revised Packages (2002)     A   Infants,   342 B   Children and Women,   344 Table E-4   Estimated Program Costs for Food per Month Using Current Packages (2002),   350

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WIC Food Packages: Time for a Change Table E-5   Estimated Program Costs for Food per Month Using Revised Packages (2002),   352 In addition to the assumptions listed in Tables E-1 and E-2, several assumptions were used to distribute mother/infant pairs by the feeding method used. These are described as follows. Assumptions on Infant Feeding in the WIC Program A recent survey by the CDC on breastfeeding practices showed that among women participating in the WIC program, at 3 months postpartum 64 percent of mothers report breastfeeding in any amount with 36 percent reporting breastfeeding exclusively (CDC, 2004b). Based on these estimates, 28 percent (64 percent minus 36 percent) were partially breastfeeding at 3 months postpartum. The same survey indicated that at 6 months postpartum, 28 percent of mothers were breastfeeding in any amount with 11 percent exclusively breastfeeding (CDC, 2004b). Based on these estimates, 17 percent (28 percent minus 11 percent) were partially breastfeeding at 6 months postpartum. From these estimates (partial breastfeeding rates of 28 percent at 3 months and 17 percent at 6 months), a partially breastfed rate of 20 percent for infants ages 4 through 5 months of age was extrapolated. For older infants, survey estimates of reported breastfeeding rates at 6 months (29 percent) and 12 months (14 percent) were used to extrapolate a rate of 21 percent breast-fed infants for the 6 through 11 month period (CDC, 2004b). The 21 percent of mothers who breast-fed infants were either fully or partially breastfeeding; the committee distributed them as 5 percent fully breastfeeding and 16 percent partially breastfeeding based on 2002 data from the Feeding Infants and Toddlers Study (Briefel et al., 2004a). For the program cost analyses, breastfeeding rates were assumed to remain the same for both the current and revised food packages. Therefore, the following assumptions were used for the calculations: Infants Ages 0 Through 3 Months—36 percent fully breast-fed; 28 percent partially breast-fed (that is, 64 percent “ever breast-fed”); 36 percent fully formula-fed; Infants Ages 4 and 5 Months—11 percent fully breast-fed; 20 percent partially breast-fed (that is, 31 percent “ever breast-fed”); 69 percent fully formula-fed; and Infants Ages 6 Through 11 Months—5 percent fully breast-fed; 16 percent partially breast-fed (that is, 21 percent “ever breast-fed”); 79 percent fully formula-fed.

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WIC Food Packages: Time for a Change These percentages are estimates of what package use might be for the revised packages. An additional term, exclusively breast-fed, is used among lactation professionals. That term, when used in the WIC program, does not necessarily mean that an infant is only receiving breast milk; it means, in this context, that an infant does not receive formula from the WIC program. Under the current system, exclusively breast-fed infants can receive cereal and juice, as early as four months of age. Therefore, they may not truly be exclusively breast-fed, as a lactation expert might define them. Assumptions on Feeding Method for Women in the WIC Program According to data from WIC Participant and Program Characteristics: PC2002, approximately 24 percent of all WIC participants are women (Kresge, 2003; Bartlett et al., 2003). Among these women, 45 percent are pregnant, 24 percent are breastfeeding, and 31 percent are non-breastfeeding postpartum women. The percentage of WIC women who were fully breastfeeding was not included in that report (Kresge, 2003; Bartlett et al., 2003). Based on the distribution of infants by age (Kresge, 2003; Bartlett et al., 2003) and the assumptions on feeding method for infants, it was estimated that of the total infants participating in the WIC program that are breastfed (in the WIC program sense), 45 percent are partially breast-fed and 55 percent are fully breast-fed. Breastfeeding women were distributed by the same percentage.1 Thus, for women, estimates of 13 percent fully breastfeeding and 11 percent partially breastfeeding were used; that is, the calculations of program costs assumed a total of 24 percent of women participating in the WIC program were breastfeeding as cited by Kresge (2003) and Bartlett et al. (2003). Possible Shifts in Participation Rates In order to evaluate the sensitivity of the estimated program costs for food with the revised packages (Tables 5-3 and E-5) to changes in participation rates among the infant and women categories, the committee simulated 1   In fact, the number of breast-fed infants reported participating in the WIC program is greater than the number of breastfeeding women reported: 678,560 versus 458,131 (Kresge, 2003). By applying the ratio of partially versus fully breast-fed infants to breastfeeding women, the committee assumed that the participation by women regarding partial versus exclusive breastfeeding is the same proportion as for infants.

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WIC Food Packages: Time for a Change costs with some shifting in categories. One such evaluation assumed the following: For infants age 0 through 3.9 months, there would be a 20 percent shift in infants from fully formula-fed to fully breast-fed; For infants age 1 through 3.9 months, there would be a 30 percent shift from partially breast-fed to fully breast-fed; For infants age 4 through 5.9 months, there would be a 10 percent shift from fully formula-fed to partially breast-fed, and a 30 percent shift from partially breast-fed to fully breast-fed; and For infants age 6 through 11.9 months, there would be an 8 percent shift from fully formula-fed to partially breast-fed, and a 30 percent shift from partially breast-fed to fully breast-fed. The shifts in the infant categories were accompanied by the appropriate shift in the mother’s classification. The result of these shifts was to decrease the average food package cost per participant from $34.57 to $33.93 per month for the revised packages.

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WIC Food Packages: Time for a Change TABLE E-1 Bases of Assumptions Used in Nutrient and Cost Analyses of Food Packages for Infants   Assumption used in Fooda Nutrient Analysesb Formula Current and Revised Packages I and II   Milk-based formula (versus soy-based formula)   Weighted mean of: Enfamil with Iron (Mead Johnson), 67.8%; Similac with Iron (Ross/ Abbott), 27.2%; and Good Start (Carnation/Nestlé), 5.0% Juice Current Package II   Apple juice (vitamin C-rich) Baby food, fruits Revised Package II Fruit(s) as the only major ingredient(s)d   Junior (stage 2), 4–8 oz/d   Equal weighting of: Applesauce; Peaches; and Pears

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WIC Food Packages: Time for a Change Cost Analysesa,c Type of Data Considered as Basis of Assumption Source of Dataa Container sizes: na, used cost per fl oz data   Oliveira et al., 2001   Representative of market share Oliveira et al., 2001   Market share within WIC program, 2001 Oliveira et al., 2001 Cost per fl oz data   Oliveira et al., 2001 Equal weighting of: Frozen concentrate, 6–12 fl oz container: Shelf-stable, 32–48 fl oz container; and Representative of likely participant choices and state agency restrictions ACNielsen Homescan, 2001 Same as for nutrient analyses Representative of likely participant choices Assumption based on age of participants Same as for nutrient analyses Nutritional and developmental appropriateness AAP, 2004   Representative of nutritional content Assumption for analyses Weighted mean (for total of 6 mo) of: Strained (stage 1) for 1 mo, 2.5 oz container; Junior (stage 2) for 2 mo, 4 oz container; and Advanced (stage 3) for 3 mo, 6 oz container Representative of developmental stages and nutritional needs ACNielsen Homescan, 2001 Manufacturer labeling and websites, 2004 Fresh banana substituted at a rate of 1 medium banana per 4 oz container for the maximum allowed (for 16 oz of baby food fruits). Assumed equivalence of 4 bananas for 2 pounds of fresh bananas. Representative of likely participant choices Assumption for analyses ERS, 2004b FNS, 1984b Weighting of other choices assumed not relevant to pricing   Reflects all available data

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WIC Food Packages: Time for a Change   Assumption used in Fooda Nutrient Analysesb Baby food, vegetables Revised Package II Vegetable(s) as the only major ingredient(s)e   Junior (stage 2), 4–8 oz/d   Equal weighting of: Carrots; Green beans; and Squash, assumed to be winter squash Cereal, baby Current and Revised Package II   Grain(s) as the only major ingredient(s)f   Rice cereal, dry

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WIC Food Packages: Time for a Change Cost Analysesa,c Type of Data Considered as Basis of Assumption Source of Dataa Same as for nutrient analyses Nutritional and developmental appropriateness AAP, 2004   Representative of nutritional content Assumption for analyses Weighted mean (for total of 6 mo) of: Strained (stage 1) for 1 mo, 2.5 oz container; Junior (stage 2) for 2 mo, 4 oz container; and Advanced (stage 3) for 3 mo, 6 oz container Representative of developmental stages and nutritional needs ACNielsen Homescan, 2001 Manufacturer labeling and websites, 2004   Representative of likely participant choices Assumption for analyses Weighting of choices assumed not relevant to pricing   Reflects all available data Container sizes: 8–16 oz   ACNielsen Homescan, 2001 Same as for nutrient analyses Nutritional and developmental appropriateness AAP, 2004   Representative of likely participant choices Assumption for analyses Dry baby cereal, all typesc,f Representative of market share ACNielsen Homescan, 2001   Weighting assumed not relevant to pricing Reflects all available data

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WIC Food Packages: Time for a Change   Assumption used in Fooda Nutrient Analysesb Baby food, meats Revised Package II-BF Meat as the only major ingredient(s)g   Strained (stage 1), 2.5 oz/d   Equal weighting of: Beef; Chicken; and Lamb aFor clarity, the food, container sizes, and source of pricing data are indicated in bold. bThe nutrient analyses referred to in this table use Nutrition Data System for Research (NDS-R) software version 5.0/35 (2004) developed by the Nutrition Coordinating Center (NCC), University of Minnesota, Minneapolis, MN (Schakel et al., 1988, 1997; Schakel, 2001). A second set of nutrient analyses using the USDA Nutrient Database for Standard Reference, Release 17 (SR-17) (NDL, 2004) is presented in Tables B-3A through B-3D, Appendix B—Nutrient Profiles of Current and Revised Food Packages. cOrganic baby foods were omitted from the cost analyses. dStrained fruit prepared for infants without added sugars, starches, or salt. Mixtures of fruits are allowed for older infants. Texture may range from pureed through diced. eStrained vegetable prepared for infants without added sugars, starches, or salt. Mixtures of vegetables are allowed for older infants. Texture may range from pureed through diced. fGrain cereal products prepared for infants without added sugars, salt, or “formula ingredients” (e.g., nonfat dry milk). Mixtures of grains are allowed for older infants.

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WIC Food Packages: Time for a Change Cost Analysesa,c Type of Data Considered as Basis of Assumption Source of Dataa Same as for nutrient analyses Nutritional and developmental appropriateness AAP, 2004 Representative of nutritional content Reflects available data Weighted mean (for total of 6 mo) of: Strained (stage 1) for 2 mo, 2.5–3 oz container; and Junior (stage 2) for 4 mo, 2.5–3 oz container Representative of nutritional and developmental needs; reflects available data ACNielsen Homescan, 2001   Representative of likely participant choices Assumption for analyses Weighting of choices assumed not relevant to pricing   Reflects all available data gStrained meat prepared for infants without added starches, vegetables, or salt. Broth (unsalted; that is, without added sodium) may be an ingredient. Texture may range from pureed through diced. NOTES : na = not applicable. The medical formulas required by infants with special dietary needs were omitted from this table. For additional detail on food specifications, see Table B-1, Appendix B—Nutrient Profiles of Current and Revised Food Packages. DATA SOURCES: Price data and other information were obtained from Economic Research Service, USDA (ERS, 2004b, 1999 price data; Oliveira et al., 2001, 2000 infant formula price data), and ACNielsen Homescan (ACNielsen, 2001, 2001 price data obtained through ERS, USDA). Additional information was obtained from the American Academy of Pediatrics (AAP, 2004), USDA (FNS, 1984b), and manufacturer labeling and websites (Abbott Laboratories Online, 2004; Mead Johnson, 2004; Nestlé, 2005).

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WIC Food Packages: Time for a Change TABLE E-2 Bases of Assumptions Used in Nutrient and Cost Analyses of Food Packages for Children and Women   Assumption used in Fooda Nutrient Analysesb,c Fruits and Vegetables Juice Current and Revised Packages Equal weighting of: Apple juice; and Orange juice Apple juice Current and Revised Packages Reconstituted from frozen   Vitamin C-rich Orange juice Current and Revised Packages Reconstituted from frozen   Not fortified Fruits Fruits, fresh Revised Packages   Equal weighting of: Apples; Oranges; and Bananas

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WIC Food Packages: Time for a Change TABLE E-3B Calculated Costs of Representative Amounts of Foods in Revised Packages for Children and Women (2002)a Food Unit Approximate Cost per Unit ($) Food Package IV-A Juice fl oz ~0.03 Milk, wholeb,c qt 0.73 Yogurtb,c qt 2.28 Cheeseb,c,d lb 3.30 Cereal oz ~0.20 Eggs doz 1.03 Fresh fruitsb,c lb ~0.69 Canned fruitsb,c oz ~0.05 Fresh vegetablesb,c lb ~0.94 Canned vegetablesb,c oz ~0.03 Bread, whole wheatb,c lb 1.80 Brown riceb,c lb 1.77 Beans, driedb,c lb 0.77 Beans, cannedb,c oz ~0.04 Peanut butterb,c oz 0.10 Total Food Package IV-B Juice fl oz ~0.03 Milk, fat-reducedb,c qt 0.69 Yogurtb,c qt 2.28 Cheeseb,c,d lb 3.30 Cereal oz ~0.20 Eggs doz 1.03 Fresh fruitsb,c lb ~0.69 Canned fruitsb,c oz ~0.05 Fresh vegetablesb,c lb ~0.94 Canned vegetablesb,c oz ~0.03 Bread, whole wheatb,c lb 1.80 Brown riceb,c lb 1.77 Beans, driedb,c lb 0.77 Beans, cannedb,c oz ~0.04 Peanut butterb,c oz 0.10 Total Food Package V Juice fl oz ~0.03 Milk, fat-reducedb,c qt 0.69 Soy beverage (“soy milk”)b,c qt 1.64

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WIC Food Packages: Time for a Change Representative Amount in Food Package Quantity Used in Calculation Assumption, Proportion Usedb Example Cost ($) 128 fl oz 1 3 32-fl oz cans 3.71 14 qt 1 7 half-gallons 10.22 1 qt 0.5 1 1-qt container 1.14 1 lb 0.5 1 1-lb package 1.65 36 oz 1 3 12-oz boxes 7.20 1 doz 1 1 doz 1.03 4.88 lb 0.5 — 1.70 110 oz 0.5 — 2.78 4.88 lb 0.5 — 2.30 110 oz 0.5 — 1.87 1 lb 1 1 1-lb loaf 1.80 1 lb 1 1 1-lb bag 1.77 1 lb 0.25 1 1-lb bag 0.19 64 oz 0.25 4 16-oz cans 0.72 18 oz 0.5 1 18-oz jar 0.90 38.98 128 fl oz 1 3 32-fl oz cans 3.67 14 qt 1 7 half-gallons 9.66 1 qt 0.5 1 1-qt container 1.14 1 lb 0.5 1 1-lb package 1.65 36 oz 1 3 12-oz boxes 7.31 1 doz 1 1 doz 1.03 4.88 lb 0.5 — 1.70 110 oz 0.5 — 2.78 4.88 lb 0.5 — 2.30 110 oz 0.5 — 1.87 1 lb 1 1 1-lb loaf 1.80 1 lb 1 1 1-lb bag 1.77 1 lb 0.25 1 1-lb bag 0.19 64 oz 0.25 4 16-oz cans 0.72 18 oz 0.5 1 18-oz jar 0.90 38.49 144 fl oz 1 3 46-fl oz cans 4.13 19 qt 0.9 6 gallons 11.80 19 qt 0.1 9 64-oz containers + 1 32-oz container 3.12

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WIC Food Packages: Time for a Change Food Unit Approximate Cost per Unit ($) Yogurtb,c qt 2.28 Tofub,c lb 1.76 Cheeseb,c,d lb 3.30 Cereal oz ~0.20 Eggs doz 1.03 Fresh fruitsb,c lb ~0.69 Canned fruitsb,c oz ~0.05 Fresh vegetablesb,c lb ~0.94 Canned vegetablesb,c oz ~0.03 Bread, whole wheatb,c lb 1.80 Brown riceb,c lb 1.77 Beans, driedb,c lb 0.77 Beans, cannedb,c oz ~0.04 Peanut butter oz 0.10 Total Food Package VI Juice fl oz ~0.03 Milk, fat-reducedb,c qt 0.69 Soy beverage (“soy milk”)b,c qt 1.64 Yogurtb,c qt 2.28 Tofub,c lb 1.76 Cheeseb,c,d lb 3.30 Cereal oz ~0.20 Eggs doz 1.03 Fresh fruitsb,c lb ~0.69 Canned fruitsb,c oz ~0.05 Fresh vegetablesb,c lb ~0.94 Canned vegetablesb,c oz ~0.03 Beans, driedb,c lb 0.77 Beans, cannedb,c oz ~0.04 Peanut butterb,c oz 0.10 Total Food Package VII Juice fl oz ~0.03 Milk, fat-reducedb,c qt 0.69 Soy beverage (“soy milk”)b,c qt 1.64 Yogurtb,c qt 2.28 Tofub,c lb 1.76 Cheeseb,c,d lb 3.30 Cheese lb 3.30 Cereal oz ~0.20

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WIC Food Packages: Time for a Change Representative Amount in Food Package Quantity Used in Calculation Assumption, Proportion Usedb Example Cost ($) 1 qt 1 1 1-qt container 2.28 1 lb 0.5 1 1-lb container 0.88 1 lb 0.5 1 1-lb package 1.65 36 oz 1 3 12-oz boxes 7.30 1 doz 1 1 doz 1.03 6.1 lb 0.5 — 2.12 140 oz 0.5 — 3.48 6.1 lb 0.5 — 2.88 140 oz 0.5 — 2.38 1 lb 0.5 1 1-lb loaf 0.90 1 lb 0.5 1 1-lb bag 0.89 1 lb 0.5 1 1-lb bag 0.39 64 oz 0.5 4 16-oz cans 1.42 18 oz 1 1 18-oz jar 1.80 48.45 96 fl oz 1 246-fl oz cans 2.76 14 qt 0.9 3 gallons + 1 half-gallon 8.69 14 qt 0.1 7 64-oz containers 2.30 1 qt 0.25 1 1-qt container 0.57 1 lb 0.25 1 1-lb container 0.44 1 lb 0.5 1 1-lb package 1.65 36 oz 1 3 12-oz boxes 7.30 1 doz 1 1 doz 1.03 6.1 lb 0.5 — 2.12 140 oz 0.5 — 3.48 6.1 lb 0.5 — 2.88 140 oz 0.5 — 2.38 1 lb 0.25 1 1-lb bag 0.19 64 oz 0.25 4 16-oz cans 0.72 18 oz 0.5 1 18-oz jar 0.90 37.41 144 fl oz 1 3 46-fl oz cans 4.13 21 qt 0.9 6 gallons 13.04 21 qt 0.1 12 64-oz containers 3.45 1 qt 1 1 1-qt container 2.28 1 lb 0.5 1 1-lb container 0.88 1 lb 0.5 1 lb 1.65 1 lb 1 1 lb 3.30 36 oz 1 3 12-oz boxes 7.30

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WIC Food Packages: Time for a Change Food Unit Approximate Cost per Unit ($) Eggs doz 1.03 Fresh fruitsb,c lb ~0.69 Canned fruitsb,c oz ~0.05 Fresh vegetablesb,c lb ~0.94 Canned vegetablesb,c oz ~0.03 Bread, whole wheatb,c lb 1.80 Brown riceb,c lb 1.77 Canned fishb,c Tunab,c oz ~0.09 Salmonb,c oz ~0.11 Beans, driedb,c lb 0.77 Beans, cannedb,c oz ~0.04 Peanut butter oz 0.10 Total aAll costs use market purchase-weighted prices estimated using 1999–2002 price data as described in Chapter 5—Evaluation of Cost. See data sources. This table is a simplification using prices that have been rounded off; small discrepancies between this table and other sections of the report are due to errors introduced by rounding for the purposes of constructing this table. Tables E-3A and E-3B are intended as easy reference guides of the costs used in cost calculations. These costs are illustrated well using the revised food packages; therefore the current food packages were not included in these tables. bAssumptions for the cost analyses included weighting alternate choices shown in this table as proportions used for calculating costs. For example, the cost of the fruit was calculated using 0.5 as the proportion for both canned and fresh fruits; that means the cost was calculated using a choice of 50% canned and 50% fresh fruits. For additional detail, see Table E-2.

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WIC Food Packages: Time for a Change Representative Amount in Food Package Quantity Used in Calculation Assumption, Proportion Usedb Example Cost ($) 2 doz 1 2 doz 2.06 6.1 lb 0.5 — 2.12 140 oz 0.5 — 3.48 6.1 lb 0.5 — 2.88 140 oz 0.5 — 2.38 1 lb 0.5 1 1-lb loaf 0.90 1 lb 0.5 1 1-lb bag 0.89 30 oz 0.8 5 6-oz cans 2.08 29.4 oz 0.2 2 14.7-oz cans 0.62 1 lb 0.5 1 1-lb bag 0.39 64 oz 0.5 4 16-oz cans 1.42 18 oz 1 1 18-oz jar 1.80 57.05 cAllowed substitutions used in the calculations are indented below the food item in the package; the total allowance for this food item is reflected in the sum of these entries. dCheese may be substituted for milk at the rate of 1 lb of cheese for 3 qt of milk. NOTE FOR TABLE E-3B: ~ indicates approximate amount. DATA SOURCES: Price data are from Economic Research Service, USDA (ERS, 2004b, 1999 price data); ACNielsen Homescan (ACNielsen, 2001, price data for 2001obtained through ERS, USDA); and the Bureau of Labor Statistics, U.S. Department of Labor (BLS, 2004a, 2002 price data).

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WIC Food Packages: Time for a Change TABLE E-4 Estimated Program Costs for Food per Month Using Current Packages (2002)a Group Age/Participant Categoryb Description Package Infants 0–3.9 mo Fully formula-fed I Partially breast-fedd I Fully breast-fedd — Subtotalse     4–5.9 mo Fully formula-fed II Partially breast-fed f II Fully breast-fed f II Subtotalse     6–11.9 mo Fully formula-fed II Partially breast-fed g II Fully breast-fed g II Subtotalse     Totals for infante     Children 1–4.9 yh Totals for childrene   IV Women Pregnante   V Partially breastfeedingi   V Non-breastfeeding postpartum e   VI Fully breastfeedingi   VII Totals for womene     Totals for program Average food package cost per participant (per month) aAll costs use market purchase-weighted prices estimated using 1999–2002 price data as described in Chapter 5—Evaluation of Cost. Data on number of participants were obtained from 2002 (Bartlett et al., 2003). bSee footnote b for Table E-5. cThe committee used data provided by FNS (public communication during open session, February, 2004, J. Hirschman, Office of Analysis, Nutrition and Evaluation, Food and Nutrition Service, USDA) to estimate that the average post-rebate cost of formula was 32.1%of the pre-rebate cost in 2002. dPercentage of infants fully breast-fed at 3 mo of age was reported (CDC, 2004b, 2004c). Percentage of partially breast-fed infants was calculated from these data and data on the percentage of infants who had ever been breast-fed at 3 mo of age (CDC, 2004b, 2004c). eNumber of participants was calculated using data Exhibit 3.1 from USDA’s WIC Participant and Program Characteristics, 2002 (Bartlett et al., 2003), recognizing that some discrepancies exist in these data. An infant is defined as a participant who, at certification, is under 1 year of age and who would be classified as a child at the age of 366 d. However, in 2002, about 2.84% of WIC participants categorized as 1-y-old children are, in fact, 11-mo-old infants who have been recertified as 1-y-old children; additionally, about 0.38% of WIC participants who are classified as infants are participants who are older than 366 d. fPercentage of infants fully or partially breast-fed at 4–5.9 mo of age was extrapolated

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WIC Food Packages: Time for a Change Percentage within Age/ Participant Category Number of Participantsb Cost (pre-rebate, if applicable) Post-Rebate Costc Program Cost (post-rebate, if applicable) 36 668,309 $ 92.69 $ 29.75 $ 19,882,193 28 519,796 $ 92.69 $ 29.75 $ 15,463,931 36 668,309 0     100 1,856,414     $ 35,346,124 69 38,428 $ 100.37 $ 37.43 $ 1,438,360 20 11,138 $ 100.37 $ 37.43 $ 416,895 11 6,126 $ 7.68   $ 47,048 100 55,692     $ 1,902,303 79 118,955 $ 100.37 $ 37.43 $ 4,452,486 16 24,092 $ 100.37 $ 37.43 $ 901,764 5 7,529 $ 7.68   $ 57,823 100 150,576     $ 5,412,073   2,062,682     $ 42,660,500 100 4,020,032 $ 39.29   $ 157,947,057 100 4,020,032     $ 157,947,057 45 878,619 $ 41.23   $ 36,225,461 11 205,559 $ 41.23   $ 8,475,198 31 597,451 $ 34.39   $ 20,546,340 13 252,572 $ 50.61   $ 12,782,669 100 1,934,201     $ 78,029,668   8,016,915     $ 278,637,225         $ 34.76 from data for infants at 3 and 6 mo of age (CDC, 2004b, 2004c; Abbott Labs, 2002, 2003 [2001 data]). gPercentages of infants fully or partially breast-fed at 6–11.9 mo of age were calculated as the average of data reported for infants at 6 mo (CDC, 2004b, 2004c) and 12 mo of age (CDC, 2004b, 2004c; Briefel et al., 2004a). hIncludes 0.8% of children, age 1–4.9 y, who were reported as “age not reported.” iPercentage distribution of women as fully breastfeeding (55% of the total) or partially breastfeeding (45%of the total) was calculated according to the distribution of infants identified as fully or partially breast-fed (see notes f and g). NOTES FOR TABLE E-4: This table is similar to Table 5-2; more detail is presented here in Appendix E. DATA SOURCES: Price data are from Economic Research Service, USDA (ERS, 2004b, 1999 price data; Oliveira et al., 2001, 2000 infant formula price data); ACNielsen Homescan (ACNielsen, 2001, price data for 2001obtained through ERS, USDA); and the Bureau of Labor Statistics, U.S. Department of Labor (BLS, 2004a, 2002 price data). Data on rates of participation are from resources published by USDA (Bartlett et al., 2003, 2002 data; Kresge, 2003, 2002 data). Data on percentages of infants breast-fed were obtained from the 2003 National Immunization Survey (CDC, 2004b, 2004c) and published resources (Abbott Labs, 2002, 2003; Briefel et al, 2004a).

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WIC Food Packages: Time for a Change TABLE E-5 Estimated Program Costs for Food per Month Using Revised Packages (2002)a Group Age or Participant Categoryb Description Package Infants 0–3.9 mo Fully formula-fed I Partially breast-fedd,e —(0–0.9 mo) Partially breast-fedd,e I (1–3.9 mo) Fully breast-fedd — Subtotalsg     4–5.9 mo Fully formula-fed II Partially breast-fedh II Fully breast-fedh II Subtotalsg     6–11.9 mo Fully formula-fed II Partially breast-fedi II Fully breast-fedi II Subtotalsg     Totals for infantsg     Children 1–1.9 y j   IV-A 2–4.9 y j   IV-B Totals for childreng     Women Pregnantg   V Partially breastfeedingk   V Non-breastfeeding postpartumg   VI Fully breastfeedingk   VII Totals for womeng     Totals for program Average food package cost per participant (per month) aAll costs use market purchase-weighted prices estimated using 1999–2002 price data as described in Chapter 5—Evaluation of Cost. Data on number of participants were obtained from 2002 (Bartlett et al., 2003). bThe analyses presented in Tables E-4 and E-5 used published data for FY2002 from FNS (Bartlett et al., 2003, Exhibits 3.1 and 5.7) for the number of participants in total and in each participant category, including age groups within the infant category. The data presented by Bartlett et al. were derived from data collected on participants at the time of certification in the WIC program. If the analyses are done using the assumption that infant ages were distributed equally across twelve months, instead of by age at certification, the average package cost per participant would be $37.10 for the current packages and $38.02 for the revised packages. This represents an increase of $0.92 for the revised packages compared to the current packages. Thus, by these estimates the revised packages would be 2.5 percent higher in cost than the current packages. These estimates represent the upper bound of effects on costs because attrition in participation rates occurs as infants mature; for example, FY2002 enrollment was 2.1 million for infants and 1.4 million for one-year-olds (Bartlett et al., 2003). In using the data presented by Bartlett et al., the participant numbers throughout FY2002 were

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WIC Food Packages: Time for a Change Percentage Within Age or Participant Category Number of Participantsb Cost (pre-rebate, if applicable) Cost Post-Rebatec Program Cost (post rebate, if applicable) 36 668,309 $ 92.69 $ 29.75 $ 19,882,193 7 129,949 $ 4.65f $ 1.49 $ 193,624 21 389,847 $ 37.25 $ 11.96 $ 4,662,570 36 668,309 0     100 1,856,414     $ 24,738,387 69 38,428 $ 101.66 $ 32.63 $ 1,253,906 20 11,138 $ 50.83 $ 16.32 $ 181,772 11 6,126 0     100 55,692     $ 1,435,678 79 118,955 $ 91.02 $ 42.30 $ 5,031,797 16 24,092 $ 55.14 $ 30.78 $ 741,552 5 7,529 $ 57.10   $ 429,906 100 150,576     $ 6,203,255   2,062,682     $ 32,377,320 36 1,447,212 $ 38.98   $ 56,412,324 64 2,572,820 $ 38.49   $ 99,027,842 100 4,020,032     $ 155,440,166 45 878,619 $ 48.45   $ 42,569,090 11 205,559 $ 48.45   $ 9,959,334 31 597,451 $ 37.41   $ 22,350,642 13 252,572 $ 57.05   $ 14,409,233 100 1,934,201     $ 89,288,299   8,016,915     $ 277,105,785         $ 34.57 overestimated. If the analyses were done using FY2002 data presented as totals per participant category calculated from monthly averages (FNS, 2004f) instead of the annual totals from data collected at certification (Bartlett et al., 2003), the average package cost per participant would be $34.75 for the current packages and $34.57 for the revised packages. This represents a decrease of $0.18 for the revised packages compared to the current packages. Please note that the material in footnote b of Table E-5 was added after the report was released. cThe committee used data provided by FNS (public communication during open session, February, 2004, J. Hirschman, Office of Analysis, Nutrition and Evaluation, Food and Nutrition Service, USDA) to estimate that the average post-rebate cost of formula was 32.1% of the pre-rebate cost in 2002. dPercentage of infants fully breast-fed at 3 mo of age was reported (CDC, 2004b, 2004c). Percentage of partially breast-fed infants was calculated from these data and data on the percentage of infants who had ever been breast-fed at 3 mo of age (CDC, 2004b, 2004c).

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WIC Food Packages: Time for a Change eFor the category of partially breast-fed infants 0–3.9 mo, the committee estimated that the number of infants aged 0–0.9 mo was 25% of the category total and the number of infants aged 1–3.9 mo was 75% of the total. In the absence of data on the proportion of infants to anticipate in each of the first 4 mo after birth, the committee assumed the distribution would be approximately equal in each month, using the census data for children under the age of 5 y as a model (20.0% ± 0.3%, mean ± SD) (U.S. Census Bureau, 2004). fOne alternative is to provide one small can (up to 15 oz) of powdered formula to breastfed infants during the first mo postpartum if requested by the mother. The committee used the assumption that the number of breastfeeding mothers requesting formula in the first mo would approximate 50% of the current number of partially breastfeeding mother/infants pairs. The additional monthly cost per participant who choose this option would be $9.30 in pre-rebate costs and $2.98 in post-rebate costs. Using the estimate of 50% of the current partially breastfeeding participants (0.5 × 129,949 = 64,747) for the first mo postpartum, the additional monthly program cost would be $193,626 or an additional 2.4¢ in the average cost per participant. gNumber of participants was calculated using data Exhibit 3.1 from USDA’s WIC Participant and Program Characteristics, 2002 (Bartlett et al., 2003), recognizing that some discrepancies exist in these data. An infant is defined as a participant who, at certification, is under 1 y of age and who would be classified as a child at the age of 366 d. However, in 2002, about 2.84% of WIC participants categorized as 1-y-old children are, in fact, 11-mo-old infants who have been recertified as 1-y-old children; additionally, about 0.38% of WIC participants who are classified as infants are participants who are older than 366 days. hPercentage of infants fully or partially breast-fed at 4–5.9 mo of age was extrapolated from data for infants at 3 and 6 mo of age (CDC, 2004b; Abbott Labs, 2002, 2003 [2001 data]). iPercentages of infants fully or partially breast-fed at 6–11.9 mo of age were calculated as the average of data reported for infants at 6 mo (CDC, 2004b, 2004c) and 12 mo of age (CDC, 2004b, 2004c; Briefel et al., 2004a). jThe committee calculated the number of participants in each category using data from the USDA sponsored WIC Participant and Program Characteristics 2002 (Bartlett et al., 2003); data from Exhibit 3.1 (Bartlett et al., 2003) were used to estimate the number of participants ages 1–1.9 y and 2–4.9 y. kPercentage distribution of women as fully breastfeeding (55% of the total) or partially breastfeeding (45% of the total) was calculated according to the distribution of infants identified as fully or partially breast-fed (see notes h and i). NOTES FOR TABLE E-5: This table is similar to Table 5-3; more detail is presented here in Appendix E. DATA SOURCES: Price data are from Economic Research Service, USDA (ERS, 2004b, 1999 price data; Oliveira et al., 2001, 2000 infant formula price data); ACNielsen Homescan (ACNielsen, 2001, price data for 2001obtained through ERS, USDA); and the Bureau of Labor Statistics, U.S. Department of Labor (BLS, 2004a, 2002 price data). Data on rates of participation are from resources published by USDA (Bartlett et al., 2003, 2002 data; Kresge, 2003, 2002 data). Data on percentages of infants breast-fed were obtained from the 2003 National Immunization Survey (CDC, 2004b, 2004c) and published resources (Abbott Labs, 2002, 2003; Briefel et al, 2004a).