Estimating Eligibility and Participation for the WIC Program Final Report (2003) / Chapter Skim
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7. Estimating Eligibility Based on Meeting Nutritional Risk Criteria
7. Estimating Eligibility Based on Meeting Nutritional Risk Criteria
Pages 83-112
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From page 83... ...
For example, for young children, a blood lead value equal to or greater than 10 micrograms per deciliter is an approved criterion for nutritional risk, so that a child with a blood lead level above the 10 microgram level would qualify as nutritionally at risk. To determine whether an applicant meets at least one of the nutrition risk criteria, a competent professional authority at the local WIC office administers a nutritional risk screen to the applicant.
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From page 84... ...
The adjustment factors for all categories TABLE 7-2 Adjustment Factors Currently Used to Estimate the Number of Income-Eligible People Who Also Meet Nutritional Risk Eligibility Criteria Category Adjustment Factor Infants Children Pregnant women NonbreastSeeding postpartum women BreastSeeding postpartum women 0.950 0.752 0.913 0.933 0.889
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From page 85... ...
For one group, children ages 1 to 2, data limitations prevent us from presenting lower bound estimates. The chapter also contains a discussion of the costs and benefits of using a dietary risk screen to determine eligibility.
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From page 86... ...
studies suggest that nearly all children ages 2 years and older and all women in the childbearing years are at dietary risk because they fail to meet the dietary guidelines as translated by recommendations of the food guide pyramid and (2) no known assessment methods can identify or hold promise of accurately identifying the small percentages of women and children who do meet the proposed criterion "failure to meet dietary guideline" with the limited amount of on-site information about food intake that is available to WIC field staffs.
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From page 87... ...
Different data sources were considered. As we discuss in this chapter, the lack of relevant national data about dietary risk of children ages 1 to 2 years limits our ability to estimate the percentage of these children who meet income eligibility requirements but not nutritional risk criteria.
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From page 88... ...
88 ESTIMATING ELIGIBILI~YANDPARTICIPATIONFOR THE WICPROGRAM TABLE 7-3 Available Data Related to Estimating Nutritional Risk, by Survey Categorical Groups to Nutritional Risk Indicatora Which Related Data Available, by Survey (Code, Description) for Criterion Is Criterion Applicable NHANES CSFII 101-103,Lowweightforheight Each Measured Self-reported 111-114, High weight for Each Measured Self-reported height 121, Short stature 134, Failure to thrive 135, Inadequate growth 141, Low birthweight 142, Prematurity 151, Small for gestational age 152, Low head circumference 153, Large for gestational age 201, Low hematocrit/ Infants, children Infants Infants, children Infants Infants Infants Infants Infants Each low hemoglobin 211, Elevated blood lead Each 311, History of preterm delivery Pregnant women 312, History of low birthweight Pregnant women 321, History of spontaneous Pregnant abortion, fetal or neonatal women loss 331, Pregnancy at a young age Pregnant women 332, Closely spaced pregnancies Pregnant women 333, High parity and young age Pregnant women 334, Lack of adequate prenatal Pregnant care women 335, Multifetal gestation Pregnant women 336, Fetal growth restriction Pregnant women Measured Self-reported
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From page 89... ...
for Criterion Is Criterion Applicable NHANES CSFII 337, History of birth of an infant who is large for women gestational age 338, Pregnant woman currently Pregnant breastSeeding 339, History of birth with Pregnant Pregnant women nutrition-related congenital women or birth defect 341, Nutrient deficiency diseases Each 342, Gastrointestinal disorders Each 343, Diabetes mellitus Pregnant Yes women 344, Thyroid disorders Each 345, Hypertension, chronic or Each Yes pregnancy induced 346, Renal disease Each 347, Cancer Each Yes 348, Central nervous system Each disorders 349, Genetic and congenital Each disorders 350, Pyloric stenosis 351, Inborn errors of metabolism 352, Infectious diseases 353, Food allergies 354, Celiac disease 355, Lactose intolerance 356, Hypoglycemia 357, Drug-nutrient interactions 358, Eating disorders Infants Each Each Each Each Each Each Each Pregnant women YYes :es 359, Recent major surgery, Each trauma, burns 360, Other medical conditions Each Yes Yes 361, Depression Each corltirlued
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From page 90... ...
. Criterion Categorical Groups to Which Criterion Is Applicable NHANES CSFII Related Data Available, by Survey Each 362, Developmental, sensory, or motor disabilities interfering with the ability to eat 371, Maternal smoking Pregnant women 372, Alcohol and illegal drug Pregnant use 381, Dental problems 401, Failure to meet USDA/DHHS Dietary Guidelines for Americans 402, Vegan diets 403, Highly restrictive diets Each Each Each Each women 411, Inappropriate infant Infants feeding practices 412, Early introduction of solid foods 413, Feeding cow milk during the first 12 months 414, No dependable source of iron for infants at 6 months of age or later 415, Improper dilution of formula 416, Feeding other foods low in .
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From page 91... ...
.lcatlons 701, Infant up to 6 months old Infants of WIC mother or of a woman who would have been eligible during pregnancy 702, BreastSeeding infant of woman at nutritional risk women Pregnant women Infants Infants Yes. See above.
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From page 92... ...
data related to the indicator. The panel used both data sets when considering lower bound estimates of the proportion of individuals meeting at least one criterion.
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From page 93... ...
The combined 1994-1998 CSFII includes over 2,500 children ages 2 to 5 years who live in households with incomes at or below 185 percent of federal poverty guidelines. The 1994-1998 CSFII is a reliable nationwide data source for estimating the proportion of income-eligible individuals for WIC who meet the dietary risk criterion failure to meet dietary guidlelines as specified in the report Dietary Risk Assessment in the WIC Program (Institute of Medicine, 2002~.
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From page 94... ...
The following characteristics of the NHANES III Phase II data limit their usefulness for estimating the proportion of income-eligible individuals who meet dietary risk criteria: · A second nonconsecutive 24-hour recall was administered to only a 5 percent subsample of individuals in NHANES III, and individuals in the subsample were offered a cash incentive to return for a .
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From page 95... ...
Since a single current data source does not provide all the data needed to estimate the percentage of individuals who would meet at least one of the many approved nutritional risk criteria, the panel investigated ways to set a lower bound for the proportion of income-eligible pregnant and postpartum women, infants, and children who would do so. The panel first identified the single most common type of nutritional risk for each of the categorical groups.
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From page 96... ...
The panel used data from CSFII 1994-1998 to estimate lower bounds on the percentages of pregnant women, postpartum women, and children ages 2 to 5 years who met a dietary risk criterion. Two dietary risk criteria were employed: one that uses the IOM's proposed dietary risk criterion and one that uses the modal dietary standards used in the WES II study.
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From page 97... ...
Box 7-1 gives the criteria for children aged 2-5 and Box 7-2 gives the criteria for pregnant and postpartum women. The panel used these specifications in its first analysis to estimate the percentages of children ages 2 to 5 years, pregnant women, and breastEeeding women who meet a dietary risk criterion.
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From page 98... ...
(The report does not provide a separate estimate of this dietary risk adjusted for income.) Those results suggest that lower bound adjustment factors for nutritional
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From page 100... ...
shows the estimated proportions of children ages 2 to 5 years living in households with annual income below 185 percent of federal poverty guidelines who would be considered to be at dietary risk under the proposed IOM criterion and the modal criterion. The table also includes percentages of those whose intake is below the criterion for each food group and for any of the food groups using both one day and two days of dietary recall data.
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From page 101... ...
. Among breastEeeding women, the estimated proportions of women with incomes below 185 percent of poverty at risk is 100 percent.3 Our findings for children, pregnant women, and breastEeeding women support the IOM's recommendation to "presume that all income- and categorically eligible women and children aged 2 to 5 years are at dietary risk" based on the criterion of failure to meet dietary guidelines specified above (Institute of Medicine, 20021.
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From page 102... ...
This is slightly higher than the value of 0.95, which is currently used by USDA. Lower Boundl Estimates for Childiren Ages 1 to 2 Years In 1998, 65 percent of children ages 1-2 years have an identified dietary risk, a majority of them because of inadequate or inappropriate nutrient intake (U.S.
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From page 103... ...
Assessing Nutritional Risk in the Field Compared with estimating the percentage of individuals in a population who meet at least one nutritional risk criterion, screening for nutritional risk, especially for dietary risk, is an even more daunting task in the WIC service site. Since WIC field staff are required to screen for nutritional risk to determine full eligibility for WIC, and since dietary risk is the most common risk reported for women and children, effective screening for nutritional risk requires an accurate screening method for dietary risk.
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From page 104... ...
In fact, information on daily dietary intake is subject to so much error that one could conclude that a person does not meet the criterion for dietary risk (that is, her habitual intake of a food group is at least equal to the cutoff point) only if the person's mean intake of that food group were considerably higher than the cutoff point (Institute of Medicine, 20001.
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From page 105... ...
With the inherent limitations of practical methods to assess dietary intake of individuals, it is arguably impossible for WIC field staff to distinguish the persons who do not meet the dietary risk criterion from those who do. COST-BENEFIT ANALYSIS OF ASSESSING THE DIETARY RISK OF WIC APPLICANTS FOR DETERMINING ELIGIBILITY Considering the limitations of methods to screen for dietary risk, the panel examined the costs and benefits of screening for dietary risk.
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From page 106... ...
This approach is consistent with the IOM recommendation to presume that all categorically and income-eligible women and children ages 2 to 5 years are at dietary risk (and thus at nutritional risk) .5 If this remedy were applied, then it would no longer be necessary to account for nutritional risk in the estimates of the number of WIC-eligible individuals for budgetary purposes.
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From page 107... ...
This depends on whether the net social benefits of providing WIC benefits to an additional 95 individuals who are at risk are greater than the net social costs of providing WIC benefits to the 45 individuals who are not at risk and would not pass the nutritional risk screen. The panel formalized this cost-benefit calculation.
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From page 108... ...
Fully Eligible (No Nutritional Risk Screen) Truly at Nutritional Risk Yes No Total Yes 950 0 950 No 50 0 50 Total 1,000 0 1,000 NOTE: Both panels assume that 95 percent of income-eligible populations are truly at nutritional risk and that the nutrition risk screen has a 90 percent sensitivity and 90 .^ .
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From page 109... ...
If the GAO estimates or the Devaney et al. estimates are correct, then it is clear that the net benefits of WIC for pregnant women are large enough to justify the presumption of nutritional risk for eligibility purposes.
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From page 110... ...
A nutritional risk screen would be justifiable, however, if a revised, highly accurate screen that correctly identifies individuals who are not at nutritional risk were available, and if the actual prevalence of nutritional risk was considerably lower than the current estimate. Lower bound estimates of dietary risk among income-eligible infants, women, and children ages 2 to 5 years all are at least 97 percent, and those children ages 1 to 2 are likely to be that high as well.
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From page 111... ...
If the IOM recommendation is not adopted by USDA, then the lower bound estimates ofthe prevalence of nutritional risk given earlier in this chapter should be used to estimate the number fully eligible for WIC. These lower bound estimates are: 0.97 for pregnant women, 1.00 for postpartum women, 0.97 for infants, and 0.98 for children ages 2 to 5.
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From page 112... ...
The eligibility estimates would then need to be adjusted accordingly (i.e., by the percentage of the income-eligible population at nutritional risk)
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