WIC Nutrition Risk Criteria A Scientific Assessment (1996) / Chapter Skim
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7 PREDISPOSING NUTRITION RISK CRITERIA
7 PREDISPOSING NUTRITION RISK CRITERIA
Pages 295-334
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From page 295... ...
expanded the definition of nutrition risk to include predisposing conditions including, lout not limited to, alcoholism and drug addiction.... Subsequent changes in regulations added homelessness and migrancy as specific predisposing nutrition risk criteria.
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Apart from homelessness, the committee did not find a scientific basis on which to review the relationship between food preparation facilities and nutrition risk or benefit. TABLE 7-1 Summary of Predisposing Risk Criteria in the WIC Program and Use by States Risk Criterion States Using Pregnant Womena Infants Children H o me l essn es s Migrancy Passive smoking Low level of maternal education and 2 illiteracy Young caregiver Maternal depression Battering Child abuse or neglect Child of a mentally retarded parent 21 20 9 7 35 26 NOTE: Dashes denote that the criterion was not reported for that population.
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The committee's recommendations for predisposing nutrition risk criteria are summarized in Table 7-3. HOMELESSNESS Until recently, homelessness by itself was not accepted as a valid nutrition risk criterion for eligibility for participation in the WIC program.
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Homeless women, especially homeless pregnant women, are more likely than housed low-income women to have alcohol problems, to use drugs, and to smoke (Becker et al., 1 992; Fischer, 1 99 1; Jaffee et al., 1 992~. Homeless women are also likely to be victims of domestic violence; 33 to 89
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A study of homeless pregnant women in New York City found significantly higher infant mortality rates and rates of low birth weight (LBW) among the homeless women than among women living in lowincome public housing (Chavkin et al., 1987~.
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Other health problems experienced by homeless children include a high reported rate of child abuse and neglect; a higher incidence of asthma; and increased risks of infectious disease, especially conjunctivitis, ringworm, gastrointestinal disorders, upper respiratory infections, and scabies and lice infestations (Khan, l 991~. High proportions of homeless children and their families have no regular source of medical care, and they over-rely on hospital emergency rooms for primary health care (Hu et al., 1989; Roth and Fox, 1990; Wood and Valdez, l 991~.
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There are apparently no research studies that have investigated the dietary or health effects of WIC program participation on homeless women and their children. Homelessness as an Indicator of Nutrition and Health Benefit Despite the lack of empirical evidence, the nutrition and health problems experienced by homeless women and their children underscore their need for the nutrition education, nutritious foods, and referrals to health care provided through the WIC program.
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Use of Homelessness as a Nutrition Risk Criterion in the WIC Setting As discussed earlier, homelessness has only recently been allowed for use as a predisposing nutrition risk criterion by state WIC programs. Given the severe health and nutrition problems experienced by homeless women, infants, and children, it is highly likely that they are placed in a priority higher than VII by virtue of an anthropometric, medical, or dietary nutrition risk criterion or by virtue of the state's option to place homeless program applicants in Priorities IV through VI.
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From page 304... ...
As a result, the final WIC program regulations published in the April 19, 1995, Federal Register also included migrancy as a predisposing nutrition risk criterion certifying eligibility for participation in the WIC program. Migrant individuals who are eligible for participation in the WIC program on the basis of categorical criteria and income but who lack any other documented medical or nutrition risk criterion are placed in Priority VII, with the state having the option of placing individuals in Priorities IV through VI.
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Common problems documented in the literature include increased risk of respiratory infections, gastroenteritis, intestinal parasites, skin infections, otitis media, scabies and head lice, pesticide exposure, tuberculosis, poor nutrition, anemia, short stature, obesity, hypertension, diabetes mellitus, congenital anomalies, delayed development, injuries, adolescent pregnancy, inadequate dental care, and delayed immunizations (AAP, CCHS, 1989; Dever, 1991~. However, large gaps exist in the literature on the health status of migrant individuals, and on factors that contribute to their poor health and nutrition status (Rust, 1990~.
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Finally, less than one-quarter of eligible migrant farmworkers participated in the Food Stamp Program-many migrants were not aware of their eligibility (Shotland et al., 1989~. Many aspects of the living conditions of migrant farmworkers and their families contribute to poor dietary patterns.
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Through referral systems, they strive to achieve a comprehensive approach to meeting their clients' health needs. Very little information is available on the WIC program participation rate by migrant women and their children, and no published studies have investigated the effects of the WIC program on the health of migrant participants.
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From page 308... ...
The recent addition of migrancy as an explicit predisposing nutrition risk criterion allows migrant women, infants, and children eligible for participation in the WIC program on the basis of categorical criteria and income to be certified under Priority VII. However, in the face of funding constraints, migrants eligible only under Priority VII may not tee served.
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As income and maternal education levels decreased, the probability of children's exposure to tobacco smoke increased. In addition, a recent survey in California found that 25 percent of female nonsmokers 18 to 44 years of age were exposed to passive smoking at work and 34 percent were exposed at work and at home (Burns and Pierce, 1992~.
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or an increase in mean birth weight of infants born to mothers exposed to passive smokers (MacArthur and Knox, 1987~. Studies that examined the relative risk of low birth weight of infants born at term generally find that maternal exposure to passive smoking during pregnancy is not associated with an increased risk of term infants being born small-forgestational-age (Chen and Petitti, 1995~.
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Passive Smoking as a Nutrition Risk Criterion in the WIC Setting Three state WIC agencies used passive smoking as a nutrition risk criterion for women in 1992 (see Table 7-1~. Recommendation for Passive Smoking Biologic markers indicate that infants and children exposed to particles from secondhand smoke are at risk for impaired health, growth, and development.
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Low Level of Maternal Education and Illiteracy as Indicators of Nutrition and Health Risk Maternal education is negatively associated with infant and childhood mortality, low birth weight, and mild mental retardation. It is positively associated with the health (including cognitive development)
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Although formal schooling and literacy are not prerequisites for the good health of the offspring, it is likely that the identification of illiterate women or women with low levels of education within the WIC program will also identify children at some degree of risk for poor health and nutrition status. Use of Low Level of Maternal Education and Illiteracy as a Nutrition Risk Criterion in the WIC Setting The two states that used low maternal education as a nutrition risk criterion (see Table 7-1)
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Therefore, the committee recommends use of low level of maternal education and illiteracy as a nutrition risk criterion for women, infants, and children in the WIC program. At this time, scientific evidence is inadequate to recommend a definitive cutoff value for low level of maternal education and literacy.
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A recent review of prior studies presented evidence that maternal depressive symptoms are associated with preterm birth among low-income urban African-American women (Orr and Miller, 1995~. Other studies have found that depressed pregnant women are more likely to smoke
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. Use of Depression as a Nutrition Risk Criterion in the WIC Setting Depression is not currently used as a nutrition risk criterion in the WIC program.
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There is a theoretical basis for benefit from participation in the WIC program. Therefore, the committee recommends use of maternal depression as a nutrition risk criterion for women in all state WIC programs.
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, to be anemic, to consume an unhealthy diet, and to abuse drugs, alcohol, and cigarettes (Parker et al., 1994; Stewart and Cecutti, 1993~. Battering as an Indicator of Nutrition and Health Benefit The committee identified no reports of trials of the effects of provision of WIC nutrition services to abused or battered pregnant women that measured improvement of pregnancy outcome and no studies providing indirect evidence of benefit.
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There is a theoretical basis but no documentation of benefit via improved outcome of pregnancy as a result of WIC participation. The committee recommends use of haltering as a nutrition risk criterion for women by the WIC program, unless contradictory information becomes available, and that it remain in the predisposing risks category.
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From page 320... ...
The provision of nutritionally dense foods and education about appropriate feeding practices is especially important for those children with nonorganic failure to thrive, but these interventions, as well as linkages to the medical and social systems, are also likely to benefit children who have been traumatized by physical, emotional, or sexual abuse. Use of Child Abuse or Neglect as a Risk Criterion in the WIC Program In 1992, seven state WIC agencies considered abuse or neglect to be a nutrition risk criterion for children, and nine considered physical abuse to be a nutrition risk criterion for infants (see Table 7-1~.
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Therefore, the committee recommends use of reported or diagnosed child abuse or neglect as a nutrition risk criterion for infants and children in the WIC program. CHILD OF A YOUNG CAREGIVER There is little disagreement that adolescent women generally are less prepared economically, emotionally, socially, and physically for motherhood than their somewhat older counterparts (Hofferth, 1987; Phipps-Yonas, 1980; Trussel, 1988~.
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Use of Child of a Young Caregiver as a Risk Criterion in the WIC Program Of the five states that included young age of the mother as a nutrition risk criterion for infants (see Table 7-1) , two broadened the definition to include a nonmaternal caregiver.
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, mentally retarded parents were overrepresented in samples of parents who abused or neglected their children. They concluded that research suggests there is an increased risk of maltreatment of children raised by mentally retarded parents.
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The WIC program's supplemental food package and nutrition education could help mentally retarded parents provide nutritionally balanced diets to infants and children. Although some WIC programs teach participants grocery shopping skills and menu planning, the specialized training required by an intellectually disabled parent to acquire child care skills is most likely beyond the scope of the WIC program.
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On a theoretical basis, WIC program services and referrals may help to prevent or treat problems resulting from the parenting inadequacies of a mentally retarded parent. Therefore, the committee recommends use of child of a mentally retarded parent as a nutrition risk criterion for infants and children by the WIC program at a higher priority.
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1989. Passive smoking and low birth weight.
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1992. The nutritional status and dietary adequacy of single homeless women and their children in shelters.
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1979. An at-risk approach to the study of child abuse: Some preliminary findings.
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1994. Scientific Base for the Nutrition Risk Criteria Used in the Special Supplemental Food Program for Women, Infants, and Children.
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1986. Association of low birth weight with passive smoking exposure in pregnancy.
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1982. Child maltreatment and mentally retarded parents: Is there a relationship?
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1993. Dietary intake and growth status of young homeless children.
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1990. Health of homeless children and housed, poor children.
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