State of Georgia Women, Infants, and Children Program participant characteristics, ffy 2002 / Georgia WIC Program

STATE OF GEORGIA WOMEN, INFANTS AND CHILDREN PROGRAM
PARTICIPANT CHARACTERISTICS FFY 2002
Georgia Department of Human Resources Division of Public Health Georgia WIC Branch
2 Peachtree Street, NW, 10th Floor Atlanta, Georgia 30303-3182 (404) 657-2900 (800) 229-9173
WEBSITE: http://health.state.ga.us/programs/wic

2
GEORGIA WIC PROGRAM
State of Georgia Women, Infants and Children Program
Participant Characteristics FFY 2002
Georgia Department of Human Resources Jim Martin
Commissioner
Division of Public Health Kathleen E. Toomey, MD, MPH
Director
Women, Infants and Children Branch Alwin K. Peterson, MA, MPA Director
WIC Participant Characteristics 2002

3
Acknowledgements
State of Georgia WIC Participant Characteristics 2002 was prepared by the Georgia WIC Branch in conjunction with the Maternal and Child Health Epidemiology Section. Our programs give special thanks to those who contributed to its completion, including local agencies, State WIC Office Program Sections, Family Health Branch, Nutrition Section and PDA Software Services, Inc. Publication number DPH-03.001.HW.
CONTRIBUTORS:
Chinaro Kennedy, Dr.P.H Chief Epidemiologist Maternal and Child Health Epidemiology Georgia WIC Program
Emily Kahn, Ph.D., M.P.H Section Chief, Maternal and Child Health Epidemiology
Gen Hunter, M.S.A. Director, Program Assessment and Resources Section Georgia WIC Branch
Hema Joshi, M.Med.Sci Epidemiologist, Maternal and Child Health Epidemiology
Sophia Autrey, M.P.H. Evaluation Consultant Georgia WIC Program
Ronnie Currie, B.S. Programmer Analyst Department of Human Resources
January 2003
"In accordance with Federal Law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-5964 (voice and TDD). USDA is an equal opportunity provider and employer."
WIC Participant Characteristics 2002

4
Table of Contents
Introduction..................................................................................................................................6
Participant Characteristics.........................................................................................................7 Demographics..................................................................................................................7 Race...................................................................................................................................7 Gender of infant/child participant...............................................................................8 Educational Level..........................................................................................................10 Income/Number of family members........................................................................10 Number of family member by race and ethnicity.................................................12 Migrant Status...............................................................................................................12
WIC Certification Type............................................................................................................13 Certification Category.................................................................................................13
Priority Codes............................................................................................................................15 Risk Priority Codes.......................................................................................................15 Risk Priority Codes by race and ethnicity...............................................................16
Participation in other programs.............................................................................................17 Georgia WIC client participation in other programs.............................................17 TANF/AFDC participation by health district............................................................18 Food Stamp participation by health district...........................................................19 Medicaid participation by health district..................................................................20
WIC Participant Nutritional Indicators.................................................................................21 Pre-pregnancy BMI......................................................................................................21 Pre-pregnancy BMI by race and ethnicity..............................................................22
WIC Participant Post-partum Body Mass Index................................................................23 Post-partum BMI..........................................................................................................23 Post-partum BMI by race and ethnicity..................................................................24
WIC Infant and Child Birthweight........................................................................................25 Infant and Child birthweight.....................................................................................25 Infant and child birthweight by race and ethnicity.............................................26
WIC Participant Clinical Indicators......................................................................................27 Hemoglobin levels at certification............................................................................27 Hematocrit percent at certification..........................................................................28
Breastfeeding Practices..........................................................................................................30 Current breastfeeding practices...............................................................................30
WIC Participant Characteristics 2002

5 Table of Contents (Con't)
Current breastfeeding by race and ethnicity.........................................................31 Ever breastfeeding.......................................................................................................32 Ever breastfeeding by race and ethnicity...............................................................33 Length of time breastfed............................................................................................34 Appendix A.....................................................................................................................35
WIC Participant Characteristics 2002

6
INTRODUCTION
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which is administered by the Food and Nutrition Service (FNS), has been an important source of nutritional education, supplemental food, and health care referrals for low-income women during and after pregnancy and for infants and children up to age 5 in the United States, since its inception in 1972. One of the early objectives of WIC was to counteract the detrimental effects of poverty on prenatal and pediatric health. By intervening during the prenatal period, WIC sought to improve fetal development and reduce the occurrence of low birthweight, short gestation and anemia.
Another early objective of the WIC program was breastfeeding promotion and support. Today, most prenatal and post-partum WIC clients are encouraged to breastfeed their infants since breast milk is an ideal source of nutritional support for infants.
Before a participant can become eligible for WIC program, they must undergo a variety of nutritional screenings to determine eligibility. These assessments include screening of height, weight, diet, health history and hematologic indices. In addition, since the WIC program serves a significant number of children younger than 5 years, it is often called on to assess immunization status and screen for child health problems.
The Georgia WIC Program was established in 1974 to help ameliorate the nutritional needs of low-income pregnant women, infants and children. Currently, Georgia's WIC program is comprised of 21 local agencies, 253 local clinics and 1,673 retail grocers that sell WIC approved items. WIC services are available in all 159 of Georgia's counties. The primary objectives of the Georgia WIC program are to improve pregnancy outcome, reduce infant mortality, and give children a healthy start in life by helping to provide nutritious food supplements and nutrition education.
This report contains analyses conducted to assess the demographic characteristics, nutritional status, clinical and breastfeeding practices of Georgia WIC Program participants during Federal Fiscal Year 2002 (FFY 2002). Information contained in this report was obtained from WIC clients during their initial WIC certification during the FFY.
WIC Participant Characteristics 2002

7
PARTICIPANT CHARACTERISTICS
I. Demographic Characteristics
A. Race:
During FFY 2002, 272,510 individuals participated in the Georgia WIC program (Figure 1). Forty six percent of the participants served were African-American, 31% White, 18% Hispanic, while Native American and Asians comprised less than 5% of the total population served (Figure 1). When examined by health districts, African-American clients tended to comprise on average 50% of the total WIC population served, with the exception of Rome, Dalton, Gainesville, LaGrange, Waycross, Brunswick and Athens where there was a larger population of White clients served by WIC (Figure 2).

Figure 1: Race and Ethnic Composition of Participants within the WIC Program in the State of Georgia, FFY 2002, N=272,510

53
52
P e 51 r 50 c 49 e 48 n t 47
46
45

Rome (nD=a1l1to,4n0(2Gn)=a7in,8es6v6iC)lleo(nb=b9-D,8Fo04uu)gltloans ((nnC==l1a93y,1,t55o22n2)G()nw=i8n,n15et6Dt)e(nK=a1l4b,0L(n2a=5G)18ra,6n6Dg6e)u(bnl=in9,(6Mn2=6a3)c,o5n11(nA)=u1g2u,5s0ta2C)(no=lu1m0,b1u1V7sa)(lnd=o1s1taA,2(2lbn3a=)n6y,4(0Sn6=a)v1a1n,2n18aW)h (any=c5r,o9Bs7s1r(u)nn=s1w3Ai,c0kt9h3(en)n=s7(,nS64=o3u6)t,1h6si6d)eG(rna=d1y,51(n6)=2,774)

Districts

Male

Female

WIC Participant Characteristics 2002

8
Figure 2: Race and Ethnic Composition of Participants within the Georgia WIC Program By District, FFY 2002

100
90
P 80 e 70 r 60 c 50 e 40 n 30 t
20
10
0

Rome(n=D1a6l,4to2n6)(nG=1a1in,3sv3i0ll)Ce(onb=b1-3D,8oF5u9ug)lltaosn(n(n=C=131la9,6y,11t11o6)n)(Gn=w1i1n,6n0e6tDt)(enK=a2l0b,0(Ln81=a)G26r,0a9n8gD)eu(nb=li1n4(,0nM3=14a),c7o8n0)(nA=u1g6u,9s6ta5)C(no=lu13m,7b4u9Vs)a(nld=o1s5ta,0A(0n2lb=)a8n,6y37(nS)=av1a5n,2n0a1h)W(na=y8cr,2o4sB2s)(rnu=n1s7w,4i2cA7k)th(ne=ns10(n,S6=o18u8,9t)h2s7i)deG(nra=d2y,0(6n3=)4,741)

White Hispanic Asian

Districts

African-American Native American

B. Gender of infant/child participant: The distribution of male and female infant/child participants was similar across districts. Approximately 50.4% of the infant/child participants served by WIC in the state of Georgia during FFY 2002 were male while 49.5% were female (Figure 3). However, several health districts served a disproportionate number of male or female infant/child clients (Figure 4). For example, the Grady and Fulton health districts tended to serve significantly more female clients than male clients while Dalton and Southside tended to serve more male clients than female clients (Figure 4). For the other health districts however, the distribution of male and female infant and child clients served were similar to that seen statewide (Figure 4).

WIC Participant Characteristics 2002

9
Figure 3: Gender of Infant/Child Participants within the WIC Program in the State of Georgia, FFY 2002, N=194,359

49.56%

50.44%

Male (n=98,034) Female (n=96,325)

Figure 4: Gender of Infant/Child Participants within the Georgia WIC Program By District, FFY 2002

53
52
P e 51 r 50 c 49 e 48 n
47
t
46
45

Rome(n=D1a1l,t4o0n2)(nG=a7i,n8e6s6v)ilCleo(nb=b-9D,8o0Fu4ug)lltaosn(n(n=C=9l1a,13y5,t52o2)n2()Gn=w8i,n1n5e6t)tD(ne=K1a4l,0b2L(5n)a=G18r,a6n6g6De)u(nb=lin9,6(n2M=6)3a,c5o1n1)(nA=u1g2u,5s0ta2)(Cn=o1lu0m,11b7uV)sa(lnd=o1s1ta,2A(2nl3b=)a6n,4y0(6nS)=a1v1a,n21n8a)Wh(nay=c5r,9o7ssB1()rnu=n1s3w,0i9cA3kt)h(ne=n7s,(6nS4=o3u6),t1h6s6id)eG(nra=d1y,5(1n6=)2,774)

Districts

Male

Female

WIC Participant Characteristics 2002

10

C. Educational Level:
Statewide, of the 159,215 women enrollees or primary caregiver of infant or child participant from whom education level is elicited, approximately 19% had a high school education (Figure 5). Less than 5% of all WIC enrollees within the state of Georgia, for whom education level could be elicited, had beyond a high school education, during FFY 2002 (Figure 5). When examined by local health districts, clients within most local agencies had at least a high school education. On average, 28% reported having a high school education within all districts examined (Appendix A).
Figure 5: Educational Level of Participants within the WIC Program in the State of Georgia, (N=159,215) FFY 2002

20

18

16

P 14

e 12
r

c 10

e n

8

t6

4

2

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Educational Level

D. Income/ Number of members in each family economic unit:

The mean family income for WIC participants, during FFY 2002 in the state of Georgia was $1,300 per month (Figure 6), while the mean number of family members within each economic unit was 3.7 (Figure 7). When examined by local health districts, the mean monthly income ranged from $998 to $1,673 (Figure 6), while the number of family members in each economic unit ranged from 3.3 to 4.1 (Figure 7).

WIC Participant Characteristics 2002

11
Figure 6: Mean Family Monthly Income at Certification Period among Participants within the Georgia WIC Program By District, FFY 2002

1700
M 1600 e a 1500 n
1400
i 1300 n c 1200 o 1100 m e 1000
900

Rome(n=D5a,8lt0o9n)(nG=a7i,n0e2s1v)iClleo(bnb=-3D,7o7Fu6ug)l)latosn(n(=nC6=,07la0,8y18t)o7n) G(nw=3in,6n6e7tt)D(ne=K7a,4l5b3L()na=G10r,a2n5g7De)u(nb=li2n,6(2nM2=)1ac,3o4n8)(nA=u4g,3u3s8ta)C(no=lu5m,84b3u)Vs(anl=d3o,s9t1aA1()nlb=a1n,6y4(S2n)a=v1a,6n0n7a)hW(na=y3c,2r3o2s)Bsr(nu=n3sw,20iAc6kt)h(nen=s4(,22S9,2o38u)8t)hsideG(rna=d2y8(7n)S=T2,A12T3E) (n=88,611)

Mean family monthly income, $ amount
Figure 7: Mean Number in Family Economic Unit among Participants within the Georgia WIC Program By District, FY 2002

5
Mh 4 eo au ns3
e #h 2
o il nd 1
0 Rome(n=D1a6l,t3o8n0)(n=G1a1i,n2e6s0v)illCeo(nb=b1-D3,o7uF9g9ul)altson(n(=n1=C31,l49a5,y03t5o)9n)(nG=1w1i,n5n39e)ttD(neK=1a9lb,69(nL7=)a2G6,0ra9n8)gDeu(nb=lin13(,n9M=944a,)7c6o6n)(nA=1u6g,9u2s9ta) (Cno=l1u3m,6b6u8Vs)(anld=o1s4ta,86(An3l=)b8a,n5y77(n)S=a1v5a,0n8n0a)hW(na=y8c,r1o7s9sB)(rnu=n1s7w,3i2cA6k)t(hne=n1s0(,n4S=7o68u),9th27si)deG(nr=a2d,y06(n1)=S4T,7A3T5)E(n=270,866)

WIC Participant Characteristics 2002

12 E. Number of family members by race/ethnicity:
When examined by race/ethnicity, Hispanic clients tended to have, on average, larger family sizes, with a mean number of 4.1 family members in each family unit, compared to the other race/ethnic groups. Among other race/ethnic groups, the family sizes tended to be similar, with an average of 3.6 family members within each economic unit.
Figure 8: Mean Number of Household Members in the Georgia WIC Program, By Race/Ethnicity, FFY 2002

4.5
4 Mh e o 3.5 au 3 n s 2.5
e #h 2
o 1.5 il 1 n d
0.5
0

3.6
White (n=86,139)

3.6
AfricanAmerican (n=126,326)

4.1
Hispanic (n=49,019)

Race/Ethnicity

3.7
Native American (n=294)

3.8
Asian (n=9,088)

F. Migrant Status:
A very small proportion of WIC clients were categorized as migrants. Of the 272,510 clients served by WIC during FFY 2002, 0.26% were classified as migrants (Figure 9). Within the local health districts, most served less than 0.001% migrants (Appendix A). Only one health district, Waycross, reported serving significantly larger number of migrants (1.5%) compared to other health districts.

WIC Participant Characteristics 2002

13 Figure 9: Migrant Status among Participants within the WIC Program in the
State of Georgia, FFY 2002, N=272,510
0.26%
99.70%
Yes (n=707) No (n=271,803)
II. WIC Certification Type A. Certification Category: The largest group of WIC clients enrolled during FFY 2002 were children between the ages of 12-59 months and comprised 42.8% of clients served (Figure 10). Infants made up 28.5% of clients served, while 13.5% of the WIC population served during FFY 2002 were pregnant women (Figure 10). Post-partum clients comprised 15% of the WIC enrollees during this time period (Figure 10). The percentile distribution of clients served within the 21 local health districts was similar to that seen statewide in which children comprised the largest percentage of WIC enrollees followed by infants (Figure 11). Among postpartum women served by WIC, a much smaller percentage were breastfeeding than those who were not (Figure 11).
WIC Participant Characteristics 2002

14

Figure 10: Certification Categories of Participants within the WIC Program in the State of Georgia, N=272,510, FY 2002

45

42.8

% 40

C 35

a 30 t e 25

g 20

o r 15

13.6

i 10

e

5.8

s5

0 Pregnant Woman Breastfeeding
(n=37,018) Woman (n=15,881)

9.3
Postpartum Woman, not breastfeeding (n=25,252)

28.5

Infant <12 monthsChild 12-59 months

(N=77,687)

(N=116,672)

Certification Category

Figure 11: Certification Categories of Participants within the Georgia WIC Program By District, FFY 2002
60

% 50
C a 40 t e g 30 o r 20 i e s 10

0 Rome(n=1D6,a4l2to6n) (n=G11a,3in3e0s)villeC(nob=b1-3D,8o5u9Fg)lualsto(nn=(n1=3,1C691l,a11y)1t6o)n(nG=1w1i,n6n06et)t(nD=e2K0a,0l8b1()nL=a2G6,r0a9n8g)e(Dn=u1b4li,n03(1n)=M4,7ac8o0n) (16A,96u5g)usta(n=C1o3l,u7m49b)usV(nal=d1o5st,0a0(2nA)=l8b,a6n3y7)(n=S1a5v,a2n0n1a)h(nW=8a,y2c4r2o)ss(Bnr=u1n7s,4w2i7c)kA(tnh=en10s,(6n1=8S8)o,9u2t7h)side(Gn=ra2d,0y63(n)=4,741)

Pregnant Postpartum Women, not breastfeeding Child (12-59 Mths.)

Breastfeeding Women Infant (<12 Mths.)

WIC Participant Characteristics 2002

15

III. Priority Codes

A. Risk Priority Codes:

At the initial assessment, WIC clients are assigned a priority code which indicates or is used to determine the urgency of WIC services needed. In our population, 34.3% of WIC enrollees during FFY 2002 were priority 1, pregnant women, breastfeeding women, and infants with nutritional needs (Figure 12). Nutritional need is usually determined by measuring length/height and weight and also by assessing hemoglobin and hematocrit levels as well as examination of medical records to assess documented needs. The next largest group was priority 5, children at nutritional need because of poor diet or homeless/migrant status, which comprised of 23.3% of WIC enrollees (Figure 12). Priority 3 enrollees, children with a nutritional need and postpartum teenagers who are not breastfeeding and whose delivery date was prior to their 18th birthday, comprised 20.6% of WIC clients statewide during this time period (Figure 12). Priority 2 which include infants up to six months of age and breastfeeding women who breastfeed priority 2 infants, priority 4 which include pregnant women, breastfeeding women, and infants with a nutritional need due to poor diet or homeless/migrant status, and priority 6, postpartum, non-breastfeeding women with a nutritional need, or homeless/migrant status, risk categories comprised 11%, 2.5%, and 8% respectively of clients enrolled into the WIC program during FFY 2002 (Figure 12). The distribution of clients enrolled into the program within the 21 local health districts was similar to that seen statewide (Figure 13).

Figure 12: Risk Priority Codes of Participants within the WIC Program in the State of Georgia, FFY 2002, N=272,510

35
30
P 25 e r 20 c e 15 n t 10
5
0

34.3
Priority 1 (n=93,579)

20.6 11.1

Priority 2 (n=30,029)

Priority 3 (n=56,360)

2.5
Priority 4 (n=7,009)

23.2
Priority 5 (n=63,505)

8.1
Priority 6 (n=22,028)

WIC Participant Characteristics 2002

16
Figure 13: Risk Priority Codes of Participants within the Georgia WIC Program By District, FFY 2002

60

50
P 40 e r
30
e n t 20
10

0 Rome(n=16D,4a2l6to)n(n=11G,3a3i0n)esville(nC=o1b3b,8-D59o)uglFasu(ltno=n1(3n,=61119C),1l1a6y)ton(n=1G1,w60in6)nett(n=D2e0K,0a8lb1)(n=2L6,0a9G8r)ange(nD=u1b4li,n03(1n)=4,7M80a)con(n=1A6,u9g6u5s)ta(n=1C3,7o4lu9m) bus(nV=a1l5d,o0s0t2a)(n=A8,l6b3a7n)y(n=1S5a,2v0a1n)nah(n=W8,a2y42cr)oss(n=B1r7u,4n2sw7)ick(nA=t1h0e,6n1s8()n=8S,9o2u7t)hside(n=G2r,0a6d3y)(n=4741)

Priority 1 Priority 4

Districts
Priority 2 Priority 5

Priority 3 Priority 6

B. Risk Priority Codes by Race/Ethnicity:
When examined by race and ethnicity the distribution of risk priority were similar to the distribution found statewide. That is, the majority of WIC enrollees, regardless of race/ethnicity, were priority 1 enrollees, followed by priority 5, then priority 3 (Figure 14). Risk priority 2, 4, and 6, like that seen for the state, made up a much smaller percentage of clients served by WIC when examined within local health districts (Figure 14).

WIC Participant Characteristics 2002

17
Figure 14: Risk Priority Codes of Participants within the Georgia WIC Program By Race/Ethnicity, FFY 2002

40

35

30 P
e 25 r c 20
e n 15 t
10

5

0 White (n=86,661)

African-American (n=126,891)

Priority 1 Priority 4

Hispanic (n=49,488)
Priority 2 Priority 5

Native American (n=297)
Priority 3 Prioirty 6

Asian (n=9,173)

IV. Participation in other Programs
A. Georgia WIC client participation in other programs:
Statewide, a small proportion of clients reported that they participated in other government mandated nutritional supplemental programs. During FFY 2002, 2.1% of WIC clients, in the state of Georgia, reported participation in TANF or AFDC (Figure 15), while 6.2% reported participation in the Food Stamp program (Figure 16). However, the report of Medicaid participation among WIC clients statewide was significantly higher with 66.1% of WIC participants reporting participation in Medicaid (Figure 17).

WIC Participant Characteristics 2002

18 B. TANF/AFDC Participation by health district: Results within the local health districts were very similar to that observed statewide. W IC participants within most local agencies reported low participation in TANF or AFDC with reported participation rates ranging from 0.02-14.47 (Figure 15). It must be noted that reported rates are not a true indication of actual participation since participants are required, at time of certification, to bring in documentation. If a participant is in TANF or AFDC but does not have documentation, then that report is recorded as missing. Figure 15: Participation in TANF or AFDC Program among Participants within
the Georgia WIC Program, FFY 2002
14 12 10 % participation 8
6 4 2 0
Rome(n=D1a6lt,4o2n6()nG=a1in1,e3s3v0ilC)leo(nb=b1-D3,oF8u5ug9ltl)aosn((nnC==1l1a39y,6,t1o11n16)()Gn=w1i1n,n60et6Dt)(enK=a2l0b,0(L8n1a=)G26r,a0n98gD)eu(bn=lin14(n,0M=314a),c7o8n0)(A16u,9g6u5st)aC(no=l1u3m,7b49Vu)sa(lnd=os1t5a,A0(n0lb=2)a8n,6y37(Sn)a=v1a5n,2n0a1Wh)(any=c8r,o2s4Bs2()rnu=n1s7w,4iAc2k7t)h(nen=s10(nS,6=o18u8,)t9h2s7id)Ger(nad=y2,(0n6S=3T4),A74T1E) (n=272,510)
Districts Yes, currently participating
WIC Participant Characteristics 2002

19
C. Food Stamp participation by health district: Again, when we examined participation in the Food Stamp program by local agency, participation rates ranged from 0.82%-26.71% (Figure 16). As was previously mentioned participants are required to bring in documentation of participation in the Food Stamp program at the time of WIC certification. If there is no documentation, even if the client is participating in the Food Stamp program, that report is recorded as missing. This may in part help to explain the low reported rate of participation in the Food Stamp program among WIC clients within each health district.
Figure 16: Participation in Food Stamp Program among Participants within the Georgia WIC Program, FFY 2002
30 25 20
% participation 15
10 5 0
Rome(nD=1a6lt,4o2n6()nG=a1i1n,e3s3v0iCl)leo(bnb=-1D3o,F8u5ug9llta)osn(n(n=C=113la9,6y,11to116n))G(nw=1in1n,6e0tt6D()2eK0,0a8lb1)(Ln=aG26r,0a9n8gD)eu(nb=li1n4(,n0M3=14a),c7o8n0)(nA=u1g6u,9s6t5a)C(no=lu13m,7b4uV9s)a(lnd=o1s5ta,A0(0nlb2=)a8n,6y3(S7n)=av1a5n,2n0a1h)W(na=yc8r,2os4Bs2()rnu=n1s7w,42iAc7kt)h(enn=s1(0nS,=6o81u,89t)h2s7i)deG(nra=d2y,06(n3S=)T4A,74T1E) (n=272,519)
Districts Yes, currently participating
WIC Participant Characteristics 2002

20 D. Medicaid participation by health district: The report of Medicaid participation was however much higher within the local health districts and ranged from 37.1%-87.4% (Figure 17). The documentation of Medicaid participation may be easier since Medicaid clients may be more apt to bring in proof of Medicaid participation to facilitate automatic enrollment into the WIC program. However, automatic enrollment into WIC also holds true for those who participate in TANF or the Food Stamp Program.
Figure 17: Participation in Medicaid among Participants within the Georgia WIC Program, FFY 2002
100 90 80 70 60
% participation 50
40 30 20 10
0
Rome(nD=1a6lt,o4n26(n)G=a1i1n,e3s3v0iCl)leo(bnb=-D13oF,8uu5gl9ltao)sn(n(n=C=1l1a39y,6,t11o11n)6G()nw=1in1n,6e0t6Dt)(enK=2a0lb,0(L8n1a=)G26r,0a9n8Dg)eu(bnl=in14(nM,0=3a41c,)7o8n0)(An=u1g6u,9st6a5C()no=lu1m3,7b4Vu9s)a(lnd=o1st5aA,0(0lnb2=a)8n,y63(Sn7a=)v1a5n,2n0a1hW) (nay=c8r,2o4sBs2r()nu=n1s7w,4iAc2k7th)(nen=s1(0nS,6=o1u88,t9)h2s7id)Ge(rna=d2y,0(n6S=3T4)A,74T1E) (n=272,510)
Districts Yes, currently participating
WIC Participant Characteristics 2002

21 WIC PARTICIPANT NUTRITIONAL INDICATORS

I. WIC Participant Pre-pregnancy Body Mass Index
A: Pre-pregnancy BMI:
Body Mass Index (BMI) is an ideal measure of body fat because it takes into account the effect that height can have on a person's crude weight. Among our prenatal WIC clients statewide, the mean pre-pregnancy BMI was 25.9 kg/m2 (Figure 18). When examined by local health districts, the mean prepregnancy BMI ranged from 25.5 kg/m2 -28.3 kg/m2 with a mode of 26.9 kg/m2 (Figure 18). Thus, the pre-pregnancy weight of many of the prenatal women in WIC signifies that they were overweight even before conception.
Figure 18: Mean Pre-pregnancy Body Mass Index of Pregnant Women within the Georgia WIC Program By District, FFY 2002
30

M 28 e a n
26
B M I 24

22 Rome(n=D2a,1lt2o6n)(nG=a1i,n46es8v)ilCleo(bnb=-1D,6o6Fu0ug)lltaosn((nn=C=12l,a7,1y72t1o6)n) (Gn=w1i,n61n9e)ttD(neK=2a,7lb97(Ln)a=G3,r7a4n4g)Deu(nb=li2n,0(0nM4=)5a6c0o)n(nA=u2g,1u0s7t)a(Cn=ol1u,9m15b)uVs(anld=o2s,2ta1A4(n)lb=a1n,3y8(9nS)=av1a,7n7n8a)hW(na=y1c,r0o9s4Bs)(rnu=n2sw,11icA8k)t(hne=n1s,5(n8S2=o)1u,5th19si)deG(nra=d2y14(n)S=T1,A21T3)E(n=37,018)

BMI=wt/ht2

Pre-pregnancy BMI

BMI <19 = malnourished BMI20-25 = healthy weight BMI 26-30 = overweight BMI>30 = obese

WIC Participant Characteristics 2002

22
B. Pre-pregnancy BMI by Race/Ethnicity:
When examined by race and ethnic group, the mean pre-pregnancy BMI tended to be higher among African-American (27.1 kg/m2) and Native American (26.3 kg/m2) clients compared to all other race/ethnic groups (Figure 19). Asian/Pacific Islanders tended to have the lowest BMI at 22.7 kg/m2, which fell within healthy range and tended not to report being overweight (Figure 19). The BMI of all other race/ethnic groups also tended to fall within healthy range.

Figure 19: Mean Pre-pregnancy Body Mass Index of Pregnant Women within the Georgia WIC Program
By Race/Ethnicity, FFY 2002

30
25
M e 20 a n 15 B M 10 I
5
0

24.4
White

27.1

26.3

24.9

22.7

African-American

Hispanic

Pre-pregnancy BMI

Native American Asian/Pacific Islander

WIC Participant Characteristics 2002

23
II. WIC Participant Postpartum Body Mass Index
A: Post-partum BMI:
There was a slight difference in BMI between breastfeeding and nonbreastfeeding women (Figure 20). Non-breastfeeding women tended to have slightly higher BMI compared to breastfeeding women (Figure 20). This was seen both statewide and within local health districts (Figure 20). These findings may suggest that breastfeeding helps post-partum women return to pre-pregnancy weight faster than women who do not breastfeed.

Figure 20: Mean Postpartum Body Mass Index (BMI: wt/ht2) of Breastfeeding and Non-Breastfeeding Women within the Georgia WIC
Program FFY 2002

35
33 31
29
27
M 25 e 23 a 21 n 19
17
B 15 M 13 I 11
9
7
5
3 1

Rome Dalton GainesvilleMarietta Fulton Clayton Gwinnett DeKalb LaGrangeDublin Macon Augusta ColumbusValdosta Albany SavannahWaycrossBrunswickAthens Southside Grady STATE

Breastfeeding Women Non-Breastfeeding women

WIC Participant Characteristics 2002

24
B. Post-partum BMI by Race/Ethnicity:
Among the differing race/ethnic post-partum WIC clients, non-breastfeeding Native American clients tended to have higher BMI, 31.1 kg/m2 , compared to non-breastfeeding clients in other race/ethnic groups (Figure 21). Among breastfeeding clients, African-American women tended to have higher BMI, 29.9 kg/m2 , compared to breastfeeding clients in other race/ethnic groups (Figure 21). The differing dietary patterns of different race/ethnic groups may in part help to explain these findings.
Figure 21: Mean Post-Partum Body Mass Index (BMI: wt/ht2) of Breastfeeding and Non-Breastfeeding Women within the Georgia WIC
Program By Race/Ethnicity, FFY 2002

31
26 M e a 21 n B 16 M I 11
6
1

29.8 28.5

29.9 30.2

27.6 28.3

31.1 27.8

26.5 26.1

White

African-American

Hispanic

Native American

Breastfeeding Women Non-Breastfeeding women

Asian/Pacific Islander

WIC Participant Characteristics 2002

25 III. WIC Infant and Children Birthweight A: WIC infant and child birth weight: The mean birthweight of WIC infant and child participants in the state of Georgia during FFY 2002 was 2,986 grams (Figure 22). This amount did not vary greatly when examined by local health district.
Figure 22: Mean Birthweight (grams) of Infant and Child Participants within the Georgia WIC Program, FY 2002
3400
M 3200 e a 3000 n
2800
g r 2600 a m 2400 s
2200 2000
Rome(n=D1a0l,t3o5n4)(n=G6a,8in75e)svillCe(onb=b9-,D06o3Fu)gullatosn(n(=nC=7,19la10y,69to)4n5)(nG=w7,7in0n8e)ttD(ne=K1a2l,b59(2nL)=a1G7,r2a6n4g)Deu(nb=li9n,0(n15=M)3,a3c5o0n)(n=A1u1g,6u9s9t)a(Cn=o9lu,4m28b)uVs(anld=o9s,9ta98A(n)l=b5a,n8y97(n)S=a1v0a,6n3n8a)hW(na=y5c,r4o7s2sB)(nru=1n2sw,27icA1k)th(ne=n6s,(4n2S=5o5)u,6t0h4si)deG(nr=a1d,3y8(9n)=S2T,5A56T)E(n=177,449)
Infant Birthweight
WIC Participant Characteristics 2002

26
B. WIC infant and child birthweight by race/ethnicity:
The evidence suggests that within the Georgia WIC program Hispanic infants tended to have a higher mean birthweight (3,116g) compared to AfricanAmerican (2,890g), Native American (2,930g), and Asian Pacific Islander infants (2,998g) (Figure 23). White infants tended to have similar mean birthweight (3,065g) compared to that observed for Hispanic infants (Figure 23).

Figure 23: Mean Birthweight (grams) of Infant/Child Participants within the Georgia WIC Program, By Race/Ethnicity, FFY 2002

3,150

3,100 M e 3,050 a n 3,000
g 2,950 r 2,900 a m 2,850 s
2,800

3,065

2,750

White (n=53,811)

3,116

2,890

AfricanAmerican (n=86,887)

Hispanic (n=30,076)

Race/Ethnicity

2,930

2,998

Native American (n=160)

Asian/Pacific Islander (n=6,515)

WIC Participant Characteristics 2002

27
WIC PARTICIPANT CLINICAL INDICATORS
I. WIC Participant Hemoglobin Levels
A. Hemoglobin levels of WIC participants at certification:
Analyses were conducted to examine the mean hemoglobin levels of WIC clients by participant type within the state of Georgia during FFY 2002. The mean hemoglobin levels of prenatal and post-partum women tended to fall within normal range (Figure 24). For pregnant participants the mean hemoglobin levels was 12.6g/dL, for postpartum breastfeeding women 17.9g/dL, while for post-partum non-breastfeeding women 12.7g/dL (Figure 24). The hemoglobin levels of infants and children are less reliable since these measures are not consistently collected at WIC visits. When examined by local agency, the mean hemoglobin levels of WIC participants by WIC type fell within the levels found when examined statewide (Figure 25).

Figure 24: Participants Mean Hemoglobin Level by Certification Category within the WIC Program in the State of Georgia, FFY 2002

90

80 h e 70

m 60 Mo e g 50

a l 40

n o b 30

i 20

12.6

n 10

0 Pregnant woman (n=35,646)

17.9
Breastfeeding woman (n=15,036)
Mean hemoglobin

12.7
Postpartum woman, no breastfeeding (n=24,077)

WIC Participant Characteristics 2002

28
Figure 25: Mean Hemoglobin Level (g/dl)of Participants within the Georgia WIC Program, FFY 2002

35

30
h
e 25 m
M o 20 eg
al n o 15
b i 10
n
5

0 Rome Dalton GainesvilleMarietta Fulton Clayton Gwinnett Dekalb LaGrangeDublin Macon Augusta ColumbusValdosta Albany Savannah Waycross BrunswickAthens Southside Grady

Pregnant

Breastfeeding Women

Postpartum Women, not breastfeeding

II. WIC Participant Hematocrit Percent
A. Hematocrit percent of WIC participants at certification:
Analyses were conducted to examine the mean hematocrit percent of WIC clients by participant type within the state of Georgia during FFY 2002. The mean hematocrit percent of prenatal women was 36.3%, for post-partum breastfeeding women 33.7%, while for post-partum non-breastfeeding women, the mean hematocrit percent was 33.0% (Figure 26). The hematocrit percent of infants and children are less reliable since these measures are not consistently collected at WIC visits. When examined by local agency, the mean hematocrit percent of WIC participants by WIC type fell within the levels found when examined statewide (Figure 27).

WIC Participant Characteristics 2002

29
Figure 26: Participants' Mean Hematocrit Percent by Certification Category within the WIC Program in the State of Georgia, FFY 2002

95
85
75
M 65 e 55 a
45
n
35
% 25
15
5
-5

36.2

33.7

Pregnant woman (n=1,331) Breastfeeding woman (n=789)

Mean Hct

33.1
Postpartum woman, no breastfeeding (n=1,098)

Figure 27: Mean Hematocrit Percent of Participants within the Georgia WIC Program, FFY 2002

100
90 80
M
70
e a 60 n 50
40
% 30
20 10
0

Rome Dalton GainesvillMe arietta Fulton Clayton GwinnettDeKalb LaGrangeDublin Macon Augusta ColumbusValdosta Albany Savannah WaycrossBrunswickAthens Southside Grady

Pregnant

Breastfeeding Women

Postpartum Women, not breastfeeding

WIC Participant Characteristics 2002

30
BREASTFEEDING PRACTICES
I. Current Breastfeeding
A. Current breastfeeding practice among WIC participants:
During FFY 2002, 21.8% of postpartum women reported that they were currently breastfeeding at the time of WIC certification within the state of Georgia. Current breastfeeding practices varied widely when examined by local agencies. Several local agencies reported low current breastfeeding rates, with percentages as low as 4.64%, while several reported moderately high current breastfeeding practices ranging between 30.2%-40.84% (Figure 28). Separate analyses were conducted to determine whether there was any association between current breastfeeding practices and level of education. We did not find any association between current breastfeeding practices and level of education (results not shown).
Figure 28: Current Breastfeeding among Participants within the Georgia WIC Program, FFY 2002

%

b r

100

c

e a

80

u r

s t

60

r e

f e

40

n t

e d

20

0 Rome Dalton GainesviMlleariettaFulton Clayton GwinnetDt eKalbLaGrangDeublin Macon AugustaColumbuVsaldostaAlbany SavannahWaycrossBrunswicAkthens SouthsideGrady STATE(n=31,547)

Districts

Yes No

WIC Participant Characteristics 2002

31 B. Current Breastfeeding by Race/Ethnicity:
When examined by race/ethnicity, our analyses found that Native American and Hispanic women were more likely to report current breastfeeding, 46.4% and 40.3% respectively compared to other race/ethnic groups (Figure 29). African-American and White women tended to report the lowest current breastfeeding rates, with 18.9% and 15.4% reported respectively (Figure 29).
Figure 29: Current Breastfeeders among Participants within the Georgia WIC Program by Race/Ethnicity, FFY 2002

100

90

%

b r

c

e a

80 70 60

u r r e n t

s t f e e d

50 40 30 20

84.5 15.4

81.1 18.9

10

0
White

(n=10,356) African-American (n=14,327)

59.6 40.3
Hispanic (n=5,469)

Race/Ethnicity Yes No

53.5 46.3

74.4 25.5

Native American Asian/Pacific Islander

(n=28)

(n=1,367)

WIC Participant Characteristics 2002

32
II. Ever Breastfeeding
A. Ever breastfeeding among WIC participants:
The ever breastfeeding percentage tended to be slightly higher than that reported for current breastfeeding. For example, 33.6% of WIC participants in the state of Georgia for FFY 2002 reported ever breastfeeding at the time of WIC certification (Figure 30). The rates seen within local agencies were also slightly higher, with practice rates ranging from as low as 17.21% to as high as 47.84% (Figure 30). The main reason for this difference is because ever breastfeeders include women who may have breastfed their infants after delivery during their hospital stay, which may have been for only 1 week. After discharge from the hospital, many may have stopped breastfeeding and started bottle feeding.

Figure 30: Ever Breastfeeders among Participants within the Georgia WIC Program By District, FFY 2002

100

90

b 80

%

r e

70

e v e r

a s t f e

60 50 40 30

d 20

10

0

Rome (n=D1a,7lt6o6n)(nG=1a,i1n1e0svilCleo(bnb=-1D,2o3Fu4ug)llatosn(n(=nC1=,12la,34y02t)o4n) (Gn=w9i7n4n)ettD(neK=1a,5lb63L(n)a=G1,r8a4n0g)Deu(nb=lin1,(4n7M=45)a5c5o)n(nA=1u,7g5u6s)ta(Cno=l1u,m54b5u)Vs(anld=o1s,3ta07A()nl=b7a8n0y)(nS=av1a,4n6n6a)Wh(na=yc9r9o0s)Bs(rnu=n1s,w28ic6Ak)th(ne=n9s3(n7S)=o8u4t8h)sideG(nr=ad2y22(n)=S3T5A2)TE(n=24,659)

Districts

Yes

No

WIC Participant Characteristics 2002

33
B. Ever Breastfeeders by Race/Ethnicity:
Hispanic women tended to have the highest proportion of women reporting ever breastfeeding with 53.8% reporting they've ever breastfed (Figure 31). Unlike the finding from current breastfeeders, where White women tended not to report current breastfeeding, 36.9% of White women tended to report ever breastfeeding which is a reversal of the current breastfeeding findings. Likewise, 33.3% Native-Americans tended to report ever breastfeeding, while 25.2% African-American women report ever breastfeeding. Thirty four percent of Asian/Pacific Islander women reported ever breastfeeding.

Figure 31: Ever Breastfeeders among Participants within the Georgia WIC Program by Race/Ethnicity, FFY 2002

100

90

80 b

r 70

% e 60

a

e v e r

s t f e

50 40 30

d 20

10

0

63.1 36.9
White (n=8,757)

74.6 25.2

53.8 46.1

66.6 33.3

65.1 34.9

African-American Hispanic (n=3,262) (n=11,607)
Race/Ethnicity Yes No

Native American Asian/Pacific Islander

(n=15)

(n=1,018)

WIC Participant Characteristics 2002

34
Length of Time breastfed
A. Reported length of time breastfed:
The mean length of time WIC participants reported that they breastfed their infant in the state of Georgia during FFY 2002 was 7 weeks (Figure 32). Within local agencies, mean length of time breastfed ranged from 5.5 weeks to 11 weeks (Figure 32).
Figure 32: Mean Length of Time Breastfed among Participants who are Currently not Breastfeeding within the Georgia WIC Program, FFY 2002

12

10

M

e a

b r

8

n e

a

ws 6

et

e k

f e

4

s d

2

0
Rome(n=D6a5l3t)on(nG=4a6in6e)svillCeo(nb=b4-D62oF)ugullatosn(n(=n5=C448la3)y7t)on(nG=w46in6)nettD(neK=6a9lb3)(nL=a7G30ra)ngDe(unb=li3n4(9n)M=1a42co)n(nA=u43g7u)sta(Cn=o3lu9m2)buVsa(nld=o2s2ta5)(An=lb1a9n2y)(nS=a4v2a2n)nahW(na=y3c6r4o)ssB(nru=n38sw7)icAkt(hne=n4s3(3n)S=o2u3t6h)sideG(nr=a8d5y)(n=S1T6A6)TE(n=8,285)
Districts Weeks Breastfed

WIC Participant Characteristics 2002

35
Appendix A
Educational Level of Participants within the Georgia WIC Program By District, FFY 2002
2

1.5 P e r c1 e n t
0.5

0

Rome

Dalton

Gainsville Cobb-DouglFauslton

Clayton Gwinnett DeKalb LaGrange Dublin Macon Augusta Columbus Valdosta Albany Savannah Waycross Brunswick Athens

Southside Grady

Years of education

1234

15

P e 10 r c
e n5 t

0

Rome

Dalton

Gainsville Cobb-DougFlauslton

Clayton Gwinnett DeKalb LaGrange Dublin Macon Augusta Columbus Valdosta Albany Savannah Waycross BrunswickAthens Southside Grady

Years of education

56789

WIC Participant Characteristics 2002

36
Educational Level of Participants within the Georgia WIC Program By District, FFY 2002

50
45
40
P e 35 r 30 c 25 e 20 n 15 t
10
5
0

Rome

Dalton

Gainsville Cobb-DouglaFsulton

Clayton Gwinnett DeKalb LaGrange Dublin

Macon

Augusta Columbus Valdosta Albany Savannah Waycross Brunswick Athens

Southside Grady

Years of education 10 11 12 13 14

15

P e 10 r c e n t5

0

Rome

Dalton

Gainsville Cobb-DouglaFsulton

Clayton Gwinnett DeKalb LaGrange Dublin

Macon Augusta Columbus Valdosta Albany Savannah Waycross Brunswick Athens

Southside Grady

Years of education

15 16 17 18

WIC Participant Characteristics 2002

37
Migrant Status among Participants within the Georgia WIC Program By District, FY 2002

100
90
P 80 e 70 r 60 c 50 e n 40 t 30
20
10
0

Rome(n=D1a6l,to4n26()nG=a1i1n,3sv3i0ll)Ce(onb=b1-3D,8oF5u9ug)lltaosn(1(n3C=,6l1a19y1,t1)o1n6(0Gn=w1i1n,n60et6Dt)(enK=2a0lb,0(L8n1a=)G26r,a0n9g8De)u(nb=li1n4,(0nM3=14)a,c7o8n0)(nA=u1g6u,9s6ta5C)(no=lu1m3,7b4uV9s)a(lnd=o1st5a,A0(0nl2b=)a8n,6y3(7Sn)a=v1a5n,2n0a1hW)(nay=c8r,2os4sB2()rnu=n1s7w,4icA2k7t)h(nen=s10(n,S6=o18u8,)9th2s7i)dGe (rna=d2y,0(n63=)4,741)

Districts

Yes No

WIC Participant Characteristics 2002

38 REFERENCES
1. U.S. Department of Agriculture, Food and Nutrition Services: Special Supplemental Nutrition Program for Women, Infants and Children (WIC): History of WIC 1974-1999 25th Anniversary, 1999 www.fns.usda.gov/wic/menu/new/wichistory.pdf
2. U.S. Department of Agriculture; Food and Nutrition Service: Women , Infants and Children Branch : The WIC Program Mission 2001 www.fns.usda.gov/wic/
3. Georgia Department of Human Resources; Division of Public Health; Women, Infants, and Children Branch (WIC): Mission and Program Objective of WIC food and Nutrition Section 2001 http://health.state.ga.us/programs/wic
WIC Participant Characteristics 2002

39 Contact Information
For technical assistance contact the State WIC Branch
Women, Infants, and Children Branch Two Peachtree Street, N.W. 10th Floor Atlanta, GA 30303
(404) 657-2900 or GIST 294-2900 Hotline 1-800-228-9173 FAX (404) 657-2910 Attn: Sophia Autrey
For nutritional related technical assistance and related topics, contact
Family Health Branch Nutrition Section
Two Peachtree Street, N.W. 11th Floor
Atlanta, GA 30303 (404) 657-2884 or GIST 294-2884
FAX (404) 657-2910 Attn: Carol McGowan
For epidemiological information, contact:
Maternal and Child Health Epidemiology Two Peachtree Street, N.W. 14th Floor Atlanta, GA 30303 (404) 657 6448 FAX (404) 657-7517 Attn: Dr. Chinaro Kennedy
WIC Participant Characteristics 2002

40

Division of Public Health Women, Infants and Children Branch
Two Peachtree Street, NW 10th Floor, Suite 10-476
Atlanta, Georgia 30303 1-800-228-9173

01/2003

WIC Participant Characteristics 2002