203 - Who disenrolls early from WIC and why?: A repeat-cross-sectional study of caregiver-child survey and electronic health record data across five states over 10 years

Publication Number: 2195.203

Cristina Gago, Boston University School of Public Health, Boston, MA, United States; Ana Poblacion, Boston University School of Medicine, Boston, MA, United States; Carley Ruemmele, Boston Medical Center, Boston, MA, United States; Allison Landowski, Center for Health Data Science (CHDS), Boston University School of Public Health, Bethel Park, PA, United States; Sharon M.. Coleman, Boston University School of Public Health, Boston, MA, United States; Diana Cutts, Hennepin Healthcare/University of Minnesota Medical School, Excelsior, MN, United States; Eduardo Ochoa, Jr., University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Megan Sandel, Boston University School of Medicine, Boston, MA, United States; Felice Le-Scherban, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States; Stephanie Ettinger de Cuba, Boston University School of Public Health, Boston, MA, United States

Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) supports the nutrition needs of low-income families. WIC is underutilized despite associated health benefits.

Objective: This study described reasons for early disenrollment among those likely eligible and estimated the association between former enrollment and child health outcomes.

Design/Methods: Children's HealthWatch is a repeat cross-sectional study that monitors the health of young children seeking care across five medical centers nationwide. Surveys collect data on maternal and child demographics, child health outcomes (weight, health status, developmental risk, and hospitalizations), WIC enrollment (former, current), and enrollment in other programs to determine current WIC eligibility among those formerly enrolled. Reasons for WIC former enrollment were categorized by Administrative Burden type: Learning (effort required to understand program), Compliance (effort to adhere to program rules), and Psychological Costs (stigma associated with program use). Adjusted logistic regression models estimated associations between WIC enrollment and child health outcomes, stratified by Administrative Burden and age (infants 0-11, children 12-48 months).

Results: Among 23,120 currently or formerly WIC-enrolled dyads surveyed, 77.9% were currently enrolled; 22.1% were formerly enrolled. Most formerly enrolled dyads cited Compliance Costs (46.6%) as the primary reason for early disenrollment, fewer as Learning Costs (28.0%), and fewer still chose not to participate due to perceived ineligibility or lack of need (9.9%). Infants whose families disenrolled early due to Compliance Costs had higher odds of developmental risk (aOR=2.32; 95% CI=1.38,3.91) and lifetime hospitalization (aOR=1.44; 95% CI=1.04,2.01). Children whose families disenrolled early due to Learning Costs had lower odds of underweight (aOR=0.70; 95% CI=0.55,0.89), fair/poor health (aOR=0.79; CI=0.65,0.97), and developmental risk (aOR=0.78; 95% CI=0.67,0.92) compared with those currently enrolled.

Conclusion(s): Compliance and Learning Costs are Administrative Burdens that hinder WIC enrollment and retention. Infant and child health profiles differ by WIC enrollment status. Designing and testing interventions to address Administrative Burdens and optimize enrollment are needed. Pediatric clinics may consider integrating WIC screening and referrals into electronic medical records, co-locating WIC services with pediatrics departments, and improving data sharing between pediatric offices and WIC clinics.

Table 1. Child health outcomes by WIC enrollment status among those eligible (five U.S. cities, 2013-2023, n=23,120).
a Analyses are stratified by mother-reported primary reason for early exit from WIC, categorized as Compliance or Learning Cost. Psychological Costs is excluded due to small sample size (n=11).
b Results from adjusted logistic regression models; shown are the adjusted odds (95% confidence interval, CI) of reporting poor child health outcomes among those formerly enrolled in WIC relative to currently enrolled (referent group). Adjusted for survey site and year; mother race/ethnicity, marital status, employment status, educational attainment, and nativity; and household TANF enrollment. Significance is shown as * P <= 0.05; ** P <= 0.01; *** P <= 0.001.
c Weight status was categorized based on weight-for-age calculated from mother-reported weight (i.e., <5th percentile as underweight, ≥5th percentile as not underweight), based on Clinical Growth Charts published by the Centers for Disease Control and Prevention.
d Developmental Risk was measured via Parents' Evaluation of Developmental Status (PEDS).