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Huaide Ye, PhD Ruth Shrock, MS, MPH Corey Y. Hamilton, MS, RD, LD David Schor, MPH, MD

The Impact of WIC on Birth Outcomes in Low And Medium Income Neighborhoods. Huaide Ye, PhD Ruth Shrock, MS, MPH Corey Y. Hamilton, MS, RD, LD David Schor, MPH, MD Ohio Department of Health. AMCHP 2005 Annual Conference February 19 – 23, 2005 Washington, DC. Objective.

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Huaide Ye, PhD Ruth Shrock, MS, MPH Corey Y. Hamilton, MS, RD, LD David Schor, MPH, MD

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  1. The Impact of WIC on Birth Outcomes in Low And Medium Income Neighborhoods Huaide Ye, PhD Ruth Shrock, MS, MPH Corey Y. Hamilton, MS, RD, LD David Schor, MPH, MD Ohio Department of Health AMCHP 2005 Annual Conference February 19 – 23, 2005 Washington, DC

  2. Objective • The purpose of this presentation is to explore the impact of WIC (the Women, Infants, and Children’s Supplemental Food Program) on birth outcomes in different income neighborhoods.

  3. WIC Data Birth Data US Census Block Group Method of Linking 2001 & 2002 WIC Prenatal Data, 2002 Birth Data, and 2000 US Census Individual Level Aggregated Level Relationship: one to one Relationship: many to one

  4. Per Capita Income in 1999 < $14,923 (<25 percentile) Low Income Neighborhood Mean = $11,702 Per Capita Income in 1999 $14,923 - $23,132 (25-75 percentiles) Medium Income Neighborhood Mean = $18,795 High Income Neighborhood Mean = $31,021 n = 2,338 n = 4,678 Per Capita Income in 1999 > $23,132 (>75 percentile) n = 2,338 Ohio Neighborhood Types by Census Block Group in 2000 Total Number of Block Group N = 9,354

  5. Neighborhood Types in Franklin County

  6. Total Births of Ohio Residents in 2002 = 147,832 Excluded in the Analyses

  7. Low Income Medium Income High Income Missing Block Group Number and Percent of Births by WIC Status and Neighborhood Type WIC Pregnant Women All Births

  8. Birth Outcome Variables • Very Low Birth Weight (< 1,500 g) • Moderate Low Birth Weight (1,500 g – 2,499 g) • Preterm LBW (< 2,500 g & < 37 Wks Gestation ) • Small-for-Gestation-Age (SGA) (< 2,500 g & ≥ 37 Wks Gestation) • Hoffman's Below 10th% Birth Weight for Gestational Age

  9. 95% CI (Confidence Interval) Estimated % Very Low Birth Weight (< 1,500 g) (n=136,065 after excluding missing birth weight & block group cases)

  10. 95% CI (Confidence Interval) Estimated % Moderate Low Birth Weight (1,500 g – 2,499 g) (n=136,065 after excluding missing birth weight & block group cases)

  11. 95% CI (Confidence Interval) Estimated % Preterm LBW (< 2,500 g & < 37 Wks Gestation) (n=136,065 after excluding missing birth weight, gestational age, & block group cases)

  12. 95% CI (Confidence Interval) Estimated % SGA (< 2,500 g & ≥ 37 Wks Gestation) (n=136,065 after excluding missing birth weight, gestational age, & block group cases)

  13. 95% CI (Confidence Interval) Estimated % Hoffman's Below 10th% Birth Weight for Gestational Age (n=135,897 after excluding missing Hoffman’s Index & block group cases)

  14. Demographic & Social Economic Variables • Plurality (Singleton/Multiple Births) • Mother’s Race & Ethnicity • Mother’s Age at Birth • Mother’s Marital Status • Mother’s Education • Mother’s Parity • Mother’s Weight Gain during Pregnancy

  15. 95% CI (Confidence Interval) Estimated % Multiple Births (Twin, Triplet, Quadruplet, etc.) (n=136,095 after excluding missing block group cases)

  16. 95% CI (Confidence Interval) Estimated % Mother’s Black Race (n=136,095 after excluding missing block group cases)

  17. 95% CI (Confidence Interval) Estimated % Mother’s Hispanic Ethnicity (n=135,745 after excluding unknown mother’s ethnicity & missing block group cases)

  18. 95% CI (Confidence Interval) Estimated % Mother’s Age (n=136,095 after excluding missing block group cases)

  19. 95% CI (Confidence Interval) Estimated % Mother Who is Unmarried (n=136,095 after excluding missing block group cases)

  20. 95% CI (Confidence Interval) Estimated % Mother’s Education < 12 Years (n=136,095 after excluding missing block group cases)

  21. 95% CI (Confidence Interval) Estimated % Mother’s High Parity (≥ 4 or More Parities) (n=135,847 after excluding missing number of living or dead previous live births & block group cases)

  22. 95% CI (Confidence Interval) Estimated % Mother’s Weight Gain during Pregnancy (n=131,553 after excluding missing weight gain cases & block group cases)

  23. Maternal & Infant Medical Variables • Mother’s Previous Preterm Birth • Mother’s Pregnancy Anemia • Mother’s Pregnancy Induced Hypertension • Mother’s Diabetes • Mother’s Complications of Labor/Delivery • Mother’s C-section Status • Infant’s Congenital Anomalies • Infant’s Delivered in Level III Hospital • Mother’s Transferring Hospital Status • Infant’s Transferring Hospital Status

  24. 95% CI (Confidence Interval) Estimated % Mother’s Previous Preterm Birth (n=136,095 after excluding missing block group cases)

  25. 95% CI (Confidence Interval) Estimated % Mother’s Pregnancy Anemia (n=136,095 after excluding missing block group cases)

  26. 95% CI (Confidence Interval) Estimated % Mother’s Pregnancy Induced Hypertension (n=136,095 after excluding missing block group cases)

  27. 95% CI (Confidence Interval) Estimated % Mother’s Diabetes (n=136,095 after excluding missing block group cases)

  28. 95% CI (Confidence Interval) Estimated % Mother’s Complications of Labor/Delivery (n=136,095 after excluding missing block group cases)

  29. 95% CI (Confidence Interval) Estimated % Mother’s C-section Status (n=136,095 after excluding missing block group cases)

  30. 95% CI (Confidence Interval) Estimated % Infant’s Congenital Anomalies (n=136,095 after excluding missing block group cases)

  31. 95% CI (Confidence Interval) Estimated % Infant Delivered in Level III Hospital (n=135,831 after excluding missing hospital code & block group cases)

  32. 95% CI (Confidence Interval) Estimated % Mother’s Transferring Hospital (n=136,095 after excluding missing block group cases)

  33. 95% CI (Confidence Interval) Estimated % Infant’s Transferring Hospital (n=136,095 after excluding missing block group cases)

  34. Maternal Behavioral Variables • Maternal Smoking during Pregnancy • Maternal Drinking Alcohol during Pregnancy • Inadequate Prenatal Care (Kotelchuck Index) • Prenatal Care Began at 1st Trimester

  35. 95% CI (Confidence Interval) Estimated % Maternal Smoking During Pregnancy (n=135,607 after excluding missing cigarette smoking & block group cases)

  36. 95% CI (Confidence Interval) Estimated % Maternal Drinking Alcohol During Pregnancy (n=135,576 after excluding missing drinking alcohol & block group cases)

  37. 95% CI (Confidence Interval) Estimated % Maternal Prenatal Care (Kotelchuck Index) (n=131,531 after excluding missing Kotelchuck Index & block group cases)

  38. 95% CI (Confidence Interval) Estimated % Prenatal Care Began at 1st Trimester (n=134,178 after excluding missing month prenatal care began & block group cases)

  39. Results from Multivariate Analyses

  40. Logistic Regression of LBW (< 2,500 g) in Each Type of Neighborhood • In low income neighborhoods, non-WIC mothers are 20% more likely to have LBW babies than WIC mothers without control of other variables. • In medium and high income neighborhoods, non-WIC mothers are significantly less likely to have LBW babies than WIC mothers without control of other variables.

  41. List of Controlled Variables: • Complications of Labor • C-section • Maternal & Infant Transferring Hospital • Infant Congenital Anomalies • Infant Delivered in Level III Hospital • Maternal Smoking & Drinking Alcohol • Prenatal Care (Kotelchuck Index) • Infant Gender • Plurality • Mother’s Race & Ethnicity • Mother’s Age & Education • Maternal Parity • Mother’s Weight Gain during Pregnancy • Mother’s Previous Preterm Birth • Mother’s Anemia, Hypertension, & Diabetes

  42. Logistic Regression of LBW (< 2,500 g) in Each Type of Neighborhood (to be Continued) • In low income neighborhoods, after controlling all listed variables, non-WIC mothers are 25% more likely to have LBW babies than WIC mothers (a 5% increase in comparison with no control model). • In medium income neighborhoods, with controls, non-WIC mothers are 10% more likely to have LBW babies than WIC mothers (the direction is totally reversed). • In high income neighborhoods, with controls, there is no difference in LBW between WIC & non-WIC mothers.

  43. Conclusion • Participation in the WIC program has a strong association with better birth outcomes in low and medium income neighborhoods in Ohio. • The strongest association with birth outcomes is seen in women who participated in WIC during pregnancy in low income neighborhoods. • This mostly descriptive study prompts additional questions about outreach; “dose effect” of WIC; investigation of systematic biases; and what could be learned by linkage to PRAMS.

  44. Contact Information Huaide Ye, Ph.D. Epidemiology Investigator 3 Ohio Department of Health Bureau of Health Services Information and Operational Support 246 North High Street Columbus, Ohio 43216-0118 Phone: (614) 466-1168 E-Mail: hye@gw.odh.state.oh.us

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