Health and Caseload Evaluation of 1995 WIC Prenatal Program Presented by: Victoria Lazariu-Bauer...
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Transcript of Health and Caseload Evaluation of 1995 WIC Prenatal Program Presented by: Victoria Lazariu-Bauer...
Health and CaseloadEvaluation of 1995 WIC Prenatal Program
Presented by: Victoria Lazariu-Bauer
Authors: Victoria Lazariu-Bauer, M.Sc., Howard Stratton, Ph.D., Robert Pruzek, Ph.D., Mary Lou Woelfel, M.A.
Conclusions
Outline for this presentation:
Introduction
Description of data and variables
Results
Introduction
• WIC participants are a self-selected group.
• Factors associated with birth outcomes influence the decision to enroll on WIC ‘early’ or ‘late’ during the pregnancy.
• Selection bias: “bias introduced by the nonrandom process of selecting participants”.
Paul R. Rosenbaum, “Observational Studies”, Springer-Verlag 1995
Introduction
Present preliminary results of the
effects of WIC participation on the
outcome of the pregnancy:
birth weight of the baby.
Description of the data
• Prenatal WIC records were matched to:
NYS 1995 birth records
WIC check redemption records
WIC administrative records
• Criteria to include participants in the study:
Participant cashed at least one check before delivery
Participant did not skip cashing checks for more than
three months.
• 77,601 prenatal WIC participants who delivered in 1995.
Variables explored :
Number of months of WIC prenatal participation
Organizational characteristics 1. NYS WIC region2. Average caseload per certified professional authority in WIC
agencies3. Farmers market participation
Socio-economic characteristics of the neighborhood1. Unmet need : county level % of people eligible to receive WIC
services but not enrolled on WIC.2. % children age 0-4 in families with incomes under 185% poverty level
for 1995.3. % related children age 0-4 in families with incomes under 100% poverty
level for 1995.
Variables explored :
Mother’s demographic and medical characteristicsAge Level of education Race/Ethnicity Inferred marital status ParityPrepregnancy BMI Employment during pregnancy Alcohol, tobacco, drug use during pregnancy Medical history Number of family members on WICAdequacy of prenatal care utilization (Kotelchuck Index)
Travel distance from participant residence to the WIC site
Number of months of WIC prenatal participation
Cumulative Cumulative # Frequency Percent Frequency Percent_________________________________________________________ 1 4182 5.39 4,182 5.39 2 6982 9.00 11,164 14.39 3 8554 11.02 19,718 25.41 4 10122 13.04 29,840 38.45 5 12444 16.04 42,284 54.49 6 13496 17.39 55,780 71.88 7 11978 15.44 67,758 87.32 8 6626 8.54 74,384 95.85 9 1937 2.50 76,321 98.35 10 1278 1.65 77,599 100.00 11 2 0.00 77,601 100.00
Participants who had Preterm Babies (born 28-36 weeks of gestation)
enroll Frequency Percent
_________________________________________
6 months or more 1762 29.56 early
4-5 months 2053 34.45
3 months or less 2145 35.99 late
Participants who had Full Term Babies (born 37-44 weeks of gestation)
enroll Frequency Percent
_________________________________________
7 months or more 18379 30.05 early
5-6 months 20694 33.84
4 months or less 22087 36.11 late
Organizational characteristics:
a. NYS WIC Region:
region Frequency Percent____________________________________
Albany 8,799 11.34 Syracuse 5,866 7.56Western 10,045 12.94
New York City 44,547 57.41Suburban NYC 8,344 10.75
b. Average Caseload per Certified Professional Authority (CPA) in WIC Agencies
Travel distance from participant residence to WIC site
WIC Effect by Duration of Pregnancy
Race/Ethnicity Groups on WIC
Results
WIC and Prenatal Care
WIC Effect by Duration of Pregnancy
Participants with full term pregnancies:
Early - Late = 68 grams
2.4 oz
Participants with preterm pregnancies:
Early - Late = 129 grams
4.5 oz
Race/Ethnicity Groups on WIC
Participants with full term pregnancies:
• White, Non-Hispanic N= 14,938
• Black, Non-Hispanic N= 11,099
• Hispanic N= 12,214
Race/Ethnicity Estimate of WICParticipation Effect
Black, Non-HispanicHispanicWhite, Non-Hispanic
79 grams (2.78 oz)75 grams (2.6 oz)41 grams (1.4 oz)
WIC and Prenatal Care
Kotelchuck’s Index of Adequacy of Prenatal Care Utilization
APNCUI Month of FirstVisit
Number of VisitsAccording to ACOG
Adequate Plus
Adequate
Intermediate
Inadequate
1st or 2nd
3rd or 4th
1st or 2nd
3rd or 4th
1st or 2nd
3rd or 4th
any
Too many
Recommended range
Less than recommended.
Too few.
APNCUI Countand
Percent
Estimated Effect ofWIC Participation
Adequate Plus
Adequate
Intermediate
Inadequate
5,98315%
13,25233%
6,58316%
9,63524%
71 grams2.5 oz
38 grams1.3 oz
67 grams2.3 oz
83 grams2.9 oz
Note: 12% of participants had incomplete information for computation of APNCUI.
WIC and Prenatal Care
Conclusion• Outreach is critically important:
women with longer participation have better outcomes.
• This analysis reveals new aspects of WIC data:
The participation patterns and participants characteristics differ across regions in NYS in the following way:
New York City resembles Western and Suburban NYC regions, but is different from the similar
Albany and Syracuse regions.