Peer-reviewed article
Remote Services, Benefits, and Program Retention Changes Among Young Children in WIC.
Kenney EL, Lee MM, Mozaffarian RS, Rimm EB ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how policy changes in the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) affected whether young children stayed enrolled after infancy. When remote services became available in March 2020, more children aged 1 to 4 years remained in the program, with retention increasing by about 1 to 1.5 percentage points per month for different age groups. Increasing the cash value of benefits for fruits and vegetables also encouraged more children to actually use their benefits, though it did not increase enrollment rates overall.
Key points
- Introduction of remote WIC services in March 2020 reversed a downward trend in child retention post-infancy
- Retention increased by 1.04-1.47 percentage points per month across different age groups after remote services launched
- Increased cash-value benefits for fruits and vegetables did not increase overall retention but did boost actual benefit usage among younger children
- The study included 238,482 WIC-participating children in Massachusetts between January 2017 and December 2022
- Making WIC easier to use through remote options appears to be more effective than benefit increases at keeping families enrolled
Limitations
This study was conducted only in Massachusetts and used observational data from a specific time period, so results may not generalise to other states or populations. The analysis cannot fully isolate the effects of remote services from other concurrent changes in the program or environment.
Abstract
Importance The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) improves health for young children with low household incomes, but it is underutilized after infancy due to program complexity and lower perceived value of benefits for participants aged 1 to 4 years. Increasing participants' retention in WIC could be an important strategy for improving the health of young children. Objective To evaluate whether policies making WIC easier to use and increasing benefit value were associated with increased retention of participants postinfancy. Design, setting, and participants This repeated cross-sectional experiment used interrupted time series analysis of Massachusetts participants in WIC younger than 4 years enrolled between January 2017 and December 2022. Analyses were conducted in between June 2024 and April 2025. Exposures Two policy changes: (1) the introduction of remote WIC services (March 2020) and (2) an increased cash-value benefit for fruits and vegetables, or cash value benefit (June 2021). Main outcomes and measures Monthly likelihood of postinfancy retention in WIC for children, calculated by counting all children younger than 4 years with active WIC certifications each month and dividing by the total number of children who had been certified as infants and stratifying by child age. The secondary outcome was the likelihood of retention plus redeeming any food package benefits. Results There were 238 482 WIC-participating children across the study period. In the baseline year (105 782 children), the mean (SD) age was 17.0 (14.0) months, half the sample were female (52 505 [50%]). After remote services were implemented, a previously downward monthly trend in retention reversed, steadily increasing each month afterwards, by 1.04 percentage points (pp) (95% CI, 0.48-1.60 pp) for children aged 12 to 23 months, 1.47 pp (95% CI, 1.06-1.87 pp) for children aged 24 to 35 months, and 1.25 pp (95% CI, 0.79-1.72 pp) for children aged 36 to 47 months. The increased cash value benefit (June 2021) was not associated with changes in retention trends overall, but was associated with immediate increases in the likelihood of retention plus benefit usage among children aged 12 to 23 months and 24 to 35 months. Conclusions and relevance In this repeated cross-sectional study, making remote WIC services available was associated with more children staying enrolled. Policy efforts to make remote service options permanent may support WIC utilization.