Interview Summary

Before we discuss your recent paper, why did you decide to study aging out of WIC?

There’s been a lot of work on pregnant and postpartum women participants of the WIC program, and also infants, and all of that research is definitely very important. There’s been less work on child participants, and one thing we were interested in was this arbitrary rule about kids losing access to WIC in the month after they turned five years old. We knew that this rule was set up because most kids start school when they turn five, although it’s not WHEN they turn five. Some previous work that I had done with my co-author Pourya on school foods, we knew that school foods really impact kids’ diet quality in a positive way. We were interested in what happens to some of these kids that have this potentially long gap in their food assistance.

It’s really fascinating to learn that there was a lot of research in this space on WIC oriented to mothers, and it sounds like what you’re saying, little or not as much was focused on children. I’m interested to understand why do you think that’s the case given the orientation of this program?

That’s a great question. I think there’s probably two ways to look at this. I think the most important is that most people would consider pregnant women and infancy the most vulnerable times of your life, and so understanding how the program impacts the most vulnerable would be of first order importance. Also, some of the early work that came out in the 1980s when people started really looking into the efficacy of WIC, focused on birth weights, for example, and you see that WIC’s impact on low birth weights far outweighs the cost of WIC itself. For example, we’re talking about women that live in low-income households, so in most cases, when these women go to give birth they most likely might be on Medicaid. Any outcome that would be a negative outcome or an adverse outcome at birth would be paid for through Medicaid. That was the first place that people looked, and that’s when researchers realized very quickly that WIC is paying for itself just on the women participants and the child participants together at birth. There is definitely other research on children, it’s just not as much research.

That’s great. Let’s go ahead and dig into the paper that was recently published in the American Journal for Agricultural Economics. What’s the upshot? What did you find?

The upshot is that it seems like that WIC does work in terms of providing nutritious foods to the child participants. These are kids that are two, three, and four years old. One reason that that’s important is that we know as kids age, the probability that they stay on WIC, even when they’re eligible, declines dramatically. For example, at birth, as I mentioned earlier, I think the take-up rate is over 95%. That is because postpartum, immediately after birth, medical providers will give a screener at the hospital and if they see that Moms are eligible for WIC, they’ll ask if you want to sign up. Part of the WIC package is to get free infant formula if the mother doesn’t want to breastfeed or she’s partially breastfeeding. So, you see a large uptake at that point. But then after the kid turns one and the package switches to milk and cereal and fruits and vegetables, that’s where we start to see parents and caregivers not re-certify the children. Over time, by the time you get to four-year-olds, you’re looking at, out of all the four-year-olds that are eligible, depends on what study you look at, but it’s definitely under 50% participation, probably in the 30 to 40% range that are taking part in the program. For those that are participating, we’re looking at what is being reported by the parents that the kids are actually eating. What we’re finding is that foods provided through WIC, which are healthy foods, do impact foods that the kids are consuming.

This raises an important question about what you did in the study. This idea of how you describe food as nutritional or healthy – could you tell us a little bit more about how you measured diet quality? I know that there’s also an interest in the quantity, so please explain.

That’s right. We use this measure called the Healthy Eating Index developed by nutritionists. It gives you a score from between zero and 100, just like you’d have a test in school. The way it works is there are 13 different components, for example, one would be fruits. As you get closer to eating the recommended fruit consumption for that age group, you can score more and more points. There are other food groups such as vegetables and whole grains, etc. There are even some components that are nutrients, like saturated fats and added sugars. As you get closer and closer to the recommendations on all these different components, you get closer and closer to scoring a 100. We use this algorithm based off what the parents are reporting that the kids are eating. Then we’re able to score how well they eat on this range from zero to 100. Now, I’ll tell you, the scores that they’re getting aren’t that great, right? It’s around 50 out of 100, so there’s already room in improvement. This is not just for kids that are on WIC, this is in general, across all ages. Americans have a lot of room to improve their diet, and so that is our main outcome in terms of the quality. But we did also look at the quantity or the overall calories that the kids were consuming as well.

So, what you found was those kids, when they aged out of WIC, before they actually entered into school, they had lower quality diets? Was the same true with the quantity? I mean, in terms of the number of calories, could you tell us a little bit about that?

That’s right. When we first looked at the sample in total, we didn’t really find much of an effect of aging out of WIC program. But we were concerned whether the kids are in school or not. So, where we find the reduction in diet quality is for the kids that are born in, say the winter, late fall period. These are called late school starters. These are kids that generally are born after the cutoff date to go to kindergarten. So, for example, if a kid was born in September, they would miss the kindergarten cutoff. For most states, that would be August. So, they would lose WIC in October, and then they must wait all the way until the next school year before they would go on to most likely free school meals. We were able to split the sample into these late school starters, and then you have the other kids that are born, for example, maybe in the summer, so they would lose WIC but then could seamlessly slide into school food programs. For those kids that lose WIC and then go into the school programs, or maybe they even lose WIC while they’re in school, depending on the state, we see no effects at all on the quality of their diet or the quantity of their diet. But for the kids that are these late school starters, the ones that are born in the winter or late fall, that’s where we see this decline of on average of 20% decline in the quality of the food that they’re consuming. But we still, for them, for those kids, we still find absolutely no effect on the quantity. What we’re seeing is that parents or caregivers lose access to these nutritious foods that are being provided for free through the WIC program. But they’re still feeding their kids the same number of calories. They are just switching to lower quality foods.

Is that finding true for everyone? Or are there differences in the individuals that you looked at in this study?

You can kind of imagine that if you were able to rank kids in households based on who’s consuming the lowest quality diet, they would be on the very lower end of this HEI score versus kids that typically consume a much higher quality diet. They would be up higher at the end of this spectrum. This could be for a whole host of unknown reasons, right? It could just be the kids’ own food preference, the household that they live in, and the parents’ preference. It could be the food environment. But regardless of whatever those reasons are, what we found was that the kids that typically consume high quality diets at home, so they’re on the upper end, we see really no effects for them when aging out of WIC. Where all the action is, where all the deficits and the diet quality come from are at the lower end. So, these are the most vulnerable kids that live potentially in areas with inadequate access to healthy food or whatever it may be, they’re the ones that are taking the largest hit, and arguably, they’re the most vulnerable.

This difference across households or across children is really important to recognize and it’s an important place for interventions as we think about what the implication of your work suggests. So that’s one of the questions I’m interested in understanding. What, if any, are the long-term effects of children aging out of WIC? It seems like there’s a special period that this is happening. Do you think there are effects beyond that window of time before they start school?

I think that there probably are. Now, we couldn’t address that specifically in our study because of the way our study was designed. The effects that we’re looking at are just for this transition when they’re around the period that they’re losing access around five. One reason just intuitively to kind of understand is why we can’t extrapolate this out is that. As we add months past five years old, the probability that that kid is going to go into school is going to be increasing. So, you’re going to start muddling the positive effects of school food programs. But to speak to these long-term effects, there’s this whole long literature from nutritionists, and your listeners will probably just know this anecdotally, if you have small children or had kids or been around kids, is that it’s really hard to get them to eat healthy, right? Or to try new foods. The WIC program is providing this opportunity to have access to these healthy foods, and the problem is that, I think, many people would also realize, or again, anecdotally, you would kind of realize that it’s really easy for kids to have a reversion, right? You’ve been trying really hard, you’re getting them to eat that broccoli, but then if all of a sudden you lose access to broccoli, and they say, oh, I can eat the French fries. It’s really easy to go back to just eating those French fries and you take all this kind of nutrition capital, so to speak, that’s been developed over these years of being on the WIC program, could quickly be wiped out. So that is a very important period. That’s what the nutrition literature says. We haven’t looked at these longer-term effects yet.

Well, thank you for that. Travis, it’s interesting to find this idea that the calories don’t change. So, if you will, the quantity doesn’t change, but the mix, the nutritional value of the foods that children are eating changes if they age out of WIC. So, the question is, what challenges do you think parents are facing to continue to buy the WIC items or to buy these more nutritious foods during this age out period?

Yes, that’s right. WIC is acting as a small income transfer, and so when you lose WIC, parents must then use their own money to buy food. By and large, whole grain bread, for example, will be more expensive than refined grains. Processed fruits and vegetables that may be canned that come with added syrups or fats will be cheaper than fresh produce. All these things add up when the parents are still feeding their kids the same amount of food and they’re making these small substitutions for the lower quality foods. You do see that add up. I will point out that in terms of the calories, there was also another paper that came out right after our paper by Marian Bitler that showed that they were able to look at what was going on in the households. What they find is that the moms actually do reduce their own calories, which is a finding that we’ve seen in the context of WIC and other programs, and also, I think it seems, I guess obvious, is that the parents would be more likely to take the hit and shield their kids. Your paper doesn’t speak to that, but there are these other implications for others in the household.

Wow, this is really important work. Thank you for sharing that. I’m interested in the policy shifts that could happen. How could policy change affect this issue, this problem, and the negative effects of aging out? What kind of policy tweaks are possible, and do you have a sense of the cost of that?

The obvious policy fix is to change the arbitrary rule of kids lose WIC in the month after they turn five years old, and just say, “Hey, you can stay on WIC until you get into kindergarten.” We were curious about how much that would cost. We know from administrative cost data from the USDA how much it costs on average per month for a four year old to be on WIC, and so we just extrapolated that number out, assuming that births are random across the year, so that would mean you would have 1/12th of the population that would have to stay on WIC for 11 more months and then you have another 1/12th that would stay on for 10 months, and so on and so forth. We calculated the total cost of that under the current rules, and it came out to about a hundred million dollars, which sounds large, right? A hundred million dollars. But you must put that into context of the current spending. WIC currently costs about 5.7 billion, with a b, so that change comes out to about a 2% increase in the program to allow kids to stay on WIC until they turn five years old. Not only is that a small percentage of the WIC program, but that’s also less than a drop in the bucket in terms of food assistance spending. Again, to have a better context, the SNAP program costs, last year, I think it was about $120 billion, so it’s actually a very small amount to allow kids to stay on the program.

Is there any political movement or any movement in the legislature to address this problem?

Somewhat. There’s been a bill called the WIC Act, which would allow states to seek a waiver from the federal government to do just that: to allow kids to stay on WIC until they get into kindergarten, or they turn six, whichever comes first. This has been proposed, I think at least since 2015, over and over. It’s bipartisan that has sponsors on both sides of the aisle, and it’s been proposed in the House and the Senate and in both also bipartisan support. But it’s never gotten out of committee, which means they sent it to committee, doesn’t get marked up, and it’s never left. I don’t know if this year will be any different. There’s been several other bills that pertained to WIC that have also been proposed. I think there’s more interest in revamping WIC. Whether this will happen with this particular one, I’m not sure, because as you may know right now, Congress is asking for more money to pay for WIC because it is discretionary, it’s not mandatory. So, who knows, right? But there is this proposal to allow this to happen.