the women (12.5 percent of total) were pregnant. About onequarter (25.4 percent) of the participants were infants under 1 year old. And about half (51.3 percent) were children 1 to 4 years old (below their fifth birthday). Younger children were more prevalent than older children; for example, there were about twice as many 1 year olds as 4 year olds. About one-seventh (13 to 14 percent) of the pregnant and postpartum women were under 18 years old. This is substantially higher than the national incidence of teenage births (5 percent for all U.S. births and 11 percent of black births in 1984). A related issue is the early initiation of prenatal services. About a third of the pregnant women were certified in WIC in their first trimester, a half in the second trimester and a sixth in the last trimester. About three-quarters of the infants were certified within one month after birth. Distribution of Participants by Priority Level Federal policy encourages the targeting of benefits to especially needy people through a nutritional risk priority system. At the time of the study, the priority system was: Priority Level I II III IV A VI Description Pregnant and breastfeeding women and infants at nutritional risk, as demonstrated by hematological or anthropometric measurements or other documented nutritionally-related medical problems Infants up to 6 months of age of women who participated in WIC during pregnancy or of women who did not participate during pregnancy, but were eligible during pregnancy under Priority I conditions Children at nutritional risk, as demonstrated by Pregnant or breastfeeding women or infants at Children at nutritional risk due to an inadequate Nonbreastfeeding postpartum women at nutritional risk In February 1985, after the data were collected, these regulations were modified slightly to permit States to place high risk postpartum women in Priority Levels III, IV or V and to create an optional Priority Level VII for participants certified to prevent regression in nutritional status (i.e., people previously at risk who may relapse without continued assistance). Table 3. Distibution of Poverty Status for WIC Participants, Based on Reported Cash Income and Household Sizes: August to December 1984 * Probably due to annualizing rounded weekly, biweekly or monthly incomes ** Totals may not sum to 100.0 percent due to rounding. SOURCE: Study of WIC Participant and Program Characteristics, 1986 the basis for income eligibility in an additional 14 percent of records and such people were assumed to have incomes below 130 percent of poverty. Combining this group with the first group yielded similar results. Based on reported cash incomes, 86 percent were below 130 percent of poverty and, based on cash income or program participation, 88 percent were below 130 percent of poverty. The mean household size was 4.1 persons. Pregnant women tended to have smaller household sizes (mean of 3.3 persons) and 3 and 4 year old children tended to have larger households (mean of 4.6 persons). Racial Distribution About half of the participants (48 percent) were white, a third were black (31 percent) and a sixth were Hispanic (17 percent); American Indians and Asians comprised about 2 percent each. This distribution was similar for all participant categories, except that breastfeeding women had more whites and fewer blacks and postpartum women had fewer whites and more Hispanics. Nutritional Risks of WIC Participants A unique aspect of the WIC Program is that in order to be eligible a person must be diagnosed as having a nutritional risk, as determined by a nutritionist, nurse, dietitian, physician, or other health professional. Federal rules establish broad guidelines for nutritional risk criteria. State and local agencies further refine these broad descriptions into specific categories of allowable risks and standards for their measurement. There are two fundamental difficulties in interpreting the nutritional risk criteria data. First, State and local agencies do not use the same risks or the same definitions of risks. Thus, a person who is classified as at risk by one State or local agency may not be by another. Second, there are varying degrees to which risks are reported. Some certification forms have space for only one risk, some have space for many. Only one risk is necessary for eligibility, but a person may have more than one disorder. About half of the participants in the study had only one risk reported. The single risk of a person may be that person's only risk, the most important of many risks or the risk which was most readily assessed in the clinic. About half had more than one risk reported. Even for these cases, it is not clear if they constituted all the risks, the most important risks or those which were most readily identified. Whether a person has single or multiple risks may depend on the person's health status, agency policies or expediency in the clinic. The study examined the prevalence of nutritional risks in three ways: single risks reported, multiple risks reported, and combined risks, which is the frequency reported regardless of single or multiple times. The prevalence of nutritional risks varied, depending on which method was used. Using the combined risks, 43 percent of participants had a medical/health type risk, 38 percent had a dietary risk, and 35 percent had an anthropometric risk; other risk types were less commonly found. The most common specific nutritional risks by participant category were (based on combined risks): According to the survey of local agency staff, the most common method of assessing dietary intake was a 24 hour recall, although other methods such as food frequency checklists were sometimes used in conjunction or by themselves. To evaluate the diet, the most common method was a comparison with the Basic Four food groups. Based on the most common standards for low hemoglobin or hematocrit values used by WIC State agencies in 1985, about 22 to 25 percent of WIC participants were anemic. Low values were somewhat more common among postpartum women, breastfeeding women and older infants. Although results for hemoglobin and hematocrit values were not identical, they showed similar trends. Coordination with Health and Social Service Programs An important role of the WIC Program is to function as an adjunct to health care, to help ensure that participants have |