NATFAN

National Food and Nutrition (NATFAN) Questionnaire – WIC Food Package Revisions 

 

Background

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritious foods, nutrition education, information and support for breastfeeding, and health care referrals to low-income women, infants, and young children who are at nutritional risk. In 2009, the WIC food benefits were revised, representing the first substantial modification of the food package since the initiation of WIC in the early 1970s.

The National Food and Nutrition (NATFAN) questionnaires are food choice and frequency instruments developed specifically for WIC participants. Three 33-item questionnaires (Women, Infant, and Child) provided the basis for a national multi-year, multi-level study to examine participant food and nutrition behavior before and after implementation of the revisions in the WIC food package. Using a repeated cross-sectional design, the NATFAN study involved state, territorial, tribal, and local WIC programs in an assessment of the impact of the WIC food package benefit revisions.

What revisions were made to the WIC food package?

The WIC foods package revisions were designed to align the WIC food benefit with the Dietary Guidelines for Americans and the American Academy of Pediatrics’ current dietary guidance for feeding infants. The primary goals of the revisions were to encourage consumption of fruits, vegetables and whole grains; to lower saturated fat intake; and to promote the establishment of long-term breastfeeding.

Highlights of the food package  revisions include:

  • Inclusion of fruits and vegetables
  • Inclusion of whole grain items such as whole wheat bread, oatmeal, brown rice, and tortillas –(both corn & whole wheat)
  • Increased amounts of food available to women and their infants who are exclusively breastfeeding
  • Exclusion of whole milk for recipients over 2 years of age
  • Expansion of commercial baby foods available for infants
  • Availability of soy milk and tofu as options to accommodate cultural food preferences

Who participated in the NATFAN study?

WIC participants from 38 states, 10 Indian Tribal Organizations (ITOs), Washington DC, and one US Territory (50 WIC programs) participated in the NATFAN survey in FY 2009 prior to the implementation of the new food package.

Following the revisions to the food package in late FY 2010 and early FY 2011 (at least 6 months after implementation), 40 states, 16 ITOs, Washington DC, and one US Territory (58 WIC programs) re-administered the NATFAN questionnaires to WIC participants.

Programs participating in NATFAN

NATFAN_participation_map

Note: Blue color denotes states that participated in NATFAN

*one or more ITOs within this state participated in NATFAN
**The Mariana Islands also participated in NATFAN but are not shown on this map.

NATFAN Survey Respondents

Survey Questionnaire Before the Food PackageRevisions After the Food PackageRevisions
Women 25,564 27,726
Infant 21,768 22,951
Child 40,404 42,856
Totals 87,736 93,533

 

What are the research focal points for NATFAN?

The pre-food package change questionnaire was completed by WIC participants prior to February 2009, in advance of the new food package roll-out on October 1, 2009.  The questionnaire focused on WIC client demographics with relation to preferences, feeding and consumption practices, with particular focus on the following areas:

  • Fruits and Vegetables
  • Whole Grain Foods
  • Low Fat Milk
  • Adult Eating Practices
  • Infant Eating Practices
  • Child Eating Practices
 NATFAN_coverpage

Summary

The NATFAN project offers an exciting opportunity to examine WIC participants’ food and beverage choices before and after the food package revisions. The project offers national and state-level information about participants’ consumption frequency for whole grain foods, milk and formula products, and a variety of fruits and vegetables. The findings will have implications for national and state WIC program policies and nutrition education practices. Summary reports with preliminary results have been provided to the participating programs.

During FY 2012 and FY 2013, Institute researchers are continuing data preparation and analysis of NATFAN results with funding support from the Economic Research Service’s Food and Nutrition Assistance Program (FANRP) of the United States Department of Agriculture. Institute researchers are developing reports that document “before and after the food package revisions” results for WIC programs, creating a national NATFAN data set to be available for use by other researchers, and preparing articles and publications to report results.

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