[Federal Register Volume 59, Number 120 (Thursday, June 23, 1994)]
[Unknown Section]
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From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-15233]


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[Federal Register: June 23, 1994]


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DEPARTMENT OF AGRICULTURE

Food and Nutrition Service

 

Special Supplemental Food Program for Women, Infants and Children 
(WIC): Accommodation of Cultural Food Preferences in the WIC Program

AGENCY: Food and Nutrition Service, USDA.

ACTION: Notice of solicitation of comments.

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SUMMARY: Recently, cultural food preferences among participants in the 
WIC Program have received considerable attention. There has been 
concern expressed that some WIC participants may not take full 
advantage of Program benefits (e.g., the food packages and nutrition 
education) for cultural reasons. In this Notice, the Department is 
soliciting public comments regarding the issues surrounding the 
accommodation of cultural food preferences in the WIC Program.

DATES: To be assured of consideration, comments must be received on or 
before December 20, 1994.

ADDRESSES: Comments should be sent to Stanley C. Garnett, Director, 
Supplemental Food Programs Division, Food and Nutrition Service, USDA, 
3101 Park Center Drive, Room 540, Alexandria, Virginia 22302. Comments 
on this notice should be clearly labeled ``Accommodation of Cultural 
Food Habits In the WIC Program Notice.'' Comments which are not within 
the scope of this Notice should not be included. All written comments 
will be available for public inspection during regular business hours 
(8:30 a.m. to 5:00 p.m., Monday through Friday) at this office of the 
Food and Nutrition Service (FNS).

FOR FURTHER INFORMATION CONTACT: Barbara Hallman, Chief, Program and 
Policy Development Branch, Supplemental Food Programs Division, Food 
and Nutrition Service, USDA, 3101 Park Center Drive, Room 540, 
Alexandria, Virginia 22302, (703) 305-2730.

SUPPLEMENTARY INFORMATION:

Executive Order 12866

    This Notice has been determined to be not significant for purposes 
of Executive Order 12866 and therefore has not been reviewed by the 
Office of Management and Budget.

Regulatory Flexibility Act

    This action is not a rule as defined by the Regulatory Flexibility 
Act (5 U.S.C. 601-612) and thus is exempt from the provisions of that 
Act.

Paperwork Reduction Act

    The Notice imposes no new reporting or recordkeeping provisions 
that are subject to review by the Office of Management and Budget in 
accordance with the Paperwork Reduction Act of 1980 (44 U.S.C. 3507).

Executive Order 12372

    The WIC Program is listed in the Catalog of Federal Domestic 
Assistance Programs under No. 10.557 and is subject to the provisions 
of Executive Order 12372, which requires intergovernmental consultation 
with State and local officials (7 CFR part 3015, subpart V, and 48 FR 
29114 (June 24, 1983).

References

    (1) Study of WIC Participant and Program Characteristics, 1988, was 
funded by the Food and Nutrition Service (FNS), United States 
Department of Agriculture (USDA), and conducted by the Research 
Triangle Institute, Research Triangle Park, North Carolina. This two-
volume report published in April 1990, and referred to as PC88, is the 
first of the biennial Congressional reports required by Section 343(a) 
of Public Law 99-500, 42 U.S.C. Sec. 1786(d)(4).
    (2) National Advisory Council on Maternal, Infant and Fetal 
Nutrition--1992 Biennial Report on the Special Supplemental Food 
Program for Women, Infants and Children and on the Commodity 
Supplemental Food Program. This report contains recommendations to the 
Congress on ways to improve the administration of the WIC Program.
    (3) Technical Papers--Review of WIC Food Packages, published by the 
USDA, November 1991. These papers were developed by a team of faculty 
members of the Pennsylvania State University, The Department of 
Nutrition, College of Health and Human Development, under a Cooperative 
Agreement with USDA's Food and Nutrition Service during the spring and 
summer of 1991. This was in response to Section 123(c) of Public Law 
101-147 which required USDA to conduct a review of the appropriateness 
of foods made available to WIC participants.

General Background

    Recently, the ability of the WIC Program to accommodate cultural 
food habits has received considerable attention. This is due in part to 
significant demographic changes in the United States. The current 
racial/ethnic participation rate in WIC is approximately: 45 percent 
White, 27 percent Black, 24 percent Hispanic, 2 percent Asian/Pacific 
Islander, and 2 percent American Indian.
    Data from the FNS/USDA study entitled, Study of WIC Participant and 
Program Characteristics, 1988, indicate that the WIC State and local 
agency workforce has changed to reflect the cultural diversity of 
participants being served. The study showed that staff members were 
bilingual in many local agencies serving non- English speaking clients. 
Although Spanish was spoken fluently by a significant number of these 
staff members, some personnel also exhibited proficiency in other 
languages such as Cambodian/Khmer, Vietnamese, Thai, Chinese, French, 
Portuguese and Haitian/Creole.
    In addition, in response to demographic changes in the WIC Program 
participation, various Federal, State and local agency publications and 
materials have been developed which target a wide variety of culturally 
diverse groups. These culturally sensitive materials may be the only 
understandable source of nutrition information that a WIC participant 
receives. Such resources link WIC participants not only to food 
assistance and nutrition education but also to a much needed health 
care system.
    Low-income populations, including WIC participants, are faced with 
numerous barriers to assistance and many difficulties in their lives. 
For populations in need of assistance who are of different cultures, 
especially those who have recently arrived in the United States and who 
lack orientation to service delivery here, the barriers to assistance 
can be of such magnitude as to adversely affect their health and well-
being. The WIC community must give special consideration to its 
approach in delivering quality benefits to this growing subpopulation.
    In its 1992 report to Congress, the National Advisory Council on 
Maternal, Infant, and Fetal Nutrition recommended that the Department 
develop policy and guidance to better accommodate WIC participants of 
culturally diverse backgrounds. In recognition of this need, and in 
response to the increased emphasis on accommodating the needs of 
culturally diverse populations, the 1993 National Association of WIC 
Directors Conference featured a session which presented various issues 
concerning service delivery to culturally diverse populations and the 
WIC food packages. In addition, the theme of the 1993 National WIC 
Nutrition Services Conference, sponsored by the Food and Nutrition 
Service, was ``Meeting the Needs of a Diverse Population.'' 
Approximately 800 persons attended, and over 60 speakers addressed 
topics pertinent to the conference theme.
Workshops on cultural accommodation in WIC food packages were also 
conducted at this conference.
    With this Notice, the Department is seeking guidance on issues/
questions concerning the accommodation of cultural food preferences in 
the WIC Program. The Department would like information on how the 
current WIC food packages can be efficiently and effectively used by 
culturally diverse populations. It is not the intention of this Notice 
to solicit comments that only identify possible WIC food substitutions. 
The intent is to gather information concerning some basic questions 
regarding the food preferences of culturally diverse WIC participants 
and ways to improve culturally sensitive service delivery. This in turn 
will help the Department to identify issues of importance for further 
consideration and policy formulation.

Definitions of Terms

    Concepts and terminology that we are using in this Notice correlate 
with terms defined below. The first four--Culture, Cultural Diversity, 
Cultural Sensitivity and Ethnicity--reflect definitions established by 
the U.S. Department of Health and Human Services for the same or 
related terms.
    Culture: The shared values, mores, traditions, norms, customs, 
arts, history, folklore, and institutions of a group of people that are 
unified by race, ethnicity, language, nationality, or religion.
    Cultural Diversity: Differences in race, ethnicity, language, 
nationality or religion among various groups within a community, 
organization, or nation. A community is said to be culturally diverse 
if its residents include members of different groups.
    Cultural Sensitivity: An awareness of the nuances of one's own and 
other cultures.
    Ethnicity: Characteristics associated with a common group--often 
linked by race, nationality, and language--that shares a common 
cultural heritage.
    Food Preferences: The characteristic and repetitive acts that 
members of an ethnic group undertake in order to secure food and 
nourishment in a culturally significant manner.

Program Background

    The authorizing legislation, Section 17 of the Child Nutrition Act 
of 1966 (CNA), as amended (42 U.S.C. 1786), established the WIC Program 
to provide supplemental foods, nutrition education, and access to 
related health and social services for low-income pregnant, 
breastfeeding and postpartum women, infants, and children up to age 5 
who are at nutritional risk. Nutritional risk is determined by a 
competent professional authority and includes conditions such as 
inadequate weight gain during pregnancy; history of high-risk 
pregnancies; growth problems in infants and children; anemia; and 
inadequate dietary patterns.
    Section 17(a) of the CNA, 42 U.S.C. 1786(a), clearly established 
the WIC Program as ``supplemental'' in nature; that is, the WIC food 
packages are not intended to provide a complete diet but are designed 
to provide specific nutrients--iron, calcium, protein, and vitamins A 
and C--historically lacking in the diets of the WIC population. WIC was 
never intended to be a primary source of general food assistance. 
Rather, WIC was intended to provide nutritional services as an 
integrated adjunct to public health delivery.
    However, along with WIC, the Department administers a variety of 
other complementary food assistance programs that work together to 
provide a more complete diet to needy persons. The largest of these 
programs, the Food Stamp Program, provides general food assistance 
intended to increase the food buying power of low-income households. 
The Food Stamp Program is the Federal Government's primary means to 
provide needed food assistance to ensure adequate nutrition for low-
income households. The National School Lunch and the School Breakfast 
Programs provide free and reduced price meals to low-income children 
and low-cost meals to non-needy children in school. Also, the Child and 
Adult Care Food Program provides meals to persons in child and adult 
day care centers and children in family day care homes. A variety of 
commodity donation programs are also available to low-income persons. 
Through the Food and Nutrition Services' domestic food assistance 
programs, over $40 billion in food help is provided to one in six 
people living in the United States.
    In addition to supplemental food assistance, WIC provides nutrition 
education, including information about the dangers of alcohol, tobacco 
and other drug use to participants. The nutrition education provided by 
WIC enables participants to make informed decisions in choosing foods 
which, together with the supplemental foods contained in the WIC food 
packages, can meet their total dietary needs. Such learned behavior 
assists participants to continue healthful dietary practices after 
leaving the Program.
    Again, WIC is a unique food assistance program in that it also 
serves as an adjunct to good health care during critical times of 
growth and development to prevent the occurrence of health problems and 
to improve the health status of Program participants. WIC participants 
are screened and referred to other necessary health and social 
services, such as prenatal care, well-baby care and immunizations.
    Numerous studies have shown that WIC is extremely cost-effective 
and highly successful in improving the health and nutritional status of 
its clients. Given this proven track record, the President and 
Congressional leaders have publicly stated that they intend to fully 
fund the WIC Program; that is, they wish to provide enough funding so 
that those who are eligible for the Program can be served by the end of 
Fiscal Year 1996.

WIC Food Packages

    Early legislation for the WIC Program, Pub. L. 92-433 (1972) 
through Pub. L. 94-105 (1975), specifically identified protein, iron, 
calcium and vitamins A and C as the target nutrients for WIC 
participants. However, Pub. L. 95-627, enacted in November 1978, 
deleted the reference to specific target nutrients. Instead, it defined 
supplemental foods as those foods containing nutrients determined by 
nutritional research to be lacking in the diets of pregnant, 
breastfeeding, and postpartum women, infants, and children, as 
prescribed by the Secretary of Agriculture. The Program direction 
announced by that law remains in effect today, Section 17(b)(14) of the 
CNA, 42 U.S.C. 1786(b)(14), and the law also directs the Secretary in 
Section 17(f)(12) of the CNA, 42 U.S.C. 1786(f)(12), to assure that, to 
the extent possible, the fat, sugar, and salt content of WIC foods is 
minimal.
    The law provides substantial latitude to the Department in 
designing WIC food packages, but obligates the Department to prescribe 
foods which effectively and economically supply those nutrients 
critical to growth and development and which are specifically lacking 
in the diets of the WIC eligible population.
    In anticipation of the passage of Public Law 95-627, the 
Department, in October 1978, assembled a WIC Food Package Advisory 
Panel composed of State health officials, representatives of the 
nutrition community and advocacy groups, to review the original food 
packages and recommend changes. Panel recommendations included 
retaining high-quality protein, iron, calcium, and vitamins A and C as 
the targeted nutrients in the WIC Program and expanding the number of 
available packages. Based on the Panel's recommendations, an evaluation 
by the Department of the fat, sugar and salt content of the WIC foods, 
and public response to proposed rules in 1979, new WIC food package 
regulations were published in 1980 which are consistent with Public Law 
95-627.
    These food package requirements appear in 7 CFR 246.10 of the WIC 
Program regulations. The final rule (45 FR 74854, November 12, 1980) 
established six different monthly packages: Food Package I for infants 
0-3 months; Food Package II for infants 4-12 months; Food Package III 
for children and women with special dietary needs; Food Package IV for 
children 1-5 years of age; Food Package V for pregnant and 
breastfeeding women; and Food Package VI for nonbreastfeeding 
postpartum women. The Department created an additional food package in 
November, 1992 (57 FR 56231, November 27, 1992). This enhanced package, 
Food Package VII, is designed for those breastfeeding women who elect 
not to receive infant formula through WIC for their infants.
    Authorized WIC foods include: iron-fortified infant formula, iron-
fortified cereals, vitamin C-rich 100 percent fruit and/or vegetable 
juice, calcium/protein-rich milk and cheese, protein/iron-rich eggs, 
protein-rich peanut-butter or dried beans/peas, and physician-
prescribed formula/medical foods for participants with certain special 
dietary needs. The enhanced package for certain breastfeeding women 
increases allowable amounts of juice, cheese, peanut butter and dry 
beans/peas, and also allows protein-rich tuna fish and carrots which 
provide beta carotene (precursor to vitamin A) and dietary fiber.
    The seven WIC food packages are designed to help accomplish the 
following: supplement participants' diets with nutritionally dense 
foods that follow current medical and nutritional guidance; complement 
the eating patterns of preschool children; and address the special 
requirements of pregnant and breastfeeding women. As described in the 
1980 final rule (45 FR 74854), the WIC food packages were initially 
designed and adopted with several considerations in mind. These 
considerations should also be taken into account when commenting on the 
issues presented in this Notice. The factors to be considered are 
discussed below, with particular emphasis on how they apply to 
accommodating cultural food habits.

1. Nutritional Integrity

    The nutritional integrity of the WIC food packages--the provision 
of specific target nutrients typically lacking in the diets of the WIC 
population--is the cornerstone of the Program. Nutrient requirements 
are particularly high during times of rapid growth, development and 
replenishment. Therefore, the WIC population, composed of pregnant, 
breastfeeding and postpartum women, infants and children, represents 
individuals whose nutritional needs are among the highest and most 
critical for optimal growth and development. Insuring optimal nutrient 
intakes during these vulnerable periods of life is paramount to prevent 
both immediate and long-term adverse health outcomes. Consequently, 
effort has been made to reflect current nutritional science and assure 
that the various packages supplement the nutrition needs of WIC's at-
risk population with nutrient-dense economical foods. Each of the 
allowable WIC foods is rich in at least one or more of the nutrients 
iron, calcium, protein, and Vitamins A and C, enabling the WIC food 
packages to make a significant nutritional contribution to the diets 
and health of Program participants.
    Preserving the nutritional integrity of the food packages is 
imperative if WIC is to remain an effective health-related program. 
Congressional intent as evidenced both in statutory and legislative 
report language has continually emphasized that the Department should 
not implement any rule which would decrease the nutritional 
contribution of the WIC foods and that any future modification should 
be based on comprehensive scientific evidence.

2. Fat, Sugar, and Salt Content

    As discussed previously, consideration of the fat, sugar and salt 
content of foods in the WIC food packages is required by Section 
17(f)(12) of the CNA. Several changes made to the WIC food packages in 
the 1980 rulemaking responded specifically to this mandate. For 
example, the Department established a limit on the amount of sugar 
allowable in WIC approved cereals.
    Additionally, FNS policy guidance permits WIC State agencies to 
issue low-fat, low-cholesterol and low-sodium forms of WIC cheeses, as 
well as low-fat and skim milks. The Department encourages local program 
administrators to tailor the WIC food packages to meet the individual 
nutritional needs of participants and, when appropriate, to adjust the 
types of WIC foods prescribed to help reduce the amount of fat, 
cholesterol, sodium and sugar the WIC food packages contribute to the 
diet. Through WIC nutrition education, participants also receive advice 
on how to further moderate their intakes of fat, cholesterol, sodium 
and sugar and how to include adequate amounts of vegetables, fruits and 
whole grain products in their diets.

3. Cost

    In addition to the criteria specified in legislation, cost was a 
prime consideration in the design of the WIC food packages. The 
Department is committed to serving as many eligible persons as possible 
while maintaining the nutritional integrity of the Program. WIC is not 
an entitlement program, and the number of potentially eligible 
individuals who can be served is determined by the amount of funds 
appropriated by Congress. Therefore, the total cost of the WIC food 
packages influences the total number of participants that can be served 
by the Program. State and local agencies have the flexibility, within 
regulatory parameters (7 CFR 246.10 and supplemented by FNS Instruction 
804-1 ``WIC Program--Food Package Design: Administrative Adjustments 
and Nutrition Tailoring'') to specify lower cost food brands, physical 
forms of foods, and types and sizes of food containers to help control 
the cost of the WIC food packages. While changes in quantities of 
allowable WIC foods can be made to accommodate nutritional needs of 
individuals or categories of persons, they cannot be made solely for 
cost-containment reasons.

4. Practicality

    All WIC food packages are designed to address a number of practical 
considerations which reflect participant and Program needs. For 
example, the WIC foods are readily available in retail food stores, 
offer variety and versatility to participants in the ways these foods 
can be used in an overall diet, are nutrient-dense, can be easily 
divisible into servings on a daily basis, and have broad appeal. 
Additionally, all WIC food packages are individual food prescriptions 
which, in order to have the full effect in improving a participant's 
nutritional status, are intended to be consumed only by the participant 
and not by other family members. Also, in selecting WIC foods, 
consideration is given to whether, in fact, participants are likely to 
have easy access to and routinely consume large quantities of a food 
item even without the WIC Program. For example, certain ethnic groups 
purchase a food in bulk and use it daily as a staple food item. In this 
type of situation, providing a small amount of a routinely consumed 
staple food item may not be a cost-effective way to use limited WIC 
resources.

5. Domestic, Natural State

    Foods offered in all WIC food packages are generally foods that are 
of domestic origin and which have undergone minimal processing. The WIC 
Program, along with other food assistance programs administered by the 
Department, participates in a longstanding partnership with American 
agriculture and endeavors to provide foods which support the nation's 
agricultural economy.

6. Administrative Feasibility

    WIC food packages are designed to strike a balance between 
desirable, nutrient dense, shelf-stable, low-cost staple food items and 
administrative feasibility. This means that although there are 
certainly some foods that would be particularly beneficial for and 
culturally appealing to WIC participants, the WIC Program is not always 
capable within the limitations of its current structure of easily 
delivering such foods. For example, fresh fruits and vegetables would 
greatly enhance WIC food packages. However, the labor intensive 
management needed to provide non-prepackaged produce items which widely 
fluctuate in cost, require participant weighing and measuring, and are 
highly perishable make them administratively prohibitive for the WIC 
Program.
    Also, WIC is limited in its ability to offer a wide range of food 
options, since from a management standpoint choice options pose 
considerable challenges to WIC participants and the vendor community. 
Each food option added to the food package magnifies the difficulties 
of program management and accountability.
    These practical considerations and constraints pose serious and 
real limitations to WIC's ability to offer a wide variety of desirable 
foods. This was most recently demonstrated when USDA proposed to 
enhance food packages for certain breastfeeding women (new Food Package 
VII, 57 FR 9505, March 19, 1992). Commenters stressed the critical 
importance of assuring that any new foods added would be 
administratively feasible and practical. As such, after reviewing the 
ability of the WIC food delivery system to provide fresh fruits and 
vegetables, we concluded in a Final Rule published at 57 FR 56231, 
November 27, 1992, that practicality and cost considerations limited 
choices considerably. We ultimately decided (7 CFR 246.10(c)(7)(ix)) 
that fresh carrots in one pound prepackaged bags were one of the few 
items that WIC had the capacity to provide without undue administrative 
difficulty for managers, food vendors and participants, as well.

7. Food Package Flexibility

    The WIC regulations (7 CFR 246.10) establish the maximum allowances 
of all WIC foods available to Program participants. However, State and 
local agencies have the authority to tailor these food quantities 
according to the needs of individual participants or categories of 
participants when based on a sound nutritional rationale. Tailoring 
must also take into consideration: food preferences; food acceptance; 
food use; household conditions; and food preparation abilities. These 
tailoring provisions, established in Program regulations at 7 CFR 
246.10 and supplemented by FNS Instruction 804-1, are designed to 
permit State and local agencies to implement their own nutrition 
policies and philosophies within the parameters of food package 
requirements. As of August 1992 (57 FR 34504, August 4, 1992), Program 
regulations at 7 CFR 246.10(e) also permit State agencies to tailor the 
food packages to better accommodate WIC participants in homeless 
situations.

8. Ability To Meet Cultural Needs

    In 1975 Congress directed the Department to consider cultural 
patterns of diet in administering the WIC Program (Pub. L. 94-105). 
Additionally, in subsequent legislation (Pub. L. 95-627), Congress 
directed the Department to permit cultural food adjustments. 
Consequently, since 1980, Program regulations have permitted WIC State 
agencies to submit for Departmental consideration proposals for 
substitutions or eliminations in the WIC food packages. As cited in 7 
CFR 246.10(e), cultural adjustments must meet the following criteria: 
the cultural food substitution must be nutritionally equivalent or 
superior to the food which it is intended to replace; it must be widely 
available to participants in the areas where the substitute is intended 
to be used; and the substitution must be cost equivalent to or less 
than the cost of the food it is intended to replace. Additionally, 
these changes must be approved by the Department.
    Since 1980, only three State agencies have submitted proposals to 
the Department for approval. The first proposal, submitted in 1980, was 
approved; it utilized the current WIC foods, substituting soy formula 
or powdered milk for fluid whole milk for Southeast Asians. The second 
proposal, submitted in 1988, requested rice and tofu to replace 
portions of the milk and cereal allowances. The intent was to better 
accommodate food preferences of Hispanics and Southeast Asians. The 
Department requested additional information from the State agency since 
it questioned the nutritional equivalency of the proposed substitutions 
and also had various other concerns. The State agency did not respond, 
presumably withdrawing the request. The third request, also in 1988, 
was for the addition of potatoes as a WIC food. Potatoes were requested 
to accommodate the needs of Eskimos who rely for food resources almost 
wholly on fishing and hunting; their diets lack dairy products, fruits, 
vegetables and grains. Potatoes are used in at least one Eskimo 
staple--caribou soup. The request was not approved for several reasons: 
1) program regulations allow substitutions, but not the addition of a 
food item; 2) potatoes would not supply a comparable amount of target 
nutrients--vitamins A and C, iron, calcium and protein--as would other 
WIC foods; and 3) the WIC food package does provide juices which can 
replace some servings of fruits and vegetables lacking in the Eskimo 
diet.
    The provisions of the WIC Program regulations which govern cultural 
food substitutions (7 CFR 246.10(e)) have been criticized as being 
difficult to conform with and inflexible. For example, the food for 
food substitution requirement has been cited as difficult or impossible 
to meet, given the requirements for nutritional and cost equivalency. 
While the Department recognizes the limitations of these provisions, it 
is the intent of the Department to maintain the nutritional integrity 
of the WIC food packages. The itent is also to prescribe foods which 
effectively and economically supply those nutrients critical to growth 
and development and which are typically lacking in the diets of the 
WIC-eligible population.
    Some culturally appealing foods, such as tofu, yogurt and rice, 
have often been formally and informally suggested for inclusion in the 
WIC food packages either as additional foods or as food substitutes. 
The following factors evoked concern about the appropriateness of these 
foods for the WIC packages. As a calcium substitute, tofu is not 
considered nutritionally equivalent to milk. Further, there is no Food 
and Drug Administration Standard of Identity for tofu to establish 
nutrient requirements and to guarantee product safety to the consumer. 
For this reason, the calcium content of tofu may vary according to 
brand and processing method and there is no assurance that tofu 
products will be free from harmful bacteria.
    Yogurt is nutritionally comparable to milk on a cup-by-cup basis. 
However, unlike white fluid milk, flavored yogurts, which are likely to 
be more acceptable, have added sugar.
    Rice is frequently suggested as a cereal substitute, yet it does 
not supply an equivalent quantity of iron. As one of the target 
nutrients in the WIC food package, iron is a critical component of WIC-
approved cereals. A one-ounce serving of cereal is intended to supply 
45 percent of the U.S. Recommended Daily Allowance of iron for adults 
and children 4 or more years of age. Therefore, WIC cereals are a rich 
source of this nutrient. In comparison, enriched rice is not highly 
iron-fortified and, therefore, is not nutritionally equivalent to iron-
fortified cereals. Further, rice, while popular, is not a particularly 
nutrient dense food product with respect to WIC's other target 
nutrients.

Nutrition Education

    WIC nutrition education requirements are explained in 7 CFR 246.11. 
Nutrition education is provided at no cost to participants and must be 
designed to achieve two broad goals. First, it should stress the 
relationship between proper nutrition and good health with special 
emphasis on the identified nutritional needs of participants. Second, 
it should assist the participant in achieving a positive change in 
eating habits, resulting in improved nutritional status and in the 
prevention of nutrition-related problems through optimal use of WIC 
foods with other nutritious foods. Nutrition education is to be taught 
in the context of the ethnic, cultural and geographic preferences of 
the participants and with consideration for educational and 
environmental limitations experienced by participants.
    Nutrition education can assist culturally diverse participants to 
adapt more readily to their environment. For example, through nutrition 
education participants can learn the importance of selecting 
inexpensive and nutritious foods which complement the supplemental 
foods provided by WIC.
    WIC State and local agencies have developed culturally sensitive 
nutrition education resources targeting the specific populations found 
in their areas. The resources include pamphlets, videos, food 
demonstrations, field trips to a local WIC food vendor, audio tapes, 
calendars, and much more.
    Some agencies have provided participants with instructions on how 
to use WIC foods to prepare traditional foods of importance to 
different cultures. For example, soy beans available through WIC can be 
used to make tofu; milk, another WIC food, can be used to make yogurt. 
Some participants need only to be familiarized with certain WIC 
supplemental foods. Those who are not familiar with peanut butter may 
have no idea how it is used or its nutrient content. A food 
demonstration about how to make peanut butter sandwiches or how to 
incorporate this product into traditional recipes which utilize a 
peanut sauce, common in some Southeast Asian dishes, would be helpful. 
WIC agencies that have approached these issues with sensitivity have 
done much to improve the acceptance of WIC foods as excellent low-cost 
sources of nutrients lacking in participants' diets.

1991 Food Package Review

    Section 123(c) of the Child Nutrition and WIC Reauthorization Act 
of 1989 (Pub. L. 101-147) required the Secretary to conduct a review of 
the appropriateness of WIC foods and food packages. The legislation 
specifically directed the Secretary to consider the nutrient density of 
such foods and how effectively needed nutrients are provided to WIC 
participants. FNS entered into a Cooperative Agreement with 
Pennsylvania State University to conduct this review. The findings, 
Technical Papers--Review of WIC Food Packages, were published in 
November 1991. The Pennsylvania State University researchers concluded, 
based on a review of the scientific literature on the dietary adequacy 
of women and children in the United States and associated nutritional/
health outcomes, that:
     the nutritional quality of the current WIC food packages 
is excellent as judged by the large contribution of target nutrients 
relative to their contribution of energy (calories) to diets of various 
categories of participants (as cited in Technical Paper #5);
     the WIC food packages are nutrient-dense sources of the 
five target nutrients--vitamins A and C, protein, calcium, and iron (as 
cited in Technical Paper #3); and,
     in general, the WIC foods provided enhance rather than 
inhibit the bioavailability of these nutrients (as cited in Technical 
Paper #3).
    The issue of lactose intolerance among different ethnic groups was 
also addressed in this review. The conclusion was that, although the 
specific prevalence of lactose intolerance in the WIC population is not 
known, there is ample evidence to indicate that the majority of adults 
in the ethnic minority populations served by WIC are potentially 
affected by this condition. However, it is essentially not a major 
issue for WIC age-eligible children because the prevalence of lactose 
intolerance in children under age 5 is very low. With respect to 
adults, there is sufficient evidence that dairy products can be and are 
consumed by many individuals who meet a clinical definition of lactose 
intolerance. Therefore, and particularly in light of the numerous 
options for improving tolerance to dairy products in individuals with 
low lactase activity, dairy foods of some type may be acceptable to 
most WIC participants. It was also pointed out that it may be difficult 
to distinguish lactose intolerance as such from non-acceptance of some 
or all dairy products for other reasons, because the diagnosis of 
lactose intolerance requires a laboratory test.
    However, the reviewers also found that there is ample evidence to 
suggest that the traditional patterns of low or non-dairy product 
consumption in some racial/ethnic groups might lead them to choose 
relatively lower quantities of various dairy products or to choose non-
dairy sources of calcium not currently allowed by regulations (i.e., 
tofu or salmon/sardines with edible soft bones). The reviewers also 
noted that there are valid scientific reasons for accommodating 
cultural food preferences in general; these extend beyond clinical 
intolerances to anthropological and sociological reasons. Foods not 
accepted, regardless of the reason, will not be consumed.
    The Department has had a long-standing policy in the WIC Program to 
allow lactose-reduced milk for those participants who suffer from 
lactose intolerance. A preliminary review of WIC State Plans of Program 
operation and administration indicates that 55 of 84 WIC State agencies 
(which include 32 Indian organizations serving as WIC State agencies) 
specifically include lactose-reduced milk in their State-approved WIC 
food lists.

Questions/Issues for Comment

    The Department presents below broadly stated questions for comment. 
Some questions are focused on ideas for regulatory or policy 
redirection; others simply are seeking information on better ways to 
meet needs within current requirements. Commenters are encouraged to 
state their responses as specifically as possible. Commenters may also 
address additional issues which are within the scope of this Notice. 
Comments which are not within the scope of this Notice will not be 
considered and therefore should not be included.
    Each of the questions presented below is numbered. In order to 
ensure full and appropriate consideration, commenters are asked to 
precede each of their comments with the number of the question to which 
it pertains. If comments are submitted on relevant issues which are not 
listed in this Notice, the issues should be clearly defined.
    Individual State and local agency comments are very important and 
strongly encouraged, as are comments from the public health nutrition 
community, industry, and the general public, including those 
individuals who have been served or are being served by WIC.

Food Package Issues

    1. Are the current food packages barriers to participation?
    2. Are the current WIC foods culturally acceptable to diverse 
populations?
    3. Keeping in mind WIC's role as a nutrition/health program and 
that WIC foods are intended to be supplementary to an overall diet, to 
what extent should cultural food preferences or food traditions be 
considered in designing the WIC food benefit?
    4. Would the authorization/approval by all WIC State agencies of 
lactose-reduced and/or lactose-free milks as WIC-eligible foods 
adequately address the potential problem of lactose intolerance among 
WIC participants? What other measures could be implemented to address 
lactose intolerance (such as the substitution of other nutrient-dense, 
low-cost calcium and/or protein rich foods for milk and cheese)?
    5. Keeping in mind the below listed considerations, are there foods 
that could be substituted or added to the WIC food packages that would 
better accommodate cultural food preferences yet still result in the 
WIC packages maintaining their nutritional integrity?
     wide availability of the product;
     participant appeal and acceptability;
     domestic origin;
     administrative feasibility (ability of participants, 
vendor community, and WIC administrators to successfully manage a wider 
variety or different types of WIC foods);
     reasonable cost;
     ease of daily apportionment;
     rich in one or more of the target nutrients: calcium, 
protein, iron, vitamins A and C; low in fat, sugar and salt content; 
and
     standardization and wholesomeness or safety of the 
product.
    6. What changes, if any, should be made in the current regulations 
governing the Department's approval of cultural food substitutions 
proposed by WIC State agencies?

Data/Information Issues

    7. What data and/or information is available to help the Department 
make informed decisions regarding this initiative (e.g., ethnic food 
consumption data, scientific studies, acculturation practices, 
participant surveys, etc.)?
    The Department welcomes any data and/or information relevant to 
this initiative.

Nutrition Education Issues

    The nutrition education component of WIC can play a major role in 
facilitating acceptance of WIC foods.
    8. How are agencies currently introducing WIC foods to new 
populations or suggesting ways to incorporate WIC foods into 
traditional diets to increase their acceptability and to make optimal 
use of current WIC food packages? How successful have these approaches 
been in acceptability and use?
    9. How could the nutrition education component of WIC play a more 
effective role in meeting the nutritional needs of culturally diverse 
populations?
    10. What role do culturally sensitive nutrition education materials 
from Federal, State and local agencies play in helping culturally 
diverse populations accept and utilize the WIC foods in their 
traditional diets?
    11. Is there a need for USDA to produce more materials of this 
nature, and, if so, what should be developed?

    Dated: June 17, 1994.
William E. Ludwig,
Administrator, Food and Nutrition Service.
[FR Doc. 94-15233 Filed 6-22-94; 8:45 am]
BILLING CODE 3410-30-U