[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