Examining changes in local health department WIC service provision and local “need”: The PHAST Study

Background: This study was conducted through the Public Health Activities and Services (PHAST) study associated with the system of state-level Public Health Practice-based Research Networks. We examined the effectiveness of using existing service statistics data gathered through local and state health departments for representing changes and variation in the “output” of a specific local health department (LHD) service—the Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Methods: Unpublished WIC-related service data representing 148 LHDs were obtained from state WIC offices in 3 U.S. states and adapted into comparable measures of number of unduplicated WIC clients served by each LHD for each of 5 years from 2005-2009. Other state-specific data included the annual number of Medicaid births per county and the availability of WIC services from local non-LHD providers. Number of Medicaid births was used as a proxy for “local need.” Data were linked at the county level along with rural, small urban, and urban population size classifications.

Results: LHDs providing WIC services appear to meet local demand rather consistently and relative to consistent federal guidelines directing WIC eligibility and service delivery. As a variable representing “local need,” the number of annual Medicaid births per county was a strong measure, accounting for major increases over time and county differences for number of WIC clients served by LHDs.

This average change in WIC clients served per unit change in Medicaid births increased each year. Within each year, this association was largest among large urban regions and smallest among rural regions.

Conclusions: Variation exists in LHD service delivery and it varies, in part, relative to jurisdiction population size, with rural LHDs seemingly less able to keep up with demand. Results also suggest that LHD service statistics can serve as useful data sources for measuring change and variation in volume of service.