WIC service use, benefit redemption, and continued participation among participants in California.

Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition assistance to pregnant and postpartum women in low-income households, and their children to age 5 years. Flexible services (in-person and remote) have been provided since 2020.

Objective: Objectives of this study were to describe WIC service utilization patterns (in-person, telephone, video conference, interactive texting, online individual education, online group education) and assess associations of service utilization with WIC benefit redemption and continued participation.

Design: A cross-sectional study with administrative data for follow-up.

Participants and setting: Study data include survey and administrative data from households with a WIC-participating child ages 1-4 years who responded to the 2023 California Statewide WIC Survey between March and August, 2023. Individuals with missing WIC administrative or survey data were excluded (n-unweighted=2,341; n-weighted: redemption=2,322, recertification=1,868).

Main outcome measures: The average percentage of WIC-issued foods redeemed over 12 months preceding survey completion (WIC food benefit redemption) and successful recertification within 2 months following the end of the child's certification period (continued WIC participation) were determined with WIC administrative data.

Statistical analysis: Associations of service utilization with benefit redemption and continued participation were assessed with generalized estimating equation linear and logistic regression models, respectively.

Results: Participants who used any in-person or fully remote services had similar levels of mean benefit redemption (53.2% and 53.3%, respectively) and continued participation (83.7% and 81.2%, respectively). In the full sample, online individual education was associated with 2.2% higher redemption (95% confidence interval [CI] 0.1% to 4.4%). Among those receiving no in-person WIC services, online individual education and online group education were associated with 2.7% (95% CI 0.1% to 5.4%) and 4.2% (95% CI 0.6% to 7.8%) higher benefit redemption; interactive texting was associated with 36% higher odds of continued participation (95% CI 1% to 83%).

Conclusions: In-person and fully remote WIC services were associated with similar levels of benefit redemption and continued participation. Online individual education and interactive texting may be important for redemption and continued participation for some WIC-participating households. Continued WIC investment in technology and staff training for these flexible services may contribute to positive outcomes, particularly for families without in-person service use.