Question 1
This research study tested the validity of FFQ's for WIC participants. WIC is a supplemental program that allows caregivers to purchase pre-approved food items; thus, the WIC program is unique to the SNAP program in that participants are limited in what food will be supplemented to them. Do you believe this difference would alter the reliability of the FFQ's? Why or why not?
Posted on behalf of Noel Konken.
Posted on behalf of Noel Konken.
posted by Julie @ 12:03 PM
15 comments
15 Comments:
Even as there is a potential for a skewed result in WIC participants compared to the general population of low income households with young children in a FFQ measure, I do not feel it would be significant upon the basis of purchasing restrictions. The WIC purchasing restrictions are generally open limiting few vendors and allowing a selection of 'junk food' products. This lenience simulates the purchasing power of a non-WIC family within the demographic. In contrast, WIC families may present altered FFQ due to other factors such as health education or support provided by the WIC program. Further research including non-WIC families would benefit health care knowledge of how possible purchase restriction (as seen through sugary beverage tax, and trans-fat restrictions) may effect public consumer habits and health behaviors.
I do not believe that having WIC participants in the study would alter the reliability of the FFQ’s. Having WIC participants allows for some continuity, and creates somewhat of a level playing field for all participants. This would allow us to see if that if the FFQ is efficient. We should see a pattern of milk, grain, beans/nut, fruit and vegetable consumption on the FFQs because these items are provided to the participants through WIC. It is important to note that WIC is a supplemental program. The participants get most of what they need, but they will still need additional foods. This allows room for soda consumption and “junk foods” that are generally less expensive items that they also might purchase on their own. WIC participants are provided nutrition education, but it is very likely that participants will still consume foods that are not recommended. I do believe it would be interesting compare this study to a similar study limited to young children on SNAP.
I don’t think that the validity testing of the FFQ with WIC participants would significantly alter FFQ reliability. The testing processes of the FFQ were designed to determine if the tool really does consistently and accurately measure intake of specific food items for low-income children on WIC. With this said, the FFQ study was not necessarily conducted to figure out how food intake compares between children. For the purpose of this study, the types of foods consumed and the associated health outcomes were not the focus. The validity and reliability of the tool to measure actual consumption among the children was the focus. If low-income children not receiving WIC supplement benefits were studied in the same way as in this study of WIC recipients, the consumption frequency of certain food items may vary due to many variables. However, I would not expect the validity and reliability results to be significantly altered since test-retest reliability was assessed and FFQ results were compared to each participant’s own 24 hour recall data. The frequency data gathered by the tool may vary based on WIC benefits and how they are spent, but the usefulness of the tool would not be effected by specific food choices.
Since the nature of the study was to evaluate an assessment tool, I agree with the others that the reliability of the FFQ would not be significantly altered. In theory, once validated, the tool should be useful across all audiences of children ages two to four. I think that it would still be useful to test this tool among a broader SNAP participant group than just WIC to ensure that this assumption is correct. Until the FFQ is used outside the WIC population, we cannot know for sure. I think this tool could be useful in comparing dietary intake of children participating in the WIC program versus other SNAP programs.
I agree with Tessa that due to the continued potential for WIC families to purchase 'junk' food with their own means the differences in diets from the general, non-WIC, public are most likely limited.
Although there is always a potential for bias in different survey tools such as the FFQ or the 24-hour recall, I do feel that it does not significantly affect the reliability of the FFQ for children eligible for WIC. With the WIC program, there are specific foods that the families are eligible to receive supplemental assistance. This limits the types of foods/beverages that children could consume. If anything, I feel that limiting the choices will result in more frequent consumption of fewer items. This will potentially provide an increased regularity in the child's eating pattern, which could increase the reliability or provide more validity of the FFQ.
I think that Tessa brings up an important point that WIC vouchers do not cover everything that a family needs. This could result in the purchase of additional foods. While this would provide children with more options (assuming their caregiver purchases additional foods/beverages), I do not think that this would drastically affect the reliability of the FFQ.
While WIC is a supplemental program allowing specific foods to be purchased, I agree with the others in that it should not have an effect of the FFQs in the study. Although there are restrictions with food they can purchase through WIC, food items typically consumed by the family or junk food items that are cheap may likely still be purchased for ease and to save money.
Rachel, I like your contrasting thought in regards to nutrition education, While WIC participants receive education, that may have an impact on the foods they choose to purchase. Effectiveness of nutrition education may vary, but can definitely have an impact on food purchases and a child's food consumption.
What Justine discussed goes along with what I was explaining as well. The study was designed to evaluate an assessment tool, not diet quality or healthfulness of food choices reported. To expand upon the results of this study, future studies on non-WIC 2-4 YO children could be conducted, as Justine suggested. Future research could also focus on adapting and validating a similar FFQ assessment tool for children in different age groups. I also think Holly's point about the somewhat restricted food choices available through use of WIC vouchers is interesting. I do think that the restrictions on the vouchers could create a greater pattern of regularity in the children's diet, which could in turn show higher degrees of validity and reliability in the study of the FFQ.
This research study was conducted to determine the reliability and validity of a FFQ specifically for use with WIC participants, so as long as the FFQ is used for individuals on WIC there should be minimal concerns about the questionnaires reliability. WIC provides financial support for purchasing items like milk, eggs, and baby formula in addition to nutrition and health education. While, SNAP benefits provide assistance to recipients to maintain healthy diets by helping purchase foods including fruits, vegetables, breads, cereals, meats, and dairy products, but nutrition education is not a part of the program. SNAP benefits can also be used to purchase food items that are not considered as healthy such as soda, candy, and cookies. Therefore, it could be possible that individuals on WIC and SNAP to purchase and eat healthier items than individuals only on SNAP. Since, this study specifically looked at a WIC population, the FFQ should be reliable with other WIC populations. Additional research would need to be conducted to determine the reliability of the FFQ in non-WIC and SNAP or non-SNAP populations.
I do not believe that the difference would alter the reliability of the FFQs. I am working in WIC right now so this research study was very interesting. As Tessa mentioned, we may see a pattern due to the foods WIC provides but WIC is supplemental, meaning it does not supply 100% of food families or individuals need to grow. Therefore, we will still see what other foods families are bringing into their homes. Also in WIC you have to be low income and have at least one risk factor. Working here currently I have found that many people have the same risk factor, which is their lack of education in nutrition. Although WIC does provide nutrition education I wouldn’t think it the amount of education provided would be enough to completely alter FFQs.
I agree with Justine that this tool could be useful to compare different supplemental programs. As Kandice mentioned, SNAP does not provide education. Therefore, comparing SNAP and WIC with this tool would help determine how helpful the nutrition education part of WIC is. After being there for two weeks now, I have learned that different WIC offices around the state educate differently. Some educate for long periods of time and have night classes and other offices do a brief education and do not have a big enough case load or enough certified health professionals to do classes or educate for longer periods. Therefore, if this research were to be conducted there would need to be some type of education outline for each program to follow.
What Kandice and Moriah said about comparing WIC, which includes an education portion, with other supplemental nutrition programs is an interesting thought. I would be curious to learn whether people's food choices are more influenced by the education they receive through WIC or the restrictions on items they are able to purchase through WIC. Moriah also brings up a good point that there is not necessarily consistency in education WIC participants receive. This makes me doubt that education would have much impact on food frequency reported in the FFQs being measured.
Great discussion! In agreement to many comments, I do think it is important to note WIC participants are required to receive nutrition education while other supplement programs do not. This is just another component that makes WIC a unique supplemental program and may alter the consumption habits of participants, but perhaps not the reliability of the FFQ..
I think that it is reasonable to hypothesize that the FFQ’s accuracy would be reduced when participants are not limited in the foods supplemented to them. The WIC program participants may be more likely to have greater consistency in their item purchases due to limited selections, therefore making the task of indicating food frequencies less strenuous. I hypothesize that more variety in one’s diet would require more time and effort put into the FFQ to ensure accuracy. Consequently, when individuals with unlimited food restraints fail to put in the extra time and effort into the FFQ's, the result could be less accurate FFQs. Research comparing FFQ's of SNAP and WIC children of similar ages would be very interesting!
Holly, you made an interesting point about how receiving WIC assistance could limit the choices of children’s food/beverage options, resulting in an increased consumption of a limited number of items. I agree with you, that if this is the case, the child’s resulting narrow “regular” eating pattern would result in the FFQ testing as more reliable and valid in this population. Consequently a follow-up study would need to address this point to insure the accuracy of this study’s findings.
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