Redemption of Specific Categories of WIC Food Benefits and Risk of Program Discontinuation.

Importance: Longer participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is positively associated with child diet quality; yet, child WIC participation decreases with age. A lower redemption rate for the WIC food package overall has been associated with risk of program discontinuation. Objective: To assess the association between redemption of specific WIC foods and risk of program discontinuation. Design, Setting, and Participants: This retrospective cohort study used WIC redemption data linked to administrative data from November 11, 2019, to June 30, 2023, and comprised a population-based sample of WIC participants from birth to 3 years of age in Southern California. Data were analyzed from May 22, 2024, to August 26, 2025. Exposure: Household-level redemption of WIC food benefit categories (fruits and vegetables, eggs, whole milk, cheese or tofu, 100% fruit or vegetable juice, reduced fat milk, legumes, canned fish, breakfast cereal, bread or whole grains, yogurt, infant formula, therapeutic infant formula, infant fruits and vegetables, infant cereal, and infant meats), averaged across certification periods and interval scaled in 10% increments. Main Outcomes and Measures: WIC program discontinuation was measured as a failure to complete eligibility recertification following the 12-month certification period (no [certified, any food benefit issuance in 2 months postcertification] compared with yes [discontinued, no food benefit issuance in 2 months postcertification]). Results: The sample included 188 368 participants (50.9% male; 46.9% aged 0-12 months at baseline; mean [SD], 1.5 years [1.2 years]). The most redeemed (≥70% redemption rate) WIC foods were infant formula (86.0%), fruits and vegetables (69.6%), eggs (67.1%), and whole milk (61.4%). Using covariate-adjusted generalized estimating equation Poisson regression, the study found that lower redemption (<70% vs 70%-100%) of fruits and vegetables, eggs, infant formula, or whole milk was associated with risk of higher program discontinuation, following a somewhat linear fashion, particularly among children younger than 2 years. For example, redeeming less than 10%, 10% to less than 20%, 20% to less than 30%, 30% to less than 40%, 40% to less than 50%, 50% to less than 60%, and 60% to less than 70% of WIC fruit and vegetable benefits was associated with a risk of program discontinuation that was 2.08 (95% CI, 2.01-2.14), 1.77 (95% CI, 1.71-1.83), 1.73 (95% CI, 1.67-1.78), 1.54 (95% CI, 1.50-1.59), 1.48 (95% CI, 1.44-1.52), 1.37 (95% CI, 1.33-1.41), and 1.24 (95% CI, 1.21-1.27) times higher, respectively, compared with redeeming 70% to 100% of fruit and vegetables issued benefits. Conclusions and Relevance: In this cohort study of WIC participants, findings suggest that understanding the redemption patterns of participants' most highly valued foods could assist in identifying children at risk for program discontinuation, information that is crucial for maintaining WIC participation and maximizing positive nutritional outcomes of longer WIC participation.