Matthew M. Lee

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) improves health for young children with low household incomes, but it is underutilized after infancy due to program complexity and lower perceived value of benefits for participants aged 1 to 4 years. Increasing participants’ retention in WIC could be an important strategy for improving the health of young children. To evaluate whether policies making WIC easier to use and increasing benefit value were associated with increased retention of participants postinfancy. This repeated cross-sectional experiment used interrupted time series analysis of Massachusetts participants in WIC younger than 4 years enrolled between January 2017 and December 2022. Analyses were conducted in between June 2024 and April 2025. Two policy changes: (1) the introduction of remote WIC services (March 2020) and (2) an increased cash-value benefit for fruits and vegetables, or cash value benefit (June 2021). Monthly likelihood of postinfancy retention in WIC for children, calculated by counting all children younger than 4 years with active WIC certifications each month and dividing by the total number of children who had been certified as infants and stratifying by child age. The secondary outcome was the likelihood of retention plus redeeming any food package benefits. There were 238 482 WIC-participating children across the study period. In the baseline year (105 782 children), the mean (SD) age was 17.0 (14.0) months, half the sample were female (52 505 [50%]). After remote services were implemented, a previously downward monthly trend in retention reversed, steadily increasing each month afterwards, by 1.04 percentage points (pp) (95% CI, 0.48-1.60 pp) for children aged 12 to 23 months, 1.47 pp (95% CI, 1.06-1.87 pp) for children aged 24 to 35 months, and 1.25 pp (95% CI, 0.79-1.72 pp) for children aged 36 to 47 months. The increased cash value benefit (June 2021) was not associated with changes in retention trends overall, but was associated with immediate increases in the likelihood of retention plus benefit usage among children aged 12 to 23 months and 24 to 35 months. In this repeated cross-sectional study, making remote WIC services available was associated with more children staying enrolled. Policy efforts to make remote service options permanent may support WIC utilization.

The United States remains the only high-income nation without a national paid family leave (PFL) policy. It also has persistently high maternal and infant mortality rates. Understanding PFL impacts on perinatal health is critical. We determined the impact of state PFL policies on perinatal health, with additional focus on socioeconomic disparities. We analyzed live singleton births using 2016 to 2022 birth certificate data (N = 11 452 411). We conducted a quasi-experimental analysis using heterogeneity-robust differences in differences, comparing pre-post trends in a comprehensive set of perinatal outcomes in jurisdictions with (Connecticut; Washington, DC; Massachusetts; New York; and Washington) and non-South states without PFL. Analyses were additionally stratified by maternal race and ethnicity, education, insurance, and Special Supplemental Nutrition Program for Women, Infants, and Children participation and adjusted for individual- and state-level time-varying covariates. Hypertensive disorders of pregnancy risk decreased by 13% following PFL implementation, as did excess gestational weight gain. PFL implementation was associated with modest increases in small for gestational age (0.290 percentage points [pp]; 95% CI, −0.300 to −0.102), preterm birth (0.590 pp; 95% CI, 0.465–0.715), and lower mean birthweight (−5.205 g; 95% CI, −7.096 to −3.314). Socioeconomically disadvantaged subgroups saw higher risks of adverse birth outcomes but improved maternal outcomes. This study adds to prior research that found that PFL is associated with improvements in parental health and breastfeeding in the United States. Our findings suggest that state PFL policies had mixed impacts on perinatal health; further investigation of policy parameters and mechanisms is warranted.

Objectives. To estimate changes in sugar-sweetened beverage (SSB) and water consumption 3 years after an SSB tax in Berkeley, California, relative to unexposed comparison neighborhoods. Methods. Data came from repeated annual cross-sectional beverage frequency questionnaires from 2014 to 2017 in demographically diverse Berkeley (n = 1513) and comparison (San Francisco and Oakland; n = 3712) neighborhoods. Pretax consumption (2014) was compared with a weighted average of 3 years of posttax consumption. Results. At baseline, SSBs were consumed 1.25 times per day (95% confidence interval [CI] = 1.00, 1.50) in Berkeley and 1.27 times per day (95% CI = 1.13, 1.42) in comparison city neighborhoods. When we adjusted for covariates, consumption in Berkeley declined by 0.55 times per day (95% CI = −0.75, −0.35) for SSBs and increased by 1.02 times per day (95% CI = 0.54, 1.50) for water. Changes in consumption in Berkeley were significantly different from those in the comparison group, which saw no significant changes. Conclusions. Reductions in SSB consumption were sustained in demographically diverse Berkeley neighborhoods over the first 3 years of an SSB tax, relative to comparison cities. These persistent, longer-term reductions in SSB consumption suggest that SSB taxes are an effective policy option for jurisdictions focused on improving public health.