Degree Name

DrPH (Doctor of Public Health)

Program

Public Health

Date of Award

12-2025

Committee Chair or Co-Chairs

Bethesda O'Connell

Committee Members

Taylor Dula, Randy Byington

Abstract

Since 1974, the federal Supplemental Nutrition Program for Women, Infants, and Children (WIC) has provided healthy food resources, nutrition education, and provider referrals for families at risk for poor nutrition. Public health professionals have consistently presented evidence that WIC engagement reduces premature births and infant mortality, improves child health and development, and increases specialized care access for participants. While average monthly participation in WIC has increased since the program’s inception, trends indicate that only around half of eligible families have consistently engaged with the program since 2011. Research has linked declining WIC participation to administrative burden, citing learning, psychological, compliance, and redemption costs as barriers. Despite evidence of administrative burden’s influence on participation, operation of the program has remained unchanged since WIC’s beginning.

As the COVID-19 pandemic emerged in 2020, the need for federal food support increased as lockdowns, school closures, and job loss ensued. In response, the federal government issued waivers under the Families First Coronavirus Response Act, relaxing many administrative and redemption requirements for WIC and other food support programs. WIC participation increased nationwide, and early assessments identified that eligible families responded favorably to the programmatic changes. Even after the pandemic’s end in 2023, the federal government opted to continue selected WIC waivers through 2026 to determine if participation rates improved as administrative burden decreased. Research has focused largely on the influence of WIC waivers in larger metropolitan areas; however, limited information is available for rural or Appalachian communities, where program supports are often deemed crucial for the food security of children.

Using the Theory of Planned Behavior, this project qualitatively assessed the influence of WIC waivers on program participation across Northeast Tennessee counties. Through Aim 1 of the project, WIC administrators provided feedback through focus groups on historical program implementation and the pandemic’s influence. Through Aim 2, eligible WIC participants engaged in key informant interviews to determine whether waivers influence the attitudes, behaviors, and beliefs of families across the region. Thematic findings supported the development of WIC outreach recommendations tailored for families in this area of Central Appalachia that were shared with public health practice partners.

Document Type

Dissertation - unrestricted

Copyright

Copyright by the authors.

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