{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T19:54:49Z","timestamp":1791402889078,"version":"4.3.3"},"reference-count":34,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Pediatr Parent"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Despite the benefits of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), many eligible children remain unenrolled.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study evaluated responses to an electronic health record (EHR)\u2013embedded federal nutrition program (FNP) participation screening and WIC referral tool implemented within 8 clinics during well-child visits for children younger than 5 years of age.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Structured EHR data from July 2020 to October 2023 were extracted to summarize screening, referral acceptance, WIC enrollment outcomes, and patient demographics. Multivariable logistic regression was used to examine patient-level predictors of WIC nonenrollment at the first screening, referral acceptance, and enrollment among those accepting a referral, with analyses stratified by clinic type.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 5385 children, 51.8% (n=2785) were newborn-aged, 36.6% (n=1969) were Hispanic, and 87.8% (n=4726) were Medicaid-insured. The mean age at the initial screening was 10.7 (SD 14.2) months. Among screened patients (n=3606), 34% (n=1235) were not enrolled in WIC at the first screening. Medicaid coverage, an academic clinic setting, non-Hispanic Black or Hispanic race, and ethnicity were associated with lower odds of WIC nonenrollment. Among those not enrolled with a documented response to referral (n=819), 59% (n=488) accepted the referral. Acceptance was higher among non-Hispanic Black and Hispanic patients, newborn-aged patients, those with Medicaid coverage, and those seen in academic clinics. Among referral acceptors with follow-up (n=438), 61% (n=265) were enrolled at the last screening, with higher odds among newborn-aged patients and those in academic clinics.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n An EHR-based automated intervention can facilitate screening and referral to WIC. WIC participation at the first screening, referral acceptance, and enrollment after referral varied by sociodemographic characteristics, suggesting opportunities to improve equitable access through health care system\u2013based approaches.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/87608","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T13:20:10Z","timestamp":1778246410000},"page":"e87608-e87608","source":"Crossref","is-referenced-by-count":0,"title":["An Electronic Health Record\u2013Based Intervention to Facilitate Primary Care Referrals to the Special Supplemental Nutrition Program for Women, Infants, and Children: Retrospective Cohort Study"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0247-3664","authenticated-orcid":false,"given":"Kimberly","family":"Montez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9695-3126","authenticated-orcid":false,"given":"Melissa C","family":"Kay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2429-116X","authenticated-orcid":false,"given":"Alysha J","family":"Taxter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4921-7230","authenticated-orcid":false,"given":"Kristina H","family":"Lewis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"issue":"10","key":"R1","doi-asserted-by":"publisher","first-page":"1411","DOI":"10.7326\/M22-0604","article-title":"Maternal, infant, and child health outcomes associated with the Special Supplemental Nutrition Program for Women, Infants, and Children","volume":"175","author":"Venkataramani","journal-title":"Ann Intern Med"},{"issue":"5","key":"R2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-2841","article-title":"WIC food package changes: trends in childhood obesity prevalence","volume":"143","author":"Daepp","journal-title":"Pediatrics"},{"issue":"3","key":"R3","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1080\/13557858.2016.1263286","article-title":"Severity of household food insecurity and lifetime racial discrimination among African-American households in South Carolina","volume":"23","author":"Burke","journal-title":"Ethn Health"},{"issue":"1","key":"R4","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s10460-022-10340-3","article-title":"Redlining, racism and food access in US urban cores","volume":"40","author":"Shaker","journal-title":"Agric Human Values"},{"key":"R5","unstructured":"Kessler C Bryant A Munkacsy K et al. National- and State-Level Estimates of WIC Eligibility and Program Reach in 2023. U.S. Department of Agriculture (USDA), Food and Nutrition Service (FNS); 2025. URL: https:\/\/www.fna.usda.gov\/sites\/default\/files\/resource-files\/wic-eer2023-report.pdf [Accessed 18-08-2026]"},{"key":"R6","unstructured":"Kessler C Bryant A Munkacsy K Gray KF . National and State Level Estimates of WIC Eligibility and Program Reach in 2022. U.S. Department of Agriculture (USDA), Food and Nutrition Service (FNS), Office of Policy Support; 2024. URL: https:\/\/www.fna.usda.gov\/research\/wic\/eer\/2022 [Accessed 14-08-2026]"},{"issue":"6","key":"R7","doi-asserted-by":"publisher","first-page":"990","DOI":"10.1007\/s10900-022-01131-2","article-title":"A review of interventions to increase WIC enrollment and participation","volume":"47","author":"Davis","journal-title":"J Community Health"},{"issue":"2","key":"R8","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-053889","article-title":"Caregiver perspectives on underutilization of WIC: a qualitative study","volume":"149","author":"Gago","journal-title":"Pediatrics"},{"key":"R9","unstructured":"Henchy G . Making WIC work better: strategies to reach more women and children and strengthen benefits use. Food Research & Action Center (FRAC); 2019. URL: https:\/\/frac.org\/wp-content\/uploads\/Making-WIC-Work-Better-Full-Report.pdf [Accessed 14-08-2026]"},{"key":"R10","unstructured":"Jacobs K Adeniran O . WIC during COVID-19: participation and benefit redemption since the onset of the pandemic. Food Research & Action Center (FRAC); 2022. URL: https:\/\/frac.org\/wp-content\/uploads\/wic-during-covid-19-2022.pdf [Accessed 14-08-2026]"},{"issue":"4","key":"R11","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1001\/jamapediatrics.2023.6504","article-title":"Reducing WIC administrative burdens to promote health equity","volume":"178","author":"Agyapong","journal-title":"JAMA Pediatr"},{"issue":"4","key":"R12","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1002\/soej.12078","article-title":"Identifying the effects of WIC on food insecurity among infants and children","volume":"82","author":"Kreider","journal-title":"South Econ J"},{"issue":"5","key":"R13","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1007\/s10995-010-0616-5","article-title":"A longitudinal study of WIC participation on household food insecurity","volume":"15","author":"Metallinos-Katsaras","journal-title":"Matern Child Health J"},{"issue":"4","key":"R14","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1002\/hec.4470","article-title":"The effect of aging out of women, infants, and children on food insecurity","volume":"31","author":"Cho","journal-title":"Health Econ"},{"issue":"5","key":"R15","doi-asserted-by":"publisher","first-page":"e1431","DOI":"10.1542\/peds.2015-3301","article-title":"Promoting food security for all children","volume":"136","author":"Gitterman","journal-title":"Pediatrics"},{"key":"R16","unstructured":"Linking WIC for health equity: expanding access to WIC through horizontal integration. 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