Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health



First Committee Member

Dr. Shinobu Watanabe-Galloway

Second Committee Member

Dr. Debora Barnes-Josiah

Third Committee Member

Dr. Melissa Tibbits

Fourth Committee Member

Ms. Peggy Trouba


Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program provides supplemental foods, health care referrals, and nutrition education to low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children. Preterm birth remains the second leading cause of infant mortality following birth defects but there is a dearth of research on characteristics of WIC clients who are at risk of preterm birth. Objectives: The objective of the service learning was to design paper and online client satisfaction survey forms in English and Spanish for use by the Nebraska WIC program. The objective of the capstone was to identify factors related to preterm birth among WIC clients. Methods: This was a cross-sectional study of 8,714 WIC clients who gave birth in 2016. Chi square tests and multivariate logistic regression were performed to identify factors associated with preterm birth. Results: The client satisfaction survey included 34 closed- and open-ended questions on five topics - WIC services, WIC checks, WIC approved foods and stores, nutrition education and breastfeeding, and “you and your family”. The online surveys were created in RedCap. So far, there are 3,703 clients who have responded to the paper and online surveys. The multivariate logistic regression analysis showed that older age (≥40 years vs. 20 -29 years) (OR=3.57; 95% CI: 2.19-5.79), multifetal pregnancies (OR 0.09; 95%CI), and maternal underweight compared to normal weight (OR=3.00, 95% CI 1.23- 7.29) were associated with higher odds of preterm births. Conclusion: Clients who are older, with a multiple fetal pregnancy, and who are underweight may need additional or tailored services to reduce the risk of preterm birth. The current study was limited to information available in the WIC database. To better understand characteristics of women who are at higher risk for preterm birth and other negative birth outcomes additional information including smoking status and other risk behaviors should be collected and analyzed.

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