The information in this Story from the Field is intended only to provide educational information.

In this story from the field, partners in Oklahoma worked with the CHOICES Team to see what would happen if they took actions in the Special Supplemental Program for Women, Infants, and Children (WIC) in Oklahoma that could help families reduce the time their young children spent watching TV, where they are frequently exposed to ads for unhealthy foods.

Identifying Priorities in Oklahoma

In 2014, Oklahoma Governor Mary Fallin requested a plan for using data and evidence to inform public health decision-making and minimize costs. Leaders from the state health and human services agencies came together and prioritized obesity as the most important issue to address.1

The Oklahoma State Department of Health (OSDH) and the Oklahoma Department of Human Services (OKDHS) identified the Special Supplemental Program for Women, Infants, and Children (WIC) as a key opportunity for focusing on obesity prevention because more than 40,000 Oklahoma children ages 2 to 4 (27%) participate in WIC – and nearly 15% of those children have obesity.2

Gathering Information for Action

In 2016, OSDH and OKDHS partnered with the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Project at the Harvard T.H. Chan School of Public Health’s Learning Collaborative Partnership (LCP). The CHOICES Project works with health agencies to create new evidence to inform decision-making. Using local data, state and local health agencies learn how to apply evaluations of effectiveness, reach, and cost to understand the relative cost-effectiveness of strategies to prevent and treat childhood obesity.

Strategy Selection

The Oklahoma CHOICES Team (OSDH and OKDHS) sought best-value-for-money strategies for preventing obesity among Oklahoma’s young children. The Oklahoma CHOICES Team attended a CHOICES training where they reviewed potential strategies with a strong evidence base. Limiting screen time is a recommended strategy to promote healthy weight among children.

The Intervention

In this scenario, WIC clinic staff would need to ask caregivers how much screen time their children view and talk with them about how to reduce that time. Prior research has shown this method to be effective.3 Reducing screen time can reduce the risk for obesity because of decreased exposure to unhealthy foods and drinks.

The Change Needed

The Oklahoma CHOICES Team, along with the OK WIC Service Team, determined that the WIC online electronic participant record needed modification so that WIC clinic staff could ask caregivers how much screen time their children view during WIC recertification visits, and provide tailored counseling to caregivers on how to reduce that time.

An infographic titled, "How much screen time should my child get?" It outlines screen time as television, computers, video games, and hand held devices like tablets, ipads, and smart phones).

Handout created by Oklahoma WIC Service given to participants during counseling sessions


Helping Change Happen

As part of the LCP, the CHOICES Team works with local stakeholders to make projections about what may happen when a program or policy is implemented. Through this collaboration, the partners determined that these program changes could result in 149,000 Oklahoma children adopting healthy screen time behaviors over 10 years and the prevention of 660 cases of childhood obesity in the final year. For every dollar spent putting this strategy into effect, $20.90 would be saved in obesity-related health care costs over 10 years. After reviewing these data and realizing how easy it would be to modify the WIC software, the Oklahoma Team decided to make the change. Screen time counseling in the Oklahoma WIC program was rolled out in 2017.

Steps Taken for Implementation

  • Modified the online system Public Health Oklahoma Client Information System (PHOCIS) to prompt WIC counselors to ask screen time question
  • Conducted staff training for WIC counselors
  • Created educational materials to use with families during counseling sessions
  • Asked participating families about their children’s screen time habits
  • Provided families the option to discuss screen time habits during the counseling session and/or to receive educational materials

Impact & Lessons Learned

Since 2017:
An infographic stating: "nearly 30,000 families received screentime guidance" and "75% are taking steps to reduce screentime."

We learned two key things: the very positive result of reducing screen time, and that this strategy was something we could not only model but implement, and we could do it fairly quickly.” – Terry Bryce, State WIC Director


  1. Oklahoma State Department of Health. Oklahoma Health 360° – Obesity Report. Retrieved from: https://www. 
  2. Communication with Oklahoma State Department of Health: WIC Service. (2017).
  3. Whaley SE, McGregor S, Jiang L, Gomez J, Harrison G, Jenks, E. A WIC-Based Intervention to Prevent Early Childhood Overweight. J Nutr Educ Behav. 2010;42(3 Suppl):S47-51.
Suggested Citation:

CHOICES Stories from the Field: Oklahoma Takes Action to Improve Child Health. Oklahoma State Department of Health & Oklahoma Department of Human Services, Oklahoma City, OK, and the CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; May 2020.

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