Observations and Conversations: Home Preparation of Infant Formula Among a Sample of Low-Income Mothers in the Southeastern US.

OBJECTIVE: Explore infant formula preparation attitudes and beliefs among low-income, formula-feeding, Southeastern US mothers. DESIGN: Cross-sectional study using in-home observations and in-depth interviews. SETTING: Participant homes. PARTICIPANTS: Thirteen low-income mothers of normal birth weight, healthy, term infants aged ≤3 months, who were predominantly feeding powdered or from-concentrate formula. VARIABLES MEASURED: Reading formula preparation instructions; order of added ingredients; leveling powdered formula scoop(s); adding cereal or other ingredients to bottles. PHENOMENON OF INTEREST: Perceptions of formula preparation or manipulation. ANALYSIS: Descriptive statistics described sample characteristics and home observation variables. Thematic analysis of in-depth interviews revealed the following major themes: formula preparation can be intimidating; expressions of complex heuristic perceptions about formula preparation; cost and convenience motivate maternal behaviors; and infant cues override recommendations. Data from qualitative and quantitative activities were triangulated. RESULTS: Behaviors, including improper reconstitution and modifications/additions to prepared formula (eg, infant cereal) were observed during home observations and/or described during in-depth interviews. Inconsistencies were detected between observed behaviors (eg, adding too much water to the bottle) and those reported during in-depth interviews (eg, stating over-dilution could be detrimental to the infant's health). CONCLUSIONS AND IMPLICATIONS: Targeting knowledge or skills gaps and behavioral motivators in the formula-feeding population could positively affect infant-feeding practices that occur outside of recommendations.

EFNEP: a nutrition education program that demonstrates cost-benefit.

OBJECTIVE: Data on the economic value of nutrition education programs, such as the Expanded Food and Nutrition Education Program (EFNEP), can help decision makers choose among alternative programs based on costs and benefits. A cost-benefit analysis of EFNEP was conducted to determine if participants' savings in food expenditures exceeded program implementation costs. DESIGN/SUBJECTS: Costs were collected over 6 months using expenditure reports and other records. Benefits were determined using prospective data from 371 women enrolled in EFNEP who completed a 24-hour food recall and behavior survey, and recorded the amount of money spent monthly on food at program entry and exit. Two treatment groups received nutrition education and one group did not receive education. One treatment group estimated food expenditures from recall and the other collected register receipts or recorded expenditures. Control group subjects reported expenditures from recall. Net present value (NPV) was calculated using mean EFNEP cost per participant subtracted from the mean change in family food expenditures per participant over a 5-year period at three discount rates. STATISTICAL ANALYSES: Analysis was designed to compare food expenditures among the two experimental groups and control group and food and nutrient intakes and survey scores between the combined experimental group and control group. RESULTS: The average EFNEP program cost perparticipant was $388, and graduating participants reported that family food expenditures decreased on average by $10 to $20 per month or $124 to $234 over a year. When benefits were projected to last 5 years, the NPV was $147 to $696 depending on the method of food expenditure estimation and the discount rate. At the same time individuals reduced food expenditures, they increased intakes of iron, vitamin C, vitamin B-6, and fiber. They added less salt when cooking and read nutrition labels more often. They also reported not running out of food at the end of the month as often. APPLICATIONS/CONCLUSIONS: Findings from this research showed that EFNEP is cost-beneficial. The magnitude of the savings in food expenditures is sensitive to the method of food expenditure reporting and assumptions about how long participants will retain the behaviors they learn.