Development and testing of a nutrition, food safety, and physical activity checklist for EFNEP and FSNE adult programs.

OBJECTIVE: To develop and assess reliability and validity of the Nutrition, Food Safety, and Physical Activity Checklist to measure nutrition, food safety, and physical activity practices among adult Expanded Food and Nutrition Education Program (EFNEP) and Food Stamp Nutrition Education program (FSNE) participants. METHODS: Test-retest reliability (Cronbach alpha), internal consistency (Pearson Correlation), criterion-related validity (Spearman Correlation Coefficients), and sensitivity-to-change, were calculated for dietary quality, food safety, and physical activity, based on data collected from 73 EFNEP and FSNE participants. RESULTS: Nutrition and physical activity domains achieved reliability coefficients of 0.70. The instrument scored Spearman correlation coefficients of 0.20 for nutrition, 0.34 for food safety, and 0.28 for physical activity. CONCLUSIONS AND IMPLICATIONS: The instrument consistently measured dietary and physical activity practices, but not food safety. All domains obtained low correlation coefficients, although consistent with other studies' validity results.

A logic model framework for community nutrition education.

Logic models are a practical method for systematically collecting impact data for community nutrition efforts, such as the Food Stamp Nutrition Education program. This report describes the process used to develop and test the Community Nutrition Education Logic Model and the results of a pilot study to determine whether national evaluation data could be captured without losing flexibility of programming and evaluation at the state level. The objectives were to develop an evaluation framework based on the Logic Model to include dietary quality, food safety, food security, and shopping behavior/food resource management and to develop a training mechanism for use. The portability feature of the model should allow application to a variety of community education programs.

Characteristics of low-income African-American and Caucasian adults that are important in self-management of type 2 diabetes.

Incidence of type 2 diabetes has greatly increased in the US, with over 90 percent having type 2. A cross-sectional, self-report survey was conducted for the purpose of assessing characteristics associated with self-management of type 2 diabetes (attitudes, certain behaviors, and perceived knowledge) among low-income Caucasian and African-American adults enrolled in the Food Stamp Nutrition Education Program (FSNEP). At the time of the study, almost 11 percent of FSNEP adult participants (457 individuals) throughout the state had type 2 diabetes. Among 196 subjects interviewed for the study, 86 were Caucasian (44%) and 100 (51%) were African-American. Results indicated that over three-fourths of subjects had been counseled on diet and exercise, but less that half were following dietary recommendations and only one-fourth were getting adequate exercise. No significant differences were found between the two race groups on assessed characteristics or among subjects grouped by place of residence (p < or = 0.01). Significant correlations were found among subjects' characteristics, including perceived health status, perceived knowledge of diabetes, attitudes towards diabetes, meal-plan adherence, perceived barriers to physical activity, and reported diabetes control (p < or = 0.0001). Findings imply that (a) self-management education for type 2 diabetes does not need to be different for African-Americans vs. Caucasians in southern states and (b) best disease control is achieved when those with type 2 diabetes have a high degree of knowledge of diabetes, positive attitudes, good meal plan adherence, and few perceived barriers to physical activity.

A video lesson series is effective in changing the dietary intakes and food-related behaviors of low-income homemakers.

OBJECTIVE: To examine the relative cost-effectiveness of a self-administered video series in delivering nutrition education to low-income homemakers. DESIGN: A quasi-experimental design was used, with subjects randomly assigned to traditional lessons (Traditional Group) or video lessons (Video Group). SUBJECTS/SETTING: 108 subjects were recruited, with 93 nonpregnant, low-income, female homemakers completing the study (response rate = 86%). Subjects had recently enrolled in the Expanded Food and Nutrition Education Program, or the Food Stamp Nutrition Education Program, and had a videocassette recorder and telephone. INTERVENTION: Both groups received 12 lessons from the Eating Right Is Basic Series, 3rd edition, with the Traditional Group being taught in face-to-face sessions and the Video Group receiving self-administered, video-lesson packets. OUTCOME MEASURES: Dietary intake and food behaviors were assessed at pre and post intervention with 24-hour recalls and a 14-item checklist. STATISTICAL ANALYSES: Chi(2) and t tests were used to compare the groups on demographics and pre-intervention dietary factors. Multiple analysis of variance was used for comparisons of change from pre to post intervention. RESULTS: Significant improvements were observed in both groups for fruits, calcium, and vitamins A and C. The Video Group improved on fiber intake (P

Cost-benefit analysis indicates the positive economic benefits of the Expanded Food and Nutrition Education Program related to chronic disease prevention.

OBJECTIVE: To provide an estimated cost-benefit ratio for the Expanded Food and Nutrition Education Program (EFNEP), based on potential prevention of diet-related chronic diseases and conditions. DESIGN: A retrospective cost-benefit study using demographic, food/nutrient intake, and food-related behavioral data previously collected on program participants by trained paraprofessionals, before and after an intervention. Actual costs of implementing EFNEP for 1 year (1996) were also used. SUBJECTS/SETTINGS: 3100 female and male adults who had participated in the Virginia EFNEP during 1996. INTERVENTION: Prior participation in 6 to 12 food/nutrition education lessons with subsequent graduation from EFNEP. MAIN OUTCOME MEASURES: Cost-benefit ratios for EFNEP, based on original assumptions and subsequent sensitivity analyses. STATISTICAL ANALYSIS: Program implementation costs were compiled and compared with monetized benefits of disease prevention to produce benefit-to-cost ratios. Excel and SPSS computer programs were used to compute cost-benefit ratios based on standard procedures used in the field of economics. RESULTS: The initial benefit-to-cost ratio was $10.64/$1.00, with subsequent sensitivity analyses producing ratios ranging from $2.66/1.00 to $17.04/1.00. IMPLICATIONS: The results of EFNEP intervention translate into a positive cost-benefit based on potential prevention of diet-related chronic diseases and conditions. Thus, EFNEP is a good use of federal tax dollars.