Food Resource Management Mediates the Relationship Between Participation in a SNAP-Ed Nutrition Education Program and Diet Quality

ObjectiveTo examine the mediating effects of food resource management skills (FRM) on the relationship between participation in a Supplemental Nutrition Assistance Program Education (SNAP-Ed) nutrition education program and diet quality.DesignSecondary analysis of data from a propensity score-matched sample of participants (n = 396) and nonparticipants (n = 111) in a SNAP-Ed nutrition education program.AnalysisIndependent-samples t tests were used to compare entry, exit, and gain scores in FRM and diet quality between participants and nonparticipants. Structural equation modeling was used to examine direct and mediated relationships among participation, FRM, and diet quality.Main Outcome MeasuresFood resource management was measured as a summated rating scale, and diet quality measured as Healthy Eating Index and program participation.ResultsMediated effect of FRM on the relationship between participation in a SNAP-Ed program and diet quality was statistically significant (P < 0.01). The effect size for the mediation effect indicated that about 70% of program participation on diet quality was transferred by FRM skills. The hypothesized model had acceptable fit indices as model χ² was nonsignificant (P = 0.31), all fit indices were above 0.9, and the root mean square of error approximation was low at 0.02.Conclusions and ImplicationsParticipation in a SNAP-Ed program enhanced participants’ FRM, which in turn enhanced their diet quality.     

Design and Implementation of a 5-Year School-Based Nutrition Education Intervention

ObjectiveTo describe the research methods of a multicomponent nutrition education program empowering teachers to improve nutrition literacy and prevent obesity among elementary school students.DesignProspective 5-year study following a pre-post intervention design.SettingFour elementary schools in a high-needs area in Washington, DC: 2 intervention and 2 comparison schools.ParticipantsApproximately 100 teachers (25/school) and 800 students (200/school) enrolled over the study period.InterventionHealthy Schoolhouse 2.0 will engage teachers as agents of change by designing, implementing, and evaluating a structured professional development program to support the integration of nutrition concepts in the classroom.Main Outcome MeasuresChange in pre-post survey assessment of students’ nutrition literacy, attitudes, and intent; change in teachers’ self-efficacy toward teaching nutrition; fruit and vegetable consumption data collected 6 times/y in the cafeteria.AnalysisProcess evaluation throughout the study to document implementation and challenges. Multilevel mixed modeling will be used to determine the impact of the intervention.     

A Supplemental Produce and eLearning Nutrition Education Program for Georgians Who Use Safety-Net Clinics for Their Health Care

ObjectiveTo explore the experiences of safety-net clinic patients who engaged in a 12-week supplemental produce and eLearning nutrition education program.MethodsThis mixed-method study employed a nonrandomized comparison study design. Participants (intervention [n = 20] and comparison control [n = 6]) had diet-related chronic diseases. Data collection included pre- and post-intervention, focus group interviews, 24-hour diet recalls, and clinical and anthropometric outcome assessments. Interviews were recorded, transcribed, and coded using the constant comparison method. Nonparametric data analyses were conducted for quantitative data.ResultsThree primary themes emerged: (1) program benefits, (2) challenges to achieving health benefits and optimal engagement of the program, and (3) recommendations for program improvement. Quantitative data analysis did not show significant differences in pre- and post-clinical and anthropometric measures between the intervention and comparison groups.Conclusions and ImplicationsFindings suggest a unique Supplemental Nutrition Assistance Program Education dissemination model that may decrease barriers to healthful eating and increase engagement in eLearning nutrition education.     

Nutrition Environment at Food Pantries Improves After Fresh Produce Donation Program

ObjectiveTo evaluate the influence of the Growing Together Illinois fresh produce donation program and understand factors that affect produce distribution at participating food pantries.MethodsIn this intervention at 17 Illinois food pantries, Master Gardeners supported food donation gardens, and Supplemental Nutrition Assistance Program Education provided educational and environmental interventions to increase selection and use of fresh produce. This mixed-methods pre-post study assessed pantry characteristics and program impact via Nutrition Environment Food Pantry Assessment Tool evaluations, interview feedback from pantry staff, and structured pantry observations.ResultsPantries experienced significant increases from preintervention to postintervention in providing various types of produce, marketing and nudging healthful products, providing additional resources, and total Nutrition Environment Food Pantry Assessment Tool scores. Participants had positive feedback about the program and educational interventions and reported the weekly timing of donations mitigated potential storage and spoilage issues.Conclusions and ImplicationsFuture research could focus on approaches to increase fresh produce in food pantries while supporting clients via nutrition and cooking education.     

Papás Saludables,Niños Saludables: Perspectives From Hispanic Parents and Children in a Culturally Adapted Father-Focused Obesity Program

ObjectiveQualitatively assess culturally adapted lifestyle intervention, Papás Saludables, Niños Saludables (PSNS; Healthy Dads, Healthy Kids), for Hispanic fathers and children.MethodsSemistructured interviews of parents and children after participation in 10-week PSNS program for Hispanic fathers and children. Qualitative data double-coded inductively and deductively until consensus reached.ResultsTotal of 26 fathers, 26 mothers, and 45 children interviewed. Parents and children had positive feedback about program content on culturally relevant nutrition and physical activity and reported improved father-child bonding. Mothers noted increased involvement among fathers in child's well-being. Participants suggested lengthening the program.Conclusions and ImplicationsPapás Saludables, Niños Saludables is an innovative approach with promise in engaging Hispanic fathers and children in a lifestyle program that emphasizes the role of fathers in children's lifestyle behaviors. Familism, respeto (respect), and promoting father-child relationships were important to engage fathers. Results from this study will inform future trials of PSNS and help identify ways to increase engagement of Hispanic men in other programs.     

Assessing Foods and Nutrition Competencies in Youth

ObjectiveTo develop a comprehensive assessment of foods and nutrition competencies with robust psychometric properties for the 4-H Foods and Nutrition Project.DesignThe Assessment of Foods and Nutrition Competencies in Adolescents was developed through a systematic measurement development process by a group of researchers, practitioners, and program alumni familiar with the theory of change and implementation procedures of the 4-H Foods and Nutrition Project.SettingRecruitment was conducted through the 4-H Online membership management program for 4-H members throughout Texas to complete online survey questions.ParticipantsFour hundred twenty-four Texas 4-H members in grades 6–12.Variables MeasuredSurvey items addressing 6 specific foods and nutrition competencies dimensions.AnalysisA series of reliability and confirmatory factor analyses were conducted to assess the psychometric qualities of Assessment of Foods and Nutrition Competencies in Adolescents.ResultsAssessment of Foods and Nutrition Competencies in Adolescents was found to possess good factor structure, reliability, validity, and measurement invariance. Program participants showed an advantage over nonparticipants in most core foods and nutrition competencies concerning positive behavioral changes.Conclusions and ImplicationsAssessment of Foods and Nutrition Competencies in Adolescents comprehensively captures the core competencies promoted by the 4-H Foods and Nutrition Project and possesses the psychometric qualities critical for program evaluation. A more diversity-focused outreach effort is needed for inclusive youth programs like the 4-H Foods and Nutrition Project to benefit the general youth population.     

Identification of a Framework for Best Practices in Nutrition Education for Low-Income Audiences

To promote effective low-income nutrition education programs, an expert panel of nutrition education and public health researchers built consensus around 28 best practices grouped into 5 domains (Program Design, Program Delivery, Educator Characteristics, Educator Training, and Evaluation) targeting direct delivery of nutrition education. These best practices can be used to assess program strengths, promote fidelity in delivery and evaluation, and design research to strengthen programs’ evidence base. A survey of Supplemental Nutrition Assistance Program–Education nutrition education leaders helped identify staff development needs and interest relative to specific best practices. Best practices can be used to identify staff development needs among frontline educators, supervisors, and program leaders in Supplemental Nutrition Assistance Program–Education, Expanded Food and Nutrition Education Program, and other programs targeting low-income audiences.     

Nutrition Literacy Tailored Interventions May Improve Diet Behaviors in Outpatient Nutrition Clinics

ObjectivesNutrition literacy examines the intersection of nutrition knowledge and skills; however, no evidence shows interventions tailored to nutrition literacy deficits affect diet behaviors. This study examined the effects of nutrition interventions tailored to individual nutrition literacy deficits on improving diet-related behaviors.MethodsFive outpatient clinics were randomized to 2 arms. The nutrition literacy and diet behaviors of patients were assessed before intervention with a dietitian and again 1 month later. Intervention-arm dietitians received patient nutrition literacy levels and tailored interventions toward nutrition literacy weaknesses. Differences in diet behaviors between arms were analyzed using Mann-Whitney U-tests and within-arms using Wilcoxon signed-rank tests.ResultsIntervention-arm patients improved 10 of 25 measured diet behaviors; control-arm patients improved 6 behaviors. Similarly, intervention-arm patients reported increased green vegetable consumption from baseline to follow-up (z = 2.00; P = 0.04).Conclusions and ImplicationsNutrition interventions tailored toward nutrition literacy deficits may play an important role in improving patient diet behaviors.     

Use of Survival Analysis to Predict Attrition Among Women Participating in Longitudinal Community-Based Nutrition Research

ObjectiveTo identify participant characteristics and study methodology that influenced the completion of a 15-month community-based longitudinal study evaluating the impact of the Supplemental Nutrition Assistance Program Education and Expanded Food and Nutrition Education Program.DesignObservational longitudinal 15-month study across 12 data collection timepoints. Sociodemographic characteristics were collected with a paper-based survey at baseline.SettingFive counties across central and southern Illinois.ParticipantsWomen, aged 18 to 65 years (n = 297), recruited at sites likely to serve families eligible for the Supplemental Nutrition Assistance Program Education and Expanded Food and Nutrition Education Program (housing departments, child care centers, etc).Main Outcome MeasuresPredictors of participant attrition during the study duration.AnalysisCox proportional hazard models.ResultsNinety-seven participants were retained across the full study. In unadjusted models, greater income and education levels were significantly related to lower attrition; however, this relationship did not persist in a multivariate model. When adjusted for other characteristics, larger household size was the only measured variable significantly related to greater odds of attrition (odds ratio = 1.09; 95% confidence interval = 1.02, 1.17).Conclusions and ImplicationsSeveral characteristics predicting attrition in other settings were not significant in this study. Future attrition analyses that evaluate social support, transportation capacity, and type of phone in longitudinal nutrition education studies are warranted.     

The Shaping Healthy Choices Program: Design and Implementation Methodologies for a Multicomponent,School-Based Nutrition Education Intervention

ObjectiveTo provide a framework for implementation of multicomponent, school-based nutrition interventions. This article describes the research methods for the Shaping Healthy Choices Program, a model to improve nutrition and health-related knowledge and behaviors among school-aged children.DesignLongitudinal, pretest/posttest, randomized, controlled intervention.SettingFour elementary schools in California.ParticipantsFourth-grade students at intervention (n = 252) and control (n = 238) schools and their parents and teachers. Power analyses demonstrate that a minimum of 159 students per group will be needed to achieve sufficient power. The sample size was determined using the variables of nutrition knowledge, vegetable preference score, and body mass index percentile.InterventionA multicomponent school-based nutrition education intervention over 1 academic year, followed by activities to support sustainability of the program.Main Outcome MeasuresDietary and nutrition knowledge and behavior, critical thinking skills, healthy food preferences and consumption, and physical activity will be measured using a nutrition knowledge questionnaire, a food frequency questionnaire, a vegetable preferences assessment tool, the Test of Basic Science Process Skills, digital photography of plate waste, PolarActive accelerometers, anthropometrics, a parent questionnaire, and the School and Community Actions for Nutrition survey.AnalysisEvaluation will include quantitative and qualitative measures. Quantitative data will use paired t, chi-square, and Mann-Whitney U tests and regression modeling using P = .05 to determine statistical significance.     

A Randomized Intervention of Supplemental Nutrition Assistance Program–Education Did Not Improve Dietary Outcomes Except for Vitamin D Among Lower-Income Women in Indiana

BackgroundThe goal of US Department of Agriculture Supplemental Nutrition Assistance Program–Education (SNAP-Ed) is to improve the likelihood that those eligible for SNAP will make healthy choices aligned with the Dietary Guidelines for Americans, 2020-2025.ObjectiveThe objective of the study was to evaluate the long-term effects of a direct SNAP-Ed intervention in which participants actively engage in learning with educator instruction about dietary quality and usual intake of key nutrient and food groups among Indiana SNAP-Ed–eligible women participants as an example sample in the context of no similar existing evaluation.DesignThe study design was a parallel-arm, randomized controlled, nutrition education intervention, with follow-up at 1 year.Participants/settingParticipants (18 years and older; n = 97 women) eligible for SNAP-Ed and interested in receiving nutrition education lessons were recruited from 31 Indiana counties from August 2015 to May 2016 and randomized to an intervention (n = 53) or control (n = 44) group.InterventionThe intervention comprised core lessons of Indiana SNAP-Ed delivered between 4 and 10 weeks after baseline assessment. Each participant completed a baseline and 1-year follow-up assessment. Dietary intake was assessed using repeated 24-hour dietary recalls (up to 2).Main outcome measuresMean usual nutrient, food group intake, diet quality (ie, Healthy Eating Index-2010 scores), and proportion of intervention and control groups meeting Dietary Guidelines for Americans, 2020-2025 recommendations and Dietary Reference Intake indicators of requirement or adequacy, were determined using the National Cancer Institute method and the simple Healthy Eating Index-2010 scoring algorithm method. Dietary changes between intervention and control groups were examined over time using mixed linear models.Statistical analyses performedBonferroni-corrected significance levels were applied to the results of the mixed linear models for comparisons of usual intake of nutrients and foods.ResultsNo differences in diet quality, intake of food group components, food group intake, or nutrients were observed at 1-year follow-up, except that vitamin D intake was higher among those who received SNAP-Ed compared with the control group.ConclusionsA direct SNAP-Ed intervention did not improve diet quality, food group intake, or key nutrient intake, except for vitamin D, among Indiana SNAP-Ed–eligible women up to 1 year after the nutrition education.     

Pilot Study of a Virtual Nutrition Intervention for Adolescents and Young Adults With Autism Spectrum Disorder

ObjectiveExamine the impact of a virtual nutrition education program, Bringing Adolescent Learners with Autism Nutrition and Culinary Education (BALANCE), on dietary intake and psychosocial determinants of healthy eating in adolescents and young adults (AYA) with autism spectrum disorder (ASD).MethodsA sample of AYA with ASD aged 12–21 years (n = 27; 6 groups of 2–7 adolescents) participated in BALANCE, a Social Cognitive Theory-based intervention, for eight 30–45-minute lessons. Outcomes were compared using a pre-post design and included dietary intake (assessed using a food frequency questionnaire) and psychosocial determinants of healthy eating (assessed by a validated survey). Wilcoxon signed-rank tests compared preintervention and postintervention medians with an alpha level of 0.05.ResultsMean added sugar intake (P = 0.026) decreased, and behavioral strategies (P = 0.010), self-efficacy (P < 0.001), and outcome expectations (P = 0.009) improved. There was no difference in fruit or vegetable intake or other psychosocial determinants.Conclusions and ImplicationsThe BALANCE intervention may improve psychosocial determinants and dietary behaviors in AYA with ASD. Future virtual programs may incorporate more assistance and support to be accessible for AYA with ASD of varying severity levels.     

SNAP-Ed Policy,Systems, and Environmental Interventions and Caregivers’ Dietary Behaviors

ObjectiveTo examine dietary behaviors and diet quality among caregivers of children regarding the number of policy, systems, and environmental (PSE) change interventions implemented in their neighborhoods.MethodsHouseholds with incomes ≤185% of the federal poverty level were randomly sampled throughout California. A validated 24-h dietary recall assessment tool was administered by telephone. The independent variable was the number of Supplemental Nutrition Assistance Program Education PSE change interventions per census tract where the caregivers lived.ResultsMost (69.1%) of the 2,222 caregivers were Latino. Policy, systems, and environmental reach predicted decreased intake of sugar-sweetened beverages (P = 0.022, Cohen d = −0.12) and added sugar (P = 0.014, Cohen d = −0.18), and increased Healthy Eating Index–2015 scores (P = 0.046, Cohen d = 0.18), regardless of race and/or ethnicity, age, or reach of Supplemental Nutrition Assistance Program Education direct education.Conclusions and ImplicationsReplication of these methods and findings, and comparisons of dietary outcomes in association with PSE change interventions with and without direct education activities aimed at the same population under study, are encouraged.     

Development of an Online Smartphone-Based eLearning Nutrition Education Program for Low-Income Individuals

The objective of this report was to describe the development process of an innovative smartphone-based electronic learning (eLearning) nutrition education program targeted to Supplemental Nutrition Assistance Program–Education–eligible individuals, entitled Food eTalk. Lessons learned from the Food eTalk development process suggest that it is critical to include all key team members from the program's inception using effective inter-team communication systems, understand the unique resources needed, budget ample time for development, and employ an iterative development and evaluation model. These lessons have implications for researchers and funding agencies in developing an innovative evidence-based eLearning nutrition education program to an increasingly technology-savvy, low-income audience.     

Long-term Student Outcomes of the Integrated Nutrition and Physical Activity Program

ObjectiveTo examine the long-term effects of the Integrated Nutrition and Physical Activity Program (INPAP), a school-based nutrition education program.DesignQuasi-experimental design comparing intervention and comparison cohorts at 3–6 years after delivery of the INPAP intervention on nutrition- and physical activity–related outcomes.SettingThis study was conducted in 1 school district in a low-income rural county of ～15,000 residents in south-central Colorado.ParticipantsIn second grade, intervention and comparison cohorts included 173 (fall 2000) and 190 (fall 1999) students, respectively. Approximately 60% of these students completed assessments in eighth grade.InterventionsINPAP is an experiential school-based nutrition education program, grounded in social cognitive theory and Piaget's cognitive development theory and adapted for use in a rural setting.OutcomesNutrition and physical activity knowledge, self-efficacy, attitudes and behaviors, body mass index.AnalysisWilcoxon signed rank test, chi-square test for proportions, and t test for means.ResultsLong-term effects were observed in nutrition-related knowledge and attitudes but not self-efficacy or behavior change. The effects that did occur were attenuated over time.Conclusion and ImplicationsThis study found that INPAP implemented in elementary school had limited lasting effects by the end of middle school, a time when students have increased autonomy to make food choices.