Food Insecurity Nutrition Incentive Grant Program: Implications for the 2018 Farm Bill and Future Directions

The 2018 Farm Bill was finalized in mid-December of 2018 after months of discussion and debate between policymakers. The Farm Bill has many implications for low-income and food-insecure populations in the United States. One program within the Farm Bill that helps bridge the nutrition gap for low-income Supplemental Nutrition Assistance Program participants is the Food Insecurity Nutrition Incentive Grant Program (FINI). This commentary explores the best practices and promising findings of FINI projects to inform future policy discussions and implementation of FINI. In addition, we discuss knowledge gaps and opportunities within the context of the extant literature. Stakeholders and FINI grantees reported positive impacts of FINI grants, describing outcomes across farmers, grocery store owners, local economies, and Supplemental Nutrition Assistance Program participants (eg, increased fruit and vegetable consumption). The 2018 Farm Bill was largely in alignment with the Academy's recommendations, and preserved the integrity of the Supplemental Nutrition Assistance Program as well as increased funding for FINI.     

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.     

Developing an online certification program for nutrition education assistants

ObjectiveTo develop an online certification program for nutrition education paraprofessionals to increase knowledge and confidence and to overcome training barriers of programming time and travel expenses.DesignAn online interactive certification course based on Supplemental Nutrition Assistance Program-Education and Expanded Food and Nutrition Education Program core competencies was delivered to employees of both programs. Traditional vs online training was compared. Course content validity was determined through expert review by registered dietitians. Parameters studied included increase of nutrition knowledge and teaching technique/ability, educator satisfaction, and programming costs related to training.SettingUtah State University Extension.ParticipantsTwenty-two Supplemental Nutrition Assistance Program-Education and Expanded Food and Nutrition Education Program educators in Utah.Main Outcome MeasuresKnowledge and skills were measured using pre/posttest statistics. Participant satisfaction was measured with a survey.AnalysisPaired t test; satisfaction survey.ResultsThe change in paraprofessional knowledge score was statistically significant (P < .001). Forty percent of paraprofessionals strongly agreed and 60% agreed they were better prepared as nutrition educators because of the training. An estimated $16,000 was saved by providing the training online as compared to a face-to-face training.Conclusions and ImplicationsThis interactive online program is a cost-effective way to increase paraprofessional knowledge and job satisfaction.     

Training Needs of Nutrition Educators Engaged in Policy,Systems, and Environmental Approaches

ObjectiveAssess training needs of nutrition educators incorporating policy, systems, and environmental (PSE) approaches into their obesity prevention efforts, to identify content for online training.MethodsConducted a national, online survey of state and local Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program Education professionals engaged in PSE efforts.ResultsRespondents (n = 601) rated the importance of 24 training topics related to planning, implementing, and evaluating PSE approaches. Most (21) topics were rated very important or essential, confirming the need for a comprehensive approach. Paired-sample t tests found significant differences (P <0.001) in some training needs between local and state staff (eg, training in evaluation rated higher for state staff). Training needs did not differ by program, region, or length of employment. The top 5 settings for PSE efforts were schools, farmers’ markets, food banks/pantries, community gardens, and after-school programs.Conclusions and ImplicationsResults informed the development of an online training for program implementers. Future research will be needed to assess and refine training needs further, which will evolve as nutrition educators gain more experience in PSE approaches.     

Nutrition program quality assurance through a formalized process of on-site program review

A protocol for a systematic onsite review of the Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program-Education was developed to support quality programming and ensure compliance with state guidelines and federal regulations. Onsite review of local nutrition program operations is one strategy to meet this goal. Observation and interaction with staff allow a comprehensive understanding of strengths, weaknesses, and emerging issues. This information provides managers with timely feedback to strengthen and improve all aspects of nutrition programming.     

Eat Smart,Live Strong Intervention Increases Fruit and Vegetable Consumption Among Low-Income Older Adults

This study evaluated the impact of a four-session interactive nutrition education program—Eat Smart, Live Strong (ESLS)—on the consumption of fruit and vegetables by low-income older adults. A pre–post quasi-experimental design study was conducted with a longitudinal sample of 614 low-income Supplemental Nutrition Assistance Program (SNAP) participants and those eligible for SNAP, aged 60 to 80 years, in 17 intervention and 16 comparison senior centers in Michigan. The study compared participants’ self-reports of their consumption of fruit and vegetables using a modified version of the University of California Cooperative Extension Food Behavior Checklist. ESLS increased participants’ average daily consumption of fruit by 0.2 cups (P < 0.05) and vegetables by 0.31 cups (P < 0.01). ESLS, a four-session, cognitive-behavioral nutrition education program is an effective curriculum for helping low-income older adults eat more fruit and vegetables.     

Assessment of low-income adults' access to technology: implications for nutrition education

ObjectiveThe main objective of this study was to investigate access and use of technologies such as the Internet among Indiana's low-income population. The secondary objective was to determine whether access and use of computers significantly differed by age, race, and/or education level.MethodsData were collected from low-income adult Supplemental Nutrition Assistance Program Education participants for a 2-year period using a cross-sectional questionnaire about access and use of technology.ResultsApproximately 50% of the total respondents (n = 1,620) indicated that they had a working computer in their home, and of those, the majority (78%) had a high-speed Internet connection. Chi-square analysis revealed that younger adults who were white and had more education were more likely to have a computer (P < .001) and Internet.Conclusions and ImplicationsThe results of this study provide evidence that using Internet-based nutrition education in a low-income population is a viable and possibly cost-effective option.     

Development of the New York State Nutrition Surveillance Program.

New York State established a Nutrition Surveillance Program (NSP) in 1984. Precedents for the program included the Pediatric Nutrition Surveillance System of the Public Health Service''s Centers for Disease Control and Prevention and periodic food and nutrition surveys conducted by the National Center for Health Statistics and the Human Nutrition Information Service, Department of Agriculture. The first phase of NSP was connected to a new program, the Supplemental Nutrition Assistance Program (SNAP), which established support for more than 1,000 emergency food programs across the State. SNAP also expanded the home delivered meal program for the frail elderly and the Special Supplemental Food Program for Women, Infants, and Children. NSP provided information on the extent of unmet nutrition needs that was used to establish funding requests and provided data describing the characteristics of SNAP participants that were used in developing new SNAP program components. The second phase of NSP began in 1988. It identified populations that were thought to be at nutrition risk and compiled information about the extent of unmet need, the characteristics of the population, and the status of current nutrition programs to meet the needs. As a result of this review, NSP added a nutrition component to the Dental Survey of School Children; conducted a dietary survey; developed an inventory of information sources in all State agencies; and established an annual work plan using department of health objectives. The third phase of NSP is the policy and planning phase, monitoring the Year 2000 Objectives and the Five-Year Plan of the New York State Food and Nutrition Policy Council.     

Leaders' Experiences in Planning,Implementing, and Evaluating Complex Public Health Nutrition Interventions

ObjectiveTo explore California local health department leaders’ experiences planning, implementing, and evaluating nutrition promotion and obesity prevention programs for low-income families.DesignQualitative, cross-sectional study using semi-structured in-depth interviews and panel interviews conducted in 2015–2016.SettingCalifornia local health departments (LHDs) funded by the California Department of Public Health to implement Supplemental Nutrition Assistance Program–Education (SNAP-Ed).ParticipantsThe authors recruited SNAP-Ed leaders from all 58 California LHDs implementing SNAP-Ed. Leaders from 49 LHDs participated: 36 in hour-long, in-depth interviews and 13 in 1 of 3 90-minute group panel interviews.Phenomenon of InterestProcesses, facilitators, and barriers connected to delivering SNAP-Ed reported by leaders in planning, implementing, and evaluating local programs.AnalysisInterviews were transcribed, coded, and analyzed using Dedoose software.ResultsLeaders grappled with introducing, implementing, and integrating policy, systems, and environmental change interventions (PSEs). Information used to make planning decisions varied widely across LHDs. Partnership with nontraditional organizations was described as a resource- intensive, nonlinear process with recognized potential for benefit. Rural programs reported specific and different experiences compared with their urban counterparts.Conclusions and ImplicationsImplementing new, complex interventions to improve diet and activity environments and behaviors is both exciting and challenging for local leaders. They expressed a desire for additional resources and capacity building to facilitate success, particularly related to policy, systems, and environmental change programs. Attention to the specific needs of rural counties is needed.     

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.     

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.     

Hunger or Deportation: Implications of the Trump Administration's Proposed Public Charge Rule

Until recently, lawfully present noncitizens participating in the US Department of Agriculture Supplemental Nutrition Assistance Program (formerly Food Stamps) faced no immigration consequences. However, in September, 2018, the Trump Administration proposed a more expansive public charge rule in the Federal Register that would deny lawfully present noncitizens a path to citizenship if they had participated in certain federal safety net programs, including Supplemental Nutrition Assistance Program. This perspective discusses the proposed rule's implications, particularly for those with professional interests in promoting effective nutrition education and healthy behavior through research, policy, and practice among individuals who will potentially be affected.     

Food shopping practices are associated with dietary quality in low-income households

ABSTRACT Nutrition education for low-income audiences often focuses on building skills in food shopping and food resource management to help families receive the best nutrition from the resources they have available. However, empirical evidence for the effect of food shopping practice on dietary quality has been limited. This article presents new analyses from two studies that found an association between food shopping practices and diet quality. Logistic regression of data from 957 respondents from the 1996 National Food Stamp Program Survey found that food shopping practices were significantly (p 相似文献   

Family Nutrition Program Assistants' Perception of Farmers' Markets,Alternative Agricultural Practices,and Diet Quality

ObjectiveTo explore Family Nutrition Program assistants' perception of farmers' markets and alternative agricultural practices for themselves and their clients.MethodsCross-section design, survey of Virginia Expanded Food and Nutrition Education Program (NEP) and Supplemental Nutrition Assistance Program–Education Family Nutrition Program assistants (n = 52) working with limited-resource populations.ResultsTwenty-one percent to 55% of FNP assistants valued alternative agricultural practices, and only 5% to 8% of FNP assistants perceived that their clients did so. Benefits to shopping at farmers' markets included supporting local economies, and food price, quality, and safety. Barriers included lack of transportation, location/convenience, hours, and food prices. Assistants rated the benefits to shopping at farmers' markets similarly for themselves and their clients, but rated many of the barriers to shopping at farmers' markets as significantly lower (P < .05) for themselves than for their clients.Conclusions and ImplicationsFuture assistant trainings should address the connection between agriculture and health, and how to overcome barriers to shopping at farmers' markets for their clients.     

Evaluation of a Policy,Systems, and Environmental-Focused Faith-Based Health Promotion Program

ObjectiveThis study assessed the impact and lessons learned from implementing policy, systems, and environmental (PSE) changes through Faithful Families Thriving Communities (Faithful Families), a faith-based health promotion program, in 3 southern states.MethodsFaithful Families classes and PSE changes were implemented through a coordinated effort between the Expanded Food and Nutrition Education Program (EFNEP) and Supplemental Nutrition Assistance Program–Education (SNAP-Ed). Changes were measured using a faith community assessment, site reports, and annual reporting.ResultsThirteen faith communities participated in the intervention. A total of 34 PSE changes were implemented across the 3 states, affecting 11 faith communities with 4,810 members across sites.Conclusions and ImplicationsPrograms such as Faithful Families can allow EFNEP and SNAP-Ed to coordinate to implement PSE changes in community settings. However, these types of coordinated programs to support faith communities require time for relationship building and trust, adequate training, and strong support for faith-based lay leaders as they carry out this work.     

Nutrition behavior change among EFNEP participants is higher at sites that are well managed and whose front-line nutrition educators value the program

Effective programs to promote improved dietary practices among low-income families depend on the motivation and performance of front-line nutrition educators, yet little is known about the work context experienced by nutrition workers or how their perceptions of work context relate to program effectiveness. This research examined the perceived work context of nutrition educators, a multidimensional construct developed through formative research, in the Expanded Food and Nutrition Education Program (EFNEP) in New York State. We proposed that work context, program management, and program and educator characteristics would be related to program effectiveness (reported behavior change among participants). A state-wide survey of paraprofessional Community Nutrition Educators (CNEs) in 30 program sites was conducted and analyzed in relation to program monitoring data. Greater behavior change was reported by participants in sites whose CNEs gave positive ratings to the value of EFNEP (P < 0.02) and to the managerial practices of their supervisors (P < 0.001). To our knowledge, this is the first time that an association was demonstrated between perceived work context at the front lines and effectiveness of a nutrition program. Higher behavior change scores were also reported at sites in which a greater proportion of participants received individual rather than group instruction (P < 0.001). Associations between participants' reported behavior change and CNEs' perceptions of program value and program management suggest that improvements in these areas could enhance nutrition program success.     

Few Changes in Food Security and Dietary Intake From Short-term Participation in the Supplemental Nutrition Assistance Program Among Low-income Massachusetts Adults

ObjectiveTo examine whether short-term participation in the Supplemental Nutrition Assistance Program (SNAP) affects food security and dietary quality among low-income adults recruited from a Massachusetts-wide emergency food hotline.MethodsA 3-month, longitudinal study was conducted among 107 adults recruited at the time of SNAP application assistance. Outcomes included household food security (10-item US Department of Agriculture Food Security Survey Module), dietary intake (eg, grains, fruit) and diet quality (modified Alternate Healthy Eating Index). Data were analyzed using paired t tests and multivariable linear regression.ResultsSupplemental Nutrition Assistance Program participation was not associated with improved household food security over 3 months (P = .25). Compared with non-participants, SNAP participants increased refined grain intake by 1.1 serving/d (P = .02), from baseline to follow-up. No associations were observed with other foods, nutrients, or dietary quality.Conclusion and ImplicationsPolicies that simultaneously improve household food security and dietary quality should be implemented to support the health of low-income Americans participating in this crucial program.     

Food and Nutrition Board Update: What Do SNAP Allotments,Physical Fitness,and Obesity Prevention Have in Common?

The Institute of Medicine’s Food and Nutrition Board had a productive year, with important expert committee reports on the Supplemental Food Assistance Program, physical fitness, and accelerating obesity prevention efforts that provided grounding for dietary guidance and nutrition policies and programs. This summary describes Food and Nutrition Board activities, including current thinking on dietary reference intakes. The summary also highlights consensus reports on defining and measuring Supplemental Food Assistance Program benefit adequacy and on physical fitness and health outcomes in youth. In addition, current and new activities related to obesity prevention and care are addressed. What do these activities have in common? All adhere to the Institute of Medicine report model by filling gaps and by being analytical, evidence-based, and challenging.     

Current Status of Nutrition Training in Graduate Medical Education From a Survey of Residency Program Directors

Introduction: Nutrition leaders surmised graduate medical nutrition education was not well addressed because most medical and surgical specialties have insufficient resources to teach current nutrition practice. A needs assessment survey was constructed to determine resources and commitment for nutrition education from U.S. graduate medical educators to address this problem. Methods: An online survey of 36 questions was sent to 495 Accreditation Council for Graduate Medical Education (ACGME) Program Directors in anesthesia, family medicine, internal medicine, pediatrics, obstetrics/gynecology, and general surgery. Demographics, resources, and open‐ended questions were included. There was a 14% response rate (72 programs), consistent with similar studies on the topic. Results: Most (80%) of the program directors responding were from primary care programs, the rest surgical (17%) or anesthesia (3%). Program directors themselves lacked knowledge of nutrition. While some form of nutrition education was provided at 78% of programs, only 26% had a formal curriculum and physicians served as faculty at only 53%. Sixteen programs had no identifiable expert in nutrition and 10 programs stated that no nutrition training was provided. Training was variable, ranging from an hour of lecture to a month‐long rotation. Seventy‐seven percent of program directors stated that the required educational goals in nutrition were not met. The majority felt an advanced course in clinical nutrition should be required of residents now or in the future. Conclusions: Nutrition education in current graduate medical education is poor. Most programs lack the expertise or time commitment to teach a formal course but recognize the need to meet educational requirements. A broad‐based, diverse universal program is needed for training in nutrition during residency.