Ruby H. Cox

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

A Logic Model Framework for Community Nutrition Education

10.64/

Impact of a Cancer Intervention on Diet-related Cardiovascular Disease Risks of White and African-American EFNEP Clients

1.00, with subsequent sensitivity analyses producing ratios ranging from

Do Food Stamps Without Education Improve the Nutrient Intake of Recipients

2.66/1.00 to

Food Stamp and Non-Food Stamp Program Participants Show Similarly Positive Change With Nutrition Education

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.

Need for physician referral of low-income, chronic disease patients to community nutrition education programs.

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.

Physical Activity Characteristics of Potential Participants in Nutrition and Fitness Programs Based on Stages of Change, Self‐Efficacy, and Decisional Balance

Abstract This study involved a retrospective data analysis of a previously published cancer prevention study. Diet-related cardiovascular disease (CVD) risks of white and African-American low-income women and reported changes, as a result of an educational intervention, were investigated. Participants were 150 Expanded Food and Nutrition Education Program (EFNEP) homemakers (103 African-Americans and 47 whites) who were randomly assigned to either a control or an experimental group. An 18-lesson educational series, emphasizing dietary and lifestyle changes to reduce cancer risks, was conducted with the experimental group over 6 months.Three random-repeat 24-hour dietary recalls, height, and weight were collected on participants, before and after the intervention. Recalls were analyzed on Nutritionist III to obtain average daily intakes of foods and nutrients. Preintervention comparisons between whites and African-Americans indicated that both had risks for CVD due to higher-than-recommended intakes of total fat, saturated fat, sodium, and the fats/sweets group, low intakes of protective food components, and a high prevalence of obesity. African-Americans had significantly higher intakes than whites of total and monounsaturated fat and the meat group. Based on body mass index, 40% of whites and 58% of African-Americans were moderately to morbidly obese. Changes from pre- to post-test on dietary components of experimental participants were significantly greater than those of controls for 9 of 17 nutrients/foods. Results indicate that both the white and African-American women in EFNEP had substantial diet-related CVD risks, based on self-report, and those risks were reduced by the cancer intervention program at immediate postcourse assessment.

Video Lessons are Effective in Changing Food-Related Behaviors and Intake of Low-Income Homemakers

The Food Stamp Program was created to enable low-income households to obtain a nutritious diet through normal channels of trade by increasing their food purchasing power. To assess effectiveness in achieving this objective, this study examined the effect of Food Stamps on the dietary intake of households in three Southern states, comparing dietary adequacy indicators of homemakers from Food Stamp households vs. non-Food Stamp households. Findings from this study suggest relatively few differences in intake of food groups and selected nutrients between Food Stamp and non-Food Stamp households. Food Stamp recipients enrolled in Expanded Food and Nutrition Education Program (EFNEP) typically consumed more meat and fat, but less milk than non-Food Stamp recipients. Food Stamp recipients enrolled in FSNEP typically consumed more fat and energy than non-Food Stamp recipients. This study shows that the additional resources provided by the Food Stamp Program alone may not substantially change participants’ dietary intake.

Energy and Selected Nutrient Intakes of Black and White, Obese and Non-Obese Low-Income Women

A retrospective study compared Food Stamp Program (FSP) and non-FSP participants on changes in dietary intake and food-related behaviors as a result of an educational intervention. Data were collected at preintervention and postintervention on 4121 low-income adults, using 24-hour recalls and a Food Behavior Checklist (FBC). Both FSP and non-FSP participants made significant improvements on assessed food groups, nutrients, and FBC items. Few differences were found on dietary change, but FSP participants made more improvement on 4 FBC items. Results indicate that nutrition education is similarly effective in improving dietary intake and food-related behaviors of FSP and non-FSP participants.

CHARACTERISTICS OF LOW-INCOME AFRICAN-AMERICAN AND CAUCASIAN ADULTS THAT ARE IMPORTANT IN SELF-MANAGEMENT OF TYPE 2 DIABETES

Abstract To ascertain levels of dietary counseling and propensity of primary care physicians toward referral of older low-income, chronic disease patients to community nutrition programs and the desire of such patients for dietary counseling, two surveys were conducted. An 18-item mail-out questionnaire was administered with 209 primary care physicians and another 13-item questionnaire was administered in interviews with 57 Food Stamp Nutrition Education Program (FSNEP) participants. Physicians (81%) reported providing dietary counseling, but limited referral of chronic disease patients to registered dietitians or community nutrition education programs. FSNEP participants indicated dissatisfaction with their physicians nutrition advice and a desire for more dietary guidance to manage chronic diseases.