Dietary improvement was assessed using 24-hour food recall in a sample of 180 homemakers who had completed six to 18 months of instruction in the Virginia Expanded Food and Nutrition Education Program (EFNEP) to determine whether they retained dietary improvement six to 36 months after leaving the program. These homemakers provided additional information on Perceived Educational Gains and Program Benefits received from participating in EFNEP. Family factors were explored which were believed to be related to dietary change - Family Composition, Family Resource Assistance, Household Roles and Responsibilities, Family Support, and Family Diet Control. Diet Scores increased significantly (p<.01) from program Entry to Exit; greatest increases were in average daily servings from milk and fruit-vegetable groups. Slight but significant (p<.01) regression occurred in average Diet Score and servings of milk from Exit to Follow-up. Homemakers with higher Diet Scores at program Entry had higher scores at program Exit and Follow-up, and higher Program Benefit Scores. Length of time in program was not significantly associated with Dietary Improvement or Retention. High average Educational Gain and Program Benefit Scores at Follow-up were evidence that EFNEP was successful from the perspective of homemakers served. Family Composition was not associated with Dietary Improvement. Family Support emerged as the only family measure related to diet; higher Family Support Scores were associated not only with greater Perceived Educational Gains and Program Benefits, but also with higher Diet Scores at program completion and follow-up. Results of the study confirmed the Virginia EFNEP to be effective in improving diets of homemakers and sustaining these changes, and suggested a key role for family support in influencing dietary outcome and program success from the view of participants. / Ph. D.

In 1981, President Ronald Reagan issued Executive Order 12291 which requires Federal agencies to perform benefits assessments of proposed major regulations and prohibits them from taking regulatory action unless potential benefits exceed potential costs to society. A review of welfare economics literature and applications of the CBA model to health, education, and nutrition is presented. CBA for use in the Cooperative Extension Service Expanded Food and Nutrition Education Program (EFNEP) is then systematically examined using the following criteria: 1) theoretical considerations - can the economic criterion appropriately be applied to EFNEP?; and 2) application of the CBA model - can it be made operational? Following the critique of application of CBA to EFNEP, conclusions are drawn as to the appropriate use of CBA or alternative techniques in evaluating EFNEP and similar programs. / Doctor of Philosophy

Master of Public Health / Department of Human Nutrition / Mary L. Higgins / Nutrition education programs strive to help low-income people make optimal food choices while living on a limited budget. This study addressed perceived understanding, acceptance, and usability of Food and Nutrition Bytes, a set of 12 eight- to eleven-minute online Expanded Food and Nutrition Education Program (EFNEP) lessons. Clients in EFNEP during 2005-2006 were surveyed on internet usage and interest in online nutrition lessons. Lessons were developed and assessed for reading levels using two formulas. Clients and professionals in six Kansas counties completed a Likert scale survey and gave comments after they viewed one online lesson. Fifty-five percent of 75 EFNEP clients who had internet access indicated they were interested in taking nutrition lessons online. The new lessons averaged a 6.64 grade reading level. Two lessons had content that was rated too general to be useful. For the remaining lessons, both groups ranked their perceived understanding, helpfulness of graphics and audio, and usefulness of information at the first or second most-desirable rating. They rated length and amount of information as “Just Right.” The only difference found between the groups was when clients rated one lesson as having a little too much information and professionals rated it as having not quite enough (Mann-Whitney U = 35.0, p = 0.039). Within-sample associations were measured for two lessons. Clients older than 30 years of age found the Grains lesson’s pictures and graphics to be more helpful than did younger clients (Kendall tau-b = 0.593, p = 0.002). White clients evaluated the Cooking lesson as being easier to understand than did non-white clients (Kendall tau-b = -0.477, p = 0.020). The most frequent comments pertained to the importance of portion sizes and appropriate pictures and graphics. Overall, Food and Nutrition Bytes lessons were easy to read, and perceived by both clients and professionals to be easy to understand, helpful and useful, and also optimal in length and amount of information. Despite low numbers of EFNEP clients who had internet access, over half were interested in taking lessons online. Limitations of this study include small samples, convenience samples, subjects’ time constraints, and interviewer bias.

No description available.

This study was conducted to determine the impact of nutrition edu cation on participants of the Supplemental Food Program for Women, Infants and Children (WIC) and the Expanded Food and Nutrition Education Program (EFNEP). The specific objectives were to: 1) determine the impact of participation in EFNEP on iron status as assessed by hematocrit (hct) and ferritin levels; 2) determine the effect of nutrition knowledge on hct and ferritin values; and 3) determine the effect dietary behavior has on hct and ferritin levels for both WIC and EFNEP participants. Each study participant completed a 24-hour dietary recall record plus food frequency record, medical history, validated nutrition knowledge test, and finger stick blood sample prior to program enrollment or nutrition education, and again six months later. There were 42 WIC, 26 EFNEP, 23 WIC-control, and 23 EFNEP-control participants. Paired t-tests were used to find differences between preprogram and postprogram evaluation scores for the variables of nutrition knowledge score, hematocrit level, ferritin level, and levels of several nutrients. Nutrition knowledge test scores increased significantly from preprogram to postprogram for both WIC and EFNEP participants (14.2 ± 3.27 to 15.5 ± 2.89 for WIC, 14.2 ± 3.77 to 15.6 ± 2.79 for EFNEP). EFNEP participants also increased significantly in hct levels (38.5% ± 3.78 to 40.7% ± 2.13). Hematocrit levels did not change significantly for the WIC or control groups and nutrition knowledge did not increase for the control group between preprogram and postprogram evaluations. Mean intakes of vitamin A, vitamin c, calcium, and protein were above the RDA at preprogram and postprogram evaluations, yet the percentage of individual participants who consumed less than 67% of the RDA in this study was higher than in the continuing survey of Food Intake of Individuals - 1985. Improvement in nutrient intake at postprogram evaluations was encouraging. Regression analysis indicated that nutrition education classes in college, income level, and level of formal education each had a positive effect on nutrient intake and nutrition knowledge.

M. Tech. (Department of Hospitality, Tourism and PR Management, Faculty of Human Sciences), Vaal University of Technology / The purpose of this study was to determine the contribution of the National School Nutrition Programme (NSNP) has made on the total nutrient intake of Kagiso learners. This was done by investigating the nutrient intake of school children participating in the NSNP (experimental group) and comparing this to the nutrient intake of learners participating in the tuck-shop or lunch box (control group) from one school. The research methodology was undertaken in two phases, namely phase one; planning and phase two; data collection and analysis. The following measuring methods were applied; socio-demographics, household food insecurity assessment scale, anthropometry measurements, food frequency questionnaires (FFQ), 24-hour recall and the observation of the NSNP during the school lunch breaks. Anthropometry measurements were analysed according to the World Health Organization standards (WHO 2008), socio-demographics, and household food insecurity assessment scale and FFQ were captured on an Excel spreadsheet by the researcher and analysed using the Statistical Package for Social Sciences (SPSS) version 22.0 for descriptive statistics such as frequencies, standard deviations and confidence intervals. An expediency sample of 160 primary school children aged 6-13 years, including girls (n=84) and boys (n=76) and 106 caregivers were recruited into the study. The results showed that majority of caregivers (59%) completed secondary level education, followed by 39% with primary level or college completion (2%). The employment rate in the Kagiso households of the sampled group was low with 20% of caregivers being unemployed. Out of the 76% of the employed caregivers, 26% were permanently employed and 51% were temporarily employed with contract work and piece jobs. The highest monthly income (42%) was between R1000-R3000 and the lowest (38%) was less than R1000 with only R101-R200 to spend on food per week. The food insecurity status of Kagiso learners showed that 44% of school children were food secure, and 56% were food insecure – of these, 29% experienced hunger. Heightfor-age, weight-for-age and BMI-for-age were measured for all of the 160 children. The group was categorized as follows; school children participating in the NSNP (n=59) and children using the tuck-shop foods (n=35) and lunch box (n=66). The nutritional status of Kagiso learners from the sampled group showed that more boys were stunted (13%) and wasted (12%) while of the girls, 30% were at risk of being overweight, with only 2% reported to be overweight. The majority of boys reported to be stunted and wasted were from the NSNP group and the girls reported to be overweight or at risk of being overweight were from the tuck-shop group. Thus, the learners from the lunchbox had optimum growth status when compared to the other two groups. The respondents consumed a mainly high carbohydrate diet with a low consumption of vegetable and fruits. The results from the Food Variety Score (FVS) revealed a low individual mean (2.25±1.57) in the legume and nuts group, followed by a medium individual mean (7.9±2.81) in the fruits and other juices group, 7.16±2.68 in the vegetable group, and lastly, the highest individual mean (9.26±3.04) in the cereal, roots and tubers diversity. The results from the top 20 popular food items ranked as follows; maize meal stiff (1st), maize meal porridge (5th), white rice (6th), white bread (7th) brown bread (9th), potato fries (12th), breakfast cereal (13th) and samp and beans (14th). Cabbage (15th) and pumpkin (20th) were the most popular vegetables and there were no fruits within the top 20 popular list of food items. The Nutrient Adequacy Ratio (NAR) of the NSNP (n=59) meals was below the 1/3 (33.3%) and 30% dietary requirements for lunch meals. This was very evident regarding vitamin A (16.85%), energy kilojoules (23.78%), calcium (18%), folate (26.72%), zinc (15.71%), dietary fiber (25.71%) and iodine (4.65%). Iron (38.98%) was slightly above the 1/3 and 30% dietary intake, but there were a high percentage (61%) of respondents who did not meet the EARs of 5.9mg for iron. The results revealed an inadequate contribution by the NSNP to the nutrient intake of Kagiso learners. The poor intake of folate, vitamin A and dietary fiber in this sampled group is linked to the low consumption of vegetable and fruits. Results from this observational study showed that a majority of respondents do not participate in the NSNP when they do not have their own eating utensils. Respondents also revealed that the NSNP meals caused allergies such as skin rash while some mentioned diarrhea as the cause of not eating meals from the NSNP. Hence, a larger percentage (41%) of school children preferred to participate in the lunch box rather than in the NSNP (37%). The high prevalence of inadequate nutrient intake and the poor nutritional status of Kagiso learners in the sampled group, is an indication that strict monitoring of dietary measures needs to be implemented and continuously evaluated to ensure that positive nutritional results are obtained by the NSNP across South Africa

Thesis (MBA.) -- University of Limpopo, 2016 / The National School Nutrition Programme (NSNP) is a poverty alleviation strategy, which was introduced in 1994 by the Government of South Africa as part of the Reconstruction and Development Programme (RDP). Studies of the Food and Agriculture Organisation, United Nations Educational, Scientific and Cultural Organisation (UNESCO) and the World Health Organisation (WHO), show that hunger, nutrition, and poverty, are strongly correlated. The same studies note that in the world as a whole, hunger impacts negatively on the Millennium Development Goals, such as universal primary education, gender equality, child mortality, maternal health, management of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS), tuberculosis (TB) and malaria, and environmental stability. Hunger, specifically, has been shown to contribute to reduced school attendance, impaired cognitive capacity, high child mortality rates, high maternal death rates, increased migratory labour that increases the spread of HIV, and the unsustainable use of forest lands and resources. The National School Nutrition Programme aims at providing meals to mostly needy learners, who come from poor families. Healthy food provides energy for the brain. The meals that are provided at schools are, therefore, intended to give energy for mental and physical activities for the body, for the brain to function, to make learners alert and receptive during lessons. Initially, meals in South African Schools were provided to all learners in Quintile 1, 2 and 3 public primary schools from Grades R to 7. The programme was extended to Quintile 1 secondary schools in April 2009. All Quintile 2 and 3 public secondary schools were included in 2010 and 2011, respectively. To collect information for research purposes, the researcher used an interview questionnaire. This approach, which is used by the researcher, seeks to identify the impediments that pose challenges to effective and efficient implementation and management of the NSNP in the Bakenberg North Circuit of the Department of Education in the Limpopo Province. The sample covered three secondary schools participating in the NSNP in the Bakenberg Circuits. In each school, the principal, the heads of departments and the teacher, formed part of the sample of the study. The empirical findings were analysed and interpreted, and in presenting the findings, special reference to the research questions was made, namely: “An assessment of theimplementation and management of NSNP in the Bakenberg North Circuit secondary schools.” The study shows that the Department of Education in the Limpopo Province has not managed the NSNP efficiently and effectively. The findings of this study reflect that there are still challenges that continue to plague the NSNP after so many years since inception of the programme by the Department of Education. The empirical findings of this study have revealed that the challenges confronting the implementation of the NSNP could be attributed to poor governance and corruption by the Department of Education officials. Some pockets of excellence of the NSNP are noted in the study. Recommendations are made to mitigate the problem situation. The study therefore recommends the:  Menu supplied by the department to be followed,  Monitoring to be done at schools,  Storage facilities to be improved,  Issues of myth to be cleared among learners regarding the programme.

A Food Behavior Checklist (FBC) was developed, validated, and pilot-tested with homemakers in Virginia's Expanded Food and Nutrition Education Program (EFNEP). The FBC was designed to measure nutrition-related practices that are taught in EFNEP, but cannot be measured by the 24-hour recall. During development, 20 EFNEP paraprofessionals in Virginia and 20 randomly selected state EFNEP coordinators helped to identify items that are most important in evaluating the overall effectiveness of EFNEP, and which could be used to establish content, face, and construct validity of a behavior assessment instrument. The Food Behavior Checklist contained 30 items, and responses were recorded on a Likert scale with four response levels: 0 = "never or seldom", 1 = "sometimes",2 = "usually", and 3 = "almost always". Cronbach-alpha revealed a reliability coefficient of 0.86. During the field test phase of this study, the FBC was used before and after EFNEP intervention to collect data on the nutrition-related practices of 147 low-income homemakers in three rural counties and one urban area in Virginia. In this phase, the experimental group, which consisted of 79 homemakers, received computer-aided feedback on their dietary practices, via a Diagnostic Report, which was used as a teaching tool. Paraprofessionals thoroughly explained the content of the diagnostic report to the homemaker at program entry and program exit. The control group, which consisted of 68 homemakers, did not receive computer-aided feedback on their dietary intakes, in that no mention was made of the computer print out to them. Results indicated that this instrument (FBC) may be useful in evaluating the overall effectiveness of EFNEP nationwide and may be useful in other nutrition programs. No significant differences were observed in the nutrient intake or Food Behavior Checklist practice change scores between the group who received computer-aided feedback and the group who did not received computer-aided feedback. The author concluded that the dietary analysis contained in the computer generated Diagnostic Report needs to be simplified if it is to become an effective tool with EFNEP homemakers. More research is needed on the use of computerized diet analysis as a teaching tool with low-income homemakers. / Ph. D.

Objective: Evaluate how a social marketing approach compares to traditional nutrition education curriculum for promoting behavioral changes related to eating and food. Design: Nonequivalent comparison group, entry-exit design. Participants from 12 Kentucky counties assigned either comparison or pilot group. Comparison group received traditional nutrition education curriculum and pilot group received the social marketing program, Cook Together, Eat Together (CTET) curriculum. EFNEP’s Behavior Checklist and 24-Hour Dietary Recall were administered at entry and exit of the 8-week programs. Participants: Females (18-72 years of age) from families eligible to receive SNAP benefits (n=64 comparison group participants, n=60 pilot group participants). Intervention: Comparison group completed an 8-week standard lesson and pilot group completed CTET program in varying time frames (1-8 weeks). Main Outcome Measures: Eating behavior changes between entry and exit for comparison versus pilot. Analysis: Quantitative data were analyzed using independent and paired t-tests with significance of P≤ 0.05 and 0.10. Results: Groups were demographically similar. Both had significant differences in entry and exit scores for Behavior Checklist and 24-Hour Recall (P≤ 0.05). Conclusion and Implications: Positive behavior change was observed in both comparison and pilot groups. A social marketing program proves to be a promising approach to nutrition education.