The Supplemental Nutrition Assistance Program Education (SNAP-Ed) is an extension of the Supplemental Nutrition Assistance Program (SNAP) that aims to promote living healthier lifestyles for low-income participants of SNAP with limited resources. This thesis aims to investigate the effectiveness of Virginia's adult SNAP-Ed program through a cost-effective analysis (CEA) for fiscal year 2013 which requires the separation of the into the costs and the effects of the program. The costs for the program are categories as the labor, capital, material, and utility costs that are required to implement the adult SNAP-Ed program. The effects are measured as the number of participants who start, graduate, and improve from the start to the end of the program. The effects were measured on a retrospective self-assessment that measured both if a participant graduated and their magnitude of improvement. The analysis showed that as the state of Virginia the adult SNAP-Ed program incurred a cost of $2,488,170.07 with 6,759 participants starting the program and 3,704 of those that graduated in fiscal year 2013. Participants that improved on at least one of the questions by a score of one were 3,609 of the 3,704 that graduated. For the state of Virginia the cost effective ratio (CER) for starting a participant was $368 and CER of $672 for each graduated participant. An improvement on at least one question saw a CER value of $689. These findings show patterns that can be used for future policy implementation and the focus of the program. / Master of Science

Objective: To assess the reliability of the Kids' Activity and Nutrition Questionnaire (KAN-Q) as part of a tiered process for developing Supplemental Nutrition Assistance Program-Education tools. Methods: The KAN-Q was administered at 2 time points to assess internal consistency using standardized values of Cronbach alpha and test-retest reliability using the intraclass correlation coefficient for continuous variables, Cohen's kappa (k) statistic for categorical variables, and the weighted k statistic for ordinal data. Results: Data were collected from 119 fourth graders. Cronbach a was adequate for behavior (.71) and knowledge (.72) scales and nutrition behavior (.78) and nutrition knowledge (.75) subscales. Test-retest reliability was generally acceptable, with intraclass correlation coefficients from 0.40 to 0.75 and k coefficients showing fair to substantial agreement (0.30 to 0.72). Conclusions and Implications: The KAN-Q is a practical and reliable questionnaire for school-based administration that aligns directly with Supplemental Nutrition Assistance Program-Education evaluation priorities.

Objective Because farmers' markets include a variety of fruits and vegetables, shopping at farmers' markets would likely improve diet quality among low-income consumers, as well as promote sustainable direct farm-to-consumer business models. However, not much is known about how to promote farmers' market shopping among low-income consumers. Therefore, the purpose of the present paper was to examine barriers to and facilitators of shopping at farmers' markets and associations between shopping at farmers' markets and self-reported dietary behaviours (fruit and vegetable, sugar-sweetened beverage and fast-food consumption) and BMI. Design Cross-sectional analyses of associations between farmers' market shopping frequency, awareness of markets, access to markets, dietary behaviours and BMI. Setting Department of Social Services, Pitt County, eastern North Carolina, USA. Subjects Between April and July 2013, Supplemental Nutrition Assistance Program (SNAP) participants (n 205) completed a quantitative survey. Results Barriers to shopping at farmers' markets included does not accept SNAP/electronic benefit transfer, out of the way and lack of transportation. Farmers' market shopping was associated with awareness of farmers' markets (estimate =0·18 (se 0·04), P<0·001). Fruit and vegetable consumption was positively associated with farmers' market shopping (estimate =1·06 (se 0·32), P=0·001). Conclusions Our study is one of the first to examine SNAP participants' farmers' market shopping, distance to farmers' markets and dietary behaviours. Barriers to shopping at farmers' markets and increasing awareness of existing markets should be addressed in future interventions to increase SNAP participants' use of farmers' markets, ultimately improving diet quality in this high-risk group.

Food Security is a situation that exists when all people, at all times, have physical, social, and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life (FAO, 1996). 17% of Kentuckians are food insecure (Kentucky Department of Agriculture, 2016). This study explored the quality of life (QoL) impact of the Bluegrass Double Dollars (BGDD) program on Supplemental Nutrition Assistance Program (SNAP) participants through secondary data analysis. Utilizing the categories of quality of life indicators established by The Commission on the Measurement of Economic Performance and Social Progress (CMEPSP) the results from this study concluded that participating in the BGDD program provides some level of quality of life benefits.

The study was conducted to explore the role of social capital in the implementation of Fruit and Vegetable Incentive Programs (FVIP) through a case study of the Appalachian Farmacy (AF) program and to fill a gap in literature on social capital utility in the implementation and evaluation of FVIPs. The study was guided by a conceptual model adopted from Berkman et al. (2000) to identify the mechanisms through which social networks can impact health. A qualitative content analysis was conducted retrospectively on secondary data from the evaluation of AF program to identify social capital attributes. In addition, the study conducted two focus groups with AF participants and four interviews with AF program administrators to explore their perceptions on the role of social capital in the implementation of FVIPs using a phenomenological approach. The study utilized both inductive and deductive analysis techniques with the conceptual model as the guide for analysis. The Bengtsson’s four steps for conducting content analysis were used for AF content analysis and Tracy’s (2013) two-level coding was used to analyze the focus groups and interviews. All the findings were triangulated and mapped on the study’s framework to identify the main and emergent themes. The findings revealed the main avenues for social networks were: cooking classes, farmers markets, recruitment sites, and a low-income housing complex. The main social capital 3 mechanisms were: instrumental and informational social support; social participation and engagement; and social influence. The main actors in the networks were the program administrators, market vendors, and other participants. Lastly, the health pathways identified were the changes in perceptions towards diet and health. The emergent themes revealed that barriers to access and individual characteristics were potential moderating themes, and case management by the program administrators was a potential mediating theme to program implementation. The study showed that the model was effective in exploring social capital in FVIPs. It highlighted the role that social networks, program actors and social capital play in implementation of public health interventions. Social capital may play an important role in health promotion and more research is needed to identify the mediating influences of the model.

Many believe eating healthfully is too expensive and therefore opt for less expensive, lower quality foods. There are disputes between research groups and government as to whether nutrition policies should be adjusted. Federal programs have made strides in combating food insecurity through nutrition help and education programs, but many question if the amount of skills in food selection and preparation can compensate for limited incomes. Regardless, the low incomes' diets are inadequate to meet nutritional needs and people are suffering the consequences. The purpose of this study was to determine the extent one can follow the USDA Food Guide Pyramid recommendations while only receiving SNAP benefits. Nine volunteers attempted to limit their food budget to $4.50 a day while maintaining MyPyramid recommendations. This study was a qualitative case study conducted in Southern Illinois in the spring of 2011. This study was descriptive, and the investigator gathered and analyzed the data.

Low consumption of fruits and vegetables due to various barriers among food insecure populations presents a significant health risk across all ages. Nutrition education is available to low-income populations, but due to the complexity and variety of influences that determine dietary behavior, increasing nutrition knowledge as a singular approach does not successfully result in behavior change. This may be supported by low Supplemental Nutrition Assistance Program (SNAP) redemption rates at farmers markets. There is a lack of data using the Theory of Planned Behavior to assess intentions to purchase fruits and vegetables by SNAP-Ed participants at farmers markets in Southern Illinois. There is also a lack of research on the interest in using social media for nutrition education on fruit and vegetable consumption in low-income populations throughout Southern Illinois. A cross-sectional survey was used to understand SNAP-Ed participants’ intentions to purchase fruits and vegetables at farmers markets, as well as their interest in receiving and using online nutrition education through various social media applications. A survey instrument was distributed to low-income participants of various SNAP-Ed nutrition classes hosted by the University of Illinois-Extension throughout the 16 southernmost counties of Illinois. The survey analyzed constructs of the Theory of Planned Behavior and relationships with intentions using regression analysis. Additionally, questions regarding social media usage were used to determine what technologies and social media applications are most commonly used among the sample, and any interest in receiving nutrition education through such applications. A total sample of n=189 SNAP-Ed participants completed the survey. The study found that attitude regarding fresh fruits and vegetables at farmers markets was the strongest predictor of intent to purchase fruits and vegetables for SNAP-Ed participants who receive SNAP benefits. Second, online nutrition education focused on fruit and vegetable purchases at farmers markets may be more generalizable regarding certain socio-demographic factors for SNAP-Ed participants who receive SNAP benefits. Third, results from the study demonstrate that 76.9% of respondents had Internet access, which is higher than current national rates for Internet accessibility in rural areas. Therefore, it is important to consider an increased Internet accessibility beyond at-home broadband coverage, which may include public libraries, work, school, or on a Smartphone. The most important socio-demographic characteristic to consider regarding social media use was age in the context of generations (Millennials, Working Adults, Seniors). Overall, SNAP-Ed participants were most likely to exhibit interest in nutrition education from text messages, email, or on Facebook. SNAP-Ed participants would like to receive online nutrition education via email (30.1%), Facebook (24.7%), and text messaging (21.0%). Online nutrition education in the form of email, Facebook, and text messaging would be the most successful in terms of recruitment and interaction for SNAP-Ed participants. Therefore, using social media to deliver nutrition education may be an effective supplement to reinforce the current classroom curriculum used in SNAP-Ed programming. Findings from this study support the use of online nutrition education through social media applications as an avenue to increase fruit and vegetable purchases at farmers markets in the Southern Illinois Mississippi Delta Region.

Increasing the number of farmers’ markets and implementing Electronic Benefit Transfer (EBT) systems for the Supplemental Nutrition Assistance Program (SNAP) at more farmers’ markets have been suggested as strategies to overcome food access issues, but little is known about their availability in the rural South. This study examines differences in availability of farmers’ markets and SNAP/EBT at markets by county-level rural/urban classification, percentage poverty, percentage racial/ethnic minority, and percentage obese residents in North Carolina counties. Data were collected using a cross-sectional survey. Though results related to rurality and economic status are mixed, regression analyses indicate that the percentage of African American residents is inversely associated with the number of markets and number of markets that accept EBT. Results suggest that access to farmers’ markets varies in North Carolina, and additional research is needed to determine whether this impacts obesity.

The Supplemental Nutrition Assistance Program (SNAP) is the United States' largest government assistance program that aims to alleviate food insecurity. The SNAP program allows low-income individuals and families the ability to purchase nutritious foods through a monthly benefit. However, the current body of literature presents evidence of the program's counterproductive effect. The purpose of this study was to determine whether incentivizing SNAP recipients to purchase additional fruits and vegetables was beneficial in increasing such purchases. Social cognitive theory was used as a theoretical framework to address research questions associated with shopping patterns and attitudes and beliefs. This quantitative study used a randomized controlled trial to study differences between incentivized and control groups. The Healthy Incentives Pilot Program (HIP) used a stratified sampling of 55,095 SNAP households receiving benefits between July, 2011, and December, 2012. Statistical analyses (t test, Pearson correlation, and multiple regression analysis) were conducted to identify changes in food shopping patterns and eating behaviors associated with the HIP intervention. Results indicated that (a) incentivizing SNAP recipients leads to an increase in fruit and vegetable purchase, and (b) a correlation exists between fruit and vegetable purchase and attitudes and beliefs. No correlation was found between the intervention and changes in food shopping patterns. Positive social change implications include the improvement of health outcomes in over 43 million people currently enrolled in the SNAP program on a national level.

Novel clustering methods are presented and applied to financial data. First, a scan-statistics method for detecting price point clusters in financial transaction data is considered. The method is applied to Electronic Business Transfer (EBT) transaction data of the Supplemental Nutrition Assistance Program (SNAP). For a given vendor, transaction amounts are fit via maximum likelihood estimation which are then converted to the unit interval via a natural copula transformation. Next, a new Markov type relation for order statistics on the unit interval is developed. The relation is used to characterize the distribution of the minimum exceedance of all copula transformed transaction amounts above an observed order statistic. Conditional on observed order statistics, independent and asymptotically identical indicator functions are constructed and the success probably as a function of the gaps in consecutive order statistics is specified. The success probabilities are shown to be a function of the hazard rate of the transformed transaction distribution. If gaps are smaller than expected, then the corresponding indicator functions are more likely to be one. A scan statistic is then applied to the sequence of indicator functions to detect locations where too many gaps are smaller than expected. These sets of gaps are then flagged as being anomalous price point clusters. It is noted that prominent price point clusters appearing in the data may be a historical vestige of previous versions of the SNAP program involving outdated paper "food stamps". The second part of the project develops a novel clustering method whereby the time series of daily total EBT transaction amounts are clustered by periodicity. The schemeworks by normalizing the time series of daily total transaction amounts for two distinct vendors and taking daily differences in those two series. The difference series is then examined for periodicity via a novel F statistic. We find one may cluster the monthly periodicities of vendors by type of store using the F statistic, a proxy for a distance metric. This may indicate that spending preferences for SNAP benefit recipients varies by day of the month, however, this opens further questions about potential forcing mechanisms and the apparent changing appetites for spending.