Thesis (M.S.)--Wisconsin. / Includes bibliographical references (leaves 60-62).

The Expanded Food and Nutrition Education Program (EFNEP) is one of the largest efforts of the US Department of Agriculture (USDA) to promote healthy dietary behavior practices among the low income adults and youths in the US. Although the program is shown to be effective in achieving its stated goals, the cost effectiveness of the money spent on EFNEP remains largely unknown. This dissertation analyzes the costs and effectiveness of the EFNEP, and is organized in three essays. The first essay investigates the effectiveness of the adult EFNEP and evaluates the returns to scale on the money spent in this program by utilizing an indirect production function approach. Results indicate that the program has increasing returns to scale at the National level, although a significant variation exists across the states. The second essay develops a framework for conducting the cost effectiveness analysis (CEA) for the youth EFNEP. The CEA framework is then applied to the data from Virginia youth EFNEP to estimate the cost effectiveness ratio (CER). The CER is estimated to be about $75 per behavior improvement. The third essay examines the outcomes and the attributes of the youth EFNEP program using the Rasch model type measurement model.  Findings suggest that the youth EFNEP is effective in achieving its stated program goals. In addition, the program related characteristics are found to be important attributes of effective programs. Overall, this dissertation has important policy implications for improving the (cost) effectiveness of nutrition education programs. " / Ph. D.

The purpose of this study was to explore the incentives and barriers perceived by low-income women of child-bearing age related to their participation in nutrition education programs. The specific programs of concern in this study are the Expanded Food and Nutrition Education Program (EFNEP) and the Food Stamp Nutrition Education (FSNE) program. This qualitative study sought to hear the voices of the women so that nutrition programs can be made more successful in reaching this population. Personal interviews were conducted with 23 women in their homes or appropriate local sites, and transcripts were analyzed to identify categories and themes. People of low socioeconomic status and those with the least education have higher rates of obesity and overweight and suffer disproportionately from poor health. Women receiving Temporary Assistance to Needy Families (TANF) also receive Medicaid. Medicaid costs have escalated due to the obesity rate, which is currently estimated at 64% of the adult population. In addition, 30% of American children are experiencing obesity or are overweight. It is important for parents to understand the causes of obesity and the effects of the chronic diseases related to obesity. Prevention programs are more cost effective than medical treatment of the diseases associated with obesity, and proper nutrition can reduce the incidence of chronic diseases. Findings of this study suggest that isolation is the main impediment to participating in nutrition education programs. Missing from the interviewed women's circumstances are social capital, human capital, and economic capital. Social capital relates to the connections and relationships that are important in life. Human capital involves the knowledge and skills acquired through life experiences. Economic capital refers to individual wealth or economic resources available to an individual or community. Nutrition education programs should be refined to incorporate opportunities for socialization that will develop trust and reciprocity, as well as nutrition knowledge. Based on the results of this study, Virginia Cooperative Extension programs will be adapted to incorporate weight control and cooking classes with nutritious recipes. The learning environment will be safe, learner-centered, and fun. New marketing tools that are more appealing to the prospective clients will be developed. / Ed. D.

Master of Public Health / Department of Food, Nutrition, Dietetics, and Health / Sandra B. Procter / There have been major shifts in the dietary patterns of people in the United States in the last four decades. People eat fast food more frequently, eating more convenience food products, and highly processed food. On the other hand, the practice of cooking from raw ingredients or cooking from scratch has been declining. The lack of cooking skills is one of the barriers of cooking from raw ingredients. Cooking skills are one of the important determinants of food choice. People who have higher cooking skills tend to choose healthier food options. There are many programs that aim to increase cooking skills and nutrition knowledge. One of them is done by EFNEP. Over the years, EFNEP has been helping the low socioeconomic population to reach nutritional well-being. Evaluation is an important component of EFNEP. There are evaluation tools in EFNEP including behavioral checklist and dietary recall that are administered pre and post program. However, these tools do not specifically measure participants’ cooking skills. A proposed short self-reported questionnaire is designed to measure cooking skills of EFNEP participants in Kansas. The questionnaire comprises of seven questions and has been tested to a representative group.

Concern that youth do not have enough fruit and vegetable intake lead to two strategies implemented to influence intake in the school environment: the Healthy Hunger-Free Kids Act (HHFKA) and Fighting with Food: Battling Chemical Toxicity with Good Nutrition program (FF), which could influence phytochemical content and knowledge regarding phytochemicals, respectively. Individual food logs (n=468) were assessed upon completion of FF curriculum to determine whether students were able to correctly apply their nutrition knowledge regarding FF. Menus from one district were analyzed pre-HHFKA and post-HHFKA in elementary (n=156), middle (n=171), and high schools (n=171), for change in the frequency of fruit and vegetables, and for changes in select phytochemical and vitamin content. In food logs, students correctly identified fighting foods 71% of the time. School menus showed an increase in dark green, red/orange vegetables, with significant increases in carotenoid and flavonol content. Results suggest students are applying their nutrition knowledge. Also, more variety of fruit and vegetables are being offered, despite lack of a robust increase in all phytochemicals, which can help to lower inflammation and oxidative stress. Both strategies have the potential to work together as a multi-level intervention that can encourage more fruit and vegetable consumption among youth.

No description available.

No description available.

Nutrition knowledge, dietary intake, body composition and perceived sport performance were measured before and after an eight week nutrition intervention. The sample consisted of eleven male high school football athletes aged 14-18 years old. Baseline nutrition knowledge was higher than anticipated but fruit and vegetable intake was low. As a result of the nutrition intervention, vegetable intake improved from 0.94 servings per day to 2.02 servings per day (p=0.02). Of the eleven subjects in the study, eleven conceded to both performing and feeling better as a result of the nutrition intervention. The present study suggests that a nutrition intervention can improve dietary intake and perceived sport performance among adolescent athletes.

Concern that youth do not have enough fruit and vegetable intake lead to two strategies implemented to influence intake in the school environment: the Healthy Hunger-Free Kids Act (HHFKA) and Fighting with Food: Battling Chemical Toxicity with Good Nutrition program (FF), which could influence phytochemical content and knowledge regarding phytochemicals, respectively. Individual food logs (n=468) were assessed upon completion of FF curriculum to determine whether students were able to correctly apply their nutrition knowledge regarding FF. Menus from one district were analyzed pre-HHFKA and post-HHFKA in elementary (n=156), middle (n=171), and high schools (n=171), for change in the frequency of fruit and vegetables, and for changes in select phytochemical and vitamin content. In food logs, students correctly identified fighting foods 71% of the time. School menus showed an increase in dark green, red/orange vegetables, with significant increases in carotenoid and flavonol content. Results suggest students are applying their nutrition knowledge. Also, more variety of fruit and vegetables are being offered, despite lack of a robust increase in all phytochemicals, which can help to lower inflammation and oxidative stress. Both strategies have the potential to work together as a multi-level intervention that can encourage more fruit and vegetable consumption among youth.

The Expanded Food and Nutrition Education Program (EFNEP) is a federal program designed to improve the nutritional status of the population and provide employment for paraprofessional aides from the indigenous target population and an example of a change agency. Diffusion and change literature offer many models and possible personality characteristics that may be associated with effective change agents. The purpose of the study was to examine characteristics of paraprofessionals employed in the Adult phase of Virginia EFNEP and their relationship to paraprofessional effectiveness and how well they fit the diffusion model. Effectiveness for the paraprofessional was measured as homemaker success (change in nutrient intake and food behavior) and as paraprofessional performance (workload and home visit evaluation). Personality, training, and demographic characteristics of the 40 paraprofessionals were obtained through a mailed Paraprofessional Questionnaire and the Sixteen Personality Factor (16PF) Test. Demographics, food behavior and knowledge, and nutrient intake for a sample of three homemakers per paraprofessional (N=116) were obtained from EFNEP Family Records. Homophily, the measure of correspondence, was calculated by comparing each paraprofessional with their sample of three homemakers. Three personality factors (concrete thinking, impulsivity, and self-discipline) along with homophily were correlated with change in food behavior, none with change in nutrient intake, and two (concrete thinking and low tension) along with perfect match homophily were correlated with workload. There were no apparent difference in training. When all factors were analyzed by stepwise multiple regression, homophily along with three of the second-order personality factors were related to change in food behavior. One second order factor, low anxiety along with perfect match, was related to workload. Implications for practice include: (a) EFNEP paraprofessionals, in part, appear to be fitting the model of change agent effectiveness, in that homophily is influencing the homemakers and (b) low anxiety and low tension appear to be related to effectiveness and could be used in employee selection and future training. Recommendations for future study include: (a) further study into quantification of homophily and (b) investigation of relationship of characteristics to supervisor view of effectiveness. / Ph. D.