NC_old3169: EFNEP Related Research, Program Evaluation and Outreach

(Multistate Research Project)

Status: Inactive/Terminating

Project Menu

SAES-422 Reports

Annual/Termination Reports:

[12/14/2018] [12/08/2019] [12/23/2020] [12/16/2021] [11/23/2022]

Date of Annual Report: 12/14/2018

Report Information

Annual Meeting Dates: 10/18/2018 - 10/20/2018
Period the Report Covers: 10/01/2017 - 09/30/2018

Participants

First Last Institution
Catalina Aragon Washington State University
Garry Auld Colorado State University
Susan Baker Colorado State University
Karen Barale Washington State University
Graham (Geb) Bastian Rutgers University
Helen Chipman NIFA
Carrie Durward Utah State University
Karen Franck University of Tennessee
Elizabeth Gollub Louisiana State University Ag Center
Patricia Guenther University of Utah
Deb Hamernik University of Nebraska
Debie Head University of Arkansas
Andrea Leschewski South Dakota State University
Cheng Li' New Jersey - Rutgers University
Janet Mullins/Tietyen University of Kentucky
Nicole Owens Duffy University of Florida
Deb Palmer-Keenan New Jersey - Rutgers University
Sandy Procter Kansas State University
Kavitha Sankavaram University of Maryland
Mary Kay Wardlaw University of Wyoming Extension
Dave Weatherspoon Michigan State University
Kelly Webber University of Nevada - Reno
Kate Yerxa University of Maine Cooperative Extension

Brief Summary of Minutes

October 18, 2018

Deb Hammernik now Associate vice chancellor of Research. Hopes to be able to continue to meet with this multi-state group.

Congrats on renewal. First official meeting NC3169, ends 9/2023. More efforts on truly collaborative activities. See Quick Guide Handout. Think about inviting other states. Linda Boeckner retired in Nebraska; try to get someone else from there.

Deb nominated us for the impact writing workshop; AES administrators are supporting this workshop for us. This is a good for us since we are struggling with writing the statement.

Helen

Impacts – highlight send to Helen so she can share w/leadership. Wants to hold up NC3169 as cutting edge. Even though their may not be money for CE, hoping that CE can find funding. Funding has changed in AFRI grants. Integration across states is important in securing grants. You are creating a way to show a piece that is important to this audience.

With 50^th anniversary of EFNEP, SNEB is highlighting the EFNEP pubs and research. Check SNEB/JNEB website for a research page (Cheng Li sent link).

Oct 29 – new NIFA director, Scott Engle, starts. Work to have a good relationship with him.

Relocation…. Deadline for submitting expressions of interest has passed. Quite a number of entities have expressed interest. In holding pattern. Agencies goal is how to move things forward. People may individually make choices, but agency will continue its work.

Programmatic side. Just received approval for a recognition event with EFNPE Coordinators meeting. Good news is that the dept has blessed it.

Introductions

DAB:

QOL: This is an active group in moving efnep research forward. This group has been progressing in building the evidence with great assessment tools that others will use. Most active group in the kind of data that goes into QOL. Someday I hope we be able to stand in front of program assistants and say “here’s what you do” for participants. Testing a roll out of FPAQ a big contribution. QOL overview. When first started, when looking at evaluation of efnep, found a QOL tool from Toronto. Longitudinal assessment of program assistants and participants. Somethings goes on besides diet and PA change. Plan to develop QOL tool for EFNEP. Original idea was about can we develop a measure for qol with this populations.

CE – interesting for economist. Is there consumer behavior change and then can we measure it biologically. This is missing in the literature. If this does happen, is their value to the society. This has major funding implications.

New Members

Kellie Weber – Started at UNR, in Las Vegas, Aug 1. New to Extension, knows EFNEP from NC. Faculty director for EFNEP. RD, MPH, nutrition, clinical interventions, evaluation experience. Interested in QOL and DAB. Is DAB wrapping up? No, many additional things coming up.

Kavitha, UMD, funded by EFNEP and research $$. Training is bench science. Doing EFNEP evaluation. Interested in DAB and CE. Planning to work on 24 hour recall.

Debra (Debby) Head, Univ Arkansas. EFNEP Coord, 60% funded. Here because of Serena Fuller. Not familiar. This is year 2 in Extension RD, CDE. Maybe cost effectiveness.

Carla Moore, UGA, RD, MPH, PhD in animal research in monkeys re: food. Worked with WIC, 75% EFNEP and 25% research; now 20% research 80% translational research and juggling EFNEP coordination. In process of hiring an EFNEP Coord.

Elizabeth Collub – RD, MPH, PhD. As of 9/17, asst prof at Ag Center at LSU. 75% Ext, 25% research. Not EFNEP; works with general public. Position not well defined; encouraged to be part of a multi-state. Interested in QOL. Was a program evaluator at a research center.

Geb (Graham) Bastian, PhD student at Rutgers. RD, former upstate NY SNAP-Ed with NYDOH. May do doctoral work on retrospective pre/post.

Andrea: Ag food resource economist. Asst Prof SD State. Looking at consumer demand for healthy/non-healthy item; possible

Presentations from DAB

PA – Cheng Li

Only people who don’t over/under report are those who are inactive.

Variance in English understanding (might read/write, but total comprehension lacking); Hispanic had poor to no correlation. May be causing some of the unexpected poor data.

Hispanics who have not taken EFNEP

Hispanic who took EFNEP did have a correlation.

For English, better correlation for Q1.

Sensitivity: include all the data tables from Garry.

SSB questions don’t hang together.

Dairy and FS are iffy. Dropping an item helps but not much.

FRM really high.

Pared t and Wilcoxon: 28 or 29 items were significant. A couple were not.

Diff mostly like .5, some were a full point and some were 0.1. Range of difference pre to post. Suggests some items aren’t that great but may need drop certain items in FY21.

Need to look at T tests for sensitivity of scales. Diff may be more. Need to look by demographics.

Concern raised about scales not matching due to different answer categories.

FRM-ppt

For construct validity, no gold standard. Comparing answers to questions with qualative interviews on shopping. 33 Interviews transcribed; coding guide completed and coding has started.Expect results by mid-November.

Validity for Spanish Translation - ppt

63% coord’s responded to survey; 45% are teaching in Spanish. Expert panel will confirm that the questions are understandable.

Rejected Food Security Paper

Rejection: reliability – no missing data or outlier analysis; no power calculation; no clustering within states; ICC 2-way mixed model was not accepted. Construct validity not accepted because of no factor analysis. Also question development was questioned. Some things lost due to leadership changes and no documentation. Why 8 question to 2.

Grocery Store Tool: Patricia – evaluating NE program with tech and avoiding self-report. Through RNECE program, evaluating quality of what people purchase vs what they eat. Developed tool based on HEI and food plans and expenditures. What to spend on diff categories. Calculates …..

Both perform similarly.

ASA 24 data – in press at J Nutr. Validity test comparing what they ate with what they reported.

Low-income population performed less well. ~70% accuracy. Thought that having a para there to assist to answer questions with ASA24 and brief overview would lead to more accurate result. But it didn’t make a difference. Means they can do ASA24 on their own. Could use for LTFU by sending a link to complete. Next step was to try using it in the field. Three states tried it out (CO, ME, TN). Developed online training to teach para’s to use ASA24. Found that people who completed training and survey. Majority had some college and/or degree. Online training not great for para’s; with less education dropped out and didn’t complete the survey. Paper in revision. In person para curriculum – train the trainer model. Collected data from 10 educators and 38 participants. Cross over design with participants did ASA24 or paper/pencil. Randomized via class model. Collected survey data re: user experience. Interviews w/7 educators for qualitative data. Interview with program directors and staff to be done. Will look at dietary data collected – total number of foods reports via each method. Based on advice from M. Townsend; will talk with her about how to count an item. Prelim coding done on qual interviews. Will do paper with both quant and qual.

Helen: A challenge we face is capturing the food people really eat; don’t know that his would be picked up in this study. Impt to think about what can/can’t report due to what’s in the database. Many foods are not in the database. Need to look at what that means for implementing. No simple answers.

CO recruited Hispanics – when they pulled out the ASA24, the Spanish screen doesn’t fit on screen because words are longer, and it was an issue for people knowing how to move the screens. Carrie: That was the purpose of the study to figure these things out. Device literacy can be an issue. May need other devices like tablet or computer screen (fits fine there). There are recommendations for entering unknown foods and how ASA 24 defines. There is a button to use if I can’t find the food.

Next steps: Pilot study using ASA24 in larger audience for feasibility and also look at efficacy. Also look at income comparison groups. Need a funding mechanism and proposal to support that work.

Big Impact

Handouts – no ppt available.

Why Impactful reporting important. It’s our job as researchers to report. Many people involved in science communication. It’s also a requirement for project, especially funding reports. Bad reports are filed away, but good reports put work in spotlight. Audience to share with are many from govt officials to public. People are busy and distracted today by info from variety of sources. Most aren’t academics. They aren’t looking for nitty gritty detail of work.

What is it” Brief summary of work and why it matters; captures audience attention. You might think of diff things for diff people. Size and shape varies. You might think of bullet points, section as report or entire report. Or infographic type presentation. They all follow same basic guidelines. Brief, general audience. They talk bout the impact.

Answers so what or who cares. Describes a change in behavior, condition or knowledge.

Influencing eating habits, increased homeowner composting,

Farmers learn new skills; research influences policy; new disc advance field of science;

Impact = Moral is a lesson learned; easier to remember with story. IS should provide the story

Issues, action (smallest section because more technical), outputs/results then impact = impact story. Explain how models, findings and papers are creating changes.

Outcomes – can be confusing. Sounds like output but usually means something closer to impact. An in between. If report asks for outcomes, and you aren’t sure, think impact and impact story. That will cover the outcomes.

Public Value – all PV statements are impact statements, but not vice versa. Public value goes beyond local impact - is impact on general public.

Parts of the Impact Story:

Problem/issue: briefly explain what and why issue, who is affected by issue, help connect research to hot topics, trending news.

Action: smallest piece of IS. Layout main action to investigate issue. Design, develop, survey, etc. Simple. Not technical – no theory or methods. Could mention innovative tools or methods used.

Who funded the work. Should connect specific researchers/intuitions to parts they worked on. How you collaborate – sheared resources, tools; perform studies at the same time in diff areas, etc. Links to more info. Give credit those involved.

Results - only major findings that are useful and impt to the research.

Impact – explain why the results manner. Change in condition, beh, know; who benefited; where the impact took place; Can be tricky connect specific impact… can say your work is playing a part in the change . OK to talk about potential impacts. Estimate and predict; If, then; could have; etc. How your research is ; how will advances create changes in condition or knowledge.

Ripple effect – sm change have potential to make larger changes over time. In multistate, with 5 years for impact development. Be clear if actual or a potential. Hard to keep track of some impact. Plan to measure changes in impact.

Can use anecdotes. Provide small, real life examples of how work impacted someone.

General guidelines

Don’t use jargon – technical, scientific terms, acronyms.

Use active voice – who did what. Not passive; more confusing and sound technical.

Use descriptive language; how work is unique

Use number that an audience can appreciate the scope and scale of impact. Value of … could be $2.5 mil. Include units of measurement and spell them out. But no too many numbers; use those that show impt and value of the work.

Photos can be helpful in explaining intricate results. Take pix of work and team

Focused and concise. Why it’s meaningful.

Once you have a good report with impacts, you can hand off to science communications people. Include IS in reports; for future grants; prepare for interviews or articles; use with stakeholders, colleagues; univ dept. and comm teams like them for websites. NIFA collects impact statement from Univ and grants holders and share. Can be turned into press releases and story pitches. Share on social media. Ok to be super brief and include a link for more info. Uploaded to databases (NIMMS, Land-Grant Database).

Friday, October 19, 2018

Infant Feeding Practices-ppt

Development, Validity and Reliability of the Infant Feeding Education Questions (IFEQ) for EFNEP. Will submit to Appetite.

QOL

Three QOL studies: longitudinal study questionnaire with new educators (QOL improved first year) Participants improved pre/post then leveled off. 60 telephone interviews with educators; 16 focus groups group with participants (4 black, 4 white, 4 eng-speaking Spanish and 4 spanish speaking). ID’d constructs impacted by efnep. Now have long series of statements related to QOL in different areas. Working on IRB approval for cognitive interviewing for questions. Later this semester or next; then reliability testing then sensitivity to longitudinal change. Bigger problem is with the response options. Toronto uses two sets: How important is X and how satisfied are you with X. Makes it longer. Would like to find a way to ask in one swipe. Will include this in cognitive interviews. Timeline – hope to be done by spring. Will need states to participate.

Cost Effectiveness-ppt

CE and CB – which is better? Hope to do both. Talked in general terms in past re: benefit for group. Waiting for data. Just received data from Colorado and Washington. Will show prelim into today. In the past you have had the impression that biometric was more important, but we need both biometric and nutritional data.

5-year plan of work

Think about your group, calls, etc. Make a timeline for 5-year plan. Set calls. Determine roles of participants/leaders.

Review 5 yr plan:

ASA24 - may have been too optimistic. First year is about developing tools and submitting proposal. Based on recent experience, we’ll have to do more testing and implementation research so may take longer.

The groups are pretty optimistic; it’s important for all to step up and take responsibility for some of the tasks. We are a small group. There are abundant opportunities for students, tenure-track positions; this is a productive group. Good to define top priorities of each group, so that groups can support the others. Think about what other expertise we need; who could we invite to join group. Next year will be a critical marker – co-chairs will need to look and see where we are on the timeline; does it need to be changed. If changes are needed, we talk to Deb Hamernik, then write it up in annual report. There is a box to check in the reporting software for changes.

Procedural guidelines

Review of NC3169 procedural guidelines. Need to change 2169 to 3169 throughout the document.

Under authorship order, #6/7; ensure that all authors are updated – who’s responsible? Is it chairs of work groups, first or corresponding author? Should be corresponding author. Would be helpful if the committee chairs would check in if they haven’t heard from authors (when they know publications are in the works), at least for virtual and face-to-face meetings.

Authorship placement question – is last author the most senior? Often that position is meant to be a faculty mentor for the student (first author). Follow your institution process and share/discuss with the author group.

D1. – don’t always bring written yearly report to the annual meeting. Can we say upon request?

Annual reporting should go to Janet, not Mary Kay. We have to do an annual report and a cumulative report.

Please review the procedural guidelines if you haven’t. So many people are working on publications it’s important to beware of expectations and have authorship guidelines.

2019 Annual meeting: Rutgers, New Jersey. Oct 17-19, Oct 16 for travel day.

Leadership: approved by vote. Deb Palmer Keenen motioned, Karen B. seconded.

Co-chairs: Janet, Catalina

DAB co-chairs: Kavitha, Karen F (Susan back-up)

DAB secretary: Kelly

Qol co-chairs: Annie, Kate

QOL secretary: Sandy (Kate will do annual meeting)

CE co-chair: Dave, Andrea

CE secretary – Debby Head

Serena Fuller update:

DAB:

24 hour recall – UMD and UWSIC agreed to work on this objective. Wisc has dropped out. Kavitha, Kelly Weber (Nevada), Debby Head (Arkansas), Karen F. Standardizing paper/pencil 24-hour recall with training materials. Will connect with Susan/Garry re: work done at CUS by Susan Gills. There are differences between and within states: diff training program (most popular is OK state); different time frames use. Could easily standardize to which time frame. Who codes is another variable; some states educator codes, some a state or county office who codes. GA hires students to enter and has a 2-hour training for their students about how to enter data with a guide. Interactive spreadsheet with questions that are submitted to Carla. Carla has interrater reliability info for students and another. Best is mid-night to mid-night and 5 pass multi-step method.

Will develop training protocol and approach and then will test it. Will get input form the group.

What is the research question: What is best training? What about fidelity?

Expectation for next year: in development

ASA24 – Patricia. Need to identify funding for study. If interested in that, contact Carrie. Will be developing plan for next steps. Established that low-income women (as defined by SNAP eligibility) could complete the tool. Current pilot study data collection is completed; there were glitches with technology. As tech matures should be OK. Need to review other problems that happen in the field and address. Good to think about what the next mid-term goal is, which might be if the EFNPE program could choose between paper/pencil or ASA24, could we develop a process for that? You can upload to WebNEERS but there is a process. You get an excel file that you upload via import. Then you have to choose participant to add, and the type (entry, exit, or). Do get clean data. NIFA looking at more automated way to enter data.

In the field, this was a research project with randomization (whole other level of data collection). People in study had moderate tech skills. But the programmatically worked ok. Different and unique issues in each state, such as consistency of wi-fi connectivity. Could they do it on their own? May need incentive for participants to do on their own. Participants did have questions, there were tricky foods, needed someone there to help.

Research question: For Patricia, the question was can they do it? Yes, they can. Next questions are about the implementation. Important to work with Helen about implementation. Are you getting the same or better response than paper/pencil. But it was longer time with the participant. Consider putting the other forms online also. Helen will follow-up with Carrie. Patricia reported there is a process in place to capture the educator and program director feedback and that will be reported.

FPAQ

Complete further reliability testing

Deb and Garry to work on scores. Cheng will request national data in the spring and clean.

All the response sets are not the same, so harder to do reliability. Need to make judgements to get all the question to have the same number in response set. That would give a scale that is comparable.IE a zero, one or two is unacceptable. Then set kind of good, really good.

Can we recode into 3 or 4 options then able to change into scale, and look at the entire tool to get to a score and scale. Need to discuss with statistician. So do we really need an entire tool scale? Makes sense for EFNEP but who else?

Need to make subscale decisions on Nutrition and PA questions.

Do internal consistency on FY18 data.

Spanish reliability: Nicole and Catalina

Year 1, expert review done by end of fiscal year and plan/protocol for future. Need volunteers – have Imelda from Michigan and Puerto Rico is on board.

Retrospective Pre/Post: Deb PK

Formatting – create and design and test a form for retrospective pre/post (?Kelly to help).

Geb could then develop and test the questions in the formats.

Infant feeding-Beth

High low knowledge groups – low done this fall. Need to find the high knowledge groups. Then will look at what else to do. Responsive feeding is the push in the field, but harder to study/test.

Need to talk with NIFA re: adding questions to national data base.

Done with testing and analysis this fall.

Want to develop a tool that can be used across EFNEP to estimate Cost benefit/effecgtiveness.

Over year, by May have paper to submit based on what learned from project. Methods based paper (using the CO/WA data).

Need assistance in understanding the literature on the nutrition side; finding the best numbers to translate into costs/benefits. Need disease state specialists (diabetes, hypertension, obesity (overweight/obese). Confused by if something impacts multiple things at the same time. How do you account for the shared benefit. If you reduce BMI, it may also reduce other health conditions. May need to run a number of diff approaches then see what makes the most sense.

CO/WA will send BCL and 24-hr recall for participants in biometrics study.

Will have monthly meetings.

Annie to join group. Kavitha will check with her mentor re: obesity and diabetes about providing input.

Focus on funding larger study. Limited by this data (CO/WA), need to give illustration about what this type of data can actually do – such as the table shown in ppt. The more money, the more is possible. Maybe check with foundations for funding requests? Not sure if foundation would be interested in a federal program. What about insurance companies? Frame as study to assess if low income nutrition education results in a cost benefit – lower costs to insurance, state and federal govt. What about DOD? Deb H. will check They are interested in a healthy population for recruitment. Previous unfunded proposal was about $5 million, national study with control group; 10-12 states, 500/states.

Mike – Connecticut; Dawn from CSU – will help as needed;

DAB Timeline for Year 1 (FY19):

Spanish - Expert review done by end of fiscal year and plan/protocol for future

24 hour recall – ?

Retrospective pre/post – need to find additional help to do formatting work.

FPAQ – complete reliability testing and internal consistency for new FPAQ

Infant Feeding – complete high/low knowledge group surveys

QOL

Plan to do cognitive interview this year; 2-3 years in do sensitivity. Short term need states to volunteer to do CI, then reliability testing (2 or 4 weeks a part?). Month a part probably better.

Many tools have to do with health status, general well-being. Pretty short and won’t pick up changes from EFNEP type things. There are some tools we could use to correlate, but question do we need to do that? Those tools not tested with low-income audience; are they then a good comparison? Why are we using these tools instead?

Need help with the response options, about importance/satisfaction.

October 20, 2018

Karen F, Janet, Catalina, Cheng, Deb P-K, Geb, Sandy, Elizabeth, Helen, Karen B, Annie, Mary Kay, Debby, Garry, Kate, Mike (online)

Susan discussed need to include impact information for coordinators. Here’s how this tool benefits you individually. We said how it would benefit program holistically. There will be facts and outcomes we didn’t have before; didn’t have nutrition specifics. We can report specifics instead of % that increased nutrition practices. May take a year or two for them to see and for it to snowball. Many colleagues are intimidated by webneers (using it to manage their employees), They are not confident in using the data in reports and impact statements. If we could put together strongly written fill in the blank sentences that would make their webneers report, they could get the number and fill in the blank to add to a glossy infographic. Group talked about putting together these sentences for every question. But first, started with what do we think from the FPAQ that would be most critical that Helen might want to include on the 2 pager that she does each year. If you are interested in working on this, contact Susan. She will send a doodle poll for the next meeting.

Helen: Not sure what will happen with NIFA communications dept. Last year had a mutlipager. Not sure what will happen this year. What will be helpful for your colleagues – that would be good.

Deb concerned that this has lower value for her. We are almost with the FPAQ tool – but we aren’t done. So wants to concentrate on current work so it doesn’t have to be redone. Extension in NJ isn’t well respected. If we can get the scales done – can say that there is a statistically significantly improvement. If we wait until we have subscales it will be more value. Need to hear from statistician. Also, there is a concern about the funding and are we working on something that will not be used.

Susan proposing getting impacts statements for Helen’s year end report. Then determine what to do. Think about it and take back to subcommittee. Can we name the group? EFNEP Year-end Rpt.

Accomplishment reports to Janet by Nov 15. Janet will combine and post to NIMMS.

Co-chairs should decide how to do the impact statement for the annual reports. Paper in press, comes out on Nov 7; list on 2169 report.

Virtual meeting: April 25, 1 PM eastern, Noon Central, 11 AM Mountain, 10 AM Pacific for three hours. Zoom invite from Catalina.

Agenda Structure of this meeting Feedback:

Separate group meetings or whole groups? Keeping whole group together is beneficial but need more time. Perhaps do the timeline before hand and have an agenda of work. Keep it that way with more time per group.

Thank Deb H for being here. We can’t take her for granted! Please express to her your gratitude.

Thanks to Karen F for hosting us! Thanks to Helen for being here the whole time!

Accomplishments

Collection of Accomplishments   October 1, 2017 – September 30, 2018 NC2169 Multistate Research Project: EFNEP Related Research, Program Evaluation, and Outreach Publications Peer-Reviewed Journals Baker S, Cheng L, Owens Duffy N, Aragon MC, Franck K. The Journey to Improve EFNEP Outcomes: The Food and Physical Activity Questionnaire and Beyond! 2018 National EFNEP Coordinators’ Conference. Engaging Families Transforming Communities. March 2018: Washington, DC.   Aragon MC, Owens Duffy N, Baker S. Validity Testing of the Spanish Translation of the Food and Physical Activity Questionnaire. 2018 National EFNEP Coordinators’ Conference. Engaging Families Transforming Communities. March 2018: Washington, DC.   Kirkpatrick, S.I., Guenther, P.M., Douglass, D., Zimmerman, T., Kahle, L.L., Atoloye, A., Marcinow, M., Savoie-Roskos, M.R., Dodd, K.W., and Durward, C.M. The provision of assistance does not substantially impact the accuracy of 24-hour dietary recalls completed using the Automated Self-administered 24-hour Dietary Assessment Tool among women with low incomes. Journal of Nutrition, in press.  Brewster, P.J., Durward, C.M., Hurdle, J.F., Stoddard, G.J., Guenther, P.M., The Grocery Purchase Quality Index-2016 performs similarly to the Healthy Eating Index-2015 in a national survey of household food purchases. Journal of the Academy of Nutrition and Dietetics, in press. Chlipalski, M., Baker, S., Olson, B., Auld, G. (2018). Evaluation and Lessons Learned from the Development and Implementation of an Online Training for EFNEP Paraprofessional addressing Prenatal Nutrition.  Journal of Nutrition Education and Behavior. Ms. Ref. No.:  JNEB-D-18-00509.   Gills, S., Auld, G., Hess, A., Baker, S. (2018). Similar 24-Hour Dietary Recall Results from Low-Income Adult Females when Collected by Paraprofessionals or a Registered Dietitian Nutritionist. JAND_2018_60. <a href="https://doi.org/10.1016/j.jand.2018.08.168">https://doi.org/10.1016/j.jand.2018.08.168</a>.   Chlipalski, M., Quick, D., Auld, G., Baker, S. (2018). Needs Assessment Regarding Online Training for Paraprofessionals in the Expanded Food and Nutrition Education Program (EFNEP).Journal of Extension, 56(6).  <a href="https://www.joe.org/joe/2018october/rb4.php?utm_source=email&utm_medium=email&utm_campaign=2018october">https://www.joe.org/joe/2018october/rb4.php</a>.   Auld, G., Baker, S., Hernandez-Garbanzo, Y., Infante, N., Inglis-Widrick, R., Procter, S., Yerxa, K. (2018). EFNEP’s Impact on Program Graduates’ Quality of Life. Journal of National Education and Behavior. JNEB-D-17-00681.  <a href="https://doi.org/10.1016/j.jneb.2018.07.021">https://doi.org/10.1016/j.jneb.2018.07.021</a>   Murray, E., Baker, S., Auld, G., (2018) Nutrition Recommendations from the US Dietary Guidelines Critical to Teach Low-Income Adults: Expert Panel Opinion Journal of the Academy of Nutrition and Dietetics. 118(2) 201-203, 205-210. <a href="https://doi.org/10.1016/j.jand.2016.11.007">https://doi.org/10.1016/j.jand.2016.11.007</a>.   Li, C., Auld, G., D’Alonzo, K., Palmer-Keenan, D. Communicating and Assessing Physical Activity: Outcomes From Cognitive Interviews With Low-Income Adults. J Nutr Behav. 2018;50(10):984-992 MacMillan Uribe AL, Olson BH. Exploring Healthy Eating and Exercise Behaviors Among Low-Income Breastfeeding Mothers. J Hum Lact. 2018 Apr 1:890334418768792. doi: 10.1177/0890334418768792. [Epub ahead of print] PubMed PMID: 29723099.   Abstracts/Posters/Professional Presentations Franck, K., & Moore, C. (March, 2018). Food safety tips: Lesson learned from testing the EFNEP food safety questions. Poster session presented at the National EFNEP Coordinator’s Meeting in Washington, DC. Bolt, L., Sweet, C., & Franck, K. (November, 2017). Lessons learned: Recruiting low-income adult participants for nutrition education studies. Paper presentation at the American Evaluation Association conference in Washington, DC. Franck, K. (November, 2017). Assessing competencies for Extension professionals: A comparison of three approaches. Paper presentation at the American Evaluation Association conference in Washington, DC. Baker, S., Li, C., Owens, N., Aragon, C., & Franck, K. (March, 2018). The journey to improve EFNEP outcomes: The Food and Physical Activity Questionnaire and beyond. Presentation at the National EFNEP Coordinator’s Meeting. Arlington, VA. Guenther, P.M., Brewster, P.J., Durward, C.M., and Hurdle, J.F., The Grocery Purchase Quality Index-2016 performs similarly to the Healthy Eating Index-2015 in a national survey of household food purchases. Presented at Nutrition 2018, Boston, June, 2018. Kirkpatrick, S., Guenther, P., Douglass, D. Subar, A. Zimmerman, T. Kahle, L., Atoloye, A., Marcinow, M, Savoie Roskos, M., Dodd, K, Durward, C. Accuracy of 24-Hour Recalls Completed by Women with Low Incomes Using the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24). Presented at Nutrition 2018, Boston, June, 2018. Brewster, P.J., Guenther, P.M., Durward, C.M., and Hurdle, J.F., The Grocery Purchase Quality Index-2016 performs similarly to the Healthy Eating Index-2015 in a national survey of household food purchases. Presented at the National Nutrient Databank Conference, Minneapolis, July, 2018. Baker, S., Aragon, C., Li, C., Franck. K., Owens, N. (March 2018). The Journey to Improve EFNEP Outcomes: The Food and Physical Activity Questionnaire and Beyond. (Plenary Session) 2018 National EFNEP Coordinators’ Conference. Arlington, VA. Aragon, C., Owens, N., Baker, S. (March 2018). Validity Testing of the Spanish Translation of the Food and Physical Activity Questionnaire (FPAQ). 2018 National EFNEP Coordinators’ Conference. Arlington, VA. Baker, S., McGirr, K. (March 2018). Eating Smart • Being Active: Engaging Spanish Speaking Participants. 2018 National EFNEP Coordinators’ Conference. Arlington, VA. Li, C., Palmer-Keenan, D. "How EFNEP Participants Describe Physical Activity" Presented as poster at 2018 EFNEP Coordinators Meeting, March 2018: Arlington, VA.   Baker, S., Aragon, C., Owens, N., Li, C., Franck, K. "The Journey to Improve EFNEP Outcomes-the Food and Physical Activity Questionnaire and Beyond" Presentation at EFNEP Coordinators Meeting, March 2018: Arlington, VA.   Li, C. and Palmer-Keenan, D. “Effects of epoch length and activity cut-points on physical activity estimates among Expanded Food and Nutrition Education Program participants in the United States.” Presented as poster at the 17th International Society of Behavioral Nutrition and Physical Activity Annual Conference, June 2018: Hong Kong. Payton C, Soprano S, Vedherey N, Edwards K, Romney M, Olson B, Abatemarco D, LaNoue M, Leader A. (2018, November). “Workplace lactation support experts’ perspectives on employer compliance with the ACA requirements for breastfeeding employees.” Poster presentation at the American Public Health Association Annual Meeting, San Diego, California. Payton, C., Romney, M., Olson, B., Abatemarco, D., LaNoue, M., Leader, A. “An evaluation of workplace lactation support provided by employers in the Greater Philadelphia and Greater Pittsburgh regions.” Oral presentation at the Leadership Excellence and Gender in Organizations Conference; 2018, March 22; West Lafayette, Indiana. MacMillan-Uribe, Alexandra. “Delivery of nutrition education to the mother-infant dyad within a primary-care group approach”.  The Edward Alexander Bouchet “You’ve got CLASS” Seminar Series, Madison WI, April 18, 2018.   Book Chapters Curricula and Educational Materials Extension Reports/Publications Articles in Popular Press (non-peer reviewed) Webinars/Videos and URL for Online Access Student Theses and/or Dissertations MacMillan Uribe, Alexandra L. Delivery of Nutrition Education to the Mother-Infant Dyad within a Primary-Care Group Approach. The University of Wisconsin - Madison, ProQuest Dissertations Publishing, 2018. 10814426.   Funding Source: University of Wyoming Agriculture Experiment Station Amount: $3,600 Start and End Dates: July 1, 2017 - June 30, 2018 Title: Special funding for NC 2169 EFNEP Related Research Project Director: Mary Kay Wardlaw   Source: USDA National Institute of Food and Agriculture Start and End Dates: 9/1/15-2/28/19 Title: Multi-disciplinary Methods for Effective, Sustainable, and Scalable Evaluations of Nutrition Education Programs Project Director: Carrie M. Durward, PhD, RD, Utah State University     Source: USDA NIFA Amount: WSU: $302,193.00  Start and End Dates: September 2014 - August 2018. Title: Western Region Nutrition Education and Obesity Prevention Center of Excellence Project Director: Susan Baker; Co-director, Karen Barale   Development and Pilot Testing of a Series of Cooking Activities for Low Income 4th Graders. Cunningham-Sabo, L. (PI), Baker, S. (Co-PI). College of Health and Human Sciences-AES (CSU Project) $60,000.00 Funded 2018-2020.   Elizabeth Chitwood, Benevenga Research Award (Fall 2018) “Construct-validity testing of the Infant Feeding Education Questionnaire for the Expanded Food and Nutrition Education Program.” $1500 student award, $500 lab supplies Source: USDA Hatch Multi-State Research Formula Fund Amount: $99,621 Start and End Dates: May 15, 2017 – April 30, 2020 Title: Reaching Mother-Infant Dyads with Nutrition Education through the CenteringParenting® Program: A Unique Collaboration of Cooperative Extension and Health Care (WIS01987) Project Director: Beth Olson   Source: University of Florida Family, Youth and Community Sciences Department Amount: $4,100 Start and End Dates: May 1, 2018 – December 31, 2019 Title: The Impact of Supplementing Peer Nutrition Education with Produce Vouchers on Health Outcomes in “Food Deserts” – Long Term Follow Up Project Director: Nicole Owens Duffy     Source: University of Florida Institute of Food and Agricultural Sciences Extension  Amount: $12,370 Start and End Dates: January 1, 2018 - December 31, 2019 Title: The Impact of Supplementing Peer Nutrition Education with Produce Vouchers on Health Outcomes in “Food Deserts” Project Director: Nicole Owens     Source: Amount: Start and End Dates: Title: Project Director:   Awards United States Department of Agriculture. Certificate of Appreciation. For commitment, dedication, and leadership to strengthen the Expanded Food and Nutrition Education Program adult evaluation and enhance program effectiveness as a member of the Food & Physical Activity Questionnaire Workgroup. March 2018: Washington, DC.   Graduate Students <ul> <li></li> <li>Abiodun Atoloye, PhD student, Utah State University</li> <li>Valliammai Chidambaram, PhD student, University of Utah</li> </ul>   Susan Gills – PhD Fall 2018 Use of the 24-Hour Dietary Recall to Evaluate Intake of Participants in the Expanded Food and Nutrition Education Program.   Lauren Rhoades - MS Spring 2018 Environmental Barriers to Healthful Dietary and Physical Activity Behaviors in the EFNEP Participant Population.   Amanda Petro – MS Fall 2018 Sensitivity of the Food and Physical Activity Questionnaire used by the Expanded Food and Nutrition Education Program   <ul> <li>Cheng Li, MS, PhD student, Rutgers University. Abiodun, Utah </li> <li>Lexi Macmillan-Uribe, PhD student, University of Wisconsin-Madison</li> </ul>     IMPACT STATEMENTS   DAB Impact Statement for 2018 (October 1, 2017 – September 30, 2018) EFNEP reaches adults in every state and all U.S. territories so it is important that assessment tools accurately measure behavior changes. Assessment of adult outcomes has been strengthened through several projects: development and implementation of  the research-tested Food and Physical Activity Questionnaire (FPAQ), adopted October 2017 for use nationally in EFNEP; a pilot study of the feasibility of using the web-based Automated Self-Administered 24-Hour (ASA24) Dietary Assessment Tool; and the development of a tool to measure infant feeding behaviors. FPAQ assessment tool: The FPAQ provides 32 items related to the five EFNEP domains (diet quality, food resource management, food safety, food security, and physical activity). The National EFNEP office selected 20 items to include on the national assessment tool.  The research methods used to develop this tool were disseminated through conference presentations and publications in Journal of Nutrition Education and Behavior with the expectation that nutrition researchers and practitioners will use these methods to strengthen assessment for other nutrition education programs. ASA24 dietary assessment tool: EFNEP adults complete 24-hour diet recalls. EFNEP paraprofessionals participated in training and piloted the use of the ASA24 with adult participants to test the feasibility of this approach. Results from the ASA24 pilot project will be shared through presentations and publications with practitioners to help improve methods for collecting 24-hour diet recalls in nutrition education classes for limited resource adults. Infant feeding behavior assessment tool; The target audience for EFNEP is limited-resource adults with children. Accurate assessment of infant feeding behaviors can help improve nutrition education for parents of young children by targeting behaviors such as infant diet quality and specific food safety practices that are critical for infant health. This work will help improve EFNEP and other nutrition education programs that work with parents of infants.    Excessive weight can begin as early as infancy. Inappropriate infant feeding practices play a role in an infant’s weight trajectory, and therefore education for caregivers is crucial.  Curricula provided by EFNEP educators and others working with low-income families with infants includes nutrition education for the feeding of their infants, including topics such as breast- and formula-feeding, when and how to introduce healthy foods, and guiding infants to develop their own feeding skills.  There has been little valid evaluation of this education.  The NC2169 Infant Feeding workgroup has used best practices to develop evaluation, and conducted preliminary research that indicates this evaluation gives meaningful results.  When complete, this evaluation will provide educators the ability to select appropriate evaluation for their infant feeding education, and the EFNEP program leadership the ability to assess and improve program efforts with this population of parents nationwide.  Healthy infant feeding is expected to improve health not only in infancy, but into childhood and beyond; resulting in an improved quality of life and increased productivity in these families.   Physical activity assessment tool: Physical activity is listed an EFNEP national priority due to its importance in overall health, (e.g., cardiovascular health, optimal glucose metabolism, weight maintenance and obesity prevention, etc.); however, previously it was minimally addressed in EFNEP adult evaluation. Moreover, there were no physical activity assessment instruments that had been assessed for validity and reliability with low-income adults. Nutrition and public health educators who provide physical activity education to low-income audiences need valid and reliable measures and optimal protocols to assess the impact of their programs. Further, stakeholders and funders are interested in the results of the nutrition education programs they are funding. Therefore, there is a need for valid and reliable means of assessing physical activity for EFNEP and other programs that address similar audiences. Researchers at Rutgers took the lead in developing three physical activity questions. With the help of other researchers and EFNEP coordinators nationwide, these physical activity questions were tested for face, content, reliability, as well as criterion validity, using cognitive interviews, expert panels, and test-retest reliability over-time, comparison of data to objective measures respectively. Results from rigorous testing demonstrated that the questions developed are valid and reliable when used with EFNEP adult participants. The questions are now being used nationally to assess EFNEP’s impacts on program participants’ physical activity levels

Publications

Baker S, Cheng L, Owens Duffy N, Aragon MC, Franck K. The Journey to Improve EFNEP Outcomes: The Food and Physical Activity Questionnaire and Beyond! 2018 National EFNEP Coordinators’ Conference. Engaging Families Transforming Communities. March 2018: Washington, DC.   Aragon MC, Owens Duffy N, Baker S. Validity Testing of the Spanish Translation of the Food and Physical Activity Questionnaire. 2018 National EFNEP Coordinators’ Conference. Engaging Families Transforming Communities. March 2018: Washington, DC.   Kirkpatrick, S.I., Guenther, P.M., Douglass, D., Zimmerman, T., Kahle, L.L., Atoloye, A., Marcinow, M., Savoie-Roskos, M.R., Dodd, K.W., and Durward, C.M. The provision of assistance does not substantially impact the accuracy of 24-hour dietary recalls completed using the Automated Self-administered 24-hour Dietary Assessment Tool among women with low incomes. Journal of Nutrition, in press.  Brewster, P.J., Durward, C.M., Hurdle, J.F., Stoddard, G.J., Guenther, P.M., The Grocery Purchase Quality Index-2016 performs similarly to the Healthy Eating Index-2015 in a national survey of household food purchases. Journal of the Academy of Nutrition and Dietetics, in press. Chlipalski, M., Baker, S., Olson, B., Auld, G. (2018). Evaluation and Lessons Learned from the Development and Implementation of an Online Training for EFNEP Paraprofessional addressing Prenatal Nutrition.  Journal of Nutrition Education and Behavior. Ms. Ref. No.:  JNEB-D-18-00509.   Gills, S., Auld, G., Hess, A., Baker, S. (2018). Similar 24-Hour Dietary Recall Results from Low-Income Adult Females when Collected by Paraprofessionals or a Registered Dietitian Nutritionist. JAND_2018_60. <a href="https://doi.org/10.1016/j.jand.2018.08.168">https://doi.org/10.1016/j.jand.2018.08.168</a>.   Chlipalski, M., Quick, D., Auld, G., Baker, S. (2018). Needs Assessment Regarding Online Training for Paraprofessionals in the Expanded Food and Nutrition Education Program (EFNEP).Journal of Extension, 56(6).  <a href="https://www.joe.org/joe/2018october/rb4.php?utm_source=email&utm_medium=email&utm_campaign=2018october">https://www.joe.org/joe/2018october/rb4.php</a>.   Auld, G., Baker, S., Hernandez-Garbanzo, Y., Infante, N., Inglis-Widrick, R., Procter, S., Yerxa, K. (2018). EFNEP’s Impact on Program Graduates’ Quality of Life. Journal of National Education and Behavior. JNEB-D-17-00681.  <a href="https://doi.org/10.1016/j.jneb.2018.07.021">https://doi.org/10.1016/j.jneb.2018.07.021</a>   Murray, E., Baker, S., Auld, G., (2018) Nutrition Recommendations from the US Dietary Guidelines Critical to Teach Low-Income Adults: Expert Panel Opinion Journal of the Academy of Nutrition and Dietetics. 118(2) 201-203, 205-210. <a href="https://doi.org/10.1016/j.jand.2016.11.007">https://doi.org/10.1016/j.jand.2016.11.007</a>.   Li, C., Auld, G., D’Alonzo, K., Palmer-Keenan, D. Communicating and Assessing Physical Activity: Outcomes From Cognitive Interviews With Low-Income Adults. J Nutr Behav. 2018;50(10):984-992 MacMillan Uribe AL, Olson BH. Exploring Healthy Eating and Exercise Behaviors Among Low-Income Breastfeeding Mothers. J Hum Lact. 2018 Apr 1:890334418768792. doi: 10.1177/0890334418768792. [Epub ahead of print] PubMed PMID: 29723099.

Impact Statements

Infant feeding behavior assessment tool; The target audience for EFNEP is limited-resource adults with children. Accurate assessment of infant feeding behaviors can help improve nutrition education for parents of young children by targeting behaviors such as infant diet quality and specific food safety practices that are critical for infant health. This work will help improve EFNEP and other nutrition education programs that work with parents of infants.

Date of Annual Report: 12/08/2019

Report Information

Annual Meeting Dates: 10/16/2019 - 10/19/2019
Period the Report Covers: 10/01/2018 - 09/30/2019

Participants

Catalina Aragon (Washington)
Garry Auld (Colorado)
Susan Baker (Colorado State)
Karen Barale (Washington State)
Geb Bastian (New Jersey; Rutgers)
Helen Chipman (USDA NIFA)
Carrie Durward (Utah State)
Patricia Guenther (Utah State)
Deb Hamernik (Nebraska)
Debi Head (Arkansas)
Debra Keenan (New Jersey; Rutgers)
Andrea Leschewski (South Dakota State)
Janet Mullins (Kentucky)
Beth Olson (Wisconsin)
Sandy Procter (Kansas)
L. Karina Diaz Rios (UC Merced)
Annie Roe (Idaho)
Kavitha Sankavaram (Maryland)
Dave Weatherspoon (Michigan State)
Kelly Webber (Nevada)
Kate Yerxa (Maine)

Participants Attachment:

2019 NC3169 Annual Meeting Minutes -- sp.docx

Brief Summary of Minutes

FY 2020 NC3169 Leadership:

Co-Chairs: Catalina Aragon, Beth Olson, Janet Mullins

Secretaries: Sandy Procter and Kate Yerxa

2020 Meeting:

Location: Kansas City, Missouri

Host: Sandy Procter

Dates: Oct 21-24, 2020 (first choice) or Nov 5-7, 2020

Minutes Attachment:

2019 NC3169 Annual Meeting Minutes -- sp.docx

Accomplishments

SHORT-TERM OUTCOMES: OUTPUTS: Training Resource: Utah ASA24 Training for Nutrition Education Programs, Online Training and In-Person Curriculum. Available at <a href="https://extensioncourses.usu.edu/product/utah-asa24-training-for-nutrition-education-programs/">https://extensioncourses.usu.edu/product/utah-asa24-training-for-nutrition-education-programs/</a> Presentations: Baker, S. (October, 2019). Baker, S., Aragon, C., Mullins, J., Procter, S. Rooted in Communities: The Scholarship, Practice and Engagement of EFNEP Engagement Scholarship. Engagement Scholarship Consortium Conference. Denver, CO. Durwood, C., Baker, S., Chidambaram, V., Franck, K., Kramer, H., McGirr, K., Savoie, K., Smith, J., Weir, C., Yerxa, K., Guenther, P. (July 2019) Exploratory Test of ASA24 to Collect 24-Hour Recalls in the Expanded Food and Nutrition Education Program. Society of Nutrition Education and Behavior Conference. Orlando, FL. Franck, K., Stephenson, L., & Salie, J. (July 2019). Web-based training videos to promote changes in policies, systems and environments for nutrition educators. Paper presentation at the Society for Nutrition Education and Behavior conference in Orlando, FL Gills, S.M.H., Baker, S., Guenther, P.M., Hess, A., Auld, G. (June 2019) Positive Change in Healthy Eating Index-2005 Scores of Low-Income Adults After Participation in the Expanded Food and Nutrition Program (EFNEP). ASN Annual Conference. Baltimore, Maryland. Keenan, P., Baker, S., Auld, G., Li, C., Aragon, C., Franck, K., Owens Duffy, N. (July 2019). Measure What You Teach: How EFNEP Rooted Its New Impact Assessment in Research. (Plenary Session). Society of Nutrition Education and Behavior Conference. Orlando, FL Auld, G., Procter, S, Roe, A., Yerxa, K. EFNEP Quality of Life Cognitive Interview Training Webinar: AES 3169. September 18, 2019. Note; Includes a YouTube Video demonstrating QoL cognitive interview. ACTIVITIES: Virtual Meeting held Spring 2019, scheduled for Spring 2020. Continuing and New Leadership - three co-chairs identified for next year (2019-2020): Catalina Aragon (Washington State), Janet Mullins (University of Kentucky), and Beth Olson (University of Wisconsin). MILESTONES: <ol> <li>Dietary Assessment and Behavior -  Food and Physical Activity Questionnaire (FPAQ) - Testing of Spanish FPAQ plans have been developed with revised methodology based on literature reviewed. Looking for FPAQ expert reviewers, native Spanish speakers, in one of five content domains. Applied for and received a mini-grant that has allowed hiring a graduate student and gift card purchase. Timeline: expert review completed soon, by end of 2020 should have the 3.0 version ready to share. Data would be available 2023. Discussion around timing of project and WebNEERS followed. Will use full 32 question tool for expert review. 24HR Participant Focus Groups – Work has been submitted to JNEB. Title: Qualitative Assessment of the EFNEP Group-Delivered 24-hour Dietary Recall. Reviewers are being sought – discussion around reviewers from non-participating members of this group. ASA24 - Exploratory study of what could happen with use of ASA24 in field (use of end of RNECE funds). Study conducted in three states (ME, CO, TN) with 10 educators. 37 participants entry, 30 at exit. Quantitative and qualitative (interviews and focus groups) data collected. Results: very similar between paper and pencil (P&P) tool and ASA24 use.  Results overall very positive. Educator preference – evenly split. Qualitative themes – accuracy noted; group size was concern – both positive and negative; barriers identified. Duration of recalls was tested. Total calories reported in both methods was identical; total food items reported was also similar.  Proposed full pilot study of ASA24, with external funding needed for extensive work to recruit and collect data from comparison group. Carrie believes NIH grant might be most appropriate. Heather Eicher-Miller from Purdue has submitted an RO1 grant on use of ASA24 (she is with SNAP-Ed there). IN, TX, UT, FL in this submission. Discussion followed around concerns of both SNAP-Ed and EFNEP in same study. The proposal is under review but should be reviewed this month. Infant Feeding Behavior Assessment Tool - Excessive weight can begin as early as infancy. Inappropriate infant feeding practices play a role in an infant’s weight trajectory, and therefore education for caregivers is crucial.  Curricula provided by EFNEP educators and others working with low-income families with infants includes nutrition education for the feeding of their infants, including topics such as breast- and formula-feeding, when and how to introduce healthy foods, and guiding infants to develop their own feeding skills.  There has been little valid evaluation of this education.  The NC2169 Infant Feeding workgroup used best practices to develop evaluation and conducted preliminary research that indicates this evaluation gives meaningful results. In NC3169, validation was completed, resulting in content validity, test-re-test reliability, and a measure of construct validity-known groups technique. When made available in WebNEERS, this evaluation will provide educators the ability to select appropriate evaluation for their infant feeding education, and the EFNEP program leadership the ability to assess and improve program efforts with this population of parents nationwide.  Healthy infant feeding is expected to improve health not only in infancy, but into childhood and beyond; resulting in an improved quality of life and increased productivity in these families. </li> <li>Quality of Life -  Quality of Life (QoL) – Review of QoL of cognitive interview training and discussion of efforts to this point, we want to do in the future. Participants’ improvement seen mostly in “being,” and educators in “belonging.” Since no existing tool captures EFNEP’s effects, this work deemed needed. Now need to do cognitive interviews to examine what details of tool could be most useful. CO, TN, KS, ME, AR, NJ, ID – seven states will be doing this phase. Why does QoL matter? Relationship in QoL literature to self-sufficiency? Bring out these factors into research, policy brief about this topic. </li> <li>Cost Effectiveness Analysis -  Using the new biometric CBA, which uses BMI, the ratio is much improved (2.29 per dollar spent previous method to 2.85 per dollar spent now) Colorado findings: 4.87 to 6.12 now. Findings showed that 30 – 35% showed BMI decrease. These are conservative numbers, but trends are very positive. Reviewed methodology of project, which compares to previous CBA studies. This did use Behavior Checklist questions, not new FPAQ questions, and looks at 6 mos. post-data as well. Indirect benefits – looked at savings in lost earnings vs. healthcare savings (direct benefits). Much higher indirect benefits seen with use of biometric methods. Next steps discussed, asked group to be sure literature cited is most current and representative. Is JNEB best place for this initial finding to be published? A policy brief will be created for EFNEP professionals. Funding sources are needed – foundations, grants. Discussed next paper looking beyond the indicator of BMI – blood pressure, A1C. Are the small changes cumulative, with simultaneous impact? Third paper will address this. Discussion around publishing strategies and steps – is this a public health focused paper rather than a methodological paper?   </li> </ol>

Publications

Publications: <ul> <li>Fuller, S., Phelps, J.A., Baker, S., Boeckner, L., Garrard-Foster, D., Walsh, J. Qualitative Assessment of the EFNEP Group-Delivered 24-hour Dietary Recall. Journal of Nutrition Education and Behavior, under review.</li> <li>Moore, C., Sweet, C., Harrison, J., & Franck, K. Validating responses to a food safety survey with observations of food preparation behaviors among limited resource audiences. Journal of Food Protection, in press.</li> <li>Moore, C. J., Lindke, A., & Cox, G. O. Using sensory science to evaluate consumer acceptance of recipes in a nutrition education intervention for limited resource populations. Journal of Nutrition Education and Behavior, in press.</li> <li>Sneed, C. T., & Franck, K. Back to the basics: Are traditional educational methods still effective in a high-tech world? Journal of Extension, in press.</li> <li>MacMillan Uribe, AL, Olson BH. Development and Evaluation of the Infant Feeding Education Questionnaire for the Expanded Food and Nutrition Program. Journal of Nutrition Education and Behavior, October 9, 2019. <a href="https://doi.org/10.1016/j.jneb.2019.09.006">https://doi.org/10.1016/j.jneb.2019.09.006</a></li> <li>Franck, K., & Sneed, C. Are we listening to our limited-resource audiences? Engaging parents and caregivers with nutrition messaging in Extension programs. Journal of Human Sciences and Extension, 7(3), 52-67, 2019.</li> <li>Spruance L, Atoloye A, Douglass D, Zimmerman TP, Guenther PM, Franck K, Henson T, Moore CJ, Wood G, Durward, CM, 2019, Pilot test of an online ASA24 training with EFNEP educators, SAGE Open 9 (2), p. 2158244019844074. Article, Refereed Journal, Published, 03/15/2019.</li> <li>Kirkpatrick SI, Guenther PM, Douglass D, Zimmerman T, Kahle LL, Atoloye A, Marcinow M, Savoie-Roskos MR, Dodd KW, Durward CM. The provision of assistance does not substantially impact the accuracy of 240hour dietary recall completed using the Automated Self-administered 24-hour Dietary Assessment Tool among women with low incomes. Journal of Nutrition 149(1);114-122. Article, Refereed Journal, Published, 01/02/2019.</li> <li>Brewster PJ, Durward CM, Hurdle JF, Stoddard GJ, Guenther PM. The Grocery Purchase Quality Index-2016 performs similarly to the Healthy Eating Index-2015 in a national survey of household food purchases. Journal of the Academy of Nutrition and Dietetics 119:45–56. Article, Refereed Journal, Published, 01/2019.</li> <li>Kirkpatrick S, Guenther P, Douglass D, Subar A, Zimmerman T, Kahle L, Atoloye A, Marcinow M, Savoie Roskos M., Dodd K, Durward C. Accuracy of 24-hour recalls completed by women with low incomes using the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24). Current Developments in Nutrition 2(11), https://doi.org/10.1093/cdn/nzy045. Abstract, Published, 11/2018.</li> <li>Guenther PM, Brewster PJ, Durward CM, Hurdle JF, The Grocery Purchase Quality Index-2016 performs similarly to the Healthy Eating Index-2015 in a national survey of household food purchases. Current Developments in Nutrition 2(11), https://doi.org/10.1093/cdn/nzy045. Abstract, Published, 11/2018.</li> </ul>

Impact Statements

The target audience for EFNEP is limited-resource adults with children. Accurate assessment of infant feeding behaviors can help improve nutrition education for parents of young children by targeting behaviors such as infant diet quality and specific food safety practices that are critical for infant health. This work will help improve EFNEP and other nutrition education programs that work with parents of infants.

Date of Annual Report: 12/23/2020

Report Information

Annual Meeting Dates: 10/21/2020 - 10/23/2020
Period the Report Covers: 10/01/2019 - 09/30/2020

Participants

Participants Attachment:

NC3169 Annual Meeting Minutes 2020.docx

Brief Summary of Minutes

Minutes Attachment:

NC3169 Annual Meeting Minutes 2020.docx

Accomplishments

Accomplishments: Outputs: Baker, S., Procter, S., Mullins, J., Aragon, M. C. (2019). Rooted in Communities The Scholarship, Practice and Engagement of the Expanded Food and Nutrition Education Program. Engagement Scholarship Consortium Conference. Denver, CO. Wilson, Hannah, Bradley Averill, Georgeanne Cook, Jackie Dallas, Christa Campbell, Jessica Moore, Zohregul Soltanmammedova et al. "Feasibility of ASA-24 in Community- Based Settings: P167." Journal of Nutrition Education and Behavior 52, no. 7 (2020). Leschewski A, Aragon MC, Baker S, Weatherspoon D, Barale K and Auld G. 2020. Expanded Food and Nutrition Education Program Generates Economic Value Through Chronic Disease Biomarker Improvement: A Cost-Benefit Analysis. Journal of the Academy of Nutrition and Dietetics. (Under Review) Funding Source: University of Florida, Department of Family, Youth and Community Sciences Amount: $4,960 Start and End Dates: June 1, 2019 – September 30th, 2020 Title: Testing the Spanish Translation of the EFNEP Food and Physical Activity Questionnaire Project Director: Nicole Owens Duffy, PhD, University of Florida; M. Catalina Aragon, MS, Washington State University Source: University of Florida, Department of Family, Youth and Community Sciences Amount: $5,000 Start and End Dates: June 1, 2020 – September 30th, 2021 Title: Testing the Spanish Translation of the EFNEP Food and Physical Activity Questionnaire: Phase Two Project Director: Nicole Owens Duffy, PhD, University of Florida; M. Catalina Aragon, MS, Washington State University Impacts: EFNEP reaches adults in every state and all U.S. territories so it is important that assessment tools accurately measure behavior changes. The Food and Physical Activity Questionnaire (FPAQ) behavioral assessment tool has been completed and is ready for use by both EFNEP and any program that provide nutrition education to low-income adults. The final version of the FPAQ has been integrated into the EFNEP national electronic data collection system for use in the new EFNEP Adult Questionnaire that will be launched in October of 2020 for use beginning federal fiscal year 2021. Activities: The Food and Physical Activity Questionnaire (FPAQ) will engage in additional work to create impact statement templates that can be used by states to share the results gleaned from the tool’s use. A Spanish version of the tool has been created and research to support its efficacy is underway. Also, a version that can be used as a retrospective pre-test (as opposed to the current pre-/post- test) is undergoing cognitive testing to ensure that the version presented is understood by the target audience. ASA24 dietary assessment tool: EFNEP adults complete 24-hour diet recalls. Pilot data (qualitative and quantitative) from the use of this method, which is new to EFNEP has been compiled and will be analyzed in the upcoming year, and the Michigan’s EFNEP program has begun use of an online training to prepare for its use in collecting their 24-hour recalls. Milestones: The year of 2020 will be an exception in many ways, notably the ability to carry on long-term work during challenging times. We were able to have a mid-year and annual meeting virtually and all work groups continued meeting. New members were recruited. Annual Meeting Agenda: https://www.dropbox.com/s/jk5evbyfmh1b9gi/2020%20NC3169%20Annual%20Meeting%20Ag enda.docx?dl=0 Publications: Wilson, Hannah, Bradley Averill, Georgeanne Cook, Jackie Dallas, Christa Campbell, Jessica Moore, Zohregul Soltanmammedova et al. "Feasibility of ASA-24 in Community-Based Settings: P167." Journal of Nutrition Education and Behavior 52, no. 7 (2020). Leschewski A, Aragon MC, Baker S, Weatherspoon D, Barale K and Auld G. 2020. Expanded Food and Nutrition Education Program Generates Economic Value Through Chronic Disease Biomarker Improvement: A Cost-Benefit Analysis. Journal of the Academy of Nutrition and Dietetics. (Under Review

Publications

Publications: Wilson, Hannah, Bradley Averill, Georgeanne Cook, Jackie Dallas, Christa Campbell, Jessica Moore, Zohregul Soltanmammedova et al. "Feasibility of ASA-24 in Community-Based Settings: P167." Journal of Nutrition Education and Behavior 52, no. 7 (2020). Leschewski A, Aragon MC, Baker S, Weatherspoon D, Barale K and Auld G. 2020. Expanded Food and Nutrition Education Program Generates Economic Value Through Chronic Disease Biomarker Improvement: A Cost-Benefit Analysis. Journal of the Academy of Nutrition and Dietetics. (Under Review)

Impact Statements

EFNEP reaches adults in every state and all U.S. territories so it is important that assessment tools accurately measure behavior changes. The Food and Physical Activity Questionnaire (FPAQ) behavioral assessment tool has been completed and is ready for use by both EFNEP and any program that provide nutrition education to low-income adults. The final version of the FPAQ has been integrated into the EFNEP national electronic data collection system for use in the new EFNEP Adult Questionnaire that will be launched in October of 2020 for use beginning federal fiscal year 2021.

Date of Annual Report: 12/16/2021

Report Information

Annual Meeting Dates: 10/27/2021 - 10/29/2021
Period the Report Covers: 10/01/2020 - 09/30/2021

Participants

Participants Attachment:

NC 3169 Membership List Oct FFY2022.xlsx

Brief Summary of Minutes

Minutes Attachment:

NC3169 2021 Annual Meeting Breakout Minutes.docx

Accomplishments

Accomplishments:  Short-term Outcomes:  <ul> <li style="font-weight: 400;">A rigorously-tested, valid and reliable tool to evaluate the success of the Expanded Food and Nutrition Education Program, which reaches thousands of low-income caregivers of young children nationwide each year.</li> <li style="font-weight: 400;">Impact statement templates for EFNEP coordinators to communicate the impacts of EFNEP education to stakeholders, such as legislators.</li> <li style="font-weight: 400;">A valid and reliable infant feeding behaviors questionnaire that EFNEPs can use to measure the success of infant feeding education provided to expecting and new parents via EFNEP.</li> </ul>   Outputs:  Presentations Aragon MC, Baker S, Barale K, Leschewski A. 2021. A Cost-Benefit Analysis of EFNEP in WA and CO using BMI. 2021 National EFNEP Coordinators Conference. (March 10, virtual). Olson B, Uribe LLM. 2021. The Development of the Infant Feeding Evaluation Items. Annual State EFNEP Coordinators’ Post Conference: Strengthening Your EFNEP Toolbox. (March 16 & 17 [offered twice]; Virtual Conference). Grants Awarded Leschewski A, Aragon MC, Sankavaram K, Baker S, Duffy N, Roe A, Sharma D. 2021. A Cost- Benefit Analysis of EFNEP Utilizing Biomarkers of Chronic Disease Risk. USDA NIFA AFRI-Program Priority Area A1344 Diet Nutrition and the Prevention of Chronic Diseases. Funding request: $963,386. Duffy NO, Aragon MC. June 1, 2020 - September 30, 2021. Testing the Spanish Translation of the EFNEP Food and Physical Activity Questionnaire: Phase Two. University of Florida, Department of Family, Youth and Community Sciences. Funding request: $5,000. Publications Gills SMH, Auld G, Hess A, Guenther PM, Baker SS. 2021. Positive Change in Healthy Eating Scores Among Adults with Low Income After Expanded Food and Nutrition Education Program Participation. Journal of Nutrition Education and Behavior. 53(6):503-510. Murray EK, Baker SS, Betts NM, Hess A, Auld G. 2020. Development of a National Dietary Behaviors Questionnaire for EFNEP Adult Participants. Journal of Nutrition Education and Behavior. 52(12):1088-1099. Leschewski A, Aragon MC, Baker S, Weatherspoon D, Barale K, Auld G, Acquah-Sarpong R. 2021. EFNEP Generates Economic Value Through BMI Improvement: A Cost-Benefit Analysis. Journal of Nutrition Education and Behavior. (Under Review). Barale K, Aragon, MC, Yerxa K, Auld G, Hess A. Development of Reliable and Valid Questions to Assess Food Resource Management Behaviors in Adults with Limited Income Journal of Nutrition Education and Behavior. (accepted for publication). Products Six videos were created to support infant feeding education, based on work affiliated through Hatch funding with NC3169. There are six videos, available in  English and Spanish (12 videos total).  Available at: https://mediaspace.wisc.edu/channel/Feeding%2BMy%2BBaby%2BVideos/225760533   Activities: Despite the ongoing COVID-19 pandemic, research activity has continued and progress towards this multistate group’s goals has been made. <ul> <li style="font-weight: 400;">Cognitive interviews were conducted with low-income adults to ensure that our developed scales were understandable by EFNEP’s target population.</li> <li style="font-weight: 400;">EFNEP coordinators were interviewed to determine how 24-hour recall practices differed among the implementing institutions.</li> <li style="font-weight: 400;">Spanish-speaking nutrition, physical activity, food safety, and food resource management experts were consulted to provide feedback on a Spanish translation of the Food and Physical Activity Questionnaire, to provide a standardized evaluation instrument to a substantial portion of EFNEP’s target audience.</li> </ul>   Milestones:  <ol> <li style="font-weight: 400;">Dietary Assessment and Behavior (DAB) 24-Hour Dietary Recall (24HDR): Researchers completed the proposed Phase 1 study, by conducting interviews with 56 EFNEP Coordinators to examine their programs’ current practices, plus their and paraprofessionals’ knowledge, training, and administration (individual or groups) of the 24HDRs. Currently, this project is in Phase 2, which consists of conducting in-depth interviews with paraprofessionals to understand their processes of administering 24HDR, the training they received, and their barriers to successful 24HDR data collection. Findings from this evaluation will help identify the gaps in 24HDR training and offer recommendations on the best 24HDR training practices and 24HDR training protocols for EFNEP paraprofessionals who work in a group or individual setting.</li> </ol>   Automated Self-administered 24-hour Diet Recall (ASA24): No research progress was made this fiscal year on this portion of the proposed work due to the retirement of one of the lead researchers, and a change of position with the other. However, a new, actively participating NC3169 member is leading others in an effort to develop another EFNEP ASA24-related project for the anticipated submission of a new EFNEP Research multi-state Proposal to be submitted for the next project period (2024-2029).   Food and Physical Activity Questionnaire (FPAQ): Internal consistency measurements of the FPAQ subscales will be conducted using Federal Fiscal Year 2021 program data over the next year. A team of researchers have developed impact statement templates related to FPAQ for EFNEP coordinators to communicate the impacts of EFNEP to stakeholders, e.g., legislators. The researchers conducted 4 focus groups with communications personnel (n=13) at land grant universities to refine the impact statements for maximum effect. Spanish Translation of FPAQ: A first round of expert reviews were completed for the Spanish FPAQ, to ensure accurate translation. Eleven experts in nutrition, physical activity, food safety, and food resource management, all of whom are bilingual in Spanish and English, were selected for this review.   Retrospective Pretest FPAQ: This project has progressed under leadership of a doctoral student, of which this is her dissertation project, and her faculty advisor. After adapting the protocol to be administered via Zoom, cognitive testing of the retrospective FPAQ questions is underway in NJ, GU, CO, TN, and MD, to test the face validity of the retrospective FPAQ (i.e., whether low-income adults understand the difference in temporality between the retrospective pretest question, and its corresponding posttest question).   Infant Feeding Questions: This work was completed in Federal Fiscal Year 2020. <ol> <li style="font-weight: 400;">Quality of Life (QoL) The QoL workgroup has identified items for a quality of life assessment tool for low-income adults who receive EFNEP lessons. Validity and reliability testing is underway and will continue into the next year to ensure the tool is appropriate for assessing quality of life changes in our target population. The face validity of the tool, i.e., the ability for the target audience to properly understand the questions’ constructs, is being assessed through qualitative cognitive interviews with low-income adults in several states (KS, ME, ID, CA, and potentially others). The construct validity (i.e., how accurate the tool assesses the intended psychological constructs) and temporal reliability (i.e., how consistently participants complete the tool over multiple administrations when they are not exposed to an intervention) will be assessed concurrently using a multistate sample of low-income adults during the next year. Both of these measurements are quantitative assessments and will require participants to complete the group’s QoL assessment twice, and a series of other validated QoL instruments once. </li> <li style="font-weight: 400;">Cost-Benefit Analysis (CBA) A team of researchers from the CBA workgroup have received funding through the Agriculture and Food Research Initiative to expand on previous pilot studies conducted in CO and WA, which found a demonstrable cost benefit of EFNEP lessons for low-income participants and chronic disease risk, based on measured bioindicators like body mass index, blood pressure, and glycosylated hemoglobin. A cost-benefit analysis of EFNEP lessons using behavioral changes from the FPAQ and 24-hour diet recall to assess chronic disease risk is also being planned. Over the next year, the CBA workgroup plans to adapt a protocol developed at the University of Idaho to conduct such a cost-benefit analysis using national FPAQ and diet recall data from Federal Fiscal Year 2021.</li> </ol>

Publications

<ol> <li>Gills SMH, Auld G, Hess A, Guenther PM, Baker SS. 2021. Positive Change in Healthy Eating Scores Among Adults with Low Income After Expanded Food and Nutrition Education Program Participation. Journal of Nutrition Education and Behavior. 53(6):503-510.</li> <li>Murray EK, Baker SS, Betts NM, Hess A, Auld G. 2020. Development of a National Dietary Behaviors Questionnaire for EFNEP Adult Participants. Journal of Nutrition Education and Behavior. 52(12):1088-1099.</li> <li>Leschewski A, Aragon MC, Baker S, Weatherspoon D, Barale K, Auld G, Acquah-Sarpong R. 2021. EFNEP Generates Economic Value Through BMI Improvement: A Cost-Benefit Analysis. Journal of Nutrition Education and Behavior. (Under Review).</li> <li>Barale K, Aragon, MC, Yerxa K, Auld G, Hess A. Development of Reliable and Valid Questions to Assess Food Resource Management Behaviors in Adults with Limited Income Journal of Nutrition Education and Behavior. (accepted for publication).</li> </ol>

Impact Statements

Through the work completed this year by NC3169, Extension Specialists, Agents, and Program Assistants are better able to evaluate the impacts provided to adult participants of EFNEP. Additionally, these methods provide means for nutrition educators to better evaluate other nutrition education programs, like the Supplemental Nutrition Assistance Program - Education (SNAP-Ed). Through more rigorous and holistic evaluation methods on the impacts of Extension nutrition education for low-income families, we can better ensure that our teaching methods are indeed helping low-income families eat healthier, be more physically active, handle food safely, better manage limited food dollars, improve household food security, improve overall quality of life, and lead to future healthcare cost savings by changing behaviors which impact chronic disease risk.

Date of Annual Report: 11/23/2022

Report Information

Annual Meeting Dates: 10/13/2022 - 10/14/2022
Period the Report Covers: 10/01/2021 - 09/30/2022

Participants

Participants Attachment:

NC3169 Membership List October 2022.xlsx

Brief Summary of Minutes

Minutes Attachment:

NC3169 2022 Annual Meeting Minutes Complete.docx

Accomplishments

Accomplishments Short-term Outcomes <ul> <li>Improved communication of EFNEP impacts to stakeholders</li> <li>Improved EFNEP evaluation methodology</li> <li>Alternative means of conducting EFNEP evaluation</li> </ul> Outputs Presentations <ol> <li>Chen, Q., Bastian, G. E., Palmer-Keenan, D., & Fitzgerald, N. (2022). A Retrospective Pretest-Posttest Design as an Alternative Evaluation Method for EFNEP. Society for Nutrition Education and Behavior Annual Meeting, Atlanta, GA.</li> </ol> Publications <ol> <li>Fuller, S., Phelps, J., Baker, S. Walsh, J. (In-Press). Qualitative Analysis of the Expanded Food and Nutrition Education Program’s 24-hour Dietary Recall. Journal of Extension</li> <li>Chen, Q., Bastian, G. E., Palmer-Keenan, D., & Fitzgerald, N. (2022). A Retrospective Pretest-Posttest Design as an Alternative Evaluation Method for EFNEP. Journal of Nutrition Education and Behavior, 54(7), S59-S60.</li> <li>Pybus, K., Gibbs, R. L., Franck, K., & Aragón, M. (In Press). Development and Evaluation of Impact Statements for the Expanded Food and Nutrition Education Program (EFNEP). The Journal of Extension.</li> <li>Leschewski A, MC Aragon , S Baker, D Weatherspoon, K Barale, G Auld, and R Acquah-Sarpong. 2022. EFNEP Generates Economic Value Through BMI Improvement: A Cost-Benefit Analysis. Journal of Extension (Status: Under Review). </li> </ol> Activities Spanish FPAQ The Spanish FPAQ workgroup lost three of five members this year, slowing down progression on this project. We are currently working on transferring data and funding from University of Florida to Texas A&M AgriLife Research. A second round of feedback on the Spanish translation of the Food and Physical Activity Questionnaire was conducted with Spanish-speaking nutrition, physical activity, food safety, and food resource management experts. Questions were modified for clarity and adequacy of words and phrases based on expert feedback. The resulting final draft will be used to face validate the questions through cognitive interviews with EFNEP-eligible Spanish-speaking adults.  Impact Statements Four impact statements for the Expanded Food and Nutrition Education Program (EFNEP) were developed and evaluated. The statements were drafted after conducting literature reviews for core content areas of EFNEP that include diet quality, food resource management, physical activity, and food safety. This work was done based on the previous work completed by a previous iteration of this multistate group (NC2169) to develop the Food and Physical Activity Behaviors Questionnaire (FPAQ), which comprises 25 of the 30 questions used for adult EFNEP evaluation.   We evaluated the statements by facilitating expert panels made up of subject matter experts and communication professionals (n=14) from 12 Land-grant Universities. These impact statements aim to support EFNEP and/or Extension Coordinators when communicating program value with key external stakeholders, including legislative staff and county leaders. The statements were disseminated to all EFNEP Coordinators in four training sessions in August and September 2022. These trainings were facilitated by two members of the impact statement team, Karen Franck and Kylie Pybus.   Milestones  FPAQ Retrospective Testing Cognitive interviews for testing the retrospective pretest-posttest format were completed with 45 adult EFNEP graduates; Colorado State University, Rutgers University-New Brunswick, University of Guam, University of Maryland-College Park and University of Tennessee-Knoxville contributed to the recruitment and interviews of the participants.  The results of the cognitive interviews were analyzed and shared with the NC3169 group; preliminary analysis results were presented as a poster at an international (SNEB) conference. Based on the results of the cognitive interviews, the side-by-side design for the retrospective Adult Questionnaire (AQ) was adopted, and full length AQ questions were revised for the retrospective testing format.  With the approval of the national EFNEP office, a multi-layered data entry system was established within WebNEERS, EFNEP's reporting system, to enable data entry for both the retrospective and regular pre-post testing. IRB approval was obtained for implementation of retrospective pre-post pilot testing. The doctoral student (Qing Chen) conducted training sessions with the EFNEP personnel (including supervisors and peer educators) from the participating states (CO, NJ, MD, and TN) in preparation for the retrospective testing. Pilot tests were conducted among 284 adult EFNEP participants from 4 states. The retrospective pre-post testing data are currently being processed and will be analyzed in FY 2023. The planning of the follow-up cognitive interviews is underway with the aim to qualitatively explore potential biases (e.g., response shift) in the currently used prospective pre-posttests. Spanish FPAQ A second and final round of expert reviews were completed for the Spanish FPAQ, to ensure accurate translation. Ten experts in nutrition, physical activity, food safety, and food resource management, all of whom are bilingual in Spanish and English, provided feedback.

Publications

<ol> <li>Fuller, S., Phelps, J., Baker, S. Walsh, J. (In-Press). Qualitative Analysis of the Expanded Food and Nutrition Education Program’s 24-hour Dietary Recall. Journal of Extension</li> <li>Chen, Q., Bastian, G. E., Palmer-Keenan, D., & Fitzgerald, N. (2022). A Retrospective Pretest-Posttest Design as an Alternative Evaluation Method for EFNEP. Journal of Nutrition Education and Behavior, 54(7), S59-S60.</li> <li>Pybus, K., Gibbs, R. L., Franck, K., & Aragón, M. (In Press). Development and Evaluation of Impact Statements for the Expanded Food and Nutrition Education Program (EFNEP). The Journal of Extension.</li> <li>Leschewski A, MC Aragon , S Baker, D Weatherspoon, K Barale, G Auld, and R Acquah-Sarpong. 2022. EFNEP Generates Economic Value Through BMI Improvement: A Cost-Benefit Analysis. Journal of Extension(Status: Under Review). </li> </ol>

Impact Statements

Through the work completed this year by NC3169, Extension Specialists, Agents, and Program Assistants are better able to evaluate the impacts provided to adult participants of EFNEP. Progress was made for both the retrospective and Spanish versions of the FPAQ, helping to create more inclusive and efficient ways to measure the success of our EFNEP programs. Additionally, the completion of the Impact Statement project and subsequent publication will help to provide resources for EFNEP programs to speak in a unified manner to the successes of their community nutrition programming efforts.