promoting healthy home-cooked family meals: …
TRANSCRIPT
University of Kentucky University of Kentucky
UKnowledge UKnowledge
Theses and Dissertations--Dietetics and Human Nutrition Dietetics and Human Nutrition
2016
PROMOTING HEALTHY HOME-COOKED FAMILY MEALS: PROMOTING HEALTHY HOME-COOKED FAMILY MEALS:
EVALUATION OF A SOCIAL MARKETING PROGRAM TARGETING EVALUATION OF A SOCIAL MARKETING PROGRAM TARGETING
LOW-INCOME MOTHERS LOW-INCOME MOTHERS
Mollie Y. Dawahare University of Kentucky, [email protected] Digital Object Identifier: http://dx.doi.org/10.13023/ETD.2016.087
Right click to open a feedback form in a new tab to let us know how this document benefits you. Right click to open a feedback form in a new tab to let us know how this document benefits you.
Recommended Citation Recommended Citation Dawahare, Mollie Y., "PROMOTING HEALTHY HOME-COOKED FAMILY MEALS: EVALUATION OF A SOCIAL MARKETING PROGRAM TARGETING LOW-INCOME MOTHERS" (2016). Theses and Dissertations--Dietetics and Human Nutrition. 43. https://uknowledge.uky.edu/foodsci_etds/43
This Master's Thesis is brought to you for free and open access by the Dietetics and Human Nutrition at UKnowledge. It has been accepted for inclusion in Theses and Dissertations--Dietetics and Human Nutrition by an authorized administrator of UKnowledge. For more information, please contact [email protected].
STUDENT AGREEMENT: STUDENT AGREEMENT:
I represent that my thesis or dissertation and abstract are my original work. Proper attribution
has been given to all outside sources. I understand that I am solely responsible for obtaining
any needed copyright permissions. I have obtained needed written permission statement(s)
from the owner(s) of each third-party copyrighted matter to be included in my work, allowing
electronic distribution (if such use is not permitted by the fair use doctrine) which will be
submitted to UKnowledge as Additional File.
I hereby grant to The University of Kentucky and its agents the irrevocable, non-exclusive, and
royalty-free license to archive and make accessible my work in whole or in part in all forms of
media, now or hereafter known. I agree that the document mentioned above may be made
available immediately for worldwide access unless an embargo applies.
I retain all other ownership rights to the copyright of my work. I also retain the right to use in
future works (such as articles or books) all or part of my work. I understand that I am free to
register the copyright to my work.
REVIEW, APPROVAL AND ACCEPTANCE REVIEW, APPROVAL AND ACCEPTANCE
The document mentioned above has been reviewed and accepted by the student’s advisor, on
behalf of the advisory committee, and by the Director of Graduate Studies (DGS), on behalf of
the program; we verify that this is the final, approved version of the student’s thesis including all
changes required by the advisory committee. The undersigned agree to abide by the statements
above.
Mollie Y. Dawahare, Student
Dr. Janet Mullins, Major Professor
Dr. Kelly Webber, Director of Graduate Studies
PROMOTINGHEALTHYHOME-COOKEDFAMILYMEALS:EVALUATIONOFASOCIALMARKETINGPROGRAM
TARGETINGLOW-INCOMEMOTHERS
_______________________________________________
THESIS
_______________________________________________
A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in the College of Agriculture, Food and Environment at the University of
Kentucky
By
Mollie Yamin Dawahare
Lexington, Kentucky
Director: Janet Mullins, Ph.D., R.D., L.D.
Lexington, Kentucky
2016
Copyright©MollieYaminDawahre2016
ABSTRACTOFTHESIS
PROMOTINGHEALTHYHOME-COOKEDFAMILYMEALS:EVALUATIONOFASOCIALMARKETINGPROGRAM
TARGETINGLOW-INCOMEMOTHERS
Objective:Evaluatehowasocialmarketingapproachcomparestotraditionalnutritioneducationcurriculumforpromotingbehavioralchangesrelatedtoeatingandfood.Design:Nonequivalentcomparisongroup,entry-exitdesign.Participantsfrom12Kentuckycountiesassignedeithercomparisonorpilotgroup.Comparisongroupreceivedtraditionalnutritioneducationcurriculumandpilotgroupreceivedthesocialmarketingprogram,CookTogether,EatTogether(CTET)curriculum.EFNEP’sBehaviorChecklistand24-HourDietaryRecallwereadministeredatentryandexitofthe8-weekprograms.Participants:Females(18-72yearsofage)fromfamilieseligibletoreceiveSNAPbenefits(n=64comparisongroupparticipants,n=60pilotgroupparticipants).Intervention:Comparisongroupcompletedan8-weekstandardlessonandpilotgroupcompletedCTETprograminvaryingtimeframes(1-8weeks).MainOutcomeMeasures:Eatingbehaviorchangesbetweenentryandexitforcomparisonversuspilot.Analysis:Quantitativedatawereanalyzedusingindependentandpairedt-testswithsignificanceofP≤0.05and0.10.Results:Groupsweredemographicallysimilar.BothhadsignificantdifferencesinentryandexitscoresforBehaviorChecklistand24-HourRecall(P≤0.05).ConclusionandImplications:Positivebehaviorchangewasobservedinbothcomparisonandpilotgroups.Asocialmarketingprogramprovestobeapromisingapproachtonutritioneducation.KeyWords:ExpandedFoodandNutritionEducationProgram,SupplementalNutritionAssistanceProgram-Education,Cook-TogetherEatTogether,low-incomemothers
MollieDawahare
March30,2016
PROMOTINGHEALTHYHOME-COOKEDFAMILYMEALS:EVALUATIONOFASOCIALMARKETINGPROGRAM
TARGETINGLOW-INCOMEMOTHERS
By
MollieYaminDawahare
JanetMullins,PhD,RD,LDDirectorofThesis
KellyWebber,PhD,MPH,RD,LDDirectorofGraduateStudies
April5,2016
iii
Acknowledgements
Iwouldliketothankallthosewhohelpedtomakethisthesispossible.IamsoappreciativeofthetimeandenergyDr.JanetMullinsdevotedtowardsthiscompilationofresearch.Itwouldnothavebeenpossiblewithouthercontinuousmotivationandguidance.IalsowouldliketothanktheteamofprofessionalsattheNutritionEducationProgramofficeincludingJacquelynWalters,RebeccaFreeman,andLolaAdedokunwhonotonlyallowedmetoworkwiththemontheproject,butofferedtheiradviseandexpertisethroughouttheresearch.Iwouldalsoliketothankmycommitteemembers,Dr.KellyWebberandDr.SandraBastin,whotookaninterestinmyresearchandspenttimetoprovideconstructivefeedback.Theyhavebeenaninspirationduringmyundergraduateandgraduatecareer,andIamincrediblygratefulfortheirencouragement.Last,butnotleast,Iwouldliketothankmyfiancé,Nick,andmyparentsforbeingasourceofsupportandmotivationduringthistime,forrecognizingthevalueofmyresearch,andpushingmetoachievegreatness.
iv
TableofContents
Acknowledgments.................................................................................................................................... iii
ListofTables. ...............................................................................................................................................v
ListofFigures ............................................................................................................................................. vi
Introduction ................................................................................................................................................. 2EffectivenessofEFNEPandSNAP-Ed...................................................................................... 2TraditionalNutritionEducationCurriculum........................................................................ 3CookTogether,EatTogetherProgram ................................................................................... 3
Methods ......................................................................................................................................................... 5StudyDesign ....................................................................................................................................... 5EvaluationInstruments ................................................................................................................. 6DataCollection................................................................................................................................... 7DataAnalysis ...................................................................................................................................... 7
Results ............................................................................................................................................................ 8Demographics .................................................................................................................................... 8BaselineComparisonofTraditionalandCTETGroups ................................................... 8OutcomeMeasuresforTraditionalNutritionEducationCurriculum........................ 9OutcomeMeasuresforCTET....................................................................................................... 9EvaluationofTraditionalversusCTETApproach............................................................10
Discussion ...................................................................................................................................................18CharacteristicsofGroupsatBaseline ....................................................................................18OutcomesforTraditionalNutritionEducationCurriculum.........................................18OutcomesforCTET........................................................................................................................19ComparisonofTraditionalNutritionEducationtoCTET .............................................20
ImplicationsforResearchandPractice .........................................................................................27
Appendices .................................................................................................................................................29AppendixA:Facilitator’sGuideforTraditionalNutritionEducationCurriculum.........................................................................................................................................29AppendixB:CurriculumMatrixforCTET............................................................................33AppendixC:BehaviorChecklist ...............................................................................................35AppendixD:24-HourDietaryRecall......................................................................................36AppendixE:NEPCookTogether,EatTogetherRecruitmentFlyer..........................38
References ..................................................................................................................................................39Vita ................................................................................................................................................................45
v
LISTOFTABLES
Table1.Demographics..........................................................................................................................11Table2.IndependentT-TestofMeanatBaselineforComparisonvs.Pilot(Behavior
Checklist) ......................................................................................................................................12Table3.IndependentT-TestofMeanatBaselineforPilotvs.ComparisonGroups
(24-HourRecall)........................................................................................................................13Table4.PairedT-testofMeansofEntryandExitforComparisonandPilotCounties
(BehaviorChecklist) ................................................................................................................14Table5.PairedT-testofMeansofEntryandExitforComparisonandPilotCounties
(24-HourRecall)........................................................................................................................15Table6.IndependentSampleT-TestofDifferencesintheEntryandExitScoresfor
Comparisonvs.PilotCounties(BehaviorChecklist) .................................................16Table7.IndependentSampleT-testofDifferencesBetweenEntryandExit
Comparisonvs.PilotCounties(24-HourRecall).........................................................17
vi
ListofFigures
Figure1.PopulationofCompleteDataSetsforFirstPilot ....................................................22Figure2.IndependentT-TestofMeanatBaselineforComparisonvs.Pilot(BehaviorChecklist)...............................................................................................................................23Figure3.PairedT-testofMeansofEntryandExitforComparisonCounties(BehaviorChecklist)...............................................................................................................................24Figure4.PairedT-testofMeansofEntryandExitforPilotCountiesfor(BehaviorChecklist).....................................................................................................................................................25Figure5.IndependentSampleT-TestofDifferencesintheEntryandExitScoresforComparisonvs.PilotCounties(BehaviorChecklist)................................................................26
1
Introduction
TheSupplementalNutritionAssistanceProgram(SNAP)isaneconomicand
hungerassistanceprogramforeligible,low-incomefamiliesforfoodpurchases
(USDA,2016).SNAP-Ed,theeducationalcomponentofSNAP,promoteshealthy,
nutritiouslifestylechoicesandobesityprevention(USDA,2012).SNAP-Edworks
withstateagencies,nutritioneducators,andcommunityorganizationsthatprovide
outreachtoqualifiedindividuals.InadditiontoSNAP-Ed,theExpandedFoodand
NutritionEducationProgram(EFNEP)promoteshealthylifestylesanddisease
preventionthroughcommunityoutreach(USDA,EFNEP).TheNutritionEducation
Program(NEP)isanationallybasedorganizationthathelpsprovidetrainingand
curriculumsupporttotheCooperativeExtensionOfficeslocatedineverycountyin
Kentucky.TheUniversityofKentuckyCooperativeExtensionOfficeinturnoffers
EFNEPandSNAP-Edservicesthroughtheirtrainedparaprofessionals.
Inthedisciplineofnutritioneducation,socialmarketinghasshowntobea
promisingapproachforprogramimplementationaimedatbehaviorchange(Grier&
Bryant,2005).Socialmarketingisa“processthatappliesmarketingprinciplesand
techniquestocreate,communicate,anddelivervalueinordertoinfluencetarget
audiencebehaviorsthatbenefitsocietyaswellasthetargetaudience”(Kotler&Lee,
2008).Formernutritioneducationprogramsusedthe“top-down”method,where
healthprofessionalsidentifiedahealth-relatedissueandthenofferedsolutions.
Thisapproachputstheburdenontheparticipanttomakechangesbasedonexpert
advice.Thetraditionalapproachdidnottakeintoaccountparticipantperceptions
andcharacteristics.Socialmarketingusesa“bottom-up”method,focusingon
2
behaviorchangethroughnutritionandhealtheducation(Young,2004).Social
marketingencouragesthetargetaudiencetoadopthealthierhabitsbyusinga
participant-centeredapproachtosettinggoalsandpersonalizedaspirationsthrough
education(Grier&Bryant,2005).
EffectivenessofEFNEPandSNAP-Ed
ManystudiesverifythatEFNEPissuccessfulinincreasingnutrition-related
knowledgeandbehaviors(Wardlaw&Baker,2012).Outcomesareassessedusing
theEFNEPBehaviorChecklistand24-HourDietaryRecall.Previousresearchhas
demonstratedpositivechangesinshoppingbehaviorsandnutrientintakeforthose
whoparticipateinEFNEP(Hersey,Anliker,Miller,etal.,2001).In2015,EFNEP
reportedthat95%ofadultparticipantsimprovedtheirdietbyconsumingan
additional½cupoffruitsandvegetables.MostadultEFNEPparticipants(89%)
reportedimprovednutritionpractices.(USDA,NIFA,2016).
SNAP-Edprogramshaveshowntobeeffectiveinimprovingnutritionand
healthbehaviors(Wardlaw&Baker,2012;Long,etal.,2013).In2010,SNAP-Ed
outcomesincludedreportsthat50%ofparticipantsimprovedtheireating
behaviorsbyconsumingfoodsclosertorecommendedamountsforgrains,
vegetables,andfruits;40%beganeatingbreakfast;39%reportedhavingfewerfood
insecuredays;and78%triednewrecipes/foods(Sexton,2013).Reportsalso
confirmfoodinsecuritysignificantlyimprovedintargetaudiencesthroughSNAP-Ed
programs(Kaiser,2015).
3
TraditionalNutritionEducationCurriculum
TheKentuckyNutritionEducationProgram(KYNEP)includesbothSNAP-Ed
andEFNEPwithsimilargoalstoeducatelow-incomefamiliesandindividualsonthe
benefitsofadoptinghealthylifestyles(NutritionEducationProgram,2012).The
missionofKYNEPisto:1)educatelimitedresourcepeopletoacquireknowledge;2)
improveskills;and3)changebehaviornecessarytoachievehealthandwellbeing
(NutritionEducationProgram,2012).Curriculausedfortraditionalprograms
consistofavarietyofcorelessonswithoptionalandmaternalnutritionsubgroups.
ThetraditionalKYNEPcorelessonsinclude:BasicKeystoFoodPreparation,Meal
Planning,PlanforFoodSpending,andBreakfastMakesaDifference(AppendixA)
(NutritionEducationProgram,2012).ThetraditionalKYNEPcurriculumincludes
learningoutcomesforeachtopic(AppendixA).Trainedparaprofessionals
implementtheprogramsthroughouteachcountyinKentucky,oftenin8-12lesson
series(NutritionEducationProgram,2012).
CookTogether,EatTogetherProgram
CookTogether,EatTogether(CTET)isanewsocialmarketingprogram
developedin2014byKYNEP.ItisdesignedtoeducateSNAP-eligiblefamilieson
makinghealthierfoodpurchasing,preparation,andcookinghabits.Eightfocus
groupswereconducted,comprisedoftargetaudiencemembersrepresentingboth
ruralandurbancounties.Questionsaskedpertainedtocookingknowledge,
preparationskills,barriersincookingdinner,andcookingwithchildren.Amongthe
focusgroupparticipants,65%reportedeatingadinnermadeathomemost(5-6)
daysoftheweek;31%reportedmakingdinnerfromscratchmostdaysoftheweek;
4
31%statedshoppingwithagrocerylist;and48%disclosedrunningoutoffood
sometimestomostofthetime(Najor,2014).Anotherkeyfindingrevealed
participantspreferredtolearnthroughhands-onandinteractivecooking
experiences(Najor,2014).Thesekeyresearchfindingsservedasthebasisfor
developmentofacookbookandfacilitator’sguidethatpilotcountiesusedto
implementthesocialmarketingprogram.TheCTETfacilitator’sguideincludesa
curriculummatrix(AppendixB)describingthelesson,skillstaught,andbehavior
checklistquestionscoveredineachlesson.Inadditiontotherecipes,theextensive
cookbookoffersinformationonhealthyeating,shoppingsmartonabudget,howto
readfoodlabels,etc.TheCTETprogramisdesignedasa“cookingsocial”rather
thanacookingclassasrequestedbyfocusgroupparticipants(Najor,2014).
Inthefieldoffoodandnutrition,therehasbeenanincreaseintheuseof
cookinginterventions(Reicks,Trofholz,Stang&Laska,2014).Whilemanyfactors
haveinfluencedfamilyeatingbehaviorsoverthepastdecade,including,butnot
limitedtomaternalemployment,increasedtimepressure,andvariousfamily
structures,researchshowsindividualsdesiretoimprovedininghabits(Condrasky,
etal.,2006).StudiessuchasCookingwithaChef,CookingMatters,andSimplyGood
Cookingdemonstrateanimprovementinshopping,cooking,andeatingbehaviorsin
targetedaudiences(Condrasky,Graham,&Kamp,2006;May,Brad,Offelen,&
Johnson,2014;Bess,2015).
Effectivenutritioneducationisassociatedwithkeycomponentssuchas
targetingspecificbehaviorsthroughtheinterestsandmotivationsofthetargeted
population(USDA,2010).Duringtheformativeresearch,participantsagreeda
5
“cookingsocial”alongwithnutritionlessonswasthepreferredmethodfor
education(Najor,2014).Thisstudyevaluateshowasocialmarketingapproach
comparestotraditionalnutritioneducationcurriculumforpromotingbehavioral
changesrelatedtoeatingandfood.Understandingwhichtechniquesofeducation
appealsmosteffectivelytothelow-incomepopulationcanaidinfurtherresearch
efforts.
MethodsStudyDesign
Thecurrentstudywasconductedwithin12countiesofKentuckyusinga
nonequivalentcomparisongroup,entry-exitdesign.Participantscompleteda
behaviorchecklist(AppendixC)and24-hourdietaryrecall(AppendixD)beforeand
afterthesessiontomeasureeffectivenessofboththeCTETcurriculum
independentlyandcomparedwiththetraditionalcurriculum.Ofthe12
participatingcounties,sixreceivedusualKYNEPcare(comparisongroup)whilethe
othersixreceivedtheCTETprogram(pilotgroup).Thepilotandcomparison
countieswereselectedbasedonawillingnesstoparticipate,similardemographics,
NEPprogramassistantposition,percentageofpoverty,SNAPusage,geographic
location,andruralversusurban.
ThetraditionalKYNEPnutritioneducationcurriculumispresentedtogroups
of2-25individuals.CTETwasfashionedsimilarlyinaudiencesize,butusedsocial
marketingrecruitingtactics.Theparticipantsforthepilotgroupswererecruited
viaflyers(AppendixE)hungingrocerystores,TheYoungMen’sChristian
Association,CooperativeExtensionOffices,placesofworship,laundromats,
libraries,anddaycarecenters.Countyextensionagentsutilizedsocialmediaby
6
postingtherecruitmentflieronFacebook.Programcoordinatorsvisitedhomesand
neighborhoodfacilitiestopersonallyrecruitparticipants.Thecurriculumwas
deliveredinvariouswayscontingentupontheextensionassistant’sdiscretion.Few
countiesextendedtheCTETprogramthroughalleightweeks.Manycompletedtwo
lessonsinthesameday,compiledalllessonsintoaweeklongcamp,orshortened
theprogramtosixweeks.
EvaluationInstruments
BothEFNEPandSNAP-EdcollectdatathroughtheEFNEPBehaviorChecklist
(AppendixA),and24-HourDietaryRecall(AppendixB).Theyaredeliveredat
baselineandimmediatelyfollowingtheintervention(entry-exitapproach).Theself-
reportedBehaviorChecklistincludestenquestionscoveringtopicsoffoodresource
management(planmealsaheadoftime,compareprices,runoutfoodattheendof
themonth,shopwithgrocerylist),foodsafety(timedairyormeatsitout,thaw
foodsatroomtemperature),andnutrition(makinghealthyfoodchoices,adding
salt,readingtheNutritionFactslabel,andfeedingchildrenbreakfast).Theresponse
optionsuseaLikertScaleof1-5withonerepresenting“never”andfiverepresenting
“almostalways”(Auld,etal,2015).The24-HourRecallisusedforparticipantsto
recallallfoodsandbeveragestheyconsumed(food,description,amount,andtime
ofday)inthelast24hours.Aprogramassistantfacilitatestherecall.Theassistant
thenentersthedataintotheWeb-BasedNutritionEducationEvaluationand
ReportingSystem(WebNEERS)softwareforcalculatingvitamin,mineral,and
nutrientdata.WebNEERSisusedonthefederal,institutional,andregionallevelto
collect,store,andmanagedatasotoprovideavarietyofreportsanddiagnostic
7
assessments(USDA,WebNEERS).Oneoftheoutcomesmeasuredthroughthe24-
HourDietaryRecallistheHealthyEatingIndex(HEI)score.TheHEIscoreisa
measureofdietqualityasdefinedbytheUSDA.Itmonitorsthequalityofthe
Americanpopulation’sdietandtheeffectivenessofnutritioninterventionprograms
(GuentherP,etal.,2013).
DataCollection
ThefirstpilotprogramofCTETbeganinthesummerof2015andwas
completedinthefall.Theexactdateswerechosenbasedontheextensionassistant
availabilitiesandworkload.Demographicinformationwasobtainedfrom
participantsincludingage,race,agesofchildreninthehouseholdyoungerthan18,
householdsize,andincome.Participantswereaskedtoanswerthequestionsonthe
BehaviorChecklistusingtheLikertscale.Programassistantsworkedwith
participantsindividuallytocomplete24-HourDietaryRecalls,whichwereentered
intoWebNEERSdataanalysissoftware.Datacollectedfromeachcountywas
transferredintoanExcelspreadsheetusingthedoubleentrymethodtocontrolfor
internalerror.
DataAnalyses
ThedatawereanalyzedusingStatisticalPackagefortheSocialSciences
(SPSS22)(version3.51.59).Anindependentsamplet-testmeasureddifferences
betweencomparisonandpilotgroupmeansatbaseline(entry)andafter
intervention(exit).Apairedt-testwaschosentocomparemeansbetweenpre-and
post-interventiondifferenceswithinthepilotandcomparisongroups.Significance
foralltestmeasureswasdefinedbyaBonferroni-adjustedPvaluesofα≤.05,andP
≤ .10werealsoreported(Armstrong,2014).
8
Results
Demographics
Thestudyhadatotalof64participants;thecomparisongroupconsistedof
30andthepilotconsistedof34participants.Onecomparisonindividual’sdatawas
discardedaftertheinterventionbecausehewasmaleandthestudyfocusedon
women.Thefinaldataused29participantsforthecomparisongroup.
Demographicinformation(Table1)revealedmostparticipantswereCaucasian
(75%)followedbyAfricanAmerican(24%)andwerebetweentheagesof26-40
(53%).Thosewhoreportedtheirincome,16(25%)madelessthan$500/month.
Theaveragehouseholdsizewas3.4people,includingparentfigure(s).
BaselineComparisonofTraditionalandCTETGroups
Overall,thepilotandcomparisongroupsstartedtheprogramwithsimilar
baselinebehaviorsasassessedbythechecklist.Thecomparisongroupranoutof
foodbeforetheendofthemonthmorefrequentlyandthoughtlessaboutfeeding
theirfamilyhealthyfoodsthanthepilotgroup(Table2).WithsignificanceatP≤
0.10,thepilotgroupletmeatanddairyfoodssitoutlongerthantwohoursmore
frequentlythanthecomparisongroup.Whenaskedhowoftenpreparedfoodswere
madewithoutaddingsalt,thecomparisongroupreported0.54pointslowerthan
thepilotgroup.ThecomparisongroupreadtheNutritionFactsonthefoodlabel
lessoftenthanthepilotgroup(P=0.002).
Fewvariableswerefoundtobesignificantlydifferentatbaselineaccording
tothe24-HourDietaryRecall(Table3).Thecomparisongrouprecordedeating
moremeals(3.77)thanthepilotgroup(3.09)andthusconsumingsignificantly
moretotalcalories(P=0.086).
9
OutcomeMeasuresforTraditionalNutritionEducationCurriculum
Thisstudyevaluatedcomparisongroupentrymeanscoresandexitmean
scoresfortheBehaviorChecklist(Table4)andfoundsignificantimprovementin
theareasofplanningmealsaheadoftime,comparingprices,lettingfoodsitout
longerthantwohours,lettingfoodsthawatroomtemperature,thinkingabout
healthyfoodchoices,andusingNutritionFactsonfoodlabel.Thegreatestpercent
changewasfoundinreadingfoodlabels(82%)wheretheparticipantsimprovedby
0.9pointsbetweenentryandexit.
Thetraditionalcurriculumprovedtobeeffectiveaccordingtothe24-Hour
DietaryRecallintheareasofHEIofVegetables(P≤0.10)andHEITotal(P≤0.05)
(Table5).Whiletherewasimprovementinnineoftheelevencategories,however,
noneoftheobservedimprovementwassufficientenoughtoattainstatistical
significance.
OutcomeMeasuresforCTET
ThemeanentryandexitscoresofthepilotgroupfortheBehaviorChecklist
(Table4)showedimprovementintheareasofplanningmealsaheadoftime,
comparingprices,runningoutoffoodbeforeendofthemonth,shoppingwitha
grocerylist,lettingfoodsitoutlongerthantwohours,thawingfoodatroom
temperature,usingNutritionFactsonfoodlabel,andfeedingchildrenbreakfast.
ThegreatestpercentchangefromentrytoexitwasinfrequencyofusingNutrition
Factsonfoodlabels(32%)wheretherewasa0.47increasebetweenentryandexit
scores.Theonlyquestionswheretheimprovementwasnotsignificantwasin
10
comparingprices,makinghealthyfoodchoicesforthefamily,andaddingsaltwhen
preparingfood.
Thepilotparticipantswhocompletedthe24-hourDietaryRecall(Table5)
demonstratedsignificantimprovement(P≤0.05)intheareasofnumberofmeals,
servingsofvegetablesandfruit,totalgramsoffiber,vitaminC,HEIoffruitsand
vegetables,andtotalHEI.Whilethepilotgroupappearedtohaveagreater
progressioninbehaviorchange,theseparticipantswerealreadyinterestedin
cookingandindevelopinghealthierhabitsbeforerecruitment.
EvaluationofTraditionalversusCTETApproach
Whenmeasuringthedifferenceinmeansbetweenthecomparisonandpilot
groupsfortheBehaviorChecklist(Table6),thequestionspertainingtothawing
frozenfoods,thinkingabouthealthychoices,andusingNutritionFactshad
significantresultsatP≤0.10favoringthecomparisongroup.Thecomparisongroup
hadalargerdifferencebetweenentryandexitsurveys,andthus,wasimpacted
greatestfromtheintervention.However,itisimportanttonotethisgroupstarted
withalowerbaselinemeanintheseareas(Table2).
The24-hourDietaryRecalldatashowedagreaterimprovementforthepilot
groupinservingsoffruit(P=0.006),vitaminC(P=0.085),HEIoffruits(P=0.016),
andtotalHEI(P=0.099)(Table7).Whilethereweregreaterdifferencesin
categoriessuchastotalcalories(318),totalgramsoffiber(0.85),andtotalgramsof
fat(13.12)forthecomparisongroup,thedatawerenotconclusive.
11
Tables
Table1.Demographics
* Onecomparisonparticipantwasdisqualifiedfromthestudyduetodiscrepancyingender(participantwasmale).Statisticsinreportincludeparticipant’sresults.
Variable Comparison Pilot TotalN 30* 34 64AgeN(%)20-25 7(11) 3(5) 1026-30 11(17) 7(11) 1831-40 7(11) 9(14) 16
41-50 2(3) 8(13) 1051+ 3(10) 7(11) 10
NoEntry 0 0 0RaceCaucasian/White 28(44) 20(31) 48African
American/Black 1(2) 14(22) 15
AmericanIndian 1(2) 0 1NoEntry 0 0 0
Income
Lessthan$500 12(19) 4(6) 16
$501-$800 4(6) 3(5) 7
$801-$1,000 1(2) 4(6) 5
$1,001ormore 4(6) 7(11) 11
NoEntry 9(14) 16(25) 25
HouseholdSize
Lessthan2 0 0 0
2-3 19(30) 20(31) 394-5 9(14) 11(17) 20
6+ 2(3) 3(5) 5
NoEntry 0 0 0
SupportSNAP 13(20) 19(30) 32
EFNEP 17(27) 15(23) 32
NoEntry 0 0 0
12
Table2.IndependentT-TestofMeanatBaselineforComparisonvs.Pilot(BehaviorChecklist)
*P≤0.05,**P≤0.10;Questions3,5,and6usereverseordering.EqualVariancesAssumed;Scoresof1-5=nevertoalmostalways.
Question Variable BaselineMean(Std.Dev)**ScoreRange(1-5) Comparison
(n=30)Pilot(n=34)
*P-value(2-tailed)
1 Howoftendoyouplanmealsaheadoftime?
3.10(0.960) 3.12(1.094) 0.946
2 Howoftendoyoucomparepricesbeforeyoubuyfood?
3.63(1.217) 4.00(1.015) 0.194
3Howoftendoyourunoutoffoodbeforetheendofthemonth?
2.83(0.913) 2.06(1.071) 0.003*
4 Howoftendoyoushopwithagrocerylist?
3.57(0.971) 3.50(0.961) 0.784
5Howoftendoyouletdairyandmeatfoodssitoutformorethan2hours?
1.23(0.430) 1.53(0.825) 0.083**
6Howoftendoyouthawfrozenfoodsatroomtemperature?
2.83(1.177) 2.62(1.206) 0.473
7
Whendecidingwhattofeedyourfamily,howoftendoyouthinkabouthealthyfoodchoices?
3.30(1.055) 3.91(0.866) 0.013*
8Howoftenhaveyoupreparedfoodswithoutaddingsalt?
2.37(1.273) 2.91(1.190) 0.082**
9HowoftendoyouusetheNutritionFactsonthefoodlabeltomakefoodchoices?
1.87(1.137) 2.82(1.193) 0.002*
10
Howoftendoyourchildreneatsomethinginthemorningwithintwohoursofwakingup?
3.93(1.388) 4.15(1.077) 0.491
13
Table3.IndependentT-TestofMeanatBaselineforPilotvs.ComparisonGroups(24-HourRecall)
*P≤0.05,**P≤0.10
Variable ComparisonMean(Std.Dev)
PilotMean(Std.Dev)
P-Value
NumberofMeals 3.77(1.222) 3.09(0.996) 0.017*ServingsofVegetables
1.67(2.469) 1.0752(1.096) 0.211
ServingsofFruit 0.514(0.908) 0.317(0.551) 0.291TotalCalories 1848.59(1343.78) 1371.264
(812.32)0.086**
TotalGramsofFiber 10.62(7.034) 9.45(6.657) 0.498TotalGramsofFat 71.07(60.222) 56.83(37.712) 0.256VitaminA 409.49(270.446) 426.75(486.015) 0.864VitaminC 38.26(39.111) 44.14(65.490) 0.670HEIofFruits 1.27(1.905) 1.22(1.832) 0.911HEIofVegetables 2.68(1.823) 2.76(1.862) 0.861HEITotal 46.84(15.404) 45.39(14.105) 0.694
14
Table4.PairedT-testofMeansofEntryandExitforComparisonandPilotCounties(BehaviorChecklist)
*P≤0.05,**P≤0.10;Questions3,5,and6usereverseordering.EqualVariancesAssumed;Scoresof1-5=nevertoalmostalways.
Question ComparisonEntrymean+(SD)
ComparisonExitmean+(SD)
PercentChange
P-value
PilotEntrymean+(SD)
PilotExitmean+(SD)
PercentChange
P-value
13.10
(0.960)3.73
(0.907)29% 0.000* 3.12
(1.094)3.50
(0.992)22% 0.040*
2 3.63(1.217)
4.03(0.809)
29% 0.031* 4.00(1.015)
4.29(0.719)
16% 0.067**
3 2.83(0.913)
2.57(1.040)
6% 0.118 2.06(1.071)
1.62(0.985)
7% 0.030*
4 3.57(0.971)
3.70(0.915)
9% 0.326 3.50(0.961)
3.79(0.880)
13% 0.039*
5 1.23(0.430)
1.03(0.183)
-8% 0.031* 1.53(1.088)
1.18(0.521)
-6% 0.050*
6 2.83(1.177)
1.40(0.968)
44% 0.000* 2.62(1.206)
4.00(0.816)
28% 0.000*
7 3.30(1.055)
3.80(0.847)
27% 0.003* 3.91(0.866)
4.0(0.8)
7% 0.619
8 2.37(1.273)
2.83(1.177)
39% 0.014* 2.91(1.190)
3.06(1.153)
14% 0.443
9 1.87(1.137)
2.77(1.040)
82% 0.000* 2.82(1.193)
3.29(1.088)
32% 0.004*
10 3.93(1.388)
4.03(1.326)
12% 0.586 4.15(1.077)
4.47(0.929)
11% 0.003*
15
Table5.PairedT-testofMeansofEntryandExitforComparisonandPilotCounties(24-HourRecall)
*P≤0.05,**P≤0.10
Variable ComparisonEntrymean+(SD)
ComparisonExitmean+(SD)
P-value PilotEntrymean+(SD)
PilotExitmean+(SD)
P-value
NumberofMeals
3.77(1.222)
3.9(1.029)
0.546 3.09(0.996)
3.56(1.021)
0.011*
ServingsofVegetables
1.67(2.469)
1.52(1.196)
0.682 1.0752(1.096)
1.573(0.959)
0.040*
ServingsofFruit
0.514(0.908)
0.502(0.763)
0.957 0.317(0.551)
1.12(1.154)
0.000*
TotalEnergy
1848.59(1343.78)
1530.35(592.986)
0.180 1371.264(812.32)
1389.11(471.00)
0.912
TotalGramsofFiber
10.62(7.034)
11.467(6.155)
0.510 9.45(6.657)
12.76(7.234)
0.033*
TotalGramsofFat
71.07(60.222)
57.952(23.225)
0.261 56.83(37.712)
55.82(28.763)
0.903
VitaminA 409.49(270.446)
500.44(313.18)
0.153 426.75(486.015)
513.01(426.892)
0.383
VitaminC 38.26(39.111)
40.474(40.124)
0.807 44.14(65.490)
75.203(63.540)
0.026*
HEIofFruits
1.27(1.905)
1.5(2.033)
0.655 1.22(1.832)
3.03(2.158)
0.000*
HEIofVegetables
2.68(1.823)
3.38(1.805)
0.059** 2.76(1.862)
3.83(1.653)
0.007*
HEITotal 46.84(15.404)
53.14(13.972)
0.050* 45.39(14.105)
59.19(10.621)
0.000*
16
Table6.IndependentSampleT-TestofDifferencesintheEntryandExitScoresforComparisonvs.PilotCounties(BehaviorChecklist)
Question Variable Mean(Std.Dev)Comparison(n=30)
Pilot(n=34)
P-value(2-tailed)
1 Howoftendoyouplanmealsaheadoftime?
0.63(.850) 0.38(1.045) 0.300
2 Howoftendoyoucomparepricesbeforeyoubuyfood?
0.40(.968) 0.29(.906) 0.653
3Howoftendoyourunoutoffoodbeforetheendofthemonth?
-0.27(.907) -0.44(1.133) 0.503
4Howoftendoyoushopwithagrocerylist?
0.13(.730) 0.29(.799) 0.406
5
Howoftendoyouletdairyandmeatfoodssitoutformorethan2hours?
-0.20(.484) -0.35(1.012) 0.453
6Howoftendoyouthawfrozenfoodsatroomtemperature?
-1.43(1.357) -0.91(1.111) 0.096*
7
Whendecidingwhattofeedyourfamily,howoftendoyouthinkabouthealthyfoodchoices?
0.50(.861) 0.09(1.026) 0.089**
8Howoftenhaveyoupreparedfoodswithoutaddingsalt?
0.47(.973) 0.15(1.105) 0.227
9
HowoftendoyouusetheNutritionFactsonthefoodlabeltomakefoodchoices?
0.90(1.125) 0.47(0.896) 0.094**
10
Howoftendoyourchildreneatsomethinginthemorningwithintwohoursofwakingup?
0.10(.995) 0.32(.589) 0.272
*P≤0.05,**P≤0.10;Questions3,5,and6usereverseordering.EqualVariancesAssumed;Scoresof1-5=nevertoalmostalways.
17
Table7.IndependentSampleT-testofDifferencesBetweenEntryandExitComparisonvs.PilotCounties(24-HourRecall)
Variable Mean(Std.Dev)Comparison(n=30)
Pilot(n=34)
P-value(2-tailed)
NumberofMeals 0.13(1.20) 0.47(1.022) 0.228ServingsofVegetables
-0.15(2.00) 0.50(1.355) 0.129
ServingsofFruit -0.012(1.232) 0.81(1.066) 0.006*TotalCalories -318.23(1269.593) 17.85(936.71) 0.229
TotalGramsofFiber 0.85(6.940) 3.30(8.658) 0.219TotalGramsofFat -13.12(62.612) -1.02(47.948) 0.386VitaminA 90.951(339.59) 86.26(568.411) 0.969VitaminC 2.21(49.101) 31.07(77.693) 0.085**HEIofFruits 0.23(2.750) 1.81(2.338) 0.016*HEIofVegetables 0.70(1.954) 1.07(2.181) 0.483HEITotal 6.30(16.892) 13.81(18.733) 0.099**
*P≤0.05,**P≤0.10
18
Discussion
CharacteristicsofGroupsatBaseline
Baselinescoreswerefairlysimilarbetweenthepilotandcomparisons
groups.Therewereonlyafewbaselinescoresthatwerelowerinthecomparison
groupthanthepilotgroupontheBehaviorChecklist(Figure2)and24-HourRecall.
Forexample,atbaseline,thepilotgroupreportedusinglesssaltwhenpreparing
food,readingtheNutritionLabelsandconsideringhealthychoicesmoreoftenthan
thecomparisongroup.The24-HourRecalldemonstratedthatthecomparison
groupatemoremeals(3.77)thanthepilotgroup(3.09)andthusconsumed
significantlymoretotalcalories(P=0.086).Allofthesedifferencescouldbedueto
thefactthattherecruitmentflyertargetedparticipantswhowerealreadyinterested
inlearning“howtomakehealthyandaffordablerecipes”aswellasgetting“tips
thatmakecookingfast,funanddelicious”(AppendixE).PromotionforCTET
utilizedsocialmarketingtechniquessuchassocialmedia(i.e.Facebookposts),
personallyknockingondoorsandcommunitycenters.Becauseoftheshorttimeline
availableforrecruitmentandthefocusoftheCTETonhomecooking,newstrategies
wereusedthatmayhaveinfluencedpilotgroupparticipantcharacteristics.
OutcomesforTraditionalNutritionEducationCurriculum
Pre-postanalysisoftheentryandexitBehaviorChecklistindicatedthatthe
comparisongroup(whoreceivedthetraditionalcurriculum)achievedstatistically
significantpositivebehaviorchangeinmostareas.Exceptionswererunningoutof
foodbyendofthemonth,shoppingwithagrocerylist,andfeedingchildren
breakfast(Figure3).Conversely,theonlyoutcomewherethecomparisongroup
19
showedimprovementforthe24-HourRecallafterreceivingthetraditional
curriculumwastheHEIforvegetablesandtotalHEItotalscore.Thismaybe
attributedtotheemphasisinthetraditionalcurriculumonfruitandvegetable
consumption.
OutcomesforCTET
Pre-postanalysisoftheBehaviorChecklistdatashowedpositivebehavior
changeoutcomesforthepilotgroupintheareasoffoodresourcemanagement,food
safety,nutrition,andfeedingchildrenbreakfast(Figure4).Analysisofthepilot
group’sFoodRecalldataalsoshowedpre-postimprovementsinthenumberof
mealsconsumed,aswellas,servingsoffruitandvegetablesandamountsoffiber
andvitaminCconsumed.Consequently,thepilotgroupshowedpositivepre-post
changesinHEIforfruitsandvegetables,andTOTALHEItotalscore.Cumulatively,
thesepositivechangesreflectthesuccessoftheCTETcurriculum.Inparticular,the
recipesdemonstratedinthecookbookincorporatefreshproducetoencouragethe
targetaudiencetobuyandpreparehealthiermeals.
ThesocialmarketingapproachachievedtheEFNEPgoalsof“improvingthe
totalfamily’snutritionalwell-being”bymeetingtheneedsofdietquality,food
resourcemanagement,foodsafety,andfoodsecurity(USDA,2016).Basedonthe
pilotresults,resourcesincludedintheCTETprogram(AppendixB)suchasproduce
availability,portionsizes,measurementsandsubstitutions,knifeskills,andcooking
basics,helptoincreasefruitandvegetableconsumption,foodsafetypractices,and
healthycookinghabitsinEFNEPandSNAP-Edparticipants.
20
ComparisonofTraditionalNutritionEducationtoCTET
Overall,theanalysissuggeststhattheCTETgroup,comparedtotheir
counterpartsinthetraditionalgrouporusualcare,hadhigherpre-postgainsin
foodresourcemanagement,feedingchildrenbreakfast,numberofmeals,fruitand
vegetableconsumption,totalfiber,vitaminC,andHEIforfruits.Boththe
comparisonandpilotgroupsshowedpositivepre-postchangesinfoodpractices
includingappropriatethawingoffrozenfood,thinkingabouthealthyfoodchoices,
andreadingNutritionFacts(Figure5).Thebaselinewaslowerforthecomparison
groupintheseareas,whichmayhaveledtoahighermeandifference.
Withregardstogroupdifferencesinthe24-HourDietaryRecall(Table7),
thecomparisongroupreporteda0.13-pointincreasefornumberofmealsbut
decreasedconsumptionoffruits(-0.012),vegetables(-0.15)andtotalenergy(-
318.23).Thiscouldbeduetolimitationsofthe24-HourDietaryRecall,self-
reportingerrorordataentrydiscrepancies.Asforservingsofvegetablesandfruit
forthepilotgroup,theparticipantsreportedhalfaservingincreaseforvegetables
(0.50)andalmostfullservingincreaseforfruit(0.81).Likelyduetotheincreasein
fruitandvegetableconsumption,vitaminCwassignificantlyhigherinthepilot
groupthanthecomparisongroup.Thepilotgroupalsohadalargermeandifference
forHEIforfruitsandtotalHEIscorethanthecomparisongroup;however,thepilot
grouphadlowerbaselinescores.Therecruitingpracticesforthissocialmarketing
programmayhaveresultedinagroupofpilotparticipantsthatdifferedfromthe
comparisongroupwithregardtofoodshopping,preparation,cooking,andeating
behaviors.
21
Theentryandexitdesignhasshowntobethemosttellingofaprogram’s
successbynumerousstudiesintheEFNEPandSNAP-Edfield(Swindle,Baker,Auld,
2007).Wallandcolleaguesfoundsignificantimprovementsinfourthgrader
attitudes,preferences,andself-efficacytowardvegetableconsumptionwhen
utilizingthepre-andpost-testintervention(Wall,Least,Gromis,&Lohse,2012).
ChungandHoerrfoundsignificantchangesinfruitandvegetableintakeamong
womenwithlimitedincomeusingapre-andpost-interventiondesign(2007).A
randomizedcontrolledtrialmeasuringtheknowledgeoflow-incomeparentsprior
toandfollowingEFNEPparticipationgavesignificantoutcomesaswell.The
BehaviorChecklistwasadministeredpreandpostinterventionandfoundpositive
outcomesrelatedtobehaviorchangeretainedatleastfor2months(Dollahite,Pijai,
Scott-Pierce,Parker,&Trochim,2014).
WhiletheCTETprogramwasconductedin12countiesofKentuckyvarying
indemographics,region,andsize,itisnotreflectiveofthenationalSNAP-eligible
populationhencethedatamaynotbegeneralizedtoallprograms.TheSNAP
populationdemographicsrangeacrossthenationfromurbantorural,ethically
diversepopulations,hence,varyingfoodpreferences,aswellasthevarious
communityresourcesthatimplementCTET.Themajorityofparticipantsidentified
themselvesasCaucasian(75%)likelyduetoKentucky’shighCaucasianpopulation
(87%)(USCensusBureau,2015).Thedatapresentedisfairlyconsistent
throughouttheparticipatingcounties,butshouldbeappliedwithdiscretiontoother
incomparableregions.
23
Figure2.IndependentT-TestofMeanatBaselineforComparisonvs.Pilot(BehaviorChecklist)
IndicatessignificanceatP≤0.10.
0 2 4 6
PlanMealPrice
OutofFoodGroceryListDairy/MeatThawFoods
HealthyAddedSalt
Nutr'nLabelBreakfast
PilotComparison
24
Figure3.PairedT-testofMeansofEntryandExitforComparisonCounties(BehaviorChecklist)
IndicatessignificanceatP≤0.10.
00.51
1.52
2.53
3.54
4.5BehaviorChecklistScale
EntryExit
25
Figure4.PairedT-testofMeansofEntryandExitforPilotCounties(BehaviorChecklist)
IndicatessignificanceatP≤0.10.
00.51
1.52
2.53
3.54
4.55
BehaviorChecklistScale
Entry Exit
26
Figure5.IndependentSampleT-TestofDifferencesintheEntryandExitScoresforComparisonvs.PilotCounties(BehaviorChecklist)
IndicatessignificanceatP≤0.10.
-2-1.5-1
-0.50
0.51
1.5
PlanMeal
Price
OutofFood
GroceryList
Dairy/Meat
ThawFoods
HealthyChoices
AddedSalt
Nutr'nLabel
Breakfast
MeanDifferences
ComparisonPilot
27
ImplicationsforResearchandPractice
TheCTETprogram,usingasocialmarketingapproach,significantly
increasedfruitandvegetableintake,aprimaryobjective.Theseresultsprovide
supportforusing“cookingsocials”toenforcepositivenutritionbehaviorsinlow-
incomefamilies.Aspredictedbyotherstudies,focusgroupsuggestionsthatguided
newprogramdevelopmentwerekeyinthebehaviorchangeofthepilotgroup
(Young,etal,2006).Afocusoncookinganddirecteducationratherthantraditional
nutritioneducation,foradults,isapromisingapproachtoimprovedietqualityfor
SNAP-EdandEFNEPaudiences(Auld,etal,2013;Bess,2016;&Condrasky,2006).
Although,morerobustexperimentalstudiesareneededtoconcludethat
participationin“cookingsocials”aremoreeffectiveinbehaviorchangethan
traditionalnutritioneducationprograms.Thefindingsofthisstudyindicatethata
socialmarketingapproachpromotinghealthyhome-cookedfamilymealsisa
promisingwaytoimprovedietsofparticipants.
Beforeadoptingasocialmarketingapproach,therearemanyprogram
characteristicsthatshouldbeconsidered.Thetraditionalclassesarenotchild-
friendly,whereasthesocialmarketingclassesencouragechildrenattendance.This
introducesconcernsabouttheincreasednoiselevel,kitchensafetywithknife
lessons,distractionsfortheparent,andlengthierexplanations.Furtherresearch
regardingrecruitmenttechniquesandparticipantretentionofsocialmarketing
programswouldprovideinformationhelpfultoprogramadministrators.Another
practicalimplicationtakenfromthecurrentstudyisthatofthetraditional
28
curriculum’stimelineandeffectiveness.Ifthesocialmarketingprogramcanbe
mergedintothetraditionalapproximate8-weekgraduationtimeline,theefficiency
ofbehaviorchangemaynotonlyimprove,butpotentiallyatagreaterconcentration.
Socialmarketingprogramsoftenaddressvariouslevelsofthesocio-
ecologicalmodel,especiallythecommunity,inordertoimprovehealthbehaviors
(Blitstein,etal.,2016;Danneferetal,2014).CTETofferedgrocerystoreand
Farmers’Markettourstobetterintegratethetargetaudienceintothecommunity.
Targetingmultiplelevelsofthesocio-ecologicalmodelthroughlongitudinalstudies
hasproventoenhancebehaviorchange(Bliesteinetal,2016;Brink&Sobal,1994,
Danneferetal,2014).OnepreliminaryretentionstudyfoundEFNEPparticipants
sustainedbehaviorchangesimmediatelyaftergraduationand1yearfollow-up
(Brink&Sobal,1994).
Thispilotstudyillustratesthatasocialmarketingprogramtargetinglow-
incomefamiliesmaybemoreeffectiveforchangingselectedbehaviorsinSNAP-Ed
andEFNEPparticipantsthanthetraditionalnutritioneducationcurriculum.The
CTETprogramappearstobemoreeffectiveforpromotingincreasedconsumption
offruitsandvegetables,apriorityoutcomefortheseprograms.
The2015DietaryGuidelinesforAmericans(USDHHS,2015)useasocio-
ecologicalframeworktodepicthowindividualbehaviorchangescanbesupported
bychangesinsocialandculturalnorms.Thispilotstudyillustrateshowasocial
marketingapproachaimedatchangingcookingnormscanhaveagreaterinfluence
onfood-relatedbehaviorsthandirecteducationalone.
29
AppendixA:Facilitator’sGuideforTraditionalNutritionEducationCurriculum
CoreLesson LearningOutcomesBasicKeystoFoodPreparation
• Understandtheimportanceofhealthyfoodchoices• Planandpreparemealsincludingavarietyoffoodsusing
MyPlate• ConsumeahealthydietconsistentwithUSDADietary
GuidelinesMyPlate • UnderstandMyPlaterecommendationsforahealthydiet
• PlanandpreparemealsincludingavarietyoffoodsusingMyPlateguidelines
• Participateinatleast30minutesofphysicalactivityeveryday
GrainsGroup • Understandwhybread,cereal,rice&pasta(grains)areanimportantpartofourdailydiet.
• KnowthenumberofounceequivalentssheneedsdailyfromtheGrainsGroup,andhowmanyoftheseshouldbewholegrains.
• IdentifyrecommendedservingsizesoffoodsintheGrainsGroup.
• Nameatleastonewaytostretchthefooddollarwhenpurchasingbreadandcerealproducts.
• Identifyhigh-andlow-caloriechoicesfromtheGrainsGroup.
• Planandservemealsthatincludeenrichedorwholegrainbreadsandcereals.
• Nametwowaystostoregrainproducts.• Calculatehowmuchdryriceorpastaitwilltaketofeedfour
people.VegetableGroup •Understandwhyvegetablesareanimportantpartofthedailydiet.
•Knowhowmanycupsofvegetablesshouldbeeatentomeetdailyneeds.•Knowhowmanycupsofdark-green,orangeandstarchyvegetablesandlegumesshouldbeeateneachweek.•Identifyrecommendedservingsizesforvegetables.•IdentifyvegetablesourcesofvitaminsAandC.•Identifyvegetablesourcesofminerals.•Nameatleastonewaytostretchthefooddollarwhenpurchasingvegetables.•Describeandpracticewaystostore,prepareandcookvegetablesinordertoconservenutrients.
30
•Tryanewmethodofcookingorservingavegetable.•ServevegetableshighinvitaminsAandC,mineralsandfibertomeetthefamily'sneeds.
FruitGroup •Explainwhyfruitsareanimportantpartofthedailydiet.•Knowtherecommendeddailyamountoffruitsfortheeatingplan.•Knowtherecommendedservingsizesforfruits.•IdentifyfruitsrichinvitaminsAandC.•ServefruitsrichinvitaminAandCtomeetthefamily'sneeds.•Identifyfruitsrichinironandpotassium.•Servefruitsrichinironandpotassiumtomeetthefamily’sneeds.•Servefruitsofmanydifferentcolors.•Tryanewmethodofcookingorservingafruit.•Nameatleastonewaytostretchthefooddollarwhenpurchasingfruits.
ProteinGroup •Understandwhymeat,poultry,fish,drybeansandpeas,eggsandnutsandseedsareanimportantpartofthedailydiet.•IdentifyfoodsthatarepartoftheMeatandBeansGroup(ProteinGroup).•KnowtheamountoffoodsfromtheMeatandBeansGroupthatUSDADietaryGuidelinesrecommendforherdaily.•IdentifywaystosavemoneywhenbuyingfoodsintheMeatandBeansGroup.•Demonstratehowtocutupawholechickenintopartsforcooking.•Tryanew,healthfulmethodofcookingorservingameatormeat·alternate.•Describeatleastonewaytocooklessexpensive,leanmeatstomakethemmoretenderandflavorful.•Identifythenumberofservingsperpoundtoexpectfromdifferenttypesofmeat•Identifyproperstoragemethodsforrawandcookedmeatsandmeatalternatives.•Explainsafewaystothawfrozenmeat,poultryandfish.•Knowsafetymeasuresforconsuminglocallycaughtfish.•Identifysoakingandcookingproceduresfordrybeans.
DairyGroup • Understandwhycalciumisanimportantnutrientforpeopleofallages.• Identifycalcium-richfoodsfromallfoodgroups.• Planabalancedmealhighincalciumtomeetfamilyneeds.• Nameseveralwaystostretchthefooddollarwhenpurchasingcalcium-richfoods.• PracticeatleastthreemethodsofpreparingfoodsintheMilkGroup(DairyGroup).
OilsandEmptyCalories
• KnowwhatdiscretionarycaloriesareandhowtheyfitintotheMyPyramideatingplan.
31
• TellhowmanydiscretionarycaloriesherMyPyramideatingplanprovides.
• Understandthatdiscretionarycaloriescancomefromanyfoodgroup.
• Estimatelimitsforsodiumandcaloriesfromfatsandsugars.• Listsourcesofsodium.• Listsourcesofcaloriesfromfatsandsugars.• Explainwhyitisnecessarytolimitsodiumandcaloriesfrom
fatsandsugars.• Uselabelstoidentifyproductshighinsodium.• Uselabelstoidentifyproductshighincaloriesfromfatand
sugar.• Explainthedifferencebetweensaturatedandunsaturated
fat.• Explainwhyitisnecessarytolimitsaturatedfat,transfats
andcholesterolinthediet.• Listfivesourcesofsaturatedfat,trans-fattyacidsand
cholesterol.• Listthebestchoicesfordietaryfat.• Determinewhethercaloriesfromsugar,fat,andsaturated
fatinherdietarewithintherecommendationsofherMyPyramideatingplan.
• Identifyhowmuchofthefamilygrocerybillisspentonfats,oilsandsweets.
• Improvethequalityoffamilymealsandsnacksbymakingchangesinfoodbuyingandpreparationpracticesthatlimittheuseoffoodshighinsodium,fatandsugar.
MealPlanning •Describethebenefitsofplanningmenus.•Planaweek'smenuforthefamilyusingfoodsthatmeetherfamily'snutritionalneedsandmoneyavailable.•Makeashoppinglistbasedonmenusfortheweek.•Describewaystomakemealsattractiveandappealing.
LabelPower • Demonstratehowtofindthefollowinginformationonfoodcontainers
o NutritionFactso Ingredientslisto Handlinginstructionso NetWeight
• 2. UsetheNutritionFactstoidentify• ServingSize• Numberofservingsinthecontainer• Amountsofnutrientsperserving• 3. Usethelistofingredientstoidentifywhichare
presentinthegreatest
32
• amounts.• 4. Demonstratehowtomatchlabelclaimswithhealth
concerns.• 5. Identifyatleastthreenutrientsandthedisease(s)
eachnutrientcanhelp• prevent.• Usethe%DailyValuetodescribeaproductashavingalow,
mediumor• highamountofanutrient.• Identifyonevitaminandonemineraltolookforonthe
NutritionFactslabel.
PlanforFoodSpending
• Prepareareasonablefoodspendingplanforthefamily• Describethestepsinpreparingashoppinglist• Makeashoppinglistbasedonmenusforoneweek• Recognizewhatshouldbeconsideredbeforegoingshopping• Identifyunitpriceshelftagsanddeterminethemost
economicalbuyusingunitpricing• Beabletofigurecostperservinganduseittofindthebest
buys• Comparepricesofconveniencefoodswithpricesofsimilar
foodsmadeathome• Identifyfactorsthataddtothecostofconveniencefoods• Giveexamplesofwaystoavoidfoodwaste• Describeatleastthreewaystosaveatthegrocery
FoodSafety • Knowwhatfoodborneillnessis• Describesignsandsymptomsoffoodborneillness• Knowsafetemperaturesforfood• Knowpropermethodsforstorage,preparation,andserving
offood
BreakfastMakesaDifference
• Explainwhyeatingbreakfastisimportant• Planwaystoprovideanutritiousbreakfastfortheirfamilies
within2hoursofwaking.
33
AppendixB:CurriculumMatrixforCTET
UNIT RECIPES SKILLS EVALUATIONQUESTIONS
Shopping N/A Shoppingtechniques,Readinglabels
BehaviorChecklistquestions1,2,3,4,7and9
Breakfast CinnamonRollOatmeal
SunriseGranola
Frittata
SpinachRiceEggBowl
BreakfastBurritos
Measure,mix
Measure,mix,bake
Measure,crackeggs,whisk,chop,bake
Measure,crackeggs,fryeggs,mix
Measure,beat,sauté,rolltortillas
BehaviorChecklistquestions1,10and6(SpinachRiceEggbowl)
FoodRecall-wholegrains,protein,vegetables
Soup HeartyVegetableSoup
CreamyBroccoliSoup
ChickenandDumplingSoup
Pareandchop,mince,measure,sauté,boil,simmer
Chop,mince,measure,shred,sauté,boil,simmer,blend
Pareandchop,measure,shred,sauté,simmer,mix,roll
BehaviorChecklistquestion5(ChickenandDumplingSoup)
FoodRecall-vegetables,protein(ChickenandDumplingSoup)
Salad CrunchyAppleandCabbageSalad
SouthernCornBreadSalad
FreshTacoSalad
Chop,shred,juice,measure,mix,whisk
Measure,chop,mix,bakeMeasure,juice,chop,tear,mix
BehaviorChecklistquestion5
FoodRecall-fruit,vegetables,protein(CornBreadandTacosalads)
34
Vegetables CrispyOvenZucchiniFries
RoastedVegetables
QuickPickles
Slice,measure,crackanegg,separateanegg,beat,whisk,dredge,bake
Pare,cut,slice,zest,toss,roast
Measure,pare,slice,mix,boil
FoodRecall-vegetables
One-PotMeals HarvestChili
CreamyBroccoliAlfredo
SouthwesternChickenandRice
Chop,measure,brownmeat,drain,simmer
Measure,mince,sauté,rollingboil,simmer
Chop,measure,sauté,brownmeat,toss
BehaviorChecklistquestions1,3,5
FoodRecall-vegetables,protein,grain
SlowCookerMeals
BeefStew
BarbecueChicken
SlowCookerSoupBeans
Pareandchop,mince,measure,brownmeat,mix
Measure,broil,mix
Measure,chop,mince,sortbeans
BehaviorChecklistquestions1,5
FoodRecall-Protein
Snacks StovetopPopcorn
AppleCrisp
Muffins
Measure,toss
Pareandslice,measure,mixliquidintocornstarch,cutinfat,bake
Measure,sift,crackanegg,mixeggandhotliquid,beat,bake
BehaviorChecklistquestion7
FoodRecall-wholegrains,fruit
39
References
ArmstrongR.WhentousetheBonferronicorrection.Opthalmic&Physiological
Optics[serialonline].September2014;34(5):502-508.Availablefrom:
PsychologyandBehavioralSciencesCollection,Ipswich,MA.AccessedMarch,
7,2016.AccessedMarch7,2016.
Auld,G,Baker,S,Conway,L,Dollahite,J,Lambea,MC,McGirr,K.Outcome
effectivenessofthewidelyadoptedEFNEPcurriculumeatingsmart∙being
active.JournalofNutritionEducationandBehavior.2015;47:1:19–27.
AccessedMarch1,2016.
BessMM.Cookingmattersatthestore:acasestudyofthreeMissouricounties.
JournalofExtension.2015;53:6.http://www.joe.org/joe/2015december
/iw5.php.AccessedMarch2,2016.
BlitsteinJL,CatesSC,HerseyJ,MontgomeryD,ShelleyM,HradekC,KosaK,BellL,
LongV,WilliamsPA,OlsonS,SignhA.Addingasocialmarketingcampaignto
aschool-basednutritioneducationprogramimproveschildren’sdietary
intake:aquasi-experimentalstudy.JournaloftheAcademyofNutritionand
Dietetics.2016;ArticleinPress.AccessedMarch11,2016.
BrinkMS,SobalJ.Retentionofnutritionknowledgeandpracticesamongadult
EFNEPparticipants.JournalofNutritionEducation.1994;26(2):74-78.
AccessedMarch11,2016.
ChungSJ,HoerrSL.Evaluationofatheory-basedcommunityinterventionto
increasefruitandvegetableintakesofwomenwithlimitedincomes.Nutr
40
ResPract.2007Spring;1(1):46-51.http://dx.doi.org/10.4162/nrp.2007
.1.1.46.AccessedMarch11,2016.
CondraskyM,GrahamK,KampJ.Cookingwithachef:aninnovativeprogramto
improvemealtimepracticesandeatingbehaviorsofcaregiversofpreschool
children.JNutrEducBehav.2006;38:324-325.
http://www.jneb.org/article/S1499-4046(06)00150-3/fulltext.Accessed
March2,2016.
DanneferR,AbramiA,RapoportR,StriphanlopP,SacksR,JohnsM.Amixed-
methodsevaluationofaSNAP-Edfarmers’market-basednutritioneducation
program.JournalofNutritionEducationandBehavior.2015:47(6):516-525.
AccessedMarch11,2016.
DollahiteJS,PijaiEI,Scott-PierceM,ParkerC,TrochimW.Arandomizedcontrolled
trialofacommunity-basednutritioneducationprogramforlow-income
parents.JournalofNutritionEducationandBehavior.2014;46(2):102-109.
AccessedMarch11,2016.
GrierS,BryantCA.Socialmarketinginpublichealth.AnnualReviewPublicHealth.
2005;26:319-339.publhealth.26.021304.144610.AccessedMarch3,2016.
GuentherPM,CasavaleKO,ReedyJ,KirkpatrickSI,HizaHAB,KuczynksiKJ,KahleLL,
Krebs-SmithSM.Healthyeatingindex.Centerfornutritionpolicyand
promotion.U.S.DepartmentofAgriculture.2013.Factsheetno.2.Accessed
March30,2016.
HerseyJ,AnlikerJ,ThomasH,etal.Foodshoppingpracticesareassociatedwith
dietaryqualityinlow-incomehouseholds.JournalOfNutritionEducation
41
[serialonline].January2,2001;33:S16-261p.Availablefrom:CINAHLwith
FullText,Ipswitch,MA.AccessedMarch3,2016.
KaiserL,ChaidezV,AlgertS,HorowitzM,MartinA,MendozaC,NeelsonM,Ginsburg
D. FoodresourcemanagementeducationwithSNAPparticipationimproves
foodsecurity.JournalofNutritionEducationandBehavior,2015;47:4:374-
378.e.AccessedMarch4,2016.
KotlerP,LeeN.,Socialmarketing:influencingbehaviorsforgood.SAGEPublications.
2008.3rdedition.
LohseB,WamboldtP.PurposiveFacebookRecruitmentEndowsCost-Effective
NutritionEducationProgramEvaluation.EysenbachG,ed.JMIRResearch
Protocols.2013;2(2):e27.doi:10.2196/resprot.2713.AccessedMarch4,
2016.
LongV,CatesS,BlitsteinJ,DeehyK.MorganR,FantaconeJ,KosaK,BellL,and
HerseyJ.(2013).SupplementalNutritionAssistanceProgramEducationand
EvaluationStudy(WaveII).AltarumInstitutefortheU.S.Departmentof
Agriculture.
MayJK,BradyA,OffelenSV,JohnsonB.SimplyGoodCooking:onlinecurriculumfor
theinteractiveSNAP-Edclassroom.JournalofNutritionEducationand
Behavior,Volume46,Issue1,85–87.http://www.jneb.org/article/S1499-
4046(13)00451-X/fulltext.AccessedMarch3,2016.
Najor,J,M.(2014).Promotinghealthy,home-cookedmeals:formativeresearchfora
socialmarketingprogramtargetinglow-incomemothers.Thesesand
42
Dissertations--DieteticsandHumanNutrition.Paper20.
http://uknowledge.uky.edu/foodsci_etds/20.AccessedFebruary22,2016.
NutritionEducationProgram.UniversityofKentucky.SchoolofHuman
EnvironmentalSciencesExtension.(2012)https://fcs-
hes.ca.uky.edu/content/nutrition-education-programs.AccessedMarch2,
2016.
ReicksM,TrofholzAC,StangJS,LaskaMN.(2014)Impactofcookingandhomefood
preparationinterventionsamongadults:Outcomesandimplicationsfor
futureprograms.JournalofNutritionEducationandBehavior,46(4)
,pp.259-276.AccessedMarch2,2016.
SextonJ.(2013).FY2010NIFANationalData:SNAP-Ed.USDA.
http://nifa.usda.gov/resource/snap-ed-2010-national-lgu-report.Accessed
March1,2016.
SwindleS,BakerSS,AuldGW.Operationfrontline:assessmentoflonger-term
curriculumeffectiveness,evaluationstrategies,andfollow-upmethods.
JournalofNutritionEducationandBehavior,2007;39(4):205-213.Accessed
March11,2016.
WallD,LeastC,GromisJ,LohseB.Nutritioneducationinterventionproves
vegetable-relatedattitude,self-efficacy,preference,andknowledgeoffourth-
gradestudents.JournalofSchoolHealth.2012;82(1):37-437p.Accessed
March11,2016.
WardlawMK,BakerS.Long-termevaluationofEFNEPandSNAP-Ed.TheForumfor
FamilyandConsumerIssues.2012;17(2).
43
https://ncsu.edu/ffci/publications/2012/v17-n2-2012-summer-
fall/wardlaw-baker.php.AccessedMarch1,2016.
USDepartmentofAgriculture.FoodandNutritionService.NutritionEducationand
Promotion:theroleofFNSinhelpinglow-incomefamiliesmakehealthier
eatingandlifestylechoices.2010.Areporttocongress.
http://www.fns.usda.gov/sites/default/files/NutritionEdRTC.pdf.Accessed
March5,2016.
USDepartmentofAgriculture.NationalInstituteofFoodandAgriculture.Expanded
FoodandNutritionEducationProgram(EFNEP).
http://nifa.usda.gov/program/expanded-food-and-nutrition-education-
program-efnep.AccessedMarch4,2016.
USDepartmentofAgriculture.FY2015NationalInstituteofFoodandAgriculture.
NationalData:ExpandedFoodandNutritionEducationProgram(EFNEP).
http://nifa.usda.gov/sites/default/files/resource/201
5%20EFNEP%20Impact%20Data%20Report_0.pdf.AccessedMarch4,2016.
USDepartmentofAgriculture.WebNEERS.NationalInstituteofFoodand
Agriculture.http://nifa.usda.gov/tool/webneers.AccessedMarch7,2016.
UnitedStatesCensusBureau.Quickfacts:Kentucky.2015.
http://www.census.gov/quickfacts/table/PST045215/21.AccessedMarch
10,2016.
UniversityofKentucky.CooperativeExtensionServices.Introductionandobjectives.
http://www2.ca.uky.edu/hes/internal/NEP/Guidelines_7_15/Introduction_a
nd_Objectives.pdf.
44
U.S.DepartmentofHealthandHumanServicesandU.S.DepartmentofAgriculture.
DietaryGuidelinesforAmericans.8thEdition.2015.Availableat
http://health.gov/dietaryguidelines/2015/guidelines/.AccessedMarch14,
2016.