Susan Baker

The purpose of this study was to determine how the 24-hour dietary recall (24HDR) is administered and how the Expanded Food and Nutrition Education Program (EFNEP) peer educators and other staff are trained on the data collection and entry process, from the EFNEP coordinators’ perspectives. This cross-sectional, quantitative study utilized an online survey to collect information from EFNEP coordinators representing 61 of 76 EFNEP programs. While 56% of the programs collected the 24HDR data starting with the first thing eaten the previous day, 49% of them started collecting data at the time of class, going backwards. Most programs, i.e., 72%, reported using a multiple-pass method; however, only one-third of them reported using the standard five-pass method. Almost all programs, i.e., 97%, reported one peer educator collecting data from a group of 2–12 clients. All programs reported collecting the 24HDR data in a group setting, with about one-third of the programs also collecting data...

The Expanded Food and Nutrition Education Program (EFNEP) is a federally funded program that teaches nutrition education to adults and youth with low-income. EFNEP is funded throughout the United States including federal territories. The purpose of EFNEP is to provide nutrition education. Evaluation for adult programs includes pre/post surveys and pre/post 24-h diet recalls (24HDR). A validated standard of dietary measures, 24HDR are useful when collected as designed: one-on-one by a trained professional. In EFNEP, 24HDR are collected in group settings by EFNEP peer educators who often have not received a college degree or any formal education in nutrition. The purpose of this study was to explore attitudes and behaviors of EFNEP peer educators regarding how they collect diet recalls in a group setting, their perceptions of how adult participants feel about the recalls, and the benefits and challenges of using recalls. Online interviews were conducted with EFNEP peer educators acros...

the form of cooking videos, recipes, and step-by-step teaching tools was highlighted as an important means to both educate and entertain participants. Digital literacy was not considered a barrier, except among the oldest old. Motivation and incentive to use Food eTalk was discussed extensively; opportunities for user engagement and entertainment were considered essential motivators to use the program. Conclusions and Implications: Nutrition educators perceived Food eTalk would be an accepted and feasible form of nutrition education for the target audience. Findings from this study will inform the user-centered development of Food eTalk. Funding: USDA, Supplemental Nutrition Assistance Program-Education.

OBJECTIVE Using 24-hour dietary recalls, compare Healthy Eating Index (HEI)-2005 scores of Expanded Food and Nutrition Education Program participants before and after 8-12 weekly lessons. DESIGN Analysis of preexisting 24-hour dietary recalls information collected from October, 2012 through September, 2014. PARTICIPANTS Participants with complete pre-post dietary data (n = 122,961); subset of those with complete demographic data (n = 97,522). MAIN OUTCOME MEASURES Change in HEI-2005 scores (total and components). STATISTICAL ANALYSIS Linear regression model fit separately for total HEI and 12 components. The response variable was changed in the HEI-2005 score; predictor variables included age, education, sex, and race/ethnicity. RESULTS The mean total HEI scores were 51.1 (SD, 13.7) at entry and 56.5 (SD, 13.7) at exit, with a change of 5.4 (SD, 16.2). Nine of 12 component scores increased. Changes were greater as age increased, with increasing education, and in women. Hispanics had the greatest improvement (mean ± SE) in total HEI score (8.3 ± 0.1). CONCLUSIONS AND IMPLICATIONS Although diet quality remained poor, participation in the Expanded Food and Nutrition Education Program resulted in improvement in dietary quality. The degree of improvements varied among demographic groups, but all groups improved.

This exploratory work was guided by the question of whether health education messages about food and exercise might inadvertently influence children’s beliefs about weight controllability, body satisfaction, weight self-assessments, desire to alter weight, and body build stereotypes. Participants were 80 children (38 boys, 42 girls) aged 7 to 13 years enrolled in a week-long “FunLIFE” summer camp offered at a large university. FunLIFE was created in response to the childhood obesity crisis and focuses upon Learning to Improve Fitness and Eating (thus, the acronym “LIFE”). Pre- and posttest questionnaires were administered at four camp sessions. Findings indicated that participation in FunLIFE camp did not influence children’s weight controllability beliefs, level of body satisfaction, their self-assessments of their weight, or their desire to alter or maintain their weight. Exposure to the FunLIFE curriculum did, however, positively impact children’s stereotypes about both overweigh...

Research methods are described for developing a food and physical activity behaviors questionnaire for the Expanded Food and Nutrition Education Program (EFNEP), a US Department of Agriculture nutrition education program serving low-income families. Mixed-methods observational study. The questionnaire will include 5 domains: (1) diet quality, (2) physical activity, (3) food safety, (4) food security, and (5) food resource management. A 5-stage process will be used to assess the questionnaire's test-retest reliability and content, face, and construct validity. Research teams across the US will coordinate questionnaire development and testing nationally. Convenience samples of low-income EFNEP, or EFNEP-eligible, adult participants across the US. A 5-stage process: (1) prioritize domain concepts to evaluate (2) question generation and content analysis panel, (3) question pretesting using cognitive interviews, (4) test-retest reliability assessment, and (5) construct validity testi...

To determine how the Expanded Food and Nutrition Education Program (EFNEP) affects the quality of life (QoL) of its exemplary paraprofessional educators. Qualitative telephone interviews with EFNEP supervisors (15), educators (28), and agency partners (15). Template analysis based on the University of Toronto's QoL constructs. The EFNEP had a positive impact on 6 of 9 a priori categories: physical being, psychological being, social belonging, community belonging, practical becoming, and growth becoming. The EFNEP enhances the QoL of its exemplary educators, which suggests that the program's benefits go beyond those documented in participants.

Determine whether the Expanded Food and Nutrition Education Program (EFNEP) affects the quality of life (QOL) of its participants and educators. Longitudinal, where QOL was measured 3 times for participants (pre, post, 3-month delayed post) and educators (before and 6 and 12 months after training). Participants' and educators' QOL was measured in Colorado, Kansas, Missouri, and Nebraska. Georgia and Texas measured educators; Minnesota and Virginia measured participants. English speaking EFNEP participants and educators. The investigators used the QOL Profile to measure QOL in 3 domains: Being (who one is), Belonging (connection with social and physical environment), and Becoming (achieving personal goals). Chi-square and t tests compared group demographics; repeated-measures ANOVA detected changes over time; ANCOVA examined the influence of demographic variables. Both groups had QOL Profile scores above 1.5, which is considered acceptable. Participants improved from pre to post in the Being domains including Overall Being (least square means [standard error of the mean], 3.1 [0.2] to 4.1 [0.3]), and in Social Belonging (3.5 [0.3] to 3.8 [0.3]); most improvements were sustained at 3 months. Educators improved in the Belonging domains, and a number of scores continued to improve at 1 year after training, for example, Social Belonging (4.2 [0.5], 5.0 [0.5], and 5.8 [0.6]); and Community Belonging (3.5 [0.5], 3.8 [0.5], and 4.7 [0.5]) at the 3 time points, respectively. EFNEP improved the QOL of participants, primarily in the Being domain, and of educators, primarily in the Belonging domain. The QOL profile has the potential to broaden the assessment of EFNEP impacts.

To determine if an online training for EFNEP paraprofessionals on the supplemental lesson Eating Smart and Being Active During Pregnancy,1 based on the perceived needs of EFNEP professionals and paraprofessionals, is an effective way to train paraprofessionals. Effectiveness to be determined by increased confidence in teaching this lesson, improved knowledge on the subject matter, and being prepared to answer some of the frequently asked questions by EFNEP participants about nutrition during pregnancy.

BACKGROUND The Expanded Food and Nutrition Education Program (EFNEP) is a federally funded, community nutrition education program that assists the low-income population in acquiring knowledge and skills related to nutrition, food safety, food resource management, food security, and physical activity. Evaluation of EFNEP includes a 24-hour dietary recall (24HDR) administered by paraprofessional educators, yet protocols for most large-scale nutrition research studies employ registered dietitian nutritionists (RDNs) or individuals with educational backgrounds in nutrition or related fields to collect dietary recalls. OBJECTIVE To compare 24HDRs collected by trained paraprofessional educators with recalls collected by an RDN. DESIGN Exploratory cross-over study comparing same-day 24HDR in a one-on-one setting collected by paraprofessional educators and an RDN. Paired recalls were separated by at least 1 hour. PARTICIPANTS AND SETTING The participants (n=41) were volunteer women who were eligible for participation in EFNEP in two states. MAIN OUTCOME MEASURES The 24HDRs were compared for energy, macronutrients, micronutrients, and food groups. STATISTICAL ANALYSIS PERFORMED Mixed-model analysis to account for repeated measures. Intraclass correlation and Spearman correlation coefficients to determine interrater agreement. RESULTS No difference in 24HDR was seen when compared by interviewer (paraprofessional vs RDN) or by site (Colorado vs North Carolina). There were significant differences in four components (energy, total fat, saturated fat, and solid fats-added sugar) based on recall order, with a higher intake in the second recall compared with the first. CONCLUSION The results of this preliminary study suggest that a well-trained paraprofessional educator using a valid methodology can collect a 24HDR that is similar to a recall collected by an RDN. The paraprofessional educator can be employed for dietary data collection, allowing the RDN to focus on more advanced aspects of scope of practice, such as data evaluation and program development.

Research has shown that women with low socioeconomic status and lack of breastfeeding support often breastfeed for shorter durations. Little research has been done on the effects of a breastfeeding peer support program for women from middle- to high-socioeconomic status. The objective of this project was to determine whether a breastfeeding peer support program would increase breastfeeding duration rates among middle- to high-socioeconomic status women. One hundred thirteen women were recruited from local OB/GYN offices to participate in a breastfeeding peer support program that included prenatal visits, phone calls, and anticipatory breastfeeding guidance throughout the infants' first year of life. Factors associated with a significant increase (p < 0.05) in breastfeeding duration included marital status, mother's ethnicity, mother's medical history, and delivery type. Mothers who remained enrolled in the study had the following breastfeeding duration rates: 85% at 6...

To confirm the reliability and validity of a previously validated evaluation instrument in a new context. In a cross-sectional study, the processes and results of testing Cooking Matters' (CM) use of the Expanded Food and Nutrition Education Program's Behavior Checklist as a retrospective pretest/posttest were described. The researchers determined reliability, face and content validity, and response-shift bias with 95 CM participants. Most items had acceptable face validity and moderate reliability; other items lacked reliability, or face or content validity (were unrelated to the CM curriculum). Proper match between evaluation tools and curricula is needed for appropriate program assessment without which outcome data can be misleading or potentially invalid. Confirmation of validity is essential when adopting others' evaluation tools in new contexts, particularly for programs with widespread use such as federally funded programs and national nonprofit organizations.

Identify practices for the collection of the 24-hour dietary recall (24HR) as used by the Expanded Food and Nutrition Education Program (EFNEP) to assess the fidelity with which dietary data are collected. An electronic survey sent nationally to all 75 EFNEP coordinators to assess methodology for collection, staff training, and coding of 24HR. A total of 67 surveys were returned, 53 of which were usable: 57% of programs used multiple collection periods (previous day vs previous 24 hours), 36% did not use a consistent number of passes in recall collection; only 17% exclusively used the validated 5-pass method; 88% trained paraprofessionals for ≤8 hours on recall collection and >6 different training programs were used; and 86% of programs used multiple coders. The wide variation in reported collection, training, and coding practices raises concerns about the validity of the recall data and the appropriateness of combining data from multiple programs. To improve consistency, EFNEP c...

The project reported here served to assess a curriculum for EFNEP to ensure theory compliance and content validity. Adherence to Adult Learning Theory and Social Cognitive Theory tenets was determined. A curriculum assessment tool was developed and used by five reviewers to assess initial and revised versions of the curriculum. T-tests for differences in mean responses from initial review to follow-up for each tenet and Cronbach's α for internal consistency of each tenet were conducted. Reviews found that the Eating Smart • Being Active curriculum successfully incorporated tenets of both theories and content remained true to Dietary Guidelines. Introduction Nutrition education can be defined as "any set of learning experiences designed to facilitate the voluntary adoption of eating and other nutrition-related behaviors conducive to health and well-being" (Contento et al., 1995). Nutrition education programs should include communication and educational strategies to build knowledge and motivation, behavioral change strategies to guide desired outcomes, environmental components to eliminate obstacles and enhance behavior change, and community activation (Contento et al., 1995; Higgins & Barkley, 2003). Programs designed to change behavior Elana Natker Nutrition Communications Consultant Enlighten Nutrition Oak Hill, Virginia elana@enlightennutriti on.com Susan S. Baker Associate Professor/Extension Specialist Department of Food Science and Human Nutrition Colorado State University Fort Collins, Colorado Susan.Baker@colostat e.edu Garry Auld Professor Department of Food Science and Human Nutrition Colorado State University Fort Collins, Colorado Garry.Auld@colostate. edu Kathryn McGirr Research Associate Department of Food Science and Human Nutrition Colorado State University Fort Collins, Colorado Kathryn.McGirr@colost ate.edu Barbara Sutherland Associate Staff Scientist Children's Hospital & Research Center Oakland, California bsutherl@gmail.com Katherine L. Cason Professor Department of Food, Nutrition, and Packaging Sciences Clemson University Clemson, South Carolina kcason@clemson.edu are most successful when rooted in appropriate behavior change theories or combination of theories (Achterberg & Miller, 2004; Baranowski, Cullen, & Baranowski, 1999; Bird & McClelland, 2010; Brownell & Cohen, 1995; Contento, Randell, & Basch, 2002; Franz, 2007; Rayner, 2003). The mission of the Expanded Food and Nutrition Education Program (EFNEP) is to improve nutrition knowledge, skills, attitudes, and behaviors of low-income families (Burney & Haughton, 2002; USDANIFA, 2009). EFNEP employs experiential learning through curricula designed to help participants make healthy food and lifestyle choices (USDA-NIFA, 2009). The lessons in EFNEP curricula are based on current Dietary Guidelines for Americans (DGA), which are updated every 5 years (US Dept. Health and Human Services, 2010). The DGA released in 2005 included many changes as compared to previous versions of the DGA. Major recommendation changes included increased emphasis on whole grain consumption, choosing fruits and vegetables in a variety of colors, the inclusion of physical activity and expanded food safety information, and shifting from using "servings" to cup and ounce equivalents (US Dept. Health and Human Services, 2010). The release of the 2005 DGA required that nutrition-based curricula for programs such as EFNEP and the Supplemental Nutrition Assistance ProgramEducation (SNAP-Ed) be updated. Rather than updating existing curricula, the EFNEP in Colorado and California used the opportunity to partner and create a new curriculum for their program participants: Eating Smart • Being Active (ESBA). Developers decided this new curriculum would incorporate both the Adult Learning Theory (ALT) (Knowles, 1984) and Social Cognitive Theory (SCT) (Bandura, 1986) and be appropriate for use by Extension paraprofessionals. SCT is often used in interventions with low-income audiences and serves as the basis for the desired behavior change outcomes, whereas ALT was used to define the andragogical approach used in both the classroom setting and the written materials and instructions for the paraprofessionals. Nationally, EFNEP uses a paraprofessional model. According to Norris and Baker, paraprofessionals are "usually hired, not for their degrees or knowledge of subject matter, but for their life experiences, cultural, social, and economic backgrounds, and their ability to relate to clients." This ability to relate to clients is termed "empathy" and has been a significant reason the paraprofessional model has been so successful in EFNEP (Norris & Baker, 1999). During the time Colorado and California EFNEP coordinators were starting to develop the new curriculum, representatives from more than 25 states expressed interest in the curriculum; these representatives indicated that their states were not going to develop new materials but intended to use this new curriculum.…

Abstract: Effective curricula are a cornerstone of successful Extension programming. The National Institute of Food and Agriculture (NIFA) Nutrition and Health Planning and Guidance Committee (NGPGC) developed a set of recommendations for a curriculum ...

Western Region EFNEP coordinators were frustrated by the apparent lack of materials available for training newly hired paraprofessional nutrition educators. An on-line survey was distributed to all EFNEP and SNAP-Ed state coordinators seeking details about initial training and available materials and requesting copies of materials for review. Results indicated diversity in training methodologies reflecting individual states' needs. Using a comprehensive document developed by the Western Region, eight states' initial training materials have been reviewed. Three reviews are posted on the EFNEP Coordinator's website hosted by Purdue University and provide a new training resource for EFNEP and SNAP-Ed program coordinators.

Literacy is an important consideration in the development of new staff orientation and ongoing training programs for Extension paraprofessional educators. In a project to develop core competencies for nutrition paraprofessionals, investigators learned that some of the competencies, (developed by a panel of Extension professionals) were not expressed using terminology understood by paraprofessionals. Implications for developing effective training programs include using terminology understood by paraprofessionals, engaging in intentional dialog with paraprofessionals to determine common language, and teaching paraprofessionals new terminology when necessary.

In developing recommendations for core measures/items for the evaluation of the Youth Expanded Food and Nutrition Education Program (EFNEP), three nutrition education curricula, implemented by land grant universities, were content analyzed. Selection criteria included the following: Curriculum content must include all EFNEP core content areas and must be implemented in more than one state with school children in third through fifth grades. Content analysis strategies were employed to identify and describe common areas/themes and mediators of behaviors addressed across the selected curricula. Content analysis coding was based on a list of behavioral mediators, which have empirical associations with nutrition, physical activity, and food safety. The most evident approaches identified across the three curricula were to enhance motivation, teach cognitive knowledge, and practice behavioral skills. The presence of self-regulation and environmental theory-based strategies was limited in all three curricula. In addition, multiple themes for nutrition, physical activity, and food safety were commonly addressed across curricula with multiple educational strategies. Based on these findings, recommendations for developing content appropriate measures and items for an outcome evaluation tool for Youth EFNEP are provided.

The project objective was to identify best practices in nutrition education for low-income audiences. Best practices are evidence-based elements or strategies that have shown effectiveness in achieving outcomes. Utilizing best practices increases stakeholder confidence that programs will be effective in helping low-income participants make positive nutrition-related behavior changes. A seven-member expert panel identified best practices criteria via telephone and electronic correspondence; the criteria were confirmed via literature review. Eight criteria were identified as characteristics of effective nutrition education programs within the following areas: a strong theoretical basis, research-based content, emphasis on goal setting, and audience-appropriate languages, activities, recipes, and reading level. Five criteria were identified for program delivery: the use of experiential learning and enhancement items, accommodation of learning styles, inclusion of contacts of appropriate frequency and duratio...

The purpose of this study was to assess the knowledge, attitudes, behaviors and training needs of child care providers on infant feeding practices, specifically breastfeeding. Needs assessment surveys for child care directors and infant room teachers were developed, tested and mailed to the 277 Colorado child care centers licensed to care for infants (< or = 12 months); 1,385 surveys were mailed. A total of 267 surveys were received for an overall response rate of 20%. The majority (79%) of infant room teachers and directors reported low knowledge on ways to adequately store breastmilk and formula. Perceived attitudes on the advantages and disadvantages of breastmilk versus formula as well as behaviors associated with offering working mothers a supportive breastfeeding environment (e.g. breast pumps available at center, offer mothers a place to breastfeed) were also examined. Directors and infant room teachers desired updated infant feeding information for themselves, co-workers and parents. They wanted English and Spanish information regarding breastfeeding, formula feeding and introducing solid foods. Eighty-six percent of directors and 67% of teachers stated they have Internet access at work. Eighty-eight percent of directors and 79% of teachers would be interested in an infant feeding website. According to the results of the needs assessment, child care directors and infant room teachers are in need of current, accessible infant feeding information. Child care directors and infant room teachers desired a website with bilingual and best practice infant feeding information specific to the needs of child care providers.

To assess the variation in breastfeeding knowledge and practices of registered nurses in hospital women and family-care units and the informal and formal hospital policies related to the initiation and support of breastfeeding. This qualitative study employed a focus group approach to solicit perceptions of hospital-based nurses regarding breastfeeding best practices. Eight state hospitals stratified by socioeconomic status (SES) and size served as settings to recruit participants for this study. Forty female registered nurses from labor and delivery (n=9), postpartum (n=13), labor and delivery/recovery/postpartum care (LDRP) (n=12) and neonatal intensive care unit (NICU) (n=6) constituted eight focus groups. The majority of nurses reported being knowledgeable of evidence-based best practices related to breastfeeding initiation. However, in non-Baby Friendly/Baby Friendly Intent (non-BF/BFI) settings, nurses' knowledge often was not in accordance with current best practices in breastfeeding initiation, and reported hospital policies were not based upon evidence-based practices. Barriers to best practices in breastfeeding initiation included hospital lactation policies (formal and informal), nurses' limited education in breastfeeding initiation best practices, high rates of surgical delivery, and lack of continuity of care with the transition of responsibility from one nurse to another from labor and delivery to transition care to postpartum care. A significant disparity between nurses' intention to support breastfeeding and their knowledge suggests a need for education based on the World Health Organization Baby Friendly standards for nurses at non-BF/BFI hospitals. A significant barrier to supporting breastfeeding is lack of hospital policy and inappropriate or outdated policy.

Determine child care providers' infant feeding knowledge, attitude and behavior changes after viewing the infant feeding Web site and determine the effectiveness of the Web site and bilingual educational materials. Intervention and control groups completed an on-line pretest survey, viewed a Web site for 3 months, and completed an on-line posttest survey; follow-up data were also assessed. Colorado child care centers. Thirty-eight child care providers. Social learning theory-based website was evaluated by child care providers in the treatment group and providers in the control group viewed a comparable website. Knowledge, attitude, and behavior changes on feeding infants breast milk, formula, and solid food; desired changes to Web site. Independent samples t tests, chi-square, and repeated measures. Changes in attitudes and behaviors from pre- to posttest occurred primarily in the intervention group (P < .05). At follow-up, no significant differences were found among the 3 time periods. Providers desired no changes to Web site or materials. Child care providers appeared to have adequate knowledge on feeding infants formula and breast milk, but not on hunger cues. Providers would continue to use this Web site in the future. Further research should determine if changes in knowledge, attitudes, and behaviors are sustained over time and how infant feeding cues are read and determined in child care centers.