Evaluating the Effect of SNAP-Ed on Household Food Security Status and Dietary Intake of SNAP-Ed-eligible Participants in Indiana
High prevalence of food insecurity and poor diet quality characterize the US low-income population qualifying for the Supplemental Nutrition Assistance Program (SNAP) when compared with higher income populations. The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) is a federal nutrition education program available at no cost to the income-eligible population with the goal to improve diet quality by promoting adherence to the Dietary Guidelines for Americans (DGA) through nutrition education while also supporting the goal of SNAP to improve food security. Limited evidence suggests that SNAP-Ed improves diet-related outcomes such as food security, intake of fruits and vegetables, and other targeted positive health behaviors over short-term periods; however, the long-term impact of SNAP-Ed on these outcomes is unknown. The overarching aims of the research in this dissertation were to evaluate the effects of direct SNAP-Ed delivered through a series of nutrition education lessons at the individual level on the outcomes of food security and dietary intake over a long-term period using a randomized and controlled nutrition education intervention study design. An additional aim was to assess whether changes in food security or dietary intake were influenced by specific program characteristics. The dissertation begins with a narrative review critically evaluating the small body of direct SNAP-Ed impact and outcome research literature on food security and dietary outcomes, concluding that inconsistent measurement tools and outcomes across studies along with weak study designs contribute to an inability to determine the effectiveness of SNAP-Ed to improve food security or dietary behaviors. Due to the inconsistencies across studies, a meta-analysis or systematic review were not possible. The research studies presented in this dissertation fill a gap in the literature and provide an example of the feasibility of implementing rigorous research to investigate the impact of SNAP-Ed. Facilitation of 2 longitudinal randomized and controlled nutrition intervention studies with the 4 core SNAP-Ed lessons as the intervention provide the data for results presented in chapters 2-5. The evaluation of the impact of SNAP-Ed on food security outcomes among Indiana households with children found improved household food security score in the intervention group compared to the control group over the 1-year study period and provides strong support of the effectiveness of SNAP-Ed to assist SNAP in improving food security. The of improvement of 1.2±0.4 (P<0.01) units on the household food security scale among the intervention compared to control group households is both statistically significant and practically meaningful; the effect size resulted in an average improvement in household food security score by 25% over the 1-year study period. Food security score among household adults also improved by 0.9±0.3 (P<0.01) units in the intervention compared to control group over the 1-year study period. A follow-up study investigated whether program characteristics influenced the increase in household food security score observed in the previous study. The number of lessons received over the 1-year study period or whether lessons were delivered on an individual, group, or combination of the two formats were not significantly associated with the increase in household food security in the intervention group. Additionally, there was not a significant effect due to variation between the SNAP-Ed paraprofessional delivering the lessons. In addition to delivering lessons, SNAP-Ed paraprofessionals may assist participants to determine eligibility and apply for nutrition assistance programs and provide links to community resources to aid resource management. This study also revealed that participation in nutrition assistance programs (SNAP, WIC, food pantry use) did not mediate the long-term improvement in household food security due to SNAP-Ed in the intervention group. These results from the first randomized controlled trial (RCT) provide strong evidence that SNAP-Ed improves long-term food security despite various programmatic factors and participant use of food assistance among SNAP-Ed households with children. The second outcome of interest was the impact of SNAP-Ed on dietary intake and quality. A cross-sectional assessment of the baseline study population recruited for the second randomized and controlled long-term evaluation featured the overall diet quality of the SNAP-Ed-eligible population using the Healthy Eating Index-2010 and mean usual intake of food groups emphasized in SNAP-Ed lessons and the DGA. The SNAP-Ed-eligible diet quality was poor (42±0.9) and lower than the general US population. (Abstract shortened by ProQuest.)i
Eicher-Miller, Purdue University.
Public Health Education|Nutrition
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