Maximizing the Impact of Nutrition Education to Meet the Dietary Quality and Food Security Needs of Children and Parents

The goals of SNAP-Ed are to "improve the likelihood that persons eligible for SNAP will make healthy choices... consistent with the current Dietary Guidelines for Americans." Our recent review found four studies evaluating household food security as an outcome of direct adult SNAP-Ed with evidence considered strong because of our studies that used randomized and controlled study designs and assessment using the U.S. Household Food Security Survey Module (HFSSM).We showed that nutrition education via adult-focused, direct SNAP-Ed improved household food security by 25% among SNAP-eligible households over 1 year after a SNAP-Ed intervention in Indiana. However, previous evidence of meaningful change in dietary quality and intake among adult SNAP-Ed recipients is less secure despite demonstrated changes in attitudes, self-efficacy, intentions, and behaviors toward increasing intake of nutrient-dense foods due to a lack of randomized, controlled, longitudinal study designs and inherent measurement error in the assessments quantifying diet. Importantly, our study, using a longitudinal, randomized, controlled design and estimating usual intake with best practice assessment and analysis, did not determine dietary quality change among adults nor other dietary components except for vitamin D. Households experiencing food insecurity often reserve food considered "healthful" for children so child dietary quality improvement may proceed that observed among adults when household food security is improved. As children age, however, diets are known to worsen. Therefore, dietary quality improvement over time due to SNAP-Ed will need to overcome a strong influence of age, yet even maintained dietary quality over time would be a success compared to the expected declines in dietary quality for a control group whose parents do not receive SNAP-Ed. Taken together, we hypothesize that dietary quality among children and household food security will improve 1 year after a direct, adult-focused SNAP-Ed intervention compared with a control group while adult dietary quality will not improve compared with the control group.

Long-Term Goal: Determine the long-term (1-year) effect of direct, adult-focused SNAP-Ed on dietary quality and household food security among children (5-18 years) of adult (≥18 years), low-income Indiana SNAP-Ed participants.

(a) dietary quality (using the HEI), usual dietary intake, among children of adult SNAP-Ed participants and the adult participants themselves, compared with a control group receiving a delayed intervention and (b) food security among the household, adults and children (using the U.S. HFSSM) in intervention compared with control group, and (c) coping mechanisms, needs, behaviors, and attitudes among adult SNAP-Ed participants compared with controls.

1. Objectives Research Objectives

2. Recruit and randomize n=275 SNAP qualifying, low-income adult (≥18 years) and child (5-18 years) pairs from Indiana to participate in this longitudinal study with approximately n=138 pairs receiving the SNAP-Ed intervention and n=138 pairs in the control group (not receiving SNAP-Ed until after the study).

3. Quantify child and adult dietary quality (HEI) and usual intake (2, 24-hour recalls at each time-point), household, adult and child food security, and additional behavioral, coping mechanisms, needs, and self-efficacy at baseline and 1 year after the intervention period.

4. Evaluate change in child and adult dietary quality and usual intake per DGA compliance and food components of public health relevance (as per Dietary Reference Intake standards); household, adult and child food security status; from baseline one year follow-up for intervention compared with control group. Due to nonresponse and loss-to-follow, we expect roughly 100 pairs in each group to provide change measures.