Food And Nutrition Service Research Articles

P052 Un-Branding Surveys for Improved Access to Evaluation Tools

<h3>Background</h3> USDA's Food and Nutrition Service (FNS) requires that surveys used to evaluate SNAP-Ed direct education interventions must not include images with or references to brand name (branded) items (USDA-FNS, 2021). Agencies may want to replace branded images with unbranded images, but differences in images, such as items presented, could impact how participants respond to survey questions. This study tested whether replacing images influenced responses. <h3>Objective</h3> The primary aim of this study was to determine if replacing branded images with unbranded images would affect how individuals responded to existing SNAP-Ed survey questions. <h3>Study Design, Setting, Participants</h3> Participants were asked to respond to two surveys, one with branded images and one with unbranded images. Participants were randomly assigned to either take the branded version first or the unbranded version first. Participants consisted of SNAP-Ed-eligible adults who had internet access and could respond to the online surveys administered three days apart. <h3>Measurable Outcomes/Analysis</h3> Four questions taken from existing SNAP-Ed surveys were used. The independent variable was the time point of the first and second survey (pre/post), and the dependent variable was the survey question response. A Spearman's rank-order correlation was used to compare pre- and post-survey responses. <h3>Results</h3> A total of 54 participants completed both pre- and post-surveys and were included in analyses. Results found a significant (<i>P</i> < .001) moderate (<i>rs</i> = 0.62) to strong (<i>rs</i> = 0.82) correlations for the four questions tested. <h3>Conclusions</h3> Results provide support for agencies to update existing surveys with unbranded images for the four questions included in the study. These findings make surveys and questions more accessible to agencies who stopped using them as a result of the branded images. Additionally, a recommendation has been made to FNS to host a webpage with a library of unbranded images that agencies can use for their surveys. <h3>Funding</h3> USDA

Exploring Acceptance and Understanding of Inclusive Language in the Breastfeeding Attrition Prediction Tool

ObjectivesInclusive language has come to the forefront of the conversation in human lactation research as a way to increase the use of essential health services by marginalized groups. While there has been a call to action to adopt inclusive language in human lactation research, few studies have assessed understanding and acceptability of inclusive language. This pilot study, conducted in partnership with the Vermont Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) agency, sought to fill this gap.MethodsThe Breastfeeding Attrition Prediction Tool (BAPT) is a reliable, valid instrument to assess breastfeeding sentiment, social and professional support, and perceived behavioral control. In 2021, the study team revised original survey language primarily to limit the use of gender-exclusive terms; 7 out of the 27 questions were revised (e.g., ‘mothers’ became ‘parents’ and ‘breastmilk’ became ‘human milk’). The team intended to update language without interfering with the interpretation of survey items in a way that could affect BAPT scores. A convenience sample of WIC participants (n = 16) completed the 2021 Revised BAPT survey, then cross-cultural cognitive interviews assessed participants’ understanding of the revised language and explored reactions to other inclusive language terminology. Interviews were recorded and transcribed, and transcriptions were analyzed in NVivo using grounded theory principles.ResultsCognitive interviews revealed that participants understood and accepted inclusive language in the 2021 Revised BAPT survey when it better reflected their own situation or when they believed it would better reflect the diversity of others’ situations. While the term ‘breastfeeding’ was preferred by most in comparison to gender-inclusive options, adding ‘chestfeeding’ alongside ‘breastfeeding’ in survey questions was generally well-understood by participants and may better support people who identify as LGBTQ + .ConclusionsCognitive interviews with Vermont WIC participants suggest that the updated inclusive BAPT language is generally understandable and accepted. Inclusive language may be especially important in increasing feelings of inclusivity and health-seeking behavior in the LGBTQ + population, and more research on this is recommended.Funding SourcesUSDA Food and Nutrition Service (FNS).

A Consideration of the Evaluation of Demonstration Projects to End Childhood Hunger (EDECH)

A Consideration of the Evaluation of Demonstration Projects to End Childhood Hunger (EDECH)

The Development, Implementation, and Evaluation of Innovative Strategies to Reduce Food Insecurity among Children in the United States

The Development, Implementation, and Evaluation of Innovative Strategies to Reduce Food Insecurity among Children in the United States

P148 California SNAP-Ed Direct Education and PSE Aggregation

<h3>Background</h3> The Agriculture Improvement Act of 2018 (Farm Bill) has refocused SNAP-Ed reporting to include and prioritize aggregation of direct education and policy, systems, and environmental (PSE) reporting. In federal fiscal year 2016, the USDA Food and Nutrition Service (FNS) Western Region Office instructed CalFresh Healthy Living (CFHL) (California's SNAP-Ed program) to synthesize results from its 4 state implementing agencies (SIAs) and 138 local implementing agencies while reducing the report's overall length. CFHL now reports all SNAP-Ed work from a state perspective by aggregating all data. <h3>Objective</h3> Synthesize and communicate the methods used by CFHL to aggregate and report their SNAP-Ed data that is in accordance with the Farm Bill. This will provide a process that other states can adapt to fit their programs and report their work within the new federal guidelines. <h3>Study Design, Setting, Participants</h3> Direct education: CFHL reviewed all surveys used by SIAs and identified common questions that could be aggregated. Statistical analyses were identified that were appropriate for the data and incorporated effect sizes to measure the size of reported changes. PSE: CFHL used an online reporting system to collect all data, ensuring that all SIAs were collecting the same information which could then be aggregated at the state level. <h3>Measurable Outcome/Analysis</h3> A review of the shifts in methodology CFHL took to aggregate analyses and improve overall research methods to be in line with the Farm Bill and Evidence Act. <h3>Results</h3> Review of outcomes from CFHL's 2018 aggregated analyses, which includes 12 statistically significant direct education findings for MT1 and MT2 indicators. <h3>Conclusions</h3> California has a process for aggregating data that is in line with the Farm Bill that other states can adapt to fit their programs and reporting needs. This may provide a framework for states who may not have evaluation staff with time to think through these processes. <h3>Funding</h3> Supplemental Nutrition Assistance Program - Education.

P42 Empower WIC Breastfeeding Experts: Use of Interactive Training Platform to Increase Staff Knowledge and Confidence in Breastfeeding Counseling

<h3>Objective</h3> To increase knowledge and confidence of WIC staff in Breastfeeding counseling and education through an interactive, visual breastfeeding curriculum platform. <h3>Use of Theory or Research</h3> Self-efficacy Theory is guiding the training to strengthen WIC staff confidence to train the trainer, promote and support breastfeeding WIC participants. Research suggests interactive learning opportunities provided through face-to-face learning, computer-based learning, and website design contribute to enhanced learning and retention, as well as improved relationship building. Furthermore, presenters who provide meaningful, full-screen imagery while verbally discussing content enhance their ability to engage participants. <h3>Target Audience</h3> WIC State and local breastfeeding coordinators across the United States. <h3>Program Description</h3> US Department of Agriculture, Food and Nutrition Service (FNS) new WIC Breastfeeding Curriculum was unveiled nationally via 7 regionally located in-person trainings to WIC staff. As a skills-based train-the-trainer approach, the trainings provided numerous opportunities for hands-on practice and application and trainer tips. Attendees accessed the interactive training platform as trainers provided orientation to the platform's visual design, including full-screen visuals, animations, videos, and other instructional components. This training empowers WIC staff to deliver effective breastfeeding counseling and education to participants. <h3>Evaluation Methods</h3> Training attendees completed surveys at the conclusion of the training. <h3>Results</h3> In spring 2019, FNS trained 358 WIC Staff for a total of 140 hours of training. All attendees completed the survey, of which 63% identified the training approaches as excellent and 25% as good. Case studies and role playing were identified as most useful. Approximately 41% rated very confident in their ability to understand and train others on content, and 39% rated confident. <h3>Conclusions</h3> Findings from the trainings suggest training approach is effective; there is a need for interactive, visual curriculum platforms to both increase knowledge and trainer confidence. The training strengthens WIC breastfeeding program and nutrition services delivery to participants.

P78 - Outcome Evaluation of Alabama Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Social Marketing Campaign

Background (Background, Rationale, Prior Research, and/or Theory): USDA's Food and Nutrition Service (FNS) encourages social marketing as a way to enhance nutrition education in SNAP-Ed. In 2016, the Alabama Cooperative Extension System at Auburn University (ACES) developed three new billboard messages as part of its rebranded Nutrition Education Program, Live Well Alabama. Objective: To measure awareness of the social marketing campaign messages among selected Alabama SNAP-Ed parents. Study Design, Setting, Participants, Intervention: Altarum conducted an outcome evaluation using measures from the SNAP-Ed Evaluation Framework to assess reach and receptivity of social marketing campaign messages among parents of third grade Body Quest students throughout Alabama. A telephone survey was designed and data collected in April and May 2017. Outcome Measures and Analysis: Descriptive statistics were produced to describe the sample population and outcome variables. Confidence intervals were calculated to estimate significant differences among survey respondents at the alpha = 0.05 level. Results: A total of 433 surveys were completed. Over one-third (37.7%) of respondents were exposed to at least one of the campaign messages. Repeated exposure to campaign messages was evident, most notably for the fruit and vegetable message where nearly half (46.9%) of all respondents exposed to this message recalled seeing it five or more times. Respondents exposed to the campaign messages consumed significantly more cups of fruits and vegetables per day than those who were unexposed (1.8 and 1.3 cups, respectively for fruits; 1.9 and 1.6 cups, respectively for vegetables). Respondents most frequently reported planning healthy meals (46.1%), eating more fruits and vegetables (44.9%), buying more fruits and vegetables (41.3%), thinking about making healthy food choices (40.7%), drinking more water (38.9%), and exercising more (34.1%) after exposure to campaign messages. Lack of time was reported as the primary barrier for adopting behaviors such as healthier eating and physical activity. Conclusions and Implications: ACES successfully launched a newly rebranded social marketing campaign in 2017 recognized by over one-third of respondents surveyed. Funding: Supplemental Nutrition Assistance Program—Education. The following is the supplementary data to this article: Download .pdf (.36 MB) Help with pdf files Poster

Formative Testing of New SNAP-Ed Social Marketing Campaign Messages Designed for Low-Income Louisiana Residents

To develop and focus group test new social marketing messages designed for low-income Louisiana residents. USDA's Food and Nutrition Service (FNS) recommends using comprehensive social marketing campaigns to expand reach of SNAP-Ed messages. In 2014, LSU AgCenter designed a SNAP-Ed social marketing campaign based on FNS’ core nutrition messages reaching 32 parishes through billboards and print materials. In 2015, Altarum Institute conducted process and outcome evaluations of the campaign and findings were used to inform the 2016 campaign. Target Audience was SNAP-eligible Louisianans. After reviewing evaluation results, considering the needs of Louisiana's SNAP-eligible population, and reassessing the goals of Louisiana SNAP-Ed, LSU AgCenter developed new messages for their FFY 2017 campaign. Altarum Institute was contracted to assist with the development and testing of these new messages. Eight focus groups were conducted statewide to test new messages within the themes of family mealtime, breakfast, physical activity and food safety. The family mealtime theme tested favorably among focus group participants while the breakfast theme was not as well received. Participants responded well to the physical activity theme and recognized its importance for maintaining health. Future use of the food safety theme may require supplemental information at the local level to better educate the target audience. Participants would like to see visual images incorporated into campaign materials that represent the diversity of their communities and for message dissemination to include social media and community outreach channels. Formative testing of new social marketing messages was effective and provided useful feedback for informing future iterations of the campaign.

Outcome Evaluation of Maine SNAP-Ed’s Print and Digital Social Marketing Campaign

To determine effectiveness of reaching Maine SNAP-Ed’s target audience with social marketing messages delivered through print and digital channels. USDA's Food and Nutrition Service (FNS) encourages the use of social marketing campaigns as a way to enhance nutrition education in SNAP-Ed. Successful campaigns are comprehensive in scope and provide education through multiple channels. In 2015, Maine SNAP-Ed launched its campaign, called Shop, Cook, Eat Healthy and on a Budget, to influence health-related behaviors of individuals and communities while building upon direct nutrition education efforts. The campaign integrated traditional print materials (direct mail postcards, posters, flyers), with a robust online presence (targeted online ads, social media, landing page). Target audience were SNAP-eligible women with children in Maine. Altarum conducted a follow-up randomized phone survey of 600 SNAP recipients statewide using measures from the SNAP-Ed Evaluation Framework to assess campaign exposure. Awareness of the campaign increased significantly from the previous year (63% vs. 49%), and women with children reported higher levels of exposure to messages compared to other respondents (81% vs. 56%), indicating that messages are resonating with the target audience. While print materials were the most commonly recalled among all respondents, women with children had higher levels of recall of the digital campaign compared to others. Exposure to the campaign led many respondents to report tying out a new behavior such as making healthier food choices (32%). Evaluation results indicate that Maine SNAP-Ed has designed a social marketing campaign that reaches a large segment of its target audience through print and digital channels.

USDA’s Food, Nutrition and Consumer Services Helps Bring Regional and Local Foods to Consumers

USDA’s Food, Nutrition and Consumer Services Helps Bring Regional and Local Foods to Consumers

What Are the New Nutrition Standards for the Child and Adult Care Food Program?

What Are the New Nutrition Standards for the Child and Adult Care Food Program?

Launching a Comprehensive SNAP-Ed Social Marketing Campaign Utilizing the Cooperative Extension Model

This project assessed the Louisiana State University (LSU) AgCenter social marketing campaign during its first year of implementation. The target audience was SNAP-eligible Louisianans. United States Department of Agriculture Food and Nutrition Service (FNS) has suggested using social marketing campaigns to broaden SNAP-Ed approaches to nutrition education. Core nutrition messages were designed by FNS and focus group tested with key target audiences. Several states have adapted these core messages for use in SNAP-Ed social marketing campaigns. LSU AgCenter implemented a social marketing campaign in 2014 to reach SNAP-eligible residents in 32 parishes. Using FNS core messages, the campaign promoted increased consumption of fruits and vegetables, family meal time and physical activity. The campaign utilized mass media and local channels for dissemination of messages. Approximately 75 billboards were displayed and LSU AgCenter local extension staff provided reinforcement by distributing print materials such as posters, brochures, activity books; partnering with local entities; and providing direct nutrition education. A phone survey of 600 SNAP recipients in participating parishes, and a web survey and key informant interviews of LSU AgCenter staff were completed. Local staff easily identified goals of the campaign and believed social marketing helped reinforce concepts from direct nutrition education. Campaign materials were utilized well by staff. Local-level partners were supportive of the campaign. Half of phone survey respondents were aware of the campaign and reported seeing billboard messages more than twice. This evaluation indicated that a social marketing campaign using mass media and print materials can be successfully launched in a one year time period with sufficient planning.

Roles of National and Local Governments and the Dietetic Association in Nutrition Assistance Response to Natural Disasters: Systems and Experiences in Japan and the USA.

In the first half of this symposium, the disaster response system in Japan will be introduced. The ultimate aim of nutrition assistance is to keep people in disaster areas healthy. This is a task for the Ministry of Health, Labour and Welfare and the health departments of prefectural governments. Our first speaker, Dr. Yasuhiro Kanatani, National Institute of Public Health, will briefly overview the disaster response system in Japan and its related laws. He will also mention how the Ministry responded to the Great East Japan Earthquake. In the second presentation, I will play one chapter of DVD that we released in last September. In that chapter, Ms. Makiko Sawaguchi, a registered dietitian working for a public health center in the area affected by the Great East Japan Earthquake, talks about her experience in supporting disaster victims. As an employee of Iwate Prefectural Government, she helped affected municipal governments and coordinated outside support. One type of outside support was registered dietitians dispatched by the Japan Dietetic Association (JDA). Dr. Nobuyo Tsuboyama-Kasaoka will report what those dietitians did in the affected areas. She will also explain the aim and training of the JDA-Disaster Assistance Team. Provision of food is essential in nutrition assistance. This is a task for the Ministry of Agriculture, Forestry and Fisheries. Our fourth speaker, Mr. Kunihiro Doi, analyzed the government procurement data and will discuss the limitations of government emergency food supplies and lessons learned from the Great East Japan Earthquake. As for the systems and experiences in the US, we invited Ms. Toni Abernathy from the Office of Emergency Management, Food and Nutrition Service (FNS), United States Department of Agriculture.

The WIC Program: Background, Trends, and Economic Issues, 2015 Edition

The mission of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is to safeguard the health of low-income women, infants, and children through age 4 who are at nutritional risk. WIC provides nutritious foods to supplement diets, nutrition education, and referrals to health care and other social services. Administered by USDA’s Food and Nutrition Service (FNS), almost half of all infants and about a quarter of all children ages 1-4 in the United States participate in the program. WIC is USDA’s third-largest food and nutrition assistance program, accounting for 10 percent of total Federal spending on food and nutrition assistance. This report describes the WIC program—how it works, its history, program trends, and the characteristics of the population it serves. It also examines current issues facing WIC, focusing mainly on those with important economic implications.

The Food Assistance Landscape: FY 2013 Annual Report

In this report, the Economic Research Service uses preliminary data from USDA's Food and Nutrition Service (FNS) to examine trends in U.S. food and nutrition assistance programs through fiscal 2013 (October 1, 2012 to September 30, 2013) and ERS data to examine trends in the prevalence and severity of household food insecurity in the United States through 2012.

Timely Resolution of Patient Concerns Improves Post-Discharge Satisfaction

This research examined the effectiveness of a Food and Nutrition Services (FNS) Patient Advocate program on post-discharge patient satisfaction. All inpatients (n=187) who rated their satisfaction with one or more of six FNS attributes as 3 or lower (on a 5-point scale) during a 4-month time period were visited by the FNS Patient Advocate, as were other patients on the units. A questionnaire similar to the inpatient satisfaction questionnaire was sent post-discharge to patients visited by the FNS Patient Advocate (n=374); a total of 158 (42%) responded. Results indicated that most patients (73%) recalled their interaction with the FNS Patient Advocate and were highly satisfied with their interaction with the Advocate (mean=5.8 on 7-point scale). Comparison of inpatient and post-discharge ratings of satisfaction indicated a significant improvement in ratings post-discharge for special/restricted diet explained ( P<0.01), food temperature ( P<0.001), food quality ( P<0.001), courtesy of server ( P<0.01), and likelihood of receiving ordered foods ( P<0.01) by inpatients who gave ratings of 3 or lower for any item and were seen by the FNS Patient Advocate. Addressing patient concerns while the patient is in the hospital appeared to be an effective strategy in improving satisfaction ratings of those patients post-discharge.

Food Assistance Landscape September 2005

USDA administers 15 domestic food assistance programs that serve an estimated 1 in 5 Americans at some point during the year. Each program targets specific populations with different nutritional needs. These programs work individually and in concert to provide a nutritional safety net for children and low-income adults. The Economic Research Service (ERS) is responsible for conducting studies and evaluations of USDA's food assistance programs, focusing on the benefits of improved diets and food choices, factors that influence diet and nutrition, and program outcomes. This report uses preliminary data from USDA's Food and Nutrition Service (FNS), the agency responsible for administering the Nation's food assistance programs, to examine trends in the programs at the midpoint of fiscal 2005. It also discusses a recent ERS report that presents findings from an evaluation of projects aimed at testing ways to increase Food Stamp Program participation among eligible elderly individuals.

FNS nurtures families with food, knowledge

![Figure][1] Providing food service for the low-income population is the primary mission of the Food and Nutrition Service (FNS), along with educating parents and children on the basics of nutrition. A unit of the U.S. Department of Agriculture (USDA), the FNS has numerous programs to

Measuring Food Insecurity and Hunger in the United States: Development of a National Benchmark Measure and Prevalence Estimates

Since 1992, the U.S. Department of Agriculture Food and Nutrition Service (FNS) has led a collaborative effort to develop a comprehensive benchmark measure of the severity and prevalence of food insecurity and hunger in the United States. Based on prior research and wide consultation, a survey instrument specifically relevant to U.S. conditions was designed and tested. Through its Current Population Survey (CPS), the U.S. Bureau of the Census has fielded this instrument each year since 1995. A measurement scale was derived from the data through fitting, testing and validating a Rasch scale. The unidimensional Rasch model corresponds to the form of the phenomenon being measured, i.e., the severity of food insufficiency due to inadequate resources as directly experienced and reported in U.S. households. A categorical measure reflecting designated ranges of severity on the scale was constructed for consistent comparison of prevalence estimates over time and across population groups. The technical basis and initial results of the new measure were reported in September 1997. For the 12 months ending April 1995, an estimated 11.9% of U.S. households (35 million persons) were food insecure. Among these, 4.1% of households (with 6.9 million adults and 4.3 million children) showed a recurring pattern of hunger due to inadequate resources for one or more of their adult and/or child members sometime during the period. The new measure has been incorporated into other federal surveys and is being used by researchers throughout the U.S. and Canada.

Meeting Joint Commission Standards for Drug/Food Interactions Utilizing Computers and Existing Personnel

LEARNING OUTCOME: To recognized how computer automation can be used to efficiently add new programs related to clinical nutrition management.Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards state that patients must be provided with instruction on potential drug/food interactions so that they can meet their ongoing health care needs. The major goals of a drug/food interaction program are to inform the patient of potential interactions and to educate them in how to adjust their food intake to prevent them. In today's health care environment, this needs to be accomplished efficiently using as few resources as possible. At a large tertiary care hospital, Pharmacy and Food and Nutrition Services (FANS) identified 16 drugs in which efficacy could be moderately or severely affected by food. The Pharmacist wrote a description of each drug and its interaction with food. The Registered Dietitian (RD) composed the dietary guidelines to assist the patient in preventing an interaction. The FANS network administrator designed a computer program that identifies patients receiving one of the key drugs and automatically prints all material needed to comply with the JCAHO standards. Education sheets specific to each drug combine the pharmacist's description and the RD's guidelines. These are printed with the patient's name and location at the top for ease of delivery. Medical record documentation (MRD) is generated that contains all of the necessary information specific to the drug and the patient except the clinician's signature. The RD Assistant gives the education sheets to the patients when making menu rounds, then signs and drops the MRD in the “to be filed” basket on each patient care area. This efficient use of resources and computer automation has enabled FANS to give instructions and to complete the MRD regarding drug/food interactions for 50 patients daily in just 3 hours.