Supplemental Nutrition Assistance Program-Education Program Research Articles

Advancing Inclusive Communication: Implementing an Audit to Center Equity in SNAP-Ed Programming.

Public health interventions rely on information exchange to influence health outcomes. Increasingly, practitioners are working to be intentional with public health messaging. The language used to communicate program objectives and health recommendations should reflect the community's lived experience and avoid perpetuating health and social inequities. Words and tone matter, and both should be inclusive and non-stigmatizing. Prioritizing a health equity lens for communication may require a critical review and revision of existing materials. This Practice Note highlights the development and implementation of an audit tool designed to systematically review a cookbook created to support healthy eating for families and individuals experiencing low income and participating in a Supplemental Nutrition Assistance Program-Education (SNAP-Ed) intervention in Maine. The purpose of the audit tool and the collaborative review process was to revise the cookbook content to ensure a weight-neutral, empowering approach to supporting the community's nutritional needs. The audit process resulted in a comprehensive methodology to examine intervention resources for inclusive communication approaches that avoid deficit framing, use person-first language, and do not overemphasize limited resources or appropriate cultures. The instrument and methodology are conceptually replicable and adaptable. In sharing the process and audit results, the authors seek to provide an example for practitioners to draw from for similar critical reviews of public health intervention resources and promotional materials.

Sensory-Informed Evaluation Method for Use With Peer Educators of Nutrition Education Programs

ObjectiveDetermine acceptance of unfamiliar recipes and investigate the practicality of a hybrid (remote and in-office) method of evaluating recipes. MethodsPeer educators from the University of Georgia's Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program-Education programs used a hybrid home-use test method to evaluate 8 recipes before and after preparation and tasting. We collected perceived and actual measures of recipe acceptance. The main outcomes included overall liking and preparation behaviors, analyzed using nonparametric approaches. ResultsNo significant differences (P > 0.05) were found between prepreparation and postpreparation overall liking or preparation behaviors for each recipe, supporting the practicality of the method. Liking of recipe preparation exceeded 7 out of 9 for all recipes, but ratings for recipe preparation willingness and perceived program participant ratings decreased after tasting. Conclusions and ImplicationsAlthough tasting new recipes is necessary to determine specific modifications, a hybrid recipe evaluation format is practical for introducing new recipes to peer educators when resources are limited.

An Analysis of Equity in Service Provided by the SNAP-Ed Program: A Comparison of Dietary Outcomes among African American and White Participants in Louisiana

Structural racism has contributed to increased poverty, food insecurity, and obesity rates among African Americans relative to Whites. Nutrition education programs should therefore consider how well they serve this population. The objective of this investigation was to assess whether African American and White Supplemental Nutrition Assistance Program Education (SNAP-Ed) participants in Louisiana had comparable dietary behavior outcomes by conducting secondary data analysis of previous program evaluations from 2017-2018 and 2018-2019 among African American and White SNAP-Ed participants (n = 434). Variables measured included pre- to post-intervention changes in dietary behaviors (e.g., self-reported consumption frequency of fruit, vegetables, whole grains, low-fat dairy, sugar-sweetened beverages, and juice). Statistical analyses included t-tests stratified by race and Pearson’s chi-square test for categories of change in dietary behaviors. In categorical analyses, Whites had increased consumption, and African Americans had decreased consumption of whole grain pasta following SNAP-Ed participation. Among those who did not change consumption patterns following SNAP-Ed participation, African Americans were more likely to consume fruit juice and juice-flavored sugary drinks at a rate above median consumption compared to White participants. Future research should identify how program participation is followed by different dietary behavior outcomes in different races and explore how SNAP-Ed could specifically address barriers to equity.

Development of EFNEP and SNAP-Ed Core Competencies in the Land-Grant University System

This report describes the development and revision of core competencies for the Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program-Education program leaders, supervisors, and paraprofessional educators across the land-grant university system. The developing curriculum methodologies were used to engage panels of exemplary employees and an advisory panel of program leaders. A crosswalk examined key documents, and a gap analysis explored the competencies of similar professions. The resulting job duties and tasks reflect cultural, environmental, and educational trends. The core competencies are critical for writing job descriptions, guiding hiring, evaluating performance, and providing initial and ongoing training for the Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program-Education.

Using social network analysis to evaluate relationships among community nutrition education partners

Abstract Background The Supplemental Nutrition Assistance Program - Education (SNAP-Ed) program is an evidence-based program funded by the United States Department of Agriculture (USDA) that provides direct education and multi-level interventions for low-income families about nutrition, physical activity, and making healthy choices on a limited budget. Each U.S. state is funded to administer the program. SNAP-Ed works by building partnerships with community organizations. The purpose of this study was to identify characteristics of Minnesota's community partnership network involved in the SNAP-Ed program from the federal fiscal years 2016 (FY16) to 2020 (FY20). Analysis aims include 1) mapping the growth of SNAP-Ed community partners each year, 2) identifying essential network patterns and thereby highlight potential network gaps, 3) gauging the current level of partner involvement, and 4) enabling a data-driven approach for future collaborative network improvements. Methods Social network theory and analysis (SNA) was used to examine changes in partnerships over time. The data was retrieved from Minnesota's SNAP Education Evaluation and Database System (SEEDS) where maintained program and evaluation data; SNA metrics such as size, breadth, density, degree centralization, clusters, and modularity were calculated for each network. Results Partners of SNAP-Ed programs expanded from 869 in FY16 to 1032 in FY19. Due to COVID-19, in FY20, the number of partners decreased to 804. The network density decreased over time due to expansion of the number of partners between FY16(.0263) and FY19(.021). In FY20, the network density significantly decreased to .001 since partners were not able to be connected to each other. Network centrality will also be reported. Conclusions Our study presents a novel use of social network analysis methods to evaluate the community partnerships involved in the SNAP-Ed program. Key messages Using social network analysis to analyze the quantity and quality of the relationship among community nutrition education program partners gives practical policy recommendations. A novel use of social network analysis methods to evaluate the community partnerships involved in the SNAP-Ed program.

O12 The Inside Scoop: Sensory Evaluation Feedback from Peer Educators Provides Important Perspective on Direct Education Recipes

<h3>Background</h3> Federal nutrition education programs such as the Expanded Food and Nutrition Education Program (EFNEP) and the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) utilize a peer educator model to teach low-income Americans about healthy eating behaviors. Recipe demonstrations are an important part of such programs and may influence participants' eating and food preparation behaviors at home. Little is known about how peer educators perceive program recipes and related participants' recipe acceptability and preparation behaviors. <h3>Objective</h3> To examine peer educators' acceptability of recipes through evaluation of sensory attributes (appearance, flavor, texture, and saltiness or sweetness), preparation behaviors, and participants' perceived behaviors. <h3>Study Design, Setting, Participants</h3> Eight online surveys were conducted with peer educators (100% female, 47% African American, 14-28 responses per recipe) in the University of Georgia EFNEP and SNAP-Ed programs. Educators completed the surveys independently in a location of their choice. Survey links were sent to educators in a single document, and weekly reminders paced them to complete 2 surveys per week. <h3>Measurable Outcome/Analysis</h3> Sensory acceptability of 16 recipes was evaluated on a 9-point hedonic scale (0=Dislike Extremely; 5=Neither Like nor Dislike; 9=Like Extremely). Preparation intent and behaviors of educators and participants were evaluated on a similar scale. Standard range of acceptability is ≥7. <h3>Results</h3> Thirteen recipes received acceptable ratings on most sensory attributes and preparation questions. Three recipes (Curly Noodles Supreme, Easy Cheesy Broccoli Soup, and Ranch Sauce) received unacceptable ratings. Across all recipes, recipe acceptability, preparation intent, and program participant perception were not significantly different by educators' program, length of employment, and quadrant district in Georgia. <h3>Conclusion</h3> The findings suggest that peer educators for the nutrition education of low-income Georgians reported overall acceptable sensory attributes and preparation behaviors related to the program recipes and indicate areas for improvement in select recipes. Sensory evaluation methodology could be used to improve nutrition education recipes for higher acceptability and healthier recipe preparation behaviors in low-income participants.

O9 Coping with COVID-19: A Qualitative Study with Former SNAP-Ed Nutrition Education Participants

<h3>Background</h3> Little is known about the ways in which evidence-based interventions with established behavior outcomes may have prepared participants in coping with changes to shopping, cooking, and eating during the COVID-19 pandemic. <h3>Objective</h3> This project assesses the extent to which participants maintained health behaviors after nutrition education interventions and how program learnings informed strategies to cope with the COVID-19 pandemic. <h3>Study Design, Setting, Participants</h3> Using a qualitative case-study approach, participants (n = 41) were recruited at least 6 months post-intervention from 5 Michigan Supplemental Nutrition Assistance Program Education (SNAP-Ed) programs. Structured interviews occurred via telephone by 13 trained interviewers in August and September 2020. <h3>Measurable Outcome/Analysis</h3> Interviews were audio recorded and transcribed. A 5-person evaluation team collaboratively developed inductive codes, double-coded each interview, and analyzed data using NVivo software. <h3>Results</h3> Based on NVivo theming, participants reported to have learned strategies regarding healthier shopping, cooking, and eating that were maintained after the class. Prominent examples included reading food labels, making food substitutions, incorporating a variety of fruits, vegetables, and leaner meats into meals, and reducing sodium intake. New obstacles to shopping, cooking, and eating were identified by participants amid the pandemic. Common obstacles were shopping routine changes, increased cooking at home, and food access and attainability. Most participants reported that new habits established from classes were not only maintained during the pandemic but helped them deal with changing circumstances caused by the pandemic. <h3>Conclusion</h3> Although nutrition education classes occurred before the pandemic, participants gained knowledge and skills that helped them maintain healthy habits during the pandemic and cope with changes to shopping, cooking, and eating. Results from this study were shared back with SNAP-Ed programs that recruited participants. Findings can help future nutrition education programs identify and incorporate coping strategies into future classes, contributing to sustainable outcomes and better preparing participants for the ongoing pandemic and possible future public health crises.

P95 Process and Outcome Evaluation of the LSU AgCenter SNAP-Ed Program Using Microsoft Dynamics 365

<h3>Background</h3> Supplemental Nutrition Assistance Program Education (SNAP-Ed) encourages healthier eating through education and policy, systems, and environmental (PSE) changes to support access to healthier foods. Collecting and managing data for process and outcome evaluations is challenging for SNAP-Ed implementing agencies (IAs) with variation in direct education and PSE change projects implemented. Several IAs have used the Program Evaluation and Reporting System (PEARS) to gather and manage evaluation data, but this may be cost prohibitive for IAs with smaller budgets. The LSU AgCenter Information Technology (IT) department adapted Microsoft Dynamics 365 to the evaluation needs of the LSU AgCenter SNAP-Ed program. <h3>Objective</h3> To conduct a process evaluation of direct education and PSE change work conducted by the LSU AgCenter SNAP-Ed program in Federal Fiscal Year 2019-2020 using the Microsoft Dynamics 365 Application. <h3>Study Design, Setting, Participants</h3> LSU AgCenter IT staff adapted Dynamics to collect the data necessary to report against priority indicators in the SNAP-Ed evaluation framework. IT staff created separate reporting modules for individual direct education contacts, groups of direct education contacts, community partnerships, community coalitions, and PSE changes. SNAP-Ed frontline staff were trained on the reporting system in a series of hands-on, in-person meetings held prior to March 2020. <h3>Measurable Outcomes/Analysis</h3> LSU AgCenter staff report direct education contacts, partnerships, coalitions, and PSE changes made in the Microsoft Dynamics application. Data can be disaggregated according to demographic information, location, and implementing staff member, enabling data to be used in performance evaluations and analyses of equity in program access. <h3>Results</h3> Feedback about the reporting system was overwhelmingly positive. The system collected data necessary for reporting to state and federal funding agencies. Over the course of FY2020, LSU AgCenter established 502 partnerships, made 6,473 direct education contacts, and 118 PSE changes. <h3>Conclusion</h3> The Microsoft Dynamics 365 Application was easily adapted to the evaluation needs of the LSU AgCenter SNAP-Ed program. Process and outcome evaluation data indicated that the LSU AgCenter met its goals for FY2020.

P75 Disaggregating Nutrition Education Evaluation Data to Assess Racial Equity in Program Outcomes

<h3>Background</h3> A legacy of structural discrimination has contributed to increased rates of poverty, food insecurity, and obesity among African American Americans compared to White Americans. Supplemental Nutrition Assistance Program - Education (SNAP-Ed) is intended to ameliorate food insecurity and obesity and must consider whether it meets the needs of African Americans at increased risk of those conditions. <h3>Objective</h3> To assess whether educational outcomes from participation in the Louisiana State University SNAP-Ed program were equivalent for African American participants compared to White participants. <h3>Study Design, Settings, Participants</h3> Change in eating behaviors following SNAP-Ed participation were evaluated with pre/post surveys. Outcomes measured included change in frequency of consuming fruits, vegetables, whole grain and dairy products, and sugar sweetened beverages after SNAP-Ed participation. Data from 2 prior evaluations were combined and stratified by race (n = 434, 66% African American). Paired <i>t</i> tests for change in dietary behaviors were conducted across race categories using Stata 16.1. <h3>Results</h3> Outcomes did not differ between African American and White participants for most behaviors. However, frequency of fruit juice consumption increased significantly among African Americans (mean increase 0.27 on a Likert scale of 1-5, <i>P</i> = 0.005), but not among White participants (0.12 increase, <i>P</i> = 0.191). Frequency of low-fat milk (0.24, <i>P</i> = 0.053) and whole grain pasta consumption (0.33, <i>P</i> = 0.001) increased among White participants with marginal significance, but not among African American participants (mean increase 0.11, <i>P</i> = 0.247 and 0.16, <i>P</i> = 0.102, respectively). <h3>Conclusion</h3> SNAP-Ed must consider whether it adequately serves African Americans given the historical structural discrimination they have faced. Though most outcomes from LSU SNAP-Ed participation were not significantly different between African American and White participants, the consumption of fruit juice, low fat milk, and whole grain pasta changed differently in African American participants. This study serves as an example for future equity-focused evaluations. Further research should assess what may contribute to racial differences in behavior change outcomes of SNAP-Ed participation.

Health Clinic Readiness to Implement Nutrition Supports in Partnership With SNAP-Ed

ObjectiveTo assess the readiness of health clinics to implement nutrition support strategies in partnership with the Supplemental Nutrition Assistance Program Education (SNAP-Ed) program. DesignQualitative study using semistructured interviews. SettingSouth Carolina. ParticipantsA convenience sample of key informants (n = 26) from health clinics (n = 15) interested in partnering with the SNAP-Ed program. Phenomenon of InterestHealth clinic readiness to implement nutrition supports, including motivation, current capacities, and capacity-building needs. AnalysisInterviews were audio-recorded and transcribed verbatim. Transcripts were analyzed descriptively and thematically. ResultsClinics were most interested in implementing food insecurity screenings and making referrals to resources for accessing nutritious foods and produce prescription programs. Motivation was largely driven by a commitment to prevent chronic disease and on the basis of past success implementing a healthy eating strategy. A wide range of current capacities and capacity-building needs to implement strategies of interest were identified. Conclusions and ImplicationsFindings suggest the readiness of some clinics to partner with SNAP-Ed to implement nutrition support strategies and identifies early insights on areas practitioners might need to engage clinics in for capacity-building. Some implementers might need further training before having their own capacity to support clinics in the wide range of nutrition support strategies included, which could be explored in future studies.

Exploring the Feasibility of Partnerships between Public Libraries and the SNAP-Ed Program

ABSTRACT This study assessed the feasibility of partnerships between public libraries and the Supplemental Nutrition Assistance Program Education (SNAP-Ed) for delivery of direct nutrition education and adoption of nutrition and physical activity supports. Reported here are findings from interviews conducted with 14 librarians between December 2015 and February 2016. Librarians spoke of initiatives they were doing around healthy eating and active living and how they would like to do more. They also articulated overlap between their patrons and the program’s target audience. Several opportunities for and challenges to building partnerships between public libraries and the SNAP-Ed program surfaced.

P146 California Youth Participatory Action Research Projects Illustrates the Need for Nutrition Staff Professional Development

<h3>Background</h3> Youth Participatory Action Research (YPAR) is an innovative approach to engage youth (ages 12-18) in projects that address issues in their community. When implemented as part of a Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program, YPAR aims to empower youth to achieve policy, systems, and environmental (PSE) changes related to community health and nutrition. SNAP-Ed programming has traditionally focused on direct nutrition education, which may require substantially different professional skills than needed to implement YPAR projects. <h3>Objective</h3> This qualitative research project aimed to assess the impact of professional development and learning to support the shift from traditional nutrition education delivery to an approach that engages youth in creating PSE changes. <h3>Study Design, Setting, Participants</h3> Pre- and post-project interviews were conducted with 6 SNAP-Ed staff members who implemented or attempted to implement YPAR projects in 4 California counties during the 2018-2019 school year. Questions assessed the impact of current technical assistance, professional learning opportunities and needs, and suggestions for improving future support. <h3>Analysis</h3> Members of the research team each individually analyzed a subset of the interview responses and reported emerging themes. The team consolidated reports and identified key findings for 3 outcome measures related to 1) Staff capacities for YPAR work aimed at PSE changes; 2) key topics; and 3) key processes/structures for additional professional learning support. <h3>Results</h3> The following themes emerged related to the outcome measures: 1) the importance of comprehensive knowledge and skills related to youth engagement and positive relationship skills to build support for YPAR: 2) the need for information on the history of YPAR; training around PSE change work, evaluation and reporting; and curricula for younger youth; and 3) the need for regular support from supervisors. <h3>Conclusions</h3> Staff articulated the capacities they gained, key learning topics and support received, and additional professional development support needed to conduct a YPAR project. Key themes were identified that can help inform practitioners interested in conducting YPAR projects, especially under the SNAP-Ed framework. <h3>Funding</h3> Supplemental Nutrition Assistance Program - Education.

P59 The Future of Clinical-Community Linkages – Nutrition Education Takes Root in Maine's Underserved Communities Through a Learning Partnership with SNAP-Ed

ObjectiveExplore the impact of exposing health professions students to the social determinants of health through a learning partnership with Maine Supplemental Nutrition Assistance Program-Education (SNAP-Ed).Use of Theory or ResearchSNAP-Ed's program theory is informed by the Social-Ecological Model, supporting training competencies for health professions students to understand the social determinants of health and ensure a Social-Ecological Approach to clinical care.Target AudienceStudents enrolled in health professions programs (eg, medicine, physical therapy, physician assistant, dental medicine).Course/Curriculum DescriptionThe learning partnership exposes Maine's Care for the Underserved Pathways Area Health Education Center Scholars (CUP AHEC Scholars) to SNAP-Ed evidence-based curricula. The two-year program combines didactic and experiential activities for students interested in working in underserved communities. Scholars gain competencies in interprofessional education and practice, social determinants of health, and culturally sensitive clinical care. The collaboration promotes an understanding of how nutrition-related supports create healthier, food-secure communities. Scholars complete an online module covering SNAP-Ed program theory and participate in community-based activities alongside a nutrition educator.Evaluation MethodsPost-activity surveys from scholars collect immediate qualitative information on trainings, focused on quality improvements and learning outcomes. Annual post-surveys collect quantitative and qualitative data measuring competency outcomes. A storytelling approach with photographic evidence will highlight results from the collaboration's first 2 years.ResultsSince 2018, 9 students have participated in the Maine SNAP-Ed learning partnership. The majority of students (89%) report they would recommend the activity to fellow students. Qualitative feedback was overwhelmingly positive, and the most commonly cited learning outcome was increased understanding of “the link between poor nutrition and its impacts on health and wellness.”ConclusionsThe health professions training collaboration demonstrates that exposure to SNAP-Ed's approach to addressing social determinants of health provides valuable real-world clinical-community linkages experience. Scholarly partnerships with SNAP-Ed have the potential to create fundamental, systemic change in local capacity to reduce the burden of hunger and improve health outcomes. Explore the impact of exposing health professions students to the social determinants of health through a learning partnership with Maine Supplemental Nutrition Assistance Program-Education (SNAP-Ed). SNAP-Ed's program theory is informed by the Social-Ecological Model, supporting training competencies for health professions students to understand the social determinants of health and ensure a Social-Ecological Approach to clinical care. Students enrolled in health professions programs (eg, medicine, physical therapy, physician assistant, dental medicine). The learning partnership exposes Maine's Care for the Underserved Pathways Area Health Education Center Scholars (CUP AHEC Scholars) to SNAP-Ed evidence-based curricula. The two-year program combines didactic and experiential activities for students interested in working in underserved communities. Scholars gain competencies in interprofessional education and practice, social determinants of health, and culturally sensitive clinical care. The collaboration promotes an understanding of how nutrition-related supports create healthier, food-secure communities. Scholars complete an online module covering SNAP-Ed program theory and participate in community-based activities alongside a nutrition educator. Post-activity surveys from scholars collect immediate qualitative information on trainings, focused on quality improvements and learning outcomes. Annual post-surveys collect quantitative and qualitative data measuring competency outcomes. A storytelling approach with photographic evidence will highlight results from the collaboration's first 2 years. Since 2018, 9 students have participated in the Maine SNAP-Ed learning partnership. The majority of students (89%) report they would recommend the activity to fellow students. Qualitative feedback was overwhelmingly positive, and the most commonly cited learning outcome was increased understanding of “the link between poor nutrition and its impacts on health and wellness.” The health professions training collaboration demonstrates that exposure to SNAP-Ed's approach to addressing social determinants of health provides valuable real-world clinical-community linkages experience. Scholarly partnerships with SNAP-Ed have the potential to create fundamental, systemic change in local capacity to reduce the burden of hunger and improve health outcomes.

SNAP-Ed Intervention to Improve the Nutritional Behavioral Habits in Preschoolers in Washington D.C.

Abstract Objectives The Supplemental Nutrition Assistance Program Education (SNAP-Ed) offers complementary education programs to improve public health through improving nutritional behavioral habits in preschoolers in Washington D.C. This study examines the influence of the SNAP-Ed program on changing a set of positive nutritional behaviors in preschoolers to encourage healthier eating habits. These nutritional behavioral changes include recognizing, choosing, and consuming nutritious and healthy foods. Methods The SNAP-Ed program implemented nutritional education in 37 preschools, schools, and community centers located in Washington D.C for Fiscal Year 2019. During the program, the nutritional behavior of 1679 children aged 2 to 5 years old was examined before and after educational interventions. Interventions focused on the types and the related benefits of different groups of foods including fruits, vegetables, dairy, and whole grains. Designed questionnaires were filled out by 130 teachers based on their observations of the children's nutritional behavioral habits. Teachers were asked if children had an increase in the amount of food consumption from different groups. Children were also observed for an increase in independently choosing healthier foods. Results The SNAP-Ed program observed a positive change in all questions in comparison to the beginning of the program. According to the questionnaires, there were 75%, 75%, 78%, and 75% increases in the amount of fruits, vegetables, dairy, and whole grains preschoolers consumed, respectively. After the educational interventions, 78% of preschoolers showcased healthy food choices, 76% of them selected fruits and vegetables in the cafeteria and 75% of them brought fruits and vegetables as a healthy snack. Conclusions SNAP-Ed nutrition education positively changed preschoolers’ nutritional knowledge and established healthier eating habits. Further research, done in multiple states, is essential to enhance the knowledge of preschoolers nationwide. More research can also be done to examine how effective nutritional education was between SNAP eligible and non-eligible preschoolers. Funding Sources Congress, through the Nutrition Education and Obesity Prevention Grant Program in the Healthy, Hunger-Free Kids Act of 2010.

P168 Farm to School Positions within State Agencies, Extension, and SNAP-Ed Programs

Background Farm to school programs are a recommended strategy to improve dietary habits and nutrition. The National Farm to School Network (NFSN) prioritizes three state-level strategies to advance and institutionalize farm to school efforts: advocacy for farm to school policies, development of farm to school networks, and investments in farm to school positions at state agencies and in university Extension programs. Objective To describe and quantify the current farm to school positions at state agencies and in university Extension and those related to Supplemental Nutrition Assistance Program Education (SNAP-Ed) programs. Study Design, Settings, Participants Data about state-level farm to school positions were collected through surveys of NFSN Core and Supporting Partners conducted by NFSN between January-April 2018. The number of positions was reported, along with qualitative data (title, description, funding, duration, and agency/organization). Measurable Outcome/Analysis NFSN partner organizations and agencies in all 50 states, Washington, DC, and US territories (n = 53) responded. Results were grouped by positions in state agencies and positions in university Extension programs. Results There are 157 farm to school positions (part-time and full-time), with 98 in state agencies and 59 in university Extension. The majority of state agency positions are in departments of agriculture and departments of education. Positions based in departments of health, social services, and environment are less common. Although some are funded through legislation, in many cases they have come through administrative authority or amendments to an agency's or university Extension program's scope of work. Some positions are supported through state and federal grant funds. Three states reported a total of 12 positions connected with SNAP-Ed. Conclusion State-level farm to school positions are integral to improving nutrition through advancing farm to school activities. Further study is needed to assess their purpose and effectiveness and the potential for similar positions in other states. Funding Tides Center.

P186 SNAP-Ed Study Finds Differences in Nutrition and Physical Activity Behavior of English Versus Spanish Speakers Before Education

Background The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) encourages healthy nutrition and physical activity (PA) behaviors for SNAP eligible adults. In Arizona, one way the AZ Health Zone SNAP-Ed program promotes behavior change is through direct education classes. While it might be presumed that SNAP-Ed participants enter classes with similar behaviors, we found that baseline behaviors differed between English and Spanish speaking cohorts. Objective To describe differences in nutrition and PA behaviors before education between English and Spanish-speaking SNAP-Ed participants in Arizona. Study Design, Settings, Participants The AZ Health Zone used two validated surveys to measure baseline nutrition and PA behaviors among184 adults in eight Arizona counties between October 1, 2017—September 30, 2018. Sixty adults completed the surveys in English; 124 completed them in Spanish. Adults were surveyed before direct education classes at sites such as schools, libraries, family shelters, and senior centers. Measurable Outcome/Analysis Surveys included 16 nutrition questions and 20 PA questions. Depending upon data type, we used t-tests (PA data), Wilcoxon signed-rank tests (nutrition - Likert data) and Chi-square tests (nutrition - binary data) to compare responses between language groups. Results For nutrition behaviors, we found that Spanish speakers drank more milk (P Conclusion Significant differences were found between SNAP-eligible English and Spanish speakers in Arizona before participating in direct education. Spanish speakers showed healthier behaviors but greater food insecurity. More evaluation is warranted to see if this finding is replicable, and to explore the underlying reasons for the observed differences.

Participant voices: examining issue, program and policy priorities of SNAP-Ed eligible adults in California

AbstractThe Supplemental Nutrition Assistance Program Education (SNAP-Ed) aims to prevent obesity and chronic disease among SNAP-eligible families by facilitating healthy eating and active living. This study aimed to capture the voices of California SNAP-Ed eligible parents to inform program planners of their challenges in feeding their families, their available supports and priorities for intervention. We conducted eight focus groups with 55 participants across five counties in California from May through August 2017. Trained researchers used Dedoose to code and analyze data for substantive themes and overarching findings.Ten key findings and 4 additional findings were identified. Participants experience multiple challenges, primarily inadequate income and limited access to high quality, affordable healthy food contrasted with easy access to affordable unhealthy food. Despite efforts to manage food resources, most struggle to afford adequate diets. Employed parents confront a particularly challenging dual poverty of money and time. Many parents report feeling guilt related to feeding their children. Participants appreciate available programs and services and suggest increasing community input; providing sustainable programs; lowering the cost of and improving access to healthy food; reducing access to unhealthy food; modifying food assistance efforts; and improving nutrition education and promotion. Overall, low-income parents in California struggle to feed their families the way they would like. Participants generally understand what to feed their children, but struggle with how to do it, perceiving their circumstances and environments as inhospitable to healthy eating. Participants' suggestions can help SNAP-Ed programs and other efforts better support families' needs.

Reliability and Construct Validity of the Supplemental Nutrition Assistance Program Education (SNAP-Ed) Youth Behavior Survey (P16-064-19)

Abstract Objectives The objective of this study was to assess the reliability and construct validity of the SNAP-Ed Youth Behavior Survey (YBS). Methods SNAP-Ed is a USDA program responsible for administering nutrition and physical activity education to SNAP-eligible children. The SNAP-Ed YBS is a 12-item program evaluation questionnaire pertaining to child food and physical activity behaviors and knowledge. There are 7 behavior questions (2 relate specifically to fruit and vegetable intake; scalar) and 5 knowledge questions (binomial). A demographic survey and the YBS was administered to 58 children attending a USDA Summer Food Service Program (SFSP) site where SNAP-Ed programming was occurring. Reliability was assessed using Cronbach's Alpha test for internal consistency. Skin carotenoid level was selected as the gold standard for assessing construct validity. Resonance Raman Spectroscopy (RRS) intensity was used to determine skin carotenoid levels. Construct validity was determined by comparing YBS fruit and vegetable behavior scores with skin carotenoid levels via Pearson Correlation coefficients. Results Mean age of participants was 8.43 ± 0.25 years, 92.86% were white, and mean RRS intensity was 26,717 counts. Alpha coefficients for internal consistency for behavior and knowledge questions were 0.66 and 0.20, respectively. There was an inverse relationship between fruit and vegetable responses and RRS intensity counts. Conclusions Results from this pilot demonstrate that the YBS is a reliable tool for assessing child behaviors, but not knowledge; validity of the fruit and vegetable intake questions was not observed. Future research should be conducted to confirm findings from this study to assure use of reliable and valid assessment tools in SNAP-Ed. Funding Sources USDA SNAP-Ed.

Use of Policy, Systems, and Environmental Change Strategies Within Supplemental Nutrition Assistance Program Education (SNAP-Ed), 2014–2016 (P04-160-19)

Abstract Objectives SNAP-Ed is the nutrition education and obesity prevention component of the Supplemental Nutrition Assistance Program, the nation's largest nutrition assistance program for eligible low-income households. The 2010 Child Nutrition Act directed SNAP-Ed to include multi-level and public-health approaches, which was operationalized through policy, systems, and environmental change strategies (PSE). This analysis examines how states incorporated and planned to use PSEs in SNAP-Ed programming. Methods Data were collected from all 50 states, District of Columbia, Guam and the U.S. Virgin Islands (collectively described as “states”) for fiscal years 2014 through 2016. The data sources were state SNAP-Ed plans, annual reports, and administrative data. Qualitative methods were used to abstract the textual information from state plans and annual reports. Numerical data were collected from administrative data sets. Both textual and numerical data were categorized, counted, and relative frequencies were calculated. Results Between 2014 and 2016, the percentage of states that included PSEs as a statewide goal for SNAP-Ed increased from 25 to 47 and the percentage that planned to implement at least one PSE increased from 56 to 98. Among states that planned to implement PSEs in 2016, the 3 most common settings were places where people learn (e.g., schools) (92%), live (e.g., local communities) (90%), and work (e.g., worksites) (83%). States partnered with a wide range of organizations to deliver PSEs, with the 3 most common being government programs or agencies (77%), agricultural organizations (58%), and others non-specified (e.g., food alliances, wellness committees) (48%). Between 2014 and 2016, the percentage of states that planned to target environmental settings from the SNAP-Ed evaluation framework increased from 31 to 78. Conclusions States increasingly planned to use and were using PSEs across a range of settings and partners in SNAP-Ed between 2014 and 2016. This increase is encouraging as PSEs are important to use in conjunction with direct nutrition education and social marketing to improve nutrition and prevent obesity. Funding Sources U.S. Department of Agriculture, Food and Nutrition Service.

Examining Barriers and Facilitators to Delivering SNAP-Ed Direct Nutrition Education in Rural Communities.

To better understand the barriers to implementing Supplemental Nutrition Assistance Program Education (SNAP-Ed) direct education programming in rural communities, as well as strategies to overcome these barriers. This includes (1) barriers to implementing direct education in rural communities, and (2) facilitators to overcoming direct-education barriers in rural communities. This was a qualitative study that included in-depth interviews. Fifteen states across all 7 SNAP-Ed regions. Participants were eligible if they (1) were SNAP-Ed staff who were involved with implementing programs; (2) implemented at least 50% of their programming in rural communities, and (3) worked in their role for at least 12 months. Twenty-seven (n = 27) staff participated in interviews. Online surveys ascertained if participants were interested in participating in a 60-minute interview about implementing SNAP-Ed in rural communities. Interviews were semistructured and focused on the barriers and facilitators to implementing SNAP-Ed direct-education nutrition programming in rural areas. Qualitative interviews were analyzed using content analysis in Atlas.ti. Barriers to implementing direct education in rural communities included lack of healthy food and physical activity infrastructure to reinforce messages taught in class, funding restrictions, transportation for SNAP-Ed staff and the perception that this was also a problem for participants, and SNAP-Ed staff being seen as "outsiders" (not from the community). Facilitators included partnering with other organizations to increase recruitment and retention of SNAP-Ed participants, buy-in from local leaders, and SNAP-Ed staff being from the community. Partnerships between SNAP-Ed programs and non-SNAP-Ed organizations were essential in helping to recruit and retain participants. The SNAP-Ed staff should get buy-in from local leaders before starting direct-education programming. The SNAP-Ed programs should explore innovative delivery modalities including online and text messaging due to transportation issues in widespread rural geographies. Lastly, more work should be done to complement SNAP-Ed direct education with policy, systems, and environmental change initiatives.