Supplemental Nutrition Assistance Program Education Research Articles

Use of Decision Cases for Building SNAP-Ed Implementers’ Capacities to Realize Policy, Systems, and Environmental Strategies

ObjectiveTo develop and validate decision cases as a capacity-building training tool for implementing policy, systems, and environmental (PSE) change strategies. DesignStudy phases were: (1) in-depth interviews conducted repeatedly over a year with Supplemental Nutrition Assistance Program Education (SNAP-Ed) partner sites and once with SNAP-Ed implementers to identify dilemmas when implementing PSE change strategies; (2) decision cases developed to highlight dilemmas; and (3) focus groups with SNAP-Ed implementers to determine decision case utility as a capacity-building training tool. SettingA southeastern state. ParticipantsSNAP-Ed partner sites and implementers; Focus group participants. InterventionDecision cases. AnalysisTo establish content validity, a thematic analysis of interviews identified common dilemmas when implementing PSE change strategies. SNAP-Ed implementers’ focus groups provided feedback to determine the utility and validity of decision cases developed from the analysis. ResultsCommon dilemmas of implementation of PSE change strategies reported by SNAP-Ed partner sites (n = 20) and implementers (n = 8) were lack of site and educator readiness and capacity; communication breakdowns; and prioritization of nutrition education over PSE implementation. Focus group participants (n = 8) reviewed a case and discussion guide and recommended them as a capacity-building tool for training. Conclusions and ImplicationsUsing decision cases could help build SNAP-Ed implementers’ capacities to implement nutrition PSE change strategies and strengthen partnerships.

Lessons learned from implementing the Supplemental Nutrition Assistance Program Education Small Corner Store Project in Los Angeles County.

As part of the federal Supplemental Nutrition Assistance Program Education (SNAP-Ed) in Los Angeles County (LAC), corner store conversions (CSCs) were an integral part of a broader, more coordinated effort to improve nutrition and to prevent obesity in low-income populations. To date, little is known about this experience in LAC. The present study addresses this gap by describing lessons learned from implementing the SNAP-Ed Small Corner Store Project (SCSP) in this region. The project, which began in 2013, sought to scale CSCs in underserved communities of LAC, employing behavioral economics (e.g., prominently displaying healthy foods at checkout aisles or using in-store signage to promote healthy options) to encourage patron selection of healthier food items. Results from an assessment of the SCSP suggest that for CSCs to do well, careful considerations should be given to factors such as time (e.g., amount of staff time dedicated to the effort), staff capacity (e.g., # staff available to assist), and available resources that can be leveraged (e.g., support from community-based organizations). For some stores, inadequate food distribution or a lack of capital improvement infrastructure (e.g., refrigeration for fresh produce/storage of excess food that can be repurposed) were key barriers that required additional funding. Although local efforts that incentivize small businesses to undergo CSCs may initially nudge store owners to participate, increasing overall consumer demand for healthier food products (i.e., so as to help maintain sales volume) remains a key to sustaining store conversions long after SNAP-Ed resources are gone.

The SNAP-Ed Evaluation Framework: demonstrating the impact of a national framework for obesity prevention in low-income populations.

The United States Department of Agriculture's Supplemental Nutrition Assistance Program Education, known as SNAP-Ed, is the country's largest and most diverse community nutrition program. In 2017, nearly 140 SNAP-Ed implementing agencies (SIAs) and hundreds of contractors delivered nutrition education to almost 5 million people in nearly 60,000 low-resource sites. Millions more were impacted with social marketing campaigns and policy, systems, and environmental changes. This article introduces and describes the benefits of the newly developed SNAP-Ed Evaluation Framework (Framework) and companion Interpretive Guide to consistently measure SNAP-Ed outcomes across different settings. The Framework uses the social ecological model as its underlying theory and features 51 indicators across four levels: Individual, Environmental Supports, Sectors of Influence, and Population Results. Topline findings from the first-year Census to track Framework adoption found that most SIAs intended to impact indicators closer to the inner levels of influence: Individual (mean = 59% of SIAs; SD = 22%) and Environmental Settings (mean = 48%; SD = 23%). As yet, few SIAs targeted outcomes for long-term indicators (mean = 26%; SD = 15%), Sectors of Influence (mean = 20%; SD = 12%), or Population Results (mean = 30%; SD = 11%). An in-depth example of how one state is using the Framework is described. The SNAP-Ed Evaluation Framework offers a new suite of evaluation measures toward eliminating disparities that contribute to poor diet, physical inactivity, food insecurity and obesity. Practitioners will need technical assistance to implement the Framework, especially to measure longer-term, multi-sector and population results, and to maximize effectiveness in SNAP-Ed.

Use of Survival Analysis to Predict Attrition Among Women Participating in Longitudinal Community-Based Nutrition Research

ObjectiveTo identify participant characteristics and study methodology that influenced the completion of a 15-month community-based longitudinal study evaluating the impact of the Supplemental Nutrition Assistance Program Education and Expanded Food and Nutrition Education Program. DesignObservational longitudinal 15-month study across 12 data collection timepoints. Sociodemographic characteristics were collected with a paper-based survey at baseline. SettingFive counties across central and southern Illinois. ParticipantsWomen, aged 18 to 65 years (n = 297), recruited at sites likely to serve families eligible for the Supplemental Nutrition Assistance Program Education and Expanded Food and Nutrition Education Program (housing departments, child care centers, etc). Main Outcome MeasuresPredictors of participant attrition during the study duration. AnalysisCox proportional hazard models. ResultsNinety-seven participants were retained across the full study. In unadjusted models, greater income and education levels were significantly related to lower attrition; however, this relationship did not persist in a multivariate model. When adjusted for other characteristics, larger household size was the only measured variable significantly related to greater odds of attrition (odds ratio = 1.09; 95% confidence interval = 1.02, 1.17). Conclusions and ImplicationsSeveral characteristics predicting attrition in other settings were not significant in this study. Future attrition analyses that evaluate social support, transportation capacity, and type of phone in longitudinal nutrition education studies are warranted.

Supplemental Nutrition Assistance Program Education Evaluation and Database System

Reporting requirements for capturing data on the delivery of Supplemental Nutrition Assistance Program Education (SNAP-Ed) have evolved. University of Minnesota (U of M) Extension developed the SNAP Education Evaluation and Database System (SEEDS) to capture unduplicated participant information for SNAP-Ed programming conducted by U of M Extension across the state of Minnesota. The data collected in SEEDS have utility related to both managing programs and measuring the success of programs at local, regional, and state levels. Extension professionals in other states may benefit from developing a similar centralized database for collecting SNAP-Ed data.

Promoting congregant health in faith-based organizations across Los Angeles County, 2013-2016.

The Los Angeles County Department of Public Health (DPH) launched the Nutrition Education and Obesity Prevention (NEOP) Project in fall 2013. As the local arm of the Supplemental Nutrition Assistance Program Education (SNAP-Ed), this project partnered with faith-based organizations (FBOs) in Los Angeles County to implement policy, systems, and environmental change interventions (PSEs) at selected church sites, alongside the usual delivery of health education.A 2-part programmatic assessment was conducted to better understand how the NEOP Faith Based Project at one of the FBOs was implemented during the 2013–2016 SNAP-Ed funding cycle. A qualitative component (key informant interviews) sought to understand and describe the PSE implementation process at each of the participating church sites, whereas the quantitative component (surveys) focused on assessing congregant perceptions about their awareness of the PSEs, their knowledge and beliefs about health, and their self-reported health behaviors after exposure to onsite changes.Among congregants who participated in the survey, 52% expressed desire for more health education classes. However, only 37% reported being aware of them at church sites that hosted them. When asked to compare their behaviors for “today” versus 6 months ago, more than half reported greater interest in eating more fruits and vegetables (66%), choosing water over soda (69%), and becoming more physically active (59%).Results from the NEOP Project have implications for how local health departments could partner with FBOs to outreach and promote health among congregants, particularly for those who are at high-risk of diet-related diseases due to poor nutrition and obesity.

A Supplemental Produce and eLearning Nutrition Education Program for Georgians Who Use Safety-Net Clinics for Their Health Care

ObjectiveTo explore the experiences of safety-net clinic patients who engaged in a 12-week supplemental produce and eLearning nutrition education program. MethodsThis mixed-method study employed a nonrandomized comparison study design. Participants (intervention [n = 20] and comparison control [n = 6]) had diet-related chronic diseases. Data collection included pre- and post-intervention, focus group interviews, 24-hour diet recalls, and clinical and anthropometric outcome assessments. Interviews were recorded, transcribed, and coded using the constant comparison method. Nonparametric data analyses were conducted for quantitative data. ResultsThree primary themes emerged: (1) program benefits, (2) challenges to achieving health benefits and optimal engagement of the program, and (3) recommendations for program improvement. Quantitative data analysis did not show significant differences in pre- and post-clinical and anthropometric measures between the intervention and comparison groups. Conclusions and ImplicationsFindings suggest a unique Supplemental Nutrition Assistance Program Education dissemination model that may decrease barriers to healthful eating and increase engagement in eLearning nutrition education.

P38 Gleaning as a SNAP-Ed Public Health Approach to Address Healthy Eating for Low-Income Mainers

Objective Evaluate the success of developing gleaning distribution systems to increase access to local food in settings where low-income individuals live, receive food assistance, obtain clinical services, and congregate for nutrition education. Use of Theory or Research Maine Supplemental Nutrition Assistance Program Education (SNAP-Ed) programming is informed by the United States Department of Agriculture's (USDA) SNAP-Ed Evaluation Framework, aligned with the Social-Ecological Model. Target Audience Mainers eligible for SNAP benefits. Program Description Maine SNAP-Ed implements evidence-based public health approaches to reduce health disparities. At the individual and environmental levels, nutrition educators deliver series-based education and develop organizational partnerships to adopt and promote nutrition-related supports. In response to community need and readiness, Maine SNAP-Ed has seen an increase in educators partnering to develop systems to gather and distribute leftover crops as part of a policy, systems, and environmental change strategy designed to increase access to fresh produce for low-income Mainers. Evaluation Methods A monthly PSE tracking tool measures progress toward outcomes. End-of-year, semi-structured interviews with educators supplement monthly data, summarizing accomplishments and potential reach. Annual data are analyzed to assess whether intended outcomes were achieved using independent and collaborative reviews with a consensus decision-making process. The Framework indicator “MT5-Nutrition Supports Adopted” guides this work. Other methods include use of public data sources to estimate reach, and photo documentation and success story templates to describe outcomes qualitatively. Results Ten gleaning systems were developed in fiscal years 2017 and 2018, impacting more than 38 sites. Partners include local farms and food councils, federally qualified health centers, the Commodity Supplemental Food Program, emergency food agencies, and public schools. Recipient sites include Head Starts, libraries, food pantries, senior and low-income housing, federally-funded summer meal sites, and clinical settings. Conclusions SNAP-Ed can successfully implement and maintain gleaning strategies that maximize local food systems and supplement nutrition education. This work supports community-based food assistance efforts, while addressing obesity prevention and food insecurity for low-income individuals. Funding SNAP-Ed.

P102 A Follow-Up Outcome Evaluation of a Comprehensive SNAP-Ed Social Marketing Campaign in Louisiana

Background In 2014, the Louisiana State University Agricultural Center (LSU AgCenter), an implementing agency for the Louisiana Supplemental Nutrition Assistance Program–Education (SNAP-Ed), launched a social marketing campaign to promote healthy eating and physical activity behaviors. LSU AgCenter contracted Altarum in 2015 and 2016 to evaluate the campaign. Using Altarum's findings, LSU AgCenter revised the messaging, images and delivery channels for the campaign and relaunched in 2017. The updated campaign utilized billboards, television and radio advertisements, and printed materials to reach SNAP-Ed eligible adults in 32 parishes in Louisiana. Objective To assess the effectiveness of the updated campaign in reaching the intended audience. Study Design, Settings, Participants Altarum conducted an outcome evaluation using measures from the SNAP-Ed Evaluation Framework. A revised telephone survey collected data from 601 randomly selected SNAP recipients living in parishes receiving the campaign. Measurable Outcome/Analysis Descriptive statistics described the sample population and assessed exposure. Significant differences between groups were estimated using 95% confidence intervals. Data were weighted by age and gender to generalize findings to the SNAP population in target Louisiana parishes. Differences between the 2015 and 2018 outcome evaluations were noted. Results Consistent with findings from 2015, 50% of SNAP recipients were exposed to one or more of campaign messages through any delivery channel. Television ads were the most recalled channel of delivery (44%) followed by billboards and printed materials (36% each) and radio advertisements (19%). Exposure to individual messages varied slightly with 31%, 30% and 23% of exposed SNAP recipients seeing the Healthy Meals at Home, Breakfast, and Physical Activity messages, respectively. Among SNAP recipients exposed to the campaign, many indicated that the messages encouraged them to think about adopting the promoted healthy behaviors, many of whom followed through with their intentions. Conclusion LSU AgCenter successfully implemented an updated social marketing campaign that was seen by half of SNAP recipients in target Louisiana parishes. Funding SNAP-Ed.

P56 Changes in Healthy Eating and Physical Activity Behaviors of Low-Income Adult Georgians Participating in Supplemental Nutrition Assistance Program Education (SNAP-Ed)

Objective To examine the impact of Food Talk: Better U (FTBU), the University of Georgia SNAP-Ed's new healthy weight management program on healthy eating, food resource management, and physical activity behaviors in a sample of low-income Georgians. Use of Theory or Research Social cognitive theory and expanded health belief model. Target Audience SNAP-Ed eligible Georgian adults with children Program Description FTBU was developed based on a comprehensive formative evaluation. FTBU is a series of four 90-minute lessons taught by paraprofessionals focusing on portion control, goal setting, limiting added sugar, small healthy shifts, and problem-solving strategies. Each lesson includes a sharing session, didactic lesson, physical activity (PA), cooking demonstration and tasting, and goal setting. Evaluation Methods Outcome evaluation of the program used pre- and post-self-administered questionnaire, 24-hour dietary recalls, and self-reported and measured weight. Outcome measures included Medium Term behavior change indicators (MT1, 2, and 3) from the SNAP-Ed Evaluation Framework and other validated measures. McNemar tests were used to examine changes in reported healthy behaviors between pre- and post-test. Results A total of 454 low-income Georgians participated in FTBU in FY 2018 (mean age 52.6 ± 17.1 years, 74.4% females, 47.6% Black, 68.3% overweight/obese). Overall, participants reported engaging in more healthy behaviors after the intervention. The percent of participants who reported eating more than one fruit (MT1c) and vegetable (MT1d) per day significantly increased after the intervention. Most food resource management indicators (MT2a, b) showed a significant increase between pre- and post-test. The percent meeting guidelines for engaging in moderate-vigorous PA (MT3b) and PA to make muscles stronger (MT3c) also increased significantly post-intervention. Conclusions The findings suggest FTBU has potential to improve healthy behaviors aimed at healthy weight management practices among SNAP-Ed eligible adults with a high burden of obesity. Further evaluations are needed using a rigorous research design with control groups. Funding SNAP-Ed.

P31 A Statewide Local Wellness Policy Assessment Finds Marked Improvements Among SNAP-Ed-Supported School Districts

Background The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) encourages nutrition and physical activity in districts and schools where over 50% of students receive free-and-reduced-price lunch. In Arizona, the AZ Health Zone implements SNAP-Ed, which includes support for developing, implementing, and evaluating local wellness policies (LWPs). Objective To assess changes in written LWPs among SNAP-Ed-participating districts across Arizona. Study Design, Settings, Participants The AZ Health Zone developed a scoring system using the WellSAT 2.0 tool to measure the quality of written LWPs and encourage use of findings among partner districts. From October 1, 2015 to September 30, 2016, local SNAP-Ed agencies in 13 Arizona counties submitted 57 LWPs and received back scores and customized recommendations to share with districts. LWPs from the same districts were scored again between October 1, 2017 to September 30, 2018 to assess changes. Measurable Outcome/Analysis We completed the six-section WellSAT 2.0 to generate scorecards for each LWP. Scorecards included section and total scores for comprehensiveness and strength, from 0 (worst) to 100 (best). We used the paired t-test to compare scores across time, and we explored changes in scores as they related to SNAP-Ed interventions, federal requirements, and state administrative reviews. Results From 2016 to 2018, total comprehensiveness and strength scores increased significantly (comprehensiveness: M = 12.33, SD = 16.05, P P P P Conclusion Written LWPs in Arizona's SNAP-Ed-supported school districts have improved in recent years. SNAP-Ed interventions may have worked synergistically with state administrative reviews and federal LWP guidelines to influence improvements. Further research is needed to understand these interrelationships.

P53 Awareness and Perceptions of Maine SNAP-Ed Among Maine SNAP Recipients

Background Contracted by the State of Maine—DHHS Office for Family Independence (OFI), Altarum has served as the external evaluator for Maine Supplemental Nutrition Assistance Program-Education (SNAP-Ed) since 2013. Objective Assess awareness, perceived value, and barriers to accessing Maine SNAP-Ed direct education classes among Maine SNAP recipients. Study Design, Settings, Participants Altarum conducted a cross-sectional telephone survey using a list of adult Maine SNAP recipients provided by the State of Maine–DHHS OFI. Measurable Outcome/Analysis Respondents were asked about awareness, perceived value, and barriers to participation in Maine SNAP-Ed direct education classes. Results were weighted to reflect characteristics of Maine SNAP recipients. Descriptive statistics and 95% confidence intervals were calculated to identify significant differences between groups. Results Approximately half of Maine SNAP recipients (49%) were aware of Maine SNAP-Ed. Many SNAP recipients (45%) learned about SNAP-Ed classes through other assistance programs (e.g., WIC). A majority (61%) recognized one or more of Maine SNAP-Ed's direct education classes by name. Only 7% of SNAP recipients had taken a Maine SNAP-Ed direct education class. However, most SNAP recipients (72%) were “somewhat” or “very interested” in learning how to eat healthy. Those who had taken a Maine SNAP-Ed class reported that the program helped them plan healthy meals for themselves and their family (96%), try a new recipe (91%), and think about making healthier food choices (91%). Barriers to participation mentioned by those who had not taken a Maine SNAP-Ed class included: being unaware that nutrition education classes were offered (52%), difficulty with the locations (43%), disbelieving classes would change behaviors (40%), and being too busy (35%). Approximately 4 in 10 who had not participated (41%) were uninterested in taking a nutrition education class. Conclusion The majority of Maine SNAP recipients were aware of SNAP-Ed and interested in learning to eat healthy. Maine SNAP-Ed may be able to increase program participation by addressing identified barriers.

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.

P187 Taste is Everything: Feasibility of Using Sensory Evaluation to Develop Responsive Recipes for the Supplemental Nutrition Assistance Program-Education (SNAP-Ed)

Background Federal nutrition education programs for low-income Americans, such as SNAP-Ed, often include recipes to facilitate healthy eating behaviors; however, little is known about acceptance and sensory evaluation of such recipes among target audiences. Objective To examine the feasibility of using sensory evaluation methodology to assess acceptability including overall liking (OL) and five specific sensory attributes (appearance, flavor, texture, saltiness, and sweetness) of the seven newly developed culturally-tailored recipes for low-income adult Georgians. Study Design, Settings, Participants Sensory evaluation was conducted to assess acceptability of the new recipes in 566 participants (83% ≥ 60 years old; 83% female; 74% African American) in the University of Georgia SNAP-Ed Food Talk Farmers Market program during summer, 2018. Recipes were prepared following standardized instructions for preparation and portion size. Participants were asked to rate for acceptability. Measurable Outcome/Analysis Sensory evaluation ballots used traditional nine-point hedonic scale to evaluate OL and five sensory attributes of the recipes (1=dislike extremely, 5=neither like nor dislike, and 9=like extremely). Standard range of acceptability for a recipe is ≥ 7.0. Descriptive statistics of the scales and their relationship with reported intention to healthy behavior changes were analyzed. Results Overall, the new recipes received favorable acceptability with the highest ratings for recipes containing meat or meat alternatives (eg, Chicken Chili with White Beans, mean OL = 7.34, flavor = 7.11, texture = 7.31) and the lowest ratings for recipes with a fruit (Banana Pudding Overnight Oats, mean OL = 5.18, flavor = 4.92, texture = 6.18). Those with standard acceptability ratings (≥ 7) also reported high intention to follow healthy behaviors. Conclusion The findings suggest the feasibility and utility of sensory evaluation methodology in the development of recipes that are more effective and responsive to the sensory preferences of low-income adults for nutrition education programs. Funding SNAP-Ed.

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.

P92 Using the PSE Readiness Assessment and Decision Instrument to Support Implementation of Community Nutrition Strategies in Ohio

Objective Promote practitioners’ confidence to use and disseminate the PSE Readiness Assessment and Decision Instrument (PSE READI) to tailor PSE strategies to local contexts. Use of Theory or Research There is increasing attention within the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) toward implementation of PSE strategies to improve dietary outcomes among low-income populations. Tools to adapt PSEs to local levels of readiness and capacity are needed. Target Audience SNAP-Ed and public health practitioners in Ohio. Program Description The PSE READI was designed to adapt implementation of four community nutrition PSEs: farmers’ markets, farm-to-school, healthy eating in childcare, healthy food retail. After completing the assessment, a tailored report is provided with three recommendations to guide local PSE implementation, which are linked to a resource library with > 1,000 tools/guides. The tool was tested for usability and first disseminated via a day-long interactive training focused on supporting others use of the tool to assess, plan, and act to optimize PSE implementation in targeted areas. Evaluation Methods Pre- and post-survey design without randomization was used to test confidence in practitioners’ ability to support and train others to use the PSE READI. Results Practitioners (N = 23) doing work in 60 Ohio counties participated in the PSE READI training. One-third reported PSE implementation is related to their current work plan; 41% supported others conducting PSEs. Confidence to support colleagues’ implementation of PSEs (extremely/very confident: pre-35%, post-70%) and train colleagues to use the PSE READI tool (pre-10%, Post-70%) increased substantially after the training. The majority (87%) planned to use the PSE READI tool in the next three months. Post-training, practitioners reported they were “better equipped,” “more informed,” and “inspired.” Conclusions The PSE READI tool provides a feasible and efficient method to tailor PSE implementation to the realities of diverse communities. The tool and training were well-received by SNAP-Ed and public health practitioners resulting in an increase in practitioner confidence to support implementation of community nutrition PSEs.

P70 Hands-On Culinary Education Program for Youth Improves Cooking Skills, Attitudes, Self-Efficacy, Behaviors, and Food Preferences

Objective Evaluate the impact of a revised version of the Illinois Junior Chefs (IJC) program using pre- and post-intervention surveys and observational assessments of hands-on cooking skills. Use of Theory or Research To date, evaluations of nutrition education and cooking programs in youth have been limited to self-reported assessments of cooking skills. Along with using an established IJC survey, this study developed a novel observational protocol to assess hands-on cooking skills in youth. Target Audience Supplemental Nutrition Assistance Program - Education (SNAP-Ed) eligible youth (n = 591) aged 8-13. Program Description IJC is a hands-on culinary and nutrition education program implemented by the University of Illinois Office of Extension and Outreach. IJC is taught over five 2-hour lessons which include nutrition education, culinary skill building activities, recipe preparation, and food tastings. Evaluation Methods Pre- and post-intervention evaluations assessed hands-on cooking skills (observational assessment, n = 37) and psychosocial predictors of dietary behaviors (IJC survey, n = 591). Results Analyses of surveys indicated participants experienced significant improvements pre- to post-intervention in cooking self-efficacy (t(590) = 18.63, P Conclusions IJC participants experienced significant improvements in cooking self-efficacy, attitudes, behaviors, and food preferences. The observational assessment was established as a feasible data collection method which demonstrated significant improvements in youth participants’ cooking skills. Funding SNAP-Ed, USDA, EFNEP, 4-H Foundation.

P63 Evaluation of an Intervention to Promote Healthful Beverages Through the Provision of Free Recipe Cards at Grocery Stores

Objective To examine consumers’ use and perceptions of healthful beverage recipe cards distributed at grocery stores as part of a campaign to reduce sugar-sweetened beverages (SSB) among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) eligible households. Use of Theory or Research Point-of-purchase interventions have been used previously to effectively promote more healthful choices and shows promise here as a means to reduce SSB intake. Target Audience Consumers who shop at grocery stores located in or near low-income communities in Nevada. Program Description Partnerships with SNAP-approved grocery retailers (n = 18) resulted in store displays featuring free recipes for healthful, low-cost beverages. Evaluation Methods For four months, displays were stocked with recipe cards inviting consumers to complete an online survey (anticipating sample of 250). The 45-item survey instrument, administered using Survio, assessed consumers’ experiences and opinions. Respondents received a $10 e-gift card. Results During the study period, approximately 20,730 recipe cards were distributed and 238 surveys were completed. Most respondents had taken the recipe card(s) from a store located 15 minutes or less from home (70%), in an urban county (89%), where they usually shop (83%). The reasons most often endorsed for taking a card were interest in a new recipe (47%), the cards were free (47%) and/or a desire to make healthy drinks (44%). Those who had prepared the recipe (90%), were satisfied with the beverage as noted by a mean rating of 4.14 ± 1.02 measured using a five-point scale with 1 = very dissatisfied and 5 = very satisfied. A majority strongly agreed/agreed that the instructions were simple (95%), the ingredients were items they already buy (71%), and the recipes made healthy drinks more convenient (79%). Few found the ingredients too costly (11%) or noted important information missing (13%). Conclusions Partnerships with SNAP-approved retailers facilitated the distribution of healthful beverage recipes that were positively perceived by consumers. This point-of-purchase strategy has the potential to reduce SSB intake among persons in SNAP-Ed eligible households.

P54 Outcome Evaluation of the University of Tennessee Extension Farmers’ Market Fresh Nutrition Education Program

Background In 2015, University of Tennessee Extension (UT Extension) piloted the nutrition education program Farmers’ Market Fresh (FMF) with a primary objective of encouraging fruit/vegetable (FV) consumption by limited-resource families through purchases at farmers’ markets. FMF is funded by the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) and has since been expanded to over 30 markets statewide. Objective To measure the effectiveness of FMF among limited-resource families. Study Design, Settings, Participants Altarum conducted an outcome evaluation to assess exposure, changes in attitudes and behavior, and demographics. Adults were surveyed at SNAP-Ed eligible farmers’ markets with FMF (intervention) and without FMF (comparison) in July and August 2018. Measurable Outcome/Analysis Descriptive statistics described the sample and outcome variables. Confidence intervals estimated associations between FMF and outcomes. Multivariate logistic regression models were conducted to determine the impact of FMF on outcomes, controlling for demographic characteristics. Results A total of 382 surveys were completed; 211 intervention and 171 comparison. Intervention respondents were two and a half times as likely as comparison to receive information on healthy eating and nutrition, almost three times as likely to learn about purchasing fresh FV on a budget, and 2.4 times as likely to learn about selecting a variety of FV. Intervention respondents were significantly more likely than comparison to report being very confident in their ability to purchase fresh FV on a budget (69% versus 50%) and to select a variety of fresh FV (82% versus 68%). Respondents attending the market at least once per week were more likely than those attending less than once per week to report increased FV consumption. Intervention respondents with minor children in the household were significantly more likely than those without children to report trying a new FV (74% versus 52%) and trying a new recipe (74% versus 46%). Conclusion FMF was successful in reaching farmers’ market shoppers and increasing confidence and behaviors related to healthy eating.

P170 Four-Week Nutrition Education Series Associated with Improved Dietary Behaviors and Confidence Among SNAP-Eligible Mainers

Background Ten Tips for Adults (10 Tips) was developed by the University of New England, implementing agency for Maine Supplemental Nutrition Assistance Program-Education (SNAP-Ed). 10 Tips comprises two independent four-session nutrition education series: Series A focuses on MyPlate while Series B focuses on eating better on a budget. Altarum was contracted by the State of Maine—DHHS Office for Family Independence to evaluate 10 Tips. Objective To assess changes in dietary behaviors and cooking and purchasing foods on a budget among participants in 10 Tips. Study Design, Settings, Participants The target audience is Maine adults eligible for SNAP benefits. A retrospective pre/post survey was administered to 10 Tips participants after the last class. Measurable Outcome/Analysis The survey assessed dietary behaviors and confidence cooking and purchasing foods on a budget before and after participation in 10 Tips. To estimate significant changes, Wilcoxon signed rank tests and z-tests with Bonferroni correction were used. Longitudinal modeling assessed the association between number of sessions attended and outcomes. Results Respondents significantly improved consumption of fruit, vegetables, low-fat and skim dairy products, whole grains, and sweets after participating in 10 Tips (P Conclusion Respondents significantly increased consumption of healthy foods and water, decreased consumption of SSB and sweets, and improved skills in buying and preparing healthy foods on a budget after participation in 10 Tips.