Abstract
Background
The goal of US Department of Agriculture Supplemental Nutrition Assistance Program–Education
(SNAP-Ed) is to improve the likelihood that those eligible for SNAP will make healthy
choices aligned with the Dietary Guidelines for Americans, 2020-2025.
Objective
The objective of the study was to evaluate the long-term effects of a direct SNAP-Ed
intervention in which participants actively engage in learning with educator instruction
about dietary quality and usual intake of key nutrient and food groups among Indiana
SNAP-Ed–eligible women participants as an example sample in the context of no similar
existing evaluation.
Design
The study design was a parallel-arm, randomized controlled, nutrition education intervention,
with follow-up at 1 year.
Participants/setting
Participants (18 years and older; n = 97 women) eligible for SNAP-Ed and interested
in receiving nutrition education lessons were recruited from 31 Indiana counties from
August 2015 to May 2016 and randomized to an intervention (n = 53) or control (n =
44) group.
Intervention
The intervention comprised core lessons of Indiana SNAP-Ed delivered between 4 and
10 weeks after baseline assessment. Each participant completed a baseline and 1-year
follow-up assessment. Dietary intake was assessed using repeated 24-hour dietary recalls
(up to 2).
Main outcome measures
Mean usual nutrient, food group intake, diet quality (ie, Healthy Eating Index-2010
scores), and proportion of intervention and control groups meeting Dietary Guidelines for Americans, 2020-2025 recommendations and Dietary Reference Intake indicators of requirement or adequacy,
were determined using the National Cancer Institute method and the simple Healthy
Eating Index-2010 scoring algorithm method. Dietary changes between intervention and
control groups were examined over time using mixed linear models.
Statistical analyses performed
Bonferroni-corrected significance levels were applied to the results of the mixed
linear models for comparisons of usual intake of nutrients and foods.
Results
No differences in diet quality, intake of food group components, food group intake,
or nutrients were observed at 1-year follow-up, except that vitamin D intake was higher
among those who received SNAP-Ed compared with the control group.
Conclusions
A direct SNAP-Ed intervention did not improve diet quality, food group intake, or
key nutrient intake, except for vitamin D, among Indiana SNAP-Ed–eligible women up
to 1 year after the nutrition education.
Keywords
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References
- FY 2022 Supplemental Nutrition Assistance Program Education (SNAP-Ed) Plan Guidance. Nutrition Education and Obesity Prevention Program. US Department of Agriculture, Food and Nutrition Service.https://snaped.fns.usda.gov/sites/default/files/documents/FY%202022%20SNAP-Ed%20Plan%20Guidance.pdfDate accessed: July 5, 2022
- US Department of Agriculture, National Institute of Food and Agriculture.https://nifa.usda.gov/program/supplemental-nutrition-education-program-education-snap-Date accessed: October 18, 2020
- Dietary Guidelines for Americans, 2020-2025. 9th ed. US Department of Agriculture, US Department of Health and Human Services,
Published December 2020https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdfDate accessed: July 5, 2022
- US Department of Agriculture Service Food and Nutrition.https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-programDate accessed: October 20, 2020
- US Department of Agriculture, Food and Nutrition Service.https://www.fns.usda.gov/snap/recipient/eligibilityDate accessed: July 26, 2021
- SNAP-Ed Toolkit Interventions.https://www.nccor.org/downloads/SNAPEdStrategiesAndInterventionsToolkitForStates.pdfDate accessed: November 29, 2021
- SNAP Data Tables. US Department of Agriculture, Food and Nutrition Service.https://www.fns.usda.gov/pd/supplemental-nutrition-assistance-program-snapDate accessed: May 2, 2022
- Funding allocations. US Department of Agriculture. SNAP-Ed Connection.https://snaped.fns.usda.gov/program-administration/snap-ed-funding-allocationsDate accessed: November 28, 2021
- Children’s dietary quality and micronutrient adequacy by food security in the household and among household children.Nutrients. 2019; 11: 965
- Diet Quality of Americans by SNAP Participation Status: Data from the National Health and Nutrition Examination Survey, 2007–2010.(Published May 5, 2015)https://fns-prod.azureedge.us/sites/default/files/ops/NHANES-SNAP07-10.pdfDate accessed: July 5, 2022
- Dietary supplement use differs by socioeconomic and health-related characteristics among U.S. adults, NHANES 2011–2014.Nutrients. 2018; 10: 1114
- Poor dietary guidelines compliance among low-income women eligible for Supplemental Nutrition Assistance Program-Education (SNAP-Ed).Nutrients. 2018; 10: 327
- Food insecurity and health outcomes.Health Aff (Millwood). 2015; 34: 1830-1839
- Food insecurity and health across the lifespan.Adv Nutr. 2012; 3: 744-745
- Food insecurity is inversely associated with diet quality of lower-income adults.J Acad Nutr Diet. 2014; 114: 1943-1953.e2
- Leading with nutrition: Leveraging federal programs for better health. Bipartisan Policy Center,
Published 2018https://bipartisanpolicy.org/report/leading-with-nutrition-leveraging-federal-programs-for-better-health/Date accessed: October 20, 2020
- The effect of food stamp nutrition education on the food insecurity of low-income women participants.J Nutr Educ Behav. 2009; 41: 161-168
- System, environmental, and policy changes: Using the social-ecological model as a framework for evaluating nutrition education and social marketing programs with low-income audiences.J Nutr Educ. 2001; 33: S4-S15
- US Department of Agriculture.https://www.myplate.gov/Date accessed: July 5, 2022
- Supplemental Nutrition Assistance Program Education Plan Guidance FY 2018. Nutrition Education and Obesity Prevention Program. US Department of Agriculture, Food and Nutrition Service.https://snaped.fns.usda.gov/snap/Guidance/FY2018SNAP-EdPlanGuidance.pdfDate accessed: July 5, 2022
- SNAP-Ed (Supplemental Nutrition Assistance Program-Education) increases long-term food security among Indiana households with children in a randomized controlled study.J Nutr. 2016; 146: 2375-2382
- A mixed-methods evaluation of a SNAP-Ed farmers’ market-based nutrition education program.J Nutr Educ Behav. 2015; 47: 516-525.e1
- Eat smart, live strong intervention increases fruit and vegetable consumption among low-income older adults.J Nutr Gerontol Geriatr. 2015; 34: 66-80
- Supplemental Nutrition Assistance Program Education and Evaluation Study (Wave II).Published 2013https://fns-prod.azureedge.us/sites/default/files/SNAPEdWaveII.pdfDate accessed: July 5, 2022
- Intention to change nutrition-related behaviors in adult participants of a supplemental nutrition assistance program-education.J Nutr Educ Behav. 2015; 47: 81-85
- Diet, shopping and food-safety skills of food stamp clients improve with nutrition education.Calif Agric. 2004; 58: 206-208
- SNAP Education and Evaluation Study (Wave I): Final Report.Published 2012https://fns-prod.azureedge.us/sites/default/files/SNAPEdWaveI.pdfDate accessed: July 5, 2022
- Learner-centered nutrition education improves folate intake and food-related behaviors in nonpregnant, low-income women of childbearing age.J Am Diet Assoc. 2008; 108: 1627-1635
- Evaluating food stamp nutrition education: Process for development and validation of evaluation measures.J Nutr Educ Behav. 2006; 38: 18-24
- Evaluation of validity of items for a food behavior checklist.J Am Diet Assoc. 2001; 101: 751-761
- Effect of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) on food security and dietary outcomes.Nutr Rev. 2019; 77: 903-921
- Dietary Guidelines for Americans, 2010.7th ed. US Department of Agriculture, US Department of Health and Human Services, 2010
- US Department of Agriculture. SNAP-ED Connection.https://snaped.fns.usda.gov/program-administration/snap-ed-plan-guidance-and-templatesDate accessed: May 2, 2022
- Welcome to the CONSORT. CONSORT. Transparent Reporting of Trials.http://www.consort-statement.org/Date accessed: November 29, 2021
- Systematic review of control groups in nutrition education intervention research.Int J Behav Nutr Phys Activity. 2017; 14: 91
- Update of the Healthy Eating Index: HEI-2010.J Acad Nutr Diet. 2013; 113: 569-580
- HEI scoring algorithm.(National Cancer Institute, Division of Cancer Control and Population Services)https://epi.grants.cancer.gov/hei/hei-scoring-method.htmlDate accessed: December 21, 2020
- Automated Self-Administered 24-Hour (ASA24®) Dietary Assessment Tool. Epidemiology and Genomics Research Program. National Cancer Institute. Division of Cancer Control and Population Sciences.https://epi.grants.cancer.gov/asa24/Date accessed: October 20, 2020
- The provision of assistance does not substantially impact the accuracy of 24-hour dietary recalls completed using the automated self-administered 24-H dietary assessment tool among women with low incomes.J Nutr. 2019; 149: 114-122
- MyPyramid equivalents product downloads. US Department of Agriculture, Agricultural Research Service, Published 2021
- Food Patterns Equivalents Database: Methodology and User Guide.https://data.nal.usda.gov/dataset/food-patterns-equivalents-database-fpedDate accessed: May 2, 2022
- Automated Self-Administered 24-Hour Dietary Assessment Tool. National Cancer Institute, Division of Cancer Control and Population Sciences.https://epi.grants.cancer.gov/asa24/resources/cleaning.htmlDate accessed: October 20, 2020
- Food and Nutrient Database for Dietary Studies, 4.1. US Department of Agriculture, Agricultural Research Service,
Published August 2010https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/fndds/fndds_4.pdfDate accessed: July 5, 2022
- Comparison of ASA24® versions. National Cancer Institute, Division of Cancer Control and Population Sciences.https://epi.grants.cancer.gov/asa24/comparison.htmlDate accessed: October 20, 2020
- Scientific Report of the 2015 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Health and Human Services and the Secretary of Agriculture.US Department of Health and Human Services, US Department of Agriculture, Agricultural Research Service, 2015
- Dietary Guidelines for Americans, 2015–2020.8th ed. US Department of Health and Human Services, US Department of Agriculture, 2015
- US Department of Agriculture SNAP-Ed Connection.https://snaped.fns.usda.gov/aboutDate accessed: May 2, 2022
- Nutrient Recommendations: Dietary Reference Intakes (DRI). National Institutes of Health Office of Dietary Supplements.https://ods.od.nih.gov/HealthInformation/Dietary_Reference_Intakes.aspxDate accessed: August 23, 2021
- Usual dietary intakes: The NCI method. National Cancer Institute, Division of Cancer Control and Population Services.https://epi.grants.cancer.gov/diet/usualintakes/method.htmlDate accessed: July 5, 2022
- A review of the food security, diet and health outcomes of food pantry clients and the potential for their improvement through food pantry interventions in the United States.Physiol Behav. 2020; 220: 112871
- How do socio-economic status, perceived economic barriers and nutritional benefits affect quality of dietary intake among US adults?.Eur J Clin Nutr. 2008; 62: 303-313
- Dietary intake contributions of food and beverages by source and food security status in US adults.J Nutr Educ Behav. 2017; 49: 667-673.e1
- Survey Tools. US Department of Agriculture, Economic Research Service.https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/survey-tools/#householdDate accessed: August 21, 2021
- DRI Dietary Reference Intakes: Applications in Dietary Assessment.National Academies Press, 2000
- A mixed-effects model approach for estimating the distribution of usual intake of nutrients: The NCI method.Stat Med. 2010; 29: 2857-2868
- Do nutritional behaviors depend on biological sex and cultural gender?.Adv Clin Exp Med. 2020; 29: 165-172
- Learn more about energy adjustment. National Cancer Institute, Dietary Assessment Primer.https://dietassessmentprimer.cancer.gov/learn/adjustment.htmlDate accessed: December 11, 2021
- A new statistical method for estimating the usual intake of episodically consumed foods with application to their distribution.J Am Diet Assoc. 2006; 106: 1575-1587
- Describing dietary intake. National Cancer Institute, Dietary Assessment Primer.https://dietassessmentprimer.cancer.gov/approach/intake.htmlDate accessed: December 11, 2021
- Analysis of repeated measures data with clumping at zero.Stat Methods Med Res. 2002; 11: 341-355
- Outcome effectiveness of the widely adopted EFNEP curriculum eating smart being active.J Nutr Educ Behav. 2015; 47: 19-27
- Improved overall quality of diets reported by expanded food and nutrition education program participants in the mountain region.J Nutr Educ Behav. 2015; 47: 421-426.e1
- SAS [computer program]. Version 9.4. SAS Institute, 2013
- Applications of the Healthy Eating Index for surveillance, epidemiology, and intervention research: Considerations and caveats.J Acad Nutr Diet. 2018; 118: 1603-1621
- Update of the Healthy Eating Index: HEI-2015.J Acad Nutr Diet. 2018; 118: 1591-1602
- Vitamin D and calcium for the prevention of fracture: A systematic review and meta-analysis.JAMA Netw Open. 2019; 2e1917789
- Dietary Reference Intakes for Calcium and Vitamin D.National Academies Press, 2011
- Three-year trends in dietary behaviours among mothers, teenagers and children from SNAP-Ed (Supplemental Nutrition Assistance Program-Education) eligible households across California.Public Health Nutr. 2020; 23: 3-12
- Nutrition policies, practices, and environments in low-income Georgia Elementary Schools, United States, 2015-2017.J School Health. 2020; 90: 278-285
- Evaluating the impact of six supplemental nutrition assistance program education interventions on children’s at-home diets.Health Educ Behav. 2015; 42: 329-338
- Healthy People 2030. US Department of Health and Human Services.https://health.gov/healthypeople/objectives-and-data/social-determinants-healthDate accessed: November 30, 2021
- Ross A.C. Taylor C.L. Yaktine A.L. Valle HB Del Dietary Reference Intakes for Adequacy: Calcium and Vitamin D. National Academies Press, 2011
- Magnesium - Health professional fact sheet. National Institutes of Health.https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/Date accessed: June 9, 2021
- Vitamin E - Health professional fact sheet. National Institutes of Health.https://ods.od.nih.gov/factsheets/VitaminE-HealthProfessional/Date accessed: June 9, 2021
- Potassium - Health professional fact sheet. National Institutes of Health.https://ods.od.nih.gov/factsheets/Potassium-HealthProfessional/Date accessed: December 2, 2021
- Diet quality and associations with food security among women eligible for Indiana supplemental nutrition assistance program-education.J Nutr. 2020; 150: 2191-2198
- Pennsylvania SNAP-Ed exploratory study shows significant increases in fruit and vegetable intake.J Nutr Educ Behav. 2014; 46: S154
- SNAP-Ed Can Improve Nutrition of Low-Income Americans Across Life Span.RTI International, 2014
- The impact of SNAP-ED and EFNEP on program graduates 6 months after graduation.J Extension. 2011; 49: 5RIB6
- The Automated Self-Administered 24-Hour Dietary Recall (ASA24): A resource for researchers, clinicians, and educators from the National Cancer Institute.J Acad Nutr Diet. 2012; 112: 1134-1137
- Structure of dietary measurement error: Results of the OPEN biomarker study.Am J Epidemiol. 2003; 158: 14-21
- The National Cancer Institute’s Dietary Assessment Primer: A resource for diet research.J Acad Nutr Diet. 2015; 115: 1986-1995
- Supplemental Nutrition Assistance Program-Education improves food security independent of food assistance and program characteristics.Nutrients. 2020; 12: 2636
- Food resource management education with SNAP participation improves food security.J Nutr Educ Behav. 2015; 47: 374-378.e1
- Food insecurity and dietary quality in US adults and children: A systematic review.Am J Clin Nutr. 2014; 100: 684-692
- Exploring the association of urban or rural county status and environmental, nutrition- and lifestyle-related resources with the efficacy of SNAP-Ed (Supplemental Nutrition Assistance Program-Education) to improve food security.Public Health Nutr. 2018; 21: 957-966
- Association between the retail food environment, neighborhood deprivation, and county-level dietary outcomes among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Recipients in Kentucky, 2010-2011.J Hunger Environ Nutr. 2013; 8: 362-377
- The Social-Ecological Model - 2015-2020 Dietary Guidelines. US Department of Health and Human Services, US Department of Agriculture.https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/chapter-3/social-ecological-model/Date accessed: October 20, 2020
Biography
Y. Qin is a PhD student, Department of Nutrition Science, Purdue University, West Lafayette, IN.
Biography
R. L. Rivera is a PhD student, Department of Nutrition Science, Purdue University, West Lafayette, IN.
Biography
Y. Zhang is a PhD student, Department of Statistics, Purdue University, West Lafayette, IN.
Biography
Q. Wang is a research scientist, Department of Statistics, Purdue University, West Lafayette, IN.
Biography
J. A. Tooze is a professor, School of Medicine, Wake Forest University, Winston-Salem, NC.
Biography
A. R. Abbott is an assistant dean of Health and Human Sciences Extension and associate director of Purdue Extension, Health and Human Sciences Extension, Purdue University, West Lafayette, IN.
Biography
M. K. Maulding is an instructor and dietetics internship coordinator, Department of Nutrition and Dietetics, Eastern Illinois University, Charleston.
Biography
B. A. Craig is a professor, Department of Statistics, Purdue University, West Lafayette, IN.
Biography
R. L. Bailey is a professor, Department of Nutrition Science, Purdue University, West Lafayette, IN.
Biography
H. A. Eicher-Miller is a professor, Department of Nutrition Science, Purdue University, West Lafayette, IN.
Article info
Publication history
Published online: June 30, 2022
Accepted:
June 28,
2022
Received:
July 26,
2021
Footnotes
Supplementary materials: Tables 2 and 3 are available at www.jandonline.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This research was funded by Purdue University as part of AgSEED Crossroads funding to support Indiana’s Agriculture and Rural Development, Purdue University Frederick N. Andrews Fellowship, the Purdue University Nutrition Education Program, Hatch Project IND90005789, and the US National Library of Medicine training grant T15LM012502.
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