MONITORING AND IMPROVING US FOOD SECURITY AND DIETARY INTAKE IN NATIONAL AND REGIONAL SUB-POPULATIONS

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: COMPLETE
• Funding Source: HATCH
• Reporting Frequency: Annual
• Accession No.: 1005709
• Project Start Date: Mar 24, 2015
• Project End Date: Sep 30, 2019
• Program Code: [(N/A)]- (N/A)

Recipient Organization
PURDUE UNIVERSITY
(N/A)
WEST LAFAYETTE,IN 47907

Performing Department
Nutrition Science

Non Technical Summary
Objective 1. Current food insecurity estimates are among the highest since monitoring in 1995 (Coleman-Jensen, et al, 2014). Disparities in dietary intake, nutrient intake, short-term and long-term health outcomes are prevalent among food insecure populations including children, adults, and the elderly (Eicher-Miller et al, 2019; Eicher-Miller et al, 2011; Jyoti & Frongilo, 2005; Kirkpatrick & Tarasuk, 2008, Lee & Frongillo, 2001; Lee & Frongillo, 2001; Olson CM, 1999; Seligmann et al, 2010; Seligmann et al, 2010; Sharkey et al, 2011; Skalicky et al, 2006; Stuff et al, 2004; Tarasuk, 2001; Tarasuk & Beaton, 1999; Stuff et al, 2004). Specific sub-populations, such as those living in rural areas, pregnant women, and others may have more dramatic dietary and health outcomes associated with food insecurity compared with other groups and may also be under-monitored compared with the general population. Dr. Eicher-Miller's previous work has identified a positive association of food insecurity with iron deficiency and inverse association to bone mineral content among US children (Eicher-Miller et al, 2009; Eicher-Miller et al, 2011), establishing basis for continued monitoring and national intervention efforts to improve iron status and healthy bone development. Her proposed work will continue to focus on understudied food insecure sub-populations including pregnant women, children, emergency food assistance clients, and others, and will include determining how mediators, such as iron source may influence status, how intake of sentinel foods are associated with nutrient and bone status such as milk, and other health exposures, and how food pantries contribute to nutrient intake among participants. The evidence gained will inform programs and policies directed to improve health and food insecurity in these populations.Objective 2. The SNAP and SNAP-Ed programs were recently at risk of severe budget cuts. Government support of these programs and evidence based programming depends on information gained through scientific studies. The creation of new interventions, such as VFF, to improve food security in the context of the increasing national food insecurity prevalence is also reliant on knowledge of effective programs. Yet, few studies using randomized, controlled study designs to evaluating these programs are documented (Eicher-Miller et al, 2009) nor is the use of evidence based evaluation frequently documented (Wilde, 2007). Yet, more than ever, studies are needed to determine impact and inform policy makers as budgets are considered for reduction. SNAP-Ed evaluation will inform policy makers of the effect of this program on food insecurity in Indiana allowing program improvements and informed budget decisions. The VFF intervention will provide evidence of how the combined effect of community, program, and education may improve food security in 24 poor, rural communities in 6 mid-western states .Objective 3. Energy and nutrients may be consumed differently among the population in a repetitive, habitual pattern over time. Some consume most of their daily energy during an eating occasion in the evening while others consume energy relatively equivalently in 3 evenly spaced eating occasions throughout the day (Khanna et al, 2011). Temporal dietary patterns is an emerging area of research that quantizes the distribution of energy or nutrient intake observed over a period of time. Work to develop temporal dietary patterning and other analytical techniques is a collaborative effort including Dr. Eicher-Miller and scientists from electrical engineering. This multidisciplinary team has recently developed novel data patterning techniques to determine population clusters exhibiting similar temporal dietary patterns. Application of the techniques to include other daily lifestyle measures will enrich knowledge of how dietary patterns and other patterns such as activity and sleep may be related to health. This multi-faceted approach may have the potential to provide new insights on the complex diet-disease relationship and represents an inclusive approach that may reveal stronger associations between indicators of health and the role of diet than earlier have been recognized (Flood et al, 2008). The development of data reduction techniques incorporating dietary, physical activity, and other temporal data may be applied to quantify the lifestyle patterns of food insecure populations and other at-risk sub-populations that may be targeted for public health interventions.

Animal Health Component

100%

Research Effort Categories

Basic

(N/A)

Applied

100%

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
704	6099	1170	30%
703	6099	1170	60%
724	6099	1170	10%

Knowledge Area
703 - Nutrition Education and Behavior; 724 - Healthy Lifestyle; 704 - Nutrition and Hunger in the Population;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
1170 - Epidemiology;

Keywords

food insecurity

dietary intake

supplemental nutrition assistance program education

lifestyle patterns

health

Goals / Objectives
Dr. Eicher-Miller's research is focused on improving the public health problem of food insecurity, a situation of inadequate resources and/or access to food that is associated with immediate and chronic negative dietary and health outcomes. The federal budget to reduce food insecurity in the US (estimated at 15% of households in 2012), was greater than $114 billion in 2012. Effective budgetary decisions rely on continuous evaluation, monitoring, and evidence-based research to determine the disparities among this population compared with the food secure population and should continue to support programs and policies that improve food insecurity and diet. Dr. Eicher-Miller's primary research goals address these needs and include: 1.) monitoring and discovering emerging nutritional disparities among food insecure, diverse sub-populations; 2.) developing and assessing evidence-based programs and policies that improve food security and diet; 3.) creating new analytical and methodological techniques to quantify and evaluate the relationship of dietary intake and other exposures to health and food insecurity.The specific objectives are: Objective 1: to characterize and compare the dietary intake of US sub-groups by food security status, including under-documented national (pregnant females and children) and regional (food pantry participants) sub-groups. The hypothesis that food insecure pregnant females 13-54y and children 1-19y from a nationally representative sample and food insecure food pantry participants ≥21y from a central northwestern Indiana sample will have less appropriate intake of nutrients of concern as outlined by the 2010 Dietary Guidelines (DG) (fiber, cholesterol, saturated fatty acids, K, Na, vitamin D, Ca, and Fe) compared with their food secure counterparts will be investigated. Objective 2: to evaluate the effect of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) on food security and diet in adults>18y in Indiana using a randomized controlled study design, and evaluate Voices for Food--a novel intervention based on the development of food policy councils, using a longitudinal comparison study design in 24 communities in 6 states. The hypothesis that these programs will improve food insecurity among participants who receive the intervention relative to those in a control/comparison group will be tested. Objective 3: to develop and evaluate new methodologies identifying exposures that predict diet and health outcomes. The hypothesis that temporal patterning methodology will improve characterization of the relationship of diet to health among US adults 21-65y will be tested.

Project Methods
Objective 1:The National Health and Nutrition Examination Survey (NHANES) 1999-2010 is a continuously conducted, nationally representative cross-sectional survey completed with over 25,000 individuals. Participants complete an in-depth questionnaire assessing diet and socioeconomic indicators. Participants that completed the 18 item USDA Household Food Security Survey Module assessing food security status for the household, adults in the household, or children in the household, that completed one or more 24-hour dietary recalls and met criteria as reliable and who do not report a chronic health condition, will classify a "healthy" sample and be included in the study.The USDA's Automated Multiple Pass Method 24-hour dietary recall will be completed initially in the mobile examination center exam and a second time in a phone interview on a non-consecutive day.The reported dietary information is linked to the USDA Food and Nutrient Database for Dietary Studies and can be used to calculate nutrient intake from diet and total nutrient intake. Total daily nutrient intakes (including K; Na, Ca; Fe; vit. D, fiber, cholesterol, saturated fatty acids, and others) will be used to estimate the sub-population "usual intake" using the NCI method. Nutritional outcome indicators available in the laboratory data files from a blood draw collected in the mobile examination center will classify iron deficiency. Bone mineral content will be quantified from a whole body DXA completed in the mobile examination center. The characteristics of the specific sub-population of interest will be compared among food security groups using t-tests or Rao-Scott Chi-square analysis. Multiple linear and logistic regression will be used to determine differences in dietary intake by food security status in models stratified by age and gender. The NCI method will be used to determine estimates of "usual intake" for dietary components. A list of frequently reported foods and their proportional representation from all food reports can also be calculated using the foods files. For Indiana, consenting adult participants >21y (n=200) will be recruited from a representative sample of the food pantries in the central northwestern region served by a common food bank over the span of one year. Recruitment from the various pantries will be staggered to prevent confounding by region and seasonality.Participants will complete a questionnaire and up to four 24-hour dietary recalls using the Automated Self-Administered 24-Hour Dietary Recall on-site and in three additional assessments. Heights and weights will be quantified to allow adjustment for BMI in the analysis. Contents of the food received from the food pantry will be recorded at the on-site data collection and weighted. Total daily nutrient intakes for each participant will be used to estimate the "usual intake" using the NCI method. Data to classify other potential confounders or variables of interest will be drawn from the questionnaire. Food security status before and aftervisiting the pantry will be assessed. Analytical methods will be similar to those described above for use with NHANES data, but will adjusted for representativeness for the food bank region. Objective 2:Methodology for evaluation of the SNAP-Ed program and Voices for Food interventions are described below.The participants (n=400) of the SNAP-Ed study will be eligible to receive SNAP-Ed (household income <130% of the income-to-poverty ratio), >18y, recruited by SNAP-Ed paraprofessionals following normal SNAP-Ed procedures, and will be randomized to a SNAP-Ed intervention and a control group. Sample size calculations will be based on a previous randomized, controlled intervention study and feasibility considering the over 19,000 annual program reach. Consent will be obtained from all participants.The study will feature a unique longitudinal, randomized and controlled study design with SNAP-Ed lessons serving as the intervention for the experimental group. A pre and post-assessment, including the US HFSSM and a characteristics questionnaire, will be completed by both groups before and after a 4 to 10 week "intervention period" during which the experimental group will receive the SNAP-Ed intervention. The control group will not receive the SNAP-Ed intervention during the "intervention period". Both groups will again complete a follow-up-assessment one year following the "intervention period". All SNAP-Ed para-professionals recruiting and delivering lessons to participants will randomly assign participants to the control (n=200) or intervention group (n=200). Control participants will complete SNAP-Ed lessons after the follow-up-assessment. The participants will be compensated each time surveys are completed. Contact with all the participants will be encouraged throughout the duration of the study by the provision of alternate non-nutrition and non-budgeting education online.Regression models will be used to compare participants from the experimental group with participants from the control group (study group as the independent variable) to determine the relationship between the study group with food security post or follow-up classification (dependent variable) for the specified time period when controlling for the initial food security classification. Other characteristics such as poverty-income-ratio, gender, race/ethnicity, and number of SNAP-Ed lessons received, will be independent variables controlled for in the analysis. A local Voices for Food (VFF) Intervention Council will be initiated in selected intervention communities with the goal of improving access and availability of nutritious food in rural, high-poverty areas.The intervention will include changes to the local food pantry such as implementing a client choice distribution system (rather than offering pre-selected food bags), offering SNAP-Ed to clients and other nutrition and food safety education. Nutrition education and cultural competency training will be offered to VFF Council members and the volunteers and staff of the food pantry. Two comparison (control) and two intervention communities will be selected in each of six states (24 rural food desert communities). Data collection will occur in both the intervention and comparison communities at three points of time, each one year apart (baseline, mid-project and post-project). A questionnaire and three 24-hour dietary recalls will be completed by recruited pantry clients. Intervention or comparison community recruitment will be the main independent variable and food insecurity level of pantry participants will be the main outcome measure in the analysis. Dietary intake will be an additional outcome variable in the analysis to determine if dietary quality of the pantry clients improved throughout the intervention and from baseline to follow-up. Assessment at the food pantry staff/volunteer level and food policy council levels will allow the quantification of change in the perceptions of food security in the community and what changes were made at the pantry and VFF Council levels. Analytical procedures similar to those described above will be implemented.Objective 3. Data from the US participants in the 1999-2010 NHANES will be used to complete objective 3. Other information in the dataset that will be used in this analysis will include self-reported physical activity and electronically quantified physical activity monitoring data over seven days, self-reported hours of sleep, shift work status, place of eating, time of eating, measured body weight, and height to calculate BMI. Data patterning methodology that can be used to successfully integrate dietary intake, physical activity and sleep patterns with circadian patterns will be developed using an integration of traditional nutrition epidemiological and engineering data patterning methods.

Progress 03/24/15 to 09/30/19

Outputs
Target Audience:Nutrition behavior researchers, epidemiologists, clinical scientists, statisticians, engineers, public health researchers were academic audiences reached by the dissemination activities during this reporting period. Professional audiences were also reached at the state and national level and include dieticians, clinicians, public health nutritionists, nutrition educators, Extension Educators, private companies, trade organizations, and non-profit organizations. Federal and state government agencies and policy makers were government groups reached. Finally, lay audiences such as food policy councils, community leaders, community groups, and other community stakeholders in the Midwest, Indiana, and in the US were served. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?One PhD student has been successfully trained on objectives 1 and 2 and graduated during this reporting period. She has secured a post-doctoral fellowship at NIH. During this reporting period, 2 undergraduate students have completed independent research projects contributing to Objectives 1 and 2. Additional students have enrolled in the lab for credit. All post-doctoral, graduate students, and undergrads with independent research projectshave presented their work at internal or external scientific conferences and additionally at seminars and trainings for professions and lay audiences. These experiences widen their network of contacts and provide them leadership opportunities. How have the results been disseminated to communities of interest?During this reporting period, results have been disserminated to the communities of interest including academic and government audiences at 1 key conference and also Extension and professional conferences in Indiana. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Objective 1: During this reporting period we completed characterization and comparison of food pantry participants dietary intake by food security status. We found that being food secure was associated with a higher whole grains HEI-2010 score and higher mean usual intake of whole grains compared to being low food secure. Being food securewas associated with a higher usual intake of iron compared to being very low food secure. Being food securewas associated with higher mean usual intake of dark green vegetables and total dairy compared to being low food secureand very low food secure. Usual intakes were below Federal guidance for all food securesubgroups among food pantry users from poor, rural, Midwestern counties. Objective 2: During this reporting period we completed analysis of the Voices for Food intervention among food pantry clients of 24 communities in 6 Midwestern states. We found that there was no improvement in food security, diet quality, nor usual intake between groups over time in this intermediate evaluation. Improvements in food security and/or diet quality occurred in both treatment groups in the short term, yet positive short-term intervention changes did not result. Objective 3: We completed this project and found additional links between the new temporal dietary patterns and body mass index among U.S. adults.

Publications

• Type: Journal Articles Status: Published Year Published: 2019 Citation: Liu Y, Remley DT, Zhang Y, Eicher-Miller HA. Frequency of food pantry use and food security status associate with diet quality among Indiana food pantry clients. Journal of the Academy of Nutrition and Dietetics. 2019; Apr 27. Doi:10.1016/j.jand.2019.02.015. PMID: 31040071 (e-pub ahead of print).
• Type: Journal Articles Status: Published Year Published: 2019 Citation: Rivera R, Maulding M, Eicher-Miller HA. Does Supplemental Nutrition Assistance Program-Education (SNAP-Ed) improve food security and diet quality? A Narrative Review. Nutrition Reviews. 2019. May 11. nuz013, https://doi.org/10.1093/nutrit/nuz013.
• Type: Conference Papers and Presentations Status: Published Year Published: 2019 Citation: Rivera R, Deckard M, Savaiano D, Lynch K, Maulding M, Ibriga H, Eicher-Miller HA. Evaluating the Validity and Reliability of the Indiana Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Evaluation Tool. Presented at: American Society for Nutrition Conference; June 2019; Baltimore. poster presentation.
• Type: Conference Papers and Presentations Status: Published Year Published: 2019 Citation: Eicher-Miller HA, Wright B, Guenther P, McCormack L, Stluka S, Remley D, Mehrle D, Franzen-Castle F, Henne B, Vasquez-Mejia C. Nutritional quality of vegetables, fruits, protein foods, and sodium distributed in client food bags is positively associated with client diet quality in rural food pantries. Presented at: American Society for Nutrition Conference; June 2019; Baltimore. poster presentation.
• Type: Conference Papers and Presentations Status: Published Year Published: 2019 Citation: Rivera R, Zhang Y, Wang Q, Maulding M, Bailey R, Eicher-Miller HA. Impact of a Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Intervention on usual dietary intake among Indiana adults. Presented at: American Society for Nutrition Conference; June 2019; Baltimore. poster presentation.

Progress 10/01/17 to 09/30/18

Outputs
Target Audience:Nutrition behavior researchers, epidemiologists, clinical scientists, statisticians, engineers, public health researchers were academic audiences reached by the dissemination activities during this reporting period. Professional audiences were also reached at the state and national level and include dieticians, clinicians, public health nutritionists, nutrition educators, Extension Educators, private companies, trade organizations, and non-profit organizations. Federal and state government agencies and policy makers were government groups reached. Finally, lay audiences such as food policy councils, community leaders, community groups, and other community stakeholders in the Midwest, Indiana, and in the US were served. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?One PhD student has been successfully trained on objectives 1 and 2 and graduated during this reporting period. She has secured a post-doctoral fellowship. One current PhD student in training is planning to complete her dissertation, also training on objectives 1 and 2 in this project, during the next reporting period. One post-doctoral fellow completed her training on this project and has transitioned to a research faculty position at a different university. During this reporting period, 2 undergraduate students have completed independent research projects contributing to Objectives 1 and 2 and an additional student is undertaking a new independent research project that wil similarly contribute to objective 2. Additional students have enrolled in the lab for credit. All post-doctoral, graduate students, and undergrads with independent research projects have presented their work at internal or external scientific conferences and additionally at seminars and trainings for professions and lay audiences. These experiences widen their network of contacts and provide them leadership opportunities. How have the results been disseminated to communities of interest?During thei reporting period, results have been disserminated to the communities of interest including academic and government audiences at 1 key conference and also Extension and professional conferences in Indiana. What do you plan to do during the next reporting period to accomplish the goals?In the next reporting period I plan to complete the data analysis to evaluate the Voices for Food intervention that has been carried out in 24 rural, poor, midwestern communities in 6 states. Data collection for this project has was completed this period and is in the process of being analyzed. We also plan to publish the additional results of objectives 1, 2, and 3 in journals and present results again at the Conference for the Society of Nutrition Education and Behavior and at the American Society of Nutrition Conferences.

Impacts
What was accomplished under these goals? Objective 1: We continue to investigate the dietary intake of food pantry clients and those eligible for the Supplemental Nutrition Assistance Program (SNAP), formerly know as the food stamp program. During this reporting period we have determined very low dietary quality among aSNAP-eligible sample of participants who are also eligible for SNAP-Education, the educational component of SNAP. Dietary quality was 42 on a scale of 0-100 and mean usual intake of fruits (0.62 servings/day), vegetables (1.2 servings/day), dairy (1.3 servings/day), and whole grains (0.05 servings/day) were very low with approximately 93-100% of the group not meeting the Dietary Guidelines for Americans recommendations for servings per day. The mean usual intake estimates and the proportion of meeting the Dietary Guidelines for Americans recommendations among this group eligible for SNAP and SNAP-Ed did not differ by food security status. Objective 2: We completed analysis of the effect of SNAP-Ed on dietary intake in adults in Indiana using a randomized controlled study design and determined no improvement in dietary intake in the intervention compared with the control group over a 1 yeartimeframe as per the nutrients (fiber, calcium, vitamin D, potassium, vitamin A, vitamin C, vitamin E, magnesium, folate) and food groups (dairy, fruit, vegetable, whole grains) that are typically under-consumed in this pouplation. We are still working to complete the evaluation of the Voices for Food intervention among food pantry clients in 24 midwestern communities in 6 states. Objective 3: We have secured additional funding for this project over the project period. We also have investigated the quality of the resulting patterns and clustersof the modified distance metric patterning methods that we have developed. We will continue to evaluate the patterns against additional outcomes besides dietary quality, such as body mass index, diabetes status, metabolic disease status, and others.

Publications

• Type: Journal Articles Status: Published Year Published: 2018 Citation: Rivera R, Dunne J, Maulding MK, Wang Q, Savaiano DA, Nickols-Richardson SM, Eicher-Miller HA. 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 Nutrition. 2018: 21(5):957-966. PMID 29199629.
• Type: Journal Articles Status: Published Year Published: 2018 Citation: Eicher-Miller HA, Zhao Y. Evidence for the age specific relationship of food insecurity and key dietary outcomes among U.S. children and adolescents. Nutrition Research Reviews. 2018: Jan 10L1-16. PMID 29318982. [Epub ahead of print] https://doi.org/10.1017/s0954422417000245.
• Type: Journal Articles Status: Published Year Published: 2018 Citation: Wright BN, Bailey RL, Craig BA, Mattes RD, McCormack L, Stluka S, Franzen-Castle L, Henne B, Mehrle D, Remley D, Eicher-Miller HA. Daily dietary intake patterns improve after visiting a food pantry among food insecure rural Midwestern adults. Nutrients. 2018; May 9;10(5).pii:E583. PMID: 29747384.
• Type: Journal Articles Status: Published Year Published: 2018 Citation: Stluka S, Moore L, Eicher-Miller H, Franzen-Castle L, Henne B, Mehrle D, Remley D, McCormack L. Methodologies for implementing a multi-state community-based intervention in rural, high poverty communities. BMC Public Health. 2018 Aug 23;18(1):1055. Doi:10.1186/s12889-018-5957-9. PMID: 30139336
• Type: Journal Articles Status: Published Year Published: 2018 Citation: Remley D, Franzen-Castle L, McCormack L, Eicher-Miller HA. Chronic health condition influences on client perceptions of limited or non-choice food pantries in poor, rural communities. American Journal of Health Behavior. 2019;43(1):105-118. Doi.10.5993/AJHB.43.1.9
• Type: Conference Papers and Presentations Status: Published Year Published: 2018 Citation: Eicher-Miller HA, Hwang Y, Gelfand S, Bhadra A, Zhao Y2, Delp E. Distance metrics optimized for clustering temporal dietary patterning among U.S. adults. Presented at: American Society for Nutrition Conference; June 2018; Boston.
• Type: Conference Papers and Presentations Status: Published Year Published: 2018 Citation: Liu Y, Eicher-Miller HA. Energy distribution and breakfast skipping associate with diet quality among Midwestern food pantry clients. Presented at: American Society for Nutrition Conference; June 2018; Boston.

Progress 10/01/16 to 09/30/17

Outputs
Target Audience:Nutrition epidemiologists, clinical scientists, statisticians, engineers, public health researchers were academic audiences reached by the dissemination activities during this reporting period. Professional audiences were also reached at the state and national level and include dieticians, clinicians, public health nutritionists, nutrition educators, Extension Educators, private companies, trade organizations, and non-profit organizations. Federal and state government agencies and policy makers were government groups reached. Finally, lay audiences such as food policy councils, community leaders, community groups, and other community stakeholders in the Midwest, Indiana, and in the US were served. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?The project has provided training opportunity for 2 graduate students and 1 post-doctoral fellow to be trained as nutrition epidemiologists. The project has also necessitated assistance from 30 student volunteers in the last year who helped to conduct dietary assessment, data entry, and other project related tasks. Several of these students have enrolled in the lab for credit after their volunteer experiences and one is currently considering an independent research project. Graduate students and post-doc have presented their work at scientific conferences and for other professionals and lay audiences. These experiences have given them exposure to other research, enhanced their network of contacts, and provided them leadership opportunities. How have the results been disseminated to communities of interest?During this reporting period, results of the project have been disseminated to academic and government through presentation at 2 key conferences. Results have also been presented to lay communities of interest through presentations to the emergency food system and Extension conferences in Indiana. What do you plan to do during the next reporting period to accomplish the goals?In the next reporting period, I plan to complete the data analysis to complete evaluation of SNAP-Ed with regard to dietary outcomes. Data collection of the large VFF project will also be completed. I also plan to publish the results of Objective 1 in the form of at least 2 manuscripts. We will present results, again, at the Conference for the Society of Nutrition Education and Behavior and at the American Society of Nutrition Conference.

Impacts
What was accomplished under these goals? Objective 1: We have determined that food pantry participants in our regional sample of food pantry clients from rural, poor, midwestern counties is prevalentaly (78%) and severly (47% very low) food insecure. The dietary quality among the sample is very low, (a acore of 44 on the Healthy Eating Index) compared with the general US population (59). When comparisons by food security status among pantry clients were made, dietary quality differences were not different but low food secure had significantly higher intakes of magnesium, potassium, vitamin A, choline, fiber, caffeine, total fruit, whole fruit, and whole grains compared with very low food secure pantry clients. However, few differences between food secure and low food secure groups were observed. Results on US pregnant females have already been shared in a previous report. Results for US childrenstratified by age groupdetermined from a review of the literature found evidence for a strong, consistent, and dose-responsive relationship of food insecurity with lower vegetable intake compared with food security among children 1-5 years and strong and consistent evidence for high added sugar intake among food insecurechildren 6-11 yearscompared with food secure children. Adolescent focused evidence was sparse and further investigation is needed to determine dietary gaps related to food insecurity among this age group. Objective 2: The food security outcome component of Objective 2 is complete and the manuscript has been published. Data collection is complete and analysis is underway for the dietary outcome component of objective 2. Final data collection for the Voices for Food project is also currently uderway. Objective 3: Further analytical work to evaluate the clusters that have been derived in objective 3 contiues. A methodological paper is in the process of being submitted to a journal.

Publications

• Type: Conference Papers and Presentations Status: Published Year Published: 2017 Citation: Wright BN, McCormack L, Stluka S, Contreras D, Franzen-Castle, Henne B, Mehrle D, Remley D, Eicher-Miller HA. Food group intake differs among adult food secure, low food secure and very low food secure rural, Midwestern emergency food pantry users. Poster presentation. The Federation of American Societies of Experimental Biology Journal. 2017;31(Sup 1):639.30.
• Type: Conference Papers and Presentations Status: Published Year Published: 2017 Citation: Liu Y, Eicher-Miller HA. Self-reported diabetes status moderates the association between food insecurity and body mass index. Poster presentation. The Federation of American Societies of Experimental Biology Journal. 2017;31(Sup 1):lb449.
• Type: Conference Papers and Presentations Status: Published Year Published: 2017 Citation: Wright BN, McCormack L, Stluka S, Contreras D, Franzen-Castle L, Henne B, Mehrle D, Remley D, Eicher-Miller HA. Pantry use predicts food security among rural, Midwestern emergency food pantry users. Mini-symposium presented at: Society for Nutrition Education and Behavior Conference; July 2017; Washington D.C.
• Type: Conference Papers and Presentations Status: Published Year Published: 2017 Citation: Liu Y, Eicher-Miller HA. Association between food insecurity and nutritional status of Indiana Food Pantry Users. Mini-symposium presented at: Society for Nutrition Education and Behavior Conference; July 2017; Washington D.C
• Type: Conference Papers and Presentations Status: Published Year Published: 2017 Citation: Liu Y, Eicher-Miller HA. Pantry visit frequency is associated with diet quality in Indiana Food Pantry Users. Poster presented at: Society for Nutrition Education and Behavior Conference (SNEB); July 2017; Washington D.C.

Progress 10/01/15 to 09/30/16

Outputs
Target Audience:Nutrition epidemiologists, clinical scientists, statisticians, engineers, public health researchers were academic audiences reached by the dissemination activities during this reporting period. Professional audiences were also reached at the state and national level and include dieticians, clinicians, public health nutritionists, nutrition educators, Extension Educators, private companies, trade organizations, and non-profit organizations. Federal and state government agencies and policy makers were government groups reached. Finally, lay audiences such as food policy councils, community leaders, community groups, and other community stakeholders in the Midwest, Indiana, and in the US were served. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?The project has provided opportunities for 4 full time graduate students to be trained as nutrition scientists. Further, the project has necessitated the assistance from over 50 student volunteers to help conduct dietary assessment, data entry, and other project related tasks and has allowed mentoring and training of these students in research methods and exposure to nutrition research. The graduate students have presented their work at scientific and professional conferences and been exposed to the national and international network of scientists and other professionals working in their areas and allowed to network with these individuals. How have the results been disseminated to communities of interest?During this reporting period, there have been several disseminations of the project results to academic and practicioners at conferences, a publication in a peer reviewed academic journal, and through our direct contact with the nutrition education paraprofessionals and community members that we work with to accomplish the project. What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period, I plan to continue to finish data collection and to engage in analysis of the data to fulfill the objectives. Further, several manuscripts are planned to disseminate the results as are further presentations at scientific conferences, meetings for professionals and lay audiences. The four graduate students working on the project will continue to work on their dissertations which are related to the project.

Impacts
What was accomplished under these goals? Objective 1:Analysis and manuscript drafting continues for comparison of food security status and dietary intake among US children and for the regional food pantry participant sub-group studies. Objective 2:The food security outcome component of Objective 2 is complete and the manuscript has been published. Data is still being collected for the dietary outcome component of objective 2. Follow-up data collection for the Voices for Food project is also currently uderway. Objective 3: Further analytical work to evaluate the clusters that have been derived in objective 3 contiues. A methodological paper is in the process of being submitted to a journal.

Publications

• Type: Journal Articles Status: Accepted Year Published: 2016 Citation: Rivera RL, Maulding MK, Abbott AR, Craig B, Eicher-Miller HA. SNAP-Ed improves long-term food security among Indiana households with children. J Nutr. In press.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Wright B*2, McCormack LA, Stluka S, Contreras D, Frazen-Castle L, Henne B, Mehrle D, Remley D, Eicher-Miller HA. Diet quality and characteristics differ among food secure and food insecure emergency food pantry users. Society for Nutrition Education and Behavior Conference, July 2016, Sam Diego, CA. minisymposium.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Rivera RL*2, Maulding MK, Abbott AR, Craig CA, Eicher-Miller HA. SNAP-Ed Program characteristics were not associated with improvement in food security. Society for Nutrition Education and Behavior Conference, July 2016, San Diego, CA. minisymposium.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Rivera RL*2, Maulding MK, Abbott AR, Craig CA, Eicher-Miller HA. SNAP-Ed improves long-term household food security regardless of participation in SNAP or WIC at recruitment. Society for Nutrition Education and Behavior Conference, July 2016, San Diego, CA. poster presentation.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Stluka S*, Moore L, Contreras C, Eicher-Miller H, Franzen-Castle L, Henne B, Arneson McCormack L, Mehrle D, Remley D. Voices for Food: Bridging the gap in multi-state collaborative grant efforts. Society for Nutrition Education and Behavior Conference, July 2016, San Diego, CA. poster presentation.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Rivera RL*2, Maulding MK, Abbott AR, Craig CA, Eicher-Miller HA. Improvement in long-term household food security among Indiana households with children did not differ between rural and urban counties after a Supplemental Nutrition Assistance Program-Education Intervention. Experimental Biology Conference, April 2016, San Diego CA. poster presentation.

Progress 03/24/15 to 09/30/15

Outputs
Target Audience:Nutrition epidemiologists, clinical scientists, statisticians, engineers, public health researchers were academic audiences reached by the dissemination activities during this reporting period. Professional audiences were also reached at the state and national level and include dieticians, clinicians, public health nutritionists, nutrition educators, Extension Educators, private companies, trade organizations, and non-profit organizations. Federal and state government agencies and policy makers were government groups reached. Finally, lay audiences such as food policy councils, community leaders, community groups, and other community stakeholders in the Midwest, Indiana, and in the US were served. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?The project has provided opportunities for 4 full time graduate students to be trained as nutrition scientists. Further, the project has necessitated the assistance from over 50 student volunteers to help conduct dietary assessment, data entry, and other project related tasks and has allowed mentoring and training of these students in research methods and exposure to nutrition research. The graduate students have presented their work at scientific and professional conferences and been exposed to the national and international network of scientists and other professionals working in their areas and allowed to network with these individuals. How have the results been disseminated to communities of interest?Results of the projects have already been presented at national and international academic conferences, professional meetings for Extension and nutrition, as well as lay audiences and representation of government affiliated groups. Academic journal articles stemming from the projects have been published during this reporting period. What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period, I plan to continue to finish data collection and to engage in analysis of the data to fulfill the objectives. Further, several manuscripts are planned to disseminate the results as are further presentations at scientific conferences, meetings for professionals and lay audiences. The four graduate students working on the project will continue to work on their dissertations which are related to the project.

Impacts
What was accomplished under these goals? Objective 1: During this reporting period, a study has been completed to determine the iron status of US pregnant food insecure females. Additionally, NHANES dataset including US children 1-19y have been created to determine the association of food insecurity to nutrient intake and analysis is underway. Finally, primary data from a representative sample of regional food pantry participants has been collected and includes food security and dietary intake information. Objective 2: An evaluation of Indiana SNAP-Ed on food security has been completed using a randomized, controlled study design. Results of the study are written in a journal format and are currently under review at an academic journal. Results have also been presented at 2 national conferences. Data collection for a similar study but to determine the effect fo SNAP-Ed on diet is currently underway. Finally, baseline data has been collected for the multi-state Voices for Food study. Objective 3: A study has been completed and published documenting novel analytical methodology created to accomplish temporal dietary patterning and determine efficacy. A second publication is currently drafted that describes further work to refine the temporal dietary patterns. Finally, 2 proposals have been written and submitted to request the necessary funds to develop temporal lifestyle patterning that will integrate diet, physical activity, and sleep data in relationship to health.

Publications

• Type: Journal Articles Status: Published Year Published: 2015 Citation: Eicher-Miller HA*, Khanna N, Boushey CJ, Gelfand SB, Delp EJ. Temporal dietary patterns derived among the adult participants of NHANES 1999-2004 are associated with diet quality. J Acad Nutr Diet 2015 Jun 30. Pii: S2212-2672(15)00595-X.doi:10.1016/j.jand.2015.05.014 [Epub ahead of print]. In press.
• Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: 8. Zhao Y, Hwang Y, Gelfand S, Delp E, Eicher-Miller HA. Temporal dietary patterns derived from spectral clustering and factor analysis are associated with diet quality using NHANES 1999-2004. Experimental Biology Conference, March 2015, Boston MA. poster presentation.
• Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: 7. Jacobs A, Craig B, Bailey R, Mattes R, Eicher-Miller HA. An evaluation of meal patterns among a sample of adult emergency food pantry users in Central Northwestern Indiana. Experimental Biology Conference, March 2015, Boston, MA. minisymposium.
• Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: 6. Rivera RL, Maulding MK, Abbot AR, Eicher-Miller HA. Food security among households with children in Indiana improved following a Supplemental Nutrition Assistance Program-Education intervention. Experimental Biology Conference, March 2015, Boston MA. minisymposium.
• Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: 5. Rivera RL, Maulding MK, Abbot AR, Eicher-Miller HA. Food security among households with children improved following a Nutrition Education intervention. Society for Nutrition Education Behavior Conference, July 2015, Pittsburgh, PA. poster presentation.