Progress 01/01/23 to 12/31/23
Outputs
Target Audience:The target audience during Project Year 2 included study participants, program coordinators, policymakers, and academics. Implementation of the study intervention took place in four states (Colorado, Florida, Maryland and Washington). Intervention activities targeted free-living, low-income individuals aged 18-50 years who were caregivers of young children. Individuals in the control group received a biometric screening including measurements of height, weight, Body Mass Index, blood pressure, pulse, and hemoglobin A1C. Intervention group participants received: 1) EFNEP education, delivered using the 9-lesson, evidence-based Eating Smart • Being Active curriculum, and 2) a biometric screening including the measures described above for the control group. Program coordinators, policymakers and academics were also reached by this project through publications and presentations. The pilot study that serves as the foundation for this project was accepted for publication and is currently in-press at the Journal of Extension. Methods employed in this project were shared with the target audience through a selected poster presentation at the Agricultural and Applied Economics Association's 2023 Annual Meeting and through a research intervention methods manuscript which is currently under review at the Journal of Nutrition Education and Behavior. Progress made on this project during Year 1 was also shared through a poster presentation at the 2023 Society of Nutrition Education and Behavior International Conference. Changes/Problems:Establishment of reliance agreements with Maryland IRB took significantly longer than expected. In total, it took 15-months to establish a reliance agreement with the University of Florida, 9-months for Colorado State University, and 9-months for Washington State University. This delayed the start of data collection from that proposed in the project timeline by 6-9 months for each involved university. What opportunities for training and professional development has the project provided?Bhavya Peddigari is a MS student in the Nutrition and Food Science program at the University of Maryland, College Park. During Year 2, Ms. Peddigari gained experience with site recruitment, participant recruitment, project supply management, data collection, and data entry. How have the results been disseminated to communities of interest?Results from this project were disseminated during Project Year 2 through: 1 journal article publication 1 journal abstract publication 2 poster presentations at national conferences What do you plan to do during the next reporting period to accomplish the goals?Research Objective 1: Analyze the short-term and long-term impact of EFNEP on participant biomarkers of chronic disease risk, including body mass index (BMI), hemoglobin A1c (HbA1c), and blood pressure. During Project Year 3, the following activities are planned to support achievement of Research Objective 1: 1) continued recruitment of partner agencies and sites, 2) continued recruitment and enrollment of eligible participants, 3) pre data collection, 4) post data collection, 5) 6mo-post data collection, 6) 1yr-post data collection, 7) data entry, and 8) analysis of the impact of adult EFNEP on biomarkers 6mo-post. Research Objective 2: Develop and apply a cost-benefit analysis methodology that uses biomarkers to quantify program benefits as dollars saved from the prevention and onset delay of chronic diseases. Work on Research Objective 2 will pause during Project Year 3 and resume in Project Year 4 when data collection is completed. Research Objective 3: Compare EFNEP benefit-cost ratios obtained using biomarkers to those obtained using behavioral data. Work related to Research Objective 3 will begin in Project Year 4. Extension Objective 1: Develop a user-friendly, online cost-benefit analysis tool that program coordinators can use to assess the value created by nutrition education interventions. During Year 3, we will finalize key decisions on the design of the online cost-benefit analysis tool, including the tool's location, format, and outputs. After these decisions are finalized, we will begin development of the online tool. Extension Objective 2: Develop and host a training webinar for the cost-benefit analysis tool. Work related to Extension Objective 2 will begin in Project Year 4. Education Objective 1: Provide graduate students at participating universities with training and experiential learning opportunities in data collection and analysis. An Economics MS student will be recruited from South Dakota State University for the 2024-2025 academic year. The student will assist with analysis of the impact of EFNEP on chronic disease biomarkers.
Impacts
What was accomplished under these goals?
Research Objective 1: Analyze the short-term and long-term impact of EFNEP on participant biomarkers of chronic disease risk, including body mass index (BMI), hemoglobin A1c (HbA1c), and blood pressure. (50% Accomplished) The following activities were completed in support of Research Objective 1 during Project Year 2: 1) established IRB reliance agreements for Colorado State University, the University of Florida, and Washington State University, 2) site recruitment, 3) participant recruitment, 4) pre data collection, 5) post data collection, 6) 6mo-post data collection, 7) data entry, and 8) submitted a research intervention methods paper for publication in the Journal of Nutrition Education and Behavior which is currently under review. As of October 2023, 31 sites have been recruited, 259 participants have completed the pre data collection, 112 participants have completed the post data collection, and 34 participants have completed the 6mo-post data collection. Participant retention is currently greater than 70% across data collection periods in all four programs. Research Objective 1 Impact: Data collection was the primary activity completed under Research Objective 1 during Project Year 2. The data collected will be used in future analyses of the impact of EFNEP on biomarkers of chronic disease risk. Results will provide insight on adult EFNEP's ability to reduce chronic disease risk and inform potential program revisions. Research Objective 2: Develop and apply a cost-benefit analysis methodology that uses biomarkers to quantify program benefits as dollars saved from the prevention and onset delay of chronic diseases. (40% Accomplished) During Project Year 2, the biomarker cost-benefit analysis (CBA) methodology developed in the pilot study that serves as a foundation for this project was modified to include three chronic disease biomarkers (BMI, blood pressure, and HbA1c), instead of one (BMI). The updated CBA methodology was shared with researchers and policymakers through a selected poster presentation at the Agricultural and Applied Economic Association's 2023 Annual Meeting. The updated biomarker CBA methodology will be applied to assess national adult EFNEP following completion of data collection in Project Year 4. Research Objective 2 Impact: The developed biomarker cost-benefit analysis methodology provides policymakers, program administrators, and stakeholders with a means to objectively assess the economic value generated by EFNEP through chronic disease risk reduction. These estimates are critical for informing public funding allocation and program revisions. Research Objective 3: Compare EFNEP benefit-cost ratios obtained using biomarkers to those obtained using behavioral data. (0% Accomplished) Work on Research Objective 3 will begin during Project Year 4. Research Objective 3 Impact: N/A Extension Objective 1: Develop a user-friendly, online cost-benefit analysis tool that program coordinators can use to assess the value created by nutrition education interventions. (10% Accomplished) Initial planning for Extension Objective 1 began in Project Year 2. We received feedback from EFNEP program coordinators and researchers attending the NC3169 Annual Meeting on where the ideal location for the tool is, what format is preferred (Excel vs web-based), and which outputs they would like the tool to provide. We also began reaching out to Extension and colleagues at our universities to determine which resources are available to help us efficiently create the online tool. Extension Objective 1 Impact: Extension Objective 2: Develop and host a training webinar for the cost-benefit analysis tool. (0% Accomplished) Work on Extension Objective 2 will begin during Project Year 4. Extension Objective 2 Impact: N/A Education Objective 1: Provide graduate students at participating universities with training and experiential learning opportunities in data collection and analysis. (50% Accomplished) An MS student in Nutrition and Food Science at the University of Maryland continued working on this project during Year 2. The MS student gained experience with site recruitment, participant recruitment, project supply management, data collection, and data entry. Education Objective 1 Impact: Valuable experiential learning opportunities were provided to prepare an MS student for an impactful future career in the public health field.
Publications
- Type:
Journal Articles
Status:
Accepted
Year Published:
2023
Citation:
A Leschewski, MC Aragon, D Weatherspoon, K Barale, G Auld, R Acquah-Sarpong*, and S Baker. Expanded Food and Nutrition Education Program Generates Economic Value Through Body Mass Index Improvement: A Cost-Benefit Analysis. Journal of Extension.
- Type:
Journal Articles
Status:
Published
Year Published:
2023
Citation:
A Leschewski, S Baker, S Pierce, K Pybus, M Udahogora, K Shelnutt, and A Roe. 2023. A Cost-Benefit Analysis of EFNEP Utilizing Biomarkers of Chronic Disease Risk: Year One. Journal of Nutrition Education and Behavior, 55(7), 105.
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2023
Citation:
A Leschewski, S Pierce, and A Roe. 2023. Economic Evaluation of Nutrition Education Interventions A Biomarker-Based Approach. Agricultural and Applied Economics Association 2023 Annual Meeting, July 23-25, 2023, Washington DC.
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2023
Citation:
A Leschewski, S Baker, S Pierce, K Pybus, M Udahogora, K Shelnutt, and A Roe. 2023. A Cost-Benefit Analysis of EFNEP Utilizing Biomarkers of Chronic Disease Risk: Year One. 2023 Society of Nutrition Education and Behavior International Conference, July 20-23, 2023, Washington DC.
- Type:
Journal Articles
Status:
Under Review
Year Published:
2023
Citation:
A Leschewski, S Pierce, MC Aragon, SS Baker, M Udahogora, K Pybus, NO Duffy, A Roe, and K Sankavaram. 2023. A Cost-Benefit Analysis of Adult EFNEP Utilizing Biomarkers of Chronic Disease Risk: Intervention Research Methods. Journal of Nutrition Education and Behavior.
- Type:
Other
Status:
Other
Year Published:
2023
Citation:
A Leschewski. 2023. NC3169 Mini-Grant Multi-State Research Group Award. $1,500. Will be used for open-access publication of manuscript resulting from this project.
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Progress 01/01/22 to 12/31/22
Outputs
Target Audience:Implementation of the study intervention began in two states (Maryland and Washington) during Project Year 1. Intervention activities targeted free-living, low-income individuals aged 18-50 years who were caregivers of young children. Individuals in the control group received a biometric screening including measurements of height, weight, Body Mass Index, blood pressure, pulse, and hemoglobin A1C. Intervention group participants received: 1) EFNEP education, delivered using the 9-lesson, evidence-based Eating Smart • Being Active curriculum, and 2) a biometric screening including the measures described above for the control group. Changes/Problems:Four Co-PI changes were made during Year 1. M. Catalina Aragon, Dr. Nicole Duffy, Dr. Kavitha Sankavaram, and Dr. Dhruv Sharma stepped down from the project due to job changes to non-academic positions. Correspondingly, four new Co-PIs were added to the project: Dr. Steven Pierce, Kylie Pybus, Dr. Karla Shelnutt, and Dr. Margaret Udahogora. In addition to Co-PI changes, state EFNEP programs involved in project data collection experienced significant employee turnover among EFNEP program peer educators and supervisors. Collectively, the Co-PI changes and employee turnover delayed the start of data collection by approximately four months. Data collection will now primarily begin in January 2023. A portion of expenditures allocated for 1) materials and supplies, 2) honoraria, 3) supervisor, data collector, and educator salaries and benefits, and 4) travel in Year One will thus be reallocated to Year Two. What opportunities for training and professional development has the project provided?Bhavya Peddigari is a MS student in the Nutrition and Food Science program at the University of Maryland, College Park. During Year Ms. Peddigari gained experience with: 1) the development of data collection and data entry protocols, participant and partner recruitment materials, data collection training, and survey instruments, 2) Spanish translation of project materials, 3) project supply management, 4) EFNEP educator training, and 5) data collection. How have the results been disseminated to communities of interest?
Nothing Reported
What do you plan to do during the next reporting period to accomplish the goals?Research Objective 1: Analyze the short-term and long-term impact of EFNEP on participant biomarkers of chronic disease risk, including body mass index (BMI), hemoglobin A1c (HbA1c), and blood pressure. During Project Year 2, the following activities are planned to support achievement of Research Objective 1: 1) continued recruitment of partner agencies and sites, 2) continued recruitment and enrollment of eligible participants, 3) data collection #1 (pre), 4) data collection #2 (post), and 5) data collection #3 (6 mo-post). Research Objective 2: Develop and apply a cost-benefit analysis methodology that uses biomarkers to quantify program benefits as dollars saved from the prevention and onset delay of chronic diseases. During Project Year 1, a BMI cost-benefit analysis methodology was refined and disseminated. During Project Year 2, two additional chronic disease biomarkers (blood pressure and hemoglobin A1C) will be incorporated into the BMI cost-benefit analysis framework to create a broader biomarker cost-benefit analysis framework. To do so, a literature review will be conducted to identify the relationship between blood pressure and hemoglobin A1C change and chronic disease risk. The identified biomarker-chronic disease risk relationships will then be integrated into the developed cost-benefit analysis methodology. Research Objective 3: Compare EFNEP benefit-cost ratios obtained using biomarkers to those obtained using behavioral data. Work related to Research Objective 3 will begin in Project Year 4. Extension Objective 1: Develop a user-friendly, online cost-benefit analysis tool that program coordinators can use to assess the value created by nutrition education interventions. Work on Extension Objective 1 will begin during Year 2. A web location for the online cost-benefit analysis tool will be identified and a platform to convert the excel-based tool to a web-based tool will be selected. Extension Objective 2: Develop and host a training webinar for the cost-benefit analysis tool. Work related to Extension Objective 2 will begin in Project Year 4. Education Objective 1: Provide graduate students at participating universities with training and experiential learning opportunities in data collection and analysis. During Year 2, a Nutrition and Food Science MS student at the University of Maryland, College Park will contribute to project data collection in Maryland, data analysis, and results dissemination.
Impacts
What was accomplished under these goals?
Research Objective 1: Analyze the short-term and long-term impact of EFNEP on participant biomarkers of chronic disease risk, including body mass index (BMI), hemoglobin A1c (HbA1c), and blood pressure. (33% Accomplished) The following activities were completed in support of Research Objective 1 during Project Year 1: 1) obtained IRB approval from the University of Maryland, College Park, 2) worked to establish reliance agreements for Colorado State University, the University of Florida, and Washington State University, 3) finalized data collection and data entry protocol, 4) created biometric and health questionnaires, 5) developed Qualtrics data entry forms, 6) created participant and partner recruitment flyers and screeners, 7) conducted Spanish translation of questionnaires, data collection forms, and recruitment materials, 8) developed data collection training videos, 9) held two data collection training sessions (25 participants), 10) began partner recruitment (4 recruited), 11) started participant recruitment and enrollment (45 recruited), 12) began data collection #1 (pre) in two states (MD, WA), and 13) started drafting a research methods paper. Research Objective 1 Impact: Activities undertaken during Project Year 1 were critical for facilitating project data collection and future analyses of the impact of EFNEP on biomarkers of chronic disease risk. These analyses will provide insight on adult EFNEP's ability to reduce chronic disease risk and inform potential program revisions. Research Objective 2: Develop and apply a cost-benefit analysis methodology that uses biomarkers to quantify program benefits as dollars saved from the prevention and onset delay of chronic diseases. (20% Accomplished) During Year 1, a Body Mass Index (BMI) cost-benefit analysis (CBA) methodology was refined based on feedback received from external reviewers. The methodology uses BMI to estimate the economic benefits generated by adult EFNEP through chronic disease risk reduction. A corresponding manuscript, "Expanded Food and Nutrition Education Program Generates Economic Value Through Chronic Disease Biomarker Improvement: A Cost-Benefit Analysis," was revised and submitted for publication at the Journal of Extension. The manuscript is currently under initial review. Results from this manuscript indicate Colorado and Washington adult EFNEP generate $9.23 of benefits per $1.00 of costs, and demonstrate the feasibility and value of using biomarkers in economic evaluations of nutrition education interventions delivered through Extension Research Objective 2 Impact: The developed BMI cost-benefit analysis methodology provides policymakers, program administrators, and stakeholders with a means to objectively assess the economic value generated by EFNEP through chronic disease risk reduction. These estimates are critical for informing public funding allocation and program revisions. Research Objective 3: Compare EFNEP benefit-cost ratios obtained using biomarkers to those obtained using behavioral data. (0% Accomplished) Work on Research Objective 3 will begin during Project Year 4. Research Objective 3 Impact: N/A Extension Objective 1: Develop a user-friendly, online cost-benefit analysis tool that program coordinators can use to assess the value created by nutrition education interventions. (0% Accomplished) Work on Extension Objective 1 will begin during Project Year 2. Extension Objective 1 Impact: N/A Extension Objective 2: Develop and host a training webinar for the cost-benefit analysis tool. (0% Accomplished) Work on Extension Objective 2 will begin during Project Year 4. Extension Objective 2 Impact: N/A Education Objective 1: Provide graduate students at participating universities with training and experiential learning opportunities in data collection and analysis. (25% Accomplished) An MS student in Nutrition and Food Science was recruited for the project at the University of Maryland, College Park during Project Year 1. The MS student gained experience with: 1) the development of data collection and data entry protocols, participant and partner recruitment materials, data collection training, and survey instruments, 2) Spanish translation of project materials, 3) project supply management, 4) EFNEP educator training, and 5) data collection. Education Objective 1 Impact: Valuable experiential learning opportunities were provided to prepare an MS student for an impactful future career in the public health field.
Publications
- Type:
Journal Articles
Status:
Submitted
Year Published:
2022
Citation:
Leschewski A, Aragon MC, Baker S, Weatherspoon D, Barale K, Auld G. 2022. Expanded food and nutrition education program generates economic value through chronic disease biomarker improvement: a cost-benefit analysis. Journal of Extension. (Under Review).
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