Source: SOUTH DAKOTA STATE UNIVERSITY submitted to
A COST-BENEFIT ANALYSIS OF EFNEP UTILIZING BIOMARKERS OF CHRONIC DISEASE RISK
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
ACTIVE
Funding Source
Reporting Frequency
Annual
Accession No.
1027902
Grant No.
2022-69015-36283
Cumulative Award Amt.
$963,368.00
Proposal No.
2021-08219
Multistate No.
(N/A)
Project Start Date
Jan 1, 2022
Project End Date
Dec 31, 2026
Grant Year
2022
Program Code
[A1344]- Diet, Nutrition and the Prevention of Chronic Disease
Project Director
Leschewski, A.
Recipient Organization
SOUTH DAKOTA STATE UNIVERSITY
PO BOX 2275A
BROOKINGS,SD 57007
Performing Department
Ness School of Mgmt & Econ
Non Technical Summary
According to the CDC, 60% of US adults have a diagnosed chronic disease. This indicates the need for focused efforts to change modifiable risk factors including diet and exercise. The Expanded Food and Nutrition Education Program (EFNEP) aims to prevent chronic diseases by educating and encouraging vulnerable populations to adopt a healthy diet and physical activity. The long-term goal of this integrated project is to assess whether EFNEP is a cost-effective nutrition education intervention that generates sustained improvement in chronic disease biomarkers. This project will be unique in its use of objective biomarkers, instead of self-reported behaviors, to quantify the economic benefits generated by EFNEP through chronic disease prevention.Project research objectives include analyzing EFNEP's sustained impact on chronic disease biomarkers and developing and applying a biomarker-based cost-benefit analysis methodology. Extension objectives are to develop an online cost-benefit analysis tool and webinar for nutrition education program evaluation. Education objectives are to provide graduate students with experiential learning opportunities in data collection and analysis.A paired location untreated control group quasi-experimental design will be employed, with biomarkers (BMI, blood pressure, HbA1c) measured for 500 adults across four representative state EFNEP programs (CO, FL, MD, WA). Biomarkers will be measured pre-EFNEP, 6-months-post-EFNEP and 1-year-post-EFNEP. Analytical techniques will include cost-benefit, bivariate, and multivariate analyses. Project results will expand the EFNEP knowledge-base, allowing for program content and delivery modifications that maximize the impact of taxpayer dollars allocated to chronic disease prevention.
Animal Health Component
90%
Research Effort Categories
Basic
0%
Applied
90%
Developmental
10%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
7036010302070%
6097310301015%
6106010301015%
Goals / Objectives
The long-term goal of this integrated project is to assess whether the Expanded Food and Nutrition Education Program (EFNEP) is a cost-effective intervention that generates sustained improvement in biomarkers of chronic disease risk.Research objectives of this project are to: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 pressureDevelop 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 diseasesCompare EFNEP benefit-cost ratios obtained using biomarkers to those obtained using behavioral dataExtension objectives include:Develop a user-friendly, online cost-benefit analysis tool that program coordinators can use to assess the value created by nutrition education interventionsDevelop and host a training webinar for the cost-benefit analysis toolEducation objectives are:Provide graduate students at participating universities with training and experiential learning opportunities in data collection and analysis.
Project Methods
Study DesignUtilizing a paired location untreated control group quasi-experimental design (with dependent pretest and posttest samples), this project will recruit 500 adult participants; 250 will receive the treatment (EFNEP) and 250 will comprise the control. Participant recruitment will take place in four states, with pairs of programs for treatment and control within each state: 1) Colorado, 2) Florida, 3) Maryland, and 4) Washington.Recruitment for this project will follow standard methods employed by EFNEP. To secure the EFNEP target population, participants will be limited to free-living caregivers of young children with income at or below 185% of the Federal Poverty Line (FPL). Additional inclusion criteria will include being fluent in English and/or Spanish and being between the ages of 18 and 50. Exclusion criteria include being pregnant or nursing, as well as being less than 9-months postpartum.Data collection will include biomarkers (body mass index (BMI), blood pressure, and hemoglobin HbA1c test), the EFNEP Adult Questionnaire, and 24 h dietary recall (24HDR). Biomarker data collection using standardized equipment and procedures will occur at three time points: (1) pre-EFNEP (first lesson), (2) 6-months-post-EFNEP and (3) 1-year-post-EFNEP. Validated Adult Questionnaires will be collected during all four time periods and 24HDR (5-step multi-pass) will be collected pre-EFNEP and post-EFNEP (final lesson) following standard EFNEP procedure. Participants will receive $20, $30, $40 and $50 of monetary compensation pre-EFNEP, post-EFNEP, 6-months-post-EFNEP and 1-year-post-EFNEP, respectively.Data collection procedures will be performed by trained collectors. Data collectors will obtain participant consent, conduct biometric assessments, answer questions, and complete research paperwork. To ensure consistency across states, extension faculty on the project team will design and deliver online training modules for data collectors. These trainings will be recorded to account for potential staff rotation and re-training needs.Research ObjectivesObjective 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.Bivariate and multivariate statistical analyses will be employed to analyze the short and long-term effects of EFNEP on chronic disease biomarkers. Bivariate analyses will be used to compare biomarkers across treatment and control participants. Welch's t-tests will be employed for continuous variables, while Pearson's chi-squared tests will be used for categorical sociodemographic variables. Short-term and long-term EFNEP impact analyses will include bivariate analyses to compare treatment and control participant biomarkers pre to 6-months-post-EFNEP and pre to 1-year-post-EFNEP. Comparative bivariate analyses will also be employed to examine biomarker change across program characteristics. ANOVA models will be used to compare EFNEP and control for the main outcome biomarkers. Specifically, we will use an ANOVA model with intervention (EFNEP vs. Control) and biomarker category (normal vs. higher) as main effects and their interaction, while controlling for state as a blocking term.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.Project personnel will develop a biomarker cost-benefit analysis methodology that incorporates three chronic disease biomarkers. To facilitate accessibility of the methodology, multivariable regression analysis will be used to estimate the relationship between changes in biomarkers and changes in food-related behaviors. Resulting estimates will serve as a proxy for biomarker change in the cost-benefit analysis tool when users do not have biomarker data for their program.Objective 3 Compare EFNEP benefit-cost ratios obtained using biomarkers to those obtained using behavioral data.Excel templates will be created for both the biomarker and behavioral cost-benefit analysis methodologies. Collected data will be inputted into the templates to obtain biomarker and behavioral benefit-cost ratios for the treatment (EFNEP) and control groups. Sensitivity analyses will be undertaken for both methodologies to obtain a feasible range of benefit-cost ratios. Resulting benefit-cost ratios will then be compared by group (treatment versus control) and methodology (biomarker versus behavioral).Extension ObjectivesObjective 4. Develop a user-friendly, online cost-benefit analysis tool that program coordinators can use to assess the value created by nutrition education interventions.Development of an online cost-benefit analysis tool will take place during years 2-4. The tool will provide nutrition education coordinators with a user-friendly, spreadsheet-based tool to assess the cost-benefit of their program as a chronic disease intervention. Tool users will be prompted to input program cost information, EFNEP Adult Questionnaire, 24HDR, and age data for adult participants, as well as available biomarker data. When biomarker data is not available, multivariate estimates of the relationship between biomarker change and food-related behavioral change will be used to estimate the benefits generated by the program through chronic disease prevention. The tool will allow users to input programmatic variables such as dosage, delivery method, and curriculum to conduct comparative cost benefit analyses. A concise results statement and graphic will be generated for users to easily insert into impact statements or infographics to share with stakeholders.Objective 5. Develop and host a training webinar for the cost-benefit analysis toolProject personnel will further develop and market a webinar to introduce the online cost-benefit analysis tool to nutrition education program coordinators nationwide. The webinar will be marketed broadly through the national EFNEP coordinators and SNAP-Ed listservs and state extension offices. Project personnel will also apply to introduce the online cost-benefit analysis tool to EFNEP program administrators at the 2026 National EFNEP Coordinators' Conference. The online tool will be formally launched to the public through South Dakota State University Extension at the beginning of Year 5.Education ObjectivesObjective 6. Provide graduate students at participating universities with training and experiential learning opportunities in data collection and analysis. This project will provide experiential learning opportunities in data collection and analysis to two graduate students in the fields of nutrition and applied economics.An MS student with interest in health economics will be actively recruited during year 3. The graduate student will participate in the project during years 3 and 4 and will assist in the analysis of the long-term benefits generated by EFNEP through chronic disease prevention and in the development of an online cost-benefit analysis tool. The student will be trained in data formatting, data analysis and results dissemination, culminating in the completion of a Master's thesis.With a specialization in nutrition science, a graduate student interested in pursuing research in community nutrition and health behaviors will be recruited in year 1. The student will gain experience in conducting nutrition assessment in a group setting, collecting anthropometric measurements and data analyses. The graduate student will also be trained in learning the process involved in community-based participatory research, implementation of the intervention and advocacy to create effective strategies for sustained and positive health outcomes.The investigators envision an active graduate exchange program at both the universities, where students will be encouraged to participate in the quarterly, web-based meetings.

Progress 01/01/24 to 12/31/24

Outputs
Target Audience:The target audience during Project Year 3 included study participants, EFNEP stakeholders, and policymakers. Study participants in the control group received a biometric screening (pre, 6mo-post, and 12mo-post) including measurements of height, weight, BMI, blood pressure, pulse, and hemoglobin A1C. Participants in the intervention group received education through the EFNEP lesson series and a biometric screening. EFNEP stakeholders and policymakers were also reached by this project through publications and presentations. Methods employed in this project were published in a research intervention methods paper in the Journal of Nutrition Education and Behavior. Progress made on this project during Year 2 was also shared through a poster presentation at the 2024 Society of Nutrition Education and Behavior International Conference and a published abstract in the Journal of Nutrition Education and Behavior. Changes/Problems:Unforeseen personnel changes and weather (Hurricane Helene and Hurricane Milton) led to data collection challenges and delays (approximately 6 months) in Florida. Visa obtainment issues also delayed the start of an economics Master's student at South Dakota State University from Project Year 3 to Project Year 4. 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 3, Ms. Peddigari gained experience with site recruitment, participant recruitment, project supply management, data collection, data entry, data analysis, and manuscript preparation. How have the results been disseminated to communities of interest?Results from this project were disseminated during Project Year 3 through: 2 journal article publications 1 journal abstract publication 1 poster presentation at an international conference. 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 4, the following activities are planned to support achievement of Research Objective 1: 1) completing post data collection, 2) completing 6mo-post data collection, 3) continuing 12mo-post data collection, 4) data entry, 5) analysis of the impact of adult EFNEP on biomarkers pre to 6mo-post, and 6) drafting a manuscript on the impact of adult EFNEP on biomarkers pre to 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 will begin on conducting a cost-benefit analysis of adult EFNEP using pre to 6mo-post data in Project Year 4. Research Objective 3: Compare EFNEP benefit-cost ratios obtained using biomarkers to those obtained using behavioral data. Behavioral cost-benefit analysis estimates for adult EFNEP using pre to 6mo-post data will be compared to biomarker cost-benefit analysis estimates (see Research Objective 2). 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. Development of the online cost-benefit analysis tool will begin in Project Year 4. 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 5. 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 from South Dakota State University will begin working on the project during Year 4. 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. (75% Accomplished) The following activities were completed in support of Research Objective 1 during Project Year 3: 1) site recruitment, 2) participant recruitment and enrollment, 3) pre data collection, 4) post data collection, 5) 6mo-post data collection, 6) 12mo-post data collection, 7) Qualtrics survey development and refinement, 8) implementation of Research.WebNEERS for data entry, 9) publication of a research intervention methods paper in the Journal of Nutrition Education and Behavior, 10) publication of Project Year 2 progress in the Journal of Nutrition Education and Behavior, and 11) presentation of Project Year 2 progress at the Society for Nutrition Education and Behavior's 2024 International Conference. As of October 2024, 64 sites have been recruited, 400 participants have completed the pre data collection, 328 participants have completed the post data collection, 199 participants have completed the 6mo-post data collection, and 75 have completed the 12mo-post data collection. Participant retention is currently 81% pre to post, 74% post to 6mo-post, and 77% 6mo-post to 12mo-post. Research Objective 1 Impact: Data collection was the primary activity completed under Research Objective 1 during Project Year 3. The data collected will be used in future analyses of the impact of EFNEP on biomarkers of chronic disease risk. Biomarker cost-benefit analysis results will provide EFNEP stakeholders and policymakers with objective estimates of the economic value generated by the program through chronic disease risk reduction. These estimates are critical for informing program revisions and public funding allocation. 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) The developed biomarker CBA methodology will be applied to assess national adult EFNEP following completion of data collection in Project Year 4. Research Objective 2 Impact: N/A 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. (25% Accomplished) Planning for Extension Objective 1 continued in Project Year 3. Feedback from EFNEP program coordinators and researchers during Project Year 2 informed the tool's design, which includes the option to use standard EFNEP program data and/or biomarkers to generate cost-benefit analysis estimates. The tool will be provided in an Excel format. Efforts are underway to identify an Extension office to host the tool. Extension Objective 1 Impact: The developed online cost-benefit analysis tool will provide nutrition education programs with an accessible tool for generating estimates of the economic value generated by their program through chronic disease risk reduction. 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. (60% Accomplished) An MS student in Nutrition and Food Science at the University of Maryland continued working on this project during Year 3. The MS student gained experience with site recruitment, participant recruitment, project supply management, data collection, data entry, data analysis, and manuscript preparation. Defense of her thesis is planned for Fall 2024. Education Objective 1 Impact: An MS student gained valuable experience conducting research on a nutrition education program in preparation for a career in public health.

Publications

  • Type: Journal Articles Status: Published Year Published: 2024 Citation: Leschewski A, Aragon MC, Weatherspoon D, Barale K, Auld G, Acquah-Sarpong R*, Baker SS. Expanded Food and Nutrition Education Program Generates Economic Value Through Body Mass Index Improvement: A Cost-Benefit Analysis. The Journal of Extension. 2024;61(4):17.
  • Type: Journal Articles Status: Published Year Published: 2024 Citation: Leschewski A, Baker S, Pierce S, Pybus K, Udahogora M, Shelnutt K, Roe A. A Cost-Benefit Analysis of EFNEP Utilizing Biomarkers of Chronic Disease Risk: Year Two. Journal of Nutrition Education and Behavior. 2024. 55(7):105.
  • Type: Journal Articles Status: Published Year Published: 2024 Citation: Leschewski A, Pierce SJ, Aragon MC, Baker SS, Udahogora M, Pybus K, Duffy NO, Roe AJ, Sankavaram K. A Proposed Cost-Benefit Analysis of Adult EFNEP Utilizing Biomarkers of Chronic Disease Risk. Journal of Nutrition Education and Behavior.(In-press, available online).
  • Type: Conference Papers and Presentations Status: Published Year Published: 2024 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 Two. 2024. Society for Nutrition Education and Behavior Conference, July 29-August 1, 2024, Knoxville, TN.


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.


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).