Recipient Organization
PURDUE UNIVERSITY
(N/A)
WEST LAFAYETTE,IN 47907
Performing Department
Nutrition Science
Non Technical Summary
Food insecurity and low diet quality are persistent problems linked with chronic disease and poor health among limited-resource children and adults using Supplemental Nutrition Assistance Program (SNAP). We have shown nutrition education via adult-focused, direct SNAP-Education (SNAP-Ed) improved household food security by 25% but not adult dietary quality among SNAP-eligible households using a randomized, controlled, longitudinal SNAP-Ed intervention in Indiana. Households experiencing food insecurity often reserve food considered "healthful" for children, so child dietary quality improvement may precede that observed among adults when household food security improves. This study will determine the effect of adult-focused direct SNAP-Ed on child dietary quality and household food security using a longitudinal randomized, controlled SNAP-Ed intervention. Assessment will include repeated 24-hour dietary recalls to determine usual intake, the U.S. Household Food Security Survey Module, and behavior data from before and after the 10-week "intervention period," and 1 year later, after which the control group will receive the intervention. Low-income participants (n=275) from Indiana will be recruited following SNAP-Ed protocol. Results of the study will inform the creation of supplementary on-demand SNAP-Ed educational material focused on improving healthful dietary intake for children and adults in situations of food insecurity in households with children. Education on modeling healthy attitudes and behaviors, planning and preparing family meals, and dietary shortfalls as informed by the results and previous evidence will be included and evaluated. The study aligns with the goals of USDA to increase food security and this RFP to improve healthful behaviors, food quality and nutrition.
Animal Health Component
100%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Goals / Objectives
Long-Term Goal: Determine the long-term (1-year) effect of direct, adult-focused SNAP-Ed on dietary quality and household food security among children (5-18 years) of adult (≥18 years), low-income Indiana SNAP-Ed participants and create and evaluate supplementary SNAP-Ed materials to improve food security and dietary intake in food insecure households with children.< > Determine the 1-year effect of direct, adult-focused SNAP-Ed on: (a) dietary quality (using the HEI), usual dietary intake, among children of adult SNAP-Ed participants and the adult participants themselves, compared with a control group receiving a delayed intervention and (b) food security among the household, adults and children (using the U.S. HFSSM (17)) in intervention compared with control group, and (c) coping mechanisms, needs, behaviors, and attitudes among adult SNAP-Ed participants compared with controls.Extension: Create supplemental on-demand SNAP-Ed material tailored for food insecure households with children based on the study results and needs assessed to improve healthful dietary intake for children and adults. Determine changes in coping mechanisms, behavior and needs related to healthful dietary intake and household food security before and after receiving the new educational content.
Project Methods
Methods:a. Stakeholders involvement in problem identification, planning, implementation, and evaluation (Goals 1 and 2): At the start of the project a stakeholder advisory council will be assembled and will include the SNAP-Ed director, key administrative staff (n=3), NEPAs (n=3), and previous participants of SNAP-Ed (n=3). The advisory council will meet before the research starts and annually to provide input on each phase of the project from problem identification to study planning (year 1), implementation (years 2 & 3), and creation and evaluation of the nutrition education (years 4 & 5).b. Proposed project activities, listed sequentially (Goals 1 and 2): Within the first month of the study the first stakeholder advisory council meeting will be held to gather input on the research protocols and plans. Following this meeting, study procedures will be refined, next the study recruiter will be trained in SNAP-Ed protocols, study recruitment of SNAP-qualifying adult-child pairs will then begin within the first 2 months of the study. All study recruitment procedures and materials will be approved through the Purdue University Institutional Review Board (IRB).Goal 1:Research Study Participants and RecruitmentRecruitment will occur at a rate of n=10 per week for 9 months in the 4 regions of the state (northwest, northeast, southwest, southeast) over the course of the school year so that each region is visited roughly once per month to avoid a seasonal effect. Dates included in summer recess will be avoided as dietary quality among children may vary considerably from the months of majority of the year spent in school (81). Approved SNAP-Ed sites within regions will serve as recruitment sites including community centers; SNAP, WIC, county Extension offices; food pantries and banks, and other locations. An informational flyer will be posted at the site on study recruitment days. A full-time study recruiter, trained through SNAP-Ed, will coordinate to recruit alongside the NEPAs in the 4 state regions who will be present to similarly recruit for SNAP-Ed programming and deliver the lessons. For example, at the recruitment sites, the NEPA will first ask whether individuals are interested in SNAP-Ed, if yes, the NEPA will inform them of the study and direct them to the study recruiter. The recruiter will explain the study procedures, assessments, and time necessary to complete the assessments. The consent form, randomization, and study assessments will follow if the individual desires to participate, if not they will be referred to the NEPA and engage in SNAP-Ed as usual without differential treatment through the program. Assent for children 5-17 years and consent for children 18 years and assessments will be scheduled with the recruiter within the following 24 hours by phone or by email when the participant desires. Treatment group (control or SNAP-Ed intervention) will be assigned 1:1 using data collection spreadsheets prepared by PD Eicher-Miller and Co-PD Craig that will include the subject ID and randomized assignment. Participants recruited simultaneously will be assigned to the same study group to prevent knowledge of differential treatment. Subject ID will be assigned to each assessment the participant completes; names will not be associated with any assessments, and the list of names and numbers will be kept separately and securely. Study recruiters will use portable internet hot spots and paper forms in rare situations of no internet. A password protected metadata file on an encrypted hard drive or REDCap or Box will securely store all information.Research Study Protocols: Adult participants will complete assessments following recruitment. The participant screener, characteristics and additional behavioral, coping mechanisms, needs, self-efficacy, and food security questionnaires will be completed online or interview assisted in Qualtrics or REDCap. Child participants will complete the child-specific questions of the U.S. HFSSM, and a brief set of behavioral, and coping mechanisms questionnaires online (with interview and parent assistance for ages 6-11 years and with interview and option to self-complete for ages 12-18 years (24)). Study assessments for the intervention group will be provided alongside the SNAP-Ed program evaluation before the first lesson. The 24-hour dietary recall will be self-completed online or via interview for adults using the Automated Self-Administered 24-hour (ASA-24) Dietary Recall (82) and by interview with parent assistance ages 6-11 years and by interview or self-completed for ages 12-18 years through a secure data management system. The same sequence of assessments will be completed at each time point, with the exception of the participant screener completed at baseline.After baseline study assessments are completed, participants randomized and recruited to the intervention group will be referred to the SNAP-Ed NEPA and receive the first SNAP-Ed lesson. The remaining 3 lessons will be received at the rate of 1 lesson per week during the 10 week intervention period, following normal protocol. Control group participants will not receive lessons during the intervention period and will be requested to wait 1 year to receive lessons. Both groups will be encouraged to stay in touch with study staff. All recruited participants (control and intervention groups) will be contacted at least once per month via communication of their choice to reduce attrition and maintain correct contact information until completion of the final survey. SNAP-Ed lessons will be delivered either one-on-one or in a group setting at a community location, following normal protocolThe study recruiter will follow-up with NEPAs delivering lessons to intervention participants to track lesson attendance, location, NEPA delivering the lessons, delivery to individual or group, contacts with the NEPA, and presence and type of county-level indirect SNAP-Ed for each participant using a spreadsheet in Qualtrics or RedCAP. After 1-year, participants will complete 1-year assessments and the control-group referred to SNAP-Ed.Goal 2: Extension Education Materials: After the research study completion, beginning in year 4, supplementary SNAP-Ed educational materials aimed to improve self-efficacy, and behavior change among household members will be created. The stakeholder advisory council will meet to initiate informing the educational materials. The results of the Goal 1,will be used to inform the creation of the supplemental nutrition education content. A literature review on background literature specific to the goal of creating educational content to improve dietary quality and food security in households with children will also inform the educational materials (using these studies 30-34, 58-61, 72-78 and additional studies). Co-PD Mayfield will use the social ecological model (65), the social cognitive theory (66), and other child and adult learning theories to create engaging supplemental SNAP-Ed material directed at parents and children in food insecure households. Content will be interactive and include hands-on activities where participants can practice decision making to build self-efficacy. The materials will be reviewed by the advisory council and revised based on feedback. Next, the Envision Center at Purdue, will transform the educational material to on-demand web-based content. Stakeholders will again critically review the pilot version of the material as well as least 3 NEPAs who will also test the content with new SNAP-Ed clients, in order to revise and improve the content. Evaluation of the material will be seamlessly integrated as pre-and post-questions that will be captured within the online platform. After educational content is developed, pilot tested, and refined, the material will be deployed throughout the state and delivered by NEPAs alongside direct adult-focused SNAP-Ed.