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thesis entitled

BEHAVIOR CHANGE OF SELECTED DEMOGRAPHIC GROUPS OF
MICHIGAN STATE UNIVERSITY EXTENSION‘S FAMILY
NUTRITION PROGRAM'S ADULT SERIES

presented by

Katherine Leigh Raphael

has been accepted towards fulﬁllment
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M.S. degreein Aggicultural and
Extension Education

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6/01 cJCIRC/DateDuepss-sz

BEHAVIOR CHANGE OF SELECTED DEMOGRAPHIC GROUPS OF
MICHIGAN STATE UNIVERSITY EXTENSION’S
FAMILY NUTRITION PROGRAM’S '
ADULT SERIES

By

Katherine Leigh Raphael

A THESIS

Submitted to
Michigan State University
In partial fulﬁllment of the requirements
For the degree of

MASTER OF SCIENCE

Department of Agricultural and Natural Resources Education
and Communication Systems

2001

ABSTRACT

BEHAVIOR CHANGE OF SELECTED DEMOGRAPHIC GROUPS OF
MICHIGAN STATE UNIVERSITY EXTENSION’S
FAMILY NUTRITION PROGRAM ’8 ADULT SERIES
by
Katherine Leigh Raphael

This study was conducted to note differences in behavior change among
selected demographic groups of Michigan State University Extension Family
Nutrition Program’s Adult Series. Demographic groups of the study included
gender, town size, ethnic background, age, and region.

The target population of the study included 2,064 participants who started
and ﬁnished the Adult Series program between the dates of November 24, 1998
and November 25, 1999. The participants completed a pre and posttest designed
to assess behavior change of nutrition education participants.

Findings indicate little difference between the behavior demonstrated by
males and females. Those living in towns and cities of 10,000 to 50,000 exhibited
higher levels of change than those of central cities and rural areas, who are more
at risk for food insecurity. Asians and Hispanics demonstrated marked behavior
change; however, African Americans demonstrated less success. Senior citizens
and young participants aged 26 through 30 were more likely to change behavior

than middle-aged participants were. Finally, most regions in Michigan

demonstrated marked change with the exception of the East Central.

Copyright by
KATHERINE LEIGH RAPHAEL
2001

This is dedicated to my parents, Dr. C. Nicholas and Joan Raphael; and to my

sister Nicole.

iii

ACKNOWLEDGEMENTS

I would like to thank the following people:

0 To my graduate committee members Dr. Randy Showerman, Dr. Dave
Krueger and Dr. Mary Andrews for their support throughout my research
and education at Michigan State University.

0 The Family Nutrition Program of Michigan and the members of the post-

hoc committee for sharing their time and valuable experience.

iv

TABLE OF CONTENTS

LIST OF TABLES ........................................................................ vii

CHAPTER I
INTRODUCTION OF THE STUDY ..................................................... 1

Introduction

The Learning Tool

Nature of the Problem

Need for the Study

Purpose

Research Questions

Deﬁnitions

Abbreviations

Limitations

Assumptions of Procedure and Data Collection

CHAPTER II
REVIEW OF THE LITERATURE ...................................................... 10

Poverty and Hunger in the State of Michigan

Food Stamp Programs and Food Security

Nutrition Education and the Family Nutrition Program
Gender

Town Size

Ethnic Background

Age

CHAPTER III
METHODOLOGY ....................................................................... 24

Introduction

Design of the Study
Variables

The Program

Validity

Reliability

Target Population
Reducing Sampling Bias
Instrument Development
Data Collection

Data Analysis

CHAPTER IV
FINDINGS ................................................................................ 32
Demographic Information
Research Questions
Research Question 1
Research Question 2
Research Question 3
Research Question 4
Research Question 5

CHAPTER V
SUMMARY/CONCLUSIONS/IMPLICATIONS and
RECOMMENDATIONS ....................................................... 57

Summary

Conclusions

Recommendations

Recommendations for Further Research

APPENDICES
Appendix A: Regional Map of Michigan

Appendix B: The Learning Tool Survey

Appendix C: Results in Terms of the Post-Hoe Committee of
Expert’s Scale of Measurement

REFERENCES ................................................................... 8 1

vi

LIST OF TABLES

1.1 Percentage of Children Living in Poverty in 17 Selected Developed Nations .1

2.1.

2.2.

2.3.

3.1.

4.1.

4.2.

4.3

4.4.

4.5.

4.6.

4.7.

4.8.

4.9.

Estimated Michigan Population Characteristics .................................. 10
Ofﬁcial Poverty Thresholds of 1998 ................................................ 11
The Food Stamp Recipient Population: 1985 through 1986 .................... 17
Measurement Descriptors Used to Analyze Results from the Adult Series
Learning Tool in Michigan .......................................................... 31
Ethnic Composition of MSUE FNP Adult Series Participants ................ 33
Residence of MSUE FNP Adult Series Participants ............................ 33
Reported 1999 Monthly Earned Incomes of Michigan FNP Adult
Series Participants .................................................................... 34
Adult Series Participants Aged Distribution ...................................... 35
Geographic Distribution by Region of Michigan FN P Adult Series
Participants ........................................................................... 36
Responses by Gender to Questions within the Dietary Quality Key Element
of Michigan FNP Adult Series Participants ....................................... 35
Differences Found in an AVONA Between Males and Females and the 5
Key Elements ........................................................................ 37
Grand Mean Differences Exhibited by Participants in Town Size in the
Dietary Quality Key Element. ..................................................... 38
Grand Mean Differences Exhibited by Participants in Town Size in the Food

Resource Management and Shopping Behavior Key Element. .............. 38

vii

4.10. Grand Mean Differences Exhibited by Participants in Town Size in the Food
Safety Key Element. ............................................................... 39
4.11. Grand Mean Differences Exhibited by Participants in Town Size in the Food
Security /System Change Key Elements ......................................... 39
4.12. Differences Found in ANOVA Between Town Size and the Five Key
Elements .............................................................................. 40
4.13. Location of Differences Between Town Size and Key Elements ............ 40
4.14. Grand Mean Differences Exhibited by Participants of Different Ethnic
Backgrounds in the Dietary Quality Key Element ............................. 41
4.15.Grand Mean Differences Exhibited by Participants of Different Ethnic
Backgrounds in the Food Resource Management and Shopping Behavior
Key Element ......................................................................... 41
4.16.Grand Mean Differences Exhibited by Participants of Different Ethnic
Backgrounds in the Food Safety Key Element .................................. 42
4.17.Grand Mean Differences Exhibited by Participants of Different Ethnic
Backgrounds in the Food Security/ System Change Key Elements .......... 42
4.18.Differences Found in ANOVA Between Ethnic Background and the Five
Key Elements. ....................................................................... 43
4.19. Location of Differences Between Ethnic Background and the Food Resource
Management and Shopping Behavior Key Element. ........................... 44
4.20. Location of Differences Between Ethnic Background and the Food Safety

Key Element. ......................................................................... 44

viii

4.21.Grand Mean Differences Exhibited by Participants of Different Age Groups
in the Dietary Quality Key Element. .............................................. 45
4.22. Grand Mean Differences Exhibited by Participants of Different Age Groups
in the Food Resource Management and Shopping Behavior Key Element..46
4.23.Grand Mean Differences Exhibited by Participants of Different Age Groups
in the Food Safety Key Element. ................................................. 47
4.24.Grand Mean Differences Exhibited by Participants of Different Age Groups
in the Food Security/System Change Key Elements. ........................... 48
4.25. Differences Found in ANOVA Between Age Groups and the Five Key
Elements. ............................................................................. 49
4.26.Location of Differences Between Age Groups and the Dietary Quality Key
Element. .............................................................................. 50
4.27. Location of Differences Between Age Groups and the Food Resource
Management and Shopping Behavior Key Element. ........................... 51
4.28. Location of Differences Between Age Groups and the Food Safety Key
Element. .............................................................................. 52
4.29. Grand Mean Differences Exhibited by Participants of Different Region of
Residence in the Dietary Quality Key Element. ................................ 53
4.30.Grand Mean Differences Exhibited by Participants of Different Region of
Residence in the Food Resource Management and Shopping Behavior Key
Element. .............................................................................. 53
4.31. Grand Mean Differences Exhibited by Participants of Different Region of

Residence in the Food Safety Key Element. .................................... 54

4.32. Grand Mean Differences Exhibited by Participants of Different Region of
Residence in the Food Security/System Change Key Element. .............. 54
4.33. Differences Found in ANOVA Between Region of Residence and the Five
Key Elements. ....................................................................... 55
4.34. Location of Differences Between Region of Residence and the Dietary
Quality Key Element. .............................................................. 55
4.35. Location of Differences Between Region of Residence and the Food
Resource Management and Shopping Behavior Key Element. .............. 56
4.36.Location of Differences Between Region of Residence and the Food
Security/ System Change Key Elements. ....................................... 56
C. 1. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Gender and Dietary Quality ......................... 71
C2 Measurement of Behavior Change exhibited by FNP Adult Series Participants
in Terms of Gender and Food Systems Management/Shopping Behavior ...71
C.3 Measurement of Behavior Change exhibited by FNP Adult Series Participants
in Terms of Gender and Food Safety ............................................... 71
G4 Measurement of Behavior Change exhibited by FNP Adult Series Participants
in Terms of Gender and Food Security/System Change ......................... 71
C5. Measurement of Behavior Change exhibited by FN P Adult Series
Participants in Terms of Town Size and Dietary Quality ....................... 72
C6. Measurement of Behavior Change exhibited by FN P Adult Series
Participants in Terms of Town Size and Food Resource Management/

Shopping Behavior .................................................................... 72

C.7. Measurement of Behavior Change exhibited by FN P Adult Series
Participants in Terms of Town Size and Food Safety ........................... 73
C8. Measurement of Behavior Change exhibited by FN P Adult Series
Participants in Terms of Town Size and Food Security/System Change ....73
C9. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Ethnic Background and Dietary Quality . . . . . . . .74
C. 1 0. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Ethnic Background and Food Resource
Management/ Shopping Behavior ................................................. 74
Cl]. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Ethnic Background and Food Safety ................ 75
C .12. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Ethnic Background and Food Security/System
Change ................................................................................. 75
C. 1 3. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Age and Dietary Quality ............................. 76
OM. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Age and Food Resource Management] Shopping
Behavior ............................................................................. 77
C .15. Measurement of Behavior Change exhibited by FNP Adult Series

Participants in Terms of Age and Food Safety ................................. 78

xi

C.16. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Age and Food Security/System Change ............ 79
C.17. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Geographic Region and Dietary Quality ........... 79
C. 18. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Geographic Region and Food Resource
Management/ Shopping Behavior ................................................. 80
C.19. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Geographic Region and Food Safety ................ 80
C .20. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Geographic Region and Food Security/ System

Change ................................................................................ 8 l

xii

CHAPTER I

INTRODUCTION OF THE STUDY

Introduction

 

There is no doubt that poverty is a major global issue. For many citizens
of developed countries, it may be surprising that poverty exists in their nations as
well. According to the 1999 Kids Count Data Book (Kids Count, 1999) the US.
ranks last when compared to seventeen other selected developed countries in
terms of percent of children living in poverty. (Table 1.1) It is very likely that

people who are poor are also hungry.

Table 1.1. Percentage of Children Living in Poverty in
17 Selected Developed Nations
ountry ear in
Poverty

USA 1 1
A 14
1
1

1
l

 

Many private and government programs exist to help alleviate hunger
throughout the world. In the United States the federal government funds the Food

Stamp Program, which distributes stamps to low income families that may be

used to purchase food. The US. government also supports many programs with
goals of alleviating hunger through nutrition education. This thesis deals with the
Family Nutrition Program (FNP) of Michigan State University’s Cooperative
Extension Service (MSUE), speciﬁcally the Adult Series Program of FNP. The
goal of this state program is to educate participants so that they may feed
themselves and their families as “economically, as safely, and as healthfully as
possible” (Coleman, Haas and Himebauch, 1997).

FNP in Michigan provides programming through nutrition education to
food stamp eligible participants in the areas of nutrition, food selection for
nutrient density, food safety, and food budgeting and family resource
management. The Family Nutrition Program in Michigan was “designed to assist
low-income families to increase the adequacy of their daily diets through
increased knowledge and skills” (Coleman, Haas and Himebauch, 1997). The
planned activities used by FNP programs were developed with the goal of
increasing the likelihood of healthy food choices by all food stamp recipients
while being economically feasible for low-income audiences. Participants are
encouraged to base their diets and nutrition habits on the most recent dietary
advice as described in the Dietary Guidelines for Americans and the Food Guide
Pyramid (Coleman, Haas and Himebauch, 1997).

The FNP program is maintained in all of the 83 counties in Michigan and
serves about 5,000 people annually (Appendix A: County Map of Michigan). It is
funded by Food Starnp Dollars sanctioned by the US. Department of

Agriculture’s Food and Nutrition Service (FN S) and passed through the Family

Independence Agency (FIA). The federal funding is matched by funds from
Michigan State University Extension and is also matched at the local level in-kind
by the counties (MSUE FNP, 2000).

There are five key elements identiﬁed by a national panel of experts
selected by the Food and Nutrition Service (FN S), which form the fundamental

content of the FNP curriculum. In Michigan, those key elements include:

Dietary Quality
0 Food Resource Management and Shopping Behavior
0 Food Safety
0 Food Security
0 Systems Change
These key elements form the base of the FNP curriculum taught to both adults and
children.

The Michigan Family Nutrition Program uses curriculum entitled “Eating
Right is Basic (Third Edition) ” (MSUE, 1995), which was developed by MSUE.
This curriculum covers the ﬁve key elements identiﬁed by the US. Department of
Agriculture’s Food and Nutrition Service. Programming relates speciﬁcally to
basic nutrition, shopping behavior, using food labels, food safety, food security,
and food preparation.

The LearninLTool

 

In 1995, the need for evaluation of FNP programs was addressed by the
F NP administration. FNP administrators came together and identiﬁed the goals

for evaluation. These included an assessment of the effectiveness of the Eating

Right is Basic (MSUE, 1995) curriculum, an assessment of the FNP participant
satisfaction, and an assessment of the delivery method of the lessons and
educational process of the program. In order to meet the needs of evaluation, an
instrument entitled The Learning T 001 was developed. This instrument is used to
collect information about participant behavior before and after participation in the
program in order to diagnose curriculum needs and assess behavior change
(Coleman, Haas and Himebauch, 1997).

The Learning Tool survey consists of 40 questions, each of which
corresponds to ﬁve different key elements. (Appendix B: The Learning Tool
Survey) The format is a pre- and post evaluation with a Likert scale ranging
from O as “never”, 1 as “hardly ever”, 2 as “sometimes”, 3 as “most of the time”
and 4 as “always”. The actual tool was designed so people who may have
difﬁculty reading can use it with ease. From November 24th, 1998 through
November 24th, 1999, MSUE nutrition instructors collected and tabulated the
results in their assigned counties. They reported these data to the F NP
administration on a quarterly basis using a computer database program.
(Appendix B: UCHRIS Approval of Data Collection)

Nature of the Problem

 

There has been no formal study, which utilizes The Learning Tool data in
terms of the different demographic groups represented in the FNP Adult Series
audience. Thus, data collected from participants have not yet been implemented
for the beneﬁt of the Family Nutrition Program alone where conclusions could be

used to change or modify the program or curriculum according to ﬁndings.

Furthermore, the Learning Tool has not been used to provide administration with
analysis based on regional and demographic differences among participants.
Need for the Study

The study is needed in order to evaluate program effectiveness among
certain demographic groups of the FNP Adult Series audience. Also, by
implementing this study, the quantitative instrument may in time be altered and in
the future provide an improved image of program effectiveness.
Purpose of the Study

The purpose of the study is to note differences in behavior change among
selected demographic groups represented in the Family Nutrition Program’s Adult
Series. The results of the study are intended for decision-makers in the FNP
administration.
Research Questions

Five research questions were designed to evaluate program success
according to different demographic groups. The questions are the following:
1. To what extent does gender have an effect on behavior change of Michigan
F NP Adult Series participants in terms of the ﬁve key elements?
2. To what extent does town size have an effect on behavior change of Michigan
FNP Adult Series participants in terms of the ﬁve key elements?
3. To what extent does ethnic background have an effect on behavior change of
Michigan FNP Adult Series participants in terms of the ﬁve key elements?
4. To what extent does age have an effect on behavior change of Michigan FNP

Adult Series participants in terms of the ﬁve key elements?

5. To what extent does region have an effect on behavior change of Michigan
FNP Adult Series participants in terms of the ﬁve key elements?
Deﬁnitions of Terms

The investigator will use the following deﬁnitions within the context of

this study:

Adult Series: A nutrition education program provided by the Family Nutrition
Program of Michigan, which is intended to educate adults aged 18 and over who
are eligible to receive food stamps although in some cases people under the age of
18 may participate.

Dietary Quality: Applies to the nutritional value of food acquired, and how well
the overall diet of the food stamp participant’s compares to recommended
guidelines such as the Food Guide Pyramid and Dietary Guidelines for
Americans” (USDA, 1999).

Ethnic Background: The anthropological origin as identiﬁed by an Adult Series
participant. These include white, African American, Native American/Alaskan,
Hispanic and Asian/Paciﬁc Islander.

Family Nutrition Program (FNP): A nutrition education program of Michigan
State University Cooperative Extension Service, which is for residents who are
food stamp eligible.

Food Safety: “Applies to how food is handled. Speciﬁcally it deals with issues
such as hand-washing, length of time food is left without refrigeration, the
temperature at which food is stored, and whether food is properly cooked or not”

(USDA, 2000).

Food Security: “Applies to the general well-being of a food stamp recipient and
their family in terms of always having enough to eat without having to seek
emergency assistance such as food banks to tide then over through the end of the
month” (USDA, 2000).

Nutrition Education: “Any set of learning experiences designed to facilitate the
voluntary adoption of eating and other nutrition related behaviors conducive to
health and well-being” (USDA, 1999).

Planned Series: Educational sessions with an individual or group with a planned
beginning and end consisting of a minimum of four pre-determined lessons.
Region: Region of residence as identiﬁed by FN P Adult Series participants, these
include Upper Peninsula, and in the Lower Peninsula North, East Central, West
Central, Southeast and Southwest. (Appendix A: Regional Map of Michigan)
Shopping Behavior/Food Resource Management: Applies to the practices
related to thrifty shopping for nutritious foods. These include practices related to
how and where food is acquired, how often food is purchased, and the types of
food purchased. This includes such skills as making shopping lists, reading labels
for nutritional values and menu planning” (USDA, 2000).

System and Environmental Change: “Applies to changes in the system or the
environment that can enable or facilitate the availability of nutritious diets to FSP
participants” (USDA, 2000).

Town Size: Area of residence as identiﬁed by FN P Adult Series participants,

these include farm, towns under 10,000 persons and rural non-farm, towns and

cities 10,000 to 50,000 persons, suburbs of cities over 50,000 persons, and central
cities over 50,000 persons.

Abbreviations

 

The investigator will use the following abbreviations within the context of this
study:
FNP: Family Nutrition Program
FSP: Food Stamp Program
MSUE: Michigan State University Cooperative Extension Service
TFP: Thrifty Food Plan
W1C: Woman, Infants and Children Program
Limitations of the Study

Participants completed the Learning Tool while being directed by county
nutrition instructors; hence there is some concern over how this affects scores.
The Learning Tool is not an anonymous paper survey distributed through the
mail, but rather it is an interactive survey that is completed with the questions
being read aloud to the participant by the nutrition instructor. The participant is
given a stack of cards with each Learning Tool question written on it along with a
picture depicting the behavior referred to in the question (for example, eating
green vegetables or washing hands with soap and warm water). The participant
holds The Learning Tool as the instructor reads a statement. The participant then
slides the card into a slot on The Learning Tool that has one of the ﬁve Likert

scale measurements on it.

The cards are required to be placed into the slot with the participant’s
corresponding answer, however this may cause a limitation to the study due to a
lack of anonymity. Some instructors may possibly see the answers as the
participant responds where others may not; this simply depends on the preference
of both parties as well as the setting where the completing The Learning Tool
survey takes place. Because of the nature of FNP reporting, the researcher did not
collect FNP Learning Tool data during a site visit. Instead it was inputted by the
county nutrition instructor into a computer program developed by FN P and sent to
the MSUE ofﬁce for analysis. Finally, some participants are mandated by the
court system to participate in the FNP program, which may have an effect on the
attitude of the participant towards learning. Information about which participants
attend the program by court mandates was not made available.

Assumptions of Procedure and Data Collection

Data collection is a job requirement of FNP nutrition instructors; thus it is
assumed that the response rate is 100 percent. The researcher assumes that the
data were collected over 12 months between the dates of November 24, 1998
through November 24, 1999. They were obtained within any of the 83 Michigan
counties that participated in the FN P Adult Series program during the designated
time. Learning Tool data were collected for all 2,064 participants of the FN P
Adult Series program using the Learning Tool instrument at the onset and directly
after planned Adult Series programming. The data were then collected and input
into a computer exactly as it appears in the Learning Tool survey and were

submitted to the FNP administration accordingly.

CHAPTER 11
REVIEW OF THE LITERATURE

The Literature Review of this thesis is divided into 8 sections. The ﬁrst
examines poverty and hunger in Michigan, the second discusses food stamp
programs and food security, and the third discusses nutrition education and the
Family Nutrition Program. The remaining four parts discuss different
demographic variables and their relation to nutrition. They are gender, town size,
ethnic background, and age.
Poverty and Hunger in the State of Michm

It has been estimated that the 1999 population of Michigan is totaled
9,863,775 persons. This represents 3.26 percent of the total US. population,
which is estimated at 272,690,813. As noted in Table 2.1, whites make up 83.5
percent of the state population followed by African Americans (14.3 percent) and

Hispanics (2.79 percent) (2001 US. Census Bureau).

Table 2.1. Estimated Michigan Population Characteristics
(1 ) . .
e (1 ) , 6,5
6 ( ) , ,
on years 0 age ( (
on or o

(1 )

(1

atrve Amencan
(1 ) -
non-Hispanic ( ) 1.1
year)
Source: US. Census Bureau http://quickfacts.census.gov/qfd/states

 

 

Michigan residents below the poverty level have been estimated to

represent 12.6 percent (estimated in 1995) of the total Michigan population.

Furthermore, Michigan children living below the poverty level in 1995 totaled
20.1 percent of the state’s population. That is, one in ﬁve children were poor.

The Scope of Hunger in Michigan brochure published by the Food Bank
Council of Michigan in 1999 determined that 31 percent of emergency food
clients are children under the age of 18 and 50 percent are adults ages ranging
from 18 to 64 (Food Bank Council of Michigan, 1999). In 1999 the ofﬁcial
government measure of poverty thresholds was an annual income of $13,880 for
a family of 3. (Table 2.2) According to the Kids Count Data Book (Kids Count,
1999), public opinion and many researchers suggest that such a ﬁgure is
unrealistically low. Moreover, ﬁgures presented in the Food Bank Council of
Michigan’s Improving Michigan’s Statewide Response to Hunger reveal that a
large percentage of household residents in Michigan live in a state below the
federal measure of poverty are apt to miss meals (Food Bank Council of

Michigan, 1998).

Table 2.2. Official Poverty Thresholds of 1998
Alaska

 

Food Stamp Programs and Food Securig':

The effects of food insecurity and hunger have been proven to be
associated with many negative health risks such as impaired growth and cognitive
development in children. Food insecurity is deﬁned as a circumstance where the
availability of nutritionally adequate and safe foods and the ability to acquire
personally acceptable foods in socially acceptable ways are limited or uncertain.
Hunger is deﬁned as “the uneasy or painful sensation caused by a lack of food”.
Hunger may be experienced at the level of individual family members within
families that are experiencing food insecurity (Alaimo, Briefel, Frongillo and
Olson, 1998). US. citizens living in hunger and experiencing food insecurity was

ﬁrst brought to the public attention in the 1960’s.

When John F. Kennedy visited Appalachia in 1960 and returned with a
graven portrayal of the existing rural poverty it became clear to the American
public that not all US. citizens enjoyed the consequences of the economic growth
that had flourished after World War II. These images shocked the American
public and served as a catalyst to the “War on Poverty” commissioned by Linden

B. Johnson in January of 1964 (Shaw 2000).

By the 1970’s the US. House Select Committee attempted to assure food
security as a major policy goal to prevent the negative effects of malnutrition and
hunger among US. citizens. The institution of the Food Stamp Act of 1977 was
the result of these efforts and is now the federal government’s ﬂagship program to

ﬁght and prevent food insecurity (Campdell, Morris and Neuhauser, 1992). The

goals of this program are to “alleviate hunger, improve the level of nutrition
among low-income individuals and households, and to strengthen the agriculture
economy through normal channels of trade” (Skolnick, 1995). In 1993, the
program served 27.3 million Americans and provided low-income households
with $22 billion for food (Skolnick, 1995). Although the program provides
stamps that can be used to purchase food items, there is criticism that beneﬁt
allotments are not enough to purchase a nutritious diet (Campdell, Morris and
Neuhauser, 1992). Much of this criticism stems from government’s use of the

Thrifty Food Plan.

The “Thrifty Food Plan” (TFP) is a rigidly set basic diet that is considered
nutritionally adequate at lowest cost as deﬁned by the USDA. It is described by
Bradbard, Michaels, Fleming and Campbell, (1997) as a “low-cost food plan
designed to provide a nutritionally adequate diet for most households, while
conforming as much as possible to the usual diets of low-income households”
(Bradbard, Michaels, Fleming and Campbell, 1997). This set of standards for cost
and nutrition is used to deﬁne the cost, type and amount of food that is needed to
meet minimum nutrition standards for males and females of a variety of ages.
This plan of the USDA has been found to supply less than the recommended daily
allowance for certain nutrients. Also, the amount of food stamps a person
receives is adjusted annually according to consumer price indices that are based
on consumer shopping means in large supermarkets in major urban areas and not
on low income spending averages (Campdell, Morris and Neuhauser, 1992).

According to Alaimo, Briefel, Frongillo and Olson (1998), clients who receive

food stamps often run out before the end of the month (i.e. before they receive a
new monthly allotment). These conditions are aggravated by the fact that many
families wait until they experience severe economic hardships before they apply

for food stamps (Alaimo, Briefel, Frongillo and Olson, 1998).

According to Skolnick (1995), the level of poverty food stamp participants
endure is extreme as 92 percent of food stamp households have gross incomes
that are at or below the poverty line (in this case $14,808 for a family of four).
Furthermore, 42 percent of food stamp recipients and their families have incomes
below half of the poverty line. “For these families, every dollar makes a
difference in food expenditures and in their total budgets”, says Robert J. Fersh,
President of the Food Research and Action Center, “sometimes we forget how
poor food stamp shoppers are.” According to Fersh, the Food Stamp Program
provides 76 cents per person per meal in food stamps and the result is that
families run out of food and must either skip meals or severely cut portions and

food choices to remain in their allocated monthly stamp quota (Skolnick, 1995).

Although the Food Stamp Program is not the ultimate solution to hunger
alleviation and ending food insecurity, it is proven to have success in increasing
nutrient intakes. For example, research reveals that people who receive food
stamps are nutritionally better off than if they did not receive assistance.
Experimental studies consistently demonstrate that food stamps do increase total
food spending of recipient households further than what cash assistance would
accomplish. Also, a study conducted by Rose, Habicht and Devarey (1997)

shows that intakes of iron, vitamin A, thiamin, niacin and zinc were signiﬁcantly

14

related to the amount of food stamp beneﬁts, extending from 0.16 to 0.48
recommended daily allowance (RDA) percentage points per capita dollar of
beneﬁt. In the same study, negative nutritional effects such as the intakes of
energy, fat, saturated fat and cholesterol were shown not signiﬁcantly related to
receiving food stamps. Other results of the study included average increases of
12.3 RDA percentage points of iron and 9.2 RDA percentage points of zinc for
preschooler diets (Rose, Habicht and Devarey, 1997). The correlation of poverty
and hunger and malnutrition is well known, but thanks to several food and
nutrition programs including food stamps, most of the poor families are less
hungry than 30 years ago (Kinsey, 1994).

Nutrition Education and the Family Nutrition Program

A deﬁnition of nutrition education is “any set of learning experiences
designed to facilitate the voluntary adoption of eating and other nutrition related
behaviors conducive to health and well-being”(USDA, 1999). Many experts feel
that complimenting the Food Stamp Program with nutrition education helps
ensure increased nutrition in participant’s diets. Studies conducted by the
American Dietetic Association and the Women, Infants and Children (WIC)
program have also revealed just as importantly the economic beneﬁts of nutrition
education services. The Michigan State University Extension (MSUE) Family
Nutrition Program (FN P) strives to advance the USDA’s commitment to alleviate
hunger in Michigan. FN P in Michigan provides direct programming for food-

stamp eligible participants in the areas of nutrition, food selection for nutrient

15

density, food safety and sanitation, and food budgeting and family resource

management (Coleman, Haas and Himebauch, 1997).

FNP is a nutrition education program that has been educating food-stamp
participants since it’s inception in Wisconsin in 1986. Presently the program
functions in 21 states with an estimated federal budget of 23 million dollars (Joy
and Doisy, 1996). Joy and Doisy (1996) refer to the FSNEP/FN P as a model
example of successful interagency cooperation between the Cooperative
Extension Service, the Food Stamp Agency and the USDA. The goal and
purpose of F SNEP is to improve the dietary intake of food stamp recipients
through nutrition education activities that increase self-sufﬁciency (Joy and

Doisy, 1996).

Parke, Wilde and McNamara (1999) provide an example of the importance of
nutrition education to the success of food stamp recipients improving nutrition. In
an investigation the researchers contrasted participants in two programs, the Food
Stamp Program and the Women, Infants and Children (WIC) program. The
researchers noted that a signiﬁcant effect of the WIC program is decreased intake
of added sugars but they found no effect in intake of total fats. They found that
the Food Stamp Program contributes signiﬁcantly to the intake of meats, added
sugars and total fats, but not to the intake of fruits. The researchers associate
positive effects of WIC with the educational component of the program. The
purpose of the Food Stamp Program is to provide resources for food purchases,
however it does maintain a small nutrition education element. Alternatively, the

Women, Infants and Children (WIC) program is geared to supplement diets of

16

infants, children and pregnant and postpartum women, and includes a more
signiﬁcant nutrition education component. Parke, Wilde and McNamara (1999)
note that a better strategy for reducing malnutrition than increasing income is to
provide nutrition education. Speciﬁcally, to educate clients on the “dietary value
of alternate food sources (including speciﬁc combinations of food) and on
methods of preparing foods,”(Parke, Wilde and McNamara (1999). This research
suggests that even a basic knowledge of nutrition is complimentary to nutrition
programs by signiﬁcantly increasing potential for better nutrition habits.

Gender:

As noted in Table 2.1, the female population in Michigan exceeds the
male population (5.0 million to 4.7 million, respectively). An advance report by
the USDA for the ﬁscal year of 1998 described the food stamp recipient
population as half (53 percent) children, eight percent were adults aged 60 and
over, working-age men represented 11 percent and working-age women
represented 28 percent (Castner and Anderson, 1999). (Table 2.3)

Table 2.3. The Food Stamp Recipient Population: 1985 through 1986

 

 

 

 

 

Food Stamp Recipients % of the Food stamp recipient
population
Children 53
Adults aged 60 and above 8
Working —aged women 28
Working aged men 1 1

 

 

 

 

Source: (Castner and Anderson, 1999)
Single women generally are more economically less independent and if

mothers, frequently bear the responsibility of child rearing. Numerous studies

ﬁnd that women who are single mothers are more likely to experience food
insecurity than those who are not. Alaimo, Briefel, Frongillo and Olson (1998)
suggest that in “total population” the majority of food insufﬁcient people lived in
married-couple families or with families (44.2 percent). Alternatively, 31.5
percent of food insufﬁcient people lived in families headed by a single female
with children (Alaimo, Briefel, Frongillo and Olson, 1998). Still, Kinsey (1994)
says that in 1986 a larger percentage of women and children in poverty received
less than 70 percent of the recommended daily allowances of many nutrients than
those whose incomes were above the poverty line. At the same time, women in
poverty were much more likely to be obese than those of higher incomes (From
Kinsey, 1994: Senaver, Asp and Kinsey, 1991). Analysis by Alaimo, Briefel,
Frongillo and Olson (1998) reports results from research done in 1985 and 1986
showing that low-income women with children reported food insufﬁcient had
lower mean food and nutrient intakes than women in food sufﬁcient families
(Alaimo, Briefel, Frongillo and Olson, 1998).

Town Size:

The major differences in nutrient intakes between town sizes in this
literature review were found between urban and rural residents. Both geographical
areas had positive attributes as well as drawbacks in terms of nutrient availability
and intakes.

Campdell, Morris and Neuhauser (1992) argue that food security in rural
America is particularly important where economic hardship exacerbates risk for

hunger. They claim that rural poverty has increased more than 25 percent

18

between 1978 and 1992 and a number of surveys show hunger problems are
impacted by relative isolation and lack of emergency food services in rural areas.
According to Campdell, Morris and Neuhauser (1992), more than 9.1 million US.
citizens have incomes below the poverty line. In 1987 the poverty rate in rural
America was 16.9 percent. Alternatively, the poverty rate in metropolitan areas
was 12.9 percent (Campdell, Morris and Neuhauser, 1992).

According to 1992 research, consumption of certain nutrients was found
less adequate in rural areas as compared with urban areas. One-half of rural
Americans have intakes of vitamin A, vitamin C, calcium, and iron below two-
thirds of the recommended daily allowance. Rural, low-income women have
lower intakes of vitamins A and C than urban, low-income women do. The rural
poor are 125 percent more likely than the non-nrral poor to have low hemoglobin
levels and 80 percent are more likely than non-poor nationwide. In the poorest
rural counties of the US, rates of infant mortality and low birth weight babies are
signiﬁcantly higher than for the nation as a whole (Campdell, Morris, and

Neuhauser, 1992).

Substantial evidence indicates that the rural poor have limited access to
supermarkets and largely depend on small, independent “mom and pop” type
stores. Studies have revealed that food prices are much higher at mom and pop
stores than in larger supermarkets, and these small independent stores commonly
offer food of inferior quality and less choice (Campdell, Morris, and Neuhauser,
1992). As far as access to the larger supermarkets, the rural poor have fewer store

options and have to travel further than the urban poor to reach supermarkets. The

19

low-income residents of urban areas have access to eight times more
supermarkets per county and ten times more per mile squared than the rural poor.
In 1988, an average of 3.8 supermarkets per county existed in rural America, or 1
every 265 square miles. Urban counties averaged 29 supermarkets per county or
one every 27 square miles. Selection of foodstuffs and competitive pricing also
favored low-income persons in urban settings. In terms of Thrifty Food Plan
(TFP) Market basket costs, the mean was $102.00 in smaller markets while larger
supermarkets averaged $81.00. At this time the UDSA’s average TF P cost was
$75.00 but it was three percent higher in supermarkets and eight percent higher in

smaller sized stores (Campdell, Morris, and Neuhauser, 1992).

In terms of food availability, supermarkets offer a greater diversity of food
stuffs such as fresh fruits, vegetables and meats. In contrast, fresh foods tend to
be limited in smaller sized stores. According to ﬁndings by Campdell, Morris and
Neuhauser (1992), 23 percent of small stores did not offer fresh vegetables and 35
percent only stocked between one and four different types. One in three smaller
sized markets stocked fresh fruits and 43 percent stocked between one and four

types of fruits (Campdell, Morris and Neuhauser, 1992).

There is evidence that the level of urbanization affects intake of several
nutrients. Children who live in non-metropolitan areas were found to have the
highest intakes of calories, total fat, saturated fat, cholesterol and sodium.
Children who had the lowest intakes of these compounds live in central cities
(1994, Public Health Reports). Many factors could have an effect on the way a

child eats. For example, diets, and inﬂuences on diets, have been shown to vary

20

by socio-economic status, ethnicity, and urban-rural status. This concept is
illustrated by children who live in urban areas who generally don’t have access to
a garden as a source of fresh vegetables and/or fruits. Still, the children who
reside in rural areas do not have access to a supply of fresh fruits and vegetables
in the smaller grocery stores that are generally nearest to their homes (Kirby,
Baranowski, Reynolds, Taylor and Binkley, 1995).

Ethnic Backgound:

 

According to Public Health Reports of 1994 ethnic background is indeed
related to nutrient consumption. Children of African American descent were
found to have the largest intake of total fat, saturated fat, cholesterol and sodium
(Public Health Reports, 1994). A study conducted by Alaimo, Briefel, F rongillo
and Olson (1998), found that food insufﬁciency strikes 15.2 percent of Mexican
Americans, more than any other race in the US. Non-Hispanic African
Americans were found to have the second highest population experiencing food
insufﬁciency (7.7 percent of the total population). Food insufﬁciency was found
lowest among non-Hispanic whites (2.5 percent). Approximately a quarter of
low-income Mexican Americans (24.8 percent) have reported that they experience
food insufficiency. Some 13.5 percent of low-income non-Hispanic African
Americans have reported that they are food insufﬁcient. 11.8 percent of low-
income non-Hispanic whites reported that they and their families were food
insufﬁcient (Alaimo, Briefel, Frongillo and Olson, 1998).

Finally, results from the Third National Health and Nutrition Examination

Survey reveal that the energy intake from fat was higher for non-Hispanic,

21

African American and Mexican-American WIC participants than for non-
participants of the same ethnic groups (Rose, Habicht and Devarey, 1997).
Agg

According to Kinsey (1994), the group of people most likely to be
impoverished is children. (Table 2.4) This includes over 18 percent of all children
in the US. When dissected, the data indicate that this group includes over 45
percent of black and Hispanic children, about half of the single mothers and their
families, the homeless and about one-ﬁfth of the unemployed.

Alaimo, Briefel, F rongillo and Olson (1998) state that, “at any one time
between 1988 and 1994: Approximately 2.4 to 3.2 million children below the age
of 12 lived in food insecure families. An additional 0.7 to 1.3 million teens (12 to
16 years) lived in food insufﬁcient families. Between 1992 and 1994 four million
low-income children below the age of 12 went hungry” (Alaimo, Briefel,
Frongillo and Olson, 1998). In addition, 6.8 percent of children (two months
through ﬁve years of age) live in families reporting food insufﬁciency while 1.7
percent were age 60 or above (Alaimo, Briefel, Frongillo and Olson, 1998).

A positive change is that there does exist evidence suggesting that poverty
among elderly persons is declining (From Kinsey, 1994: Senaver, Asp and
Kinsey, 1991). Olson et al. (Alaimo, Briefel, Frongillo and Olson, 1998) have
found that the elderly tend to be more hesitant to state that they do not have
enough to eat. Thus, it is possible that a number of studies may have
underestimated the number of adults aged 60 and above who experienced food

insufﬁciency (Alaimo, Briefel, Frongillo and Olson, 1998).

22

Conclusion

The information discussed in this literature review presents the deﬁnitions
of hunger, poverty and food insufﬁciency. The population characteristics of the
state of Michigan are observed as well as the history and development of the Food
Stamp Program and complimentary nutrition education programs. A view of the
speciﬁc circumstances of the different demographic variables that were observed
in this study was also presented. These subjects are intended to provide a
background into the overall state of Michigan State University Extension’s

Family Nutrition Program and the participants it serves.

23

CHAPTER III

METHODOLOGY

Introduction

 

This chapter examines the methodology used in evaluating the behavior
change of different demographic groups of Adult Series participants of the Family
Nutrition Program in Michigan. Items discussed include the study design, the
variables, validity, reliability and the target population of the study. The chapter
also discusses the method of instrument development, data collection and data
analysis of the study.

Dcsigp of the Study

 

This study uses the pretest and posttest design as described by Campbell
and Stanley (1966). The design exists as follows:
01 X 02
Variables
For each research question, independent variables and dependent variables
were deﬁned. The research questions of this study and the independent and
dependent variables were:
1) To what extent does gender have an effect on the behavior change of
Michigan FN P Adult Series participants in terms of the ﬁve key elements?
The independent variables are male and female. The dependent variable is the
measure of behavior change in FN P Adult Series participants in terms of the ﬁve

key elements.

24

2) To what extent does town size have an effect on the behavior change of
Michigan FNP Adult Series participants in terms of the ﬁve key elements?

The independent variables are farms, towns under 10,000 and rural non farm

areas, towns and cities 10,000 to 50,000, suburbs of cities over 50,000, and

central cites over 50,000. The dependent variable is the measure of behavior

change in FNP Adult Series participants in terms of the ﬁve key elements.

3) To what extent does ethnic background have an effect on the behavior change
of Michigan FNP Adult Series participants in terms of the ﬁve key elements?

The independent variables are white, African American, Hispanic, Native

American/Alaskan, and Asian/Paciﬁc Islander. The dependent variable is the

measure of behavior change in FNP Adult Series participants in terms of the ﬁve

key elements.

4) To what extent does age have an effect on the behavior change of Michigan
FN P Adult Series participants in terms of the ﬁve key elements?

The independent variables are participants aged 0 to 17, 18 to 25, 26 to 30, 31 to

35, 36 to 40, 41 to 45, 46 to 50, 51 to 55, 56 to 60, 61 to 65 and those aged 66 and

above. The dependent variable is the measure of behavior change in FNP Adult

Series participants in terms of the ﬁve key elements.

5) To what extent does region have an effect on the behavior change of Michigan
FNP Adult Series participants in terms of the ﬁve key elements?

The independent variables are Upper Peninsula, North, East Central, West

Central, Southeast and Southwest regions of Michigan. (Appendix A: Regional

25

Map of Michigan) The dependent variable is the measure of behavior change in
FNP Adult Series participants in terms of the ﬁve key elements.

The PLogram

 

The FN P Adult Series program consists of at least four planned nutrition
education lessons. Nutrition instructors must be high school graduates who are
then trained by FN P staff in the content of the Eating Right Is Basic (3” Edition)
(MSUE, 1995) curriculum and delivery. Nutrition instructors work with
participants in a variety of settings. Often they visit the participant in the home
for individual lessons, or they may teach a group of participants in a church social
hall or even the county extension office. One county uses a converted mobile
home as a “traveling kitchen” to visit communities.

In a planned Adult Series program, the ﬁrst step is to complete the pretest
with the Learning Tool. The Learning Tool is designed to be orated by the
nutrition instructor as the participant follows along and slides the cards pertaining
to a speciﬁc behavior (ex. washing hands, thawing meat in the reﬁigerator, etc) in
the slots that they feel correspond to their behavior (ex. always, never sometimes,
etc.). Some nutrition instructors may make photocopies of a paper version of the
Learning Tool where the participant actually reads the survey and marks the
appropriate number in a slot next to the question. In this case, the nutrition
instructor may or may not read the questions aloud.

The Learning Tool pretest serves nutrition instructors both as an
icebreaker as well as a diagnostic tool. After completion of the pretest, the data is

carried back to the ofﬁce and input into a computer either by the instructor or by

26

support staff. Since the curriculum is based on the 5 key elements, the data
collected from the pretest tells nutrition instructors which areas the participant
excels in and which areas need improvement. The nutrition instructor bases the
rest of the Adult Series instruction upon these results. Treatment consists of
demonstrations, question and answer sessions and other creative teaching methods
the nutrition instructors feel are appropriate to the individual participant’s needs.

At the end of the Adult Series (after at least four planned lessons), the
participant completes the Learning Tool a second time. This is also orated by the
nutrition instructor if the Learning Tool is used. It the paper version is used the
nutrition instructor may or not read the questions aloud. The post test data is then
input into the database and all data are sent to the FN P administration on a
quarterly basis.
Validity

A team of nutrition experts from the Family Nutrition Program and the
Expanded Food and Nutrition Education Program established face validity and
content validity during development of the Learning Tool pre/post survey.
According to Campbell and Stanley (1966) the pretest/posttest design controls for
internal invalidity sources of selection and mortality. The pretest/posttest design
does not control for internal invalidity sources of history, maturation, testing,
instrumentation or interaction of selection and maturation. The pretest posttest
design does not control for external invalidity sources of interaction of testing and

X and interaction of selection and X. Regression is a possible source of concern

27

to internal validity and reactive arrangements are a possible source of concern for
external validity (Campbell and Stanley, 1966).
Reliability

Reliability of the Learning Tool instrument was calculated using
Statistical Package for the Social Sciences (SPSS Inc., 1999). Reliability was
measured using Cronbach’s Alpha coefﬁcients with Alpha set at 0.05. The
resulting reliability coeffrcients ranged from .28 to .79.

Target Population

 

The target population for this study includes all participants who started
and ﬁnished the Michigan FNP Adult Series program between the dates of
November 24, 1998 and November 24, 1999. This nutrition education program
had a planned beginning and end and consisted of at least 4 educational sessions
with a Michigan county FN P nutrition instructor.

Reducing Sampling Bias

 

Frame Error: Frame error was controlled for this study by double-checking the
dates of every participant’s data set. The purpose of checking these dates was to
assure that the population participated in the FNP program between the prescribed
dates (November 24, 1998 to November 24, 1999).

Non-response Error: No follow-up was necessary to control for non-response
error since every participant took the pre and posttest as part of the FN P Adult

Series program.

28

Selection Bias: Selection bias was controlled for in this study since the entire
population of 2,064 reported answers for both the pre and posttests as part of the
FNP Adult Series Program.

Instrument Develrmment

 

The FNP administration began the development of the evaluation
instrument by creating an advisory team of two state staff and 20 county staff
persons. All staff were employed in the Food and Nutrition Program and worked
either directly in the Family Nutrition Program or with the Expanded Food
Nutrition Education Program (EFNEP), which has also utilized the Leaming Tool
in the 16 Michigan counties where the program operates. The goals of the
evaluation were to:

Describe the population and process

Diagnose the participant needs

Assess participant satisfaction

Evaluate the impact of the program and behavior change among participants
Evaluate the curriculum (Coleman, Haas and Himebauch, 1997).

The team developed the content and established initial face validity of 37
original behavior statements in the Leaming Tool. The team found more than 80
percent agreement in the content and wording of the statements in the Learning
Tool and in January of 1996 the ﬁrst round of testing using the instrument was
conducted in three counties where both FNP and EFNEP operate. Each county

tested 50 participants.

29

Results were gathered, summed, and reported to the advisory committee.
Based on test ﬁndings, the committee altered the Learning Tool items by
rewording statements resulting in 40 behavior statements. In the fall of 1996 the
second round of testing was conducted with all 83 FNP counties in Michigan and
all 16 EFNEP counties. The ﬁrst quarter data consisted of 250 participants (150
FNP and 100 EFNEP). These data were used to further test the validity and
reliability of the Learning Tool instrument and determined that the pilot data
reﬂected the entire population of the state. The data were then used to evaluate
the impact of both FNP and EFNEP programs (Coleman, Haas and Himebauch,
1997).
Data Collection

Data were collected and recorded by Michigan county nutrition instructors
for each participating county at the beginning and end of every FN P Adult Series
program. The data were input into the FN P Learning Tool computer database
program and were then mailed to the researcher on a 3.5-inch ﬂoppy disk. The
researcher merged all county data to analyze the information for the state.

Data Analysis

 

The survey was analyzed using Statistical Package for the Social Sciences
(SPSS Inc. 1999). The data were aggregated by each demographic variable and
analyzed using means, frequencies, ANOVAs and mean differences for each
group and by each category of individual variables. A post hoc panel of
registered dieticians, FNP regional directors, and FNP nutrition instructors was

established to determine the description of change relative to the change in mean

30

from before and after treatment. The measurement descriptors that were instituted
are illustrated in Table 3.1.

Table 3.1. Measurement Descriptors Used to Analyze Results from the Adult
Series Learning Tool in Michigan

 

 

 

 

 

 

Mean Change Description

.76 and above Very strong change
.51 to .75 Substantial change
.26 to .50 Moderate change
.11 to .25 Low change

.01 to .10 Negligible change

 

 

 

 

(Source: Krueger, 1994)

31

CHAPTER IV

FINDINGS

Data were collected to examine the behavior change of different
demographic groups of Adult Series participants of MSUE’s Family Nutrition
Program. In all, a questionnaire of 40 questions was presented in a pretest at the
onset of nutrition education classes. The same 40 questions were then asked in a

posttest at the end of the series.

Demgraphic Information

The total population that completed FNP Adult Series as well as the
Learning Tool Pre and Post evaluation was 2, 064. The majority (74.8 percent or
1,545) was female. Ages ranged from 13 to 98. To provide an understanding and
a perspective of the participants in the FNP Adult Series Program, background
data were obtained. These data were quantiﬁed and are presented in table form.
Five population characteristics are documented. These include ethnic
background (Table 4.1), town size (rural, urban, etc.) (Table 4.2), monthly income

per family (Table 4.3), age (Table 4.4), and region (Table 4.5).

Table 4.1 reveals the ethnic proﬁle of the 2,064 FNP Adult Series
participants. The population was divided into 5 different ethnic groups as
indicated. White persons clearly demonstrate the ethnic composition of the
population. The whites (59 percent) represented more than the total black, Native

American, Hispanic and Asian populations combined. Blacks represented the

32

second highest ethnic group (35 percent) followed by Hispanics (3.6 percent),

Native Americans (2 percent), and Asians (0.4 percent).

Table 4.1. Ethnic Composition of MSUE FNP Adult Series Participants

 

 

 

 

 

 

Ethnic Background Frequency Percent
White 1 ,21 7 59.0
Black 722 35.0

Native American 42 2.0

Hispanic 75 3.6

Asian 8 0.4
Total 2,064 1 00.0

 

In terms of environmental setting (Table 4.2) most of the FN P Adult
Series participants live in central cities of a population of at least 50,000 persons.
However, about a third (34.4 percent) of the population resides in small (under
10,000) rural clusters and rural non-farm isolated homesteads. As might be
expected, farmsteads and suburbs have the lowest representation (3.4 percent) of

FNP Adult Series participants.

Table 4.2. Residence of MSUE FNP Adult Series participants

 

 

 

Town Size Frequency Percent
Farm 71 3.4
Towns under 10,000and rural, non-farm 711 34.4
Towns and cities 10,000 to 50,000 402 19.5
Suburbs of cities 50,000+ 70 3.4
Central cities 50,000+ 810 39.2

 

 

 

 

33

The level of monthly income per family in 1999 (Table 4.3) clearly states

the plight of poverty of the population. Ninety-nine percent of the population

earns incomes of less than $3,000.00 per month. Almost 85 percent have 3 digit

monthly incomes and only about 15 percent earn four digit monthly incomes. The

1999 ofﬁcial poverty threshold is an annual income of $13, 880 for a family of

three residing within the 48 contiguous states, and 85 percent of this group clearly

falls below this earned income level. (Table 2.3)

Table 4.3. Reported 1998-1999 Monthly Earned Incomes of Michigan FNP

Adult Series Participants

 

 

 

 

 

Monthly Earned Dollars Per Participant Frequency Percent
0 through 200 726 35.2
201 through 400 175 8.5
401 through 600 438 21.2
601 through 800 236 11.4
801 through 1,000 166 8.0
1,001 through 2,000 278 13.5
2,001 through 3,000 31 1.5
3,001 and above 14 0.7

 

N= 2,064

Age distribution among Michigan FNP Adult Series participants varies

greatly. Participants between the age of 18 through 25 make up the largest group

(24.7 percent) followed by those between ages 26 through 30. Participants ages

51 through 65 make up the smallest totaled group (N=48, N= 48 and N=29 for a

total of 125). There is a sharp distinction between groups aged 61 through 65

34

 

who make up 1.4 percent (N=29) and those who are 66 and above who make up

8.6 percent (N=l77). (Table 4.4)

Table 4.4. Adult Series Participants Aged Distribution

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Age in years Frequency Percent
0-17 200 9.7
18-25 510 24.7
26-30 299 ' 14.5
31-35 262 12.7
36-40 245 11.9
41-45 143 6.9
46-50 103 5.0
51-55 48 2.3
56-60 48 2.3
61-65 29 1.4
66 and above 177 8.6
N= 2.064

Based on Table 4.5 it is apparent that FNP Adult Series participants in
Michigan resided in 5 of 6 regions between the dates of November 24, 1998 and
November 24, 1999. The program was not executed in any West Central Region
counties. This could have occurred for a variety of reasons such as lack of
funding, holding the program until a larger group of participants are enrolled, or
changes in stafﬁng at the regional, administrative or individual county levels. The

largest population (961 or 46.6 percent) resides in the Southeast Region, which

35

includes a highly urbanized and industrialized area of the Detroit Metropolitan
area (i.e. Wayne County). The Southwest Region, which is less urban, made up
the second largest group (N=451 or 21.9 percent). The third largest group
represented was those residing in the Upper Peninsula, one of the least populated
regions of the state, yet known to be economically less advantaged and more

rural.

Table 4.5. Geographic Distribution by Region of Michigan FNP
Adult Series Participants

 

 

 

 

 

 

 

Michigan Region Frequency Percent
Upper Peninsula 325 15.7
North 84 4.1
East Central 243 11.8
West Central 0 0
Southeast 961 46.6
Southwest 45 l 21 .9
N= 2,064

Research Questions

The following section presents the results of the Michigan FNP Adult
Series participant responses to the 40 pre- and posttest questions that were
presented directly before and after FNP Adult Series nutrition education
programming. The data are tabulated and presented by each key element
represented in The Learning T 001 evaluation instrument. (Appendix B: The

Learning Tool Survey) The key elements include Dietary Quality, Food Resource

36

Management and Shopping Behavior, Food Safety, Food Security and System
Change. The behavior change is measured in units of very strong change,
substantial change, moderate change, low change and negligible change. (Table

3.1)

Research Question 1

The ﬁrst research question of the study asks to what extent does gender
have on behavioral change of FNP Adult Series participants in terms of the ﬁve
key elements? An ANOVA was computed to locate differences between the ﬁve
key elements and males and females. (Table 4.7) No signiﬁcant differences were
found between the behavior change between males and females in any of the ﬁve

key elements.

Table 4.7. Differences Found in an ANOVA Between Males and Females and

 

 

 

 

 

 

 

 

the 5 Key Elements
Scale F-value Signiﬁcance
Dietary Quality 1.745 .187
Food Resource Management and Shopping Behavior .637 .425
Food Safety .113 .113
Food Security/ System Change .466 .466

 

Research Question 2

 

 

The second research question of this study asks to what extent does town
size have on behavior change of FNP Adult Series participants in terms of the ﬁve

key elements? Grand mean differences were calculated to determine the level of

37

 

behavior change exhibited within each key element. Results are illustrated in

Table 4.8 through Table 4.11.

Table 4.8. Grand Mean Differences Exhibited by Participants in Town Size
in the Dietary Quality Key Element

 

 

 

Dietary Quality N Mean Difference
Farm 71 .1198
Central cities of 50,000 and above 809 .1916
Towns and cities under 10,000 and rural non-farm 711 .2054
Suburbs of cities 50,000 and above 70 .2382
Towns and cities 10,000 to 50,000 402 .104

 

 

 

Table 4.9. Grand Mean Differences Exhibited by Participants in Town Size
in the Food Resource Management and Shopping Behavior Key Element

 

 

 

 

 

 

Food Resource Management and Shopping Behavior N Mean Difference
Farm 70 .2923
Central cities of 50,000 and above 71 .3200
Towns and cities under 10,000 and rural non-farm 807 .3440
Suburbs of cities 50,000 and above 710 .3494
Towns and cities 10,000 to 50,000 401 .4786

 

38

Table 4.10. Grand Mean Differences Exhibited by Participants in Town Size
in the Food Safety Key Element

 

 

 

 

 

 

Food Safety N Mean Difference
Farm 780 -8.70E-04
Central cities of 50,000 and above 69 3.865E-03
Towns and cities under 10,000 and rural non-farm 389 1.964E-02
Suburbs of cities 50,000 and above 698 5.398E-02
Towns and cities 10,000 to 50,000 71 8.387E-02

 

Table 4.11. Grand Mean Differences Exhibited by Participants in Town Size
in the Food Security / System Change Key Elements

 

Food Security and System Change N Mean Difference

 

Farm 662 1.511E-03

Central cities of 50,000 and above 756 5.952E-03

Towns and cities under 10,000 and rural non-farm 68 7.353E-03
Suburbs of cities 50,000 and above 368 9.511E-O3

Towns and cities 10,000 to 50,000 67 2.985E-02

 

 

 

 

 

An ANOVA was computed to locate differences between the size of town
of residence and the behavior change exhibited by participants in each of the key
elements. Results are illustrated in Table 4.12. A signiﬁcant difference exists for

the area of Food Resource Management and Shopping Behavior.

39

Table 4.12. Differences found in ANOVA Between Town Size
and the Five Key Elements

 

Scale F-value Signiﬁcance

 

Dietary Quality 1.734 .140

 

Food Resource Management and Shopping Behavior 4.796 .001*

 

Food Safety 1.294 .270

 

 

 

 

Food Security/ System Change .242 .915

 

 

(*Denotes signiﬁcance at .05.)

A Tukey post hoc analysis was computed to locate the differences that
occurred within the Food Resource Management and Shopping Behavior key
element. The results are illustrated in Table 4.13. A signiﬁcant difference
occurred between those living in towns and cities of 10,000 to 50,000 and those
living in towns under 10,000 and rural non-farm areas. A signiﬁcant difference
also occurred between those living in central cities of 50,000 and greater and

those living in towns and cities of 10,000 to 50,000.

Table 4.13. Location of Differences Between Town Sizes and Key Elements

 

 

 

Towns and cities 10,000 to 50,000 Mean Difference Signiﬁcance
Farm .1585 .191
Towns < 10,000 and rural non-farm .1292 .002*
Suburbs of cities 50,000 plus .1863 .083
Central cities 50,000 plus .1346 .001*

 

 

 

(* Denotes signiﬁcance at .05.)

40

 

Research Question 3

The third research question of this study was used to determine what
extent ethnic background has on the behavior change of Michigan F NP Adult
Series participants in terms of the ﬁve key elements. Grand mean differences
were calculated to determine the level of behavior change exhibited within each

key element. Results are illustrated in Table 4.14 through Table 4.17.

Table 4.14. Grand Mean Differences Exhibited by Participants of Different
Ethnic Backgrounds in the Dietary Quality Key Element

 

 

 

 

 

 

Dietary Quality N Mean Difference
Black 721 .1879
White 1217 .2081
Native American 42 .2331
Hispanic 75 .2789
Asian 8 .5695

 

Table 4.15. Grand Mean Differences Exhibited by Participants of Different
Ethnic Backgrounds in the Food Resource Management and Shopping
Behavior Key Element

 

 

 

 

 

Food Systems Management and N Mean Difference
Shopping Behavior
Black 721 .3292
White 1213 .3984
Native American 42 .5069
Hispanic 75 .5978
Asian 8 1.0103

 

41

 

Table 4.16. Grand Mean Differences Exhibited by Participants of Different
Ethnic Backgrounds in the Food Safety Key Element

 

 

 

Food Safety N Mean Difference
Black 696 -3.08E-02
White 1 187 4.875E-02
Native American 41 .1300
Hispanic 75 .1197
Asian 8 1 .994E-02

 

 

 

 

Table 4.17. Grand Mean Differences Exhibited by Participants of Different
Ethnic Backgrounds in the Food Security / System Change Key Elements

 

 

 

 

 

 

Food Security and System Change N Mean Difference
Black 682 6.598E-03
White 1121 6.690E-03
Native American 41 .0000
Hispanic 72 -6.94E-03
Asian 5 .0000

 

An AN OVA was computed to locate differences between the ethnic
backgrounds represented by the FNP Adult Series participants and their exhibited
behavior change in each of the key elements. Results are illustrated in Table 4.18.
Signiﬁcant differences exist for the areas of Food Resource Management and

Shopping Behavior and Food Safety.

42

Table 4.18. Differences found in ANOVA Between Ethnic Background and

 

 

 

 

 

 

the Five Key Elements
Scale F-value Signiﬁcance
Dietary Quality 2.276 .059
Food Resource Management and Shepping 8.258 .000*
Behavior
Food Safety 3.692 .005*
Food Security/ System Change .062 .993

 

 

 

 

(* Denotes signiﬁcance at .05)

A Tukey post hoc analysis was computed to locate the differences that
occurred within the Food Resource Management and Shopping Behavior and the
Food Safety key elements. The results are illustrated in Table 4.19 and Table

4.20.

In the Food Resource Management and Shopping Behavior key element,
a signiﬁcant difference also occurred between whites and Hispanics and whites
and Asians. Signiﬁcant differences also occurred between African Americans
and Hispanics and African Americans and Asians for this key element. In the
Food Safety key element, a signiﬁcant difference was found between African

Americans and whites. (Table 4.19 and Table 4.20)

43

Table 4.19. Location of Differences Between Ethnic Background the Food
Resource Management and Shopping Behavior Key Element

 

Food Resource Management and Shopping Behavior

 

 

 

 

 

 

 

White Mean Difference Significance
African American -6.9180E-02 .070
Native American -.1777 .264
Hispanic -.2686 .001*
Asian -.681 1 .006*
African American Mean Difference Significance
White 6.918E-02 .070
Native American -.1086 .746
Hispanic -.1995 .030*
Asian -.61 19 .020*

 

(*Denotes signiﬁcance at .05.)

Table 4.20. Location of Differences Between Ethnic Background the

 

 

Food Safety Key Element
African Americans Mean Difference Significance
White -7.9595E-02 .011*
Native American -.1608 .301
Hispanic -.1505 .1 18
Asian -5.0787E-02 .999

 

 

 

 

(*Denotes signiﬁcance at .05.)

44

 

 

Research Question 4

The fourth research question of this study asks to what extent does age
have on behavior change of FNP Adult Series participants in terms of the ﬁve key
elements? Grand mean differences were calculated to determine the level of

behavior change exhibited within each key element. Results are illustrated in

Table 4.21 through Table 4.24.

Table 4.21. Grand Mean Differences Exhibited by Participants of Different

Age Groups in the Dietary Quality Key Element

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dietary Quality N Mean Difference
0 to 17 200 .2231
18to 25 510 .2413
26 to 30 299 .2491
31 to 35 261 .1690
36 to 40 245 .1997
41 to 45 143 .1651
46 to 50 103 .2092
51 to 55 48 .2683
56 to 60 48 .1289
61 to 65 29 8.448E-02
66+ 177 .1245

 

215

 

Table 4.22. Grand Mean Differences Exhibited by Participants of Different
Age Groups in the Food Resource Management and Shopping Behavior

 

 

 

 

 

 

 

 

 

 

 

 

Key Element
Food Resource N Mean Difference
Management and

Shopping

Behavior
0 to 17 199 .2668
18 to 25 510 .4370
26 to 30 299 .4370
31 to 35 261 .3344
36 to 40 244 .3701
41 to 45 142 .2652
46 to 50 102 .2935
51 to 55 48 .3492
56 to 60 48 .2506
61 to 65 29 .4218
66+ 177 .4046

 

 

 

 

 

46

Table 4.23. Grand Mean Differences Exhibited by Participants of Different
Age Groups in the Food Safety Key Element

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Food Safety N Mean Difference

0 to 17 187 .1602

18 to 25 500 4.399E.02
26 to 30 294 5.906E-02
31 to 35 251 1.737E-02
36 to 40 236 2.303E-02
41 to 45 137 -3.67E-02
46 to 50 101 -9.62E-03
51 to 55 48 -4.47E-02
56 to 60 48 -5.31E-02
61 to 65 29 3.112E-02
66+ 176 -.1049

 

47

Table 4.24. Grand Mean Differences Exhibited by Participants of Different
Age Groups in the Food Security and System Change Key Elements

 

 

 

 

 

 

 

 

 

 

 

 

Food Security/ N Mean Difference

System Change
0 to 17 171 2.047E-02
18 to 25 483 1.242E-02
26 to 30 283 5.300E-03
31 to 35 242 4.132E-03
36 to 40 226 -4.42E-03
41 to 45 134 .0000
46 to 50 95 2.105E-02
51 to 55 45 .000
56 to 60 47 -4.26E-02
61 to 65 26 .0000
66+ 169 2.959E-03

 

 

 

 

 

An AN OVA was computed to locate differences between the age groups
represented by the FNP Adult Series participants and their exhibited behavior
change in each of the key elements. Results are illustrated in Table 4.25.
Signiﬁcant differences exist for the areas of Dietary Quality, Food Resource

Management and Shopping Behavior, and Food Safety.

48

Table 4.25. Differences found in ANOVA Between Age Groups and the Five

 

 

 

 

 

Key Elements
Scale F-value Signiﬁcance
Dietary Quality 2.077 .023*
Food Resource Management and Shopping 2.725 .002*
Behavior
Food Safety 3.031 .001*
Food Security/ System Change .383 .954

 

 

 

 

 

("' Denotes signiﬁcance at .05.)

A Tukey post hoc analysis was computed to locate the differences that
occurred within the Dietary Quality, Food Resource Management and Shopping
Behavior and the Food Safety key elements. The results are illustrated in Table

4.26, Table 4.27 and Table 4.28.

In the Dietary Quality key element, there is borderline signiﬁcant
difference between those aged 66 and above and those aged 18 to 25. There is
also borderline signiﬁcant difference between those aged 66 and above and those
aged 26 through 30. (Table 4.26) In the Food Resource Management and
Shopping Behavior key element, signiﬁcant differences were found between those
who were aged 0 to 17 and those aged 18 to 25. Signiﬁcant difference was also
found between those aged 0 to 17 and those aged 26 through 30 years. (Table
4.27) In the Food Safety key element, signiﬁcant difference was found between
those aged 0 to 17 and those aged 41 to 45, 66 and above. Signiﬁcant difference
was also found between those aged 66 and above and participants aged 18 to 25,

26 to 30, and 0 tol7. (Table 4.28)

49

Table 4.26. Location of Differences Between Age Groups and
the Dietary Quality Key Element

 

 

 

 

 

 

Dietary Quality

Age 66+ Mean Difference Significance
0 to 17 -9.8595E—02 .508
18 to 25 -.1168 .076*
26 to 30 -.1246 .089*
31 to 35 -4.4539E-02 .994
36 t0 40 -7.5161E-02 .809
41 to 45 -4.0584E-02 .999
46 to 50 -8.4683E-02 .895
51 to 55 -.1438 .628
56 to 60 -4.3548E-03 1.000
61 to 65 4.003E-02 1.000

 

(*Denotes signiﬁcance at .05)

50

 

Table 4.27. Location of Differences Between Age Groups and the Food
Resource Management and Shopping Behavior Key Element

 

 

 

 

 

Food Resource Management and Shopping Behavior
Ages 0 to 17 Mean Difference Significance
18 to 25 -.1629 .025*
26 to 30 -.1702 .041*
31 to 35 -6.7615E-02 .974
36 t0 40 -.1033 .713
41 to 45 1.614E-03 1.000
46 to 50 -2.6745E-02 1.000
51 to 55 -8.2424E-02 .998
56 to 60 1.622E-02 1.000
61 to 65 -.1549 .955
66+ -.1378 .398

 

 

 

(*Denotes signiﬁcance at .05)

51

Table 4.28. Location of Differences Between Age Groups and the Food

 

 

 

 

 

 

 

Safety Key Element
Ages 0 to 17 Mean Difference Significance
18 to 25 .1163 .236
26 to 30 .1012 .583
31 to 35 .1429 .136
36 t0 40 .1372 .194
41 to 45 .1969 .029*
46 to 50 .1699 .218
51 to 55 .2050 .334
56 to 60 .2133 .275
61 to 65 .1291 .976
66+ .2652 .000*
Age 66+ Mean Difference Significance
0 to 17 -.2652 .000*
18 to 25 -.1489 .040*
26 to 30 -.1640 .035*
31 to 35 -.1223 .362
36 t0 40 -.1280 .313
41 to 45 -6.8219E-02 .987
46 to 50 -9.5306E-02 .928
51 to 55 -6.0182E-02 1.000
56 to 60 -5.1849E-02 1.000
61 to 65 -.1360 .967

 

 

(*Denotes signiﬁcance at .05)

52

Research Question 5

The ﬁfth research question of this study asks to what extent does
region of residence have on behavior change of Michigan FNP Adult Series
participants in terms of the ﬁve key elements? Grand mean differences were

calculated to determine the level of behavior change exhibited within each key

element. Results are illustrated in Table 4.29 to Table 4.32.

Table 4.29. Grand Mean Differences Exhibited by Participants of Different

Region of Residence in the Dietary Quality Key Element

 

 

 

 

 

Dietary Quality N Mean Difference
Upper Peninsula 325 .2300
North 84 .1871
East Central 243 .1233
Southeast 960 . 1 98 1
Southwest 451 .25 1 3

 

Table 4.30. Grand Mean Differences Exhibited by Participants of Different
Region of Residence in the Food Resource Management and Shopping

 

 

Behavior Key Element
Food Resource Management and N Mean Difference
Shopping Behavior
Upper Peninsula 325 .4329
North 84 .2808
East Central 243 .2728
Southeast 959 .361 1
Southwest 448 .4105

 

 

 

 

53

 

 

Table 4.31. Grand Mean Differences Exhibited by Participants of Different
Region of Residence in the Food Safety Key Element

 

 

 

 

 

 

Food Safety N Mean Difference
Upper Peninsula 324 1.527E-02
North 84 8.095E-02
East Central 240 1.630E-02
Southeast 926 l .926E-02
Southwest 433 4.010E-02

 

Table 4.32. Grand Mean Differences Exhibited by Participants of Different
Region of Residence in the Food Safety Key Element

 

 

 

 

 

 

Food Security/ System Change N Mean Difference
Upper Peninsula 3 17 -2.05E-02
North 82 -1 .22E-02
East Central 219 - l .37E-02
Southeast 896 6.138E-03
Southwest 407 4.054E-02

 

An AN OVA was computed to locate differences between the regions of
residence represented by the FN P Adult Series participants and their exhibited
behavior change in each of the key elements. Results are illustrated in Table 4.33.
Signiﬁcant differences exist for the areas of Dietary Quality, Food Resource

Management and Shopping Behavior and Food Security/ System Change.

54

Table 4.33. Differences found in ANOVA Between Region of Residence and
the Five Key Elements

 

Scale F -value Signiﬁcance

 

Dietary Quality 3.780 .005*

 

Food Resource Management and Shopping Behavior 3.924 .004*

 

Food Safety .408 .803

 

 

 

 

 

Food Security/ System Change 3.561 .007*

 

(* Denotes signiﬁcance at .05)

A Tukey post hoc analysis was computed to locate the differences that
occurred within the Dietary Quality, Food Resource Management and Shopping
Behavior, and Food Security /System Change key elements. In the Dietary
Quality key element a signiﬁcant difference was found between the East Central
region and the Upper Peninsula. A signiﬁcant difference was also found between

the East Central region and the Southwest. (Table 4.34)

Table 4.34. Location of Differences Between Region of Residence and the
Dietary Quality Key Element

 

 

 

 

 

East Central Mean Difference Signiﬁcance
North -6.3797E-02 .775
Upper Peninsula -. 1067 .031*
Southwest -. 1280 .002*
Southeast -7.4797E-02 .1 1 7

 

 

(*Denotes signiﬁcance at .05)

In the Food Resource Management and Shopping Behavior key element, a

signiﬁcant difference was found between the East Central region and the Upper

55

Peninsula. There was also a signiﬁcant difference between the East Central

region and the Southwest. (Table 4.35)

Table 4.35. Location of Differences Between Region of Residence and the
Food Resource Management and Shopping Behavior Key Element

 

 

 

 

 

 

East Central Mean Difference Signiﬁcance
North -8.0042E-02 1 .000
Upper Peninsula -. 1601 .008*
Southwest -. 1377 .020*
( Southeast -8.8324E-02 . 1 93

(*Denotes signiﬁcance at .05)

In the Food Security/System Change key elements, a signiﬁcant difference

was found between the Southwest region and the Upper Peninsula. There was

also a borderline signiﬁcant difference between the Southwest region and the East

Central. (Table 4.36)

Table 4.36. Location of Differences Between Region of Residence and the

Food Security/ System Change Key Elements

 

 

 

 

 

East Central Mean Difference Signiﬁcance
North 5.274E-02 .365
Upper Peninsula 6.105E-02 .006*
Southwest 5.424E-02 .054*
Southeast 3 .440E-02 . 1 1 6

 

(*Denotes signiﬁcance at .05)

56

 

 

CHAPTER V

SUMMARY, CONCLUSIONS, IMPLICATIONS AND

RECOMMENDATIONS

Summary

The purpose of the study was to investigate differences in levels of
behavior change among demographic groups represented in the Michigan Family
Nutrition Program’s Adult Series in Michigan. Speciﬁcally, the demographic
groups studied were gender, age, ethnic background, town size, and geographical

region. The research questions of this study were:

1) To what extent does gender have an effect on behavior change of Michigan

FNP Adult Series Participants in terms of the ﬁve key elements?

2) To what extent does town size have an effect on behavior change of Michigan

F NP Adult Series Participants in terms of the ﬁve key elements?

3) To what extent does ethnic background have an effect on behavior change of

Michigan FNP Adult Series Participants in terms of the ﬁve key elements?

4) To what extent does age have an effect on behavior change of Michigan FNP

Adult Series Participants in terms of the ﬁve key elements?

5) To what extent does geographical region have an effect on behavior change of

Michigan FNP Adult Series Participants in terms of the ﬁve key elements?

57

The target population of the study was comprised of 2, 064 participants of
the Family Nutrition Program of Michigan State University Cooperative
Extension Service Adult Series Program. The respondents participated in the
program between the dates of November 24th 1998 and November 24th 1999. The
nutrition education program had a planned beginning and end and consisted of at

least four educational sessions with a Michigan county FNP nutrition instructor.

The instrumentation of the study was a pre-post survey administered
before a set of FNP Adult Series nutrition education sessions and immediately
upon completion of the series. The survey was administered aloud by a Michigan
FNP nutrition instructor as participants followed along using The Learning Tool
to answer the questions presented. The instrument utilized multiple-choice
questions with a Likert-type scale. Five possible responses included: 0= “never”,
1 = “hardly ever”, 2 = “sometimes”, 3 = “most of the time”, and 4 = “always”.
(Appendix B: The Leaming Tool Survey) A committee of FNP administrative
personnel comprised of two state staff and 20 county level staff persons
developed the instrument. The validity of the instrument was established through
pilot testing in 3 counties with 50 participants per county. Reliability was tested

using Chronbach’s Alpha.

Data collection is an employment requirement of FNP nutrition
instructors; thus it is assumed that this study utilized a response rate of 100
percent and this was a census study. All together pre-posttest surveys were

reported for 2, 064 participants who completed FNP Adult Series. This

58

information was administered and collected by Michigan FN P nutrition

instructors and delivered to the researcher.
Conclusions and Implications

Conclusions drawn from this study are limited to FNP participants who
completed FNP Adult Series between the dates of November 24‘h 1998 through

November 24th 1999. These ﬁndings are based only upon this study.

Research mestion 1: To what extent does gender have an effect on behavior

 

change of Michigan FNP Adult Series Participants in terms of the ﬁve key

elements?

Overall there was little difference between the performance of males and
females in every key element observed. Although the results of the AN OVA
indicated no signiﬁcant difference between the performance of males and females
in terms of all key elements, the scale measurement determined by the post-hoe
committee of experts found a slight difference. (Appendix C: Table CI to C4)
In this case, it was females who exhibited slightly more change than males. As
women tend to be more at risk for food insecurity, even a slightly higher change
than males can be considered a step in the right direction. As single women are
more likely to have the custody of children than men, this small success could

possibly have a positive effect on the nutrient intakes of children as well.

59

Research Question 2: To what extent does town size have an effect on

 

behavior change of Michigan FNP Adult Series Participants in terms of the

five key elements?

As indicated in the Literature Review, low-income urban dwellers and
rural poor are at risk for hunger and food insecurity. Unfortunately, the results
indicated that the group that was most successful in changing behavior was those
living in towns and cities of 10,000 to 50,000, which is not a group who is as
likely to be at risk for food insecurity and hunger. In the scale created by the
post-hoe committee of experts, there was not one case where those living in
central cities exhibited a higher level of change than the rest of the groups.
(Appendix C: Table C5 to Table C.8) This demonstrates a genuine need for
increased focus on urban populations and those in rural areas who’s poverty is
augmented by many factors due to their locations such as lack of access to social

services or fresh fruits and vegetables.

Research Question 3: To what extent does ethnic background have an effect

 

on behavior change of Michigan FNP Adult Series Participants in terms of

the five key elements?

The most notable ﬁndings in the measurements of behavior change
exhibited by FNP participants in terms of ethnic background is the extremely high
level of behavior change exhibited by the Asian population and very low change
by the African American population. The Asian group who demonstrated such

strong change represents the smallest minority population of the Michigan FNP

60

Adult Series program 0.4 percent (Table 4.1). On the other hand, the African
American participants represented some of the lowest change, yet they make up
the largest minority population in the state of Michigan. As noted in the
Literature Review, African Americans are at a very high-risk for food insecurity
and hunger than other minorities. This is augmented further by the fact that the
African American population in Michigan is relatively large. Another minority
group in Michigan, Hispanics, exhibited much higher change than the African
American populations. This implies that something is being done effectively to
educate the Hispanic population but there is a barrier for the African American
group. Results were similar using the scale determined by the post-hoc

committee of experts. (Appendix C: Table C9 to C. 12)

Research Question 4: To what extent does age have an effect on behavior

 

change of Michigan FNP Adult Series Participants in terms of the five key

elements?

Participants aged 66 and above represented some of the most successful
behavior change measured. Other age groups that exhibited notable behavior
change were those aged 26 to 30. The ages in between these young and older
ages did not perform as well as these groups. This implies that senior citizens and
younger participants are more likely to change behavior. As indicated in the
Literature Review, low-income children and elderly are more at risk for food
insecurity and hunger than other age groups, thus the changes indicated in this

study represent a positive effect on these higher-risk participants. Results were

61

similar using the scale determined by the post-hoc committee of experts.

(Appendix C: Table C.13 to C. 16)

Research Question 5: To what extent does region of residence have an effect

 

on behavior change of Michigan FNP Adult Series Participants in terms of

the five key elements?

The region that is struggling more than any of its neighbors that also ran
the FNP Adult Series when the data was collected the most is the East Central.
This demonstrates a barrier to the success of the participants in the FNP Adult
Series program who reside in the counties of the East Central region. The Upper
Peninsula and the Southeast and Southwest exhibited more positive changes.

The Southeast contains the Detroit Metropolitan Area, which is highly urban, and
the Upper Peninsula is rural. This implies the possibility that populations that are
at higher risk for hunger and food insecurity (rural and central cities) are being

reached by the FN P program. Results were similar using the scale determined by

the post-hoe committee of experts. (Table C. 1 7to C. 20)

Recommendations

 

In this study, a large amount of change was found in towns and cities with
a population of 10,000 to 50,000 with little in central cities with a population
exceeding 50,000. This suggests that participants who live in rural and urban

areas (and are more at risk for food insecurity and hunger) could beneﬁt from

62

direct programming focused for their populations. It is recommended that more

efforts are instituted to reach these higher-risk populations.

In terms of ethnic background, there is a great need for more effective
programming among Aﬁican American participants. A needs assessment could
help FNP determine what those barriers are and how to better reach and serve this

population.

In terms of the evaluation instrument, it is recommended that a nutrition
instructor who does not do programming with clients administer the Learning
Tool. This is to facilitate more anonymity among participants, as they could be
hesitant to be fully honest in their responses given the relationship they may have
built with the instructor they have worked with through the treatment. It may also
be beneﬁcial to use it as a diagnostic tool only at the start of a planned series. The
instrument is quite long, is repetitive, and takes a great deal of time to complete.
Nutrition instructors may use the tool as an indicator of the participant’s
awareness, but a more condensed tool is preferable for program evaluation. Of
the 40 questions, there are questions that seem to cover the same type of
information. It would be beneﬁcial to both the nutrition instructors as well as
their clients to condense the Learning Tool Survey in order to prevent users from

growing tired of completing the survey and acquire more accurate data.

County staff that use the Learning Tool are not trained in how to analyze
the results. Instead they are instructed to send in the data they collect to the

administration after reading the pre test to diagnose the needs of their clients. It

63

would be beneﬁcial to the moral of the nutrition instructors to train them in how
to read the pre and post results to determine what change occurred in their speciﬁc
programs. These results could be used directly at the county level to improve
programs or to report successes as well. With the improved knowledge of the
tools capabilities for the nutrition instructor, there is a potential for the reporting
to become more accurate, more enjoyable for those handling the data, and more

useful at both the county and the administrative levels.
Recommendations for Further Research

This thesis only began the study of different low-income populations
represented in the Michigan FNP Adult Series program. A greater understanding
of the populations could be gained by a variety of more extensive research. For
example, extensive cross-tabulations between different demographic groups (i.e.
Hispanics in central cities compared with African Americans in central cities)
could dramatically inﬂuence the FNP curriculum as well as the teaching

methodology nutrition instructors are trained to use.

This study brieﬂy examined the differences between Michigan regions.
Research that focuses on the demographics used in this study (and others
considered important) coupled with a direct focus on only regions rather than a
state could be useful to many. This sort of study could also delve into the
characteristics of the region (rural, large metropolitan area, etc.) and apply them
to the ﬁndings. Further breakdowns to the county level have the potential to be of

great importance to local communities. Finally, the use of qualitative data

64

collected among focus groups would greatly enhance any of these studies. A
study that utilizes a control group could help to determine results more

effectively.

65

e/ctyentpg/

Appendix A: Regional Map of Michigan

Source: http://www.msue.msu.edu/msu

 

 

 

 

 

 

66

10.

11.

12

13.

14.

15.

16.

17.

18.

Eating Right is Basic (3rd Edition)
LEARNING TOOL
Michigan State University Extension — August 1996

1: “I never do”, 2 = “I seldom do”, 3 = “I sometimes do”, 4 = “I usually do”,
and 5 = “I always do”

. I use foods I have “on-hand” when I make a meal.

I check what foods I have “on-hand” before going grocery shopping.

I budget money for food expenses.

I plan meals for a few days ahead of time before going grocery shopping.

I plan meals to include a variety of foods from different food groups in the Food
Guide Pyramid.

I plan for leftovers and use them later.

I use a shopping list when I shop for food.

I use store specials when buying my meals.

I compare prices when I shop to find the best buy.

I buy store-brand food instead of name-brand foods, unless the name brands cost
less.

I buy convenience foods, such as frozen dinners or a “helper” mix, each week.

. I use the information on food labels to compare fat or other nutrients in foods.

I eat dark green, orange or dark yellow vegetables at least once a week.

I eat cabbage, cauliﬂower, broccoli or green/red peppers at least once a week.
I eat citrus fruits, strawberries, or drink citrus fruits at least three times a week.
I drink milk at least once a day.

I eat cheese or yogurt at least once a day.

I drink soda pop or fruit-ﬂavored drinks at least once a day.

67

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

I eat candy or chips, such as potato chips, tortilla chips or corn chips, at least once
a day.

I cook meals using dry beans of peas at least once a week.

I steam or microwave my vegetables with a little water when I cook them.

I buy lean cuts of meat, like round steak or stew meat, when I buy meat.

I fry chicken and other meats for meals.

I pour the fat off meat after cooking and throw the fat away.

I bake, boil or microwave my potatoes when I cook them.

I thaw frozen meat by letting it sit out on the counter or another space outside of
the refrigerator.

Before I eat or prepare food, I remember to do both these things; wash my hands
for at least 20 seconds; use warm, soapy water.

I scrub raw, tough-skinned vegetables or fruits before I serve or eat them.

I store uncooked cereal products, such as cornmeal and rice, in tightly closed
containers.

I use hot soapy water to wash dishes and countertops every time I prepare food.
I keep raw meat, such as hamburger, in the refrigerator for more than 2 days.

I eat breakfast.

I run out of food at the end of the month.

I use emergency food services, such as a food pantry or church pantry, or
participate in a free meal program, such as a soup kitchen.

I enjoy cooking and preparing food.

68

36.

37.

38.

39.

40.

41.

For Participants with children

My children get me to buy candy, sweet cereals, and other things that I wouldn’t
otherwise buy.

I plan snacks for my children.

My children eat breakfast.

My children wash their hands with warn, soapy water before eating.

My children help me decide what fruits, vegetables and other healthy foods to

buy.

69

Appendix C: Results in Terms of the Post-Hoe Committee of Expert’s
Scale of Measurement

Table C.1. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Gender and Dietary Quality

 

 

 

Dietary Negligible Low Moderate Substantial Very No
Quality Strong Change
Female 1 4 12 1
Male 9 8 1

 

 

 

 

 

 

 

 

Table C.2. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Gender and Food Resource Management/

 

 

Shopping Behavior
Food Resource Negligible Low Moderate Substantial Very No
Management/ Strong Change
Shopping Behavior
Female 2 9 l 1
Male 1 (-) 3 7 1 l

 

 

 

 

 

 

 

 

 

Table C.3. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Gender and Food Safety

 

 

 

Food Safety Negligible Low Moderate Substantial Very No
Strong Change
Female 1 (-) 2 3 1
Male 4 (-) 2 1

 

 

 

 

 

 

 

 

Table C.4. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Gender and Food Security and System Change

 

 

 

Food Security/ Negligible Low Moderate Substantial Very No
System Change Strong Change
Female 1 (-) 1
Male 1 (-) l

 

 

 

 

 

 

 

70

 

Table C.5. Measurement of Behavior Change exhibited by F NP Adult Series
Participants in Terms of Town Size and Dietary Quality

 

 

 

 

 

 

 

 

Dietary Quality Negligible Low Moderate Substantial Very
Strong

Farm 2 (-) 7 9
Towns less than 10,000 and rural 3 l4 1
non-farm
Town/City 10,000 to 50,000 3 '3 1 ‘
Suburbs 50,000+ 3 (-) 5 6 4
Central Cities 50,000+ l 8 8 l

 

Table C.6. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Town Size and Food Resource Management]

 

 

Shopping Behavior
Food Resource Management/ Negligible Low Moderate Substantial Very
Shopping Behavior Strong

Farm 3 6 1
Towns less than 10,000 and rural 1 8 1
non-farm

. 6 3 I
Town/City 10,000/ 50,000
Suburbs 50,000+ 2 H 2 '
Central Cities 50,000+ ' H 1 7 '

 

 

 

 

 

 

 

71

 

 

Table C.7. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Town Size and Food Safety

 

 

Central Cities 50,000+

 

 

 

 

 

 

 

Food Safety Negligible Low Moderate Substantial Very No
Strong Change
Farm 1 2 3 1
Towns less than 10,000 3 3 l
and rural non-farm
Town/City 10,000/ ‘ ' 4 1
50,000
I 3 2 l
Suburbs 50,000+
l 4 1 l

 

Table C.8. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Town Size and Food Security/System Change

 

Food Security/System
Change

Negligible

Low

Moderate

Substantial

Very
Strong

No
Change

 

Farm

Towns less than 10,000
and rural non-farm

Town/City 10,000 to
50,000

Suburbs 50,000+

 

Central Cities 50,000+

 

1 H

1 (-)

1 (-)

 

 

 

 

 

 

72

 

 

Table C.9. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Ethnic Background and Dietary Quality

 

 

 

 

 

 

 

 

Dietary Quality Negligible Low Moderate Substantial Very No
Strong Change
— j—I

White 6 ll 1

African American 1 5 l 1 1

Native American 1 6 8 3

Hispanic 2 l2 2 2

Asian 1 1 5 10 1

 

 

 

Table C.10. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Ethnic Background and Food Resource

Management! Shopping Behavior

 

 

 

 

 

 

 

 

 

Food Resource Negligible Low Moderate Substantial Very No
Management/ Strong Change
Shopping Behavior

White 2 9

African American 1 1 8 1

Native American 1 7 1

Hispanic 1 2 4 3

Asian 2 4 7

 

73

 

Table C.11. Measurement of Behavior Change exhibited by FNP Adult Series

Participants in Terms of Ethnic Background and Food Safety

 

 

 

Food Safety Negligible Low Moderate Substantial Very No
Strong Change
White 1 2 3 1
African American 2 2 2 1
Native American 2 2 3 1
Hispanic 3 2 l 1
Asian 1 1 5

 

 

 

 

 

 

 

Table C.12. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Ethnic Background and
Food Security/System Change

 

 

 

Food Security/ System Negligible Low Moderate Substantial Very No
Change Strong Change

White 1 (-) 1 H

African American 1 (-) 1 (-)

Native American
Hispanic

Asian

 

1 (-)

 

2 H

 

1 (-)

 

1 (-)

 

 

 

74

 

 

Table C.13. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Age and Dietary Quality

 

 

 

 

 

 

 

Dietary Quality Negligible Low Moderate Substantial Very No
Strong Change

0-17 3 (-) 8 5 (-) 2

18-25 1 6 10 1

26-30 1 15 2

31-35 2 8 7 1

36-40 1 4 12 1

41-45 2 6 9 I

46-50 3 6 8 1

51-55 4 2 10 2

56-60 2 4 9 2 1
61-65 1 4 (-) 7 2 3 (-) 1
66+ 1 7 7 (-) 1 1

 

 

 

 

75

Table C.14. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Age and Food Resource Management/Shopping Behavior

 

 

 

 

 

 

 

 

 

Food Resource Negligible Low Moderate Substantial Very No
Management! Strong Change
Shopping Behavior

0-17 2 (-) 4 7

18-25 1 1 6 3 2

26-30 3 5 3 2

31-35 1 5 5 1 1

36-40 1 3 6 2 l

41.45 7 5 1

46-50 7 4 2

51-55 5 (-) 6 1 1

56-60 3 (-) 3 4 2 1

61-65 3 8 2

66+ 1 7 5

 

 

76

Table C.15. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Age and Food Safety

 

 

 

Food Safety Negligible Low Moderate Substantial Very No
Strong Change
0-17 3 (~) 4
18-25 3 3 1
26-30 2 4 1
31-35 1 4 1 1
36-40 2 1 3 1
41-45 1 2 3 1
46-50 3 (-) l 2 1
51-55 1 4 l 1
56-60 4 (-,-,-) l 1 1
61-65 1 (-) 3 (-) 2 1
66+ 3 (-) l l 2

 

 

 

 

 

 

 

 

77

Table C.16. Measurement of Behavior Change exhibited by FNP Adult Series

Participants in Terms of Age and Food Security/System Change

 

Food Security/System
Change

Negligible

Moderate

Substantial

Very
Strong

No
Change

 

0-17

18—25

26-30

31-35

36-40

41-45

46-50

51-55

56-60

61-65

 

66+

 

1 H
1 (-)

 

2 (-)

 

2 (-)

2 (-)

 

1 (-)

 

 

 

Table C.17. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Geographic Region and Dietary Quality

 

 

 

 

 

 

 

 

 

Dietary Quality Negligible Low Moderate Substantial Very No
Strong Change
North 2 5 9 2
Upper Peninsula 1 12 5
East Central 5 9 4
Southeast 1 5 10 l 1
Southwest 1 5 1 l 1

 

78

 

 

Table C.18. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Geographic Region and Food Resource
Management/Shopping Behavior

 

 

 

 

 

 

 

 

 

Food Resource Negligible Low Moderate Substantial Very No
Management/ Strong Change
Shopping Behavior

North 6 5 l 1

Upper Peninsula 1 9 3

East Central 2 6 3 1 1

Southeast 1 l 8 2 1

Southwest 1 2 7 2 1

 

Table C.19. Measurement of Behavior Change exhibited by FNP Adult Series

Participants in Terms of Geographic Region and Food Safety

 

 

 

 

 

 

 

 

 

Food Safety Negligible Low Moderate Substantial Very No
Strong Change
North 2 l 3 1
Upper Peninsula 1 4 l 1
East Central 2 4 1
Southeast 1 1 4 1
Southwest 1 3 2 1

 

79

 

 

Table C.20. Measurement of Behavior Change exhibited by FNP Adult Series
Participants in Terms of Geographic Region and Food Security/System
Change

 

Food Security/
System Change

Negligible

Low

Moderate

Substantial

Very
Strong

No
Change

 

North
Upper Peninsula
East Central

Southeast

 

Southwest

 

1 (-)

 

1 (-)
1 (-)
1 H

 

 

 

 

 

80

 

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