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8707170

N ierm a n , L in d a G ould

A LONGITUDINAL STUDY OF THE RETENTION OF FOODS AND NUTRITION
KNOWLEDGE AND PRACTICES OF PARTICIPANTS FROM THE MICHIGAN
EXPANDED FOOD AND NUTRITION EDUCATION PROGRAM

Michigan State University ,

University
Microfilms
International

Ph.D.

300 N. Zeeb Road, Ann Arbor, Ml 48106

Copyright 1986
by
Nierman, Linda Gould
All Rights Reserved

1986

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A LO NGITUDINAL STUDY OP THE RETENTION OP
FOODS A N D N UTRITION KNOWLEDGE AND PRACTICE OP
PARTICIPANTS PROM THE MICHIGAN
E XPANDED P O O D A N D NUTRITION EDUCATION PROGRAM

By
Linda Gould Nierman

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OP PHILOSOPHY

Department of Adult and Continuing Education

1986

Copyright by
LINDA GOULD NIERMAN

1986

A BS T R A C T
A L O N G I T U D I N A L S T U DY OF THE R E T E N T I O N OF FOOD S &
N U T R I T I O N K N O W L E D G E AND PRAC T IC ES OF
PA RT I C I P A N T S FR OM THE M I C H I G A N
E X P A N D E D FOO D AND N U T R I T I O N E D U C A T I O N PROGRAM
Ly
L i n d a Gould N i e r m a n

The p u rp o se of this l o n g i t ud in al study w as to
d e t er mi ne if p a r t i c i p a n t s of the M i c h i g a n Expan de d Food
and N u t r i t i o n E d u c a t i o n Program retain their improved food
and n u t r i t i o n k n o w l e d g e and p r ac ti ce five ye a r s after nine
m o nt hs of E F N E P p r o g r a m instruction.
Far e Survey,

The M ic hi ga n F a m i l y

the 24-Hour D i e ta ry Food R e c al l

(USDA score),

and EFNE P F a m i y R e c o r d are the data colle ct io n instruments
use d for this study.
P ar ti ci pa nt s
enrolled

included all ho m em a k e r s

in EFNEP,

instruction).

(n = 444) who

October t h r ou gh N o ve mb e r 1979

Post-instruction

o c c ur re d Jul y t h r o ug h October

(Time 2) data collection

1980.

Fo rt y - f i v e p a r t i c ­

ipants were inter vi ew ed July through August
follow-up

(pre-

1985 for the

(Time 5) data collection.

The M i c h i g a n F a m i l y Far e Survey

(128 points)

p i c t o r i a l a s se s s m e n t that m e a s u r e s participants'

is a
foods and

n u t r i t i o n k n o w l e d g e and food p ra c t i c e s in the categories
of nutrition,

food preparation,

food shopping,

sources of

food and n ut r it io n information,
liked
Bcore)

or diBliked.

and food p r e p a r a t i o n tasks

The 24-Hour D i e ta ry Food Recall

analyzes the participants'

diet by number of

B ervings of food in each of the four food groups.
m a x i m u m score

is 100 points.

o btains the demogr ap hi c

(USDA

The

The EFNE P F a m i l y Recor d

i n f o r m at io n on the participants.

Th e major findi ng s from this study sho w that E FN E P
p a r t i c i p a n t s 1 USD A scores and Fam il y Fare Sur ve y scores
are increased s i g n i f i c a n t l y due to E FN E P participation.
R e t e n t i o n of these change scores for five yea rs

1 b also

significant.
In summary,

this r et en ti o n study showed:

- E F N E P p a r t i ci pa nt s had

signif ic an t change on their

F a m i l y Fare and USDA scores and retained
change

this

over time.

- E F N E P p a r t i ci pa nt s who entered with a USDA score of
0 to 50 points had the most
over time,

significant

change,

and they wer e able to m a i n t a i n this

change.
- M i n o r i t y p a r t ic i pa nt s who entered wi th low USDA
scor es

(0 to 50 points)

change in scores.
the ir

had the most s ignificant

These pa rt ic ip a nt s

retained

improved scores for five years.

- A shortened EFNEP

instruc ti o n period of nine months

or less is effective in changing participants'
b e h a v i o r and practice.

food

F or Way n e Who
Persevered

ii

ACKNOWLEDGEMENTS
I would like to thank committee me mb e r b , Dr. Maxine
Ferris,

Dr. Howard Hickey,

Dr. Lawrence Lezotte,

Dr. Raymond Vlasin for their guidance,
patience,

confidence,

contributions.
a friendly,

friendship,

and

encouragement,

and positive

They were always willing to assist and had

most helpful approach,

I also wish to thank the Michigan State University,
Cooperative Extension Service,

Dr. Gordon Guyer,

Director of Extension; Dr. Wally Moline,
Extension;

and Dr. Doris Wetters,

Extension Home Economics;
Program Leader,
Agriculture,

Director of

Assistant Director of

and Nancy Leidenfrost,

SEA-Extension,

former

U.S.

EFNEP

Department of

for their support and encouragement to

complete this lengthy study.
The impetus for this study evolved from the many hours
of intense work with the Expanded Pood and Nutrition
Education Program

(EENEP) and the pleasure of observing by

firsthand experience the impact the program has on
developing self-confidence in EFNEP personnel and the
program's graduated families.

iii

Special thankB must be given to the many EFNEP program
participants and to the outstanding Michigan EFNEP Staff
of Home Economists,

Nutrition Aides,

and Supervisory Aides

w ho were most cooperative and supportive.
Accolades are also due Michigan State University
co-workers who supported my work on thiB study; to Bethany
Ledford for typing; to Micki Horst and Don Gregg, for
editing;

to Win-Jing Chung, for statistical and computer

assistance; to Henrietta Harmon, former EFNEP Supervisory
Aide, who conducted the follow-up interviews;
K end ra AnderBon,

Kim Johns,

and to

and Victoria Brady who carried

forth in my absence and gave many words of encouragement.
Special gratitude is alBO due my father, Francis
Gould;

and to Dr. Ernest Snodgrass,

Dr. Eva Goble, Beatrice Paolucci,
Kathryn Doughtery,
Dr. John Banning,
Hank Harmon,

Dr. Ester Taskerud,

Mary Frances Smith,

Beatrice Robertson,

Dona Baxter Hall,

Dr. Joel Soobitsky, Eloise Caldwell,

Kendra Anderson,

Les Nichols,

and Dr. Doris

Wetters who have made many contributions to my life and
career.
A special thanks to Gerald and Beulah Kellogg, who
watched the dog on many occasions and offered
encouragement; and to Virginia and Jo of the College of
Education,
smiles.

who always knew the answers and had pleasant

A warm thank you is also due Lois, Jeannie,

and Sandy for all the strokes and vote of confidence.

iv

Gene,

Finally, m y deepest appreciation and gratitude to my
friend and husband, Wayne, who provided constant support,
patience,

and encouragement to complete the degree.

last "but not least to the United States Congress and
the Michigan Legislature who believe enough in EFNEP to
continue its support.

Flint, Michigan

Linda Nierman

1986

v

FORWARD

Former evaluations of EFNEP have provided increased
evidence regarding the program's influence on program
participants and program staff;

however, very few long­

term longitudinal studies have been completed.

This study

addresses the retention of foods and nutrition knowledge
and practice five years after program participation and
provides the beginning framework for future retention
studies as program operation, program management and
program Instruction change.
The completion of this study was made possible by the
cooperation,

support, and encouragement of the EFNEP

Extension Home Economists,

the EFNEP Nutrition Aides, and

the EFNEP Supervisory Aides.

vi

TAB LE OP CONTENTS

D E D I C A T I O N ....................................................

ii

AC K N O W L E D G E M E N T S ..............................................ill
F O R W A R D ........................................................

vi

LIS T OP T A B L E S ...............................................

ix

LIS T OP A P P E N D I C E S ............................................xii
C HAPT ER
I.

I N T R O D U C T I O N ..........*..... * ..... * ..............

1

S ta te me nt of the Problem
Objectives of the Study
Hypotheses
R a t i o n a l e for the Study
F ootn ot es
II.

SELECTED REVIEW OP L I T E R A T U R E ....................19
I nt ro du ct io n
Related L it er a t u r e and Theories of
A du l t L e a r n i n g
M e t h o d o l o g y for Adult Educa t io n
Concepts for Adult L ea r n i n g
E x pa nd ed Pood and N u tr it io n E d uc a t i o n
Program Studies
Summ a ry
Foot n ot es

III.

M E T H O D O L O G Y ......................................... 52
The Setti ng
P op ul at io n
R e s e a r c h Design
P rocedures
P op ul at io n and Sample
I ns t r u m e n t a t i o n
C o l l e c t i o n of Data
Tr ea t m e n t of D a t a
As su mp ti on s
Li m i t a t i o n s of the Study
Sum ma ry
Footn o te s
vil

IV.

13

FINDINGS
Overview
C h a r a c t e r i s t i c s of the P op ul at io n
Sample
Hypotheses
P re s e n t a t i o n of the Find i ng s

V.

S U M M A R Y , CONCLUSIONS,

AND R E C O M M E N D A T I O N S

128

P u r po se of the Stud y
O bj ec t i v e s of the Study
S u m ma ry of P r oc ed ur e
S u m ma ry of Majo r F in d i n g s
C on cl u s i o n s and Implications
Im p l i c a t i o n s for F ut u r e Rese ar ch
Reflections
B I B L I O G R A P H Y .................................................. 140
A P P E N D I C E S .................................................... 1 45
A.
B.
C.
D.
E.

Fami ly Recor d
24-Hour Diet ar y Food Recall
M i c h i g a n E F N E P F a m i l y Fare Survey
Quest io ns
M i c h i g a n EFN EP Famil y Fare Survey
Q ue st i o n n a i r e Pictures
S c o r i n g Table for 24-Hour D i e t a r y
Foo d Recall

viii

LIST OP TABLES

1.

Characteristics of the Population Sample

2.

Characteristics of Participants Total S a m p l e ........ 77

5.

Mean and Percentage Change of Family Fare
Survey ScoreB (n = 3 99 ) * ............................... 80

4*

Mean and Percentage Change of TJSDA Scores
Cn = 3 9 9 ) ................................................ 81

5.

Mean Change of Family Fare Survey Scores
(n s 4 5 ) ....................................... * .........82

6.

Mean Scores of USDA Survey

7.

Percentage Change of Family Fare Survey Scores
(n - 4 5 ) ................................................. 84

8.

Percentage Change of USDA Survey Scores
(n = 4 5 ) ................................................. 85

9.

t-test on the Family Fare Score between High
USDA Score Group and Low USDA Score Group Measured
at
, and Tg
(n = 3 9 9 ) ............................... 87

10.

t -test on the USDA Score between High USDA
Score Group and low USDA Score Group Measured
at
i and Tg
(n = 3 9 9 ) ............................... 88

11.

t-test on the Family Fare Score between High
USDA Score Group and Low USDA Score Group Measured
at Tj, Tg* ana
(n = 4 5 ) ............................ 90

12.

t-test on the
USDA Score
between High USDA
Score
Group and Low
USDA Score
Group Measured at
T, f
T 2 , and T 5 (n = 4 5 ) ............................J ...... 91

13*

ANOVA Test on the Average Family Fare Scores
Measured at T^ and Tg (n = 3 9 9 ) ............*......... 93

14*

ANOVA Test on the Average USDA Score Measured
at T^ and Tg (n = 399)**
............................ 94

15-

ANOVA Test on the Average Family Fare Scores
Measured at
, Tg, and T^ (n = 4 5 ) .................. 95
ix

........... 58

(n = 4 5 ) ........* .........83

ANOVA Test on the A v e r a g e USDA Scores
,
M e as ur ed at Tg, an^
Tn = 4 5 ) ...................

96

P ercen ta ge Change of USDA and F a mi l y Fare Scores
b e t w e e n T^ and Tg (n “ 3 9 9 ) ..................... »*•

102

Perce n ta ge Change of USD A and F a mi ly Fare Scores
b e t w e e n T, and T 0 by Selected Demog r ap hi cs

(n = 4 5 ) . ! ........... ? ................................................................

104

P ercen ta ge Change of USDA and F a mi l y Fare Scores
b e t w e e n T„ and T, by Selected Demogr a ph ic s

(n = 4 5 ) . ? ........... ? ................................................................

105

P ercen ta ge Change
B e t w e e n T^ and T^

106

of USDA and F a mi ly Fare
(n = 4 5 ) .........................

C o r r e l a t i o n b e tw ee n USDA Score and F a m i l y Fare
S c o r e ..................... * .......................

108

Grand M e a n of C o mp os it e USDA Score and F a m i l y
F a r e Score b y T 1 , T p , and T, (n = 399 and
n = 4 5 ) ........ ......................................

109

P ercen ta ge Change
of Comp os i te USDA Score and
F a m i l y Far e Score
by T 1 , T-, and T,
(n = 399 and n = 4 5 ) • • J
• ....... ................

110

MANOVA Test on the USDA and F a m il y Fare Score
Di ff e r e n c e by M a j o r i t y and M i n o r i t y Ethnic Group
M e as ur ed at T^ and Tg (n = 3 9 9 ) . . . ..... ..........

112

MANOVA Test on the USDA and F a m il y Fare Score
D i f f e r e n c e b e t w e e n Foo d Stamp and No n - F o o d Stamp
Gro u p at T^ and Tg (n = 3 9 9 ) ......................

113

MANOVA Test on USDA and F a m i l y Fa re Score
D i f f e r e n c e B e t w e e n WIC and non-WIC Gro up at
T 1 and Tg (n = 3 9 9 ) ........ ........................

114

MANOVA Test on the USDA and F a m il y Fare Score
D i f f e r e n c e B e t w e e n Different Age Groups at T 1
and Tg (n - 3 9 9 ) ............ ........................

115

MANOVA Test on the USDA and F a m il y Fare Score
D i f f e r e n c e b e t w e e n D if f e r e n t E d u c a t i o n a l Bevels
at T^ and Tg (n = 3 9 9 ) ..............................

117

x

29.

MANOVA Test on the USDA and Family Fare Score
Difference Between Number of Children at T 1 ,
T 1 , and T^ (n = 3 9 9 ) ..................... - ........... 118

30.

MANOVA Test on the USDA
and Family Fare Score
Difference Between Number of Instructional
Visits at T^ and Tg (n = 3 9 9 ) ........................ 119

31.

MANOVA Test on the USDA Family Fare Score
Difference by Majority and Minority Ethnic
Group Measured at T ^ , Tg, and T^ (n = 4 5 ) ........ ...120

32.

MANOVA Test on the USDA
and Family Fare Score
Difference Between Food Stamp and Non-Food Stamp
Group at T^ , Tg, and T^ (n = 4 5 ) .................... 121

33.

MANOVA Test on the USDA
and Family Fare Score
Difference Between VIC and Non-WIC
Group
T.j, Tg, and T^ (n = 4 5 ) . . . . . . ........................ 122

34.

MANOVA Test on the USDA
and Family Fare Score
Difference Between Different Age Groups at T . ,
Tg, and T^ (n = 4 5 ) ................................... 124

35.

36.

37.

MANOVA Test on the USDA and Family Fare Score
Difference Between Educational levels T. , T ? ,
and T^ (n = 4 5 ) .......................

125

MANOVA Test on the USDA and Family Fare Score
Difference Between Number of Children at T . ,
Tg, T ? (n = 4 5 ) ........................... I ........... 126
MANOVA Test on the USDA
and Family Fare Score
Difference Between Different Number of Visits
at T^ , Tg, and T^ (n = 4 5 ) ................

xi

..127

LIST OF APPENDICES

A.

Family Record,

ES # 2 5 5 ................................. 145

B.

24 Hour Dietary Food

Recall F o r m .........

C.

Michigan Family Fare

Survey Q u e a t i o n n a i r e .

D.

Michigan Family Fare

Survey P i c t u r e s

E.

Scoring System for 24 Hour Food R e c a l l ...............197

xii

146
....... 147
..........155

CHAPTER 1

INTRODUCTION

A m e ri ca was shaken with a new revelation in the
1960s.

This revelation was poverty and malnutrition.

A

b o om in g postwar economy had lulled Americans into assuming
that abject poverty and hunger died with the depression of
the 1930s.

The reality was that hunger and poverty did in

fact exist in these United States.
Eor the first time in this nation's history,

attempts

w ere made to define and measure economic hardship.
official poverty measure...

"The

judged each member of a family

to be poor if the family had pretax cash income less than
three times the cost of a nutritionally adequate but
minimum diet."^
During the early 1960s thiB nation's Cooperative
Extension Service

(CES) initiated pilot projects to

provide specially designed education for low-income
homemakers.

The original pilot occurred in Alabama.

Other later pilot projects were conducted
Texas,

Massachusetts,

and Missouri.

in Rhode Island,

These pilot projects

demonstrated that low-income participants could change
their food behavior patterns and that paraprofessionals
could be trained to teach low-income homemakers

1

2

effectively.

It appeared that the low-income homemakers

had to he taught with nontraditional approaches since they
did not attend meetings,
or publications,
resources.

did not regularly read newspapers

and were not in contact with community

In addition,

speak or write English.

some of the homemakers could not
Work with low-income homemakers

required special and intensive educational approaches.
Ihese approaches included visits to the home,

simple but

practical ideas for food preparation and food safety,
well as practical ideas for clothing construction,

as

repair,

and practical ideas on how to meet other basic family
2
needs.
Dur in g the 1960s the nation's media reported examples
of poverty and hunger everywhere.
hunger, malnutrition,

and

It became evident that

starvation were not reserved

for specific regions of the country.
blacks,

Hispanics,

and American Indians; it occurred in

the cities and the rural areas.
ages.

It affected whites,

It affected people of all

It waB everywhere.

While the existence of poverty and hunger was
pervasive,

two general conclusions were inescapable:

- Several million Americans were living at or below the
p overty level
- Children and adultB in low-income families were
suffering from inadequate nutrition and sometimes
severe malnutrition

3

It is in this context that the Extension Home
Economics,

Expanded Pood and Nutrition Education Program

(EFNEP) was designed,
Congress.

proposed,

and funded by the U.S.

EFNEP was created to address the following

situation:

It was unden ia b ly true that many low-income
families were malnourished Bimply because there
was insufficient food.
In addition, many of
the families lacked a knowledge about the
importance of nutrition and its relation to
health.
Thus, even with access to food,
m a lnutrition often occurred because of a poorly
balanced diet.
Those families most likely to be malnourished
w e r e also likely to be isolated from sources of
information and assistance in foods and
nutrition.
In rural areas, the Isolation was
mainly geographic.
In cities, low-income
families were cut off from educational
opportunities by the high-crime areaB ringing
the urban slums.
Existing educational institutions were largely
a product of mainstream American society.
W hil e possessing great technical skills and
resources, they maintained no explicit lines of
communication with poverty families.
Their
educational capabilities could not, therefore,
be focused directly on the nutritional needs of
the poor.

These conditions suggested some important objectives
for the designers of the new CES,
Economics,
thrust.

Extension Home

Expanded Food and Nutrition Education Program

These objectives were:
1.

To develop and implement a food and
nutrition education program tailored
specifically to the needs of the poor.

4
2.

To help low-income families, especially
those with young children, to acquire the
knowledge, Bkills, attitudes, and changed
behaviors necessary to improve their diets.

3.

To deliver the food and nutrition education
directly to the low-income audience by
employing, training, and supervising
paraprofessional Nutrition Aides.
These
AideB would be indigenous to the communities
in which they would be working, and would
w ork with families in a one-to-one setting
or in small groups.

The Cooperative Extension Service presented a good
organizational situation for the new Expanded Food and
Nutrition Education Program
educational,

technical,

networking the U.S.

(EFNEP).

The existing

and administrative capabilities

Department of Agriculture,

nation's land grant universities and U.S.

through the

counties, was a

ready-made organization which could allow the program to
function.

Hence EFNEP was organized and initiated

November 1968 within the national,

state,

Cooperative Extension Service framework.

in

and county
Operations to

implement a nutrition education program designed to reach
low-income families began in early 1969EFNEP program management responsibility is shared at
these levels:
EFNEP leadership at the national level has
overall responsibilities for monitoring and
evaluating the nationwide program.
It also
provides administrative and technical support
to coordinate interstate program activities and
to implement federally mandated procedures.

5
State Cooperative Extension Services (CES)
provide second-line administrative control for
EFNEP.
CES Program Coordinators provide
overall and/or delegated leadership for
coordination and management of EFNEP within
the States.
CES Pood and Nutrition Specialists
prepare training and resource materials in
nutrition and nutrition-related subject matter
which serve the needs of unit-level program
professionals, p a r a p r o f e ss io na l s, volunteers
and participants.
County Cooperative Extension Service EPNEP
personnel are the backbone of EPNEP, since it
is at the county level that contact with the
low-income clientele occurs.
Professional Home
E conomists have direct responsibility for the
successful operation of local/county EPNEP
units.
Home Economists train and supervise the
paraprofeBsional staff who are generally
indigenous to the geographic area in which they
w o r k and who teach low-income homemakers and
youth directly.
In addition, volunteers are
recruited to work with both adults and 4-H
youth.

The program structure and program operations are well
7
documented.
Of greater importance are the studies that
have been conducted to address program impact or effects
of the program with the target audience.

These early

studies are preliminary to this study.
In the 1979 U.S.

Department of Agriculture "Historical

and Statistical Profile of the EPNEP Program," it is
reported that:

The impact of EPNEP is demonstrated in a
variety of ways.
Throughout the course of the
Program, EPNEP management has sponsored a
number of national studies to assess the impact
of EPNEP on its audience.
There have also been

6
a number of State and local studies performed
by local CES groups, candidates for advanced
degrees, and by other agencies and org an ­
izations with an interest in the aims and goals
of EPNEP.
lastly, there is the EPNEP Reporting
SyBtera which provides National, State, and
County EPNEP administrative personnel with a
continuing source of dgta on the status and
trendB in the Program.

Historically the program has been evaluated by
analyzing changes in food consumption practices of the
enrolled homemaker,

vi a 24-Hour Dietary Pood Recalls taken

at entry and every six months thereafter until graduation
from the program.

The progression rate of homemakers

enrolled in the program may be influenced by factors such
as initial nutritional knowledge,
preparation,

interest in food

food shopping and food safety practices,

socio-economic conditions of the family,

and recent family

events.
Past research has evaluated the impact of the EPNEP by
interviewing homemakers and repeating the dietary
assessment twelve to twenty-four months after particip ati on in the program.

9

Other studies,

/ \
(a) have

compared the cost-benefit of the program based on the
required length of h o m e m a k e r s ' program participation to
achieve dietary c h a n g e s ; ^

(b) have examined the impact

of a basic nutrition education curriculum on length of
enrollment

11

and on dietary change scoresj and

(c) have

analyzed various teaching methods so that the enrollment

7

period could be shortened and more participants could be
r e a c h e d .^ ^
No studieB have been undertaken to determine whether
participants retain their improved nutrition Btatus for
longer

(more than 38 months) periods of time.

It is the

longer term longitudinal consequence that this Btudy
addresses along with the nature of the curriculum; the
method of instruction;

and the future potential of the

program.

Statement of the Problem
The purpose of the Btudy was to determine if
participants of the Michigan Expanded Food and Nutrition
Education Program retain their improved food and nutrition
knowledge and practice change scores five years after
program participation.

Objectives of the Study
This study is a report of an analysis of the retention
of food and nutrition knowledge and practices of
participants from the Michigan Expanded Food and Nutrition
Education Program.
three times:

Program participants were tested at

(1) Time 1: upon entry into the program

(pre-instruction);

(2) Time 2: upon leaving the program;

8

and

(3) Time 3:

five years after completion of the

instructional program

(follow-up).

The Btudy objectives

were:
1.

To compare participants'

24-Hour Dietary Pood

Recall scores at Time 1 f Time 2, and Time 3 and to
analyze the effect of selected demographic
c h ar ac t e r i s t i c s .
2.

To compare participants' Michigan Family Fare
Survey scores at Time 1, Time 2, and Time 3 and to
analyze the effect of selected demographic
characteristics.

3-

To interpet analyses of results and make recom­
mendations to USDA Cooperative Extension Service
leadership,

State legislators and the U.S.

Congress regarding the long-term impact of the
Michigan Expanded Food and Nutrition Education
Program on participants'

retention of improved

food knowledge and practices.

Hypothesis
The research hypotheses for this Btudy were:
1.

Participants will exhibit improved scores from
pre-instruction to post-instruction as measured by
the 24-Hour Dietary Food Recall
Michigan Family Fare Survey.

(USDA Score) and

9

2.

Participants who exhibit improved scores from preinstruction to post-instruction will retain their
post-instruction score at follow-up five years
later.

3.

Participant scores over time from poBt-instruction
to the follow-up survey will be retained and not
influenced by selected demographics.

Need for the Study
Federally-funded and state-funded programs that
provide nutrition

information and education to the poor

are being subjected to both increased scrutiny and fiscal
constraints.

Therefore it becomes increasingly important

to provide solid research data to increase the

public's

understanding of successful programs that serve this
clientele and to demonstrate how these successful programs
influence low-income families to change.

From its

beginning in 1969* the Expanded Food and Nutrition
Education Program has focused on nontraditional methods of
reaching and educating the low income homemakers.
In 1978 the Comptroller General of the U.S.

reported

to the U.S. Congress that the Federal Government was
spending $73 to $117 million annually on human nutrition
research.

The report indicated that "Comprehensive,

consolidated information on Federal Human Nutrition

10

R esearch activity is lacking; no department or agency has
human nutrition as its primary mission."

13

The report

also noted that advancement in nutrition was fundamental
in improving human health,
knowledge,

examined the gaps in nutrition

and discussed changes needed to facilitate

progress. 14
^
From the list of many recommendations made by the
General Accounting Office of the United States,

the first

recommendations emphasized research needs for responding
to human nutrition knowledge gapB.

These recommendations

included the need for:
- Long-term studies of human subjects across the full
range of both health and disease;
- Comparative studies in populations of different
geographic,

cultural,

and genetic backgrounds.

15

The report went on to state that human nutrition
research haB traditionally concerned itself with
identifying essential nutrients,
nutrients in the body,
that "good nutrition"

defining the role of

and preventing diseases.

It stated

iB assumed and that studies are

needed to reflect relationships between nutritional status
at one period of life to

nutritional status and health in

later periods of l i f e . ^
This longitudinal five-year study is an attempt to
respond to some of the General Accounting Office's
recommendations about needed research,

especially focusing

on participant's change Bcores as the unit of analysis.

11

Rationale for the Study
The United States Congress funds several nutrition
programs to provide food for low-income famlies; however,
EPNEP is the only federally funded nutrition program that
provides education to low-income families with young
children.

Participation in the EFNEP is expected to

result in:
- Improved dietB and nutritional welfare for the total
family
- Increased knowledge of the essentials of human
nutrition
- Increased ability to select and buy food that
satisfies nutritional needs
- Improved practices in food production,
storage,

safety,

preparation,

and sanitation

- Increased ability to manage food budgets and related
resources such as.food stamps

EFNEP targets food and nutrition programming to reach
two primary low-income audience segments:

adult and

youth.

Adult:

Low-income homemakers or Individuals with
y o u ng children who are responsible for
planning and preparing food for their
families.

12

Youth:

Low-income youth,

from enrolled EPNEP

families, who are eligible for 4-H Youth
programs.

Traditionally,
in Home Economics,

Cooperative Extension Service programs
Agriculture,

and 4-H Youth Education

have helped rural families "to help themselves" by
providing the most recent "how to"

information to improve

the f a m i l i e s ’ economic and social well being.
In the beginning,

families served by the Cooperative

Extension Service were primarily rural.

Over time,

has expanded its audience to include rural, urban,
suburban families.

CES
and

The Cooperative Extension Service as

an agency of the United States Department of Agriculture
and the State Land Grant Institutions in cooperation with
local units of government,
information,

has assisted many families with

demonstrations,

educational seminars,

and

research in BOlving many of the social and economic
problems facing families.

EPNEP wa s created because of

the intense interest of the U.S.

Congress and the American

public in the plight of the low-income family without
food.
Although the U.S.

diet is generally good, nutritional

problems still exist within various segments of the
population.

Malnutrition is fast becoming a primary

health problem.

17

At the same time,

federal and Btate

13

p r o g r a m s that p r o vi de inform at io n and assis ta n ce to the
poor are b e i n g subjected to bo th increased scrutiny and
f i s ca l constraints.

Therefore,

it b e co me s in creasingly

important to p r o vi de information:

(a) to increase the

p u b l i c 'b u n d e r s t a n d i n g of programs that serve this
c lientele and

(b) to hel p resear ch e rs and other E x t e n s i o n

S t a f f t o u n d e r s t a n d how these programs

influence families

to change.
F e de ra l food p ro g r a m s such as Food Stamps,
foods,

s up p l e m e n t a l f e e d i n g programs

school lunch,
However,

and school breakfast,

c om mo d it y

(WIC/Focus Hope),
are in operation.

the p r o gr a ms may not hav e p r im a ry n ut r it io n

e d u c a t i o n as the ir p r im ar y focus.

Feaster

(1972)

conducted a study for the USDA that showed that
i ndivid ua ls

re ce i v i n g food stamps still had nutrition

p r ob le ms even though they had used food stamp
vouchers.

18

to select,

The q u e st io n became:

Do families k n o w how

use and serve n u t r i ti on al food?

Could part of

th e m a l n u t r i t i o n p r o bl em be a refle ct io n of the need for
n u t r i t i o n education?
The role of the F e d e r a l government

in nutrition

e du c a t i o n is limited and w i t h o u t formal c o o r d in at io n since
m a j o r food and n ut r i t i o n p r o g ra ms are administered by the
U n i te d States Depart me nt
Health,

of Agriculture,

and the Depar tm en t

n u mb er of thes e p r o gr am s

of Education.

the Depart m en t
A very limited

include an ev al ua t i o n component

of

14

-bo assess their impact on m odifying food consumption and
food behavior practices of participants over time.
exception to this is the USDA,
Educa ti on Program.

(An

Expanded Pood and Nutrition

EPNEP does have evaluation data on the

program's effectiveness in modifying low income
participants food consumption and food behavior
practices.)
This limited evaluation of the impact of nutrition
education has resulted

in a lack of understanding of

nutrition education's potential worth.

However,

assessment of the impact of any program's effectiveness
requires recognized and acceptable measures.
One nutrition education effectiveness measure used
frequently is the 24-Hour Dietary Pood Recall, which is a
record of an individual's food consumption within one
twenty-four hour period.

The 24-Hour Dietary Pood Recall

originated in dietary research when aggegated data were
needed to represent community or subpopulationB.
Current dietary standards are called the Recommended
D ietary Allowance

(RDA),

established by the National

A cade my of Science of the National Research Council.
RDAs are used as a guide for the best estimates of the
nutrients needed by a person on a daily basis.
Twenty-four Hour Dietary Pood Recall results may be
converted to nutrients and compared to this standard.

The

15

Ab bo t t and L ev in so n p r o v id ed a s u m m ar y of criteria
that should be consid er ed in a s s e s s i n g the r elevance and
relative ef fe c t i v e n e s s

of a n u t r i t i o n education

program. 19

1.

M a i n t e n a n c e . . .a su cc es s f u l program should be
defined as one capable of m a i n t a i n i n g its effect.
A m a s si ve

"one-shot"

n u t r i t i o n educ a ti on program

r e s u l t i n g in si g n i f i c a n t short term change,

for

example, but h a v i n g no lasting benefit woul d not
be considered

2.

successful.

Coverage and R e p l i c a b i l i t y . . .the u l ti m at e need 1 b
for pr o g r a m s w i t h larger scale impact and
a ct iv i t i e s that lend themse lv e s to broad

coverage,

and to r ep li c a b i l i t y b e yo nd pilot stage.

3*

Speed of I m p l e m e n t a t i o n . ..the problems are u s u a l l y
i mmedi at e and

"time lost means op p ortunities

f o r e g o n e to reach clientele who otherwise woul d
not b e reached."

4.

F e a s i b i l i t y C o n s t r a i n t s ...many interventions
require

resources

(such as skilled manpower)

are in Bhort supply,
addressed

that

such constraints must be

in the d es i g n and selection of programs

and activities.

16

5.

Political A c c e p t a b i l i t y .. .the final acceptance of
any program muBt be made in the context of
conflicting interests and varying evaluations of
the outcome of any approach.

Many times political

considerations outweigh economic efficiency.
Visab il it y of a program may be more important than
the long run impact of the intervention.

Information gained from this study ma y be applied to
other adult education programs that reach similar
clientele.

The study is organized and presented so that

Chapter II provides a selected

review of the literature

related to adult learning and a summary of some of the
long term EFNEP studies.

Chapter II highlights the

m e thodology for the study and Chapter IV presents the
findings of the study; Chapter V provides the results of
the Study and the implications for future research.

17

Footnotes
i
Congressional Budget Office, "Reducing Poverty
A m o n g Children" (The Congress of the United States, May
1985) p. xii.
?
USDA Extension Service, "An Assessment of the
Objectives, Implementation and Effectiveness of the Adult
Expanded Food and Nutrition Education Program" (Technical
Summary), (USDA Service and Education, Washington D.C.,
D ecember 1981), para. 3.0.
•j.
^USDA Science and Education Administration,
"The Expanded Food and Nutrition Education Program - A
Historical and Statistical Profile," (Program Aid No. 20),
pp. 2-3.
4Ibid.

p. 3.

5Ibid.
6Ibid. p.
7Ibid.

pp.

8 Ibid. p.

9.
10-26.
29.

q

M. Kerr, L. Nierman, M. Andrews, "Evaluation
of the Long Term Effects of the Expanded Food and
N ut ri ti on Education Program in Michigan" (Final Report,
M i c h g a n State University), June 1979^®T. Tate, "The Role and Status of CoBtEffectiveness Analysis in Federally Funded Nutrition
E d u ca ti on Programs in U.S.," Master Thesis, (M.S.
Research, Massachusetts Institute of Technology, 1965*
^ 1 . Nierman, et. al., "You Too Can Participate
in EFNEP," (Final Report, Michigan State University
Cooperative Extension Service: Project Number
12-05-300-456), February 1982.

18
S.
Walker, L. Nierman, K. Akpom, "EffectivelyTeaching Foods and Nutrition to Low Income F a m i l i e s ,"
(Michigan State University, Cooperative Extension
Service:
Cooperative Agreement 12-05-300-548), August
1983.
13
Comptroller General, Government Accounting
Office, "Federal Human Nutrition Research NeedB a
Coordinated Approach to Advance Nutrition Knowledge,"
Report to the Congress of the United StateB. (Volume I,
PSAD - 77-156, March 28, 1978), p. i.
14Ihia.
15Ibid.,

pp.

14-15.

16Ihid.,

pp.

30-33.

17
'Physician TaBk Force on Hunger in America,
"Hunger Counties 1986 - The Distribution of America's High
Rise Areas, (Harold University School of Public Health,
January 1986), pp. 3-6.
1 ft
G. Feaster, "Impact of the Expanded Food and
Nutri ti on Education Program on Low Income Families:
An
Indepth Analysis," (USDA Agriculture Research Service
Report 0220) t 1972.

19

P.C. Abbott and F.J. Levinson, "Assessing
Alternatives Nutrition Strategies:
An Application of
Cost-Effectiveness Analysis,"
Cambridge, MA;
Massachusetts Institute of T e c h n o l o g y ; International
N u t ri ti on Planning Program, 1974.

CHAPTER II
SELECTED REVIEW OF LITERATURE
Introduction
Beginning with its inception in 1969,

the Cooperative

E xtension Service's Expanded Pood and Nutrition Education
Program

(EFNEP) mandate was to focus on the low-income

population.

Unlike other poverty relief programs that

place money or physical goods in the hands of the poor,
EPNEP's intervention was nutrition education.

Given that

malnutrition was a severe problem in the poverty
population,

the U.S.

Congress decided that new modes of

educational delivery should be devised.

First,

the

education would have to be taken to the participant since
the participant would not seek out information from
traditional Cooperative Extension Service programs.
Second, low-income participants would not seek out
information from trained professionals and in moBt cases
the professional could not relate well to the
participants'
conditions.

economic,

Bocial,

and environmental

A new paraprofessional position,

the

Nutrition Aide, was created by the CES to carry basic
nutrition instruction into the homes of low-income
families.
The value of paraprofessionalB has been conclusively

19

20

p r o v e n in the last tw en t y years.^
Reissman,

A c c o r d i n g to

"indigenous pe o p l e have the same Bocial

background,

the same a ttitudes and values aB we l l as a

f amiliar p a t te rn of l a ng ua ge to f acilitate their
c o m m u n i c a t i o n w i t h people n e e di ng p r o f e s si o na l
services.
Since E F N EP 's inception,

national,

state,

studies hav e eval ua te d the ef fe c ti ve ne ss

and local

of the

p r o gr am s *delivery m e t h o d s and impact on partici pa nt s
d i et ar y adequacy.

Since this Btudy looks at the r e te nt i on

of foods and n u t r i t i o n k n o w l e d g e and practice
n e ce s s a r y to review adult l e a rn in g theory,

it was

educational

wor k w i t h the d is a d v a n t a g e d and studies that have focused
on the ef fe c t i v e n e s s of EFNEP.
This review wi ll
p a r t i c i pa nt s

relate to the t e a ch in g of EFNEP

in their home l e a rn in g environment.

focus will be on how adults learn,

The

the setting neces sa ry

fo r the d i f fu s io n and adoption of new practices,

and

f i na ll y the t e a c h i n g fr am e w o r k that must be remembered by
the instructor

or N u t r i t i o n Aide as they teach this

audience.
E FN E P ev al u a t i o n studies reviewed for ths study
p r i m a r i l y will focus on m e a s u r i n g the long term impact of
p a r t i c i p a t i o n in EFNEP.
wa s the maj or

The 24-Hour Dietary Food R e ca ll

instrument used

the p r o g r a m ’s effectiveness.

in these studies to mea su r e
The studies were selected

21

since they provide historical information on EPNEP program
evaluation,

over time,

and describe length of program

participation before the evaluation was completed.

Related Literature and Theories of Adult Learning
In undertaking a study of knowledge and skill
retention it is appropriate to review perspectives that
relate to adult learning and also the methodology for
adult education.

In working with the disadvantaged it is

apparent that the greatest learning comes from "learning
by doing" with others like oneself.

EPNEP provides that

special learning environment.
Human development depends upon the dual factors of
physical growth and learning.

The factors influencing

growth are basically genetically determined.

The factors

influencing learning are chiefly determined by the events
in the person's living environment,

including family

environment,

school environment,
5

community environment,

and the various social environments.

Learning is often defined as "changed behavior."

If a

change Is to take place in a learner's behavior the
learner must be able to do more than k n o w some new
information.
us e it.4

The learner must be able to understand and

"Learning by doing" becomes a cornerstone.

According to Gagne, learning is defined as, a change

22

in human disposition or capability,

which can be retained,

and which is simply ascribable to the process of growth.
He further maintains that "...learning exhibits itself as
a change in behavior and the influence of learning is made
by comparing what behavior was possible before the
individual was placed

in a

'learning situation'

and what

behavior can be exhibited after such treatment."
Acquisition of skills and knowledge are the typical
form of content for the "learning situation;" however,
other varieties of interaction,
persuasion,

which include motivation,

and the development of attitudes and values,

are of tremendous importance to learning.

It is not

clear how to continue the process of learning to its
maximum.^
Motiv at io n for adult learning begins with what people
feel they want.

Houle defines need as:

"...a condition or

situation in which something necessary or desirable
required or wanted.

is

A need may be perceived by a person

or persons possessing it (when it may be called a felt
need)

or by some observer

(when it may be called an

7

ascribed need)."
Many classifications of need can be found in the
literature.

Maslow maintains that people are motivated

with in a hierarchy of needs,

and once their basic needs

are satisfied, people begin to seek the next higher level
of need.

In ascending order, M s b I o w states that these

23

needs are:

physiological needs,

safety needs, love and

0
affection,

esteem, and self-actualization.

According

to Maslow, with the gratification or fulfillment of a
hasic need, people set new goals.
developed

Objectives are

in a hierarchy and represent fundamental

knowledge within which the educator must Belect suitable
information to design learning experiences.
Harry Miller explains why socioeconomic status and
participation in adult education are related.

M i l l e r ’s

Social Class Theory builds on M a s l o w rs Hierarchy of Needs
Theory to explain why people participate in education
programs and why there are large differences in what
people hope to attain from participation.

Maslow's theory

explains why low-income people are primarily interested

in

education to meet basic survival needs, while persons of
higher economic levels seek education to fulfill
q
achievement needs and self- actualization.
Roger Boshier's conclusion of non-participation is
that,

"both adult education participation and

non-participation occur due to the discrepancy between the
participant's Belf-concept and the key aspects of the
educational environment.

Non-participants manifest

self-institutional incongruence and do not enroll."

10

Boshier suggests that incongruencies between Belf and
ideal self,

Belf and other students,

self and teacher,

self and the institutional environment may lead to
n on-par t i c i pat i o n .

and

24

M ethodology for Adult Education
Patricia Cross suggests that educators designing adult
learning opportunities for people with low self-confidence
Bhould create learning opportunities that have low levels
of risk.

Cross believes that self-directed learning

projects can be most effective since learners have
complete control over the situation.

Cross states,

"...they can gauge the learning tasks to levels of
achievement with which they feel comfortable; they can
expose themselves to the queries of others on topics of
their own choosing; and they can retreat or withdraw from
any task at any t i m e . " ^
Cross submits that there are pessimists and optimists
regarding current theories of adult learning.

She

contends that Knowles is being optimistic regarding the
elements of adult learning-theory Bince most of the
elements have been discovered.
that "androgogy"

Furthermore,

she asserts

is the "unifying theory" that can provide

the "glue to bind the diverse institutions,
activities into some sense of unity"

12

clients,

and

Cross thinks

Miller is more pessimistic since Miller believes that we
are not ready for any advanced activity in adult education
theory.^ ^
Houle was probably the most realistic when he made the
following observation:

25
It cannot "be said that most of the work in the field
is guided by any...system or even by the desire to
follow a systematic theory.
The typical career
worker in adult education is still concerned with an
institutional pattern of service or a methodology,
seldom or never catching a glimpse of the total
terrain of which he is cultivating one corner, and
content to be, for example, a farm or home advisor,
museum creator, public librarian, or institutional
trainer.

Androgogy is an old word popularized by Malcom
Knowles.

Knowles defines androgogy b b

"the art and

science of helping adults learn" and contrasts it with
pedagogy,
learn.

15

which is concerned with helping children to
According to Knowles,

androgogy is based on

four assumptions about characteristics of adultB that
are different from characteristics of child learners.

These assumptions are that as a person matures,
(1) his self-concept moves to one of being a self­
directed human being, (2) he accumulates a growing
reservoir of experience that becomes an increasing
resource for learning, (5) his readiness to learn
b ecomes oriented increasingly to the developmental
tasks of his social roles, and (4) his time
perspective changes from one of postponed appli­
cation of knowledge to immediacy of application, and
accordingly his orientation toward learning shiftB
from one of By^ject centeredness to one of problem
centeredness.

While there are additional humanistic,

developmental,

and behavioral theories that undoubtedly contribute to
understanding the conditions for learning, those presented
are pertinent to the population of this study.

In

applying the theories of this chapter to the low-income
population in the study it appears that the

readiness for

26

l e a rn in g of the po p ul a t i o n members

is p ro b lem-centered.

V e r y few lo w- i n c o m e families call to enroll
program.

in the E P N E P

Most are referred to the p r o gr am by a friend,

social worker,

minister,

or food bank volunteer.

Prospe ct iv e p a r t i ci pa nt s are a tt em pt i ng to resolve their
immediate d i l em ma of h ow to feed their families w i t h
limited resources.

C on ce pt s of Adult Le a r n i n g
B e h a v i o r a l change
infor m at io n to people.

is facil it at ed by p r ov id in g
Individ ua ls must be aware that

e x is ti ng b e h a v i o r a l patterns may be di sf un ct i on al if they
are to consi de r a d o p t i n g new m o d e s

of behavior.

Boh le n

argues that in the d iffusion and a d o pt io n process,

people

mu s t be aware of the need for change and be provided
infor ma ti on about the proposed
can be given to adoption.

17

change before c o n s i de ra ti on

E P N E P provides an

o p p o r t u n i t y for fami li e s to become aware of a lternative
food and n u t r i t i o n choices.

These choices assist the

f a m il y to meet a felt need thus e n c o u ra gi n g adoption of
the new practices.
D i f fu si on and adop ti on rese ar c h

(Rogers and Shoemaker)

has demonstrated that awareness often takes place far in
a d v a n c e of adoption.
states that,

The t h e or y of c o gn it iv e dissonance

w h e n a p e rs o n is introduced to new

27

in f o r m a t i o n that is inconsistent w i t h internalized
"behavior p at t e r n s p r e s e n t l y held,
emerges.

1R

a conflict situation

F e s t i n g e r submits that a person wi ll strive

t o reduce the dissonance by r e c o n c il in g one b e li e f wi t h
t he o p po si ng one; however,

the method

c og n i t i v e di ss on a n c e varies with

of reducing

individuals.

19

E n r o l l m e n t in E F N E P could easily f o B te r cognitive
dissonance.

Participants ma y respond by rat io na li zi n g w h y

their fami l ie s can't change a food practice,

or they m a y

adopt the new standard as the norm to reduce the cognitive
dissonance.
An important q u es ti on for the adult

educator is:

What

in the contact wit h the audience b r i n gs about learning? Is
it the material,
participant,
t a k es place?
r e s p o n s ib le

the presentation,

the mo ti v a t i o n of the

or the condit io ns under whi c h the l e a rn i ng
Ac co r d i n g to Bugental,
involvement

the learner's own

in the change process

to the e d u c a ti o na l process.

20

is essential

This view stresses the

impor t an ce of the edu ca to r- le ar n er

relati on sh ip and

es pe ci a l l y the involvement of the learner.
E d u c a t i o n has been defined as any l ea r n i n g process
r e s u l t i n g in a change of b e ha vi o r on the part of the
learner.

21

"Process'1 in thiB context,

is defined as the

i n t e r a c ti on b e t w e e n the educator and the learner.

The

E F N E P has co ns t a n t l y sought to examine the needs of its
low-i n co me a u di en ce in the de si g n of its educational
program.

28

E d u c a t o r s g e n e r a l l y agre e that in fo rm a t i o n cannot be
"poured"

into the hea ds of adults.

indicate that persons
w h a t -they hear,
a nd hear,
and say.

retain

30 # of wh at they see,

Hence,

of reten ti on

10# of what they read,

70 # of what th ey say,

22

Studies

20# of

50# of what the y see

and 90# of wha t they do

the educator w h o s e m e t ho ds

stimulate

th e wid e v a r i e t y of a p e r s o n ' s Benses w i l l ge ne r a l l y have
the largest re te n t i o n rate a mo n g participants.
Adult l e ar ne rs ha ve special ch a ra ct e r i s t i c s that need
to be consi de r ed w h e n p l a n n i n g ed u ca ti on al

experiences.

The s e c ha r ac te r i s t i c s are that adult learners:
1.

Like a f a i l u r e free

(safe) le a r n i n g environment.

2.

Hee d to k n o w the r elevance of what t h e y are
learning.

3.

Need relevant,

p r ac t ic al educat io na l materials.

4.

B ri n g a "life of experience" to the l e ar ni ng
scene.

5.

Are se lf - d i r e c t e d

rather than dependent learners,

6.

Need

7.

Have m a n y outside demands

immediate f e e d b a c k on progress.
on their timet hence,

l e a r n i n g must be p a r t i c i p a t i v e to k e e p their
attention.
8.

Have a v a r i e t y of internal and external m o t i ­
v a ti on s for p a rt ic ip at in g ;

c o n s e q u e n t l y , they

w a n t l ea r ni ng in m a n a g e a b l e pieces.
9.

Need

a social environment.

23

29

Adults participate in learning experiences for a
vari et y of reasons but the moBt common reason is a "sense
of expectation"
them.

that something pleasant will happen to

In work in g w i t h the low-income EFNEP audience,

the

e d u c a t o r 'b personal interest and concrete help with
immediate matters is most important.

There are five basic

laws of learning that have implications for the success or
failure of the adult educator and EFNEP Nutrition Aides in
planning the learning environment.
1.

law of Effect:

2.

Law of Primary:

These are:

Success breeds success.
FirBt impressions are vital and

lasting.
3.

law of Exercise:

The more something is practiced

or repeated the quicker the habit will become
established.
4.

law of Disuse:

Indicates that skills not

practiced and knowledge not used are largely
forgotten.

Repetition does in fact reinforce

learning.
5.

Law of Intensity:

A vivid,

dramatic learning

experience is more likely to be remembered
Ai

than a dull, routine,

or boring experience.

Adults ma y understand a concept, but interfering w ith
retention and use is the "curve of forgetting."
implies that,

This

if the educational activity is listening,

5056 will be forgotten almost immediately and 25^ a short

30

time later. Hence 50^ will "be forgotten.
To combat the "curve of forgetting" the following
activities may he used:
1.

Utilize short periods of review (evaluation after
instruction).

2.

Review goals at the beginning of each session.

3.

Encourage oral expression of the learning
activities.

4•

Encourage recording of the information for future
UBe.

5.

Apply basic principles of effective
instruction.

25

There are a number of other learning blocks,

some are

controllable and some are not.

The learning blockB are

boredom,

and fear.

irritation,

confusion,

The three paths

to learning that should be incorporated and recognized
w h e n teaching adults are instructor to participant,
participant to instructor,

and participant to

p a r t i c i p a n t .^
Learning goals need to be established by both the
instructor and the participant.
clearly defined, attainable,

The goals should be

and shared.

Roger Mager

suggests that learning goals should include identifying
the terminal behavior,

identifying the conditions upon

whi ch the behavior will occur,

and identifying the

"standards for success" for performing the described
behavior.

27

31

U n d e r w o o d p r ov id es c on si de r ab le evidence that the
va r i a b l e that outwe ig hs all others in importance,
l on g - t e r m retention,
initial learning.

28

is the amount of practice during
A u B u be l suggests that one can

p r ed ic t re te n t i o n on the basis
a n c h o r i n g ideas,

for

of a v a i l ab i li ty of

st ab i l i t y and c l a ri ty of these ideas,

and

the d i s t i n g u i s h a b i l i t y of new m a t e r i a l from its a n c h o r i n g
ideas.

Thus,

ne w m a t e r i a l mu st be readily subsumable

u n d e r p re vi ou sl y learned

ideas and at the same time

di st in gu i s h a b l e fro m them.
Caplovitz's

29

(1969) work confirmed the fact that

l ow-income families face three majo r problems:
cash,

lack of credit,

and lack of information.

L a c k of
30

S il ve rm an emphasized the need for t e m p e r i n g k no w l e d g e with
tenderness.

31

A c l i m at e of realness and tende rn e ss is

n ec es sa ry for c a r r y i n g out a h e l pi ng p r og r am for the E F N E P
audience of l ow-income families w i t h limited
In summary there are three basic

resources.

challenges that are

of concern in the educat io na l p r o ce s s wh en w o r k i n g with
l ow-income famiieB.
1.

These chall en ge s are:

To instill in the p a r t i c i p a n t a greater
desire to change;

2.

To help the pa r t i c i p a n t to show greater
courage to change;

3.

To have avail ab le more
w i t h the change.

resources to help

32

E x p an de d Fo od and N u t r i t i o n Program Studies
Hi s to ri ca ll y,

the effect iv en es s of E F N E P has "been

m e a s u r e d "by the 24-Hour D i e ta ry Food Recall.

The 24-Hour

D i e t a r y Food Recall has b e e n used to document eati n g
h a b i t s for large p o p u l a t i o n groups since it provides a
q ui c k econo mi ca l mea ns of m o n i t o r i n g food intake.
Framingham

study the c o r r e l a t i o n of the 24-Hour Diet ar y

Foo d R e c al l wit h actual nutrient
0.92.

32

In the

intake was 0,52 to

Y o u n g reported c o mp a r a b l e results wit h food
77

d i a ri es and the food recall method.
a report to the U.S.

and Pao,

in

(USDA),

d i sa d v a n t a g e s and ap plications

o f the 24-Hour D i e ta ry Fo od Recall.
it is a useful,

Burke

Depar tm e nt of A g r i c ul tu re

d iscus se d the advantages,

that

J

Their e valuation was

valid method of obtaining diet

I n f o r m at io n from large p o p u l a t i o n groups.

34

It is cost-

effective and the results obtained from it are well
c orrelated w i t h thoBe of other, mo re t i m e - c o n s u m i n g
methods.

A l t e r n at i ve s to the 24-Hour D i e ta ry Food Reca ll

mu st meet the requirement of b e i n g a useful research tool.
This review of EFN EP studies wil l report primarily
t ho s e studies that have looked at the co s t- ef f e c t i v e n e s s
of E FN E P p r o gr am delivery;

the lo ng term impact of the

p r o g r a m on p a rt ic ip an ts d i e t ar y adequacy in relation to
leng th of instruc ti on or enrol lm en t b e fo re the prog ra m
ev al u a t i o n was completed.
M a n y evalua ti o ns of EFN EP have shown that the prog r am

33

has had an impact on the dietary adequacy level of its
participants.
changes

In 1 9 7 3 f Michigan State University examined

in the nutritional attitudes and food shopping

behavior of 163 low-income homemakers from randomly
selected counties.

Only 3*5 percent of the homemakers had

an adequate diet at the time they entered the EFNEP
program.

Most of the homemakers had food recall scores

that showed one serving from each food group.

When the

entry dietary adequacy scores of these homemakerB were
compared with scores taken nine monthB later, there was an
overall increase in the percentage of homemakers who ate
the recommended number of servings in each food group.
The 24-Hour Food Recall mean scores of the study and
control group showed that those in the Btudy group tended
to increase the number of adequate servings in the four
food groups and improve the adequacy of their dietary
•zc

intake during EFNEP program instruction.

p

Feaster studied EFNEP*s impact on 10,500 homemakers
and found that about 4 percent of the homemakers had
adequate diets when they enrolled in the program.
six months,

After

the percentage of homemakers who had adequate

diets increased to almost

11 percent.

Homemakers who had

the poorest initial diets showed more improvement than
those who had better food consumption practices
i n i t i a l l y .^
Feaster and Perkins reported similar findings in their

54

study of dietary changes among EFNEP program families in
selected Florida and Georgia countieB.

Improvement

occurred in the consumption of the four basic food groups
of meat, milk, vegetables and fruits,
cereals.

and breads and

More improvement was noted in the fruits and

vegetable group and the milk group,
lowest inital scores.

groups that had the

57

To determine the cost-effectiveness of EFNEP,

Tate

analyzed the program's impact in Georgia, Maryland,
and Oregon.

He divided participants into four groups

according to their entry dietary food recall scores
26-50,

Ohio,

51-75,

and 76-100).

(0-25,

Tate used a chi-Bquare test of

a ssociation to examine the relationship between
improvement during the program, length of time in the
program, and entry dietary adequacy level.

He found that

significant dietary changes ceased after the two lowest
groups

(0 -2 5 , 26-50) had participated in the program for

12 to 18 months,
and 76-100)

and that the two highest groups

(50-75

showed no significant changes in dietary

scores at any time during the program.

Tate concluded

that the program was effective for those homemakers whose
dietary adequacy level was bel ow 50 at the time they
entered the p ro g ra m. ^8
A few follow-up studies have been conducted to
determine if participants sustain the dietary changes that
occur during EFNEP participation.

Gassie reported a study

35

of 258 homemakers in six parishes of Louisiana noting
that only 5 percent had adequate diets at enrollment.
However,

after only eight lessons,

the percentage of

homemakers with adequate diets increased to 25
percent.

59

Patterson, Workman,

and Jones studied 50 homemakers in

B a r r y County, Missouri to determine whether or not these
homemakers maintained their improved dietary adequacy
level after they left EFNEP and whether or not periodic
educational contacts would help these families to maintain
or improve their dietary adequacy levels.

They found that

homemakers maintained some of the improvements achieved
w hi l e enrolled

in EFNEP.

However,

periodic educational

contacts after graduation did not improve the homemakers
diets "beyond the levels

initially attained during

e n r o l l m e n t .^
Hountree in a study of 51 homemakers in Franklin
County,

Ohio found that homemakerB did not significantly

improve the adequacy of their diets during EFNEP
participation and that the improvements made were not
sustained eight months after the program had
t e r m i n a t e d .^

In another study,

Duff reported that it

was not possible to find food consumption behavior
AO

differences after families had been enrolled

in EFNEP.

Many studies have also been conducted to determine the
most effective length of time for enrollment in EFNEP.

36

During the first external evaluation of EFN E P nationally
the records of 2,189 families were examined and 438
homemaker interviews were conducted.

Researchers found

that homemakers who had inadequate diets at the time they
entered the program started improving H h e i r diets after
six months of EFNEP participation.

4*3

Over 3f120 records and 698 interviews were conducted
in a Becond major external evaluation of EFNEP.

The

researchers found that the participants' Food Recall
scores tended to increase w i t h up to 18 months of EFNEP
program participation.

The study also found that

participants with the lowest entry dietary scores tended
to participate in EFNEP longer and that this group also
showed the most improvement.

The researchers recommended

that homemakers with average food and nutrition Bcores and
increased learning capabilities complete EF N E P betwe en the
6th and 12th m o n t h . ^
Jones and Verman Btudied the nutrition change
phenomena at selected intervals over a period of one year
with 822 homemakers in lousiana.

They found that the

group as a who le increased their consumption of foods in
all four food groups.

However,

the most significant

changes in food consumption occurred during the
homemakers'

first two months of enrollment.

Dur in g the

second two-month period there was another significant

31

change, hut this was followed by a definite leveling off
4.5

of dietary improvement.
Green, Wang,
study,

and Ephross,

in a three-year longitudinal

compared changes in the knowledge,

attitudes,

and

practices of 98 rural homemakers with a matched group of
58 urb an homemakers.

One of their research questions

concerned the effectiveness of home visits and the point
of diminishing returns.

They found that while the impact

of the Nutrition Aide's visit diminished after the first
year of contact,

food and nutrition improvements made

during enrollment were not lost.
year,

However, b y the third

continued home visits with the same homemaker were

of minimal value.
Morris

46

(1975), found that EFNEP participants improved

their food recall scores during EFHEP participation and
that these changes were positively correlated with the
number of contacts the homemaker had with the Nutrition

Aide.^
Even though participation in EFNEP is determined by
level of family income,

the findings about the

r elationship between income and dietary adequacy level are
mixed.
Pielemier,

Jones,

and Munger emphasised that studies

of m alnutrition over the past 20 years have made it
abundantly clear that the educational backgrounds and

38

economic and cultural c h a r a c te ri st ic s of a society have an
impact on its nutri ti o na l

status.

They added that

m a l n u t r i t i o n ma y be the most dramatic

indicator of pov er ty

s in c e food intake is h i gh ly co rrelated wit h income.
However,

studies such as those conducted by the U.S.

D e p a r t m e n t of Health,
U.S.

Education,

D ep a r t m e n t of A g r i c u lt ur e

income alone
The

48

and W e l f a r e

(1972) and

(1978) have shown that

does not guara nt ee an adequate diet.

49

1969 N a t i o n a l EFN EP e v a l u a t i o n study found that

h o m e m a k e r s who had the poorest diets at the time they
entered the p r o gr am tended to be from u rb a n areas,
p o o r l y educated,

were on welfare,

and were poor.

the h om em a k e r s did show substa nt ia l

improvements

were
Although

in their

f o o d c o n su mp ti on prac ti ce s after six m o n th s in the
program,

there wa s no consi s te nt diffe re nc e

in overall

d i et ar y ad e q u a c y changes that could be attributed to
so ci o- e c o n o m i c characteristics.

*50

M o r r i s examined the r e l a t i o n s h i p b e t w e e n personal and
f a m i l y c h a r a c t e r i s t i c s of E F N E P p a r t i c i p a n t s and their
c h a ng es in food consumption.

W i t h a co r r e l a t i o n matrix,

the rel at io ns h ip s b e t w e e n nine variables:

food recall,

t h i a m i n e e xc r e t i o n level,

r ib of l a v i n excret io n level,

n u t r i t i o n attitu de score,

n u t r i t i o n k n ow le dg e score,

e d u c a t i o n a l level,

and fami ly income.

age,

Morris found that

a ge is n e g a t i v e l y related to food c on su m p t i o n practices,

39

but the homemaker's educational level and per capita
family income were positively related to food
consumption.

Although these correlations indicate that

there is a tendency for age,

education,

and per capita

family income to be related to food consumption behavior,
the relationships are not signifcant or meaningful for
practical purposes.
In evaluating the long-term effects of participation
in EFNEP, Rountree studied the relationship between
improvements in dietary adequacy scores and five
variables:
program,

Income,

education,

residence.

participation in the food Btamp
number of children and area of

Family size and the number of children, under

18 years of age were significantly related to sustained
improvements in dietary adequacy level.

52

In 1983, researchers did a follow-up study of 73
former EFNEP homemakers who had participated 2-3 years
earlier in a California EFNEP evaluation study.

This

follow-up showed that the improvements in 24-Hour Dietary
Food Recall score,

shown in the earlier evaluation study

(1979-1981), were still present in the follow-up
population.

The total food recall score

(0-100 points)

did not significantly change from the evaluation Btudy,
post-test score of 72 points,
of 80 points.

to the follow-up study score

40

In Muskogee,

Oklahoma,

the 24-Hour Dietary Pood Recall

and the Pood Behavior Checklist were used to assess
sustained change in a group of 121 EFNEP homemakers.
Resu lt s showed that significant improvements in intake and
food "behavior practices were sustained three years after
participants completed the program.

54

A study was completed by Maryland researchers to
determine the programs'
participants diets.
participants,

effectiveness in improving

The sample consisted of 129 graduated

who had been enrolled in EPNEP an average of

31.2 months and had been out of the program an average of
20.8 months.

Findings showed that graduated participants

had final diet scores that were significantly higher than
initial enrollment scores.

Although some regression

occurred after participants left the program, follow-up
scores did remain significantly higher than initial
enrollment scores.

55
^

R e searchers investigated the long-term effects of
EPN EP in Georgia by determining differences between
participants'

total diet scores and food behavior practice

scores at program entry,
after graduation.

at graduation,

and twelve months

The population for the study waB

homemakerB who had graduated between June and September
1977.

Follow-up data were collected in October 1978.

Results showed that the majority of the homemakers
maintained improvement in food behavior practices 12

41

m o n t h s after graduation.

56

An e va lu a t i o n o f E F N E P in Orleans Parish,
(1983-86) showed the E F N E P was

effective

Louisiana,

in i mp r o v i n g the

d i e t a r y pr ac t i c e s of l o w- in co me ho me m a k e r s enrolled
program.

Co mp a r i s o n of p o s t - e n r o l l m e n t scores,

m o n t h B after graduation,

in the

6-12

to p r o gr am entry scores,

showed

that h o m e m a k e r s sustained s t a t i s t i c a l l y s i gnificant
i m p r o v e m e n t scores.

57

A f o l l o w - u p stu d y of P e n n s y l v a n i a E F N E P p a r t i c i p a n t s
who participated
project.
hut

in the 1981-82 E F N E P Foo d Stamp pilot

The pilo t p r o j e c t had p r o vi d ed re l at iv el y short

intense food and n u t r i t i o n in st ru ct io n w i t h a set of

s t a n d a r d i z e d lessons.

The f i nd i ng s showed that project

h o m e m a k e r s wer e ahle to retain and even improve their
n ut ri t i o n a l k n o w l e d g e six mon th s after project
completion.

Ho me m a k e r age and family size wer e factors

succe s sf ul m a i n t e n a n c e of homemakers'
k nowledge.

Older h o m e m a k e r s

in

increase in

(28 y e a r B and over) w i t h four

fa mi l y m e m b e r s ou t- p e r f o r m e d those wit h smaller families.
F o o d St a m p p r og ra m p a r t i c i p a t i o n had no effect.
F o x interviewed

57 ho me m a k e r s who had gradua te d from

th e Grand Island, N e b r a s k a E F N E P u n i t October
March

1984-

58

The Food B e h a v i o r Checklist

1982 throu g h

and 24-Hour

D i e t a r y Food Reca ll wer e used for the co mparison
measures.

The findings

revealed that gradu at ed h o m e m a k e r s

ha d a s i g n i f c a n t l y higher score

(78.9) at g r a d u a t i o n than

42

at entry

(61.6).

The consumption of foods from each of

the four food groups was also compared.

Homemakers

maintained their graduation intake of the fruits and
vegetables group.
group,

In the milk group,

and bread and cereal

the homemakers did not maintain graduation level

scores, but intake was still higher than at entry.
Homem ak er s did not maintian either the graduation level or
the entry level for the meat group.

59

Summary
The selected review of literature has focuBed on how
adults learn and the special characteristics to be
considered when teaching disadvantaged low-income
families.

This review has substantiated that the design

of the EPNEP learning experience is not only practical but
that the methods used in EPNEP are also supported by
research that has been conducted on adult learning.
The conditions for learning were reviewed since EPNEP
paraprofessionals have a crucial role in providing the
food and nutrition information to participants in a tender
and practical manner.
over time,

The success of the EPNEP program

rests with the Nutrition Aide's skills in

t eaching and communicating w ith the p a r t i c i p a n t s . . .the
learners.

43

The following conclusions may be drawn from the
previous Expanded Pood and Nutrition Education Program
studies, which have assessed the long-term effects of
E P N E P participation:
1.

The 24-Hour Dietary Pood Recall adequacy improve­
ments that occur during program participation
appear to be sustained from 6 months to 38 months
after program completion.
research,

In reviewing the

38 months is the longest period of time

dietary adequacy has been measured on former EPNEP
participants.
2.

Participants who have the lower 24-Hour Dietary
Pood Recall scores at program enrollment appear to
benefit more from program participation than
p articipants who enter with higher 24-Hour Dietary
Pood Recall scores.

3.

Overall,

participant 24-Hour Dietary Pood Recall

changes do not appear to be related to selected
participant demographic variables of age,
family size,
programs.

income,

of participation in food assistance

However, based on particular studies

w i t h specific areaB of interest:
a.

Dietary food behavior is maintained
regardless of family composition.

44

b.

Participants receiving food assistance
tend to improve their dietary adequacy
more than those not on food assistance.

c.

Some regression in dietary adequacy
occurs after leaving the program but
scores still remain significantly
higher than enrollment scores.

The EPNEP Pood Stamp Project used the 24-Hour Dietary
Pood Recall and a -participant knowledge questionnaire to
evaluate

the effect of the project; however, most of the

E P N E P evaluations

have only used the 24-Hour Dietary Pood

Rec al l as a measure of the program effectiveness.

A few

studies have also used the USDA Pood Behavior Checklist,
w h i c h is a form, completed by the Nutrition Aide,

that

measures observable food and nutrition practices exhibited
by the enrolled family.
Most of the long-term effects studies have utilized
interviews with graduated EPNEP participants anywhere from
6 to 38 months after EPNEP completion.

However,

program

enrollment has varied from 12 months to over 36 months.
This study will analyze retention of foods and
nutri t io n knowledge and practice five years after
completion of nine months of EPNEP instruction.

Both the

24-Hour Dietary Pood Recall change scores and the Michigan
Fami l y Pare Survey scores have been used in this study.
The Michigan Family Pare Survey provides an assessment of

45

the EFNEP participant's food and nutrition knowledge and
food practices,

It appears this is the longest period

of time after EFNEP participation that has been used to
assess the retention of foods and nutrition information
wi th this audience.

46

Footnotes
^ l e i d e n f r o s t , N. , "Using Paraprofesslonals to
Deliver Educational P rograms," USDA Extension Service
Program Aide #137, April 1986, Appendix 2.
2
Reissman, F. and Pearl, A., New Careers For the
P o o r , Non-Professional in Human Service, Glencoe,
Illinois:
Free Press, 1965York:

^Gagne, R.M.,
Holt, Rinehart,

The Conditions of L e a r n i n g . New
arid WinB-fcbn, I n c . 1970, pT 1,

^"Teaching and Applying Educational Principles
in E F N E P , 11 USDA Science and Educational Administration
Extension. GPD 862-005*
''Gagne, R.M.
The Conditions of L e a r n i n g . New
York: Holt, Rinehart and Winston, Inc. 1970, p T 3 .
6Ibid., p. 25*
7
Houle, C.O., The Design of E d u c a t i o n * San
Francisco:
Jossy-Bass Publications, 1972.
Q
Haslow, A.H. Motivation and P e r s o n al it y. New
York: Harper and Row, 1921 .
^Miller, H . L . , "Adults in Education:
A
Forcefield Analysis,"
Boston:
Center for the Study of
liberal Education for Adults.
Boston University, 1967.
^ B o s h i e r , R. "Educational Participation and
Despant:
A Theoretical Model"
Adult Education, 1973,
23(4), P* 260.
^ C r o s s , K.P. Adults as L e a r n e r s . Jossey-Bass
Publishers, San Francisco, 1984, pp^ 133-13412Ibid., p. 220.

15Ibid,, p. 220.

47
^^Houle, C.O., The Design of E d u c a t i o n . San
Francisco, Jossy-Bass Publications* 1972, p. 5.
^ K n o w l e s , M.S. The Modern Practices of Adult
Education:
Andragogy versus P e d a g o g y . New York:
Associated PresB, 1970 .
p.' '56.
t6Ibid, p. 59*
^ B o h l e n , J.M. "The Adoption and Diffusion of
IdeaB in Agriculture, Our Changing Rural Society:
Perspective and Trends," Iowa University Press, 1967.
^®Rogers, E . M . , Shoemaker, F.F., Communications
of Innovations:
A Cross Cultural A p p r o a c h , New1 York:
Free Press, 1971.
19

Festinger, Leon, A Theory of Cognitive
D i s s o n a n c e , Evanston, Illinois:
Row, Peterson, T957*

20Bugental, J.F., "Humanistic Psychology:
Breakthrough," American Psychologist X V I I I , Sept.
pp. 565-67.

21

Gagne, R.M.
York: Holt, Rinehart,

A New
1965,

The Conditions of L e a r n i n g , New
and Winston, Inc. 1970. pT 5.

22

ANREI,

Cooper, C., "Tips for Effective Instruction,"
East Lansing, Michigan, MSU, Handout, (n.d)

^ K n o w l e s , M.S.
The Modern Practices of Adult
Education:
Andragogy versus P e d a g o g y , New York:
Associated Press, 1970.

ANREI,

2 ^Cooper, C. Tips For Effective Instruction
East Lansing, Michigan, MSU, Handout, (n.d.)
2 5 Ibid

2 fi
Rogers, E . M . , Shoemaker, F.F. Communication of
Innovations:
A Cross Cultural A p p r o a c h , New Y o r k : Free
Press, 1971.------------------- ------

27
Palo Alto,

Mager, R . , Preparing Instructional O b j e c t i v e s ,
California” T962I

48
28Underwood, B . J . , Schultz, R.W., Meaning
F u l ln es s and Verbal Learning, Philadelphia:
Lippincott,
---------------

2 ^Ausubel, D.P. , Educational P s yc ho l og y :
A
Cognitive View, New York:
Holt, Reinhart, ana Winston,
-----

^ " T h e People Left B e h i n d , ’1 Report of the
Presidents' National Advisory Commission on Rural Poverty,
Supt. of Documents., 1967*
31

Silverman, S.A.
Journal of Extension VII,

SubprofeBsional In E x t e n s i o n ,
Spring 1969, p. 49.

■7p

^ Christakis, G . , Nutritional Assessment in
Hea lt h Programs Proceedings from Nutritional Assessment
C o n f ., American Public Health Association, 1972.
^ Y o u n g , C.M., Hanan, G.C., Tucker, R . E . , and
Foster, W.D., "A Comparison of Dietary Study Methods:
Diet a ry History vs. Seven-Day Record vs. 24-Hour Recall,"
Journal of Dietetics A s s o c i a t i o n , 1952, 28, 218-219^ B u r k , M.C., Pao, E.M., "Methodology for
Large-Scale Surveys of Household and Individual Diets,"
Home Economics Research Report 40, pp. 55-56, USDA,
Washington, D.C.
^ K e r r , M.E. "Demographic Characteristics and
the Nutritional Status of Families Entering the Expanded
Nutrition and Family Programs," Unpublished Master's
thesis, Michigan State University, East Lansing, Mich.
1973-

36

FeaBter, J . , "Imapct of the Expanded Food and
N ut ri ti on Education Program in Low-income Families:
An
Indepth Analysis," USDA Economic Research Service, 1972.
^ F e a s t e r , J . G . , Perkins, G.B., "Progress of
Selected Florida and Georgia Families in the Expanded Food
and Nutrition Education Program," (Report No. ERS-636)
Washington, D.C., USDA, Economic Research Service, 1976.
^®Tate, T . , "The Role and Status of CostEffectiveness Analysis in Federal Funded Nutrition
Education Programs in the United States," unpublished
Master's Thesis:
Massachusetts Institute of Technology,
Cambridge, Mass. 1977*

49
^ ?Gassie, E.W., irAn Evaluation of the Expanded
Pood and Nutrition Education Program in Six Louisiana
P ar i s h e s , 11 Louisiana Cooperative Extension Service, (n.d.)
^ N o l a n , J . , "The Effect of Progression from the
Expanded Pood and Nutrition Education Program on Dietary
Adequacy,"
Lincoln, Mo:
University of Missouri, Lincoln
Universty Extension 1976* (Summary of work by A.
Patterson, I. Workman, ad D. Jones)
^ R o u n d t r e e , M.C., "Effectiveness of the
Expanded Pood and Nutrition Education Program in Producing
Improvements in Diets of Homemakers,"
Unpublished Ph.D.
Dissertation, Ohio State University, Columbia, Ohio, 1973.
^ D u f f , D.A., "A Biological Dietary and
Additional Assessment of the Effects of Nutrition
Education on Families Enrolled in the Expanded Nutrition
and Family Program," unpublished M a s t e r ’s Thesis, Michigan
State University, East Lansing, Mich. 1974.
A'X.

United States Department of Agriculture,
Federal Extension Service. "Program Performance:
Expanded
Pood and Nutrition Education Program."
Washington, D.C.
1969^ U n i t e d States Department of Agriculture,
Federal Extension Service, "Program Performance:
Expanded
Pood and Nutrition Education Program," Washington, D.C.
1971 .
^ J o n e s , J . H . , Verma, A., "Comparison of Pood
Consumption Patterns of Homemakers Enrolling at Various
Times in the Expanded Pood and Nutrition Education
Program," Lousiana, March 1972, Baton Rouge, La. 1972
46

Green, L.W., Wang, V . L . , and Ephross, P., "A
Three-Year longitudinal Study of the Impact of Nutrition
Aides on Poor Homemakers," Paper presented APHA.
Atlantic
City, New Jersey, College Park, Maryland, Univ. of
Maryland, 1972.
A7

Morris, P., Cooperative Agreement
12-05-300-187 between USDA-Extension Service and Michigan
State; Cooperative Extension Service: Final Report, EaBt
Lansing, Michigan, 1975.

50
^ P i e l e m e i e r , N.R. , Jones, E.M., and Hunger,
S.J., "Use of C h i l d ’s Growth Chart As An Educational
Tool," Washington D.C., USAID 1978.
^ U . S . Dept. Health, Education and Welfare,
"Ten-State Nutrition Survey," 1968-1970, published 1972
and 1977-78, National Food Consumption S u r v e y , USDA,
Washington, D 7 C ., published I960, Governmental Printing
Office; Wa s hi ng to n D.C.
"^"Impact of the Expanded Food and Nutrition
Education Program on low-income Families," USDA, Economic
Research Service, Report 220, Washington, D.C. 1972.
*51
Morris, P. Cooperative Agreement No.
12-05-300-187 between the USDA Extension Service and Mich.
State University. Cooperative Extension Service:
Final
Report East lansing, Mich. 1975.
^ R o u n t r e e , M.C., "Effectiveness of the Expanded
Food and Nutrition Education Program in Producing
Improvements in Diets of Homemakers," unpublished Ph.D.,
Dissertation Ohio State University, Columbus, Ohio, 1973.
^ " C a l i f o r n i a EFNEP Evaluation Study,"
Cooperative Extension Service University of California,
Berkeley, CA, 1985.
^ J o r d o n , C., "Assessment of the Long-Term
Effect of the Expanded Food and Nutrition Education
Program on Adequacy of Dietary Intake and Food Behavior
Practices of EFNEP Homemakers in Muskogee County,"
Oklahoma State University, Stillwater, Oklahoma, 1985.
^ A m s t u l s , M . , "The Effectiveness of the
Maryland Expanded Food and Nutrition Education Program in
Improving the Diets of Enrolled Homemakers," University of
Maryland, College Park, MD, 1982.
-^Brown, A., Pestte, R . , "Dietary Intake and
Food Behavior Practices:
Long-Term Effects of the Georgia
Expanded Food and Nutrition Education Program,"
Unive r si ty of Georgia, Athens, GA. 1980.
•^Fletcher, B . H . , "An Evaluation of the Expanded
Food and Nutrition E ducation Program Orleans Parish,
Louisiana,"
Louisiana State Univ., Baton Rouge, LA. 1986

51
^^)unn, P., Sims, 1., Brown, E.J., "EFNEP/Food
S t a m p Pilot Project," 1981-83, USDA Contract with
C o o p e r a t i v e E x t e n s i o n Service.
*^Fox, M., "M ea s u r i n g the Impact and R e t e n t i o n
of the E x p a nd ed Food and N u t r i t i o n E d u c a t i o n Program on
G r a d u a t e H o m e m a k e r s , " A F o l l o w - U p Study.
U n i v e r s i t y of
Nebraska, Lincoln, Nebraska, 1985*

CHAPTER III

METHO DO LO GY

This chapter provides a description of the survey
procedures and research materials used
study.
setting,

in conducting the

Specific components of the chapter include the
population,

(sampling,

research design,

instrumentation,

procedures

collection of data, treatment

of data) assumptions and limitations of the study.

The Setting

State land grant universities seek and receive annual
appropriations from state and federal sources to conduct
nonformal information and educational activities through
the institution formally known nationally as the
"Cooperative Extension Service" or "Agriculture Extension
Service."
Since its Congressional creation,
Smith Lever Act,

through the 1914

the Cooperative Extension Service has

imparted information and conducted demonstrations,
encourage trial and adoption of new innovations,
practices,

and skills,

to a variety of clientele.

52

to

53

In November 1968 -the U.S.

Congress,

through the

Department of Agriculture,

designated ten million dollars

of USDA,

for establishment of the

Section 52 funds,

Expanded Pood and Nutrition Education Program

(EFNEP).^

This initial funding to state land grant universities via
the Cooperative Extension Service provided an opportunity
for each state to operationalize the EPNEP concept tested
by the earlier pilot projects.

While the Cooperative

Extension Service traditionally has focused on rural areas
and families of all economic levels, EPNEP was designed to
include poor families in both urban and rural settings.
Michi ga n has participated in the EPNEP program since its
inception.
The review of literature has set forth some of the
basic conditions for adult learning and noted many of the
longitudinal studies conducted to evaluate EPNEP's
effectiveness.

Criticisms regarding EPNEP program

effectiveness and educational methods were also
presented.

It is these challenges that provided the

motivation to examine the retention,
program participation,

five yearB after

of foods and nutrition knowledge

and practices of participants in the Michigan EPNEP.

Population
During the initiation of this study the Michigan EPNEP
operated

in sixteen Michigan counties; Bay, Berrien,

54

Calhoun, Dickinson,
Lenawee, Monroe,

Genesee,

Ingham,

Macomb, Muskegon,

Oakland,

Clair, and Wayne. All newly-enrolled,
participants in the EPNEP

Kalamazoo, Kent,
Saginaw,

St,

low-income

program during October through

November 1979 were considered candidates for this study.
The target audience for EPNEP is low-income families with
children.

Priority attention is given to those families

with young children.

Many program participants receive

public assistance.

Research Design

Given the interest

in providing information about the

retention of food and nutrition knowledge and practices of
EPNEP particiants five years after program instruction,

a

longitudinal follow-up research approach was chosen for
the study.

This Bingle group, longitudinal,

quasi-

experiraental, time-series design model was considered
appropriate since the same data collection instruments may
be

administered at enrollment,

at program completion
follow-up

(pre-inBtruction,

(post-instruction,

(five years later,

Time 3)*

Time 1);

Time 2); and at

The administration

of these same instruments five years after program
completion provided a means of assessing participants'
retention of food and nutrition knowledge and practices
over time.

This design also examined selected

55

demographics of participants and the number of
instructional visits they received to assess the effect of
these variables on retention and change scores*
The major research question to he answered by this
study waB:

Will EFNEP program participants retain

improvement of their food and nutrition knowledge and
practices five years after program participation?
Specific research questions to be answered were:
1.

Do participants exhibit change from preinBtruetion

(time 1) to post-instruction

(time 3)

as measured by the 24-Hour Dietary Food Recall and
the Michigan Family Fare Survey?
2.

Do participants who exhibit change from preinstruction

(time 1) to post-instruction

(time 2)

retain post-instruction scores for five yearB?
3*

Do participant

24-Hour Dietary Food Recall and

Michigan Family Fare Survey scores change when
analyzed by selected demographics?
Stated in the null form the statistical hypotheses for
this study were:
1.

No significant difference will result in pre­
instruction (time 1) and poBt-instruction

(time 2)

scores aB measured by the 24-Hour Dietary Food
Recall and the Michigan Family Fare Survey.

56

2.

N o signi fi c an t d ifference will

occur among

p ar ticipants'

(time 2) and

f ol lo w- up
3.

po st - i n s t r u c t i o n

(time 5) scores.

No significant

difference w i l l

participants'

poBt-inBtruction

their f o ll ow -u p

exist among
(time 2) Bcores and

(time 3) scores bas ed on the

selected demographics.
To examine participants'

r etention of changes in

foods and nu tr i t i o n k n o w l e d g e and practice,
24-Hour D i e t ar y Poo d R e ca ll

scores

participants'

(IJSDA scores) were

compared to p a r t i c i p a n t s ' M i c h i g a n F a m i l y Fare Survey
scores b ef o r e

instr uc ti on

post-instruction
follow-up

(at enrollment)

(at p r og ra m completion)

(five y ea r s later) Time 3.

Food Recall

Time

1,

Time 2, and at

The 24-Hour Diet a ry

instrument looks at participants'

food

c onsump ti on in a 24 hour period whil e the M i c h i g a n F a m i l y
Far e Survey m e a s u r e s the participants'
knowledge,

skills and pr ac t i c e s

foods and n u tr it i on

in the f ol l ow in g

categories:
1.

Nutrition

(sources of nutrients)

2.

Food groups

3.

Food storage,

4.

Food p r e p a r a t i o n practices

5.

Food s h o p pi ng or pr e pa r a t i o n skills

6.

Food s h op pi n g practices

7.

Source of food and n ut r i t i o n in formation

8.

Food p re pa r a t i o n tasks

(classi fi ca ti o n of foods)
sa ni ta t i o n and safety p r ac ti ce s

(liked and disliked)

57

P roced ur es

P o pu la t i o n and Sample
The data collec ti on instruments

are a d m i n is te re d to

all low-income pa r t i c i p a n t s upon enrol l me nt
M i c h i g a n EFNEP.

A total of 699 p ar t i c i p a n t s enrolled

October through N o v e m b e r
counties.

1979

Of the orig in al

participated

(time

(n = 699)

1) in the sixteen
partici p an ts 449

in the p o s t - i n s t r u c t i o n data c o ll ec ti on July

through October 1980
Time 2 sample

(time 2).

F i f t y pa r t i c i p a n t s of the

(n = 449) wer e located five y ea r s after

i nstruc ti on and p a r t i c i pa te d
July through August,

1985.

in the Time 5 data c ol l ec ti on
Dat a co l le c t i o n instruments

w e r e complete for 45 of the 50 subjects
sample,

in the

and w e r e used for c om p a r i n g Time

in the f o ll ow - up
1, Time 2 and

Time 3 scores.
The final sample

(n = 399) used for Time

1 and Time 2

data in this study has the 45 p a r t i ci pa nt s of Time 3
removed.

Consequently,

the p op u l a t i o n sample for this

stu d y iB 444 participants.
th e Time

1 and Time

D e m o g r ap hi c ch a r a c t e r i s t i c s of

2 sample are shown in Table

d e m o g ra p hi c v ar ia bl es used in this study were
Time

1.

All

obtained at

1, w i t h the e xc e p t i o n of the number of instruc ti on al

visits, w h i c h was recorded by the N u t r i t i o n Aides d u r in g a
post-instruction

(Time 2) interview.

58

TABLE 1

CHARACTERISTICS OP THE POPULATION SAMPLE
(n = 444)

Demographics

Participants

Percentage

Race:
Caucasian
Black
Hispanic
Asian

283
124
33
4

64*
28*
7*
1*

86
248
70
40

19*
56*
16*
9*

8th grade or less
9-1 2th grade
Over 12th grade

50
358
39

11*
80*
9*

Ho.

on Pood Stamps

304

68*

Ho.

on WIC

194

44*

No.

of Children

993

Age of Participants:
21 yearB or less
22-33 years
33-44 years
45 years and older
Education:

Average Ho. Children/Family

2.24

---

59

Instrumentation
The data collection instruments used for this study are:
1.

Family Record,

ES #255

(Appendix A)

2.

24-Hour Dietary Food Recall, ES #256

3.

Michigan Family Fare Survey

(Appendix B)

(Appendix C and D)

These instruments are normally completed by the
Nutrition Aide during the first or second enrollment visit
with the family.
The Family Record
data on

(Appendix A) provides demographic

participants and their families.

Information

obtained from thiB record for the study was:
1.

Participant age,

sex, and race

2.

Number of chidren in the family

3.

Highest grade in school completed by participant

4-

Participation in food assistance programs

(WIC or

Food Stamps)
5.

Income level and dollar resources spent for food.

The total number of instruction visits with the
participant

is recorded at graduation.

The 24-Hour Dietary Food Recall

(Appendix B) is a

record of food eaten by the enrolled participant in a
24-hour time period before the interview.
report,

as accurately as possible,

Respondents

the food and drink

they have consumed in the 24-hour time period before the
visit.

Using household measures such as glasses,

spoons, bowls,

and plates,

cupe,

the Nutrition Aide with the

60

p a r t i c i p a n t ' s help,

estimates the amount

of food that has

b e e n consumed.
The foods recorded

are then c lassified

food groups and the n u mb er of servings
g r o u p is recorded.
score)

into four majo r

consumed

The dietary a d eq u ac y score

is computed u s i n g a p r o g r e s s i o n scale

in each
(USDA

(Appendix E)

d eveloped by Synetics S c o ri ng System for the USDA
E x t e n s i o n Service.
points,

is b as e d

This scale,

on the recommended number

ea ch of the four food groups.
based

These

on the number of servings

leaflet,

No.

Guide,"

are:

424,

w h i c h ranges from 0 to 100

titled

of Bervings for

recommended servings,

suggested

in the USDA

"Pood P o r Pitness,

A Da i l y Pood

two or mor e servings from the m i l k group;

two or mor e servings from the meat,
dried bea ns or peas group; four

poultry,

fish,

eggs,

or more servings from the

fruit and ve ge t a b l e group and four or more servings from
the br e a d and cereal group.

Pood and b ev e ra ge s that do

not b e l o n g to one of the four food groups are classified
as "other".
T h e s e recommended

servings have bee n UBed as a simple

gui de for food c l a s s i f i c a t i o n since the recomme n da ti on s
are considered to comprise an adequate diet.

Servings

excess of the recom me nd ed amounts are not scored.

in

ThuB a

US DA score of 0 indicates that the p a r t i ci p an t did not eat
the recomme n de d number of servings

in any food group that

day, w h i l e a score of 100 indic at e s that the p a r t i c i pa nt

61

had the recom me nd ed number of servingB for each food
group.

One s e r vi ng from each of the food groupB

is

c o ns id e r e d m i n im um a d e q u a c y and yiel d s a dietary score of
42.

The three

categories for analysis

for this study are:
points.

0-50 points,

of the USDA score

51-100 points,

See Synetics S c o ri ng System

and 0-100

(Appendix E and F).

T he 24 Ho ur D i e t ar y Poo d R e c a l l is simple to UBe,
costs less than other m e as ur e s

of dietary adequacy,

consi de re d a u s e fu l t e a c h i n g tool.

and is

It requ ir e s mini mu m

time to admin is te r and is w i d e l y used as a m e as ur em en t
i nstru me nt by the n ut r i t i o n community.
i nstru me nt
that

doeB have limitations.

However,

the

The major li mi t a t i o n is

only one day's food c o n s u mp ti on is measured;

consequently,

the instru me nt does not account for the

great v a r i a t i o n in an i nd i v i d u a l ' s diet,
resources,

avail ab l e food

changes over time.

Bupply,

Furthermore,

food habits,

day of week,

food

or appetite

some individuals m a y not

r e m em be r wha t they a c tu al ly ate in the p r e c e d i n g 24
hours.

In some cases,

to partic ip at e

the respo nd e nt m a y not be m o t iv at ed

in the Poo d R e c a l l or rapport w i t h the

inter vi ew er m a y be poor.

C o n s e q u e n t l y the 24-Hour Diet ar y

Fo o d R e c a l l ma y be a b e t t e r estimate for a s se ss in g group
d i e ta ry a d e q ua cy than

individual dietary a d eq ua c y since

u n d e r or over estim at io n of food consu mp ti on by
indiv i du al s m a y be b al a n c e d by the larger number of
respondents.

62

Th ou g h

it has some limitations,

the

24-Hour Diet ar y

P o o d R e c a l l has t r a d i t i o n a l l y h e e n consi d er ed as the moBt
s u i ta bl e instrument for m e a s u r i n g change

in the food

c o n s u m p ti on b e h a v i o r of EPN EP p a r t i c i p a n t s and was
t he r e f o r e use d

in this Btudy.

The E x pa nd e d Pood

and

N u t r i t i o n E d u c a t i o n Program ’’Hi st o r i c a l and S tatistical
P r o fi le of E F N E P " ^ pr o v i d e s the f o l l o w i n g justif ic at io n
for its use in EPNEP:

The diet a ss es s m e n t method used by EP N E P must be
sim pl e and brief.
Program h o m e m a k e r s wil l not
lik el y tolerate l e n g th y and involved q u e s t i o n i n g
about their n ut ri ti on habits, nor wi l l they
submit to compli ca te d b i o c h e m i c a l and medic al
tests.
Fu rthermore, the p ro c e d u r e has to be
a cc ur a t e l y applied by p a r a p r o f e s B i o n a l aides,
w h o ma y not hav e the b a c k g r o u n d to collect and
interpret detailed in f o r m a t i o n on nutri e nt s in
food consumed.
The method has to serve as a
m e a su re of a s s e s s i n g p ro g re ss during the homem a k e r ' s p a r t i c i p a t i o n in the program.
This
implies repeated diet assessments, w hi c h woul d
not be feasible wit h complex assessment
procedures.
Hence, the use of the 24 hour
D i e t a r y Pood Recall.

S u p e r v is or y N u t r i t i o n Aid e s and N u t r i t i o n Aides
c o n d u c t i n g 24-Hour D i e ta ry Poo d R e c al ls

in M i c h i g a n have

b e e n trained to m ax i m i z e a c c ur a cy of the recall by
e s t a b l i s h i n g rapport at the b e g i n n i n g of the program;
s o l i c i t i n g c o o p e r a t i o n and c onfidence by e x p l a i n i n g the
p u rp os e of the food recall,
about the food consumed,

a s k i n g f o l l o w - u p questions

and v e r i f y i n g the reported food

c onsu me d by r e pe a ti ng the i n f o r m at io n and ask in g if
e v e r y t h i n g has been included.

63

The third data collection instrument is the Michigan
Fam il y Fare Survey

(Appendix C and D).

The Michigan

F a m i l y Fare Survey was developed by this researcher and
M a r y Kerr, graduate student with EFNEP,

in 1977.

The

survey was redesigned after a pilot test in five Michigan
counties, March through Ma y 1979*
The Michigan Family Fare Survey consists of a serieB
of 68 questions that can be grouped and coded into seven
major categories.

These categories are:

knowledge of

food groups; nutrition knowledge; food storage and food
sanitation; food preparation practices; food shopping
practices; food shopping skills; and Bources of food and
nutrition information.

A series of colorful pictures and

a problem-solving approach are used
of this instrument.

in the administration

The interviewer reads the question

and the participant views the picture and selects
response.

a

The interviewer marks the response on the

questionnaire.
Nine scores are derived from the Michigan Family Fare
Survey,

one score for each component and an overall score

that represents the Family Fare composite score.

Six of

the component categories and their maximum scores are:
1.

Food Groups

15

points

2.

Nutrients Sources/Functions

13 points

3.

Food Storage/Safety

13

points

64

4.

Food Preparation Practices

55 points

5.

Food Shopping Practices

25 points

6.

Food Shopping Skills

12 points

The seventh component score is derived from responses
to items that identify where the participant receives food
and nutrition information

(17 points).

The eighth

component score is hased on the food preparation tasks
that are disliked hy the participant

(8 points).

(This

score ranges from 0-8 points with eight representing the
most disliked t a s k . )

The ninth score represents the total

score of all eight comonents.
The fundamental reason for the development of the
M ic hi ga n Family Fare Survey was to assess impacts of the
M ic hi ga n EF N E P program not assessed by the 24-Hour Dietary
Food Recall.

Since EFN EP w as designed to provide

education rather than food, EFNE P program instruction
concentrates on knowledge of food and nutrition,

skillful

buy i ng and preparation of food for low-cost nutritious
meals,

and management of food-related resources.

Consistent with this focus,

the Michigan Family Fare

Survey instrument waB designed to supplement the 24-Hour
Dietary Food Recall in determining how participation in
E FN E P influences participant changes.
To test the instrument's content validity,
Fare Survey was administered in 1977 to 591

the Family

respondents

before EFNEP instruction and nine months after instruction

65

and to control groups.

Analysis performed acrosB the

entire Bample revealed that Time 2 scores obtained by the
respondents were significantly greater than Time 1 scores.
The control group scores did not improve significantly.
R e l i a b i l i t y of the Family Fare instrument was tested
in a separate study
administered

(1982).

The instrument waB

(test- re t es t) to the same sample of

individuals on two occasions with no intermittent
instruction.

The results indicated that only one

dimension improved, but the improvement over time was not
statistically significant.

Some participants in the

reliability study were interviewed by the same interviewer
on both occasions while others were interviewed by
different interviewers on each occasion.

There were no

significant differences in scores in any category under
either interview condition.

Consequently,

the Family Fare

Survey is considered reliable or stable in producing
similar results regardless of the method of
administration.

Any differences

in participants'

entering

scores should be attributed to program participation
rather than to the survey instrument or the interviewer.
The Famil y Fare Survey was evaluated in two additional
studies with the same staff administering the survey but
with different participants.

The instrument demonstrated

reliability and internal consistency in all the Btudies.
In addition,

the Michigan Fami ly Fare Survey haB been

66

UBed

in the following Btudies,

which have Bhown it to be

useful in measu ri ng participant changeB over time:
1.

"You Too Can Participate in EFNEP,"
al.,

2.

et.

1982)

"Effectively Teaching Foods and Nutrition to
Low-Income Families,"

3.

(Nierman,

(Valker,

et. al.,

1983)

"A Follow-Up Evaluation of the Effects of the
M ic hi ga n Expanded Food and Nutrition Education
Program on Homemakers'

Dietary Adequacy:

Implication for Future Management,"
1 98 1

4-

(Kateregga,

)

"Evaluation of the Long-Term Effects of the
Expanded Food and Nutrition Education Program in
Michigan:

A Final Report,"

(Kerr,

et. al.,

1979)

Collection of Data
All data collection instruments were administered by
the EFNEP Supervisory Nutrition Aide in the respective
counties.

The Supervisory Nutrition Aide accompanied the

Nutri ti on Aide on the pre-instruction visit to administer
the data collection instruments.

Having the Supervisory

N u t r i t i o n Aide administer all the instruments ensured that
all data were collected pre-instruction and in the Bame
manner.

Identification numbers were assigned to

p articipants by each county.

To protect the identity of

67

the participants,

only identification numbers and the last

nameB were used on the instruments submitted for analysis.
The instruments were again administered
post-instruction (Time 2) July through October 1980, by
the Supervisory Nutrition Aide.

The Time 2 measurement

was taken nine months after enrollment or at graduation,
whichever occurred first.

The Supervisory Nutrition Aides

who administered the data instruments pre-instruction,
also administered the instruments post-instruction (Time
2) to ensure consistent instrument administration.
Administration of the data collection instruments
p re -instruction and post-instruction by the Supervisory
N utrit io n Aide is the only change from the usual Michigan
EPN E P procedure for obtaining enrollment information.
The third data collection
through August

(Time 3) occurred July

1985, five years after the participant

completed EFNEP instruction.

All data collection

instruments were identical to those used
pre-instruction
data collection.

in the

(Time 1) and post-instruction (Time 2)
A former Supervisory Nutrition Aide who

had been involved in administration of the instruments for
the pre-instruction

(Time 1) and post-instruction

(Time 2), administered all the instruments for the Time 3
(five years after instruction)

collection of data.

Admini st ra ti on of the Family Pare Survey and the
24-Hour Dietary Pood Hecall took approximately thrity
minutes.

68

T r e a t m e n t of the Data
D a t a w e r e co ll e c t e d to obtain inform a ti on to answer
t he qu e s t i o n s stated
t h i s chapter.

in the research design section of

D a t a wer e analyzed to assess the change in

p r o g r a m participants'
from pre-instruction

scores on the two s u r v ey instr um en ts
(Time

2), and the participants'
post-instruction

1 ) to p o s t - i n B t r u c t i o n

(Time

r e te nt i on of the

(Time 3) score five y e a r s afte r E P N E P

i n s t r u c t i o n was completed.

A d d i t i o n a l analyses

compared

th e change scores and re te n t i o n a ccording to selected
demographic

c h a ra ct er i st ic s

of p a r t i c i p a n t s and a c co rd in g

to the number of in s tr uc ti on al visits.
Since the p r i ma ry p u rp os e of the study w as to desc ri be
c h a ng es

in scores and the nat ur e of the dat a limits,

d e s c r i p ti ve
means,

statistics

and standard

(i.e.

frequencies,

deviations) we re used.

percentages,
All data were

computerized.
Statistical

c o r r e l at io ns of repeated measures,

A n a l y s i s o f Variance
r e g r e s s i o n analyis

(ANOVA),

like

t - te Bt s and mu l t i p l e linear

(MANOVA), w e r e used fo r the analyses.

An a lp h a level of 0.05 was used to deter m in e the
s i g n i f i c a n c e of the results.

P o r statis t ic al analysis,

t he 6. 5

v e r s i o n of the S t a t i s ti ca l

Sciences

(SPSS) by Nie,

Bent,

1975,

Computers,
N.C.

Hull,

Jenkins,

and the S t a t i st ic al
V e r s i o n 6 Edition,

SAS Institute,

Package for the Social

System

S t e i n b r e n n e r , and
(SAS) for Personal

SAS Insti t ut e Inc.,

1985 w e r e used.

Cary

69

Assumptions

Certain assumptions were made for the purpose of the
study.
1.

They are as follows:
A time series longitudinal study of this nature is
valid.

2.

Participants interviewed for the study are
representative of the Michigan EFNEP population.

3.

The data collection instruments measure the array
of foods and nutrition knowledge and foods and
nutrition-related practices that constitutes the
scope of M ichigan EFNEP instruction.

4.

Participants'

reported responses on the survey

instruments accurately reflects their actual
"behavior.

Limitations of the Study
Limitations to the study include the following:
1.

Only ten counties of the original sixteen counties
participated in the Time 3 collection of data
since six counties were eliminated from the
program in 1983. The potential numher of
participants for the Time 3 follow-up was reduced
since no EFNEP contact was available in the six
eliminated counties.

70

2.

The sample size for the Time 3 data collection was
further reduced due to the difficulty of locating
low-lncome participants five years after personal
contact had ceased.

Original study participants

w ere identified to the researcher only by identi­
fication and laBt name;

c o n s e q u e n t l y , local county

E P N E P staff were aBked to locate the former
participants for the third
collection.

(Time 3) data

In some counties,

former participant

records were not available for complete
addresses.

In so far as possible,

former

landlords and former EPNEP staff members were
contacted in an attempt to locate participants.
Telephone directories were not helpful as many
EPNEP participants cannot afford telephones.
3.

The study did not utilize a control group since a
longitudinal study of this nature with a control
group of low-income families would have been
unmanageable due to Borne of the above mentioned
limitations.

Summary

P ina l conclusions from this research study will be
used to document retention of food and nutrition knowledge

71

and practices of participants from the Michigan Expanded
Food and Nutrition Education Program.

Information gained

from these findings may he applicable to other adult
education programs that reach similar clientele.

72

Footnotes

This is section 32 of an Act identified as
"Removal of Surplus Agriculture Commodities" passed on
August 24, 1935*
(United States Code reference 7, U.S.C.
612)
2

"The Expanded Food and Nutrition Education
Program:
Historical and Statistical Profile;" USDA,
SEA-Extension Program Aide 1230, January, 1979, pp. 40-41.
5
L. Nierman, K. Akpom, and P. Boyce, "You Too
Can Participate in EPNEP" a final report sponsored by USDA
SEA-Extension, Michigan State University, Cooperative
Exte n si on Service, 1982.
^S. Walker, K. Akpom, and L. Nierman,
"Effectively Teaching Foods and Nutrition to Low-Income
Families," a final report sponsored by USDA SEA-Extension,
M ichigan State University, Cooperative Extension Service,
1983.

5
C. Kateregga, "A Follow-Up Evaluation of the
Effects of the Michigan Expanded Food and Nutrition
Educa ti on Program on Homemakers Dietary Adequacy:
Implications for Future Management."
A Dissertation,
M i ch ig an State University, 1981.
^M. Kerr, M. Andrews, and L. Nierman,
"Evaluation of the Long-Term Effects of the Expanded Food
and Nutrition Education Program in Michigan:
A Final
Report," Michigan State University, 1979

CHAPTER IV

FINDINGS

Overview
The major research question addressed by this study
was:

Will EFNEP participants retain improvement of their

food and nutrition knowledge and practices five years
after program participation?

This chapter presents a

description of the findings regarding the retention of
dietary adequacy changes and of foods and nutrition
knowledge changes.

The relationship of theBe changes to

selected demographic variables and to the frequency of
instructional visits is also discussed.
The population sample
divided
1.

(n = 444) for this study waB

into the following groups for data analysis:
Sample
included

(n = 399) of former EFNEP participants
in the Time 1 and Time 2 data col­

lection only.
2.

Sample
included

The
the two

(n = 45) of former EFN EP participants
in the Time 3 data collection.

separation of the population Bample

(n = 444)

into

groups for analysis was needed to confirm that the

73

74

Time 3 group

(n = 45),

(Table 2), was demographically

representative of the larger sample.
Data were analyzed, usi ng descriptive statistics.

Due

to the nature of the data collection instruments and the
multitude of variables measured,

statistical analysis was

concentrated on meanB and percentages derived from change
scores.

The meanB and percentages were then used for the

comparative analysis of the two population sample groups
over time.

ANOVA,

MANOVA,

and t-tests provided additional

analyses.
The significance level of .05 was used for all
statistical tests of significance level in this study.
Analyses used to test the overall time effect included
Wilks' Lambda,

Pillai's Trace, H o t e l l i n g - L a w l e y 'a Trace,

and Roy's Greatest Root.
effect, the t-test
multiple t-test,

(LSD), Ryan-Einot-Gobril-Welsch

Sidak t-test,

t-test were used.

and Bonferroni

(Dunna)

To measure the overall time-group

effect the Wilks' Lambda,
L awl ey 's Trace,

To test the overall group

Pillai's Trace, Hotelling-

and Roy's Greatest Root were used.

The

tests will not be mentioned in their entirety again as the
results of the data analyses are described.
For ease in presenting and interpreting the data the
following abbreviations of variables were used:

75
Variable Name

Survey
24~Hour Pood Recall

M i l k Group
Meat Group
Vegetable & Fruit
Group
Bread & Cereal
Group
Other Group

Abbreviation
USDA Score
MI IK
MEAT
VEG/PRT
BRD/CR
OTHER
PAMPARE

Michigan Fami ly Pare Survey
Pood Groups
Nutrition
Pood Storage
Pood Preparation
Practices
Shopping
Practices
Pood Information

PDGP
NUT
PDSTO
PDPRP

Ethnic Group
Pood Stamp Family
WIC Family
Age of
Participant
Highest School
Grade Completed
Children in the
Home

RACE
PDSTAMP
WIC

SHOP PR
FNINFO

Family Record Demographics

AGE
ED
CHINHM

Characteristics of the Population Sample
The population sample for this study consisted of 444
former EPNEP participants who participated in the Time 1 ,
Time 2, and Time 5 data collection.

All participants had

received EPNEP instruction for nine months during
enrollment.

76

The demographic characteristics of .the Time 1 and
Time 2 samples of 399 participants shoved the ethnic
population mix to he:
(27#).

White:

258 (65#); Black:

All minorities numbered

participants in this group.

family was two.
227

and 321

(81#) had graduated

The average number of children per
Families receiving Food Stamps numbered

(69 # ) t while 176 families,

coupons

(35#) of the

Host of the participants

(227) were 22-33 years of age,
from high school.

141

111

(44#), were receiving WIC

(Table 2).

Forty-five

(45) participants completed the follow-up

(Time 3) data collection interview five years after
program completion.

The selected demographic

characteristics of these 45 participants and the remaining
population sample
in Table 2.
sample

(n = 399) for this study are presented

Demographic characteristics of the Time 3

(n =■ 45) were representative of the larger sample.

The ethnic population mix of the Baraple was 56# Major i ty
and 44# Hinority.

Most of the participants,

22-33 years of age.
high school.
three.

The majority,

47#, were

82#, had graduated from

The number of children per family averaged

Sixty percent

(60#) of the sample participants

were receiving Food Stamps and 40 # were participating in
WIC.

77
TABLE 2
CHARACTERISTICS OP PARTICIPANTS
TOTAL SAMPLE

Demographics

Participants
(n = 399)

Race:
Maj ority
(White)
Minority
(Black)
Hispanic)
Asian)

Participants
(n = 45)

25B 65*
(258)

25 56*
(25)

141
35*
(111)
(28)
(2)

20 44*
(13)
(5)
(2)

Age of Homemaker
79
227
56
35

19*
57*
15*
8*

7
21
■- 12
5

16*
47*
26*
11*

Education of Homemaker
Under 8th grade
9-1 2th grade/Grad.
Over 12th grade

45
321
33

11*
81*
6*

5
37
3

11*
82*
7*

No. Children in the Home
none
one
two
three
four
five
Bix
seven
eight
nine
twelve
Average

18
104
116
94
35
7
7
2
2
1
0
2.24

3
7
12
10
8
3
0
1
0
1
1
2. 88

No. Families on Food Stamps

277

69*

27

60*

No. Families in WIC

176

44*

IB

40*

Average Monthly Expenditure
on Food

SI 48

No. of Instructional Visits
Time 1 to Time 2
0-6 visitB
7-12 viBits
13-24 visits
25-34 visits

31
168
138
62

21 y e a r s or u n d e r
22-33 y e a r B
33-44 y e a r s
45 or o l d e r

$1 75

4
19
16
6

78

Hypotheses
Three s t a t i s t ic al hypoth es es wer e uBed for this
study.

Stated in the null form and measured by the

24-Hour D i et ar y Poo d Rec a ll and M i c h i g a n Fa mi l y Pare
Sur ve y scores,
1.

the h y p o t h e s e s were:

There wi l l be no signi fi c an t diffe r en ce b e t w e e n
p ar ti ci pa nt s '

2.

1 and Time 2 scores.

There w i l l be no significant
participants'

3.

Time

Time

2 and Time 3 scores.

There will be no signi f ic an t
partic ip an ts '
selected

Time

difference betw e en

difference b e t w e e n

2 and Time 3 scores based

on

demographics.

P R E S E N T A T I O N OF THE FINDINGS
The tables that present most
organized,

insofar as possible,

of the findings are
to include both the

24-Hour D i e t ar y F o o d R e c al l scores and M i c h i g a n Fam il y
P a r e Survey scores
24-Hour

in the same table.

The composite

D i e ta r y Food R ec a l l score is identified as the

U S D A sco re

(maximum points

100) in this study.

The

co mp o n e n t c a te go ry scores from the M i c h i g a n F a m i l y Pare
S u rv ey are pr e s e n t e d

in some of the tables; however, most

of the analyses to respond to the hy po t h e s e s are presented
u s i n g F a m i l y Pare Surv ey composite score
points).

(maximum 128

79

Tables 3 through 12 are addressing the two null
hypotheses:
1.

There will be no significant difference between
participants'

2.

Time 1 and Time 2 Bcores.

There will be no significant difference between
participants'

Time 2 and Time 3 scores.

Table 3 presents the means and percentage change
scores for the Famil y Fare Survey.

Table 4 presents means

and percentage change scores for the USDA score and the
four food groups,

Time 1 and Time 2.

Tables 5 through 8

provide the same information for the 45 participants at
Time

1, Time 2, and Time 3*
Composite USDA scores and composite Family Fare scores

are presented in each table along with the data for each
component category of the Family Fare Survey.
group data are represented by serving size
score tables.

All food

on the USDA

Since the tables are self-explanatory,

the study contained so many variables,
in the tables are not described

and

the data presented

in detail in the text.

USDA scores improved 26# for the 399 participants and
34>8#

for the 45 participants from Time 1 to Time 2.

The

F ami ly Fare Survey scores increased 14*5# for the sample
of 399 and 17.3# for the sample of 45*

Food Group serving

scores and Family Fare Survey component scores also showed
improvement over time.

80
TABLE 3
MEAN AND PERCENTAGE CHANGE OF FAMIL Y FARE SURVEY SCORES
(N=399)

T1
Time

T2

Mean ± Sd

Mean + Sd

PERCENTAGE
CHANGE

FAMILY FARE Category
FDGP

9.77 ± 2.09

12.44 + 2,32

27.35

NUT

8.09 + 2.05

9.97 + 2.19

23.24

FDSTO

9*49 ± 1.78

10.88 + 1.64

14.65

FDPRP

22.98 ± 5.37

24.36 ± 3.57

6.01

SHOPPR

18.78 + 4.36

20.58 + 4.20

9.58

SHOPS

7.70 + 2.66

9.76 + 2.12

26.75

FNINFO

3.70 + 2.54

6.67 + 3.68

80.27

FAMILY FARE

(Composite Score)
87- 99 j’ 10.16

14-54

76.82 +

9-50

Measured score category variable names are explained in the
text. All results are given as 'means + SD',

81
TABLE 4
MEAN AND PERCENTAGE CHANGE OF USDA SURVEY SCORES
(N<399)

T1
Time

T2

Mean + Sd

Mean + Sd

PERCENTAGE
CHANGE

Pood Group Serving

M ILK

1.08 + 1 .13

1.46 + 1.10

35.19

MEAT

2.04 ± 1 .21

2.20 + 1 .01

7.84

VEG/FT

1. 94 ± 1 .47

2.61

+ 2.42

34.54

BREAD/
CEREAL

2.77 + 1 .85

3.19 ± 1.73

15.16

OTHER

1.34 + 2.34

1 .35 ± 1 .69

0.75

USDA (Composite Score)
52,^8 +

24.51

66.50 + 25.81

26.96

Measured score category variable names are explained in the
text. All results are given as ’means + S D 1.

82
TABLE 5
M E A N CHANGE OF FAMILY FARE SURVEY SCORES
(N=45)

T1
Time

Mean + Sd

T2

T3

Mean + Sd

Meani + Sd

FAM IL Y FARE Category

FDGP

9-71

+ 1 .71

12.62 + 2.24

11.51

NUT

8.09 + 2.00

10,16 + 2.10

10.24 + 2.24

FDSTO

9•80 + 1.84

11.13 + 1.49

11.78 + 1.58

FDPRP

22.47 ± 4.04

24.67 + 2.86

27.02 + 3-26

SHOPPR

18.16 + 4.14

20. 56 + 2.98

21 .91 + 3.78

SHOPS

7.42 + 2.56

9.67 + 2.39

10.53 + 1.74

FNINFO

4.44 + 3*21

7.87 + 4.19

9.09 + 4.50

F A MI LY FARE

(Composite Score)
9.82

0
0
tA

88.80 i

CT\

75.64 + 10.12

+ 1 .90

± 9.97

Measured score category variable names are explained in the
text. All results are given as ’means + S D . f Percentage
changes of T1 to T2 are based on T2.

83
TABLE 6
M E A N SCORES OP USDA SURVEY
(N=45)

T1
Time

Mean + Sd

T2

T3

Mean + Sd

Mean + Sd

1-51

Pood Group Serving
MIL K

0.91 ± 0.92

1.56 + 1.03

MEAT

1.84 + 0.85

2.04

1 .02

3.00 + 1.40

VEG/PT

1.64 + 1.27

2.38 + 1.74

3*91 ± 3.18

BREAD/
CEREAL

2.72 + 1.57

2-2 9 + 1. 91

3.91

OTHER

1 .22 + 1.29

2.04 + 2.69

2.20 + 1.58

USDA

+ 1.27

+ 1.92

(Composite Score)
48.52 + 23.12

6 5 .44

23.48

64.93

25-89

Measured score category variable names are explained in the
text. All results are given as ’means + S D . ’ Percentage
changes of T1 to T2 are baBed on T2.

84
TABLE 7
PERCENTAGE CHANGE OP FAMILY PARE SURVEY SCORES
(N= 45 )

T1 TO T2
(SO

T1 TO T3
<*)

T2 TO T3
(*)

P A M I L Y PARE Category

FDGP

29.97

18.54

-8.80

NUT

25.59

26.58

0.79

FDSTO

11.53

20.20

5.84

PDPRP

9.79

20.25

9.53

SHOPPR

13.22

20. 65

6.57

SHOPS

30.32

1.42

8.89

FNINPO

77.23

106.59

15.50

P AM I L Y PARE

(Composite Score)
16.34

22.95

4.73

Measured Bcore category variable names are explained in the
text* Percentage changes of T1 to T2, and T1 to T3 are
based on T1 . Percentage changeB of T2 to T3 are based on T2.

85
TABLE 8
PERCENTAGE CHANGE OF USDA SURVEY SCORES
<N*45)

T1 TO T2
00

T1 TO T3
(SO

T2 TO T3
00

Food Group Serving
MI LK

71.43

65-93

65.93

MEAT

10.87

63.04

47.04

VEG/FT

45.12

38.41

64-29

BREAD/
CEREAL

20.51

43.22

43.22

OTHER

67.21

80.33

7.84

USDA

(Composite Score)
34.84

33.79

0.78

Measured score category variable names are explained in the
text. Percentage changes of T1 to T2, and T1 to T3 are
based on T 1 . Percentage changes of T2 to T3 are based on T2.

86

The 45 participants from Time 2 to Time 3 had an
increase of 4*73# on the Family Fare Survey score ana .78#
on the USDA score.

All food group scores and component

scores increased or remained the same except the Milk
Group scores, which decreased 8.80#.
Major increases are noted when Time
percentage change scores are compared.

1 to Time 3
The USDA score

increased 33.7 9# and the Family Fare Survey score
increased 22.9# for the 45 participants.
Tables 9 and 10 present the results of the t-tests
completed for the 399 participants.

The t-tests were used

to analyze the difference between the high and low USDA
score groups over time.
points,

The low USDA score group is 0-50

and the high group is 51-100 points.

Participants

were placed in one of the two groups based upon their
entry USDA scores.

The t-test results determine if the

difference between the two USDA score groups is
significant at entry and after instruction by the
respective measurement instruments.
In Table 8, t-test results indicate that the Family
F are Survey score was significant between the two USDA
(high and low) groups at entry; however,
not significant at Time 2.

the scores were

The Family Fare component

n utrition score was significant over time; however,

the

components of food practice and food shopping skills were
significant at Time 1 but not Time 2.

87
TABLE 9
T-TEST ON THE FAMILY FARE SCORE BETWEEN HIGH USDA SCORE
GROUP AND LOW USDA SCORE GROUP MEASURED AT T1 AND T2
(N=399)
------- USDA SCORE G RO U P ---------51-100
0-50
(N&202)
(N=1 97)

T-test
Results

M e a n + SD

Mean + SD

FAMILY FARE Category

FDGP

T1
T2

NUT

T1
T2

FDSTO

9.59 + 2.22
12.43 + 2.45

9*96 + 1.95
12.46 + 2.19

NS
NS

+ 2.02
+ 2.16

8.37 + 2.05
10.22 + 2.20

*
*

T1
T2

9.36 + 1.75
10.67 + 1.63

9.63 + 1.80
11.08 + 1.61

NS
*

FDPRP

T1
T2

22.54 + 3.38
24.19 ± 3.66

23*41 ± 3.31
24-52 + 3.49

*
NS

SHOPPR

T1
T2

18.29 + 4.47
20.18 + 4.26

19.27 + 4*20
20.97 + 4.12

*
NS

SHOPS

T1
T2

7.29 + 2.64
9-59 + 2.02

8.09 + 2.63
9.93 + 2.21

*
NS

FNINFO

T1
T2

3-64 £ 2.65
6.55 ± 3-76

3-75 + 2.44
6.79 + 1.82

NS
NS

78.73 + 8.89
89.19 + 9. 86

*
NS

FAMILY FARE
T1
T2

7.81
9.71

(Composite Score)
9-72
74.87 ±
86.77 + 10.34

Measured score category variable nameB are explained in the
text. All results are given as 'means + S D . ' Statistical
significance results were assessed by T-test. NS, not
significant. *, p < 0.05.

88
TABLE 10
T-TEST ON THE USDA SCORE BETWEEN HIGH USDA SCORE GROUP AND
LOW USDA SCORE GROUP MEASURED AT T1 AND T2
(N*399)

-USDA Score G rou p------0-50
51 -100
(N=202)
(N-1 97)

T-test
Results

Mean + SD

Mean + SD

Pood Group Serving
MIL K

T1
T2

0.43 + 0.77
1.25 + 1.04

1 .72 + 1 .06
1.66 + 1.12

*
*

MEAT

T1
T2

1.73 + 1 .22
2.07 + 0.99

2.34 + 1 .12
2.32 + 1.02

*
*

VEG/FT

T1
T2

1.43 + 1.34
2.49 + 3.09

2.44 + 1 .42
2.73 + 1 .49

*
NS

BREAD/
CEREAL

T1
T2

2.25 + 1.86
2.93 + 1.74

3.27 + 1 .69
3.44 ± 1 .67

*
#

OTHER

T1
T2

1.41 + 2.97
1.46 i 2.01

1.28 ± 1 .48
1 .24 + 1 .29

NS
NS

USDA

(Composite Score)
T1
T2

31.54 + 12.94
60.32 ± 23-30

72.71 + 13.62
72.53 + 22.78

*
*

Measured score category variable names are explained in the
text. All results are given as 'means + S D . ' Statistical
significance results were assessed by T-test. NS, not
significant. *, p < 0.05*

89

The USDA scores were significantly different for the
high and low USDA score group over time.

All food group

scores were significant except the Vegetable and Fruit
group that waB not significant at Time 2 and the Other
group, which was never significant.
The 45 participants had similar t-test results.
results are presented

in Tables

These

11 and 12.

The difference between high and low USDA scores for
the 45 participants was significant at Time 1 for the
composite USDA score and each food group-serving Bcore.
Only the m ea t-Berving USDA Bcore remained significant at
Time 2.
On the Family Fare score the difference between the
high and low USDA scores measured at Time 1, Time 2, and
Time 3 is significant only at Time 3 for the food
Btorage.
at Time 1.

USDA composite score difference was significant
The four food groups were alBO significant at

Time 1, and the Meat group was also significant at Time 2.
The USDA score waB significantly different between the
high and low USDA score groups at Time 1; this
significance was sustained over Time 2 and Time 3*

The

Meat group continued to show significant difference also
at Time 2.

90
TABLE 11
T-TEST ON THE FAMILY FARE SCORE BETW EE N HIGH USDA SCORE
GROUP AND LOW USDA SCORE GROUP M E A SU RE D AT T 1 , T2, AND T3
(N-45)
------- USDA SCORE GRO U P ----51-100
0-50
(N-21)
(N=24)

T-test
Results

Mean + SD

Mean + SD

FAMILY FARE Category
F DG P

T1
T2
T3

10.17 +_ 1 .61
12.54 + 2.36
11 .37 + 1.91

9.19 + 1 .72
12.71 ± 2.15
11 .67 + 1.93

NS
NS
NS

NUT

T1
T2
T3

8.08 4- 2.32
10.29 + 2.40
9.96 + 2.63

8.10 + 1.61
10.00 -f- 1.73
10.57 ± 1.69

NS
- NS
NS

FDSTO

T1
T2
T3

9-38 + 2.06
10.92 + 1.53
11.17 4* 1.79

10.29 ± 1 .45
11.38 ± 1.43
12.48 + 0.93

NS
NS
*

FDPRP

T1
T2
T3

22.08 + 3.93
3.10
24.67
27.00 + 3-56

22. 90 + 4.22
24.67 + 2. 63
27.05 ± 2.97

NS
NS
NS

SHOPPR

T1
T2
T3

18.12 ±_ 3.66
20.71 ± 2.54
21 .33 + 4.41

18.19 + 4.72
20.38 ± 3-47
22.57 + 2.86

NS
NS
NS

SHOPS

T1
T2
T3

8.04 ± 2.26
9.79 + 2.50
10.29 ± 1 .88

6.71 ± 2.76
9.52 + 2.32
10.81 ± 1.57

NS
NS
NS

FNINFO

T1
T2
T3

4-42 4- 3.09
8.29 + 4-40
9.00 ± 4.42

4-48 + 3.41
7.38 + 3.98
9-19 ± 4.70

NS
NS
NS

75.38 ± 12.06
9-30
88.67 +
7.65
95.14

NS
NS
NS

f a m i l y - FARE

T1
T2
T3

(Composite S c o r e )
8.38
75.87 ±
88.92 + 10.45
91.12 ± 11.46

text. All results are given as 'means + S D . 1 Statistical
significance results were assessed by T-test. NS, not
significant. *, p < 0.05.

91
TABLE 12
T-TEST ON THE USD A SCOR E B E T W E E N H I G H USDA SCORE
G RO U P AND LOW USDA SCORE GROUP M E A S U R E D AT T 1 , T2, AN D T3
(N*45)
--------------- USDA Score G r o u p ----------Pood Gro up

0 -5 0

51-100

(N*24)

( N *2 1)

Me a n

SD

Mean + SD

T-test
Results

MILK 'SERVING
T1
T2
T3

0.38 ±. 0.49
1.50 + 0.88
1. 50 + 1.14

1 .52 ±_ 0. 93
1.62 ±_ 1 .20
1.52 ± 1.44

*
NS
NS

1.46 + 0.78
1.67 ± 1.01
2.71 ± 1 .46

2.29 + 0.72
2.48 ± 0.8 7
3.33 + 1 .28

#
*
NS

1 .08 ± 1 .21
2.58 + 1 .01
3.79 + 1 .46

2.29 + 1.27
2.14 + 1.68
4.05 ± 3.25

*
NS
NS

*
NS
NS

ME AT SERVI N G
T1
T2
T3
V E G / P T SERV IN G
T1
T2
T3

B R E A D / C E R E A L SERVI NG
T1
T2
T3

2.25 + 1 .22
3-08 + 2.21
3*83 T 2.24

3.29 + 1.76
3.08 + 1.54
3.83 £ 1.52

T1
T2
T3

1.37 ±. 1 .35
1.58 + 1.35
2.25 ± 1.45

1 .24
1.05
2.57 + 5.22
2.14 + 1.65

OTHER

USDA

*
NS
NS

(Composite S c o r e s )
T1
T2
T3

30.25 ±. 13.74
63-67 ± 25.23
64*71 ± 27-35

9.98
69.43 +
67.48 ± 21.75
65.19 + 24.79

*
NS
NS

Measured Bcore category v a ri a bl e names are explained in the
text. All results are given aB fmeans + S D . f S tatistical
s i g n i fi c an ce resultB wer e assessed by T-test. NS, not
significant. *, p < 0.05.

92

Tables

13 and 14 present the ANOVA tests on the

difference between the average Family Fare scores and USDA
scores measured at Time 1 and Time 2 for the 399
participants.

ANOVA results show that the difference

b etwe en the average Fami ly Fare scores over time is
significant for all components and the composite Family
Fare score.

The difference between average USDA score and

the Food Group scores was also significant except for the
other group which was not significant.
vegetable/ fruit,
reached

The milk, meat,

and bread and cereal mean serving scores

.001 significance.

TableB

15 and 16 provide the results of the ANOVA

tests for the 45 participants.

The results show that the

difference between the average Family Fare Survey score is
significant over time.

The USDA composite score and the

Food Group Serving scores are also significant over time.
The tests reject the null hypothesis on the average
Fam il y Fare score for 399 participants at the

.05

significance level that there is no overall time effect
and no group effect.

The tests fail to reject the

hypothesis that these is no overall time-group effect on
the average Family Fare score.
The Family Fare Survey component scores for 399
participants affect the hypotheses as follows:

93
TABLE 13
ANOVA TEST ON THE AVERAGE FAMILY FARE SCORES
MEASURED AT T 1 , AND T2
(N—3 99)
---------Repeated M e as ur e— —
T2
T1
Mean + SD
Mean + SD

ANOVA
Test
Results

F A M I L Y FA R E Category
FDGP

9.77 ± 2.09

12.44 + 2.32

* (F=336.02)

NUT

8.09 + 2.05

9.97 + 2.19

* (F<=230.29)

FDSTO

9-49 ± U 7 8

10.88 + 1 • 64

* ( F d 79.38)

FDPRP

22.98 ± 3.37

24.36 + 3.57

*

(Fe73.09)

SHOPPR

18.78 ± 4.36

20.58 +

*

(Fe69.09)

4.2

SHOPS

7.7+

2.66

9-76 + 2.12

* (Fe280.87)

FNINFO

3.7 + 2.54

6.67 ± 5-68

* (Fc245-06)

FAMILY FARE

(Composite Score)
76.83 +

9*5

87.99 + 10.16 * (F*527.75)

Measured score category variable names are explained in
the text. All results are given as 'means + S D . ' Statistical
significance results were assessed by ANOVA. NS, not
significant. **, p < 0.03- *, p < 0.001. F value from the
tests are listed below *.

94
TABLE 14
ANOVA TEST ON THE AVERAGE USDA SCORE MEASURED
AT T1 AND T2
(N*399)
ceecceeteecccccscctcececcecctcceettteteicteiiieeec

---------Repeated M e a s u r e ----T1
T2
M e a n + SD
Mean + SD

ANOVA
Test
Results

Food Group Serving

1 .08 + 1 .13

MEAT

2.04 + 1 .12

VE&/FT

1 .94 + 1 .47

BC/SEREAL

2.77+1

OTHER

USDA

1.46 +

1.1

2.2 + 1.01
2.61

+ 2.42

* (F*28.64)
**

(F*5.28)

* (Fc24.44)

in
00
•

MILK

3.19 + 1 .73

* (F*12 .3 1 )

1.34 + £ 34

1. 35 + 1 . 69

NS

(Composite Score)
52.38 + 24.51

66.5 + 23.81

* (F*96.34)

Measured score category variable names are explained in
the text. All results are given aB 'means + S D . ' Statistical
significance results were assessed by ANOVA. NS, not
significant. **, p < 0.05. *, P < 0.001. E value from the
tests are listed below *.

95
TABLE 15
ANOVA TEST ON THE AVERAGE FAM I LY FARE SCORES
M EASURED AT T 1 , T2, AND T3
(N*45)

------------- Repeated M e a s u r e ---------T1
T2
T3
Mean ± SD
Mean + SD
Mean + SD

ANOVA
Test
Results

F ami ly fare Category
FDGP

9-71+1 .71

12.62+2.24

11.51+ 1 - 9

* (F * 2 1.93)

NUT

8. 09+2.00

10.16+2.10

10.2 4 ± 2 .24

* (F*1 8.34)

FDSTO

9.80±1 .84

11-13±1 -49

11.7 8 ± 1 .58

* (F*27-97)

FDPRP

22.47±4-04

24.60±2.86

27-02±3.26

* (Fe26.30)

SHOPPR

1 8 . 16±4.14

20.56+2.98

21.91+3-78

* (F*1 2.80)

SHOPS

7.42+2,56

9-67+2.39

10.53+1 -74

* (F*33-19)

FNINFO

4-44+5•21

7.87+4.19

9.09+4.50

* (F*39-28)

93.00+9-97

* (F*52.75)

FAMILY FARE

(Composite Score)

75-64+1 0.12

88.8+9.82

Masured score category variable nameB are explained in the
text. All results are given as 'Mean ± Sd.' Statistical
significance results were assessed by ANOVA. NS, not
significant. **, p < 0.05. *» p < 0.001.

96
TABLE 16
ANOVA TEST ON THE AVERAGE USDA SCORES MEASURED
AT T1, T2, AND T3
(N*45)

----------- Repeated M e a s u r e ---------ANOVA
T1
Mean + SD

T2
Mean +, SD

TeBt
Results

T3
Mean + SD

Food Group Serving
MILK

0.91+0.92

1. 56+1 .03

1 . 51+1 .27

*

MEAT

1.84+0.85

2.04+1.02

3.00+1.40

* (FM4.38)

VEG/FT

1.64+1.57

2.38+1.74

3.91+3.18

* (F=10.33)

BD/CL

2.73+1.57

3.29+1 .91

3*91+1 .92

**

(F*5.12)

OTHER

1.22+1.29

2.04+3.69

2.20+1.53

*

(F=5•76)

65-44+23.48

64-93+25.89

USDA

(F&6.48)

(Composite Score)
48.53+23-12

* (F*7-24)

Masured score category variable names are explained in the
text. All results are given as 'Mean ± Sd.' Statistical
significance results were assessed by ANOVA. NS, not
significant. **, p < 0.05* *» p < 0.001.

The tests reject the hypothesis that there is no
overall time effect and fail to reject that there
is no group effect,

and no time-group effect for

the average food

group score.

The tests reject

the hypothesis that

time effect,

no group effect; however, they

and

there is no

fail to reject the time-group effect for the
average nutrition score.
The tests reject the hypothesis that there is no
overall time effect and no group effect; however,
the tests fail to reject the time-group effect for
the average food

Btorage score.

The tests reject

the hypothesis that

overall time effect,

there is

no

and no group effect; however,

they fail to reject the time-group effect for the
average food practice score.
The teBts reject the hypothesis that there is no
overall time effect,
is no group effect,

and fail to reject that there
and no time-group effect for

average shopper score.
The tests reject the hypothesis that there is no
overall time effect,
is no group effect,

and fail to reject that there
and no time-group effect for

the average shopping skills score.

98

7.

The tests reject the h yp ot h e s i s that there
time effect,

is no

and fail to reject that there

gr o u p effect,

is no

or no overall t im e- gr ou p effect for

th e average source of in f or m a t i o n score.
The tests reject the h yp o th e s i s at the

.05

s ig n i f i c a n c e level for the 599 p a r t i c i p a n t s on the average
U SDA score th at there

is:

1.

Ho overall time effect.

2.

No gr o u p effect.

3.

No overall t im e- g r o u p effect.

Therefore,

there is a significant

difference

U S D A scores for the 39 9 p a r t i c ip an t s from Time

in the

1 to

Time 2.
The tests reject the h y po t h e s i s for the 399
p a r t i c ip an ts at the
1.

.05 signifi ca nc e level that there is:

No overall time effect,

no overall group effect,

and no overall t i m e - g r o u p effect on the average
m ilk group score.
2.

N o overall time effect,

no overall group effect,

and no overall t im e -g ro up effect on the average
m eat gr o u p score.
3.

No time effect,

no group

t i m e - g r o u p effect on the

effect, and no overall
average v e g e t ab le /f ru i t

g rou p score.
4.

No overall time effect,
t im e- g r o u p effect on the
cereal group score.

no group

effect,

and no

average bread and

99

The tests fail to reject the hypothesis that there is
no overall time effect,

no group effect,

or overall

time-group effect for the average other group score.

All

Food Group scores except the other group score increased
significantly over time.
The tests reject the hypothesis on the average Family
Fare score for 45 participants at

.05 significance level

that there is no overall time effect and fail to reject
that there is no group effect and no overall time-group
effect on the average composite Family Fare Bcore.
The average Family Fare Survey component scores for
the 45 participants affect the hypotheses as follows:
1.

The tests reject the hypothesis that there iB
no overall time effect and fail to reject that
there is no group effect and no overall timegroup effect for the average food group score.

3.

The tests reject the hypothesis that there is no
overall time effect and fail to reject that there
is no group effect and no overall time-group
effect for the average nutrition score.

4.

The testB reject the hypothesis that there is no
overall time effect and fail to reject the group
effect and the overall time-group effect for the
average food practice score.

1 00

5*

The tests reject the hypothesis that there is no
overall time effect and fail to reject that there
is no group effect and no overall time-group
effect for the average shopper score.

All Family Fare Survey component scores and the Family
F are Survey composite score showed there was a time effect
on the average scores and that the scores over time did
change s i g n f i c a n t l y .
The tests reject the hypothesis for 45 participants at
the 0.5 significnace level on the average USDA score that
there 1b:
1.

No overall time effect.

2.

No group effect.

3.

No overall time-group effect.

Therefore,

there is a significant difference in the

average USDA Bcore for the 45 participants from Time 1 to
Time 2, Time 2 to Time 3, and Time 1 to Time 3*
The tests reject the hypotheses for the 45 par ti ci ­
pants at the 0.5 significance level that there is:
1.

No overall time effect,

no group effect,

and no

overall time-group effect for average milk group
score.
2.

No overall time effect and no group effect;
however,

the tests fail to reject the hypothesis

that there is no overall time-group effect for
average meat group score.

101

3*

No overall time effect and no group effect;
however,

the teats fail to reject the hypothesis

that there is no overall time-group effect for
average vegetable/fruit score.
4.

No overall time effect,

and fail to reject the

hypothesis that there is no group effect,

and

no overall time-group effect on the average
bread and cereal group score.
5*

No overall time effect,

and the tests fail to

reject the hypothesis that there is no group
effect and no overall time-group effect on the
average other group score.

All food group serving scores incresed significantly
from Time 1 to Time 2, Time 2 to Time 3, and Time 1 to
Time 3*
Table

17 presents the percentage change score by USDA

score and Family Fare score for each of the selected
demographics for the 399 participants at Time 1 to
Time 2.

It appears the Minority participants and

participants 22 to 33 years of age, with a high school
education who had 25 to 34 instructional visits had the
most percentage change in the USDA score.

Family Fare

Survey scores changed among Food Stamp participants and
among particpants who were 33 to 44 years of age.

102
TABLE 17
PERCENTAGE CHANGE OP U S DA/FAMILY FARE SCORES
B ETWEEN T 1 t AND T2
(N=399)
S

i : E

t : X

e C

=

C

S

E

S

5 S

S

! : S

S

E

e s i : S

C

C

C

£ C

E

C

S

S

S

U

S

E

£ &

5 s £ E

E

C

^ s £ ^ ^ £ £ =

=

E

---------Percentage Change-----Demographic
Variable

R AC E

Category

Majority
Minority

USDA
(#)

FAMFARE
(#)

N

25.64
29.42

12.57
18.36

258
141

FDSTMP

Yes
No

25.58
29.94

14.93
13-68

122
277

WIC/FOCUS

Yes
No

18.57
34.78

12.68
16.01

223
179

AGE

21
22
33
45

or under
- 33
- 44
or older

15.51
28.29
36.28
32.01

16.07
13-40
17.62
13.53

79
227
58
35

EDUC

Under 8th
9 -12th/Grad
Higher

23.83
28.59
16.45

20.08
13.91
13.79

45
321
33

13.39
32.31
23-23
25.42
35.48
19.93
32.37
1.69
412.00
-73.33

15-76
14.72
13.24
15-51
13-70
18.27
12.43
17.68
12.55
0.00

18
104
116
94
35
20
7
2
2
1

21.96
25.65
28,49
67.98

10.55
14.14
14.14
67.98

31
168
138
62

None
One
Two
Three
Four
Five
Six
Seven
Eight
Nine

CHINHM

VISIT

3 - 6
7 - 1 2
13-24
25 - 34

Measured score category variable names are explained in
the text. The percentage change is based on measure T 1 .

£

103

Table 18 presents the Family Fare Survey's percentage
change scores for the 45 participants at Time 1 to Time
2.

Minority and Food Stamp participants who were 33 to 44

y ear s of age with 13 to 24 instructional visits appeared
to have increased their USDA score.

This was also true

for the Family Fare Survey.
Table

19 presents percentage change scores for the 45

p articipants between Time 2 and Time 3 for the same
selected demographics.

Again, minor i ty participants on

Food Stamps and WIC Beemed to have increased USDA scores
and Family Fare Survey scores.
Table 20 presents the percentage change scores for
Time

1 to Time 3*

The minority participants,

and

participants on Food Stamps and WIC had the largest
percentage change.

Participants 33 to 44 years of age

achieved on the USDA score but not on the Family Fare
Survey score.

Participants 21 years and younger alBO

achieved.
The minority ethnic group had the largest percentage
of change on both the USDA score and the Family Fare
Survey score over all three time periods.

Participants

Food Stamps had larger percentage changes over time than
non-Food Stamp participants; however, WIC participants
increased their scores more than non-WIC participants at
Time 2 to Time 3 and Time 1 to Time 3*

USDA scores

in

104
TABLE 18
PERCENTAGE CHANGE OP U SDA/PAMILY FARE SCORES
BETWEEN T 1 , AND T2 B Y SELECTED DEMOGRAPHICS
(N=45)

--------- Percentage Change---------Demographic
Variable

R ACE

USDA
Category

Majority
Minority

PAMPARE
(#)

N
($)

34.45
35.30

13.86
22.28

25
20

PDSTMP

Yes
No

38.24
29.70

17.82
16.74

27
18

WIC/POCUS

Yes
No

32.14
36.62

15.56
18.59

18
27

AGE

21
22
33
45

or under
- 33
- 44
or older

40.13
34.84
56,98
-15-09

23.24
15.40
19.30
13.89

7
21
12
5

EDUC

Under 8th
9-12th/Grad
Higher

56.74
27.80
133-34

-1 6.90
1.31
1.73

5
37
3

81 .95
93.92
21.17
18.12
26.74
-14.61
553-85
42.86

39.69
21.76
15.23
12.92
18.37
16.18
9.52
9.46

3
7
12
10
8
3
1
1

32.31
25.45
68.05
-1 .03

33.33
13.36
16.32
23.97

4
19
16
6

CHINHM

VISIT

None
One
Two
Three
Pour
Five
Seven
Twelve
3 - 6
7 - 1 2
13-24
25 - 34

Measured score category variable names are explained in the
Text. The percentage change is based on measure T1.

105
TABLE 19
PERCENTAGE CHANGE OP US DA/FAMILY F A R E SCORES
BETWEEN T2, AND T3 BY SELECTED DEMOGRAPHICS
(N=45)
------ percentage

Change-------

Demographic
Variable

Category

US DA
<30

FANFARE
(SO

N

Majority
Minority

-4.84
3.85

3-02
6.93

25
20

FDSTMP

Yes
No

5.17
-8.17

6.20
2.59

27
18

WIC/FOCUS

Yes
No

7-67
-6.17

8.77
2.17

18
27

RACE

AGE

21
22
35
45

or under
- 35
- 44
or older

-2.08
-8.19
-5.56
64.44

9.02
5.30
1.68
3.77

7
21
12
5

EDUC

Under 8th
9-12th/Grad
Higher

3.56
-2.62
13.79

6,55
4.92
-0,43

5
37
3

None
One
Two
Three
Four
Five
Seven
Twelve

-3.61
-4.60
1.73
6.17
-10.77
-22.60
10.59
51.67

10.51
6.02
0.95
6.68
5.22
2.20
9.78
2.47

3
7
12
10
8
3
1
1

-27.62
-17.30
4-42
85.72

-2.99
5.36
7.24
1.64

4
19
16
6

CHINHM

VISIT

3 - 6
7-1 2
13-24
25 - 34

Measured score category variable names are explained in the
Text. The percentage change is based on measure T2.

106
TABLE 20
PERCENTAGE CHANGE OP USDA/PAMILY PARE SCORES
BETWEEN T 1 t AND T3
(N-45)
££S££S:5555SS££5££S£SSS5 & —— 2Si
^—Po^non
n itn Hn
on eyo_____
ivlLLlII+UwQW
vllmipyV
Demographic
Variable

RA CE

Category

US DA
W

PAMPARE
(*>

N

Maj ority
Minority

27.93
40.51

17-30
30.76

25
20

PDSTMP

Yes
No

45.38
19.10

25.13
19.77

27
18

WIC/POCUS

Yes
No

42.29
28.19

25.69
21 .16

18
27

AGE

21
22
33
45

or under
- 33
- 44
or older

37.22
23.80
48.26
39.62

34.35
21 .52
21 .31
18.18

7
21
12
5

EDUC

Under 8th
9-12th/Grad
Higher

62.33
24-46
165-52

37.85
22.13
11.24

5
37
3

None
One
Two
Three
Pour
Pive
Seven
Twelve

75.39
85.00
23.26
25.40
13.09
-33.91
623.08
116.67

54.36
29.09
16.32
20.46
24.55
24.55
20.24
12.16

3
7
12
10
8
3
1
1

-4.23
3.75
75.48
83.80

29.35
19.43
24.74
26.01

4
19
16
6

CHINHM

VISIT

3 - 6
7-1 2
13-24
25 - 34

Measured score category variable nameB are explained in the
Text. The percentage change is based on measure T 1 .

107

increased the most from Time
instructional viBits.

1 to Time 2 for 13 to 24

This change was sustained over

time and also showed a large increase

{15%) from Time 1 to

Time 3Correlations betwe en the USDA score and Family Fare
Survey scores are provided
populations.

in Table 21 for both the sample

The correlations for the 399 participants

are significant; however,

the Time 2 USDA Score to

Time 3

F amil y Fare score is a significantly positive
relationship.

This general relationship pattern does not

exist with the 45 participants.

The Family Fare Survey

score relationship is stronger than the USDA score
relationship Time 1 to Time 2.
The grand mean of the USDA score and Family Fare
Survey score for 45 participants confirms the change in
scores from Time 1 to Time 2 and Time 2 to Time 3 for the
Fam il y Fare Survey score

(Table 23).

Grand mean scores

increased for the 399 participants from Time 1 to Time 2.
The USDA score regressed

.78# from Time 2 to Time 3

(Table 23).
Tables 24 through 37 present the MANOVA tests over
time to confirm the findings.

MANOVA's look at the

demographic effects on the average USDA scores and Family
Fare scores.

The purpose of the MANOVA teBt is to test

the effect of the demographic and the time variables to
veri fy if their effect is significant.
29 represent the 399 participants.

Tables 24 through

108
TABLE 21
C ORRELATION BETW EE N USDA SCORE AND FAMIL Y FARE SCORE

Correlation Coefficient
------- U S D A -------T2
T1

FAMI LY F A R E ---T1
T2
(N=399)

USDA T1

1 .00
**

USDA T2

0.29

FAMI LY
FARE T1

0.20

F A M IL Y
F A R E T2

0.11

1 .00
**

**

**

*

T1

1 .00

0.05

0.51

0.23

-USDAT2

1*00

---- FAMFARE F A R E ----T1
T2
T3

T3
(N=45)

USDA T1

1.00

USDA T2

0.13

1.00

USDA T3

-0.05

0.25

1.00

FAMILY
FARE T1

0.01

-0.10

0.09

1.00

FAMILY
FARE T2

-0.09

0.21

0.25

0.55

1.00

0.27

0.26

0.55

FAMILY
F AR E T3

M
0.06

0.36

1*00

*, correlation coefficient is significantly different at
the .05 level.
**, correlation coefficient is
significantly different at the .01 level.

109
TABLE 22
GRAND M E A N OP C O M P O S I T E USDA S CO R E AND F A M I L Y P A R E SCORE
B Y T 1 , T2, AND T3
(N«399 And N*:45)

FAMILY PARE

USDA
Time

Mean + Sd

Mea n + Sd

(N=45)
T1

48.53 + 23.12

75.64 + 10.12

T2

65-44 + 23.48

88.8 0 +

9-82

T3

64.93 + 25.12

93.00 +

9.97

(n=399)
T1

52.38

T2

66. 50 + 23.80

24.51

76.82 +

9.49

87.99 + 10.16

M e as ur ed score ca t e g o r y v a r i a b l e names are explained
text. All results are give n as 'Means + S D . '

in the

110
TABLE 23
P ERCENTAGE C H AN GE OP C O M P O S I T E USD A SC O R E AND P A M I L Y P A R E
SCO R E B Y T 1 , T 2 t AN D T3
(N=399 And N=45)

USDA
Time

P A M I L Y PA R E

(*)

<*)
(N=45)

T1 TO T2

34.84

17.40

T1 TO T3

33*79

22.95

T2 TO T3

-0.78

5.68

(n=399)
T1 TO T2

26.96

14-54

M ea su re d score category v a ri ab l e names are explained in the
text. Pe rc e n t a g e change T1 to T2 and T1 to T3 are based on
T1. P er ce nt ag e change T2 to T3 is based on T2.

111

Table 24 BhowB “the overall time effect on the
difference between Time 1 and Time 2 on the average USDA
score and Family Fare Survey scores by racial ethnic
groups of Majority and Minority.

The USDA score and

Fam il y Fare Survey score are significant for time and
race.

The Family Fare Survey score is significant for

time, racial group and for the overall time and racial
group effect.
Table 25 shows that the USDA and Family Fare Survey
score difference between Time 1 and Time 2 is only
significant for overall time effect for the Food Stamp
particpants.
Table 26 provides support for the USDA score and
F ami ly Fare Survey score difference betw e en VIC and
non-WIC participants that is significant in overall time
effect, VIC group effect and overall time-VIC group
participant effect.
Table 27 shows that the USDA and Family Fare Survey
score difference between various age groups of the
population sample is significant for Time 1 and Time 2
in overall time effect.

The Famil y Fare Survey is also

significant in overall age-group effect.

However,

neither

USDA nor the Family Fare Survey scores are significant in
overall time-age effect for the population.

112
TABLE 24
MANOVA TEST ON THE USDA/FAMILY FARE SCORE DIFFERENCE BY
MAJORITY AND MINORITY ETHNIC GROUP MEASURED AT T1 AND T2
(N=399)

-Ethnic Group
Score

Maj ority
(N^258)
Mean + Sd

Minority
(N«1 41 )

MANOVA
Test

Mean + Sd

USDA
T1

52.81

+ 24.09

51.60 + 25-33

T2

66.35 ± 24.30

66.78 + 22.96

T1

78.36 +

74.01

T2

88.21

a,NS,NS

FAMI L Y FARE
9.19

+ 10.25

+

9.44

87-60 + 10.02

a,b,c

Measured score category variable names are explained in the
text. All results are given as 'means ± S D . ' Statistical
significance results were assessed by MANOVA test. NS, not
significant, 'a', significantly different In overall time
effect, fb', significantly different in overall race effect.
'cr, significantly different in time*race effect, p < 0.05.

113
TABLE 25
MANOVA TEST ON THE USDA/FAMILY PARE SCORE DIFFERENCE
BETWEEN FOODSTAMP AND NON-FOODSTAMP GROUP AT T 1 f AND T2
(N=399)

-Foodstamp GroupScore

No
(N;=277)
Mean + Sd

Yes
(N=1 22)

MANOVA
Test

Mean + Sd

USDA
T1

53.65 + 25-82

51.83 + 23.94

T2

69-71

+ 25.21

65.09 + 23.97

a,NS,NS

FAMI L Y FARE
T1

78.07 +

T2

88.75 + 10.58

8.79

76.27 +

9.75

87.66 ± 10.06

a,NS,NS

Measured score category variable names are explained in the
text. All results are given as 'means ,+ SD. ' Statistical
significance results were assessed by MANOVA test. NS, not
significant. 'a'f significantly different in overall time
effect, 'b', significantly different in overall foodstamp
effect. * c ’, significantly different in time*foodstamp
effect,
p < 0.05*

nil
TABLE 26
MANOVA TEST ON THE USDA/FAMILY PARE SCORE DIFFERENCE
BETWEEN WIC AND NON-WIC GROUP AT T 1 f AND T2
(N=399)
£ C

£ S S

S

S S

S 5 5 R

« £ S

f i £ £ £ S

£ S

S

S

5 9 S

S

i ; 5 C

5 « S

S

5 £ £ £ £ S

5 K

5 S

S

5 « £ £ £ £ £ £ C

S

£ S

S

--------WIC —
Score

No
(N*223)
Mean + Sd

Yes
(N«176)

MANOVA
Test

Mean ±_ Sd

USDA
T1

48.51 ± 23.3

57.29 + 24.5

T2

65-38 + 23.5

67-93 + 24.0

a ,b ,c

FAMI LY FARE
T1

76.51

T2

88.78 ± 9.88

+ 9.71

77-20 +.

9.23

86.99 + 10.40

a,b, c

Measured score category variable names are explained in the
text. All results are given as ’means ± S D . ' Statistical
significance results were assessed by MANOVA test. NS, not
significant, 'a', significantly different in overall time
effect, ’b', significantly different in overall WIC group
effect, 'c', significantly different in time*WIC effect,
p < 0.05.

115
TABLE 27
MANOVA TEST ON THE USDA/FAMILY FARE SCORE DIFFERENCE
BETWEEN DIFFERENT AGE GROUPS AT T 1 , AND T2
(N=399)

-AgeScore

21 Y r s /u nd er
(N=79)

22-53 Yr s
(N=227)

33-44 Yrs
(N=58)

45 Y r s /o ld er
(N=35)

M e a n + Sd

M ea n + Sd

Me an + Sd

Mean + Sd

T1

56.34+ 25 .9 4

5 2 .6 6+ 24 .1 7

4 9 . 0 9 + 2 3* 42

47.14+24.57

T2

65.08+26.33

67 -56+22.85

66.90 +2 4. 72

6 2 .2 3+ 2 2. 78

USDA

M A N O V A test:

a,NS, NS

F A M I L Y FA R E
T1

7 2. 2 9 + 9.43

7 7 . 70 + 9.1 8

7 9 . 8 9 ± 9.46

77.26^8.79

T2

83. 91 ±10. 91

88.11+9-67

93.26+8.72

87.71±9*98

MA NO V A t e s t : a , b , N S

M e as ur ed score c a te g or y v a r i a b l e names are expla in ed in the
text. Al l results are given as 'means + S D . ' S ta ti st ic al
signif ic an ce results we r e assessed by MA NO V A test. NS, not
significant, 'a', s i g n i f i c a n t l y different in o v e ra ll time
effect, 'b', si gn i f i c a n t l y d if fe re nt in overall age group
effect, 'c', s ig ni f i c a n t l y different in ti m e * a g e effect,
p < 0.05.

116

T abl e 28 shows that the USDA and F a m i l y Fa re Surv ey
Bcore diffe r en ce b e t w e e n educa ti on al leve l of the
participants

is signi fi ca n t over time; however,

F a r e Survey score is also s i gn if ic an t

the F a m i l y

in overall

e d u c a t io na l group p o p u l a t i o n effect.
Tab le 29 shows that the diffe re nc e b e t w e e n USDA and
F a m i l y Far e Su r v e y scores over time,
c h i ld re n in a family,

for the number of

is s i gn if ic a nt in overall time

effect only.
Table 30 shows that the di ff er e n c e b e t w e e n USDA and
F a m i l y Fa re S u rv e y scores over time, b e t w e e n the number of
i ns t r u c t i o n a l visits,

is not s ig ni fi c an t for overall time

effect,

or overall t i m e - g r o u p effect.

g r o u p effect,

T a b le s 31-37 p r e se nt the MANOVA test
p a r t i c i p a n t s at Time

results for 45

1, Time 2, and Time 3*

Table 31 shows that race is si gnificant for overall
time effect for th e three time periods on average USDA and
F a m i l y F a r e Survey scores.

The F a m i l y Fare S u rv ey score

is also signif ic a nt in overall t im e- ra ce effect.
T ab l e 32 presents the USDA and F a m i l y Fa r e Su rv e y
s co r e diffe re nc e b e t w e e n F o o d Stamp and non-Food Stamp
p ar t i c i p a n t s

over time.

in overall time effect

The di ff er e n c e s are signifi c an t
only.

Table 33 shows the USDA and F a m i l y Fa re S u r v e y score
d i f f e r e nc es by WIC and non-WIC participants.

The

d i f f e r e nc es are signif ic a nt only in overall time effect.

117
TABLE 28
MANOVA TEST ON THE USDA/FAMILY FARE SCORE DIFFERENCE
BETWEEN DIFFERENT EDUCATIONAL LEVELS AT T 1 , AND T2
(N=399)

—
Score

Under 8th
(N=45)
M e a n +. Sd

E d u c a t i o n L e v e l --------------9- 1 2th/Grad
(N=321)
Mea n ± Sd

High er
(N=33)
Mean ±. Sd

USDA
T1

51.02 + 23*95

51.94 + 24-42

58.55 i 26.06

T2

65.18 ± 19.73

66.79 + 23. 99

68.18 + 2 7. 2 0
M A N O V A teBt:

a,NS,NS

F A M I L Y FARE
T1

71. 38 ±

T2

85.71

9.05

+ 10.09

77.15A

9.44

87 - 8 8 ± 10.25

81 .06 ±.

7.55

92.24 +

8.23

M A N O V A test:

a,b,NS

M e a s u r e d score c a te go ry v a r i a b l e names are explained in the
text. All results are given as 'means ± S D . ' Statistical
s i g n i fi c an ce results we r e assessed b y M A N O V A teBt. NS, not
significant, 'a*, s i g n i f i c a n t l y differ en t in overall time
effect, ' b ' , s i g n i f i c a n t l y d i ff er en t in overall education
effect, 'c', s i g n i f i c a n t l y d ifferent in t i m e * e d u c a t i o n effect,
p < 0.05-

118
TABLE 29
MANOVA TEST ON THE USDA/FAMILY PARE SCORE DIFFERENCE
BETWEEN NUMBER OP CHILDREN AT T 1 , T2, AND T3
(N=399)
D

Score

q t \q o

4*

Time One

USDA

72.28
76.29
77.13
77.20
77.40
79.10
80.43
73.50
73.50
66.00

N

Time Two

Mean + Sd
None
One
Two
Three
Four
Five
Six
Seven
Eight
Nine

Moft

+ 17.44
+ 27.08
± 23.79
+ 23.76
+ 22.82
± 26.37
± 24.74
+
7.07
±.17.68
+
0.00
#*

Mean ±_ Sd
83.67
87.52
87.34
89.17
88.00
93.55
90.43
86.50
82.50
66.00

+
+
+
+
±
±
+
+
±
±

21.62
25.44
21 .27
25.89
24.04
23.75
16.97
26.87
2.83
0.00

18
104
116
94
35
20
7
2
2
1

MANOVA test: a ,NS,NS

FAMI LY PAR E
None
One
Two
Three
Pour
Five
Six
Seven
Eight
Nine

Mean ± Sd
72.28
76.29
77.13
77.20
77.40
79.10
80.43
73.50
73-50
66.00

±
±
±.
±
±
±
±
±_
±
+

8.43
9.55
9*10
9.30
10.73
11 .21
8.60
0.71
13.44
0.00

Mean ± Sd
83-67
87-52
87-34
89.17
88.00
93.55
90.43
86.50
82.50
66.00

±
9.57
±
9.88
± 10.61
± 10.19
± 9.09
±
9.71
+ 7.32
±
3*54
± 13.44
+ 0.00

MANOVA test:

18
104
116
94
35
20
7
2
2
1
a ,NS,NS

Measured score category variable names are explained in the
text. All results are given as 'means + S D . ' Statistical
significance results were assessed by MANOVA test. NS, not
significant, ’a', significantly different in overall time
effect, 'b'. significantly different in overall child number
effect. ' c \ significantly different in time*child-number
effect, p < 0.05-

119
TABLE 30
MANOVA TEST ON THE USDA/FAMILY FARE SCORE DIFFERENCE
BETWEEN NUMBER OF INSTRUCTIONAL VISITS AT T 1 , T2
(N=399)

of V i s i t s---0-6
( N=3 1)
Mean + Sd

7-1 2
(N=1 68)
M ean + Sd

13-24
(N=138)
Mean + Sd

25-34
(N=62)
Mean + Sd

USDA
T1

51•8 7 ± 2 3 . 54

54.35+25.96

50.2+22.83

52.19+23.95

T2

63.26+21.32

68.29+23.72

64.5+24.36

67-98+24.60

MANOVA test: NS,NS,NS

F A M I L Y FARE
T1

77.06+10.58

78.07+ 9.27

75.88+9.08

75-68+1 0.37

T2

85.19+11.28

89* 11±10. 45

86. 61j;9.89

89-42+ 8.83

MANOVA test: NS,NS,NS

Measured score category variable names are explained in the
text. All results are given as 'means ± S D . ' Statistical
significance results were assessed by MANOVA test. NS, not
significant, 'a', significantly different in overall time
effect, 'b', Bignificantly different in overall visiting
number effect. 'c't significantly different in time*visit
effect, p < 0.05.

120
TABLE 31
MANOVA TEST ON THE USDA/FAMILY FARE SCORE DIFFERENCE BY
MAJORITY AND MINORITY ETHNIC GROUP MEASURED AT T 1 , T2 AND T3
(N=45)

--------Ethn ic
Majority
(N=25)

Score

M e a n ± Sd

G r o u p -----Minority
{N =20)

MANOVA
Test

M e a n ± Sd

USDA
T1

46.68 ± 22.63

50.85 + 24-10

T2

62.76 + 25.17

68.80 + 21 .34

T3

59-72 + 28.43

71.45 ± 21.23

T1

79.08 +

9.22

71.35 +

T2

90.04 +

9.36

87.25 ± 10.40

T3

92.76 ± 10.44

a ,NS,NS

FAMILY FARE

93.30 ±

9.74

9.60

a,NS,c

M e as ur ed score categ or y v a r ia bl e names are explained in the
text. All results are given as 'means 4- S D . * St atistical
s ignifi ca nc e results wer e assess ed by MANOVA test. NS, not
significant, 'a', s i g n i f i c a n t l y different in overall time
effect, ' b ' t si gn i f i c a n t l y different in overall race effect,
'c', si gn i f i c a n t l y diffe re nt in time*race effect, p < 0.05*

121
TABLE 52
MANOVA TEST ON THE USDA/FAMILY FARE SCORE DIFFERENCE
BETWEEN FOODSTAMP AND NON-FOODSTAMP GROUP AT T 1 , T2, AND T5
(N=45)

Score

No
(N=27)
Mean £ Sd

Yes
(N=18)

MANOVA
Test

Mean + Sd

USDA
T1

55-50 £ 20.4

45*22 + 24.58

T2

69-59 ± 25.4

62.81

T5

65.72 ± 25.5

65.74 ± 26.56

T1

77.28 ±

9.9

74.56 £ 10.5

T2

90.22 £

8.2

87.85 ± 10.81

T5

92.56 + 10.1

95.50 £ 10.00

± 22.14
a,NS,NS

FAMI LY FARE

a,NS,NS

Measured score category variable names are explained in the
text. All results are given as ’means + S D . 1 Statistical
significance results were assessed by MANOVA test. NS, not
significant, 'a', significantly different in overall time
effect, 'b'f significantly different in overall foodstamp
group effect, 'c', significantly different in time*foodstamp
effect, p < 0.05.

122
TABLE 33
MANOVA TEST ON THE IISDA/FAMILY FARE SCORE DIFFERENCE
BETWEEN WIC AND NON-WIC GROUP AT T1 , T2, T3
(N=45)

— W I C ---------------Score

No
(N=27)
Mean + Sd

MANOVA
Test

Yes
(N=18)
Mean £ Sd

USDA
T1

48.74 + 22.60

48.22 ± 24.50

T2

66.59 ± 23.50

63.72 + 24.00

T3

62.48 ± 25-50

68.61

T1

76.33 + 10.60

74.61 ± 9-510

T2

90.52

8.98

86.22 ± 10.70

T3

92.48

11 .00

+ 26.70

a,NS,NS

FAMILY FARE

93.78 ±

8.37

a,NS,NS

Measured score category variable nameB are explained in the
text* All results are given as 'means + S D . ' Statistical
significance results were assessed by MANOVA test. NS, not
significant, 'a', significantly different in overall time
effect, fb f, significantly different in overall WI C group
effect, 'c', significantly different in time*WIC effect,
p < 0.05.

123

Tattle 34 shows that the USDA and Family Fare Survey
score differences are significant only in overall time
effect for the different age groups.
Table 35 shows that the USDA and Family Fare Survey
score differences over time for educational levels are
significant only on the Family Fare Survey scores.
Table 36 shows that the USDA and Family Fare Survey
score difference over time are only significant between
the number of children in a family and overall time
effect.
Table 37 shows that the difference between USDA and
Fami ly Fare Survey scores over time between the number of
instructional visits is significant only for USDA scores
in overall time effect.
The third statistical hypothesis is rejected as
significant differences do exist over time between USDA
scores and Family Fare Survey scores by selected
demographics.

12*1

TABLE 34
MANOVA TEST ON THE USDA/FAMILY FARE SCORE DIFFERENCE
B ETWE EN DIFFERENT AGE GROUPS AT T 1 , T2, AND T3
(N-45)

Score

21 Yrs/under
(N=7)
Mean+Sd

22-33 Yrs
(N=21 )
Mean+Sd

33-44 YrB
(N=1 2)
Mean±Sd

45 Yrs/older
<N=5)
Mean + Sd

USDA
49.14+29*60

68.00+20.42

43.00+24.3

53.0+26.80

T2 68.86+28.60

66.95+24.14

67.50+18.9

45.0+18.64

T3 67.43+51.44

62.43+22.56

63.75+29.3

74.8+29.27

T1

MANOVA test: a,NS,N

F AMIL Y FA RE
T1 70. 71 ± 7.95

77.00+10.55

74.67+8.38

79.2+14.52

T2 87.14+13.07

88.86+ 9*47

89.08*9-3

90.2+10. 52

T3 95-00+10.18

93.57+ 9.17

90.58+1 0.0

93- 6+1 4.50

MANOVA t e s t :a,NS,NS

Measured score category variable names are explained in the
text. All results are given e b 'means + S D . ' Statistical
significance results were assessed "by MANOVA test. NS, not
significant, 'a', significantly different in overall time
effect, 'h', significantly different in overall age group
effect. 'c», significantly different in time*age effect,
p < 0.05.

125
TABLE 35
MANOVA TEST ON THE USDA/FAMILY FARE SCORE DIFFERENCE
BETWEEN EDUCTAIONAL LEVELS AT T 1 f T 2 t AND T3

(
I
M
S
)

E du ca ti o n Leve l ----------------Nutrition
Score
Category

Under 8th
(N=5)
Mean ± Sd

9-12th/Grad
(N=37)

Higher
(N=3)

Mean ±. Sd

Mean ± Sd

USDA
T1
T2
T3

45*00 ± 31*87
67.40 ± 28.36
69*80 ± 27*24

50.86
65*00
63*50

± 22.08
± 23*86
± 25*52

29.00 ± 14.42
67*67 i 15*82
77*00 ± 34*77

MANOVA test: NS,NS,NS

F A M I L Y FARE
T1
T2
T3

70.80 ± 1 1 . 3 7
91*60 ±
9*45
97*60 +
7*57

75*46 +
9*92
87.84 ± 10.05
92.16 ± 10*47

86.00 +
96.00 ±
95*67 ±

MANOVA teat:

2.00
3*46
4*73
a,NS,NS

Measured score category variable names are explained in the
text. All results are given as 'means ± S D . ' Statistical
significance results were assessed by MANOVA test. N S f not
significant. 'a ' t significantly different in overall time
effect, 'b', significantly different in overall education
effect, 'c', significantly different in time*education effect,
p < 0.05.

126
TABLE 36
MANOVA TEST ON THE USDA/FAMILY PARE SCORE DIFFERENCE
BETWEEN NUMBER OF CHILDREN AT T 1 , T2, AND T3
(N= 45 )
Measure
Score

Timef One

Time ■ Two

Mean + Sd

Mean ± Sd

Time Three

N

Mean + Sd

USDA
None
One
Two
Three
Four
Five
Seven
Twelve

40.67
40.00
51.58
56.30
46.75
57.00
13.00
42.00

+ 55-23
+ 24-32
22.59
+ 17-52
+ 28.94
+ 12.29
± 00.00
+ 00.00

74.00
77.57
62.50
66.50
59.25
48.67
85-00
60.00

+
+
+
+
+
+
+
±

10.39
26.43
26.22
23.06
24.93
10. 60
00.00
00.00

71.33
74.00
63-58
70.60
52.87
37.67
94.00
91.00

+
+
±
+
+
±
+
+

21.55
19-93
27.86
23.46
30.08
14-05
00.00
00.00

3
7
12
10
8
3
1
1

MANOVA test: a,NS ,NS

FAMILY FAR E
None
One
Two
Three
Four
Five
Seven
Twelve

61.33
76.14
76.08
78.20
74.87
78.33
84.00
74.00

+ 13.05
+ 8.32
9.27
±
± 10.96
+ 10.97
7.02
±
0.00
±
± 0.00

85.67
92.71
87.67
88.30
88.62
91.00
92.00
81 .00

± 15.50
± 10.39
+ 8. 61
9-37
±
£ 13.24
£ 4.58
£ 0.00
+ 0.00

94* 67
98.29
88.50
94.20
93-25
93.00
101.00
83*00

+ 7.09
+ 4.23
+ 13.65
t 9.33
9.82
±
± 3.61
±
0.00
+ 0.00

3
7
12
10
8
3
1
1

MANOVA test : a,NS ,NS
Measured score category variable names are explained in the
text. All results are given as ’means ± S D . ' Statistical
significance results were assessed by MANOVA test. NS, not
significant. fa ' f significantly different In overall time
effect, 'b1, significantly different In overall child number
effect, 'c', significantly different in tim e#child-number
effect, p < 0.05.

127
TABLE 37
MANOVA TEST ON THE USDA/FAMILY FARE SCORE DIFFERENCE
BETWEEN DIFFERENT NUMBER OF VISITS AT T 1 , T2, AND T3
(N=45)

of Visits-----0-6
(N=4)

7-1 2
(N=19)

13-24
(N=16)

Mean + Sd

Mean + Sd

Mean + Sd

Mean + Sd

T1

65-00+1 6. 21

53 ■37+21. 60

38.75+24.58

48.33+21 .0

T2

86.00 ± 9-7

66.95+24.87

65.1 2+23.45

47.83+14.1

T3

62.25+28.98

55-37+25.73

68.00+21.14

88.83+24. 5

25-34
(N=6)

USDA

MANOVA test:

a,b,c

FAMILY FARE
T1

69.00+1 7.96

78.84+ 9.69

74.25+7-73

7 3 • 6 7 ± 9.20

T2

92.00+10.03

89* 37±1 0. 26

86.37+9-62

91.33+ 9-79

T3

89-25+12.69

94.16+ 9.32

92.62+9.14

92.83+14.00

MANOVA test: NS,NS,NS

Measured score category variable names are explained in the
text. All results are given as 'means ± S D . 1 Statistical
significance results were assessed by MANOVA test. NS, not
significant, 'a', significantly different in overall time
effect, fb f, significantly different in overall visiting
number effect. fc', significantly different in time*vislt
effect, p < 0.05-

CHAPTER V

SUMMARY,

CONCLUSIONS,

AND RECOMMENDATIONS

Purpose of the Study
The United States Congress funds several food programs
to provide food for low-income families; however,
Expanded Pood and Nutrition Education Program

the

(EPNEP) is

the only federally funded program that provides education
to low-income families with young children hut not f o o d .
Prom its beginning in 1969, EPNEP has directed its
attention to nontraditional methods on how to reach and
educate the low-income participants with foods and
nutrition information.
M a n y evaluations have shown that participation in
EFNEP improves the nutritional status of the participant
and their family; however, EPNEP has Btill been faced with
the formidable task of demonstrating that it is
coBt-effective and has a real and lasting impact on the
graduated participant.
This longitudinal five-year study seeks to determine
if participants of the Michigan EPNEP program retain their
food and nutrition knowledge and practice change scores as

128

129

measured "by the 24-Hour D i et ar y Pood R e c al l

(USDA score)

and M i c h i g a n F a m i l y Far e S u rv ey score five year s after
p r o g r a m participation.

O b je ct i v e s

of the Study

A n a l y s e s of rete nt i on of food and n u tr it io n kn o w l e d g e
and pr ac t i c e s of pa r t i c i p a n t s from the M i c h i g a n E FH E P
p r o g r a m occurred by c o n d u c t i n g f o l l o w - u p interviews with
p a r t i c i p a n t s after co mp l e t i o n of their initial nine month s
or less of p a r t i c i p a t i o n and instruction.

The objectives

of this study were:
1.

To compare pa r ti c i p a n t USDA scores u p o n entry
(Time

1),

into the p r o g ra m

post-instruction

(Time 2),

p r o gr am c om pl e t i o n

(pre-instruction),
and five years after

(Time 3),

analyze these change

and to further

scores by selected

demographics.
2.

To compare p r og ra m participants' M i c h i g a n
F a m i l y Far e Sur ve y scores upo n entry
into the p r o gr a m
i nB tr u c t i o n

(pre-instruction),

(Time 2),

p r o gr am c om pl e t i o n

(Time 1)
post-

and five yea rs after

(Time 3)» and to further

analyze these scores by selected de m og ra ph ic
characteristics.

130

3.

To draw conclusions and make recommendations to
the USDA and Cooperative Extension Service leader­
ship,

State Legislatures,

and the U.S.

Congress

regarding the long-term impact of the Michigan
EFNEP program on participants'

retention of

improved food and nutrition knowledge and
practices.

Summary of Procedures
All newly enrolled EFNEP participants from October
through December 1979 participated in Time 1 data
collection at program entry.

Time 2 data collection

occurred nine months or less after the program enrollment.
Time 3 follow-up was conducted five years after program
participation.

The population for Time 1 and Time 2 data

collection was 444 participants of which 45 were
interviewed for the follow-up

(Time 3) data collection

five years later.

Summary of Major Findings
The results of the longitudinal study indicate that
EFNEP participants retain post-instruction change scores
for five years as measured by the 24-Hour Dietary Food
Recall and Michigan Fam il y Fare Survey.

Analysis of the

change scores for both instruments rendered the same
research finding.

This finding is supported since

131

p a r t i c i p a n t s ' mean retention scores on the 24-Hour Dietary
Pood Recall

(USDA score) and Michigan P a m i l y Pare Survey

were significantly higher than entry and post-instruction
scores.

Conclusions and Implications
The results of this study indicate that participants
did significantly improve their dietary adequacy and food
and nutrition knowledge and that participants retained
this improvement over time.

It is alBO apparent that

participants with the lowest entry USDA score and minority
participants significantly gained the most from program
participation and that this gain was retained.
Very few evaluation studies of EFNEP have examined the
post-program effect of EPNEP on participants'
nutrition practices beyond 36 months.

food and

MoBt of these

long-term impact studies have provided program instruction
for 12 to 18 months before the impact study was completed.
The completed studies have documented that participants do
maintain dietary adequacy improvements.
The implications of this study for the Expanded Pood
and Nutrition Education Program are:
1.

Verification of other studies that participants
do learn from participation in EPNEP.

132

2.

Information learned in EPNEP is used for long
periods of time,
participation.

at leaBt five years after program
T h e r e f o r e , the educational me th o d ­

ology used "by the EPNEP program appears to he
appropriate for the low-income audience.
3.

Participant retention scores did not regress to
p os t-instruction levels after five years.
Therefore,

the new food and nutrition behavior

and practice may he ingrained hy the participant
for life.
4 . Participants retained these significantly improved
scoreB for five years with nine months or less of
E P N EP instruction.

Therefore,

shorter length of

enrollment for instruction is not a detriment to
participant learning.
5.

Participants enrolled

in the WIC and Pood Stamp

program are prime candidates for EPNEP enrollment
since they retain their improvement more than
non-participants.
6.

Participants under 21 years of age and 33 to 44
y e a rs of age appear to improve during instruction
and to retain this improvement.

However,

younger

participants had younger children; therefore,

the

transfer of the new educational knowledge to
practice with the family m a y occur more rapidly
wi t h the younger participants and lead to more
lifetime behavior change of more family members.

133

7.

M i n o r i t y p a r t i c i p a n t s enter wit h lower scores and
p ro gr es s to higher scores than Ca uc a s i a n p a r t i c i ­
pan t s w i t h i n the same amount of i n s t r u ct io n time.
T hes e same m i n o r i t y p a r t i c i p a n t s retain this
improv em en t;

m i n o r i t y p ar t i c i p a n t s w i t h low

a ss es s m e n t ent r y scores are prime c andidates for
the program.
8.

The p r o gr am seems to have equal

impact on p a r t i c i ­

p ant s r eg ar dl es s of educat io na l at ta i nm en t and the
n u m b e r of c h i ld re n at home.
9.

The number

of i ns tr u c t i o n a l visits s i g n i f i c a n t l y

impacted the 24-Hour D i e t ar y Pood R e c a l l score
over time.

Therefore,

it appears reinfo rc em en t

and p ra ct ic e do lead to b e h a v i o r change.
10.

Participants who have lower 24-Hour Dietary Pood
R e c a l l scores

(0-50 points)

at entry s i g n i fi ca nt ly

improve their F a m i l y Pare Survey scores and their
24-Hour D i e t ar y Poo d R ec a l l scores over time and
r e t ai n this improv em en t for five years.
if resources are limited,

Therefore,

it appears the program

should address p a r t i c ip an t s most

in need as

m e a s u r e d by the entry 24-Hour D i et a ry Pood R e c a l l
score.
11.

F u n d i n g sources need to be mad e aware of EPN EP
p r o g r a m participants'

change o f food and n u t ri ti on

k n o w l e d g e and pr a c t i c e from entry to g r ad u at io n
and the r et en t io n of this change over time.

134

Implications for Future Research
Fut ur e research on the EFNEP needs to he examined from
these points of view:
1.

There is a continued need and potential for EFNEP.

2.

An efficient and effective delivery system to
meet these needs and problems has been developed.

3.

EFNEP program instruction does significantly alter
the food and nutrition knowledge and practices
of enrolled participants.

4.

EFNEP graduated participants retain thiB improve­
ment for long periods of time.

Since the inception of this study, Michigan EFNEP has
undertaken development of a standardized national
curriculum for the program.
competency-based.

This national curriculum is

Competency-based education programs are

effective and efficient because teaching is directed
toward specific outcomes that are defined by explicitly
stated competencies and learner needs.

Teaching is

directed only to specific competency areas that the
learner does not possess.

Future research needs to focus

on the cost-effectiveness of the competency-based
curriculum over time.

The questions to be addressed by

this research are:
1.

Do participants improve their competency levels
from Time 1 to Time 2?

2,

Do participants retain this improvement over
time?

135

3.

How do the levels of retention compare with this
study's levelB?

4.

What is the coBt-effectiveness of the program?

5.

What is the optimum instruction time per partic­
ipant to achieve mastery?

Reflections
The first step in changing any food and nutrition
behavior is awareness for change.

This is followed by the

acquisition of knowledge and skills needed for improving
dietary practices.

Concurrently,

and proper nutrition improve,

attitudes toward health

providing motivation and

reinforcement for the new behaviors.

The end product is

an improved diet.
To promote changes in behavior the learner must not
only learn about them, but must engage in them.
is contingent upon its consequences:

Behavior

people learn to do

those things that have positive consequences and they
learn not to do those things that have negative
consequences.

Therefore, learning takes place when the

consequences are immediate.

EFNEP's approach to teaching

is to tailor the lessons to the participants and involve
them immediately in food preparation.
preparation,

For food

Btretching the family's food resources so

that the food lastB the entire month,

and the resulting

136

increased Belf-confidence all provide the positive
reinforcements for the participants'

changed behavior.

E F N E P participants also teach others especially other
family members and relatives.
learning is unmeasurable.

This "chain reaction" to

Many people have been changed

in the "chain reaction" learning process.

EFNEP program

spin-offs have also occurred as graduated families have
aspired to a higher quality of life; have improved their
management of family finances,
children to stay in school.
have found

and have motivated their

Former EFNEP participants

and left public assistance.

Maslov's model of the Hierarchy of Human NeedB follows
the basic assumption that an individual cannot fully
satisfy any level of need unlesB the prerequisite need is
satisfied.
This theory is relevant to EFNEP.

EFNEP contributes

to a family's personal development by helping members
learn to meet basic nutritional needs for survival.

By

m e et in g this need they are able to meet higher levels of
need.

EFNEP helps the participant to move up the

h ierar ch y of needs.

For some participants it is their

first educational success-

The problem-solving and

self-help skills learned through EFNEP are often
generalized to other life tasks.

Other participants have

learned Borne basic concepts like bei ng on time for
appointments.

Organizational skills learned for shopping

137

and planning of meals have "been applied to "budgeting,
planning,
purposes.

and comparison shopping for non-food items and
This planning also teaches delayed

gratification.

Children "benefit not only through improved

diets, "but also through role modeling of improved
behaviors.
Through Maslov*s Hierarchy of Needs, EPNEP helps
participants increase self-eBteem and self-confidence.
Only by removing the barriers to self-actualization can
families break out of the cycle of poverty.
This study confirms that the EPNEP participants do
significantly well in the program and that they retain
their learning.

This study found that there were a

limited number of demographics that had any effect on
participant change scores over the five years*
differences did occur,

When

they reflected the tendency for

participants who knew less orignally to benefit more from
the program.
EPNEP has had seventeen years of experience.

During

these seventeen years there has been much probing and
searching for the most effective way to reach and teach
low-income families.

The challenge now is to build from

the program's strength of experience.

The need iB to

focus only on the essentials of basic foods and nutrition
survival skillB; to teach those "most in need" of
education with the new direction of concentrated teaching

138

in a shorter time frame:

basically,

the economy of more

with less.
EFNEP is a mature program that is constantly
changing.

There is no other program within the

Cooperative Extension Service that has been studied,
evaluated,

and audited more often by Congressional

Committtees and others than EFNEP.

A total of 256 State

and National studies have been completed on EFNEP.

By the

nature of its funding and its concise purpose it has
attained high visibility.

Visibility occurs with a viable

program that has measurable results and increased
efficiency and effectiveness in program management.

EFNEP

has a need to use this high visibility to generate more
public and private support; to tell the story that
low-income participants do retain the foods and nutrition
knowledge and practice learned

in EFNEP.

This study confirms that EFNEP participants do retain
their significantly improved food and nutrition
practices.

Performance differences noted by minority

participants,

younger participants and participants who

have low 24-Hour Dietary Food Recall
entry achieve significantly,

(USDA scoress)

at

over time in their change

scores as measured by the Family Fare Survey and 24-Hour
Dietary Food Recall.

EFNEP doeB make a difference.

EFNEP instruction haB followed basic adult learning
processes and provided participants an opportunity to

139

"learn by doing."

The instruction has been designed based

on the needs of the audience with appropriate goals
established.

The learning environment has been low-risk

and the reinforcement provided by the Nutrition Aide has
helped to relieve the isolation felt by many low-income
families.

EFNEP instruction provides that "sense of

expectation" for the participant.

The awarenesB before

adoption of the new foods and nutrition information.
Results of this Btudy show that participants are
improving more than just their dietary adequacy as
measured by the 24-Hour Dietary Food Recall, they are also
gaining in food knowledge,
management,

food shopping skills,

and food storage techniques.

food

Self-confidence

iB also achieved as participants begin to feel life can be
different.

It appears EFNEP has proven its worth to

society aB a whole.
(U.S.

Now the question 1 b :

Will society

Citizens) now reward EFNEP for a job well-done and

continue its funding?

*

v

BIBLIOGRAPHY

140

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Expanded Nutrition and Family Progr am s, ”
Unpublished M a s t e r ’s Thesis, Michigan State
University, East lansing, Michigan 1973.
Kerr, M., Andrews, M., and Nierman, 1., "Evaluation
of the Long-Term Effects of the Expanded Food and
Nutri ti on Education Program in Michigan:
A Final
Report," Michigan State University, 1979.
Knowles,

M . S . , The Mode rn Practices of Adult Education:
Andragogy versus Pedagogy.
New York:
Associated
Press, T 9 7 0 . --------

Leidenfrost, Nancy, "Using Paraprofessionals to Deliver
Educational Programs," USDA Extension Service
Program Aide #137, April 1986, Appendix 2.
Mager, R . , Preparing Instructional Objectives,
C alifornia? 1 ' 9 6 2 T --------- ---------

Palo Alto,

Maslow,

A.H. Motivation and P e r s o n a l i t y , Ne w York:
and Row, 1921.

Miller,

H . L . , "Adults in Education:
A Forcefield
A n a l y s i s , ” Boston:
Center for the Study of
Liberal Education for Adults.
Boston University,
1967.

Morris,

P., Cooperative Agreement 12-05-300-187 between
USDA-Extension Service and Michigan State;
Cooperative Extension Service:
Final Report,
East Lansing, Michigan, 1975.

Nierman,

Nolan,

Harper

L . , Akpom, K . , and Boyce, P. "You Too Can
Participate in E F N E P ” a final report sponsored
b y USDA SEA-Extension, Michigan State University,
Cooperative Extension Service, 1982.

J., "The Effect of Progression From the Expanded
Food and Nutrition Education Program on Dietary
Adequacy," Lincoln, Mo:
University of Missouri,
L incoln University Extension 1976.
( S u m m a r y of
work by A. Patterson, I. Workman, ad D. Jones)

Pielemeier, N.R., Jones, E.M., and Munger, S.J., "Use of
Child's Growth Chart As An Educational Tool,"
Washi ng to n D.C., USAID 1978.

143
Physician Task Force on Hunger in America, "Hunger Counties
1986 - The Distribution of America's High Rise
Areas, (Harold University School of Public Health,
J anuary 1986)
Reissman; Fra nk and Pearl; Arthur, Hew Careers For the
P o o r , Non-Professional in Human Service, Glencoe,
I l l i n o i s : Free Press, 1965Rogers,

E.M., Shoemaker, F.F. Communication of Innovations:
A Cross Cultural Approach, New York:
Free PreBS,
1971 .

Roundtree, M.C., "Effectiveness of the Expanded Food and
N u t r i t i o n E du ca ti on Program in Producing
Improvements in Diets of Homemakers," Unpublished
Ph.D. Dissertation, Ohio State University,
Columbia, Ohio, 1973*
Silverman, S.A., SubprofeBsional In E x t e n s i o n , Journal of
E xt en si on VII, Spring 1969Supt.

of Documents., "The People Left Behind," Report of
the Presidents' National Advisory Commission on
Rural Poverty, 1967.

Tate,

T . , "The Role and Status of Cost-Effectiveness
Analysis in Federal Funded Nutrition Education
Programs in the United States," unpublished
Master's Thesis:
Massachusetts Institute of
Technology, Cambridge, Mass. 1977.

Underwood, B.J., Schultz, R.W., M e a n in g Fullness and
Verbal L e a r n i n g , Philadelphia:
L i p p i n c o t t , 1960.
United States Code Reference 7, USC 612, This is section
32 of an Act idenitfied as "Removal of Surplus
A griculture Commodities" passed on August 24,
1935.
United States Department of Agriculture SEA-Extension,
"The Expanded Food and Nutrition Education
Program:
Historical and Statistical Profile;"
Program Aide 1230, January, 1979*
United States Department of A gr iculture-Extension Service,
"An Assessment of the Objectives, Implementation
and Effectiveness of the Adult Expanded Food and
N u tr i t i o n Education Program" (Technical Summary),
USDA Service and Education, Washington, D.C.,
December 1981), para. 3.0.

144
United States Department of Agriculture, Federal Extension
Service, ’’Program Performance:
Expanded Food and
Nutri ti on Education Program," Washington, D.C.,
1971 .
United States Department of Agriculture Science and
Educational Administration Extension,
"Teaching and Applying Educational Principles in
EFNEP," GPD 862-005.
Walker

S., Nierman, L . , Akpom, K . , "Effectively Teaching
Foods and Nutrition to Low Income Families,"
(Michigan State University, Cooperative Extension
Service:
Cooperative Agreement 12-05-300-548),
August 1983.

Young,

C.M., Hanan, G.C., Tucker, R.E. , and Foster, W.D.,
"A Comparison of Dietary Study Methods:
Dietary
Hist or y vs. Seven-Day Record vs. 24-Hour Recall,"
Journal of Dietetics Association, 1952.

APPENDICES

APPENDIX A
FAMILY RECORD

145

E xpanded Food an d N utrition E ducation
FAMILY RECORD
A. O eicrlptlon
1. AIDE'S NAME

2.

STATE HO.

CD

2-

UNIT NO.

IT 1

AIDE'S NO. I f l
F llloullor each family In unit a* a o o n a t poaatbt*and avary S m ooth* ttvaraalier. Keep In family flI* a fler review by
TralnarTAgenl.
FAMILY
LD. No.

5. OATE FAMILY ENROLLED:
Mo. |_ j_ | Day I I I Yf. I I I

Li U J

(a) Nam* _________

6. FAMILY RECEIVED (Somr tm tt during year;
(a) □ Participating USDA Food Si amp!
Food Dlalrlbutlon Program
(b) □ W1CTCSFP
(C) □ W lllar*

f t Sir**! _________
(t) City------------------

.(d) S ta i* .

(*) Telephone

CHICK IF"YES"

SEX
AOE
tyaari)

FAMILY MEMBERS
(Firstname)
fn

no o r

FAiinr uruaritfi

__

m

TOTALS

CHECK FOR HOMEMAKER
(a) □ Whit* (not o t H itpanlc origin)
f t □ Black (not ot Hitpanlc origin)

IS. TERMINATION DATE AND REASON
Oat*: Mo. I I I Day I I I Yr. I I i
Raaaon:
(a) Graduated _______
(b) T*rmlnat*d
Moved
_______

tunas*

_____

D*c«a**d_______
Oth*r
_______
(c) Total No. of Vlalta
Group n
Individual □

urifi»B«trh|Ftiin
M U * • " Afl|4paai4*

ParticipatedInChildNutrition
Program* lealweek

nn

♦

13. HIGHEST GRADE IN SCHOOL COMPLETED BY HOMEMAKER
O Sth Qrad* or L ast
D Bth thru 101h
O 11tn thru 12th
14.

Mai*
_
(
B
y

Now in
Female School
-rof-j (H)_

O Bayond High School

(c) □ H itpanlc
(d) D Am ahean IndlanlAlaakan Native

(a) D A altn or P a d lie lalandar

IS. PLACE OF RESIDENCE
D Farm
□ Town* under 10,000 and rural non-farm
□ Town* a n d Cities 10,000 to 50.000
P Suburb* of Cillea o w 50,000
P C entral Cilia* of a w 50,000
IT. TOTAL ACTUAL INCOME FOR FAMILY LAST MONTH7
• ________
(Include w ages and aalartet, aocia! security, w ellara
a n d Inauranc* payment*, panaiona and caah aupport
from other* H family h a s Income from farming, Ind u d * iM2th of la it year'* Income a tta r expense*.)
Check one:
□ Under S315
□ SS224723
D S31SS41B

□ ST2AS8S4

□ S41BSS1B
□ S 5 » tS Ii

□ U » -I9 t?
□ $018 and over

APPENDIX B
-HOUR DIETARY FOOD RECALL

146

B. HOMEMAKER FOOD CONSUMPTION RECORD
Mam* at H om em aker____________

tfnll No. I I I I

Homamakar 1.0. No. I I 1 I I
Ald*‘a No.

Alda'* Nam* _ _ _ _ _ _ _ _ _ _ _ _

I~l P

How many toed recall record* Hare you
taken on IN* family fateWing Iftu onaj’’ ....

Ho.

Q]

Day \ J J

Yr.

ITI

1, Data a t Food Recall:
Mo. □ □

No. of rtalt* alnca la i t recall; 1 I I Group

County.

Data Family Enrolled:

Day Q D

Yr. \J O

1 I I Individual

J. Whal Did Horn* maker Eal and Drink In lb* Laat 34 Hour*?
To bo til lad out by Aida on Hom*m*k*r
Lial tpaclfic nama ot aach food and drink contum ad.
(Cniar mam food* in rrv«td tftanay Include alt* ol Barring
or amount ol lood aalan.

To Ba Fitted Owl by
Trainer Agent
Milk

Maat

_ TOTAL NO. OF BENV1NQS

(4)

PI

A ToUla T or more aarelnga of each of four food group*.

1

i

Vag/
Frull

Bread/
Cereal

O tter

Morning:

Midmorning:

Noon:

Attarnoon:

Evening:

Before bad:

D ya*
Total* I or more tarring* mllfcfmaat; 4 or more
VagfFrull and BreadfCaraat*.

UR •MT**IFNt»»IB!

a

I

2
□ yea

w
X
1
/\
1

M u • m IHtmahwU

«

1

i

□ no
*
□ no

v

4

O w h iK i N lW

F

APPENDIX C
MICHIGAN E X P A N D E D F O O D & NUTRITION EDUCATION PROGRAM
FAMILY FARE SURVE Y QUESTIONS AND SCORE S HE E T

H7
HIchf9«n Expanded food I N utrition Education Program
•family F an" Survey

family - Name:__________________________________________
S tre e t:________________________________ Cl tv:
County; ______________________________ 1.0. No.
Survey given by;_________________________________Date;
NOTE TO AIDE:

REMEMBER, DO HOT GIVE HOMEMAKER THE ANSWERS TO THE SURVEY
QUESTIONS. READ EACH OUESTION CLEARLY AND HOVE RAPIDLY
THROUGH THE SURVEY.

CiraU the
n w rin r th a t

match*» th*

Picture
'ttunber

homemaker’«

mponif
Here Is a picture of some food. What do you
think a ll these foods hive In conmon?

(1)

dairy/mlIk
Other

How many servings do you think Is the lea st
Mount an adult needs every day from th is
proup, counting milk substitutes?

(2)

2 servings
other

0)

This Is a picture of a h alf glass of milk
(4 o i.) and a fu ll glass of milk (A o t . ) .
Which one do you think equals one serving?

(3)

8 oz. glass
4 oz. glass

(4)

I f you don’t like to drink m ilk, what two foods
would give you the same food value as arllk?

(4)

2 dairy
products
1 dairy
product
no dairy
product

Here Is another picture of some food.
you think we’d c a ll th is food group?

(5)

f r u i t/
vegetable
other

How winy servings do you need every day from
th is group?

(6)

4 servings
other

(7)

This Is an 6-ounce glass of orange ju ic e . Hw
many servings of orange Juice does th is equal?

(7)

2 servings
other

(8)

How many servings do you think a 1/2 cup of
peas equal?

(8)

1 serving
other

This Is a th ird group of foods.
you c a ll th is group?

(9) m eat/protein
other

( 1-z)

(5-6)

(9-10)

What do

What would you

How many servings do you think you need every
day from th is group?

(10)

2 servings
other

(11)

Here Is a big haafcurger sandwich and an egg.
How many servings from the meat group do you
get with the sanAilch. not counting the cheese?

(11)

2 servings
other

(12)

How maqy servings from the meat group do you
get with one egg?

(12)

1/2 serving
other

This 1s another group of foods. Can you
figure out the name o f th is group?

(13)

grain/bread/
cereal
other

How many servings do you think you need every
day from th is group?

(14)

4 servings
other

(13-14)

148
050

How many serving! frees the bread/cereal group
would you get I f you had • bowl of cereal for
breakfast, a sandwich and apple for lunch,
and one taco fo r supper?

(t>)

We have talked about the basic four food groups:
■ ilk, fru it 8 vegetables, M at, and bread 8
cereals. This Is a picture of the ‘other* group,
where we put food that doesn't belong in the
other four food groups. We need some of these
foods, like f a t and o i l, but we need to be care­
ful to eat enough food from the other four groups
f i r s t . All foods have soew nutrients, like v lte■1ns and Minerals, but s q m have wore of certain
kinds than others have.

(c)

Which do you think has w re protein—M at loaf
or popcorn? (Wet the hOMnaker answer, but do
not record her answer fo r this question.)

(IS) 4 servings
other

1
0

05}

Which food would you choose for vitamin C,
to u to Juice or an apple?

(16)

tomato juice
apple

1
0

07)

Which food would you say had nore vitamin A,
corn or carrots?

(1?)

carrots
com

1
0

08)

Which food do you think has aore Iron, cheese
or a M at patty?

(IB) M at patty
cheese

09}

Which food would you choose for protein, bacon
or peanut butter?

(19)

(20)

Which food has wore calcltat, milk or scraafcled
eggs?

(20) ■Ilk
scrambled
eggs

0
1
0

peanut butter 1
bacon
0

(21)

Which food do you thlrtk would be a wore
nutritious snack, potato chips or bread and
butter?

(21) bread 8
butter
potato chips

(22)

Which food do you think hat more vitamin 8,
rice or peaches?

(22)

(23)

Which do you think has more c a lo rie s, baked
potato with butter or frie d fish?

(23)

(20

Which item do you think has enre calo ries,
a can of cola or a 3/4 glass of milk?

(25)

Which Item do you think has sure calo ries,
one tablespoon of je lly o r one tablespoon of
mayonnaise?

(26-28)

( 29- 32)

1
0

rice
peaches

1

1
0

1O

(25)

3
3m
**
<

frie d fish
1
baked potato
with b utter 0
(24) cola
1
■Ilk
0
Je lly

1
0

These are pictures o f how vitamins A and C and
Iron help our bodies, Picture X shows carrying
oxygen to a ll parts of our bodies. Picture V
shows healing cuts and making healthy gums.
Picture 1 shows helping our eyes see in the dark.
Which olcture shows idiat vitamin A does?

(26)

picture Z
other

1
0

Which picture shows what vitamin C does?

(27)

picture Y
other

1
0

Which picture shews what Iron does?

(28)

picture X
other

1
0

(29)

refrig e rato r 1
other
0

Here are pictures of auny kinds of food we
store In our hemes, and these are various
storage places. Please t e l l M where you think
various foods should be stored: refrig erato r,
cupboard, or freeting compartment of refrigerator.
Where would you store eggs?

119
Mitre would you store potatoes?

cuoboard
other

1
0

Where would you store a leftover pork chop
you wanted to keep for a week?

freeier
other

1
0

Where would you keep h a lf an orange?

refrig erato r
other

1
0

03)

This Is a picture of raw hamburger, a hot
dog, and a whole chicken. I f properly wrapped,
which food do you think would keep the longest
In the refrigerator before spoiling?

(33)

hot dog
other

1
0

(34)

This Is a picture of some cottage cheese, yogurt
and Cheddar cheese. Which do you think would
spoil most oulcklv In the refrig erato r?

(34)

cottage
cheese
other

1
0

An eight year old boy came home from school
hungvy, so he made a bologna sandwich, and had
some chocolate pudding. He l e f t the bologna,
bread, b u tte r, and dish of pudding on the table.
His mom came home from work la te and was tire d .
She d id n 't discover the food on the tab le until
the next morning. Which food Items would s t i l l
be safe to eat?

(35) bread t
b u tte r
bread 1 but­
t e r , and
pudding
bread t but­
t e r , and
bologna
pudding or
bologna

05)

(36)

07-44)

(45)

(46-54)

85.SI1-

A family went to a neighborhood potluck. Everyone (36)
ate about noon, then played and talked a ll a fte r ­
noon, leaving the food covered on the picnic table.
About six o'clock that evening everyone snacked on
the food. Some people got 111 la te r that night.
Which foods do you think made them sick?
(Circle any or a ll o f tho iteme i f they arm
mentioned. I f none o f the items are mentioned,
the to ta l ie 0.)

baby food
potato salad
hot dogs
baked beans
pie

2
1
1
0
1
1
1
1
1

Total:

This Is a picture of many foods. Some may be
foods you eat regularly; others you may have never
tasted. For each food. I 'd like you to t e ll me
about how often you prepare i t for your family—
often, sometimes, or almost never.
(Circle the appropriate mentors,)
Almost SomeFood
(sever times Often
Sweet potatoes
1
2
3
broccoli
1
2
3
Kon-fat dry milk
1
2
3
3
Liver
1
2
3
Cabbage
1
2
Winter squash
1
2
3
3
Tuna
1
2
3
Creens/splnach
1
2
Which picture do you think shows the best wav
to prepare vegetables, such as green beans:
- a small amount of water fo r a short time
- a small amount of water for a long time
- a large amount of water fo r a short time
- a large amount of water for a long time
I'm going to describe some food shopping and
preparation practices and I want you to t e l l n
whether you almost always (4 ), usually (3),
sometimes (2 ), or almost never (1) do I t:
(Circle hanenaker'e anever, flotation* begin
on the folletsirtg page.)

(45)

small amount
of water,
short time
other

1
0

150
How often do you prepare breakfast for your
faallyT

V

C

'V

(46)

1

2

3

4

How often do you prepare dinner/supper for
your faally?

(47)

1

2

3

4

How often do you sake a w ritten 11st of what you
want to buy and use I t when shopping?

(4B)

1

2

3

4

How often do you compare prices of two brands of
the sane kind of food?

(49)

1

2

3

4

How often do you look over the advertised
specials In the store?

(50)

1

2

3

4

How often do you plan some of your aenus before
you go shopping?

(51)

1

2

3

4

How often do you w rite down how nuch you spent
In the grocery sto re?

(52)

1

2

3

4

How often do you read the nutritio n labels on
food?

(53)

1

2

3

4

Host of us have to pick up an extra lo af of
bread or carton of milk once In awhile. How
many tin es each «onth do you do e ast of your
grocery shopping?

(54)

twice a week 0
once a week
1
once a nonth 1
twice a nonth 1

(55)

Here are some pictu res of wrappers from two
loaves of bread. Both loaves are the sane size
and sane p rice. Which kind of bread would you
buy and why? (C ircle J fo r exm ple A*
enriched bread only. I f homemaker cheat**
exmple A fo r other reaecne or exmale B,
c irc le O.t

(56)

exanple k*
enriched
other

(56)

Here are labels front three kinds of canned
vegetables. Which two vegetables have the
nost Iron?

(56)

kidney beans
6 spinach
green beans
6 other
other

1
0

Suppose you were going to buy canned vegetables
and you saw these on special a t three cans fo r
$1.00 and these a t 324 a can. They are both the
sane size can. Which would be a b e tte r buy?

(57)

324 each
3/61.00

1
0

I f the package of dry a llk costs $2.99 and wakes
10 q uarts, how auch does ohe quart cost?

(56)

29-304
other

Which Bilk would wake the cheapest pudding?

(59) dry atlk
whole atlk

1
0

I f 15 servings cost 754, how auch does one
serving cost?

(60)

1
0

The other package of rice costs 644 and you get
32 servings. (Point to mobere.) I f 32
servings cost 644, how •uch does one serving cost?

(61) 24

(57)

(50-59)

(60-61)

Suppose you were going to wake chocolate pudding
and you could use e ith e r a quart o f fresh whole
■11k or a quart of *11k Made fro* a package of dry
■11k th at aakes 10 q u arts. The whole a llk costs
494 for one quart.

(Shoo picture* 90 and 61— t w separata picture*.)
Here are pictures of wrappers fro* two kinds of
ric e —Instant rice and regular ric e . The package
of Instant rice costs 754 and you get 15 servings.
(Point to mmbere. )
54
other
other

1
0

151
(62-65)

Here a r t pictures of fresh f r u its end vegetables.
I 'd like you to te ll me which season of the
year—winter, spring, tu rn er, or f a l l —they are
Most likely to be cheapest because they are "In
season."
When are oranges In season and usually cheaper?

(62)

fall/w in ter
other

1
0

When Is com on the cob In season and usually
cheaper?

(63)

sumaer/fall
other

1
0

When are apples In season and usually cheaper?

(64)

fa ll
other

1
0

When are tomatoes In season and usally cheaper?

(65)

tu rn e r/fa ll
other

1
0

THE FOLLOWING QUESTIONS UTIL HOT SAVE AMY PICTURES, JUST READ TEE QUESTION TO TEE
BONEHAXER AND RECORD RESPONSE PLEASE.
(66-67)
(no pic­
ture)

Where do you get foods and n u tritio n
Information? (Litton and d r a t * a l l aneatre.l

(6667)

nowhere
0
friends 1
relativ es
1
radio/TV
z
newspapers.
magazines,
books
2
n u tritio n
labels
3
agencies
3
Health Dept.>
WIC, doctor 3
Cooperative
Extension
3
Total

(66)

Taking care of a hone and family 1s hard work.
There are some things we don't lik e to do.
Which picture here shows one thing you d o n 't
Tike to do? (Circle ane only.}

(69)

Thank you fo r answering our survey questions.

(68) cooking
putting away
leftovers
planning
aeals
washing
dishes
grocery
shopping
cleaning the
kitchen
throwing out
the trash
d oesn't iitnd/
Tikes a ll

(70) ■ Now we would lik e to get b e tte r acquainted with
you and your family.

ROTE TO AIDE/DATA COLLECTOR: Tht fo lia tin g quettione a r t identioal to th t Family
Record, part* A 4 8. I f you a lrta iy A s m recent
Fanil y Rteord and If-Eour Dietary Pood Rteall
ecwnplittd, you do not n ttd to u e e the next quettione
to got the information. I f you do wee thie form to
get the data you may uant to record i t on the Fcmily
Record form, Parte A 4 8, arfth the etlf-earbon.

152
Can you t e l l me the f i r s t name of e ll family Meifcers,
th e ir sex, end th e ir ages?
Name

H or F

Age

(69) Total
number
of
family
■ H b trt:

Did ai\y of your children p a rticip a te in the
school lunch program, summer food program, or
child care (day care) food program l a s t week?

(70) ¥ e s _____

Hon many?

(71) How maiyy

How many of your children are 1n school

(72)

Ho_____

U-12)?
Please share your age In one of these
categories; (Htad ohoieta.)

(13) IS and under

1
2
3
4
5
6
7
8

Whit was the highest grade you completed In
school 7

(74) 6th or less

1
2
3
4
5
6
7
8
9

Ethnic background of homemaker,
i f unture.)

(75) White (not
Hispanic)
Black (not
Hispanic)
Hispanic
Aamrlcan
Indian or
Alaskan
Native
Aslan or
Pacific
Islander
Refused

5
6

(76)

1

Homemaker place o f residence.

(juk only

19*21
22*25
26*30
31*40
41-44
45 and over
refused

9th
10th
11th
12th
H.S. Grad.
G.E.D.
Beyond H.5.
fief used

farm
town under
10,000 i
rural
non-farm
town or city
10,00050,000
suburb of
c ity over
50,000
central city
of over
50,000

I
2
3

4

2
3
4
5

153
Can you t e l l m the to ta l aaeunt you spent fo r
food l o s t oonth, Including cash and c re d it and
v a lu t o f food i t o p i ?

(7?)

Under 9315
i)K-*4ia
119*9519
1520*9621
9622*9723
9724*9824
9825-9917
9918 6 over

How 1 would lik e to ask you a few questions about
th e food you have eaten In th e l a s t 24 hours.
flak* H-Bour Food tk o a tl on hommdkor.)
RECORD W A T BCHEHAXER ATE AMD DRAMK iff TEE LAST
U SOURS I S SPACE BELOV.

Heal

Food

Burcher of
Servings'

B reakfast:

Lunch:

Dinner:

Other:

Total nw ber o f servings fro« each o f the food
groups.

(78
(79)
(80)

(82)

■ ilk
■eat
vegetable/
fru it
bread/
cereal
eth er

USDA 24-Hour Food Recall score (Code a
score o f 100 as 99.)

(B3)

score

One or acre servings 1n each o f four food
groups?

(84)

Two or a c re servings a llk /a e a ti four o r
acre v e g e ta b le /fru iti and bread/cereal?

(85)

(81)

yes
MO

yes
no

How awny food r e c a lls have you taken on
th is family?

(BG)

Fa*11y Fare Interview nw ber.

(6?)

firs t
second
th ird
e th er
(specify)

154

ranlly Hue______________________

•FAH1LV FARE* SWVET
SCORE SHEET

I n itia l Interview
0»te__________________
Ave.
State
Score

Possible
Points

Second Interview
Date___________________

Third Interview
Date________

Score

Score

Score

No. Servings

Ho. Servings

No. Servings

One o r aare servings In
each o f four food groups

Vet or No

Ves or No

Vet or No

Two or more servings mllk/meat.
Four or more v e g /fru lti bread/
cereal

Ves or No

Vet o r No

l.e

Food Croups
( IM S )

15

0.0

Nutrient Sources 4
Functions
(#15-28)

13

9.0

A ide's N an_______________
County____________________

Food Storage I Safety
(#29-34)
(#35-36)

6
7

22.7

Food Preparation
(#37-44)
(#45-47)

24
9

19.4

Food Shopping Practices
(#46-53)
(#54)

24
1

7.6

Food Shopping S k ills
(#55-65)

12

3.6

Sources of Food 6
N utrition Information
(#56-67)

17

T01AL

128

FOOD RECALL:
Hllk (#78)
Heat (#79)
Fruit/Vegetables (#60)
Bread-Cereals (#81)
Other (#82)
IBM Food Recall
S con (#83)

j

Vet or No

APPENDIX D
MICHIGAN EXPANDED F O O D & NUTRITION EDUCATION PROGRAM
FAMILY FARE SURVEY QUESTIONNAIRE PICTURES

155

156

A U T H O R #

P M P A

M E R M A N ,

A M c i x r z f m f V M m ,

FAMIUV HVlNfir ftW ATlON ■

lOOP&l A W £

UNIV£R6lTY

MARY MERR,r*m0?eo&mj
PXTANDePRJOP ANPNinRITlOM education
PROGRAM, MiCttl&AN ^TATE UNIVERSITY,
c m t R K x m

exrmitM

tewice

- m a u th o r * w ou ld m k£ t o th a n k t h e toxweN M iou & w
EfNEP ooomtt THAT fltOTSD UfE ^fivEY /W D BELIEVED
in i t * iMFw?mw6P R « e w l v a t i o w .

ftf f f MOJ?£ INFORMATION GOkiTAGTt

UftOA NOERM/KI

EXPANDED NaTRITIOM PROGRAM
ZOZ W lU -6 HOUSE

M llH l& A N - S W E UNIVERSITY
E A S T M W 6 lh f 6 , MlCfHfirAW 4 0 0 2 4 -

157

Question 1 and Question 2

158

GUP

M

1L

11GUP

Question 3

C

C

159

CHlU6fiH&ARNt

F R I E P CUIGKltJ

WITHPEAH>
1 61)P /

uteese,
1V“ /

WHOLEWHEAT

BREAD
VAK1UA
UTTU6E

LEAVER (2MrtC)

vtuam
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Q uestion 4 , Q uestion 5 and Q uestion 6

C O FFEE 9 / ^

160

&

Question 7

O

Z

.

161

k

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162

Q u e s t i o n 9 and Q u e s t i o n 10

163

BIG
h a m b u r g e r

Question 11

164

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Question 12

Q u e s t i o n 13 and Q u e s t i o n 14

166

F I L A , ( £ £ $

% a u p

MMPW16S4

B£1F TA&Q

question 15A

167

3

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Q uestion 15B

168

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Q uestion 15C

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Question 16

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C-ORM

Question 17

171

14IEAT PATTY

Question 18

172

Question 19

173

MILK

Question 20

Ilk

POTATO CHIPS

Question 21

Question 22

176

m w >

b w

$AK&9
POTATO
w

w

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Question 23

177

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m il k
%

Question 24

178

TA0§£$PO0N!

Question 25

179

HgLPS Otfff Ef&> * E £ lH V i£ ©ARK

P

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y

CARRIES O m U E N T o
A H FARTS C f TOE g fflp y
FOR HEAUNft

CUTS
FOR H E A L W
HUMS

Question 26, Question 27 and Question 28

180

60PBOARP

REFRIGERATOR

O R A N Q E

Question 29, Question 30, Question 31, and Question 32

vmookw

182

CHEDPAff
OWE BSE

Question 34

183

P O L O ft H A

Question 35

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fOOP>

flsa u sH

tV JT W C r

185

C A g M S g

S tt/E E T POTATO

WlNTTEf? $<?UA$H

mocxzou

UVER

GKEEfiS

Question 37, Question 38, Question 39, Question 40,
Question 41, Question 42, Question 43, and Question 44

166

6M AU AMOUNT OF
VttTER, SHORTTIM E

LARGE AMOUNT O F
WATER,SHORT TIME

SMALL /AMOUNT OF
WATER, LOfiGr TIME

LARGE AMOUMT OF
WATER, UON&T1ME

Question 45

187

m & A ®
h e t v v t . 2^ o z O U e O

EXAMPLE A

bread

E X A M

P L E

Question 55

&

188

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Hiwmional wrcmAnnw
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M

$wm, ?(t

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TH/AMlWf 2

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189

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ill

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Question 57

190

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INSTANTS' M®N FAT

PRY MILK
JAOcW MAKES 10 QUARTS

$239

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192

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G O R N

TOMATO
Question 62, Question 63, Question 64, and Question 65

19*1

GROCERY
♦HOPPING

COOKIHQ

mum
v\m$

tt-EANINfr Tf{£

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THROWING OUT

putting a w a y
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t h e t k a &h

P U A N N IN fir

MEALS

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195

Question 69

APPENDIX E
SCORING TABLE FOR 2H-HOUR DIETARY FOOD R E C A L L

196

Question 70

197

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198

QUAJTTIFICATICK CF THE 24-BOW FOOD RECALL
The 24-hour food recall originated In the sphere of dietary research
Where the concern was with aggregate data for a canmunity or subpojwlation.
Even In the research sphere, the validity of resultant data is the subject
of arnch controversy. Riere 1b among experts, however, general agreement
that the technique is the best coet-to-benefit tradeoff among available
methods for measuring food intake in noninstitirtional settiTgB.
A 24-hour food recall procedure has been implemented inEFflEP Bince its
Inception and ways were explored to assimilate thisinformationinto the
progression methodology to provide scoreB comparable to those achieved
through application of the Fbod Behavior Checklist, lhat Is, to arrive at a
set of mmerical scores ranging trcm 0 - JLOO and descriptive of the reported
diet.
The "objective” or target diet established for the program is:
2 servings of milk or milk products
2 servings of meat or meat substitutes
4 servings of fruits and vegetables
4 servings of breads and cereals
The number of possible dietary patterns which might be elicited within
this framework is calculated by:
C = dm i x d m e x d i V x d bc
where:

C is the number of combinations,

d . is the number of servings Which discriminate quality
of diet in terms of the milk category,
d

is the number of servings which discriminate quality
of diet in terms of the seat category,

d-

is the number of servings Which discriminate quality
of diet in terms of the fruit and vegetable category, and

d.

is the number of servings Which discriminate quality
of diet in terms of the bread and cereal category.

Jones, E.M., Hunger, S.J., ft Altman, J.V. A field guide for evaluation of
nutrition education. Allison Park, Fa.: &nectlcs Corporation, 1975*

199
Vi thin the Bilk and neat categories there are three discriminators (0, 1,
2); vlthln the fruit/vegetable and bread/cereal categories there are a
possible five discriminators (0, 1, 2, 3i 4)* Thus, the number of possible
combinations 1b calculated by:

C » 3 x 3 x 5 x 5 e 225 combinations
Derivation of Food Recall Scores
A quantification scheme which takeB into account several
nutrition-related factors was devised. The basic assumption is that any­
one food group, while it contributes in a unique way, has importance in the
diet equal to that of any other food group* The factors entering into the
scoring scheme and the moethod of quantification are described below.
Total Fumber of Servlnga of Fbod. Intake of food is essential
to life. This factor is included in the quantification with
incrementally weighted scores for the number of servings, irre­
spective of food categories. Die weighed scores are:
• 1 to 4 servingB = a weight of "I" (number of servings x 1)
• 5 to 8 servings = a weight of "2" (number of servings x 2)
• 9 to 12 Bervings = a weight of "5" (manber of servings x 3)
Number of Fbod Groups Included. Variety of food in the diet is
essential to good health. TEFb factor is included In the quanti­
fication with incrementally weighted scores for the number of food
groups, irrespective of number of servings. Die weighted scores
are:
• 1 food group = 0
• 2 food groups = 5
• 3 food groups = 15
• 4 food groups = 30
Percent of Target Diet Achieved. The target diet is: 2 servings
in the milk group, 2 servings in the neat gorup, 4 serviigs in the
fruit/vegetable group, and 4 servingB in the bread/cereal group.
IJy examining each food category separately for "percent of achieve­
ment of target” and combining across all four food groups, a
composite "percent of achievement of the target" of "2-2-4-4-" is
derived. This factor is included in the quantification ty estab­
lishing incremental scores for composite percent of target diets,
as follows:
-2 -

200

25)6 = 1 point

17556 e 10 points

325)6 * 23 pointB

50)6 e 2 points

20056 = 12 points

75^ = 3 points

225)6 = 14 points

775)6 = 29 points

10CD6 & 4 points

250)6 = 1€ points

400)6 *= 32 points

125)6 = 6 points

275)6 = 18 points

150)6 = 8,points

300)6 = 20 points

*

350)6 * 26 points

BornB Points. Since it ia possible to have a rather high cumulative canposite percentage on the preceding component score basis,
but to be severely deficient In one of the food groups, two (2)
bonus appoints are awarded when at least 50)6 of the required number
of daily servings is achieved for each food group.
Figure 6 illustrates the derivation of each component score and the
resultant diet score for two food recalls.
The quantification technique described above was applied to all
possible diet patterns derivable, frca 0-0-0-0 to 2-2-4-4- The result was
52 cateogries of diet patterns and of related scores ordered fran 0 to 100.
Table 2 presents the scores for each of the 225 possible dietary patterns.
Example B

Example A
Food Recall = O-O-2-l
vt'd
Score Component
score
Number of Servings
O + 0 + 2 + 1 = 3
3 x 1 weight = 3
Number of fbod Groups
O + O + I +1 - 2
Percent of Target Diet
(0 divided ly 2) +
(0 divided ty 2) +
12 divided ty 4) +
(1 divided ty 4) =
0)6 + 0)6 + 5056 = 25)6 = 75)6

Food Recall = 2-2-T-4
Score Component

vt'd
score

3

Number of Servings
2 + 2 + 3 + 4 = 11
1 1 x 3 weight of 3 =

33

5

Number of Food Groups
1 + 1 + 1+ 1 = 4

30

3

Percent of Target Diet
(2 divided ty 2) +
(2 divided ty 2) +
t3 divided ty 4) +
(4 divided by 4) =
100)6 + 100)6 = 75)6 = 100)6 = 375)6 29

Bonus

Bonus

Only 1 of 4 categories at
5006 or greater
lanposite Score Total
Figure 6.

4 of 4 categories at
50)6 or greater
Composite Score Total

0
11

Examples of derivation of food recall Bcores.
-

3-

2
94

201
Table 2

Bunmry of Scores for 5Veirty-four Bair Diet Patterns
(Based on 2-2-4-4 Blnlimxa Timber of dally eerving requireoente.
Order le ailk, neat, vegetables and fruit, bread and cereal *)

S
T

SCORE
0
2
3
4
6
8
9
10
11
12
13
14
15
16
17
21
22
23
24
25

IT
V

27
29

CATEGORY
A
B
C
D
£

F
G
B
I
J
K
I

K
H
0
P
Q

R

V

33
35
37

z

T
Z

39

AA

41

HB
■CC

42
43
*

DD
EE

FF
GG
EH

11
JJ
DC

LL
KM
HH

45
47
50
51
52
54
56
58
60
62
64

DIET PATTBOTS
0000
0001, 0010
0100, 1000
0002, 0020
0003, 0030, 0200, 2000
0004, 0040
0011
0101, 0110, 1001, 1010
0012, 0021, 1100
0102, 0120, 1002, 1020
0013, 0022, 0051
0201, 0210, 2001, 2010
0103, 0130, 1003, 1030
1200, 2100
0202, 0220, 2002, 2020
0014, 0023, 0032, 0041,
0111, 1011
0104, 0140, 1004, 1040
1101, 1110
0024, 0033, 0042, 0112,
1021, 2003, 2030
0211, 1102, 1120, 2011
0034, 0043, 0204, 0240,
2101, 2110
0044, 0113, 0122, 0131,
0212, 0221, 1103, 1130,
0114, 0123, 0132, 0141,
1220, 2102, 2120
0213, 0222, 0231, 1104,
2201, 2210
0124, 0133, 0142, 1024,
2105, 2130
1111
0214, 0223, 0232, 0241,
2202, 2220
0134, 0143, 1034, 1043,
0224, 0233, 0242, 2024,
1112, 1121
2204, 2240
1211, 2111
1113, 1131
1122, 1212, 1221, 2112,
0144, 1044, 1114, 1141,
0234, 0243, 1123, 1132,
1222, 2122, 2212, 2221
1124, 1133, 1142, 1214,
-

4-

*

PATTERNS
1
2
2
2

-A-

2200

2
1
4
3
4
3
4
4
2
4
5
2
4
2

0121, 0203, 0230, 1012,
11
4
1201, 1210, 2004, 2040,
1013, 1022, 1031
2012, 2021
1023, 1032, 1041, 1202,

10
7
6
12

1140, 2013, 2022, 2031.
10
1033, 1042, 1203, 1230,
10
1
2014, 2023, 2052, 2041,
1204, 1240, 2104, 2140
2053, 2042, 2203, 2230

2121
2211
1213, 2034, 2113, 2131
1241, 2114, 2141

10
8
8
2
2
2
2
5
5
10
4
7

202

" "
CATHJORY
00
PP
QQ
HR
8S
TT
UD
W
w
XX
TY
zz
•

SCORE
65
66
66
77
79
GO
82
85
88
91
94
100

DIET PATTBttE
0244, 2044
1225, 1252, 2123, 2132, 2213, 2231
2222
1154, 1143
1224, 1233, 1242, 2124, 2133, 2142
2214, 2241
1144, 2223, 2232
1234, 1243, 2134, 2143
2224, 2233, 2242
1244, 2144
2234, 2243
2244
Total

TO. C T M B T
FATTERNS
Z
6
1
2
6
2
3
4
3
2
2
1
226

tThe Scoring Table for flood Recalls
Looking up a diet score Is simplified ty design ccf a scorirg table directly
related to the information the aide has in the existing program record, the food
recall record gives the inforaation in the following pattern:

KEAT

Kmc

FRUIT

BESET

veg etab le

CBCEAL

Total Nimber of Servirge

The scorirg table Is Shewn In Figure 7«
Bach food group, In the order In
which it appears to the aide, sequentially reduces the area of search. She
number of servings in the ailk group tells her Aether the score Is in the right,
left, or middle block of the scorii^ table. Tbr example, if the food recall
shows 1 milk servings the diet score is in the middle block of the scores, the
number of servings in the second food group tells the aide Aether the score is
in the first, second, or third colusn of the larger block. For example, if the
food recall shows 1 milk servitg and 1 meat serving, the score is somewhere In
the middle of the colum of the middle block, the scoring table Is further
subdivided so that the mober of servings of fruit/vegetable and bread/cereal
sequentially delimit the area of search and identifies the correct score.

-

5-