Journal of Nutrition Education and Behavior
Research ArticleCreating Healthful Home Food Environments: Results of a Study with Participants in the Expanded Food and Nutrition Education Program
Introduction
Obesity is a serious problem in the United States (US) for both children and adults,1 particularly for low-income groups,1, 2 and is associated with both medical3 and economic costs.4, 5, 6 Unfortunately, overweight children are likely to remain overweight as adults,7 and weight reduction is difficult to achieve and maintain at any age.8 Therefore, primary prevention for both children and adults is important.9 Even small changes in energy balance could help prevent weight gain.10 For example, one study estimated that an excess energy consumption of 110 to 165 kilocalories (kcal) per day might explain the increase in body weight observed for 2- to 7-year-old children in the US during the periods 1988 to 1994 and 1999 to 2002.11 Interventions should be theory driven and target the mediating psychosocial/environmental variables, or changeable correlates of a behavior, that are in the causal pathway of the behavior.12
Previous studies have documented that home food availability and parenting behaviors around food and eating influence child dietary behaviors.13, 14, 15, 16, 17 Improvements in low-income overweight mothers' dietary behaviors resulted in improved dietary behaviors among their children.18 Therefore, obesity prevention efforts for families should promote the availability of healthful food in the home as well as improving parenting behaviors and skills associated with food and eating. Interventions should also be in convenient locations for the target populations.19
Several federal assistance programs provide potential channels for obesity prevention. Interventions promoting fruit and vegetable consumption among participants in the Special Supplemental Food Program for Women, Infants, and Children20 and through a home-based program21 have had some success, as have Head Start programs.22, 23 The Expanded Food and Nutrition Education Program (EFNEP) has been providing food and nutrition education to limited-resource families since 1968, in over 800 counties throughout the 50 states and 6 territories.24 Trained peer paraprofessionals conduct EFNEP lessons on basic nutrition, food budgeting, and food preparation.25 Past EFNEP studies have documented significant improvements in clients' diets,26 delayed introduction of cow's milk to infants,27 greater meal planning and comparison shopping, and reduced food expenditures compared to nonparticipants.28
Formative research with Texas EFNEP clients was conducted to help develop an intervention component specifically targeting obesity prevention. Surveys and focus groups with EFNEP clients were used to obtain information on the influences and barriers associated with healthful home food environments. Clients were also asked about the strategies they used to overcome the reported barriers to healthful family eating. Based on the results from the formative research, the constructs of modeling, self-regulation, self-efficacy, behavioral skills, and the environment from Social Cognitive Theory were used to develop the intervention materials (Thompson DI, et al, personal observation, June 2009).29
The new intervention was named Building Healthy Families: Step by Step (BHF). The components included the intervention video and discussion guide with supporting materials (goal setting, problem solving, goal review, handouts, and session-specific recipes). This manuscript presents the results of an evaluation study conducted in 3 Texas EFNEP sites during 2006 and 2007. It was hypothesized that the EFNEP clients in the BHF intervention classes would have a lower body mass index (BMI); report greater home availability and consumption of fruit, vegetables, and low-fat milk products; and show more positive changes in menu planning, parent self-efficacy, home food preparation practices, barriers, and parental feeding styles compared with comparison class clients. Improved dietary intake was also expected.
Section snippets
Study Design
This study was approved by the Institutional Review Boards at Baylor College of Medicine, Houston, TX. Agents in 3 Texas cities recruited a total of 100 EFNEP classes between February 2006 and March 2007. A random numbers table was used to assign classes, by city, to the intervention or the control condition. The Texas EFNEP has 6 weekly sessions. Three data collection class sessions were added: baseline (session 1), post (session 8), plus a 4-month follow-up session. Clients from these 100
Participants
There were 100 classes (54 intervention and 46 comparison) with 1,252 clients; 1,107 clients provided consent for measurement (88%). Data for 101 pregnant participants were excluded from the analyses, leaving 1,006 participants at baseline (582 intervention and 424 comparison). There were no differences in demographics between groups at baseline. Most participants were women (97%) and Hispanic (89%), with 8% black and 3% white. Mean participant age was 35 years; mean number of children in the
Discussion
On a national basis, EFNEP reaches over 150,000 low income families in many communities in the US.24 It therefore provides a logical and convenient channel for obesity prevention efforts.24 Although the usual Texas EFNEP classes do address healthful eating, there has been no specific attempt to organize the classes around the dietary behaviors, and the theoretical influences on those dietary behaviors, associated with obesity prevention in families. Therefore, the goal of the BHF intervention
Implications for Research and Practice
The findings in this study document the potential public health impact that existing local community-based programs like EFNEP could have on family dietary behaviors for at-risk populations, and, ultimately, obesity prevention efforts. The maintenance of some of the dietary changes for 4 months following the end of the study is very encouraging. Interventions for at-risk families should be available in local communities, and it is logical to update existing educational programs that have proven
Acknowledgments
This work is a publication of the USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX. This project was supported by the National Research Initiative of the USDA Cooperative State Research, Education and Extension Service, grant number # 2004-35215-14225 (to Dr. Cullen). This project has also been funded in part by federal funds from the USDA/ARS under Cooperative Agreements No. 143-3AEL-2-80121 and 58-6250-6001. The contents of this
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Cited by (0)
This project was supported by the National Research Initiative of the USDA Cooperative State Research, Education and Extension Service, grant number #2004-35215-14225 (to Dr. Cullen). This project has also been funded in part by federal funds from the USDA/ARS under Cooperative Agreements No. 143-3AEL-2-80121 and 58-6250-6001.