The Food Stamp Nutrition Education Program's (FSNEP) Impact on Selected Food and Nutrition Behaviors Among Texans

Introduction

According to the United States Department of Agriculture (USDA, 2000), the goal of the Food Stamp Nutrition Education Program (FSNEP) is "to provide educational programs that increase, within a limited budget, the likelihood of all food stamp recipients making healthy food choices consistent with the most recent dietary advice as reflected in the Dietary Guidelines for Americans and the Food Guide Pyramid." Educational programs in FSNEP also focus on teaching limited resource individuals and families the skills needed to select, store, prepare, and serve food safely and to adopt economically sound shopping skills to help prevent food insecurity. 

In comparison to the national average of 13.2%, an estimated 16% of Texas families live in poverty (U.S. Census Bureau, 1998). While the Food Stamp program is available to eligible individuals and families in Texas, participation in the program has fallen by approximately 44%. Nationwide, there has been a 30% drop in the participation in the Food Stamp program (Center for Public Policy Priorities, 2000). Reasons behind the overall decline in the number of Food Stamp program participants are numerous and include:

• Improvements in the U.S. economy,
• Stricter requirements for eligibility,
• Lack of information about program eligibility,
• The stigma attached to receiving public assistance, and
• The perception that the perceived amount of time and effort that must be spent applying for Food Stamp benefits are not worth the amount of benefits received (CPPP, 2000; Dodds, Ahluwalia, & Baligh, 1996; United States General Accounting Office, 1999)

Because participation in the Food Stamp program is low, FSNEP, which is conducted through the Texas Agricultural Extension Service, is offered to both food stamp and food stamp eligible individuals and families. To make the program more marketable to Texas consumers, FSNEP is known as the Better Living for Texans (BLT) program. Individuals in the BLT program participate in a minimum of five lessons that focus on knowledge and behaviors relative to the Food Guide Pyramid, the Dietary Guidelines for Americans, food safety, and food resource management.

In order to evaluate the effectiveness and success of the BLT program, the need to examine selected food and nutrition behaviors of participants was identified. The purpose of the study reported here was to evaluate participant changes in selected food and nutrition behaviors as a result of completing the BLT program.

Methodology

Subject Recruitment for Participation in the BLT Program

Between September of 1998 and July of 1999, 165 counties in Texas offered the BLT program. County agents and assistants recruited participants through radio and newspaper advertisements, and by distributing informational fliers at specific areas, including public housing authorities, subsidized health clinics, and food banks/pantries. Local DHS (Department of Human Services) offices and health departments also referred individuals to the program.

Subject Recruitment for Participation in the BLT Evaluation Survey

At the request of the BLT program director, county Extension agents were asked to submit names and telephone numbers of individuals who had participated in the BLT program during the 1998 fiscal year. One hundred of the 165 counties submitted a total of 3,027 potential subjects for the study. Because of incorrect phone numbers, duplicate numbers, the inclusion of deaf language calls, and unqualified respondents (under the age of 18 or not a participant in the BLT program), the number of usable names and phone numbers was decreased to 1,307. From this set of usable names and numbers, 481 potential subjects were randomly selected to participate in the survey.

Survey Development and Administration

The major portion of the survey instrument focused on 20 selected food, nutrition, and food resource management behaviors both before and after attending the BLT program. Most of the questions were asked in an "always, most of the time, sometimes, seldom, and never" format (Table 1). In addition, participants were asked to estimate the number of servings consumed daily from each section of the Food Guide Pyramid. The survey was administered by trained, bilingual interviewers to randomly selected BLT participants via the telephone by the Public Policy Research Institute during August and September of 1999.

Statistical Analysis

Using the SAS system (version 6.2), paired t-tests were performed on the 20 sets of items to determine if the differences between before and after self-reported behaviors were statistically significant. The level of significance was set at p < .05.

Results

Subject Characteristics

Of the 481 individuals selected, 459 agreed to participate in the survey (95% cooperation rate), representing 76 of the 165 counties that offered the BLT program. As reported in Table 2, a majority of respondents were female, married, and Hispanic. One-third of the interviews were conducted in Spanish. More than one-half of the respondents were under the age of 40. More than 30% of respondents reported household sizes of five or more, while 40% of the participants had three or fewer household members. At least one child under the age of 18 was indicated to be present in 71% of the households. More than one-third (37%) of the respondents had not completed high school. Household incomes of $15,000 or less were reported by nearly one-half (47%) of the respondents.

Only 23% of the subjects reported that they were currently participating in the Food Stamp program. By comparison, 29% of the subjects reported receiving benefits from the Special Supplemental Food Program for Women, Infants, and Children (WIC), and 43% of the households stated participating in the National School Lunch/Breakfast program. Only 7% of households reported receiving benefits from the Temporary Assistance for Needy Families (TANF) program. At the time this survey was conducted, 10% of the households reported using food banks and food pantries as means of obtaining food.

Self-Reported Changes in Selected Nutrition, Food Safety, and Food Resource Management Behaviors

In comparison to food consumption habits prior to the BLT program, subjects reported increasing their intakes of foods from four sections of the Food Guide Pyramid after completing the program. (Table 3). The consumption of the number of servings of fruits, vegetables, and dairy products was significantly higher after subjects completed the BLT program in comparison to before entering the program. There was also a trend towards a higher consumption of breads, cereals, rice, and pasta after participating in the program, although the increase was not significant.

On average, participants made self-reported changes in a number of behaviors that are in agreement with the Dietary Guidelines for Americans (Table 4). The percentage of respondents who reported that they never used lard for cooking rose from 58% before the BLT program to 74% after the BLT program. Nearly 21% of the subjects reported that before the BLT program they seldom or never added salt to foods; after the BLT program, the percentage rose to 41%. Prior to the BLT program, 31% of respondents reported that they read food labels for nutrition information always or most of the time. After completing the BLT program, the percentage of respondents reading food labels always or most of the time rose to 71%. In addition, 68% of the subjects reported that after participating in the BLT program, they were reading food labels to help them choose foods with less fat always or most of the time, up from 26%.

Participants also reported engaging in behaviors that reflect improvements in safe food handling practices. Before participating in the BLT program, subjects reported that they let cooked foods sit out for an average of 1 hour and 10 minutes. After the program, cooked foods were left out for an average of 68 minutes, a reduction by only 2 minutes. However, the percentage of subjects who allowed cooked foods to sit out for longer than 2 hours decreased from 9.4% to 2%. The percentage of subjects who reported washing their hands for 20 seconds always or most of the time increased from 89.3% to 95.9%.

Self-reports of practicing proper food resource management skills also improved among participants (Table 5). The percentage of respondents planning meals always or most of the time increased from 27% before BLT to 57% after BLT. More than 70% of the subjects shopped with a list always or most of the time, up from 47% before completing the BLT program. Two-thirds (66%) of the subjects reported that they compared prices when shopping before participating in the program, while 87% reported doing so after the program. For the households of respondents receiving food stamp benefits, 70% reported that their food stamps were lasting longer since completing the BLT program. In addition, the percentage of subjects who reported running out of money, food stamps, or food before the end of the month always or most of the time decreased from 17% to 7%.

Table 5
Mean ^a Self-Reported Food Resource Management Behaviors, Before and After the BLT Program

Discussion 

For educators who work with limited resource audiences, this study demonstrates that Extension programs and educators are effective in reaching this audience and making a difference in selected food and nutrition behaviors. Subjects who participated in the BLT program reported significant changes in selected nutrition, food safety, and food resource management behaviors. Because increased consumption of fruits and vegetables and decreased consumption of dietary fat are thought to promote good health and prevent disease (USDA, 1992; USDA, 2000), the reported changes in these food consumption behaviors, along with the reported increase in calcium-rich dairy products, are encouraging.

Breads, cereals, grains, and pasta are also important for a healthful diet, but the upward trend in the consumption of these foods was not significant. It is possible that participants in this survey did not have a clear understanding of the suggested portion sizes for foods within this section of the Food Guide Pyramid. Due to the fact that more than 52% of participants identified at least one overweight person in the household, it is also possible that some individuals in this study were attempting to follow one or more variations of low-carbohydrate diets as a means of managing their weight. Unfortunately, this survey did not measure the subject's knowledge of portion sizes or weight management practices; therefore, only conjectures about the low consumption of breads, grains, cereals, and pasta can be made. Perhaps assessing participant knowledge about specific food and nutrition behaviors would be helpful in explaining future survey findings.

The self-reported improvements in selected food safety behaviors are also encouraging given the current national attention to this issue. An estimated 19% of foodborne illnesses originate in the home (Centers for Disease Control and Prevention, 1996); therefore, adopting safe food handling practices is critical for all people, including limited resource individuals who cannot afford to lose food due to spoilage or improper handling or who often lack health insurance or employee benefits to accommodate time loss from work due to a personal or family illness.

A major objective of the BLT program is to provide education and guidance in the area of food resource management to prevent food insecurity. According to the Life Sciences Research Office (1990), "food insecurity exists whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain." In a recent survey published by the United States Department of Agriculture (USDA, 1999), the percentage of food-insecure households was nationally estimated at 9.7%. In Texas, however, approximately 12.9% of families were food insecure. Furthermore, 5% of the food-insecure households in Texas demonstrated signs of hunger (USDA, 1999).

These statistics, which show a need for food resource management education, along with the finding that subjects in this study stretched their food dollars and reduced the need for assistance from emergency programs like food banks and food pantries, reinforce the importance of teaching food resource management skills through programs like BLT.

The findings of the telephone survey and the reported changes in the selected behaviors compare favorably with previous studies (Romero, Medeiros, & Melcher, 1988; Amstutz & Dixon, 1986). However, there are three limitations to this study that should be addressed.

First, the manner by which this survey was administered may have excluded participants who did not have easy access to a telephone. Participants who moved and changed phone numbers after completing the program might also have been excluded. Unfortunately, the geographical area (165 counties throughout Texas) from which our subjects were recruited, the need to use trained, bilingual interviewers, and financial limitations prohibited face-to-face interviews.

Second, it is possible that the reported changes in behavior were not due solely to the BLT program but instead to other educational programs, including those offered by Extension. Although we do not know the extent to which participants engaged in other educational activities, more than 46% of the subjects reported that the BLT program was their first experience with Extension.

Third, the study relied on retrospective self-reported data. Again, the extensive geographical area in which this program was offered plus the desire to use trained interviewers prevented the collection of pre and post behaviors. Furthermore, because of the possibility that some of our participants had limited literacy skills, we administered our survey via an interview. Having Extension agents interviewing the participants individually would have been extremely difficult to do at the county level because of the time involved to interview each participants and would also have introduced more variability in the data.

Conclusion

Results of this survey indicate that the Food Stamp Nutrition Education Program (BLT in Texas) is effective in teaching limited resource individuals and families food and nutrition skills that mirror the Dietary Guidelines for Americans and the Food Guide Pyramid. Additionally, the skills learned in the area of food resource management are helping individuals and families stretch their limited food resources and are reducing the need for emergency food. Further investigation is needed to determine the level of understanding that program participants have with respect to portion sizes--especially breads, grains, cereals, rice, and pasta--that are recommended by the Food Guide Pyramid. 

References

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