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Theses and Dissertations--Dietetics and Human Nutrition Dietetics and Human Nutrition

2016

PROMOTING HEALTHY HOME-COOKED FAMILY MEALS: PROMOTING HEALTHY HOME-COOKED FAMILY MEALS:

EVALUATION OF A SOCIAL MARKETING PROGRAM TARGETING EVALUATION OF A SOCIAL MARKETING PROGRAM TARGETING

LOW-INCOME MOTHERS LOW-INCOME MOTHERS

Mollie Y. Dawahare University of Kentucky, mollie.dawahare@gmail.com Digital Object Identifier: http://dx.doi.org/10.13023/ETD.2016.087

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Recommended Citation Recommended Citation Dawahare, Mollie Y., "PROMOTING HEALTHY HOME-COOKED FAMILY MEALS: EVALUATION OF A SOCIAL MARKETING PROGRAM TARGETING LOW-INCOME MOTHERS" (2016). Theses and Dissertations--Dietetics and Human Nutrition. 43. https://uknowledge.uky.edu/foodsci_etds/43

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Mollie Y. Dawahare, Student

Dr. Janet Mullins, Major Professor

Dr. Kelly Webber, Director of Graduate Studies

PROMOTINGHEALTHYHOME-COOKEDFAMILYMEALS:EVALUATIONOFASOCIALMARKETINGPROGRAM

TARGETINGLOW-INCOMEMOTHERS

_______________________________________________

THESIS

_______________________________________________

A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in the College of Agriculture, Food and Environment at the University of

Kentucky

By

Mollie Yamin Dawahare

Lexington, Kentucky

Director: Janet Mullins, Ph.D., R.D., L.D.

Lexington, Kentucky

2016

Copyright©MollieYaminDawahre2016

ABSTRACTOFTHESIS

PROMOTINGHEALTHYHOME-COOKEDFAMILYMEALS:EVALUATIONOFASOCIALMARKETINGPROGRAM

TARGETINGLOW-INCOMEMOTHERS

Objective:Evaluatehowasocialmarketingapproachcomparestotraditionalnutritioneducationcurriculumforpromotingbehavioralchangesrelatedtoeatingandfood.Design:Nonequivalentcomparisongroup,entry-exitdesign.Participantsfrom12Kentuckycountiesassignedeithercomparisonorpilotgroup.Comparisongroupreceivedtraditionalnutritioneducationcurriculumandpilotgroupreceivedthesocialmarketingprogram,CookTogether,EatTogether(CTET)curriculum.EFNEP’sBehaviorChecklistand24-HourDietaryRecallwereadministeredatentryandexitofthe8-weekprograms.Participants:Females(18-72yearsofage)fromfamilieseligibletoreceiveSNAPbenefits(n=64comparisongroupparticipants,n=60pilotgroupparticipants).Intervention:Comparisongroupcompletedan8-weekstandardlessonandpilotgroupcompletedCTETprograminvaryingtimeframes(1-8weeks).MainOutcomeMeasures:Eatingbehaviorchangesbetweenentryandexitforcomparisonversuspilot.Analysis:Quantitativedatawereanalyzedusingindependentandpairedt-testswithsignificanceofP≤0.05and0.10.Results:Groupsweredemographicallysimilar.BothhadsignificantdifferencesinentryandexitscoresforBehaviorChecklistand24-HourRecall(P≤0.05).ConclusionandImplications:Positivebehaviorchangewasobservedinbothcomparisonandpilotgroups.Asocialmarketingprogramprovestobeapromisingapproachtonutritioneducation.KeyWords:ExpandedFoodandNutritionEducationProgram,SupplementalNutritionAssistanceProgram-Education,Cook-TogetherEatTogether,low-incomemothers

MollieDawahare

March30,2016

PROMOTINGHEALTHYHOME-COOKEDFAMILYMEALS:EVALUATIONOFASOCIALMARKETINGPROGRAM

TARGETINGLOW-INCOMEMOTHERS

By

MollieYaminDawahare

JanetMullins,PhD,RD,LDDirectorofThesis

KellyWebber,PhD,MPH,RD,LDDirectorofGraduateStudies

April5,2016

iii

Acknowledgements

Iwouldliketothankallthosewhohelpedtomakethisthesispossible.IamsoappreciativeofthetimeandenergyDr.JanetMullinsdevotedtowardsthiscompilationofresearch.Itwouldnothavebeenpossiblewithouthercontinuousmotivationandguidance.IalsowouldliketothanktheteamofprofessionalsattheNutritionEducationProgramofficeincludingJacquelynWalters,RebeccaFreeman,andLolaAdedokunwhonotonlyallowedmetoworkwiththemontheproject,butofferedtheiradviseandexpertisethroughouttheresearch.Iwouldalsoliketothankmycommitteemembers,Dr.KellyWebberandDr.SandraBastin,whotookaninterestinmyresearchandspenttimetoprovideconstructivefeedback.Theyhavebeenaninspirationduringmyundergraduateandgraduatecareer,andIamincrediblygratefulfortheirencouragement.Last,butnotleast,Iwouldliketothankmyfiancé,Nick,andmyparentsforbeingasourceofsupportandmotivationduringthistime,forrecognizingthevalueofmyresearch,andpushingmetoachievegreatness.

iv

TableofContents

Acknowledgments.................................................................................................................................... iii

ListofTables. ...............................................................................................................................................v

ListofFigures ............................................................................................................................................. vi

Introduction ................................................................................................................................................. 2EffectivenessofEFNEPandSNAP-Ed...................................................................................... 2TraditionalNutritionEducationCurriculum........................................................................ 3CookTogether,EatTogetherProgram ................................................................................... 3

Methods ......................................................................................................................................................... 5StudyDesign ....................................................................................................................................... 5EvaluationInstruments ................................................................................................................. 6DataCollection................................................................................................................................... 7DataAnalysis ...................................................................................................................................... 7

Results ............................................................................................................................................................ 8Demographics .................................................................................................................................... 8BaselineComparisonofTraditionalandCTETGroups ................................................... 8OutcomeMeasuresforTraditionalNutritionEducationCurriculum........................ 9OutcomeMeasuresforCTET....................................................................................................... 9EvaluationofTraditionalversusCTETApproach............................................................10

Discussion ...................................................................................................................................................18CharacteristicsofGroupsatBaseline ....................................................................................18OutcomesforTraditionalNutritionEducationCurriculum.........................................18OutcomesforCTET........................................................................................................................19ComparisonofTraditionalNutritionEducationtoCTET .............................................20

ImplicationsforResearchandPractice .........................................................................................27

Appendices .................................................................................................................................................29AppendixA:Facilitator’sGuideforTraditionalNutritionEducationCurriculum.........................................................................................................................................29AppendixB:CurriculumMatrixforCTET............................................................................33AppendixC:BehaviorChecklist ...............................................................................................35AppendixD:24-HourDietaryRecall......................................................................................36AppendixE:NEPCookTogether,EatTogetherRecruitmentFlyer..........................38

References ..................................................................................................................................................39Vita ................................................................................................................................................................45

v

LISTOFTABLES

Table1.Demographics..........................................................................................................................11Table2.IndependentT-TestofMeanatBaselineforComparisonvs.Pilot(Behavior

Checklist) ......................................................................................................................................12Table3.IndependentT-TestofMeanatBaselineforPilotvs.ComparisonGroups

(24-HourRecall)........................................................................................................................13Table4.PairedT-testofMeansofEntryandExitforComparisonandPilotCounties

(BehaviorChecklist) ................................................................................................................14Table5.PairedT-testofMeansofEntryandExitforComparisonandPilotCounties

(24-HourRecall)........................................................................................................................15Table6.IndependentSampleT-TestofDifferencesintheEntryandExitScoresfor

Comparisonvs.PilotCounties(BehaviorChecklist) .................................................16Table7.IndependentSampleT-testofDifferencesBetweenEntryandExit

Comparisonvs.PilotCounties(24-HourRecall).........................................................17

vi

ListofFigures

Figure1.PopulationofCompleteDataSetsforFirstPilot ....................................................22Figure2.IndependentT-TestofMeanatBaselineforComparisonvs.Pilot(BehaviorChecklist)...............................................................................................................................23Figure3.PairedT-testofMeansofEntryandExitforComparisonCounties(BehaviorChecklist)...............................................................................................................................24Figure4.PairedT-testofMeansofEntryandExitforPilotCountiesfor(BehaviorChecklist).....................................................................................................................................................25Figure5.IndependentSampleT-TestofDifferencesintheEntryandExitScoresforComparisonvs.PilotCounties(BehaviorChecklist)................................................................26

1

Introduction

TheSupplementalNutritionAssistanceProgram(SNAP)isaneconomicand

hungerassistanceprogramforeligible,low-incomefamiliesforfoodpurchases

(USDA,2016).SNAP-Ed,theeducationalcomponentofSNAP,promoteshealthy,

nutritiouslifestylechoicesandobesityprevention(USDA,2012).SNAP-Edworks

withstateagencies,nutritioneducators,andcommunityorganizationsthatprovide

outreachtoqualifiedindividuals.InadditiontoSNAP-Ed,theExpandedFoodand

NutritionEducationProgram(EFNEP)promoteshealthylifestylesanddisease

preventionthroughcommunityoutreach(USDA,EFNEP).TheNutritionEducation

Program(NEP)isanationallybasedorganizationthathelpsprovidetrainingand

curriculumsupporttotheCooperativeExtensionOfficeslocatedineverycountyin

Kentucky.TheUniversityofKentuckyCooperativeExtensionOfficeinturnoffers

EFNEPandSNAP-Edservicesthroughtheirtrainedparaprofessionals.

Inthedisciplineofnutritioneducation,socialmarketinghasshowntobea

promisingapproachforprogramimplementationaimedatbehaviorchange(Grier&

Bryant,2005).Socialmarketingisa“processthatappliesmarketingprinciplesand

techniquestocreate,communicate,anddelivervalueinordertoinfluencetarget

audiencebehaviorsthatbenefitsocietyaswellasthetargetaudience”(Kotler&Lee,

2008).Formernutritioneducationprogramsusedthe“top-down”method,where

healthprofessionalsidentifiedahealth-relatedissueandthenofferedsolutions.

Thisapproachputstheburdenontheparticipanttomakechangesbasedonexpert

advice.Thetraditionalapproachdidnottakeintoaccountparticipantperceptions

andcharacteristics.Socialmarketingusesa“bottom-up”method,focusingon

2

behaviorchangethroughnutritionandhealtheducation(Young,2004).Social

marketingencouragesthetargetaudiencetoadopthealthierhabitsbyusinga

participant-centeredapproachtosettinggoalsandpersonalizedaspirationsthrough

education(Grier&Bryant,2005).

EffectivenessofEFNEPandSNAP-Ed

ManystudiesverifythatEFNEPissuccessfulinincreasingnutrition-related

knowledgeandbehaviors(Wardlaw&Baker,2012).Outcomesareassessedusing

theEFNEPBehaviorChecklistand24-HourDietaryRecall.Previousresearchhas

demonstratedpositivechangesinshoppingbehaviorsandnutrientintakeforthose

whoparticipateinEFNEP(Hersey,Anliker,Miller,etal.,2001).In2015,EFNEP

reportedthat95%ofadultparticipantsimprovedtheirdietbyconsumingan

additional½cupoffruitsandvegetables.MostadultEFNEPparticipants(89%)

reportedimprovednutritionpractices.(USDA,NIFA,2016).

SNAP-Edprogramshaveshowntobeeffectiveinimprovingnutritionand

healthbehaviors(Wardlaw&Baker,2012;Long,etal.,2013).In2010,SNAP-Ed

outcomesincludedreportsthat50%ofparticipantsimprovedtheireating

behaviorsbyconsumingfoodsclosertorecommendedamountsforgrains,

vegetables,andfruits;40%beganeatingbreakfast;39%reportedhavingfewerfood

insecuredays;and78%triednewrecipes/foods(Sexton,2013).Reportsalso

confirmfoodinsecuritysignificantlyimprovedintargetaudiencesthroughSNAP-Ed

programs(Kaiser,2015).

3

TraditionalNutritionEducationCurriculum

TheKentuckyNutritionEducationProgram(KYNEP)includesbothSNAP-Ed

andEFNEPwithsimilargoalstoeducatelow-incomefamiliesandindividualsonthe

benefitsofadoptinghealthylifestyles(NutritionEducationProgram,2012).The

missionofKYNEPisto:1)educatelimitedresourcepeopletoacquireknowledge;2)

improveskills;and3)changebehaviornecessarytoachievehealthandwellbeing

(NutritionEducationProgram,2012).Curriculausedfortraditionalprograms

consistofavarietyofcorelessonswithoptionalandmaternalnutritionsubgroups.

ThetraditionalKYNEPcorelessonsinclude:BasicKeystoFoodPreparation,Meal

Planning,PlanforFoodSpending,andBreakfastMakesaDifference(AppendixA)

(NutritionEducationProgram,2012).ThetraditionalKYNEPcurriculumincludes

learningoutcomesforeachtopic(AppendixA).Trainedparaprofessionals

implementtheprogramsthroughouteachcountyinKentucky,oftenin8-12lesson

series(NutritionEducationProgram,2012).

CookTogether,EatTogetherProgram

CookTogether,EatTogether(CTET)isanewsocialmarketingprogram

developedin2014byKYNEP.ItisdesignedtoeducateSNAP-eligiblefamilieson

makinghealthierfoodpurchasing,preparation,andcookinghabits.Eightfocus

groupswereconducted,comprisedoftargetaudiencemembersrepresentingboth

ruralandurbancounties.Questionsaskedpertainedtocookingknowledge,

preparationskills,barriersincookingdinner,andcookingwithchildren.Amongthe

focusgroupparticipants,65%reportedeatingadinnermadeathomemost(5-6)

daysoftheweek;31%reportedmakingdinnerfromscratchmostdaysoftheweek;

4

31%statedshoppingwithagrocerylist;and48%disclosedrunningoutoffood

sometimestomostofthetime(Najor,2014).Anotherkeyfindingrevealed

participantspreferredtolearnthroughhands-onandinteractivecooking

experiences(Najor,2014).Thesekeyresearchfindingsservedasthebasisfor

developmentofacookbookandfacilitator’sguidethatpilotcountiesusedto

implementthesocialmarketingprogram.TheCTETfacilitator’sguideincludesa

curriculummatrix(AppendixB)describingthelesson,skillstaught,andbehavior

checklistquestionscoveredineachlesson.Inadditiontotherecipes,theextensive

cookbookoffersinformationonhealthyeating,shoppingsmartonabudget,howto

readfoodlabels,etc.TheCTETprogramisdesignedasa“cookingsocial”rather

thanacookingclassasrequestedbyfocusgroupparticipants(Najor,2014).

Inthefieldoffoodandnutrition,therehasbeenanincreaseintheuseof

cookinginterventions(Reicks,Trofholz,Stang&Laska,2014).Whilemanyfactors

haveinfluencedfamilyeatingbehaviorsoverthepastdecade,including,butnot

limitedtomaternalemployment,increasedtimepressure,andvariousfamily

structures,researchshowsindividualsdesiretoimprovedininghabits(Condrasky,

etal.,2006).StudiessuchasCookingwithaChef,CookingMatters,andSimplyGood

Cookingdemonstrateanimprovementinshopping,cooking,andeatingbehaviorsin

targetedaudiences(Condrasky,Graham,&Kamp,2006;May,Brad,Offelen,&

Johnson,2014;Bess,2015).

Effectivenutritioneducationisassociatedwithkeycomponentssuchas

targetingspecificbehaviorsthroughtheinterestsandmotivationsofthetargeted

population(USDA,2010).Duringtheformativeresearch,participantsagreeda

5

“cookingsocial”alongwithnutritionlessonswasthepreferredmethodfor

education(Najor,2014).Thisstudyevaluateshowasocialmarketingapproach

comparestotraditionalnutritioneducationcurriculumforpromotingbehavioral

changesrelatedtoeatingandfood.Understandingwhichtechniquesofeducation

appealsmosteffectivelytothelow-incomepopulationcanaidinfurtherresearch

efforts.

MethodsStudyDesign

Thecurrentstudywasconductedwithin12countiesofKentuckyusinga

nonequivalentcomparisongroup,entry-exitdesign.Participantscompleteda

behaviorchecklist(AppendixC)and24-hourdietaryrecall(AppendixD)beforeand

afterthesessiontomeasureeffectivenessofboththeCTETcurriculum

independentlyandcomparedwiththetraditionalcurriculum.Ofthe12

participatingcounties,sixreceivedusualKYNEPcare(comparisongroup)whilethe

othersixreceivedtheCTETprogram(pilotgroup).Thepilotandcomparison

countieswereselectedbasedonawillingnesstoparticipate,similardemographics,

NEPprogramassistantposition,percentageofpoverty,SNAPusage,geographic

location,andruralversusurban.

ThetraditionalKYNEPnutritioneducationcurriculumispresentedtogroups

of2-25individuals.CTETwasfashionedsimilarlyinaudiencesize,butusedsocial

marketingrecruitingtactics.Theparticipantsforthepilotgroupswererecruited

viaflyers(AppendixE)hungingrocerystores,TheYoungMen’sChristian

Association,CooperativeExtensionOffices,placesofworship,laundromats,

libraries,anddaycarecenters.Countyextensionagentsutilizedsocialmediaby

6

postingtherecruitmentflieronFacebook.Programcoordinatorsvisitedhomesand

neighborhoodfacilitiestopersonallyrecruitparticipants.Thecurriculumwas

deliveredinvariouswayscontingentupontheextensionassistant’sdiscretion.Few

countiesextendedtheCTETprogramthroughalleightweeks.Manycompletedtwo

lessonsinthesameday,compiledalllessonsintoaweeklongcamp,orshortened

theprogramtosixweeks.

EvaluationInstruments

BothEFNEPandSNAP-EdcollectdatathroughtheEFNEPBehaviorChecklist

(AppendixA),and24-HourDietaryRecall(AppendixB).Theyaredeliveredat

baselineandimmediatelyfollowingtheintervention(entry-exitapproach).Theself-

reportedBehaviorChecklistincludestenquestionscoveringtopicsoffoodresource

management(planmealsaheadoftime,compareprices,runoutfoodattheendof

themonth,shopwithgrocerylist),foodsafety(timedairyormeatsitout,thaw

foodsatroomtemperature),andnutrition(makinghealthyfoodchoices,adding

salt,readingtheNutritionFactslabel,andfeedingchildrenbreakfast).Theresponse

optionsuseaLikertScaleof1-5withonerepresenting“never”andfiverepresenting

“almostalways”(Auld,etal,2015).The24-HourRecallisusedforparticipantsto

recallallfoodsandbeveragestheyconsumed(food,description,amount,andtime

ofday)inthelast24hours.Aprogramassistantfacilitatestherecall.Theassistant

thenentersthedataintotheWeb-BasedNutritionEducationEvaluationand

ReportingSystem(WebNEERS)softwareforcalculatingvitamin,mineral,and

nutrientdata.WebNEERSisusedonthefederal,institutional,andregionallevelto

collect,store,andmanagedatasotoprovideavarietyofreportsanddiagnostic

7

assessments(USDA,WebNEERS).Oneoftheoutcomesmeasuredthroughthe24-

HourDietaryRecallistheHealthyEatingIndex(HEI)score.TheHEIscoreisa

measureofdietqualityasdefinedbytheUSDA.Itmonitorsthequalityofthe

Americanpopulation’sdietandtheeffectivenessofnutritioninterventionprograms

(GuentherP,etal.,2013).

DataCollection

ThefirstpilotprogramofCTETbeganinthesummerof2015andwas

completedinthefall.Theexactdateswerechosenbasedontheextensionassistant

availabilitiesandworkload.Demographicinformationwasobtainedfrom

participantsincludingage,race,agesofchildreninthehouseholdyoungerthan18,

householdsize,andincome.Participantswereaskedtoanswerthequestionsonthe

BehaviorChecklistusingtheLikertscale.Programassistantsworkedwith

participantsindividuallytocomplete24-HourDietaryRecalls,whichwereentered

intoWebNEERSdataanalysissoftware.Datacollectedfromeachcountywas

transferredintoanExcelspreadsheetusingthedoubleentrymethodtocontrolfor

internalerror.

DataAnalyses

ThedatawereanalyzedusingStatisticalPackagefortheSocialSciences

(SPSS22)(version3.51.59).Anindependentsamplet-testmeasureddifferences

betweencomparisonandpilotgroupmeansatbaseline(entry)andafter

intervention(exit).Apairedt-testwaschosentocomparemeansbetweenpre-and

post-interventiondifferenceswithinthepilotandcomparisongroups.Significance

foralltestmeasureswasdefinedbyaBonferroni-adjustedPvaluesofα≤.05,andP

≤ .10werealsoreported(Armstrong,2014).

8

Results

Demographics

Thestudyhadatotalof64participants;thecomparisongroupconsistedof

30andthepilotconsistedof34participants.Onecomparisonindividual’sdatawas

discardedaftertheinterventionbecausehewasmaleandthestudyfocusedon

women.Thefinaldataused29participantsforthecomparisongroup.

Demographicinformation(Table1)revealedmostparticipantswereCaucasian

(75%)followedbyAfricanAmerican(24%)andwerebetweentheagesof26-40

(53%).Thosewhoreportedtheirincome,16(25%)madelessthan$500/month.

Theaveragehouseholdsizewas3.4people,includingparentfigure(s).

BaselineComparisonofTraditionalandCTETGroups

Overall,thepilotandcomparisongroupsstartedtheprogramwithsimilar

baselinebehaviorsasassessedbythechecklist.Thecomparisongroupranoutof

foodbeforetheendofthemonthmorefrequentlyandthoughtlessaboutfeeding

theirfamilyhealthyfoodsthanthepilotgroup(Table2).WithsignificanceatP≤

0.10,thepilotgroupletmeatanddairyfoodssitoutlongerthantwohoursmore

frequentlythanthecomparisongroup.Whenaskedhowoftenpreparedfoodswere

madewithoutaddingsalt,thecomparisongroupreported0.54pointslowerthan

thepilotgroup.ThecomparisongroupreadtheNutritionFactsonthefoodlabel

lessoftenthanthepilotgroup(P=0.002).

Fewvariableswerefoundtobesignificantlydifferentatbaselineaccording

tothe24-HourDietaryRecall(Table3).Thecomparisongrouprecordedeating

moremeals(3.77)thanthepilotgroup(3.09)andthusconsumingsignificantly

moretotalcalories(P=0.086).

9

OutcomeMeasuresforTraditionalNutritionEducationCurriculum

Thisstudyevaluatedcomparisongroupentrymeanscoresandexitmean

scoresfortheBehaviorChecklist(Table4)andfoundsignificantimprovementin

theareasofplanningmealsaheadoftime,comparingprices,lettingfoodsitout

longerthantwohours,lettingfoodsthawatroomtemperature,thinkingabout

healthyfoodchoices,andusingNutritionFactsonfoodlabel.Thegreatestpercent

changewasfoundinreadingfoodlabels(82%)wheretheparticipantsimprovedby

0.9pointsbetweenentryandexit.

Thetraditionalcurriculumprovedtobeeffectiveaccordingtothe24-Hour

DietaryRecallintheareasofHEIofVegetables(P≤0.10)andHEITotal(P≤0.05)

(Table5).Whiletherewasimprovementinnineoftheelevencategories,however,

noneoftheobservedimprovementwassufficientenoughtoattainstatistical

significance.

OutcomeMeasuresforCTET

ThemeanentryandexitscoresofthepilotgroupfortheBehaviorChecklist

(Table4)showedimprovementintheareasofplanningmealsaheadoftime,

comparingprices,runningoutoffoodbeforeendofthemonth,shoppingwitha

grocerylist,lettingfoodsitoutlongerthantwohours,thawingfoodatroom

temperature,usingNutritionFactsonfoodlabel,andfeedingchildrenbreakfast.

ThegreatestpercentchangefromentrytoexitwasinfrequencyofusingNutrition

Factsonfoodlabels(32%)wheretherewasa0.47increasebetweenentryandexit

scores.Theonlyquestionswheretheimprovementwasnotsignificantwasin

10

comparingprices,makinghealthyfoodchoicesforthefamily,andaddingsaltwhen

preparingfood.

Thepilotparticipantswhocompletedthe24-hourDietaryRecall(Table5)

demonstratedsignificantimprovement(P≤0.05)intheareasofnumberofmeals,

servingsofvegetablesandfruit,totalgramsoffiber,vitaminC,HEIoffruitsand

vegetables,andtotalHEI.Whilethepilotgroupappearedtohaveagreater

progressioninbehaviorchange,theseparticipantswerealreadyinterestedin

cookingandindevelopinghealthierhabitsbeforerecruitment.

EvaluationofTraditionalversusCTETApproach

Whenmeasuringthedifferenceinmeansbetweenthecomparisonandpilot

groupsfortheBehaviorChecklist(Table6),thequestionspertainingtothawing

frozenfoods,thinkingabouthealthychoices,andusingNutritionFactshad

significantresultsatP≤0.10favoringthecomparisongroup.Thecomparisongroup

hadalargerdifferencebetweenentryandexitsurveys,andthus,wasimpacted

greatestfromtheintervention.However,itisimportanttonotethisgroupstarted

withalowerbaselinemeanintheseareas(Table2).

The24-hourDietaryRecalldatashowedagreaterimprovementforthepilot

groupinservingsoffruit(P=0.006),vitaminC(P=0.085),HEIoffruits(P=0.016),

andtotalHEI(P=0.099)(Table7).Whilethereweregreaterdifferencesin

categoriessuchastotalcalories(318),totalgramsoffiber(0.85),andtotalgramsof

fat(13.12)forthecomparisongroup,thedatawerenotconclusive.

11

Tables

Table1.Demographics

* Onecomparisonparticipantwasdisqualifiedfromthestudyduetodiscrepancyingender(participantwasmale).Statisticsinreportincludeparticipant’sresults.

Variable Comparison Pilot TotalN 30* 34 64AgeN(%)20-25 7(11) 3(5) 1026-30 11(17) 7(11) 1831-40 7(11) 9(14) 16

41-50 2(3) 8(13) 1051+ 3(10) 7(11) 10

NoEntry 0 0 0RaceCaucasian/White 28(44) 20(31) 48African

American/Black 1(2) 14(22) 15

AmericanIndian 1(2) 0 1NoEntry 0 0 0

Income

Lessthan$500 12(19) 4(6) 16

$501-$800 4(6) 3(5) 7

$801-$1,000 1(2) 4(6) 5

$1,001ormore 4(6) 7(11) 11

NoEntry 9(14) 16(25) 25

HouseholdSize

Lessthan2 0 0 0

2-3 19(30) 20(31) 394-5 9(14) 11(17) 20

6+ 2(3) 3(5) 5

NoEntry 0 0 0

SupportSNAP 13(20) 19(30) 32

EFNEP 17(27) 15(23) 32

NoEntry 0 0 0

12

Table2.IndependentT-TestofMeanatBaselineforComparisonvs.Pilot(BehaviorChecklist)

*P≤0.05,**P≤0.10;Questions3,5,and6usereverseordering.EqualVariancesAssumed;Scoresof1-5=nevertoalmostalways.

Question Variable BaselineMean(Std.Dev)**ScoreRange(1-5) Comparison

(n=30)Pilot(n=34)

*P-value(2-tailed)

1 Howoftendoyouplanmealsaheadoftime?

3.10(0.960) 3.12(1.094) 0.946

2 Howoftendoyoucomparepricesbeforeyoubuyfood?

3.63(1.217) 4.00(1.015) 0.194

3Howoftendoyourunoutoffoodbeforetheendofthemonth?

2.83(0.913) 2.06(1.071) 0.003*

4 Howoftendoyoushopwithagrocerylist?

3.57(0.971) 3.50(0.961) 0.784

5Howoftendoyouletdairyandmeatfoodssitoutformorethan2hours?

1.23(0.430) 1.53(0.825) 0.083**

6Howoftendoyouthawfrozenfoodsatroomtemperature?

2.83(1.177) 2.62(1.206) 0.473

7

Whendecidingwhattofeedyourfamily,howoftendoyouthinkabouthealthyfoodchoices?

3.30(1.055) 3.91(0.866) 0.013*

8Howoftenhaveyoupreparedfoodswithoutaddingsalt?

2.37(1.273) 2.91(1.190) 0.082**

9HowoftendoyouusetheNutritionFactsonthefoodlabeltomakefoodchoices?

1.87(1.137) 2.82(1.193) 0.002*

10

Howoftendoyourchildreneatsomethinginthemorningwithintwohoursofwakingup?

3.93(1.388) 4.15(1.077) 0.491

13

Table3.IndependentT-TestofMeanatBaselineforPilotvs.ComparisonGroups(24-HourRecall)

*P≤0.05,**P≤0.10

Variable ComparisonMean(Std.Dev)

PilotMean(Std.Dev)

P-Value

NumberofMeals 3.77(1.222) 3.09(0.996) 0.017*ServingsofVegetables

1.67(2.469) 1.0752(1.096) 0.211

ServingsofFruit 0.514(0.908) 0.317(0.551) 0.291TotalCalories 1848.59(1343.78) 1371.264

(812.32)0.086**

TotalGramsofFiber 10.62(7.034) 9.45(6.657) 0.498TotalGramsofFat 71.07(60.222) 56.83(37.712) 0.256VitaminA 409.49(270.446) 426.75(486.015) 0.864VitaminC 38.26(39.111) 44.14(65.490) 0.670HEIofFruits 1.27(1.905) 1.22(1.832) 0.911HEIofVegetables 2.68(1.823) 2.76(1.862) 0.861HEITotal 46.84(15.404) 45.39(14.105) 0.694

14

Table4.PairedT-testofMeansofEntryandExitforComparisonandPilotCounties(BehaviorChecklist)

*P≤0.05,**P≤0.10;Questions3,5,and6usereverseordering.EqualVariancesAssumed;Scoresof1-5=nevertoalmostalways.

Question ComparisonEntrymean+(SD)

ComparisonExitmean+(SD)

PercentChange

P-value

PilotEntrymean+(SD)

PilotExitmean+(SD)

PercentChange

P-value

13.10

(0.960)3.73

(0.907)29% 0.000* 3.12

(1.094)3.50

(0.992)22% 0.040*

2 3.63(1.217)

4.03(0.809)

29% 0.031* 4.00(1.015)

4.29(0.719)

16% 0.067**

3 2.83(0.913)

2.57(1.040)

6% 0.118 2.06(1.071)

1.62(0.985)

7% 0.030*

4 3.57(0.971)

3.70(0.915)

9% 0.326 3.50(0.961)

3.79(0.880)

13% 0.039*

5 1.23(0.430)

1.03(0.183)

-8% 0.031* 1.53(1.088)

1.18(0.521)

-6% 0.050*

6 2.83(1.177)

1.40(0.968)

44% 0.000* 2.62(1.206)

4.00(0.816)

28% 0.000*

7 3.30(1.055)

3.80(0.847)

27% 0.003* 3.91(0.866)

4.0(0.8)

7% 0.619

8 2.37(1.273)

2.83(1.177)

39% 0.014* 2.91(1.190)

3.06(1.153)

14% 0.443

9 1.87(1.137)

2.77(1.040)

82% 0.000* 2.82(1.193)

3.29(1.088)

32% 0.004*

10 3.93(1.388)

4.03(1.326)

12% 0.586 4.15(1.077)

4.47(0.929)

11% 0.003*

15

Table5.PairedT-testofMeansofEntryandExitforComparisonandPilotCounties(24-HourRecall)

*P≤0.05,**P≤0.10

Variable ComparisonEntrymean+(SD)

ComparisonExitmean+(SD)

P-value PilotEntrymean+(SD)

PilotExitmean+(SD)

P-value

NumberofMeals

3.77(1.222)

3.9(1.029)

0.546 3.09(0.996)

3.56(1.021)

0.011*

ServingsofVegetables

1.67(2.469)

1.52(1.196)

0.682 1.0752(1.096)

1.573(0.959)

0.040*

ServingsofFruit

0.514(0.908)

0.502(0.763)

0.957 0.317(0.551)

1.12(1.154)

0.000*

TotalEnergy

1848.59(1343.78)

1530.35(592.986)

0.180 1371.264(812.32)

1389.11(471.00)

0.912

TotalGramsofFiber

10.62(7.034)

11.467(6.155)

0.510 9.45(6.657)

12.76(7.234)

0.033*

TotalGramsofFat

71.07(60.222)

57.952(23.225)

0.261 56.83(37.712)

55.82(28.763)

0.903

VitaminA 409.49(270.446)

500.44(313.18)

0.153 426.75(486.015)

513.01(426.892)

0.383

VitaminC 38.26(39.111)

40.474(40.124)

0.807 44.14(65.490)

75.203(63.540)

0.026*

HEIofFruits

1.27(1.905)

1.5(2.033)

0.655 1.22(1.832)

3.03(2.158)

0.000*

HEIofVegetables

2.68(1.823)

3.38(1.805)

0.059** 2.76(1.862)

3.83(1.653)

0.007*

HEITotal 46.84(15.404)

53.14(13.972)

0.050* 45.39(14.105)

59.19(10.621)

0.000*

16

Table6.IndependentSampleT-TestofDifferencesintheEntryandExitScoresforComparisonvs.PilotCounties(BehaviorChecklist)

Question Variable Mean(Std.Dev)Comparison(n=30)

Pilot(n=34)

P-value(2-tailed)

1 Howoftendoyouplanmealsaheadoftime?

0.63(.850) 0.38(1.045) 0.300

2 Howoftendoyoucomparepricesbeforeyoubuyfood?

0.40(.968) 0.29(.906) 0.653

3Howoftendoyourunoutoffoodbeforetheendofthemonth?

-0.27(.907) -0.44(1.133) 0.503

4Howoftendoyoushopwithagrocerylist?

0.13(.730) 0.29(.799) 0.406

5

Howoftendoyouletdairyandmeatfoodssitoutformorethan2hours?

-0.20(.484) -0.35(1.012) 0.453

6Howoftendoyouthawfrozenfoodsatroomtemperature?

-1.43(1.357) -0.91(1.111) 0.096*

7

Whendecidingwhattofeedyourfamily,howoftendoyouthinkabouthealthyfoodchoices?

0.50(.861) 0.09(1.026) 0.089**

8Howoftenhaveyoupreparedfoodswithoutaddingsalt?

0.47(.973) 0.15(1.105) 0.227

9

HowoftendoyouusetheNutritionFactsonthefoodlabeltomakefoodchoices?

0.90(1.125) 0.47(0.896) 0.094**

10

Howoftendoyourchildreneatsomethinginthemorningwithintwohoursofwakingup?

0.10(.995) 0.32(.589) 0.272

*P≤0.05,**P≤0.10;Questions3,5,and6usereverseordering.EqualVariancesAssumed;Scoresof1-5=nevertoalmostalways.

17

Table7.IndependentSampleT-testofDifferencesBetweenEntryandExitComparisonvs.PilotCounties(24-HourRecall)

Variable Mean(Std.Dev)Comparison(n=30)

Pilot(n=34)

P-value(2-tailed)

NumberofMeals 0.13(1.20) 0.47(1.022) 0.228ServingsofVegetables

-0.15(2.00) 0.50(1.355) 0.129

ServingsofFruit -0.012(1.232) 0.81(1.066) 0.006*TotalCalories -318.23(1269.593) 17.85(936.71) 0.229

TotalGramsofFiber 0.85(6.940) 3.30(8.658) 0.219TotalGramsofFat -13.12(62.612) -1.02(47.948) 0.386VitaminA 90.951(339.59) 86.26(568.411) 0.969VitaminC 2.21(49.101) 31.07(77.693) 0.085**HEIofFruits 0.23(2.750) 1.81(2.338) 0.016*HEIofVegetables 0.70(1.954) 1.07(2.181) 0.483HEITotal 6.30(16.892) 13.81(18.733) 0.099**

*P≤0.05,**P≤0.10

18

Discussion

CharacteristicsofGroupsatBaseline

Baselinescoreswerefairlysimilarbetweenthepilotandcomparisons

groups.Therewereonlyafewbaselinescoresthatwerelowerinthecomparison

groupthanthepilotgroupontheBehaviorChecklist(Figure2)and24-HourRecall.

Forexample,atbaseline,thepilotgroupreportedusinglesssaltwhenpreparing

food,readingtheNutritionLabelsandconsideringhealthychoicesmoreoftenthan

thecomparisongroup.The24-HourRecalldemonstratedthatthecomparison

groupatemoremeals(3.77)thanthepilotgroup(3.09)andthusconsumed

significantlymoretotalcalories(P=0.086).Allofthesedifferencescouldbedueto

thefactthattherecruitmentflyertargetedparticipantswhowerealreadyinterested

inlearning“howtomakehealthyandaffordablerecipes”aswellasgetting“tips

thatmakecookingfast,funanddelicious”(AppendixE).PromotionforCTET

utilizedsocialmarketingtechniquessuchassocialmedia(i.e.Facebookposts),

personallyknockingondoorsandcommunitycenters.Becauseoftheshorttimeline

availableforrecruitmentandthefocusoftheCTETonhomecooking,newstrategies

wereusedthatmayhaveinfluencedpilotgroupparticipantcharacteristics.

OutcomesforTraditionalNutritionEducationCurriculum

Pre-postanalysisoftheentryandexitBehaviorChecklistindicatedthatthe

comparisongroup(whoreceivedthetraditionalcurriculum)achievedstatistically

significantpositivebehaviorchangeinmostareas.Exceptionswererunningoutof

foodbyendofthemonth,shoppingwithagrocerylist,andfeedingchildren

breakfast(Figure3).Conversely,theonlyoutcomewherethecomparisongroup

19

showedimprovementforthe24-HourRecallafterreceivingthetraditional

curriculumwastheHEIforvegetablesandtotalHEItotalscore.Thismaybe

attributedtotheemphasisinthetraditionalcurriculumonfruitandvegetable

consumption.

OutcomesforCTET

Pre-postanalysisoftheBehaviorChecklistdatashowedpositivebehavior

changeoutcomesforthepilotgroupintheareasoffoodresourcemanagement,food

safety,nutrition,andfeedingchildrenbreakfast(Figure4).Analysisofthepilot

group’sFoodRecalldataalsoshowedpre-postimprovementsinthenumberof

mealsconsumed,aswellas,servingsoffruitandvegetablesandamountsoffiber

andvitaminCconsumed.Consequently,thepilotgroupshowedpositivepre-post

changesinHEIforfruitsandvegetables,andTOTALHEItotalscore.Cumulatively,

thesepositivechangesreflectthesuccessoftheCTETcurriculum.Inparticular,the

recipesdemonstratedinthecookbookincorporatefreshproducetoencouragethe

targetaudiencetobuyandpreparehealthiermeals.

ThesocialmarketingapproachachievedtheEFNEPgoalsof“improvingthe

totalfamily’snutritionalwell-being”bymeetingtheneedsofdietquality,food

resourcemanagement,foodsafety,andfoodsecurity(USDA,2016).Basedonthe

pilotresults,resourcesincludedintheCTETprogram(AppendixB)suchasproduce

availability,portionsizes,measurementsandsubstitutions,knifeskills,andcooking

basics,helptoincreasefruitandvegetableconsumption,foodsafetypractices,and

healthycookinghabitsinEFNEPandSNAP-Edparticipants.

20

ComparisonofTraditionalNutritionEducationtoCTET

Overall,theanalysissuggeststhattheCTETgroup,comparedtotheir

counterpartsinthetraditionalgrouporusualcare,hadhigherpre-postgainsin

foodresourcemanagement,feedingchildrenbreakfast,numberofmeals,fruitand

vegetableconsumption,totalfiber,vitaminC,andHEIforfruits.Boththe

comparisonandpilotgroupsshowedpositivepre-postchangesinfoodpractices

includingappropriatethawingoffrozenfood,thinkingabouthealthyfoodchoices,

andreadingNutritionFacts(Figure5).Thebaselinewaslowerforthecomparison

groupintheseareas,whichmayhaveledtoahighermeandifference.

Withregardstogroupdifferencesinthe24-HourDietaryRecall(Table7),

thecomparisongroupreporteda0.13-pointincreasefornumberofmealsbut

decreasedconsumptionoffruits(-0.012),vegetables(-0.15)andtotalenergy(-

318.23).Thiscouldbeduetolimitationsofthe24-HourDietaryRecall,self-

reportingerrorordataentrydiscrepancies.Asforservingsofvegetablesandfruit

forthepilotgroup,theparticipantsreportedhalfaservingincreaseforvegetables

(0.50)andalmostfullservingincreaseforfruit(0.81).Likelyduetotheincreasein

fruitandvegetableconsumption,vitaminCwassignificantlyhigherinthepilot

groupthanthecomparisongroup.Thepilotgroupalsohadalargermeandifference

forHEIforfruitsandtotalHEIscorethanthecomparisongroup;however,thepilot

grouphadlowerbaselinescores.Therecruitingpracticesforthissocialmarketing

programmayhaveresultedinagroupofpilotparticipantsthatdifferedfromthe

comparisongroupwithregardtofoodshopping,preparation,cooking,andeating

behaviors.

21

Theentryandexitdesignhasshowntobethemosttellingofaprogram’s

successbynumerousstudiesintheEFNEPandSNAP-Edfield(Swindle,Baker,Auld,

2007).Wallandcolleaguesfoundsignificantimprovementsinfourthgrader

attitudes,preferences,andself-efficacytowardvegetableconsumptionwhen

utilizingthepre-andpost-testintervention(Wall,Least,Gromis,&Lohse,2012).

ChungandHoerrfoundsignificantchangesinfruitandvegetableintakeamong

womenwithlimitedincomeusingapre-andpost-interventiondesign(2007).A

randomizedcontrolledtrialmeasuringtheknowledgeoflow-incomeparentsprior

toandfollowingEFNEPparticipationgavesignificantoutcomesaswell.The

BehaviorChecklistwasadministeredpreandpostinterventionandfoundpositive

outcomesrelatedtobehaviorchangeretainedatleastfor2months(Dollahite,Pijai,

Scott-Pierce,Parker,&Trochim,2014).

WhiletheCTETprogramwasconductedin12countiesofKentuckyvarying

indemographics,region,andsize,itisnotreflectiveofthenationalSNAP-eligible

populationhencethedatamaynotbegeneralizedtoallprograms.TheSNAP

populationdemographicsrangeacrossthenationfromurbantorural,ethically

diversepopulations,hence,varyingfoodpreferences,aswellasthevarious

communityresourcesthatimplementCTET.Themajorityofparticipantsidentified

themselvesasCaucasian(75%)likelyduetoKentucky’shighCaucasianpopulation

(87%)(USCensusBureau,2015).Thedatapresentedisfairlyconsistent

throughouttheparticipatingcounties,butshouldbeappliedwithdiscretiontoother

incomparableregions.

22

Figures

Figure1.PopulationofCompleteDataSetsforFirstPilot

23

Figure2.IndependentT-TestofMeanatBaselineforComparisonvs.Pilot(BehaviorChecklist)

IndicatessignificanceatP≤0.10.

0 2 4 6

PlanMealPrice

OutofFoodGroceryListDairy/MeatThawFoods

HealthyAddedSalt

Nutr'nLabelBreakfast

PilotComparison

24

Figure3.PairedT-testofMeansofEntryandExitforComparisonCounties(BehaviorChecklist)

IndicatessignificanceatP≤0.10.

00.51

1.52

2.53

3.54

4.5BehaviorChecklistScale

EntryExit

25

Figure4.PairedT-testofMeansofEntryandExitforPilotCounties(BehaviorChecklist)

IndicatessignificanceatP≤0.10.

00.51

1.52

2.53

3.54

4.55

BehaviorChecklistScale

Entry Exit

26

Figure5.IndependentSampleT-TestofDifferencesintheEntryandExitScoresforComparisonvs.PilotCounties(BehaviorChecklist)

IndicatessignificanceatP≤0.10.

-2-1.5-1

-0.50

0.51

1.5

PlanMeal

Price

OutofFood

GroceryList

Dairy/Meat

ThawFoods

HealthyChoices

AddedSalt

Nutr'nLabel

Breakfast

MeanDifferences

ComparisonPilot

27

ImplicationsforResearchandPractice

TheCTETprogram,usingasocialmarketingapproach,significantly

increasedfruitandvegetableintake,aprimaryobjective.Theseresultsprovide

supportforusing“cookingsocials”toenforcepositivenutritionbehaviorsinlow-

incomefamilies.Aspredictedbyotherstudies,focusgroupsuggestionsthatguided

newprogramdevelopmentwerekeyinthebehaviorchangeofthepilotgroup

(Young,etal,2006).Afocusoncookinganddirecteducationratherthantraditional

nutritioneducation,foradults,isapromisingapproachtoimprovedietqualityfor

SNAP-EdandEFNEPaudiences(Auld,etal,2013;Bess,2016;&Condrasky,2006).

Although,morerobustexperimentalstudiesareneededtoconcludethat

participationin“cookingsocials”aremoreeffectiveinbehaviorchangethan

traditionalnutritioneducationprograms.Thefindingsofthisstudyindicatethata

socialmarketingapproachpromotinghealthyhome-cookedfamilymealsisa

promisingwaytoimprovedietsofparticipants.

Beforeadoptingasocialmarketingapproach,therearemanyprogram

characteristicsthatshouldbeconsidered.Thetraditionalclassesarenotchild-

friendly,whereasthesocialmarketingclassesencouragechildrenattendance.This

introducesconcernsabouttheincreasednoiselevel,kitchensafetywithknife

lessons,distractionsfortheparent,andlengthierexplanations.Furtherresearch

regardingrecruitmenttechniquesandparticipantretentionofsocialmarketing

programswouldprovideinformationhelpfultoprogramadministrators.Another

practicalimplicationtakenfromthecurrentstudyisthatofthetraditional

28

curriculum’stimelineandeffectiveness.Ifthesocialmarketingprogramcanbe

mergedintothetraditionalapproximate8-weekgraduationtimeline,theefficiency

ofbehaviorchangemaynotonlyimprove,butpotentiallyatagreaterconcentration.

Socialmarketingprogramsoftenaddressvariouslevelsofthesocio-

ecologicalmodel,especiallythecommunity,inordertoimprovehealthbehaviors

(Blitstein,etal.,2016;Danneferetal,2014).CTETofferedgrocerystoreand

Farmers’Markettourstobetterintegratethetargetaudienceintothecommunity.

Targetingmultiplelevelsofthesocio-ecologicalmodelthroughlongitudinalstudies

hasproventoenhancebehaviorchange(Bliesteinetal,2016;Brink&Sobal,1994,

Danneferetal,2014).OnepreliminaryretentionstudyfoundEFNEPparticipants

sustainedbehaviorchangesimmediatelyaftergraduationand1yearfollow-up

(Brink&Sobal,1994).

Thispilotstudyillustratesthatasocialmarketingprogramtargetinglow-

incomefamiliesmaybemoreeffectiveforchangingselectedbehaviorsinSNAP-Ed

andEFNEPparticipantsthanthetraditionalnutritioneducationcurriculum.The

CTETprogramappearstobemoreeffectiveforpromotingincreasedconsumption

offruitsandvegetables,apriorityoutcomefortheseprograms.

The2015DietaryGuidelinesforAmericans(USDHHS,2015)useasocio-

ecologicalframeworktodepicthowindividualbehaviorchangescanbesupported

bychangesinsocialandculturalnorms.Thispilotstudyillustrateshowasocial

marketingapproachaimedatchangingcookingnormscanhaveagreaterinfluence

onfood-relatedbehaviorsthandirecteducationalone.

29

AppendixA:Facilitator’sGuideforTraditionalNutritionEducationCurriculum

CoreLesson LearningOutcomesBasicKeystoFoodPreparation

• Understandtheimportanceofhealthyfoodchoices• Planandpreparemealsincludingavarietyoffoodsusing

MyPlate• ConsumeahealthydietconsistentwithUSDADietary

GuidelinesMyPlate • UnderstandMyPlaterecommendationsforahealthydiet

• PlanandpreparemealsincludingavarietyoffoodsusingMyPlateguidelines

• Participateinatleast30minutesofphysicalactivityeveryday

GrainsGroup • Understandwhybread,cereal,rice&pasta(grains)areanimportantpartofourdailydiet.

• KnowthenumberofounceequivalentssheneedsdailyfromtheGrainsGroup,andhowmanyoftheseshouldbewholegrains.

• IdentifyrecommendedservingsizesoffoodsintheGrainsGroup.

• Nameatleastonewaytostretchthefooddollarwhenpurchasingbreadandcerealproducts.

• Identifyhigh-andlow-caloriechoicesfromtheGrainsGroup.

• Planandservemealsthatincludeenrichedorwholegrainbreadsandcereals.

• Nametwowaystostoregrainproducts.• Calculatehowmuchdryriceorpastaitwilltaketofeedfour

people.VegetableGroup •Understandwhyvegetablesareanimportantpartofthedailydiet.

•Knowhowmanycupsofvegetablesshouldbeeatentomeetdailyneeds.•Knowhowmanycupsofdark-green,orangeandstarchyvegetablesandlegumesshouldbeeateneachweek.•Identifyrecommendedservingsizesforvegetables.•IdentifyvegetablesourcesofvitaminsAandC.•Identifyvegetablesourcesofminerals.•Nameatleastonewaytostretchthefooddollarwhenpurchasingvegetables.•Describeandpracticewaystostore,prepareandcookvegetablesinordertoconservenutrients.

30

•Tryanewmethodofcookingorservingavegetable.•ServevegetableshighinvitaminsAandC,mineralsandfibertomeetthefamily'sneeds.

FruitGroup •Explainwhyfruitsareanimportantpartofthedailydiet.•Knowtherecommendeddailyamountoffruitsfortheeatingplan.•Knowtherecommendedservingsizesforfruits.•IdentifyfruitsrichinvitaminsAandC.•ServefruitsrichinvitaminAandCtomeetthefamily'sneeds.•Identifyfruitsrichinironandpotassium.•Servefruitsrichinironandpotassiumtomeetthefamily’sneeds.•Servefruitsofmanydifferentcolors.•Tryanewmethodofcookingorservingafruit.•Nameatleastonewaytostretchthefooddollarwhenpurchasingfruits.

ProteinGroup •Understandwhymeat,poultry,fish,drybeansandpeas,eggsandnutsandseedsareanimportantpartofthedailydiet.•IdentifyfoodsthatarepartoftheMeatandBeansGroup(ProteinGroup).•KnowtheamountoffoodsfromtheMeatandBeansGroupthatUSDADietaryGuidelinesrecommendforherdaily.•IdentifywaystosavemoneywhenbuyingfoodsintheMeatandBeansGroup.•Demonstratehowtocutupawholechickenintopartsforcooking.•Tryanew,healthfulmethodofcookingorservingameatormeat·alternate.•Describeatleastonewaytocooklessexpensive,leanmeatstomakethemmoretenderandflavorful.•Identifythenumberofservingsperpoundtoexpectfromdifferenttypesofmeat•Identifyproperstoragemethodsforrawandcookedmeatsandmeatalternatives.•Explainsafewaystothawfrozenmeat,poultryandfish.•Knowsafetymeasuresforconsuminglocallycaughtfish.•Identifysoakingandcookingproceduresfordrybeans.

DairyGroup • Understandwhycalciumisanimportantnutrientforpeopleofallages.• Identifycalcium-richfoodsfromallfoodgroups.• Planabalancedmealhighincalciumtomeetfamilyneeds.• Nameseveralwaystostretchthefooddollarwhenpurchasingcalcium-richfoods.• PracticeatleastthreemethodsofpreparingfoodsintheMilkGroup(DairyGroup).

OilsandEmptyCalories

• KnowwhatdiscretionarycaloriesareandhowtheyfitintotheMyPyramideatingplan.

31

• TellhowmanydiscretionarycaloriesherMyPyramideatingplanprovides.

• Understandthatdiscretionarycaloriescancomefromanyfoodgroup.

• Estimatelimitsforsodiumandcaloriesfromfatsandsugars.• Listsourcesofsodium.• Listsourcesofcaloriesfromfatsandsugars.• Explainwhyitisnecessarytolimitsodiumandcaloriesfrom

fatsandsugars.• Uselabelstoidentifyproductshighinsodium.• Uselabelstoidentifyproductshighincaloriesfromfatand

sugar.• Explainthedifferencebetweensaturatedandunsaturated

fat.• Explainwhyitisnecessarytolimitsaturatedfat,transfats

andcholesterolinthediet.• Listfivesourcesofsaturatedfat,trans-fattyacidsand

cholesterol.• Listthebestchoicesfordietaryfat.• Determinewhethercaloriesfromsugar,fat,andsaturated

fatinherdietarewithintherecommendationsofherMyPyramideatingplan.

• Identifyhowmuchofthefamilygrocerybillisspentonfats,oilsandsweets.

• Improvethequalityoffamilymealsandsnacksbymakingchangesinfoodbuyingandpreparationpracticesthatlimittheuseoffoodshighinsodium,fatandsugar.

MealPlanning •Describethebenefitsofplanningmenus.•Planaweek'smenuforthefamilyusingfoodsthatmeetherfamily'snutritionalneedsandmoneyavailable.•Makeashoppinglistbasedonmenusfortheweek.•Describewaystomakemealsattractiveandappealing.

LabelPower • Demonstratehowtofindthefollowinginformationonfoodcontainers

o NutritionFactso Ingredientslisto Handlinginstructionso NetWeight

• 2. UsetheNutritionFactstoidentify• ServingSize• Numberofservingsinthecontainer• Amountsofnutrientsperserving• 3. Usethelistofingredientstoidentifywhichare

presentinthegreatest

32

• amounts.• 4. Demonstratehowtomatchlabelclaimswithhealth

concerns.• 5. Identifyatleastthreenutrientsandthedisease(s)

eachnutrientcanhelp• prevent.• Usethe%DailyValuetodescribeaproductashavingalow,

mediumor• highamountofanutrient.• Identifyonevitaminandonemineraltolookforonthe

NutritionFactslabel.

PlanforFoodSpending

• Prepareareasonablefoodspendingplanforthefamily• Describethestepsinpreparingashoppinglist• Makeashoppinglistbasedonmenusforoneweek• Recognizewhatshouldbeconsideredbeforegoingshopping• Identifyunitpriceshelftagsanddeterminethemost

economicalbuyusingunitpricing• Beabletofigurecostperservinganduseittofindthebest

buys• Comparepricesofconveniencefoodswithpricesofsimilar

foodsmadeathome• Identifyfactorsthataddtothecostofconveniencefoods• Giveexamplesofwaystoavoidfoodwaste• Describeatleastthreewaystosaveatthegrocery

FoodSafety • Knowwhatfoodborneillnessis• Describesignsandsymptomsoffoodborneillness• Knowsafetemperaturesforfood• Knowpropermethodsforstorage,preparation,andserving

offood

BreakfastMakesaDifference

• Explainwhyeatingbreakfastisimportant• Planwaystoprovideanutritiousbreakfastfortheirfamilies

within2hoursofwaking.

33

AppendixB:CurriculumMatrixforCTET

UNIT RECIPES SKILLS EVALUATIONQUESTIONS

Shopping N/A Shoppingtechniques,Readinglabels

BehaviorChecklistquestions1,2,3,4,7and9

Breakfast CinnamonRollOatmeal

SunriseGranola

Frittata

SpinachRiceEggBowl

BreakfastBurritos

Measure,mix

Measure,mix,bake

Measure,crackeggs,whisk,chop,bake

Measure,crackeggs,fryeggs,mix

Measure,beat,sauté,rolltortillas

BehaviorChecklistquestions1,10and6(SpinachRiceEggbowl)

FoodRecall-wholegrains,protein,vegetables

Soup HeartyVegetableSoup

CreamyBroccoliSoup

ChickenandDumplingSoup

Pareandchop,mince,measure,sauté,boil,simmer

Chop,mince,measure,shred,sauté,boil,simmer,blend

Pareandchop,measure,shred,sauté,simmer,mix,roll

BehaviorChecklistquestion5(ChickenandDumplingSoup)

FoodRecall-vegetables,protein(ChickenandDumplingSoup)

Salad CrunchyAppleandCabbageSalad

SouthernCornBreadSalad

FreshTacoSalad

Chop,shred,juice,measure,mix,whisk

Measure,chop,mix,bakeMeasure,juice,chop,tear,mix

BehaviorChecklistquestion5

FoodRecall-fruit,vegetables,protein(CornBreadandTacosalads)

34

Vegetables CrispyOvenZucchiniFries

RoastedVegetables

QuickPickles

Slice,measure,crackanegg,separateanegg,beat,whisk,dredge,bake

Pare,cut,slice,zest,toss,roast

Measure,pare,slice,mix,boil

FoodRecall-vegetables

One-PotMeals HarvestChili

CreamyBroccoliAlfredo

SouthwesternChickenandRice

Chop,measure,brownmeat,drain,simmer

Measure,mince,sauté,rollingboil,simmer

Chop,measure,sauté,brownmeat,toss

BehaviorChecklistquestions1,3,5

FoodRecall-vegetables,protein,grain

SlowCookerMeals

BeefStew

BarbecueChicken

SlowCookerSoupBeans

Pareandchop,mince,measure,brownmeat,mix

Measure,broil,mix

Measure,chop,mince,sortbeans

BehaviorChecklistquestions1,5

FoodRecall-Protein

Snacks StovetopPopcorn

AppleCrisp

Muffins

Measure,toss

Pareandslice,measure,mixliquidintocornstarch,cutinfat,bake

Measure,sift,crackanegg,mixeggandhotliquid,beat,bake

BehaviorChecklistquestion7

FoodRecall-wholegrains,fruit

35

AppendixC:BehaviorChecklist

36

AppendixD:24-HourDietaryRecall

37

38

AppendixE:NEPCookTogether,EatTogetherRecruitmentFlyer

39

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45

VITA

MollieY.DawaharewasborninPikeville,Kentucky.InMay2013,she

obtainedaBachelorofScienceinDieteticsfromtheUniversityofKentucky.Sheis

currentlyobtainingherMastersofScienceinNutritionandFoodSystems.Shehas

heldprofessionalpositionsasadieteticinternandgraduateteacherandresearch

assistant.