Biomarker Cost-Benefit Analysis of EFNEP

University of Idaho, University of Maryland, College Park, Washington State University, Michigan State University, Colorado State University, University of Florida

The goal of this integrated project is to assess whether EFNEP is a cost-effective nutrition education intervention that generates sustained improvement in chronic disease biomarkers. This project will be unique in its use of objective biomarkers, instead of self-reported behaviors, to quantify the economic benefits generated by EFNEP through chronic disease prevention. A paired location untreated control group quasi-experimental design will be employed, with biomarkers (BMI, blood pressure, HbA1c) measured for 500 adults across four representative state EFNEP programs (CO, FL, MD, WA). Biomarkers will be measured pre-EFNEP, 6-months-post-EFNEP and 1-year-post-EFNEP. Analytical techniques will include cost-benefit, bivariate, and multivariate analyses.

According to the CDC, 60% of US adults have a diagnosed chronic disease. This indicates the need for focused efforts to change modifiable risk factors including diet and exercise. The Expanded Food and Nutrition Education Program (EFNEP) aims to prevent chronic diseases by educating and encouraging vulnerable populations to adopt a healthy diet and physical activity. Addressing the program priority area Diet, Nutrition and the Prevention of Chronic Diseases, the long-term goal of this integrated project is to assess whether EFNEP is a cost-effective nutrition education intervention that generates sustained improvement in chronic disease biomarkers. This project will be unique in its use of objective biomarkers, instead of self-reported behaviors, to quantify the economic benefits generated by EFNEP through chronic disease prevention. Project research objectives include analyzing EFNEP's sustained impact on chronic disease biomarkers and developing and applying a biomarker-based cost-benefit analysis methodology. Extension objectives are to develop an online cost-benefit analysis tool and webinar for nutrition education program evaluation. Education objectives are to provide graduate students with experiential learning opportunities in data collection and analysis. A paired location untreated control group quasi-experimental design will be employed, with biomarkers (BMI, blood pressure, HbA1c) measured for 500 adults across four representative state EFNEP programs (CO, FL, MD, WA). Biomarkers will be measured pre-EFNEP, 6-months-post-EFNEP and 1-year-post-EFNEP. Analytical techniques will include cost-benefit, bivariate, and multivariate analyses. Project results will expand the EFNEP knowledge-base, allowing for program content and delivery modifications that maximize the impact of taxpayer dollars allocated to chronic disease prevention.

Subjects will participate in nine hands-on EFNEP lessons to teach nutrition, healthy lifestyle choices, physical activity, food preparation, food safety, and food resource management.

Change in Systolic and Diastolic blood pressure measurements from baseline to 6 months post intervention

Change in Systolic and Diastolic blood pressure measurements from baseline to 12 months post intervention

A range of participant demographics will be collected including sex, age, race/ethnicity, public assistance receipt, pregnancy status, and breastfeeding status.

A range of participant demographics will be collected including public assistance receipt, pregnancy status, and breastfeeding status.

A range of participant demographics will be collected including public assistance receipt, pregnancy status, and breastfeeding status.

A range of participant demographics will be collected including public assistance receipt, pregnancy status, and breastfeeding status.

A Health Questionnaire will be used to identify whether participants have a health condition, take medication(s) for a health condition, and smoke.

A Health Questionnaire will be used to identify whether participants have a health condition, take medication(s) for a health condition, and smoke.

A Health Questionnaire will be used to identify whether participants have a health condition, take medication(s) for a health condition, and smoke.

Inclusion Criteria: Free-Living Speaks and understands English and/or Spanish Income at or below 185% of the Federal Poverty Line Exclusion Criteria: Being pregnant, nursing, and/or less than 9-months postpartum

Deidentified participant data will be made available on South Dakota State University's Open Access Institutional Repository, Open PRAIRIE.