KA 703. Nutrition Education and Behavior (San Juan County)

Kitchen Creations
A total of 785 individuals (White 41%, Hispanic 39%, Native American 17%, African American 1%, Asian American 1%, Other 1%) participated in 45 Kitchen Creations cooking schools in 26 counties during 2009. Classes were team taught by local Extension Home Economists and a health care professional. Four bilingual cooking schools were held during FY09, one in Bernalillo, Dona Ana, Lea, and Luna Counties.

Kitchen Creations cooking schools consist of four, three-hour long lessons. The cooking schools feature current nutrition recommendations for people with diabetes and hands-on food preparation and cooking experiences. Participants completed demographics and knowledge questionnaire and program evaluations at the completion of the cooking school.

Funding for Kitchen Creations is provided in part through a grant from the New Mexico Department of Health ($197,000).


ICAN
Ideas for Cooking and Nutrition Program (ICAN) is the umbrella name used in New Mexico to refer to both the Supplemental Nutrition Assistance Program Education (SNAP ED) and Expanded Food and Nutrition Education Program (EFNEP) programs. The primary goal of the ICAN program is to provide individuals with limited resources educational programs that increase the likelihood of all participants making healthy food choices consistent with the most recent dietary advice as reflected in the Dietary Guidelines for Americans and the MyPyramid.

During FY09 SNAP ED reached 24,964 adults (White 25.1%, African American 2.1%, Native American 14.4%, Asian 0.9%, Hawaiian/Pacific Islander 0.3%, Hispanic 57.2%) and 37,461 youth (White 16.1%, African American 2.3%, Native American 12.3%, Asian 0.3%, Hawaiian/Pacific Islander 0.1%, Hispanic 58.9%) in 474 sites in New Mexico, including the Zuni Reservation with the following results:

The Adult Behavior Survey is administered in a pre/post format. During FY09 participants indicated a positive change in behaviors on each of the 16 questions.
• 30% increase in comparing prices at the grocery store
• 130% increase in using nutrition labels when deciding what foods to buy
• 66% increase in purchasing healthy items at the grocery store
• 55% increase in preparing healthy meals at home each day
• 71% increase in involving their child in meal preparation each day
• 19% increase in sitting down for family meals
• 48% increase in eating breakfast daily
• 92% increase in eating fruits and vegetables for snacks each day
• 30% increase in drinking water
• 60% increase in performing 30 minutes of physical activity each day
• 44% increase in watching less than 2 hours of television each day
• 122% increase in paying attention to portion size
• 100% increase in eating at least 3 ounces of whole grains each day
• 105% increase in eating at least 4 cups of fruits and vegetable each day
• 80% increase in drinking at least 3 cups from the dairy group each day
• 56% increase in drinking less than one cup of sugary beverages each day

Every item on the adult behavior survey showed substantial change from pre to post. The lowest amount of change was 19%, and the highest was 130%. Some of the items which showed the least change are those that are least emphasized by many of our educators, such as involving children in meal preparation and watching less television. In general, items related directly to nutrition scored highest, except for comparing prices.

Youth Evaluation Results
The Youth Behavior Survey is administered in a pre/post format. During FY09 youth participants indicated a positive change in 11 of the 12 behavior questions. The 12th question remained unchanged.
• 6% increase in eating breakfast each day
• 8% increase in drinking water when thirsty
• 2% increase in performing 30 minutes of physical activity each day
• 9% increase in eating fruits or vegetables for snacks each day
• 0% change in watching less than 2 hours of television each day
• 13% increase in paying attention to portion size
• 23% increase in knowledge about how much to eat from each group of MyPyramid
• 20% increase in knowledge about the importance of calcium
• 100% increase in knowledge about how to properly wash hands
• 133% increase in knowledge about how physical activity improves health
• 21% increase in knowledge about identifying dark green vegetables
• 49% increase in knowledge about calories

Every item on the youth behavior survey showed change from pre to post. The knowledge questions all had higher rates of change than the behavior questions. Among the behavior questions, change was greater on the four nutrition questions than on the two questions related to physical activity. The knowledge questions all show substantial spread.

During FY09 EFNEP reached 929 adults and 2,053 youth in Bernalillo and Dona Ana counties. Fifteen educators provided 16,872 hours of education to graduate 801 adults (White 9%, African American 1%, Native American 3%, Hispanic 86%) and 2,053 youth (White 14%, African American 6%, Native American 3%, Hispanic 75%).

Two evaluation tools are used with the adult EFNEP population – a 24-hour food recall and a 10-question Behavior Change questionnaire. The following results were reported using the 24-hour food recall:
• 11.1% increase in intake of grains
• 33.3% increase in intake of fruits
• 18.2% increase in intake of vegetables
• 30.8% increase in intake of milk
• 12.1% increase in intake of meats & beans

A summary of the nutrient adequacy ratio or protein, iron, calcium, vitamin A, C, and B6 show an increase of 16.7%.

The 10-question Behavior Change Questionnaire shows the following results:
• 47% improved in the area of planning meals
• 41% improved in the area of comparing prices
• 41% improved in having food o the month
• 47% improved in using a grocery list
• 40% improved in following recommended guidelines for letting foods sit out
• 57% improved in thawing foods properly
• 41% improved in providing health food choices for their families
• 41% improved in preparing foods without adding salt
• 55% improved in using the Nutrition Facts label to make food choices
• 41% improved in providing breakfast for their children

Funding for SNAP ED is provided from USDA/FNS through New Mexico Human Services Department, Income Support division for $2,022,785. An equal dollar amount of math comes from New Mexico State University.

Funding for EFNEP is provided through a grant from USDA/CSREES for $589,841.

Funding for these programs is also provided through the New Mexico Legislature for $200,000.

General Nutrition
In addition to the funded series of nutrition education classes, home economist around the state conducted a variety of programs to meet the needs of the individuals in their counties. Classes included both one-time programs and mini-series classes that were taught in schools, senior centers, activity centers, and churches. Topics included: snacks, gifts, nutrition and health, food safety, grilling, feeding your newborn, feeding your young child, and food preservation.

Food preservation and food safety remain the most consistently taught courses in the state. The need for families to have safe food at affordable cost will continue to be a priority for teaching and training in the coming year.

Funding for some of these programs is provided by two grants through the New Mexico Department of Health ($50,000)

General Nutrition
In addition to the funded series of nutrition education classes, home economist around the state conducted a variety of programs to meet the need of the individuals in their counties. Classes included both one time programs and mini-series classes which were taught in schools, senior centers, activity centers, and churches. Topics included: snacks, gifts, nutrition and health, food safety, grilling, feeding your newborn, feeding your young child, and food preservation.

Food preservation and food safety remain the most consistently taught courses in the state. The need for families to have safe food at affordable cost will continue to be a priority for teaching and training in the coming year.

The Sithsonian exhibit visited Eastern New Mexico University and was titled America by Food. With the food related theme the promoters incorporated activities that served 6,000 people. Weekly movies with a food theme were played as well as one time demonstrations.


Kitchen Creations
A total of 818 individuals (White 44%, African American 1%, Native American 11%, Asian American 1%, Hispanic 40%, Other 3%) participated in 46 Kitchen Creations cooking schools during 2008. Classes were team taught by local Extension Home Economists and a health care professional. Two bilingual cooking schools were held in Dona Ana county in FY2008.

Kitchen Creations cooking schools consist of four, three-hour long lessons. The cooking schools feature current nutrition recommendations for people with diabetes and hands-on food preparation and cooking experiences. Participants completed a 3-day food record and demographics and knowledge questionnaire prior to attending the class and one month after completing the four Kitchen Creations classes.

The 3-day food records were analyzed for energy, calories from fat and saturated fat, grams of fat, saturated fat, protein, carbohydrates, fiber, sugar, milligrams of cholesterol, sodium, diabetes exchange groups and percent of calories from protein, carbohydrates and fat. Analysis of this data showed an improvement of nutrition recommendations for people with diabetes. Participants showed a decrease in energy, fat energy, fat grams, percent of calories from fat, fat exchanges, saturated fat grams, carbohydrate grams, cholesterol and sodium. Bread exchanges and other carbohydrate exchanges also decreased. Vegetable exchanges increased in women but not in men.


ICAN/EFNEP
Ideas for Cooking and Nutrition Program (ICAN) is the umbrella name used in New Mexico to refer to both the Food Stamp Nutrition Education Program (FSNEP) and Expanded Food and Nutrition Education Program (EFNEP) programs. The primary goal of the ICAN program is to provide individuals with limited resources educational programs that increase the likelihood of all participants making healthy food choices consistent with the most recent dietary advice as reflected in the Dietary Guidelines for Americans and the MyPyramid.

During 2008 FSNEP reached 35,427 adults (White 25.1%, African American 2.1%, Native American 14.4%, Asian 0.9%, Hawaiian/Pacific Islander 0.3%, Hispanic 57.2%) and 32,498 youth (White 16.1%, African American 2.3%, Native American 12.3%, Asian 0.3%, Hawaiian/Pacific Islander 0.1%, Hispanic 58.9%) in 411 sites in New Mexico, including the Zuni Reservation with the following results:
*Increase the consumption of fruits and vegetables among adults and youth participants by 30% statewide (actual 60%)
*Increase the consumption of whole grains among adult and youth participants by 20% statewide (actual 49%)
*Increase the consumption of dairy products among adult and youth participants by 20% statewide (actual 48%)
*Increase the number of adult participants who maintain a balance between calorie Intake and calorie expenditure by 20% statewide (actual 56%)
*Increase the number of adult participants who use shopping lists by 20% statewide (actual 42%)
*Increase the number of adult and youth participants who compare food prices by 20% statewide (actual 31%)
*Increase the number of adult participants who prepare a food budget by 20% statewide (actual 54%)
*Increase the number of adult and youth participants who wash their hands immediately after handling raw meat or poultry by 20% statewide (actual 11%)
*Increase the number of adult and youth participants who keep perishable foods at room temperature for less than two hours by 20% statewide (actual 36%)
*Increase the number of adult participants who keep food in the house to make last minute meals by 20% statewide (actual 31%)
*Increase the number of adult participants who cook extra food to use for lunches or meals on busy days by 30% statewide (actual 44%)
*Increase the number of youth participants who cook at home by 40% statewide (actual 52%)

During the last quarter of 2008 the evaluation tool for FSNEP was changed and administered to 220 adults. Preliminary data analysis for the 16 question pre- and post-survey show substantial improvement at the group level. More rigorous analysis will be conducted for adults and youth during 2009.

During 2008 EFNEP reached 882 adults and 2,175 youth in Bernalillo and Dona Ana counties. Fifteen educators provided 15,392 hours of education to graduate 801 adults (White 8%, African American 1%, Native American 2%, Hispanic 83%) and 2,175 youth (White 16%, African American 3%, Native American 1%, Hispanic 79%) .

Two evaluation tools are used with the adult EFNEP population - a 24-hour food recall and a 10 question Behavior Change questionnaire. The following results were reported using the 24-hour food recall:

* 15.5% increase in intake of grains
* 16.6% increase in intake of fruits
* 36.4% increase in intake of vegetables
* 28.6% increase in intake of milk
* 15.3% increase in Intake of meats & beans

A summary of the nutrient adequacy ratio for protein, iron, calcium, vitamins A, C, and B6 show an increase of 16.7%.

The 10 question Behavior Change Questionnaire show the following results:

* 45% improved in the area of planning meals
* 45% improved in the area of comparing prices
* 42% improved in having food for the month
* 45% improved in using a grocery list
* 40% improved in following recommended guidelines for letting foods sit out
* 58% improved in thawing foods properly
* 38% improved in providing healthy food choices for their families
* 38% improved in prepared foods without adding salt
* 51% improved in using Nutrition Facts to make food choices
* 45% improved in providing breakfast for their children


Keep Moving Keep Healthy (KMKH)
Keep Moving, Keep Healthy with Diabetes is an educational program developed by Joslin Diabetes Center that targets adults who have diabetes or at risk for developing diabetes. This program is designed to assist individuals in addressing barriers to increasing physical activity and to become more active. KMKH helps individuals with diabetes begin self-management of their diabetes and for those at risk for developing diabetes to help prolong a diagnosis with proper diet and being more physically active. In 2008 plans were made to implement this program in at least 10 counties for 2009 with the assistance of a grant from Joslin ($51,604) materials are provided for each participant to include an exercise DVD, a pedometer, a tape measure, and medical testing – A1C, total cholesterol, and blood pressure. Training materials were developed and promoted through Centra. Training for the home economist was

Coordinated Approach to Children's Health (CATCH)
CATCH is the largest evidence-based coordinated school health program in the United States, teaching children to identify, practice, and adopt healthy eating and physical activity behaviors. In 2008 13,028 students (White 37.7%, African American 3.5%, Native American 3.9%, Hispanic 55.4%) received CATCH programming through one of the 44 participating elementary schools during the school day, 1,218 students (ethnicity information not collected) received CATCH programming during after school through the YMCA, and another 110 students (ethnicity information not collected) received CATCH programming. Funding for the CATCH program is provided from the New Mexico Department of Health for in school programming ($255,000) and from the New Mexico Public Education Department for after school programming ($100,000).

Fit Families
Fit Families is a Healthy lifestyle program for overweight children and their families which provides the knowledge, skills, abilities, and support to learn and incorporate healthy eating behavior and physical activity in their daily lives and improve self-esteem, all of which will improve health and enhance quality of life. Pediatricians, specialists, dietitians, school nurses, youth organizations, and case managers refer clients and patients, expanding their ability to address the problem of childhood obesity.

Six series of Fit Families classes were held in 2008. A total of 165 children and family members participated (attended some of the classes); 70% of the participants graduated (attended at least 5 of the 7 classes) from the program. Of the total 165 participants, 5% were Non-Hispanic and 89% Hispanic, 2% each were either both, African American or other.

Fit Families has expanded to the southern part of Dona Ana County in 2008 by proving 3 classes in Anthony, funded through the New Mexico Department of Health. These classes serve the needs of this border community which are primarily Spanish speakers. A bi-monthly newsletter was developed to mail to children who participated in Fit Families and contains family-oriented exercise activities, food recipes, and health tips.

Funding for Fit Families is provided through a grant from General Mills ($24,000). A new grant was awarded for $15,000 from the New Mexico Diabetes Prevention & Control Program (Department of Health) for 2008.

In San Juan County, as well as New Mexico, five of the leading causes of death include heart disease, cancer, stroke, diabetes and hypertension – which have all been linked to a person’s diet. Because good nutrition is essential to improve and maintain good health in individuals, a variety of nutrition education programs were requested by San Juan County clientele. The goal of the home economist has been to improve the health of San Juan County residents by providing education on healthy food choices, food preparation skills, meal management and food resource management.

“Native American Traditional Cooking”, “Fun with Food,” “Healthy Eating for the Holidays”, “Heart Healthy Cooking”, “Avoid Portion Distortion”, “MyPyramid for Kids”, “MyPyramid for Adults”, and “How much Fat” and “How much Sugar” are just a few of the topics taught by the home economist during presentations this year.

A new program entitled “Summer Time (or anytime) Food Safety 101” was presented to 483 employees of CononoPhillips. Members learned about the “two hour rule”, lunch box safety, how hot it is inside their vehicles, as well as basic food safety information. Where lunch boxes are kept in cars was also addressed with much discussion on this topic. Supervisors commented about some contractors that kept their burritos “hot” all day by keeping them on the dash boards of their pick-ups. Approximately 5% of the room stated they also practiced this form of “heating” their food but now, due to this presentation, would abstain from this practice.

“Native American Traditional Cooking” was a class given to a pre-diabetes evaluation study group in Shiprock. During the course of the workshop the sixteen participants learned how to prepare healthier traditional Navajo foods, how to limit high fat food choices, how much sugar is in soft drinks, how to choose lower fat breads and grains and how to avoid proportion distortion by paying attention to what a serving size is. A lower fat traditional Navajo Taco was made, with specific care taken in demonstrating the proper serving size the fry bread should be. 100% of the participants increased their knowledge of on ways to prepare healthier Native American food choices.

A class entitled “Fun with Food” was developed for day care providers through San Juan College’s Family Resource Center. The nineteen participants learned tips for feeding children, making meal times pleasant, serving food safely, how to offer nutritious foods and how to personalize and develop MyPyramid food plans for 2 year old boys and girls. They also learned the appropriate serving sizes that children this age need to maintain a healthy diet. A variety of hands on snacks were made so participants could see that food could indeed be fun. 100% of the participants stated they increased their knowledge of food preparation and meal planning for their in home day care centers and also learned the importance of physical activity for the children in their care.

The home economist trained seventy-seven Navajo Nation WIC case workers and care givers in “Healthy Eating for the Holidays.” They learned how to incorporate low fat dairy products into holiday favorites to make them more nutritious for their clients, as well as their families. They were also instructed on low fat tips for vegetables, and low fat cooking for meat, poultry and fish. How to prepare healthy meals using commodities, and learning to use herbs and spices in their cooking instead of salt was discussed. Incorporating more vegetables into an individual’s diet was also stressed and participants had the opportunity to try unusual foods such as nopales, jicama, and quelites. Other classes provided to fifteen Navajo Nation WIC workers include food preservation.


“The Bottom Line on Energy Drinks and Soft Drinks” was a program that was delivered to 194 Navajo students at Navajo Preparatory School in Farmington. The school/dorm banned energy drinks from the campus at the end of the previous school year and the staff wanted this issue addressed during the health and wellness day at the school. Students learned what energy drinks are, what’s in them, and how much (or lack of) nutritional value they have. They learned what’s so bad about energy drinks and measured how much sugar these drinks and soft drinks have in them. Students were shocked to learn that a 12 ounce soda has between 10 and 12 teaspoons of sugar in it. Based on comments from 50% of the students, they plan to lower their energy drink and soft drink consumption. “A Look at Serving Sizes” was part two of the program. Students had to choose which serving size was the healthiest. 80% of the participants increased their knowledge on portions sizes and 40% stated they plan to choose smaller serving sizes of fast foods.

“Cold Pizza for Breakfast”, a program developed by Nebraska Extension about MyPyramid food safety tips for tweens and teens who cook was presented to 101 Family Consumer Science Students at Piedra Vista High School. Students learned how to safety wash their hands, how to properly clean, separate, cook and chill and had fun playing the game “Keep or Toss”. They were surprised to learn that some people (like the very young, older adults and people with weakened immune systems) are more susceptible to food poisoning than others. The “two hour rule” was a surprise to many. In the “Keep or Toss” game they got to practice which scenario safely kept food at it’s most harmless and if the food was left out for more than two hours at room temperature.

Three hundred thirty-six family members participated in the MyPyramid and “How Much Sugar and Fat are in Foods” workshops presented by the Home Economist during the summer feeding programs at area parks. Youth of all ages loved to measure the amounts of fat found in their favorite fast foods. Many were astonished to discover just how much fat these foods had. They had to guess how much sugar was in a 12 ounce bottle of pop and a 20 ounce bottle of pop. Participants learned about the benefit of eating healthy and being how important it is to be physically active.


Indian Livestock Days is an annual event that is traditionally all livestock oriented. This year some of the committee members wanted to add a food and nutrition component. Home Economists in three counties (San Juan, McKinley and Sandoval) planned and implemented a “Heart Healthy Cooking” demonstration as well a mini health fair that had booths featuring our ICAN posters during the break times of the two day conference. The thirteen participants in the “Hearth Healthy Cooking” workshop learned about fat facts, choosing fats and oils, low fat cooking for meat, fish and poultry, and practiced making a variety of lower fat recipes.


Southwestern Private Services provides care givers to members of the Navajo Nation who need assistance with their daily living and cooking because of illness. The Home Economist was asked to provide nutrition, meal planning and food safety training to these care givers over a period of three months. Fifty-nine care givers received the hands on training and food preparation class. Comments from the participants about what they learned include: “I learned how to make low fat foods using ordinary ingredients, some without using low fat items.” “I learned about serving sizes and food safety, preparation and sanitation.” “I learned how you can become sick anytime from foods that aren’t properly cooked or stored. And some do’s and don’s about food storage. And some people that we take care of can get sick easily if their immune systems are weak.” 100% of the participants increased their knowledge of food preparation and meal planning. 50% said they plan to adopt the new food preparation and meal planning techniques they learned during the classes.

Ninety-eight Ojo Elementary School fifth and sixth graders participated in the “Healthy Snacking” workshop taught by the Home Economist. The students learned about the MyPyramid plan and how they could make their own nutrition and exercise plan by going to the mypyramid.gov website. They were taught what makes a snack healthy and practiced measuring the correct serving size for foods they like to eat. 75% of the participants increased their knowledge of MyPyramid. Thirty-two Shiprock Northwest High School Dorm students also participated in a Healthy Snacking workshop. 80% of these participants increased their knowledge of the importance of physical activity.

Kitchen Creations Diabetes Cooking Schools

The home economist, in collaboration with a nurse from San Juan Regional Medical Center and Certified Dietitians from Northern Navajo Medical Center in Shiprock, NM taught the four series of Kitchen Creations Diabetes Cooking Schools that were provided to residents of San Juan County during the 2006 and 2007 program year. Sixty-nine individuals completed the classes. Participants entered the classes with a limited knowledge about diabetes and left with a better understanding of how to control their blood glucose levels through diet and exercise. They learned how to plan meals using the 50/50 Plate and the Diabetes Food Pyramid, how to count carbohydrates, how to prepare low fat vegetables, the importance of beans and grains in the diet, serving sizes, and how to cook more “heart healthy.” Seven months after one series ended, a participant stated that her husband’s blood sugar had dropped tremendously and that he had lost 17 pounds because of knowledge learned during the classes. More than 50% of participants use the Diabetes Food Guide Pyramid to plan a day’s meal and 59% read food labels to find the amount of carbohydrates in a serving. 42% now measure their food portions.

San Juan County ICAN

The ICAN program in San Juan County utilizes two Nutrition Educators and one Program Assistant to provide a multitude of hands-on learning experiences in the areas of nutrition, food preparation, food safety and food budgeting by providing programming to limited resource residents. The home economist provides quarterly staff trainings to the educators.

Obesity, diabetes and heart disease are prevalent in San Juan County and are often caused by poor food choices. Food Stamp clients learned they have a decision when it comes to improving their food choices and changing their physical activity habits. Participants have increased their use of the Dietary Guidelines and the new MyPyramid in making food choices and meal planning. They have also increased the use of thrifty shopping and quick, economical food preparation techniques and food choices. Since October 1, 2006 over 504 youth and 220 adults have graduated from the programs conducted at Roscinate Alternative School, Day Reporting School, Kirtland Elementary School, Aztec Navajo Dorm, Farmington and Aztec Boys and Girls Clubs, Navajo Preparatory High School, Aztec and Farmington Sr. Citizens Centers, Family Crisis Shelters and ISD (Income Support Division). Many others have benefited from “one shot” programs offered by the nutrition educators. Comments from teen parents include: “I learned how to feed my child healthy food. At first I thought it was stupid but then I found myself liking this class. I very much like to stay in this class because you get to learn different things and have fun.”

Lynne Beam has signed on to support KA 703. Nutrition Education and Behavior within San Juan County.