KA 703. Nutrition Education and Behavior (Santa Fe County)

ICAN
Santa Fe County has both a Youth and Adult Ideas for Cooking and Nutrition Program (ICAN) which is nationally referred to as the Supplemental Nutrition Assistance Program Education (SNAP ED). 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/MyPlate guidelines.

Our educational efforts do change nutrition behavior, see highlights from Adult Surveys:
-59% of participants showed improvement in paying attention to portion sizes
-58% of participants showed improvement in eating 4 cups or more of fruits and vegetables each day
-54% of participants showed improvement in drinking at least 3 cups of dairy each day
-53% of participants showed improvement in use of nutrition labels
-51% of participants showed improvement in eating more than 3oz. of whole grains each day
-46% of participants showed improvement in doing at least 30 minutes of physical activity each day
-45% of participants showed improvement in eating fruits and vegetables as snacks
-41% of participants showed improvement in preparation of healthy meals
-38% of participants showed improvement in involving child in meal preparation
-36% of participants showed improvement in purchasing healthy items
-33% of participants showed improvement in comparing prices when shopping for food
-33% of participants showed improvement in drinking less than 1 cup of sugary beverages
-30% of participants showed improvement in eating breakfast
-28% of participants showed improvement in watching less than 2 hours of TV per day
-27% of participants showed improvement in drinking water when thirsty
-21% of participants showed improvement in eating meals together at home

See highlights for Youth Surveys:

-85% Improvement in knowledge of the relationship between physical activity and good health.
-35% Improvement in knowledge of hand washing and food safety.
-25% Improvement in knowledge of how much to eat of the MyPyramid food groups (Grain, Vegetables, Fruits, Milk, and Meat and Beans).
-23% Improvement in knowledge of where energy or calories come from (carbohydrates, fat and protein).
-15% Improvement in knowledge of the relationship between calcium and bone health and the importance of consuming milk products that are an excellent source of calcium.

• This summer I taught a series of Youth ICAN classes in Santa Fe at the YMCA day camp, a nutrition workshop at the Genoveva Chavez Community Center with 90 children, and also observed the ICAN educators at several other Parks and Recreation summer camp sites. We worked with 7 out of the 8 Parks and Recreation sites this summer, and it elevated the awareness of the ICAN Youth Program in Santa Fe. The children love the hands-on cooking activity and they also like the germ detective class where they get to gather samples of germs and then look at them under a microscope the following week. The entire ICAN group (two educators and I) graduated over 60 additional Youth this summer (we had over 200 children each week, but many only came for two or three weeks during the summer). The summer Youth ICAN effort numbers are not reflected in the Youth ICAN third quarter report.
• I did do healthy snack tastings at the Santa Fe County Fair with over 300 people attending the Fair this August and also had an ICAN Information booth. I also participated in a Just Be It (JBI) Parent night activity. In late August, I gave a presentation to healthcare workers at the local hospital (Christus St. Vincent Regional Medical Center) on Child Nutrition and Dealing with the Fast Food Epidemic.
• We had a very successful meeting with the new Santa Fe County ISD Director and the Bureau Chief, NM HSD/ISD/Food and Nutrition Services Bureau. This is the first step in building a relationship, I gave a presentation on the ICAN program in Santa Fe and the Bureau Chief gave us an update on what was happening statewide. One good thing that happened in New Mexico for the SNAP clients is their SNAP benefit will be matched dollar for dollar at Farmer’s Markets and Santa Fe’s Farmers Market can accept SNAP Electronic Benefit Transfer (EBT) cards. We will also agreed to provide classes in the near future or the Santa Fe County ISD staff to help with program recruitment, and starting in November we will be doing classes in the Santa Fe County ISD lobby on a regular basis as a recruiting effort. Santa Fe County’s minimum graduation goal is 150 adults (series of 4 classes/client to graduate) which can be challenging as the adults are not in a contained classroom setting like the youth and are very transient.

• Supervising the ICAN staff is not without its challenges, and there is a lot of work to be done in the area of team building. One ICAN Nutrition Educator has already exceeded their annual Youth ICAN graduation goal, as of the third quarter with 137 Youth graduates and 33 Adult graduates, and this Nutrition Educator is on track to meet or exceed their annual adult graduation goal of 75 Adults. This individual is outstanding and has begun Adult ICAN recruiting at both the Santa Fe and Pojoaque Farmer’s Markets as more SNAP Ed clients are coming to the markets due to the new dollar for dollar benefit match initiated by Governor Richardson in late August. The Santa Fe County Program Assistant has also done an outstanding job by: volunteering to teach an adult class at a local food bank resulting in 11 additional adult ICAN graduates and plans to teach another class in 2011; writing articles for local newsletters; and attends and represents the Santa Fe County ICAN Program in monthly planning meetings at one of the food banks in Santa Fe.
As with all paraprofessional staff there are performance issues, the other Nutrition Educator will not meet their Youth or Adult graduation goal for last year, and we are working toward meeting our annual graduation goal in this new fiscal year. That being said, it is very challenging to run both Youth and Adult programs and many states have different Nutrition Educators for Youth and Adult SNAP Ed programs.
Our ICAN clients do appreciate our efforts, Please see below for our Adult ICAN clients comments:
 “My child would not eat until I started preparing these fast and easy recipes that I learned in the ICAN classes.”
 “We eat more fruits and try new foods.”
 “Since I started the classes I was encouraged to have more healthy eating habits.”
 “Yes, I have been trying, but it is really easy. I learned a lot.”
Our Educators do make a difference; please below for ICAN Behavior Survey % Improvement:
Most of the time:
• I looked at nutrition labels when deciding what food to buy. (71% improvement)
• I prepared healthy meals at home each day. (50% improvement)
• I did 30 minutes of physical activity each day. (46% improvement)
• I paid attention to portion sizes. (50% improvement)
• I ate at least 3 ounces of WHOLE grains each day. (43% improvement)
• I ate at least 4 cups of fruits and vegetables each day. (42% improvement)

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.