Cost-effectiveness model for youth EFNEP programs: what do we measure and how do we do it?

The Youth Expanded Food and Nutrition Education Program (EFNEP) is one of the United States Department of Agriculture's hallmark nutrition education programs for limited-resource youth. The objective of this study was to gather opinions from experts in EFNEP and related content areas to identify costs, effects (impacts), and related instruments to develop a cost-effectiveness model (instrument) for youth EFNEP, which does not exist. A cost-effectiveness model determines the economic or financial cost of producing an impact. The findings highlight several challenges in identifying inputs through consensus and provide a roadmap for the creation of a model that can be adopted by state EFNEP coordinators.

Development and testing of a nutrition, food safety, and physical activity checklist for EFNEP and FSNE adult programs.

OBJECTIVE: To develop and assess reliability and validity of the Nutrition, Food Safety, and Physical Activity Checklist to measure nutrition, food safety, and physical activity practices among adult Expanded Food and Nutrition Education Program (EFNEP) and Food Stamp Nutrition Education program (FSNE) participants. METHODS: Test-retest reliability (Cronbach alpha), internal consistency (Pearson Correlation), criterion-related validity (Spearman Correlation Coefficients), and sensitivity-to-change, were calculated for dietary quality, food safety, and physical activity, based on data collected from 73 EFNEP and FSNE participants. RESULTS: Nutrition and physical activity domains achieved reliability coefficients of 0.70. The instrument scored Spearman correlation coefficients of 0.20 for nutrition, 0.34 for food safety, and 0.28 for physical activity. CONCLUSIONS AND IMPLICATIONS: The instrument consistently measured dietary and physical activity practices, but not food safety. All domains obtained low correlation coefficients, although consistent with other studies' validity results.

Cost-benefit analysis indicates the positive economic benefits of the Expanded Food and Nutrition Education Program related to chronic disease prevention.

OBJECTIVE: To provide an estimated cost-benefit ratio for the Expanded Food and Nutrition Education Program (EFNEP), based on potential prevention of diet-related chronic diseases and conditions. DESIGN: A retrospective cost-benefit study using demographic, food/nutrient intake, and food-related behavioral data previously collected on program participants by trained paraprofessionals, before and after an intervention. Actual costs of implementing EFNEP for 1 year (1996) were also used. SUBJECTS/SETTINGS: 3100 female and male adults who had participated in the Virginia EFNEP during 1996. INTERVENTION: Prior participation in 6 to 12 food/nutrition education lessons with subsequent graduation from EFNEP. MAIN OUTCOME MEASURES: Cost-benefit ratios for EFNEP, based on original assumptions and subsequent sensitivity analyses. STATISTICAL ANALYSIS: Program implementation costs were compiled and compared with monetized benefits of disease prevention to produce benefit-to-cost ratios. Excel and SPSS computer programs were used to compute cost-benefit ratios based on standard procedures used in the field of economics. RESULTS: The initial benefit-to-cost ratio was $10.64/$1.00, with subsequent sensitivity analyses producing ratios ranging from $2.66/1.00 to $17.04/1.00. IMPLICATIONS: The results of EFNEP intervention translate into a positive cost-benefit based on potential prevention of diet-related chronic diseases and conditions. Thus, EFNEP is a good use of federal tax dollars.