Identification of a Framework for Best Practices in Nutrition Education for Low-Income Audiences.

To promote effective low-income nutrition education programs, an expert panel of nutrition education and public health researchers built consensus around 28 best practices grouped into 5 domains (Program Design, Program Delivery, Educator Characteristics, Educator Training, and Evaluation) targeting direct delivery of nutrition education. These best practices can be used to assess program strengths, promote fidelity in delivery and evaluation, and design research to strengthen programs' evidence base. A survey of Supplemental Nutrition Assistance Program-Education nutrition education leaders helped identify staff development needs and interest relative to specific best practices. Best practices can be used to identify staff development needs among frontline educators, supervisors, and program leaders in Supplemental Nutrition Assistance Program-Education, Expanded Food and Nutrition Education Program, and other programs targeting low-income audiences.

Eating Competence and Oral Health in Supplemental Nutrition Assistance Program Eligible Populations.

Purpose. To determine the association of eating competence and Mediterranean diet adherence with oral health and to examine if they lessen any impact of food insecurity on oral health of SNAP-eligible persons.Methods. Free clinic patrons (n=93) in Pennsylvania evaluated oral health nutrition education via an online survey. The Satter Eating Competence Inventory, Mediterranean diet and USDA Food Security scores were compared to tested measures of oral health as assessed by self-report.Results. Respondents noted food insecurity (33%), food selection (32%), and oral health problems that interfered with life satisfaction (30%), and unafforded dental care (60%). Mediterranean diet adherence was associated with annual dental visits (82% vs. 46%, p=.026). Competent eaters had greater food security and less frequently reported oral health issues interfering with life satisfaction (13% vs. 43%; p=.002) or avoiding particular foods (18% vs 45%; p=.006). These relationships remained significant controlling for low-income (p=.008, p=.006 respectively) but not when controlling for food security.Conclusions. Competent eaters had fewer oral health issues except when controlling for food security, a considerable challenge to oral health.

Impact of a Weight Management Intervention on Eating Competence: Importance of Measurement Interval in Protocol Design.

PURPOSE: To examine changes in eating competence (EC) in 12-month weight loss intervention. DESIGN: Randomized, parallel-arm with weight loss phase (baseline to month 4) and weight-maintenance phase (months 4-12). SETTING: Face-to-face in University classrooms, supervised and self-directed fitness sessions at University fitness center, and home. PARTICIPANTS: Premenopausal, mostly college-educated Pennsylvania women, body mass index >25 (n = 101). INTERVENTION: Twenty-eight, 1-hour classes tailored for extremes of the Dietary Guidelines' fat recommendations, based on social cognitive theory, problem-based learning delivery over 12 months. Exercise component included supervised and self-directed stretching, aerobics, and strength training. MEASURES: Anthropometrics, lipid profile, blood pressure, 24-hour dietary recalls, cognitive behavioral measures, Satter Eating Competence Inventory (ecSI). ANALYSIS: General linear model repeated measures analysis of variance for outcome variables. RESULTS: A total of 40% (n = 40) completed the ecSI. Overall, education and supervised exercise session attendance were 77% and 88%, respectively. Similar weight loss for lower and moderate fat groups (6.7 kg and 5.4 kg). The EC was unchanged baseline to month 4 but increased significantly from months 4 to 12, baseline to month 12 for both groups. The EC change baseline to month 12 was inversely associated with weight change from baseline to months 4 and 12. CONCLUSION: Weight management interventions, likely to introduce concerns with eating attitudes, behaviors, and foods, can reduce EC. Short-term measurement of EC change captures these consequent adjustments without opportunity to regain self-efficacy. Extending the measurement interval better reflects intervention impact on EC.

Middle school-aged child enjoyment of food tastings predicted interest in nutrition education on osteoporosis prevention.

BACKGROUND: NEEDs for Bones (NFB), based on the Health Belief Model, is a 4-lesson osteoporosis-prevention curriculum for 11- to 14-year-olds. This study examined the relationship between enjoyment of food tastings and interest in NFB. METHODS: NFB was administered by teachers as part of standard practice and evaluated after the fourth lesson using a 21-item survey. Significant clustering of students within classrooms required use of random-intercept multilevel ordinal regression models in SAS proc GLIMMIX, with students nested within classrooms. Analyses considered tasting experience, eating attitudes, sex, grade, and cohort. RESULTS: Students (N = 1619; 50% girls) participated from 85 fourth to eighth grade classrooms (47% sixth grade and 31% seventh grade) in 16 Pennsylvania SNAP-Ed eligible schools over 2 academic years. For all foods tasted, students who did not enjoy the food tasting were less interested in the lesson than students who did enjoy the food tasting (all p < .001); refried beans (odds ratio [OR] = 0.30), soy milk (OR = 0.55), cranapple juice (OR = 0.51), sunflower kernels (OR = 0.48), and Swiss cheese (OR = 0.49). The relationship persisted net of covariates. CONCLUSIONS: Enjoyment of food tasting activities can predict interest in nutrition education on osteoporosis prevention, supporting resource allocation and inclusion of food tasting activities in school-age nutrition education.

About Eating: an online program with evidence of increased food resource management skills for low-income women.

OBJECTIVE: Produce and evaluate About Eating (AE), an online program for low-income women aligned with the Satter eating competence model, congruent with best practices for nutrition education of low-income audiences. METHODS: Responses from iterative cognitive interviews and online surveys with diverse samples of low-income women informed lesson revisions. The researchers conducted a randomized controlled trial of AE with low-income women to determine its impact on dietary behavior and food security. RESULTS: In all, 284 women reviewed at least 1 AE lesson and endorsed it. After AE, women (n = 288) increased in use of food resource management skills (eg, using a budget [P = .008] and planning meals to include all food groups [P = .002]). About Eating participants who were food secure had more confidence in managing money for food (P = .002) and keeping track of food-related purchases (P = .02) than food-insecure persons. CONCLUSIONS AND IMPLICATIONS: Mixed-methods research with life stage and geodiverse samples confirmed the usefulness of AE. Food security assessment may enhance interpretation of intervention effectiveness.

The Satter Eating Competence Inventory for Low-income persons is a valid measure of eating competence for persons of higher socioeconomic position.

Eating competence is an important behavioral construct, shown to be associated with healthful lifestyle practices, including dietary quality, weight management, physical activity, and sleep duration. A 16-item instrument to measure eating competence, the Satter Eating Competence Inventory was previously validated in a general sample and subsequently, a 16-item instrument was developed to address specific concerns of low-income persons; 12 items were common to both instruments. The purpose of this study was to determine if the low-income version could be applied to a general audience, simplifying intervention evaluation and facilitating cross-study comparison. Both surveys were fully completed by 127 parents (89% white; 35.8 ± 5.3 y; 86% college graduates; 51% eating competent) of preschool-age children; 96 of whom were not considered low-income. Cognitive interviews with 14 parents of varying eating competence levels clarified and confirmed findings. Scores were highly correlated (r = .98) and only 2 of the 96 were not congruently classified for eating competence. Mean difference between the two versions was .24 ± 1.55. The general audience version explained 95% of the variance in the low-income version score. Findings support the low-income version of the Satter Eating Competence Inventory for general audience use as the Satter Eating Competence Inventory 2.0.

Telephone and Face-to-Face Interviews with Low-Income Males with Child Care Responsibilities Support Inclusion as a Target Audience in SNAP-Ed.

Federally funded nutrition programs mostly target females. Changes in family dynamics suggest low-income men have an important role in food management responsibilities. The purpose of this study was to inform nutrition education program planning to meet needs of lower-income males. Cross-sectional telephone and face-to-face interviews. Stratified random sample of men (n = 101), 18-59 years of age, with child care responsibilities, living in households participating in the Supplemental Nutrition Assistance Program and a convenience sample of adult males (n = 25) recruited from lower income venues. (1) Scripted telephone interviews about health status, eating behaviors, eating competence, food security, technology usage and topics and strategies for nutrition education. (2) In-person cognitive interviews during review of selected online nutrition education lessons. Nutrition education topics of interest, preferred educational strategies, influences on and barriers to intake, eating competence, critiques of online program content, graphics, format. Bivariate correlations, independent t tests, one-way analysis of variance or Chi square, as appropriate. Thematic analyses of cognitive interviews. Of telephone interviewees, 92.1% prepared meals/snacks for children and 54.5% made major household food decisions. Taste was the greatest influence on food selection and the greatest barrier to eating healthful foods. Topics of highest interest were "which foods are best for kids" and "how to eat more healthy foods." Preferred nutrition education strategies included online delivery. Online lessons were highly rated. Interactive components were recognized as particularly appealing; enhanced male centricity of lessons was supported. Findings provided compelling evidence for including needs specific to low-income males when planning, designing, and funding nutrition education programs.

Development of a tool to assess adherence to a model of the division of responsibility in feeding young children: using response mapping to capacitate validation measures.

BACKGROUND: Accurate early assessment and targeted intervention with problematic parent/child feeding dynamics is critical for the prevention and treatment of child obesity. The division of responsibility in feeding (sDOR), articulated by the Satter Feeding Dynamics Model (fdSatter), has been demonstrated clinically as an effective approach to reduce child feeding problems, including those leading to obesity. Lack of a tested instrument to examine adherence to fdSatter stimulated initial construction of the Satter Feeding Dynamics Inventory (fdSI). The aim of this project was to refine the item pool to establish translational validity, making the fdSI suitable for advanced psychometric analysis. METHODS: Cognitive interviews (n = 80) with caregivers of varied socioeconomic strata informed revisions that demonstrated face and content validity. fdSI responses were mapped to interviews using an iterative, multi-phase thematic approach to provide an instrument ready for construct validation. RESULTS: fdSI development required five interview phases over 32 months: Foundational; Refinement; Transitional; Assurance; and Launching. Each phase was associated with item reduction and revision. Thirteen items were removed from the 38-item Foundational phase and seven were revised in the Refinement phase. Revisions, deletions, and additions prompted by Transitional and Assurance phase interviews resulted in the 15-item Launching phase fdSI. Only one Foundational phase item was carried through all development phases, emphasizing the need to test for item comprehension and interpretation before psychometric analyses. CONCLUSIONS: Psychometric studies of item pools without encrypted meanings will facilitate progress toward a tool that accurately detects adherence to sDOR. Ability to measure sDOR will facilitate focus on feeding behaviors associated with reduced risk of childhood obesity.

Purposive facebook recruitment endows cost-effective nutrition education program evaluation.

BACKGROUND: Recent legislation established a requirement for nutrition education in federal assistance programs to be evidence-based. Recruitment of low-income persons to participate and evaluate nutrition education activities can be challenging and costly. Facebook has been shown to be a cost-effective strategy to recruit this target audience to a nutrition program. OBJECTIVE: The purpose of our study was to examine Facebook as a strategy to recruit participants, especially Supplemental Nutrition Assistance Program Education (SNAP-Ed) eligible persons, to view and evaluate an online nutrition education program intended to be offered as having some evidence base for SNAP-Ed programming. METHODS: English-speaking, low-income Pennsylvania residents, 18-55 years with key profile words (eg, Supplemental Nutrition Assistance Program, Food bank), responded to a Facebook ad inviting participation in either Eating Together as a Family is Worth It (WI) or Everyone Needs Folic Acid (FA). Participants completed an online survey on food-related behaviors, viewed a nutrition education program, and completed a program evaluation. Facebook set-up functions considered were costing action, daily spending cap, and population reach. RESULTS: Respondents for both WI and FA evaluations were similar; the majority were white, <40 years, overweight or obese body mass index, and not eating competent. A total of 807 Facebook users clicked on the WI ad with 73 unique site visitors and 47 of them completing the program evaluation (ie, 47/807, 5.8% of clickers and 47/73, 64% of site visitors completed the evaluation). Cost per completed evaluation was US $25.48; cost per low-income completer was US $39.92. Results were similar for the FA evaluation; 795 Facebook users clicked on the ad with 110 unique site visitors, and 73 completing the evaluation (ie, 73/795, 9.2% of ad clickers and 73/110, 66% of site visitors completed the evaluation). Cost per valid completed survey with program evaluation was US $18.88; cost per low-income completer was US $27.53. CONCLUSIONS: With Facebook we successfully recruited low-income Pennsylvanians to online nutrition program evaluations. Benefits using Facebook as a recruitment strategy included real-time recruitment management with lower costs and more efficiency compared to previous data from traditional research recruitment strategies reported in the literature. Limitations prompted by repeated survey attempts need to be addressed to optimize this recruitment strategy.

Evaluation of About Being Active, an online lesson about physical activity shows that perception of being physically active is higher in eating competent low-income women.

BACKGROUND: Eating competence (EC) has been associated with positive health outcomes such as reduced cardiovascular risk and higher diet quality. This study compared reported physical activity and EC in 512 low-income women participating in an online program that included a physical activity lesson and assessed response to this lesson. METHODS: Educational intervention and surveys were completed online. EC was assessed with the Satter Eating Competence Inventory for Low-Income (ecSI/LI). RESULTS: Participants were mostly white, <31 years, overweight/obese (60%), and food insecure (58%). EC was higher for those who self-reported being physically active (30.1 ± 8.3 vs. 24.9 ± 8.1; P<0.001) and were active for ≥ 30 minutes/day (29.9 ± 8.3 vs. 26.3 ± 8.6), even with age, weight satisfaction, and BMI controlled. EC of obese physically active persons was higher than normal weight, but physically inactive women. The physical activity module was well received with responses unrelated to time involved or physical activity level. CONCLUSIONS: Low-income women were interested in learning about physical activity and responded positively to online delivery. Overall EC levels were low, but higher for physically active women, supporting efforts to enhance EC. Additional research is needed to determine if EC is associated with responses to physical activity education.

Facebook is an effective strategy to recruit low-income women to online nutrition education.

OBJECTIVE: Nutrition education research recruitment expense and effort are substantial; sample selection is crucial for intervention assessment. Effectiveness and cost of Facebook to recruit low-income women to an online nutrition program were examined, including biopsychosocial characteristics of Facebook responders. METHODS: An ad appeared on the Facebook page of low-income women, 18-45 years old, living in Pennsylvania to invite access to an online nutrition program. Eligible persons completed surveys about food-related behaviors including eating competence, food security, and assistance program use. RESULTS: Of 465 people who clicked on the ad, 81 completed the eligibility survey, and 62 were eligible; 52 completed a preprogram survey. Completers were mostly white (79%), overweight/obese (mean body mass index 36.2 ± 12.9), and not eating competent (75%). Low-income status was identified for 75% (n = 39) of completers. Total recruitment cost over 19 days was $596.71. CONCLUSIONS AND IMPLICATIONS: Facebook appears to be an effective tool to recruit low-income women to nutrition education projects.

Impact of an online healthful eating and physical activity program for college students.

PURPOSE: To identify impact of an online nutrition and physical activity program for college students. DESIGN: Randomized, controlled trial using online questionnaires and on-site physical and fitness assessments with measurement intervals of 0 (baseline), 3 (postintervention), and 15 months (follow-up). SETTING: Online intervention delivered to college students; a centralized Web site was used for recruitment, data collection, data management, and intervention delivery. SUBJECTS: College students (18-24 years old, n = 1689), from eight universities (Michigan State University, South Dakota State University, Syracuse University, The Pennsylvania State University, Tuskegee University, University of Rhode Island, University of Maine, and University of Wisconsin). INTERVENTION: A 10-lesson curriculum focusing on healthful eating and physical activity, stressing nondieting principles such as size acceptance and eating competence (software developer: Rainstorm, Inc, Orono, Maine). MEASURES: Measurements included anthropometrics, cardiorespiratory fitness, fruit/vegetable (FV) intake, eating competence, physical activity, and psychosocial stress. ANALYSIS: Repeated measures analysis of variance for outcome variables. RESULTS: Most subjects were white, undergraduate females (63%), with 25% either overweight or obese. Treatment group completion rate for the curriculum was 84%. Over 15 months, the treatment group had significantly higher FV intake (+.5 cups/d) and physical activity participation (+270 metabolic equivalent minutes per week) than controls. For both groups, anthropometric values and stress increased, and fitness levels decreased. Gender differences were present for most variables. First-year males and females gained more weight than participants in other school years. CONCLUSION: A 10-week online nutrition and physical activity intervention to encourage competence in making healthful food and eating decisions had a positive, lasting effect on FV intake and maintained baseline levels of physical activity in a population that otherwise experiences significant declines in these healthful behaviors.

Eating competence of Hispanic parents is associated with attitudes and behaviors that may mediate fruit and vegetable-related behaviors of 4th grade youth.

Parent self-efficacy, outcome expectancies, and behaviors toward cooking and fruits and vegetables mediate children's eating. Eating competence, an intra-individual approach to food-related attitudes and behaviors, is associated with healthful outcomes but has not been studied as a moderator of parent food-related behaviors that mediate healthful eating in 4th grade children. Parents (n = 339; 78% Hispanic, 89% female) of 4th graders who participated in an impact study of the Cooking with Kids curriculum in Santa Fe, NM schools eligible for Supplemental Nutrition Assistance Program Education completed the following surveys: Satter eating competence inventory for low-income (ecSI/LI) (16 items, Likert scale, possible score 0-48); modeling behaviors related to food preparation and fruits/vegetables (11 items, Likert scale, possible score 0-33); self-efficacy/outcome expectancies (SE/OE) (12 items, Likert scale, possible score 12-60); and availability of fruits/vegetables (20 items, possible score 0-20). Higher scores indicate more desired behaviors. The mean ecSI/LI score was 33.6 ± 8.5; 59% were eating competent, i.e., ecSI/LI ≥ 32. Eating-competent parents demonstrated more modeling (16.3 ± 5.0 vs. 14.0 ± 4.3; P < 0.001), greater SE/OE (53.7 ± 10.1 vs. 51.2 ± 8.5; P = 0.03), and greater in-home fruit/vegetable availability (12.7 ± 3.0 vs. 11.9 ± 3.2; P = 0.02). Two clusters of modeling behavior were defined: achievers and strivers. Modeling achievers (34.9 ± 6.9) were more eating competent (P < 0.001) than strivers (30.3 ± 8.9). Eating competence moderated parent food-related behaviors. Measuring eating competence may contribute to understanding parent behavior as a mediator in school-based nutrition interventions.

Nutrition education intervention improves vegetable-related attitude, self-efficacy, preference, and knowledge of fourth-grade students.

BACKGROUND: Impact of a classroom-based, standardized intervention to address limited vegetable consumption of fourth graders was assessed. METHODS: A 4-lesson, vegetable-focused intervention, revised from extant materials was repurposed for Pennsylvania fourth graders with lessons aligned with state academic standards. A reliability-tested survey was modified, then examined for face and content validity and test-retest reliability. Lessons and evaluation materials were modified through an iterative testing process with educator feedback. A nonequivalent control group design was stratified by local Supplemental Nutrition Assistance Program Education (SNAP-Ed) partnering organizations with random assignment of participating elementary schools as control (N = 68) or intervention (N = 72) treatments. Independent t-tests compared control and intervention group changes. A mixed effects model was created to account for classroom effects from the nested sampling method of selecting classrooms within SNAP-Ed partnering organizations. General linear model univariate analyses of variance were conducted to assess intervention effects considering gender, and food preparation/cooking experience. RESULTS: During a 3- to 5-week time frame, 57 intervention classrooms (N = 1047 students) and 51 control classrooms (N = 890) completed pre- and post-testing. Intervention students improved in vegetable-related attitude, self-efficacy, preference, and knowledge scores (p < .001). For example, intervention vegetable preference increased 1.56 ± 5.80 points; control group mean increase was only 0.08 ± 4.82 points. Group differences in score changes were not affected by gender or interactions between gender and food preparation/cooking experience with family. CONCLUSIONS: A defined intervention delivered in a SNAP-Ed setting can positively impact mediators associated with vegetable intake for fourth-grade students.

Validation of a measure of the Satter eating competence model with low-income females.

BACKGROUND: The purpose of this study was to evaluate the construct validity of a version of the ecSatter Inventory (ecSI), a measure of eating competence (EC), as adapted for use in a low-income (LI) population. METHODS: Females (n=507), aged 18 to 45 years, living in households with a history of participating in the Supplemental Nutrition Assistance Program completed a web-based survey that included the ecSI for LI (ecSI/LI) and valid measures of cognitive and affective eating behavior, food preference and practice, and food preparation. RESULTS: Most correlations and differences between eating competent and non-eating competent categories and among EC tertiles were compatible with hypothesized relationships. ecSI/LI scores were positively related with self-reported physical activity, food acceptance, fruit and vegetable intake, and food planning/resource management. ecSI/LI scores were negatively associated with body mass index, dissatisfaction with body weight, tendency to overeat in response to external or emotional stimuli, and indices of psychosocial attributes related to disordered eating. CONCLUSIONS: The ecSI/LI is a valid measure of EC for low-income females and provides a tool for researchers and educators to assess intervention outcomes and further explore the EC construct.

Cognitive testing with female nutrition and education assistance program participants informs validity of the Satter eating competence inventory.

OBJECTIVE: Examine the validity of a self-report measure of eating competence with low-income women. METHODS: Twenty-five females (18-49 years old) recruited from low-income venues in Pennsylvania completed cognitive testing through an iterative interview process. Respondents' oral responses were compared to researchers' intended meaning of ecSatter Inventory (ecSI) items; responses were mapped to evaluate the similarity between respondents' internally generated answers and their ecSI choices for survey items; and scored responses were compared among participants. RESULTS: Interview findings provided a rationale for modifying the ecSI prior to use with low-income women. Four items were misinterpreted for various reasons, including problems with clarity and wording. The modified ecSI, termed the ecSatter Inventory for Low-Income (ecSI/LI), was comprehended as intended by researchers. Congruence of cognitive responses and ecS/LI scores further supported the instrument's validity. CONCLUSIONS AND IMPLICATIONS: Cognitive testing resulted in the development of an instrument to measure eating competence in low-income adults. The ecSI/LI requires validation with a large, heterogeneous low-income sample.

Feeding practices and styles used by a diverse sample of low-income parents of preschool-age children.

OBJECTIVE: To describe the feeding practices and styles used by a diverse sample of low-income parents of preschool-age children. DESIGN: Thirty- to 60-minute meetings involving a semistructured interview and 2 questionnaires administered by the interviewer. SETTING: Low-income communities in Philadelphia, PA. PARTICIPANTS: Thirty-two parents of 2- to 6-year-old children. PHENOMENA OF INTEREST: The feeding practices and styles of low-income parents of preschoolers. ANALYSIS: Qualitative interviews analyzed iteratively following a thematic approach; quantitative data analyzed using nonparametric and chi-square tests. RESULTS: Qualitative analyses revealed parents used a myriad of feeding practices to accomplish child-feeding goals. Racial/ethnic differences were seen; East Asian parents used more child-focused decision-making processes, whereas black parents used more parent-focused decision-making processes. Quantitative analyses substantiated racial/ethnic differences; black parents placed significantly higher demands on children for the amounts (H = 5.89, 2 df, P = .05; Kruskal-Wallis) and types (H = 8.39, 2 df, P = .01; Kruskal-Wallis) of food eaten compared to parents of other races/ethnicities. In contrast, significantly higher proportions of East Asian parents were classified as having an indulgent feeding style compared to black parents and parents of other races/ethnicities (chi(2)[4, n = 32] = 9.29, P < .05). CONCLUSIONS AND IMPLICATIONS: Findings provide support for tailoring nutrition education programs to meet the diverse needs of this target audience.

Interviews with low-income Pennsylvanians verify a need to enhance eating competence.

Continuation of unhealthful dietary patterns and poor diet-related health outcomes among socioeconomically disadvantaged populations underscores the need to improve diet quality for this group. Enhancing eating competence, based on the Satter model of eating competence (ecSatter), may be one effective method to reach this goal, but requires substantiation in a low-income audience. This study utilized a qualitative approach to examine the congruence of the ecSatter model with the cognitive eating behaviors of a low-income audience. Structured interviews were conducted during summer of 2006 with 70 low-income adults in Pennsylvania. Themes about decisional factors that guide food selection, nutrition/health interests, and cognitive and affective responses to eating experiences were generated through content analysis. Thematic differences among eating competence levels and food security categories were examined. Nutrition information access preferences were also obtained. Eating competence, measured with the ecSatter Inventory, was low for this sample (mean 28.8+/-8.3). Convenience, mood, family, and availability of food at home, but not nutrition, were salient factors guiding meal and snack planning for both eating competent and noneating competent participants. Nearly equal proportions of persons with eating competence and without eating competence reported that they would make changes to their food purchases if they had more money to spend on food. Interestingly, for participants without eating competence, but not for those with eating competence, weight management played an important role in meal/snack planning, food purchases, and nutrition/health interests. ecSatter provided a tenable framework for rationalizing participants' cognitive and affective responses to eating experiences. Participants without eating competence were more likely to express negative thoughts and feelings associated with eating, regardless of food security status. The Internet, which was accessible to 80% (n=56) of participants, was the most frequently reported convenient method for accessing nutrition information. These findings lead us to recommend that increased attention be placed on cognitive eating behaviors of low-income adults to improve their diet quality.