Population risk factors and trends in health care and public policy.

Many factors affect the current and future practice of dietetics in the United States. This article provides an overview of the most important population risk factors and trends in health care and public policy that are anticipated to affect the current dietetics workforce and future of dietetics training and practice. It concludes with an overview of the state of the current workforce, highlighting the opportunities and challenges it will face in the future. Demographic shifts in the age and racial/ethnic composition of the US population will be a major determinant of future the dietetics profession because a growing population of older adults with chronic health conditions will require additional medical nutrition therapy services. Dietetics practitioners will work with an increasingly diverse population, which will require the ability to adapt existing programs and services to culturally diverse individuals and communities. Economic factors will affect not only the type, quantity, and quality of food available in homes, but also how health care is delivered, influencing future roles of registered dietitians (RDs) and dietetic technicians, registered (DTRs). As health care services consume a larger percentage of federal and corporate expenditures, health care agencies will continue to look for ways to reduce costs. Health promotion and disease prevention efforts will likely play a larger role in health care services, thus creating many opportunities for RDs and DTRs in preventive care and wellness. Increasingly, dietetics services will be provided in more diverse settings, such as worksites, community health centers, and home-care agencies. To address population-based health care and nutrition priorities effectively, dietetics practice will need to focus on appropriate evidence-based intervention approaches and targets. The workforce needs to be skilled in the delivery of culturally competent interventions across the lifespan, for all population groups, and across all levels of the social-ecological model for primary, secondary, and tertiary prevention. Because there is an assumption that the dietetics profession will experience rates of attrition of 2% to 5% based on historical workforce data, an important consideration is that the current dietetics workforce is limited in terms of diversity. An increasingly diverse population will demand a more diverse dietetic workforce, which will only be achieved through a more focused effort to recruit, train, and retain practitioners from a variety of racial, ethnic, social, and cultural backgrounds. In addition, the geographic distribution of RDs and DTRs must be addressed through strategic planning efforts related to dietetics training to provide access to and delivery of services to meet population needs. Furthermore, the health care workforce is projected to bifurcate as a result of growth in demand for the "frontline workforce" that works in direct patient contact. This bifurcation will require the dietetics profession to consider new practice roles and the level of education and training required for these roles in relation to how much the health care delivery system is willing and able to pay for services. There are many challenges and opportunities for the dietetics workforce to address the changing population risk factors and trends in health care and public policy by working toward intervention targets across the social-ecological model to promote health, prevent disease, and eliminate health disparities. Addressing nutrition-related health needs, including controlling costs and improving health outcomes, and the demands of a changing population will require careful research and deliberation about new practice roles, integration in health care teams, workforce supply and demand, and best practices to recruit and retain a diverse workforce.

Nutrition education is positively associated with substance abuse treatment program outcomes.

The scope and types of nutrition services provided in substance abuse treatment programs has not been well defined nor has there been an attempt to determine if associations exist between the provision of nutrition services and substance abuse treatment outcomes. The objectives of this study were to assess the provision (use and extent) of nutrition education in substance abuse treatment programs in facilities that provide a single or two or more substance abuse treatment programs, and to determine the possible association between nutrition intervention and substance abuse treatment program outcome measures (defined as changes in Addiction Severity Index [ASI] composite scores). A descriptive, single, cross-sectional survey of registered dietitians with clinical nutrition program management responsibility (n=152) was used to define the use and extent of nutrition services in substance abuse treatment programs. Positive associations between nutrition services provided, particularly nutrition education services and substance abuse treatment program outcome measures, were detected. When group nutrition/substance abuse education was offered, ASI psychological and medical domain scores improved by 68% and 56%, respectively (P<.05). Individual nutrition/substance abuse education was a predictor of ASI family/social domain change scores improving by 99% (P<.05). In those programs where group nutrition/substance abuse education was offered, moderate to strong correlations with various nutrition education services were observed, specifically in individual nutrition/substance abuse education (r=0.51; P<.05), group normal/nutrition education (r=0.64; P<.01), and individual normal/nutrition education (r=0.46; P<.05). Substance abuse treatment programs offering group nutrition/substance abuse education offered significantly (P<.05) more nutrition services overall. Findings support the position that nutrition education is an essential component of substance abuse treatment programs and can enhance substance abuse treatment outcomes. Dietitians should promote and encourage the inclusion of nutrition education into substance abuse treatment programs.

Food insufficiency is not related to the overall variety of foods consumed by young children in low-income families.

This study explored the relationship between food sufficiency status and redundancy of food choices, or dietary variety, among children in low-income families using the Variety Score from the Healthy Eating Index. Two samples of children ages 2 to 3 (n=1,242) and 4 to 8 years (n=1,506) were selected from the Continuing Survey of Food Intakes by Individuals 1994-1996, 1998 and then classified as either food sufficient, food sufficient with limitations, or food insufficient. Mean variety scores were low for all children, but did not differ by food sufficiency status for either age group. However, they did differ by Special Supplemental Nutrition Program for Women, Infants, and Children participation and region of the country for the younger and older children, respectively. Results suggest the importance of nutrition education and food assistance programs that enhance dietary variety. Further research should explore how food assistance program participation is related to dietary variety and the degree to which variety within food groups is related to food security.

EFNEP: a nutrition education program that demonstrates cost-benefit.

OBJECTIVE: Data on the economic value of nutrition education programs, such as the Expanded Food and Nutrition Education Program (EFNEP), can help decision makers choose among alternative programs based on costs and benefits. A cost-benefit analysis of EFNEP was conducted to determine if participants' savings in food expenditures exceeded program implementation costs. DESIGN/SUBJECTS: Costs were collected over 6 months using expenditure reports and other records. Benefits were determined using prospective data from 371 women enrolled in EFNEP who completed a 24-hour food recall and behavior survey, and recorded the amount of money spent monthly on food at program entry and exit. Two treatment groups received nutrition education and one group did not receive education. One treatment group estimated food expenditures from recall and the other collected register receipts or recorded expenditures. Control group subjects reported expenditures from recall. Net present value (NPV) was calculated using mean EFNEP cost per participant subtracted from the mean change in family food expenditures per participant over a 5-year period at three discount rates. STATISTICAL ANALYSES: Analysis was designed to compare food expenditures among the two experimental groups and control group and food and nutrient intakes and survey scores between the combined experimental group and control group. RESULTS: The average EFNEP program cost perparticipant was $388, and graduating participants reported that family food expenditures decreased on average by $10 to $20 per month or $124 to $234 over a year. When benefits were projected to last 5 years, the NPV was $147 to $696 depending on the method of food expenditure estimation and the discount rate. At the same time individuals reduced food expenditures, they increased intakes of iron, vitamin C, vitamin B-6, and fiber. They added less salt when cooking and read nutrition labels more often. They also reported not running out of food at the end of the month as often. APPLICATIONS/CONCLUSIONS: Findings from this research showed that EFNEP is cost-beneficial. The magnitude of the savings in food expenditures is sensitive to the method of food expenditure reporting and assumptions about how long participants will retain the behaviors they learn.