ACADEMIC CRITERIA FOR ADVANCEMENT

EXTENSION, RESEARCH, AND CREATIVE ACTIVITY

Administrative Leadership

Chronic Disease Prevention

Childhood Obesity

Development of Nutrition Education Materials for Low-literacy Populations

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Section 1.0 Administrative Leadership

1.1 Staff Support and Evaluation1.2 Staff Development 1.3 Program Development

Section 2.0 Chronic Disease Prevention

2.1 Expanded Food and Nutrition Education Program (Adult EFNEP)2.2 Adult Food Stamp Nutrition Education Program (Adult FSNEP)2.3 FSNEP Fish Connection Pilot Project

Section 3.0 Childhood Obesity

3.1 Youth Food Stamp Nutrition Education Program3.2 FSNEP Nutrition Education Promotion for Adolescents Project3.3 Tri-County Childhood Obesity Prevention Project in the Hmong Population

Section 4.0 Development of Nutrition Education Materials for Low-Literacy Populations

4.1 Multi-state Poverty, Obesity, and Energy Density Research Project4.2 Visually Enhanced Food Behavior Checklist Project4.3 Every Step Counts Project

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SECTION 1.0: Administrative Leadership

In San Joaquin County, I administer the Adult Expanded Food and Nutrition Education Program (Adult EFNEP), Adult Food Stamp Nutrition Education Program (Adult FSNEP), and Youth Food Stamp Nutrition Education Program (Youth FSNEP). During this program review period, I continued to supervise the San Joaquin County component of the Poverty, Obesity, and Energy Density Project (Food Cost Study) and the FSNEP Nutrition Education Promotion for Adolescents Project (EatFit Study). I also continue to supervise a community nutrition volunteer internship program in San Joaquin County and to provide opportunities for UC Davis and UC Berkeley students to explore nutrition and foods related issues with low-income county residents. I expanded my management responsibilities with the Adult FSNEP Fish Connection Pilot Project (Fish Study) and a 2005 ANR Core Issues Grant (Hmong Study) to research, develop, and deliver a childhood obesity prevention program targeting the Hmong population.

Two projects involve multi-county administrative responsibilities. The Nutrition Education Promotion for Adolescents Project staff works 50% in San Joaquin County and 50% in Calaveras County but her home base is San Joaquin County. I am responsible for administering the budget and co-supervising the project. The Core Issues Grant started as a one county project and has developed into a tri-county project, which includes San Joaquin, Butte, and Fresno Counties. As the Principal Investigator on this project, I administer the program for all three counties and supervise the San Joaquin County staff.

The following table delineates the percentage of my time and the staffing patterns I allocated for administration of these projects during 2005. Appendix C details the grant support for each project.

Table 1: Nutrition, Family and Consumer Science Programs/Projects and Staffing PatternsProgram (Administration %*) Duration Staffing

Classification/FTEProject 2.1:Adult EFNEP (5%)

FY2004/2005 1.0 FTE PRII; 0.25 FTE CHPR

Project 2.2:Adult FSNEP (10%)

FY2004/2005 0.7 FTE PRI; 0.4 FTE CHPR

Project 2.3:FSNEP Fish Connection Pilot Project (5%)

FY2004/2005 1.0 FTE PRI

Project 3.1:Youth FSNEP (5%)

FY2004/2005 1.0 FTE PR II; 0.50 FTE PR I

Project 3.2:FSNEP Nutrition Education Promotion for Adolescents Project (5%)

FY2004/2005 1.0 FTE PRI

Project 3.3:Tri-County Childhood Obesity Prevention Project in the Hmong Population (10%)

June-Aug 2005Oct-Dec 2005

1.0 FTE Lab Assistant II 1.2 FTE CHPR(3 staff/3 months)

Project 4.2: Multi-state Poverty, Obesity, and Energy Density Research Project (5%)

FY2004/2005 0.3 FTE Senior Survey Worker

Community Nutrition Volunteer Internship Program (2%)

Sept-Dec 2005 one CSU, Sacramento student volunteer

* Please note that the percentages in parentheses represent estimates of the administrative/supervisory percentage I devote to each program. It does not include my participation in the research and workgroup activities that are directly related to these programs.

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Project 1.1 Staff Support and Evaluation (2005)

Collaborators. County Director, 4-H Youth Development Advisor, County and Regional Support Staff.

Grant support. County budget plus project funding listed in Appendix C.

Background and rationale. During 2005, administration and staff supervision continued to be major components of my assignment. My commitment to building an effective team of nutrition educators provides not just manpower but dedicated staff to accomplish outstanding achievements in extension, research, and creative activity.

Extension methods. Communication: I have a policy of checking with each staff every other day and sometimes daily. I hold quarterly business meetings with each program and collaborate with Ann Brosnahan, 4-H Youth Development Advisor, to bring the San Joaquin County Human Resources staff together for interstaff meetings. Evaluation: My method of evaluating my staff includes a self-evaluation by the staff, my evaluation of their performance, and a meeting to compare each facet of their performance. During 2005, I met with each staff person to set goals and plan for optimizing their performance over the next fiscal year. Special Projects: I provide the same level of support to the special project staff as I do to my regular staff. In addition, each special project has either a monthly or bimonthly conference calls/meetings to ensure the collaborators, specialists, advisors, and project support staff are closely following the project’s goals and objectives. Prior to these conference calls/meetings, I meet with the San Joaquin County staff to discuss their progress and address any issues that have arisen in our county. This has proved to be a highly effective method of increasing communication between my local project staff and the project team members who are located throughout the state.

My role. Communication: ● I communicated regularly with my staff.● I held quarterly business meetings with each program and special project.● I co-facilitated interstaff meetings.● I participated in special project conference calls/meetings.

Evaluation:● I conducted annual evaluations, including observations of their performance in the field.● I met with staff members individually to help them plan their performance for the next year.Recruitment and hiring● I recruited and hired two contract employees and three limited term employees. ● I recruited, interviewed, and hired new staff as needed.Supervision● I supervised a total of eleven NFCS program staff housed in San Joaquin County and provided

project-related consultation on the supervision of the two Hmong Study staff housed in Butte and Fresno Counties.

Impact on staff. The San Joaquin County NFCS staff exhibits a responsive, caring attitude toward their program delivery and, most of the time, toward each other. This attitude is reflected in their interactions with agency personnel and their clientele.

Impact on program. I expanded program delivery in San Joaquin County through special projects and to a select segment of our low-income, Asian population, Hmong families in San Joaquin, Butte, and Fresno Counties through the UC ANR Core Issues Grant.

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Project 1.2 Staff Development (2005)

Collaborators. California EFNEP, UC Davis FSNEP, UCCE Specialists, UCCE NFCS Advisors, UC Davis Nutrition Department, UC Berkeley Undergraduate Research Apprenticeship Program, and Community Outreach and Information Dissemination National Center for Minority Health Disparities at Children's Hospital & Research Institute in Oakland.

Grant support. County budget plus project funding listed in Appendix C.

Background and rationale. As extension educators, our staff’s mandate is to extend University, research-based nutrition education programs to teachers, childcare providers, parents, youth and community workers. Our vision for our clients is that our nutrition education programs will motivate significant behavior changes that will lead to healthier, happier lives through research-based, cooperative, experiential learning methods and curricula. In order to achieve this vision, our staff and our advisors need to have the tools to be successful, which means continual training and updating in their nutrition knowledge and teaching skills.

Extension methods. During 2005, two statewide staff trainings (one EFNEP and one FSNEP) were conducted by our UCCE EFNEP and FSNEP State Programs and eight special project trainings were conducted by special project research team members. Nutrition updates and advisor trainings were conducted for the UCCE NFCS Program Leaders/Advisors. Each of the statewide programs and several of the special projects focused on training staff using an experiential model of learning taught by Joye Norris, Ed.D., the dialogue model, which can be more accurately described as a learner-centered approach based on the educational components--“anchor, add, apply, and away”. My regular EFNEP and FSNEP program staff practiced the new approach both in their regular activities and as mentors to new staff members and special project staff. This type of mentorship training increases their skills and helps to update their nutrition knowledge.

My role.● I chaired the FSNEP Nutrition Education Committee that planned the July 2005 FSNEP Statewide

Staff Training. ● I collaborated with EFNEP/FSNEP state directors and/or their support staff to plan two statewide

staff trainings and two advisor/administrative trainings during 2005. ● I ensured my staff attended all EFNEP/FSNEP statewide trainings and special project trainings.● I collaborated with special project research team members to plan and deliver staff trainings for

multi-county special projects (see University Service, Regional Level Activities).● I ensured new staff had multiple opportunities to observe and learn from more experienced

community nutrition educators.

Results. The ability our UC NFCS programs to identify and address critical needs in our communities is enhanced by providing continual training and updating of our advisors, nutrition educators and support staff. Reports from my EFNEP/FSNEP staff and special project staff indicate that their training in the learner-centered approach has been successfully incorporated into their program/project delivery methods. I have observed that Joye Norris’s book, From Telling to Teaching, is not sitting on a bookshelf but in plain view on most of my nutrition educator’s desks and becoming tattered from regular use. This is the best testament to training success that I can think of—actual application of the model in the field.

Impacts. Clients participating in our NFCS Programs make behavior changes that improve their family’s health both short-term and long-term. Agencies/schools in the community continue to ask our program’s deliver workshops for their clients despite increasing competition in the nutrition education arena.

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Project 1.3 Program and Resource Development (2005)

Collaborators. See Appendix C, Grant Support Table for extensive list of collaborators on all projects.

Grant support. County budget plus project funding listed in Appendix C.

Background and rationale. As extension educators, our staff’s mandate is to extend University, research-based nutrition education programs to teachers, childcare providers, parents, youth and community workers. Our vision for our clients is that our nutrition education programs will motivate significant behavior changes that will lead to healthier, happier lives through research-based, cooperative, experiential learning methods and curricula.

Extension methods. In order to achieve this vision, several components must be addressed at the administrative level: 1) funding must be secured, 2) evidence-based curricula and program materials must be continually updated and/or developed, and 3) priority needs in the community must be identified. In addition, the funding for our federal FSNEP programs and/or related research projects is dependent on our ability to find agency directors, agency staff, teachers, principals, nurses, etc. that are paid with non-federal dollars to provide in-kind matches of time and effort devoted to implementing our FSNEP program.

My role. ● I initiated and was awarded a UC ANR Core Issues Grant to research, develop, and deliver a

childhood obesity prevention program, the Tri-County Childhood Obesity Prevention Project in the Hmong Population (Hmong Study).

● I negotiated with the County Director, county office manager, and 4-H Youth Development Advisor to devote a percentage of their time in-kind to support FSNEP program delivery. I committed 60% of my time to administration and supervision of Adult and Youth FSNEP. I negotiated with the several local agencies/school personnel to devote a small percentage of their time in-kind to the Adult FSNEP program.

● I collaborated with internal and external partners to develop proposals for special projects that expanded our SNJ NFCS programs.

● As a member of state EFNEP and FSNEP advisory committees, their subcommittees, and UC ANR workgroups, I provided leadership in development of educational materials and pilot testing of curricula/program materials.

● I collaborated with community partners to acquire funds for delivering nutrition and physical activity education to their clientele.

● As my program review clearly demonstrates, I am a member of a variety of local and statewide collaborative groups that identify priority needs of families and plan for programming to meet those needs.

Outcomes. I succeeded in forming a collaboration that was awarded a UC ANR Core Issues Grant to address childhood obesity in the Hmong population. I am principal investigator on this project. I received continued funding for Adult EFNEP, Adult FSNEP, Youth FSNEP, and FSNEP special projects. I was able to leverage additional funding either in dollars or in in-kind services from a variety of collaborators. A learner-centered adaptation of the Adult EFNEP curriculum, various evaluation instruments, and education/program materials are being pilot tested in California NFCS program counties.

Impacts. My commitment to maintaining and developing resources for my NFCS programs enables me to conduct the projects presented in the “Extension, Research, and Creative Activity Section”.

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Section 2.0 Chronic Disease Prevention

Project 2.1 Expanded Food and Nutrition Education Program (2005)

Collaborators. USDA, California EFNEP, and community agencies serving low-income families.

Grant support. See Appendix C, Section 1.

Background and rationale. Research indicates that women of childbearing years, families/individuals living in poverty, substance abusers, elderly, migrant workers, and certain ethnic subgroups such as African-Americans, Latinos, and Southeast Asians are considered to be at highest risk of chronic disease and other nutrition/physical activity-related problems. Our Adult EFNEP program has provided culturally-appropriate nutrition education workshops for over 30 years with the end goal of improved health and well being of low-income families within these subpopulations.

Extension methods. During 2005, EFNEP Nutrition Educators delivered parent education workshops focused on improving dietary behaviors and physical activity practices for low-income, ethnically diverse clientele using a variety of extension methods. Extender training (train-the-trainer) to local agencies serving low-income families. Home study lessons to north county Creative Child Care preschool parents through the school nurse.

As part of this project, EFNEP provided three parent/child interactive workshops for parents from all the sites to attend.

Child care provider training through Family Resource and Referral Center focused on nutrition, healthy child feeding practices, and food safety training.

Workshops and/or educational materials in Spanish as needed.

My role. I administered and supervised the EFNEP program (Section 1.0 Administrative Leadership).

Results. During Fiscal Year 2004/2005, EFNEP trained four agencies to teach nutrition education to their low-income parents. EFNEP Nutrition Educators provided 263 low-income families with a minimum of six hours of nutrition education. A pre/post “Food Behavior Checklist” was used to evaluate knowledge/behavior changes in EFNEP clientele (n=____). The table below documents the evaluation results by fiscal year.

Food Behavior Practice Fiscal Year

% (#) improved in one or more

practiceFood Resource Management (plan meals, compare prices, does not run out of food or uses grocery list) 2004/2005 72% (182)Nutrition (plan meals, makes healthy food choices,

prepares foods without adding salt, reads nutrition labels or has children eat breakfast) 2004/2005 81% (189)

Food Safety (thawing and storing foods properly) 2004/2005 56% (140)

Impacts. The ethnic breakdown of families served in Fiscal Year 2004/2005 was 17% Black, 24% White, 53% Hispanic, 2% American Indian, and 4% Asian/Pacific Islander. The improvements reported in the above table are expected to improve the family’s nutritional status. Long term this improvement should translate into a decreased incidence of diet-related diseases, reduced health care costs for Californians, and reduced incidence of racial/ethnic disparities in health and well-being experienced by low-income San Joaquin County residents.

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Project 2.2 Adult Food Stamp Nutrition Education Program (2005)

Collaborators. USDA/Food & Consumer Services; CDSS Food Stamp Bureau; and county-level community agencies/organizations/schools serving food stamp recipients and applicants.

Grant support. See Appendix C, Section 2.

Background and rationale. As stated in Project 2.1, specific subpopulations within San Joaquin County are considered to be at higher risk of chronic disease and other nutrition/physical activity-related problems. Included within these subpopulations are food stamp recipients or applicants. Our Adult FSNEP program has been outreaching to these families since 1994 in an effort to improve their nutrition, food preparation, and food resource management practices. Improvement in physical activity levels was recently included as an additional FSNEP goal.

Extension methods. Adult FSNEP Nutrition Educators delivered workshops to participants focused on money management, food buying, food preparation, keeping food safe, physical activity, and nutrition. Workshop materials were made available in both English and Spanish. FSNEP Nutrition Educators conducted either one 1 and 1/2 hour workshops or a series of workshops totaling four hours or more. During FY2004-2005, the FSNEP Nutrition Educators collaborated with eleven local programs and numerous elementary schools to provide FSNEP lessons to their clientele.

My role. I administered and supervised the Adult FSNEP program in our county (see Section 1.0 Administrative Leadership for details).

Results. During FY2004-2005, Adult FSNEP Nutrition Educators provided workshops for 596 food stamp recipients/applicants. A pre- and post- California Food Behavior Checklist was used to evaluate knowledge/behavior changes in a sampling of FSNEP clientele who had received a minimum of four hours of education. The table below documents the evaluation results.

Food Behavior Practice Fiscal Year

% (#) improved in one or more

practicesFood Resource Management (plan meals, compare prices, does not run out of food or uses grocery list) 2004/2005 78% (79)

Nutrition (plan meals, makes healthy food choices, prepares foods without adding salt, reads nutrition labels or has children eat breakfast) 2004/2005 80% (74)

Food Safety (thawing and storing foods properly) 2004/2005 44% (46)

Impacts. The Adult FSNEP clients were low-income and ethnically diverse (Ethnic breakdown for 2004/2005: 20% Black, 28% White, 42% Hispanic, 2% American Indian, and 8% Asian/Pacific Islander). The improvements reported in the above table are expected to reduce obesity and chronic disease risk for participants, therefore reducing the incidence of racial/ethnic disparities in health and improving the well-being of participant families.

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Project 2.3 FSNEP Fish Connection Pilot Project (2005)

Collaborators. California Department of Health Services, Environmental Health Investigations Branch (EHIB); UC Cooperative Extension FSNEP state and county offices; and Dr. Sheri Zidenberg-Cherr’s research group in the Department of Nutrition, at UC Davis.

Grant support. See Appendix C, Section 4.

Background and rationale. The goal of the FSNEP Fish Connection (FFC) is to improve the likelihood that persons eligible for the Food Stamp Program (FSP) will make healthy food choices within a limited budget and choose active lifestyles consistent with the current Dietary Guidelines for Americans and the My Pyramid. Fish consumption is addressed in both the Dietary Guidelines for Americans and the My Pyramid, thus it is important to provide consumers with accurate information regarding both the health benefits and potential concerns associated with fish consumption. To meet this goal the collaborators have developed a framework for education regarding the health benefits and potential risks of fish consumption.

Research and Extension Methods. During 2005, Nutrition Educators in Solano and San Joaquin Counties pilot tested the educational materials and lessons being developed/recommended for project implementation. In San Joaquin County, the Nutrition Educator delivered the lessons at local agencies and health fairs serving food stamp recipients and applicants. Pre- and Post- California Food Behavior Checklists were used to assess behavior changes related to the nutrition, food resource management, and food safety portion of the lessons. Feedback from Nutrition Educators was used to adapt lessons.

My role. I administered and supervised the staff in San Joaquin County. I worked with the initial project collaborators to adapt four of the Adult FSNEP lessons for delivery and evaluation. Diane Metz developed a research-based set of power point presentations for each lesson. I worked with Diane in Fall of 2005 to revise and finalize the lessons and slide sets for use in staff training and program delivery. I assisted Diane in presenting the project at the FSNEP Statewide Staff Training in Summer 2005 and to the project team at the new staff training in December 2005.

Results. During FY2004-2005, the FSNEP Fish Connection Nutrition Educator provided workshops for 142 food stamp recipients/applicants. A pre- and post- Food Behavior Checklist was used to evaluate knowledge/behavior changes in a sampling of FSNEP clientele (n=28) who had received a minimum of four hours of education. Seventy-nine percent of those surveyed improved in food resource management practices, ninety percent in nutrition practices, and fourteen percent in food safety practices. The FSNEP Fish Connection clients were low-income and ethnically diverse (Ethnic breakdown for 2004/2005: 21% Black, 30% White, 35% Hispanic, 2% American Indian, and 12% Asian/Pacific Islander).

Impact. The FSNEP Fish Connection Nutrition Educator reported many success stories from the field. For example, at the Day of the Farm Worker, one man said, “What are you suppose to do if you have nothing to eat but the fish you catch?” He was concerned about the mercury but was going to continue fishing because he had no other source of food. The new knowledge empowered him to make decisions about what types and the amounts of fish to consume. Many families did not realize that tuna and fish sticks were included in the advisories on fish consumption. After the lessons, families were more aware of the type and amounts of these products that were lower in mercury. As a result of the pilot project’s success in 2005, the project will be expanded in 2006 for implementation in eight watershed counties of California. The evaluation will include pre- and post- assessment of the changes in participant knowledge on the issues of mercury contaminated fish, the health implication to women and young children, and improvement in fish-eating practices. Once the data is gathered and analyzed, current education and/or literature may be further modified to meet the needs of the audience.

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Section 3.0 Childhood Obesity

Project 3.1 Youth Food Stamp Nutrition Education Program (2005)

Collaborators. Youth University of California, Davis Campus, UC Cooperative Extension offices, and United State Department of Agriculture (USDA), California Department of Social Services (CDSS), and San Joaquin County low-income schools.

Grant support. See Appendix C, Section 3.

Background and rationale. The Youth FSNEP is a federally funded program to address the nutrition education needs of California youth (preschool through high school) who are from families that receive or have applied for food stamps. The overall goal is to promote healthy lifestyles for youth and their families as outlined in the Dietary Guidelines for Americans. This is done by training teachers who will provide children with four to six hours of nutrition education. Specific objectives include: Increasing awareness of fruits, vegetables and other high-fiber, low-fat foods. Increasing awareness of food safety practices for children who prepare some of their own meals and

snacks. Encouraging daily physical activity.

Extension methods. San Joaquin County Youth FSNEP Program Representatives in offer a variety of program delivery approaches. Program Representatives provide training to teachers. Teachers in turn conduct educational activities for students in a classroom setting using approved curricula. Another method of program delivery is after-school programs, preschools, and community organizations such as Parks and Recreation Departments. Program Representatives train youth directors, program coordinators or other youth leaders who in turn provide educational activities using approved youth curricula. During 2005, I collaborated with a UCCE research team led by Marilyn Townsend, UC Davis Nutrition Specialist, to evaluate the UCCE EatFit curriculum used by Youth FSNEP for program delivery to middle school students (See Project 3.2 for details). The regular Youth FSNEP Program Representatives participated in this project by acting as liaisons between Webster Middle School Principal and Teachers, assisting in the data collection and documentation, directly delivering the control group’s lessons, and involvement in the process evaluation of the project.

My role. I administer and supervise the Youth FSNEP program (see Section 1.0 Administrative Leadership for details).

Results. During 2005, My youth-focused programs (Projects 3.1 and 3.2) delivered 157 copies of Youth FSNEP curriculums to 32 low-income schools extending nutrition and physical activity knowledge and behavior change education to 3895 youth and 127 teachers. Approximately seventy-seven percent of the students who benefited from our Youth FSNEP program were from food stamp eligible families. The students were ethnically diverse (Ethnic breakdown for 2004/2005: 12% Black, 19% White, 60% Hispanic, 1% American Indian, and 9% Asian/Pacific Islander).

Impact. The Youth FSNEP program provided the tools for teachers and community leaders to address the many of the factors indicated as possible causes/concerns in the growing epidemic of childhood overweight and obesity. The nutrition educators and I have worked closely with teachers, principals, and community leaders to build the content of Youth FSNEP lessons into their lesson plans. During 2005, the Youth FSNEP impact was broadened to include teacher supervised after school care, preschools, Boy’s and Girl’s club, and a peer-teaching literacy based nutrition program.

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Project 3.2: FSNEP Nutrition Education Program for Adolescence (2005)

Collaborators. Marilyn Townsend, UC Davis; NFCS Advisors from Tulare and Amador/Calaveras Counties; UC Davis FSNEP; and Shaping America’s Youth (funded by Nike, McNeil Nutritionals, Campbell Soup, and Gerber Foods with the support of the Office of the US Surgeon General and American Academy of Pediatrics).

Grant support. See Appendix C, Section 5.

Background and rationale. In my last PR, I reported on the initial planning stages and expected outcomes of the Youth FSNEP EatFit Evaluation Study (currently entitled the Youth FSNEP Nutrition Promotion for Adolescence Project). Three counties (Tulare, Calaveras, and San Joaquin) had agreed to participate in the project using three different research designs. In 2005, the research team trained staff and pilot tested research instruments. During the Fall semester, San Joaquin County implemented their component of the research project at Webster Middle School. Middle school teachers are the targeted implementers of the EatFit lessons. School teachers have limited time to introduce nutrition and fitness concepts in their classroom. Determining the optimal intervention intensity to meet the time constraints of the school teacher and maximize behavioral impact on the students has proven to be a challenge. San Joaquin County investigated the influence of intervention intensity on 7th and 8th grade participants’ dietary and physical activity behaviors.

Research methods. A convenience sample was drawn from Webster Middle School, a low-income school in Stockton (n=126). Participants were randomly assigned to treatment (12 lesson intervention) or control (6 lesson intervention) with data collected before and after the intervention. Measures assessed participants’ dietary self-efficacy and behavior and physical activity self-efficacy and behavior. Analysis included ANCOVA where the explanatory variable was group as the main effect with the covariates being pre-intervention score, gender, class period, and ethnicity.

My role. I participated as a research team member in planning all aspects of this project. I recruited for a Program Representative to conduct the research study in Calaveras and San Joaquin Counties. I administered the budget for both counties and provided home office supervision for the Program Representative. I supervised the coordination of program delivery, data collection, and project reporting in San Joaquin County. I supervised the regular Youth FSNEP staff that assisted with the project and delivered the Money Talks lessons to the control group. I supervised staff that acquired sites in San Joaquin County with age-appropriate participants for the cognitive testing of the retrospective instrument that would be used in Calaveras County and the standards assessment tool that would be used in Tulare County. I sponsored EatFit staff training at the UCCE San Joaquin County office.

Results. One hundred and seven ethnically diverse participants with a mean age of 12.2±0.6 years old were included in the analyses (46% male). No significant differences were found between groups for the dietary behavior (p=0.11), dietary self-efficacy (p=0.41), physical activity behavior (p=0.23), or physical activity self-efficacy (p=0.23) variables. The intervention intensity of six lessons resulted in similar outcomes for changing one dietary and one physical activity behavior in adolescents compared to intervention intensity of 12 lessons. Additional analysis of the data is being conducted that will look at various different aspects of this project. Abstracts, journal publications, and news releases are currently being developed to disseminate the findings.

Impacts. The findings that 6 lessons can be delivered with similar results as 12 lessons should be good news for middle school teachers given their limited time schedule. On the other hand, the findings indicate a need for further analysis of the EatFit curriculum. If a teacher preferred to deliver 12 lessons, how should the curriculum delivery be modified to achieve significantly better results?

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Project 3.3 Tri-County Childhood Obesity Prevention Project in the Hmong Population (2005)

Collaborators. Patsy Wakimoto, National Center for Minority Health Disparities at Oakland; UC Berkeley Undergraduate Research Apprenticeship Program; Barbara Sutherland, California EFNEP; UC ANR Health Promotion Workgroup; UCCE NFCS Advisors and EFNEP Nutrition Educators from Butte and Fresno Counties; and local social service agencies serving low-income Hmong families.

Grant support. See Appendix C, Section 7.

Background and rationale. In my last program review, I reported on the results of focus groups conducted with the San Joaquin County Hmong and Cambodian communities. Preliminary results from Hmong and Cambodian groups indicated the urgency of implementing a culturally appropriate health promotion program that emphasized healthy food choices/preparation, physical activity, and diabetes awareness and prevention education. After careful consideration of the resources available to me, I decided to seek funding for adapting the California EFNEP curriculum to meet the needs expressed by the Hmong families in San Joaquin County. I initiated and was awarded a UC ANR Core Issues Grant to research, develop, and deliver a childhood obesity prevention program, the Tri-County Childhood Obesity Prevention Project in the Hmong Population. The objective of this study was to develop a culturally appropriate, extender-delivered, learner-centered, series of lessons based on the Expanded Food and Nutrition Education Program curriculum to address childhood obesity through parent education in Northern California Hmong communities.

Research methods. Focus groups with Hmong parents, grandparents, and parent educators in San Joaquin County were conducted to confirm previous results from the 2004 Southeast Asian Project. The current California EFNEP curriculum was tailored to Hmong preferences and practices and designed to be user friendly. Low-literacy handouts were created and tested with Hmong audiences. Messages were designed to respect and maintain healthy traditional habits, emphasize My Pyramid concepts, modify less healthy food patterns, encourage safe food handling practices, and promote physical activity. Essential components of the lessons are family involvement, goal setting and weekly evaluation. Extension methods. During 2006, the lessons and handouts that were developed will be pilot tested in three counties. Four Hmong women from three California counties have been trained as extenders to pilot test the eight lesson series. Process evaluation will include post-lesson journals and qualitative analysis of the curricula, instructional material, activities and content; monthly conference calls; individual extender interviews; and a final formal discussion group with Hmong extenders. The standard EFNEP evaluation tools will be used to evaluate participant knowledge and behavior changes.

My role. I initiated the application for the grant. As Principal Investigator on this project, I administer the project, provide San Joaquin County staff supervision, and consult on project-related issues for the two other counties. During 2005, I co-authored four peer-reviewed abstracts that were presented by UC Berkeley URAP students at the Federation of American Societies for Experimental Biology (Bibliography 20, 21, 22, and 23)

Results. A culturally appropriate, extender-delivered, learner-centered, series of lessons based on the Expanded Food and Nutrition Education Program (EFNEP) curriculum has been developed and is ready to pilot test with San Joaquin, Fresno, and Butte Counties’ Hmong communities. Four Hmong women from three California counties have been trained as extenders to pilot test the eight lesson series.

Impact. The research team anticipates the Hmong EFNEP Extender Curriculum will help to prevent unhealthy acculturation-related changes in diet and physical activity in families.

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Section 4.0 Development of Nutrition Education Materials for Low-Literacy Populations

Project 4.1 Poverty, Obesity, and Energy Density Research Project (2005)

Collaborators. USDA-ARS-WHNRC; University of California, Davis; University of Washington, Seattle; and UC Cooperative Extension in San Joaquin, Solano, Amador, and Tulare Counties, CA Grant support. See Appendix C, Section 10.

Background and rationale. In my last program review, I reported on the first phase of a multi-state research study to develop and validate an instrument to study the relationship between dietary energy density, diet costs, and actual food expenditures. The second phase of this study is currently underway in San Joaquin, Amador, Calaveras, Solano, Tulare, and Tuolumne Counties and will be reported on in my 2006 program review. During 2005, a component of the study was evaluated to identify indicators at the local level that are outside the individual’s control and may vary by location and by economic cycling. Although households control many food purchase decisions, our objective was to identify non-volitional external indicators that predict local ability to support compliance with TFP recommendations in four California Counties. Links between poverty and obesity may be mediated by food purchase decisions based these indicators. The USDA food stamp allotments are connected to the Thrifty Food Plan (TFP), which supports access to a nutritious diet on a limited budget. A shopping list is provided with the TFP menu to assist in obtaining all the items needed for that week. Food Stamp Program participants have indicated that although the TFP worked with a limited budget, in the long-run there were problems.

Research methods. A food list based on the TFP was used to assess local food prices and availability within each county between a large chain supermarket and a market identified within each county as most used by food stamp recipients. Food items were chosen based on a family of four for the first week menu from the thrifty food plan. A ‘shopping list’ was made for 40 of the 87 food items needed for one week. Items were analyzed for variations in price by county, supermarket, and food group.

My role. I administer and supervised San Joaquin County research staff collecting data on this study. I helped university researchers identify contacts and sites to conduct their study. During 2005, I co-authored one peer-reviewed abstract that was presented as a poster session at the North American Association for the Study of Obesity Annual Scientific Meeting 2005 (Bibliography 27)

Results. This study demonstrated the actual food unit prices across four counties within a food market frequented by food stamp varied slightly by county and type of market. Price variation depended on food group. Foods with the shortest shelf-lives (fresh fruits) showed the most variation between stores and counties. It is evident that purchase of all the TFP first week items as whole units could meet or exceed the average monthly food stamp allotment for a family of four. This may in turn impact food purchase decisions so that families choose less nutritious but more inexpensive food sources to prevent the family from feeling hungry. In addition, the total weight of these 40 items was approximately 80 pounds thus requiring food stamp recipient food purchases to possibly be effected by two more variables, distance and transportation.

Impact. This study indicates that food stamp cuts, food price and food availability all may serve as external indicators predicting food stamp recipient’s vulnerability to economic cycling and less nutritious food selections. Further research is needed to determine if this economic cycling leads to poor food choices and/or is contributing to the higher rates of overweight and obesity in low-income, food stamp eligible populations.

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Project 4.2 Visually Enhanced Food Behavior Checklist Project (2005)

Collaborators. Marilyn Townsend, University of California, Davis; Kathryn Sylva, University of California, Davis; Diane Metz, UCCE Solano County; Patti Wooten-Swanson, UCCE San Diego County; Nancy Keim, USDA Western Human Nutrition Research Center, Davis; Barbara Sutherland, California EFNEP, Davis; Sharon Sugerman, Cancer Prevention and Nutrition Section of California Department of Health Services, Sacramento.

Grant support. See Appendix C, Section 12.

Background and rationale. Comprehending text of an evaluation tool such as the EFNEP Food Behavior Checklist can be problematic for low-literacy EFNEP clients. We added carefully crafted photographs to improve the understandability of the FBC. The purpose of this study was to use a systematic process to assess the content and face validity of these visuals. Literacy is also an issue for many EFNEP clients. There is a need for an EFNEP food behavior checklist (FBC) with improved client understanding as determined, in part, by an assessment of readability. Our objective for this component of the study was to improve readability of the FBC questions for EFNEP clients.

Research methods. Content and Face Validity: In a three-step process to improve the FBC, step #1 used a focus group discussion protocol to interview EFNEP clients at an emergency food bank. Clients guided the content of the color photographs for each question using foods popular with their families. In step #2, other clients reviewed the photographs and proposed layouts for the final instrument. In step #3, clients compared the original with the visually enhanced revised version. Readability: We used cognitive testing procedures to assess client understanding of the current version of FBC questions and response options. We conducted interviews in both group and individual settings. Next, we assessed readability of the current and revised versions of the FBC using two readability formulas.

My role. I collaborated with other members of the research team on planning and designing the Every Step Counts materials. I administered and supervised staff that assisted with and coordinated the details of the cognitive testing with EFNEP/FSNEP clients. During 2005, I co-authored three peer-reviewed abstracts. Results. Content and Face Validity: Clients expressed their preference for the revised version. Example: The question How often do your children eat something in the morning within two hours of waking up? was revised to read: Do your children eat within 2 hours of waking up? and with a 2-part visual (color photograph). Part 1 of the photograph is a child in bed with a clock showing 7 am. Part 2 is a child/children at a kitchen table eating with a clock showing 8:30 am. Because clients felt that the text “in the morning” and “of waking up” were expressed in the 2-part photograph with the clocks, the words were deleted from the text of the question. Readability: The overall message from clients was “keep it simple”. Example: When deciding what to feed your family, how often do you think about healthy food choices? Clients recommended that the 16-word question be simplified to 12 words: When deciding what to feed your family, do you think about healthy foods? The current FBC text is readable by clients at grade 4.5 and higher. Readability formulas indicated that the revised version of the FBC is readable by clients at grade 3.3. These results have been presented at the 2005 FNEE and SNE Conference (Bibliography 24, 25, and 26).

Impact. The testing process produced a Food Behavior Checklist with improved readability, content and face validity. This study is important because enhancing the readability of the EFNEP FBC is one approach to improving our ability to capture existing program outcomes. With USDA approval and California EFNEP approval, this FBC version potentially could used in California with the current EFNEP ERS reporting system without software adjustments as the question topics have not been altered.

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Project 4.3 Every Step Counts Project (2005)

Collaborators. Marcel Horowitz, Yolo County 4-H/Youth Advisor; Marilyn Townsend, UCCE Nutrition Specialist; Gloria Espinosa-Hall, Shasta County NFCS Advisor; Diane Metz, Solano/Yolo County NFCS Advisor/Yolo County CD; and Margaret Johns, Kern County NFCS Advisor; and UC Berkeley and UC Davis Nutrition Departments.

Grant support. See Appendix C, Section 6.

Background and rationale.

Extension Methods. During 2005, the Every Step Counts project team focused determining the feasibility of an adaptation of a pedometer-based physical activity intervention that could be integrated as a supplement into existing nutrition education materials. The objective was to test the Every Step Counts lessons in conjunctions with existing nutrition curriculum at four county sites, including one youth site. The target audience was Youth FSNEP and Adult FSNEP participants.

My role. I collaborated with other members of the project team on planning and designing the Every Step Counts materials. I administered and supervised staff that tested the Adult component of the project.

Results. Thirty-one low-income adults participated from four counties (Kern, Shasta, Solano and San Joaquin) and 264 low-income youth from Shasta County. The results for the youth feasibility study show that for all areas we had a positive outcome. The biggest change in barriers was “perceptions of convenience”. Students were able to use the step counters successfully, and felt that the information

presented was useful and easy to understand. Overall, programmatic feasibility was rated successful. The results of the adult effectiveness study show a positive outcome as well. The greatest change in scores was seen for perceptions of feeling better when exercising and for having more energy when exercising. As shown in the graph to the left, on average, over the course of 3 weeks, the number of steps increased by 21,294 steps per week per client. This is a 58% increase in the average number of steps taken weekly.

Impact: Although the sample size is small, the results of this project show a substantial increase in physical activity behaviors using the Every Step Counts program with step counters. Physical activity behaviors were favorably

changed by the program. The minimal cost and time necessary to integrate this program into existing nutrition education efforts appears to be a feasible and positive option. The Every Step Counts program materials will be sent to the joint youth curriculum committee and adult curriculum committee to review for final approval by FSNEP. Once approved, the materials will be sent to print, and copies will be mailed to county offices for integration into existing nutrition education courses.

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