Abstract
Background
The Expanded Food and Nutrition Education Program (EFNEP)’s return on investment has been examined several times over the years, and benefit-cost ratio estimates range from $3.62 to $12.50 in benefits for every $1.00 spent. Recent studies have estimated benefit-cost ratios using participant biomarkers, which are beyond most programs’ capacity to collect. Cost-benefit analysis methods have yet to be conducted using EFNEP’s current evaluation measures, particularly the Adult Questionnaire.
Objective
Identify optimal nutrition behaviors for cardiometabolic health, using routine EFNEP evaluation indicators, to inform a program cost-benefit analysis.
Study Design, Setting, Participants
Five cardiometabolic diseases were included for the cost profile: heart disease, stroke, hypertension, type 2 diabetes, and obesity. We elicited prevention guidelines from relevant national organizations (e.g., American Heart Association) to identify optimal nutrition behaviors. When no specific consumption amounts were recommended, we defaulted to the 2020–2025 Dietary Guidelines for Americans 2000-kcal US-style healthy dietary pattern.
Measurable Outcome/Analysis
We compared prevention guidelines to relevant indicators measured by the EFNEP 24-hour dietary recall and the EFNEP Adult Questionnaire. We then codified the chosen behaviors in a Microsoft Excel matrix.
Results
For each cardiometabolic disease, we identified 12–16 preventative behaviors measured by dietary recall and 5–11 preventative behaviors measured by the EFNEP Adult Questionnaire. Preventative behaviors consistent across all 5 diseases were increased fruit, vegetable, dairy, and whole grain consumption; decreased alcohol and sodium consumption; and increased cardiovascular exercise. Cardiovascular conditions (heart disease, stroke, hypertension) had multiple guidelines and position statements with specific food group and nutrient recommendations, whereas metabolic conditions (diabetes and obesity) relied mostly on recommendations from the Dietary Guidelines for Americans.
Conclusions
These optimal nutrition behaviors will inform the cost-benefit model to estimate EFNEP’s impact on health care cost savings related to cardiometabolic diseases. The next steps are to analyze the distributions of these behaviors among a national EFNEP sample to determine cutoff points and to calculate nationally applicable models based on a reference EFNEP participant (i.e., a woman of reproductive age).