Abstract
Objective
To assess whether the Expanded Food and Nutrition Education Program (EFNEP) is a cost-effective nutrition education intervention that generates sustained improvement in chronic disease biomarkers.
Description
Research efforts focused on data collection, data integrity, and preliminary analyses. Data collection for the baseline, postintervention, and 6-month postintervention time points has been completed, whereas data will be collected for the 12-month postintervention time point will be completed in June 2026. After data entry, migration and quality checks, analyses began, focusing on the impact of EFNEP on biomarkers from preintervention to 6 months postintervention and study retention. Preliminary findings were disseminated through the Journal of Nutrition Education and Behavior and Society for Nutrition Education and Behavior presentations. Manuscript drafting is also in progress. Education efforts included the completion of a master’s thesis.
Evaluation
The sample consists of 472 participants (246 intervention and 226 control). Multilevel models were used to evaluate the impact of EFNEP from baseline to 6 months postintervention on body mass index, systolic and diastolic blood pressure, and hemoglobin A1c. Preliminary analyses rely on listwise deletion of missing data, which dropped the active analytic sample size significantly below the baseline threshold, and do not include confounding factors. Comparing the intervention to the control group established neither the presence nor the direction of any program effects on any of the biomarkers. Retention analysis, currently being evaluated by intervention and program factors, shows a retention rate of 80% at postintervention, 60% at 6 months postintervention, and 51% at 6 months postintervention.
Conclusions and Implications
Preliminary 6-month findings do not indicate a measurable EFNEP treatment effect on biomarkers of chronic disease risk. While these metrics are intermediate, 12-month postintervention data analysis will assess whether longer follow-up periods may be needed to fully capture the effects of EFNEP participation on physiological outcomes. These initial estimates are also limited by a substantial loss of statistical power because of missing participant data, which likely yields biased estimates because the missingness is not completely random. Future final analyses will continue using multilevel modeling alongside advanced missing data estimation techniques to correct for potential biases, incorporate key confounding factors, and account for site-level variations to estimate EFNEP’s impact on biomarkers of chronic disease risk.