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The SNAP-Ed Evaluation Framework offers a new suite of evaluation measures toward eliminating disparities that contribute to poor diet, physical inactivity, food insecurity and obesity., The United States Department of Agriculture’s Supplemental Nutrition Assistance Program Education, known as SNAP-Ed, is the country’s largest and most diverse community nutrition program. In 2017, nearly 140 SNAP-Ed implementing agencies (SIAs) and hundreds of contractors delivered nutrition education to almost 5 million people in nearly 60,000 low-resource sites. Millions more were impacted with social marketing campaigns and policy, systems, and environmental changes. This article introduces and describes the benefits of the newly developed SNAP-Ed Evaluation Framework (Framework) and companion Interpretive Guide to consistently measure SNAP-Ed outcomes across different settings. The Framework uses the social ecological model as its underlying theory and features 51 indicators across four levels: Individual, Environmental Supports, Sectors of Influence, and Population Results. Topline findings from the first-year Census to track Framework adoption found that most SIAs intended to impact indicators closer to the inner levels of influence: Individual (mean = 59% of SIAs; SD = 22%) and Environmental Settings (mean = 48%; SD = 23%). As yet, few SIAs targeted outcomes for long-term indicators (mean = 26%; SD = 15%), Sectors of Influence (mean = 20%; SD = 12%), or Population Results (mean = 30%; SD = 11%). An in-depth example of how one state is using the Framework is described. The SNAP-Ed Evaluation Framework offers a new suite of evaluation measures toward eliminating disparities that contribute to poor diet, physical inactivity, food insecurity and obesity. Practitioners will need technical assistance to implement the Framework, especially to measure longer-term, multi-sector and population results, and to maximize effectiveness in SNAP-Ed.

Objective Consumption of sugar-sweetened beverages (SSB) is linked to obesity. The authors hypothesized that school-based nutrition education would decrease SSB consumption. Design Self-selected interventional cohort with random selection for pre and post measurements. Setting Arizona Supplemental Nutrition Assistance Program–Education Program–eligible schools. Participants Randomly selected (9%) fourth- and fifth-grade classroom students. Intervention The University of Arizona Nutrition Network provided general nutrition education training and materials to teachers, to be delivered to their students. The University of Arizona Nutrition Network administered behavioral questionnaires to students in both fall and spring. Main Outcome Measure(s) Change in SSB consumption. Analyses Descriptive statistics were computed for student demographics and beverage consumption on the day before testing. Paired t tests evaluated change in classroom averages. Linear regression assessed potential correlates of SSB consumption. Results Fall mean SSB consumption was 1.1 (± 0.2) times; mean milk and water intake were 1.6 (± 0.2) and 5.2 (± 0.7) times, respectively. Beverage consumption increased (3.2%) in springtime, with increased SSBs (14.4%) accounting for the majority (P = .006). Change in SSB consumption was negatively associated with baseline SSB and water consumption but positively associated with baseline milk fat (P ≤ .05). Conclusions and Implications The results suggest the need for beverage-specific education to encourage children to consume more healthful beverages in warmer weather.

BACKGROUND In 2016, the United States Department of Agriculture issued a final rule to strengthen local wellness policies (LWPs). As school districts pursue compliance, states can provide critical guidance by leveraging support from intermediary programs such as the Supplemental Nutrition Assistance Program-Education (SNAP-Ed). After Arizona SNAP-Ed piloted a statewide model for assessing LWPs, we evaluated that model by exploring local SNAP-Ed agency experiences with the pilot. Our case study objectives were to determine the model's feasibility and utility from the perspective of local agencies supporting school districts during LWP review and revision. METHODS We used open-ended semistructured interviews with the 13 local SNAP-Ed agencies who engaged in each LWP assessment phase and analyzed data using constant comparative analysis. RESULTS Participants found the model feasible and useful. Five themes emerged, 3 of which tracked strongly with successful LWP review and revision: local agency staff comprehension, the openness of local agency staff and district/school personnel to the process, and the local agency's engagement of the district/school throughout the process. CONCLUSIONS Leveraging local agency support can be an effective strategy to improving LWPs, given understanding, buy-in, and staff engagement. Findings can inform agencies seeking to engage intermediaries in LWP assessment and revision.

To assess the reliability of the Kids' Activity and Nutrition Questionnaire (KAN-Q) as part of a tiered process for developing Supplemental Nutrition Assistance Program-Education tools.The KAN-Q was administered at 2 time points to assess internal consistency using standardized values of Cronbach α and test-retest reliability using the intraclass correlation coefficient for continuous variables, Cohen's kappa (κ) statistic for categorical variables, and the weighted κ statistic for ordinal data.Data were collected from 119 fourth graders. Cronbach α was adequate for behavior (.71) and knowledge (.72) scales and nutrition behavior (.78) and nutrition knowledge (.75) subscales. Test-retest reliability was generally acceptable, with intraclass correlation coefficients from 0.40 to 0.75 and κ coefficients showing fair to substantial agreement (0.30 to 0.72).The KAN-Q is a practical and reliable questionnaire for school-based administration that aligns directly with Supplemental Nutrition Assistance Program-Education evaluation priorities.

Despite the widespread availability of oral rehydration therapy, diarrheal illness remains a major cause of morbidity and mortality around the world. Previous studies have shown individualized homeopathic therapy to be effective in treating childhood diarrhea, but this approach requires specialized training.A homeopathic combination medicine, if effective, could be used by health personnel on a widespread basis.A double-blind randomized controlled trial was conducted in Honduras to evaluate the effectiveness of a homeopathic combination therapy to treat acute diarrhea in children. A total of 292 children with acute diarrhea was recruited; 145 were randomized to the experimental group and 147 to the placebo group. Tablets containing a combined preparation of the five most common single homeopathic remedies used to treat diarrhea or placebo were administered by a parent after each unformed stool. Children were followed up daily for 7 days or until symptoms resolved, whichever occurred first. Time until resolution of symptoms, daily rate of unformed stools, and total number of unformed stools were compared between the two groups.There was no significant difference in the likelihood of resolution of diarrheal symptoms between the treatment and placebo groups (hazard ratio = 1.02, 95% confidence interval: 0.79-1.32), with a median time until resolution of 3 days for both groups. Children in the treatment group had an average of 2.6 unformed stools per day compared to 2.8 among those in the placebo group; this difference was not significant (p = 0.43). The median number of unformed stools was 7 among children in the treatment group and 8 among those in the placebo group (p = 0.41).The homeopathic combination therapy tested in this study did not significantly reduce the duration or severity of acute diarrhea in Honduran children. Further study is needed to develop affordable and effective methods of using homeopathy to reduce the global burden of childhood diarrhea.

Objectives. Using a mixed-method, participatory research approach, we investigated factors related to community health worker (CHW) community advocacy that affect social determinants of health. Methods. We used cross-sectional survey data for 371 CHWs to assess demographics, training, work environment, and leadership qualities on civic, political, and organizational advocacy. We present advocacy stories to further articulate CHW activities. The data reported are from the recently completed National Community Health Workers Advocacy Study. Results. CHWs are involved in advocacy that is community-focused, although advocacy differs by intrinsic leadership, experience, training, and work environment. We propose a framework to conceptualize, support, and evaluate CHW advocacy and the iterative processes they engage in. These processes create opportunities for community voice and action to affect social and structural conditions that are known to have wide-ranging health effects on communities. Conclusions. The framework presented may have utility for CHWs, their training programs, and their employers as well as funders and policymakers aiming to promote health equity.

Objective: To measure change in sugary beverage consumption with nutrition education among low-income 4th and 5th graders. Theory, Prior Research, Rationale: Fifteen percent of US children aged 6 to 11 years are overweight, with an additional 30% at risk. Sugary beverage consumption is linked to obesity and US Dietary Guidelines recommend limiting intake. We hypothesized that nutrition education would result in decreased sugary beverage consumption. Study Design, Setting, Participants, and Intervention: The University of Arizona Nutrition Network (UANN) provides general nutrition education training and materials, aligned with USDA guidelines, to teachers at SNAP-Ed eligible schools. UANN administered self-report behavioral questionnaires to students in 8% of participating 4th and 5th grade classrooms in 5 Arizona counties in both Fall and Spring. Outcome, Measures and Analysis: Descriptive statistics were computed for student demographics and beverage consumption on the prior day. Paired t-tests were used to evaluate change in classroom averages between Fall and Spring. Results: Thirty-three classrooms participated (N1⁄4770 pre, 765 post, 90% complete surveys). Participant characteristics: 71% 4th graders, 50.5% female, 10.1 years of age. Fall sugary beverage consumption was 1.05 ( 0.23) times the previous day; milk and water were consumed 1.58 ( 0.24) and 5.20 ( 0.70) times, respectively. As expected, Arizona springtime beverage consumption increased overall (3.2%). Sugary beverage consumption increased 14.4% and accounted for the greatest portion of the total increase (p1⁄40.006). Small increases in milk (p1⁄40.03) and water (p1⁄40.86) were observed. Conclusions and Implications: This study suggests the need for beverage specific education to shift the children toward more healthful choices. Further research is needed to assess beverage consumption patterns longitudinally, controlling for season. Funding: Supplemental Nutrition Assistance Program Education.