Hunger Free & Healthy Pilot Year Outcome Evaluation Report Submitted by: Emily F. Rothman, ScD Allyson Baughman, MPH Abstract In January of 2008, the Worcester Advisory Food Policy Council received funding from The Health Foundation of Central Massachusetts to pilot test a local initiative called the Hunger-Free and Healthy program over the course of one year. The primary goal of the program was to decrease the proportion of households experiencing hunger in Worcester, MA. The program’s secondary goals included improving access to food stamps, health care, and fresh nutritional foods, increasing the financial and budgeting practices of participants, and improving the self-reported general health status of the target population. The impact of the Hunger-Free and Healthy program was evaluated by a team from the Boston University School of Public Health. The evaluation used a pre-experimental, one group pre-/post-test design, and supplemented quantitative data collection with qualitative data from participants at the project mid-point. This report provides detailed information about the quantitative data collection methods and analysis, and summarizes key findings. Our analysis of the self-reported pre-/post-test data suggests that the Hunger Free and Healthy program may have had a positive impact on participants’ level of food insecurity, receipt of food stamps, knowledge and enjoyment of cooking, confidence about their level of personal financial fitness, consumption of vegetables, and knowledge about the affordability of organic fruit and vegetables. We were unable to detect an impact on participants’ use of food pantries, preparation of nutritious meals for their families, food shopping cost reduction practices, money management behaviors, and understanding of the link between healthy eating, body weight, and disease prevention. It is possible that changes occurred on these items, but we were unable to detect the changes. Key findings: • At pre-test, 27% (6) of participants reported that in the prior three months, members of their households sometimes did not have enough to eat. After the intervention, only 9% (2) reported the same. • Approximately half (55%, n=12) of participants were receiving food stamps at pre-test, and by post-test two additional participants reported receiving them (64%, n=14). • There was a statistically significant increase in the proportion of participants who reported feeling “very good” about their level of personal financial fitness from pre-test (5%) to post-test (23%) (Fisher’s exact, p<.10). • At post-test, participants were less likely to report having overdrawn their bank account in the preceding three months as they were at Page | 1 pre-test (72% vs. 59%, ns), were almost three times as likely to report that they could provide for their needs if they lost their source of income for three or more months (14% vs. 5%, ns), and substantially more likely to report feeling “completely at ease” about their ability to meet future debts and expenses (18% vs. 0%, Fisher’s exact, p<.10). • Half as many participants reported that they “never made written spending plans or budgets” at post-test as at pre-test (18% vs. 36%, ns). Otherwise, no substantial changes in money management were detected. • Participants were substantially less likely to endorse the statement “I cannot cook” at post-test as compared to pre-test (0% vs. 9%, ns), “I do not like to cook” (9% to 5%, ns), and “I don’t know how to follow a recipe (0% vs. 9%, ns). In addition, participants were approximately half as likely to agree with the statement “I don’t know what foods are good for me and my family” at post-test as compared to pre-test (14% vs. 27%, ns). • We observed a substantial increase in the proportion of participants reporting that they ate enough vegetables for their health from preto post-test (45% to 72%, Fisher’s exact p<.10). Future efforts should consider how to translate new knowledge about nutrition and personal finance management into skills that are used consistently and correctly at home, how to broaden the impact of the intervention by reaching a larger number of Worcester residents, and how to ensure that food stamp registration assistance remains a cost-effective intervention component. Page | 2 Background and Purpose There is a need to reduce hunger (i.e., food insecurity) and to improve nutrition among residents of Worcester, MA. The prevalence of hunger in Worcester, MA, is approximately 6 times the Massachusetts average [1]. In 14 low-income neighborhoods in Worcester, one child in three lives in a family unable to meet its basic need for food [1]. Moreover, in 2006, 24.2% of Worcester residents were obese (body mass index >30) as compared to 20.3% of Massachusetts residents overall [2]. In January of 2008, the Worcester Advisory Food Policy Council received funding from the Health Foundation of Central Massachusetts to pilot test a local initiative called the Hunger-Free and Healthy program over the course of one year. The primary goal of the program was to decrease the proportion of households experiencing hunger in Worcester, MA. The program’s secondary goals included improving access to food stamps, health care, and fresh nutritional foods, increasing the financial and budgeting practices of participants, and improving the self-reported general health status of the target population. The program comprised a variety of components, including offering a variety of multi-session classes at no cost to participants (e.g., cooking/nutrition, personal economics, English for Speakers of Other Languages (ESOL), General Education Development (GED), and gardening), making available case management and Food Stamp and health care application assistance, hunger screenings at a health center, advocacy work, and providing deliveries of fruits and vegetables during the summer. The impact of the Hunger-Free and Healthy program was evaluated by a team from the Boston University School of Public Health. The evaluation used a pre-experimental, one group pre-/post-test design, and supplemented this quantitative data collection with qualitative data from participants at the project mid-point. This report provides detailed information about the quantitative data collection methods and analysis, and summarizes key findings. Methods Study design The outcome evaluation used a pre-experimental, one group pre- and post-test design to assess changes in food insecurity status, and nutrition- and personal economics-related knowledge, attitudes, behavior among participants. Quantitative data was supplemented with qualitative data collected via two focus groups. The results of the qualitative data analysis are available separately. Sample The evaluation study sample was drawn from participants in the 2008 Hunger-Free and Healthy intervention. To recruit participants in the intervention, recruitment flyers were posted at area food banks, community health centers, Page | 3 and schools in February and March 2008. Interested participants called the project coordinator (Ms. Christa Drew), and were screened on the phone for eligibility. Those who were eligible were invited to meet Ms. Drew for a program intake appointment. Pre-test data was collected at program intake, and post-test data was collected at a follow-up appointment in August 2008. In total, 64 individuals completed eligibility surveys, 39 completed pre-tests, and 22 completed both pre- and post-tests. This analysis is restricted to the 22 individuals on whom we have complete data. The 22 individuals who completed both pre- and post-test were mostly female (91%), Non-Hispanic (59%), English-speaking (55%), US citizens (77%), unmarried (55%), and unemployed (52%) (Table 1). At pre-test, the mean average monthly household income was $1275 and 68% reported that they lived with children less than 18 years old. Calculated body mass index revealed that 39% were obese and an additional 39% overweight at the post-test assessment (Table 1). At both pre-test and post-test, participants reported spending an average of $400 per month on food at supermarkets, and approximately an additional $50 per month at specialty markets (Table 19). Measures An identical survey was implemented prior to the intervention (“pre-test”) and after the intervention (“post-test”) in order to assess participants’ status on outcomes of interest at both time points. The complete survey took participants approximately 60 minutes to complete. The survey comprised 16 different instruments, including measures of: food security, benefits, barriers to making healthy food choices, food preparer’s nutrition concerns and meal planning practices, cost reduction practices, family resource management, financial fitness, access, affordability, and motivation to eat fruits and vegetables, diet and health knowledge, and food stamp participation, personal financial practices, household food purchasing practices, and demographics. Food security was assessed using a combination of items from the short form of the USDA food security module and original items [3]. For example, participants were asked, ”Which of these statements best describes the food eaten in your household in the last 3 months- enough of the kinds of food we want to eat; enough but not always the kinds of food we want to eat; sometimes not enough to eat; often not enough to eat?” Another question asked participants about their family’s utilization of food pantries. Benefits including income, food stamps, WIC vouchers, and school breakfast and lunch programs were measured by a 20-item USDA survey. Reliability and validity are not available for this instrument. Healthy food choices were assessed via an unpublished tool [4]. Participants were read 13 statements such as, “I don’t know what food are good for me and my family,” and “I do not have enough time to cook healthy meals”, Page | 4 and asked to report which were true for them. Reliability and validity are not available for this instrument. Food preparer’s practices were assessed using two instruments: Food Preparer’s Nutrition Concern and Meal Planning Practices, and Food Preparer’s Cost Reduction Practices [5]. The respective 5 and 4 item tools, assess concerns and practices using a 4-point Likert scale (1-strongly agree, 2-somewhat agree, 3-somewhat disagree, 4-strongly disagree). Example statements include, “I frequently worry about whether the meals I serve are really nourishing”, and “I save a lot of money by shopping around for food bargains”. Reliability and validity are not available for this instrument. Family resource management was assessed with questions from a USDA survey instrument. Participants were asked about how they usually manage their resources (e.g., “How often do your have bills that are overdue?”, “How often do you use a written spending plan or budget?”) and the responses ranged from 0-4 (0-do not do, 1-seldom, 2-sometimes, 3-most of the time, 4-almost always). Reliability and validity are not available for this instrument. Financial fitness was measured with an 8-item original instrument. Questions were asked about credit cards, bank, accounts, overall financial situation, and providing for basic needs in the event of loss of income. Reliability and validity are not available for this instrument. The Access, Affordability, and Motivation to Eat Fruits and Vegetables Scale was used to assess participants’ attitudes and behavior towards eating fruits and vegetables [6]. This device is divided up into five sections: Choice, Health, Affordability, Organic, and Transport. Participants were asked to respond to each item using a Likert scale from 0-6 (1-strongly disagree, 6-strongly agree, with 0-neither agree nor disagree). An example item in the Choice section is, “Where I shop has a wide choice of fresh vegetables” (Cronbach’s α=0.87). An example in the Health section is, “I eat enough vegetables for my health” (Cronbach’s α= 0.83). An example of an item in the Affordability section is, “I would consider cutting out foods I normally eat to eat more vegetables” (Cronbach’s α= 0.85). An example in the Organic section is, “I would like to eat more organic vegetables” (Cronbach’s α= 0.98). Finally an example item for the Transport section is, “I often use taxis to get my shopping home” (Cronbach’s α= 0.55). Attitudes and knowledge about food and nutrition: The USDA’s Diet and Health Knowledge Survey Questionnaire was used to assess attitudes and knowledge about food and nutrition, food safety, taste, and price, and healthy food substitutions [7]. This 3-item instrument uses Likert scales of various lengths depending on the item. Reliability and validity are not available for this instrument. Page | 5 Food shopping practices: The USDA’s What We Eat in America: 19941996 Household Survey was used to assess the general food shopping practice of participants’ households [8]. This 7-item instrument asked questions such as, “On average, how often does someone do a major food shopping for this household?”. Questions about the amount of money spent on food were also asked (e.g., “During the last 3 months, how much money has this household spend per week or per month at fast food or carryout places when the food was brought into your home?”). Reliability and validity are not available for this instrument. Data Collection The evaluation protocols were reviewed and approved by the Boston University School of Public Health (BUSPH) Institutional Review Board (IRB). Data were collected in person by a trained, master’s level research assistant. . Intervention participants completed a 126-item pre-test survey in March 2008. The 113-item post-test assessment took place approximately five months later (August 2008). The procedure was as follows: at the appointment for program enrollment, the research assistant provided each participant with a written consent form in either English or Spanish, and an explanation of the survey procedure. Once consent was obtained, the research assistant administered the pre-test survey to each participant (i.e., reading each question and response option aloud) in a private setting. Both the pre- and post-test surveys took approximately one hour to complete. Completed surveys were transported back to BUSPH by the research assistant where they were cleaned and hand-entered into a database. Statistical analysis Data were cleaned, coded and analyzed by the research assistant. Frequencies, proportions and means were calculated using STATA 10.0 software. Chi-square, fisher’s exact and t-tests were conducted to assess differences in proportions and means, respectively. Results Food Security Before the intervention, 61% of participants qualified as “food insecure” according to the USDA criteria [3]. At pre-test, 27% (6) of participants reported that in the prior three months, members of their households sometimes did not have enough to eat. After the intervention, only 9% (2) reported the same (Table 2). While the difference between these two statistics (27% vs. 9%) did not reach statistical significance due to the small sample size, we note that the risk for food insecurity reported before the intervention was three times what it was after the program was implemented. At pre-test, participants who had experienced hunger in the preceding three months reported that they had not had enough money to buy food on 12 days (on average) during that period, whereas at postPage | 6 test, participants who had experienced hunger in the preceding three months reported not having had enough money to buy food on 2 days (on average) (Table 2) (t-test, p<.05). The primary reasons given for not having enough food to eat both before and after the intervention were not having enough money (including food stamps) to buy it, and having transportation problems (Table 2). Both before and after the intervention, the proportion of participants who reported using a food pantry one or more times in the preceding month was 32% (Table 2). Receipt of food stamps and AFDC Approximately half (55%, n=12) of participants were receiving food stamps at pre-test, and by post-test two additional participants reported receiving them (64%, n=14) (Table 3). The number of participants receiving AFDC payments did not change from pre- to post-test (Table 3). Personal Financial Fitness There was a statistically significant increase in the proportion of participants who reported feeling “very good” about their level of personal financial fitness from pre-test (5%) to post-test (23%) (Fisher’s exact, p<.10)(Table 9). At post-test, participants were less likely to report having overdrawn their bank account in the preceding three months as they were at pretest (72% vs. 59%, ns), were almost three times as likely to report that they could provide for their needs if they lost their source of income for three or more months (14% vs. 5%, ns), and substantially more likely to report feeling “completely at ease” about their ability to meet future debts and expenses (18% vs. 0%, Fisher’s exact, p<.10) (Table 9). Participants were also more likely to report having reached the maximum limit on one of their credit cards during the preceding three months at post-test than they were at pre-test (40% vs. 12%, ns) (Table 9). We also observed one positive change in participants’ self-reported money management; half as many participants reported that they never made written spending plans or budgets at post-test as at pre-test (18% vs. 36%, ns) (Table 8). Otherwise, no substantial changes in money management were detected (Table 8). Attitudes and Behaviors related to Cooking, Food and Nutrition Several indicators suggest that participants learned how to cook, increased their enjoyment of cooking, and learned how to cook more healthily. Participants were substantially less likely to endorse the statement “I cannot cook” at post-test as compared to pre-test (0% vs. 9%, ns), “I do not like to cook” (9% to 5%, ns), and “I don’t know how to follow a recipe (0% vs. 9%, ns) (Table 4). In addition, participants were approximately half as likely to agree with the statement “I don’t know what foods are good for me and my family” at post-test as compared to pre-test (14% vs. 27%, ns) (Table 4). Participants’ meal planning practices appear not to have changed substantially during the intervention period (Table 5). While there was a minor increase in the proportion of participants who indicated that they make a Page | 7 complete list before going food shopping (a positive meal planning behavior), from 50% to 63%, there were no other changes observed in cost reduction practices related to food shopping (Table 6). Motivation to Eat Fruits and Vegetables While few participants reported that fruits and vegetables were affordable to them at either pre-test or post-test (~40-50%), we observed a substantial increase in the proportion of participants reporting that they ate enough vegetables for their health from pre- to post-test (45% to 72%, Fisher’s exact p<.10) (Table 10). We also observed positive change in the proportions of participants reporting that they ate healthily (from 50% to 64%, ns), that a lack of funds prevented them from eating healthily (from 3% to 32%, ns), and reporting that they could not afford to buy organic fruits or vegetables (from 55% to 27%, ns) (Table 10). However, despite feeling like they could afford them, there were no substantial changes in the proportions of participants who indicated that they would like to eat more organic fruit or vegetables, or that they enjoy eating fruits or vegetables in general (Table 10). Attitudes about nutritional eating Participant responses to the “Ideas About What People Eat” assessment (see Table 12) indicated some confusion related to nutritional advice. For example, the proportion of respondents who strongly agreed with the statement “Some people are born to be fat and some thin; there is not much you can do to change this,” increased from 14% to 18% from pre- to post-test (Table 12). The proportion of respondents who strongly agreed with the statement “There are so many recommendations about healthy ways to eat, it’s hard to know what to believe,” also increased from 24% to 32% (Table 12). Meanwhile, the proportion who strongly agreed with the statement “What you eat can make a big difference in your chance of getting a disease, like heart disease or cancer,” did not change at all (45% at both assessments). Discussion The Hunger Free and Healthy program may have had a positive impact on participants’ level of food insecurity, receipt of food stamps, knowledge and enjoyment of cooking, confidence about their level of personal financial fitness, consumption of vegetables, and knowledge about the affordability of organic fruit and vegetables. From these data, we were unable to detect an impact on participants’ use of food pantries, preparation of nutritious meals for their families, food shopping cost reduction practices, money management behaviors, and understanding of the link between healthy eating, body weight, and disease prevention. From these results, we suspect that the aspects of the program that had the most impact on participants was the “Eating Right” cooking and nutrition class, the farm fresh produce basket deliveries during the summer months, Page | 8 and—to a limited extent—the personal economics class. We observed a change in participants’ feelings about their financial health, but few changes in their selfreported money management practices and a slight increase in the proportion who had spent up to the maximum limit on their credit cards during the intervention period. Therefore, it is possible that the class provided participants with knowledge and confidence, but not the skills to change their behavior. Alternately, it is possible that there was insufficient time during the project period for participants to put into practice what they had learned in the personal finance course, and that behavior changes would have been observed had the follow-up period been longer. Among these 22 participants, only 2 appear to have signed up for food stamps during the course of the intervention. Given that a certain percent of intervention resources were spent on food stamp registration assistance and advocacy, the expectation was that more participants would have registered as a result of the project. The reasons why few reported registering are unclear; it may be that only a small subset of program participants were eligible and not already receiving food stamps. At baseline 64% of participants (n=14) reported that in the preceding three months someone in their household had received food stamps, and 55% (n=12) reported that they were receiving them at the time. The eligibility of the remaining 8-10 participants is unknown. Although participants’ enjoyment and knowledge of cooking appears to have increased during the intervention period, it is not clear that all were able to translate their acquired knowledge into practice (although qualitative data findings suggest that at least some did so). Participants did not report that they prepared healthier meals for their families subsequent to the intervention, nor that they wished to purchase more fruits and vegetables. One possibility is that the class was successful in engaging their interest in cooking, but fell just short of giving them the tools to implement new behaviors at home consistently. In addition, it appears that the “Eating Right” class may not have been able to counter some misperceptions about nutrition for all participants—14% did not understand that healthy eating can reduce risk for cancer and heart disease, 27% did not understand that starchy foods contribute to overweight and obesity, and 73% felt that there are so many different recommendations about healthy eating that it’s hard to know what to believe, at the end of the class. One of the most striking findings of this evaluation was that the proportion of participants reporting that they ate enough vegetables for their health increased from 45% to 72% during the intervention period. While it is possible that their vegetable consumption remained the same, and their understanding of how many servings of vegetables they needed to eat “for their health” changed (i.e., the survey question was not interpreted the same way at both assessments), it seems more likely that vegetable consumption actually increased due to the farm fresh produce basket deliveries that were made by the program. In part, this assumption is based on the qualitative data which revealed Page | 9 that the participants were enthusiastic about the deliveries (see accompanying focus group report). Moving forward, it will be important for program planners to determine whether produce basket deliveries are a sustainable program component. Limitations This outcome evaluation is limited by several factors. First, the preexperimental (one group, pre-/post-test) design does not permit us to make inferences about whether the intervention caused the changes that we observed. The lack of a control or comparison groups makes it impossible to determine whether changes were due to the intervention or to another factor such as statewide policy changes, economic conditions, or new federal programs. However, given that we are aware of no new state or federal policies, programs or conditions that arose during the intervention period, the likelihood that observed changes were due to these factors seems unlikely. Second, only a subset of participants provided us with data at both pretest and post-test assessments (n=22). There is a chance that the individuals who remained in the program differed in important ways from those who dropped out, which might have influenced our results (e.g., making them appear more positive or more negative). To assess the likelihood of this threat to the validity of our results, we assessed differences between “dropouts” and “completers” on demographic variables. Dropouts were slightly less likely than completers to be White or employed, but the differences were not statistically significant. Given the similarities between those who completed both rounds of data collection and those who completed only one round on demographic characteristics, we feel some confidence that the results presented were not highly subject to bias due to attrition. Third, the primary goal of the Hunger Free and Healthy program is to reduce hunger (i.e., food insecurity) in Worcester. Because the program (and thus, the outcome evaluation) relied upon participants’ voluntary enrollment, it is possible that the program would affect only those individuals who are predisposed to join such programs, and would not have as substantial an impact on neighborhoods or the city as a whole. Future implementation and evaluation efforts should consider whether the intervention is reaching its intended audience. Conclusions To the extent that we are able to make a determination based on the selfreported data that we collected from a small number of participants using a preexperimental evaluation design, the Hunger Free and Healthy program successfully accomplished its primary goal of reducing hunger among intervention participants. We believe that the program also may have Page | 10 accomplished secondary goals of improving access to farm fresh produce, and teaching participants about cooking, nutrition, and personal economics. Future efforts should consider how to translate new knowledge about nutrition and personal finance management into skills that are used consistently and correctly at home, how to broaden the impact of the intervention by reaching a larger number of Worcester residents, and how to ensure that food stamp registration assistance remains a cost-effective intervention component. Page | 11 REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. Project Bread, Status Report on Hunger in Massachusetts. 2006, Project Bread: Boston, MA. Massachusetts Department of Public Health, A Profile of Health Among Massachusetts Adults, 2006. 2006, Massachusetts Department of Public Health: Boston, MA. p. 48-50. Bickel, G., et al., Guide to Measuring Household Food Security. March 2000, US Dept of Agriculture, Food and Nutrition Service: Alexandria, VA. Sargent, D., Evaluation of two nutrition education programs: the Expanded Food and Nutrition Education Program (EFNEP) and Out for Lunch (OFL). 2006, North Carolina State University. Dinkins, J., Food preparers: their food budgeting, cost-cutting, and meal planning practices. Family Economics and Nutrition Review, 1997. 10: p. 34-37. Dibsdall, L., et al., Low-income consumer's attitudes and behaviour towards access, availability, and motivation to eat fruits and vegetables. Public Health Nutrition, 2002. 6: p. 159-168. US Department of Agriculture, A.R.S., Diet and Health Knowledge Survey. 1994-1996, USDA, Beltsville Health and Nutrition Research Center, Food Surveys Research Group: Beltsville, MD. US Department of Agriculture, A.R.S., What We Eat in America 19941996 Household Questionnaire. 1996: Beltsville, MD. Page | 12 Table 1. Demographics (N=44) % (n) Baseline 100% (22) % (n) Post-test 100% (22) 41 (22-62) 41 (22-62) 9% (2) 91% (20) 9% (2) 91% (20) 9% (2) 0% (0) 5% (1) 0% (0) 68% (16) 14% (3) 9% (2) 0% (0) 5% (1) 0% (0) 68% (16) 14% (3) 41% (9) 59% (13) 41% (9) 59% (13) 0% (0) 11% (1) 0% (0) 33% (3) 0% (0) 33% (3) 0% (0) 0% (0) 0% (0) 11% (1) 0% (0) 33% (3) 0% (0) 33% (3) 0% (0) 0% (0) 18% (4) 32% (7) 0% (0) 14% (3) 23% (5) 9% (2) 27% (6) 32% (7) 0% (0) 9% (2) 27% (6) 5% (1) US Citizen Yes No No response 77% (17) 18% (4) 5% (1) 77% (17) 18% (4) 5% (1) Currently Married Yes No No response 41% (9) 55% (12) 5% (1) 41% (9) 55% (12) 5% (1) Primary Language English Spanish Other 55% (12) 41% (9) 5% (1) 55% (12) 41% (9) 5% (1) Total Age (mean and range) Sex Male Female Race Black or African American Asian Native Hawaiian or Pacific Islander Alaska Native White American Indian Hispanic Yes No Ethnicity of Hispanic participants Brazilian Central American Cuban Dominican Mexican Puerto Rican South American Other Education Some high school High school diploma or equivalent (GED) Some VOC/Tech training VOC/Tech diploma Some college College graduate Page | 13 Table 1. (continued) Total Employment Status Unemployed Employed Number of people in household (HH) (mean average and range) % (n) Baseline 100% (22) % (n) Post-test 100% (22) 50% (11) 50% (11) 45% (10) 55% (12) 3.5 (1-7) Number of Children who attend Elm Park or Chandler School (mean average and range) Self-reported Health Excellent Very good Good Fair Poor Height (lbs.)(mean average and range) Weight (ft./inches)(mean average and range) BMI (mean average and range) Underweight (BMI<18.5) Normal weight (BMI 18.5-24.9) Overweight (BMI 25-29.9) Obese (BMI >30) - 9% (2) 27% (6) 45% (10) 14% (3) 5% (1) 168 (106-275) 5’4” (4’9”-5’9”) 28 (21-40) 0% (0) 32% (7) 36% (8) 27% (6) 173 (110-278) 5’4” (4’9”-5’9”) 29 (22-42) 0% (0) 32% (7) 36% (8) 32% (7) Health Care Coverage Yes No No response 95% (21) 5% (1) 0% (0) - Last Checkup Within past year Within past 2 years Within past 5 years 5 or more years No response 86% (19) 5% (1) 0% (0) 9% (2) 0% (0) - Zip code 01603 01604 01605 01606 01609 01610 5% (1) 5% (1) 9% (2) 5% (1) 77% (17) 0% (0) - HH= household Page | 14 Table 2. Food Security Total Which statement best describes your HH in the last 3 months? Enough of the kinds of food we want to eat Enough but not always the kinds of food we want to eat Sometimes not enough to eat Often not enough to eat In which of the past 3 months did your HH not have enough to eat? Last month Month before last Two months before last Two of the past three months All three past months None of the past three months- we had enough to eat Reasons why household did not have enough to eat Not enough money, food stamps, WIC Did not have working appliances Did not have transportation/transportation problems + Other reasons In the months without food, how many days did your HH not have food or money/food stamps to buy food? (mean average and range) In the past 3 months, how many times has your HH used a food pantry? None 1 time 2 to 5 times 6 to 10 times 11 or more times + reasons listed: lack of childcare/babysitter HH=household % (n) Baseline 100% (22) % (n) Post-test 100% (22) 32% (7) 41% (9) 27% (6) 0% (0) 36% (8) 55% (12) 9% (2) 0% (0) 14% (3) 5% (1) 5% (1) 9% (2) 9% (2) 57% (12) 9% (2) 0% (0) 9% (2) 0% (0) 0% (0) 82% (18) 80% (8) 10% (1) 20% (2) 14% (1) 75% (6) 14% (1) 38% (3) 0% (0) 9 (3-21) 2 (0-8) 68% (15) 9% (2) 9% (2) 9% (2) 5% (1) 68% (15) 5% (1) 9% (2) 9% (2) 9% (2) Page | 15 Table 2a. Food Security Status Total % (n) Post-test 100% (22) We worried whether our food would run out before we got money to buy more Often Sometimes Never true 5% (1) 50% (11) 45% (10) The food that we bought just didn’t last and we didn’t have money to get more Often Sometimes Never true 0% (0) 41% (9) 59% (13) In the last 12 months did you or other adults in the household ever cut the size of your meals or skip meals because there wasn’t enough money for food? Yes No 23% (5) 77% (17) In the last 12 months were you ever hungry but didn’t eat because you couldn’t afford enough food? Yes No 14% (3) 86% (19) In the last 12 months did you or other adults in the household ever not eat for a whole day because there wasn’t enough money for food? Yes No 5% (1) 95% (21) (Households with children) In the last 12 months did any of your children ever not eat for a whole day because there wasn’t enough money for food? (n=16) Yes No 7% (1) 93% (14) Food Security Score (mean and range) Food insecure (score of 2 or greater) Food secure (score of 0-1) 1 (0-4) 55% (12) 45% (10) Page | 16 Table 3. Benefits Total In the past month, has anyone in your household received income from the following sources? Wages or salary from a job Yes No Mean average per month (range) Social Security, SSDI, or Supplemental Security income Yes No Mean average per month (range) Pension or Retirement Yes No Mean average per month Unemployment/Worker’s Compensation Yes No Mean average per month (range) AFDC, general assistance, other public assistance not including food stamps Yes No Mean average per month (range) Other sources- alimony, child support, etc. Yes No Mean average per month (range) Monthly Household Income (mean and range) Food Stamps Did any member of your household receive food stamps in the past 3 months? Yes No No response % (n) Baseline 100% (22) % (n) Post-test 100% (22) 59% (13) 41% (9) $1119 ($186-2800) 50% (11) 50% (11) $1235 ($80-3000) 50% (11) 50% (11) $884 ($183-2000) 52% (12) 48% (10) $864 ($259-2000) 5% (1) 95% (21) $180 5% (1) 95% (21) $180 0% (0) 100% (22) $0 5% (1) 95% (21) $800 18% (4) 82% (18) $316 ($115-600) 18% (4) 82% (18) $366 ($141-620) 9% (2) 91% (20) $1070 ($940-1200) 14% (3) 86% (19) $657 ($30-1000) $1275($0-4400) $1335 ($0-4700) 64% (14) 36% (8) 0% (0) 68% (15) 32% (7) 0% (0) Page | 17 Table 3. Benefits (cont.) % (n) Baseline 100% (22) % (n) Post-test 100% (22) Is anyone in your household receiving food stamps at the present time? Yes No No response 55% (12) 45% (10) 0% (0) 64% (14) 36% (8) 0% (0) Is everyone in the household covered under this food stamp allotment? Yes No No response 63% (10) 37% (6) 0% (0) 57% (12) 43% (9) 0% (0) $237 ($37-583) $204 (37-486) 27% (6) 73% (16) 0% (0) 23% (5) 77% (17) 0% (0) 2 (1-4) 2 (1-4) 100% (30) 0% (0) 100% (27) 0% (0) 100% (30) 0% (0) 96% (26) 4% (1) Total Amount of food stamps per month (mean average and range) WIC program Is anyone is your household receiving benefits under the WIC program? Yes No No response School Breakfast and Lunch Programs Number of children in household age 5-18 years (mean average and range) Children who attend school Yes No Children who attend school that serves a complete lunch Yes No Number of days per week child receives lunch (mean average and range) Cost of lunch Free Reduced Price Full Price No response 4.6 (0-5) 4.96 (4-5) 83% (25) 10% (3) 7% (2) 0% (0) 81% (21) 19% (5) 0% (0) 0% (0) Children who attend school that serves complete breakfast Yes No 86% (24) 14% (4) 88% (23) 12% (3) 2.4 (0-5) 3.6 (0-5) Number of days per week child receives breakfast at school (mean average and range) Page | 18 Table 3. Benefits (cont.) %(n) Baseline Cost of breakfast Free Reduced Price Full Price No response 89% (17) 11% (2) 0% (0) 0% (0) %(n) Post-test 95% (21) 5% (1) 0% (0) 0% (0) Page | 19 Table 4. Food Choices % (n) Baseline 100% (22) % (n) Post-test 100% (22) 14% (3) 14% (3) 9% (2) 0% (0) I do not have a grocery store near my house 14% (3) 5% (1) My children won’t eat healthy foods 18% (4) 14% (3) Healthy foods cost too much money 45% (10) 50% (11) I do not like to cook 9% (2) 5% (1) I do not have a refrigerator to store food 0% (0) 0% (0) I do not have a stove to cook meals 0% (0) 0% (0) I do not have a car to get to the grocery store 32% (7) 32% (7) I don’t know what foods are good for me and my family 27% (6) 14% (3) I do not have enough kitchen equipment to prepare food to eat 5% (1) 5% (1) No one in the family likes to eat what I cook 9% (2) 9% (2) I don’t know how to follow a recipe 9% (2) 0% (0) Total I do not have enough time to cook healthy meals I cannot cook Other reasons+ 9% (2) + reasons listed- (baseline) My health problems interfere with cooking I don’t always feel like cooking 9% (2) (post-test) Sometimes I feel tired, lazy My children are picky eaters Page | 20 Table 5. Nutrition Concerns and Meal Planning Practices % (n) Baseline 100% (22) % (n) Post-test 100% (22) I frequently worry about whether the meals I serve are really nourishing. Strongly agree Somewhat agree Somewhat disagree Strongly disagree 33% (7) 33% (7) 24% (5) 10% (2) 14% (3) 45% (10) 14% (3) 27% (6) I feel that if I give my family a large variety of food, they will get the proper nutrition. Strongly agree Somewhat agree Somewhat disagree Strongly disagree 36% (8) 36% (8) 14% (3) 14% (3) 55% (12) 36% (8) 9% (2) 0% (0) I make every possible effort to see that my family eats really nourishing foods. Strongly agree Somewhat agree Somewhat disagree Strongly disagree 64% (14) 23% (5) 14% (3) 0% (0) 59% (13) 27% (6) 14% (3) 0% (0) I prepare each meal to be nutritionally balanced. Strongly agree Somewhat agree Somewhat disagree Strongly disagree 33% (7) 43% (9) 24% (5) 0% (0) 23% (5) 55% (12) 18% (4) 5% (1) Once in a while, I serve my family meals that are not nutritionally complete. Strongly agree Somewhat agree Somewhat disagree Strongly disagree 38% (8) 38% (8) 9% (2) 14% (3) 18% (4) 55% (12) 14% (3) 14% (3) Total Page | 21 Table 6. Cost Reduction Practices Total % (n) % (n) Baseline Post-test 100% (22) 100% (22) I make a complete list before going shopping. Strongly agree Somewhat agree Somewhat disagree Strongly disagree 36% (8) 14% (3) 23% (5) 27% (6) 45% (10) 18% (4) 14% (3) 23% (5) When I find a sale on the brand of food items I like, I stock up. Strongly agree Somewhat agree Somewhat disagree Strongly disagree 41% (9) 41% (9) 14% (3) 5% (1) 36% (8) 32% (7) 18% (4) 14% (3) 59% (13) 18% (4) 14% (3) 9% (2) 36% (8) 32% (7) 18% (4) 14% (3) 37% (7) 32% (6) 5% (1) 26% (5) 33% (7) 33% (7) 5% (1) 29% (6) I save a lot of money by shopping around for food bargains. Strongly agree Somewhat agree Somewhat disagree Strongly disagree When I get coupons, I almost always redeem them. Strongly agree Somewhat agree Somewhat disagree Strongly disagree Page | 22 Table 7. Behavior Checklist/Locus of Control Total How much of an effect do you feel what you eat will have on your future health? Not very much Somewhat Very much To what extent do you feel your health depends on how you take care of yourself? Not very much Somewhat Very much Some people feel that if they are going to be sick, they will be. How much do you feel it is possible to prevent sickness? Not very much Somewhat Very much If qualified health professionals recommend eating certain foods, how likely are you to try them? Not very much Somewhat Very much % (n) Baseline 100% (22) 5% (1) 14% (3) 82% (18) 0% (0) 14% (3) 86% (19) 5% (1) 27% (6) 68% (15) 14% (3) 32% (7) 55% (12) How much more are you concerned about what you eat than you used to be? Not very much Somewhat Very much 77% (17) Score for Locus of Control (mean and range) >13 indicates internal locus of control (self-reliance) Internal locus of control External locus of control 77% (17) 23% (5) 5% (1) 18% (4) Page | 23 Table 8. Resource Management % (n) Baseline Total % (n) Post-test 100% (22) 100% (22) How often do you use a written spending plan or budget? Do not do Seldom Sometimes Most of the time Almost always 36% (8) 5% (1) 9% (2) 23% (5) 27% (6) 18% (4) 27% (6) 5% (1) 27% (6) 23% (5) How often do you keep track of some or all of your expenses? Do not do Seldom Sometimes Most of the time Almost always 9% (2) 5% (1) 23% (5) 27% (6) 36% (8) 9% (2) 23% (5) 9% (2) 27% (6) 32% (7) How often do you have bills that are overdue? Do not do Seldom Sometimes Most of the time Almost always 27% (6) 18% (4) 18% (4) 14% (3) 23% (5) 32% (7) 27% (6) 18% (4) 9% (2) 14% (3) How often do you set aside money for emergencies? Do not do Seldom Sometimes Most of the time Almost always 18% (4) 36% (8) 23% (5) 5% (1) 18% (4) 36% (8) 14% (3) 36% (8) 14% (3) How often do you set aside money for occasional bills? Do not do Seldom Sometimes Most of the time Almost always 41% (9) 27% (6) 18% (4) 9% (2) 5% (1) 32% (7) 41% (9) 14% (3) 14% (3) How often do you feel confident about managing your money to make healthy food available in your home? Do not do Seldom Sometimes Most of the time Almost always 5% (1) 18% (4) 27% (6) 27% (6) 23% (5) 9% (2) 14% (3) 32% (7) 36% (8) 9% (2) Page | 24 0% (0) 0% (0) Table 9. Financial Fitness % (n) Baseline 100% (22) % (n) Post-test 100% (22) 41% (9) 59% (13) 45% (10) 55% (12) 88% (7) 12% (1) 60% (6) 30% (3) 10% (1) 77% (17) 23% (5) 82% (18) 18% (4) 59% (10) 6% (1) 12% (2) 24% (4) 72% (13) 6% (1) 6% (1) 17% (3) If you lost your source of income, how many months could you provide for your needs and pay your bills? 3 or more 1 to 3 Less than 1 5% (1) 25% (5) 70% (14) 14% (3) 18% (4) 68% (15) Have you created a written budget within the past 3 months? Yes No 38% (8) 62% (13) 36% (8) 64% (14) 43% (9) 29% (6) 29% (6) 41% (9) 32% (7) 27% (6) Overall Financial situation compared to 3 months ago Better Same Worse 32% (7) 45% (10) 23% (5) 14% (3) 59% (13) 27% (6) Feeling about ability to meet future debts and expenses Completely at ease Moderately concerned Very concerned 0% (0) 50% (11) 50% (11) 18% (4) 41% (9) 41% (9) Feeling about level of personal financial fitness Scared OK Very good 38% (8) 57% (12) 5% (1) 23% (5) 55% (12) 23% (5) Total Do you have any credit cards? Yes No How many times in the past 3 months has one of your credit cards reached the maximum limit? None 1-3 times 4 or more times Do you have a bank account? Yes No How many times in the past 3 months has your bank account been overdrawn? None 1 2 3 or more How often is a monthly budget used to manage spending? Almost always Sometimes Never 0% (0) Page | 25 Table 10. Access, Affordability, and Motivation to Eat Fruits and Vegetables Scale % (n) Baseline 100% (22) % (n) Post-test 100% (22) Where I shop has a wide choice of fresh vegetables Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 0% (0) 0% (0) 0% (0) 0% (0) 0% (0) 36% (8) 64% (14) 5% (1) 5% (1) 0% (0) 0% (0) 14% (3) 27% (6) 50% (11) Where I shop has a wide choice of fresh fruit Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 0% (0) 0% (0) 0% (0) 0% (0) 9% (2) 32% (7) 59% (13) 0% (0) 5% (1) 5% (1) 0% (0) 14% (3) 23% (5) 55% (12) Choice Total Where I shop has a wide choice of frozen vegetables Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 5% (1) 0% (0) 0% (0) 0% (0) 0% (0) 5% (1) 23% (5) 27% (6) 41% (9) 9% (2) 14% (3) 27% (6) 45% (10) Where I shop has a wide choice of canned vegetables Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 5% (1) 0% (0) 5% (1) 9% (2) 18% (4) 18% (4) 45% (10) 0% (0) 5% (1) 0% (0) 9% (2) 9% (2) 27% (6) 50% (11) 0% (0) 0% (0) 5% (1) 0% (0) 9% (2) 9% (2) 27% (6) 50% (11) Where I shop has a wide choice of canned fruit Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 5% (1) 5% (1) 5% (1) 23% (5) 18% (4) 45% (10) 5% (1) Page | 26 Table 10. (continued) % (n) Baseline 100% (22) % (n) Post-test 100% (22) I am satisfied with the shop where I buy most of my food Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 0% (0) 5% (1) 5% (1) 14% (3) 9% (2) 27% (6) 41% (9) 0% (0) 5% (1) 0% (0) 9% (2) 14% (3) 23% (5) 50% (11) I think vegetables are affordable to me in the shop where I buy most of my food Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 0% (0) 0% (0) 27% (6) 5% (1) 27% (6) 14% (3) 27% (6) 5% (1) 14% (3) 14% (3) 0% (0) 14% (3) 36% (8) 18% (4) I think fruit is affordable to me in the shop where I buy most of my food Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 0% (0) 14% (3) 14% (3) 9% (2) 27% (6) 9% (2) 27% (6) 9% (2) 9% (2) 23% (5) 0% (0) 18% (4) 23% (5) 18% (4) Visiting a supermarket is easy for me to do Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 14% (3) 27% (6) 9% (2) 9% (2) 9% (2) 9% (2) 23% (5) 5% (1) 23% (5) 0% (0) 9% (2) 9% (2) 23% (5) 32% (7) 9% (2) 5% (1) 9% (2) 5% (1) 5% (1) 14% (3) 52% (11) 5% (1) 14% (3) 0% (0) 0% (0) 14% (3) 14% (3) 55% (12) Choice Total There is a wide choice of food shops in my local area Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree Page | 27 Table 10. (continued) % (n) Baseline 100% (22) % (n) Post-test 100% (22) 23% (5) 0% (0) 27% (6) 5% (1) 23% (5) 18% (4) 5% (1) 0% (0) 5% (1) 18% (4) 5% (1) 36% (8) 18% (4) 18% (4) I eat enough fruit for my health Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 18% (4) 9% (2) 14% (3) 5% (1) 45% (10) 5% (1) 5% (1) 9% (2) 9% (2) 18% (4) 5% (1) 32% (7) 18% (4) 9% (2) I eat healthily Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 18% (4) 5% (1) 9% (2) 18% (4) 23% (5) 18% (4) 9% (2) 5% (1) 5% (1) 14% (3) 14% (3) 32% (7) 18% (4) 14% (3) I enjoy eating fruit Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 0% (0) 9% (2) 5% (1) 0% (0) 14% (3) 18% (4) 55% (12) 5% (1) 18% (4) 0% (0) 0% (0) 18% (4) 9% (2) 50% (11) I enjoy eating vegetables Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 5% (1) 0% (0) 5% (1) 5% (1) 18% (4) 14% (3) 55% (12) 0% (0) 5% (1) 9% (2) 0% (0) 14% (3) 14% (3) 59% (13) Health Total I eat enough vegetables for my health Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree Page | 28 Table 10. (continued) % (n) Baseline 100% (22) % (n) Post-test 100% (22) Buying more fruit than I already do would be difficult on my budget Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 23% (5) 5% (1) 9% (2) 5% (1) 18% (4) 9% (2) 32% (7) 18% (4) 0% (0) 0% (0) 14% (3) 14% (3) 27% (6) 27% (6) Buying more vegetables than I already do would be difficult on my budget Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 18% (4) 9% (2) 0% (0) 9% (2) 27% (6) 5% (1) 32% (7) 23% (5) 0% (0) 0% (0) 5% (1) 14% (3) 36% (8) 23% (5) I cannot afford to buy organic vegetables Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 0% (0) 0% (0) 9% (2) 9% (2) 9% (2) 14% (3) 55% (12) 5% (1) 5% (1) 5% (1) 14% (3) 23% (5) 23% (5) 27% (6) I cannot afford to buy organic fruit Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 0% (0) 5% (1) 9% (2) 14% (3) 9% (2) 9% (2) 55% (12) 5% (1) 5% (1) 5% (1) 14% (3) 18% (4) 27% (6) 27% (6) 23% (5) 5% (1) 23% (5) 14% (3) 0% (0) 5% (1) 32% (7) 18% (4) 9% (2) 9% (2) 23% (5) 9% (2) 5% (1) 27% (6) Health Total Lack of money prevents me from eating healthily Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree Page | 29 Table 10. (continued) % (n) Baseline 100% (22) % (n) Post-test 100% (22) 9% (2) 5% (1) 0% (0) 9% (2) 27% (6) 5% (1) 45% (10) 5% (1) 0% (0) 5% (1) 18% (4) 32% (7) 14% (3) 27% (6) I would consider cutting out foods I normally eat to eat more fruit Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 9% (2) 5% (1) 5% (1) 14% (3) 18% (4) 14% (3) 36% (8) 14% (3) 5% (1) 0% (0) 9% (2) 27% (6) 18% (4) 27% (6) I would eat more fruit and vegetables in order to lose weight Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 9% (2) 0% (0) 5% (1) 23% (5) 9% (2) 14% (3) 41% (9) 5% (1) 5% (1) 5% (1) 9% (2) 14% (3) 36% (8) 27% (6) 0% (0) 0% (0) 0% (0) 14% (3) 9% (2) 18% (4) 59% (13) 5% (1) 0% (0) 5% (1) 5% (1) 14% (3) 32% (7) 41% (9) 9% (2) 0% (0) 5% (1) 18% (4) 18% (4) 9% (2) 41% (9) 14% (3) 0% (0) 5% (1) 18% (4) 9% (2) 14% (3) 41% (9) Affordability Total I would consider cutting out foods I normally eat to eat more vegetables Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree I would eat more fruit and vegetables in order to protect myself against cancer Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree Organic I would like to eat more organic fruit Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree Page | 30 Table 10. (continued) % (n) Baseline 100% (22) % (n) Post-test 100% (22) 9% (2) 0% (0) 5% (1) 23% (5) 18% (4) 9% (2) 36% (8) 14% (3) 5% (1) 5% (1) 9% (2) 14% (3) 14% (3) 41% (9) I often use taxis to get my shopping home Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 71% (15) 0% (0) 14% (3) 5% (1) 0% (0) 5% (1) 5% (1) 64% (14) 5% (1) 5% (1) 5% (1) 9% (2) 9% (2) 5% (1) I often use my local bus service to get my shopping home Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 76% (16) 0% (0) 0% (0) 5% (1) 9% (2) 0% (0) 9% (2) 68% (15) 9% (2) 0% (0) 0% (0) 0% (0) 9% (2) 14% (3) I often get my shopping delivered to my home Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree 90% (19) 0% (0) 5% (1) 5% (1) 0% (0) 0% (0) 0% (0) 95% (21) 0% (0) 0% (0) 0% (0) 0% (0) 5% (1) 0% (0) 14% (3) 0% (0) 5% (1) 33% (7) 14% (3) 14% (3) 19% (4) 14% (3) 9% (2) 5% (1) 27% (6) 5% (1) 9% (2) 32% (7) Organic Total I would like to eat more organic vegetables Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree Transportation My local bus service is affordable Strongly Disagree Moderately Disagree Slightly Disagree Neither Agree Nor Disagree Slightly Agree Moderately Agree Strongly Agree Page | 31 Table 11. Diet and Health Knowledge Survey How many servings from each food group should a person have everyday for good health? Total Baseline only 100% (22) Fruit Group Mean Median Range 5 5 1-9 Vegetable Group Mean Median Range 4 4 0-9 Milk, Yogurt, and Cheese Group Mean Median Range 4 3 2-8 Bread, Cereal, Rice, and Pasta Group Mean Median Range Meat, Poultry, Fish, Dry Beans, and Eggs Group Mean Median Range 3 2 1-10 3 3 1-8 Page | 32 Table 12. Ideas About What People Eat % (n) Baseline 100% (22) % (n) Post-test 100% (22) 63% (13) 29% (6) 0% (0) 9% (2) 77% (17) 23% (5) 0% (0) 0% (0) Eating a variety of foods each day probably gives you all the vitamins and minerals you need. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree 41% (9) 41% (9) 9% (2) 9% (2) 50% (11) 45% (10) 5% (1) 0% (0) Some people are born to be fat and some thin; there is not much you can do to change this. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree 14% (3) 23% (5) 14% (3) 50% (11) 18% (4) 14% (3) 14% (3) 55% (12) 32% (7) 32% (7) 23% (5) 14% (3) 9% (2) 41% (9) 9% (2) 18% (4) There are so many recommendations about healthy ways to eat, it’s hard to know what to believe. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree 24% (5) 52% (11) 14% (3) 9% (2) 32% (7) 41% (9) 9% (2) 18% (4) What you eat can make a big difference in your chance of getting a disease, like heart disease or cancer. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree 45% (10) 45% (10) 9% (2) 0% (0) 45% (10) 41% (9) 14% (3) 0% (0) The things I eat and drink now are healthy so there is no reason for me to make changes. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree 9% (2) 23% (5) 45% (10) 23% (5) 5% (1) 55% (12) 32% (7) 9% (2) Total Choosing a healthy diet is just a matter of knowing what foods are good and what foods are bad. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree Starchy foods, like bread, potatoes, and rice, make people fat. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree Page | 33 Table 13. Your Own Diet Total Compared to what is healthy, do you think your diet is too low, too high, or about right in each of the following? Calories Too Low Too High About Right Don’t Know Calcium Too Low Too High About Right Don’t Know % (n) Baseline 100% (22) 10% (2) 52% (11) 14% (3) 24% (5) 29% (6) 14% (3) 38% (8) 19% (4) Iron Too Low Too High About Right Don’t Know 29% (6) 5% (1) 38% (8) 29% (6) Vitamin C Too Low Too High About Right Don’t Know 43% (9) 5% (1) 29% (6) 24% (5) Protein Too Low Too High About Right Don’t Know 33% (7) 0% (0) 38% (8) 29% (6) Fat Too Low Too High About Right Don’t Know 19% (4) 38% (8) 24% (5) 19% (4) Saturated fat Too Low Too High About Right Don’t Know 24% (5) 24% (5) 29% (6) 24% (5) Cholesterol Too Low Too High About Right Don’t Know 19% (4) 14% (3) 43% (9) 24% (5) Page | 34 Table 13. (continued) Total % (n) Baseline 100% (22) Compared to what is healthy, do you think your diet is too low, too high, or about right in each of the following? Salt or sodium Too Low Too High About Right Don’t Know 10% (2) 33% (7) 33% (7) 24% (5) Fiber Too Low Too High About Right Don’t Know 43% (9) 0% (0) 43% (9) 14% (3) Sugar or sweets Too Low Too High About Right Don’t Know 5% (1) 52% (11) 33% (7) 10% (2) Page | 35 Table 14. Important Issues When Buying Food % (n) Baseline 100% (22) % (n) Post-test 100% (22) When you buy food, how important is each of the following? How safe the food is to eat Very Important Somewhat Important Not Too Important Not At All Important Don’t Know 86% (19) 14% (3) 0% (0) 0% (0) 0% (0) 0% (0) 95% (21) 5% (1) 0% (0) 0% (0) 0% (0) 0% (0) Nutrition Very Important Somewhat Important Not Too Important Not At All Important Don’t Know 64% (14) 32% (7) 5% (1) 0% (0) 0% (0) 59% (13) 41% (9) 0% (0) 0% (0) 0% (0) Price Very Important Somewhat Important Not Too Important Not At All Important Don’t Know 73% (16) 27% (6) 0% (0) 0% (0) 0% (0) 68% (15) 23% (5) 5% (1) 5% (1) 0% (0) How well the food keeps Very Important Somewhat Important Not Too Important Not At All Important Don’t Know 77% (17) 18% (4) 5% (1) 0% (0) 0% (0) 68% (15) 32% (7) 0% (0) 0% (0) 0% (0) How easy the food is to prepare Very Important Somewhat Important Not Too Important Not At All Important Don’t Know 19% (4) 48% (10) 29% (6) 5% (1) 0% (0) 18% (4) 41% (9) 23% (5) 18% (4) 0% (0) Taste Very Important Somewhat Important Not Too Important Not At All Important Don’t Know 91% (20) 9% (2) 0% (0) 0% (0) 0% (0) 82% (18) 18% (4) 0% (0) 0% (0) 0% (0) Total Page | 36 Table 15. Food Labels % (n) Baseline 100% (22) Total When you buy food, do you use each of the following often, sometimes, rarely, or never? The list of ingredients Often (Always) Sometimes Rarely Never Never Seen The short phrases on the label like “low-fat” or “light” or “good source of fiber” Often (Always) Sometimes Rarely Never Never Seen 27% (6) 27% (6) 32% (7) 9% (2) 5% (1) 9% (2) 54% (12) 23% (5) 9% (2) 5% (1) The nutrition panel that tells the amount of calories, protein, fat, and such in a serving of the food Often (Always) Sometimes Rarely Never Never Seen 23% (5) 41% (9) 23% (5) 9% (2) 5% (1) The information about the size of a serving Often (Always) Sometimes Rarely Never Never Seen 9% (2) 32% (7) 18% (4) 36% (8) 5% (1) Statements on the label that describe the health benefits of nutrients or foods Often (Always) Sometimes Rarely Never Never Seen 18% (4) 45% (10) 23% (5) 9% (2) 5% (1) Page | 37 Table 16. Understanding Food Labels % (n) Baseline 100% (22) Total Do you think each of the following is very easy, somewhat easy, or not too easy to understand? The list of ingredients Very Easy Somewhat Easy Not Too Easy Never Seen Don’t Know 19% (4) 38% (8) 33% (7) 9% (2) 0% (0) A short phrase like “low-fat” or “light” or “good source of fiber” Very Easy Somewhat Easy Not Too Easy Never Seen Don’t Know 33% (7) 38% (8) 24% (5) 5% (1) 0% (0) The number of calories in a serving Very Easy Somewhat Easy Not Too Easy Never Seen Don’t Know 23% (5) 45% (10) 23% (5) 9% (2) 0% (0) The number of calories from fat in a serving Very Easy Somewhat Easy Not Too Easy Never Seen Don’t Know 19% (4) 29% (6) 43% (9) 10% (2) 0% (0) The number of grams or milligrams of nutrients like fat and sodium in a serving Very Easy Somewhat Easy Not Too Easy Never Seen Don’t Know 14% (3) 18% (4) 55% (12) 9% (2) 5% (1) The percent of the daily value for each nutrient Very Easy Somewhat Easy Not Too Easy Never Seen Don’t Know 5% (1) 32% (7) 45% (10) 9% (2) 9% (2) A description like “lean” or “extra lean” on meats Very Easy Somewhat Easy Not Too Easy Never Seen Don’t Know 36% (8) 27% (6) 27% (6) 9% (2) 0% (0) Page | 38 Table 17. Statements About Food Labels Total The nutrition label on food labels is useful to me. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree No Opinion % (n) Baseline 100% (22) 36% (8) 32% (7) 9% (2) 9% (2) 14% (3) I feel confident that I know how to use food labels to choose a healthy diet. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree No Opinion 32% (7) 55% (12) 5% (1) 5% (1) 5% (1) The nutrition information on food labels is hard to interpret. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree No Opinion 9% (2) 59% (13) 18% (4) 5% (1) 9% (2) Reading food labels takes more time than I can spare. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree No Opinion 14% (3) 23% (5) 18% (4) 41% (9) 5% (1) I read food labels because good health is important to me. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree No Opinion 36% (8) 36% (8) 5% (1) 5% (1) 18% (4) I would like to learn more about how to use food labels to choose a nutritious diet. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree No Opinion Reading food labels makes it easier to choose foods. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree No Opinion 68% (15) 18% (4) 0% (0) 5% (1) 9% (2) 38% (8) 29% (6) 14% (3) 10% (2) 10% (2) Page | 39 Table 17. (continued) % (n) Baseline 100% (22) Total Sometimes I try new foods because of the information on the food label. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree No Opinion 14% (3) 45% (10) 14% (3) 23% (5) 5% (1) When I use food labels, I make better food choices. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree No Opinion 43% (9) 33% (7) 10% (2) 10% (2) 5% (1) Using food labels to choose foods is better than just relying on my own knowledge about what is in them. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree No Opinion 36% (8) 41% (9) 5% (1) 9% (2) 9% (2) Page | 40 Table 18. Foods You Eat % (n) Baseline 100% (22) % (n) Post-test 100% (22) 24% (5) 38% (8) 14% (3) 19% (4) 5% (1) 23% (5) 41% (9) 18% (4) 14% (3) 5% (1) Use skim or 1% milk instead of 2% or whole milk Always (Almost always) Sometimes Rarely Never Don’t eat this food 36% (8) 14% (3) 23% (5) 27% (6) 0% (0) 41% (9) 18% (4) 9% (2) 32% (7) 0% (0) Eat special, low-fat cheeses, when you eat cheese Always (Almost always) Sometimes Rarely Never Don’t eat this food 9% (2) 18% (4) 27% (6) 41% (9) 5% (1) 18% (4) 36% (8) 5% (1) 41% (9) 0% (0) 0% (0) 55% (12) 23% (5) 18% (4) 5% (1) 14% (3) 36% (8) 50% (11) 0% (0) 0% (0) 14% (3) 23% (5) 18% (4) 32% (7) 14% (3) 18% (4) 27% (6) 27% (6) 23% (5) 5% (1) Have fruit for dessert when you eat dessert Always (Almost always) Sometimes Rarely Never Don’t eat this food 5% (1) 59% (13) 23% (5) 14% (3) 0% (0) 18% (4) 50% (11) 18% (4) 14% (3) 0% (0) Eat fish or poultry instead of meat (meat refers to beef, pork, or lamb.) Always (Almost always) Sometimes Rarely Never Don’t eat this food 27% (6) 55% (12) 14% (3) 5% (1) 0% (0) 36% (8) 55% (12) 9% (2) 0% (0) 0% (0) Total Think about the foods you eat. Would you say you always, sometimes, rarely, or never did any of the following things? Eat lower-fat luncheon meats instead of regular luncheon meats Always (Almost always) Sometimes Rarely Never Don’t eat this food Eat ice milk, frozen yogurt, or sherbet instead of ice cream Always (Almost always) Sometimes Rarely Never Don’t eat this food Use low-calorie instead of regular salad dressing Always (Almost always) Sometimes Rarely Never Don’t eat this food Page | 41 Table 19. What We Eat in America- Household Survey % (n) Baseline Total % (n) Post-test 100% (22) 100% (22) 9% (2) 18% (4) 32% (7) 41% (9) 0% (0) 9% (2) 14% (3) 32% (7) 36% (8) 9% (2) 100% (22) 0% (0) 0% (0) 95% (21) 0% (0) 5% (1) $107 ($10-200) $379 ($107-900) $117 ($25-200) $409 ($25-1700) Money spent at grocery stores of non-food items Per week (mean average and range) Per month (mean average and range) $37 ($30-50) $60 ($0-200) $25 ($0-100) $50 (0-200) Money spent on food at specialty stores Per week (mean average and range) Per month (mean average and range) $10 ($0-20) $63 ($0-690) $12 (0-50) $49 ($0-203) Money spent on carry-out food Per week (mean average and range) Per month (mean average and range) $15 ($0-40) $52 ($0-400) $18 (0-100) $36 ($0-200) $25 ($20-30) $61 ($0-600) $32 ($0-75) $56 ($0-450) Major Food Shopping > Once a week Once a week Once every two weeks Once a month or less Never Store of major food shopping Supermarket A small store + Someplace else Money spent at grocery stores Per week (mean average and range) Per month (mean average and range) Money spent on eating outside of the home Per week (mean average and range) Per month (mean average and range) + Walmart Page | 42