Afterword: EFNEP celebrates 40 years of delivering nutrition education to limited-resource families.

Paddock, Joan Doyle ; Dollahite, Jamie S.

The discovery of hunger in America during the 1960s resulted in political action and legislation by Congress. The U.S. Department of Agriculture (USDA) launched several pilot studies through Cooperative Extension to investigate strategies for addressing the nutrition and health needs of poor families. The effective model that emerged for providing nutrition education and skill-building utilized paraprofessional staff to teach nutrition to low-income families in their homes. Recommendations based on results of these pilot studies were the basis for initiating the Expanded Food and Nutrition Education Program (EFNEP) in 1969.

EFNEP in New York just celebrated its 40th anniversary. While much has changed in the last 40 years, the program commitment and research-based delivery strategy have withstood the test of time. One unique feature of EFNEP that has remained constant is the method of program delivery: employment of paraprofessionals indigenous to the areas in which they work as the front-line educators. These educators continue to work with limited-resource families, either in small groups or one on one. Group nutrition education has largely replaced the home-visit model with about 80 percent of participants in New York state being reached in group settings. The remainder, primarily home visits, occurs in upstate rural counties where lack of transportation is an issue for participants.

Obesity is the nutrition-related health problem of greatest concern now, often occurring side by side with food insecurity among the poor. Chronic diseases, such as diabetes and obesity, plague our population, but the poor are particularly at risk. Americans have become more sedentary, the use of computers as a means of recreation has replaced active play for children, and making healthy food choices has become increasingly difficult. Calorie-dense (high-sugar, high-fat) foods are cheap and readily available. Fruits and vegetables, especially high-quality fresh fruits and vegetables, are far less available, and their cost has increased markedly. All this contributes to the difficulty of making healthy choices for everyone. The challenges to limited-resource families are especially difficult, and obtaining high-quality food must be balanced with other priorities such as the increasing cost of heating in the winter and buying gas for transportation, rising rent, and family pressures such as single-parent families and parents working outside the home.

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In 2009 alone, EFNEP served 6,304 adults in New York, representing 25,690 family members. We have learned from educators' experiences that young parents have few cooking skills and that "cooking from scratch" is only vaguely understood. Use of convenience foods high in sodium, fat, and sugar are just that--convenient to prepare, have a familiar taste, and are acceptable to children. Using unfamiliar whole foods, taking time to prepare a recipe that requires cooking or baking instead of microwaving, and risking a negative reaction from family members are not things taken lightly by the EFNEP audience.

Working within this context is a challenging job for EFNEP educators. Yet the nature and quality of the success experienced by graduates of EFNEP show that change is possible, the benefits are long lasting, and the rewards are great. Hearing what participants have to say makes the challenges of this work worthwhile and motivates educators and supervisors alike.

For example, one participant said, "I wish I had taken a picture of my pantry before this class and then after this class. The difference is amazing. I thought I was eating healthy before, but I didn't realize how much better I could be doing."

Another excited participant reported, "I learned how to prepare a recipe as written." Others begin to use a meat thermometer to assure food safety and use coupons to save money. Many report giving up soda completely and learning to prepare easy, accessible snacks with vegetables that "everyone ate."

The current economic crisis has expanded the EFNEP target population and the need for the program continues.

The experience of 40 years of successfully reaching participants where they are, with their unique strengths and challenges, provides a sound foundation for the future. EFNEP is just as important now, if not more so, than when it was first established in helping families through tough situations.