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Kristin McCartney, MPH, RDN, LD

WV SNAP Ed Director

WVU Extension Public Health Specialist

Laura Dice-Hill, MPH

Program Coordinator

WV SNAP-Ed

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Background

Statistics. Theory. Research

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In West Virginia, almost 20% of adults eat vegetables and less than once per day and over 40% eat fruits less than once per day.

Children develop food preferences based on:

Foods they are familiar with
Ones they see adults and older siblings eat
Ones they see peers eat
Being introduced to foods early and often

If parents don't buy/provide opportunities to try foods whether it is due to availability, affordability or their own preferences, it creates an additional barrier for children.

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Behavioral

Fruit and vegetable consumption

Store regularly stocks fruits and vegetables

Cognitive

Nutrition knowledge

Knowledge of child food preference development

Cooking skills

Safe Storage/Handling Produce

Environmental

Preferences of family members (parent/child)

Home availability and accessibility (children)

Parent attitudes (children)

Availability in community (parent/store)

Cost (parent/store)

Social Cognitive Theory

Reciprocal determinism (interplay between cognitive, behavioral and environmental factors)

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A Pandemic Pivot

Why

Access to schools was limited
When produce distribution was permitted, it was pre-bagged, eliminating children's ability to choose

Benefits

Expanded data collection
Greater parent/family engagement
Partnerships with retail establishments
Integration of virtual education and engagement
Summer feeding opportunity aligned with growing season

Barrier

Less peer influence
Negative family influence
Availability based on parent/guardian interest

Kids Market

Kids Market @ the Store

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Implementation

Enrollment.Engagement.Education

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Families in Rural Communities

Complete pre/post surveys, participate in educational opportunities, participate in shopping experiences

Kids Market @ the Store: Roles and Partnership

Schools

Distribute enrollment information. Identify families

Multimedia/Social Media Specialist

Oversee development and implementation of virtual education and engagement and electronic communications

FNP Administration

Plans logistics, secure funding, order materials

Retail Locations

Stocking produce items, store displays, accounting, marketing

Health Educator/Nutrition Outreach Instruction/ Extension Agent

Recruit and provide ongoing communications for stores, farmers and participants, support educational outreach with live cooking demonstrations

Farm/Farmers Market

Stocking produce items, store displays, accounting, ,marketing

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Funding Partnerships & Reach

2021-$10,000 (pilot/2 counties/250 families)
2022-$60,000

$30 per family X 21 counties X 100 families/county ($3000/county)

2023-$35,000 ($15,000 additional pending)

Private foundations: Save the Children, Sisters Health and Wellness Foundation, Sisters Health, Walmart Foundation, Save the Children

Non-profit partnership: Mountaineer Foodbank

Government Grants: CDC High Obesity Grant

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Geography based needs assessment and identification of Stores: Application of WV FOODLINK

Food Resource Finder (arcgis.com)

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Store Agreements

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Enrollment

Enrollment cards are distributed through the school system, DHHR, WIC, food pantry

Guardians sign up via a link/QR code linked to a Qualtrics survey to collect the following:

Demographics

Education
Age
Race
Income
Names, ages and genders of children being enrolled

Participation in assistance programs (SNAP/EBT)

Cooking and Food Provisioning Action Scale (Efficacy)

Nutrition Education preferences

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Cooking and Food Provisioning Action Scale (CAFPAS)

Lahne, J., Wolfson, J. A., & Trubek, A. (2017).Cooking and Food Provisioning Action Scale (CAFPAS)[Database record]. APA PsycTests.https://doi.org/10.1037/t64661-000

CAFPAS

28 Item scale
Measure self-efficacy, Attitude, Structure
7-point, bipolar Likert scale (Strongly disagree/Strongly agree)

Modified to only assess self-efficacy

Used a 3-point Likert (Agree, Neutral, Disagree)

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Educational Preferences

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Participation in Assistance Programs

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Recruitment through �Social Media

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Shopping Bag

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Recipe Cards

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Wooden Tokens

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In-Store Tastings, Education & Demonstrations

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Virtual Parent Engagement

Electronic Newsletter-Distributed weekly for 6 weeks. List of produce items available, changes/updates with stores, nutrition/feeding tip and link to a recipe demonstration

Text Reminders-Distributed weekly for 6 weeks. List of produce items available and link to recipe.

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Education & Engagement through Social Media

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Evaluation

Process & Outcome

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Focus Group Results

The Program Made their Child Feel: “grown up”, “important” and “feeling like a real customer", “contributing to family meals"

Benefits of the Program Were:

“And he ate a lot more stuff by him being able to pick it. He even wanted to help peel or whatever”.

“It's gotten now whenever we go to the store, it's like, "Mommy, I don't have my bag, but can I get this?".
[The program gave] “ A lot of the kids, a chance to get food over the summer. There's a lot of that around here”.

Barriers to the Program Were:

So sometimes what the farmers brought was the stuff that they maybe couldn't sell anywhere else.” She would go on to say, “Even though it was free, we really did appreciate it. Sometimes we didn't want it either”.
“Like if we didn't go the day that stuff went in, a lot of times we didn't get anything, “ Even like at the school, our internet, you think that would be the best and it's really, the internet in the county is very slow”.

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Participant Demographics

Child Demographics

Total number of children participating: 1246

Average age: 8 (range 1-17)

Parent/Guardian Education

Some school/no degree: 4%
High school degree/GED: 27%
Some college/no degree: 30%
College degree: 40%

Parent/Guardian Age

18-24: 3%
25-34: 35%
35-44: 38%
45 and older: 24%

Participation in SNAP/EBT

Income

Less than $10,000:13%
$10,000-$39,999: 35%
$40,000-$99,999: 36%
Over $100,000: 5%
Prefer not to say: 11%

Race

White: 97%

Black/African American: 3%

Other: <1%

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Overall Educational Engagement

Email/Text communications

(91%)

Class

(2.5%)

Recipe Demonstrations (Live)

(6%)

Try recipes from email (48%)
Try recipes from cards (35%)

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Process Evaluation: Participant Satisfaction

Highest Ranked Program Elements:
Tokens
Shopping bags
I Love Vegetable Book
Store employees

Lowest Ranked Program Elements:
Store Location
Store Displays
Surveys

Intervention Element	Mean Satisfaction Score
Store Location	2.34
Store displays	2.38
Surveys	2.46
Passport	2.47
Enrollment	2.51
Communications	2.53
Store employees	2.55
I Love Vegetable Book	2.62
Shopping bags	2.63
Tokens	2.63

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Retrospective Pre-test

Post-test Survey

Child's Mealtime Behaviors

Fruit and Vegetable Consumption (cups)
Willingness to taste
Ease in preparing fruits and vegetables
Help in preparing meals/snacks

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Evaluation

Children's Mealtime Behaviors

Mealtime Behavior Variable	N	Mean (SD)	Lower-Upper 95%
Increase in Cups F&V	540	1.05 (1.51)	.93-1.18
Willingness to Taste F&V	527	1.00 (1.28)	.89-1.11
More than 1 Variety of F&V	520	.96 (1.32)	.85-1.08
Ease in Preparing F&V	527	.67 (1.13)	.58-.76
Assist w/Meal Prep	530	.44 (.77)	.38-.51

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Cooking and Food Provisioning Action Scale: Self Efficacy Results

Self-efficacy scores among those interested in participating in Kids Market @ the Store Program. (n=5,488)

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Cooking and Food Provisioning Action Scale: Self Efficacy-Continued

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SNAP Ed Framework

LT18e.	Retail food stores: Number of retail food stores that have established marketing practices that promote the choice of healthier foods and beverages. These may include, but are not limited to, in-store merchandising, labeling, promotion, and family-friendly placements (including check-out lanes) that intentionally encourage the choice of foods/beverages-to-encourage; partnerships with SNAP-Ed projects to support community marketing events; and projects to support consumer uptake of foods/beverages-to-encourage. These business changes should extend past those that occur only while a SNAP-Ed intervention is being conducted and may include changes a company makes on its own that can be attributed in whole or in part to SNAP-Ed influence.

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Community Support & Engagement

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Success Story

Lincoln wanted me to tell you how much he has LOVED Kid’s Market! So much so, now that his tokens are gone, we have to start giving him a produce allowance so he can continue cooking. This has been really great, he’s already talking about next summer, so we hope you do this again!

He wants me to tell you about what he has made. He made pizza sauce, using his tomatoes, for a green pepper pizza. He made air fryer French fries. He cooked a couple of entire meals for our family: one was mozzarella chicken over a bed of garlic and diced tomatoes roasted with olive oil, mashed potatoes, and corn on the cob. He made apple turnovers for dessert. Tonight, with the pepper and onions, he made us chicken stir fry, rice, and rice pudding for breakfast tomorrow. Apple danishes for dessert. He froze zucchini from one of his other trips and is going to make zucchini bread. He has plans to make spaghetti soon, to use up more of the onion, pepper, and his last tomato.

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Lessons Learned and Improvements for 2023

Communication with Store and Food Producers

HEs/NOIs had mostly great relationship with store owners and farmers perhaps because they often visited and saw in person
Sometimes other staff were less aware of program and how to implement when primary contact was gone

Communication with Participants

People didn’t check email or it went to spam oftentimes.
Texting provided higher rate of response to post-survey – use of Text Magic gave anonymity

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Lessons Learned and Improvements for 2023

Enrolling Participants

List participating stores

Some participants were very far away from the stores and never used the tokens.

In-store sign ups. Have QR code where potential participant can use to sign up at register.

Store owner or HE can sign someone up if visual or low-literacy level.

Enrolling Stores

MOU for mutual understanding

Food sourcing

Lack of variety and quality was primary complaint of participants