[Show abstract][Hide abstract] ABSTRACT: help ensure that many low-income children have enough nutritious food to eat, some studies have suggested that the programs could be more efficient and cost-effective. In particular, concerns have been raised about erroneous payments that reimburse schools for meals served to students who are not eligible for them. Policymakers would also like to find ways to reduce errors that arise when schools and school districts process or report meal reimbursement information incorrectly. This brief draws on Mathematica’s Access, Participation, Eligibility, and Certification (APEC) study to examine these issues. It provides the most detail to date on certification and payment errors in school meal programs. It suggests key factors for policymakers and program
[Show abstract][Hide abstract] ABSTRACT: This study investigated factors that influence studentsâ€™ participation in the National School Lunch and School Breakfast Programs using recent data from a large, nationally representative sample of students certified for free and reduced-price meals during the 2005â€“2006 school year. Whether students are in elementary school and whether they like the taste of the meals are among the most important factors associated with picking up the meal offered that day. In addition, if students currently eligible for reduced-price meals were instead given free meals, they would participate more at lunch than they do now, although not at breakfast. Finally, parentsâ€™ reports of the previous dayâ€™s or previous weekâ€™s participation tend to be overstated, resulting in higher reported annual participation rates than administrative data suggest.
[Show abstract][Hide abstract] ABSTRACT: To address challenges faced by hard-to-employ TANF clients, the University of Nebraska-Lincoln Extension, in partnership with the Nebraska Health and Human Services System, operated the Building Nebraska Families (BNF) program from 2002 to 2005. The initiative combined intensive home visitation and life skills education to prepare high-risk TANF clients in rural Nebraska to succeed in the world of work and improve their familiesâ€™ well-being. This issue brief notes significant impacts for the very hard-to-employ. BNF was effective in increasing employment and earnings as well as reducing poverty for this group.
[Show abstract][Hide abstract] ABSTRACT: Over the years, concern has mounted that many of the more than 26 million children certified to receive free or reduced-price meals may be ineligible for these benefits. This brief looks at the issue of reducing payment errors in the National School Lunch Program (NSLP) and the School Breakfast Program (SBP). Mathematicaâ€™s study, the first effort to quantify the amounts and rates of improper payments in these programs, looked at two types of certification errors: (1) household reporting errors, which occur when households misreport information on their applications; and (2) administrative errors, which occur when districts make mistakes in processing applications, determining eligibility, or recording certification status. For all students who applied for school meal benefits or were directly certified, about one in five were either incorrectly deemed eligible for the level of benefits they were approved for, or erroneously denied benefits. In addition, among those certified in error, overcertification was about twice as likely as undercertification. For both the NSLP and SBP, about nine percent of total meal reimbursements were erroneous because of certification error.
[Show abstract][Hide abstract] ABSTRACT: This report presents 30-month impact and benefit-cost analysis findings for the Building Nebraska Families program, an intensive home visitation and life skills education program for hard-to-employ TANF clients in rural Nebraska. The program improved employment near the end of the 30-month followup and significantly improved family income and reduced poverty. It also had major impacts for a subgroup of more disadvantaged clients with multiple obstacles, including large impacts on employment and earnings. During the last six months, the program group earned 56 percent more than the control group, about $200 more per month.
[Show abstract][Hide abstract] ABSTRACT: This report presents 30-month impact analysis findings for the Illinois Future Steps program, an employment-focused case management program in rural, southern Illinois. By teaming the welfare agency with a regional community college, Future Steps aimed to connect people with services and employment. Future Steps had few positive impacts on employment, self-sufficiency, and well-being. Implementation challenges included limited ties with local employers and difficulty retaining and supporting qualified staff. Moreover, the program was not able to capitalize on job-training and employment resources available through its community college partner. In addition, case management may have helped clients address barriers to work and self-sufficiency, but many obstacles remained. Expanded job opportunities and infrastructure improvements may be needed to overcome persistent barriers to self-sufficiency common in depressed rural areas.
[Show abstract][Hide abstract] ABSTRACT: Helping low-income families in rural areas find gainful employment and achieve economic self-sufficiency is an ongoing policy concern. The Rural Welfare-to-Work Strategies demonstration is using rigorous experimental designs to build knowledge about how to help low-income families in rural areas strive toward sustained employment and self-sufficiency. This report examines an employment-focused case management initiative deployed in southern Illinois. Despite a lack of impacts on employment, earnings, and self-sufficiency, the findings imply a need for stronger interventions in rural areas and demonstrate the challenges inherent in designing, implementing, and evaluating programs in these types of settings. The following are appended: (1) Survey Data Collection and Weighting Methods; (2) Additional Cost Study Analysis: Costs by Program Component; and (3) Supplemental Figures and Tables. (Contains 16 tables and 11 figures.)
[Show abstract][Hide abstract] ABSTRACT: Erroneous payments in the National School Lunch and Breakfast programs occur when school districts claim reimbursement at the free or reduced-price rate for meals served to students who are not eligible. They can also happen when schools don't claim reimbursement for children who have applied and are eligible (called certification error). Errors in reporting the number and type of meals in claims for reimbursement (called noncertification error) also create erroneous payments. This report from Mathematica's Access, Participation, Eligibility, and Certification study estimates the amounts and rates of erroneous payments. Slightly more than one in five children was certified inaccurately or erroneously denied meal benefits. The authors also found that household reporting error was substantially more prevalent than administrative error. Approximately nine percent of total reimbursements for both the lunch and breakfast programs were erroneous due to certification errors, although the amounts and rates of most erroneous payments due to noncertification errors were relatively small.
[Show abstract][Hide abstract] ABSTRACT: To compare demographic and maternal characteristics and usual nutrient intakes of Hispanic and non-Hispanic infants and toddlers 4 to 24 months of age in the United States.
We conducted three interviews by telephone to collect information on sociodemographic and maternal characteristics, feeding practices, and dietary intake in the 2002 Feeding Infants and Toddlers Study. We collected 24-hour dietary recalls, including a second day's intake on a subsample, using the Nutrition Data System for Research. We used the Personal Computer version of the Software for Intake Distribution Estimation to estimate usual nutrient intake and nutrient adequacy and excess for three age subgroups-infants 4-5 months, infants 6-11 months, and toddlers 12-24 months-and Hispanic or non-Hispanic ethnicity.
A national sample of 3,022 infants and toddlers age 4-24 months, including 371 Hispanic and 2,637 non-Hispanic subjects.
We compared means, percentile distributions, and percentages by age/Hispanic ethnicity subgroup, and applied the Dietary Reference Intakes to assess nutrient intakes.
Mothers of Hispanic infants and toddlers were younger, less likely to be married, and had lower education levels than mothers of non-Hispanic infants and toddlers (P<.01). Hispanic infants and toddlers had significantly higher rates of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children than non-Hispanic infants and toddlers (42% to 23%) and were more likely to reside in urban areas and have lower annual household income levels (P<.01). There were no significant differences in usual energy intake between Hispanic and non-Hispanic infants and toddlers, and mean usual energy intake exceeded the mean estimated energy requirement for all age/ethnicity subgroups. Hispanic toddlers consumed a significantly higher proportion of energy from carbohydrate (56% to 53%, P<.01) and a significantly lower percentage of energy from fat (31% to 33%, P<.01) than non-Hispanics. Comparing usual mean intakes, Hispanic infants age 6 to 11 months had a significantly lower intake of calcium than non-Hispanics (means of 574 mg and 626 mg per day, respectively, P<.05) and a significantly higher intake of sodium compared with non-Hispanics of the same age (means of 647 mg to 476 mg per day, P<.01). For infants, mean usual intakes were adequate for all nutrients. For toddlers, the prevalence of nutrient inadequacy was low (<1%) with the exception of vitamin E, which was inadequate for 39% of Hispanic toddlers and 50% of non-Hispanic toddlers. For nutrients with defined Tolerable Upper Intake Levels, more than one third to almost half of toddlers exceeded the Tolerable Upper Intake Levels for vitamin A and zinc, and more than half (53% and 58% for Hispanics and non-Hispanic toddlers, respectively) exceeded the Tolerable Upper Intake Level for sodium. Usual mean intakes of vitamins A, C, and E and folate, potassium, and fiber were significantly higher among Hispanic toddlers compared with non-Hispanic toddlers.
The Feeding Infants and Toddlers Study data provide information that is useful to practitioners, Special Supplemental Nutrition Program for Women, Infants, and Children program staff, and parents for delivering nutrition education messages that are consistent with dietary guidance for infants and toddlers as well as compatible with cultural preferences.
Journal of the American Dietetic Association 02/2006; 106(1 Suppl 1):S84-95. DOI:10.1016/j.jada.2005.09.040 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe meal and snack patterns of Hispanic and non-Hispanic infants and toddlers.
A cross-sectional telephone survey in which mothers or other primary caregivers reported their infants' and toddlers' food and beverage intake for a 24-hour period.
Subjects were a subset of the national random sample of children aged 4-24 months who participated in the 2002 Feeding Infants and Toddlers Study. The Feeding Infants and Toddlers Study includes a stratified random sample of 3,022 infants and toddlers aged 4-24 months. Three hundred seventy-one Hispanic and 2,637 non-Hispanic children who had 24-hour dietary recalls are included in the subset.
Means+/-standard errors of daily intakes of energy, nutrients, and nutrient densities were calculated, as were percentages of children consuming foods at each eating occasion.
Hispanic and non-Hispanic infants and toddlers, on average, were fed seven times per day. Overall, the percentages of children who ate snacks increased with age, and more than 80% of toddlers aged 12-24 months consumed afternoon snacks, with more than 90% of Hispanic children consuming an afternoon snack. In each age group, there were significant differences between ethnic groups in nutrient intakes by eating occasion. No significant difference was seen for energy across all meal occasions. At age 6-11 months, Hispanic children had a significantly lower intake of carbohydrate at dinner and lower intake of saturated fat at afternoon snacks compared with non-Hispanic children (P<.05). The main difference between Hispanic children's and non-Hispanic children's intakes by eating occasion is at age 12-24 months. Hispanics aged 12-24 months had significantly (P<.05) lower percentages of energy from fat and saturated fat and a significantly (P<.05) higher percentage of carbohydrate at lunch compared with non-Hispanic children. For dinner, Hispanic toddlers had significantly (P<.05) lower intakes of total fat and saturated fat compared with non-Hispanic toddlers at age 12-24 months. Overall fiber intake contributed 2 g/meal for both ethnic groups. Snacks contributed, on average, less than 1 g fiber, except Hispanic toddlers had significantly higher fiber intake at afternoon snacks (1.5 g) than non-Hispanic toddlers. Foods frequently consumed at meals and snacks were lacking in whole grains, vegetables, and fruits. Most nutrients were not significantly different between Hispanics and non-Hispanics for meals and snacks.
Considering the sizeable contribution that snacks make toward overall energy, parents and caregivers should plan toddlers' snacks to complement meals by including additional fruits, vegetables, and whole grains that are culturally appropriate rather than fruit drinks, cookies, and crackers. This will increase fiber intake and limit fat and sugar intakes. To develop healthful eating patterns, introduce toddlers to foods eight to 10 times to increase food acceptance and the likelihood of establishing healthful eating patterns. Dietetics professionals need to consider cultural differences when developing meal and snack patterns for Hispanic and non-Hispanic infants and toddlers.
Journal of the American Dietetic Association 02/2006; 106(1 Suppl 1):S107-23. DOI:10.1016/j.jada.2005.09.037 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe nutrient intake and food patterns of lunches and snacks eaten at various locations by US toddlers.
A national, cross-sectional telephone survey in which mothers and primary caretakers reported toddlers' food and beverage intake for a 24-hour period.
Toddlers (n=632), aged 15 to 24 months, a subset in the 2002 Feeding Infants and Toddlers Study.
Means+/-standard errors of the mean, percentages, t tests of mean differences, mean energy and nutrient intake, and nutrient density of toddlers' lunches and snacks.
Overall, on any given day, 42.6% of toddlers consumed all meals and snacks at home, 8.1% consumed any meal or snack at day care (and others at home), and 49.3% consumed any meal or snack away from home (all other locations excluding day care). Mean energy intake at lunch ranged from 281 kcal at home to 308 kcal away from home to 332 kcal at day care. There were no significant differences in mean macronutrient intake or fiber intake across locations, but lunches eaten at day care were significantly higher in calcium, phosphorus, magnesium, vitamin D, potassium, and riboflavin compared with those eaten at home or away (P<.05). Mean trans fat intake was significantly (P<.01) lower for lunches consumed at home compared with away from home. For lunches consumed at away locations, the most frequently consumed item, by 35% of toddlers, was french fries. Carbonated beverages were consumed at away lunches by 16% of toddlers, compared with 3% at home and none at day care. Morning snacks provided 124 to 156 kcal and afternoon snacks provided from 139 to 170 kcal, depending on the location. Foods typically eaten at morning snacks for all locations were water, cow's milk, crackers, and 100% juice. Beverages frequently consumed at afternoon snacks were water, whole cow's milk, fruit-flavored drinks, and 100% apple juice. The most frequently consumed foods for an afternoon snack at home or day care were crackers or non-baby food cookies.
Nutritious choices such as milk, fruits, vegetables, and whole grains need to be encouraged in a variety of forms to give toddlers an opportunity to build broader food preferences for life. The consumption of milk at home and other locations, such as restaurants and friends' homes, needs to be encouraged in place of fruit-flavored drinks or other sweetened beverages. For lunches at home, parents may be especially receptive to suggestions about appropriate and easy-to-serve foods, homemade or commercial, for a toddler's lunches and snacks. Day-care providers should be encouraged to use menu planning aids, such as those available from the US Department of Agriculture, even if they are not regulated by a government program.
Journal of the American Dietetic Association 02/2006; 106(1 Suppl 1):S124-34. DOI:10.1016/j.jada.2005.09.036 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although rural America is diverse, ever changing, and different from urban America, less is known about rural human and social services conditions and needs. The U.S. Department of Health and Human Services, which plays a major role in protecting and enhancing human capital and self-sufficiency in rural America, launched a study to learn more about social and economic conditions and trends in rural areas, identify high-priority family and community needs, and assess knowledge about these needs and the services available to address them. This report describes the study and findings. It also identifies data that could support empirical research, presenting information on 80 data sources that the research community could use to study three human services topics in rural areas: work supports for low-income families, substance abuse, and child welfare.
[Show abstract][Hide abstract] ABSTRACT: To examine the nutrient intakes, foods consumed, and feeding patterns of infants and toddlers participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Cross-sectional telephone survey, including 24-hour dietary recalls of infants' and toddlers' food and nutrient intakes, as reported by parents or other primary caregivers.
National random sample of 3,022 children ages 4 to 24 months who participated in the 2002 Feeding Infants and Toddlers study. Sample sizes by age were infants 4 to 6 months: 265 WIC participants, 597 nonparticipants; infants 7 to 11 months: 351 WIC participants, 808 nonparticipants; and toddlers 12 to 24 months: 205 WIC participants, 791 nonparticipants.
We used Statistical Analysis Software (version 8.2) to examine the breastfeeding status, infant feeding patterns, and foods consumed; the personal computer version of the Software for Intake Distribution Estimation to estimate mean usual intake of food energy and of key nutrients targeted by the WIC program; and methods recommended by the Institute of Medicine to assess nutrient adequacy.
Infants participating in WIC were less likely than nonparticipants to have ever been breastfed or to be currently breastfeeding, and they were more likely to be consuming formula. Mean usual nutrient intakes exceeded the adequate intake for WIC participants, and the percentage with inadequate nutrient intake was less than 1%. Reported mean energy intakes exceeded mean energy requirements, with the largest discrepancy observed for WIC participants. Sizeable proportions of WIC and non-WIC infants and toddlers did not consume fruits and vegetables on the recall day.
WIC providers should focus nutrition education on appropriate infant and toddler feeding patterns, should continue to reinforce their message of the importance delaying the use of cow's milk until 1 year of age, and should stress the importance of fruit and vegetable consumption.
Journal of the American Dietetic Association 02/2004; 104(1 Suppl 1):s71-9. DOI:10.1016/j.jada.2003.10.018 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe transitions and patterns in infants' and toddlers' beverage intakes, with focus on nonmilk beverages.
A cross-sectional study was conducted by telephone to obtain a 24-hour dietary recall of infants' and toddlers' food intakes, as reported by mothers or other primary caregivers.
A nationwide sample of infants and toddlers (n=3,022) ages 4 to 24 months, who participated in the Feeding Infants and Toddlers Study (FITS).
Beverages were categorized as total milks (ie, breast milk, infant formulas, cow's milk, soy milk, goat's milk), 100% juices, fruit drinks, carbonated beverages, water, and "other." Analyses included means +/- standard deviations, percentages, frequencies, nutrient densities, and linear regression.
Beverages provided 84% of total daily food energy for infants 4 to 6 months of age, decreasing to 36% at ages 19 to 24 months. Apple juice and apple-flavored fruit drinks were the most frequently consumed beverages in the 100% juice and fruit drink categories, respectively. Juices, fruit drinks, and carbonated beverages appeared to displace milk in toddlers' diets (P<.0001).
This research shows that beverages make important contributions to infants' and toddlers' energy and nutrient needs, but they must be wisely chosen. Registered dietitians should advise parents and caregivers that excessive intakes of any beverage, including milks and 100% juices, may displace other foods and beverages in the diet and/or contribute to excess food energy (kcal). Further research is needed to define excessive amounts in each beverage category, and such guidance could be very useful to parents and caregivers of infants and toddlers.
Journal of the American Dietetic Association 01/2004; 104(1 Suppl 1):s45-50. DOI:10.1016/j.jada.2003.10.027 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To guide national policy, Congress mandated the 1992 research evaluation of the Elderly Nutrition Program (ENP), the nation's oldest framework for providing community- and home-based preventive nutrition and health-related services to older persons. This article summarizes key findings on the program's influence on nutritional health, the targeting and costs of its nutrition services, and the study's policy implications.
The research included a nationally representative sample of ambulatory and homebound ENP participants And a matched sample of nonparticipants drawn from the US Health Care Financing Administration's Medicare beneficiary listings. Interviews conducted in respondents' homes considered demographic and health characteristics and assessed anthropometry and physical functioning, nutrient intake and socialization patterns, and utilization of ENP program services (participants only). Administrative and service delivery data were gathered from all levels of the ENP infrastructure.
The ENP program currently provides congregate and home-delivered meals and other nutrition- and health-related services to about 7% of the older population overall, including an estimated 20% of the nation's poor elders. Compared with nonparticipants, ambulatory and homebound ENP participants are better nourished (4% to 31% higher mean daily nutrient intakes; P<.001) and achieve higher levels of socialization (17% higher average monthly social contacts; P<.001). Federal spending on ENP nutrition services is efficiently leveraged by funding from other public and private sources, allowing ENP to more than double the nutrition services it provides to program participants.
ENP is a well-targeted, effective, and efficient federal program available to dietetics and other professionals for providing elderly persons with community-based and home-delivered nutrition and related services. The ENP infrastructure offers a potential model for preventive nutrition intervention programs in ambulatory and homebound at-risk older populations.
Journal of the American Dietetic Association 03/2002; 102(2):234-40. DOI:10.1016/S0002-8223(02)90055-6 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Examines and synthesizes current knowledge about the relationship between breakfast and learning, including the relationship between nutrition and cognitive development, children's breakfast consumption patterns, relative contribution of breakfast to dietary intake over 24 hours, and impact of breakfast consumption on cognitive and school outcomes.
[Show abstract][Hide abstract] ABSTRACT: This report finds that the typical Food Stamp client is quite satisfied with services, although misperceptions about eligibility deter many eligible households from participating, and costs to comply with program requirements are significant. Call the Food and Nutrition Service at 703-305-2133 for printed copies.
[Show abstract][Hide abstract] ABSTRACT: Describes the evaluation strategy for a comprehensive, rigorous study of the universal-free school breakfast programs to be implemented in six school districts across the country as part of the SBP Pilot Project, including a methodologically rigorous randomized design, a well-defined set of outcome variables, and comprehensive data collection to provide evidence of program effectiveness.