Summary
The Centers for Disease Control and Prevention recently reported that poor nutrition and lack of physical activity are catching up to tobacco use as the leading cause of death in the United States. In addition to having negative health outcomes, children with poor nutrition may have a harder time succeeding in school than other children. To help improve nutrition, the U.S. Department of Agriculture (USDA) provides nutrition education through five of its programs. The department spent $472 million on these efforts in fiscal year 2002. GAO was asked: (1) What key actions can officials take to increase the likelihood of success in nutrition education? (2) Do USDA and state and local officials take these actions during program design, service delivery, and program monitoring and evaluation?
GAO identified several key actions, based on research and performance-based management principles, that increase the likelihood that programs providing nutrition education will achieve their goals. Examples of these actions include identifying program goals, tailoring services to meet the needs of participants, and collecting data on program results. The actions can be taken during program design, service delivery, and program monitoring and evaluation. USDA programs providing nutrition education that we reviewed--the Food Stamps Program; the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); the National School Lunch Program; the Child and Adult Care Food Program; and the Expanded Food and Nutrition Education Program--generally incorporated the key program design actions likely to contribute to success. For example, the USDA programs identified nutrition education goals and target populations. However, the programs' administrative structures hinder coordination among the USDA nutrition education efforts. We found that the USDA programs incorporated the service delivery actions likely to contribute to successful nutrition education in different ways and to varying extents, but they faced similar challenges that affected their ability to fully incorporate these actions. The challenges included limited resources and systems for providing nutrition education and competing program requirements that took time or resources away from nutrition education. For example, WIC officials said they had limited time for nutrition education because of competing requirements, such as providing information on drug and alcohol counseling. USDA's nutrition education efforts did not fully incorporate the monitoring and evaluation actions that contribute to success, such as collecting data on the types of nutrition education provided and the outcomes of the efforts. As a result, little is known about what nutrition education is provided and whether these programs have met their nutrition education goals.
Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change
from "In process" to "Implemented" or "Not implemented" based on our follow up work.
Director:
Team:
Phone:
Kay E. Brown
Government Accountability Office: Education, Workforce, and Income Security
(415) 904-2272
Recommendations for Executive Action
Recommendation: To help overcome the challenges associated with USDA's nutrition education efforts and to help programs incorporate the key actions related to successful nutrition education, the Secretary of Agriculture should ensure that the department develop a unifying strategy that, at a minimum, identifies ways to improve coordination efforts and strengthen the linkages among the nutrition education efforts, which would include examining options ranging from more systematically sharing nutrition education resources across programs to identifying and promoting approaches for federal, state, and local officials to implement cross-program strategies to more efficiently use existing resources. In developing a unifying strategy, the department may need to submit requests for program changes to Congress.
Agency Affected: Department of Agriculture
Status: Implemented
Comments: USDA has taken a number of steps to strengthen coordination on nutrition education services and to develop strategies for more effective long-term cross-program linkages. The Secretary established a departmental working group led by the Under Secretaries responsible for the two key offices that provide nutrition education. This working group examined ways to improve coordination and consistency across USDA's nutrition education efforts. The group's efforts resulted in the Nutrition.gov website, which serves as a gateway for food and nutrition information from across the federal government. USDA also continues to participate in a number of federal interagency committees related to nutrition education, including the Healthy People 2010 Nutrition Work Group and the 5-a-Day program. The two key offices that provide nutrition education have also focused on increased coordination efforts in their letters of intent and program plans, and administrators from the two offices have conducted joint site visits and are investigating joint training opportunities. Finally, USDA has previously submitted requests to Congress for cross-program nutrition education funding; however, competing priorities in the face of limited available funding have precluded such requests in recent budget cycles.
Recommendation: To help overcome the challenges associated with USDA's nutrition education efforts and to help programs incorporate the key actions related to successful nutrition education, the Secretary of Agriculture should ensure that the department develop a unifying strategy that, at a minimum, explores options to collect reliable data on services delivered and recipients served, and to identify and disseminate lessons learned. A longer-term evaluation strategy could include planning periodic and complementary evaluations of the impact of the nutrition education efforts to the extent possible, in order to make the most efficient use of the resources available for such evaluations.
Agency Affected: Department of Agriculture
Status: Implemented
Comments: USDA had taken a number of steps to more systematically collect reliable data and identify and disseminate lessons-learned for its nutrition education efforts. For its nutrition education component of the Food Stamp Program (FSNE), it conducted a systematic review of FSNE to include information on target audiences, types of interventions, and expenditures. In addition, USDA released a new framework for FSNE in August 2005. USDA also is implementing an Education and Administrative Reporting System that will provide uniform data and information about FSNE recipients and activities in all participating states. The reporting form is being reviewed by OMB and USDA expects implementation to begin in FY 2008. The department also is developing diet quality outcome measures for conducting sound impact assessments of FSNE and other nutrition education efforts. These are being developed by the Economic Research Service, with input from both the Food and Nutrition Service and the unit administering the Expanded Food and Nutrition Education Program (EFNEP). Also, USDA has issued "Nutrition Education: Principles of Sound Impact Evaluation" to define the steps and features of research that can determine whether a nutrition education intervention changed behavior. It is conducting a focused review of existing research to assess what is known about the effectiveness of certain nutrition messages. Also, a revised version of the EFNEP Evaluation/Reporting System that includes new measures of youth impacts and new reports on adult dietary intakes has been delivered to the states and territories and must be used for FY 2007. Finally, the department has initiated a number of activities to share lessons-learned, such as conferences for nutrition professionals and food assistance staff, roundtable discussions between different USDA agencies, and electronic mailing lists. Many of these efforts have brought together representatives from the various USDA nutrition education programs to share ideas and information. In addition, the Food and Nutrition Service national conferences have resulted in State Nutrition Action Plans (SNAPs), through which representatives from different food assistance programs in each state create identifying common state-level nutrition goals and strategies to achieve them.
