• Kushi, Lawrence (PI)

Project: Research project

Project Details


This is a proposal to develop and evaluate a nutrition education
program to reduce cardiovascular disease risk in persons with low
literacy skills. The setting for this study is the Minnesota Extension
Service's Expanded Food and Nutrition Education Program (EFNEP), which is
a U.S. Department of Agriculture-funded program to improve the nutrition
knowledge and behavior of low-income individuals who are responsible for
food preparation. The emphasis of EFNEP is on obtaining adequate and
nutritious foods, and not on dietary behaviors for the prevention of
chronic disease. Because a large proportion of this population has no
more than an 8th grade education (30.9% nationally), EFNEP provides
access to individuals with low literacy skills and a need for nutrition
education for disease prevention. For example, a pilot study indicated
that 34 of 42 respondents had never had their blood cholesterol level
checked. This study proposes to develop education strategies using focus
groups of both EFNEP program participants and the EFNEP paraprofessionals
who deliver the program. The intent of the focus groups will be to
identify concerns, interests, barriers, and perceived needs for nutrition
education for cardiovascular disease prevention. This information will
be used to develop effective education strategies that address the needs
of the study participants, while accomplishing the study goal of
effecting dietary change (specifically, decrease in dietary fat and
cholesterol intake) for cardiovascular disease risk reduction. The effectiveness of this nutrition education program will be
evaluated in a randomized trial, with pre- and post-intervention measures
of dietary fat intake and plasma total and HDL cholesterol as outcome
measures. This study will be conducted in Hennepin, Ramsey and Dakota
Counties, which have a total adult EFNEP enrollment of about 1,842
people. Because EFNEP enrollment is predominantly female (94%), this
study will be limited to adult women, age 18 or older. We propose to
randomize all 22 EFNEP paraprofessionals in these counties to
intervention and control groups, and estimate that approximately 330
women will be enrolled and complete the study. Randomization will be at
the level of paraprofessional to simplify program delivery and to
minimize contamination between intervention and control groups. Based on
power calculations that account for the fact that paraprofessionals and
not individuals are randomized, we estimate that the we have about 90%
power to detect a 10% decrease in total fat intake as measured by 24-hour
recall, and about 88% power to detect a decrease of 6 mg/dl in plasma
total cholesterol in this population. The differential change in fat
intake and plasma cholesterol level between the intervention and control
groups will be estimated using analysis of covariance, adjusting for
within paraprofessional correlation and other potential confounders.
Effective start/end date8/16/915/31/95


  • National Institutes of Health: $464,175.00


  • Medicine(all)


Explore the research topics touched on by this project. These labels are generated based on the underlying awards/grants. Together they form a unique fingerprint.