April 2008 // Volume 46 // Number 2 // Ideas at Work // 2IAW6

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Increasing EFNEP Program Outreach and Enhancing Program Content Through Local Partnerships

The Expanded Food and Nutrition Education Program (EFNEP) has been shown to be a cost-effective investment of federal dollars. The funding for the program has not increased significantly since the 1980's. Growing rates of poverty in cities like Cleveland have increased the demand for the program. This article describes some innovative strategies that EFNEP in Cuyahoga County, Ohio has used to enhance program quality and expand program outreach.

Punam Ohri-Vachaspati
Ohio State University Extension
Cuyahoga County
Cleveland, Ohio

Over the past 8 years, Expanded Food and Nutrition Education Program (EFNEP) in Cuyahoga County, Ohio has developed a number of local partnerships to bring additional resources for the program. As a result, EFNEP has been able to expand its outreach as well as enhance its programming efforts. This article describes two examples where EFNEP in Cuyahoga County has collaborated with other partners to strengthen its efforts to benefit program participants.

EFNEP is a national nutrition education program funded through United States Department of Agriculture's Cooperative Research Education and Extension Services (CREES) in all 50 states and six U.S. territories. EFNEP targets limited resource families with children and limited resource youth and teaches them strategies for making healthy and inexpensive food choices in order to improve their nutritional well-being.

EFNEP has been shown to be a cost-effective program. A study done in Virginia by Rajgopal, Cox, Lambur, and Lewis (2002) showed that for every dollar spent in nutrition education, a saving of $10.64 can be expected from reduced future health care costs. Burney and Haughton (2002) in Tennessee showed that for every dollar spent on EFNEP, $2.48 is saved on food expenditures by the program participants.

EFNEP has been operating in Cuyahoga County, Ohio since its inception in 1969. The program has come to be recognized as a premier nutrition education resource for limited resource audience in the county. While EFNEP has had a long history of successfully providing nutrition education, the program had not seen any significant funding increase since the 1980's. Therefore, the total number of outreach workers supported by the program in 2006 was lower compared to the numbers in 1990's. For example, 16 adult EFNEP educators were supported by the program in 1995 compared to 11 in 2006.

The need for outreach to limited resource audience in Cuyahoga County continues to be critical. City of Cleveland, the county seat, was declared the poorest city in the nation in 2004 and 2006 by the census bureau. The two collaborative efforts described below are examples of how EFNEP is continuing to meet the needs of its clientele in the era of limited federal funds.

Steps to a Healthier Cleveland

Under the leadership of Cleveland Department of Public Health, Cleveland, Ohio received the 5-year Steps to a HealthierUS grant in 2003. The Steps to a HealthierUS Cooperative Agreement is a U.S. Department of Health and Human Services program advancing the HealthierUS goal to help Americans live longer, better, and healthier lives. Through funding of community-based interventions, this program aims to reduce the burdens of diabetes, obesity, and asthma, and address three related risk behaviors, poor nutrition, physical inactivity, and tobacco use and exposure.

One of the community interventions that Steps to a HealthierUS in Cleveland funded was Cuyahoga County's EFNEP program. It allowed for an expanded and enhanced outreach of the youth-EFNEP program by hiring a 95% outreach worker. The Steps-EFNEP outreach worker reaches out to 5th and 6th grade children, while the 3rd and 4th grade children are reached by the traditional federally funded EFNEP program. This doubles the exposure that children in the program have to age-appropriate nutrition education program that has been found effective in two recent studies (Rabe, Ohri-Vachaspati, & Scheer, 2006; Townsend, Johns, Shilts, & Farfan-Ramirez, 2006).

The Steps grant also adds an experiential component to the summer youth-EFNEP program to target three specific obesity related behaviors, choosing fruits and vegetables as snacks, choosing healthy beverages, and being physically active. The funds are used to purchase food and materials for food tasting and other hands-on activities. In addition, resources are being developed to engage parents through newsletters, in-school attractive and interactive displays, and parent partner activities that promote the role of parents as effective role models in helping their children make healthy choices.

City Fresh--A Community Foods Program

In 2003, Ohio State University Extension, Cuyahoga County and the New Agrarian Center based in Oberlin, Ohio put together a collaborative to improve access of fresh locally grown produce to low-income inner-city neighborhoods by creating a sustainable local food system. The collaborative received a 3-year Community Foods Projects project grant. EFNEP, Community Gardening, and Community Development program at OSU Extension contribute to this multi-agency initiative.

For the past two summers, produce from local farms has been brought to the neighborhood Fresh Stops where weekly "market bags" that include a mix of produce available from local farmers are sold at subsidized prices to low-income families. City Fresh brings competitively priced, fresh, locally grown produce right to city neighborhoods. EFNEP complements the program by bringing easy-to-prepare recipes that can be tried at City Fresh Food Stops. These recipes are prepared using produce available at the Fresh Stops. City Fresh shareholders get a packet of nutrition education materials including the recipe of the week in their weekly produce bags.

All the materials distributed through the City Fresh program are available in English and Spanish. EFNEP also provides nutrition displays and brief presentations on current nutrition topics like the new MyPyramid, fruits and vegetables--how they help prevent chronic diseases, healthy choices when eating out, nutrition facts labels, etc.

An incentive-based system has been developed where City Fresh participants who participate in nutrition education sessions for at least 10 weeks graduate from EFNEP and also receive a free bag of fresh produce. At the end of the 15-18 week program, all program participants receive a recipe book containing all City Fresh recipes and educational materials. For the next year's program, recipes are being solicited from program participants. These will be tested in our kitchen, analyzed for nutrient content, and used in the program to enhance participant ownership.

Materials and concepts developed through programs like Steps and City Fresh enhance the "traditional" EFNEP program, thus having a longer term impact on the overall program capacity and quality than the length of the grant or contract.


Rajgopal, R., Cox, R., Lambur, M., & Lewis, E. C. (2002). Cost-benefit analysis indicates the positive economic benefits of the Expanded Food and Nutrition Education Program related to chronic disease prevention. Journal of Nutrition Education and Behavior, 34(1):26-37.

Burney, J., & Haughton, B. (2002). EFNEP: A nutrition education program that demonstrates cost-benefit. Journal of the American Dietetic Association, 102:39-45.

Rabe, M., Ohri-Vachaspati, P., & Scheer, S. D. (2006). The influence of the Youth Expanded Food and Nutrition Education Program on nutrition knowledge and self-reported behaviors of elementary school children. Journal of Extension. [On-line], 44(3) Article 3RIB6. Available at: http://www.joe.org/joe/2006june/rb6.shtml

Townsend, M., Johns, M., Shilts, M .K., & Farfan-Ramirez, L. (2006). Evaluation of a USDA nutrition education program for low-income youth. Journal of Nutrition Education and Behavior, 38:30-41.