Logic Model Overview:

Sue Buteau

Situation:

From Family & Consumer Resources:
Diet Quality and Physical Activity
Nutrition plays a vital role in overall health. In fact, research has found that diet is associated with the leading causes of death, many of which are preventable heart disease, diabetes, obesity, and several types of cancer. Cardiovascular disease and cancer together account for almost two thirds of all deaths in the United States. Despite the importance of diet, however, Americans fail to achieve recommendations of the Dietary Guidelines which lower the risk of disease. Of particular interest, are the results of the 2004 New Hampshire Food Stamp Recipient telephone survey conducted with 402 randomly selected recipients.

Overall Health and Nutritional Quality of Food Stamp Recipients' Diet
In the 2004 telephone survey, food stamp recipients were asked to describe the quality of both their general health and the nutritional quality of their diet. Over time, respondents have continually and consistently described their overall health less favorably than the general New Hampshire population. In 2004, 42% of respondents described the overall nutritional quality of their diet as excellent (16%) or very good (26%), an increase of 11 points since the 2003 study. By comparison, according to the 2000 Centers for Disease Control Behavioral Risk Factor Surveillance System Survey, general population residents in New Hampshire (63%) described their health as excellent or very good, and only (10%) described their health as fair or poor.

When Food Stamp recipients were asked to describe how interested they were in improving the nutritional quality of their overall diet, 73% said they were either very (41%) or moderately (32%), an increase of eight-points since the 2003 study.

Adopting a Healthier Diet
Food Stamp recipients were asked, in a series of questions, which of the following factors were a major or minor reason why they do not adopt a healthier diet.

The factors are:
• It is too confusing to figure out what foods are really healthier than others.
• Healthy foods are too difficult to prepare.
• Healthy foods don't taste as good.
• It costs too much to eat healthy food.
• I don't have the time to cook and prepare healthy meals.

Thirty-seven percent of respondents exposed to the social marketing campaign identified costs as a major reason not to adopt a healthier diet, four-points fewer than respondents who were not exposed to the social marketing campaign. Eleven percent of respondents exposed to the campaign identified time as a major reason not to adopt a healthy diet, 10-points fewer than respondents who were not exposed to the campaign.

Food stamp recipients were presented with a list of dietary practices and asked to describe how much they agreed or disagreed with the importance of each practice. No more than four percent of respondents disagreed with the importance of any of the dietary practices. A majority of respondents agreed completely that keeping food safe (67%), eating a healthy diet (57%), maintaining a healthy weight (55%), and eating a variety of fruits and vegetables (53%) are important. A large minority of respondents agreed completely that being active on a regular basis (44%) is important.

Respondents were asked if they read the nutritional labels printed on food packages. Eighty-four percent of respondents said that they read the nutritional labels on food packages. Thirty-seven percent of respondents said that they read 100% of all nutritional labels, and 15 percent mentioned that they read the nutritional labels on 75-to-99% of all labels. Sixteen percent of all respondents said that they do not read nutritional labels on food packages. When asked for their reasons why, respondents said that it took too much time (40%), they don't know how (31%) or it is too difficult (20%).

Healthy Weight
New Hampshire respondents can be classified as underweight, overweight, obese or as having a healthy weight using the National Institutes of Health's Body Mass Index (BMI). The following formula is used:

BMI = [Weight (lbs) x 703] ÷ [Height (in) 2]

Where: < 18.5 is underweight
18.5 - 24.9 is a healthy weight
25 - 30 is overweight
> 30 is obese

Application of this formula to self-reported height and weight data show that only one-third of food stamp recipients (32%) enjoy a healthy weight. Sixty-three percent of food stamp recipients are either overweight (26%) or obese (37%). Only five percent of respondents are underweight according to the Body Mass Index.

As categorized by the Body Mass Index calculations, overweight and obese respondents were asked if they were currently trying to lose weight or trying to maintain a healthy weight. Eighty-nine percent of overweight and obese respondents indicated that they are trying to lose weight or trying to maintain a healthy weight. When asked to list all the methods that they were using, respondents who are trying to lose weight or maintain a healthy weight mentioned exercising regularly (51%), eating better food (38%) and eating less in general (31%) more frequently than specific dietary approaches.

Changing Health Status of New Hampshire Residents
The UNH Cooperative Extension State Advisory Council has requested that obesity prevention be a major focus in the 5 year plan of work. A formal motion was passed on April 5, 2005 to (a) support these programs by making them more clear and evident in the plan of work regardless of client income level, and (b) to continue and enhance the resources dedicated to this critical issue.

More than half of New Hampshire residents describe themselves as overweight or obese. Twenty-two percent of the state's school-age boys and 17 percent of girls are overweight, with another 20 percent at risk for overweight. Since mid-2003, an interdisciplinary team has been meeting and planning a statewide initiative called Lighten Up New Hampshire! that will identify and integrate the vast network of obesity prevention/reduction resources and programs throughout the Granite State.

Shopping Behavior/Food Resource Management
Food resource management applies to the practices related to thrifty shopping for food and management of food dollars. These include such skills as making shopping lists, reading labels for nutritional value, planning menus, and basic cooking. Extremely low incomes can make it difficult for people to buy enough food to meet their minimum nutritional needs, thereby putting them at risk for under nutrition. A consumer's perception of the cost of various foods can also play a role in his or her choices. For example, two barriers that prevent people from adopting healthful eating habits are the beliefs that it would be too expensive and inconvenient. Below is a list of barriers to healthful eating:
- Healthy foods are not always available from fast-food and take-out restaurants.
- It costs more to eat healthy foods
- I'm too busy to take the time to eat healthfully
- There is too much conflicting information about which foods are healthy and which foods are not.
- Healthy foods don't taste as good.
- The people I usually eat with do not eat healthy foods.

In fact, 40 percent of consumers who answered one survey said that fruits, vegetables, seafood, and other elements of a low-fat diet; nutrient-rich diet would strain their budgets. But some research has shown that switching from a high-fat diet to one that is lower in fat can reduce food costs.

Food Safety
Food borne illness is one of the greatest concerns of public health experts and the food industry. Each year, as many as 76 million Americans experience food borne illness, and an estimated 5,000 deaths are linked to tainted foods. Incredible as these figures are, they probably represent only a fraction of the whole picture.

Many mild cases of food borne illness are never reported for a number of reasons: The victims pass off the symptoms as flu and do not seek medical attention, the illness is misdiagnosed as another problem with similar symptoms, the victim fails to recognize food as the source of the illness, or the physician doesn't report the illness to local health agencies. Diarrhea, nausea, abdominal pain, or vomiting without fever or upper respiratory distress is often taken to be flu, but people who experience such symptoms are highly likely to be suffering from food borne illness.

Parenting Education
Strong families raise children to become responsible, productive and caring adults. As a nation we have gradually increased the supports that we offer for families and overall, our knowledge and understanding of children and their developmental needs have greatly improved. However, deficits remain and many families face problems that place their children at risk for a life of adversity. Parents, from diverse backgrounds and with diverse strengths and weaknesses, are in need of education to help them understand how to more effectively parent their children. For example, many parents do not understand that infants begin to "take in" their environment in the fist few days of life; and, about the harmful effects of children being exposed to violence or how a parent's state of depression can place his or her children at risk for adjustment problems. Characteristics about children's families can also place them at-risk for future problems. For example, in 2003, 1 in 5 New Hampshire children lived in families that were headed by a single parent and 22% of children lived in families that were considered low-income. In that same year, over 12,000 children lived in extreme poverty and 7,000 children lived in a household where no adult worked in the past 12 months. When these types of risk factors are combined with a lack of knowledge, children can suffer. For example, in the year 2001 1,436 cases of child maltreatment were substantiated in the state of New Hampshire and in that the same year 1,214 children were in state-sponsored placements because of maltreatment. In 2000, 132 New Hampshire youth were committed to a state correctional facility; children from the poorest New Hampshire communities were almost more than twice as likely to be committed to a correctional facility than children from middle income communities. Children from poorer and less educated homes can also suffer academically. In 2001, New Hampshire elementary school children who scored below the state's average on proficiency testing were more likely to be from poorer communities than from middle or high income communities. There is vast evidence to indicate that education and prevention campaigns over the past three decades have helped to reduce the adversity in children's lives, such as lower rates of maltreatment, crime and higher rates of high school completion. However, more education and programming is needed to assist those children who continue to be at-risk for future problems.

Quality Child Care

Quality Child CareIt is not only parents who need assistance in raising and caring for children. Many caregivers outside the home have a significant impact on children's lives. More parents work outside the home today than ever before. This is especially true of parents with young children. Nationwide, 72% percent of women with minor children participate in the work force, and among New Hampshire families with children under the age of six, 61% of those families have both parents in the workforce. Nationally, almost three-quarters of children under the age of 5 whose mothers are employed are in non-relative child care. The demand for necessary child care services was met with a 25% increase in the number of licensed child care facilities in the state of New Hampshire between 1987 and 1997. While many children attend an organized daycare or nursery school center, many others do not. This can lead to great variations in the level of knowledge of caregivers and in the quality of care that children receive. Variations in the quality of care that children and families receive is true just not of childcare providers, but for many different types of family providers. There is evidence which suggests that adults have significant gaps in their knowledge about children and developmental norms, and that general education may be beneficial for providers on many different levels.

Caring for New Hampshire's Aging Population
According to 2005-2025 Population Projections for NH and Counties by Age and Sex, prepared by the State Data Center, New Hampshire's population of elders (65-plus) will grow 150 percent over the next 20 years, as compared with an increase of 21 percent in the overall population. The 25-44 year age group will increase by only 6 percent during the same time. This group traditionally provides the pool of lower-wage workers who serve as hands-on professional healthcare providers. With no end in sight for escalating health care costs, with fewer employers each year offering health insurance, with insured families paying more out of pocket for health care, the additional resources needed to care for the rapidly-increasing group of elders will likely place tremendous new burdens on families.

Ultimately, it adds up to more stress on families, many of whom have already begun investing more time and more money into family caregiving. Families won't have the discretionary incomes they have now, or the amount of discretionary time they have now for entertainment, travel, eating out, or consumer purchases. That will force changes for many sectors of the local economy.

Family Policy Education
Nationwide, there has been a call to strengthen the relationship between state universities and state legislatures. Recent national research indicates that at least 75% of legislators obtain most of their policy information from special interest groups such as grassroots organizations, lobbyists and groups representing ethnic populations. When asked where else they obtain information, only 5% of state legislators reported that they seek information from universities or think tanks. This represents a significant loss of opportunity for university researchers to help inform state-level policy, especially at a time when researchers are routinely questioned about the practice and policy implications of their research findings. One answer to this problem has been the implementation of Family Policy Impact Seminars-now in existence in 18 different states. Coordinated by Cooperative Extension specialists and staff, Family Impact Seminars provide research-based educational seminars on family policy issues to legislators, and help decision-makers to keep a family-oriented perspective in their policy-making. UNHCE will implement similar educational seminars to help bridge the gap between the university and the New Hampshire General Assembly, and to provide timely research-based information on pertinent family policy issues.

Family Resource Management
Americans are making less and saving less. Personal income declined from 6.1% in 2004 to 4.3% in 2005 (U.S. Department of Commerce, Bureau of Economic Analysis). Personal savings as a percentage of disposable personal income declined from 1.8% in 2004 to -.4% in 2005 (U.S. Department of Commerce, Bureau of Economic Analysis). Consumer credit increased 3% in 2005 (Federal Reserve). There were 6058 bankruptcy filings in NH in 2005 which was a 32% increase from 2004 (United States Bankruptcy Court for the District of New Hampshire). Households are saving less and spending more putting their financial security at risk. Spending habits start early. Comparing 2005 to 2004, teens overall spending level declined 6% but nearly half believe they'll spend more in 2006 than they did in 2005 (Teenage Research Unlimited). The Jump$tart Coalition for Personal Financial Literacy 2004 survey found 12th graders' personal finance knowledge level to be 52.3% which is a failing grade based upon the typical grade scale. Many young people could establish bad financial management habits, and stumble through their lives learning by trial and error.

Family Lifeskills Program
Federal law now requires most recipients of Temporary Aid to Needy Families (TANF) to prepare for and find paid work. Many TANF recipients find they need help mastering basic lifeskills to make a successful transition to paid work. Some people have difficulty managing time, conflict, anger and stress. They may fear change or rejection. Some need help building support networks for themselves. Many people do not have successful role models for balancing paid work and family life. Some have family difficulties that undermine their ability to seek and find a job. Many need help with parenting skills and understanding the developmental needs of children. Parents often worry about finding childcare or interacting with childcare providers. Some may be concerned about how employment will affect them and their children. They may need help developing a spending/savings plan or preparing nutritious meals within their budget and time constraints.

Stakeholder Input

From Family & Consumer Resources:
Data was collected from stakeholders via county visits, county and state advisory councils; and reviewed by Family & Consumer Resources specialists and educators.

Assumptions

From Family & Consumer Resources:
1. A committed and skilled professional staff in Family and Consumer Resources will be retained.
2. Cooperative Extension has the capacity to address the educational needs of the residents of NH.
3. Cooperative Extension is a highly effective educational program development and delivery organization and is a non-biased research-based source of information and education.
4. Educational resources needed to achieve long term outcomes will be supported and developed.
5. Effective collaborations of agencies and organizations, and strategic partnerships will strengthen program development, delivery and evaluation.
6. Funding through CSREES, State of NH, and NH counties remains in place and is enhanced through sustainable grants, contracts and gifts.

External Factors

From Family & Consumer Resources:
• Family and Consumer Sciences will become better understood as a discipline.
• Poverty places families and communities under great stress that interferes with their ability to achieve positive outcomes.
• Economic development and stability is a goal for individuals, families, communities and businesses.
• Individuals are challenged to balance personal, family and professional goals and often lack the time to participate in learning opportunities.
• Individuals will choose to make good decisions, be effective parents, choose quality child care, make healthy food choices, handle food safely, and manage their resources with skill if they have the awareness, knowledge, attitudes and skills to do so.

   Outputs

      Attend Staff Meetings    (Show details)

      Planning and Reporting    (Show details)

      COA work    (Show details)

      Advisory Council Meetings    (Show details)

   Inputs:

   (Show details)

   Outputs

      Nutrition Connections - educational courses to income eligible New Hampshire residents'- ability to meet nutritional needs through available resources. Includes EFNEP (Expanded Food and Nutrition Education Program) and FSNE (Food Stamp Nutrition Education.)    (Show details)

      ServSafe®, SAFE (Safety Awareness in the Food Environment) -    (Show details)

      Parenting Education such as Strengthening Families 10- 14, Dare To Be You, Family Focus, Supportive Connections for Single Parent Families, Stepfamilies, Relatives as Parents; Cradle Crier and Toddler Tales ( age paced newsletters); Single topic sessions including Positive Discipline, Raising Your Child's Self- Esteem    (Show details)

      Prepare for Eldercare - Cooperative Extension and AARP working together with local partners to develop effective delivery mechanisms to reach out to family caregivers with limited incomes and those whose care recipients may have limited incomes and resources    (Show details)

      Making Money Work for You, Planning Ahead...Staying Ahead, Credit Check Up, Debt Check Up, Starting Over Bankruptcy Education, Take the Road to Financial Security in Later Life, Investing for Your Future, Legally Secure Your Financial Future, High School Financial Planning, Taking Charge of Your Finances
   (Show details)

      Grants - Development and Maintenance    (Show details)

      General Extension    (Show details)

   Inputs:

   (Show details)

   Outputs

      Professional development    (Show details)

   Inputs:

   (Show details)