Analysis of 24-hour recalls completed by expanded food and nutrition education paraprofessionals in Rhode Island

Background. The Expanded Food and Nutrition Education Program (EFNEP) in Rhode Island provides nutrition and healthy lifestyle education to the poorest families in the state. This nationwide program collects data each year on participant demographics and kilocalorie and nutrient intake using surveys and a single pre and post intervention 24-hour recall. This information is collected by EFNEP staff and provides insight into the habits of the Rhode Island EFNEP population. This information could be used to create targeted training to the RI EFNEP staff and focused lessons for EFNEP clients.;Objective. To better understand the accuracy of the information collected in the 24-hour recalls obtained by RI EFNEP staff, as well as to gain insight into the kilocalorie intake of the RI EFNEP population.;Design. A secondary data analysis of an EFNEP participant sample (n=47,738) from the 2009 reporting year was completed which compared mean reported kilocalorie intake of Rhode Island clients (n=164) with the rest of the United States (n=47574) as well as differences between each groups' client reported kilocalorie intake and USDA recommendations. Differences between client reported kilocalorie intake and USDA recommendations were also compared by RI paraprofessional staff.;Statistical analysis. Three-way analysis of variance (ANOVA) was used to compare RI with U.S. client kilocalorie intakes by gender and age group. Covariates of activity level and ethnicity were introduced using ANCOVA. Differences between kilocalorie intakes reported and USDA recommendations were evaluated using ANOVA. Differences between kilocalorie intake and USDA recommendations were also compared between recalls collected by RI EFNEP paraprofessional staff using ANOVA. A statistical significance criterion was set at p < 0.05.;Results. Significant differences were found between RI and U.S. groups' mean reported kilocalories by location and gender. Covariates ethnicity and activity level had a small but significant impact on the variation in reported kilocalorie intake. When looking at the differences in kilocalories reported vs. kilocalories recommended, there were no significant differences between RI and U.S. participants. There were no significant differences in kilocalories reported vs. kilocalories recommended when compared by RI paraprofessional staff.;Conclusion. Both RI and U.S. EFNEP clients reported lower kilocalorie intake than USDA recommendations, which is consistent with some literature on underreporting, especially with initial 24-hour recalls. The differences in client kilocalorie intake between RI paraprofessionals were not significant. Due to the high number of RI respondents who indicated sedentary lifestyle, the RI EFNEP program may want to further increase the focus of the importance of physical activity in its lesson plans. In addition, there is some indication that the RI EFNEP program may benefit from further training in the challenging task of collecting 24 hour recalls in a group setting, especially with teenagers.