{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,3]],"date-time":"2025-05-03T04:10:24Z","timestamp":1746245424694,"version":"3.40.4"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T00:00:00Z","timestamp":1746144000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>The Expanded Food and Nutrition Education Program (EFNEP) is a federal initiative aimed at improving the dietary behaviors and nutrition knowledge of low-income households. This study evaluates the impact of Texas EFNEP on the dietary quality of participants using data from across ten counties over four fiscal years (2019\u20132022). Dietary quality was assessed using the Healthy Eating Index-2015 (HEI), calculated from 24-hour dietary recalls collected before and after participation in the program. The study analyzed changes of HEI scores across fiscal years, counties, socio-demographic characteristics, and public assistance program participation. The Texas EFNEP intervention resulted in a statistically significant improvement in overall HEI scores, 4.23 on average. The greatest dietary improvements were noted in Tarrant and Hidalgo counties. Among racial groups, participants identified as Asian showed the most improvement on average, followed by participants identified as white and as black. On average, Hispanic participants experienced greater dietary improvements than non-Hispanic participants. Based on regression analysis, geographic location and participation in public assistance programs such as the Child Nutrition Program (CNP) significantly impacted total HEI scores, but age, income, and hours taught in EFNEP were not statistically significant determinants. Statistically significant improvements were detected in eight of the nine adequacy components of the HEI, including total fruit, whole grains, and dairy. Concerning the moderation components, statistically significant changes were evident for refined grains, added sugar, and saturated fat. However, the program was less effective in moderating sodium intake, a known dietary challenge in low-income populations. The findings suggest that the Texas EFNEP contributed to improvements in overall dietary quality, including enhancements in both adequacy and moderation components of the Healthy Eating Index. These findings are consistent with prior research concerning the effectiveness of EFNEP studied in other states and regions.<\/jats:p>","DOI":"10.1371\/journal.pone.0320607","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T17:36:38Z","timestamp":1746207398000},"page":"e0320607","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The role of the expanded food and nutrition education program in improving healthy eating index scores for low-income households in selected counties in Texas"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9063-1740","authenticated-orcid":true,"given":"Oral","family":"Capps","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xingguo","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,5,2]]},"reference":[{"issue":"6","key":"pone.0320607.ref001","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/S0022-3182(89)80145-1","article-title":"20 years of EFNEP: Changes and challenges","volume":"21","author":"H Chipman","year":"1989","journal-title":"Journal of Nutrition Education Behavior"},{"key":"pone.0320607.ref002","article-title":"United States Department of Agriculture\u2019s Cooperative State Research, Education, and Extension Service (USDA-CSREES)."},{"issue":"1","key":"pone.0320607.ref003","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1177\/1077727X8101000108","article-title":"Dietary intake and food behavior practices: long\u2010term effects of the Georgia Expanded Food and Nutrition Program","volume":"10","author":"AJ Brown","year":"1981","journal-title":"Home Economics Research Journal"},{"issue":"2","key":"pone.0320607.ref004","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/S0022-3182(86)80226-6","article-title":"Dietary changes resulting from the expanded food and nutrition education program","volume":"18","author":"MK Amstutz","year":"1986","journal-title":"Journal of Nutrition Education"},{"issue":"2","key":"pone.0320607.ref005","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/S0002-8223(21)01937-4","article-title":"Evaluation study of the California Expanded Food and Nutrition Education Program: 24-hour food recall data","volume":"88","author":"AM Del Tredici","year":"1988","journal-title":"J Am Diet Assoc"},{"key":"pone.0320607.ref006","unstructured":"Nierman LG. A longitudinal study of the retention of foods and nutrition knowledge and practices from Michigan Expanded Food and Nutrition Education Program. 1988."},{"issue":"1","key":"pone.0320607.ref007","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/S0022-3182(88)80290-5","article-title":"Use and effectiveness of wyoming EFNEP\u2019s lesson series","volume":"20","author":"VA Romero","year":"1988","journal-title":"Journal of Nutrition Education"},{"issue":"6","key":"pone.0320607.ref008","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0022-3182(89)80143-8","article-title":"Virginia EFNEP homemakers\u2019 dietary improvement and relation to selected family factors","volume":"21","author":"DM Torisky","year":"1989","journal-title":"Journal of Nutrition Education"},{"issue":"2","key":"pone.0320607.ref009","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/S0022-3182(12)81073-9","article-title":"Retention of nutrition knowledge and practices among adult EFNEP participants","volume":"26","author":"MS Brink","year":"1994","journal-title":"Journal of Nutrition Education"},{"issue":"3","key":"pone.0320607.ref010","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/S0022-3182(00)70540-1","article-title":"Food practices and nutrition knowledge after graduation from the Expanded Food and Nutrition Education Program (EFNEP)","volume":"32","author":"CG Arnold","year":"2000","journal-title":"Journal of Nutrition Education"},{"issue":"1","key":"pone.0320607.ref011","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/S0002-8223(02)90014-3","article-title":"EFNEP: a nutrition education program that demonstrates cost-benefit","volume":"102","author":"J Burney","year":"2002","journal-title":"J Am Diet Assoc"},{"issue":"9","key":"pone.0320607.ref012","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1093\/jn\/135.9.2199","article-title":"Nutrition behavior change among EFNEP participants is higher at sites that are well managed and whose front-line nutrition educators value the program","volume":"135","author":"KL Dickin","year":"2005","journal-title":"J Nutr"},{"issue":"1","key":"pone.0320607.ref013","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.jneb.2014.07.001","article-title":"Outcome effectiveness of the widely adopted EFNEP curriculum Eating Smart-Being Active","volume":"47","author":"G Auld","year":"2015","journal-title":"J Nutr Educ Behav"},{"issue":"5","key":"pone.0320607.ref014","doi-asserted-by":"crossref","first-page":"421-6.e1","DOI":"10.1016\/j.jneb.2015.05.001","article-title":"Improved overall quality of diets reported by Expanded Food and Nutrition Education Program participants in the mountain region","volume":"47","author":"PM Guenther","year":"2015","journal-title":"J Nutr Educ Behav"},{"issue":"2","key":"pone.0320607.ref015","article-title":"Demonstrating impact through replicable analysis: Implications of an evaluation of Arkansas\u2019s Expanded Food and Nutrition Education Program","volume":"55","author":"J Phelps","year":"2017","journal-title":"JOE"},{"issue":"4","key":"pone.0320607.ref016","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1177\/1559827615607194","article-title":"What social, program, and behavioral factors influence the Healthy Eating Index for EFNEP and SNAP-Ed adult participants?","volume":"11","author":"DD Weatherspoon","year":"2017","journal-title":"Am J Lifestyle Med"},{"issue":"3","key":"pone.0320607.ref017","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1177\/1559827619872733","article-title":"The effectiveness of the Expanded Food and Nutrition Education Program (EFNEP) on diet quality as measured by the Healthy Eating Index","volume":"14","author":"S Perkins","year":"2019","journal-title":"Am J Lifestyle Med"},{"key":"pone.0320607.ref018","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.ypmed.2018.12.006","article-title":"Interventions targeting diet quality of Supplemental Nutrition Assistance Program (SNAP) participants: A scoping review","volume":"119","author":"A Verghese","year":"2019","journal-title":"J Prev Med"},{"issue":"8","key":"pone.0320607.ref019","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.jneb.2021.03.006","article-title":"Effectiveness of expanded food and nutrition education program in changing nutrition-related outcomes among adults with low income: A systematic review","volume":"53","author":"AT Atoloye","year":"2021","journal-title":"J Nutr Educ Behav"},{"issue":"6","key":"pone.0320607.ref020","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.jneb.2020.12.006","article-title":"Positive change in healthy eating scores among adults with low income after Expanded Food and Nutrition Education Program participation","volume":"53","author":"SMH Gills","year":"2021","journal-title":"J Nutr Educ Behav"},{"key":"pone.0320607.ref021","unstructured":"Valdez GG. 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