A Proposed Cost-Benefit Analysis of Adult EFNEP Utilizing Biomarkers of Chronic Disease Risk

Objective: To assess whether the adult Expanded Food and Nutrition Education Program (EFNEP) is a cost-effective intervention that generates sustained improvement in biomarkers of chronic disease risk.

Design: A longitudinal quasi-experimental design with 2 parallel arms (untreated comparison vs EFNEP) and 4 waves of data collection (pretest, posttest, 6 months, and 12 months after completion).

Setting: Eligible adult EFNEP community settings in Colorado, Florida, Maryland, and Washington.

Participants: Free-living adults (n = 500) aged 18-50 years, with income ≤ 185% of the Federal Poverty Line.

Intervention(s): Adult EFNEP delivered using an evidence-based curriculum, Eating Smart • Being Active.

Main outcome measure(s): Chronic disease biomarkers (body mass index, blood pressure, and HbA1c), food and physical activity behaviors, dietary intake, health status, and demographics will be measured using objective biometric indicators, the Adult EFNEP Questionnaire, a 24-hour dietary recall, a health questionnaire, and demographic forms.

Analysis: Linear mixed models will be used to assess whether adult EFNEP has a significant (P < 0.01) impact on 3 chronic disease biomarkers. The program's estimated impact on chronic disease biomarkers will be incorporated into a cost-benefit analysis framework to assess the economic value generated by adult EFNEP through chronic disease risk reduction.