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R4: Dairy

Framework Component

Population Results - Trends and Reductions in Disparities

Indicator Description

This indicator represents change in dairy product consumption and/or adequacy of consumption over time, from year to year, of the low-income population of the state. Unlike MT1 and LT1 (Healthy Eating Behaviors), which measure increases in low-fat/fat-free dairy consumption attributed to SNAP-Ed series-based programs, R4 is intended to measure the proportion of the SNAP-Ed eligible population that is achieving the Dietary Guidelines for Americans recommendations. Thus, R4 measures dairy consumption status for low-income households surveyed within the state or area of focus. R4 is a population-level surveillance measure.

Background and Context

Under-consumption of calcium is a public health concern for the majority of Americans. Calcium plays a major role in bone health and also is essential for proper functioning of the cardiovascular system, nerve transmission, muscle contraction, cell signaling pathways, and vascular integrity. Although there are other sources of calcium, the calcium from plant foods is less bioavailable than that of animal foods, like dairy. Fifty-seven percent of women and 41 percent of men aged 19 and older in the United States have calcium intake below the estimated average requirement. Preadolescent and adolescent females, pregnant females, middle aged and older females, and elderly males are at particular risk.1

This is an appropriate indicator to use when SNAP-Ed in the program being evaluated provided a sufficient dose of R4 low-fat dairy intervention to expect behavior change that will last over an extended time period. Examples include Rethink Your Drink interventions in which fat-free/low-fat milk is emphasized as a preferred alternative; provider/parent education in early child care settings that include a strong component about fat-free/low-fat dairy items and number of servings for preschool age children; and PSE interventions to increase access to fat-free/low-fat dairy items in corner stores.

Outcome Measures

What to Measure

Adults
  1. Number or percentage of adults who report drinking low-fat (1%) or fat-free versions of milk or fortified soy beverages
  2. Number or percentage of adults who report eating low-fat (1%) or fat-free versions of yogurt or cheese
  3. Number or percentage of adults who report switching from whole or 2% milk to low-fat (1%) or fat-free milk
  4. Number or percentage of adults who report drinking/eating any dairy products, regardless of fat level, three or more times per day
Children/Adolescents
  1. Number or percentage of children/adolescents who report drinking low-fat (1%) or fat-free versions of milk or fortified soy beverages
  2. Number or percentage of children/adolescents who report eating low-fat (1%) or fat-free versions of yogurt or cheese
  3. Number or percentage of children/adolescents who report switching from whole or 2% milk to low-fat (1%) or fat-free milk
  4. Number or percentage of children/adolescents who report drinking/eating any dairy products, regardless of fat level, three or more times per day

Population

Youth (3rd grade and above) or Adults

Surveys and Data Collection Tools

At this time, no national surveillance systems routinely collecting data provides state-level statistics on dairy indicators. Consequently, evaluation data can only be collected by 1) adding a module of questions like those listed below to a statewide survey collecting population data that can identify the low-income segment of its sample, such as your state's BRFSS; 2) conducting a population-level 24-hour recall with your state SNAP-Ed population or another representative low-income population sample; or 3) conducting another type of annual regular data collection that includes these questions from either your total SNAP-Ed eligible population or a representative random sample of it. The same question module should be used year-to-year for consistency.

Example: All Michigan Fitness Foundation (MFF) funded partners are required to administer the National Cancer Institute (NCI) Fruit and Vegetable Screener as a pre-post instrument based on a convenience sample of program participants per funded partner. If a partner's direct SNAP-eligible reach is less than 500, it is required to administer 75 survey pairs. If it is greater than 500, a representative sample of 15 percent is required. Representative is a key word. If necessary, oversampling must be done in order to obtain a sample reflective of the characteristics of the partner's population.

ADULTS

CHILDREN & YOUTH

Additional Resources or Supporting Citations

1What We Eat in America, NHANES 2007-2010, individuals 1 year and over (excluding breast-fed children and pregnant or lactating females), dietary intake data. Prepared by the Food Surveys Research Group, Beltsville Human Nutrition Research Center, and Agricultural Research Service. U.S. Department of Agriculture as Part E. Section 2: Supplementary Documentation to the 2015 DGAC Report.

2 Hedrick VE, Savla J, Comber DL, et al. Development of a brief questionnaire to assess habitual beverage intake (BEVQ-15): Sugar-sweetened beverages and total beverage energy intake. J Acad Nutr Diet. 2012;112;(6):840-9.

3 BSQ - Neuhouser ML, Lilley S, Lund A, et al. Development and validation of a beverage and snack questionnaire for use in evaluation of school nutrition policies. J Am Diet Assoc 2009. 109;(9):1587-1592.