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Access Type

Open Access

Degree Program


Degree Type

Master of Science (M.S.)

Year Degree Awarded


Month Degree Awarded



Nutrition, Food Security, Low-Income, EFNEP, Education, Dietary Practices, Food Behaviors


Food insecure individuals do not always have access to adequate food for a healthy lifestyle and are at high risk of detrimental health outcomes. Researchers hypothesize that food insecurity leads to changes in dietary practices, including greater overall food purchase in times of adequate resources and purchase of low-cost, unhealthful foods when resources are constrained. Most measures of food insecurity do not measure changes in dietary practices and dietary quality. Research findings suggest education that provides alternative strategies to manage resources and improve dietary practices can improve food insecurity.

We assessed the relationship between 1) food security and ability to afford foods and 2) the impact of Expanded Food and Nutrition Education Program (EFNEP) in a low-income, multi-cultural population in Massachusetts. We used a pre/post-education survey design, including the USDA six-item Food Security Module (FSM), food-affordability questions and EFNEP behavior checklist.

EFNEP participants experienced high rates of food insecurity with over 40% of participants classified as food insecure (N=80). Pre-EFNEP, individuals in households with low food security were less likely to report being able to afford healthy foods (51.5%) and fruits and vegetables (57.6%) throughout the month compared to those in households with high (80.9%) and marginal (78.7%) food security (P=0.007, P=0.051). Individuals in households with marginal, low and very low food security were less likely to report being able to afford the same kinds of food throughout the month compared to individuals in high food secure households (56.4% vs. 84%) (P=0.022). Individuals in food insecure households reported running out of food before the end of the month more often than their food secure peers (P=0.013). Post-EFNEP, a greater proportion of participants fell into the high and marginal categories of food security (60.0% to 71.7%, P=0.065).

Our results indicate that food insecure households have a harder time affording healthy foods throughout the month, leading to poor diet quality that possibly contributes to poor health outcomes. The food affordability questions may capture changes in dietary practices in food insecure populations throughout the month. EFNEP can provide skills and knowledge to at risk populations to improve abilities and combat food insecurity.

First Advisor

Jerusha Nelson Peterman