Document Type

Thesis - Open Access

Award Date

2026

Degree Name

Master of Science (MS)

Department / School

Economics

First Advisor

Andrea Leschewski

Abstract

This study examined the individual and combined associations of participation in the Expanded Food and Nutrition Education Program (EFNEP) and nutrition assistance programs with diet quality and biomarkers of chronic disease risk. Multistate longitudinal data were analyzed using triple difference-in-differences regression models for body mass index (BMI), systolic and diastolic blood pressure, hemoglobin A1c (HbA1c), and Diet Quality Index (DQI). EFNEP participation was associated with a reduction in BMI over time among participants not receiving nutrition assistance, but this association was attenuated among assistance participants. A similar differential pattern was observed for HbA1c. No significant differential changes were found for blood pressure. EFNEP was associated with a modest short-term improvement in diet quality, but the improvement was not sustained, and combined participation in EFNEP and child nutrition assistance did not produce additional gains. Overall, the findings provided limited evidence that nutrition assistance strengthened the effects of EFNEP on diet quality or chronic disease biomarkers.

Publisher

South Dakota State University

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Rights Statement

In Copyright