However, the USDA leads the nation’s  nutrition education efforts, providing nutrition education through the  EFNEP program and through four of its major nutrition assistance  programs. On the basis of this work, program  officials should take these actions during program design, service delivery,  and program monitoring and evaluation. Key Actions in Nutrition Education Can Increase the Likelihood of Success

We identified several key actions presented in general nutrition education  research, prior GAO reports, and other documents on performance-based  management that program officials should take during any nutrition  education program. However, if seriously  addressed, these actions will increase the likelihood that the nutrition  education will achieve its goals. These actions occur at three separate  stages in a nutrition education program: program design, service delivery,  and program monitoring and evaluation. Identifying the target  population can help program officials focus their goals and planning  efforts appropriately. Programs Incorporated the Service Delivery Actions in Different Ways and to Varying Extents but Faced Similar Challenges to Incorporating Them

We found that the USDA programs incorporated the service delivery  actions likely to contribute to successful nutrition education in different  ways and to varying extents, but they faced similar challenges that  affected their ability to fully incorporate these actions. The  children received tailored interventions, based on the assessments, with  goals such as increasing fruit intake at lunch and increasing physical  activity throughout the school day. In  addition, other program requirements restricted the time and resources  available for nutrition education. For  example, WIC providers were required by law to provide services  unrelated to nutrition education, such as voter registration and drug and  alcohol counseling. Programs Generally Did Not Incorporate Key Nutrition Education Evaluation Actions, Leaving Officials with Limited Information about Program Results

The programs we reviewed generally did not fully incorporate the  monitoring and evaluation actions that are key to performance-based  management and likely to contribute to successful nutrition education. Most of the programs—with the exception of EFNEP—did not  systematically collect data at the federal level on the types of nutrition  education services provided, who received these services, and the  outcomes of the services. Available Research Provides Little Information about whether the Programs Have Met Their Nutrition Education Goals

Despite the lack of regular nationwide evaluations, USDA and others have  conducted some limited or smaller-scale evaluations and studies of the  nutrition education efforts. Conclusions

Over the past few decades, the negative health consequences of poor  nutrition have grown dramatically in the United States. Recommendations for Executive Action

To help overcome the challenges associated with USDA’s nutrition  education efforts and to help programs incorporate the key actions related  to successful nutrition education, we recommend that the Secretary of  Agriculture ensure that the department develop a unifying strategy that, at  a minimum:  Identifies ways to improve coordination efforts and strengthen the  linkages among the nutrition education efforts, which would include  examining options ranging from more systematically sharing nutrition  education resources across programs to identifying and promoting  approaches for federal, state, and local officials to implement cross- program strategies to more efficiently use existing resources.
Why GAO Did This Study

The Centers for Disease Control and Prevention recently reported that poor nutrition and lack of physical activity are catching up to tobacco use as the leading cause of death in the United States. In addition to having negative health outcomes, children with poor nutrition may have a harder time succeeding in school than other children. To help improve nutrition, the U.S. Department of Agriculture (USDA) provides nutrition education through five of its programs. The department spent $472 million on these efforts in fiscal year 2002. GAO was asked: (1) What key actions can officials take to increase the likelihood of success in nutrition education? (2) Do USDA and state and local officials take these actions during program design, service delivery, and program monitoring and evaluation?

What GAO Found

GAO identified several key actions, based on research and performance-based management principles, that increase the likelihood that programs providing nutrition education will achieve their goals. Examples of these actions include identifying program goals, tailoring services to meet the needs of participants, and collecting data on program results. The actions can be taken during program design, service delivery, and program monitoring and evaluation. USDA programs providing nutrition education that we reviewed--the Food Stamps Program; the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); the National School Lunch Program; the Child and Adult Care Food Program; and the Expanded Food and Nutrition Education Program--generally incorporated the key program design actions likely to contribute to success. For example, the USDA programs identified nutrition education goals and target populations. However, the programs' administrative structures hinder coordination among the USDA nutrition education efforts. We found that the USDA programs incorporated the service delivery actions likely to contribute to successful nutrition education in different ways and to varying extents, but they faced similar challenges that affected their ability to fully incorporate these actions. The challenges included limited resources and systems for providing nutrition education and competing program requirements that took time or resources away from nutrition education. For example, WIC officials said they had limited time for nutrition education because of competing requirements, such as providing information on drug and alcohol counseling. USDA's nutrition education efforts did not fully incorporate the monitoring and evaluation actions that contribute to success, such as collecting data on the types of nutrition education provided and the outcomes of the efforts. As a result, little is known about what nutrition education is provided and whether these programs have met their nutrition education goals.