Maryland Health and Nutrition Literacy Study  

The goal of this project is to conduct a needs assessment examining nutrition knowledge, attitudes, skills, and behaviors among Maryland’s SNAP-eligible (Supplemental Nutrition Assistance Program) families to improve nutrition education programs.  Using interview and survey data from SNAP clients in five Maryland counties, this study is using a mixed-methods approach to address unanswered questions about the strengths, needs, and unique experiences of this population. The study addresses a broad range of topics, including the ways in which the current economic conditions have impacted families' abilities to afford food, the strategies families have used to acquire food and make ends meet, and how families believe receiving SNAP will change their circumstances. It contains five sub-studies:

  • Latino Immigrant Substudy: This study uses in-depth interviews of recent Latino immigrants to examine food security coping mechanisms, social support, cultural food preferences and access, and other food and nutrition issues.  This project is funded by the USDA Food and Nutrition Service SNAP-Ed program through the Maryland Department of Human Resources. Hopefully, findings from this study will be used to improve food assistance outreach programs.
  • Men's Experiences with Food Insecurity:  Information on this exciting project is coming soon.
  • Parental Feeding Practices in Low-Income, African American Families:  This project explored the parental feeding practices and family eating patterns of low-income, African American parents. Five parent-child feeding interactions were described through the interviews: accommodation, encouragement, food as a reward, parent as leader, and involvement. Two feeding contexts were evident: the influence of government feeding programs and the influence of family, friends, and neighbors.
  • Assessment of The Newest Vital Sign: The Newest Vital Sign (Weiss et al., 2005) is a measure of health literacy that uses a Nutrition Facts Label to quickly assess an individual's ability to answer questions regarding the label information. However, it is difficult to determine whether the instrument assesses label reading and comprehension or arithmetic skills. To examine this question, the original version and a revised version of the NVS with simplified arithmetic tasks were given to a sample of 219 low-income participants. Results indicated a different level of sensitivity in the two instruments and different correlations with other measures of health literacy. Findings provide evidence of a need to clarify concepts like health literacy, nutrition literacy, and numeracy in order to better measure related skills. Accurate conceptualization and measurement are important in assessing needs for programmatic and educational efforts aimed at improving nutrition knowledge and behavior.
  • Food Security, Mental Health, and Locus of Control: This study investigated whether a relationship between food security and mental health exists for both males and females, as well as whether health locus of control mediates this relationship. Data were from a convenience sample of 110 female and 40 male Supplemental Nutrition Assistance Program (SNAP) eligible adults in Maryland. Based on self-reports, the relationship between food security and mental health was significant among males and borderline significant among females. Whereas health locus of control mediated the relationship between food security and mental health for women, it did not for men. Findings indicated men and women commonly experience food insecurity and poor mental health concurrently.   


This study pilots a text-message based nutrition and physical activity program targeting low-income parents of elementary students who participate in school-based FSNE programming. Targeted messages are sent to parents 2-3 times per week for several months. Process and outcome evaluations examine the implementation and effectiveness of the program in improving fruit and vegetable consumption, physical activity, readiness to change health behaviors, and mobile usage.

Project ReFresh

Project ReFresh is a school-based intervention program aimed at improving nutrition and health decisions among students in Title I elementary schools in Maryland. This program strives to integrate classroom education with cafeteria improvements that help students choose more fruits and vegetables through the use of environmental nudges. A toolkit of cafeteria improvement strategies aims to structure choices in the cafeteria environment, market and promote healthy foods, enhance interactions between cafeteria staff and students, and improve student decision-making in the cafeteria.

Feeding for Healthy Eating

Feeding for Healthy Eating (FHE) is a nutrition education curriculum that focuses on caregiver feeding practices and is based on the USDA Core Nutrition Messages. There are two versions, one for use with parents and one for use with child care providers caring for preschool-aged children.   Intended outcomes include: 1) Caregivers learn the impact of their eating habits and feeding practices; 2) Caregivers prepare and consume foods with young children more often; and 3) Young children develop healthy eating habits. FHE is currently being pilot-tested in classes taught by Maryland Food Supplement Nutrition Education.

Healthy Cents

Healthy Cents is a food resource management curriculum aimed at integrating resource management and nutrition principles in a dialogue learning-based education program. In addition to developing curricular materials, research includes formative, process, and outcome evaluation during the pilot period. The objective of the curriculum is to assist low-income individuals and families with the development of skills in managing their food resources, such as cash, food stamps, and community assistance, which will, in turn, help them to obtain nutritious and adequate food.