- Author: Mike Hsu
The buzz or chirp of an incoming text message started some San Diego County residents on the path to a healthier diet during this past year. In September 2020, most CalFresh participants in the county – more than 172,000 households – began receiving monthly text messages about the benefits of California-grown fruits and vegetables as part of a pilot program.
This novel approach to delivering nutrition messages to California food assistance program participants was developed by a partnership of the Nutrition Policy Institute of UC Agriculture and Natural Resources, the UC San Diego Center for Community Health and the County of San Diego Health and Human Services Agency, which administers CalFresh in the county.
The HHSA, which had been using its text messaging platform to send administrative reminders and alerts, was receptive to using the tool for sending nutrition-focused information. NPI and CCH partnered with ideas42, a firm that applies behavioral science to solutions for social change, to develop a series of five text messages promoting California-grown fruits and vegetables.
The text messages – originally delivered in English and Spanish, with the addition of Arabic beginning in July 2021 – were friendly and conversational in tone.
“In a text, you have very few characters you're communicating with people, so we wanted to make sure we were using cutting-edge behavioral science to construct those messages to have the most impact,” said Wendi Gosliner, NPI senior researcher and policy advisor.
Each text included a link directing recipients to a website developed as part of the project, with information on selecting, storing and preparing California-grown fruits and vegetables; health benefits; tips to reduce food waste; and recipes – including TikTok videos.
Initially running from September 2020 to March 2021, the pilot program was well-received. Nearly 90% of CalFresh participants responding to a survey said they appreciated receiving the texts. “It is very important for us to eat healthy, to teach our children to eat healthy,” wrote one participant. “I love the recipes…they're so delicious and easy to make…I'm very, very grateful for the help because without you guys, I would be struggling more and I just want a better life for my children.”
Gosliner said it was encouraging to see that two-thirds of the approximately 5,000 survey respondents reported eating more California-grown fruits and vegetables after receiving the messages, and 85% expressed a desire to see more texts.
“What we see is that there's definitely a decent-sized population of people participating in CalFresh –now this is just in San Diego County but imagine the entire state – who would benefit from having this kind of information available to them,” Gosliner said. “And there is at least a subset of people who really liked it.”
UC San Diego's Center for Community Health was instrumental in facilitating the partnership between UC ANR and the HHSA. Further, CCH, in partnership with the San Diego County Childhood Obesity Initiative, formed a community council composed of residents representing diverse communities throughout San Diego County. Together, the council facilitated CalFresh participants to take part in focus groups, which provided feedback and guidance on the messaging and design for online resources. Gosliner said the success of the text program has been a direct result of community input and involvement.
“The Center for Community Health-led focus groups were integral to ensuring CalFresh resources were accessible and informative to a wide range of CalFresh participants, and local individuals and families more broadly,” said Blanca Meléndrez, executive director at the UC San Diego Center for Community and Population Health, Altman Clinical Translational Research Institute. “In the process, the text-based campaign also placed a greater focus on the local production of nutritious fruits and vegetables, ensuring access to healthy and nutritious food in all communities, and building new streams of income for the region's farmers and producers.”
This effort also suggests a simple way to reach CalFresh participants and bridge gaps between the Supplemental Nutrition Assistance Program and programming that offers nutrition education and healthy eating resources.
“By combining UCSD and UC ANR knowledge about healthy eating with our outreach capability, we are able to reach thousands of families via text message each month,” said Michael Schmidt, human services operations manager for the HHSA. “With the click of a button, these families are provided with resources to assist them in making healthier lifestyle choices, supporting a region that is building better health, living safely and thriving.”
The effort has been so effective that HHSA has asked for additional messages, beyond the original five months' worth of texts and resources.
“The partnership between UC ANR's Nutrition Policy Institute, UC San Diego's Center for Community Health, the County of San Diego Health and Human Services Agency and San Diego County community residents brought together a great team to develop an innovative, technology-based intervention,” said Shana Wright, San Diego County Childhood Obesity Initiative co-director at CCH. “Each partner provided knowledge, resources and assets that enhanced the project beyond the initial pilot phase, exceeding preliminary expectations.”
Gosliner said the pilot program has been a “great example and wonderful experience” of partnership in action.
“You can sit with your research or program ideas for a long time but if you don't have people who can help you implement them, then they really aren't helpful in any way,” she said. “In this case, it was just a nice combination of an idea…with partners who wanted to work to make something happen.”
- Author: Rachael Callahan
- Author: Cooper Limon
The COVID-19 pandemic hit farmers hard. Supply chains were disrupted and even non-traditional agritourism revenue streams such as hay mazes and on-farm events had to be canceled due to shelter-in-place mandates.
On the other hand, demand for local farm products skyrocketed, and thus many farmers and ranchers needed a quick pivot strategy and a set of new skills.
UC Sustainable Agriculture Research and Education Program (SAREP) was well-positioned to support this shift toward direct sales, pulling in trusted community partners and experienced farmers and ranchers to put together a comprehensive webinar series, “Agritourism and Direct Sales: Best Practices in COVID Times and Beyond”.
Funded by a USDA Farmers Market Promotion Program (FMPP) grant, the webinar series is part of a three-year project, Strengthening California Local Food Networks with Agritourism and Direct Sales, which provides trainings and technical assistance to farmers and ranchers on how to diversify their revenue streams.
The strength of the series, which includes eight webinars that were recorded earlier this year and are available online, lies in the collaborations among the UC SAREP Agritourism Program, UCCE, community groups, and farmers and ranchers.
The series features a range of speakers, including representatives from community organizations, technical experts, academic researchers, and farmers – all coming together to build resilience and adaptability for small-farming operations and the agritourism industry across California during the pandemic and after.
“It's great to collaborate with other organizations and regions, to learn from each other and to broaden our networks, as we are all working to create more resilient and sustainable food systems,” said Carmen Snyder, executive director of Sonoma County Farm Trails, one of the nonprofit partners on this project.
And because of those strong partnerships, the webinar topics reflected the on-the-ground needs facing agricultural producers.
“COVID initially dramatically affected farmers' restaurant contracts, with many losing more than 80% of their accounts overnight,” Snyder said. “CSAs [Community Supported Agriculture], on the other hand, couldn't keep up with the demand, and all of our CSA members were full and had wait lists for the first time ever. Producers pivoted by creating more online stores, including pick-up and delivery options. It was a challenge for them to navigate the new technology and platforms.”
The “Online Sales Options and Methods” webinar, a partnership with the Community Alliance with Family Farmers (CAFF), provided an overview of several e-commerce marketing and online sales strategies that farmers can implement to diversify their revenue pathways and reach new customers. CAFF stressed the importance of farmers enhancing their resiliency through e-commerce.
The webinar also featured Ciara Shapiro, the owner of AM Ranch in Penn Valley, who shared her experience with online marketing and how it helped her and her husband survive the pandemic when the restaurants and farmers markets they sold to shut down. This personal and informative webinar demonstrated the effectiveness of online sales and marketing, while highlighting available resources from groups like CAFF.
The “Safe, Healthy and Successful Farm Stands” webinar was aimed at farms of all sizes and organizations that operate or advise agricultural operations using farm stands as a form of revenue. The webinar provided an outline of the rules and regulations that farm stand operators needed to follow during COVID – as well as during business-as-usual times.
Both farmers saw an increase in farm stand business during the pandemic, which Yagi attributed to the “traffic storm of people” who attended their annual plant sale fundraiser and came to participate in new farm outdoor activities and volunteer opportunities. Yagi also noted the growing number of low-income individuals who were unable to access fresh produce during the pandemic.
The speakers' shared experiences running successful farm stands gave audience members tangible examples and real-time information on how to incorporate farm stands into their businesses.
Carmen Snyder of Sonoma County Farm Trails, which helped circulate the recorded webinars to their network of farmers and ranchers, remarked: “These webinars were extremely helpful for local producers, to get clarity on best pandemic practices during these challenging times and to learn how other producers are adapting and navigating the circumstances.”
Contrary to the messages we are exposed to from popular culture, media, and public health about body size, focusing on how much a person weighs isn't necessarily an effective way to promote health. These messages play a role in reinforcing what some call “diet culture” and others have called “anti-fat bias.” Diet culture associates weight loss and thinness with health despite mounting evidence of the negative impacts of dieting. Anti-fat bias can persist in workplace, healthcare, and educational settings, threatening both the emotional and physical health of obese or overweight individuals.
Research is showing that weight is not a reliable indicator of an individual's health nor is a weight-centric approach helpful in improving overall well-being. Weight-centric, or weight-normative, approaches emphasize weight, body mass index (BMI), and weight loss as positive indicators of health and well-being. This type of approach values thin body types over others and can have negative consequences such as weight stigmatization, discrimination, and body dissatisfaction; consequences that are associated with weight gain, unhealthy eating behaviors, and depression.
While some weight loss interventions may reduce weight or improve health metrics in the short term, these interventions typically involve other behavioral changes such as increasing physical activity or changing eating patterns which make it difficult to attribute the cause of health improvements. Is the improvement in health due to the reduction in weight or to the increase in physical activity?
Also, while some people on weight loss diets lose weight in the first year, if followed for more than one year, people in peer-reviewed studies typically regain most of the weight back within the following five years. Repeatedly losing and regaining weight, or weight-cycling, increases the risk of heart disease and high blood pressure and is an independent risk factor for poor health outcomes, even in normal-weight individuals. Studies reveal that losing and regaining weight may be worse for a person's physical and psychological health than consistently staying at a higher weight.
Due to the issues with long-term ineffectiveness of weight-centric interventions, and increasing recognition of the relationship between racism and anti-fat bias, there is a need to shift focus to weight-inclusive or weight- neutral approaches. Weight-inclusive or weight-neutral approaches emphasize improving access to health promoting resources and reducing weight stigma. Studies have shown numerous health benefits, even in the absence of weight loss, are achievable and sustainable in the long-term using a weight-neutral approach.
One example of this approach includes Health at Every Size (HAES). HAES principles promote the acceptance of body diversity, intuitive eating not focused on weight control, support for policies that equalize access to resources, respectful care towards ending weight discrimination, and inclusive physical activity. Weight-inclusivity does not promote the message that everyone, in every body size, is healthy. What it does promote is that everyone, regardless of their body size, can be working on health-related goals without focusing on changing their body size.
Weight-inclusive approaches that are rooted in a social justice and systems-oriented framework can powerfully acknowledge the social and political roots of health inequities. To be most effective, and to avoid other forms of stigma or shame, these approaches should consider the influence of life factors such as poverty, discrimination, stigma, and job insecurity and how these factors constrain or support health behaviors and personal choice.
Research spanning the last decade has been showing that the HAES approach is associated with improvements in blood pressure, health behaviors, self-esteem, and body image and has done so more successfully than weight loss treatment. Further, studies show that interventions that encourage individuals to eat intuitively help participants abandon unhealthy weight control behaviors, improve metabolic fitness, increase body satisfaction, and improve psychological distress. Results from literature reviews favor the promotion of programs that emphasize a non-restrictive pattern of eating, body acceptance, and access to health promoting resources rather than weight loss.
There is a growing body of research showing that HAES and weight-inclusive approaches are better able to address overall health and wellness than focusing on BMI or weight reduction. Shifting focus away from weight loss, thinness, obesity prevention, and looking a certain way to achieve better health could potentially make us a healthier and more equitable society. Despite these movements being met with hesitation, weight-inclusive approaches have been demonstrated to be effective health promoting strategies.
Shifting the focus of health interventions away from losing weight as an end goal is not new and it doesn't even have to be that revolutionary. Many of the governmental recommendations to be physically active and follow a balanced diet following the Dietary Guidelines for Americans that UC ANR nutrition programs and CalFresh Healthy Living, UCCE programs teach in communities across California could be used in either a weight-centric or weight-inclusive approach. In our San Luis Obispo & Santa Barbara county nutrition programs we have advocated for books to be removed from curricula if they promote anti-fat bias and have started making changes in how we talk about our work to prevent chronic disease and promote health instead of preventing obesity. Still, the idea of obesity and overweight as the central concern for public health and popular media has stayed with us longer than has proven necessary or effective for actually improving the health of individuals and society.
Do you have unconscious bias toward overweight or obese people? Consider taking the Harvard Implicit Association Test for Weight.
- Author: Ricardo A. Vela
The CalFresh Healthy Living, UC Program, administered through UC Cooperative Extension (UCCE), works with ethnic communities to transform their environment by implementing a community garden. UCCE created three gardens in partnership with community organizations in an equal number of neighborhoods located in this populous county.
In the first one, adults and minors dug and planted seeds and various vegetable plants in a community garden located in Riverside's popular Latino neighborhood. The vegetable garden has brought people in this low-resource community together to address healthy food access and learn about healthy eating and nutrition.
Gonzalo Rodríguez, an active member of the Community Settlement Association, said, "We planted pepper plants, tomatoes and little seeds. Vegetables are an excellent food for us, and another thing that keeps children off the streets and helps them understand the process while having fun taking care of their plants."
The garden in this thriving Latino community has grown over the years and is now a place for families to get together to celebrate healthy living. Educating food-insecure families of different ethnicity, the importance of having a vegetable garden, and how to grow your own food is a goal of the CalFresh Healthy Living, UC Program, and UCCE in Riverside County.
The second garden is located on what used to be a vacant lot in the Riverside Faith Temple under Pastor Duane Sims' supervision, who spoke about his vision. "I would like to see it a complete food force, a source of food that won't cost anybody anything, and something for people that don't have anything to do, a place to put their hands in the dirt and accomplish something."
These community gardens collaborate with several programs from the University of California Agriculture and Natural Resources and partner with ethnic organizations to combat the poor eating habits that result in obesity, chronic diseases, and sometimes premature death.
"We're trying to get low-income families to eat more vegetables, and the best way to do this is to encourage them to plant their own fruits and vegetables in an orchard, and that's why we're promoting community gardens," said Chutima Ganthavorn, UCCE nutrition specialist in Riverside County.
Adela Torres and her children are involved in the project with the Community Settlement Association in Riverside. "It's beneficial for the children because they are fresh fruits or things that we can have at home," she said.
Ganthavorn reaffirmed the UCCE and CalFresh Healthy Living, UC's commitment to helping ethnic communities live a healthier diet. "We know that many people's diets today are fast food and soft drinks, and they are not consuming fruits and vegetables. We need to eat almost nine portions of fruits and vegetables a day, and most of us aren't getting close to that level. We are trying to encourage the consumption of fruits and vegetables, especially vegetables because they contain many nutrients and many health benefits," she said.
- Author: Katie Panarella
- Author: Andra Nicoli
In the spring of 2020, UC Agriculture and Natural Resources' Expanded Food and Nutrition Education Program (EFNEP) and the CalFresh Healthy Living, UC (CFHL UC) Program faced the unprecedented experience of shelter-in-place and school closures due to COVID-19. Both federal nutrition education programs relied on in-person contact by UC Cooperative Extension nutrition education staff as a means of building and sustaining relationships with community members, stakeholders and partners serving vulnerable populations.
CFHL UC and EFNEP state office staff, in collaboration with the Center for Nutrition in Schools, reacted quickly to serve their clientele's needs. The coordinated effort of state office teams resulted in the dissemination of a staff needs assessment, which culminated in the training of over 150 educators and supervisors to quickly pivot lessons for online and distance learning. State staff and educators began designing online curricula delivery models to re-engage students, creating a library of virtual lessons with distance-learning strategies. This included using Zoom, social media platforms such as Facebook Live and YouTube, and learning platforms such as Google Classroom. To provide quality assurance, reach and outcome measures also began undergoing adaptation for this new learning environment.
Examples of new remote learning capabilities include:
More than 60 online lessons under development for children pre-kindergarten through 8th grade that emphasize healthy eating, active living and gardening.
CalFresh Healthy Living, UCCE county programs are developing the online delivery of five adult curricula, including UC-developed Plan, Shop, Save and Cook and Making Every Dollar Count that provide food resource management tips, as well as ideas for how to stay active and purchase healthy food on a limited budget. These lessons are particularly valuable at this time of high unemployment.
EFNEP's Technology and Social Media Plan includes a pilot of ‘blended learning' using mail, phone and video chat for our UCCE Connects to You Series. CFHL UC also utilizes mailings and phone call follow-ups with this curriculum.
Further, CFHL UC educators are offering lessons and short educational segments online, maintaining school gardens, working at food banks (with the permission of local county directors) and, in partnership with school meal programs, offering complimentary nutrition education and physical activity take-home lessons and resources to students and families at meal pick up locations. Youth engagement projects continue to engage student leaders online through Youth-Led Participatory Action Research (YPAR) projects.
In response to COVID-19, the EFNEP and CFHL UC state and county staff continue to build and enhance the skills of our educators while serving California's most vulnerable communities. These efforts are critical to maintain trusted relationships, which both programs successfully established over decades of service to promote healthy people and communities in California.