In addition to a deeper understanding of Native foods and their nutritional properties, young people came away from the summer program with a binder of Native American recipes. Photo by Cailin McLaughlin

Program with Foothill Indian Education Alliance teaches healthy eating to young people of many tribes

More than a tutoring center, the Foothill Indian Education Alliance facility in Placerville also provides cultural activities for youth in El Dorado and Amador counties affiliated with a broad diversity of Native American tribes.

In addition to traditional crafts like drum- and jewelry-making, the center began offering a food component last summer, through a partnership with CalFresh Healthy Living, University of California – one of the agencies in the state that teaches nutrition to people eligible for SNAP (Supplemental Nutrition Assistance Program).

“A lot of the kids, because they don't live on a reservation or their family might not be connected to a local tribe, don't know a lot of their history or their foods,” said Cailin McLaughlin, nutrition educator for CalFresh Healthy Living, UC, based at the UC Cooperative Extension office in El Dorado County. “Food is a good way to explore any heritage because food is at the central point of a lot of cultures and customs – sharing meals and sharing stories behind it.”

Last spring, McLaughlin worked with Hal Sherry, the head tutor at Foothill Indian Education Alliance, to create a new, five-week “summer camp” during which youth would learn about and prepare Native foods in the center's kitchen, primarily with ingredients from its backyard garden.

One strength of the program is that CalFresh Healthy Living, UC nutrition educator Cailin McLaughlin empowered the youth to take the lead in preparing the dishes in the kitchen. Photo by Cailin McLaughlin

Sherry said that the experience provided the participants – 10 elementary school students and seven middle or high school students – an important perspective on the interconnectedness of all living things.

“Part of the objective of the program is for them to understand that each one of us is part of the natural order of things, and that we have to do our part to fit into that cycle,” he explained. “There's kind of an ecological lesson that's also being learned…and we don't want to put poisons in our bodies, and we don't want to put poisons in our environment.”

Program combines cultural lessons, nutrition information

For the summer program, McLaughlin selected a curriculum centered on garden-based nutrition, and infused it with elements of Indigenous food ways.

“We predominantly picked ingredients that had cultural significance to Native American communities, so things like blueberries, blackberries, pine nuts, squash, things of that nature,” she said. “So we could feed into the history of that ingredient, why it's important to the Indigenous communities – and then give (the students) the nutritional information about it.”

After the youth prepared chia seed parfaits – from a recipe that is part of a series developed by CalFresh Healthy Living, the California Indian Museum and Cultural Center, and the Center for Wellness and Nutrition – a Foothill Indian Education Alliance staff member shared that Native hunters would eat chia seeds for strength before a long hunt.

Many of the participants had never had chia seeds before, and the parfaits were an “absolute favorite,” in the words of McLaughlin.

“I wish we could have made them more often!” said Lacey, a fifth grader who participates in the center's programs year-round.

Participants tended to the garden at the Foothill Indian Education Alliance center, harvesting ingredients for their Native dishes. Photo by Cailin McLaughlin

In addition to working outside in the garden, Lacey said she also liked cooking in the kitchen during the summer camp – and the fact that the young people could take the lead.

“It was all the kids doing it, but (McLaughlin) was just supervising and making sure we were doing it right – it was really nice,” said Lacey, who identifies as Miwok.

Sharing within families, across tribes

Active participation by the young people is one of the strengths of the program, according to Sherry. He expressed admiration for McLaughlin's engaging teaching style, which eschews “lectures” and instead draws the participants into lively conversations about the nutritional content of the ingredients.

“Hopefully they're going to retain some of that knowledge and information and then remember: ‘You know what, yes, I think I would like to have some corn and some beans tonight, because that's going to help my bones grow strong and my eyesight get better,'” Sherry said. “That's really a big part of what we want them to come away with.”

At the end of the summer program, participants also came away with a binder of recipes from a cookbook of Native American dishes, “Young, Indigenous and Healthy: Recipes Inspired by Today's Native Youth.” James Marquez, director of the Foothill Indian Education Alliance, said he heard from students that they were bringing many of the lessons from the program back to their homes.

Part of a series developed by CalFresh Healthy Living, the California Indian Museum and Cultural Center, and the Center for Wellness and Nutrition, the "Chia of the Valley" parfait was a big hit with the students.

“I've heard the same kind of thing from parents and grandparents, who have said how wonderful that was and that kids come back home and have an interest in cooking and trying to serve nutritious meals to their families,” Marquez said.

That crucial sharing of knowledge also happens between and among staff members and students, as the center comprises members of many tribes, from South Dakota Lakota to Navajo.

“We serve Native people, we don't care what tribe they come from – they're all welcome,” Marquez said. “What we do represents a lot of different tribes, so we share information from one tribe to another, and that way people can appreciate everybody and what we have to bring to the table.”

Talia, a sixth grader who participated in the summer program, said that she enjoys that cultural sharing.

“I like how I can learn new things…and how I learn more about the people around me,” she explained. “It's also fun to learn about other people's cultures, and what Native American they are, too.”

McLaughlin went on to partner with Foothill Indian Education Alliance on a “Cooking Academy” program during this past fall, and is planning another spring/summer program for 2023, as well. The ongoing teaching and sharing of food ways is just one part of a long process to recover and rebuild Native American cultural traditions.

“Unfortunately, there was a very concerted effort to obliterate the Native culture on this continent; it was a very intentional, very deliberate effort to just stamp that culture out like it had somehow never existed,” Sherry said. “Now there's a much greater awareness of what a terrible thing that was, and so it's like trying to regrow a new garden over an area that was severely burned…and it's being done all over the country.”

Suzanna Martinez (right), a Nutrition Policy Institute-affiliated researcher, represents UC efforts to reduce hunger in the university system, alongside UC Berkeley Basic Needs Center Fellow Jocelyn Villalobos. Photo courtesy Suzanna Martinez

Researchers contribute recommendations for national strategy on hunger, nutrition, health

At the first White House Conference on Hunger, Nutrition and Health convened since 1969, President Biden announced on Sept. 28 a national strategy “to end hunger in America and increase healthy eating and physical activity by 2030 so fewer Americans experience diet-related diseases.” Much of the foundational research undergirding the strategy has been informed in part by the Nutrition Policy Institute, a program of UC Agriculture and Natural Resources.

“Science is the work of many – and no one study answers all the questions – but we have a tremendous body of work that has contributed to this conference, building from all the programs and changes that were made from the last conference,” said NPI director Lorrene Ritchie.

The original Nixon-era conference produced about 1,800 recommendations – and 1,600 were eventually implemented in the subsequent years, according to Stacy Dean, U.S. Department of Agriculture Deputy Under Secretary for Food, Nutrition and Consumer Services.

In a speech during the opening plenary of the White House Conference on Hunger, Nutrition and Health, President Biden says "in America, no child should go to bed hungry (and) no parent should die of a disease that can be prevented." Photo by Jocelyn Villalobos

A litany of far-reaching programs grew from or were propelled by the 1969 conference: the School Breakfast Program, WIC (the Special Supplemental Nutrition Program for Women, Infants and Children), SNAP (the Supplemental Nutrition Assistance Program)-Ed and CalFresh Healthy Living UC, the Expanded Food and Nutrition Education Program, and more.

This history illustrates the potential for sweeping change from this 2022 conference – which gathered about 500 experts and advocates (with 1,000 more participating online) – and from the national strategy that represents the Biden-Harris administration's “playbook.”

“Does that document have everything in it that we would like? No – but, oh my goodness, if we could accomplish all the things that they've laid out, what a transformational impact it would have,” said Ritchie, adding that she was thrilled that the highest levels of government are prioritizing hunger and nutrition-related chronic disease.

Including beverages in the conversation

In the course of gathering ideas and input from across the country, conference organizers asked Christina Hecht, NPI senior policy advisor, to author and submit NPI recommendations on encouraging the public to choose water instead of sugary drinks. Those suggestions – which range from including water in the “MyPlate” dietary guideline graphic to ensuring that every public school has a water bottle-filling station – crystallized extensive, rigorous scholarship by a broad community.

Suzanna Martinez greets U.S. Rep. and Chairman of the House Rules Committee James McGovern, who played a leading role in convening the White House conference. Photo by Jocelyn Villalobos

“NPI's recommendations were built on lots of work by many water researchers and advocates over the years; they're based on many years of thinking by many people,” Hecht said.

Christina and Ken Hecht, NPI policy director, also submitted recommendations as part of the Sugar-Sweetened Beverage Reduction Workgroup, which brings together experts from national, state and local organizations. Several of their key proposals, such as targeting the marketing of sugary drinks and clarifying front-of-package nutrition labels, appear as recommended steps in the national strategy document.

Other nutrition policy changes compiled by Christina Hecht – like updating the Federal Food Service Guidelines used on federal properties and in federal programs – are also reflected in the national strategy, albeit without specifically mentioning sugary drinks. Nonetheless, Hecht believes doors have been opened for future discussions that could incorporate and promote healthy beverages.

“What those doors require are continuing to develop the evidence base, continuing to translate and share the evidence base, and continuing the advocacy to bring that evidence base to the attention of decision makers,” she said.

University of California setting an example

Suzanna Martinez, an NPI-affiliated researcher who attended the White House conference, said she hopes the convening generates momentum for two bills before Congress that would help alleviate food insecurity in higher education: one that provides funding for campuses to address students' basic needs, and another that reduces barriers to SNAP (Supplemental Nutrition Assistance Program, formerly known as food stamps). The national strategy document explicitly acknowledges that “SNAP's college student eligibility restrictions are out of date given the current population who seek higher education credentials.”

Martinez, an associate professor in the Department of Epidemiology and Biostatistics at University of California San Francisco, was invited to the conference because she's part of a group driving the UC's effort to halve the number of students facing food insecurity across the system by 2030. That commitment, and UC Berkeley's work on basic needs, were highlighted by Second Gentleman Douglas Emhoff during the closing plenary session.

The day before the White House conference, Suzanna Martinez (left) meets with Emily Mercado, a staffer in the office of U.S. Rep. Jimmy Gomez (D-CA), to discuss student basic needs and the importance of SNAP in addressing student food insecurity. Photo by Crystal Martinez

“The work that we're doing here in California tends to set the stage for what happens in other states,” said Martinez, who also cited California's pioneering effort to provide meals for all public school students.

NPI's ongoing work evaluating universal school meals in California and other states is just one example of how its academics and staff are refining innovative programs so they can be adopted more effectively and broadly (perhaps nationally). In fact, the White House identified “healthy school meals for all” as the top strategy for improving food access and affordability, and Ritchie applauds the administration's consistent emphasis on early interventions for healthier outcomes.

“The earlier you can create healthy habits – meaning in utero all the way through childhood – the more likely you are going to have adults who don't end up with nutrition-related chronic diseases,” she explained. “The last thing you want to do is to wait until people are really sick before they start to change their habits.”

Another overarching theme that excites Ritchie is the national strategy's “whole of government” approach to addressing a host of nutrition and hunger issues. One example is how the strategy calls for agencies not traditionally associated with food to contribute to reducing waste, such as the Department of the Treasury clarifying tax benefits for businesses that donate food.

“Throughout the document, over and over again, there are countless examples of creating synergies across government agencies and with local and state governments that can help move the needle,” Ritchie said. “It's just this kind of bold call to action that we really need.”

Food insecurity, which affects college students at roughly four times the rate of the general population, is a detriment to their health and academic pursuits. Photo by Antor Paul on Unsplash

Nutrition Policy Institute researchers contribute to studies that inform policy changes

Marcela Gonzalez, who had wanted to be a physical therapist since she was a teenager, was in the final stage of realizing her dream.

But when she started in the PT program at the University of California San Francisco in 2021, a vexing struggle of her undergraduate years came back. Academic pressures and stomach troubles, compounded by financial worries, drained her of any energy and capacity to feed herself.

“I didn't eat; I lost a lot of weight because I just couldn't eat,” Gonzalez recalled. “I was too stressed out all the time; I was a mess.”

During her first year at UCSF, Gonzalez, for whom food has “always just been hard,” discovered that she qualified for CalFresh (California's version of the Supplemental Nutrition Assistance Program, formerly known as “food stamps”). Her participation in the program – as well as the presence of a campus food pantry – helped lift a heavy mental burden and allowed her to refocus on school.

By enrolling in CalFresh, UCSF student Marcela Gonzalez was able to refocus on school and continue on her path to become a physical therapist.

To understand the mechanisms that connect eligible students with CalFresh benefits, which could greatly improve their lives and education, University of California researchers interviewed UC campus staff responsible for guiding undergraduate and graduate students through the application process. Their recently published study, which involved researchers at UC Agriculture and Natural Resources' Nutrition Policy Institute, illuminated several major facilitators and barriers to CalFresh enrollment.

Campus-county coordination, boosting staffing key factors

Ensuring that college students have access to CalFresh is especially crucial, given that food insecurity affects that segment of the population roughly four times the rate of the general population, according to the study's principal investigator and co-author Suzanna Martinez, an associate professor in the department of epidemiology and biostatistics at UCSF.

It's estimated that more than 40% of college students face uncertain access to healthy food – and inflation, the rising cost of attending college and increasingly unaffordable housing are likely to swell those numbers.

That's why researchers say it's critical for campus staff who work on CalFresh outreach to collaborate with the financial aid office and the county office that administers the CalFresh program locally. Through close coordination, staff members can determine if students meet the necessary exemptions and help them with the paperwork.

“When that happens, it's much easier than when a student applies without their campus Basic Needs coordinator, or when they just go to the county and apply on their own,” Martinez explained. “Maybe they don't know all of the verification documents that have to be included, or they might not know their financial aid status.”

Erin Esaryk, NPI research data analyst and first author of the study published in the Journal of Nutrition Education and Behavior, also highlighted the need for increased campus staffing to help with CalFresh enrollment, as well as more outreach by campus and county staff to student populations about the benefits.

“When there's a lot of outreach, that helps alleviate some of the stigma, to normalize the receiving of CalFresh,” Esaryk said.

Helping others worry less about food

Gonzalez, for whom food has “always just been hard,” works to educate her classmates about CalFresh eligibility and the enrollment process.

Given her own history of travails, Gonzalez, the physical therapy student, wanted to help others at UCSF “de-stress” about food. In summer and fall 2021, she served as a “CalFresh ambassador” for her cohort of new PT students, developing presentations and guides that break down how to apply for or renew CalFresh benefits.

She became the go-to person for her classmates' questions on the logistics and details of applying for the program, and also encouraged fellow health-professional students who, like herself, did not think they would qualify.

“To take out less loans, or to not worry about food a little bit every week, is a great thing,” said Gonzalez, pointing out that subtracting food costs allows students to shave down their loans.

After helping introduce her classmates to CalFresh, she transitioned to working at the food pantry at the Parnassus campus. In addition to setting up and distributing the items, Gonzalez also posts on Instagram and TikTok (@ucsf_basicneeds) to promote the “food market,” which attracts about 100 students and campus community members every Thursday afternoon.

“You never know what you're going to get, but there's so much really good, fresh produce,” she said.

Campus food pantries deliver health benefits

Researchers are also studying how campus food pantries affect students' overall health, including easing the challenges of anxiety, depression and sleep deprivation. Another recent study published in the Journal of Nutrition Education and Behavior analyzed health-survey responses of 1,855 undergraduate and graduate students at all 10 UC campuses – before and after access to a campus food pantry.

“What we found was that students reported improvements in their perceived health and sufficient sleep,” said UCSF's Martinez, the lead author. “We also found that they reported fewer depressive symptoms, compared to before having access to the food pantry.”

By 2019, all UC campuses had established food pantries, although nationwide only about 25% of four-year colleges have one. The significant health benefits reported by UC students in this study give researchers hope that campus food pantries will see additional governmental support, in California and beyond.

In a recent study, students reported that college food pantries were a boon to their overall health. Photo by Aaron Doucett on Unsplash

“It was important to evaluate whether the food pantries were actually making a difference…if you don't have numbers or evidence, then you're not going to get funded to support future programming,” Martinez said.

Research guides state policy changes

Studies of food insecurity in the college setting have already informed policymaking aimed at smoothing the application process for CalFresh – benefits regarded by Martinez as a better long-term solution than food pantries, which constitute an emergency “short-term response” to the problem.

One example of the research's impact is a law passed last year in California that requires community colleges and California State University campuses to designate a campus-county liaison who would help students procure social services, including CalFresh. A separate law expanded the list of training programs within which students would potentially qualify for CalFresh, and another bill currently under consideration by the state Legislature would make the processing of students' CalFresh applications more consistent from county to county, through more standardized training of staff.

Meanwhile, on the research front, Esaryk, Martinez and their colleagues are completing a follow-up study on students and CalFresh enrollment, this time looking at the perspectives of county staff. And while their broader goal remains clarifying and streamlining student eligibility rules and processes at all levels, they remain focused on students and meeting their needs.

“Right now, our main mission is just to try to increase awareness of CalFresh for students and to let them know they may be eligible,” Martinez said, “and then assist them through that application process so they can actually get the benefits.”

In addition to Esaryk and Martinez, NPI director Lorrene Ritchie and Laurel Moffat of Washington State University are also authors of the CalFresh/SNAP benefits study, while co-authors of the college food pantry study are Ritchie, Gwen Chodur of UC Davis, Sevan Kaladijian of UC Irvine and Michael Grandner of the University of Arizona.

A pilot program to promote California-grown fresh fruits and vegetables via text message has seen promising early returns. Photo by Corine Yoshihara, (c)2020 University of California

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.

About 172,000 households participating in CalFresh in San Diego County have been receiving texts about the benefits of fresh fruits and vegetables. Photo from program website

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.”

The texts, written in a friendly and conversational tone, were developed using the latest behavioral science. Image courtesy of the program

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.

Information on selecting, storing and preparing the produce is available in English, Spanish and Arabic. Image from Arabic version of program website

“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.”