New research from the University of California Nutrition Policy Institute suggests that a 4-week Rethink your Drink curriculum for high school students can improve high school students' use of Nutrition Facts labels and decrease their consumption of diet soda. The Rethink Your Drink curriculum, developed by the California Department of Public Health (CDPH), promotes drinking water and a variety of healthy beverages instead of sugar-sweetened beverages and use of the Nutrition Facts label and Ingredient List to choose beverages with little or no added sugars. The curriculum was pilot-tested in three California high schools with over 220 students and compared to 92 students in two schools that did not receive the curriculum. Despite the positive impact on Nutrition Facts label usage and decreasing consumption of diet soda, there was only a small but not significant decrease in sugar-sweetened beverage intake by students receiving the curriculum compared to those that did not. These findings suggest that developing a curriculum that is effective for improving beverage consumption among high school students may be challenging. Interviews and surveys with teachers and focus groups with students suggest the curriculum could be shortened, made more engaging with interactive activities as well as taste-tests of healthy beverages, and that the curriculum be modified to target younger students to support earlier development of healthy beverage consumption habits. Researchers suggest the effectiveness of the Rethink Your Drink curriculum could be increased if paired with evidence-based policy, systems and environmental change strategies that eliminate sugar-sweetened beverages from high-school students' environments. The study, funded by the CDPH, was published in the Health Education Journal in September 2021. Authors include Ron Strochlic, Gail Woodward-Lopez, Kaela Plank and Sridharshi Hewawitharana from NPI, and Jackie Richardson and Lauren Whetstone from CDPH.
Schools are an ideal setting to improve child nutrition and food security and are critical environments in which to implement policy, systems, and environmental (PSE) public health interventions. Federal mandates for the Supplemental Nutrition Assistance Program-Education, known as CalFresh Healthy Living in California, require PSE interventions for obesity prevention efforts combined with direct and indirect education interventions. Researchers at the University of California Division of Agriculture and Natural Resources, Nutrition Policy Institute developed a new method to evaluate the ‘dose' score of complex and multicomponent SNAP-Ed interventions in schools, which can then be linked to student health outcomes. The method also proposes how to calculate dose scores for different intervention categories, including direct education, PSE, garden-based interventions, and physical education. This novel evaluation method can be used in future SNAP-Ed evaluations to inform practitioners and policymakers about the most promising school-based public health interventions to support children's health. The proposed method was published in the American Journal of Evaluation. Study authors include researchers from the NPI CalFresh Healthy Living evaluation team, Sridharshi Hewawitharana, Janice Kao, Carolyn Rider, Evan Talmage, Karen Webb, Wendi Gosliner, and Gail Woodward-Lopez, and Sadie Costello from UC Berkeley.
USDA's Supplemental Nutrition Assistance Program – Education (SNAP-Ed) impacts the lives of participants through education as well as policy, systems, and environmental (PSE) change initiatives at schools, early care and education facilities, food banks and pantries, and other community sites. SNAP-Ed, which focuses on individuals and families with low income and the communities in which they live, can improve health equity. However, SNAP-Ed interventions were dramatically impacted in 2020 by the global COVID-19 pandemic. Researchers at the Nutrition Policy Institute presented relevant research findings at the 2021 National Health Outreach Conference, held virtually on May 3-7, 2021. Their presentation, entitled 'Challenges and Opportunities for SNAP-Ed Programs during the COVID-19 Pandemic', described the ways in which California's local health departments shifted their SNAP-Ed efforts, barriers that COVID-19 created in their PSE work, and factors that facilitated new and continued efforts. Despite a 37% reduction in the number of SNAP-Ed sites reached in 2020 when compared to each of the previous two years, many successful PSE efforts were implemented by local health departments in 2020, including new interventions at numerous sites that were initiated in response to COVID-19. A common theme reported in relation to successful efforts was the importance of strong partnerships. NPI's Carolyn Rider presented these findings in collaboration with NPI researchers Janice Kao, Christina Becker, Evan Talmage, and Gail Woodward-Lopez.
- Author: Danielle L. Lee
The Nutrition Policy Institute (NPI) works in partnership with the California Department of Public Health (CDPH) and local health departments (LHDs) to evaluate CDPH's CalFresh Healthy Living (CFHL) program, which is known federally as the Supplemental Nutrition Assistance Program Education Program (SNAP-Ed). Over 60 LHDs in California partner with CDPH to operate the CHFL program in ways that are consistent with state and federal guidance but responsive to local context. This non-standardized approach coupled with the size and scope of CDPH-CFHL present challenges for evaluation. Gail Woodward-Lopez, an NPI researcher, presented an overview of the CDPH-CFHL evaluation model and how the interrelated components work together to create a comprehensive nimble approach to evaluation aligned with the SNAP-Ed Evaluation Framework. The presentation took place at the Association of SNAP Nutrition Education Administrators (ASNNA) 2021 virtual conference. Woodward-Lopez presented on the development of intervention dose scores for assessing CFHL-CDPH statewide outcomes. Evaluation results using dose scores show significant associations between CDPH-CFHL school-site intervention exposure (or dose) with student aerobic fitness and student fruit and vegetable consumption. In the presentation, Woodward-Lopez also demonstrated how the CDPH-CFHL evaluation approach allowed NPI to make adaptations to capture the influence of the COVID-19 pandemic and state nutrition legislation.
- Author: Danielle L. Lee
Daily physical activity supports youth physical and phychosocial health and is also important for obesity prevention. Schools are an important location for physical activity promotion and obesity prevention given youth spend up to half of their waking hours in school. The latest study from Nutrition Policy Institute (NPI) researchers suggests that United States Department of Agriculture (USDA) Supplemental Nutrition Assistance Program Education (SNAP-Ed, and known asCalFresh Healthy Living (CFHL) in California) physical activity interventions at school-sites are associated with slightly lower body mass index (BMI) and greater cardiovascular fitness in students compared to sites that did not receive these interventions. Further, schools with higher intervention levels had students with the highest cardiovascular fitness levels. Interventions included physical activity-related direct education, where students were actively engaged with an educator; indirect education, where students received information or resources related to physical activity; or changes to the school or district's physical activity related policies, systems, and/or environments (PSE). Student-level FitnessGram(R) data from between 2015-2016 was obtained from the California Department of Education for the study. Researchers compared BMI and student cardiovascular fitness levels from over 97,000 fifth and seventh grade students from 904 California public schools that implemented the SNAP-Ed physical activity interventions to over 372,000 fifth and seventh grade students from 3,506 California public schools that did not implement the interventions. These findings are important as the California Department of Public Health's Nutrition Education and Obesity Prevention Branch distributes over $50 million in CFHL funding to local health departments to implement physical activity and nutrition interventions, which primarily occur in the public school setting. Also, California has more public schools than any other US state. The study was published online in the journal Preventive Medicine Reports. The study was conducted by NPI's Hannah Thompson, Sridharshi Hewawitharana, Janice Kao, Carolyn Rider, Evan Talmage, Wendi Gosliner and Gail Woodward-Lopez in collaboration with Lauren Whetstone of the California Department of Public Health. The study was funded by the California Department of Public Health, with funding from the USDA Supplemental Nutrition Assistance Program. The full study is available online.