A recent study by Nutrition Policy Institute (NPI) researchers assessed differences in quick-service, or fast-food, restaurants with and without voluntary healthy default beverage standards for kids' meals. ‘Voluntary standards' are restaurant commitments to offer healthier drinks with kids' meals. Researchers evaluated the beverages shown on kids' meal menu boards, beverages offered by cashiers with kids' meals, and kids meal beverages selected by customers in 111 quick-service restaurants--70 with voluntary standards and 41 without--in SNAP-Ed eligible neighborhoods in 11 California counties. Data was collected by menu board and cashier order observations and customer surveys in December 2018 prior to the January 2019 implementation of a new California law (SB-1192) that requires all restaurants offering a kids' meal make the default beverage offered water, unflavored milk or a nondairy milk alternative and that only these beverages be displayed on kids' meal menus or advertisements.

Results from the study showed that significantly more quick-service restaurants with voluntary healthy default beverage standards for kids' meals offered unflavored milk or water on their menu boards compared to restaurants without voluntary standards. Customers at restaurants with voluntary standards reported purchasing healthier drinks and less soda compared with customers at restaurants without voluntary standards. These results suggest the voluntary healthy default beverage standards were effective at positively influencing restaurant practices and customer behavior. However, not all quick-service restaurants followed their own standards and much room for improvement remains. Additional intervention may be necessary to support full implementation of the standards and to maximize the impact on customer behavior and jurisdictions passing healthy default beverage laws for restaurant kids' meals may need to provide education and outreach alongside enforcement to ensure full implementation. The study was published online on July 22, 2020 in the International Journal of Environmental Research and Public Health by NPI researchers Phoebe Harpainter, Sridharshi Hewawitharana, Danielle Lee, Anna Martin, Wendi Gosliner, Lorrene Ritchie and Gail Woodward-Lopez. Read the full study online.

Sugar-sweetened beverages (SSBs) are the largest single source of added sugars in the U.S. diet. Consumption of SSBs is a major contributing factor to excessive weight gain in young children and is linked to increased risk of dental decay, type-2 diabetes, metabolic dysfunction and heart disease later in life. For over 10 years, Nutrition Policy Institute (NPI) researchers have been working closely with child care stakeholders and advocates from the California Food Policy Advocates to improve the beverages served in licensed child care settings. The implementation of California's Healthy Beverages in Child Care Act (CA AB 2084) in 2012 was a major milestone for this long-term collaboration, which requires all licensed child care providers in California to serve only healthy beverages and serve no SSBs to children in their care. NPI's latest research brief shares results from state wide surveys conducted in 2012 and 2016 in collaboration with CFPA and the Sarah Samuels Center for Public Health Research & Evaluation that suggests only 45% of California child care providers are fully adherent to all four components of CA AB 2084:

• Serve only low-fat or non-fat milk to children aged 2 years or older.
• Limit juice to no more than one serving daily of 100% juice.
• Serve no beverages with added sweeteners, either natural or artificial.
• Make safe drinking water available and readily accessible throughout the day.

The research brief also shares how NPI researchers collaborated with the UCSF School of Nursing and the California Child Care Health Program, UC Cooperative Extension, and UC Merced to develop and evaluate a free, on-demand online training in English and Spanish to support child care providers to offer healthy beverages. The research brief is available online. 

Nutrition Policy Institute (NPI) researchers' new study of 297 licensed California child care providers that care for infants suggests that those participating in the federal Child and Adult Care Food Program (CACFP) offered fruits and vegetables more often and sweetened yogurt less often to infants in their care compared to sites that did not participate in the CACFP. Additionally, more CACFP participants compared to those that did not participate in CACFP were in alignment with the current recommendations to not offer cow's milk to infants prior to their first birthday. However, the study also showed that CACFP participants were less likely to usually provide breastmilk to infants, suggesting the need for additional support and recommendations for CACFP participants on breastfeeding resources for providers and families. The study was conducted in 2016 prior to updates to the CACFP nutrition standards which went into effect in October 2017. Results from the study were published online ahead of print on April 29, 2020 in the Maternal and Child Health Journal. The state-wide child care study was funded by the Robert Wood Johnson Foundation's Healthy Eating Research Program, and was conducted by NPI's Lorrene Ritchie, Danielle Lee, Klara Gurzo (currently with Stockholm University Department of Public Health Sciences), and Lilly Nhan (currently with University of California, Los Angeles Fielding School of Public Health) in collaboration with Elyse Homel Vitale of the Child Care Food Program Roundtable (previously with California Food Policy Advocates) and Sallie Yoshida of Social Policy Research Associates (previously with Sarah Samuels Center for Public Health Research & Evaluation).

Nutrition Policy Institute (NPI) researchers' latest study of 680 licensed child care providers across California evaluating adherence to California's 2010 Healthy Beverages in Child Care Act (CA AB2084) suggests that nearly half were adherent to the policy in 2016, an increase from about one quarter shortly after the policy was implemented in 2012. The study was published in Preventing Chronic Disease. California's AB2084 policy requires licensed child care sites to (1) serve only lowfat or nonfat milk to children two years of age or older, (2) limit juice to not more than one serving per day of 100-percent juice, (3) serve no beverages with added sweeteners, either natural or artificial, and (4) make clean and safe drinking water readily available and accessible for consumption throughout the day. These requirements align with the federal Child and Adult Care Food Program (CACFP) nutrition standards. Providers participating in CACFP and child care centers were found to be more compliant than those not participating in CACFP and family child care homes, respectively. In 2016, providers were most adherent to the sugar-sweetened beverages (97%) and 100% juice (91%) requirements, while fewer were adherent to the requirements on drinking water (77%) and milk (65%). To support increased adherence to the beverage policy, NPI collaborated with Abbey Alkon from the UC San Francisco School of Nursing and California Childcare Health Program to develop a free online training in English and Spanish for California child care providers, funded by the UC Division of Agriculture and Natural Resources. The statewide child care study was funded by the Robert Wood Johnson Foundation's Healthy Eating Research Program, and was conducted in collaboration with Elyse Homel Vitale of the Child Care Food Program Roundtable (previously with California Food Policy Advocates) and Sallie Yoshida of Social Policy Research Associates (previously with Sarah Samuels Center for Public Health Research & Evaluation).