Teens enrolled in Contra Costa County's virtual YPAR series gained knowledge about the social determinants of health and explored career trajectories to address critical health issues in their community. These projects help to increase community health and wellness and promote college readiness and access

The Issue

The COVID-19 pandemic exposed health inequities associated with the social determinants of health (SDOH),¹ which “are the conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of-life-risks and outcomes.”² Educating young people about the SDOH and engaging them in youth-led research to address health issues in their community is essential in shaping their future education and career goals.

How UC Delivers

The pandemic presented challenges initiating and engaging students in educational programs such as a Youth-Led Participatory Action Research Project (YPAR) because of the transition to online learning. Meeting the challenge to pivot from in-person to virtual programming, the Contra Costa County YPAR coordinator successfully facilitated a 100% remote youth-led program during the 2020-2021 school year at a new site, Dozier Libbey Medical High School (DLMHS), in Antioch, California.

DLMHS is a charter school where 58.9% of students are socioeconomically disadvantaged^.3 The school focuses on health and medicine and developing future health professionals and was selected because its mission and values align with CFHL, UC to help people lead healthier lives.

An existing relationship with a DLMHS teacher and 4-H parent led to a virtual meeting with the principal who agreed to offer a YPAR program at DLMHS. Students were recruited through the school website and social media platforms, and five teens from the 11^th grade were interviewed and selected to join the program and were also enrolled in 4-H.

The YPAR coordinator and a colleague from Merced County met with the teen leaders weekly over Zoom. They used various educational tech tools to facilitate activities from the Community Futures, Community Lore's Nine Stepping Stones guides to educate student leaders about YPAR. To encourage critical thinking and learning, the coordinators assigned videos and readings for group discussion that addressed the SDOH. These activities exposed the teens to health inequities in their community to consider for their YPAR project and fueled their career aspirations to make a difference in individual and community health.

The Impact

After this program year, four of the five teens completed a survey. They reported learning about the SDOH and when asked what, if any, impact this project had on their future education plans or future career interests, responses included:

“This project has opened my eyes to many different issues in my community and I feel like in my future job/career interests I will bring these issues with me and try to make a change so new generations don't see the same issues that we did. I want to make a change with my line of study.”

“I want to be a Doctor of Internal Medicine due to the program since I have learned the factors in the environment that affect health and can even cause chronic conditions which could be prevented or alleviated with the right nutrition and physical activity.”

These responses indicate new learning about community health and wellness, as well as increased college readiness. Youth participating in YPAR projects focused on nutrition and physical activity interventions, have been shown to promote healthy weight and reduce the risk of chronic disease.^4;5 UCCE Contra Costa County's effort demonstrate UC ANR's public value of Healthy People and Communities.

 References

 1. Abrams, E. M., & Szefler, S. J. (2020). COVID-19 and the impact of social determinants of health. The Lancet Respiratory Medicine, 8(7), 659-661.

 2. Centers for Disease Control and Prevention. Social Determinants of Health: Know What Effects Health. https://www.cdc.gov/socialdeterminants/index.htm. Accessed September 7, 2021.

 3. California Department of Education. California School Dashboard. 2020. https://www.caschooldashboard.org/reports/07616480117218/2020. Accessed September 7, 2021

4. Nour, M., Lutze, S., Grech A., & Allman-Farinelli, M (2018). The Relationship between Vegetable Intake and Weight Outcomes: A Systematic Review of Cohort Studies. Nutrients. 10(11), 1626. 

5. US Department of Health and Human Services. Physical Activity Guidelines for Americans https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf. Accessed October 18, 2021.

CFHL, UCCE Kern offers evidence-based food and nutrition education to 42 parents. Participants improved their food resource management and nutrition practices, contributing to UC ANR's public value of promoting healthy people and communities.

The Issue

According to KidsData, Kern County has a food insecurity rate that is higher than the state average at 23.8%, compared to California's overall rate of 18%. Obesity rates are also high, with nearly 50% of children and 74% of adults being either overweight or obese.

Southeast Neighborhood Partnership Family Resource Center (FRC) is a non-profit organization located in Bakersfield, CA.  Southeast Neighborhood Partnership FRC is dedicated to providing outreach, case management, and supportive services for families in need. They also provide parenting classes that can be attended voluntarily or mandated by court orders for Kern County residents.

How UC Delivers

The Southeast Neighborhood Partnership FRC staff requested that CFHL, UCCE Kern assist with providing evidence-based nutrition lessons for their 42 parents to satisfy a 12-week parenting course. As a result, nutrition and physical activity direct education efforts were remotely conducted via Zoom from April through June 2021 during the COVID-19 pandemic

Lesson objectives focused on advancing actions and behaviors that improve health and wellness for participants and their families. CFHL, UCCE Kern staff provided parents lesson handouts from the Plan, Shop, Save, & Cook curriculum. Parents received information regarding how to plan, read nutrition labels, save money on food, and food safety. Virtual education allowed the CFHL, UCCE Kern team to provide services to residents in Ridgecrest, Mojave, and Buttonwillow. These outlying cities in Kern were previously not reached due to geographic distance.

The Impact

During Zoom meetings, several participants shared that they began to increase vegetable servings in their meals, and others shared that they were now reading the nutrition facts label to choose healthier food and snacks for their family.

Plan, Shop, Save, and Cook (PSSC) adult participant evaluation survey results indicated that after attending the Plan, Shop, Save & Cook series, out of the 30 survey respondents:

o   33% reported running out of food before the end of the month less often, indicating an improvement in families' food security.

o   90% reported improvement in at least 1 of 5 food resource management behaviors (plan, prices, shop, think, facts).

o    80% reported using MyPlate to make food choices more often.

o    67% reported that they use "Nutrition Facts" on the food label to make food choices more often.

o    53% reported shopping with a grocery list more often.

o    40% reported planning meals ahead of time more often.

o    43% reported comparing unit prices before buying food more often.

o    27% reported that when deciding what to feed their family, they thought about healthy food choices more often.

In addition, adults (n=30) who participated in the Plan, Shop, Save & Cook series showed statistically significant improvements (p<.05) from the pre to post survey in how often they planned meals ahead of time, shopped with a grocery list, used the “Nutrition Facts” on the food label, used MyPlate to make food choices, and used the five food resource management behaviors (plan, price, shop, think, fact).

These changes in budgeting, nutrition knowledge, and skills of families in Kern County demonstrate UC ANR's commitment to healthy people and communities and safeguarding abundant, healthy food for all Californians.

“Our partnership with CalFresh Healthy Living, UCCE Kern County program has been key in providing our clients the health education they need to care for their children properly. CFHL, UCCE Kern staff have been so insightful and consistent in educating our participants regarding meal planning, food labels, saving money and cooking meals for years now. Our collaboration has been essential in providing our court mandated parenting clients with the nutrition component needed to meet the criteria required by the Department of Human Services. Thank you so much for all your help, we truly appreciate our partnership.” – Cecilia R., Parent Educator, Southeast Neighborhood Partnership FRC

 

UCCE Santa Barbara County educators partnered with P.E. teachers to boost enrolled classes  by 53% during COVID-19 distance learning. About half of the students surveyed indicated intentions to drink more water and increase activity, contributing to improved youth health.

The Issue

The CalFresh Healthy Living, University of California Cooperative Extension (UCCE) program serving Santa Barbara County has partnered with elementary schools in the Santa Maria-Bonita School District (SMBSD) for several years to provide evidence-based curriculum and trainings in nutrition and physical activity. SMBSD serves over 16,900 students with 87.2% of the students qualifying for free or reduced-price school meals.[1] During the COVID-19 Pandemic, many families, especially those with young children, experienced an increase in food insecurity, making them more vulnerable to negative health outcomes.[2] Unfortunately, during the same time UCCE educators in Santa Barbara County experienced a decrease in K-6th grade classroom teachers being able to partner to provide nutrition and physical activity support, limiting access to important resources and information on diet and exercise habits that promote healthy living.[3-4]

How UC Delivers

Working closely with school partners, UCCE educators pivoted programming to meet the needs of school communities to promote health and increased the total number of enrolled classes by 53% compared to the start of the 2020-21 school year.

Specifically, three SMBSD P.E. Specialists expressed interest in signing up as program extenders for nutrition lessons in their 1st-6th grade P.E classes. This new approach in partnering with P.E. Specialists, instead of focusing on classroom educators to deliver nutrition education, increased the program's overall reach and aided extenders in meeting their nutrition education standards for physical education. UCCE educators adapted the lessons using online learning technologies, incorporating physical activity into each lesson and interactive features such as collaboration boards, drawing, and polls to increase youth participation during each lesson. In addition to lessons, students received recipes and asynchronous assignments to complete. This innovative format allowed students to engage with one another and the material in a variety of ways.

The Impact

All three P.E Specialists expressed interest in continuing the partnership as extenders and felt the lessons were beneficial to their students. Two of the extenders reported the virtual UCCE lessons were easy to integrate into their class schedule and observed that students were actively engaged in the material and activities. Several additionalSMBSD P.E. Specialists expressed further interest in professional development around teaching nutrition curricula and have been provided access to a library of online resources and support from UCCE Educators.

Overall, this partnership resulted in reaching more than 1,000 students across two school sites with quality nutrition education using the Serving UpMyPlate and Up4It! curricula tailored to their grade level. As a result, 59% of 4th-6th grade youth surveyed (n=73) reported that when given a choice they will drink water and 45% reported that when given a choice they will try to engage in more physical activity.

According to the Physical Activity Guidelines for Americans (2018), regular moderate-to-vigorous physical activity reduces the risk of many chronic diseases among children and adults. These outcomes support UCANR's public value of promoting healthy people and communities.

 

“I have learned that in sports drinks, sodas, teas, and coffee that there is a lot of sugar and added sugar into the drinks. I have also learned that it is good to have some type of protein or dairy or anything that is on my plate when you eat.” – Rice Elementary Student (SMBSD)

References:

1.  Ed-Data: Education Data Partnership, Santa Maria-Bonita School District; Accessed on 15 June 2021, http://www.ed-data.org/district/Santa-Barbara/Santa-Maria--Bonita

2.   Wolfson JA, Leung CW. Food Insecurity and COVID-19: Disparities in Early Effects for US Adults. Nutrients. 2020; 12(6):1648. https://doi.org/10.3390/nu12061648

3.   Pérez-Rodrigo, C., & Aranceta, J. (2001). School-based nutrition education: Lessons learned and new perspectives. Public Health Nutrition, 4(1a), 131-139. doi:10.1079/PHN2000108

4.   Rivera, R. L., Maulding, M. K., & Eicher-Miller, H. A. Effect of Supplemental Nutrition Assistance Program–Education (SNAP-Ed) on food security and dietary outcomes, Nutrition Reviews, Volume 77, Issue 12, December 2019, Pages 903–921, https://doi.org/10.1093/nutrit/nuz013

After participating in UCCE's virtual Family Cook Night series, 60% of parents reported intention to not offer a treat as a reward for eating other foods and 80% would try new strategies for picky eaters, promoting healthy people and communities.

The Issue

The COVID-19 pandemic has impacted all aspects of life, including family, work, and education. The pandemic has exacerbated social inequalities, affected access to education for adults and youth and magnified food insecurity for children and families. Two US COVID-19 Impact Surveys indicated that 34.5% of households with a child ≤ 18 years old and 34.4% of households with children ≤ 12 years old were food insecure by end of April 2020. [2] 

How UC Delivers

As schools remained in distance learning, CalFresh Healthy Living, UCCE in Santa Barbara County worked closely with principals and partners at two elementary schools to find innovative ways to support the health of youth and families during these unprecedented times. Meeting virtually with partners and youth, UCCE educators realized a need for programming that involved the whole family.

UCCE educators hosted two 4-class series of evening classes via Zoom with school leadership to meet this need. Families signed up through their respective schools and got access to the virtual classrooms through school computers and district Zoom rooms. Using the Healthy, Happy Families curriculum, the families learned about topics that promote healthful behaviors. These included how to involve youth in cooking and meal preparation and using words instead of food to praise positive behavior. Families also learned basic nutrition, food safety, and the current USDA dietary guidelines. Throughout each lesson, UCCE educators encouraged families to include their children in the cooking process by demonstrating tasks appropriate for varying levels of child development.

UCCE educators continued to strengthen partnerships with Santa Barbara Food Bank (SBFB), extenders, youth, and families in Santa Barbara County. Families utilized resources available in their homes and supplemental materials provided by the SBFB and UCCE staff. Educators created dynamic lessons that provided families with the opportunity to openly share their experiences, thoughts, and welcomed participation from all family members, including fathers and male guardians. Participation from men in these classes promoted gender equality, an essential step towards addressing the double burden of unpaid caretaking work that disproportionately impacts the health and well-being of women. [4] 

 

The Impact

After attending the classes, adult participants shared that they changed their approach to feeding their children to promote healthful behaviors. Pre- and post-course survey (n=64) results indicated that the proportion of parents or guardians who would not offer a treat as a reward for eating other foods increased from 36% to 60%. Additionally, the proportion of parents or guardians who indicated that they would offer food to their child rejected more than once increased from 36% to 80%. Overall, the Family Cook Nights Series was impactful, educators and families practiced cooking healthy recipes, promoted gender equality, and changed feeding habits to encourage healthful behaviors.

According to Jensen (2020), “besides a direct relation with higher intake of unhealthy foods, frequent use of food as a reward may also increase the risk of being overweight through long-term effects on eating behavior”. [3] This intervention fostered healthy behaviors as part of the UC ANR's commitment to promoting healthy people and communities.

When asked about the class series, one school principal remarked: "Our families enjoyed it and had fun. Cooking is community building. We appreciate the thoughtfulness of the food bank and CalFresh." -Liberty Elementary School Principal

Sources:
1. Nalita James, Virginie Thériault. (2021) Reimagining community and belonging amid COVID-19. Studies in the Education of Adults 53:1, pages 1-3. https://doi.org/10.1080/02660830.2020.1811474
2. Bauer L. The COVID-19 crisis has already left too many children hungry in America. 2020. https://www.brookings.edu/blog/up-front/2020/05/06/the-covid-19-crisis-has-already-left-too-many-children-hungry-in-america/. Accessed June 18, 2021
3. Jansen PW, Derks IPM, Mou Y, et al.Associations of parents' use of food as reward with children's eating behaviour and BMI in a population-based cohort. Pediatric Obesity. 2020;15:e12662.https://doi.org/10.1111/ijpo.1266210 of 10 JANSEN ET AL.
4. Kate Power (2020) The COVID-19 pandemic has increased the care burden of women and families, Sustainability: Science, Practice and Policy, 16:1, 67-73, https://doi.org/10.1080/15487733.2020.1776561