- Author: Amanda M Linares
- Contributor: Kaela Plank
- Contributor: Sridharshi Hewawitharana
- Contributor: Gail Woodward-Lopez
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Nutrition Policy Institute rolled out an online evaluation tool, EATS, for local health departments to evaluate school-based CalFresh Healthy Living during pandemic-related school closures. EATS data showed that students receiving school meals during the closures were more likely to eat fruits and vegetables, an important insight that could impact school nutrition policy in the future.
The Issue
In March 2020, schools across California shuttered in an effort to protect students and staff from COVID-19 infection. School closures impacted provision of the National School Lunch Program and School Breakfast Program, and thus, the nutrition safety net they provided. School districts across the state pivoted to centralized meal distribution via grab-and-go and drive-up, or even utilized home delivery in some cases. Despite monumental efforts to get school meals to the children who needed them most, meal participation declined significantly during this time.
The California Department of Public Health's CalFresh Healthy Living Program (CDPH-CFHL) prioritizes improving child nutrition security and diet quality. Local health departments partner with K-12 schools to implement CFHL nutrition education and policy, systems, and environmental (PSE) change strategies that aim to increase consumption of fruits and vegetables and decrease consumption of sugary drinks. Their existing relationships with school districts enabled them to support efforts to ensure that school meals met dietary standards and student needs during school closures.
How UC Delivers
During the pandemic, local health departments modified their school-based programs to continue to reach students outside of the school setting. For example, they delivered nutrition education remotely via Zoom or pre-recorded lessons, and they pivoted to PSE change strategies like modifying school meal distribution practices to help ensure students continued to have access to healthy foods.
Nutrition Policy Institute supports local health department evaluation of school-based CDPH-CFHL interventions, and without modifying the existing data collection methodology to reach students learning at home, evaluation would not have continued. Evaluators adapted their methods, including migration of the Eating and Activity Tool for Students (EATS) to an online platform. This survey measures student eating and physical activity behaviors, and during pandemic school closures, included questions about if and where students ate school breakfast and lunch. Nutrition Policy Institute prioritized school data collection during this extraordinary period, understanding that analysis of these data could draw attention to the impacts of COVID-19 on California's youth, in particular, those already facing nutrition disparities.
The Impact
During the 2020-21 school year, as a result of Nutrition Policy Institute's development and coordination of the online EATS tool, local health departments were able to collect data from 3,297 4th and 5th grade students from 67 CFHL-eligible schools (where at least half of students are eligible for free or reduced-price meals). About half of students were female (52%) and half identified as Latino (50%). Most students were attending school exclusively by distance learning at the time of the survey (83%). Approximately one quarter of students had eaten at least one school meal the previous day (27%), with about 1 in 7 reporting they ate both breakfast and lunch (15%).
We found that students who ate one or two school meals a day had significantly higher intakes of vegetables, whole fruits, and 100% fruit juice, compared to students who did not eat school meals. Specifically, students who ate one school meal a day ate more beans and orange vegetables, while those who ate two school meals a day consumed a wider variety of vegetables, including beans and orange vegetables. However, children who ate one school meal a day drank more fruit drinks (non-100% juice) and flavored milks than those who did not eat school meals. Further, students who ate two school meals consumed more fruit drinks, flavored milks, and sports and energy drinks than those who did not eat school meals.
Our findings suggest that school meals continued to be an important source of fruits and vegetables for school-aged children during the pandemic. This highlights the importance of focusing PSE efforts on improving school meal distribution and overall quality, should students' in-person attendance be challenged again. Despite this, findings also underscore the need to reduce consumption of sugary drinks, which are a primary source of added sugars and nutrient poor energy in children's diets. This highlights an opportunity to strengthen school-based CFHL interventions by incorporating nutrition education and PSE strategies that focus specifically on healthy beverage consumption. Nutrition Policy Institute's leadership of CDPH-CFHL local program evaluation not only highlights the successes of CFHL, but just as important, the areas for program improvement. Nutrition Policy Institute's commitment to strengthening CDPH-CFHL interventions in California schools is a hallmark of UC ANR's public value of promoting healthy people and healthy communities.
This study was conducted as part of a contract with the California Department of Public Health with funding from the United States Department of Agriculture (USDA) Supplemental Nutrition Assistance Program-- SNAP. These institutions are equal opportunity providers and employers.
- Author: Kelly Hong
- Editor: Mishelle Costa
- Editor: Rosa I Vargas
- Editor: Shannon A Klisch
After attending a Teens Love Cooking summer series focused on nutrition and culinary skills, 83% of youth participants were more willing to try new foods and ask for them at home. The class helped reinforce their healthy eating habits and support their long-term health.
The Issue
Collectively, Santa Maria-Bonita and Santa Maria Joint Union High school districts serve over 25,600 students, with more than half of the students qualifying for free or reduced-price school meals. While schools provide nutritious meals for students, teens, in particular, purchase fast food during non-mealtimes such as after school. Fast food meals are heavily targeted towards youth living in low-income neighborhoods and are typically high calorie foods that contain added sugars, saturated fats, and sodium. Furthermore, 52.1% of youth in Santa Barbara County reported eating fast food two or more times a week. Studies have indicated that children and adolescents who learn how to cook at a young age are more likely to adopt healthier eating practices that follow into adulthood. Eating a healthy diet and getting regular exercise can help reduce the risk of diseases related to poor nutrition and weight management such as high blood pressure, heart disease, and stroke.
How UC Delivers
To address this need, CalFresh Healthy Living, University of California Cooperative Extension in Santa Barbara County (UCCE) partnered with Santa Maria Recreation and Parks (SM R&P) to promote a Teens Love Cooking series to middle school and high school-aged youth throughout the city of Santa Maria. Additionally, SM R&P provided access to a full commercial kitchen, kitchenware, and storage space for program materials. With the support of a SM R&P staff member, UCCE staff met with students for two hours, twice a week over three weeks to teach various nutrition and cooking topics, including knife safety, how to follow a recipe, and how to cook a healthy meal using MyPlate as a guide. Additionally, participants put into practice what they learned by preparing recipes from the Cooking for Health Academy curriculum. As needed, recipes were modified to meet COVID-19 safety protocols when cooking in groups using Eat Fresh and Food Hero. Although some recipes needed to be simplified for COVID-19 safety, each participant was provided ample opportunities to practice and grow their food safety and culinary skills. Lastly, every student took home lesson and recipe information to reinforce the learning and to share with their families.
The Impact
At the end of each session, youth were asked to complete the Teacher Tasting Tool, which measures how willing participants are to consume a particular target food again. After tasting a pizza on a whole wheat tortilla, eight (80%) out of 10 respondents reported that they were willing to eat it again. Additionally, after a separate session where participants tasted a fruit salad made with jicama, 15 (83%) of the 18 respondents reported they were both willing to eat it again and ask for it at home.
At the end of the class series, youth completed the “What Did You Learn” open-ended qualitative survey, which asks about changes in knowledge and behaviors. Ten youth responded to the survey, and for the question related to learning, the theme of improved knife skills and safety was reported most frequently, followed by reports related to increased nutrition knowledge, and increased knowledge of healthy food preparation. When asked about one thing that they do differently because of these classes, students responded with the theme of comfortability using a knife and preparing nutritious foods. When teens are confident in their culinary and nutrition skills, they are more likely to make healthier food choices. Overall, participants gained valuable life skills in culinary, food safety, and nutrition to support healthy choices to reduce the risk of diet related diseases which supports ANR's efforts to promote healthy people and communities.
/h3>/h3>/h3>/h3>“I really liked the Oatmeal Bites, so I made them at home for my family to taste”. - high school student
- Author: Amanda M Linares
- Contributor: Kaela Plank
- Contributor: Sridharshi Hewawitharana
- Contributor: Gail Woodward-Lopez
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Nutrition Policy Institute partnered with local health departments to evaluate school-based CalFresh Healthy Living, finding that it improved student diet during COVID-19, contributing to improved community health and wellness.
The Issue
In March 2020 schools across California halted in-person instruction in an effort to protect students and staff against COVID-19 and embarked on “distance learning.” In spring 2021, over half of California's public schools, and disproportionately those serving low-income students, remained in full-time distance learning.
Distance learning had a substantial impact on student food security and dietary intake. Many students lost access to the consistent nutrition provided by school meal programs. Additionally, students may have had increased access to less healthy foods in the home environment, and/or experienced increases in snacking behaviors and eating/drinking out of boredom. For these reasons, continuance of public health programs that operate largely in the school environment, such as the California Department of Public Health's CalFresh Healthy Living (CFHL) program, were essential to addressing health impacts and widening disparities from school closures. When schools shuttered, local health departments (LHDs) administering CFHL had to swiftly adjust their approach to classroom direct education and school-wide policy, system, and environmental (PSE) change strategies as they prepared to deliver and evaluate their school-based interventions from afar. Likewise, evaluators at Nutrition Policy Institute (NPI) needed to devise new methods to enable and support evaluation of this valuable program.
How UC Delivers
To address the need to continue delivery of high quality CFHL programming, LHDs migrated nutrition and physical activity education from delivery in-person to delivery online. Curricula were delivered live via online platforms like Zoom or Google Classroom, or pre-recorded via websites like YouTube. Popular PSE change approaches, like improving school wellness policies or implementing a school garden had limited impact on students if not attending school. With limited or nonexistent in-person school-student interaction, LHDs opted to initiate more feasible and timely PSEs like modifying food distribution practices to ensure students had access to healthy meals.
While LHDs focused on modifying interventions, NPI evaluators were busy adapting evaluation methodology for students learning outside the classroom. A key component of this evaluation involved measuring student eating and physical activity behavior using the Eating and Activity Tool for Students (EATS). Pre-COVID-19, a hardcopy survey was administered to students before and after annual CFHL interventions. In Fall 2020, NPI launched an online version of EATS and provided technical assistance to schools to support virtual administration. Survey questions were also added to capture the unique impact of school closures on students' eating and physical activity behaviors.
The Impact
In 2020-21, pre/post EATS data were collected from 1,087 students from 47 CFHL intervention schools and 846 students from 17 comparison schools- schools where no programming occurred. During this time, intervention students reported a greater increase in frequency of consumption of fruit (by 0.16 times/day; p-value=0.032) and vegetables (by 0.45 times/day; p-value<0.001) than comparison students. Research suggests that higher fruit and vegetable intake protects against the development of cardiovascular and other chronic diseases.
Our findings suggest that LHD-led CFHL programs played a role in protecting student fruit and vegetable consumption during COVID-19 school closures and exemplifies how school-based CFHL may safeguard students' access to and consumption of nutritious food. California's health departments and their school partners proved that even with program adaptations, this important work continued to positively impact student health and wellbeing. Nutrition Policy Institute contributes to UC ANR's public value of Healthy People and Communities through their leadership and support of CFHL evaluation. Efforts by NPI help California communities understand the importance of CFHL programming for their children and families.
Acknowledgments
This study was conducted as part of a contract with the California Department of Public Health with funding from the United States Department of Agriculture (USDA) Supplemental Nutrition Assistance Program-- SNAP. These institutions are equal opportunity providers and employers.
/h3>/h3>/h3>/h3>/h3>- Author: Betsy George
- Author: Carolyn D Rider
- Author: Janice Kao
- Contributor: Christina Becker
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SNAP-Ed practitioners adopt a practical, effective tool from UC ANR's NPI to evaluate program impact in schools, ECEs, after-school programs, and grocery stores, adding workforce capacity to public health agencies.
The Issue
In recent decades, increasing attention has been placed on improving access to healthy foods and opportunities to participate in physical activity in California communities with high rates of poverty and food insecurity. Schools and other places where children receive care are important partners in promoting wellness, as are the retail establishments where families purchase food. Supplemental Nutrition Assistance Program Education (SNAP-Ed) interventions partner with these community sites to promote healthy eating and physical activity.
How UC Delivers
UC ANR's Nutrition Policy Institute (NPI) has developed and tested Site-level Assessment Questionnaires (SLAQs) to empower local health departments (LHDs) and other agencies working with schools, early childhood education centers (ECE), out-of-school programs, and grocery stores to perform annual assessments of wellness practices at each site. A SLAQ is a setting-customized, easy-to-use questionnaire comprised of multiple sections, each of which addresses a specific wellness domain, such as the school food environment or prominence of healthy food displays in a grocery store. Topic experts, including extension and SNAP-Ed professionals, education professionals with nutrition expertise, and academic researchers,reviewed SLAQs and provided valuable contributions regarding their questionnaire validity and content. The SLAQs were then pilot-tested in the field for feasibility, validity, and reliability.
Extension programs can partner with schools, ECEs, out-of-school programs, and grocery stores to use completed SLAQs to identify areas of need and create action plans for improvement. As sites perform annual reassessments, they receive concrete data that reflect the progress of their programs. SLAQ scores from multiple sites can be aggregated to measure the degree of health promotion in a community, a county, or across the state. Extension programs can also examine how improving health-promoting practices over time relates to changes in health outcomes.
The Impact
In the first year, SLAQs were implemented across 46 California counties receiving SNAP-Ed funding, including 161 schools, 144 ECE sites, 68 out-of-school programs and 87 grocery stores. Additionally, SLAQs were adopted for use by five California LHDs who received CDC SPAN funding and SNAP-Ed funded elementary schools in Washington.
Local SNAP-Ed implementing agencies are already working with sites to tailor interventions based on the individual site's areas of strengths and opportunities. SLAQ users appreciate having a standardized tool to gather data, pinpoint weaker areas of performance, and strengthen their efforts to improve the health of California's children. NPI's role in expanding science-based evaluation practices demonstrates UC ANR's commitment to promoting healthy people and communities. Maridet Ibanez, Project Director for Orange County Health Care Agency's CalFresh Healthy Living program, highlighted how SLAQs helped them create a “menu” of intervention options that they were ready and willing to collaborate with their sites to implement:
We were able to compare 10 different [ECE] sites. It was a uniform tool that we could use to assess our sites. This wouldn't have been possible without the SLAQs. - Maridet Ibanez, Project Director