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. 

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.

A Teens Love Cooking student measuring ingredients to make a smoothie

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.

“I really liked the Oatmeal Bites, so I made them at home for my family to taste”. - high school student

Teens Love Cooking students assembling “Myplate” pizzas

 

 

CalFresh Healthy Living (CFHL), UCCE Kern County aims to improve health in farm working families by encouraging healthy eating and physical activity. As a result of a partnership with Head Start centers serving migrant communities, youth completed over 140 hours of physical activity and 92% of adult family members intended to use nutrition facts when shopping.

The Issue

According to County Health Rankings & Roadmaps, Kern County is ranked among the least healthy counties in California in terms of length and quality of life and a significant portion of residents have one or more risk factors that threaten their longevity and quality of life. For instance, 34% of adults are either overweight or obese, 35% of residents are physically inactive, and 23% are food insecure. 

Children and adults with these risk factors are more likely to develop chronic diseases like heart disease and diabetes.

 How UC Delivers

In order to work with residents on early healthy start interventions, CFHL, UCCE Kern County partnered with Community Action Partnership of San Luis Obispo (CAPSLO), which has five migrant Head Start centers in Kern County. CAPSLO provides no-cost childcare and preschool services to low-income families whose primary occupation is agricultural production and harvesting in the Arvin, Lamont/Weedpatch, Wasco, and Delano communities.

CFHL, UCCE Kern has conducted evening adult nutrition education at the centers.

• 94 parents received evidence based lessons from Plan, Shop, Save, and Cook (PSSC) and Healthy, Happy Families.
• Parents learned how to read the nutrition facts label, save money on food and how to start healthy habits with their children. Parents also learned how to incorporate physical activity in their everyday family routine. Physical Activity Guidelines for Americans (2018)recommends moderate-to-vigorous physical activity to reduce the risk of many chronic diseases among children and adults.

In order to impact families CFHL, UCCE Kern provided CAPSLO teachers with four hour training on Coordinated Approach to Child Health Early Childhood Education (CATCH ECE). CATCH ECE provides children with skill development exercises to develop locomotor, non-locomotor, manipulative skills and nurture their love for physical activity through games and activities. Teachers conducted CATCH 2-4 days per week for 30 minutes.

CAPSLO teachers trained in CATCH ECE

Teachers being trained in CATCH ECE

The Impact

Seventeen parents who received the PSSC lesson on understanding food labels completed an “Intent to Change” survey. Results of the survey include:

• Of the 12 respondents who did not use the “Nutrition Facts” label prior to the lesson, 92% reported that they will use the nutrition facts on the food label to choose foods the next time they go shopping.
• A parent shared how the workshop helped her family and that they are “eating better and know how to choose foods with better nutrition.”

From August to October 2022, 130 children participated in 143 hours of physical activity through CATCH ECE lessons delivered by 15 teachers at CAPSLO's centers. Research shows that regular moderate-to-vigorous physical activity reduces the risk of many chronic diseases among children and adults.

“All my children enjoy the CATCH activities. The CATCH program is fun and beneficial,” one teacher shared. The Center Director said “I really like how teachers and children are physically active with CATCH. The nutrition sessions given to the parents also makes it more impactful for the whole family.”

By motivating and teaching CFHL participants to adopt healthier lifestyle practices, and training ECE teachers to support physical activity, CFHL, UCCE Kern helps create healthier families and communities.

Students participating in CATCH ECE activity.

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.

Students participate in a taste test survey

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.

Students paint a mural

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.