- Author: Brianna Aguayo Villalon
- Editor: Danielle Lee
- Editor: Lorrene Ritchie
The excessive consumption of added sugars by Americans has surpassed the recommended levels outlined in the Dietary Guidelines for Americans, highlighting a pressing public health concern.The Nutrition Policy Institute at the University of California, Agriculture and Natural Resources submitted a public comment in response to the US Food and Drug Administration's call for strategies to reduce added sugars consumption in the United States. The comment outlines 13 recommended actions for federal agencies and four recommended actions that other stakeholders can take to minimize added sugars consumption. Additionally, NPI urged the FDA to address safety concerns around the replacement of added sugars with low- and no-calorie sweeteners, specifically among children. Federal agencies and stakeholders have ample opportunities to decrease added sugars consumption in the US. and NPI emphasized the need for action on recommendations to enhance food safety and empower consumers to make healthier choices. The public comment period was open from November 6, 2023, to January 22, 2024. All submitted comments are available to view online on Regulations.gov.
- Author: Michael Hsu
Nutrition Policy Institute researcher developed techniques that help identify effective public health programs
When Suzanne Rauzon and May Wang were in the master's of public health program at the University of California, Berkeley during the mid-1980s, Wang knew that her classmate had unique brilliance to bring to their field.
“You know how you vote for the person in high school who's most likely to succeed? That was Suzanne,” said May Wang, a professor of community health sciences in the UCLA Fielding School of Public Health. “Suzanne was always ahead of every one of us; she was so visionary and forward-thinking and I think we were all – to be honest – a little bit in awe of her.”
Decades later, as Rauzon prepares to retire in January 2024 as director of community health at the Nutrition Policy Institute, she has fulfilled that exceptional promise. Her many contributions are helping communities identify the most effective programs to benefit public health.
Lorrene Ritchie, director of NPI (an institute under UC Agriculture and Natural Resources), said that Rauzon has played a pivotal role in translating research findings into community action and policy change. She added that Rauzon has brought an extraordinary combination of strategic vision for the overall direction of nutrition studies and tactical savvy to anticipate the needs of project funders and communities.
“Few people can bring both of those skills – efficiently complete the day-to-day tasks as well as be a big-picture thinker,” Ritchie said. “She has been so instrumental in contributing to NPI's impacts.”
A unique skill set to tackle complex challenges
Part of what makes Rauzon unique in her field is her extensive experience in the private sector. After attaining her master's degree, Rauzon developed a comprehensive employee worksite wellness initiative at a telecommunications company – a new set of programs that led the field in the 1990s.
“Suzanne was, is and has always been very visionary,” Wang said.
After years in the corporate space, however, Rauzon leaped at the chance to return to academia (and reunite with Wang) in 2001 at UC Berkeley's Center for Weight and Health, a precursor to NPI. Working with center co-director Patricia Crawford, Rauzon said the project to investigate the effects of sugar-sweetened beverages was a “perfect fit” for her.
Concerned with rising childhood obesity, the researchers studied the significant differences in health outcomes for students in high schools that limited access to beverages such as soft drinks, versus schools that did not.
“That field in general – looking to limit sugar-sweetened beverages – started with a focus in schools, and expanded into other environments (such as college campuses) over the years, and has continued to be a focus in public health,” Rauzon said, “all the way up to work now on limiting sugar-sweetened beverages access in other public institutions.”
Rauzon's change-management and communication skills also were crucial in studying the revolutionary School Lunch Initiative in the Berkeley Unified School District – a collaboration with chef Alice Waters' Chez Panisse Foundation and the Center for Ecoliteracy to engage young people in the growing and preparation of food. Brought in to evaluate the efficacy of the program, Wang and Rauzon found they had to alter their mindset and methods when working with partners who were responding to oft-changing circumstances.
Rauzon's cross-sector perspective, practical know-how and people skills in cultivating positive relationships with district staff and educators were instrumental in successfully completing studies with as much rigor as possible in real-world settings such as schools.
The researchers created new analytical tools to evaluate health interventions developed by communities themselves – as opposed to programs engineered by academics and applied to community members with the expectation that they would accept it.
“Most researchers, to be honest, are still striving to do that with communities,” Wang said. “It is an incredibly challenging task because communities will do what they want to do – and what they need to do – to respond to the needs of people.”
Wang, who now trains academics in community-based participatory research, said that the ground-up paradigm has been shaped by Rauzon's thinking. “A lot of the ideas I have today really came about from our work together on the School Lunch Initiative,” Wang said.
A legacy of new methods, mentoring early-career professionals
One of Rauzon's longest-running – and most complex – projects has been the evaluation of community health interventions across the country, including a variety of Kaiser Permanente initiatives to promote healthy eating and physical activity.
“What was interesting about that work was we really were trying to understand the combined effects of doing a lot of different things that are related – and to see the overall effect that can have on the community,” said Rauzon, noting that interventions ranged from nutrition classes to policy changes to park and bike-safety improvements.
Wang said some of their findings, particularly from one study in Los Angeles County, suggest that effective programs are early childhood interventions (including an emphasis on breastfeeding), home visitations by nurses and social workers to vulnerable households, and partnerships with retailers to make healthy food choices more accessible.
In the process, the researchers helped pioneer new research tools – including interdisciplinary “systems mapping” approaches in which computer scientists discern linkages among various programs and their effects, and the highly influential “community intervention dose index” concept that can be used to evaluate multiple intervention strategies within a community.
In addition to Rauzon's contributions in research and evaluation, Ritchie also highlighted her role in supervising and mentoring students and NPI staff and researchers during her 20-plus years with the UC – the role in which Rauzon takes the most pride.
“While I made a contribution to community health in effective interventions and how to measure them,” Rauzon said, “I would say personally the most rewarding part of the work I've done over the last couple of decades is seeing the growth and development and advancement of people who have worked for me and who have really taken off in their own careers – that to me has been immensely satisfying.”
As an emeritus researcher, Rauzon will continue to support NPI professionals and their research, and she added that she's excited to embark on a new partnership – with her husband, a geographer – to mitigate impacts of climate change on human and environmental health across the globe.
People interested in supporting Rauzon's legacy and the ongoing work in health and nutrition can donate to NPI's Student Fellowship, which provides students from underrepresented groups the opportunity to work on NPI research and be mentored by NPI researchers.
/h3>/h3>/h3>- 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.
The University of California Research Consortium on Beverages and Health, a group of faculty from every UC campus coordinated by the Nutrition Policy Institute, has released two new resources to support reducing consumption of sugary drinks. The first is a factsheet, University Beverage Pouring Rights Contracts – And Alternatives, which aims to educate university stakeholders about beverage “pouring rights” contracts that allow a beverage company—usually PepsiCo or Coca-Cola—nearly exclusive rights to market and sell its products throughout the university's campus and during events. The factsheet outlines the variety of stipulations present in these contracts and suggests alternative strategies for healthier, more up-to-date beverage procurement. The second resource is a living document, an Interactive Table of Policy Strategies to Reduce Consumption of Sugary Drinks (US – Proposed and Enacted). The table portrays the landscape of federal and tribal, state, city, workplace and educational institution policies in use in the US to reduce consumption of sugary drinks: excise taxes on sugary drink distributors, bans or restrictions on sugary drink sales or service, and other policies such as restrictions on marketing, requirements for labeling, or regulation of vending machine contents. It includes links to the policy language to provide sample language for entities that are considering developing new policy. Consortium members Ken Hecht from NPI, Kristine Madsen from UC Berkeley and Jennifer Falbe from UC Davis were interviewed about these topics in a July 10, 2023 story in The Daily Californian, “A unique responsibility': Campaigns work to limit soda consumption, stop UC pouring rights contracts.”
- Author: Katherine Lanca
- Editor: Danielle L. Lee
- Editor: Wendi Gosliner
The U.S. Department of Agriculture proposed new nutritional standards to improve the healthfulness of child nutrition programs, which includes school meals. The new rule sets strict sodium targets and the first ever restriction on added sugars. Among many school cafeteria foods, chocolate milk, which has almost half of a child's daily recommended intake of added sugars in one carton, is potentially on the chopping block. The LAist edition of AirTalk, hosted by Austin Cross, invited Dr. Wendi Gosliner, senior researcher with the Nutrition Policy Institute, to discuss the significance of the USDA's latest proposal for school nutrition standards. The podcast conversation centers around a central question: “How do we make sure [school] meals appeal to students while meeting their nutritional needs?” Gosliner acknowledged that initial pushback of the proposal is expected, citing pushback on the implementation of the 2012 Healthy Hunger Free Kids Act as an example. But she reminded listeners that new nutrition standards require a learning curve—they teach students what to get used to. She described how thoughtful removal of cafeteria staples, like chocolate milk, may help students part ways with familiar school foods and can offer a long term investment in student health. She also highlighted California's Universal School Meals program as a model for the nation with its bold investments. “School meals have the potential to be both tasty and nutritious,” said Gosliner. The LAist “AirTalk” episode is titled “USDA Considers Banning One Of The Best Parts Of School Lunch: Chocolate Milk” and can be found on the KPCC LAist website; scroll past the episodes listed in order of airing to find the May 19, 2023 episode.