- (Condition Change) Improved community health and wellness
CalFresh Healthy Living (CFHL), University of California Cooperative Extension (UCCE) in Contra Costa County promotes healthy communities with a nutrition education curriculum designed to improve teens' eating and fitness choices. Of the 117 middle school youth who participated in EatFit, 30% increased the number of times they ate vegetables.
Food and beverage companies invest over $1 billion in marketing each year to advertise their food products to Black and Hispanic consumers, specifically the youth. Students at Hillview Jr. High School (HJHS)–which is located in a low-income neighborhood of Pittsburg and has a 60% Hispanic and 19% African American student population– are not exempt from these widespread and targeted food marketing campaigns. Fast food restaurants, convenience stores, and gas stations line the main street avenue near the school, attracting hungry teens.The easy availability and promotion of these foods, which are linked to negative life-long consequences, influence the food choices made by youth every day. When hunger strikes, healthy eating and active living are out of sight and out of mind to many teens.
How UC Delivers
CFHL, UCCE in Contra Costa County partnered with HJHS to deliver EatFit during the 2022-2023 school year. EatFit is a nutrition education goal-setting curriculum designed to challenge middle school students to improve their eating and fitness choices. The program reached 149 students who participated in activities focused on goal setting, nutrition facts label, energy, breakfast, exercise, fast food, and the media's influence on food choices.
In one of the EatFit lessons, students learned about food marketing. They were asked to name a commercial or ad on the Internet about water or healthy food. None could. However, when asked for examples of fast food or soda ads and commercials, all hands went up. Some students even sang the jingle or acted out the commercial. Students realized that food companies target young people and hardly promote healthy foods. Instead, TV commercials and advertisements on the Internet and social media try to persuade teens to eat and drink unhealthy foods and sugary beverages that harm their health. In the same lesson, students also learned about food marketing techniques and were encouraged to create fruit and vegetable posters to promote healthy choices at school.
With support from the principal, the school's busiest hallways were decorated with students' colorful fruit and vegetable posters. Not one poster was vandalized or torn off.
One hundred and seventeen students in grades 6-8 completed the Eating and Activity Tool for Students (EATS) pre-post survey at Hillview Jr. High to assess changes in their behaviors after participating in the FY 2023 EatFit lesson series. Respondents were ten to thirteen years old, and identified as Latino or Hispanic (48%), Black or African American (18%), or more than one race (27%). After taking part in EatFit, the student survey results included the following:
- 34% increased the number of time they ate fruit yesterday.
- 30% increased the number of time they ate vegetables yesterday.
- 50% reduced the number of times they drank sweetened beverages yesterday - with the largest decreases seen in fruit drinks, soda, and sweetened coffees and teas.
- 40% increased the number of days they were physically active for 60 minutes or more last week.
“One change I made to eat healthier/be more physically active is to exercise/stretch when I wake up and lower how much unhealthy food I eat (high fat food, high calories etc) and start eating more fruits and veggies.” — EatFit Participant
This work is vital in adolescents as they begin to become more independent in the way they think, learn, and interact with food. Likewise, nutrition education intervention efforts in majority Black, Indigenous, and People of Color (BIPOC) communities are of particular importance because these groups have been expressly targeted as potential consumers of nutrient-poor food while also facing barriers to accessing affordable and convenient healthy food. By supporting students to reflect critically on how unhealthy food and beverages are advertised to them and then develop their counter-messages to promote healthy choices, inclusive SNAP-Ed-approved programs like EatFit and others can help improve nutrition behaviors among low-income adolescent Californians and prevent the chances of developing chronic disease later in life.
CFHL, UCCE staff will continue to partner with Hillview Jr. High to deliver quality nutrition education during the 2023-2024 school year. The fruit and vegetable posters made by students serve as a friendly reminder to all that food marketing does not steal your independence; you can still make a healthy, tasty choice.
“Before, I use to just get snacks to eat them but a lot of them were unhealthy and I got cavities. During the lesson we learned that the labels are actually important. Now I check the label to compare and buy the snack that is more healthy. It is working I am more healthy and happy.”— Jacob Ponce, EatFit Participant
- Author: Amanda M Linares
- Contributor: Kaela Plank
- Contributor: Sridharshi Hewawitharana
- Contributor: Gail Woodward-Lopez
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.
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.
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: Amanda M Linares
- Contributor: Kaela Plank
- Contributor: Sridharshi Hewawitharana
- Contributor: Gail Woodward-Lopez
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.
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.
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.
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>
A social media campaign aims to improve health of residents at low-income housing sites by encouraging vegetable intake through container gardening
In the U.S., vegetable intake is lowest among adults with low income. Eating the recommended daily amount of vegetables is important for overall health. Gardening has a role in promoting vegetable consumption. CalFresh Healthy Living, University of California Cooperative Extension (CFHL, UCCE) Butte Cluster and UC Master Gardeners, kicked off their second annual “Great Tomato Challenge” in 2022, a social media contest for Community Housing Improvement Program (CHIP).CHIP is a non-profit corporation that serves Butte, Glenn, Yuba and Colusa Counties by assisting low-income residents with quality, affordable housing. The goal of the “Great Tomato Challenge” event is to promote container gardening at apartment complexes through a workshop and social media contest.
How UC Delivers
The 1.5 hour Fresh from the Garden curriculum workshops took place at 5 CHIP sites, having been advertised in English, Spanish, and Hmong language flyers. Over 40 adults learned how to harvest, store, and prepare fresh tomatoes. Those who opted to sign up for the social media challenge received a tomato plant and agreed to submit photos, drawings, and recipes accessed on the CFHL, UCCE Butte Cluster Facebook page.
UC Master Gardeners partnered with CFHL, UCCE Butte Cluster to provide Facebook Live sessions to answer any questions participants had about growing their tomato plant. CFHL, UCCE Butte Cluster Educators translated questions and answers into Spanish and Hmong.
Three winners were selected from the 36 contestants from the following categories: best photo of you and your tomato plant; best tomato drawing; and best recipe photo. Winners received a colander, whole wheat spaghetti noodles, and a jar of locally-sourced pasta sauce.
Eighteen participants completed an "Intent to Change" Survey for the workshop. Thirty-eight percent reported that they would: “eat more than 1 kind of vegetable each day more often within the next week.” One participant wrote “This workshop helps my family to be healthier.” Gardening has a role in promoting greater vegetable intake and variety among families with low income which improves overall health.
CalFresh Healthy Living, UCCE Butte Cluster will continue this challenge annually and is considering starting an additional annual challenge, using the same model, for a cool-season vegetable such as beets.
UCCE partners with a school site to promote health and wellness and develop student leaders. As a result of the program, 92% of students reported gaining skills in teaching others.
Studies show that school gardens support student health through increased physical activity, increased consumption of healthy foods, and decreased body mass index. School gardens are also associated with positive emotions and social interactions. Additionally, school gardens have the potential to improve students' leadership skills and teamwork abilities. CalFresh Healthy Living, UCCE (CFHL,UCCE) in Santa Barbara County partners with schools to gather stakeholders, create plans, fundraise, and build, maintain and teach in school gardens. One partnering school, Hapgood Elementary, has a flourishing garden that has been expanded and maintained over several years.
How UC Delivers
As COVID-19 restrictions at schools began to ease, UCCE garden nutrition educator Abbi Marrs reached out to the student leadership class to see if there was interest in developing leadership skills related to nutrition and food production in their school garden. Over 30 student leaders expressed interest in learning more about the garden. With the support of the school administration, UCCE staff met with the students to provide support and training related to growing food, composting, garden maintenance, and teaching in the garden. Throughout these trainings, UCCE staff worked with the youth to make decisions related to what they wanted to do with their new skills to support the garden. One group decided to focus on building more awareness of their garden by providing school garden tours. Another group decided to focus on supporting school and family health by providing garden enhanced nutrition education lessons in the garden.
UCCE staff supported youth by facilitating school garden training, helping write scripts for the garden tours, training in Teams With Intergenerational Support (TWIGS) curriculum, and practicing presentations. On April 15th, 2022, 26 youth delivered a garden tour to other youth, teachers, families, and community members. The mayor and city staff were invited to attend, and youth had the opportunity to share their garden and how it impacts their learning and health. In addition, 10 lessons were taught to 211 students in grades TK-6th.
Additionally, eight student leaders shared their garden experience while presenting at the 2022 California Agriculture in the Classroom Conference in September. Student leaders worked with UCCE staff to develop a presentation focused on the responsibilities of a garden student leader. The topics included: how the garden youth leader program started, garden jobs, composting, working with hydroponic towers, working with food service staff, safe harvesting practices, and how to teach garden-based and nutrition education lessons. During the presentation, student leaders shared their favorite parts of working in the garden. Some answers included teaching younger students about the garden, learning healthy recipes, and learning more about gardening in general. Student leaders then delivered a condensed version of the “Pest or Pal” lesson from the TWIGS garden-based curriculum to over fifty attendees. The presentation concluded with question-and-answers and students answered questions such as the biggest challenge they faced working in the garden, their favorite foods to grow, and how working in the garden has helped develop them as leaders.
Youth leaders completed the Youth Leader Retrospective survey at the end of the school year (n=26). This survey asks participants to reflect on changes they see in themselves due to their participation in programming. Questions ask about behavior changes related to safely preparing and cooking healthy foods, leadership skills gained, and support received from adult facilitators.
For healthy behaviors, students agreed or strongly agreed, due to their participation in the UCCE Student Leaders Garden Committee: I wash my hands frequently (100%), my family has purchased healthier foods (92%), my family has prepared healthier foods (88%).
For leadership skills, youth retrospectively rated their ability before and after the program using a 4-point scale from No Ability to Excellent Ability. Improvement was observed in all leadership skills assessed, including the ability to work as a team member, speak before a group, teach others, and plan programs. The biggest change was observed in their ability to teach others. Prior to the program, only 1 (4%) youth reported an Excellent Ability, and 11 (42%) reported Good Ability. After the program, 11 (42%) rated themselves as having Excellent Ability and 13 (50%) rated themselves Good Ability. In addition, 0 youth rated themselves as No Ability after participating in the program, compared to 5 (19%) before the program.
For program support, youth agreed or strongly agreed with the following statements: There were dedicated adults who supported me as a youth leader (100%), I received ongoing training and support throughout the program (88%), The program made sure I had everything I needed to be successful as a youth leader (100%).
As a result of the garden tours, the Lompoc City Council adopted a school garden resolution that states the importance of school gardens to student health and the commitment of the city to support school gardens. Youth attended the council meeting and their school was gifted an apricot tree and the principal hosted a tree planting ceremony with students and family members. UCCE plans to work with student leaders next school year with 6th grade student leaders taking on the responsibility of training 5th grade student leaders. This peer to peer model will create a solid foundation for garden program sustainability for years to come. Lastly, when asked about the student youth leader the city mayor stated:
“I am so impressed with the students and the garden at Hapgood! Their passion for growing food was evident as the young scholars taught us about composting and what each part of the plant contributes to in its growth. I want to thank the UC CalFresh Education Program, all the parents and volunteers as well as the staff at Hapgood for supporting such an awesome learning experience in how our food grows.”- Lompoc City Mayor
Through this partnership, CFHL, UCCE in Santa Barbara contributes to improved health for the local community, and guides students to become effective public leaders.