A new set of data briefs developed by the Nutrition Policy Institute showcases the impactful programming carried out by local health departments through California's SNAP-Ed program in Federal Fiscal Year 2023.
- FFY 2023 CalFresh Healthy Living Program at a Glance: Learn more about the community context and overall reach of local health department CalFresh Healthy Living in FFY 2023.
- Policy, Systems, & Environmental Change Efforts: Learn about the audiences local health departments reached with policy, systems and environmental change—commonly known as PSE— efforts, as well as common settings and PSE approaches.
- Educational Activities: Learn about the audiences local health departments reached with CalFresh Healthy Living education, as well as common settings and educational approaches.
- Partnerships & Multi-Sector Coalitions: Learn about the ways local health departments engaged with community partners and multi-sector coalitions to support and sustain impactful interventions.
- Program Effectiveness: Learn about the PSE practices in place at CalFresh Healthy Living sites as measured by site-level assessment questionnaires, behavioral outcomes of school-based interventions as evaluated via Impact Outcome Evaluation and outcomes from adult direct education.
The data briefs were created by NPI's CalFresh Healthy Living Evaluation Unit.
A new research brief developed by the Nutrition Policy Institute highlights promising school-based CalFresh Healthy Living—California's SNAP-Ed program—physical activity interventions. The study used latent class analysis to describe the predominant combinations of CFHL physical activity interventions implemented in California public schools in partnership with local health departments. Using Fitnessgram data from over 440,000 students in nearly 4,300 schools, the researchers assessed whether intervention combinations were associated with student cardiorespiratory fitness, as measured by V02 max. The study found that students in schools with CFHL interventions focused on establishing or improving wellness policies and increasing opportunities for physical activity had better cardiorespiratory fitness than students in schools without CFHL interventions or in schools with other types of CFHL intervention combinations. The peer-reviewed study was authored by Sridharshi Hewawitharana, Gail Woodward-Lopez, and Wendi Gosliner from the Nutrition Policy Institute, Punam Ohri-Vachaspati and Francesco Acciai from Arizona State University, and John Pugliese from the California Department of Public Health. The research brief was created by NPI's CalFresh Healthy Living Evaluation Unit, including: Summer Cortez, Reka Vasicsek, Miranda Westfall, and Sridharshi Hewawitharana.
- Author: Michael Hsu
NPI researchers provide influential evidence that shapes federal, state nutrition programs
Of the many challenges facing humanity, nothing is more fundamental than securing healthy food and water for all. Life itself would not be possible without nutrients, energy and water – but for many people across the United States, that essential fuel is compromised.
“Right now, the average American diet quality has a failing grade,” said Lorrene Ritchie, University of California Cooperative Extension nutrition specialist. “If you scored it from 0 to 100, it would be about 55 to 60. And we're trying to move that number closer to 80.”
To help society reach that goal, the Nutrition Policy Institute was established 10 years ago, under the UC Agriculture and Natural Resources umbrella.
“NPI was created in recognition of the fact that more people in the United States are now ill with a nutrition-related chronic disease than are well,” said Ritchie, who has been director of the institute since its founding. “Six in 10 adults in the U.S. have one or more chronic diseases – 4 in 10 have two chronic diseases – that are preventable. When you have that big of a public health nutrition problem, the scope requires big policies, big program changes and big environmental changes.”
Since 2014, NPI – building upon the work of the Center for Weight and Health at UC Berkeley – provides scientific data to inform and guide a host of nutrition improvements across wide swaths of the population, with a focus on low-income and racially and ethnically diverse communities.
The work of NPI's 40 academics, staff and students have furnished policymakers, program managers and school administrators with the pivotal research that, among other things, has enhanced access to federal nutrition programs, reduced food insecurity for children of all ages, and removed unhealthy snack foods and beverages from schools while boosting access to drinking water.
And with about 1 in 3 people in the U.S. touched by federal nutrition programs, NPI experts have become instrumental in evaluating programs such as SNAP (Supplemental Nutrition Assistance Program, popularly known as food stamps or CalFresh in California) and SNAP-Education, WIC (Special Supplemental Nutrition Program for Women, Infants and Children), school meal programs, and the Child and Adult Care Food Program.
“This institute is the only one of its kind on the West Coast, with a very substantial number of graduate-level nutritionists and policy experts who are ready and able to take on policy questions that are being considered at the federal, state and local levels,” said Pat Crawford, a pioneer in the field of nutrition policy and the founding director of the UC Berkeley Center for Weight and Health, which merged with NPI in 2015.
In assessing NPI's overall contributions to the nutrition and public health space, Ritchie is astonished by the work of its academics and staff.
“Our findings have really informed policy and moved the field in a way that I could have hardly conceived of 20 or 30 years ago, when I first started working in this area,” she said. “I could not imagine that we would have achieved all the policy impacts that we have.”
Trusted partners in researching school meal programs
An illustrative example of NPI's prominence in nutrition policy research is its leading role in studying California's effort to provide school meals for all students.
The Nutrition Services Division of California's Department of Education oversees virtually all meal programs in public schools across the state, serving 870 million meals and snacks each year to about 5.8 million students.
According to its director, Kim Frinzell, the division relies on NPI to help evaluate and understand the emerging trends at schools by gathering and analyzing feedback from students, teachers, food service directors, parents, community organizations and other partners. With a better pulse on these trends, Frinzell's team uses the data to inform its policies, practices, training and overall strategy.
“NPI brings the expertise of knowing what kind of research questions to ask; as a state agency, we don't have research resources, nor the specific expertise,” Frinzell said. “So being able to partner with NPI is an incredibly valuable service.”
In addition to working with Christina Hecht on drinking water access and Wendi Gosliner on food waste issues, the California Department of Education has partnered with NPI researchers in recent months to conduct surveys and organize focus groups on California's universal school meals program, School Meals for All.
Coming out of the COVID-19 pandemic, California was one of the first states in the U.S. to adopt a universal school meals program, offering breakfast and lunch at no cost to all K-12 students, regardless of household income. NPI was funded to evaluate the implementation and impact of the program.
“The great value of what NPI brings to School Meals for All is that their work is not just quantitative but qualitative, value-added information that tells a story about real individuals and real situations that is backed by the data about a particular program, and you're able to anchor back to a very well-respected institute and the research they've done and say: ‘This is what the survey says, this is what the evaluations and the data provide,'” Frinzell explained.
“What's been really wonderful about NPI over the past 10 years is they're such leaders in studying and helping to create strategies for greater access to healthy meals for all – while also promoting healthy habits for all – across the entire child-nutrition spectrum,” Frinzell added.
Pioneers in researching universal school meals
May Lynn Tan was one of the first students working at NPI. She was interested in learning about universal school meals and accessed data on meal programs from across the U.S. using Lorrene Ritchie's work on a nationwide collaborative school nutrition project.
“At the time, there was not a lot of evidence on the impact of universal meals on participation, because there just weren't that many places where that was happening,” Tan said. “So that data set really helped illustrate some of these patterns that I wouldn't have been able to get at, otherwise.”
Tan chose this topic for her doctoral dissertation. She concluded that students who previously had been ineligible for free or reduced-price meals experienced the greatest impact through universal school meal programs. “It really just went to show that when you offered universal meals in schools, the kids who weren't qualified to get them for free before, but who still needed them, could start participating at a higher rate,” said Tan, noting that her research continues to be used in modeling to predict the effects of such programs in other states.
Presently, as director of research and strategic initiatives for California Association of Food Banks, Tan is thankful for her relationships with NPI team members – and regularly accesses NPI resources and briefs (compiled by NPI communications director Danielle Lee, in collaboration with other NPI researchers) to stay abreast of the latest research.
“NPI does a really good job packaging their findings for practitioners who are managing and providing services for communities,” Tan said. “That's really important in this field, because policymakers and program staff don't necessarily want to wade through a giant study. NPI often puts out one-pagers and things that are more graphically designed that make it easy to understand the findings – and what they mean for the real world.”
Experts in examining WIC program policies, impact
In the early 2010s, Lauren Au was working in Washington, D.C. as a U.S. Senate nutrition advisor, providing lawmakers with the latest research on nutrition programs. But she sought a more active role in the field.
“Instead of being the legislative assistant who's meeting with constituent groups that are giving me their one-pagers about why their legislation should be supported, I wanted to be driving the research that's behind that one-pager,” Au explained.
Having studied with Pat Crawford as an undergraduate student at UC Berkeley, Au returned to the West Coast in 2014 as a postdoctoral researcher with NPI. One of her projects was a long-term study of children, from birth to age 9, participating in the WIC program.
Au's experience in studying WIC – including its pandemic-era changes that increased fruits and vegetables and offered online options for participant enrollment, recertification and education – allowed her to carve out her own niche in the academic space. She cited that research focus, along with the collaborative relationships she cultivated at NPI, as major reasons for her success as a recently tenured professor in the Department of Nutrition at UC Davis.
“I love this work because you're constantly learning and keeping up with where the field is going,” Au said. “I've seen, over time, how it's changed from focusing on obesity to now focusing more on the social determinants of health. And that's where my research has shifted as well, becoming broader and seeing how all these environmental influences play a role in impacting nutrition and public health.”
Trailblazers in studying policy, systems and environmental approaches
NPI's work has been a driver of the field expanding its focus to research and interventions beyond the individual (such as direct education efforts) to the social, cultural and environmental context.
“We know now that nutrition is absolutely one of the determinants of all of the chronic diseases that we're suffering from in this country, whether it be cancer, heart disease, stroke, diabetes or obesity,” said Crawford, emeritus CE nutrition specialist and adjunct professor of public health. “And we've learned that it takes more than just educating people – it really takes policymakers to help make those good, nutritious choices easier for the public.”
Sugar-sweetened beverages, for example, have a significant negative impact on children's diet quality and health, according to Ritchie. And because such beverages are heavily marketed and ubiquitous, parents and caregivers are challenged to make the right choice – even if they know about their harms.
“Regardless of the quality of the education, the onus is on the parents to remember to make the healthy choices, which can be hard when kids naturally love sweets, and given the influence of kids' ‘pester power,'” Ritchie explained.
To help those dietary decision-makers, a bill was passed in California to make the healthy choice (i.e., milk or water) the “default” beverage offered with kids' meals served in restaurants. Since that law went into effect in 2019, its efficacy – and shortcomings in practice – and have been extensively studied by NPI's CalFresh evaluation team.
Innovators in SNAP, SNAP-Ed evaluation
Federally funded by the United States Department of Agriculture, the California Department of Public Health oversees SNAP-Ed (known as CalFresh Healthy Living at the state level) as the largest of four CFHL state implementing agencies to fund work in California's 61 local health departments. CDPH contracted with NPI (and before that the Center for Weight and Health) to conduct ongoing comprehensive evaluation of CalFresh Healthy Living interventions, including individual education and behavior change as well as broader systems approaches.
“NPI has been a wonderful partner and contributed a tremendous amount in how CalFresh Healthy Living evaluates its work, especially as policy, systems and environmental change approaches have evolved and been encouraged over the years,” said Erica Eilenberg, chief of CDPH's Nutrition and Physical Activity Branch.
While developing more efficient systems and processes for tracking, evaluating and reporting results of CalFresh Healthy Living initiatives across California, NPI also provides technical assistance to local health departments in collecting crucial data and measuring outcomes. In particular, NPI researchers helped develop an innovative “dose score” method to quantify the cumulative and combined impact of multiple interventions at school sites – as opposed to measuring each type of intervention independently.
As a result, more robust evaluation data and reporting have provided local health departments with key information to improve their program planning and delivery.
“NPI's evaluation work has resulted in more effective initiatives that have contributed to improving food and nutrition access for many CalFresh Healthy Living-eligible participants across California,” said Eilenberg, who added that NPI academics are valued contributors to state-level workgroups and national committees advising SNAP-Ed.
Respected voices on food insecurity, nutrition in higher education
One of the many NPI-affiliated researchers who have become prominent voices at the national level, Suzanna Martinez was among the 500 invited attendees at the 2022 White House Conference on Hunger, Nutrition and Health – the first convening of its kind since 1969. Many of the conference's recommendations, outlined in the Biden-Harris administration's national strategy, are supported by research underpinnings from NPI and its partners.
Martinez was invited to the conference because she's part of a UC effort to halve, by 2030, the number of students in the UC system who are facing food insecurity – meaning they are regularly unable to access enough food for a healthy lifestyle.
Now an associate professor in the Department of Epidemiology and Biostatistics at University of California San Francisco, Martinez said her research on student food security in higher education was a direct result of her time at NPI. One of the first researchers to join NPI in 2014, she began working with Ritchie on a groundbreaking, systemwide survey about food security across the UC system.
“Up until that point, there had only been some smaller studies, convenience sample surveys of community college students, and so this was one of the bigger studies to look at this issue in a large public university system,” said Martinez, who noted that she had to be resourceful to avoid being food insecure as a graduate student.
Their initial study found that 4 in 10 UC students were facing food insecurity – a startling statistic that provided hard evidence to policymakers on the need for additional funding and resources, such as campus food pantries. In subsequent years, Martinez and NPI colleagues partnered with staff at UC campus basic-needs centers to pinpoint the barriers preventing greater student access to food assistance – and offered potential ways to streamline processes.
Follow-up surveys indicated improvement in food security at UC locations, until the pandemic halted that progress. Nonetheless, Martinez – who continues to intensively study the subject – said that NPI's broad platform was crucial in spotlighting food needs at colleges and universities.
“It was important, at that time, that this work came out of NPI,” she said. “I don't think it would have had as much impact as it has had because of where the work was coming from.”
Growing as a key source of research in food systems
The depth and breadth of NPI's influence is even more striking given the “youth” of nutrition policy as a field in public health nutrition, which dates back only about 50 years.
“For the applied nutrition policy research that we do at Nutrition Policy Institute, it's only in the last couple of decades that we've really been doing research to see how policy, systems and environmental change can support behavior changes of everyday people like you and me,” Ritchie said.
She pointed out that NPI's partnerships are key to expanding its reach. Partners assist in bringing NPI's rigorous research to legislators, policy staff and the people who manage and deliver nutrition programs. By working with state entities like the Departments of Education, Public Health, Social Services, and Food and Agriculture – as well as organizations such as the California and National WIC Associations, CACFP (Child and Adult Care Food Program) Roundtable and the Center for Science in the Public Interest – NPI researchers provide key data to decision makers and advocates, and receive critical guidance on their research projects in return.
“We are researchers, but we are not on the ground implementing these programs and policies and we absolutely cannot do the work that we do without our partners,” Ritchie explained. “Asking the right questions of the right people is really hard to figure out if we don't have the community partners at the table.”
By virtue of its place alongside UC ANR experts on agriculture, natural resources and the environment, the NPI team is also connected to an even larger community of farmers, producers and other people along the food supply chain. Ritchie envisions, in the next decade, NPI taking a larger role in examining and improving the greater food system. As Wendi Gosliner and Ron Strochlic did through NPI's involvement in a recent project linking local growers with state correctional facilities, UC ANR can help connect the many scattered dots from farm to fork – from the food production side to the consumer nutrition side.
“Looking toward the future, that's the kind of thing I'm most excited about – helping those two arms, and everybody in between, talk to each other so that agricultural decisions are made thinking about human and planetary health, and nutrition decisions by consumers are made thinking about both planetary and human health,” Ritchie said. “We're going to need to do that to address climate change.”
‘We can see where the future is headed'
Meeting the challenges of the climate crisis – as well as incipient global health crises – will require a continued influx of talent, innovation and new ideas.
“The U.S. is now leading all nations in the prevalence of chronic disease, and what happens here, in terms of our food system, often gets exported all around the world,” Ritchie said. “We can see where the future is headed, and what we need to do is to figure out how to go back to a healthier lifestyle and a healthier diet. So the field of nutrition policy research, though there aren't that many of us, needs the brightest and best minds, the most enthusiastic and passionate people.”
The NPI Student Fellowship, established in 2019 in honor of Pat Crawford, has funded about a dozen students to work with NPI researchers on a variety of projects. While they gain hands-on research skills, glimpses of potential career paths, and access to nutrition professionals and resources, they also contribute their own diverse perspectives.
“We intentionally recruit students with this fellowship funding who bring a diversity of lived experiences.” Ritchie said.
“Students participate in interdisciplinary and cross-cultural discussions on research design and data interpretation,” Crawford added.
Brianna Aguayo, a second-year undergraduate studying nutritional sciences at UC Berkeley, is a first-generation Latina college student currently working at NPI through the fellowship program. Growing up in East Palo Alto, Aguayo saw how systemic barriers prevented community members from accessing vital nutrition assistance and resources.
Through her time at NPI, Aguayo has gained new insights on how researchers, policy analysts and communication specialists work together to generate the scientific evidence that can improve federal, state and local policies so they can potentially benefit more people. That knowledge will only enhance her ability to create positive change in her community, as she plans to incorporate that public health policy perspective along her journey to becoming a pediatrician.
“It's not just one sole person making this change,” Aguayo said. “But it really takes a group effort to help initiate change, and then make sure that that change is constantly being implemented.”
People interested in supporting and celebrating NPI's first decade of research, which has led to more healthful food offerings to vulnerable children and their families, can donate to NPI's Student Fellowship. It provides students from underrepresented groups the opportunity to work with NPI, learn from NPI and continue after graduation to improve nutrition for all. An anonymous matching gift of up to $10,000 will double every donation made through June 30, 2024.
/h3>/h3>/h3>/h3>/h3>/h3>/h3>/h3>/h3>- Author: Michael Hsu
Tehama County students empowered by CalFresh Healthy Living, UCCE educator and teachers
It's not uncommon for high school or college students to speak up and seek to improve their school environment. But at Evergreen Middle School in Tehama County, more than 100 sixth graders led the way to create healthy changes at their school.
As part of their health classes during the 2022-23 school year, the students researched the availability of spaces for physical activity, developed a survey gauging their peers' health awareness and needs, analyzed the results and data, and made recommendations for improvements.
“We learned that there's not a lot of places – except for Evergreen Middle School and some other parks around [our community of] Cottonwood – that have many physical activity places that you can easily get to or have access to,” said Bailey, one of the students.
They were guided by Mario Monroy-Olivas, a nutrition educator with CalFresh Healthy Living, University of California Cooperative Extension in Tehama, Shasta and Trinity counties. Locally administered by UC Agriculture and Natural Resources, CFHL, UCCE is one of the agencies in California that teaches nutrition to people eligible for SNAP (Supplemental Nutrition Assistance Program) – referred to as CalFresh Food in California.
Working alongside Evergreen teachers Roxanne Akers and Albert Estrada, Monroy-Olivas challenged the sixth graders to tackle a “Youth Participatory Action Research” project – a yearlong, multi-step undertaking typically designed for older teens.
“The fact that we're doing it with these younger kids, starting a lot sooner, I think it's super impactful for them to know that, together, collectively they can make huge changes that will create positive outcomes – not just for themselves but for an entire community,” Monroy-Olivas said.
Middle school students speak up at school board meeting
In February 2023, eight class representatives presented their findings to the Evergreen Union School District Board of Education. Speaking before the five-member board for 20 minutes, the young people were naturally a bit nervous.
“It was a little nerve-wracking at first, but it wasn't that bad, once we got up there and got it over with,” said Lilah, one of the presenters. “Me and a couple of my friends were doing pep talks and practicing what we were going to say.”
The students showed a composite map that they drew from their classes' investigation of spaces for physical activity in the area, and shared a brochure that outlined their research and survey results. In a survey of more than 80 of their peers, 92% of respondents said they needed more access to physical activity equipment during class breaks, recess and lunch.
“The board members were super impressed with the students, coming to the school board and doing this,” Monroy-Olivas said. “They said they haven't had students doing this kind of advocacy work; for them, it was a really big deal.”
In the end, the young people made a strong case for more water-bottle refilling stations, badminton equipment and balls for other sports, and stencils for schoolyard activities like hopscotch, four square and snail (a type of hopscotch game).
“We got almost everything we asked for, and the project we're working on now is to help put in the things we asked for,” said Lilah, adding that, during this current school year, the students (now in seventh grade) are working on acquiring the stencils and paint.
More than just equipment, students gain skills and confidence
While the promise of new gear is exciting for the youth, they are acquiring something even more valuable and enduring – a sense that they are empowered to make a difference in their community, according to Janessa Hartmann, UC Cooperative Extension community nutrition and health advisor for Tehama, Shasta and Trinity counties.
“Yes, it's important to want to do stencils and hydration stations and have more equipment,” Hartmann said, “but the bigger impact for the students is that they think: ‘Now I know that my health is important, now I know how to advocate for myself, and now I know that I can do that.'”
Monroy-Olivas said he observed tremendous growth in all the students, and especially in the self-confidence of the class representatives.
“I grew as a leader because I used to be really shy and hated talking in front of people, but through this project we're doing, this has really helped me be able to talk in front of crowds – and listen to others,” Lilah explained.
In a survey at the end of the sixth-grade project, the percentage of youth who answered “Yes, most definitely” to the statement “I want to make a difference in making my school/community healthier” jumped from 19% before the project to 44% after. And that percentage of “Yes, most definitely” replies jumped from 6% to 31% for the statement “I can use research results to come up with solutions or recommendations for making my school/community a healthier place.”
“We learned to promote what we want and try to get it as much as we can, so we can get more physical activities and more people can be included,” said Brian, another student working on the project.
“It's important so when we get older, we know how to voice our opinions and let people know what we're thinking,” added classmate Brooklynn.
Wishing that he had such an opportunity when he was growing up, Monroy-Olivas said he feels the students now know the power of their voice.
“I wholeheartedly believe that's the biggest win out of this whole project, that they're learning how to advocate for their own voice and change,” he said.
/h3>/h3>/h3>- Author: Brianna Aguayo Villalon
- Editor: Amanda Linares
- Editor: Danielle Lee
Nutrition Policy Institute researchers led a recent study published in the California Agriculture journal. During COVID-related school closures school meal consumption was associated with eating more fruits and vegetables. Researchers administered online surveys to 3,297 fourth and fifth-grade students in 67 CalFresh Healthy Living–eligible schools and after-school programs in California during the pandemic. Survey results showed that, on average, students who ate one or more school meals daily consumed fruit and vegetables four times per day. This was significantly higher than students who did not eat school meals; they consumed fruits only two times and vegetables three times per day. However, 100% fruit juice accounted for 40% of daily fruit intake and students who ate school meals had significantly higher sugar-sweetened beverage intake with three-quarters of it coming from flavored milk. Study results suggest an opportunity for improvement in supporting and encouraging schools to continue providing nutritious meals, whole fruits instead of 100% juice, and reduce sugary drink consumption by promoting unflavored milk. The study was led by NPI researchers Kaela Plank, Amanda Linares, Sridharshii Hewawitharana and Gail Woodward-Lopez. This study was conducted as a part of a contract with the California Department of Public Health with funding from the USDA Supplemental Nutrition Assistance Program Education.