Posts Tagged: policy

Online ordering for fast food inconsistent with healthy beverage law, study finds

Lack of specific language for online context makes assessing compliance difficult

Beverages offered on fast-food restaurant websites and platforms such as DoorDash, GrubHub and UberEats often do not adhere to the spirit of California's healthy beverage law for children's meals, according to a new study from University of California researchers.

California's healthy-by-default beverage law (SB1192), which went into effect at the beginning of 2019, requires restaurants to offer only plain or sparkling water with no added sweeteners, unflavored milk, or unflavored non-dairy milk as the default beverage in “kids meals.” The law also requires that menus, menu boards and advertisements for those meals include only approved default options.

The law was passed to address increasing rates of childhood obesity and related chronic diseases, with sugary beverages factoring as a significant contributor to those poor health outcomes.

“Healthy-by-default beverage laws work by making the healthiest choice, the easiest choice for families,” said the study's lead author, Hannah Thompson, senior epidemiologist for the UC Nutrition Policy Institute and assistant adjunct professor at the UC Berkeley School of Public Health. “Drinking sugar-sweetened beverages like sodas has been directly linked to health problems such as Type II diabetes, heart disease and cavities.”

Researchers at the NPI – a program of UC Agriculture and Natural Resources – found that most fast-food restaurants serving low-income census tracts did not offer beverages online in a way that is consistent with SB1192. The study focused on those neighborhoods because children from low-income families consume sugar-sweetened beverages in greater quantities, likely exacerbating health disparities.

Published online in the journal Public Health Nutrition, the study looked at a random sample of 254 “quick service restaurant” sites and collected observations from their restaurant-specific websites and three of the most popular online platforms that deliver their menu items – DoorDash, GrubHub and UberEats.

Researchers developed four increasingly restrictive criteria – incorporating beverage availability, upcharges and presentation of beverage options – to assess the implementation of SB1192 in these online ordering contexts. Half of their observations met their most lenient criteria, while less than 6% were consistent with their most restrictive – findings that Thompson called “discouraging.”

“It means families have to work harder to make the healthiest drink choices for their children,” she said. “This also means the law is likely not nearly as successful as it could be in its intent to help reduce sugary drink consumption by kids.”

The researchers had to create their own criteria for “compliance” with the law because, as written, SB1192 does not specifically mention online ordering, which has become increasingly popular due to the COVID-19 pandemic.

“Part of what makes it hard in the online context is that the law was written using language very specific to the in-restaurant physical space, making interpretation of compliance with the law for meals sold online challenging,” Thompson explained. “I'd love to see amended language in the law specific to meals sold online.”

Thompson also said she would like to see “clear and effective” communication with fast food restaurants and online delivery platforms so that they fully understand the healthy beverage law – as well as the use of a monitoring system that could help ensure compliance.

“Laws, which target system-level changes, are one of the most important public health tools we have to reduce sugary drink consumption and improve health for youth of all backgrounds,” she said. “But laws are only as strong as the structures in place to ensure their successful implementation.”

The other NPI-affiliated authors of the study are Senior Evaluators Anna Martin and Ron Strochlic, Evaluation Associate Sonali Singh, and Associate Director of Research Gail Woodward-Lopez, the principal investigator.

Study: Government shutdown stressed food assistance program participants

A U.S. federal government shutdown can represent a minor inconvenience, a delay in paychecks, or – for people living in some of the most difficult circumstances – an extended period of hunger and anxiety.

A study published recently in the journal Nutrients provides a unique glimpse into the shutdown experiences of participants in CalFresh – California's name for the federally funded Supplemental Nutrition Assistance Program (formerly known as food stamps). Currently, about 42 million people participate in SNAP across the U.S.

In focus groups conducted in 2019 with 26 low-income CalFresh participants from four diverse California counties, participants shared how the 2018-19 federal government shutdown affected their SNAP benefits, their perception of the program and their faith in government.

One of the immediate effects of the 2018-19 shutdown was that February CalFresh benefits were distributed in January. And while that meant program participants saw extra benefits that month, they then had to wait 40 to 44 days until the March issuance – much longer than the usual 28 to 31 day cycle.

“What we saw with this study is that this extended lag in benefit receipt from January to March was devastating,” said Wendi Gosliner, senior researcher and policy advisor at the Nutrition Policy Institute of UC Agriculture and Natural Resources, and an author of the study funded by UC ANR.

She recalled one participant who, despite having a gastrointestinal issue that requires a special diet, had to eat canned food from the food bank that made her sick – rather than go hungry while waiting for her March benefits. Others described cascading financial challenges after using rent money for food in February, or going into debt to pay for food and getting behind on other expenses.

The study also chronicles the experiences of a woman who was anguished to hear the suffering of her daughter, also a CalFresh participant: “She called me several times crying, ‘Ma, I don't – we don't have enough food. What am I going to do…? You know, I can't afford to this and this and this.' And I can't help her.”

For individuals grappling with food insecurity, the stress of feeding their families was compounded by the uncertainties of the government shutdown. And while many participants exercised their agency and resourcefulness in coping with the situation, they also felt a degree of powerlessness amid the “confusion and craziness,” as one person put it.

“No one knew how long that shutdown was going to last; no one knew if the March benefits were going to be paid,” Gosliner said. “And as we learned, there were all kinds of stories circulating out there about what was going on with the uncertainty – a lot of people didn't have the information about what was actually happening.”

Some participants, seeing the “double benefit” in January 2019, thought that it was the last-ever distribution and that SNAP was ending. Others described being unable to get in touch with the CalFresh agency to get their questions answered about the benefits. Most participants had not heard about the disrupted benefit schedule before receiving the benefits. As a result, many people in the focus groups shared that their overall faith in government had been shaken.

Improving customer service, boosting benefit levels and adjusting eligibility and benefit formulas to reflect high cost-of-living and expenses related to working were three recommendations that came from the focus group participants.

A fourth recommendation tackles the shutdown issue head-on: Don't let it happen again.

“Congress should do absolutely everything in their power to be sure that the program operates on the usual time schedule – even if the government is shut down,” Gosliner said.

In the context of the global pandemic, when financial and social inequities and physical and mental health disparities have been laid bare, ensuring access to healthful food is even more important. And with studies showing that hospitalizations increase with longer lags between SNAP distributions, Gosliner said the “absolute last thing” the overburdened health system needs is more people in emergency departments seeking acute care.

“It's the worst time to be having people who need money to feed their families face additional insecurity,” she said. “It's critically important that Congress acts to be sure that there is not any disruption in benefits.”

The authors of the study, “Participants' Experiences of the 2018–2019 Government Shutdown and Subsequent Supplemental Nutrition Assistance Program (SNAP) Benefit Disruption Can Inform Future Policy,” are Wendi Gosliner, Wei-Ting Chen, Cathryn Johnson, Elsa Michelle Esparza, Natalie Price, Ken Hecht and Lorrene Ritchie.

The study can be found online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353319.

CalFresh participants welcome texts on benefits of California-grown produce

The buzz or chirp of an incoming text message started some San Diego County residents on the path to a healthier diet during this past year. In September 2020, most CalFresh participants in the county – more than 172,000 households – began receiving monthly text messages about the benefits of California-grown fruits and vegetables as part of a pilot program.

This novel approach to delivering nutrition messages to California food assistance program participants was developed by a partnership of the Nutrition Policy Institute of UC Agriculture and Natural Resources, the UC San Diego Center for Community Health and the County of San Diego Health and Human Services Agency, which administers CalFresh in the county.

The HHSA, which had been using its text messaging platform to send administrative reminders and alerts, was receptive to using the tool for sending nutrition-focused information. NPI and CCH partnered with ideas42, a firm that applies behavioral science to solutions for social change, to develop a series of five text messages promoting California-grown fruits and vegetables.

The text messages – originally delivered in English and Spanish, with the addition of Arabic beginning in July 2021 – were friendly and conversational in tone.

“In a text, you have very few characters you're communicating with people, so we wanted to make sure we were using cutting-edge behavioral science to construct those messages to have the most impact,” said Wendi Gosliner, NPI senior researcher and policy advisor.

Each text included a link directing recipients to a website developed as part of the project, with information on selecting, storing and preparing California-grown fruits and vegetables; health benefits; tips to reduce food waste; and recipes – including TikTok videos.

Initially running from September 2020 to March 2021, the pilot program was well-received. Nearly 90% of CalFresh participants responding to a survey said they appreciated receiving the texts. “It is very important for us to eat healthy, to teach our children to eat healthy,” wrote one participant. “I love the recipes…they're so delicious and easy to make…I'm very, very grateful for the help because without you guys, I would be struggling more and I just want a better life for my children.”

Gosliner said it was encouraging to see that two-thirds of the approximately 5,000 survey respondents reported eating more California-grown fruits and vegetables after receiving the messages, and 85% expressed a desire to see more texts.

“What we see is that there's definitely a decent-sized population of people participating in CalFresh –now this is just in San Diego County but imagine the entire state – who would benefit from having this kind of information available to them,” Gosliner said. “And there is at least a subset of people who really liked it.”

UC San Diego's Center for Community Health was instrumental in facilitating the partnership between UC ANR and the HHSA. Further, CCH, in partnership with the San Diego County Childhood Obesity Initiative, formed a community council composed of residents representing diverse communities throughout San Diego County. Together, the council facilitated CalFresh participants to take part in focus groups, which provided feedback and guidance on the messaging and design for online resources. Gosliner said the success of the text program has been a direct result of community input and involvement.

“The Center for Community Health-led focus groups were integral to ensuring CalFresh resources were accessible and informative to a wide range of CalFresh participants, and local individuals and families more broadly,” said Blanca Meléndrez, executive director at the UC San Diego Center for Community and Population Health, Altman Clinical Translational Research Institute. “In the process, the text-based campaign also placed a greater focus on the local production of nutritious fruits and vegetables, ensuring access to healthy and nutritious food in all communities, and building new streams of income for the region's farmers and producers.”

This effort also suggests a simple way to reach CalFresh participants and bridge gaps between the Supplemental Nutrition Assistance Program and programming that offers nutrition education and healthy eating resources.

“By combining UCSD and UC ANR knowledge about healthy eating with our outreach capability, we are able to reach thousands of families via text message each month,” said Michael Schmidt, human services operations manager for the HHSA. “With the click of a button, these families are provided with resources to assist them in making healthier lifestyle choices, supporting a region that is building better health, living safely and thriving.”

The effort has been so effective that HHSA has asked for additional messages, beyond the original five months' worth of texts and resources.

“The partnership between UC ANR's Nutrition Policy Institute, UC San Diego's Center for Community Health, the County of San Diego Health and Human Services Agency and San Diego County community residents brought together a great team to develop an innovative, technology-based intervention,” said Shana Wright, San Diego County Childhood Obesity Initiative co-director at CCH. “Each partner provided knowledge, resources and assets that enhanced the project beyond the initial pilot phase, exceeding preliminary expectations.”

Gosliner said the pilot program has been a “great example and wonderful experience” of partnership in action.

“You can sit with your research or program ideas for a long time but if you don't have people who can help you implement them, then they really aren't helpful in any way,” she said. “In this case, it was just a nice combination of an idea…with partners who wanted to work to make something happen.”

Interactive map flags locations of tap water contamination

Drinking water safety, especially for children, has become an issue of heightened concern since the water crisis in Flint, Michigan, in 2014. 

The  National Drinking Water Alliance map has recently been updated to add over 235 new points linking to news reports of tap water contamination, with nearly half of the incidents emerging since 2019.

“We created the map to help community members, advocates and decision-makers visualize the tap water contamination landscape, particularly for incidents of lead that exceed state action levels,” said Christina Hecht, UC Nutrition Policy Institute senior policy advisor and National Drinking Water Alliance coordinator.

Residents can zoom in on their state to check for contamination incidents that were reported in the news. Red pins indicate lead contamination in schools and parks. Clicking on a pin on the map produces a pop-up box containing the name of the town, date and link to the news story.

“Although most tap water is safe for drinking, the number of dots on the map show that there are times and places where tap water is not safe,” Hecht said. “The only way to know if tap water has elevated lead is by testing through an accredited lab.”

The interactive map was created by the Nutrition Policy Institute and Informatics and Geographic Information System at the University of California Agriculture and Natural Resources. The map only includes tap water contamination with lead and contaminants regulated by the U.S. Environmental Protection Agency. For example, reports of perfluoroalkyl substances, or PFAS, contaminating drinking water are not included because PFAS are not regulated by the EPA. 

Although a few states now maintain some type of online database of results from school or childcare tests for lead in tap water, to date, there is no national database of lead exceedances in school or childcare drinking water. 

The National Drinking Water Alliance map includes information on state policies and programs to test for lead in school drinking water. Almost one-third of U.S. states have enacted legislation providing policy to test for lead in drinking water in schools and, in some cases, in child-care centers. California tests for lead in drinking water at all public K-12 schools and posts the results online. Policies for mandatory testing have recently passed in Oregon and Vermont. New legislation has been proposed in Wisconsin, Iowa, Nebraska and Connecticut. Voluntary programs are now present in every state, funded by nationwide federal grants supporting testing in child-care facilities and schools.

More information on each state's actions can be found on the interactive map at www.drinkingwateralliance.org/new-map, which was updated by Nutrition Policy Institute intern Laurel Denyer, a recent UC Davis graduate.

For more information about drinking water safety, and to propose additions to the map, please contact the NDWA at DWAalliance@ucanr.edu.

 

Ag Pass program aims to improve wildfire preparedness on rangeland

When the Detwiler Fire broke out near his family's ranch in 2017, Tony Toso was home to take defensive action to protect his family and animals. The Mariposa County rancher feels fortunate that he was on site.

“We were on the front end of the fire damage and it started on a Sunday,” recalled Toso. “Had I not been home that day, it would have been very difficult for me to access my property and help keep our livestock safe. Within a matter of hours of the fire starting, the CHP had our county road closed and would not let anyone in.”

Emergency personnel close roads around wildfires for the safety of people and to prevent them from impeding fire suppression efforts. When fire threatens large ranching operations, ranchers need to move their livestock out of harm's way and make sure they have feed and water. While volunteer groups can assist in rescuing dogs, cats, and a few sheep or horses, they don't have a rancher's knowledge, expertise and experience that are essential for managing hundreds of cattle at large-scale ranching operations.

To help rural communities prepare for wildfire, it would be helpful for farmers and ranchers to have a plan in place to coordinate with first responders, according to Max Moritz, UC Cooperative Extension wildfire specialist. Ag Pass is a program developed in Ventura County to identify farmers and ranchers to firefighters, law enforcement and other emergency personnel so they can allow them onto their property to rescue animals and identify access roads and water sources. 

“Because fires are increasingly impacting people and are not going away anytime soon, we need to figure out approaches to sustainably live on fire-prone landscapes. In a broader sense, the Ag Pass is another way that we can adapt to, and coexist with, wildfire,” Moritz said.

Matthew Shapero, UC Cooperative Extension livestock and range advisor, and Moritz have written a publication to guide people who would like to create an Ag Pass Program for wildfire preparedness in their own locale.

“Our neighbors had cattle just north of us and they tried to get in and could not,” said Toso. “An Ag Pass in that situation, would have been a huge benefit had I not been at home and then wanted to access my property.”

In Ventura County, agricultural workers can apply for identification cards from the Central Ventura County Fire Safe Council, which verifies farm information through the county's pesticide applicator permit database. Ag Pass members provide detailed maps of their farms that show access roads – including many that don't show up on other maps.

Shapero, who works in Ventura and Santa Barbara counties, has been working with ranchers and county agencies to create an Ag Pass program in Santa Barbara County.

“The last few fire seasons have made a program like the Ag Pass more urgent than ever, especially as awareness of wildfire's impacts to agriculture has grown,” Shapero said. “We hope that this publication provides localities with a workable blueprint that will expedite the adoption of this or similar programs.”

Shapero has been working with Anthony Stornetta of Santa Barbara County Fire and representatives of other agencies to develop a training for Ag Pass participants in Santa Barbara County.

“After being at the Carr, Sonoma, Creek and Camp fires for months at a time, I started developing the program from the fire side and presented it to California Cattlemen's Association a couple years ago,” Stornetta. “This was a great collaborative effort. After meeting with our fire safe council, we are looking at the program being fully adopted very soon.”

In September, the Bear Fire raged through the Plumas National Forest where 400 of Dave Daley's cattle roamed to graze. The fifth-generation rancher wrote in moving detail of his grueling search for surviving cows in the rugged terrain during the wildfire and posted it to the California Cattlemen's Association website.

“I was unable to get access initially,” Daley said. “After working with our sheriff, I was able to get access through his office. But it required a deputy to take his time every day for 10 days to meet me at the roadblocks and escort me for several miles into our cattle range. I am very thankful for their willingness to do so. However, it was probably not the best use of their time when they were dealing with so many crises simultaneously and the fire was still raging. If there had been an Ag Pass system, that would have simplified the process, freed up law enforcement and given me a chance to save more cattle.”

Toso, the Mariposa County rancher and president of the California Cattlemen's Association, thinks a program as described in the UC Cooperative Extension publication benefits both ranchers and first responders.

“We can not only help protect ranching families, but we can use the opportunity to build working relationships and create trust between landowners and emergency personnel, as well as provide valuable information to those first responders from knowing the lay of the land,” he said. “Helping other counties and our member ranchers get a program on the books with their respective counties will be a priority for our organization.”

“Given each community's unique agency and personnel structure, it is our belief that the Ag Pass is best administered at the local or county level, however we are working with the state to see if policy measures can be developed that would simplify and support the Ag Pass concept,” Shapero said.

The training developed for Santa Barbara County includes an overview of hazards and safety issues, entrapment avoidance, incident organization, fire behavior, working with law and fire liaisons, access to incident, carding and certification. Stornetta anticipates the Santa Barbara County training will be held in spring 2021 and hopes it can be used in other counties as well. Ranchers who are interested in the Ag Pass training should contact Stornetta or Shapero.

“Preparing for Disaster: Establishing an Ag Pass Program in Your Community,” can be downloaded for free at https://anrcatalog.ucanr.edu/pdf/8685.pdf.

(First published Dec. 21, 2020)

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