Impact of a Teacher Intervention to Encourage Students to Eat School Lunch.

While school meals are often the healthiest option for students, lunch participation remains relatively low. Few approaches for increasing participation have leveraged teachers' potential social influence. We determined if a teacher intervention about the benefits of school lunch could improve teachers' perceptions of, and participation in, school lunch, and encouragement of students to eat school lunch. This repeated cross-sectional study included teacher/student survey administration in spring of 2016 and 2018 in 19 public secondary schools (9 intervention, 10 comparison) educating students of ages ≈ 11-18. Intervention teachers received monthly newsletters; lunch taste tests; and a promotional video and website. Mixed effects models with a random effect for school showed the proportion of teachers that reported eating with students increased in intervention schools relative to control schools (difference-in-change: 7.6%; 95% CI: 3.578%, 14.861%), as did student agreement that adults at their schools encouraged them to eat school lunch (difference-in-change: 0.15 on a 5-point scale; 95% CI: 0.061, 0.244). There were no between-group differences in teachers' perceptions of school meals or teachers' lunch participation. These findings suggest that teachers' perceptions of school meals do not necessarily need to improve to promote the school lunch program to students. However, to see meaningful change in teacher lunch participation, the taste of school meals likely needs improving.

Association Between Educational Attainment and EFNEP Participants' Food Practice Outcomes.

OBJECTIVE: Examine the association between educational attainment and improvement in food practice outcomes of the California Expanded Food and Nutrition Education Program (EFNEP) participants. DESIGN: Secondary data analysis. PARTICIPANTS: A total of 19,089 participants, 92.3% female, 77.2% Hispanic, 19.7% with ≤ sixth-grade education, and 68.9% with incomes ≤ 100% of the federal poverty level. MAIN OUTCOME MEASURES: Improvement in food resource management practices (FRMP), nutrition practices, and food safety practices (FSP). ANALYSIS: Wilcoxon signed rank tests examined pre-post outcomes. Mann-Whitney U tests compared whether participants in the lowest and highest educational attainment quartiles had similar levels of improvement. RESULTS: California EFNEP is associated with improved FRMP (z = -95.33), nutrition practices (z = -94.91), and FSP (z = -92.37); (P < 0.001). Lowest educational quartile was associated with more improvement in FRMP and FSP (P < 0.001). CONCLUSIONS AND IMPLICATIONS: California EFNEP contributed to improved food practice outcomes for low and high educational attainment participants. Program content and instruction are effective across the education continuum.

Self-Paced Online Training on Healthy Beverage Policy for Child Care Providers.

OBJECTIVE: Determine if online training for child care providers increases knowledge and awareness of and adherence to California's Healthy Beverages in Child Care Act (AB2084) policy. DESIGN: Cluster, randomized controlled trial with 2 intervention groups and 1 control group. SETTING: Licensed child care centers and family child care homes. PARTICIPANTS: Child care providers in 3 California regions. INTERVENTION: Thirty-minute, self-paced online training in English or Spanish, with or without 6-months of ongoing technical assistance. MAIN OUTCOMES MEASURED: Providers' self-reported knowledge and awareness of and adherence to AB2084 at baseline, after 1 and 6 months. ANALYSIS: Generalized estimating equations and generalized linear models, adjusted for the percentage of children on child care subsidies and region. RESULTS: Outcomes were similar between groups receiving and not receiving technical assistance. Providers receiving training (both intervention groups combined) experienced larger increases in knowledge (P = 0.002 and P = 0.003) and awareness (P = 0.004 and P = 0.001) of AB2084 compared with the control group after 1 and 6 months. All groups reported pre-post increases in adherence to AB2084. CONCLUSIONS AND IMPLICATIONS: A brief online training supports increased knowledge and awareness of healthy beverage policy among child care providers. The training is available online and is free for California child care providers.

Multi-pronged intervention to increase secondary student participation in school lunch: Design and rationale.

BACKGROUND: In the United States, the National School Lunch Program (NSLP) is the healthiest lunch option for students, yet participation is suboptimal and fruit and vegetable waste remains high. Improving school meal convenience, engaging teachers in the school-lunch program, and enhancing the cafeteria environment are promising strategies to improve participation and dietary intake, yet little evidence is available on their impact. METHODS/DESIGN: The Multi-Pronged Intervention to Increase Secondary Student Participation in School Lunch (MPI) is a 3-year quasi-experimental study in a large urban school district in California. A total of 24 middle and high schools participated in the study: half received the intervention and half served as controls. The intervention consisted of additional school lunch points of sale (vending machines and mobile carts), a school meal outreach program for teachers, and cafeteria redesigns. School meal participation, student-reported fruit and vegetable consumption, and school lunch plate waste were assessed at baseline and in years 1 and 2 of the intervention. Change in meal participation and fruit and vegetable consumption were compared between intervention and control arms to determine the impact of the intervention on school meal participation and dietary intake. DISCUSSION: This study is positioned to provide evidence on the feasibility and efficacy of a multi-level intervention to increase school meal participation and consumption of fruits and vegetables.

Food Resource Management Education With SNAP Participation Improves Food Security.

OBJECTIVE: To determine the influence of Supplemental Nutrition Assistance Program (SNAP) and participant demographics on nutrition education outcomes. METHODS: At program enrollment (pre) and 1 month later (post), a statewide convenience sample of adults, who participated in the Plan, Shop, Save, and Cook program, completed a 7-item questionnaire to evaluate change in resource management skills (RMS) and running out of food before the end of the month. RESULTS: Percent of participants (n = 3,744) who reported behavioral improvements in RMS ranged from 38.8% in comparing prices to 54% in reading labels. Female gender and Hispanic ethnicity were positively related to pre-post RMS change (P = .001). Participants who received SNAP food assistance and made greater pre-post improvement in RMS reported the greatest decrease in running out of food (P = .001). CONCLUSIONS AND IMPLICATIONS: Both food assistance and education on nutrition and resource management are needed to reduce food insecurity in SNAP-eligible audiences.

Reliability and validity of nutrition knowledge questionnaire for adults.

OBJECTIVE: To determine the validity and reliability of a nutrition knowledge questionnaire for adults in California. METHODS: A convenience sample of adults was recruited for cognitive interviews. A mail-based survey of 400 randomly selected addresses was used to assess internal consistency (Cronbach α). Researchers assessed content validity (Student t test) and test-retest reliability (Pearson correlation) in a convenience sample of university students who had previously taken a college nutrition course, compared with students who had not. RESULTS: Twenty adults participated in cognitive interviews, 94 adults returned the mailed questionnaire, and 48 university students participated in validity and reliability testing. Cronbach α = .91 and test-retest r = 0.95, demonstrating internal consistency reliability and test-retest reliability. Students who had taken a college-level nutrition course scored significantly higher compared with students who had not (P < .001), demonstrating construct validity. CONCLUSIONS AND IMPLICATIONS: Findings show that the questionnaire is a valid and reliable nutrition knowledge measure for use in California and may be of use in other places.

Improving the quality of data from EFNEP participants with low literacy skills: a participant-driven model.

Low literacy skills and poor evaluation tool readability combined with the stresses of the classroom environment create a high cognitive load for Expanded Food and Nutrition Education Program (EFNEP) participants, resulting in lower quality data. The authors advocate for 9 strategies for improving the participant cognitive load for the evaluation process using the EFNEP Family Record as an example.

Development and use of an evaluation tool for taste-testing activities by school-aged children.

We describe the development and application of a teacher-administered tool for routine program evaluation of food-tasting activities among low-income children and adolescents in a classroom or afterschool setting. This six-item evaluation tool is intended to capture student willingness to try new foods and ask for them at home. Phase 1 involved one-on-one interviews to determine the feasibility of the taste test tool among nine elementary school teachers in 2009 (168 students) and a validation pilot study in 2010 among 114 school-aged students participating in a University of California Supplemental Nutrition Assistance Program Nutrition Education (UC SNAP-Ed) summer program. Phase 2 determined instrument reliability and compared student response by grade level and food category in a convenience sample of 514 UC SNAP-Ed classrooms in 2010-2011. The mean proportion of the classroom ever having tried the foods before was 0.62 ± 0.33, and 0.77 ± 0.27 were willing to ask for the foods at home (P<0.0001). Compared with younger students (preschool through sixth grade), older students (seventh through 12th grade) were less likely to try the foods in class and less willing to try them again or ask for them at home (P<0.05). Students reported significantly greater previous exposure and willingness to try the food again for fruits than for vegetables (P<0.0001). A teacher-administered taste test tool is feasible to use in a group setting and capable of yielding valid, reliable information to evaluate student response and to guide SNAP-Ed program delivery.