August 2006

Grant Results

SUMMARY

In the early 2000, California passed groundbreaking legislation that set nutrition standards for foods and beverages in its public schools. For a year, beginning in March 2004, researchers at Samuels & Associates, an Oakland, Calif., research and evaluation firm, conducted in-depth case studies in six California school districts to examine the implementation and effect of these laws.

Key Findings

  • Beverages: Schools were able to remove most sweetened beverages from their campuses.
  • Foods: Three out of four items sold in the case study districts were not in compliance with California nutrition standards.
  • Continuing challenges: Although staff in the school districts studied were highly motivated to change their schools' food and beverage environments, they identified several challenges to implementing nutrition policies, including:
    • Interpreting the policies and translating standards into actual food and beverage products that school districts allow for sale.
    • Fear of decreased revenue.
    • Perceptions that students only purchase highly sweetened beverages and unhealthy snack and fast foods.

Key Recommendations

  • School district and staff-level personnel need technical assistance on how to:
    • Identify which food and beverage products actually meet the standards in the policy.
    • Offer foods and beverages that are appealing to students.
    • Make the changes in a way that is financially feasible.
  • The process of monitoring and implementing the policy should be well defined and the person(s) responsible for monitoring clearly identified, with school food service playing a central role in policy implementation.
  • Evaluate the implementation and impact of the school food and beverage policies to keep public officials and policy-makers informed of their impact.

Funding
The Robert Wood Johnson Foundation (RWJF) supported the study through an unsolicited grant of $42,247.

 See Grant Detail & Contact Information
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THE PROBLEM

In more than half of California's State Assembly Districts, 25 percent of all school-age children are overweight. Because overweight children are likely to become overweight adults, these children are more liable to suffer from cardiovascular disease, cancer and diabetes in adulthood.

These are all chronic but largely preventable diseases that account for two-thirds of all deaths in California (An Epidemic: Overweight and Unfit Children in California Assembly Districts, California Center for Public Health Advocacy, December 2002). See Grant Results on ID# 038118.

Schools are in a unique position to reinforce both healthy eating and physical activity behaviors that children will need throughout their lives. Yet, school food service purveyors often are caught between competing responsibilities: to serve children nutritious foods and to run a financially viable food service business.

In California and across the country, schools rely heavily on the income from sales of unregulated competitive foods and beverages — i.e., foods sold a la carte, in vending machines, in school stores, or as part of school fundraisers — to offset the inadequate reimbursement they receive from the USDA-approved cafeteria menu offerings (Foods Sold in Competition with USDA School Meal Programs: A Report to Congress, U.S. Department of Agriculture [USDA], January 2001).

In 2003–05, California was in the vanguard of states passing bills establishing minimum nutrition standards for a-la-carte foods (SB 12 [2005] — banning the sale of junk food, and eliminating sweetened beverages from its public elementary, middle and high schools; SB 677 [2003] — in elementary/middle schools; and SB 965 [2005] high schools).

The nonpartisan California Center for Public Health Advocacy has an overview of the California legislation online. Several California school districts had also created their own food and beverage standards before the state laws were passed.

California's efforts to improve the nutrition environment in its schools provided an opportunity to:

  • Document both the positive and potential negative impacts of these policy changes.
  • Study what helps and hinders school nutrition reforms.

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RWJF STRATEGY

This project built on grant ID# 038118, in which the California Center for Public Health Advocacy published policy briefs about childhood obesity and fitness levels of children in each of California's legislative districts, and diabetes mortality rates throughout California and developed accompanying fact sheets individualized for each of California's 80 assembly and 40 senate districts.

The 2001 study found that:

  • High rates of overweight and unfit children exist in all California assembly and senate districts. Statewide, 26.5 percent of the children are overweight and 39.6 percent are unfit.
  • Percentages of overweight children and for diabetes-related deaths range widely among legislative districts, and those with higher diabetes-related death rates also tend to have a higher prevalence of overweight and unfit children.
  • African Americans, Latinos and American Indians/Alaskan Natives have the highest burden of diabetes-related deaths.

Center staff publicized the briefs and fact sheets and distributed them to lawmakers. Members of the state Legislature, public health departments, government agencies and community organizations throughout the state found the breakdown of data by legislative district to be very useful, according to Samuels & Associates.

The policy briefs on overweight (comparing 2001 findings to 2004 findings) and on diabetes and a map of overweight students by assembly district are posted on their Web site.

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THE PROJECT

For a year beginning in March 2004, researchers at Samuels & Associates conducted in-depth case studies in six California school districts to examine the implementation and effect of district-wide policies addressing a-la-carte food and beverages and adherence to the state's new laws:

  • Capistrano Unified School District
  • Eureka City Unified School District
  • Hemet Unified School District
  • Los Angeles Unified School District
  • Oakland Unified School District
  • San Francisco Unified School District

Researchers gathered data from the following sources:

  • Stakeholder Surveys: interviews with district-level staff, principals, school administrators, school site financial managers, school board members, school food service staff and community advocates.
  • Environmental Assessments: 22 visits to schools (between three and seven in each district) to determine which foods and beverages were available for sale and interviews with key school or district staff. Researchers visited only middle and high schools because of the high prevalence of a-la-carte foods and beverages available on secondary school campuses.
  • Nutrient information on the labels of individual foods and beverages sold, including serving size, calories, total fat, saturated fat and sugar per serving.

The California Endowment provided an additional $30,000 for the project.

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FINDINGS

The study yielded the following findings:

  • Beverages: Schools were able to remove most sweetened beverages from the variety of venues on campus-student stores, vending machines and food service points of sale (snack bars, snack carts and cafeterias). Overall, school beverages adhered to California laws 82 percent of the time, and district policies 91 percent of the time. For the most part, the districts studied removed sodas, juice drinks with added sweeteners, sweetened teas and coffees, and some sweetened milks.
    • Seventy-nine percent of food service a-la-carte beverages adhered to the state standards.
    • School stores were most likely to be non-adherent.
    • Vending machine beverages were most likely to adhere to state standards; 85 percent of beverages in vending machines were adherent.
  • Foods: Three out of four items sold in the case study districts were not in compliance with standards established by California laws. These were high-fat or high-sugar snack and fast foods. Districts with their own food policy had 61 percent of foods in compliance with the district policy. However, some of the district policies were less stringent than the California standards, and they allowed non-adherent foods to be sold on campus (along with sweetened drinks, particularly fruit drinks with added sweeteners).
  • Continuing Challenges: Although staff at the school districts studied were highly motivated to change their schools' food and beverage environments, they face challenges in implementing nutrition policies, including:
    • Difficulties in interpreting the policies, in part because of vague policy language. For instance, one policy stated that "sugary" beverages were prohibited, but school staff members did not know which beverages should be considered sugary.
    • Confusion about how to implement the policies. For example, some school staff members had questions as to whether implementation should be rapid or gradual, and how much input and buy-in to get from the school community and students.
    • Fear among district level staff that food and beverage revenues would decline. However, districts with a longer history of policy implementation reported an initial decline in a-la-carte sales followed by a gradual return to pre-policy profit levels.
    • Misperceptions by staff at the school district level that students only purchase highly sweetened beverages and unhealthy snack and fast foods.

Recommendations

  • School district and staff level personnel need technical assistance on how to:
    • Identify which food and beverage products actually meet the standards in the policy.
    • Offer foods and beverages that meet the standards and are appealing to students.
    • Make the changes in a way that is financially feasible.
  • Clearly define the process for monitoring and implementing the policy and the person(s) responsible for monitoring. School food service personnel should play a central role in policy implementation.
  • Put measures in place to track changes in revenue due to policy implementation.
  • To sustain policy change, school districts should develop methods of communicating with, educating and engaging the school community on nutrition, obesity prevention and student health issues.
  • Evaluate the implementation and impact of the school food and beverage policies to keep public officials and policy-makers informed of their impact.

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AFTER THE GRANT

Along with working to publish an article on the study in a peer-reviewed journal, researchers at Samuels & Associates engaged in the following projects:

  • Samuels published its case study report, Improving School Food Environments Through District Level Policies: Findings from Six California Case Studies.
  • In partnership with California Project LEAN, in 2005–06 the research team conducted an assessment of food and beverage marketing on 20 California high school campuses. This study found that most of the food and beverage industry presence on campuses comes from companies associated with sugary beverages and fast or junk foods. (California Project LEAN [Leaders Encouraging Activity and Nutrition] is a joint program of the California Department of Health Services and the Public Health Institute focusing on youth empowerment, policy and environmental change strategies, and community-based solutions.)
  • Researchers are leading an evaluation team assessing the HEAC (Healthy Eating Active Communities) Initiative. Sponsored by the California Endowment, the HEAC Initiative is a four-year (2005–09), $26 million program to fight the growing childhood obesity epidemic in California and to develop state policy changes that will reduce the risk factors for diabetes and obesity.
  • RWJF made a grant (ID# 056800) to Samuels & Associates to develop a School Nutrition Policy Implementation and Monitoring Training Platform to strengthen the capacity of state departments of education, health departments, advocacy and community organizations, researchers, school board members, school business officials and food service directors to monitor and assess the implementation of nutrition policies and demonstrate changes occurring as a result of these policies.

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GRANT DETAILS & CONTACT INFORMATION

Project

Changing School Policies to Prevent Childhood Obesity: Case Studies of Vanguard Schools in California

Grantee

Samuels & Associates (Oakland,  CA)

  • Amount: $ 42,247
    Dates: March 2004 to February 2005
    ID#:  050462

Contact

Sarah E. Samuels, Dr.P.H.
(510) 271-6799
sarah@samuelsandassociates.com

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Crawford PB, Gosliner W, Strode P, Samuels SE, Burnett C, Craypo L and Yancey A. "Walking the Talk: Fit WIC Wellness Programs Improve Self-Efficacy in Pediatric Obesity Prevention Counseling." American Journal of Public Health, 94(9): 1480–1485, 2004. Abstract available online.

Crawford PB, Gosliner W, Anderson C, Strode P, Becerra-Jones Y, Samuels S, Carroll A and Ritchie L. "Counseling Latina Mothers of Preschool Children about Weight Issues: Suggestions for a New Framework." Journal of the American Dietetic Association, 104(3): 387–394, 2004. Abstract available online.

Reports

Samuel SE, Craypo L, Boyle M, Stone-Francisco S and Schwarte L. Improving School Food Environments Through District Level Policies: Findings from Six California Case Studies. Oakland, Calif.: Samuels & Associates, July 2006. Available online.

School District Food and Beverage Policy Implementation: The Experience of Six California School Districts. Oakland, Calif.: Samuels & Associates, 2005. Unpublished.

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Report prepared by: Robert Crum
Reviewed by: Kelsey Menehan
Reviewed by: Molly McKaughan
Program Officer: Dwayne C. Proctor

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