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Nutrition Policy Institute: 10 years of making healthy choices more accessible for all

Adaptado al español

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.

UCCE advisor Bruno guides, learns from dairies switching to milking robots

Automatic milking systems increasingly used in California amid labor challenges

When third-generation dairy farmer Shonda Reid first saw a milking robot at a farm show 13 years ago, she immediately recognized that the technology represented the future. Her father, however, took a bit more convincing.

“I came home and showed him and said, ‘This is what we need to do.' And he thought I was kidding!” said Reid, dairy and farm manager for Fred Rau Dairy, which has a herd of 1,400 milk cows in Fresno County.

Years later, after the family had visited several dairies using automatic milking systems (AMS) across the U.S., they installed their first six robots in November 2021. By fall 2022, they had 24 robots, evenly split between two newly built “free stall” barns where the cows can freely go to the milking machines.

As Fred Rau Dairy was one of the first in California to implement AMS at such a scale, Reid and her team have been instrumental in growing practical knowledge on these systems. She also has been a valued partner to Daniela Bruno, University of California Cooperative Extension dairy advisor for Fresno, Madera and Kings counties.

“Automatic milking robots are not a new technology, but it's new to California,” said Bruno, noting that the milking robots were first used on small, family-run farms in Europe, where the technology granted family members more time for rest and other pursuits.

To better understand the feasibility of milking robots for large dairies in California, Bruno – alongside former UC Davis School of Veterinary Medicine professor Fernanda Ferreira, University of Minnesota researcher Marcia Endres and other collaborators – began a project in 2020 to study the risks and opportunities of automated systems.

“The information is extremely useful for California producers to make informed decisions about implementing AMS on their facilities,” said Denise Mullinax, executive director of the California Dairy Research Foundation, which supported the effort through a competitive grant. “Cow care, labor requirements and profitability are key issues for producers, and CDRF was pleased to support this project which assists producers in understanding how AMS may impact those areas on their facility.”

Dairy farmer: ‘We needed to make some changes'

The project produced a paper analyzing existing research on automatic systems, which have been more widely used in the Midwest, where there are more small-scale, family-run dairies. In 2020, there were only 14 “box robots” in California, according to Bruno. Now there are about 200 across California – and both Bruno and Reid cited labor challenges as the primary reason for the increased use of automated systems.

“California suffers from labor quality and quantity issues,” Bruno said. “By bringing robots to California, you can minimize those problems.”

Higher costs of hiring and retaining employees, driven in part by new labor laws, are one factor. And then there's the reliability and availability of labor, as fewer people are willing to do the physically demanding work of conventional milking.

“People just don't want to milk in a flat barn [a conventional setup where the employee works at the same level as the cow] – there's a lot of kneeling, squatting, that type of thing – it's pretty tough on the body,” Reid explained.

Faced with labor shortages and mounting regulatory burdens, Reid said Fred Rau Dairy had to make the leap to automated systems to keep the 80-year-old dairy operation running.

“We needed to make some changes, or we're going out of the dairy business,” she said.

In a survey conducted by Bruno and her colleagues of large dairies using AMS across the U.S., a majority of the 29 respondents reported reductions in labor costs – but survey results did not offer a definitive picture on whether AMS improved bottom-line profitability.

Calmer, healthier cows

Nevertheless, most of the survey respondents said they were generally happy with their transition to automatic systems.

“It's totally met our expectations, and cow health has gotten much better, too,” Reid said.

In a typical conventional system where cows are outside in “open corral” pens, dairy employees must cajole the cows into the milking parlor. But within a “free stall” barn where the cows can voluntarily go to the milking robots when they want, as often as they want, the animals are much less stressed.

“When you think about cow handling, if you have robots, you don't have anybody pushing and screaming at them to walk to the parlor,” Bruno explained. “You have less cow-people interaction so they are more calm; there is less stress.”

In the survey of large dairies using milking robots, more than 90% of the respondents said their cows were calmer. Reid also noted that many people have noticed how calm their cows are in the free stall barns.

“They're not skittish, you can walk in and they don't run,” Reid said. “They'll just watch you or they'll even come up and start licking on your jacket or shirt.”

Bruno also said that many of the large dairies reported fewer cases of mastitis and other diseases, less lameness, and greater milk production. But she added it's hard to know whether the benefits can be attributed to the robots and their real-time monitoring technology – or to changes in the physical environment (cows save energy in the free stall barn setup, versus the open-corral system that requires walking to the milking parlor).

Dairy producers seek counsel on potential transition

Less bovine travel from outside to inside was a boon for Fred Rau Dairy during last year's unusually wet winter.

“Even if it's just a couple of weeks of rain, that mud and manure and everything – you do what you can, but oh my gosh – it's a mess,” said Reid, noting that easier facility maintenance during extreme weather was another benefit of switching to automatic systems within free stall barns.

Reid shared many of her experiences with attendees of an AMS Field Day in October 2022, arranged by Bruno, Ferreira and their collaborators. About 60 farmers, researchers, industry representatives and consultants visited Fred Rau Dairy and Jones Dairy in Merced County.

If a dairy producer is considering implementing automatic systems, Reid recommends that they research all their options, visit dairies that use the systems, and check who in their area would be providing service and technical support.

And there are crucial workforce considerations, as dairy workers must learn an entirely new set of skills and processes. Instead of spending their time fetching the cows, prepping them and milking them in the parlor, workers might need to gather and interpret data from the robots. “Cow people,” as Reid puts it, must become computer people.

“You have a group of people who have been with you for a while, and you hope that they can transition to the new technology of what you're doing,” Reid said.

During this technological transition, and on the myriad other challenges that dairy operators face, Reid said she is grateful for Bruno's expertise and responsiveness.

“If there's something that I need, she's been really good about trying to help – or putting me in contact with the right people,” she explained. “I've enjoyed working with her.”

The AMS project team also includes UC Davis School of Veterinary Medicine professor Fabio Lima, postdoctoral researcher Thaisa Marques and former postdoctoral researcher Camila Lage.

Universal school meals increased student participation, lessened stigma

The COVID-19 pandemic exacerbated food and nutrition challenges. Many families initially lost access to meals offered by school and childcare facilities, experienced unemployment or work reductions, and faced increasing prices for food and other necessities. National and state policies and programs provided food and cash assistance to mitigate impacts on food security. Researchers at the Nutrition Policy Institute, a research center of University of California Agriculture and Natural Resources, evaluated safety-net policies implemented during the pandemic to better support families with low incomes in the U.S. 

Benefits of universal school meals

The National School Lunch Program and the School Breakfast Program meet the nutritional needs of approximately 30 million K-12 students in America each day. Typically, students from families meeting income eligibility criteria receive school meals for free or a reduced price, while others pay full price.

NPI researchers Wendi Gosliner, project scientist, and Lorrene Ritchie, director and UC Cooperative Extension specialist, are co-leading studies of school meals in California in collaboration with researchers from the NOURISH Lab for Health Inclusion Research and Practice, who study school meals in Maine and other states.

During the COVID-19 pandemic, Congress funded school meals for all students at no charge, in order to address the dramatic increase in food insecurity among families with children after schools shut down in March 2020. This federal provision allowing for meals to be free for all students ended after the 2021-2022 school year, but some states elected to continue providing universal school meals with state funding, in recognition of the importance of these meals for student health and academic success.

California was the first state to adopt a statewide Universal Meals Program starting in the 2022-23 school year. To support the program's development, $650 million were invested to help schools improve kitchen infrastructure and provide staff training and technical assistance. Investments include Farm to School programs and other mechanisms to help update and improve school meals. Maine and several other states also have adopted universal school meals at least through the 2022-23 school year. 

“States often act as incubators – things that work well in states sometimes get translated into federal policy,” Gosliner said. Identifying the success of the programs – and their challenges – can lead to improvements and help inform advocates and policymakers considering universal school meals policies at the state and national level. 

Two of the team's research studies in California and Maine documented the benefits and challenges of universal school meals, as reported by school food authorities. Among 581 school food-service leaders in California who responded to the survey, nearly half (45.7%) reported reductions in student stigma as a result of providing free school meals to all students. Among 43 respondents in Maine, over half (51%) reported lessened stigma related to school meals being free for all. In both studies, nearly three-quarters of respondents reported increases in student meal participation. These and other data suggest that universal school meals are meeting their aim, to increase student participation while providing nutritionally balanced meals. 

But when the child leaves campus, the responsibility to put a nutritious meal on the table falls on the caregiver. 

“Universal school meals provide food and can ease families' budgets, but for too many families, wages as well as time and other resources are not adequate for access to and consumption of enough healthy foods and beverages,” Gosliner noted. 

That is when other public programs are helpful, for example the Earned Income Tax Credit, or EITC.

Many eligible families do not claim Earned Income Tax Credit

The Earned Income Tax Credit is a national program designed to lift families out of poverty. The supplemental income can contribute up to nearly $7,000 per year for a family. Despite the EITC's known ability to improve participants' health, research shows that many EITC-eligible households in California and across the nation don't receive the benefits for which they are eligible, leaving $2 billion unclaimed in California in 2018 alone.

Gosliner led a study along with Lia Fernald from UC Berkeley and Rita Hamad from UC San Francisco to document levels of awareness, barriers to uptake, and benefits of participation in the EITC. Their recent publication reported that among 411 EITC-eligible California female caregivers, those who were younger, spoke languages other than English, and had less awareness of the EITC were less likely to receive the tax credit. 

Developing a user-friendly system for providing safety-net support and, in the meantime, providing information and support to help more EITC-eligible families receive these benefits are suggested to help alleviate financial stressors. In the long term, these strategies may reduce poverty and improve the health of children.

Increasing WIC Cash Value Benefit a boon to health

In addition to universal school meals and EITC, families with low income may be eligible for the Special Supplemental Nutrition Assistance Program for Women, Infants and Children, or WIC. The program supports women and children up to 5 years old through nutrition education, nutritious foods and access to other health and social services. 

One component of the WIC food packages, the Cash Value Benefit, provides participants a fixed dollar amount to supplement their family's diet with fruits and vegetables. During the pandemic, the U.S. Department of Agriculture increased this benefit from $9 to $35 per month, which was later revised to $24 per month per child in October 2021. 

Ritchie contributed to a growing body of evidence on the importance and multidimensional benefits of the WIC Cash Value Benefit increase.

“Nine dollars buys only a quarter of what a child is recommended to eat every day,” Ritchie said. “The increase in Cash Value Benefit during the pandemic was an ideal natural experiment to investigate its impact.” 

In collaboration with Shannon Whaley and her team at the Public Health Foundation Enterprises-WIC, NPI launched a longitudinal cohort study of nearly 2,000 California WIC participants. They found that the increased Cash Value Benefit improved WIC participant satisfaction with the program and allowed families to purchase greater quantities and varieties of fruits and vegetables.

“The increased Cash Value Benefit enabled WIC families to expose young children to new fruits and vegetables. Early exposure to a variety of fruits and vegetables is critical to establishing lifelong healthy habits,” said Ritchie. 

The researchers found that the benefit increase also reduced food insecurity. It is hoped that the increase in program satisfaction translates into more eligible families enrolling and continuing to receive WIC. In November 2022, the U.S. Department of Agriculture proposed making the increased Cash Value Benefit a permanent part of WIC.

Knowing the proven benefits of the WIC program, Ritchie and colleagues from the National WIC Association, and Loan Kim at Pepperdine University, also engaged with WIC participants in other states.

In 2021, all state WIC agencies were invited to participate in a WIC satisfaction survey. Of the 12 WIC state agencies that opted to participate, Connecticut, Inter Tribal Council of Arizona, Nevada, New Hampshire and New Mexico added questions on the survey to understand how the increased Cash Value Benefit impacted children's dietary intake.

The study showed consumption of fruits and vegetables by children on WIC increased by one-third cup per day on average, which is sizable when considering the impact across the WIC population.

NPI research on universal school meals, the EITC and WIC constitute a small part of a more comprehensive approach to make healthy food more accessible, affordable, equitable and sustainable for all. The NPI provides resources such as policy briefs, peer-reviewed publications and technical assistance on several research areas such as safe drinking water, childcare and education. To learn more, please visit the Nutrition Policy Institute website.

No break for kids’ hunger: Partnerships help secure school meal programs

Partnering for California

As the gravity of the COVID-19 pandemic hit communities across the U.S. in mid-March 2020, the policy team at UC Agriculture and Natural Resources' Nutrition Policy Institute received an urgent email from a longtime partner in the San Joaquin Valley.

“It was simply entitled 'Help' in the subject line – with multiple exclamation points,” said Christina Hecht, NPI senior policy advisor.

The colleague was writing on behalf of community groups concerned that pandemic-related school closures would jeopardize school meal programs – a nutritional lifeline for children in a predominantly agricultural region with many low-income households.

Hecht immediately contacted a frequent collaborator, Anisha Patel, an associate professor of pediatrics at Stanford University. To help school districts continue those essential meals during the fast-approaching spring holiday, they quickly produced a fact sheet, “Kids' Hunger Doesn't Take a Spring Break,” sharing resources on how districts could use new program flexibility to continue meal distribution.

Then, as the pandemic evolved throughout 2020, the U.S. Department of Agriculture and California Department of Education continued to issue a flurry of waivers and guidance updates. To keep pace, the authors produced three more fact sheets to help districts digest the information and adapt and sustain their school meal programs.

“We tried to make a really user-friendly resource that would help districts sort through everything they needed to do, and easily discover resources for best practices,” Hecht said.

The fact sheet information, paired with advocacy by local partners, encouraged districts to take steps to make more meals more easily accessible to students by taking advantage of USDA waivers: for example, allowing parents to pick up meals without children present, providing multiple meals in one pick-up or implementing bus delivery of meals.

These efforts attracted the attention of the School Nutrition Association, a prominent nonprofit representing more than 50,000 members who provide meals to students across the country. The organization co-branded general versions of the fact sheets and distributed them widely through its website.

Gathering community perspectives on school meals

Those resources represent just one way that lessons from the San Joaquin Valley experience are shaping the national conversation on school nutrition programs. Cultiva La Salud and Dolores Huerta Foundation – health equity and social justice organizations based in Fresno and Bakersfield, respectively – approached the researchers to study ways to boost participation in school meal programs and address food insecurity in their largely Latino communities.

“Working alongside Stanford and NPI is crucial in expanding our capacity and ability to use data and research as a tool to empower parents to advocate for improved health and wellness policies and practices,” said Cecilia Castro, deputy director of Dolores Huerta Foundation, which works in Kern, Fresno and Tulare counties, as well as Antelope Valley in Los Angeles County.

To better understand the “barriers and facilitators” to meal program participation, Hecht, Patel and their collaborators – including student trainees who were eager to learn about community-based participatory research and wanted to help their local communities – sought the perspectives of school district administrators and staff, community groups and parents.

Through the relationships nurtured by Cultiva La Salud and Dolores Huerta Foundation, the researchers convened focus groups of parents with children in six school districts across the San Joaquin Valley.

“We needed to understand better what helped and hindered families from getting the school meals,” Hecht said.

According to Castro, parents have leveraged their feedback to advocate for increased access to school meals, through the use of buses for meal delivery and changes to meal pickup times and locations.

“This engagement has validated the lived experience of our communities,” Castro said. “It has provided an additional strategy for parent leaders to use in efforts to engage decision-makers about ways to improve quality and access to school meals.”

Another key takeaway from these conversations is that the parents are deeply concerned about the content and nutritive value of the meals served to their children.

“We learned that although school meals meet nutrition standards, parents are not aware of this,” Patel said. “Parents also worry about the healthfulness of school meals, noting heavy processing and added sugar. Most compelling was that parents want to provide feedback to improve school meal appeal and healthfulness but have no way to act.”

San Joaquin Valley voices go national

The Nutrition Policy Institute played a crucial role in bringing the parents' perspectives to legislative staff members at the state and federal levels, through the production of four policy briefs that center the voices of San Joaquin Valley residents. In the first, “School Meals: Kids Are Sweeter with Less Sugar,” one parent says: “Children cannot sustain themselves on treats that give pure sugar…They give with the best intentions, but less food would be better, but better quality and healthier.”

“One of the most rewarding parts of all this work has been seeing how meaningful it has been for the parents in the San Joaquin Valley to see their voices getting carried all the way to Washington, D.C. by these policy briefs,” said Hecht. “And it was so meaningful for them that Cultiva La Salud had the briefs translated into Spanish so that the parents could actually read their own words.”

Their voices joined a chorus comprising over 200 organizations who called for universal school meals across California. In June, the state became the first in the nation to adopt a policy, starting in the 2022-2023 school year, to provide free meals for all K through 12 public school students, regardless of family income. Momentum continues to build on the national scale.

The next step for the team is to explore ways to make school meals even more appealing to potential program participants in the Latino communities of San Joaquin Valley. Patel said they will draw on the expertise of Szu-chi Huang, associate professor of marketing in Stanford's Graduate School of Business.

“Using a participatory approach, we will work with parents and school officials to design an intervention focused on communicating the benefits of school meals, and test strategies to improve the appeal of school meals,” Patel explained. “Then we will examine how that intervention affects parents' satisfaction with school meals, students' participation in meals and food insecurity.”

Those insights will be another valuable result of a unique partnership – spurred by a call for help and galvanized by the ongoing health crisis – that continues to benefit families across California.

“Our partnership has been very unusual and very fruitful because we had policy experts, we had research experts and trainees, and then we had the organizations actually working in the community,” Hecht said. “And as we look back on it, it's hard to imagine working that successfully without that kind of partnership.”

CalFresh Healthy Living, UCCE educators and promotoras teach children gardening to encourage healthy eating

When local promotoras - volunteer health workers - team with CalFresh Healthy Living, UC Cooperative Extension educators, magic happens in school gardens. Trained by Ceres Partnership for Healthy Families in Stanislaus County, promotoras encourage children to eat well by growing their own produce in school gardens.

In 2018, twenty promotoras  were trained to implement the Powerful People curriculum designed to engage community leaders. This is a partnership with Cultiva La Salud and Ceres Partnership for Healthy Families with funding support from Stanislaus County Health Services Agency. After the training, the promotoras worked with Ceres Unified School District to create school gardens at five Ceres elementary schools where their children attended afterschool programs that host UC Cooperative Extension CalFresh Healthy Living, UC programs.

A key initiative CalFresh, Healthy Living, UC (CFHL) offers in counties throughout the state involves growing fresh produce and making it a regular part of family diets. TWIGS: Youth Gardening and Healthy Eating Curriculum is a UC Agriculture and Natural Resources comprehensive curriculum with 16 garden lessons and 15 nutrition lessons available for free download from its website.

CFHL has teamed with promotoras in Stanislaus County since 2018 to ignite local participation in teaching children that participate in garden clubs about plant and nutrition science, from building soil to creating sumptuous salads. Two years ago, a new UCCE community education specialist was assigned to the project, Rosalinda Ruiz. A native Spanish speaker and a mother herself, Ruiz quickly developed close relationships with the promotoras.

“She's not just their teacher. They look to her as a mentor and a friend,” said Jaci Westbrook, CalFresh Healthy Living, UC Community Education Supervisor for Stanislaus and Merced counties.

Ruiz is also a certified UC Master Gardener, having completed rigorous coursework in sustainable food gardening, pest management, irrigation practices and soil health. She realized the TWIGS curriculum would reach more students if she taught the promotoras how to implement the lessons at school sites.

“This empowered the promotoras to gain knowledge and gave them a different purpose,” Westbrook said. “They don't need to rely on others to offer activities. Working in pairs or small groups, they are reaching 100 to 135 elementary school students themselves.”

Ruiz marvels at the many benefits of food gardening.

“Learning about gardening is the best thing families can do to teach their kids about healthy foods,” Ruiz said. “To grow your own food is a way to get fresh, nutritious food in your home. When kids see the fruit and vegetables growing and they're part of it, they are more willing to try it out.”

During the COVID-19 pandemic, promotoras instruction continued online using Zoom, which was completely new to them, and with WhatsApp, a familiar platform for promotoras to communicate among themselves.

The students are also getting virtual instruction. Promotoras have become proficient at Zoom and are offering simple garden lessons. Socially distanced in-person gardening lessons are also resuming to give children hands-on experience growing their own food.

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