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February 2023 | Vol. 7, No. 1
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The Nutrition Policy Institute’s Innovating Approach to Evaluating SNAP-Ed
What is SNAP-Ed?
The USDA’s Supplemental Nutrition Assistance Program-Education (SNAP-Ed—known as CalFresh Healthy Living or CFHL in California)—is the largest source of on-going funding for nutrition education and community-based obesity prevention efforts in the state. The part of the program that is administered by the California Department of Public Health (CDPH) reaches nearly every county in the state through partnerships with local health departments. The scope and longevity of the program provide an important opportunity to improve health and health equity in California.
Unique and diverse combinations of educational interventions and policy, systems and environmental (PSE) changes are chosen by health departments to be responsive to local needs and priorities. PSE interventions are a relatively new component of SNAP-Ed, reflecting growing evidence that education in combination with PSE changes show the most promise for sustained impact. Examples of PSE interventions include nutrition standards for foods in schools, increasing accessibility to parks, and improving the walkability of neighborhoods.
The Nutrition Policy Institute (NPI) partners with CDPH to evaluate these interventions to inform implementation and improvement. Our innovative approach responds to the challenges of evaluating complex and variable CFHL interventions, changing political and social landscapes, unexpected developments such as the COVID-19 pandemic, and heightened concerns about health inequity and structural racism.
How is NPI's approach to evaluating SNAP-Ed innovative?
Developing an intervention dose score
- The intervention dose method developed by NPI assigns a score to diverse combinations of interventions to measure the intensity and reach of combined CDPH-CFHL interventions at each site or location.
- We found schools with higher physical activity intervention dose scores—those that are more intensive and reach more students—are associated with higher levels of student fitness.
Applying latent class analysis
- Latent class analysis allows us to determine the predominant combinations of CDPH-CFHL interventions in schools and communities, and identify which combinations are associated with better health outcomes.
- We identified the combination of interventions associated with higher student fitness—increasing opportunities for physical activity during the school day AND physical activity-related policy improvements—but also found it was the least frequently used. The more commonly used interventions involve less intensive combinations which are not likely to improve student fitness.*
- This suggests the need for local health departments and their partners to focus on certain combinations of strategies to be more impactful.
Developing an online policy, systems and environmental change reporting system
- NPI worked with the developers of the online SNAP-Ed reporting system, the Program Evaluation and Reporting System (called PEARS), so that states can report on PSE interventions using a common tool.
- This module is now used by the majority of states and is critical for informing SNAP-Ed PSE work across the nation.
Developing site-level assessment questionnaires for intervention sites
- PEARS lacked some details useful for program planning and evaluation, so NPI developed and validated site-level assessment questionnaires (SLAQs), a simple method that schools, daycare, food stores, and out-of-school programs can use to report how they support healthy eating and active living. SLAQs generate site-level scores that can measure change over time.
- This helps CFHL sites assess the impact of their interventions on policies and practices and identify areas for improvement. SLAQ scores can also be used to assess disparities in institutional practices, and to assess the relationship between institutional changes in policies and practices and health outcomes.
Impact evaluation of promising interventions
- Schools are the primary setting for CDPH-CFHL work. To improve annual evaluations of students’ behavioral outcomes, NPI added comparison schools and changed evaluation survey timing from before and after direct education interventions to the beginning and end of the school year. This enabled attribution of the combination of direct education and PSE interventions to outcomes.
- We were able to show that participation in CDPH-CFHL during COVID-related school closures increased student fruit and vegetable intake, demonstrating the protective effect of comprehensive nutrition and physical activity education interventions even when modified during emergencies.
- We also found that the Harvest of the Month curriculum is effective at increasing fruit intake among a low-income, diverse student population in grades 4-6 and is well-received and feasible to implement.
- These types of findings help local health departments effectively implement interventions with the highest potential for impact.
Capturing the impact of COVID-19
- Using PEARS data, we found that reductions to CDPH-CFHL interventions during COVID-19 exacerbated pre-existing neighborhood-level inequities.* Larger decreases in CDPH-CFHL programming occurred in census tracts with higher poverty and less healthy neighborhood conditions. Prioritization of CDPH-CFHL, especially in disadvantaged neighborhoods, is warranted to address disparities during public health emergencies.
- Our survey of SNAP-Ed eligible households in California during COVID-19 indicated that online grocery and restaurant ordering increased and were associated with worsened dietary intake and increases in weight during COVID-19. Cooking and eating together at home also increased but were associated with improved dietary intake; but only cooking healthy meals together at home was associated with decreases in weight. These findings point to the need for CDPH-CFHL programs to address the negative influence of online food shopping and to continue to support cooking healthy meals at home.*
Assessing health equity to inform programs and reduce disparities
- NPI has increased efforts to address health inequities and structural racism in our evaluation strategies. In addition to the aforementioned evaluations on the impact of COVID-19, several other analyses on equity using data from PEARS, SLAQs and our survey of SNAP-Ed eligible households during COVID are forthcoming, including the development of a metric using PEARS data to assess the extent to which CDPH-CFHL strategies address health equity.*
Learn more
NPI is using innovative and responsive evaluation strategies to evaluate the largest source of funding for nutrition education and community-based obesity prevention efforts in the country, and to inform the development and improvement of a program that reaches millions statewide and nationally. Our approach to evaluating complex SNAP-Ed interventions is comprehensive, ongoing, and nimble in its response to changing social and political landscapes, priorities, and needs. Visit our website to learn more about our evaluation efforts in California.
The studies and work referenced in this brief were conducted as part of a contract with the California Department of Public Health with funding originating from USDA SNAP-Ed. These institutions are equal opportunity providers and employers. The views expressed are those of the authors and do not necessarily reflect those of the funders. *Indicate that peer-reviewed publications are forthcoming.
For more information, please contact Miranda Westfall at mrwestfall@ucanr.edu.
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News
Announcements
- Welcoming Reka Vasicsek to the Nutrition Policy Institute as program assistant
Conferences & Events
- CalFresh Forum, February 15-16, 2023 | NPI will showcase text messaging innovation to improve CalFresh participants purchasing of California-grown produce
NPI in the Media
New Projects
- NPI partners with National WIC Association and Pepperdine University to conduct survey of WIC participants from multiple states in 2023
- Wendi Gosliner and collaborators receive grant to test an outreach program to increase WIC participants take-up of the Earned Income Tax Credit
NPI Research
- NPI leads special issue on improving school nutrition and student health in International Journal of Environmental Research and Public Health
- NPI director to serve on National Academies of Sciences, Engineering, and Medicine committee to review interventions to improve infant and toddler feeding behaviors
- The ACCESS Study investigates take-up of the Earned Income Tax Credit among eligible Californians
- New NPI report and brief share results from the CDFA Healthy Stores Refrigeration Grant Program
- Data brief demonstrates how an increase to the WIC cash value benefit affected fresh fruit and vegetable redemption trends
- New study shows variation of WIC participants’ perceptions and satisfaction with WIC nutrition education and services by race, ethnicity, and language preference
- Study finds that SNAP-Ed interventions modified during the COVID-19 pandemic increased student fruit and vegetable intake
Policy
- Policy briefs elevating parent voices on the importance of school meals now available in Spanish
- University of California researchers release new, user-friendly fact sheets on sugary drinks
For a complete list of NPI news, please visit http://npi.ucanr.edu/news/.
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NPI Publications and Reports
Fact Sheet: The Heavy Environmental Impact of Sugary Drinks
University of California Research Consortium on Beverages and Health. American Heart Association. November 2022.
Fact Sheet: Sugary Drinks and COVID
University of California Research Consortium on Beverages and Health. American Heart Association. November 2022.
Fact Sheet: The Health Harms of Sugary Drinks
University of California Research Consortium on Beverages and Health. American Heart Association. November 2022.
Fact Sheet: How Four Cities in California are Using Sugary Drink Tax Revenue
University of California Research Consortium on Beverages and Health. American Heart Association. November 2022.
Fact Sheet: What are Sugary Drinks?
University of California Research Consortium on Beverages and Health. American Heart Association. November 2022.
Fact Sheet: 7 Reasons to Skip Sugary Drinks
University of California Research Consortium on Beverages and Health. American Heart Association. November 2022.
A Qualitative Examination of California WIC Participants’ and Local Agency Directors’ Experiences during the COVID-19 Pandemic
Au LE, Whaley SE, Hecht CA, Tsai MM, Anderson CE, Chaney AM, Vital NA, Martinez CE, Ritchie LD. Journal of the Academy of Nutrition and Dietetics, volume 122, issue 12, pages 2218-2227, December 2022. DOI: https://doi.org/10.1016/j.jand.2022.07.003
Understanding Take-Up Of The Earned Income Tax Credit Among Californians With Low Income
Hamad R, Gosliner W, Brown EM, Hoskote M, Jackson K, Esparza EM, Fernald LCH. Health Affairs, volume 41, issue 12, pages 1715-1724, December 2022. DOI: https://10.1377/hlthaff.2022.00713
Research brief: Increasing the WIC vegetable and fruit benefits results in large increases to both the amount and variety purchased
Yepez CE, Anderson CE, Whaley SE, Ritchie LD, Tsai MM, Au LE. Public Health Foundation Enterprises-WIC. Nutrition Policy Institute, University of California, Agriculture and Natural Resources. December 2022.
Research brief: Water is K’é: A Community-Based Intervention to Increase Healthy Beverage Consumption by Navajo Preschool Children
Nutrition Policy Institute, University of California, Agriculture and Natural Resources. Brigham and Women's Hospital. December 2022.
Perceptions of water safety and tap water taste and their associations with beverage intake among U.S. adults
Park S, Onufrak S, Cradock A, Patel A, Hecht C, Blanck HM. American Journal of Health Promotion, published online 6, January 2023. DOI: https://doi.org/10.1177/08901171221150093
Policy brief: Findings from an evaluation of the CDFA Healthy Stores Refrigeration Grant Program
Chelius C, Long C, Baisey T, Gosliner W. Policy Nutrition Policy Institute, University of California, Agriculture and Natural Resources. 9 January 2023.
Racial and Ethnic Comparisons in Satisfaction with Services Provided by the Special Supplemental Nutrition Program for Women, Infants, and Children in California
Chaney AM, Ritchie LD, Whaley SE, Tsai MM, Randel-Schreiber HR, Yepez CE, Sabatier S, Young A, Meza M, Au LE. Nutrients, volume 15, issue 2, article 447, 14 January 2023. DOI: https://doi.org/10.3390/nu15020447
The impact of SNAP-Ed interventions on California students’ diet and physical activity during COVID-19
Linares A, Plank K, Hewawitharana SC, Woodward-Lopez G. Public Health Nutrition, pages 1-28, 19 January 2023. DOI: https://10.1017/S1368980023000137
Adherence to healthy default beverage laws for children's meals in 3 US cities
Zaltz DA, Lee DL, Woodward-Lopez G, Ritchie LD, Bleich SN, Benjamin-Neelon SE. American Journal of Preventive Medicine, available online 8 February 2023. DOI: https://doi.org/10.1016/j.amepre.2023.01.023
For a complete list of NPI publications, please visit npi.ucanr.edu/publications.
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