Drinking water is the healthy alternative to the sugary drinks that are a risk factor for many diet-related chronic diseases and tooth decay, and plain drinking water is also more environmentally friendly than packaged sugary drinks. Nutrition Policy Institute (NPI) researcher Christina Hecht, who coordinates the National Drinking Water Alliance, received funding from the Robert Wood Johnson Foundation Healthy Eating Research program to develop a 'photo-evidence' tool to document the condition of drinking water access in schools and other community locations. This work was conducted in collaboration with the University of Washington School of Public Health and Stanford Medicine Department of Pediatrics. The tool, Assessing the Quality of Water Access (AQWA), is designed for use by community or citizen scientists and allows a documentary and quantitative survey of the elements that should be present to maximize water consumption. The AQWA toolkit is available online. Critical elements in drinking water access, dubbed ‘Effective Access to Drinking Water' were identified by researchers during the development of the AQWA tool. These include water dispenser cleanliness, condition and accessibility, adequate water flow, presence of cups, and educational or promotional messaging about drinking water and healthy hydration. A new research brief, entitled ‘Effective Access to Drinking Water in Schools: What is it and why does it matter?' provides a summary of the research on the importance of these elements as well as the evidence base on school drinking water access around the US. The research brief is available online. Contact Christina Hecht, at ceahecht@ucanr.edu, if your group might undertake a project using AQWA.

Congress is working on Child Nutrition Reauthorization, which has been delayed since 2015. The previous reauthorization resulted in the Healthy, Hunger-Free Kids Act of 2010 (HHFKA). Despite the delay, a recent study shows that school meals are the single overall healthiest source of eating in the U.S., suggesting children's nutrition has fared well under HHFKA. Limitation of added sugars in school meals was not incorporated into the HHFKA, due in large part to the United States Department of Agriculture (USDA) anticipating that maximum calorie levels in school meals would effectively curb amounts of added sugars. However, this was not effective as a recent study showed that most schools exceeded the guideline of 10% of total calories daily limit for added sugars at both breakfast (92%) and lunch (69%). In their latest policy brief, Nutrition Policy Institute researchers in collaboration with Stanford Medicine Department of Pediatrics, Cultiva La Salud, and the Dolores Huerta Foundation, share findings from a research project involving San Joaquin Valley parents of children who receive school meals during COVID-19 related school closures. Parent experiences of school meals were collected from focus groups and PhotoVoice documentation of one week's worth of school meals. Parents expressed concern about the freshness, nutritional quality, and amount of added sugars in the school meals. The brief, entitled ‘School Meals: Kids are Sweeter with Less Sugar' presents parent photographs together with parent quotes and a brief summary of the background. It concludes with the policy recommendation that Congress, through Child Nutrition Reauthorization, direct USDA to implement a standard for added sugars that aligns with the current Dietary Guidelines for Americans. The brief is available online.

Researchers at the University of California, Division of Agriculture and Natural Resources (UC ANR), Nutrition Policy Institute (NPI) presented at the 2021 Virtual Sugary Drink Summit, hosted by the Center for Science in the Public Interest, on April 20-22. The three-day event brought together public health experts and advocates to discuss national, state, and local policies that build community capacity for advocacy, improve health and health equity while reducing consumption of sugary drinks. Christina Hecht from NPI hosted a session on the importance of equitable access to safe and affordable drinking water. Marisa Tsai, an NPI researcher, presented a session titled, 'Evidence base for policy interventions to reduce SSB consumption', where she shared findings from NPI's recent studies on healthy default beverage policies for restaurant kids meals and a chocolate milk removal policy for school cafeterias. The summit culminated on Friday, April 23, when summit participants had an opportunity to participate in a virtual Hill day to visit their Congressional offices. Participants provided information on the evidence base and recommendations to improve nutrition and particularly to reduce consumption of added sugars, with a focus on upcoming legislation including Child Nutrition Reauthorization and the SWEET Act, that would impose a tiered national tax on sugary drinks.

The University of California (UC) Merced Farmworker Health Research Conference brought together researchers from across the country, UC officials, local and state leaders, and community members on April 9 for a virtual conference on farmworker health. The conference is part of a study that started in May 2020 and runs through June 2022. Researchers aim to expand on findings from the 1999 California Agricultural Health Workers Survey, conducted by the California Institute for Rural Studies, and will focus on the long-term health of farmworkers. University of California, Division of Agriculture and Natural Resources (UC ANR), Nutrition Policy Institute (NPI) researcher Ron Strochlic will be contributing to the study by conducting interviews with growers and other stakeholders to identify ways to increase farmworkers' access to health care. Strochlic also served on the conference planning committee, in collaboration with the event chair, Edward Flores, co-director of the Community and Labor Center at UC Merced, and fellow committee members Ana Padilla, executive director of the Community and Labor Center, public health Professor Paul Brown and graduate student Nimrat Sandhu of UC Merced, Christy Getz, associate cooperative extension specialist of UC Berkeley, consultant Joel Diringer and legislative advocate Noe Paramo of California Rural Legal Assistance Foundation. The conference was funded in support by the California Department of Public Health and the California Endowment. Conference presentations and discussions were uploaded to the Community and Labor Center's YouTube channel, where they will be available until June 9, 2021.

The COVID-19 pandemic had both positive and negative impacts on the implementation of the California Department of Public Health's CalFresh Healthy Living (CFHL) activities over the past year. CFHL, known nationally as SNAP-Ed, supports healthy, active, and nourished lifestyles by teaching Californians about good nutrition and how to stretch their food dollars, while also building partnerships in communities to make the healthy choice, the easy choice. CFHL activities are implemented by California's Local Health Departments (LHDs) and other agencies. Researchers at the University of California (UC) Nutrition Policy Institute (NPI) evaluated the impact of COVID-19 on CFHL efforts using data gathered in the Program Evaluation and Reporting System (PEARS), a tool used by CFHL professionals to track policy, systems, and environmental change efforts (often referred to as PSE), direct nutrition education, indirect education, partnerships, and multi-sector coalitions. In addition, NPI researchers surveyed 54 LHDs in October 2020 to understand more about how the pandemic impacted their programs. Evaluation results showed that LHDs found new ways to deliver CFHL interventions during COVID-19, building on existing capacity and branching out into new areas, including developing new sites and partners, developing new skills to implement programming virtually, and developing novel food procurement and distribution mechanisms. NPI researchers presented results from their evaluation in a March 23, 2021 webinar, titled Challenges and Opportunities for Local Health Departments Implementing CalFresh Healthy Living during a Pandemic, with over 50 state agency and LHD staff in attendance. The webinar was hosted by the NPI PEARS team, including Carolyn Rider, Janice Kao, Christina Becker, and Evan Talmage in collaboration with Jennifer Murphy and Kylie Gacad from California State University, Chico, Anna Luciano from Orange County Health Care Agency, and Jessica Bellow and Gaby Gregg, from Community Action Partnership of Orange County. The webinar slides and recording are available online.

Over 40% of US children ages 2-5 years consume sugar-sweetened beverages (SSB), a concerning statistic given SSB are a leading contributor to child obesity. One-in-three children eat at quick-service restaurants on any given day and policies that require restaurant kids' meals to offer only healthy default beverages are one strategy to improve children's beverage intake. Researchers at the University of California (UC) Nutrition Policy Institute and the University of Delaware Center for Research in Education and Social Policy recently examined restaurant beverage offerings in 111 quick-service restaurants in California and 16 quick- and full-service restaurants in Wilmington, Delaware before and after restaurant healthy default beverage policies were implemented. California law, SB1192, requires that only water and unflavored milk or a non-dairy equivalent be offered with restaurant kids' meals. The Wilmington policy, ordinance no. 18-046, allows for flavored milk and unsweetened 100% juice or juice diluted with water in addition to the beverages allowed in California. Observations of restaurant menus showed improvement from 2019 to 2020 in beverages offered with kids' meals in California, but not in Wilmington, post-policy. However, during orders of kids' meals, only 1% of restaurant cashiers or servers offered the healthy default beverage in California and none in Wilmington after the policies went into effect. Less than one in four restaurant managers interviewed in California knew about the beverage policy, and none did so in Wilmington, despite most managers in both California and Wilmington expressing support for the policy. This study suggests the need for additional efforts to strengthen the implementation of kids' meal beverage policies. The study was published in the journal Public Health Nutrition by NPI researchers Lorrene Ritchie, Phoebe Harpainter, Marisa Tsai, Gail Woodward-Lopez and Wendi Gosliner in collaboration with Tara Tracy, Kathleen McCallops and Allison Karpyn from the University of Delaware and Isabel Thompson from UC Berkeley. The study was funded by the California Department of Public Health, with funding from the United States Department of Agriculture's Supplemental Nutrition Assistance Program – USDA SNAP, a grant to Duke University from the Robert Wood Johnson Foundation and the University of California, Division of Agriculture and Natural Resources.

Sugar-sweetened beverages, including chocolate milk, are the leading source of added sugars in youths' diets. During the 2017-18 school year, the San Francisco Unified School District (SFUSD) implemented a policy removing chocolate milk from school lunches as part of a district-wide strategy to reduce students' intake of added sugars. A new research brief from the University of California, Nutrition Policy Institute (UC NPI) describes the impact of this policy on students' intake of milk and its associated nutrients. This impact was measured by UC researchers in a study of students' milk selection and consumption in 24 SFUSD middle and high schools during one lunch period at each school during each study year. The study included 3,158 students in 2016 before the policy and 2,966 students after the policy was implemented in 2018. Study results showed that after chocolate milk was removed, milk taking at lunch declined, but average per-student intake of key nutrients from milk did not. In addition, students' intake of added sugars from milk declined significantly. The study suggests that removing chocolate milk from school cafeterias may improve student nutrition. The research brief encourages schools to consider eliminating chocolate milk to help reduce students' added sugar intake. The study was conducted in collaboration with researchers at the UC NPI, UC Berkeley School of Public Health and Berkeley Food Institute, and SFUSD Student Nutrition Services. This work is supported by the Agriculture and Food Research Initiative grant no. 2015-68001-23236 from the USDA National Institute of Food and Agriculture. The research brief is available online. The full research study is also available online.

Feeding America published a new resource, the Nutrition in Food Banking Toolkit, aimed to guide the charitable food sector to better meet the nutritional and cultural food needs of people they serve. The toolkit, released on March 23, 2021, was developed by Feeding America's Nutritious Food Revisioning Task Force, made up of more than a dozen food banks and national organization staff, with input and expertise from partnering organizations. This first edition of the Nutrition in Food Banking Toolkit is composed of three main sections, each focused on a different aspect of the charitable food system. Healthy Eating Research (HER) Nutrition Guidelines for the Charitable Food System provides recommendations to improve the quality of food in food banks and food pantries in order to increase access to healthier food for food-insecure households. Applying an Intercultural Competence Lens provides insights and recommendations for developing nutrition-related cultural competence at the organizational, partner, and individual levels. Role of Food Bank Nutrition Policies: A Guide to Action provides food banks with strategies to achieve nutrition policies that lead to a more nutritious food supply. The final section on food bank nutrition policies was developed by University of California (UC) Nutrition Policy Institute (NPI) researcher Karen Webb and UC Agriculture and Natural Resources advisor Laura Vollmer. This section was adapted from NPI's Guide to Drafting a Food Bank Nutrition Policy, which was created for the online course Developing a Food Bank Nutrition Policy. Toolkit partners include Healthy Eating Research (HER); the CDC's Nutrition and Obesity Policy Research and Evaluation Network; UConn Rudd Center for Food Policy and Obesity; UC NPI; MAZON: A Jewish Response to Hunger; Partnership for a Healthier America; and Academy of Nutrition and Dietetics. The toolkit is available online.

Researchers at the Nutrition Policy Institute (NPI), University of California, Davis, and the University of South Carolina published a new study describing the use of factor analysis methods to evaluate the effectiveness of school nutrition environments on child health outcomes. Given the complexity of school food environments, factor analysis can be a useful method in identifying latent or unmeasured factors underlying observed environmental characteristics to determine which have the largest influence on child health outcomes. Researchers applied this method to data collected from the Healthy Communities Study which included 4,635 children in the US between the ages of four and 15 years from 386 elementary and middle schools in 2013–2015. Although the findings from the study were mixed, results suggest that restriction of unhealthy foods in school is associated with lower added sugar intake by children. The study was published online in March 2021 in The Journal of Nutrition. Co-authors include Marisa Tsai, Lorrene Ritchie, and Gail Woodward-Lopez from NPI, Lauren Au from the University of California, Davis, and Edward Frongillo from the University of South Carolina. The study was funded by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health.

Previous research conducted by the University of California (UC) Nutrition Policy Institute identified that, in 2016, 44 percent of undergraduate and 26 percent of graduate students at the UC reported having experienced food insecurity; in addition, 5 percent of students reported experiencing homelessness at some point during their enrollment. A new study published in the American Journal of Health Promotion by NPI, UC San Francisco, and Washington State University researchers explores how UC students define basic needs and reports on their experiences of housing insecurity, and food insecurity within the context of housing insecurity. Fifty-eight UC undergraduate and graduate students were recruited from basic needs centers at five UC campuses to participate in researcher-led focus groups. Results showed that UC students define basic needs as more than minimal food and shelter, but also include mental health, well-being, hygiene and safety; they also reported that meeting basic needs was the joint responsibility of students and the university. Students reported multifaceted housing insecurity issues, said that affording rent is a priority that most often leads to experiencing food insecurity, and also that transportation was a key barrier to meeting their basic needs. Further, students with non-traditional characteristics, graduate students, and out-of-state students reported facing unique challenges in meeting basic needs. Limited financial aid, lack of financial aid guidance and unanticipated University fees were additional barriers reported by students to meeting basic needs. Students reported that additional university basic needs services, such as food pantries and other free food programs, were essential in supporting their basic needs. The findings demonstrate the need for multi-faceted basic needs programs that go beyond food and housing on college campuses. The study was led by Suzanna Martinez of UC San Francisco in collaboration with Erin Esaryk and Lorrene Ritchie of NPI, and Laurel Moffat of Washington State University. The study was funded by a grant from the UC Global Food Initiative. The full study is available online.