Plain water is recommended to replace sugar-sweetened beverages to support health, yet concerns about tap water safety and barriers to access present challenges to making water the beverage of choice. In a new article, Nutrition Policy Institute (NPI) researchers and collaborators review evidence through a socioecological lens – considering the complex web of individual, relationship, community, and societal factors that influence water consumption. The paper reviews intake of drinking water in the US compared to requirements across age and racial/ethnic groups showing that most people do not drink enough plain water. It describes US regulations that support safe drinking water as well as strategies to reduce drinking water exposure to lead. Programs, policies, and environmental interventions that support access to safe and appealing drinking water, which is necessary to improve water intake, are also discussed, concluding with recommendations for research, policies, regulations, and practices needed to ensure optimal water intake by all. The review was published online in September 2020 by the journal Annual Review of Nutrition. Authors include Anisha Patel of Stanford Medicine Division of General Pediatrics, NPI researchers Christina Hecht and Lorrene Ritchie, Angie Cradock of Harvard T.H. Chan School of Public Health, and Marc Edwards of Virginia Polytechnic Institute and State University.

Schools across the nation are instituting new policies to remove chocolate milk from their meal programs in an effort to reduce students' added sugar intake. These efforts have some stakeholders concerned that this policy may lead to a decrease in students' milk consumption--specifically the essential nutrients that milk provides such as calcium, protein and vitamin D--and may also lead to an increase in milk waste. However, the latest study from the Nutrition Policy Institute shows promising results that may alleviate these concerns. The study found that although the number of students that selected milk during lunch dropped by about 14% in the year the chocolate milk removal policy was implemented, there was no significant difference in the proportion of milk wasted before and after policy implementation. Further, although milk consumption declined by about 1 ounce per student post policy implementation, there was no significant decrease in the average amount of calcium, protein, or vitamin D consumed from milk. Finally, the chocolate milk removal policy did result in a significant reduction in added sugar consumption from milk, by an average of 3.1 grams per student. These results suggest that a school meal chocolate milk removal policy may reduce middle and high school students' added sugar intake without compromising intake of essential nutrients nor increasing milk waste. The study was conducted by NPI affiliated researchers Hannah Thompson and Esther Park from the UC Berkeley School of Public Health in collaboration with NPI researchers Lorrene Ritchie and Wendi Gosliner, and Kristine Madsen from the Berkeley Food Institute and UC Berkeley School of Public Health. The study was published online on August 27, 2020 in the journal Preventing Chronic Disease. The full study is available online.

The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) Infant and Toddler Feeding Practices Study-2 (ITFPS-2) captures data on caregivers and their children over the first 6 years of the child's life after WIC enrollment to address a series of research questions regarding feeding practices, associations between WIC services and those practices, and the health and nutrition outcomes of children receiving WIC. The study, also known as the 'Feeding My Baby' study, previously produced four reports, the Intentions to Breastfeed Report, Infant Year Report, Second Year Report, and Third Year Report. The latest Fourth Year Report, which focuses on findings from children's fourth year of life, shows that consistent 4-year participation in WIC is associated with a higher quality diet among 4-year-old children. It also finds that caregivers who participate in WIC until their child is 4 years old truly value the education and support they receive through the program. In fact, the top reported reasons for continued participation are the education received from WIC (94 percent), the WIC food package (93 percent), and the perception that WIC personnel listen when participants talk about their child's health (91 percent). Findings from this new report also demonstrate how WIC nutrition education improves families' eating behaviors. Nutrition Policy Institute (NPI) director Lorrene Ritchie and NPI affiliated researcher Lauren Au from the University of California, Davis are co-authors of the new report. The study was funded by the United States Department of Agriculture and conducted in collaboration with researchers from Westat including Christine Borger, Thea Zimmerman, Tracy Vericker, Jill DeMatteis, and Laurie May, as well as Shannon Whaley from Public Health Foundation Enterprise (PHFE) WIC and Linnea Sallack from Altarum Institute. The full Fourth Year Report, along with a brief summary of the study's findings, is available online.

Nutrition Policy Institute (NPI) director and cooperative extension specialist Lorrene Ritchie presented new information on the challenges faced by California families with young children that participate in the USDA Special Supplemental Nutrition Program for Women, Infants and Children (WIC) during the COVID-19 pandemic. The presentation, titled "WIC Participation: Why do Families Stay and What has Changed During COVID-19?" was part of the California WIC Association and California WIC program's annual conference and trade show, which was held virtually on Friday August 28, 2020. Ritchie co-presented with collaborators Susan Sabatier at the California Department of Public Health and Shannon Whaley at the Public Health Foundation Enterprise (PHFE) WIC. They shared data from three studies: a state wide survey of WIC participants completed in 2019 prior to the pandemic as well as preliminary data from interviews and surveys with WIC families in Los Angeles County being completed this year. Funding for NPI's work was provided by The David & Lucille Packard Foundation and the California Department of Public Health.

Nutrition Policy Institute (NPI) and affiliated researchers recently conducted research across the University of California (UC) to develop new survey questions to assess student homeless and housing insecurity. They presented their findings during a free webinar, "Redefining Basic Needs and Assessing Housing Insecurity in Higher Education" on August 13, 2020. The webinar was featured NPI affiliated researcher Suzanna Martinez of UC San Francisco and the research team, Erin Esaryk and Eli Jimenez. Martinez shared the newly developed questions for the assessment of homelessness and housing insecurity, provided a student-informed definition of basic needs, and shared UC student experiences of housing and food insecurity from multiple campuses. These findings provide a comprehensive student definition of basic needs to inform research, programs, and policy to address housing and food insecurity in higher education. Findings were discussed in a question and answer session with student leader, Gwen Chodur, of the UC Graduate & Professional Council. The event was co-hosted by Ruben Canedo from UC Berkeley and Tim Galarneau from UC Santa Cruz, co-chairs of the UC Basic Needs Systemwide Effort. The webinar recording is available online. This research project was funded by the UC Global Food Initiative and the full research report and survey questions are available for download online. 

Nutrition Policy Institute (NPI) director and cooperative extension specialist Lorrene Ritchie commented on why school meals matter now more than ever as the United States is grappling with two major public health crises, the COVID-19 pandemic and systemic racism and inequities. The invited commentary was published online on August 20, 2020 in the journal Public Health Nutrition. Ritchie's commentary describes how the USDA National School Lunch Program (NSLP), which provided over 4.8 billion lunches to nearly 30 million children in the US during the 2018-2019 school year, supports improved food security for all students. This is important as students from lower income non-Hispanic Black or Hispanic families who have higher rates of participation in the NSLP than their non-minority counterparts. Given the historic levels of food insecurity Americans are now facing due to the COVID-19-related economic downturn, and the disproportionate effect it is having on black families, Ritchie also cites the importance of the NSLP in supporting health equity through improved nutrition. Ritchie shares evidence from a recent nationally representative study conducted by colleagues at Boston University School of Medicine which shows that NSLP participating students' diet quality improved after the school meal nutrition standards were updated in 2012-2013 to align with the 2010 Dietary Guidelines for Americans, as mandated by the Healthy, Hunger-Free Kids Act (HHFKA) of 2010. Ritchie closes her commentary requesting public health researchers, practitioners and policy makers (1) object to any rollbacks to the HHFKA nutrition standards, and (2) advocate for school meals to be made available to all students without additional charge. The commentary is available online.

The University of California (UC) has focused on student food security since the inception of the UC Global Food Initiative (GFI) in 2014 and has been instrumental in shaping the state and national conversation around students' basic needs challenges. In 2018, as part of a GFI funded project, UC commissioned Nutrition Policy Institute (NPI) affiliated researcher Suzanna Martinez at the UC San Francisco and NPI's director Lorrene Ritchie and graduate student researchers Laurel Moffat and Erin Esaryk to conduct a study titled “Defining Student Basic Needs in Higher Education: An Exploratory Study on Housing and Food Insecurity Among University of California Students.” The study explored the issue of student housing insecurity across the UC campus communities and developed, vetted and validated housing-related questions to accurately measure housing security. The study included a racially diverse group of 58 undergraduate and graduate students--of which 98% reported experiencing food insecurity in the last year and 24% reported that they had experienced homelessness since attending UC--from UC Berkeley, UC Irvine, UC Merced and UC Santa Cruz. The students participated in cognitive interviews on housing-related survey questions and focus groups on the concept of basic needs and housing. The final survey contains four modules that assess a variety of living circumstances: students' current and past living situations (17 items), housing insecurity and challenges students encountered around housing (21 items), overcrowding issues (6 items), and food insecurity timing and issues regarding basic needs security (21 items). The full study, including the final survey questions, was released on August 13, 2020, and is available for download online.

Lorrene Ritchie, director and cooperative extension specialist, and Gail Woodward-Lopez, director of research at the UC ANR Nutrition Policy Institute (NPI) were quoted in an August 25, 2020 article in Morning Ag Clips titled "New policies can help provide healthy beverages to children." The article highlights California's Healthy Default Beverage law, California State Senate Bill 1192, which requires that all restaurants in California as of January 6, 2019 offer only healthy beverages -- plain water or unflavored milk -- as the default beverage with kids' meals. The article also highlights research findings from NPI researchers in collaboration with University of Delaware on the impact of the law in California and a similar law in Wilmington, Del. Dr. Ritchie is quoted, "Parents look at menu boards and kids look at menu boards, but it is likely that what the cashier says also influences which drink they choose. In our data collection, we would order a kids' meal and wait for them to offer a drink. But mostly they said, ‘What drink do you want?' instead of ‘Do you want water or milk with that?'”. Woodward-Lopez is quoted, “NPI in partnership with the California Department of Public Health is working with some local health departments to provide training and materials to help restaurants comply with the letter and spirit of the law. Our next step is to measure whether this health department support is effective. The role of default beverage policies in this context is important and not well understood.” Read the full article online. 

The National Drinking Water Alliance, coordinated by the Nutrition Policy Institute, developed and submitted a recent comment in response to the Scientific Report of the 2020 Dietary Guidelines Advisory Committee. The comment, addressed to U.S. Departments of Agriculture and Health & Human Services' officials responsible for translation of the science in the report into the 2020-2025 Dietary Guidelines for Americans (DGAs), focused on the attention that the next DGAs should give to drinking water in place of sugar-sweetened beverages. The comment had 97 signatories, including 23 organizations, as well as 74 researchers, health professionals and advocates, among them, Glenda Humiston, PhD, Vice President of the University of California (UC) Division of Agriculture and Natural Resources, and 25 UC scientists. The comment asks for clear, actionable advice in the 2020-2025 DGAs that will help encourage the American public to drink water in lieu of sugar-sweetened beverages. It urges USDA to add a symbol for water to the MyPlate graphic and other educational messaging. Read the full comment and see all the signatories here.

Nutrition Policy Institute (NPI) partnered with Stanford Medicine Department of Pediatrics to develop a series of fact sheets to support the provision of nutritious and sustainable school meals during the COVID-19 pandemic. NPI's Christina Hecht led development of the fact sheets that are targeted to school nutrition professionals, school boards, and advocacy organizations.  The fact sheets distill the latest on the USDA Child Nutrition Program waivers that have provided flexibility for school districts, allowing them to maximize their meal service despite COVID-19 disruptions including school closures and supply chain problems. Each fact sheet in the series addressed a specific challenge: how to continue meal service during “spring break,” provision of school meals over the summer, and the transition to “back to school” school re-opening scenarios. The fact sheets also provide tips and resources from the field, aiming to encourage school districts to take full advantage of the USDA flexibilities to maintain meal quality and build student participation in the meal programs. As one example, when providing “grab & go” meals while schools are closed, districts can aid families, keep meals fresh, and reduce waste by providing “bulk foods.” By using the waivers for non-congregate feeding and meal times, a district could provide a weekly sack of foods equivalent to the amounts and nutritional requirements normally provided by single meals.  Bulk food provision can reduce the use of pre-packaged one-portion items, for example substituting a fresh melon for individual fruit cups. It can also minimize the number of trips a family needs to make to pick up school meals and it can support use of fresh and local produce. Fact sheets were designed for California districts and for a national audience; the latter were co-branded by the School Nutrition Association (SNA) and provided to SNA's 53,000 members. Template versions make it easy to pull and co-brand the information to target specific regions. The fact sheets and modifiable templates are available for download at the links below. 

"Back-to-School” Fact Sheet:

• Back-to-School: We'll Keep Feeding Those Kids! UC ANR Nutrition Policy Institute. Stanford Medicine Department of Pediatrics. School Nutrition Association. 12 August 2020. [Download (PDF)]

“Summer Meals” Fact Sheets:

• Calling all Districts! USDA Summer Meals Can Keep Kids Healthy (National version). UC ANR Nutrition Policy Institute. Stanford Medicine Department of Pediatrics. School Nutrition Association. 20 June 2020. [Download (PDF)] [Download Template (Word document)]
• Calling all Districts! USDA Summer Meals Can Keep Kids Healthy (California version). UC ANR Nutrition Policy Institute. Stanford Medicine Department of Pediatrics. Updated 20 June 2020. [Download (PDF)] [Download Template (Word document)]

"Spring Break” Fact Sheets:

• Kids' Hunger Doesn't Take a Spring Break. While closed for COVID-19, school districts can serve meals over spring break (National version). UC ANR Nutrition Policy Institute. Stanford Medicine Department of Pediatrics. 2 April 2020. [Download (PDF)] [Download Template (Word document)]
• Kids' Hunger Doesn't Take a Spring Break. While closed for COVID-19, California districts can serve meals over spring break. UC ANR Nutrition Policy Institute. Stanford Medicine Department of Pediatrics. 1 April 2020. [Download (PDF)] [Download Template (Word document)]