CalFresh Healthy Living Evaluation | CA Department of Public Health
The U.S. Department of Agriculture provides SNAP-Ed funding to all states and territories to implement interventions that promote healthy eating and active living. In California, SNAP-Ed is called CalFresh Healthy Living (CFHL) and is the largest nutrition education and obesity prevention program in the United States, with more than one-third of California residents eligible for CFHL.
The University of California’s Nutrition Policy Institute (NPI) works in partnership with the California Department of Public Health (CDPH) and local health departments (LHDs) to evaluate CDPH’s portion of the CalFresh Healthy Living program.
CDPH/NPI CalFresh Healthy Living Evaluation Projects
The California Department of Public Health and local health departments partner with local organizations, schools, and contractors to implement thousands of CFHL programs each year throughout California. NPI works with LHDs to collect, monitor, and report data required by USDA to capture the scope, nature, and number of programs. NPI designs, implements and shares lessons learned from various evaluations to assess the implementation, outcomes and impact of the CFHL program in order to inform ongoing and future SNAP-Ed efforts.
These CalFresh Healthy Living evaluations conducted by the Nutrition Policy Institute include the following:
Program Evaluation and Reporting System (PEARS)
NPI supports local health department (LHD) use of the Program Evaluation and Reporting System (PEARS) to report on their CFHL activities. NPI provides technical assistance, training, monitoring, and data cleaning of the PEARS system. PEARS data is used by NPI, LHDs, and CDPH to report on and to inform process, outcome, and impact evaluations.
See research briefs related to PEARS
See presentations related to PEARS
Site Level Assessment Questionnaires (SLAQs)
The SLAQ questionnaires were developed for California Department of Public Health (CDPH) and local health departments by NPI to provide comprehensive annual site-level assessment data for program planning and evaluation in four settings: schools, out-of-school, early care and education, and retail.
See publications related to SLAQs
See research briefs related to SLAQs
See presentations related to SLAQs
See news related to SLAQs
Impact Outcome Evaluation (IOE)
Annually, NPI evaluates the impact of local health departments’ school and school-based afterschool program CFHL interventions by assessing change (pre/post) in student behavioral outcomes using the Eating and Activity Tool for Students (EATS).
See publications related to IOE
See presentations related to IOE
Adult Direct Education Evaluation
NPI continuously evaluates behavior change, using an online survey [link], among adults participating in direct education (consisting of 4+ sessions) provided as part of the CFHL efforts of local health departments.
See Adult Direct Education Evaluation project website
Other Strategy Evaluations
Strategy evaluations are designed to assess the effectiveness of promising approaches, identify areas needing CalFresh Healthy Living programming, and inform programming to better serve priority populations. Strategy evaluations have focused on:
- Healthy default beverages with kid's meals
- School meal access during COVID-19 school closures
- Food and physical activity behaviors of SNAP-Ed eligible households during the COVID-19 shelter-in-place orders and school closures
- Retail food store assessments in SNAP-Ed eligible communities
- Physical activity programming in community parks
- Effectiveness of CDPH-developed curricula.
See publications related to Strategy Evaluations
See research briefs related to Strategy Evaluations
See presentations related to Strategy Evaluations
Studies that link statewide CDPH-CFHL program data to outcomes in secondary data sets.
To characterize, evaluate, and further inform CFHL programming, NPI conducts analysis and reporting of multiple data collected across the CalFresh Healthy Living (CFHL) systems and projects, such as PEARS and SLAQs, and combines CFHL program data with data from the US census, CA Department of Education’s Fitnessgram test, and other sources. NPI has used these data in the following ways:
- Evaluate the relationship between CFHL interventions and Individual health outcomes. To inform continued improvements in CDPH-CFHL programs, , NPI identifies underlying types and combinations of CDPH-CFHL interventions and evaluates their effect on behavioral and health outcomes, using various types of analyses.
- Health Equity analyses. To advance equity in CDPH-CFHL efforts NPI conducts analyses to identify any inequities in programming and any disparities in outcomes. For example: NPI assessed census tract level disparities during COVID-19 pandemic-related interruptions of CFHL programming throughout California to ensure equitable CFHL program planning.
See publications related to Secondary Data Analyses
See presentations related to Secondary Data Analyses
Literature Reviews
To identity best practices and inform CDPH-CFHL intervention development and evaluation design, NPI conducts literatures reviews of nutrition and physical activity intervention strategies in a variety of settings including Early Childcare Education, Schools and retail settings.
See Literature Reviews.
Publications and Products
Below is a list of publications and products from NPI's CalFresh Healthy Living evaluation activities.
PEARS
Woodward-Lopez G, Esaryk EE, Hewawitharana SC, Kao J, Talmage E, Rider CD. Supplemental nutrition assistance program education reductions during COVID-19 may have exacerbated health inequities. SSM - Population Health, article number 101471, available online 23 July 2023. DOI: https://doi.org/10.1016/j.ssmph.2023.101471
Research Brief: Health inequities may have been exacerbated by SNAP-Ed reductions during the COVID-19 pandemic. Nutrition Policy Institute, University of California, Agriculture and Natural Resources. 13 November 2023.
Local Health Department CalFresh Healthy Living FFY 2022: Introduction to PEARS Data Briefs. July 2023. CalFresh Healthy Living Evaluation Unit, Nutrition Policy Institute, University of California, Agriculture and Natural Resources.
Local Health Department PEARS Data Briefs: FFY 2022 Brief 1. Educational Activities (Direct and Indirect). July 2023. CalFresh Healthy Living Evaluation Unit, Nutrition Policy Institute, University of California, Agriculture and Natural Resources.
[Full text] [Video] [Video with descriptive audio]
Local Health Department PEARS Data Briefs: FFY 2022 Brief 2. Policy, Systems, and Environment Change Interventions. July 2023. CalFresh Healthy Living Evaluation Unit, Nutrition Policy Institute, University of California, Agriculture and Natural Resources.
[Full text] [Video] [Video with descriptive audio]
Local Health Department PEARS Data Briefs: FFY 2022 Brief 3. Partnerships and Coalitions. July 2023. CalFresh Healthy Living Evaluation Unit, Nutrition Policy Institute, University of California, Agriculture and Natural Resources.
[Full text] [Video] [Video with descriptive audio]
Local Health Department PEARS Data Briefs: FFY 2022 Brief 4. Multi-Year PEARS Data Review. July 2023. CalFresh Healthy Living Evaluation Unit, Nutrition Policy Institute, University of California, Agriculture and Natural Resources.
[Full text] [Video] [Video with descriptive audio]
Local Health Department PEARS Data Briefs: FFY 2022 Full Report. Multi-Year PEARS Data Review. July 2023. CalFresh Healthy Living Evaluation Unit, Nutrition Policy Institute, University of California, Agriculture and Natural Resources.
Becker C, Talmage E, Kao J, Rider CD. Background on Local Health Department Reporting of CalFresh Healthy Living Programs in the Program Evaluation and Reporting System, FFY 2020. Nutrition Education and Obesity Prevention Research and Evaluation Unit, UC ANR Nutrition Policy Institute. July 2021.
California Department of Public Health SNAP-Ed Evaluation: PSE FFY18 Reporting Results. Nutrition Policy Institute. 2019.
California Department of Public Health SNAP-Ed Evaluation: PSE FFY17 Reporting Results. Nutrition Policy Institute. 2018.
Kao J, Rider C, Becker C, Talmage E, Plank K, Linares A, Woodward-Lopez, G. Where Do We Go From Here? California Local Health Departments Navigate School-Based SNAP-Ed During COVID-19. Society for Nutrition Education and Behavior Annual Meeting. 31 July 2022. Poster presentation. [Abstract]
Becker C, Kao J, Woodward-Lopez G. Where do we go from here? COVID-19 impacts on local health department SNAP-Ed programing, priority populations and equity in California. ASNNA. 10 February 2022.
Rider C. Challenges and Opportunities for SNAP-Ed Programs during the COVID-19 Pandemic. National Health Outreach Conference. May 2021.
Webinar: Rider C, Kao J, Becker C, Talmage E, Murphy J, Gacad K. Luciano A, Bellow J, Gregg G. Challenges and Opportunities for Local Health Departments Implementing CalFresh Healthy Living during the COVID-19 Pandemic. 23 March 2021.
[Presentation slides] [Recording]
Kao J, Woodward-Lopez G, Becker C, Whetstone L. Roundtable discussion: What SNAP-Ed PSE strategies do communities use to improve health equity for low-income Californians? APHA. 13 November 2018.
SLAQs
Thompson HR, London R. Not All Fun and Games: Disparities in School Recess Access Persist, and Must Be Addressed. Preventative Medicine Reports, volume 35, article number 10230123, October 2023. DOI: https://10.1016/j.pmedr.2023.102301
Rider CD, Kao J, Hewawitharana SC, Beker CM, Linares A, Woodward-Lopez G. Validity and Reliability of a Site-Level Assessment Questionnaire to Assess Nutrition and Physical Activity Practices in Schools. Childhood Obesity, 20 December 2021. DOI: https://doi.org/10.1089/chi.2021.0148
Rider C, Linares A, Kao J, Becker C, Woodward-Lopez G. Assessing Healthful Eating and Physical Activity Practices in Places Children Learn. Journal of Extension, 17 December 2020.
Site-Level Assessment Questionnaire (SLAQ): An overview. Nutrition Policy Institute. August/September 2019.
Kao J, Rider C, Becker C, Talmage E, Plank K, Linares A, Woodward-Lopez, G. Where Do We Go From Here? California Local Health Departments Navigate School-Based SNAP-Ed During COVID-19. Society for Nutrition Education and Behavior Annual Meeting. 31 July 2022. Poster presentation. [Abstract]
Becker C, Kao J, Woodward-Lopez G. Where do we go from here? COVID-19 impacts on local health department SNAP-Ed programing, priority populations and equity in California. ASNNA. 10 February 2022.
Rider C, Linares A, Becker C, Kao J, Woodward-Lopez G. From Vision to Validation: Creating comprehensive tools to self-assess eating and activity practices in settings where children learn. APHA. November 2019.
School Recess: A Chance to Address Health Inequity Across California. NPI Research to Action News Brief. 8 February 2024.
[Article]
Hsu M. NPI researchers find school recess varies with school size, family income. UCANR News. 7 February 2024.
[Article]
George B, Rider C, Kao J, Becker C, Linares A, Woodward-Lopez G. Community health and wellness practioners increase evaluation capacity by using NPI tools. UC Delivers. 2 June 2021.
[Article]
IOE
Plank K, Linares A, Hewawitharana S, Woodward-Lopez G. Schools provided healthy meals even during COVID. California Agriculture, volume 77, number 3, 7 November 2023. DOI: https://doi.org/10.3733/ca.2023a0012
Linares A, Plank K, Hewawitharana SC, Woodward-Lopez G. The impact of SNAP-Ed interventions on California students’ diet and physical activity during COVID-19. Public Health Nutrition, pages 1-28, 19 January 2023. DOI: https://10.1017/S1368980023000137
Linares A, Harpainter P, Plank K, Woodward-Lopez G. Lessons Learned Recruiting Comparison Elementary Schools for Impact Evaluation of SNAP-Ed Interventions. The Journal of Extension, volume 60, issue 2, article 17, 16 June 2022. DOI: https://doi.org/10.34068/joe.60.02.17
CalFresh Healthy Living Interventions Increase Students' Fruit and Vegetable Consumption During Covid-19 School Closures. Nutrition Policy Institute, University of California, Agriculture and Natural Resources. 19 September 2023. [Full text]
Pugliese J, Rider C, Linares A, Bricker A. What Works: Identifying Effective Nutrition Education Curricula Delivered to Low-Income California Adults. SNEB July 2018.
Rider C, Linares A, Whetstone L. A Quick and Easy School Environment Assessment for Obesity Prevention Programs. Child Obesity Conference. May 2017.
Strategy Evaluations
Woodward-Lopez G, Esaryk E, Rauzon S, Hewawitharana SC, Thompson HR, Cordon I, Whetstone L. Associations between Changes in Food Acquisition Behaviors, Dietary Intake, and Bodyweight during the COVID-19 Pandemic among Low-Income Parents in California. Nutrients, volume 15, issue 21, article 4618, 31 October 2023. DOI: https://doi.org/10.3390/nu15214618
Rauzon S, Hewawitharana SC, Esaryk EE, Thompson HR, Whetstone L, Cordon I, Woodward-Lopez GM. Parent perceptions of changes in eating behavior during COVID-19 of school-aged children from Supplemental Assistance Program Education (SNAP-Ed) eligible households in California. Preventive Medicine Reports, volume 35, article number 102365, October 2023. DOI: https://doi.org/10.1016/j.pmedr.2023.102365
Plank K, Hewawitharana S, Talmage E, Rauzon S, Woodward-Lopez G. School meal access and changes in meal participation during COVID-19 school closures: A stratified random sample of CalFresh Healthy Living Eligible school districts in California. Preventive Medicine Reports, volume 28, August 2022. DOI: https://doi.org/10.1016/j.pmedr.2022.101794
Thompson HR, Martin A, Strochlic R, Singh S, Woodward-Lopez G. Limited implementation of California’s Healthy Default Beverage law for children’s meals sold online. Public Health Nutrition, 10 January 2022, pages 1-23. DOI: https://doi.org/10.1017/S1368980022000039
Strochlic R, Woodward-Lopez G, Plank K, Hewawitharana S, Richardson J, Whetstone L. Will high school students 'rethink their drink'? Findings from an impact evaluation of a healthy beverage curriculum. Health Education Journal, 23 September 2021. DOI: https://doi.org/10.1177/00178969211045725
Strochlic R, Woodward-Lopez G, Hewawitharana S, Streng K, Richardson J, Whetstone L, Gorshow D. A Harvest of the Month Curriculum Increases Fruit and Vegetable Intake Among 4th-6th Grade Students. Journal of School Health, September 2021, Volume 91, Issue 9, Pages 750-760. DOI: https://doi.org/10.1111/josh.13066
Harpainter P, Hewawitharana SC, Lee DL, Martin AC, Gosliner W, Ritchie LD, Woodward-Lopez G. Voluntary Kids' Meal Beverage Standards: Are They Sufficient to Ensure Healthier Restaurant Practices and Consumer Choice? International Journal of Environmental Research and Public Health. 22 July 2020. DOI: https://doi.org/10.3390/ijerph17155275
Tsai M, Harpainter P, Martin A, Woodward-Lopez G, Lee D, Ritchie L. Healthy Default Beverages in Kids’ Meals: Evaluating Policy Adherence and Impact in California. Current Developments in Nutrition, Volume 4, Issue Supplement 2, 29 May 2020. DOI: https://doi.org/10.1093/cdn/nzaa051_027
Gosliner W, Shah H. Participant voices: examining issue, program and policy priorities of SNAP-Ed eligible adults in California. Renewable Agriculture and Food Systems, 24 June 2019. DOI: https://doi.org/10.1017/S1742170519000243
Shah HD, Adler J, Ottoson J, Webb K, Gosliner W. Leaders' Experiences in Planning, Implementing, and Evaluating Complex Public Health Nutrition Interventions. Journal of Nutrition Education and Behavior, Volume 51, Issue 5, May 2019, Pages 528-538. DOI: https://doi.org/10.1016/j.jneb.2019.02.005
Gosliner W, Brown DM, Sun BC, Woodward-Lopez G, Crawford PB. Availability, quality and price of produce in low-income neighbourhood food stores in California raise equity issues. Public Health Nutrition, published online 15 March 2018. DOI: https://doi.org/10.1017/S1368980018000058
Thompson HR, Strochlic R, Singh S, Plank K, Martin A, Woodward-Lopez G. Research Brief: Study in SNAP-Ed eligible communities finds that limited implementation of California’s Healthy Default Beverage law for kids’ meals sold online may limit the law’s effectiveness. California Department of Public Health, CalFresh Healthy Living. Nutrition Policy Institute, University of California, Agriculture and Natural Resources. 21 October 2022.
Research Brief: Opportunities for CalFresh Healthy Living to support equitable school meal access during emergency school closures. California Department of Public Health, CalFresh Healthy Living. University of California, Division of Agriculture, Nutrition Policy Institute. 25 May 2022.
Evaluation Brief for Local Health Departments, Healthy Default Beverages in Kid's Meals. Nutrition Policy Institute. October 2019.
Increasing Local Park Use Requires Infrastructure Improvement and Sustainable Programming. Nutrition Policy Institute. 18 September 2019.
Becker C, Kao J, Woodward-Lopez G. Where do we go from here? COVID-19 impacts on local health department SNAP-Ed programing, priority populations and equity in California. ASNNA. 10 February 2022.
Rider C. Weighing the Options: Strategies Associated with Lower Obesity and Improved Fitness in Low-Income Schools. Child Obesity Conference. July 2019.
Rider C, Johnson-Arthur C, Linares A. Rethink Your Drink: Youth Intervention Successes and a Call to Action. Child Obesity Conference. June 2015.
Secondary Analysis
Pulvera R, Hewawitharana SC, Thompson HR, Leung CW, Gosliner W. Availability and Quality of Healthy Foods Vary by Store Participation in SNAP and WIC in Low-Income California Neighborhoods. Journal of Hunger & Environmental Nutrition, published online 26 November 2023. DOI: https://doi.org/10.1080/19320248.2023.2285922
Hewawitharana SC, Woodward-Lopez G, Ohri-Vachaspati P, Acciai F, Thompson HR, Pugliese J, Gosliner W. Latent class analysis identifies a promising combination of Supplemental Nutrition Assistance Program-Education interventions for improving student cardiorespiratory fitness. Preventive Medicine, volume 175, article 107687, October 2023. DOI: https://doi.org/10.1016/j.ypmed.2023.107687
Hewawitharana SC, Kao L, Rider CD, Talmage E, Costello S, Webb K, Gosliner W, Woodward-Lopez G. Method for Scoring Dose of Multicomponent Interventions: A Building Block for Future Evaluations. American Journal of Evaluation, 21 October 2021. DOI: https://doi.org/10.1177/1098214020962223
Thompson HR, Hewawitharana SC, Kao J, Rider C, Talmage E, Gosliner W, Whetston L, Woodward-Lopez G. SNAP-Ed physical activity interventions in low-income schools are associated with greater cardiovascular fitness among 5th and 7th grade students in California. Preventive Medicine Reports, Volume 20, December 2020. DOI: https://doi.org/10.1016/j.pmedr.2020.101222
Pugliese J, Whetstone L, Hewawitharana S, Woodward-Lopez G. A replication study of school-based SNAP-ed programmatic efforts to address student nutrition and physical activity outcomes. APHA. October 2020.
Gosliner W, Hewawitharana S, Kao J, Costello S, Woodward-Lopez G. Limited progress found in healthy checkout among food stores in economically disadvantaged California neighborhoods, 2011-2017. APHA. October 2020.
Pugliese J, Whetstone L, Hewawitharana S, Woodward-Lopez G. Evaluation of the relationship between school-based CDPH SNAP-Ed efforts and student nutrition and physical activity outcomes. APHA. November 2019.
Hewawitharana S. Building on low-income consumer perspectives and practices to inform healthy retail interventions. Child Obesity Conference. July 2019.
Pugliese J, Whetstone L, Gosliner W, Woodward-Lopez G, Hewawitharana S. Mother-Child Differences in Nutritional Quality among Low-Income Latinos. APHA. 13 November 2018.
Pugliese J, Whetstone L, Gosliner W, Woodward-Lopez G, Hewawitharana S. Trends in Nutritional Quality among SNAP-Eligible Californians. APHA. 13 November 2018.
Literature Reviews
Blondin K, Crawford P, Orta-Aleman D, Randel-Schreiber H, Strochlic R, Webb K, Woodward-Lopez G. School-based interventions for promoting nutrition and physical activity & preventing obesity: overview of studies and findings. Nutrition Policy Institute. November 2019.
Blondin K, Orta-Aleman D, Woodward-Lopez G. Early Care and Education (ECE) Interventions for Promoting Nutrition and Physical Activity and Preventing Obesity. Nutrition Policy Institute. March 2019.
Review of the Evidence: Health Promotion Strategies for Retail Food Shopping Venues. UC Agriculture and Natural Resources Nutrition Policy Institute, 2016.