Grab-and-go meals replaced cafeteria lunch lines during COVID-19 campus closures to ensure that students have reliable access to food. To understand strategies that can improve participation in school meal programs, a study during COVID-19 documented how parents perceived the quality, healthfulness, and benefits of the grab-and-go school meals. Parents from eight school districts in the San Joaquin Valley, California, a region of predominantly Latino farm worker communities, participated in the study. Using a predetermined protocol, parents photographed all meal items provided in their students' school meals for a full week. They then participated in focus groups and group discussions to describe their perceptions of the school meals. Parents expressed appreciation for the convenience of grab-and-go meals, consistent access to food, and safety when collecting meals from school sites during the pandemic. Parents also reported concerns about unappealing meals, lack of variety in foods, and unsafe food packaging. The most common concern parents shared was about the healthfulness of packaged food items. Parents noted sugary, greasy, and fatty options, which did not meet their children's preference for fresh fruit and vegetables. Research findings suggest ways in which school meals can better appeal to both parents and their children to reduce food waste, support those who are food insecure, and increase school meal participation. Researchers of the publication in the Nutrients journal include Tatum Sohlberg, Emma Higuchi, Valeria Ordonez, Gabriela Escobar, Janine Bruce, and Anisha Patel from the Department of Pediatrics, Stanford University School of Medicine, Ashley De La Rosa and Cecelia Castro from Dolores Huerta Foundation, Genoveva Islas from Cultuva La Salud, and Ken Hecht and Christina Hecht from the Nutrition Policy Institute. This study was supported by funding from No Kid Hungry, Stanford Pediatrics Residency, and Stanford Children's Health Community Benefits Grant.

Dania Orta-Aleman joined the Nutrition Policy Institute on March 1, 2023 as a project scientist. She is a nutrition epidemiologist with a master of public health degree in epidemiology and biostatistics from the University of California, Berkeley and a doctoral degree in human nutrition from the Johns Hopkins Bloomberg School of Public Health. Dania has over ten years of experience working on public health nutrition and food insecurity research projects, domestically and internationally. Her past research focused on enhancing services for participants in the federal Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the affordability of high-protein foods, and the effect of federal food programs on meat and other high-protein foods purchasing. Dania brings her experience to NPI to support our collaborative School Meals for All evaluation project.

The USDA recently proposed changes to the Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages, which includes a permanent increase to the cash value benefit (CVB) for the purchase of fresh fruits and vegetables. In response, the Nutrition Policy Institute submitted a public comment to the Federal Register in strong support of this revision. The comment focuses on NPI-led research that highlights benefits associated with an increase to the CVB– including reduced food insecurity and improved dietary intake. Most notable is a large study of nearly 8,000 WIC participants from several states, who shared the desire for a greater variety of WIC food options, particularly more fruits, vegetables, and dairy alternatives. Additional research on WIC participants' perspectives of the program suggested that increases to the CVB were well received by WIC participants, and support participant retention and satisfaction with WIC. As the USDA reassesses the WIC food package, the research provided in NPI's public comment illustrates the benefits stemming from temporary changes to WIC. The public comment period was open from November 21, 2022 to February 21, 2023. All submitted comments are available online on Regulations.gov.

Researchers conducted a small community-based participatory research pilot of a drinking water intervention in the Navajo Nation and found that caregivers' reported knowledge of Diné (Navajo) traditions about water doubled and that the influence of Diné traditions on beverages they offered their children more than doubled. A Community Advisory Group met monthly to develop a curriculum for preschoolers and their caregivers that responded to caregiver knowledge gaps and centered Navajo language and traditions. Four monthly lessons were delivered by Early Childhood Education teachers through remote learning using multimedia materials to 21 households with children ages 2-5 enrolled in four Navajo Nation preschools. A majority (86%) of participating households had tap water at home, but only 38% stated they trusted their tap water's safety. While not statistically significant, children's average daily water consumption increased by 16% while consumption of sugary drinks decreased by 21%, with a reduction in energy intake from sugary drinks of 26 calories per day. The study was led by Brigham and Women's Hospital in partnership with Community Outreach and Patient Empowerment (COPE) of Navajo Nation and the Nutrition Policy Institute, University of California, Agriculture and Natural Resources. The study was funded by Healthy Eating Research, a national program of the Robert Wood Johnson Foundation (grant no. 77234). To learn more, read the research brief, “Water is K'é: A Community-Based Intervention to Increase Healthy Beverage Consumption by Navajo Preschool Children.”

California's San Joaquin Valley is home to many low-income Latino agricultural-worker families who disproportionately experience food insecurity and diet-related diseases. Yet free school meal participation is surprisingly low. Through the existing alliance between the Nutrition Policy Institute, Stanford Medicine's Partnerships for Research in Child Health, Cultiva La Salud, and the Dolores Huerta Foundation, the Stanford University Office of Community Engagement will fund a new project to co-create culturally and linguistically relevant materials for Spanish-speaking families, utilizing their feedback, that explain the history of school meals, United States Department of Agriculture nutrition requirements, and how families can advocate for school meal improvements that fit within the constraints of the school nutrition programs. The funding will also support dissemination of report findings to the USDA and other key nutrition advocacy groups. The 8-month project started in January 2023, and includes NPI's senior policy advisor Christina Hecht and policy director Ken Hecht. Learn more about their project online, and visit the NPI website to learn more about our work to evaluate school meals for all in California and other states.

Drinking sugar-sweetened beverages (SSB), instead of plain water, is associated with poorer health outcomes and a higher risk of developing diet-related chronic diseases. However, public distrust of the local water supply may deter the intake of plain drinking water. A recent study investigated the perceptions of tap and bottled water safety, as well as plain water and SSB intake of participants following reports on drinking water quality violations in the US, specifically the Flint water crisis. Researchers used survey data on 4,041 American adults in 2018. They found that 1 in 7 adults did not think their tap water at home was safe to drink, 2 in 5 adults thought bottled water was safer than tap water, and 1 in 4 adults did not like the taste of their local tap water. Those with negative perceptions of tap water safety and taste reported low tap water intake and were more likely to consume bottled water. The study also identified an association between perceiving bottled water as safer than tap water and a higher SSB intake. This research provides guidance for effective interventions to promote water consumption and address perceptions of water safety. The study was published in the American Journal of Public Health Promotion by the following researchers: Sohyun Park, Stephen Onufrak, and Heidi Blanck of the Centers for Disease Control and Prevention, Angie Cradock of Harvard T.H. Chan School of Public Health, Anisha Patel of Stanford University, and Christina Hecht of the Nutrition Policy Institute.

The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) food packages provide a specific set of foods to meet nutritional needs of low-income pregnant, breastfeeding, and postpartum individuals, infants, and children up to age 5 who are at nutritional risk. The USDA's proposed revisions include increasing the value of WIC's fruit and vegetable benefit, flexibility in food package sizes, and closer alignment with the current Dietary Guidelines of America, 2020-2025. A new research brief highlights WIC participants' preferences for recommended changes to the WIC food package. Among nearly 8,000 WIC participants from 12 States that responded to an open-ended survey question in 2021 about their experiences with WIC, there was a common desire for greater flexibility and personalization of the WIC food packages. Participants expressed an interest in purchasing more fruits and vegetables and highlighted inadequacy of the current CVB amount to meet their dietary preferences and needs. The research offers WIC participants' input to develop WIC food packages that improve participants' health outcomes, and addresses inequitable access to nutritious foods. The USDA, Food and Nutrition Service, invites public comment on WIC food package revisions on the Federal Register by February 21, 2023. The research brief was developed by Gabby Underwood and Loan Kim of Pepperdine University, Danielle Lee and Lorrene Ritchie of the Nutrition Policy Institute, and Christina Chauvenet of the National WIC Association.

Licensed family child care homes (FCCH) provide child care in individual homes, are often located in the same neighborhood as the families they serve and often provide longer hours of care at a lower cost than child care centers. New research shows that a self-paced, online nutrition training for FCCH providers has the potential to make childhood nutrition guidance more accessible and may help bridge a potential regulatory gap: licensed FCCHs in California not currently participating in the federal Child and Adult Care Food Program only receive one hour of mandatory nutrition training if licensed after 2016—leaving out nearly 30,000 providers licensed before 2016 who provide care to over 310,000 children—and are not required to offer foods and beverages that meet nutrition standards. The training—available in both English and Spanish and free of cost to California-based providers—consists of four 20-minute interactive models providing guidance on what and how to feed infants and toddlers. Child care providers reported high levels of satisfaction, as well as an intention to make changes in feeding practices, after completing a pilot-test of the online training. Findings also identified a need for culturally relevant information and a live nutrition educator to discuss the training material. The research article was published in the California Agriculture journal and authored by Danielle Lee, Ron Strochlic, and Lorrene Ritchie from the Nutrition Policy Institute, Deepa Srivastava and Marisa Neelon from the University of California's Division of Agriculture and Natural Resources, and Abbey Alkon and Victoria Keeton from UC, San Francisco and the California Childcare Health Program. The project was funded by a grant from UC ANR.

Healthy default beverage laws require restaurants to list healthier beverages—such as water or unflavored milk as opposed to sugary drinks—as the default option for children's meals. These laws intend to address unhealthy beverage consumption by young children, directing consumers toward healthier beverage choices at no additional cost. New research evaluates the adherence of children's meals to healthy default beverage laws from online restaurant meal ordering platforms available in Los Angeles, Baltimore, and New York City. Among over 100 of the top-grossing restaurant chains sampled, fewer than 3% of online children meal orders in any jurisdiction adhered to the strictest interpretation of the healthy default beverage laws. Varying adherence to healthy default beverage laws by jurisdiction was found and may be attributable to differing definitions of a healthy beverage. For example, California's law considers non-flavored milk and water as healthy default beverage options, while Baltimore and New York laws also allow 100% juice and flavored milk. Policy can be optimized by clearly defining  healthy beverages, bundled children's meals, and what constitutes adherence to the law for online ordering platforms. The study, published in the American Journal of Preventative Medicine, was conducted by Daniel Zaltz and Sara Benjamin-Neelson of Johns Hopkins Bloomberg School of Public Health, Danielle Lee, Gail Woodward-Lopez, and Lorrene Ritchie of the Nutrition Policy Institute, and Sara Bleich of Harvard T.H. Chan School of Public Health with partial support from a grant from the National Institutes of Health (no. T32DK062707).

Healthy Eating Research (HER), a program of the Robert Wood Johnson Foundation, conducted a rapid Health Impact Assessment (HIA) to understand how improving school nutrition standards could impact the nutritional quality of school meals, school meal participation, student dietary consumption, students' health and wellbeing, and academic performance. The HIA features several studies conducted by the Nutrition Policy Institute, including a study showing the effectiveness of removing flavored milk from schools in reducing added sugar intake without compromising the intake of milk-related nutrients. Another showed that schools successfully implemented the school meal nutrition standards per the 2010 Healthy, Hunger Free Kids Act. It also features a study showing that limiting competitive foods offered in California schools didn't lead to significant revenue loss and improved schools adherence to nutrition standards. Overall, the HIA evidence reviewed suggests that aligning school meal nutrition standards with the 2020-2025 Dietary Guidelines for Americans could have significant positive implications for child nutrition and health and is likely to increase student participation in school meal programs, improve food security, increase school food service revenue, and improve academic performance.