Child Nutrition Reauthorization (CNR) Program Evidence

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1 Child Nutrition Reauthorization (CNR) Program Evidence Coalition Resources Child Nutrition Forum The Child Nutrition Forum a diverse group of hundreds of national organizations of the Academy is a steering committee member urges Congress to make critical investments and improvements in the upcoming Child Nutrition Reauthorization that would increase and protect access to quality, nutritious foods in programs that serve children in child care, at home, during school and out of school. Such an investment is critical to improving the overall well being of millions of children in America. National Alliance for Nutrition and Activity The National Alliance for Nutrition and Activity (NANA), of which the Academy is a steering committee member, advocates policies and programs to promote healthy eating and physical activity, with the aim of reducing the illnesses, disabilities, premature deaths, and costs caused by diet- and inactivity-related diseases, such as heart disease, cancer, high blood pressure, diabetes, and obesity. General Need 1. Data A, Chung PJ. Changes in socioeconomic, racial/ethnic, and sex disparities in childhood obesity at school entry in the United States. JAMA Ped. 2015;169(7): Obesity increased by almost 20% between 1998 and 2010 in a sample of kindergarten children Obesity rates significantly increased among non-hispanic black children Obesity prevalence significantly declined among children of higher SES and significantly increased among children of lower SES Nutrition Education 1. Molitor F, Sugerman S, Hongjian Y, et al. Reach of supplemental nutrition assistance program education (SNAP-Ed) interventions and nutrition and physical activity-related outcomes, california, Preventing Chronic Disease. 2015;12(E33):1-10. Kids and adults reported more fruit and vegetable consumption in high-reach census tracts compared to no-intervention census tracts

2 Adults in high, moderate, and low-reach census tracts reported less frequent fast food eating compared to no-intervention census tracts No significant difference for sugar-sweetened beverages 2. Ohri-Vachaspati P, Turner L, Chaloupka FJ. Elementary school participation in the United States department of agriculture s team nutrition program is associated with more healthful school lunches. J Nutr Educ Behav. 2013;45(6): Sample of ~2500 elementary school across the US Team Nutrition participation was higher among schools in the south, rural areas, and in states with stronger nutrition policies Participating schools offered were more likely to offer healthy choices and less likely to offer unhealthy choices 3. Wan LY, Yang Q, Lowry R, Wechsler H. Economic analysis of a school-based obesity prevention program. Obesity Res. 2003;11(11): Assessed cost-effectiveness of obesity intervention in school Intervention of $14 per student per year would prevent 1.9% of female students from becoming overweight in adulthood 4.1 quality-adjusted life years would be saved Cost-effective savings of ~$16,000 in medical care costs and ~25,000 in lost productivity costs 4. Overcoming obesity: an initial economic analysis. McKinsey Global Institute website. file:///c:/users/dcintern2/downloads/mgi_overcoming_obesity_full_report.pdf. Accessed July 27, School-based nutrition education is more a cost-effective intervention than pharmaceuticals, taxing of certain foods, and weightmanagement programs 5. Brown HS, Perez A, Yen-Pen L, et al. The cost-effectiveness of a school-based overweight program. Int J Behav Nutr Phys Act. 2007;4(47) Coordinated Approach to Child Health (CATCH) intervention program showed cost- effectiveness ratio of $900 National School Lunch & Breakfast Programs 1. Terry-McElrath YM, O Malley PM, Johnston LD. Foods and Beverages offered in US public secondary Schools through the National School Lunch Program from : early evidence of improved nutrition and reduced disparities. Preventive Med. 2015;78: Significantly more secondary students went to schools with healthier lunches in 2013 (post-nslp standards) than 2011 (pre-nslp standards) In 2013, no longer a significant difference in access to healthier lunches between students in large/predominantly white schools and smaller/diverse schools 2. Cullen KW, Chen T, Dave JM. Changes in foods selected and consumed after implementation of the new National School Lunch Program meal patterns in southeast Texas. Preventive Med. 2015;2:

3 Same number of schools still enrolled in NSLP pre and post new standards Students significantly chose fruit, 100% fruit juice, vegetables, total grains, whole grains, protein, and milk more and starchy vegetables less post new standards No difference in food waste for fruit, whole grains and most vegetables; however more legumes and milk were wasted post new standards 3. Cullen KW, Chen T, Dave JM. Differential improvements in student fruit and vegetable consumption in response to the new national school lunch program regulations: a pilot study. J Acad Nutr Diet. 2015;115(5): Over 1500 elementary and intermediate students in Houston, TX Compared to control schools on old NSLP rules, new NSLP students selected significantly more vegetables, fruits, and legumes and fewer calories were consumed by new NSLP students Summer Food Service WIC 1. Collins AM, Briefel R, Klerman JA, et al. Summer electronic benefits transfer for children (SEBTC) demonstration: 2013 final report. USDA FNS. November $30 per month per child reduced very-low food security among children (VLFS-C) as well at the $60 per month $60 per month per child benefit produced greater reductions in food insecurity among adults and the full household 2. Collins AM, Briefel R, Klerman JA, et al. Summer electronic benefits transfer for children (SEBTC) demonstration: 2012 final report. USDA FNS. August Provide $60 per month per child reaches up to 75% of eligible children and reduced prevalence of very low food security among children by about one-third 3. Nord M, Romig K. Seasonal food insecurity and the national school lunch and summer food service programs. J Child Poverty. 2007;12(2): Higher prevalence of food insecurity in the summer and greater for households with school-aged children Among households with school-aged children, seasonal differences were greater in states providing smaller numbers of summer food service program meals 1. Batrick M, Reinhold A. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics. 2010;125(5): If 90% of US families breastfed exclusively for 6 months, the US would save $13 billion annually and prevent an excess of 911 death annually

4 2. Colman S, Nichols-Barrer IP, Redline JE, et al. Effects of the special supplemental nutrition program for women, infants, and children (WIC): a review of recent research. USDA FNS. January 2012 WIC participation was associated with increased iron density, fewer added sugars, and a wider variety of foods 3. Whaley SE, Ritche LD, Spector P, et al. Revised WIC food package improves diets of WIC families. J Nutr Ed Behav. 2012;44(3): Random sample of ~6000 California pregnant/postpartum women or caregivers of children on WIC Since new WIC package: 17.3% increase in whole grains (51% from baseline), decrease of 19.7% of kids drinking whole milk (63% from baseline), small but significant increases in fruit/vegetable consumption 4. Kong A, Odoms-Young, AM, Schiffer LA, et al. The 18-month impact of Special Supplemental Nutrition Program for Women, Infants, and Children food package revisions on diets of recipient families. Am J Prev Med. 2014;46(6): hour dietary recalls done in Chicago pre-wic food package revisions and 18 months post Significant decreases in total and saturated fat and increases in dietary fiber and overall diet quality for Hispanic children Significant increase in reduced-fat milk intake for African American and Hispanic children, and significant decrease in whole milk across entire population CACFP 1. Ritchie LD, Boyle M. Chandran K, et al. Participation in the child and adult care food program is associated with more nutritious foods and beverages in child care. Child Obes. 2012;8(3): State-wide survey of 429 child care providers in California CACFP sites served more fruits, vegetables, milk, and meat/meat alternatives and fewer sweetened beverages and sweets/snacks than non-cacfp sites 2. Korenman S, Abner KS, Kaestner R, et al. The child and adult care food program and the nutrition of preschoolers. Early Child Res Q. 2013;28(2): Sample of 4-year olds from the early childhood longitudinal study Among low-income children, CACFP participation increases consumption of milk and vegetables and may reduce prevalence or overweight and underweight 3. Crepinsek MK, Burstein NR. Maternal employment and children s nutrition: volume 1, diet quality and the role of the CACFP. USDA ERS. June CACFP participants with working mothers have higher quality diets (based on the Healthy Eating Index) compared to not-in-care children of homemakers CACFP participants with working mothers consume less soda than not-in-care children of homemakers Farm-to-School

5 1. Jones SJ, Childer C, Weaver AT. SC farm-to-school programs encourages children to consume vegetables. J Hunger Environ Nutr Children in farm-to-school programs ate more vegetables than in matched comparison schools Children in farm-to-school programs asked for more fruits and vegetables at home 2. Evans A, Ranjit N, Rutledge R, et al. Exposure to multiple components of a garden-based intervention for middle school students increases fruit and vegetable consumption. Health Promot Pract. 2012;13(5): adolescents (59% Hispanic, 70% low-income) had intervention of in-class lessons, after-school gardening, farm-to-school, farmers visits to schools, taste tests, and trips to farms If students had 2 or more of the interventions, they scored significantly higher on F&V intake, self-efficacy, and knowledge and they scored lower on preference for unhealthy foods 3. Heim S, Stang J, Ireland M. A garden pilot project enhances fruit and vegetable consumption among children. J Am Diet Assoc. 2009;109(7): week intervention with kids participating in garden-based activities two timer per week and nutrition education activities once a week Significant increase in number of fruits and vegetables ever eaten, vegetable preferences, and asking for fruits and vegetables at home Fresh Fruit and Vegetable Program 1. Olsho LEW, Klerman JA, Ritchie L, et al. Increasing child fruit and vegetable intake: finding for the US Department of Agriculture Fresh Fruit and Vegetable Program. J Acad Nutr Diet. 2015;115(8): Students in FFVP-participating elementary schools consumed 1/3 of a cup more fruits and vegetables per day on FFVP-days than nonparticipating schools Also a higher intake of fresh fruits and vegetables at home on FFVP-days 2. Ohri-Vachaspati P, Turner L, Chaloupka FJ. Fresh fruit and vegetable program participation in elementary schools in the United States and availability of fruits and vegetables in school lunch meals. J Acad Nutr Diet. 2012;112(6): % of FFVP-schools had majority of students eligible for free/reduced lunch Participation in Team Nutrition or having an RD on staff were significantly associated with FFVP participation FFVP schools offered more fruits, vegetables, and salads than non-participating schools 3. Qian Y, Nayga RM, Thomsen MR, et al. The effect of the fresh fruit and vegetable program on childhood obesity. Applied Econ Perpect Policy. After implementation of FFVP, obesity rates in sampled low-income elementary schools dropped from 20% to 17% FFVP costs $50-75 per child per year compared to $ per child per year via other interventions

6 Among households with school-aged children, seasonal differences were greater in states providing smaller numbers of summer food service program meals