Data Findings of the Evaluation of the Alliance for a Healthier Generation s Competitive Foods Agreement

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1 Data Findings of the Evaluation of the Alliance for a Healthier Generation s Competitive Foods Agreement Founded in 2005 by the American Heart Association and the William J. Clinton Foundation, the Alliance for a Healthier Generation (the Alliance) is working to reduce the prevalence of childhood obesity by 2015 in the United States. Through its programs -- the Healthy Schools Program (HSP), the Industry Initiative, and the empowerme campaign -- the Alliance works to positively influence places that make a difference in a child s health, such as homes, schools, doctor s offices, and communities. This executive summary highlights the OMG Center for Collaborative Learning s evaluation findings on the Alliance s School Competitive Foods Agreement. This agreement is a part of the Alliance s Industry Initiative. The Industry Initiative serves as a catalyst for businesses to become a part of the solution for childhood obesity, the Alliance engages with companies from diverse industries that have the ability to improve the health and well-being of future generations of children. One agreement that has been brokered by the Alliance Industry Initiative is to shift the types of competitive foods offered in schools to provide healthier options through a voluntary agreement between the Alliance and food manufacturers. 1 The Alliance for a Healthier Generation contracted with OMG to conduct an assessment of progress made on the Alliance Competitive Foods Agreement in This evaluation places primary emphasis on the progress that the food industry made and its ability to change the competitive foods environment. This was assessed by quantifying change by signatories and by surveying a broad sample of schools (both HSP and non-hsp). 1. The Alliance s Industry Initiative and the Healthy Schools Program The Alliance for a Healthier Generation works with both the food industry and schools to create the conditions necessary so that all children have access to healthier foods, beverages, and physical activity in their schools, communities and homes. The Alliance s School Competitive Foods Agreement, a part of its Industry Initiative, focuses on promoting the consumption of fruit, vegetables, nutrient-rich foods, fat-free and low-fat dairy products and also limiting calories, fat, saturated fat, trans fat, sugar, and sodium. The Guidelines cover snack foods and side items offered outside of the reimbursable meal program, such as products sold in vending machines, à 1 Competitive foods and beverages are those that are sold at school outside of and in competition with federally reimbursable meal programs. Examples of competitive foods and beverages include those sold during the school day in vending machines (that are not reimbursable meals), student stores, à la carte items sold by the school food services department, or as fundraisers. 1

2 la carte lines, snack carts, and in school stores. The Alliance s Healthy School Program aims to bolster local school policies and practices in support of healthy eating. Industry Initiative: The Alliance s Industry Agreement works with the food, beverage, health care, and physical activity industries to broker voluntary agreements to shift business practices so that children and families have access to healthier foods, physical activity and health care. The Alliance School Competitive Foods Agreement was signed in October 2006 when five of the nation s leading food manufacturers agreed to adopt the science-based Alliance School Competitive Foods Guidelines to make healthier snack food choices available in schools. To date, the Alliance has 47 active agreements (MOUs) with the beverage, dairy, and snack food industries with the goal of accelerating the shift to lower calorie and more nutritious beverages and snacks offered to children during the regular and extended school day. Signatories have been able to help schools maximize success implementing the Guidelines by offering competitive food products that meet the Guidelines. Healthy Schools Program: Since 2006, the Alliance s Healthy Schools Program has been widely embraced by schools. To date, more than 11,000 schools across the United States participate in the Healthy Schools Program with more than 4,400 schools receiving onsite support. The Healthy Schools Program is working to create healthier school environments by supporting schools to implement best practices in eight key content areas competitive foods is one of these key content areas. As a part of this work, the Alliance developed its Competitive Foods Guidelines which are science-based, age-appropriate, calorie and portion controlled standards covering snacks and side items offered for sale to students outside of the school meal program such as products sold in school vending machines, à la carte lines, snack bars, fundraisers, and school stores. It is the intention that availability of these snacks in schools will help students make healthier food choices in the school environment. 2. Methodology A mixed-methodology design was used including qualitative and quantitative elements to examine the status of the progress of the Alliance s Competitive Foods Guidelines implementation. It had two primary components: An analysis of the efforts of food companies participating in the Industry Initiative who have signed the Competitive Foods MOU with the Alliance. A comparison of schools participating in the Healthy Schools Program to those not participating in Healthy Schools Program, in terms of steps they have taken to implement the Guidelines. The specific data collection strategies included: A group interview with key program staff at the Alliance and review of background materials. In-depth interviews with industry participants (n=13 companies). Self-administered questionnaires with industry participants (n=13) Online surveys with school administrators at HSP and non-hsp schools (n=129). 2

3 Key informant interviews with school administrators and school staff (n=12). Site visits to HSP and non-hsp schools (n=10 schools). 3. Summary Assessment of the Implementation of the Competitive Foods Guidelines The Critical Role of Industry In-depth interviews with food industry participants and a self-administered questionnaire of these same participants examined a number of different areas including: Types of Competitive Foods that are offered as part of their company s school foodservice portfolio. Changes in reformulation and resizing and introduction of new compliant products since companies have signed on to the MOU. The marketing and supporting efforts being undertaken by companies to promote healthier products within the schools channel. Key barriers and facilitators to implementing the agreement Industry agreements with the Alliance have facilitated product reformulation and new product development. Interview findings revealed that the vast majority of participating companies have a commitment to providing healthy foods across multiple categories. Most industry interviewees (n=11/13) stated that their company has always had a commitment to providing healthy foods. Many of these signatories also highlighted their specific commitment to providing healthier food options to youth (e.g., reduced fat, sugar and/or sodium). In fact 5 out of 13 companies specified that they had a specific commitment/mission to providing youth with healthier foods. Over half of companies interviewed (n=7/12) have school portfolios that are 100% compliant to the Alliance Guidelines. Of these seven companies, several interviewees noted that their products were already compliant because of their commitment to providing healthy foods. Others had 100% compliance as a result of signing the Alliance agreement. As a result of the work with the Alliance, along with state and local guidelines, many of the signatories have reformulated, resized, and/or developed new healthier products that have become a part of the school portfolio. Half of the companies interviewed (n=6/12) reformulated products in their school portfolio since signing the MOU. Five companies did not reformulate because their portfolios were already 100% compliant. 3

4 Chart 1: Marketing Efforts to Promote Healthy Foods in Schools % n National or State School Trade Conferences 85% (11/13) Website Contains Alliance Information 38% (5/13) Sell Sheet for Alliance Compliant Products Advertising Alliance Affiliation Through Other Outlets Discount/Incentive Program for Purchasing Compliant Products Direct Mail Efforts Advertising Alliance Affiliation 38% (5/13) 31% (4/13) 31% (4/13) 23% (3/13) Member of the Cool School Café Group 23% (3/13) Member of the School Nutrition Association 23% (3/13) *Totals do not equal 100% because responses are not mutually exclusive and companies spoke of several marketing efforts Food industry signatories are participating in marketing efforts and making internal policy changes to promote healthier foods in schools (see Chart 1). Signatories noted that national conferences are the most popular form of marketing to promote healthier foods in schools (n=11/13). Other marketing efforts include: websites, ads, sell sheets, discounts or incentives, direct mailings, Cool School Café rewards program, member of the SNA, electronic e-blasts, samples of compliant products for schools, and sales presentations of compliant foods. Promoting the Alliance Guidelines directly to schools does occur to some extent (n=5/13); however, nearly one-third of the interviewed companies do not directly promote the Alliance Guidelines. Almost one-third of respondents made internal policy changes since signing the MOU. Most often, companies interviewed stated that they changed requirements for ingredient levels; for example: sugar, sodium, wheat flour, etc. (n=4/13) While the industry initiative has resulted in some positive changes there have been challenges as well in moving the needle on producing healthier products. Approximately one-third of companies believe that the greatest barrier to implementing the guidelines is the conflicts with state level guidelines. Additionally, nearly a quarter of the industry respondents requested more leadership from the Alliance to help interpret the Guidelines and to aid in the distribution of information. As evidenced by this research, many food companies are working to reformulate products and create healthier portfolios; however, feedback from company represented indicated that in the end consumer demand will ultimately drive change on the part of industry. Early Evidence of Positive Change in Competitive Food Offerings in the School Environment Schools are recognized as key places to impact health and wellness of children and evidence from the evaluation demonstrates that schools are working to implement changes in their competitive foods environment. In the past 4 years 91% of HSP respondents and 82% of non- HSP respondents indicated they have made changes to provide more nutritious foods to students. 4

5 The biggest changes for HSP and non-hsp schools alike were around providing less high-fat snacks, high-sugar snacks, and high-sodium snacks. OMG research revealed that participation in the Alliance Healthy Schools Program accelerates a school s shift to more nutritious food offerings, and provides support for overall school wellness policies and practices. Findings indicate that participating schools have made progress across a number of wellness dimensions including: Offering healthier competitive foods at the same or lower price than less nutritious choices (HSP 73% and non-hsp 65%) Displaying healthier competitive foods in more prominent places than less nutritious choices (HSP 58% and non-hsp 51%) Having more promotional/marketing materials around healthier competitive foods (HSP 67% and non-hsp 50%) The presences of a wellness policy with specific competitive foods standards (HSP 65% and non-hsp schools 54%) The presences of a policy to reduce less nutritious foods at fundraisers (HSP 48% and non-hsp 35%) A policy to reduce or eliminate classroom parties and school celebrations with less nutritious choices (HSP 48% and non-hsp 46%) A policy around reducing food as a reward or reinforcement (HSP 39% and non-hsp 33%) Evidence suggests that implementing the Alliance Competitive Foods Guidelines generates revenue for schools to help support food service operations and some student activities. Due to misconceptions about healthy foods yielding reduced revenue, schools are often reluctant to provide healthier competitive foods. School administrators are fearful of overall school revenue loss. Evidence from this evaluation revealed that many schools report revenue neutrality (HSP 27% and non-hsp 13%) or revenue increases (HSP 13% and non-hsp 1%) since the implementation of healthier competitive foods. Further evidence from one of the site visits to a handful of HSP schools demonstrated that the elimination of certain foods coupled with some of the new and healthier foods being a little more expensive to purchase resulted in an initial decline in revenue in à la carte and vending sales that has since leveled off. Interviewees at this site visit noted that district-level support was a primary reason that despite an initial loss in revenue - efforts around healthy eating were continued. The district recognized they had made a commitment to teaching students about health and nutrition and that there may be initial costs associated with that commitment but that in the long term the payoff would be greater. Due to the work that has been done and the momentum behind the Healthy Schools Program one of the site visit schools received a $48,000 Fresh Fruit and Vegetable Grant from the USDA. This has been an added bonus and next year multiple schools within that district are receiving the grant which is just one example of the long term investment paying off for the entire district. 5

6 Key School-Based Factors to Successful Implementation of the Guidelines Survey results highlighted the top three factors that helped schools implement the changes in competitive foods were the same for both HSP and non-hsp schools: o Presence of a school wellness policy such as a nutrition policy (HSP 61% and non-hsp 82%). o Administrator and staff support and buy-in to encourage implementation (HSP 60% and non-hsp 67%). o The presence of the Alliance Competitive Foods Guidelines (HSP 44% and for non-hsp schools other competitive food policies 43%). Many of these survey findings were corroborated during the site visits as well. Data from our site visits demonstrates that supportive state nutrition policies coupled with school participation in the Healthy Schools Program accelerates positive changes to healthier competitive foods offered in schools. Healthy Schools Program schools are offering more nutritious competitive foods in à la carte lines, snack bars, and vending machines and in some cases eliminating or reducing the number of venues where competitive foods are sold. Evidence from the site visits demonstrates that schools have success when they have policies in place around wellness and competitive foods and the Guidelines provide specific science-based strategies to implement. Having a team of school administrators and on-the-ground school-based healthy food advocates plays a significant role in advancing wellness work. Findings from the site visits demonstrate that administrative support from superintendents, principals, and food service directors for student health and wellness are particularly important in implementing changes in competitive foods. In addition, Healthy Schools Program schools that have been able to garner support from teachers, students, and parents interested in leading healthier lifestyles have been able to provide a comprehensive approach to wellness and nutrition. Due to multiple levels of school involvement and interest, these schools have more successfully integrated this approach in the classroom, fundraising, and the cafeteria. The Alliance Healthy Schools Program elements have significantly helped schools implement healthy change. Interviewees during site visits noted that resources from the Alliance for a Healthier Generation, such as the relationship managers, action plans, and coaching have been instrumental in helping schools and districts implement positive changes in competitive foods. Evidence from this evaluation demonstrates that the Healthy Schools Builder has been an important communication device and tool for taking inventory, reevaluating what individual schools have accomplished, and putting together an action plan. Qualitative findings from site visits indicate that support from the Alliance is instrumental in accelerating the important work already being done in schools. 6

7 Barriers to the Successful Implementation of the Guidelines Survey findings clearly highlighted three primary perceived challenges to implementing the Guidelines; however, these perceived challenges were not in all cases supported by site visit data. While the findings around what has been successful in implementing the Guidelines were corroborated between the surveys and the site visits the barriers to implementation have been less conclusive. Perceived lack of student acceptance of changes to competitive foods is seen as a barrier (HSP 64% and non-hsp 77%). Data from site visits show some support for this perception. A focus group of students who were interviewed during one of the site visits report some perceived limitations with à la carte options. Although a small sample of students, this group shared that they rarely buy competitive foods because they are too pricey, too high in calories, or not healthy enough for them. However, evidence from another site visit to a different set of HSP schools demonstrates that school districts that are engaged in a multitude of activities which are directly related to promoting and engaging students in healthful behavior have witnessed greater student acceptance to changes in competitive foods. Districts that have taken a multi-faceted approach to addressing nutrition so students can understand food systems and production have been more successful in bringing students along in the process. Students who learn which vegetables are in season, how they are harvested, the process involved in getting them from the farms to the cafeteria and student taste tests of any new potential food product have demonstrated a greater acceptance to the changes in food products sold in their schools. Perceived loss of revenue is viewed as a barrier (HSP 61% and non-hsp 53%). Data from site visits does not support this perception of loss. Interviewees during the site visits highlighted that despite changes and maybe some initial dips revenue has remained relatively stable over time. In one example from a site visit the Food Service Manager reports that her district earns approximately $6500/month in competitive food sales, with roughly $1000 of those earnings being categorized as profits. She notes no major changes in food sales revenue over the past four years. Perceived lack of product availability/choice in products is viewed as a barrier (HSP 51% and non-hsp 57%). Data from the site visits shows some support for this notion of lack of product availability/choice. The issue of product availability/choice appears to be a particular challenge in smaller and more rural school districts. Interviewees at one of the smaller school districts noted that vendors lack of responsiveness challenged this district s ability to implement healthy changes to its competitive foods. The Food Services Manager talked about how vendors seem less responsive to small districts than to larger ones and that vendors seem less interested in small districts because they purchase fewer foods and have limited buying power in comparison to larger districts. Vendors also might not offer certain foods to districts unless they are ordered in large quantities.

8 4. Summary The industry evaluation showed that, for the most part, the participating food companies fulfilled their commitments under the Alliance Competitive Foods Agreement; however, that may not be enough to cause a nationwide shift in school product purchases and availability. Food manufacturers are responsible for creating reformulating competitive food products that are available to schools. The evaluation showed that positive changes to the nutrition profile of these products have occurred since Yet, today, much of the onus still lands on the school to make the changes to their competitive foods offerings and work with multiple vendors to achieve success. School districts typically purchase food products from distributors who respond to regional demands and volume. The issue of product availability specifically impacts small and mid-size districts that may have differing product needs than surrounding districts and do not warrant the volume for distributors in their area to carry requested products. Although healthier products exist from participating manufacturers nationwide, schools still may not be able to obtain products in their region. Additionally, thirdparty vending operators contract to stock vending machines in school districts and, like distributors, are not addressed as part of the Alliance Competitive Foods Agreement. In order to be successful, industry agreements must address all elements of the supply chain. The Alliance experienced success with the School Beverage Agreement, which involved both manufacturers and bottlers (distributors) in order to drive implementation of the Guidelines in schools nationwide. Because the competitive foods agreement focused solely on manufacturers, the success of this agreement was limited in scope. The Alliance has applied the lessons from the Competitive Foods Agreement to subsequent industry agreements focusing on school meals in order to address product availability and cost. Successful implementation of the Alliance Competitive Foods Guidelines is still being achieved by schools who are leading the way. Despite product availability barriers, schools continue to implement the Guidelines across the country. The evaluation showed that not only are schools making positive changes to the competitive foods offerings, they are using creative pricing and promotion tactics to maintain sales. Support from HSP resources are seen as facilitating factors to implementation to help schools identify products that meet the Guidelines, encourage student feedback and achieve national recognition. 8