Successful Students Through Healthy Food Policies
Overview
California Project LEAN’s (CPL) 'Successful Students Through Healthy Food Policies' programme used a social marketing approach to move local school board members to establish and enforce school nutrition policies.
Working with the California School Board Association, CPL embarked on a programme to motivate policymakers to address and enact local school district policies that support healthy eating. This programme provided school board members with printed guides on policy and nutrition, training at conferences and professional workshops, and fact sheets for board members and parents of students.
Successful Students Through Healthy Food Policies was awarded the Innovation in Prevention Award by the Department of Health and Human Services in 2004.
Results (2004):
- Approximately 10 per cent of school districts had at least 1 high school that had developed or was developing a healthier nutrition policy
- The programme helped create nutrition policies to increase the availability of healthy foods to 1 million of California’s 6.3 million students
Policies were introduced to set standards for fundraising activities, classroom celebrations and the ban of soft drinks
Getting Started
Across the US diet and physical activity patterns have resulted in crisis proportions of overweight and obese adolescents and have placed these youth at risk of chronic illnesses, such as coronary heart disease, diabetes, high blood pressure and some cancers.
Proper nourishment can have a positive effect on children’s cognitive development, behaviour, ability to concentrate, school attendance and educational performance.
Physical activity has a positive effect on alertness, mental function and learning. Local school boards play a critical role by setting expectations and making important policy decisions that determine whether and how student health is a priority throughout the school district.
California Project LEAN (Leaders Encouraging Activity and Nutrition) is a joint programme of the California Department of Public Health (formerly California Department of Health Services) and the Public Health Institute. California Project LEAN (CPL) works to advance nutrition and physical activity policy in schools and communities to prevent obesity and its associated chronic diseases. Its efforts are centred on youth and parent empowerment approaches, policy and environmental change strategies, and community-based solutions that improve nutrition and physical activity environments.
While some school health policies are carefully planned, others (such as a la carte food sales and vending machine sales) have been developed out of perceived necessity. The deliberate enactment of policy and regulation, however, is a key way in which authorities influence health behaviour.
Despite recommendations to promote healthier eating at school, schools and school boards responses have been varied, and many have contracts with fast food companies, which are often viewed as an essential way to maintain financial support.
In light of this backdrop, CPL wanted to promote awareness of nutrition related policies that support healthier food choices in the school setting by developing a social marketing programme that prioritised school board members as key individuals who could effect change.
The programme, called 'Successful Students Through Healthy Food Policies’, was funded by the California Department of Public Health, Cancer Research Programme, the California Endowment and the Robert Wood Johnson Foundation, and was guided by the:
- Surgeon General’s Prescription for Change
- Centers for Disease Control and Prevention’s (CDC’s) School Health Index
- United States Department of Agriculture’s Changing the Scene
- National Alliance for Nutrition and Activity’s Model Local School Wellness Policies on Physical Activity and Nutrition (prior to Congress’s Nutrition Act)
CPL formed a Community Research Collaborative with three partners to aid the development and implementation of the programme:
- Academic staff members representing the social marketing and health education programme of the University of South Florida College of Public Health
- The California School Boards Association (CSBA)
- A private non-profit social marketing firm, Best Start Social Marketing, Inc.
Scoping
Behavioural goals
The behavioural goals of the programme were to:
- Increase the number of school districts that have enacted school policies that support healthy eating for high school students, in which at least 50 per cent or more are eligible for free and reduced price meals
- Increase the frequency with which nutrition-related policy issues were placed on the agendas of school board meetings
Behavioural theory: Logic Model
A Logic Model for using social marketing to influence policy was employed. This model postulates that it is still individuals who make policy, even though they may reside within organisations. These stakeholders and partners may be individuals, or may reside in groups made up of individuals. Advocacy and pressure from partners and stakeholders can empower and facilitate policy change by lowering the barriers that policymakers face in achieving that change.
This theory informed the segmentation and approach of the programme.
Target audience
The programme targeted school board members because they are in a powerful position to encourage and facilitate programmes that enhance student health.
Socioeconomic segmentation also helped guide this programme. CPL decided to focus on California school districts with high schools in low-income communities, specifically school board members serving rural and urban high school districts in which at least 50 per cent or more students are eligible for free and/or reduced price meals.
Secondary research
A literature review was conducted to assess:
- Published school policies
- Existing soda contracts in California’s 25 largest school districts
- Newspaper coverage in California’s major newspapers to evaluate how they cover adolescent nutrition policies (media analysis)
- The 2000 California High School Fast Food Survey
- State and national data regarding obesity and the role of schools (paying particular attention to discernable trends, stakeholder interests and economic and political forces at play)
The review of school policy found little published data focusing on factors that influence the decision-making process used by school board members in advancing policy, particularly in relation to nutrition issues.
Primary research
This programme was heavily driven by a focus on the customer and how best to address their needs. Formative research was conducted to gain insight about:
- The factors that motivate school board members to develop and/or implement healthy food policies in their school district
- The factors that deter school board members from developing and/or implementing healthy food policies in their school district
- Effective information channels and spokespersons for school board members regarding healthy food policies
- Effective strategies for increasing school board members’ interest in healthy food policies in schools
Programme development was guided by:
- 157 interviews with school board members and other key stakeholders (such as superintendents, state and national school health leaders)
- Focus groups with school board members
- Strategy sessions with school board members and partners
- A 41-item survey of California school board members
Insight
Research revealed that school board members were moved to become board members because they are concerned about the overall wellbeing of youth and they have a desire to give back to community.
Findings revealed school board members’ beliefs and perceptions of nutrition-related school policies, their perceived needs for professional development and training, policies they did or did not support, and spokespersons who could influence their nutrition-related policy decision making.
Barriers
- Nutrition was not a priority within school districts and among parents and community members
- Lack of knowledge of the impact of poor nutrition on students’ health and academic performance amongst school board members, parents and the wider community
- Inadequate education and/or preparation in developing nutrition-related school policies
- Budget considerations
- Lack of support, time and/or personal interest
Competition
A range of factors competed with the ability of school board members to implement nutrition-related school policies:
- Cost of implementing policy changes – Unhealthy food options are less expensive, introducing new foods causes costly disruptions to existing school meal programmes and supply arrangements
- Lobbying and marketing power of large multinational fast food and soda companies
- Competing school board policy priorities
- Student and parent attitudes towards healthy foods
Other findings
- 76 per cent did not believe their school districts were doing everything to foster healthy eating behaviours among students
- The majority of school board members believed policies supporting good nutrition on school campuses could contribute to the reduction of student cancer and heart disease risks in the future and the number of overweight or obese students
- School health issues, particularly healthy food choices, were rarely brought to the attention of school board members and parents
- School board members highlighted the need for increased understanding by parents of how the school board operates so they can have a greater influence on policies and increased knowledge of the importance of health and nutrition for children
- More than 50 per cent did not feel adequately prepared to develop nutrition-related policies
- 75 per cent stated their district provided ongoing professional development for school board members
- Two-thirds would like to receive training on nutrition-related school health issues
- Preferred methods for learning about nutrition-related issues included the internet, school board publications, email, school board conferences and seminars
Four concepts were created based on these insights and pretested with 25 school board members prior to implementation.
Development
A key component of the programme was the development and dissemination of information designed to educate school board members about nutrition issues and assist in policy development. The following communication resources and tools were developed:
Healthy Food Policy Resource Guide
Provides background information on the issues; describes actions that school districts and school boards can take to provide a comprehensive programme on nutrition and physical activity; provides sample nutrition related policies; and provides tools for policy development. Over 3,000 guides have been widely used by school boards, food service directors, parents, county offices of education and others.
Sample board policies and administrative regulations
Made available through CSBA on related topics, such as goals of the district; the district’s food service/child nutrition programme; free and reduced price meals programme; other food sales; physical education; comprehensive health education; and local wellness policies. Sample policies were critical, as school boards looked to CSBA for guidance. By changing institutional practices to incorporate language that supported healthy eating, school boards were able to discuss and modify sample policies before actually adopting a new policy within their own school.
Fact sheets
Developed on the key issues of importance to school boards and distributed locally during presentations and one-on-one meetings with school board members, parents and community leaders. Topics included nutrition and youth health statistics, creative school fundraising ideas, and nutrition, physical activity and academic achievement.
Advertisements
Communicated the campaign message and ran in CSBA’s quarterly magazine, California Schools.
Articles, case studies and resources
Appeared in CSBA’s newsletter and magazine, California Schools; publications of the National School Boards Association, Association of California School Administrators, National Association of State Boards of Education, and Parent-Teacher Association; Healthy Kids Resource Catalogue; and on the CSBA and CPL websites.
Professional workshops
School board members needed assistance to help them develop sound nutrition-related policies and provide community leadership on the issues. Conferences, workshops and one-on-one training offered an opportunity to share information in an interactive setting. School board members were trained through workshops that covered the following topics:
- Linkages between nutrition, physical activity and student learning
- Scope and risks associated with the rise of obesity among Americans, especially youth
- Making school policies work
- Discussing the school board’s role in community relations and policy development
- Understanding the policy process and analysis of sample policies
- Success stories from other school districts
Mobilising communities
The programme helped mobilise communities to advocate for nutrition policy initiatives. CPL regional coordinators were trained to work with community partners, including health experts, food service directors, parents and students, to influence school districts to establish policies that support healthy eating and physical activity. A guidebook, Reaching School Board Members, was developed for community groups on working effectively with school board members on healthy nutrition and physical activity policies. CPL state and regional coordinators and CSBA offered ongoing technical assistance to school boards in their establishment and implementation of policies. Local health experts provided credibility and research for school board members who championed the issue in their own school districts.
The 4Ps
This programme considered the 4Ps of the marketing mix:
- Product interventions sought to link benefits such as improved academic performance from improved nutrition with the behaviour of implementing a nutrition policy
- Price strategies worked to decrease barriers to creating a policy, such as lack of preparation of board members to address nutrition issues
- Placement strategies resulted in information and training being provided at conferences attended by school board members
- Promotional interventions reiterated that passing a sound nutrition policy would improve student performance and behaviour, and materials were presented in a respectful tone, with a ‘scholarly and authoritative’ manner
The exchange
The programme sought to minimise the barriers identified by the scoping phase.
Nutrition was not a priority
Through Healthy Food Policies, CPL implemented programmes educating students, parents and community members about the importance of good nutrition and how to advocate for healthier foods and school environments.
Inadequate education and/or preparation in developing nutrition-related school policies
The programme offered school board members training sessions, professional workshops and professional development tools aimed at providing individuals with the necessary resources and skills to develop appropriate nutrition-related school policies.
Budget considerations
The programme addressed these concerns by showing how nutrition policies need not adversely impact budgets and by exploring new opportunities to generate support and revenue that are not based on the sale of unhealthy foods. Case studies were also used from other school districts that had been successful in selling healthy foods.
Lack of support, time and/or personal interest
Increased education and training regarding nutrition-related school issues sought to convey the importance of good school-based nutrition to student academic performance and behaviour, and to prioritise healthy eating of students among school board agendas.
Addressing competition
The programme sought to address the two key sources of competition – the cost of implementing policy changes and the marketing power of fast food companies. In response to these two factors, a media advocacy campaign released the results of a fast food survey, showing the high prevalence of fast food on high school campuses. It called for schools to be more adequately funded so that they no longer have to rely on the sale of cheap, unhealthy foods, and to facilitate the sale of convenient and affordable healthy foods. This was also the impetus behind state nutritional standards legislation.
Implementation
The sample policies provided on the CSBA website were deemed a key success of the programme, primarily because the school boards routinely look to the CSBA as a trusted authority when the need for policies arises, and these sample policies were ready and available, offering a clear structure for school districts to follow.
The development of these sample policies and the resource guide required a lot of work around ensuring that acceptable language was used. Each partner or stakeholder had motivations for wanting the language to be framed in one way or another. Making sure that the language was suitable to all stakeholders took time to ‘learn one another’s language’ and requirements, and thus required more reviewing time than had originally been scheduled.
“When working with partners it’s important to understand that we may have different approaches and perspectives, but ultimately we want the same goals and outcomes – healthier students and improved academic performance. We successfully compromised in certain aspects of our toolkit, understanding our role as advocates, and their role to provide their members with unbiased information.” (Victoria Berends, Marketing Director)
In addition, the training was found to be highly beneficial, but working in such a large and highly populated state meant that reaching school board members through this mechanism was limited. Ideally the programme would have liked to see more members attending these training sessions, but was aware that long travel times was a key barrier.
“We need to identify creative ways to deliver training to more school administrators, beyond traditional methods, in order to have a broader and deeper impact. In California there are about 5,000 school board members and we had several hundred attend the trainings. We had training sessions in five areas in California, but with the state being so large it's hard to reach everyone. People aren’t going to drive more than an hour for training.” (Victoria Berends, Marketing Director)
Evaluation
CPL’s Successful Students through Health Food Policies programme was evaluated by an independent external evaluator (Robert McDermott, a consultant employed by the University of South Florida). The evaluation focused on a number of process and outcome measures and used key informant interviews and a second school board survey carried out in 2004.
Process measures:
- Training sessions and attendance
- Internet ‘hits’
- Emails to school board members about nutrition-related issues
- School board publications and conferences about nutrition-related issues
- Programme ‘champions’ among school board members and other stakeholders
Outcome measures:
- Ensuring less healthy foods are not offered as fundraisers
- Offering more healthy choices in school vending and school meal programme
- Pricing healthier foods and beverages lower than unhealthy alternatives
- Restricting or banning fast food advertising in schools
- Restricting or banning vending machines in elementary schools
Results
The programme demonstrated significant progress:
- Approximately 10 per cent of school districts with at least 1 high school have developed or were developing healthier nutrition policies
- The programme helped create nutrition policies to increase the availability of healthy foods to 1 million of California’s 6.3 million students
- Policies included nutrition standards for foods sold outside of the school meal programme (this was prior to local wellness policies or state legislation)
- Policies were introduced to set standards for fundraising activities, classroom celebrations and the ban of soft drinks
The programme also demonstrated success on several other fronts, including:
- New schools adopting school board policies
- Increased discussion of nutrition issues at school board meetings
- Increasing the importance of nutrition issues among school board members
- Increasing support from school board members for healthy nutrition agenda
- Changes in school board members’ attitudes regarding banning fast food and a la carte food sales, and food and soda advertisings in school
Follow Up
The sample policies and other resources continue to be available on CSBA’s website as part of their policy services, and the training workshops continue to be supplemented by professional development activities carried out by CPL regional representatives and the CSBA.
Since the end of the programme, the Federal Mandate for Wellness Policy has been passed. This requires that any district participating in a federal nutrition programme adopt a policy on student wellness that, at a minimum:
- Includes goals for nutrition education, physical activity and other school-based activities that are designed to promote student wellness in a manner that the district determines is appropriate
- Includes nutrition guidelines selected by the district for all foods available on each campus during the school day, with the objectives of promoting student health and reducing childhood obesity
- Provides an assurance that the district’s guidelines for reimbursable school meals will not be less restrictive than federal regulations and guidance issued pursuant to 42 USC 1758(f)(1), 1766(a) and 1799(a) and (b), as they apply to schools
- Establishes a plan for measuring implementation of the policy, including the designation of one or more persons in the district or at each school charged with operational responsibility for ensuring that this policy is implemented
These requirements have meant that the lessons learnt from the CPL programme have become exceedingly valuable and have been shared in a number of ways. An article that outlined the programme and its results, Impact of the California Project LEAN School Board Member Social Marketing Campaign, was published in the Social Marketing Quarterly journal in 2005. A number of presentations have been made, including a presentation to the 138th American Public Health Association Annual Meeting in 2010. CPL has also presented the work at the meetings of other State Board Association meetings to share learning on how to work with a state’s School Board Association and what resonates with school board members, so they could implement similar initiatives.
For the Governor’s 2010 California Summit on Health, Nutrition and Obesity, the work of CPL was referenced. This summit led to Senate Bill 1413 (Leno) being introduced, which requires school districts to make free, fresh drinking water available in school food service areas by 1 January 2012.
Lessons learned
Make the desired policy change seem inevitable
If school board members perceive that these policy changes are being made everywhere and that everyone important wants it and is doing it, they will be more motivated to get behind the policy changes. Make sure that the key decision makers receive lots of information, expressions of support, examples of others in similar situations who are doing it, and examples of successful change.
Coalition building and audience research
Building strong coalitions is crucial and ensures that the social marketing process is followed thoroughly. Audience research is still needed to learn about the needs of decision makers, what is important to them, and the barriers and benefits they perceive in making the desired change.
"Listen to your audience and work with your partners. Basic marketing – don’t assume you know what is needed, do the research with your audience and work closely with your partners to get their buy-in and input.” (Victoria Berends, Marketing Director)
Commit for the long haul
This programme asks for behaviour change on the part of potential partners, as well as decision makers, and this will not happen overnight.
Intermediate measures
Policy change is a long process and grants are short. Make sure you have some intermediate measures to show success.
Budget considerations
Budget considerations are an important factor and continue to be a guiding force. The programme addressed these concerns by showing how nutrition policies need not adversely impact budgets and by exploring new opportunities to generate support and revenue that are not based on the sale of unhealthy foods.
Acknowledgement
All photos in this case study are courtesy of Tim Wagner, HEAC
