ALongitudinalStudytoAssessImpactandSustainabilityofaScratchCookingInterventionamong5ColoradoSchoolDistrictsLeahCarpenter,MPHGretchenSwansonCenterforNutritionOmaha,NE

PresenterDisclosures

LeahCarpenter

NoRelationshipstodisclose

Introduction:TheProblem

• Currentnationalrates• 17%ofchildrenandadolescentsareobese

• Environmentalandpolicyapproachesarewarranted• 32%ofemptycaloriescomefromschool• Inadequateequipmentisabarriertochange

• Lunchparticipationdeclinedby5%eachyearfrom2006to2014• StudiesfindingmealimprovementduetoHeathyHunger-FreeKidsAct• Newmealstandardsnotassociatedwithanegativeeffectonstudentmealparticipation,norfoodwaste

Introduction:LiveWell Colorado’sSchoolFoodInitiative(SFI)

• Goal:partnerwithdistrictstoservemorefresh/wholefoods• Providesworkshops/training,on-sitechefsupport,operations&marketingtechnicalassistanceandsmallequipmentdonation• Developedin2010withtheinitialgoalofreachingall178publicschooldistricts(~90districtstodate)• Modelhasevolvedovertimetobetterserveparticipants

Introduction:ExternalEvaluation

• Goal:MeasureimpactofSFIonlevelofscratch-cooking• Provideresultsandfeedbackto:• Program: Identifyareasofimprovementtoinformprogrammodificationtobestserveschooldistrictsandyieldpositiveoutcomes• Districts:Provideinformation/resultsbacktodistrictsforschoolboardpresentations,grantapplications,etc.• Community:Contributetoscientificliteratureforreplicationofbestpracticesnationally

Methods:EvaluationQuestions

• Whatarethelong-termeffectsoftheSFIonanalumnidistrict’sabilitytoincorporatefresh/wholeingredients1,2,and3yearsaftercompletingtheprogram?

• Whatarethelong-termeffectsofscratch-cookingonparticipationintheNationalSchoolLunchProgram(NSLP)?

Methods:QuantitativeMenuAnalysis(QMA)

• In-personmenucyclereviewwithFoodServiceDirector• Scoreeachingredientusedbasedonrubricbycomponent• Collectrecipesandlabels• Administered3times(Spring2014,2015,2016)

Animal-basedProteinGroupA(Scratch/Fresh) GroupB(Transitional/CleanLabel) GroupC(HighlyProcessed)

Meatandmeatalternativesdeliveredraw/uncookedwiththeonlyprocessingbeingskinned,cutand/orfrozen:

• Raw meat:beef,pork,lamb• Rawpoultry:chicken,turkey,

duck• Groundrawmeat(includeraw

preformedpatties)• Groundrawpoultry(includeraw

preformedpatties)• ShelledEggs• Rawfish,shrimp

Meatandmeatalternativesthatareminimallyprocessed,oftenprecookedandflashfrozenwithnofillersandnopreservativesadded(100%meat):

• Precookedmeat,nofillers,nopreservatives:Beef,pork,lamb(ex.crumbles,meatballs,roast,steaks,andpreformedcookedhamburgerpatties)

• Precookedpoultry,nofillers,nopreservatives:Chicken,turkey,duck(ex.Fajitastrips,unbreaded chickenbreast,turkeycrumblewithnofillers)

• LiquidEggs• CannedTuna(fishandwateror

oil,nopreservatives)• Frozenunbreaded precooked

fish,shrimp

Meatandmeatalternativesthathavebeencommerciallyprepared,i.e.heat&serveitems;cured/preserveditems;hasfillers,preservatives,orotheringredients:

• Heat&serve meat:Beef(ex.Hamburgers,crumbles,andmeatballs)withfillers);Hotdogs;Bacon

• HeatandServepoultry:Chicken(ex.nuggets,stripsandpatties);turkeycrumblewithfillers

• Delimeat(ex.turkey,roastbeef,ham,salami,pepperoni)

• Powderedeggs• CannedTuna(fishandwateror

oil,hasfillers,preservatives,orotheringredients)

• Frozenbreadedprecookedfish,shrimp

Figure1.Animal-basedProteinSectionofQMARubric

Methods:ParticipationRateAnalysis• SecondarydatafromtheColoradoDepartmentofEducation• CalculatedforeachdistrictbymonthAug2012-May2016• Combinedandbygradelevel• ComparisonofinterventiondistrictsandColorado’saverage

AverageDailyParticipation(ADP)=TotalMealsserved/#ofOperatingDays

Participation=ADP/totalEnrollment

Methods:SamplingDistricts

• 5districtsfromoriginalsample• Variationindistrictsizes• Eachchefteamrepresented• NopriorSFIexperience• Diversegeographiclocation

Results:LongitudinalQMA• Theuseoffresh/wholeingredientsincreasedby17%fromSpring2013toSpring2016acrossalldistricts

61% 62%

75% 78%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

2013 2014 2015 2016

AverageUseofFresh/WholeIngredientsOverTime

Figure2.Averageyearlyuseoffresh/wholeingredients.

Baseline:40%to75%

Afteroneyearinprogram:51%to72%

Aftertwoyears:69%to83%

After3years:69%to85%

Results:LongitudinalQMA• 17%averageimprovementacrossschooldistricts

Figure3.Eachdistrict’schangeintheuseoffresh/wholeingredientsfrom2013-2016.

Changeacross3-yeartimeframerangedfrom-1%to+33%perdistrict

22% 21%

-1%

33%

11%

17%

-5%

0%

5%

10%

15%

20%

25%

30%

35%

DistrictA DistrictB DistrictC DistrictD DistrictE DistrcitAve

TotalChangeintheUseofFresh/WholebySchoolDistrict

Results:ParticipationResults•Whentransitioningtofresh/wholeingredients,participationratesremainconstant

Figure4.Pre-PostAverageDailyParticipationbyDistrict.Fourdistrictsincreasedparticipation

Onedistrictdecreasedparticipation

Average2013rate=53.2%Average2016rate=53.9%+0.7%

35.6 38.3

71.674.6

46.143.839.2

63.2

76.7

46.6

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

DistrictA DistrictB DistrictC DistrictD DistrictE

LunchParticipationRate(%)

2013 2016

Results:ParticipationResults Figure5.Participationoftheinterventiondistricts

from2013– 2015,comparedtotheColoradoaverage

0

10

20

30

40

50

60

70

80

90

100

8/1/13 10/1/13 12/1/13 2/1/14 4/1/14 6/1/14 8/1/14 10/1/14 12/1/14 2/1/15 4/1/15

AverageDa

ilyParticipation(%

)

NationalSchoolLunchParticipationRatebyMonthforLWCSchoolDistrictsandColorado,SchoolYears2013-2015

LWCdistricts Colorado

• InterventiondistrictshavehigherparticipationthantheColoradoaverage

DiscussionandConclusion• QuantitativeMenuAnalysis(QMA)findingsshowedanaverageincreaseof17% amongSFIschooldistrictsinuseoffresh/wholeingredientsovertime(andsustained!)• Asuseoffresh/wholeincreased,schoollunchparticipationstayedconstant• SFIseenasafacilitatorinimplementinganimprovedNSLPasrequiredbyHealthyHunger-FreeKidsAct• Nextsteps:Evaluationtoincludeprocurementdataanalysis

Acknowledgements

ContributingAuthors:KelliGruber,MPH

GabriellaWarner,MS,RDAmyYaroch,PhD

ResearchsupportedbyLiveWell Colorado andTheColoradoHealthFoundation

ThankYou!Questions?