Title: Evaluation of the Chef Ann Foundation’s Tompkins County School Food Reboot Program: Phase 1

Authors: Grace Stott, MS, RDN, LDN,1 (corresponding author, presenting author), Leah Carpenter, MPH,1 (corresponding author), Byron Batchelor, MPH, RD, 2 Lori Nelson, 2

1: Gretchen Swanson Center for Nutrition, Omaha, USA
2: Chef Ann Foundation, Boulder, USA

Purpose: Since children consume one-half to one-third of their daily calories at school, it is crucial for school food service departments participating in the United States National School Lunch Program to offer meals that contribute to a high diet quality. One way to do this is through the practice of scratch cooking: cooking their own meals while incorporating fresh ingredients. The Tompkins County, New York school districts have a unique opportunity to transition to scratch cooking through their participation in a county-level learning collaborative model, called the Tompkins County School Food Reboot Program (TCSFRP), an intervention led by the Chef Ann Foundation (CAF) and evaluated by the Gretchen Swanson Center for Nutrition (GSCN), through funding by the Park Foundation.

Methods: School districts in Tompkins County, NY (n=6) with a total enrollment of 9,000 students, engaged with CAF to increase their scratch cooking. GSCN led the evaluation of the TCSFRP, which included: 1) a key document review, 2) semi-structured interviews with Food Service Directors (Directors) and other key staff to inquire about progress completing program recommendations, overall impact, and 3) a descriptive analysis of recommendation progress to produce an implementation score. Data collection occurred at early implementation (6 months into the intervention).

Results: At early implementation, 22 recommendations have been completed (12%), 106 are in progress (57%), and 57 are incomplete (31%). This progress is in alignment with expectations, due to the amount of time and effort needed to transition a meal program. The Directors shared major facilitators and challenges to implementing the recommendations in each category and attributed their success thus far to CAF’s technical assistance and robust resources.

Conclusions: Results indicate, though early, that the county-level collaborative model is an effective strategy in conducting trainings, providing technical assistance (TA), and building relationships. Additionally, the TA content provided by CAF was key in addressing upstream factors and infrastructure necessary to strengthen a scratch cooking model. The findings from this evaluation have also helped inform CAF’s programming and TA model. The lessons learned from this initial phase can be applied to school food authorities in other regions throughout the United States.

Purpose: The Family Nutrition and Physical Activity (FNPA) screening tool has been widely used as a clinical assessment to identify youth at risk for unhealthy weight gain. The FNPA assesses home environmental factors and the FNPA summary score is inversely associated with obesity risk. The purpose of this study is to evaluate the potential moderating influence of FNPA in reducing incidence of hypertension associated with weight gain in youth.
Methods: Data were obtained from annual well-child visits collected within the Geisinger Health System (Pennsylvania, USA). The sample was restricted to participants ages 3 to 9 with no record of hypertension, at least one FNPA completion, two independent assessments of BMI, and at least one blood pressure measure after the age of 9 years. Participants were classified into subgroups in a 3 by 3 manner using the 25th and 75th percentiles of the total FNPA scores and the continuous BMI85 score (a relative indicator of BMI change that reflects the relative movement to or from the age- and sex-specific 85th percentile; CDC growth charts). Cox proportional hazards models were used to estimate the hazard ratios of hypertension development with the reference groups denoted as the moderate FNPA score group and the BMI85 stable group.
Results: The final sample comprised 3808 participants. The BMI85 gain group exhibited a higher rate (41.7%) of hypertension development compared to the BMI85 stable group (29.9%) and the BMI85 loss group (27.7%). After accounting for confounders (sex, race, ethnicity, and income), the BMI85 gain group was associated with 2.01 times higher hypertension risk compared to the BMI85 stable group. Participants with high FNPA score displayed the lowest rate (29.3%) of hypertension development, compared to those with moderate FNPA score (32.1%) and low FNPA score (35.2%). Among the BMI85 gain group, the hazard ratios of low, moderate, and high FNPA score groups were estimated at 1.99, 2.01, 1.54, respectively.
Conclusion: Promoting healthy home environments may reduce hypertension risk among youth experiencing weight gain. A healthy home environment, as assessed by the FNPA, effectively moderated the elevated risk of hypertension resulting from BMI85 gain by approximately 25%.

Purpose: Cooking demonstrations are a widely used strategy among community-based programs
for building culinary skills and promoting home-cooked meals. Cooking videos have gained
popularity as a nutrition education method addressing commonly reported barriers of time and
transportation and increasing accessibility. However, evidence assessing the impact of cooking
videos on self-efficacy to prepare healthy meals among low-income families is lacking. This
study aims to describe the development of a cooking video series, and its impact on improving
families’ self-efficacy in cooking skills and the families’ cooking-related activities.
Methods: Brighter Bites (BB) is a non-profit co-op nutrition education program distributing
donated produce to schools serving low-income families. Rooted in Social Cognitive Theory,
twenty cooking videos featuring ten BB recipes were developed and distributed to BB
participants via text message. Using a natural experimental design, we gathered preliminary data
self-reported by participants. Descriptive analysis and Fisher’s Exact test were used to assess
respondents’ characteristics and association between utilization of cooking videos and selfefficacy
on basic cooking skills and at-home-meal preparation behaviors.
Results: Out of 715 survey respondents, 84% are Hispanic, and 9% are Black; 54 % are stay-athome
parents; 85.2% reported household food insecurity. Out of the 10 recipes, 81% participants
reportedly watched 1-5 videos, and 19% watched 6-10 videos. Fisher’s Exact Test showed
significant positive associations between number of videos watched and number of times
participants: tried making the recipes at home, tried making recipes with children, and visiting
the BB website to access recipes. On average, participants reportedly increased in self-efficacy
in cooking skills pre-to-post, where the greatest increase was seen in preparing root vegetables
(mean=.3 level increase), and the least increase seen in knife skills (mean=.14 level increase).
When asked about the reasons for not trying the recipes, the most common responses reported
were lack of access to the space/ingredients/equipment followed by lack of time.
Conclusion: The results from this study showed a change in the desired direction in cooking
related self-efficacy, indicating video as a delivery method helped engage low-income families
in nutrition education. Future research should continue to explore facilitators and barriers to
video utilization for cooking self-efficacy.

Purpose: Preference for diet and physical activity interventions vary by cancer type and age. To date, only two published young adult cancer survivor studies incorporated a multimodal diet and physical activity health behavior approach. Each study followed different dietary guidelines and were conducted in young adult breast cancer survivors, who may have different needs because of treatment and gender differences. Efficacious multiple health behavior interventions to improve diet and physical activity in diverse groups of young adult cancer survivors are needed. The goal of this study was to collect quantitative data to inform the basis of a diet and physical activity intervention for young adult cancer survivors of diverse cancer types.

Methods: Young adult cancer survivors between 20 to 30 years of age participated in a cross-sectional study to determine preferences for diet and physical activity interventions. Descriptive statistics (means and frequencies) were generated for multiple choice question responses. Responses to open-ended questions were recorded and grouped based on themes, and verified by quality assurance checks by a second study team member.

Results: Study participants N=81 had a mean age of 26 years, 68% were female, 31% were from a racial/ethnic minority, and common cancer types included thyroid, brain, breast, sarcoma, and leukemia. All were at least one-year post-treatment completion (range 1-8 years). For dietary counseling, most participants reported a preference for remote based (e.g., ZOOM), one-on-one, counseling from a registered dietitian beginning before treatment with enthusiasm for free dietary coaching and cooking classes, such as eating healthy on a budget. For physical activity, most participants reported a preference for one-on-one, face-to-face sessions beginning before treatment, ideally within 1-15 miles from their home that were free. Participants reported interest for a variety of physical activities including running, swimming/water fitness, dancing, weightlifting, and yoga.

Conclusions: Future diet and physical activity intervention planning for young adult cancer survivors should focus on strategies to promote in-person fitness training with telehealth dietary counseling beginning before treatment. Sessions should incorporate topics important for this age group such as eating healthy on a budget and utilizing, free, local parks for physical activity sessions such as yoga.

Purpose: Unstructured play – child-led spontaneous play that has no or few rules and limited adult involvement – can contribute to the accumulation of physical activity, improve social and emotional wellbeing, improve academic performance, and provide opportunities for social interactions and risk-taking. Loose parts play, an approach to encouraging unstructured play, involves providing children with a collection of non-traditional natural or human-made play materials with which children for themselves decide what to use and how to use them. Loose parts play interventions have been successfully implemented in parks and playgrounds, schools, and childcare settings, but their implementation in home environments has yet to be investigated. We undertook a study to explore parent perspectives on unstructured play and use of take-home loose parts play kits. Take-home play kits were offered to the public during the COVID-19 pandemic by Vivo for Healthier Generations (“Vivo”), a local recreational facility situated in north central Calgary (Alberta, Canada). From May 2021 to March 2022, 201 take-home play kits were signed out, with 37 different households borrowing a play kit on at least one occasion.

Methods: A convenience sample of caregivers (9 parents and 1 grandparent) who had borrowed a take home play kit participated in semi-structured interviews via telephone or videoconferencing. The interviews captured parents’ experiences of the take-home play kits, their perspectives on unstructured play, and their perceived impacts of the pandemic on their children’s play. Using Thematic Analysis, we identified emerging themes and subthemes from the interviews.

Results/findings: Three themes emerged: (1) A forced renaissance of play; (2) Bringing unstructured play home, and; (3) Parenting is child’s play. Parents described the importance of encouraging unstructured play. They shared how the pandemic negatively affected children’s play and physical activity and opportunities for social interaction with peers. Parents perceived the play kits as a useful resource for encouraging their children to participate in unstructured indoor and outdoor play within the home environment.

Conclusions: Given the growing environmental and societal constraints that can inhibit children’s play, loose parts interventions implemented in the home environment have the potential to promote unstructured play in children.

Purpose

Summer is a critical time for youth physical activity (PA) as structured opportunities may decline. Additionally, many studies report that girls are often less physically active than boys. Previous research shows that adolescent self-reported PA levels and friendships at summer care programs are related. This study examines one program that aimed to leverage social connectedness to promote PA and mental health among girls at a summer care program.



Methods

Youth (n=47) ages 10-14 years old attending a summer care program (i.e., Boys & Girls Club) completed researcher-administered surveys and wore accelerometers (ActiGraph GT9X) in May 2023 and August 2023 – the start and end of the summer programming. Surveys recorded mental health (i.e., Kessler-10; K10) and the names of peers they spent time with at the program. Moderate-to-vigorous PA (MVPA) was derived using a machine-learned random forest classifier specifically designed and validated for assessing PA in school-aged youth. A subsample of girls (n=11) participated in an eight-session program designed to improve PA and social-emotional learning. Preliminary associations between PA, mental health, and social networks have been determined. Continued modeling procedures are being conducted to determine significant changes in MVPA and mental health for girls participating in the program and potential social ripple effects based on social network analysis.



Results

MVPA was significantly higher at the end of summer (M=62.7, SD=26.6) compared to the start of summer (M=53.7, SD=17.0; F(1,46)=4.92,p=.03,partial η2=.06). Adolescents were significantly more likely to receive new friendship nominations over time if they reported greater K10 scores (higher scores indicate greater psychological distress); however, greater K10 scores reduced odds of sending new nominations. Adolescents with higher MVPA were significantly more likely to send new friendship nominations. Additional analysis will be conducted on program participation and their social connections.

Conclusions

While more analysis is still needed, the findings thus far underscore the importance of leveraging both PA promotion and peer relationships in summer care programming for adolescent girls. The planned additional analyses on the small group intervention will further elucidate the role that targeted programming, grounded in social-emotional learning, and building social connections can potentially play in improving outcomes.