Nutrition Policy Research

Reports

• "Direct Certification in the National School Lunch Program: State Implementation Progress. Report to Congress." Dennis Ranalli, Edward Harper, Rosemary O’Connell, Jay Hirschman, Nancy Cole, Quinn Moore, and Brandon Coffee-Borden. October 2009. Direct certification simplifies the process of certifying certain children for free school meals by eliminating the need for households to apply. The 2004 Child Nutrition and WIC Reauthorization Act required all local education agencies (LEAs) to establish a system of direct certification by school year 2008-2009 for children from households receiving Supplemental Nutrition Assistance Program (SNAP—formerly the Food Stamp Program) benefits. Seventy-eight percent of all LEAs directly certified some SNAP participants in school year 2008-2009. These LEAs enroll 96 percent of all students in schools participating in the National School Lunch Program. The percentage of SNAP-participant children who were directly certified varied greatly across states. States with the highest rates were able to directly certify all or nearly all eligible children. The least successful states certified no more than 50 percent. Half of all states directly certified at least 72 percent of school-age SNAP participants. Mathematica’s contribution to this report included interviewing states with high rates of direct certification and documenting best practices.
• “WIC Eligibles and Coverage, 1994-2007: Estimates of the Population of Women, Infants, and Children Eligible for WIC Benefits.” Ed Harper, Jay Hirschman, James Mabli, Sandi Nelson, and Kerianne Hourihan, September 2009. WIC provides food, nutrition education, breastfeeding support, and health care and social service referrals to nutritionally at-risk low-income pregnant women, new mothers, infants, and children through age 4. This report updates estimates of those meeting the criteria for WIC benefits from 1994 through 2007. In 2007, 14.2 million individuals were eligible for WIC benefits in an average month, slightly less than the amount in 2006. The program served 8.4 million, or 59 percent, in 2007. Executive summary
• “Child and Adult Care Food Program (CACFP): Improper Payments Data Collection Pilot Project.” Rhoda Cohen, Lara Hulsey, Stacie Feldman, Claudia Gentile, and John Hall, September 2009. The Child and Adult Care Food Program subsidizes nutritious meals served to eligible children and functionally impaired adults participating in family day care homes, day care facilities, emergency shelters, and afterschool programs. This report discusses the results of a pretest and pilot study that explored four methods for estimating erroneous meal claim payments in CACFP nationally. As a result of the pilot study, the authors recommend the Parent Recall Method due to its relatively low cost and consistency with estimates based on direct observations of meals served. Executive summary
• "Effects of Economic Conditions and Program Policy on State Food Stamp Program Caseloads, 2000 to 2006." James Mabli, Emily Sama Martin, and Laura Castner, August 2009. From 2000 to 2008, the average number of Food Stamp Program (FSP) participants rose by 65 percent because of increases in eligibility and participation. These changes occurred during a period that included declining national unemployment—the same period during which states were being given the authority to implement state-specific FSP policies, including changes in eligibility determination rules, income reporting requirements, and program outreach efforts. This report uses quantitative analysis of administrative data and qualitative findings from interviews with FSP administrators and community-based organization staff to examine how the increase in the number of program participants from 2000 to 2006 was associated with the economic and policy factors that characterized the changing environment.
• “School Meal Program Participation and Its Association with Dietary Patterns and Childhood Obesity.” Philip Gleason, Ronette Briefel, Ander Wilson, and Allison Hedley Dodd, July 2009. Does eating school meals influence children’s dietary habits or chances of being overweight or obese? This study addressed these questions using data from the School Nutrition Dietary Assessment III Study. National School Lunch Program participants had lower intakes of sugar-sweetened beverages and a lower percentage of calories from low-nutrient energy dense foods and beverages than did nonparticipants. Overall, however, participation was not significantly related to students’ BMI. School Breakfast Program participants had significantly lower BMI than did nonparticipants, possibly because participants were more likely to eat breakfast and ate more at breakfast, spreading calorie intake more evenly over the course of the day.
• "Trends in Supplemental Nutrition Assistance Program Participation Rates: 2000 to 2007." Joshua Leftin and Kari Wolkwitz, June 2009. The Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program, helps low-income individuals purchase food so that they can obtain a nutritious diet. Ability to reach the target population is an important measure of SNAP's performance. Of the 39 million people eligible for benefits in an average month in 2007, 26 million (66 percent) participated. SNAP also provided 81 percent of the benefits that all eligible people could receive because the neediest, who are eligible for higher benefits, participated at higher rates than other people. Participation rates remained relatively high for children, individuals in households with incomes below the poverty line, and recipients of TANF or SSI. Summary
• “Factors Associated with School Meal Participation and the Relationship Between Different Participation Measures.” Quinn Moore, Lara Hulsey, and Michael Ponza, June 2009. This study investigated factors that influence students’ participation in the National School Lunch and School Breakfast Programs using recent data from a large, nationally representative sample of students certified for free and reduced-price meals during the 2005–2006 school year. Whether students are in elementary school and whether they like the taste of the meals are among the most important factors associated with picking up the meal offered that day. In addition, if students currently eligible for reduced-price meals were instead given free meals, they would participate more at lunch than they do now, although not at breakfast. Finally, parents’ reports of the previous day’s or previous week’s participation tend to be overstated, resulting in higher reported annual participation rates than administrative data suggest.

Journal Articles

• "A National Survey of Obesity Prevention Practices in Head Start." Robert Whitaker, Rachel Gooze, Cayce Hughes, and Daniel Finkelstein. Archives of Pediatrics & Adolescent Medicine (subscription required), December 2009. This study describes obesity prevention practices and environments in Head Start, the largest federally funded early childhood education initiative in the United States. Most programs reported doing more to support healthy eating and physical activity than federal performance standards require. Ninety-four percent of the programs studied served some fruit each day, other than 100 percent fruit juice; 97 percent served some vegetables, other than fried potatoes. Fifty-four percent did not allow soda or other vending machines for staff use; 96 percent did not keep children sitting for more than 30 minutes at a time; and 89 percent had an on-site outdoor play area at every center. In addition, more than half (56 percent) provided children with at least 60 minutes each day of unstructured physical activity in addition to the 30 minutes of adult-led physical activity. Data were collected from a self-administered survey included as part of the Study of Healthy Activity and Eating Practices and Environments in Head Start (SHAPES).
• “Publishing Nutrition Research: A Review of Epidemiologic Methods.” Barbara Bruemmer, Jeffrey Harris, Phil Gleason, Carol J. Boushey, Patricia M. Sheean, Sujata Archer, and Linda Van Horn, Journal of the American Dietetic Association (subscription required), October 2009. The use of epidemiologic research designs and analytical methods is common in nutrition research, as researchers seek to understand dietary and other factors associated with health status and illness. This monograph on research methodology presents the basic observational study designs most commonly used in epidemiology, and provides an overview of the univariate and bivariate statistical methods on which these epidemiologic designs are based.
• "An Introduction to Qualitative Research for Food and Nutrition Professionals." Jeffrey E. Harris, Philip M. Gleason, Patricia M. Sheean, Carol Boushey, Judith A. Beto, and Barbara Bruemmer, Journal of the American Dietetic Association (subscription required), January 2009. This article defines qualitative research as applied in the field of dietetics to increase knowledge and competency in evaluating this type of research. The authors explain the design of qualitative studies, explore congruence with quantitative research, and provide examples of applications in dietetics, stressing the importance of ensuring validity and reliability of qualitative measures. The article aims to help food and nutrition professionals add to the body of peer-reviewed, dietetics-related qualitative publications.
• "School Food Environments and Policies in U.S. Public Schools." Daniel M. Finkelstein, Elaine L. Hill, and Robert C. Whitaker, Pediatrics (subscription required), July 2008. This article uses data from the third School Nutrition Dietary Assessment study, conducted by Mathematica for the U.S. Department of Agriculture (USDA), to examine three areas of school food environments: policies and practices, availability of foods and beverages that are not a part of reimbursable USDA meals, and nutritional content of USDA school lunches in 395 schools in 38 states. Researchers found that the overall food environment becomes significantly less healthy as students progress from elementary to high school. High schools were more likely to have vending machines, school store or snack bars, fundraising activities involving sweet or salty snacks, and contracts with beverage companies. In addition, 93 percent of high schools and 92 percent of middle schools sold food and beverages a la carte, and nearly 80 percent of these secondary schools offered unhealthy a la carte options. Schools with a higher percentage of children from low-income families were significantly less likely to offer fruits or raw vegetables each day.
• "Tightening Income Documentation in a Means-Tested Program: Who Stays Away?" Philip Gleason, John Burghardt, Paul Strasberg, and Lara Hulsey, Evaluation Review (subscription required), June 2008. Programs using means tests to identify low-income households face a trade-off between promoting access and ensuring program integrity. In the case of the National School Lunch Program, the U.S. Department of Agriculture recently implemented a pilot program to improve the accuracy of the process of certifying students for free or reduced-price meals. This pilot program required households to provide income documentation with their applications for these benefits. This paper uses a comparison district design to estimate the effects of the up-front income documentation requirement on free/reduced-price certification among ineligible families as well as on access to the program among eligible low-income families. The key finding was that requiring income documentation did not reduce the proportion of ineligible households getting free or reduced-price meals, but it did reduce access to the program among eligible households.

Issue Briefs

• "Reaching Those in Need: State Supplemental Nutrition Assistance Program Participation Rates in 2007." Karen E. Cunnyngham and Laura A. Castner, November 2009. In the continuing debate about the effectiveness of nutrition programs for low-income people, policymakers and others concerned about hunger in America want to know whether people in different areas of the country who need SNAP benefits—formerly called food stamp benefits—are getting them. This brief notes wide variation across states in 2007—with participation rates ranging from 47 to 100 percent. About 66 percent of eligible people across the United States received SNAP benefits in that year. The brief also notes that 56 percent of eligible working poor—people who live in households in which someone earns income from a job but have income low enough to qualify for SNAP—participated in the program. Mathematica has produced these rates for the U.S. Department of Agriculture, Food and Nutrition Service, since the mid-1990s. The estimates were derived using shrinkage estimation methods drawing on data from the Current Population Survey, the American Community Survey, and administrative records
• "Who Picks Up the Tab? Reducing Payment Errors in School Nutrition Programs." Michael Ponza, Philip Gleason, Lara Hulsey, and Quinn Moore, Trends in Nutrition Policy Issue Brief #3, February 2009. Over the years, concern has mounted that many of the more than 26 million children certified to receive free or reduced-price meals may be ineligible for these benefits. This brief looks at the issue of reducing payment errors in the National School Lunch Program (NSLP) and the School Breakfast Program (SBP). Mathematica’s study, the first effort to quantify the amounts and rates of improper payments in these programs, looked at two types of certification errors: (1) household reporting errors, which occur when households misreport information on their applications; and (2) administrative errors, which occur when districts make mistakes in processing applications, determining eligibility, or recording certification status. For all students who applied for school meal benefits or were directly certified, about one in five were either incorrectly deemed eligible for the level of benefits they were approved for, or erroneously denied benefits. In addition, among those certified in error, overcertification was about twice as likely as undercertification. For both the NSLP and SBP, about nine percent of total meal reimbursements were erroneous because of certification error.
• "Reaching Those in Need: State Food Stamp Participation Rates in 2006." Karen E. Cunnyngham, Laura A. Castner, and Allen L. Schirm, November 2008. This policy brief includes state and regional breakdowns and comparisons of state Food Stamp Program participation rates. Sixty-seven percent of those eligible for the program, now called the Supplemental Nutrition Assistance Program (SNAP), received benefits in 2006, a two percentage point increase from 2005. The participation rate for the working poor—people who qualify for program benefits and live in households in which someone earns income from a job—was 57 percent. The findings show that Missouri, Maine, and Tennessee likely had higher participation rates for all eligible people than most states. In contrast, California likely had a lower rate than most states. Among regions, the Midwest region had the highest participation rate at 74 percent, and the Western region had the lowest at 58 percent.
• "I Am Moving, I Am Learning (IM/IL): Early Findings from the Implementation of an Obesity Prevention Enhancement in Head Start Region III." Daniel Finkelstein, Robert Whitaker, Elaine Hill, Mary Kay Fox, Linda Mendenko, and Kimberly Boller, December 2008. I Am Moving, I Am Learning is a Head Start program enhancement for integrating obesity prevention activities into daily practices. This research brief, based on Mathematica’s interim report, documents the findings from a survey of 53 Head Start programs that participated in training in Region III in spring of 2006. It describes early implementation of IM/IL, including successes, challenges, and sustainability.

Other

• “School Meals: Building Blocks for Healthy Children.” Mary Kay Fox, Institute of Medicine committee member, October 2009. The National School Lunch Program and School Breakfast Program play key roles in supporting the nutrition and health of schoolchildren in the United States by providing nutritionally balanced, low-cost or free meals every school day. This Institute of Medicine committee report provides the following recommendations to revise standards and requirements so that school meals are more healthful: increase the amount and variety of fruits, vegetables, and whole grains; set a minimum and maximum level of calories; and reduce saturated fat and sodium.
• An article by Mathematica’s obesity and nutrition researchers was selected by the Robert Wood Johnson Foundation as one of the top five articles in 2009 that the foundation believes had a major policy impact, affected its work and thinking, or warranted attention, given the foundation’s focus on advancing the research and knowledge base for childhood obesity prevention. The article, “Association Between School Food Environment and Practices and Body Mass Index of US Public School Children,” by Mary Kay Fox, Allison Hedley Dodd, Ander Wilson, and Philip Gleason, appeared in the February 2009 supplement to the Journal of the American Dietetic Association. The supplement featured findings from the School Nutrition Dietary Assessment-III study, which Mathematica conducted in 2005.
• "Interpretation and Use of Data from the National Nutrition Monitoring and Related Research Program." Ronette R. Briefel and Karil Bialostosky, in Research: Successful Approaches, 2008. The National Nutrition Monitoring and Related Research Program is composed of interconnected federal and state activities that provide information about the dietary and nutritional status of the U.S. population. This chapter provides an overview of the uses of nutrition-monitoring data, the program’s surveys and surveillance systems, research activities, and the resources available to registered dietitians and other nutrition professionals. It also provides information on uses and limitations of nutrition-monitoring data, tips for the proper interpretation of the data, and sources of further information.
• "Dietary Intakes of Infants and Toddlers: Problems Start Early." Barbara Devaney and Mary Kay Fox, in Eating Behaviors of the Young Child: Prenatal and Postnatal Influences on Healthy Eating, American Academy of Pediatrics, 2008. Mathematica’s Feeding Infants and Toddlers (FITS) study, sponsored by Gerber Products Company in 2002, provides a comprehensive picture of the food and nutrient intakes of American infants and toddlers and of the feeding practices used by children’s caregivers. This chapter summarizes key findings from the FITS analyses about infants’ and toddlers’ energy intake and food consumption patterns. The data show that, overall, the diets of infants and toddlers in the United States are nutritionally adequate. However, children are consuming too many calories. In addition, there are problems with the food choices some parents and caregivers are making for their children, such as introducing solid foods, cow’s milk, and juices too early. A main message from FITS is that pediatric health care professionals need to encourage parents and caregivers to think about the quality of the foods they are feeding their children, as well as when to introduce specific kinds of foods.