How policy implementation shapes the impact of U.S. food assistance policies: the case study of the Child and Adult Care Food Program

Much of the chronic disease burden in the U.S. population can be traced to poor diet. There has been a sustained focus on influencing children's diets and encouraging healthier eating habits by changing policies for what foods and beverages can be served to children through large federally-funded nutrition assistance programs. Yet without attention to how nutrition policies are implemented, and the surrounding context for these policies, these policy changes may not have the intended results. In this perspective, we used Bullock et al.'s (2021) Process Model of Implementation from a Policy Perspective to analyze how the complexities of the implementation process of large-scale nutrition policies can dilute potential health outcomes. We examine the Child and Adult Care Food Program (CACFP), a federal program focused on supporting the provision of nutritious meals to over 4 million children attending childcare, as a case study. We examine how the larger societal contexts of food insecurity, attitudes towards the social safety net, and a fragmented childcare system interact with CACFP. We review the “policy package” of CACFP itself, in terms of its regulatory requirements, and the various federal, state, and local implementation agencies that shape CACFP's on-the-ground implementation. We then review the evidence for how each component of the CACFP policy implementation process impacts uptake, costs, feasibility, equity, and effectiveness at improving children's nutrition. Our case study demonstrates how public health researchers and practitioners must consider the complexities of policy implementation processes to ensure effective implementation of nutrition policies intended to improve population health

Association of the Healthy, Hunger-Free Kids Act With Dietary Quality Among Children in the US National School Lunch Program

Thesis (Master's)--University of Washington, 2020Importance: The Healthy, Hunger-Free Kids Act of 2010, implemented nationwide in 2012, was intended to improve the nutritional quality of meals served in the National School Lunch Program (NSLP). Objective: To assess whether there was an association between the Healthy, Hunger-Free Kids Act of 2010 and dietary quality of lunch for students participating in the NSLP, stratified by income. Design, Setting, Participants: Serial cross-sectional study design, using National Health and Nutrition Examination Survey (NHANES) data 2007-2008, 2009-2010, 2013-2014, and 2015-2016, of students surveyed in NHANES and attending schools participating in the NSLP. Individuals who were aged 5 to 18 years, in kindergarten through 12th grade, enrolled in a school that served school lunch, and had a reliable weekday dietary recall were included. Exposure: The Healthy, Hunger-Free Kids Act of 2010 (pre-policy period: 2007-2010; post-policy period: 2013-2016), with participation in the NSLP estimated based on an algorithm. Main Outcome and Measure: The primary outcome was dietary quality of intake for lunch, measured by Healthy Eating Index-2010 (HEI-2010) score (range 0-100; 0 indicates a diet with no adherence to the 2010 Dietary Guidelines for Americans and 100 indicates a diet with complete adherence to the guidelines). Results: Among 6389 students included in the surveys (mean age, 11.7 [95%CI, 11.6-11.9] years; 3145 [50%] female students; 1880 [56%] were non-Hispanic white), 32%were low-income, 12% were low-middle–income, and 56% were middle-high–income students.A total of 2472 (39%) were participants in the NSLP. Among low-income students, the adjusted mean prepolicy HEI-2010 score was 42.7 and the postpolicy score was 54.6 among NSLP participants and the adjusted mean prepolicy score was 34.8 and postpolicy score was 34.1 among NSLP nonparticipants (difference in differences, 12.6 [95%CI, 8.9-16.3]). Among low-middle–income students, the adjusted mean prepolicy HEI-2010 score was 40.4 and postpolicy score was 54.8 among NSLP participants and the adjusted mean prepolicy score was 34.2 and postpolicy score was 36.1 among NSLP nonparticipants (difference in differences, 12.4 [95%CI, 4.9-19.9]). Among middle-high–income students, the adjusted mean HEI-2010 prepolicy score was 42.7 and postpolicy score 55.5 for NSLP participants and the adjusted mean prepolicy score was 38.9 and prepolicy score was 43.6 for NSLP nonparticipants (difference in differences, 8.1 [95%CI, 4.2-12.0]). Conclusions and Relevance: In a serial cross-sectional study of students, the Healthy, Hunger-Free Kids Act of 2010 was associated with better changes in dietary quality for lunch among presumed low income, low-middle income, and middle-high income participants in the National School Lunch Program compared with non-participants

De-implementing public health policies: a qualitative study of the process of implementing and then removing body mass index (BMI) report cards in Massachusetts public schools

Abstract Background This study explored reasons for the adoption of a policy to distribute report cards to parents about children’s weight status (“BMI report cards”) in Massachusetts (MA) public schools in 2009 and the contextual factors influencing the policy removal in 2013. Methods We conducted semi-structured, qualitative interviews with 15 key decision-makers and practitioners involved with implementing and de-implementing the MA BMI report card policy. We analyzed interview data using a thematic analytic approach guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Results Primary themes were that (1) factors other than scientific evidence mattered more for policy adoption, (2) societal pressure spurred policy adoption, (3) problems with the policy design contributed to inconsistent implementation and dissatisfaction, and (4) media coverage, societal pressure, and organizational politics and pressure largely prompted de-implementation. Conclusions Numerous factors contributed to the de-implementation of the policy. An orderly process for the de-implementation of a policy in public health practice that manages drivers of de-implementation may not yet exist. Public health research should further focus on how to de-implement policy interventions when evidence is lacking or there is potential for harm

Cultured proteins: An analysis of the policy and regulatory environment in selected geographies

The global burden of malnutrition is unacceptably high. Animal-source foods are important components of diverse diets and provide high-quality proteins and other essential nutrients that promote optimal growth and development. The global demand for animal-source foods is projected to increase substantially, particularly in many low- and lower-middle income countries (LMICs). However, cost is a significant barrier to access and meeting this growing demand through livestock production will be highly resource intensive. As such, sustainable, high-quality alternatives to protein from livestock have the potential for significant transformative impact for both people and the planet. Through a process known as fermentation-based cellular agriculture, animal proteins found in milk and eggs can be produced without animals. According to this method, a gene encoded with an animal protein is introduced into a starter culture of microflora (e.g., fungi or yeast). This culture is grown in controlled fermentation tanks, where it expresses the desired protein. Finally, the protein is separated from the microflora, generally producing a purified protein powder. These resulting “cultured” proteins are designed to be identical to the corresponding animal-source proteins produced through traditional livestock farming and can be used as ingredients in existing or new food products. Although there are many potential sustainability and nutritionrelated benefits of these nnovations, they also face several challenges to commercialization and market uptake