Research and Evaluation Publications
Peer Review Journal Articles
Preventing Chronic Disease
This study combined information on the interventions of the US Department of Agriculture’s Supplemental Nutrition Assistance Program–Education with 5,927 interview responses from the California Health Interview Survey to investigate associations between levels of intervention reach in low-income census tracts in California and self-reported physical activity and consumption of fruits and vegetables, fast food, and sugar-sweetened beverages.
Molitor, F., Sugerman, S., Yu, H., Biehl, M., Aydin, M., Levy, M., & Ponce, N. A. (2015). Reach of Supplemental Nutrition Assistance Program–Education (SNAP–Ed) Interventions and Nutrition and Physical Activity-Related Outcomes, California, 2011–2012. Preventing Chronic Disease, 12, E33.
Journal of Nutrition Education and Behavior
Objective: Evaluate the effectiveness of the Fruit, Vegetable, and Physical Activity Toolbox for Community Educators (Toolbox), an intervention originally designed for Spanish- and English-speaking audiences, in changing knowledge, attitudes, and behavior among low-income African American women.
Backman, D., Scruggs, V., Atiedu, A. A., Bowie, S., Bye, L., Dennis, A., Hall, M., Ossa, A., Wertlieb, S., & Foerster, S. B. (2011). Using a Toolbox of tailored educational lessons to improve fruit, vegetable, and physical activity behaviors among African American women in California. Journal of nutrition education and behavior, 43(4), S75-S85.
According to the California Dietary Practices Survey, nearly two-thirds of California adults report that it is difficult to get fruits and vegetables at work (California Department of Public Health, unpublished data, 2005). Common food sources for working adults in California are employee cafeterias, quick service or fast-food restaurants, sit-down restaurants, and catering trucks. Project Community Action on Food Environments has estimated that in 3 low-income communities in central and south Los Angeles, 11.2% of food access came from mobile food service trucks.
Objective: To examine the impact of fresh fruit availability at worksites on the fruit and vegetable consumption and related psychosocial determinants of low-wage employees.
From 2004-2008, capacity to conduct program evaluation was built among the Network for a Healthy California’s 48 largest local partners. Capacity building was done within a framework of Empowerment Evaluation and Utility-Focused evaluation. Tools included: a Scope of Work template, a handbook, a compendium of surveys, an evaluation plan and report template, data entry and analysis templates, teleconferences, workshops, and technical assistance. Over time, more programs completed an evaluation, used a more rigorous design, and reported statistically significant results. Acting as an evaluation guide, rather than a funder, Network staff built rapport with local programs that annually undertake new evaluations.
Fourney, A., Gregson, J., Sugerman, S., & Bellow, A. (2011). Building evaluation capacity in local programs for multisite nutrition education interventions. Journal of nutrition education and behavior, 43(4), S130-S136.
Objective: To develop a retail grocery instrument with weighted scoring to be used as an indicator of the food environment.
Ghirardelli, A., Quinn, V., & Sugerman, S. (2011). Reliability of a retail food store survey and development of an accompanying retail scoring system to communicate survey findings and identify vendors for healthful food and marketing initiatives. Journal of nutrition education and behavior, 43(4), S104-S112.
Objective: To determine whether fruit and vegetable consumption among California adults significantly increased from 1997-2007.
Sugerman SB, Foerster SB, Gregson J, Linares A, Hudes M. California Adults Increase Fruit and Vegetable Consumption From 1997-2007. J Nutr Educ Behav. 2011; 43:4, Supplement 2, S96-103.
Objective: To gain opinions from low-income, limited-English-speaking Hispanic and Asian immigrants for formative research in a social marketing campaign.
Sugerman SB, Backman D, Foerster SB, Ghirardelli A, Linares A, Fong. Using an Opinion Poll to Build an Obesity-Prevention Social Marketing Campaign for Low-Income Asian and Hispanic Immigrants: Report of Findings. J Nutr Educ Behav. 2011; 43:4, Supplement 2, S53-66.
Objective:Examine the effect of the California Children’s Power Play! Campaign’s School Idea & Resource Kits for fourth/fifth grades on the psychosocial determinants of fruit and vegetable (FV) intake and physical activity (PA).
Keihner, A.J., R. Meigs, S. Sugerman, D. Backman, T. Garbolino, and P. Mitchell. 2011. “The Power Play! Campaign’s School Idea & Resource Kits Improve the Determinants of Fruit and Vegetable Intake and Physical Activity among Fourth- and Fifth-Grade Children.” Journal of Nutrition, Education and Behavior 43:S122-S129.
American Journal of Public Health
The Supplemental Nutrition Assistance Program (SNAP) provides a vital buffer against hunger and poverty for 47.6 million Americans. Using 2013 California Dietary Practices Survey data, we assessed support for policies to strengthen the nutritional influence of SNAP. Among SNAP participants, support ranged from 74% to 93% for providing monetary incentives for fruits and vegetables, restricting purchases of sugary beverages, and providing more total benefits. Nonparticipants expressed similar levels of support. These approaches may alleviate the burden of diet-related disease in low-income populations.
Leung, C.W., Ryan-Ibarra, S., Amanda Linares, A., Induni, M., Sugerman, S., Long, M. W., Rimm, E. B., and Willett, W. C. Support for Policies to Improve the Nutritional Impact of the Supplemental Nutrition Assistance Program in California. American Journal of Public Health: August 2015, Vol. 105, No. 8, pp. 1576-1580.
Objectives: We examined conditions in California low-income neighborhoods that affect obesity to inform program planning, nutrition education, community participation, investment of resources, and involvement of stakeholders.
Ghirardelli, A., Quinn, V., & Foerster, S. B. (2010). Using geographic information systems and local food store data in California’s low-income neighborhoods to inform community initiatives and resources. American journal of public health, 100(11), 2156-2162.
Californian Journal of Health Promotion
This study explored the risk factors for higher BMI and overweight in 9- to 11-year-old children using the 2007 California Children’s Healthy Eating and Exercise Practices Survey. A total of 741 children completed a two-day food and activity diary. Of these, 299 children participated in the follow-up telephone interview, reporting attitudes and beliefs. Linear regressions identified risk factors related to BMI z-scores; logistic regressions were used for binomial overweight status. Independent variables included children’s diet, activity, screen time, food modeling, family norms/rules, home environment, poverty, and parent education, adjusting for race/ethnicity. Parent education was the strongest risk factor with a clear gradient towards reduced risk as parent education improved. Children were .3 BMI z points lower and one-third less likely to be overweight as education level rose. Each serving of fried vegetables consumed was related to .3 point increase in BMI z. Children were 1.2-1.3 times more likely to be overweight with each increase in school lunch participation. Low-cost overweight prevention efforts targeting children with less parent education, school lunches, and consumption of fried vegetables may reduce BMI and help prevent childhood overweight. Additional investigation should determine the underlying factors contributing to the relationship between eating school lunch and overweight.
Keihner, A. J., Mitchell, P. R., Kitzmann, C., Sugerman, S., & Foerster, S. B. (2009). Psychosocial, socioeconomic, behavioral, and environmental risk factors for BMI and overweight among 9-to 11-year-old children. Californian Journal of Health Promotion, 7(Special Issue), 99-118.
Diets high in fruits and vegetables and participation in regular physical activity are associated with a lower risk for several chronic diseases and conditions. The present study analyzed the combined prevalence of these two activities by race/ethnicity and gender among adults in California and among adults in California at or below 130% of the federal poverty level (FPL), using self-reported data from the 2005 and 2006 California Behavioral Risk Factor Surveillance System (BRFSS).
Findings for California were similar to findings for the nation, showing gender and racial/ethnic differences for each of these variables, singly and in combination. Also, low-income men had a significantly lower prevalence of goal-level fruit and vegetable consumption than did low-income women.
Although some demographic disparities are evident among Californians, the prevalence of achievement of two key healthy lifestyle behaviors concurrently remains quite low. These results emphasize the need for promoting diets high in fruits and vegetables and regular physical activity among all Californians.,
Epstein, J. F., Sugerman, S. B., Mitchell, P., & Induni, M. (2008). Prevalence of Fruit and Vegetable Consumption and Physical Activity by Gender and Race/Ethnicity-California, 2005-2006. Californian Journal of Health Promotion. 2008. 6(2): 61-72
Journal of Family and Community Health
Fruit and vegetable consumption among California’s fourth and fifth graders appears to be lower than in adults, and there is little literature reporting large-scale interventions that increase consumption. A oneyear evaluation funded by the National Cancer Institute (NCI) and the Centers for Disease Control and Prevention (CDC) was conducted with 3,966 students in 49 schools located in three geographically distant school communities. One community conducted intervention activities in the schools (T1), one conducted activities in school and community channels (T2), and the third served as a control. Behavioral and attitudinal changes were based on one-day food diaries administered preintervention and postintervention. Consumption rose in T1 and T2% and 14%, respectively, while dropping 12% in the control group (p<.05, control different from T1 and T2. While behavioral changes can occur in the school environment, even larger changes can be made when the school interventions are accompanied by community-wide involvement. (C) Williams & Wilkins 1998. All Rights Reserved
Foerster SB, Gregson J, Beall DL, Hudes M, Magnusen H, Livingston SA, Davis MA, Joy AB, Garbolino T. The California Children’s 5 a Day-Power Play! Campaign: Evaluation of a Large-Scale Social Marketing Initiative. Journal of Family and Community Health, 1998. 21(1): 46-64.
Combined and California Dietary Practices Survey
In California, approximately half of children, teens, and adults drink at least one serving of sugar-sweetened beverages (SSB) daily. This brief highlights the associations between SSB intake and demographic and socioeconomic factors; consumption of healthy and less healthy foods; health behaviors; psychosocial factors; and the home, work, and school environments. The California Department of Public Health’s Network for a Healthy California, in partnership with the Public Health Institute and other organizations and in conjunction with the California Obesity Prevention Plan, supports the prioritization of public health efforts that aim to promote good nutrition, physically active lifestyles, and a healthy weight among low-income California families.
Keihner, A., Linares, A., Rider, C., Sugerman, S., Mitchell, P., Hudes, M. (2012). Education, Diet, and Environmental Factors Influence Sugar-Sweetened Beverage Consumption Among California Children, Teens, and Adults. Sacramento, CA: California Department of Public Health.
The Network for a Healthy California is a large-scale nutrition education, social marketing, and obesity prevention program of the California Department of Public Health, providing nutrition education to CalFresh participants and other low-income Californians. With fruit and vegetable intake being a clear indicator of eating healthy foods, having adequate access to quality and affordable fruits and vegetables is a key component of increasing consumption in low-income communities. This brief presents differences in fruit and vegetable intake among low-income children, teens, and adults from households receiving CalFresh based on their access to fruits and vegetables where they live, work, learn, and play. Effective strategies to improve access to fresh, healthy foods in these areas may improve the health of low-income Californians.
Keihner, A., Sugerman, S,. Linares, A., Rider, C., Egelski, E., Mitchell, P., Hudes, M., and Biehl, M. (2013). Low-Income Californians with Access to Produce in Their Home, School, Work, and Community Environments Eat More Fruits and Vegetables. Sacramento, CA: California Department of Public Health.
The California Dietary Practices Survey (CDPS) is one of three surveys implemented by the California Department of Public Health Nutrition Education and Obesity Prevention Branch. Conducted biennially, it surveys Californian adults aged 18 years and older. Seven key findings from the 2011 survey are summarized in this document.
Egelski, E., Linares, A. (2013). Key Comparisons from the 2011 California Dietary Practices Survey: Opportunities for Improvement in the Health Behaviors of Low-Income Californians. Sacramento, CA: California Department of Public Health.
Physical activity is an important component of a healthy lifestyle, yet most teens fall short of recommended levels. This brief report presents research identifying community and school opportunities that predict how much physical activity California adolescents get. It also identifies differences in predictors for teen boys and girls that may help explain the marked gender disparities that currently exist in teen physical activity. Effective strategies to improve access to opportunities for teens to be physically active may help Californian teens meet physical activity guidelines and improve their overall health.
Rider, C., Biehl. M., Yuan. H. (2014). California Adolescents Are More Physically Active When They Have Greater Opportunities for Physical Activity in Their School and Community. Sacramento, CA: California Department of Public Health.
The California Department of Public Health Nutrition Education and Obesity Prevention Branch randomly-selected teens (age 12-17) across California by phone every two years through the California Teen Eating, Exercise and Nutrition Survey (CalTEENS). These key facts from the 2010 CalTEENS highlight barriers faced by California’s teens to achieving a healthy lifestyle as well as promising opportunities for intervention.
Rider, C., Perez, E. (2013). Key Facts about California Teens, 2010: Creating Change With Youth Voice. Sacramento, CA: California Department of Public Health.
The Nutrition Education and Obesity Prevention Branch (NEOPB) strives to create innovative partnerships that empower low-income Californians with the goal of preventing obesity and related chronic diseases through increased consumption of healthy foods, decreased consumption of less healthy foods, increased opportunities for physical activity, and support for food security.
Keihner, A., Mitchell, P., Rossi, M., Sugerman, S., Molitor, F., Perez, E., Rylett, I., and Garcia, K. (2014). Supporting a Healthy Lifestyle Among Low-Income Children: Key Findings from the 2011 California Children’ Healthy Eating and Exercise Practices Survey. Sacramento, CA: California Department of Public Health.
The Network for a Healthy California (Network) surveys 9- to 11-year-old children using the California Children’s Healthy Eating and Exercise Practices Survey (CalCHEEPS) every two years.1 These key facts from the 2009 CalCHEEPS show that children from low-income families face greater barriers to achieving a healthy lifestyle. In California, the majority of children (56%) are enrolled in free or reduced price school meals due to their families’ low-income.2
Data Sources 1 California Department of Public Health, Network for a Healthy California, 1999-2009 California Children’s Healthy Eating and Exercise Practices Survey (CalCHEEPS). Background and Documentation: 2009 CalCHEEPS. www.cdph.ca.gov/programs/cpns/Documents/REUCalCHEEPSBackground_and_Documentation2009.pdf. Accessed April 7, 2011.
2 California Department of Education. DataQuest: 2009-2010 Free or Reduced Price Meals Data. http://data1.cde.ca.gov/dataquest/. Accessed April 7, 2011.
Keihner, A., Mitchell, P., Linares, A., and Sugerman, S. (2011). Low-Income Children Face Healthy Lifestyle Barriers: Top Facts from California, 2009. Sacramento, CA: California Department of Public Health.