Lucia Kaiser is a University of California Cooperative Extension (UCCE) specialist in the Department of Nutrition at UC Davis. She has developed nutrition education materials for use in the Expanded Food and Nutrition Education Program (EFNEP), the Supplemental Nutrition Assistance Program – Nutrition Education and other community programs. Her research interests include the impacts of acculturation; food insecurity on child feeding practices and growth in low-income audiences, particularly Latinos; development of tools to evaluate the impact of nutrition education on obesity; and diabetes risk prevention.
Dorina Espinoza is a University of California Cooperative Extension (UCCE) advisor working in the areas of youth, family and community. She manages the 4-H Youth Development and Expanded Food and Nutrition Education Programs in Humboldt, Del Norte, Lake and Mendocino counties. Espinoza has professional and personal interest in healthy lifestyles, healthy communities and healthy policies. She is passionate about working with people to create communities that make the healthy choice the easy choice and to help decision-makers support policies that ensure health for today and tomorrow.
Kaiser is part of a larger UC team that’s recently completed a research project on a program called “Plan, Shop, Save & Cook.” The research findings have implications for identifying strategies that tackle food insecurity. Espinoza has participated in subsequent research.
A note about terms: The Supplemental Nutrition Assistance Program (SNAP) was formerly called “food stamps.” It is a federally funded nutrition assistance program administered at the national level by the U.S. Department of Agriculture through its Food and Nutrition Service (USDA FNS). The USDA FNS works with state partners and the retail community to improve program administration and ensure program integrity. SNAP Ed is the nutrition education program for SNAP recipients. In California, SNAP Ed is administered by the University of California, which has branded it UC CalFresh. The Expanded Food and Nutrition Education Program (EFNEP) is also a federally funded program through the USDA’s National Institute of Food and Agriculture (USDA NIFA); it offers nutrition education to limited-resource families and children in all 50 states and U.S. territories.
We’ve provided a link to the “Plan, Shop, Save & Cook” resources, which are available at no charge in both Spanish and English.
Q: Can you tell our readers a bit about your most current research project, “Plan, Shop, Save & Cook”?
Kaiser: “Plan, Shop, Save & Cook” is a nutrition education program teaching smart shopping, menu planning and healthy cooking to low-income adults who are either enrolled in – or eligible for – the Supplemental Nutrition Assistance Program (SNAP). That means that these individuals are below 130 percent of the federal poverty level. The program consists of four lessons delivered in community settings by UC Cooperative Extension staff, specifically through UC’s CalFresh program. The Expanded Food and Nutrition Education Program (EFNEP) also delivers similar kinds of information through their program.
We started in 2008 when the recession was reaching a peak. Our UCCE nutrition advisors – who work in California counties – were very concerned about what was happening and what they were seeing in communities. During that time food insecurity significantly increased … nationwide many families who previously had no problems began to experience issues. Nationally, the food insecurity rate jumped from about 11 percent before 2007 to 14.6 percent households being food insecure. [The USDA Economic Research Service provides statistics]. Our response was to try to enable families to know how to make the best choices with what they had and to keep within a limited budget.
After we polished the curriculum, trained the staff and began delivering the program in 15 California counties, we realized we had nearly 4,000 people who had completed pre- and post-tests. There was a massive amount of data … so we could look to see changes and improvements. We saw significant improvements in reading labels and many other kinds of food shopping behaviors.
We really wanted to find out who was making the biggest changes and what kind of impact did that have on food security. Could this sort of education help reduce food insecurity?
Q: Your research concluded that food assistance combined with nutrition and resource management education reduces food insecurity in low-income families. What implications might that have for public policy? For practice?
Espinoza: For public policy at the national level, suggestions have been made about the SNAP. For example, financially incentivizing the purchase of healthy foods, such as fruits and vegetables, at a dollar value greater than 1:1 … this helps SNAP participants manage their food purchasing resources while improving their access to healthy foods. In addition, the SNAP program could adopt food-stocking standards, similar to policies within the WIC (Women, Infants, and Children) program, to be followed by SNAP retailers.
In unison, these strategies for the retailer and the consumer could help expand access to healthy foods, help make healthy food choices the easy choice, help reduce the purchasing of nutritionally poor foods and support the retailer by helping to move perishable items through the market.
Kaiser: A lot of effort in the public health arena has been about changing the environment … making it easier to make healthier choices. While those efforts are very important, it may still not be enough to help low-income people choose a healthier diet when faced with limited resources. What we’re seeing there is that this nutrition education builds skills and motivation to get the kinds of outcomes that will reduce food insecurity and promote a healthy diet. What Dorina has just described is an extremely important factor – creating incentives, as well as increasing purchasing power and improving neighborhood access.
Some of the stressors that these families face are the sorts that drive people to make decisions in the moment, and respond to the store’s marketing environment. Incentives could be very important in this whole mix to help people make these healthier choices. Incentives may encourage healthier choices. These are families that suffer stress, often fears about neighborhood safety, depression about food insecurity and other types of stressors. Research shows that stress can drive people to choose less healthy foods (like foods that are high in added sugar), so we need to see if incentives and nutrition education can help override that negative response to stress
Espinoza: Also, nutrition education and the breakfast, lunch or dinner programs in public schools fit into the systemic wave of change to support making healthy foods an easier choice. Youth are exposed to healthy and potentially new foods at school, whether in an education or meal setting, and can make suggestions for a family meal with foods they’ve tasted or prepared in school. There’s potential to create a whole environment of making healthy foods an easy choice at the individual, family and school level, driven by the market, the setting and youth.
Kaiser: This idea of a systemic environment also contributes to the sustainability of these programs overall. When they’re delivered through the school system, you can reach so many people in the future generation.
Q: Your research also indicated that receiving the supplemental food benefits is “a critical factor in addressing food insecurity,” and that helping eligible people get enrolled and receive food assistance is important. Seniors in particular seem to be underenrolled in SNAP (the USDA just reported that only 42 percent of eligible elderly were participating in the program). What strategies might help states improve program participation?
Kaiser: A few years ago I did some research with the California Women’s Health Survey to try to answer the question of why low-income people don’t access SNAP. California’s enrollment of eligible individuals was very low at the time and we were concerned.
One of the survey questions enabled respondents to provide reasons why they didn’t access food assistance in the SNAP program. Among older women, one of the major reasons was lack of information … they didn’t know they were eligible. It wasn’t stigma … it was a lack of information. There were other groups that indicated that stigma discouraged them from enrolling. Others were worried about citizenship, or felt they didn’t need the assistance. Those who said they didn’t need the benefit did report that they were more food secure on other questions in survey.
I think with the older women the lack of information was more of a reason. That led me to believe at the time that older women are also facing more nutrition-related health problems by that time, such as diabetes, hypertension, etc. What may be needed to improve enrollment among eligible people in that age group is a stronger nutrition spin … “get these foods and they may really help your health.” A marketing piece may be needed to let older people know they are eligible and could buy the nutritious foods they need to manage their health, including diabetes. National nutrition studies have reported that greater food insecurity is associated with poorer control of diabetes. It’s an issue.
Espinoza: At the county-level there are some interesting strategies being used to increase enrollment among SNAP-eligible individuals. A particularly effective campaign of the Humboldt County food bank – Food for People – is “Bring a Million to Humboldt.” The campaign framed enrollment in CalFresh [federally known as SNAP] as an appeal to eligible community members, to help bring dollars into the county through the CalFresh program.
The county was losing about a million dollars a month available to eligible households. That’s significant, because those funds ripple through the local economy at a rate of $1.79 for every CalFresh dollar spent. Food for People’s approach completely reframed the stigma around enrollment by asking the community to help bring funds into the county. CalFresh enrollment has increased by a tremendous amount … 64 percent since 2009, jumping from 11,000 to 18,000 participants locally, in part due to the 2007-2009 recession and in part due to the campaign.
Another successful CalFresh strategy in Humboldt County, and practiced in other communities, is the farmers market “Market Match” program. At the farmers market, anyone with an EBT card can receive wooden tokens at a value greater than 1:1 to spend at the farmers market. For example, a CalFresh participant could get a $5 bonus of farmers market tokens when they spend $10 at the market. The Market Match program is funded through local grants.
Kaiser: That’s an outcome we often are missing when we think about these programs. We think about improving food security and the quality of diet. What it does for the community and economy is also a reason we want to support the food assistance programs.
Q: Your work is really on the front line, so to speak. What are the greatest challenges you see in the 31 California counties you’re working in?
Espinoza: Humboldt and Del Norte counties have not quite pulled out of the recession. Numbers of individuals eligible for participation in CalFresh and our EFNEP [Expanded Food and Nutrition Education Program] is high. One challenge within the county is meeting community members caloric and nutritional needs, among other basic needs that go unmet in our community because of the economic downturn.
Kaiser: Food insecurity as reported by the federal government really jumped in the recession. Humboldt is not unlike other communities … there are many, many communities that haven’t fully recovered from the recession. We’re still seeing lots of households that are having a great difficulty accessing affordable foods that are of an acceptable quality. Some of the available foods through the charitable emergency food system [food pantries] are those people are not familiar with and don’t know how to use. Teaching people how to use those foods will make it easier. Also, since pantries and food assistance programs (including WIC) are now distributing more fresh produce, many people also need information on how to store and prepare these items.
What the drought means for some families is more separation … people having to move out of communities for jobs, families breaking up. There are lots of acute issues in communities. Securing an adequate supply of acceptable healthy foods, stress, time and distance issues for families are complex … it requires many things to come together to make this all work.
Espinoza: Lucia recently used the phrase “The strength of the family system is getting disrupted.” That resonated with me. We’re seeing that the long-term impact of the recession shakes the foundation of families and communities.
Kaiser: I’m very concerned about that, and I think we should be. If there’s any chance for children to grow up and be successful, having strong family ties is important. Economic situations that drive families apart impact children. It impacts their school attendance. The long-term consequences of some of these changes are concerning. It certainly takes a lot of effort to try to go in and provide emergency foods. But food is only one of the issues families face … they need medicine, they need clothing, they need other things as well. Drought is hitting many families very hard in our agricultural state.
Q: As a researcher, you may exert a profound influence in “food politics.” The SNAP program is under fire by some politicians. Can you talk a little about the dynamics of these situations? Ultimately, what do you think might happen?
Kaiser: I recently had a conversation with one of the directors of our nutrition program about funding challenges. We’re beginning to demonstrate that we can get good nutrition outcomes from these programs. We’re beginning to feel that the SNAP and nutrition education programs can work together to get better outcomes. The national dialogue is worrisome in some ways, because it could drive away the needy.
We’re all working as hard as we can to demonstrate the results. A 2015 national study on SNAP with data from 6,500 SNAP recipients collected baseline information and re-assessed six months later. This enabled the research team to make some comparisons. The national study has documented that the SNAP program has a very strong effect in decreasing food insecurity … by 12-19 percent in the people who are experiencing very low food security. We know the programs are making a difference. We have more work to do to make sure people make the healthiest choices. But these programs are very important in alleviating hunger.
Q: What’s your take on the current national food and nutrition policies? What policies do you feel would help promote health and sustainability?
Kaiser: We’ve been through some different thinking on policies. There has been a great deal of emphasis on changing the built environment as something that would sustain behavior change and promote health. Now there’s more thinking about incentivizing purchasing healthy food, which Dorina talked about earlier.
It may be we move on to tying that more to education pieces using the Web to greater advantage. Right now, some of the lowest literacy populations are not tapping into that area of education that much. Here’s one example of how policy makes a difference. WIC changed their food packages in 2009, adding a fruit and vegetable voucher. It was an important and effective move … some research indicates it has increased the availability of fruits and vegetables in local stores … not just those operated by WIC vendors.
That’s a tremendous impact of a policy starting with a food assistance program, and how that may change food availability at the local level. I’m excited to see some of these positive outcomes.
Espinoza: School food programs have the potential to make healthy food choices a sustainable lifestyle. The school setting is a favorable place to expose children to healthy foods and there is a secondary impact from the child to the family in promoting healthy foods. Whether through nutrition education programs such as EFNEP, farm-to-school programs such as Harvest of the Month or school meal programs, all forms of support for healthy foods in the school can have a tremendously positive impact on what children eat in and out of school
Kaiser: I was at a nutrition conference last month where the discussion in the changes of the school lunch program was a topic of one of the sessions. There’s a perception in the media that children aren’t finding these changes acceptable. But that’s not a picture showing up in research. In fact, changes are working in the school. There may be a disconnect between what the public perception is and what some of the evaluations are showing. We must always evaluate the impact of policy on behavior … it’s very complex. The research is really needed here to evaluate the policies to see how well they’re working and to enable us to tweak them as we go along.
Q: What would you tell young people entering your profession?
Espinoza: There is great potential to impact the lives of individuals; the communities in which we live, work and play; and policy at the local, state and national level. That range of impact is motivating, rewarding and inspiring … the potential to engage at multiple levels is wonderful. It’s a great fit for people looking to impact lives, communities and policies.
Kaiser: I remember when I was doing my dietetics internship. I looked at my mentor and thought she had an interesting job. She told me it was up to me to make my job … to make it as interesting and fulfilling as it can be. “The potential is there,” she said, “but it’s your responsibility to seek that out and make it happen.” You have to be actively engaged in continual learning and be aware of the opportunities that are going to enhance and go after it actively.
Q: I’m giving you a super power. You can change one thing about the food system with that super power. What change would you make?
Kaiser: It’s bigger than the food system. It’s about how our economic system works in the United States. We have a fairly consumer-driven food system, meaning the greater consumption of foods is the goal. There are many food choices for people. The only way that companies can survive in the market is to get people to consume more and more. And even with healthy foods, consuming more and more can still add up to too many calories. We’ve moved from a society where more people sat down for meals and snacking was limited — eating while walking down the street was even considered “rude” — to a culture of constantly feeling we need to have food around all the time.
This cultural shift is yielding some real challenges. I wouldn’t take us back 50 years to the way things were, but I do wish we could have more of a culture of regular meals and not this need to be constantly eating all the time. Today, we now feel it’s the norm to be grazing and that we don’t have the time to sit down and eat a regular meal. Food advertising continues to promote that all the time.
It’s very competitive for the food industry. But again, we’ve moved from a society that had a cultural norm around regular meals and you were hungry when it was time for dinner.
