Wisconsin Farm to School EvaluationWisconsin Farm to School Summit27 June 2013Andrea Bontrager Yoder, Dale Schoeller

Outline

• Context: Why transform?– Back to our roots

• Wisconsin Farm to School Evaluation– 2010-2011 Communities Putting Prevention to Work

– 2013-2014 Transform Wisconsin

• What else can we learn?

http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm

Background: Energy Balance

Physical ActivityThermic Effect of Foods

Basal Energy ExpenditureGrowth

FoodCaloric beverages

Energy Balance

• Is it really that simple?

• Yes – it’s simple physics. Energy cannot be created nor destroyed.

• No – biological systems are regulated. There are feedback systems

Background:Why Farm to School?

• Fruits and Vegetables for Health!• Protective against chronic disease• Believed to be protective against overweight

– displace energy-dense, nutrient-poor foods

CDC strategies to increase FV consumption

• Objective data?– 2004 review linking dietary energy density to body

weight (Drewnowski et al, Nutrition Reviews)• Inconsistent, cross-sectional data• no longitudinal data

Early Farm to School

• Early 1900’s Wisconsin “Pint Jar Program”– Bring a pint Mason jar from home– Soup, macaroni, leftovers– Heat in water bath on stove or room heater– Serve piping hot at noon

• 2013– No more pot bellied stoves in classroom– Really! Bring a glass jar?

Déjà vu all over again Yogi Berra

Some Google Hits

Wisconsin AmeriCorpsFarm to School Evaluation

Context

• ARRA grant to promote public health initiatives in communities

• Centers for Disease Control – required program evaluation: “What works?”– Community Guide,

http://www.thecommunityguide.org/index.html

Context

• Document activity• Assessed student outcomes relative to time

(years) in F2S programming– Knowledge & Attitudes Survey (KA)– Block Kids Food Frequency Questionnaire (FFQ)– Lunch Tray Photo Observation (LTPO)

• Qualitative assessment of perceived barriers, strengths – School Food Service directors; Farmers

Context

• 9 schools• 3rd, 4th, 5th grades• 2010-2011 school year

Farm to School Related Activity # SchoolsClassroom lessons 8/9Local items on school lunch menu 8/9

School garden 7/9Information sent home to parents 7/9Farmers selling to district 7/9Classroom tastings 7/9

Cafeteria tastings 6/9Local items on school breakfast menu 6/9

Other 4/9

Classroom F/V snacks 3/9Field trips to farms 3/9

Local items on after-school snack menu 2/9Local foods fundraiser 2/9Farmers visiting student classrooms 1/9

1Activity reports from 1 of these 2 schools were missing for 3 of 10 months.

 Prior F2S, years

0 1 2+Number of schools 2 21 5Classroom lessons 2/2 1/2 5/5Local items on school lunch menu 2/2 2/2 4/5School garden 1/2 2/2 4/5Information sent home to parents 2/2 1/2 4/5Farmers selling to district 1/2 2/2 4/5Classroom tastings 2/2 1/2 4/5Cafeteria tastings 2/2 1/2 3/5Local items on school breakfast menu 2/2 1/2 3/5Other 0/2 1/2 4/5Classroom F/V snacks 1/2 1/2 1/5Field trips to farms 2/2 0/2 1/5Local items on after-school snack menu 0/2 0/2 2/5Local foods fundraiser 0/2 0/2 2/5Farmers visiting student classrooms 0/2 0/2 1/5

KA Survey

• Positive effects on indicators of students’:– Knowledge – Attitudes toward eating fruits & vegetables– Willingness to try fruits & vegetables

0 1 ≥20

3

6

9

12

15

Knowledge

Fall 2010 May 2011

Sco

re (

ran

ge

0-15

)

0 1 ≥220

30

40

50

60

70

80Attitudes

Prior years of F2S programming

Sco

re (

ran

ge

20-8

0)

0 1 ≥202468

101214161820

Willingness

Sco

re (

ran

ge

0-20

)

Block Kids FFQ• No baseline differences or across the year• Students with lowest reported baseline fruit intake significantly ↑• ↓ percent of students reporting very low fruit and vegetable intake

Ver

y Lo

w

Low

Ade

quat

e

Ver

y Lo

w

Low

Ade

quat

e

Fruit Vegetables

0.0

0.5

1.0

1.5

2.0

2.5

Average Reported Intake of Fruits and Vegetables

Fall 2010 May 2011

cu

ps/

1000

kca

l

Very

Low

Low

Adequ

ate

Very

Low

Low

Adequ

ate

010203040506070

Percent of Students with Varying Levels of Intake

Per

cen

t o

f S

tud

ents

Fruit Vegetable

LTPO

LTPO

• ↓ in percent of trays with no FV items• ↓ in percent of trays with no FV consumed

0 1 ≥20

10

20

30

40

50

No fruit/vegetable disap-pearance

0 1 ≥20

10

20

30

40

50

No fruit/vegetable items

Fall 2010 May 2011

% o

f T

rays

Prior years of F2S programming

Qualitative: Key Stakeholder Interviews

• 8 sites– 6 school food service directors (SFS)– Farmers from four different sites

• Feasibility of F2S– SFS: supply-related barriers– Farmers: supply/demand-balance related

barriers

Qualitative: F2S Sustainability

• SFS directors (continuing sites) reported positive interactions with the widest variety of stakeholder groups where the most F2S activities were taking place

• Those interviewed appeared to be psychologically engaged in F2S motivated action sustainability

Qualitative:Business or Personal Success?

• SFS:– Program expansions – what will benefit the school?

(e.g., salad bar, school garden)– Personal job satisfaction – student enjoyment

• Farmers:– Pro-social overall slant: student interaction/positive

student outcomes– Anticipated future economic benefit (2 farmers)

Summary of Findings

• F2S programming…– Improves indicators of:

• Knowledge of nutrition and agriculture concepts• Attitudes toward eating, trying fruits and vegetables

– Increased exposure to fruits and vegetables– More favorably affects students with poor initial

dietary behaviors– Feasible, but time needed to establish program and

overcome barriers– Psychological involvement of key stakeholders may

augment outcomes for students and overall program

Transform WisconsinFarm to School Evaluation

Transform WI

• In the context of new and continuing F2S sites and their specific activities:– Assess student health, behaviors, and

attitudes– Assessed perceived challenges, strengths,

and opportunities

Future Analysis

• Ongoing comparison of longitudinal exposure to F2S programming– Combined TWi and ARRA data

• Differences on student outcomes according to types of activities

Acknowledgements

• Partnering organizations– WI Dep’t of Health Services– WI Dep’t of Agriculture,

Trade, and Consumer Protection – AmeriCorps Farm to School

– UW-Madison (Nutritional Sciences, Family Medicine, WI Clearinghouse for Prevention)

• Community partners, past and present

Many unanswered questions•School Meals:

–Caloric intakes, before vs with F2S–Change in amount of fresh FV served and consumed–How much is F2S: amount, product, calories, frequency served?

•Programming:–School garden– how much PA? what level? (frequency, duration, intensity)–Frequency and intensity of engagement activities

•Economic impact:–NSLP Participation rates–Willingness to Pay–Local purchasing data–Cost of programming activities

•Long-term:–Program start time - high school vs middle vs elementary?–How long to get the full effect (i.e., carry-over into adulthood)?–Potential to link FV factors against chronic health problems

FV Waste ~ Preparation

Baked

(N=1

2)

Canne

d (

N= 30

4)

Cooke

d (N

=274

)

Puree

d (N

=708

)

Raw (N

=163

9)

Steam

ed (N

=265

)0.00

0.05

0.10

0.15

0.20

0.25

Preparation Method

Mea

n C

up

s W

aste

Vegetables

Baked

(N=2

3)

Canne

d (N

=138

4)

Dried

(N=2

)

Fresh

(N=1

237)

Juice

(N=1

16)

Puree

d (N

=291

)-0.05

0.00

0.05

0.10

0.15

0.20

0.25

0.30

Preparation Method

Mea

n C

up

s W

aste

Fruit

Most Wasted FV Items

vege

table

sou

p

tom

ato

soup

apple

s

mixe

d co

oked

veg

gies

unsw

eete

ned

apple

sauc

e

bana

nas

flavo

red

apple

sauc

e

stea

med

pea

s

mixe

d ca

nned

fruit

rom

aine

lettu

ce0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

0.40

Mea

n C

up

s W

aste

d

Least Wasted Items*

stra

wberry

cup

cant

eloup

e

cucu

mbe

r

radis

h

kohlr

abi

stra

wberri

es

pars

ley b

utte

red

pota

toes

grap

e to

mat

oes

regu

lar to

mat

oes

chee

sy p

otat

oes

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

0.40

Mea

n C

up

s W

aste

d

*Among items appearing on at least 20 trays

FV Waste ~ Meal Component Type

Entrée Side Dish Topping0.00

0.02

0.04

0.06

0.08

0.10

0.12

0.14

0.16

0.18

Meal Component

Mea

n C

up

s W

aste