Nutrition Policy Research


	Good nutrition is critical to health, functioning, and quality of life. Mathematica has been a leader in designing and evaluating policies to ensure that all Americans have access to adequate food. We have extensively studied all of the major U.S. food and nutrition assistance programs, including the Supplemental Nutrition Assistance Program (formerly known as the Food Stamp Program), the school nutrition programs, child and adult care feeding programs, and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Our research has examined the nutritional needs and dietary status of people at all stages of the life cycle, from infancy through old age. Read more about our nutrition research.

Highlights

ADA Journal Supplement Highlights Findings from Our Study of School Meal Programs

The National School Lunch Program currently provides subsidized meals to more than 30 million children each school day. A special supplement to the February 2009 issue of the Journal of the American Dietetic Association presents findings from the recently released Third School Nutrition Dietary Assessment Study (SNDA-III), conducted by Mathematica, as well as research from other studies using SNDA-III data. While more than 85 percent of schools offered reimbursable lunches that met U.S.D.A. standards for key target nutrients—protein, vitamin A, vitamin C, calcium, and iron—none of the schools served lunches that met the sodium benchmark, and only one in three served lunches that met the saturated fat standard. Read the press release.

Briefel Appointed to IOM Committee to Study Sodium Reduction Strategies

Ronette Briefel, senior fellow, has been appointed to an Institute of Medicine Committee to review and make recommendations about strategies to reduce dietary sodium intake. An expert in the dietary, nutritional, and health status of the U.S. population, Briefel is responsible for coordinating Mathematica’s work with the U.S. Department of Agriculture. Her expertise covers epidemiological studies, nutrition and health assessment methodologies, childhood obesity, and analysis and interpretation of national survey data to study low-income and high-risk populations. Read more.

Latest Work

	Reports:
	“Diet Quality of American Young Children by WIC Participation Status: Data from the National Health and Nutrition Examination Survey, 1999-2004.” Nancy Cole and Mary Kay Fox, July 2008. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrient-dense foods, nutrition education, and referral to health care services for low-income pregnant women, postpartum women, infants, and children up to age five who are at nutritional risk. This study uses the most recent data from the National Health and Nutrition Examination Survey (NHANES) for children age one to four years old to examine the diets of WIC participants and nonparticipants. A primary conclusion is that the diets of children who participate in the WIC program were generally comparable to the diets of children who do not participate. The prevalence of adequate nutrient intakes is very high for this age group. However, there are specific areas where dietary quality is in need of improvement. Recommendations include reducing children’s intakes of saturated and solid fats, sodium, and sweetened beverages, and increasing intakes of dietary fiber. Back to Top
	“Diet Quality of American School-Age Children by School Lunch Participation Status: Data from the National Health and Nutrition Examination Survey, 1999-2004.” Nancy Cole and Mary Kay Fox, July 2008. The National School Lunch Program (NSLP) is the oldest food assistance program in the U.S. Department of Agriculture’s nutrition safety net. Strategies for improving the diets of NSLP participants are crucial for meeting children’s nutritional needs, fostering healthy eating habits, and safeguarding children’s health. This report examines the nutrient intakes, food choices, and diet quality of NSLP participants and nonparticipants. The diets of most school-age children, NSLP participants and nonparticipants, are generally nutritionally adequate, although teenage girls are a subgroup at greatest risk for inadequate nutrient intakes. Lunches consumed by NSLP participants were more nutrient dense than lunches consumed by nonparticipating children, but NSLP participants had higher prevalence of excess sodium and saturated fat intakes than nonparticipants. Areas of greatest concern for all children are excess consumption of discretionary calories from solid fats and added sugars, excess intakes of saturated fat and sodium, and inadequate consumption of specific types of foods that are nutrient-dense and high in fiber such as whole fruits, dark green and deep yellow vegetables, legumes, and whole grains. Nutrition education should target these concerns. Back to Top
	“Dynamics of WIC Program Participation by Infants and Children, 2001 to 2003.” Laura Castner, James Mabli, and Julie Sykes, April 2009. This report provides information on the participation patterns of infants and children who were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) from 2001 through 2003. Several aspects of participation were examined including at what age and under what household circumstances infants and children entered the program, how long they stayed in the program, characteristics of their mothers, and how often infants and children re-entered the program. Back to Top
	"Empirical Bayes Shrinkage Estimates of State Food Stamp Program Participation Rates in 2004-2006 for All Eligible People and the Working Poor." Karen Cunnyngham, Laura Castner, and Allen Schirm, February 2009. The Supplemental Nutrition Assistance Program (SNAP)—formerly the Food Stamp Program (FSP)—is a central component of American policy to alleviate hunger and poverty. This report presents estimates that, for each state, measure the need for the FSP and its effectiveness in each of the three years from 2004 to 2006. The estimated numbers of people eligible for the FSP measure the need for the program. The estimated participation rates measure, state by state, the program’s performance in reaching its target population. In addition to the participation rates that pertain to all eligible people, researchers derived estimates of participation rates for the “working poor,” that is, people who were eligible for the FSP and lived in households in which someone earned income from a job. The estimates were derived jointly using empirical Bayes shrinkage estimation methods and data from the Current Population Survey, the decennial census, and administrative records. The report also describes the shrinkage estimator in detail. More Reports Back to Top

	Journal Articles:
	"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. Back to Top
	"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. Back to Top
	"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. More Journal Articles Back to Top

	Issue Briefs:
	"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. Read the release. Back to Top
	"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. Back to Top
	"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. More Issue Briefs Back to Top

	Other:
	On December 8, senior researcher Mary Kay Fox testified before the U.S. Senate Agriculture, Nutrition, and Forestry Committee hearing on “Promoting Health, Preventing Chronic Disease, and Fighting Hunger: Assessment of USDA Food Assistance and Child Nutrition Programs in the Economic Downturn.” She presented findings from our School Nutrition Dietary Assessment (SNDA) studies and outlined priorities for the future. Read her testimony. Back to Top
	"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. Back to Top
	"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. Back to Top