Table 3.
Lessons learned from the adoption and implementation of healthy nutrition standards and other recommended practices in food procurement across three institutional settings in Los Angeles County, 2010–2012
| At the institutional level |
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| Facilitators | Phase | Public school district (Los Angeles Unified School District) | County government (County of Los Angeles) | Municipalities (targeted/selected cities in Los Angeles County)1 |
| Understand past and/or current institutional food procurement practices and readiness to adopt new approaches | Needs assessment | Reviewed nutrition standards for school meal program and identified opportunities for improving school meal nutritional content | Conducted a needs assessment to explore the facilitators and barriers to proposed changes in County of Los Angeles food procurement practices | Reviewed existing food and beverage nutrition standards and other procurement practices in Los Angeles County cities Across targeted/selected cities, city staff conducted community needs assessments to inform planning |
| Institutional authority to adopt healthy nutrition standards and/or other recommended practices in food procurement | Needs assessment | The district has the authority to impose stricter nutrition standards while complying with state and federal requirements | County departments have the authority to impose food procurement requirements within food service and vending contracts | Targeted/selected cities have independently passed previous city-level nutrition standards for food services operated by the municipality. |
| Educate key partners and stakeholders to build support for healthy nutrition standards and/or other recommended practices in food procurement | Stakeholder education and strategy development | Worked with a committee comprising parents, community-based organizations (CBOs)2, and school administrators to guide development of menu planning and adoption of standards and other recommended practices in food procurement | Worked with an advisory committee of food service experts to guide development and implementation of healthy nutrition standards and other recommended practices in food procurement Worked with key county department staff who oversee food service contracts to provide context and rationale for changes in food procurement practices | Worked with a food policy task force comprising key stakeholders to guide development of healthy nutrition standards |
| CBOs and city staff held community meetings to seek community input and build support for proposed standards | ||||
| Capitalize on external influences and institutional interest to change | Adoption | Recent changes in the USDA school meal nutrition standards provided an opportunity to promote district-wide changes in menu planning and food procurement practices | Lessons learned from other local, state, federal, and private institutions that have successfully adopted healthy nutrition standards and other procurement practices (e.g., Kaiser Permanente and New York City) informed efforts in the County of Los Angeles | Targeted/selected cities built on the momentum of existing nutrition education campaigns such as “Rethink Your Drink” to establish support for proposed nutrition standards |
| Identify, educate, and provide technical assistance to champions | Adoption | The District’s Board of Education and District administration have led efforts to improve school menu changes CBOs also partnered with the District to build support for healthy menu changes and provided technical assistance to establish more rigorous school meal nutrition standards and other procurement practices | A County of Los Angeles supervisor championed efforts that contributed to the adoption of a Board motion that required inclusion of healthy nutrition standards and other recommended food procurement practices in new and renewing county food service and vending contracts | City officials (e.g., council member, city board) collaborated with various stakeholders (e.g., city management, city health departments) to draft resolutions in support of adopting and/or updating nutrition standards for vending and other concessions across public sites and city facilities |
| Use social marketing, media, and other educational efforts to prepare operational managers and the public for changes | Implementation | The District partnered with a public relations and communication firm to promote and launch the district’s new school menu promotional campaign (i.e., menu event launches, celebrity-sponsored events, press releases, and development and dissemination of promotional materials) | A public relations and communications firm was used to develop public education campaigns (e.g., videos and print materials) on topics such as the importance of reducing sodium consumption to prevent cardiovascular disease | The Los Angeles County DPH2 worked with the CBOs to develop promotional health education videos for educating various stakeholders in the cities/communities |
| Staff capacity and expertise to support the implementation of adopted standards and/or practices | Implementation | The District has a team of registered dietitians and other administrative staff who support efforts to comply with local, state, and federal requirements to receive funding reimbursements for the school meal program | Select county departments have dietitians on staff to assist with menu planning and compliance with nutrition standards | The DPH worked with staff in targeted/selected cities to develop staff training materials to help prepare them for the implementation of nutrition standards |
| The District has a food procurement division that assists with contract development, purchasing and monitoring, and compliance with food contract provisions | County departments have procurement staff to assist with contract development, monitoring, and compliance | |||
| Technical assistance to support ongoing implementation | Implementation | DPH supported CBOs to partner and provide direct technical assistance to the District on menu planning, implementation, and promotion of the new nutrition requirements to staff, students, parents, and the community | DPH staff provided technical assistance to County of Los Angeles departments, including site visits, menu reviews, and technical advice on programmatic monitoring, evaluation (internal), and vendor compliance with food service contracts | CBOs provided direct technical assistance to targeted/selected cities on drafting, adopting, and implementing city-level healthy nutrition standards |
| Monitoring and evaluation for quality improvement purposes | Compliance and quality Improvement | The District regularly conducts a nutritional analysis of school menus to comply with local, state, and federal nutrition requirements. Key indicators such as meal participation rates are regularly reported to the District’s Board of Education | The DPH established a compliance and evaluation plan to document the progress of expanding access to healthy food options for county staff, clients, and other members of the public who may visit county facilities or participate in county-sponsored programs | Targeted/selected cities had staff conduct site visits to all city-owned and -operated vending machines to assess compliance with nutrition standards |
| The DPH and the District partnered to evaluate the new 2011–2012 school menu changes through nutrient analyses, examination of food production records, and plate waste studies | ||||
| Understand past and/or current institutional food procurement practices and readiness to adopt new approaches | Needs Assessment | Awaiting the release of the new USDA school meal guidelines delayed aspects of District menu planning and finalizing of the new 2011–2012 menu. | Institutional nutrition standards and food procurement practices must align with other local, state, and federal guidelines | Information not available |
| Complex institutional administrative processes | Adoption | Changes in administrative leadership and competing institutional priorities affected the implementation of the new 2011–2012 menu | Each county department and food setting has its own internal administrative processes, contracts divisions, and unique needs and concerns | Each city has its own internal administrative processes, contracts divisions, and unique needs and concerns |
| Cost and budget constraints | Adoption and Implementation | District meal production costs and federal meal reimbursement presented challenges to purchasing healthier food items | County departments had concerns about costs, availability, and acceptability of healthier food options | City staff and council had concerns over revenue reduction and other “unintended” consequences of adopting healthy nutrition standards |
| Meal preparation and presentation | Implementation | Inconsistencies in meal preparation, esthetics, and food packaging affected student acceptance of the new school menu | Information not available | Information not available |
| Consumer acceptance of changes in food offerings | Implementation | Initial resistance to the new menu was due in part to student and parent unfamiliarity with the newly presented food products | Information not available | Information not available |
| Gaps in social marketing, media, and dissemination of education materials | Implementation | Although the social marketing campaign to prepare students and parents for the new menu changes was of high quality, competing coverage of higher profile news diluted some of the key messages from the campaign | Limited staff time and resources constrained and delayed the wide distribution of social marketing and education materials | Limited staffing and resources constrained the development and wide distribution of social marketing and education materials |
| Limited institutional and staff capacity | Implementation | Although training was provided to cafeteria managers and front-line staff to assist with the uniform implementation of the new menu, there were gaps in the topics covered | The DPH encountered select staff resistance to healthy nutrition standards and other recommended practices in food procurement due to misperceptions about how diet contributes to obesity | Cities encountered select staff resistance to healthy nutrition standards and other recommended practices in food procurement due to misperceptions about how diet contributes to obesity |
| Monitoring and evaluation for quality improvement purposes | Compliance and quality Improvement | Variable capacity to conduct rigorous evaluation | Variable capacity to conduct rigorous evaluation | Variable capacity to conduct rigorous evaluation |
1
Cities include those that participate in the local obesity prevention and health promotion initiatives: Baldwin Park, Bell Gardens, El Monte, Huntington Park, La Puente, Long Beach, Pasadena, Pico Rivera, San Fernando, and South El Monte.
2
CBOs, community-based organizations; DPH, Los Angeles County Department of Public Health.