A Longitudinal Study to Assess Impact and Sustainability of a Scratch Cooking Intervention among 5 Colorado School Districts | Presented at the American Public Health Association's 2016 conference in Denver, CO by Leah Carpenter, MPH, Gretchen Swanson Center for Nutrition

1. A Longitudinal Study to Assess Impact and
Sustainability of a Scratch Cooking Intervention
among 5 Colorado School Districts
Leah Carpenter, MPH
Gretchen Swanson Center for Nutrition
Omaha, NE

2. Presenter Disclosures
Leah Carpenter
No Relationships to disclose

3. Introduction:
The Problem
• Current national rates
• 17% of children and adolescents are obese
• Environmental and policy approaches are warranted
• 32% of empty calories come from school
• Inadequate equipment is a barrier to change
• Lunch participation declined by 5% each year from 2006 to 2014
• Studies finding meal improvement due to Heathy Hunger-Free Kids Act
• New meal standards not associated with a negative effect on student
meal participation, nor food waste

4. Introduction:
LiveWell Colorado’s School Food Initiative (SFI)
• Goal: partner with districts to serve more fresh/whole foods
• Provides workshops/training, on-site chef support, operations &
marketing technical assistance and small equipment donation
• Developed in 2010 with the initial goal of reaching all 178 public
school districts (~90 districts to date)
• Model has evolved over time to better serve participants

5. Introduction:
External Evaluation
• Goal: Measure impact of SFI on level of scratch-cooking
• Provide results and feedback to:
• Program: Identify areas of improvement to inform program modification
to best serve school districts and yield positive outcomes
• Districts: Provide information/results back to districts for school board
presentations, grant applications, etc.
• Community: Contribute to scientific literature for replication of best
practices nationally

6. Methods:
Evaluation Questions
• What are the long-term effects of the SFI on an alumni
district’s ability to incorporate fresh/whole ingredients 1, 2,
and 3 years after completing the program?
• What are the long-term effects of scratch-cooking on
participation in the National School Lunch Program (NSLP)?

7. Methods:
Quantitative Menu Analysis (QMA)
• In-person menu cycle
review with Food Service
Director
• Score each ingredient
used based on rubric by
component
• Collect recipes and labels
• Administered 3 times
(Spring 2014, 2015, 2016)
Animal-based Protein
Group A (Scratch/Fresh) Group B (Transitional/Clean Label) Group C (Highly Processed)
Meat and meat alternatives delivered
raw/uncooked with the only
processing being skinned, cut and/or
frozen:
• Raw meat: beef, pork, lamb
• Raw poultry: chicken, turkey,
duck
• Ground raw meat (include raw
preformed patties)
• Ground raw poultry (include raw
preformed patties)
• Shelled Eggs
• Raw fish, shrimp
Meat and meat alternatives that are
minimally processed, often
precooked and flash frozen with no
fillers and no preservatives added
(100% meat):
• Precooked meat, no fillers, no
preservatives: Beef, pork, lamb
(ex. crumbles, meatballs, roast,
steaks, and preformed cooked
hamburger patties)
• Precooked poultry, no fillers, no
preservatives: Chicken, turkey,
duck (ex. Fajita strips,
unbreaded chicken breast,
turkey crumble with no fillers)
• Liquid Eggs
• Canned Tuna (fish and water or
oil, no preservatives)
• Frozen unbreaded precooked
fish, shrimp
Meat and meat alternatives that have
been commercially prepared, i.e. heat
& serve items; cured/preserved
items; has fillers, preservatives, or other
ingredients:
• Heat & serve meat: Beef (ex.
Hamburgers, crumbles, and
meatballs) with fillers);
Hotdogs; Bacon
• Heat and Serve poultry:
Chicken (ex. nuggets, strips and
patties); turkey crumble with
fillers
• Deli meat (ex. turkey, roast beef,
ham, salami, pepperoni)
• Powdered eggs
• Canned Tuna (fish and water or
oil, has fillers, preservatives, or
other ingredients)
• Frozen breaded precooked fish,
shrimp
Figure 1. Animal-based Protein Section of QMA Rubric

8. Methods:
Participation Rate Analysis
• Secondary data from the Colorado Department of Education
• Calculated for each district by month Aug 2012-May 2016
• Combined and by grade level
• Comparison of intervention districts and Colorado’s average
Average Daily Participation (ADP) = Total Meals served/# of Operating Days
Participation = ADP/total Enrollment

9. Methods:
Sampling Districts
• 5 districts from original sample
• Variation in district sizes
• Each chef team represented
• No prior SFI experience
• Diverse geographic location

10. Results:
Longitudinal QMA
• The use of fresh/whole ingredients increased by 17% from
Spring 2013 to Spring 2016 across all districts
61% 62%
75%
78%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
2013 2014 2015 2016
Average Use of Fresh/Whole Ingredients Over Time
Figure 2. Average yearly use of fresh/whole ingredients.
Baseline: 40% to 75%
After one year in program:
51% to 72%
After two years: 69% to 83%
After 3 years: 69% to 85%

11. Results:
Longitudinal QMA
• 17% average improvement across school districts
Figure 3. Each district’s change in the use of
fresh/whole ingredients from 2013-2016.
Change across 3-year
time frame ranged from
-1% to +33% per district
22% 21%
-1%
33%
11%
17%
-5%
0%
5%
10%
15%
20%
25%
30%
35%
District A District B District C District D District E Distrcit Ave
Total Change in the Use of Fresh/Whole by School District

12. Results:
Participation Results
• When transitioning to fresh/whole ingredients, participation
rates remain constant
Figure 4. Pre-Post Average Daily Participation by District.
Four districts increased
participation
One district decreased
participation
Average 2013 rate = 53.2%
Average 2016 rate = 53.9%
+0.7%
35.6
38.3
71.6
74.6
46.1
43.8
39.2
63.2
76.7
46.6
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
District A District B District C District D District E
Lunch Participation Rate (%)
2013 2016

13. Results:
Participation Results Figure 5. Participation of the intervention districts
from 2013 – 2015, compared to the Colorado
average
0
10
20
30
40
50
60
70
80
90
100
8/1/13 10/1/13 12/1/13 2/1/14 4/1/14 6/1/14 8/1/14 10/1/14 12/1/14 2/1/15 4/1/15
Average Daily Participation (%)
National School Lunch Participation Rate by Month for LWC School Districts and
Colorado, School Years 2013-2015
LWC districts Colorado
• Intervention districts
have higher participation
than the Colorado
average

14. Discussion and Conclusion
• Quantitative Menu Analysis (QMA) findings showed an average
increase of 17% among SFI school districts in use of
fresh/whole ingredients over time (and sustained!)
• As use of fresh/whole increased, school lunch participation
stayed constant
• SFI seen as a facilitator in implementing an improved NSLP as
required by Healthy Hunger-Free Kids Act
• Next steps: Evaluation to include procurement data analysis

15. Acknowledgements
Contributing Authors:
Kelli Gruber, MPH
Gabriella Warner, MS, RD
Amy Yaroch, PhD
Research supported by LiveWell Colorado and The Colorado Health Foundation

16. Thank You!
Questions?