The Healthy Food Procurement Initiative in Los Angeles County is a PSE Change intervention designed to improve the nutrition standards of the county’s food service contracts.  In 2011, the County of Los Angeles (“County”) Board of Supervisors adopted Healthy Food Promotion in Los Angeles County Food Service Contracts, a motion aimed at County departmental food procurement policies and practices as they relate to nutrition. The motion established a process for the County’s Department of Public Health to develop nutrition standards and/or healthy food procurement practices in new and renewing Requests for Proposals (RFP) for food service and vending contracts across County departments.

Target Behavior: Healthy Eating

Intervention Type: PSE Change

The adoption of the Board motion has the potential to reach a broad audience with almost ten million people living in Los Angeles County. As of 2011, approximately 48% of the population is Hispanic or Latino, 29% is non-Hispanic white, 14% is Asian, and 9% is Black. The percent of foreign-born residents in this jurisdiction was nearly 46%. Additionally about 18% of county residents lived below the poverty line. Approximately 22% of children in grades 5, 7, and 9 were obese (BMI >95^th percentile) and approximately 37% of adults were overweight (body mass index [BMI] between 25 and 29.9), and another 23.6% were obese (BMI >30).²

As an institutional policy, the procurement motion specifically targets County employees (100,000 + individuals); patrons who purchase food and beverages at County venues, and populations whose meals are provided by County of Los Angeles food venues and programs. The County distributes meals to youth, seniors, patients, and incarcerated individuals; populations who are at greater risk for obesity and poverty. Once the institutional policy is fully implemented, DPH estimates that it will impact the nutritional quality of nearly 37 million meals offered/sold in various County settings per year.

Setting: Community, Retail, Worksite

Target Audience: Preschool (<5 years old), Elementary School, Middle School, High School, Pregnant/Breastfeeding Women, Parents/Mothers/Fathers, Adults , Older Adults

Race/Ethnicity: All

The Healthy Food Procurement Initiative includes the following components:

• Institutional policy should include evidence-based nutrition standards, as well as other healthy food procurement strategies that promote selection/consumption of healthy foods and beverages.
• Institutional policy should designate an organization or formal group to coordinate implementation of new nutrition standards and other promotion strategies.
• The coordinating organization should consult with stakeholders whom the institutional policy will impact, such as food service vendors and department leadership in charge of food service contracts. This step must precede policy implementation.
• The coordinating organization should have adequate resources to oversee institutional policy implementation, including sufficient resources to offer ongoing technical assistance and evaluation.
• An organization or formal group should be authorized to evaluate and monitor the institutional policy or system change. In Los Angeles County, the coordinating organization (Los Angeles County Department of Public Health) also serves as the entity that evaluates and monitors policy implementation.

The materials supporting this institutional policy have been carefully developed by the County of Los Angeles Department of Public Health, Division of Chronic Disease and Injury Prevention. They are meant to serve as example documents, not exact guidelines for successful intervention/policy replication. Provide credit to the LA County Department of Public Health when reproducing materials in the original, or adapted, form:

• Model policy– Healthy Food Promotion in LA County Food Service Contracts
• “Creating Healthy Food Environments” policy brief
• Model memo from the Department of Public Health’s Health Officer to all the County Departments informing them of the Board of Supervisors’ motion and its implications
• Sample Food Service Requirements for Concession Operations at a County of Los Angeles Cafeteria, 2011
• Nutrition Standards Implementation Guides (available for vending machine beverages and snacks, and a sodium reduction plan)
• Case study on the vending machine program
• Policy brief on working with public and private hospitals

 

The County of Los Angeles has 37 departments and over 100,000 employees. An internal assessment found that twelve out of the 37 departments procure (i.e., sell, serve, or distribute) food. The healthy food procurement initiative is a very large undertaking and the creators have outlined short (1-3 year), intermediate (3-5 year) and long-term (6+ year) outcomes. At this time, the short-term and intermediate outcomes have been assessed.

The initial assessment involved an extensive survey of the settings (e.g., cafeterias, vending machines, and concessions), practices (current nutrition standards, dietary accommodations), and challenges anticipated by each County department. Since 2011, DPH has partnered with 7 County departments including the Probation Department, Department of Public Works, Department of Health Services, Department of Children and Family Services, Department of Parks and Recreation, Department of Beaches and Harbors, and the Chief Executive Office. DPH provided technical assistance to each department, conducted site visits and menu reviews, recommended nutrition standards to be integrated into their contract solicitation processes, and established a monitoring and compliance system.

An adapted version of the validated Nutrition Environment Measures Survey for Vending Machines (NEMS-V) tool and an internally developed environmental scan tool for cafeterias were used to collect baseline data on the food and beverage options offered in vending machines and cafeterias at selected facility locations. To date, we have collected baseline data on food and beverages that are offered in 5 hospitals and multiple worksite cafeterias.

In addition, vendor quarterly sales (revenue), food production records, and nutritional information of vending machine snacks and beverages have been collected to examine the level of adherence to a 100% healthy vending policy at a large urban agency in Los Angeles County, as well as its impact. In terms of the latter, DPH assessed changes in the product line nutrients and revenues as a result of the vending policy for a timeframe of nearly 2 years (November 2013 to September 2015). Results suggest that policy adherence increased for snacks and beverages sold by the vending machines, 28% and 49%, respectively. Average snack and beverage revenues appeared to decrease by $137.30 and $93.87 per month, respectively, during the sampled period. However, based on a vending machine environmental scan sub-assessment, DPH found that large price increases occurred shortly after the implementation of the 100% healthy vending machine policy; this may, to some extent, explain the decreases in snack and beverage revenue.

DPH plans to conduct further impact evaluation and continue technical assistance through the dissemination of healthy food procurement toolkits, and promotion of model procurement guidelines for a variety of venues and institutions. The DPH evaluation team has published several articles pertaining to healthy food procurement work, and has several manuscripts in development that document the challenges and successes of creating healthier food environments. Contribution to this evidence base provides valuable information for informing similar efforts in other sectors (e.g., cities, private companies, community-based organizations with food services).

Classification: Practice-tested

Based on the SNAP-Ed Evaluation Framework, the following outcome indicators can be used to evaluate intervention progress and success.

	Readiness and Capacity – Short Term (ST)	Changes – Medium Term (MT)	Effectiveness and Maintenance – Long Term (LT)	Population Results (R)
Individual
Environmental Settings		MT5	LT5
Sectors of Influence		MT7

Center TRT developed an evaluation logic model and evaluation plan for a policy modeled after the Healthy Food Promotion in Los Angeles County Food Service Contracts institutional policy. The policy aims to increase access and availability of healthy foods and beverages in county departments and programs by including nutrition standards and healthy food promotion practices into food service contract requests for proposals. The logic model is intended to guide the evaluation process (as opposed to the planning process); the evaluation plan focuses on the implementation and effectiveness of an approach similar to LA County’s. The evaluation plan addresses the reach, adoption, extent of implementation, and effectiveness of a policy modeled after the LA County policy. The evaluation is a pre-post design with no comparison group. This evaluation plan provides guidance on evaluation questions and types and sources of data for both process and outcome evaluation. If you are interested in answering evaluation questions not listed in the evaluation plan, please refer to the list of additional evaluation questions here. We suggest a variety of data collection tools throughout the evaluation plan.

• Logic Model
• Evaluation Plan

 

Website: Additional information on the intervention can be found on the Center TRT website: http://www.centertrt.org/?p=intervention&id=1184&section=1. The LA County Department of Public Health website is http://www.choosehealthla.com/.

Contact Person(s):
Michelle Wood, MPP
Program Manager, Food Procurement and Policy
Choose Health LA
Division of Chronic Disease and Injury Prevention
Los Angeles County Department of Public Health
3530 Wilshire Blvd., 8th Floor
Los Angeles, CA 90010
Phone: (213) 351-7809
Email: mwood@ph.lacounty.gov