Dietary Effects of School-Based SNAP-Ed Education with and without Policy, Systems, and Environmental Change Strategies.

There is potential value in combining education with policy, systems, and environmental (PSE) change strategies in school-based dietary and physical activity (PA) interventions. We investigated the impact of different combinations of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) interventions on diet and PA and determined if student and school characteristics modified these impacts. A quasi-experimental, two-group (intervention (I) and comparison (C)), pre-post design examined the impact of interventions on diet and PA of 4th /5th grade students (n=2,115;n=1,102) in SNAP-Ed-eligible California public schools (n=51;n=18). Compared to students receiving no intervention, students receiving education + PSE decreased soda intake by 0.08 times/day [95% CI: -0.15, -0.02], increased whole fruit intake by 0.17 times/day [95% CI: 0.03-0.32], and increased total vegetable intake by 0.46 times/day [95% CI: 0.18-0.75]. Among students who received education only, sport and energy drink intake increased by 0.11 times/day [95% CI: 0.03-0.19] and 0.05 times/day [95% CI: 0.01-1.10] respectively, compared to students receiving no intervention, and fruit juice intake increased by 0.11 times/day [95% CI: 0.03, 0.20]. School urbanicity and Free and Reduced-Price Meal (FRPM) eligibility level modified intervention impacts. Compared to students from no intervention schools, students in urban schools receiving education only increased intake frequency of sweetened fruit drinks (β[95% CI] = 0.12[0.01-0.23], and students from schools with FRPM above the state average receiving education + PSE significantly increased intake frequency of beans (β[95% CI] = 0.14[0.04-0.24]. Findings highlight the benefit of coupling nutrition education with PSE changes and identify key areas for refining dietary and PA interventions in schools.