Street vendors in los angeles

Street Vendors in Los Angeles: Promoting Healthy Eating in L.A. Communities Applied Policy Project UCLA School of Public Affairs Department of Public Policy March 2007 Katherine Goetz & Joelle Wolstein

STREET VENDORS IN L.A.

TABLE OF CONTENTS

Table of Contents Acknowledgments

4

Executive Summary

5

Introduction

7

Background of the Problem The Obesity Epidemic Existing Childhood Obesity Prevention Policies Street Vendors Policies Regarding Street Vendors Enforcement of Policies

10 10 12 13 14 15

Methods

16

Analysis Survey Results Trends Related to the Frequency of Purchasing Supply of Snacks by Vendors Analysis Concerning the Impact of Unhealthy Snacks on Obesity

19 19 21 23 23

Theoretical Framework for Policy Recommendations

29

Criteria for Selecting our Policy Options

32

Policy Recommendation Scoring the Options

34 40

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TABLE OF CONTENTS

Conclusions and Applicability

44

References

47

Appendix A: More Information about Our Target Schools

50

Appendix B: Existing Nutrition Policies in Los Angeles

56

Appendix C: List of Interviewees

59

Appendix D: Classroom Survey

60

Appendix E: Letter to Parents

61

Appendix F: Survey Instructions for Teachers

63

Appendix G: Questionnaire for Food Vendors

67

Appendix H: Analysis of Caloric Intake from Snacks

68

Appendix I: Additional Survey Data

75

Appendix J: Implementation Plan for School Snack Program

80

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ACKNOWLEDGEMENTS

Acknowledgments We thank Professor Michael Stoll for his guidance and support throughout this entire process, and Dr. Bill McCarthy for his invaluable advice about nutrition. We also thank our peer reviewers, Ethan Scherer and Sterling Thomas, for their helpful feedback.

Thank you to Aurora Flores, our contact at the Healthy Eating, Active Communities Initiative, for supporting this project by providing us with links to the primary stakeholders.

There are many others who helped us with this project, including LAUSD officials, local law enforcement representatives, and experts from obesity prevention organizations whom we interviewed. We thank them all for their time and contribution to our project.

We are very grateful to the principals at our three schools, Betsy Castillo, Frances Goldman, and Eufrosino Espinoza, for their support and assistance, and for allowing us to visit their schools so often and take the students’ and teachers’ time.

Thank you to Matt Atkin, our research assistant, for his great work and design talents.

We acknowledge and thank the Lewis Center for Regional Policy Studies for its generous financial support of this project and for recognizing that street vending and childhood obesity are important problems in Los Angeles. .

Suggested citation: Wolstein J, Goetz K. Street Vendors in Los Angeles: Promoting Healthy Eating in L.A. Communities. Department of Public Policy, UCLA School of Public Affairs.

Funded by The Lewis Center for Regional Policy Studies, UCLA. Los Angeles, CA, March 2007. http://lewis.spa.ucla.edu This report was prepared in partial fulfillment of the requirements for the Master of Public Policy degree in the Department of Public Policy at the University of California, Los Angeles. It was prepared at the direction of the Department and the Healthy Eating, Active Communities Initiative as a policy client. The views expressed herein are those of the authors and not necessarily those of the Department, the UCLA School of Public Affairs, the Lewis Center for Regional Policy Studies, UCLA as a whole, or the Healthy Eating, Active Communities Initiative.

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EXECUTIVE SUMMARY

Executive Summary Throughout Los Angeles, but particularly in low-income areas, street vendors sell enticing high-sugar, high-fat foods outside elementary schools. In light of the alarming increase in childhood obesity, vendor activity has gotten the attention of schools and many community based obesity-prevention organizations. Of concern to the schools and the Los Angeles Unified School District (LAUSD) is the way street vendors undermine newly implemented nutrition policies. These policies promote healthier eating within the schools by improving the nutritional content of foods served and sold on school grounds. Although LAUSD’s efforts have contributed to healthier lunches and have eliminated the sale of junk foods on campuses, students are still consuming unhealthy snacks immediately after the school day ends. Obesity-prevention groups believe the street vendors may be contributing to the prevalence of obesity.

The childhood obesity epidemic in the U.S. affects over nine million children and youth over the age of six. Recent figures show that 17.1% of children are obese and another 16.5% are at risk of becoming obese. Estimates predict that if nothing is done to reverse this trend, 20% of children in the U.S. will be obese by 2010.

In particular, the prevalence of obesity is higher in minorities and low-income individuals. In Los Angeles, 28.2% of people living below the Federal Poverty Line (FPL) are obese, while only 16.5% of those living at or above 300% of the FPL are obese. Data from the 2005 L.A. County Health Survey show that the rate of obesity is significantly higher in African Americans and Latinos than in Asians or Whites. Because most of the street vendors work in predominantly low-income and Latino areas, the students buying these snacks are already at higher risk of becoming obese.

To determine the nutritional impact of snacks sold by vendors, we surveyed students in three elementary schools in South Central Los Angeles and found that 83% of students buy snacks from the street vendors, and 44% do so at least three or four times a week. We estimated the average calories in these snacks and determined that students who buy these snacks devote a large percentage of their daily caloric intake to unhealthy foods like chips and soda. Furthermore, this consumption of unhealthy snacks leads students to surpass their daily recommended caloric intake, which will result in weight gain unless balanced by physical activity. Given the low level of organized physical activity in these schools, in addition to other environmental barriers to physical activity in low-income neighborhoods, the students are unlikely to be exercising enough to balance this surplus consumption.

Based on our findings regarding the frequency of snack purchases by students and the impact on their daily nutritional intake, our client, the Healthy Eating, Active Communities Initiative (HEAC) should take steps to limit the vendors’ influence on these environments. The status quo is not acceptable because enforcement of anti-vending laws is insufficient and there are not enough resources to expand enforcement. Without an intervention, the supply and GOETZ & WOLSTEIN

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EXECUTIVE SUMMARY

demand for these goods will persist. Based on theories about behavior change and previous nutrition interventions to reduce unhealthy snacking, we provide the following recommendations for HEAC: 1. Work with the schools to create a program of healthy after-school snack sales to provide a healthy alternative for the students who want snacks after school.

2. Work with the schools to increase nutrition education and information about the negative impact of unhealthy snacks on one’s health.

3. Use informal outreach to work with the vendors so that they will sell healthier options.

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INTRODUCTION

I. Introduction The prevalence of obesity in America is a problem that is immediate and grave. The term “obesity epidemic” has become commonplace and obesity has become one of the country’s major public health concerns. In 2003, nearly two-thirds of all Americans were overweight or obese. The rate of obesity in 1 2004 was 32% compared to 15% in 1980. In particular, childhood obesity is at a record high and is getting the attention of our nation’s parents, teachers, physicians, and government officials. From 1980 to 2004, the rate of obesity in children increased from 4% 2 to 17%. According to a survey by The California Endowment, nearly all Californians believe childhood obesity is a problem, with about half deeming it a 3 “serious problem.”

As our nation becomes increasingly more obese, Los Angeles is at the forefront of obesity-prevention policy. Since 2002, the Los Angeles Unified School District (LAUSD) has adopted three measures to eliminate high-sugar, high-fat foods served and sold on elementary, middle, and high school campuses. Similarly, the City of Los Angeles recently implemented the Child Nutrition Policy, which aims to promote healthy eating throughout L.A. by insuring that city departments, such as the Department of Parks and Recreation, offer healthy food choices to youth and, where applicable, provide organized physical activity. While such action demonstrates progress in the promotion of healthy behaviors amongst youth, there are other factors that must also be dealt with to address the problem accurately. For example, street vendors sell food surrounding elementary schools so that when children leave their “nutritionally safe” environments at the end of the school day, they encounter enticing high sugar, high fat, and energy-dense options, such as chips, candy and soda.

What this report will do This report is prepared for the Healthy Eating, Active Communities Initiative (HEAC) of The California Endowment. HEAC’s purpose is to improve the healthy eating and physical activity environments for children, with the goal of reducing disparities in obesity. HEAC works in six communities chosen for their (1) high prevalence of obesity, (2) community readiness to address health disparities, (3) active school district and public health department participation, GOETZ & WOLSTEIN

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INTRODUCTION

and (4) willingness to collaborate.

The South Central L.A. division, called the Childhood Obesity Brain Trust (COBT), focuses on two zip codes, 90011 and 90007, which are low-income and predominately Latino and African American. We focus on three elementary schools in this area—Norwood Elementary, 20th Street Elementary and Hooper Elementary. The students in these schools are 97% Latino, 2-3% African American, and 100% eligible for the National School Lunch Program (NSLP). Our primary research took place in and around the periphery of these schools. We documented that these schools are demographically similar and operated similarly to many schools in certain parts of Los Angeles, an issue to which we will later return (For more information about the schools, see Appendix A) One of the topics COBT has chosen to address is the aforementioned street vendor issue.

These vendors primarily sell unhealthy snacks and may contribute to the rising rates of childhood obesity. In this report, we examine the activity of street vendors outside elementary schools, present policy options for HEAC to address this concern, and, based on our findings, recommend a course of action. The policy question we answer in this report is: To what extent are the street vendors contributing to childhood obesity, and what should HEAC do to counter their effect?

The primary goal of this study is to determine if street vendors near elementary schools contribute to obesity. The first objective is to assess the market for street vendors around schools.

There is no existing information on street vendors from an obesity stand point, which makes it difficult to determine the extent of this problem, or if the street vendors actually do pose a problem. We assess the market by obtaining information from vendors about their business and the food items they supply, and by asking students their frequency at which they purchase goods from the vendors, as well as other questions relevant to understanding the demand for these items. The second objective is to determine if the activity of the vendors contributes to obesity by estimating the nutritional content of the foods they sell and their impact on the daily nutrition of children. We do this by measuring the caloric values and energy-densities of vendor-sold snacks. Based on this information, we estimate the over consumption that occurs because of vendor foods. The third objective is to present policy recommendations for HEAC that correspond to what we determine is the impact of the vendors on obesity. These recommendations take into account the resources of HEAC, LAUSD, individual schools, the city, and community based organizations.

What this report will not do This report focuses strictly on the street vendors and their impact on childhood obesity.

We acknowledge that there are many other concerns related to the street vendors, such as public safety, sanitation, immigration, and the informal economy. We recognize their existence but have deemed these issues outside of the scope of this study, based on HEAC’s objectives. The mission of our client is to reduce health disparities and combat obesity, not to address these other concerns. We, therefore, do not attempt to provide options based on the aforementioned GOETZ & WOLSTEIN

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INTRODUCTION

problems, though they may be concerns of LAUSD and the City and County of Los Angeles.

We also acknowledge that addressing the activity of street vendors will not eliminate the problem of childhood obesity. There are many contributing factors to the obesity epidemic, such as an environment that promotes physical inactivity and the availability of fast food. HEAC will certainly not be able to change all of these factors. For instance, preferences and parental choices have an impact on obesity, but HEAC is not able to reach every home and change every child’s preferences.

Organization of this report The remainder of the report is organized as follows: II. III. IV. V. VI. VII. VIII.

Background information on the obesity epidemic and current obesity-prevention policies in Los Angeles Description of our methods for collecting data from the students and vendors Analysis of our findings that describes the extent of the problem Theoretical framework for building our policy options Criteria for selecting a policy recommendation Policy recommendation Conclusions and applicability of our conclusions to other areas of Los Angeles

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BACKGROUND

II. Background of the Problem The Obesity Epidemic Obesity is a problem because it has a detrimental impact on one’s overall health. Of the many co-morbidities of obesity, the most common ones are diabetes, heart disease, and hypertension. More than 80% of individuals with diabetes are overweight. Diabetes accounts for 11% of total health care 4 costs and is the sixth leading cause of death. A 2005 study estimates that 27% of total health care costs are related to 5 physical inactivity, overweight, and obesity. Obesity is a public problem because, as each individual shares the responsibility of paying for health care, everyone is affected by the rising costs of obesity.

The incidence of obesity has increased dramatically over the past few decades, suggesting the influence of significant changes in our environment and behavior rather than the influence of genetic predisposition. The two most frequently cited contributors to obesity are poor nutrition and insufficient physical activity, which are typically the targets of public health interventions. Intake of energy-dense foods has risen, while the amount of healthy foods 6 consumed (specifically fruits, vegetables, and whole grains) has decreased. At the same time, energy expenditure has decreased. In 2000, for example, 41% of Los Angeles County adults 7 participated in less than ten minutes of continuous, moderate physical activity per week.

Similarly, 21.7% of adults in Los Angeles County reportedly spend more than three hours per day watching television or using a computer.8 While these overall figures are alarming, relevant data suggest that low-income and ethnic populations are even more disproportionately affected by obesity.

Studies relating socioeconomic status (SES) and obesity reveal disparities, as do obesity rates among racial and ethnic groups.i An inverse relationship exists in the U.S. between SES and Body Mass Index (BMI), thus suggesting that people of low SES are more likely to be 9 overweight and obese than others. In Los Angeles, 28.2% of people living below the Federal i

To define obesity we use the common indicator, Body Mass Index (BMI), which measures one’s body fat based on height and weight. Adults classified as obese have a BMI of 30 or above and fall at or above the 95th percentile.

Overweight adults have a BMI between 25 and 29.9, which places them between the 85th and 95th percentile.

Adults of normal weight have a BMI between 18.5 and 24.9. Children in the 85th and 95th percentiles are considered “at risk for obesity” and “obese”, respectively.

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BACKGROUND

Poverty Line (FPL) are obese, while only 16.5% of those living at or above 300% of the FPL are 10 obese. Similarly, racial and ethnic minorities are more likely to be overweight and obese. Data from the 2005 L.A. County Health Survey show that obesity is prevalent at significantly higher 11 rates amongst African Americans and Latinos than Asians or Whites.

Until 2005, African Americans had the highest rates of obesity in L.A. County, reaching 30% of the African American population. However, the most recent data show that obesity in Latinos has reached 12 those of the African American population. As one might expect, SES and race/ethnicity are 13 related. Although SES and ethnicity are independent factors linked to BMI, they are related in that African Americans and Latinos are more likely to live in poverty than other groups. In 2000, for instance, 37% of African American children and 46% of Latino children in L.A. County lived in poverty.14 The Childhood Obesity Epidemic in the U.S. affects over nine million children and youth 15 over the age of six. As in the adult population, obesity amongst children has increased over time. In children over the age of six, obesity rates have risen from 4% in 1963 to 17% in 2004 (Figure 2.1). Recent figures show that 17.1% of children are obese and 16.5% are at risk of 16 becoming obese. Estimates predict that if nothing is done to reverse this trend, 20% of children 17 in the U.S. will be obese by 2010. Respectively, 70% and 80% of overweight children and 18 adolescents continue being overweight or become obese in adulthood. Because of the increasing rates of obesity and its comorbidities, American children born in 2000 could have a shorter life expectancy than their parents; they would be the first generation in history to do so.19 FIGURE 2.1 Changes in the Childhood Obesity from 1963-2004 20

percent obese

1963-1970 NHES 1970-1974 NHANES I

15

1976-1980 NHANES II 1988-1994 NHANES III

10

1999-2004 NHANES

5

0 6-11 yr

20

The aforementioned income and ethnic disparities persist in children and youth. Latino adolescents, in particular, are the most likely to be obese or at risk of becoming obese (Figure 2.2).21 Many Latinos do not eat enough healthy foods or get enough exercise to avoid becoming overweight.22 Research shows that Latino and African American adolescents drink almost twice as many sodas daily as Whites and eat more fast food and fewer vegetables than their White counterparts.23 GOETZ & WOLSTEIN

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BACKGROUND

FIGURE 2.2 Prevalence of Obesity by Race/Ethnicity

percent obese

50 Non-Hisp. W hite Non-Hisp. Black Mex. American All

40 30 20 10 0 2-5 yr

6-11 yr

12-19 yr 24

Although there has been a focus on understanding and minimizing racial and ethnic disparities related to obesity, it is important to keep in mind that the prevalence of childhood obesity in communities of middle and high SES is still a major concern. In Los Angeles County, for example, there is not a single Assembly District where the prevalence of overweight or obese children is lower than 18.2% (Figure 2.3). For instance, in Beverly Hills, a high SES area, 26.7 to 25 28.3% of children are overweight or obese.

FIGURE 2.3: Percentage of overweight children by Assembly District, 2004

26

Existing Childhood Obesity Prevention Policy We claim that street vendors are a problem because they offer unhealthy foods to children who have been in a “nutritionally safe” environment throughout the school day. We consider schools in LAUSD “nutritionally safe” because of recent steps the district has taken to improve GOETZ & WOLSTEIN

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BACKGROUND

the nutritional content of foods served and sold on its campuses. The purpose of these changes is to begin reducing the risk of childhood obesity in Los Angeles by limiting the amount of unhealthy foods in schools. We include this information to demonstrate that the amount of junk food available to children is decreasing in the primary places where children spend their time. We also want to highlight the positive efforts that street vendors undermine by selling unhealthy foods.

In 2002, LAUSD passed the Healthy Beverage Motion, which banned the sale of sodas and other sugary beverages on school campuses. One year later, it passed the Obesity Prevention Motion, which provides nutritional and portion-size standards to all food served and sold on school campuses, excluding meals under the National School Lunch Program (NSLP). These standards primarily apply to items sold in vending machines, student stores, and at fundraisers.

Other changes include the addition of salad bars over a six-year period, second chance breakfast (served after the official breakfast service and before lunch) within two years, and a vegetarian option served daily in the cafeteria. In 2005, the district adopted the Cafeteria Improvement Motion to enhance the nutritional value of meals provided at school. Like the Obesity Prevention Motion, it created policies limiting allowances of sodium, fat, and sugar in prepared meals.

The City of Los Angeles has also made efforts to reduce the high prevalence of childhood obesity. In 2005, it passed the Child Nutrition Policy (CNP) to improve the health and well being of youth in Los Angeles. City Council aims to achieve these goals by targeting school-age children who participate in City-sponsored programs through a three-pronged approach. It requires City Departments to (1) increase access to nutrition programs, (2) provide healthy meals and snacks that encourage healthy choices, and (3) provide nutrition education to children.

Additionally, City Council instructed the L.A. Child Health and Nutrition Task Force to modify food and vending sales contracts to allow for compliance of the CNP. This policy supports the obesity-prevention efforts of LAUSD by extending the “nutritionally safe” environment beyond the periphery of the schools. (For more detailed descriptions of these policies, see Appendix B)

Street Vendors Street vendors can be found throughout Los Angeles. They typically work on sidewalks with heavy pedestrian traffic near parks, plazas, schools, intersections, parking lots, and privately owned venues. The items they sell include, but are not limited to, pre-packaged snacks, cooked 27 food, fruits and vegetables, toys, clothing, household items, and counterfeit merchandise.

The focus of this project is on vendors near elementary schools who sell snack foods to students before, during, and after school hours. They can be found at the school’s immediate periphery or within a two-block radius of the campus. Some vendors sell out of ice cream trucks but the majority does so from baby strollers, shopping carts, coolers, wagons, and push carts (Figure 2.4). While some vendors are present before school hours, most convene a few minutes prior to the end of the school day. Morning vendors typically sell tamales and champurrado, a traditional Mexican drink made from hot chocolate, sugar, hominy flour, and spices. Afterschool vendors sell a wider variety of foods, including chips, candy, ice cream, corn on the cob, GOETZ & WOLSTEIN

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BACKGROUND

shaved ice, nachos, soda, fruit, hot dogs, and pork rind. The foods and toys they sell generally range in price from 25¢ to $1.00.

Based on our observations, children rush towards the vendors to purchase snacks when the school day is over. Some are alone but most are accompanied by an adult, presumably a parent or care-taker, or by friends. However, students who purchase from vendors are not limited to those leaving school by foot. Many vendors situate themselves on street corners so community members and parents can drive up to their cart and either order from the car or have their children get out to make a purchase. Students who remain on school grounds to participate in after-school programs are also customers. Some buy from vendors during the few minutes after the bell rings and before the after-school program starts, while others make purchases through the playground fence.

FIGURE 2.4 Street Vendor Vehicles: Push-cart (left), ice cream truck (middle), baby stroller (right)

Policies Regarding Street Vendors Street vending is illegal throughout Los Angeles. Of the vendors described above, only those selling from licensed ice cream trucks are legal. However, an additional City of Los Angeles mandate prohibits all forms of vending within 500 feet of schools between the hours of 28 7:30 a.m. and 4:00 p.m. on school days.

The principals and teachers at our target schools have made the following efforts to address the street vendor issue:29 • principals sent letters home to the parents asking them not to give their children money to spend on vendor snacks • some teachers have taken it upon themselves to confiscate unhealthy snacks from students and to emphasize the importance of healthy eating • one principal banned Flaming Hot Cheetos from school grounds and announced the ban over the PA system • enforcement of closed-campus policies to prevent students in after-school programs from GOETZ & WOLSTEIN

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BACKGROUND

leaving campus to purchase food items from the vendors.

In the face of these efforts, students continue to purchase unhealthy snacks from the vendors.

Enforcement of Policies Despite existing regulations prohibiting vendors from selling at all, but particularly from doing so near schools, there is ineffective enforcement of these policies. The primary reasons for this are the burden of necessary inter-agency coordination, the low impact of penalties, and the lack of resources of enforcement agencies.

There are three organizations that enforce vendor policies: LAUSD School Police, the Department of Public Health (DPH), and the Los Angeles Police Department (LAPD).

Enforcement of vendor policies involves seizure of food items, carts, and strollers, as well as the citation or arrest of vendors. DPH is the only agency that can independently confiscate vendor carts and/or food, but it has no ability to cite or arrest a person for illegal vending.30 On the other hand, LAPD and School Police can cite and arrest vendors but they cannot confiscate carts unless they are with a DPH officer. Thus, these agencies need to work together to fully enforce existing laws.

If School Police or LAPD were to fully enforce the law, officers would arrest illegal vendors. However, because of a lack of resources, neither of these agencies can do so. LAUSD Police oversees the 700+ schools in the district and has a force of approximately 600 officers. In order for School Police to fully enforce vendor-related policy, two officers would have to arrest the vendor, take him to the local station, and book him. This process would take between four 31 and six hours, and would leave schools unattended during that time. Because of the disproportionate officer-to-school ratio, LAUSD Police officers resort to citing vendors but only when schools or community members make formal complaints. LAPD typically resorts to citations, as well, although they do not specifically focus on vendors near schools.

The citation process, in itself, is a poor enforcement mechanism because it has minimal impact. First, vendors incur fines of about $35 per citation, which most consider the cost of doing business. Second, effective citing can only occur if vendors provide officers with formal identification documents. The majority of street vendors are unable to produce the necessary documents and, instead, give officers their names. Typically, cited vendors are required to appear in court, but the lack of identification unbinds them from this and makes the citation unenforceable.32 None of these agencies considers enforcement of vendor-related policies a high priority.

LAPD deals with serious crimes through the City, School Police focus on gang violence and student safety, and DPH oversees food safety issues throughout the entire County of Los Angeles. These three major players are overwhelmed with other work and, thus, unable to regulate the vendor.

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METHODS

III. Methods There is currently no formal information about the amount of activity of street vendors around schools.

Principals, teachers, and School Police officers, as well as community based obesity-prevention organizations, all believe that street vending is a problem but they are unable to quantify it. As part of this report, we attempt to systematically measure the vendor activity in order to establish its impact on obesity. This information will be the foundation for our policy recommendations.

Interviews We began acquiring information about the street vendor issue through our client’s contacts, who referred us to other sources of information. Throughout the process we accumulated knowledge about vendor-related problems, such as law enforcement, management of the school environment, creation of related LAUSD policy, and nutrition education. Our pool of interview subjects extended across different levels of public and private organizations and expanded from four to 13 interviewees over the course of eight weeks. The people we interviewed included officers from LAPD and LAUSD School Police, LAUSD personnel and administrators, and leaders of community based organizations, like the Center for Food and Justice and L.A.’s BEST, an after-school program.

In particular, we interviewed principals and teachers in our target schools to gain an understanding of vendor activity around schools, and how students, teachers, and principals have been responding to the existing situation. Because the teachers and principals have the most contact with the students and observe what happens at school every day, they were able to give us first hand accounts. (See Appendix C for a list of interviewees.)

Each person we approached was willing to speak with us and all seemed eager to find a solution to the street vendor problem and to contribute his/her expertise to do so.

Surveys We distributed a 17-question survey to all 3rd, 4th and 5th grade students at Norwood Elementary, 20th Street Elementary and Hooper Elementary as a way to measure the demand for vendor goods (Appendix D). Of the 1,309 students in these grades whose classes were on-track, we collected responses from 776 students, or 59% of the total population.ii Students did not ii

The response rates for Norwood and 20th Street were closer to 90%. In these schools, 23 students were absent, 17

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METHODS

respond because of absence from school, insufficient completion of the survey, the teacher's decision to not participate, or student testing. When classes participated in the survey all students in that classroom participated. Therefore, there is no bias within classes but there could be bias across classes. Because students are assigned randomly to classes we do not suspect differences between students in the sample and those who did not participate.

Prior to conducting the survey we sent letters home to parents in both English and Spanish describing our project and explaining that the survey was voluntary (Appendix E).

Students filled out surveys on Fridays to make it easier for them to remember their weekly activity. Teachers administered them in their classes, using a prepared script that asked each teacher to read the questions and answers aloud and to clarify the questions, if necessary (Appendix F). We personally distributed the survey to two classes and read the teacher script.

Each survey took approximately 10-15 minutes to administer and complete.

The purpose of the survey was to learn about students’ behaviors in regards to the vendors. It asked them how often they buy food items from vendors outside their schools, what types of foods they buy, and whom they are with while purchasing goods. We also collected independent measures such as age, grade, and language spoken at home.

We surveyed students in 3rd, 4th, and 5th grades based on the recommendation from the school principals about students’ ability to comprehend and respond to the questions. While we are also interested in the activity of younger students, we concluded that these children would have difficulty completing a survey, and time limitations prevented us from administering the survey to each student individually. We chose to survey the students because there is no other reliable source of information; teachers and principals can only estimate the level of activity.

We acknowledge some limitations on our survey. To ensure these young students would respond completely, we kept the survey short, which means we were unable to ask every question we considered. We also wanted more information about the students' weight but we chose not to ask sensitive questions. Therefore, we can only speculate that those kids who buy frequently from the vendors are overweight or obese. There may also be some instrumentation effects because the teachers could have varied their instructions while distributing the survey, despite our guidance.

Questionnaires We completed questionnaires with eight street vendors that work outside the target schools as a means of measuring the supply of vendor goods and vendor activity. Of the vendors we spoke with, four sell from shopping carts, two from strollers, and two from trucks. We chose to speak to different types of vendors in order to have a representative sample of the total students did not participate because the teacher declined, and ten students had incomplete responses. Hooper's response rate was much lower at 37%. This is because Hooper was doing standardized testing at the time of our survey distribution.

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METHODS

population of vendors. We approached the vendors before and after the school day ended. We asked those who were amenable to speaking with us about the products they sell, their prices, clientele, and beliefs about the healthfulness of their goods. The information provided was used to complete the questionnaire (Appendix G). Conversations were conducted in Spanish and each one lasted approximately ten minutes. This was the best way to learn what goods vendors sell and who their clientele is because of the transient and independent nature of their work.

We approached two vendors who did not want to speak with us. We also did not interview all vendors around the schools because of the mobility of their business and limited working hours. Regardless, we believe our sample is representative because we spoke to vendors that sold each type of food and used each type of vehicle (truck, push cart, stroller, shopping cart). Additionally, prices did not vary substantially across vendors, so speaking with more would not necessarily have guaranteed new insight regarding the supply of goods. While at the schools we observed the vendors and saw that foods sold fell into five categories, which were hot food, ice cream, pre-packaged snacks, drinks and produce.

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ANALYSIS

IV. Analysis of Findings From the information collected through the student surveys and vendor questionnaires, we determine the market for vendor goods outside our target schools. With this general idea of what the purchasing patterns are for unhealthy snacks, we can estimate their impact on child health and risk for obesity.

Survey Results With the survey responses, we can estimate the demand for snacks sold by vendors. Of our sample of 776 students, 83% responded that they buy food from the vendors. Of those who said they do buy food from the vendors, 54% said they buy food one or two times per week, 17% said three or four times per week, and another 28% said five or more times a week (Figure 4.1).

Ninety-four percent of the students who buy food do so after school.

Although the proportion of students who purchase snacks five or more times per week seems low, in reality this is cause for concern. The percentage of children in each of the higher frequency groups is close to those who qualify as overweight and obese. We cannot claim that a correlation exists between these groups; rather, we point out the significant of these numbers.

FIGURE 4.1 Frequency of Vendor Use per Week

FIGURE 4.2 Number of Items Purchased per Visit 45

60

41 38

40

30

28

20

percent

percent

54

20

15

17 0 1 or 2 times 3 or 4 times

5+ times

0 o ne s nac k

t wo s nac k s

three s nac k s

Of the students who buy from the vendors, 38% said they buy one item, 41% said they buy two, and 20% said they buy three (Figure 4.2). This information allows us to further estimate the number of calories consumed by students who purchase snacks from the vendors. Because a large portion buys two snacks, the number of calories they consume could be twice as many as those who purchase only one snack.iii This information was confirmed during interviews with the iii

A few students said they buy more than three items but we placed them in the group that buys three items. While

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vendors, who claimed that most students purchase one or two food items per visit.

The snack most frequently purchased by students is chips, with 74% of students responding that they buy chips from the vendors (Figure 4.3). The vendors confirmed that chips are, in fact, the most popular item they sell. Flaming Hot Cheetos were specifically mentioned as the favorite in the chip selection. Ice cream (51%) and candy (44%) were the next most commonly purchased items. Soda, water, juice, and sports drinks are all popular as well, with purchase frequency ranging from approximately 43% to 36%, respectively.

FIGURE 4.3 Popularity of Vendor Snacks 80

percent

60 40 20

ot he ce r re al ba r

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About half (53%) of the students who buy food from the vendors are with an adult, presumably their parent or caretaker who picks them up from school (Figure 4.4). Another 34% buy food with their friends, and 13% buy on their own.

When asked what they would do if they wanted a snack and the vendors were not there, almost 42% of the students said they would buy a snack from a local store or a local restaurant.

Thirty-seven percent would not buy anything, and 21% would bring a snack from home (Figure 4.5). Therefore, without the easy access the vendors provide, nearly 60% of the students who currently buy food from them would either forgo buying a snack or would simply bring one from home. We cannot assume snacks from home are necessarily healthier but the home food environment is beyond our scope for this project.

designing the survey, we did not anticipate that students would buy more than three items at a time.

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FIGURE 4.4 With Whom Students Visit the Vendors

FIGURE 4.5 What Students Would Do If There Were No Vendors 40

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Trends Related to the Frequency of Purchasing Of particular interest are the differences in activity of students who buy vendor-sold snacks everyday in comparison to those who do so less frequently. With this information we can determine the varying impact of these snacks, depending on how often students buy them, and what potential impact our recommendations will have. We define students who buy snacks one or two times a week as “low frequency,” three or four times a week as “medium frequency,” and everyday as “high frequency.”

TABLE 4.1: Breakdown of Students By Level of Purchasing Frequency Percent of Medium Responses (in Low Frequency High Frequency Frequency boxes) How many items do you buy?

One 51 26 21 Two 37 55 42 Three 12 19 37 With whom do you buy?

Alone 9 11 20 With friends 34 42 30 With an adult 57 47 50 If there were no vendors, what would you do?

Buy nothing 45 34 26 Bring snack from 24 22 13 home Buy snack from 32 44 61 store/restaurant

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These findings show that more high frequency students buy three items per visit than do medium and low frequency students. More of these students would also seek an alternative source for snacks in their neighborhoods than students who purchase vendor snacks at lower frequencies (Table 4.1). For instance, 61% of high frequency students claim they would visit a store or restaurant in the absence of the vendors. Therefore, we imagine this group would substitute other unhealthy snacks by purchasing them elsewhere.

Low and medium-frequency students make up the group that buys fewer snacks per visit and is less likely to visit a store or restaurant to substitute for vendor-snacks. If the vendors were not present, these students would be more likely to bring a snack from home or buy nothing. In other words, because of their relative indifference about purchasing a snack after school, these students may not substitute anything or may actually be willing to substitute a healthy snack, if it were available.

We also have information about the students’ preferences for snacks and we can see some differences in the three groups of students (Table 4.2). High frequency students say they prefer more chips and less fruit and vegetables than the low frequency students. However, when asked what they wish they could buy from vendors, each group of students gave roughly the same answers, suggesting that perhaps the high frequency group would buy fruit if it were available.

TABLE 4.2: Percentages of students in each frequency category who gave the following responses to the listed questions Percent of Medium Responses Low Frequency High Frequency Frequency (in boxes) What is your favorite snack?

Candy/Sweets 11 19 10 Cheetos/chips 41 55 51 Fruit/Vegetables 15 10 9 Hot food 5 4 6 Ice cream 10 2 8 Sandwich 5 2 2 What do you wish you could buy?

Candy/Sweets Chips Fruit/Vegetables Hot food Ice cream Juice/Water Soda/Sports drinks Non-food items

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10 3 7 14 2 2 5 35

12 7 7 11 5 3 3 36

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Supply of Snacks by Vendors As mentioned above, the street vendors arrive at the school periphery shortly before the end of the school day and most only sell for twenty to thirty minutes. In general, the goods they sell are chips, soda, juice, candy, ice cream, and corn. The price of chips ranges from 50¢ to $1.00, depending on the size of the bag. Sodas and juice cost 50¢. Candy ranges from 25¢ for two small pieces to 75¢ for a bag of M&Ms, Reese’s Pieces, etc. The most popular items are Flaming Hot chips, particularly Flaming Hot Cheetos, ice cream, candy, and soda.

All interviewed vendors claim their primary and secondary customers are parents and students, respectively. Parents often purchase snacks for the kids upon picking them up from school. However, many students buy their own snacks.

The number of customers each vendor gets varies based on his/her inventory. Vendors carrying a wide variety of food items in high quantities can get between 20 and 45 customers per visit. Vendors with limited supplies usually do business with five to seven customers per site.

Because street vendors are mobile they typically travel to neighboring schools and parks, and reach a much larger customer base. In some instances vendors use their own children to sell items to other students. During an interview with a vendor, we observed her daughter, a high school student, selling chips through the school’s gate to students in after-school programs.

When asked about their products, most of the vendors replied that they do not believe they sell healthy snacks, and agreed that they primarily sell unhealthy ones. All but one were willing to attend a free nutrition education class held in a school or community center.

Analysis Concerning the Impact of Unhealthy Snacks on Obesity Based on the data collected from the surveys and interviews with the street vendors, we were able to determine which individual snacks and combinations of these foods the students at our target schools consume. Using three categories of energy expenditure, we analyze the impact of these snacks on daily nutrition by establishing what percentage of a student’s daily recommended caloric intake is composed of vendor snacks. With this information we estimate the over-consumption of calories that results from eating vendor snacks.

We compare the over consumption of calories from vendor snacks against the USDA’s recommended caloric intake rather than the counterfactual of what the students would consume if there were no vendors. Determining the counterfactual would have been difficult given our time and resources, so we rely on federal nutrition standards, which are an appropriate measure iv for determining over consumption. iv Obtaining information regarding the snacking habits of students in our sample would have required a 24-hour

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Proportion of Calories Consumed by Unhealthy Snacksv The 2005 Dietary Guidelines for Americans, produced by the United States Department of Agriculture (USDA), provides science-based recommendations for food intake according to a personâ&#x20AC;&#x2122;s age, gender, and level of physical activity. We generate recommendations for students based on the USDAâ&#x20AC;&#x2122;s three levels of physical activity (less than 30 minutes, 30 to 60 minutes, vi and more than 60 minutes of moderate to vigorous physical activity or MVPA ). The average intake recommendations for all children from lowest to highest level of energy expenditure are 1525, 1750, and 2000 calories (Table 4.3). We then calculate the fraction of calories consumed through vendor-sold snacks by dividing the average calories in popular snack food categories by the USDAâ&#x20AC;&#x2122;s recommended calorie intake for each level of energy expenditure.vii TABLE 4.3: Calorie intake recommendations for children ages 8 to 11, based on physical activity levels <30 Min. Exercise

30-60 Min. Exercise

>60 Min. Exercise

Females

1450

1700

1900

Males

1600

1800

2100

All Students

1525

1750

2000

If we take chips, the most popular snack, our findings suggest that students who purchase chips from the vendors consume an average of 300 snack calories (Appendix H). In terms of daily-recommended calorie consumption, those who eat chips and engage in less than 30 minutes of exercise allot 20% of their daily calories to this particular snack (Figure 4.6). Students who exercise 30 to 60 minutes per day assign 17% of their calories to chips, and those who exercise more than 60 minutes per day consume 15% of their calories from chips. Students who purchase both chips and soda consume an average of 480 snack calories and dedicate 31%, 28%, and 24% of their recommended daily intake to snacks, based on low to high energy expenditure, respectively (Figure 4.7).

Using average lunch and breakfast calories, and those from vendor-sold snacks, we can determine the number of calories students should consume during the rest of the day to remain in the recommended caloric allowance.viii For students consuming chips as a snack, eating lunch and breakfast, and exercising less than 30 minutes, a meager 345 calories (23% of daily calories) food recall from each student in our sample. Our sample size would have been significantly smaller because this method is very time consuming; it would have made our results less reliable. v The information included in this section regarding student eating patterns reflects the following information: 79% of elementary school students in LAUSD eat breakfast (California Healthy Kids Survey, 2005) and 80% of surveyed students eat lunch provided by NSLP (Appendix I, Figure L) vi The Centers for Disease Control defines Moderate to Vigorous Physical Activity as efforts that produces increased breathing or heart rate or any activity that burns 3.5 to 7 calories per minute. vii These are conservative averages. For more details see Appendix H. viii These estimates are conservative. For more details see Appendix H.

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are left for consumption within the recommended range. Those exercising 30 to 60 minutes and more than 60 minutes are left with 570 and 820 calories (33% and 41%) to consume during the day, respectively. Those eating both chips and soda are left with 165, 390, and 640 calories (11%, 22%, 32%) to consume during the rest of the day, based on energy expenditure ranging from low to high. Therefore, vendor snacks take up a substantial portion of a studentâ&#x20AC;&#x2122;s daily recommended calories, particularly if that child does not engage in more than 60 minutes of physical activity per day.

energy expenditure

FIGURE 4.6 Distribution of daily recommended caloric intake with a chips snack 20

< 30 m in

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energy expenditure

FIGURE 4.7 Distribution of daily recommended caloric intake with a chips & soda snack 20

< 30 m in

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Although there is no existing information regarding the average calories in a studentâ&#x20AC;&#x2122;s dinner, we can assume that dinner is comparable to lunch in order to approximate the overconsumption caused by vendor snacks. Students who engage in less than 60 minutes of exercise and consume vendor snacks will surpass or exactly meet their daily recommended allowance.

Those who consume a higher number of snack calories will over-consume by a greater amount. See Figures 4.8 and 4.9 for estimates of the over-consumption that occurs from eating vendor snacks.

There are other factors that lead us to believe that over-consumption exists on the GOETZ & WOLSTEIN

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extreme end of, and even beyond, our predictions. First, elementary students engage in only 45 minutes of MVPA per week, or nine minutes per school day, through PE classes.33 Based on our observations of students during recess and lunchtime, the energy that they expend while playing does not qualify as MVPA and does not contribute much to their daily energy expenditure.

Additionally, most surveyed students do not participate in after-school programs, of which some focus on physical activity (Appendix I). The majority of students in our study fall into the lowest energy expenditure range. Therefore, students who eat vendor snacks surpass their daily caloric recommendations by at least 10%, or 150 calories, which is the average number of calories in half a bag of chips.

energy expenditure

FIGURE 4.8 Over-consumption of recommended caloric intake with a chips snack 20

<3 0 m in 3 0 -6 0 m in

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FIGURE 4.9 Over-consumption of recommended caloric intake with a chips & soda snack

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The second factor that leads us to believe that over-consumption exists beyond our predictions is that students consume more than one snack per day. Research shows that 98% of 34 children consume three snacks per day, and 50% consume five snacks per day. Our calculations are based on one and two snacks but children may be surpassing their recommended intake levels by a much greater amount. We also know from our survey that 40% of students bring GOETZ & WOLSTEIN

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snacks to school as often as five times a week.

This information is particularly important in regards to the obesity epidemic because over-consumption, or expenditure of less energy than one’s intake, leads to weight gain.

Research shows that for every 3,500 stored calories (those not burned through energy 35 expenditure) one gains an excess pound of fat. Theoretically, if students are consuming 100 additional calories per day, they can gain one pound within a 35 day period. One study shows that younger children gain approximately one additional pound of fat per year, which could be 36 prevented by consuming 100 to 165 fewer calories per day. Over the course of a lifetime, this amount of over-consumption can lead to obesity and its accompanying detrimental health effects.

Energy Density of Unhealthy Snacks In addition to caloric intake, the energy density of vendor-sold snacks also plays an important role in the nutrition of children who consume them. The energy density of a food is represented as the ratio of total calories per servings divided by the number of grams of weight per serving. Foods that have more water and fiber have lower energy densities than foods with sugar and fat because they have fewer calories per unit. For instance, an apple has an energy 37 density of 0.6 kcal/gix while a bagel has an energy density of 2 kcal/g. In terms of diet, this measure is significant because energy density is negatively correlated with satiety. A food of low energy density will fill a person faster and with fewer calories than will a food of high energy density.

Research has shown that foods with an energy density above 1.5 kcal/g lead to “passive over-consumption” of calories.38 One should eat foods with energy densities at or below 1.1 kcal/g to avoid passive over-consumption and the resultant weight gain.

The majority of foods sold by vendors, especially the most popular among students in our sample, are of high energy density (Table 4.4). We calculated the average energy density for vendor-sold chips and found it to be 5.5 kcal/g. Flaming Hot Cheetos, the most popular snack, have an energy density of 6 kcal/g. American candies sold by vendors, including Skittles, M&Ms, Snickers, and Fruit Roll Ups, have an average energy density of 4.4 kcal/g. The snacks with the lowest energy density were Mexican candies, with an average energy density of 2.3.

TABLE 4.4: Energy density of popular vendor-sold snacks Average Energy Density Food (kcal/g) Chips 5.5 American Candy 4.4 Mexican Candy 2.3 ix

A kcal, or kilocalorie, is the scientific term for the commonly used measure “calorie”. We refer to kcals only for arithmetic purposes.

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ANALYSIS

The energy density of these snacks is important in regards to obesity because the snacks students are eating are not only calorie-rich, as we saw in the previous section, but also nutrientpoor. All vendor-sold snacks have high energy densities and will lead to passive overconsumption of “empty” calories. Therefore, students will eat more calories to establish a “full” sensation throughout the day, which will increase the likelihood by the end of the day that they will have surpassed their recommended caloric intake level.

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THEORETICAL FRAMEWORK

V. Theoretical Framework for Policy Recommendations There have been numerous studies on the causes of obesity and the success rates of different interventions. We use this existing research as a framework for designing our policy options.

Availability of Healthier Options Literature on the food choices suggests people are more likely to consume a healthy option when there are more of them available in relation to unhealthy options. One study in particular showed the effects of reducing the number of unhealthy entrees from two-thirds to one-third in school cafeterias. The selection of healthy entrees increased substantially when the 39 competing high-fat entrĂŠe was reduced to one option. This is pertinent to our study in that it suggests that an increase in the ratio of healthy to unhealthy snack options could increase the likelihood that children will select healthy snacks. In other words, children are more likely to select healthy options when there are a number of them to choose from.

Pricing Strategies The literature regarding pricing shows a strong relationship between low price and healthy choice. One study showed that price reductions of low-fat snacks of 50%, 25%, and 10% 40 were associated with increases in low-fat snack sales of 93%, 39%, and 9%, respectively. The effects of the 50% reduction also showed to be greater in schools than worksites, which suggests that such an intervention would be successful in areas where kids are the primary consumers.

This study also demonstrates that in the 25% and 50% price reduction scenarios there were increases in overall sales, suggesting either that the price reduction attracted new customers or that the same customers purchased more low-fat snacks. Another study in high school cafeterias showed that a price reduction of 50% of fresh fruit and baby carrots increased consumption by 41 200% to 400%, respectively. Because street vendors are already providing unhealthy snacks at very low cost, successful promotion of healthy snacks would require a further reduction in price of those healthy options.

Market Theory The above information about pricing draws on economic principles about demand and supply of goods. If the price of a good decreases, the demand for that good will increase. The supply will also increase to respond to the change in demand in order to reach a new market equilibrium. Other factors that shift demand and supply are price changes in substitutes and new GOETZ & WOLSTEIN

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information, such as the health effects of the good. For example, if pretzels are a substitute for chips and the price of pretzels falls, the demand for pretzels will increase while the demand for chips will fall. If new information influenced consumers’ behavior, like knowing that certain foods contribute to obesity, the demand will decrease as well.

In addition, firms will exit a market if they cannot sell enough to cover their costs. If new firms were to enter and they had lower production costs, they could push existing firms out of the market. We propose that if a new seller of snacks enters the market and has a cost advantage, it could reduce the demand for the vendors and slowly push them out of the market.

School-based interventions The school is the ideal environment for implementing strategies to address obesity because of the school’s stable, structured environment and the ability to reach the majority of 42 children. The school has the capacity to influence nutrition education, meal content and physical activity level, which are all useful ways to fight obesity. There is evidence that schoolbased interventions are effective ways to reduce or slow the rate of obesity in children. For example, the Teens Eating for Energy and Nutrition at School (TEENS) study was a randomized school-based intervention in middle schools in the Midwest with the goal of “evaluating school and family-linked intervention strategies to promote students’ consumption of fruit, vegetable 43 and lower-fat snacks.” There were several components of the intervention that targeted both the school and home environments. This intervention had more success in improving the school lunch offerings than in improving the home food environment. Improving the school food environment and fighting obesity in the school is more feasible than the home because of many additional factors that shape what families eat at home, like income, access to grocery stores and time constraints.

Over 80% of Californians believe that public schools should take a major role in 44 providing information to children and parents about obesity. Schools were ranked only second to health care providers as the desired source of obesity education. Nearly all Californians surveyed expressed support for “enforcing current school requirements to teach students about healthy weight, nutrition and physical activity.”45

Education’s Role in Obesity Prevention Education about healthy lifestyles, particularly disseminated in schools, is a possible way to change behaviors and influence children who are overweight or at risk of being overweight. A review of school-based interventions showed that nearly all of those reviewed included an education component that focused on teaching children about healthy eating and physical 46 activity. Education is used with the goal of influencing behaviors and producing life-long 47 changes in eating habits and activity. Informal evidence suggests that teacher to student GOETZ & WOLSTEIN

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education can make a small difference. One teacher we spoke to said some students responded with changed behaviors when she shared informal information about healthy eating and 48 exercise. However, studies about successful interventions show that nutrition education is not 49 very effective alone but is effective when used in combination with other components. Using education is useful for increasing knowledge about healthy eating but is not the most effective way to change behavior.

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CRITERIA

VI. CRITERIA Choosing the Criteria Based on our interviews with school district officials, police departments, school principals and teachers and participating members of the COBT, the important factors to consider when designing a policy are how politically feasible it is, how technically feasible it is, given the resources and authority of the schools and school district, and how effective it will be at reducing the problem.

Our interviews suggest that political and technical feasibility are the most important criteria to use when evaluating options. Any recommendation that involves the school must be acceptable to both individual schools and the school district.

Otherwise, HEAC is limited in what it can do, unless the recommendation only involves the environment outside the school. In addition, any recommendation must recognize the limited resources of the district, police force and school site personnel, particularly when these players have so many other responsibilities within the school environment.

The third criterion is the degree of effectiveness, or the option's ability to reduce the number of students purchasing unhealthy snacks. To determine how effective the policy options will be, we use the above research and evidence about obesity interventions as guidance. The policy recommendation will be stronger if it has a basis in existing obesity research because we can say with more certainty that it will be effective at addressing this problem.

Political feasibility There are many stakeholders in this particular issue because it affects the schools, the community, and the City. Our policy recommendation must depend on what is feasible given the current political constraints of the school district and the schools themselves. Our recommendation must gain support from the teachers and the principals because they often have personal relationships with the vendors, get support from the school district because the individual schools must comply with district policy, and not interfere with existing city policy or law.

In addition, HEAC is concerned about the potential harmful impact on the vendors GOETZ & WOLSTEIN

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because they are members of the community. Along with the teachers and principals, HEAC wants to strike a balance between limiting unhealthy snack sales and possibly cutting off someone’s only means of financial support. While we do not specifically address the broader social issues involved with street vending, we do acknowledge their existence by trying to limit the harm to the vendors. Thus, the measures of political feasibility will be: • •

The level of support from teachers, principals, the school district, the city, and parents Minimization of the harm to vendors

Technical feasibility A recommendation must take into account the difficulty of limiting vendor activity or changing the students’ behavior. The schools and school district have financial and organizational constraints and may find it difficult to devote time and money to this problem because of other educational goals and requirements. The city and school police have higher priorities and limited resources to enforce vending laws.

As mentioned above, there are many stakeholders in this issue and implementation of options requires cooperation among these different people or their respective agencies. For example, decisions that come from the school district must be implemented in the schools with the cooperation of principals and teachers. The technical feasibility of our recommendation will be measured by: • •

The amount of money and number of personnel needed from the school, the school district, the city and community-based organizations The necessary level of inter-agency cooperation and coordination

Degree of Effectiveness We will evaluate policy options according to their capacity to reduce the number of students who buy snacks from the street vendors. We draw on existing research and knowledge of successful obesity interventions as a basis for designing our own recommendation. In particular, we are using examples of successful efforts to change behavior and educate children about nutrition. Effectiveness will be measured by: •

The reduction in the number of children who buy unhealthy snacks from the street vendors

Overall, we will use these criteria to choose a policy option that will be supported by key stakeholders, will be technically feasible given existing financial and organizational constraints and will be an effective way to reduce the number of students buying vendor snacks.

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RECOMMENDATIONS

VII. POLICY RECOMMENDATIONS Based on our findings, theoretical background, and knowledge of the existing system of enforcement and education, we have considered the following options for HEAC to carry out:

A. Work with the schools and district to create a program of low-cost, healthy snack sales after school, and promote the enforcement of a closedcampus policy.

The convenience of street vendors, in regards to their location and low-cost of their foods, seems to be driving students to purchase snacks from them. Therefore, a program that is more convenient can be established to compete with the vendors.

LAUSD can create a program where low-cost, healthy snacks are sold at the end of the school day and on school grounds. Because the snacks would be sold in schools they would naturally be compliant with LAUSD nutrition policies, thus making them healthier than the snacks sold by vendors.

Individual schools can ask parent volunteers to help with sales and basic food preparation, which avoids the high costs of hiring and builds the parent community in the school.

Parents will gain a sense of ownership and participation in the school, particularly if they understand that the purpose of having healthier snacks is to combat obesity in their children and community.

The low-cost and greater convenience will drive students to buy those snacks instead of snacks from the vendors. This will reduce the number of students who purchase unhealthy vendor goods by offering a substitute at a lower price.

Finally, implementation of the closed-campus policy after school will prevent students in after-school programs from leaving campus to purchase foods from the vendors. One principal noted that she does not currently enforce this policy because she understands that, during the five hours between lunch and the time children are picked up from school, they need a snack.50 Thus, making a snack available on campus would eliminate the need for lax closed-campus policies and would likely reach students who are in after-school programs. (Implementation details are in Appendix J)

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Discussion Political feasibility This option is likely to earn support from the school personnel and LAUSD, particularly if the parents get involved in the snack program. The district will not support a program that requires the dedication of additional resources, including personnel, but will support a program that encourages healthy eating and parental involvement at low cost. Although LAUSD has had to deal with problems regarding fraud and the allocation of food sale profits, the school-based snack program will not be created for the purpose of raising money.

The school-based snack program does not directly interfere with vendor business but may cause their sales to decrease through market competition. Their businesses will not be forcibly shut down, allowing them to sell elsewhere, nor will enforcement of existing vendor-related policies be increased.

Technical feasibility To be able to afford snacks at a lower cost than the vendors, this option will require the participation of school parents. Parents can volunteer their time but they would have to commit to run the program, which may be difficult depending on work schedules and time constraints.

The schools also have to acquire the healthier foods, which means working with existing vendors or finding new suppliers. The school might have to negotiate costs to avoid charging high prices for these snacks. In order to keep prices low to draw customers, the school or district might consider subsidizing snack purchases. After settling these initial cost and staff arrangements, the program would not be difficult to manage because it would only be there after school hours and for a short period of time.

Degree of effectiveness This option is well grounded in obesity-intervention theory because it would take place in the school itself, would increase the amount of healthy options available to the students, would make the price of food items equal to or less than those offered by vendors, and would also increase the accessibility of healthy snacks.

Making healthy snacks more convenient and accessible will encourage the purchase of these snacks over vendor goods. The theory of market competition suggests this option is a viable solution; if the school can provide a substitute for the vendor goods, the students will have additional options from which to choose. In other words, by offering alternatives to vendor-sold snacks such a program will also increase the likelihood that students will consume better foods than those offered by the vendors. This policy alternative will be effective at reducing the number of students who buy snacks from the vendors and could reduce the total sales of vendor snacks overall.

The foods offered through this school-based snack program are demanded by students.

Our survey responses show that 20% of students would buy fruit and vegetables if they could.

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Currently, however, these snacks are not readily available to students. Incorporating preferred foods into the snack program will also increase the likelihood that children will purchase them.

B. Provide educational information to the vendors about the effect of energy-dense snacks on obesity This option would involve one-on-one or group outreach to the vendors by HEAC and/or x its community affiliates, like the Promotoras. The education component should include information about the harmful health effects of the foods they sell, alternative items, ways they can comply with LAUSD and City nutrition policy, and a presentation of student demands. Street vendors would also benefit from information about where to purchase low-cost, healthy foods, information about preparing foods in a healthier way, and non-comestible options they can sell.

Many of the vendors are already aware that their products are unhealthy, and seem only to sell them because of their high demand and resultant profitability. This suggests a willingness to sell healthier foods as long as they generate equal or greater profits. Additionally, learning that their products contribute to the obesity epidemic may put pressure on the vendors to replace some of their food items with healthier ones.

Based on our interviews, the vendors generally seem willing to participate in a nutrition class that would be free of charge and conducted in a neutral environment, such as a local school or recreation center. Those who said they would not attend noted lack of time for a nutrition class as the primary reason, thus supporting the idea of one-on-one outreach while the vendors are waiting for their clients to leave school.

Discussion Political feasibility Most stakeholders are unlikely to disagree with this option because it does not directly involve the schools or the local government, aside from potentially using their facilities to hold group education classes. LAUSD is likely to be less supportive of this option because it is not able to support a partnership with the illegal street vendors. Furthermore, LAUSD does not support their presence because they undermine the nutrition policies that it worked so hard to implement.51 This option will not harm the vendors because they will simply learn about nutrition and how they can contribute to the improvement of their communityâ&#x20AC;&#x2122;s health. As parents and community members they will likely feel compelled to do so. Additionally, they will be given information about alternatives to their current food choices. Educators will provide information about where to purchase healthier foods and non-food items. Such information will facilitate the transition to healthier food sales or non-food sales. x Promotoras are health advocates for the Latino Community.

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Technical feasibility This policy option may be technically difficult to implement because of the transient nature of the vendors and the number of people required to do one-on-one outreach. First, there is no guarantee that the vendors will be in the same place each day. Second, they may be unwilling to speak with an educator for more than a few minutes because of their need to attend to clients, as well as their need to move quickly from one location to another. Finally, they may be reluctant to speak with unfamiliar people.

Degree of effectiveness Because street vendors are business people with the primary goal of generating profit, there is no guarantee that they will change their behavior, especially if the demand for unhealthy foods is greater than that for healthier items.

C. Provide more educational information to parents and children about the harmful effects of the vendors Although many students independently purchase food from the vendors, slightly more than half do so with their parents. This leads us to believe that children, but especially their parents, may be unaware of the negative health impacts of these snacks. The schools currently address this issue with parents by sending home information about the harm of junk food.

However, there is a large capacity for more information to be disseminated. Much of this information is distributed informally, but the school could formalize the process. For example, the school could provide a monthly newsletter that addresses healthy eating and physical activity, or could create regularly scheduled assemblies to which both parents and students are invited.

Information to include would be ideas of healthy snacks that appeal to children, why vendor snacks are bad for oneâ&#x20AC;&#x2122;s health, and how to respond to children who demand unhealthy snacks.

In regards to student education, teachers are more restricted because of the lack of federal funding for nutrition education. However, teachers can complement the health component taught from a textbook by pointing out the high calorie, fat, and sodium levels found in vendor snacks.

Principals can also encourage teachers to participate in Nutrition Network, which serves to encourage students in low-income communities to make healthy food choices by enhancing their curriculum with food-related examples. Assemblies directed at eating behaviors, such as those noted above, would also help educate students. Finally, principals can recommend that teachers serve as examples of healthy eating.

The principals and teachers do not see parental nutrition education as part of their role, in part because of the sensitive nature of topics like obesity and unhealthy eating. Information dissemination, whether to parents or students, should be less intrusive and done on a broad scale so that families and individuals do not feel singled out. If this education were presented in a friendly, fun, and supportive manner, parents and children would likely be responsive.

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Discussion Political feasibility The school would support giving more education to parents and students, although on a more informal basis because of curriculum constraints. LAUSD cannot add an additional nutrition component to the curriculum because of strict allocation of federal funds to other xi education programs. However, they would support increased utilization of supplemental programs, like Nutrition Network.

Education-based policy would not harm the vendors. They would likely still get business from students and parents, although possibly at a lower level.

Technical feasibility This option is technically feasible because the teachers can incorporate nutrition education into their regular teaching program as they best see fit, depending on other teaching requirements. In term of parent education, the schools currently hold free classes for parents, through which some information about nutrition is presented. Schools would likely support expanded efforts at educating the parents.

Nutrition education does not necessarily cost much because there are multiple sources of free education. For instance, schools could send home educational brochures from the National Dairy Council and/or American Cancer Society. Similarly, the 5-A-Day Campaign offers free classes about the importance of incorporating fruits and vegetables into oneâ&#x20AC;&#x2122;s diet. Schools can and should take advantage of these resources. To involve more parents, schools can take advantage of existing parent-education classes, sponsored by Head Start and First 5, as venues to inform parents about child nutrition. To increase participation, schools can engage in heavier promotion of these classes and consider offering them at more convenient time for parents.

Degree of effectiveness Interviews with teachers indicated that students are receptive to information about food and exercise.52 They are likely to adapt their behavior based on new information if is supports other health related components like increased physical activity.53 Education alone is not very effective at changing behaviors but this option could be more effective when paired with another nutrition or physical activity intervention.

xi Currently LAUSDâ&#x20AC;&#x2122;s nutrition education comes from a health textbook and is sub par. It is neither comprehensive nor teaches students practical nutrition-related skills.

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D. Encourage improvement of the current system of monitoring of the vendors and enforcement of existing laws.

If the vendors did not situate themselves outside schools, substantially fewer students would purchase unhealthy snacks immediately after school. To remove the vendors from the school periphery, the LAUSD School Police, DPH, LAPD, and school principals can increase the enforcement of vendor laws outside the school. In particular, these agencies can increase patrol units and enforcement in areas where the vendor problem is most intense (see Figures 7.1 & 7.2).

Certain principals have taken a strong stance against the vendor issue and have made a concerted effort to address it. They have done so by enforcing closed-campus policies, sending letters to parents asking them to stop purchasing food from the vendors, and telling vendors to leave the school periphery. Based on previous experience, these all seem to have a positive effect on temporarily reducing vendor use.

Discussion Political feasibility Although the school district would highly support this policy option, it is politically infeasible because of the level of opposition that would arise from other stakeholders. Some teachers and principals are hesitant to support a higher level of enforcement because many of the vendors are parents who solely rely on the income generated by after-school snack sales. In other words, they would indirectly be hurting some of their students by preventing vendors from working outside the schools. Elected City officials would also not support such a policy because it targets a group that is predominately composed of first and second generation immigrants.

Likewise, HEAC also disagrees with the complete elimination of vendors because of its implications on immigrant rights. We also believe that the community would oppose a measure as aggressive as this, in particular because of its discomfort and distrust of police officers.

Technical feasibility The School Police, LAPD, and DPH do not have the resources to enforce vendor policies around every school. Illegal street vending is a low priority for these agencies, and none have the manpower to fully enforce the laws. It is not feasible to expect more enforcement over in either the short or long term.

Degree of effectiveness This option could be very effective at reducing the snack sales and studentsâ&#x20AC;&#x2122; purchases of unhealthy snacks. If the police restrict vendor activity, the market would essentially disappear or would at least be much smaller. Without this supply of after-school snacks from vendors, the students would be purchasing less of these snacks all together because there are few alternatives in the immediate neighborhood from which they could purchase unhealthy snacks.

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Scoring the Options To evaluate our policy options, we use the following scoring system to measure our alternatives against the criteria. This system made it easy to see where the alternative succeeded or failed to meet the stated criteria, and which option(s) is most preferable. Table 7.1 displays the scores assigned to each policy option. We choose the option that best meets our criteria, or has the highest positive value, as our recommendation for HEAC.

“++” = favorable “-” = unfavorable

“+” = acceptable “0” = not applicable

The explanations of the symbols and their meaning for each criterion are listed below.

Political Feasibility •

•

•

“++” is given if all stakeholders (i.e., the school district, teachers/principals, the city, and community based organizations) support the option and would ensure it xii gets implemented at the target schools ; has no intentional harm to the vendors (i.e., does not forcefully prevent them from doing business) “+” is given if half the stakeholders (i.e., teachers/principals, and community based-organizations) support the option but the other half would block it from being implemented (i.e., LAUSD, the city); has minimal harm to the vendors (i.e., may adversely affect their business) “-” is given if no stakeholders support the option and would prevent it from being pursued further; imposes intentional harm on the vendors (i.e., forcefully prevents them from doing business)

Technical Feasibility •

•

•

“++” is given if the option does not cost the schools, district, city, or organization any money and does not require the additional hiring of personnel to implement the option; would only require intra-agency coordination (i.e., individual schools) “+” is given if the option costs the schools, district, city, or organization money and requires additional part-time staff for implementation; would require coordination between two agencies at most (i.e., LAUSD and individual schools) “-” is given if the option costs more than the schools and district can afford and requires hiring full-time staff; would require coordination between more than two agencies (i.e., DPH, LAPD, and School Police)

xii We believe that all stakeholders have equal value in ensuring an option’s implementation despite differences in authority. LAUSD and the City of Los Angeles, who have more de jure authority, the teachers and principals have de facto authority in the schools. For example, teachers and principals can prevent a policy from being fully and successfully implemented, despite the governing body’s desire for success.

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Degree of Effectiveness • • •

“++” is given to an option that will reduce the number of total students buying snacks by 50% “+” is given to an option that will reduce the number of total students buying snacks by 25% “-” is given to an option that has no impact on the number of the students buying snacks

All individual scores are weighted evenly. Through interviews with key stakeholders we have determined that political and technical restrictions are very constraining and the most important criteria. We characterize each of these criteria using two subcategories while defining the degree of effectiveness using one. This difference places greater weight on the former two criterion.

TABLE 7.1: Comparison of Alternatives Using our Criteria Political Feasibility

Technical Feasibility

Degree of Effectiveness Decrease in student snack buyers

Total

Support from key stakeholders

Minimize harm to vendors

Level of cooperation needed

Resources required

Alternative

++

++

+

+

+

+++++++

School sales of healthy snacks

+

0

++

+

-

+++

Nutrition education

++

0

+

++

-

++++

Increase enforcement

+

-

-

-

+

-

The snack program has the strongest score and meets all our criteria, so we recommend this option to HEAC as its first priority. HEAC should suggest to LAUSD trying a pilot program at 20th Street Elementary, where there are the fewest vendors and fewest students, to determine its impact and its cost-effectiveness before implementing it at the other schools. We believe that such a program will have a significant impact on the overall health of students, particularly those in areas where vendor presence is high.

We also recommend that the nutrition education program and vendor intervention be implemented concurrently and as secondary priorities. HEAC should work with the schools to begin a supplemental educational component designed to discourage unhealthy snacking and purchasing from the vendors. It should also work with the promotoras or other community health partners to begin vendor outreach, providing information to the vendors about the unhealfulness GOETZ & WOLSTEIN

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of the snacks they sell to the students. These three policy alternatives are not mutually exclusive; executing all recommendation jointly can only have a positive effect on the outcome, and we advise doing so.

A school-based snack program has the potential to reach the entire population of students, but we predict it will have the greatest effect on the 72% of students who purchase snacks at low and medium frequencies. It will have a lesser effect on the remaining 28% of students who visit the vendors every day. As mentioned earlier, students who purchase snacks from the vendors everyday are more likely to buy snacks from a store or restaurant in the absence of vendors.

Therefore, we assume their total demand for snacks is high and they may not be amenable to substituting healthy snacks for unhealthy ones. On the other hand, students who purchase snacks at lower frequencies are more likely to forego buying a snack in the absence of vendors. We assume their total demand for unhealthy snacks is lower and they may be more willing to substitute healthy snacks for unhealthy ones.

Based on these assumptions, we predict that a school based snack program will attract more low frequency buyers than high frequency ones. However, while students who purchase snacks everyday may not be willing to completely replace their unhealthy snacks with those offered through the snack program, they might replace one dayâ&#x20AC;&#x2122;s worth of unhealthy snacks with program foods. Although this does not seem like a significant change, it would have a positive effect on their health.

If we assume that students buy only one bag of chips per visit, they consume 300, 900, and 1500 calories per week, from low to high frequency (Table 7.2). Using a conservative estimate, we assume the snacks in the school program have 75% of the calories of vendor snacks (225 calories). If students replaced all their snacks with school program snacks, they would consume 225, 675, and 1125 calories each week, from low to high frequency. If student replaced only one of their weekly snacks with school program snacks, they would consume 225, 825, and 1425 calories per week, from low to high frequency. Although it seems that high frequency buyers will hardly be affected by the 75 fewer calories they consume per week, over the course of a year this could add to 3,600 calories, or the equivalent of about one pound of fat.

Realistically, they will avoid the consumption of more than 75 calories per week. This estimate is based on one snack per visit but, as noted earlier, high frequency students are much more likely to consume three snacks per visit. Therefore, if they replace an entire dayâ&#x20AC;&#x2122;s worth of vendor snacks (three snacks) with program snacks, the savings will be higher, as will be the impact on their weight.

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Table 7.2: Estimates of snack calorie intake, based on current activity and projected activity with snack program Medium Low frequency High frequency frequency Percent of respondents Average snack calories each school day Average vendor snack calories per week Average snack program calories per week, replacing all snacks Average snack program calories per week, replacing one snack

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17

27

60

180

300

300

900

1500

225

675

1125

225

825

1425

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CONCLUSIONS

VIII. Conclusions and Applicability We believe that if HEAC can work with the schools to provide healthy snack alternatives for the students, the majority of them will choose these options over the vendor snacks. The students will still be snacking but will be eating better food and fewer calories. A supplemental education component will arm them with the knowledge necessary for making informed decisions both in and outside of the school.

Our findings are useful not only for HEAC and our target schools, but also for other schools with similar characteristics, as well as the entire school district. These recommendations can be applied more broadly because of the ethnic character of our target areas and the presence of street vendors in other parts of the district.

Interviews with LAPD, School Police, and other stakeholders led us to believe that street vendor presence was a problem specific to Latino neighborhoods and not all communities in Los Angeles54,55. To assess the validity of this assertion, we contacted a random sample of schools in xiii LAUSD to determine in which local districts of LAUSD street vendors are present. By looking at census data regarding ethnicity, we created a map that displays the density of the Latino population in Los Angeles by census tract (Figure 8.1). When comparing this to an LAUSD map that displays vendor presence (Figure 8.2), it is clear that vendors are located in predominately Latino communities. This leads us to believe that our results and recommendations are generalizeable to other schools with similar characteristics to those of our target schools.

xiii We took a stratified sample of 25% of the elementary schools in each local district, for a sample of 113 out of 455 schools.

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CONCLUSIONS

FIGURE 8.1: Latino Density of the Greater Los Angeles Area

FIGURE 8.2: Vendor Distribution in LAUSD

Fillmore Santa Clarita

Symar San Granada Fernando Hills Chatsw orth Northridge

Moorpark Simi Valley

Camarillo

Tujunga

Panorama CIty Thousand Oaks

Agoura Hills Westlake Village

Canoga Park West Hills Woodland Hills

Van Nuys

La Canada Flintridge

Burbank

Glendale Pasadena

Sherman Oaks

City of

Sierra Madre

Arcadia Eagle San Marino Rock Hollyw ood Silver San Gabriel West Hollywood Lake Alhambra Beverly Echo Lincoln El Monte Pacific Hills Heights Park Westlake Palisades Monterey Park Dow ntow n East Santa Crenshaw Monica LA Montebello Culver CityBaldw in Commerce Venice Hills Pico Rivera Huntington Park Whittier Inglewood Bell Gardens Westchester

Calabasas

Los Angeles

Malibu

Hispanic Population in LA 2000 70.1 to 98.5 50.1 to 70 25.1 to 50 10.1 to 25 0.1 to 10 0 to 0 all others

Hawthorne El Segundo Gardena Manhattan Beach Lawndale

(628) (490) (839) (864) (528) (11) (13)

Hermosa Beach Redondo Beach Torrance

Lynwood Norwalk La Mirada Paramount Compton Bellflower Cerritos Lakewood Carson

Los Alamitos Palos Verdes Lomita Wilmington Long Beach Estates Rolling Hills Westminster Rancho Palos Seal Beach Verdes San Pedro

Our findings from the random sample also allow us to characterize vendor presence in each local district as a “high intensity” or “low intensity” problem (Figure 8.3). We considered vendor presence a high intensity problem if the percentage of street vendors is above the mean (48.6%), and a low intensity problem if it is below the mean. High intensity local districts are 2, 4, 5, and 7. Low intensity local districts are 1, 3, 6, and 8.

% of Schools with Vendors

FIGURE 8.3 Vendor Distribution in LAUSD Local Districts 10 0 75 50 25 0

1

2

3

4

5

6

7

8

L o c a l D ist ric t s

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CONCLUSIONS

While vendors are more prevalent in some local districts than others, and while certain communities are more affected than others, it is important to note that not a single local district is free of vendors. Therefore, we feel our findings and recommendations are generalizeable to each district within LAUSD.

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REFERENCES

References 1

Levi J, Juliano C, Segal L. “F as in Fat: How Obesity Policies are Failing in America.” Trust for America’s Health. August 2006. 3. http://www.healthyamericans.org. Accessed January 25, 2007.

2 Levi J, Juliano C, Segal L. “F as in Fat: How Obesity Policies are Failing in America.” Trust for America’s Health. August 2006. 3. http://www.healthyamericans.org. Accessed January 25, 2007.

3 “A Survey of Californians about the Problem of Childhood Obesity.” Conducted for The California Endowment

by Field Research Corporation. October-November, 2003. 2.

4 Levi J, Juliano C, Segal L. “F as in Fat: How Obesity Policies are Failing in America.” Trust for America’s Health. August 2006. 13. http://www.healthyamericans.org. Accessed January 25, 2007.

5 Levi J, Juliano C, Segal L. “F as in Fat: How Obesity Policies are Failing in America.” Trust for America’s Health. August 2006. 13. http://www.healthyamericans.org. Accessed January 25, 2007.

6 Kant, Ashima. Reported Consumption of Low-Nutrient-Density Foods by American Children and Adolescents.

Archives of Pediatric and Adolescent Medicine. 2003; 157:789-796.

7 1999-2000 LA County Public Health Survey Data, Adults Engaging in Any Physical Activity.

8 1999-2000 LA County Public Health Survey Data, Adults Who Are Sedentary.

9 Sundquist J, Johansson SE. The influence of socioeconomic status, ethnicity and lifestyle on body mass index in a longitudinal study. International Journal of Epidemiology. 1998; 27:57-63.

10 2005 LA County Public Health Survey Data, Prevalence of Overweight and Obesity.

11 2005 LA County Public Health Survey Data, Prevalence of Overweight and Obesity.

12 2005 LA County Public Health Survey Data, Prevalence of Overweight and Obesity.

13 Sundquist J, Johansson SE. The influence of socioeconomic status, ethnicity and lifestyle on body mass index in a longitudinal study. International Journal of Epidemiology. 1998; 27:57-63.

14 1999-2000 Los Angeles County Healthy Survey Data.

15 Koplan JP, Liverman CT, Kraak VA. Preventing Childhood Obesity: Health in Balance. Institute of Medicine Report Sept 30, 2004.

16 Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. Journal of the American Medical Association. 2004; 291:2847-2850.

17 Sondik. Progress in Preventing Childhood Obesity: How Do We Measure Up? Institute of Medicine Report.

September 2006.

18 United States Department of Health and Human Services (USDHHS). The Surgeon General’s Call to Action To Prevent and Decrease Overweight and Obesity. USDHHS 2001.

19 Lopez, Steve. “A contest that will ‘super-size’ you.” The Los Angeles Times. April 21, 2007. Lopez quotes Harold Goldstein, director of the California Center for Public Health Advocacy.

20 Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. Journal of the American Medical Association. 2004; 291:2847-2850.

21 Rodriguez M, Kane M, Alonzo-Diaz L, Flores G. One out of Three Latino Adolescents Overweight or At Risk. UCLA Center for Health Policy Research. 2005. http://www.healthpolicy.ucla.edu. Accessed November 13, 2006.

22 Rodriguez M, Kane M, Alonzo-Diaz L, Flores G. One out of Three Latino Adolescents Overweight or At Risk. UCLA Center for Health Policy Research. 2005. http://www.healthpolicy.ucla.edu. Accessed November 13, 2006.

23 Hastert T, Babey S, Diamant A, Brown R. More California Teens Consume Soda and Fast Food Each Day than Five Servings of Fruits and Vegetables. UCLA Center for Health Policy Research. 2005. http://www.healthpolicy.ucla.edu. Accessed November 13, 2006.

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24

Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. Journal of the American Medical Association. 2004; 291:2847-2850.

25 Child Overweight Rates on the Rise in California Assembly Districts. California Center for Public Health Advocacy. 2005.

26 Child Overweight Rates on the Rise in California Assembly Districts. California Center for Public Health Advocacy. 2005.

27 Cupers, Kenny. Tactics of Mobility: The Spatial Politics of Street Vending in Los Angeles. Harvard Univeristy, Graduate School of Design. 2006.

28 Los Angeles Municipal Code, Chapter VIII, Traffic, http://lacodes.lacity.org/NXT/gateway.dll/lamc/code00000.htm/chapter00008.htm 29 Interviews with Betsy Castillo and Eufrosino Espinoza, 20th Street and Hooper. Conducted on January 16, 2007; Interview with Frances Goldman, Norwood. Conducted on January 23, 2007.

30 Interview with Lieutenant Glymph, LAUSD School Police. Conducted on January 26, 2007.

31 Interview with Capt. Smith, LAPD. Conducted on February 12, 2007.

32 Interview with Randolph Glymph. Conducted on January 26, 2007.

33 UCLA Center to Eliminate Health Disparities and Samuels & Associates. Failing Fitness: Physical Activity and Physical Education in Schools. Funded by The California Endowment. Los Angeles, CA, January 2007.

34 Position of the American Dietetic Association (ADA): Dietary Guidance for Healthy Children Ages 2 to 11, 2004.

JADA: 104: 660-677.

35 Wang CY, Gortmaker SL, Sobol AM, Kuntz KM. Estimating the Energy Gap Among US Children: A Counterfactual Approach. Journal of the American Academy of Pediatrics. 2006; 118; 1721-1733.

36 Wang CY, Gortmaker SL, Sobol AM, Kuntz KM. Estimating the Energy Gap Among US Children: A Counterfactual Approach. Journal of the American Academy of Pediatrics. 2006; 118; 1721-1733.

37 Calculated using information from: Bowes AP. Food Values of Portions Commonly Used. Pennsylvania: Lippincott Company; 1994.

38 Rolls B, Barnett RA. Volumetrics: feel full on fewer calories. New York: HarperCollins; 2000.

39 Bartholomew JB, Jowers EM. Increasing Frequency of Lower-Fat Entrees Offered at School Lunch: An Environmental Change Strategy to Increase Healthful Selections. Journal of the American Dietetic Association.

2006; 106(2):248-52.

40 French SA, Jefferey RW, Story M, Breitlow KK, et al. Pricing and Promotion Effects in Low-Fat Vending Snack Purchases: The CHIPS Study. American Journal of Public Health. 2001; 91(1):112-7.

41 French SA, Story M, Jeffery RW, et al. Pricing strategy to promote fruit and vegetable purchase in high school cafeterias. Journal of the American Dietetic Association. 1997; 97: 1008-1010.

42 French SA, Story M, Jeffery RW, et al. Pricing strategy to promote fruit and vegetable purchase in high school cafeterias. Journal of the American Dietetic Association. 1997; 97: 1008-1010.

43 Lytle L, Kubik M, Perry C, Story M, Birnbaum A, Murray D. Influencing healthful food choices in school and home environments: Results from the TEENS study. Preventative Medicine. 43(2006) 8-13.

44 “A Survey of Californians about the Problem of Childhood Obesity.” Conducted for The California Endowment

by Field Research Corporation. October-November, 2003. 22.

45 “A Survey of Californians about the Problem of Childhood Obesity.” Conducted for The California Endowment

by Field Research Corporation. October-November, 2003. 22.

46 Cole K, Waldrop S, D’Auria J, Garner H. An Integrative Research Review: Effective School-Based Childhood Overweight Interventions. Journal for Specialists in Pediatric Nursing. Vol. 11, No. 3. July 2006. 166-177.

47 Cole K, Waldrop S, D’Auria J, Garner H. An Integrative Research Review: Effective School-Based Childhood Overweight Interventions. Journal for Specialists in Pediatric Nursing. Vol. 11, No. 3. July 2006. 166-177.

48 Interview with teacher at Norwood Elementary. Conducted on February 6, 2007.

49 Pyle S, Sharkey J, Yetter G, Felix E, Furlong M, Poston C. Fighting an Epidemic: The Role of Schools in Reducing Childhood Obesity. Psychology in the Schools. Vol. 43(3), 2006. 361-376.

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50

Interview with Frances Goldman, Norwood Elementary. Conducted on January 23, 2007.

Interview with Melissa Infusino, LAUSD. Conducted on February 9, 2007.

52 Interview with Norwood teachers. Conducted on February 6, 2007.

53 Pyle S, Sharkey J, Yetter G, Felix E, Furlong M, Poston C. Fighting an Epidemic: The Role of Schools in Reducing Childhood Obesity. Psychology in the Schools. Vol. 43(3), 2006. 361-376.

54 Interview with Lieutenant Glymph, LAUSD School Police. Conducted on January 26, 2007.

55 Interview with Captain Smith, LAPD. Conducted on February 12, 2007.

51

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APPENDIX A

Appendix A:

More Information about Our Target Schools Norwood Elementary Demographics and facts: The students at Norwood are 97% Latino and 2-3% African American. They are 100% on the National School Lunch Program (NSLP), which is a proxy for low-income status. Norwood also offers the School Breakfast Program (SBP). All of its students are eligible and about 75% participate. The SBP is first offered one half-hour before school starts, and second-chance breakfast is offered during recess time, which begins around 9:30 a.m. The students get a 20 minute recess and a 40 minute lunch, of which half is devoted to recess or play time and the other half to eating.

Fitnessgram Body Composition scores: Below are the results of the 2005-06 Physical Fitness Test for 5th graders at Norwood Elementary. The results show the following percentages of students who are in the Healthy Fitness Zone (HFZ) for the corresponding measure.1 The first two tests measure the capacity of the cardio respiratory system and an estimate of the body fat percentage, which are two of the most important indicators of fitness.

• • • • • •

46.2% in aerobic capacity 50.9% in body composition 30.1% in abdominal strength 68.8% in trunk extension strength 26.6% in upper body strength 78.6% in flexibility

Of particular importance to our project is the proportion of students who are not in the HFZ for body composition. This measure is composed of two parts including a skin fold test, a common measure of body fat percentage, and BMI. Thus, students not in the HFZ qualify as overweight

1

According to the California Department of Education, being in the Healthy Fitness Zone "represents a level of fitness that offers some degree of protection against diseases that result from sedentary living." Additional information about the Fitnessgram, including definitions and results, can be found at http://www.cde.ca.gov/ta/tg/pf/.

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APPENDIX A

or obese.2 We can assume, based on this information, that if 51% of 5th graders at Norwood are in the HFZ for body composition, then 49% are overweight or obese.

Neighborhood: As shown below, the surrounding neighborhood is primarily residential, with the closest main streets in Washington Blvd to the north and Hoover Ave to the West. There is only one food store within a two-block radius, which means the students have little alternative to buy snacks in the school's immediate neighborhood. There are no restaurants nearby, with the closest ones more than two blocks away.

Vendors: There are typically five vendors who come to Norwood at the end of the school day. There are two ice cream trucks and three vendors who sell out of strollers and boxes.

FIGURE A: Map of Norwood Elementary and Surrounding Area

2

The females who are not in the healthy fit zone have a measure above 32% body fat in the skin fold test and a BMI greater than 24. For males it is above 25% body fat and a BMI greater than 21. (Fitnessgram Standards for Healthy Fit Zone, http://www.cde.ca.gov/ta/tg/pf/documents/healthfitzone06.pdf)

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APPENDIX A

20th Street Elementary Demographics: The students at 20th Street are 97% Latino and 2-3% African American. All students are eligible for the NSLP, which is a proxy for low-income status. 20th Street also offers the School Breakfast Program (SBP). All of its students are eligible and about one-third participate. The SBP is first offered one half-hour before school starts, and second-chance breakfast is offered during recess time, which begins around 9:30 a.m. The students get a 20 minute recess and a 40 minute lunch, of which half is devoted to recess or play time and the other half to eating.

Fitnessgram Body Composition scores: Below are the results of the 2005-06 Physical Fitness Test for 5th graders at 20th Street Elementary. The results show the following percentages of students who are in the Healthy Fitness Zone (HFZ) for the corresponding measure.

• • • • • •

56.8% in aerobic capacity 46.0% in body composition 83.5% in abdominal strength 95.0% in trunk extension strength 72.7% in upper body strength 55.4% in flexibility

Of particular importance to our project is the proportion of students who are not in the HFZ for body composition. This measure is composed of two parts including a skin fold test, a common measure of body fat percentage, and BMI. Thus, students not in the HFZ qualify as overweight or obese. We can assume, based on this information, that if 46% of 5th graders at 20th Street are in the HFZ for body composition, then 54% are overweight or obese.

Neighborhood: As shown below, the surrounding neighborhood is residential and commercial because this school is close to two major streets, Central Ave to the west and Washington Blvd to the north.

There are two food stores and four restaurants within a two-block radius, which means the students have a few options other than the vendors if they want to buy snacks.

Vendors: There are four vendors who come to 20th Street on a regular basis. They sell out of boxes or mobile carts.

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APPENDIX A

FIGURE B: Map of 20th Street Elementary and Surrounding Area

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APPENDIX A

Hooper Elementary Demographics: The students at Hooper are 97% Latino and 2-3% African American. They are 100% on the NSLP, which is a proxy for low-income status. Hooper also offers the School Breakfast Program (SBP). All of its students are eligible and about 80% participate. The SBP is first offered one half-hour before school starts, and second-chance breakfast is offered during recess time, which begins around 9:30 a.m. The students get a 20 minute recess and a 40 minute lunch, of which half is devoted to recess or play time and the other half to eating.

Fitnessgram Body Composition scores: Below are the results of the 2005-06 Physical Fitness Test for 5th graders at Hooper Elementary.

The results show the following percentages of students who are in the Healthy Fitness Zone (HFZ) for the corresponding measure.

• • • • • •

37.8% in aerobic capacity 52.7% in body composition 73.3% in abdominal strength 94.0% in trunk extension strength 83.2% in upper body strength 41.0% in flexibility

Of particular importance to our project is the proportion of students who are not in the HFZ for body composition. This measure is composed of two parts including a skin fold test, a common measure of body fat percentage, and BMI. Thus, students not in the HFZ qualify as overweight or obese. We can assume, based on this information, that if 53% of 5th graders at Hooper are in the HFZ for body composition, then 47% are overweight or obese.

Neighborhood: As shown below, the surrounding neighborhood is primarily residential and commercial because this school is close to two major streets, Central Ave to the west and 51st Street to the north.

There are eight food stores and within a two-block radius, including one directly across the street from a school entrance, which means the students have many options other than the vendors if they want to buy snacks.

Vendors: There are many more vendors around Hooper, with 8-10 selling on a street corner opposite from the primary school entrance and 6-7 selling very close to the school on different streets.

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APPENDIX A

FIGURE C: Map of Hooper Elementary and Surrounding Area

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APPENDIX B

Appendix B:

Existing Nutrition Policies in Los Angeles LAUSD Obesity Prevention Motion3 In October 2003, the LAUSD School Board passed the Obesity Prevention Motion, to be implemented on July 1, 2004. The primary mandates of this motion concerned foods served and sold from vending machines, student stores, a la carte at lunch, and fund raisers. The following nutritional standards were to be implemented: • No more than 35% calories from fat (not including nuts, seeds) • No more than 10% of total calories from saturated fat, including trans fat • No more than 35% added sugar by weight (not including fruits and vegetables when used as additives) • No more than 480 mg of sodium per serving Standards for portion-size, not including those within the National School Lunch Program (NSLP), were implemented as well. They include: • Snacks & Sweets (chips, crackers, popcorn, cereal, trail mix, nuts, seeds, dried fruit, jerky): 1.5 oz • Cookies/cereal bars: 2 oz • Bakery Items: 3 oz • Frozen Desserts, Ice cream: 3 oz • Entrée items and side dishes: no larger than portions of foods served through FSMP Additional changes included the addition of salad bars over a six-year period, second chance breakfast within two years, and a vegetarian option served daily in the cafeteria. Second chance breakfast comes between first breakfast, typically served one half-hour before the beginning of the school day, and lunch.

LAUSD Cafeteria Improvement Motion4 In December 2005, the LAUSD Board of Education adopted the Cafeteria Improvement Motion to better the nutritional value of meals provided at school. It created policies limiting allowances of sodium, fat, and sugar in prepared meals. The specifications were as follows:

3 4

Marlene Canter, Julie Korenstein, LAUSD Obesity Prevention Motion. October 2003.

Cafeteria Improvement Motion, Board of Education, Los Angeles Unified School District. December 2005

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APPENDIX B

Reduce sodium levels to no more than 1500 mg per meal period by January 1, 2007, and to 1100 mg per meal by July 1, 2008.

Eliminate trans fats added during the manufacturing process.

Limit entrée fat content to 35 grams.

Reduce the availability of entrees with more than 15% total calories from saturated fat.

Limit foods with high fructose corn syrup and other sugars to reduce consumption of sugars. Reduce added sugars to less than 7 grams per ounce of cereal.

LAUSD Healthy Beverage Motion5 This motion bans the sale of soda on school campuses, in vending machines, student stores and for fund raisers.

School Nutrition Education Programs At present, there is no comprehensive nutrition education in LAUSD. There is a health component in the curriculum but it only contains a small amount of information about nutrition and the teachers just follow this framework.

Nutrition Network is a state program given matched federal funding through the United States Department of Agriculture. The goal of Nutrition Network is to increase consumption of fruits and vegetables and increase daily physical activity, particularly for low-income children.

Elements of the program include Harvests of the Month, Student-led Nutrition Advisory Councils, school gardens and a physical activity program. Teachers have to sign up to participate so not every classroom receives these additional educational and activity-based resources. There are currently 325 eligible schools, which means at least 50% of students are eligible for free lunch, who participate in this program.

City of Los Angeles Child Nutrition Policy On February 18, 2005 the Los Angeles City Council passed the Child Nutrition Policy (CNP) to improve the health and well being of youth in Los Angeles. The CNP targets schoolage children who participate in City-sponsored programs through a three-pronged approach. It requires City Departments to: increase access to nutrition programs provide healthy meals and snacks that encourage healthy choices provide nutrition education to children Additionally, City Council instructed the L.A. Child Health and Nutrition Task Force to modify food and vending sales contracts to allow for compliance of the CNP. Such changes include increasing the amount of healthy food options (as determined by guidelines reflecting those of LAUSD’s Obesity Prevention Motion) in vending machines to a minimum of 25%, with 5

Healthy Beverage Motion, Board of Education, Los Angeles Unified School District. August 2002

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APPENDIX B

yearly incremental increases to eventually reach 100%. The CNP could potentially reach the 15,000 children who participate in City-sponsored programs each day. While the policy extends to a number of City Departments, such as Community Development, Cultural Affairs, and Library, its primary target is the Department of Recreation and Parks (RAP), since it works most frequently and most directly with youth through its 175 centers.

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APPENDIX C

Appendix C:

List of Interviewees Craig Blumenthal, BEST Fit Director, LA’s BEST/LAUSD. Conducted on February 11, 2007.

Dr. Bethsaida Castillo, Principal, 20th Street Elementary School. Conducted on January 16, 2007.

Eufrosino Espinoza, Principal, Hooper Avenue Elementary School. Conducted on January 16, 2007.

Luz Ferregur, Cafeteria Manager, 20th Street Elementary School. Conducted on March 2, 2007.

Lt. Randolph Glymph, Los Angeles School Police Department. Conducted on January 26, 2007.

Frances Goldman, Principal, Norwood Elementary School. Conducted on January 23, 2007.

Melissa Infusino, Director of Policy, Office of President Marlene Canter, Los Angeles Unified School District. Conducted on February 9, 2007.

Elizabeth Medrano, Community Organizer, Center for Food & Justice, Urban and Environmental Policy Institute, Occidental College. Conducted on March 5, 2007.

Matt Sharp, Director of Los Angeles Office, California Food Policy Advocates. Conducted on February 7, 2007.

Capt. Andrew Smith, Los Angeles Police Department. Conducted on February 12, 2007.

Cheri Thomas, Coordinated School Health Facilitator, Los Angeles Unified School District.

Conducted on February 8, 2007.

Lori Vollandt, Coordinator, Health Education Programs, Los Angeles Unified School District.

Conducted on January 30, 2007.

LA’s BEST coordinators, Hooper Avenue Elementary School and 20th Street Elementary School.

Conducted on February 9, 2007.

Teachers at Norwood Elementary. Conducted as a group on February 6, 2007.

Teachers at 20th Street Elementary. Conducted as a group on February 23, 2007.

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APPENDIX D

Appendix D:

Classroom Survey 1.

How old are you? ________

2.

What grade are you in? ________

3.

Are you a boy or a girl? ________

4.

What language do you speak at home? a. English b. Spanish c. Both English and Spanish d. Other ______________

5.

Do you participate program? (Circle one) Yes or No

6.

How often do you bring your lunch to school? a. Never b. 1 or 2 times a week c. 3 or 4 times a week d. Every day

7.

How often do you get lunch from the school cafeteria? a. Never b. 1 or 2 times a week c. 3 or 4 times a week d. Every day

8.

9.

10.

an

When you buy food from the vendors are you usually a. Alone b. With friends c. With a grown-up d. I don’t buy food from the vendors

13.

What snacks do you buy from the vendors?

(Circle ALL that apply) a. Chips (Doritos, Cheetos, Lays, etc.) b. Candy (M&Ms, Snickers, etc.) c. Cereal bars/Granola bars d. Ice Cream e. Fruit f. Soda (Coke, Sprite, etc) g. Juice h. Water i. Gatorade/Powerade/Sports Drink j. Champurrado/Hot Chocolate k. Tamales l. Elote/Corn m. Other ______________

14.

When you buy from the vendors, how many items do you normally buy? a. One b. Two c. Three d. I don’t buy from the vendors

15.

What is your favorite snack? ______________________

16.

What else do you wish you could buy from the vendors? ______________________

17.

If you wanted a snack before or after school and the vendors were NOT there, would you: a. Buy a snack from a local store (7-11, liquor store, etc.) b. Buy a snack from a local restaurant (McDonalds, etc) c. Bring a snack from home d. Not buy anything

after-school

How often do you bring a snack to school from home? a. Never b. 1 or 2 times a week c. 3 or 4 times a week d. Every day Do you ever buy food from vendors outside your school? (Circle) Yes or No How often do you buy food from them? a. b. c. d. e.

11.

in

12.

Never 1 or 2 times a week 3 or 4 times a week 5 or more times a week Every day

When do you buy food from them?

(Circle all that apply) a. Before school b. During school c. After school d. I don’t buy from the vendors

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APPENDIX E

Appendix E:

Letter to Parents (English) Letter to Parents (English) Dear Parents,

We are writing to inform you that your child has been invited to participate in a survey conducted

by Katherine Goetz and Joelle Wolstein from the University of California, Los Angeles. His/Her participation is voluntary and very much appreciated.

PURPOSE OF THE STUDY The purpose of this study is to better understand the role of vendors who sell food near elementary schools, and the effect they have on child nutrition. With this project we hope to develop a better understanding of both the supply and demand for food sold by vendors.

PROCEDURE The entire survey will take less than ten minutes. Your childâ&#x20AC;&#x2122;s participation is voluntary and he/she can choose not to participate if he/she does not wish to.

POTENTIAL RISKS AND DISCOMFORTS There is no risk to your child by participating in the study. Questions are not sensitive in nature.

Your child will not be asked to identify him/herself by name or identification number. Surveys will be anonymous.

POTENTIAL BENEFITS TO SUBJECTS AND/OR TO SOCIETY The results of the research will help us better understand the nutritional environment to which your child is exposed, as well as the role vendors play in LAUSD efforts towards creating healthy environments. Your child and community will benefit through information collected from these surveys.

IDENTIFICATION OF INVESTIGATORS If you have any questions or concerns about the research, please feel free to contact: Joelle Wolstein and/or Katherine Goetz Principal Investigators UCLA â&#x20AC;&#x201C; Lewis Center for Regional Policy Studies 3250 Public Policy Building Box 951656 Los Angeles, CA 90095-1656 Thank you for your attention and anticipated cooperation.

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APPENDIX E

Letter to Parents (Spanish) Estimados padres, Les estamos escribiendo para informarles que su hijo/a ha sido invitado a participar en una encuesta dirigida por Katherine Goetz y Joelle Wolstein de la Universidad de California, Los Angeles (UCLA). Su participación en este estudio es voluntaria y desde ya estamos muy agradecidas.

EL PROPÓSITO DE ESTE ESTUDIO El propósito de este estudio es obtener un mejor entendimiento del papel de los vendedores callejeros que venden comida cerca de escuelas primarias, y el efecto que tienen con respecto a la nutrición de los jovenes. A través de este proyecto esperamos desarrollar un mejor entendimiento de la oferta y la demanda de comida vendida por los vendedores callejeros.

PROCEDIMIENTOS La encuesta durará menos de diez minutos. La participación de su hijo/a es voluntaria y él/ella puede elegir no participar si él/ella no quiere.

RIESGOS E INCOMODIDADES No hay ningun riesgo para su niño si participa en la encuesta. Las preguntas no se tratan de temas delicados. Su hijo/a no tiene que dar su nombre ni su número de identificación. Las encuestas serán anónimas.

BENEFICIOS POTENCIALES PARA LOS PARTICIPANTES Y/O LA SOCIEDAD Los resultados de esta investigación nos ayudarán a entender mejor el ambiente nutricional al cual su hijo/a está expuesto/a, y también el papel de los vendedores callejeros de alimentos en relación a los esfuerzos de LAUSD para crear ambientes saludables. Su hijo/a y la comunidad se beneficiarán de los resultados obtenidos a través de estas encuestas.

IDENTIFICACIÓN DE LAS INVESTIGADORAS Si tienen cualquier pregunta o duda sobre la investigación, pueden comunicarse con: Joelle Wolstein y/o Katherine Goetz Investigadoras Principales UCLA – Lewis Center for Regional Policy Studies 3250 Public Policy Building Box 951656 Los Angeles, CA 90095-1656 Gracias por su atención y anticipada cooperación.

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APPENDIX F

Appendix F:

Survey Instructions for Teachers When the students are finished with the survey, please check over each survey in front of the students to make sure that each question has been answered. If you prefer that we do this, please call one of us from the hall and we will come into the classroom.

I am going to be reading the questions you have in front of you out loud. Please do not skip ahead.

I will give you time to complete your answers. If you do not understand the question, raise your hand so I can help you. (If a student does not understand a question, please answer it to the best of your ability. If you are not sure how to answer it, please call us from the hallway.) Before we begin, please turn over your survey and make sure there is a number written at the bottom corner. If there is not a number, please raise your hand.

1.

How old are you? ________

Fill in your age. (Suggest the number, like 10 or 11 if you have 5th grade students.)

2.

What grade are you in? ________

Fill in 3, 4, or 5. (You can tell them which to fill in).

3.

Are you a boy or a girl? ________

Write ‘boy’ or ‘girl’.

4.

What language do you speak at home? a. English b. Spanish c. Both English and Spanish d. Other ______________

If you only speak English to your parents, circle A. If you only speak Spanish to your parents, circle B. If you speak both English and Spanish to your parents, circle C. If you speak another language to your parents, circle D and fill out which language you speak. Please raise your hands if you do not understand the question.

5.

Do you participate in an after-school program? (Circle one) Yes or No

If you attend any of the after school programs, like LA’s Best, EYS, YS Care, etc., circle YES. If you do not attend any of these programs, circle NO. If you are not sure, please raise your hand.

6.

How often do you bring your lunch to school? a. Never b. 1 or 2 times a week c. 3 or 4 times a week d. Every day

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APPENDIX F

raise your hand so I can help you. (If a student does not understand a question, please answer it to the best of your ability. If you are not sure how to answer it, please call us from the hallway.)

Before we begin, please turn over your survey and make sure there is a number written at the bottom corner. If there is not a number, please raise your hand.

During a regular week, how many times out of the five school days do you bring your lunch to school? Try to remember what you did this week on Mon., Tues., Wed., Thurs., and today. If you never bring your lunch to school, circle A. If you bring it 1 or 2 times, circle B. If you bring it 3 or 4 times, circle C. If you bring it every day, circle D. If you don’t understand the question, raise your hand. (If a student is not sure, ask him/her “Did you bring your lunch Monday? Did you bring your lunch Tuesday? Etc. To try to help him/her remember.)

7.

How often do you get lunch from the school cafeteria? a. Never b. 1 or 2 times a week c. 3 or 4 times a week d. Every day

During a regular week, how many times out of the five school days do you get your lunch from the school cafeteria? Try to remember what you did this week on Mon., Tues., Wed., Thurs., and today. If you never get your lunch from the cafeteria, circle A. If you get it 1 or 2 times, circle B. If you get it 3 or 4 times, circle C. If you get it every day, circle D. If you don’t understand the question, raise your hand.

8.

How often do you bring a snack to school from home? a. Never b. 1 or 2 times a week c. 3 or 4 times a week d. Every day

During a regular week, how many times out of the five school days do you bring a snack from home? Try to remember what you did this week on Mon., Tues., Wed., Thurs., and today. If you never bring a snack from home, circle A. If you bring a snack 1 or 2 times each week, circle B. If you bring a snack 3 or 4 times each week, circle C. If you bring a snack from home every day, circle D. If you don’t understand the questions, raise your hand.

9.

Do you ever buy food from vendors outside your school? (Circle) Yes or No

Do you ever buy from the people selling food outside the school, like from the ice cream truck or the people with shopping carts and strollers? If you do, circle YES. If you do not, circle NO. Raise your hand if you do not understand the question.

10.

How often do you buy food from them? a. b. c. d. e.

Never 1 or 2 times a week 3 or 4 times a week 5 or more times a week Every day

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APPENDIX F

During a regular week, how many times do you buy food from the people selling outside the school? If you buy something in the morning and the afternoon, that counts as two times in one day. If you buy something just in the afternoon, that counts as one time per day. Try to remember what you did this week on Mon., Tues., Wed., Thurs., and what you will do today. Raise your hand if you do not understand the question.

11.

When do you buy food from them?

(Circle all that apply) a. Before school b. During school c. After school d. I don’t buy from the vendors

When do you usually buy food from the people selling outside the school? If you buy from them before school, circle A. If you do this during school, like during lunchtime, circle B. If you do this after school, once the bell has rung, circle C. If you do not buy anything from the vendors, ever, circle D. Raise your hand if you do not understand the question.

12.

When you buy food from the vendors are you usually a. Alone b. With friends c. With a grown-up d. I don’t buy food from the vendors

Who are you with when you buy food from the people outside the schools? If you are all by yourself, circle A. If you are with a friend or a few friends, circle B. If you are with a grown-up, circle C. If you do not buy anything from the vendors, ever, circle D. 13.

What snacks do you buy from the vendors?

(Circle ALL that apply) a. Chips (Doritos, Cheetos, Lays, etc.) b. Candy (M&Ms, Snickers, etc.) c. Cereal bars/Granola bars d. Ice Cream e. Fruit f. Soda (Coke, Sprite, etc) g. Juice h. Water i. Gatorade/Powerade/Sports Drink j. Champurrado/Hot Chocolate k. Tamales l. Elote/Corn m. Other ______________

What kinds of snacks do you buy from the people selling food outside the school? I’m going to read the list. If you buy the item I read, circle it when I say it. (Read list slowly.)

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14.

APPENDIX F

When you buy from the vendors, how many items do you normally buy? a. One b. Two c. Three d. I don’t buy from the vendors

When you buy from the people outside the school, how many things do you usually buy? If you only buy one thing, like a bag of chips or only a soda, circle A. If you buy two things at the same time, like a bag of chips and candy, or a bag of chips and a soda, or candy and an ice cream, circle B. If you buy three things at the same time, circle C. If you do not buy from the people outside the school, circle D. 15.

What is your favorite snack? ______________________

Write down what your favorite snack.

16.

What else do you wish you could buy from the vendors? ______________________

Is there something that the vendors do not sell that you wish they sold? Write down what it is.

17.

If you wanted a snack before or after school and the vendors were NOT there, would you: a. Buy a snack from a local store (7-11, liquor store, etc.) b. Buy a snack from a local restaurant (McDonalds, etc) c. Bring a snack from home d. Not buy anything

If you knew that the people selling food outside the school would not be at school next week, what would you do? If you would go to a store, like 7-11 or a corner store, to get a snack, circle A. If you would go to a restaurant like McDonalds, Burger King, Taco Bell, etc., circle B. If you would bring a snack from home instead of buying something, circle C. If you would just not have a snack or would not buy anything, circle D. Please check each student’s survey while it is in front of him/her to see if all the questions have been answered. If a question has not been answered, please ask the student to complete it. We have provided stickers for you to give each student who has completed the survey.

Thank you!! ☺

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APPENDIX G

Appendix G:

Questionnaire for Food Vendors Date: Location: What are the primary locations where you vend?

When school is not in session, where do you vend?

Inventory 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

Price

Portion____________

Do you believe you sell healthy snacks? Yes / No Do you believe you sell unhealthy snacks?

Yes / No Do you sell water?

Yes / No Do you sell soda?

Yes / No Who are your primary customers? (Students, parents, teachers, other community members) Who are your secondary customers?

Which items are your top 3 sellers?

1.

2.

3.

When kids buy food from you, do they usually get one item, two items, three items, or more?

Approximately how many children do you sell to in a day?

Approximately how many children do you sell to in a week?

Would you be willing to attend a class about nutrition education?

Can we take a picture of you with your cart?

Could we come one day and stand behind you when the kids are buying so we can see exactly what they are buying?

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APPENDIX H

Appendix H:

Analysis of Caloric Intake from Snacks The ages of the children included in our study extend from 7 to 12 years old, with 99% falling in the 8 to 11 year-old range. We therefore use recommendations for the 8 to 11 year-old range. We generate recommendations based on the USDAâ&#x20AC;&#x2122;s three levels of physical activity for males and females between the ages of 8 and 11 years old. The activity levels are:

less than 30 minutes 30 to 60 minutes more than 60 minutes

For purposes of simplification, and because the differences in recommended caloric intake across our age range was not substantially different, we calculated averages for males, females, and all children (Table A). The average intake recommendations for all children from lowest to highest level of energy expenditure are 1525, 1750, and 2000 calories. We use these figures to measure the proportion of calories consumed from unhealthy snacks sold by street vendors near elementary schools.

In order to determine how many calories are consumed through chips we calculate the average calories from all chips sold by vendors (Table B). This measure includes different brands and flavors of chips, as well as different bag sizes. The average number of calories per bag of chips is 301.86, which we round to 300 for purposes of simplicity. Because we did not measure the frequency at which students buy certain brands, flavors, or bag sizes of chips, we weighted all chips equally. Our estimate of the average is therefore conservative because the highest calorie chips are also the most popular items to purchase.

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APPENDIX H

TABLE A: USDA Caloric Intake Recommendations for Children Ages 8-116 Energy Expenditure Gender Age <30 min.

30-60 min. >60 min.

Female 8 1400 1600 1800 Female 9 1400 1600 1800 Female 10 1400 1800 2000 Female 11 1600 1800 2000 Male 8 1400 1600 2000 Male 9 1600 1800 2000 Male 10 1600 1800 2200 Male 11 1800 2000 2200 Average for Children 8-11 1525 1750 2000 Female 8 1400 1600 1800 Female 9 1400 1600 1800 Female 10 1400 1800 2000 Female 11 1600 1800 2000 1700 1900 Average for girls 8-11 1450 Male 8 1400 1600 2000 Male 9 1600 1800 2000 Male 10 1600 1800 2200 Male 11 1800 2000 2200 Average for boys 8-11 1600 1800 2100

6

http://www.mypyramid.gov/mypyramid/index.aspx.

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STREET VENDORS IN L.A. TABLE B: Average Calories in Vendor-sold Chips Total Size (oz) Cals Chips Cheeto Puffs 1 160 Chester Fries 1.75 263 Chester Fries 3.75 563 Doritos Nacho Cheese 2.75 385 Doritos Ranch 2.75 385 FH Cheetos 3.03 515 FH Cheetos 2 340 FH Cheetos w/ Lemon 2 320 FH Fritos 2 320 FH Fritos 2 320 FH Munchies 2 280 Fritos Original 2 320 Funyuns 1.25 175 Lays Classic 1.5 225 Lays Limon 2.5 375 Lays Limon 1.5 225 Lays Salt & Vinegar 1.5 225 Ruffles Cheddar 2.5 400 Ruffles original 1.5 240 Sunflower seeds 1.75 303 Average Calories 301.86

APPENDIX H Energy Density 5.6 5.3 5.3 4.9 4.9 6 6 5.6 5.6 5.6 4.9 5.6 4.9 5.3 5.3 5.3 5.3 5.6 5.6 6.1 5.46

We calculate the energy density of all solid foods by dividing the total calories in each item by its weight in grams. The ice cream category was problematic because, while it is a solid food at the time of consumption, it is actually made of liquids. The energy densities of ice cream generated through this measure are not reliable and, thus, not included in the analysis of energy density.

We do the same for the most popular foods, candy, ice cream, and soda (Table C).

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APPENDIX H

TABLE C: Average Calories in Other Popular Foods Size (oz) Total Cals Energy Density Candy Blowpops 0.64 60 3.3 Fruit by the foot 0.74 80 3.8 Fruit roll up 0.5 50 3.5 M&M Tubes 1.08 162 5.3 M&Ms peanut 1.74 250 5.1 M&Ms regular 1.69 240 5 Nerds Rope 0.92 90 3.5 Push Pops 0.57 70 4.3 Reeses PB Cups 1.8 280 5.5 Reeses Pieces 1.6 220 4.9 Ring Pop 0.5 70 4.9 Skittles 2 250 4.4 Snickers 2.07 280 4.8 Snickers Crunch 1.56 220 5 Sour Punch Straws 2 186.66 3.3 Average Calories 167.2 4.4 Mexican Candy Gusano Chamoy 45 1.18 Gusano Tamarindo 50 1.32 Limonazo 60 3 Lucas Baby Powder 70 3.5 Pelon Roller 80 2 Vero elotes 62 2.48 Average Calories 61.2 2.3 Ice Cream Big Dipper 3.52 330 3.3 Dora 4 100 0.9 Ice Cream Cone 4 205 1.8 Ice Cream Sundae 14 764 1.9 King Kong 4 100 0.9 Spongebob 4 100 0.9 Tear Jerkers 4.27 140 1.2 Average Calories 248.4 1.5 Soda Pepsi 12 195.96 Shasta Cola 12 145.5 Shasta Lemon 12 196 Sunkist 12 190 Average Calories 140.2

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APPENDIX H

We also created a separate calculation of the proportion of calories consumed through a combination of two snacks. Based on interviews with vendors, a common two-item combination is chips and soda. The surveys also reveal that students who choose chips also frequently choose candy, soda or ice cream. For example, 52% of students who said they buy chips also said they buy soda. Thus, we calculate the portion of calories consumed through this snack combination.

In the case of those surveyed, we know students consume approximately the same amount of calories at lunch as a function of their 100% eligibility for the NSLP. We verify this through our survey, which shows that 78% of our sample â&#x20AC;&#x153;gets lunch from the school cafeteriaâ&#x20AC;? everyday, 9% gets it 3 or 4 times per week, and 8% gets it 1 or 2 times week. Five percent of students said they never get lunch from the cafeteria.

We calculate the average calories consumed per lunch from LAUSD menus for a threeweek period (Table D). When using the average school lunch calories in the report we use a representative value of 90% of lunch calories. Although our interview with Food Services staff confirmed that nearly all children eat their entire meals, some leave a portion of their vegetables untouched. While the calories in vegetables are so low that this amount of plate waste can be considered negligible, we account for it by subtracting 10% of the total lunch calories from the figure. This produces a conservative estimate of 580 calories per school lunch.

Additionally, based on evidence from the California Healthy Kids Survey, we can assume that 80% of the students surveyed eat breakfast.7 Although the proportion of students who eat school breakfast varies across schools, we must consider other foods when calculating average breakfast calories. We generate this information based on school breakfast calories, as well as common breakfast foods (Table E). This measure is also conservative in that we do not weight different foods by frequency of consumption, even though we know that in two schools over 75% of students eat school breakfast. The average calories consumed during breakfast is 280.

7

http://www.wested.org/pub/docs/chks_surveys.html

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STREET VENDORS IN L.A.

APPENDIX H

TABLE D: Average Calories in School Lunch Week

Day

Menu

Calories

1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 Average Calories from Lunch

Monday Monday Tuesday Tuesday Wednesday Wednesday Thursday Thursday Friday Friday Monday Monday Tuesday Tuesday Wednesday Wednesday Thursday Thursday Friday Friday Monday Monday Tuesday Tuesday Wednesday Wednesday Thursday Thursday Friday Friday

1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

675 705 492 568 570 584 507 797 545 702 686 538 703 874 584 666 692 663 586 727 708 536 644 528 629 572 655 707 696 772

GOETZ & WOLSTEIN

Average per day

Average per week

690 530 577 652 623.5

614.5

612 788.5 625 677.5 656.5

671.9

622 586 600.5 681 734

644.7 643.7

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APPENDIX H

TABLE E: Average Calories in Breakfast Foods Size (oz)

Total Cals

Breakfast Waffles with 1/4 cup syrup

2.5

390

Pop tarts (2)

3.7

400

Apple jacks w/ 1/2 cup milk

1.2

170

Corn pops w/ 1/2 cup milk

1.1

160

1.06

150

9.9

338.5

Cheerios w/ 1/2 cup milk Tamales School breakfast program Average Calories from Breakfast

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471 297.1

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APPENDIX I

Appendix I:

Additional Survey Data This data shows responses to several of the survey questions with the responses broken up by school. The responses are generally similar with a few exceptions.

Figure D shows the percentage of students per school that were included in the sample.

As mentioned in the report, we distributed the survey to all 3rd, 4th, and 5th graders in our target schools, which totaled 1,309 students. Of those, 776 error-free surveys were included in the study. The overall response rate was 59%. However, the response rates for Norwood and 20th Street were closer to 90%. In these schools, 23 students were absent, 17 students did not participate because the teacher declined, and ten students had incomplete responses. Hooper's response rate was much lower at 37%. This is because Hooper was doing standardized testing at the time of our survey distribution, and teachers were not able to distribute the surveys.

FIGURE D Percentage of each schoolâ&#x20AC;&#x2122;s respondents in sample

29

35

20th Norwood Hooper

36

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STREET VENDORS IN L.A.

APPENDIX I

Figure E shows the proportion of students per school who buy food from the street vendors. Approximately 80% of students in each school buy food from the vendors. This is significant because teachers estimated that between 25 and 40 percent of students bought snacks from the vendors. The problem is much greater than we anticipated after our initial interviews.

FIGURE E Percent of Students Who Buy From Vendors 100

percent

80

83 82 79 87

60 40 20

17 18 21

0

13

no All

yes

20th

Norw ood

Hooper

Figure F shows the breakdown by school of how often students purchase food from the vendors. On average, more students purchase one or two times per week. At Hooper, however, more students purchase five or more times per week than one to four times per week. This implies that the students at Hooper are more affected by the vendors. Based on our analysis, they are also more likely to overconsume because a larger proportion of them visit the vendors everyday and many also purchase more than one snack during each visit. Interestingly, according to Fitnessgram results, 47% of students at Hooper are overweight or obese and over 40% visit the vendors five or more day per week.

FIGURE F Frequency of Vendor Use per Week

percent

75 50

60

64

54 44

40

25 17

21 16 16

28 29 20

0 1 or 2 times 3 or 4 times All

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20th

Norwood

5+ times Hooper

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STREET VENDORS IN L.A.

APPENDIX I

Figure G shows the breakdown by school of the average number of items purchased each time a student visits the vendors. The majority of students purchase less than three items per visit. At Hooper, however more students purchase three or more snacks per week, which confirms that they are consuming more than students in other schools.

FIGURE G Number of Items Purchased per Visit 50

percent

40 30 20 10 0 o ne snack

All

20th

two snacks

three snacks

Norw ood

Hooper

Figure H shows with whom students purchase vendor snacks. On average, most students purchase snacks with an adult. This is important in regards to our secondary recommendation that parents and students be educated about the lack of nutritional value of such foods. We assume that most students and parents are unaware of the adverse health effects of overconsumption caused by snacking, and that gaining knowledge will alter their behaviors to some extent.

FIGURE H With Whom Students Visit the Vendors

percent

75 50

62 53

60 50

40

34

25 13 9 10

0 an adult All

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20th

18

alone Norw ood

29

22

friends Hooper

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STREET VENDORS IN L.A.

APPENDIX I

Figure I demonstrates that nearly all vendor-snack purchases are made after school.

Stakeholders were concerned that the street vendor problem near schools was not only present in the afternoons but also before and during school hours. While some students do purchase food from the vendors before and during school, this activity does not warrant intervention. The primary focus of HEAC should be on after-school snack purchases.

FIGURE I When Students Purchase Vendor Food 100 percent

75 50 25 0 before All

20th

during Norw ood

after Hooper

Figure J shows that the percentage of students who participate in after-school programs, like L.A.â&#x20AC;&#x2122;s Best, YS Care, etc. This is relevant to the vendor issue for two reasons. First, our interviews revealed that students who participate in after-school programs often leave campus to purchase a snack from the vendors and then return to their program a few minutes later. If a large proportion of students participated in after-school programs, and if vendor-snack purchase was prevalent in this group, then programmers could implement an intervention directed specifically at these children. However, the majority of students surveyed do not participate in after-school programs. Additional analysis also revealed that there was no correlation between after-school program participation and vendor use.

FIGURE J After-School Program Participation 80

percent

60 40

61

32

65 52

48 39

68

35

20 0 yes All

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20th

no Norwood

Hooper

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STREET VENDORS IN L.A.

APPENDIX I

Figure K reveals the breakdown by school of language spoken at home. These results are consistent with the demographics presented to us by each school. All schools said their student body was 97% Latino and 2-3% African American.

FIGURE K Language Spoken At Home

percent

80 60 40 20 0 English

All

20th

Spanish

Both (E & S)

Norwood

Hooper

Figure L and M show that approximately 80% of students surveyed consume lunch from the school cafeteria everyday. This information allowed us to estimate with confidence the average number of calories students consumed for lunch. Because such a large proportion of students eat a standard number of calories per lunch, we felt comfortable making the generalization that all students consume the same number of calories per lunch. We further accounted for plate waste, which was minimal according to a cafeteria manager, by subtracting a portion of the average calories per lunch. See Appendix H for more details.

FIGURE M Frequency of Lunch Brought From Home

100

100

75

75 percent

percent

FIGURE L Frequency of NSLP Lunch Consumption

50

50

25

25

0

0 never

All

20th

1o r2

Norw ood

GOETZ & WOLSTEIN

3o r4

everyday

Hooper

never

All

1or2

20th

3or4

everyday

Norw ood

Hooper

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APPENDIX J

Appendix J:

Implementation Plan for School Snack Program The school-based snack program will sell foods that are healthier relative to those sold by vendors. This program aims to present snack options to students before they have the opportunity to purchase snacks from vendors or neighborhood stores and restaurants, and before they consume snacks at home. We assume that the foods offered through the snack program will be healthier than any of these alternatives because of the lack of access to healthy foods, particularly fresh fruits and vegetables, in low income communities. The following presents the details of the program:

1. Logistics Each school will offer snacks to students at the end of the school day for one half hour after the school bell. Snacks will be sold at the entrance to the school to make purchase convenient and easily accessible to students and parents.

2. Management Parents from existing volunteer groups will be asked to assist in selling the snacks.

Schools will also increase recruitment efforts to acquire more parent volunteers. Having parents participate in the snack program will not only give them a sense of ownership in the school but will also insure that program costs (i.e., labor) remain as low as possible. Parents will be asked to aid in food preparation (i.e., slicing apples) and to sell the snacks.

3. Offerings Snacks that are compliant with LAUSD nutrition policies can be sold through the program; a special effort will be made to sell fresh fruits and vegetables. Pre-packaged snack foods can be obtained through LAUSDâ&#x20AC;&#x2122;s Food Services Division, which has an existing contract with Pepsi-Co. Fruits and vegetables can be acquired through Farm-to-School programs, through produce distribution centers, and/or through the Food Bank, which currently delivers fruits and vegetables to schools in low-income areas.

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APPENDIX J

4. Costs In order to compete with street vendors, the snack program must offer foods at prices equal to or lower than those of the vendors. Therefore, all foods must cost less than $1 but the majority should cost 50¢. The schools will sell snacks at cost or at a few cents higher than their wholesale price. Schools can sustain these low prices by earning minimal to zero profits from the sales. Since elementary schools do not have vending machines, selling low-cost foods will not have a negative impact on the school’s resources.

5. Incentives for students The students will be drawn to the school snack program because of the following reasons: • Greater convenience, especially for those in after-school programs • Low cost • More choices, including some foods that the students said they like but are not offered by the vendors, like fruit, sandwiches and crackers

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