Student and school characteristics modify the impact of SNAP-Ed on student dietary and physical activity outcomes

Objective: To examine the impacts of school-based CalFresh Healthy Living (CFHL-California’s SNAP-Ed) interventions post-COVID-19-related school closures and whether student and school characteristics modified intervention impacts on student diet and physical activity (PA). Design: Quasi-experimental, two-group, pre-post, self-report. Setting: CFHL eligible public schools (n intervention =51;n comparison =18). Participants: 4 th /5 th grade students (n intervention =2115;n comparison =1102). Results: CFHL interventions were associated with an increase in consumption frequency of fruit (0.19 times/day[p=0.015]) and vegetables (0.35 times/day[p=0.006]). Differences in baseline diet and PA behaviors were observed by student race and gender and by whether the proportion of Free and Reduced-price Meal (FRPM) -eligible students was above the state average. Notably, students in schools with FRPM above the state average reported more frequent consumption of sugar-sweetened beverages (Mean[SE]: 3.18[0.10] vs 2.58[0.11];p=0.001) and fewer days/week with 60+ minutes of moderate-to-vigorous PA (MVPA) (Mean[SE]: 2.8[0.10] vs 3.21[0.12];p=0.020) than those at schools with FRPM at/below the state average. Student gender, school urbanicity, and school FRPM modified the relationship between the interventions and certain dietary and/or PA outcomes. Interventions were associated with greater increases in vegetable consumption in more urban schools (β[95% CI]=0.67[0.15,1.20]), and greater increases in fruit consumption (β[95% CI]= 0.37[0.07,0.66]) and in MVPA in higher FRPM schools (β[95% CI]=0.86[0.33,1.39]). Conclusions: Findings reaffirmed effectiveness of school-based CFHL interventions. We identified existing student and school-level disparities, then observed that interventions were associated with greater increases in moderate-to-vigorous PA in the highest FRPM schools. Findings can inform an equity-centered approach to delivery of school-based interventions that facilitate equal opportunity for all children to achieve lifelong health.