Posts Tagged: Nutrition Policy Institute

College students eligible for food assistance deterred by confusing requirements

Modifying Farm Bill could reduce barriers to SNAP for students and improve nutrition

Inadequate access to food can harm college students' health and academic performance. A recent University of California research study in the Journal of Nutrition Education and Behavior investigated why UC students who are eligible for the federal Supplemental Nutrition Assistance Program (SNAP) – the nation's largest food assistance program – do not receive the benefit.

“Based on our study findings, eliminating the extra requirements for college students to qualify for SNAP would go a long way in ensuring that more eligible students get the support they need to meet their basic food needs,” said study coauthor Lorrene Ritchie, director of the UC Nutrition Policy Institute, which is part of UC Agriculture and Natural Resources.

A 2015 study by NPI found four in 10 UC students didn't have enough money to buy sufficient food for a healthy lifestyle. To promote better health, UC has taken steps to ensure students are aware of SNAP, established campus food pantries and other basic needs resources.   

"In California, SNAP is known as CalFresh and despite policies and communication to improve college students' access to CalFresh, participation remains low, with approximately 78% of those eligible not receiving benefits," said lead study author Suzanna M. Martinez, associate professor in the Department of Epidemiology and Biostatistics at UC San Francisco.

For insight on why low-income UC students aren't receiving the benefits, Martinez, Ritchie and colleagues at UC San Francisco and Nutrition Policy Institute consulted county agencies that process student CalFresh applications. The researchers interviewed county staff in nine counties that are home to UC campuses: Alameda, Los Angeles, Merced, Orange, Riverside, San Francisco, Santa Barbara, Santa Cruz and Yolo.

While CalFresh benefits have mainly been paid by the federal government through the Farm Bill, counties contribute and county agencies are responsible for implementing policies, determining eligibility, processing applications and distributing funds.

“With the Farm Bill still up for reauthorization, these findings could provide insight into how to strengthen SNAP policy related to eligible students,” Martinez said.

The researchers conducted focus groups and interviews with county staff to determine how agency workers interpret the complex criteria for students to meet CalFresh eligibility.

Their questions focused on how students' applications differed from those of community members, steps taken when processing student applications, student-specific training and suggested improvements to the process.

Five central themes were identified in the interviews: 

• More consistent policy dissemination and program administration is needed
• Student exemptions and the application process are perceived as challenges for students
• Key supports for successful student applications include carefully reviewing applications for potential exemptions, providing useful resources to students, and campus partnerships
• Tracking policy changes is burdensome
• Eliminating student rules and treating students as regular clients would be more equitable

The researchers found that CalFresh rules are challenging for students as well as the county agency staff.

Also, eligibility requirements, written over 50 years ago, are based on the assumption that college students are supported by middle-class families.

The research supports simplifying the student CalFresh process to increase participation for eligible students, especially for historically underrepresented racial and ethnic groups and low-income students for whom equitable access to CalFresh benefits is critical.

“Once students get confused or don't know what they need to do, they don't follow through with their application,” one CalFresh eligibility worker told the researchers.

During the COVID-19 pandemic, some federal and state requirements were waived or relaxed for students.

“The timing of this study resulted in a natural experiment since COVID-19-related SNAP modifications streamlined the student application process and reduced administrative burden,” Martinez noted. “These modifications alleviated some challenges discussed by county workers, confirming existing opinions to eliminate the student rules.”

Ritchie said, “We hope our research informs policy to remove some of the barriers so students no longer have as much difficulty getting the food they need.”

This study was funded by the California State Legislature, which provided funding to the University of California to address students' basic needs (UC Basic Needs Initiative).

‘Farm to corrections’ project provides fresh produce to people in prison, boosts California growers

Nutrition Policy Institute, Impact Justice, ChangeLab Solutions partner with California Department of Corrections and Rehabilitation

Serving slices of watermelon on the Fourth of July is a long-standing tradition at some facilities within the California Department of Corrections and Rehabilitation. But this July, there was something different about the watermelon offered to the approximately 8,000 residents at California State Prison Solano, California Medical Facility and Folsom State Prison.

It was juicy. It was sweet. It was “scrumdiddlyumptious,” according to one resident. And it was grown on a California family farm.

The three institutions are part of a “farm to corrections” project, Harvest of the Month, which aims to serve seasonal, locally grown produce to people who are incarcerated in California, while opening new opportunities for California farmers.

“We appreciate that someone cares enough to introduce this program that gives us something new,” said Jason Romero, a California State Prison Solano resident. “We look forward to what's coming in the future – California has the best stuff, right? – and hopefully we get other varieties of stuff.”

The program – bringing together the Nutrition Policy Institute, the nonprofit Impact Justice, and ChangeLab Solutions in collaboration with CDCR – was officially launched with the watermelon delivery in July. Pluots followed in August, and Bartlett pears were delivered in September.

“It's a ‘multiple wins' kind of an effort,” said Wendi Gosliner, the NPI principal investigator on the California Department of Food and Agriculture specialty crop block grant supporting the project. “The funding is available because the state is looking for state partners to purchase and expand the markets for California-grown fruits and vegetables. And we know that getting more of those fruits and vegetables on the plates of people who are incarcerated would be a huge bonus for them.”

California State Prison Solano resident Patrick Range said that, after tasting pluots for the first time through the program, the plum-apricot hybrid is now one of his favorites.

“I think I had five of them that day – and I'm waiting for them to have them again so I can get more; they were so good,” Range said. “It's something I'd never experienced, in the outside world or in prison.”

With rave reviews from residents and staff alike, CDCR – the State of California's biggest purchaser of food – is planning to roll out Harvest of the Month to all 33 of its adult facilities within the next two years.

“Food brings individuals together and introducing new products can give those in the care of CDCR something to talk about, as well as look forward to,” said Lance Eshelman, CDCR's departmental food administrator.

Improving conditions for people within correctional institutions is core to the mission of Impact Justice, which is working with partner organizations across the U.S. to bring fresher, more nutritious food to facilities, in support of residents' physical, mental and emotional health.

“We really want to prioritize the holistic well-being of an individual to help ensure that once they come home from incarceration, they are in a place where they are ready to actually contribute back to society,” said Heile Gantan, program associate with the Food in Prison project at Impact Justice.

Range said that enjoying the fresh produce – and learning more about its nutritional value – is helping him live a healthier, more energized, and hopefully longer life.

“I was a kid that didn't like vegetables; I didn't want nothing to do with vegetables…[but] as an adult, being 46 years of age, I want this for myself – I want to be able to tell someone else, to teach someone else about what I experienced when getting these fruits and vegetables that helped that nutritional factor,” he said.

In addition, Gosliner noted that early research suggests better food can benefit not only the well-being of residents but also of staff, with a calmer and safer work environment.

Partnership built on shared values, priorities

Gosliner and Ron Strochlic, academic coordinator at NPI, saw an opportunity to support “farm to corrections” work through a CDFA block grant, which aims to boost the purchase of California-grown specialty crops.

“CDCR is the state's largest single purchaser of food, so they're a natural place to consider ways to improve food systems,” said Gosliner, who was awarded the grant in 2020 to work with partners to research and develop pathways that encourage CDCR procurement of California produce, as well as nutrition programs for formerly incarcerated individuals. The project produced a report summarizing the opportunities and challenges in bringing more California-grown produce to the state's prison system.

The staff at Impact Justice appreciated that the NPI team brought not only research and evaluation acumen to the partnership but also an abiding concern for the people inside correctional facilities.

“Our grant funding was focused on simply increasing access to and consumption of California-grown specialty crops in CDCR prisons, but our team was very much in alignment around values and really focusing on the health and well-being of residents – highlighting and amplifying residents' experiences and voices,” said Leslie Soble, senior program manager of the Food in Prison Project.

Gantan echoed that sentiment, adding that NPI – which is under the University of California Agriculture and Natural Resources umbrella – also contributed its familiarity with regional food systems, particularly food hubs across the state.

According to the NPI team, engaging food hubs – organizations that aggregate, distribute and market food products from local producers – was a logical way to make a “farm to corrections” match.

“The majority of CDCR facilities are located in rural, agricultural regions, so to us, it was kind of a no-brainer to connect those facilities with the local communities and local farmers in the area,” Strochlic explained.

For the Harvest of the Month project, the partners teamed up with Spork, a Davis-based, mission-driven food hub that sources from growers across Northern California. Spork also aggregates the fresh produce from local farmers and delivers it to participating CDCR facilities each month.

“The farmers are very excited to see the change in the systems at CDCR in food and nutrition and what they're offering to the residents – and they're excited for the potential that this has for a larger, more consistent market,” said Hope Sippola, co-owner of Spork, which emphasizes working with underserved farmers as part of its mission. “We really needed to dig deep to figure out how to successfully implement this change of CDCR purchasing from large distributors to a food hub who sources from local family farms.”

Carolyn Chelius, an NPI project policy analyst and project manager of NPI's Farm-to-Corrections work, said the team hopes, as Harvest of the Month scales up, that they will be able to make Spork's generous investment of time and resources pay off.

“Our ultimate goal is to be able to benefit Spork and help them with their business, but it's been really helpful to have them as champions – people who are really interested in the mission,” Chelius said. “I don't know if this project would have been possible otherwise.”

California produce purchasing requirement helped spur project

Of course, cultivating a strong working relationship with CDCR also was essential. On the heels of AB 822 (a policy requiring state agencies to buy California-produced food over other options if the price differential is 5% or less), another powerful impetus for CDCR was the passage of AB 778 in 2022. It requires that, by the end of 2025, at least 60% of food purchased by state-run institutions must be grown or produced in California.

Eshelman, the departmental food administrator, said the law has challenged CDCR to look closely at its statewide menus and identify items that could be sourced from California growers and producers. He said that, through this project, food service team members have gained new knowledge about food production in the state, such as variability due to regional differences and weather trends.

“The Harvest of the Month program provides an additional resource, and places CDCR in contact with subject matter experts such as food hubs and local growers who can provide valuable insight into what to expect in terms of California-grown or produced food items and their accessibility,” Eshelman explained, adding that NPI and Impact Justice also have been vital resources for CDCR.

Gosliner acknowledges the challenges in retooling processes and procedures across CDCR, the second-largest correctional system in the U.S. With nearly 100,000 incarcerated individuals in its care, CDCR purchases more than $163 million in food each year.

“It's a big ask of a major state institution to reconsider some of their systems for doing something that they do every day: providing food to the people who are incarcerated,” Gosliner said. “It's revolutionary for them to rethink who they're sourcing from, to rethink how much fresh produce they're serving, to rethink the variety of that produce – it's a big lift for CDCR.”

‘This is really the beginning'

As CDCR brings Harvest of the Month to more institutions across the state, the collaborators anticipate that the logistics will smooth out – and that more farmers will be willing to participate.

“If we can add some more facilities and increase the volume, we have a better chance of making it work for growers, so we're really hoping that we can continue with this food hub model,” Strochlic said. “For us it's really important to be able to source from small and medium growers as well.”

And while flyers describing the health benefits of each month's “Harvest” item are currently distributed at the participating facilities, the partners hope they can provide additional nutrition education opportunities for the residents – during their time inside and after incarceration (like in the workshops held across the state).

Soble and Gantan of Impact Justice also noted that all members of the project team have been learning together, exploring “new territory” in growing this innovative partnership.

“I know personally I've learned so much from the NPI folks just about policy related to food and nutrition in California and about different nutrition interventions,” Soble said. “To me, it's been a very valuable and positive partnership.”

Gosliner said that building on those relationships will be crucial, as the movement to improve the services provided to incarcerated individuals continues to gain momentum in the state.

“This is really the beginning of California's work,” she said. “Even though we grow so much of the food here, there are other states in the country that are further along than we are in California. This is really the launch.”

Funding for this project was made possible by the U.S. Department of Agriculture's (USDA) Agricultural Marketing Service through grant AM200100XXXXG032. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the USDA.

Funds from UC Sustainable Agriculture Research and Education Program's Small Grants Program also helped support this project.

Universal school meals increased student participation, lessened stigma

The COVID-19 pandemic exacerbated food and nutrition challenges. Many families initially lost access to meals offered by school and childcare facilities, experienced unemployment or work reductions, and faced increasing prices for food and other necessities. National and state policies and programs provided food and cash assistance to mitigate impacts on food security. Researchers at the Nutrition Policy Institute, a research center of University of California Agriculture and Natural Resources, evaluated safety-net policies implemented during the pandemic to better support families with low incomes in the U.S. 

Benefits of universal school meals

The National School Lunch Program and the School Breakfast Program meet the nutritional needs of approximately 30 million K-12 students in America each day. Typically, students from families meeting income eligibility criteria receive school meals for free or a reduced price, while others pay full price.

NPI researchers Wendi Gosliner, project scientist, and Lorrene Ritchie, director and UC Cooperative Extension specialist, are co-leading studies of school meals in California in collaboration with researchers from the NOURISH Lab for Health Inclusion Research and Practice, who study school meals in Maine and other states.

During the COVID-19 pandemic, Congress funded school meals for all students at no charge, in order to address the dramatic increase in food insecurity among families with children after schools shut down in March 2020. This federal provision allowing for meals to be free for all students ended after the 2021-2022 school year, but some states elected to continue providing universal school meals with state funding, in recognition of the importance of these meals for student health and academic success.

California was the first state to adopt a statewide Universal Meals Program starting in the 2022-23 school year. To support the program's development, $650 million were invested to help schools improve kitchen infrastructure and provide staff training and technical assistance. Investments include Farm to School programs and other mechanisms to help update and improve school meals. Maine and several other states also have adopted universal school meals at least through the 2022-23 school year. 

“States often act as incubators – things that work well in states sometimes get translated into federal policy,” Gosliner said. Identifying the success of the programs – and their challenges – can lead to improvements and help inform advocates and policymakers considering universal school meals policies at the state and national level. 

Two of the team's research studies in California and Maine documented the benefits and challenges of universal school meals, as reported by school food authorities. Among 581 school food-service leaders in California who responded to the survey, nearly half (45.7%) reported reductions in student stigma as a result of providing free school meals to all students. Among 43 respondents in Maine, over half (51%) reported lessened stigma related to school meals being free for all. In both studies, nearly three-quarters of respondents reported increases in student meal participation. These and other data suggest that universal school meals are meeting their aim, to increase student participation while providing nutritionally balanced meals. 

But when the child leaves campus, the responsibility to put a nutritious meal on the table falls on the caregiver. 

“Universal school meals provide food and can ease families' budgets, but for too many families, wages as well as time and other resources are not adequate for access to and consumption of enough healthy foods and beverages,” Gosliner noted. 

That is when other public programs are helpful, for example the Earned Income Tax Credit, or EITC.

Many eligible families do not claim Earned Income Tax Credit

The Earned Income Tax Credit is a national program designed to lift families out of poverty. The supplemental income can contribute up to nearly $7,000 per year for a family. Despite the EITC's known ability to improve participants' health, research shows that many EITC-eligible households in California and across the nation don't receive the benefits for which they are eligible, leaving $2 billion unclaimed in California in 2018 alone.

Gosliner led a study along with Lia Fernald from UC Berkeley and Rita Hamad from UC San Francisco to document levels of awareness, barriers to uptake, and benefits of participation in the EITC. Their recent publication reported that among 411 EITC-eligible California female caregivers, those who were younger, spoke languages other than English, and had less awareness of the EITC were less likely to receive the tax credit. 

Developing a user-friendly system for providing safety-net support and, in the meantime, providing information and support to help more EITC-eligible families receive these benefits are suggested to help alleviate financial stressors. In the long term, these strategies may reduce poverty and improve the health of children.

Increasing WIC Cash Value Benefit a boon to health

In addition to universal school meals and EITC, families with low income may be eligible for the Special Supplemental Nutrition Assistance Program for Women, Infants and Children, or WIC. The program supports women and children up to 5 years old through nutrition education, nutritious foods and access to other health and social services. 

One component of the WIC food packages, the Cash Value Benefit, provides participants a fixed dollar amount to supplement their family's diet with fruits and vegetables. During the pandemic, the U.S. Department of Agriculture increased this benefit from $9 to $35 per month, which was later revised to $24 per month per child in October 2021. 

Ritchie contributed to a growing body of evidence on the importance and multidimensional benefits of the WIC Cash Value Benefit increase.

“Nine dollars buys only a quarter of what a child is recommended to eat every day,” Ritchie said. “The increase in Cash Value Benefit during the pandemic was an ideal natural experiment to investigate its impact.” 

In collaboration with Shannon Whaley and her team at the Public Health Foundation Enterprises-WIC, NPI launched a longitudinal cohort study of nearly 2,000 California WIC participants. They found that the increased Cash Value Benefit improved WIC participant satisfaction with the program and allowed families to purchase greater quantities and varieties of fruits and vegetables.

“The increased Cash Value Benefit enabled WIC families to expose young children to new fruits and vegetables. Early exposure to a variety of fruits and vegetables is critical to establishing lifelong healthy habits,” said Ritchie. 

The researchers found that the benefit increase also reduced food insecurity. It is hoped that the increase in program satisfaction translates into more eligible families enrolling and continuing to receive WIC. In November 2022, the U.S. Department of Agriculture proposed making the increased Cash Value Benefit a permanent part of WIC.

Knowing the proven benefits of the WIC program, Ritchie and colleagues from the National WIC Association, and Loan Kim at Pepperdine University, also engaged with WIC participants in other states.

In 2021, all state WIC agencies were invited to participate in a WIC satisfaction survey. Of the 12 WIC state agencies that opted to participate, Connecticut, Inter Tribal Council of Arizona, Nevada, New Hampshire and New Mexico added questions on the survey to understand how the increased Cash Value Benefit impacted children's dietary intake.

The study showed consumption of fruits and vegetables by children on WIC increased by one-third cup per day on average, which is sizable when considering the impact across the WIC population.

NPI research on universal school meals, the EITC and WIC constitute a small part of a more comprehensive approach to make healthy food more accessible, affordable, equitable and sustainable for all. The NPI provides resources such as policy briefs, peer-reviewed publications and technical assistance on several research areas such as safe drinking water, childcare and education. To learn more, please visit the Nutrition Policy Institute website.

Teaching Kitchen course helps improve college students’ food security

Cooperative Extension researcher: Nutrition course a boon for UC Berkeley students

College students across the nation are struggling to meet their basic food needs. Within the University of California system of 280,000 students, 38% of undergraduate students and 20% of graduate students report food insecurity.

As part of the UC Global Food Initiative, in 2015 the Nutrition Policy Institute (a UC Agriculture and Natural Resources statewide research center) identified student food insecurity as a UC systemwide problem, prompting the UC Regents and campuses to collectively address the issue.

All 10 UC campuses now have on-site basic needs centers, providing food, emergency housing and support services. The UC system and campus working groups recognize that meeting basic needs, such as food, is a multidimensional challenge.

In response to the 2022 White House Conference on Hunger, Nutrition, and Health, which called for national efforts to reduce diet-related disease and food insecurity, UC renewed their commitment to cut the proportion of students facing food insecurity in half by 2030. Campuses will partner with local counties to maximize enrollment in the Supplemental Nutrition Assistance Program (also known as CalFresh in California), provide food for students who do not qualify for CalFresh, and allocate campus food resources to historically underserved student populations.

NPI's collaborative researchers continue to monitor the impact of these efforts, in addition to other interventions, such as supporting students in building basic culinary skills, to improve food security. One multipronged approach to address food insecurity at UC Berkeley is a 14-week course on Personal Food Security and Wellness with a Teaching Kitchen laboratory component.

Sarah Minkow, who teaches the Personal Food Security and Wellness course at UC Berkeley, shared that students learn about nutrition and gain culinary skills through the Cal Teaching Kitchen.

The curriculum is designed with consideration for the time, cost and convenience of healthy eating. Discussions include food safety, calculating nutrient needs, mindful eating and reading nutrition labels. The Teaching Kitchen laboratory brings the lessons to life through knife skills, “no-cook” cooking, microwave cooking and sheet pan meals.

Minkow enthusiastically highlighted her students' “overwhelmingly positive [response to the] lecture and lab,” suggesting the benefits of an interactive learning environment to garner student engagement.

“Students often give feedback that they wish this was a required course for all UC Berkeley students,” said Minkow. She noted one barrier to reaching more students: capacity of the Teaching Kitchen space.

Susana Matias, a Cooperative Extension specialist at the UC Berkeley Department of Nutritional Sciences and Toxicology and collaborative researcher with the NPI, evaluated the impact of the Personal Food Security and Wellness course at UC Berkeley.

Matias reported that increasing food literacy and culinary skills among students has shown to increase intake of fruits and vegetables, and frequency of cooking, and reduce the number of skipped meals. Her study on the impact of the 14-week nutrition course also found a significant decrease in student food insecurity.

Across the UC System, students are benefiting from their campus Teaching Kitchens, including UC Berkeley, UC Davis, UCLA and UC Riverside. Other campuses such as UC San Diego, UC San Francisco, UC Santa Cruz and UC Santa Barbara offer basic student cooking classes as well.

Katherine Lanca, UC Global Food Initiative fellow working with NPI, attended the 2022 Teaching Kitchen Research Conference as part of her fellowship to learn about the latest research on teaching kitchens supporting equitable health outcomes.

The conference was hosted at UCLA by Harvard T.H. Chan School of Public Health Department of Nutrition in association with the Teaching Kitchen Collaborative. Teaching kitchens are a promising approach to supporting food security and cultivating lifelong habits, especially among a college student population.

Study: Government shutdown stressed food assistance program participants

A U.S. federal government shutdown can represent a minor inconvenience, a delay in paychecks, or – for people living in some of the most difficult circumstances – an extended period of hunger and anxiety.

A study published recently in the journal Nutrients provides a unique glimpse into the shutdown experiences of participants in CalFresh – California's name for the federally funded Supplemental Nutrition Assistance Program (formerly known as food stamps). Currently, about 42 million people participate in SNAP across the U.S.

In focus groups conducted in 2019 with 26 low-income CalFresh participants from four diverse California counties, participants shared how the 2018-19 federal government shutdown affected their SNAP benefits, their perception of the program and their faith in government.

One of the immediate effects of the 2018-19 shutdown was that February CalFresh benefits were distributed in January. And while that meant program participants saw extra benefits that month, they then had to wait 40 to 44 days until the March issuance – much longer than the usual 28 to 31 day cycle.

“What we saw with this study is that this extended lag in benefit receipt from January to March was devastating,” said Wendi Gosliner, senior researcher and policy advisor at the Nutrition Policy Institute of UC Agriculture and Natural Resources, and an author of the study funded by UC ANR.

She recalled one participant who, despite having a gastrointestinal issue that requires a special diet, had to eat canned food from the food bank that made her sick – rather than go hungry while waiting for her March benefits. Others described cascading financial challenges after using rent money for food in February, or going into debt to pay for food and getting behind on other expenses.

The study also chronicles the experiences of a woman who was anguished to hear the suffering of her daughter, also a CalFresh participant: “She called me several times crying, ‘Ma, I don't – we don't have enough food. What am I going to do…? You know, I can't afford to this and this and this.' And I can't help her.”

For individuals grappling with food insecurity, the stress of feeding their families was compounded by the uncertainties of the government shutdown. And while many participants exercised their agency and resourcefulness in coping with the situation, they also felt a degree of powerlessness amid the “confusion and craziness,” as one person put it.

“No one knew how long that shutdown was going to last; no one knew if the March benefits were going to be paid,” Gosliner said. “And as we learned, there were all kinds of stories circulating out there about what was going on with the uncertainty – a lot of people didn't have the information about what was actually happening.”

Some participants, seeing the “double benefit” in January 2019, thought that it was the last-ever distribution and that SNAP was ending. Others described being unable to get in touch with the CalFresh agency to get their questions answered about the benefits. Most participants had not heard about the disrupted benefit schedule before receiving the benefits. As a result, many people in the focus groups shared that their overall faith in government had been shaken.

Improving customer service, boosting benefit levels and adjusting eligibility and benefit formulas to reflect high cost-of-living and expenses related to working were three recommendations that came from the focus group participants.

A fourth recommendation tackles the shutdown issue head-on: Don't let it happen again.

“Congress should do absolutely everything in their power to be sure that the program operates on the usual time schedule – even if the government is shut down,” Gosliner said.

In the context of the global pandemic, when financial and social inequities and physical and mental health disparities have been laid bare, ensuring access to healthful food is even more important. And with studies showing that hospitalizations increase with longer lags between SNAP distributions, Gosliner said the “absolute last thing” the overburdened health system needs is more people in emergency departments seeking acute care.

“It's the worst time to be having people who need money to feed their families face additional insecurity,” she said. “It's critically important that Congress acts to be sure that there is not any disruption in benefits.”

The authors of the study, “Participants' Experiences of the 2018–2019 Government Shutdown and Subsequent Supplemental Nutrition Assistance Program (SNAP) Benefit Disruption Can Inform Future Policy,” are Wendi Gosliner, Wei-Ting Chen, Cathryn Johnson, Elsa Michelle Esparza, Natalie Price, Ken Hecht and Lorrene Ritchie.

The study can be found online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353319.

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