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

## TL;DR

This study examines how combining nutrition education with policy and environmental changes in schools affects students' diets and physical activity.

## Contribution

The study evaluates the effectiveness of combining education with policy, systems, and environmental strategies in school-based dietary interventions.

## Key findings

- Combining education with PSE strategies reduced soda intake and increased whole fruit and vegetable intake.
- Education-only interventions increased sport and energy drink intake but also increased fruit juice consumption.
- School urbanicity and FRPM eligibility modified the impact of interventions on dietary behaviors.

## Abstract

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

The online version contains supplementary material available at 10.1007/s10900-025-01507-0.