To assess the progress of PHA partner commitments, we work with a team of external verifiers, including:
- Altarum Institute
- Center for Active Design
- Food, Nutrition & Policy Consultants LLC
- RTI International
- Rudd Center for Food Policy and Obesity
Increasing Physical Activity
For Dick’s Sporting Goods and Dick’s Sporting Goods Foundation, verifiers obtained summary data on the amount of funding, projects, and reach for the Sports Matter project from the DonorsChoose.org website. No detailed information about these projects was provided. Presence of the Sports Matter website was confirmed by going to www.sportsmatter.com. Details on who could apply through the website were identified in the “Apply” section of the website. Verifiers reviewed names and affiliations of the grant-making panel, as well as the complete scoring rubric and points of consideration for the panel. For Dick’s Sporting Goods Foundation media and in-store campaigns, verifiers reviewed media reports that included goals of the campaigns, dates run, amounts spent per channel, and media impressions by channel. Data was summed for each campaign and then across all campaigns that ran in 2015 and 2016. Dick’s Sporting Goods Foundation’s involvement in creating a documentary film was verified using a copy of the agreement to create the film. Completion of the documentary was confirmed via viewing the movie trailer on IMDb and announcement on espnW of the film premiere date.
To assess Mercedes-Benz, USA’s progress towards meeting its commitment, verifiers reviewed data on distribution of funds to various organizations and key activities for funds. Funds awarded to New Orleans-based organizations were tallied independently to assess investment in this geographic area. Information on coaches was assessed via review of coach training log information including the number of coaches trained and city of placement.
To measure New York Road Runners’ progress, verifiers reviewed financial statements to confirm funding commitments were met. To calculate the number of schools participating in the Mighty Milers program, a verifier reviewed school names, addresses, student enrollment, free and reduced-price lunch eligibility and Mighty Milers enrollment. The verifier then calculated the number of unique schools in the list, the number of schools where 50 percent or more of the student population was eligible for free or reduced-price school lunch (schools with no data excluded), and the total number of youth participating in the Mighty Milers program. Verifiers then calculated the percentage increase over baseline by comparing current data to data from baseline year. Data from trainings that incorporated Running Start were analyzed to determine the number of unique trainings and attendees.
NIKE provided information on investments made, including award type, category, amount, date, recipient, city and state and key activities to be completed with the investment. Verifiers reviewed all data and calculated total investments for all areas.
United States Tennis Association (USTA) provided data on new youth tennis courts they had built during the reporting year, including details such as site names, addresses and size of courts. This information was used to calculate the number and type of new courts created. USTA submitted data on participants in the National Junior Tennis League, including addressed and numbers of participants in each age group. Verifiers reviewed data and summed the number of participants in each category. To calculate the value of tennis equipment donated by USTA, verifiers confirmed the retail value of products and shipping costs and summed these numbers. The total number of coaches trained was obtained from documentation listing training dates, workshop names and addresses and numbers of coaches in attendance.
The Outdoor Industry Association provided data on all schools and nonprofit partners that created fundraising campaigns on their Parks-4-Kids website between March 2016 and February 2017, including project descriptions, addresses, Title 1 school status, hours of physical activity per student, total youth participants, fundraising goal and funds raised. Data were cleaned to remove ranges entered for any measures (an average was calculated) and implausible values (e.g., number of youth reached in a grade level exceeded total youth reached, larger value was taken as reach). Across the entire dataset, total campaigns entered, projected youth reach, and funds raised were summed and unique cities and states were calculated in Excel. Amount of funding raised was divided by the funding goal to calculate percentage of fundraising goal met. Campaigns that raised 50% or more of their goal were considered completers. The number of youth reached for those campaigns was summed to provide the total youth reach for the commitment. Hours of activity per youth were multiplied by the total youth reached to obtain total hours of physical activity for completed projects. Hours of activity per youth were averaged across completed campaigns to obtain the average hours of physical activity per child.
Transforming the Marketplace
Dannon’s commitment was verified through an analysis of nutrient density, sugar and fat content across all fresh cultured dairy products within the brand. To verify progress on education and research investments, Dannon provided detailed accounts of training, educational presentation, exhibit and research expenditures.
To assess progress on Darden’s commitment to achieve calorie and sodium reductions, calorie and sodium averages were calculated for each restaurant type. These averages included all typical menu items combined. Each restaurant’s calorie and sodium averages were then weighted and combined to provide one calorie and sodium average for Darden overall. Darden also supplied children’s menus from restaurants, nutrition analysis and recipe analysis calculations or certification of chemical analysis for at least one meal from each restaurant that met guiding principles.
For the Doctor Associates, Inc. (Subway) commitment, Subway provided menu and nutrient information for all kids meals. Verifiers reviewed nutrition information for all meals to confirm that they met the required nutrient profile. Affordability of kids’ meals was assessed using the prices recommended by Subway for the items individually and as a combo. To confirm meals met the required food profile, independent verifiers assessed volume measurements for all items in sandwiches as well as sides, including photographs of volume measures for vegetable items. Advertising and marketing activities and policies were assessed via review of Subway’s website, select training materials and photographs of promotional stickers, tags and other promotional messaging for stores.
To verify progress on Hyatt’s commitment, calorie, sodium and total sugar averages were calculated for the top two selling a la carte items for breakfast, lunch and dinner from a random sample of 24 hotels of three-meal restaurants and in room dining. Calorie, sodium and total sugar values were averaged across the sample to monitor baseline values and annual changes throughout the commitment. Hyatt also provided three-meal restaurant and in-room dining menus to verify affordability and local procurement commitments.
To supports its progress, the Mushroom Council provided an annual report detailing their activities including progress on school pilots and media impressions, as well as copies of recipes disseminated to schools, specification sheets for newly created mushroom blend recipes, and budget records to demonstrate dedicated funds to mushroom marketing, innovation and promotion. Independent verifiers confirmed conference activities by viewing conference materials such as exhibit hall diagrams. Mushroom Council provided information on new products developed with restaurants, and these restaurants were cross-referenced with the National Restaurant News 2015 Top 100 report, which ranks the largest restaurant chains and parent companies.
Nutri Ventures USA, Inc.’s progress was assessed by reviewing the Nutri-guardians website created by the organization. An independent verifier extensively reviewed website material, documenting availability of various types of content and information and applicability to various key audiences, including professionals and educators.
Verifiers reviewed a copy of One Medical’s affiliation agreement with Iowa State University Dietetic Internship Program, which articulated the terms of intern involvement in the provision of nutrition coaching to Rise App participants in support of One Medical’s commitment. A list of de-identified Rise App participants that received free nutrition coaching, as well as the number of children they have, their BMI, qualification for low-income programs, willingness to commit to a three-month program, and iPhone status, was reviewed and any participants not meeting all criteria were excluded before summing the eligible participants that received free coaching. Screen shots of the Rise App, as well as a description of the app in the Apple App Store, were reviewed to assess app functionality.
Progress on the commitment between PHA and Sesame Workshop and the Produce Marketing Association was assessed via review of data on sub-licensee applicants, which included names of organizations seeking use of Sesame Workshop Assets, as well as character requests and associated fruits and vegetables. These findings were totaled and reported. Promotions, including press releases, videos, conferences, and magazine articles were reviewed and totaled.
Progress on commitments made by Kwik Trip, Sheetz, Vintner Distributers, Tri Star Energy and U-Gas was determined by reviewing shipping logs and reports from stores to confirm that a minimum number of types of fruits, vegetables, whole grain products and low-fat dairy options were available. When applicable, verifiers reviewed inventory lists or store planograms and spreadsheets of products’ nutritional information to ensure stores offered a minimum number of products and grab and go items that met PHA’s definition of a Healthier Food and Beverage Product Criteria and to calculate linear feet of shelf space dedicated to fruits, vegetables, whole grains and low fat dairy. For healthier combo meals, verifiers reviewed recipes, nutritional information and store menus to ensure options are available that meet PHA’s Healthier Recipe Criteria. Verifiers reviewed employee handbooks to confirm commitment elements around employee benefits, and installation of bicycle racks, if applicable, was verified through review of building plans showing location of bicycle racks.
Walgreens and The Fresh Grocer supplied data for all new or expanded stores, including store numbers, street addresses and building or conversion (renovation) dates. Addresses were used to identify latitude and longitude coordinates via Google Earth and ArcGIS Desktop to confirm the existence of store locations. Stores were classified as urban or rural based on their spatial relationship to the U.S. Census Urbanized areas. To determine the proximity of store locations to food deserts, distances were calculated from the latitude and longitude coordinates of each store to three different food desert data sources (USDA Food Research Atlas [uses 2010 Census tracts], USDA Food Desert Locator 2006 [uses 2000 Census tracts], and The Reinvestment Fund Limited Supermarket Access (LSA) areas [based on Census 2000 block groups].) To meet the criteria for being located in or around a food desert, stores had to be located within 1 mile (urban) or 10 miles (rural) of a food desert census tract or LSA. Food deserts are urban or rural areas without ready access to fresh, healthy and affordable food. Population characteristics for each store were calculated using spatial selection tools. When more than one food desert census tract or LSA was located within the appropriate buffer, population numbers were aggregated. For the Walgreens commitment only, Walgreens provided data by store location on whether the store had fresh, or frozen fruits and vegetables and the dates that these products were first made available.
Job creation was calculated based upon methods adapted from the Office of Management and Budget. Created jobs were defined as new, paid positions—including full-time, part-time and temporary jobs—that were created as a direct result of the partner’s commitment to PHA. Partners provided data on total hours worked for individual employees or employee categories, which were used to calculate full time equivalents. The total number of people hired was calculated utilizing estimates from partners of the total number of people hired to fill new jobs.
The funds raised and expended by The California Endowment for the California FreshWorks Fund (CAFWF) were verified via review of confidential documents provided by the partners. Population numbers were provided by CAFWF and based on formal and informal market analyses conducted by recipients of capital at the time of funding; however, precise methods were not provided to verifiers.
Creating Healthier Places
Hospital Healthier Food Initiative
For the Hospital Healthy Food commitment, documentation of total food purchases and the percentage of those purchases accounted for by fruits and vegetables was calculated using spreadsheets supplied by hospitals containing dollar amounts for all foods or categories of foods purchased in a baseline year designated by PHA.
Hospitals supplied photographs of cafeteria advertising and copies of general and pediatric patient menus that reviewers used to verify alignment with healthier food marketing criteria. Hospital-supplied photographs and lists of products within five feet of all cafeteria cash register stations were used by reviewers to verify whether hospitals adhered to healthier check out criteria. Independent verifiers utilized recipes, nutrient analyses, menus, and cafeteria pricing supplied by hospitals for three days that were selected by the independent verifier for children’s wellness meals and adult wellness meals. The verifier reviewed all meals to determine whether they met nutrient and food profiles and were offered at lunch and dinner. In order to meet each wellness meal commitment element, hospitals had to offer one to three meals (depending on year of commitment) in the cafeteria and on the patient menu during lunch and dinner that met nutrient and food profiles for all three days that data were collected. To determine whether hospitals achieved percentage goals for healthier foods available in the cafeteria and on patient menus, independent verifiers reviewed spreadsheets prepared by hospitals that contained lists of all foods available over the course of two days selected by the independent verifier. The verifiers reviewed the accuracy of product categorization of entrée or side dish according to protocol, and nutrient criteria to determine whether the product met healthier standards. The verifiers then calculated the percentage healthier entrees and healthier sides. Independent verifiers reviewed photos of cafeteria menu boards, food and beverage stations, and cafeteria menus to assess whether hospitals met requirements for nutrition labeling of all foods in the cafeteria footprint. Finally, hospitals submitted before/after photos to demonstrate removal of fryers or other data supporting removal of fryers and all fried foods, which were reviewed by verifiers. If fried products were still offered by the hospitals, nutrition information was requested to assess whether each product met nutrient requirements.
Morrison conducted a survey with its hospital clients in 2016. In the survey, hospitals self-reported whether they were meeting each of the Wellness Platform criteria to provide healthier hospital environments. Morrison provided the raw survey results to an independent verifier, who cross-referenced with hospitals participating in a separate, but similar PHA commitment, the Hospital Healthier Food Commitment. In instances where a hospital was part of the PHA Hospital Healthier Food Commitment and also had responded to the Morrison survey, the self-reported survey results were discarded and replaced with verified results from the more comprehensive review of hospital practices. The verifier then calculated the number and percentage of hospitals meeting each Wellness Platform criteria and those meeting 100% of the criteria. Percentage of healthier beverages purchased was verified using purchasing data that listed all beverage items and dollar amounts purchased by Morrison for one year. Verifiers reviewed all items and classified according to whether the item met the healthier beverage criteria, and then calculated the percentage of healthier beverages out of total beverages purchased. Percentage of fruits and vegetables purchased was verified using purchasing data that listed all food items purchased and dollar amounts purchased by Morrison for one year. Items were classified as a fruit/vegetable or other food item, and then the percentage of total purchases dedicated to fruits and vegetables was calculated. Data on presence of deep-fat fryers in hospitals and offering of fried items on patient and cafeteria menus were obtained via self-report survey of Morrison hospitals. Number of hospitals meeting each criteria was calculated as well as the number and percentage of hospitals meeting all three criteria.
Active Design Verified
To verify the progress of our partners in meeting the active design criteria, verifiers reviewed the technical building plans, photographs, and related documentation for each affordable housing site. Verifiers ensured that each building was designed using the evidence-based strategies outlined in the developer’s commitment.
Healthier Campus Initiative
Each post-secondary education institution participating in the Healthy Campus Initiative selected twenty-three elements across the following categories: food and nutrition, physical activity and movement, and wellness programming.
For food and nutrition guidelines, independent verifiers reviewed two days, that were selected by the independent verifier, of breakfast, lunch, and dinner menus for each campus dining venue. Menus, which included nutrient information, allowed verifiers to ensure nutrient targets were met for calories, percent calories from saturated fat, grams of trans fat, and milligrams of sodium in wellness meals. Verifiers utilized production records, planograms, recipes, nutrition facts panels, product specifications, and additional photographs to determine whether campuses offered fruits, vegetables, whole grains, and plant-based food options and limited fried foods and desserts. Procurement records, sales records, and nutrition information were also reviewed and evaluated to verify healthy vending and beverage purchases. Campuses provided additional photographic evidence to verify their use of healthy icons and calorie labeling at the point of purchase. Policies were reviewed to determine the use of local procurement programs, tray-less dining initiatives, and merchandising programs to promote nutritious options. To verify availability of water in each dining, recreation, and educational facility, campuses provided an inventory of water fountains, bottle filling stations, and access points for filtered water in at least five percent of the campus buildings, selected by the verifier.
Physical activity elements were verified through campus maps, photographs, and policies outlining walking and biking infrastructure, access to public transportation, and recreation, physical activity, and competitive sports opportunities.
Wellness elements were verified by examining policy and program documentation to determine whether integrated, comprehensive wellness programming including breastfeeding support, strategies to reduce food insecurity, health insurance benefits, and access to hands-on nutrition education and cooking classes were provided.
Early Childhood and Out-of-School Time
Progress for YMCA of the USA (Y-USA) was measured via the Healthy Eating and Physical Activity (HEPA) survey. YMCA Member Associations with early childhood or afterschool programs that had committed to implementing the HEPA standards in their programs were eligible to participate in the survey. Respondents reported implementation of each HEPA standard individually at their program sites, as well as whether any sites were meeting 100 percent of these standards. Verifiers analyzed survey data to determine the total number of Member Associations with at least one program site meeting 100 percent of the standards and the percentage of Member Associations meeting each standard. To assist program sites in implementation, Y-USA developed training courses and technical assistance resources and distributed grants to facilitate standards implementation. Y-USA provided backup documentation to support completion of these activities, which was reviewed and confirmed by verifiers.
Progress on commitments made by KinderCare Education and Learning Care Group were assessed via scoring of corporate policies using the Wellness Child Care Assessment Tool (i), and an online survey of directors of childcare centers was used to assess the nutrition and physical activity environment of each center (adapted from Henderson et al., 2011 (ii)).
Progress on commitments for the National Recreation and Park Association (NRPA) was measured via the Healthy Eating and Physical Activity (HEPA) inventory (iii) and document review. NRPA sites with early childhood or afterschool programs that had committed to implementing the HEPA standards in their programs participated in the inventory. Respondents reported whether they were “Fully Demonstrating,” “Not Fully Demonstrating” or it was “Not Feasible” to demonstrate each HEPA standard individually at their program site. A random sample of 30 sites that completed the inventory were asked to submit program documents, including daily schedules, menus, program handbooks, and parent outreach materials, which were then reviewed by verifiers against definitions of meeting each of the HEPA standards. Verifiers analyzed the inventory to determine the percentage of sites meeting each of the standards and the document review data to provide a confidence level on whether sites had the documentation showing that they were meeting the standards. The confidence level is based on the document audit of 26 sites and reflects the proportion of audited sites that submitted clear or plausible evidence to support a claim that they were fully implementing a commitment element. We established four categories: Highly confident = 76 to 100% of sites that said they were demonstrating a commitment element submitted clear or plausible evidence to support their claim; Confident = 51 to 75%; somewhat confident = 26 to 50%; not confident = 0 to 25%. To assist sites in implementation, NRPA with the Alliance developed training courses and technical assistance resources to facilitate standards implementation.
i. Falbe, J., Kenney, E.L., Henderson, K.E., Schwartz, M.B. (2011). The wellness childcare assessment tool: a measure to assess the quality of written nutrition and physical activity policies. Journal of the American Dietetic Association; 111:1852-1860.
ii. Henderson, K.E., Grode, G.M., Middleton, A.E., Kenney, E.L, Falbe, J., Schwartz, M.B. (2011). Validity of a measure to assess the child-care nutrition and physical activity environment. Journal of the American Dietetic Association; 111:1306-1313.
iii. Alliance for a Healthier Generation. (2014). Online Assessment for 2013.