Interview Questions for Advocacy for Nutrition-Related Policies

The US policy landscape surrounding school nutrition programs is complex and constantly evolving. At its core, it’s driven by the National School Lunch Program (NSLP) and the School Breakfast Program (SBP), both federally funded initiatives aiming to provide nutritious meals to students. These programs are guided by the Healthy, Hunger-Free Kids Act of 2010, which introduced stricter nutrition standards for meals served. This included increasing the availability of fruits, vegetables, and whole grains, while limiting sodium, saturated fat, and trans fat.

However, the implementation and enforcement of these standards have faced challenges. There’s ongoing debate about the flexibility needed for schools to meet the requirements, particularly in areas with limited access to fresh produce or culturally appropriate foods. Furthermore, funding levels for these programs often fluctuate, impacting their reach and effectiveness. There’s also a growing focus on addressing issues such as food insecurity beyond school meals, advocating for universal free school meals and better coordination with other community-based nutrition assistance programs. The current policy environment is marked by a push and pull between improving the nutritional quality of school meals and the practical considerations of implementation and affordability.

Lobbying plays a crucial role in shaping nutrition policy. It’s essentially a form of advocacy where individuals or organizations attempt to influence policymakers to adopt specific policies or legislation. In the context of nutrition, this involves educating legislators and their staff about the scientific evidence linking diet to health outcomes, highlighting the economic benefits of healthy eating, and demonstrating the potential impact of proposed policies. Effective lobbying requires building relationships with policymakers, utilizing data-driven arguments, and mobilizing public support through grassroots campaigns.

For example, a coalition of public health organizations might lobby for increased funding for nutrition education programs. Their strategy might include providing research data on the effectiveness of such programs, meeting with congressional representatives to discuss the issue, and organizing public events to raise awareness and garner support from constituents. The success of lobbying efforts often depends on the resources available, the strength of the evidence, and the ability to build broad-based coalitions.

Measuring the success of a nutrition advocacy campaign requires a multifaceted approach. It goes beyond simply looking at whether a specific policy was passed or not. Instead, it involves assessing changes across various levels – policy, program, and population.

• Policy changes: Was the desired policy change enacted? What’s the scope and strength of the policy? Were there any unintended consequences?
• Programmatic impact: Did the campaign lead to improvements in program implementation, such as increased participation or enhanced quality of services offered?
• Population-level outcomes: Were there measurable improvements in dietary behaviors, health outcomes (e.g., reduction in obesity rates), or health equity among the target population? This may require longitudinal studies to observe long-term effects.

Quantitative data, such as survey results, sales figures for healthy foods, or changes in health indicators, are essential. Qualitative data, including feedback from stakeholders and case studies, provides valuable context and helps interpret the findings. A well-designed evaluation plan with clearly defined indicators is crucial from the outset of the campaign.

Advocating for healthy eating initiatives in low-income communities faces unique challenges. These communities often experience food insecurity, limited access to affordable and nutritious food (food deserts), and higher rates of diet-related chronic diseases. Addressing these requires a holistic approach.

• Food deserts: Improving access to healthy food requires advocating for grocery store development, farmers’ markets, and community gardens. This involves navigating complex zoning regulations and attracting private investment to underserved areas.
• Affordability: Policies like SNAP (Supplemental Nutrition Assistance Program) benefits increases and tax incentives for healthy food purchases are crucial. Advocating for such policies requires demonstrating their cost-effectiveness by highlighting potential savings in healthcare costs due to reduced chronic disease prevalence.
• Cultural considerations: Promoting healthy eating needs to be culturally sensitive and respectful. This necessitates collaboration with community leaders and organizations to understand local dietary preferences and traditions and tailor interventions accordingly.
• Health literacy: Many individuals lack the knowledge and skills to make healthy food choices. Effective interventions must improve nutrition education, making information accessible and relevant.

Overcoming these challenges requires building strong partnerships with community-based organizations, addressing systemic inequities, and advocating for comprehensive policy changes.

Ethical considerations in nutrition policy advocacy are paramount. Advocates have a responsibility to be truthful, transparent, and accountable in their work. This involves:

• Evidence-based advocacy: Promoting policies based on sound scientific evidence, avoiding misinformation or exaggeration of findings. This includes acknowledging limitations and uncertainties in the research.
• Transparency and disclosure: Clearly disclosing funding sources and potential conflicts of interest. This builds trust and credibility with policymakers and the public.
• Equity and justice: Ensuring that policies promote health equity and address the needs of vulnerable populations, not exacerbating existing inequalities.
• Respect for autonomy: Promoting policies that empower individuals to make informed choices about their diet, rather than imposing restrictions or creating barriers to access.
• Collaboration and consensus-building: Engaging diverse stakeholders in a respectful and inclusive manner to achieve shared goals.

Failing to uphold these ethical standards can undermine public trust and damage the credibility of the advocacy movement.

Engaging stakeholders with conflicting interests in a nutrition policy debate requires skillful negotiation and facilitation. The key is to find common ground and build consensus, even when there are substantial disagreements.

• Identify shared goals: Begin by identifying areas of agreement among stakeholders. This might be a shared commitment to improving public health, even if the approaches differ.
• Facilitate open communication: Create a safe space for dialogue where all stakeholders can express their perspectives and concerns without feeling attacked or dismissed.
• Mediation and compromise: Employ mediation techniques to help stakeholders find mutually acceptable solutions. This may involve compromise on some aspects of the policy to secure broader support.
• Data-driven discussions: Use data and evidence to inform the debate and challenge unsubstantiated claims. This can help build a more objective understanding of the issue.
• Transparency and accountability: Maintain transparency throughout the process, ensuring that all stakeholders understand the decision-making process and the rationale behind the policy choices.

Remember, building relationships and fostering trust is essential for achieving productive collaborations, even when interests are initially divergent.

While both policy briefs and policy analysis papers aim to inform policymakers, they differ significantly in their scope, depth, and intended audience.

A policy brief is a concise, summary document intended to quickly inform policymakers about a specific issue and recommend a course of action. It is typically short (2-4 pages), presents a clear policy problem and solution, includes strong evidence to support recommendations, and often targets a specific audience or decision-maker. Think of it as a ‘pitch’ for a specific policy change.

A policy analysis paper, on the other hand, provides a more comprehensive and in-depth examination of a policy issue. It explores the background of the issue, analyzes different policy options, evaluates their potential impacts, and may consider the broader political and economic context. It is longer and more academically rigorous than a policy brief and seeks to inform a broader audience, including researchers, policymakers, and the public.

In essence, a policy brief advocates for a particular solution, while a policy analysis paper informs decision-making by providing a thorough and balanced examination of the issue and potential solutions.

Data analysis is fundamental to effective nutrition policy advocacy. It allows us to move beyond anecdotal evidence and build compelling arguments based on robust evidence. My experience involves using various statistical methods to analyze datasets related to dietary intake, health outcomes, and socio-economic factors. For example, I’ve used regression analysis to demonstrate the correlation between access to healthy food options and rates of obesity in specific communities. I’ve also utilized geographic information systems (GIS) to map food deserts and identify areas requiring targeted interventions. In one project, we analyzed data from national surveys to show the impact of a proposed sugar tax on consumption patterns, demonstrating a statistically significant decrease in sugary drink purchases among low-income families. This allowed us to present a strong case to policymakers for the implementation of the tax. My skills extend to data visualization, creating clear and persuasive infographics and presentations to communicate complex data effectively to both technical and non-technical audiences.

I am extremely familiar with the Dietary Guidelines for Americans. I understand their core principles, the scientific basis for their recommendations, and the iterative process of their development and revision. I’ve used these guidelines extensively in my advocacy work, referencing them to support policy proposals and to critique existing policies that fall short of their recommendations. For example, I’ve used the guidelines to advocate for school meal programs that align with nutrient-dense food recommendations and to challenge policies that promote unhealthy food marketing to children. My understanding extends to the application of the guidelines within various contexts, considering factors such as cultural appropriateness, dietary diversity, and accessibility.

Advocating for increased funding for community nutrition programs requires a multi-pronged approach. Firstly, we need to demonstrate the return on investment (ROI) of these programs through rigorous evaluation studies. For instance, quantifying the reduction in healthcare costs associated with improved dietary habits or the increased school performance linked to well-nourished children provides a strong economic argument. Secondly, we need to build strong coalitions with community leaders, healthcare professionals, and concerned citizens, creating a unified voice that amplifies our message. This involves effectively communicating the impact of these programs on individuals, families, and the community as a whole, using compelling narratives and real-life examples. Thirdly, I would actively engage with policymakers at all levels, using data-driven presentations to highlight the needs and the potential benefits of increased funding, tailoring our arguments to their specific priorities and concerns. Finally, strategic media outreach and public awareness campaigns can further build public support and pressure on legislators to prioritize funding.

During a campaign to implement a city-wide ban on sugary drinks in public schools, we faced strong opposition from beverage industry lobbyists. While our initial goal was a complete ban, we realized that achieving this ambitious target would require an extended and potentially unsuccessful battle. To achieve a meaningful policy change in a timely manner, we compromised by agreeing to a phased implementation, starting with a reduction in the availability of sugary drinks and eventually progressing towards a full ban over a three-year period. This compromise allowed us to secure initial support from key stakeholders, gain momentum for the cause, and ultimately achieve a significant improvement in the school environment, preventing the immediate failure of the campaign. While not ideal, this demonstrated the pragmatic approach needed for successful advocacy in a complex political landscape.

Addressing nutrition misinformation requires a multi-faceted strategy. Firstly, identifying the source and dissecting the misinformation is crucial. Often, it stems from poorly designed studies, biased reporting, or deliberate manipulation. I would rely on credible sources such as peer-reviewed scientific literature, governmental health agencies, and registered dietitians to counter the misinformation. Secondly, I’d use clear, evidence-based communication to educate the public about accurate nutrition information. This may involve creating informative infographics, writing accessible articles, and participating in public forums or media interviews. Thirdly, promoting media literacy skills enables individuals to critically assess information and identify unreliable sources. This could involve educational workshops or creating online resources that teach how to evaluate scientific studies and identify bias. Finally, working with social media platforms to flag and remove demonstrably false content is also a necessary approach.

Current trends in nutrition policy research include a growing focus on the interplay between nutrition, the environment, and sustainability. There’s increased attention on the environmental impact of food production and distribution, including its carbon footprint and water usage. Research is exploring sustainable dietary patterns that minimize environmental damage while maintaining nutritional adequacy. Another significant trend is the use of big data and advanced analytics to better understand dietary behaviors and the effectiveness of interventions. This includes leveraging technology such as mobile apps and wearable sensors to collect data and personalize nutrition advice. The precision nutrition approach, tailoring dietary recommendations to individual genetic and metabolic profiles, is gaining momentum, though ethical considerations and the availability of personalized data remain challenging. Furthermore, research is increasingly addressing the social determinants of health, recognizing that factors like income inequality and access to healthcare significantly influence nutrition and health outcomes.

Collaboration is paramount to successful nutrition advocacy. It’s rarely a solo effort. Building strong partnerships with diverse stakeholders is essential to amplify our message and increase our reach. This includes collaborating with other non-profit organizations, community groups, healthcare professionals, researchers, policymakers, and even the food industry (where appropriate and ethically sound). For example, working with a food company to develop healthier products can be more effective than simply criticizing their existing offerings. Each partner brings unique skills, resources, and perspectives, allowing for a more comprehensive and impactful approach. Effective collaboration requires clear communication, shared goals, and a willingness to compromise. By working together, we can achieve broader and more sustainable improvements in nutrition policies and public health.

Food security is the state where all people, at all times, have physical and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life. It’s not just about having enough food to survive; it’s about having access to a variety of nutrient-rich foods that support optimal health and well-being.

Food insecurity, the opposite, directly impacts nutrition. When people lack consistent access to sufficient food, their diets are often deficient in essential vitamins and minerals. This can lead to malnutrition, including undernutrition (stunting, wasting, underweight), micronutrient deficiencies (e.g., anemia, vitamin A deficiency), and overnutrition (obesity). These conditions weaken the immune system, impair cognitive development, reduce productivity, and increase the risk of chronic diseases.

For example, a family facing unemployment might struggle to afford nutritious fruits and vegetables, relying instead on cheaper, calorie-dense processed foods. This can result in children experiencing stunted growth and an increased risk of obesity later in life, showcasing the direct link between food insecurity and poor nutritional outcomes.

Advocating for nutrition-related legislation requires a multi-pronged approach. My strategies would involve:

• Data-driven research and analysis: Identifying the specific nutritional needs of the population, analyzing existing legislation and policies, and conducting cost-benefit analyses to demonstrate the potential impact of proposed legislation. This involves gathering evidence from reputable sources like the WHO and national health surveys.
• Building relationships with policymakers: Establishing strong communication channels with legislators, their staff, and relevant committees through meetings, briefings, and written communications. This ensures they understand the importance of the legislation and the evidence supporting it.
• Grassroots mobilization: Engaging communities and individuals affected by the issues addressed in the legislation, encouraging them to contact their representatives and express their support. This includes organizing public forums, rallies, and awareness campaigns.
• Media engagement: Utilizing press releases, interviews, and social media to raise public awareness of the issue and the proposed legislation, shaping public opinion and increasing political pressure.
• Collaboration with relevant stakeholders: Working with other organizations and experts (nutritionists, healthcare professionals, NGOs, etc.) to build a strong coalition in support of the legislation. This increases the visibility and credibility of the advocacy efforts.

For instance, advocating for a school lunch program reform would involve demonstrating the link between improved nutrition and improved academic performance using research data, mobilizing parent groups to pressure school boards, and collaborating with nutrition experts to propose menu improvements.

Building effective coalitions for nutrition policy change requires identifying key stakeholders and understanding their interests and capabilities. My approach would include:

• Identifying key stakeholders: This includes public health organizations, community-based organizations, healthcare providers, food industry representatives, academic institutions, and consumer advocacy groups. Careful selection ensures a diverse representation of perspectives.
• Developing a shared vision and goals: Establishing a common understanding of the desired policy outcomes, ensuring all stakeholders are working towards the same objectives. This involves clear communication and compromise.
• Facilitating communication and collaboration: Organizing regular meetings, workshops, and communication channels to maintain consistent communication and shared understanding between stakeholders. This requires active listening and conflict resolution.
• Leveraging each stakeholder’s strengths: Recognizing and utilizing the unique capabilities of each stakeholder, such as research expertise, community outreach capacity, or policy influence. This involves strategic task assignment and resource allocation.
• Celebrating successes and acknowledging challenges: This reinforces collaboration and trust, allowing for constructive feedback and adaptation of strategies.

Imagine building a coalition to promote breastfeeding. It would involve partnering with lactation consultants (expertise), hospitals (policy influence), and mothers’ support groups (grassroots mobilization) to create a comprehensive support system and advocate for policies promoting breastfeeding support in the workplace and public spaces.

Staying updated on nutrition policy requires a proactive approach involving multiple information channels.

• Subscribing to relevant journals and newsletters: Publications such as the American Journal of Clinical Nutrition and newsletters from organizations like the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) provide current research and policy updates.
• Attending conferences and workshops: These events provide opportunities to network with experts and learn about the latest research and policy developments in the field.
• Monitoring government websites and policy databases: Regularly checking relevant government websites for announcements, reports, and legislative updates.
• Following key organizations and individuals on social media: Keeping abreast of current debates and developments through relevant Twitter accounts, LinkedIn groups, and other platforms.
• Engaging with professional networks: Participating in professional organizations like the Academy of Nutrition and Dietetics provides access to resources, networking opportunities, and policy discussions.

Evidence-based practice is crucial in nutrition policy advocacy. It means using the best available research evidence to inform policy decisions and advocacy strategies. This ensures policies are effective, efficient, and ethically sound.

Strong evidence includes:

• Systematic reviews and meta-analyses: These provide a comprehensive summary of existing research on a particular topic, helping to identify robust conclusions.
• Randomized controlled trials (RCTs): These provide high-quality evidence on the effectiveness of interventions.
• Cohort studies and observational studies: While not as strong as RCTs, these can provide valuable insights into relationships between nutrition and health outcomes.

Ignoring evidence-based practice can lead to ineffective and even harmful policies. For example, advocating for a specific food supplement without sufficient evidence of its efficacy and safety could be detrimental to public health. Conversely, strong evidence of the link between sugar consumption and dental caries strengthens the argument for policies that limit sugar intake in children.

Health disparities are systematic differences in health outcomes across different population groups, often linked to social, economic, and environmental factors. These disparities are strongly related to nutrition because access to nutritious food, and the ability to make healthy food choices, is not equally distributed.

Factors contributing to nutrition-related health disparities include:

• Poverty and food insecurity: Low-income communities often have limited access to affordable, healthy food options, leading to increased rates of malnutrition and diet-related diseases.
• Lack of access to healthcare: Limited access to healthcare services, including nutrition counseling and education, exacerbates existing nutritional deficiencies and health problems.
• Cultural and social norms: Cultural food traditions, along with societal pressures, can influence dietary habits and choices, sometimes leading to unhealthy eating patterns.
• Environmental factors: Lack of safe places for physical activity and exposure to food marketing can negatively impact dietary habits.

For example, communities living in ‘food deserts’ – areas lacking access to supermarkets and grocery stores – often have higher rates of obesity and diet-related diseases compared to communities with better access to healthy food.

Advocating for the implementation of a specific nutrition policy requires a strategic and phased approach:

• Develop a clear implementation plan: Detailing the specific steps required for successful implementation, including timelines, responsibilities, and resource allocation. This might include creating educational materials, training healthcare providers, or establishing monitoring mechanisms.
• Secure funding and resources: Identifying and securing funding from government sources, private foundations, or other organizations to support implementation activities. This involves developing compelling proposals and budgeting for program activities.
• Build partnerships and collaborations: Partnering with relevant organizations and stakeholders, including government agencies, healthcare providers, and community-based organizations, to ensure coordinated and effective implementation. This requires strong communication and negotiation skills.
• Monitor and evaluate progress: Establishing a robust system for monitoring program activities and evaluating outcomes to assess the impact of the policy and identify areas for improvement. This involves collecting data, analyzing results, and reporting findings.
• Advocate for policy sustainability: Working to ensure the long-term sustainability of the policy by integrating it into existing programs and policies, securing continued funding, and building public support. This requires ongoing communication and engagement.

For instance, implementing a school-based nutrition program would involve securing funding, training school staff, establishing monitoring protocols to assess student dietary intake, and working with food service providers to meet nutritional standards. Advocacy would continue to ensure funding and policy maintenance.

Unintended consequences in nutrition policy are often complex and can arise from various factors. A well-intentioned policy might have negative impacts on specific populations, the economy, or even lead to unforeseen health problems. For example, a policy focused on reducing sugar intake might inadvertently lead to increased consumption of unhealthy fats if healthier alternatives aren’t readily accessible or affordable.

• Economic impacts: A tax on sugary drinks, while aiming to improve health, could disproportionately affect low-income families who rely on cheaper, sugary options. This could lead to social unrest and economic hardship.
• Behavioral changes: Policies restricting access to certain foods may lead to people seeking out less healthy alternatives, or engage in unhealthy coping mechanisms.
• Market distortions: Subsidies for certain crops might lead to overproduction and environmental damage, or favor certain food producers over others.
• Equity issues: Policies that don’t consider the diverse needs of different communities may exacerbate existing health inequalities. A policy focused on school lunches, for instance, might not adequately address the needs of children from low-income families who rely on free or reduced-price meals.

To mitigate these risks, thorough impact assessments, including stakeholder consultations and cost-benefit analyses, are crucial before policy implementation.

Social media has become an indispensable tool for nutrition policy advocacy. I’ve used platforms like Twitter, Instagram, and Facebook to disseminate information, engage with policymakers, mobilize public support, and build coalitions.

• Information dissemination: I’ve shared research findings, policy briefs, and infographics on the impact of nutrition on health outcomes, using compelling visuals and concise language.
• Policymaker engagement: I’ve directly engaged with elected officials and their staff through targeted tweets and messages, highlighting key policy recommendations and urging their support.
• Public mobilization: I’ve used social media campaigns to raise awareness about important nutrition issues and encourage people to contact their representatives to voice their support for specific policies.
• Coalition building: I’ve used social media to connect with other organizations working in the field of nutrition, fostering collaborations and amplifying our collective message.

Measuring the impact of social media efforts requires careful tracking of metrics like reach, engagement, website traffic, and changes in public opinion or policymaker behavior. For example, tracking mentions of specific policy hashtags can indicate increased public awareness.

Tailoring advocacy messages is essential for effectiveness. Different audiences require different approaches, considering their knowledge, values, and concerns.

• Policymakers: Messages to policymakers focus on evidence-based arguments, cost-effectiveness analyses, potential policy impacts, and alignment with existing policy priorities.
• General public: Messaging for the general public emphasizes the health benefits of adopting healthy eating patterns and the impacts of nutrition on quality of life, using simple language and compelling stories.
• Health professionals: Communication with health professionals emphasizes scientific evidence, clinical implications, and practical strategies for promoting healthy eating among patients.
• Food industry: When engaging the food industry, the focus should be on the economic benefits of adopting healthier practices and exploring collaborative strategies to improve food quality and accessibility.

Using plain language, strong visuals, and relevant examples tailored to the audience’s context is key for effective communication. For instance, I might use infographics for the general public, while detailed policy briefs would be appropriate for policymakers.

Quantitative data is crucial for supporting nutrition policy, but it has limitations. While it provides objective measurements, it can’t always capture the full complexity of the issues.

• Correlation vs. Causation: Statistical associations don’t always imply a causal relationship. For example, a correlation between sugar consumption and obesity doesn’t definitively prove that sugar causes obesity.
• Data limitations: Data collection methods might be flawed, leading to biased or incomplete results. For instance, self-reported dietary intake can be unreliable.
• Contextual factors: Quantitative data may not adequately account for social, economic, cultural, and environmental factors that influence dietary behaviors.
• Oversimplification: Focusing solely on quantitative data might lead to an oversimplified understanding of the problem and neglect other crucial aspects such as equity, accessibility, and affordability.

Addressing these limitations requires integrating quantitative data with qualitative data (e.g., interviews, focus groups), considering contextual factors, and employing rigorous research methodologies.

Responding to criticism requires a calm, thoughtful, and evidence-based approach. I would acknowledge the concerns raised, and address them directly using facts and data.

• Acknowledge concerns: Begin by acknowledging the validity of the criticism and showing respect for the person’s perspective.
• Provide evidence-based counterarguments: Use credible scientific evidence and data to refute inaccurate or misleading claims.
• Address potential unintended consequences: Acknowledge and address any potential negative impacts of the policy, highlighting measures taken to mitigate these risks.
• Demonstrate transparency: Be transparent about the limitations of the evidence and the ongoing process of evaluation and refinement of the policy.
• Engage in constructive dialogue: Seek common ground and work collaboratively with critics to find solutions that address their concerns while achieving policy goals.

Maintaining open communication and demonstrating a willingness to adapt and improve the policy based on feedback is crucial for building trust and achieving consensus.

Cost-effectiveness analysis (CEA) is crucial for nutrition policy development because it helps evaluate the value for money of different interventions. It compares the cost of a program to its health outcomes, allowing policymakers to prioritize interventions that produce the greatest health benefits per dollar spent.

For example, a CEA might compare the cost-effectiveness of a school-based nutrition education program to a mass media campaign to promote healthy eating. The analysis would determine which intervention produces the greatest improvement in children’s dietary intake for the investment.

Considering cost-effectiveness helps policymakers allocate scarce resources efficiently, maximizing the impact of nutrition interventions and ensuring that funds are used to achieve the greatest possible public health gains. A well-conducted CEA considers direct costs (e.g., program staffing, materials), indirect costs (e.g., lost productivity due to illness), and health benefits (e.g., reduced hospitalizations, improved quality of life).

Measuring the impact of a nutrition policy intervention involves a multi-faceted approach using both quantitative and qualitative methods. The specific indicators will depend on the policy’s objectives.

• Quantitative indicators: These might include changes in dietary intake (e.g., fruit and vegetable consumption, sugar intake), prevalence of obesity or malnutrition, blood pressure, cholesterol levels, healthcare utilization rates, and economic measures (e.g., changes in food prices, employment in the food industry).
• Qualitative indicators: These could include changes in knowledge, attitudes, and behaviors related to nutrition, community perceptions of the policy, and equity considerations. Qualitative data can be gathered through focus groups, interviews, and surveys.
• Process evaluation: This assesses the implementation process, including reach, coverage, fidelity, and contextual factors that may have influenced the policy’s effectiveness.
• Longitudinal studies: Measuring impact requires tracking outcomes over time, ideally using longitudinal studies to understand the long-term effects of the policy.

It’s important to establish a baseline before the intervention and to use a robust evaluation design to determine whether the observed changes are attributable to the policy itself, rather than other factors.