BackgroundIn the United States, the National School Lunch Program (NSLP) is the healthiest lunch option for students, yet participation is suboptimal and fruit and vegetable waste remains high. Improving school meal convenience, engaging teachers in the school-lunch program, and enhancing the cafeteria environment are promising strategies to improve participation and dietary intake, yet little evidence is available on their impact.
Methods/DesignThe Multi-Pronged Intervention to Increase Secondary Student Participation in School Lunch (MPI) is a 3-year quasi-experimental study in a large urban school district in California. A total of 24 middle and high schools participated in the study: half received the intervention and half served as controls. The intervention consisted of additional school lunch points of sale (vending machines and mobile carts), a school meal outreach program for teachers, and cafeteria redesigns. School meal participation, student-reported fruit and vegetable consumption, and school lunch plate waste were assessed at baseline and in years 1 and 2 of the intervention. Change in meal participation and fruit and vegetable consumption were compared between intervention and control arms to determine the impact of the intervention on school meal participation and dietary intake.
DiscussionThis study is positioned to provide evidence on the feasibility and efficacy of a multi-level intervention to increase school meal participation and consumption of fruits and vegetables.
BACKGROUNDObesity, one of the most pressing health issues of our time, has been linked to secular changes in dietary intake. 1 Improving dietary intake among youth is critical to reducing childhood obesity, as only 1% of children in the United States meet the Dietary Guidelines. 2 Fruits and vegetables, in particular, play a vital role as intake is associated with reduced risk of obesity 3-6 and chronic disease. 3,6,7 However, approximately one third of adolescents consume less than one serving of fruit or vegetables per day, 8 and low-income youth consume less than their higher income peers. 9Schools are arguably the most important system in which to intervene to improve youth dietary intake; 10 school-aged children consume up to half of their daily calories at school. 11 While participation in the National School Lunch Program (NSLP) has been associated with significantly higher lunchtime fruit and vegetable intake 13 and higher diet quality overall, 14 only 57% of students with program access participate on a given day. 15 Furthermore, though fruit and vegetable consumption has increased slightly since the 2010 Healthy Hunger-Free Kids Act went into effect, plate waste remains high; up to 59% of selected vegetables are wasted. 16,17 Efforts to improve what students eat at school are especially important for adolescents as they have greater
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