The Impact of a Multi-Pronged Intervention on Students’ Perceptions of School Lunch Quality and Convenience and Self-Reported Fruit and Vegetable Consumption

Abstract

School lunch programs provide an opportunity to improve students’ diets. We sought to determine the impact of a multifaceted intervention (cafeteria redesigns, increased points-of-sale and teacher education) on secondary students’ perceptions of school-lunch quality and convenience and fruit and vegetable intake. Surveys (n = 12,827) from middle and high school students in 12 intervention and 11 control schools were analyzed. We investigated change in school-lunch perceptions and lunchtime and daily fruit and vegetable consumption from 2016 to 2018. Among 8th graders, perceptions that school lunch tastes good and that school lunch was enough to make students feel full increased 0.2 points (on a 5-point scale; p < 0.01) in intervention schools relative to control schools. Among 10th graders, lunchtime fruit and vegetable consumption increased 6% in intervention relative to control schools (p < 0.05 and p < 0.01 respectively). Daily fruit intake increased 0.1 cups/day in intervention relative to control schools among 9th graders (p < 0.01). This study provides important evidence on the limited effect of design approaches in the absence of meal changes. We observed only modest changes in school lunch perceptions and fruit and vegetable consumption that were not consistent across grades, suggesting that additional efforts are needed to improve school-lunch uptake.

Interventions based on sensory‐hedonic strategies and on nudging to facilitate vegetable and pulses consumption in the school environment

“…Reinforcement and incentives using prompts (Chinchanachokchai et al., 2022; Dave et al., 2015; Erjavec et al., 2021; Machado, Ritchie et al., 2020; Quinn et al., 2018; Song et al., 2016a; Hubbard et al., 2015; Hanks et al., 2013; Hendy et al., 2007; Hoffman et al., 2010; Perry et al., 2004; Taylor, Darby et al., 2013), using rewards (Hendy et al., 2007; Horne et al., 2009; McCormick et al., 2009; Perry et al., 2004; Presti et al., 2015; Taylor, Upton et al., 2013; Wardle et al., 2003, Taylor, Darby et al., 2013), using incentives (Hoffman et al., 2011; Hudgens et al., 2017; Joyner et al., 2017; Machado, Ritchie et al., 2020; McCormick et al., 2009; Wengreen et al., 2021, Ansu et al., 2021, Marcano‐Olivier et al., 2021), using marketing techniques such as characters, banners, and messages, using modeling (role and peer modeling) (Hoffman et al., 2010; Horne et al., 2009; Perry et al., 2004; Taylor, Upton et al., 2013; Hubbard et al., 2015; Birnbaum et al., 2002; Machado, Ritchie et al., 2020; Marcano‐Olivier et al., 2019, 2021; Presti et al., 2015); …”

“…Thirteen out of the 16 studies identified reported that incentives such as small prizes (Birnbaum et al., 2002; de Marchi et al., 2020; Hendy et al., 2007; Machado, Ritchie et al., 2020, Marcano‐Olivier et al., 2021), raffle tickets (Machado, Ritchie et al., 2020), virtual currencies (Joyner et al., 2017), and stationery (Horne et al., 2009) increased children's liking, acceptance, willingness to try, and intake of vegetables. Incentives were commonly used together with modeling and education, with most of the interventions reporting positive effects (Birnbaum et al., 2002; Horne et al., 2009; Machado, Ritchie et al., 2020; McCormick et al., 2009; Presti et al., 2015; Song et al., 2016a; Wengreen et al., 2021, Marcano‐Olivier et al., 2021), except from one intervention targeting children with autism, in which no significant effect was reported (Taylor, Upton et al., 2013); however, results from the latter could be attributed to the small sample size ( n = 12) or the special needs of the children. Finally, in a study that used incentives in combination with repeated exposure to sweet peppers, an increase in the peppers’ consumption was only recorded in the exposure group and not in the group that was offered stickers if they would choose a piece of pepper (Wardle et al., 2003).…”

“…Incentivizing children to eat plant‐based foods is a common approach used in school‐based interventions, with most studies providing positive effects in promoting vegetables; however, no intervention promoting pulses was identified. Thirteen out of the 16 studies identified reported that incentives such as small prizes (Birnbaum et al., 2002; de Marchi et al., 2020; Hendy et al., 2007; Machado, Ritchie et al., 2020, Marcano‐Olivier et al., 2021), raffle tickets (Machado, Ritchie et al., 2020), virtual currencies (Joyner et al., 2017), and stationery (Horne et al., 2009) increased children's liking, acceptance, willingness to try, and intake of vegetables. Incentives were commonly used together with modeling and education, with most of the interventions reporting positive effects (Birnbaum et al., 2002; Horne et al., 2009; Machado, Ritchie et al., 2020; McCormick et al., 2009; Presti et al., 2015; Song et al., 2016a; Wengreen et al., 2021, Marcano‐Olivier et al., 2021), except from one intervention targeting children with autism, in which no significant effect was reported (Taylor, Upton et al., 2013); however, results from the latter could be attributed to the small sample size ( n = 12) or the special needs of the children.…”

“…Ten studies were identified reporting an intervention that included the use of role or peer modeling to promote vegetables. Peer modeling examples include the use of videos with other children or characters of a similar age (Hoffman et al., 2010; Horne et al., 2009; Marcano‐Olivier et al., 2019, 2021; Presti et al., 2015; Taylor, Upton et al., 2013) and role modeling examples include celebrities (Hubbard et al., 2015), college students, and school staff (Hoffman et al., 2010; Machado, Ritchie et al., 2020). Eight out of the 10 interventions targeted children and pre‐adolescents, except two which also targeted adolescents (Birnbaum et al., 2002; Hubbard et al.…”

Impact of a Teacher Intervention to Encourage Students to Eat School Lunch

“…One question [ 21 ] asked: “adults at school encourage me to eat school lunch” with response options on a 5-point scale from strongly disagree (1) to strongly agree (5).…”