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Promoting school lunch fruit and vegetable intake through role modeling: a pilot study

1 School of Public Health, University of California, Berkeley, Berkeley, CA, United States
2 Department of Humanities and Social Sciences, Oregon Institute of Technology, Klamath Falls, OR, United States

Objectives: Child fruit and vegetable consumption is a critical component of adult chronic disease prevention, yet fruit and vegetable intake remains low among elementary school children in the United States. This pilot study tested a role modeling intervention designed to promote fruit and vegetable consumption in a U.S elementary school cafeteria setting. Methods: This one-year, repeated cross-sectional study used digital photographs to assess fruit and vegetable waste at baseline (n = 566 trays) and follow-up (n = 231 trays) of kindergarten through fifth grade students in one elementary school. Differences in waste were assessed through Mann-Whitney statistical tests. Feedback on intervention acceptability was provided by the intervention team during implementation. Results: The proportion of students consuming all of their selected fruits and vegetables increased by 11.1% and 8.7% respectively (p < 0.01). There was a significant decrease in the proportion of students not consuming any of their selected fruit (16.0%, p < 0.001). Staff and students provided positive reports of intervention acceptance. Conclusions and Implications: Findings from this pilot study indicate that role modeling in a school cafeteria setting may be a promising health promotion strategy and provide groundwork for future research in the development of school cafeteria role modeling interventions. Further research is needed to assess intervention efficacy and acceptability at a larger scale.
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1. Jääskeläinen P, Magnussen CG, Pahkala K, et al. (2012) Childhood nutrition in predicting metabolic syndrome in adults: the cardiovascular risk in Young Finns Study. Diabetes Care 35: 1937–1943.    

2. Mikkilä V, Räsänen L, Raitakari OT, et al. (2004) Longitudinal changes in diet from childhood into adulthood with respect to risk of cardiovascular diseases: The Cardiovascular Risk in Young Finns Study. Eur J Clin Nutr 58: 1038–1045.    

3. Kim SA, Moore LV, Galuska D, et al. (2014) Vital signs: fruit and vegetable intake among children-United States, 2003–2010. MMWR Morb Mortal Wkly Rep 63: 671–676.

4. Huang J, Barnidge E (2016) Low-income Children's participation in the National School Lunch Program and household food insufficiency. Soc Sci Med 150: 8–14.    

5. The NCES Fast Facts Tool (2018) National Center for Education Statistics. Available from: https://nces.ed.gov/fastfacts/display.asp?id=372.

6. Woo Baidal JA, Taveras EM (2014) Protecting progress against childhood obesity-the National School Lunch Program. N Engl J Med 371: 1862–1865.    

7. Byker CJ, Farris AR, Marcenelle M, et al. (2014) Food Waste in a School Nutrition Program After Implementation of New Lunch Program Guidelines. J Nutr Educ Behav 46: 406–411.    

8. Niaki SF, Moore CE, Chen TA, et al. (2017) Younger Elementary School Students Waste More School Lunch Foods than Older Elementary School Students. J Acad Nutr Diet 117: 95–101.    

9. Graziose MM, Ang IYH (2018) Peer Reviewed: Factors Related to Fruit and Vegetable Consumption at Lunch Among Elementary Students: A Scoping Review. Prev Chronic Dis, 15.

10. Di Noia J, Byrd-Bredbenner C (2014) Determinants of fruit and vegetable intake in low-income children and adolescents. Nutr Rev 72: 575–590.    

11. Kubik MY, Lytle L, Fulkerson JA (2005) Fruits, vegetables, and football: findings from focus groups with alternative high school students regarding eating and physical activity. J Adolesc Health Off Publ Soc Adolesc Med 36: 494–500.    

12. Rasmussen M, Krølner R, Klepp KI, et al. (2006) Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: quantitative studies. Int J Behav Nutr Phys Act 3: 22.    

13. Brug J (2008) Determinants of healthy eating: motivation, abilities and environmental opportunities. Fam Pract 25(Suppl–1): i50–i55.

14. Bahn D (2001) Social Learning Theory: its application in the context of nurse education. Nurse Educ Today 21: 110–117.    

15. Bryant AL, Zimmerman MA (2003) Role Models and Psychosocial Outcomes Among African American Adolescents. J Adolesc Res 18: 36–67.    

16. Herrera C, Grossman JB, Kauh TJ, et al. (2011) Mentoring in Schools: An Impact Study of Big Brothers Big Sisters School-Based Mentoring. Child Dev 82: 346–361.    

17. Winzer E, Luger M, Schindler K (2018) Using digital photography in a clinical setting: a valid, accurate, and applicable method to assess food intake. Eur J Clin Nutr 72: 879–887.    

18. Byker Shanks C, Banna J, Serrano EL (2017) Food Waste in the National School Lunch Program 1978–2015: A Systematic Review. J Acad Nutr Diet 117: 1792–1807.    

19. Brownson RC, Colditz GA, Proctor EK (2012) Dissemination and Implementation Research in Health: Translating Science to Practice. Oxford University Press.

20. Rotenberg KJ (2010) Interpersonal Trust during Childhood and Adolescence. Cambridge University Press.

21. Rosner B, Glynn RJ (2011) Power and sample size estimation for the clustered wilcoxon test. Biometrics 67: 646–653.    

22. Rosner B, Glynn RJ (2009) Power and sample size estimation for the Wilcoxon rank sum test with application to comparisons of C statistics from alternative prediction models. Biometrics 65: 188–197.    

23. Carroll C, Patterson M, Wood S, et al. (2007) A conceptual framework for implementation fidelity. Implement Sci 2: 40.    

© 2020 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution Licese (http://creativecommons.org/licenses/by/4.0)

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