Salad bars and students' fruit and vegetable consumption: A group-randomized trial with objective assessments

抽象的。在生命早期建立健康的水果和蔬菜(FV)消费习惯对初学者来说至关重要 预防癌症和心血管疾病等疾病。然而，美国的年轻人并不是 接近达到国家关于FV摄入量的建议。鉴于年轻人消耗了他们饮食的1/3-1/2 在学校收生和学校供餐方案为3000多万名儿童提供服务方面，已经做出了重大努力 通过健康无饥饿儿童的通过，改善获得和随后的FV消费 行动起来。沙拉吧是《健康饥饿》中最受推崇的符合FV规定的方式之一 免费儿童作为一种增加学生FV摄入量的手段。让我们把沙拉吧搬到学校，让我们的手臂 米歇尔·奥巴马的肥胖预防倡议Move！已经在学校设立了超过4715家沙拉吧， 目标是在每一所学校都有一个沙拉吧，这是一项数百万美元的投资。与…相反 普遍认为，到目前为止，只有一项准实验研究评估了实施 增加FV的学校沙拉吧；这项研究只对一所学校的小学生进行 地区。还没有研究表明在初中或高中使用沙拉吧是否会增加 学生的FV消费情况。基于行为经济学的概念框架，目的是 这项研究旨在考察是否在小学、初中和高中引入沙拉吧 从来没有沙拉吧会影响学生午餐期间的FV消耗和浪费。随机化的集群 对照试验将在6周内对照等待名单控制测试新的沙拉吧，包括和不包括额外的4- 周营销期(36所学校，6804所：小学12所，初中12所，高中12所)。盘子 学生选择FV的浪费测量和浪费将被用来客观地估计消耗。 这项研究的主要目的是比较没有沙拉吧的学校和有新沙拉吧的学校的FV消费。 沙拉吧按年级(即初级、中等、高级)划分。我们假设，学生的FV消费将 在实施沙拉吧的学校里做得更好。我们将考察三个次要目标：a)FV营销如何 影响沙拉吧在改变FV消费方面的成功。我们假设市场营销将有助于 增加FV消费；b)评估沙拉吧是否不同地导致更多FV盘子浪费 与传统的食用方法相比；c)测试使用沙拉吧作为FV消费的成本效益 服务方法，以便向100,000多所为儿童提供膳食的学校提供更好的证据 参加国家学校午餐计划。第三个目标是检查沙拉吧(内部)的位置 采购点之前的服务线与服务线外)与FV摄入量有关。当这样做的目的是 研究已经完成，这个项目将是迄今为止关于沙拉功效的最明确的研究之一。 学校中的酒吧和促进他们成功的背景因素。调查结果将为如何 BEST花费有限的联邦资金来增加学校的FV摄入量。

Abstract. Building healthy fruit and vegetable (FV) consumption habits early in life are critical for primary prevention of diseases such as cancer and cardiovascular disease. However, youth in the US do not come close to meeting the national recommendations for FV intake. Given that youth consume 1/3-1/2 of their dietary intake in schools and the school meals program serves over 30 million children, major efforts have been made to improve access and subsequent consumption of FVs through the passage of the Healthy Hunger Free Kids Act. Salad bars are one of the most heavily promoted ways to meet the FV regulations in the Healthy Hunger Free Kids Act as a means to increase student FV intake. Let's Move Salad Bars to School, an arm of Let's Move!, Michelle Obama's obesity prevention initiative, has already instituted over 4715 salad bars in schools, with the goal of having a salad bar in every single school, an investment of millions of dollars. Contrary to popular belief, to date, just a single quasi-experimental study has evaluated the efficacy of implementing school salad bars for increasing FVs; this study was conducted with only elementary students from one school district. No studies have examined whether implementing salad bars in middle or high schools increase students' FV consumption. Grounded in the conceptual framework of behavioral economics, the purpose of this study is to examine whether introducing salad bars in elementary, middle, and high schools that have never had salad bars affects students' FV consumption and waste during lunch. A cluster randomized controlled trial will test new salad bars against wait-list controls for 6 weeks, with and without an additional 4- week marketing phase (N=36 schools, N=6804: n=12 elementary, n=12 middle and n=12 high schools). Plate waste measurements of students' selection of FVs and waste will be used to objectively estimate consumption. The primary aim of this study is to compare FV consumption in schools without salad bars to those with new salad bars by grade level (i.e., elementary, middle, high). We hypothesize that students' FV consumption will be greater in schools that implement salad bars. We will examine three secondary aims: a) how FV marketing impacts the success of salad bars at changing FV consumption. We hypothesize that marketing will help to increase FV consumption; b) assess whether salad bars differentially result in more FV plate waste compared to traditional serving methods; c) test the cost-benefit of using salad bars for FV consumption over traditional serving methods in order to provide better evidence to over 100,000 schools serving meals to children participating in the National School Lunch program. A tertiary aim is to examine how salad bar location (inside service line before point of purchase vs. outside service line) is related to FV intake. When the aims of this study are complete, this project stands to be one of the most definitive studies to date on the efficacy of salad bars in schools and contextual factors that promote their success. Findings will provide evidence for how to best spend limited federal dollars to improve FV intake in schools.