Can changing the position of online menu items increase selection of fruit and vegetable snacks? A cluster randomized trial within an online canteen ordering system in Australian primary schools.

BACKGROUND: Manipulating the position of food items within the physical food environment has consistently been found to influence item selection. However, the extent to which this strategy is effective in an online food environment is unknown. OBJECTIVE: This study investigated whether an intervention to position fruit and vegetable snack items as the first and last menu items in an online school canteen ordering system increased the selection of those items. It was hypothesized that at follow-up, a higher proportion of online lunch orders in intervention schools would contain the target items (fruit and vegetable snacks) in comparison to control schools. DESIGN: Six primary schools in New South Wales, Australia, were recruited to a clustered randomized controlled trial conducted over an 8-wk period. Intervention schools received a redesigned menu where the target items were positioned first and last on the online menu. Control schools received no change to their online menu. RESULTS: During the baseline period 1938 students (1203 intervention, 735 control) placed at least one online lunch order and were included in the study, with 16,109 orders placed throughout the study. There was no significant difference between groups over time in the proportion of orders that contained a "Fruit and Veggie Snack" item (OR = 1.136 [95% CI: 0.791, 1.632] P = 0.490). CONCLUSIONS: Evidence from this large trial with robust study design and objectively collected data suggests that positioning fruit and vegetable snack items first and last within an online canteen menu does not increase the selection of these items. Further research is warranted to confirm this finding with other target menu items (e.g., treats) and across other purchasing contexts and online food ordering platforms. This trial was registered at the Australian New Zealand Clinical Trials Registry, http://www.anzctr.org.au/ as ACTRN12616001520426.

Fruit-Promoting Smarter Lunchrooms Interventions: Results From a Cluster RCT.

INTRODUCTION: The Smarter Lunchrooms Movement was developed to provide schools with simple, low-cost solutions to encourage students to make healthier food choices at school. The objective of this study was to evaluate the impact of fruit-promoting Smarter Lunchroom interventions on middle school students' selection and consumption of fruits. DESIGN: A 9-week cluster RCT was conducted using a pre-test/post-test control group design in upstate New York in February-April 2014. SETTING/PARTICIPANTS: Ten middle schools (Grades 5-8) were recruited and randomized into a fruit intervention (n=4), vegetable intervention (n=3), or control group (n=3). This article focuses only on the fruit intervention and control groups. INTERVENTION: The fruit intervention group made changes to the convenience, visibility, and attractiveness of fruit in their lunchrooms for a period of 6 weeks. The control group made no changes, and were offered Smarter Lunchrooms training post-intervention. MAIN OUTCOME MEASURES: Selection and plate waste data were collected from February to April 2014, and analyzed in 2014-2015. Average selection, waste, and consumption of food items were computed, and the statistical differences between treatment and control groups were analyzed using t-test statistics and difference-in-difference analysis. RESULTS: Fruit selection increased overall by 36% (p<0.001), and fruit consumption increased overall by 23% (p<0.017). Vegetable selection and consumption and white milk selection also increased significantly in the treatment schools (p<0.001), though were not significant overall. CONCLUSIONS: The fruit intervention increased the selection and consumption of fruits overall, and increased the selection and consumption of vegetables and the selection of white milk in treatment schools. These findings provide evidence supporting the use of fruit-promoting Smarter Lunchrooms techniques in middle schools to increase the selection and consumption of healthy food items.

Who's adopting the smarter lunchroom approach? Individual characteristics of innovative food service directors.

School cafeterias and, subsequently, food service directors (FSDs) play a vital role in feeding children in the U.S. This study investigates which FSDs with different characteristics and organizational affiliations are most willing to embrace and implement new programs in their cafeterias. In 2014 we surveyed a representative sample of 8143 school FSDs across the U.S. regarding their knowledge and use of innovative methods that encourage children to select healthy food options. Nearly all of the surveyed FSDs (93%) are aware of behavioral strategies to promote healthier eating in school lunchrooms, and nearly 93% report having made at least one change in their lunchroom. Male FSDs are more likely to be aware of new programs, though they are less likely to adopt them relative to female FSDs. In addition, membership in a professional organization increases awareness as well as the number of changes made by 0.14 (p<0.01). Finally, 22% of all respondents say they know about the Smarter Lunchrooms approach, a set of research-based lunchroom behavioral strategies that positively influence children to select healthy foods. The findings highlight the importance of participation in professional associations which provide career-building activities for school FSDs increasing awareness and adoption of innovative approaches to motivate children to eat the nutritious foods. Given these findings, there is reason for policy makers and school districts to consider allocating funds to encourage FSDs to engage more fully in professional association meetings and activities.