Source: COLORADO STATE UNIVERSITY submitted to
EAT WELL TO EXCEL: NUDGING MIDDLE SCHOOL STUDENTS TOWARD MORE HEALTHFUL FOOD CHOICES
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
Reporting Frequency
Annual
Accession No.
0225676
Grant No.
(N/A)
Cumulative Award Amt.
(N/A)
Proposal No.
(N/A)
Multistate No.
(N/A)
Project Start Date
Jul 1, 2011
Project End Date
Jun 30, 2013
Grant Year
(N/A)
Program Code
[(N/A)]- (N/A)
Recipient Organization
COLORADO STATE UNIVERSITY
(N/A)
FORT COLLINS,CO 80523
Performing Department
Food Science & Human Nutrition
Non Technical Summary
There have been a number of federal policy and regulatory changes aimed at helping schools create policy and environmental changes to address poor childhood eating habits. Foremost among these was passage of the Child Nutrition and WIC Reauthorization act in 2004, which made it mandatory for U.S. school districts participating in the NSLP and SBP to create a local district wellness policy. The recently passed Healthy, Hunger-Free Kids Act of 2010 directs USDA to develop and implement even stronger nutrition standards for all foods sold in schools including USDA meals, a la carte items, vending machines and school stores. Despite positive steps toward a healthier school food environment, implementation of policies and recommendations has been inconsistent, with many schools continuing to offer less nutritious foods and beverages in addition to USDA meals. The emerging discipline of behavioral economics provides set of tools for encouraging healthier eating behavior in schools that are low or no cost and without the conscious knowledge of participants. Behavioral studies of food choices suggest subtle changes in the food environment may offer novel and sustainable ways for improving diets and health. These changes are also thought of as elements of choice architecture, the context in which individuals make decisions. A nudge is any aspect of choice architecture that alters an individual's behavior in a predictable manner without eliminating or forbidding any options. By applying these concepts to school meal programs, the inadvertent signals school cafeterias may send that trigger less nutritious eating can be identified and altered, without resorting to draconian measures of banning foods deemed unhealthy. For USDA and state agencies findings from behavioral economics research can offer alternative strategies for increasing program effectiveness and increasing diet quality of program participants without restricting the ability to choose foods they like. CSU and TSD collaborated for the past year to assess and strategically plan to effectively improve the TSD school nutrition environment. With funding from a CanDo member grant, we conducted a formative assessment of the school meal program. Upon completion of the formative assessment, data will be used to identify the choice architecture strategies to be implemented as part of the intervention. Preliminary observations from the formative assessment indicate middle school will provide the greatest opportunity to influence school meal participation and food choices. Based on TSD data from nutrition services, there is a significant drop in NSLP participation as students progress from elementary to middle school. Middle school students have more food choices available in the cafeteria. Competitive foods, from a la carte sales, vending machines and school stores are more prevalent in middle schools as compared to elementary schools. Also, middle school students are beginning to make more of own choices and connect those choices to possible health consequences. This combination of factors makes middle school an ideal setting for testing behavioral economic strategies.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
6076099302025%
7036099301025%
7246099101025%
8036299301025%
Goals / Objectives
Eat Well to Excel (EWTE) is a partnership between Colorado State University (CSU) Department of Food Science and Human Nutrition and Thompson R2-J School District (TSD) established a year ago with the specific objectives of evaluating all aspects of the TSD school meal program and identifying the factors that influence students' participation, food choices and consumption. This assessment, the initial phase of Stephanie Smith's dissertation research, was modestly funded by a member grant from the Coalition of Nutrition and Activity to Defeat Obesity (CanDo). It has included plate waste assessment using innovative digital photography technology, observation of cafeteria layout and meal periods, and student surveys addressing issues related to participation and non-participation in the school meals program. The goal was to determine where cost effective changes could be made to the cafeteria environment to increase participation encourage healthier food choices. With the formative assessment nearing completion, this CAHS/AES funding will allow us to implement the next stage of Stephanie Smith's dissertation project, which is to test several strategies, based on behavioral economic principles, to increase school lunch participation and make the healthiest choice the easiest choice for students. Students who participate in the school meals program have been shown to have better quality diets and increased likelihood of adequate nutrient intakes.1 Encouraging more students to eat lunch at school and select the more healthful meal options is a win-win for the students and school meal program. The objective of this CAHS/AES two-year project is to identify, implement and evaluate the effectiveness of behavioral economic strategies designed to encourage more middle school students to participate in the National School Lunch Program (NSLP) and make more healthful choices from cafeteria options. Strategies will be evaluated by comparing data on food choice, food sales, food production records, and average daily participation rates before and after implementation. This project is designed to test the following hypotheses: TSD middle schools that implement targeted environmental changes in their cafeterias will: increase student participation in the National School Lunch Program (NSLP), increase student selection of the more healthful meal options, and decrease sales of a la carte food items (foods sold in competition with NSLP meal) and desserts. TSD has recently made a number of positive changes in the meals they serve including increasing fresh fruits, vegetables and whole grains, limiting a la carte items and removing fryers from the kitchens. However, simply making these changes does not ensure children will actually eat the healthier foods. CAHS/AES funding would help ensure students take advantage of these improvements by helping to create a cafeteria environment that encourages students to select the healthier options.
Project Methods
This study will evaluate the effect of selected choice architecture strategies on students' food choices and lunch participation in TSD middle schools, reaching approximately 2,700 students. Effectiveness will be determined by tracking point of sale data, food production records, average daily participation rates, and plate waste at baseline, monthly intervals during the year and at the end of the school year. Two middle schools will participate in Year 1 of this study. During Year 2, the most effective strategies from Year 1 will be implemented and evaluated in the other TSD middle schools. Intervention: Preliminary observations and input from the district school nutrition services staff have identified a set of choice architecture strategies (or nudges) for implementation in two middle schools in Year 1 and two middle schools in Year 2. Each set of strategies includes three different nudges, two of which will be the same in the intervention schools and one will be customized for each specific school. Improved signage to highlight the more healthful menu items and use of verbal prompts by cafeteria staff that encourage selecting the more healthful menu items are the two common nudges. The custom nudge for each school will be identified upon completion of formative assessment. Baseline data collection will occur during the first month of the 2011-2012 school year, with implementation of the strategies occurring immediately thereafter. Prior to implementation of cafeteria staff will be trained. This training will include basic information about behavioral economics and a detailed explanation of the strategies to be implemented in their school cafeterias. Booster training will be conducted prior to the start of Year 2. Evaluation: Effectiveness of the choice architecture strategies at each school will be tracked with school lunch data from TSD's point-of-sale data system, which has the ability to track average daily participation, total meal sales, and sales of individual food items. Information from cafeteria food production records will be gathered to corroborate point-of-sale data. To account for temporal and menu-related differences in participation and sales, data will be collected for one week at baseline (prior to the intervention), and then on five randomly selected days each month for the remainder of the school year. Data from one year previous to the intervention year will be obtained for comparison purposes. Digital photographic plate waste assessment of specific menu items will be used to determine amounts of these foods consumed. Plate waste assessment will occur on randomly selected days per school each month. To ensure consistent implementation of the intervention strategies, cafeteria observation will be conducted on three randomly selected days per school each month throughout the intervention period. Any inconsistencies will be documented and then corrected at the time of occurrence.

Progress 07/01/11 to 06/30/13

Outputs
Target Audience: The target audience included approximately 1500 middle school students (grades 6-8) within Thompson School District in Northern Colorado who participate in the National School Lunch Program. Approximately 720 students were from the 2 middle schools where the cafeteria environment changes were implemented and 60 students were from the 2 control middle schools. During school year 2012-13, Thompson School District was the 16th largest district in Colorado. It had a total population of 15,667 students of 77% were white, 18% Hispanic, 1.5% Asian, and 1% African-American. Thirty-five percent qualified for free or reduced price meals. Also in the target audience group were school cafeteria staff in the 4 participating middle schools and district level nutrition services staff. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Graduate and undergraduate students were trainedon plate waste data collection (digital photography), photograph assessment and data entry. Five graduate students gained direct experience with intervention implementation, data collection and data entry. How have the results been disseminated to communities of interest? An abstract was prepared, published and presented as an oral presentation at a national conference of nutrition professionals. The citations are listed in the publications section of this report. Additionally, the results to date have been shared with our school district partner. What do you plan to do during the next reporting period to accomplish the goals? While this is the final report for this project, we will conduct additional data analysis and prepare manuscripts and conference abstracts based the results. A doctoral student dissertation will be completed. We will also disseminate pertinent results and information to the middle school cafeteria and district nutrition services staff.

Impacts
What was accomplished under these goals? The following outputs have been accomplished since the end of the last reporting period (January 2013). Major activities completed: Analysis of plate waste and food production record data for year 1 of the project was completed, results of which are described below under the heading “Significant Results Achieved.” We continued to investigate the effect environmental strategies to increase middle school student vegetable selection and consumption during lunch at two middle schools. The strategies included tray line signs, with creative names, to highlight vegetable items (implemented in Fall 2011), verbal prompts from cafeteria staff (implemented in Spring 2012), and the addition of flavorings to California blend vegetables, steamed garden blend vegetables and baked sweet potato (implemented in Fall 2012). Three days (1 each month in February, March, and April of 2013) of vegetable plate waste data were collected in each of two intervention middle schools and the two control schools. During this time vegetable plate waste was collection from 483 student lunch trays. Additionally, data analysis and observation from the first three semesters of this project revealed that students from the two control schools chose significantly fewer servings of fresh vegetables than the two intervention schools. Therefore, strategies to increase fresh (raw) vegetable selection and consumption were implemented during February, March, April and May of 2013 in the two middle schools that had served as control schools. The strategies included specific signs to promote fresh vegetables, more prominent placement on the cafeteria line, increasing the number of fresh vegetable servings offered and verbal prompting from the cafeteria staff. In January 2013, training sessions were conducted with graduate and undergraduate students for plate waste assessment and plate waste data entry. Specific objectives met: During this reporting period, we completed implementation of this two-year project and met the primary objective which was to identify, implement and evaluate the effectiveness of behavioral economic strategies on middle school student vegetable selection and consumption at lunch. Significant results achieved: A total of 646 days of per meal vegetable sales data was collected during the first year of this study (SY 2011-2012), representing an average of 162 of 180 (90%) school days per school. Over of the course of the 2011-12 school year, there was no change in per meal vegetable servings selected by students in the intervention schools (schools which received the enhanced tray line signs and verbal prompts from cafeteria staff). However, there was a significant decrease in per meal vegetable servings in both control schools (p<.03). When vegetable sales were examined by type (fresh versus hot) there was significant increase in per meal fresh vegetable servingsone of the intervention schools(p<.001). Vegetable waste was estimated from 1499 student lunch trays. Students in both the intervention and control schools wasted more than 50% of vegetables they selected. Installation of the new signs with creative names in the intervention schools had no significant effect on vegetable consumption. When the cafeteria staff used the verbal prompts, there was a small decrease in vegetable waste, 55% to 48%, however, the change was not statistically significant. Additionally, no difference in waste was observed between the intervention and control schools when verbal prompts were added in the intervention schools. We also examined the effect of the enhanced flavorings on vegetable waste from California blend and garden blend vegetables. The flavorings were implementedbeginning in October 2013 and continues through the rest of the schools year.The implementation is described in a previous report. In the two intervention schools, in which the flavorings were used, there was a decrease in overall vegetable waste (59.7% to 51.2%) from baseline (Sept-Oct.) to post intervention (April-May), however, the change was not statistically significant. A similar decrease was observed in the control schools, therefore, there was no difference in vegetable waste between the intervention and the control schools after the addition of the flavorings. Analysis of fresh vegetable waste following the implementation of the new fresh vegetable promotion strategies is pending.

Publications

  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: (abstract) Smith, S.L. and Cunningham-Sabo, L. Environmental Strategies Modestly Influence Selection but not Waste of Lunch Vegetables among Middle School Students. September 2013, suppl 3, 113:9, A-11.
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2013 Citation: (conference presentation) Smith, S.L. and Cunningham-Sabo, L. October 2013, Environmental Strategies Modestly Influence Selection but not Waste of Lunch Vegetables among Middle School Students. Academy of Nutrition and Dietetics, Houston, TX.


Progress 01/01/12 to 12/31/12

Outputs
OUTPUTS: The most significant outputs and dissemination activities for 2012 are reported here. Activities: Conducted investigations of 2 different strategies to increase vegetable selection and consumption during school lunch. The first took place in spring 2012 and examined the influence of verbal prompts on vegetable selection and consumption. Cafeteria staff in 2 middle schools used the verbal prompt "Would you like [hot vegetable of the day] or fresh vegetables with your lunch" with each student who did not choose vegetables. If a student indicated he or she did not want any vegetable, the staff did not prompt further. Two other middle schools served as control schools. One day of baseline and 2 days of post intervention vegetable plate waste data were collected in each school. Daily food production records were collected. The 2nd intervention was an investigation of the influence of different flavorings on vegetable selection and consumption during lunch in fall 2012. Vegetables on the middle school lunch menu with the lowest sales were identified by the school nutrition staff. These were the California blend (broccoli, cauliflower and carrots), steamed garden blend (broccoli, zucchini, peppers, beans, cauliflower), and baked sweet potato and were chosen for flavor enhancement. Two different seasonings were taste-tested with students from 2 middle schools. A garden seasoning blend was used to season the California blend and steamed garden blend vegetables. A spice blend was used to enhance the flavor of the baked sweet potato. Approximately 200 students participated in each test. Students completed a short survey asking them to rate appearance, aroma, texture, taste and overall appeal of each vegetable. The results were favorable (described below in the Outcomes section). Recipes for using each seasoning were provided to the cafeteria staff of the 2 middle schools participating in the taste tests. Staff began using the flavorings in November 2012. New cafeteria signs were created to promote the vegetables. Two other middle schools served as control schools. Two days of baseline and 2 days of post intervention vegetable plate waste data were collected in each school. Daily food production records were also collected. One PhD student's doctoral project is included in the activities described above. 15 graduate students and 5 undergraduate students gained experience with intervention implementation, data collection and data entry. Events: Training sessions were conducted for cafeteria managers on implementation of the intervention described above and keeping accurate food production records. Training sessions were conducted for student volunteers on study protocols for data collection and data entry. Services: no consulting, counseling or tutoring was provided as part of this project. Products: Training protocols for cafeteria staff, taste test protocols and surveys, databases and data. New cafeteria signs installed in 2 middle schools serving flavored-enhanced vegetables. Dissemination activities included a poster presentation and education session at the 2012 School Nutrition Association Annual National Conference. PARTICIPANTS: Individuals - Principal Investigator: Leslie Cunningham-Sabo, Co-Investigator: Garry Auld. Graduate students: Stephanie Smith, Julie Gardner, Jessica Haas, Erin Harner, Adam Hillman, Amanda Mancuso, Katie McKenna, Shanna Stocker, Rebecca Washa, Sarah Hibbs-Shipp, Mara McGuin, Reanna Moore, Joel McClurg, Kelsie Dunn, Eliza Goss. Undergraduate students: Alexandra Johnson, Melanie Martin, Sarah Heckroth, Ian Isby and Valerie Ward. Partner Organizations - Thompson School District: Tammie Rempe, Shannon Emslie, Lisa Kendall, Carla Bankes, Kathy Schlepp along with cafeteria managers and staff from 4 middle schools. The spice blend used on the baked sweet potato was provided by Custom Blending of Fort Collins, Colorado. TARGET AUDIENCES: Target audience included approximately 1500 middle school students (grades 6-8) within TSD in Colorado who participate in the National School Lunch Program. Approximately 720 students were from the 2 middle schools where the staff delivered the verbal prompts and served the flavor-enhanced vegetables and 760 students were from the two control middle schools. Thompson School District is the 16th largest district in Colorado. It has a total population of 15,667 students of which 77% are white, 18% are Hispanic, 1.5% are Asian, and 1% are African-American. 35% qualify for free or reduced price meals. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
Analyses are not yet complete therefore limited evaluation results are available to describe the scope and nature of changes in knowledge, actions and conditions as a result of this project. Vegetable plate waste was collected from approximately 600 student lunch trays in spring 2012. Preliminary analysis of vegetable plate waste collected during implementation of the verbal prompts indicate there was no significant difference (p = .05) in vegetable plate waste between baseline and implementation of the verbal prompts in the two intervention schools. There was also no significant difference (p=.05) in vegetable plate waste between the intervention and control schools. For the flavoring interventions, the taste test results revealed that students had a very favorable opinion of both seasonings but in particular the spice blend used on the baked sweet potato. One hundred ninety-four students participated in the steamed garden vegetable taste test. Approximately 45% were from one middle school and 55% from the other. Fifty-seven percent of participants were females, 44% were in grade 6, 28% in grade 7 and 28% in grade 8. Mean responses for vegetable appearance, aroma, texture, taste and overall appeal were all between 3.5 and 4.0 on a 5-point Likert scale. Two-hundred eleven students participated in the baked sweet potato taste test. Approximately 55% were from one middle school and 45% from the other. Fifty-six percent were females, 37% were in grade 6, 28% in grade 7, and 35% in grade 8. Mean responses for baked potato appearance, aroma, texture, taste and overall appeal ranged were between 3.74 and 4.37 on a 5-point Likert scale. Vegetable plate waste was collected from approximately 900 student lunch trays in the fall of 2012. Analyses of vegetable plate waste following the implementation of the new flavorings is pending.

Publications

  • No publications reported this period


Progress 07/01/11 to 12/31/11

Outputs
OUTPUTS: The most significant outputs (activities, events, services and products) and dissemination activities for the first 6 months of this project are reported here. Activities: Conducted cafeteria observation in 5 Thompson School District (TSD) middle schools to determine most appropriate behavioral economics strategy to implement to increase student vegetable consumption during lunch. Designed and conducted an investigation of the influence of new signs with creative names on vegetable selection and consumption during school lunch. Specifically, new signs with creative names for the vegetable menu items were created and installed in 2 TSD middle school cafeteria tray lines. Two other middle schools served as control schools. Two days of baseline and 2 days of post intervention vegetable plate waste data were collected in each school. Daily food production records were collected from each middle school. Three focus groups with a total of 24 students (approximately 8 students in each group) from 2 TSD middle schools (grades 6-8) were conducted to help develop creative names for the vegetable menu items. One PhD student's doctoral project is included in the activities described above. Eleven graduate students and two undergraduate students gained experience with intervention implementation, data collection and data entry. Events: Training sessions were conducted for TSD middle school cafeteria managers on implementation of the intervention described above and on keeping accurate food production records. Training sessions were conducted for student volunteers on study protocols for all data collection and data entry. Services: no consulting, counseling or tutoring was provided as part of this project. Products: Revision and use of cafeteria observation protocol and instrument, development and use of focus group interview guides, databases and data. New cafeteria tray line signs, specifically for the vegetable menu items, were developed and installed in two TSD middle school cafeterias. Dissemination activities included presentations on behavioral economic strategies in school nutrition to 30 school nutrition staff at the Colorado School Nutrition Association conference, 60 undergraduate students in a CSU community nutrition course, 25 graduate students in a CSU nutrition education course, 25 graduate students and faculty at CSU Food Science and Human Nutrition department seminar, and attendees of the Colorado Association of School Boards conference. PARTICIPANTS: Individuals - Principal Investigator: Leslie Cunningham-Sabo, Co-Investigator: Garry Auld. Graduate students: Stephanie Smith, Jessica Haas, Rachel Hurshman, Sarah Hibbs-Shipp, Rosie Thornton, Mara McGuin, Reanna Moore, Lindsey Fishering, Michelle DellOrto, Amber Kahl, Kristen Nicholls, Katherine Henry. Undergraduate students: Sara Heckroth, Alexandra Johnson. Partner Organizations - Thompson School District: Tammie Rempe, Shannon Emslie, Carla Bankes, Kathy Schlepp along with cafeteria managers and staff from 4 middle schools; Brian Wansink, Cornell Center for Behavioral Economics in Child Nutrition Programs TARGET AUDIENCES: Target audience included approximately 1500 middle school students (grades 6-8) within TSD in Colorado who participate in the National School Lunch Program. Approximately 720 students were from the 2 middle schools that received the new signs for vegetable menu items and 760 students were from the two control middle schools. 77% of students in TSD are white, 18% are Hispanic, and 1% are African-American. 34% qualify for free or reduced price meals. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
Analyses of vegetable plate waste and data from the school's food production records is not complete and therefore evaluation results are not yet available to describe the scope and nature of changes in knowledge, actions and conditions as a result of this project.

Publications

  • No publications reported this period