2017 Theses Doctoral

One-Year Evaluation of the Wellness in the Schools Program on School Lunch Consumption of Fruits, Vegetables, and Salad Bar Items in Urban Elementary Students

Ang, Ian Yi Han

Children in the United States do not eat enough fruits and vegetables to meet current dietary guidelines of 1 to 1.5 cups of fruits, and 1.5 to 2 cups of vegetables. Fruits and vegetables are an important source of various nutrients, and higher consumption of fruits and vegetables help children meet adequate nutrition needs for physical growth, and to lower risk of various chronic diseases such as cancer and cardiovascular diseases. School-based nutrition or wellness intervention programs by local governments or non-profit organizations are part of the multi- prong approach to help increase fruit and vegetable consumption in children.

One such school-based wellness intervention program based in New York City is Wellness In The Schools (WITS). WITS is a non-profit organization with the aim of implementing programs in schools that help facilitate healthy eating and positive group play in children. The two main arms of the WITS programming is the Cook for Kids and Coach for Kids programs. Overall, the goal of the WITS Cook for Kids program is to increase fruit and vegetable consumption, decrease processed foods consumed, and improve the perception of school lunch; the goal of the WITS Coach for Kids program is to increase physical activity, increase pro-social behaviors and team-based activities, and decrease schoolyard bullying at recess. A WITS Chef and a WITS Coach are placed in each school and work alongside school food and recess aids on every school day during the first year of intervention.

This dissertation study investigated the impact of one-year of WITS programming, as well as school lunch environmental factors, on school lunch consumption of fruits, vegetables, and salad bar items, in 2nd and 3rd grade students. The study utilized a non-randomized controlled trial design, with seven intervention schools receiving the WITS programming, and seven matched control schools. Intervention schools received the WITS programming starting from September 2015 that continued through the last week of June 2016 when the school year ended, while control schools did not receive any WITS programming. This study is significant in that it evaluated a real-world health program using a large sample of schools with match controls, along with using valid and reliable methods assessing multiple outcome measures of food consumption and environmental factors. WITS intervention and Control schools in this study were in an urban setting with high percentage of minority and high percentage poverty.

The first research question explored the differences in consumption of fruits, vegetables, and salad bar items at school lunch for 2nd and 3rd grade students. Comparisons were made between WITS intervention schools and Control schools, 2nd grade students and 3rd grade students, and girls and boys, after one year of the WITS intervention programming. School lunch food on tray and consumption of students was assessed by observation over three school days for each school at Time 0 and Time 1 study time periods. About thirty students were observed each observation day for each school, totaling over 1300 student observations each study time period.

The second research question focused on testing the impact of various school lunch environmental factors on 2nd and 3rd grade students’ consumption of fruits, vegetables, and salad bar items at school lunch. The school lunch environmental factors included: time duration of school lunch, wait time before getting school lunch, order of lunch and recess, pre-plating of fruits on lunch trays, slicing of fruits, whole fruits in an attractive serving bowl, number of fruit options, position of vegetables in lunch line, pre-plating of vegetables on lunch trays, number of vegetable options, position of salad bar, and number of salad bar items. These school lunch environmental factors were assessed using observation.

This study found that there were no differences in consumption of fruits, vegetables, and salad bar items between WITS intervention schools and Control schools at Time 0 or at Time 1. This study did find that 3rd grade students ate more fruits and salad than 2nd grade students, when analyzed for only students who had the food item on the tray and when analyzed for all students. Students in 3rd grade ate significantly more vegetable than students in 2nd grade, analyzed within students that had vegetable on tray. Additionally, more 3rd grade students had any salad on tray than 2nd grade students. This study also found that across all students, girls ate more fruits and salad than boys. More girls had any fruit and salad on tray than boys, and across all students, more girls ate any fruit and salad than boys.

Having lunch after recess, and slicing or pre-cutting of fruits were found to have a significant positive correlation with fruit consumption across all students. However, displaying whole fruits being served in an attractive serving bowl were found to have a significant negative correlation with fruit consumption across all students. Pre-plating of vegetables on lunch trays, and having two or more vegetable options were found to have a significant positive correlation with vegetable consumption across all students. Only wait time before getting school lunch was found to have a significant positive correlation with salad consumption across all students.

The WITS programming might not have been executed in full due to real-world limitations, which may have contributed to the lack of differences in fruit, vegetable and salad consumption between WITS intervention and Control schools. Future review of the level of implementation of all the components of the WITS programming would allow for improvements in the execution of the programming. The findings from this study also indicate that some school lunch environmental factors could have strong influences on the consumption of fruits, vegetables, and salad bar items. Interventions working on increasing fruit and vegetable consumption could thus consider incorporating steps to manipulate these factors to improve the impact of their programming.