Nudging for Behavior Change in School Cafeterias
Condition: Behavior, Child; Food Selection
Study type: Interventional

Summary: 
      The main purpose of this research is to look at a school lunchroom intervention that is known
      to improve fruit, vegetable, and milk consumption and see how it changes in the long run and
      if it affects the child's behavior permanently. The intervention will include the giving the
      vegetables descriptive names, moving the fruit to right next to the register and in
      attractive bowls, and increasing the amount of white milk served by 10%. The main forms of
      analyzing these results are through food preparation records, lunch sales records, and tray
      waste records. The first focus of this study is to see if there is a specific point in an
      intervention when improvement stops and therefore the intervention needs to be updated. This
      procedure involves looking at five similar middle schools with this same intervention over a
      15 week period. The time of intervention implementation will vary by three week intervals, so
      the first will start the first week of school, the next school will start after three weeks
      of school, the next will start after six weeks of school, and the next will start after nine
      weeks of school, and the last will be a control school where there will be no intervention
      implementation. These intervals will help eliminate bias dealing with the beginning of the
      year excitement and seasonal effects. Food preparation records and lunch sales records will
      be collected from the school for the 15 week period. Tray waste will be recorded by having
      200 randomly selected trays measured and collected twice a week over the 15 week period. This
      focus will help schools manage when they need to change their intervention so that
      improvements will not stop. The second focus of this study is to see if the children's
      improvement is kept when the intervention has stopped. This procedure will involve looking at
      a similar school to the other 5 schools. But unlike the other schools, this one will have the
      first 5 weeks without the intervention, then 5 weeks with the intervention, and then another
      5 weeks without the intervention. Food preparation records and lunch sales records will be
      collected from the school for the 15 week period. Tray waste will be recorded by having 200
      randomly selected trays measured and collected twice a week over the 15 week period. This
      second focus will help identify how effective this intervention is in permanently changing
      dietary habits.
    


Intervention name(s): Basic School Lunchroom Nudges
Intervention type(s): Behavioral
Intervention description(s): The intervention consists of three components: 1) serving fresh fruit in attractive bowls in at least two locations on the lunch line; 2) providing descriptive names for the vegetables; and 3) increasing amount of plain milk availability by 10% and placing it in front of the chocolate milk. For the vegetable naming intervention, researchers first developed, printed, and laminated descriptive vegetable name cards (2"x4"). Some examples included "Savory Collard Greens," and "[School Mascot] Salad." Cafeteria staff affixed name cards to the serving line sneeze-guards in front of the vegetables for the day. For the fruit intervention, we purchased and delivered two ceramic bowls to the intervention school. The cafeteria staff filled the bowls and put them in different locations on the lunch line. For the milk intervention, cafeteria staff increased the amount of plain milk available by 10% and placed plain in front of chocolate milk in the coolers.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: We randomly assigned the six participating schools to either be a control school (N=1) or a treatment school (N=5). Each of the treatment schools administered a single intervention, but at different times. In our fifteen-week study, one school implemented the intervention for five weeks after five weeks of baseline data collection. Once this school completed the five weeks with the treatment, it removed the intervention and collected five more weeks of post-intervention data. In the other four schools, we staggered intervention implementation. The first school implemented the intervention on the first day of the study. The next school implemented the intervention after three weeks of collecting baseline data. The next school implemented the intervention after six weeks of collecting baseline data. Lastly, the final school implemented the intervention after nine weeks of collecting baseline data.
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Behavioral nudges; Food environment; Choice architecture; Lasting behavior change; Child nutrition; National School Lunch Program