Nutritional PSA's on Fruit and Vegetable Consumption
Condition: Fruit and Vegetable Selection in the Lunchroom; Consumption Frequency Versus Selection Frequency
Study type: Interventional

Summary: 
      The overall goal of this project is to learn how positive advertising messages impact school
      food choices. More specifically, this study will determine if positive video messages about
      fruits and vegetables delivered during the elementary school morning news program can
      influence children to select more fruits and vegetables in a school lunch setting.
      Additionally, it will determine if assessing food selection is representative of food
      consumption by children in a school lunch room setting.
    

Detailed description: 
      This project will be carried out in three distinct phases: 1) development of commercials, 2)
      assessing food selection and consumption before, during and after commercial airing, and 3)
      outcome analysis and dissemination of results. Four elementary schools in Alachua County,
      Florida will be chosen to participate in this study. Two schools will have high participation
      in free and reduced fee school lunch programs while two will have lower participation. The
      schools will be divided such that two participate in the intervention (one with high
      free/reduced lunch participation and one with low) and two will serve as controls. All
      schools have a morning broadcast of announcements where 15-30 second fruit and vegetable
      "commercials" can be shown to all students in K-5th grades. Given the scope (1 year, limited
      budget) of this pilot project, we will assess purchasing and consumption behaviors of 3rd,
      4th, and 5th graders in each school, rather than all children. As students at these schools
      (and the controls) have the option of what fruits and vegetables to select (if any) as part
      of the school lunch, the investigators will be able to observe if the commercials have an
      impact on student choice of healthy products. Students will be assessed collectively per
      class and thus no individual identifying information will be collected.

      Two commercials will be prepared for the schools using messages developed for this age group
      that feature children as the main characters. This approach captures the potential influence
      of peers. Potential 3-5th grade "actors" and adult actors will be recruited from local
      drama/playhouse venues. The two commercials will be shown each week in alternating weeks for
      a total of four weeks. Example: Week 1, commercial A shown; Week 2, commercial B shown; Week
      3, commercial 1 shown; Week 4 commercial B shown. Child actors will likely not attend the
      test schools, but they and their parents will be informed that the commercials will be shown
      in two Alachua County Public Schools. Children will include an equal mix of girls and boys
      and approximately half of the children will be from racial/ethnic minority groups that are
      represented in the Alachua County school system. These videos will be created using existing
      video production facilities at the University of Florida.

      Six observations will be made at each school to assess the frequency of selection as well as
      the consumption of fruits and vegetables: once prior to the airing of the commercials, one
      day during each of the four consecutive weeks when commercials are shown, and once two weeks
      after the commercial airing has ended. This last assessment will allow the investigators to
      gather pilot information on whether any lasting effect of the commercials has occurred. At
      each school, all observations will occur on the same day of the week and children in grades
      3-5 will be monitored. The frequency of fruit and vegetable purchase by children will be
      assessed using a combination of information from student identification numbers at the cash
      registers and University student monitors to observe the quantity of students selecting the
      fruit/vegetable promoted in the commercials. To assess food intake, the investigators will
      photograph each student's tray for future visual plate waste analysis (Silver 2008). Visual
      plate waste analysis allows trained student and faculty assessors to estimate whether 10, 25,
      50, 75, or 90% of a food item remains uneaten on the plate. To evaluate the agreement between
      selection and consumption, a food item will be considered "consumed" if no more than 25% of
      the item remains on the plate. Each plate will be evaluated by a minimum of three trained
      assessors. If the values vary, the item will be discussed as a group until consensus is
      reached. Moreover, the investigators will work closely with the school food service directors
      in selecting our days for evaluation and ensuring that equal and adequate amounts of fruits
      and vegetables are offered on study days.

      The primary outcomes are fruit and vegetable selection and consumption. With over 11,500
      school students enrolled in the Alachua County School System at 23 elementary schools, we
      anticipate a total sample size of approximately 1000 3rd, 4th, and 5th grade children.
      Anticipating a 15% attrition rate over the study period, due primarily to absences, the
      investigators expect having repeated observations from 850 children, half from intervention
      schools, half from control schools. Although pilot in nature, this sample size is adequate to
      detect a mean difference fruit/vegetable selection frequency of 0.5 servings between the
      study schools with over 99% power using a two-sided 0.05 significance level to detect a
      standardized effect of 20 standard deviations. Whether food selection can serve as a proxy
      for food consumption as assessed by visual plate waste analysis will be assessed using
      regression analysis.
    

Intervention name(s): Commercials
Intervention type(s): Behavioral
Intervention description(s): These commercials will display child actors and try to grab the attention of the 3rd - 5th grade viewers. They will be humorous, fun, and call the viewer to action so the students will feel they should consume fruits and vegetables like the children in the commercials.
Other intervention name(s): PSA's; Video messages; Media messages
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Nutrition; Commercials; Elementary; Lunchroom; Fruits; Vegetables