Salad Bars in the National School Lunch Program: Impact on Dietary Consumption Patterns in Elementary School Students

Study Overview
=================
Brief Summary
-----------------
This project is a research study looking at what foods students choose and eat during school lunch and examines how salad bars impact what children eat.

Detailed Description
-----------------
This project applies a wait list control cluster randomized controlled trial to evaluate school salad bars. This project uses digital images (pictures) of labeled trays in the cafeteria before and after children eat lunch. This project also asks cafeteria workers about their thoughts about salad bars and their experiences with the salad bar program.

Official Title
-----------------
Salad Bars in the National School Lunch Program: Impact on Dietary Consumption Patterns in Elementary School Students

Conditions
-----------------
Diet, Food, and Nutrition

Intervention / Treatment
-----------------
* Other: Salad bar
* Other: Waitlisted control
* Other: Salad bar post-COVID


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Students: All K-6th grade students at target schools who participate in the school lunch program on rating day Cafeteria staff: All cafeteria personnel at the randomly selected target schools will be eligible to complete surveys Exclusion Criteria: Students: Unsure sex of child Cafeteria staff: None

Ages Eligible for Study
-----------------
Minimum Age: 5 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Schools with salad bars<br>Schools with salad bars | Other: Salad bar<br>* Schools where the school district has installed salad bars<br>|
| Schools without salad bars<br>Schools without salad bars | Other: Waitlisted control<br>* Schools where the school district has not yet installed salad bars<br>|
| Schools with salad parts post COVID-19<br>A subset schools with salad bars that were examined pre-COVID-19 will undergo methods again. | Other: Salad bar post-COVID<br>* Schools where the school distract has re-opened salad bars will have methods repeated in a subset of schools post-COVID-19<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| fruits and vegetables (FV) selection | Amount of FV selection will be calculated based on digital photographs of student's lunch trays before consumption | Baseline to up to 6 weeks after salad bars installed | 
| FV consumption | Amount of FV consumed will be calculated by subtracting amount of FV remaining after lunch is consumed from amount of FV selected based on digital photographs of student's lunch trays before and after consumption. | Baseline to up to 6 weeks after salad bars installed | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| energy intake (kcal) | Amount of calories consumed will be calculated by subtracting the total amount of calories remaining on trays from the total amount of calories initially selected based on digital photographs of student's lunch trays before and after consumption. | Baseline to up to 6 weeks after salad bars installed | 
| dietary quality (Healthy Eating Index) | the Healthy Eating Index will be calculated for food and beverages consumed at lunch (amount on the tray before minus after consumption) using NDSR | Baseline to up to 6 weeks after salad bars installed | 
| fruits and vegetables (FV) selection post-COVID-19 | To examine the the impact of salad bars on student dietary intake patterns after their reintroduction post-COVID-19 school closures. Amount of FV selection will be calculated based on digital photographs of student's lunch trays before consumption | 4-6 weeks after salad bars re-installed | 
| FV consumption post-COVID-19 | To examine the the impact of salad bars on student dietary intake patterns after their reintroduction post-COVID-19 school closures. Amount of FV consumed will be calculated by subtracting amount of FV remaining after lunch is consumed from amount of FV selected based on digital photographs of student's lunch trays before and after consumption. | 4-6 weeks after salad bars re-installed | 
| energy intake (kcal) post-COVID-19 | To examine the the impact of salad bars on student dietary intake patterns after their reintroduction post-COVID-19 school closures. Amount of calories consumed will be calculated by subtracting the total amount of calories remaining on trays from the total amount of calories initially selected based on digital photographs of student's lunch trays before and after consumption. | 4-6 weeks after salad bars re-installed | 
| dietary quality (Healthy Eating Index) post-COVID-19 | To examine the the impact of salad bars on student dietary intake patterns after their reintroduction post-COVID-19 school closures. The Healthy Eating Index will be calculated for food and beverages consumed at lunch (amount on the tray before minus after consumption) using NDSR | 4-6 weeks after salad bars re-installed |