BackgroundIn the United States, the National School Lunch Program (NSLP) is the healthiest lunch option for students, yet participation is suboptimal and fruit and vegetable waste remains high. Improving school meal convenience, engaging teachers in the school-lunch program, and enhancing the cafeteria environment are promising strategies to improve participation and dietary intake, yet little evidence is available on their impact. Methods/DesignThe Multi-Pronged Intervention to Increase Secondary Student Participation in School Lunch (MPI) is a 3-year quasi-experimental study in a large urban school district in California. A total of 24 middle and high schools participated in the study: half received the intervention and half served as controls. The intervention consisted of additional school lunch points of sale (vending machines and mobile carts), a school meal outreach program for teachers, and cafeteria redesigns. School meal participation, student-reported fruit and vegetable consumption, and school lunch plate waste were assessed at baseline and in years 1 and 2 of the intervention. Change in meal participation and fruit and vegetable consumption were compared between intervention and control arms to determine the impact of the intervention on school meal participation and dietary intake. DiscussionThis study is positioned to provide evidence on the feasibility and efficacy of a multi-level intervention to increase school meal participation and consumption of fruits and vegetables. BACKGROUNDObesity, one of the most pressing health issues of our time, has been linked to secular changes in dietary intake. 1 Improving dietary intake among youth is critical to reducing childhood obesity, as only 1% of children in the United States meet the Dietary Guidelines. 2 Fruits and vegetables, in particular, play a vital role as intake is associated with reduced risk of obesity 3-6 and chronic disease. 3,6,7 However, approximately one third of adolescents consume less than one serving of fruit or vegetables per day, 8 and low-income youth consume less than their higher income peers. 9Schools are arguably the most important system in which to intervene to improve youth dietary intake; 10 school-aged children consume up to half of their daily calories at school. 11 While participation in the National School Lunch Program (NSLP) has been associated with significantly higher lunchtime fruit and vegetable intake 13 and higher diet quality overall, 14 only 57% of students with program access participate on a given day. 15 Furthermore, though fruit and vegetable consumption has increased slightly since the 2010 Healthy Hunger-Free Kids Act went into effect, plate waste remains high; up to 59% of selected vegetables are wasted. 16,17 Efforts to improve what students eat at school are especially important for adolescents as they have greater

College food insecurity is a known detriment to student success, but little is known about the implementation of campus-based programmes to help address this issue on campus in the United States. The objective of this research study was to determine the types of food insecurity initiatives implemented and assess how such programmes are managed, funded, and evaluated. A cross-sectional, 23-item online survey was administered among individuals involved with campus food insecurity initiatives identified through professional networks. Food pantries were the most common (97.1%) and mobile food sharing applications were the least common (14.7%) food security initiatives. A majority of respondents (69.7%) stated that at least one programme on their campus was evaluated, although the methods varied and uncertainty about the methods used was common. An allocated budget was provided at some institutions (38.9%), but funding mechanisms varied. Student Life Offices were most commonly reported as being responsible for programme management. Most respondents (75.3%) reported there had been programme changes due to COVID-19. This research confirmed that food insecurity programmes are widely available, although the type, funding,

School lunch programs provide an opportunity to improve students’ diets. We sought to determine the impact of a multifaceted intervention (cafeteria redesigns, increased points-of-sale and teacher education) on secondary students’ perceptions of school-lunch quality and convenience and fruit and vegetable intake. Surveys (n = 12,827) from middle and high school students in 12 intervention and 11 control schools were analyzed. We investigated change in school-lunch perceptions and lunchtime and daily fruit and vegetable consumption from 2016 to 2018. Among 8th graders, perceptions that school lunch tastes good and that school lunch was enough to make students feel full increased 0.2 points (on a 5-point scale; p < 0.01) in intervention schools relative to control schools. Among 10th graders, lunchtime fruit and vegetable consumption increased 6% in intervention relative to control schools (p < 0.05 and p < 0.01 respectively). Daily fruit intake increased 0.1 cups/day in intervention relative to control schools among 9th graders (p < 0.01). This study provides important evidence on the limited effect of design approaches in the absence of meal changes. We observed only modest changes in school lunch perceptions and fruit and vegetable consumption that were not consistent across grades, suggesting that additional efforts are needed to improve school-lunch uptake.

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