RESUMO
INTRODUCTION: The Smarter Lunchrooms Movement was developed to provide schools with simple, low-cost solutions to encourage students to make healthier food choices at school. The objective of this study was to evaluate the impact of fruit-promoting Smarter Lunchroom interventions on middle school students' selection and consumption of fruits. DESIGN: A 9-week cluster RCT was conducted using a pre-test/post-test control group design in upstate New York in February-April 2014. SETTING/PARTICIPANTS: Ten middle schools (Grades 5-8) were recruited and randomized into a fruit intervention (n=4), vegetable intervention (n=3), or control group (n=3). This article focuses only on the fruit intervention and control groups. INTERVENTION: The fruit intervention group made changes to the convenience, visibility, and attractiveness of fruit in their lunchrooms for a period of 6 weeks. The control group made no changes, and were offered Smarter Lunchrooms training post-intervention. MAIN OUTCOME MEASURES: Selection and plate waste data were collected from February to April 2014, and analyzed in 2014-2015. Average selection, waste, and consumption of food items were computed, and the statistical differences between treatment and control groups were analyzed using t-test statistics and difference-in-difference analysis. RESULTS: Fruit selection increased overall by 36% (p<0.001), and fruit consumption increased overall by 23% (p<0.017). Vegetable selection and consumption and white milk selection also increased significantly in the treatment schools (p<0.001), though were not significant overall. CONCLUSIONS: The fruit intervention increased the selection and consumption of fruits overall, and increased the selection and consumption of vegetables and the selection of white milk in treatment schools. These findings provide evidence supporting the use of fruit-promoting Smarter Lunchrooms techniques in middle schools to increase the selection and consumption of healthy food items.