Role of the Elementary School Cafeteria Environment in Fruit, Vegetable, and Whole-Grain Consumption by 6- to 8-Year-Old Students.

ABSTRACT

OBJECTIVE: Examine how the physical cafeteria environment contributes to 6- to 8-year-olds' school food consumption. DESIGN: Cross-sectional observational study. Before-and-after lunch tray photos taken with iPads to capture food selection and consumption. SETTING: 10 New York City public elementary school cafeterias. PARTICIPANTS: A total of 382 students aged 6-8 years who ate lunch in the cafeteria on observation days. MAIN OUTCOME MEASURES: Fruit, vegetable, or whole-grain consumption. ANALYSIS: Pearson's chi-square and multivariate logistic regression assessed associations between cafeteria environmental factors (time to eat lunch, noise, and crowding) and vegetable, fruit, and/or whole-grain consumption with 95% confidence, adjusted for school-level demographics and clustered by school. RESULTS: Approximately 70% of students selected fruits, vegetables, and/or whole grains. When selected, consumption was 25%, 43%, and 57%, respectively. Longer time to eat lunch was associated with higher consumption of fruits (odds ratio [OR] = 2.0; 95% confidence interval [CI], 1.1-3.8; P = .02) and whole grains (OR = 2.1; 95% CI, 1.003-4.2; P < .05). Quieter cafeterias were associated with eating more vegetables (OR = 3.9; 95% CI, 1.8-8.4; P < .001) and whole grains (OR = 2.7; 95% CI, 2.6-4.7; P < .001). Less crowding was associated with eating more fruit (OR = 2.3; 95% CI, 1.03-5.3; P = .04) and whole grains (OR = 3.3; 95% CI, 1.9-5.6; P < .001). CONCLUSIONS AND IMPLICATIONS Healthy food consumption by 6- to 8-year-old students is associated with cafeteria crowding, noise, and time to eat lunch. Implementing and enforcing changes to the cafeteria environment mandated by wellness policies may reduce plate waste.