Incentives, Substituting Nutritious Food Are Key to Getting Chicago-Area Students to Eat Better at School
In 2005, Action for Healthy Kids used a working group comprised of educators, food service personnel, health advocates and others to:
- Develop, implement and assess a technical assistance model to assist 12 diverse Chicago-area schools improve students' food choices through various strategies.
- Advise the schools on how to establish school health advisory councils as a mechanism to help sustain healthy behaviors. The councils provide a school or school district with an ongoing infrastructure to address school health and wellness issues. Councils may include as members school principals, health educators, parents, food service personnel and students.
- Most of the strategies tested appeared to help make students aware of the new, more nutritious food offerings; however, getting students to switch to those offerings did not come as easily.
- Salad bars appeared to be very popular, with a sizable percentage of students choosing salad as their meal (25 percent at one school and 30 to 35 percent at another).
- Offering healthy breakfasts also appeared to be popular among students, particularly when combined with some "perk" such as a "breakfast and a movie" or the opportunity to eat with their parents.
The Robert Wood Johnson Foundation (RWJF) provided a $50,000 grant to support this solicited project.
The Institute of Medicine's 2004 report, Preventing Childhood Obesity: Health in the Balance highlighted the growing epidemic of childhood obesity and the need to make nutritional changes in school food-service programs. According to the institute:
- Children living in low-socioeconomic communities have higher rates of obesity than children living in more prosperous communities.
- The prevalence of obesity is two to three times higher among African American, Latino and Native American children than the national average.
- Minority children have higher rates of risk factors for high blood pressure, high cholesterol and type II diabetes.
Since many children in low-income communities receive one to two meals per day in school, an opportunity exists to make changes in the school environment to foster healthy eating habits, according to the project director.
RWJF is committed to addressing the issue of childhood obesity. The goal is to help halt the rise in childhood obesity rates by promoting healthy eating and physical activity in schools and communities throughout the nation. RWJF places special emphasis on reaching children at greatest risk: African-American, Hispanic, Native American and Asian/Pacific Islander children living in low-income communities.
RWJF has a four-pronged approach to halting the increase in childhood obesity:
- Building evidence regarding what works to promote healthy eating and increase physical activity among kids.
- Testing innovative approaches in order to spread promising models.
- Educating leaders and investing in advocacy strategies.
- Working on ways to help health care providers screen and counsel to prevent and manage childhood obesity.
Prior to receiving RWJF funding, staff from Action for Healthy Kids, an Illinois-based organization that works to improve nutrition and increase physical activity in schools, convened a working group of educators, food service personnel, advocates, academics and government staff to improve nutrition in schools.
With RWJF funding, project staff:
- Developed, implemented and assessed a technical assistance model (see the Bibliography) to assist 12 diverse Chicago-area schools to improve student's food choices through various strategies. The key elements of the technical assistance model are:
- Recruit key contacts at the school.
- Recruit a group of volunteer experts.
- Convene monthly calls with schools/school districts.
- Include school health advisory councils. The councils provide a school or school district with an ongoing infrastructure to address school health and wellness issues. They may include school principals, health educators, parents, food service personnel and students.
- Use Action for Healthy Kids' network of volunteers.
- Provide schools with materials and resources.
- Provide schools with an evaluation method and training.
- Used the working group to provide technical assistance to the schools.
- Advised schools on how to establish school health advisory councils as mechanisms to help sustain health-promoting changes.
- Collected assessment data to assess the impact of the demonstration projects.
- Disseminated the findings.
Action for Healthy Kids subcontracted with a graduate student from the University of Illinois, Chicago, to compile the data received from each school and provide an analysis of the project.
Nine of the 12 participating schools/districts completed their projects. (See the Appendix.) Three schools were unable to complete their projects. Two could not obtain necessary equipment (salad bars or cold vending machines) on time and one school did not make the project a priority. The strategies the schools tested included:
- Introducing healthier choices for entrees, snacks and beverages. Two schools revamped their food offerings, requiring that the new offerings meet specific nutritional standards. These schools also removed less healthy snack options from vending machines.
- Repackaging food to make healthy options more attractive. One high school introduced plastic bottles of flavored low-fat milk during a one-week promotion in an attempt to increase students' milk consumption.
- Adding salad bars to the lunchroom. Two schools introduced a salad bar that offered a variety of fruits, vegetables and protein choices to meet the meal standards of the National School Lunch Program.
- Promoting and introducing new fruits and vegetables. Two schools launched the "Eat Your Colors" program that introduced students to a new fruit or vegetable each day for a defined period of time (e.g., a week or a month).
- Increasing participation in breakfast. Three schools began offering and promoting a healthy breakfast. One implemented a breakfast bar, the second launched "Friday Family Breakfasts" at which parents and students together could eat a healthy meal and the third implemented "Breakfast and a Movie," where a segment from a popular movie was played during breakfast.
- Accommodating healthier snack foods. One school installed a cold vending machine offering healthy beverages and snacks. Another renamed its school store and revamped its offerings to emphasize healthier food options.
The schools promoted the interventions to students and parents through the use of posters, stickers, grand opening parties, teacher education, formal nutrition education classes and letters to parents. Some schools used giveaways (e.g., movie tickets) and contests with prizes to entice participation. Others offered price discounts on the new healthier products.
To help schools sustain their nutrition demonstration projects, project staff provided training, small grants ($200$500) and assistance to those schools willing to form school health advisory councils.
The composition of the councils varied by school, but typically included school principals, assistant principals, health educators, counselors, physical education teachers, nurses, parents and parent-teacher association representatives, food service personnel and student representatives.
Five schools initiated the process to form school health advisory councils. Four schools, however, made little or no progress toward developing one.
The project took more time and effort from staff and consultants than expected. To cover the funding shortfall, staff used general operating grants received from the National Football League and the National Dairy Council.
Staff reported other challenges they and the schools faced in implementing their projects. They ranged from resource limitations to support and acceptance of the projects within the schools. (See Challenges for details.)
Project staff wrote a report titled Helping Students Make Better Food Choices in School. The report outlines the strategies undertaken by each of the schools to improve food choices and details the results of these strategies including lessons learned toward making changes within school environments. (See the Bibliography.)
Staff released the report at a press event on February 26, 2006, at Evanston Township High School in Evanston, Ill. U.S. Senator Richard Durbin (D-Ill.) attended the event. Durbin also distributed the report to his colleagues in the U.S. Senate. The report is posted on the Action for Healthy Kids Web site.
Staff reported the following results in its report Helping Students Make Better Food Choices in School. (See the Bibliography for details.)
- Most of the strategies tested appeared to help make students aware of the new, more nutritious food offerings. However, success in getting students to switch to those offerings did not come as easily. The transition to healthier foods occurs more quickly when the new choices replace less nutritious foods as opposed to the two being offered side by side.
- Salad bars appeared to be very popular, with a sizeable percentage of students choosing salad as their meal (25 percent in one school and 30 to 35 percent in another).
- Offering healthy breakfasts also appeared to be popular among students, particularly when combined with some "perk," for example, watching a movie during breakfast or the opportunity to eat with their parents.
- Getting students to try a healthy food for a period of time appeared to be the most important breakthrough strategy. Once they did this, their habits tended to change even after the perk was gone. The "Breakfast and Movie" promotion, for example, increased daily breakfast attendance at one school from 250 to 343 (a 37 percent increase); once the promotion ended the average attendance dipped only slightly to 320 students (a 28 percent increase).
Staff described the following challenges in a report to RWJF:
- Project staff underestimated the time and effort it would take to maintain workgroup participation and provide technical assistance to schools. Staff reported to RWJF that it was an enormous undertaking to coordinate a volunteer working group and keep schools motivated to implement and evaluate the project.
- A challenge that is inherent in working with schools is the schedule. School administrators are consumed with the day-to-day responsibilities of operating a school and a lunchroom and managing their staff. The school schedule includes time for testing requirements, vacations and intermittent days off to accommodate events, such as parent conferences. Scheduling project implementation, conference calls, data collection and follow-up can be daunting under these circumstances.
The following challenges are documented in the report, Helping Students Make Better Food Choices in School.
- Some healthier foods offerings, such as salad and breakfast bars take more time to prepare/maintain than traditional offerings. This placed a strain on existing food service staff and created a need to hire additional staff at additional cost.
- Some healthier food items, such as fresh fruits and vegetables or specially packaged low-fat milk, tend to be more expensive. This may lead schools to charge a higher price for these items, but doing so may discourage students from buying them.
- Some schools had difficulties obtaining or preparing great-tasting healthier food choices to compete against less nutritious foods and beverages. For example:
- One school could not immediately purchase or trade its existing vending machines to newer cold vending machines that hold yogurt, veggies and dip, bagels and cream cheese, sandwiches, cheese sticks and fruit.
- Schools that added a salad bar found it required special equipment to accommodate the smaller size of their young students. For some schools, the cost and space required for the equipment may make this option impossible.
- All schools wanted to sell more healthful options in school stores, vending machines and the cafeteria, but found their options limited. Many of their distributors did not stock some of the newer products that students think taste great while also having fewer calories, less fat and less sugar.
- Some schools reported a loss in revenue because they did not have adequate product substitutes for some of the best-selling snack items they no longer offered.
- Support and acceptance of nutrition policy changes among administrators, school food service, teachers, parents and students is essential for these practices to be adopted. Staff at each school found that:
- It was difficult to engage teachers and administrators. Their busy schedules made it hard for them to devote time to projects or committees such as the school health advisory councils.
- Students tend to resist changes they viewed as "imposed" on them by school administrators. Students want to feel as if they are part of the decision-making process. If the students are not consulted beforehand about the proposed changes, it can be difficult for schools to anticipate how students will react to specific foods offerings.
- Schools offering breakfast programs did not involve parents and subsequently found it difficult to get students to school early enough to participate.
The following recommendations are from the report, Helping Students Make Better Food Choices in School.
- Approaches for improving nutrition must come with financial resources and must be cost-effective for successful implementation.
- Wellness practices and programs need to complement the larger school context by fitting within the school schedule and aligning with the school health model.
- Approaches for improving nutrition practices must be sustainable. One-time events without additional programs and practices to improve students' food choices will not have a lasting impact.
- Schools need to develop school health advisory councils. This ongoing, institutionalized body can be charged with identifying problems that affect children's health and with recommending changes to alleviate the problems.
- Wide support from critical audiences is necessary—this includes administrators, parents, teachers, students and other community leaders.
Staff documented the following lessons learned in its report, Helping Students Make Better Food Choices in School.
- Involve students. Gather information from students about their insights, perceptions and opinions of new food choices. Involve students throughout the planning, implementation and evaluation process. Students provide valuable guidance. (Project Report)
- Tastings and promotions get attention. To identify popular options and familiarize students with new products, schools should promote new programs as widely as possible. Use printed educational materials, nutrition education, video or audio announcements at schools, cafeteria taste-tests, games, contests and giveaways. Widespread sustained promotion is likely to encourage students to try new food offerings. (Project Report)
- Information is powerful. Give students information on the nutrition and caloric content of available foods. A survey conducted in 2000 by the federal Centers for Disease Control and Prevention found that more than nine in 10 schools give menus to students, at least half collect student suggestions for the food service program and more than a third conduct taste tests with students. (Project Report)
- Support collaboration. Gather support from a group of individuals inside and outside of the school. These individuals can work together and share ideas, thoughts and responsibilities. (Project Report)
- Packaging counts. Supply healthy options in appealing, fun packaging. The goal is to make healthy options more acceptable and more fashionable. (Project Report)
- Offer healthy options at a lower price (at least initially). Price is a key factor to students and lowering prices of healthy options encourages trial and purchase. (Project Report)
- Be consistent and comprehensive. Provide a consistent healthy environment throughout the school by replacing all items of low nutritional value sold though vending machines, school stores and cafeterias. Students with the option of both healthy and non-healthy items will often choose the latter. (Project Report)
- It's OK to imitate. Do not try to reinvent the wheel. Implement a project or nutritional education curriculum that has already been developed and tested by another school. (Project Report)
Action for Healthy Kids received a $125,000 grant from the U.S. Department of Agriculture to enhance the work completed through this project.
- Project staff worked with five Illinois schools to test strategies for introducing students to healthier foods, promoting healthy eating habits and increasing knowledge about good nutrition.
- Using non-classroom based activities, this project aimed to motivate youth to make better food choices during the school day. Food demonstrations took place at each school cafeteria highlighting better food choices from certain food groups including: dairy and milk products; whole grains; and fruits and vegetables.
GRANT DETAILS & CONTACT INFORMATION
Helping Children Make Better Food Choices in the School Environment
Action for Healthy Kids (Skokie, IL)
Dates: December 2004 to December 2005
Schools That Completed Their Projects
- Jones College Prep High School - Chicago
- Kennedy High School - Chicago
- Oscar DePriest Elementary School - Chicago
- Namaste Charter School - Chicago
- Sullivan Elementary School - Chicago
- Century Junior High - Orland Park
- Arlington Heights School District #25 - Arlington Heights (includes seven elementary schools)
- Evanston Township High School - Evanston
- Quincy Senior High School - Quincy
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
A Model Approach to Providing Technical Assistance to Schools. Chicago: Action for Healthy Kids. Unpublished.
Becke T. Helping Students Make Better Food Choices in the School Environment: Evaluation Report. Chicago: Action for Healthy Kids, 2006.
Helping Students Make Better Food Choices in School. Chicago: Action for Healthy Kids, 2006. Available online.
Report prepared by: Barbara Matacera Barr
Reviewed by: Richard Camer
Reviewed by: Molly McKaughan
Program Officer: Terry L. Bazzarre