title: Location of School Lunch Salad Bars and Fruit and Vegetable Consumption in Middle Schools: A Cross-Sectional Plate Waste Study.
abstract: BACKGROUND
  The school lunch environment is a prime target for increasing a child's consumption of fresh fruits and vegetables (F/V). Salad bars are heavily encouraged in schools; however, more research is needed to examine the contexts in which salad bars promote consumption of F/V among students.
  
  
  OBJECTIVE
  To compare the amount of fresh F/V self-served, consumed, and wasted by students during lunch at schools with differing salad bar placement: inside or outside of the serving line.
  
  
  METHODS
  Cross-sectional plate waste study in which salad bar placement differed between schools.
  
  
  METHODS
  A random sample of middle school students (N=533) from six schools (three schools per district).
  
  
  METHODS
  Amount of fresh F/V taken, consumed, and wasted.
  
  
  METHODS
  Negative binomial multivariable regression examined placement of salad bars, adjusting for sex, grade, race/ethnicity, free/reduced status, day of the week, and nesting of students within schools.
  
  
  RESULTS
  Almost all students (98.6%) in the schools with salad bars inside serving lines self-served F/V compared with only 22.6% of students in the schools with salad bars outside lines (adjusted prevalence ratio=5.38; 95% CI 4.04 to 7.17). Similarly, students at schools with salad bars inside the line had greater prevalence of consuming any F/V compared with students in schools with salad bars outside the line (adjusted prevalence ratio=4.83; 95% CI 3.40 to 6.81). On average, students with the salad bar outside the line wasted less F/V compared with those with salad bars inside the line (30% vs 48%, respectively).
  
  
  CONCLUSIONS
  Few students visited salad bars located outside the lunch line. Salad bars inside the lunch line resulted in significantly greater fresh F/V taken, consumed, and wasted. When possible, schools should try to include salad bars inside the line to increase students' exposure to F/V.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Adams
authors.forename: Meg
authors.initials: M
authors.lastname: Bruening
authors.forename: Punam
authors.initials: P
authors.lastname: Ohri-Vachaspati
authors.forename: Jane C
authors.initials: JC
authors.lastname: Hurley
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D005518:Food Preferences; D005522:Food Services / Q000458:organization & administration*; D005638:Fruit / Q000600:supply & distribution*; D006801:Humans; D062409:Lunch; D008297:Male; D012574:Schools; D014675:Vegetables / Q000600:supply & distribution*
keywords: Children; Fruit and vegetable intake; School lunch; Students; Waste