title: Efficacy of the Lunch is in the Bag intervention to increase parents' packing of healthy bag lunches for young children: a cluster-randomized trial in early care and education centers.
abstract: BACKGROUND
  Lunches that parents pack for their young children to eat at school or the Early Care and Education (ECE) center fall short of recommended standards. Lunch is in the Bag is a multi-level behavioral nutrition intervention to increase parents' packing of fruit, vegetables, and whole grains in their children's lunches. Designed for implementation in ECE centers, the five-week long intervention is followed three months later with a one-week booster.
  
  
  METHODS
  Efficacy of Lunch is in the Bag was tested in cluster randomized trial. Participants were 633 families from 30 ECE centers (15 intervention, 15 control) across Austin, San Antonio, and Houston, Texas, USA. Primary outcomes were servings of fruit, vegetables, and whole grains observed in the children's parent-packed bag lunches. Servings of refined grains, meats/beans/eggs/nuts, dairy, chips, and sweets also were observed. Data were collected at baseline, post-intervention (6-week follow-up), pre-booster (22-weeks follow-up), and post-booster (28-week follow-up). Time-by-treatment interactions were analyzed separately for each of the food groups using multi-level models to compare changes from baseline. Analyses were adjusted for relevant demographic variables and clustering within centers and parents.
  
  
  RESULTS
  The intervention effected increases from baseline to 6-week follow-up in vegetables (0.17 servings, SE = 0.04, P < 0.001) and whole grains (0.30 servings, SE = 0.13, P = 0.018). The increase in whole grains was maintained through the 28-week follow-up (0.34 servings, SE = 0.13, P = 0.009). Fruit averaged more than 1.40 servings with no differences between groups or across time. The intervention prevented increase in sweets (-0.43 servings, SE = 0.11, P < .001, at the 22-week follow-up). Parents persisted, however, in packing small amounts of vegetables (averages of 0.41 to 0.52 servings) and large amounts of sweets and chips (averages of 1.75 to 1.99 servings).
  
  
  CONCLUSIONS
  The need for and positive effects of the Lunch is in the Bag intervention at ECE centers where parents send bag lunch for their preschool-aged children was confirmed. An important direction for future research is discovery of more options for leveraging the partnership of ECE centers and families to help young children learn to eat and enjoy vegetables and other healthy foods in preference to less healthy choices such as chips and sweets.
  
  
  BACKGROUND
  The Clinical Trials Number is NCT01292434 .
authors.affiliation: Third Coast R & D, Inc., 2728 Avenue Q, Galveston, TX, 77550, USA. croberts@thirdcoastresearch.com.
authors.forename: Cindy
authors.initials: C
authors.lastname: Roberts-Gray
authors.affiliation: Nutritional Sciences, School of Human Ecology, The University of Texas at Austin, 1 University Station, Austin, TX, 78746, USA. m.briley@austin.utexas.edu.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Briley
authors.affiliation: Health Promotion/Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health Austin Regional Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX, 78701, USA. Nalini.Ranjit@uth.tmc.edu.
authors.forename: Nalini
authors.initials: N
authors.lastname: Ranjit
authors.affiliation: Health Promotion/Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health Austin Regional Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX, 78701, USA. courtney.e.byrdwilliams@uth.tmc.edu.
authors.forename: Courtney E
authors.initials: CE
authors.lastname: Byrd-Williams
authors.affiliation: Nutritional Sciences, School of Human Ecology, The University of Texas at Austin, 1 University Station, Austin, TX, 78746, USA. sjsweitz@mail.utexas.edu.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Sweitzer
authors.affiliation: Epidemiology, University of Texas School of Public Health, 1200 Hermann Pressler Lane, Houston, TX, 77030, USA. Shreela.V.Sharma@uth.tmc.edu.
authors.forename: Shreela V
authors.initials: SV
authors.lastname: Sharma
authors.affiliation: Nutritional Sciences, School of Human Ecology, The University of Texas at Austin, 1 University Station, Austin, TX, 78746, USA. majorromo@gmail.com.
authors.forename: Maria Romo
authors.initials: MR
authors.lastname: Palafox
authors.affiliation: Health Promotion/Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health Austin Regional Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX, 78701, USA. Deanna.M.Hoelscher@uth.tmc.edu.
authors.forename: Deanna M
authors.initials: DM
authors.lastname: Hoelscher
mesh_terms: D002675:Child, Preschool; D004032:Diet / Q000592:standards*; D005260:Female; D005638:Fruit; D006801:Humans; D062409:Lunch; D008297:Male; D010290:Parents / Q000193:education*; D012574:Schools; D013781:Texas; D016896:Treatment Outcome; D014675:Vegetables