title: Project ReFresh: Testing the Efficacy of a School-Based Classroom and Cafeteria Intervention in Elementary School Children.
abstract: The purpose of this study was to assess the effect of a school-based nutrition program using a cafeteria environment intervention and classroom nutrition education on self-reported fruit and vegetable (FV) consumption, self-efficacy to select FV, and preference for healthy foods.
  
  
  
  Using quasi-experimental pre-post design with 3 study conditions, a total of 665 fourth- and fifth-grade students participated in the study. The comprehensive intervention included a behavioral economics cafeteria intervention and weekly classroom nutrition education for 1 academic year. The intervention was designed and delivered by the extension system.
  
  
  
  The comprehensive group showed significant improvement in some indicators including eating vegetables for lunch (p = .007), number of days eating vegetables (p < .001) and fruits (p < .001) in the last week, and self-efficacy in preparing FV at home (p = .034) compared to the control and cafeteria groups. Food preference of some food items, including oatmeal (p = .036 for cafeteria group, p < .001 for comprehensive group), whole grain noodles (p = .011 for comprehensive group), and vegetables (p = .003 for comprehensive group), significantly improved in the cafeteria and/or comprehensive group.
  
  
  
  Classroom nutrition education combined with cafeteria improvement has the potential to improve diet-related behavior of elementary school children. Also, collaborative partnership between schools and extension can enhance program sustainability.
authors.affiliation: Department of Nutrition and Food Science, College of Agriculture and Natural Resource, University of Maryland, 3301 Marie Mount Hall, College Park, MD. hjsong@umd.edu.
authors.forename: Hee-Jung
authors.initials: HJ
authors.lastname: Song
authors.affiliation: Nutrition Program, College of Public Health and Human Sciences, School of Biological and Population Health Sciences, Oregon State University, 118C Milam Hall, Corvallis, OR 97331. stephaniegrutzmacher@oregonstate.edu.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Grutzmacher
authors.affiliation: Department of Child and Family Studies, California State University, Los Angeles, 5151 State University Drive, Los Angeles, CA 90032-8530. amunger@calstatela.edu.
authors.forename: Ash L
authors.initials: AL
authors.lastname: Munger
mesh_terms: D002648:Child; D000072001:Diet, Healthy; D005260:Female; D005522:Food Services / Q000458:organization & administration*; D005638:Fruit; D006266:Health Education / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D012574:Schools / Q000458:organization & administration*; D014675:Vegetables
keywords: behavioral economics; cafeteria; nutrition education; school-based nutrition program