title: Milk Options Observation (MOO): A Mixed-Methods Study of Chocolate Milk Removal on Beverage Consumption and Student/Staff Behaviors in a Rural Elementary School.
abstract: Providing flavored milk in school lunches is controversial, with conflicting evidence on its impact on nutritional intake versus added sugar consumption and excess weight gain. Nonindustry-sponsored studies using individual-level analyses are needed. Therefore, we conducted this mixed-methods study of flavored milk removal at a rural primary school between May and June 2012. We measured beverage selection/consumption pre- and post-chocolate milk removal and collected observation field notes. We used linear and logistic mixed models to assess beverage waste and identified themes in staff and student reactions. Our analysis of data from 315 unique students and 1,820 beverages choices indicated that average added sugar intake decreased by 2.8 g postremoval, while average reductions in calcium and protein consumption were negligible (12.2 mg and 0.3 g, respectively). Five thematic findings emerged, including concerns expressed by adult staff about student rebellion following removal, which did not come to fruition. Removing flavored milk from school-provided lunches may lower students' daily added sugar consumption without considerably decreasing calcium and protein intake and may promote healthy weight.
authors.affiliation: 1 Department of Family Medicine, OHSU-PSU School of Public Health, Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Melinda M
authors.initials: MM
authors.lastname: Davis
authors.affiliation: 2 School-Based Health Center, Multnomah County, Portland, OR, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Spurlock
authors.affiliation: 3 OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Katrina
authors.initials: K
authors.lastname: Ramsey
authors.affiliation: 4 Adolescent and School Health Program, Oregon Public Health Division, Portland, OR, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Smith
authors.affiliation: 5 Warm Springs Extension, Warm Springs, OR, USA.
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Beamer
authors.affiliation: 6 Center for Evidence-Based Policy, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Aromaa
authors.affiliation: 7 Greater Oregon Behavioral Health Inc., The Dalles, OR, USA.
authors.forename: Paul B
authors.initials: PB
authors.lastname: McGinnis
mesh_terms: D000293:Adolescent; D000818:Animals; D001628:Beverages / Q000009:adverse effects / Q000706:statistics & numerical data*; D002099:Cacao; D002648:Child; D019422:Dietary Sucrose / Q000008:administration & dosage; D005247:Feeding Behavior; D005260:Female; D005522:Food Services / Q000592:standards*; D006801:Humans; D008297:Male; D008892:Milk; D012424:Rural Population; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data*
chemical_list: D019422:Dietary Sucrose
keywords: elementary school; flavored milk; participatory research; rural; school lunch; school nursing