French, S. A., Story, M., Fulkerson, J. A., & Hannan, P. (2004).American Journal of Public Health, 94,1507-1512
Secular increases in the prevalence of adolescent obesity have focused attention on trends in adolescent health-related lifestyle behaviors including patterns of dietary intake. Accumulated data suggest that the school food environment can influence adolescents' food choices because a large proportion of their total daily energy intake is consumed at school. Competitive foods, available outside the National School Lunch Program, are energy-dense, high in fat, and comprise an increasing share of students' food purchases at school, particularly at the secondary level (Fox et al., 2001; Mathematica Policy Research, 2001). The Trying Alternative Cafeteria Options in Schools Study (TACOS), a 2-year, group-randomized, school-based nutrition intervention trial, was designed to evaluate an environmental intervention targeting increased sales of lower-fat foods in secondary school cafeterias. Twenty secondary schools were randomly assigned to either a multicomponent environmental intervention (consisting of increased availability of lower-fat foods in cafeteria a la carte areas and implementing school-wide student-based promotions of lower-fat food choices) or no intervention. The primary outcome measure was percentage of lower-fat a la carte food sales calculated from the weekly a la carte sales data. Results indicated a greater increase in sales of lower-fat foods in year 1 (10% intervention versus -2.8% control; p = .002) and a higher percentage of sales of lower fat foods in year 2 (33.6% intervention versus 22.1% control, p = .04).
Taken together and placed in the context of other school-based research, the results support the potential for improving adolescent patterns of dietary intake through modification of the school food environment. The epidemic of overweight in children and youth has prompted a reexamination of both the school food and physical activity environments. Nurses and other pediatric healthcare providers can play an important role in advocating for the multilevel policy changes necessary to optimize the role of schools in promoting the health of our children and youth.
Comment by Laura L. Hayman
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