Executive Summary

Introduction

Literature Review

Methods

Annotated Bibliography:

Executive Summary

Research question

Will eating a lunch containing fresh fruit, vegetables, whole grains, unprocessed meat, and
unflavored (not chocolate or strawberry) milk lead to fewer off-task behaviors in 3rd grade students in the instructional period after
lunch?

How the work of others has influenced how I think about this question

The cafeteria is one of the few places in a school that touches ALL students. If changes in the food, environment, or both can be shown to improve student learning behaviors, then it can be treated as a centralized point of control that can positively affect learning.

Much research has been done seeking to measure the effects of various improvements in the foods and/or the food environment in school cafeterias. Studies in this area have included enhancements to school nutrition in three areas: the student, the cafeteria, and the food. Curriculum-only interventions attempt to increase nutritional knowledge of learners (improve the student) (Song, 2016). Physical enhancements to cafeteria environments attempt to “nudge” students into making better nutritional choices. (Improve the cafeteria) (Golley, 2010; Storey, 2010; Song, 2016) Upgrades to school lunches or lunch policies attempt to raise the quality of the actual nutrition that students consume. (Improve the food) (Golley, 2010; Storey, 2010; Alaimo, 2013). Most studies have sought to make an improvement in one, or at most two, of these areas, but none have made direct and comprehensive changes to the entire lunchtime diet of participants

This paper also draws from work that has been done on the links between diet and cognition. While there is good evidence to suggest a link between an improvement in diet and improved cognitive and emotional functioning, these effects are generally present only when moving a subject from poor nutritional status to normal nutritional status. This suggests that the greatest gains in learning behaviors would be made by improving the diets of the most nutritionally at-risk students.

How the work of others has influenced the way I plan to study

Studies measuring the effects of improving nutrition education in schools (improving the student) relied on self-reported data from students (Song, 2016). While statistically significant improvements were measured, this data relied on students’ abilities to accurately self-report their meals, and did not include behavioral components. A study measuring the effects of improvements in the food environment (improve the cafeteria) showed mixed or no results in learning behaviors or self-reported diet improvements (Alaimo, 2013). Two studies measuring the effects of dietary enhancements and cafeteria improvements (improve the food and the cafeteria) did demonstrate a link between those enhancements and student learning behaviors (Golley, 2010; Story, 2010). However, the samples studied were diluted with subjects that did not take part in the interventions, and observed data were unnecessarily complicated and prone to error.

Research Plan

Twelve sections of 3rd grade students at four elementary schools will take part in this study. Two schools will be given a healthful box lunch consisting of fresh fruit, vegetables, whole grains, unprocessed meat, and unflavored milk. Trained observers will tally instances of off-task (distracted or disengaged) behavior in the hour after lunch at all four schools. This plan seeks to narrow the focus of what others have done. The data it seeks to measure are simple, and are less prone to error as previous studies. It seeks to make a direct connection between improved diet and learning behavior, and will not rely on self-reported data from young students.

Introduction

Research Question

Does the nutritional quality of food and the environment in which it is served by schools at lunch have an effect on student learning behaviors?  This paper will attempt to determine whether student learning behaviors are influenced by their lunch diet and cafeteria environment.  This paper will not attempt to directly connect diet with learning achievement.  Rather, it will attempt to determine whether diet can influence certain behaviors that are associated with learning, such as attention span, energy or alertness level, and attendance. The desired outcome of these behaviors is essentially that students are “on-task.” This means they are actively engaging with the learning content in a method that is consistent with the learning goals of the teacher.  Work that has been done in this area has used various terms for these behaviors in the context of schools and/or learning: “Cognitive Efficiency,” (Bellisle, 2004) “Classroom Behaviour,” “On Task,” (Storey, 2011)  “Learning Behavior,” “Alertness.” (Golley, 2010)  For clarity, I will use Golley’s “on-task.”

Personal Significance
My wife is an elementary music specialist, and part of her daily routine includes lunch duty.  Her district is relatively affluent, middle class, and suburban.  However, she is appalled by the dietary options available to the students at lunch.  Sugar-rich chocolate muffins are served as main entrees, chocolate milk is the beverage of choice, and heavily processed “stagnant and greasy” (her words) pizza is often the only thing approaching a vegetable.  (Congress has declared that the 2 tablespoons of canned tomato paste in the pizza does indeed count as a vegetable) This district is hardly an anomaly.  

My wife and I taught in Kuwait from 2010 to 2013.  Kuwait is one of the unhealthiest countries in the world, often ranking above the United States for obesity, and many of our students had health problems - some of them major.  Diabetes was common, and each year, a shockingly high number of our teenage students underwent gastric bypass surgery.  While correlation does not imply causation, and many factors influence attentiveness and actions, student behaviors in Kuwait, on the whole, are poor. We found that off-task behavior is the norm, attention spans are generally short, and emotional regulation was lacking.

Pragmatic Significance
Because nutritional manipulation has an effect on cognitive ability and efficiency, (Bellisle, 2004) could schools exert some level of positive influence on learning behaviors by improving student eating habits at lunch?

What work has been done in this area?
Overall, the quality of food that students eat at lunch is poor, regardless of the source - packed at home or cafeteria (Taylor, 2011). Highly processed food, like pizza and chicken nuggets, are some of the most popular meal choices for children, so this is typically what schools provide (Julian, 2010). Significant improvements to nutritional health require effort not just from schools, but from parents as well (Taylor, 2011). While improving the complete diet of every student is impossible for schools to accomplish, improvements in cafeteria choices have been shown to improve student alertness (Golley, 2010; Storey, 2011). This paper will attempt to synthesize research about any possible links between student lunch and learning behaviors.  It will also include some improvements that schools can make to their cafeterias.

Literature Review

Introduction
School lunches, in general, are of poor quality.  Processed foods high in sodium, sugar, and saturated fat are common. Greasy pizza and mealy chicken nuggets, despite being of low nutritional value, are popular items among children (Taylor, 2012; Julian, 2010). While there are many reasons why this is, (cost, demand, etc) this paper will attempt to explore methods of improving the student’s diet and eating environment, and the effects of those improvements on learning behaviors. A review of relevant literature has shown that there were three basic ways that schools have attempted to improve the eating habits of their students: (1) Educate, empower, and influence students to make better choices when they eat in the cafeteria, (Song, 2016), (2) Improve the quality of food choices available to students (Golley, 2010; Storey, 2011), and (3) some combination of both (Alaimo, 2013; Golley, 2010; Storey, 2011).

Overview of the literature
Many cafeteria and food interventions have been proposed, implemented, and tested (some concurrently) in schools.  Among them were:

-Education interventions:  Attempting to help students make better choices from what was already available (Song, 2016)
-Environment enhancements:  Re-arranging and highlighting various options, using crowd-flow experts to maximize efficiency, improving the aesthetic quality (Song, 2016; Golley, 2010; Storey, 2010)

-Nutritional improvements: The quality of the cafeteria food itself was improved (Golley, 2010; Storey, 2010)

-Improvements in competitive foods: Policy-driven improvements made to “a la carte” options and vending machines (Alaimo, 2013)

Generally, studies attempted to (1) make an involuntary change to food/cafeteria nutrition options and/or environment and then measure the effect on students, or (2) influence the voluntary choices students make from what is available and then measure how much those choices have changed.

Rationale
If student diet affects student behavior, then a cafeteria can be a centralized area that can exert some degree of influence over students’ learning behaviors, and thus increase their learning potential.  

Food and behavior
In order for the brain to function properly, the body needs adequate nutrition (Bellisle, 2004).  Deficiencies in certain nutrients, like thiamin for example, can result in aggressive behavior and other personality changes. Thiamin supplements have been shown to decrease these behaviors in patients with the junk-food diets typical of those with thiamin deficiencies (Bellisle, 2004).

The adage that “breakfast is the most important meal of the day” is mostly supported by modern studies.  While skipping breakfast does impact cognition, there seems to be a greater impact on nutritionally at-risk children than well-nourished children (Bellisle, 2004).  

A number of studies in the 1980’s and 1990’s showed that IQ scores could be increased with simple vitamin supplementation. However, these improvements were only seen if subjects had a poor diet. Children with adequate nutrition levels were not affected by vitamin supplementation (Bellisle, 2004).

School Lunch Quality
In the United States, the National School Lunch Program, or NSLP, is a federal program to provide public schools with balanced meals.  Schools that take part receive subsidies and food commodities from the USDA, but must serve meals that meet federal nutrition requirements. These nutrition requirements are laid out in the federal government’s “Dietary Guidelines for Americans” document that is released every 5 years. According to the NSLP 2013 fact sheet: “While school lunches must meet federal meal requirements, decisions about what specific foods to serve and how they are prepared are made by local school food authorities.”

Not all food sold in schools, however, is part of the NSLP.  “Competitive foods” are the options sold directly to students “a la carte” in school cafeterias and/or vending machines. These almost universally unhealthy options are a way for districts to generate extra cash, as NSLP subsidies are often insufficient to cover food service costs. Approximately 90 percent of middle and high schools offer some kind of competitive food (Alaimo, 2013; Julian, 2010).

Making changes to school lunches and competitive foods
In 2013, the USDA made an interim final rule: “Nutrition Standards for All Foods Sold in School” designed to improve the health quality of all food sold in schools (Alaimo, 2013). However, some states, like California, had already created their own policies that address competitive foods.  Students in California reported consuming less fat, sugar, and calories than students in states without competitive food standards. State level and school level policies regarding competitive foods do have an impact on what students eat while in school (Alaimo, 2013).

Another intervention schools can implement to improve student eating habits is to offer nutrition-based education as part of their curriculum (Alaimo, 2013; Song, 2016). Students can be taught the difference between healthy and unhealthy food and can be encouraged to make good choices when selecting lunch options. Project ReFresh, for example, is a school based nutrition intervention program that combines nutrition education with behavioral economics (cafeteria design “nudges”). The ReFresh curriculum is an 8 week program designed to improve the selection decisions of elementary school children. The cafeteria design changes attempt to influence student choice through better food presentation, strategic placement of healthy foods, and better interactions between food workers and students. A 2016 study on the effectiveness of Project Refresh found that self-reported fruit and vegetable consumption in schools that underwent both curriculum and cafeteria-based interventions was significantly higher than both the control schools and the schools that only implemented the cafeteria interventions (Song, 2016).

Schools can also make slight changes to the actual menu items they offer without upending their entire food service system. A UK based study on the effects of lunch improvement and learning behavior included both cafeteria environment interventions and nutrition interventions.  The nutrition interventions included a checklist of improvements schools can satisfy by tweaking aspects of their cafeterias. Example items include meal deals, (special prices for certain grouped items) taster pots, themed food days, and salad bars (Storey, 2011.)

Diet and environment improvements on behavior
Two UK studies (one with elementary schools, and another with high schools) attempted to determine whether an intervention that made improvements to menus, environments, and curriculum could make a difference in student behaviors. For both studies, trained observers monitored individual students and measured the frequency of “on-task” (student appeared to be concentrating and alert) and “off-task” (student appeared to be disruptive or disengaged) behaviors in the hour after lunch. Intervention group schools were compared with control group schools. Attempts were made to keep demographics as similar as possible between the groups.  At the secondary level, students in schools that underwent intervention were more likely to be on-task after lunch, particularly when working on their own, than students in schools that did not go through the intervention (Storey, 2011). The elementary results had different results, however. As expected, observers of schools in the intervention group reported much higher on-task behaviors when working with a teacher than schools in the control group. However, observers reported much higher levels of off-task behaviors when students were working together (without a teacher) than at the intervention schools. This suggests that student alertness and energy levels were indeed raised in the intervention schools. (Storey, 2011; Golley, 2010)

These particular UK studies did not make any attempt to track which students ate cafeteria food and which brought their own brown bag lunch. It was thought that students who brought their own lunch would also benefit from the cafeteria environment improvements, and should thus be included as part of the data set. This decision seems to be a limitation of the study, and most likely blunted the effects of what appeared to be a causal relationship between an improved food environment and on task behavior. It is possible that a study involving only students who ate different cafeteria food and their after-lunch behaviors would show even more of an effect.

Discussion
An improved diet seems to be a lever we can use to improve student behavior - particularly among students from poor socio-economic backgrounds who may have diminished access to high-quality nutrient-rich food. These are the students that show the most behavioral and cognitive responses to improvements in nutrition and vitamin status (Bellisle, 2004).  Improvements to NSLP food quality, competitive food quality, and cafeteria environments have the potential to improve the health and behaviors of some of our most vulnerable children.  School cafeterias can be a kind of “centralized point of influence” that can positively affect other aspects of the learning environment. The cafeteria has been an underutilized asset that could benefit schools with increased investment.

Methods

Research Question

Will eating a lunch containing fresh fruit, vegetables, whole grains, unprocessed meat, and unflavored (not chocolate or strawberry) milk lead to fewer off-task behaviors in 3rd grade students in the instructional period after lunch? (A student demonstrating “off-task” behavior would appear to be disruptive or disengaged, and is inhibiting learning for themselves or others in some way)

Research Methods
This will be a quasi-experimental study. Primary schools in the College Community School District in Cedar Rapids, Iowa will be divided at random into an intervention group and a control group. After a 4 week baseline measurement period, all 3rd grade students at the schools in the intervention group will receive a modified boxed lunch containing fresh fruit, vegetables, whole grains, unprocessed meat, and unflavored milk. All 3rd grade classes in both groups will be observed in the instructional period after lunch, where all separate instances of “off-task” (disruptive and/or disengaged) behavior will be tallied. This experiment seeks to build on, and address the weaknesses of, the UK study that sought to determine a connection between a better diet and food environment and learning behavior. (Golley, 2010)

Sample

The demographic distribution of students in the College Community Schools (CCS) in Cedar Rapids, Iowa provides a unique and ideal opportunity to study interventions. While most districts have their schools geographically scattered, and those schools draw students from their immediate vicinity, all the schools in the CCS are located on the same campus, (at 6 separate buildings) and draw from the entire district. CCS Administration makes efforts to evenly distribute students of different demographics, and the 4 elementary schools are therefore very similar in their makeup. No efforts need to be made to control for socio-economic, race, or cultural differences.

All 12 sections of 3rd grade students at the 4 elementary schools in the district will be observed. 2 Schools will be randomly selected for the intervention group, and the remaining two will be the control group. In the UK study, (Golley, 2010) random students from the intervention schools were observed for on-task and off-task behaviors, but no effort was made to determine whether those students had indeed eaten different food. It is thought that by subjecting an entire grade level, that any behavioral effects would be more potent, easier to measure, and easier to attribute to the intervention. It is also thought that for an entire grade that is relatively self-contained, eats lunch together, and receives the same instructional curriculum that dietary changes would be easier to control and monitor than by simply tweaking a few menu options and food displays, as in the Golley study,

Study Design

Parental consent to take part in the study will be needed. For the intervention group, families will give consent for their children to receive a healthful box lunch for 4 weeks. Students who normally bring their own lunches will not need to supply them for the intervention period. For the control group, families will need to give consent for their students to be observed. There will be no identifying records, and all data is completely anonymous.

Once these conditions are met, and the intervention and control groups are determined, baseline observations of all 3rd grade students will last for 4 weeks. For the intervention period, the 3rd grade students at the two intervention schools will receive a self-contained box lunch containing only fresh fruit, vegetables, whole grains, unprocessed meat or cheese, and unflavored milk.

Each observer will be assigned to watch the same 3rd grade class in the instructional period after lunch for the entire 8 week period. Care must be taken for these observers to remain blind as to which group their class is a part of.

Data Sources

Observers will not attempt to record on-task and off-task behavior in 3 different instructional modes, (Teacher-student, student-student, and student alone) as in the Golley study. Rather, they will only talley off-task behavior in two instructional modes - teacher-student, and student alone. It is thought that fewer judgment calls on the part of the observer would lead to more consistent data, and that group work (student-student interactions) can look chaotic to observers, and might result in false positives.  Off-task behavior is defined as clear disengagement from the learning process. These behaviors could be inappropriate talking, intentional disruptiveness, or other activities that are clearly hindering the learning process of the individual or the class. Care must be taken not to confuse basic fidgeting or other individual student quirks with off-task behavior. Observers will be trained to only tally behaviors that intentionally disrupt the learning environment for other students.

Procedure

Observers will undergo training from classroom videos. This will attempt to standardize tally measurements. However, because observers will watch the same class for 8 weeks, and will not know if their class is in the intervention group, variations between individual observer sensitivity should not be an issue, provided that sensitivity remains consistent throughout the 8 week period. Care will be taken to make observations as simple as possible. Observers will have only two tally clickers - one to count any instances of off-task behavior during teacher-student instruction, and another to count instances of off-task behavior while students are working alone. Student-student interaction and other group work will not be included in this study. Observers will tally separate instances of off-task behavior when they happen.

Data Analysis

Tallied instances of off-task behavior in the intervention group will be compared with that of the control group. If the number in the intervention group is lower after the 4 week intervention period, then it can be determined that the altered lunch had an effect on behavior. Graphing results of tallied off-task behavior over time could also yield useful insights, such as how long an effect (if there is one) takes to become visible.

Annotated Bibliography:

School lunch and behaviors

School lunch and learning behaviour in primary schools: an intervention study

Golley, R., Baines, E., Bassett, P., Wood, L., Pearce, J., & Nelson, M. (2010). School lunch and learning behavior in primary schools: An intervention study. European Journal of Clinical Nutrition, 64(11), 1280-8. doi:http://dx.doi.org.proxy2.cl.msu.edu/10.1038/ejcn.2010.150

Need – Why is this research needed? Why is it important?
Improving learning behaviors can also improve learning, and improving school lunch quality is a relatively straightforward (though possible costly) step
Purpose – What is the purpose of this research in particular?
To determine a direct causal relationship between cafeteria improvement and learning behaviors
Sample(s) – Who participated in the study and what implications does this have for generalizability?
6 primary schools with similar demographics, and direct observations of 146 pupils.
Method – What is the research design and how appropriate is it given the purpose of the research?
Quasi-Experimental.  Schools were selected for similar demographics, but participating students were selected randomly
Results – What were the key findings?
Significant improvements in alertness level were observed in the schools that underwent cafeteria interventions over the control schools
Conclusions – What conclusions may be inferred from the findings?
Improving cafeteria food quality does indeed raise the alertness level of primary school students
Limitations – What are the methodological and/or conceptual limitations of the research?
1. Observers of individual students probably knew which schools had undergone interventions, and could therefore be biased. (Or at least, the study did not state that they were unaware)

2. Much of the population of students did not actually take the cafeteria lunch - they brought theirs from home.  It was reasoned that they would benefit from the non food related improvements to the cafeteria (aesthetics, lower noise levels, etc.)  including “brown-baggers” would blunt the measurement of cafeteria food on student behavior

3. Only the post-lunch period was observed.  While this is probably the best place to observe a relationship, measuring the entire afternoon would give a more complete picture.
Implications – How do the findings relate to previous work, and what are the implications for theory, future research, and practice?

Finding is in line with other work showing more alertness and vitality in students with better diets, and that schools have a reasonable degree of control

A randomized controlled trial of the effect of school food and dining room modifications on classroom behaviour in secondary school children

Storey, H. C., Pearce, J., Ashfield-watt, P., Wood, L., Baines, E., & Nelson, M. (2011). A randomized controlled trial of the effect of school food and dining room modifications on classroom behaviour in secondary school children. European Journal of Clinical Nutrition, 65(1), 32-8. doi:http://dx.doi.org.proxy2.cl.msu.edu/10.1038/ejcn.2010.227

Need – Why is this research needed? Why is it important?
Improving learning behaviors can also improve learning, and improving school lunch quality is a relatively straightforward (though possible costly) step
Purpose – What is the purpose of this research in particular?
To determine a direct causal relationship between cafeteria improvement and learning behaviors
Sample(s) – Who participated in the study and what implications does this have for generalizability?
12 secondary schools with similar demographics, and direct observations of 156 pupils.
Method – What is the research design and how appropriate is it given the purpose of the research?
Quasi-Experimental.  Schools were selected for similar demographics, but participating students were selected randomly
Results – What were the key findings?
Significant improvements in alertness level were observed in the schools that underwent cafeteria interventions over the control schools
Conclusions – What conclusions may be inferred from the findings?
Improving cafeteria food quality does indeed raise the alertness level of secondary school students
Limitations – What are the methodological and/or conceptual limitations of the research?
1. Observers of individual students probably knew which schools had undergone interventions, and could therefore be biased. (Or at least, the study did not state that they were unaware)

2. Much of the population of students did not actually take the cafeteria lunch - they brought theirs from home.  It was reasoned that they would benefit from the non food related improvements to the cafeteria (aesthetics, lower noise levels, etc.)  including “brown-baggers” would blunt the measurement of cafeteria food on student behavior

3. Only the post-lunch period was observed.  While this is probably the best place to observe a relationship, measuring the entire afternoon would give a more complete picture.
Implications – How do the findings relate to previous work, and what are the implications for theory, future research, and practice?

Finding is in line with other work showing more alertness and vitality in students with better diets, and that schools have a reasonable degree of control

Diet and learning/cognition

Effects of diet on behaviour and cognition in children

Bellisle, F. (2004). Effects of diet on behaviour and cognition in children. The British Journal of Nutrition, 92, S227-32. doi:http://dx.doi.org.proxy2.cl.msu.edu/10.1079/BJN20041171

Need – Why is this research needed? Why is it important?
We can help improve students’ behavior and cognition with better diet.
Purpose – What is the purpose of this research in particular?
To determine a causal relationship between nutritional status and the cognitive abilities of children.
Sample(s) – Who participated in the study and what implications does this have for generalizability?
None - this is a review of other studies and attempt to draw broader conclusions from them.
Method – What is the research design and how appropriate is it given the purpose of the research?
Descriptive.  
Results – What were the key findings?
The presence or absence of certain nutrients, as well as eating patterns, have an effect on behavior and cognition in children
Conclusions – What conclusions may be inferred from the findings?
We can exert some control on students’ behavior and learning ability by influencing their diet.
Limitations – What are the methodological and/or conceptual limitations of the research?
No “new” findings - only synthesizes the work of other studies into a narrative.
Implications – How do the findings relate to previous work, and what are the implications for theory, future research, and practice?

Because we can exert some control on students’ behavior and learning ability by influencing their diet, we should try to study how much we can control, and the best and cheapest way to do it.

Student Lunch Quality

Project ReFresh: Testing the Efficacy of a School-Based Classroom and Cafeteria Intervention in Elementary School Children

Song H-J, Grutzmacher S, Munger A. L. (2016). Project ReFresh: testing the efficacy of a school-based classroom and cafeteria intervention in elementary school children. Journal of School Health.86: 543-551.  Retrieved from: http://onlinelibrary.wiley.com.proxy2.cl.msu.edu/doi/10.1111/josh.12404/epdf

Need – Why is this research needed? Why is it important?
We want to help students establish good eating habits
Purpose – What is the purpose of this research in particular?
To determine the effect of a nutrition program on student food choices
Sample(s) – Who participated in the study and what implications does this have for generalizability?
665 fourth and fifth grade students in 34 elementary schools
Method – What is the research design and how appropriate is it given the purpose of the research?
Quasi-Experimental.  Schools were intentionally grouped according to demographic populations.
Results – What were the key findings?
Groups that underwent interventions showed significant improvement in some indicators of healthy food choice
Conclusions – What conclusions may be inferred from the findings?
Students can be educated to make better food choices.
Limitations – What are the methodological and/or conceptual limitations of the research?
Data was self-reported, and only mentioned food choices.  Health-related results were not part of this study
Implications – How do the findings relate to previous work, and what are the implications for theory, future research, and practice?

Collaborative efforts between cafeterias and other school environments are needed to give students consistent messages about dietary choices and habits.

 

Effects of Changes in Lunch-Time Competitive Foods, Nutrition Practices, and Nutrition Policies on Low-Income Middle-School Children’s Diets

Alaimo, K., Oleksyk, S., Drzal N., Golzynski, D., Lucarelli, J., Wen, Y., & Velie. (2013). Effects of Changes in Lunch-Time Competitive Foods, Nutrition Practices, and Nutrition Policies on Low-Income Middle-School Children’s Diets. Childhood Obesity, 9(6): 509-523. doi:10.1089/chi.2013.0052. Retrieved from:  http://online.liebertpub.com.proxy2.cl.msu.edu/doi/pdf/10.1089/chi.2013.0052

Need – Why is this research needed? Why is it important?
It is important to know what kids are eating at school, and how we can influence that
Purpose – What is the purpose of this research in particular?
This study wanted to get an assessment of whether state and federal nutrition policies in schools that affect competitive foods (vending machines, etc) have an impact on the kind of food that students consume in school
Sample(s) – Who participated in the study and what implications does this have for generalizability?
1176 lower income middle school students in 55 schools
Method – What is the research design and how appropriate is it given the purpose of the research?
Quasi-Experimental.  Schools were grouped and recruited according to certain eligibility requirements
Results – What were the key findings?
Some interventions had an impact on the amount of various nutrients (like vitamin C) or unhealthy components (like cholesterol).  The number of interventions a school had made a difference.
Conclusions – What conclusions may be inferred from the findings?
Schools need multiple interventions, or practice changes, to affect diet in lower-income middle school students.  In this case, 3-6 practice changes had significant effects, while less than 3 did not.
Policies that only call for an increase in healthy competitive options, without eliminating unhealthy options, would have little effect on student eating habits
Limitations – What are the methodological and/or conceptual limitations of the research?
Data was self-reported, and only mentioned food choices.  Health-related results were not part of this study
Implications – How do the findings relate to previous work, and what are the implications for theory, future research, and practice?

If the only options for competitive food are healthy ones, students will be more likely to select them.  Collaborative efforts between policies for healthy competitive foods and nutrition education are more successful in getting kids to eat healthier.

Nutritional quality of children’s school lunches: differences according to food source

Taylor, J. P., Hernandez, K. J., Caiger, J. M., Giberson, D., MacLellan, D., Sweeney-Nixon, M., & Veugelers, P. (2012). Nutritional quality of children's school lunches: Differences according to food source. Public Health Nutrition, 15(12), 1-6. doi:10.1017/S1368980012000699 retreived from: https://www-cambridge-org-proxy1-cl-msu-edu.proxy2.cl.msu.edu/core/services/aop-cambridge-core/content/view/F64FA11BB64541378116F441E9C6E92C/S1368980012000699a.pdf/nutritional-quality-of-children-s-school-lunches-differences-according-to-food-source.pdf

Need – Why is this research needed? Why is it important?
We want to know the quality of what students are eating
Purpose – What is the purpose of this research in particular?
This study wanted to assess the quality of students’ food according to its source - school or home
Sample(s) – Who participated in the study and what implications does this have for generalizability?
1,980 5th and 6th grade students on Prince Edward Island in Canada
Method – What is the research design and how appropriate is it given the purpose of the research?
Survey/Ethnography - data was collected from students, but from live trained interviewers.  Food intake reported by the student was then assessed by how much Ca, Mg, Na, etc. (Nutrients) it was estimated to contain

Results – What were the key findings?
Most food - regardless of source fell below recommended daily intake amounts for nutrients.  Home lunches had higher densities in some nutrients, and school lunches had higher densities in other nutrients.

Overall, the quality of school lunch was higher than that of home lunch.
Conclusions – What conclusions may be inferred from the findings?
Overall, the quality of lunch, regardless of source, is poor.  
Limitations – What are the methodological and/or conceptual limitations of the research?
PEI, in some ways, is not necessarily representative of other western countries with regard to diet.
Implications – How do the findings relate to previous work, and what are the implications for theory, future research, and practice?

Canada is the only G7 country to not  have a school meal nutrition program.   Without a national program for school lunch, there would be little incentive for schools to improve their school meal choices.  

Other sources:

Julian, L. (2010). Why school lunch is "nasty!" Policy Review, (163), 43+. Retrieved from http://ezproxy.msu.edu.proxy2.cl.msu.edu.proxy1.cl.msu.edu.proxy2.cl.msu.edu.proxy1.cl.msu.edu/login?

Krukowski, R. A., Philyaw Perez, A. G., Bursac, Z., Goodell, M., Raczynski, J. M., Smith West, D. and Phillips, M. M. (2011), Development and Evaluation of the School Cafeteria Nutrition Assessment Measures. Journal of School Health, 81: 431–436. retrieved from: http://onlinelibrary.wiley.com.proxy2.cl.msu.edu.proxy1.cl.msu.edu/doi/10.1111/j.1746-1561.2011.00612.x/full

National School Lunch Program Fact Sheet - 2013.  Retrieved from:  http://www.fns.usda.gov/sites/default/files/NSLPFactSheet.pdf

Dietary Guidelines for Americans 2015-2020. Retrieved from: https://health.gov/dietaryguidelines/2015/guidelines/