UVM Theses and Dissertations
Format:
Print
Author:
Yon, Bethany Ann
Dept./Program:
Animal, Nutrition and Food Sciences Program
Year:
2012
Degree:
Ph. D.
Abstract:
Background: The United States Department of Agriculture (USDA) published new regulations in January 2012 for school meals setting lower and upper limits on calories served and limiting milk offerings to fat-free or low fat (1 %), and if flavored, only fatfree. Milk processors are lowering calories by lowering fat and/or addedsugars in flavored milks. The primary aim of this study was to evaluate school children's acceptance of the lower-calorie flavored milks. The support of school nutrition directors (SNDs) is integral to successful implementation of policy changes within the school food environment. Therefore, a secondary aim was to describe the perceptions, beliefs and attitudes of SNDs about the offering and student acceptance of lower-calorie flavored milk.
Design: Mixed methods using quasi-experimental and qualitative methods.
Methods: Elementary and middle schools (n=117) from 17 school districts across the country that changed to lower-calorie flavored milk (less than or equal to 150 calories) between 2008 and 2009 were enrolled. Milk shipment, usage, National School Lunch Program (NSLP) participation rates, and free/reduced meal eligibility were collected for three time periods over 12 months (4-6 months prior to reformulation, at the time of reformulation, 4-6 months later). Four schools in the northeast and south were selected for a plate waste study. Five control schools serving standard flavored milk (>150 calories/8 oz) were enrolled. Flavored milk cartons were collected from 793 third to fifth grade students after lunch, and individually weighed to determine consumption. Four additional SNDs who changed to fat-free, low added sugars flavored milk were enrolled and participated in the qualitative study. All SNDs (n=21) completed a survey, nine attended a focus group and four were interviewed in-person. Survey responses and verified transcripts were coded for themes based on the principles of grounded theory.
Results: Using linear mixed models, adjusted for increases in free/reduced meal eligibility, no changes were seen in shipment of flavored milk or all milk (including unflavored). While NSLP participation rates dropped when· lower-calorie milk was first offered, it was explained by free/reduced meal eligibility ([eta]²=78.5%) and not flavored milk reformulation ([eta]²=0.7%). NSLP participation rates recovered over time (p=0.15). Overall, students consumed an average of 5.52 oz ±SE 0: 10 of flavored milk. Students consumed an average of 5.88 oz ±SE 0.12 of standard flavored milk compared to an average of 4.92 oz ±SE 0.17of lower-calorie flavored milk. Using linear mixed models, although children drinking standard milk were more likely to consume>7 oz, the difference was not significant (p=0.09). When adjusted for SES, region and sex group differences, there were no differences in consumption (p=0.29). The main qualitative themes included 1) SNDs' responses to change, 2) their views of flavored milk, 3) perceptions of the school cafeteria as a learning environment, and 4) themselves as advocates for good nutrition supporting policies that promote healthy school meals.
Conclusions and Implications: While children consumed less lower-calorie milk, it was explained by demographic differences, as were the changes in NSLP participation, thus over time school children appear to accept lower-calorie flavored milk. Most of the reformulated flavored milks were not fat-free as required by USDA, so additional monitoring is warranted. This study also provides further evidence in support of the importance of engaging SNDs in policy making, evaluation, and nutrition education.
Design: Mixed methods using quasi-experimental and qualitative methods.
Methods: Elementary and middle schools (n=117) from 17 school districts across the country that changed to lower-calorie flavored milk (less than or equal to 150 calories) between 2008 and 2009 were enrolled. Milk shipment, usage, National School Lunch Program (NSLP) participation rates, and free/reduced meal eligibility were collected for three time periods over 12 months (4-6 months prior to reformulation, at the time of reformulation, 4-6 months later). Four schools in the northeast and south were selected for a plate waste study. Five control schools serving standard flavored milk (>150 calories/8 oz) were enrolled. Flavored milk cartons were collected from 793 third to fifth grade students after lunch, and individually weighed to determine consumption. Four additional SNDs who changed to fat-free, low added sugars flavored milk were enrolled and participated in the qualitative study. All SNDs (n=21) completed a survey, nine attended a focus group and four were interviewed in-person. Survey responses and verified transcripts were coded for themes based on the principles of grounded theory.
Results: Using linear mixed models, adjusted for increases in free/reduced meal eligibility, no changes were seen in shipment of flavored milk or all milk (including unflavored). While NSLP participation rates dropped when· lower-calorie milk was first offered, it was explained by free/reduced meal eligibility ([eta]²=78.5%) and not flavored milk reformulation ([eta]²=0.7%). NSLP participation rates recovered over time (p=0.15). Overall, students consumed an average of 5.52 oz ±SE 0: 10 of flavored milk. Students consumed an average of 5.88 oz ±SE 0.12 of standard flavored milk compared to an average of 4.92 oz ±SE 0.17of lower-calorie flavored milk. Using linear mixed models, although children drinking standard milk were more likely to consume>7 oz, the difference was not significant (p=0.09). When adjusted for SES, region and sex group differences, there were no differences in consumption (p=0.29). The main qualitative themes included 1) SNDs' responses to change, 2) their views of flavored milk, 3) perceptions of the school cafeteria as a learning environment, and 4) themselves as advocates for good nutrition supporting policies that promote healthy school meals.
Conclusions and Implications: While children consumed less lower-calorie milk, it was explained by demographic differences, as were the changes in NSLP participation, thus over time school children appear to accept lower-calorie flavored milk. Most of the reformulated flavored milks were not fat-free as required by USDA, so additional monitoring is warranted. This study also provides further evidence in support of the importance of engaging SNDs in policy making, evaluation, and nutrition education.