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标题：An Environmental Intervention to Promote Lower-Fat Food Choices in Secondary Schools: Outcomes of the TACOS Study
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作者：Simone A. French ; Mary Story ; Jayne A. Fulkerson 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2004
卷号：94
期号：9
页码：1507-1512
语种：English
出版社：American Public Health Association
摘要：Objectives. We evaluated an environmental intervention intended to increase sales of lower-fat foods in secondary school cafeterias. Methods. Twenty secondary schools were randomly assigned to either an environmental intervention or a control group for a 2-year period. The intervention increased the availability of lower-fat foods and implemented student-based promotions. Results. A steeper rate of increase in sales of lower-fat foods in year 1 (10% intervention vs −2.8% control, P = .002) and a higher percentage of sales of lower-fat foods in year 2 (33.6% intervention vs 22.1% control, P = .04) were observed. There were no significant changes in student self-reported food choices. Conclusions. School-based environmental interventions to increase availability and promotion of lower-fat foods can increase purchase of these foods among adolescents. Trends in adolescent eating patterns have become a focus of concern in light of secular increases in the prevalence of adolescent obesity 1, 2 and increasing recognition of the contribution of diet to long-term health. 3, 4 The prevalence of overweight has increased dramatically during recent years and currently affects 24% of US children and adolescents. 1, 2 Two-thirds of US youths exceed dietary fat recommendations, 5 and only 20% meet guidelines for vegetable intake and 14% for fruit intake. 6 High-fat diets contribute to the development of obesity, diabetes, cardiovascular disease, and some cancers. 3, 7, 8 Interventions targeting youth are important because of the potential for establishing healthful dietary patterns that may persist into adulthood and reduce chronic disease risk. 9, 10 The school food environment can have a significant effect on adolescents’ food choices because a large proportion of their total daily energy is consumed at school. 11– 13 Foods sold outside the National School Lunch Program (e.g., “competitive foods,” “à la carte” foods) make up an increasing share of students’ food purchases at school, especially at the secondary level. 11– 13 Available data indicate that these foods are higher in fat compared with foods sold as part of the federally reimbursable school lunch program. 14– 17 However, competitive foods have not been the focus of school-based nutrition intervention research to date. Adolescence is a time when youths attempt to establish independence from adult authority and when peer influence becomes more prominent. 18 Peers represent an important environmental influence on secondary school students’ food choices. 18 Interventions with adolescent populations can make use of peers as a normative influence to promote healthful eating behaviors at school. 18 Peer influence has been used in prevention interventions targeting youth tobacco and alcohol use, 19– 21 but little work has been done in the area of peer-based nutrition interventions among adolescents. Our study was a randomized trial that evaluated the ability of an environmental intervention to increase the sales of lower-fat foods in secondary school cafeteria à la carte areas. It was hypothesized that an increase in the availability and promotion of lower-fat à la carte foods would result in increased sales of these foods in intervention schools relative to sales of these foods in control schools.