A statewide project to nudge healthy choices: Processes, outcomes and reflections

Introduction: Smarter Lunchrooms-Ohio is a statewide dissemination project to create and evaluate subtle environmental changes in 50 cafeterias.  The Smarter Lunchrooms Movement applies behavioral economic theory to nudge students to a more desirable food choice. 

Methods: Food service directors across Ohio were paired with local university faculty and graduate students, public health educators and or extension agents.  Phase one goals were to recruit, implement and evaluate smarter strategies and build capacity for future dissemination. 

Results: All schools participated in a cafeteria assessment and sales and production trend analysis; half of enrolled schools implemented planned strategies.  The common intervention strategies were as follows: renaming of vegetables and use of fruit sectioners (elementary schools); fruit in multiple locations, repositioning of salad bars and grab-and-go coolers (middle and high schools).  Production and tray waste data were used to report changes in food selection and consumption.  Post intervention data will be completed in May 2014.  Pre-intervention data indicates that half of fruits and vegetable were wasted, with higher waste for red/orange (65%) and dark green (70%) vegetables.  Capacity building was achieved with the establishment of training, communication, data collection and data reporting processes.  Staff changes, building readiness and equipment delays created challenges to implementation.  Characteristics of successful partnerships, as reported by food service directors that successfully completed the project, will also be shared.

Discussion: Diffusion of evidence-based programs into school settings is important to population health improvements.  The sharing of systems and process measures can facilitate further disseminate in state child nutrition programs.