Better Bites: Implementation and Outcomes of a Campus-wide Healthy Food Program

1. Better Bites: Implementation and Outcomes of a Campus-wide Healthy Food Program Jannette Berkley-Patton, PhD Ann D. Chapman, MS, RD Robert R. Basow, BS, MBA Melissa G. Smith, MS, CHES

2. Contextual Background • ADA guidelines for balanced eating: • 2 cups of fruit and 2 ½ cups of vegetables per day • 6-ounce equivalents of whole grains per day • 3 cups of fat-free, low-fat milk, and/or cheese equivalent per day. • 2005 National College Health Assessment* • Among students, 43% of men overweight to obese and 31% of women • Only 28.5% of students consume 3-4 servings of fruits and vegetables per day and less than 6% consume 5 or more servings • College students begin to experience weight gain in freshman year. • Many university residence halls have “all-you-can-eat” dining halls. • Supermarket studies have demonstrated the effectiveness of social and point marketing (posters, food labels) on food selection behaviors. *American College Health Association. American College Health Association - National College Health Assessment (ACHA-NCHA) Web Summary. Updated April 2006. Available at http://www.acha.org/projects_programs/ncha_sampledata.cfm. 2006.

3. KU Contextual Background • 29,000 students on Lawrence campus • 2006 KU National College Health Assessment (N=1,266 students): • Only 30% consume 3 or more servings of fruits and vegetables • Only 50% exercise 3 or more days per week vigorously for at least 20 min. • 31% are overweight to obese • Newer campus Union dining facility (Underground) • Changes/renovations in residence hall cafeterias • Changes in KU Dining Services personnel/organizational structure

4. Overview of Better Bites Program • H.O.M.E.B.A.S.E. (Healthy Options for Movement and Exercise, Body Acceptance, and Savvy Eating) • Goals: • Offer students, faculty, and staff healthier alternatives in campus dining venues and vending machines • Advocate for healthier food options on campus • Involve faculty, staff, and students in the implementation and maintenance process • The multidisciplinary H.O.M.E.B.A.S.E. partnership includes: • Student Health Services -KU Dining Services • Strategic Campaigns Class • Student Recreation Center • Community Health and Education Department • Human Resources • Interested students, staff, and faculty • Vending machine supplier

5. Better Bites Implementation • In 2002, in response to KU Dining Services desire to offer healthier foodoptions, H.O.M.E.B.A.S.E. launched “Fresh and Hearty” in campus dining facilities. • Items were identified from the list of vending items and hot-food items in dining halls that met the AHA guidelines for fat, calories, and sugar, and for hot-food items, used flavorful herbs and spices (baked chicken, stir fry). • The SHS dietitian reviewed residence dining hall menus and met with staff to discuss the new program • Dining hall staff provided input on how to attach logo to the food service lines • In 2002, the vending machine supplier attended H.O.M.E.B.A.S.E. meetings, and agreed to affix Better Bites logos to suitable vending items • In 2003, “Better Bites” was launched in vending machines • Strategic campaigns class began providing evaluation and recommendations for Better Bites • Funding for the programs was generated for SHS, participating residence halls, and KU Food Services • By 2004, the “Fresh & Hearty” program was renamed to Better Bites, which is has been the campus-wide name of the program since that time • Better Bites was selected as a premiere campus initiative by the American Association of Colleges and Universities Sumer Symposium in Washington D.C. • In 2004, the Better Bites program expanded to include “Grab & Go” items in Campus Dining facilities and KU Dining Services broadly incorporated Better Bites into its convenience stores, new eating facilities, marketing plan, and menus

6. Implementation of Better Bites • All campus Union dining facilities (3) • All campus residence hall dining centers (4) • All campus Hawk Shop convenience stores (6) • All campus vending machines

7. Better Bites Marketing • Brochures to prospective students during Summer Orientation • Brochures and cups in new students rooms prior to check-in at the start of Fall semester • Posters in dining halls • Postings on Food Service website and alongside menu items • Better Bites “Man” at entry to dining facilities with brochures • Better Bites logo on food service lines identifying qualifying foods • Signs in vending machines • Table tents • Better Bites punch cards to receive free food • Media coverage • Campus sidewalk chalking

8. Better Bites Marketing Sidewalk Chalking

9. Case Study 1: Focus Groups & Semi-structured Interviews • Study conducted by senior-level Strategic Campaigns class • Goal of focus groups and interviews: • To assess student, faculty, and staff opinions on healthy foods and the Fresh & Hearty and Better Bites programs • In Fall 2003, two focus held with freshmen living in residence halls groups

10. Case Study 1:Student Focus Group Findings • Most students recognized the “Fresh & Hearty” logo • Students did not understand the meaning of “Fresh & Hearty” • Use one name -- “Better Bites” -- for all healthy food programs • Students eat what sounds good instead of what is healthy • Few had seen the “Better Bites” logos in vending machines and were unaware of meaning • Females were more likely than males to want to learn more about making healthy choices

11. Case Study 1:Faculty and Staff Interview Findings • Suggested use of one name for the entire program • “Hearty” may convey heavy meals • “Healthy” was not a good selling tool • Increase marketing strategies (e.g., table tents, displays near registers when students enter dining halls, bus signs) • Changes coming in Union Food Services may provide opportunities for expanding a healthy eating food program • Implementation issues in Unions and cafeterias • Need for lower prices on healthy food items • Cooks and servers need to be educated on healthy foods • Plan healthier menus with food service staff • Educate students on healthy food selection

12. After Case Study 1:Changes in Implementation • The overall program was renamed to “Better Bites.” • Signs were added to the glass of vending machines to describe the Better Bites program and the logo identifying Better Bites items. • Marketing of the overall program was expanded and KU Dining Services included “Grab & Go” items, such as applesauce and fruit, whole wheat bagel with peanut butter, and salad with grilled chicken and low fat dressing. • Ongoing meetings were scheduled with residence halls and dining services to provide feedback and make improvements on implementation.

13. Case Study 2:Observational Study of Vending Machines Issues and Concerns: • Better Bites logos placed on wrong food items in vending machines • Stickers attached to food items as they dropped • Better Bites items not regularly restocked • Small selection of Better Bites items • Price of Better Bites items (expensive) • Positioning of Better Bites items

14. Case Study 2:Observational Study of Vending Machines • Assessment took place in Spring 2005 • Approximately 40 vending machines on campus • Vending machines assessed for: • Visibility of Better Bites logo, number of items labeled as Better Bites, specific items marked as Better Bites, empty Better Bites slots • 5 student and staff members conducted assessment on 29 vending machines over 4-week period. • Vending machines and vending items maintained by contracted vendor.

15. Case Study 2 : Vending Machine Findings • Week One: • 82 Better Bites stickers in 25 machines • Approximately 3 Better Bites stickers per machine • No Better Bites stickers in 4 machines • Week Four: • 52 Better Bites stickers remaining • 37% of stickers had disappeared • 84% of stickers were visible, but many partially covered by food items • 13 products were incorrectly labeled as Better Bites (e.g., Fritos, Butterfinger, Buffalo wing chips, Chili Cheese chips) • 4 Better Bites items unmarked (e.g., Skittles, Trail mix) • Some machines still contained the Nabisco Sensible Choice sticker and did not contain the Better Bites sign

16. Vending Machine Implementation Changes Recommendations: • Remove all Nabisco Sensible Choice signs • Attach Better Bites sign to machine glass • Arrange placement of Better Bites items in machine so sticker would not be needed (as a row); uniform placement • Restock Better Bites items more frequently to better assess frequency of item selection • Rotate Better Bites items in machines more frequently Final actions: • Better Bites in vending machines pulled until more consistent implementation.

17. Case Study 3:Survey of Student’s Campus Eating Behaviors and Knowledge of Better Bites • Study conducted by KU’s Strategic Campaigns class • November 2005 • 5-minute oral survey • 555 usable surveys • Respondents: • Students living off campus • Students living in residence halls or other campus housing • Students commuting from outside the Douglas County area

18. Case Study 3: Survey Findings • Lunch is the most popular meal of the day • 76% felt it was important to have healthy food choices; yet they don’t always prefer these options • 81% said healthy eating was somewhat to very important to them • 73% wanted affordable health food items • 50% said they would pay more for healthier food • Overall, students expressed an interest in healthier food choices (fruits & vegetables, natural food, low in fat & calories) • More than half of all students surveyed recognized the Better Bites logo • Significantly more underclassmen recognized Better Bites than upperclassmen (possibly from residence hall dining facilities) • Students eating in campus dining facilities less frequently were more likely to recognize the Better Bites logo than others who ate on campus more frequently

19. Challenges to Implementation • Cost of healthier food items • In vending machines, inconsistent stocking of Better Bites items and labeling • Positioning of Better Bites items • Cost of marketing and promotional items • Competing priorities for Dining Services and vending company • Transitioning Better Bites into normal infrastructure and processes of menu planning, food preparation, logo placement in food lines, regular promotional activities, and expansion of items that could be identified as Better Bites

20. Discussion • Better Bites is a healthy food program that continues to evolve and grow at KU. • Better Bites is meeting a critical need in helping students, faculty and staff make healthier food selections. • Social and food labeling marketing strategies are important for providing information on and stimulus for healthy food selection. • Critical to the success of a campus healthy food program: • Ongoing collaboration with a shared mission • Sharing of resources • Continued evaluation and input from campus members • Constant improvement • H.O.M.E.B.A.S.E. and the Strategic Campaigns class continues to work with Dining Services to make improvements for promoting healthy eating and providing healthy options to do so.

21. Acknowledgements The authors would like to thank the students in Bob Basow’s Strategic Campaigns classes for providing incredibly valuable and highly professional campaign research and development for the Better Bites program! We’d also like to thank KU Dining Services staff members for their work and commitment to growing Better Bites bigger and better every year.