A Process Improvement Project By Jeff Gibberman

1. A Process Improvement ProjectBy Jeff Gibberman The Sage Colleges, Dietetic Intern 2013/2014 FSM Preceptor: Margaret Sullivan, School Lunch Program Director

2. ASSESSMENT OF THE IMPACT OF AN EDUCATIONAL MARKETING MEDIA INTERVENTION ON SCHOOL LUNCH PARTICIPATION RATES AT AN UPSTATE NY SCHOOL DISTRICT

3. Schools with low participation rates are unable to break even in foodservice operation costs. • Cant fire employees = stagnate labor. • Threat of foodservice companies taking over self-operated foodservice operations. • LOOSING MONEY!!!!!!! Why is school lunch participation important?

4. Decreased school lunch participation rates also seen at many school districts across the United States. • In 2008, the National Food Service Management Institute found the average nationwide school lunch participation rate to be only 29.5% of school aged children.1 Decreased school lunch participation nationwide

5. Importance of identifying students that do not currently participate in the school lunch program and understanding the factors that drive these students’ choices to not participate in the school lunch program.1 • Uncovering students’ motivations is crucial for developing strategies to encourage students to participate in school lunch.1 • Multiple factors which effect school lunch participation rates including: • The economy • Student perception • Desirability of the food provided How can we fix this?

6. Schools required to comply for government funding. • The Healthy, Hunger-Free Kids Act, which with its accompanying amendments, aim to increase the healthfulness of school meals.2 • First major changes in school meals in fifteen years in an effort to help raise a healthier generation of children in the United States.2 • Mechanism – changing offerings to influence intake. • This mechanism has proven successful in two recent cluster randomized controlled trials that observed the effects of modifying the school cafeteria environments.3 New regulations

7. Offering students more fruits and vegetables does not necessarily mean that students are actually taking or eating these offerings. • A plate waste study was conducted in northern Colorado on elementary and middle-school students in order to assess food choices and consumption patterns of students who participate in the NSLP.4 • Results: • Only 45% of elementary and 34% middle-school students selected a vegetable.4 • Elementary school students left more than one third of grain, fruit and vegetable menu items uneaten. • Middle-school students left 50% of fresh fruit, 37% of canned fruit, and 1/3 of vegetables uneaten.4 • One can thus conclude that student motivation for selecting and eating extra fruits and vegetables must be investigated. Results of a Plate waste study

8. 3rdgraders either received education about fruit consumption or were exposed to teachers’ modeling fruit consumption; the control group receiving no intervention.5 • During the intervention period of one academic year, information about fruit and dietary intake of the school children was attained with help of their parents before the intervention; after, and one year after the study.5 • It was found that both the education and teacher modeling groups had increased fruit intake compared to the control group. The teacher modeling group had sustained significantly increased fruit intake whereas no other group did.5 • According to this study role modeling is one way that students’ motivation for selecting and eating extra fruits and vegetables is affected. • This study sparks interest to whether role modeling behavior also affects older student’s motivation. Modeling of fruit consumption study

9. A survey study of 1,823 high school students from nine schools was conducted to observe the student satisfaction and participation in school foodservice.6 • Results: • Variety of food offered was the best predictor of student satisfaction. • Factors that correlated with overall satisfaction include variables such as attractiveness of food on the serving line, quality of food choices, and courteousness of the foodservice staff.6 • The authors of this study argue that high school students’ participation in school food programs is dependent on multiple factors including: • Variety • Satisfaction with food quality • Effective marketing strategies • Students are influenced by multiple dining experiences at early ages which influence the evaluation and thus participation in school foodservice programs.6 • It is crucial to incorporate ongoing strategic planning and quality improvement to increase student participation rates, which will in turn, lead to positive outcomes of the school foodservice business model.6 A study that examined factors effecting students perception and choices

10. A 5-item school foodservice survey was administered to 190 (12%) middle school and 119 (5.6%) high school students to assess perceived quality and healthfulness of school lunch and knowledge of required meal components. • Teachers distributed the surveys in the classrooms for a period of 3 days. Survey results were quantified by a simple tally. Materials and methods:Survey

11. Survey results • Of middle and high school students that identified themselves as eating in the school cafeteria ≥ 50% of the time (n=182), 66 (36%) students did not think the cafeteria food is healthy.

12. High School: https://www.youtube.com/watch?v=Wi7i30EKbwk • Middle School: https://www.youtube.com/watch?v=vUruDWKfjBs Intervention - Educational marketing Video's

13. Intervention - Video board • Intervention period of 18 days, PowerPoint video board displayed in all breakfast and lunches at the high school.

14. Results after intervention

15. Many factors affect school lunch participation rates from day-to-day including but not limited to: • Decreased student attendance related to field trips • Type and variety of entrees offered • Day of the week • Student exposure to educational/marketing videos was brief. • It is possible that more frequent and sustained educational and marketing content is necessary to improve school lunch participation rates. Limitations of intervention

16. Results of this school lunch survey and process improvement project is consistent with literature pertaining to poor school foodservice reputations and a need for increased education/marketing to improve school foodservice perception. • One challenge for SLP directors is finding the time for additional activities such as education and marketing to students. • SLP directors should utilize interns for working on projects on which they do not have time to work. • Win-win situation: This facilitates invaluable experience for interns and free labor for director’s foodservice operations. Impact of Findings

17. Free intern work, no cost to produce videos. • The cost of a complete meal to students in middle school is $2.60 and $2.75 in the high school. • About half of the revenue from each meal covers the cost of the food and the other half of the revenue covers labor. • At the high school level, every additional 100 students that participate in the school lunch program daily would increase net revenue by $137.50 and qualify the school for an additional $6 of government reimbursement ($0.06 reimbursable each meal), totaling $143.50 extra revenue daily. • Maximizing labor hours Cost benefit model

18. Educational and marketing media aimed at students may improve perceived quality and healthfulness of school lunch and knowledge of required meal components in middle and high school students. • Future studies implementing more frequent and prolonged educational and marketing media interventions are recommended to fully assess their impact on lunch participation. Conclusions

19. THE END, THANK YOU COME Again!

20. Investigation of factors impacting participation of high school students in the national school lunch program. National Food Service Management Institute. Available at: http://www.nfsmi.org/documentlibraryfiles/PDF/20100315042240.pdf • United States Department of Agriculture Food and Nutrition Services. Healthy Hunger-Free Kids Act of 2010. Available at: http://www.fns.usda.gov/cnd/governance/legislation/CNR_2010.htm. Accessed February 18, 2014. • Williamson DA, Han H, Johnson WD, Martin CK, Newton RL. Modification of the school cafeteria environment can impact childhood nutrition. Results from the Wise Mind and LA Health studies. Appetite. 2013;61:77-84. • Smith SL, Cunningham-Sabo L. Food choice, plate waste and nutrient intake of elementary-and middle-school students participating in the US National School Lunch Program. Public Health Nutr. 2013:1-9. • Perikkou A, Gavrieli A, Kougioufa MM, Tzirkali M, Yannakoulia M. A Novel Approach for Increasing Fruit Consumption in Children. J AcadNutr Diet. 2013;113(9):1188-1193. • Meyer MK, Conklin MT. (1998). Variables affecting high school students’ perceptions of school foodservice. J Am Diet Assoc. 1998;12:1424-1431. • Bergman EA, Cashman L, Englund T, et al. (2013). Healthier US schools challenge lunches are more nutritious than lunches brought from home. J AcadNutr Diet. 2013;113(9):A61-A61. • Foodservice Director. 2013 K-12 Census: School districts struggle with elements of the new meal regs. Available at: http://www.foodservicedirector.com/research/industry-census/articles/2013-k-12-census-school-districts-struggle-elements-new-meal-regs. Accessed March 31, 2014. References