The CAFETERIA POWER PLUS Program will assess the effects of a school cafeteria-focused intervention for promoting increased consumption of vegetables and fruit (V and F) among elementary school children to reduce their risk of cancer. This will be accomplished through a school-based environmental intervention which includes four components: a) school food service environmental changes, b) links to classroom, c) family involvement, and d) food industry support. Special attention is given to increased consumption of vegetables, especially among boys. The hypothesis is that a multi-component school-based program, that uses environmental changes in the school cafeteria and food services program as the key element for intervention, will significantly increase vegetable and fruit consumption both at lunch and throughout the day. This will be assessed through a trial in which 26 elementary schools from within one suburban/rural school district in Minnesota are randomly assigned to intervention and control conditions. The primary endpoints will be the number of servings of total vegetables and fruit consumed at lunch per day, and the total number of servings of vegetables and fruits consumed throughout the day, measured in two cohorts of students initially in the first and third grades and followed through the third and fifth grades. Specifically the study will evaluate the hypothesis that children in the intervention schools, in comparison to those in the controls, will demonstrate at follow-up an average number of vegetables and fruits consumed, when controlled for baseline values, that is at least .6 servings greater at lunch and .85 greater over the entire day than in control schools, with half of the change coming from vegetables. Secondary outcome measures will be the total number of servings of vegetables and fruits made available to the students, either as an ingredient or as an individual item. Outcome data will include sales data for all hot meal and snack items, recipe analysis of school lunch menus and all menu items, and changes in V and F content of vendor products and snack items. The major goal of the study is to achieve a total effect, similar to previous multi-component school based programs, but with a program that is more easily incorporated into the school. As such, cost data will be carefully recorded, cost analysis will be conducted.
