1. Policy to Practice in Youth Programs | Nutrition Center Symposium | March 2014 Eeny, Meeny, Miny, Whoa! Children select unhealthy choices when given a choice among snack offerings Michael W. Beets, M.Ed., M.P.H., Ph.D., Falon Tilley, M.S., Rebecca Kyryliuk, M.P.H., Robert G. Weaver, Ph.D., Justin Moore, Ph.D., Gabrielle Turner-McGrievy, Ph.D., M.S., R.D. Funding: Research reported in this presentation was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number R01HL112787. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

2. Policy to Practice in Youth Programs | Nutrition Center Symposium | March 2014 Out-of-School Time Programs (OSTs) Afterschool Programs ~3hrs/day of school year 8.4 million children enrolled Serve snack daily Summer Day Camps ~8hrs/day, every day of summer 14 million children enrolled Some serve 2 snacks/day (morning/afternoon)

3. Policy to Practice in Youth Programs | Nutrition Center Symposium | March 2014 What Types of Snacks are Served? Healthy Eating in OSTs Majority of snacks served in OSTs are C.R.A.P. Cheap, empty calories that are Refined, Artificially flavored, and individually Packaged

4. Policy to Practice in Youth Programs | Nutrition Center Symposium | March 2014 10 Comparison ASPs (Fall 2014 Receive Training) 10 1 st Year Intervention ASPs (Fall 2013 Receive Training) Other Fruit Veggies Desserts R01 20 ASPs in Midlands Baseline Healthy Eating in OSTs

5. Policy to Practice in Youth Programs | Nutrition Center Symposium | March 2014 Snack Menu Example Healthy Eating in OSTs Monday, March 17 Cheezits & Apple Juice Tuesday, March 18 Banana, Vanilla Wafers & Water Wednesday, March 19 Cinnamon Toast Crunch & Milk Thursday, March 20 Peanut Butter, Ritz Crackers & Water Friday, March 21 Carrots, Ranch, Animal Crackers & Apple Juice Monday, March 24 Orange, Graham Crackers & Water Tuesday, March 25 String Cheese, Teddy Grahams & Water Wednesday, March 26 Scoops, Salsa & Grape Juice Thursday, March 27 Doritos & Apple Juice Friday, March 28 Lucky Charms & Milk Monday, March 3 Cheetos & Grape Juice Tuesday, March 4 Grapes, Teddy Grahams & Water Wednesday, March 5 Cocoa Puffs & Milk Thursday, March 6 Strawberries, Animal Crackers & Water Friday, March 7 Honey Nut Cheerios & Milk Monday, March 10 Rice Krispy Treat & Milk Tuesday, March 11 Yogurt, Wheat Thins & Water Wednesday, March 12 Banana, Vanilla Wafers & Water Thursday, March 13 Poptarts & Milk Friday, March 14 Broccoli, Ranch, Animal Crackers & Apple Juice

7. Policy to Practice in Youth Programs | Nutrition Center Symposium | March 2014 Changing Snacks Healthy Eating in OSTs National Standards Guide types of snacks OST programs should serve

8. Policy to Practice in Youth Programs | Nutrition Center Symposium | March 2014 Healthy Eating Standards Healthy Eating in OSTs Serve Fruit or Vegetable Option at Every Snack/Daily Provide foods free of sugar as one of the first three ingredients Avoids foods made with artificial ingredients (flavors or colors)

9. Policy to Practice in Youth Programs | Nutrition Center Symposium | March 2014 Intent of Standards? Healthy Eating in OSTs Increase FV consumption of kids? Token gesture to say we’re doing something? Veggies Fruit

10. Policy to Practice in Youth Programs | Nutrition Center Symposium | March 2014 Healthy Eating Standards Healthy Eating in OSTs NAA Serve FV daily, avoid artificially flavored snacks and sugar-based foods Y USA Serve FV daily, avoid sugar-based foods OSNAP Serve FV daily

11. Policy to Practice in Youth Programs | Nutrition Center Symposium | March 2014 Research Questions FV selection in presence of more healthful items? FV selection in presence of less healthful items? Practical/Logistic Standpoint Ordering FV How much to order? How much waste?

12. Policy to Practice in Youth Programs | Nutrition Center Symposium | March 2014 Methodology Snack Selection Day long summer camp 2wks (Elementary-age children) 2 snacks, morning/afternoon 3 Experimental Conditions Fruit only Whole banana, whole apple or orange, or sliced apple or orange Fruit or Sugar-sweetened or Cookie, gummies, animal crackers Artificially flavored grain Doritos, Cheetos, Goldfish Fruit or Unflavored gains Plain pretzels, air popped popcorn, plain tortilla chips

13. Policy to Practice in Youth Programs | Nutrition Center Symposium | March 2014 Methodology Snack Selection Snack Conditions randomly scheduled Total 18 snack occasions (6 for each comparison) No snack condition appeared twice in same day Or appeared at same time on consecutive days Snacks displayed together Child select one from the available options Children left snack waste/leftover at table Outcomes Detailed Accounting of Snacks Selected Counted 100% consumed Weighed Waste

14. Policy to Practice in Youth Programs | Nutrition Center Symposium | March 2014 Results Snack Selection Total of 1,053 observations Range of 33 to 76 children present at any given snack

15. Fruit Only (Whole fruit apples or oranges; Sliced fruit apples or oranges) Fruit (Whole, Sliced, Bananas) vs. Sugar Sweetened or Flavored Grain Snacks Fruit (Whole, Sliced, Bananas) vs. Unflavored Grain Snacks Percentage of Children Selecting Snack Items Snack Selection

16. Fruit Only (Whole fruit apples or oranges; Sliced fruit apples or oranges) Fruit (Whole, Sliced, Bananas) vs. Sugar Sweetened or Flavored Grain Snacks Fruit (Whole, Sliced, Bananas) vs. Unflavored Grain Snacks Percentage of Children Selecting Snack Items Snack Selection Sliced > Whole or Banana

17. Fruit Only (Whole fruit apples or oranges; Sliced fruit apples or oranges) Fruit (Whole, Sliced, Bananas) vs. Sugar Sweetened or Flavored Grain Snacks Fruit (Whole, Sliced, Bananas) vs. Unflavored Grain Snacks Percentage of Children Selecting Snack Items Snack Selection Sugar Sweetened & Flavored Grains > Fruit

18. Fruit Only (Whole fruit apples or oranges; Sliced fruit apples or oranges) Fruit (Whole, Sliced, Bananas) vs. Sugar Sweetened or Flavored Grain Snacks Fruit (Whole, Sliced, Bananas) vs. Unflavored Grain Snacks Percentage of Children Selecting Snack Items Snack Selection Unflavored Grains > Fruit

19. Fruit Only (Whole fruit apples or oranges; Sliced fruit apples or oranges) Fruit (Whole, Sliced, Bananas) vs. Sugar Sweetened or Flavored Grain Snacks Fruit (Whole, Sliced, Bananas) vs. Unflavored Grain Snacks 100% Consumption Percentage of Children Consuming 100% Bananas Higher No differences

20. Fruit Only (Whole fruit apples or oranges; Sliced fruit apples or oranges) Fruit (Whole, Sliced, Bananas) vs. Sugar Sweetened or Flavored Grain Snacks Fruit (Whole, Sliced, Bananas) vs. Unflavored Grain Snacks Amount of Waste Percentage of Waste Remaining Whole greater waste No differences

21. Policy to Practice in Youth Programs | Nutrition Center Symposium | March 2014 Conclusions & Implications Children offered something other than Fruit, select the alternative Policy intent to increase Fruit, language needs to specify limits on alternative snacks Implications for ordering snacks

22. Policy to Practice in Youth Programs | Nutrition Center Symposium | March 2014 Thank you