1. University of Wisconsin-Eau Claire Measuring the Impact of Group Incentives on Aggregate Fruit and Vegetable Consumption for Lunch in Two Wisconsin Elementary Schools Student Researchers Tiffany Christner, Nicholas Douglass, Mitchell Fischer, Jisu Kim, Aaron Lickel, Jonathan Pumper & Lucy Ramquist Faculty Mentors Eric Jamelske Sydney Chinchanachokchai

2. University of Wisconsin-Eau Claire Overview  Motivation and Previous Research  Study Design  FV Consumption Measurement  Phases of Study  Demographic Summary  Preliminary Results  Conclusions and Future Work  Questions and Discussion

3. Motivation  Inadequate FV consumption (not 5-9 a day)  Lots of less healthy alternatives  Rising rates of childhood and adult obesity  Significant health care concern, annual costs in the BILLIONS of $

4. University of Wisconsin-Eau Claire  FFVP in Elementary Schools (Jamelske, Bica, Lagoria 2009-10) –Bring FV from home for snack on non-FFVP days, toys and encouragement  After School Program (Jamelske 2012-13) –Eat FV for snack/dinner, chance to win $15-20 prizes weekly, encouragement  Elementary School Lunch FV Consumption (Just & Price 2013) –Small monetary incentives increase fraction of children eating FV by 80%  Elementary School Lunch FV Intake (Wengreen et al. 2013) –Incentives increase F/V intake increased by 0.53 cups per day  Red Pepper Strips Individual Meetings (Wardle et al. 2003) –Exposure and reward raise short term consumption and preferences Using Incentives to Increase FV Intake

5. University of Wisconsin-Eau Claire Study Design  Two Wisconsin elementary schools  Self-serve salad bar at lunch  Children must take two items  Three lunch periods, 2 grades each period  Three observation days each week (M W F)

6. University of Wisconsin-Eau Claire Study Design  Table set up at waste disposal area  All children drop tray on table upon leaving  Researchers separate FV waste into bus trays by item  After all lunch periods, waste is weighed for each FV item

7. University of Wisconsin-Eau Claire FV Measures  All amounts weighed using digital scale (pounds)  Pounds to ounces (multiply by 16)  Ounces per lunch served (divide by lunches served)  Initial FV available for serving  Leftover FV not served/taken  FV waste, taken but not eaten  Initial – Waste – Leftover = Consumption  Aggregate measure of FV (daily)

9. University of Wisconsin-Eau Claire Three Phases of Study  Initial baseline, 3 days –No intervention, just measuring  Announcements, encouragement and incentives, 6 days –Prizes if aggregate FV consumption increases  Return to baseline, 3 days  Administrator and teacher survey after all phases of study –Participation, engagement, encouragement, enthusiasm

10. University of Wisconsin-Eau Claire Announcements/Encouragement & Incentives  Announcements and Encouragement –Daily morning announcement over PA system (general, principal) –Daily classroom announcement before lunch (specific, teachers) –Letter sent home to parents –Posters and encouragement in cafeteria  Incentives –All students and staff receive free bowling or roller skating passes –Chance to win $20 Walmart gift card (two each grade, 12 total in each school) –Plaque of recognition for school office

12. School I N = 424 F & R = 47.2% School II N = 406 F & R = 63.1%

13. University of Wisconsin-Eau Claire Preliminary Results

14. University of Wisconsin-Eau Claire Salad Bar FV Offerings  Generally same in both schools and repeated through study phases  Apple Slices, Diced Peaches, Red Grapes, Diced Pears, Kiwi Halves, Fruit Cocktail, Pineapple Chunks, Cooked Apples, Banana  Baby Carrots, Green Salad, Cherry Tomatoes, Cooked Carrots

15. Baseline 1: mean = 277, std dev = 2.1 Incentives: mean = 271, std dev = 4.8 Baseline 2: mean =261, std dev = 34.4 # of Lunches Served

16. Baseline 1: mean = 303, std dev = 13.3 Incentives: mean = 293, std dev = 31.6 # of Lunches Served

17. Translate Ounces into 1/2 Cup Servings Per Lunch Served  Ounces per ½ cup vary by FV item  Minimum of 0.8 oz. per ½ cup for salad  Maximum of 4 oz. per ½ cup for peaches and pears

18. Total FV Consumption During Initial Baseline and Incentives Phases

19. University of Wisconsin-Eau Claire Re-Cap  Combined FV intake of School II > School I at initial baseline (fruit) –2.97 > 2.32 –FFVP influence, lower socioeconomic status – just hungrier  F intake > V intake at both schools at initial baseline –School I: 1.80 > 0.52 –School II: 2.55 > 0.43  Combined FV intake increased at both schools during incentives phase –School I: 3.17 > 2.32 (36.6%, p=0.09) –School II: 3.24 > 2.97 (9.0%, p=0.66)

20. University of Wisconsin-Eau Claire Re-Cap  School I larger absolute increase and percentage increase in F intake compared to V during incentives phase –Fruit ↑ 0.69 (38.2%) Vegetable ↑ 0.16 (30.9%)  School II larger absolute increase in F intake and larger percentage increase in V intake during incentives phase –Fruit ↑ 0.16 (6.3%) Vegetable ↑ 0.10 (25.3%)  School I sustained combined FV increase through return to baseline phase –2.94 > 2.32 (p=0.46)

21. University of Wisconsin-Eau Claire Conclusions  Group Level Incentives Matter!  Evidence that children can be influenced to eat more FV  Aggregate level data allow for more students in study  Aggregate level data allow for more accurate measuring  Aggregate level data do not allow for individual level analysis  Very likely some children increased intake, others did not  Gains are small in terms of increased servings of FV, but not trivial

22. University of Wisconsin-Eau Claire Conclusions  Results are suggestive, but do not confirm a causal effect  Several minor challenges conducting this study  Food service staff  Menu items, food quality  School schedules  Teacher and administration participation/cooperation  Data have some variability for specific FV items over the study  FV intake can vary for a number of reasons on any given day

23. University of Wisconsin-Eau Claire Future Work  More detailed analysis of individual FV items  More accurate translation to serving size  Analyze FV intake given other lunch items served  Teacher surveys reporting level of encouragement  Analyze changes in food waste

24. University of Wisconsin-Eau Claire Future Work  Return in spring to measure FV consumption again  Present, write and publish  Work with schools and food service staff to develop next study  Different incentives, longer observation phases  Marketing and promotions, nutrition education

25. University of Wisconsin-Eau Claire Questions & Discussion

26. University of Wisconsin-Eau Claire Appendix

27. University of Wisconsin-Eau Claire Administration Responsibilities  Coordinate and encourage teacher participation  Distribute teacher participation survey after data collection  Complete administrator participation survey after data collection  Read school-wide announcement below over PA system each day during incentive period  Provide school-level student demographic data  Distribute rewards/prizes to students if FV intake increases

28. University of Wisconsin-Eau Claire Teacher Responsibilities  Read classroom announcement right before lunch each day during incentive period  Continue encouraging students to eat more FV after incentive period  Report any morning snacks served in classroom on observation days  Complete teacher participation survey after data collection

29. University of Wisconsin-Eau Claire Food Service Staff Responsibilities  Serve FV items as planned on menu on observation days  Provide weight measurements of initial amounts of FV available for serving on observation days  Assist in weighing left over FV not served on observation days  Share any other valuable information with researchers

31. School-Wide Morning Announcement

32. Classroom Pre-Lunch Announcement

36. School I FV Consumption

37. School II FV Consumption