Fewer than half of California’s school districts participated in the program, but participating school districts had larger student enrollments than nonparticipating districts . The ethnic profile of students and the average school breakfast participation rates were similar in participating and nonparticipating school districts. School districts were stratified according to their number of elementary, middle and high schools, and the schools were randomly selected for participation in the evaluation. Of 93 schools that were contacted, 20 were ineligible because they were not participating in the program and four declined to participate in the evaluation. Of the remaining 69 schools, 61 were able to supply sufficiently complete data for the evaluation. The Committee for the Protection of Human Subjects at UC Berkeley approved the study. Parents received letters about the study, and students consented verbally to participate. Data were collected before and during the program. Breakfast menu production records and invoices were sought from the schools’ child nutrition directors on 20 randomly selected days during the months of September, October and November in the year before the program was implemented and during the program . Data from the menu production records included the nature and number of fruit servings prepared and taken by students at breakfast. Nonfood expenses directly relating to operating the program were also reported. Of the 61 nutrition directors, 55 recorded their views of the program’s impact on nutrition services operations, perceived student satisfaction, challenges and barriers to operating the program, nutrition education and promotional techniques, and staff training and needs. A stratified random sample of 18 schools was selected for site visits,raspberry grow in pots which were successfully conducted at 16 schools: six elementary, six middle and four high schools.
This sample was similar to other schools participating in the program in terms of school level, enrollment, geographic location, free- and reducedprice enrollment and student ethnicity. Interviews with nutrition directors were conducted at each of the 16 schools. Student surveys were completed by 1,205 students in grades 4 to 12 in a convenience sample of one or two classes at each of the 16 visited schools as well as at the school cafeterias during breakfast service. Questions were asked about where breakfast is eaten, how often fruits and vegetables are consumed at breakfast, favorite fruits to eat at breakfast, importance of eating fruits and vegetables at breakfast, change in fruit and vegetable consumption compared to the previous year and basic sociodemographic information. The cafeteria questionnaire asked additional questions regarding opinions about the school breakfast and perceptions of change since the previous year. The classroom questionnaire included questions regarding barriers to eating the school breakfast. In addition, trained research staff facilitated classroom discussions with students in 28 classes in grades 4 to 12 . Students were questioned about their views on breakfast in general, the School Breakfast Program, the California Fresh Start Program and factors influencing their school breakfast participation and food choices. Nutrition directors recorded School Breakfast Program participation on a standardized form. The researchers obtained monthly participation data during the course of the evaluation, including number of operating days and school average daily attendance. In addition, observations of the breakfast environment were made at each of the visited schools. Costs of specific fruits and vegetables were calculated from invoices provided by the nutrition directors. The costs of fruits and vegetables prepared and served were based on the total value of the prepared items reported on the menu production records. Nonfood expenses identified on invoices were classified as transportation, facilities, large and small equipment, material, promotional, training, additional staff time, and other. The percentage of total nonfood expenses for each category was calculated. Differences in both fresh fruit and total fruit taken by students and in the variety of fruits offered at each school were calculated from menu production records and analyzed by t-test.
Descriptive findings were reported for schools demonstrating more successful program implementation, specifically, schools with increases of 0.10 or more units of total and fresh fruit taken and increases greater than 0.90 for number of different fresh fruits offered. Although the California Fresh Start Program was designed to increase fruit and vegetable consumption, its effect was almost completely seen on fruit consumption, since vegetables were rarely included in the breakfast menu; vegetables represented less than 1% of produce offered to students. Thus the results presented here are based on fruit offerings. The California Fresh Start Program resulted in substantial increases in the variety of all, and especially fresh, fruits offered to students. More than twice as many different fresh fruits were offered per day during the program compared with the same period a year before: an average of 1.38 fruits compared to 0.66 . When considering all forms of fruit , there was a 46% increase in the average number of fruits offered per day: 2.55 fruits compared with 1.75 prior to the program . The California Fresh Start Program brought the offerings into compliance with dietary recommendations for two produce servings at breakfast. During the program, fresh fruit made up the majority of the fruit offered at breakfast. Juice, which previously had been the primary source of fruit, decreased substantially as a proportion of total fruit. All types of fresh fruit were offered with greater frequency; however, apples remained the most commonly offered individual fruit, followed by oranges and bananas. Stone fruits, though offered less frequently, showed the greatest percentage increase during the program . Our findings suggest that when offered a greater variety of fruits and less juice, students will increase their intake of fruit, especially fresh varieties . Students eating the school breakfast took more than twice as many fresh fruit servings during the California Fresh Start Program than before the program, 0.32 servings compared to 0.14, while taking substantially less juice and nearly the same amounts of canned, frozen and dried fruit offerings .
Although there were no direct measures of student consumption in this evaluation, the amounts taken, as recorded by food service personnel, provide a reasonable indirect basis for assessing student consumption. Observations by research staff and food service personnel confirmed that most students who choose to take a fruit at breakfast do eat it. Therefore, student consumption of fresh fruit at breakfast appears to have doubled as a result of the California Fresh Start Program. During the program, students took more of almost all types of fruit; however, the percentage increases were greatest for less common fruits such as cantaloupe, tangerines/tangelos and blueberries, which were not often offered before the program. Increases of about 20% to 30% were observed for common fruits such as apples, bananas and oranges; increases were 100% or more for tangerines, berries and cantaloupe, reflecting their appeal among students, and the low frequency with which they were offered before the program. Although the greatest increase in offerings occurred for the most common fruits — apples, oranges and bananas — the relative increase in servings of fruits was highest for the less common fruits. The demand for more common fruits may be approaching saturation,30 planter pot but unmet demand exists for a wider variety of fruits. Thus, future increases in the fruit servings students take at breakfast will likely require offerings of fruits other than apples, oranges and bananas.While the overall impact of the program on the amount of fruit — particularly the amount of fresh fruit — taken by students is impressive, this impact is even more dramatic when looking specifically at the schools that experienced the greatest success in implementing the program. At these schools, the California Fresh Start Program led to a 46% increase in the total amount of fruits taken by students, and a 383% increase in the fresh fruits and vegetables taken . It had the most impact in schools where students took the lowest number of fruit servings before the program — schools with the greatest need for an increase in produce intake. Schools that offered increased quantities of fruit, more variety of fruits and more unusual fruits and less juice were most successful in increasing student selection of fresh fruit. Limiting juice and providing fruits other than apples, oranges and bananas appear to be particularly important for increasing student consumption of fresh fruit. The fruits most often served at breakfast are rarely the ones that students most prefer .Students’ attitudes toward eating fruit, already positive, showed modest changes during the program. Most students reported it was important to have fruit at breakfast, saying that fruits and vegetables are “good for you because it’s healthy, makes you strong; there is natural sugar, and it contains vitamins like A and C.” However, only 13% said they always eat fruits and vegetables at breakfast, and only 19% said they often do. This maybe due in part to the fruits most often served at breakfast not being the fruits students prefer. Students prefer more exotic fruits than they are currently served. Fruits mentioned were mangos, kiwi, strawberries, peaches, pineapple, watermelon and grapes, with melons and berries being most popular . Students also want more variety in the ways fruit is presented, including chopped fruit, fruit salads, salad-type fruit bars, fruit with condiments and ethnic favorites. Variety, convenience, quality and freshness are key concerns. High school students, in particular, expressed a desire for more tropical fruits such as mangos. Successful implementation of the California Fresh Start Program was not significantly related to school characteristics or student socio-demographics. The type of school , ethnicity/race of the students, ruralurban geographic location, percentage of free- and reduced-price meal participation and size of student enrollment did not have any statistically significant association with the program’s success in terms of the number of fresh and total fruit servings students took or the variety of fruits offered. Whether students were offered and/ or took more fruit was affected by a variety of school institutional and economic factors, including the physical layout of the school’s food service department and the availability of funding for program support.
Because the California Fresh Start Program did not mandate or provide funding for facility improvements, it is not surprising that only about 9% of the schools made improvements to their kitchen, dining area, serving areas or points of service. Data from the evaluation indicated that adequate dining space for students was related to students taking more fruit and an appealing dining ambience was related to students taking more fresh fruit. Almost one-third of schools did not have sufficient facilities to seat all students comfortably. The temperature was uncomfortably cold in many of the serving and dining areas, which may have played a role on cold days in students’ preference for hot breakfast items rather than cold fruit. The student survey revealed that a majority of students want more options regarding when and where they can eat breakfast, particularly the options of eating in the classroom and indoors or outdoors. Only about one-third of schools offered students the choice of eating indoors or outdoors. Our findings suggest an investment in facilities has the potential to attract higher participation in the breakfast program and to increase students’ intake of fresh fruit. Schools that offered more variety of fruits were more likely to have made improvements in customer service, nutrition education, student attitudes and the quality and appeal of the fruit offered. Quality concerns were prominent in discussions with students about the changes in foods offered. Students noticed both positive and negative changes in food and beverage temperatures, freshness, taste, portion size and preparation. In addition to presentation, the position of fruit in the serving sequence might affect student selections. At one site, the fruit was not visible; it had to be requested. Fresh fruit was the first item offered in the serving sequence at only three of the 13 sites where these data were recorded. Nutrition directors at schools where students chose more fresh and total fruit were more likely to describe inadequate storage space and facilities. Many schools increased nutrition education and promotion efforts among students as part of the California Fresh Start Program but lacked the staff time and resources to mount a sufficiently intensive effort. Of the nutrition directors surveyed, 96% reported that lack of opportunity was a barrier to fully providing the nutrition education component of the program, 87% reported a lack of staff time as a reason, and 81% reported that lack of funding was a barrier .