Location of School Lunch Salad Bars and Fruit and Vegetable Consumption in Middle Schools: A Cross-Sectional Plate Waste Study

Background: The school lunch environment is a prime target for increasing a child's consumption of fresh fruits and vegetables (F/V). Salad bars are heavily encouraged in schools; however, more research is needed to examine the contexts in which salad bars promote consumption of F/V among students. Objective: To compare the amount of fresh F/V self-served, consumed, and wasted by students during lunch at schools with differing salad bar placement: inside or outside of the serving line. Design: Cross-sectional plate waste study in which salad bar placement differed between schools. Participants/setting: A random sample of middle school students (N=533) from six schools (three schools per district). Main outcome measures: Amount of fresh F/V taken, consumed, and wasted. Statistical analyses: Negative binomial multivariable regression examined placement of salad bars, adjusting for sex, grade, race/ethnicity, free/reduced status, day of the week, and nesting of students within schools. Results: Almost all students (98.6%) in the schools with salad bars inside serving lines self-served F/V compared with only 22.6% of students in the schools with salad bars outside lines (adjusted prevalence ratio=5.38; 95% CI 4.04 to 7.17). Similarly, students at schools with salad bars inside the line had greater prevalence of consuming any F/V compared with students in schools with salad bars outside the line (adjusted prevalence ratio=4.83; 95% CI 3.40 to 6.81). On average, students with the salad bar outside the line wasted less F/V compared with those with salad bars inside the line (30% vs 48%, respectively). Conclusions: Few students visited salad bars located outside the lunch line. Salad bars inside the lunch line resulted in significantly greater fresh F/V taken, consumed, and wasted. When possible, schools should try to include salad bars inside the line to increase students' exposure to F/V.