An environmental intervention to promote lower-fat food choices in secondary schools: Outcomes of the TACOS Study
Abstract
OBJECTIVES: We evaluated an environmental intervention intended to increase sales of lower-fat foods in secondary school cafeterias. METHODS: Twenty secondary schools were randomly assigned to either an environmental intervention or a control group for a 2-year period. The intervention increased the availability of lower-fat foods and implemented student-based promotions. RESULTS: A steeper rate of increase in sales of lower-fat foods in year 1 (10% intervention vs -2.8% control, P =.002) and a higher percentage of sales of lower-fat foods in year 2 (33.6% intervention vs 22.1% control, P =.04) were observed. There were no significant changes in student self-reported food choices. CONCLUSIONS: School-based environmental interventions to increase availability and promotion of lower-fat foods can increase purchase of these foods among adolescents.
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Seventeen of the included studies were assessed as high risk of detection bias.
“Seventeen of the included studies were assessed as high risk [26, 28, 37, 41, 43, 44, 46–49, 52, 54–56, 58, 66, 67] and seven studies were assessed as low risk of detection bias [27, 42, 51, 53, 60, 62, 63].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [47]
Thirteen studies, including four RCTs, were assessed as unclear risk of selection bias as methods of sequence generation and allocation were not reported.
“Thirteen studies, including four RCTs were assessed as unclear risk of selection bias as methods of sequence generation and allocation were not reported [44, 46, 47, 50, 51, 54–56, 58, 64, 66, 67].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [47]
For studies using a cluster-RCT design (n = 15), potential risk of recruitment to cluster was assessed as low for seven studies as randomization occurred either postrecruitment or postbaseline data collection.
“Potential risk of recruitment (to cluster) was assessed as low for seven studies as randomization occurred either postrecruitment or postbaseline data collection [47, 54–56, 58, 60, 64].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [47]
For risk of bias due to baseline imbalances, the majority of studies (n = 11) were assessed as low risk as studies accounted for imbalances by making adjustments for baseline differences during analyses, stratifying by school characteristics or through random allocation of schools to experimental groups.
“For risk of bias due to baseline imbalances, the majority of studies (n = 11) were assessed as low risk as studies accounted for imbalances by making adjustments for baseline differences during analyses, stratifying by school characteristics or through random allocation of schools to experimental groups [37, 38, 41, 46, 47, 55, 56, 58, 60, 64, 67].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [47]
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- Authors
- French, S. A., Story, M., Fulkerson, J. A., & Hannan, P.
- Affiliations
- University of Minnesota (US)
- Venue
- American Journal of Public Health
- Publisher
- American Public Health Association
- Published
- 2004-09
- Volume
- 94
- Issue
- 9
- Pages
- 1507-1512
- ISSN
- 0090-0036 (ISSN-L)
- 1541-0048
- OpenAlex
- W2061761180
- Cited by
- 181
- References
- 27
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 9 · 2018: 7 · 2017: 9 · 2016: 10 · 2015: 18 · 2014: 6 · 2013: 11 · 2012: 18
- FWCI
- 8.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Public Health (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r18hl061305-04)
- National Heart, Lung, and Blood Institute (R18-HL61305)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Keywords
- environmental interventions, school canteens, secondary schools, adolescent food choices, food availability, food sales
- MeSH terms
- Adolescent, Attitude to Health, Child, Dietary Fats, Dietary Services, Female, Food Preferences, Health Education, Humans, Male, Menu Planning, Minnesota, School Health Services, Schools, Time Factors, Diet, Fat-Restricted, Child Nutrition Sciences
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