Integrative Health and the Underserved
Secondary Topic: Research Methodology
Tertiary Topic: Patient-Centered Outcomes Research
Stakeholder-informed addition of spices and herbs increased vegetable intake in the National School Lunch Program at an underserved and predominantly African-American high school
Christopher R D'Adamo, PhD; Patrick F McArdle, PhD; Elizabeth A Parker, PhD, RD; Ariel Trilling, BS, University of Maryland School of Medicine, Baltimore, MD, United States; Brandin Bowden , MS, The Institute for Integrative Health, Baltimore, MD, United States; Mary K Bahr-Robertson, BA; Brian M Berman, M.D., University of Maryland School of Medicine, Baltimore, MD, United States
Late Breaker: No
The National School Lunch Program (NSLP) serves over 5 billion school meals per year and helps surmount many barriers to healthy eating among underserved children and adolescents. However, vegetable intake in the NSLP remains strikingly low among underserved African-American high school students. The purpose of this study was to evaluate whether addition of stakeholder-informed vegetable recipes flavored with spices and herbs to the NSLP at an underserved and predominantly African-American high school in Baltimore, Maryland would increase vegetable intake as compared to typical NSLP vegetable recipes.
A two-phase, controlled intervention was conducted during the 2015-2016 and 2016-2017 academic years. Phase I involved stakeholder engagement with students, cafeteria staff, and school administration to determine intervention feasibility and perform student sensory-testing of vegetable recipes flavored with spices and herbs that was evaluated with mixed-methods outcomes assessment. Phase II involved direct comparison via student's t-test of vegetable intake with spices and herbs ("spiced") and without spices and herbs ("typical") that was assessed via the gold standard of plate waste measurement.
A total of 4,285 plates (Typical: n=2,160, Spiced: n=2,125) were collected from students over 8 weeks for assessment of vegetable intake. There was a 21% increase in total vegetable intake when spiced compared to typical (0.33-ounce increase, p<0.0001). Vegetables with the largest increases when spiced compared to typical recipes were carrots, broccoli, and vegetable medley (broccoli, carrots, cauliflower).
Adding student-tested vegetable recipes flavored with spices and herbs to the NSLP and evaluating vegetable intake was feasible at an underserved and predominantly African-American high school in Baltimore. Extensive stakeholder engagement facilitated one of the largest school-based vegetable intake studies conducted to date. While additional interventions are needed to further engage students in dietary improvements, addition of spices and herbs provides a resource-efficient means of achieving modest increases in vegetable intake among this challenging demographic.