Background
Methods
Context
Design and setting
Participants and recruitment
Random allocation and blinding
Multi-strategic intervention group
Conceptual model
Implementation strategies
Control group
Data collection and measures
School and canteen characteristics
Exposure to other nutrition interventions
Fidelity of intervention delivery
Perceived helpfulness of intervention support strategies
Primary trial outcomes
Green | Amber | Red |
---|---|---|
Breads and breakfast cereals (those high in fibre and low in saturated fat and sugars). Fruits and vegetables. Reduced fat dairy products. Lean meat, fish and poultry. Water. 99% fruit juice in 200 mL serves or less. | Breakfast cereals (those refined with added sugar). Full fat dairy products. 99% fruit juice in serves greater than 200 mL but less than 300 mL. Fats, oils, spreads and gravies. Processed meats. Savoury commercial products, snack food bars and biscuits, savoury snack foods, muffins and cakes, ice creams and dairy desserts that fall below the Occasional Food Criteria [4]. Sugar sweetened drinks that have less than 300 kJ and/or less than 100 mg of sodium per serve. | All confectionery, deep fried foods and chocolate coated or premium ice creams. Foods that exceed the Occasional Food Criteria [4]. All sugar sweetened drinks with greater than 300 kJ per serve and/or greater than 100 mg of sodium per serve are banned from sale in school canteens. |
Secondary trial outcomes
Sample size and power
Analysis
Results
Intervention | Control | |
---|---|---|
n = 35 |
n = 35 | |
Mean (SD) number of studentsa
| 256 (147) | 253 (173)a
|
Socioeconomic region (SEIFA 2006) | ||
Least advantaged | 15 (42.9%) | 16 (45.7%) |
Most advantaged | 20 (57.1%) | 19 (54.3%) |
Type of manager | ||
Paid manager | 16 (45.7%) | 16 (45.7%) |
Volunteer manager | 14 (40.0%) | 15 (42.9%) |
Other | 5 (14.3%) | 4 (11.4%) |
Mean (SD) time as manager (in months) | 51 (56) | 57 (57) |
Days of operationb
| ||
5 days a week | 15 (44.1%) | 20 (57.1%) |
3–4 days a week | 14 (41.2%) | 9 (25.7%) |
1–2 days a week | 5 (14.7%) | 6 (17.1%) |
Staffing of canteen | ||
All volunteer staff | 19 (54.3%) | 17 (48.6%) |
Combination of volunteer and paid staff | 15 (42.9%) | 15 (42.9%) |
Other | 1 (2.9%) | 3 (8.6%) |
Primary trial outcomes
Variable | Baseline | Follow-up | Intervention vs control at follow-up | |||
---|---|---|---|---|---|---|
Int. (n = 35) | Cont. (n = 35) | Int. (n = 27) | Cont. (n = 30) | Relative risk (95% CI) |
P value | |
Canteen menu does not contain foods and beverages restricted for sale (‘red’ or ‘banned’). | 4 (11.43%) | 6 (17.14%) | 19 (70.37%) | 1 (3.33%) | 21.11 (3.03 to 147.28) | <0.01** |
Healthy canteen items (‘green’) represent >50% of products listed on the canteen menu. | 5 (14.29%) | 7 (20.00%) | 22 (81.48%) | 8 (26.67%) | 3.06 (1.64 to 5.68) | <0.01** |
Variable | Baseline | Follow-up | Intervention vs control at follow-up | |||
---|---|---|---|---|---|---|
Int. (n = 35) | Cont. (n = 35) | Int. (n = 27) | Cont. (n = 30) | Relative risk (95% CI) |
P value | |
Canteen menu does not contain foods and beverages restricted for sale (‘red’ or ‘banned’). | ||||||
School size | ||||||
•Small | 3 (33.33%) | 4 (36.36%) | 7 (77.78%) | 1 (14.29%) | 5.44 (0.86 to 34.55) | 0.04* |
•Medium/large | 1 (3.85%) | 2 (8.70%) | 12 (66.67%) | 0 | 30.26 (1.91 to 478.45) | <0.01** |
Socioeconomic region (SEIFA 2006) | ||||||
•Least advantaged | 0 | 5 (31.25%) | 9 (81.82%) | 1 (7.69%) | 10.64 (1.59 to 71.37) | <0.01** |
•Most advantaged | 4 (25.00%) | 1 (5.26%) | 10 (62.50%) | 0 | 22.24 (1.41 to 350.79) | <0.01** |
Healthy canteen items (‘green’) represent >50% of products listed on the canteen menu. | ||||||
School size | ||||||
•Small | 0 | 1 (9.09%) | 7 (77.78%) | 3 (42.86%) | 1.81 (0.72 to 4.57) | 0.30 |
•Medium/large | 5 (19.23%) | 6 (26.09%) | 15 (83.33%) | 5 (22.73%) | 3.67 (1.65 to 8.14) | <0.01** |
Socioeconomic region (SEIFA 2006) | ||||||
•Least advantaged | 2 (13.33%) | 4 (25.00%) | 11 (100.0%) | 4 (30.77%) | 3.25 (1.44 to 7.35) | <0.01** |
•Most advantaged | 3 (15.00%) | 3 (15.79%) | 11 (68.75%) | 4 (23.53%) | 2.92 (1.17 to 7.32) | 0.01* |
Secondary outcomes
Nutritional quality of canteen purchases
Variable | Intervention | Control | Intervention vs control | |
---|---|---|---|---|
(n = 2492) | (n = 2310) | Difference |
P value | |
Energy (kJ) | 801 (770 to 831) | 933 (900 to 966) | −132.32 (−280.99 to 16.34) | 0.08 |
Total fat (g) | 5.83 (5.56 to 6.11) | 7.34 (7.02 to 7.66) | −1.51 (−2.84 to −0.18) | 0.03* |
Sodium (mg) | 261 (248 to 274) | 308 (293 to 322) | −46.81 (−96.97 to 3.35) | 0.07 |
Canteen revenue
Intervention | Control |
p value | |
---|---|---|---|
Baseline |
n = 12a
|
n = 15c
| 0.34 |
$6833.33 (5706.03) | $5920.00 (6459.23) | ||
Follow-up |
n = 12b
|
n = 14d
| |
$2678.83 (4121.86) | $4583.21 (4315.69) |
Exposure to other nutrition interventions
Fidelity of intervention delivery
Perceived helpfulness of intervention support strategies
Intervention component | Not helpful | Slightly helpful–helpful | Very helpful–extremely helpful |
---|---|---|---|
Resource kit (n = 23) | 0 | 8 (34.8%) | 13 (56.5%) |
Kitchen equipment (n = 24) | 1 (4.2%) | 4 (16.7%) | 13 (54.2%) |
Training workshop (n = 23) | 0 | 4 (17.4%) | 13 (56.5%) |
Email contact (n = 23) | 0 | 3 (13.0%) | 15 (65.2%) |
Menu audit and feedback report (n = 24) | 0 | 4 (16.7%) | 19 (79.2%) |
Newsletters (n = 23) | 2 (8.7%) | 6 (26.1%) | 11 (47.8%) |
Face-to-face meetings (n = 23) | 0 | 7 (30.4%) | 14 (60.9%) |
Telephone support calls (n = 23) | 0 | 6 (26.1%) | 14 (60.9%) |