Increasing School Meal Participation

Evaluating a Marketing Campaign to Increase Participation in School Meals

This study aims to determine whether an online marketing campaign increases children's school meal participation. Parents whose children do not currently eat school meals frequently will be exposed to messages designed to encourage their children's increased participation in school meals.

Study Overview

• Status: Completed
• Conditions: Nutrition, Healthy
• Intervention / Treatment: Behavioral: School meal messages; Behavioral: Control (neutral) messages

Detailed Description

In this 6-week-long online randomized controlled trial, participants will be randomized to one of two arms: 1) Control (neutral) messages or 2) Messages designed to increase school meal participation. In each arm, participants will join private Facebook groups corresponding to their study arm. The study team will post campaign messages to these groups. Participants will answer online survey questions before and after the study on their attitudes about school meals and their child's participation in school meals.

• Study Type: Interventional
• Enrollment (Actual): 832
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Palo Alto, California, United States, 94304
      • Stanford School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• 18 years or older
• Parent of a child attending a public school in grades 1-5
• Resides in one of the following states: California, Colorado, Maine, Minnesota, Michigan, Massachusetts, New Mexico, Vermont
• Has internet access
• Has a Facebook account
• Child consumes 3 or fewer school lunches per week or 3 or fewer school breakfasts per week

Exclusion Criteria:

• Younger than 18 years old
• Does not have a child attending a public school in grades 1-5
• Resides out of one of the following states: California, Colorado, Maine, Minnesota, Michigan, Massachusetts, New Mexico, Vermont
• Does not have internet access
• Does not have a Facebook account
• Child consumes more than 3 school lunches per week and more than 3 school breakfasts per week

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: School meal messages; Participants will view messages focused on the benefits of children eating school meals, using text and images developed based on parent interviews. Participants will view a total of 10 messages.	Behavioral: School meal messages; Messages focused on the benefits of children consuming school lunch and breakfast, using text and images developed based on parent interviews. Participants will view a total of 10 messages.
Active Comparator: Control (neutral) messages; Participants will view messages focused on the benefits of children reading. Messages will be matched in length to the experimental messages. Participants will view a total of 10 messages.	Behavioral: Control (neutral) messages; Control messages approximately matched to the intervention messages on length and design, but discussing a neutral topic unrelated to school meals (reading). Participants will view a total of 10 messages.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Children's consumption of school lunches	Parental report of the usual number of days per week their child ate school lunch during the past month. Assessed with 1 item: "Thinking about the last month, how many days a week did your child usually eat school lunch?" This item will be scored on a 6-point scale from "0 days per week" (0) to "5 days per week" (5).	Collected in a ~10 minute survey at baseline and again at 6 weeks.
Children's consumption of school breakfasts	Parental report of the usual number of days per week their child ate school breakfast during the past month. Assessed with 1 item: Thinking about the last month, how many days a week did your child usually eat school breakfast?" This item will be scored on a 6-point scale from "0 days per week" (0) to "5 days per week" (5).	Collected in a ~10 minute survey at baseline and again at 6 weeks.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Noticing the school meal campaign	Parental report of whether they noticed the school meal campaign. Assessed with 1 item: "In the last 6 weeks, have you seen any messages or advertising on Facebook encouraging children to eat school lunch or school breakfast?" Response options are "yes" (1) and "no" (0).	Collected in a ~10 minute survey at 6 weeks.
Number of school meals campaign topics recognized	Parental report of the number of topics they recognize having seen in messages about school meals. Assessed with 1 item: "Which of these topics did the messages discuss, if any? Check all that apply." Response options list 8 topics plus options for "none of these" and "not sure." Number of topics recognized will be calculated as the sum of all topics that parents indicate they have seen. Those who answer, "none of these" and "not sure" will be coded as recognizing 0 topics. Those who report not noticing the school meal marketing campaign will be coded as recognizing 0 topics.	Collected in a ~10 minute survey at 6 weeks.
Frequency of reading campaign messages	Parental report of the frequency with which they read their assigned campaign messages. Assessed with 1 item: "In the past month, how often did you read these messages?" This item will be scored on a 5 point scale ranging from "Never or less than 1 time per week" (1) to "Every day or more often" (5).	Collected in a ~10 minute survey at 6 weeks.
Social interactions about campaign	Parental report of the frequency with which they talked to others about their assigned campaign messages. Assessed with 1 item: "In the last month, how often did you talk to others about these messages?" This item will be scored on a 5 point scale ranging from "Never or less than 1 time per week" (1) to "Every day or more often" (5).	Collected in a ~10 minute survey at 6 weeks.
Social interactions about school meals	Parental report of the frequency with which they talked to others about school meals. Assessed with 3 items (e.g., "In the last month, how often did you talk to others about school meals?"). Response options are on a 5-point scale ranging from "Never or less than 1 time per week" (1) to "Every day or more often" (5). Responses to the 3 items will be averaged to create a mean score.	Collected in a ~10 minute survey at 6 weeks.
Perceived benefits of school lunch	Parental report of the benefits of their child consuming school lunch. Assessed with 8 items (e.g., "My child eating school lunch helps my child do well in school"). Response options are on a 5-point scale ranging from "Strongly disagree" (1) to "Strongly agree" (5). Responses to the 8 items will be averaged to create a mean score.	Collected in a ~10 minute survey at baseline and again at 6 weeks.
Perceived benefits of school breakfast	Parental report of the benefits of their child consuming school breakfast. Assessed with 8 items (e.g., "My child eating school breakfast helps my child do well in school"). Response options are on a 5-point scale ranging from "Strongly disagree" (1) to "Strongly agree" (5). Responses to the 8 items will be averaged to create a mean score.	Collected in a ~10 minute survey at baseline and again at 6 weeks.
Knowledge that school lunch is free	Parental knowledge that lunches served at their child's school are free to all students. Assessed with 1 item: "Are school lunches free for all students at your child's school?" Response options "yes" (coded as 1) and "no" or "not sure" (both coded as 0).	Collected in a ~10 minute survey at baseline and again at 6 weeks.
Knowledge that school breakfast is free	Parental knowledge that breakfasts served at their child's school are free to all students. Assessed with 1 item: "Are school breakfasts free for all students at your child's school?" Response options "yes" (coded as 1) and "no" or "not sure" (both coded as 0).	Collected in a ~10 minute survey at baseline and again at 6 weeks.
Perceived healthfulness of school lunch	Parental perception of the healthfulness of the lunches served at their child's school. Assessed with 1 item: "How healthy or unhealthy are the school lunches at your child's school?" Response options are on a 5-point scale ranging from "Very unhealthy" (1) to "Very healthy" (5).	Collected in a ~10 minute survey at baseline and again at 6 weeks.
Perceived healthfulness of school breakfast	Parental perception of the healthfulness of the breakfasts served at their child's school. Assessed with 1 item: "How healthy or unhealthy are the school breakfasts at your child's school?" Response options are on a 5-point scale ranging from "Very unhealthy" (1) to "Very healthy" (5).	Collected in a ~10 minute survey at baseline and again at 6 weeks.
Intentions to encourage their children's consumption of school lunch	Parental report of the likelihood of encouraging their child to eat school lunch in the next month. Assessed with 1 item: "In the next month, how likely are you to encourage your child to eat school lunch?" Response options are on a 5-point scale ranging from "Not at all likely" (1) to "Extremely likely" (5).	Collected in a ~10 minute survey at baseline and again at 6 weeks.
Intentions to encourage their children's consumption of school breakfast	Parental report of the likelihood of encouraging their child to eat school breakfast in the next month. Assessed with 1 item: "In the next month, how likely are you to encourage your child to eat school breakfast?" Response options are on a 5-point scale ranging from "Not at all likely" (1) to "Extremely likely" (5).	Collected in a ~10 minute survey at baseline and again at 6 weeks.
Barriers to children's school lunch consumption	Parental report of the barriers preventing their child from eating school lunch. Assessed with 1 item: "What are some reasons that your child doesn't eat school lunch more often? Check all of the reasons that apply." Response options list 15 reasons plus "NA - my child eats school lunch every day or almost every day" and a free response option for "other." Total number of barriers selected will be summed. Those who report "NA - my child eats school lunch every day or almost every day" will be coded as having 0 barriers.	Collected in a ~10 minute survey at baseline and again at 6 weeks.
Barriers to children's school breakfast consumption	Parental report of the barriers preventing their child from eating school breakfast. Assessed with 1 item: "What are some reasons that your child doesn't eat school breakfast more often? Check all of the reasons that apply." Response options list 16 reasons plus "NA - my child eats school breakfast every day or almost every day" and a free response option for "other." Total number of barriers selected will be summed. Those who report "NA - my child eats school breakfast every day or almost every day" will be coded as having 0 barriers.	Collected in a ~10 minute survey at baseline and again at 6 weeks.
Household food insecurity	Parental report of household food insecurity. Assessed with 6 items (e.g., "In the last month, were you ever hungry but didn't eat because there wasn't enough money for food?") Response options include "no" or "yes"; "never true", "sometimes true", or "often true"; "only 1 or 2 days," "some days but not every day," or "almost every day." Responses of "often" or "sometimes" and "yes" are coded as affirmative (yes). Likewise, responses of "almost every day" and "some days but not every day" are coded as affirmative (yes). The sum of affirmative responses to the six questions in the module is the household's raw score on the scale. Household food security status is assigned as follows: Raw score 0-1-High or marginal food security Raw score 2-4-Low food security Raw score 5-6-Very low food security Analyses will dichotomize households into those with high or marginal food security and those with low or very low food security.	Collected in a ~10 minute survey at baseline and again at 6 weeks.
Child food insecurity	Parental report of child food insecurity. Assessed with 8 items (e.g., "In the last month, did you ever cut the size of your child's meals because there wasn't enough money for food?") Response options include "no" or "yes"; "never true", "sometimes true", or "often true"; "only 1 or 2 days," "some days but not every day," or "almost every day." Responses of "often" or "sometimes" and "yes" are coded as affirmative (yes). Responses of "almost every day" and "some days but not every day" are coded as affirmative (yes). The sum of affirmative responses to the 8 questions in the module is the child's raw score on the scale. Child food security status is assigned as follows: Raw score 0-1-High or marginal food security among children; Raw score 2-4-Low food security among children; Raw score 5-8-Very low food security among children Analyses will dichotomize households into those with children with high or marginal food security or children with low or very low food security.	Collected in a ~10 minute survey at baseline and again at 6 weeks.

Collaborators and Investigators

• Sponsor: Stanford University
• Collaborators: Robert Wood Johnson Foundation
• Investigators: Principal Investigator: Anna Grummon, PhD, Assistant Professor

Study record dates

Study Major Dates

• Study Start (Actual): September 19, 2024
• Primary Completion (Actual): December 20, 2024
• Study Completion (Actual): December 20, 2024

Study Registration Dates

• First Submitted: May 13, 2024
• First Submitted That Met QC Criteria: May 16, 2024
• First Posted (Actual): May 17, 2024

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 30, 2025
• Last Verified: January 1, 2025

More Information

Terms related to this study

• Keywords: health; nutrition; children; school lunch; food access; parent perceptions; school breakfast
• Other Study ID Numbers: 75335

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: We plan to post de-identified raw data from the surveys to a public repository.
• IPD Sharing Time Frame: We plan to post de-identified raw data from the surveys to a public repository upon publication of papers arising from the study.
• IPD Sharing Access Criteria: These materials will be posted publicly; researchers will be free to download them.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No