Project ReFresh: Tools for integrating classroom nutrition education and cafeteria-based environmental changes to improve school nutrition environments

INTRODUCTION: Project ReFresh is a school-based intervention program aimed at improving nutrition and health decisions among students in Title I elementary schools in Maryland. This program strives to integrate classroom education with cafeteria improvements that help students choose more fruits and vegetables through the use of environmental nudges. A toolkit of cafeteria improvement strategies aims to structure choices in the cafeteria environment; market and promote healthy foods; enhance interactions between cafeteria staff and students; and improve student decision-making in the cafeteria. METHODS: Thirty-two schools participated in cafeteria improvements, of which half also incorporated classroom nutrition education into the standard curriculum. Evaluation was conducted using surveys of food service staff and students, observations of the school nutrition environment and student-staff interactions, classroom tasting journals, and meal service records. This innovative program enabled University of Maryland Extension (UME) to partner with food service and instructional staff to serve as choice architects in designing a nutrition-promoting school environment. RESULTS: Pre and post-assessments will be used to assess fruit and vegetable selection in the school meals program, taste preferences, staff attitudes on barriers to fruit and vegetable consumption, and environmental nutrition promotion. DISCUSSION: This innovative program enabled partnerships between food service and instructional staff and UME educators. Unique aspects of the program design include the training of cafeteria staff to serve as choice architects, enhancement to the cafeteria environment, and integrating nutrition education into the curriculum. This comprehensive, low-cost approach offers promise at improving students' dietary quality in the school cafeteria.