School Resources and Engagement in Technical Assistance Programs Is Associated with Higher Prevalence of Salad Bars in Elementary School Lunches in the United States

Background Salad bars have been promoted as a strategy for increasing fruit and vegetable consumption in schools. Objective To examine school-level resources and programs associated with the presence of salad bars in elementary schools and to assess whether there were differential changes in salad bar prevalence based on school-level resources and programs before and after the new US Department of Agriculture schools meals standards were proposed (January 2011) and implemented (July 2012). Design Repeated cross-sectional design. Data were collected annually between 2006-2007 and 2013. Setting Nationally representative sample of 3,956 elementary schools participating in the National School Lunch Program. School personnel (ie, administrators and foodservice staff) provided data using a mail-back survey. Measures Presence of salad bars in school was the primary outcome variable. School-level programs and resources were investigated as independent variables. Statistical analysis Weighted logistic regression analyses examined associations between dependent and independent variables controlling for school demographic characteristics. Results Prevalence of salad bars increased significantly from 17.1% in 2006-2007 to 29.6% in 2012-2013. The prevalence of salad bars was significantly higher among schools that participated in the Team Nutrition program (odds ratio [OR] 1.37, 95% CI 1.10 to 1.70), the Fresh Fruit and Vegetable Program (OR 1.48, 95% CI 1.13 to 1.95), a Farm to School program (OR 1.77, 95% CI 1.36 to 2.33), and where school meals were provided by a foodservice management company (OR 1.46, 95% CI 1.08 to 1.97). No association was found for schools with full-service kitchen, school gardens, those offering nutrition education, or those with dietitians/nutritionists on staff. Conclusions Prevalence of salad bars increased significantly after the US Department of Agriculture school meal guidelines were proposed and implemented. It is likely that schools are using salad bars to offer a variety of fruits and vegetables to students, and schools with greater numbers of school-level resources and programs are better positioned for having salad bars.