To examine whether requiring children to place fruits and vegetables on their lunch trays increases consumption of these items.

Observational study that exploited naturally occurring variation between two school districts and a pre–post observational study at schools that changed their lunch policy mid-year.

Fifteen elementary schools from two school districts, one requiring students to place a fruit or vegetable on their tray and one that does not. In addition, three schools that implemented a default option part way through the school year.

Students at eighteen elementary schools (41 374 child-day observations) across the two experiments.

Requiring that fruits and vegetables be placed on each child's tray increased the fraction of children who ate a serving of fruits or vegetables by 8 percentage points (P < 0·01) but led to an extra 0·7 servings being thrown away per lunch served (P < 0·01). The default option approach cost $US 1·72 to get one additional child to eat one serving of fruits and vegetables for 1 d. However, when default options were combined with a small rewards programme the efficacy of both interventions increased.

A default option, as a stand-alone programme, had only a limited impact on fruit and vegetable consumption but was much less cost-effective than other approaches. Schools requiring children to take fruits and vegetables with their lunch might consider adopting additional interventions to ensure that the additional items served do not end up being thrown away.

To study the feasibility of iron and folic acid (IFA) supplementation among tribal adolescent girls and identify factors associated with high compliance.

Intervention study with IFA supplementation among tribal adolescent girls of Bijadandi block, Mandla district, Madhya Pradesh, India. Girls (n 274) from twelve villages randomly selected out of 100 potential villages received daily tablets containing iron (iii) hydroxide polymaltose complex equivalent to 100 mg of elemental Fe and 350 μg of folic acid (commercially available as Feritas tablets, marketed by Intas Pharmaceutical Ltd, India). IFA was given for 100 d and supervised by school teachers and anganwadi workers. Compliance was measured using cards and interviews.

Community-based iron supplementation programme.

Tribal adolescent girls aged 12–19 years.

In total 233 girls completed the study. Prevalence of anaemia was reduced from 94 % at baseline to 69 % after the intervention. Compliance rate (>80 tablets) was 89 %. Minor side-effects were reported by three girls, yet they consumed >80 tablets. Factors associated with compliance included fasting during the local festival (χ2 = 72·74, df 3; P < 0·0001) and counselling (χ2 = 72·74, df 3; P < 0·0001). Other qualitative factors like social mobilization, timely supply of tablets, quality of tablets (blister pack) and availability of teachers and anganwadi workers were also associated with the compliance and feasibility.

High compliance indicates that IFA supplementation with tablets is feasible among the tribal adolescent girls of Bijadandi block, Mandla district.

The aim of the present study was to explore the implementation of nutrition recommendations made in the 2010 Institute of Medicine (IOM) report, Child and Adult Care Food Program: Aligning Dietary Guidance for All, in school-based after-school snack programmes.

A descriptive study.

One large suburban school district in Minneapolis, Minnesota, USA.

None.

Major challenges to implementation included limited access to product labelling and specifications inconsistent with the IOM's Child and Adult Care Food Program (CACFP) recommendations, limited access to healthier foods due to current school district buying consortium agreement, and increased costs of wholegrain and lower-sodium foods and pre-packaged fruits and vegetables.

Opportunities for government and industry policy development and partnerships to support schools in their efforts to promote healthy after-school food environments remain. Several federal, state and industry leadership opportunities are proposed: provide product labelling that makes identifying snacks which comply with the 2010 IOM CACFP recommended standards easy; encourage compliance with recommendations by providing incentives to programmes; prioritize the implementation of paperwork and technology that simplifies enrolment and accountability systems; and provide support for food safety training and/or certification for non-food service personnel.

To identify factors associated with food insecurity and household eating patterns among American-Indian families with young children.

Cross-sectional survey among households with young children that were receiving emergency food services. We collected information on food insecurity levels, household eating patterns, experiences with commercial and community food sources and demographics, and used multivariate regression techniques to examine associations among these variables.

Four Southwestern American-Indian reservation communities.

A total of 425 parents/caregivers of young children completed the survey.

Twenty-nine per cent of children and 45 % of adults from households participating in the survey were classified as ‘food insecure’. Larger household size was associated with increased food insecurity and worse eating patterns. Older respondents were more likely than younger respondents to have children with food insecurity (relative risk = 2·19, P < 0·001) and less likely to have healthy foods available at home (relative risk = 0·45, P < 0·01). Consumption of food from food banks, gas station/convenience stores or fast-food restaurants was not associated with food insecurity levels. Respondents with transportation barriers were 1·46 times more likely to be adult food insecure than respondents without transportation barriers (P < 0·001). High food costs were significantly associated with greater likelihoods of adult (relative risk = 1·47, P < 0·001) and child (relative risk = 1·65, P < 0·001) food insecurity.

Interventions for American-Indian communities must address challenges such as expense and limited transportation to accessing healthy food. Results indicate a need for services targeted to older caregivers and larger households. Implications for innovative approaches to promoting nutrition among American-Indian communities, including mobile groceries and community gardening programmes, are discussed.