摘要：We used a case study approach to examine the nutritional effect of a policy to increase fruit and vegetable consumption in the Students Today Achieving Results for Tomorrow after-school program. The snack menu was changed in 44 after-school programs serving 8000 low-income and ethnically diverse elementary-school students. A comparison of previous and current snack menus identified a significant increase in fruit servings (83%) and no change in vegetable servings. We discuss the unintended consequences resulting from the menu changes. Public health researchers have proposed policy changes to reduce the prevalence of obesity and diet-related chronic diseases. 1 , 2 These policy proposals range from imposing a tax on high-fat foods to making fresh fruits and vegetables more available in schools and workplaces. However, few researchers have investigated the effect of actual policy changes on the diet of high-risk populations, such as low-income and ethnic minority children. 3 – 6 We used a case study approach to examine a new organizational policy to increase fruit and vegetable servings during the snack period of the Students Today Achieving Results for Tomorrow (START) after-school program. START serves approximately 8000 low-income and ethnically diverse children at 44 public elementary schools in the greater Sacramento, Calif, area. START is a free program offered only at public elementary schools where a high proportion of families qualify for free or reduced-price school meals. About 33% of START participants are African American, 26% are Hispanic, 25% are Asian American, 14% are White, and 2% are of other race/ethnicity. 7 The city of Sacramento Parks and Recreation Department administers the program and trains and employs staff. Since its inception in 1995, START has served reimbursable afternoon snacks for at-risk youths as part of the US Department of Agriculture’s Child and Adult Care Food Program. The Afterschool Snacks Program provides funding to after-school centers to purchase afternoon snacks for children who are from low-income families and, in order for the center to qualify for the program, requires that the snack foods being served meet certain nutritional requirements. The snacks being served must contain at least 2 different components from the following: (1) a dairy product, (2) a serving of meat or meat alternative, (3) a serving of vegetable(s) or fruit(s) or full-strength vegetable or fruit juice, and (4) a serving of whole grain or enriched bread or cereal. In 2001, START administrators adopted the Children’s 5 a Day—Power Play! curriculum, which teaches children to eat at least 5 daily servings of fruits and vegetables. 8 The following year, they changed their snack vendor and implemented a policy that increased the servings of fruits and vegetables on after-school program snack menus to be more consistent with the 5 a Day guidelines (Table 1 ▶ ). TABLE 1— Previous and Current Sample Snack Menus Monday Tuesday Wednesday Thursday Friday Previous menu Yogurt and snack bar Chips and juice Peach cup and graham crackers Snack bar and juice Brownie and milk Current menu Chex Mix and pineapple juice Cheez-Its and celery with peanut butter Peanut butter crackers and apple Graham crackers and orange juice Animal crackers and grape juice Open in a separate window
