***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Aims : To estimate the impact of school fruit tuck shops on  children ’s consumption of fruit and sweet and savoury snacks . Design : Cluster r and omised effectiveness trial with school as the unit of r and omisation . Setting : 43 primary schools in deprived areas in south Wales and south-west Engl and with a range of school food policies . Intervention : Schools operated fruit tuck shops throughout one academic year . Control schools did not do so . Measures : Repeated cross-sections of children aged 9–11 years completed a  computerised 24-hour recall question naire  at baseline ( n = 1902 ) and at 1-year follow-up ( n = 1924 ) , when a brief question naire was also completed ( n = 1976 ) . Results : Approximately 70 000 fruits were sold in the 23 intervention schools over the year , equivalent to 0.06 fruits per student per day . Children in intervention schools were more likely to report eating fruit as a snack at school ‘ often ’ ( OR 1.49 , 95 % CI 1.15 to 1.95 ) . There were no significant differences in children ’s intake of fruit or other snacks . There was a significant interaction ( p<0.02 ) between the intervention group and school food policy : where students were only allowed to bring fruit to school , fruit consumption was 0.37 portions per day ( 0.11 to 0.64 ) higher in intervention schools , compared to 0.14 portions ( −0.30 to 0.58 ) where no food was allowed and −0.13 portions ( −0.33 to 0.07 ) where there were no restrictions . Conclusions : In isolation , fruit tuck shops were not effective in changing children ’s snacking behaviour in schools . However , the results suggest that fruit tuck shops had a greater impact when reinforced by school policies restricting the types of foods students were allowed to bring to school BACKGROUND  Boy Scouts  are an important channel to complement school-based programs to enable boys to eat more fruit , 100 % juice , and vegetables ( FJV ) for chronic disease prevention . The " 5 a Day Achievement Badge " program was presented on a pilot study basis to African-American Boy Scout troops in Houston . METHODS Troops were the unit of recruitment and r and om assignment to treatment and control groups . The badge program was presented in Fall 1997 by trained dietitians and included activities to increase availability and accessibility of fruit and vegetables  at scouts ' homes , increase  preferences for vegetables , and train in the preparation of FaSST ( fast , simple , safe , and tasty ) recipes . Weekly comic books demonstrated and reinforced what scouts were expected to do at home . A weekly newsletter with recipes was sent to parents . The program was revised and presented to the control group in Winter 1998 . Two 24-h recalls were the primary assessment tools . Telephone interviews were conducted with parents . RESULTS The intervention result ed in a 0.8 FJV serving difference ( post values of treatment versus control groups with pre value covaried ) . CONCLUSIONS The changes obtained suggest that the intervention was effective in promoting dietary change PURPOSE OBJECTIVES The purpose of this study is to report the impact of the three-year middle school-based HEALTHY study on intervention school vending machine offerings . There were two goals for the vending machines : serve only dessert/snack foods with 200 kilocalories or less per single serving package , and eliminate 100 % fruit juice and beverages with added sugar . METHODS Six schools in each of seven cities ( Houston , TX , San Antonio , TX , Irvine , CA , Portl and , OR , Pittsburg , PA , Philadelphia , PA , and Chapel Hill , NC ) were r and omized into intervention ( n=21 schools ) or control ( n=21 schools ) groups , with three intervention and three control schools per city . All items in vending machine slots were tallied twice in the fall of 2006 for baseline data and twice at the end of the study , in 2009 . The percentage of total slots for each food/beverage category was calculated and compared between intervention and control schools at the end of study , using the Pearson chi-square test statistic . RESULTS At baseline , 15 intervention and 15 control schools  had beverage and /or snack vending machines , compared with 11 intervention and 11 control schools at the end of the study . At the end of study , all of the intervention schools with beverage vending machines , but only one out of the nine control schools , met the beverage goal . The snack goal was met by all of the intervention schools and only one of the four control schools with snack vending machines . APPLICATIONS TO CHILD NUTRITION PROFESSIONALS The HEALTHY study 's vending machine beverage and snack goals were successfully achieved in intervention schools , reducing access to less healthy food items outside the school meals program . Although the effect of these changes on student diet , energy balance and growth is unknown , these results suggest that healthier options for snacks can successfully be offered in school vending machines OBJECTIVE To assess lunchtime provision of food and drink in English primary schools and to assess both choices and consumption of food and drink by pupils having school lunches . These findings were compared with similar data collected in 2005 . DESIGN Cross-sectional data collected between February and April 2009 . In each school , food and drink provision , including portion weights and number of portions of each item served at lunchtime , were recorded over five consecutive days . Caterers provided school lunchtime menus and recipes . SETTING Engl and . SUBJECTS A r and om selection of 6696 pupils having school lunches in a nationally representative sample of 136 primary schools in Engl and . RESULTS Compared with 2005 , schools in 2009 provided significantly more  fruit , fruit-based desserts , vegetables and salad , water and fruit juice  , and less ketchup , sauces and gravy , starchy foods cooked in fat , snacks and confectionery  ( P < 0·01 ) . Pupils were also making healthier choices , choosing an average of 2·2 portions of fruit and vegetables from their ' five a day ' , but about one-third to two-fifths of these were wasted . CONCLUSIONS Lunchtime food provision and consumption in primary schools have improved substantially since 2005 , following the introduction of new st and ards for school food in 2008 . However , improvements still need to be made to increase the Fe and Zn content and to decrease the Na content of recipes , and in encouraging pupils to eat more of the fruits and vegetables taken at lunchtime OBJECTIVES The effects of a  Boy Scout Five-A-Day Badge program on fruit juice ( FJ ) and low-fat vegetable ( LV ) consumption were evaluated using a two-condition ( treatment , active-attention-placebo-control ) group r and omized trial , with three data collection periods ( baseline , immediate post , 6-month post ) . METHODS Forty-two Boy Scout troops ( n=473 , 10- to 14-year-old Scouts ) in Houston , TX , were r and omly assigned to condition . The 9-week program included approximately 30 min of weekly troop time , plus approximately 25 min of weekly Internet programming . The intervention was delivered in two waves ( Spring and Fall ) . Data were collected in 2003 - 2004 , and analyses were completed in 2008 . Main outcomes were FJ and LV consumption ( vali date d food frequency question naire ) . FV self-efficacy , preferences , and home availability were also measured . RESULTS Significant increases in FJ consumption ( p=.003 ) , FJ home availability ( p=.009 ) , and LV self-efficacy ( p=.004 ) were observed among the intervention group immediately following the intervention but were not maintained 6 months later . CONCLUSION A Boy Scout troop-plus-Internet intervention promoting FJ and LV consumption result ed in short-term changes in FJ consumption among U.S. Boy Scouts . Future research should investigate ways to extend these results to LV and maintain the increases over time To increase opportunities for healthy eating and physical activity , US school districts participating in the National School Lunch Program were required to create a Local Wellness Policy ( LWP ) by June 2006 . The What 's Working project described the initial influence of this m and ate on nutrition environments and policies . In 2005 and 2007 ( before and after the m and ate went into effect ) , a survey about school features related to nutrition and physical activity was sent to a r and om sample of 45 low-income , rural elementary foodservice managers and principals . Schools averaged 204 students , 27 % Hispanic . Districts ' LWPs were coded for strength and comprehensiveness . In addition , key informant interviews were conducted with foodservice managers almost 2 years after the LWP went into effect . Three improvements were observed : increases in the percent of schools with policies stipulating predominantly healthy items be offered in classroom parties ( 21.4 % in 2005 vs 48.7 % in 2007 ) , daily fresh fruit offerings in the lunchroom ( 0.80 choices in 2005 vs 1.15 choices in 2007 ) , and the percent of schools using skinless poultry ( 27 % in 2005 vs 59 % in 2007 ) . LWPs were weakly worded and rarely addressed energy content . Nutrition guideline elements most commonly addressed included vending machines , school stores , and à la carte food offerings . Seveny-three percent of foodservice managers were familiar with their district 's LWP but did not perceive it changed lunchroom practice s. Although LWPs offer a framework to support opportunities for healthy eating , few evidence -based practice s were implemented as a direct result of the m and ate . Schools need more information about evidence -based practice s , as well as technical and financial assistance for implementation OBJECTIVE Previous studies on the relationship of dietary intake to the neighbourhood food environment have focused on access to supermarkets , quantified by geographic distance or store concentration measures . However , in-store food availability may also be an important determinant , particularly for urban neighbourhoods with a greater concentration of small food stores . This study synthesis es both types of information - store access and in-store availability - to determine their potential relationship to fruit and vegetable consumption . DESIGN Residents in four census tracts were surveyed in 2001 about their fruit and vegetable intake . Household distances to food stores in these and surrounding tracts were obtained using geographical information system mapping techniques . In-store fruit and vegetable availability was measured by linear shelf space . Multivariate linear regression models were used to measure the association of these neighbourhood availability measures with consumption . SETTING Four contiguous census tracts in central -city New Orleans . SUBJECTS A r and om sample of 102 households . RESULTS Greater fresh vegetable availability within 100 m of a residence was a positive predictor of vegetable intake ; each additional metre of shelf space was associated with 0.35 servings per day of increased intake . Fresh fruit availability was not associated with intake , although having a small food store within this same distance was a marginal predictor of fruit consumption . CONCLUSIONS The findings suggest the possible importance of small neighbourhood food stores and their fresh produce availability in affecting fruit and vegetable intake The Nutrition , Prevention and Health for Children and Teenagers in Aquitaine program is a regional implementation of the French National Program of Nutrition and Health ( PNNS ) . The first of two surveys of a representative sample of Aquitaine preschools was conducted in 2004 - 2005 . This survey showed that more than 2/3 of teachers offered a morning snack to their pupils at around 10 o'clock in the morning , mainly composed of sweet cakes , cookies , or c and ies . Following this initial survey , actions were implemented starting in September 2005 , aim ing to stop systematic morning snacks or improve their composition . The same survey was repeated during 2007 - 2008 in order to analyze the changes in morning snack practice s in preschools between 2004 - 2005 and 2007 - 2008 . Data were collected from teachers of Aquitaine 's preschools who filled out question naires . Schools were r and omly chosen according to their size and whether or not they belonged to a priority education zone ( ZEP ) . The results show that 57.9 % of teachers organized a morning snack in 2007 - 2008 , versus 68.7 % in 2004 - 2005 . In 2004 - 2005 , 22 % of teachers considered the morning snack as " unjustified " compared to 44 % in 2007 - 2008 . The composition of morning snacks improved : 17.7 % of teachers offered fruit and /or milk in 2007 - 2008 versus 8.5 % in 2004 - 2005 . Morning snacks composed of other foods ( such as sweets , chocolate pieces , cookies , pastries , bread , fruit juice ) decreased from 60.2 % in 2004 - 2005 to 40.2 % in 2007 - 2008 . In 2007 - 2008 , 19 % of the teachers reported that children had snacks in their schoolbag versus 34 % in 2004 - 2005 . The proportion of teachers reporting children having snacks in their schoolbag decreased from 34 % in 2004 - 2005 to 19 % in 2007 - 2008 . Comparison between these two surveys is encouraging as it shows an improvement of the perception and practice s of teachers regarding morning snacks . These results encourage the partners of this program to continue the fieldwork actions 
    Output:
    
The most promising strategies for improving the FV environment for children are through local school food service policies .
Similarly family interventions had no or small impact on home accessibility , with smaller impact on consumption .