***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: OBJECTIVE Owing to modern lifestyles , individuals are dependent on out-of-home eating . The catering sector can have a pivotal role in influencing our food choices . The objective of the present study was to examine the impact of a structured catering initiative on food choices in a public sector workplace setting . DESIGN A cross-sectional comparison study in two hospitals , one of which had implemented a catering initiative design ed to provide nutritious food while reducing sugar , fat and salt intakes . SETTING Two public sector hospitals in Cork , Irel and . SUBJECTS A total of 100 r and om participants aged 18 - 64 years ( fifty intervention , fifty non-intervention ) who consumed at least one main meal in the hospital staff canteen daily .  Each respondent was asked to complete one anonymous 24 h dietary recall and question naire . Food and nutrient analysis was conducted using WISP ( Weighed Intake Software Program ) . RESULTS Reported mean intakes of total sugars ( P < 0·001 ) , total fat ( P < 0·000 ) , saturated fat ( P < 0·000 ) and salt ( P < 0·046 ) were significantly lower in the intervention hospital when adjusted for age and gender . In the intervention hospital , 72 % of respondents , compared with 42 % in the non-intervention hospital , complied with the recommended under-3 daily servings of food high in fat and sugar ( P < 0·005 ) . In the intervention hospital , 43 % of respondents exceeded the recommended salt intake of 4 - 6 g/d , compared with 57 % in the non-intervention hospital . CONCLUSIONS Structured catering initiatives in the workplace are a potentially important option in the promotion of healthy food choices . Targeted public health programmes and health policy changes are needed to motivate caterers in the public sector and other industries to develop interventions that promote a healthy diet OBJECTIVE To assess the impact of a school-based nutrition education intervention aim ed at increasing the consumption of fruits and vegetables . DESIGN The intervention programme increased the provision of fruits and vegetables in schools and provided a range of point-of-purchase marketing material s , newsletters for children and parents , and teacher information . Curriculum material s at age 6 - 7 and 10 - 11 years were also developed and utilised . Evaluation was undertaken with groups of younger ( aged 6 - 7 years ) and older ( aged 10 - 11 years ) children . Methods included 3-day dietary records with interview and cognitive and attitudinal measures at baseline , with follow-up at 9 months , in intervention and control schools . SETTING The work was undertaken in primary schools in Dundee , Scotl and . SUBJECTS Subjects comprised 511 children in two intervention schools with a further 464 children from two schools acting as controls . RESULTS Children ( n=64 ) in the intervention schools had an average increase in fruit intake ( 133+/-1.9 to 183+/-17.0 g day(-1 ) ) that was significantly ( P<0.05 ) greater than the increase ( 100+/-11.7 to 107+/-14.2 g day(-1 ) ) estimated in children ( n=65 ) in control schools . No other changes in food or nutrient intake were detected . Increases in scores for variables relating to knowledge about fruits and vegetables and subjective norms were also greater in the intervention than in the control group , although taste preferences for fruits and vegetables were unchanged . CONCLUSIONS It is concluded that a whole school approach to increasing intakes of fruits and vegetables has a modest but significant effect on cognitive and attitudinal variables and on fruit intake The S and y Lake school-based diabetes prevention program is a culturally appropriate intervention for Ojibway-Cree students in the 3rd , 4th , and 5th grade s. This paper reports the results of the program in changing dietary intake behaviors and related psychosocial factors . Physical activity results are not included . The study was a pretest/post-test , single- sample design conducted during the 1998 - 1999 school year . A total of 122 students completed all 4 measurements ( anthropometry , 24-h dietary recall , and 2 question naires ) , at baseline and follow-up . There were significant increases ( P < 0.0001 ) in dietary intention , dietary preference , knowledge , and dietary self-efficacy , and in the curriculum knowledge scale between baseline and follow-up . Intervention exposure was significantly associated with being in the highest category for knowledge about foods that were low in dietary fat [ Medium Exposure odds ratio ( OR ) : 3.4 ; P < 0.05 ; High Exposure OR : 6.4 ; P < 0.05 ] , being in the highest category for dietary self-efficacy ( Medium Exposure OR : 3.7 ; P < 0.05 ; High Exposure OR : 3.9 ; P < 0.1 ) , being in the highest category for knowledge about curriculum concepts ( Medium Exposure OR : 3.4 ; P < 0.05 ; High Exposure OR : 9.4 : P < 0.01 ) , and for having met the age + 5 g dietary fiber intake/d ( Medium Exposure OR : 2.9 ; P < 0.1 ; High Exposure OR : 11.0 ; P < 0.01 ) . Exposure to the intervention was not associated with dietary intent or the percentage of energy from dietary fat . This program was associated with improved knowledge and the psychosocial factors related to healthy eating and dietary fiber intake of students in a remote First Nations community BACKGROUND This study evaluated the effects of a school-based dietary intervention program to increase fruit and vegetable consumption among fourth- grade rs . METHODS Twenty-eight elementary schools were r and omized to an immediate intervention condition or to a delayed intervention control condition . Measures of diet and psychosocial variables were collected at base line and 1 and 2 years post-baseline . The intervention included classroom , parent , and cafeteria components . RESULTS Mean daily consumption of fruit and vegetables was higher for the intervention children compared with controls at Follow-up 1 ( X(t ) = 3.96 , X(c ) = 2.28 ) and at Follow-up 2 ( X(t ) = 3.20 , X(c ) = 2.21 ) . Macro- and micronutrient changes favoring the intervention children were also observed at both Follow-up 1 and Follow-up 2 . Mean daily consumption of fruit and vegetables was higher for intervention parents compared with controls at Follow-up 1 ( X(t ) = 4.23,X(c ) = 3.94 ) but not at Follow-up 2 . CONCLUSIONS Strong effects were found for the High 5 intervention on fruit and vegetable consumption , on macro- and micro-nutrients , and on psychosocial variables . Future work is needed to enhance the intervention effects on parents ' consumption and to test the effectiveness of the intervention when delivered by classroom teachers OBJECTIVES This study examined the effects of pricing and promotion strategies on purchases of low-fat snacks from vending machines . METHODS  Low-fat snacks were added to 55 vending machines in a convenience sample of 12 secondary schools and 12 worksites . Four pricing levels ( equal price , 10 % reduction , 25 % reduction , 50 % reduction ) and 3 promotional conditions ( none , low-fat label , low-fat label plus promotional sign ) were crossed in a Latin square design . Sales of low-fat vending snacks were measured continuously for the 12-month intervention . RESULTS Price reductions of 10 % , 25 % , and 50 % on low-fat snacks were associated with significant increases in low-fat snack sales ; percentages of low-fat snack sales increased by 9 % , 39 % , and 93 % , respectively . Promotional signage was independently but weakly associated with increases in low-fat snack sales . Average profits per machine were not affected by the vending interventions . CONCLUSIONS Reducing relative prices on low-fat snacks was effective in promoting lower-fat snack purchases from vending machines in both adult and adolescent population OBJECTIVES A r and omized school based trial sought to increase fruit and vegetable consumption among children using a multicomponent approach . METHODS The intervention , conducted in 20 elementary schools in St. Paul , targeted a multiethnic group of children who were in the fourth grade in spring 1995 and the fifth grade in fall 1995 . The intervention consisted of behavioral curricula in classrooms , parental involvement , school food service changes , and industry support and involvement . Lunchroom observations and 24-hour food recalls  measured food consumption . Parent telephone surveys and a health behavior question naire measured psychosocial factors . RESULTS The intervention increased lunchtime fruit consumption and combined fruit and vegetable consumption , lunchtime vegetable consumption among girls , and daily fruit consumption as well as the proportion of total daily calories attributable to fruits and vegetables . CONCLUSIONS Multicomponent school-based programs can increase fruit and vegetable consumption among children . Greater involvement of parents and more attention to increasing vegetable consumption , especially among boys , remain challenges in future intervention research OBJECTIVES We evaluated an environmental intervention intended to increase sales of lower-fat foods in secondary school cafeterias . METHODS Twenty secondary schools were r and omly assigned to either an environmental intervention or a control group for a 2-year period . The intervention increased the availability of lower-fat foods and implemented student-based promotions . RESULTS A steeper rate of increase in sales of lower-fat foods in year 1 ( 10 % intervention vs -2.8 % control , P = .002 ) and a higher percentage of sales of lower-fat foods in year 2 ( 33.6 % intervention vs 22.1 % control , P = .04 ) were observed . There were no significant changes in student self-reported food choices . CONCLUSIONS School-based environmental interventions to increase availability and promotion of lower-fat foods can increase purchase of these foods among adolescents BACKGROUND 5 a Day for Better Health is a simple message encouraging people to eat more fruits and vegetables . The Seattle 5 a Day worksite investigators design ed and evaluated an intervention , organized on stages of behavioral change , to increase worksitewide fruit and vegetable consumption . METHODS We recruited 28 worksites with cafeterias and r and omized 14 to intervention and 14 to control . The intervention addressed both changes in the work environment and individual level behavior change . In each worksite , an employee advisory board , with study interventionist assistance , implemented the program . By surveying cross-sectional sample s of 125 employees per worksite , we compared worksite mean fruit and vegetable consumption at 2-year follow-up with that at baseline .  Unobtrusive site-level indicators including plate observation and cafeteria checklist  were also used . RESULTS The difference at 2 years was 0.5 for the intervention worksites and 0.2 for the control worksites , with an intervention effect of 0.3 daily serving ( P < 0.05 ) . Other measures of fruit and vegetable consumption , including unobtrusive indicators , supported the effectiveness of the intervention . CONCLUSIONS This simple 5 a Day intervention is feasible and acceptable for use in worksites with cafeterias . There was a significant differential increase in fruit and vegetable consumption in the intervention worksites . This kind of worksite intervention can achieve important health benefits on a population basis , because of its potential to reach large numbers of people The Cafeteria Power Plus project examined whether a cafeteria-based intervention would increase the fruit and vegetable ( FV ) consumption  of children . Twenty-six schools were r and omly assigned to either an intervention or control condition . Baseline lunch observations of a sample ( N = 1668 ) of first- and third- grade students occurred in the spring of 2000 ; follow-up was in the spring of 2002 . The intervention took place during two consecutive school years beginning in the fall of 2000 and consisted of daily activities ( increasing the availability , attractiveness , and encouragement for FV ) and special events ( kick-offs , samplings , challenge weeks , theater production , and finale meal ) . Training of food-service staff and cook managers was ongoing throughout the intervention phase . Students in the intervention schools significantly increased their total fruit intake . Process measures indicated that verbal encouragement by food-service staff was associated with outcomes . The outcomes suggest that multicomponent interventions are more powerful than cafeteria programs alone with this age group OBJECTIVE A two-phase study was conducted to determine the effect of an environmental intervention aim ed to increase the selection of low- and moderate-fat entrees  at school . DESIGN An evaluation of a school-wide intervention followed for two semesters . SUBJECTS Two schools of similar size and demographic data were r and omly assigned to either intervention or control . Participants were the children in these schools . INTERVENTION In Phase 1 , the rotation of existing entrees was modified such that one of three entree choices was low or moderate in fat . In Phase 2 , the number of competing high-fat entrees was reduced from two choices to one . MAIN OUTCOME MEASURES Data were : ( a ) entree fat content ( determined by a registered dietitian ) and ( b ) the aggregate entree selection s compiled from daily selection reports . STATISTICAL ANALYSES PERFORMED Frequency distributions were used to describe entree availability . Two-way analysis of variance indicated differences in the mean daily selection of low- , moderate- , and high-fat entrees . RESULTS In Phase 1 in the intervention school , the number of days that a low-fat entree was offered increased by 70 % , with no increase in the rate of selection of the low- or moderate-fat entrees . In Phase 2 
    Output:
    
Implementation of healthy food procurement policies in schools , worksites , hospitals , care homes , correctional facilities , government institutions , and remote communities increase markers of healthy eating .