***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: OBJECTIVES We evaluated a low-cost strategy for schools to improve the convenience and appeal of drinking water . METHODS We conducted a group-r and omized , controlled trial in 10 Boston , Massachusetts , schools in April through June 2013 to test a cafeteria-based intervention . Signage promoting water and disposable cups were installed near water sources . Mixed linear regression models adjusting for clustering evaluated the intervention impact on average student water consumption over 359 lunch periods . RESULTS The percentage of students in intervention schools  observed drinking water during lunch nearly doubled from baseline to follow-up compared with controls ( + 9.4 % ; P < .001 ) . The intervention was associated with a 0.58-ounce increase in water intake across all students ( P < .001 ) . Without cups , children were observed drinking 2.4 ( SE = 0.08 ) ounces of water from fountains ; with cups , 5.2 ( SE = 0.2 ) ounces . The percentage of intervention students observed with sugar-sweetened beverages  declined ( -3.3 % ; P < .005 ) . CONCLUSIONS The current default of providing water through drinking fountains in cafeterias results in low water consumption . This study shows that an inexpensive intervention to improve drinking water 's convenience by providing cups can increase student water consumption BACKGROUND Price can influence food purchases , which can influence consumption . Limited laboratory research has assessed the effect of price changes on food purchases , and no research on individual differences that may interact with price to influence purchases exists . OBJECTIVE We aim ed to assess the influence of price changes of low-energy-density ( LED ) and high-energy-density ( HED ) foods on mother 's food purchases in a laboratory food-purchasing analogue . DESIGN Mothers were r and omly assigned to price conditions in which the price of either LED or HED foods was manipulated from 75 % to 125 % of the reference purchase price , whereas the price of the alternative foods was kept at the reference value .  Mothers completed purchases for 2 income levels ( $ 15 or $ 30 per family member ) . RESULTS Purchases were reduced when prices of LED ( P < 0.01 ) and HED ( P < 0.001 ) foods were increased .  Maternal BMI  interacted with price to influence purchases of HED foods when the price of  HED  foods increased ( P = 0.016 ) and interacted with price to influence purchases of LED foods when the price of HED foods increased ( P = 0.008 ) . CONCLUSION These results show the relevance of considering price change as a way to influence food purchases of LED compared with HED foods and the possibility that individual differences may influence the own-price elasticity of HED foods and substitution of LED for HED foods Project FIT was a two-year multi-component nutrition and physical activity intervention delivered in ethnically-diverse low-income elementary schools in Gr and Rapids , MI . This paper reports effects on children ’s nutrition outcomes and process evaluation of the school component . A quasi-experimental design was utilized . 3rd , 4th and 5th- grade students ( Yr 1 baseline : N = 410 ; Yr 2 baseline : N = 405 ; age range : 7.5–12.6 years ) were measured in the fall and spring over the two-year intervention . Ordinal logistic , mixed effect models and generalized estimating equations were fitted , and the robust st and ard errors were utilized . Primary outcomes favoring the intervention students were found regarding consumption of fruits , vegetables and whole grain bread during year 2 . Process evaluation revealed that implementation of most intervention components increased during year 2 . Project FIT result ed in small but beneficial effects on consumption of fruits , vegetables , and whole grain bread in ethnically diverse low-income elementary school children OBJECTIVES : Dishware size is thought to influence eating behaviors , but effects on children ’s self-served portion sizes and intakes have not been studied . We aim ed to evaluate whether larger dishware increased children ’s  self-served portion sizes and intake during meals . METHODS : A within-subjects experimental design was used to test the effects of dishware size ( ie , plates and bowls ) on children 's self-served portion sizes and intakes in a naturalistic setting . Subjects were predominantly African American elementary school – aged children ( n = 42 ) observed on repeated occasions during school lunch . Children served themselves an entree and side dishes using either child- or adult-size dishware , which represented a 100 % increase in the surface area of plates and volume of bowls across conditions . Condition order was r and omly assigned and counterbalanced across 2 first- grade classrooms . Entrées of amorphous and unit form were evaluated on separate days . Fruit and vegetable side dishes were evaluated at each meal . Fixed portions of milk and bread were provided at each meal . RESULTS : Children served more energy ( mean = 90.1 kcal , SE = 29.4 kcal ) when using adult-size dishware . Adult-size dishware  promoted energy intake indirectly , where every additional calorie served result ed in a 0.43-kcal increase in total energy intakes at lunch ( t = 7.72 , P = .001 ) . CONCLUSIONS : Children served themselves more with larger plates and bowls and consumed nearly 50 % of the calories that they served . This provides new evidence that children ’s self-served portion sizes are influenced by size-related facets of their eating environments , which , in turn , may influence children ’s energy intake BACKGROUND It is often assumed that children avoid fruit in school cafeterias because of higher relative prices and preferences for other foods . Interviews with children reveal that eating whole fresh fruit can be difficult for those with small mouths or braces . Older girls find whole fruits messy and unattractive to eat . PURPOSE To determine the effect of offering pre-sliced fruit in schools on selection and intake . DESIGN Three of six schools were assigned r and omly to serve apples in slices .  Three control schools  served apples whole . Selection , consumption , and waste of apples were measured prior to and during treatment . SETTING / PARTICIPANTS Cafeterias in six public middle schools in Wayne County NY in 2011 . Participants included all students who purchased lunch on days when data were collected . INTERVENTION Treatment schools were provided with a st and ard commercial fruit slicer , and cafeteria staff members were instructed to use it when students requested apples . Trained research ers recorded how much of each apple was consumed and how much was wasted in both control and treatment schools . MAIN OUTCOME MEASURES Daily apple sales , percentage of an apple serving consumed per student , and percentage of an apple serving wasted per student . RESULTS Data were analyzed in 2012 . Schools that used fruit slicers to pre-slice fruit increased average daily apple sales by 71 % compared to control schools ( p<0.01 ) . The percentage of students who selected apples and ate more than half increased by 73 % ( p=0.02 ) at schools that served pre-sliced fruit , and the percentage that wasted half or more decreased by 48 % ( p=0.03 ) . CONCLUSIONS Sliced fruit is more appealing to children than whole fruit because it is easier and tidier to eat . This study applies the principle of convenience from behavioral economics and provides an example of a scalable , low-cost environmental change that promotes healthy eating and decreases waste OBJECTIVES : This study examined the long-term effects on BMI of a r and omized controlled trial of  Students for Nutrition and Exercise  , a 5-week , middle school – based obesity prevention intervention combining school-wide environmental changes , encouragement to eat healthy school cafeteria foods , and peer-led education and marketing . METHODS : We r and omly selected schools from the Los Angeles Unified School District and assigned 5 to the intervention group and 5 to a wait-list control group . Of the 4022 seventh- grade rs across schools , a total of 1368 students had their height and weight assessed at baseline and 2 years ’ postintervention . RESULTS : A multivariable linear regression was used to predict BMI percentile at ninth grade by using BMI percentile at seventh grade , school indicators , and sociodemographic characteristics ( child gender , age , Latino race/ethnicity , US-born status , and National School Lunch Program eligibility [ as a proxy for low-income status ] ) . Although the Students for Nutrition and Exercise intervention did not exhibit significant effects on BMI percentile overall , intervention students who were classified as obese at baseline ( in seventh grade ) showed significant reductions in BMI percentile in ninth grade ( b = –2.33 percentiles ; SE , 0.83 ; P = .005 ) compared with control students . This outcome translated into ∼9 pounds ( ∼4.1 kg ) lower expected body weight after 2 years for an obese student in the intervention school at the mean height and age of the sample at baseline . CONCLUSIONS : Multilevel school-based interventions can have long-term effects on BMI among students who are obese . Future research should examine the mechanisms by which school-based obesity interventions can affect BMI over time 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 BACKGROUND The school lunch environment is a prime target for increasing a child 's consumption of fresh fruits and vegetables ( F/V ) . Salad bars are heavily encouraged in schools ; however , more research is needed to examine the context s in which salad bars promote consumption of F/V among students . OBJECTIVE To compare the amount of fresh F/V self-served , consumed , and wasted by students during lunch at schools with differing salad bar  placement : inside or outside of the serving line . DESIGN Cross-sectional plate waste study in which salad bar placement differed between schools . PARTICIPANTS / SETTING A r and om sample of middle school students ( N=533 ) from six schools ( three schools per district ) . MAIN OUTCOME MEASURES Amount of fresh F/V taken , consumed , and wasted . STATISTICAL ANALYSES Negative binomial multivariable regression examined placement of salad bars , adjusting for sex , grade , race/ethnicity , free/reduced status , day of the week , and nesting of students within schools . RESULTS Almost all students ( 98.6 % ) in the schools with salad bars inside serving lines self-served F/V compared with only 22.6 % of students in the schools with salad bars outside lines ( adjusted prevalence ratio=5.38 ; 95 % CI 4.04 to 7.17 ) . Similarly , students at schools with salad bars inside the line had greater prevalence of consuming any F/V compared with students in schools with salad bars outside the line ( adjusted prevalence ratio=4.83 ; 95 % CI 3.40 to 6.81 ) . On average , students with the salad bar outside the line wasted less F/V compared with those with salad bars inside the line ( 30 % vs 48 % , respectively ) . CONCLUSIONS Few students visited salad bars located outside the lunch line . Salad bars inside the lunch line result ed in significantly greater fresh F/V taken , consumed , and wasted . When possible , schools should try to include salad bars inside the line to increase students ' exposure to PURPOSE To conduct a r and omized controlled trial of Students for Nutrition and eXercise  , a 5-week middle school-based obesity-prevention intervention combining school-wide environmental changes , multimedia , encouragement to eat healthy school cafeteria foods , and peer-led education . METHODS We r and omly selected schools ( five intervention , five waitlist control ) from the Los Angeles Unified School District . School records were obtained for number of fruits and vegetables served , students served lunch , and snacks sold per attending student , representing an average of 1,515 students ( SD = 323 ) per intervention school and 1,524 students ( SD = 266 ) per control school . A total of 2,997 seventh- grade rs ( 75 % of seventh- grade rs across schools ) completed pre- and postintervention surveys assessing psychosocial variables . Consistent with community-based participatory research principles , the school district was an equal partner , and a community advisory board provided critical input . RESULTS Relative to control schools , intervention schools showed significant increases in the proportion of students served fruit and lunch and a significant decrease in the proportion of students buying snacks at school . Specifically , the intervention was associated with relative increases of 15.3 % more fruits served ( p = .006 ) , 10.4 % more lunches served ( p < .001 ) , and 11.9 % fewer snacks sold ( p < .001 ) than would have been expected in its absence . Pre-to-post intervention , intervention school students reported more positive attitudes about cafeteria food ( p = .02 ) and tap water ( p = .03 ) , greater obesity- 
    Output:
    
Conclusions This review found successful system 1 type school cafeteria interventions to be more common than system 2 type interventions and system 2 type interventions are less effective than system 1