MIDDLE SCHOOL STUDENT PERCEPTIONS OF SCHOOL LUNCH FOLLOWING

REVISED FEDERAL SCHOOL MEAL GUIDELINES

A THESIS

SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS

FOR THE DEGREE OF MASTER OF SCIENCE

IN THE GRADUATE SCHOOL OF THE

TEXAS WOMAN’S UNIVERSITY

COLLEGE OF HEALTH SCIENCES

BY

MARIA M. KJOSEN, B.S., R.D.

DENTON, TX

DECEMBER 2014

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ACKNOWLEDGMENTS

I would like to acknowledge the committee members of this study for their

exceptional efforts to convey advice and offer encouragement during the process of

completing this thesis. Thank you, Dr. Karen Cullen for providing the data used in this

study and for the outstanding support and guidance you provided from day one. Your

quick responses and exceptional advice has helped me tremendously. Thank you, Dr.

Carolyn Moore, for agreeing to chair this thesis committee, and accommodating my

timeline and needs throughout the process. I am also thankful to Dr. Cynthia Warren for

agreeing to sit on this thesis committee despite the last minute request. Finally, I am

thankful to my parents who have supported and encouraged my personal and academic

goals from day one.

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ABSTRACT

MARIA M. KJOSEN

MIDDLE SCHOOL STUDENT PERCEPTIONS OF SCHOOL LUNCH FOLLOWING

REVISED FEDERAL SCHOOL MEAL GUIDELINES

DECEMBER 2014

Since the revisions to the school meal guidelines in 2012, few studies have

assessed student perceptions about school lunch. During the 2012-2013 school year,

1,867 middle school students (grades 6th, 7th, and 8th) in the Houston, Texas area

completed questionnaires regarding various aspects of school lunch. The questionnaires

examined if perceptions of school lunch differed based on gender, grade level, income, or

frequency of eating school lunch. Analysis of variance was used in the analyses. Sixth

graders (more than any other grade) reported greater satisfaction for meal perceptions

(including taste, presentation, and variety) (P < .001), while students from low-income

schools reported less satisfaction in this category (P< .001). Sixth graders, and boys, were

significantly more likely to report selecting and consuming fruits, vegetables, and whole

grains (P < .001, P < .05 respectively). Finally, students from low-income schools, and

students who consumed school lunch more frequently were more satisfied with staff

attentiveness (P < .001, P < .001 respectively). The most popular reason for eating

school lunch was “I am hungry”. These results demonstrate the need for further

investigation and intervention in order to accommodate the varying student perceptions

of school lunch.
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 TABLE OF CONTENTS

Page

ACKNOWLEDGMENTS ............................................................................................... iv

ABSTRACT ..................................................................................................................... v

LIST OF TABLES ........................................................................................................viii

Chapter

I. INTRODUCTION...........................................................................................1

Statement of the Problem.................................................................................1

Purpose of the Study........................................................................................3
Hypotheses.......................................................................................................4

II. LITERATURE REVIEW ............................................................................... 5

Childhood Overweight and Obesity ............................................................... 5

National School Lunch Program .................................................................... 6
Revised Federal School Meal Requirements .................................................. 7
Perceptions of School Lunch .......................................................................... 9
Gender .................................................................................................... 9
Grade Level .......................................................................................... 10
Income .................................................................................................. 11
Frequency of School Lunch.................................................................. 11
Reasons for Eating School Lunch ................................................................ 12

III. METHODOLOGY ....................................................................................... 13

Participants ................................................................................................... 13
Instrument ..................................................................................................... 13
Statistical Tests ............................................................................................. 14

IV. RESULTS ..................................................................................................... 16

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 V. DISCUSSION............................................................................................... 24

Meal Perceptions .......................................................................................... 24

Fruits, Vegetables, Whole Grains ................................................................. 25
Staff Attentiveness........................................................................................ 26
Top Reasons For Eating School Lunch ........................................................ 27
Limitations .................................................................................................... 27

VI. CONCLUSIONS AND IMPLICATIONS FOR FUTURE RESEARCH .... 28

REFERENCES ............................................................................................................... 31

APPENDICES
A. Institutional Review Board, Baylor College of Medicine Approval................. 40
B. Questionnaire..................................................................................................... 42
C. Institutional Review Board Exempt Approval .................................................. 44

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LIST OF TABLES

Table Page

1. Scales of School Lunch Experience Survey ........................................................... 16

2. Demographic Characteristics of 6th to 8th Grade Participants ................................. 18

3. Perceptions of School Meals Based on Gender ...................................................... 19

4. Perceptions of School Meals Based on Grade Level .............................................. 20

5. Perceptions of School Meals Based on School’s Income Classification ................ 21

6. Perceptions of School Meals Based on Frequency of Eating School Lunch .......... 22

7. Top 5 Reasons for Eating School Lunch ................................................................ 23

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CHAPTER I

INTRODUCTION

Statement of the Problem

American schools are continuously implementing new strategies to provide

healthy, well-balanced meals to school-aged children. The heightened rate of childhood

overweight and obesity in America gives justification for providing healthy meals in

schools. Nearly 31.8% of children in the United States (U.S.) from ages 2-18 years are

considered overweight or obese (Ogden, Carroll, Kit, & Flegal, 2014). Energy imbalance,

due to poor diet and physical inactivity, is a major contributor to the increases in

childhood obesity seen during the past two decades (Institute of Medicine, Food and

Nutrition Board, 2007).

There are numerous detrimental consequences of childhood obesity. Physically,

an overweight or obese adolescent may face unfavorable health outcomes including

obstructive sleep apnea, type 2 diabetes, hypertension, dyslipidemia, and the metabolic

syndrome (Daniels, Arnett, & Eckel, 2005). Excessive body weight may also lead to

negative psychosocial experiences. Obese children may feel they are socially and

athletically less capable, less attractive, and less valuable than their non-obese peers

(Riazi, Shakoor, Dundas, Eiser & McKenzie, 2010). There is also an economic burden

connected to the high childhood obesity rate. In 2005, approximately 237 million dollars

was spent for inpatient costs related to childhood obesity (Trasande, Yinghua, Fryer &

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Weitzman, 2009). This was a dramatic increase from an estimated 126 million spent in

childhood hospitalization with primary diagnosis of obesity in 2001. Since eating and

food choice patterns established during youth likely influence long-term health behaviors,

it is essential that health interventions begin prior to sixth grade, before behavioral

patterns are resistant to change (Kelder, Perry, Klepp & Lytle, 1994).

The United States Department of Agriculture launched the National School Lunch

Program (NSLP) in 1946, and it has since been a major influence on the diet quality of

American school children. Over the years, U.S. Congress has passed legislation to require

schools in the NSLP to comply with nutritional requirements in an attempt to improve

energy balance via healthful eating in children and adolescents. The most recent federal

requirements mandated by the 2010 Healthy, Hunger Free Kids Act, places stricter

guidelines on participating schools (Byker, Pinard, Yaroch & Seranno, 2013). Newly

implemented in the 2012-2013 school year, research is needed to determine the impact of

these obligations.

One challenge school nutrition programs face is the gradual decline of school

lunch participation in high schools (Gilmore, Hutchinson & Brown, 2000). Earlier

research reveals that the decline in school lunch participation begins during middle

school years (McConnell, Matta, & Shaw, 1997). Adolescents around the middle school

age begin to make decisions independent of their parents, such as whether or not they will

eat school lunch on a given day. By this age, adolescents are very aware of foods due to

constant exposure from grocery stores, restaurants, television, and other advertising

media. Through these experiences, they are able to appreciate quality, recognize brands,
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expect good customer services, and independently make decisions about school lunch

(Castillo & Lofton, 2012). Nonetheless, factors associated with food choices are not the

same for all adolescents, and may differ on the basis of gender, age or the overall

personal importance of health (Shannon, Story, Fulkerson & French, 2002). Ultimately,

school nutrition professionals need to investigate the perceptions, wants, and needs of

middle school students in regards to school foodservice, so they can please these

customers and maintain participation once students enter high school (Roseman &

Niblock, 2006). It is also important for schools to assess the perceptions of students to

ensure that healthy food choices are actually selected and consumed.

Purpose of the Study

The purpose of the study was to assess the perceptions of students from 6th to 8th

grade in regards to different aspects of school lunch. Student feedback can be

instrumental in developing strategies to increase participation and customer satisfaction.

Following new meal requirements, the objective was to determine overall student

opinions of school lunch, portion sizes, taste, freshness, appearance, amount of choices

available, and general atmosphere of the cafeteria. Using the data collected, the purpose

of this study was to determine if these perceptions differed based on gender, grade level,

income, or frequency of eating school lunch. The top reasons for why students choose to

eat school lunch were also examined.

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Hypotheses

1. H0: There will be no differences in perceptions about school meals based on

the students’ gender.

2. H0: There will be no differences in perceptions about school meals based on

the students’ grade level.

3. H0: There will be no differences in perceptions about school meals based on

the school’s overall student income status.

4. H0: There will be no differences in perceptions about school meals based on

the frequency of eating school meals.

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CHAPTER II

LITERATURE REVIEW

Childhood Overweight and Obesity

As the rate of adult overweight and obesity increases in the United States, there is

a similar rising trend for children. Body mass index (BMI) is a measure used to define

childhood overweight and obesity; BMI is calculated using weight in kilograms divided

by height in meters squared (kg/m2). However, a child’s weight status is based upon an

age and gender specific percentile for BMI rather than the BMI categories used for adults

because children’s body composition differs between boys and girls and varies as they

grow (Centers for Disease Control and Prevention [CDC], 2013). Using the 2000 CDC

BMI-for-age-growth charts for children, overweight is defined as a BMI greater than or

equal to the 85th percentile. A BMI greater than or equal to the 95th percentile is

categorized as obese (Barlow and the Expert Committee, 2007).

In the United States, data from the National Health and Nutrition Examination

Survey (NHANES) estimates progress towards reducing the national prevalence of

overweight and obesity. Based on the most recent NHANES data from 2011-2012, about

17% of US children and adolescents aged 2-19 years of age were considered obese (at or

above the 95th percentile) and 31.8% were considered overweight and/or obese (at or

above the 85th percentile)(Ogden, Carroll, Kit, & Flegal, 2014). When comparing this

data to data from 1970, overweight and obesity levels have nearly tripled (CDC, 2013).

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Nevertheless, the prevalence of obesity observed in children and adolescents in 2011-

2012 was unchanged when compared with data from 2003-2004, which suggests that the

rates may be starting to plateau (Ogden, Carroll, Kit & Flegal, 2014).

Eating practices of school-aged youth is a lifestyle behavior linked to childhood

overweight/obesity. Overweight and obese adolescents may face bone and joint

problems, sleep apnea and psychological problems such as discrimination, rejection and

low self-esteem (Daniels, Arnett, & Eckel, 2005). Evidence of poor bone health,

increasing rates of pre-diabetes and cardiovascular risk factors in children suggest that

health interventions need to occur during childhood due to the fact that obese adolescents

have an increasingly greater risk to become obese as adults (CDC, 2013). Overweight

and obese adolescents have an estimated 70 percent chance of being overweight or obese

as an adult, which increases to 80 percent if one or more parent is overweight or obese

(U.S. Department of Health & Human Services, 2005).

National School Lunch Program

The National School Lunch Program (NSLP) is a federal program operating in

public and not-for-profit private schools and provides meals which are low cost or free

and nutritionally balanced (United States Department of Agriculture [USDA], 2013). The

legislation, passed by the U.S. Congress in 1946, was in response to claims that many

American soldiers were rejected for the World War II military draft because of diet-

related health problems. More than one-third of the men examined for the draft for World

War II were rejected because of poor nutritional status (Martin, 1999). In order to

participate in the program, schools are required to comply with regulations intended to
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ensure that meals served in these schools are healthful and nutritious. The NSLP offers

free or reduced price (FRP) meals to participating children from low-income families.

The USDA then provides subsidies to the schools for all full price, reduced price, or free

meals that meet federally set nutrition requirements (Institute of Medicine, Food and

Nutrition Board, 2007).

In 2012, an average of 31.6 million children participated in the National School

Lunch Program per day (USDA, 2013). Youth between the ages of 5 and 18 may

consume up to one half of their daily nourishment in the school setting (Briefel, Wilson

& Gleason, 2009). Additionally, most American children attend school 180 days per year

for six or more hours a day from ages 5-18 years. No other institution has as much

continuous and intensive contact with children during their first two decades of life

(Pearson & Fox, 2007). Because of the widespread availability, the NSLP has a unique

ability to impact the nutritional quality of children’s diets.

Revised Federal School Meal Requirements

The foundation of the NSLP remains to provide nutritious and affordable meals to

American children and adolescents. In the early 1990’s, the first School Nutrition

Dietary Assessment Study (SNDA-I) was conducted to assess the nutritional quality of

school lunches. The assessment determined that although average daily intake met or

exceeded the Recommended Dietary Allowance (RDA) for most vitamins and minerals,

it unfortunately exceeded recommended levels for total fat, saturated fat, and sodium

(Clark & Fox, 2009). Recognizing the significant role that school nutrition can play in

protecting health, recent federal initiatives have focused on school-based nutrition

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interventions aimed at improving the quality of foods served in schools. New regulations

indicate specific fat limitations while also paying greater attention to sodium, cholesterol,

and fiber content (Institute of Medicine, Food and Nutrition Board, 2007).

In 2012, the USDA implemented revised nutritional guidelines for school meals

(USDA Food and Nutrition Services, 2012). This decision was mandated by the 2010

Healthy, Hunger-Free Kids Act, and the recommendations align school meals with the

2010 Dietary Guidelines for Americans (Byker, Pinard, Yaroch & Seranno, 2013).

According to the Congressional Budget Office, about $1.5 billion over 5 years will be

provided in performance-based funding, which includes!the six-cent per lunch

performance-based reimbursement increase (USDA, 2011). The legislation requires

schools to increase the availability of fruits, vegetables (including different subgroups)

and whole grains in meals served to students. There are now minimum and maximum

calorie ranges the school district must meet. Additionally, schools can now only serve

lower-fat milk options and need to reduce the saturated fat, trans fats, and sodium content

of the meals (USDA Food and Nutrition Services, 2012). School food authorities must

offer five meal components daily, including fruits, vegetables, grains, meat/meat

alternatives, and milk. However, the “offer versus serve” method allows students to

choose three of the five provided options (or all five, if desired) on their own, as long as

one of the options is a fruit or vegetable serving (Byker, Pinard, Yaroch, & Seranno,

2013). The federal legislation mandated implementation of the new requirements in

school year 2012-2013. The changes should improve the diet of school-aged children.

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Perceptions of School Lunch

Appealing to the child customer is not an easy task. Today, most children are

raised in an atmosphere of fast food. Children consume many meals away from home

with restaurant and carry-out purchases comprising approximately 49% of the average

family’s food bill (You, Zhang, Davy, Carlson & Biing-Hwan, 2009). Development of

strategies to promote adoption of healthy eating behaviors requires an understanding of

eating behavior and students’ view of school lunch. One study indicated that the majority

of students did not perceive foods available at the school to be healthy and only 33%

responded that the school lunch was always or often healthy (Gosliner, Madsen,

Woodward-Lopez, & Crawford, 2011). Furthermore, over two-thirds of these students

reported that fresh fruit was one of the top items they considered important to buy. Over

half of them also reported green salad and other vegetables on the list of important items

available for purchase. Unfortunately, while students want healthy options to be

available, consumption of fruits and vegetables at school is surprisingly low (Gosliner et

al, 2011; Cashman, Tripurana, Englund, & Bergman, 2010).

Gender

Boys tend to have a higher consumption of food groups than girls, significant for

the grain, dairy, and meat groups (Cashman, Tripurana, Englund & Bergman, 2010).

Nevertheless, while girls stated a greater preference for fruits and vegetables than boys

(Cullen, Thompson, Watson & Nicklas, 2005), actual plate waste may indicate that there

is no significant gender difference in consumption of fruit and vegetables (Cashman,

Tripurana, Englund & Bergman, 2010). Girls were more likely than boys to report weight
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control as a motive for eating fruit and vegetables; however, only about 33% of all girls

cited this reason (Cullen, 2005). Furthermore, focus groups suggest that boys’ decisions

to eat certain foods stems from a desire to have more muscle, gain or lose weight, and to

grow taller (Neumark-Sztainer, Story, Perry & Casey, 1999). Despite lower consumption,

one study indicated that girls are more satisfied with school meals compared to boys

(Meyer, 2000b). This satisfaction may be due to gender differences in regards to

developmental maturity levels between boys and girls at varying ages. Accordingly, girls

may be more willing to try new foods at an earlier age (Meyer, 2000b).

Grade Level

As students grow and develop, their wants and needs for school foodservice change,

along with the changes they experience in themselves and in their environments (Meyer,

2000a). There are some differences among grades for satisfaction in adolescents eating

school lunch. For example, in middle school, students in grade 6 were more satisfied than

students in grades 7 and 8. This difference in satisfaction may be due to conditioning

factors, as the school lunch program characteristics in middle schools are new to these

students, and they have not become uninterested in the menu and surroundings (Meyer,

2000a). For this reason, modification to school menus are the most frequently made

changes to school nutrition programs (American School Food Service Association, 1998).

Nevertheless, there is some conflicting research that shows fifth grade students actually

have better food group consumption patterns compared to students in younger grades

(Cashman, Tripurana, Englund, & Bergman, 2010). Admittedly, this may not be related

to satisfaction, but rather the fact that older children simply require more food. However,
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researchers suggest that this could also be related to repeated exposure to school lunches

over the past years. For instance, Birch and Fisher (1998) found that repeated exposure to

foods influence children’s food acceptance patterns. Thus, fifth grade students may

become familiar with the school meals and have fewer inhibitions for consuming these

foods (Cashman, Tripurana, Englund, & Bergman, 2010).

Income

In 2012-2013, an average of 70 percent of all lunches served were served to

students who qualified for a free or reduced price meal (USDA, 2013). Families that

qualify for free meals have an annual household income at or below 130 percent of the

poverty line. For reduced price meals, annual income must be above the 130 percent

poverty line and at or below 185 percent of the poverty line (USDA, 2013). Lower

income children who are eligible for free and reduced priced meals participate in school

meal programs at a higher rate than do those who are not eligible for these benefits

(USDA, 2013).

Frequency

Research suggests that students who consume school lunch more frequently are

more satisfied with the school lunch program itself (Meyer, 1998, 2005). The significant

difference of satisfaction rating between groups that never ate school lunch and those that

ate 3-5 times per week indicated that satisfaction with school foodservice might be

associated with more frequent purchase behavior in the NSLP.

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Reasons for Eating School Lunch

Research from the National Food Service Management Institute documented that

the top five reasons middle school students choose to eat school lunch were hunger,

getting to sit with friends, not bringing anything else to eat, gaining energy for the rest of

the day, and having no other choice (Castillo & Lofton, 2012). The same study found

that student satisfaction with their school lunch experience could be attributed to two

main factors: food preference and staff attentiveness. Food preference includes a variety

of aspects of the food served such as appearance, quality, aroma, variety, and freshness.

Furthermore, staff attentiveness denotes the interaction of cafeteria staff with the

students, including friendliness, attitude at work and listening to the students (Castillo &

Lofton, 2012).

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CHAPTER III

METHODOLOGY

Participants

This study used data from a larger study completed at the Children’s Nutrition

Research Center of the Baylor College of Medicine entitled “Revised Federal School

Meal Guidelines: Impact on Student Food Intake and Costs”, which was approved by the

Institutional Review Board at Baylor College of Medicine (see Appendix A). The study

group consists of 1, 867 anonymous questionnaires completed by sixth, seventh and

eighth grade students attending one of four middle schools in Clear Creek Independent

School District in Clear Lake, Texas. The questionnaires were distributed during lunch,

and students were asked to leave the completed surveys on the table. The Institutional

Review Board (IRB) of the Texas Woman’s University approved this study of the data

from the surveys and subsequently determined exemption status (Appendix C).

Instrument

Demographic data collected included grade level and gender. Additionally, the

adolescents were asked to report how many times per week that they ate school lunch.

The questionnaire used to collect the data originated from a previously validated

customer service survey from the National Food Service Management Institute (Castillo

& Lofton, 2012). This validated survey was specifically designed for middle school

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students. In the first section of the questionnaire, there were four possible responses in

regards to how much the children agreed with the provided statements: “agree a lot,

agree a little, disagree a little, disagree a lot” (See Appendix B). Each possible response

was assigned a number in order to calculate the results (agree a lot-1, agree a little-2,

disagree a little-3, disagree a lot-4). This portion of the survey provided three separate

scales in order to categorize the statements: meal perceptions, fruit/vegetable/whole

grains, and staff attentiveness. The responses to these scales were analyzed for

differences in perceptions about school meals controlling for grade level, gender,

frequency of eating school meals, and free and reduced price eligibility rate of the middle

school.

Students were asked to check the top five reasons why they consumed the school

lunch meal (Appendix B). The provided choices were as follows: “it’s convenient”, “I

like the food”, “I am hungry”, “I get a balanced meal”, “I didn’t bring anything to eat”, “I

get to try different foods”, “I have no choice”, “I like the variety of the menu items”, “it

prepares me for after school activities”, “it fits my schedule”, “I know what is being

served”, “my parents/I pay in advance”, “my friends eat school lunches” and “I can

afford it”.

Statistical Tests

Prior to analyzing data, reliability of questions for the first section was analyzed

by Cronbach’s alpha. Analysis of variance (ANOVA) was used to test the relationship

between the student responses to the statements in the three distinct scales (menu

perceptions, fruits/vegetables/whole grains, staff attentiveness), controlling for

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gender, grade level, FRP school status, and frequency of eating school lunch. The

significance level was set at P < 0.05. The responses for reasons why students consumed

the school lunch meal were summed and percentages calculated. Data was analyzed using

the Statistical Package for the Social Sciences software for windows (IBM SPSS

Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.).

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CHAPTER IV

RESULTS

Internal consistency of the instrument was confirmed by a Cronbach’s alpha

coefficient of inter-term reliability for meal perceptions of 0.84, fruits/vegetables/whole-

grains scale of 0.77, and staff attentiveness of 0.81 (Table 1). Scales greater than 0.6

indicate good internal consistency.

Table 1. Scales of School Lunch Experience Survey

Number Statement
Meal Perceptions
1 The food tastes good.
2 The food looks good.
3 The food served is fresh.
4 There are a lot of choices on the menu each day.
5 The food is cooked the proper way.
6 The amount of food I get is enough.
7 I know what is being served before I get to the cafeteria.
8 The menu provides healthy foods.
9 I have enough time to eat.

Cronbach’s Alpha = 0.84

Fruits, Vegetables, Whole Grains
1 I select 2 servings of vegetables for my lunch meal.
2 I select 2 servings of fruits for my lunch meal.
3 I can identify the whole grain foods on the menu.

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4 I eat the whole grain foods on the menu.

Cronbach’s Alpha = 0.77

Staff Attentiveness
1 Servers and cashiers smile and talk to me.
2 Servers and cashiers listen to the students.

Cronbach’s Alpha = 0.81

*Scales!determined!to!be!reliable!if!Cronbach’s!Alpha!greater!than!0.6.!

Data were analyzed for 1,867 questionnaires (see Table 2). The study sample

consisted of 808 (43%) male and 970 (52%) female participants. The grade distribution

was comprised of 664 (36%) sixth graders, 562 (30%) seventh graders, and 567 (30%)

eighth graders. Nearly 1,233 (66%) of students reported consuming school lunch four to

five times per week, while 546 (29%) students reported consuming school meals three

times or less a week. Two of the four middle schools were considered low-income

schools based on FRP eligibility status (~34% FRP) and comprised 905 (48.5%) of the

total questionnaires.

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Table 2.
Demographic Characteristics of 6th to 8th Grade
Participants1
Frequency Percentage
Gender
Male 808 43.3
Female 970 52.0
Missing 89 4.8
Grade
6th 664 35.6
7th 562 30.1
8th 567 30.4
Missing 74 4.0
Lunch Per Week
4-5 days per week 1233 66.0
3 or less days per week 546 29.2
Missing 88 4.7
Low-Income School
Yes 905 48.5
No 962 51.5
1
n = 1867
!

For each of the three scales, the responses to the questions of every individual

student were summed according to the level of agreement (agree a lot-1, agree a little-2,

disagree a little-3, disagree a lot-4). The average of all the students’ summed responses in

that category was then calculated and is portrayed in the results. Higher scores indicate

more disagreement with the provided statement.

The results for hypothesis 1 (there will be no differences in perceptions about

school meals based on the students’ gender) are found in Table 3. Significant gender

differences were found for the fruit, vegetable, and whole grain scale. Boys

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were found to be significantly more likely to report selecting and consuming fruits,

vegetables, and whole grains than girls (P = .015). There were no significant differences

in meal perceptions (P = .177) or staff attentiveness (P = .549) between boys and girls.

Hypothesis 1, which states there will be no differences in perceptions about school meals

based on the students’ gender, is rejected.

Table 3
Perceptions of School Meals Based on Gender
Average Summed
Scale Score P-value
Meal Perceptions
Boy 22.38
0.177
Girl 22.80
Fruit, Vegetable, and Whole
Grain
Boy 11.72
0.015*
Girl 12.08
Staff Attentiveness
Boy 5.09
0.549
Girl 5.16
*
Significant finding indicating P <0.05

The results for hypothesis 2 (there will be no differences in perceptions about

school meals based on the students’ grade level) are found in Table 4. Significant

differences were found for meal perceptions and the fruit, vegetable, and whole grain

scales. Sixth graders were found to be significantly more satisfied with meal perceptions

(including taste, appearance, freshness, choices, cooking method, portion size, and time

to eat) than any other grade (P = .000). Seventh graders reported more satisfaction with

meal perceptions than eighth graders. Additionally, sixth graders were also found

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to have significantly different perceptions regarding the fruit, vegetable, and whole grain

scale. These sixth grade students were significantly more likely to report selecting and

consuming fruits, vegetables, and whole grains than seventh or eigth grade students,

respectively (P = .000). There was no significant difference found between grade levels

for staff attentiveness (P = .335). Hypothesis 2, which states there is no difference in

perceptions about school meals based on grade level, is rejected.

Table 4
Perceptions of School Meals Based on Grade Level
Average Summed
Scale Score P-value
Meal Perceptions
6 20.56
7 23.16 0.00***
8 24.52
Fruit, Vegetable, Whole Grain
6 11.32
7 12.01 0.00***
8 12.55

Staff Attentiveness
6 5.07
7 5.25 0.335
8 5.16
***
Significant finding indicating P< 0.001

The results for hypothesis 3 (there will be no differences in perceptions about

school meals based on the school’s overall student income status) are found in Table 5.

Significant differences were found for meal perceptions and the staff attentiveness scales.

The students at the low-income schools were found to be significantly less satisfied with

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meal perceptions than students attending the other two schools (P = .000). However,

students at the low-income schools were more satisfied with the friendliness and

attentiveness of the staff (P = .000). There was no significant difference found between

the regular and low-income schools for the fruit, vegetable and whole-grain scale (P =

.456). Hypothesis 3, which states there is no difference in perceptions about school meals

based on the school’s overall student income status, is rejected.

Table 5
Perceptions of School Meals Based on School's Income Classification
Average
Scale Summed Score P-value
Meal Perceptions
Low Income 23.88
0.00***
Not Low Income 21.69

Fruit, Vegetable, Whole Grain

Low Income 12.00
0.456
Not Low Income 11.89

Staff Attentiveness
Low Income 4.82
0.00***
Not Low Income 5.49

***
Significant finding indicating P <0.001

The results for hypothesis 4 (there will be no differences in perceptions about

school meals based on the frequency of eating school meals) are found in Table 6. A

significant difference was found for the staff attentiveness scale (P = .000). Students

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who ate school lunch four to five times per week were more satisfied with server/cashier

attentiveness than those students who ate three times or less per week. There were no

significant differences found for meal perceptions (P = .095) or the fruit, vegetable, and

whole-grain scales (P = .713) between the two groups. Hypothesis 4, which states there

will be no differences in perceptions about school meals based on the frequency of eating

school meals, is rejected.

Table 6
Perceptions of School Meals Based on Frequency of Eating School Lunch
Average Summed
Scale Score P-value
Meal Perceptions
4-5 times per week 22.45
0.095
3 or less times per week 23.02

Fruit, Vegetable, Whole Grain

4-5 times per week 11.95
0.713
3 or less times per week 11.89

Staff Attentiveness
4-5 times per week 5.01
0.00***
3 or less times per week 5.43

***
Significant finding indicating P <0.001

The student responses for the top reasons for eating school lunch are presented in

Table 7. The most popular reasons that students chose for eating school lunch were “I am

hungry” (18% of total), followed by “I didn’t bring anything to eat” (14%), “it’s

convenient” (10%), and “I have no choice” (10%). The next popular statements were, “I

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can afford it” and “I like the food” (both 8%), while “it fits my schedule” was the fifth

choice (6%).

Table 7
Top 5 Reasons for Eating School Lunch
Percent
Rank Reason Total
1 I am hungry 18
2 I didn't bring anything to eat 14
3 It's convenient 10
3 I have no choice 10
4 I can afford it 8
4 I like the food 8
5 It fits my schedule 6
6 My friends eat school lunches 5
7 My parents/I pay in advance 5
8 I like the variety of menu items 4
9 I know what is being served 4
10 I get to try different foods 4
11 It prepares me for after school activities 3
12 I get a balanced meal 3

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CHAPTER V

DISCUSSION

Although research has been conducted looking at the perceptions and satisfaction

of students participating in the NSLP, there is limited research regarding these students’

perceptions following the federal revised school meal guidelines set into place in 2012.

The purpose of this study was to determine if after these new guidelines were

implemented, students’ perceptions of school meals varied based on gender, grade level,

school income classification, and frequency of consuming school lunch. There were

three scales used in this study: meal perceptions, fruit/vegetable/whole grain statements,

and staff attentiveness. Meal perceptions and staff attentiveness were two scales that

included similar statements to the validated survey from the National Food Service

Management Institute (Castillo & Lofton, 2012). The Cronbach’s alpha level of these

three separate scales confirmed reliability.

Meal Perceptions

Sixth grade students were found to be the most satisfied out of all three grades

regarding taste, appearance, freshness, choices, cooking method, portion size, and having

enough time to eat (meal perceptions). This result coincides with research prior to meal

revisions that indicated sixth graders were more satisfied with school lunch (Meyer,

2000b). Oftentimes, these students are not yet conditioned to the school lunch program,

thus have not become tired of the menu and general atmosphere. School foodservice

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professionals should regularly modify or upgrade menus, decorations/themes, and overall

atmosphere of the cafeteria and school lunch program in order to keep students of all

grades interested in the meals. The students attending the low-income schools reported

less satisfaction with meal perceptions. Contrary to our findings, a separate study in a

low-income district conducted after implementation of the new revisions revealed

increased student consumption of the school meal, suggesting satisfaction with various

aspects of the meal (Cohen, Richardson, Parker, Catalano & Rimm, 2014).

Fruits, Vegetables, Whole Grains

Sixth grade students were also more likely to agree with statements regarding

selecting and consuming fruits, vegetables, and whole grains than seventh or eighth grade

students, respectively. This is similar to other research findings as well (Cullen,

Thompson, Watson & Nicklas, 2005; Meyer, 2000b). Adolescents begin to make more

independent decisions as they move into early teenage years. This maturity level may

ultimately decrease satisfaction with foodservice as students move up in grades (Meyer,

2000b.) To elucidate, younger students likely purchased meals due to a parental decision.

However, older adolescents may seek freedom to make their own decisions, but will

likely express lowered satisfaction with the school meal if they perceive they have no

choice. Accordingly, school nutrition programs may benefit from incorporating meal

programs and menus that emphasize customization of the meal and allowing students to

make independent decisions about their lunch, while continuing to meet USDA

guidelines.

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Boys were found to have significantly higher scores on selecting and consuming

fruits, vegetables, and whole grains scales than girls. This is a different finding than a

study conducted prior to the revised meal guidelines, which revealed that girls reported a

greater preference for fruits and vegetables than boys (Cullen, Thompson, Watson &

Nicklas, 2005). Nonetheless, adolescent boys ages 9-13 years of age generally require

approximately 200 to 400 additional calories per day than adolescent girls of the same

age and activity level (USDA & United States Department of Health and Human

Services, 2010). This added calorie requirement might increase feelings of hunger in boys

thus leading to greater consumption of the school lunch meal.

Other factors may influence youth to consume fruits and vegetables. For instance,

one study completed after the new guidelines found that a longer lunch period is

associated with increased odds for student consumption of fruits and vegetables

(Gosliner, 2014). Additionally, visual appeal and variety were positively associated with

fruit intake, while the presence of a salad bar was positively associated with increased

vegetable consumption (Gosliner, 2014). These factors should also be taken into

consideration by food service professionals to encourage more middle school students to

select and consume greater amounts of fruits and vegetables.

Staff Attentiveness

The students who consumed school lunch more frequently throughout the week (4-5

times) reported greater satisfaction with staff attentiveness than students who ate three

times or less. This is similar to pre-meal revision studies that report increased satisfaction

with increased participation (Meyer, 2000, 2005). Furthermore, the students attending the
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low-income schools also reported greater satisfaction for staff attentiveness scale. It is

important to note that in 2012-2013 an average of 70 percent of NSLP meals were served

to students in the free or reduced price meal category (USDA, 2013). These FRP students

may eat school lunch more frequently throughout the week due to family income

restrictions, thus it is possible that they develop positive relationships with the staff

because of frequent contact.

Top Reasons for Eating School Lunch

The reasons students report for eating school lunch are important. School nutrition

professionals can respond to comments and maintain student participation and potentially

even increase school lunch participation by reaching out to students. In this study, nearly

32 percent of the students chose one of their top responses as having no choice/no other

food, or affordability (“I didn’t bring anything to eat”, “I have no choice”, and “I can

afford it”). These comments reflect the large majority of FRP eligible students

participating in the NSLP. Nonetheless, regular priced students may have no choice as

well due to a parent decision to solely utilize NSLP meals.

Limitations

There are a few limitations to this study, which shall be noted. The data were

collected from one district in southern Texas by surveying only middle school students.

This approach decreases the generalizability of the overall study to other grades and

areas. Another limitation of this study was the use of self-report questionnaires. Although

previously validated survey statements were used to maximize the accuracy of the

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response, it is possible that the students’ attitudes could change from day to day

concerning these topics.

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CHAPTER VI

CONCLUSIONS AND IMPLICATIONS FOR FUTURE RESEARCH

This study found that there were differences in perceptions of school lunch

regarding meal perceptions, fruit/vegetable/whole grain selection, and staff attentiveness

by gender, grade level, income status of the school, and frequency of eating school lunch.

Sixth grade students reported significantly greater satisfaction for meals based on taste,

appearance, freshness, choices, cooking method, portion size, and having enough time to

eat, than seventh and eighth graders. Moreover, students attending a low-income school

were less satisfied with meal perceptions. Sixth graders (more than seventh and eighth

graders) and boys (more than girls) were more likely to endorse questions on selecting

and consuming fruits/vegetables and whole grain food items. Students who ate school

lunch more frequently and students from low-income schools were more satisfied with

the staff attentiveness aspect of school lunch.

Little research has yet to be published regarding the impact of the NSLP revised

federal guidelines on student intake, opinions and perceptions. This study demonstrates

that satisfying all types of students in the NSLP is multifaceted due to varying

perceptions, maturity levels, and socioeconomic status. In order to maximize the benefits

of the new meal revisions, it is imperative that researchers and school professionals look

at the various aspects that satisfy the student customer. Forming student advisory

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groups and conducting focus groups with students may help food service professionals

enhance meal programs, and identify strategies to increase participation and improve

consumption of school lunch. Ultimately, increasing consumption of school lunch may

enrich the overall health status of students.

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APPENDIX A
Institutional Review Board, Baylor College of Medicine Approval

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APPENDIX B
Questionnaire

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APPENDIX C
Institutional Review Board Exempt Approval

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