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Abstract Objective Examine how the physical cafeteria environment contributes to 6- to 8-year-olds' school food consumption. Design Cross-sectional observational study. Before-and-after lunch tray photos taken with iPads to capture food selection and consumption. Setting 10 New York City public elementary school cafeterias. Participants A total of 382 students aged 6–8 years who ate lunch in the cafeteria on observation days. Main Outcome Measures Fruit, vegetable, or whole-grain consumption. Analysis Pearson's chi-square and multivariate logistic regression assessed associations between cafeteria environmental factors (time to eat lunch, noise, and crowding) and vegetable, fruit, and/or whole-grain consumption with 95% confidence, adjusted for school-level demographics and clustered by school. Results Approximately 70% of students selected fruits, vegetables, and/or whole grains. When selected, consumption was 25%, 43%, and 57%, respectively. Longer time to eat lunch was associated with higher consumption of fruits (odds ratio [OR] = 2.0; 95% confidence interval [CI], 1.1–3.8; P =.02) and whole grains (OR = 2.1; 95% CI, 1.003–4.2; P <.05). Quieter cafeterias were associated with eating more vegetables (OR = 3.9; 95% CI, 1.8–8.4; P <.001) and whole grains (OR = 2.7; 95% CI, 2.6–4.7; P <.001). Less crowding was associated with eating more fruit (OR = 2.3; 95% CI, 1.03–5.3; P =.04) and whole grains (OR = 3.3; 95% CI, 1.9–5.6; P <.001). Conclusions and Implications Healthy food consumption by 6- to 8-year-old students is associated with cafeteria crowding, noise, and time to eat lunch. Implementing and enforcing changes to the cafeteria environment mandated by wellness policies may reduce plate waste. [ABSTRACT FROM AUTHOR]