School Transformation after Redesign of 3 Cafeterias (STARCafé).

Objective: Creating healthy food environments in schools is a national strategy to reduce childhood obesity. In this study, we explore the impact of major changes to school cafeterias on students. Method: We conducted a natural experiment of redesigns in 3 cafeterias within New York City (NYC) public high schools. All received an intervention, STARCafé, that changed the cafeteria serving line, dining area, aesthetics, and signage and menu. Student outcomes were school lunch consumption, participation, and attitudes measured at pre-redesign, 3-month, and oneyear post-redesign. Additional outcomes were fidelity to the Healthy Eating Design Guidelines and ripple effect on health-related programming. Results: STARCafé had a statistically significant and positive change on 4 of the 5 students' attitude scales (serving line, dining/seating space, aesthetics, and general) from pre-redesign to one-year post-redesign (all ps < .05), and a positive impact on school lunch participation (p = .04). There were no positive changes in school lunch consumption or on a ripple effect on additional health-related programming. Conclusions: Our results show that school cafeteria redesigns may promote long-term increases in participation and students' attitudes toward school lunch. Future studies are needed to understand how various redesigns and menu changes influence healthy eating behaviors such as increasing fruit and vegetable consumption. [ABSTRACT FROM AUTHOR]