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in children. Yumbox provides distinct compartments for the recommended food components, leveraging the visibility principles of behavioral economics theory. Caretakers may be more likely to pack lunches that include more components of the US Department of Agriculture MyPlate
because of visual cues present in Yumbox. To test this hypothesis, a pilot program examined whether the Yumbox lunchbox, a bento-style box with compartments labeled for each component of a complete meal (vegetable, fruit, dairy, grain, protein) that is based on the US Department of Agriculture MyPlate,
would influence the number and types of foods that caretakers of preschoolers packed for their children's lunches.
PILOT PROGRAM DESIGN
In piloting this program, a Yumbox was given to each child enrolled in a preschool (intervention school) whose parents or guardians consented for their participation (n = 30). Parents and caretakers received a brief orientation on how to use the Yumbox, as well as a list of suggestions for foods that would fit into each section. A similar preschool was selected to compare the content of students’ lunches (control school; n = 26). Both schools were private, Montessori preschools where students bring lunch to school every day. The mean age of participants in the intervention school was 3.74 years, and 3.76 years in the control school. The intervention school enrollment was 53% boys and 47% girls, and the control school was 49% boys, 51% girls. Although neither school was able to provide demographics on race or ethnicity, the 2 schools are located less than 8 miles apart in communities that are similar in racial/ethnic makeup, and according to the schools’ directors, the racial and ethnic makeup of the schools’ student populations reflect that of their catchment areas.
The contents of the students’ lunches in both preschools were documented over 3 days by a team of 3 trained research assistants. The original plan was to complete 10 days of lunch observations; however, after 3 days, both schools closed because of coronavirus disease 2019 quarantine mandates. During each lunch period on the 3 days of assessments, the research team photographed the lunch of each student in the control and intervention schools (n = 110 lunches) without linking the lunches to any individual student at the request of the schools.
The photographs were then analyzed by undergraduate students in nutritional sciences to identify if a meal component was present or absent in the student's lunch (see Figure). When a food contained more than 1 component (eg, macaroni and cheese), those 2 components were categorized into their 2 distinct categories (eg, grain and dairy). All analyses were conducted using SPSS (version 26.0, IBM Corporation, 2019). Descriptive statistics of food present for each food component (vegetable, fruit, dairy, grain, and protein) for both the intervention and control schools were conducted. Chi-square analyses were also conducted to assess significant group differences in the presence of each food component. A comparison of the mean number of food components present in each student's lunch was used to assess the impact of the intervention. In addition to analyzing the contents of students’ lunches, online surveys were distributed to staff and caretakers in the intervention school after the data collection took place to ascertain their opinions and experiences with the Yumbox. The staff survey was given to teachers and aides who were present in each classroom during lunchtime, and therefore able to observe the children eat lunch daily. The staff survey included Likert-scale questions asking them to indicate how strongly they agreed or disagreed with various statements about the Yumbox, such as “Yumbox has made it easier to talk to students about nutrition/healthy eating.” The caretaker survey also included Likert-scale questions asking to indicate their agreement with statements such as “Using Yumbox has helped me feel more comfortable preparing a complete meal for my child.” Both the staff and caretaker surveys also asked 3 open-ended questions about the benefits and drawbacks of the Yumbox.
The lunches were analyzed for the total number (out of a possible 5: fruit, vegetable, grain, protein, and dairy) and percent of meal components present in each lunch, along with stratifying by food component and day assessed. Because so few Americans eat the recommended amounts of fruits and vegetables, these 2 food components were of particular interest. Approximately 44.5% of the lunches in the intervention group had at least 3 food components, whereas only 10.0% of the control group had the same number of food components (Table 1). This study found that the intervention group had a statistically significantly higher number of components (3.8 ± 0.95) than the control group (1.9 ± 0.93) t = −10.56; P < 0.0001 (Table 2). In addition, chi-square tests of independence found that the intervention group had statistically significantly more fruit, protein, and dairy across all days and significantly more vegetables for the first 2 days (Table 3). The effect sizes can be considered very strong for all the daily comparisons,
except grains in which there were no significant differences between the groups on any day. In addition, caretakers and staff reported experiencing several benefits of using Yumbox, both for themselves and for the children (Table 4).
Table 1Number and Percentage of Total Lunches That Contained Specified Number of Food Components Over 3 Days
On average, children in the intervention school had a statistically significant greater variety of foods (at least 3 of the 5 MyPlate components), and their caretakers were more likely to include fruits and vegetables in their meal, thus indicating the Yumbox had a positive influence on the types of foods caretakers pack for their children's lunches. After sharing the results, the administrative staff of the intervention school indicated they would consider making Yumbox their official lunch box so that teachers may use it as a jumping-off point for future nutrition education programming.
This study reinforces findings from previous studies and the effectiveness of the behavioral economics principle that visual cues may help to ensure the presence of a full component meal. Yumbox may be an effective tool to reinforce positive eating behaviors by facilitating an opportunity for parents and caretakers to consistently create well-balanced meals for their children. Yumbox may be used in any setting where children bring their meals from home, including schools, camps, clubs, and after-school activities. Yumbox provides the change in the built environment (visual cues) that allows caretakers to consistently pack complete lunches for children. Furthermore, when caretakers use Yumbox every day, it has the potential to create a habit of making complete meals on a regular basis that may extend to meals outside school lunches, such as family dinners.
Approval for this research was granted by the Institutional Review Board of Rutgers, The State University of New Jersey. This manuscript and the pilot program and research behind it would not have been possible without the enthusiastic participation of Unitarian Montessori School and Children First Montessori School and the support of their boards, administrative staff, teachers, students, and parents/caregivers. In addition, the authors would like to thank Rutgers Nutritional Sciences students, Bokyung Kim, Kristen Homoki, and Allison Cooper, who collected and entered data for this pilot program, and Dr Virginia Quick for reviewing the data analysis and manuscript.