Photo of various muffins

Evaluation of a Comprehensive School Nutrition Enrichment Intervention (CSNEI) in Rural School Districts

Project Number:
Project Period:
01/12/2022 - 06/01/2026 link

Diseases or Conditions Being Studied
Childhood obesity, healthy nutrition

Communities of Focus
Students ages 5 to 18 years

Study Sites
Six rural public school districts in Arkansas

Intervention or Treatment
CSNEI is a policy intervention designed to address childhood obesity by modifying lunch and breakfast meal/menu items, changing the school cafeteria environments, and making changes to purchasing and procurement practices.


Obesity is a significant cause of cancer and cardiovascular disease incidence and mortality, and diabetes incidence among rural communities. Arkansas has the sixth-highest proportion of rural population (~41%),and has the third-highest obesity prevalence (37.4%) in the nation. Arkansas has the third-highest prevalence of obesity for high school students (22.1%) and the fifth-highest prevalence for children ages 10-17 (20.2%). In Arkansas, children in rural areas have very high rates of both food insecurity (26%) and free and reduced lunch eligibility (72.9%). In the study's 6 participating school districts, free and reduced lunch eligibility ranges from 51.4% to 79.3%. School meals are an important opportunity to influence students' nutritional intake and long-term food preferences, which can reduce obesity. A multidisciplinary team has partnered with 6 rural Arkansas school districts which have agreed to participate in a study to evaluate the effects of an evidence-based population-level policy intervention designed to improve the nutritional quality of food served in schools.

The study team will conduct a matched-pairs cluster-randomized trial with pre-test and repeated post-tests in 6 rural Arkansas school districts, 3 implementing CSNEI, and 3 matched comparison school districts following their existing nutritional practices. Baseline data collection will take place prior to implementation (Year 1), and follow-up data will be collected annually thereafter (Years 2-5). The study will compare individual-level change in relative body mass index (adjusted for age and sex) and district-level changes in the nutritional quality of food served, amount of food consumed per diner, and fruit and vegetable intake in school districts implementing the intervention compared to matched comparison districts.

Specific Aims

Our specific aims are:

  • Aim 1. A: Evaluate the effects of a CSNEI on students' relative (accounting for age and sex) BMI change over time.
  • Aim 1.B: Evaluate the short-term and long-term effects of a CSNEI on the nutritional quality of food served in school meals.
  • Aim 1.C: Evaluate the short-term and long-term effects of a CSNEI on students' consumption of food served in school meals.
  • Aim 1.D: Evaluate the short-term and long-term effects of a CSNEI on students' skin carotenoid levels, as an indicator of fruit and vegetable intake.
  • Aim 2: Conduct an implementation study to document barriers and facilitators of CSNEI implementation in rural schools. We will complete the first implementation study of a CSNEI in rural schools, which will provide critical information to ensure successful implementation of similar interventions in school districts and will be an innovative step to accelerate translation of evidence into broad practice. Existing paradigms for the study of comprehensive school nutrition interventions do not appropriately address needs and potential barriers of rural children, particularly those living in low-income households. This study will fill critical gaps in evidence by rigorously evaluating a CSNEI in rural schools with high proportions of students eligible for free and reduced price meals (>50%); employing a matched-pairs cluster randomized design to compare changes in BMI z-scores over time; and incorporating economic status, age (in months), sex, and race/ethnicity in the analyses.


Christopher Long
Principal Investigator
Kelsey Bounds
Project Manager
Bonnie Faitak
Project Manager
Joe Thompson, MD, MPH
Team Member
Rachel Novotny, MS, PhD
Team Member
Anthony Goudie, PhD
Team Member
James Selig, PhD
Team Member
Geoffrey Curran, PhD
Team Member
Bryan Law
Team Member
Stephanie Alsbrook, LD, MS, RD
Team Member
Ally Mrachek
Team Member