Student Acceptance of Plain Milk Increases Significantly 2 Years after Flavored Milk Is Removed from School Cafeterias: An Observational Study



      Previous studies document decreases in lunchtime milk consumption immediately after flavored milk is removed. Less is known about longer-term effects.


      Plain milk selection and consumption were measured the first year flavored milk was removed in a school district (2010 to 2011 [Time 1]) and 2 years later (2012 to 2013 [Time 2]). Four behavioral economic interventions to promote milk were tested in one school at Time 2.


      This was a longitudinal, observational study.


      Participants were kindergarten through grade 8 students in two schools in an urban district. Primary data were collected 10 times per school year at Time 1 and Time 2, yielding 40 days of data and 13,883 student observations. The milk promotion interventions were tested on 6 additional days.

      Main outcome measures

      Outcomes were the percentage of students selecting milk at lunch, the ounces of milk consumed per carton, and the ounces of milk consumed school-wide per student.

      Statistical analyses

      Logistic regressions were used to assess how sex, grade, time, availability of 100% juice, and behavioral interventions affected milk selection and consumption.


      At Time One, 51.5% of students selected milk and drank 4 oz (standard deviation=3.2 oz) per carton, indicating school-wide per-student consumption of 2.1 oz (standard deviation=3.0 oz). At Time Two, 72% of students selected milk and consumed 3.4 oz per carton (standard deviation=3.2 oz), significantly increasing the school-wide per-student consumption to 2.5 oz (standard deviation=3.1 oz). Older students and boys consumed significantly more milk. Availability of 100% fruit juice was associated with a 16–percentage point decrease in milk selection. None of the behavioral economic interventions significantly influenced selection.


      These data suggest that after flavored milk is removed from school cafeterias, school-wide per-student consumption of plain milk increases over time. In addition, the presence of 100% juice is associated with lower milk selection.


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        • US Department of Health and Human Services and U.S. Department of Agriculture
        2015-2020 Dietary Guidelines for Americans.
        8th ed. US Department of Agriculture, Washington, DCDecember 2015
        • Vos M.B.
        • Kaar J.L.
        • Welsh J.A.
        • et al.
        Added sugars and cardiovascular disease risk in children: A scientific statement from the American heart association.
        Circulation. 2017; 135: e1017-e1034
      1. US Department of Agriculture, Food and Nutrition Service. Nutrition standards in the national school lunch and school breakfast program. Vol. 76, No. 9. Vol. 7 CFR parts 210 and 220. 2011:2494–2570. Fed Reg. 2011;76.

        • American Academy of Pediatrics Council on School Health, Committee on Nutrition
        Snacks, sweetened beverages, added sugars, and schools.
        Pediatrics. 2015; 135: 575-584
        • Dooley D.
        • Patel A.
        • Schmidt L.A.
        Letter to editor: Chocolate milk in schools.
        Pediatrics. 2015; 136
        • Condon E.
        • Crepinsek M.K.
        • Fox M.K.
        School meals: Types of foods offered to and consumed by children at lunch and breakfast.
        J Am Diet Assoc. 2009; 109: S67-S78
        • Briefel R.R.
        • Wilson A.
        • Cabili C.
        • Hedley Dodd A.
        Reducing calories and added sugars by improving children's beverage choices.
        J Acad Nutr Diet. 2013; 113: 269-275
        • Briefel R.R.
        • Wilson A.
        • Gleason P.M.
        Consumption of low-nutrient, energy-dense foods and beverages at school, home, and other locations among school lunch participants.
        J Am Diet Assoc. 2009; 109: S79-S90
        • Johnson R.K.
        • Appel L.J.
        • Brands M.
        • et al.
        Dietary sugars intake and cardiovascular health A scientific statement from the American Heart Association.
        Circulation. 2009; 120: 1011-1020
        • Johnson R.K.
        • Panley C.
        • Wang M.Q.
        The association between noon-time beverage consumption and the diet quality of school-aged children.
        J Child Nutr Manage. 1998; 2: 95-100
        • Murphy M.M.
        • Douglass J.S.
        • Johnson R.K.
        • Spence L.A.
        Drinking flavored or plain milk is positively associated with nutrient intake and is not associated with adverse effects on weight status in US children and adolescents.
        J Am Diet Assoc. 2008; 108: 631-639
        • Nicklas T.A.
        • O'Neil C.E.
        • Fulgoni V.L.
        The nutritional role of flavored and white milk in the diets of children.
        J Sch Health. 2013; 83: 728-733
        • Fayet
        • Ridges L.A.
        • Wright J.K.
        • Petocz P.
        Australian children who drink milk (plain or flavored) have higher milk and micronutrient intakes but similar body mass index to those who do not drink milk.
        Nutr Res. 2013; 33: 95-102
        • Institute of Medicine, Food and Nutrition Board, Committee on Nutrition Standards for Foods in Schools
        Nutrition Standards for Foods in Schools: Leading the Way Towards Healthier Youth.
        National Academies Press, Washington, DC2007
        • Munsell C.
        • Harris J.
        • Vishnudas S.
        • Schwartz M.
        Parents' beliefs about the healthfulness of sugary drink options: Opportunities to address misperceptions.
        Public Health Nutr. 2016; 19: 46-54
        • Mennella J.A.
        • Bobowski N.K.
        • Reed D.R.
        The development of sweet taste: From biology to hedonics.
        Rev Endocr Metab Disord. 2016; 17: 171-178
        • Cohen J.F.W.
        • Richardson S.
        • Parker E.P.
        • Catalano P.J.
        • Rimm E.B.
        Impact of the new U.S. department of agriculture school meal standards on food selection, consumption, and waste.
        Am J Prev Med. 2014; 46: 388-394
        • Cohen J.F.
        • Smit L.A.
        • Parker E.
        • et al.
        Long-term impact of a chef on school lunch consumption: Findings from a 2-year pilot study in Boston middle schools.
        J Acad Nutr Diet. 2012; 112: 927-933
        • Hanks A.S.
        • Just D.R.
        • Wansink B.
        Chocolate milk consequences: A pilot study evaluating the consequences of banning chocolate milk in school cafeterias.
        PLoS One. 2014; 9: e91022
      2. US Department of Agriculture. Help make the healthy choice the easy choice for kids at school: A guide to smart snacks in school. Published July 2016. Updated 2016. Accessed December 23, 2016.

        • Just D.R.
        • Wansink B.
        • Mancino L.
        • Guthrie J.
        Behavioral economic concepts to encourage healthy eating in school cafeterias.
        USDA ERS. 2008; 68: 1-27
        • Yon B.A.
        • Johnson R.K.
        • Stickle T.R.
        School children's consumption of lower-calorie flavored milk: A plate waste study.
        J Acad Nutr Diet. 2012; 112: 132-136
      3. SAS [computer program]. Version 9.4. Cary NC: SAS Institute Inc; 2013.

      4. Gordon AR, Fox MK. School Nutrition Dietary Assessment Study-III: Final Report. Report No. CN-07-SNDA-III. Washington, DC: US Department of Agriculture, Food and Nutrition Service, Office of Analysis and Evaluation, Alexandria, VA; 2007.

        • Yon B.A.
        • Johnson R.K.
        Elementary and middle school children's acceptance of lower calorie flavored milk as measured by milk shipment and participation in the national school lunch program.
        J Sch Health. 2014; 84: 205-211
        • Yon B.A.
        • Johnson R.K.
        New school meal regulations and consumption of flavored milk in ten US elementary schools, 2010 and 2013.
        Prev Chronic Dis. 2015; 12: E166


      M. B. Schwartz is director, UConn Rudd Center for Food Policy and Obesity, Hartford; at the time of the study, she was a senior research scientist, Yale University, New Haven, CT.


      K. E. Henderson is sole proprietor, Henderson Consulting, Guilford, CT; at the time of the study, she was a research scientist, Yale University, New Haven, CT.


      M. Read is a research associate, UConn Rudd Center for Food Policy and Obesity, Hartford; at the time of the study, she was a research associate, Yale University, New Haven, CT.


      T. Cornelius is a graduate student, Department of Psychology, University of Connecticut, Storrs.