Prevalence of and Differences in Salad Bar Implementation in Rural Versus Urban Arizona Schools.

BACKGROUND
Rural children consume more calories per day on average than urban children, and they are less likely to consume fruit. Self-service salad bars have been proposed as an effective approach to better meet the National School Lunch Program's fruit and vegetable recommendations. No studies have examined how rural and urban schools differ in the implementation of school salad bars.

OBJECTIVE
To compare the prevalence of school-lunch salad bars and differences in implementation between urban and rural Arizona schools.

DESIGN
Secondary analysis of a cross-sectional web-based survey.

PARTICIPANTS/SETTING
School nutrition managers (N=596) in the state of Arizona.

MAIN OUTCOMES MEASURED
National Center for Education Statistics locale codes defined rural and urban classifications. Barriers to salad bar implementation were examined among schools that have never had, once had, and currently have a school salad bar. Promotional practices were examined among schools that once had and currently have a school salad bar.

STATISTICAL ANALYSES PERFORMED
Generalized estimating equation models were used to compare urban and rural differences in presence and implementation of salad bars, adjusting for school-level demographics and the clustering of schools within districts.

RESULTS
After adjustment, the prevalence of salad bars did not differ between urban and rural schools (46.9%±4.3% vs 46.8%±8.5%, respectively). Rural schools without salad bars more often reported perceived food waste and cost of produce as barriers to implementing salad bars, and funding was a necessary resource for offering a salad bar in the future, as compared with urban schools (P<0.05). No other geographic differences were observed in reported salad bar promotion, challenges, or resources among schools that currently have or once had a salad bar.

CONCLUSIONS
After adjustment, salad bar prevalence, implementation practices, and concerns are similar across geographic settings. Future research is needed to investigate methods to address cost and food waste concerns in rural areas.