A Comparative Intervention Study on Strategies for Fruit Distribution and Awareness Campaigns in Schools

This study is part of the Europe (EU) project "Improving and upscaling primary prevention of cancer by addressing childhood obesity through implementation research" (PREVENT), which aims to promote healthier dietary habits among students by improving access to fruits in school environments. The intervention is implemented in a set of participating schools, each assigned to one of the predefined strategies. The study examines whether providing fruit ad libitum during school hours influences students' snacking patterns, and whether an accompanying awareness campaign adds value beyond fruit availability alone.

In each participating school, fruit stands offering two types of fruit will be placed in central areas where students typically gather. Fruit will be available during periods when students have access to common spaces, and digital scales integrated into the stands will enable weight-based monitoring of fruit uptake. Designated school staff will photograph scale readings at the beginning, end, and one or more intermediate points during the day. These images will be processed using optical character recognition (OCR) to extract weight data and upload it to a secure backend system for automated monitoring of fruit distribution and potential food waste.

To evaluate students' eating behaviour and fruit consumption patterns, participating students will use a research mobile application to photograph their meals and snacks. Data collection takes place in three periods: (1) a baseline period prior to the introduction of fruit stands, (2) an early-intervention period immediately following the introduction of the stands, during which students continue to report all meals to capture short-term behavioural changes, and (3) a post-intervention period to assess sustained effects. The app records time and location metadata for each entry, allowing analysis of when and where food is consumed and how eating patterns change during the intervention.

The primary aim is to assess whether increased availability of free fruit influences students' snacking habits and whether the addition of an awareness campaign further enhances engagement with the fruit stands. Secondary aims include evaluating the feasibility of weight-based digital monitoring, characterising patterns of fruit uptake over the school day, and examining changes in students' overall eating behaviour across measurement periods. All data will be analysed at group level, and the study is considered minimal risk. Findings will support future scalable strategies for fruit distribution in school settings and contribute to broader evaluation of school-based dietary promotion initiatives.

Inclusion criteria

• Students enrolled in a Swedish school (elementary, middle, or high school)
• Ages 7-19 years
• Able to use a mobile phone to document meals and snacks
• Provided informed consent (with parental consent required for participants under 15 years old)

Exclusion criteria

• Presence of any clinically significant disease or condition that, in the opinion of the research team, may interfere with participation or influence study outcomes