Parental perception of children’s school lunch milk

School lunch programs are mandated by the US Code of Federal Regulations to serve pasteurized milk that is skim or 1% fat and fortified with vitamins A and D. In recent years, proposals have been made to alter nutritional requirements for school lunches and school lunch milk, including changes to the milk fat and flavor options available. The objective of this study was to evaluate parental understanding and perception of school lunch milk to better understand how changes to school lunch milk are perceived by parents. Four focus groups (n = 34) were conducted with parents of school-aged children (5–13 yr) who purchased milk as part of a lunch at school. Participants were asked about school lunch milk, including nutritional content, packaging, and flavoring. Focus groups included a build-your-own milk activity and discussion of children’s milk products currently available on the market. Two subsequent online surveys were conducted with parents of school-aged children (survey 1, n = 216; survey 2, n = 133). Maximum difference scaling was used to evaluate what beverages parents would prefer their child to drink at school (survey 1) and which attributes of chocolate milk for children were most important to parents (survey 2). An adaptive choice-based conjoint activity (survey 1) included flavor, milk fat, heat treat-ment, label claims, and packaging type. Both surveys included questions to evaluate knowledge of milk nutrition and attitudes regarding milk and flavored milk. Agree/disagree questions were used in both surveys to assess parental opinions of school lunch milk. Survey 2 also included semantic differential (sliding scale) questions to assess parental opinions of chocolate milk and their acceptance of sugar alternatives in chocolate milk served in schools. Parents were familiar with the flavor options and packaging of school lunch milk, but expressed limited familiarity with school lunch milk fat content. Parents perceived milk to be healthy and a good source of vitamin D and calcium. From survey re-sults, parents placed the highest importance on school lunch milk packaging, followed by milk fat percentage and flavoring over label claims and heat treatment. The


INTRODUCTION
Previous research has established that consumption of dairy milk positively affects child health over a lifetime, beginning with supporting growth and development and later reducing risk of osteoporosis and hypertension (Herber et al., 2020;Sipple et al., 2020).To ensure that school-aged children have access to adequately nutritious meals, the USDA established the National School Lunch Program (NSLP; Economic Research Service, 2020a) and School Breakfast Program (NSBP; Economic Research Service, 2020b).These programs provide cash subsidies and reimbursements to school districts for the cost of meals consumed at school.To qualify for reimbursement, school meals must meet nutritional standards laid out in the Food and Drug Administration's (FDA) Code of Federal Regulations (CFR; Office of the Federal Register, 2021a).To receive subsidies from the NSLP and NSBP, schools must offer their students 1 cup (8 oz.[236 mL]) of milk per day as a component of breakfast and lunch.Students must have at least 2 milk options to choose from, including one unflavored milk option.Flavored options can include chocolate, vanilla, and strawberry milk, but most school districts offer chocolate milk.From 2012 to 2017, flavored milk served in schools was required to be fat free.On November 20, 2017, the USDA announced that low-fat flavored milk could be served in schools (Gelski, 2018).
Flavored milk products for children are often a source of controversy due to their higher sugar content compared with unflavored milk.An 8-oz serving of milk contains approximately 12 g of carbohydrates due to the native lactose.Chocolate milks can have as many as 18 g of added sugar, although current (2020) school lunch formulations have approximately 7.5 to 8 g of added sugar per 8-oz serving to have a minimal impact on total calories.Both total meal calories and fat content (not total carbohydrates or g of added sugar) are mandated in the federal school lunch program (Sipple et al., 2020).Flavored milk was endorsed by the American Academy of Pediatrics over other sugar-sweetened beverages due to its important nutritional advantages, including significant calcium and vitamin D content (Ballew et al., 2000;Patel et al., 2018).In a 2018 review of published literature regarding associations between flavored milk consumption and milk intake, added sugar intake, energy intake, and obesity, authors identified 13 studies that met inclusion criteria.Of those 13 studies, 11 found that flavored milk increased overall milk intake, 5 showed that flavored milk increased energy intake, and 1 concluded that flavored milk consumption produced demonstrable weight gain in children.However, the authors also stated that further evidence from unbiased studies is needed to fully understand the impact of flavored milk on children and adolescent health (Patel et al., 2018).Children who consumed flavored milk have a lower intake of added sugar than children who do not consume flavored milk (Noel et al., 2013).Other researchers studied dairy consumption and obesity and found no correlations between dairy consumption and obesity in adolescents (Phillips et al., 2003;Fayet et al., 2013;Keast et al., 2015).
Flavored milk is generally preferred by children over unflavored milk (sweet taste is a driver of liking) (Quann and Adams, 2013).Quann and Adams (2013) found that removing flavored milk from the school environment had significant unintended consequences on children's milk consumption, but stated that further exploration was needed to understand impacts on nutrient intake.Fazzino et al. (2019) defined foods that contain combinations of fat, sugar, carbohydrates, and sodium at moderate to high levels as "hyper-palatable foods."These combinations of ingredients may circumvent physiological satiety mechanisms and contribute to a lifelong obesity risk (Fazzino et al., 2019).In a recent meta-study of food items offered on school lunch menus, researchers found that nearly half of foods qual-ified as hyper-palatable foods (and were presumably compliant with federal school lunch guidelines), which researchers hypothesized could influence risk of child obesity (Dilsaver et al., 2023).However, the current definition of a hyper-palatable food does not include beverages, as liquids have different optimal palatability compared with solid foods (Drewnowski et al., 1989;Fazzino et al., 2019).While milk and flavored milks are not considered hyper-palatable foods using the current definition, governmental concerns around limiting excessive added sugar intake in children are clearly reflected in recent proposed changes to school lunch milk regulations.The USDA has proposed limiting the amount of added sugar in flavored milks to no more than 10 g of added sugar per 8 fluid ounces for milk served with school lunch or breakfast and 15 g of added sugar per 12 fluid ounces for flavored milk sold outside of meals (Food and Nutrition Service, 2023).Given the controversy for addition of sugar to (flavored) milk, previous studies have evaluated child liking of chocolate milks with nonnutritive sweeteners in place of sugar (Li et al., 2015a,b).
Since adult fluid milk consumption is associated with childhood habit, establishing fluid milk consumption in children is a critical activity for lifelong nutrition and fluid milk consumption (McCarthy et al., 2017).Relatively little research has been done on children's sensory perception of milk, though a few studies have evaluated child acceptance of flavored milk with varying milk fat and flavor attributes.Palacios et al. (2010) evaluated child acceptance of lactose-free milks and milk alternatives, including soy milk.Children preferred chocolate-flavored lactose-free 1% dairy milk over all other beverage options in the study, including unflavored 1% lactose-free dairy milk and chocolate-flavored soy milk (Palacios et al., 2010).Other researchers have evaluated child perception of sweeteners in chocolate milk, including monk fruit and stevia, as part of an effort to identify reduced-sugar chocolate milks (Li et al., 2015a;Verruma-Bernardi et al., 2015).Other studies have sought to understand the effect of packaging on child perception and acceptance of school lunch milk.Sipple et al. (2021) documented that children preferred the flavor of unflavored milk, regardless of fat content, packaged in high-density polyethylene (HDPE) or polyethylene terephthalate (PET) bottles over milk packaged in cardboard cartons, but their preferences were not distinct for chocolate milk.
While much of the research focus has been on child consumption and acceptance of milk, a few studies have been conducted to better understand parent perception of milk.Li et al. (2015a)  blinded (no nutritional information) and primed (nutritional information provided) conditions.Nutritional information affected parent preferences for chocolate milks.Parents also conceptually preferred natural nonnutritive sweeteners or sucrose over artificial sweeteners, and indicated that reduced fat was preferred over full fat or skim.Parents also found the claim of "added calcium for strong bones" appealing (Li et al., 2014).School lunch milk was not part of the context of this study.
The importance of parental influence on child milk consumption should not be underestimated.By acting as a both a provider of food and a role model, parent and caregiver decisions regarding food and beverages can have a powerful influence on child eating patterns (Savage et al., 2007).Brett et al. (2018) conducted a cross-sectional analysis of participants aged 2 to 8 yr old from a vitamin D trial to better understand parental attitudes and understanding of milk consumption.Parent self-reported intake of milk influenced their children's intake of milk.A different cross-sectional study conducted using a calcium-intake questionnaire identified 3 groups of parents with differing perception of milk and provided further evidence that parent perception of milk influenced their children's intake of milk (Reicks et al., 2012).Schiano et al. (2022) recently demonstrated that most parents still have an implicit positive bias toward milk for their children but less than half actively encourage their children to consume milk.To our knowledge, no studies have specifically addressed parents' understanding and perception of the milk that their children drink at school, and little is known about parental opinions on school lunch milk.The objective of this study was to evaluate parental understanding of and familiarity with school lunch milk.

Experimental Overview
A series of 4 focus groups were conducted with parents to establish parent familiarity with their children's school lunch milk.Qualitative responses from focus groups were used to develop an online survey that assessed the value that parents placed on milk and other beverages served with school lunches, along with the importance and familiarity of school lunch milk attributes.Following the completion of survey 1, a second online survey (survey 2) was conducted to evaluate parent perception of sugar claims in chocolate milk served in schools.Surveys utilized psychographic questions, maximum difference (MXD) scaling exercises, and adaptive choice-based conjoint (ACBC) exercises (Figure 1).

Participants
All testing was conducted in compliance with North Carolina State University Institutional Review Board regulations.Participants were contacted using an online database of >10,000 consumers from the greater Raleigh/Durham/Chapel Hill, North Carolina, area maintained by the Sensory Service Center at North Carolina State University (SSC).Consumers who reported that they had children under the age of 18 yr that attended public or private school and consumed milk at school could qualify for this study.Additional qualification criteria for the focus groups and surveys are subsequently specified.

Focus Groups
The objective of the focus groups was to establish a baseline for parent familiarity with school lunch milk.Participants were recruited from a database maintained by the SSC, which consisted of over 10,000 consumers.Participants who indicated in a screener survey that they had at least 1 child between the ages of 5 and 13 yr who purchased fluid dairy milk as part of their lunch at school were considered qualified for the focus groups.Parents that represented a range of milk purchase habits (n = 34) were selected to participate in the focus groups, including parents who purchased dairy milk, plant-based dairy alternatives, and a mix of both for their children to consume at home.
A total of 4 focus groups were held on the North Carolina State University campus.Each focus group followed a pre-established moderator guide and lasted about 90 min.Parents began the focus group by describing their milk consumption as children to establish an understanding of their personal experience with milk.Next, they answered questions about their family's milk consumption, including why they do or do not serve milk to their family at home.The core of the focus group focused on understanding of parent beliefs surrounding school lunch milk, including questions about fat content, flavor, and the importance of other milk attributes.
Parent familiarity with school lunch milk was assessed by displaying FDA regulations from the CFR for flavored milk and milk fat content of school lunch milk on an LCD projector screen in the focus group room followed by a discussion of the information presented.Parents were shown the statement, "Schools must offer students a variety (at least two different options) of fluid milk.All milk must be fat-free (skim) or low-fat (1% fat or less).Milk with higher fat content is not allowed.Low-fat or fat-free lactose-free and reduced-lactose fluid milk may also be offered.Milk may be unflavored or flavored provided that unflavored milk is offered at each meal service."Regulations were taken from the CFR regarding milk served as part of the NSLP and NSBP (Meal requirements for lunches and requirements for afterschool snacks, CFR §210.10;Office of the Federal Register, 2021a).Parents then completed a worksheet that asked them to use a list of provided characteristics to build their ideal school lunch milk for their children, similar to the build-your-own (BYO) portion of an ACBC (see below).The attributes included in the BYO section included flavor, fat content, protein content, heat treatment, package, and label claims.For heat treatment, parents were provided with information on shelf life and heat treatment as for survey 1 (Table 1, footnote).Finally, each group was shown a range of commercially available milks (flavored and unflavored) and asked to discuss their perception of each of them, including package, protein content, sugar content, fat content, and other nutritional attributes.Parents who fully participated in the focus group were compensated with a $50 gift card to an online retailer.

Online Surveys
Survey 1.The objective of survey 1 was to assess the importance of child milk consumption to parents.The online survey was developed using Lighthouse Studio (Sawtooth Software version 9.8.0,Orem, UT).The survey was uploaded to a database maintained by the SSC, which consists of over 10,000 consumers.Participants who indicated they had children younger than 18 yr were able to enter the survey.Participants who indicated that they had at least 1 child between the ages of 5 and 13 yr who purchased fluid milk as part of their lunch at public or private school (n = 216) completed psychographic questions, maximum difference (MXD) scaling questions, and an ACBC exercise on school lunch milk attributes.Psychographic questions included assessments of familiarity with milk nutrition and attributes of school lunch milk, as well as agreement questions regarding statements about milk served at school.Parents were prompted to answer questions based on their previous knowledge or best guess instead of searching for answers while completing the survey.
The beverage MXD exercise consisted of 19 beverages, including milk with different milk fat content and flavor choices as well as water, juice, soda, and similar nondairy beverages.A MXD or "best-worst" scaling exercise allows participants to rank a long list of items with relatively few questions by utilizing a series of comparisons to generate importance scores (Buoye et al., 2018).Parents were asked to indicate which options they would be "most interested" (best) and "least interested" (worst) in their child consuming as part of The term "HTST pasteurized" was accompanied by the description "HTST (High Temperature, Short Time) Pasteurized Milk is heated to at least 72°C for 15 seconds.This is the milk that you typically buy at the grocery store from the refrigerated section.If refrigerated properly, this milk has a shelf life of 18-21 days."

3
The term "Ultrapasteurized" was accompanied by the description "Ultrapasteurized milk is heated to a higher heat treatment than HTST milk, at least 138°C for at least 2 sec, which extends its refrigerated shelf life.Ultrapasteurized Milk has an unopened refrigerated shelf life of 60-90 days." 4 The term "UHT pasteurized/shelf stable" was accompanied by the description "UHT (Ultra High Temperature) is commercially sterile milk and does not require refrigeration when unopened.It is typically stored unrefrigerated for 6-9 months." their lunch at school.Each respondent completed 13 sets of best-worst questions with 5 items in each set.These questions were asked to evaluate which beverages parents placed the most value on for their children's consumption at school lunch.
The ACBC exercise was used to determine the relative importance of milk attributes to parents and to establish their ideal school lunch milk product for their children.The ACBC exercises are designed to examine consumer purchase choices and tradeoffs utilizing a series of product concept builds to generate utility scores, which are commonly zero-centered to sum to 100 (Orme, 2006;Buoye et al., 2018).Higher scores represent attribute levels that are more appealing, and negative utility scores represent levels that are less appealing compared with those with positive scores (Orme, 2006).The exercise consisted of 5 levels with 4 to 6 attributes per level (Table 1) that represented extrinsic and intrinsic factors of school lunch milk.Levels included flavor, fat content, heat treatment, label claims, and package type.Parents first completed a BYO task by selecting one level within each attribute to create their ideal school lunch milk product for their children, followed by 8 screening tasks in which they were presented with 4 school lunch milk concepts per task and asked to select whether each product concept was "a possibility" or "won't work for me."Next, parents completed a choice task tournament with a maximum of 20 school lunch milk concepts presented.Concepts in the choice tournament were presented in groups of 3 to minimize panelist fatigue.Throughout the ACBC exercise, parents were prompted to consider that they were selecting a milk they might want their child to drink at school.Parents were prohibited from making overlapping selections, such as the label claim "organic" and the label claims "rBST-free" or "GMO-free" because organic milk is required to be free from added hormones and cows producing organic milk may not be fed genetically modified feed (Office of the Federal Register, 2021b).Parents were also prohibited from making conflicting selections, such as HTST-pasteurized milk packaged in a Tetra Pak container.Participants who completed the survey were entered into a drawing for one of twenty $25 gift cards to a local store.The average time to complete the survey was 20 min.
Survey 2. Survey 1 demonstrated the importance that parents placed on chocolate milk for their children's school lunch milk.The objective of survey 2 was to expand upon results from survey 1 regarding chocolate milk and to further develop parental understanding of the importance of label claims and nutritional content specifically for school lunch chocolate milk.The online survey was developed using Lighthouse Studio (Saw-tooth Software version 9.8.0).The survey was uploaded to the same database used by survey 1. Participants who indicated they had children younger than 18 yr were able to enter the survey.Participants who indicated that they had at least 1 child between the ages of 5 and 13 yr who purchased chocolate fluid milk as part of their lunch at public or private school (n = 133) completed psychographic and agreement questions, along with a MXD exercise regarding chocolate milk nutrition and sweeteners.Approximately 90 d passed between survey 1 and survey 2. Consumers could participate in both surveys providing that they met the qualification criteria for both.Participant identification between surveys and focus groups were not connected to protect participant privacy per North Carolina State University Institutional Review Board regulations.
Parents began the survey with familiarity questions about milk and chocolate milk nutrition, including questions that asked them to guess how many grams of added sugar are in the chocolate milk their children drink at school and at home.Parents then completed a series of 49 randomized agreement questions regarding attributes of chocolate milk served in schools.Next, survey participants completed a series of 4 sliding-scale questions surrounding perception of child chocolate milk products.The first sliding-scale question used the anchor points "It's important that the chocolate milk my child drinks is healthy" (value: −10) and "It's important that my child likes the chocolate milk they are drinking" (value: 10).The next 3 sliding-scale questions assessed parent perception of sugar alternatives.All 3 used the same format in which the left anchor was valued at −10 and used the text, "I would not like to see [ingredient] in the chocolate milk served at school" and the right anchor was valued at 10 and used the label text, "I would like to see [ingredient] used in the in the chocolate milk served at school."Ingredients assessed were "sugar alternatives," "natural sugar alternatives," and "low-calorie sugar alternatives."Participants were provided with sucralose, agave, stevia, and monkfruit as sugar alternatives; stevia and monkfruit as examples for natural sugar alternatives; and agave and erythritol for low-calorie sugar alternatives.The MXD exercise consisted of 28 extrinsic and intrinsic properties of chocolate milk, including fat content, use of alternative sweeteners, packaging, and flavor.Parents were asked to indicate which attributes were "most important" and "least important" for the chocolate milk their child consumed at school.Each respondent completed 22 sets of best-worst MXD questions with 5 items per question.This MXD exercise was included in the survey to assess the relative importance of different school lunch chocolate milk attributes to parents.Participants who completed the survey were entered into a drawing for one of fifteen $25 gift cards to a local store.The average time to complete the survey was 18 min.

Statistical Analysis
Transcripts of audio from focus groups were manually analyzed for central themes.Data from ideal milk activity and other demographics from focus groups were analyzed for frequency of responses and percentage distribution of demographic information.For surveys, attention check questions were asked throughout the survey to ensure participant engagement.All statistical analyses were performed at a 95% confidence level (P < 0.05).Hierarchical Bayes (HB) estimation was performed in Sawtooth Software (version 9.9.0,Orem, UT) and all other analyses were performed using XLSTAT (version 2019.3.1,Addinsoft, New York, NY).Individual utility scores from the ACBC in survey 1 were calculated by HB estimation, and importance scores for ACBC attributes were calculated as the percentage of the total utility range for each attribute.The HB estimation was also used to calculate importance scores for MXD attributes for both survey 1 and survey 2. Cluster analysis for survey 1 was performed using agglomerative hierarchical clustering with Euclidean distances and Ward's linkage to place similar respondents into clusters based on individual utility scores from the ACBC.Cluster analysis for survey 2 was performed using the same technique on individual importance scores from the MXD exercise.Analysis of variance with Fisher's least significant difference means separation was performed on sliding-scale questions and Kruskal-Wallis with Dunn's post hoc test was performed on agreement questions.

Focus Groups
Focus group participants (n = 34) were primarily female (82% female, 18% male).Thirty-two percent of participants were 25 to 34 yr, 50% were 35 to 44 yr, and 18% were 45 to 54 yr.Eighty-five percent of participants had 2 or more children in the household and 15% reported 1 child in the household.Most participants (56%) had at least 1 child between the ages of 5 and 7 yr, 32% had at least 1 child 8 to 10 yr, and 50% had at least 1 child 11 to 13 yr.Ninety-five percent of focus group participants' children attended public school and 5% attended private school, charter school, or a magnet school program.All participants indicated that their children consumed fluid dairy milk as part of their lunch at school, and 91.2% (n = 31) indicated their children also consumed milk at home.Eighty-seven percent of parents whose children consumed milk at home indicated they served unflavored or white milk at home, and 77% indicated that they also served chocolate milk at home.Parents were asked to select the type of milk they served at home from a check-all-thatapply (CATA) list of options.Parents indicated skim milk (38%), 1% fat milk (38%), 2% fat milk (84%), and whole milk (42%) were served at home, but 68% of parents also indicated that they served nondairy milk alternatives at home.A similar distribution of parental purchasing habits was observed in a 2020 Mintel study surrounding milk and nondairy milk alternative consumption in the United States (Bonnett, 2020).
Parents were generally familiar with the flavor of milk that their child consumed at school and the flavor options available to them.Most parents (82%) reported that their children consumed chocolate milk at school, and 73% reported their children consumed unflavored or white milk at school.However, parents expressed less familiarity with fat content of milk that their children consumed at school.Before displaying USDA regulations surrounding milk fat content of school lunch milk, parents were asked what fat content of milk their child consumed most often at school (participants could make more than one selection).Fourteen percent indicated skim milk, 21% indicated 1% fat milk, 56% indicated 2% fat milk, and 29% indicated whole milk.Parents also indicated limited familiarity with school lunch milk portion sizes.When asked what volume of milk their children consumed as part of a lunch at school, 73% of parents correctly selected 1 cup (8 fluid oz), 9% guessed 2 cups (16 fluid oz), and 18% guessed 0.7 cups (5.7 fluid oz).When presented with school lunch milk regulations, 91% of parents indicated they were not aware of the displayed information before their focus group.Most parents (65%) indicated they were surprised by the information presented.Follow-up discussion showed that most parents (>50%) were unaware that 2% and whole milk were not allowed in schools and were surprised by this information.
Parents who participated in the focus group were asked to choose from a list of options to generate their ideal school lunch milk.Overall, the ideal milk for focus group participants was chocolate-flavored, 2% fat, contained 8 g of protein, was HTST pasteurized, was packaged in a plastic bottle, and had an all-natural label claim.Parents were split on preferences for milk flavor that children consumed at school: 41% of parents indicated they would prefer their children to drink unflavored (white milk) at school and 53% preferred chocolate.A 2% fat milk was preferred by 47% of focus group participants and 18% chose skim, 18% 1% fat, and 15% whole milk.Parents were less certain of milk protein content per 1 cup serving, with 41% choosing 8 g, 24% choosing 10 g protein, 12% choosing 12 g protein, and 24% choosing "no preference/unsure."An even distribution of responses was observed for heat treatment, with 29% of parents selecting ultrapasteurization as their preferred heat treatment, 32% selecting HTST pasteurization, 24% selecting UHT/shelf stable, and 15% indicating "no preference/unsure."Parents also indicated interest in Tetra Pak packaging and cardboard cartons for school lunch milk (selected by 26% and 21% of participants, respectively), but 41% selected plastic bottles as their preferred package for school lunch milk.Organic and genetically modified organism (GMO)-free label claims were appealing to parents, with 32% and 35% of parents selecting these claims in a CATA format, respectively.The selections made by parents during the focus group were used to generate the list of levels and attributes for the ACBC exercise conducted in the online survey portions of this study.
Overall, focus group participants perceived milk as a healthy choice for their children regardless of its fat content and flavor.Most parents mentioned that milk was important for bone health and development and that they encouraged their children to consume milk for this reason.Approximately 40% of parents mentioned that advertisements regarding the benefits of milk for bone development influenced their decision to serve milk to their own children, such as "Got milk?" and "Milk does a body good" advertisements.The "Got milk?" advertisement campaign, which launched in 1993, was at its peak during Millennial and Gen X parent adolescences (Daddona, 2018;Dimock, 2019).Parent familiarity with milk as a component of bone health was also observed by Li et al. (2014), as parents returned a positive utility for the claim "added calcium for strong bones" in an ACBC exercise regarding selection of chocolate milk for their children.Parents preferred milk over other beverages, including water, juice, and soda, to be served in schools as part of lunch and breakfast due to its protein and vitamin content.However, some parents (30%) expressed an interest in seeing more nondairy options to be served in schools out of concern for children with intolerances and allergies.Focus group results from this study may be limited in that sessions only included parents who purchased dairy milk for their children to consume at home and did not include any parents who did not serve milk at home.We also did not ask parents to report their own milk intake.As previously discussed, parent perception and intake of milk has a significant impact on child consumption of milk.Children of dedicated milk provider parents consumed more milk (10.36 oz/d vs. 5.64 and 7.16 oz/d for other parent groups, respectively) and less soda and fruit juice products (Reicks et al., 2012).Dedicated milk providers/drinkers also indicated that culture/tradition and health benefits were significantly more important to them compared with parents from other groups (Reicks et al., 2012).

Survey 1
A variety of parents participated in survey 1.Most participants (83%) were female, and 17% were male.Most (55%) parents were aged 35 to 44 yr, but 18% were 18 to 34 yr, 24% were 45 to 54 yr, and 4% were 55 to 64 yr.Twenty-five percent of respondents selfidentified as black/African American, 9% identified as Hispanic/Latinx, 5% identified as Asian/Indian, 63% identified as white/Caucasian, and 2% selected "other."A range of household incomes was also reported: 12% of parents indicated $20,000 to $39,999, 25% indicated $40,000 to $59,999, 15% indicated $60,000 to $79,999, 17% indicated $80,000 to $99,999, and 31% of respondents indicated their annual household income was greater than $100,000.Parents confirmed that they had at least 1 elementary or middle school-aged child (5-13 yr) in their household.Most parents had children that attended public school (86%), 8% attended private school, 2% attended charter school, and 4% attended a magnet school program.Parents reported that their children purchased lunch, including milk, at school (an average of 3.3 d out of 5).Most parents (69%, n = 150) selected "yes" when asked if their children talk to them about the milk they drink at school.
Based on the MXD exercise from survey 1, parents valued milk as a beverage to be served in schools, as all 8 milk options presented were in the top 10 highestscoring beverages out of a list of 19 possible options (Table 2).Flavored 2% fat milk was preferred overall, followed by 2% fat milk, flavored 1% fat milk, flavored whole milk, and flavored skim milk (Table 2).Flavored milk was preferred over unflavored milk for all fat content options, likely due to parent understanding of their children's milk preferences and consumption habits as evidenced by demographic and consumption information collected during earlier parts of the survey.When asked to select which type of milk their child consumed most often at school, 24% of parents selected "unflavored/plain/white milk," while 74% of parents selected flavored milk, including 56% chocolate milk, 10% strawberry milk, and 8% vanilla milk.From MXD results, parents placed value on flavored milk as a beverage for their children to consume at school, as flavored milks were ranked first, third, fourth, and fifth out of all beverage choices.Parents also indicated that they valued 2% fat milk as a beverage choice for their children (Table 2).Lower-fat milk options were less preferred by parents, with 1% fat milk and skim milk scoring below water as a beverage option for schools.Reduced-fat milk (2% milk fat milk) has consistently been chosen by milk consumers across the past 10 yr among milks with varying fat contents (McCarthy et al., 2017;Mintel, 2022).Further, a recent review confirmed the lack of a link between child milk fat consumption and childhood obesity (Vanderhout et al., 2020).Collectively, these items are consistent with reduced-fat school lunch milk being preferred by parents.As such, skim and low-fat milk options currently being served in schools may not meet parental expectations.
Survey 1 respondents indicated the most familiarity (3.8 on a 5-point familiarity scale) with the flavor of the milk their children drink at school, and the low-est familiarity (3.0 on a 5-point familiarity scale) with the fat content of school lunch milk (Table 3).About one-third of parents indicated that they were familiar with fat content of the milk their children drink at school, while the remaining two-thirds of parents were unsure or unfamiliar.Parents had more confidence with milk nutrition (Table 6).Ninety-one percent of parents agreed with the statement "Milk is an excellent source of calcium" and 87% agreed that milk is an excellent source of vitamins A and D and contains lactose (Table 4).Parents were less certain (P < 0.05) regarding milk as a complete protein; 74% of parents agreed that milk is a source of complete protein.Animal-based products such as dairy milk are complete proteins, meaning that they contain all of the AA essential for human growth and metabolism (Hoffman and Falvo, 2004).Nearly 47% of parents surveyed also agreed that milk is an excellent source of dietary fiber, despite dairy milk containing 0 mg of fiber per serving.More than 50% agreed that milk contains glucose, which it does not.Schiano and Drake (2021) noted that most consumers were unaware of milk composition.
Most parents underestimated the amount of lactose in a serving of milk with 53% of parents guessing 4 or 8 g of lactose per serving of plain milk.An 8-fluid ounce serving of plain milk contains 12 to 13 g of lactose (Vaskova and Buckova, 2016).Previous research has shown a general lack of food knowledge and health literacy for dairy foods.Schiano and Drake (2021) evaluated dairy consumer familiarity with fluid milk and dairy processing using an online survey and a series of in-depth interviews.A majority (80%) of n = 54 interview participants indicated they do not typically read nutrition labels on dairy products, and only 1.8% of 1,210 online survey participants could correctly identify the amount of fat, protein, and lactose in whole milk.Milk as an excellent source of calcium and "builds strong bones" were messages that most US adults know, consistent with results from this study and Schiano et al. (2022).Researchers also studied knowledge and perception of milk fat in consumers from Denmark, the United King- Means in a column followed by a different letter indicate differences (P < 0.05).1Parents were asked to indicate which beverage they were most interested and least interested in their child consuming as part of their lunch at school.Means have been rescaled to sum to 100.A higher number indicates a more preferred beverage.
2 Flavored milk was specified as "(Chocolate, Strawberry, Vanilla)."a-c Means within a column followed by a different superscript are significantly different (P < 0.05).

1
A 5-point familiarity scale was used where 1 = not at all familiar and 5 = extremely familiar.Percentages represent percentage of survey 1 participants that selected each option for each row.
dom, and the United States and, not surprisingly, found that a large portion of participants were not aware of different types of milk fat fatty acids including n-3 and trans fatty acids (Vargas-Bello-Pérez et al., 2020).Parent preference for milk over other beverages for their children was also reflected in their responses to agree/ disagree statements.Parents most strongly agreed with the statement, "Schools should be required to offer milk as part of a lunch at school" (Table 5).Similar to the trends observed during focus groups, parents preferred their child to drink plain or flavored milk over other beverage options such as water, soda, or juice.
Parents also agreed that schools should offer plantbased alternative beverages as part of a lunch at school (Table 5).This item is likely motivated by concerns about allergies and intolerances voiced during the focus groups.Parents also indicated the same level of agreement for lactose-free milk as a school lunch offering.An estimated 68% of the world's population experiences lactose malabsorption or intolerance, including 30 to 50 million Americans (National Institute of Child Health and Human Development, 2006;Messia et al., 2007).Due to increasingly diverse household dietary requirements, parents are some of the most frequent purchasers of both the dairy and plant-based milk categories, as evidenced by a Mintel survey of n = 2,000 consumers, which reported that 88% of participating parents indicated that they purchased dairy milk and 65% of parents indicated that they also purchased plant-based milk alternatives.Comparatively, 80% of nonparent participants purchased dairy milk and 44% purchased nondairy milk alternatives (Bonnett, 2020).Previous research has also shown that both plant-based alternative consumers and consumers of both dairy milk and plant-based alternatives place value on a lactose-free claim for beverages, which may be motivating parent desire for plant-based alternatives or lactose-free milk in the school cafeteria setting (McCarthy et al., 2017;Rizzo et al., 2020).
Survey respondents indicated that flavored milk should be offered as part of a lunch at school and also indicated that they would prefer flavored milk options a-c Means within a column followed by a different letter are significantly different (P < 0.05).

1
A 5-point agree/disagree scale was used where 1 = completely disagree and 5 = completely agree.Percentages represent percentage of survey 1 participants that selected each option for each row.

Statement Mean score
Schools should be required to offer milk as part of a lunch at school.4.5 a I would prefer my child drink plain milk than other beverages, like soda or juice, served at school.4.4 ab I would prefer my child drink flavored milk than other beverages, like soda or juice, served at school.
4.2 abc Schools should offer lactose-free milk for lunch at school.4.0 bcd Schools should offer plant-based alternative beverages (e.g., almond milk) for lunch at school.
3.9 cd Flavored milk should be offered at school as part of a lunch at school.
3.8 de I would prefer the flavored milk served at school lunches to be reduced sugar or sugar free.
3.7 de Schools should offer ultrafiltered (protein enriched) milk for lunch at school.
3.4 ef It doesn't matter to me what kind of milk (white/unflavored, chocolate, strawberry, etc.) the school offers.
3.0 fg It doesn't matter to me what kind of fat level of milk the school offers.
3.0 fg I would prefer my child drink plain milk than water served at school.
3.0 fg I would prefer my child drink flavored milk than water served at school.
2.8 gh It doesn't matter to me if there is added sugar in the flavored milk the school offers as long as my child likes and drinks the milk.
2.8 gh It doesn't matter to me if there are natural sugar alternatives, like stevia, in the flavored milk the school offers to my child.
2.7 gh It doesn't matter to me if there are sugar alternatives, like stevia or sucralose, in the flavored milk the school offers to my child.

h a-h
Means followed by a different superscript are different (P < 0.05). 1 A 5-point agree/disagree scale was used where 1 = completely disagree and 5 = completely agree.
served at school to be reduced-sugar or sugar-free (3.7 on a 5-point agree/disagree scale; Table 5).This result was also observed in previous research with parents regarding purchase of chocolate milk for their children, which found that parents' purchase decisions around chocolate milk are primarily driven by sweetener type, likely due to concerns around the effect of sugar on children's health (Li et al., 2015a).Responses to statements about fat content were more neutral, with the statement, "It doesn't matter to me what kind of fat level of milk the school offers" returning a score of 3.0 on a 5-point agreement scale.This result indicates that there may be differing opinions or confusion among parents regarding school lunch milk fat content.Parents were also less sure about statements regarding alternative sweeteners in flavored milk at school, which prompted the decision to further explore perception of sweeteners in chocolate milk in survey 2.
Before completing the ACBC exercise, parents were presented with a list of 26 school lunch milk attributes in a CATA format and asked to select which were most important to them for a school lunch milk (Table 6).The most selected attributes were unflavored (white milk) (61%), chocolate milk (57%), and 2% fat (53%), followed by cardboard carton (34%) and whole fat (33%).One percent fat was selected by 32% of parents and skim milk was selected by 20% of parents, which further demonstrates that these milk fat contents are less preferred by parents compared with 2% and whole milk.A similar trend was observed by Kim et al. (2013), who reported that 1% and 2% fat chocolate milks were conceptually preferred by consumers over skim chocolate milk in an online conjoint analysis exercise (Kim et al., 2013).Li et al. (2014) also observed that low-and reduced-fat milks received the highest utility score in a conjoint exercise regarding parent choices for chocolate milk for their children.
In survey 1, the average ideal school lunch milk for parents from the ACBC exercise was unflavored (white milk) or chocolate, 2% fat, ultrapasteurized, with allnatural and hormone-free label claims, packaged in a cardboard gabletop carton.Parents displayed the highest utility for package, milk fat percentage, and flavoring over label claims and heat treatment (Figure 2).For label claims, an all-natural claim had the highest utility among the first group of claims evaluated followed by organic.Among the second group of label claims, parents displayed the highest utility for hormone free.This claim is unrealistic because hormones are naturally present in milk (and other foods).Interestingly, a GMO-free claim had the next highest utility for consumers rather than recombinant bovine somatotropin (rBST) free.This result suggests a general lack of understanding of an rBST-free claim, which is a commonly encountered label claim on many dairy products, or a consumer lack of understanding that all foods naturally contain hormones.Positive utility scores were also observed for 1% fat milk, organic and GMO-free label claims, and plastic bottles.
Two clusters of parents were identified from utility scores (Figure 3).Cluster 1 (n = 141) parent ideal school lunch milk was chocolate, 2% fat, ultrapasteurized, with an all-natural label claim packaged in a cardboard gabletop carton.Cluster 2 (n = 75) parent ideal school lunch milk was unflavored (white milk), 2% fat, ultrapasteurized, with organic, all-natural, and hormone-free label claims packaged in a cardboard carton.Chocolate and unflavored milk were preferred by both parent clusters over strawberry-and vanillaflavored milk.A 2% fat milk was preferred over all other milk fat contents by both groups of parents, but cluster 1 parents indicated a significant preference for whole milk to be served in schools and had the lowest utility score for skim milk, whereas cluster 2 parents indicated preference for 1% fat and skim milk.Both groups of parents preferred an ultrapasteurized milk over other heat treatment options.Cluster 2 parents displayed a significant preference for organic and allnatural label claims, whereas cluster 1 parents returned a positive utility score for school lunch milk with no label claims.Similar to cluster 1, a group of parents with a preference for all-natural chocolate milk was also observed by Li et al. (2014) in an online survey of extrinsic attributes that motivated parent purchase of chocolate milk for their children.Cluster 2 parents also returned a positive utility score for glass bottles as a packaging material for school lunch milk, which may indicate that they are sustainability focused.United States consumers are increasingly interested in sustainable package options for beverages, and glass and metal are perceived as more sustainable than other package options by most consumers (Feber et al., 2020;Otto et al., 2021).From the current study, groups of parents with distinct preferences for school lunch milk exist, but chocolate and unflavored 2% fat milk are universally appealing for school lunch milk.Parental preference for 2% fat milk observed in this study is supported by data collected by the Agricultural Marketing Service and USDA Foreign Agricultural Service from January to December 2019, which showed that whole milk and 2% fat milk were the most consumed milk types in the United States in 2019.Parent preference for chocolate school lunch milk likely reflects child preference for flavored milk over unflavored milk.Children consistently display a preference for flavored milk and their consumption of milk significantly decreases when flavored milk options are removed.When Williamson et al. (2015) asked schoolchildren to explain why they preferred chocolate milk, response themes ranged from unavailability of chocolate milk at home to a preference for increased sweetness and cocoa taste, consistent with Quann and Adams (2013).

Survey 2
Participant demographics for survey 2 were similar to those seen in survey 1 (results not shown).All respondents (100%) indicated their children consumed chocolate milk at school, as this was required to participate in the survey.Nearly a quarter of parents surveyed (24%) indicated that their child or children consumed chocolate milk every day at school, and 12% indicated their child consumed chocolate milk every day at home.Forty-eight percent of parents indicated their children consumed chocolate milk about 2 to 4 times per week at school, and 31% indicated the same response for athome consumption.
Parents were generally not familiar with the amount of added sugar in chocolate milks served at school and at home.All parents who participated in survey 2 were asked to guess how many grams of added sugar they thought was in the chocolate milk their children consumed at school using a multiple-choice question format with a provided list of options.Currently, school lunch chocolate milk contains approximately 8 g of added sugar.Parents tended to overestimate the amount of added sugar in school lunch chocolate milk, with 69% of parents indicating 10 or more grams of added sugar and only 31% indicating 6 g or less (data not shown).A much wider distribution of responses was observed for parent responses regarding the amount of added sugar in the chocolate milk they served at home.Only parents who previously indicated their children consumed chocolate milk at home (n = 127) were shown this question.Of this group of parents, 20% indicated <6 g of added sugar, 34.6% noted 6 to 12 g, and 44.9% indicated 14 to 22 g.Consumers tend to underestimate sugar content in foods that have a perceived "health halo" and overestimate sugar content of foods that are perceived as unhealthy (Dallacker et al., 2018;König et al., 2019).Dallacker et al. (2018) reported that parents underestimated the amount of sugar in products such as orange juice and fruit-flavored yogurt in an online study, but 66.2% of n = 224 participants overestimated the amount of sugar in a chocolate-flavored granola bar.
Overall responses to agree/disagree questions supported the trends seen in focus groups and in survey 1 and provided further context to parent preferences for school lunch chocolate milk (Table 7).Similar to the trends seen in focus groups, parents agreed that milk is healthy for children because it contains protein and calcium, and some chocolate milks are healthier than others (4.5 and 4.2 on a 5-point agreement scale, respectively).Health statement results showed that parents perceived unflavored milk and water as healthier than chocolate milk, but chocolate milk was healthier than soda or juice.Overall agreement results showed that parents encouraged their children to drink milk at school (4.6 on a 5-point agreement scale), but selfreported that they preferred their children to drink unflavored milk over chocolate milk (3.7 vs. 2.4 on a 5-point agreement scale) and encouraged their children to drink plain milk over chocolate milk at school (3.6 vs. 2.9 on a 5-point agreement scale).Parent agreement results in combination with their tendency to overestimate sugar content observed in this study suggest that chocolate milk does not benefit from a "health halo" in most parents' eyes, despite positive perception of its vitamin and protein content.
Survey 2 respondents most strongly agreed that their children chose the flavor of milk that they wanted to drink at school (4.6 on a 5-point agreement scale) and indicated that their children liked both unflavored and chocolate milk (4.3;Table 7).Parents also indicated that their child preferred chocolate milk to unflavored milk and agreed that schools should offer both unflavored and chocolate milk as part of lunches (4.3).Overall, survey respondents indicated that nutrition, protein content, vitamin/mineral content, and sugar content of school lunch milk were important to them (4.3, 4.3, 4.2, and 4.2, respectively).Parents were neutral that the only sweetener used in chocolate milk should be sugar (3.4 on a 5-point scale).Previous research has shown that parents are divided when it comes to sugar alternatives in children's chocolate milks, with some parents being acceptors of these ingredients and others preferring their children to consume traditional sweeteners such as sucrose (Li et al., 2015a).
Overall, parents indicated in the MXD exercise that the most important characteristics of chocolate milk served in school were high calcium content and freshness, followed by child consumption of the milk (Table 8).Parents also indicated that vitamin D and protein content were important.Parents had a general preference for higher fat chocolate milks, with whole milk and 2% fat milk receiving higher importance scores than 1% fat milk or skim milk, consistently with milk fat content preferences throughout this study.High MXD scores for calcium, vitamin D, and protein content highlight the importance that parents place on the nutritional benefits of chocolate milk, which corroborates what was seen in focus groups.Parent desire for these nutrients may be influenced by advertisement campaigns men-tioned by focus group participants that highlighted the benefits of calcium, protein, and vitamin D (Daddona, 2018) as well as what parents actually know about milk (Schiano and Drake, 2021;Schiano et al., 2022).Parents also indicated that it was important for chocolate school lunch milk to not contain artificial sugar alternatives, but were more accepting of natural and unspecified sugar alternatives.
Further exploration of parental perception of alternative sweeteners through semantic differential (sliding scale) questions also revealed distinct groups of parents with differing preferences for sugar alternatives and illustrated that most parents are open to these ingredients in school lunch milk (Table 9).Overall, parents indicated that it was more important for chocolate milk to be healthy than for their children to like it (−4.0 on a sliding scale where −10 = important for it to be healthy and 10 = important for my child to like it).Survey participants were neutral toward sugar alternatives in school lunch milk when the type of sugar alternative was not specified (0.3 on a sliding scale where −10 = not interested and 10 = interested), but their acceptance of sugar alternatives significantly increased when the sugar alternatives were specified as "natural" (3.9) and decreased when sugar alternatives in school lunch chocolate milk were specified as "low-calorie" (−0.4).These results correlate with those observed by Li et al. (2014) in which the majority of parents indicated preference for natural nonnutritive sweeteners over artificial nonnutritive sweeteners.
Survey respondents were clustered based on their responses to the MXD exercise in survey 2 (Table 8).Three clusters of parents were identified, designated the "Natural" parents (n = 64), the "Vitamins" parents (n = 43), and the "Sugar" parents (n = 16) to represent the core values of each group.Other survey results, including agreement questions and sliding-scale responses, were also analyzed by cluster to build a comprehensive consumer profile for these groups of parents (Tables 7 and 9).
"Natural" Parents (n = 74)."Natural" parents were motivated by freshness, simple ingredients, and an all-natural label in the MXD exercise, as well as chocolate milks that do not contain sugar alternatives, particularly artificial sugar alternatives (Table 8).This group's responses to agreement questions indicate a preference for unflavored/plain milk over chocolate milk, as parents in this group indicated that they viewed chocolate milk as a treat and showed the lowest agreement score of the 3 identified clusters with the statement, "Schools should offer chocolate milk as part of lunches" with a score of 3.7 on a 5-point agreement scale compared with 4.4 for "Vitamins" parents and 4.3 "Sugar" parents.These parents were also neutral re-garding the statement, "I want my child to drink milk, it doesn't matter if it's plain or chocolate," whereas parents in other groups agreed with this statement.These "Natural" parents also agreed that chocolate milk usually has too much sugar, which may help to explain why it is viewed as a treat.Parents were asked to indicate their opinion of sugar alternatives using a series of sliding-scale questions ( The sugar content of milk my child drinks at school is important to me.
4.17 ABCDEF 4.2 3.9 4.7 The protein content of chocolate milk is more important than the sugar content.
2.94 KLMNOPQR 3.0 2.9 2.8 The vitamin/mineral content of chocolate milk is more important than the sugar content.Means followed by a different superscript are different (P < 0.05). 1 Agreement was rated on a 5-point scale where 1 = completely disagree and 5 = completely agree."Natural," "vitamins," and "sugar" are identified clusters of parents from maximum difference scores for important attributes of school lunch chocolate milk in survey 2. A-N Different uppercase letters next to means in the overall column indicate significant differences between attributes overall (P < 0.05). 1 Parents were asked to indicate which characteristics were most important and least important when considering the chocolate milk their children drank at school.Means have been rescaled to sum to 100.Top 5 most important attributes (highest importance scores) have been bolded to represent the defining characteristics of each group.A higher number indicates a more preferred attribute.
2 "Natural," "vitamins," and "sugar" are identified clusters of parents from maximum difference scores for important attributes of school lunch chocolate milk in survey 2.
milk was most important to them.This group of parents felt that schools should not offer low-sugar chocolate milks if children like them less and agreed that the nutrient content of chocolate milk was more important than the sugar content (Table 7).While this cluster of parents still felt it was important for chocolate milk to be healthy, the level of importance they placed on their children liking the milk was significantly higher than either of the other clusters (Table 9).These parents viewed chocolate milk as an important nutrient delivery mechanism for their children and were willing to make compromises on sugar content in exchange for their children's acceptance and consumption of important vitamins and minerals for growth."Sugar" Parents (n = 16).These parents were the most accepting of sugar alternatives in chocolate school lunch milk, returning positive sliding-scale scores for unspecified, natural, and low-calorie sugar alternatives (Table 9)."Sugar" parents valued label claims regarding sugar content above all other characteristics of chocolate milk, placing the highest importance on "no sugar added," "low sugar," and "reduced sugar" label claims, followed by calcium and protein content (Table 8).This group of parents agreed more strongly that schools should offer low-sugar chocolate milks even if children like them less, and indicated that the sugar content of chocolate milk is more important than its nutrient content.
Parents' responses to survey 2 provide further context to the results observed in survey 1 and suggest that parents value chocolate milk as part of meals at school for its nutritional benefits.This work, along with previous studies (Kim et al., 2013;Li et al., 2014Li et al., , 2015a)), supports the conclusion that distinct groups of parents with different preferences for chocolate milk and sugar alternatives exist.Parental opinions surrounding chocolate milk observed in this study align with previously observed trends that parents value low-and reducedfat (1% and 2%) milk options and natural labeling on children's chocolate milk products.It was also observed in both surveys that most parents are interested in reducing the sugar content of children's chocolate milk and are open to the use of sugar alternatives, particularly natural alternatives.Limited studies have been conducted to evaluate sugar alternatives in chocolate milk (Li et al., 2015b).Previous work has evaluated child perception of school lunch milk, including both its extrinsic and intrinsic characteristics, but more work is required to understand how reduced-sugar chocolate milks are perceived by children (Sipple et al., 2021).Some limitations of this study are that the respondents were generally from the Raleigh, North Carolina, area and may not be representative of parents nationally.This study is also subject to response bias, as only parents who at least moderately valued their children's milk consumption completed online survey activities.This may have resulted in an over-or underestimation of the value that parents place on school lunch milk attributes (Villar, 2011).

CONCLUSIONS
Children's consumption of milk as part of lunch of school is important to parents, and milk is preferred  Left anchor (−10): I would not like to see low-calorie sugar alternatives in the chocolate milk served at school.Right anchor (10): I would like to see low-calorie sugar alternatives in the chocolate milk served at school.Survey participants were provided with the terms erythritol and agave as example of low-calorie sugar alternatives."Natural," "vitamins," and "sugar" are identified clusters of parents from MXD scores for important attributes of school lunch chocolate milk in survey 2.
over other beverage options for school lunches, including water, juice, and soda.Parents in all phases of this study displayed a consistent and clear preference for 2% fat milk over skim and 1% fat milk and indicated that the calcium, vitamin D, and protein content of children's school lunch milk are important to them.In general, parents demonstrated low awareness of milk nutrition, but indicated that they value flavored milk as a vehicle for delivering important nutrients to their children.Current school lunch milk options, which are limited to skim and 1% plain and flavored milk, may not meet parental expectations for their children.
Parents are divided on the use of sugar alternatives in chocolate milk served in schools, with some parents highly in favor of these ingredients and others less so.
To further bolster parent positive attitudes toward milk and flavored milk, manufacturers of school lunch milk should consider the use of natural sugar alternatives in chocolate milk as a means of reducing the sugar content while highlighting milk's calcium, vitamin D, and protein.
Racette et al.: PARENTAL PERCEPTION OF SCHOOL LUNCH MILK evaluated parent perception of chocolate milks made with different sweeteners under Racette et al.: PARENTAL PERCEPTION OF SCHOOL LUNCH MILK

Table 1 .
Adaptive choice-based conjoint (ACBC) levels and attributes for parent importance of school lunch milk attributes (survey 1) 2

Table 2 .
Racette et al.: PARENTAL PERCEPTION OF SCHOOL LUNCH MILK Maximum difference scores for parent-preferred beverages to be served as part of school lunches from survey 1 (n = 216) 1

Table 3 .
Mean parent responses to school lunch milk familiarity questions from survey 1 (n = 216) 1

Table 4 .
Racette et al.: PARENTAL PERCEPTION OF SCHOOL LUNCH MILK Mean parent responses to milk nutrition agreement questions from survey 1 (n = 216) 1

Table 6 .
Racette et al.: PARENTAL PERCEPTION OF SCHOOL LUNCH MILK Results of check-all-that-apply exercise for parent important school lunch attributes asked in survey 1 (n = 216) 1 1Values represent percentage of survey 1 participants that selected each option.DHA = docosahexaenoic acid; rBST = recombinant bovine somatotropin.

Table 9 )
. Sliding-scale Racette et al.: PARENTAL PERCEPTION OF SCHOOL LUNCH MILK

Table 7 .
Results of agree/disagree questions from parents in survey 2 (n = 133) 1 Continuedresponses from "Natural" parents indicated a disinterest in sugar alternatives in chocolate school lunch milk unless the alternatives were specified as "natural."This group was the largest cluster observed in the study.

Table 8 .
Maximum difference scores for parent ideal school lunch chocolate milk attributes from survey 2 (n = 133)1,2

Table 9 .
Semantic differential (sliding scale) results from survey 2 (n = 133) Left anchor (−10): It's important that the chocolate milk my child drinks is healthy.Right anchor (10): It's important that my child likes the chocolate milk they are drinking."Natural," "vitamins," and "sugar" are identified clusters of parents from maximum difference (MXD) scores for important attributes of school lunch chocolate milk in survey 2. not like to see sugar alternatives in the chocolate milk served at school.Right anchor (10): I would like to see sugar alternatives in the chocolate milk served at school.Survey participants were provided with the terms sucralose, agave, monk fruit, and stevia as example of sugar alternatives."Natural," "vitamins," and "sugar" are identified clusters of parents from MXD scores for important attributes of school lunch chocolate milk in survey 2. would not like to see natural sugar alternatives in the chocolate milk served at school.Right anchor (10): I would like to see natural sugar alternatives in the chocolate milk served at school.Survey participants were provided with the terms monkfruit and stevia as example of natural sugar alternatives."Natural," "vitamins," and "sugar" are identified clusters of parents from MXD scores for important attributes of school lunch chocolate milk in survey 2.