Increasing the fruit and vegetable consumption of fourth-graders: results from the high 5 project

BACKGROUND: This study evaluated the effects of a school-based dietary intervention program to increase fruit and vegetable consumption among fourth-graders. METHODS: Twenty-eight elementary schools were randomized to an immediate intervention condition or to a delayed intervention control condition. Measures of diet and psychosocial variables were collected at base line and 1 and 2 years post-baseline. The intervention included classroom, parent, and cafeteria components. RESULTS: Mean daily consumption of fruit and vegetables was higher for the intervention children compared with controls at Follow-up 1 (X(t) = 3.96, X(c) = 2.28) and at Follow-up 2 (X(t) = 3.20, X(c) = 2.21). Macro- and micronutrient changes favoring the intervention children were also observed at both Follow-up 1 and Follow-up 2. Mean daily consumption of fruit and vegetables was higher for intervention parents compared with controls at Follow-up 1 (X(t) = 4.23,X(c) = 3.94) but not at Follow-up 2. CONCLUSIONS: Strong effects were found for the High 5 intervention on fruit and vegetable consumption, on macro- and micro-nutrients, and on psychosocial variables. Future work is needed to enhance the intervention effects on parents' consumption and to test the effectiveness of the intervention when delivered by classroom teachers.     

Achieving fruit, juice, and vegetable recipe preparation goals influences consumption by 4th grade students

Background  

Including children in food preparation activities has long been recommended as a method to encourage children's consumption, but has not been evaluated. Goal setting is also a common component of behavior change programs. This study assessed the impact of attaining goals to prepare fruit-juice or vegetable recipes on student fruit and vegetable consumption as part of a 10-week fruit and vegetable intervention for fourth grade students.     

Self-efficacy and norm measures for lunch fruit and vegetable consumption are reliable and valid among fifth grade students

OBJECTIVE: To determine the reliability and validity of a questionnaire measuring fruit and vegetable (FV) self-efficacy and social norms during school lunch among 5th graders. DESIGN: In this cross-sectional study, students completed lunch food records and a psychosocial questionnaire measuring school lunch FV self-efficacy and social norms regarding consumption during the fall and spring semesters. Test-retest reliability was assessed between fall and spring semesters. The measurement model was cross-validated in the spring data. SETTING: One middle school in Houston, Texas. PARTICIPANTS: 275 fifth graders in the 1998 fall semester and 262 of these fifth graders in the 1999 spring semester. MAIN OUTCOME MEASURES: FV consumption and psychosocial variables. ANALYSES: Principal components analyses, confirmatory factor analyses and bivariate correlations. RESULTS: Three scales were identified: Fruit Self-Efficacy, Vegetable Self-Efficacy, and FV Social Norms. FV self-efficacy were positively correlated with low-fat vegetable and fruit consumption. Social norms were positively correlated with total vegetable, low-fat vegetable, fruit and total FV consumption. CONCLUSIONS AND IMPLICATIONS: Self-efficacy and norms for eating FV at school lunch are related to lunch FV consumption. Increasing self-efficacy and social norms about consuming FV at school appears to be important targets to improve FV consumption.     

Increasing children's fruit and vegetable consumption: a peer-modelling and rewards-based intervention

OBJECTIVE: To evaluate a peer-modelling and rewards-based intervention designed to increase children's fruit and vegetable consumption. DESIGN: Over a 5-month period, children in an experimental and a control school were presented with fruit and vegetables at lunchtime. Children aged 5-7 y also received fruit at snacktime (mid-morning). The intervention was implemented in the experimental school and levels of fruit and vegetable consumption were measured at baseline, intervention and at 4-month follow-up. SETTING: Two inner-city London primary schools. SUBJECTS: In total, 749 children aged 5-11 y. INTERVENTION: Over 16 days children watched video adventures featuring heroic peers (the Food Dudes) who enjoy eating fruit and vegetables, and received small rewards for eating these foods themselves. After 16 days there were no videos and the rewards became more intermittent. MAIN OUTCOME MEASURES: Consumption was measured (i) at lunchtime using a five-point observation scale; (ii) at snacktime using a weighed measure; (iii) at home using parental recall. RESULTS: Compared to the control school, lunchtime consumption in the experimental school was substantially higher at intervention and follow-up than baseline (P<0.001), while snacktime consumption was higher at intervention than baseline (P<0.001). The lunchtime data showed particularly large increases among those who initially ate very little. There were also significant increases in fruit and vegetable consumption at home (P<0.05). CONCLUSIONS: The intervention was effective in bringing about substantial increases in children's consumption of fruit and vegetables.     

Increasing fruit and vegetable consumption through worksites and families in the treatwell 5-a-day study.

OBJECTIVES: We report on the results of the Treatwell 5-a-Day study, a worksite intervention aimed at increasing consumption of fruits and vegetables. METHODS: Twenty-two worksites were randomly assigned to 3 groups: (1) a minimal intervention control group, (2) a worksite intervention, and (3) a worksite-plus-family intervention. The interventions used community-organizing strategies and were structured to target multiple levels of influence, following a socioecological model. Data were collected by self-administered employee surveys before and after the intervention; the response rate was 87% (n = 1359) at baseline and 76% (n = 1306) at follow-up. A process tracking system was used to document intervention delivery. RESULTS: After control for worksite, gender, education, occupation, race/ethnicity, and living situation, total fruit and vegetable intake increased by 19% in the worksite-plus-family group, 7% in the worksite intervention group and 0% in the control group (P = .05). These changes reflect a one half serving increase among workers in the worksite-plus-family group compared with the control group (P = .018). CONCLUSIONS: The worksite-plus-family intervention was more successful in increasing fruit and vegetable consumption than was the worksite intervention. Worksite interventions involving family members appear to be a promising strategy for influencing workers' dietary habits.     

Factors associated with fruit and vegetable consumption among adults

Background: The higher consumption of fruit and vegetables is considered to be an indicator of healthy eating and the protective effects of fruit and vegetable (FV) consumption for noncommunicable diseases have been investigated extensively. The present study aimed to investigate the association between fruit and vegetable intake (FVI), health behaviours and socio‐demographic factors among adult Canadians. Methods: This analysis was based on the information from the Canadian Community Health Survey, Cycle 3.1. Daily intake of fruit and vegetables from a total number of 15 512 apparently healthy individuals, aged 18–64 years, were assessed using a structured questionnaire, which included 20 questions on the frequency of consumption of different types of fruit and vegetables. Multiple logistic regression models were used to determine the association between FVI and some socio‐economic factors and lifestyle behaviour among adult Canadians. Results: In total 77% of Canadian adults consumed fruit and vegetables less than five times per day. Females were more likely to consume more fruit [odds ratio (OR) 2.05; 95% confidence interval (CI) 1.75–2.4], vegetables (OR 1.95; 95% CI 1.65–2.29) and FV (OR 2.52; 95% CI 2.20–2.90) than males. Single/never married individuals, individuals with higher levels of education, never smokers, former drinkers and older people reported more consumption of fruit and vegetables than others. Conclusions: The results obtained in the present study indicate an association between FVI and some socio‐economic and healthy lifestyle behaviours, and that a substantial gap exists between the recommended level and the actual intake of the FV among the Canadian population. Because a higher intake of FV improves public health, it is imperative to tailor nutrition education at the individual and community levels in Canadian populations.     

Fruit and vegetable consumption among Turkish university students

A questionnaire was developed to determine the behaviors associated with eating fruit and vegetables and to assess perceived benefits and barriers to increasing fruit and vegetable consumption. A total of 713 non-food/nutrition major university students were randomly selected from seven universities in Turkey. Self-reported mean intake was found to be 3.67+/-1.81 servings of fruit and vegetables per day. Positive correlations existed between daily fruit and vegetable portions. Male students were significantly higher than female students in body mass index measurements (BMI 22.71 vs. 20.1, p < or = .05). Among male students only BMI was positively associated with age. Compared to male students, female students were more likely to eat fruit and vegetables. Male students were less likely to eat fruit instead of dessert. Vegetables were more preferred by female students at lunch and dinner. Exploratory principal-components analyses showed that a two-component solution best represented the data. The first component represented the benefits of eating more fruit. The second component described barriers to eating more fruit. Both components have an internal consistency of 0.73 and 0.56 respectively, with benefits accounting for 17% and barriers 12% of variance These scales may be used to increase the benefits to get students to think about change, and decreasing the barriers to allow the behavior to change in fruit and vegetable consumption should follow this. Since Turkish students do not eat enough fruit and vegetables, nutrition education efforts must be targeted at students (i.e. acceptability of these foods in different meal and snacks is maintained, promoted, and encouraged). Barriers may be reduced, thereby allowing students to take action and maintain the behavior change.     

Work-to-family spillover and fruit and vegetable consumption among construction laborers

PURPOSE: Spillover is the effect of one role on another as working adults attempt to integrate demands from work and family. We conducted a survey to understand how worker, job, and family characteristics were related to negative work-to-family spillover and how spillover was related to fruit and vegetable consumption to inform intervention design. DESIGN: A combined mail and telephone survey. SETTING: A national random sample in the United States. SUBJECTS: 1108 (44% response) unionized construction laborers. MEASURES: Personal characteristics, job factors, family factors, work-to-family spillover, and fruit and vegetable consumption. ANALYSIS: Multivariable logistic and least-squares regression. RESULTS: A range of 20% to 50% of respondents reported negative work-to-family spillover, agreeing that work demands, time, fatigue, and stress interfered with family meals or food choices. Higher spillover was associated with job factors, being of white race/ethnicity, and having children at home. Lower fruit and vegetable consumption was associated with higher work-to-family spillover (p = .002), being of white race or ethnicity (p < .0001), and working the graveyard or day shift (p = .02). CONCLUSION: Negative experience of work-to-family spillover may link employment to fruit and vegetable consumption and thus to worker health. Understanding the contribution of spillover to fruit and vegetable consumption aids understanding of how work experience affects health.     

Increasing daily fruit and vegetable consumption: what changes do cardiac patients make?

BACKGROUND: Interventions targeting fruit and vegetable consumption report significant increases in consumption but do not detail how increases are achieved. This prospective study explored (i) the changes in daily fruit and daily vegetable consumption of cardiac patients participating in an intervention study and (ii) how participants made these changes. METHODS: A total of 120 cardiac patients were asked to increase their daily fruit and vegetable consumption by two portions and to maintain this over 3 months. They were telephoned at 7-, 28- and 90-day follow-up to record daily consumption using a dietary questionnaire; 94 participants completed all parts of the study. RESULTS: Mean reported daily fruit and daily vegetable consumption increased by 1.07 (SD = 1.26) and 0.34 (SD = 0.96) portions, respectively, over 3 months. These increases were statistically significant (P < 0.001) and greatest for participants who reported eating low levels of fruit and vegetables at recruitment. Eating fresh fruit as a snack and at mealtimes were preferred choices for participants. CONCLUSIONS: Providing information and telephone follow-up could be used by busy healthcare professionals instead of face-to-face contact. Interventions to increase total fruit and vegetable consumption could usefully focus on eating fruit. Interventions to increase vegetable consumption need further investigation.     

A measure of outcome expectations for fruit and vegetable consumption among fourth and fifth grade children: reliability and validity

An outcome expectations questionnaire for fruit and vegetable(F&V) consumption among fourth and fifth grade studentswas developed, pilot-tested at one school and field-tested attwo schools. Seventeen questions generated from focus groupswere listed for fruits and repeated for vegetables. Principalcomponents analysis indicated two subscales ‘social’and ‘health and physical ability’ accounting for37.3% of the total variance; items loaded on the same subscaleswhen applied to fruits or vegetables. Internal consistenciesand test-retest reliabilities for the subscales were acceptable.Mean scores for the ‘health and physical ability’subscale were almost twice as large as the ‘social’subscale regardless of gender, grade and ethnicity. Pearsoncorrelations between F&V outcome expectation subscales andconsumption of F&V (from daily food records) were low, similarto patterns of correlations with preferences for F&V. Furtherresearch regarding outcome expectations is needed to clarifythe extent of their impact on F&V consumption specifically,and perhaps on consumption in general, among pre-adolescentchildren.     

Food prices and fruit and vegetable consumption among young American adults

Multivariate negative binomial count models were estimated to examine associations between young adults’ fruit and vegetable (FV) consumption and the prices of FV, other food at home grocery items, and fast food and the availability of restaurants and food stores. This study used the 2002 wave of data collected from US young adults aged 18–23 years in the 1997 National Longitudinal Survey of Youth merged by geocode identifiers with food prices and restaurant and food store availability. The results showed that higher levels of FV consumption were associated with lower FV prices (price elasticity of −0.32) and that this own-price effect was robust to the inclusion of other food prices and food outlet availability. Lower income and lower educated young adults and those with lower educated mothers and middle-income parents were found to be most price sensitive. No statistically significant cross-price effects on FV consumption were found with other grocery food (meat, dairy and bread) prices or fast food prices. Fiscal policy instruments such as FV subsidies may help to increase FV intake, particularly among young adults of lower socioeconomic status.     

Psychosocial correlates of fruit and vegetable consumption among African American men

OBJECTIVE: To determine the best predictors of fruit and vegetable consumption among African American men age 35 years and older. DESIGN: Data (n = 291) from a 2001 nationally representative mail survey commissioned by the American Cancer Society. PARTICIPANTS: 291 African American men age 35 years and older. MAIN OUTCOME MEASURES: Dependent variables: (1) total fruits and vegetables without fried potatoes, (2) total fruit with juice, and (3) total vegetables without fried potatoes. Independent variables included 3 blocks of predictors: (1) demographics, (2) a set of psychosocial scales, and (3) intent to change variables based on a theoretical algorithm. ANALYSIS: Linear regression models; analysis of variance for the intent to change group. Alpha = .05. RESULTS: Regression model for total fruits and vegetables, significant psychosocial predictors: social norms, benefits, tangible rewards, and barriers-other. Total fruit with juice: social norms, benefits, tangible rewards. Total vegetables, no fried potatoes: tangible rewards, barriers-other interests. CONCLUSIONS AND IMPLICATIONS: For African American men, fruit consumption appears to be motivated by perceived benefits and standards set by important people in their lives; vegetable consumption is a function of extrinsic rewards and preferences for high-calorie, fatty foods. The results suggest that communications to increase fruit and vegetable consumption should be crafted to reflect differences in sources of motivation for eating fruits versus eating vegetables.     

Psychosocial predictors of fruit and vegetable consumption among elementary school children

A self-efficacy questionnaire for fruit and vegetable (F&V)consumption among fourth and fifth grade students was developed,pilot tested with 140 students from one school and field testedwith 252 students from two schools. The questionnaire included34 items generated by inventorying behaviors targeted for changein the F&V school curriculum. The four subscales derivedfrom principal components analysis were labeled ‘after-schoolF&V snacks’; ‘breakfast and lunch F&V, andpaying for F&V'; ‘independent shopping for F&V';and ‘assisted shopping for F&V'; they accounted for43.8% of the total variance. Subscale test-re-test reliabilitiesand internal consistencies were acceptable. Criterion validitiesagainst F&V consumption from food records were low. Relationshipswere stronger with preferences and outcome expectations. Resultsfrom stepwise regression analyses indicated that preferenceswere the only significant predictors of fruit and total F&Vconsumption, as well as the main predictor of vegetable consumption;however, the models accounted for less than 13% of the variance.Nutrition education programs which target preferences may bemore effective in increasing F&V consumption among elementaryschool children than programs which target self-efficacy andoutcome expectations. However, since preferences accounted foronly small proportions of the variances, further research shouldconsider other issues such as availability.     

Environmental determinants of fruit and vegetable consumption among adults: a systematic review

The current ecological approach in health behaviour research recognises that health behaviour needs to be understood in a broad environmental context. This has led to an exponential increase in the number of studies on this topic. It is the aim of this systematic review to summarise the existing empirical evidence pertaining to environmental influences on fruit and vegetable (FV) consumption. The environment was defined as 'all factors external to the individual'. Scientific databases and reference lists of selected papers were systematically searched for observational studies among adults (18-60 years old), published in English between 1 January 1980 and 31 December 2004, with environmental factor(s) as independent factor(s), and fruit intake, vegetable intake or FV intake combined as one outcome measure as dependent factor(s). Findings showed there was a great diversity in the environmental factors studied, but that the number of replicated studies for each determinant was limited. Most evidence was found for household income, as people with lower household incomes consistently had a lower FV consumption. Married people had higher intakes than those who were single, whereas having children showed mixed results. Good local availability (e.g. access to one's own vegetable garden, having low food insecurity) seemed to exert a positive influence on intake. Regarding the development of interventions, improved opportunities for sufficient FV consumption among low-income households are likely to lead to improved intakes. For all other environmental factors, more replicated studies are required to examine their influence on FV intake.     

Improving fruit and vegetable consumption: use of farm-to-consumer venues among US adults

Improvements to the food environment including new store development and more farm-to-consumer approaches (ie, farmers' markets, roadside stands, pick-your-own produce farms, or community-supported agriculture programs) may aid Americans in making healthier dietary choices. We analyzed data from a subset of respondents (N = 1,994) in the National Cancer Institute's Food Attitudes and Behaviors Survey, a mail survey of US adults. We determined associations between primary grocery shoppers' region and sociodemographic characteristics and frequency of purchasing fruits and vegetables in the summer from farm-to-consumer venues. A little more than one-quarter (27%) of grocery shoppers reported a frequency of at least weekly use of farm-to-consumer approaches. Older adults and respondents who live in the Northeast were most likely to shop farm-to-consumer venues at least weekly, and no differences were found by sex, race/ethnicity, education, or annual household income. These findings suggest that farm-to-consumer venues are used by many Americans and could be expanded to increase access to fruits and vegetables.     

Life-course events and experiences: association with fruit and vegetable consumption in 3 ethnic groups

OBJECTIVE: To examine how life-course experiences and events are associated with current fruit and vegetable consumption in 3 ethnic groups. DESIGN: A theoretic model developed from previous qualitative research guided the development of a telephone survey. Data were collected on fruit and vegetable consumption, sociodemographic characteristics, ethnic identity, and life-course events and experiences, including food upbringing, social roles, food skills, dietary changes for health, and practice of food traditions. SUBJECTS/SETTING: Low- to moderate-income adults living in a northeastern US city were selected randomly from 3 ethnic groups: black (n = 201), Hispanic (n = 191), and white (n = 200). STATISTICAL ANALYSES: Bivariate and multiple linear regression analysis of associations between life-course variables and fruit and vegetable consumption. RESULTS: Black, Hispanic, and white respondents differed significantly in life-course experiences, family roles, socio-demographic characteristics, and place of birth. Explanatory models for fruit and vegetable consumption differed among ethnic groups and between fruits and vegetables. Among black respondents, a college education was positively associated with fruit consumption; education and family roles contributed most to differences in fruit (R2 = .16) and vegetable (R2 = .09) consumption. Among Hispanic respondents, life-course experiences such as liking fruits and vegetables in youth, making dietary changes for health, and food skills were positively associated with fruit (R2 = .25) and vegetable (R2 = .35) consumption. Among white respondents, socio-demographic characteristics, such as being married with a young child or single with no child and having a garden as an adult, were positively associated with fruit (R2 = .20) and vegetable (R2 = .22) consumption. APPLICATIONS/CONCLUSIONS: An understanding of the determinants of food choice in different subcultural groups can be used to design effective nutrition interventions to increase fruit and vegetable consumption. Experiences such as eating fresh-picked fruits and vegetables while growing up or vegetable gardening as an adult may enhance fruit and vegetable consumption among members of some ethnic groups.