Telephone counseling promotes dietary change in healthy adults: results of a pilot trial

Telephone counseling is increasingly reported to be an effective behavior change strategy, but more studies in broader populations are needed. This uncontrolled pilot trial investigated whether a 3-month/eight-call telephone counseling intervention could promote dietary changes associated with reduced chronic disease risk in adults consuming <5.0 servings of vegetables and fruits daily. Between 2002 and 2004, 97 adults (mean age 46 years; range 21 to 84 years) completed the intervention and a follow-up assessment at 6 months. Approximately half were of nonwhite ethnicity (53%). The majority were women (95%) and had never had cancer (89%). The intervention promoted daily intakes of three to five vegetable servings, two to four fruit servings, and three whole-grain and/or beans/legumes servings. Average total daily intake of vegetables, fruits, whole grains, beans/legumes, fiber, and fat were assessed at baseline and at 6 months, each by a set of three 24-hour recalls. Plasma carotenoids were measured on a subsample (n=41) as an objective biomarker of vegetable and fruit intake. Change in mean self-reported dietary intake (ie, vegetables, fruit, whole grains, beans/legumes, fiber, and fat) and plasma carotenoids were compared by paired t tests. The intervention was associated with a significant (P<0.001) increase in vegetable servings per day (baseline 2.1 servings per day, 6 months 3.5 servings per day; 67% increase), fruit servings per day (baseline 1.4 servings per day, 6 months 2.4 servings per day; 71% increase), and whole-grain and/or bean servings per day (baseline 1.0 serving per day, 6 months 1.4 servings per day; 40% increase). These changes were corroborated by a significant (P<0.001) increase in total plasma carotenoids. This 3-month/eight-call telephone counseling intervention was associated with dietary change in healthy adults consuming fewer than five servings per day of vegetables and fruit at study entry.     

Fruit and vegetable intake of US adults: comparing intake by mode of survey administration

Modes for collecting dietary data vary across studies and include in-person/interviewer-administered surveys, mail, and telephone surveys. Few studies use mixed modes to assess dietary intakes. Using data from the 2007 Health Information National Trends Survey, we compared fruit and vegetable intake of adults measured through dual modes (mail and random-digit dial [RDD] telephone), and discussed potential factors that could account for mode differences. The Health Information National Trends Survey data were collected through mailed (n=3,582), and RDD (n=4,092) surveys from December 2007 to May 2008. Data were weighted and analyzed in SUDAAN. Unadjusted mean fruit and vegetable intake was 0.48 servings higher (P<0.001) among mail (mean 5.40) vs RDD (mean 4.09) participants. In a multivariate model that controlled for other predictors, the odds of consuming ≥5 servings of fruit and vegetables per day was 83% higher among mail respondents compared to RDD (odds ratio 1.83, 95% confidence interval 1.62 to 2.07). Other predictors of fruit and vegetable intake were sex, education, participation in physical activity, self-rated health, and knowledge of the fruit and vegetable recommendation. Methodologic issues may account for modal differences in fruit and vegetable intake. Different measures (cups, servings) were used to assess fruit and vegetable intake in both modes, details about portion sizes were provided on the mail mode vs RDD, and closed-ended responses were provided on the mail vs open-ended responses for RDD. We cannot recommend one mode over the other nor attribute mode differences to real differences in reported fruit and vegetable intake between participants from both modes. Future research that uses dual modes needs to use identical methods of dietary assessment to minimize these potential sources of error. Further research is needed to validate the use of dual modes to assess dietary intake and inform research practice.     

Fruit and vegetable intake in the United States: the baseline survey of the Five A Day for Better Health Program

PURPOSE. The purpose of the Five A Day Baseline Survey was to assess fruit and vegetable intake and associated factors among US adults. DESIGN. Questionnaires querying frequency of intake of 33 fruits and vegetables, as well as demographics, attitudes, and knowledge related to fruits and vegetables were administered by telephone. SETTING. The study was a nationally representative random digit dial survey conducted by telephone in the summer of 1991; response rate was 42.8%. SUBJECTS. Respondents were 2811 US adults (including an oversample of African-Americans and Hispanics). MEASURES. Mean and median self-reported intakes of fruits and vegetables were calculated. Estimated servings per week were adjusted on the basis of responses to summary questions regarding overall fruit and vegetable intakes. RESULTS. Median intake of fruits and vegetables was 3.4 servings per day. Linear regressions (accounting for no more than 10% of the variation) showed that education, income, and smoking status were predictors of fruit and vegetable intake and that intake increased with education, income, and nonsmoking status. Women had higher intakes than men at all ages; these differences between men and women increased with age. Fruit and vegetable intakes increased with age for whites and Hispanics, but not for African-Americans. CONCLUSIONS. Fruit and vegetable intake among adults in the United States is lower than the recommended minimum of five daily servings. These data will be useful in targeting campaign efforts and in assessing progress of the Five A Day for Better Health Program.     

US adults' fruit and vegetable intakes, 1989 to 1991: a revised baseline for the Healthy People 2000 objective.

OBJECTIVES. This study provides revised baseline data for the Healthy People 2000 objective related to fruit and vegetable intakes, accounting for fruits and vegetable intakes, accounting for fruits and vegetables from all sources and measuring servings in a manner consistent with current dietary guidance. METHODS. Dietary data from 8181 adults in the US Department of Agriculture's 1989-1991 Continuing Surveys of Food Intakes by Individuals were examined. All foods were disaggregated into their component ingredients; all fruit and vegetable ingredients were assigned specific weights to correspond to a serving as defined by current dietary guidance materials; and the number of servings was tallied. RESULTS. While mean intakes of fruits and vegetables--4.3 servings per day--were not far from the Year 2000 objective, only 32% of American adults' intakes met the objective. When more stringent standards were set either to compensate for higher calorie levels or to achieve the balance between fruits and vegetables suggested in current guidance, only 24% and 12%, respectively, met the recommendations. CONCLUSIONS. These results suggest a need to develop strategies for overcoming barriers to eating fruits and vegetables.     

Fruit and vegetable intake and knowledge increased following a community-based intervention in older adults in Georgia senior centers

Our purpose was to evaluate a community-based fruit and vegetable intervention conducted in rural and urban areas of Georgia. Participants were a convenience sample from Georgia senior centers that completed a pre-test, the intervention, and a post-test (N = 558, mean age = 75, 83% female, 47% white, 53% black). The 4-month intervention had eight sessions focused on practical ways to increase intake of fruits and vegetables at meals and snacks and included physical activity. Pre- and post-tests examined self-reported intakes of fruits and vegetables at breakfast, lunch, the evening meal, and snacks, knowledge of recommended intakes, and barriers to intake. Following the intervention, the number of participants reporting consumption of at least 7 servings of fruits and vegetables daily increased by 21-percentage points (P < or = 0.001), knowledge that 7 to 10 servings of fruits and vegetables are recommended daily (for 1,600 to 2,200 calories) increased from 7% to 57% (P < or = 0.001), and three barriers to fruit and vegetable intake decreased (P < or = 0.05): "difficulties with digestion," "too many are recommended," and "too much trouble." Regression analyses indicated that increased intake following the intervention was independently associated with living in more urban rather than rural areas, improved knowledge of intake recommendations, decrease in perception of cost as a barrier, and increase in digestive problems as a barrier (P < or = 0.05). These results provide an evidence base for the effectiveness of this community intervention for improving knowledge and intake and decreasing barriers to fruit and vegetable intake in older adults.     

Demographic and Psychosocial Predictors of Fruit and Vegetable Intakes Differ: Implications for Dietary Interventions

Objective The National Cancer Institute (Rockville, Md) has launched a nationwide initiative—5 A Day for Better Health—to encourage consumption of fruits and vegetables. Because the tastes and culinary uses of fruits and vegetables differ, however, it is not known whether a general 5-A-Day message is an effective intervention strategy. This study examined whether there are differences between the demographic and psychosocial correlates of fruit and vegetable intakes.

Design Data are from the Washington State Cancer Risk Behavior Survey (1995-1996), a cross-sectional, random-digit-dial telephone survey representative of the adult population of Washington State.

Subjects/setting Interviews were completed with 1,450 adults. Data were collected about demographic characteristics, health status, health-related behavior, fruit and vegetable intakes, and the following diet-related psychosocial factors: beliefs, motives, barriers, attitudes, and stages of dietary change.

Statistical analyses Multivariate linear regression analysis was used to test whether the associations of demographic characteristics and psychosocial factors with fruit intake differed from associations with vegetable intake.

Results In general, health status, health-related behavior, and psychosocial factors were more strongly associated with fruit intakes than vegetable intakes. For example, regular exercisers consumed 0.44 more daily servings of fruits and 0.36 more servings of vegetables than nonexercisers. Compared with those in the preaction stage of dietary change, adults in the maintenance stage consumed 0.99 more daily servings of fruits and 0.68 more servings of vegetables. Intrinsic motivations for eating a healthful diet (eg, to feel better) were strongly associated with both fruit and vegetable intakes, and these associations were stronger for fruit. Extrinsic motivations were not associated with either fruit or vegetable intakes.

Applications Dietary interventions based on a general 5-A-Day message may be more effective in increasing fruit intakes than vegetable intakes. Targeted interventions that focus specifically on vegetables are probably necessary. Intrinsic motives for eating a healthful diet should be key components of interventions to increase fruit and vegetable intakes. J Am Diet Assoc. 1998;98:1412-1417.     

Knowledge, barriers, and stage of change as correlates of fruit and vegetable consumption among urban and mostly immigrant black men

BACKGROUND: Daily fruit and vegetable consumption in black men is low and has remained relatively unchanged during the past 20 years. OBJECTIVE: To examine awareness of fruit and vegetable recommendations promoted by federal agencies and correlates of fruit and vegetable consumption among an urban and mostly immigrant population of adult black men. DESIGN: A cross-sectional study analyzing baseline data (n=490) from a randomized controlled trial. SETTING: A large health care worker's union. MAIN OUTCOME MEASURES: Knowledge, perceived benefits, stage of readiness, perceived barriers, and daily servings of fruit and vegetable intake. STATISTICAL ANALYSES PERFORMED: One-way analysis of variance and t tests were used to compare fruit and vegetable intake across main study variables. Regression analysis was used to identify independent predictors of fruit and vegetable intake. RESULTS: Fruit and vegetable intake was low (mean was three servings/day). Ninety-four percent were not aware that men should consume at least nine servings of fruits and vegetables daily and 59.8% were not aware that eating a colorful variety is important. In contrast, over half (54.7%) were aware that a single serving is equal to about a handful; 94.1% correctly reported fruit and vegetables as an important source of fiber; 79.6% correctly reported vitamin pills were not a substitute for eating fruits and vegetables; and 94.5% recognized that there are health benefits to eating fruits and vegetables, although identification of specific benefits was minimal. In regression analysis, a greater level of fruit and vegetable consumption was significantly associated with greater knowledge of fruit and vegetable recommendations, lower perceived barriers, and a more advanced stage of change (action vs contemplation/preparation). Perceived health benefits were not associated with fruit and vegetable consumption. CONCLUSIONS: There is a lack of awareness of the current fruit and vegetable recommendations. In addition, men reported fruit and vegetable intakes that were far below national recommendations. Greater efforts are needed to help urban and primarily immigrant black men realize the importance of and recommendations for fruit and vegetable consumption.     

Fruit and vegetable intakes are an independent predictor of bone size in early pubertal children

BACKGROUND: Adequate intakes of fruit and vegetables are recommended for optimum health in children. OBJECTIVE: The objective of this study was to determine whether consuming fruit and vegetables >3 times per day is beneficial to bone mass in children. DESIGN: Fifty-six white females (Tanner stage 2) recorded dietary intake on 3 independent days. The numbers of servings of fruit and vegetables were recorded for each day and tallied, and the subjects were divided into 2 consumption groups for analysis (low consumption: <3 servings/d, n = 22; high consumption: > or = 3 servings/d, n = 34). Bone area and the bone mineral content of the whole body and radius were assessed by using dual-energy X-ray absorptiometry. Radioimmunoassays measured serum parathyroid hormone and 25-hydroxyvitamin D. Twenty-four-hour urine samples were assessed for calcium, sodium, and creatinine. RESULTS: After adjustment for age, body mass index, and physical activity, those children who reported consuming > or = 3 servings fruit and vegetables/d had more bone area of the whole body (6.0%; P = 0.03) and radius (8.3%; P = 0.03), lower urinary calcium excretion (2.6 +/- 0.2 compared with 1.8 +/- 0.3 mg/kg; P = 0.04), and lower parathyroid hormone (19.6 +/- 1.9 compared with 25.0 +/- 1.6 pg/mL; P = 0.01) than did those children who reported consuming <3 servings fruit and vegetables/d. CONCLUSIONS: High fruit and vegetable intakes have beneficial effects on the bone area of the radius and whole body in early pubertal girls. The lower urinary calcium output associated with higher fruit and vegetable intakes may be a modulating factor.     

Fruit and vegetable intakes and risk of colorectal cancer in the NIH-AARP diet and health study

The authors examined the associations between fruit and vegetable intakes and risk of colorectal cancer in the NIH-AARP Diet and Health Study. Diet was assessed with a food frequency questionnaire at baseline. Relative risks and 95% confidence intervals were estimated by using the Cox proportional hazards model. During 5-year follow-up of 488,043 men and women aged 50-71 years, 2,972 incident colorectal cancer cases were identified. The respective 10th and 90th percentiles of total fruit and vegetable intake (servings/1,000 kcal per day) were 1.4 and 5.2 for men and 1.8 and 6.5 for women. Compared with that for the lowest quintile of vegetable intake, the multivariate relative risk for the highest quintile was 0.82 (95% confidence interval: 0.71, 0.94) for men and 1.12 (95% confidence interval: 0.90, 1.38) for women. Increased risk of colorectal cancer was observed for very low intake of total fruits and vegetables by men (multivariate relative risk for <1 vs. > or =2.0 servings/1,000 kcal per day = 1.26, 95% confidence interval: 1.03, 1.54). Among subgroups of vegetables, green leafy vegetables were associated with a lower risk of colorectal cancer for men (multivariate relative risk for the highest quintile vs. the lowest = 0.86, 95% confidence interval: 0.74, 0.99). Intake of fruits was not related to risk of colorectal cancer in men or women.     

Have Americans Increased Their Fruit and Vegetable Intake? : The Trends Between 1988 and 2002

BACKGROUND: Previous research indicates that few Americans meet the United States Department of Agriculture (USDA) guidelines for fruit and vegetable consumption, and that adequate fruit and vegetable consumption may decrease the risk for chronic disease. METHODS: Twenty-four-hour dietary recall data from NHANES III, 1988-1994 (n=14,997) and NHANES 1999-2002 (n=8910) were used to assess adult (equal to or more than 18 years) trends in daily fruit and vegetable consumption (number of servings and types). RESULTS: In 1988-1994, an estimated 27% of adults met the USDA guidelines for fruit (equal to or more than two servings) and 35% met the guidelines for vegetables (equal to or more than three servings). In 1999-2002, 28% and 32% of adults met fruit and vegetable guidelines, respectively. There was a significant decrease in vegetable consumption over time (p=0.026). Only 11% met USDA guidelines for both fruits and vegetables in 1988-1994 and 1999-2002, indicating no change in consumption (p=0.963). In both data sets, non-Hispanic blacks were less likely to meet USDA guidelines compared to non-Hispanic whites (p<0.05). Higher income and greater education were significantly associated with meeting the guidelines in both data sets (p<0.05). CONCLUSIONS: Despite the initiation of a national fruit and vegetable campaign in 1991, the findings indicated that Americans' fruit and vegetable consumption did not increase in 1999-2002, and only a small proportion met the related dietary recommendations. Greater public health efforts and approaches are needed to promote healthy eating in the United States.     

Trends in adolescent fruit and vegetable consumption, 1999-2004: project EAT

BACKGROUND: Diets abundant in fruits and vegetables are associated with reduced risk for chronic disease, but intakes of adolescents are often inadequate. To design effective interventions it is important to understand how dietary intake changes longitudinally during adolescence and to monitor progress in the population toward fruit and vegetable consumption recommendations. The objective of this study was to examine longitudinal and secular trends in fruit and vegetable intake among two cohorts of Minnesota adolescents over the period 1999-2004. METHODS: Measures of fruit and vegetable intake and demographics were completed by 944 boys and 1161 girls who were Project EAT participants in 1999 and 2004. In 2005, mixed linear regression models were used to estimate (1) longitudinal trends among two cohorts of young people during developmental transitions and (2) age-matched secular trends between the two cohorts of young people at middle adolescence. RESULTS: Longitudinal trends indicated that adolescents decreased their daily intake of fruit and vegetables by an average of 0.7 servings during the transition from early to middle adolescence and by 0.6 servings from middle to late adolescence. Analyses of age-matched secular trends at middle adolescence showed a mean daily decrease of 0.7 servings among girls and 0.4 servings among boys between 1999 and 2004. CONCLUSIONS: The large longitudinal and secular declines in fruit and vegetable intakes of adolescents indicate a strong need for further research to understand why consumption is decreasing among adolescents and to develop more effective interventions for increasing fruit and vegetable consumption during this critical developmental period.     

Internal locus of control and social support associated with some dietary changes by elderly participants in a diet intervention trial

OBJECTIVE: Measure relationships of locus of control and social support to diet changes in an intervention trial. DESIGN: Participants in the Polyp Prevention Trial (PPT) completed Multidimensional Health Locus of Control (MHLC) and Norbeck Social Support Questionnaires (NSSQ) and modified Block food frequency questionnaires. Data were collected at baseline and 1 year later. SUBJECTS/SETTING: A convenience sample of PPT intervention (N = 68) and control (n = 43) participants at 1 clinical center participated in this ancillary study. MAIN OUTCOME MEASURES: Mean daily dietary intakes after 1 year were compared with baseline values. Intervention participants' scores for MHLC internal locus of control and NSSQ total functional network were correlated with diet changes. STATISTICAL ANALYSES PERFORMED: Group percentages were compared using the Fisher exact test; means were compared by t test. RESULTS: Groups were comparable in demographics, baseline diet, and scores for internal locus of control and total functional network. Intervention group participants made greater diet changes than control participants in intake of fat (-27 g vs -8 g), fat as a percentage of kilocalories (-8% vs -2%), fiber as grams per 1,000 kcal (7 g vs 0.3 g), and daily fruit/vegetable servings (2.0 vs 0.2). Pearson correlations of diet changes with internal locus of control scores (all P > .05) were fat grams, r = 0.031; fat as percentage of kilocalories, r = 0.023; fiber grams per 1,000 kcal; r = 0.230; and fruit/vegetable servings, r = 0.186. Correlations with total functional network scores were: fat grams, r = 0.022 (P > .05); fat as percentage of kilocalories, r = -0.108 (P > .05); fiber grams per 1,000 kcal, r = 0.276, P < .05; and daily fruit/vegetable servings, r = 0.326, P < .05. APPLICATIONS/CONCLUSIONS: Intensive and skillful dietary intervention can succeed whether or not clients bring strong internal locus of control or social support to the diet change program.     

Predictors of fruit and vegetable intakes in young adults by gender

The objective of this study was to identify predictors of fruit and vegetable consumption by gender in collegiate young adults to guide interventions to help increase intakes. A sample of 294 subjects reported demographics, self-efficacy, dietary patterns, and food group intakes from 3 days of food records. Average daily servings of fruits and of vegetables were 1.9 ± 2.0 and 3.9 ± 2.6, respectively, for men, and 2.0 ± 1.6 and 2.9 ± 1.7, for women. For both genders, living in a residence hall and frequency of eating breakfast were positively associated with intakes of fruit and of fruit juice, whereas vegetable intakes were positively associated with intakes of energy and discretionary fat (P < .01). Self-efficacy to eat fruit predicted 8% and 9% of the variance in fruit intakes for women and men, respectively, with percentages increasing to 11% and 17% when juice was removed from the total. Self-efficacy to eat vegetables did not predict vegetable intake in men as it did for women. Predictors of fruit and vegetable intakes in this group of young adults varied by gender and by whether juice was included with fruit and fried potatoes with vegetables.     

Baseline fruit and vegetable intake among adults in seven 5 a day study centers located in diverse geographic areas.

OBJECTIVE: To examine baseline rates of fruit and vegetable consumption among adults in the 5 A Day research trials in order to identify any regional and sociodemographic differences associated with daily servings. DESIGN: The main outcome measure was the frequency of fruits and vegetables consumed within 1 month of the baseline survey as assessed by a 7-item food frequency questionnaire (FFQ). SUBJECTS/SETTING: Participants (N = 15,060) were from 7 study centers. Study centers included schools (N = 48), worksites (N = 60), churches (N = 50), or the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics (N = 15) in interventions to increase fruit and vegetable consumption. STATISTICAL ANALYSES: Means and standard errors, adjusting for clusters, were calculated. A mixed linear model analyzed relationships between fruit and vegetable consumption and regional center, gender, age, race, education, income, marital status, food-shopping responsibility, and whether one lives with children. RESULTS: Results indicate an overall mean intake of 3.6 daily servings of fruits and vegetables. Significant differences in mean daily servings were found among the regional study centers (low of 3.0 to high of 4.1). There were significant differences in mean daily consumption by age (< 30 years = 3.7 servings per day; 30 to 49 years = 3.4; > or = 50 years = 3.7), education (> high school = 3.4 servings per day; high school graduate = 3.4; some college = 3.5; college graduate = 3.9), race (black = 3.7 servings per day; Hispanic = 3.0; white = 3.6; other = 3.7), marital status (married = 3.6 servings per day; single = 3.5), and food-shopping responsibilities (little = 3.2 servings per day; about half = 3.6; most = 3.8). Only 17% of respondents ate 5 or more servings of fruits and vegetables per day. CONCLUSIONS: The 7 regions showed significant variability in daily fruit and vegetable consumption, suggesting that a single national message to increase fruit and vegetable consumption may not reach the population segments most in need of changing. It is advisable to spend more time understanding the food consumption habits of the population under investigation to develop messages to foster behavior change.     

Older adults need guidance to meet nutritional recommendations

OBJECTIVE: The purpose of this study was to compare the diet of healthy, free-living senior volunteers to the dietary reference intakes (DRIs) and Food Guide Pyramid recommendations. METHODS: This study was a cross-sectional assessment of dietary habits, as measured using a standardized food frequency questionnaire, among 1,740 healthy Southwestern U.S. adults, aged 51 to 85 years. Assessment of independently-living volunteers to chemoprevention trials provides an efficient mechanism to profile typical dietary habits among the older adult population. RESULTS: Daily estimated macronutrient intakes exceeded recommended proportions of protein and fat. In contrast, more than 60% of this senior population reported dietary vitamin D, vitamin E, folate and calcium intakes below estimated average requirements (EAR). Based on the Food Guide Pyramid recommendations, fewer than 10% of the older adults consumed the recommended daily dairy and grain servings. More females than males consumed recommended vegetable (49% versus 40%) and fruit (53% versus 48%) servings (p < 0.05). More males consumed recommended grain (11% versus 7%) and protein (78% versus 73%) servings (p < 0.05) than females. CONCLUSIONS: Mean micronutrient intakes compared well with DRIs, although fewer than one-half of these older adults consumed recommended levels for vitamin D, vitamin E, folate, and calcium or daily food servings of dairy, grains, vegetables or fruits. Since the beneficial aspects of foods are not limited to essential nutrients, nutrition recommendations to older adults may be improved by emphasizing daily servings of nutrient-dense choices within the Food Pyramid.     

Sex differences in fruit and vegetable intake in older adults

Fruits and vegetables are important components of a healthy diet, but intakes in most Western countries are well below the recommended five servings a day. Men in particular are eating too little. The aim of this study is to understand the processes underlying this gender difference. Fruit and vegetable intake, nutrition knowledge, taste preferences, attitudes to fruit and vegetable intake, and dieting status, were assessed in a simple questionnaire in 1,024 older adults attending population-based cancer screening across the UK. The results confirmed the pattern of men consuming fewer servings of fruit and vegetables daily than women (2.52 vs 3.47; p<0.01). Fewer men than women knew the current recommendations for fruit and vegetable intake, and fewer were aware of the links between fruit and vegetable consumption and disease prevention. Women rated their liking for vegetables but not fruit higher, and there were no differences in attitudes. Men were less likely to be dieting to lose weight. Multivariate analysis showed that the gender difference in intake was substantially attenuated by controlling for nutrition knowledge. There were no significant attenuating effects of preferences, attitudes or dieting status. These results indicate that men's poorer nutrition knowledge explains a significant part of their lower intake of fruit and vegetables.     

Awareness of the Fruits and Veggies-More Matters campaign, knowledge of the fruit and vegetable recommendation, and fruit and vegetable intake of adults in the 2007 Food Attitudes and Behaviors (FAB) Survey

Increased consumption of fruits and vegetables is recommended to reduce chronic disease risk. Few studies have examined awareness of the current fruit and vegetable campaign in the United States, Fruits and Veggies-More Matters. This study assessed awareness of the Fruits and Veggies-More Matters campaign and knowledge of the 7-13 serving recommendation for fruit and vegetable consumption among adults, and determined whether these were associated with fruit and vegetable intake. Cross-sectional data from 3021 adults in the United States' National Cancer Institute's 2007 Food Attitudes and Behaviors Survey were analyzed. Few participants were aware of the Fruits and Veggies-More Matters campaign (2%) and the 7-13 recommendation (6%) for adults. More participants were aware of the former 5 A Day campaign (29%) and recommendation (30%). Thirty-nine percent reported consuming ≥5 servings of fruits and vegetables daily. Participants were more likely to consume ≥5 servings of fruits and vegetables/day if they were aware of the 5 A Day/Fruits and Veggies-More Matters campaign, and reported that the recommendation for adults was ≥5 servings/day. Findings suggest the need to increase awareness of the Fruits and Veggies-More Matters campaign, and the 7-13 recommendation among adults to support high fruit and vegetable intake.     

A randomized trial of a brief intervention to increase fruit and vegetable intake: a replication study among callers to the CIS

BACKGROUND: Results are reported from a large randomized trial designed to increase fruit and vegetable consumption among callers to the National Cancer Institute's Cancer Information Service (CIS) (n = 1,717). METHODS: CIS callers assigned to the intervention group (n = 861) received a brief proactive educational intervention over the telephone at the end of usual service, with two follow-up mailouts. Key educational messages and print material derived from the NCI 5 A Day for Better Health program were provided to intervention participants. Participants were interviewed by telephone at 4 weeks (n = 1,307), 4 months (n = 1,180), and 12 months for follow-up (n = 1,016). RESULTS: Results obtained from a single-item measure of fruit and vegetable consumption indicate a significant intervention effect of 0.88 servings per day at 4 weeks follow-up (P < 0.001), 0.63 servings per day at 4 months follow-up (P < 0.001), and 0.43 servings per day at 12 months follow-up (P < 0.001). Using a 7-item food frequency measure, an intervention effect of 0.63 servings per day was obtained at 4 weeks follow-up (P < 0.001), compared with 0.39 servings per day at 4 months follow-up (P = 0.002) and 0.44 servings per day at 12 months follow-up (P = 0.002). A 24-h recall assessment included in the 4-month interviews also yielded a significant intervention effect of 0.67 servings per day (P = 0.015). The vast majority of callers (90%) endorsed the strategy of providing 5 A Day information proactively within the CIS. CONCLUSIONS: This brief educational intervention was associated with higher levels of self-reported fruit and vegetable intake at both short- and long-term follow-up. Additional research is recommended to test this or a similar intervention in diverse populations.     

Evaluation of fruit and vegetable intakes of Australian adults: the National Nutrition Survey 1995

OBJECTIVE: To evaluate the fruit and vegetable intakes of Australian adults aged 19-64 years. METHODS: Intake data were collected as part of the National Nutrition Survey 1995 representing all Australian States and Territories, including city, metropolitan, rural and remote areas. Dietary intake of 8,891 19-to-64 year-olds was assessed using a structured 24-hour recall. Intake frequency was assessed as the proportion of participants consuming fruit and vegetables on the day prior to interview and variety was assessed as the number of subgroups of fruit and vegetables consumed. Intake levels were compared with the recommendations of the Australian Guide to Healthy Eating (AGHE). RESULTS: Sixty-two per cent of participants consumed some fruit and 89% consumed some vegetables on the day surveyed. Males were less likely to consume fruit and younger adults less likely to consume fruit and vegetables compared with females and older adults respectively. Variety was primarily low (1 subcategory) for fruit and medium (3-4 subcategories) for vegetables. Thirty-two per cent of adults consumed the minimum two serves of fruit and 30% consumed the minimum five serves of vegetables as recommended by the AGHE. Eleven per cent of adults met the minimum recommendations for both fruit and vegetables. CONCLUSION: A large proportion of adults have fruit and vegetable intakes below the AGHE minimum recommendations. IMPLICATIONS: A nationally integrated, long-term campaign to increase fruit and vegetable consumption, supported by policy changes to address structural barriers to consumption, is vital to improve fruit and vegetable consumption among adults.