Household food security and fruit and vegetable intake among low-income fourth-graders

Objective

To examine the relationship between household food security and children’s and parents’ fruit, vegetable, and breakfast consumption and fruit and vegetable availability.

Design

Cross-sectional study using matched parent-child surveys.

Setting

Title I elementary schools in Maryland.

Participants

Ninety-two low-income parent-child dyads recruited from fourth-grade nutrition education programs completing a baseline evaluation.

Main Outcome Measures

Fruit and vegetable intake, breakfast consumption, and fruit and vegetable availability in home and school.

Analysis

Chi-square tests, 1-way ANOVA.

Results

Thirty-six percent of parents reported low/very low household food security, and both parents and students reported low fruit and vegetable intake. Students from households with low food security who were not participating in school nutrition programs had the lowest vegetable consumption and the fewest number of days consuming breakfast, indicating a relatively greater need for enrollment than their peers.

Conclusions and Implications

Few differences between children in food-secure and food-insecure households were observed, which underscores the need for research on food insecurity and children’s eating behaviors. Examination of other factors influencing fruit and vegetable intake and improvements in food environments and programs are needed. Efforts to increase enrollment among eligible students in school nutrition programs may reduce negative consequences of household food insecurity.     

Sisters in health: experiential program emphasizing social interaction increases fruit and vegetable intake among low-income adults

Sisters in Health, a nutrition education program aimed at increasing fruit and vegetable consumption among low-income women, includes active food experiences, positive social settings, a flexible meeting series, and small-group facilitation by paraprofessionals. The program's impact was evaluated in a nonrandom sample of 269 low-income adults in 32 intervention and 10 control groups in New York State using a quasi-experimental, pre-/postprogram evaluation design. Intervention groups reported increased fruit and vegetable consumption, measured by a brief screener, of 1.6 times a day (versus 0.8 times in the control groups) and were 0.44 times more likely to be eating fruits and vegetables 5 or more times a day (P < .05) than control groups. Group support, taste, and food skill experiences can be effective for increasing fruit and vegetable consumption.     

Cultural tailoring for mammography and fruit and vegetable intake among low-income African-American women in urban public health centers

BACKGROUND: It is widely accepted that disease prevention efforts should consider cultural factors when addressing the needs of diverse populations, yet there is surprisingly little evidence that doing so enhances effectiveness. The Institute of Medicine has called for randomized studies directly comparing approaches that do and do not consider culture. METHODS: In a randomized trial, 1227 lower-income African-American women from 10 urban public health centers were assigned to either a usual care control group, or to receive a series of six women's health magazines with content tailored to each individual. By random assignment, these magazines were generated from either behavioral construct tailoring (BCT), culturally relevant tailoring (CRT) or both (BCT + CRT). The CRT magazines were based on four cultural constructs: religiosity, collectivism, racial pride, and time orientation. All tailored magazines sent to women ages 40-65 promoted use of mammography; magazines sent to women ages 18-39 promoted fruit and vegetable (FV) intake. Analyses examined changes from baseline to 18-month follow-up in use of mammography and servings of FV consumed daily. RESULTS: Women receiving BCT + CRT magazines were more likely than those in the BCT, CRT, and control groups to report getting a mammogram (76% vs. 65% vs. 64% vs. 55%, respectively), and had greater increases in FV servings consumed daily (+0.96 vs. + 0.43 vs. + 0.25 vs. + 0.59). CONCLUSIONS: Systematically integrating culture into tailored cancer prevention and control interventions may enhance their effectiveness in diverse populations.     

两省青少年水果蔬菜摄入知识、态度和行为调查

目的 了解中国青少年的水果和蔬菜摄入相关知识、态度和行为,为制定健康饮食行为干预措施提供科学依据.方法 在中国辽宁省和贵州省城乡选取18所中小学,每所学校随机抽取小学4～6年级、初一至高三各1～2个班,共2 638 名学生为调查对象.采用自填式问卷对学生进行水果蔬菜摄入相关知识、态度和摄入频度的调查.结果 水果和蔬菜推荐摄入量回答正确率分别为31.9%和33.3%;70.0%和66.0%的青少年对水果摄入和吃蔬菜持积极态度;40.4%青少年每天至少吃1次水果;58.1%的学生每天至少吃1次炒熟的蔬菜.结论 大部分青少年对吃水果和蔬菜的态度积极,但缺乏足够的摄入量知识,果蔬摄入量达不到推荐标准,应当积极开展儿童健康饮食促进活动.     

Food spending behaviors and perceptions are associated with fruit and vegetable intake among parents and their preadolescent children

OBJECTIVE: Examine the role of food spending behaviors and perceptions on fruit and vegetable intake among preadolescent children and their parents. DESIGN: Cross-sectional study. SETTING: Metropolitan city. PARTICIPANTS: Five hundred fifty-five parent/child dyads participating in the PARADE study. More than 50% of participants were African American and nearly 40% of households were low income. VARIABLES MEASURED: Body mass index calculated from child anthropometric data and parents' self-reported height and weight. Adult and child fruit and vegetable intake, annual household income, and food purchase behavior and perceptions obtained from parent questionnaire. ANALYSIS: Analysis of variance used to identify differences in means at P<.05 level. RESULTS: No statistically significant differences in fruit and vegetable intake by income status were observed. Children in households spending the least per week on groceries consumed fewer daily fruits and vegetables. Perceptions of cost of fruits and vegetables were also found to be significantly associated with fruit and vegetable intake among children and parents. CONCLUSIONS AND IMPLICATIONS: Public health efforts to raise awareness of the relatively low cost of fruits and vegetables should be continued. These efforts may be complemented with policy strategies that make fruits and vegetables more viable options for low-income households.     

A rapid food screener to assess fat and fruit and vegetable intake

BACKGROUND: The U.S. Preventive Services Task Force recommends that Americans lower dietary fat and cholesterol intake and increase fiber and fruit/vegetables to reduce prevalence of heart disease, cancer, stroke, hypertension, obesity, and non-insulin-dependent diabetes mellitus in the United States. To provide preventive services to all, a rapid, inexpensive, and valid method of assessing dietary intake is needed. METHODS: We used a one-page food intake screener based on national nutrition data. Respondents can complete and score the screener in a few minutes and can receive immediate, brief feedback. Two hundred adults self-administered the food screener. We compared fat, fiber, and fruit/vegetable intake estimates derived from the screener with estimates from a full-length, 100-item validated questionnaire. RESULTS: The screener was effective in identifying persons with high-fat intake, or low-fruit/vegetable intake. We found correlations of 0.6-0.7 (p<0. 0001) for total fat, saturated fat, cholesterol, and fruit/vegetable intake. The screener could identify persons with high percentages of calories from fat, total fat, saturated fat, or cholesterol, and persons with low intakes of vitamin C, fiber, or potassium. CONCLUSIONS: This screener is a useful tool for quickly monitoring patients' diets. The health care provider can use it as a prelude to brief counseling or as the first stage of triage. Persons who score poorly can be referred for more extensive evaluation by low-cost paper-and-pencil methods. Those who still have poor scores at the second stage ultimately can be referred for in-person counseling.     

Evaluating a school-based fruit and vegetable co-op in low-income children: A quasi-experimental study

The purpose of this study was to evaluate the effectiveness of a new school-based food co-op program, Brighter Bites (BB), to increase fruit and vegetable intake, and home nutrition environment among low-income 1st graders and their parents. This was a non-randomized controlled comparative effectiveness trial (2013–2015). Six schools received BB (n = 407 parent-child dyads); six comparison schools implemented a coordinated school health program (n = 310 parent-child dyads) in Houston, Texas, 2013–2015. Brighter Bites (BB) is a 16-week school-based food co-op comprising weekly distribution of fresh produce (50 servings); nutrition education in schools and for parents; and weekly recipe tastings. Measurements included parent-reported home nutrition environment surveys, and food frequency questionnaires for parent and child. Intervention effects were examined using multivariate analyses. At baseline, the sample was 71% Hispanic, 24% African American; 43% of 1st graders were overweight/obese. Children receiving BB had significant increases in intake of fruit servings (P = 0.046), vegetable servings (P = 0.049), and decreased intake of added sugars (P = 0.014). Among parents, there were significant increases in fruit consumed (P = 0.032); vegetable intake increased baseline to midpoint but not post-intervention. Among BB families, there were significant improvements in the home environment including understanding and usage of nutrition facts labels to make food purchases (P < 0.05), frequency of cooking (P = 0.007), rules and practices regarding eating family meals (P = 0.022), serving fruits (P = 0.005) and vegetables (P = 0.028) at meals, and limiting portion sizes (P = 0.016).In conclusion, a school-based food co-op model shows promising results in improving dietary habits and home nutrition environment among low-income families.     

Children's fruit and vegetable intake: associations with the neighbourhood food environment

OBJECTIVE: To examine associations between availability of different types of food outlets and children's fruit and vegetable intake. METHOD: Parents of 340 5-6 and 461 10-12 year-old Australian children reported how frequently their child ate 14 fruits and 13 vegetables in the last week in 2002/3. A geographic information system (GIS) was used to determine the availability of the following types of food outlets near home: greengrocers; supermarkets; convenience stores; fast food outlets; restaurants, cafés and takeaway outlets. Logistic regression analyses examined the likelihood of consuming fruit >or=2 times/day and vegetables >or=3 times/day, according to access to food outlets. RESULTS: Overall, 62.5% of children ate fruit >or=2 times/day and 46.4% ate vegetables >or=3 times/day. The more fast food outlets (OR=0.82, 95%CI=0.67-0.99) and convenience stores (OR=0.84, 95%CI=0.73-0.98) close to home, the lower the likelihood of consuming fruit >or=2 times/day. There was also an inverse association between density of convenience stores and the likelihood of consuming vegetables >or=3 times/day (OR=0.84, 95%CI=0.74-0.95). The likelihood of consuming vegetables >or=3 times/day was greater the farther children lived from a supermarket (OR=1.27, 95%CI=1.07-1.51) or a fast food outlet (OR=1.19, 95%CI=1.06-1.35). CONCLUSION: Availability of fast food outlets and convenience stores close to home may have a negative effect on children's fruit and vegetable intake.     

贵州省青少年水果蔬菜摄入行为影响因素研究

目的 了解并分析贵州省中小学生水果和蔬菜摄入行为情况和影响因素,为有效的饮食干预提供依据.方法 选取贵州省贵阳市城乡中小学四年级至高三年级的学生1 552例作为调查对象,采用自填式结构问卷进行调查.结果 调查对象水果摄入达标(每天2次或以上)率为13.3%,蔬菜摄入达标(每天2次或以上)率为32.4%,影响水果摄入的危险因素包括知识不足、缺乏父母的帮助、缺少吃水果的习惯、缺乏对水果的喜好、选择吃水果行为的自我效能感不足.影响蔬菜摄入的因素包括知识不足、男性、自我效能感不足;知识水平低是影响蔬菜、水果摄入的共同独立危险因素.结论 提高健康饮食知识和改善饮食营养环境是促进儿童青少年健康生活方式的重要内容.     

The challenge of measuring global fruit and vegetable intake

The WHO recently conducted, within its Global Burden of Disease 2000 Study, a Comparative Risk Assessment (CRA) to estimate the global health effect of low fruit and vegetable intake. This paper summarizes the methods used to obtain exposure data for the CRA and provides estimates of worldwide fruit and vegetable intakes. Intakes were derived from 26 national population-based surveys, complemented with food supply statistics. Estimates were stratified by 14 subregions, 8 age groups, and gender. Subregions were categorized on the bases of child mortality under age 5 y and 15- to 59-y-old male mortality (A: very low child and adult mortality; B: low child and adult mortality; C: low child, high adult mortality; D: high child and adult mortality; E: high child, very high adult mortality). Mean intakes were highest in Europe A [median = 449 g/(person.d)] and the Western Pacific Region A. They were lowest in America B [median = 192 g/(person.d)], and low in Europe C, the South East Asian Regions B and D, and Africa E. Children and elderly individuals generally had lower intakes than middle-aged adults. SDs varied considerably by region, gender, and age [overall median = 223 g/(person.d)]. Assessing exposure levels for the CRA had major methodological limitations, particularly due to the lack of nationally representative intake data. The results showed mean intakes generally lower than current recommendations, with large variations among subregions. If the burden of disease attributable to dietary factors is to be assessed more accurately, more countries will have to assess the dietary intake of their populations using comparable methods.     

Estimates of fruit and vegetable intake in childhood and adult dietary behaviors of African American women

OBJECTIVE: This exploratory study examined how estimates of one's fruit and vegetable intake in childhood are related to 3 current dietary behaviors among African American women: intake of fruits and vegetables, exposure to and preference for fruits and vegetables, and preference for trying new foods. DESIGN: Baseline data from a randomized dietary intervention trial. Setting: Ten urban public health centers in St. Louis, Missouri. PARTICIPANTS: 1227 African American women. Variables Measured: A 33-item fruit and vegetable food frequency questionnaire, items measuring estimates of childhood fruit and vegetable intake, adult fruit and vegetable intake, exposure to and preference for fruit and vegetable, and preference for trying new foods. ANALYSIS: Linear regression evaluated the association between predictors and continuous measures; logistic regression determined the association between predictors and categorical measures. RESULTS: Estimates of one's vegetable intake as a child were significantly related to exposure and preference for both fruits and vegetables, trying of new foods, and intake of both fruits and vegetables in adulthood. Estimates of eating fruit as a child were not significantly associated with these adult dietary behaviors. CONCLUSIONS AND IMPLICATIONS: Developmental influences on adult dietary patterns may be stronger for vegetables than fruits among African American women. Additional emphasis is needed regarding exposure to and preference for vegetable intake in childhood.     

Association between fruit and vegetable consumption in mothers and children in low-income, urban neighborhoods.

To understand factors influencing fruit and vegetable (F&V) consumption in children, the authors studied the association between F&V consumption in mothers and children in a sample of 1,106 boys and girls in Grades 4-6 in 24 elementary schools in low-income, multiethnic neighborhoods in Montreal, Canada. Approximately 10% of girls and 19% of boys reported not having eaten any vegetables in the week prior to questionnaire administration; 53% of girls and 63% of boys did not consume whole fruits daily. Each unit increase in F&V consumption in mothers was associated with a 10% to 20% increase in F&V consumption in children. Interventions to improve F&V consumption should aim to improve awareness among parents of the importance of fruits and vegetables and of the impact of their own behavior on their children's F&V consumption.     

Using food experience,multimedia and role models for promoting fruit and vegetable consumption in Bangkok kindergarten children

Aim: To evaluate the use of food experience, multimedia and role models for promoting fruit and vegetable consumption in kindergarten children. Methods: A quasi-experimental study was conducted. A Bangkok public primary school was randomly selected and one of the kindergarten levels was purposively chosen. Program implementation consisted of 11 activities over an eight-week period from July to September, 2003. Data on demographic variables, and types and amounts of fruit and vegetables consumed and frequency of fruit and vegetables served were collected before and after the intervention. Program evaluation consisted of an analysis of the pre- and post-test data. Results: After the intervention, fruit and vegetable eating behaviour scores (median ± interquartile range) revealed significant changes from 3 ± 8 to 7 ± 8 for vegetables and 6 ± 8 to 9 ± 8 for fruit (P-value < 0.001); the different types of consumed vegetables were increased from two to four (P-value ≤ 0.001); and the fruit and vegetable intake was significantly increased from 53 g to 77 g and from 11 g to 23 g respectively (P-value < 0.005). Conclusions: Results of this pilot study were effective in increasing fruit and vegetable consumption in the kindergarten, however, longer-term evaluation and assessment of the impact on the home environment are required. The inclusion of nutrition education and instruction on healthy eating habits in the course curriculum combined with social support from teachers and families may improve and sustain fruit and vegetable eating behaviours.     

The relationship between the food environment and fruit and vegetable intake of adolescents living in Residential Children's Homes

The purpose of this study was to examine the relationship between food environments and fruit and vegetable (FV) consumption of adolescents (n=246) living in Residential Children's Homes (RCHs) in North and South Carolina, USA. Administrators of 21 RCHs completed the Physical Activity and Dietary Environmental Assessment (PADEA), an instrument assessing FV-related environmental variables of RCHs: (i) policies, (ii) availability, (iii) social environment, (iv) community collaboration and (v) administrative support. Two different approaches using mixed-effects regression models were used to compare FV consumption of adolescents living in RCHs with more conducive food environments compared with adolescents living in RCHs with less conducive environments. Using one approach, PADEA variables were analyzed as categorical data and in the second approach, PADEA variables were analyzed as continuous data. Results indicated greater FV consumption among adolescents residing in RCHs with more conducive food environments compared with less conducive RCHs. Specifically, adolescents living in RCHs with higher levels of administrative support and more FV policies reported greater FV intake compared with adolescents living in RCHs with less support and fewer policies. Food environments are related to adolescents' dietary behaviors and interventions targeting FV consumption should include strategies to increase administrative support and the development of FV-related policies.     

Association of fruit and vegetable intake with dietary fat intake

We examined the relation of fruit and vegetable intake with dietary fat intake under conditions in which individuals consume recommended number of portions of dairy, meat and grain foods, using 24-hour dietary recall data from the NHANES II of 1976–80. Only recalls that included at least 2 servings each of dairy foods and meat and 4 servings of grains, but variable servings of fruits and vegetables (ranging from 0 to 2 or more) were examined, yielding a total of 9 food group patterns (possible combinations of food group servings) as reported by 1,490 respondents. In patterns ranging from 0 to 2 servings each of fruits and vegetables, the mean percent of energy as fat varied from 39% to 36%. We observed a slight trend for decreasing energy from fat with increasing number of fruit-but not vegetable-servings. Consumption of fruits and vegetables was not associated with selection of lower-fat foods in the meat, dairy or grain groups. The percent of daily fat contributed by the miscellaneous food group (containing visible fats, sweeteners, and baked products with a high fat or sugar content) increased with increasing vegetable-but not fruit-servings. These results suggest that without conscious effort to reduce fat intake, an increase in fruit and vegetable intake may have a relatively minor impact on reduction of dietary fat.