Longitudinal and cross-sectional influences on youth fruit and vegetable consumption

Both cross-sectional and longitudinal research depict a decline in the fruit and vegetable consumption (FVC) of children and youths with age, but identifying developmental changes and their influences with regard to FVC cannot be fully explained with application of only one of these research designs. Reviewed here are results from longitudinal and cross-sectional research, and a proposal is presented for a lifespan development methodology that uses a sequential design strategy to illuminate the multilevel processes that determine FVC. Conclusions from the review were similar for both cross-sectional and longitudinal research, with fruit and vegetable (FV) preferences and FV accessibility/availability being the most consistent influences on FVC. Furthermore, this review illuminates several methodological issues, offering suggestions to strengthen comparisons between studies. Research designs that incorporate longitudinal, cross-sectional, and time-lag data are warranted.     

Use of the think aloud method to examine fruit and vegetable purchasing behaviors among low-income African American women

The purpose of this report is to describe the development and implementation of the think aloud method in relation to fruit and vegetable purchasing behaviors of low-income African American mothers. Women (n = 70) were audiotaped as they thought aloud while selecting fruits and vegetables during a routine shopping trip. Audiotapes were transcribed, text was coded, and coded text was sorted using a database software program. Data were analyzed using content analysis procedures. The method was found to be useful in its ability to provide verbalization data for the majority of the women in the sample that reflected a typical shopping experience, were not excessively affected by the presence of the investigator, and captured information processing in relation to salient factors that influenced food purchasing decisions. Because a few women indicated that the method itself may have influenced behavior, future research is needed to test the reactivity of the think aloud method and its relationship to final choice of products.     

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.     

The use of inappropriate feeding practices by rural parents and their effect on preschoolers' fruit and vegetable preferences and intake

ObjectiveTo describe the frequency of inappropriate feeding practices used by parents of preschoolers and the impact on a child’s preference for and intake of fruits and vegetables (FV).DesignCross-sectional analysis of baseline data from a telephone interview.SettingA community-based program in rural southeastern Missouri.Participants1555 rural parents participating in the High 5 for Kids project. The mean age of parents was 28.9 years, the mean age for children was 38.0 months, and 52.1% of children were male.Variables MeasuredDemographic characteristics; intake and preferences for FV; inappropriate child feeding practices.AnalysisInappropriate feeding practices, preferences for and intake of FV were examined using Kruskal-Wallis tests and Spearman’s correlations. Logistic regression was used to assess the relationships between FV intake and preference and inappropriate feeding practices.ResultsAn increasing number of inappropriate feeding practices negatively impacted FV preference of children but positively impacted FV intake.Conclusions and ImplicationsThis study documents the public health need to develop programs that guide and advise rural parents on information about how children develop patterns of intake, and how to foster children’s preferences and acceptance of healthful food.     

Using financial incentives to increase fruit and vegetable consumption in the UK

Encouraging the consumption of fruits and vegetables can help people increase their intake of micronutrients, dietary fibre and non‐nutrient substances, which together have benefits for health. A high intake of fruits and vegetables is associated with a lower risk of a number of diseases including heart disease, stroke, type 2 diabetes and some cancers. Among the numerous barriers to purchasing fruits and vegetables, price is still cited as a common factor. Therefore, more needs to be done to incentivise consumers to pick up more of these foods during their weekly shop. The UK Public Health Responsibility Deal seeks to reshape the food environment through behaviour change interventions; however, evidence to support the effectiveness of altering environments to change behaviour as a means to improve population health is weak. In particular, reducing price is a frequently considered policy to improve dietary habits. However, few studies to date have evaluated the effectiveness of such interventions on encouraging fruit and vegetable consumption. Our goal (The Co‐operative Group), in line with the Public Health Responsibility Deal, is to do more to create a positive environment that supports and enables people to increase their fruit and vegetable consumption. In light of this, we piloted a coupon incentive scheme in July 2012 for low fruit and vegetable spenders to see if making these items more affordable would encourage purchases and facilitate increased consumption. Results showed that sales of fruits and vegetables increased by 23.2% during the four‐week campaign, with 132 000 redemptions of the coupon by 90 000 members.     

Fourth-grade children's consumption of fruit and vegetable items available as part of school lunches is closely related to preferences

OBJECTIVE: To use data from observations and interviews to document fourth-graders' preferences for, and consumption of, fruits compared to vegetables available as part of school lunches. DESIGN: Observations and interviews were conducted for studies regarding the impact of time interval between eating and reporting on the accuracy of children's school lunch recalls. SUBJECTS/SETTINGS: Children were recruited from up to 4 schools in one district during 3 school years; 63% agreed to participate. Randomly selected children (n = 237) were each observed eating school lunch once and were interviewed (regarding items eaten and preferences for items eaten) within 11/2 hours or the next morning. MAIN OUTCOME MEASURES: Observed consumption of servings of items available as part of school lunch was recorded as none, taste, little bit, half, most, and all. Response options for preferences for items available as part of school lunch were liked not at all, a little, and a lot. STATISTICAL ANALYSES PERFORMED: Mixed-model analysis of variance. RESULTS: Preferences were higher for fruits than vegetables. As preferences increased, consumption increased (P <.0001). Consumption of fruits compared to vegetables was similar after adjusting for preferences. IMPLICATIONS: Research is needed to understand how to increase children's preferences for vegetables as a means of increasing consumption.     

Patterns of fruit, vegetable, and milk consumption among smoking and nonsmoking female teens

BACKGROUND: The increase in teenage smoking, and the fact that concern about body weight is given as a reason for smoking initiation by girls, suggest that food intake may be compromised in female teens who smoke. Daily consumption of a variety of foods is important due to the health-protective constituents they contain. Few studies have documented how smoking and the consumption of fruits, vegetables, and milk may be associated in female teens. METHODS: This study examined the relationship of smoking and the consumption of fruit, fruit juice, vegetables, and milk in ninth- to twelfth-grade Caucasian (n=2797), African-American (n=2196), and Hispanic (n=2052) female teens. Data from the Youth Behavior Risk Survey (1999) were analyzed with SUDAAN software, using logistic regression models. RESULTS: Smoking was significantly associated with decreased odds of consuming milk at 0.74 (95% confidence interval [CI], 0.55-0.98); fruit, 0.70 (95% CI, 0.54-0.92); fruit juice, 0.74 (95% CI, 0.56-0.98); and vegetables, 0.75 (95% CI, 0.63-0.89) among Caucasian female teens, and with decreased odds of consuming fruit juice among Hispanic female teens at 0.59 (95% CI, 0.40-0.89). For each significant food variable, a dose-response relationship was detected with significantly more females consuming each food at lower smoking levels and significantly fewer doing so at the highest level (p<0.05). By contrast, African-American female teen smokers tended to consume higher levels of the specified food/beverages than nonsmokers, but this relationship was not statistically significant. IMPLICATIONS: This study establishes a smoking/food intake interaction for the specific foods tested, in an adolescent female population. Compromising the intake of healthy foods and their protective nutrients leaves young women more vulnerable to the serious health consequences of smoking. These results underscore the need for young women to be educated on the importance of eating maximum servings of fruits and vegetables and dairy products, such as milk, particularly if they smoke or are at risk for smoking initiation. The study also underscores the need to culturally tailor programs according to differences in smoking initiation and eating/dieting behaviors.     

Understanding barriers and facilitators of fruit and vegetable consumption among a diverse multi-ethnic population in the USA

A diet high in fruits and vegetables (F&V) has been associated with a decreased risk of certain cancers, reduced morbidity and mortality from heart disease, and enhanced weight management. Yet to date, most of the US population does not consume the recommended amount of F&V despite numerous interventions and government guidelines to promote consumption. Research has found various impediments to F&V consumption, such as high costs, an obesogenic environment and low socio-economic status. However, studies have not sufficiently focused on barriers and enablers to F&V intake among adult multi-ethnic populations. The present qualitative study examines 147 focus group participants' perceptions of impediments and enablers to F&V consumption. Twelve focus groups were conducted among African American, Hispanic and Caucasian men and women in North Carolina and Connecticut. Focus groups were audiotaped, transcribed verbatim and entered into QSR NVivo Software. Text data were systematically analyzed by investigators to identify recurrent themes both within and across groups and states. Focus group results indicate that most participants were aware of the health benefits associated with a diet rich in F&V. Yet many admitted not adhering to the Health and Human Service's recommendations. Individual impediments consisted of the high costs of F&V and a perceived lack of time. Early home food environment was perceived as affecting F&V consumption later in life. Other barriers reported were ethnic-specific. The African American participants reported limited access to fresh produce. This finding is consistent with numerous studies and must be addressed through health promotion intervention. Both the church and primary care clinics were described by African Americans as appropriate settings for health behavior interventions; these findings should be considered. Hispanic participants, mostly immigrants, cited inhibiting factors encountered in their adopted US environment. There is a need to improve the availability and access to fresh F&V commonly available in the home countries of Hispanic immigrants.     

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.     

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.     

Processes of change for increasing fruit and vegetable consumption among economically disadvantaged African American adolescents

This study sought to identify Transtheoretical Model processes of change associated with consumption of ≥ 5 daily servings of FVs in a sample of economically disadvantaged African American adolescents (N = 549; mean (SD) age = 12.44 (.99) years; 61% female; 15% African American Hispanic). Participants completed measures of stages and processes of change, and were ranked according to intake level based on their reported stage. Spearman correlations and independent samples t tests were used in cross-sectional analyses of the relationship between processes of change and FV consumption. Consciousness raising, environmental reevaluation, helping relationships and stimulus control processes were significantly associated with FV consumption (ρ ≥ .12; p < .01), and were practiced more often by youths who consumed ≥ 5 daily servings of FVs relative to those who did not (p < .05). Findings highlight the potential of these processes for increasing FV consumption in this population.     

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.     

Affective associations mediate the influence of cost–benefit beliefs on fruit and vegetable consumption

Consumption of fruits and vegetables is far lower than recommended. The behavioral affective associations model posits that affective associations influence behavior and mediate the influence of perceived benefits and barriers on behavioral choices. The purpose of this study was to test the model's predictions about the influence of affective associations and benefits/barriers on fruit and vegetable consumption. Community adults (N = 446) reported perceived benefits and barriers to fruit and vegetable consumption, affective associations with fruits and vegetables, and current fruit and vegetable intake. Affective associations predicted behavior and mediated the influence of benefits and barriers on behavior, supporting predictions made by the behavioral affective associations model. This highlights the need to incorporate affective factors in decision-making models and intervention strategies.     

Serum salicylic acid and fruit and vegetable consumption in obese and normal-weight children: a pilot-study

Salicylic acid (SA), a phenolic compound produced by plants, may play a beneficial role on health. This pilot study evaluated whether there might be an association between serum SA and fruit and vegetable (FV) consumption in obese and normal-weight children. Thirty-four obese children (17 boys and 17 girls) and 34 normal-weight children were recruited. Dietary intake was evaluated by the 7-day dietary record. Serum SA was measured using gas chromatography-mass spectrometry method. FV intake in obese and normal-weight children was not different between groups (175.00 (97.66) g versus 192.29 (90.54) g, p?=?.455). Obese children had lower serum SA than normal-weight children [mean difference, ?0.025; 95% CI (?0.044; ?0.006) μmol/L]. Serum SA was not associated with daily intake of FV in obese (p?=?.111) and normal-weight (p?=?.092) children. Further studies are needed to evaluate the role of FV on serum SA, taking into account also the quantity and the type.     

Overweight and average-weight children equally responsive to "Kids Choice Program" to increase fruit and vegetable consumption

Secondary analyses were conducted for children participating in the school-based Kids Choice Program [Hendy, H. M., Williams, K., & Camise, T. (2005). "Kids Choice" school lunch program increases children's fruit and vegetable acceptance. Appetite, 45, 250-263.] to examine whether fruit and vegetable consumption and preference ratings by overweight and average-weight children within the original sample were equally responsive to the program. The Kids Choice Program produced increased fruit and vegetable consumption by both overweight and average-weight children that lasted throughout the month-long program, while avoiding "over-justification" drops in later fruit and vegetable preference ratings. We believe that the Kids Choice Program shows promise for encouraging overweight children to improve nutrition and weight management behaviors while in their everyday peer environment.     

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.