title: The effects of a fruit and vegetable promotion intervention on unhealthy snacks during mid-morning school breaks: results of the Dutch Schoolgruiten Project.
abstract: BACKGROUND
  Ample fruit and vegetable (F&V) intake has been associated with a decreased risk of chronic disease. The health-enhancing effects of increased F&V consumption, however, would be even more apparent if the increased F&V consumption additionally led to a lower intake of unhealthy, high calorie snacks. Therefore, the present study aimed to investigate whether a primary school-based intervention (the Dutch Schoolgruiten Project) that promoted F&V intake could additionally reduce the intake of unhealthy, high calorie snacks during school breaks.
  
  
  METHODS
  The study applied a longitudinal design with baseline and two follow-up measurements. Children were aged 9-10 years old at baseline; 705 children were included. The main strategy was a F&V scheme that improved the availability, accessibility and exposure to F&V at school by providing one serving of fruit or vegetables twice a week at no cost. The amounts of F&V and unhealthy snacks for consumption at school were measured using a single-item question included in a questionnaire. Multilevel autoregressive logistic regression models with a three-level structure (school, child and time) were used to assess the effect of the intervention on both F&V and unhealthy snack consumption.
  
  
  RESULTS
  The children of the intervention group brought F&V from home to school at follow-up significantly more often than the children of the control schools [odds ratio (OR) = 1.41, 95% confidence interval (CI) = 1.04; 1.90] and brought fewer unhealthy snacks (OR = 0.56, 95% CI = 0.34; 0.92).
  
  
  CONCLUSIONS
  The present study provides some evidence that the Schoolgruiten intervention effect on F&V intake also reduced unhealthy snacking during school breaks.
authors.affiliation: Department of Epidemiology & Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands. n.tak@vumc.nl
authors.forename: N I
authors.initials: NI
authors.lastname: Tak
authors.forename: S J
authors.initials: SJ
authors.lastname: Te Velde
authors.forename: A S
authors.initials: AS
authors.lastname: Singh
authors.forename: J
authors.initials: J
authors.lastname: Brug
mesh_terms: D002648:Child; D004032:Diet; D002149:Energy Intake; D005260:Female; D005502:Food; D005638:Fruit; D006293:Health Promotion; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands; D012572:School Health Services; D011795:Surveys and Questionnaires; D014675:Vegetables