Increasing Child Fruit and Vegetable Intake: Findings from the US Department of Agriculture Fresh Fruit and Vegetable Program.
BACKGROUND
Fewer than 10% of US children and adolescents consume the recommended amounts of fruits and vegetables (F/V). The US Department of Agriculture's Fresh Fruit and Vegetable Program (FFVP) is intended to increase child F/V consumption by funding low-income schools to distribute free fresh F/V snacks outside of school mealtimes.


OBJECTIVE
The evaluation assessed FFVP effects on student F/V consumption and total energy intake in and out of school.


METHODS
The evaluation employed a regression discontinuity design; that is, cross-sectional comparisons of a sample of students in schools just above and just below the FFVP funding cutoff for the program, which depended on the proportion of students eligible for free or reduced-price meals. During the 2010-2011 school year within a randomly selected sample of states, we selected schools in closest proximity to each state-specific FFVP funding cutoff. Interviewers conducted 24-hour diary-assisted recall interviews to assess dietary intake among children in selected schools.


METHODS
Participants were 4,696 students (grades 4 to 6) from 214 elementary schools in 16 randomly selected states.


METHODS
Analysis proceeded via multivariate regression, comparing adjusted mean student intake in schools just above and just below the funding cutoff.


RESULTS
Adjusted mean daily F/V intake was one-third of a cup per day higher in FFVP-participating schools than in nonparticipating schools (0.32 cups per day; P<0.001), a difference of 15.5%. This included one-quarter cup higher daily F/V intake during school hours (0.26 cups; P<0.001) among students attending FFVP-participating schools. Fresh (but not total) F/V consumption also increased outside of school.


CONCLUSIONS
The FFVP increases child fresh and total F/V intake in school, and fresh F/V intake outside of school.
Lauren E W
LE
Olsho
Jacob Alex
JA
Klerman
Lorrene
L
Ritchie
Patricia
P
Wakimoto
Karen L
KL
Webb
Susan
S
Bartlett
D002648:Child; D002664:Child Nutritional Physiological Phenomena; D003430:Cross-Sectional Studies; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D005522:Food Services / Q000592:standards*; D005638:Fruit; D006801:Humans; D008297:Male; D018673:Nutrition Policy; D011203:Poverty; D014481:United States; D016885:United States Department of Agriculture; D014675:Vegetables
Fresh Fruit and Vegetable Program; Fruit and vegetable intake; Impact evaluation; Regression discontinuity; School nutrition