Increasing Child Fruit and Vegetable Intake: Findings from the US Department of Agriculture Fresh Fruit and Vegetable Program

Abstract

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.

Design: 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.

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

Statistical analyses performed: 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.

Keywords: Fresh Fruit and Vegetable Program; Fruit and vegetable intake; Impact evaluation; Regression discontinuity; School nutrition.